WorldWideScience

Sample records for stage clinical development

  1. Clinical and laboratory characteristics of chronic hepatitis C on the early stages of development

    Directory of Open Access Journals (Sweden)

    N. S. Zhevnerova

    2016-01-01

    Full Text Available Aim of the research – to assess the clinical and laboratory parameters in patients with chronic hepatitis C (CHC on the early stages of development and their comparison with the level of galectin3. The study included 78 patients with oligosymptomatic course of the disease and minimal liver fibrosis in the most cases. In the most patients with stages of the disease exceeding 8 years, viral load was over a million copies/ml. In 10 % of patients on the early stages of the disease, changes corresponding to severe liver fibrosis and cirrhosis F3 and F4 were detected. Moderate correlation of ALT activity, viral load and low severity with the duration of the disease was identified. There is a trend towards a higher level of galectin3 in a long course of CHC in comparison with earlier stages of its development, with significantly higher average level of galectin-3 in patients with minimal liver fibrosis (F0–F1 as compared to advanced stages, suggesting its importance in the launching and initial mechanisms of fibrogenesis.

  2. Development of a nomogram combining clinical staging with 18F-FDG PET/CT image features in non-small-cell lung cancer stage I-III

    International Nuclear Information System (INIS)

    Desseroit, Marie-Charlotte; Visvikis, Dimitris; Majdoub, Mohamed; Hatt, Mathieu; Tixier, Florent; Perdrisot, Remy; Cheze Le Rest, Catherine; Guillevin, Remy

    2016-01-01

    Our goal was to develop a nomogram by exploiting intratumour heterogeneity on CT and PET images from routine 18 F-FDG PET/CT acquisitions to identify patients with the poorest prognosis. This retrospective study included 116 patients with NSCLC stage I, II or III and with staging 18 F-FDG PET/CT imaging. Primary tumour volumes were delineated using the FLAB algorithm and 3D Slicer trademark on PET and CT images, respectively. PET and CT heterogeneities were quantified using texture analysis. The reproducibility of the CT features was assessed on a separate test-retest dataset. The stratification power of the PET/CT features was evaluated using the Kaplan-Meier method and the log-rank test. The best standard metric (functional volume) was combined with the least redundant and most prognostic PET/CT heterogeneity features to build the nomogram. PET entropy and CT zone percentage had the highest complementary values with clinical stage and functional volume. The nomogram improved stratification amongst patients with stage II and III disease, allowing identification of patients with the poorest prognosis (clinical stage III, large tumour volume, high PET heterogeneity and low CT heterogeneity). Intratumour heterogeneity quantified using textural features on both CT and PET images from routine staging 18 F-FDG PET/CT acquisitions can be used to create a nomogram with higher stratification power than staging alone. (orig.)

  3. Microbial landscape features in patients with generalized periodontitis at pre-clinical and radiological stage of its development

    Directory of Open Access Journals (Sweden)

    Vatamanyuk N.V.

    2014-11-01

    Full Text Available The paper presents the results of a comparative study of microbial landscape features in patients with generalized periodontitis at pre-clinical and radiological stage of its development in 42 patients. The purpose of the study is a comparative study of the composition of microbiocenosis of periodontal tissues in patients with chronic catarrhal gingivitis (CCG and chronic generalized periodontitis (CGP at an early stage of development and development studies of microbiological criteria for early emergence of the destructive process in periodontal structures. We found that the microflora isolated from dento-gingival grooves is of importance in diagnostics to identify the etiology of chronic generalized catarrhal gingivitis (CGCG and chronic generalized periodontitis in the early stages of its development. It was established that the presence of two or more types of fixed parodonto-pathogenic microorganisms in microbial association increases the likelihood of inflammatory and destructive events in periodontal tissues in patients with GCCG and is one of the reasons of is becoming CGP.

  4. Staged Repository Development Programmes

    International Nuclear Information System (INIS)

    Isaacs, T

    2003-01-01

    Programs to manage and ultimately dispose of high-level radioactive wastes are unique from scientific and technological as well as socio-political aspects. From a scientific and technological perspective, high-level radioactive wastes remain potentially hazardous for geological time periods-many millennia-and scientific and technological programs must be put in place that result in a system that provides high confidence that the wastes will be isolated from the accessible environment for these many thousands of years. Of course, ''proof'' in the classical sense is not possible at the outset, since the performance of the system can only be known with assurance, if ever, after the waste has been emplaced for those geological time periods. Adding to this challenge, many uncertainties exist in both the natural and engineered systems that are intended to isolate the wastes, and some of the uncertainties will remain regardless of the time and expense in attempting to characterize the system and assess its performance. What was perhaps underappreciated in the early days of waste management and repository program development were the unique and intense reactions that the institutional, political, and public bodies would have to repository program development, particularly in programs attempting to identify and then select sites for characterization, design, licensing, and ultimate development. Reactions in most nations were strong, focused, unrelenting, and often successful in hindering, derailing, and even stopping national repository programs. The reasons for such reactions and the measures to successfully respond to them are still evolving and continue to be the focus of many national program and political leaders. Adaptive Staging suggests an approach to repository program development that reflects the unique challenges associated with the disposal of high-level radioactive waste. The step-wise, incremental, learn-as-you-go approach is intended to maximize the

  5. Influence of the gestational stage on the clinical course, lesional development and parasite distribution in experimental ovine neosporosis.

    Science.gov (United States)

    Arranz-Solís, David; Benavides, Julio; Regidor-Cerrillo, Javier; Fuertes, Miguel; Ferre, Ignacio; Ferreras, Maria Del Carmen; Collantes-Fernández, Esther; Hemphill, Andrew; Pérez, Valentín; Ortega-Mora, Luis Miguel

    2015-03-03

    Neospora caninum is considered one of the main causes of abortion in cattle, yet recent studies have also emphasised its relevance as an abortifacient in small ruminants. In order to gain deeper insight into the pathogenesis of ovine neosporosis, pregnant ewes were intravenously inoculated with 10(6) tachyzoites of the Nc-Spain7 isolate at days 40, 90 or 120 of gestation. Infection during the first term resulted in the death of all foetuses between days 19 and 21 post-infection, showing mainly necrotic lesions in foetal liver and the highest parasite DNA detection and burden in both placenta and foetal viscera. After infection at day 90, foetal death was also detected in all ewes, although later (34-48 days post-infection). In this group, lesions were mainly inflammatory. Foetal livers showed the lowest frequency of lesions, as well as the lowest parasite detection and burden. All ewes infected at day 120 delivered viable lambs, although 3 out of 9 showed weakness and recumbency. Neospora DNA was detected in all lambs but one, and parasite burden was similar to that observed in day 90 group. Lesions in this group showed more conspicuous infiltration of inflammatory cells and higher frequency in foetal brain and muscle when compared to both previous groups. These results highlight the crucial role that the stage of gestation plays on the course of ovine neosporosis, similar to that reported in bovine neosporosis, and open the doors to consider sheep as a valid model for exogenous transplacental transmission for ruminant neosporosis.

  6. Worldwide Esophageal Cancer Collaboration: clinical staging data.

    Science.gov (United States)

    Rice, T W; Apperson-Hansen, C; DiPaola, L M; Semple, M E; Lerut, T E M R; Orringer, M B; Chen, L-Q; Hofstetter, W L; Smithers, B M; Rusch, V W; Wijnhoven, B P L; Chen, K N; Davies, A R; D'Journo, X B; Kesler, K A; Luketich, J D; Ferguson, M K; Räsänen, J V; van Hillegersberg, R; Fang, W; Durand, L; Allum, W H; Cecconello, I; Cerfolio, R J; Pera, M; Griffin, S M; Burger, R; Liu, J-F; Allen, M S; Law, S; Watson, T J; Darling, G E; Scott, W J; Duranceau, A; Denlinger, C E; Schipper, P H; Ishwaran, H; Blackstone, E H

    2016-10-01

    To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg 2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection. © 2016 International Society for Diseases of the Esophagus.

  7. Content of Diabetes-Associated Autoantibodies against Islet Autoantigens (IA-2A, GADA, IAA and the Level of Different Cytokines in Children and Adolescents on the Pre-Clinical and Early Clinical Stages of Type 1 Diabetes Mellitus Development

    Directory of Open Access Journals (Sweden)

    V.V. Popova

    2015-03-01

    Full Text Available The article provides the data on the immunological mechanisms of type 1 diabetes mellitus (T1DM on the preclinical and early clinical stages of disease formation on the basis of studying the features of T1DM pathogenesis, monitoring the process of autoimmune destruction of insulin-producing β-cells by determining the content of diabetes-associated auto-antibodies (the incidence and titers dynamics, the study of the characteristics of cytokine secretion on the pre-clinical stage of T1DM development in children and adolescents. Introduction of new approaches to pre-clinical diagnosis of T1DM allowed determine the group of marker-positive children with burdened heredity and predictable risk of disease development. The study involved 450 healthy normoglycemic children and adolescents aged from 7 to 15 years old. It was revealed that 94 (26.7 % of 366 children with burdened hereditary by at least two-fold determination of DAAb had an increased DAAb titer, mainly GADA and IA-2A, the clinical debut of T1DM manifested in 49 (52.1 % of them from 6 months to 12 years (30.9 ± 3.2 months. T1DM developed in the same period in a child, that was 0.8 % of the 272 (73.3 % DAAb-negative children. There was determined a formula of combined incidence and values of simultaneously elevated DAAb titers to islet autoantigens, namely IA-2A + GADA, which are predictor of the duration of T1DM pre-clinical stage and debut occurrence. It has been also established a disturbance of cytokine production (increased level of pro-inflammatory cytokines IL-1α, IL-6 and FNO-α, IL-8 and IL-16 while reduced concentration of IL-4 in blood plasma as a key factor in the T1DM pathogenesis that causes the debut occurrence, and aggressiveness of its course.

  8. Clinical staging of major depressive disorder: an empirical exploration

    NARCIS (Netherlands)

    Verduijn, J.; Milaneschi, Y.; van Hemert, A.M.; Schoevers, R.A.; Hickie, I.B.; Penninx, B.W.J.H.; Beekman, A.T.F.

    2015-01-01

    Objective: Clinical staging has been proposed to supplement psychiatric diagnoses. We examined the construct and predictive validity of a clinical staging model for major depressive disorder (MDD) that distinguishes 8 consecutive stages (0, 1A, 1B, 2, 3A, 3B, 3C, 4) based on symptom severity

  9. Theory of Economic Development (Secondary Stage)

    OpenAIRE

    Mashkoor, Aasim; Ahmed, Ovais

    2015-01-01

    This is a secondary stage of theory of economic development. This research study is covering the secondary phase of development which rules the tactical plans of the main strategy. In this stage, the social and economical demands varies from country to country and we have developed the theory according to the Pakistani economic conditions. It requires great a lot of technical and strategic analysis to chose the accurate plans accordingly.

  10. Implications of inaccurate clinical nodal staging in pancreatic adenocarcinoma.

    Science.gov (United States)

    Swords, Douglas S; Firpo, Matthew A; Johnson, Kirsten M; Boucher, Kenneth M; Scaife, Courtney L; Mulvihill, Sean J

    2017-07-01

    Many patients with stage I-II pancreatic adenocarcinoma do not undergo resection. We hypothesized that (1) clinical staging underestimates nodal involvement, causing stage IIB to have a greater percent of resected patients and (2) this stage-shift causes discrepancies in observed survival. The Surveillance, Epidemiology, and End Results (SEER) research database was used to evaluate cause-specific survival in patients with pancreatic adenocarcinoma from 2004-2012. Survival was compared using the log-rank test. Single-center data on 105 patients who underwent resection of pancreatic adenocarcinoma without neoadjuvant treatment were used to compare clinical and pathologic nodal staging. In SEER data, medium-term survival in stage IIB was superior to IB and IIA, with median cause-specific survival of 14, 9, and 11 months, respectively (P < .001). Seventy-two percent of stage IIB patients underwent resection vs 28% in IB and 36% in IIA (P < .001). In our institutional data, 12.4% of patients had clinical evidence of nodal involvement vs 69.5% by pathologic staging (P < .001). Among clinical stage IA-IIA patients, 71.6% had nodal involvement by pathologic staging. Both SEER and institutional data support substantial underestimation of nodal involvement by clinical staging. This finding has implications in decisions regarding neoadjuvant therapy and analysis of outcomes in the absence of pathologic staging. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Clinical presentation and staging of Hodgkin lymphoma

    DEFF Research Database (Denmark)

    Gallamini, Andrea; Hutchings, Martin; Ramadan, Safaa

    2016-01-01

    In the present chapter the authors present a brief overview of the diagnostic methods proposed over time for Hodgkin lymphoma (HL) spread detection, moving from surgical procedures, through standard radiological and functional imaging techniques to the present state of the art for HL staging....... The main body of the review will be dedicated to the recently published guidelines for lymphoma staging (including HL) agreed by the experts during the 12th International Congress for Malignant Lymphoma in Lugano. The recommendations of the panel on how to integrate flurodeoxyglucose positron emission...

  12. Validation of the Mayo Clinic Staging System in Determining Prognoses of Patients With Perihilar Cholangiocarcinoma

    NARCIS (Netherlands)

    Coelen, Robert J. S.; Gaspersz, Marcia P.; Labeur, Tim A.; van Vugt, Jeroen L. A.; van Dieren, Susan; Willemssen, François E. J. A.; Nio, Chung Y.; Ijzermans, Jan N. M.; Klümpen, Heinz-Josef; Groot Koerkamp, Bas; van Gulik, Thomas M.

    2017-01-01

    BACKGROUND & AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiologic variables, but has not yet been validated. We

  13. INNOVATION DIFFUSION THEORY MAIN DEVELOPMENT STAGES

    Directory of Open Access Journals (Sweden)

    S. V. Lisafiev

    2011-01-01

    Full Text Available Abstract: Main innovation diffusion development theory stages are: Rogers model of moving new products to the market including characteristics of its segments; mathematic substantiation of this model by Bass; Moor model taking into account gaps between adjacent market segments; Goldenberg model making it possible to predict sales drops at new product life cycle initial stages. It is reasonable to use this theory while moving innovative products to the market.

  14. Radiation therapy in clinical stage I and II Hodgkin's disease

    International Nuclear Information System (INIS)

    Gospodarowicz, M.K.; Sutcliffe, S.B.; Bergsagel, D.E.; Chua, T.

    1992-01-01

    A review of the Princess Margaret Hospital (Toronto, Canada) experience over the last 20 years in treating clinically staged patients with stage I and II Hodgkin's disease was performed to analyse the impact of patient selection and extended field radiation on relapse and survival. Of the 878 patients with stage I and II Hodgkin's disease, 521 with clinical stages I and II received radiation alone as the initial treatment. The actuarial survival for all stage I and II patients was 85.1% at 5 years and 76.2% at 10 years, and for clinically stages patients treated with radiation alone, 87.2 and 77.6%, respectively. The relapse-free rate (RFR) for all clinical stage I and II patients treated with radiotherapy (RT) alone was 70.1% at 5 years and 65.8% at 10 years. Significant prognostic factors for RFR and survival included age, stage and histology. In addition, the extent of radiation was identified as an independent prognostic factor for survival as well as for relapse. (Author)

  15. [Clinical staging and early intervention for borderline personality disorder].

    Science.gov (United States)

    Hutsebaut, J; Hessels, C J

    Within the accumulating evidence for a life span perspective on borderline personality disorder (BPD), the key factor is a developmental perspective. AIM: To demonstrate that the lessons learnt from early intervention in somatic medicine and psychosis should be used to improve the diagnosis and treatment of BPD. METHOD: We describe the rationale for early detection and intervention and present a staging model which can serve as a guideline for the development and selection of interventions for BPD. RESULTS: There is increasing evidence that BPD first manifests itself in adolescence and that BPD symptoms can already be distinguished from normative adolescent development. BPD tends to develop gradually and to have a progressive, social and professional impact. Inadequate treatment can lead to iatrogenic damage, whereas adequate treatment shows promising results in adolescents with emerging BPD. These findings may underpin an early intervention paradigm for BPD. CONCLUSION: Early intervention and clinical staging can improve the assessment and treatment of severe forms of psychopathology, such as BPD. This has implications for research, mental health care policy and society.

  16. The development of self-regulated learning during the pre-clinical stage of medical school: a comparison between a lecture-based and a problem-based curriculum.

    Science.gov (United States)

    Lucieer, Susanna M; van der Geest, Jos N; Elói-Santos, Silvana M; de Faria, Rosa M Delbone; Jonker, Laura; Visscher, Chris; Rikers, Remy M J P; Themmen, Axel P N

    2016-03-01

    Society expects physicians to always improve their competencies and to be up to date with developments in their field. Therefore, an important aim of medical schools is to educate future medical doctors to become self-regulated, lifelong learners. However, it is unclear if medical students become better self-regulated learners during the pre-clinical stage of medical school, and whether students develop self-regulated learning skills differently, dependent on the educational approach of their medical school. In a cross-sectional design, we investigated the development of 384 medical students' self-regulated learning skills with the use of the Self-Regulation of Learning Self-Report Scale. Next, we compared this development in students who enrolled in two distinct medical curricula: a problem-based curriculum and a lectured-based curriculum. Analysis showed that more skills decreased than increased during the pre-clinical stage of medical school, and that the difference between the curricula was mainly caused by a decrease in the skill evaluation in the lecture-based curriculum. These findings seem to suggest that, irrespective of the curriculum, self-regulated learning skills do not develop during medical school.

  17. Developing Clinical Competence

    NARCIS (Netherlands)

    P.F. Wimmers (Paul)

    2006-01-01

    textabstractThe development of clinical competence is the main purpose of medical education. The long road to become clinically competent starts on the first day of medical school, and every institution strives to select the best students. The responsibility of medical schools is to train

  18. Nuclear Cryogenic Propulsion Stage Affordable Development Strategy

    Science.gov (United States)

    Doughty, Glen E.; Gerrish, H. P.; Kenny, R. J.

    2014-01-01

    The development of nuclear power for space use in nuclear thermal propulsion (NTP) systems will involve significant expenditures of funds and require major technology development efforts. The development effort must be economically viable yet sufficient to validate the systems designed. Efforts are underway within the National Aeronautics and Space Administration's (NASA) Nuclear Cryogenic Propulsion Stage Project (NCPS) to study what a viable program would entail. The study will produce an integrated schedule, cost estimate and technology development plan. This will include the evaluation of various options for test facilities, types of testing and use of the engine, components, and technology developed. A "Human Rating" approach will also be developed and factored into the schedule, budget and technology development approach.

  19. Clinical and endorectal ultrasound staging of circumferential rectal cancers

    International Nuclear Information System (INIS)

    Smith, A.; Farmer, K.C.; Chapple, K.

    2008-01-01

    Full text: Circumferential rectal cancers present at a more advanced stage than those located in a single quadrant. Although accurate staging is an important aspect of the preoperative management of the patient with a rectal cancer, the clinical and radiological staging of this subgroup of rectal cancer patients has been poorly studied. All patients with a rectal cancer were assessed clinically (by digital rectal examination and rigid sigmoidoscopy) before the radiological assessment by endorectal ultrasound (ERUS). Data collected included tumour height (distance from anal verge in centimetre) and tumour type (circumferential or non-circumferential). Radiological tumour staging was with the TNM system. Fifty-nine subjects (33 men, 26 women; median age 65 years (range 38-86 years)) were identified with a circumferential rectal cancer. Mean height of the cancer was 8 - 0.4 cm (standard error of the mean; range 2-13 cm). Forty-two cancers were palpable, and 17 cancers were impalpable. All cancers assessed clinically as circumferential were confirmed as circumferential on ERUS scanning. Tumour stage as assessed by ERUS was either T3 (n = 57) or T4 (n = 2). Nodal status was NO (n = 29) and N1 (n = 30). All rectal cancers assessed as circumferential on clinical examination have an ERUS stage of T3 or greater.

  20. Development of clinical sites.

    Science.gov (United States)

    O'Brien, Mary

    2015-02-01

    Clinical experiences are vital to all types of healthcare educational programs. Supervised clinical experiences provide the opportunity for the learner to apply didactic knowledge and theory to real world situations and hone skills necessary for entry into practice. Nurse anesthesia programs utilize a wide variety of clinical sites to expose student registered nurse anesthetists to experiences that will prepare them clinically, academically and professionally to enter practice as a Certified Registered Nurse Anesthetist. This article describes the process of developing a clinical site. A thorough evaluation will determine the types of experiences meant to be offered at the site, the resources available to house and educate the students, and how to evaluate the effectiveness of the clinical site. Open communication between the clinical coordinator and the program director or designee is essential to ensure success of the clinical site. The Council on Accreditation of Nurse Anesthesia Educational Programs has resources available to guide those interested in becoming a clinical site, as well as for program administrators who seek to add new experiences to their programs.

  1. Staging in bipolar disorder: from theoretical framework to clinical utility.

    Science.gov (United States)

    Berk, Michael; Post, Robert; Ratheesh, Aswin; Gliddon, Emma; Singh, Ajeet; Vieta, Eduard; Carvalho, Andre F; Ashton, Melanie M; Berk, Lesley; Cotton, Susan M; McGorry, Patrick D; Fernandes, Brisa S; Yatham, Lakshmi N; Dodd, Seetal

    2017-10-01

    Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a

  2. Correlation of clinical data, anatomical site and disease stage in ...

    African Journals Online (AJOL)

    Objective: To evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease. Design: Retrospective observational study. Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya. Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic ...

  3. Stages of educational development? Beeby revisited

    Science.gov (United States)

    Guthrie, Gerard

    1980-12-01

    Beeby's model of stages of educational change in developing countries has been accepted into the educational literature with remarkably little critical analysis. Though valuable for a large number of experiential insights, the author argues that the model has certain weaknesses which should restrict its application. The stages have a teleological bias and are not sufficiently distinct, nor do the labels used for them meet the formal requirements of measuring scales. Furthermore, the model overgeneralizes from the experience of British-tradition South Pacific school systems, and the equation of western teaching with good teaching is an unsupported view which may not be valid in many countries. The most fundamental problem is the lack of clear distinction between empirical issues and the ethical judgements implicit in the formulation. However, the model has a number of positive features well worth building upon, such as its focus on the qualitative aspects of teaching and on qualitative change, the realistic emphasis on the gradualism of such change in practice, and the identification of the teacher as the key change agent in the classroom — a fundamental point often overlooked by innovators. The continua of general and professional education which underlie the teaching styles provide useful hypotheses for empirical analysis of the relationship between teacher education and classroom teaching style, but the association of this education with certain types of teaching style needs careful examination. Stripped of its evaluative connotations, Beeby's interest in qualitative change was a valuable early attempt to move attention in developing countries from linear, quantitative expansion of existing systems to a consideration of what was actually being taught and how. The real lesson to be learned from his work is that education should be paying closer attention to its theoretical propositions.

  4. Antibiotics in late clinical development.

    Science.gov (United States)

    Fernandes, Prabhavathi; Martens, Evan

    2017-06-01

    Most pharmaceutical companies have stopped or have severely limited investments to discover and develop new antibiotics to treat the increasing prevalence of infections caused by multi-drug resistant bacteria, because the return on investment has been mostly negative for antibiotics that received marketing approved in the last few decades. In contrast, a few small companies have taken on this challenge and are developing new antibiotics. This review describes those antibiotics in late-stage clinical development. Most of them belong to existing antibiotic classes and a few with a narrow spectrum of activity are novel compounds directed against novel targets. The reasons for some of the past failures to find new molecules and a path forward to help attract investments to fund discovery of new antibiotics are described. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Yan Xiao

    2015-01-01

    Full Text Available Background: End-stage hypertrophic cardiomyopathy (HCM is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM. Methods: End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality. Results: End-stage HCM was identified in 99 (5.4% patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05-3.80; P = 0.036, left bundle branch block (LBBB (HR: 2.80; 95% CI: 1.47-5.31; P = 0.002, and an abnormal Q wave (HR: 2.21; 95% CI: 1.16-4.23; P = 0.016 as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death. Conclusions: LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

  6. Location and cellular stages of NK cell development

    Science.gov (United States)

    Yu, Jianhua; Freud, Aharon G.; Caligiuri, Michael A

    2013-01-01

    The identification of distinct tissue-specific natural killer (NK) cell populations that apparently mature from local precursor populations has brought new insight into the diversity and developmental regulation of this important lymphoid subset. NK cells provide a necessary link between the early (innate) and late (adaptive) immune responses to infection. Gaining a better understanding of the processes that govern NK cell development should allow us to better harness NK cell functions in multiple clinical settings as well as to gain further insight into how these cells undergo malignant transformation. In this review, we summarize recent advances in understanding sites and cellular stages of NK cell development in humans and mice. PMID:24055329

  7. Adjuvant Chemotherapy for Stage II Colon Cancer: A Clinical Dilemma.

    Science.gov (United States)

    Kannarkatt, Joseph; Joseph, Joe; Kurniali, Peter C; Al-Janadi, Anas; Hrinczenko, Borys

    2017-04-01

    The decision to treat a patient with stage II colon cancer with adjuvant chemotherapy can be challenging. Although the benefit of treatment is clear in most patients with stage III disease, the decision to provide chemotherapy after surgical resection in stage II disease must be made on an individual basis. Several trials have demonstrated the small but absolute benefits of receiving adjuvant chemotherapy for stage II colon cancer for disease-free survival and overall survival. In an attempt to better understand the role of chemotherapy, several studies were performed that identified high-risk characteristics that can be used prognostically and predictively to aid in the clinical decision making process. ASCO, the National Comprehensive Cancer Network, and the European Society of Medical Oncology have published guidelines describing these high-risk characteristics. Since then, several other molecular markers have emerged that may offer more information on a given patient's risk for recurrence. The decision to treat a patient with stage II colon cancer must be made on an individual basis, considering the risks and benefits of treatment. In this short review, we will present the available evidence and offer possible directions for future study.

  8. LENS: Science Scope and Development Stages

    Science.gov (United States)

    Vogelaar, R. Bruce

    2013-04-01

    The Low-Energy Neutrino Spectroscopy (LENS) experiment will resolve the solar metallicity question via measurement of the CNO neutrino flux, as well as test the predicted equivalence of solar luminosity as measured by photon versus neutrinos. The LENS detector uses charged-current interaction of neutrinos on Indium-115 (loaded in a scintillator, InLS) to reveal the complete solar neutrino spectrum. LENS's optically segmented 3D lattice geometry achieves precise time and spatial resolution and unprecedented background rejection and sensitivity for low-energy neutrino events. This first-of-a-kind lattice design is also suited for a range of other applications where high segmentation and large light collection are required (eg: sterile neutrinos with sources, double beta decay, and surface detection of reactor neutrinos). The physics scope, detector design, and logic driving the microLENS and miniLENS prototyping stages will be presented. The collaboration is actively running programs; building, operating, developing, and simulating these prototypes using the Kimballton Underground Research Facility (KURF). New members are welcome to the LENS Collaboration, and interested parties should contact R. Bruce Vogelaar.

  9. The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging.

    Science.gov (United States)

    In, Haejin; Ravetch, Ethan; Langdon-Embry, Marisa; Palis, Bryan; Ajani, Jaffer A; Hofstetter, Wayne L; Kelsen, David P; Sano, Takeshi

    2018-01-01

    New stage grouping classifications for clinical (cStage) and post-neoadjuvant treatment (ypStage) stage for gastric adenocarcinoma have been proposed for the eighth edition of the AJCC manual. This article summarizes the analysis for these stages. Gastric adenocarcinoma patients diagnosed in 2004-2009 were identified from the National Cancer Database (NCDB). The cStage cohort included both surgical and nonsurgical cases, and the ypStage cohort included only patients who had chemotherapy or radiation therapy before surgery. Survival differences between the stage groups were determined by the log-rank test and prognostic accuracy was assessed by concordance index. Analysis was performed using SAS 9.4 (SAS, Cary, NC, USA). Five strata for cStage and four strata for ypStage were developed. The 5-year survival rates for cStages were 56.77%, 47.39%, 33.1%, 25.9%, and 5.0% for stages I, IIa, IIb, III, and IV, respectively, and the rates for ypStage were 74.2%, 46.3%, 19.2%, and 11.6% for stages I, II, III, and IV, respectively. The log-rank test showed that survival differences were well stratified and stage groupings were ordered and distinct (p < 0.0001). The proposed cStage and ypStage classification was sensitive and specific and had high prognostic accuracy (cStage: c index = 0.81, 95% CI, 0.79-0.83; ypStage: c index = 0.80, 95% CI, 0.73-0.87). The proposed eighth edition establishes two new staging schemata that provide essential prognostic data for patients before treatment and for patients who have undergone surgery following neoadjuvant therapy. These additions are a significant advance to the AJCC staging manual and will provide critical guidance to clinicians in making informed decisions throughout the treatment course.

  10. [Stages of development of flight medical expertise in Russia].

    Science.gov (United States)

    Chaplyuk, A L; Vovkodav, V S; Churilov, Yu K; Klepikov, A N

    2015-07-01

    Flight medical expertise (FME) in military aviation is one of the most important areas of medical support of flight crews manning, maintaining of aircrew health and flight safety. The authors analyse the main stages of development of this area of medical practice. The priority in creation of FME system belongs to our country. Domestic scientists, prominent organizers of military medicine and a large group of aviation physicians developed organizational and methodological basis for studying different impacts of flight factors on the health of flight personnel, development of criteria for admission to flight operations, principles of organization of the examination, implementation of effective methods of disease diagnosis. At the present stage FME development is determined by the needs of medical, technical and psycho-physiological support of supersonic aircraft, the need to adjust to the requirements of aircrew health, advanced diagnostics of the functional state and the search for means to improve the stability of his body to flight factors. The main principles of the FME remains the complexity of the study of the human body in terms of its professional and individual approach to a medical examination, a thorough clinical, clinical and physiological and psychological examinations, regular medical supervision of the health of flight crews.

  11. Development Stages and Curriculum: A Japanese Perspective.

    Science.gov (United States)

    Abiko, Tadahiko

    2002-01-01

    Discusses contemporary psychologists' criticism of Jean Piaget's developmental theory; reviews research in brain science, psychology, history, and the experiences of teachers; proposes a new theory of developmental stages based on children's shifting interests; discuses implications of "shifting interest center theory" for school…

  12. MRI features of patients with heroin spongiform leukoencephalopathy of different clinical stages

    International Nuclear Information System (INIS)

    Shi Zhu; Pan Suyue; Zhou Liang; Dong Zhao; Lu Bingxun

    2007-01-01

    Objective: To investigate radiological features of patients with heroin spongiform leukoencephalopathy (HSLE) of different clinical stages and discuss the evolutional characteristics of the disease. Methods: Thirty two patients with HSLE underwent precontrast MRI and postcontrast MRI. The history of addiction, clinical presentations, and brain MRI were analyzed and summarized according to the patient's clinical staging. There are 6 cases in I stage, 21 cases in II stage, 5 cases in III stage. Results: All patients had history of heroin vapor inhalation. Most of the cases developed subacute cerebellar impairment in earlier period. Brain MRI revealed symmetrical lesion within bilateral cerebellum in all patients. Splenium of the corpus callosum, posterior limb of the internal capsule, deep white matter of the occipital and parietal lobes, were gradually involved with progressive deterioration of HSLE. The brain stem and deep white matter of the frontal and temporal lobes were involved in some cases. Conclusions: The history of heated heroin vapor inhalation was the prerequisite for the diagnosis of HSLE. Brain MRI presented the characteristic lesion and its evolution of HSLE. Brain MRI was very important for accurate diagnosis and helpful to judge the clinical stages according to the involved brain region. (authors)

  13. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles desc...

  14. Dental Age Estimation (DAE): Data management for tooth development stages including the third molar. Appropriate censoring of Stage H, the final stage of tooth development.

    Science.gov (United States)

    Roberts, Graham J; McDonald, Fraser; Andiappan, Manoharan; Lucas, Victoria S

    2015-11-01

    The final stage of dental development of third molars is usually helpful to indicate whether or not a subject is aged over 18 years. A complexity is that the final stage of development is unlimited in its upper border. Investigators usually select an inappropriate upper age limit or censor point for this tooth development stage. The literature was searched for appropriate data sets for dental age estimation and those that provided the count (n), the mean (x¯), and the standard deviation (sd) for each of the tooth development stages. The Demirjian G and Demirjian H were used for this study. Upper and lower limits of the Stage G and Stage H data were calculated limiting the data to plus or minus three standard deviations from the mean. The upper border of Stage H was limited by appropriate censoring at the maximum value for Stage G. The maximum age at attainment from published data, for Stage H, ranged from 22.60 years to 34.50 years. These data were explored to demonstrate how censoring provides an estimate for the correct maximum age for the final stage of Stage H as 21.64 years for UK Caucasians. This study shows that confining the data array of individual tooth developments stages to ± 3sd provides a reliable and logical way of censoring the data for tooth development stages with a Normal distribution of data. For Stage H this is inappropriate as it is unbounded in its upper limit. The use of a censored data array for Stage H using Percentile values is appropriate. This increases the reliability of using third molar Stage H alone to determine whether or not an individual is over 18 years old. For Stage H, individual ancestral groups should be censored using the same technique. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. A clinical staging system and treatment guidelines for maxillary osteoradionecrosis in irradiated nasopharyngeal carcinoma patients

    International Nuclear Information System (INIS)

    Cheng, S.-J.; Lee, J.-J.; Ting, L.-L.; Tseng, I.-Y.; Chang, H.-H.; Chen, H.-M.; Kuo, Y.-S.; Hahn, L.-J.; Kok, S.-H.

    2006-01-01

    Purpose: To develop a clinical staging system for maxillary osteoradionecrosis (ORN) in irradiated nasopharyngeal carcinoma (NPC) patients. Methods and Materials: The data of maxillary ORN cases among 1,758 irradiated NPC patients were analyzed. A staging system based on the degrees of bone exposure (E), infection (I), and bleeding (B) was developed. Correlations between various clinical parameters and stages of maxillary ORN and relationships between treatment modalities and outcomes at each stage were evaluated. Cumulative success of treatment and risk factors that affect treatment outcomes were analyzed. Results: The incidence of maxillary ORN was 2.7% (48/1,758). TNM stage of NPC (p < 0.001), radiation dose (p = 0.029), and tooth extraction (p < 0.001) appeared to have significant influences on disease severity. Success rates between conservative therapy and surgical treatment were not significantly different for Stage I ORN but differed significantly for Stage II (p = 0.013) and Stage III (p = 0.008) lesions. Grade 3 infection and bleeding significantly jeopardized treatment success (p = 0.043 and 0.015, respectively). The risk ratios of treatment failure for Grade 3 infection and bleeding were 2.523 (p = 0.034) and 3.141 (p = 0.027), respectively. Conclusions: More serious maxillary ORN tended to occur in cases with more advanced NPC, higher radiation dose, and history of tooth extraction. Surgical treatment was usually required in Stage II and III ORN. The grades of infection and bleeding are important factors in guidance of treatment and prediction of outcomes

  16. Outsourcing technical services : Stages of development

    NARCIS (Netherlands)

    Elfring, T.; Baven, Geert

    1994-01-01

    This article is based on an investigation of the development of two service functions, software development and engineering, in the automobile industry. The inquiry revealed the importance of 'learning and leverage', and the need for a successful combination of functional and application

  17. Collaboration with Pharma Will Introduce Nanotechnologies in Early Stage Drug Development | FNLCR Staging

    Science.gov (United States)

    The Frederick National Lab has begun to assist several major pharmaceutical companies in adopting nanotechnologies in early stage drug development, when the approach is most efficient and cost-effective. For some time, the national lab’s Nanotechno

  18. Stages of growth in economic development

    Czech Academy of Sciences Publication Activity Database

    Kejak, Michal

    2003-01-01

    Roč. 27, č. 5 (2003), s. 771-800 ISSN 0165-1889 Institutional research plan: CEZ:AV0Z7085904 Keywords : growth * human capital * development Subject RIV: AH - Economics Impact factor: 0.690, year: 2003

  19. Development: Ages & Stages--Spatial Awareness

    Science.gov (United States)

    Poole, Carla; Miller, Susan A.; Church, Ellen Booth

    2006-01-01

    Spatial concepts such as a sense of distance are learned through movement and exploration which is the most effective way for children to gain body awareness and an understanding of spatial relationships. It simultaneously develops muscle strength, coordination, self-confidence, and thinking skills. Spatial awareness can be defined as "an…

  20. Life Skills Developed on the Camp "Stage."

    Science.gov (United States)

    Powell, Gwynn M.

    2000-01-01

    Draws on research concerning the components of sense of place, the rootedness of college students to their hometowns, and categories of environmental competence. Offer insights to camp staff into fostering sense of place and the emotional attachments to camp that comprise place attachment, and to developing environmental competence among campers…

  1. Developing Effective Clinical Trainers

    Directory of Open Access Journals (Sweden)

    Kevin Khamarko

    2012-05-01

    Full Text Available Continuing education and training provides a means to improve performance among health care professionals (HCP. Research shows, however, that continuing professional education activities have inconsistent effects on HCP competence, performance, and patient health outcomes. Furthermore, the trainer’s role as a facilitator of knowledge translation (KT has been understudied. To understand how clinical trainers support their trainees in translating what they learned into practice, we conducted 16 in-depth interviews with expert trainers. These interviews yielded a variety of KT-enhancing strategies, including tailoring training activities to their trainees’ needs. In addition, participants recommended trainers familiarize themselves with their trainees’ work environments, be able to identify their knowledge deficits, and devote time to provide trainees with post-training support. Creating an effective training, one that leads to transfer, requires active planning, communication, and command of the training topic by skilled trainers.

  2. Cross-stage immunity for malaria vaccine development.

    Science.gov (United States)

    Nahrendorf, Wiebke; Scholzen, Anja; Sauerwein, Robert W; Langhorne, Jean

    2015-12-22

    A vaccine against malaria is urgently needed for control and eventual eradication. Different approaches are pursued to induce either sterile immunity directed against pre-erythrocytic parasites or to mimic naturally acquired immunity by controlling blood-stage parasite densities and disease severity. Pre-erythrocytic and blood-stage malaria vaccines are often seen as opposing tactics, but it is likely that they have to be combined into a multi-stage malaria vaccine to be optimally safe and effective. Since many antigenic targets are shared between liver- and blood-stage parasites, malaria vaccines have the potential to elicit cross-stage protection with immune mechanisms against both stages complementing and enhancing each other. Here we discuss evidence from pre-erythrocytic and blood-stage subunit and whole parasite vaccination approaches that show that protection against malaria is not necessarily stage-specific. Parasites arresting at late liver-stages especially, can induce powerful blood-stage immunity, and similarly exposure to blood-stage parasites can afford pre-erythrocytic immunity. The incorporation of a blood-stage component into a multi-stage malaria vaccine would hence not only combat breakthrough infections in the blood should the pre-erythrocytic component fail to induce sterile protection, but would also actively enhance the pre-erythrocytic potency of this vaccine. We therefore advocate that future studies should concentrate on the identification of cross-stage protective malaria antigens, which can empower multi-stage malaria vaccine development. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. A Bayesian predictive strategy for an adaptive two-stage design in phase II clinical trials.

    Science.gov (United States)

    Sambucini, Valeria

    2010-06-15

    Phase II clinical trials are typically designed as two-stage studies, in order to ensure early termination of the trial if the interim results show that the treatment is ineffective. Most of two-stage designs, developed under both a frequentist and a Bayesian framework, select the second stage sample size before observing the first stage data. This may cause some paradoxical situations during the practical carrying out of the trial. To avoid these potential problems, we suggest a Bayesian predictive strategy to derive an adaptive two-stage design, where the second stage sample size is not selected in advance, but depends on the first stage result. The criterion we propose is based on a modification of a Bayesian predictive design recently presented in the literature (see (Statist. Med. 2008; 27:1199-1224)). The distinction between analysis and design priors is essential for the practical implementation of the procedure: some guidelines for choosing these prior distributions are discussed and their impact on the required sample size is examined. Copyright (c) 2010 John Wiley & Sons, Ltd.

  4. Improved clinical staging of esophageal cancer with FDG-PET

    International Nuclear Information System (INIS)

    Kim, Young Hwan; Choi, Joon Young; Lee, Kyung Soo; Choi, Yong Soo; Lee, Eun Jeong; Chung, Hyun Woo; Lee, Su Jin; Lee, Kyung Han; Shim, Young Mog; Kim, Byung Tae

    2004-01-01

    Since preoperative staging in esophageal cancer is important in both therapy and prognosis, there had been many efforts to improve its accuracy. Recent studies indicate that whole body FDG-PET has high sensitivity in detection of metastasis in esophageal cancer. Therefore, we added FDG-PET to other conventional methods in staging esophageal cancer to evaluate the usefulness of this method. Subjects were 142 esophageal cancer patients (average 62.3±8.3 yrs) who received CT and PET just before operation. First, we compared N stage and M stage of the CT or PET with those of the post-operative results. Then we compared the stage according to the EUS (T stage) and CT (N and M stage) or EUS (T stage) and CT and PET (N and M stage) to that according to the post-operative results. Among 142 patients, surgical staging of 69 were N0 and 73 were N1. In M staging, 128 were M0 and 14 were M1. Sensitivity, specificity, and accuracy of N staging were 35.6%, 89.9%, 62.0% with CT and 58.9%, 71.0%, 64.7% with PET, respectively. In M staging, 14.3%, 96.9%, 88.7% with CT and 50.0%, 94.5%, 90.1% with PET, respectively. The concordances of [EUS+CT] and [EUS+CT+PET] with post-operative results were 41.2% and 54.6%, respectively and there was significant improvement of staging with additional PET scan (p<0.005). The concordance of [EUS+CT+PET] with post-operative result was significantly increased compared to that of [EUS+CT]. Thus, the addition of FDG-PET with other conventional methods may enable more accurate preoperative staging

  5. [Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study].

    Science.gov (United States)

    Alom Poveda, J; Baquero, M; González-Adalid Guerreiro, M

    2013-10-01

    The diagnostic paradigm of Alzheimer disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). Participants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1,707 patients, of whom 1,694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI:17.4-17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSEde Neurología. Published by Elsevier Espana. All rights reserved.

  6. New development stage of China's uranium industry

    International Nuclear Information System (INIS)

    Zhang Rong

    2001-01-01

    From the early 1980s China adjusted its uranium industry to better meet the market economy requirements. Until 1997, the adjustment has been completed. The technical and managerial improvements result in a more efficient uranium production. In 1996 a series of events related to the nuclear power development of China manifests very favorable situation for the uranium industry. The first two nuclear power plants with a total installed capacity of 2100 MW in the mainland of China have been operating safely and steadily for several years. The additional nuclear power projects to be constructed for the rest of this century are implemented in an all-round way. Four plants with eight reactors of a total of 6900 MW have entered their construction period in succession. In 1996 a commercial ISL mine in Xinjiang with annual capacity 100 tU was completed, and the larger scale of ISL mine is expected to be constructed by 2000. The Benxi uranium mine in northeast China was put into production. It applies some new mining and processing technologies and improved management, which might serve as a new model of uranium mines in China. (author)

  7. Stages of Change in Relationship Status Questionnaire: Development and Validation

    Science.gov (United States)

    Ritter, Kathrin; Handsel, Vanessa; Moore, Todd

    2016-01-01

    This study involved the development of the Stages of Change in Relationship Status (SOCRS) measure in 2 samples of college students. This scale is designed to measure how individuals progress through stages of change when terminating violent and nonviolent intimate relationships. Results indicated that the SOCRS is a reliable and valid tool to…

  8. Development of two-stage grain grinder

    Directory of Open Access Journals (Sweden)

    V. N. Trubnikov

    2016-01-01

    Full Text Available The most important task in the development of the diet of farm animals feeding is a selection of the most balanced in its composition and most nutritious feeds, which are safe and meet all the necessary requirements at the same time. To evaluate the productive value of feeds and their effectiveness the rate of food productive action η was proposed. This ratio reflects the productive part of the total value of the exchange energy of the daily feed ration and is an essential criterion of the feed quality indicators. In the feed rations of animals the most expensive, but energy-rich feed is a mixed fodder, a mixture of grinded seeds of agricultural crops and protein, mineral and vitamin additives. In the diet for its nutritional value, this feed product is for cattle – 50, pigs – 60… 100 and birds – 100%. The basic operation in the production of mixed fodder is seeds grinding, i.e. their destruction under the influence of external forces, exceeding the forces of molecular adhesion of the grains particles. To grind the grain different ways are used: chopping, grinding, impact «in flight», crushing, etc. In the production of mixed fodder on the existing production equipment, there is the problem of getting the grain mixed fodder the necessary degree of grinding and uniform in its particle size distribution at the same time. When receiving too coarse grinding there is a problem of difficult digestibility of mixed fodder by farm animals. Moreover grinding process is accompanied by a high energy consumption. Grain grinder, the principle of which is based on the implementation of two ways of grinding grain: splitting and impact «in flight» is proposed. The proposed constructive solutions allow to obtain a high-performance technical means for crushing seeds of crops, as well as reduce energy costs that arise during the course of the process of obtaining of mixed fodder. The methodology justification of degree of grain grinding by

  9. Recommendations for clinical staging (cTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals.

    Science.gov (United States)

    Rice, Thomas W; Ishwaran, Hemant; Blackstone, Eugene H; Hofstetter, Wayne L; Kelsen, David P; Apperson-Hansen, Carolyn

    2016-11-01

    We report analytic and consensus processes that produced recommendations for clinical stage groups (cTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration (WECC) provided data on 22,123 clinically staged patients with epithelial esophageal cancers. Risk-adjusted survival for each patient was developed using random survival forest analysis from which (1) data-driven clinical stage groups were identified wherein survival decreased monotonically and was distinctive between and homogeneous within groups and (2) data-driven anatomic clinical stage groups based only on cTNM. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced (3) consensus clinical stage groups. Compared with pTNM, cTNM survival was "pinched," with poorer survival for early cStage groups and better survival for advanced ones. Histologic grade was distinctive for data-driven grouping of cT2N0M0 squamous cell carcinoma (SCC) and cT1-2N0M0 adenocarcinoma, but consensus removed it. Grouping was different by histopathologic cell type. For SCC, cN0-1 was distinctive for cT3 but not cT1-2, and consensus removed cT4 subclassification and added subgroups 0, IVA, and IVB. For adenocarcinoma, N0-1 was distinctive for cT1-2 but not cT3-4a, cStage II subgrouping was necessary (T1N1M0 [IIA] and T2N0M0 [IIB]), advanced cancers cT3-4aN0-1M0 plus cT2N1M0 comprised cStage III, and consensus added subgroups 0, IVA, and IVB. Treatment decisions require accurate cStage, which differs from pStage. Understaging and overstaging are problematic, and additional factors, such as grade, may facilitate treatment decisions and prognostication until clinical staging techniques are uniformly applied and improved. © 2016 International Society for Diseases of the Esophagus.

  10. Radiopharmaceutical development and clinical needs

    International Nuclear Information System (INIS)

    Vieira, M.R.

    1998-01-01

    The use of radionuclides for medical applications has continued to grow at a very rapid pace. The use of radiotracers for nuclear medicine imaging and for radiotherapy of cancer as well as certain benign disorders is firmly established as an important clinical modality. Over the past ten years, nuclear medicine has experienced an evolution towards functional studies and novel therapeutic approaches. New radionuclides are required for these applications. In the developmental stages, each new isotope has to go through a phase of careful scrutiny and evaluation, and practical concerns related to the cost of production and availability must be addressed. The development of 18 F-labeled radiopharmaceuticals has opened a completely new area of investigation. Research on bioconjugates (this term includes radiolabeled antibodies, peptides, receptor-specific and other bioactive molecules) has experienced rapid growth because of the promise of a number of these ''bioactive molecules'' to serve as selective carriers of radionuclides for tumor-associated and other specific antigens/receptors ''in vivo''. The new concept of nuclear medicine, particularly when applied to the field of oncology is directed towards the physiological mechanisms and the study of molecular disfunctions. The search for new radiopharmaceuticals thus aims at studying tumors at a tissue and molecular level. Examples of this new approach are scans utilizing the following substances: -guanethidine and noradrenaline analogues such as meta-iodo-benzyl-guanidine labeled with iodine-131 or iodine-123 aimed at targeting neuroendocrine cells and their secretory granules; -various monoclonal antibodies directed at different tumor types, both for diagnostic and therapeutic purposes. Radioimmunotherapy is considered particularly suited for treatment of tumors not easily amenable to surgery and for the treatment of small disseminated lesions; -somatostatin analogs tagged with indium-111 or more recently with Yttrium

  11. Treatment results in women with clinical stage I and pathologic stage II endometrial carcinoma

    NARCIS (Netherlands)

    Jobsen, J.J.; Schutter, E.M.J.; Meerwaldt, J.H.; van der Palen, Jacobus Adrianus Maria; van der Sijde, R.; Naudin ten Cate, L.

    2001-01-01

    The aim of this study is to report survival and results of therapy and possible prognostic factors in women with pathologic stage II endometrial carcinoma. Forty-two patients with pathologic stage II endometrial carcinoma were treated at the department of Radiation Oncology of the Medisch Spectrum

  12. Young children's understanding of stages of human development

    OpenAIRE

    濱田, 祥子; 杉村, 伸一郎

    2010-01-01

    The self-concept is composed through the interaction with others (Mead,1934). As selfconceptual study in early childhood, most targets the same age others. However, it is thought that the existence of the others at other stages of development brings the influence to the self-concept if the self-concept is composed by the interaction with others. The present study aimed to search for children's understanding of stages of human development and children's self-concept by the comparisons between ...

  13. A proposed model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development.

    Science.gov (United States)

    Knight, Zelda Gillian

    2017-09-01

    Just as Freud used stages of psychosexual development to ground his model of psychoanalysis, it is possible to do the same with Erik Erikson's stages of development with regards to a model of psychodynamic psychotherapy. This paper proposes an eight-stage model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development. Various suggestions are offered. One such suggestion is that as each of Erikson's developmental stages is triggered by a crisis, in therapy it is triggered by the client's search. The resolution of the search often leads to the development of another search, which implies that the therapy process comprises a series of searches. This idea of a series of searches and resolutions leads to the understanding that identity is developmental and therapy is a space in which a new sense of identity may emerge. The notion of hope is linked to Erikson's stage of Basic Trust and the proposed model of therapy views hope and trust as essential for the therapy process. Two clinical vignettes are offered to illustrate these ideas. Psychotherapy can be approached as an eight-stage process and linked to Erikson's eight stages model of development. Psychotherapy may be viewed as a series of searches and thus as a developmental stage resolution process, which leads to the understanding that identity is ongoing throughout the life span. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Stages of Teachers' Careers: Implications for Professional Development.

    Science.gov (United States)

    Christensen, Judith; And Others

    This monograph on the development of teachers' careers synthesizes researchers' prescriptions for early-, mid-, and late-career professional development; and describes successful programs that demonstrate sensitivity to the stages of teachers' growth. The first chapter, "Teachers' Career Development," reviews current adult- and career-stage…

  15. Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Leach, M.O.; Orton, M. [Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Cancer Research UK and EPSRC Cancer Imaging Centre, Sutton, Surrey (United Kingdom); Morgan, B. [Univ. of Leicester, College of Medicine, Biological Sciences and Psychology, Leicester (United Kingdom); Tofts, P.S. [Brighton and Sussex Medical School, Univ. of Sussex, Clinical Imaging Sciences Centre, Sussex (United Kingdom); Buckley, D.L. [University of Leeds, Division of Medical Physics, Leeds (United Kingdom); Huang, W. [Oregon Health and Science Univ., Advanced Imaging Research Centre, Portland, OR (United States); Horsfield, M.A. [Medical Physics Section, Leicester Royal Infirmary, Dept. of Cardiovascular Sciences, Leicester (United Kingdom); Chenevert, T.L. [Univ. of Michigan Health System, Ann Arbor, MI (United States); Collins, D.J. [Royal Marsden Hospital NHS Foundation Trust, Cancer Research UK and EPSRC Cancer Imaging Centre, Sutton, Surrey (United Kingdom); Jackson, A. [Univ. of Manchester, Wolfson Molecular Imaging Centre, Withington, Manchester, M20 3LJ (United Kingdom); Lomas, D. [Univ. of Cambridge, Dept. of Radiology, Cambridge (United Kingdom); Whitcher, B. [Unit 2 Greenways Business Park, Mango Solutions, Chippenham (United Kingdom); Clarke, L. [Cancer Imaging Program, Imaging Technology Development Branch, Rockville, MD (United States); Plummer, R. [Univ. of Newcastle Upon Tyne, The Medical School, Medical Oncology, Northern Inst. for Cancer Research, Newcastle Upon Tyne (United Kingdom); Judson, I. [Royal Marsden Hospital, Sutton, Surrey (United Kingdom); Jones, R. [Beatson West of Scotland Cancer Centre, Glasgow (United Kingdom); Alonzi, R. [Mount Vernon Cancer Centre, Northwood (United Kingdom); Brunner, T. [Gray Inst. for Radiation, Oncology and Biology, Oxford (United Kingdom); Koh, D.M. [Royal Marsden NHS Foundation Trust, Diagnostic Radiology, Sutton, Surrey (United Kingdom)] [and others

    2012-07-15

    Many therapeutic approaches to cancer affect the tumour vasculature, either indirectly or as a direct target. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important means of investigating this action, both pre-clinically and in early stage clinical trials. For such trials, it is essential that the measurement process (i.e. image acquisition and analysis) can be performed effectively and with consistency among contributing centres. As the technique continues to develop in order to provide potential improvements in sensitivity and physiological relevance, there is considerable scope for between-centre variation in techniques. A workshop was convened by the Imaging Committee of the Experimental Cancer Medicine Centres (ECMC) to review the current status of DCE-MRI and to provide recommendations on how the technique can best be used for early stage trials. This review and the consequent recommendations are summarised here. (orig.)

  16. Clinical approach to quality of life in children with end-stage renal disease.

    Science.gov (United States)

    Cho, Min Hyun

    2013-08-01

    Quality of life in addition to various medical problems in children with end-stage renal disease (ESRD) should be objectively assessed to accomplish normal growth and development during childhood. However, unfortunately, studies of quality of life (QoL) in children with ESRD have been not popular yet and there are only fewer suitable assessment tools compared with adults. Recently, disease-specific modules to evaluate QoL in children with chronic disease such as ESRD have been developed. This review was made to introduce these QoL instruments for children and help the clinical application of them.

  17. Development and Applications of a Stage Stacking Procedure

    Science.gov (United States)

    Kulkarni, Sameer; Celestina, Mark L.; Adamczyk, John J.

    2012-01-01

    The preliminary design of multistage axial compressors in gas turbine engines is typically accomplished with mean-line methods. These methods, which rely on empirical correlations, estimate compressor performance well near the design point, but may become less reliable off-design. For land-based applications of gas turbine engines, off-design performance estimates are becoming increasingly important, as turbine plant operators desire peaking or load-following capabilities and hot-day operability. The current work develops a one-dimensional stage stacking procedure, including a newly defined blockage term, which is used to estimate the off-design performance and operability range of a 13-stage axial compressor used in a power generating gas turbine engine. The new blockage term is defined to give mathematical closure on static pressure, and values of blockage are shown to collapse to curves as a function of stage inlet flow coefficient and corrected shaft speed. In addition to these blockage curves, the stage stacking procedure utilizes stage characteristics of ideal work coefficient and adiabatic efficiency. These curves are constructed using flow information extracted from computational fluid dynamics (CFD) simulations of groups of stages within the compressor. Performance estimates resulting from the stage stacking procedure are shown to match the results of CFD simulations of the entire compressor to within 1.6% in overall total pressure ratio and within 0.3 points in overall adiabatic efficiency. Utility of the stage stacking procedure is demonstrated by estimation of the minimum corrected speed which allows stable operation of the compressor. Further utility of the stage stacking procedure is demonstrated with a bleed sensitivity study, which estimates a bleed schedule to expand the compressors operating range.

  18. Independent and interactive effects of HIV infection, clinical stage ...

    African Journals Online (AJOL)

    Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization ...

  19. CLINICAL STAGING OF CANCER OF THE PROSTATE DURING ITS PRIMARY BIOPSY

    OpenAIRE

    S. B. Petrov; S. A. Rakul; A. V. Zhivov; R. A. Eloyev; A. Yu. Plekhanov; P. V. Kharchenko

    2010-01-01

    Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC) and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA) and the results of digital rectal examination (DRE) and ultrasound study (USS...

  20. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles......, and is available in 14 languages. Taking into account the increasing differentiation of Alzheimer's disease in preclinical and predementia stages, there is an urgent need for global rating scales to be refined as well....

  1. Design and Development of the MSL Descent Stage Propulsion System

    Science.gov (United States)

    Weiss, Jeffrey M.; Guernsey, Carl S.

    2013-01-01

    On August 5, 2012, The Mars Science Laboratory mission successfully landed the largest interplanetary rover ever built, Curiosity, on the surface of Mars. The Entry, Descent, and Landing (EDL) phase of this mission was by far the most complex landing ever attempted on a planetary body. The Descent Stage Propulsion System played an integral and critical role during Curiosity's EDL. The Descent Stage Propulsion System was a one of a kind hydrazine propulsion system designed specifically for the EDL phase of the MSL mission. It was designed, built, and tested at the Jet Propulsion Laboratory (JPL). The purpose of this paper is to present an overview of the design and development of the MSL Descent Stage Propulsion System. Driving requirements, system design, component selection, operational sequence of the system at Mars, new developments, and key challenges will be discussed.

  2. The Malemute development program. [rocket upper stage engine design

    Science.gov (United States)

    Bolster, W. J.; Hoekstra, P. W.

    1976-01-01

    The Malemute vehicle systems are two-stage systems based on utilizing a new high performance upper stage motor with two existing military boosters. The Malmute development program is described relative to program structure, preliminary design, vehicle subsystems, and the Malemute motor. Two vehicle systems, the Nike-Malemute and Terrier-Malemute, were developed which are capable of transporting comparatively large diameter (16 in.) 200-lb payloads to altitudes of 500 and 700 km, respectively. These vehicles provide relatively low-cost transportation with two-stage reliability and launch simplicity. Flight tests of both vehicle systems revealed their performance capabilities, with the Terrier-Malemute system involving a unique Malemute motor spin sensitivity problem. It is suggested that the vehicles can be successfully flown by lowering the burnout spin rate.

  3. Clinical study on N0-stage tongue cancer

    International Nuclear Information System (INIS)

    Maruoka, Yasubumi; Ando, Tomohiro; Hoshino, Makoto; Sangu, Yoshikuni; Ogiuchi, Hideki

    2003-01-01

    We retrospectively analyzed the cases of N0-stage tongue cancer patients treated at the Department of Oral Maxillofacial Surgery, Tokyo Women's Medical University Hospital, between January 1980 and December 2000. Primary tongue cancers were treated by surgery (52%) and radiotherapy (48%). In principle, we did not perform elective neck dissection for N0-stage necks. Instead, a policy of careful observation was adopted for the management of N0-stage necks in patients with tongue cancer, and a radical neck dissection or modified radical neck dissection was performed in the event of a secondary neck metastasis. A local recurrence was confirmed in 25 patients. Twenty of the 25 local recurrences were successfully controlled by a therapy. The incidence of secondary neck metastasis was 4/46 (8%) for T1 patients, 21/48 (45%) for T2 patients, and 9/15 (60%) for T3/T4 patients. Overall, secondary neck metastases occurred in 34 out of 109 (32%) patients, and eventually 12 patients died from uncontrolled tumors. As for the distribution of involved lymph nodes, level I to level III nodes were involved in 30 (88%) patients, and level IV nodes were involved in 4 patients. (author)

  4. [Clinical stages and outcomes of severe cases on hand, foot and mouth disease].

    Science.gov (United States)

    Zhang, J; Jin, Y; Sun, J L; Wang, Y X; Wang, X J; Fu, X Q; Miao, Z P; Lyu, J

    2017-05-10

    Objective: To understand the characteristics and relation of clinical stage and outcome of severe cases on hand, foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease. Methods: According to factors as geographical location, economic and epidemic levels, five provinces (Henan, Shandong, Yunnan, Zhejiang and Sichuan provinces) were selected. Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces. Basic epidemiological information, clinical data, and pathogen testing results in the involved hospitals were collected. Clinical stages on all the patients were decided in accordance with"the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)" . Data were analyzed using SPSS software 18.0 and other epidemiological methods. Results: A total of657 severe HFMD cases were investigated, with 326 cases positive of EV71, accounting for 91.3 % (326/357) among all the laboratory-confirmed cases. Of the 657 cases, 542 cases (82.5 % , 95 %CI : 79.4 %- 85.3 % ) were diagnosed as in stage 2 (with nervous system involvement), 99 cases (15.1 % , 95 %CI : 12.4 %- 18.0 % ) in stage 3 (early phase of function failure on heart and lung), and 16 cases (2.4 % , 95 %CI : 1.4 %- 3.9 % ) were in stage 4 (function failure of heart and lung). 11 cases (1.7 % , 95 %CI : 0.9 %- 3.0 % ) were with squeal when discharged from hospital with 8 cases (1.2 % , 95 %CI : 0.6 %- 2.3 % ) died. When comparing the proportions among stage 2, stage 3 and stage 4, significant differences were found between age groups ( χ (2)=22.632, P =0.012). The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared. When comparing the proportions of clinical stages among the five provinces, significant differences ( χ (2)=41.481, P =0.000) were noticed. Proportions of

  5. Fine structure of endogenous stages of Eimeria turcicus developing ...

    African Journals Online (AJOL)

    1988-05-06

    May 6, 1988 ... Transmission electron microscopic study of endogenous development of Eimeria turcicus Upton, McAllister and Freed, 1988 (Eimeriorina, Apicomplexa), in the gall bladder epithelium of the gecko Hemidactylus turcicus from Israel, revealed merogony and gamogony stages which induce hypertrophy and ...

  6. Clinical staging and survival in refractory celiac disease: a single center experience.

    Science.gov (United States)

    Rubio-Tapia, Alberto; Kelly, Darlene G; Lahr, Brian D; Dogan, Ahmet; Wu, Tsung-Teh; Murray, Joseph A

    2009-01-01

    Refractory celiac disease (RCD) occurs when both symptoms and intestinal damage persist or recur despite strict adherence to a gluten-free diet. In RCD, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The aim is to describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. We compared the clinical characteristics and outcome in 57 patients with RCD: 42 with RCD I and 15 with RCD II. Fifteen of 57 patients died during follow-up (n=8 with RCD I and n=7 with RCD II), each within the first 2 years after RCD diagnosis. The overall 5-year cumulative survival is 70%, 80%, and 45% for the entire cohort, RCD I, and RCD II, respectively. The refractory state itself and enteropathy-associated T-cell lymphoma (EATL) were the most common causes of death, respectively. A new staging system is proposed based on the cumulative effect of 5 prognostic factors investigated at the time of the refractory state diagnosis: for patients in stages I, II, and III, the 5-year cumulative survival rate was 96%, 71%, and 19%, respectively (PRCD is associated with high mortality with RCD II having an especially poor prognosis because of the development of EATL. A new staging model is proposed that may improve the precision of prognosis in patients with RCD.

  7. Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

    International Nuclear Information System (INIS)

    Liu Xiao; Wang Guiqi; He Shun

    2014-01-01

    Objective: To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC). Methods: A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS), esophagoscopy, thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed. The disease free survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings. Results: The median follow-up was 47 months.A total of 305 (85.2%) of all patients were analyzed by clinical stage based on EUS + CT.Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6%, highest (88.6%) for T1 stage and lowest for T4 stage. The predictive value of clinical N stage (N 0 /N1) was 62.5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P=0.000 and 0.000). There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted (P=0.000 and 0.000). Conclusions: Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients

  8. Prognostic value of WHO histological and Masaoka clinical stage in postoperative radiotherapy for thymoma

    International Nuclear Information System (INIS)

    Li Hongxuan; Lu Changxing; Liu Jun; Wang Jiaming; Guo Jindong; Wang Changlu; Gao Lanting

    2009-01-01

    Objective: To evaluate the prognostic significance of WHO histological subtype and Masaoka clinical stage in postoperative radiotherapy for thymoma. Methods: Between October 2000 and December 2006, 94 eligible patients with thymoma were retrospectively analyzed, including 40 male and 54 female. The median age was 46 years. The WHO histological subtypes were type AB in 3 patients, type B 1 in 7, type B 2 in 22, type B 3 44, and type C in 18. The Masaoka clinical staging was stage I in 9 patients, stage II in 36, stage III in 38, and stage IV in 11. All patients received conventional radiotherapy after thymoma resection. The median dose was 5442 cGy (4011-6213 cGy). Kaplan-Meier method was used to calculate survival rate, and correlation analysis method was used to analyze the correlation between WHO histological subtype and Masaoka clinical stage. Cox regression model was used for multivariate analysis. Results: The follow-up rate was 91%, with a 5-year follow-up in 31 patients. The 5-year overall survival rate was 72%. According to Masaoka staging system, the 5-year survival rates of stage I, II, III and IV were 100 %, 83%, 66% and 36%, respectively. In patients with WHO type AB, B 1 , B 2 , B 3 and C, the 5-year survival rates were 100%, 86%, 76%, 67% and 44%, respectively. There was a correlation between WHO histological subtype and Masaoka clinical stage (r=0.614, P=0.000). In multivariate analysis, WHO histological subtype, resection completeness and capsule invasion were independent prognostic factors for long-term survival. Conclusions: Masaoka clinical stage, WHO histological subtype, resection completeness and capsule invasion are important prognostic factors for long-term survival in patients with thymoma after surgery. There is a certain correlation between WHO histological subtype and Masaoka clinical stage, and their combination is valuable for guiding postoperative treatment in thymoma. (authors)

  9. Assessment of the prognostic value of the 8th AJCC staging system for patients with clinically staged prostate cancer; A time to sub-classify stage IV?

