WorldWideScience

Sample records for striking clinical responses

  1. Acute neuromuscular responses to short and long roundhouse kick striking paces in professional Muay Thai fighters.

    Science.gov (United States)

    Cimadoro, Giuseppe; Mahaffey, Ryan; Babault, Nicolas

    2018-04-04

    Muay Thai fighters strongly rely on the use of the roundhouse kick due to its effectiveness (i.e. power) and implications on the final score. Therefore, different striking tempos at full power are used during training as a method to enhance kicking power. However, the neuromuscular responses are unknown. Thus, the goal of this study was to investigate neuromuscular responses to a single bout of shorter (every second = H1) and longer (every 3s = H3) kick striking time intervals, measured with the countermovement jump (CMJ). Nine professional Muay Thai fighters participated in this randomized, cross-over trial. CMJs were measured on force plates before and after (post 0min, post 5min, post 10min, post 20min and post 30min) two striking (1set x 20reps) conditions (H1; H3). Although no difference was observed between H1 and H3 values, neuromuscular fatigue parameters displayed different patterns over time. CMJ height decreased immediately after H3 striking (PMuay Thai and conditioning coaches should focus on hard striking with both long and slow pacing during specific heavy bag or pad work.

  2. [Lightning strike and lesions outside the brain: Clinical cases and a review of the literature].

    Science.gov (United States)

    Morin, A; Lesourd, A; Cabane, J

    2015-01-01

    Every year, 240,000 people are struck by lightning worldwide, causing injuries leading to significant handicaps. Most of the symptoms involve brain lesions; neuromuscular sequelae and myelopathy are less common. We describe five cases of patients struck by lightning with various clinical presentations. The first patient presented painful paresthesias in both upper limbs that disappeared 18 months later; the injury was a plexopathy. The second patient developed proximal weakness in the upper-left limb due to a myopathy. Two patients presented with various motor weaknesses in the lower limbs due to motor neuron disease and myelopathy. The last patient had a transient tetraplegy, which resolved in 5minutes; the diagnosis was keraunoparalysis. Lightning injuries can have many consequences depending on the different mechanisms involved. The clinical presentation is often due to a very focal lesion without any secondary extension. Motor neuron disease probably results from post-traumatic myelopathy. We discuss the ALS-electrocution association, frequently described in the literature. Various peripheral nerve and spinal cord lesions can be seen in lightning strike victims involving myelopathy, motor neuron, muscle and plexus. Clinical syndromes are often atypical but outcome is often favorable. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Professional ethics in extreme circumstances: responsibilities of attending physicians and healthcare providers in hunger strikes.

    Science.gov (United States)

    Irmak, Nurbay

    2015-08-01

    Hunger strikes potentially present a serious challenge for attending physicians. Though rare, in certain cases, a conflict can occur between the obligations of beneficence and autonomy. On the one hand, physicians have a duty to preserve life, which entails intervening in a hunger strike before the hunger striker loses his life. On the other hand, physicians' duty to respect autonomy implies that attending physicians have to respect hunger strikers' decisions to refuse nutrition. International medical guidelines state that physicians should follow the strikers' unpressured advance directives. When physicians encounter an unconscious striker, in the absence of reliable advance directives, the guidelines advise physicians to make a decision on the basis of the patient's values, previously expressed wishes, and best interests. I argue that if there are no advance directives and the striker has already lost his competence, the physician has the responsibility to resuscitate the striker. Once the striker regains his decision-making capacity, he should be asked about his decision. If he is determined to continue fasting and refuses treatment, the physician has a moral obligation to respect this decisions and follow his advance directives.

  4. Professional solidarity versus responsibility for the health of the public: is a nurses' strike morally defensible?

    Science.gov (United States)

    Tabak, N; Wagner, N

    1997-07-01

    The purpose of this article is to deliberate the moral and legal dilemma entailed in the weapon of the labour strike as a pressure tactic on the Israeli Finance Ministry regarding job slots, budgets and, in effect, violating the collective agreement signed by the nurses and impairing patients' treatment, as opposed to refraining from striking and suffering the heavy burden of work, the lack of trained personnel, low wages, and the inability to give patients proper, high quality treatment.

  5. The immune system strikes back: cellular immune responses against indoleamine 2,3-dioxygenase.

    Directory of Open Access Journals (Sweden)

    Rikke Baek Sørensen

    2009-09-01

    Full Text Available The enzyme indoleamine 2,3-dioxygenase (IDO exerts an well established immunosuppressive function in cancer. IDO is expressed within the tumor itself as well as in antigen-presenting cells in tumor-draining lymph nodes, where it promotes the establishment of peripheral immune tolerance to tumor antigens. In the present study, we tested the notion whether IDO itself may be subject to immune responses.The presence of naturally occurring IDO-specific CD8 T cells in cancer patients was determined by MHC/peptide stainings as well as ELISPOT. Antigen specific cytotoxic T lymphocytes (CTL from the peripheral blood of cancer patients were cloned and expanded. The functional capacity of the established CTL clones was examined by chrome release assays. The study unveiled spontaneous cytotoxic T-cell reactivity against IDO in peripheral blood as well as in the tumor microenvironment of different cancer patients. We demonstrate that these IDO reactive T cells are indeed peptide specific, cytotoxic effector cells. Hence, IDO reactive T cells are able to recognize and kill tumor cells including directly isolated AML blasts as well as IDO-expressing dendritic cells, i.e. one of the major immune suppressive cell populations.IDO may serve as an important and widely applicable target for anti-cancer immunotherapeutic strategies. Furthermore, as emerging evidence suggests that IDO constitutes a significant counter-regulatory mechanism induced by pro-inflammatory signals, IDO-based immunotherapy holds the promise to boost anti-cancer immunotherapy in general.

  6. Inelastic off-fault response and three-dimensional dynamics of earthquake rupture on a strike-slip fault

    Science.gov (United States)

    Andrews, D.J.; Ma, Shuo

    2010-01-01

    Large dynamic stress off the fault incurs an inelastic response and energy loss, which contributes to the fracture energy, limiting the rupture and slip velocity. Using an explicit finite element method, we model three-dimensional dynamic ruptures on a vertical strike-slip fault in a homogeneous half-space. The material is subjected to a pressure-dependent Drucker-Prager yield criterion. Initial stresses in the medium increase linearly with depth. Our simulations show that the inelastic response is confined narrowly to the fault at depth. There the inelastic strain is induced by large dynamic stresses associated with the rupture front that overcome the effect of the high confining pressure. The inelastic zone increases in size as it nears the surface. For material with low cohesion (~5 MPa) the inelastic zone broadens dramatically near the surface, forming a "flowerlike" structure. The near-surface inelastic strain occurs in both the extensional and the compressional regimes of the fault, induced by seismic waves ahead of the rupture front under a low confining pressure. When cohesion is large (~10 MPa), the inelastic strain is significantly reduced near the surface and confined mostly to depth. Cohesion, however, affects the inelastic zone at depth less significantly. The induced shear microcracks show diverse orientations near the surface, owing to the low confining pressure, but exhibit mostly horizontal slip at depth. The inferred rupture-induced anisotropy at depth has the fast wave direction along the direction of the maximum compressive stress.

  7. A forward-striking technique for reducing fracture gaps during intramedullary nailing: A technical note with clinical results.

    Science.gov (United States)

    Lim, Seung-Jae; So, Sang-Yeon; Yoon, Yong-Cheol; Cho, Won-Tae; Oh, Jong-Keon

    2015-12-01

    A residual postoperative fracture gap between major bone fragments following intramedullary nailing of long-bone fractures is recognised as one of the major risk factors for delayed union and non-union. The most common method for reducing a fracture gap after nail insertion is through application of the backstroke technique. We introduce forward-striking as a new and simple technique that can be used to reduce fracture gaps during cephalomedullary or intramedullary nailing. The forward-striking technique was used in 20 patients with subtrochanteric or femoral shaft fractures and three patients with tibial shaft fractures who underwent cephalomedullary or intramedullary nailing at two university teaching hospitals between February 2013 and March 2014. Bone union was achieved in all cases, with a mean time of 5.7 months (range, 3-9 months). No major complications, including, non-union, implant failure, or infection, were encountered during the follow-up period. A forward-striking technique is simple, convenient, and highly efficient in terms of reducing fracture gaps during cephalomedullary or intramedullary nailing. The advantage of this technique is that it carries no risk of deforming the proximal interlocking screw, prevents excessive protrusion of the nail, and enables the lag screw to be placed into the optimal lag screw position relative to the femoral head at the time of cephalomedullary nailing. The forward-striking technique is particularly useful if no compression screw system is available. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Dynamic response to strike-slip tectonic control on the deposition and evolution of the Baranof Fan, Gulf of Alaska

    Science.gov (United States)

    Walton, Maureen A. L.; Gulick, Sean P. S.; Reece, Robert S.; Barth, Ginger A.; Christeson, Gail L.; VanAvendonk, Harm J.

    2014-01-01

    The Baranof Fan is one of three large deep-sea fans in the Gulf of Alaska, and is a key component in understanding large-scale erosion and sedimentation patterns for southeast Alaska and western Canada. We integrate new and existing seismic reflection profiles to provide new constraints on the Baranof Fan area, geometry, volume, and channel development. We estimate the fan’s area and total sediment volume to be ∼323,000 km2 and ∼301,000 km3, respectively, making it among the largest deep-sea fans in the world. We show that the Baranof Fan consists of channel-levee deposits from at least three distinct aggradational channel systems: the currently active Horizon and Mukluk channels, and the waning system we call the Baranof channel. The oldest sedimentary deposits are in the northern fan, and the youngest deposits at the fan’s southern extent; in addition, the channels seem to avulse southward consistently through time. We suggest that Baranof Fan sediment is sourced from the Coast Mountains in southeastern Alaska, transported offshore most recently via fjord to glacial sea valley conduits. Because of the translation of the Pacific plate northwest past sediment sources on the North American plate along the Queen Charlotte strike-slip fault, we suggest that new channel formation, channel beheadings, and southward-migrating channel avulsions have been influenced by regional tectonics. Using a simplified tectonic reconstruction assuming a constant Pacific plate motion of 4.4 cm/yr, we estimate that Baranof Fan deposition initiated ca. 7 Ma.

  9. Lightning Often Strikes Twice

    Science.gov (United States)

    2005-01-01

    Contrary to popular misconception, lightning often strikes the same place twice. Certain conditions are just ripe for a bolt of electricity to come zapping down; and a lightning strike is powerful enough to do a lot of damage wherever it hits. NASA created the Accurate Location of Lightning Strikes technology to determine the ground strike point of lightning and prevent electrical damage in the immediate vicinity of the Space Shuttle launch pads at Kennedy Space Center. The area surrounding the launch pads is enmeshed in a network of electrical wires and components, and electronic equipment is highly susceptible to lightning strike damage. The accurate knowledge of the striking point is important so that crews can determine which equipment or system needs to be retested following a strike. Accurate to within a few yards, this technology can locate a lightning strike in the perimeter of the launch pad. As an added bonus, the engineers, then knowing where the lightning struck, can adjust the variables that may be attracting the lightning, to create a zone that will be less susceptible to future strikes.

  10. [Physicians' strikes--ethical considerations].

    Science.gov (United States)

    Glick, Shimon; Schwarzfuchs, Dan

    2012-01-01

    Strikes in general represent a solution based on a form of coercion. Historically, the striker caused direct damage to his employer, who was responsible for the perceived unfair treatment of the employee. In the case of strikes in the public sector, the employer is generally not harmed, but innocent citizens suffer in order to pressure the government agencies, a questionable practice from an ethical viewpoint. Physicians' strikes have more serious ethical problems. They cause suffering and death to innocent citizens. They violate the ethical codes to which physicians have committed themselves as professionals, and they seriously impair the trust of the public in physicians. Better and more ethical ways to provide fair compensation for physicians must be employed, perhaps like those used for judges and members of the IDF.

  11. Options with Extreme Strikes

    Directory of Open Access Journals (Sweden)

    Lingjiong Zhu

    2015-07-01

    Full Text Available In this short paper, we study the asymptotics for the price of call options for very large strikes and put options for very small strikes. The stock price is assumed to follow the Black–Scholes models. We analyze European, Asian, American, Parisian and perpetual options and conclude that the tail asymptotics for these option types fall into four scenarios.

  12. Should doctors strike?

    Science.gov (United States)

    Park, John J; Murray, Scott A

    2014-05-01

    Last year in June, British doctors went on strike for the first time since 1975. Amidst a global economic downturn and with many health systems struggling with reduced finances, around the world the issue of public health workers going on strike is a very real one. Almost all doctors will agree that we should always follow the law, but often the law is unclear or does not cover a particular case. Here we must appeal to ethical discussion. The General Medical Council, in its key guidance document for practising doctors, Good Medical Practice, claims that 'Good doctors make the care of their patients their first concern'. Is this true? And if so, how is this relevant to the issue of striking? One year on since the events, we carefully reflect and argue whether it was right for doctors to pursue strike action, and call for greater discussion of ethical issues such as the recent strikes, particularly among younger members of the profession.

  13. Dose-response relationship in clinical oncology

    International Nuclear Information System (INIS)

    Gehan, E.A.

    1984-01-01

    The relationship of dose (and dose rate) to response and toxicity in clinical oncology is reviewed. The concepts expressed by some authors in dose-response studies in animal and human systems are reviewed briefly. Dose rate and tactics of conducting clinical studies are reviewed for both radiotherapy and various types of chemotherapeutic treatment. Examples are given from clinical studies in Hodgkin's disease, acute leukemia, and breast cancer that may prove useful in planning future clinical studies

  14. Responsiveness of Clinical Outcome Measures

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    the MCID (MCIDpost). Results The responsiveness in subgroups study. The ODI measurement error ranged between -11.5 and +13 points. Responsiveness was comparable to the external measures. A floor effect was seen in the PrS patients. The MCID was nine points in PrS and LBP only patients and eight points...

  15. Mesozoic strike-slip movement of the Dunhua-Mishan Fault Zone in NE China: A response to oceanic plate subduction

    Science.gov (United States)

    Liu, Cheng; Zhu, Guang; Zhang, Shuai; Gu, Chengchuan; Li, Yunjian; Su, Nan; Xiao, Shiye

    2018-01-01

    The NE-striking Dunhua-Mishan Fault Zone (DMFZ) is one of two branches of the continental-scale sinistral Tan-Lu Fault Zone in NE China. The field data presented here indicate that the ca. 1000 km long DMFZ records two phases of sinistral faulting. The structures produced by these two phases of faulting include NE-SW-striking ductile shear belts and brittle faults, respectively. Mylonite-hosted microstructures and quartz c-axis fabrics suggest deformation temperatures of 450 °C-500 °C for the ductile shear belts. Combining new zircon U-Pb dates for 14 igneous rock samples analyzed during this study with the geology of this region indicates these shear belts formed during the earliest Early Cretaceous. This phase of sinistral displacement represents the initial formation of the DMFZ in response to the northward propagation of the Tan-Lu Fault Zone into NE China. A phase of Early Cretaceous rifting was followed by a second phase of sinistral faulting at 102-96 Ma, as evidenced by our new U-Pb ages for associated igneous rocks. Combining our new data with the results of previous research indicates that the DFMZ records a four-stage Cretaceous evolutionary history, where initial sinistral faulting at the beginning of the Early Cretaceous gave way to rifting during the rest of the Early Cretaceous. This was followed by a second phase of sinistral faulting at the beginning of the Late Cretaceous and a second phase of local rifting during the rest of the Late Cretaceous. The Cretaceous evolution of the DMFZ records the synchronous tectonic evolution of the NE China continent bordering the Pacific Ocean. Two phases of regional N-S compression generated the two phases of sinistral faulting within the DMFZ, whereas two-stage regional extension generated the two phases of rifting. The two compressive events were the result of the rapid low-angle subduction of the Izanagi and Pacific plates, whereas the two-stage extension was caused by the roll-back of these respective

  16. Respecting the right to strike

    CERN Multimedia

    Staff Association

    2015-01-01

    Since two years the representatives of the employers in the ILO, a tripartite multilateral body responsible for guaranteeing the correct application of an international labour code, try to weaken the global work regulations. On the occasion of the Global Day of Action for the right to strike at the invitation of the Geneva community of Union action (Communauté genevoise d’action syndicale) and the Swiss Trade Union Association (Union syndicale suisse) around noon on Wednesday 18th February some fifty staff representatives of international organizations gathered on the place des Nations in Geneva to reaffirm the importance of this fundamental right, too often flouted. A delegation of the CERN Staff Association was also present. In a short speech, the Staff Association said that, while being one of the fundamental human rights, to be efficient the right to strike must be used intelligently. It must be implemented taking into account the sensitivities of the professional environment and r...

  17. A right to strike?

    Science.gov (United States)

    Jennings, K; Western, G

    1997-07-01

    During 1995, there was a major shift in the United Kingdom in the debate of whether it is right for nurses to strike. The Royal College of Nursing, the former advocate of a non-industrial action policy, moved towards the UNISON position that industrial action is ethical in some circumstances, as well as the necessary thing to do. The authors, both nurses and UNISON officials, look at the reasons for this change and why UNISON's historical position sees industrial action as an effective weapon in defending services, as well as wages and jobs. It can be right to strike.

  18. Strikes, solidarity and scabs. Union members participation norms and williengness to participate in strikes.

    NARCIS (Netherlands)

    Akkerman, A.; Born, M.; Torenvlied, R.

    2013-01-01

    This article studies how participation norms affect workers' willingness to strike. A factor analysis on the responses of 468 Dutch union members about appropriate behavior during a strike produces two factors. The first factor reflects a "solidarity norm" favoring group solidarity; the second

  19. Algab õppus "Saber Strike"

    Index Scriptorium Estoniae

    2014-01-01

    Täna algab Eestis, Lätis ja Leedus Ameerika Ühendriikide Euroopa väekoondise õppus "Saber Strike", mille eesmärk on maaväeüksuste koostöö harjutamine. Õppusest võtab osa üle 2000 kaitseväelase Baltimaadest, USAst, Ühendkuningriigist, Taanist, Norrast, Soomest ja Saksamaalt. Eestist osaleb õppusel ligi 400 kaitseväelast

  20. Global strike hypersonic weapons

    Science.gov (United States)

    Lewis, Mark J.

    2017-11-01

    Beginning in the 1940's, the United States has pursued the development of hypersonic technologies, enabling atmospheric flight in excess of five times the speed of sound. Hypersonic flight has application to a range of military and civilian applications, including commercial transport, space access, and various weapons and sensing platforms. A number of flight tests of hypersonic vehicles have been conducted by countries around the world, including the United States, Russia, and China, that could lead the way to future hypersonic global strike weapon systems. These weapons would be especially effective at penetrating conventional defenses, and could pose a significant risk to national security.

  1. Impulse of a Kendo Strike

    Directory of Open Access Journals (Sweden)

    Masahiro Abe

    2012-06-01

    Full Text Available An expert swordsman struck a target with a kendo sword. The velocity and force of the strike were measured. The relationship between the strike velocity, impact force and effective mass of the sword was investigated. It was shown that the effective mass of the sword remains constant for typical strike velocities.

  2. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2015-01-01

    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...

  3. Responsive Assessment: Assessing Student Nurses' Clinical Competence.

    Science.gov (United States)

    Neary, Mary

    2001-01-01

    A study involving 300 nursing students, 155 nurse practitioners, and 80 assessors tested a model of responsive assessment that includes identification of learning needs and potential, assignment to suitable placements, continuous assessment of clinical practice and patient care, and alignment of teaching and assessment with patient needs and…

  4. Strike Point Control for the National Spherical Torus Experiment (NSTX)

    International Nuclear Information System (INIS)

    Kolemen, E.; Gates, D.A.; Rowley, C.W.; Kasdin, N.J.; Kallman, J.; Gerhardt, S.; Soukhanovskii, V.; Mueller, D.

    2010-01-01

    This paper presents the first control algorithm for the inner and outer strike point position for a Spherical Torus (ST) fusion experiment and the performance analysis of the controller. A liquid lithium divertor (LLD) will be installed on NSTX which is believed to provide better pumping than lithium coatings on carbon PFCs. The shape of the plasma dictates the pumping rate of the lithium by channeling the plasma to LLD, where strike point location is the most important shape parameter. Simulations show that the density reduction depends on the proximity of strike point to LLD. Experiments were performed to study the dynamics of the strike point, design a new controller to change the location of the strike point to desired location and stabilize it. The most effective PF coils in changing inner and outer strike points were identified using equilibrium code. The PF coil inputs were changed in a step fashion between various set points and the step response of the strike point position was obtained. From the analysis of the step responses, PID controllers for the strike points were obtained and the controller was tuned experimentally for better performance. The strike controller was extended to include the outer-strike point on the inner plate to accommodate the desired low outer-strike points for the experiment with the aim of achieving 'snowflake' divertor configuration in NSTX.

  5. HiSCR (Hidradenitis Suppurativa Clinical Response)

    DEFF Research Database (Denmark)

    Kimball, B. A.; Sobell, J. M.; Zouboulis, C C

    2016-01-01

    Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility as an out......Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility...... as an outcome measure. Methods: Patients with baseline total abscess and inflammatory nodule count (AN count) of at least three and draining fistula count of 20 or fewer comprised the post hoc subpopulation analysed. HiSCR (at least a 50% reduction in total AN count, with no increase in abscess count...... week, or placebo (1 : 1 : 1). Results: The subpopulation included 132 (85.7%) patients; 70.5% women and 73.5% white. At week 16, HiSCR was achieved by 54.5% receiving weekly adalimumab, 33.3% every other week, and 25.6% placebo and HS-PGA Response was achieved by 20.5% receiving weekly adalimumab, 6...

  6. Precision Strike Annual Programs Review

    Science.gov (United States)

    2009-03-11

    Damage Area*• GPS / INS Navigation + SAL Terminal • Precise əm CEP • Low Probability of Collateral Damage • GPS Extends Glide Range to 10+km • Agile...Page 311 Mar 09 Unclassified Unclassified Viper Strike Lineage Viper Strike SAL Seeker Proof of Principle Demos I & II Hunter-Viper Strike Quick...Information Management • CCA - Clinger Cohen Act • RIT- Rapid Improvement Team • BMMP – Business Management Modernization Program • BTA/ERAM – Business

  7. The 2015 Mw7.2 Sarez Strike-Slip Earthquake in the Pamir Interior: Response to the Underthrusting of India's Western Promontory

    Science.gov (United States)

    Metzger, Sabrina; Schurr, Bernd; Ratschbacher, Lothar; Sudhaus, Henriette; Kufner, Sofia-Katerina; Schöne, Tilo; Zhang, Yong; Perry, Mason; Bendick, Rebecca

    2017-11-01

    The Pamir orogen, Central Asia, is the result of the ongoing northward advance of the Indian continent causing shortening inside Asia. Geodetic and seismic data place the most intense deformation along the northern rim of the Pamir, but the recent 7 December 2015, Mw7.2 Sarez earthquake occurred in the Pamir's interior. We present a distributed slip model of this earthquake using coseismic geodetic data and postseismic field observations. The earthquake ruptured an ˜80 km long, subvertical, sinistral fault consisting of three right-stepping segments from the surface to ˜30 km depth with a maximum slip of three meters in the upper 10 km of the crust. The coseismic slip model agrees well with en échelon secondary surface breaks that are partly influenced by liquefaction-induced mass movements. These structures reveal up to 2 m of sinistral offset along the northern, low-offset segment of modeled rupture. The 2015 event initiated close to the presumed epicenter of the 1911 Mw˜7.3 Lake Sarez earthquake, which had a similar strike-slip mechanism. These earthquakes highlight the importance of NE trending sinistral faults in the active tectonics of the Pamir. Strike-slip deformation accommodates shear between the rapidly northward moving eastern Pamir and the Tajik basin in the west and is part of the westward (lateral) extrusion of thickened Pamir plateau crust into the Tajik basin. The Sarez-Karakul fault system and the two large Sarez earthquakes likely are crustal expressions of the underthrusting of the northwestern leading edge of the Indian mantle lithosphere beneath the Pamir.

  8. Continental United States Hurricane Strikes

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Continental U.S. Hurricane Strikes Poster is our most popular poster which is updated annually. The poster includes all hurricanes that affected the U.S. since...

  9. Debunking the viper's strike: harmless snakes kill a common assumption.

    Science.gov (United States)

    Penning, David A; Sawvel, Baxter; Moon, Brad R

    2016-03-01

    To survive, organisms must avoid predation and acquire nutrients and energy. Sensory systems must correctly differentiate between potential predators and prey, and elicit behaviours that adjust distances accordingly. For snakes, strikes can serve both purposes. Vipers are thought to have the fastest strikes among snakes. However, strike performance has been measured in very few species, especially non-vipers. We measured defensive strike performance in harmless Texas ratsnakes and two species of vipers, western cottonmouths and western diamond-backed rattlesnakes, using high-speed video recordings. We show that ratsnake strike performance matches or exceeds that of vipers. In contrast with the literature over the past century, vipers do not represent the pinnacle of strike performance in snakes. Both harmless and venomous snakes can strike with very high accelerations that have two key consequences: the accelerations exceed values that can cause loss of consciousness in other animals, such as the accelerations experienced by jet pilots during extreme manoeuvres, and they make the strikes faster than the sensory and motor responses of mammalian prey and predators. Both harmless and venomous snakes can strike faster than the blink of an eye and often reach a target before it can move. © 2016 The Author(s).

  10. Tornadoes Strike Northern Wisconsin

    Science.gov (United States)

    2007-01-01

    A series of tornadoes ripped through the Upper Midwest region of the United States in the evening of June 7, 2007. At least five different tornadoes touched down in Wisconsin, according to the Associated Press, one of which tore through the Bear Paw Resort in northern Wisconsin. Despite dropping as much as fifteen centimeters (six inches) of rain in some places and baseball-size hail in others, authorities were reporting no deaths attributable to the storm system, and only a smattering of injuries, but considerable property damage in some areas. When the MODIS instrument on NASA's Terra satellite observed the area on June 9, 2007, the track torn through the woods by one of the tornadoes stands out quite clearly. This photo-like image uses data collected by MODIS in the normal human vision range to give a familiar natural-looking appearance. The landscape is largely a checkerboard of farms, towns, roads, and cities. The pale land is predominantly farmland where crops have not fully grown in yet. Dark blue shows the winding path of rivers and lakes dotting the landscape. The large blue lake on the east (right) side of the image is Lake Michigan. Towns and cities, including the city of Green Bay, are gray. To the north side, farmland gives way to dark green as land use shifts from agriculture to the Menominee Indian Reservation and Nicolet National Forest. The diagonal slash through the dark green forested land shows the tornado track. Bare land was revealed where the tornado tore down trees or stripped vegetation off the branches. The high-resolution image provided above is at MODIS' full spatial resolution (level of detail) of 250 meters per pixel. The MODIS Rapid Response System provides this image at additional resolutions.

  11. EDITORIAL: Dearing strikes again!

    Science.gov (United States)

    Dobson Honorary Editor, Ken

    1996-05-01

    recommendations which will need very careful and intelligent management if they are to be both workable and beneficial; unfortunately recent history tells us that the Government's agencies responsible for educational management are insensitive to the advice of practitioners and work to hidden political agendas based on prejudgement if not downright prejudice. The Report's recommendations certainly provide a challenge for post-16 physics, especially for A-level. It is to be hoped that the new structures and initiatives of the Institute of Physics will be able to play a full part in ensuring that changes are beneficial and workable. Firstly, Sir Ron wants A-levels to provide opportunities and contexts for the development of some general skills, identified as communication (both written and oral), numeracy and in information technology, with a less clear reference to an ability to work as part of a team. Challenge 1: find good contexts in physics for these - and a valid assessment system. Secondly, the curriculum should be broadened by a kind of two-phase approach to post-16 studies. Potential A-level students would spend a year studying as many as six Advanced Subsidiary level subjects, chosen from four main areas: science, maths and technology; modern languages; arts and humanities; `the way the community works' (business, economics, law, psychology etc). Each new-style AS would be the first half of an A-level course. The second phase would allow specialization into, say, three A-levels as at present, or to a combination of A and AS courses. Challenge 2: design a half course that makes sense, and is as useful to potential lawyers as to potential physicists. Thirdly, there should be an increase in the size of the A-level subject cores. Challenge 3: design such an extended core that is less boringly old-fashioned than the current one (not too difficult, that) and is capable of useful fission (see Challenge 2). This is a good opportunity to consider the nature of a `core' in physics

  12. Contribution of novel ATGL missense mutations to the clinical phenotype of NLSD-M: a strikingly low amount of lipase activity may preserve cardiac function.

    Science.gov (United States)

    Tavian, Daniela; Missaglia, Sara; Redaelli, Chiara; Pennisi, Elena M; Invernici, Gloria; Wessalowski, Ruediger; Maiwald, Robert; Arca, Marcello; Coleman, Rosalind A

    2012-12-15

    The lack of adipose triglyceride lipase (ATGL), a patatin-like phospholipase domain-containing enzyme that hydrolyzes fatty acids from triacylglycerol (TAG) stored in multiple tissues, causes the autosomal recessive disorder neutral lipid storage disease with myopathy (NLSD-M). In two families of Lebanese and Italian origin presenting with NLSD-M, we identified two new missense mutations in highly conserved regions of ATGL (p.Arg221Pro and p.Asn172Lys) and a novel nonsense mutation (p.Trp8X). The Lebanese patients harbor homozygous p.Arg221Pro, whereas the Italian patients are heterozygotes for p.Asn172Lys and the p.Trp8X mutation. The p.Trp8X mutation results in a complete absence of ATGL protein, while the p.Arg221Pro and p.Asn172Lys mutations result in proteins with minimal lipolytic activity. Although these mutations did not affect putative catalytic residues or the lipid droplet (LD)-binding domain of ATGL, cytosolic LDs accumulated in cultured skin fibroblasts from the patients. The missense mutations might destabilize a random coil (p.Asn172Lys) or a helix (p.Arg221Pro) structure within or proximal to the patatin domain of the lipase, thereby interfering with the enzyme activity, while leaving intact the residues required to localize the protein to LDs. Overexpressing wild-type ATGL in one patient's fibroblasts corrected the metabolic defect and effectively reduced the number and area of cellular LDs. Despite the poor lipase activity in vitro, the Lebanese siblings have a mild myopathy and not clinically evident myocardial dysfunction. The patients of Italian origin show a late-onset and slowly progressive skeletal myopathy. These findings suggest that a small amount of correctly localized lipase activity preserves cardiac function in NLSD-M.

  13. ["Bell-striking" Saying of Acupuncture Therapy].

    Science.gov (United States)

    Zhao, Jing-Sheng

    2017-04-25

    As an analogy, a prototype of "bell-striking" is proposed in the present paper for exploring the basic properties, major elements, and potential mechanisms of acupuncture stimulation. On the strength of analysis on the physiological basis of acupuncture effect, several fundamental aspects of acupuncture are summarized as a) the body-surface stimulating characters, b) general and local effects, and c) triggering the auto-regulative function of the organism, which mimics the "bell-striking" response. Namely, when stroke, bell will chime, otherwise, chiming will not be heard. During analyzing special contents of acupuncture theory, its formative background should not be separated, and it is improper to take, modern medical theory of the human body as the guiding thinking way for researching the ancient Chinese medical literature.

  14. Central hyperadrenergic state after lightning strike.

    Science.gov (United States)

    Parsaik, Ajay K; Ahlskog, J Eric; Singer, Wolfgang; Gelfman, Russell; Sheldon, Seth H; Seime, Richard J; Craft, Jennifer M; Staab, Jeffrey P; Kantor, Birgit; Low, Phillip A

    2013-08-01

    To describe and review autonomic complications of lightning strike. Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.

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

    OpenAIRE

    Popovitz, Juliana Maria Bubna; Silveira, Jocelaine Martins da

    2017-01-01

    Abstract: The current study aims to evaluate the possible effects of interrupting problematic clinically relevant behaviors on the percentage of these responses and of clinical improvement-related responses. Two clients were treated with Functional Analytic Psychotherapy (FAP), alternating two conditions (ABAB). On condition A, procedures to the therapist consisted of responding to the clinical improvement responses, and to description of outside of therapeutic setting behaviors, but therapis...

  16. Structural evolution of Cenozoic basins in northeastern Tunisia, in response to sinistral strike-slip movement on the El Alia-Teboursouk Fault

    Science.gov (United States)

    Bejaoui, Hamida; Aïfa, Tahar; Melki, Fetheddine; Zargouni, Fouad

    2017-10-01

    This paper resolves the structural complexity of Cenozoic sedimentary basins in northeastern Tunisia. These basins trend NE-SW to ∼ E-W, and are bordered by old fracture networks. Detailed descriptions of the structural features in outcrop and in subsurface data suggest that the El Alia-Teboursouk Fault zone in the Bizerte area evolved through a series of tectonic events. Cross sections, lithostratigraphic correlations, and interpretation of seismic profiles through the basins show evidence for: (i) a Triassic until Jurassic-Early Cretaceous rifting phase that induced lateral variations of facies and strata thicknesses; (ii) a set of faults oriented NE-SW, NW-SE, N-S, and E-W that guided sediment accumulation in pull-apart basins, which were subject to compressive and transpressive deformation during Eocene (Lutetian-Priabonian), Miocene (Tortonian), and Pliocene-Quaternary; and (iii) NNW-SSE to NS contractional events that occurred during the Late Pliocene. Part of the latest phase has been the formation of different synsedimentary folded structures with significant subsidence inversion. Such events have been responsible for the reactivation of inherited faults, and the intrusion of Triassic evaporites, ensuring the role of a slip layer. The combined effects of the different paleoconstraints and halokinetic movements are at the origin of the evolution of these pull-apart basins. The subsurface data suggest that an important fault displacement occurred during the Mesozoic-Cenozoic. The patterns of sediment accumulation in the different basins reflect a high activity of deep ancient faults.

  17. Lightning strike-induced brachial plexopathy

    Directory of Open Access Journals (Sweden)

    Amita N Bhargava

    2014-01-01

    Full Text Available We describe a patient who presented with a history of lightning strike injury. Following the injury, he sustained acute right upper limb weakness with pain. Clinically, the lesion was located to the upper and middle trunk of the right brachial plexus, and the same confirmed with electrophysiological studies. Nerve damage due to lightning injuries is considered very rare, and a plexus damage has been described infrequently, if ever. Thus, the proposed hypothesis that lightning rarely causes neuropathy, as against high-voltage electric current, due to its shorter duration of exposure not causing severe burns which lead to nerve damage, needs to be reconsidered.

  18. Evaluation of Clinical and Pathological Response after Two Cycles ...

    African Journals Online (AJOL)

    Results: The clinical response rate was 83%; 11 patients (11.2%) had a complete clinical remission (cCR); 71 had a partial remission (72.4%); 13 had stable disease (13.3%), and 3 had progressive disease (3.1%). Seven patients had complete pathological response. Conclusion: Neoadjuvant chemotherapy can achieve a ...

  19. Strikes by physicians: a historical perspective toward an ethical evaluation.

    Science.gov (United States)

    Thompson, Stephen L; Salmon, J Warren

    2006-01-01

    Current conditions surrounding the house of medicine-including corporate and government cost-containment strategies, increasing market-penetration schemes in health care, along with clinical scrutiny and the administrative control imposed under privatization by managed care firms, insurance companies, and governments-have spurred an upsurge in physician unionization, which requires a revisiting of the issue of physician strikes. Strikes by physicians have been relatively rare events in medical history. When they have occurred, they have aroused intense debate over their ethical justification among professionals and the public alike, notwithstanding what caused the strikes. As physicians and other health care providers increasingly find employment within organizations as wage-contract employees and their work becomes more highly rationalized, more physicians will join labor organizations to protect both their economic and their professional interests. As a result, these physicians will have to come to terms with the use of the strike weapon. On the surface, many health care strikes may not ever seem justifiable, but in certain defined situations a strike would be not only permissible but an ethical imperative. With an exacerbation of labor strife in the health sector in many nations, it is crucial to explore the question of what constitutes an ethical physician strike.

  20. Determine the Foot Strike Pattern Using Inertial Sensors

    Directory of Open Access Journals (Sweden)

    Tzyy-Yuang Shiang

    2016-01-01

    Full Text Available From biomechanical point of view, strike pattern plays an important role in preventing potential injury risk in running. Traditionally, strike pattern determination was conducted by using 3D motion analysis system with cameras. However, the procedure is costly and not convenient. With the rapid development of technology, sensors have been applied in sport science field lately. Therefore, this study was designed to determine the algorithm that can identify landing strategies with a wearable sensor. Six healthy male participants were recruited to perform heel and forefoot strike strategies at 7, 10, and 13 km/h speeds. The kinematic data were collected by Vicon 3D motion analysis system and 2 inertial measurement units (IMU attached on the dorsal side of both shoes. The data of each foot strike were gathered for pitch angle and strike index analysis. Comparing the strike index from IMU with the pitch angle from Vicon system, our results showed that both signals exhibited highly correlated changes between different strike patterns in the sagittal plane (r=0.98. Based on the findings, the IMU sensors showed potential capabilities and could be extended beyond the context of sport science to other fields, including clinical applications.

  1. 42 CFR 493.1419 - Standard; Clinical consultant responsibilities.

    Science.gov (United States)

    2010-10-01

    ... Testing Laboratories Performing Moderate Complexity Testing § 493.1419 Standard; Clinical consultant... clinical consultation to the laboratory's clients; (b) Be available to assist the laboratory's clients in... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

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

    Directory of Open Access Journals (Sweden)

    Juliana Maria Bubna Popovitz

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

  3. Macular damage following lightning strikes.

    Science.gov (United States)

    Augustin, A J; Koch, F; Böker, T

    1995-07-01

    Two men with recent history of lightining strike were referred to our hospital. Both patients complained of metamorphosia in one eye and reduced visual acuity. Funduscopy revealed target-like alterations at the fovea. Fluorescein angiography showed window defects of the central retinal pigment epithelium in both patients. One patient developed an anterior subcapsular cataract. If the eye is part of the current-circuit, the melanin granules of the iris, pigment epithelium, and choroid might act as a resistor. The resulting accumulation of heat may lead to damage of the surrounding tissues.

  4. [An Investigation of the Role Responsibilities of Clinical Research Nurses in Conducting Clinical Trials].

    Science.gov (United States)

    Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu

    2015-06-01

    Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p research coordination and management" (p clinical practice.

  5. Acute transient hemiparesis induced by lightning strike.

    Science.gov (United States)

    Rahmani, Seyed Hesam; Faridaalaee, Gholamreza; Jahangard, Samira

    2015-07-01

    According to data from the National Oceanic and Atmospheric Administration,in the years from 1959 to 1994, lightning was responsible for more than 3000 deaths and nearly 10,000 casualties. The most important characteristic features of lightning injuries are multisystem involvement and widely variable severity. Lightning strikes are primarily a neurologic injury that affects all 3 components of the nervous system: central, autonomic,and peripheral. Neurologic complications of lightning strikes vary from transient benign symptoms to permanent disability. Many patients experience a temporary paralysis called keraunoparalysis. Here we reported a 22-year-old mountaineer man with complaining of left sided hemiparesis after being hit by a lightning strike in the mountain 3 hours ago. There was no loss of consciousness at hitting time. On arrival the patient was alert, awake and hemodynamically stable. In neurologic examination cranial nerves were intact, left sided upper and lower extremity muscle force was I/V with a combination of complete sensory loss, and right-sided muscle force and sensory examination were normal. There is not any evidence of significant vascular impairment in the affected extremities. Brain MRI and CT scan and cervical MRI were normal. During 2 days of admission, with intravenous hydration, heparin 5000 unit SC q12hr and physical therapy of the affected limbs, motor and sensory function improved and was normal except mild paresthesia. He was discharged 1 day later for outpatient follow up while vitamin B1 100mg orally was prescribed.Paresthesia improved after 3 days without further sequels.

  6. Strike action by nurses in South Africa: A value clarification

    Directory of Open Access Journals (Sweden)

    Marie Muller

    2001-09-01

    Full Text Available The Labour Relations Act (South Africa, 1991 made provision for protected strike action by employees, subject to certain conditions, procedures and negotiated agreements. This led to the removal of the strike clause in the Nursing Act (South Africa, 1992. The labour rights of all citizens are entrenched in the Constitution of the country (South Africa, 1996. Participation in strike action by the nurse/ midwife, regardless of the legal requirements and specifications, does, however, pose an ethical question. It is therefore necessary to conduct a value clarification on strike action by nurses in South Africa. The purpose of this research is to explore and describe the perceived values of participants from an accessible population on this phenomenon. A qualitative, exploratory and descriptive research design was deployed. The perceived values of nurses on strike action were collected by means of an openended questionnaire/sketch. Over a period of three years a purposive and convenient sampling method was used, involving all the enrolled post basic nursing/midwifery students/ learners at a particular Nursing Education Institution. The justification of the sample was further enhanced by also collecting data on the participants’ age and provincial distribution location. Although a 63% sample realisation (of the accessible population was achieved, this represents only 1,5% of the registered nursing/midwifery population in the country. A descriptive analysis of the participants’ age and provincial distribution was undertaken, as well as a content analysis of their perceived values on strike action. The mean age of the participants was 48 years, which could be attributed to the fact that most of them were enrolled for a post-basic Diploma in Community Nursing Science. Most of the responses (52,7% were against strike action and 32,5% supported strike action by nurses as a constitutional and legal right. A fairly substantial number of participants (14

  7. Women, transition and strikes in Serbia

    OpenAIRE

    Novaković, Nada G.

    2014-01-01

    The author, in a sociological way, describes and analyzes the concepts of transition, privatization and strikes in Serbia, particularly the place of women in it. It examines the most important economic and social causes and consequences of these phenomena. The main hypothesis is: women's strikes in the Serbian transition are less efficient than strikes and public protests of women in the developed world and the second Yugoslavia. A strike is a class conflict, in which the workers are fighting...

  8. 14 CFR 35.38 - Lightning strike.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Lightning strike. 35.38 Section 35.38... STANDARDS: PROPELLERS Tests and Inspections § 35.38 Lightning strike. The applicant must demonstrate, by... lightning strike without causing a major or hazardous propeller effect. The limit to which the propeller has...

  9. 42 CFR 493.1457 - Standard; Clinical consultant responsibilities.

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Personnel for Nonwaived Testing Laboratories Performing High Complexity Testing § 493.1457 Standard; Clinical consultant... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Clinical consultant responsibilities. 493...

  10. Recommendations for imaging tumor response in neurofibromatosis clinical trials.

    Science.gov (United States)

    Dombi, Eva; Ardern-Holmes, Simone L; Babovic-Vuksanovic, Dusica; Barker, Fred G; Connor, Steve; Evans, D Gareth; Fisher, Michael J; Goutagny, Stephane; Harris, Gordon J; Jaramillo, Diego; Karajannis, Matthias A; Korf, Bruce R; Mautner, Victor; Plotkin, Scott R; Poussaint, Tina Y; Robertson, Kent; Shih, Chie-Schin; Widemann, Brigitte C

    2013-11-19

    Neurofibromatosis (NF)-related benign tumors such as plexiform neurofibromas (PN) and vestibular schwannomas (VS) can cause substantial morbidity. Clinical trials directed at these tumors have become available. Due to differences in disease manifestations and the natural history of NF-related tumors, response criteria used for solid cancers (1-dimensional/RECIST [Response Evaluation Criteria in Solid Tumors] and bidimensional/World Health Organization) have limited applicability. No standardized response criteria for benign NF tumors exist. The goal of the Tumor Measurement Working Group of the REiNS (Response Evaluation in Neurofibromatosis and Schwannomatosis) committee is to propose consensus guidelines for the evaluation of imaging response in clinical trials for NF tumors. Currently used imaging endpoints, designs of NF clinical trials, and knowledge of the natural history of NF-related tumors, in particular PN and VS, were reviewed. Consensus recommendations for response evaluation for future studies were developed based on this review and the expertise of group members. MRI with volumetric analysis is recommended to sensitively and reproducibly evaluate changes in tumor size in clinical trials. Volumetric analysis requires adherence to specific imaging recommendations. A 20% volume change was chosen to indicate a decrease or increase in tumor size. Use of these criteria in future trials will enable meaningful comparison of results across studies. The proposed imaging response evaluation guidelines, along with validated clinical outcome measures, will maximize the ability to identify potentially active agents for patients with NF and benign tumors.

  11. Strikes in Serbia since 2000 to 2005

    Directory of Open Access Journals (Sweden)

    Novaković Nada

    2005-01-01

    Full Text Available In this article author deals with main characteristics of strikes in Serbia within the period 2000–2005. Analysis starts with thesis that strike is open class conflict within class divided society. Therefore strike is radical form of trade union struggle for workers rights. Main questions in the analysis were: on social structure as a background of strikes, on organizations and trade unions included in it, on effects of strikes in Serbia in the given period. Main thesis of the article is that every power dislike strikes and is ready to do everything to diminish them. Main reason lies in the class nature of social conflict that underlie them. Main processes that underlie strike phenomena in Serbia since 2000. are the processes of originally capital accumulation. These bring about the formation of new capitalist class and proletariat of all professions. Author gives a brief analysis of privatization process, as well as of restructuring of public sector and deregulation of economy trying to show the role of all of it in origins of strikes. Main conclusion is that there are large number of strikes in all parts of society, that are well organized, with support of one or more trade unions. For these in power they are factor of obstacle on the way of successful transition. As for the reasons and outcomes these strikes are akin to the strikes at the beginning of 19th century.

  12. Third-party support for strike action.

    Science.gov (United States)

    Kelloway, E Kevin; Francis, Lori; Catano, Victor M; Dupré, Kathryne E

    2008-07-01

    Labor strikes are often seen as battles for public support. Members of the public are asked to show respect for a strike by refusing to cross the picket line or by joining strikers on the picket line. Such public support may affect the morale of strikers and influence the strike's duration. Despite the perceived importance of the public in labor disputes, members of third parties have not been considered in previous strike research. In 2 studies, the authors show that a new measure of third-party strike support is unidimensional and highly reliable. In both cases, union attitudes and perceptions of distributive justice were significant predictors of support for strike action. Those who are more supportive of unions in general and believe that the contract offered to the strikers was unfair were more likely to support the strike by engaging in such actions as conversing with strikers, writing letters, and refusing to cross the picket line.

  13. Spores of Clostridium difficile clinical isolates display a diverse germination response to bile salts.

    Directory of Open Access Journals (Sweden)

    Daniela Heeg

    Full Text Available Clostridium difficile spores play a pivotal role in the transmission of infectious diarrhoea, but in order to cause disease spores must complete germination and return to vegetative cell growth. While the mechanisms of spore germination are well understood in Bacillus, knowledge of C. difficile germination remains limited. Previous studies have shown that bile salts and amino acids play an important role in regulating the germination response of C. difficile spores. Taurocholate, in combination with glycine, can stimulate germination, whereas chenodeoxycholate has been shown to inhibit spore germination in a C. difficile clinical isolate. Our recent studies of C. difficile sporulation characteristics have since pointed to substantial diversity among different clinical isolates. Consequently, in this study we investigated how the germination characteristics of different C. difficile isolates vary in response to bile salts. By analysing 29 isolates, including 16 belonging to the BI/NAP1/027 type, we show that considerable diversity exists in both the rate and extent of C. difficile germination in response to rich medium containing both taurocholate and glycine. Strikingly, we also show that although a potent inhibitor of germination for some isolates, chenodeoxycholate does not inhibit the germination, or outgrowth, of all C. difficile strains. Finally, we provide evidence that components of rich media may induce the germination of C. difficile spores, even in the absence of taurocholate. Taken together, these data suggest that the mechanisms of C. difficile spore germination in response to bile salts are complex and require further study. Furthermore, we stress the importance of studying multiple isolates in the future when analysing the nutrients or chemicals that either stimulate or inhibit C. difficile spore germination.

  14. Predicting timing of foot strike during running, independent of striking technique, using principal component analysis of joint angles.

    Science.gov (United States)

    Osis, Sean T; Hettinga, Blayne A; Leitch, Jessica; Ferber, Reed

    2014-08-22

    As 3-dimensional (3D) motion-capture for clinical gait analysis continues to evolve, new methods must be developed to improve the detection of gait cycle events based on kinematic data. Recently, the application of principal component analysis (PCA) to gait data has shown promise in detecting important biomechanical features. Therefore, the purpose of this study was to define a new foot strike detection method for a continuum of striking techniques, by applying PCA to joint angle waveforms. In accordance with Newtonian mechanics, it was hypothesized that transient features in the sagittal-plane accelerations of the lower extremity would be linked with the impulsive application of force to the foot at foot strike. Kinematic and kinetic data from treadmill running were selected for 154 subjects, from a database of gait biomechanics. Ankle, knee and hip sagittal plane angular acceleration kinematic curves were chained together to form a row input to a PCA matrix. A linear polynomial was calculated based on PCA scores, and a 10-fold cross-validation was performed to evaluate prediction accuracy against gold-standard foot strike as determined by a 10 N rise in the vertical ground reaction force. Results show 89-94% of all predicted foot strikes were within 4 frames (20 ms) of the gold standard with the largest error being 28 ms. It is concluded that this new foot strike detection is an improvement on existing methods and can be applied regardless of whether the runner exhibits a rearfoot, midfoot, or forefoot strike pattern. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Physicians’ Professionally Responsible Power: A Core Concept of Clinical Ethics

    Science.gov (United States)

    McCullough, Laurence B.