    Directory of Open Access Journals (Sweden)

    Omar Abdel-Rahman

    Full Text Available The American Joint Committee on Cancer (AJCC staging system (8th edition for prostate cancer has been published. The current study seeks to validate the prognostic performance of the changes in the new system among clinically staged prostate cancer patients registered within the surveillance, epidemiology and end results (SEER database.SEER database (2004-2014 has been accessed through SEER*Stat program and AJCC 7th and 8th edition stages were calculated utilizing T, N and M stages as well as baseline prostatic specific antigen (PSA and grade group. Cancer-specific and overall survival analyses according to 6th, 7th and 8th editions were conducted through Kaplan-Meier analysis. Moreover, multivariate analysis was conducted through a Cox proportional hazard model.A total of 110499 patients with prostate cancer were identified in the period from 2004-2014.For cancer- specific survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.01 except for stage IIA vs. IIB; while for overall survival according to 8th AJCC, all pair wise P values for comparison were significant (<0.02 except for stage IIIA vs. IIIB. Results of c-index assessment for cancer-specific survival for the three AJCC editions were as follows: c-index for AJCC 6th edition was 0.816; c-index for AJCC 7th edition was 0.897; c-index for AJCC 8th edition was 0.907. For stage IVB prostate cancer (i.e.M1 disease, further sub-staging was proposed according to M1 sub-stage (i.e. M1a, M1b and M1c. Pair wise comparison between these proposed sub-stages was conducted for both cancer-specific and overall survival. For both cancer-specific and overall survival, all pair wise P values for comparisons were <0.0001.Compared to older staging systems (6th and 7th, the 8th system is more discriminatory. Further sub-classification of stage IV disease is suggested.

  10. Disorganization at the stage of schizophrenia clinical outcome: Clinical-biological study.

    Science.gov (United States)

    Nestsiarovich, A; Obyedkov, V; Kandratsenka, H; Siniauskaya, M; Goloenko, I; Waszkiewicz, N

    2017-05-01

    According to the multidimensional model of schizophrenia, three basic psychopathological dimensions constitute its clinical structure: positive symptoms, negative symptoms and disorganization. The latter one is the newest and the least studied. Our aim was to discriminate disorganization in schizophrenia clinical picture and to identify its distinctive biological and socio-psychological particularities and associated genetic and environmental factors. We used SAPS/SANS psychometrical scales, scales for the assessment of patient's compliance, insight, social functioning, life quality. Neuropsychological tests included Wisconsin Card Sorting Test (WCST), Stroop Color-Word test. Neurophysiological examination included registration of P300 wave of the evoked cognitive auditory potentials. Environmental factors related to patient's education, family, surrounding and nicotine use, as well as subjectively significant traumatic events in childhood and adolescence were assessed. Using PCR we detected SNP of genes related to the systems of neurotransmission (COMT, SLC6A4 and DRD2), inflammatory response (IL6, TNF), cellular detoxification (GSTM1, GSTT1), DNA methylation (MTHFR, DNMT3b, DNMT1). Disorganization is associated with early schizophrenia onset and history of psychosis in family, low level of insight and compliance, high risk of committing delicts, distraction errors in WCST, lengthened P300 latency of evoked cognitive auditory potentials, low-functional alleles of genes MTHFR (rs1801133) and DNMT3b (rs2424913), high level of urbanicity and psychotraumatic events at early age. Severe disorganization at the stage of schizophrenia clinical outcome is associated with the set of specific biological and social-psychological characteristics that indicate its epigenetic nature and maladaptive social significance. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Clinical variants, stages, and management of basal cell carcinoma

    Science.gov (United States)

    Dourmishev, Lyubomir A.; Rusinova, Darena; Botev, Ivan

    2013-01-01

    Basal cell carcinoma (BCC) is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.5% of the cases; however, a considerable local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is made according to Tumor, Node, Metastasis (TNM) classification and is essential for performing the adequate treatment. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis. Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not be underestimated. PMID:23439912

  12. Clinical variants, stages, and management of basal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Lyubomir A Dourmishev

    2013-01-01

    Full Text Available Basal cell carcinoma (BCC is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.5% of the cases; however, a considerable local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is made according to Tumor, Node, Metastasis (TNM classification and is essential for performing the adequate treatment. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis. Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not be underestimated.

  13. Developing clinical piano improvisation skills

    DEFF Research Database (Denmark)

    Wigram, Anthony Lewis

    2003-01-01

    in a new direction. Structure and lack of structure play a balanced role in the clinical process, and reflects the skills of the therapist to musically meet the needs of the client. This workshop will provide teaching and practice tools for the participants that are intended to sustain the creativity......Teaching piano improvisation skills for use in clinical work relies on the development of a range of musical techniques and therapeutic methods that are combined and integrated. Simple musical styles of playing such as melody dialogues, two chord accompaniments, walking basses (tonal and atonal), 6......ths with octave grounds, pentatonic and Spanish style frameworks are easily learnt and applied through in combination with therapeutic approaches such as matching, supporting, frame-working grounding – and many others. The use of transitions in therapeutic improvisation are a primary and musically...

  14. Development of 52 inches last stage blade for steam turbines

    International Nuclear Information System (INIS)

    Suzuki, Atsuhide; Hisa, Shoichi; Nagao, Shinichiro; Ogata, Hisao

    1986-01-01

    The last stage blades of steam turbines are the important component controlling the power output and performance of plants. In order to realize a unit of large capacity and high efficiency, the proper exhaust area and the last stage blades having good performance are indispensable. Toshiba Corp. has completed the development of the 52 inch last stage blades for 1500 and 1800 rpm steam turbines. The 52 inch last stage blades are the longest in the world, which have the annular exhaust area nearly 1.5 times as much as that of 41 inch blades used for 1100 MW, 1500 rpm turbines in nuclear power stations. By adopting these 52 inch blades, the large capacity nuclear power plants up to 1800 MW can be economically constructed, the rate of heat consumption of 1350 MW plants is improved by 3 ∼ 4 % as compared with 41 inch blades, and in the plants up to 1100 MW, LP turbines can be reduced from three sets to two. The features of 52 inch blades, the flow pattern and blade form design, the structural strength analysis and the erosion withstanding property, and the verification by the rotation test of the actual blades, the performance test using a test turbine, the vibration analysis of the actually loaded blades and the analysis of wet steam behavior are reported. (Kako, I.)

  15. COPD, stage and treatment in a large outpatient clinic

    DEFF Research Database (Denmark)

    Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette

    2017-01-01

    Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history...... of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics...... status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients...

  16. Development of Taenia asiatica cysticerci to infective stage and adult stage in Mongolian gerbils.

    Science.gov (United States)

    Chang, S L; Ooi, H K; Nonaka, N; Kamiya, M; Oku, Y

    2006-09-01

    The development of metacestodes and adult worms of Taenia asiatica in Mongolian gerbils (Meriones unguiculatus) were observed. Cysticerci were recovered from gerbils subcutaneously injected with hatched oncospheres. The recovery rate ranged from 0.1 to 3.2%. No cysticerci were recovered from the orally inoculated gerbils. The infectivity of the cysticerci recovered at 48 weeks post-infection was evaluated. Tapeworms were recovered on day 14 post-infection from the small intestine of 5 of 11 gerbils, with a recovery rate of 27% (6 worms recovered/22 worms inoculated). Three and four adult worms were recovered from two human volunteers who ingested five cysticerci after 4 months post-infection. In worms recovered from gerbils, segmentation and genital primordia in the posterior proglottids and hooklets in the residual rostellum were observed. The results indicate that gerbils can serve as an alternative intermediate host and that partial development of the adult worm stage occurs in gerbils.

  17. Subcortical volumetric differences between clinical stages of young people with affective and psychotic disorders.

    Science.gov (United States)

    Eggins, Peta S; Hatton, Sean N; Hermens, Daniel F; Hickie, Ian B; Lagopoulos, Jim

    2018-01-30

    The aim of this study was to investigate differences in subcortical and hippocampal volumes between healthy controls, young people at an early stage of affective and psychotic disorders and those in more advanced stages, to identify markers associated with functional outcomes and illness severity. Young people presenting to youth mental health services with admixtures of depressive, manic and psychotic symptoms (n = 141), and healthy counterparts (n = 49), aged 18-25 were recruited. Participants underwent magnetic resonance imaging, clinical assessments and were rated as to their current clinical stage. Eighty-four patients were classified at the attenuated syndrome stage (Stage 1b) and 57 were classified as having discrete and persistent disorders (Stage 2+). Automated segmentation was performed using NeuroQuant® to determine volumes of subcortical and hippocampus structures which were compared between groups and correlated with clinical and functional outcomes. Compared to healthy controls, Stage 2+ patients showed significantly reduced right amygdala volumes. Whereas Stage 1b patients showed significantly reduced left caudate volumes compared to healthy controls. Smaller left caudate volume correlated with greater psychological distress and impaired functioning. This study shows a clinical application for an automated program to identify and track subcortical changes evident in young people with emerging psychopathology. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  18. Contraceptive development and clinical trials.

    Science.gov (United States)

    Fraser, I S

    1986-02-01

    This article provides an overview of the contraceptive development process, with particular emphasis on the importance of clinical trials. Development of a new contraceptive drug begins with chemical synthesis of a large number of substances that may have antifertility effects. Before human trials are considered, drugs must undergo a complex process of animal toxicology testing. Such studies assess acute, subacute, and chronic toxicity. Once a drug has passed the initial screening process, human testing must follow a logical sequence of clinical trials: phase I, pharmacology testing; phase II, initial assessment of efficacy, safety, acceptability, and ease of use; phase III, acurate assessment of efficacy, side effects, and reasons for discontinuation under controlled conditions; and phase IV, evaluation of effectiveness under field conditions. When these have been satisfactorily completed, a detailed marketing application must be submitted to the drug regulatory agency in each country. The process of assessment of the application often takes as long as 2 years. Once marketing approval has been received, there is still a need for postmarketing surveillance of the performance of the new contraceptive method. In many cases, a careful program of training is required. Among the research and recording strategies for postmarketing surveillance are voluntary recording of possible adverse reactions, longterm prospective cohort studies, retrospective case-control studies, and registered release. As controls on the safety and performance of new contraceptive methods are being tightened, the time scale and costs of development are increasing. The time from the 1st synthesis of a drug to marketing approval often takes 13-14 years and costs US$25-50 million. Since the patent life of a new substance is limited to 17 years in most countries, pharmaceutical companies have little time to recoup development costs, which has caused fewer new methods to be developed.

  19. Development of a Multi-Stage Vaccine against Paratuberculosis in Cattle

    DEFF Research Database (Denmark)

    Thakur, Aneesh

    of quantitative real-time PCR (qPCR) for the evaluation of microbial load in tissues and vaccine efficacy (Article 4). Costimulation of vaccine-induced ex vivo T cells significantly increased IFN-γ levels following use of anti-CD28 and anti-CD49d antibodies (Article 2). Recombinant interleukin IL-12 (rIL-12) also...... to considerable economic losses to farming community. Paratuberculosis is a staged infection in which young calves acquire the infection in the first months of life, may progress into a prolonged asymptomatic stage of about 2-5 years and may eventually become clinically infected animals. Vaccination with whole......-cell live or inactivated vaccines prevents or delays the development of clinical stage of the disease but does not eliminate MAP and is usually accompanied by interference with bovine tuberculosis diagnostics as well as local tissue damage. Subunit vaccines with well-defined antigens in combination...

  20. Development of Motorized Slewing Mirror Stage for the UFFO Project

    DEFF Research Database (Denmark)

    Nam, J.; Ahn, K.B.; Cho, M.

    2013-01-01

    redirects the optical path rather than slewing entire spacecraft. We have developed a 15 cm two-axis Gimbal mirror stage for the UFFO-Pathfinder which is going to be on board the Lomonosov satellite which is to be launched in 2013. The stage is designed for fast and accurate motion with given budgets of 3...... kg of mass and 3 Watt of power. By employing stepping motors, the slewing mirror can rotate faster than 15 deg/sec so that objects in the UFFO coverage (60 deg × 60 deg) can be targeted in ~1 sec. The obtained targeting resolution is better 2 arcmin using a close-loop control with high precision...

  1. Development of 52 inch last stage blade for steam turbine

    International Nuclear Information System (INIS)

    Kadoya, Yoshiki; Harada, Masakatsu; Watanabe, Eiichiro

    1985-01-01

    Mitsubishi Heavy Industries, Ltd. has developed the last stage blades with 1320 mm length for a 1800 rpm LP turbine, and the verification by rotating vibration test using actual blades was finished, thus the blades were completed. In a nuclear power plant with an A-PWR of 3800 MW thermal output, the 1350 MW steam turbine has one HP turbine and three LP turbines coupled in tandem, and the optimum last stage blades for the LP turbines became the 1320 mm blades. The completion of these blades largely contributes to the improvement of thermal efficiency and the increase of generator output in large nuclear power plants, and has the possibility to decrease three LP turbines to two in 900 MW plants, which reduces the construction cost. The velocity energy of steam coming out of last stage blades is abandoned as exhaust loss in a condenser, which is the largest loss in a turbine. The increase of exhaust area using long blades reduces this loss. The economy of the 1320 mm blades, the features of the 1320 mm blades, the aerodynamic design and its verification, the prevention of the erosion of the 1320 mm blades due to wet steam, the strength design, the anti-vibration design and its verification, and the CAD/CAM system are reported. (Kako, I.)

  2. [Stages in the development of instruments for determining subjective refraction].

    Science.gov (United States)

    Twisselmann, L; Forchmann, J; Duis, W

    1991-01-01

    By the equipments constructed from the J. D. Möller Company in Wedel during the last 40 years the different stages of development of the phoropter are shown. There was a big step from the simple technology of the VISUTEST-A to the VISUTEST-C-Phoropter, which in connection with the inclination apparatus according to Reiner is one of the most successful equipments of German output. VISUTRON, which is the first motor-operated phoropter, started a new era. Concerning VISUTRON-Plus, the latest product of this series, great importance was especially set to efficient and easy operation.

  3. Life cycle assessment of nanoadsorbents at early stage technological development

    DEFF Research Database (Denmark)

    Kazemi, Ali; Bahramifar, Nader; Heydari, Akbar

    2018-01-01

    in the control and removal of environmental pollutants. This application is still an emerging technology at the early stages of development. Hence, the heart of this study enables an environmental assessment of nanoadsorbents as an emerging product. In addition, the environmental impacts of synthesized...... the process of the functionalization of nanoadsorbents leads to the increase of the adsorption capacity of nanoadsorbents, it is also paired with a significant enhancement of negative environmental impacts. The results of t-test comparing the cradle-to-use life cycle impacts of studied impact categories for 1...

  4. Informal roles and the stages of interdisciplinary team development.

    Science.gov (United States)

    Farrell, M P; Schmitt, M H; Heinemann, G D

    2001-08-01

    After presenting a theory of team development, we propose that the informal role structure of a team is dependent upon the degree of anomie in the team culture, and we provide measures of anomie and informal roles that can be used in field settings. Then we test hypotheses on a national sample of 111 interdisciplinary health care teams in geriatrics in US Veterans Affairs medical centers. We find evidence that as teams develop from early to later stages, the interpersonal behavior of members becomes less differentiated on three dimensions: prominence, sociability, and task-orientation. In addition, we find that images of each member come into clearer focus, as evidenced by reduced variation in how each member is seen by other team members. Finally, we find that regardless of stage of team development, the more education the team members have, the more prominent and task-oriented they are. In general, physicians score highest in prominence and task-orientation, but relatively low in sociability.

  5. Clinical Staging of HIV Infection as a Surrogate for CD4 Count in HIV ...

    African Journals Online (AJOL)

    naive HIV-infected children. METHODS: Newly diagnosed HIV-infected children, antiretroviral-naïve attending a paediatric infectious diseases unit were enrolled. The clinical manifesta-tions, age, sex, and. WHO clinical stage of each patient were ...

  6. Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers

    NARCIS (Netherlands)

    Kassa, E.; Rinke de Wit, T. F.; Hailu, E.; Girma, M.; Messele, T.; Mariam, H. G.; Yohannes, S.; Jurriaans, S.; Yeneneh, H.; Coutinho, R. A.; Fontanet, A. L.

    1999-01-01

    OBJECTIVE: To study the association between the clinical axis of the World Health Organization (WHO) staging system of HIV infection and disease and laboratory markers in HIV-infected Ethiopians. DESIGN: Cross-sectional study. METHODS: Clinical manifestations and stage of HIV-positive individuals

  7. Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

    Science.gov (United States)

    Salerno, Jennifer; Finelli, Antonio; Morash, Chris; Morgan, Scott C.; Power, Nicholas; Schieda, Nichola; Haider, Masoom A.

    2016-01-01

    Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11–85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations. PMID:27800062

  8. Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru.

    Science.gov (United States)

    Romanoff, Anya; Constant, Tara Hayes; Johnson, Kay M; Guadiamos, Manuel Cedano; Vega, Ana María Burga; Zunt, Joseph; Anderson, Benjamin O

    2017-11-01

    Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Method of breast cancer detection and factors that influence time to and stage at diagnosis. Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more

  9. Professional Development through Clinical Supervision

    Science.gov (United States)

    Farhat, Amal

    2016-01-01

    Studies have shown that clinical supervisory practices result in implementation of new skills in teachers' classroom performance. This study examines the impact of two clinical supervisory cycles on teachers' performance in classroom management. Multiple data collection tools were used to determine the impact of clinical supervisory interventions…

  10. Brain Activity at the Embryonic Stages of Development

    Directory of Open Access Journals (Sweden)

    D.R. Akhmetshina

    2015-06-01

    Full Text Available The main function of our brain is to run internal models of the external world. These models enable us to analyze complex sensory inputs from the outside and our bodies, as well as to generate a system of commands underlying our behavior. This is implemented by a complex network, which is built out of billions of interconnected neurons. The network is formed during the ontogeny with the most intense phase of synaptogenesis starting during second half of gestation in the utero. So, the neonate is born with a remarkably developed frame of the central nervous system capable of receiving, processing, and memorizing information from the external world. This review discusses how the brain operates during the fetal stages of development and how the early activities expressed in the fetal brain contribute to the prenatal assembly of the nervous system.

  11. Initial Clinical Experience in Multiple Myeloma Staging by Means of Whole-Body Resonance Techniques

    International Nuclear Information System (INIS)

    Gallego, J. I.; Concepcion, L.; Alonso, S.; Sanchez, B.; Manzi, F.

    2003-01-01

    To develop a magnetic resonance (MR) exploratory technique equivalent to serial bone X-ray, and to compare their precision in the staging of multiple myeloma (MM) patients. Multiple acquisition T1-weights TSE and STIR sequences in the coronal plane were performed. Ten healthy volunteers and 11 multiple myeloma diagnosed patients were included. The visualization of bony structures was particularly noted,with special attention given to those which would normally be included in a serial bone X-ray. In the case of the patients, a comparison was made between diagnostic capacities of the MR sequences. MR highlighters significantly more (p<0.05) bony elements than did the serial bone X-ray. This was greatly due to a sequential displacement of the scanner bed, allowing for field-of-views which were minimally from head to third proximal of the leg. Magnetic resonance detected a significantly higher number (p<0.05) of lesions. It was, in turn, capable of revealing greater lesion extensions, even to the point of implying staging classification changes in 18% of the patients. The utilization of whole-body MR techniques in multiple myeloma patients is feasible and clinically beneficial. MR is both more sensitive and more specific than serial bone X-ray for evaluation of bony lesions in MM. It is currently serving as a valid alternative in a growing numbers of patients. (Author) 10 refs

  12. NLV Upper Stage Development and Flight Testing, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — The technical innovation proposed here is the design during Phase I of a high performance upper stage for a two-stage "20 / 450" Nanosat Launch Vehicle (NLV) that is...

  13. The recovery process utilizing Erikson's stages of human development.

    Science.gov (United States)

    Vogel-Scibilia, Suzanne E; McNulty, Kathryn Cohan; Baxter, Beth; Miller, Steve; Dine, Max; Frese, Frederick J

    2009-12-01

    Of current interest to the field are clinical frameworks that foster recovery. The authors offer a psycho-developmental model that parallels Erik Erikson's theory of human development, and theorize that the process of psychiatric recovery involves a psychic reworking of these fundamental steps. Understanding recovery in this context allows the client and the practitioner of psychiatric rehabilitation to design and implement a coherent treatment strategy.

  14. Modelling of the initial stage of the surface discharge development

    International Nuclear Information System (INIS)

    Gibalov, V.; Pietsch, G.

    1998-01-01

    Computer modelling of the initial stage of the surface discharge was performed by solving numerically the coupled continuity, the Poisson and Townsend ionization equations and taking into account the ionization, attachment and detachment processes. The potential distribution at the dielectric surface and at the boundaries which surround the integration region have been calculated with the charge-image method in a 3D approach. In order to eliminate numerical diffusion effects, the solution of the continuity equation was corrected using a flux correction transport routine. At the positive voltage the development of the discharge channel is determined mainly by the shape of the electrode tip. At the negative voltage the following phases of the discharge may be distinguished: the initial phase, the cathode directed streamer phase resulting in the cathode layer formation, and the propagating phase. The physical processes governing each discharge phase are described in detail. (J.U.)

  15. Development of RLV-TD Stage Separation System

    Science.gov (United States)

    Mohan, Ganesh; Rao, Y. Naga Sreenivasa; Prakash, P.; Subramanian, U. A.; Purushothaman, P.; Premdas, M.; Abraham, Baby; Kishorenath, V.; Jayachandran, T.

    2017-12-01

    Hyper Sonic Experiment (HEX-01), with main focus on the aero thermodynamic characterization and end to end autonomous mission management, is the first in a series of demonstrators planned by ISRO for the development of a Reusable Launch Vehicle (RLV). This paper gives the evolution of the split collet based separation system used in the separation of the spent booster stage from the RLV-Technology Demonstrator Vehicle (TDV). The separation mechanism is very compact, yet has a very high load bearing capacity. The design details and the challenges faced during flight qualification of the system are discussed in this paper. There are a lot of promising areas where this system can be used.

  16. Transarterial chemoembolization with gelatin sponge microparticles for barcelona clinic liver cancer Stage C and large hepatocellular carcinoma: Initial clinical experience

    Directory of Open Access Journals (Sweden)

    Jun Zhou

    2017-01-01

    Conclusions: From our preliminary clinical experience, GSMs-TACE in the treatment of BCLC Stage C and large HCC appears to offer favorable survival and tumor response with low morbidity. However, further prospective studies are required to assess its safety and efficacy.

  17. Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

    NARCIS (Netherlands)

    Heijdenrijk, Kees

    2002-01-01

    The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

  18. Rethinking the Food and Drug Administration's 2013 guidance on developing drugs for early-stage Alzheimer's disease.

    Science.gov (United States)

    Schneider, Lon S

    2014-03-01

    The February 2013 Food and Drug Administration (FDA) draft guidance for developing drugs for early-stage Alzheimer's disease (AD) creates certain challenges as they guide toward the use of one cognitive outcome to gain accelerated marketing approval for preclinical AD drugs, and a composite clinical scale - the Clinical Dementia Rating Scale in particular - for the primary outcome for prodromal AD clinical trials. In light of the developing knowledge regarding early stage diagnoses and clinical trials outcomes, we recommend that FDA describe its requirements for validating preclinical AD diagnoses for drug development purposes, maintain the principle for requiring coprimary outcomes, and encourage the advancement of outcomes for early stage AD trials. The principles for drug development for early stage AD should not differ from those for clinical AD, especially as the diagnoses of prodromal and early AD impinge on each other. The FDA should not recommend that a composite scale be used as a sole primary efficacy outcome to support a marketing claim unless it requires that the cognitive and functional components of such a scale are demonstrated to be individually meaningful. The current draft guidelines may inadvertently constrain efforts to better assess the clinical effects of new drugs and inhibit innovation in an area where evidence-based clinical research practices are still evolving. Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  19. Cognitive reserve in granulin-related frontotemporal dementia: from preclinical to clinical stages.

    Science.gov (United States)

    Premi, Enrico; Gazzina, Stefano; Bozzali, Marco; Archetti, Silvana; Alberici, Antonella; Cercignani, Mara; Bianchetti, Angelo; Gasparotti, Roberto; Turla, Marinella; Caltagirone, Carlo; Padovani, Alessandro; Borroni, Barbara

    2013-01-01

    Consistent with the cognitive reserve hypothesis, higher education and occupation attainments may help persons with neurodegenerative dementias to better withstand neuropathology before developing cognitive impairment. We tested here the cognitive reserve hypothesis in patients with frontotemporal dementia (FTD), with or without pathogenetic granulin mutations (GRN+ and GRN-), and in presymptomatic GRN mutation carriers (aGRN+). Education and occupation attainments were assessed and combined to define Reserve Index (RI) in 32 FTD patients, i.e. 12 GRN+ and 20 GRN-, and in 17 aGRN+. Changes in functional connectivity were estimated by resting state fMRI, focusing on the salience network (SN), executive network (EN) and bilateral frontoparietal networks (FPNs). Cognitive status was measured by FTD-modified Clinical Dementia Rating Scale. In FTD patients higher level of premorbid cognitive reserve was associated with reduced connectivity within the SN and the EN. EN was more involved in FTD patients without GRN mutations, while SN was more affected in GRN pathology. In aGRN+, cognitive reserve was associated with reduced SN. This study suggests that cognitive reserve modulates functional connectivity in patients with FTD, even in monogenic disease. In GRN inherited FTD, cognitive reserve mechanisms operate even in presymptomatic to clinical stages.

  20. Development of an international schedule for the assessment and staging of care for dementia.

    Science.gov (United States)

    Semrau, Maya; Burns, Alistair; Djukic-Dejanovic, Slavica; Eraslan, Defne; Han, Changsu; Lecic-Tosevski, Dusica; Lobo, Antonio; Mihai, Adriana; Morris, Julie; Palumbo, Claudia; Robert, Philippe; Stiens, Gerthild; Stoppe, Gabriela; Volpe, Umberto; Rikkert, Marcel Olde; Sartorius, Norman

    2015-01-01

    A reliable and valid global staging scale has been lacking within dementia care. To develop an easy-to-use multi-dimensional clinical staging schedule for dementia. The schedule was developed through: i) Two series of focus groups (40 and 48 participants, respectively) in Denmark, France, Germany, Netherlands, Spain, Switzerland, and UK with a multi-disciplinary group of professionals working within dementia care, to assess the need for a dementia-staging tool and to obtain suggestions on its design and characteristics; ii) A pilot-study over three rounds to test inter-rater reliability of the newly developed schedule using written case histories, with five members of the project's steering committee and 27 of their colleagues from Netherlands, France, and Spain as participants; and iii) A field-study to test the schedule's inter-rater reliability in clinical practice in France, Germany, Netherlands, Spain, Italy, Turkey, South Korea, Romania, and Serbia, which included 209 dementia patients and 217 of their caregivers as participants. Focus group participants indicated a clear need for a culture-fair international dementia staging scale and reached consensus on face validity and content validity. Accordingly, the schedule has been composed of seven dimensions including behavioral, cognitive, physical, functional, social, and care aspects. Overall, the schedule showed adequate face validity, content validity, and inter-rater reliability; in the nine field-sites, intraclass correlation coefficients (ICCs; absolute agreement) for individual dimensions ranged between 0.38 and 1.0, with 84.4% of ICCs over 0.7. ICCs for total sum scores ranged between 0.89 and 0.99 in the nine field-sites. The IDEAL schedule looks promising as tool for the clinical and social management of people with dementia globally, though further reliability and validity testing is needed.

  1. Development of Wireless Dimming Control System for LED Stage Light

    OpenAIRE

    Wang Hui Qin; Bai Shi Lei

    2016-01-01

    Compared with the existing wire dimming system of LED stage light which uses the heavy light operating console to adjust the brightness of stage light, a portable wireless dimming control system for LED stage lighting is proposed, fabricated and tested in this paper. The scheme with the core of ATmega16L microcontroller is composed of wireless transmission and reception units, constant current driving circuit of LED, and the control circuit between this two modules. Through the system present...

  2. Clinical management of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat: A case report

    OpenAIRE

    Faez Firdaus Abdullah Jesse; Eric Lim Teik Chung; Yusuf Abba; Asinamai Athliamai Bitrus; Idris Umar Hambali; Mohd Azmi Mohd Lila; Abd Wahid Haron

    2017-01-01

    Objective: This clinical case reports the occurrence of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat. Materials and methods: A 2-year-old Jamnapari goat weighing 25 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with primary complain of eye problem and inappetence. Results: Upon clinical examination, the most prominent abnormality observed was corneal opacity of the right eye with presence of ulceration on the corneal surface a...

  3. Association of oxidative stress biomarkers with adiposity and clinical staging in women with breast cancer.

    Science.gov (United States)

    Carioca, A A F; Verde, S M M L; Luzia, L A; Rondó, P H C; Latorre, M R D O; Ellery, T H P; Damasceno, N R T

    2015-11-01

    Breast cancer is a disease characterised by both oxidative reactions and inflammation. However, few studies have focused on the oxidative and inflammatory biomarkers. The aim of the present study was to evaluate the association between oxidative stress markers and adiposity and clinical staging, as well as the association between the oxidative and the antioxidant biomarkers of women with breast cancer. A total of 135 cases of breast cancer occurring in 2011 and 2012 were assessed. After exclusions, 101 pre- and post-menopausal women with clinical staging I to IV were eligible to participate in the study. The anthropometric evaluation was performed by collecting data on waist circumference, body mass index and body composition. The socioeconomic and clinical profiles were determined using a standard questionnaire. For the oxidative biomarkers, thiobarbituric acid reactive substances (TBARS), oxidative DNA damage (8-hydroxy-2-deoxyguanosine (8-OHdG)), low-density lipoprotein(-) (LDL(-)), autoantibody anti-LDL(-) and liposoluble antioxidants (α-tocopherol, retinol and β-carotene) were analysed. The data were analysed using differences in the mean values, correlation tests and multiple linear regression. The antioxidant levels were higher in postmenopausal women with clinical staging I and II and negative lymph nodes. The TBARS level was associated with clinical staging. Adiposity was associated with levels of retinol and 8-OHdG, whereas LDL(-), 8-OHdG and TBARS were correlated with liposoluble antioxidants after adjusting for the confounders. The adiposity and clinical staging of patients were associated with oxidative stress. The oxidative and antioxidant biomarkers showed a negative correlation in patients with breast cancer.

  4. Correlation of CliniCal data, anatomiCal site and disease stage in ...

    African Journals Online (AJOL)

    2008-06-01

    Jun 1, 2008 ... Objective: to evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease. Design: retrospective observational study. Setting: Kenyatta national Hospital (KnH), nairobi, Kenya. Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), ...

  5. Late-stage disease at presentation to an HIV clinic in eastern Tanzania

    African Journals Online (AJOL)

    African patients. Little is known about the proportion and characteristics of patients presenting to HIV care and treatment clinics in the later stages of the disease. Most reports in sub-Saharan Africa focus on the CD4 count at. ART initiation and reveal that a majority of patients initiate. ART at low CD4 levels6. This study aimed ...

  6. Correlation of who clinical staging with CD4 counts in adult HIV ...

    African Journals Online (AJOL)

    Objective: To determine the degree of correlation between the WHO clinical staging and CD4 T-cell counts in HIV/AIDS adults at Kenyatta National Hospital, Nairobi. Design: Cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: One hundread and fifty two newly diagnosed HIV patients were recruited ...

  7. Clinical outcome of radical prostatectomy for stage C prostate cancer. Comparison with other treatment modalities

    International Nuclear Information System (INIS)

    Maeda, Osamu; Meguro, Norio; Saiki, Shigeru; Kinouchi, Toshiaki; Kuroda, Masao; Usami, Michiyuki; Kotake, Toshihiko

    1997-01-01

    Of the 69 patients with clinical stage C prostate cancer under 75 years old and with good performance status between 1986 and 1995, 29 underwent radical prostatectomy combined with endocrine therapy, 21 underwent radiation therapy combined with endocrine therapy and remaining 19 patients were treated by endocrine therapy alone. The median follow-up was 44 months (range 4 to 122). Radical prostatectomy resulted in progression-free rates of 79% and 61% at 5 and 10 years, respectively. Progression-free rates were lower in patients with lymph node metastasis or positive surgical margins. In patients with clinical stage T3a-c and well or moderately differentiated tumor, radical prostatectomy resulted in a progression-free rate of 100% at 5 years. However, in patients with clinical stage T4a or poorly differentiated tumor, radiation therapy resulted in a better progression-free rate than radical prostatectomy. These findings suggest that patients with clinical stage T3a-c and well or moderately differentiated tumor will benefit from radical prostatectomy combined with endocrine therapy and that radiation therapy will be effective for advanced diseases. (author)

  8. Evolution of Fractal Parameters through Development Stage of Soil Crust

    Science.gov (United States)

    Ospina, Abelardo; Florentino, Adriana; Tarquis, Ana Maria

    2016-04-01

    Soil surface characteristics are subjected to changes driven by several interactions between water, air, biotic and abiotic components. One of the examples of such interactions is provided through biological soil crusts (BSC) in arid and semi-arid environments. BSC are communities composed of cyanobacteria, fungi, mosses, lichens, algae and liverworts covering the soil surface and play an important role in ecosystem functioning. The characteristics and formation of these BSC influence the soil hydrological balance, control the mass of eroded sediment, increase stability of soil surface, and influence plant productivity through the modification of nitrogen and carbon cycle. The site of this work is located at Quibor and Ojo de Agua (Lara state, Venezuela). The Quibor Depression in Venezuela is a major agricultural area being at semi-arid conditions and limited drainage favor the natural process of salinization. Additionally, the extension and intensification of agriculture has led to over-exploitation of groundwater in the past 30 years (Méndoza et al., 2013). The soil microbial crust develops initially on physical crusts which are mainly generated since wetting and drying, being a recurrent feature in the Quíbor arid zone. The microbiotic crust is organic, composed of macro organisms (bryophytes and lichens) and microorganisms (cyanobacteria, fungi algae, etc.); growing on the ground, forming a thickness no greater than 3 mm. For further details see Toledo and Florentino (2009). This study focus on characterize the development stage of the BSC based on image analysis. To this end, grayscale images of different types of biological soil crust at different stages where taken, each image corresponding to an area of 12.96 cm2 with a resolution of 1024x1024 pixels (Ospina et al., 2015). For each image lacunarity and fractal dimension through the differential box counting method were calculated. These were made with the software ImageJ/Fraclac (Karperien, 2013

  9. Multi-stage subunit vaccine development against Mycobacterium paratuberculosis and Johne’s disease in ruminants

    DEFF Research Database (Denmark)

    Jungersen, Gregers

    paratuberculosis provide only partial protection and interfere with diagnostic tests for JD and surveillance for bovine TB. In contrast, recombinant subunit vaccines can be designed to be used without compromising control of bTB and Map. Taking advantage of data from mouse TB studies, and early Map vaccination......- and field-studies we developed a vaccine with a single recombinant fusion protein comprising four acute-stage antigens (Ags) and one latent-stage Ag formulated in adjuvant (FET-vaccine). In post-exposure vaccination of calves and goats with necropsy 8-12 months post inoculation, we determined...... in macrophages. The disease progression is very slow with neonatal animals being the most susceptible to infection, but without development of detectable IFN-γ responses for months after infection and rarely with clinical disease before the second or third year of life. Available whole cell vaccines against...

  10. Radiographic studies of developing calvaria at prenatal stages in ...

    African Journals Online (AJOL)

    The study involved the radiographic evaluation of calvaria of different fetuses at first, second and third trimester stages of the gestational ages. Radiographic observations made in this study revealed that the onset of mineralization was recognizable even at the first trimester stage through the radio-opaque appearances of ...

  11. Relationship Marketing Stage of Development in Romanian Banking Industry

    Directory of Open Access Journals (Sweden)

    Alina Filip

    2016-02-01

    Full Text Available The paper emphasizes the relationship marketing stage of development within the banking industry in Romania, by identifying the extent to which business objectives and marketing strategies of companies are customer oriented. In order to achieve this aim a qualitative marketing research was conducted, by applying in-depth semi-structured interviews. The target group of the research consisted of nine banking companies, selected according to the market share, while the research participants were employees responsible for marketing, sales and customer relationship management activities. Due to respondents’ expertise, during the interviews could be applied mixed research methods in the process of data collection and subsequently, in data analysis. According to research objectives and results, although there is an increase in the importance of customer orientation within banking policies, the integration of relationship marketing optics at the institutional management level is facing a number of deficiencies, especially with regard to the concerns about employees’ satisfaction and loyalty or to the development of relationships with other stakeholders. The degree of satisfaction with the adoption of customer relationship management technology is relatively high among banks, being appreciated mainly those banking performance achieved in terms of retention rate, cross-selling and customer satisfaction. Most banks use the gross customer retention index as the main indicator of customer portfolio stability, although retention objectives tend to be set differently depending on customer value. Internal marketing strategies are developed around staff training processes, while performance evaluation criteria are rather specific to a transactional marketing approach. Results of the research provide clues on the relationship marketing processes and activities that need to be improved, in order to strengthen the current customer base and the competitive

  12. Development of a hybrid mode linear transformer driver stage

    Science.gov (United States)

    Zhang, Le; Wang, Meng; Zhou, Liangji; Tian, Qing; Guo, Fan; Wang, Lingyun; Qing, Yanling; Zhao, Yue; Dai, Yingmin; Han, Wenhui; Chen, Lin; Xie, Weiping

    2018-02-01

    At present, the mainstream technologies of primary power sources of large pulse power devices adopt Marx or linear transformer driver (LTD) designs. Based on the analysis of the characteristics of these two types of circuit topologies, the concept of a hybrid mode LTD stage based on Marx branches is proposed. The analysis shows that the hybrid mode LTD stage can realize the following goals: (a) to reduce the energy and power handled by the basic components (switch and capacitor) to lengthen their lifetime; (b) to reduce the requirements of the multipath synchronous trigger system; and (c) to improve the maintainability of the LTD stage by using independent Marx generators instead of "traditional LTD bricks." To verify the technique, a hybrid mode LTD stage consisting of 50 branches (four-stage compact Marx generators) was designed, manufactured and tested. The stage has a radius of about 3.3 m and a height of 0.6 m. The single Marx circuit's load current is about 21 kA, with a rise time of ˜90 ns (10%-90%), under the conditions of capacitors charged to ±40 kV and a 6.9 Ω matched load. The whole stage's load current is ˜1 MA , with a rise time of ˜112 ns (10%-90%), when the capacitors are charged to ±45 kV and the matched load is 0.14 Ω .

  13. Validating a Measure of Stages of Change in Career Development

    Science.gov (United States)

    Hammond, Marie S.; Michael, Tony; Luke, Charles

    2017-01-01

    Research on the processes of change in career development has focused on developmental stages rather than processes. This manuscript reports on the development and validation of the stages of change-career development scale, adapted from McConnaughy, Prochaska, & Velicer (1983) measure of stages of change in psychotherapy. Data from 875…

  14. Clinical stage of oral cancer patients at the time of initial diagnosis

    International Nuclear Information System (INIS)

    Shah, I.; Sefvan, O.; Luqman, Z.; Ibrahim, W.; Mehmood, S.

    2010-01-01

    Background: Squamous cell carcinoma is the most common oral cancer. Early diagnosis ensures better prognosis. Late diagnosis is however common around the world and contributes to the high morbidity and mortality related to oral cancer. The objective of this study was to determine the clinical stage of oral cancer patients at the time of diagnosis. Methods: This retrospective study was carried out on 334 oral cancer patients who presented to the outdoor departments of Armed Forces Institute of Dentistry, and Armed Forces Institute of Pathology, Rawalpindi from July 2008 to December 2009. The records that were reviewed included history and clinical examination findings, OPG and CT scans of the head and neck region, chest X-rays, abdominal ultrasounds and liver function tests. Size of the primary tumour, the size, number and laterality of the involved cervical lymph nodes and the presence/absence of distant metastases were documented and statistically analysed using SPSS-17. Results: Out of the 334 patients, 203 (60.8%) were males and 131 (39.2%) females. The age range was from 21 to 88 years. Buccal mucosa was the most commonly involved site (32 %). The primary tumour was 4 Cm or more in size, (T3/T4) 71.25% of the cases. Cervical lymph nodes were involved in 211 patients (63.2%) and distant metastases were present in 39 patients (11.7%). Overall, clinical stage IV was the most common (57.18%) followed by stage III(24.55%), stage II (13.77%) and stage I (4.49%). Conclusion: Oral cancers are diagnosed late (Stage III and IV) in Pakistan and need immediate public and professional attention. (author)

  15. Clinical experience in staging of lung cancer at Martin-Luther University Halle-Wittenberg.

    Science.gov (United States)

    Neef, H

    1999-01-01

    Staging of lung cancer needs an accurate diagnostic programme resulting in therapeutic and prognostic consequences. A modern, articulate flow-chart is presented and discussed. As a result, the rate of exploratory thoracotomy was reduced from 15.1% in 1988 to 2.1% in 1997 and the rate of resectability raised up to 30%. Preoperative over-staging was found in about 25% and the same value for understaging. Looking to the N-values, there was concordance of clinical and postoperative data in 61.9% of cases.

  16. Analysis of clinical features, serologic and cerebrospinal fluid tests in patients with neurosyphilis at different stages

    Directory of Open Access Journals (Sweden)

    Bao-jie WANG

    2016-08-01

    Full Text Available Objective To summarize the clinical features, serologic, cerebrospinal fluid (CSF tests in patients with neurosyphilis at different stages.  Methods A retrospective analysis was made on the clinical features, imaging, serologic and CSF tests, treatment and prognosis of 12 cases diagnosed as neurosyphilis. In those cases, 5 cases were early-stage neurosyphilis, including 4 syphilitic meningitis (meningomyelitis and one meningovascular syphilis; 7 cases were late-stage neurosyphilis, all of whom were general paresis.  Results The serum Treponema pallidum antibody (TP-Ab and rapid plasma regain (RPR tests were positive in all 12 cases. The CSF TP-Ab tests of 12 cases were all positive and CSF RPR tests were positive in 9 cases. In 5 cases of early-stage neurosyphilis, one case had elevated intracranial pressure (ICP, 3 cases presented with elevated white blood cell (WBC, 4 cases had elevated protein concentration. In 7 cases of late-stage neurosyphilis, one case had elevated ICP, 7 cases presented with elevated WBC and protein concentration. CSF cytology showed lymphocyte reaction, mainly small lymphocytes. All cases were treated with different doses of intravenous penicillin or ceftriaxone sodium by intramuscular injection, among whom 8 cases presented improved neuropsychiatric symptoms, while 4 cases had no significant improvement.  Conclusions Neurosyphilis is easy to be misdiagnosed because of various styles of onset and nontypical clinical manifestations. A definite diagnosis depends on clinical manifestations and serologic and CSF examinations. Early diagnosis and standard treatment is essential for improving prognosis and reducing complications. DOI: 10.3969/j.issn.1672-6731.2016.07.005

  17. Development of an early-stage toll revenue estimation model.

    Science.gov (United States)

    2012-05-01

    With agencies and states increasingly considering tolls as a means to finance transportation infrastructure, : there is an increasing need to quickly assess the feasibility of potential tolling projects. In the early stages : of a project when an age...

  18. A sporozoite asparagine-rich protein controls initiation of Plasmodium liver stage development.

    Directory of Open Access Journals (Sweden)

    Olivier Silvie

    2008-06-01

    Full Text Available Plasmodium sporozoites invade host hepatocytes and develop as liver stages (LS before the onset of erythrocytic infection and malaria symptoms. LS are clinically silent, and constitute ideal targets for causal prophylactic drugs and vaccines. The molecular and cellular mechanisms underlying LS development remain poorly characterized. Here we describe a conserved Plasmodium asparagine-rich protein that is specifically expressed in sporozoites and liver stages. Gene disruption in Plasmodium berghei results in complete loss of sporozoite infectivity to rodents, due to early developmental arrest after invasion of hepatocytes. Mutant sporozoites productively invade host cells by forming a parasitophorous vacuole (PV, but subsequent remodelling of the membrane of the PV (PVM is impaired as a consequence of dramatic down-regulation of genes encoding PVM-resident proteins. These early arrested mutants confer only limited protective immunity in immunized animals. Our results demonstrate the role of an asparagine-rich protein as a key regulator of Plasmodium sporozoite gene expression and LS development, and suggest a requirement of partial LS maturation to induce optimal protective immune responses against malaria pre-erythrocytic stages. These findings have important implications for the development of genetically attenuated parasites as a vaccine approach.

  19. Development of a Multiple-Stage Differential Mobility Analyzer (MDMA)

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Da-Ren [ORNL; Cheng, Mengdawn [ORNL

    2007-01-01

    A new DMA column has been designed with the capability of simultaneously extracting monodisperse particles of different sizes in multiple stages. We call this design a multistage DMA, or MDMA. A prototype MDMA has been constructed and experimentally evaluated in this study. The new column enables the fast measurement of particles in a wide size range, while preserving the powerful particle classification function of a DMA. The prototype MDMA has three sampling stages, capable of classifying monodisperse particles of three different sizes simultaneously. The scanning voltage operation of a DMA can be applied to this new column. Each stage of MDMA column covers a fraction of the entire particle size range to be measured. The covered size fractions of two adjacent stages of the MDMA are designed somewhat overlapped. The arrangement leads to the reduction of scanning voltage range and thus the cycling time of the measurement. The modular sampling stage design of the MDMA allows the flexible configuration of desired particle classification lengths and variable number of stages in the MDMA. The design of our MDMA also permits operation at high sheath flow, enabling high-resolution particle size measurement and/or reduction of the lower sizing limit. Using the tandem DMA technique, the performance of the MDMA, i.e., sizing accuracy, resolution, and transmission efficiency, was evaluated at different ratios of aerosol and sheath flowrates. Two aerosol sampling schemes were investigated. One was to extract aerosol flows at an evenly partitioned flowrate at each stage, and the other was to extract aerosol at a rate the same as the polydisperse aerosol flowrate at each stage. We detail the prototype design of the MDMA and the evaluation result on the transfer functions of the MDMA at different particle sizes and operational conditions.

  20. Establishing a clinical phenotype for cachexia in end stage kidney disease - study protocol.

    Science.gov (United States)

    Reid, Joanne; Noble, Helen R; Adamson, Gary; Davenport, Andrew; Farrington, Ken; Fouque, Denis; Kalantar-Zadeh, Kamyar; Mallett, John; McKeaveney, C; Porter, S; Seres, David S; Shields, Joanne; Slee, Adrian; Witham, Miles D; Maxwell, Alexander P

    2018-02-13

    Surveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD. A longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia. Cachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required

  1. Tailoring exercise interventions to comorbidities and treatment-induced adverse effects in patients with early stage breast cancer undergoing chemotherapy: a framework to support clinical decisions

    NARCIS (Netherlands)

    van der Leeden, Marike; Huijsmans, Rosalie J.; Geleijn, Edwin; de Rooij, Mariëtte; Konings, Inge R.; Buffart, Laurien M.; Dekker, Joost; Stuiver, Martijn M.

    2018-01-01

    Delivery of exercise interventions to patients with early-stage breast cancer undergoing chemotherapy requires complex clinical decisions. The purpose of this study was to develop a framework to support clinical decisions for tailoring exercise interventions to common comorbidities and cancer

  2. Rock stress measurements. Preparatory stage of the equipment development project

    International Nuclear Information System (INIS)

    Mononen, S.; Hakala, M.; Mikkola, P.

    2002-01-01

    In recent years the rock stress measurement methods used in Finland have been overcoring and hydraulic fracturing. There have been mainly two companies involved in these measurements, namely Suomen Malmi Oy (Smoy) and SwedPower AB. Smoy has done measurements for mines and for rock engineering projects, whereas SwedPower AB has mainly been involved in nuclear waste disposal investigations and conducted hydraulic fracturing measurements in deep boreholes. Smoy together with its partners started in February 2001 a project named JTM, which was a preliminary stage for a future project, which aims to develop a device most suitable for rock stress measurements in Finland. The partners in the project were HUT Rock Engineering, Posiva Oy, Saanio and Riekkola Oy, Gridpoint Finland Oy and Geopros Oy. Tekes, the National Technology Agency, provided almost half of the project funding. In the management group of the project were Pekka Mikkola (chairman) and Tero Laurila from Smoy, Pekka Saerkkae and Sakari Mononen (full-time researcher) from HUT, Aimo Hautojaervi (Posiva Oy), Erik Johansson (Saanio and Riekkola Oy), Matti Hakala (Gridpoint Finland Oy) and Heikki Haemaelaeinen (Geopros Oy). The aim of the JTM-project was to find out the needs for the development of a device most suitable for rock stress measurements in Finnish mines and rock engineering projects. During the project work was done to find out the range of rock stress measurement devices available, to find out the needs for measurements, and to get acquainted to the measurements done in Scandinavia. Also a report of the most suitable methods for Finnish rock conditions was done based on literature and on interviews of rock stress experts. Based on all the information collected during the project a clear picture of the needs for rock stress measurements in Finland could be formed and a preliminary plan of a future project was done. The aim of the suggested project is to build a device based on hydraulic fracturing

  3. Stages of socio-economic development: Shah Wali-Allah's concept of al-irtifaqat

    OpenAIRE

    aislahi, Abdul Azim

    1989-01-01

    The present paper introduces Shah Wali-Allah Dehlawi’s concept of the stages of socio-economic developments (al-irtifaqat). According to him, starting from simple primitive village life to an international community, the socio-economic development of human society can be divided into four stages. The first stage is dominated by simple economic struggle while the last stage is developed to maintain just political order on international level, to safeguard the socio-economic interests of differ...

  4. Atrophy patterns in early clinical stages across distinct phenotypes of Alzheimer's disease.

    Science.gov (United States)

    Ossenkoppele, Rik; Cohn-Sheehy, Brendan I; La Joie, Renaud; Vogel, Jacob W; Möller, Christiane; Lehmann, Manja; van Berckel, Bart N M; Seeley, William W; Pijnenburg, Yolande A; Gorno-Tempini, Maria L; Kramer, Joel H; Barkhof, Frederik; Rosen, Howard J; van der Flier, Wiesje M; Jagust, William J; Miller, Bruce L; Scheltens, Philip; Rabinovici, Gil D

    2015-11-01

    Alzheimer's disease (AD) can present with distinct clinical variants. Identifying the earliest neurodegenerative changes associated with each variant has implications for early diagnosis, and for understanding the mechanisms that underlie regional vulnerability and disease progression in AD. We performed voxel-based morphometry to detect atrophy patterns in early clinical stages of four AD phenotypes: Posterior cortical atrophy (PCA, "visual variant," n=93), logopenic variant primary progressive aphasia (lvPPA, "language variant," n=74), and memory-predominant AD categorized as early age-of-onset (EOAD, 65 years, n=114). Patients with each syndrome were stratified based on: (1) degree of functional impairment, as measured by the clinical dementia rating (CDR) scale, and (2) overall extent of brain atrophy, as measured by a neuroimaging approach that sums the number of brain voxels showing significantly lower gray matter volume than cognitively normal controls (n=80). Even at the earliest clinical stage (CDR=0.5 or bottom quartile of overall atrophy), patients with each syndrome showed both common and variant-specific atrophy. Common atrophy across variants was found in temporoparietal regions that comprise the posterior default mode network (DMN). Early syndrome-specific atrophy mirrored functional brain networks underlying functions that are uniquely affected in each variant: Language network in lvPPA, posterior cingulate cortex-hippocampal circuit in amnestic EOAD and LOAD, and visual networks in PCA. At more advanced stages, atrophy patterns largely converged across AD variants. These findings support a model in which neurodegeneration selectively targets both the DMN and syndrome-specific vulnerable networks at the earliest clinical stages of AD. © 2015 Wiley Periodicals, Inc.

  5. Correlative study of the brain CT and clinical features of patients with Down's syndrome in three clinical stages of Alzheimer type dementia

    International Nuclear Information System (INIS)

    Maruyama, Keiko; Ikeda, Shu-ichi; Yanagisawa, Nobuo.

    1995-01-01

    Patients with Down's syndrome often develop Alzheimer type neuropathological changes as well as dementia of the Alzheimer type after the age of 40. We studied brain CT findings in relation to three clinical stages of Alzheimer type dementia in 11 patients with Down's syndrome aged from 17 to 55 years. In addition, 123 I-IMP-SPECT was studied in 4 of these patients. Dementia of the Alzheimer type was present in 9 patients; 5 patients were in the early stage, 2 were in the progressive stage, and the other 2 were in the end stage. The earliest CT finding was enlargement of the suprasellar cistern, which indicated atrophy of the medial temporal lobe including the hippocampus and amygdala. This finding was not present in non-demented individuals with Down's syndrome. Moreover, CT scans showed that brain atrophy progressed to the temporal, frontal lobe, and then generalized cerebral cortices, which correlated clinically with the severity of dementia. Studies of 123 I-IMP-SPECT in two patients with mild dementia revealed abnormally decreased isotope uptake in the temporal and posterior parietal regions. We suggest to measure the size of the suprasellar cistern in CT and SPECT scans for early detection and diagnosis of mild dementia of the Alzheimer type in patients with Down's syndrome. (author)

  6. Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development

    Science.gov (United States)

    2011-01-01

    Background The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Methods Caregivers (N = 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively. Results Analyses of covariance (ANCOVAs) were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child. Conclusions These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage. PMID:22074416

  7. Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development

    Directory of Open Access Journals (Sweden)

    Hullmann Stephanie E

    2011-11-01

    Full Text Available Abstract Background The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Methods Caregivers (N = 59 of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively. Results Analyses of covariance (ANCOVAs were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child. Conclusions These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage.

  8. Differences in adjustment by child developmental stage among caregivers of children with disorders of sex development.

    Science.gov (United States)

    Hullmann, Stephanie E; Fedele, David A; Wolfe-Christensen, Cortney; Mullins, Larry L; Wisniewski, Amy B

    2011-11-10

    The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Caregivers (N = 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale and Parenting Stress Index/Short Form as measures of overprotective behaviors and parenting stress, respectively. Analyses of covariance (ANCOVAs) were conducted to examine differences between caregiver report of overprotection and parenting stress. Results revealed that caregivers of infants and toddlers exhibited more overprotective behaviors than caregivers of children in the other age groups. Further, caregivers of adolescents experienced significantly more parenting stress than caregivers of school-age children, and this effect was driven by personal distress and problematic parent-child interactions, rather than having a difficult child. These results suggest that caregivers of children with disorders of sex development may have different psychosocial needs based upon their child's developmental stage and based upon the disorder-related challenges that are most salient at that developmental stage.

  9. Clinically-staged T3N0 rectal cancer: is preoperative chemoradiotherapy the optimal treatment?

    Science.gov (United States)

    Lombardi, Raffaele; Cuicchi, Dajana; Pinto, Carmine; Di Fabio, Francesca; Iacopino, Bruno; Neri, Stefano; Tardio, Maria Lucia; Ceccarelli, Claudio; Lecce, Ferdinando; Ugolini, Giampaolo; Pini, Sara; Di Tullio, Piergiorgio; Taffurelli, Mario; Minni, Francesco; Martoni, Andrea; Cola, Bruno

    2010-03-01

    Preoperative chemoradiotherapy has been widely adopted as the standard of care for stage II-III rectal cancers. However, patients with T3N0 lesions had been shown to have a better prognosis than other categories of locally advanced tumor. Thus, neoadjuvant chemoradiation is likely to be overtreatment in this subgroup of patients. Nevertheless, the low accuracy rate of preoperative staging techniques for detection of node-negative tumors does not allow to check this hypothesis. We analyzed a group of patients with cT3N0 low rectal cancer who underwent neoadjuvant chemoradiotherapy with the purpose of evaluating the incidence of metastatic nodes in the resected specimens. Between January 2002 and February 2008, 100 patients with low rectal cancer underwent clinical staging by means of endorectal ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging. All patients received preoperative 5-fluorouracil-based chemoradiotherapy and surgical resection with curative aim. Of 100 patients with locally advanced rectal cancer, 32 were clinically staged as T3N0M0. Pathological analysis showed the presence of lymph node metastases in nine patients (28%) (node-positive group). In the remaining 23 cases, clinical N stage was confirmed at pathology (node-negative group). Node-positive and node-negative groups differ only in the number of ypT3 tumors (P cancer represents an undertreatment risk in at least 28% of cases, making necessary the use of postoperative chemoradiotherapy. Preoperative chemoradiotherapy should be the therapy of choice on the grounds of the principle that overtreatment is less hazardous than undertreatment for cT3N0 rectal cancers.

  10. TDP-43 stage, mixed pathologies, and clinical Alzheimer's-type dementia.

    Science.gov (United States)

    James, Bryan D; Wilson, Robert S; Boyle, Patricia A; Trojanowski, John Q; Bennett, David A; Schneider, Julie A

    2016-11-01

    Hyperphosphorylated transactive response DNA-binding protein 43 (TDP-43, encoded by TARDBP ) proteinopathy has recently been described in ageing and in association with cognitive impairment, especially in the context of Alzheimer's disease pathology. To explore the role of mixed Alzheimer's disease and TDP-43 pathologies in clinical Alzheimer's-type dementia, we performed a comprehensive investigation of TDP-43, mixed pathologies, and clinical Alzheimer's-type dementia in a large cohort of community-dwelling older subjects. We tested the hypotheses that TDP-43 with Alzheimer's disease pathology is a common mixed pathology; is related to increased likelihood of expressing clinical Alzheimer's-type dementia; and that TDP-43 pathologic stage is an important determinant of clinical Alzheimer's-type dementia. Data came from 946 older adults with ( n = 398) and without dementia ( n = 548) from the Rush Memory and Aging Project and Religious Orders Study. TDP-43 proteinopathy (cytoplasmic inclusions) was present in 496 (52%) subjects, and the pattern of deposition was classified as stage 0 (none; 48%), stage 1 (amygdala; 18%), stage 2 (extension to hippocampus/entorhinal; 21%), or stage 3 (extension to neocortex; 14%). TDP-43 pathology combined with a pathologic diagnosis of Alzheimer's disease was a common mixed pathology (37% of all participants), and the proportion of subjects with clinical Alzheimer's-type dementia formerly labelled 'pure pathologic diagnosis of Alzheimer's disease' was halved when TDP-43 was considered. In logistic regression models adjusted for age, sex, and education, TDP-43 pathology was associated with clinical Alzheimer's-type dementia (odds ratio = 1.51, 95% confidence interval = 1.11, 2.05) independent of pathological Alzheimer's disease (odds ratio = 4.30, 95% confidence interval = 3.08, 6.01) or other pathologies (infarcts, arteriolosclerosis, Lewy bodies, and hippocampal sclerosis). Mixed Alzheimer's disease and TDP-43 pathologies were

  11. TDP-43 stage, mixed pathologies, and clinical Alzheimer’s-type dementia

    Science.gov (United States)

    Wilson, Robert S.; Boyle, Patricia A.; Trojanowski, John Q.; Bennett, David A.; Schneider, Julie A.

    2016-01-01

    Hyperphosphorylated transactive response DNA-binding protein 43 (TDP-43, encoded by TARDBP) proteinopathy has recently been described in ageing and in association with cognitive impairment, especially in the context of Alzheimer’s disease pathology. To explore the role of mixed Alzheimer’s disease and TDP-43 pathologies in clinical Alzheimer’s-type dementia, we performed a comprehensive investigation of TDP-43, mixed pathologies, and clinical Alzheimer’s-type dementia in a large cohort of community-dwelling older subjects. We tested the hypotheses that TDP-43 with Alzheimer’s disease pathology is a common mixed pathology; is related to increased likelihood of expressing clinical Alzheimer’s-type dementia; and that TDP-43 pathologic stage is an important determinant of clinical Alzheimer’s-type dementia. Data came from 946 older adults with (n = 398) and without dementia (n = 548) from the Rush Memory and Aging Project and Religious Orders Study. TDP-43 proteinopathy (cytoplasmic inclusions) was present in 496 (52%) subjects, and the pattern of deposition was classified as stage 0 (none; 48%), stage 1 (amygdala; 18%), stage 2 (extension to hippocampus/entorhinal; 21%), or stage 3 (extension to neocortex; 14%). TDP-43 pathology combined with a pathologic diagnosis of Alzheimer’s disease was a common mixed pathology (37% of all participants), and the proportion of subjects with clinical Alzheimer’s-type dementia formerly labelled ‘pure pathologic diagnosis of Alzheimer’s disease’ was halved when TDP-43 was considered. In logistic regression models adjusted for age, sex, and education, TDP-43 pathology was associated with clinical Alzheimer’s-type dementia (odds ratio = 1.51, 95% confidence interval = 1.11, 2.05) independent of pathological Alzheimer’s disease (odds ratio = 4.30, 95% confidence interval = 3.08, 6.01) or other pathologies (infarcts, arteriolosclerosis, Lewy bodies, and hippocampal sclerosis). Mixed Alzheimer’s disease and

  12. Use of biomarkers in ALS drug development and clinical trials.

    Science.gov (United States)

    Bakkar, Nadine; Boehringer, Ashley; Bowser, Robert

    2015-05-14

    The past decade has seen a dramatic increase in the discovery of candidate biomarkers for ALS. These biomarkers typically can either differentiate ALS from control subjects or predict disease course (slow versus fast progression). At the same time, late-stage clinical trials for ALS have failed to generate improved drug treatments for ALS patients. Incorporation of biomarkers into the ALS drug development pipeline and the use of biologic and/or imaging biomarkers in early- and late-stage ALS clinical trials have been absent and only recently pursued in early-phase clinical trials. Further clinical research studies are needed to validate biomarkers for disease progression and develop biomarkers that can help determine that a drug has reached its target within the central nervous system. In this review we summarize recent progress in biomarkers across ALS model systems and patient population, and highlight continued research directions for biomarkers that stratify the patient population to enrich for patients that may best respond to a drug candidate, monitor disease progression and track drug responses in clinical trials. It is crucial that we further develop and validate ALS biomarkers and incorporate these biomarkers into the ALS drug development process. This article is part of a Special Issue entitled ALS complex pathogenesis. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Myeloma cell morphology and morphometry in correlation with clinical stages and survival.

    Science.gov (United States)

    Seili-Bekafigo, Irena; Valković, Toni; Babarović, Emina; Duletić-Načinović, Antica; Jonjić, Nives

    2013-11-01

    Multiple myeloma (MM) shows great variability in clinical course of the disease, and survival varies between a few months and more than 10 years. Myeloma plasma cells (PCs) can appear completely "normal" in morphology, but can also be overtly atypical, polymorphic, immature, as well as in all transitional forms. The aim of this investigation was to analyze the relationship between various morphological and morphometric parameters of myeloma cells, common staging/prognostic systems and survival in patients with MM. Sixty newly diagnosed MM patients were included in the study. Morphologic as well as basic morphometric features of myeloma PCs were analyzed in bone marrow (BM) aspirates, and compared with patient's clinical stage determined by Durie-Salmon and International Staging System, and with survival. We conclude that myeloma cell morphology has a prognostic potential. The most significant morphologic characteristics indicating shorter survival are: finding of >15% atypical PCs in BM aspirate, largest nuclear diameter/largest cytoplasmatic diameter of PCs ratio (maxND/maxCD)≥0.65, and anisocytosis expressed as standard deviation of maxCD ≥4.2 µm. Furthermore, PCs with irregular nuclei and absence of paranuclear clearing of the cytoplasm indicate more advanced stage of disease and worse prognosis. This preliminary results obtained on myeloma cells morphology and morphometry should be confirmed in the larger study which will include cytogenetic data as well as a therapeutic protocols applied. Copyright © 2013 Wiley Periodicals, Inc.

  14. Development of a hybrid mode linear transformer driver stage

    Directory of Open Access Journals (Sweden)

    Le Zhang

    2018-02-01

    Full Text Available At present, the mainstream technologies of primary power sources of large pulse power devices adopt Marx or linear transformer driver (LTD designs. Based on the analysis of the characteristics of these two types of circuit topologies, the concept of a hybrid mode LTD stage based on Marx branches is proposed. The analysis shows that the hybrid mode LTD stage can realize the following goals: (a to reduce the energy and power handled by the basic components (switch and capacitor to lengthen their lifetime; (b to reduce the requirements of the multipath synchronous trigger system; and (c to improve the maintainability of the LTD stage by using independent Marx generators instead of “traditional LTD bricks.” To verify the technique, a hybrid mode LTD stage consisting of 50 branches (four-stage compact Marx generators was designed, manufactured and tested. The stage has a radius of about 3.3 m and a height of 0.6 m. The single Marx circuit’s load current is about 21 kA, with a rise time of ∼90  ns (10%–90%, under the conditions of capacitors charged to ±40  kV and a 6.9  Ω matched load. The whole stage’s load current is ∼1  MA, with a rise time of ∼112  ns (10%–90%, when the capacitors are charged to ±45  kV and the matched load is 0.14  Ω.

  15. Caput succedaneum thickness in prolonged second stage of labour: a clinical evaluation.

    Science.gov (United States)

    Gilboa, Yinon; Kivilevitch, Zvi; Kedem, Alon; Spira, Maya; Borkowski, Tamar; Moran, Orit; Katorza, Eldad; Achiron, Reuven

    2013-10-01

    Data are scarce regarding the association between the presence of caput succedaneum and the mode of delivery. To evaluate the presence and clinical significance of caput succedaneum thickness in prolonged second stage of labour. We conducted a prospective study of women, beyond 37 weeks of gestation, during prolonged second stage of labour. Transperineal ultrasound was performed to assess the caput succedaneum thickness. The relationships between caput succedaneum thickness, feto-maternal characteristics, delivery mode and immediate post-natal outcomes were analysed. Fifty-eight women, of whom 47 were nulliparas, in prolonged second stage of labour, were included in the study. The caput succedaneum thickness could be measured in all cases. Overall mean thickness was 21.9 (±4.9) mm (range 14-40 mm). No significant difference or correlation was found between caput succedaneum thickness, fetal head positions, modes of delivery, duration of second stage, head circumference or neonatal outcomes. Caput succedaneum is measurable in all cases at prolonged second stage using transperineal sonography. Its presence and dimensions presented in our pilot study seem to have no implication on delivery mode and neonatal outcome. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  16. The relationship between clinical phenotype and early staged bilateral deep brain stimulation in Parkinson disease.

    Science.gov (United States)

    Sung, Victor W; Watts, Ray L; Schrandt, Christian J; Guthrie, Stephanie; Wang, Deli; Amara, Amy W; Guthrie, Barton L; Walker, Harrison C

    2013-12-01

    While many centers place bilateral deep brain stimulation (DBS) systems simultaneously, unilateral subthalamic nucleus (STN) DBS followed by a staged contralateral procedure has emerged as a treatment option for many patients. However, little is known about whether the preoperative phenotype predicts when staged placement of a DBS electrode in the opposite STN will be required. The authors aimed to determine whether preoperative clinical phenotype predicts early staged placement of a second STN DBS electrode in patients who undergo unilateral STN DBS for Parkinson disease (PD). Eighty-two consecutive patients with advanced PD underwent unilateral STN DBS contralateral to the most affected hemibody and had at least 2 years of follow-up. Multivariate logistic regression analysis determined preoperative characteristics that predicted staged placement of a second electrode in the opposite STN. Preoperative measurements included aspects of the Unified Parkinson's Disease Rating Scale (UPDRS), motor asymmetry index, and body weight. At 2-year follow-up, 28 (34%) of the 82 patients had undergone staged placement of a contralateral electrode while the remainder chose to continue with unilateral stimulation. Statistically significant improvements in UPDRS total and Part 3 scores were retained at the end of the 2-year follow-up period in both subsets of patients. Multivariate logistic regression analysis showed that the most important predictors for early staged placement of a second subthalamic stimulator were low asymmetry index (OR 13.4, 95% CI 2.8-64.9), high tremor subscore (OR 7.2, CI 1.5-35.0), and low body weight (OR 5.5, 95% CI 1.4-22.3). This single-center study provides evidence that elements of the preoperative PD phenotype predict whether patients will require early staged bilateral STN DBS. These data may aid in the management of patients with advanced PD who undergo STN DBS.

  17. CLINICAL STAGING OF CANCER OF THE PROSTATE DURING ITS PRIMARY BIOPSY

    Directory of Open Access Journals (Sweden)

    S. B. Petrov

    2014-07-01

    Full Text Available Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA and the results of digital rectal examination (DRE and ultrasound study (USS of the gland. Subjects and methods. The examination and follow-up records were analyzed in 2579 males aged 38-88 years who had indications for primary puncture biopsy of the prostate. Results. PC was detected in 997 (38.66% patients. Clinically localized adenocarcinoma was diagnosed in 50.85% of cases, locally advanced one being in 49.15%, including that with its invasion into the seminal vesicles in 8.73%. The findings of DRE and transrectal USS and serum PSA values allow one to substantially define the likely extent of cancer.

  18. CLINICAL STAGING OF CANCER OF THE PROSTATE DURING ITS PRIMARY BIOPSY

    Directory of Open Access Journals (Sweden)

    S. B. Petrov

    2010-01-01

    Full Text Available Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA and the results of digital rectal examination (DRE and ultrasound study (USS of the gland. Subjects and methods. The examination and follow-up records were analyzed in 2579 males aged 38-88 years who had indications for primary puncture biopsy of the prostate. Results. PC was detected in 997 (38.66% patients. Clinically localized adenocarcinoma was diagnosed in 50.85% of cases, locally advanced one being in 49.15%, including that with its invasion into the seminal vesicles in 8.73%. The findings of DRE and transrectal USS and serum PSA values allow one to substantially define the likely extent of cancer.

  19. Stages of recovery in early psychosis: Associations with symptoms, function, and narrative development.

    Science.gov (United States)

    Bourdeau, Geneviève; Lecomte, Tania; Lysaker, Paul H

    2015-06-01

    This study sought to explore the links between recovery stages, symptoms, function, and narrative development among individuals with a recent onset of psychosis. A qualitative longitudinal study was conducted including quantitative data at baseline. Forty-seven participants were administered the Indiana Psychiatric Illness Interview three times over 9 months and content analysis was performed. Participants also completed the Social Functioning Scale, the Brief Psychiatric Rating Scale--Expanded, the California Verbal Learning Test, and the Trailing Making Test at baseline. Descriptive discriminant analysis was performed. Results suggested that participants were mostly in the first two stages of recovery (moratorium, awareness) and that being in the awareness, rather than moratorium, stage was associated, to a different extent, with richer narrative development, better levels of psychosocial function, less negative and positive symptoms, and more years of education. Furthermore, recovery appeared to be a stable process over the assessment period. Recovery is a complex concept including objective and subjective aspects. In the recovery path of persons recently diagnosed with psychosis, social engagement, narrative development, and occupational functioning seem to be particularly important aspects. This study is a first step, and future research is needed with larger and more diverse participant pools, and assessments conducted over longer periods of time. As greater level of social engagement was the most robust predictor of membership in the awareness versus moratorium stage, treatment of early psychosis should include interventions targeting social relations and social skills. As greater narrative development was the second most robust predictor, enhancing it via psychotherapy could be a pertinent clinical goal. © 2014 The British Psychological Society.

  20. Using Motivational Interviewing within the Early Stages of Group Development

    Science.gov (United States)

    Young, Tabitha L.

    2013-01-01

    This article presents developmentally appropriate applications of Motivational Interviewing (MI; Miller & Rollnick, 2002) for use in preparing group members for the working stages of group. Practical strategies are offered for using MI to facilitate an atmosphere of trust, recognize member readiness for change, identify and resolve members'…

  1. Assessment of Kohlberg's Stages of Moral Development in Two Cultures.

    Science.gov (United States)

    Bouhmama, Djilali

    1984-01-01

    Forty male and female students, ages 14 and 15, from Algeria and the United Kingdom, were interviewed on two of Kohlberg's moral dilemmas. Results support the prediction that cultural and religious values have an impact on Kohlberg's moral stages. (Author/RM)

  2. Developing Clinical Research Relationship: Views from Within.

    Science.gov (United States)

    Zvonareva, Olga; Akrong, Lloyd

    2015-12-01

    The nature of the relationship between clinical investigator and research participant continues to be contested. The related discussions have largely focused on the doctor-researcher dichotomy thought to permeate the work of a clinical investigator with research participants, whom in turn occupy two corresponding roles: patient and subject. This paper contributes to current debates on the topic by providing a voice to research participants, whose perspectives have been largely invisible. It draws on 42 in-depth interviews conducted in Ghana and South Africa with respondents at different stages of involvement in clinical research, ranging from no experience in clinical research to enrollment in several clinical trials. The perspectives of all respondents were largely congruent and rooted in the common view that clinical research contributed to the improvement of local health. They went beyond the researcher/participant versus doctor/patient dichotomy, long established in research ethics, and preferred to view participants and investigators as partners working together to find ways to address local health needs. The conceptualization of investigator-participant relations as a partnership reinforced expectations of care, transparency and accountability, which were viewed as necessary expressions of mutuality and respect within equal collaborations. It is important to engage with these views in order to avoid antagonizing societal expectations and to build up long-term public trust, crucial for the continuous operation of clinical research. © 2014 John Wiley & Sons Ltd.

  3. The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma

    International Nuclear Information System (INIS)

    Oezsarlak, Oe.; Schepens, E.; Corthouts, B.; Beeck, B.O. de; Parizel, P.M.; De Schepper, A.M.; Tjalma, W.; Marck, E. van

    2003-01-01

    The aim of this study was to compare the preoperative findings of abdominal/pelvic CT and MRI with the preoperative clinical International Federation of Obstetrics and Gynecology (FIGO) staging and postoperative pathology report in patients with primary cancer of the cervix. Thirty-six patients with surgical-pathological proven primary cancer of the cervix were retrospectively studied for preoperative staging by clinical examination, CT, and MR imaging. Studied parameters for preoperative staging were the presence of tumor, tumor extension into the parametrial tissue, pelvic wall, adjacent organs, and lymph nodes. The CT was performed in 32 patients and MRI (T1- and T2-weighted images) in 29 patients. The CT and MR staging were based on the FIGO staging system. Results were compared with histological findings. The group is consisted of stage 0 (in situ):1, Ia:1, Ib:8, IIa:2, IIb:12, IIIa:4, IVa:6, and IVb:2 patients. The overall accuracy of staging for clinical examination, CT, and MRI was 47, 53, and 86%, respectively. The MRI incorrectly staged 2 patients and did not visualize only two tumors; one was an in situ (stage-0) and one stage-Ia (microscopic) disease. The MRI is more accurate than CT and they are both superior to clinical examination in evaluating the locoregional extension and preoperative staging of primary cancer of the cervix. (orig.)

  4. [FROM THEORY TO PRACTICE. THE ROLE OF QUALITY CONTROL OF ANALYTICAL STAGE OF STUDIES IN INCREASING CLINICAL INFORMATIVENESS OF LABORATORY TESTS].

    Science.gov (United States)

    Kovyazina, N A; Altukhova, N A; Bardysheva, N A; Zybina, N N; Kalinina, N M

    2016-03-01

    Nowadays, improving accuracy and clinical informativeness of results of studies is one of main directions of development of laboratory. The article presents originally developed algorithm of evaluation of quality of immunochemical studies in part related to analytical stage. The case of application in practice of the results of such evaluation is presented.

  5. CLINICAL FEATURES OF PATIENTS WITH PERMANENT PACEMAKERS DEPENDING ON THE STAGE OF ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    T. Derienko

    2015-12-01

    Full Text Available The study included 131 patients (70 men and 61 women aged 69,5 ± 11,6 years who underwent permanent pacing because of atrio-ventricular block(AV, permanent atrial fibrillation(AF and sick sinus node syndrome(SSS with pacing modes DDD/DDDR and VVI /VVIR as well as chronic heart failure (CHF with cardiac resynchronization therapy (CRT-P and CRT-D. Clinical features of patients were evaluated according to the stage of arterial hypertension (AH. The results showed that all patients with implanted pacemakers had hypertension the II and III stages with their ratio 1:2.5. Stable angina, diabetes mellitus (DM, AF, heart failure (HF II A and moderate degree of AH were associated with the II stage of AH. The III stage of AH was associated with persistent AF and postinfarction cardiosclerosis, while the frequency of occurrence moderate and severe degree of AH were the same. The high frequency of AH in patients with implanted pacemakers and their relationship with other disorders in the health of patients, requires optimization of blood pressure control.

  6. Staged development economics and key development factors: Is deep water commercially viable?

    International Nuclear Information System (INIS)

    Burton, C.D.; Wheeler, S.A.; Ruthrauff, R.G.

    1993-01-01

    If development of the deepwater Gulf is to proceed, operators must be convinced that technically and commercially viable development options exist. These solutions must be tailored to address the size of the reserve accumulations lying in the relatively deepwaters (3000-6000 feet) that are typical of the Gulf of Mexico. They must minimize operator's capital risk and maximize his ability to avoid large capital commitments prior to verification of acceptable reservoir performance. The intent of this paper is to discuss methods and parameters that will facilitate deepwater development using staged subsea solutions

  7. Clinical approach to quality of life in children with end-stage renal disease

    OpenAIRE

    Cho, Min Hyun

    2013-01-01

    Quality of life in addition to various medical problems in children with end-stage renal disease (ESRD) should be objectively assessed to accomplish normal growth and development during childhood. However, unfortunately, studies of quality of life (QoL) in children with ESRD have been not popular yet and there are only fewer suitable assessment tools compared with adults. Recently, disease-specific modules to evaluate QoL in children with chronic disease such as ESRD have been developed. This...

  8. 99mTc-MDP Bone Scan Findings in Various Clinical Stages of Malignancies

    International Nuclear Information System (INIS)

    Yoon, Hwi Joong; Lee, Myung Chul; Cho, Bo Yeon; Kim, Noe Kyeong; Koh, Chang Soon

    1981-01-01

    Bone scans with 99m Tc-MDP (methylene diphosphonate) were obtained and analysed in 574 from April, 1979 to June, 1931. Clinical staging was done in all patients without bone scan information and compared with bone scan to determine the predictive value of bone scanning. 1) Primary site of the malignancies were lung in 152, breast in 97, stomach in 43, colon in 15, esophagus in 9, liver and pancreas in 11, kidney in 14, bladder in 27, prostate in 22, thyroid in 20, skin in 11, bone in 9, head and neck in 36, ovary and uterus in 17, hematopoietic and lymphoretic ular system in 33, nervous system in 10, and others in 9 cases. Primary site was not defined in 39 cases. 2) Bone scans were positive in 186 cases (32.4%), which, included 48 cases (31.6%) of lung cancer, 27 cases (27.8%) of breast cancer, 12 cases (28%) of stomach cancer, 6 cases (40%) of colon cancer, 6 cases (43%) of kidney tumor, 4 cases (15%) of bladder cancer, 14 cases (64%) of prostate cancer, 3 cases (15%) of thyroid cancer and 66 other cases. 3) Bone scans were suspicious in 64 cases (11.2%) which included 29 cases (19.1%) of lung cancer, 10 cases (10.3%) of breast cancer, 4 cases (9.3%) of stomach cancer, one case (7%) of colon cancer, 3 cases (11%) of bladder cancer, 2 cases (10%) of thyroid cancer and 15 other cases. 4) Out of 121 cases with early stage of malignancy (which included 20 cases of lung cancer in stage I, II, 38 cases of breast cancer, 13 cases of stomach cancer, 8 cases of kidney tumor, 14 cases of thyroid cancer in stage I-III, and 6 cases of colon cancer, 14 cases of bladder cancer, 8 cases of prostate cancer in stage A-C, bone scans were positive in 5 cases (4.1%) which included 3 cases of lung cancer one case of breast cancer and one case of prostate cancer, and considered as further advanced stage, Out of 121 cases with early stage of malignancy, bone scans were suspicious in 21 cases (17.4%) which included 9 cases of lung cancer, 4 cases of breast cancer, 2 cases of stomach

  9. Clinical pharmacology: special safety considerations in drug development and pharmacovigilance.

    Science.gov (United States)

    Atuah, Kwame N; Hughes, Dyfrig; Pirmohamed, Munir

    2004-01-01

    The dose of a drug is a major determinant of its safety, and establishing a safe dose of a novel drug is a prime objective during clinical development. The design of pre-marketing clinical trials precludes the representation of important subpopulations such as children, the elderly and people with co-morbidities. Therefore, postmarketing surveillance (PMS) activities are required to monitor the safety profile of drugs in real clinical practice. Furthermore, individual variations in pharmacogenetic profiles, the immune system, drug metabolic pathways and drug-drug interactions are also important factors in the occurrence of adverse drug reactions. Thus, the safety of a drug is a major clinical consideration before and after it is marketed. A multidisciplinary approach is required to enhance the safety profile of drugs at all stages of development, including PMS activities. Clinical pharmacology encompasses a range of disciplines and forms the backbone of drug safety consideration during clinical drug development. In this review we give an overview of the clinical drug development process and consider its limitations. We present a discussion of several aspects of clinical pharmacology and their application to enhancing drug safety. Pharmacokinetic-pharmacodynamic modelling provides a method of predicting a clinically safe dose; consideration of drug pharmacokinetics in special populations may enhance safe therapeutics in a wider spectrum of patients, while pharmacogenetics provides the possibility of genotype-specific therapeutics. Pharmacovigilance activities are also discussed. Given the complex nature and unpredictability of type B reactions, PMS activities are crucial in managing the risks drugs pose to the general population. The various aspects of clinical pharmacology discussed make a strong case for this field as the backbone of optimising and promoting safe development and use of drugs.

  10. Managing customer knowledge during the concept development stage of the new food product development process

    OpenAIRE

    Bogue, Joe; Sorenson, Douglas

    2006-01-01

    New product development (NPD) is a knowledge intensive process where the generation of new ideas and concepts requires detailed knowledge of both products and customers. The high reported failure rates for innovative functional beverages suggest an inability to manage customer knowledge effectively, as well as a lack of knowledge management between functional disciplines involved in the NPD process. This research explored the concept of managing customer knowledge at the early stages of the N...

  11. Visual expertise development among clinical pathologists

    NARCIS (Netherlands)

    Jaarsma, Thomas; Jarodzka, Halszka; Nap, Marius; Van Merriënboer, Jeroen; Boshuizen, Els

    2013-01-01

    Jaarsma, T., Jarodzka, H., Nap, M., Van Merriënboer, J. J. G., & Boshuizen, H. P. A. (2012, 23 August). Visual expertise development among clinical pathologists. Paper presented at the EARLI Special Interest Group 14, Antwerp, Belgium.

  12. Clinical skill development for community pharmacists.

    Science.gov (United States)

    Barnette, D J; Murphy, C M; Carter, B L

    1996-09-01

    The importance of establishing clinical pharmacy services in the community cannot be understated in light of current challenges to the traditional dispensing role as the primary service of the community pharmacist. Advancements in automated dispensing technology and declining prescription fee reimbursement are rapidly forcing pharmacists to seek alternative sources of revenue. Providing pharmaceutical care is a viable option to increase customer loyalty job satisfaction, and reimbursement. To support the development of clinical services, academic institutions are forming partnerships with individual community practitioners to overcome perceived educational and training barriers. The authors describe the design and development of two unique clinical skill development programs at the University of Illinois at Chicago. This paper also outlines the patient focused services that the participants have established upon completing the training. These programs successfully enhanced participants' therapeutic knowledge base and facilitated development of the clinical skills necessary for direct patient care.

  13. Single-stage osseointegrated implants for nasal prosthodontic rehabilitation: A clinical report.

    Science.gov (United States)

    de Carvalho, Bruna M D F; Freitas-Pontes, Karina M; de Negreiros, Wagner A; Verde, Marcus A R L

    2015-08-01

    Malignant tumors in the nasal region may be treated by means of invasive surgical procedures, with large facial losses. Nasal prostheses, retained by osseointegrated facial implants, instead of plastic surgery, will, in most patients, offer good biomechanical and cosmetic results. This clinical report describes the prosthetic rehabilitation of a patient with nasal cancer who had the entire nasal vestibule removed in a single-stage surgical procedure in order to shorten the rehabilitation time. The nasal prosthesis was built on a 3-magnet bar and was made of platinum silicone with intrinsic pigmentation, thereby restoring the patient's appearance and self-esteem. The authors concluded that single-stage implants may reduce the rehabilitation time to as little as 1 month, and the correct use of materials and techniques may significantly improve the nasal prosthesis. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  14. Comparison of clinical and surgical-pathological staging in IIIA non-small cell lung cancer patients.

    Science.gov (United States)

    Muehling, Bernd; Wehrmann, Caren; Oberhuber, Alexander; Schelzig, Hubert; Barth, Thomas; Orend, Karl Heinz

    2012-01-01

    The heterogeneous group of IIIA NSCLC patients requires careful preoperative clinical staging as tumor size and lymph node involvement guide treatment. The purpose of our study was to analyze the correctness of clinical staging in IIIA patients. Retrospective analysis of all patients resected due to lung cancer that had been staged IIIA either clinically using invasive and noninvasive techniques or surgical-pathologically after surgical resection. Correctness, sensitivity, specificity, and positive and negative predictive values of clinical staging were calculated. From our tumor database, 49 patients who met the inclusion criteria were identified. The histology of the primary tumor included adenocarcinoma (53%), squamous cell carcinoma (41%), and other (6%). Preoperative clinical staging consisted of computed tomography (CT), integrated positron emission tomography-CT (PET-CT), bronchoscopy, and mediastinoscopy. The predominant surgical procedures performed were lobectomies (57%) and pneumonectomies (29%). Clinical staging for UICC, T and N stage was correct in 36.7, 38.7, and 40.8%, respectively. In terms of T4 stage, sensitivity was 28.5%, specificity was 80.9%, positive predictive value was 20%, and negative predictive value was 87.1%. As for N2 involvement, we found a sensitivity of 66.6% and a specificity of 35.7%. Positive and negative predictive values for N2 involvement were 43.7 and 58.8% in that order. Despite multimodal preoperative invasive and noninvasive staging techniques, the correctness of clinical staging in IIIA NSCLC patients is low. Hence, in doubt more invasive staging or probatory thoracotomy should be performed not to deny potentially curative surgery in those patients.

  15. Developing a web page: bringing clinics online.

    Science.gov (United States)

    Peterson, Ronnie; Berns, Susan

    2004-01-01

    Introducing clinical staff education, along with new policies and procedures, to over 50 different clinical sites can be a challenge. As any staff educator will confess, getting people to attend an educational inservice session can be difficult. Clinical staff request training, but no one has time to attend training sessions. Putting the training along with the policies and other information into "neat" concise packages via the computer and over the company's intranet was the way to go. However, how do you bring the clinics online when some of the clinical staff may still be reluctant to turn on their computers for anything other than to gather laboratory results? Developing an easy, fun, and accessible Web page was the answer. This article outlines the development of the first training Web page at the University of Wisconsin Medical Foundation, Madison, WI.

  16. Clinical observation on the effect of resection of eyelid tumor and stage Ⅰ recovery

    Directory of Open Access Journals (Sweden)

    Guo-Hai Wu

    2014-08-01

    Full Text Available AIM: To investigate clinical effects of local resection of eyelid tumors and pathological examination or frozen section examination as well as the stage I recovery.METHODS: For all 92 cases 92 eyes of eyelid tumor patients who underwent local resection, reconstruction in stage Ⅰ and routine pathological examination(37 cases of suspected malignant tumors using frozen section examination. If it was malignant, excision by Moths surgery. Using free palate mucosa autograft in stage I or reconstruction by Hughes surgery combined with eye flaps repaired eyelid defects.RESULTS: The postoperative pathological diagnosis: 52 cases were benign tumors, and 40 cases malignant tumors. All cases of eye flaps and hard palate mucosa grafts were survived. Followed up for more than 6mo, no tumor were recurred. The appearance and function of eyelid were satisfactory.CONCLUSION: In this group of cases, nearly half of eyelid tumors are malignant tumors. It should be treated and operated as early as possible. For suspected malignant tumors, we use frozen section examination to confirm its properties in order to excision cleanly in stage Ⅰ, reducing the recurrence and metastasis. According to the eyelid defect after resection, we could do repair operation in stage Ⅰ. The inner larger defect is repaired by using hard palate mucosa transplantation or Hughes surgery. The outer layer of the eyelid defect is repaired by using eye flap glide, the free flap, the kite flap, the simple suture, etc. It should be careful when using the hard palate mucosa transplantation in the upper eyelid defect.

  17. Developing clinical teaching capacities of midwifery students.

    Science.gov (United States)

    Rance, Sharon; Sweet, Linda

    2016-06-01

    Competency Standards in Australia articulate that the midwife must be able to contribute to the professional development of themselves and others. Few undergraduate health professional curricula currently incorporate content for the development of specific knowledge and skills required for clinical teaching. This project aimed to understand and enhance midwifery students' preparedness to assume their future clinical teaching responsibilities. Design-based research was used to implement an educational intervention aimed at developing clinical teaching skills through a peer education session between 1st and 3rd year students. The perspectives of 30 undergraduate midwifery students about their preparedness for their teaching role and the intervention were obtained through 3 focus groups. A thematic analysis of the data was undertaken. Three themes were identified encompassing the research aims and objectives; 'Co-creating a culture for learning', 'reciprocal teaching and learning' and 'developing clinical teaching capacities'. The findings indicate that the midwifery students had a holistic understanding of their responsibilities in clinical teaching in the workplace. They were able to identify ways in which their teaching capacities were being developed through their clinical experiences and the curriculum, both intended and hidden. Despite limited educational activities for clinical teaching, the midwifery students made explicit connections of the relational interdependence of workplace-based experiences and their learning. Students were clearly able to identify ways in which their own learning experiences and the culture in which this learning is embedded, assists them to develop clinical teaching skills, ready to support the next generation of midwifery students. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. Evaluation of carcinoma cervix using magnetic resonance imaging: correlation with clinical FIGO staging and impact on management

    International Nuclear Information System (INIS)

    Dhoot, Nilu Malpani; Bhuyan, Utpal; Kumar, Vinay; Shinagare, Atul; Kataki, Amal Chandra; Barmon, Debabrata

    2012-01-01

    To evaluate carcinoma of the cervix using magnetic resonance imaging (MRI), correlate with clinical approach of International Federation of Gynecology and Obstetrics (FIGO) staging system and to study the impact of MRI findings on patient management. Pathologically confirmed, 75 cases of carcinoma cervix referred to our institute from April 2007 to March 2008 were prospectively studied. Clinical FIGO stage was assigned to each patient by gynaecologists blinded to MRI findings. MRI stage (based on FIGO and TNM) was allotted by radiologists blinded to clinicopathological details. For patients who were operated, histopathological stage was taken as gold standard. For patients who were not operated, gynaecologists decided on a gold standard stage based on all available clinical and imaging data. MR staging was correlated with FIGO staging, with focus on significant alterations in treatment strategy caused due to MRI findings. MRI staging had an accuracy of 89.3% (67/75), while clinical FIGO staging had 61.3% (46/75) accuracy. MRI staging and FIGO staging concurred in 65.6% of the patients and differed in 34.4% of the patients. In about 30.6% (23/75) of the patients, there were relevant additional MRI findings not suspected clinically. The common significant MRI findings were detection of pelvic lymphadenopathy and clinically unsuspected bowel/bladder invasion. The management protocol was significantly altered in 86.9% (20/23) of the patients with additional MRI findings constituting 26.6% (20/75) of the total population. MRI is highly accurate in evaluating carcinoma of the cervix. MRI findings significantly altered therapeutic decisions in 26.6% of the patients. MRI should be considered prior to treatment planning in every patient.

  19. Assessment of the Relation between Clinical Phases of Dental Eruption and Skeletal Maturity Stages Using Cervical Vertebrae Method

    Directory of Open Access Journals (Sweden)

    MohammadJavad KharraziFard

    2012-01-01

    Full Text Available Introduction: Timing is an important factor in orthodontic treatment planning. Skeletal age is a standard indicator for determining optimum time for treatment. On the other hand, in clinic the phases of the dentition (deciduous, early and late mixed, permanent have often been used for treatment timing, investigations of the different outcomes of treatment protocols at earlier vs later stages of development. Considering the importance of this issue and to evaluate it in the Iranian adolescents, the purpose of this study was to evaluate the relation between clinical phases of dental eruption and the skeletal maturity stages by cervical vertebrae method (CVM.Materials & Methods: Panoramic radiographs and lateral cephalograms of 100 boys and 100 girls were used. For determination of the Phases of dentition, Vander Linden method and for the skeletal maturity, CVM were used. The relationship between the skeletal maturity (stages in CVM and the phases of the dentition was evaluated statistically by means of indicators of diagnostic tests and spearman’s rho analysis.Results: Spearman’s rho analysis indicated a relatively strong correlation of 0.775 (P<0.001; The early mixed dentition phase was a valid indicator of prepubertal stage (CS1, but the late mixed and early permanent dentitions were not valid indicators for the diagnosis of the onset of the pubertal growth spurt (CS3.Conclusion: In comparison with a reliable indicator of skeletal maturity (CVM, the dentition phases perform poorly in the detection of the onset of the pubertal spurt in skeletal growth.

  20. Clinical Staging of Stage I Non-Small Cell Lung Cancer in the Netherlands-Need for Improvement in an Era With Expanding Nonsurgical Treatment Options: Data From the Dutch Lung Surgery Audit.

    Science.gov (United States)

    Heineman, David Jonathan; Ten Berge, Martijn Geert; Daniels, Johannes Marlene; Versteegh, Michaël Ignatius; Marang-van de Mheen, Perla Jacqueline; Wouters, Michael Wilhelmus; Schreurs, Wilhelmina Hendrika

    2016-11-01

    The clinical stage of non-small cell lung cancer (NSCLC) determines the initial treatment, whereas the pathologic stage best determines prognosis and the need for adjuvant treatment. In an era in which stereotactic ablative radiotherapy (SABR) has become an alternative modality to surgical intervention, clinical staging is even more important, because pathologic staging is omitted in the case of SABR. The objective of this study was to determine the concordance between clinical and pathologic stage in routine clinical practice for patients with early-stage NSCLC. Prospective data were derived from the Dutch Lung Surgery Audit (DLSA) in 2013 and 2014. Patients with clinical stage I NSCLC who underwent surgical resection and had a positron emission tomography-computed tomography (PET-CT) scan in their clinical workup were selected. Clinical and pathologic TNM (cTNM and pTNM) stages were compared. From a total of 1,790 patients with clinical stage I, 1,555 (87%) patients were included in this analysis. Concordance between cTNM and pTNM was 59.9%. Of the patients with clinical stage I, 22.6% were upstaged to pathologic stage II or higher. In total, 14.9% of all patients with clinical stage I had nodal metastases, and 5.5% of all patients had unforeseen N2 disease. In patients with clinical stage T2a tumors, 21.3% had nodal metastases, 14.5% being N1 and 6.7% being N2 disease. Concordance between clinical and pathologic stage is 59.9%. In patients with clinical stage I NSCLC, 22.6% were upstaged to pathologic stage II or higher, which is an indication for adjuvant chemotherapy. Improvement in accuracy of staging is thus needed, particularly for these patients. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. A Bayesian predictive two-stage design for phase II clinical trials.

    Science.gov (United States)

    Sambucini, Valeria

    2008-04-15

    In this paper, we propose a Bayesian two-stage design for phase II clinical trials, which represents a predictive version of the single threshold design (STD) recently introduced by Tan and Machin. The STD two-stage sample sizes are determined specifying a minimum threshold for the posterior probability that the true response rate exceeds a pre-specified target value and assuming that the observed response rate is slightly higher than the target. Unlike the STD, we do not refer to a fixed experimental outcome, but take into account the uncertainty about future data. In both stages, the design aims to control the probability of getting a large posterior probability that the true response rate exceeds the target value. Such a probability is expressed in terms of prior predictive distributions of the data. The performance of the design is based on the distinction between analysis and design priors, recently introduced in the literature. The properties of the method are studied when all the design parameters vary.

  2. Model Development for Atomic Force Microscope Stage Mechanisms

    National Research Council Canada - National Science Library

    Smith, Ralph C; Hatch, Andrew G; De, Tathagata; Salapaka, Murti V; Raye, Julie K; del Rosario, Ricardo C

    2005-01-01

    In this paper, we develop nonlinear constitutive equations and resulting system models quantifying the nonlinear and hysteretic field-displacement relations inherent to lead zirconate titanate (PZT...

  3. Developments in statistical evaluation of clinical trials

    CERN Document Server

    Oud, Johan; Ghidey, Wendimagegn

    2014-01-01

    This book describes various ways of approaching and interpreting the data produced by clinical trial studies, with a special emphasis on the essential role that biostatistics plays in clinical trials. Over the past few decades the role of statistics in the evaluation and interpretation of clinical data has become of paramount importance. As a result the standards of clinical study design, conduct and interpretation have undergone substantial improvement. The book includes 18 carefully reviewed chapters on recent developments in clinical trials and their statistical evaluation, with each chapter providing one or more examples involving typical data sets, enabling readers to apply the proposed procedures. The chapters employ a uniform style to enhance comparability between the approaches.

  4. An overview of the development principles, stages and building ...

    African Journals Online (AJOL)

    Expert Systems are not suited for all types of problems. Many developers actively seek problems pliable to Expert System solution or tried to solve all problems encountered using Expert System. Experience has also shown that developers' attention has become more focused on the problems to be solved rather than on the ...

  5. Clinical management of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat: A case report

    Directory of Open Access Journals (Sweden)

    Faez Firdaus Abdullah Jesse

    2017-12-01

    Full Text Available Objective: This clinical case reports the occurrence of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat. Materials and methods: A 2-year-old Jamnapari goat weighing 25 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with primary complain of eye problem and inappetence. Results: Upon clinical examination, the most prominent abnormality observed was corneal opacity of the right eye with presence of ulceration on the corneal surface and chemosis of the right conjunctiva with excessive lacrimation. On auscultation, there was the presence of crackle lung sounds with bilateral mucopurulent nasal discharges. Samples from the ocular swab yielded a positive growth for Mycoplasma spp., while the nasal swab yielded a positive growth for Mannheimia haemolytica. The goat was diagnosed with stage I pinkeye with concurrent pneumonic pasteurellosis infection. Treatment was instituted with 400 mL of 0.9% NaCl administered intravenously once for rehydration. Flunixin meglumine 2.2 mg/kg bwt was given intramuscularly twice daily for three days as anti-inflammatory and analgesic. Oxytetracycline 20 mg/kg bwt was injected once intramuscularly as long acting broad spectrum antibiotic for treatment of pinkeye and pasteurellosis infections. Furthermore, terramycin eye ointment containing oxytetracycline HCl was also administered intraocularly twice daily for seven days as treatment for the Mycoplasma spp. Conclusion: The prognosis for this case was good as the goat were treated promptly and effectively. [J Adv Vet Anim Res 2017; 4(4.000: 390-393

  6. Individualized Prediction and Clinical Staging of Bipolar Disorders using Neuroanatomical Biomarkers.

    Science.gov (United States)

    Mwangi, Benson; Wu, Mon-Ju; Cao, Bo; Passos, Ives C; Lavagnino, Luca; Keser, Zafer; Zunta-Soares, Giovana B; Hasan, Khader M; Kapczinski, Flavio; Soares, Jair C

    2016-03-01

    Neuroanatomical abnormalities in Bipolar disorder (BD) have previously been reported. However, the utility of these abnormalities in distinguishing individual BD patients from Healthy controls and stratify patients based on overall illness burden has not been investigated in a large cohort. In this study, we examined whether structural neuroimaging scans coupled with a machine learning algorithm are able to distinguish individual BD patients from Healthy controls in a large cohort of 256 subjects. Additionally, we investigated the relationship between machine learning predicted probability scores and subjects' clinical characteristics such as illness duration and clinical stages. Neuroimaging scans were acquired from 128 BD patients and 128 Healthy controls. Gray and white matter density maps were obtained and used to 'train' a relevance vector machine (RVM) learning algorithm which was used to distinguish individual patients from Healthy controls. The RVM algorithm distinguished patients from Healthy controls with 70.3 % accuracy (74.2 % specificity, 66.4 % sensitivity, chi-square prelevant' in distinguishing both groups. Patients identified by the algorithm with high certainty (a high probability score) - belonged to a subgroup with more than ten total lifetime manic episodes including hospitalizations (late stage). These results indicate the presence of widespread structural brain abnormalities in BD which are associated with higher illness burden - which points to neuroprogression.

  7. Clinical Significance of IGFBP-3 Methylation in Patients with Early Stage Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Seung Tae Kim

    2015-08-01

    Full Text Available BACKGROUND: IGFBP-3 is a multifunctional protein that inhibits growth and induces apoptosis of cancer cells. Hypermethylation of the promoter represses expression of the IGFBP-3 gene. We undertook this study to assess the impact of IGFBP-3 methylation on survival of early stage gastric cancer patients. METHODS: Of the 482 tissue samples from gastric cancer patients who underwent curative surgery, IGFBP-3 methylation was tested in 138 patients with stage IB/II gastric cancer. We also analyzed IGFBP-3 methylation in 26 gastric cancer cell lines. IGFBP-3 methylation was evaluated by methylation-specific polymerase chain reaction (MethyLight. Statistical analyses, all two-sided, were performed to investigate the prognostic effects of methylation status of the IGFBP-3 promoter on various clinical parameters. RESULTS: Hypermethylation of IGFBP-3 was observed in 26 (19% of the 138 stage IB/II gastric cancer patients. Clinicopathological factors such as age, Lauren classification, sex, tumor infiltration, lymph node metastasis, and histologic grade did not show a statistically significant association with the methylation status of the IGFBP-3 promoter. Patients with a hypermethylated IGFBP-3 promoter had similar 8-year disease-free survival compared with those without a hypermethylated IGFBP-3 promoter (73% vs 75%, P = .78. In subgroup analyses, females, but not males, seemed to have poorer prognosis for DFS and OS in the subset of patients with IGFBP-3 methylation as compared with those without IGFBP-3 methylation (8-year DFS: 55.6% vs 71.6%, P = .3694 and 8-year overall survival: 55.6% vs 68.4%, P = .491, respectively even with no statistical significance. CONCLUSIONS: The status of IGFBP-3 methylation as measured by methylation-specific polymerase chain reaction proposed the modest role for predicting survival in specific subgroups of patients with early-stage gastric cancer who undergo curative surgery. However, this needs further investigation.

  8. The role of competence assessment in the different stages of competence development

    NARCIS (Netherlands)

    Schoonenboom, J.; Tattersall, C.; Miao, Y.; Stefanov, K.; Aleksieva-Petrova, A.; Adelsberger, H.H.; Kinshuk,; Pawlowski, J.M.; Sampson, D.

    2008-01-01

    This chapter discusses the role of e-assessment in the process of competence development. Its basic claim is that competence development is a process with distinct stages, and that the assessment forms and the roles taken on by those involved in the process depend on the stage in which learning

  9. Director's Corner: Professional Development Workshop Helps Early Stage Investigators

    Science.gov (United States)

    The Professional Development and Mock Review Workshop is a seminal event organized each year for CURE scholars and trainees. The event includes informative presentations, interactive discussions, a mock review, and poster session.

  10. Upper Stage Flight Experiment (USFE) Integral Structure Development Effort

    National Research Council Canada - National Science Library

    Guerrero, Jim; Hamilton, Brent; Burton, Randy; Crockett, Dave; Taylor, Zach

    2004-01-01

    .... AFRL/VS is developing a wide range of tank concepts that include linerless cryogenic tankage, self-healing cryogenic tankage, hydrogen peroxide compatible tankage, volumetrically efficient toroidal (donut shaped...

  11. Upper Stage Flight Experiment (USFE) Integral Structure Development Effort

    National Research Council Canada - National Science Library

    Guerrero, Jim; Hamilton, Brent; Burton, Randy; Crockett, Dave; Taylor, Zach

    2004-01-01

    The Air Force Research Laboratory's Space Vehicle Directorate (AFRL/VS) has established a customer focused Composite tankage development program that is targeted to existing and future aerospace applications...

  12. Breast Cancer/Stromal Cells Coculture on Polyelectrolyte Films Emulates Tumor Stages and miRNA Profiles of Clinical Samples.

    Science.gov (United States)

    Daverey, Amita; Brown, Karleen M; Kidambi, Srivatsan

    2015-09-15

    In this study, we demonstrate a method for controlling breast cancer cells adhesion on polyelectrolyte multilayer (PEM) films without the aid of adhesive proteins/ligands to study the role of tumor and stromal cell interaction on cancer biology. Numerous studies have explored engineering coculture of tumor and stromal cells predominantly using transwell coculture of stromal cells cultured onto coverslips that were subsequently added to tumor cell cultures. However, these systems imposed an artificial boundary that precluded cell-cell interactions. To our knowledge, this is the first demonstration of patterned coculture of tumor cells and stromal cells that captures the temporal changes in the miRNA signature as the breast tumor develops through various stages. In our study we used synthetic polymers, namely poly(diallyldimethylammonium chloride) (PDAC) and sulfonated poly(styrene) (SPS), as the polycation and polyanion, respectively, to build PEMs. Breast cancer cells attached and spread preferentially on SPS surfaces while stromal cells attached to both SPS and PDAC surfaces. SPS patterns were formed on PEM surfaces, by either capillary force lithography (CFL) of SPS onto PDAC surfaces or vice versa, to obtain patterns of breast cancer cells and patterned cocultures of breast cancer and stromal cells. In this study, we utilized cancer cells derived from two different tumor stages and two different stromal cells to effectively model a heterogeneous tumor microenvironment and emulate various tumor stages. The coculture model mimics the proliferative index (Ki67 expression) and tumor aggressiveness (HER-2 expression) akin to those observed in clinical tumor samples. We also demonstrated that our patterned coculture model captures the temporal changes in the miRNA-21 and miRNA-34 signature as the breast tumor develops through various stages. The engineered coculture platform lays groundwork toward precision medicine wherein patient-derived tumor cells can be

  13. Development and evaluation of the Stages of Change in Oral Health instrument.

    Science.gov (United States)

    Jamieson, Lisa M; Armfield, Jason M; Parker, Eleanor J; Roberts-Thomson, Kaye F; Broughton, John; Lawrence, Herenia P

    2014-10-01

    Oral health personnel are limited in their ability to assess the readiness of patients to make changes to improve oral health. We aimed to develop and test the Stages of Change in Oral Health (SOCOH) model, a scaled index of the stages of change - pre-contemplative, contemplative or active - with particular emphasis on pregnancy. Items were collected in a self-report questionnaire conducted among a convenience sample of 446 mothers (age range: 14-43 years) pregnant with Aboriginal children in South Australia, Australia. Scales representing openness (four items; Cronbach's alpha = 0.73), value (four items; Cronbach's alpha = 0.71), inconvenience (six items; Cronbach's alpha = 0.79) and permissiveness (four items; Cronbach's alpha = 0.66) were developed. Participants were categorised according to the Stages of Change model and were evaluated against key self-reported oral health outcomes. Some 11.9% of participants were classified as pre-contemplators, 46.4% as contemplators and 41.7% as active. A higher proportion of active participants had a higher education, last visited a dentist less than a year previously, had no dental fear, owned a toothbrush, brushed the previous day, used toothpaste, had no difficulties paying a $100 dental bill, self-reported their dental health as 'excellent' and in the previous 12 months did not experience dental pain, embarrassment related to their dental appearance or difficulties eating food. The SOCOH model offers an internally consistent and valid instrument for detailed assessment of the readiness for change in regarding oral health behaviours in pregnancy and has potential benefits for clinical decision making and research. © 2014 FDI World Dental Federation.

  14. Structured reporting adds clinical value in primary CT staging of diffuse large B-cell lymphoma.

    Science.gov (United States)

    Schoeppe, Franziska; Sommer, Wieland H; Nörenberg, Dominik; Verbeek, Mareike; Bogner, Christian; Westphalen, C Benedikt; Dreyling, Martin; Rummeny, Ernst J; Fingerle, Alexander A

    2018-03-29

    To evaluate whether template-based structured reports (SRs) add clinical value to primary CT staging in patients with diffuse large B-cell lymphoma (DLBCL) compared to free-text reports (FTRs). In this two-centre study SRs and FTRs were acquired for 16 CT examinations. Thirty-two reports were independently scored by four haematologists using a questionnaire addressing completeness of information, structure, guidance for patient management and overall quality. The questionnaire included yes-no, 10-point Likert scale and 5-point scale questions. Altogether 128 completed questionnaires were evaluated. Non-parametric Wilcoxon signed-rank test and McNemar's test were used for statistical analysis. SRs contained information on affected organs more often than FTRs (95 % vs. 66 %). More SRs commented on extranodal involvement (91 % vs. 62 %). Sufficient information for Ann-Arbor classification was included in more SRs (89 % vs. 64 %). Information extraction was quicker from SRs (median rating on 10-point Likert scale=9 vs. 6; 7-10 vs. 4-8 interquartile range). SRs had better comprehensibility (9 vs. 7; 8-10 vs. 5-8). Contribution of SRs to clinical decision-making was higher (9 vs. 6; 6-10 vs. 3-8). SRs were of higher quality (p < 0.001). All haematologists preferred SRs over FTRs. Structured reporting of CT examinations for primary staging in patients with DLBCL adds clinical value compared to FTRs by increasing completeness of reports, facilitating information extraction and improving patient management. • Structured reporting in CT helps clinicians to assess patients with lymphoma. • This two-centre study showed that structured reporting improves information content and extraction. • Patient management may be improved by structured reporting. • Clinicians preferred structured reports over free-text reports.

  15. Cost planning in the stage of product development

    Directory of Open Access Journals (Sweden)

    Todić Vladimir V.

    2014-01-01

    Full Text Available The total product life cycle cost can be planned based on one of the methods of global cost estimation. Also, total product life cycle cost can be planned based on cost plans and estimates by phases of the product life cycle, such as the phases of development, production, use and termination of the life cycle. By identifying the specific activities related to the relevant phases of life cycle as corresponding cost drivers, it is possible to accurately determine the total cost of individual phases using suitable methods known in the literature. This paper presents planning possibility respectively cost assessment of product development phase.

  16. Classical and post-classical stages of development of ideas on global conflicts

    Directory of Open Access Journals (Sweden)

    Y. S. Pilipenko

    2016-06-01

    Thus, in the history of the development of ideas about the nature of the conflict, it is possible to allocate three stages. The first stage is a classic, it representatives of which are O. Conte, K. Marx, G. Zimmel. The second stage is post-classical, represented by such scholars as P. Sztompka, G. lutsishin, N. Luhmann, M. Zelenkov, V. Zavalniuk. The third stage is multi-paradigmal, not formed yet, but actively developed by modern sociologists as I. Bekeshkina, Ye. Golovakha, A. Ruchka and other.

  17. Radiographic studies of developing calvaria at prenatal stages in ...

    African Journals Online (AJOL)

    HP USER

    This tendency however increased with increase in gestational age of the ... understanding the radiographical anatomy of the developing calvaria in this animal species. Keywords:Calvaria, Camel, prenatal, radiography. Introduction. Camel is an important ... need to establish morphologic and radiographic data of the fetal ...

  18. Curriculum Planning and Development in Mathematics from the Formative Stages

    Science.gov (United States)

    Festus, Azuka Benard; Kurumeh, Mary Seraphina

    2015-01-01

    Curriculum of a school consists of all the experiences that a learner encounters under the direction of the school. The curriculum of any educational system is planned and developed according to the needs of the society. Just as the society is dynamic, the curriculum is also dynamic. Hence, curriculum is usually changed from time to time. This…

  19. A novel genetic technique in Plasmodium berghei allows liver stage analysis of genes required for mosquito stage development and demonstrates that de novo heme synthesis is essential for liver stage development in the malaria parasite.

    Directory of Open Access Journals (Sweden)

    Upeksha L Rathnapala

    2017-06-01

    Full Text Available The combination of drug resistance, lack of an effective vaccine, and ongoing conflict and poverty means that malaria remains a major global health crisis. Understanding metabolic pathways at all parasite life stages is important in prioritising and targeting novel anti-parasitic compounds. The unusual heme synthesis pathway of the rodent malaria parasite, Plasmodium berghei, requires eight enzymes distributed across the mitochondrion, apicoplast and cytoplasm. Deletion of the ferrochelatase (FC gene, the final enzyme in the pathway, confirms that heme synthesis is not essential in the red blood cell stages of the life cycle but is required to complete oocyst development in mosquitoes. The lethality of FC deletions in the mosquito stage makes it difficult to study the impact of these mutations in the subsequent liver stage. To overcome this, we combined locus-specific fluorophore expression with a genetic complementation approach to generate viable, heterozygous oocysts able to produce a mix of FC expressing and FC deficient sporozoites. These sporozoites show normal motility and can invade liver cells, where FC deficient parasites can be distinguished by fluorescence and phenotyped. Parasites lacking FC exhibit a severe growth defect within liver cells, with development failure detectable in the early to mid stages of liver development in vitro. FC deficient parasites could not complete liver stage development in vitro nor infect naïve mice, confirming liver stage arrest. These results validate the heme pathway as a potential target for prophylactic drugs targeting liver stage parasites. In addition, we demonstrate that our simple genetic approach can extend the phenotyping window beyond the insect stages, opening considerable scope for straightforward reverse genetic analysis of genes that are dispensable in blood stages but essential for completing mosquito development.

  20. A novel genetic technique in Plasmodium berghei allows liver stage analysis of genes required for mosquito stage development and demonstrates that de novo heme synthesis is essential for liver stage development in the malaria parasite.

    Science.gov (United States)

    Rathnapala, Upeksha L; Goodman, Christopher D; McFadden, Geoffrey I

    2017-06-01

    The combination of drug resistance, lack of an effective vaccine, and ongoing conflict and poverty means that malaria remains a major global health crisis. Understanding metabolic pathways at all parasite life stages is important in prioritising and targeting novel anti-parasitic compounds. The unusual heme synthesis pathway of the rodent malaria parasite, Plasmodium berghei, requires eight enzymes distributed across the mitochondrion, apicoplast and cytoplasm. Deletion of the ferrochelatase (FC) gene, the final enzyme in the pathway, confirms that heme synthesis is not essential in the red blood cell stages of the life cycle but is required to complete oocyst development in mosquitoes. The lethality of FC deletions in the mosquito stage makes it difficult to study the impact of these mutations in the subsequent liver stage. To overcome this, we combined locus-specific fluorophore expression with a genetic complementation approach to generate viable, heterozygous oocysts able to produce a mix of FC expressing and FC deficient sporozoites. These sporozoites show normal motility and can invade liver cells, where FC deficient parasites can be distinguished by fluorescence and phenotyped. Parasites lacking FC exhibit a severe growth defect within liver cells, with development failure detectable in the early to mid stages of liver development in vitro. FC deficient parasites could not complete liver stage development in vitro nor infect naïve mice, confirming liver stage arrest. These results validate the heme pathway as a potential target for prophylactic drugs targeting liver stage parasites. In addition, we demonstrate that our simple genetic approach can extend the phenotyping window beyond the insect stages, opening considerable scope for straightforward reverse genetic analysis of genes that are dispensable in blood stages but essential for completing mosquito development.

  1. Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Olumayowa Abimbola Oninla

    2014-01-01

    Full Text Available Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%, PPE (24.4%, dermatophytic infections (8.9%, and herpes zoster (3.8% as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson’s Chi square with P value <0.05 was obtained between dermatoses and WHO clinical stages. Pearson’s correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4.

  2. Long-term results of patients with clinical stage C prostate cancer treated by photontherapy and early orchiectomy

    International Nuclear Information System (INIS)

    Wiegel, T.; Tepel, J.; Schmidt, R.; Klosterhalfen, H.; Arps, H.; Berger, P.; Franke, H.D.

    1996-01-01

    Background: To evaluate the value of radiotherapy and immediate hormonal therapy in the treatment of stage C prostate cancer. Patients and Method: From 1977 to 1986, 169 patients with clinically stage C prostate cancer underwent irradiation with curative intent following early orchiectomy. Sixty-four patients had a transurethral resection, 22 patients a prostatectomy and 83 patients had only a biopsy. In 38 patients a grade Ia/b tumor was found, in 78 patients a grade IIa/b tumor and in 43 patients a grade IIIa/b tumor using the German grade of malignancy. Treatment fields included the prostate, the seminal vesicles and the locoregional lymphatics. Until 1979 the dose was 60 Gy for the tumor encompassing isodose and from then on 65 Gy with a single dose of 2 Gy. Results: With a median follow-up of 98 months, the overall survival rate for 8 and 10 years was 51% and 37% and the cause-specific survival rate was 84% and 77%, respectively. Thirty-two patients (19%) developed distant metastases. Patients with local tumor control (n=148) had a significantly better overall survival rate of 45% for 10 years compared to patients with clinical local progression of disease (n=21) of 22% (p [de

  3. Decrease of CD4+ T lymphocytes in patients with H1N1 in early stage and its clinical significances

    International Nuclear Information System (INIS)

    Zuo Lingyun; Zhao Wei; Zhao Hong; Yu Haiying; Sun Weiwei

    2010-01-01

    Objective: To observe the change of CD4 + T Lymphocytes in patients with H1N1 at early stage and figure out its clinical significances on the progress and therapeutic selection of H1N1. Methods: The absolute counts of T lymphocyte subset from the peripheral blood samples of 48 H1N1 patients in first ten days' duration were detected by flow cytometry, and the serial chest CT examinations were performed. Results: In all 48 clinical cases, 28 cases were in normal range of CD4 + lymphocyte absolute count, whose pulmonary lesions were limited and illness condition stayed in the stability, they didn't need steroid. In the other 20 cases with low level of CD4 + , 4 cases' illness presented the progressive development and needed to be treated with steroid and 16 cases with lightly decreased CD4 + level which had a stable condition without treatment with steroid. The result of Pearson correlation analysis showed that there were negative correlations between absolute count of CD4 + cells and pulmonary lesions (r=-0.299, P + cell absolute count of H1N1 patients at early stage indicates the worse condition of pulmonary lesions. The patients with remarkable decrease of CD4 + lymphocytes are in need of treatment with steroid. (authors)

  4. The Early Stages of Heart Development: Insights from Chicken Embryos

    Directory of Open Access Journals (Sweden)

    Johannes G. Wittig

    2016-04-01

    Full Text Available The heart is the first functioning organ in the developing embryo and a detailed understanding of the molecular and cellular mechanisms involved in its formation provides insights into congenital malformations affecting its function and therefore the survival of the organism. Because many developmental mechanisms are highly conserved, it is possible to extrapolate from observations made in invertebrate and vertebrate model organisms to humans. This review will highlight the contributions made through studying heart development in avian embryos, particularly the chicken. The major advantage of chick embryos is their accessibility for surgical manipulation and functional interference approaches, both gain- and loss-of-function. In addition to experiments performed in ovo, the dissection of tissues for ex vivo culture, genomic, or biochemical approaches is straightforward. Furthermore, embryos can be cultured for time-lapse imaging, which enables tracking of fluorescently labeled cells and detailed analysis of tissue morphogenesis. Owing to these features, investigations in chick embryos have led to important discoveries, often complementing genetic studies in mice and zebrafish. As well as including some historical aspects, we cover here some of the crucial advances made in understanding early heart development using the chicken model.

  5. Quantitative Profiling Identifies Potential Regulatory Proteins Involved in Development from Dauer Stage to L4 Stage in Caenorhabditis elegans.

    Science.gov (United States)

    Kim, Sunhee; Lee, Hyoung-Joo; Hahm, Jeong-Hoon; Jeong, Seul-Ki; Park, Don-Ha; Hancock, William S; Paik, Young-Ki

    2016-02-05

    When Caenorhabditis elegans encounters unfavorable growth conditions, it enters the dauer stage, an alternative L3 developmental period. A dauer larva resumes larval development to the normal L4 stage by uncharacterized postdauer reprogramming (PDR) when growth conditions become more favorable. During this transition period, certain heterochronic genes involved in controlling the proper sequence of developmental events are known to act, with their mutations suppressing the Muv (multivulva) phenotype in C. elegans. To identify the specific proteins in which the Muv phenotype is highly suppressed, quantitative proteomic analysis with iTRAQ labeling of samples obtained from worms at L1 + 30 h (for continuous development [CD]) and dauer recovery +3 h (for postdauer development [PD]) was carried out to detect changes in protein abundance in the CD and PD states of both N2 and lin-28(n719). Of the 1661 unique proteins identified with a proteomic approach identifies and quantitates the regulatory proteins potentially involved in PDR in C. elegans, which safeguards the overall lifecycle in response to environmental changes.

  6. Development of the siriraj clinical asthma score.

    Science.gov (United States)

    Vichyanond, Pakit; Veskitkul, Jittima; Rienmanee, Nuanphong; Pacharn, Punchama; Jirapongsananuruk, Orathai; Visitsunthorn, Nualanong

    2013-09-01

    Acute asthmatic attack in children commonly occurs despite the introduction of effective controllers such as inhaled corticosteroids and leukotriene modifiers. Treatment of acute asthmatic attack requires proper evaluation of attack severity and appropriate selection of medical therapy. In children, measurement of lung function is difficult during acute attack and thus clinical asthma scoring may aid physician in making further decision regarding treatment and admission. We enrolled 70 children with acute asthmatic attack with age range from 1 to 12 years (mean ± SD = 51.5 ± 31.8 months) into the study. Twelve selected asthma severity items were assessed by 2 independent observers prior to administration of salbutamol nebulization (up to 3 doses at 20 minutes interval). Decision for further therapy and admission was made by emergency department physician. Three different scoring systems were constructed from items with best validity. Sensitivity, specificity and accuracy of these scores were assessed. Inter-rater reliability was assessed for each score. Review of previous scoring systems was also conducted and reported. Three severity items had poor validity, i.e., cyanosis, depressed cerebral function, and I:E ratio (p > 0.05). Three items had poor inter-rater reliability, i.e., breath sound quality, air entry, and I:E ratio. These items were omitted and three new clinical scores were constructed from the remaining items. Clinical scoring system comprised retractions, dyspnea, O2 saturation, respiratory rate and wheezing (rangeof score 0-10) gave the best accuracy and inter-rater variability and were chosen for clinical use-Siriraj Clinical Asthma Score (SCAS). A Clinical Asthma Score that is simple, relatively easy to administer and with good validity and variability is essential for treatment of acute asthma in children. Several good candidate scores have been introduced in the past. We described the development of the Siriraj Clinical Asthma Score (SCAS) in

  7. New, but slow – technical newness challenges late stage development speed

    DEFF Research Database (Denmark)

    Smed, Marie; Salomo, Søren; Getz, Kenneth A.

    2014-01-01

    such as technical innovativeness may be a critical factor when going through the crucial late stages of development. We have limited knowledge of the relation between product newness and the speed of NPD, and how this may be related to firm size and partnering strategies during development. Combining product traits...... with firm resources relevant to late stage development speed can enrich our understanding of time-tomarket in the aim of improving this crucial measure of NPD. The research model is tested on a dataset of all new drug developments approved for the US market 2000-2010. The results show that newness...... of a product, small size of a development company and partnering for external resources all increases the speed of late stage development speed. The results show that technical innovativeness of products in late stage development has the consequence of extending this important process of NPD. Also, partnering...

  8. Course strategies for clinical nurse leader development.

    Science.gov (United States)

    Gerard, Sally; Grossman, Sheila; Godfrey, Marjorie

    2012-01-01

    The scope of the clinical nurse leader (CNL) is evolving in practice across the country. The preparation of this pivotal role in a complex healthcare environment has prompted the collaboration of nurse academics, nurse administrators, and clinicians to design unique educational experiences to maximize best practice. Knowledge attained regarding healthcare improvement and patient safety must not only be theoretical, but personal and application focused. Utilizing the American Association of Colleges of Nursing's CNL white paper and published resources faculty developed a clinical leadership course focused on active learning and reflection. Students explore concepts of improvement and quality related to business models of high functioning organizations including healthcare. Three key components of the course are described in detail; "quality is personal", executive interviews and the "5P" clinical microsystems assessment. Evaluation outcomes are discussed. Course content and innovative teaching/learning strategies for CNL are shared which may support the growth of CNL program development nationally. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Political parties in the Sverdlovsk region: stages of development

    Directory of Open Access Journals (Sweden)

    Mukhametov Ruslan Salikhovich

    2013-12-01

    Full Text Available This article analyzes the processes of party building in the Russian Federation. On the example of a single region – the Sverdlovsk region – we study the evolution of political parties. The factors favoring the process of formation and functioning of regional political parties and political movements in the Middle Urals are identified and classified. Much attention is paid to such factors of development of the parties in the region as a party-electoral law and the electoral system view.

  10. Pharmacometrics in early clinical drug development

    NARCIS (Netherlands)

    Keizer, R.J.

    2010-01-01

    Pharmacometrics, the science of quantitative clinical pharmacology, has been recognized as one of the main research fields able to improve efficiency in drug development, and to reduce attrition rates on the route from drug discovery to approval. This field of drug research, which builds heavily on

  11. Foot drop caused by lumbar degenerative disease: clinical features, prognostic factors of surgical outcome and clinical stage.

    Directory of Open Access Journals (Sweden)

    Kun Liu

    Full Text Available OBJECTIVE: The purpose of this study was to analyze the clinical features and prognostic factors of surgical outcome of foot drop caused by lumbar degenerative disease and put forward the clinical stage. METHODS: We retrospectively reviewed 135 patients with foot drop due to lumbar degenerative disease. The clinical features and mechanism were analyzed. Age, sex, duration of palsy, preoperative muscle strength of tibialis anterior (TA, sensation defect of affected lower limb, affected foot, diagnosis and compressed nerve roots were recorded and compared with surgical outcome. RESULTS: Foot drop was observed in 8.1% of all inpatients of lumbar degenerative disease. L5 nerve root compression was observed in 126 of all 135 patients (93.3%. Single, double and triple roots compression was observed respectively in 43, 83, and 9 patients (31.9%, 61.5%, and 6.6%. But there was no significant relationship between preoperative muscle strength of TA and the number of compressed roots. The muscle strength of TA was improved in 113 (83.7% patients after surgery, but it reached to >=4 in only 21 (15.6% patients. Improvement of the muscle strength of TA was almost stable at the 6-month follow-up. At the last follow-up, the muscle strength of TA was 1, 2, 3, 4, 5 respectively in 28, 24, 62, 13, 8 patients. Multivariate logistic regression showed duration of palsy (p=0.0360, OR=2.543, preoperative muscle strength of TA (p=0.0064, OR=5.528 and age (p=0.0309, OR=3.208 were factors that influenced recovery following an operation. CONCLUSIONS: L5 nerve root was most frequently affected. The muscle strength of TA improved in most patients after surgery, but few patients can get a good recovery from foot drop. Patients of shorter duration of palsy, better preoperative muscle strength of TA and younger age showed a better surgical outcome.

  12. Evaluation of Eight Different Clinical Staging Systems Associated with Overall Survival of Chinese Patients with Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Jian-Jun Zhao

    2015-01-01

    Full Text Available Background: Hepatocellular carcinoma (HCC is a common cancer in China, an area of high hepatitis B virus (HBV infection. Although several staging systems are available, there is no consensus on the best classification to use because multiple factors, such as etiology, clinical treatment and populations could affect the survival of HCC patients. Methods: This study analyzed 743 HBV-related Chinese HCC patients who received surgery first and evaluated the predictive values of eight different commonly used staging systems in the clinic. Results: The overall 1-, 3-, 5-year survival rates and a median survival were 91.5%, 70.3%, 55.3% and 72 months respectively. Barcelona Clinic Liver Cancer (BCLC staging systems had the best stratification ability and showed the lowest Akaike information criterion (AIC values (2896.577, followed by tumor-node-metastasis 7 th (TNM 7 th (AIC = 2899.980, TNM 6 th (AIC = 2902.17, Japan integrated staging score (AIC = 2918.085, Tokyo (AIC = 2938.822, Cancer of the Liver Italian Program score (AIC = 2941.950, Chinese University Prognostic Index grade (AIC = 2962.027, and Okuda (AIC = 2979.389. Conclusions: BCLC staging system is a better staging model for HBV infection patients with HCC in Chinese population among the eight currently used staging systems. These identifications afford a large group of Chinese HCC patients with HBV infection and could be helpful to design a new staging system for a certain population.

  13. Clinical significance of CT in the preoperative diagnosis of the staging of rectal cancer patients

    International Nuclear Information System (INIS)

    Itano, Satoshi; Fuchimoto, Sadanori; Hamada, Fumihiro; Kimura, Takanobu; Iwagaki, Hiromi; Maeda, Tetsuya; Orita, Kunzo

    1987-01-01

    The value of computed tomography (CT) in the preoperative clinical staging of rectal cancer was prospectively studied in 28 patients with macroscopically proven cancer. The CT studies were based on the previously established CT diagnostic criteria for wall invasion (S factor), lymph node metastases (N factor), and liver metastases (H factor). When macroscopic findings were used as the standard, the accuracy of CT was 61 % for S factor, 32 % for N factor, and 86 % for H factor. Using histological findings as the standard, the accuracy was 48 % for S factor and 16 % for N factor. Overall, CT had a high accuracy for H factor in all sites of cancer (75 % in the rectosigmoid, 86 % in the area above the peritoneal reflection, and 90 % in the area below the peritoneal reflection). For the other S and N factors, CT seemed to be of limited value in the preoperative diagnosis. (Namekawa, K.)

  14. Bioethics as a stage in development of humanism

    Directory of Open Access Journals (Sweden)

    T. N. Ketova

    2015-01-01

    Full Text Available This article uncovers humanistic substance of bioethics - a discipline which originated in 1960's. Bioethics has an interdisciplinary character and presents itself as a reflection on problematic situations, which can appear as a result of biomedical progress. Bioethics in a wider sense can be viewed as ethics of life, which highlights its ecological substance. This article analyses the problem of consequences of radical human transformation and also the article shows significance of leading principle of «personal autonomy of the patient». In the article functions and goals of ethical committees, existing in various countries, are highlighted. In conclusion, the article highlights specifics of bioethics as a syncretic discipline, which assists development of humanism and responds to modern civilization's challenges.