    2016-01-01

    The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power—the legitimation of physicians’ power—a core concept of clinical ethics. In the absence of legitimation, the physician’s power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians’ power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. PMID:26671961

  16. Pretreatment Mitochondrial Priming Correlates with Clinical Response to Cytotoxic Chemotherapy

    Science.gov (United States)

    Chonghaile, Triona Ni; Sarosiek, Kristopher A.; Vo, Thanh-Trang; Ryan, Jeremy A.; Tammareddi, Anupama; Moore, Victoria Del Gaizo; Deng, Jing; Anderson, Ken; Richardson, Paul; Tai, Yu-Tzu; Mitsiades, Constantine S.; Matulonis, Ursula A.; Drapkin, Ronny; Stone, Richard; DeAngelo, Daniel J.; McConkey, David J.; Sallan, Stephen E.; Silverman, Lewis; Hirsch, Michelle S.; Carrasco, Daniel Ruben; Letai, Anthony

    2011-01-01

    Cytotoxic chemotherapy targets elements common to all nucleated human cells, such as DNA and microtubules, yet it selectively kills tumor cells. Here we show that clinical response to these drugs correlates with, and may be partially governed by, the pre-treatment proximity of tumor cell mitochondria to the apoptotic threshold, a property called mitochondrial priming. We used BH3 profiling to measure priming in tumor cells from patients with multiple myeloma, acute myelogenous and lymphoblastic leukemia, and ovarian cancer. This assay measures mitochondrial response to peptides derived from pro-apoptotic BH3 domains of proteins critical for death signaling to mitochondria. Patients with highly primed cancers exhibited superior clinical response to chemotherapy. In contrast, chemoresistant cancers and normal tissues were poorly primed. Manipulation of mitochondrial priming might enhance the efficacy of cytotoxic agents. PMID:22033517

  17. 14 CFR 29.631 - Bird strike.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Bird strike. 29.631 Section 29.631... STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Design and Construction General § 29.631 Bird strike. The... safe landing (for Category B) after impact with a 2.2-lb (1.0 kg) bird when the velocity of the...

  18. Skin Cancer Can Strike Anyone

    Science.gov (United States)

    ... left temple. He has spoken out about the importance of regular screening for skin cancer. Photo: Frontpage / ... melanin, which is responsible for skin and hair color. Melanoma can spread very rapidly, and the incidence ...

  19. Admission Privileges and Clinical Responsibilities for Interventional Radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [The American University of Beirut Medical Center, IR Division, The Department of Diagnostic Radiology (Lebanon)

    2015-04-15

    Although clinical involvement by interventional radiologists in the care of their patients was advocated at the inception of the specialty, the change into the clinical paradigm has been slow and patchy for reasons related to pattern of practice, financial remuneration or absence of training. The case for the value of clinical responsibilities has been made in a number of publications and the consequences of not doing so have been manifest in the erosion of the role of the interventional radiologists particularly in the fields of peripheral vascular and neuro intervention. With the recent recognition of interventional radiology (IR) as a primary specialty in the USA and the formation of IR division in the Union of European Medical Specialists and subsequent recognition of the subspecialty in many European countries, it is appropriate to relook at the issue and emphasize the need for measures to promote the clinical role of the interventional radiologist.

  20. Information needs for the rapid response team electronic clinical tool.

    Science.gov (United States)

    Barwise, Amelia; Caples, Sean; Jensen, Jeffrey; Pickering, Brian; Herasevich, Vitaly

    2017-10-02

    Information overload in healthcare is dangerous. It can lead to critical errors and delays. During Rapid Response Team (RRT) activations providers must make decisions quickly to rescue patients from physiological deterioration. In order to understand the clinical data required and how best to present that information in electronic systems we aimed to better assess the data needs of providers on the RRT when they respond to an event. A web based survey to evaluate clinical data requirements was created and distributed to all RRT providers at our institution. Participants were asked to rate the importance of each data item in guiding clinical decisions during a RRT event response. There were 96 surveys completed (24.5% response rate) with fairly even distribution throughout all clinical roles on the RRT. Physiological data including heart rate, respiratory rate, and blood pressure were ranked by more than 80% of responders as being critical information. Resuscitation status was also considered critically useful by more than 85% of providers. There is a limited dataset that is considered important during an RRT. The data is widely available in EMR. The findings from this study could be used to improve user-centered EMR interfaces.

  1. Comparison of blade-strike modeling results with empirical data

    Energy Technology Data Exchange (ETDEWEB)

    Ploskey, Gene R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Carlson, Thomas J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2004-03-01

    This study is the initial stage of further investigation into the dynamics of injury to fish during passage through a turbine runner. As part of the study, Pacific Northwest National Laboratory (PNNL) estimated the probability of blade strike, and associated injury, as a function of fish length and turbine operating geometry at two adjacent turbines in Powerhouse 1 of Bonneville Dam. Units 5 and 6 had identical intakes, stay vanes, wicket gates, and draft tubes, but Unit 6 had a new runner and curved discharge ring to minimize gaps between the runner hub and blades and between the blade tips and discharge ring. We used a mathematical model to predict blade strike associated with two Kaplan turbines and compared results with empirical data from biological tests conducted in 1999 and 2000. Blade-strike models take into consideration the geometry of the turbine blades and discharges as well as fish length, orientation, and distribution along the runner. The first phase of this study included a sensitivity analysis to consider the effects of difference in geometry and operations between families of turbines on the strike probability response surface. The analysis revealed that the orientation of fish relative to the leading edge of a runner blade and the location that fish pass along the blade between the hub and blade tip are critical uncertainties in blade-strike models. Over a range of discharges, the average prediction of injury from blade strike was two to five times higher than average empirical estimates of visible injury from shear and mechanical devices. Empirical estimates of mortality may be better metrics for comparison to predicted injury rates than other injury measures for fish passing at mid-blade and blade-tip locations.

  2. Responsiveness of clinical tests for people with neck pain

    DEFF Research Database (Denmark)

    Jørgensen, René; Ris, Inge; Juhl, Carsten

    2017-01-01

    , positive and negative predictive values, in addition to positive and negative likelihood ratios were calculated. RESULTS: In total, 164 participants completed the 4 month follow up. One-hundred forty four participants were classified as unchanged whereas 20 patients were considered to be improved. Twenty...... with sensitivity ranging from 20 to 60%, and specificity from 54 to 86%. LR+ (0.8-2.07) and LR- (0.7-1.1) showed low diagnostic value for all variables, with PPV ranging from 12.1 to 26.1 and NPV ranging from 84.7 to 89.2. CONCLUSION: Responsiveness of the included clinical tests was generally low when using...... change in NDI score as the anchor from baseline to the 4-month follow up. Further investigations of responsiveness are warranted, possibly using other anchors, which to a higher degree resemble similar dimensions as the clinical tests....

  3. Lightning Strike in Pregnancy With Fetal Injury.

    Science.gov (United States)

    Galster, Kellen; Hodnick, Ryan; Berkeley, Ross P

    2016-06-01

    Injuries from lightning strikes are an infrequent occurrence, and are only rarely noted to involve pregnant victims. Only 13 cases of lightning strike in pregnancy have been previously described in the medical literature, along with 7 additional cases discovered within news media reports. This case report presents a novel case of lightning-associated injury in a patient in the third trimester of pregnancy, resulting in fetal ischemic brain injury and long-term morbidity, and reviews the mechanics of lightning strikes along with common injury patterns of which emergency providers should be aware. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  4. Expeditionary Strike Group: Command Structure Design Support

    National Research Council Canada - National Science Library

    Hutchins, Susan G; Kemple, William G; Kleinman, David L; Hocevar, Susan P

    2005-01-01

    An Expeditionary Strike Group (ESG) is a new capability mix that combines the combat power of three surface combatants and one submarine with an Amphibious Readiness Group/ Marine Expeditionary Unit...

  5. The Chicago Teachers Strike and Its Public

    Science.gov (United States)

    Shuffelton, Amy B.

    2014-01-01

    This article considers the 2012 Chicago Teachers Strike in light of John Dewey's "The Public and Its Problems." It engages Dewey's conceptualization of practical reason to challenge the educational reform movement's commitment to technocratic decision-making.

  6. Strikes in the public sector in Denmark

    DEFF Research Database (Denmark)

    Scheuer, Steen; Ibsen, Flemming; Høgedahl, Laust

    2016-01-01

    This article looks at strikes by employees in the public sector, discusses the theoretical background to these conflicts and shows – based on a case study of three strikes in the Danish public sector – how different union strategies lead to very different outcomes in terms of economic gains......, while public sector unions trying to move up the wage hierarchy cannot expect much help from fellow public sector unions, often quite the reverse....

  7. Physicians' Professionally Responsible Power: A Core Concept of Clinical Ethics.

    Science.gov (United States)

    McCullough, Laurence B

    2016-02-01

    The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power--the legitimation of physicians' power--a core concept of clinical ethics. In the absence of legitimation, the physician's power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians' power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Simulating Bird Strike on Aircraft Composite Wing Leading Edge.

    OpenAIRE

    Ericsson, Max

    2012-01-01

    In this master thesis project the possibility to model the response of a wing when subjected to bird strike using finite elements is analyzed. Since this transient event lasts only a few milliseconds the used solution method is explicit time integration. The wing is manufactured using carbon fiber laminate. Carbon fiber laminates have orthotropic material properties with different stiffness in different directions. Accordingly, there are damage mechanisms not considered when using metal that ...

  9. Management of patients during hunger strike and refeeding phase.

    Science.gov (United States)

    Eichelberger, M; Joray, M L; Perrig, M; Bodmer, M; Stanga, Z

    2014-01-01

    Hunger strikers resuming nutritional intake may develop a life-threatening refeeding syndrome (RFS). Consequently, hunger strikers represent a core challenge for the medical staff. The objective of the study was to test the effectiveness and safety of evidence-based recommendations for prevention and management of RFS during the refeeding phase. This was a retrospective, observational data analysis of 37 consecutive, unselected cases of prisoners on a hunger strike during a 5-y period. The sample consisted of 37 cases representing 33 individual patients. In seven cases (18.9%), the hunger strike was continued during the hospital stay, in 16 episodes (43.2%) cessation of the hunger strike occurred immediately after admission to the security ward, and in 14 episodes (37.9%) during hospital stay. In the refeed cases (n = 30), nutritional replenishment occurred orally, and in 25 (83.3%) micronutrients substitutions were made based on the recommendations. The gradual refeeding with fluid restriction occurred over 10 d. Uncomplicated dyselectrolytemia was documented in 12 cases (40%) within the refeeding phase. One case (3.3%) presented bilateral ankle edemas as a clinical manifestation of moderate RFS. Intensive medical treatment was not necessary and none of the patients died. Seven episodes of continued hunger strike were observed during the entire hospital stay without medical complications. Our data suggested that seriousness and rate of medical complications during the refeeding phase can be kept at a minimum in a hunger strike population. This study supported use of recommendations to optimize risk management and to improve treatment quality and patient safety in this vulnerable population. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Neural response imaging (NRI) cochlear mapping: prospects for clinical application.

    Science.gov (United States)

    Arnold, L; Lindsey, P; Hacking, C; Boyle, P

    2007-12-01

    The objective of the study was to investigate the potential for clinical application of neural response imaging (NRI) cochlear mapping. Cochlear mapping was performed at each fitting session up to at least six months following initial fitting. Stimulation was delivered to one electrode site. NRI was recorded from each of the remaining sites. The procedure was repeated for apical, medial and basal stimulation sites, stimulating at subjective threshold and most comfortable levels. Responses were obtained in five out of six subjects and are discussed in terms of: reproducibility, quality, changes over time. Cochlear mapping provided repeatable data that gave interesting insights into the implanted cochlea. Further work is required to determine whether this approach could contribute to programme optimisation. Copyright (c) 2007 John Wiley & Sons, Ltd.

  11. Shame, honor and responsibility in clinical dialog about lifestyle issues

    DEFF Research Database (Denmark)

    Guassora, A.D.; Reventlow, S.; Malterud, K.

    2014-01-01

    OBJECTIVE: To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. METHODS: We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. RESULTS: Patients...... presented themselves with an orientation toward responsibility in dialog about lifestyle. They described how they were taking care of themselves and doing their best. In this respect, they demonstrated their achievements as matters of honor. If one lifestyle issue was considered problematic, in some cases......: Negotiations of shame and honor, revolving around personal responsibility, are embedded in clinical discourse about lifestyle. Patients take a proactive role in presenting and defending the self against shame. PRACTICE IMPLICATIONS: GPs should pay more attention to the tacit role of shame in consultations...

  12. Women, transition and strikes in Serbia

    Directory of Open Access Journals (Sweden)

    Novaković Nada G.

    2014-01-01

    Full Text Available The author, in a sociological way, describes and analyzes the concepts of transition, privatization and strikes in Serbia, particularly the place of women in it. It examines the most important economic and social causes and consequences of these phenomena. The main hypothesis is: women's strikes in the Serbian transition are less efficient than strikes and public protests of women in the developed world and the second Yugoslavia. A strike is a class conflict, in which the workers are fighting for their social and economic rights, threatened by the capitalist class. Elites in government and state authorities protect the interests of big capital at the detriment of the interests of the majority of workers. Exploring women's strikes in transition reveals the nature of the social and political system. Their strikes in enterprises, the blocking of public spaces and public protests are systemic, ie. class determined. As the transition was very fast, the resistance of the strikers was inefficient, and the protests of women became an expression of desperation against the loss of jobs and basic resources for lifehood. In short, this research is about the main causes, the organizational forms and the consequences of strikes in which the majority were women. For this purpose, the author chose to describe an array of strikes in the industries and the companies where women are most employed. The choice of strikes in the economic sector is not accidental, but a consequence of the fact that the women there were the most vulnerable. Women in public institutions and companies had much higher financial and social position. They are less likely to strike and publicly protested. After 2000, these strikes were more successful than worker's strikes in textile, food processing, manufacturing and trade. Relationship between the government and the public towards them was tainted by self-interest and selective. The main criterion for the selection of companies and

  13. Clinical profile and response to oral prednisolone in infantile spasm.

    Science.gov (United States)

    Noureen, Nuzhat; Rana, Muhammad Tariq

    2010-03-01

    To evaluate the clinical profile and response to oral prednisolone in infantile spasms. Case series. Neurology Department, The Children Hospital and Institute of Child Health, Multan, from July 2005 to June 2007. Fifty patients of infantile spasms were studied. Age, gender, age at onset of seizures, type of spasms (flexor, extensor or mixed), history of intrapartum asphyxia, developmental history, dysmorphic facial features, any hypopigmented/ hyperpigmented skin lesions, computed tomogram and electroencephalogram findings and response to oral prednisolone was noted. Data was analyzed statistically by SPSS 10. Descriptive statistics was used to find out frequencies and percentages of all above mentioned variables. Chi-square test was applied to determine the association between these variables and response to treatment. P-value of less than 0.05 was taken significant. Male to female ratio was 2.1:1. Mean age of babies was 6.5+/-3.35 months. Mean age at onset of seizures was 5.35+/-3.52 months. Flexor spasms was seen in 32 (64%), extensor spasms in 8 (16%) and mixed spasms in 10 babies (20%). Symptomatic infantile spasms were noted in 48 (96%) babies while two babies (4%) were having cryptogenic infantile spasm. History of intrapartum asphyxia was noted in 54% of symptomatic cases. Favourable response to oral prednisolone was seen in 27 babies (54%). Except male gender, none of the other variable reached the statistical significance for favourable response to treatment. Infantile spasms were found more common in males, flexor spasms were the commonest type noted. Symptomatic spasm was noted in 96% of cases and intrapartum asphyxia was the commonest cause of symptomatic group. Response to oral prednisolone was noted in more than half of cases of infantile spasms.

  14. Active and recent strike-slip tectonics

    Science.gov (United States)

    Nur, Amos; Boccaletti, Mario

    An international workshop cosponsored by the Department of Geology, University of Florence, Italy and the Department of Geophysics, Stanford University, Stanford, Calif., was held in Florence, Italy, April 18-20, 1989,on the topic of active and recent strike-slip tectonics in the continental crust. Workshop participants from Turkey, Ethiopia, Israel, Greece, and various universities in Italy, Spain, West Germany, France, the United Kingdom, Brazil, and the United States reported on a broad range of studies involving strike-slip faulting in continental crustal setting. As it turned out, much of the work reported on involved aspects of strike-slip faulting that are only poorly understood, especially crustal deformation, which is distributed over a multiplicity of faults, or even fault domains.One of the rewarding aspects of this workshop was the diversity of geographic areas and geological settings covered by the reporters. The north and east Anatolian faults, the Dead Sea transform zone, western Turkey, north and central Greece, Malta, Sicily, southern Italy, the bethic Cordillera in southern Spain, Tunisia, Tibet and southwest China, offshore Brazil, Alaska, Nevada, and California. A recurring observation reported for all those areas was mixed mode faulting, i.e., the coterminous or sequential occurrence of strike-slip and normal faulting, or strike-slip and thrust, and in many instances also strikeslip, normal and thrust faulting in a single tectonic setting.

  15. Impact of genetic polymorphisms on clinical response to antithrombotics

    Directory of Open Access Journals (Sweden)

    Kena J Lanham

    2010-06-01

    Full Text Available Kena J Lanham1,2, Julie H Oestreich3, Steven P Dunn1,2, Steven R Steinhubl41Pharmacy Services, UK HealthCare, University of Kentucky, Lexington, Kentucky, USA; 2Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA; 3Department of Pharmacy Practice, College of Pharmacy, University of Nebraska, Omaha, Nebraska, USA; 4The Medicines Company, Zurich, Switzerland and The Geisinger Clinic, Danville, Pennsylvania, USAAbstract: Antithrombotic therapy, including anticoagulants as well as antiplatelet drugs, is an important component in the treatment of cardiovascular disease. Variability in response to such medications, of which pharmacogenetic response is a major source, can decrease or enhance the benefits expected. This review is a comprehensive assessment of the literature published to date on the effects of genetic polymorphisms on the actions of a variety of antithrombotic medications, including warfarin, clopidogrel, prasugrel, and aspirin. Literature evaluating surrogate markers in addition to the impact of pharmacogenetics on clinical outcomes has been reviewed. The results of the studies are conflicting as to what degree pharmacogenetics will affect medication management in cardiovascular disease. Additional research is necessary to discover, characterize, and prospectively evaluate genetic and non-genetic factors that impact antithrombotic treatment in order to maximize the effectiveness and limit the harmful effects of these valuable agents.Keywords: aspirin, warfarin, clopidogrel, prasugrel, pharmacogenetic, antithrombotic, antiplatelet

  16. Immune and clinical response to honeybee venom in beekeepers.

    Science.gov (United States)

    Matysiak, Jan; Matysiak, Joanna; Bręborowicz, Anna; Kycler, Zdzisława; Dereziński, Paweł; Kokot, Zenon J

    2016-01-01

    The aim of the study was to assess immune response to honeybee venom in relation to the degree of exposure, time after a sting and clinical symptoms. Fifty-four volunteers were divided into 2 groups: beekeepers and a control group. The serum levels of total IgE (tIgE), bee venom-specific IgE (venom sIgE), phospholipase A2-specific IgE (phospholipase A2 sIgE), tryptase and venom-specific IgG4 (venom sIgG4) were determined. In beekeepers, diagnostic tests were performed within 3 hours following a sting and were repeated after a minimum of 6 weeks from the last sting. In individuals from the control group, the tests were performed only once, without a sting. The tests showed significant differences in venom sIgE (beekeepers' median = 0.34 kUA/l, control group median = 0.29 kUA/l), baseline serum tryptase (beekeepers' median = 4.25 µg/l, control group median = 2.74 µg/l) and sIgG4 (beekeepers' median = 21.2 mgA/l, control group median = 0.14 mgA/l), confirming higher levels of the tested substances in the beekeepers than in the control group. A significant positive correlation was observed between phospholipase A2 sIgE concentration and severity of clinical symptoms after a sting in the group of beekeepers. It was also demonstrated that the clinical symptoms after a sting became less severe with increasing age of the beekeepers. The differences in the immune response to a bee sting between the beekeepers and individuals not exposed to bees were probably due to the high exposure of the beekeepers to honeybee venom allergens. This may suggest a different approach to the bee venom allergy diagnostic tests in this occupational group.

  17. Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2010-01-01

    Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

  18. Control of striking velocity by table tennis players.

    Science.gov (United States)

    Marinovic, Welber; Iizuka, Cristina Akiko; Freudenheim, Andrea Michele

    2004-12-01

    This study investigated how 7 skilled table tennis players controlled velocity of a forehand drive stroke when the ball's trajectory, velocity, and spin were modified. They hit a target in response to balls launched under four different conditions. The relative and absolute times used in the backswing phase showed no significant differences among conditions. When subjects hit fastballs, there was a significant change in the time required for them to reach the peak of velocity in the forward swing phase. In addition, players decreased the velocity of their strokes to hit fast-approaching balls. These results indicate that highly skilled table tennis players need to adjust the striking velocity and striking time (relative and absolute) required to reach the peak of velocity in the forward swing phase for these task modifications. Since they used slower movement velocities to hit faster-approaching balls, skilled table tennis players may override this speed-coupling process.

  19. ELMs, strike point jumps and SOL currents

    International Nuclear Information System (INIS)

    Solano, Emilia R.; Jachmich, S.; Villone, F.; Hawkes, N.; Guenther, K.; Korotkov, A.; Stamp, M.; Andrew, P.; Conboy, J.; Mattews, G.F.; Corre, Y.; Loarte, A.; Pitts, R.A.; Cenedese, A.; Kempenaars, M.; Bolzonella, T.; Rachlew, E.

    2005-01-01

    Plasma equilibria before and after ELMs in JET are investigated. ELMs could be associated with fragile equilibria and separatrix instabilities: previously closed field lines would open up, releasing plasma current and leading to the formation of a new, smaller separatrix. This model could explain experimental observations of sudden jumps and shifts in strike point positions. Novel instability mechanisms are discussed to explain the large transient jumps observed in the strike point position: positive X-point instability, due to positive toroidal current density at the X-point and diamagnetic instability, due to negative inboard toroidal current density. (author)

  20. Simulating the Risk of Bird Strikes

    NARCIS (Netherlands)

    Metz, I.C.; Ellerbroek, J.; Muhlhausen, Thorsten; Kügler, D.; Hoekstra, J.M.

    2017-01-01

    This paper presents a fast-time simulation environment for assessing the risk of bird strikes in aviation. An existing air traffic simulator was enhanced in order to simulate air and bird traffic simultaneously and to recognize collisions between birds and aircraft. Furthermore, a method was

  1. The Front Line: No Strikes, Just Balls.

    Science.gov (United States)

    Unks, Gerald

    1979-01-01

    Recent actions of British teachers suggest an alternative to the teacher strike. Those teachers dramatically demonstrated their grievances by withholding the voluntary extra services they customarily perform. American teachers could accomplish the same end by collectively refusing to perform extraneous administrative services: collecting money,…

  2. When Lightning Strikes a Second Time

    Science.gov (United States)

    Allen, Kent

    2017-01-01

    The chances of lightning striking twice are infinitesimal, at best. What are the odds, in middle age, of being struck with a jarring bolt of figurative lightning, then a few months later being an eyewitness as the same sizzle in the sky jolts a group of students--those decision-makers of tomorrow? The author describes two experiences that proved…

  3. Impact of lightning strikes on hospital functions.

    Science.gov (United States)

    Mortelmans, Luc J M; Van Springel, Gert L J; Van Boxstael, Sam; Herrijgers, Jan; Hoflacks, Stefaan

    2009-01-01

    Two regional hospitals were struck by lightning during a one-month period. The first hospital, which had 236 beds, suffered a direct strike to the building. This resulted in a direct spread of the power peak and temporary failure of the standard power supply. The principle problems, after restoring standard power supply, were with the fire alarm system and peripheral network connections in the digital radiology systems. No direct impact on the hardware could be found. Restarting the servers resolved all problems. The second hospital, which had 436 beds, had a lightning strike on the premises and mainly experienced problems due to induction. All affected installations had a cable connection from outside in one way or another. The power supplies never were endangered. The main problem was the failure of different communication systems (telephone, radio, intercom, fire alarm system). Also, the electronic entrance control went out. During the days after the lightening strike, multiple software problems became apparent, as well as failures of the network connections controlling the technical support systems. There are very few ways to prepare for induction problems. The use of fiber-optic networks can limit damage. To the knowledge of the authors, these are the first cases of lightning striking hospitals in medical literature.

  4. Roles and responsibilities of clinical ethics committees in priority setting.

    Science.gov (United States)

    Magelssen, Morten; Miljeteig, Ingrid; Pedersen, Reidar; Førde, Reidun

    2017-12-01

    Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees (CECs) be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Descriptions of activities involving priority setting in annual reports from Norwegian CECs (2003-2015) were studied and categorized through qualitative content analysis. Three hundred thirty-nine reports from 38 CECs were studied. We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs' work further. The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests.

  5. [Management of the hunger strike in prison].

    Science.gov (United States)

    Fayeulle, Stéphanie; Renou, Frédéric; Protais, Emmanuel; Hédouin, Valéry; Wartel, Guillaume; Yvin, Jean-Luc

    2010-10-01

    Entering prison can feed pre-existent behavior of demands or generate them. Several means of expression are then used. Hunger strike is an average privileged act. It belongs to prison culture. Estimate how practitioners working in prison take care of the hunger strikers. The study, realised in 2008, was led with all the Units of Consultations and Ambulatory Care in France. It is a declarative investigation where a medical testimony by unit was asked. From 174 "maisons d'arrêt" and establishments for punishment in France, 95 answers were obtained. This situation was already seen by 98,8% of the doctors. The motives for hunger strike were mainly judicial for "maisons d'arrêt" (70,1%) and prison motives for detention centers (68,7%). Mainly, doctors opted for a neutral attitude (63% of the cases). The hunger strikes were mostly brief (less than a week in 85% of the cases). Only 5,5% of the doctors proposed written information concerning the risks incurred during a fast. A doctor in 4 approximately (23%) was already witness to complications due to fasting. The fact that a patient may refuse care makes the medical approach difficult. Faced with such a situation, 45% of the doctors privileged their duty of care, 28% respected the patient's wishes, and 27% did not pronounce. From a therapeutic point of view, the place of treatment using vitamins was rarely recognized (32,7%). Hunger strike is rarely severe, but it is rather frequent in prison so that every doctor working there will be confronted with it. The refeeding syndrome seems often ignored. The coverage of hunger strike is governed by the law, but ethical questions stay in the appreciation of every doctor. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  6. Response to treatment of myasthenia gravis according to clinical subtype.

    Science.gov (United States)

    Akaishi, Tetsuya; Suzuki, Yasushi; Imai, Tomihiro; Tsuda, Emiko; Minami, Naoya; Nagane, Yuriko; Uzawa, Akiyuki; Kawaguchi, Naoki; Masuda, Masayuki; Konno, Shingo; Suzuki, Hidekazu; Murai, Hiroyuki; Aoki, Masashi; Utsugisawa, Kimiaki

    2016-11-17

    thymoma-associated MG and AChR-Ab-positive MG without thymic abnormalities; by contrast, those classified as AChR-Ab-negative MG showed the worst early-stage response to treatment and stability of improved status. Differences were seen between the five subtypes in demographic characteristics, clinical severity, and therapeutic response. Our five-subtype classification approach would be beneficial not only to elucidate disease subtypes, but also to plan treatment strategies for individual MG patients.

  7. Gait Retraining From Rearfoot Strike to Forefoot Strike does not change Running Economy.

    Science.gov (United States)

    Roper, Jenevieve Lynn; Doerfler, Deborah; Kravitz, Len; Dufek, Janet S; Mermier, Christine

    2017-12-01

    Gait retraining is a method for management of patellofemoral pain, which is a common ailment among recreational runners. The present study investigated the effects of gait retraining from rearfoot strike to forefoot strike on running economy, heart rate, and respiratory exchange ratio immediately post-retraining and one-month post-retraining in recreational runners with patellofemoral pain. Knee pain was also measured. Sixteen participants (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. A 10-minute treadmill RE test was performed by all subjects. The experimental group performed eight gait retraining running sessions where foot strike pattern was switched from rearfoot strike to forefoot strike, while the control group received no intervention. There were no significant differences for running economy (p=0.26), respiratory exchange ratio (p=0.258), or heart rate (p=0.248) between the groups. Knee pain reported on a visual analog scale was also significantly reduced (p<0.05) as a result of retraining. The present study demonstrates that retraining from rearfoot strike to forefoot strike did not affect running economy up to one-month post-retraining while reducing running-related patellofemoral pain. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Striking dynamics and kinetic properties of boxing and MMA gloves

    Directory of Open Access Journals (Sweden)

    Benjamin Lee

    2014-08-01

    Full Text Available With the growing popularity of Mixed Martial Arts (MMA as a competitive sport, questions regarding the dynamic response and properties of MMA gloves arise. High-energy impacts from punches are very similar to boxing yet MMA competition requires the use of 4 oz fingerless glove, compared to the larger full enclosure boxing glove. This work assessed the kinetic properties and strike dynamics of MMA gloves and compared findings with traditional boxing gloves. Gloves mounted on a molded fist were impacted repetitively on an instrumental anvil designed for impact, over a 5 hour period resulting in 10,000 continuous and consistent strikes. Kinetic data from impacts were sampled at the beginning of the data collection and subsequently every 30 minutes (every 1,000 strikes. MMA gloves produced 4-5 times greater peak force and 5 times faster load rate compared to the boxing glove. However, MMA gloves also showed signs of material fatigue, with peak force increasing by 35% and rate of loading increasing by 60% over the duration of the test. Boxing glove characteristics did deteriorate but to a lesser extent. In summary, the kinetic properties of MMA glove differed substantially from the boxing glove resulting in impacts characterized by higher peak forces and more rapid development of force. Material properties including stiffness and thickness play a role in the kinetic characteristics upon impact, and can be inferred to alter injury mechanisms of blunt force trauma.

  9. Refractory myasthenia gravis - clinical profile, comorbidities and response to rituximab.

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27-53 years. In our study 25 patients (32.89%) belonged to the age group of 21-30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA 1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% ( p =3.3x10 -8 ) to 94.6% ( p =2.2x10 -14 ) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA 1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low.

  10. Improving work conditions through strike: Examination of nurses' attitudes through perceptions of two physician strikes in Israel.

    Science.gov (United States)

    Gafni-Lachter, Liat; Admi, Hanna; Eilon, Yael; Lachter, Jesse

    2017-01-01

    Strikes are means to influence policies related to working conditions, yet raise ethical dilemmas for healthcare workers. Nurse strikes have become more prominent around the world. To assess the change in Israeli nurses' attitudes towards strikes in light of two physician strikes that have preceded a nursing strike. An anonymous survey was administered once in 2000 (N = 106) and again in 2011 (n = 175) following 110 days of a physician strike, to assess nurses' attitudes towards the strike and resulting ethical issues. A statistically significant change (p working conditions related to professional and public health agendas.

  11. Stress distribution of metatarsals during forefoot strike versus rearfoot strike: A finite element study.

    Science.gov (United States)

    Li, Shudong; Zhang, Yan; Gu, Yaodong; Ren, James

    2017-12-01

    Due to the limitations of experimental approaches, comparison of the internal deformation and stresses of the human man foot between forefoot and rearfoot landing is not fully established. The objective of this work is to develop an effective FE modelling approach to comparatively study the stresses and energy in the foot during forefoot strike (FS) and rearfoot strike (RS). The stress level and rate of stress increase in the Metatarsals are established and the injury risk between these two landing styles is evaluated and discussed. A detailed subject specific FE foot model is developed and validated. A hexahedral dominated meshing scheme was applied on the surface of the foot bones and skin. An explicit solver (Abaqus/Explicit) was used to stimulate the transient landing process. The deformation and internal energy of the foot and stresses in the metatarsals are comparatively investigated. The results for forefoot strike tests showed an overall higher average stress level in the metatarsals during the entire landing cycle than that for rearfoot strike. The increase rate of the metatarsal stress from the 0.5 body weight (BW) to 2 BW load point is 30.76% for forefoot strike and 21.39% for rearfoot strike. The maximum rate of stress increase among the five metatarsals is observed on the 1st metatarsal in both landing modes. The results indicate that high stress level during forefoot landing phase may increase potential of metatarsal injuries. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Autophagy in the immune response to tuberculosis: clinical perspectives.

    LENUS (Irish Health Repository)

    Ní Cheallaigh, C

    2011-06-01

    A growing body of evidence points to autophagy as an essential component in the immune response to tuberculosis. Autophagy is a direct mechanism of killing intracellular Mycobacterium tuberculosis and also acts as a modulator of proinflammatory cytokine secretion. In addition, autophagy plays a key role in antigen processing and presentation. Autophagy is modulated by cytokines; it is stimulated by T helper type 1 (Th1) cytokines such as tumour necrosis factor (TNF)-α and interferon (IFN)-γ, and is inhibited by the Th2 cytokines interleukin (IL)-4 and IL-13 and the anti-inflammatory cytokine IL-10. Vitamin D, via cathelicidin, can also induce autophagy, as can Toll-like receptor (TLR)-mediated signals. Autophagy-promoting agents, administered either locally to the lungs or systemically, could have a clinical application as adjunctive treatment of drug-resistant and drug-sensitive tuberculosis. Moreover, vaccines which effectively induce autophagy could be more successful in preventing acquisition or reactivation of latent tuberculosis.

  13. A numerical model for bird strike on sidewall structure of an aircraft nose

    OpenAIRE

    Liu, Jun; Li, Yulong; Gao, Xiaosheng; Yu, Xiancheng

    2014-01-01

    In order to examine the potential of using the coupled smooth particles hydrodynamic (SPH) and finite element (FE) method to predict the dynamic responses of aircraft structures in bird strike events, bird-strike tests on the sidewall structure of an aircraft nose are carried out and numerically simulated. The bird is modeled with SPH and described by the Murnaghan equation of state, while the structure is modeled with finite elements. A coupled SPH–FE method is developed to simulate the bird...

  14. Traumatic neuralgia from pressure-point strikes in the martial arts: results from a retrospective online survey.

    Science.gov (United States)

    Kelly, Michael D

    2008-06-01

    Many techniques in Asian martial arts hand-to-hand combat systems emphasize hitting or striking specific sites on the body that correlate with exposed portions of peripheral nerves. To evaluate the prevalence and clinical effects of this unique sports-related injury. An anonymous self-administered retrospective 20-question electronic survey was posted on a high-traffic martial arts Web site. Primary outcome measures were demographic and medical history data, including martial arts experience and neuropathic symptoms associated with injury from this form of combat. Risk of symptoms was calculated by dividing the number of individuals with symptoms in each pressure-point area by the number of individuals who were struck in these areas during martial arts training. Of the 651 survey responses received, 605 met inclusion criteria. Neuropathic symptoms were reported by 291 subjects. Most symptoms occurred in individuals aged between 20 and 30 years as well as in individuals with less than 1 year of martial arts training. The majority of respondents with neuropathic symptoms reported a symptom duration of less than 1 year (207 [71%]). Individuals with more than 5 years of combat training experience had a greater risk of chronic symptoms than individuals with less experience. Strikes to pressure points on the back had the greatest risk of inducing neuropathic symptoms. Symptoms of neurapraxia can occur in individuals as a result of practicing martial arts involving strikes on pressure points. Although the majority of symptoms resolve within 1 year, individuals with prolonged exposure to pressure-point strikes may be more likely to have chronic symptoms.

  15. PSpice Model of Lightning Strike to a Steel Reinforced Structure

    International Nuclear Information System (INIS)

    Koone, Neil; Condren, Brian

    2003-01-01

    Surges and arcs from lightning can pose hazards to personnel and sensitive equipment, and processes. Steel reinforcement in structures can act as a Faraday cage mitigating lightning effects. Knowing a structure's response to a lightning strike allows hazards associated with lightning to be analyzed. A model of lightning's response in a steel reinforced structure has been developed using PSpice (a commercial circuit simulation). Segments of rebar are modeled as inductors and resistors in series. A program has been written to take architectural information of a steel reinforced structure and 'build' a circuit network that is analogous to the network of reinforcement in a facility. A severe current waveform (simulating a 99th percentile lightning strike), modeled as a current source, is introduced in the circuit network, and potential differences within the structure are determined using PSpice. A visual three-dimensional model of the facility displays the voltage distribution across the structure using color to indicate the potential difference relative to the floor. Clear air arcing distances can be calculated from the voltage distribution using a conservative value for the dielectric breakdown strength of air. Potential validation tests for the model will be presented

  16. Analysis of Simulated Aircraft Lightning Strikes and Their Electromagnetic Effects

    National Research Council Canada - National Science Library

    Gruden, James

    2001-01-01

    To survive the intense electromagnetic fields associated with a lightning strike, proper design of aircraft electrical control systems requires knowledge of the transient current pulse associated with a lightning strike...

  17. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...... in clinical departments and the leadership skills of clinical consultants responsible for education....

  18. Strike-slip tectonics during rift linkage

    Science.gov (United States)

    Pagli, C.; Yun, S. H.; Ebinger, C.; Keir, D.; Wang, H.

    2017-12-01

    The kinematics of triple junction linkage and the initiation of transforms in magmatic rifts remain debated. Strain patterns from the Afar triple junction provide tests of current models of how rifts grow to link in area of incipient oceanic spreading. Here we present a combined analysis of seismicity, InSAR and GPS derived strain rate maps to reveal that the plate boundary deformation in Afar is accommodated primarily by extensional tectonics in the Red Sea and Gulf of Aden rifts, and does not require large rotations about vertical axes (bookshelf faulting). Additionally, models of stress changes and seismicity induced by recent dykes in one sector of the Afar triple junction provide poor fit to the observed strike-slip earthquakes. Instead we explain these patterns as rift-perpendicular shearing at the tips of spreading rifts where extensional strains terminate against less stretched lithosphere. Our results demonstrate that rift-perpendicular strike-slip faulting between rift segments achieves plate boundary linkage during incipient seafloor spreading.

  19. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments.

    Science.gov (United States)

    Malling, Bente; Mortensen, Lene S; Scherpbier, Albert J J; Ringsted, Charlotte

    2010-09-21

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate in clinical departments and the leadership skills of clinical consultants responsible for education. The study was a trans-sectional correlation study. The educational climate was investigated by a survey among all doctors (specialists and trainees) in the departments. Leadership skills of the consultants responsible for education were measured by multi-source feedback scores from heads of departments, peer consultants, and trainees. Doctors from 42 clinical departments representing 21 specialties participated. The response rate of the educational climate investigation was moderate 52% (420/811), Response rate was high in the multisource-feedback process 84.3% (420/498). The educational climate was scored quite high mean 3.9 (SD 0.3) on a five-point Likert scale. Likewise the leadership skills of the clinical consultants responsible for education were considered good, mean 5.4 (SD 0.6) on a seven-point Likert scale. There was no significant correlation between the scores concerning the educational climate and the scores on leadership skills, r = 0.17 (p = 0.29). This study found no relation between the educational climate and the leadership skills of the clinical consultants responsible for postgraduate medical education in clinical departments with the instruments used. Our results indicate that consultants responsible for education are in a weak position to influence the educational climate in the clinical department. Further studies are needed to explore, how heads of departments and other factors related to the clinical organisation could influence the educational climate.

  20. Bird strike incidence at Addis Ababa Bole International Airport ...

    African Journals Online (AJOL)

    The time and rate of bird strike incidences, species composition and number of birds involved in strikes, and the behaviour of birds were recorded at Bole International Airport from December 1994 to December 1995. The gut contents of the birds struck by aircraft were analyzed. A total of 33 bird strikes were recorded during ...

  1. Evaluating the Effects of a Bird Strike Advisory System

    NARCIS (Netherlands)

    Metz, I.C.; Mühlhausen, T; Ellerbroek, J.; Hoekstra, J.M.

    2016-01-01

    Bird strikes have operational impacts and cause economic loss to the aviation industry. In the worst case, the damages resulting from bird strikes lead to crashes. The highest risk for bird strikes lies in the area below 3000 ft and thus mainly in airport environments. Despite intense efforts from

  2. effects of strike cost on economic development in nigeria

    African Journals Online (AJOL)

    USER

    productivity as in most cases strike cost (wages and salaries as well as other unavoidable payments) are paid during the .... Many times the Nigeria Labour Congress (NLC) and students have had to strike against ... the direct compensation package and other conditions of service. This is the most popular cause of strike in ...

  3. Gender differences in the neural response to acupuncture: Clinical implications

    NARCIS (Netherlands)

    Yeo, S.; Rosen, B.; Bosch, M.P.C.; Noort, M.W.M.L. van den; Lim, S.

    2016-01-01

    Objective: To examine gender differences and similarities in the psychophysical and brain responses to acupuncture at GB34, a point that is frequently used to treat motor function issues in Traditional Chinese Medicine. Methods: Functional MRI (fMRI) was used to measure brain activation in response

  4. Manipulation of the metabolic response in clinical practice

    DEFF Research Database (Denmark)

    Kehlet, H

    2000-01-01

    morbidity. Effective afferent neural blockade with continuous epidural local anesthetic techniques inhibits a major part of the endocrine metabolic response, leading to improved protein economy but without important effects on inflammatory or immunologic responses. In contrast, pain treatment with other...... modalities such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids has only a small inhibitory effect on endocrine metabolic responses. Preoperative high-dose glucocorticoid therapy provides additional pain relief and improves pulmonary function, but it reduces the inflammatory response (acute....... The effect of these techniques to alter endocrine metabolic and inflammatory responses during severe surgical illness has not been established. Neural blockade and minimally invasive surgery have improved outcome following elective surgery, especially when integrated into a multimodal postoperative...

  5. Clinical Response To Pericardiectomy At UNTH, Enugu Nigeria ...

    African Journals Online (AJOL)

    ; diagnostic and prognostic investigations conducted were extracted from the case ... The clinical features noted were mainly of shortness of breath, abdominal, facial and feet swelling, ascites, low pulse pressure and tender hepatomegaly.

  6. Forward to the Past: Strikes and Striking as Dialogue by other ...

    African Journals Online (AJOL)

    In Nigeria, from the colonial period to the present, the employment of strikes and protests by nationalists, Nigerian workers and civil society groups has been established as one of the potent means of conveying viewpoints, positions as well as the demand for equality, fairness, social justice and reforms. It has been used as ...

  7. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  8. The placebo response: neurobiological and clinical issues of neurological relevance.

    Science.gov (United States)

    Pollo, Antonella; Benedetti, Fabrizio

    2009-01-01

    The recent upsurge in placebo research has demonstrated the sound neurobiological substrate of a phenomenon once believed to be only patient mystification, or at best a variable to control in clinical trials, bringing about a new awareness of its potential exploitation to the patient's benefit and framing it as a positive context effect, with the power to influence the therapy outcome. Placebo effects have been described both in the experimental setting and in different clinical conditions, many of which are of neurological interest. Multiple mechanisms have been described, namely conditioning and cognitive factors like expectation, desire, and reward. A body of evidence from neurochemical, pharmacological, and neuroimaging studies points to the involvement of neural pathways specific to single conditions, such as the activation of the endogenous antinociceptive system during placebo analgesia or the release of dopamine in the striatum of parkinsonian patients experiencing placebo reduction of motor impairment. The possible clinical applications of placebo studies range from the design of clinical trials incorporating specific recommendations and minimizing the use of placebo arms to the optimization of the context surrounding the patient, in order to maximize the placebo component present in any treatment.

  9. Migraine strikes as neuronal excitability reaches a tipping point.

    Directory of Open Access Journals (Sweden)

    Marten Scheffer

    Full Text Available Self-propagating waves of cerebral neuronal firing, known as spreading depolarisations, are believed to be at the roots of migraine attacks. We propose that the start of spreading depolarisations corresponds to a critical transition that occurs when dynamic brain networks approach a tipping point. We show that this hypothesis is consistent with current pathogenetic insights and observed dynamics. Our view implies that migraine strikes when modulating factors further raise the neuronal excitability in genetically predisposed subjects to a level where even minor perturbations can trigger spreading depolarisations. A corollary is that recently discovered generic early warning indicators for critical transitions may be used to predict the onset of migraine attacks even before patients are clinically aware. This opens up new avenues for dissecting the mechanisms for the onset of migraine attacks and for identifying novel prophylactic treatment targets for the prevention of attacks.

  10. The therapeutic effect of clinical trials: understanding placebo response rates in clinical trials – A secondary analysis

    Directory of Open Access Journals (Sweden)

    Walach Harald

    2005-08-01

    Full Text Available Abstract Background and purpose Placebo response rates in clinical trials vary considerably and are observed frequently. For new drugs it can be difficult to prove effectiveness superior to placebo. It is unclear what contributes to improvement in the placebo groups. We wanted to clarify, what elements of clinical trials determine placebo variability. Methods We analysed a representative sample of 141 published long-term trials (randomized, double-blind, placebo-controlled; duration > 12 weeks to find out what study characteristics predict placebo response rates in various diseases. Correlational and regression analyses with study characteristics and placebo response rates were carried out. Results We found a high and significant correlation between placebo and treatment response rate across diseases (r = .78; p Conclusion Medication response rates and placebo response rates in clinical trials are highly correlated. Trial characteristics can explain some portion of the variance in placebo healing rates in RCTs. Placebo response in trials is only partially due to methodological artefacts and only partially dependent on the diagnoses treated.

  11. Immune and clinical response to honeybee venom in beekeepers

    Directory of Open Access Journals (Sweden)

    Jan Matysiak

    2016-03-01

    The differences in the immune response to a bee sting between the beekeepers and individuals not exposed to bees were probably due to the high exposure of the beekeepers to honeybee venom allergens. This may suggest a different approach to the bee venom allergy diagnostic tests in this occupational group.

  12. Public health response to striking solid waste management.

    Science.gov (United States)

    Murti, Michelle; Ayre, Reg; Shapiro, Howard; de Burger, Ron

    2011-10-01

    In 2009, the City of Toronto, Ontario, Canada, experienced a six-week labor disruption involving 24,000 city workers that included solid waste and public health employees. In an attempt to control illegal dumping and to manage garbage storage across the city during this period, 24 temporary garbage storage sites were established by the city (mostly in local parks) for residents to dispose of their household waste. No other municipality in North America has attempted to operate this many temporary sites for this long a period. Management and nonunion staff from Healthy Environments in Toronto Public Health performed daily inspections, responded to community questions, issued public health orders, and worked closely with Solid Waste Management and the Ministry of the Environment to actively manage the public health concerns associated with these sites. This intensive oversight mitigated public health risks to the community and facilitated an effective, safe solution to the temporary garbage storage problem.

  13. Geological Effects on Lightning Strike Distributions

    KAUST Repository

    Berdahl, J. Scott

    2016-05-16

    Recent advances in lightning detection networks allow for detailed mapping of lightning flash locations. Longstanding rumors of geological influence on cloud-to-ground (CG) lightning distribution and recent commercial claims based on such influence can now be tested empirically. If present, such influence could represent a new, cheap and efficient geophysical tool with applications in mineral, hydrothermal and oil exploration, regional geological mapping, and infrastructure planning. This project applies statistical analysis to lightning data collected by the United States National Lightning Detection Network from 2006 through 2015 in order to assess whether the huge range in electrical conductivities of geological materials plays a role in the spatial distribution of CG lightning. CG flash densities are mapped for twelve areas in the contiguous United States and compared to elevation and geology, as well as to the locations of faults, railroads and tall towers including wind turbines. Overall spatial randomness is assessed, along with spatial correlation of attributes. Negative and positive polarity lightning are considered separately and together. Topography and tower locations show a strong influence on CG distribution patterns. Geology, faults and railroads do not. This suggests that ground conductivity is not an important factor in determining lightning strike location on scales larger than current flash location accuracies, which are generally several hundred meters. Once a lightning channel is established, however, ground properties at the contact point may play a role in determining properties of the subsequent stroke.