  15. Clinical outcome of fiducial-less CyberKnife radiosurgery for stage I non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jung, In Hye; Song, Si Yeol; Cho, Byung Chul; Kwak, Jung Won; Jung, Nuri Hyun; Kim, Su Ssan; Choi, Eun Kyung [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Jung, Jin Hong [Dept. of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul (Korea, Republic of); Je, Hyoung Uk [Dept. of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of); Choi, Won Sik [Dept. of Radiation Oncology, Gangneung Asan Hospital, Uiversity of Ulsan College of Medicine, Gangneung (Korea, Republic of)

    2015-06-15

    To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

  16. Development and clinical application of transient elastography(FibroScan

    Directory of Open Access Journals (Sweden)

    Guo-feng CHEN

    2011-11-01

    Full Text Available Chronic liver fibrosis,an important step in the development of liver diseases,is an anaplerotic reaction of an organism to chronic liver damage caused by various kinds of pathogens.It is a common pathologic change in chronic liver diseases and the intermediate link in the development of liver cirrhosis.Liver fibrosis can be reversed in the early stage,as well as in the later stage.Cases of liver cirrhosis that are confirmed during the earlier stage can be treated and prognosticated more efficiently.Currently,liver biopsy is still the gold standard for diagnosing liver fibrosis.However,its invasiveness causes patients to refuse the examination.Noninvasive diagnostic technology for liver fibrosis has made considerable development in recent years.One of these technologies is transient elastography(FibroScan of liver stiffness using elastic shear wave,which has good accuracy and specificity for the determination of liver fibrosis.It is noninvasive,fast,repeatable,and it can evaluate liver fibrosis objectively and quantitatively.It will have a broad range of clinical applications in the future.

  17. Subjective cognitive concerns and neuropsychiatric predictors of progression to the early clinical stages of Alzheimer disease.

    Science.gov (United States)

    Donovan, Nancy J; Amariglio, Rebecca E; Zoller, Amy S; Rudel, Rebecca K; Gomez-Isla, Teresa; Blacker, Deborah; Hyman, Bradley T; Locascio, Joseph J; Johnson, Keith A; Sperling, Reisa A; Marshall, Gad A; Rentz, Dorene M

    2014-12-01

    To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer disease (AD). From a total sample of 559 older adults from the Massachusetts Alzheimer's Disease Research Center longitudinal cohort, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI), and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Two latent cognitive factors (memory-semantic, attention-executive) and two neuropsychiatric factors (affective, psychotic) were derived from the Alzheimer's Disease Centers' Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. Higher/better memory-semantic factor score predicted lower hazard of progression (hazard ratio [HR] = 0.4 for 1 standard deviation [SD] increase, p diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a fourfold risk of progression compared with CN (HR = 4.1, p <0.0001). These results identify affective and memory-semantic factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. Hospital-level Variation in Utilization of Surgery for Clinical Stage I-II Pancreatic Adenocarcinoma.

    Science.gov (United States)

    Swords, Douglas S; Mulvihill, Sean J; Skarda, David E; Finlayson, Samuel R G; Stoddard, Gregory J; Ott, Mark J; Firpo, Matthew A; Scaife, Courtney L

    2017-07-11

    To (1) evaluate rates of surgery for clinical stage I-II pancreatic ductal adenocarcinoma (PDAC), (2) identify predictors of not undergoing surgery, (3) quantify the degree to which patient- and hospital-level factors explain differences in hospital surgery rates, and (4) evaluate the association between adjusted hospital-specific surgery rates and overall survival (OS) of patients treated at different hospitals. Curative-intent surgery for potentially resectable PDAC is underutilized in the United States. Retrospective cohort study of patients ≤85 years with clinical stage I-II PDAC in the 2004 to 2014 National Cancer Database. Mixed effects multivariable models were used to characterize hospital-level variation across quintiles of hospital surgery rates. Multivariable Cox proportional hazards models were used to estimate the effect of adjusted hospital surgery rates on OS. Of 58,553 patients without contraindications or refusal of surgery, 63.8% underwent surgery, and the rate decreased from 2299/3528 (65.2%) in 2004 to 4412/7092 (62.2%) in 2014 (P < 0.001). Adjusted hospital rates of surgery varied 6-fold (11.4%-70.9%). Patients treated at hospitals with higher rates of surgery had better unadjusted OS (median OS 10.2, 13.3, 14.2, 16.5, and 18.4 months in quintiles 1-5, respectively, P < 0.001, log-rank). Treatment at hospitals in lower surgery rate quintiles 1-3 was independently associated with mortality [Hazard ratio (HR) 1.10 (1.01, 1.21), HR 1.08 (1.02, 1.15), and HR 1.09 (1.04, 1.14) for quintiles 1-3, respectively, compared with quintile 5] after adjusting for patient factors, hospital type, and hospital volume. Quality improvement efforts are needed to help hospitals with low rates of surgery ensure that their patients have access to appropriate surgery.

  19. The newest stage of development of the White Sea depression

    Science.gov (United States)

    Yevzerov, V. Ya.; Vinogradov, A. N.; Nikolaeva, S. B.

    2016-12-01

    Analysis of materials on the geological structure and tectonics of the White Sea depression area suggests that this depression existed in the Middle Pleistocene and was connected with the World Ocean. It is still impossible to determine the exact time of its formation due to an insufficient knowledge of the depression loose cover. However it is most likely that the depression was formed in the Late Miocene and Early Pliocene, when after the regressive development of the continental margin the shelf subsidence began. Probably in the Holocene the divergent regime was replaced by the transform regime. This period saw the subsidence of the Kandalaksha graben to about 150 m and the formation of the Kolvitsa graben. The crystalline rocks surrounding Kandalaksha bay were involved in the subsidence which is reflected in the isobase curve of the glacioisostatic uplift of the area. The combined impact of the tectonic component and the glacioisostatic uplift led to a rise of tensions which discharge caused a high seismic activity of the Kandalaksha graben and its environs.

  20. The development of co-innovation strategies: stages and interaction patterns in interfirm innovation

    OpenAIRE

    Bossink, B.A.G.

    2002-01-01

    Organizations that choose or are forced to innovate in co-operation with other organizations, go through four stages of co-innovation strategy development. The stages are successively: (1) autonomous strategy making: organizations develop strategies on their own, (2) co-operative strategy making: organizations concentrate on developing innovation strategies in close co-operation with other organizations, (3) founding an organization for co-innovation: organizations found a joint organization ...

  1. From Trust to Intimacy: A New Inventory for Examining Erikson's Stages of Psychosocial Development.

    Science.gov (United States)

    Rosenthal, Doreen A.; And Others

    1981-01-01

    A new inventory for examining the first six of Erikson's psychosocial stages is described. It is concluded that the Erikson Psychosocial Stage Inventory (EPSI), a self-report questionnaire, is a useful measure for researchers interested in development from early adolescence and in mapping changes as a function of life events. (Author/GK)

  2. The development of co-innovation strategies: stages and interaction patterns in interfirm innovation

    NARCIS (Netherlands)

    Bossink, B.A.G.

    2002-01-01

    Organizations that choose or are forced to innovate in co-operation withother organizations, go through four stages of co-innovation strategy development.The stages are successively: (1) autonomous strategy making: organizations developstrategies on their own, (2) co-operative strategy making:

  3. Participatory and Anticipatory Stages of Mathematical Concept Learning: Further Empirical and Theoretical Development

    Science.gov (United States)

    Simon, Martin A.; Placa, Nicora; Avitzur, Arnon

    2016-01-01

    Tzur and Simon (2004) postulated 2 stages of development in learning a mathematical concept: participatory and anticipatory. The authors discuss the affordances for research of this stage distinction related to data analysis, task design, and assessment as demonstrated in a 2-year teaching experiment.

  4. Using STEM Approach to Develop Visual Reasoning and Learning Independence for Preparatory Stage Students

    Science.gov (United States)

    Abbas, Rasha Al-Sayed Sabry

    2017-01-01

    This research aimed at investigating the effectiveness of STEM approach in developing visual reasoning and learning independence for preparatory stage students. To achieve this aim, the researcher designed a program based on STEM approach in light of the principles of nanotechnology. Twenty one preparatory stage students participated in the…

  5. Influence of sports on human mental and physical development in various stages of life

    OpenAIRE

    SLÁDKOVÁ, Jitka

    2011-01-01

    The thesis deals with the impact of sports and physical activity on human physical and mental development in various developmental stages of life. It contains a brief description of the stages of life and presents the possibilities, nature and influence of sports and physical activity on human physical and mental state.

  6. Effects of marketing in different stages of development

    Directory of Open Access Journals (Sweden)

    Demir Lima

    2016-07-01

    Full Text Available In everyday life, by reason of ignorance of the essence of marketing, we come across numerous cases of misuse and improper understanding of word marketing. Nowadays people have more the attitude in the consciousness of the need for understanding and recognition of the right meaning of the word marketing. There are many definitions about Marketing in literature and contemporary practice, each attempt to define the term marketing can only partly be understood as successful and complete. Indeed, it is impossible to define and summarize in only a few sentences everything that has to do with marketing as a process and its roles. Marketing specialists need to identify the concerns and desires of consumers to be able to target their minds, hearts and souls. In the paradox of globalization, concern and common consumer’s desire is to make the society and the world a better place and even an ideal place to live. Some companies are doing a kind of differentiation through corporate philanthropy for social or environmental causes. Now we are witnessing the birth of Marketing 3.0. In a world full of confusion, they are looking for those companies that can complement them deeper for social justice, economic and environmental mission, vision and company values that they represent. In selecting products and services, people not only demand the fulfillment of their functional and emotional, but also the human spiritual fulfillment. The third force that gives impetus to the creation of marketing 3.0 is the emergence of creative society. People in creative society are people who have developed the activity of the right brain hemisphere and working in creative sectors such as science, arts and professional services. Based on these facts the era of marketing 3.0 is the era where marketing practices are strongly affected by changes in consumer behaviors and attitudes. It is the most sophisticated customercentric era where the customer requires more cooperative

  7. Clinical usefulness of diffusion-weighted MRI in various stages of ischemic stroke

    International Nuclear Information System (INIS)

    Song, So Youne; Cho, Woo Ho; Kim, Soung Hee; Kim, Jung Sook; Kim, Young Hoon; Kim, Myung Gyu; Hur, Gham

    2002-01-01

    Diffusion-weighted MRI (DWI) is well known to be sensitive in the detection of hyperacute infarct, but has not been systematically investigated in patients with acute or subacute infarct. We evaluated the usefulness of diffusion-weighted MRI in assessing the various stages of brain infarct. Fifty-five consecutive patients with symptoms of brain infarct underwent fast spinecho T2-weighted MRI (T2WI) and DWI. Using only a brief clinical history, two radiologists first attempted to detect the lesion using T2W1, which was then compared with DWI. The usefulness of the latter was then evaluated in terms of the following criteria: 1) Its abilility to detect a lesion not seen at T2WI(detection); 2) localization of the responsible ischemic focus among multiple high-signal intensities seen at T2WI (localization); 3) conspicuity of a lesion which was subtle at T2WI (conspicuity); 4) detection of multiple lesions (multiplicity). DWI was useful in 44 of 55 patients (80%), including 9 of 9 (100%) with hyperacute infarct (<6 hours), 20 of 27 (74%) with acute infarct (<48 hours), and 15 of 19 (79%) with subacute infarct (<2 weeks). Among the nine patients at the hyperacute stage, DWI was useful for detection of the lesion in six (67%), for localization, 4 (44%) in one (11%), for conspicuity in four (44%), and for multiplicity in five (56%); at the acute stage (20 patients), for detection in three (15%), for localization in ten (50%), for conspicuity in eight (40%), and for moltiplicity in five (25%); and at the subacute stage (15 patients), for detection in three (20%), for localization in nine (60%), for conspicuity in two (13%), and for multiplicity in three (20%). DWI is very sensitive for the diagnosis of hyperacute infarct. In the assessment of this, it is useful during the acute or subacute period for the detection of small lesions, the localization of ongoing lesions among multiple high signal intensities seen at T2WI, and the determination of lesion conspicuity

  8. Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

    Science.gov (United States)

    Masters, Gregory A.; Temin, Sarah; Azzoli, Christopher G.; Giaccone, Giuseppe; Baker, Sherman; Brahmer, Julie R.; Ellis, Peter M.; Gajra, Ajeet; Rackear, Nancy; Schiller, Joan H.; Smith, Thomas J.; Strawn, John R.; Trent, David; Johnson, David H.

    2015-01-01

    Purpose To provide evidence-based recommendations to update the American Society of Clinical Oncology guideline on systemic therapy for stage IV non–small-cell lung cancer (NSCLC). Methods An Update Committee of the American Society of Clinical Oncology NSCLC Expert Panel based recommendations on a systematic review of randomized controlled trials from January 2007 to February 2014. Results This guideline update reflects changes in evidence since the previous guideline. Recommendations There is no cure for patients with stage IV NSCLC. For patients with performance status (PS) 0 to 1 (and appropriate patient cases with PS 2) and without an EGFR-sensitizing mutation or ALK gene rearrangement, combination cytotoxic chemotherapy is recommended, guided by histology, with early concurrent palliative care. Recommendations for patients in the first-line setting include platinum-doublet therapy for those with PS 0 to 1 (bevacizumab may be added to carboplatin plus paclitaxel if no contraindications); combination or single-agent chemotherapy or palliative care alone for those with PS 2; afatinib, erlotinib, or gefitinib for those with sensitizing EGFR mutations; crizotinib for those with ALK or ROS1 gene rearrangement; and following first-line recommendations or using platinum plus etoposide for those with large-cell neuroendocrine carcinoma. Maintenance therapy includes pemetrexed continuation for patients with stable disease or response to first-line pemetrexed-containing regimens, alternative chemotherapy, or a chemotherapy break. In the second-line setting, recommendations include docetaxel, erlotinib, gefitinib, or pemetrexed for patients with nonsquamous cell carcinoma; docetaxel, erlotinib, or gefitinib for those with squamous cell carcinoma; and chemotherapy or ceritinib for those with ALK rearrangement who experience progression after crizotinib. In the third-line setting, for patients who have not received erlotinib or gefitinib, treatment with erlotinib is

  9. Development of clinical application of radiation

    International Nuclear Information System (INIS)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun

    2000-04-01

    The aim is to develop the clinical radiation therapy techniques, which increase local control and cure rate of cancer. The contents were 1. technique of stereotactic radiotherapy 2. technique of intraoperative radiation therapy(IORT) 3. technique of fractionated radiotherapy 4. technique of 3D conformal therapy 5. chemoradiotherapy in lung cancer, rectal cancer and biliopancreatic cancer 6. network based information communication system of radiation oncology 7. animal studies for the best application of chemoradiotherapy and for elucidating mechanism of slide effect in radiotherapy. The results were 1. completion of quality assurance protocol, frame and mounting system 2. completion of applicator of IORT 3. clinical protocol of fractionated radiotherapy 4. clinical protocol of 3D conformal therapy for brain, head and neck, breast and lung cancer 5. completion of multimodality treatment protocol for lung, rectal and biliopancreatic cancer 6. completion of database system for patient information and simulation image 7. standardization of estimation for radiation induced pneumonitis in animal model. Future plans are 1) developed fractionated stereotactic radiotherapy system will be commercialized 2) developed applicator of brachytherapy for IORT will be commercialized 3) 3D conformal therapy will increase local control rate for brain tumor and decrease complications such as zerostomia after treatment for nasopharygeal cancer 4) training manpower and skills for randomized clinical trial 5) suggest possibility of clinical usefulness of oral 5-fluorouracil 6) to provide basic technique for electric chart 7) promote developing database system for image information 8) also in view of double edge sword effect of NO, it is possible to modify the NO production from irradiation to increase the tolerance to radiation

  10. Development of clinical application of radiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Sook; Yoo, Seoung Yul; Yoo, Hyung Jun [and others

    2000-04-01

    The aim is to develop the clinical radiation therapy techniques, which increase local control and cure rate of cancer. The contents were 1. technique of stereotactic radiotherapy 2. technique of intraoperative radiation therapy(IORT) 3. technique of fractionated radiotherapy 4. technique of 3D conformal therapy 5. chemoradiotherapy in lung cancer, rectal cancer and biliopancreatic cancer 6. network based information communication system of radiation oncology 7. animal studies for the best application of chemoradiotherapy and for elucidating mechanism of slide effect in radiotherapy. The results were 1. completion of quality assurance protocol, frame and mounting system 2. completion of applicator of IORT 3. clinical protocol of fractionated radiotherapy 4. clinical protocol of 3D conformal therapy for brain, head and neck, breast and lung cancer 5. completion of multimodality treatment protocol for lung, rectal and biliopancreatic cancer 6. completion of database system for patient information and simulation image 7. standardization of estimation for radiation induced pneumonitis in animal model. Future plans are (1) developed fractionated stereotactic radiotherapy system will be commercialized (2) developed applicator of brachytherapy for IORT will be commercialized (3) 3D conformal therapy will increase local control rate for brain tumor and decrease complications such as zerostomia after treatment for nasopharygeal cancer (4) training manpower and skills for randomized clinical trial (5) suggest possibility of clinical usefulness of oral 5-fluorouracil (6) to provide basic technique for electric chart (7) promote developing database system for image information (8) also in view of double edge sword effect of NO, it is possible to modify the NO production from irradiation to increase the tolerance to radiation.

  11. The Heme Biosynthesis Pathway Is Essential for Plasmodium falciparum Development in Mosquito Stage but Not in Blood Stages*

    Science.gov (United States)

    Ke, Hangjun; Sigala, Paul A.; Miura, Kazutoyo; Morrisey, Joanne M.; Mather, Michael W.; Crowley, Jan R.; Henderson, Jeffrey P.; Goldberg, Daniel E.; Long, Carole A.; Vaidya, Akhil B.

    2014-01-01

    Heme is an essential cofactor for aerobic organisms. Its redox chemistry is central to a variety of biological functions mediated by hemoproteins. In blood stages, malaria parasites consume most of the hemoglobin inside the infected erythrocytes, forming nontoxic hemozoin crystals from large quantities of heme released during digestion. At the same time, the parasites possess a heme de novo biosynthetic pathway. This pathway in the human malaria parasite Plasmodium falciparum has been considered essential and is proposed as a potential drug target. However, we successfully disrupted the first and last genes of the pathway, individually and in combination. These knock-out parasite lines, lacking 5-aminolevulinic acid synthase and/or ferrochelatase (FC), grew normally in blood-stage culture and exhibited no changes in sensitivity to heme-related antimalarial drugs. We developed a sensitive LC-MS/MS assay to monitor stable isotope incorporation into heme from its precursor 5-[13C4]aminolevulinic acid, and this assay confirmed that de novo heme synthesis was ablated in FC knock-out parasites. Disrupting the FC gene also caused no defects in gametocyte generation or maturation but resulted in a greater than 70% reduction in male gamete formation and completely prevented oocyst formation in female Anopheles stephensi mosquitoes. Our data demonstrate that the heme biosynthesis pathway is not essential for asexual blood-stage growth of P. falciparum parasites but is required for mosquito transmission. Drug inhibition of pathway activity is therefore unlikely to provide successful antimalarial therapy. These data also suggest the existence of a parasite mechanism for scavenging host heme to meet metabolic needs. PMID:25352601

  12. Clinical pharmacology considerations in biologics development

    Science.gov (United States)

    Zhao, Liang; Ren, Tian-hua; Wang, Diane D

    2012-01-01

    Biologics, including monoclonal antibodies (mAbs) and other therapeutic proteins such as cytokines and growth hormones, have unique characteristics compared to small molecules. This paper starts from an overview of the pharmacokinetics (PK) of biologics from a mechanistic perspective, the determination of a starting dose for first-in-human (FIH) studies, and dosing regimen optimisation for phase II/III clinical trials. Subsequently, typical clinical pharmacology issues along the corresponding pathways for biologics development are summarised, including drug-drug interactions, QTc prolongation, immunogenicity, and studies in specific populations. The relationships between the molecular structure of biologics, their pharmacokinetic and pharmacodynamic characteristics, and the corresponding clinical pharmacology strategies are summarised and depicted in a schematic diagram. PMID:23001474

  13. Clinical pharmacology considerations in biologics development.

    Science.gov (United States)

    Zhao, Liang; Ren, Tian-hua; Wang, Diane D

    2012-11-01

    Biologics, including monoclonal antibodies (mAbs) and other therapeutic proteins such as cytokines and growth hormones, have unique characteristics compared to small molecules. This paper starts from an overview of the pharmacokinetics (PK) of biologics from a mechanistic perspective, the determination of a starting dose for first-in-human (FIH) studies, and dosing regimen optimisation for phase II/III clinical trials. Subsequently, typical clinical pharmacology issues along the corresponding pathways for biologics development are summarised, including drug-drug interactions, QTc prolongation, immunogenicity, and studies in specific populations. The relationships between the molecular structure of biologics, their pharmacokinetic and pharmacodynamic characteristics, and the corresponding clinical pharmacology strategies are summarised and depicted in a schematic diagram.

  14. Clinical observation of Artisan iris-clip intraocular lens implantation at stage

    Directory of Open Access Journals (Sweden)

    Qing Zhou

    2014-09-01

    Full Text Available AIM: To observe the clinical efficacy of Artisan iris-clip intraocular lens(IOLimplantation on cataract with a wide range of lens dislocation.METHODS: Twenty-four hospital patients(28 eyesof cataract with lens subluxation by trauma(20 patients, 20 eyesand Marfan's syndrome(4 patients, 8 eyesduring May 2007 to December 2011 were selected. All of them underwent phacoemulsification or an anterior vitrectomy and Artisan iris-clip IOL implantation at stage Ⅰ. Postoperative visual acuity, corneal endothelial cell count, intraocular lens position and postoperative complications were observed. Follow-up time was 6mo.RESULTS:Compared with the preoperative, postoperative best corrected visual acuity improved to varying degrees, visual acuity of 0.1-0.5 was in 20 eyes, 0.5-1.0 in 8 eyes. After followed up 1-6mo, no artificial lens shift, iris inflammation, iris atrophy and corneal decompensation and other complications were observed.CONCLUSION: Cataract surgery with a wide range of lens dislocation is difficult, but as long as surgeons who have a wealth of clinical experience and superb skills, still can carry out phacoemulsification surgery or anterior vitrectomy and Artisan iris-clip IOL implantation and obtain a better outcome.

  15. Effects of high temperature stress at different development stages on soybean isoflavone and tocopherol concentrations.

    Science.gov (United States)

    Chennupati, Pratyusha; Seguin, Philippe; Liu, Wucheng

    2011-12-28

    Soybean contains a range of compounds with putative health benefits including isoflavones and tocopherols. A study was conducted to determine the effects on these compounds of high temperature stress imposed at specific development stages [i.e., none, pre-emergence, vegetative, early reproductive (R1-4), late-reproductive (R5-8), or all stages]. Two cultivars (AC Proteina and OAC Champion) were grown in growth chambers set at contrasting temperatures [i.e., stress conditions of 33/25 °C (day/night temperature) and control conditions of 23/15 °C] in order to generate these treatments. Isoflavone and tocopherol concentrations in mature seeds were determined using high-performance liquid chromatography. In both cultivars isoflavone response was greatest when stress occurred during the R5-8 stages and during all development stages, these treatments reducing total isoflavone concentration by an average of 85% compared to the control. Stress imposed at other stages also affected isoflavone concentration although the response was smaller. For example, stress during the vegetative stages reduced total isoflavones by 33% in OAC Champion. Stress imposed pre-emergence had an opposite effect increasing daidzein concentration by 24% in AC Proteina. Tocopherol concentrations were affected the most when stress was imposed during all stages of development, followed by stress restricted to stages R5-8; response to stress during other stages was limited. The specific response of tocopherols differed, α-tocopherol being increased by high temperature by as much as 752%, the reverse being observed for δ-tocopherol and γ-tocopherol. The present study demonstrates that while isoflavone and tocopherol concentrations in soybeans are affected the most by stress occurring during seed formation, concentrations can also be affected by stress occurring at other stages including stages as early as pre-emergence.

  16. The Clinical Stages of Sporadic Creutzfeldt-Jakob Disease with Met/Met Genotype in Korean Patients.

    Science.gov (United States)

    Park, So Young; Wang, Min Jeong; Jang, Jae-Won; Park, Young Ho; Lim, Jae-Sung; Youn, Young Chul; Kim, Jungeun; Kim, SangYun

    2016-01-01

    Clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) is currently based on changes occurring in the late disease stages, which limits early-stage detection. Therefore, we investigated the disease course from the vague symptomatic to the terminal phase. We retrospectively reviewed 36 sCJD patient records, classifying the disease progression into 4 stages based on clinical manifestations: vague symptomatic, possible CJD, probable CJD and chronic vegetative state. We analyzed findings from diffusion-weighted imaging (DWI), electroencephalography (EEG) and cerebrospinal fluid (CSF) 14-3-3 protein testing performed at each stage. In stage 1, the most distinctive feature was DWI hyperintensities in the neocortex, even with negative CSF 14-3-3 protein and EEG results. In stage 2, DWI hyperintensities in the limbic cortex were more remarkable. CSF 14-3-3 protein testing yielded positive results in >80% of patients; EEG showed sensitivity in disease stage-dependent differences in clinical symptoms and laboratory test results will facilitate early and accurate diagnosis. © 2016 S. Karger AG, Basel.

  17. Assessment of liver fibrosis stage influence on clinical course of periodontal diseases in patients with chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    О. М. Slaba

    2017-08-01

    Full Text Available The aim. To assess the influence of liver fibrosis stage on the clinical course of periodontal diseases in patients with chronic hepatitis C. Material and Methods. 122 patients with chronic hepatitis C, treated at the 7th department ofLvivRegionalInfectiousDiseasesHospital during 2013 – 2015 were included into dental investigation. The periodontal disease was diagnosed in accordance with the classification of M. F. Danilevsky (1994. The clinical condition of periodontium was assessed by the papillary marginal alveolar index (PMA in the modification ofParma, by the periodontal index – PI (AL Russel, 1956, by the Muhlemann and Son index – the degree of bleeding in the region of the gingival papilla (PBI. The stage of liver fibrosis was determined according to the medical history. The significance of the difference between two or more relative indicators was calculated using the Fisher test with the Metropolis algorithm. The correlation dependence between the clinical condition of periodontal tissues and the stage of liver fibrosis in patients with viral hepatitis C was studied using the Spearman rank correlation coefficient. Results. The highest percentage of patients with stage of liver fibrosis F0 (70.00 ± 15.28 % was registered in patients with healthy periodont, the lowest - in patients with generalized periodontitis of the third stage (7.89 ± 4.37 %. The highest frequency of patients with the stage of liver fibrosis F3 (73.68 ± 7.14 % was also observed in persons suffering from generalized periodontitis stage III (73.68 ± 7.14 %. Conclusions. The distribution of periodontal lesion severity statistically significant (p < 0.001 depended on the stage of liver fibrosis in patients with chronic hepatitis C. Direct (R = 0.70; p < 0.001 strong correlation between the clinical state of periodontal tissues and the stage of liver fibrosis in patients with chronic hepatitis C (using the Spearman rank correlation coefficient has been determined

  18. Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L; Horwich, A; Ashley, S

    1994-01-01

    To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy.......To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy....

  19. Periods and stages of the prenatal development of the domestic cat.

    Science.gov (United States)

    Knospe, C

    2002-02-01

    Twenty-two stages of the prenatal development of the domestic cat are described for intraspecies comparison in embryological studies. These are assigned to the 15 embryonal periods based on the Nomina Embryologica Veterinaria to make the interspecies comparison possible.

  20. Collaboration with Pharma Will Introduce Nanotechnologies in Early Stage Drug Development | FNLCR

    Science.gov (United States)

    The Frederick National Lab has begun to assist several major pharmaceutical companies in adopting nanotechnologies in early stage drug development, when the approach is most efficient and cost-effective. For some time, the national lab’s Nanotechno

  1. Collaboration with Pharma Will Introduce Nanotechnologies in Early Stage Drug Development | Poster

    Science.gov (United States)

    The Frederick National Lab has begun to assist several major pharmaceutical companies in adopting nanotechnologies in early stage drug development, when the approach is most efficient and cost-effective.

  2. Effects of laser immunotherapy on late-stage, metastatic breast cancer patients in a Phase II clinical trial

    Science.gov (United States)

    Ferrel, Gabriela L.; Zhou, Feifan; Li, Xiaosong; Hode, Tomas; Nordquist, Robert E.; Alleruzzo, Luciano; Chen, Wei R.

    2014-03-01

    Laser immunotherapy (LIT), a novel technique with a local intervention to induce systemic antitumor effects, was developed to treat metastatic cancers. The pre-clinical studies of LIT have shown its unique characteristics in generating a specific antitumor immunity in treating metastatic tumors in rats and mice. For late-stage, metastatic breast cancer patients, who were considered to be out of other available treatment options, we conducted a small Phase II clinical trial using LIT starting in 2009 in Lima, Peru. This Phase II study was closed in December of 2012, as acknowldged by the Ministry of Health (MOH) of Peur letter 438-2014-OGITT/INS dated March 5th, 2014. Ten patients were enrolled and received LIT in one or multiple 4-week treatment cycles. At the study closing date, four patients were alive and two of them remained cancer free. Here, following the successful conclusion of our Phase II study, we report the clinical effects of LIT on metastatic breast cancer patients. Specifically, we present the overall status of all the patients three years after the treatment and also the outcomes of two long-term surviving patients.

  3. The detection rates and tumor clinical/pathological stages of whole-body FDG-PET cancer screening

    International Nuclear Information System (INIS)

    Ono, Ken; Omagari, Junichi; Ochiai, Reiji; Yoshida, Tsuyoshi; Kitagawa, Mami; Kobayashi, Hisashi; Yamashita, Yasuyuki

    2007-01-01

    Fluorodeoxyglucose (FDG)-positron emission tomography (PET) has been used for cancer screening, mainly in East-Asia, and cancers are found not infrequently. However, their stages have not been clarified. We examined the detection rates of various cancers using whole-body PET for the screening of cancers in asymptomatic individuals, focusing on their clinical and pathological stages. Whole-body PET was obtained as a part of our cancer screening program among 3,426 healthy subjects. All subjects participated in a course of PET examination in conjunction with conventional examinations including a medical questionnaire, tumor markers, immunological fecal occult blood test, neck and abdominal ultrasonography and whole body computed tomography. A diagnosis and staging was obtained by an analysis of the pathological findings or by an analysis of the clinical follow-up data. Malignant tumors were discovered in 65 lesions found in 3,426 participants (1.90%). The PET findings were true-positive in 46 of the 65 cancer cases. The cancers were found in the following organs: the colon 14; thyroid gland 10; stomach 7; lung 5; liver 3; breast 2; and one each in the kidney, gallbladder, esophagus, pancreas and retroperitoneum. The stages were as follows: stage 0 5, stage I 17, stage II 10, stage III 7, and stage IV 6. One was an unknown primary. There were 19 false-negative findings (0.6%) on PET. Six cancers (0.18%) were missed in our screening program. PET imaging has the potential to detect a wide variety of cancers at potentially curative stages. Most PET-negative cancers are early stage cancers, and thus can be detected using other conventional examinations such as endoscopy. (author)

  4. From trust on intimacy: A new inventory for examining erikson's stages of psychosocial development.

    Science.gov (United States)

    Rosenthal, D A; Gurney, R M; Moore, S M

    1981-12-01

    A new inventory for examining the first six of Erikson's psychosocial stages is described. The self-report questionnaire, developed in a pilot study of 97 adolescents and tested in a study of 622 adolescents, has 12 items for each subscale. Measures of reliability and validity are reported. It is concluded that the Erikson Psychosocial Stage Inventory (EPSI) is a useful measure for researchers interested in development from early adolescence and in mapping changes as a function of life events.

  5. Phase II clinical development of new drugs

    CERN Document Server

    Ting, Naitee; Ho, Shuyen; Cappelleri, Joseph C

    2017-01-01

    This book focuses on how to appropriately plan and develop a Phase II program, and how to design Phase II clinical trials and analyze their data. It provides a comprehensive overview of the entire drug development process and highlights key questions that need to be addressed for the successful execution of Phase II, so as to increase its success in Phase III and for drug approval. Lastly it warns project team members of the common potential pitfalls and offers tips on how to avoid them.

  6. The embryonic development of Schistosoma mansoni eggs: proposal for a new staging system.

    Science.gov (United States)

    Jurberg, Arnon D; Gonçalves, Tiana; Costa, Tatiane A; de Mattos, Ana Carolina A; Pascarelli, Bernardo M; de Manso, Pedro Paulo A; Ribeiro-Alves, Marcelo; Pelajo-Machado, Marcelo; Peralta, José M; Coelho, Paulo Marcos Z; Lenzi, Henrique L

    2009-05-01

    Schistosomiasis is a water-borne parasitic illness caused by neoophoran trematodes of the genus Schistosoma. Using classical histological techniques and whole-mount preparations, the present work describes the embryonic development of Schistosoma mansoni eggs in the murine host and compares it with eggs maintained under in vitro conditions. Two pre-embryonic stages occur inside the female worm: the prezygotic stage is characterized by the release of mature oocytes from the female ovary until its fertilization. The zygotic stage encompasses the migration of the zygote through the ootype, where the eggshell is formed, to the uterus. Fully formed eggs are laid still undeveloped, without having suffered any cleavage. In the outside environment, eight embryonic stages can be defined: stage 1 refers to early cleavages and the beginning of yolk fusion. Stage 2 represents late cleavage, with the formation of a stereoblastula and the onset of outer envelope differentiation. Stage 3 is defined by the elongation of the embryonic primordium and the onset of inner envelope formation. At stage 4, the first organ primordia arise. During stages 5 to 7, tissue and organ differentiation occurs (neural mass, epidermis, terebratorium, musculature, and miracidial glands). Stage 7 is characterized by the nuclear condensation of neurons of the central neural mass. Stage 8 refers to the fully formed larva, presenting muscular contraction, cilia, and flame-cell beating. This staging system was compared to a previous classification and could underlie further studies on egg histoproteomics (morphological localizome). The differentiation of embryonic structures and their probable roles in granulomatogenesis are discussed herein.

  7. Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion

    Directory of Open Access Journals (Sweden)

    Candace Wu

    2017-01-01

    Full Text Available Background. Sorafenib, an oral tyrosine kinase inhibitor (TKI, targets multiple tyrosine kinase receptors (TKRs involved in angiogenesis and tumor growth. Studies suggest that inhibition of TKR impacts cardiomyocyte survival. Inhibition of VEGF signaling interrupts angiogenesis and is associated with the development of hypertension and compensatory hypertrophy. Compensated hypertrophy ultimately leads to heart failure. Case Description. A 76-year-old man with a past medical history of systolic heart failure due to ischemic cardiomyopathy and stage IIIC hepatocellular carcinoma (HCC presented with symptoms of decompensated heart failure. Four months prior to admission, he was started on sorafenib. Results. Our patient was treated with intravenous furosemide and guideline directed therapy. Clinical status was complicated by the development of low cardiac output and shock requiring inotropic support. Careful titration of heart failure medication led to hemodynamic improvement and discontinuation of dobutamine. Conclusion. Greater awareness of sorafenib cardiotoxicity is essential. As TKI usage grows for treatment of cancers, heart failure-related complications will increase. In our patient, routine heart failure management and cessation of sorafenib led to clinical improvement. Future studies on the treatment of sorafenib cardiotoxicity should be explored further in this unique patient population.

  8. Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

    Science.gov (United States)

    Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan

    2017-10-01

    Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

  9. Changes in psychosocial well-being during stages of gay identity development.

    Science.gov (United States)

    Halpin, Sean A; Allen, Michael W

    2004-01-01

    The current study evaluated the stage theory of Homosexual Identity Formation (HIF) developed by Cass (1979), in terms of the relationship between stage of gay identity development and psychosocial well-being. Four hundred twenty-five males (12 to 64 years, M = 29.2) reporting sexual attraction to other men provided demographic information and completed psychosocial measures: the Happiness-Sadness Scale (McGreal & Joseph, 1993), the Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985), the UCLA Loneliness Scale (Russell, Peplau & Ferguson, 1978), the Index of Self-Esteem (Hudson, 1982), and the Gay Identity Questionnaire (Brady & Busse, 1994). Correlation analysis and ANCOVAs controlling for age and nationality demonstrated that the 6 sequential stages of HIF were associated with a U-shaped function for the psychosocial variables. Well-being was high during the initial Confusion and Comparison stages of HIF, was reduced during the middle Tolerance and Acceptance stages, and was again high in the later Pride and Synthesis stages. Each of the psychosocial variables was significantly different according to stage of development (p <.001). Qualitative analysis of subjects' comments also revealed support for the U-shaped pattern.

  10. Volatile organic compound emissions from different stages of Cananga odorata flower development.

    Science.gov (United States)

    Qin, Xiao-Wei; Hao, Chao-Yun; He, Shu-Zhen; Wu, Gang; Tan, Le-He; Xu, Fei; Hu, Rong-Suo

    2014-06-27

    Headspace-solid phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) was used to identify the volatile organic compounds (VOCs) of the different flower development stages of Cananga odorata for the evaluation of floral volatile polymorphism as a basis to determine the best time of harvest. Electronic nose results, coupled with discriminant factor analysis, suggested that emitted odors varied in different C. odorata flower development stages, including the bud, display-petal, initial-flowering, full-flowering, end-flowering, wilted-flower, and dried flower stages. The first two discriminant factors explained 97.52% of total system variance. Ninety-two compounds were detected over the flower life, and the mean Bray-Curtis similarity value was 52.45% among different flower development stages. A high level of volatile polymorphism was observed during flower development. The VOCs were largely grouped as hydrocarbons, esters, alcohols, aldehydes, phenols, acids, ketones, and ethers, and the main compound was β-caryophyllene (15.05%-33.30%). Other identified compounds were β-cubebene, D-germacrene, benzyl benzoate, and α-cubebene. Moreover, large numbers of VOCs were detected at intermediate times of flower development, and more hydrocarbons, esters, and alcohols were identified in the full-flowering stage. The full-flowering stage may be the most suitable period for C. odorata flower harvest.

  11. Volatile Organic Compound Emissions from Different Stages of Cananga odorata Flower Development

    Directory of Open Access Journals (Sweden)

    Xiao-Wei Qin

    2014-06-01

    Full Text Available Headspace-solid phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS was used to identify the volatile organic compounds (VOCs of the different flower development stages of Cananga odorata for the evaluation of floral volatile polymorphism as a basis to determine the best time of harvest. Electronic nose results, coupled with discriminant factor analysis, suggested that emitted odors varied in different C. odorata flower development stages, including the bud, display-petal, initial-flowering, full-flowering, end-flowering, wilted-flower, and dried flower stages. The first two discriminant factors explained 97.52% of total system variance. Ninety-two compounds were detected over the flower life, and the mean Bray–Curtis similarity value was 52.45% among different flower development stages. A high level of volatile polymorphism was observed during flower development. The VOCs were largely grouped as hydrocarbons, esters, alcohols, aldehydes, phenols, acids, ketones, and ethers, and the main compound was β-caryophyllene (15.05%–33.30%. Other identified compounds were β-cubebene, D-germacrene, benzyl benzoate, and α-cubebene. Moreover, large numbers of VOCs were detected at intermediate times of flower development, and more hydrocarbons, esters, and alcohols were identified in the full-flowering stage. The full-flowering stage may be the most suitable period for C. odorata flower harvest.

  12. Clinical utility of multigene profiling assays in early-stage breast cancer.

    Science.gov (United States)

    Chang, M C; Souter, L H; Kamel-Reid, S; Rutherford, M; Bedard, P; Trudeau, M; Hart, J; Eisen, A

    2017-10-01

    This clinical practice guideline was developed to determine the level of evidence supporting the clinical utility of commercially available multigene profiling assays and to provide guidance about whether certain breast cancer patient populations in Ontario would benefit from alternative tests in addition to Oncotype dx (Genomic Health, Redwood City, CA, U.S.A.). A systematic electronic Ovid search of the medline and embase databases sought out systematic reviews and primary literature. A systematic review and practice guideline was written by a working group and was then reviewed and approved by Cancer Care Ontario's Molecular Oncology Advisory Committee. Twenty-four studies assessing the clinical utility of Oncotype dx, Prosigna (NanoString Technologies, Seattle, WA, U.S.A.), EndoPredict (Myriad Genetics, Salt Lake City, U.S.A.), and MammaPrint (Agendia, Irvine, CA, U.S.A.) were included in the evidence base. The clinical utility of multigene profiling assays is currently established for an appropriate subset of patients with estrogen receptor-positive, her2-negative, node-negative breast cancer for whom a decision to give chemotherapy is difficult to make. For patients with estrogen receptor-positive tumours who receive tamoxifen alone, Oncotype dx, Prosigna, and EndoPredict validly identify a low-risk population with favourable outcomes, indicating that a low-risk assay result is actionable and the decision to withhold chemotherapy is supported. Clinical evidence indicates that a high Oncotype dx recurrence score can predict for chemotherapy benefit, but a high Prosigna or EndoPredict score, although prognostic, is not, based on clinical trial evidence, directly actionable. Prosigna and EndoPredict are statistically more likely to identify a population at risk for recurrence beyond 5 years, but that information is currently not actionable because of a lack of interventional studies.

  13. Statistical issues for design and analysis of single-arm multi-stage phase II cancer clinical trials.

    Science.gov (United States)

    Jung, Sin-Ho

    2015-05-01

    Phase II trials have been very widely conducted and published every year for cancer clinical research. In spite of the fast progress in design and analysis methods, single-arm two-stage design is still the most popular for phase II cancer clinical trials. Because of their small sample sizes, statistical methods based on large sample approximation are not appropriate for design and analysis of phase II trials. As a prospective clinical research, the analysis method of a phase II trial is predetermined at the design stage and it is analyzed during and at the end of the trial as planned by the design. The analysis method of a trial should be matched with the design method. For two-stage single arm phase II trials, Simon's method has been the standards for choosing an optimal design, but the resulting data have been analyzed and published ignoring the two-stage design aspect with small sample sizes. In this article, we review analysis methods that exactly get along with the exact two-stage design method. We also discuss some statistical methods to improve the existing design and analysis methods for single-arm two-stage phase II trials. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Know-Who? Linking Faculty's Networks to Stages of Instructional Development

    Science.gov (United States)

    Van Waes, Sara; Van den Bossche, Piet; Moolenaar, Nienke M.; De Maeyer, Sven; Van Petegem, Peter

    2015-01-01

    Research into faculty members' instructional development has primarily focused on individual skills and knowledge. As collegial interactions may support or constrain faculty's professional development in higher education, this study compared and contrasted the networks of faculty members in different stages of instructional development (novice,…

  15. The problems of plant control on modern stage of development of the nuclear industry

    Directory of Open Access Journals (Sweden)

    Gusev S. S.

    2017-04-01

    Full Text Available the article describes the successful development of nuclear industry at the present stage of its development, the problems of control of nuclear power plants, their classes and the choices of modern science in the field of design of fast neutron reactors as one of the promising directions of development of atomic energy.

  16. ANALYSIS OF HIV SUBTYPES AND CLINICAL STAGING OF HIV DISEASE/AIDS IN EAST JAVA

    Directory of Open Access Journals (Sweden)

    Yulia Ismail

    2012-04-01

    Full Text Available Human Immunodeficiency Virus type 1 (HIV-1 known to cause Acquired Immune Deficiency Syndrome (AIDS disease are divided into several subtypes (A, B, C, D, F, G, H, J, K and Circulating Recombinant Form (CRF. Different characteristics of subtype of the virus and its interaction with the host can affect the severity of the disease. This study was to analyze HIV-1 subtypes circulating in HIV/AIDS patients from the East Java region descriptively and to analyze its relationship with clinical stadiums of HIV/AIDS. Information from this research was expected to complement the data of mocular epidemiology of HIV in Indonesia. This study utilited blood plasma from patients who had been tested to be HIV positive who sected treatment to or were reffered to the Intermediate Care Unit of Infectious Disease (UPIPI Dr. Soetomo Hospital Surabaya from various area representing the East Java regions. Plasma was separated from blood samples by centrifugation for use in the the molecular biology examination including RNA extraction, nested PCR using specific primer for HIV gp120 env gene region, DNA purifying, DNA sequencing, and homology and phylogenetic analysis. Based on the nucleotide sequence of the HIV gp120 env gene, it was found that the most dominant subtypes in East Java were in one group of Circulating Recombinant Form (CRF that is CRF01_AE, CRF33_01B and CRF34_01B which was also found in Southeast Asia. In the phylogenetic tree, most of HIV samples (30 samples are in the same branch with CRF01_AE, CRF33_01B and CRF34_01B, except for one sample (HIV40 which is in the same branch with subtype B. HIV subtypes are associated with clinical stadiums (disease severity since samples from different stages of HIV disease have the same subtype.

  17. Changes in clinical presentation and staging of lung cancer over two decades.

    Science.gov (United States)

    Leiro-Fernández, Virginia; Mouronte-Roibás, Cecilia; Ramos-Hernández, Cristina; Botana-Rial, Maribel; González-Piñeiro, Ana; García-Rodríguez, Esmeralda; Represas-Represas, Cristina; Fernández-Villar, Alberto

    2014-10-01

    Important clinical and epidemiological changes have been observed in lung cancer (LC) in our healthcare area compared to the previous decade. In the last 10 years, specific LC care circuits have been implemented and the active search for cases has been stepped up. The aim of this study was to analyze the progress of these changes over the last 20 years. This is a retrospective study comparing clinical and epidemiological changes between 2 historical cohorts of LC patients (1992-1994 [group 1, 164 patients] and 2004-2006 [group 2, 250 patients]) and a current group from the period 2011-2012 (group 3, 209 patients) Two hundred and nine (209) LC patients were included in group 3 (2011-2012 period). After comparing groups 3 and 2, a non-significant rise in smoking was observed in women (59% vs 41%, p=.25), while the prevalence of adenocarcinoma was unchanged (45% vs 44%, p=.9). The main changes observed were the increase in cases with previous malignancies (23% vs 16%, p=.04), the rise in patients with no associated LC symptoms (33% vs 16%, p<.001), and an increased number of localized NSCLC (non-small cell LC) diagnoses (42% vs 24% in series 2, p<.001 and 14.2% in series 1, p<.001). The number of LC patients diagnosed in localized stages has increased significantly. Furthermore, the number of patients with no symptoms associated with LC and with a history of previous malignancy were significantly increased. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  18. Treatment results of chemoradiotherapy for clinical stage I (Taman) esophageal carcinoma

    International Nuclear Information System (INIS)

    Yamada, Kazunari; Murakami, Masao; Okamoto, Yoshiaki; Okuno, Yoshishige; Nakajima, Toshifumi; Kusumi, Fusako; Takakuwa, Hiroshi; Matsusue, Satoru

    2006-01-01

    Purpose: In 1991, we started a clinical prospective trial for operable esophageal carcinoma, foreseeing organ preservation, to assess the treatment results after definitive chemoradiotherapy (Crt) for clinical Stage I (Taman) esophageal cancer. Patients and Methods: Between 1992 and 2003, 63 patients were enrolled in this study. Tumor depth was mucosal cancer (T 1a) in 23 and submucosal cancer (T 1b) in 40. Crt consisted of 55-66 Gy/50-60 fractions (median, 59.4 Gy); from 1 to 3 cycles (median, 2) of concurrent chemotherapy (Cisplatin and 5-fluorouracil), followed by high-dose-rate intraluminal brachytherapy 10-12 Gy/2-3 fractions. Results: The 5-year overall and cause-specific and disease-free survival rates were 66.4%, 76.3%, and 63.7%, respectively. The 5-year cause-specific survival rates for T 1a and T 1b cancer patients were 85.2% and 70.0%, respectively (p = 0.06). The 5-year disease-free survival rates for T 1a and T 1b were 84.4% and 50.5%, respectively (p < 0.01). Esophageal fistula as a late toxicity occurred in 2 patients (G: 1; G: 1), and esophageal stricture requiring a liquid diet occurred in 2 patients. Pericardial effusion was observed in 3 patients. Conclusion: We confirmed that patients with Taman esophageal carcinoma had their esophagus preserved in 89.2% of cases after definitive Crt, and the survival rates were equivalent to those of previous reports of surgery

  19. Transmission blocking malaria vaccines: Assays and candidates in clinical development.

    Science.gov (United States)

    Sauerwein, R W; Bousema, T

    2015-12-22

    Stimulated by recent advances in malaria control and increased funding, the elimination of malaria is now considered to be an attainable goal for an increasing number of malaria-endemic regions. This has boosted the interest in transmission-reducing interventions including vaccines that target sexual, sporogenic, and/or mosquito-stage antigens to interrupt malaria transmission (SSM-VIMT). SSM-VIMT aim to prevent human malaria infection in vaccinated communities by inhibiting parasite development within the mosquito after a blood meal taken from a gametocyte carrier. Only a handful of target antigens are in clinical development and progress has been slow over the years. Major stumbling blocks include (i) the expression of appropriately folded target proteins and their downstream purification, (ii) insufficient induction of sustained functional blocking antibody titers by candidate vaccines in humans, and (iii) validation of a number of (bio)-assays as correlate for blocking activity in the field. Here we discuss clinical manufacturing and testing of current SSM-VIMT candidates and the latest bio-assay development for clinical evaluation. New testing strategies are discussed that may accelerate the evaluation and application of SSM-VIMT. Copyright © 2015. Published by Elsevier Ltd.

  20. Clinical outcome of stage III non-small-cell lung cancer patients after definitive radiotherapy.

    Science.gov (United States)

    Nakamura, Tatsuya; Fuwa, Nobukazu; Kodaira, Takeshi; Tachibana, Hiroyuki; Tomoda, Takuya; Nakahara, Rie; Inokuchi, Haruo

    2008-01-01

    Primarily combined radiotherapy and chemotherapy are used to treat unresectable non-small-cell lung cancer; however, the results are not satisfactory. In this study treatment results were retrospectively analyzed and the prognostic factors related to survival were identified. From March 1999 to January 2004, 102 patients with stage IIIA/IIIB non-small-cell lung cancer received definitive radiotherapy with or without chemotherapy. Radiotherapy involved a daily dose of 1.8-2.0 Gy five times a week; 60 Gy was set as the total dose. Maximal chemotherapy was given to patients with normal kidney, liver, and bone marrow functions. The 5-year overall survival rate was 22.2%; the median survival was 18 months. The median follow-up of surviving patients was 53 months. The complete or partial response rate was 85%. At the time of the last follow-up, 21 patients were alive and 81 patients had died, including 5 patients who had died due to radiation pneumonitis. There were significant differences in survival and in the fatal radiation pneumonitis rate between patients with superior lobe lesions and those with middle or inferior lobe lesions. Patients whose primary tumor is located in the superior lobe appear to have a better clinical outcome.

  1. Traditional Chinese medical herbs staged therapy in infertile women with endometriosis: a clinical study.

    Science.gov (United States)

    Ding, Zhaorong; Lian, Fang

    2015-01-01

    Endometriosis is a common gynecological disease defined as the presence of endometrioid tissue (glands and stroma) outside the uterus. About 30 to 40% patients with endometriosis are infertile. In traditional Chinese medical system, endometriosis associated infertility is mostly caused by kidney deficiency and blood stasis. The herb of reinforcing kidney and removing blood stasis is designed to treat the disease. All the 80 up-to-standard patients were divided into two different groups exactly according to the random principle. They were treated with hormone and traditional Chinese medical herb separately. After half year's therapy, all the patients received one year's follow-up. Their transvaginal ultrasonographic changes, serum hormone levels and pregnancy rate were recorded to analysis the effect. No significant difference happened in two groups' demographic and clinical characteristics (P > 0.05). After the treatment, the effect on serum hormone levels and specific markers are significant (P traditional Chinese medical herb is safe and effective for endometriosis patients with infertility. Compared with hormone therapy, traditional Chinese medical herb's two-staged therapy is effective and safe for endometriosis patients with infertility.

  2. Impact of breast pumping on lactogenesis stage II after cesarean delivery: a randomized clinical trial.

    Science.gov (United States)

    Chapman, D J; Young, S; Ferris, A M; Pérez-Escamilla, R

    2001-06-01

    Women at risk for delayed onset of lactation are often advised to pump their breasts before lactogenesis stage II to hasten the timing of this process. The effectiveness of this clinical practice has not been previously evaluated. This study investigates the effects of breast pumping before the onset of lactation on early milk transfer and subsequent breastfeeding duration among women giving birth by cesarean delivery. Sixty women were randomly assigned to either the pumping group (n = 30), which used a double electric breast pump for six 10- to 15-minute sessions from 24 to 72 hours postpartum, or to the control group (n = 30), which held the pump to their breasts without suction for the same amount of time. Milk transfer was assessed by test weighing infants before and after 3 breastfeeding sessions daily. Test weight data were fitted to a second-order polynomial curve, to predict milk transfer over time. Breast pumping between 24 and 72 hours after cesarean delivery did not improve milk transfer. Participants in the pumping group tended to have lower milk transfer than did controls. Primiparae in the pumping group breastfed for ~5 months less than their counterparts in the control group; however, this difference was not statistically significant. Breast pumping did not improve milk transfer during the first 72 hours postpartum and may negatively affect breastfeeding duration among primiparous women. lactation, lactogenesis, breast milk, breast pumping, milk expression, breastfeeding, cesarean delivery.

  3. Type II fatty acid synthesis is essential only for malaria parasite late liver stage development.

    Science.gov (United States)

    Vaughan, Ashley M; O'Neill, Matthew T; Tarun, Alice S; Camargo, Nelly; Phuong, Thuan M; Aly, Ahmed S I; Cowman, Alan F; Kappe, Stefan H I

    2009-03-01

    Intracellular malaria parasites require lipids for growth and replication. They possess a prokaryotic type II fatty acid synthesis (FAS II) pathway that localizes to the apicoplast plastid organelle and is assumed to be necessary for pathogenic blood stage replication. However, the importance of FAS II throughout the complex parasite life cycle remains unknown. We show in a rodent malaria model that FAS II enzymes localize to the sporozoite and liver stage apicoplast. Targeted deletion of FabB/F, a critical enzyme in fatty acid synthesis, did not affect parasite blood stage replication, mosquito stage development and initial infection in the liver. This was confirmed by knockout of FabZ, another critical FAS II enzyme. However, FAS II-deficient Plasmodium yoelii liver stages failed to form exo-erythrocytic merozoites, the invasive stage that first initiates blood stage infection. Furthermore, deletion of FabI in the human malaria parasite Plasmodium falciparum did not show a reduction in asexual blood stage replication in vitro. Malaria parasites therefore depend on the intrinsic FAS II pathway only at one specific life cycle transition point, from liver to blood.

  4. Innovative approaches to clinical development and trial design

    Directory of Open Access Journals (Sweden)

    John J Orloff

    2011-01-01

    Full Text Available Pharmaceutical innovation is increasingly risky, costly and at times inefficient, which has led to a decline in industry productivity. Despite the increased investment in R&D by the industry, the number of new molecular entities achieving marketing authorization is not increasing. Novel approaches to clinical development and trial design could have a key role in overcoming some of these challenges by improving efficiency and reducing attrition rates. The effectiveness of clinical development can be improved by adopting a more integrated model that increases flexibility and maximizes the use of accumulated knowledge. Central to this model of drug development are novel tools, including modelling and simulation, Bayesian methodologies, and adaptive designs, such as seamless adaptive designs and sample-size re-estimation methods. Applications of these methodologies to early- and late-stage drug development are described with some specific examples, along with advantages, challenges, and barriers to implementation. Because they are so flexible, these new trial designs require significant statistical analyses, simulations and logistical considerations to verify their operating characteristics, and therefore tend to require more time for the planning and protocol development phase. Greater awareness of the distinct advantages of innovative designs by regulators and sponsors are crucial to increasing the adoption of these modern tools.

  5. Identification of an AP2-family protein that is critical for malaria liver stage development.

    Directory of Open Access Journals (Sweden)

    Shiroh Iwanaga

    Full Text Available Liver-stage malaria parasites are a promising target for drugs and vaccines against malaria infection. However, little is currently known about gene regulation in this stage. In this study, we used the rodent malaria parasite Plasmodium berghei and showed that an AP2-family transcription factor, designated AP2-L, plays a critical role in the liver-stage development of the parasite. AP2-L-depleted parasites proliferated normally in blood and in mosquitoes. However, the ability of these parasites to infect the liver was approximately 10,000 times lower than that of wild-type parasites. In vitro assays showed that the sporozoites of these parasites invaded hepatocytes normally but that their development stopped in the middle of the liver schizont stage. Expression profiling using transgenic P. berghei showed that fluorescent protein-tagged AP2-L increased rapidly during the liver schizont stage but suddenly disappeared with the formation of the mature liver schizont. DNA microarray analysis showed that the expression of several genes, including those of parasitophorous vacuole membrane proteins, was significantly decreased in the early liver stage of AP2-L-depleted parasites. Investigation of the targets of this transcription factor should greatly promote the exploration of liver-stage antigens and the elucidation of the mechanisms of hepatocyte infection by malaria parasites.

  6. Preliminary study of clinical staging of moderately advanced and advanced thoracic esophageal carcinoma treated by non-surgical methods

    International Nuclear Information System (INIS)

    Zhu Shuchai; Li Ren; Li Juan; Qiu Rong; Han Chun; Wan Jun

    2004-01-01

    Objective: To explore the clinical staging of moderately advanced and advanced thoracic esophageal carcinoma by evaluating the prognosis and provide criteria for individual treatment. Methods: The authors retrospectively analyzed 500 patients with moderately advanced and advanced thoracic esophageal carcinoma treated by radiotherapy alone. According to the primary lesion length by barium meal X-ray film, the invasion range and the relation between location and the surrounding organs by CT scans the disease category was classified by a 6 stage method and a 4 stage method. With the primary lesion divide into T1, T2a, T2b, T3a, T3b and T4 incorporating the locregional lymph node metastasis, a 6 stage system was obtained, I, IIa , IIb, IIIa, IIIb and IV. The results of this as compared with those of 4 stage system, the following data were finally arrived at. Results: Among the 500 cases, there were T1 23, T2a 111, T2b 157, T3a 84, T3b 82 and T4 43. The survival rates of these six categories showed significant differences (χ 2 =63.32, P 2 =56.29, P 2 =94.29, P 2 =83.48, P<0.05). Conclusions: Both the 6 stage and 4 stage systems are adaptable to predict prognosis of moderately advanced and advanced esophageal carcinoma treated by radiotherapy alone. For simplicity and convenience, the 4 stage classification is recommended. (authors)

  7. Method of development force at the young gymnasts on the stages of initial and specialized preparation

    Directory of Open Access Journals (Sweden)

    Khudolii O.N.

    2010-08-01

    Full Text Available The terms of effective development of force are considered for young gymnasts on the stages of initial and specialized preparation. The models of urgent and moved aside training effect of the power loadings are certain for young gymnasts 7-13 years. It is set that the process of power preparation of young gymnasts can be separate on two stages. On the first stage by means of the concentrated power loadings the expressed decline of force of group of muscles is arrived at. On the second stage by means of favourable a display maximal efforts of loadings the increase of force of group of muscles is arrived at. Application of the power loadings of different orientation is given by possibility during 10-12 employments on 30-60% to increase force of group of muscles, shorten time of training on development of force in two times.

  8. Clinical data combined with radiological imaging improves the accuracy of TNM staging of pancreatic body and tail adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Xu W

    2017-10-01

    Full Text Available Wei Xu,* Bo Jiang,* Xinmin Yin* Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, Changsha, China *These authors contributed equally to this work Purpose: Pancreatic body and tail adenocarcinoma (PBTA remains one of the deadliest cancers, and current radiological modalities still have limitations on the staging of PBTA. Improving PBTA staging will contribute to the management of this disease.Patients and methods: Clinicopathological characteristics of 91 surgically treated PBTA patients were retrospectively retrieved. Clinical data associated with postoperative tumor staging (pTNM were assessed using ordinal logistic regression model. Discriminant analysis was performed using function formula based on multivariate analysis results; further cross-validation was conducted by Bootstrap methods.Results: Multivariate analysis showed that carbohydrate antigen 19-9 ≥955.0 U/L, albumin, and alkaline phosphatase/total bilirubin ratio were independent factors contributing to improved accuracy of pTNM staging. Discriminant analysis exhibited better performance and showed that the probability of accurate prediction of pTNM stage was 90.6% and the probability of cross-validation was 85.9%. After excluding patients with preoperative diagnosis of stage IV disease, the probability of accurate prediction of pTNM stage was 86.1% and the probability of cross-validation was 75.0%.Conclusion: The combination of imaging and clinical data has higher accuracy in staging PBTA than radiological data alone. A model proposed in this study will improve the management of PBTA. Keywords: pancreatic cancer, pancreatic body and tail adenocarcinoma, TNM staging, diagnostic imaging

  9. Effect of Habits and Nutritional Status on Clinical Grading and Histopathological Staging in Patients with Oral Sub Mucous Fibrosis

    Science.gov (United States)

    Lanke, Rama Brahmam; Shetty, Rakhith; Akifuddin, Syed; Sahu, Manish; Singh, Navneet; Kaur, Gagandeep; Goyal, Garish

    2015-01-01

    Background Oral submucous fibrosis (OSMF) is a chronic progressive debilitating disease affecting the oral, oropharyngeal and sometimes the oesophageal mucosa resulting in inability to eat due to burning, ulcers and stiffness. Aim The study was undertaken, to evaluate the correlation of clinical staging, histological grading and nutritional status using body mass index (BMI) with gutkha (habit) index in OSMF patients. Materials and Methods The study group comprised of 50 patients clinically diagnosed and histopathologically confirmed cases of OSMF. Habit (gutkha) index was calculated by multiplying duration and frequency. Body mass index was calculated by dividing weight in kilograms and height in centimetres of the patient. Results Male to female ratio was 2.8:1. Clinical grading increased with increase in gutkha index, patients with gutkha index 1-50, maximum were in mild stage; with gutkha index 51-100, maximum in moderate and patients with gutkha index 101-150, all were in severe stage. Histological staging showed direct correlation with gutkha index, it increased with increase in gutkha index with p <0.05. Site analysis showed that buccal mucosa and retromolar area were involved in all the patient and floor of mouth in 46% of patients Body mass index analysis revealed that out of 27 patients with moderate clinical staging 3 was underweight; out of 3 with severe clinical staging, 2 was underweight. Conclusion The duration and frequency of areca nut product use effects on the incidence and severity of OSMF and the patient becomes unable to eat due to burning, ulcers and inability to open mouth which affect the health of the individual. Thus it is important to access the nutritional status to improve the survival rate of patients. PMID:26557616

  10. CRITERIA OF THE CLINICAL OUTCOME OF THE ACUTE CORONARY SYNDROME INTO THE PROGRESSIVE STENOCARDIA AT THE HOSPITAL STAGE

    Directory of Open Access Journals (Sweden)

    M. G. Alieva

    2017-01-01

    Full Text Available Aim. The aim of this study is to develop a prognostic flowchart for the clinical outcome of acute coronary syndrome into progressive stenocardia at the hospital stage.Materials and methods. The studies were carried out basing on the results of the survey of 68 patients admitted to the infarction department of the Republican Clinical Hospital of the Center for Special Emergency Medical Care in Makhachkala in 2015 which correspond to the basic principles of the Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects as amended in 2000. The severity of acute heart failure by Killip, electrocardiography (ECG and EchoCG studies were conducted according to generally accepted standards.Findings. The research allowed developing the model of the prognostic block diagram. All indicators of relative risk (RR for the studied indicators were reliable. Calculations of the values of RR were carried out according to the most frequent ranges of concentration of indicators of the number of patients. The greatest statistical power was possessed by concentration ranges for cardiac markers - TP-I from 0.6 to 1.1 ng / ml and BNP-32 from 60 to 110 pg / ml; For inflammation markers - IL-1β from 1.4 to 2.4 pg / ml and TNF-α from 2.6 to 3.6 pg / ml; For endothelial dysfunction markers - NO from 10 to 15 μmol / l and ET from 3.3 to 4.3 fmol / ml; For immunomarkers, cardiolipin antibodies (CA from 1 to 3 U / ml and NP from 17 to 26 nmol / l. Measurement of these parameters at the initial stage of admission of patients with acute coronary syndrome (ACS to the hospital (the starting point of reference and the statement of positive results (the point of separation made it possible to predict the outcome of ACS into the progressive stenocardia (end point with high probability.Conclusion. In the calculation of relative risk, were taken into account the concentration ranges that were most frequently encountered among the number of patients

  11. Why Are There Developmental Stages in Language Learning? A Developmental Robotics Model of Language Development.

    Science.gov (United States)

    Morse, Anthony F; Cangelosi, Angelo

    2017-02-01

    Most theories of learning would predict a gradual acquisition and refinement of skills as learning progresses, and while some highlight exponential growth, this fails to explain why natural cognitive development typically progresses in stages. Models that do span multiple developmental stages typically have parameters to "switch" between stages. We argue that by taking an embodied view, the interaction between learning mechanisms, the resulting behavior of the agent, and the opportunities for learning that the environment provides can account for the stage-wise development of cognitive abilities. We summarize work relevant to this hypothesis and suggest two simple mechanisms that account for some developmental transitions: neural readiness focuses on changes in the neural substrate resulting from ongoing learning, and perceptual readiness focuses on the perceptual requirements for learning new tasks. Previous work has demonstrated these mechanisms in replications of a wide variety of infant language experiments, spanning multiple developmental stages. Here we piece this work together as a single model of ongoing learning with no parameter changes at all. The model, an instance of the Epigenetic Robotics Architecture (Morse et al 2010) embodied on the iCub humanoid robot, exhibits ongoing multi-stage development while learning pre-linguistic and then basic language skills. Copyright © 2016 Cognitive Science Society, Inc.

  12. Development of a renal transplant clinical pathway: one hospital's journey.

    Science.gov (United States)

    Darrikhuma, I M

    1999-05-01

    Mounting pressures to resolve multiple challenges related to quality, cost, and access in a resource-driven, customer-focused health care environment have compelled clinicians to develop innovative strategies to provide cost-effective, state-of-the-art care. Targeted patient groups include those associated with high cost, high volume, or high resource use. Patients undergoing renal transplantation fall into one or more of these categories. Recently, the management of patients with end-stage renal disease (ESRD) has come under national focus, as evidenced by the fact that Health Care Financing Administration (HCFA) has commissioned an ESRD managed care demonstration project. The purpose of this article is to describe how one case management tool--the clinical pathway--can be used to decrease costs and improve outcomes associated with renal transplantation. This discussion will include a review of the origins and components of clinical pathways and a description of how one institution developed, implemented, evaluated, and refined a renal transplantation clinical pathway.