  14. Collective bargaining and strikes among physicians.

    Science.gov (United States)

    Keith, S N

    1984-11-01

    UNLIKE EMPLOYEES IN OTHER SECTORS OF THE ECONOMY, HEALTH CARE WORKERS ARE DIRECTED TOWARD ONE ULTIMATE GOAL: making people well and keeping them healthy. The development of collective bargaining and union activities during this century has had a great impact on all industries in the United States and the western world. However, only in recent years have workers in the health care sector been affected by the organized labor movement. The history of collective bargaining and strikes among physicians, the key decision-makers in the health care sector, is even more recent. Because of their central position, physicians' collective activity has had and will continue to have tremendous implications for the viability of the present health care system and the quality of patient care. Even though most physicians continue to function as individual, entrepreneurial service providers and "professionals," physicians as a group are more frequently being seen as members of a utility like industry. Their importance to individuals and society as a whole, it can be argued, is second to none; if physicians refuse to work there can be no worse set of outcomes. To estimate the potential future impact of growing collective action on the part of physicians, this article explores the general historical developments.

  15. Clinical utility and validity of minoxidil response testing in androgenetic alopecia.

    Science.gov (United States)

    Goren, Andy; Shapiro, Jerry; Roberts, Janet; McCoy, John; Desai, Nisha; Zarrab, Zoulikha; Pietrzak, Aldona; Lotti, Torello

    2015-01-01

    Clinical response to 5% topical minoxidil for the treatment of androgenetic alopecia (AGA) is typically observed after 3-6 months. Approximately 40% of patients will regrow hair. Given the prolonged treatment time required to elicit a response, a diagnostic test for ruling out nonresponders would have significant clinical utility. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. The aim of this study was to assess the clinical utility and validity of minoxidil response testing. In this communication, the present authors conducted an analysis of completed and ongoing studies of minoxidil response testing. The analysis confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA. © 2014 Wiley Periodicals, Inc.

  16. Concussion in professional football: biomechanics of the striking player--part 8.

    Science.gov (United States)

    Viano, David C; Pellman, Elliot J

    2005-02-01

    Concussive impacts in professional football were simulated in laboratory tests to determine the collision mechanics resulting in injury to the struck player and the biomechanics of the striking players, who were not concussed or neck-injured in the tackle. Twenty-seven helmet-to-helmet collisions were reconstructed in laboratory tests using Hybrid III dummies. The head impact velocity, direction, and kinematics matched game video. Translational and rotational head accelerations and six-axis upper neck loads and moments were used to evaluate how the striking player delivered the concussive blow. The neck injury criterion, Nij, was calculated to assess neck injury risks in the striking player. The time-averaged impact force reached 6372 +/- 2486 N at 7.2 milliseconds because of 46.8 +/- 21.7 g head acceleration and 3624 +/- 1729 N neck compression force in the striking player. Fifty-seven percent of the load was contributed by neck compression. The striking players had their heads down and lined up the impact axis through their necks and torsos. This allowed momentum transfer with minimal neck bending and increased the effective mass of the striking player to 1.67 times that of the struck player at peak load. The impact caused 94.3 +/- 27.5 g head acceleration in the concussed players and 67.9 +/- 14.5 g without concussion (t = 2.06, df = 25, P = 0.025). The striking player's Nij was greater than tolerance in 9 of 27 cases by exceeding the 4000 N neck compression limit. For these cases, the average neck compression force was 6631 +/- 977 N (range, 5210-8194 N). Nij was 1.25 +/- 0.16 for eight cases above the tolerance Nij = 1.0. In the NFL, striking players line up their heads, necks, and torsos to deliver maximum force to the other player in helmet-to-helmet impacts. The concussive force is from acceleration of the striking player's head and torso load through the neck. Even though neck responses exceeded tolerances, no striking player experienced neck injury or

  17. Children on hunger strike: child abuse or legitimate protest?

    Science.gov (United States)

    Mok, A.; Nelson, E. A.; Murphy, J.; Hampson, A.; Hendriks, J. H.

    1996-01-01

    The issue of children on hunger strike (voluntary total fasting) has not been reported before. The World Medical Association Declaration of Tokyo 1975 and the Declaration of Malta 1991 (revised 1992) provide clinicians with guidelines for the management of adult patients on hunger strike but do not mention children. We report the management of 14 Vietnamese children, aged 1 to 12 years, who took part in a hunger strike at a refugee detention centre in Hong Kong. PMID:8597690

  18. Children on hunger strike: child abuse or legitimate protest?

    OpenAIRE

    Mok, A.; Nelson, E. A.; Murphy, J.; Hampson, A.; Hendriks, J. H.

    1996-01-01

    The issue of children on hunger strike (voluntary total fasting) has not been reported before. The World Medical Association Declaration of Tokyo 1975 and the Declaration of Malta 1991 (revised 1992) provide clinicians with guidelines for the management of adult patients on hunger strike but do not mention children. We report the management of 14 Vietnamese children, aged 1 to 12 years, who took part in a hunger strike at a refugee detention centre in Hong Kong.

  19. The effect of hand dominance on martial arts strikes.

    Science.gov (United States)

    Neto, Osmar Pinto; Silva, Jansen Henrique; Marzullo, Ana Carolina de Miranda; Bolander, Richard P; Bir, Cynthia A

    2012-08-01

    The main goal of this study was to compare dominant and non-dominant martial arts palm strikes under different circumstances that usually happen during martial arts and combative sports applications. Seven highly experienced (10±5 years) right hand dominant Kung Fu practitioners performed strikes with both hands, stances with left or right lead legs, and with the possibility or not of stepping towards the target (moving stance). Peak force was greater for the dominant hand strikes (1593.76±703.45 N vs. 1042.28±374.16 N; p<.001), whereas no difference was found in accuracy between the hands (p=.141). Additionally, peak force was greater for the strikes with moving stance (1448.75±686.01 N vs. 1201.80±547.98 N; p=.002) and left lead leg stance (1378.06±705.48 N vs. 1269.96±547.08 N). Furthermore, the difference in peak force between strikes with moving and stationary stances was statistically significant only for the strikes performed with a left lead leg stance (p=.007). Hand speed was higher for the dominant hand strikes (5.82±1.08 m/s vs. 5.24±0.78 m/s; p=.001) and for the strikes with moving stance (5.79±1.01 m/s vs. 5.29±0.90 m/s; p<.001). The difference in hand speed between right and left hand strikes was only significant for strikes with moving stance. In summary, our results suggest that the stronger palm strike for a right-handed practitioner is a right hand strike on a left lead leg stance moving towards the target. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. [Application of three compartment model and response surface model to clinical anesthesia using Microsoft Excel].

    Science.gov (United States)

    Abe, Eiji; Abe, Mari

    2011-08-01

    With the spread of total intravenous anesthesia, clinical pharmacology has become more important. We report Microsoft Excel file applying three compartment model and response surface model to clinical anesthesia. On the Microsoft Excel sheet, propofol, remifentanil and fentanyl effect-site concentrations are predicted (three compartment model), and probabilities of no response to prodding, shaking, surrogates of painful stimuli and laryngoscopy are calculated using predicted effect-site drug concentration. Time-dependent changes in these calculated values are shown graphically. Recent development in anesthetic drug interaction studies are remarkable, and its application to clinical anesthesia with this Excel file is simple and helpful for clinical anesthesia.

  1. Bird/Wildlife Strike Control for Safer Air Transportation in Nigeria ...

    African Journals Online (AJOL)

    Kites and hawks were found to be responsible for 57% of reported strikes. Several factors including lack of adequate data, shortage of funds, inadequate training of staff and lack of public awareness about bird/wildlife hazard were found to be militating against effective control in Nigeria. The paper concludes by making ...

  2. Strong Algerian Earthquake Strikes Near Capital City

    Science.gov (United States)

    Ayadi, A.; Maouche, S.; Harbi, A.; Meghraoui, M.; Beldjoudi, H.; Oussadou, F.; Mahsas, A.; Benouar, D.; Heddar, A.; Rouchiche, Y.; Kherroubi, A.; Frogneux, M.; Lammali, K.; Benhamouda, F.; Sebaï, A.; Bourouis, S.; Alasset, P. J.; Aoudia, A.; Cakir, Z.; Merahi, M.; Nouar, O.; Yelles, A.; Bellik, A.; Briole, P.; Charade, O.; Thouvenot, F.; Semane, F.; Ferkoul, A.; Deramchi, A.; Haned, S. A.

    On 21 May 2003, a damaging earthquake of Mw 6.8 struck the region of Boumerdes 40 km east of Algiers in northern Algeria (Figure 1). The mainshock, which lasted ~ 36-40 s, had devastating effects and claimed about 2300 victims, caused more than 11,450 injuries, and left about 200,000 people homeless. It destroyed and seriously damaged around 180,000 housing units and 6000 public buildings with losses estimated at $5 billion. The mainshock was widely felt within a radius of ~ 400 km in Algeria. To the north, the earthquake was felt in southeastern Spain, including the Balearic Islands, and also in Sardinia and in southern France. The mainshock location, which was calculated at 36.91°N, 3.58°E (15 km offshore of Zemmouri; Figure 1), and the local magnitude (Md 6.4) are from seismic records of local stations. International seismological centers obtained Mw 6.8 (NEIC) with a thrust focal mechanism solution and 1.83 × 1026 dyne.cm for the seismic moment. A sequence of aftershocks affected the epicentral area with two strong shocks reaching Mw 5.8 on 27 and 29 May 2003. Field investigations allowed us to assign a maximum intensity X (European Macroseismic Scale 98) and to report rockfalls, minor surface cracks, and liquefaction phenomena. The mainshock was not associated with inland surface faulting, but one of the most striking coseismic effects is the coastal uplift and the backwash along the littoral of the Mitidja basin.

  3. Decreased clinical response to infliximab in ankylosing spondylitis is correlated with anti-infliximab formation

    NARCIS (Netherlands)

    de Vries, Mirjam K.; Wolbink, Gerrit Jan; Stapel, Steven O.; de Vrieze, Henk; van Denderen, J. Christiaan; Dijkmans, Ben A. C.; Aarden, Lucien A.; van der Horst-Bruinsma, Irene E.

    2007-01-01

    OBJECTIVES: Correlation of serum trough infliximab levels and antibodies to infliximab (anti-infliximab) with clinical response in ankylosing spondylitis. METHODS: In accordance with the international ASsessment in Ankylosing Spondylitis (ASAS) consensus statement, patients were treated with

  4. Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (Russian Edition)

    International Nuclear Information System (INIS)

    2014-01-01

    This publication addresses the shortfall of well trained and clinically qualified medical physicists working in radiation medicine. The roles, responsibilities and clinical training requirements of medical physicists have not always been well defined or well understood by health care professionals, health authorities and regulatory agencies. To fill this gap, this publication provides recommendations for the academic education and clinical training of clinically qualified medical physicists, including recommendations for their accreditation certification and registration, along with continuous professional development. The goal is to establish criteria that support the harmonization of education and clinical training worldwide

  5. A decade of U.S. Air Force bat strikes

    Science.gov (United States)

    Peurach, Suzanne C.; Dove, Carla J.; Stepko, Laura

    2009-01-01

    From 1997 through 2007, 821 bat strikes were reported to the U.S. Air Force (USAF) Safety Center by aircraft personnel or ground crew and sent to the National Museum of Natural History, Smithsonian Institution, for identification. Many samples were identified by macroscopic and or microscopic comparisons with bat specimens housed in the museum and augmented during the last 2 years by DNA analysis. Bat remains from USAF strikes during this period were received at the museum from 40 states in the United States and from 20 countries. We confirmed that 46% of the strikes were caused by bats, but we did not identify them further; we identified 5% only to the family or genus level, and 49% to the species level. Fifty-five of the 101 bat-strike samples submitted for DNA analysis have been identified to the species level. Twenty-five bat species have been recorded striking USAF planes worldwide. The Brazilian free-tailed bat (Tadarida brasiliensis; n = 173) is the species most commonly identified in USAF strike impacts, followed by the red bat (Lasiurus borealis; n = 83). Bat strikes peak during the spring and fall, with >57% occurring from August through October; 82% of the reports that included time of strike were recorded between 2100 and 0900 hours. More than 12% of the bat strikes were reported at >300 m above ground level (AGL). Although $825,000 and >50% of this sum was attributable to 5 bat-strike incidents. Only 5 bats from the 10 most damaging bat strikes were identified to the species level, either because we did not receive remains with the reports or the sample was insufficient for identification.

  6. Clinical, pathological and functional characterization of riboflavin-responsive neuropathy.

    Science.gov (United States)

    Manole, Andreea; Jaunmuktane, Zane; Hargreaves, Iain; Ludtmann, Marthe H R; Salpietro, Vincenzo; Bello, Oscar D; Pope, Simon; Pandraud, Amelie; Horga, Alejandro; Scalco, Renata S; Li, Abi; Ashokkumar, Balasubramaniem; Lourenço, Charles M; Heales, Simon; Horvath, Rita; Chinnery, Patrick F; Toro, Camilo; Singleton, Andrew B; Jacques, Thomas S; Abramov, Andrey Y; Muntoni, Francesco; Hanna, Michael G; Reilly, Mary M; Revesz, Tamas; Kullmann, Dimitri M; Jepson, James E C; Houlden, Henry

    2017-11-01

    Drosophila also resulted in severely impaired locomotor activity and reduced lifespan, mirroring patient pathology, and these phenotypes could be partially rescued using a novel esterified derivative of riboflavin. Our findings expand the genetic, clinical and neuropathological features of Brown-Vialetto-Van Laere syndrome, implicate mitochondrial dysfunction as a downstream consequence of riboflavin transporter gene defects, and validate riboflavin esters as a potential therapeutic strategy. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain.

  7. A numerical model for bird strike on sidewall structure of an aircraft nose

    Directory of Open Access Journals (Sweden)

    Liu Jun

    2014-06-01

    Full Text Available In order to examine the potential of using the coupled smooth particles hydrodynamic (SPH and finite element (FE method to predict the dynamic responses of aircraft structures in bird strike events, bird-strike tests on the sidewall structure of an aircraft nose are carried out and numerically simulated. The bird is modeled with SPH and described by the Murnaghan equation of state, while the structure is modeled with finite elements. A coupled SPH–FE method is developed to simulate the bird-strike tests and a numerical model is established using a commercial software PAM-CRASH. The bird model shows no signs of instability and correctly modeled the break-up of the bird into particles. Finally the dynamic response such as strains in the skin is simulated and compared with test results, and the simulated deformation and fracture process of the sidewall structure is compared with images recorded by a high speed camera. Good agreement between the simulation results and test data indicates that the coupled SPH–FE method can provide a very powerful tool in predicting the dynamic responses of aircraft structures in events of bird strike.

  8. Making inference from wildlife collision data: inferring predator absence from prey strikes.

    Science.gov (United States)

    Caley, Peter; Hosack, Geoffrey R; Barry, Simon C

    2017-01-01

    Wildlife collision data are ubiquitous, though challenging for making ecological inference due to typically irreducible uncertainty relating to the sampling process. We illustrate a new approach that is useful for generating inference from predator data arising from wildlife collisions. By simply conditioning on a second prey species sampled via the same collision process, and by using a biologically realistic numerical response functions, we can produce a coherent numerical response relationship between predator and prey. This relationship can then be used to make inference on the population size of the predator species, including the probability of extinction. The statistical conditioning enables us to account for unmeasured variation in factors influencing the runway strike incidence for individual airports and to enable valid comparisons. A practical application of the approach for testing hypotheses about the distribution and abundance of a predator species is illustrated using the hypothesized red fox incursion into Tasmania, Australia. We estimate that conditional on the numerical response between fox and lagomorph runway strikes on mainland Australia, the predictive probability of observing no runway strikes of foxes in Tasmania after observing 15 lagomorph strikes is 0.001. We conclude there is enough evidence to safely reject the null hypothesis that there is a widespread red fox population in Tasmania at a population density consistent with prey availability. The method is novel and has potential wider application.

  9. Making inference from wildlife collision data: inferring predator absence from prey strikes

    Directory of Open Access Journals (Sweden)

    Peter Caley

    2017-02-01

    Full Text Available Wildlife collision data are ubiquitous, though challenging for making ecological inference due to typically irreducible uncertainty relating to the sampling process. We illustrate a new approach that is useful for generating inference from predator data arising from wildlife collisions. By simply conditioning on a second prey species sampled via the same collision process, and by using a biologically realistic numerical response functions, we can produce a coherent numerical response relationship between predator and prey. This relationship can then be used to make inference on the population size of the predator species, including the probability of extinction. The statistical conditioning enables us to account for unmeasured variation in factors influencing the runway strike incidence for individual airports and to enable valid comparisons. A practical application of the approach for testing hypotheses about the distribution and abundance of a predator species is illustrated using the hypothesized red fox incursion into Tasmania, Australia. We estimate that conditional on the numerical response between fox and lagomorph runway strikes on mainland Australia, the predictive probability of observing no runway strikes of foxes in Tasmania after observing 15 lagomorph strikes is 0.001. We conclude there is enough evidence to safely reject the null hypothesis that there is a widespread red fox population in Tasmania at a population density consistent with prey availability. The method is novel and has potential wider application.

  10. Factors Influencing Response to Pharmacologic Treatment of Migraine in a Pediatric Headache Clinic.

    Science.gov (United States)

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

    2016-07-01

    The responses of different patients to the same drug may vary as a consequence of biologic, psychosocial, and genetic differences. The aim of this study was to identify clinical factors associated with a response to pharmacologic treatment in pediatric patients with migraine. The medical files of patients with migraine attending the headache clinic of a tertiary pediatric medical center in 2010-2015 were reviewed. The children and parents (or only the parents if the child was very young) completed the International Headache Society-based questionnaire. Patients were treated with at least one of the following medications: propranolol, amitriptyline, topiramate. Response to treatment was rated as no change in migraine pattern (grade 1) or a decrease in migraine attack frequency per month by at least 50% (grade 2) or at least 75% (grade 3). The highest-grade response to any pharmacologic treatment was defined as the best clinical response. The study group included 248 patients of mean age 12.71 ± 3.04 years. A grade 3 best clinical response was significantly associated with a positive maternal history of migraine, younger age at treatment onset, lower frequency of headache attacks per month, postpubertal children had a significantly lower rate of grade 3 response than prepubertal children (P pediatric headache clinic setting should consider these factors before initiating a treatment program. © 2016 American Headache Society.

  11. Reporting the Great Railroad Strike: How Ideology Shaped the News.

    Science.gov (United States)

    Coward, John

    The Great Railroad Strike of 1877, a national catastrophe and the major news story of the year, was the first national labor strike in U.S. history. Because of the ideological bias of the press, specifically its implicit commitment to capitalism and to objectivity (itself a "myth" of social order), newspapers of the period could be…

  12. The public's attitude towards strike action by healthcare workers and ...

    African Journals Online (AJOL)

    The strength of the associations was determined by Cramer's V. Results. Results revealed strong opinions among the population regarding strikes, numerous misapprehensions when it comes to striking and rights, a poor awareness of other healthcare-related rights and the perception of poor treatment at public hospitals.

  13. Teaching Striking Skills in Elementary Physical Education Using Woodball

    Science.gov (United States)

    Chang, Seung Ho; Lee, Jihyun

    2017-01-01

    Object control (OC) skills are a part of fundamental motor skills and basic functional skills, which work as a prerequisite to becoming a skilled performer in many sports. Of various OC skills, striking is one of the most difficult to master due to a variety of interrelated movement components. A form of vertical or underarm striking is a more…

  14. LAW AND ETHICS OF STRIKES IN THE NIGERIAN HEALTH SYSTEM

    African Journals Online (AJOL)

    2014-10-06

    Oct 6, 2014 ... employment. Kidnapping has been affecting virtually every sector of the Nigerian economy. Thus it is not the right of any health worker to embark on strike. Rather the right to strike can be derived from the principle of collective bargaining, which according to Ahmed (2014) is an essential principle. Workers ...

  15. Ban on right to strike by police challenged

    NARCIS (Netherlands)

    Grünell, M.

    2008-01-01

    After months of negotiation between the police force and the minister of the interior on the renewal of the collective agreement, the police trade unions began threatening industrial action and strikes in December 2007. The courts were divided on the issue, with some ruling out strikes as a means of

  16. Martial arts striking hand peak acceleration, accuracy and consistency.

    Science.gov (United States)

    Neto, Osmar Pinto; Marzullo, Ana Carolina De Miranda; Bolander, Richard P; Bir, Cynthia A

    2013-01-01

    The goal of this paper was to investigate the possible trade-off between peak hand acceleration and accuracy and consistency of hand strikes performed by martial artists of different training experiences. Ten male martial artists with training experience ranging from one to nine years volunteered to participate in the experiment. Each participant performed 12 maximum effort goal-directed strikes. Hand acceleration during the strikes was obtained using a tri-axial accelerometer block. A pressure sensor matrix was used to determine the accuracy and consistency of the strikes. Accuracy was estimated by the radial distance between the centroid of each subject's 12 strikes and the target, whereas consistency was estimated by the square root of the 12 strikes mean squared distance from their centroid. We found that training experience was significantly correlated to hand peak acceleration prior to impact (r(2)=0.456, p =0.032) and accuracy (r(2)=0. 621, p=0.012). These correlations suggest that more experienced participants exhibited higher hand peak accelerations and at the same time were more accurate. Training experience, however, was not correlated to consistency (r(2)=0.085, p=0.413). Overall, our results suggest that martial arts training may lead practitioners to achieve higher striking hand accelerations with better accuracy and no change in striking consistency.

  17. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene Sundahl; Scherpbier, Albert J J

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate ...... in clinical departments and the leadership skills of clinical consultants responsible for education.......The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...

  18. Rebuttal to Nelson et al. 'Response to Bodin and Grote regarding postdoctoral recruitment in clinical neuropsychology'.

    Science.gov (United States)

    Bodin, Doug; Grote, Christopher L

    2016-07-01

    Nelson et al. provided a response to our commentary on the postdoctoral match in clinical neuropsychology. In this brief rebuttal, we will focus on statements from Nelson et al. that we believe are factual inaccuracies or misunderstandings of some of the points we made in our commentary. In addition, we will comment briefly on the proposed guidelines offered in their response.

  19. Survey Response Rates and Survey Administration in Counseling and Clinical Psychology: A Meta-Analysis

    Science.gov (United States)

    Van Horn, Pamela S.; Green, Kathy E.; Martinussen, Monica

    2009-01-01

    This article reports results of a meta-analysis of survey response rates in published research in counseling and clinical psychology over a 20-year span and describes reported survey administration procedures in those fields. Results of 308 survey administrations showed a weighted average response rate of 49.6%. Among possible moderators, response…

  20. Risk Considerations of Bird Strikes to Space Launch Vehicles

    Science.gov (United States)

    Hales, Christy; Ring, Robert

    2016-01-01

    Within seconds after liftoff of the Space Shuttle during mission STS-114, a turkey vulture impacted the vehicle's external tank. The contact caused no apparent damage to the Shuttle, but the incident led NASA to consider the potential consequences of bird strikes during a Shuttle launch. The environment at Kennedy Space Center provides unique bird strike challenges due to the Merritt Island National Wildlife Refuge and the Atlantic Flyway bird migration routes. NASA is currently refining risk assessment estimates for the probability of bird strike to space launch vehicles. This paper presents an approach for analyzing the risks of bird strikes to space launch vehicles and presents an example. The migration routes, types of birds present, altitudes of those birds, exposed area of the launch vehicle, and its capability to withstand impacts affect the risk due to bird strike. A summary of significant risk contributors is discussed.

  1. Power electromagnetic strike machine for engineering-geological surveys

    Science.gov (United States)

    Usanov, K. M.; Volgin, A. V.; Chetverikov, E. A.; Kargin, V. A.; Moiseev, A. P.; Ivanova, Z. I.

    2017-10-01

    When implementing the processes of dynamic sensing of soils and pulsed nonexplosive seismic exploration, the most common and effective method is the strike one, which is provided by a variety of structure and parameters of pneumatic, hydraulic, electrical machines of strike action. The creation of compact portable strike machines which do not require transportation and use of mechanized means is important. A promising direction in the development of strike machines is the use of pulsed electromagnetic actuator characterized by relatively low energy consumption, relatively high specific performance and efficiency, and providing direct conversion of electrical energy into mechanical work of strike mass with linear movement trajectory. The results of these studies allowed establishing on the basis of linear electromagnetic motors the electromagnetic pulse machines with portable performance for dynamic sensing of soils and land seismic pulse of small depths.

  2. Seronegative and seropositive autoimmune autonomic ganglionopathy (AAG): Same clinical picture, same response to immunotherapy.

    Science.gov (United States)

    Tijero, Beatriz; Del Pino, Rocio; Pérez-Concha, Tomás; Acera, Maria Angeles; Gabilondo, Iñigo; Berganzo, Koldo; Graus, Frances; Martinez-Alday, Jesus Daniel; Barcena, Joseba; Gómez-Esteban, Juan Carlos

    2018-06-15

    Two patients with a syndrome of pandisautonomia with clinical criteria of AAG are provided. Both patients present a similar clinical picture and response to immunosuppressive treatment. One of them has positive antibodies against the ganglionic nicotinic acetylcholine (gAChr) and the other does not. This brief article serves to reflect the spectrum of AAG, at a clinical level, in laboratory tests and in the response to immunotherapy, independently of the presence of positive gAChr antibodies. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. Wavelet transform analysis of electromyography kung fu strikes data.

    Science.gov (United States)

    Neto, Osmar Pinto; Marzullo, Ana Carolina de Miranda

    2009-11-01

    In martial arts and contact sports strikes are performed at near maximum speeds. For that reason, electromyography (EMG) analysis of such movements is non-trivial. This paper has three main goals: firstly, to investigate the differences in the EMG activity of muscles during strikes performed with and without impacts; secondly, to assess the advantages of using Sum of Significant Power (SSP) values instead of root mean square (rms) values when analyzing EMG data; and lastly to introduce a new method of calculating median frequency values using wavelet transforms (WMDF). EMG data of the deltoid anterior (DA), triceps brachii (TB) and brachioradialis (BR) muscles were collected from eight Kung Fu practitioners during strikes performed with and without impacts. SSP results indicated significant higher muscle activity (p = 0.023) for the strikes with impact. WMDF results, on the other hand, indicated significant lower values (p = 0. 007) for the strikes with impact. SSP results presented higher sensitivity than rms to quantify important signal differences and, at the same time, presented lower inter-subject coefficient of variations. The result of increase in SSP values and decrease in WMDF may suggest better synchronization of motor units for the strikes with impact performed by the experienced Kung Fu practitioners. Key PointsThe results show higher muscle activity and lower electromyography median frequencies for strikes with impact compared to strikes without.SSP results presented higher sensitivity and lower inter-subject coefficient of variations than rms results.Kung Fu palm strikes with impact may present better motor units' synchronization than strikes without.

  4. Predictors of short-term clinical response to cardiac resynchronization therapy.

    Science.gov (United States)

    Linde, Cecilia; Abraham, William T; Gold, Michael R; Daubert, J Claude; Tang, Anthony S L; Young, James B; Sherfesee, Lou; Hudnall, J Harrison; Fagan, Dedra H; Cleland, John G

    2017-08-01

    Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with symptomatic heart failure and QRS prolongation but there is uncertainty about which patient characteristics predict short-term clinical response. In an individual patient meta-analysis of three double-blind, randomized trials, clinical composite score (CCS) at 6 months was compared in patients assigned to CRT programmed on or off. Treatment-covariate interactions were assessed to measure likelihood of improved CCS at 6 months. MIRACLE, MIRACLE ICD, and REVERSE trials contributed data for this analysis (n = 1591). Multivariable modelling identified QRS duration and left ventricular ejection fraction (LVEF) as predictors of CRT clinical response (P chronic heart failure patients (NYHA class II-IV), longer QRS duration and lower LVEF independently predict early clinical response to CRT. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  5. General Practitioners' responses to global climate change - lessons from clinical experience and the clinical method.

    Science.gov (United States)

    Blashki, Grant; Abelsohn, Alan; Woollard, Robert; Arya, Neil; Parkes, Margot W; Kendal, Paul; Bell, Erica; Bell, R Warren

    2012-08-08

    Climate change is a global public health problem that will require complex thinking if meaningful and effective solutions are to be achieved. In this conceptual paper we argue that GPs have much to bring to the issue of climate change from their wide-ranging clinical experience and from the principles underpinning their clinical methods. This experience and thinking calls forth particular contributions GPs can and should make to debate and action. We contend that the privileged experience and GP way of thinking can make valuable contributions when applied to climate change solutions. These include a lifetime of experience, reflection and epistemological application to first doing no harm, managing uncertainty, the ability to make necessary decisions while possessing incomplete information, an appreciation of complex adaptive systems, maintenance of homeostasis, vigilance for unintended consequences, and an appreciation of the importance of transdisciplinarity and interprofessionalism. General practitioners have a long history of public health advocacy and in the case of climate change may bring a way of approaching complex human problems that could be applied to the dilemmas of climate change.

  6. Vaccination elicits correlated immune and clinical responses in glioblastoma multiforme patients.

    Science.gov (United States)

    Wheeler, Christopher J; Black, Keith L; Liu, Gentao; Mazer, Mia; Zhang, Xiao-xue; Pepkowitz, Samuel; Goldfinger, Dennis; Ng, Hiushan; Irvin, Dwain; Yu, John S

    2008-07-15

    Cancer vaccine trials have failed to yield robust immune-correlated clinical improvements as observed in animal models, fueling controversy over the utility of human cancer vaccines. Therapeutic vaccination represents an intriguing additional therapy for glioblastoma multiforme (GBM; grade 4 glioma), which has a dismal prognosis and treatment response, but only early phase I vaccine trial results have been reported. Immune and clinical responses from a phase II GBM vaccine trial are reported here. IFN-gamma responsiveness was quantified in peripheral blood of 32 GBM patients given therapeutic dendritic cell vaccines. Posttreatment times to tumor progression (TTP) and survival (TTS) were compared in vaccine responders and nonresponders and were correlated with immune response magnitudes. GBM patients (53%) exhibited >or=1.5-fold vaccine-enhanced cytokine responses. Endogenous antitumor responses of similar magnitude occurred in 22% of GBM patients before vaccination. Vaccine responders exhibited significantly longer TTS and TTP relative to nonresponders. Immune enhancement in vaccine responders correlated logarithmically with TTS and TTP spanning postvaccine chemotherapy, but not with initial TTP spanning vaccination alone. This is the first report of a progressive correlation between cancer clinical outcome and T-cell responsiveness after therapeutic vaccination in humans and the first tracing of such correlation to therapeutically exploitable tumor alteration. As such, our findings offer unique opportunities to identify cellular and molecular components of clinically meaningful antitumor immunity in humans.

  7. Defining Clinical Response Criteria and Early Response Criteria for Precision Oncology: Current State-of-the-Art and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Vivek Subbiah

    2017-02-01

    Full Text Available In this era of precision oncology, there has been an exponential growth in the armamentarium of genomically targeted therapies and immunotherapies. Evaluating early responses to precision therapy is essential for “go” versus “no go” decisions for these molecularly targeted drugs and agents that arm the immune system. Many different response assessment criteria exist for use in solid tumors and lymphomas. We reviewed the literature using the Medline/PubMed database for keywords “response assessment” and various known response assessment criteria published up to 2016. In this article we review the commonly used response assessment criteria. We present a decision tree to facilitate selection of appropriate criteria. We also suggest methods for standardization of various response assessment criteria. The relevant response assessment criteria were further studied for rational of development, key features, proposed use and acceptance by various entities. We also discuss early response evaluation and provide specific case studies of early response to targeted therapy. With high-throughput, advanced computing programs and digital data-mining it is now possible to acquire vast amount of high quality imaging data opening up a new field of “omics in radiology”—radiomics that complements genomics for personalized medicine. Radiomics is rapidly evolving and is still in the research arena. This cutting-edge technology is poised to move soon to the mainstream clinical arena. Novel agents with new mechanisms of action require advanced molecular imaging as imaging biomarkers. There is an urgent need for development of standardized early response assessment criteria for evaluation of response to precision therapy.

  8. Hospital in the Home nurses' recognition and response to clinical deterioration.

    Science.gov (United States)

    Gray, Erika; Currey, Judy; Considine, Julie

    2017-09-19

    To obtain an understanding of how Hospital in the Home (HITH) nurses recognise and respond to clinical deterioration in patients receiving care at home or in their usual place of residence. Recognising and responding to clinical deterioration is an international safety priority and a key nursing responsibility. Despite an increase in care delivery in home environments, how HITH nurses recognise and respond to clinical deterioration is not yet fully understood. A prospective, descriptive exploratory design was used. A survey containing questions related to participant characteristics and 10 patient scenarios was used to collect data from 47 nurses employed in the HITH units of three major health services in Melbourne, Australia. The 10 scenarios reflected typical HITH patients and included medical history and clinical assessment findings (respiratory rate, oxygen saturation, heart rate, blood pressure, temperature, conscious state and pain score). The three major findings from this study were that: (i) nurse and patient characteristics influenced HITH nurses' assessment decisions; (ii) the cues used by HITH nurses to recognise clinical deterioration varied according to the clinical context; and (iii) although HITH nurses work in an autonomous role, they engage in collaborative practice when responding to clinical deterioration. Hospital in the Home nurses play a fundamental role in patient assessment, and the context in which they recognise and respond to deterioration is markedly different to that of hospital nurses. The assessment, measurement and interpretation of clinical data are a nursing responsibility that is crucial to early recognition and response to clinical deterioration. The capacity of HITH services to care for increasing numbers of patients in their home environment, and to promptly recognise and respond to clinical deterioration should it occur, is fundamental to safety within the healthcare system. Hospital in the Home nurses are integral to a

  9. PET Parametric Response Mapping for Clinical Monitoring and Treatment Response Evaluation in Brain Tumors.

    Science.gov (United States)

    Ellingson, Benjamin M; Chen, Wei; Harris, Robert J; Pope, Whitney B; Lai, Albert; Nghiemphu, Phioanh L; Czernin, Johannes; Phelps, Michael E; Cloughesy, Timothy F

    2013-04-01

    PET parametric response maps (PRMs) are a provocative new molecular imaging technique for quantifying brain tumor response to therapy in individual patients. By aligning sequential PET scans over time using anatomic MR imaging information, the voxel-wise change in radiotracer uptake can be quantified and visualized. PET PRMs can be performed before and after a particular therapy to test whether the tumor is responding favorably, or performed relative to a distant time point to monitor changes through the course of a treatment. This article focuses on many of the technical details involved in generating, visualizing, and quantifying PET PRMs, and practical applications and example case studies. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. "Thunderstruck": penetrating thoracic injury from lightning strike.

    Science.gov (United States)

    van Waes, Oscar J F; van de Woestijne, Pieter C; Halm, Jens A

    2014-04-01

    Lightning strike victims are rarely presented at an emergency department. Burns are often the primary focus. This case report describes the improvised explosive device like-injury to the thorax due to lightning strike and its treatment, which has not been described prior in (kerauno)medicine. Penetrating injury due to blast from lightning strike is extremely rare. These "shrapnel" injuries should however be ruled out in all patients struck by lightning. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  11. Direct and nearby lightning strike interaction with test power distribution lines

    Science.gov (United States)

    Schoene, Jens Daniel

    the lightning currents entered the neutral conductor through the line grounding. Additional topics include an investigation of the response of metallic structures (a buried counterpoise and a vertical wire of 7 m height) to nearby rocket-triggered and natural lightning strikes and the characterization of rocket-triggered lightning return stroke currents.

  12. Clinicians' emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation.

    Science.gov (United States)

    Gazzillo, Francesco; Lingiardi, Vittorio; Del Corno, Franco; Genova, Federica; Bornstein, Robert F; Gordon, Robert M; McWilliams, Nancy

    2015-06-01

    The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed. (c) 2015 APA, all rights reserved).

  13. Establishing Good Practices for Exposure?Response Analysis of Clinical Endpoints in Drug Development

    OpenAIRE

    Overgaard, RV; Ingwersen, SH; Torn?e, CW

    2015-01-01

    This tutorial aims at promoting good practices for exposure?response (E-R) analyses of clinical endpoints in drug development. The focus is on practical aspects of E-R analyses to assist modeling scientists with a process of performing such analyses in a consistent manner across individuals and projects and tailored to typical clinical drug development decisions. This includes general considerations for planning, conducting, and visualizing E-R analyses, and how these are linked to key questi...

  14. Continental United States Hurricane Strikes 1950-2012

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Continental U.S. Hurricane Strikes Poster is our most popular poster which is updated annually. The poster includes all hurricanes that affected the U.S. since...

  15. 2005 Significant U.S. Hurricane Strikes Poster

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2005 Significant U.S. Hurricane Strikes poster is one of two special edition posters for the Atlantic Hurricanes. This beautiful poster contains two sets of...

  16. Ethical and legal consideration of prisoner's hunger strike in Serbia.

    Science.gov (United States)

    Alempijevic, Djordje; Pavlekic, Snezana; Jecmenica, Dragan; Nedeljkov, Aleksandra; Jankovic, Milos

    2011-03-01

    Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made. © 2011 American Academy of Forensic Sciences.

  17. Nuclear First Strike-Have the Rules Changed?

    National Research Council Canada - National Science Library

    Carter, Rosemary M

    2008-01-01

    .... Nuclear first strike is the policy that reserves the right to use nuclear weapons against an enemy before that enemy employs a like weapon without any constraints on the decision to employ the weapon...

  18. Joint Strike Fighter fit for duty in Europe?

    NARCIS (Netherlands)

    Heerkens, Johannes M.G.

    2000-01-01

    Focuses on the potential growth of the Joint Strike Fighter (JSF) market in Europe. Competition between Lockheed Martin and Boeing for the fighter's design contract; Disadvantages of the fighter plane; Stealth performance of JSF.

  19. [SIRS (systemic inflammatory response syndrome): clinical entity, definitions, and the significance].

    Science.gov (United States)

    Kushimoto, S; Yamamoto, Y

    1999-01-01

    The clinical entity, definitions, and the significance of SIRS (systemic inflammatory response syndrome) were reviewed. The term, SIRS was proposed to define sepsis and its sequelae clearly in 1991, in order to make early detection of the disease possible, and to improve the ability to compare innovative potential diagnostic and therapeutic modalities by standardizing terms. Although the criteria of SIRS is not strict and too sensitive, SIRS has been shown to be useful as a warning sign of severe condition in clinical setting. We also discussed about a new concept, CARS (compensatory anti-inflammatory response syndrome), which was characterized as anti-inflammatory mediators-dominant condition, in this issue.

  20. Comparison of force, power, and striking efficiency for a Kung Fu strike performed by novice and experienced practitioners: preliminary analysis.

    Science.gov (United States)

    Neto, Osmar Pinto; Magini, Marcio; Saba, Marcelo M F; Pacheco, Marcos Tadeu Tavares

    2008-02-01

    This paper presents a comparison of force, power, and efficiency values calculated from Kung Fu Yau-Man palm strikes, when performed by 7 experienced and 6 novice men. They performed 5 palm strikes to a freestanding basketball, recorded by high-speed camera at 1000 Hz. Nonparametric comparisons and correlations showed experienced practitioners presented larger values of mean muscle force, mean impact force, mean muscle power, mean impact power, and mean striking efficiency, as is noted in evidence obtained for other martial arts. Also, an interesting result was that for experienced Kung Fu practitioners, muscle power was linearly correlated with impact power (p = .98) but not for the novice practitioners (p = .46).

  1. Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination.

    Science.gov (United States)

    Beltrán-Velasco, Ana Isabel; Bellido-Esteban, Alberto; Ruisoto-Palomera, Pablo; Clemente-Suárez, Vicente Javier

    2018-01-12

    The aim of the present study was to explore changes in the autonomic stress response of Psychology students in a Psychology Objective Structured Clinical Examination (OSCE) and their relationship with OSCE performance. Variables of autonomic modulation by the analysis of heart rate variability in temporal, frequency and non-linear domains, subjective perception of distress strait and academic performance were measured before and after the two different evaluations that composed the OSCE. A psychology objective structured clinical examination composed by two different evaluation scenarios produced a large anxiety anticipatory response, a habituation response in the first of the evaluation scenarios and a in the entire evaluation, and a no habituation response in the second evaluation scenario. Autonomic modulation parameters do not correlate with academic performance of students.

  2. Pharmacogenomics of Methotrexate Membrane Transport Pathway: Can Clinical Response to Methotrexate in Rheumatoid Arthritis Be Predicted?

    Science.gov (United States)

    Lima, Aurea; Bernardes, Miguel; Azevedo, Rita; Medeiros, Rui; Seabra, Vitor

    2015-01-01

    Background: Methotrexate (MTX) is widely used for rheumatoid arthritis (RA) treatment. Single nucleotide polymorphisms (SNPs) could be used as predictors of patients’ therapeutic outcome variability. Therefore, this study aims to evaluate the influence of SNPs in genes encoding for MTX membrane transport proteins in order to predict clinical response to MTX. Methods: Clinicopathological data from 233 RA patients treated with MTX were collected, clinical response defined, and patients genotyped for 23 SNPs. Genotype and haplotype analyses were performed using multivariate methods and a genetic risk index (GRI) for non-response was created. Results: Increased risk for non-response was associated to SLC22A11 rs11231809 T carriers; ABCC1 rs246240 G carriers; ABCC1 rs3784864 G carriers; CGG haplotype for ABCC1 rs35592, rs2074087 and rs3784864; and CGG haplotype for ABCC1 rs35592, rs246240 and rs3784864. GRI demonstrated that patients with Index 3 were 16-fold more likely to be non-responders than those with Index 1. Conclusions: This study revealed that SLC22A11 and ABCC1 may be important to identify those patients who will not benefit from MTX treatment, highlighting the relevance in translating these results to clinical practice. However, further validation by independent studies is needed to develop the field of personalized medicine to predict clinical response to MTX treatment. PMID:26086825

  3. Local avian density influences risk of mortality from window strikes

    Science.gov (United States)

    Sabo, Ann M.; Hagemeyer, Natasha D.G.; Lahey, Ally S.

    2016-01-01

    Up to a billion birds die per year in North America as a result of striking windows. Both transparent and reflective glass panes are a cause for concern, misleading birds by either acting as invisible, impenetrable barriers to desired resources, or reflecting those resources over a large surface area. A high number of window strikes occur during migration, but little is known about the factors of susceptibility, or whether particular avian taxa are more vulnerable than others. We report on a study of window strikes and mist-netting data at the Virginia Zoological Park (Norfolk, Virginia, USA), conducted in the autumn of 2013 and 2014. We focused on three factors likely to contribute to an individual’s predisposition to collide with windows: (i) taxonomic classification, (ii) age, and (iii) migrant vs. resident status. Thrushes, dominated by the partial migrant American Robin (Turdus migratorius), were significantly less likely to strike glass than be sampled in mist nets (χ2 = 9.21, p = 0.002), while wood-warblers (Parulidae) were more likely to strike than expected (χ2 = 13.55, p windows (45.4%) was not significantly different (χ2 = 0.05, p = 0.827) than the population of juvenile birds naturally occurring at the zoo (48.8%). Migrants, however, were significantly more susceptible to window strikes than residents (χ2 = 6.35, p = 0.012). Our results suggest that resident birds are able to learn to avoid and thus reduce their likelihood of striking windows; this intrinsic risk factor may help explain the apparent susceptibility of certain taxa to window strikes. PMID:27366656

  4. Typhoid fever in young children in Bangladesh: clinical findings, antibiotic susceptibility pattern and immune responses.

    Directory of Open Access Journals (Sweden)

    Farhana Khanam

    2015-04-01

    Full Text Available Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains.As a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest during acute typhoid fever in adults. We similarly assessed membrane preparation (MP IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years with those seen in older children (6-17 years, adults (18-59 years, and age-matched healthy controls.We found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid.This study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest

  5. The Role of Near-Fault Relief in Creating and Maintaining Strike-Slip Landscape Features

    Science.gov (United States)

    Harbert, S.; Duvall, A. R.; Tucker, G. E.

    2016-12-01

    Geomorphic landforms, such as shutter ridges, offset river terraces, and deflected stream channels, are often used to assess the activity and slip rates of strike-slip faults. However, in some systems, such as parts of the Marlborough Fault System (South Island, NZ), an active strike-slip fault does not leave a strong landscape signature. Here we explore the factors that dampen or enhance the landscape signature of strike-slip faulting using the Channel-Hillslope Integrated Landscape Development model (CHILD). We focus on variables affecting the length of channel offsets, which enhance the signature of strike-slip motion, and the frequency of stream captures, which eliminate offsets and reduce this signature. We model a strike-slip fault that passes through a mountain ridge, offsetting streams that drain across this fault. We use this setup to test the response of channel offset length and capture frequency to fault characteristics, such as slip rate and ratio of lateral to vertical motion, and to landscape characteristics, such as relief contrasts controlled by erodibility. Our experiments show that relief downhill of the fault, whether generated by differential uplift across the fault or by an erodibility contrast, has the strongest effect on offset length and capture frequency. This relief creates shutter ridges, which block and divert streams while being advected along a fault. Shutter ridges and the streams they divert have long been recognized as markers of strike-slip motion. Our results show specifically that the height of shutter ridges is most responsible for the degree to which they create long channel offsets by preventing stream captures. We compare these results to landscape metrics in the Marlborough Fault System, where shutter ridges are common and often lithologically controlled. We compare shutter ridge length and height to channel offset length in order to assess the influence of relief on offset channel features in a real landscape. Based on our

  6. NASA storm hazards research in lightning strikes to aircraft

    Science.gov (United States)

    Fisher, B. D.; Brown, P. W.; Plumer, J. A.

    1985-01-01

    The lightning strike condition data gathered in the 1980-1984 period are presented, together with the lightning attachment point analysis for the NASA F-106B research aircraft are presented. The analysis of the experienced 637 direct lightning strikes shows that the highest strike rates (2.1 strikes/min and 13 strikes/penetration) occurred at altitudes between 38,000 and 40,000 ft. The regions of highest risk for an aircraft to experience a direct lightning strike were the areas of thunderstorms where the ambient temperature was colder than -40 C and where the relative turbulence and precipitation intensities were characterized as negligible to light. The presence and location of lightning, therefore, did not necessarily indicate the presence and location of hazardous precipitation and turbulence. The total onboard data show that the lightning attachment patterns on this aircraft fall into four general categories, although the 1984 data suggest that the entire surface of the F-106B may be susceptible to lightning attachment.

  7. WAVELET TRANSFORM ANALYSIS OF ELECTROMYOGRAPHY KUNG FU STRIKES DATA

    Directory of Open Access Journals (Sweden)

    Ana Carolina de Miranda Marzullo

    2009-11-01

    Full Text Available In martial arts and contact sports strikes are performed at near maximum speeds. For that reason, electromyography (EMG analysis of such movements is non-trivial. This paper has three main goals: firstly, to investigate the differences in the EMG activity of muscles during strikes performed with and without impacts; secondly, to assess the advantages of using Sum of Significant Power (SSP values instead of root mean square (rms values when analyzing EMG data; and lastly to introduce a new method of calculating median frequency values using wavelet transforms (WMDF. EMG data of the deltoid anterior (DA, triceps brachii (TB and brachioradialis (BR muscles were collected from eight Kung Fu practitioners during strikes performed with and without impacts. SSP results indicated significant higher muscle activity (p = 0.023 for the strikes with impact. WMDF results, on the other hand, indicated significant lower values (p = 0. 007 for the strikes with impact. SSP results presented higher sensitivity than rms to quantify important signal differences and, at the same time, presented lower inter-subject coefficient of variations. The result of increase in SSP values and decrease in WMDF may suggest better synchronization of motor units for the strikes with impact performed by the experienced Kung Fu practitioners

  8. Positive Emotions Associated with "Counter-Strike" Game Playing.

    Science.gov (United States)

    Shin, Mirim; Heard, Rob; Suo, Chao; Chow, Chin Moi

    2012-10-01

    Digital game playing engages people for long periods of time. The pleasure offered by digital games may explain the players' consumption of this activity. Games may elicit both positive and negative emotions, which can be measured by encephalography (EEG). The EEG alpha asymmetry index (AI) is different in positive and negative emotions and so may be used to distinguish positive from negative emotions that occur during gaming. We hypothesized that the "Counter-Strike" (CS) game (Valve Software, Bellevue, WA) is pleasurable and demonstrable with a positive EEG AI. Twelve male participants ages 18-30 years underwent EEG recordings continuously during and postgame. EEG was also recorded pregame for control conditions of baseline (sitting on a chair staring at a blank wall), movement (moving fingers on the computer keyboard with a blank screen), sound (listening to the sound of the CS game with a blank screen), and screen (watching the CS game without playing). Self-ratings of emotional responses were completed at pre-, during, and postgame. A significant decrease in the EEG AI was observed under the screen condition compared with baseline, whereas an increase was observed postgame compared with the screen condition. The participants demonstrated a positive EEG AI following the "shoot" events (shoot opponents) and negative emotions after the "being shot" events. Subjective ratings of emotional response indicated happiness during and postgame, but anger and arousal were reported only during the game. The overall results are consistent with the hypothesis that predominantly positive emotional reactions are elicited from playing the CS game and concur with positive subjective ratings of happiness. Future studies may explore the relationship of game pleasure and obsessive game play.