  13. Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L.; Horwich, A.; Ashley, S.

    1994-01-01

    patients in the International Database on Hodgkin's Disease who were initially in clinical Stages I or II, who were staged with laparotomy, and who relapsed after initial treatment with irradiation alone. Factors analyzed for outcome after first relapse included initial stage, age, sex, histology......PURPOSE: To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy. METHODS AND MATERIALS: Data were analyzed on 681...

  14. Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease

    DEFF Research Database (Denmark)

    Specht, L.; Horwich, A.; Ashley, S.

    1994-01-01

    PURPOSE: To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy. METHODS AND MATERIALS: Data were analyzed on 681...... patients in the International Database on Hodgkin's Disease who were initially in clinical Stages I or II, who were staged with laparotomy, and who relapsed after initial treatment with irradiation alone. Factors analyzed for outcome after first relapse included initial stage, age, sex, histology...

  15. P38 mitogen-activated protein kinase (p38 MAPK) overexpression in clinical staging of nasopharyngeal carcinoma

    Science.gov (United States)

    Farhat; Asnir, R. A.; Yudhistira, A.; Daulay, E. R.; Muzakkir, M. M.; Yulius, S.

    2018-03-01

    Molecular biological research on nasopharyngeal carcinoma has been widely practiced, such as VEGF, EGFR, COX-2 expression and so on. MAPK plays a role in cell growth such as proliferation, differentiation, and apoptosis, primarily contributing to gene expression, where p38 MAPK pathway mostly associate with anti-apoptosis and cause cell transformation. The aim of this study is to determine the expression of p38 MAPK in clinical stage of nasopharyngeal carcinoma so that the result can be helpful in prognosis and adjunctive therapy in nasopharyngeal carcinoma. The research design is descriptive. It was done in THT- KL Department of FK USU/RSUP Haji Adam Malik, Medan and Pathology Anatomical Department of FK USU. The study was conducted from December 2011 to May 2012. The Samples are all patients who diagnosed with nasopharyngeal carcinoma in oncology division of Otorhinolaryngology Department. p38 MAPK overexpression was found in 21 samples (70%) from 30 nasopharyngeal carcinoma samples. The elevated of p38 MAPK expression most found on T4 by eight samples (38.1%), N3 lymph node group by nine samples (42.9%), stage IV of clinical staging is as many as 15 samples (71.4%). p38 MAPK most expressed in stage IV clinical staging of patients with nasopharyngeal carcinoma.

  16. American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    OpenAIRE

    Azzoli, Christopher G.; Giaccone, Giuseppe; Temin, Sarah

    2010-01-01

    ASCO published a guideline on use of chemotherapy in advanced stage non–small-cell lung cancer in 1997. The latest update covers treatment with chemotherapy and biologic agents and reviews literature from 2002 to 2009.

  17. Classification of Clinical Research Study Eligibility Criteria to Support Multi-Stage Cohort Identification Using Clinical Data Repositories.

    Science.gov (United States)

    Cimino, James J; Lancaster, William J; Wyatt, Mathew C

    2017-01-01

    One of the challenges to using electronic health record (EHR) repositories for research is the difficulty mapping study subject eligibility criteria to the query capabilities of the repository. We sought to characterize criteria as "easy" (searchable in a typical repository), "hard" (requiring manual review of the record data), and "impossible" (not typically available in EHR repositories). We obtained 292 criteria from 20 studies available from Clinical Trials.gov and rated them according to our three types, plus a fourth "mixed" type. We had good agreement among three independent reviewers and chose 274 criteria that were characterized by single types for further analysis. The resulting analysis showed typical features of criteria that do and don't map to repositories. We propose that these features be used to guide researchers in specifying eligibility criteria to improve development of enrollment workflow, including the definition of EHR repository queries for self-service or analyst-mediated retrievals.

  18. Development of the Clinical Teaching Effectiveness Questionnaire in the United States

    Directory of Open Access Journals (Sweden)

    Michelle E. Wormley

    2017-06-01

    Full Text Available Purpose The purpose of this study was to develop a valid measure for assessing clinical teaching effectiveness within the field of physical therapy. Methods The Clinical Teaching Effectiveness Questionnaire (CTEQ was developed via a 4-stage process, including (1 initial content development, (2 content analysis with 8 clinical instructors with over 5 years of clinical teaching experience, (3 pilot testing with 205 clinical instructors from 2 universities in the Northeast of the United States, and (4 psychometric evaluation, including principal component analysis. Results The scale development process resulted in a 30-item questionnaire with 4 sections that relate to clinical teaching: learning experiences, learning environment, communication, and evaluation. Conclusion The CTEQ provides a preliminary valid measure for assessing clinical teaching effectiveness in physical therapy practice.

  19. Fish early life stage: Developing AOPs to support targeted reduction and replacement

    Science.gov (United States)

    There is an interest in developing alternatives to the fish early-life stage (FELS) test (OECD test guideline 210), for predicting adverse chronic toxicity outcomes (e.g., impacts on growth and survival). Development and characterization of adverse outcome pathways (AOPs) related...

  20. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient

    Directory of Open Access Journals (Sweden)

    M. A. C. Onuigbo

    2014-01-01

    Full Text Available Despite decades of research, a full understanding of chronic kidney disease (CKD-end stage renal disease (ESRD progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34% patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92 years. Precipitating AKI followed pneumonia (8, acutely decompensated heart failure (7, pyelonephritis (4, post-operative (5, sepsis (3, contrast-induced nephropathy (2, and others (2. Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.

  1. Dyskerin overexpression in human hepatocellular carcinoma is associated with advanced clinical stage and poor patient prognosis.

    Directory of Open Access Journals (Sweden)

    Bei Liu

    Full Text Available BACKGROUND: Dyskerin (encoded by the DKC1 gene is an essential nucleolar protein involved in cell proliferation, where it is required for the pseudo-uridylation of ribosomal RNA (rRNA molecules and the stabilization of the telomerase RNA component. Dyskerin expression has been reported to predict poor survival in some cancer patients. The aim of the present study was to analyze the expression of dyskerin in hepatocellular carcinoma (HCC and to determine its correlation with clinicopathologic features, including the survival of patients with HCC. METHODOLOGY/PRINCIPAL FINDINGS: Dyskerin protein expression was detected by immunohistochemistry in paraffin sections of 252 HCC cases and 80 noncancerous liver tissues. The correlation was analyzed between dyskerin expression levels and clinicopathologic variables and prognosis. Dyskerin protein was significantly overexpressed in HCC tissues when compared to noncancerous liver tissue. Dyskerin overexpression was positively correlated with the hepatitis B surface antigen status, serum alpha-fetoprotein, and advanced clinical stage in HCC patients. A survival analysis indicated that HCC patients with higher dyskerin expression had a significantly shorter overall survival and 5-year survival time when compared to those with low expression. A multivariate analysis suggested that dyskerin overexpression was an independent factor for prognosis (hazard risk, 2.912; P = 0.007. Expression of DKC1 mRNA was measured by quantitative RT-PCR in 80 HCC and 50 non-cancerous tissues. The relationship between DKC1, TERT, MKI67, and MYC mRNA expression in HCC tissues was also evaluated. DKC1 mRNA was significantly overexpressed in HCC tissues and showed a significant correlation with MKI67 and MYC mRNA but a weak correlation with TERT mRNA. CONCLUSIONS/SIGNIFICANCE: Dyskerin overexpression in HCC patients was correlated with MYC and MKI67 expression and showed a possible involvement in the tumorigenic process. Dyskerin

  2. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection

    NARCIS (Netherlands)

    Rodrigo, J.P.; Shah, J.P.; Silver, C.E.; Medina, J.E.; Takes, R.P.; Robbins, K.T.; Rinaldo, A.; Werner, J.A.; Ferlito, A.

    2011-01-01

    The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this

  3. Detection of virus level in tissues of rainbow trout, Oncoryhinchus mykiss in clinical stage of viral hemorrhagic septicemia

    DEFF Research Database (Denmark)

    Ghiasi, Farzad; Olesen, Niels Jørgen

    2014-01-01

    In order to detecting VHS virus titer in various tissues in clinical stage of VHS disease, rainbow trout, Oncorhynchus mykiss, were exposed to virus by bath. The experiments were carried out with 140 fish obtained from rainbow trout farm. The fish were divided into two equal groups in 120 Liter t...

  4. Clinical efficacy of paclitaxel in the treatment of mid-stage and ...

    African Journals Online (AJOL)

    Conclusion: Paclitaxel has a significant effect when used to treat mid-stage and advanced gastric cancer. Moreover, additional nursing not only enhances the therapeutic effect but also improves prognosis and quality-of-life. Keywords: Paclitaxel, Mid-stage/advanced cancer, Gastric cancer, Nursing efficacy, Karnofsky ...

  5. Clinical experience with radiation enhancement by hyperbaric oxygen in children with recurrent neuroblastoma stage IV

    NARCIS (Netherlands)

    Voûte, P. A.; van der Kleij, A. J.; de Kraker, J.; Hoefnagel, C. A.; Tiel-van Buul, M. M.; van Gennip, H.

    1995-01-01

    The high risk group of patients with neuroblastoma are children over 1 year with stage IV disease. Most series report a maximum of 20% survival at 5 years. For recurrent neuroblastoma stage IV, cure rates are not reported in the literature, but they are nil. Any treatment for recurrent neuroblastoma

  6. Investigational BET bromodomain protein inhibitors in early stage clinical trials for acute myelogenous leukemia (AML).

    Science.gov (United States)

    Braun, Thorsten; Gardin, Claude

    2017-07-01

    Acute myelogenous leukemia (AML) is a heterogeneous group of malignancies driven by genetic mutations and deregulated epigenetic control. Relapse/refractory disease remains frequent in younger patients and even more so in older patients, including treatment with epigenetic drugs in this age group, mainly with hypomethylating agents. New treatment strategies are urgently needed. The recent discovery that epigenetic readers of the bromodomain (BRD) and extraterminal (BET) protein family, are crucial for AML maintenance by transcription of oncogenic c-MYC lead to rapid development of BET inhibitors entering clinical trials. Areas covered: We provide a critical overview using main sources for the use of BET inhibitors in AML treatment. Limits of this treatment approach including resistance mechanisms and future directions including development of new generation BET inhibitors and combination strategies with other drugs are detailed. Expert opinion: BET inhibitors were expected to overcome limits of conventional treatment in patients as impressive in vitro data emerged recently in well-characterized AML subsets, including those associated with poor risk characteristics in the clinic. Nevertheless single activity of BET inhibitors appears to be modest and resistance mechanisms were already identified. BET inhibitors with alternative mechanisms of action and/or combination strategies with epigenetic drugs should be tested.

  7. Development and tests of fast 1-MA linear transformer driver stages

    Directory of Open Access Journals (Sweden)

    A. A. Kim

    2009-05-01

    Full Text Available In this article we present the design and test results of the most powerful, fast linear transformer driver (LTD stage developed to date. This 1-MA LTD stage consists of 40 parallel RLC (resistor R, inductor L, and capacitor C circuits called “bricks” that are triggered simultaneously; it is able to deliver ∼1  MA current pulse with a rise time of ∼100  ns into the ∼0.1-Ohm matched load. The electrical behavior of the stage can be predicted by using a simple RLC circuit, thus simplifying the designing of various LTD-based accelerators. Five 1-MA LTD stages assembled in series into a module have been successfully tested with both resistive and vacuum electron-beam diode loads.

  8. Development of a XYθz 3-DOF nanopositioning stage with linear displacement amplification device

    Directory of Open Access Journals (Sweden)

    Chu Chih-Liang

    2017-01-01

    Full Text Available The main purpose of this study is to develop a XYθZ 3-DOF nanopositioning stage with linear displacement amplification device. This stage is used by three groups of linear displacement amplification device to composition, and thus achieves precise XYθZ 3-DOF movement. The linear displacement amplification device makes use of a symmetrical layer mechanism, toggle amplification mechanism and parallel guiding spring to composition, and with amplification capability. Then it uses an equilateral triangle way to set the three groups of linear displacement amplification device. Overall design uses the finite element software ANSYS 12.0 to analysis the displacement, stress and dynamic response of nanopositioning stage. Experiment demonstrated takes the laser interferometer as the standard of displacement measurement. The result of experiment measurement shows that the maximum XY axis displacement and θZ rotational angle travel of the stage is 36.5 μm, 32 μm and 265 arc sec.

  9. [Clinical-pharmacological aspects to accelerate the development process from the preclinical to the clinical phase/1st communication: The contribution of clinical pharmacology].

    Science.gov (United States)

    Kuhlmann, Jochen

    2004-01-01

    To improve the transition from research to development a critical evaluation of the individual project by research and disease area teams is required to include input from pharmacology, toxicology, pharmacokinetics, galenics, clinical pharmacology, clinical as well as regulatory experts and marketing. Decisions on the individual development strategy should be made prior to the start of development and all projects should be reviewed at predefined stages throughout the product development life cycle. This ensures consistency of decision-making not only during the development of individual products but throughout the entire development pipeline. Studies in the exploratory stage of drug development should be designed for decision making in contrast to later clinical trials in the confirmatory stage that require power for proof-of-safety and proof-of-efficacy. The more thorough and profound studies have been carried out during this exploratory stage of drug development, the earlier a decision can be made on the continuation or discontinuation of further development, thus saving development time and money and assessing and considerably reducing the risk for the patients and increasing the success rate of the project in the later confirmatory effectiveness trial with an adequate number of subjects receiving the new therapy under typical conditions of use. Strategies which may be helpful to improve the quality of decisions in drug discovery and drug development are: discovery experiments should be done to critically evaluate the compound, the "killer" experiments should be done as early as possible, continuous effort on preclinical disease models is necessary to improve predictability of efficacy in patients ("humanized" research): genomic technology should be used to identify novel, disease-related targets and to characterise preclinical test systems, improvement of knowledge and experience concerning the relevance of new technologies for the clinical picture; genotyping

  10. Diagnosis of clinical staging of bladder cancer by CT and angiography

    International Nuclear Information System (INIS)

    Kobayashi, Isao; Igawa, Mikio; Ohnishi, Yoshio; Nakano, Hiroshi; Nihira, Hiromi; Mori, Masaki; Okada, Mitsuo.

    1984-01-01

    The preoperative staging of bladder cancer is of fundamental importance for prognostic evaluation and surgical indication. We studied the accuracy of computed tomography (CT) and angiography in defining the extent of local invasion in 16 patients with surgically proven carcinoma of the bladder. The overall accuracy of CT and angiographic staging in these cases was 75 % and 50 % respectively. In low stage, the accuracy was 90 % in CT and 70 % in angiography. In high stage, the accuracy was 50 % in CT and 16.7 % in angiography. Our results seems to indicate lower accuracy in high stage bladder cancer compared with other research. Data from a much larger series are required to ascertain whether the additional information provided by CT and angiography will produce any improvement in patient management. (author)

  11. Aerodynamic Analyses and Database Development for Ares I Vehicle First Stage Separation

    Science.gov (United States)

    Pamadi, Bandu N.; Pei, Jing; Pinier, Jeremy T.; Holland, Scott D.; Covell, Peter F.; Klopfer, Goetz, H.

    2012-01-01

    This paper presents the aerodynamic analysis and database development for the first stage separation of the Ares I A106 Crew Launch Vehicle configuration. Separate databases were created for the first stage and upper stage. Each database consists of three components: isolated or free-stream coefficients, power-off proximity increments, and power-on proximity increments. The power-on database consists of three parts, all plumes firing at nominal conditions, the one booster deceleration motor out condition, and the one ullage settling motor out condition. The isolated and power-off incremental databases were developed using wind tunnel test data. The power-on proximity increments were developed using CFD solutions.

  12. The Clinical Functional Impairment Scale Development.

    Science.gov (United States)

    Sandler, Adrian; Wright, Mary Ellen; Denslow, Sheri

    2017-10-01

    The purpose of the project was to review content validity and assess the span of responses for the newly developed Clinical Functional Impairment Scale (CFIS). A cross-sectional, content validity process using focus groups of developmental, behavioral pediatric clinicians was conducted. After qualitative analysis of the focus group data, adjustments were made in the CFIS based on the recommendations of the content experts. A survey was conducted of clinicians participating in the online Society of Developmental and Behavioral Pediatrics Discussion Board. Clinicians reviewed 2 case studies and used the CFIS to score severity and interval change of predetermined functional impairments. The amount of spread in the answers was assessed by calculating the index of dispersion. Qualitative analysis of the focus groups resulted in adjustment to the CFIS to 20 functional impairments, with a 5-point Likert scale of severity and a 7-point Likert scale of interval change. Ninety-four clinicians participated in the survey. The index of dispersion ranged from 0.49 to 0.88. The interval ratings of severity and interval change had lower dispersion ranges. The CFIS uses a mutual prioritization by the family and clinician of the child's functional impairments. The study demonstrated that the clinicians' ratings of the case studies were more variable in the initial symptom severity score than their ratings of symptom severity and interval change in symptoms. Further testing of the CFIS is planned using face-to-face clinical encounters and including parent/caregiver ratings of severity and interval change.

  13. Are stage IV vestibular schwannomas preoperatively different from other stages?

    Science.gov (United States)

    Tringali, Stéphane; Dubreuil, Christian; Zaouche, Sandra; Ferber-Viart, Chantal

    2008-01-01

    contrast, the occurrence of balance disorder was higher in Stage IV compared with all other stages. In clinical and paraclinical manifestation, Stage IV VS is different from the other stages. The PTA differences may be attributed to the younger age. Occurrence of clinical symptoms, ABR, and VNG pattern can be explained by the fact that Stage IV develops rapidly in the vestibular, rather than the cochlear nerve and by the fact that larger tumors can be cerebellar compression. This has been confirmed by the higher occurrence of balance disorders in Stage IV and the lower occurrence of tinnitus with similar hearing loss in all stages.

  14. 7-year follow-up after stereotactic ablative radiotherapy for patients with stage I non-small cell lung cancer: Results of a phase 2 clinical trial.

    Science.gov (United States)

    Sun, Bing; Brooks, Eric D; Komaki, Ritsuko U; Liao, Zhongxing; Jeter, Melenda D; McAleer, Mary F; Allen, Pamela K; Balter, Peter A; Welsh, James D; O'Reilly, Michael S; Gomez, Daniel; Hahn, Stephen M; Roth, Jack A; Mehran, Reza J; Heymach, John V; Chang, Joe Y

    2017-08-15

    The authors evaluated the efficacy, patterns of failure, and toxicity of stereotactic ablative radiotherapy (SABR) for patients with medically inoperable, clinical stage I non-small cell lung cancer (NSCLC) in a prospective clinical trial with 7 years of follow-up. Clinical staging was performed according to the seventh edition of the American Joint Committee on Cancer TNM staging system. Eligible patients with histologically confirmed NSCLC of clinical stage I as determined using positron emission tomography staging were treated with SABR (50 grays in 4 fractions). The primary endpoint was progression-free survival. Patients were followed with computed tomography and/or positron emission tomography/computed tomography every 3 months for the first 2 years, every 6 months for the next 3 years, and then annually thereafter. A total of 65 patients were eligible for analysis. The median age of the patients was 71 years, and the median follow-up was 7.2 years. A total of 18 patients (27.7%) developed disease recurrence at a median of 14.5 months (range, 4.3-71.5 months) after SABR. Estimated incidences of local, regional, and distant disease recurrence using competing risk analysis were 8.1%, 10.9%, and 11.0%, respectively, at 5 years and 8.1%, 13.6%, and 13.8%, respectively, at 7 years. A second primary lung carcinoma developed in 12 patients (18.5%) at a median of 35 months (range, 5-67 months) after SABR. Estimated 5-year and 7-year progression-free survival rates were 49.5% and 38.2%, respectively; the corresponding overall survival rates were 55.7% and 47.5%, respectively. Three patients (4.6%) experienced grade 3 treatment-related adverse events. No patients developed grade 4 or 5 adverse events (toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 3.0]). With long-term follow-up, the results of the current prospective study demonstrated outstanding local control and low toxicity after SABR in

  15. Targeting mental health care attributes by diagnosis and clinical stage: the views of youth mental health clinicians.

    Science.gov (United States)

    Hamilton, Matthew P; Hetrick, Sarah E; Mihalopoulos, Cathrine; Baker, David; Browne, Vivienne; Chanen, Andrew M; Pennell, Kerryn; Purcell, Rosemary; Stavely, Heather; McGorry, Patrick D

    2017-11-20

    To explore the potential utility of clinical stage and mental disorder categories as a basis for determining which attributes of youth mental health care should be offered to which groups of young people. In June 2017, we conducted an online survey of youth mental health clinicians that collected information on the participants' background and areas of expertise, then presented vignettes describing young people with different stages of six mental disorders (disorder-based vignettes were matched to participants' area of expertise). For each vignette, participants were asked to give a quantitative estimate of the proportion of young people with similar mental health problems they thought would clinically benefit from each of twelve attributes of mental health care (other than pharmacological or individual psychological therapies). Survey results were analysed as independent, disorder-based samples, using standard statistical tests of significance, and as a stratified sample using mixed-effects models. A total of 412 clinicians working in 32 countries participated in both parts of the survey. Respondents represented a broad range of clinical disciplines, settings and areas of expertise. Their estimated proportions of young people who would benefit from the mental health care attributes varied by clinical stage and disorder (eg, a mean of 93% [interquartile range (IQR), 90%-100%] of young people with Stage 2 psychosis were estimated to benefit from case management with a multidisciplinary team; while only 15% [IQR, 1%-25%] of young people with Stage 1b generalised anxiety disorder were estimated to benefit from collection and processing of biological samples). Neither the background of the respondents nor the sex of the characters in the vignettes significantly influenced the results. A combination of clinical stage and disorder information might be an appropriate basis for ensuring that the right attributes of early intervention mental health care are provided to the

  16. Surgical resection improves long-term survival of patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages

    Directory of Open Access Journals (Sweden)

    Guo H

    2018-02-01

    Full Text Available Hui Guo,1,2 Tao Wu,2 Qiang Lu,1,3 Miaojing Li,2 Jing-Yue Guo,2 Yuan Shen,4 Zheng Wu,1,3 Ke-Jun Nan,2 Yi Lv,1,3 Xu-Feng Zhang1,3 1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 2Department of Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 3Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China; 4Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China Objectives: Surgical resection remains a controversial treatment for hepatocellular carcinoma (HCC within different Barcelona Clinic Liver Cancer (BCLC stages. The objective of this study was to evaluate the long-term outcome of patients undergoing surgical resection (SR compared to non-surgical treatments across different BCLC stages.Patients and methods: One thousand four hundred forty-three HCC patients within BCLC 0, A, B and C stages were identified. Overall survival was compared by log-rank test among patients within different BCLC stages and among patients receiving different treatments (SR vs locoregional therapy [LRT] vs best supportive care. Propensity score matching analysis was introduced to mitigate the confounding biases between the groups.Results: The median survival time of the patients diminished from early, intermediate to advanced BCLC stages (BCLC 0-A 43 [range 0–100] months vs BCLC B 32 [range 0–100] months vs BCLC C 27 [range 0–90] months, all p<0.05. Patients undergoing SR presented with better liver function and more favorable tumor status and, consequently, displayed significant better overall survival than patients receiving LRT or best supportive care at different BCLC stages. In adjusted cohort after propensity score matching, patients who were surgically

  17. Role development and career stages in addiction nursing: an exploratory study.

    Science.gov (United States)

    Clancy, Carmel; Oyefeso, Adenekan; Ghodse, Hamid

    2007-01-01

    This paper reports a study to explore factors influencing recruitment and retention in addiction nursing, and the stages and features of role acquisition and personal qualities important to that role. Specialist addiction nurses engage in a number of roles in the care of individuals with problematic use of psychoactive substances. These include assessment, outreach, prescribing, counselling, and harm reduction. In a climate of increasing demand for specialist substance misuse workers, and a trend to identify key occupational competencies, there is a need for a framework in which career progression can be supported. Studies exploring the roles of addiction nurses are minimal, and there is less comment on how these roles are developed in the context of career stages. A qualitative study using focus groups was undertaken with specialist addiction nurses between March and June 2004. The data were transcribed verbatim and analysed using Burnard's six content analysis stages. Positive factors identified as influencing recruitment and retention included: prior knowledge of the working environment (as a nursing student), opportunities for autonomous practice, the client profile, and associated treatment philosophy and care approach. There was consensus that nurses choosing to work in the field of addiction needed, in addition to being non-judgmental, personal qualities including hardiness, patience and tolerance. Five role development stages, with a set of descriptors, were identified: encounter, engagement, stabilization, competency and mastery. Identification of these five role development stages for addiction nurses offers employers, nurse managers, educators and addiction nurses a starting point from which specific occupational competencies can be further explored. In addition, continuing professional development needs can be mapped to specific role development stages. Employers and nurse managers may wish to offer increased learning opportunities to student nurses to

  18. Vascular endothelial growth factor behavior in different stages of tooth germ development.

    Science.gov (United States)

    Mastrangelo, Filiberto; Sberna, Maria T; Vinci, Raffaele; Iaderosa, Giovanni; Tettamanti, Lucia; Cantatore, Giuseppe; Tagliabue, Angelo; Gherlone, Enrico F

    2016-08-01

    Scientific studies show a possible influence of intercellular and intracellular proteins (VEGF) on the development of physiological and pathological tissue. VEGF, a key regulator of angiogenesis, it would seem essential to take action during the embryonic development of the dental germ. The purpose of the study is to investigate the importance of the enzymatic activity of VEGF through protein quantification at different stages of tooth germ development. The quantification of VEGF protein was performed by 3 different laboratory tests: Western-blot analysis, semi-quantitative reverse transcriptase-polymerase chain reaction analysis (RT-PCR) and finally immunohistochemical analysis. Cell cultures of tooth tissue examined are: endothelial cells, stellate reticulum cells, odontoblasts and ameoblast. The VEGF peptide seems to induce an intense cell proliferation, not concomitant with differentiation towards the endothelial line. The expression of VEGF in the inner enamel epithelium (ameloblasts) would seem to depend on the stage of differentiation, leading us to deduce that VEGF and its respective receptor are expressed in dental germ and that induce alterations not only on the vascularization, but also on the inner epithelium activation and then on dental enamel development, respectively on cap and bell stages of embryogenesis. In our survey, the positive expression of VEGF in all the samples examined, might suggest a fundamental role of angiogenic gene proteins during all stages of embryonic tooth development. It is also characteristic the behavior of stellate reticulum cells, with a significant reduction in VEGF action between early and late stage, which could suggest a possible role of stellate reticulum cells, which would be able to promote and maintain an adequate energy supply to the tissues during early and late stages of differentiation and proliferation.

  19. Clinical-pathologic correlation in early cervical carcinoma: CT-MR imaging comparison for effect on staging and treatment choices

    International Nuclear Information System (INIS)

    Rubens, D.; Thornbury, J.R.; Weiss, S.L.; Lerner, R.M.; Angel, C.; Beecham, J.; Stoler, M.H.

    1986-01-01

    A group of patients with clinical stage I or II squamous cell cervical carcinoma have been examined using a 1.5-T magnet. Of these, six have had radical hysterectomy (by April 1986), providing specimens for pathologic correlation. In this preliminary group of patients, MR imaging gave a more accurate assessment of primary tumor extent than did clinical staging. In three of six patients, the disease was underestimated clinically at examination under anesthesia. These patients would have been managed with preoperative radiation rather than surgery alone if the investigative MR imaging information had been used in treatment planning. CT examinations of these patients did not contribute useful information for patient management. Preoperative MR imaging has the potential to alter patient treatment in early cervical carcinoma

  20. Acquired immunodeficiency syndrome-related Kaposi's sarcoma: clinical features, staging, and treatment.

    Science.gov (United States)

    Dezube, B J

    2000-08-01

    The clinical course of acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) is highly variable, ranging from minimal stable disease to explosive growth. Although KS is primarily a cutaneous disease, extracutaneous spread is common; the oral cavity, gastrointestinal (GI) tract, lungs, and lymph nodes are often involved. The psychosocial burden associated with KS may be profound. The initial evaluation of a patient with KS consists mainly of a thorough physical examination with special attention paid to those areas typically affected by the disease, the testing of stool for occult blood, and a chest x-ray. Treatment options depend greatly on the tumor (extent of tumor and rate of growth), human immunodeficiency virus type I (HIV-I) viral load, and host factors (CD4+ T-lymphocyte count and overall medical condition). Limited cutaneous disease may be treated with topical alitretinoin gel, intralesional vinblastine, radiation therapy, laser therapy, or cryotherapy. The high benefit-to-risk ratio of liposomal anthracyclines (daunorubicin and doxorubicin) and paclitaxel have tremendously simplified the management of patients in whom systemic therapy is warranted. Additionally, epidemiologic evidence of a marked decline in new KS since the widespread use of highly active antiretroviral therapy (HAART) advocates its use. KS herpes virus/human herpes virus 8 (KSHV/HHV-8), sex hormones, and the processes of angiogenesis and cellular differentiation all serve as targets for pathogenesis-based clinical trials. Virtually all patients with KS can benefit from the many approved and investigational agents developed through years of collaborative translational and clinical research.

  1. Causes and outcome of late referral of children who develop end-stage kidney disease.

    Science.gov (United States)

    Kennedy, Sean E; Bailey, Rohan; Kainer, Gad

    2012-03-01

    This study aims to characterise the timing of referral to a paediatric nephrology unit of children who develop end-stage kidney disease (ESKD). This study also aims to determine whether late referral (LR) influences outcomes and to explore factors that may lead to LR. A retrospective case review of all incident patients with ESKD who received renal replacement therapy (RRT) at a single paediatric centre. Time between referral to a paediatric nephrologist and commencement of RRT, demographic and clinical data were collated. Estimated glomerular filtration rate (eGFR) at referral was calculated using height and creatinine. LR was defined as having an eGFR ≤ 30 mL/min/1.73 m(2) when first seen by a paediatric nephrologist. RRT was initiated for 74 patients Children referred before age 1 year (41%) had a more prolonged course before ESKD. Median (interquartile range) eGFR at referral of children > 1 year was 27.2 (9.0-52.0) mL/min/1.73 m(2) . Twenty-two (55%) of these children were referred late (LR) with an eGFR ≤ 30 mL/min/1.73 m(2) . LR patients were more likely to have glomerulonephritis or haemolytic uraemic syndrome and to live in a remote or outer regional area. LR patients had higher urea, lower haemoglobin and were more likely to receive haemodialysis via a vascular catheter. A significant proportion of children who develop ESKD are referred late to nephrology units with potentially preventable complications. Aetiology of renal disease and geographic isolation contribute to LR. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  2. Significant clinical impact and prognostic stratification provided by FDG-PET in the staging of oesophageal cancer

    International Nuclear Information System (INIS)

    Duong, Cuong P.; Demitriou, Helen; Thompson, Anne; Williams, David; Thomas, Robert J.S.; Weih, LeAnn; Hicks, Rodney J.

    2006-01-01

    To evaluate the clinical impact of FDG-PET in staging oesophageal cancer and whether this information improves prognostic stratification. Impact was based on comparison of a prospectively recorded pre-PET plan with post-PET treatment in 68 consecutive patients undergoing primary staging. Survival was analysed using the Kaplan-Meier product limit method and the Cox proportional hazards regression model. FDG-PET findings impacted on the management of 27/68 patients (40%): in 12 therapy was changed from curative to palliative and in three from palliative to curative, while in 12 other patients there was a change in the treatment modality or delivery but not in the treatment intent. The median survival was 21 months, with post-PET stage and treatment intent both strongly associated with survival (p<0.001). Conventional stage was not able to clearly stratify this population. The use of FDG-PET for primary staging of oesophageal cancer changed the clinical management of more than one-third of patients and provided superior prognostic stratification compared with conventional investigations. (orig.)

  3. Host biotin is required for liver stage development in malaria parasites.

    Science.gov (United States)

    Dellibovi-Ragheb, Teegan A; Jhun, Hugo; Goodman, Christopher D; Walters, Maroya S; Ragheb, Daniel R T; Matthews, Krista A; Rajaram, Krithika; Mishra, Satish; McFadden, Geoffrey I; Sinnis, Photini; Prigge, Sean T

    2018-03-13

    Acetyl-CoA carboxylase (ACC) is a biotin-dependent enzyme that is the target of several classes of herbicides. Malaria parasites contain a plant-like ACC, and this is the only protein predicted to be biotinylated in the parasite. We found that ACC is expressed in the apicoplast organelle in liver- and blood-stage malaria parasites; however, it is activated through biotinylation only in the liver stages. Consistent with this observation, deletion of the biotin ligase responsible for ACC biotinylation does not impede blood-stage growth, but results in late liver-stage developmental defects. Biotin depletion increases the severity of the developmental defects, demonstrating that parasite and host biotin metabolism are required for normal liver-stage progression. This finding may link the development of liver-stage malaria parasites to the nutritional status of the host, as neither the parasite nor the human host can synthesize biotin. Copyright © 2018 the Author(s). Published by PNAS.

  4. Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda.

    Directory of Open Access Journals (Sweden)

    Irene Kuepfer

    Full Text Available BACKGROUND: A wide spectrum of disease severity has been described for Human African Trypanosomiasis (HAT due to Trypanosoma brucei rhodesiense (T.b. rhodesiense, ranging from chronic disease patterns in southern countries of East Africa to an increase in virulence towards the north. However, only limited data on the clinical presentation of T.b. rhodesiense HAT is available. From 2006-2009 we conducted the first clinical trial program (Impamel III in T.b. rhodesiense endemic areas of Tanzania and Uganda in accordance with international standards (ICH-GCP. The primary and secondary outcome measures were safety and efficacy of an abridged melarsoprol schedule for treatment of second stage disease. Based on diagnostic findings and clinical examinations at baseline we describe the clinical presentation of T.b. rhodesiense HAT in second stage patients from two distinct geographical settings in East Africa. METHODOLOGY/PRINCIPAL FINDINGS: 138 second stage patients from Tanzania and Uganda were enrolled. Blood samples were collected for diagnosis and molecular identification of the infective trypanosomes, and T.b. rhodesiense infection was confirmed in all trial subjects. Significant differences in diagnostic parameters and clinical signs and symptoms were observed: the median white blood cell (WBC count in the cerebrospinal fluid (CSF was significantly higher in Tanzania (134 cells/mm(3 than in Uganda (20 cells/mm(3; p<0.0001. Unspecific signs of infection were more commonly seen in Uganda, whereas neurological signs and symptoms specific for HAT dominated the clinical presentation of the disease in Tanzania. Co-infections with malaria and HIV did not influence the clinical presentation nor treatment outcomes in the Tanzanian study population. CONCLUSIONS/SIGNIFICANCE: We describe a different clinical presentation of second stage T.b. rhodesiense HAT in two distinct geographical settings in East Africa. In the ongoing absence of sensitive diagnostic

  5. Infectivity and development of X-irradiated third-stage larvae of Angiostrongylus cantonensis in rats

    International Nuclear Information System (INIS)

    Fujiu, Yoshinori

    1989-01-01

    Angiostrongylus cantonensis third-stage larvae were exposed to less than 10Krad of X-radiation and then given orally to white rats to examine the effects of X-radiation on infectivity and development of the irradiated third-stage larvae and on fecundity of adults developing from the irradiated third-stage larvae. The deleterious effects of X-radiation were observed at relatively lower dosage in the above three parameters. A degree in susceptibility on X-radiation was shown to be radiation-dose-dependent. Comparing to the irradiation of larvae in vitro, the irradiation of larvae in snails caused less deleterious effects at the same dose of X-irradiation. Application of X-radiation to food hygiene was also discussed. (author)

  6. Development of Four-Stage X-ray Telescope (FXT) for DIOS mission

    Science.gov (United States)

    Sakurai, Ikuya; Sugita, Satoshi; Tawara, Yuzuru; Takizawa, Shunya; Babazaki, Yasunori; Nakamichi, Ren

    2013-09-01

    A Four-stage X-ray Telescope (FXT) has been developed as the best-fit optics for the Diffuse Intergalactic Oxygen Surveyor (DIOS) mission, a small satellite mission for mapping observations of the warm-hot intergalactic medium. The FXT mirrors are based on a conical approximation of the Wolter-I design, fabrication technique used in the Suzaku satellite. We developed processes for fabricating a large-diameter (>= 50 cm) foil mirror and made a new full size quadrant housing 60 cm in diameter with four-stage integrated alignment plates. We made optical measurement using one set of four-stage mirrors over than diameter of more than 50 cm.

  7. Expression and role of CXCL10 during the encephalitic stage of experimental and clinical African trypanosomiasis

    DEFF Research Database (Denmark)

    Amin, Daniel N; Rottenberg, Martin E; Thomsen, Allan R

    2009-01-01

    BACKGROUND: Human African trypanosomiasis, caused by Trypanosoma brucei, involves an early hemolymphatic stage followed by a late encephalitic stage. METHODS: We studied the expression of chemokines with use of microarray and enzyme-linked immunosorbent assay in T. brucei brucei-infected mice...... and in patients with human African trypanosomiasis and examined their role in controlling brain accumulation of T cells and parasites. RESULTS: The messenger RNAs (mRNAs) encoding CXCR3 ligands CXCL9 and CXCL10 demonstrated the greatest increases among chemokines in brain specimens of infected mice, as determined...... accumulation of trypanosomes and T cells in the brain parenchyma but similar parasitemia levels, compared with wild-type mice. CXCL10 and IFN-gamma levels were increased in the cerebrospinal fluid of patients with late stage but not early stage human African trypanosomiasis. Levels of CXCL10 in patients...

  8. Clinical identifiers for early-stage primary/idiopathic adhesive capsulitis: are we seeing the real picture?

    Science.gov (United States)

    Walmsley, Sarah; Osmotherly, Peter G; Rivett, Darren A

    2014-07-01

    Adhesive capsulitis is often difficult to diagnose in its early stage and to differentiate from other common shoulder disorders. The aim of this study was to validate any or all of the 8 clinical identifiers of early-stage primary/idiopathic adhesive capsulitis established in an earlier Delphi study. This was a cross-sectional study. Sixty-four patients diagnosed with early-stage adhesive capsulitis by a physical therapist or medical practitioner were included in the study. Eight active and 8 passive shoulder movements and visual analog scale pain scores for each movement were recorded prior to and immediately following an intra-articular injection of corticosteroid and local anesthetic. Using the local anesthetic as the reference standard, pain relief of ≥70% for passive external rotation was deemed a positive anesthetic response (PAR). Sixteen participants (25%) demonstrated a PAR. Univariate logistic regression identified that of the proposed identifiers, global loss of passive range of movement (odds ratio [OR]=0.26, P=.03), pain at the end of range of all measured active movements (OR=0.06, P=.02), and global loss of passive glenohumeral movements (OR=0.23, P=.02) were associated with a PAR. Following stepwise removal of the variables, pain at the end of range of all measured active movements remained the only identifier but was associated with reduced odds of a PAR. The lack of a recognized reference standard for diagnosing early-stage adhesive capsulitis remains problematic in all related research. None of the clinical identifiers for early-stage adhesive capsulitis previously proposed by expert consensus have been validated in this study. Clinicians should be aware that commonly used clinical identifiers may not be applicable to this stage. © 2014 American Physical Therapy Association.

  9. Role of SUVmax and GLUT-1 Expression in Determining Tumor Aggressiveness in Patients With Clinical Stage I Endometrioid Endometrial Cancer.

    Science.gov (United States)

    Lee, Dong Wook; Chong, Gun Oh; Lee, Yoon Hee; Hong, Dae Gy; Cho, Young Lae; Jeong, Shin Young; Park, Ji Young; Lee, Yoon Soon

    2015-06-01

    The aim of this study was to determine the role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in estimating tumor aggressiveness in patients with clinical stage I endometrial cancer and the correlation between aggressiveness and expression of glucose transporter 1 (GLUT-1). F-fluorodeoxyglucose positron emission tomography/computed tomography was performed on 43 patients with clinical stage I endometrioid endometrial cancer. (18)F-fluorodeoxyglucose uptake was quantified by calculating the maximum standardized uptake value (SUV(max)) and GLUT-1 expression status based on immunohistochemistry. The mean (SD) SUV(max) of the primary tumor was 8.55 (5.04). The mean SUV(max) and GLUT-1 expression in stage IB and stage IC were significantly higher than that in stage IA (P = 0.001; P = 0.003). The mean (SD) SUV(max) was 6.81 (4.55) in grade 1, 10.92 (4.61) in grade 2, and 15.35 (1.34) in grade 3 (grade 1 vs grade 2 and 3; P = 0.005). The mean (SD) GLUT-1 expression was 1.17 (0.94) in grade 1, 2.00 (0.94) in grade 2, and 3.00 (0.00) in grade 3 (grade 1 vs grade 2 and 3; P = 0.017). Tumor aggressiveness, such as myometrial invasion or tumor grade, had a positive correlation with the SUV(max) and GLUT-1 expression in patients with clinical stage I endometrioid endometrial cancer.

  10. Multi-stage versus single-stage inflation and deflation cycle for alternating low pressure air mattresses to prevent pressure ulcers in hospitalised patients: a randomised-controlled clinical trial.

    Science.gov (United States)

    Demarré, L; Beeckman, D; Vanderwee, K; Defloor, T; Grypdonck, M; Verhaeghe, S

    2012-04-01

    The duration and the amount of pressure and shear must be reduced in order to minimize the risk of pressure ulcer development. Alternating low pressure air mattresses with multi-stage inflation and deflation cycle of the air cells have been developed to relieve pressure by sequentially inflating and deflating the air cells. Evidence about the effectiveness of this type of mattress in clinical practice is lacking. This study aimed to compare the effectiveness of an alternating low pressure air mattress that has a standard single-stage inflation and deflation cycle of the air cells with an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. A randomised controlled trial was performed in a convenience sample of 25 wards in five hospitals in Belgium. In total, 610 patients were included and randomly assigned to the experimental group (n=298) or the control group (n=312). In the experimental group, patients were allocated to an alternating low pressure air mattress with multi-stage inflation and deflation cycle of the air cells. In the control group, patients were allocated to an alternating low pressure air mattress with a standard single-stage inflation and deflation cycle of the air cells. The outcome was defined as cumulative pressure ulcer incidence (Grade II-IV). An intention-to-treat analysis was performed. There was no significant difference in cumulative pressure ulcer incidence (Grade II-IV) between both groups (Exp.=5.7%, Contr.=5.8%, p=0.97). When patients developed a pressure ulcer, the median time was 5.0 days in the experimental group (IQR=3.0-8.5) and 8.0 days in the control group (IQR=3.0-8.5) (Mann-Whitney U-test=113, p=0.182). The probability to remain pressure ulcer free during the observation period in this trial did not differ significantly between the experimental group and the control group (log-rank χ(2)=0.013, df=1, p=0.911). An alternating low pressure air mattress with multi-stage inflation

  11. Role of KIR and CD16A genotypes in colorectal carcinoma genetic risk and clinical stage.

    Science.gov (United States)

    Canossi, Angelica; Aureli, Anna; Del Beato, Tiziana; Rossi, Piero; Franceschilli, Luana; De Sanctis, Flavio; Sileri, Pierpaolo; di Lorenzo, Nicola; Buonomo, Oreste; Lauro, Davide; Venditti, Adriano; Sconocchia, Giuseppe

    2016-08-12

    NK cell cytotoxicity is regulated by the types of the interaction between killer immunoglobulin-like receptors (KIRs) and human leukocyte antigen (HLA) class I ligands on target cells and the different binding affinity of the Fcγ receptor IIIA (CD16A) for IgG-coated tumor cells. Thus, it is conceivable that KIR and CD16A gene contents may contribute to the function of NK cells by modulating an immune response in the colorectal carcinoma (CRC) microenvironment. This hypothesis is supported by recent evidence suggesting that NK cells improve the clinical course of CRC patients by enhancing the anti-CRC effect of CD8 + T cells. This information provides the rationale to test the hypothesis whether the independent KIR segregation and specificity, as well as CD16A gene polymorphisms, have an impact on CRC. Using polymerase chain reaction-sequence-specific primers (PCR-SSP) and sequence-based typing (SBT), we investigated KIR/HLA-C complex and CD16A (48H/R/L,158V/F) gene polymorphisms in 52 CRC patients and 61 local healthy controls (LCTRs). The allele frequency (AF) of at least five activating KIR (aKIRs) of the B haplotype (p = 0.036, OR 0.204), KIR2DL2 (p = 0.047, OR 0.2616), and KIR2DS2 genes (5.8 vs LCTR 13.8 % and vs. Fasano's CTR 16.3 %, p = 0.05, OR 0.3145), in the absence of their cognate HLA-C1 ligands, were significantly associated with a reduced genetic risk of CRC. In contrast, CD16A-48H polymorphism was positively associated with an increased genetic risk of CRC (p = 0.05, OR 2.761). The latter was also found to be correlated with advanced stages of disease [III and IV (p = 0.03, OR 3.625)]. Our data suggest that the analysis of aKIRs and KIR2DL2 gene and CD16A-48H may be of interest for the identification of individuals at reduced and increased genetic risk of CRC, respectively.

  12. [Preparation of a gel-forming ointment base applicable to the recovery stage of bedsore and clinical evaluation of a treatment method with different ointment bases suitable to each stage of bedsore].

    Science.gov (United States)

    Shigeyama, Masato

    2004-02-01

    An ointment base for better treatment of bedsores was developed to improve the release rate of minocycline hydrochloride (MH) and the water absorption capacity using various types of hydrophobic to hydrophilic ointment bases. The effect of purified lanolin (PL) on the release behavior of MH from a hydrophilic ointment (HO) base was the primary focus. It was found that the drug release rate from the ointment base was modified according to the method of preparation of the ointment base and the type of cyclodextrins admixed. The physicochemical properties, such as viscosity, elution volume, and water absorption, of the ointment base were also modified by those factors. To develop an ointment formulation suitable for the recovery stages of bedsores, including the proliferation period of granulation and the formative period of epidermis, the physicochemical properties of Macrogol ointment containing various hydrophilic polymers, which have gel-forming ability, were tested. A novel ointment base suitable for the treatment in the recovery stage of bedsores was developed using hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC). Considerably sustained release of MH (T50 of 170 at a min) was attained with a macrogol ointment mixed with HM-HPMC and Carbopol formulation ratio of 3:7. We clinically evaluated the effectiveness of bedsore treatment by applying different ointment bases to patients with different stages of bedsores.

  13. Assessing hospitals' clinical risk management: Development of a monitoring instrument

    Directory of Open Access Journals (Sweden)

    Pfeiffer Yvonne

    2010-12-01

    Full Text Available Abstract Background Clinical risk management (CRM plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals. Methods The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes. Results The monitoring instrument consists of 28 main questions organized in three sections: 1 Implementation and organizational integration of CRM, 2 Strategic objectives and operational implementation of CRM at hospital level, and 3 Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian. It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement. Conclusions We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.

  14. Assessing hospitals' clinical risk management: Development of a monitoring instrument.

    Science.gov (United States)

    Briner, Matthias; Kessler, Oliver; Pfeiffer, Yvonne; Wehner, Theo; Manser, Tanja

    2010-12-13

    Clinical risk management (CRM) plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals. The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals) was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes. The monitoring instrument consists of 28 main questions organized in three sections: 1) Implementation and organizational integration of CRM, 2) Strategic objectives and operational implementation of CRM at hospital level, and 3) Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian). It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement. We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.

  15. Breast cancer in kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk

    Directory of Open Access Journals (Sweden)

    Safar Banaz M

    2009-12-01

    Full Text Available Abstract Background Breast cancer in the Middle-East occurs in relatively young women and frequently presents as advanced disease. A protective effect of multiparity is not apparent, and high familial risk is reported in some countries. This study investigates breast cancer rates and clinical stage related to age in the Kurdish region of Iraq and evaluates risk associated with parity and family history. Findings are compared with nearby countries and the West. Methods Sulaimaniyah Directorate of Health records identified 539 women diagnosed with breast cancer during 2006-2008. Clinical survey forms were completed on 296 patients and on 254 age-matched controls. Age specific incidence rates were calculated from Directorate of Health population estimates. Results Average patient age was 47.4 ± 11 years and 59.5% were pre-menopausal. Diagnosis was at clinical stage 1 for 4.1%, stage 2 for 43.5%, stage 3 for 26.0%, and stage 4 for 8.1% of patients. For 18.2%, stage was unknown. Annual breast cancer incidence rates per 100,000 women peaked at 168.9 at age 55 to 59 and declined to 57.3 at 60 and above. Patients had an average of 5.0 ± 3.3 children compared to 5.4 ± 3.5 for controls, P = 0.16. A first degree family member had breast cancer among 11.1% of patients and 2.1% of controls (P 50% of these patients and controls being ≥50 years old. No statistically significant relationship was found between tumor stage and age, P = 0.59. Conclusions In Kurdish Iraq, breast cancer is predominantly a disease of pre-menopausal women having multiple pregnancies. For younger patients, breast cancer incidence was similar to the West and possibly higher than many Middle-Eastern countries, but unlike the West, the estimated rates declined markedly in the elderly. The familial breast cancer risk for both older and younger women was within the general population risk of Western countries. Clinical stages were advanced and indicated delays in diagnosis that were

  16. Sonoluminescence and acoustic emission spectra at different stages of cavitation zone development.

    Science.gov (United States)

    Dezhkunov, N V; Francescutto, A; Serpe, L; Canaparo, R; Cravotto, G

    2018-01-01

    The way in which a cavitation zone develops in a focused pulsed ultrasound field is studied in this work. Sonoluminescence (SL), total hydrophone output and cavitation noise spectra have been recorded across a gradual, smooth increase in applied voltage. It is shown that the cavitation zone passes through a number of stages of evolution, according to increasing ultrasound intensity, decreasing pulse period and increasing ultrasound pulse duration. Sonoluminescence is absent in the first phase and the hydrophone output spectra consists of a main line with two or three harmonics whose intensity is much lower than that of the main (fundamental) line. The second stage sees the onset of SL whose intensity increases smoothly and is accompanied by the appearance of higher harmonics and subharmonics in the cavitation noise spectra. In some cases, the wide-band (WBN) component can be seen in noise spectra during the final part of the second stage. In the third stage, SL intensity increases significantly and often quite sharply, while WBN intensity increases in the same manner. This is accompanied by a synchronous increase in the absorption of ultrasound by the cavitation zone, which is manifested in a sharp decrease in the hydrophone output. In the fourth stage, both SL and WBN intensities tend to decrease despite the increased voltage applied to the transducer. Furthermore, the fundamental line tends to decrease in strength as well, despite the increasing ultrasound intensity. The obtained results clearly identify the different stages of cavitation zone development using cavitation noise spectra analyses. We then hypothesize that three of the above stages may be responsible for three known types of ultrasound action on biological cells: damping viability, reversible cell damage (sonoporation) and irreversible damage/cytotoxicity. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. [The four stages of drug addiction (based on clinical experience with 5,000 drug addicts)].

    Science.gov (United States)

    Hovnanian, L

    1994-06-01

    A medical practitioner has been inquiring on the subject for eighteen years, and confronting the discrepancy between the facts observed and the social and psychiatric approach of the plague. His study of adolescent toxicomania was proceeding from the care of 1000 drug-fiends, plus a dialogue with 3000 schoolers and the interview of about one thousand drug-fiends on their way to recovery. Four stages have been made clear in the evolution of the disease. Stage 1--Contamination of 12 to 18 year-old-individuals, among whom 90% find a safe escape through mere self-defense (contamination from the cannabis "joint" in 95% of cases). Stage 2--Occasional users, one or two "joints", now and then, several times a month, for fun, out of submissiveness to a group or search for adventure or challenge. Stage 3--Regular use of one or several drugs entailing the spiral of dependency resulting in a distorted psyche, a disinterest in studies, marginality delinquency. Recovery is possible provided they give up the use of any drugs whatever thanks to firm ans understanding help from the family or and institution, avoiding any psychiatric response. Stage 4--Drud-fiends hooked to hard drugs such as cocaine, heroin, polytoxicomaniacs they have become the slaves of drugs, undergoing a severe physical and psychic decay, they feel lovely, consider drugs as they only friend, they have a suicidal behaviour. The immuno-deficiency caused by drug-use makes intercurrent diseases likely to strike. Recovery is still possible through drastic weaning treatment, even under constraint since they endanger their own lives, and a 12 to 18 months treatment of remotivation as well as training for social reinsertion. The therapeutic community, well organized and governed, is able to provide low cost solutions to a plague that too often comes to a deadlock. Although we can't say that first and second stage teenagers are real drug-fiends, on the contrary, third and fourth stage patients have necessary gone

  18. Predictive Coding Accelerates Word Recognition and Learning in the Early Stages of Language Development

    Science.gov (United States)

    Ylinen, Sari; Bosseler, Alexis; Junttila, Katja; Huotilainen, Minna

    2017-01-01

    The ability to predict future events in the environment and learn from them is a fundamental component of adaptive behavior across species. Here we propose that inferring predictions facilitates speech processing and word learning in the early stages of language development. Twelve- and 24-month olds' electrophysiological brain responses to heard…

  19. The networked instructor: The quality of networks in different stages of professional development

    NARCIS (Netherlands)

    Van Waes, Sara; Moolenaar, Nienke M.; Daly, Alan J.; Heldens, Henderijn; Donche, V.; van Petegem, P.; van den Bossche, Piet

    2016-01-01

    This article focuses on the quality of instructional networks in different stages of professional development. Drawing theoretically from social capital theory and literature on teacher interaction, we conducted in-depth interviews with 30 instructors at the university level. Using qualitative

  20. The networked instructor : The quality of networks in different stages of professional development

    NARCIS (Netherlands)

    Van Waes, Sara; Moolenaar, Nienke M.; Daly, Alan J.; Heldens, Henderijn H P F; Donche, Vincent; Van Petegem, Peter; Van den Bossche, Piet

    2016-01-01

    This article focuses on the quality of instructional networks in different stages of professional development. Drawing theoretically from social capital theory and literature on teacher interaction, we conducted in-depth interviews with 30 instructors at the university level. Using qualitative

  1. Creating Socionas : Building creative understanding of people's experiences in the early stages of new product development

    NARCIS (Netherlands)

    Postma, C.E.

    2012-01-01

    This work presents the research into Creating Socionas, a step-by-step approach to building creative understanding of user experience in the early stages of new product development (NPD). Creative understanding is the combination of a rich, cognitive and affective understanding of the other, and the

  2. Main stages in the development of radiation immunology: from immunochemical analysis of injury to monitored radiotherapy

    International Nuclear Information System (INIS)

    Yarilin, A.A.; Kashkin, K.P.

    1982-01-01

    The results of research of the radiation action on immunity are presented. The results of immunochemical investigation of radiation tissue injuries are considered. Much attention is given to the problem of radiation injury and repair of the lymphoid system. It is shown that the next stage of development of radiation immunology is immunologic control of radiotherapy of oncologic patients

  3. Reading Skills of Students with Speech Sound Disorders at Three Stages of Literacy Development

    Science.gov (United States)

    Skebo, Crysten M.; Lewis, Barbara A.; Freebairn, Lisa A.; Tag, Jessica; Ciesla, Allison Avrich; Stein, Catherine M.

    2013-01-01

    Purpose: The relationship between phonological awareness, overall language, vocabulary, and nonlinguistic cognitive skills to decoding and reading comprehension was examined for students at 3 stages of literacy development (i.e., early elementary school, middle school, and high school). Students with histories of speech sound disorders (SSD) with…

  4. Nondestructive phenotyping of lettuce plants in early stages of development with optical sensors

    Science.gov (United States)

    Rapid development of plants is important for the production of ‘baby-leaf’ lettuce that is harvested when plants reach the four- to eight-leaf stage of growth. However, environmental factors, such as high or low temperature, or elevated concentrations of salt, inhibit lettuce growth. Therefore, nond...

  5. Jean Piaget and Rudolf Steiner: Stages of Child Development and Implications for Pedagogy.

    Science.gov (United States)

    Ginsburg, Iona H.

    1982-01-01

    The views of Jean Piaget and Rudolf Steiner concerning children's stages of development are compared and related to present-day instructional practices used in the Waldorf schools, which employ Steiner's ideas. Educational principles and practices used at the elementary school level are discussed. (PP)

  6. Integrating Environmental Decisions into the Product Development Process: Part 2 - The Later Stages

    DEFF Research Database (Denmark)

    Poole, S.; Simon, M; Sweatman, A.

    1999-01-01

    , Central Europe, and the USA are carrying out ecodesign. The survey also investigated the successes and failures that compnies have experienced and the lessons learned along the way. Part 1 of this two-part paper focuses on the early stages of the product development process. It shows how products can...

  7. Evaluating Managerial Styles for System Development Life Cycle Stages to Ensure Software Project Success

    Science.gov (United States)

    Kocherla, Showry

    2012-01-01

    Information technology (IT) projects are considered successful if they are completed on time, within budget, and within scope. Even though, the required tools and methodologies are in place, IT projects continue to fail at a higher rate. Current literature lacks explanation for success within the stages of system development life-cycle (SDLC) such…

  8. Advanced Development Program for a 625 lbf thrust engine for Ares First Stage Roll Control System

    Science.gov (United States)

    Dawson, Matt; Chenevert, Blake; Brewster, Gerry; Frei, Tom; Bullard, Brad; Fuller, Ray

    2009-01-01

    NASA's new Ares Launch Vehicle will require twelve thrusters to provide roll control of the vehicle during the first stage firing. All twelve roll control thrusters will be located at the inter-stage segment that separates the solid rocket booster first stage from the second stage. NASA selected a mono propellant hydrazine solution and as a result awarded Aerojet-General a contract in 2007 for an advanced development program for an MR-80- series 625 Ibf vacuum thrust monopropellant hydrazine thruster. This thruster has heritage dating back to the 1976 Viking Landers and most recently for the 2011 Mars Science Laboratory. Prior to the Ares application, the MR-80-series thrusters had been equipped with throttle valves and not typically operated in pulse mode. The primary objective of the advanced development program was to increase the technology readiness level and retire major technical risks for the future flight qualification test program. Aerojet built on their heritage MR-80 rocket engine designs to achieve the design and performance requirements. Significant improvements to cost and lead-time were achieved by applying Design for Manufacturing and Assembly (DFMA) principles. AerojetGeneral has completed Preliminary and Critical Design Reviews, followed by two successful rocket engine development test programs. The test programs included qualification random vibration and firing lite that significantly exceed the flight qualification requirements. This paper discusses the advanced development program and the demonstrated capability of the MR-80C engine. Y;

  9. PREVENTION OF BLOOD LOSS IN THIRD STAGE OF LABOUR BY PLACENTAL BLOOD DRAINAGE- A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    B. K. Dutta

    2017-12-01

    Full Text Available BACKGROUND Placental cord drainage is a simple, safe and non-invasive method which reduces the duration and blood loss in the third stage of labour thereby preventing PPH. This method is of great use in day to day obstetric practices not requiring any extra effort, cost or equipment, so this type of practice is more relevant in rural areas. The objectives of the study were1. To evaluate the effectiveness of placental blood drainage via umbilical cord in reducing duration and blood loss in third stage of labour. 2. Reducing the incidence of postpartum haemorrhage. 3. Decreasing the complications in third stage of labour and reduce maternal mortality. MATERIALS AND METHODS This study was carried out in 100 full term pregnant women admitted in the labour room in Gauhati medical college and hospital in the department of obstetrics and gynaecology since 1st August 2007 to 30th August 2008. Cases were divided into two. Study group and control group. RESULTS In control group the average duration of third stage was 7.41 minutes and in study group 5.57 minutes and p value was <0.001 which is very highly significant. The blood loss in third stage of labour was more in case of control group, the mean blood loss in control was 169.48 ml and study group was 110.38 ml after delivery of placenta. The post-partum haemorrhage was present in 2% of cases in control group while in study group it was present in 0% case. CONCLUSION Placental blood drainage is one of the additional components in active management of third stage of labour, which is safe, simple and non-invasive method. It reduces the duration of third stage of labour, amount of blood loss and decreases the duration of placental separation time.

  10. Clinical Association of Thyroid Stimulating Hormone Receptor Antibody Levels with Disease Severity in the Chronic Inactive Stage of Graves' Orbitopathy.

    Science.gov (United States)

    Woo, Young Jae; Jang, Sun Young; Lim, Tyler Hyung Taek; Yoon, Jin Sook

    2015-08-01

    To investigate associations between serum thyroid stimulating hormone (TSH) receptor antibody (TRAb) levels and Graves' orbitopathy (GO) activity/severity in chronic-stage GO and compare the performance of two newly-developed TRAb assays (third-generation TSH-binding inhibition immunoglobulin [TBII] assay versus Mc4 thyroid-stimulating immunoglobulin [TSI] bioassay). This study is a retrospective review of medical charts and blood tests from Korean GO patients who first visited the departments of ophthalmology and endocrinology, Yonsei University College of Medicine from January 2008 to December 2011, were diagnosed with GO and Graves' hyperthyroidism, and were followed up for ≥18 months. Third-generation M22-TBII and Mc4-TSI assays were performed in the chronic-inactive GO patients in whom euthyroidism status was restored. Patients' GO activity/severity clinical activity scores (CAS), and modified NOSPECS scores were examined for a correlation with TRAb assays. Fifty patients (mean age, 41.3 years; 41 females) were analyzed. The mean duration of Graves' hyperthyroidism symptom was 63 months (range, 18 to 401 months) and that of GO was 46 months (range, 18 to 240 months). All patients had been treated previously with anti-thyroid drugs for a median period of 52.3 months, and two patients underwent either radioiodine therapy or total thyroidectomy. Mean CAS and NOSPECS scores were 0.5 ± 0.9 (standard deviation) and 4.8 ± 3.1, respectively. Mean M22-TBII and Mc4-TSI values were 7.5 ± 10.2 IL/L and 325.9 ± 210.1 specimen-to-reference control ratio. TSI was significantly correlated with NOSPECS score (R = 0.479, p 0.05), because GO inflammatory activity subsided in the chronic stages of GO. In chronic-inactive GO after euthyroid restoration, GO activity score did not associate with serum levels of TRAb or TBII. However, levels of the functional antibody Mc4-TSI did correlate with GO severity. Therefore, the TSI bioassay is a clinically relevant measure of disease

  11. correlation of who clinical staging with cd4 counts in adult hiv/aids

    African Journals Online (AJOL)

    2011-02-02

    Feb 2, 2011 ... designed to identify HIV/AIDS related clinical events using clinical presentation and simple laboratory and radiological investigations, with the clinical diagnosis being either presumptive or definitive depending on the tiers of investigation carried out. This has enabled. WHO as well as countries in Africa, ...

  12. Validation of Transient Elastography and Comparison with Spleen Length Measurement for Staging of Fibrosis and Clinical Prognosis in Primary Sclerosing Cholangitis.

    Directory of Open Access Journals (Sweden)

    Hanno Ehlken

    Full Text Available Patients with primary sclerosing cholangitis (PSC develop progressive liver fibrosis and end-stage liver disease. Non-invasive and widely available parameters are urgently needed to assess disease stage and the risk of clinical progression. Transient elastography (TE has been reported to predict fibrosis stage and disease progression. However, these results have not been confirmed in an independent cohort and comparison of TE measurement to other non-invasive means is missing.In a retrospective study we collected data from consecutive PSC patients receiving TE measurements from 2006 to 2014 (n = 139. Data from 62 patients who also underwent a liver biopsy were used to assess the performance of TE and spleen length (SL measurement for the staging of liver fibrosis. Follow-up data from this cohort (n = 130, Hamburg and another independent cohort (n = 80, Paris was used to compare TE and SL as predictors of clinical outcome applying Harrel's C calculations.TE measurement had a very good performance for the diagnosis and exclusion of higher fibrosis stages (≥F3: AUROC 0.95 and an excellent performance for the diagnosis and exclusion of cirrhosis (F4 vs. < F4: AUROC 0.98. Single-point TE measurement had very similar predictive power for patient outcome as previously published. In a combined cohort of PSC patients (n = 210, SL measurements had a similar performance as TE for the prediction of patient outcome (5 x cross-validated Harrel's C 0.76 and 0.72 for SL and TE, respectively.Baseline TE measurement has an excellent performance to diagnose higher fibrosis stages in PSC. Baseline measurements of SL and TE have similar usefulness as predictive markers for disease progression in patients with PSC.

  13. MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation

    International Nuclear Information System (INIS)

    Vogl, T.J.; Beutel, F.; Wilhelm, K.; Tempka, A.; Schedel, H.; Haas, R.; Felix, R.