  9. Hepatitis B vaccine antibody response and the risk of clinical AIDS or death.

    Directory of Open Access Journals (Sweden)

    Michael L Landrum

    Full Text Available Whether seroresponse to a vaccine such as hepatitis B virus (HBV vaccine can provide a measure of the functional immune status of HIV-infected persons is unknown.This study evaluated the relationship between HBV vaccine seroresponses and progression to clinical AIDS or death.From a large HIV cohort, we evaluated those who received HBV vaccine only after HIV diagnosis and had anti-HBs determination 1-12 months after the last vaccine dose. Non-response and positive response were defined as anti-HBs <10 and ≥ 10 IU/L, respectively. Participants were followed from date of last vaccination to clinical AIDS, death, or last visit. Univariate and multivariable risk of progression to clinical AIDS or death were evaluated with Cox regression models. A total of 795 participants vaccinated from 1986-2010 were included, of which 41% were responders. During 3,872 person-years of observation, 122 AIDS or death events occurred (53% after 1995. Twenty-two percent of non-responders experienced clinical AIDS or death compared with 5% of responders (p<0.001. Non-response to HBV vaccine was associated with a greater than 2-fold increased risk of clinical AIDS or death (HR 2.47; 95% CI, 1.38-4.43 compared with a positive response, after adjusting for CD4 count, HIV viral load, HAART use, and delayed type hypersensitivity skin test responses (an in vivo marker of cell-mediated immunity. This association remained evident among those with CD4 count ≥ 500 cells/mm³ (HR 3.40; 95% CI, 1.39-8.32.HBV vaccine responses may have utility in assessing functional immune status and risk stratificating HIV-infected individuals, including those with CD4 count ≥ 500 cells/mm³.

  10. [The Teachers' Right to Strike Versus the Students' Right to an Education.

    Science.gov (United States)

    Powell, Edward M.

    The speaker establishes himself in opposition to teacher strikes, outlines the scope of teacher strikes, discusses arguments for and against the right of teachers to strike, presents the kinds of strikes that are possible, outlines what a board and the administration can do to head off a strike, and presents the American Association of School…

  11. The Value of Item Response Theory in Clinical Assessment: A Review

    Science.gov (United States)

    Thomas, Michael L.

    2011-01-01

    Item response theory (IRT) and related latent variable models represent modern psychometric theory, the successor to classical test theory in psychological assessment. Although IRT has become prevalent in the measurement of ability and achievement, its contributions to clinical domains have been less extensive. Applications of IRT to clinical…

  12. Refining Video Game Use Questionnaires for Research and Clinical Application: Detection of Problematic Response Sets

    Science.gov (United States)

    Faust, Kyle A.; Faust, David; Baker, Aaron M.; Meyer, Joseph F.

    2012-01-01

    Even when relatively infrequent, deviant response sets, such as defensive and careless responding, can have remarkably robust effects on individual and group data and thereby distort clinical evaluations and research outcomes. Given such potential adverse impacts and the widespread use of self-report measures when appraising addictions and…

  13. T cell responsiveness correlates differentially with antibody isotype levels in clinical and asymptomatic filariasis

    NARCIS (Netherlands)

    Yazdanbakhsh, M.; Paxton, W. A.; Kruize, Y. C.; Sartono, E.; Kurniawan, A.; van het Wout, A.; Selkirk, M. E.; Partono, F.; Maizels, R. M.

    1993-01-01

    To establish the relationships among T and B cell responses, active infection, and clinical manifestations in lymphatic filariasis, filarial-specific lymphocyte proliferation, IgG antibody isotypes, and IgE levels were determined in an exposed population: 31 asymptomatic amicrofilaremics, 43

  14. Long-Term Clinical Responses of Neoadjuvant Dendritic Cell Infusions and Radiation in Soft Tissue Sarcoma

    Directory of Open Access Journals (Sweden)

    Shailaja Raj

    2015-01-01

    Full Text Available Purpose. Patients with large >5 cm, high-grade resectable soft tissue sarcomas (STS have the highest risk of distant metastases. Previously we have shown that dendritic cell (DC based vaccines show consistent immune responses. Methods. This was a Phase I single institution study of neoadjuvant radiation with DC injections on 18 newly diagnosed high-risk STS patients. Neoadjuvant treatment consisted of 50 Gy of external beam radiation (EBRT, given in 25 fractions delivered five days/week, combined with four intratumoral injections of DCs followed by complete resection. The primary endpoint was to establish the immunological response to neoadjuvant therapy and obtain data on its clinical safety and outcomes. Results. There were no unexpected toxicities or serious adverse events. Twelve out of 18 (67% patients were alive, of which an encouraging 11/18 (61% were alive with no systemic recurrence over a period of 2–8 years. Favorable immunological responses correlated with clinical responses in some cases. Conclusions. This study provides clinical support to using dendritic cell injections along with radiation in sarcomas, which when used optimally in combination can help clinical outcomes in soft tissue sarcoma. Study registration number is NCT00365872.

  15. Clinical responsibility, accountability, and risk aversion in mental health nursing: a descriptive, qualitative study.

    Science.gov (United States)

    Manuel, Jenni; Crowe, Marie

    2014-08-01

    A number of recent, highly-publicized, perceived health-care service failures have raised concerns about health professionals' accountabilities. Relevant to these concerns, the present study sought to examine how mental health nurses understood clinical responsibility and its impact on their practice. A descriptive, qualitative design was used, and a convenience sample of 10 mental health nurses was recruited from specialist inpatient and outpatient mental health settings in Canterbury, New Zealand. Data were collected using semistructured interviews, and the transcriptions were analysed using an inductive, descriptive approach. Three major themes were identified: being accountable, fostering patient responsibility, and shifting responsibility. Being accountable involved weighing up patients' therapeutic needs against the potential for blame in an organizational culture of risk management. Fostering patient responsibility described the process of deciding in what situations patients could take responsibility for their behaviour. Shifting responsibility described the culture of defensive practice fostered by the organizational culture of risk aversion. The present study highlighted the challenges mental health nurses experience in relation to clinical responsibility in practice, including the balancing required between the needs of patients, the needs of the organization, and the perceived need for self-protection. © 2014 Australian College of Mental Health Nurses Inc.

  16. Medical student responses to clinical procedure teaching in the anatomy lab.

    Science.gov (United States)

    Wilson, Donald R; Nava, Pedro B

    2010-03-01

    the teaching of gross anatomy to first-year medical students has progressed from a 'stand-alone' discipline to one with much clinical emphasis. The curriculum at Loma Linda University School of Medicine has had increasing clinical correlates in recent years. We decided to supplement this with procedure demonstrations early in the course, and measure the student response. clinical procedures were performed on cadavers in the anatomy lab. For example, pleural and pericardial effusions were simulated by placing bags of intravenous fluid in the pleural and pericardial cavities; pneumothorax and tension pneumothorax were simulated using an inflatable rubber bladder. Videos were made and then presented in sequence with gross anatomy lectures. The student response was evaluated with a survey sheet. the Student response was overwhelmingly positive, with all students stating that the presentations made anatomy more relevant, and most indicating that anatomy also became easier to learn. Feedback confirmed that first-year medical students have a strong clinical orientation, which can facilitate both the teaching and learning of gross anatomy. advantages of having clinicians present simulated procedures in the anatomy lab include: heightened student interest; mentoring and modelling for students; introduction to clinical concepts now encountered in basic science examinations; supplementation of the thinning ranks of qualified gross anatomy teachers. The use of intravenous fluid bags and distensible bladders to simulate abnormal collections of fluid and air in body cavities is simple, inexpensive, and can be replicated in any anatomy lab. Blackwell Publishing Ltd 2010.

  17. Learning in clinical practice: Stimulating and discouraging response to social comparison.

    Science.gov (United States)

    Raat, Janet; Kuks, Jan; Cohen-Schotanus, Janke

    2010-01-01

    Social comparison theory is relevant for learning in general. In a clinical context, we examined four hypotheses concerning: preferred other to compare with, preferred direction of comparison, response to social comparison and influence of personal social comparison orientation (SCO). To investigate the relevance of social comparison for clinical workplace learning. Students (n = 437) from nine different hospitals completed two questionnaires measuring their SCO and the direction of and response to their comparisons. t-tests were used to analyse the data. Students substantially did compare. They preferred to compare with peer students more than with residents or staff, and with peers doing better more than with peers doing worse. Their response to social comparison was more often stimulating for learning than discouraging. Students high in SCO reported a stronger stimulating and discouraging response to their comparisons than students low in SCO. Social comparison does play a role in clinical workplace learning. The mainly stimulating response to social comparison indicates a positive learning influence. The preferred comparison with peers emphasizes the role of peers in the learning process. Further research should focus on student comparison behaviour and on situations that strengthen the positive effects of social comparison and reduce the negative or obstructing ones.

  18. Responses to clinical uncertainty in Australian general practice trainees: a cross-sectional analysis.

    Science.gov (United States)

    Cooke, Georga; Tapley, Amanda; Holliday, Elizabeth; Morgan, Simon; Henderson, Kim; Ball, Jean; van Driel, Mieke; Spike, Neil; Kerr, Rohan; Magin, Parker

    2017-12-01

    Tolerance for ambiguity is essential for optimal learning and professional competence. General practice trainees must be, or must learn to be, adept at managing clinical uncertainty. However, few studies have examined associations of intolerance of uncertainty in this group. The aim of this study was to establish levels of tolerance of uncertainty in Australian general practice trainees and associations of uncertainty with demographic, educational and training practice factors. A cross-sectional analysis was performed on the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study. Scores on three of the four independent subscales of the Physicians' Reaction to Uncertainty (PRU) instrument were analysed as outcome variables in linear regression models with trainee and practice factors as independent variables. A total of 594 trainees contributed data on a total of 1209 occasions. Trainees in earlier training terms had higher scores for 'Anxiety due to uncertainty', 'Concern about bad outcomes' and 'Reluctance to disclose diagnosis/treatment uncertainty to patients'. Beyond this, findings suggest two distinct sets of associations regarding reaction to uncertainty. Firstly, affective aspects of uncertainty (the 'Anxiety' and 'Concern' subscales) were associated with female gender, less experience in hospital prior to commencing general practice training, and graduation overseas. Secondly, a maladaptive response to uncertainty (the 'Reluctance to disclose' subscale) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status, and being Australian-trained. This study has established levels of three measures of trainees' responses to uncertainty and associations with these responses. The current findings suggest differing 'phenotypes' of trainees with high 'affective' responses to uncertainty and those reluctant to disclose uncertainty to patients. More

  19. Multiple strike slip faults sets: A case study from the Dead Sea transform

    Science.gov (United States)

    Ron, Hagai; Nur, Amos; Eyal, Y.

    1990-01-01

    In many strike slip tectonic settings, large rotations of crust blocks about vertical axes have been inferred from paleomagnetic data. These blocks are bounded by sets of parallel faults which presumably accommodate the relative motion between the blocks as regional deformation progress. A mechanical model by Nur et al., (1986) suggests that rotations greater than phi sub c equals 25 to 45 degrees must be accommodated by more than one set of faults, with angle phi sub c between their direction; consequently the sum of the angles between sets must be roughly equal to the total tectonic material rotation. To test this model, the authors investigated the fault geometry and field relation of fault sets in the Mt. Hermon area in northern Israel, where paleomagnetic declination implies data 69 degrees plus or minus 13 degrees counter-clockwise block rotation. The statistical and field relation analysis of over 315 faults shows that the faulting is predominantly right lateral strike slip consisting of three distinct sets. The oldest set strikes 253 degrees, the second oldest set strikes 293 degrees and the youngest strikes 339 degrees. This last direction is consistent also with the current north-south direction of the maximum principle stress axis. The angle phi sub c between the first and second sets is 39 degrees and between the second and third sets 46 degrees, in good agreement with the phi sub c angle predicted from mechanical considerations. The sum of the two angles is 85 degrees, in good agreement with the 69 degrees plus or minus 13 degrees CCW paleomagnetically derived rotation. The results suggest specifically that the sequential development of multiple intersecting fault sets is responsible for the faulting in the Mt. Hermon area; and generally that the model of block rotation with multiple faults provides very good simple rules for analyzing very complex fault patterns.

  20. The effectiveness of nurse education and training for clinical alarm response and management: a systematic review.

    Science.gov (United States)

    Yue, Liqing; Plummer, Virginia; Cross, Wendy

    2017-09-01

    To identify the effectiveness of education interventions provided for nurses for clinical alarm response and management. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating effectiveness for nurse education interventions is limited. Systematic review. A systematic review of experimental studies published in English from 2005-2015 was conducted in four computerised databases (MEDLINE, EMBASE, CINAHL and Scopus). After identification, screening and appraisal using Joanna Briggs Institute instruments, quality research papers were selected, data extraction and analysis followed. Five studies met the inclusion criteria for alarm response and no articles were concerned with clinical alarm education for management. All had different types and methods of interventions and statistical pooling was not possible. Response accuracy, response time and perceptions were consistent when different interventions were adopted. A positive effect was identified when learning about general alarms, single alarms, sequential alarms and medium-level alarms for learning as the primary task. Nurses who were musically trained had a faster and more accurate alarm response. Simulation interventions had a positive effect, but the effect of education provided in the care unit was greater. Overall, clinical alarm awareness was improved through education activities. Nurses are the main users of healthcare alarms and work in complex environments with high numbers of alarms, including nuisance alarms and other factors. Alarm-related adverse events are common. The findings of a small number of experimental studies with diverse evidence included consideration of various factors when formulating education strategies. The factors which influence effectiveness of nurse education are nurse demographics, nurse participants with musical training, workload and characteristics of alarms. Education interventions based in clinical practice settings increase

  1. Development of criteria for evaluating clinical response in thyroid eye disease using a modified Delphi technique

    DEFF Research Database (Denmark)

    Douglas, Raymond S; Tsirbas, Angelo; Gordon, Mark

    2009-01-01

    OBJECTIVE: To identify components of a provisional clinical response index for thyroid eye disease using a modified Delphi technique. METHODS: The International Thyroid Eye Disease Society conducted a structured, 3-round Delphi exercise establishing consensus for a core set of measures for clinical...... trials in thyroid eye disease. The steering committee discussed the results in a face-to-face meeting (nominal group technique) and evaluated each criterion with respect to its feasibility, reliability, redundancy, and validity. Redundant measures were consolidated or excluded. RESULTS: Criteria were...... exercise, we developed provisional core measures for assessing disease activity and severity in clinical trials of therapies for thyroid eye disease. These measures will be iteratively refined for use in multicenter clinical trials....

  2. Isolated Sensorineural Hearing Loss as a Sequela after Lightning Strike

    Directory of Open Access Journals (Sweden)

    Mahfuz Turan

    2015-01-01

    Full Text Available In most of the surviving patients after a lightning strike, audiovestibular abnormalities have been reported. The most frequently reported type of abnormalities is a tympanic membrane perforation with hearing loss and external ear canal burn. However a sensor neural hearing loss and mixed type hearing loss can also occur, but these occur rarely. A nineteen-year-old female patient had, after a lightning strike, serious burns on the left ear, behind the ear, and on the chest and neck. She also had in her left ear 108 dB hearing loss with irregular central perforation and in her right ear 52 dB sensorineural hearing loss. There was no hearing loss before the strike. A hearing aid was recommended for the right ear and good care and follow-up were recommended for the left ear. A lightning strike can cause serious audiological damage. Therefore, it is necessary to make a careful audiovestibular evaluation of the patients. Although there exist rarely healed cases from sensorineural hearing loss after lightning strike in literature, in our case hearing loss occurred bilaterally and then it healed unilaterally. This condition is quite rare in literature.

  3. Sunitinib in urothelial cancer: clinical, pharmacokinetic, and immunohistochemical study of predictors of response.

    LENUS (Irish Health Repository)

    Gallagher, David J

    2012-02-01

    BACKGROUND: Sunitinib has activity in patients with metastatic urothelial cancer (UC), but most patients do not respond. OBJECTIVE: To identify predictors of response to sunitinib. DESIGN, SETTING, AND PARTICIPANTS: Seventy-seven patients with advanced UC received sunitinib on one of two schedules at a single institution. Blood pressure (BP), immunohistochemistry (IHC), and pharmacokinetic (PK) results were correlated with response to sunitinib. MEASUREMENTS: BP was assessed on day 1 and 28 of each cycle and on day 14 of cycle 1. IHC was performed on 55 samples from 38 cases using mammalian target of rapamycin and hypoxia-inducible factor (HIF) pathway marker antibodies. Blood samples for PK analysis were collected from 15 patients at three time points. Response was assessed using Response Evaluation Criteria in Solid Tumors criteria. RESULTS AND LIMITATIONS: Sunitinib-induced hypertension predicted improved response when hypertension was categorized as a discrete (p = 0.02) or continuous variable (p = 0.005 [systolic BP] and p = 0.007 [diastolic BP]). The odds ratio of response was 12.5 (95% confidence interval, 1.95-246.8) for grade 3\\/4 hypertension compared with grade 0. Response was associated with low HIF-1alpha expression in primary (p = 0.07) tissue. A nonstatistically significant trend was seen for an association between greater drug concentration and best response. A correlation between expression markers within the same pathways was identified, phosphorylated-4EBP1 and phosphorylated-S6 (p = 6.5 x 10(-9)), and vascular endothelial growth factor receptor 2 and HIF-1alpha (p = 0.008). Results are limited by small numbers. CONCLUSIONS: Clinical and molecular biomarkers of response to sunitinib may have clinical relevance and require prospective validation. There is an urgent need for predictive biomarkers to guide the management of UC.

  4. Ethical responsibilities toward indirect and collateral participants in pragmatic clinical trials.

    Science.gov (United States)

    Smalley, Jaye Bea; Merritt, Maria W; Al-Khatib, Sana M; McCall, Debbe; Staman, Karen L; Stepnowsky, Carl

    2015-10-01

    Pragmatic clinical trials are designed to inform decision makers about the benefits, burdens, and risks of health interventions in real-world settings. Pragmatic clinical trials often use for research purposes data collected in the course of clinical practice. The distinctive features of pragmatic clinical trials demand fresh thinking about what is required to act properly toward people affected by their conduct, in ways that go beyond ensuring the protection of rights and welfare for "human research subjects" under conventional research ethics regulations. To stimulate such work, we propose to distinguish among categories of research participants in pragmatic clinical trials as follows: Direct participants: (1) individuals being directly intervened upon and/or (2) individuals from whom personal identifiable data are being collected for the purposes of the pragmatic clinical trial. Indirect participants: individuals who are (1) not identified as direct participants and (2) whose rights and welfare may be affected by the intervention through their routine exposure to the environment in which the intervention is being deployed. Collateral participants: patient groups and other stakeholder communities who may be otherwise affected by the occurrence and findings of the pragmatic clinical trial. We illustrate these distinctions with case examples and discuss the distinctive responsibilities of researchers and pragmatic clinical trial leadership toward each type of participant. We suggest that pragmatic clinical trial investigators, institutional review boards, health systems leaders, and others engaged in the research enterprise work together to identify these participants. For indirect participants, risks and benefits to which they are exposed should be weighed to ensure that their rights and welfare are protected accordingly, and communication strategies should be considered to help them make well-informed decisions. Collateral participants could provide input on the

  5. Criteria for evaluating response and outcome in clinical trials for children with juvenile myelomonocytic leukemia.

    LENUS (Irish Health Repository)

    Niemeyer, Charlotte M

    2015-01-01

    Juvenile myelomonocytic leukemia is a rare myeloproliferative disease in young children. While hematopoietic stem cell transplantation remains the only curative therapeutic option for most patients, children with juvenile myelomonocytic leukemia increasingly receive novel agents in phase I-II clinical trials as pre-transplant therapy or therapy for relapse after transplantation. However, response criteria or definitions of outcome for standardized evaluation of treatment effect in patients with juvenile myelomonocytic leukemia are currently lacking. Here we propose criteria to evaluate the response to the non-transplant therapy and definitions of remission status after hematopoietic stem cell transplantation. For the evaluation of non-transplant therapy, we defined 6 clinical variables (white blood cell count, platelet count, hematopoietic precursors and blasts in peripheral blood, bone marrow blast percentage, spleen size and extramedullary disease) and 3 genetic variables (cytogenetic, molecular and chimerism response) which serve to describe the heterogeneous picture of response to therapy in each individual case. It is hoped that these criteria will facilitate the comparison of results between clinical trials in juvenile myelomonocytic leukemia.

  6. Safety, Clinical Response, and Microbiome Findings Following Fecal Microbiota Transplant in Children With Inflammatory Bowel Disease.

    Science.gov (United States)

    Goyal, Alka; Yeh, Andrew; Bush, Brian R; Firek, Brian A; Siebold, Leah M; Rogers, Matthew Brian; Kufen, Adam D; Morowitz, Michael J

    2018-01-18

    The role of fecal microbiota transplant (FMT) in the treatment of pediatric inflammatory bowel disease (IBD) is unknown. The aims of this study were to assess safety, clinical response, and gut microbiome alterations in children with Crohn's disease (CD), ulcerative colitis (UC), or indeterminate colitis (IC). In this open-label, single-center prospective trial, patients with IBD refractory to medical therapy underwent a single FMT by upper and lower endoscopy. Adverse events, clinical response, gut microbiome, and biomarkers were assessed at baseline, 1 week, 1 month, and 6 months following FMT. Twenty-one subjects were analyzed, with a median age of 12 years, of whom 57% and 28% demonstrated clinical response at 1 and 6 months post-FMT, respectively. Two CD patients were in remission at 6 months. Adverse events attributable to FMT were mild to moderate and self-limited. Patients prior to FMT showed decreased species diversity and significant microbiome compositional differences characterized by increased Enterobacteriaceae, Enterococcus, Haemophilus, and Fusobacterium compared with donors and demonstrated increased species diversity at 30 days post-FMT. At 6 months, these changes shifted toward baseline. Clinical responders had a higher relative abundance of Fusobacterium and a lower diversity at baseline, as well as a greater shift toward donor-like microbiome after FMT compared with nonresponders. A single FMT is relatively safe and can result in a short-term response in young patients with active IBD. Responders possessed increased Fusobacterium prior to FMT and demonstrated more significant microbiome changes compared with nonresponders after FMT. Microbiome characteristics may help in predicting response. © 2018 Crohn’s & Colitis Foundation of America. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. Traumatic Reticuloperitonitis in Water Buffalo (Bubalus bubalis: Clinical Findings and the Associated Inflammatory Response

    Directory of Open Access Journals (Sweden)

    Maged El-Ashker

    2013-01-01

    Full Text Available The present study was carried out to describe the clinical picture of traumatic reticuloperitonitis (TRP in water buffalo (Bubalus bubalis and to evaluate the inflammatory and immunologic responses for this clinical condition. Twenty-two buffalo with acute local TRP were monitored in our study. Additionally, 10 clinically healthy buffalo were randomly selected and served as controls. Acute local TRP was initially diagnosed by clinical examination and confirmed by ultrasonographic (USG examination and/or necropsy findings. Blood samples were collected from all examined buffalo to measure the respective levels of tumor necrosis factor alpha (TNF-α, interleukin (IL-1β, IL-6, IL-10 and interferon gamma (INF-γ, serum amyloid A (SAA, C-reactive protein (CRP, haptoglobin (Hp, fibrinogen (Fb, and serum sialic acid (SSA. It was found that TNF-α, IL-1β, IL-6, IL-10, SAA, CRP, Hp, Fb, and SSA were significantly higher in buffalo with TRP than the controls. Our findings suggest that the examined immunologic variables were helpful in documenting the inflammatory response in buffalo with TRP. However, their diagnostic usefulness only becomes apparent when considered in tandem with the clinical findings for any given animal, its anamnesis, and a subsequent USG assessment. Due to the frequent complications of TRP, more accurate indicators of its occurrence and severity would be useful.