    1994-01-01

    During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T 1 weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T 2 -sequences and axial spin echo T 2 sequences. The T 1 weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T 1 weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [de

  14. Forensic age estimation based on development of third molars: a staging technique for magnetic resonance imaging.

    Science.gov (United States)

    De Tobel, J; Phlypo, I; Fieuws, S; Politis, C; Verstraete, K L; Thevissen, P W

    2017-12-01

    The development of third molars can be evaluated with medical imaging to estimate age in subadults. The appearance of third molars on magnetic resonance imaging (MRI) differs greatly from that on radiographs. Therefore a specific staging technique is necessary to classify third molar development on MRI and to apply it for age estimation. To develop a specific staging technique to register third molar development on MRI and to evaluate its performance for age estimation in subadults. Using 3T MRI in three planes, all third molars were evaluated in 309 healthy Caucasian participants from 14 to 26 years old. According to the appearance of the developing third molars on MRI, descriptive criteria and schematic representations were established to define a specific staging technique. Two observers, with different levels of experience, staged all third molars independently with the developed technique. Intra- and inter-observer agreement were calculated. The data were imported in a Bayesian model for age estimation as described by Fieuws et al. (2016). This approach adequately handles correlation between age indicators and missing age indicators. It was used to calculate a point estimate and a prediction interval of the estimated age. Observed age minus predicted age was calculated, reflecting the error of the estimate. One-hundred and sixty-six third molars were agenetic. Five percent (51/1096) of upper third molars and 7% (70/1044) of lower third molars were not assessable. Kappa for inter-observer agreement ranged from 0.76 to 0.80. For intra-observer agreement kappa ranged from 0.80 to 0.89. However, two stage differences between observers or between staging sessions occurred in up to 2.2% (20/899) of assessments, probably due to a learning effect. Using the Bayesian model for age estimation, a mean absolute error of 2.0 years in females and 1.7 years in males was obtained. Root mean squared error equalled 2.38 years and 2.06 years respectively. The performance to

  15. Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease.

    Science.gov (United States)

    Simons, Janine A; Fietzek, Urban M; Waldmann, Annika; Warnecke, Tobias; Schuster, Tibor; Ceballos-Baumann, Andrés O

    2014-09-01

    Dysphagia in patients with Parkinson's disease (PD) significantly reduces quality of life and predicted lifetime. Current screening procedures are insufficiently evaluated. We aimed to develop and validate a patient-reported outcome questionnaire for early diagnosis of dysphagia in patients with PD. The two-phased project comprised the questionnaire, diagnostic scales construction (N = 105), and a validation study (N = 82). Data for the project were gathered from PD patients at a German Movement Disorder Center. For validation purposes, a clinical evaluation focusing on swallowing tests, tests of sensory reflexes, and fiberoptic endoscopic evaluation of swallowing (FEES) was performed that yielded a criteria sum score against which the results of the questionnaire were compared. Specificity and sensitivity were evaluated for the detection of noticeable dysphagia and for the risk of aspiration. The Munich Dysphagia Test - Parkinson's disease (MDT-PD) consists of 26 items that show high internal consistency (α = 0.91). For the validation study, 82 patients, aged 70.9 ± 8.7 (mean ± SD), with a median Hoehn & Yahr stage of 3, were assessed. 73% of patients had dysphagia with noticeable oropharyngeal symptoms (44%) or with penetration/aspiration (29%). The criteria sum score correlated positively with the screening result (r = 0.70, p dysphagia vs. risk of aspiration (noticeable dysphagia) with a sensitivity of 90% (82%) and a specificity of 86% (71%), and yielded similar results in cross-validation, respectively. MDT-PD is a valid screening tool for early diagnosis of swallowing problems and aspiration risk, as well as initial graduation of dysphagia severity in PD patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. LES Investigation of Wake Development in a Transonic Fan Stage for Aeroacoustic Analysis

    Science.gov (United States)

    Hah, Chunill; Romeo, Michael

    2017-01-01

    Detailed development of the rotor wake and its interaction with the stator are investigated with a large eddy simulation (LES). Typical steady and unsteady Navier-Stokes approaches (RANS and URANS) do not calculate wake development accurately and do not provide all the necessary information for an aeroacoustic analysis. It is generally believed that higher fidelity analysis tools are required for an aeroacoustic investigation of transonic fan stages.

  17. The clinical study of interventional therapy of advanced and late staged carcinoma of digestive tract

    International Nuclear Information System (INIS)

    Liu Zengrong; Ren Shuiming; Luo Xiuzhen; Liu Fang; Liu Junxiang; Han Liping

    2003-01-01

    Objective: To evaluate the transarterial chemoembotherapy in the treatment of advanced or late staged digestive tract carcinoma. Methods: One hundred fifty-one patients with advanced or late staged digestive tract carcinoma (including 20 cases of esophageal carcinoma, 29 cases of cardia carcinoma, 71 cases of gastric carcinoma and 31 cases of large intestinal carcinoma) underwent super selective transarterial chemoembotherapy. Results: Interventions were successful. Symptoms were apparently improved in all cases. Decreased diameter of tumor was seen in all cases. Half-year survival rate was 95% (144/151); one year survival was 86% (130/150); two year survival rate was 66% (99/151); and three year survival rate was 29% (44/151). Conclusion: The transarterial chemoembotherapy is an effective treatment of advanced or late staged digestive tract carcinoma. In patients with metastases, the intervention is especially valuable for both primary and metastatic lesions

  18. Organ-Specific Metabolic Shifts of Flavonoids in Scutellaria baicalensis at Different Growth and Development Stages.

    Science.gov (United States)

    Xu, Jingyuan; Yu, Yilan; Shi, Ruoyun; Xie, Guoyong; Zhu, Yan; Wu, Gang; Qin, Minjian

    2018-02-15

    Scutellaria baicalensis Georgi is a traditional Chinese herbal medicine mainly containing flavonoids that contribute to its bioactivities. In this study, the distributions and dynamic changes of flavonoid levels in various organs of S. baicalensis at different development stages were investigated by UHPLC-QTOF-MS/MS and HPLC-DAD methods. The results indicated that the metabolic profiles of S. baicalensis changed with growth and development. During the initial germination stage, the seeds mainly contained flavonols. With growth, the main kinds of flavonoids in S. baicalensi s changed from flavonols to flavanones and flavones. The results also revealed that the accumulation of flavonoids in S. baicalensis is organ-specific. The flavones without 4'-OH groups mainly accumulate in the root and the flavanones mainly accumulate in aerial organs. Dynamic accumulation analysis showed that the main flavonoids in the root of S. baicalensis accumulated rapidly before the full-bloom stage, then changed to a small extent. The results suggested the proper harvest time for the aerial parts was at the initial stage of reproductive growth and the flower buds should be collected before flowering. This study deepening the knowledge of S. baicalensis should provide valuable information for guiding the scientific cultivation of this plant and the development and utilization of S. baicalensis .

  19. Organ-Specific Metabolic Shifts of Flavonoids in Scutellaria baicalensis at Different Growth and Development Stages

    Directory of Open Access Journals (Sweden)

    Jingyuan Xu

    2018-02-01

    Full Text Available Scutellaria baicalensis Georgi is a traditional Chinese herbal medicine mainly containing flavonoids that contribute to its bioactivities. In this study, the distributions and dynamic changes of flavonoid levels in various organs of S. baicalensis at different development stages were investigated by UHPLC-QTOF-MS/MS and HPLC-DAD methods. The results indicated that the metabolic profiles of S. baicalensis changed with growth and development. During the initial germination stage, the seeds mainly contained flavonols. With growth, the main kinds of flavonoids in S. baicalensis changed from flavonols to flavanones and flavones. The results also revealed that the accumulation of flavonoids in S. baicalensis is organ-specific. The flavones without 4′-OH groups mainly accumulate in the root and the flavanones mainly accumulate in aerial organs. Dynamic accumulation analysis showed that the main flavonoids in the root of S. baicalensis accumulated rapidly before the full-bloom stage, then changed to a small extent. The results suggested the proper harvest time for the aerial parts was at the initial stage of reproductive growth and the flower buds should be collected before flowering. This study deepening the knowledge of S. baicalensis should provide valuable information for guiding the scientific cultivation of this plant and the development and utilization of S. baicalensis.

  20. Early stage follicular lymphoma: what is the clinical impact of the first-line treatment strategy?

    Science.gov (United States)

    Michallet, Anne-Sophie A S; Lebras, Laure L; Bauwens, Deborah D; Bouafia-Sauvy, Fadhela F; Berger, Françoise F; Tychyj-Pinel, Christelle C; D'Hombres, Anne A; Salles, Gilles G; Coiffier, Bertrand B

    2013-07-01

    Less than 20% of patients with follicular lymphoma (FL) present with Ann Arbor Stage I or II disease at diagnosis. Numerous therapeutic options exist, however radiation therapy is considered the standard of care for early-stage disease based on single-institution or retrospective series. Our aim was to revisit the outcome of patients with localized FL in the rituximab era. We analyzed the characteristics and outcomes of 145 early-stage FL patients, who were retrospectively divided into six groups according to their initial treatment: watchful waiting (WW), chemotherapy alone (CT), radiotherapy alone (RT), combined radiotherapy and chemotherapy (RT-CT), rituximab alone (Ri), and immunochemotherapy (Ri-CT). Of the 145 patients, 84 (57.9%) had stage I disease and 61 (42.1%) stage II. The complete response (CR) rate varied from 57% for the Ri group to 95% for the RT-CT group. Overall survival (OS) at 7.5 y of patients treated after 2000 was better than that of those treated prior to 2000. OS did not significantly differ from one treatment to another. In contrast, a significant difference was found for progression-free survival (PFS) at 7.5 y, which favored Ri-CT (60%) therapy versus the others (p=0.00135). Delayed therapy initiation was associated with a similar OS than that observed in patients receiving immediate intervention. The "watchful waiting" strategy may thus be proposed as first-line therapy, similar to stage III and IV FL patients with a low tumor burden. However, when treatment is required, immunochemotherapy appears to be the best option.

  1. New idea for treatment strategies for Barcelona Clinic Liver Cancer stages based on a network meta-analysis.

    Science.gov (United States)

    Li, Kun; Wang, Hai-Tao; He, Yu-Kun; Guo, Tao

    2017-05-01

    Currently, the Barcelona Clinic Liver Cancer staging (BCLC) system still remains controversies in the management of hepatocellular carcinoma. We are trying to determine the best therapeutic strategy for each BCLC stage through a network meta-analysis and provide a new treatment idea. We conducted a systematic literature search of the PubMed, EMBASE, and Cochrane Library databases and extracted data from randomized controlled trials (RCTs) that compared various strategies. Network meta-analyses were conducted in ADDIS by evaluating different overall survival of each stage. Cumulative probability was used to rank the included strategies. A node-splitting model assessed whether direct and indirect evidence on a specific node was in agreement. Of the 24 included RCTs, 3667 patients were included. Based on the probability P values, the results showed that TACE plus surgical resection (SR) was the first choice for BCLC Stage A (P = .38 and P = .52 for 3- and 5-year OS, respectively). The application of SR was the best strategy for BCLC Stage B (P = .51 and P = .95 for 1- and 3-year OS, respectively). For Stage C, whole net connections could not be established in this research, but combined therapy seemed to produce better results based on 3 separated net connections (P = .92, P = .80, and P = .69 for 1-year OS). The updated therapy strategies discussed in this study are recommended. More importantly, we deemed that the recommended strategy for each patient may be subject to adjustment due to individual clinical factors. The applicable scope of each strategy should also be evaluated before application.

  2. [The clinical and microbiological characteristics of oropharyngeal candidiasis in the HIV-infected patients at the late stages of the disease].

    Science.gov (United States)

    Charushin, A O; Elovikov, A M; Charushina, I P; Vorob'eva, N N; Katretskaya, G G

    Oropharyngeal candidiasis in 512 HIV-infected patients at the late stages of the disease was studied with special reference to the clinical and microbiological characteristics of this condition. The diagnosis was established based on the results of the clinical and microbiological examination of the patients including investigation of the tissue samples taken from the oral cavity and the throat with the use of the device specially developed for this purpose. It was shown that the disease existed in various clinical forms the most common of which were monocomponent pathology represented by pseudomembranous candidiasis in 37.5±2.14% of the patients, the two-component mixed form (pseudomembranous candidiasis with concomitant angular chelitis) diagnosed in 27.5±1.97% cases, and the ternary form (the combination of pseudomembranous candidiasis, acute atrophic process, and angular chelitis) documented in 11.9±1.43% patients. The main clinical features of the disease included the combination of its various forms, multiple localization of the pathological process, and its polymorphous manifestations. Changes in the clinical course of oropharyngeal candidiasis associated with the progression of HIV from the 4A to the 4B stage were detected for the first time. They were shown to be accompanied by variations in the species composition and concentration of fungal flora in the crypts of the palatine tonsils and its sensitivity to fluconazole therapy.

  3. Materials, Processes and Manufacturing in Ares 1 Upper Stage: Integration with Systems Design and Development

    Science.gov (United States)

    Bhat, Biliyar N.

    2008-01-01

    Ares I Crew Launch Vehicle Upper Stage is designed and developed based on sound systems engineering principles. Systems Engineering starts with Concept of Operations and Mission requirements, which in turn determine the launch system architecture and its performance requirements. The Ares I-Upper Stage is designed and developed to meet these requirements. Designers depend on the support from materials, processes and manufacturing during the design, development and verification of subsystems and components. The requirements relative to reliability, safety, operability and availability are also dependent on materials availability, characterization, process maturation and vendor support. This paper discusses the roles and responsibilities of materials and manufacturing engineering during the various phases of Ares IUS development, including design and analysis, hardware development, test and verification. Emphasis is placed how materials, processes and manufacturing support is integrated over the Upper Stage Project, both horizontally and vertically. In addition, the paper describes the approach used to ensure compliance with materials, processes, and manufacturing requirements during the project cycle, with focus on hardware systems design and development.

  4. Development and Testing of Carbon-Carbon Nozzle Extensions for Upper Stage Liquid Rocket Engines

    Science.gov (United States)

    Valentine, Peter G.; Gradl, Paul R.; Greene, Sandra E.

    2017-01-01

    Carbon-carbon (C-C) composite nozzle extensions are of interest for use on a variety of launch vehicle upper stage engines and in-space propulsion systems. The C-C nozzle extension technology and test capabilities being developed are intended to support National Aeronautics and Space Administration (NASA) and Department of Defense (DOD) requirements, as well as those of the broader Commercial Space industry. For NASA, C-C nozzle extension technology development primarily supports the NASA Space Launch System (SLS) and NASA's Commercial Space partners. Marshall Space Flight Center (MSFC) efforts are aimed at both (a) further developing the technology and databases needed to enable the use of composite nozzle extensions on cryogenic upper stage engines, and (b) developing and demonstrating low-cost capabilities for testing and qualifying composite nozzle extensions. Recent, on-going, and potential future work supporting NASA, DOD, and Commercial Space needs will be discussed. Information to be presented will include (a) recent and on-going mechanical, thermal, and hot-fire testing, as well as (b) potential future efforts to further develop and qualify domestic C-C nozzle extension solutions for the various upper stage engines under development.

  5. Development of a multi-stage cloud water collector. Part 1: Design and field performance evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Moore, K.F.; Sherman, D.E.; Reilly, J.; Collett, J.L. Jr. [Colarado State Univ., Fort Collins, CO (United States). Dept. of Atmospheric Science

    2002-07-01

    Cloud chemistry can vary as a function of drop size. In order to investigate variations in chemical composition across the drop size spectrum, a new multi-stage cloud water collector was developed. The Colorado State University 5-Stage cloud water collector (CSU 5-Stage) separates drops, based upon the principles of cascade inertial impaction, into five different fractions. Its design incorporates many features to facilitate its use in the field, and maintain both consistent performance between varying atmospheric conditions and the chemical and physical integrity of the collected sample. Limited field tests indicate the CSU 5-Stage works reasonably within field measurement uncertainty, and its results are comparable to those from other cloud collectors and consistent with additional concurrent measurements. Data obtained using the CSU 5-Stage provide additional insight into drop size-dependent chemistry in fogs/clouds. These insights should result in an improved understanding of both the impact of clouds on the fate of atmospheric species, and cloud microphysics and dynamics.

  6. Five-year disease-free survival among stage II-IV breast cancer patients receiving FAC and AC chemotherapy in phase II clinical trials of Panagen.

    Science.gov (United States)

    Proskurina, Anastasia S; Gvozdeva, Tatiana S; Potter, Ekaterina A; Dolgova, Evgenia V; Orishchenko, Konstantin E; Nikolin, Valeriy P; Popova, Nelly A; Sidorov, Sergey V; Chernykh, Elena R; Ostanin, Alexandr A; Leplina, Olga Y; Dvornichenko, Victoria V; Ponomarenko, Dmitriy M; Soldatova, Galina S; Varaksin, Nikolay A; Ryabicheva, Tatiana G; Uchakin, Peter N; Rogachev, Vladimir A; Shurdov, Mikhail A; Bogachev, Sergey S

    2016-08-18

    We report on the results of a phase II clinical trial of Panagen (tablet form of fragmented human DNA preparation) in breast cancer patients (placebo group n = 23, Panagen n = 57). Panagen was administered as an adjuvant leukoprotective agent in FAC and AC chemotherapy regimens. Pre-clinical studies clearly indicate that Panagen acts by activating dendritic cells and induces the development of adaptive anticancer immune response. We analyzed 5-year disease-free survival of patients recruited into the trial. Five-year disease-free survival in the placebo group was 40 % (n = 15), compared with the Panagen arm - 53 % (n = 51). Among stage III patients, disease-free survival was 25 and 52 % for placebo (n = 8) and Panagen (n = 25) groups, respectively. Disease-free survival of patients with IIIB + C stage was as follows: placebo (n = 6)-17 % vs Panagen (n = 18)-50 %. Disease-free survival rate (17 %) of patients with IIIB + C stage breast cancer receiving standard of care therapy is within the global range. Patients who additionally received Panagen demonstrate a significantly improved disease-free survival rate of 50 %. This confirms anticancer activity of Panagen. ClinicalTrials.gov NCT02115984 from 04/07/2014.

  7. Implementing the IA stage and developing an instrument to assess the fidelity of critical time interventional: task shifting

    Directory of Open Access Journals (Sweden)

    Tatiana Fernandes Carpinteiro Silva

    2014-10-01

    Full Text Available One strategy that has been used for treat patients with mental health disorder is the implementation of psychosocial interventions. Like the development of a new drug, which requires safety studies before efficacy assessment, the psychosocial interventions should be implemented following defined stages, with the objective of increase the validity and reliability of such interventions. These stages are IA (pre-pilot, IB (pilot study, II (randomized clinical trial and III (additional studies. This study proposes a description of all activities carried out in implementation of the pre-pilot (IA Critical Time Intervention – Task Shifting (CTI-TS, including the development of manuals and the development of an instrument to assess fidelity to the original protocol. As a result, were performed the adaptation of instruments to be used in the pilot study, the adaptation of CTI-TS manual to Brazilian context, the adaptation of the agents CTI-TS training manual, as well the development of the CTI-TS assessment scale fidelity and its instruction manual. This allows multicentric studies conducted in different contexts could be performed avoiding biases. Considering that Brazil is a country that lacks resources allocated to mental care, it is expected that more psychosocial interventions can be implemented, since it was possible to develop the implementation process according to the methods recommended by the international scientific literature.

  8. Soil microbial community composition changes according to the tillage practice and plant development stage

    Science.gov (United States)

    Degrune, Florine; Dufrêne, Marc; Colinet, Gilles; Taminiau, Bernard; Hiel, Marie-Pierre; Daube, Georges; Vandenbol, Micheline

    2015-04-01

    Soil microorganisms are abundant and diverse and can have both beneficial and adverse effects on crop growth. Some, such as plant-growth-promoting rhizobacteria and mycorrhizae, are well known to favor crop productivity and plant health. They are notably involved in key processes such as improving plant nutrient acquisition, and they also play major roles in stimulating plant growth and protecting plants against pathogens by producing bioactive substances. Conversely, both agricultural practices and the plant development stage are known to influence the physical and chemical properties of the soil and hence the abundance and diversity of soil microorganisms. Here we investigated the impact of both tillage practice (conventional versus reduced tillage) and plant development stage (germination versus flowering) on the microbial community composition of an agricultural soil supporting a faba bean crop. Samples were taken at a depth of 15-20 cm from a silty soil in Belgium. For bacteria, we observed significant shifts in community composition according to both factors. Some changes were strongly related to the plant development stage and others to the tillage practice. Some taxa, including Gemmatimonas, Xanthomonadaceae, and Sinobacteraceae, showed a higher relative abundance at the flowering stage than at the germination stage, but no effect of tillage practice. Other taxa, including Flovobacterium, Chitinophaga, and Luteolibacter, showed a higher relative abundance under conventional tillage than under reduced tillage, but no change according to the stage of plant development. For fungi, significant shifts in community composition were observed according to the plant development stage. No effect of tillage practice was observed. The relative abundances of certain taxa, including Chaetomium and Clavicipitaceae, were higher during germination than during flowering, whereas other taxa, including Minimedusa and Teberdinia, showed a higher relative abundance during

  9. [Development of a staging classification for leisure activities and social communication in dependent elderly persons].

    Science.gov (United States)

    Okochi, Jiro; Takamuku, Kiyoshi; Higashi, Kentaro; Orimo, Kenichiro; Honma, Tatsuya; Nishiwaki, Keiko; Ando, Shigeru

    2014-01-01

    The aim of this study was to develop a simple staging classification to measure leisure activity and social communication among the elderly at geriatric health care facilities. In order to construct a staging scale for measuring the participation of the elderly subjects, we developed a list of 28 items for three domains: leisure activities, social participation and communication. Data were obtained from users of institutional and day care services at geriatric health service facilities. The Rasch model was applied to test the degree of item fit and difficulty. Simple staging scales were constructed based on 12 leisure activity and nine social communication items. The validity and reliability were tested using these newly developed scales according to the Rasch model and assessments of the test-retest reliability. The participants were 3,458 elderly persons, of whom 1,560 were currently using institutional services and 1,898 were using day care services. Among the 28 items, "traveling" was identified as the most difficult and "watching television" was identified as the easiest. Because items related to "social participation," such as volunteer activities, exhibited a low frequency, they were not used in the further analyses. Simple staging scales were constructed by analyzing the remaining items of leisure activities and social communication according to the Rasch model. The thresholds within the scales were determined in order of item difficulty. Cohen's kappa, as assessed by two different evaluators, was 0.75 for leisure activities and 0.77 for social communication. In this study, we developed staging scales for leisure activity and social communication. The construct validity and test-retest reliability were adequate for both scales. Service providers can improve service quality by using these scales for individual case management of elderly persons in conjunction with existing scales of activities of daily living.

  10. Nerve growth factor regulates axial rotation during early stages of chick embryo development

    Science.gov (United States)

    Manca, Annalisa; Capsoni, Simona; Di Luzio, Anna; Vignone, Domenico; Malerba, Francesca; Paoletti, Francesca; Brandi, Rossella; Arisi, Ivan; Cattaneo, Antonino; Levi-Montalcini, Rita

    2012-01-01

    Nerve growth factor (NGF) was discovered because of its neurotrophic actions on sympathetic and sensory neurons in the developing chicken embryo. NGF was subsequently found to influence and regulate the function of many neuronal and non neuronal cells in adult organisms. Little is known, however, about the possible actions of NGF during early embryonic stages. However, mRNAs encoding for NGF and its receptors TrkA and p75NTR are expressed at very early stages of avian embryo development, before the nervous system is formed. The question, therefore, arises as to what might be the functions of NGF in early chicken embryo development, before its well-established actions on the developing sympathetic and sensory neurons. To investigate possible roles of NGF in the earliest stages of development, stage HH 11–12 chicken embryos were injected with an anti-NGF antibody (mAb αD11) that binds mature NGF with high affinity. Treatment with anti-NGF, but not with a control antibody, led to a dose-dependent inversion of the direction of axial rotation. This effect of altered rotation after anti NGF injection was associated with an increased cell death in somites. Concurrently, a microarray mRNA expression analysis revealed that NGF neutralization affects the expression of genes linked to the regulation of development or cell proliferation. These results reveal a role for NGF in early chicken embryo development and, in particular, in the regulation of somite survival and axial rotation, a crucial developmental process linked to left–right asymmetry specification. PMID:22308471

  11. PRINCIPLES, STAGES AND OBJECTIVES OF FORMATION OF INNOVATIVE DEVELOPMENT PATTERNS AT CONSTRUCTION ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Mikhaylov Valeriy Yurevich

    2012-10-01

    Full Text Available In the article, the results of the research performed in the field of innovative development of enterprises are provided, and the main principles and the content of each stage of innovative development of construction enterprises in the new economic environment are developed on the basis of the research. Actions, proposed in the article, will ensure the implementation of the strategy of innovative development with a view to effective attainment of objectives of case management and successful adaptation of construction enterprises to altering factors of the media.

  12. USE OF EXTENDED-RELEASE PRAMIPEXOLE IN EARLY-STAGE PARKINSON’S DISEASE: DESCRIPTION OF A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    N. V. Fedorova

    2014-11-01

    Full Text Available The paper considers a clinical case of early-stage mixed Parkinson’s disease (PD with significant affective disorders and restless legs syndrome. Once-daily extended-release pramipexole 3 mg significantly improved a patient’s status and led to regression of movement and affective disorders. The paper gives data on the efficacy of dopamine receptor agonists in treating PD and the benefits of their extended-release formulations.

  13. Correlation of CliniCal data, anatomiCal site and disease stage in ...

    African Journals Online (AJOL)

    2008-06-01

    Jun 1, 2008 ... and stage of disease. Design: retrospective observational study. ... Design: this was a retrospective review of medical records, analysing the ... nodal basins. Dukes 'D: Metastatic disease. Statistical analysis: the data were analysed using the computer statistical program sPss (version 11.5 for Windows, sPss ...

  14. Isolated port site recurrence of node-negative clinical stage IB1 cervical adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Uma Deshmukh

    2017-05-01

    Conclusion: This is the first case report describing an isolated port site recurrence in a patient who underwent robotic-assisted laparoscopic surgery for early-stage cervical adenocarcinoma with negative margins and negative lymph nodes. The mechanism underlying this isolated recurrence remains unknown.

  15. Photoacoustic intra-operative nodal staging using clinically approved superparamagnetic iron oxide nanoparticles

    NARCIS (Netherlands)

    Grootendorst, Diederik; Fratila, R.M.; Visscher, M.; ten Haken, Bernard; van Wezel, Richard Jack Anton; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J.M.; Oraevsky, Alexander A.; Wang, Lihong V.

    2013-01-01

    Detection of tumor metastases in the lymphatic system is essential for accurate staging of various malignancies, however fast, accurate and cost-effective intra-operative evaluation of the nodal status remains difficult to perform with common available medical imaging techniques. In recent years,

  16. Hyperfractionated radiotherapy alone for clinical stage I nonsmall cell lung cancer

    International Nuclear Information System (INIS)

    Jeremic, Branislav; Shibamoto, Yuta; Acimovic, Ljubisa; Milisavljevic, Slobodan

    1997-01-01

    Purpose: Among patients with Stage I nonsmall cell lung cancer (NSCLC), those treated with conventional radiotherapy show poorer prognosis than those treated by surgery. To improve the prognosis of such patients, we have used hyperfractionated radiation therapy. Methods and Materials: Between 1988 and 1993, 49 patients were treated with hyperfractionated radiotherapy with 1.2 Gy twice daily to a total dose of 69.6 Gy. All patients were technically operable, but 29 had medical problems and 20 refused surgery. The median age and Karnofsky Performance Status was 63 years and 90, respectively. No patient received chemotherapy or immunotherapy. Prophylactic mediastinal irradiation was not given. Results: The median survival time was 33 months, and the 5-year survival rate was 30%. The rate at 5 years for freedom from each of relapse, local recurrence, mediastinal lymphnode metastasis, and distant metastasis was 41%, 55%, 89%, and 75%, respectively. Univariate analysis revealed that higher Karnofsky Performance Status score, absence of weight loss before treatment, and T1 stage were associated with better survival, although the T stage became insignificant on multivariate analysis. There were two Grade 3 acute toxicities and three Grade 3 late toxicities, but there was no Grade 4-5 toxicity. Conclusion: The results of this study compare favorably with those of most previous studies employing conventional fractionation. Further studies on hyperfractionation seem to be warranted for Stage I NSCLC

  17. Association between in vivo iododeoxyuridine labeling, MIB-1 expression, malignancy grade and clinical stage in human prostate cancer

    DEFF Research Database (Denmark)

    Borre, M; Høyer, M; Sørensen, Flemming Brandt

    1998-01-01

    Large variability in the biological behavior of prostate cancer makes prognostic markers important. The extent of tumor cell proliferation has been suggested as an important predictor of clinical outcome. Fifty-five patients suspected of having or with previously diagnosed prostate cancer were...... proliferation rates measured by in vivo IdUrd labeling and MIB-1 expression in formalin-fixed paraffin-embedded tumors. Good correlations were also found between S-phase fraction, MIB-1 expression, clinical stage and malignancy grade. These results make larger retrospective studies on archival tissue meaningful....

  18. Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder

    DEFF Research Database (Denmark)

    Vinberg, Maj; Mikkelsen, Rie Lambaek; Kirkegaard, Thomas

    2017-01-01

    AIM: In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional...... level, the presence of comorbid personality disorders and coping strategies. METHODS: Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status...... using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style...

  19. Research and Development Program in Reactor Diagnostics and Monitoring with Neutron Noise Methods, Stage 18

    International Nuclear Information System (INIS)

    Pazsit, Imre; Nam, Tran Hoai; Dykin, Victor; Jonsson, Anders

    2013-01-01

    This report constitutes Stage 18 of a long-term research and development program concerning the development of diagnostics and monitoring methods for nuclear reactors. The objective of the research program is to contribute to the strategic research goal of competence and research capacity by building up competence within the Department of Nuclear Engineering at Chalmers University of Technology, regarding reactor physics, reactor dynamics and noise diagnostics. The purpose is also to contribute to the research goal of giving a basis for SSM's supervision by developing methods for identification and localization of perturbations in reactor cores. Results up to Stage 17 were reported in SKI and SSM reports, as listed in the report's summary

  20. A Product Analysis Method and its Staging to Develop Redesign Competences

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp; Lenau, Torben Anker

    2013-01-01

    Most product development work in industrial practice is incremental, i.e. the company has had a product in production and on the market for some time, and now time has come to design an upgraded variant. This type of redesign project requires that the engineering designers have competences to carry...... through an analysis of the existing product encompassing both a user-oriented and a technical perspective, as well as to synthesise solution proposals for the upgraded variant. In the course module Product Analysis and Redesign we have developed a product analysis method and a staging of it, which seems...... to be very productive. In this paper we present the product analysis method and its staging and we reflect on the students’ application of it. We conclude that the method is a valid contribution to develop the students’ redesign competences....

  1. Genome-scale transcriptomic insights into early-stage fruit development in woodland strawberry Fragaria vesca.

    Science.gov (United States)

    Kang, Chunying; Darwish, Omar; Geretz, Aviva; Shahan, Rachel; Alkharouf, Nadim; Liu, Zhongchi

    2013-06-01

    Fragaria vesca, a diploid woodland strawberry with a small and sequenced genome, is an excellent model for studying fruit development. The strawberry fruit is unique in that the edible flesh is actually enlarged receptacle tissue. The true fruit are the numerous dry achenes dotting the receptacle's surface. Auxin produced from the achene is essential for the receptacle fruit set, a paradigm for studying crosstalk between hormone signaling and development. To investigate the molecular mechanism underlying strawberry fruit set, next-generation sequencing was employed to profile early-stage fruit development with five fruit tissue types and five developmental stages from floral anthesis to enlarged fruits. This two-dimensional data set provides a systems-level view of molecular events with precise spatial and temporal resolution. The data suggest that the endosperm and seed coat may play a more prominent role than the embryo in auxin and gibberellin biosynthesis for fruit set. A model is proposed to illustrate how hormonal signals produced in the endosperm and seed coat coordinate seed, ovary wall, and receptacle fruit development. The comprehensive fruit transcriptome data set provides a wealth of genomic resources for the strawberry and Rosaceae communities as well as unprecedented molecular insight into fruit set and early stage fruit development.

  2. Association of serum ferritin levels with immunological status and clinical staging of HIV patients: a retrospective study

    Science.gov (United States)

    Saragih, R. H.; Mardia, A. I.; Purba, G. C. F.; Syahrini, H.

    2018-03-01

    Serum ferritin has long known as an acute phase reactant during inflammation. It works as an oxidative stress marker beside its role in the storage of intracellular iron. The increase of serum ferritin levels (SFL) has been reported found in HIV patients. It remains unclear though whether it causes, or is the cause, to the progressivity of the disease. The purpose of this study was to find the association between the SFL and the progressivity of the HIV disease. A retrospective study of 91 patients was carried out at the Haji Adam Malik Central General Hospital. All of the study population were HIV positive inpatients admitted from January to December 2016. The data needed to be all obtained from the patient’s medical records. The WHO Clinical Staging System was used to assess the HIV clinical staging. An inverse relationship was found between the SFL with the immunological status of the HIV patients (r=-0.213) based on their CD4+ count. There was no association found between the SFL with the clinical staging of the HIV patients (p=0.953). The elevated SFL is a feature found in HIV-diagnosed patients with the low CD4+ count, and it affects the progressivity of the disease.

  3. Stages of Biological Development across Age: An Analysis of Canadian Health Measure Survey 2007-2011.

    Science.gov (United States)

    Chao, Yi-Sheng; Wu, Hsing-Chien; Wu, Chao-Jung; Chen, Wei-Chih

    2017-01-01

    The stages of biological development are not clearly defined despite the fact that they have been used to refer to concepts such as adolescence and aging. This study aimed to (1) propose and test a framework to search for stages of representative components and determine stages of stability and transition, (2) identify stages of biological development based on health questionnaire and biomarker data, and (3) interpret the major trajectories in a health and biomarker database. This study analyzed the data on the Canadian Health Measures Survey (CHMS) interviewees from cycle 1 to 3 (2007-2013) in Canada. We selected 282 variables containing information from questionnaire and on biomarkers after removing redundant variables based on high correlation. Fifty-nine nominal variables were replaced by 122 binominal variables, leaving 345 variables for analysis. Principal component (PC) analysis was conducted to summarize the data and the loadings were used to interpret the PCs. A stable stage was assumed to be the age groups without significantly different values of PCs. The CHMS interviewed 16,340 Canadians. Of all, 51.25% were female. The age ranged from 6 to 79 years (mean = 34.41 years, 95% CI = 34.74-34.08). The proportions of total variance explained by the first three PCs were 12.14, 4.03, and 3.19%, respectively. The differences of the first PC were not significant, especially between age 22 and 33, 34 and 40, 41 and 45, 46 and 71, and 72 and 79 years (adjusted p  > 0.05 for all). The leading variable, in terms of the variance contributed to PC1, was time spent in physical activities, followed by variables related to alcohol consumption, and smoking. The 13 leading contributors to PC2 variances were all lung function measures. There are stages of stability and transition across all age groups based on the first PCs. The first and second PCs are related to physical development and lung function. The identification of stable stages is the first step

  4. Modulith SL20--development and clinical experience.

    Science.gov (United States)

    Köhrmann, K U; Henkel, T O; Potempa, D; Rassweiler, J; Heine, G; Alken, P

    1993-01-01

    A third generation lithotripter was developed incorporating the advantages of high disintegrative efficacy, anaesthesia-free treatment, combined sonographic and fluoroscopic localization system as well as a multifunctional table for interdisciplinary use. The shock wave generator consists of a cylindrical-shaped electromagnetic coil with a paraboloid reflector. The waves are coupled by means of a water cushion and an impedance adapted foil in which the patient is comfortably positioned. Stones are localized by an in-line ultrasound probe or fluoroscopically by the integrated C-arm. Preclinical trials using the in-vitro stone model demonstrated the superior disintegrative capacity. The in-vivo animal studies evaluated the dose-dependent and reversible kidney trauma, which was comparable to that induced by other lithotripters. The clinical evaluation of the Modulith SL since 1988 was divided into three phases with different technical equipment. It was indicated that sonographic stone localization enables treatment of nearly all kidney stones and 12% of the ureteric calculi. As preference was given to in situ disintegration of all ureteral stones, X-ray targeting became necessary. By increasing the generator voltage in the third phase together with advanced experience, the disintegration rate (94%) was improved. The number of auxiliary measures after ESWL (11%) and treatment time (average 39 min) was decreased. Eighty-eight percent of our patients were stone-free at follow-up. The experience demonstrated that this lithotripter is also easy to handle for gallbladder stones and highly effective (82%) in treatment of endoscopically non-extractable bile duct stones.

  5. Assessing level of development and successional stages in biological soil crusts with biological indicators.

    Science.gov (United States)

    Lan, Shubin; Wu, Li; Zhang, Delu; Hu, Chunxiang

    2013-08-01

    Biological soil crusts (BSCs) perform vital ecosystem services, but the difference in biological components or developmental level still affects the rate and type of these services. In order to differentiate crust successional stages in quantity and analyze the relationship between crust developmental level and successional stages, this work determined several biological indicators in a series of different developmental BSCs in the Shapotou region of China. The results showed that crust developmental level (level of development index) can be well indicated by crust biological indicators. Photosynthetic biomass was the most appropriate to differentiate crust successional stages, although both photosynthetic biomass and respiration intensity increased with the development and succession of BSCs. Based on of the different biological compositions, BSCs were quantificationally categorized into different successional stages including cyanobacterial crusts (lichen and moss coverages 20 % but moss coverage 20 % but 75 %). In addition, it was found that cyanobacterial and microalgal biomass first increased as cyanobacterial crusts formed, then decreased when lots of mosses emerged on the crust surface; however nitrogen-fixing cyanobacteria and heterotrophic microbes increased in the later developmental BSCs. The structural adjustment of biological components in the different developmental BSCs may reflect the requirement of crust survival and material transition.

  6. Risk identification for quality on stage of pharmaceutical development of combined eye drops for glaucoma treatment

    Directory of Open Access Journals (Sweden)

    Олександр Миколайович Якубчук

    2015-12-01

    Full Text Available Aim: To identify the possible risks associated with critical quality attribute of combined eye drops for the treatment of glaucoma using of common risk evaluation methodologies for plannig a drug quality on the stage of pharmaceutical development. Methods: The paper used method of causal analysis. The maximal number of factors has been define to identify potential factors that provide most significant impact on the drug quality and Ishikawa diagram - graphical representation of causes and effects has been built.Results: Analysis allowed to organize the possible factors affecting the drug quality in the generalized categories: quality control methods, medicines and excipients, primary packaging, proper manufacturing conditions and the stage of the process. The most important factors that are carriers of the risk factors and may lead to negative effects have been identified for the generalized categories.Conclusions: Determined at the stage of pharmaceutical development potential critical quality attribute of AFI, excipients and primary packaging, critical parameters of the process, provide a better understanding, reduction and adoption of risk in subsequent stages of the life cycle of the drug

  7. Research and Development Program in Reactor Diagnostics and Monitoring with Neutron Noise Methods. Stages 14 and 15

    International Nuclear Information System (INIS)

    Pazsit, Imre; Wihlstrand, Gustav; Tambouratzis, Tatiana; Jonsson, Anders; Dahl, Berit

    2009-12-01

    This report constitutes Stages 14 and 15 of a long-term research and development program concerning the development of diagnostics and monitoring methods for nuclear reactors. Stage 14 was a full one-year project, whereas Stage 15 consisted of a half-year project. The program executed in Stages 14 and 15 consists of the following three parts: - Study of criticality, neutron kinetics and neutron noise in molten salt reactors (MSR) (Stages 14 and 15); - An overview and introduction to fuzzy logics (Stage 14), and an application to two-phase flow identification (Stage 15) - Preparations for and execution of an IAEA-ICTP workshop on Neutron fluctuations, reactor noise and their applications in nuclear reactors (Stage 14)

  8. The effect of flurbiprofen on the development of anencephaly in early stage chicken embryos.

    Science.gov (United States)

    Özeren, Ersin; Er, Uygur; Güvenç, Yahya; Demirci, Adnan; Arıkök, Ata Türker; Şenveli, Engin; Ergün, Rüçhan Behzat

    2015-04-01

    The study investigated the effect of flurbiprofen on the development of anencephaly in early stage chicken embryos. We looked at four groups with a total of 36 embryos. There was a control group, a normal saline group, a normal-dose group and a high-dose group with ten, ten, eight and eight eggs with embryo respectively. Two embryos in the control group, studied with light microscopy at 48 h, were consistent with 28-29 hours' incubation in the Hamburger-Hamilton System. They had open neural tubes. The other embryos in this group were considered normal. One embryo in the normal saline group was on the occlusion stage at 48 h. One embryo showed an open neural tube. They were compatible with 28-29 hours' incubation in the Hamburger-Hamilton system. The remaining eight embryos showed normal development. In the normal dose group, one embryo showed underdevelopment of the embryonic disc and the embryo was dead. In four embryos, the neural tubes were open. One cranial malformation was found that was complicated with anencephaly in one embryo. In two embryos the neural tubes were closed, as they showed normal development, and they reached their expected stages according to the Hamburger-Hamilton classification. There was no malformation or growth retardation. Four experimental embryos were anencephalic in the high dose group, and three embryos had open neural tubes. One embryo exhibited both anencephaly and a neural tube closure defect. None of the embryos in this group showed normal development. Even the usual therapeutic doses of flurbiprofen increased the risk of neural tube defect. Flurbiprofen was found to significantly increase the risk of anencephaly. The provision of improved technical materials and studies with larger sample sizes will reveal the stage of morphological disruption during the development of embryos.

  9. Developing an inventor support service which performs early stage market and manufacturing evaluations. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1991-10-01

    American businesses are learning the difficult high cost lesson of ignoring production and market factors (producibility, unit product cost (UPC), marketability, etc) during the engineering design phase of product development. Studies have shown that the Japanese spend three times as long as Americans in the design feasibility and decision process of new product introductions and one third the amount of time in the implementation of those products. There is a 20 to 1 cost benefit on effort applied in the design phase versus the production phase of the product life cycle. The number one goal of this project was to establish an organization that has, as one of its purposes, the providing of services responsive to the needs of independent inventors. The number two goal was to demonstrate the value of providing marketing and manufacturing counsel at an early stage in the product development process. The first study goal was met by providing the materials and information necessary to establish an evaluation team and an organization to handle such evaluations. The second study goal was met by demonstrating the impact of early market analysis and manufacturing considerations on product design and therefore on the description of the invention for four different inventions. These inventions were selected at various stages of development. Regardless of stage of development, the marketing and manufacturing reviews resulted in significant changes in design and/or market positioning.

  10. Developing an inventor support service which performs early stage market and manufacturing evaluations. [Final Report

    Energy Technology Data Exchange (ETDEWEB)

    1991-10-01

    American businesses are learning the difficult high cost lesson of ignoring production and market factors (producibility, unit product cost (UPC), marketability, etc) during the engineering design phase of product development. Studies have shown that the Japanese spend three times as long as Americans in the design feasibility and decision process of new product introductions and one third the amount of time in the implementation of those products. There is a 20 to 1 cost benefit on effort applied in the design phase versus the production phase of the product life cycle. The number one goal of this project was to establish an organization that has, as one of its purposes, the providing of services responsive to the needs of independent inventors. The number two goal was to demonstrate the value of providing marketing and manufacturing counsel at an early stage in the product development process. The first study goal was met by providing the materials and information necessary to establish an evaluation team and an organization to handle such evaluations. The second study goal was met by demonstrating the impact of early market analysis and manufacturing considerations on product design and therefore on the description of the invention for four different inventions. These inventions were selected at various stages of development. Regardless of stage of development, the marketing and manufacturing reviews resulted in significant changes in design and/or market positioning.

  11. Anther development stage and gamma radiation effects on tomato anther-derived callus formation

    International Nuclear Information System (INIS)

    Brasileiro, Ana Christina R.; Willadino, Lilia; Guerra, Marcelo; Colaco, Waldeciro; Meunier, Isabelle; Camara, Terezinha R.

    1999-01-01

    Two experiments were carried (I) to determine tomato anther development stage influence on callus production; and (II) to investigate gamma radiation effects on anther culture. In the first experiment, anthers of a tomato hybrid (IPA 5 x Rotam 4-F 1 ) were grown on three media. Although calli were induced at all stages of anther development, varying from prophase I to mono nucleate microspore, callus frequency decreased as anther development progressed and calli induction were not significantly affected by all media tested. Anthers containing prophase I meiocytes produced the highest calli frequency. Anther and flower bud length both were significantly correlated with anther development stage. In the second experiment, seed and floral buds of tomato hybrids IPA 5 x Rotam 4 (F 2 ), IPA 6 x Rotam 4 (F 2 ) and IPA 8 x 217.1 (F 2 ) were submitted to gamma-ray and anthers were plated on two media described by Gresshoff and Doy (1972) supplemented with 2.0 mg L -1 NAA + 5.0 mg L -1 KIN and 2.0 mg L -1 NAA + 1.0 mg L -1 KIN. No significant differences for genotype and dosage testes were found for calli formation. (author)

  12. Reflective journaling for clinical judgment development and evaluation.

    Science.gov (United States)

    Lasater, Kathie; Nielsen, Ann

    2009-01-01

    Reflective journaling is a strategy used often in clinical education to gain insight into students' clinical thinking; however, studies indicate that students may benefit from guided reflections. Numerous tools have been used to structure student reflection with varying results. This article describes the outcomes from using the Guide for Reflection based on Tanner's Clinical Judgment Model. The Lasater Clinical Judgment Rubric, created from the Model, is used to evaluate development of clinical judgment and provides language to communicate about clinical thinking with students. Senior immersion course competencies, also developed with language from Tanner's Clinical Judgment Model,offer a comprehensive package that fosters students' clinical judgment development, faculty-student communication about clinical judgment, and evaluation of students' clinical thinking.

  13. Stages of flower bud development in Iris pumila and between-habitat morphological differences

    Directory of Open Access Journals (Sweden)

    Barišić-Klisarić Nataša

    2012-01-01

    Full Text Available Previous studies revealed significant phenotypic plasticity and between-population differentiation in flower morphometric traits of Iris pumila in response to environmental variability between natural shade and exposed habitats. Since these habitats differed in flowering times as well, in this work we investigated at which stages of flower bud development differences between open and shaded habitats start to appear. Our analysis detected several groups of trait development patterns through the I. pumila bud development in two contrasting habitats, with stem length being the most suitable trait for application in further analyses of so-called “shade avoidance syndrome���.

  14. APPROACHES TO DETERMINING THE STAGES OF THE LANGUAGE TEACHING METHODS DEVELOPMENT IN WESTERN UKRAINE (1867-1939)

    OpenAIRE

    Labinska, Bogdana

    2016-01-01

    The article under discussion focuses on scientific works, dedicated to the development of language teaching methods. We have analysed the criteria for singling out the stages of contemporary scholars’ methods of development and created our own criteria regarding language teaching methods in Western Ukraine (1867-1939). According to the selected criteria, we have determined the basic stages of development methods on a particular territory, in a specific chronological framework: stage I – 1867–...

  15. Clinical impact of FDG-PET/CT on colorectal cancer staging and treatment strategy

    DEFF Research Database (Denmark)

    Petersen, Rasmus K; Hess, Søren; Alavi, Abass

    2014-01-01

    and patients divided as follows: (A) Patients with a change in therapy following FDG-PET/CT and (B) Patients without a change following FDG-PET/CT. Sixty-two patients had colon and five had rectal cancer. Of these, 20 (30%; CI 20.2-41.7) belonged to group A, whereas 47 (70%; CI 58.3-79.8) fell in group B......FDG-PET/CT is rarely used for initial staging of patients with colorectal cancer (CRC). Surgical resection of primary tumor and isolated metastases may result in long-term survival or presumed cure, whereas disseminated disease contraindicates operation. We analyzed a retrospective material...... to elucidate the potential value of FDG-PET/CT for staging of CRC. Data were retrieved from 67 consecutive patients (24-84 years) with histopathologically proven CRC who had undergone FDG-PET/CT in addition to conventional imaging for initial staging. Treatment plans before and after FDG-PET/CT were compared...

  16. Research and Development Program in Reactor Diagnostics and Monitoring with Neutron Noise Methods, Stage 16

    International Nuclear Information System (INIS)

    Pazsit, Imre; Dykin, Victor; Jonsson, Anders; Demaziere, Christophe

    2010-12-01

    This report gives an account of the work performed by the Dept. of Nuclear Engineering, Chalmers Univ. of Technology, in the frame of a research contract with the Swedish Radiation Safety Authority (SSM), contract No. SSM 2009/2093. The present report is based on work performed by Imre Pazsit, Victor Dykin, Anders Jonsson and Christophe Demaziere, with Imre Pazsit being the project leader. This report describes the results obtained during Stage 16 of a long-term research and development program concerning the development of diagnostics and monitoring methods for nuclear reactors. The long-term goals are elaborated in more detail in e.g. the Final Reports of Stage 1 and 2 (SKI Report 95:14 and 96:50, Pazsit et al. 1995, 1996). Results up to Stage 15 were reported in (Pazsit et al. 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2003a, 2003b; Demaziere et al, 2004; Sunde et al, 2006; Pazsit et al. 2008, 2009). A brief proposal for the continuation of this program in Stage 17 is also given at the end of the report. The program executed in Stage 16 consists of four parts as follows: - An overview of the present status of experience with BWR stability; - An investigation of the significance of the properties of the noise source for BWR instability; - Study of the dynamics of molten salt systems: construction of the adjoint and calculating the space dependent noise induced by propagating perturbations in the fuel; - A specific study of some novel methods of analysis of non-linear and non-stationary processes

  17. The percentage of iNKT cells among other immune cells at various clinical stages of laryngeal cancer

    Directory of Open Access Journals (Sweden)

    Janusz Klatka

    2016-04-01

    Full Text Available Introduction: Invariant natural killer T (iNKT cells constitute a small population of immune cells that share functional and phenotypic characteristics of T lymphocytes and NK cells. Due to their involvement in specific and non-specific immune responses, iNKT cells may represent an important component of antitumor and anti-infectious immunity. Material and methods: Using flow cytometry, we analyzed the percentages of iNKT cells as well as T and B lymphocytes in peripheral blood of 50 laryngeal cancer patients at various clinical stages in comparison to healthy controls (n=15. Moreover, we determined the expression of CD25, CD69 and CD95 antigens on T lymphocytes.Results: The percentage of CD4+/CD3+ T lymphocytes in the controls was higher than in laryngeal cancer patients, both with early and late stages of the disease. The percentage of CD8+/CD3+ T lymphocytes in healthy controls was lower than in patients with early and late clinical stages of laryngeal cancer. Patients with advanced laryngeal cancer showed a lower percentage of iNKT cells and higher frequencies of T regulatory cells (Tregs than the controls. Advanced clinical stages of laryngeal cancer are associated with impaired activation of lymphocytes.Conclusions: Our study confirmed that laryngeal cancer cells exert a strong suppressor effect on the immune system of the host. This is reflected by a decrease in the percentage of iNKT cells that are capable of cancer cell elimination, and a concomitant increase in the percentage of Tregs. However, further studies are needed in order to explain the underlying mechanisms of immunosuppression and understand interactions between immune and cancer cells.

  18. A comparative analysis of clinical and molecular factors with the stage of cervical cancer in a Brazilian cohort.

    Directory of Open Access Journals (Sweden)

    Sergio M Amaro-Filho

    Full Text Available UNLABELLED: Cell cycle protein expression plays an important role in the pathophysiology of cervical cancer. However, few studies have attempted to correlate the use of these biomarkers with the clinical progression of the tumor. OBJECTIVES: 1 To analyze the expression of Ki-67, p53 and p16(INK4a in cervical cancer, 2 to correlate the relative expression of these proteins as well as clinical parameters with the stage of disease, and 3 to determine the HPV DNA prevalence and subtype distribution. METHODS: Tissue Micro-Arrays (TMA from patients with invasive cervical cancer (ICC and controls were analyzed. HPV DNA detection was done by PCR and in situ hybridization. Ki-67, p53 and p16(INK4a were analyzed by immunohistochemistry; clinical data was derived from the chart review. RESULTS: Advanced tumor stage (III and IV was strongly associated (p55 years old, with more than four pregnancies and with the lack of formal education. HPV DNA was found in 94.3% of cases with the most prevalent types being HPV16 (67.5%, followed by HPV33 (12.0% and HPV35 (3.6%. High expression of Ki-67 and p16 was more common in the advanced FIGO stages (p = 0.023. Women with HPV16 tended to be younger (50.9 years; SE 1.9 compared to women with other types (59.9 years; SE 2.8. CONCLUSION: We found that Ki-67 and p16 expression were independently associated with the tumor stage. We also noted that about 1/3 of the cervical cancers in this Brazilian cohort were not associated with HPV types directly targeted by the current HPV vaccines.

  19. A Comparative Analysis of Clinical and Molecular Factors with the Stage of Cervical Cancer in a Brazilian Cohort

    Science.gov (United States)

    Amaro-Filho, Sergio M.; Golub, Jonathan E.; Nuovo, Gerard J.; Cunha, Cynthia B.; Levi, José E.; Villa, Luisa L.; Andrade, Cecília V.; Russomano, Fabio B.; Tristão, Aparecida; Pires, Andrea; Nicol, Alcina F.

    2013-01-01

    Cell cycle protein expression plays an important role in the pathophysiology of cervical cancer. However, few studies have attempted to correlate the use of these biomarkers with the clinical progression of the tumor. Objectives 1) To analyze the expression of Ki-67, p53 and p16INK4a in cervical cancer, 2) to correlate the relative expression of these proteins as well as clinical parameters with the stage of disease, and 3) to determine the HPV DNA prevalence and subtype distribution. Methods Tissue Micro-Arrays (TMA) from patients with invasive cervical cancer (ICC) and controls were analyzed. HPV DNA detection was done by PCR and in situ hybridization. Ki-67, p53 and p16INK4a were analyzed by immunohistochemistry; clinical data was derived from the chart review. Results Advanced tumor stage (III and IV) was strongly associated (p55 years old), with more than four pregnancies and with the lack of formal education. HPV DNA was found in 94.3% of cases with the most prevalent types being HPV16 (67.5%), followed by HPV33 (12.0%) and HPV35 (3.6%). High expression of Ki-67 and p16 was more common in the advanced FIGO stages (p = 0.023). Women with HPV16 tended to be younger (50.9 years; SE 1.9) compared to women with other types (59.9 years; SE 2.8). Conclusion We found that Ki-67 and p16 expression were independently associated with the tumor stage. We also noted that about 1/3 of the cervical cancers in this Brazilian cohort were not associated with HPV types directly targeted by the current HPV vaccines. PMID:23505442

  20. Can videogames be used to develop the infant stage educational curriculum?

    Directory of Open Access Journals (Sweden)

    Verónica Marín Díaz

    2014-01-01

    Full Text Available The utilization of videogames is not too common due to their consideration as an element that interferes with the educational and learning process. Thus, few teachers are ready to include videogames as didactic tools. Nevertheless, some educators who consider that they have a potential to become didactic tools are progressively adopting videogames as part of their teaching strategies. This paper presents the result of an academic experiment conducted with university students from the degree of Primary Education. The initial step in this experience consisted in determining whether videogames could be seen as another of the many tools employed to develop the infant stage educational curriculum. A survey was developed in order to achieve this goal. The interviewees answered this survey in two different stages, providing as a result that these future teachers would definitely be willing to incorporate videogames in their classrooms once they have been trained to do so.

  1. Development of advanced air-blown entrained-flow two-stage bituminous coal IGCC gasifier

    Directory of Open Access Journals (Sweden)

    Abaimov Nikolay A.

    2017-01-01

    Full Text Available Integrated gasification combined cycle (IGCC technology has two main advantages: high efficiency, and low levels of harmful emissions. Key element of IGCC is gasifier, which converts solid fuel into a combustible synthesis gas. One of the most promising gasifiers is air-blown entrained-flow two-stage bituminous coal gasifier developed by Mitsubishi Heavy Industries (MHI. The most obvious way to develop advanced gasifier is improvement of commercial-scale 1700 t/d MHI gasifier using the computational fluid dynamics (CFD method. Modernization of commercial-scale 1700 t/d MHI gasifier is made by changing the regime parameters in order to improve its cold gas efficiency (CGE and environmental performance, namely H2/CO ratio. The first change is supply of high temperature (900°C steam in gasifier second stage. And the second change is additional heating of blast air to 900°C.

  2. Development of advanced air-blown entrained-flow two-stage bituminous coal IGCC gasifier

    Science.gov (United States)

    Abaimov, Nikolay A.; Ryzhkov, Alexander F.

    2017-10-01

    Integrated gasification combined cycle (IGCC) technology has two main advantages: high efficiency, and low levels of harmful emissions. Key element of IGCC is gasifier, which converts solid fuel into a combustible synthesis gas. One of the most promising gasifiers is air-blown entrained-flow two-stage bituminous coal gasifier developed by Mitsubishi Heavy Industries (MHI). The most obvious way to develop advanced gasifier is improvement of commercial-scale 1700 t/d MHI gasifier using the computational fluid dynamics (CFD) method. Modernization of commercial-scale 1700 t/d MHI gasifier is made by changing the regime parameters in order to improve its cold gas efficiency (CGE) and environmental performance, namely H2/CO ratio. The first change is supply of high temperature (900°C) steam in gasifier second stage. And the second change is additional heating of blast air to 900°C.

  3. The development of DIOS FXT (Four-stage X-ray Telescope)

    Science.gov (United States)

    Tawara, Yuzuru; Kurebayashi, Yuki; Sugita, Satoshi; Sakurai, Ikuya; Masuda, Tadashi; Torii, Tatsuharu; Matsushita, Kohji

    2010-07-01

    A small satellite mission DIOS (Diffuse Intergalactic Oxygen Surveyor ) is planned to observe the warm-hot intergalactic medium ( WHIM ) of a few millions of degree, by mapping the redshifted emission lines of oxygen. FXT( Four Stage X-ray Telescope) has been developed as the best fit optics for DIOS. The X-ray measurement of the first demonstration model showed a few time larger angular resolution than designed value and compact optical measurement systems for each stage single mirror were made to clarify the reason of worse performance. We will report on the present status of the development of FXT including compact optical measurement system and reexamination of the process of replica foil mirror fabrication.

  4. Hedgehog signaling is required at multiple stages of zebrafish tooth development

    Directory of Open Access Journals (Sweden)

    Stock David W

    2010-11-01

    Full Text Available Abstract Background The accessibility of the developing zebrafish pharyngeal dentition makes it an advantageous system in which to study many aspects of tooth development from early initiation to late morphogenesis. In mammals, hedgehog signaling is known to be essential for multiple stages of odontogenesis; however, potential roles for the pathway during initiation of tooth development or in later morphogenesis are incompletely understood. Results We have identified mRNA expression of the hedgehog ligands shha and the receptors ptc1 and ptc2 during zebrafish pharyngeal tooth development. We looked for, but did not detect, tooth germ expression of the other known zebrafish hedgehog ligands shhb, dhh, ihha, or ihhb, suggesting that as in mammals, only Shh participates in zebrafish tooth development. Supporting this idea, we found that morphological and gene expression evidence of tooth initiation is eliminated in shha mutant embryos, and that morpholino antisense oligonucleotide knockdown of shha, but not shhb, function prevents mature tooth formation. Hedgehog pathway inhibition with the antagonist compound cyclopamine affected tooth formation at each stage in which we applied it: arresting development at early stages and disrupting mature tooth morphology when applied later. These results suggest that hedgehog signaling is required continuously during odontogenesis. In contrast, over-expression of shha had no effect on the developing dentition, possibly because shha is normally extensively expressed in the zebrafish pharyngeal region. Conclusion We have identified previously unknown requirements for hedgehog signaling for early tooth initiation and later morphogenesis. The similarity of our results with data from mouse and other vertebrates suggests that despite gene duplication and changes in the location of where teeth form, the roles of hedgehog signaling in tooth development have been largely conserved during evolution.

  5. Hydrogeological conceptual model development and numerical modelling using CONNECTFLOW, Forsmark modelling stage 2.3

    Energy Technology Data Exchange (ETDEWEB)

    Follin, Sven (SF GeoLogic AB, Taeby (Sweden)); Hartley, Lee; Jackson, Peter; Roberts, David (Serco TAP (United Kingdom)); Marsic, Niko (Kemakta Konsult AB, Stockholm (Sweden))

    2008-05-15

    of spatial variability of the hydraulic properties within soil layers and horizontal versus vertical anisotropy in the hydraulic conductivity of soils. For the deformation zones, the same prescription for assigning transmissivities was followed as for stage 2.2, but a new method for automating the local conditioning of the deformation zone transmissivity in the vicinity of a measurement interval was used. The numerical simulations carried out in stage 2.2 demonstrated that the three geological units: deformation zones, fracture domains and regolith, can be parameterised by means of single-hole hydraulic tests and satisfactorily transformed into heterogeneous hydraulic conductor domains (HCD), hydraulic rock mass domains (HRD) and hydraulic soil domains (HSD). This means that the conceptual model developed from the interpretation of Forsmark data in stage 2.2 can be used to predict a wide range of different types of data and processes such as 1) large-scale cross-hole test responses, 2) natural point-water heads in the bedrock and the regolith, and 3) hydrochemistry profiles along the many cored boreholes drilled in close proximity to the so called target area. It is noted that a primary idea of the confirmatory testing applied in stage 2.2 is that the same groundwater flow and solute transport model is used for each type of simulation to make it transparent that a single implementation of the conceptual model could be calibrated against all three types of field observations, although it may have been possible to improve the modelling of a particular data type by refining the model around a relevant observation borehole, for example. The conceptual modelling in stage 2.2 invoked a number of hypotheses, three of which that were addressed in stage 2.3 by means of complementary field investigations (hydraulic tests). The results from these investigations do not falsify (contradict) any of the three hypotheses, hence none of them should be rejected. In fact, the three

  6. [Observation on clinical therapeutic effect of "mother-son" reinforcing-reducing method on stroke at restoration stage].

    Science.gov (United States)

    Wang, Li; Yan, De-Ying

    2005-05-01

    To probe into the role of "mother-son" reinforcing-reducing method of five Shu points in clinical treatment of stroke at restoration stage. Sixty-six cases of stroke were randomly divided into a treatment group (n = 34) and a control group (n = 32). The treatment group were treated by acupuncture at acupoints of The Hand-Yangming and The Foot-Yangming Channels, and "mother-son" reinforcing-reducing method of the five Shu for reinforcing deficiency and reducing excess according to deficiency and excess of channels differentiated by Cunkou Renying diagnosis; the control group were treated only by acupuncture at acupoints of The Hand-Yangming and Foot-Yangming Channels with uniform reinforcing-reducing method. Blood flow velocity in Cunkou and Renying Vessels before and after treatment were determined with transcranial Doppler ultrasono-blood flow meter and their clinical therapeutic effects were compared. There was a very significant difference before and after treatment in blood flow velocity in Cunkou and Renying vessels in the treatment group; the clinically basic recovery and markedly improving rate after treatment in the treatment group was significantly superior to that in the control group (P mother-son" reinforcing-reducing method of five Shu points based on differentiation of yin, yang and deficiency and excess of channels by Cunkou and Renying Vessel methods can increase clinical therapeutic effect on stroke at restoration stage.

  7. Agile Product Development Governance – On Governing the Emerging Scrum/Stage-Gate Hybrids

    OpenAIRE

    Sommer, Anita,; Dukovska-Popovska, Iskra; Steger-Jensen, Kenn

    2014-01-01

    Part 1: Knowledge Discovery and Sharing; International audience; Product Development (PD) management is changing through the emergence and implementation of agile principles into existing PD frameworks. This process changes PD governance assets, even though this aspect is not yet described in existing literature. Thus, this paper introduces PD governance of agile/stage-gate hybrid solutions through a comparative study including five case companies supported by a review of existing literature....

  8. Isoflavone and protein content in soybeans grains submitted to flooding at different stages of development

    OpenAIRE

    Fante,Camila Argenta; Goulart,Patrícia de Fátima Pereira; Alves,José Donizeti; Henrique,Paôla de Castro; Fries,Daniela Deitos

    2011-01-01

    The stress imposed on plants by soil flooding constitutes a major barrier to growth and productivity. The identification of soybean varieties that produce higher levels of isoflavones, is necessary as soybeans have been used as human food to reduce risks of chronic diseases. Thus, this study was conducted with the objective of quantifying proteins and isoflavones in soybean cultivars subjected to flooding at various stages of development. The cultivars 'BRS267', 'BRS257' and 'BRS213' were sub...

  9. Three Global Land Cover and Use Stage considering Environmental Condition and Economic Development

    Science.gov (United States)

    Lee, W. K.; Song, C.; Moon, J.; Ryu, D.

    2016-12-01

    The Mid-Latitude zone can be broadly defined as part of the hemisphere between around 30° - 60° latitude. This zone is a home to over more than 50% of the world population and encompasses about 36 countries throughout the principal regions which host most of the global problems related to development and poverty. Mid-Latitude region and its ecotone demands in-depth analysis, however, latitudinal approach has not been widely recognized, considering that many of natural resources and environment indicators, as well as social and economic indicators are based on administrative basis or by country and regional boundaries. This study sets the land cover change and use stage based on environmental condition and economic development. Because various land cover and use among the regions, form vegetated parts of East Asia and Mediterranean to deserted parts of Central Asia, the forest area was varied between countries. In addition, some nations such as North Korea, Afghanistan, Pakistan showed decreasing trends in forest area whereas some nations showed increasing trends in forest area. The economic capacity for environmental activities and policies for restoration were different among countries. By adopting the standard from IMF or World Bank, developing and developed counties were classified. Based on the classification, this study suggested the land cover and use stages as degradation, restoration, and sustainability. As the degradation stage, the nations which had decreasing forest area with less environmental restoration capacity based on economic size were selected. As the restoration stage, the nation which had increasing forest area or restoration capacity were selected. In the case of the sustainability, the nation which had enough restoration capacity with increasing forest area or small ratio in forest area decreasing were selected. In reviewing some of the past and current major environmental challenges that regions of Mid-Latitudes are facing, grouping by

  10. An embryonic staging table for in ovo development of Eublepharis macularius, the leopard gecko.

    Science.gov (United States)

    Wise, Patrick A D; Vickaryous, Matthew K; Russell, Anthony P

    2009-08-01

    Squamates constitute a major vertebrate radiation, representing almost one-third of all known amniotes. Although speciose and morphologically diverse, they remain poorly represented in developmental studies. Here, we present an embryonic staging table of in ovo development for the basal gekkotan Eublepharis macularius (the leopard gecko) and advocate this species as a laboratory-appropriate developmental model. E. macularius, is a hardy and tractable species of relatively large body size (with concomitantly relatively large eggs and embryos), that is widely available and easy to maintain and propagate. Additionally, E. macularius displays a body plan appropriate to the study of the plesiomorphic quadrupedal condition of early pentadactylous terrestrial amniotes. Although not unexpected, it is worth noting that the morphological events characterizing limb development in E. macularius are comparable with those described for the avian Gallus gallus. Therefore, E. macularius holds great promise as a model for developmental studies focusing on pentadactyly and the formation of digits. Furthermore, it is also attractive as a developmental model because it demonstrates temperature-dependent sex determination. The staging table presented herein is based on an all-female series and represents the entire 52 day in ovo period. Overall, embryogenesis of E. macularius is similar to that of other squamates in terms of developmental stage attained at the time of oviposition, patterns of limb and pharyngeal arch development, and features of the appearance of scalation and pigmentation, indicative of a conserved developmental program. (c) 2009 Wiley-Liss, Inc.

  11. Vitamin A Affects Flatfish Development in a Thyroid Hormone Signaling and Metamorphic Stage Dependent Manner

    Directory of Open Access Journals (Sweden)

    Ignacio Fernández

    2017-06-01

    Full Text Available Vitamin A (VA and retinoid derivatives are known morphogens controlling vertebrate development. Despite the research effort conducted during the last decade, the precise mechanism of how VA induces post-natal bone changes, and particularly those operating through crosstalk with the thyroid hormones (THs remain to be fully understood. Since effects and mechanisms seem to be dose and time-dependent, flatfish are an interesting study model as they undergo a characteristic process of metamorphosis driven by THs that can be followed by external appearance. Here, we studied the effects of VA imbalance that might determine Senegalese sole (Solea senegalensis skeletogenetic phenotype through development of thyroid follicles, THs homeostasis and signaling when a dietary VA excess was specifically provided during pre-, pro- or post-metamorphic stages using enriched rotifers and Artemia as carriers. The increased VA content in enriched live prey was associated to a higher VA content in fish at all developmental stages. Dietary VA content clearly affected thyroid follicle development, T3 and T4 immunoreactive staining, skeletogenesis and mineralization in a dose and time-dependent fashion. Gene expression analysis showed that VA levels modified the mRNA abundance of VA- and TH-specific nuclear receptors at specific developmental stages. Present results provide new and key knowledge to better understand how VA and TH pathways interact at tissue, cellular and nuclear level at different developmental periods in Senegalese sole, unveiling how dietary modulation might determine juvenile phenotype and physiology.

  12. Cognitive development, clinical knowledge, and clinical experience related to diagnostic ability.

    Science.gov (United States)

    Aquilino, M L

    1997-01-01

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

  13. [Development of integrated support software for clinical nutrition].

    Science.gov (United States)

    Siquier Homar, Pedro; Pinteño Blanco, Manel; Calleja Hernández, Miguel Ángel; Fernández Cortés, Francisco; Martínez Sotelo, Jesús

    2015-09-01

    to develop an integrated computer software application for specialized nutritional support, integrated in the electronic clinical record, which detects automatically and early those undernourished patients or at risk of developing undernourishment, determining points of opportunity for improvement and evaluation of the results. the quality standards published by the Nutrition Work Group of the Spanish Society of Hospital Pharmacy (SEFH) and the recommendations by the Pharmacy Group of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) have been taken into account. According to these quality standards, the nutritional support has to include the following healthcare stages or sub-processes: nutritional screening, nutritional assessment, plan for nutritional care, prescription, preparation and administration. this software allows to conduct, in an automated way, a specific nutritional assessment for those patients with nutritional risk, implementing, if necessary, a nutritional treatment plan, conducting follow-up and traceability of outcomes derived from the implementation of improvement actions, and quantifying to what extent our practice is close to the established standard. this software allows to standardize the specialized nutritional support from a multidisciplinary point of view, introducing the concept of quality control per processes, and including patient as the main customer. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  14. Development of integrated support software for clinical nutrition

    Directory of Open Access Journals (Sweden)

    Pedro Siquier Homar

    2015-09-01

    Full Text Available Objectives: to develop an integrated computer software application for specialized nutritional support, integrated in the electronic clinical record, which detects automatically and early those undernourished patients or at risk of developing undernourishment, determining points of opportunity for improvement and evaluation of the results. Methods: the quality standards published by the Nutrition Work Group of the Spanish Society of Hospital Pharmacy (SEFH and the recommendations by the Pharmacy Group of the Spanish Society of Parenteral and Enteral Nutrition (SENPE have been taken into account. According to these quality standards, the nutritional support has to include the following healthcare stages or sub-processes: nutritional screening, nutritional assessment, plan for nutritional care, prescription, preparation and administration. Results: this software allows to conduct, in an automated way, a specific nutritional assessment for those patients with nutritional risk, implementing, if necessary, a nutritional treatment plan, conducting follow-up and traceability of outcomes derived from the implementation of improvement actions, and quantifying to what extent our practice is close to the established standard. Conclusions: this software allows to standardize the specialized nutritional support from a multidisciplinary point of view, introducing the concept of quality control per processes, and including patient as the main customer

  15. Nuclear methodology development for clinical analysis

    International Nuclear Information System (INIS)

    Oliveira, Laura Cristina de

    2003-01-01

    In the present work the viability of using the neutron activation analysis to perform urine and blood clinical analysis was checked. The aim of this study is to investigate the biological behavior of animals that has been fed with chow doped by natural uranium for a long period. Aiming at time and cost reduction, the absolute method was applied to determine element concentration on biological samples. The quantitative results of urine sediment using NAA were compared with the conventional clinical analysis and the results were compatible. This methodology was also used on bone and body organs such as liver and muscles to help the interpretation of possible anomalies. (author)

  16. Renal Failure in Patients with End Stage Liver Disease and its Impact on Clinical Outcome

    International Nuclear Information System (INIS)

    Qureshi, M. O.; Shafqat, F.; Dar, F. S.; Salih, M.; Khokhar, N.

    2014-01-01

    Objective: To evaluate the prevalence of renal failure (RF) in the patients of end stage liver disease (ESLD), to determine the causes of RF in these patients and its impact on patient's outcome. Study Design: Descriptive, analytical study. Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, from May 2011 to March 2013. Methodology: A total of 523 patients with end stage liver disease (ESLD) were evaluated, renal failure (RF) and its causes were recognized in these patients according to established criteria. Outcome of these patients was assigned as reversal of RF or mortality. Data was analyzed using SPSS version 16. Chi-square test was used for comparing proportions and t-test was used for comparing mean values. P < 0.05 was considered significant. Results: Out of 523 patients, 261 (49.9%) had RF. Acute kidney injury (AKI) was the most common presentation seen in 160 (61%) patients. Hypovolemia and infections were the most frequent causes of RF. Mortality was significantly higher in the patients with RF, when compared to the patients without RF (31% vs. 4.5%, p < 0.001). Reversal of RF was seen in 98 (37%) of the affected patients. Reversal was more common in the patients with hypovolemia. The mortality was higher in the patients with hepatorenal syndrome (HRS) and infections. Conclusion: Renal failure in the end stage liver disease is an important prognostic factor. Etiology of RF is the key factor in patients' outcome. Patients of ESLD with RF had higher mortality. Majority of the cases of RF were reversible in patients of ESLD coming in the setup. (author)

  17. Clinical impact of FDG-PET/CT on colorectal cancer staging and treatment strategy

    DEFF Research Database (Denmark)

    Petersen, Rasmus K; Hess, Søren; Alavi, Abass

    2014-01-01

    and patients divided as follows: (A) Patients with a change in therapy following FDG-PET/CT and (B) Patients without a change following FDG-PET/CT. Sixty-two patients had colon and five had rectal cancer. Of these, 20 (30%; CI 20.2-41.7) belonged to group A, whereas 47 (70%; CI 58.3-79.8) fell in group B......FDG-PET/CT is rarely used for initial staging of patients with colorectal cancer (CRC). Surgical resection of primary tumor and isolated metastases may result in long-term survival or presumed cure, whereas disseminated disease contraindicates operation. We analyzed a retrospective material...

  18. Patient Perspectives on Deep Brain Stimulation Clinical Research in Early Stage Parkinson's Disease.

    Science.gov (United States)

    Heusinkveld, Lauren; Hacker, Mallory; Turchan, Maxim; Bollig, Madelyn; Tamargo, Christina; Fisher, William; McLaughlin, Lauren; Martig, Adria; Charles, David

    2017-01-01

    The FDA has approved a multicenter, double-blind, Phase III, pivotal trial testing deep brain stimulation (DBS) in 280 people with very early stage Parkinson's disease (PD; IDE#G050016). In partnership with The Michael J. Fox Foundation for Parkinson's Research, we conducted a survey to investigate motivating factors, barriers, and gender differences among potentially eligible patients for participation in a trial testing DBS in early PD compared to standard medical treatment. The majority of survey respondents (72%) indicated they would consider learning more about participating. Early PD patients are therefore likely to consider enrolling in trials of invasive therapies that may slow symptom progression and help future patients.

  19. [Historic Development of Clinical Biology Laboratories in Luxembourg].

    Science.gov (United States)

    Wennig R; Humbel R-L

    2014-01-01

    After a short overview on the development of diagnostic tools in clinical biology at an international level from Antiquity towards today, a history of the clinical biology including public and private institutions in Luxembourg will be outlined.

  20. Adverse event development in clinical oncology trials

    NARCIS (Netherlands)

    Walraven, I.; Aaronson, N.; Sonke, J.-J.; Verheij, M.; Belderbos, J.

    Gita Thanarajasingam and colleagues' Article1 in The Lancet Oncology reports on a novel longitudinal approach for adverse event analysis and reporting. Comprehensive adverse event reporting in clinical oncology trials is essential to monitor tolerability of new cancer treatments. In view of the

  1. Therapeutic options in early stage testicular seminoma. Literature survey on first results of a prospective multi-center study on radiotherapy of seminoma in the clinical stages I, IIA and IIB

    International Nuclear Information System (INIS)

    Schmidberger, H.; Bamberg, M.

    1995-01-01

    Testicular seminoma in the early stages is treated with orchiectomy and radiotherapy to the retroperitoneal nodes. Despite the high cure rates of this treatment, there is an ongoing controversy concerning the extent of the radiation fields and the radiation doses to be given in the clinical stages I, IIA and IIB. In the present literature review, these controversial issues are discussed. Four hundred and ninety-one patients in stage I testicular seminoma received adjuvant paraaortic irradiation with a total dose of 26 Gy. Forty-one patients in stage IIA, and 19 patients in stage IIB received 30 Gy or 36 Gy respectively to the paraaortic and ipsilateral iliacal nodes. Paraaortic radiotherapy in stage I disease was associated with low acute side effects and a disease-free survival in 97.1% of the patients after a median observation of 13 months. In stage IIA the disease-free survival was 100%, in stage IIB 94.7%. The literature review and preliminary results of the reported ongoing trial are indicating that paraaortic irradiation in stage I and paraaortic with ipsilateral iliacal irradiation in stages IIA and IIB seem to be a sufficient treatment in early stage testicular seminoma with low treatment associated morbidity. (orig./MG) [de

  2. Staged pallidotomy: MRI and clinical follow-up in status dystonicus.

    Science.gov (United States)

    Franzini, Angelo; Levi, Vincenzo; Franzini, Andrea; Dones, Ivano; Messina, Giuseppe

    2017-11-28

    We report on a patient affected by Status Distonicus who was treated with Deep Brain Stimulation electrodes implanted in the Globus Pallidus internus (Gpi) and used for serial radiofrequency lesions. The evolution of radiofrequency lesions was monitored by post-operative and late Magnetic Resonance Imaging (MRI). After the first lesion the patient did improve, though not in a significant fashion. Therefore, three further radiofrequency lesions were delivered 2, 4 and 6 days respectively after surgery with subsequent improvement of dystonic movements. MRI scans performed at 8 days, 3 months, and 6 months after surgery showed a diffuse T2-hyperintense and T1-hypointense GPi signal alteration which progressively decreased over time. We confirm that the possibility to stage pallidotomies over time using a couple of new contacts is a safe and efficacious procedure in treating SD patients where the lesions themselves are limited by the appearance of side effects, or in patients showing a poor response to a single lesion. As far as we know, this is the first description of MRI evolution and monitoring of a staged pallidotomy.

  3. Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines.

    Science.gov (United States)

    Abraham, Anasooya; Habermann, Elizabeth B; Rothenberger, David A; Kwaan, Mary; Weinberg, Armin D; Parsons, Helen M; Gupta, Pankaj; Al-Refaie, Waddah B

    2013-01-15

    Randomized trials demonstrating the benefits of chemotherapy in patients with American Joint Committee on Cancer stage III colon cancer underrepresent persons aged ≥ 75 years. The generalizability of these studies to a growing elderly population remains unknown. Using the California Cancer Registry for 1994 through 2008, the authors conducted a population-based study of postcolectomy patients aged 50 years to 94 years with stage III (N1M0) colon adenocarcinoma. A 2-sided chi-square test and Cochran-Armitage test for trend were used to compare patient and tumor characteristics associated with receipt of chemotherapy across age groups. Multivariate regression was used to assess the association between older age and receipt of chemotherapy. Kaplan-Meier methods and Cox proportional hazards modeling were used to evaluate the association between chemotherapy and mortality, with propensity score adjustment. Approximately 44% (12,382 patients) of the study cohort was aged ≥ 75 years. Persons aged ≥ 75 years were found to be less likely to have received adjuvant chemotherapy than those aged colon cancer in the elderly. Copyright © 2012 American Cancer Society.

  4. ENTEROVIRUS INFECTION IN CHILDREN: CLINICAL AND EPIDEMIOLOGICAL FEATURES AT THE CURRENT STAGE

    Directory of Open Access Journals (Sweden)

    G. P. Martynova

    2016-01-01

    Full Text Available The article presents the current clinical and epidemiological features of enterovirus infection in children of Krasnoyarsk Territory. A retrospective analysis of the incidence of enterovirus infection and enterovirus meningitis in the period 2014—2015 according to the forms of state statistical reporting №2 «Information on infectious and parasitic diseases». Clinical and epidemiological analysis of enterovirus infection in 454 children who were treated at MBUZ «City Children's Infectious Hospital №1» in the period of seasonal rise of morbidity in 2014 revealed a prevalence of etiological structure of enteroviruses Coxsackie B, Coxsackie B5, Coxsackie B3, Coxsackie B4. The region recorded the different clinical forms of enterovirus infection (rash, myalgia, diarrhea, gerpangina, the structure of which is still, aseptic meningitis prevails.

  5. Phase I (or phase II) dose-ranging clinical trials: proposal of a two-stage Bayesian design.

    Science.gov (United States)

    Zohar, Sarah; Chevret, Sylvie

    2003-02-01

    We propose a new design for phase I (or phase II) dose-ranging clinical trials aiming at determining a dose of an experimental treatment to satisfy safety (respectively efficacy) requirements, at treating a sufficiently large number of patients to estimate the toxicity (respectively failure) probability of the dose level with a given reliability, and at stopping the trial early if it is likely that no dose is safe (respectively efficacious). A two-stage design was derived from the Continual Reassessment Method (CRM), with implementation of Bayesian criteria to generate stopping rules. A simulation study was conducted to compare the operating characteristics of the proposed two-stage design to those reached by the traditional CRM. Finally, two applications to real data sets are provided.

  6. Clinically different stages of Alzheimer's disease associated by amyloid deposition with [11C]-PIB PET imaging.

    Science.gov (United States)

    Hatashita, Shizuo; Yamasaki, Hidetomo

    2010-01-01

    We investigated whether [11C]-PIB PET detects underlying amyloid deposition at clinically different stages of Alzheimer's disease (AD) and preclinical dementia. The Japanese cohort of 214 subjects underwent cognitive testing and 60-min dynamic [11C]-PIB PET. [11C]-PIB data were acquired from 35-60 min after injection. Regions of interest were defined on co-registered MRI. Distribution volume ratios (DVR) of PIB retention were determined using Logan graphical analysis. All 56 patients with AD showed a robust increase in PIB retention in cortical areas (typical PIB AD-pattern). A mean DVR value in 11 patients with moderate AD (CDR: 2.1 ± 0.4) showed significantly higher PIB retention (2.38 ± 0.42, p PIB PET imaging. Further, the cortical amyloid deposition could be detected at preclinical stage of AD.

  7. Differential expressed protein in developing stages of Nepenthes gracilis Korth. pitcher.

    Science.gov (United States)

    Pinthong, Krit; Chaveerach, Arunrat; Tanee, Tawatchai; Sudmoon, Runglawan; Mokkamul, Piya

    2009-03-15

    Nepenthes gracilis Korth. is a member of carnivorous plants in family Nepenthaceae. The plants have beautiful and economically important pitchers. It is interesting to study the protein(s) correlated with the pitcher. Crude proteins were extracted from leaf, leaf with developing pitcher and developed pitcher of the same plant and analyzed by Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE). Two protein bands with molecular weights of 42.7 and 38 kDa were obtained from young leaf and leaf with developing pitcher, respectively. The 42.7 kDa protein was identified as phosphoglycerate kinase (PGK) by Liquid Chromatography Mass Spectrometry (LC-MS/MS), but the 38 kDa band is an unknown protein. Both proteins were differentially expressed in each developing stage of the pitcher, thus may be powerful candidates play role in development pathway of leaf and pitcher.

  8. Carbohydrate metabolism in floral structures of Lilium pumilum in different development stages

    Directory of Open Access Journals (Sweden)

    Mirelle Nayana de Sousa Santos

    2016-01-01

    Full Text Available ABSTRACT: Lilium pumilum is a species that stands out in floriculture for presenting orange inflorescences that attract the consumer. This study thus aimed at characterizing the carbohydrate metabolism of floral structures of L. pumilum in different development stages. For this purpose, carbohydrate levels (total soluble sugars, reducing sugars, non-reducing sugars, and starch, at different floral stages (E0 - bud with no color; E1 - bud at early coloring; E2 - orange bud; E3 - open flower; E4 - senescent flower were quantified after extraction with ethanol. Lilium pumilum flowers showed high energy potential during floral opening and senescence; total soluble sugars were the main carbohydrates present in the species, reducing with the floral development, and the same occurred with the non-reducing sugar and starch contents. The reducing-sugar content increased with the floral stages. Therefore, this species presents great mobilization of compounds, which are utilized in the production of energy that is employed in floral opening.

  9. B3GNT3 Expression Is a Novel Marker Correlated with Pelvic Lymph Node Metastasis and Poor Clinical Outcome in Early-Stage Cervical Cancer

    Science.gov (United States)

    Niu, Chunhao; Song, Libing; Zhang, Yanna

    2015-01-01

    Background The β1,3-N-acetylglucosaminyltransferase-3 gene (B3GNT3) encodes a member of the B3GNT family that functions as the backbone structure of dimeric sialyl-Lewis A and is involved in L-selectin ligand biosynthesis, lymphocyte homing and lymphocyte trafficking. B3GNT3 has been implicated as an important element in the development of certain cancers. However, the characteristics of B3GNT3 in the development and progression of cancer remain largely unknown. Thus, our study aimed to investigate the expression pattern and the prognostic value of B3GNT3 in patients with early-stage cervical cancer. Methods The mRNA and protein levels of B3GNT3 expression were examined in eight cervical cancer cell lines and ten paired cervical cancer tumors, using real-time PCR and western blotting, respectively. Immunohistochemistry (IHC) was used to analyze B3GNT3 protein expression in paraffin-embedded tissues from 196 early-stage cervical cancer patients. Statistical analyses were applied to evaluate the association between B3GNT3 expression scores and clinical parameters, as well as patient survival. Results B3GNT3 expression was significantly upregulated in cervical cancer cell lines and lesions compared with normal cells and adjacent noncancerous cervical tissues. In the 196 cases of tested early-stage cervical cancer samples, the B3GNT3 protein level was positively correlated with high risk TYPES of human papillomavirus (HPV) infection (P = 0.026), FIGO stage (P cervical cancer patients. Conclusions Our study demonstrated that elevated B3GNT3 expression is associated with pelvic lymph node metastasis and poor outcome in early-stage cervical cancer patients. B3GNT3 may be a novel prognostic marker and therapeutic target for the treatment of cervical cancer. PMID:26709519

  10. Scrum integration in stage-gate models for collaborative product development

    DEFF Research Database (Denmark)

    Sommer, Anita Friis; Slavensky, Andreas; Nguyen, Vivi Thuy

    2013-01-01

    The relevance of collaborative Product Development (PD) is rising with the decrease of product life cycles combined with growing customer demands. Industrial manufacturers now experience competition in the global market, where differentiation is necessary for survival. Hence, in order...... to differentiate from low-cost competitors and increase PD performance, some industrial manufacturers now seek competitive advantage by experimenting with new ways for collaborative PD. This includes integrating customer-focused agile process models, like Scrum, from the software industry into their existing PD...... models. Thus, instead of replacing traditional stage-gate models agile methods are currently integrated in existing PD models generating hybrid solution for collaborative PD. This paper includes a study of three industrial cases that have successfully integrated Scrum into a stage-gate process model...

  11. Development of the Four-stage X-ray telescope (FXT) for the DIOS mission

    Science.gov (United States)

    Tawara, Yuzuru; Sakurai, Ikuya; Sugita, Satoshi; Takizawa, Shunya; Babazaki, Yasunori; Nakamichi, Ren; Bandai, Ayako; Maeda, Yoshitomo; Hayashi, Takayuki

    2014-07-01

    A Four-stage X-ray Telescope (FXT) has been developed as the best-fit optics for the Diffuse Intergalactic Oxygen Surveyor (DIOS) mission, a small satellite mission for mapping observations of the warm-hot intergalactic medium. The FXT mirrors are based on a conical approximation of the Wolter-I design, fabrication technique used in the Suzaku satellite. We made the second FXT demonstration model, in which we installed 4 sets of 4 stage mirrors with diameter of about 500 mm using alignment plate. Both optical and X-ray measurement were done to estimate FXT performance. Although angular resolution is two to three times worse than that of the requirement and the goal, the field of view and the effective area are consistent with expected performance derived by the ray tracing simulation.

  12. The development of pneumoconiosis and its final stages in miners of the Karvina district

    Energy Technology Data Exchange (ETDEWEB)

    Pochmon, O.; Kratochvil, Z.

    1974-01-01

    The authors studied 63 retired miners from the Ostrava- Karvina coal mines who had a complicated form of pneumoco niosis. They had been repeatedly hospitalized in the department for tuberculosis and respiratory diseases, mostly because of a complicated respiratory illness. Under conditions of the Ostrava-Karvina mines, pneumoco niosis develops rapidly in proportion to the dust pollution the miners are exposed to. In the above 63 miners pneumoconiosis was in an advanced stage (type B and C according to the Geneva classification). The disease progressed most rapidly (within 10 years) in the group of drifters. Chronic bronchitis was found in 44% of the patients, lung emphysema in 56%, cor pulmonale in 57% of cases. The gravest complications in retired miners with an advanced stage of pneumoconiosis were exacerbated chronic bronchitis and bronchopneumonia endangering the lives of the patients.

  13. Development of a Rotating Rake Array for Boundary-Layer-Ingesting Fan-Stage Measurements

    Science.gov (United States)

    Wolter, John D.; Arend, David J.; Hirt, Stefanie M.; Gazzaniga, John A.

    2017-01-01

    The recent Boundary-Layer-Ingesting Inlet/Distortion Tolerant Fan wind tunnel experiment at NASA Glenn Research Center's 8- by 6-foot Supersonic Wind Tunnel (SWT) examined the performance of a novel inlet and fan stage that was designed to ingest the vehicle boundary layer in order to take advantage of a predicted overall propulsive efficiency benefit. A key piece of the experiment's instrumentation was a pair of rotating rake arrays located upstream and downstream of the fan stage. This paper examines the development of these rake arrays. Pre-test numerical solutions were sampled to determine placement and spacing for rake pressure and temperature probes. The effects of probe spacing and survey density on the repeatability of survey measurements was examined. These data were then used to estimate measurement uncertainty for the adiabatic efficiency.

  14. Towards the development of a comprehensive framework: Qualitative systematic survey of definitions of clinical research quality.

    Science.gov (United States)

    von Niederhäusern, Belinda; Schandelmaier, Stefan; Mi Bonde, Marie; Brunner, Nicole; Hemkens, Lars G; Rutquist, Marielle; Bhatnagar, Neera; Guyatt, Gordon H; Pauli-Magnus, Christiane; Briel, Matthias

    2017-01-01

    To systematically survey existing definitions, concepts, and criteria of clinical research quality, both developed by stakeholder groups as well as in the medical literature. This study serves as a first step in the development of a comprehensive framework for the quality of clinical research. We systematically and in duplicate searched definitions, concepts and criteria of clinical research quality on websites of stakeholders in clinical research until no further insights emerged and in MEDLINE up to February 2015. Stakeholders included governmental bodies, regulatory agencies, the pharmaceutical industry, academic and commercial contract research organizations, initiatives, research ethics committees, patient organizations and funding agencies from 13 countries. Data synthesis involved descriptive and qualitative analyses following the Framework Method on definitions, concepts, and criteria of clinical research quality. Descriptive codes were applied and grouped into clusters to identify common and stakeholder-specific quality themes. Stakeholder concepts on how to assure quality throughout study conduct or articles on quality assessment tools were common, generally with no a priori definition of the term quality itself. We identified a total of 20 explicit definitions of clinical research quality including varying quality dimensions and focusing on different stages in the clinical research process. Encountered quality dimensions include ethical conduct, patient safety/rights/priorities, internal validity, precision of results, generalizability or external validity, scientific and societal relevance, transparency and accessibility of information, research infrastructure and sustainability. None of the definitions appeared to be comprehensive either in terms of quality dimensions, research stages, or stakeholder perspectives. Clinical research quality is often discussed but rarely defined. A framework defining clinical research quality across stakeholders

  15. Ophthalmic clinical officers: developments in Uganda

    Directory of Open Access Journals (Sweden)

    Godfrey Kaggwa

    2014-07-01

    Full Text Available In the rural areas, OCOs refer patients with complicated clinical problems to ophthalmologists and those requiring complicated refractions are referred to optometrists. They review patients after operations, perform extra-ocular surgery, assist surgeons in theatre, and conduct eye care outreach to schools, rural parts of the community and remote health facilities. At district level, OCOs coordinate eye care services (including planning and budgeting and also train and supervise other eye care personnel.

  16. Current developments in clinical multiphoton tomography

    Science.gov (United States)

    König, Karsten; Weinigel, Martin; Breunig, Hans Georg; Gregory, Axel; Fischer, Peter; Kellner-Höfer, Marcel; Bückle, Rainer

    2010-02-01

    Two-photon microscopy has been introduced in 1990 [1]. 13 years later, CE-marked clinical multiphoton systems for 3D imaging of human skin with subcellular resolution have been launched by the JenLab company with the tomograph DermaInspectTM. In 2010, the second generation of clinical multiphoton tomographs was introduced. The novel mobile multiphoton tomograph MPTflexTM, equipped with a flexible articulated optical arm, provides an increased flexibility and accessibility especially for clinical and cosmetical examinations. The multiphoton excitation of fluorescent biomolecules like NAD(P)H, flavins, porphyrins, elastin, and melanin as well as the second harmonic generation of collagen is induced by picojoule femtosecond laser pulses from an tunable turn-key near infrared laser system. The ability for rapid highquality image acquisition, the user-friendly operation of the system, and the compact and flexible design qualifies this system to be used for melanoma detection, diagnostics of dermatological disorders, cosmetic research, and skin aging measurements as well as in situ drug monitoring and animal research. So far, more than 1,000 patients and volunteers have been investigated with the multiphoton tomographs in Europe, Asia, and Australia.

  17. Leidos Biomed Supports Clinical Trials for Vaccine Against Mosquito-borne Chikungunya | FNLCR Staging

    Science.gov (United States)

    An experimental vaccine for mosquito-borne chikungunya is being tested at sites in the Caribbean as part of a phase II clinical trial being managed by the Frederick National Lab. No vaccine or treatment currently exists for the viral disease, which c

  18. Art Therapy for an Individual with Late Stage Dementia: A Clinical Case Description

    Science.gov (United States)

    Tucknott-Cohen, Tisah; Ehresman, Crystal

    2016-01-01

    This article describes the healing benefits of art therapy for an individual with dementia of the Alzheimer's type. In this clinical case description, a woman diagnosed with Alzheimer's disease received individual art therapy for 17 weeks. The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on…

  19. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  20. Evolution of Ventricular Energetics in the Different Stages of Palliation of Hypoplastic Left Heart Syndrome: A Retrospective Clinical Study.

    Science.gov (United States)

    Di Molfetta, A; Iacobelli, R; Guccione, P; Di Chiara, L; Rocchi, M; Cobianchi Belisari, F; Campanale, M; Gagliardi, M G; Filippelli, S; Ferrari, G; Amodeo, A

    2017-12-01

    Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation including the hybrid, the Norwood, the bidirectional Glenn (BDG), and the Fontan procedures. We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or BDG and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data. Measured data were used to calculate energetic variables such as ventricular elastances, external and internal work, ventriculo-arterial coupling and cardiac mechanical efficiency. From 2010 to 2016, a total of 29 HLHS patients undergoing cardiac catheterization after hybrid (n = 7) or Norwood (n = 6) or Glenn (n = 8) or Fontan (n = 8) procedure were retrospectively enrolled. Ventricular volumes were significantly higher in the Norwood circulation than in the hybrid circulation (p = 0.03) with a progressive decrement from the first stage to the Fontan completion. Ventricular elastances were lower in the Norwood circulation than in the hybrid circulation and progressively increased passing from the first stage to the Fontan completion. The arterial elastance and Rtot increased in the Fontan circulation. The ventricular work progressively increased. Finally, the ventricular efficiency improves passing from the first to the last stage of palliation. The use of ventricular energetic parameters could lead to a more complete evaluation of such complex patients to better understand their adaptation to different pathophysiological conditions.

  1. [Comparison of clinical pathological characteristics in ovarian preserving patients with stage IB1 cervical adenocarcinoma and squamous cell carcinoma].

    Science.gov (United States)

    Hu, J; Zheng, P Z; Zhu, L R

    2016-10-18

    To analyze the risk and prognostic of patients with stage IB1 cervical adenocarcinoma. The clinical data of 139 patients with stage IB1 cervical adenocarcinoma treated at Department of Gynecology and Obstetrics in Peking University First Hospital from August 1994 to April 2015 were retrospectively reviewed, which included 38 cases of cervical adenocarcinoma and 101 cases of cervical squamous cell carcinoma. A comparison was made between ovarian preserving group and bilateral oophorectomy group, in order to justify the risk and prognosis of ovarian preserving patients. The 5-year cumulative survival rate of stage IB1 cervical adenocarcinoma and squamous cell carcinoma were 89.1% and 92.9% respectively with significant difference (P=0.034). One ovarian metastasis case was observed among the 32 cervical adenocarcinoma patients of bilateral oophorectomy, while another ovarian metastasis case was observed among 54 cervical squamous cell carcinoma patients of bilateral oophorectomy. The ovarian metastasis rate was 3.1% (1/32) and 1.8 % (1/54) respectively with no statistical difference (P=0.574). The cumulative 5-year survival of 6 ovarian preserving patients with cervical adenocarcinoma was 80.1%, while that of 47 ovarian preserving patients with cervical squamous cell carcinoma was 94.6% (P=0.127). There was no statistical difference between the survival curve of the two groups. The prognosis of stage IB1 cervical adenocarcinomas was somewhat poorer than that of cervical squamous cell carcinoma. However it was still reasonable to perform ovarian preservation among young patients of stage IB1 cervical adenocarcinoma with no high risk factors.

  2. Clinical pharmacy activities in chronic kidney disease and end-stage renal disease patients: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Stemer Gunar

    2011-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD and end-stage renal disease (ESRD represent worldwide health problems with an epidemic extent. Therefore, attention must be given to the optimisation of patient care, as gaps in the care of CKD and ESRD patients are well documented. As part of a multidisciplinary patient care strategy, clinical pharmacy services have led to improvements in patient care. The purpose of this study was to summarise the available evidence regarding the role and impact of clinical pharmacy services for these patient populations. Methods A literature search was conducted using the Medline, Embase and International Pharmaceutical Abstracts databases to identify relevant studies on the impact of clinical pharmacists on CKD and ESRD patients, regarding disease-oriented and patient-oriented outcomes, and clinical pharmacist interventions on drug-related problems. Results Among a total of 21 studies, only four (19% were controlled trials. The majority of studies were descriptive (67% and before-after studies (14%. Interventions comprised general clinical pharmacy services with a focus on detecting, resolving and preventing drug-related problems, clinical pharmacy services with a focus on disease management, or clinical pharmacy services with a focus on patient education in order to increase medication knowledge. Anaemia was the most common comorbidity managed by clinical pharmacists, and their involvement led to significant improvement in investigated disease-oriented outcomes, for example, haemoglobin levels. Only four of the studies (including three controlled trials presented data on patient-oriented outcomes, for example, quality of life and length of hospitalisation. Studies investigating the number and type of clinical pharmacist interventions and physician acceptance rates reported a mean acceptance rate of 79%. The most common reported drug-related problems were incorrect dosing, the need for additional

  3. Bone radioisotope scanning: usefulness in the evaluation and observation of patients with breast cancer in clinical stage II, III, IV

    International Nuclear Information System (INIS)

    Cano P, R.A.

    1995-01-01

    The clinical records of 420 patients with diagnosis of breast cancer well documented by the pathological anatomy in clinical stage II, III and IV were reviewed. In each one of them has been done at least a bone scanning during the diagnosis. In 52 cases carried out sericeous dosages of CA 15-3 and in some cases it was necessary to administer Samarium-153 EDTMP as palliative therapy of bone pain. The presence of secondary gamma-graphic focuses was 0/84 cases (0%) in clinical stage II, 54/265 cases (20%) in III and 41/91 cases (45%) in IV. The one focus appeared in 6.7% of the cases. In 7 of the 52 cases that received sericeous dosages of CA 15-3 were detected secondary osseous lesions, and 5 of them presented a marker elevation. The bone scanning has shown in many cases the presence of getters focuses in singular places of skeleton, urinary excretory system or mammary tissue. The gamma rays from Sm-153 allowed us to get some appropriate basal views post-therapy of the secondary lesions. The results show that the great incidence of secondary lesions in the skeleton occurred in cases of stages III and IV unlike other countries. The serial repetition of the radioisotope scanning. The presence of one focus in the skeleton of a patient with a well-known neoplasia makes us to do a careful evaluation of the focus nature. The presence of tracer accumulation in the kidney, ureter and bladder allows us to infer the pathology of excretory system that is the first evidence of its presence in many cases. (author). 71 refs., 7 figs., 6 tabs

  4. Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease

    DEFF Research Database (Denmark)

    Ladekarl, M; Bæk-Hansen, T; Henrik-Nielsen, R

    1995-01-01

    a projection microscope and a simple test system in fields of vision systematically selected from the whole tumor area of one routine section, five quantitative histopathologic variables were estimated: the mean nuclear volume, the mean nuclear profile area, the density of nuclear profiles, the volume fraction...... of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease.RESULTS: Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I...... and II) and young age (P stage, age, and mean nuclear...

  5. Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease

    DEFF Research Database (Denmark)

    Ladekarl, M; Bæk-Hansen, T; Henrik-Nielsen, R

    1995-01-01

    a projection microscope and a simple test system in fields of vision systematically selected from the whole tumor area of one routine section, five quantitative histopathologic variables were estimated: the mean nuclear volume, the mean nuclear profile area, the density of nuclear profiles, the volume fraction...... of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease. RESULTS: Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I...... and II) and young age (P stage, age, and mean nuclear...

  6. Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial.

    Science.gov (United States)

    Kahn, Elyne; D'Haese, Pierre-Francois; Dawant, Benoit; Allen, Laura; Kao, Chris; Charles, P David; Konrad, Peter

    2012-02-01

    Recent evidence suggests that deep brain stimulation of the subthalamic nucleus (STN-DBS) may have a disease modifying effect in early Parkinson's disease (PD). A randomised, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. 15 of 30 early PD patients were randomised to receive STN-DBS implants in an institutional review board approved protocol. Operative technique, location of DBS leads and perioperative adverse events are reported. Active contact used for stimulation in these patients was compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. 14 of the 15 patients did not sustain any long term (>3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior -1.1±1.7 mm, lateral 10.7±1.7 mm and superior -3.3±2.5 mm (anterior and posterior commissure coordinates). This location is statistically no different (0.77 mm, p>0.05) than the optimal contact used in the treatment of 47 advanced PD patients. The perioperative adverse events in this trial of subjects with early stage PD are comparable with those reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomised, surgical versus best medical therapy trial for the early treatment of PD.

  7. Application of the development stages of a cluster randomized trial to a framework for evaluating complex health interventions

    Directory of Open Access Journals (Sweden)

    Loeb Mark B

    2002-07-01

    Full Text Available Abstract Introduction Trials of complex health interventions often pose difficult methodologic challenges. The objective of this paper is to assess the extent to which the various development steps of a cluster randomized trial to optimize antibiotic use in nursing homes are represented in a recently published framework for the design and evaluation of complex health interventions. In so doing, the utility of the framework for health services researchers is evaluated. Methods Using the five phases of the framework (theoretical, identification of components of the intervention, definition of trial and intervention design, methodological issues for main trial, promoting effective implementation, corresponding stages in the development of the cluster randomized trial using diagnostic and treatment algorithms to optimize the use of antibiotics in nursing homes are identified and described. Results Synthesis of evidence needed to construct the algorithms, survey and qualitative research used to define components of the algorithms, a pilot study to assess the feasibility of delivering the algorithms, methodological issues in the main trial including choice of design, allocation concealment, outcomes, sample size calculation, and analysis are adequately represented using the stages of the framework. Conclusions The framework is a useful resource for researchers planning a randomized clinical trial of a complex intervention.

  8. [A physiological development time-based simulation model for cotton development stages and square- and boll formation].

    Science.gov (United States)

    Ma, Fuyu; Cao, Weixing; Zhang, Lizhen; Zhu, Yan; Li, Shaokun; Zhou, Zhiguo; Li, Cundong; Xu, Lihua

    2005-04-01

    In this study, three cotton varieties (CRI 36, CRI 35 and CRI 41) were planted in Nanjing, Anyang, Baoding and Shihezi, respectively, in 2002, and the dynamic relationships between their development and environmental factors were analyzed. Based on this, a simulation model for cotton development stages and square-and boll development was built in terms of physiological development time (PDT). In calculating relative thermal effectiveness, the effect of diurnal temperature differences in different regions on cotton development was incorporated, and the enhancement of plastic mulching on air temperature was quantified. To simulate development stages, the initial fruiting node index (IFIN), sunlight duration factor (FSH), and solar radiation index on fruiting branch (IFBR) were introduced, besides earliness factor of a given genotype. The validation of the model with the data obtained from different years, ecological zones, genotypes, and cultivation practices indicated a high goodness of fitness between the simulated results and observed values. The root mean square error (RMSE) between simulated and observed days from sowing to emergence, emergence to squaring, anthesis to boll opening, and sowing to boll opening was 0.9, 2.2, 1.7, and 2.1 d, respectively, with a mean of 2.1 d, and in all plant sites, the RMSE between simulated and observed days from squaring to boll opening was 1.8-3.7 d, and that from squaring to opening was 4.6-5.8 d.

  9. Profiling microRNA expression during multi-staged date palm (Phoenix dactylifera L.) fruit development

    KAUST Repository

    Xin, Chengqi

    2015-01-29

    MicroRNAs (miRNAs) play crucial roles in multiple stages of plant development and regulate gene expression at posttranscriptional and translational levels. In this study, we first identified 238 conserved miRNAs in date palm (Phoenix dactylifera) based on a high-quality genome assembly and defined 78 fruit-development-associated (FDA) miRNAs, whose expression profiles are variable at different fruit development stages. Using experimental data, we subsequently detected 276 novel P. dactylifera-specific FDA miRNAs and predicted their targets. We also revealed that FDA miRNAs function mainly in regulating genes involved in starch/sucrose metabolisms and other carbon metabolic pathways; among them, 221 FDA miRNAs exhibit negative correlation with their corresponding targets, which suggests their direct regulatory roles on mRNA targets. Our data define a comprehensive set of conserved and novel FDA miRNAs along with their expression profiles, which provide a basis for further experimentation in assigning discrete functions of these miRNAs in P. dactylifera fruit development.

  10. Stage-related expression of mRNAs during pollen development in lily and tobacco.

    Science.gov (United States)

    Schrauwen, J A; de Groot, P F; van Herpen, M M; van der Lee, T; Reynen, W H; Weterings, K A; Wullems, G J

    1990-09-01

    Homogeneous populations of developing microspores and pollen from anthers of lily (Lilium longiflorum Thumb.) and tobacco (Nicotiana tabacum L.) show a continuous production of biomass, reaching a maximum in young pollen. The rate of RNA synthesis was 460 fg · h(-1) in young binucleate cells, 138 fg · h(-1) in late binucleate cells and 56 fg · h(-1) in microspores. The mRNA population in developing pollen can be separated into three groups. In the first group, certain types of mRNAs are present at a constant level during all stages of development. A second group is characteristic of young pollen and increases quantitatively until anthesis. A third group is seen transiently; to this belong mRNAs present only before mitosis or at a distinct cell stage after mitosis. Some of the translation products of this latter group of mRNAs showed similarities between lily and tobacco on two-dimensional gels in respect of molecular weight and isolectric point, indicating that those mRNAs and proteins play a role in the regulation of pollen development.

  11. Profiling microRNA expression during multi-staged date palm (Phoenix dactylifera L.) fruit development.

    Science.gov (United States)

    Xin, Chengqi; Liu, Wanfei; Lin, Qiang; Zhang, Xiaowei; Cui, Peng; Li, Fusen; Zhang, Guangyu; Pan, Linlin; Al-Amer, Ali; Mei, Hailiang; Al-Mssallem, Ibrahim S; Hu, Songnian; Al-Johi, Hasan Awad; Yu, Jun

    2015-04-01

    MicroRNAs (miRNAs) play crucial roles in multiple stages of plant development and regulate gene expression at posttranscriptional and translational levels. In this study, we first identified 238 conserved miRNAs in date palm (Phoenix dactylifera) based on a high-quality genome assembly and defined 78 fruit-development-associated (FDA) miRNAs, whose expression profiles are variable at different fruit development stages. Using experimental data, we subsequently detected 276 novel P. dactylifera-specific FDA miRNAs and predicted their targets. We also revealed that FDA miRNAs function mainly in regulating genes involved in starch/sucrose metabolisms and other carbon metabolic pathways; among them, 221 FDA miRNAs exhibit negative correlation with their corresponding targets, which suggests their direct regulatory roles on mRNA targets. Our data define a comprehensive set of conserved and novel FDA miRNAs along with their expression profiles, which provide a basis for further experimentation in assigning discrete functions of these miRNAs in P. dactylifera fruit development. Copyright © 2015. Published by Elsevier Inc.

  12. Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: A naturalistic study.

    Science.gov (United States)

    Vinberg, Maj; Mikkelsen, Rie Lambaek; Kirkegaard, Thomas; Christensen, Ellen Margrethe; Kessing, Lars Vedel

    2017-01-15

    In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional level, the presence of comorbid personality disorders and coping strategies. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style using the Coping Inventory for Stressful Situations. In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid personality disorders. Finally, they exhibited a trend towards using less adaptive coping styles. It cannot be omitted that some patients may have progressed from BD II to BD I. Most measures were based on patient self report. Overall, BD II was associated with a higher disease burden. Clinically, it is important to differentiate BD II from BD I and research wise, there is a need for tailoring and testing specific interventions towards BD II. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Surviving a flood: effects of inundation period, temperature and embryonic development stage in locust eggs.

    Science.gov (United States)

    Woodman, J D

    2015-08-01

    The Australian plague locust, Chortoicetes terminifera (Walker), is an important agricultural pest and oviposits into compacted soil across vast semi-arid and arid regions prone to irregular heavy summer rainfall. This study aimed to quantify the effects of flooding (control, 7, 14, 21, 28 and 35 days) at different temperatures (15, 20 and 25°C) and embryonic development stages (25 and 75%) on egg viability, hatchling nymph body mass and survival to second-instar. Egg viability after flooding was dependent on temperature and flood duration. Eggs inundated at 15°C showed ≥53.5% survival regardless of flood duration and development stage compared with ≤29.6% for eggs at 25°C for ≥21 days early in development and ≥14 days late in development. Hatchling nymphs did not differ in body mass relative to temperature or flood duration, but weighed more from eggs inundated early in development rather than late. Survival to second-instar was ≤55.1% at 15 and 20°C when eggs were flooded for ≥28 days late in development, ≤35.6% at 25°C when flooded for ≥28 days early in development, and zero when flooded for ≥21 days late in development. These results suggest that prolonged flooding in summer and early autumn may cause very high egg mortality and first-instar nymph mortality of any survivors, but is likely to only ever affect a small proportion of the metapopulation. More common flash flooding for ≤14 days is unlikely to cause high mortality and have any direct effect on distribution and abundance.

  14. [Clinical nursing manpower: development and future prospects].

    Science.gov (United States)

    Lin, Chiou-Fen; Kao, Ching-Chiu

    2014-04-01

    The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.

  15. Waterhammer Modeling for the Ares I Upper Stage Reaction Control System Cold Flow Development Test Article

    Science.gov (United States)

    Williams, Jonathan H.

    2010-01-01

    The Upper Stage Reaction Control System provides three-axis attitude control for the Ares I launch vehicle during active Upper Stage flight. The system design must accommodate rapid thruster firing to maintain the proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted in the fall of 2009 at Marshall Space Flight Center were performed using a water-flow test article to better understand fluid performance characteristics of the Upper Stage Reaction Control System. A subset of the tests examined waterhammer along with the subsequent pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

  16. Oil production at different stages of leaf development in Lippia alba

    Directory of Open Access Journals (Sweden)

    Diego Pandeló

    2012-01-01

    Full Text Available The aim of this work was to analyze terpene oil production and terpene synthases (TPS gene expression from leaves at different developmental stages of different chemotypes of Lippia alba (Mill. N.E. Br. ex Britton & P. Wilson, Verbenaceae. Hydro-distilled essential oil were used for chemical analysis and gene expression of three monoterpene synthase genes called LaTPS12, LaTPS23 and LaTPS25 were used for analyses of gene expression associated to oil production. The putative genes were associated to TPS-b gene class. Semi-quantitative PCR and quantitative PCR (qPCR analysis were used to investigate the expression profile of those three putative genes in different leaf stages and different chemotypes. Additionally, total oil production and gene expression of putative TPS genes cloned from L. alba chemotype linalool were evaluated at different stages of leaf development. The expression level of those three genes was higher when the highest oil production was observed, mainly in young leaves at the fourth nodal segment for all evaluated chemotypes. Total oil production was higher at leaves that had unopened trichomes. We also observed that the 1mM of MeJA treatment increased the gene expression in all chemotypes after 24 h elicitation.

  17. Oil production at different stages of leaf development in Lippia alba

    Directory of Open Access Journals (Sweden)

    Diego Pandeló

    2012-06-01

    Full Text Available The aim of this work was to analyze terpene oil production and terpene synthases (TPS gene expression from leaves at different developmental stages of different chemotypes of Lippia alba (Mill. N.E. Br. ex Britton & P. Wilson, Verbenaceae. Hydro-distilled essential oil were used for chemical analysis and gene expression of three monoterpene synthase genes called LaTPS12, LaTPS23 and LaTPS25 were used for analyses of gene expression associated to oil production. The putative genes were associated to TPS-b gene class. Semi-quantitative PCR and quantitative PCR (qPCR analysis were used to investigate the expression profile of those three putative genes in different leaf stages and different chemotypes. Additionally, total oil production and gene expression of putative TPS genes cloned from L. alba chemotype linalool were evaluated at different stages of leaf development. The expression level of those three genes was higher when the highest oil production was observed, mainly in young leaves at the fourth nodal segment for all evaluated chemotypes. Total oil production was higher at leaves that had unopened trichomes. We also observed that the 1mM of MeJA treatment increased the gene expression in all chemotypes after 24 h elicitation.

  18. Reading skills of students with speech sound disorders at three stages of literacy development.

    Science.gov (United States)

    Skebo, Crysten M; Lewis, Barbara A; Freebairn, Lisa A; Tag, Jessica; Avrich Ciesla, Allison; Stein, Catherine M

    2013-10-01

    The relationship between phonological awareness, overall language, vocabulary, and nonlinguistic cognitive skills to decoding and reading comprehension was examined for students at 3 stages of literacy development (i.e., early elementary school, middle school, and high school). Students with histories of speech sound disorders (SSD) with and without language impairment (LI) were compared to students without histories of SSD or LI (typical language; TL). In a cross-sectional design, students ages 7;0 (years;months) to 17;9 completed tests that measured reading, language, and nonlinguistic cognitive skills. For the TL group, phonological awareness predicted decoding at early elementary school, and overall language predicted reading comprehension at early elementary school and both decoding and reading comprehension at middle school and high school. For the SSD-only group, vocabulary predicted both decoding and reading comprehension at early elementary school, and overall language predicted both decoding and reading comprehension at middle school and decoding at high school. For the SSD and LI group, overall language predicted decoding at all 3 literacy stages and reading comprehension at early elementary school and middle school, and vocabulary predicted reading comprehension at high school. Although similar skills contribute to reading across the age span, the relative importance of these skills changes with children's literacy stages.

  19. 2011 Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

    Science.gov (United States)

    Azzoli, Christopher G.; Temin, Sarah; Aliff, Timothy; Baker, Sherman; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pao, William; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

    2011-01-01

    Purpose An American Society of Clinical Oncology (ASCO) focused update updates a single recommendation (or subset of recommendations) in advance of a regularly scheduled guideline update. This document updates one recommendation of the ASCO Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer (NSCLC) regarding switch maintenance chemotherapy. Clinical Context Recent results from phase III clinical trials have demonstrated that in patients with stage IV NSCLC who have received four cycles of first-line chemotherapy and whose disease has not progressed, an immediate switch to alternative, single-agent chemotherapy can extend progression-free survival and, in some cases, overall survival. Because of limitations in the data, delayed treatment with a second-line agent after disease progression is also acceptable. Recent Data Seven randomized controlled trials of carboxyaminoimidazole, docetaxel, erlotinib, gefitinib, gemcitabine, and pemetrexed have evaluated outcomes in patients who received an immediate, non–cross resistant alternative therapy (switch maintenance) after first-line therapy. Recommendation In patients with stage IV NSCLC, first-line cytotoxic chemotherapy should be stopped at disease progression or after four cycles in patients whose disease is stable but not responding to treatment. Two-drug cytotoxic combinations should be administered for no more than six cycles. For those with stable disease or response after four cycles, immediate treatment with an alternative, single-agent chemotherapy such as pemetrexed in patients with nonsquamous histology, docetaxel in unselected patients, or erlotinib in unselected patients may be considered. Limitations of this data are such that a break from cytotoxic chemotherapy after a fixed course is also acceptable, with initiation of second-line chemotherapy at disease progression. PMID:21900105

  20. Syntheses of nucleic acid and protein in somatic embryos of Fritillaria ussuriensis maxim in different development stages

    International Nuclear Information System (INIS)

    Wang Shuyu; Tang Wei; Wang Hui

    1993-09-01

    After developing a procedure for somatic embryogenesis in Fritillaria ussuriensis, dynamics on the syntheses of DNA, RNA, and protein during globular, heart-shaped, torpedo-shaped, cotyledonary, and mature somatic embryo stages was demonstrated by both autoradiography and scintillation counting. The rates of syntheses of DNA, RNA, and protein gradually increase between the globular and cotyledonary somatic embryos stages. DNA, RNA, and protein synthesis rates are in peak at the cotyledonary later stage, precotyledonary stage, and cotyledonary stage, respectively. It appears that more DNA, RNA, and protein are synthesized in the cotyledonary somatic embryo stage than in other stages. All these results indicate that an increased syntheses of DNA, RNA, and protein is associated with the differentiation of embryogenic cells and organogenesis in somatic embryos

  1. Clinical and radiologic evaluation of 2-stage IMZ implants placed in a single-stage procedure : 2-year results of a prospective comparative study

    NARCIS (Netherlands)

    Heydenrijk, K; Raghoebar, GM; Meijer, HJA; Stegenga, B

    2003-01-01

    Purpose: The aim of this study was to evaluate the feasibility of using a 2-stage implant system in a single-stage procedure and to study the impact of the microgap between the implant and the abutment. Materials and Methods: Sixty edentulous patients (Cawood class V or VI) participated in this

  2. Lymphadenectomy in locally advanced cervical cancer study (LiLACS): Phase III clinical trial comparing surgical with radiologic staging in patients with stages IB2-IVA cervical cancer.

    Science.gov (United States)

    Frumovitz, Michael; Querleu, Denis; Gil-Moreno, Antonio; Morice, Philippe; Jhingran, Anuja; Munsell, Mark F; Macapinlac, Homer A; Leblanc, Eric; Martinez, Alejandra; Ramirez, Pedro T

    2014-01-01

    Radiation treatment planning for women with locally advanced cervical cancer (stages IB2-IVA) is often based on positron emission tomography (PET). PET, however, has poor sensitivity in detecting metastases in aortocaval nodes. We have initiated a study with the objective of determining whether pre-therapeutic laparoscopic surgical staging followed by tailored chemoradiation improves survival as compared with PET/computed tomography (CT) radiologic staging alone followed by chemoradiation. This international, multicenter phase III trial will enroll 600 women with stages IB2-IVA cervical cancer and PET/CT findings showing fluorodeoxyglucose-avid pelvic nodes and fluorodeoxyglucose-negative para-aortic nodes. Eligible patients will be randomized to undergo either pelvic radiotherapy with chemotherapy (standard-of-care arm) or surgical staging via a minimally invasive extraperitoneal approach followed by tailored radiotherapy with chemotherapy (experimental arm). The primary end point is overall survival. Secondary end points are disease-free survival, short- and long-term morbidity with pre-therapeutic surgical staging, and determination of anatomic locations of metastatic para-aortic nodes in relationship to the inferior mesenteric artery. We believe this study will show that tailored chemoradiation after pre-therapeutic surgical staging improves survival as compared with chemoradiation based on PET/CT in women with stages IB2-IVA cervical cancer. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  3. Development of a theoretical-practical script for clinical simulation.

    Science.gov (United States)

    Fabri, Renata Paula; Mazzo, Alessandra; Martins, José Carlos Amado; Fonseca, Ariadne da Silva; Pedersoli, César Eduardo; Miranda, Fernanda Berchelli Girão; Fumincelli, Laís; Baptista, Rui Carlos Negrão

    2017-04-10

    To develop a theoretical-practical script based on the opinion of experts to be used in simulated clinical activities. Qualitative study through analysis of content of interviews with experts on the theme in order to develop the proposed script. Of the 24 invited experts, 12 specialists from educational institutions in Brazil and abroad participated in the study in compliance with the ethical precepts. The experts responded to questions on the characterization of their study attributes and described the items required for the development of a simulated scenario. In view of the responses obtained, data content was analyzed and classified into units and subunits of significance. The items mentioned for the development of the script generated seven units of significance. The units and subunits of significance were gathered in three stages of the main components of the simulated scenario: prior, preparation, and finals. This study enables an innovative, stimulating teaching experience, making it easier for professors to use the simulation resource as a learning process in an effective and objective manner, as a guide to professors and researchers in the area of clinical simulation. Construir, com base na opinião de peritos, roteiro teórico-prático para uso em atividade clínica simulada. Trata-se de um estudo qualitativo por meio de análise de conteúdo de entrevistas de peritos no assunto para construção do roteiro proposto. Seguido os preceitos éticos, entre os 24 peritos convidados pertencentes a instituições de ensino do Brasil e do exterior. Os peritos responderam a questões sobre a caracterização dos seus atributos de estudo e descreveram os itens imprescindíveis à construção de um cenário simulado. Diante das respostas obtidas, os dados foram analisados em relação ao seu conteúdo e organizados em unidades e subunidades de significância. Participaram 12 especialistas. Os itens mencionados para construção do roteiro originaram sete unidades

  4. Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness.

    Science.gov (United States)

    Kim, Sung-Wan; Jeong, Bo-Ok; Kim, Jae-Min; Shin, Il-Seon; Hwang, Michael Y; Paul Amminger, G; Nelson, Barnaby; Berk, Michael; McGorry, Patrick; Yoon, Jin-Sang

    2015-03-30

    This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Clinical Stages in Patients with Primary and Subsequent Cancers Based on the Czech Cancer Registry 1976–2005

    Science.gov (United States)

    Štampach, Radim; Dítě, Petr; Kozel, Jiří; Horváth, Teodor; Kubíček, Petr

    2013-01-01

    Of 1,486,984 new cancers registered in the Czech Cancer Registry in 1976-2005, 290,312 (19.5%) were multiple malignant neoplasms (MMNs), of which there were 65,292 primary and 89,796 subsequent cases in men and 59,970 primary and 75,254 subsequent cases in women. The duplicities were higher in women, and the triplicities and others (3–6 MMNs) were higher in men. The most frequent diagnoses were the primary cancers of skin, gastrointestinal and urinary tract, male genital organs, respiratory tract in men, and cancers of skin, breast, female genital organs, and gastrointestinal tract in women. The analysis of the early and advanced clinical stages shows that the number of subsequent advanced stages increased after primary advanced stages. Their time-age-space distributions visualized maps of MMNs in 14 Czech regions. These results support the improvement of algorithms of dispensary care for the early detection of the subsequent neoplasms. PMID:23936674

  6. Clinical stages in patients with primary and subsequent cancers based on the czech cancer registry 1976-2005.

    Science.gov (United States)

    Geryk, Edvard; Stampach, Radim; Dítě, Petr; Kozel, Jiří; Horváth, Teodor; Kubíček, Petr

    2013-01-01

    Of 1,486,984 new cancers registered in the Czech Cancer Registry in 1976-2005, 290,312 (19.5%) were multiple malignant neoplasms (MMNs), of which there were 65,292 primary and 89,796 subsequent cases in men and 59,970 primary and 75,254 subsequent cases in women. The duplicities were higher in women, and the triplicities and others (3-6 MMNs) were higher in men. The most frequent diagnoses were the primary cancers of skin, gastrointestinal and urinary tract, male genital organs, respiratory tract in men, and cancers of skin, breast, female genital organs, and gastrointestinal tract in women. The analysis of the early and advanced clinical stages shows that the number of subsequent advanced stages increased after primary advanced stages. Their time-age-space distributions visualized maps of MMNs in 14 Czech regions. These results support the improvement of algorithms of dispensary care for the early detection of the subsequent neoplasms.

  7. Development of the excretory system in a polyplacophoran mollusc: stages in metanephridial system development.

    Science.gov (United States)

    Baeumler, Natalie; Haszprunar, Gerhard; Ruthensteiner, Bernhard

    2012-09-14

    Two types of excretory systems, protonephridia and metanephridial systems are common among bilaterians. The homology of protonephridia of lophotrochozoan taxa has been widely accepted. In contrast, the homology of metanephridial systems - including coelomic cavities as functional units - among taxa as well as the homology between the two excretory systems is a matter of ongoing discussion. This particularly concerns the molluscan kidneys, which are mostly regarded as being derived convergently to the metanephridia of e.g. annelids because of different ontogenetic origin. A reinvestigation of nephrogenesis in polyplacophorans, which carry many primitive traits within molluscs, could shed light on these questions. The metanephridial system of Lepidochitona corrugata develops rapidly in the early juvenile phase. It is formed from a coelomic anlage that soon achieves endothelial organization. The pericardium and heart are formed from the central portion of the anlage. The nephridial components are formed by outgrowth from lateral differentiations of the anlage. Simultaneously with formation of the heart, podocytes appear in the atrial wall of the pericardium. In addition, renopericardial ducts, kidneys and efferent nephroducts, all showing downstream ciliation towards the internal lumen, become differentiated (specimen length: 0.62 mm). Further development consists of elongation of the kidney and reinforcement of filtration and reabsorptive structures. During development and in fully formed condition the metanephridial system of Lepidochitona corrugata shares many detailed traits (cellular and overall organization) with the protonephridia of the same species. Accordingly, we suggest a serial homology of various cell types and between the two excretory systems and the organs as a whole. The formation of the metanephridial system varies significantly within Mollusca, thus the mode of formation cannot be used as a homology criterion. Because of similarities in overall

  8. High-Sensitivity Troponin: A Clinical Blood Biomarker for Staging Cardiomyopathy in Fabry Disease.

    Science.gov (United States)

    Seydelmann, Nora; Liu, Dan; Krämer, Johannes; Drechsler, Christiane; Hu, Kai; Nordbeck, Peter; Schneider, Andreas; Störk, Stefan; Bijnens, Bart; Ertl, Georg; Wanner, Christoph; Weidemann, Frank

    2016-05-31

    High-sensitivity troponin (hs-TNT), a biomarker of myocardial damage, might be useful for assessing fibrosis in Fabry cardiomyopathy. We performed a prospective analysis of hs-TNT as a biomarker for myocardial changes in Fabry patients and a retrospective longitudinal follow-up study to assess longitudinal hs-TNT changes relative to fibrosis and cardiomyopathy progression. For the prospective analysis, hs-TNT from 75 consecutive patients with genetically confirmed Fabry disease was analyzed relative to typical Fabry-associated echocardiographic findings and total myocardial fibrosis as measured by late gadolinium enhancement (LE) on magnetic resonance imaging. Longitudinal data (3.9±2.0 years), including hs-TNT, LE, and echocardiographic findings from 58 Fabry patients, were retrospectively collected. Hs-TNT level positively correlated with LE (linear correlation coefficient, 0.72; odds ratio, 32.81 [95% CI, 3.56-302.59]; P=0.002); patients with elevated baseline hs-TNT (>14 ng/L) showed significantly increased LE (median: baseline, 1.9 [1.1-3.3] %; follow-up, 3.2 [2.3-4.9] %; PFabry disease and a qualified predictor of cardiomyopathy progression. Thus, hs-TNT could be helpful for staging and follow-up of Fabry patients. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  9. Effect of Interval to Definitive Breast Surgery on Clinical Presentation and Survival in Early-Stage Invasive Breast Cancer

    International Nuclear Information System (INIS)

    Vujovic, Olga; Yu, Edward; Cherian, Anil; Perera, Francisco; Dar, A. Rashid; Stitt, Larry; Hammond, A.

    2009-01-01

    Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and Materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.

  10. New developments in multimodal clinical multiphoton tomography

    Science.gov (United States)

    König, Karsten

    2011-03-01

    80 years ago, the PhD student Maria Goeppert predicted in her thesis in Goettingen, Germany, two-photon effects. It took 30 years to prove her theory, and another three decades to realize the first two-photon microscope. With the beginning of this millennium, first clinical multiphoton tomographs started operation in research institutions, hospitals, and in the cosmetic industry. The multiphoton tomograph MPTflexTM with its miniaturized flexible scan head became the Prism-Award 2010 winner in the category Life Sciences. Multiphoton tomographs with its superior submicron spatial resolution can be upgraded to 5D imaging tools by adding spectral time-correlated single photon counting units. Furthermore, multimodal hybrid tomographs provide chemical fingerprinting and fast wide-field imaging. The world's first clinical CARS studies have been performed with a hybrid multimodal multiphoton tomograph in spring 2010. In particular, nonfluorescent lipids and water as well as mitochondrial fluorescent NAD(P)H, fluorescent elastin, keratin, and melanin as well as SHG-active collagen have been imaged in patients with dermatological disorders. Further multimodal approaches include the combination of multiphoton tomographs with low-resolution imaging tools such as ultrasound, optoacoustic, OCT, and dermoscopy systems. Multiphoton tomographs are currently employed in Australia, Japan, the US, and in several European countries for early diagnosis of skin cancer (malignant melanoma), optimization of treatment strategies (wound healing, dermatitis), and cosmetic research including long-term biosafety tests of ZnO sunscreen nanoparticles and the measurement of the stimulated biosynthesis of collagen by anti-ageing products.

  11. Affordable Development and Demonstration of a Small NTR Engine and Stage: How Small is Big Enough?

    Science.gov (United States)

    Borowski, Stanley K.; Sefcik, Robert J.; Fittje, James E.; McCurdy, David R.; Qualls, Arthur L.; Schnitzler, Bruce G.; Werner, James E.; Weitzberg (Abraham); Joyner, Claude R.

    2015-01-01

    The Nuclear Thermal Rocket (NTR) derives its energy from fission of uranium-235 atoms contained within fuel elements that comprise the engine's reactor core. It generates high thrust and has a specific impulse potential of approximately 900 seconds - a 100% increase over today's best chemical rockets. The Nuclear Thermal Propulsion (NTP) project, funded by NASA's AES program, includes five key task activities: (1) Recapture, demonstration, and validation of heritage graphite composite (GC) fuel (selected as the "Lead Fuel" option); (2) Engine Conceptual Design; (3) Operating Requirements Definition; (4) Identification of Affordable Options for Ground Testing; and (5) Formulation of an Affordable Development Strategy. During FY'14, a preliminary DDT&E plan and schedule for NTP development was outlined by GRC, DOE and industry that involved significant system-level demonstration projects that included GTD tests at the NNSS, followed by a FTD mission. To reduce cost for the GTD tests and FTD mission, small NTR engines, in either the 7.5 or 16.5 klbf thrust class, were considered. Both engine options used GC fuel and a "common" fuel element (FE) design. The small approximately 7.5 klbf "criticality-limited" engine produces approximately 157 megawatts of thermal power (MWt) and its core is configured with parallel rows of hexagonal-shaped FEs and tie tubes (TTs) with a FE to TT ratio of approximately 1:1. The larger approximately 16.5 klbf Small Nuclear Rocket Engine (SNRE), developed by LANL at the end of the Rover program, produces approximately 367 MWt and has a FE to TT ratio of approximately 2:1. Although both engines use a common 35 inch (approximately 89 cm) long FE, the SNRE's larger diameter core contains approximately 300 more FEs needed to produce an additional 210 MWt of power. To reduce the cost of the FTD mission, a simple "1-burn" lunar flyby mission was considered to reduce the LH2 propellant loading, the stage size and complexity. Use of existing and

  12. Clinical learning spaces: Crucibles for practice development in physiotherapy clinical education.

    Science.gov (United States)

    Patton, Narelle; Higgs, Joy; Smith, Megan

    2018-08-01

    This paper, through a deep examination of clinical workplaces as learning spaces, uses a holistic interpretation of clinical education and offers a practice development crucible metaphor as a useful way to deepen how clinical education can be conceptualized. An in-depth conceptualization of clinical education is needed if educators are able to develop wise educational practice and optimize the time students spend in clinical learning settings. The research reported here was undertaken in the qualitative paradigm guided by philosophical hermeneutics. Data collection strategies included observation, semi-structured interviews, focus groups and photo-elicitation. Twenty-four undergraduate physiotherapy students and twelve physiotherapy clinical supervisors participated in this research. Consistent with hermeneutic principles of dialogue of question and answer and hermeneutic circle, data analysis was achieved through an iterative process of reading, interpreting and re-reading the transcripts resulting in the emergence of a deeper understanding of clinical education that is represented for the reader. Clinical education has been revealed as a multidimensional learning space where workplace influences, engagement in professional practices, clinical supervisors' intentions and actions in combination with students' dispositions interact to shape and challenge students' clinical learning. A practice development crucible metaphor has been introduced as a way to represent this complexity and conceptualize clinical education, not as a set of techniques or supervision ratios but as a relational, fluid, complex space where learning is catalyzed. Importantly, the crucible metaphor assists academics, clinical supervisors and students to harness the power of clinical education to facilitate learning during clinical placements.

  13. Development of the immature stages of Culex (Culex saltanensis Dyar (Diptera, Culicidae under laboratory conditions

    Directory of Open Access Journals (Sweden)

    João Antonio C. Zequi

    2012-03-01

    Full Text Available Development of the immature stages of Culex (Culex saltanensis Dyar (Diptera, Culicidae under laboratory conditions. Culex (Culex saltanensis Dyar, 1928 is becoming frequent and abundant in natural and artificial breeding sites in urban and rural areas of Brazil. This study contributes to the knowledge of the biology of a Brazilian strain of C. saltanensis. The development of specimens reared individually or grouped was observed. The study was conducted at a constant temperature of 27 ± 2°C, 14L:10D photoperiod and 80 ± 5% relative humidity. The immature stages were observed every 6 hours until adult emergence, which occurred in 12.29 days among individually reared specimens and in 13.12 days among group-reared specimens. Egg rafts for the experiment were obtained from the laboratory and field. Eggs hatched at a rate of 97.48 ± 2.32%. More eggs per egg raft were obtained from the field than from the laboratory. Males from individually reared specimens emerged in 12.29 ± 1.11 days and females in 13.12 ± 1.58 days. The male-female ratio was 1:1. Larval survival rate was higher than 85% for larvae reared isolated and higher than 95% for group-reared larvae. The Culex saltanensis life cycle was completed within 12 to 14 days, where larval instars I and IV took the most time to develop and the pupae, the shortest.

  14. The stage of soil development modulates rhizosphere effect along a High Arctic desert chronosequence

    KAUST Repository

    Mapelli, Francesca

    2018-01-09

    In mature soils, plant species and soil type determine the selection of root microbiota. Which of these two factors drives rhizosphere selection in barren substrates of developing desert soils has, however, not yet been established. Chronosequences of glacier forelands provide ideal natural environments to identify primary rhizosphere selection factors along the changing edaphic conditions of a developing soil. Here, we analyze changes in bacterial diversity in bulk soils and rhizospheres of a pioneer plant across a High Arctic glacier chronosequence. We show that the developmental stage of soil strongly modulates rhizosphere community assembly, even though plant-induced selection buffers the effect of changing edaphic factors. Bulk and rhizosphere soils host distinct bacterial communities that differentially vary along the chronosequence. Cation exchange capacity, exchangeable potassium, and metabolite concentration in the soil account for the rhizosphere bacterial diversity. Although the soil fraction (bulk soil and rhizosphere) explains up to 17.2% of the variation in bacterial microbiota, the soil developmental stage explains up to 47.7% of this variation. In addition, the operational taxonomic unit (OTU) co-occurrence network of the rhizosphere, whose complexity increases along the chronosequence, is loosely structured in barren compared with mature soils, corroborating our hypothesis that soil development tunes the rhizosphere effect.

  15. Norovirus infection: features of epidemiology and clinical and laboratory manifestations at the present stage

    Directory of Open Access Journals (Sweden)

    N.V. Pronko

    2017-02-01

    Full Text Available Background. Among most significant for practical medicine infections, acute intestinal infections of viral etiology are becoming increasingly topical [2, 4]. According to domestic and foreign literature, up to 70 % of gastroenteritis occur during cold seasons of the year and are induced by viruses [3, 5]. The range of the factors producing viral diarrheas is rather wide. One of the comparatively new acute intestinal infections (AII producing factors is noroviruses [5, 6]. The prevalence of noroviruses has been little studied, and the clinical picture has been characterized insufficiently. This can be explained by insufficient diagnostics and registration of this infection [3, 6, 7]. Aim of the work: analysis of the morbidity and determination of clinical laboratory features of noroviral infection (NVI in children according to the data of the Regional Clinical Infectious Di­seases Hospital in Grodno. Materials and methods. A comprehensive clinical laboratory analysis of 1,105 case histories of children aged 1 month to 14 years with verified viral intestinal infection, who were admitted to Grodno Regional Clinical Infectious Diseases Hospital from January 2013 to December 2016, was carried out. The patients were divided according to the final clinical diagnosis in the following way: rotaviral infection (RVI was found in 676 (61.2 % individuals, adenoviral intestinal infection (AVI — in 212 (19.2 %, NVI was detected in 156 (14.1 % and enteroviral infection — in 61 (5.5 % persons. The examination was carried out according to the protocols approved by the Ministry of Health of the Republic of Belarus. Results. As our study showed, at the period analyzed the viral intestinal diseases amounted to 70.4 % of all the cases of diseases in the structure of AII in children. Patients hospitalized with viral diarrhea showed prevalence of RVI (61.2 %. NVI was the third by the incidence among viral diarrheas, and it was registered in 14.1 % of the cases

  16. Call for Applications – Clinical Assay Development Program | Office of Cancer Clinical Proteomics Research

    Science.gov (United States)

    The NCI Clinical Assay Development Program (CADP) is requesting project applications from investigators seeking clinical assay validation resources.  These resources are designed to assist with the development of assays that may predict therapy response or prognostic behavior of a diagnosed cancer, primarily for use in clinical trials. Approved projects for the NCI CADP will be provided access to the Institute’s assay development and validation resources, including project management support.

  17. Assessment methods for comfort of consumer products at early stages of the development process

    DEFF Research Database (Denmark)

    Stavrakos, Stavros-Konstantinos

    Design engineers who are involved in the early conceptual phase of the development of products such as seats, headphones and domestic appliances stress the increasing importance of comfort. Comfort is taken into account in the purchasing decisions of buying a chair, a bed, and when driving a car...... and experience of comfort and vice versa. Additionally, archetype individuals were identified for the issuing of representative user panels to be used in the comfort studies conducted at the early conceptual phase of the design process. From the findings, a methodological framework was developed summarizing all...... have been evaluated and implemented within the collaborating company of external- ear body worn products. The research has contributed towards understanding the multidimensionality of comfort and towards providing with methods to assess comfort at the early stages of conceptual development....

  18. Development of novel monoclonal antibodies that define differentiation stages of human stromal (mesenchymal) stem cells

    DEFF Research Database (Denmark)

    Andersen, Ditte Caroline; Kortesidis, Angela; Zannettino, Andrew C W

    2011-01-01

    Human mesenchymal stem cells (hMSC) are currently being introduced for cell therapy, yet, antibodies specific for native and differentiated MSCs are required for their identification prior to clinical use. Herein, high quality antibodies against MSC surface proteins were developed by immunizing...

  19. Clinical characteristics of restless legs syndrome in end-stage renal failure and idiopathic RLS patients.

    Science.gov (United States)

    Enomoto, Minori; Inoue, Yuichi; Namba, Kazuyoshi; Munezawa, Takashi; Matsuura, Masato

    2008-04-30

    This study was done to identify the clinical characteristics of uremic restless legs syndrome (RLS). Consecutive uremic RLS patients (n = 15) and idiopathic RLS patients (iRLS; n = 20) were evaluated. The groups were compared with respect to their clinical course, subjective symptoms [using the Pittsburgh Sleep Quality Index (PSQI) and the International Restless Legs Syndrome Severity Scale (IRLS)], polysomnographic (PSG) variables, the results of the suggested immobilization test (SIT), and the drug doses used to treat RLS. The duration of the disorder was significantly shorter in the uremic RLS group than in the iRLS group. The PSQI and IRLS scores before treatment were higher in the uremic RLS group than in the iRLS group. The periodic leg movement index (PLM index) on PSG and the SIT index were also higher in the uremic RLS group (P RLS was significantly higher in the uremic RLS group (P RLS appears to deteriorate faster and to become more severe than iRLS. Moreover, uremic RLS patients appear to have a decreased response to dopaminergic agonists. (c) 2008 Movement Disorder Society.

  20. Stereotactic body radiation therapy (SBRT) for early stage lung cancer delivers clinically significant radiation to the draining lymph nodes

    Science.gov (United States)

    Singh, Prabhsimranjot; Christos, Paul; Arora, Shruthi; Desai, Prashant; Wernicke, A Gabriella; Delamerced, Marylynn; Boothe, Dustin; Nori, Dattatreyudu; Chao, KSC

    2013-01-01

    Background To evaluate clinically significant radiotherapy (RT) dose to draining lymph nodes (LN) in patients treated with SBRT. Findings Early stage non-small cell lung cancer patients treated with SBRT were selected for analysis. Patients received SBRT if they were not considered eligible for surgical resection. RT plans for 29 patients (32 lesions) were analyzed. For each patient, ipsilateral and contralateral levels 2, 3, 4, 5, 6, 7 and ipsilateral hilar LN stations were contoured. Dose volume histograms and dosimetric coverage of each lymph node region were obtained for each patient. There were 14 males and 15 females. Median age was 75 (range 60-89). Clinically significant RT was received at the corresponding draining lymph node station depending on the primary tumor location. Friedman’s non-parametric test revealed a statistically significant difference in RT dose to LN stations depending on the location of the tumor (p<0.0001). Conclusion SBRT for early stage lung cancer results in significant RT dose to the draining LN. This RT dose may be sufficient to eliminate subclinical microscopic disease despite being a highly conformal treatment. Prospective studies are needed to evaluate if SBRT is comparable to lobectomy plus mediastinal lymph node dissection as a treatment option. PMID:29296376

  1. Transition from failing dentition to complete-arch implant rehabilitation with a staged approach: a 3-year clinical report.

    Science.gov (United States)

    Papaspyridakos, Panos; Chronopoulos, Vasilios

    2014-09-01

    The transition of patients from failing dentition to complete-arch implant rehabilitation often means that the patient is rendered edentulous and has to wear a removable complete denture for a time. Many patients find this objectionable. A staged treatment approach provides a fixed interim prosthesis for use throughout the rehabilitation process, allowing patient comfort and prosthodontic control. This clinical report describes a staged approach protocol with a new type of interim prosthesis. The prosthesis is supported by hopeless teeth and the soft tissues of the maxillary tuberosities and mandibular retromolar pads for the complete-arch implant rehabilitation of a patient with failing dentition. This protocol allows for a fixed interim prosthesis with combined tooth and mucosa or implant support during the entire rehabilitation process, thus avoiding the use of complete dentures. The implants and prostheses were functioning successfully after 3 years of clinical service. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making.

    Science.gov (United States)

    Mokhles, S; Nuyttens, J J M E; de Mol, M; Aerts, J G J V; Maat, A P W M; Birim, Ö; Bogers, A J J C; Takkenberg, J J M

    2018-01-15

    The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

  3. Methods for assessment of innovative medical technologies during early stages of development.

    Science.gov (United States)

    Bartelmes, Marc; Neumann, Ulrike; Lühmann, Dagmar; Schönermark, Matthias P; Hagen, Anja

    2009-11-05

    Conventional Health Technology Assessment (HTA) is usually conducted at a point in time at which the development of the respective technology may no longer be influenced. By this time developers and/or purchasers may have misinvested resources. Thus the demand for Technology Assessment (TA) which incorporates appropriate methods during early development stages of a technology becomes apparent. Against this health political background, the present report describes methods for a development-accompanying assessment of innovative medical technologies. Furthermore, international research programmes set out to identify or apply such methods will be outlined. A systematic literature search as well as an extensive manual literature search are carried out in order to obtain literature and information. The greatest units of the identified methods consist of assessment concepts, decision support methods, modelling approaches and methods focusing on users and their knowledge. Additionally, several general-purpose concepts have been identified. The identified research programmes INNO-HTA and MATCH (Multidisciplinary-Assessment-of-Technology-Centre-for-Healthcare) are to be seen as pilot projects which so far have not been able to generate final results. MATCH focuses almost entirely on the incorporation of the user-perspective regarding the development of non-pharmaceutical technologies, whereas INNO-HTA is basically concerned with the identification and possible advancement of methods for the early, socially-oriented technology assessment. Most references offer only very vague descriptions of the respective method and the application of greatly differing methods seldom exceeds the character of a pilot implementation. A standardisation much less an institutionalisation of development-accompanying assessment cannot be recognized. It must be noted that there is no singular method with which development-accompanying assessment should be carried out. Instead, a technology and

  4. Methods for assessment of innovative medical technologies during early stages of development

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-11-01

    Full Text Available Conventional Health Technology Assessment (HTA is usually conducted at a point in time at which the development of the respective technology may no longer be influenced. By this time developers and/or purchasers may have misinvested resources. Thus the demand for Technology Assessment (TA which incorporates appropriate methods during early development stages of a technology becomes apparent. Against this health political background, the present report describes methods for a development-accompanying assessment of innovative medical technologies. Furthermore, international research programmes set out to identify or apply such methods will be outlined. A systematic literature search as well as an extensive manual literature search are carried out in order to obtain literature and information. The greatest units of the identified methods consist of assessment concepts, decision support methods, modelling approaches and methods focusing on users and their knowledge. Additionally, several general-purpose concepts have been identified. The identified research programmes INNO-HTA and MATCH (Multidisciplinary-Assessment-of-Technology-Centre-for-Healthcare are to be seen as pilot projects which so far have not been able to generate final results. MATCH focuses almost entirely on the incorporation of the user-perspective regarding the development of non-pharmaceutical technologies, whereas INNO-HTA is basically concerned with the identification and possible advancement of methods for the early, socially-oriented technology assessment. Most references offer only very vague descriptions of the respective method and the application of greatly differing methods seldom exceeds the character of a pilot implementation. A standardisation much less an institutionalisation of development-accompanying assessment cannot be recognized. It must be noted that there is no singular method with which development-accompanying assessment should be carried out. Instead, a

  5. Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment.

    Science.gov (United States)

    Nord, Carina; Olofsson, Sven-Erik; Glimelius, Ingrid; Cedermark, Gabriella Cohn; Ekberg, Sara; Cavallin-Ståhl, Eva; Neovius, Martin; Jerkeman, Mats; Smedby, Karin E

    2015-11-01

    To investigate if testicular cancer survivors (TCSs) have a higher incidence of work loss compared with the population, accounting for stage, treatment and relapse. A cohort of 2146 Swedish TCSs diagnosed 1995-2007 (seminoma n = 926, non-seminoma n = 1220) was identified in the SWENOTECA (Swedish-Norwegian Testicular Cancer Group) register, and matched 1:4 to population comparators. Prospectively recorded work loss data (both before and after diagnosis) were obtained from national registers through September 2013. Adjusted relative risks (RR) and 95% confidence intervals (CI) of sick leave and/or disability pension were calculated annually and overall with Poisson- and Cox regression, censoring at relapse. The mean number of annual work days lost was also estimated. TCSs were at a modestly increased annual risk of work loss up to the third year of follow-up (RR3rd year 1.25, 95% CI 1.08, 1.43), attributed to a more pronounced risk among extensively treated patients (4 chemotherapy courses: RR3rd year 1.60, 95% CI 1.19, 2.15; > 4 courses: RR3rd year 3.70, 95% CI 2.25, 6.11). Patients on surveillance or limited treatment (radiotherapy, 1-3 chemotherapy courses) did not have an increased risk of work loss beyond the first year. TCSs receiving > 4 chemotherapy courses had higher mean number of annual days of work loss up to the 10th year post-diagnosis, and a five-fold risk of disability pension (RR 5.16, 95% CI 2.00, 10.3). Extensively treated TCSs, but not those on surveillance or limited treatment, are at increased risk of work loss long-term, not explained by relapse. These patients may benefit from early rehabilitation initiatives.

  6. Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease

    International Nuclear Information System (INIS)

    Gazzaz, Z.J.; Dhafar, K.O.; Tashkandi, M.A.; Farooq, M.U.

    2010-01-01

    To know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. The data had been collected retrospectively from 13-11-2005 to 12-12-2005 from the diabetic patients directly those were on dialysis due to end stage renal disease (ESRD) and from their files. The total study subjects were 51 with mean age of Diabetics was (55.2 years +-7.9) showing male predominance 31(60.8%). All were Saudies. The mean duration of Diabetes mellitus and dialysis were (16.8years) and (22 months), respectively. The mean age of start of Diabetes mellitus and dialysis was (37.4 years) and (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29(56.9%) were non-smoker. Patients with family history of diabetes with other associated illnesses were 23(45%) followed by 15(29.4%) had family history of only diabetes. Type II diabetics were 40(78.4%). Regarding metabolic profile, patients with high blood glucose level were 10(19.6%) while 3(5.9%), 50(98%) and 18(35.3%) patients had high cholesterol, low density lipoprotein and triglyceride levels, respectively. Maximum number of patients were in sixth decade of life. Up to three fourth patients had family history of diabetes. Most of the subjects had only diabetic nephropathy. Maximum patients had high low density lipoprotein level. (author)

  7. Clinical significance of Fusobacterium nucleatum, epithelial–mesenchymal transition, and cancer stem cell markers in stage III/IV colorectal cancer patients

    Directory of Open Access Journals (Sweden)

    Yan X

    2017-10-01

    Full Text Available Xuebing Yan,1,* Liguo Liu,2,* Hao Li,1,* Huanlong Qin,1 Zhenliang Sun1,3 1Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 2Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 3Central Laboratory, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, South Campus, Shanghai, China *These authors contributed equally to this work Abstract: Colorectal cancer (CRC is a common digestive malignancy and emerging studies have closely linked its initiation and development with gut microbiota changes. Fusobacterium nucleatum (Fn has been recently identified as a pathogenic bacteria for CRC; however, its prognostic significance for patients is poorly investigated and is less for patients within late stage. Therefore, in this study, we made efforts to analyze its level and prognostic significance in a retrospective cohort of 280 stage III/IV CRC patients. We found that the Fn level was abnormally high in tumor tissues and correlated with tumor invasion, lymph node metastasis status, and distant metastasis. We also identified it as an independent adverse prognostic factor for cancer-specific survival (CSS and disease-free survival (DFS. The following subgroup analysis indicated that Fn level could stratify CSS and DFS in stage IIIB/C and IV patients but failed in stage IIIA patients. In addition, stage III/IV patients with low Fn level were found to benefit more from adjuvant chemotherapy than those with high Fn level, in terms of DFS. Finally, we analyzed the expression and clinical significance of epithelial-to-mesenchymal transition (EMT markers (E-cadherin and N-cadherin and cancer stem cell (CSC markers (Nanog, Oct-4, and Sox-2 in CRC tissues. The results indicated that N-cadherin, Nanog, Oct-4, and Sox-2 were adverse prognostic factors in these patients, while the opposite was true for E-cadherin. More importantly, expression of E

  8. The Life Cycle Completed. Extended Version with New Chapters on the Ninth Stage of Development by Joan M. Erikson.

    Science.gov (United States)

    Erikson, Erik H.

    This expanded edition of a 1982 book by Erik Erikson summarizes his work on the stages of the human life cycle, including chapters on psychosexuality and the cycle of generations, major stages in psychosocial development, and ego and ethos. An additional chapter on the ninth stage sets forth his philosophy on old age--i.e. the 80s and 90s--and how…

  9. Carbon Stocks of Fine Woody Debris in Coppice Oak Forests at Different Development Stages

    Directory of Open Access Journals (Sweden)

    Ender Makineci

    2017-06-01

    Full Text Available Dead woody debris is a significant component of the carbon cycle in forest ecosystems. This study was conducted in coppice-originated oak forests to determine carbon stocks of dead woody debris in addition to carbon stocks of different ecosystem compartments from the same area and forests which were formerly elucidated. Weight and carbon stocks of woody debris were determined with recent samplings and compared among development stages (diameter at breast height (DBH, D1.3m, namely small-diameter forests (SDF = 0–8 cm, medium diameter forests (MDF = 8–20 cm, and large-diameter forests (LDF = 20–36 cm. Total woody debris was collected in samplings; as bilateral diameters of all woody debris parts were less than 10 cm, all woody parts were in the “fine woody debris (FWD” class. The carbon concentrations of FWD were about 48% for all stages. Mass (0.78–4.92 Mg·ha−1 and carbon stocks (0.38–2.39 Mg·ha−1 of FWD were significantly (p > 0.05 different among development stages. FWD carbon stocks were observed to have significant correlation with D1.3m, age, basal area, and carbon stocks of aboveground biomass (Spearman rank correlation coefficients; 0.757, 0.735, 0.709, and 0.694, respectively. The most important effects on carbon budgets of fine woody debris were determined to be coppice management and intensive utilization. Also, national forestry management, treatments of traditional former coppice, and conversion to high forest were emphasized as having substantial effects.

  10. Private portraits or suffering on stage: curating clinical photographic collections in the museum context

    Directory of Open Access Journals (Sweden)

    Dr Mieneke te Hennepe

    2016-03-01

    Full Text Available Medical photography collections often remind us of the inescapable reality of human suffering and pain, and at the same time they oblige us to deal with questions of ownership and privacy. Medical photography collections are thus considered ‘sensitive’ collections within the museum context. This essay investigates privacy issues involved in the curating of historical photographic collections in museum spaces. When medical photography entered into non-medical domains privacy issues emerged. It is these privacy issues that cast a shadow of sensitivity on the medical material. But the relationship between clinical photograph collections and museums is not as straightforward as it may seem. Personal pictures involve power and privacy, and both aspects play a role in the public display of historical medical photographs, often in unexpected ways.

  11. Clinical outcomes and benefits for staging of surgical lymph node mapping after esophagectomy.

    Science.gov (United States)

    Lagarde, S M; Phillips, A W; Navidi, M; Disep, B; Griffin, S M

    2017-12-01

    Dissection of lymph nodes (LN) immediately after esophagectomy is utilized by some surgeons to aid determination of LN stations involved in esophageal cancer. Some suggest that this increases LN yield and gives information regarding the pattern of lymphatic spread, others feel that this may compromise a circumferential resection margin (CRM) assessment. The aim of this study is to evaluate the effect of ex vivo dissection on the assessment of the CRM and the pattern of lymph node dissemination in patients with adenocarcinoma of the esophagus and gastroesophageal junction (GEJ) undergoing radical surgery after neoadjuvant chemotherapy and their prognostic impact. Data from consecutive patients with potentially curable adenocarcinoma of the distal esophagus and GEJ who received neoadjuvant treatment followed by surgery were analyzed. Clinical and pathological findings were reviewed and LN burden and location correlated with clinical outcome. Pathology specimens were dissected into individual LN groups 'ex-vivo' by the surgeon. A total of 301 patients were included: 295 had a radical proximal and distal resection margin however in 62(20.6%) CRM could not be assessed. A median of 33(10-77) nodes were recovered. A 117(38.9%) patients were ypN0 while 184(61.1%) were LN positive (ypN1-N3). LN stations close to the tumor were most frequently involved. Twenty-seven (14.7%) patients had only thoracic stations involved, 48(26.1%) only abdominal stations and 109 (59.2%) had both. Median survival for yN0 patients was 171 months compared to 24 months for those LN positive (PCRM assessment in up to 20% of cases. It also provides valuable information regarding the pattern of nodal spread. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Plasma viscosity: a potential predictor of both medical treatment response and clinical stage of ulcerative colitis.

    Science.gov (United States)

    Yakar, Tolga; Cosar, Arif Mansur; Gokturk, Huseyin Savas; Kanat, Unler Gurhan; Parlakgumus, Alper; Kozanoglu, Iknur; Serin, Ender

    2016-01-01

    Ulcerative colitis (UC) is one of the major forms of chronic relapsing inflammatory bowel diseases. The ability to identify type, severity and responsiveness to therapy of UC using laboratory parameters has long been the aim of clinical studies. The aim of this study was to assess the relation betweenplasma viscosity (PV) and disease activity and response to medical treatment in patients with UC. The study included 105 patients with UC and 42 healthy volunteers. Blood samples were assessed for PV, erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (hs-CRP), D-dimer, and fibrinogen. Patients with UC were grouped according to disease activity, i.e. active (n= 59) and remission (n= 46). PV was higher in those with active UC compared with those with UC in remission or healthy subjects. It was significantly higher in both UC refractory to steroid compared to UC responsive to steroid (pUC refractory to cyclosporine compared to UC responsive cyclosporine (p= 0.003). IncreasedSimple Clinical Colitis Activity Index (SCCAI), Endoscopic Grading Scale (EGS), and Histological Disease Activity (HAD) scores were significantly associated with higher PV in patients with UC. PV is a useful marker in predicting response to steroid or cyclosporine treatment in patients with active UC. It could be replaced by ESR or hs-CRP as a measure of the acute phase response in UC since it is sufficiently sensitive. These findings may help identify patients with active UC who will require colectomy. Biomarkers, Disease activity, Medical treatment, Steroid-refractory ulcerative colitis, Ulcerative colitis.

  13. The status and challenges of clinical informatics development in ...

    African Journals Online (AJOL)

    Clinical informatics has enormous potential to ensure healthcare quality in both developed and developing countries. This paper examines the status and challenges of clinical informatics in the South African health care sector, In a recent survey of major international research databases such as Scopus, it was observed ...

  14. Effects of marine toxins on the reproduction and early stages development of aquatic organisms.

    Science.gov (United States)

    Vasconcelos, Vítor; Azevedo, Joana; Silva, Marisa; Ramos, Vítor

    2010-01-19

    Marine organisms, and specially phytoplankton species, are able to produce a diverse array of toxic compounds that are not yet fully understood in terms of their main targets and biological function. Toxins such as saxitoxins, tetrodotoxin, palytoxin, nodularin, okadaic acid, domoic acid, may be produced in large amounts by dinoflagellates, cyanobacteria, bacteria and diatoms and accumulate in vectors that transfer the toxin along food chains. These may affect top predator organisms, including human populations, leading in some cases to death. Nevertheless, these toxins may also affect the reproduction of aquatic organisms that may be in contact with the toxins, either by decreasing the amount or quality of gametes or by affecting embryonic development. Adults of some species may be insensitive to toxins but early stages are more prone to intoxication because they lack effective enzymatic systems to detoxify the toxins and are more exposed to the toxins due to a higher metabolic growth rate. In this paper we review the current knowledge on the effects of some of the most common marine toxins on the reproduction and development of early stages of some organisms.

  15. Water erosion and soil water infiltration in different stages of corn development and tillage systems

    Directory of Open Access Journals (Sweden)

    Daniel F. de Carvalho

    2015-11-01

    Full Text Available ABSTRACTThis study evaluated soil and water losses, soil water infiltration and infiltration rate models in soil tillage systems and corn (Zea mays, L. development stages under simulated rainfall. The treatments were: cultivation along contour lines, cultivation down the slope and exposed soil. Soil losses and infiltration in each treatment were quantified for rains applied using a portable simulator, at 0, 30, 60 and 75 days after planting. Infiltration rates were estimated using the models of Kostiakov-Lewis, Horton and Philip. Based on the obtained results, the combination of effects between soil tillage system and corn development stages reduces soil and water losses. The contour tillage system promoted improvements in soil physical properties, favoring the reduction of erosion in 59.7% (water loss and 86.6% (soil loss at 75 days after planting, and the increase in the stable infiltration rate in 223.3%, compared with the exposed soil. Associated to soil cover, contour cultivation reduces soil and water losses, and the former is more influenced by management. Horton model is the most adequate to represent soil water infiltration rate under the evaluated conditions.

  16. CLINICAL EXPERIENCE OF INTRODUCING MEDICAL ABORTION IN THE LATER STAGES IN THE REPUBLIC OF BURYATIA

    Directory of Open Access Journals (Sweden)

    Ирина Базаровна Жамсоева

    2018-01-01

    Full Text Available Currently, the detection of many malformations of the fetus is possible only after 18-21 weeks. pregnancy, and so abortion at this time is forced, unavoidable, since some genetic diseases and congenital deformities in children is not compatible with life and are the cause of infant mortality. In other cases of malformations in children seriously affects the quality of life of both the child and the family. The problem of «safe» abortion in the later stages remains today one of the most urgent and difficult problems in obstetric practice. The aim of the study was to comparatively evaluate the effectiveness and complications of medical abortion for late term (22 week using different schemes of combination of mifepristone in combination with misoprostol. Materials and methods.The study included 152 women of reproductive age to perinatal consultation on termination of pregnancy in the second trimester for medical indications in gynecology Department of SAHIRPC MZ RB for the period from 2015 to 2017, the Basic criteria for inclusion in the study was the pregnancy from 16 weeks before 22 weeks, absence of contraindications to medical abortion. The patients were divided into 2 groups according to regimens of mifepristone in combination with misoprostol. The results of the study. Expulse of the fetus and placenta occurred in 95,51 % (86/91 patients in the first group, 95,08 % (58/61 of women who received drugs according to the scheme 2. Conclusion. Mifepristone is bosonisation a drug with abortifacient effects, are identical at high and low dose. A lower dose of mifepristone does not increase the number of its complications. Optimal regimen for medical abortion: T. mifepristone 200 mg orally 24 hours so misoprostol 200 mcg vaginally with efficiency 95,08 %. These studies demonstrate a promising method to reduce complications and maternal mortality among women forced to terminate pregnancy in the second trimester.

  17. Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Diavolitsis, V. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Rademaker, A. [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Lurain, J.; Hoekstra, A. [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Strauss, J. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Small, W., E-mail: wsmall@nmff.org [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)

    2012-10-01

    Purpose: To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). Methods and Materials: All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Results: Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. Conclusions: The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

  18. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

    Science.gov (United States)

    2013-01-01

    Background Anemia is a common condition in CKD that has been identified as a cardiovascular (CV) risk factor in end-stage renal disease, constituting a predictor of low survival. The aim of this study was to define the onset of anemia of renal origin and its association with the evolution of kidney disease and clinical outcomes in stage 3 CKD (CKD-3). Methods This epidemiological, prospective, multicenter, 3-year study included 439 CKD-3 patients. The origin of nephropathy and comorbidity (Charlson score: 3.2) were recorded. The clinical characteristics of patients that developed anemia according to EBPG guidelines were compared with those that did not, followed by multivariate logistic regression, Kaplan-Meier curves and ROC curves to investigate factors associated with the development of renal anemia. Results During the 36-month follow-up period, 50% reached CKD-4 or 5, and approximately 35% were diagnosed with anemia (85% of renal origin). The probability of developing renal anemia was 0.12, 0.20 and 0.25 at 1, 2 and 3 years, respectively. Patients that developed anemia were mainly men (72% anemic vs. 69% non-anemic). The mean age was 68 vs. 65.5 years and baseline proteinuria was 0.94 vs. 0.62 g/24h (anemic vs. non anemic, respectively). Baseline MDRD values were 36 vs. 40 mL/min and albumin 4.1 vs. 4.3 g/dL; reduction in MDRD was greater in those that developed anemia (6.8 vs. 1.6 mL/min/1.73 m2/3 years). These patients progressed earlier to CKD-4 or 5 (18 vs. 28 months), with a higher proportion of hospitalizations (31 vs. 16%), major CV events (16 vs. 7%), and higher mortality (10 vs. 6.6%) than those without anemia. Multivariate logistic regression indicated a significant association between baseline hemoglobin (OR=0.35; 95% CI: 0.24-0.28), glomerular filtration rate (OR=0.96; 95% CI: 0.93-0.99), female (OR=0.19; 95% CI: 0.10-0.40) and the development of renal anemia. Conclusions Renal anemia is associated with a more rapid evolution to CKD-4, and a higher

  19. Clinical leadership development and education for nurses: prospects and opportunities

    Directory of Open Access Journals (Sweden)

    Joseph ML

    2015-07-01

    Full Text Available M Lindell Joseph, Diane L Huber College of Nursing, The University of Iowa, Iowa City, IA, USA Abstract: With the implementation of the Affordable Care Act, elevated roles for nurses of care coordinator, clinical nurse leader, and advanced practice registered nurse have come to the forefront. Because change occurs so fast, matching development and education to job requirements is a challenging forecasting endeavor. The purpose of this article is to envision clinical leadership development and education opportunities for three emerging roles. The adoption of a common framework for intentional leadership development is proposed for clinical leadership development across the continuum of care. Solutions of innovation and interdependency are framed as core concepts that serve as an opportunity to better inform clinical leadership development and education. Additionally, strategies are proposed to advance knowledge, skills, and abilities for crucial implementation of improvements and new solutions at the point of care. Keywords: clinical leadership, nursing leadership, CNL, care coordination, innovation, interdependency

  20. Clinical and economic aspects of sevelamer therapy in end-stage renal disease patients

    Directory of Open Access Journals (Sweden)

    Ossareh S

    2014-05-01

    Full Text Available Shahrzad OssarehDepartment of Medicine, Nephrology Section, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, IranAbstract: Phosphate control is still a great challenge in chronic kidney disease (CKD, and in spite of the great improvements in dialysis techniques, achievement of the goals for mineral metabolism control is still far from ideal. Aluminum hydroxide has been largely abandoned due to the high risk of aluminum toxicity, while the use of calcium-based phosphate binders may cause hypercalcemia, overzealous parathyroid suppression, and extraskeletal calcification. Sevelamer hydrochloride has been introduced as an efficient medication for phosphate control, with a lower risk of hypercalcemia and parathyroid suppression. Various clinical trials have compared the risk of vascular calcification between sevelamer and calcium salts with inconsistent results. In spite of these inconsistencies, the Kidney Disease Outcomes Quality Initiative (KDOQI suggests non-calcium phosphate binders as the preferred phosphate binder in dialysis patients with severe vascular and/or other soft-tissue calcifications and in those with hypercalcemia or parathyroid hormone (PTH <150 mg/dL. The Kidney Disease Improving Global Outcome (KDIGO limits the use of non-calcium phosphate binders to patients with hypercalcemia. Regarding the effect on mortality, the results of clinical trials are again inconsistent. The other important aspect of using sevelamer is the issue of price, which is substantially higher than calcium-based phosphate binders. Reviewing the studies on economic aspects shows that sevelamer increases quality-adjusted life-years (QALY and possibly life years, with a higher cost compared to calcium-based phosphate binders. In conclusion, sevelamer is a very useful drug for phosphate control, reduction of hypercalcemia, and lessening the risk of adynamic bone disease, with probable reduction in vascular calcification and possible

  1. Overall survival and clinical characteristics of BRCA mutation carriers with stage I/II pancreatic cancer.

    Science.gov (United States)

    Golan, Talia; Sella, Tal; O'Reilly, Eileen M; Katz, Matthew H G; Epelbaum, Ron; Kelsen, David P; Borgida, Ayelet; Maynard, Hannah; Kindler, Hedy; Friedmen, Eitan; Javle, Milind; Gallinger, Steven

    2017-03-14

    BRCA1/BRCA2 germ line (GL) mutation carriers with pancreatic adenocarcinoma (PDAC) may have distinct outcomes. We recently described an apparent more favourable prognosis of surgically resected BRCA-associated PDAC patients in a single-arm, uncontrolled, retrospective study. However, the prognostic impact of GL BRCA1/2 mutations in surgically resected PDAC has not been compared with a matched control population. A larger multi-centre, case-control retrospective analysis was performed. Cases were patients with surgically resected, BRCA1/2-associated PDAC from 2004 to 2013. Controls included surgically resected PDAC cases treated during the same time period that were either BRCA non-carriers, or had no family history of breast, ovarian or pancreatic cancers. Cases and controls were matched by: age at diagnosis (within ±5-year period) and institution. Demographics, clinical history, overall survival (OS) and disease-free survival (DFS) were abstracted from patient records. Statistical comparisons were assessed using χ 2 - and Fisher's exact test, and median DFS/OS using Kaplan-Meier method and log-rank testing. Twenty-five patients with BRCA1-(n=4) or BRCA2 (N=21)-associated resectable PDAC were identified. Mean age was 55.7 years (range, 34-78 years), 48% (n=12) were females and 76% (n=19) were Jewish. Cases were compared (1 : 2) with 49 resectable PDAC controls, and were balanced for age, ethnicity and other relevant clinical and pathological features. BRCA-associated PDAC patients received neoadjuvant, or adjuvant platinum-based treatment more frequently than controls (7 out of 8 vs 6 out of 14) and (7 out of 21 vs 3 out of 44), respectively. No significant difference in median OS (37.06 vs 38.77 months, P=0.838) and in DFS (14.3 vs 12.0 months, P=0.303) could be demonstrated between cases and controls. A trend to increased DFS was observed among BRCA-positive cases treated with neoadjuvant/adjuvant platinum-containing regimens (n=10) compared with similarly

  2. Teen Choices, an Online Stage-Based Program for Healthy, Nonviolent Relationships: Development and Feasibility Trial.

    Science.gov (United States)

    Levesque, Deborah A; Johnson, Janet L; Prochaska, Janice M

    2017-01-01

    This paper describes the theoretical foundation, development, and feasibility testing of an online, evidence-based intervention for teen dating violence prevention designed for dissemination. Teen Choices: A Program for Healthy, Non-Violent Relationships relies on the Transtheoretical Model of Behavior Change and expert system technology to deliver assessments and feedback matched to stage of change for using healthy relationship skills. The program also tailors feedback to dating status, risk level, and other key characteristics. Ninety-nine students from high schools in Tennessee and Rhode Island completed a Teen Choices session and 97 completed an 11-item acceptability evaluation. 100% of participants completed the intervention session as intended. Evaluations of the program were favorable. For example, 88.7% agreed the program feedback was easy to understand, and 86.7% agreed that the program could help people develop healthier relationships. Findings provide encouraging evidence of the acceptability and feasibility of this approach to dating violence prevention.

  3. [Active management of the third stage of labor: Three schemes of oxytocin: randomised clinical trial].

    Science.gov (United States)

    Neri-Mejía, M; Pedraza-Avilés, A G

    2016-05-01

    To compare the effectiveness of intramuscular oxytocin against intravenous oxytocin against intravenous traditional oxytocin infusion, in the active management of the third period of the delayed impingement labor work and controlled cord traction. Randomized controlled blinded clinical trial. In women age 14 to 40 with full term pregnancy, childbirth attended by ISSSTE's Regional Hospital "Gral. Ignacio Zaragoza", in the period from August to December 2015. 152 deliveries were attended, from which 66 fulfill with selection criteria. Group 1 = 22 patients, group 2 = 21 patients and Group 3 = 23 patients. The total age average was 26.92 + 5.8. For blood volume, statistical differences were significant among the three groups (p = 0.000). Adverse reactions were presented in 1 .5%, without difference between the groups. (P = 0.337). The differences in hemoglobin values and final and initial hematocrit presented differences with statistical significance (p = 0.000 for both). Nonetheless, the differences obtained in the analysis of the diverse variables among the three types of treatment, the three schemes are effective on the obstetrical hemorrhage prevention.

  4. Effect of aggressive osteodystrophy management on clinical outcomes in stage 5 chronic kidney disease.

    Science.gov (United States)

    Byham-Gray, Laura; Drasher, Tammy; Deckman, Karen; Graham, Diane; Liftman, Carol; Roberto, Linda; Peiffer, Phyllis; Denmark, Robert

    2009-07-01

    The study investigated whether the type of bone disease management (aggressive versus conventional) had an impact on clinical outcomes, namely bone health measures (e.g., biointact parathyroid hormone [BiPTH], serum corrected calcium [cCa] level, serum phosphorus [phos] level, and corrected calcium-phosphorus product [cCaPO(4)]). Retrospective chart review of 173 closed medical records of maintenance hemodialysis patients on thrice-weekly therapy from January 1, 2005, through December 31, 2005. Two Conventional Management (i.e., control group) and three Aggressive Management (i.e., treatment group) dialysis facilities were enrolled. There was a significant interaction for group assignment and BiPTH levels (F = 4.12, P = .01), with the Aggressive Group trending toward lower BiPTH levels than the Conventional Group. The Conventional Group experienced a significantly lower mean annualized serum cCa level (F = 8.85, P = .003), and used non-calcium-based binders significantly more (P management appears to be as effective as traditional interventions in the treatment of mineral and bone metabolism disorders in chronic kidney disease.

  5. Development of PBPK models for PFOA and PFOS for human pregnancy and lactation life stages.

    Science.gov (United States)

    Loccisano, Anne E; Longnecker, Matthew P; Campbell, Jerry L; Andersen, Melvin E; Clewell, Harvey J

    2013-01-01

    Perfluoroalkyl acid carboxylates and sulfonates (PFAA) have many consumer and industrial applications. Developmental toxicity studies in animals have raised concern about potential reproductive/developmental effects of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS); however, in humans conflicting results have been reported for associations between maternal PFAA levels and these outcomes. Risk assessments and interpretation of available human data during gestation and lactation are hindered due to lack of a framework for understanding and estimating maternal, fetal, and neonatal pharmacokinetics (PK). Physiologically based pharmacokinetic (PBPK) models were developed for PFOA and PFOS for the gestation and lactation life stages in humans to understand how the physiological changes associated with development affect pharmacokinetics of these compounds in the mother, fetus, and infant. These models were derived from PBPK models for PFOA/PFOS that were previously developed for adult humans and rats during gestation and lactation and from existing human pregnancy and lactation models developed for other chemicals. The models simulated PFOA and PFOS concentrations in fetal, infant, and maternal plasma and milk, were compared to available data in humans, and also were used to estimate maternal exposure. The models reported here identified several research needs, which include (1) the identification of transporters involved in renal resorption to explain the multiyear half-lives of these compounds in humans, (2) factors affecting clearance of PFOA/PFOS during gestation and lactation, and (3) data to estimate clearance of PFOA/PFOS in infants. These models may help address concerns regarding possible adverse health effects due to PFOA/PFOS exposure in the fetus and infant and may be useful in comparing pharmacokinetics across life stages.

  6. Relation between clinical findings and progression of cerebral cortical pathology in MM1-type sporadic Creutzfeldt-Jakob disease: proposed staging of cerebral cortical pathology.

    Science.gov (United States)

    Iwasaki, Yasushi; Tatsumi, Shinsui; Mimuro, Maya; Kitamoto, Tetsuyuki; Hashizume, Yoshio; Yoshida, Mari

    2014-06-15

    In our pathologic observation of the cerebral cortex including the neocortex, hippocampus, and limbic cortex in 43 Japanese patients with MM1-type sporadic Creutzfeldt-Jakob disease, the earliest pathologic finding was spongiform change and next was gliosis. Subsequently, neuropil rarefaction appeared, followed by neuron loss. On the basis of these observations, we propose the following cortical pathologic staging: Stage I, spongiform change; Stage II, hypertrophic astrocytosis; Stage III, neuropil rarefaction; Stage IV, neuron loss; Stage V, status spongiosus; and Stage VI, large cavity formation. We also suggest a more simple staging classification: Stages I and II, mild; Stages III and IV, moderate; and Stages V and VI, severe involvement. Based on statistical analysis of the cases, strong correlation coefficients were obtained between the neocortical and limbic pathologic stage and both total disease duration and brain weight. We estimated that the first observation times of cortical hyperintensity on diffusion-weighted images of magnetic resonance imaging, myoclonus, and periodic sharp wave complexes on the electroencephalogram approximately correspond to the early phase of Stage II of the neocortex. The time to reach the akinetic mutism state approximately corresponds to the middle phase of Stage II of the neocortex. Therefore, we think that approximate clinical manifestations at death, total disease duration, and brain weight can be estimated according to the pathologic stage of the neocortex or limbic cortex. Panencephalopathic-type pathology appeared approximately 12 months after disease onset, and this time approximately corresponds to the middle phase of Stage III of the neocortex. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Mammography - recent technical developments and their clinical potential

    Energy Technology Data Exchange (ETDEWEB)

    Hemdal, Bengt; Mattsson, Soeren [Malmoe Univ. Hospital (Sweden). Dept. of Radiation Physics; Andersson, Ingvar [Malmoe Univ. Hospital (Sweden). Dept. of Diagnostic Radiology; Thilander Klang, Anne [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Medical Physics and Biomedical Engineering; Bengtsson, Gert; Jarlman, O. [Lund Univ. Hospital (Sweden). Dept. of Diagnostic Radiology; Leitz, Wolfram [Swedish Radiation Protection Authority, Stockholm (Sweden); Bjurstam, Nils [Univ. of North Norway, Troms (Norway). Dept. of Radiology

    2002-05-01

    The recent technical developments in digital as well as screen-film X-ray mammography have been reviewed in order to evaluate their clinical potential and to analyse possible lines for future development. Material and methods: The scientific literature has been reviewed, conferences covered and contacts with colleagues developed. Companies in the field have been inquired and invited for presentations. Own experience has been gathered from different screen-film and digital mammography systems. Results and conclusions: Although there are important complementary techniques such as ultrasound and magnetic resonance imaging (MRI), X-ray mammography is still the golden standard for breast imaging. It is relatively simple and cost-effective, and it is presently the only realistic technique for screening in a large scale. It is still largely the only technique that can detect breast cancer in a pre invasive stage. Equipment for digital mammography is commercially available both with small area and full field technique (FFDM). The development of FFDM systems is now intense, as well as the development of dedicated workstations and computer-aided detection (CAD). In spite of this, the introduction of digital mammography has been very slow compared to most other X-ray examinations due to high costs and technical challenges to meet the high demands on image quality and dose in mammography as well as the demands on specialised workflow support for screening mammography and suitable display techniques. Film reading of digital mammograms has been the most common display mode so far, but to take full advantage of the digital concept, diagnostic as well as logistic, monitor reading must be applied. There is a potential of FFDM systems for significantly higher image quality or significantly lower dose than screen-film mammography (SFM), or both. Further research is necessary to fully use this potential. The investment costs are much higher for digital than screen-film mammography

  8. Mammography - recent technical developments and their clinical potential

    International Nuclear Information System (INIS)

    Hemdal, Bengt; Mattsson, Soeren; Bjurstam, Nils

    2002-05-01

    The recent technical developments in digital as well as screen-film X-ray mammography have been reviewed in order to evaluate their clinical potential and to analyse possible lines for future development. Material and methods: The scientific literature has been reviewed, conferences covered and contacts with colleagues developed. Companies in the field have been inquired and invited for presentations. Own experience has been gathered from different screen-film and digital mammography systems. Results and conclusions: Although there are important complementary techniques such as ultrasound and magnetic resonance imaging (MRI), X-ray mammography is still the golden standard for breast imaging. It is relatively simple and cost-effective, and it is presently the only realistic technique for screening in a large scale. It is still largely the only technique that can detect breast cancer in a pre invasive stage. Equipment for digital mammography is commercially available both with small area and full field technique (FFDM). The development of FFDM systems is now intense, as well as the development of dedicated workstations and computer-aided detection (CAD). In spite of this, the introduction of digital mammography has been very slow compared to most other X-ray examinations due to high costs and technical challenges to meet the high demands on image quality and dose in mammography as well as the demands on specialised workflow support for screening mammography and suitable display techniques. Film reading of digital mammograms has been the most common display mode so far, but to take full advantage of the digital concept, diagnostic as well as logistic, monitor reading must be applied. There is a potential of FFDM systems for significantly higher image quality or significantly lower dose than screen-film mammography (SFM), or both. Further research is necessary to fully use this potential. The investment costs are much higher for digital than screen-film mammography

  9. Observations of flow path interactions with surface structures during initial soil development stage using irrigation experiments

    Science.gov (United States)

    Bartl, Steffen; Biemelt, Detlef; Badorreck, Annika; Gerke, Horst H.

    2010-05-01

    Structures and processes are dynamically linked especially during initial stages of soil and ecosystem development. Here we assume that soil pore structures and micro topography determine the flow paths and water fluxes as well as further structure changes. Reports about flow path developments at the soil surface are still limited because of an insufficient knowledge of the changing micro topography at the surface. The objective of this presentation is to evaluate methods for parameterisation of surface micro topography for analysing interactions between infiltration and surface runoff. Complex irrigation experiments were carried out at an experimental site in the neighbourhood of the artificially created water catchment "Chicken Creek". The irrigation rates between 160 mm/h and 250 mm/h were held constant over a time period of 20 minutes. The incoming intensities were measured as well as the raindrop-velocity and -size distributions. The surface runoff was continuously registered, soil samples were taken, and soil water potential heads were monitored using tensiometers. Surface and subsurface flow paths were identified using different tracers. The soil surface structures were recorded using a high resolution digital camera before, during, and after irrigation. Micro topography was surveyed using close-range photogrammetry. With this experimental design both, flow paths on the surface and in the soil as well as structure and texture changes could be observed simultaneously. In 2D vertical cross-sections, the effect of initial sediment deposition structure on infiltration and runoff was observed. Image analysis of surface pictures allowed identifying structural and soil textural changes during the runoff process. Similar structural changes related to surface flow paths were found with the photogrammetric surface analysis. We found evidence for the importance of the initial structures on the flow paths as well as a significant influence of the system development

  10. A Human Life-Stage Physiologically Based Pharmacokinetic and Pharmacodynamic Model for Chlorpyrifos: Development and Validation

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Jordan N.; Hinderliter, Paul M.; Timchalk, Charles; Bartels, M. J.; Poet, Torka S.

    2014-08-01

    Sensitivity to chemicals in animals and humans are known to vary with age. Age-related changes in sensitivity to chlorpyrifos have been reported in animal models. A life-stage physiologically based pharmacokinetic and pharmacodynamic (PBPK/PD) model was developed to computationally predict disposition of CPF and its metabolites, chlorpyrifos-oxon (the ultimate toxicant) and 3,5,6-trichloro-2-pyridinol (TCPy), as well as B-esterase inhibition by chlorpyrifos-oxon in humans. In this model, age-dependent body weight was calculated from a generalized Gompertz function, and compartments (liver, brain, fat, blood, diaphragm, rapid, and slow) were scaled based on body weight from polynomial functions on a fractional body weight basis. Blood flows among compartments were calculated as a constant flow per compartment volume. The life-stage PBPK/PD model was calibrated and tested against controlled adult human exposure studies. Model simulations suggest age-dependent pharmacokinetics and response may exist. At oral doses ≥ 0.55 mg/kg of chlorpyrifos (significantly higher than environmental exposure levels), 6 mo old children are predicted to have higher levels of chlorpyrifos-oxon in blood and higher levels of red blood cell cholinesterase inhibition compared to adults from equivalent oral doses of chlorpyrifos. At lower doses that are more relevant to environmental exposures, the model predicts that adults will have slightly higher levels of chlorpyrifos-oxon in blood and greater cholinesterase inhibition. This model provides a computational framework for age-comparative simulations that can be utilized to predict CPF disposition and biological response over various postnatal life-stages.

  11. Plasma 24-metabolite panel predicts preclinical transition to clinical stages of Alzheimer’s disease

    Directory of Open Access Journals (Sweden)

    Massimo S Fiandaca

    2015-11-01

    Full Text Available We recently documented plasma lipid dysregulation in preclinical late-onset Alzheimer’s disease (LOAD. A ten plasma lipid panel, predicted phenoconversion and provided 90% sensitivity and 85% specificity in differentiating an at-risk group from those that would remain cognitively intact. Despite these encouraging results, low positive predictive values limit the clinical usefulness of this panel as a screening tool in subjects aged 70-80 years or younger. In this report we re-examine our metabolomic data, analyzing baseline plasma specimens from our group of phenoconverters (n=28 and a matched set of cognitively normal subjects (n=73, and discover and internally validate a panel of 24 plasma metabolites. The new panel provides a classifier with receiver operating characteristic area under the curve, for the discovery and internal validation cohort, of 1.0 and 0.995 (95% Confidence Intervals of 1.0 to 1.0, and 0.981 to 1.0, respectively. Twenty-two of the 24 metabolites were significantly dysregulated lipids. While positive and negative predictive values were improved compared to our 10-lipid panel, low positive predictive values provide a reality check on the utility of such biomarkers in this age group (or younger. Through inclusion of additional significantly dysregulated analyte species, our new biomarker panel provides greater accuracy in our cohort but remains limited by predictive power. Unfortunately, the novel metabolite panel alone may not provide improvement in counseling and management of at-risk individuals, but, may further improve selection of subjects for LOAD secondary prevention trials. We expect that external validation will remain challenging due to our stringent study design, especially compared with more diverse subject cohorts. We anticipate, however, external validation of reduced plasma lipid species as a predictor of phenoconversion to either prodromal or manifest LOAD.

  12. Development of the precision long-stroke 3-DOF nano-stage for the photonic crystal process

    Science.gov (United States)

    Jywe, Wen-Yuh; Liu, Chien-Hung; Lin, Bor-Jeng; Lee, Meng-Tse; Lee, Jeng-Dao; Teng, Yun-Feng; Hsieh, Tung-Hsien

    2011-05-01

    In this paper, it develops a precision long-stroke 3-DOF nano-stage for the nano photonic crystal process. It integrates a linear motor driven long-stroke stage, a piezoelectric driven three-degrees-of-freedom (3-DOF) nano stage, multi-degrees-of-freedom (MDOF) laser interferometer measurement system and their control systems. The long-stroke nano-stage is a hybrid precision stage that can provide long-stroke and high precision positioning. The common focus horizon regulation system is used to keep the parallelism between writing instrument and the target while the laser direct writing instrument is used to write the nano structure needed. Furthermore, the automatic focusing and horizon control system can compensate the defocusing and angular errors that caused by machining automatically. With this precision 3-DOF nano-stage, the laser direct writing system can improve the process speed, overcome the optical limit of interference to reduce the writing spot, generate arbitrary patterns.

  13. The development and validation of oral cancer staging using administrative health data

    International Nuclear Information System (INIS)

    Li-Ting, Chang; Chung-Ho, Chen; Yi-Hsin, Yang; Pei-Shan, Ho

    2014-01-01

    Oral cancer is a major global health problem. The complexity of histological prognosticators in oral cancer makes it difficult to compare the benefits of different treatment regimens. The Taiwanese National Health database provides an opportunity to assess correlations between outcome and treatment protocols and to compare the effects of different treatment regimens. However, the absence of indices of disease severity is a critical problem. The aim of this study was to ascertain how accurately we could assess the severity of oral cancer at the time of initial diagnosis on the basis of variables in a national database. In the cancer registry database of a medical center in Taiwan, we identified 1067 histologically confirmed cases of oral cancer (ICD9 codes 140, 141 and 143–145) that had been first diagnosed and subjected to initial treatment in this hospital. The clinical staging status was considered as the gold standard and we used concordance (C)-statistics to assess the model’s predictive performance. We added the predictors of treatment modality, cancer subsite, and age group to our models. Our final overall model included treatment regimen, site, age, and two interaction terms; namely, interactions between treatment regimen and age and those between treatment regimen, site, and age. In this model, the C-statistics were 0.82–0.84 in male subjects and 0.96–0.99 in female subjects. Of the models stratified by age, the model that considered treatment regimen and site had the highest C-statistics for the interaction term, this value being greater than 0.80 in male subjects and 0.9 in female subjects. In this study, we found that adjusting for sex, age at first diagnosis, oral cancer subsite, and therapy regimen provided the best indicator of severity of oral cancer. Our findings provide a method for assessing cancer severity when information about staging is not available from a national health-related database

  14. Evaluation systems for clinical governance development: a comparative study.

    Science.gov (United States)

    Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Ebrahimipour, Hossein

    2014-01-01

    Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different evaluation systems for clinical governance development a necessity. These studies must provide applied strategies to design criteria of implementing clinical governance for hospital's accreditation. This is a descriptive and comparative study on development of clinical governance models all over the world. Data have been gathered by reviewing related articles. Models have been studied in comprehensive review method. The evaluated models of clinical governance development were Australian, NHS, SPOCK and OPTIGOV. The final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating clinical governance application and provide practical framework to evaluate country's hospital on the basis of clinical governance elements.

  15. Development of a clinical data warehouse from an intensive care clinical information system.

    Science.gov (United States)

    de Mul, Marleen; Alons, Peter; van der Velde, Peter; Konings, Ilse; Bakker, Jan; Hazelzet, Jan

    2012-01-01

    There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  16. [The role of clinical-electrophysiological indices in therapy for late-stage residual stroke by dynamic correction of proprioception].

    Science.gov (United States)

    Veĭn, A M; Shvarkov, S B; Khaspekova, N B; Vendrova, M I; Davydov, O S; Bobrovskaia, A N

    2001-01-01

    The new method dynamic proprioceptive correction using a medical loading costume was included into complex therapy in patients with late-stage residual stroke. Application of the costume promoted normalization of complex locomotor acts of walking by correcting proprioceptive pulsation resulted from the system of elastic draughts. Thus, a new motor stereotype was forced upon the patients. Clinical observation, computer analysis of the motor potential, spectrum of heart rhythm variabilities before and after therapy, and psychological testing were performed in 120 patients with motor disorders (pareses, paralyses) resulted from acute cerebral circulatory disorders. A steady-state clinical effect (p < 0.05) was found in 71.9% of the patients after 15 sessions of therapy. The patients became to walk independently, a possibility to self-attendance appeared, their speech became better. Lateralization of a damage and preservation of both the most significant homeostatic vasomotor mechanisms and the cerebral mechanisms of preparation of a movement with the minimal manifestations of emotional-affective disorders were shown to have impact on the patients' rehabilitation and on the early clinical features of pyramidal defect.

  17. Physico-chemical composition of native fruits of the Ceará coast at different development stages

    Directory of Open Access Journals (Sweden)

    Nigéria P. Gonçalves

    Full Text Available ABSTRACT This study aimed to evaluate the physico-chemical composition of native fruits of the Ceará coast at different development stages. The fruits of ‘guajiru’, ‘manipuçá’, ‘murici-pitanga’ and ‘murta’ were collected during the year 2014, and the following evaluations were made: total soluble solids, total titratable acidity, pH, total soluble solids and titratable acidity ratio. A completely randomized design was used, with 5 or 6 treatments, depending on the maturation stage and 4 replicates. For total soluble solids, ‘murta’ obtained a minimum of 2.6 °Brix in stage 1 and ‘manipuçá’ obtained maximum of 24.53 °Brix in stage 5. For the total titratable acidity, ‘guajiru’ showed minimum of 0.09% in stages 3 and 4, and ‘murici-pitanga’ showed maximum of 3.29% in stage 6. ‘Murici-pitanga’ had minimum pH of 3.44 in stage 5 and ‘guajiru’, maximum pH of 5.9 in stage 2. For total soluble solids and titratable acidity ratio, ‘murici-pitanga’ exhibited a minimum of 3.25 in stages 1 and 3, and ‘guajiru’ showed maximum of 141.11 in stage 4. It was concluded that ‘guajiru’ and ‘manipuçá’ fruits reached physiological maturity in stage 3, whereas ‘murici-pitanga’ and ‘murta’ fruits reached in stage 4; thus, these are the ideal stages for fruit harvest.

  18. Stage specific requirement of platelet-derived growth factor receptor-α in embryonic development.

    Science.gov (United States)

    Qian, Chen; Wong, Carol Wing Yan; Wu, Zhongluan; He, Qiuming; Xia, Huimin; Tam, Paul Kwong Hang; Wong, Kenneth Kak Yuen; Lui, Vincent Chi Hang

    2017-01-01

    Platelet-derived growth factor receptor alpha (PDGFRα) is a cell-surface receptor tyrosine kinase for platelet-derived growth factors. Correct timing and level of Pdgfra expression is crucial for embryo development, and deletion of Pdgfra caused developmental defects of multiple endoderm and mesoderm derived structures, resulting in a complex phenotypes including orofacial cleft, spina bifida, rib deformities, and omphalocele in mice. However, it is not clear if deletion of Pdgfra at different embryonic stages differentially affects these structures. To address the temporal requirement of Pdgfra in embryonic development. We have deleted the Pdgfra in Pdgfra-expressing tissues at different embryonic stages in mice, examined and quantified the developmental anomalies. Current study showed that (i) conditional deletion of Pdgfra at different embryonic days (between E7.5 and E10.5) resulted in orofacial cleft, spina bifida, rib cage deformities, and omphalocele, and (ii) the day of Pdgfra deletion influenced the combinations, incidence and severities of these anomalies. Deletion of Pdgfra caused apoptosis of Pdgfra-expressing tissues, and developmental defects of their derivatives. Orofacial cleft, spina bifida and omphalocele are among the commonest skeletal and abdominal wall defects of newborns, but their genetic etiologies are largely unknown. The remarkable resemblance of our conditional Pdgfra knockout embryos to theses human congenital anomalies, suggesting that dysregulated PDGFRA expression could cause these anomalies in human. Future work should aim at defining (a) the regulatory elements for the expression of the human PDGFRA during embryonic development, and (b) if mutations / sequence variations of these regulatory elements cause these anomalies.

  19. Stage line diagram: An age-conditional reference diagram for tracking development

    NARCIS (Netherlands)

    Buuren, S. van; Ooms, J.C.L.

    2009-01-01

    This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and

  20. Stage line diagram: an age-conditional reference diagram for tracking development.

    NARCIS (Netherlands)

    Van Buuren, S.|info:eu-repo/dai/nl/074806777; Ooms, J.C.L.

    2009-01-01

    This paper presents a method for calculating stage line diagrams, a novel type of reference diagram useful for tracking developmental processes over time. Potential fields of applications include: dentistry (tooth eruption), oncology (tumor grading, cancer staging), virology (HIV infection and

  1. SUCCESS FACTORS IN GROWING SMBs: A STUDY OF TWO INDUSTRIES AT TWO STAGES OF DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Tor Jarl Trondsen

    2002-01-01

    Full Text Available The study attempts to identify factors for growing SMBs. An evolutionary phase approach has been used. The study also aims to find out if there are common and different denominators for newer and older firms that can affect their profitability. The study selects a sampling frame that isolates two groups of firms in two industries at two stages of development. A variety of organizational and structural data was collected and analyzed. Amongst the conclusions that may be drawn from the study are that it is not easy to find a common definition of success, it is important to stratify SMBs when studying them, an evolutionary stage approach helps to compare firms with roughly the same external and internal dynamics and each industry has its own set of success variables.The study has identified three success variables for older firms that reflect contemporary strategic thinking such as crafting a good strategy and changing it only incrementally, building core competencies and outsourcing the rest, and keeping up with innovation and honing competitive skills.

  2. Modeling bacterial attachment to surfaces as an early stage of biofilm development.

    Science.gov (United States)

    El Moustaid, Fadoua; Eladdadi, Amina; Uys, Lafras

    2013-06-01

    Biofilms are present in all natural, medical and industrial surroundings where bacteria live. Biofilm formation is a key factor in the growth and transport of both beneficial and harmful bacteria. While much is known about the later stages of biofilm formation, less is known about its initiation which is an important first step in the biofilm formation. In this paper, we develop a non-linear system of partial differential equations of Keller-Segel type model in one-dimensional space, which couples the dynamics of bacterial movement to that of the sensing molecules. In this case, bacteria perform a biased random walk towards the sensing molecules. We derive the boundary conditions of the adhesion of bacteria to a surface using zero-Dirichlet boundary conditions, while the equation describing sensing molecules at the interface needed particular conditions to be set. The numerical results show the profile of bacteria within the space and the time evolution of the density within the free-space and on the surface. Testing different parameter values indicate that significant amount of sensing molecules present on the surface leads to a faster bacterial movement toward the surface which is the first step of biofilm initiation. Our work gives rise to results that agree with the biological description of the early stages of biofilm formation.

  3. Development of a two-stage microalgae dewatering process – A life cycle assessment approach

    Directory of Open Access Journals (Sweden)

    Rizwan R. Soomro

    2016-02-01

    Full Text Available Even though microalgal biomass is leading the third gener