  8. Adaptive Response, Evidence of Cross-Resistance and Its Potential Clinical Use

    Directory of Open Access Journals (Sweden)

    Dušan Šuput

    2012-08-01

    Full Text Available Organisms and their cells are constantly exposed to environmental fluctuations. Among them are stressors, which can induce macromolecular damage that exceeds a set threshold, independent of the underlying cause. Stress responses are mechanisms used by organisms to adapt to and overcome stress stimuli. Different stressors or different intensities of stress trigger different cellular responses, namely induce cell repair mechanisms, induce cell responses that result in temporary adaptation to some stressors, induce autophagy or trigger cell death. Studies have reported life-prolonging effects of a wide variety of so-called stressors, such as oxidants, heat shock, some phytochemicals, ischemia, exercise and dietary energy restriction, hypergravity, etc. These stress responses, which result in enhanced defense and repair and even cross-resistance against multiple stressors, may have clinical use and will be discussed, while the emphasis will be on the effects/cross-effects of oxidants.

  9. VARIATION OF STRIKE INCENTIVES WITH DAMAGE PREFERENCES; FINAL

    International Nuclear Information System (INIS)

    G. CANAVAN

    2001-01-01

    For START III level forces, strike allocations and magnitudes vary little with L, but first strike costs vary directly with L, which means that for K reflecting a preference for the survival of high value targets over their destruction and a preference for high value over military targets, the costs of action are far greater than those of inaction for a wide range of values of damage preference L. Thus, if both sides have much greater preferences for the survival of their high value targets than for military targets or destruction, they do not see a net incentive to strike, and crises are terminated by inaction. Recent decades suggest strong preferences for the survival of high value and that this has contributed to the lack of direct conflict during that period

  10. Preoperative neutrophil response as a predictive marker of clinical outcome following open heart surgery and the impact of leukocyte filtration.

    LENUS (Irish Health Repository)

    Soo, Alan W

    2010-11-01

    Open heart surgery is associated with a massive systemic inflammatory response. Neutrophils, are the main mediator of this response. We hypothesised that the degree of neutrophil activation and inflammatory response to open heart surgery varies individually and correlates with clinical outcome. The aim of this study was to determine if individual clinical outcome can be predicted preoperatively through assessment of in-vitro stimulated neutrophil responses. Following that, the effects of neutrophil depletion through leukocyte filters are examined.

  11. Natural history and clinical response: "it's the virus, stupid, or is it the host?".

    Science.gov (United States)

    Nucara, Stefania; Caroleo, Benedetto; Guadagnino, Vincenzo; Perrotti, Nicola; Trapasso, Francesco

    2012-01-01

    A major goal of modern medicine is the application of personalized therapies, consisting of decisions and practices tailored to the individual patient. Information about genetic variants, either mutant or polymorphic, represents the basis for the development of this clinical approach. Recently, several independent genome-wide association studies (GWAS) have identified two single nucleotide polymorphisms (SNPs) on the IL28B locus associated with HCV containment, spontaneous clearance, treatment response, and disease progression. In this minireview we will concisely discuss some critical genetic concepts that may have possible implications for clinical decisions in the treatment of HCV infection.

  12. Simulation and measurement of melting effects on metal sheets caused by direct lightning strikes

    Science.gov (United States)

    Kern, Alexander

    1991-01-01

    Direct lightning strikes melt metal parts of various systems, like fuel and propellant tanks of rockets and airplanes, at the point of strike. Responsible for this melting are the impulse current and, if occurring, the long duration current, both carrying a remarkable charge Q. For studying these meltings the simulation in the laboratory has to be based on the parameters of natural lightnings. International standards exist defining certain threat levels of natural lightnings and giving possible generator circuits for the simulation. The melting caused by both types of lightning currents show different appearance. Their characteristics, their differences in melting and heating of metal sheets are investigated. Nevertheless the simulation of lightning in the laboratory is imperfect. While natural lightning is a discharge without a counter electrode, the simulation always demands a close counter electrode. The influence of this counter electrode is studied.

  13. [Force-feeding of hunger-striking prisoners].

    Science.gov (United States)

    Glick, Shimon

    2014-09-01

    In contrast to the position of the World Medical Association and the Ethics Council of the Israel Medical Association, the author argues for forced-feeding of hunger-striking prisoners when their condition reaches a stage of danger of death or permanent injury. This position is based on the priority of human life over autonomy, and of a communitarian ethic. This position is supported by a District Court decision ordering the feeding of a hunger-striking prisoner, by a Supreme Court decision imposing surgery on a non-consenting prisoner, and in line with Israel's Patient's Right Law.

  14. Sound Quality and Striking Position of a Conga Drum

    Directory of Open Access Journals (Sweden)

    Dylan Harvey

    2014-12-01

    Full Text Available The relationship between the location at which a drum membrane was struck and the quality of sound produced was investigated by striking the drum at several distances between the center and the rim. Through analyzing the harmonics of the wave produced from the impact, it was shown that as the striking location changes, the relative amplitudes of different modes of vibration also changes. It was found that sound of a higher pitch is produced at the rim of the drum than anywhere else on the drum head due to higher modes of vibration becoming dominant.

  15. MORE THAN A LABOR DISPUTE: THE PATCO STRIKE OF 1981

    Directory of Open Access Journals (Sweden)

    Paul L. Butterworth

    2005-01-01

    Full Text Available On August 3, 1981, 13,000 air traffic controllers walked off the job. Under US law, the strike was illegal. President Ronald Reagan ordered the strikers as a group to return to work; when they did not, he ordered individual strikers to return, and again they refused. Two days later the president fired the strikers. Reagan's action transformed relations between organized labor and American management, and created the worst turbulence to hit the American airways in recent history. “More Than a Labor Dispute” examines the work stoppage and aftermath through the eyes of two controllers and a pilot, all of whom worked during the strike.

  16. Remarkable rates of lightning strike mortality in Malawi.

    Science.gov (United States)

    Mulder, Monique Borgerhoff; Msalu, Lameck; Caro, Tim; Salerno, Jonathan

    2012-01-01

    Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.

  17. Placebo response rate in clinical trials of fistulizing Crohn's disease: systematic review and meta-analysis.

    Science.gov (United States)

    Ford, Alexander C; Luthra, Pavit; Hanauer, Stephen B; Travis, Simon P; Harris, M Scott; Reinisch, Walter

    2014-12-01

    It is important to determine the magnitude and identify modifiers of the rate of response to placebo in clinical trials of fistulizing Crohn's disease (CD), to understand disease progression, and to calculate sample size. We conducted a systematic review and meta-analysis of rates of response to placebo in trials of patients with fistulizing CD. We searched MEDLINE, EMBASE, EMBASE CLASSIC, and the Cochrane central register of controlled trials for randomized controlled trials (RCTs) comparing pharmacologic agents with placebo in adults with fistulizing CD. We identified studies that reported complete fistula closure, partial closure, or response. Data were extracted as intention-to-treat analyses and pooled by using a random-effects model. Proportions of patients who received placebo and had complete or partial fistula(e) closure were calculated, with 95% confidence intervals (CIs). The effects of trial characteristics on the magnitude of response to placebo were examined. Thirteen RCTs were eligible for our analysis; these included 579 patients assigned to placebo groups. The pooled rate of response to placebo, among all RCTs, for complete fistula closure was 15.6% (95% CI, 10.9%-20.9%), with significant heterogeneity (I(2) = 62.5%, P = .001). The pooled rate of response to placebo for partial fistula closure or response in 9 trials, comprising 423 patients, was 18.3% (95% CI, 14.8%-22.1%). Rates of response to placebo were significantly lower in trials with shorter durations of therapy and shorter intervals to assessment of fistula closure. Neither exposure to the pharmacologic agent during the induction phase of the same (or related) RCT nor concomitant medications had any effect. In a meta-analysis of rate of response to placebo in patients with fistulizing CD, we found that fistulae closed in almost 1/6 patients given placebo in RCTs of pharmacologic agents. Future research should identify characteristics of patients that predict response to placebo. Copyright

  18. AMERICAN CUTANEOUS LEISHMANIASIS WITH UNUSUAL CLINICAL PRESENTATION AND RESPONSE TO TREATMENT

    Directory of Open Access Journals (Sweden)

    Andrea Claudia Bekner Silva FERNANDES

    2016-01-01

    Full Text Available The clinical manifestations and prognosis of cutaneous leishmaniasis (CL can be influenced by the immune response of the patient and the species of the parasite. A case of atypical clinical presentation of CL, with development of non-characteristic lesions, poor response to therapy, and a long time to resolution is reported. Confirmatory laboratory tests included parasite detection, indirect immunofluorescence, Montenegro skin test, polymerase chain reaction, and parasite identification by multilocus enzyme electrophoresis. The parasite was identified as Leishmaniabraziliensis. The lesion was unresponsive to three complete courses of N-methylglucamine antimoniate intramuscular, and to treatment with pentamidine. The patient did not tolerate amphotericin B. The lesion finally receded after treatment with intravenous N-methylglucamine antimoniate. It is essential to ensure the accuracy of diagnosis and the appropriate treatment, which can include the use a second choice drug or a different route of administration.

  19. Clinical features and early treatment response of central nervous system involvement in childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Levinsen, Mette; Taskinen, Mervi; Abrahamsson, Jonas

    2014-01-01

    BACKGROUND: Central nervous system (CNS) involvement in childhood acute lymphoblastic leukemia (ALL) remains a therapeutic challenge. PROCEDURE: To explore leukemia characteristics of patients with CNS involvement at ALL diagnosis, we analyzed clinical features and early treatment response of 744...... leukemia and patients without such characteristics (0.50 vs. 0.61; P = 0.2). CONCLUSION: CNS involvement at diagnosis is associated with adverse prognostic features but does not indicate a less chemosensitive leukemia....

  20. Evaluation of the tip-bending response in clinically used endoscopes.

    Science.gov (United States)

    Rozeboom, Esther D; Reilink, Rob; Schwartz, Matthijs P; Fockens, Paul; Broeders, Ivo A M J

    2016-04-01

    Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current technique of endoscope tip control is adequate for a future of high precision procedures, steerable accessories, and add-on robotics. The aim of this study was to determine the status of the tip response of endoscopes used in clinical practice. We evaluated 20 flexible colonoscopes and five gastroscopes, used in the endoscopy departments of a Dutch university hospital and two Dutch teaching hospitals, in a bench top setup. First, maximal tip bending was determined manually. Next, the endoscope navigation wheels were rotated individually in a motor setup. Tip angulation was recorded with a USB camera. Cable slackness was derived from the resulting hysteresis plot. Only two of the 20 colonoscopes (10 %) and none of the five gastroscopes reached the maximal tip angulation specified by the manufacturer. Four colonoscopes (20 %) and none of the gastroscopes demonstrated the recommended cable tension. Eight colonoscopes (40 %) had undergone a maintenance check 1 month before the measurements were made. The tip responses of these eight colonoscopies did not differ significantly from the tip responses of the other colonoscopes. This study suggests that the majority of clinically used endoscopes are not optimally tuned to reach maximal bending angles and demonstrate adequate tip responses. We suggest a brief check before procedures to predict difficulties with bending angles and tip responses.

  1. Predictive clinical model of tumor response after chemoradiation in rectal cancer.

    Science.gov (United States)

    Santos, Marisa D; Silva, Cristina; Rocha, Anabela; Nogueira, Carlos; Castro-Poças, Fernando; Araujo, António; Matos, Eduarda; Pereira, Carina; Medeiros, Rui; Lopes, Carlos

    2017-08-29

    Survival improvement in rectal cancer treated with neoadjuvant chemoradiotherapy (nCRT) is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. The ability to predict tumor response before treatment may significantly have impact the selection of patients for nCRT in rectal cancer. The aim is to identify potential predictive pretreatment factors for Mandard response and build a clinical predictive model design. 167 patients with locally advanced rectal cancer were treated with nCRT and curative surgery. Blood cell counts in peripheral blood were analyzed. Pretreatment biopsies expression of cyclin D1, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) and protein 21 were assessed. A total of 61 single nucleotide polymorphisms were characterized using the Sequenom platform through multiplex amplification followed by mass-spectometric product separation. Surgical specimens were classified according to Mandard TRG. The patients were divided as: "good responders" (Mandard TRG1-2) and "poor responders" (Mandard TGR3-5). We examined predictive factors for Mandard response and performed statistical analysis. In univariate analysis, distance from anal verge, neutrophil lymphocyte ratio (NLR), cyclin D1, VEGF, EGFR, protein 21 and rs1810871 interleukin 10 (IL10) gene polymorphism are the pretreatment variables with predictive value for Mandard response. In multivariable analysis, NLR, cyclin D1, protein 21 and rs1800871 in IL10 gene maintain predictive value, allowing a clinical model design. It seems possible to use pretreatment expression of blood and tissue biomarkers, and build a model of tumor response prediction to neoadjuvant chemoradiation in rectal cancer.

  2. Clinical and Laboratory Presentation of Hairy Cell Leukemia (Hcl and Rate of Response to Cladribine

    Directory of Open Access Journals (Sweden)

    M Forat Yazdi

    2008-04-01

    Full Text Available Introduction: HCL is a rare malignant condition that is curable if diagnosed early. HCL can present with reduced blood cells and splenomegaly which maybe misdiagnosed with other conditions. The aim of the present study was to determine the frequency of early clinical and laboratory findings as well as the response rate of patients to the standard treatment regimen of Cladribine. Methods: The study was an uncontrolled clinical trial including 25 HCL patients referring to Oncology Clinics of Shahid Sadoughi (Yazd - Iran and Shahid Beheshti (Tehran - Iran between 1999 and 2005. Data was gathered by a pre–designed questionnaire. 21 out of 25 patients were treated with Cladribine and the clinical and laboratory response was assessed. Results: Of the 25 patients studied, 20 patients (80% were male and 5 patients (20% were female. Most of the patients at diagnosis were 55–67 years old and the most common presenting symptom was fatigue and lassitude secondary to anemia. Two patients were asymptomatic and were diagnosed incidentally. Splenomegaly was the main clinical finding which was present in about 80% of the males and all of the females. Accordingly, hairy cells in the peripheral blood smear, leukopenia and anemia were the most common laboratory findings. In contrast to previous results, pancytopenia was found in only 60% of the patients. Response rate was 90% (19 out of 21 of which 61.9% (13 patients and 28.5% (6 patients had complete remission (CR and partial remission (PR, respectively. Conclusion: According to the results, it can be concluded that HCL should be considered as a possible diagnosis in the context of fatigue, splenomegaly and reduced blood cell count. The results of the present study were similar to other similar international studies.

  3. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  4. Clinical and biological predictors of response to electroconvulsive therapy (ECT): a review.

    Science.gov (United States)

    Pinna, Martina; Manchia, Mirko; Oppo, Rossana; Scano, Filomena; Pillai, Gianluca; Loche, Anna Paola; Salis, Piergiorgio; Minnai, Gian Paolo

    2018-03-16

    Electroconvulsive therapy (ECT), developed in the 30's by Bini and Cerletti, remains a key element of the therapeutic armamentarium in psychiatry, particularly for severe and life-threatening psychiatric symptoms. However, despite its well-established clinical efficacy, the prescription of ECT has declined constantly over the years due to concerns over its safety (cognitive side effects) and an increasingly negative public perception. As for other treatments in the field of psychiatry, ECT is well suited to a personalized approach that would increment its efficacy, as well as reducing the impact of side effects. This should be based on the priori identification of sub-populations of patients sharing common clinical and biological features that predict a good response to ECT. In this review we have selectively reviewed the evidence on clinical and biological predictors of ECT response. Clinical features such as an older age, presence of psychotic and melancholic depression, a high severity of suicide behavior, and speed of response, appear to be shared by ECT good responders with depressive symptoms. In mania, a greater severity of the index episode, and a reduction of whole brain cortical blood flow are associated with ECT good response. Biological determinants of ECT response in depressive patients are the presence of pre-treatment hyperconnectivity between key areas of brain circuitry of depression, as well as of reduced glutamine/glutamate levels, particularly in the anterior cingulated cortex (ACC). Furthermore, pre ECT high plasma homovanillic acid (HVA) levels, as well as of tumor necrosis factor (TNF)-α, and low pre-ECT levels of S-100B protein, appear to predict ECT response. Finally, polymorphisms within the genes encoding for the brain-derived neurotrophic factor (BDNF), the dopamine 2 receptor gene (DRD2), the dopamine receptor 3 gene (DRD3), the cathechol-o-methyltransferase (COMT), the serotonin-transporter (5-HTT), the 5-hydroxytryptamine 2A receptor

  5. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations.

    Science.gov (United States)

    Kim, Hunmin; Hwang, Hee; Cheong, Hae Il; Park, Hye Won

    2011-11-01

    Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1Sp.Arg528His and SCN4A p.Arg672His). Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

  6. Impact of Clinical Response on Different Approved Doses in Japan and the United States.

    Science.gov (United States)

    Sugita, Yuko; Inoue, Eisuke; Narukawa, Mamoru

    2012-10-01

    The pharmaceutical industry has increasingly aimed to achieve efficient strategies for simultaneous international and worldwide development of medicines, and there has been a growing need to understand ethnic differences in drug evaluation. Japan is one of the unique countries in which substantial domestic clinical data are required for dose selection as well as for marketing authorization. However, it appears challenging to accumulate a large amount of data in a single country in the recent shift to international drug development. To gain a better understanding of the influence of ethnic factors, the dosages of the products approved in Japan during 2003-2010 were reviewed, and differences in clinical responses between Japan and the United States were evaluated using a modeling approach. Of new medicines (new molecular entities) approved in Japan, 39 products (28.1%) have been approved at a different dose level compared with the United States, of which 13 products have considerable difference, twice or greater. Of those 13 products, only 2 were suggested to have a different clinical response, although limited data availability should be taken into careful consideration. Further investigation is recommended to establish new approaches for appropriate dose selection and thereby increase the efficiency of international drug development. 2012 American College of Clinical Pharmacology.

  7. Clinical, haematological and biochemical responses of sheep undergoing autologous blood transfusion

    Directory of Open Access Journals (Sweden)

    Sousa Rejane

    2012-05-01

    Full Text Available Abstract Background This study aimed to evaluate the clinical, haematological and biochemical responses to autologous blood transfusion and the feasibility of this practice in sheep. Thus, we used eight male, 8 months old sheep, weighing on average 30 kg, from which 15 mL/kg of whole blood was collected and stored in CPDA-1 bags. Blood samples were refrigerated for 8 days and subsequently re-infused. The clinical, haematological and biochemical parameters were evaluated before blood collection and reinfusion, after 10 minutes of collection and reinfusion, after 3, 6, 12, 24, 48, 96 and 192 hours after collection and reinfusion. Results With respect to clinical parameters, we observed a decrease in heart rate after 24, 48 and 196 hours from reinfusion compared to basal values (p p p p  Conclusion Autologous transfusion in sheep slightly altered the physiological, biochemical and haematological responses of sheep, indicating that the technique proposed is safe and can be applied in the clinical practice of this species. The 8 d period was not sufficient for complete recovery of the haematological parameters after blood collection.

  8. EDITORIAL Plagiarism - time to strike at the epidemic

    African Journals Online (AJOL)

    admin

    Plagiarism - time to strike at the epidemic. Lukman Yusuf1, Abraham Aseffa2. We live in a globalized world where information is instantly shared across continents. The number of biomedical journals available for reference is quite enormous and there is a sudden huge surge of free open access journals in the last few years ...

  9. The Eastern Pacific Tropical Cyclone Strike Probability Program (EPSTRKP).

    Science.gov (United States)

    1980-08-01

    of nine preselected points of interest. Although subject to change the points currently listed within the program are: Acapulco, Mazatlan, Puerto ... Vallarta , La Paz, San Diego, Hilo, Honolulu, Johnston Island and Midway Island. The strike probabilities, computed upon receipt of each 6-hourly warning

  10. Effects of Union Organization on Strike Incidence in EU Companies

    NARCIS (Netherlands)

    Jansen, Giedo

    2014-01-01

    The author reinvestigates the relationship between the organizational power of trade unions and strikes based on data from the European Company Survey 2009 (ECS-2009) and the Institutional Characteristics of Trade Unions, Wage Setting, State Intervention and Social Pacts (ICTWSS) database, which

  11. Monte Carlo Simulation to Estimate Likelihood of Direct Lightning Strikes

    Science.gov (United States)

    Mata, Carlos; Medelius, Pedro

    2008-01-01

    A software tool has been designed to quantify the lightning exposure at launch sites of the stack at the pads under different configurations. In order to predict lightning strikes to generic structures, this model uses leaders whose origins (in the x-y plane) are obtained from a 2D random, normal distribution.

  12. Torts Liability for Strike Action and Third Party Rights.

    Science.gov (United States)

    Raday, Frances

    1979-01-01

    Studies the nature of the torts liability incurred in strikes and the extent of existing immunities bestowed on strikers and their organizers, and explores the principles that should govern liability and immunity. Available from Israel Law Review Association, c/o Faculty of Law, Hebrew University of Jerusalem, Mount Scopus, P.O.B. 24100, Jerusalem…

  13. Nurses need the right to strike to protect patients.

    Science.gov (United States)

    Harrison, Malcolm

    2012-04-25

    Four of your readers panellists were asked if the RCN should be affiliated to the Trades Union Congress (reflections April 4). One of them said the RCN needs to modernise and join the wider trade union movement, but 'should keep the "no strike" policy that has always served it so well'.

  14. Analysis of the effects of frequent strikes on academic performance ...

    African Journals Online (AJOL)

    The history of Academic Staff Union of Universities (ASUU)'s strike can be traced back to 1978, the period of the beginning of the decline in the oil boom, when the country faced the consequences of the failure by its rulers to use the oil wealth to generate production and a social welfare system. Military dictatorship had ...

  15. On Striking for a Bargain between Two Completely Informed Agents

    NARCIS (Netherlands)

    Houba, H.E.D.; Wen, Q.

    2007-01-01

    This paper provides a thorough equilibrium analysis of a wage contract negotiation model where the union must choose between strike and holdout between offers and counter-offers. When the union and the firm have different discount factors, delay in reaching an agreement may Pareto dominate many

  16. Assemblage of strike-slip faults and tectonic extension and ...

    Indian Academy of Sciences (India)

    12

    and its effect on the productivity of the tight reservoirs. The study will not only guide. 95 the oil-gas ..... 5 Effect of tectonic extension and compression on coal reservoir productivity. 288. 5.1 Strike-slip compression and ..... staff of all the authors that cooperated in performing the analyses. We are also. 425 grateful to the ...

  17. Assemblage of strike-slip faults and tectonic extension and ...

    Indian Academy of Sciences (India)

    12

    Assemblage of strike-slip faults and tectonic. 1 extension and compression analysis: A case. 2 study of a Lower Permian commercial coal. 3 reservoir in China. 4. 5. Shuai Yina,*, Dawei Lvb, Zhonghu Wu c .... high-quality reservoirs, and tectonic action is a leading factor for oil and gas. 70 enrichment. Therefore, it is of great ...

  18. BIRD/WILDLIFE STRIKE CONTROL FOR SAFER AIR ...

    African Journals Online (AJOL)

    Osondu

    2012-06-05

    Jun 5, 2012 ... These include staff training and retraining, developing good data bank based on .... wildlife is very important in bird control. Successful habitat ... Designated staff patrols the airside areas using chemical repellants, propane cannons, distress call. Birds/Wildlife Strikes Control for Safer Air .................Usman et ...

  19. LAW AND ETHICS OF STRIKES IN THE NIGERIAN HEALTH SYSTEM

    African Journals Online (AJOL)

    2014-10-06

    Oct 6, 2014 ... MDCN Code of ethics intends to give right for cessation of work by workers in the health sector of the economy. Thus under the Common Law, a strike, especially in the essential services is a breach of the contract of employment. The Trade. Union (amendment) Act (Federal Republic of. Nigeria, 2005) ...

  20. Growth control of kalanchoe cultivars Rako and Gold Strike by ...

    African Journals Online (AJOL)

    This study was conducted to test the potential of paclobutrazol and uniconazole used at the propagation stage as a plant growth retardant (PGR) of kalanchoe cultivars Rako and Gold Strike. Three node terminal cuttings were soaked in 500 mL of 0.05, 0.25, or 0.50 mg·L-1 paclobutrazol or uniconazole solution for 2 h.

  1. Striking Inside Angola with 32 Battalion | Scheepers | Scientia ...

    African Journals Online (AJOL)

    Scientia Militaria: South African Journal of Military Studies. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 42, No 1 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Striking Inside Angola with 32 ...

  2. Force, reaction time, and precision of Kung Fu strikes.

    Science.gov (United States)

    Neto, Osmar Pinto; Bolander, Richard; Pacheco, Marcos Tadeu Tavares; Bir, Cynthia

    2009-08-01

    The goal was to compare values of force, precision, and reaction time of several martial arts punches and palm strikes performed by advanced and intermediate Kung Fu practitioners, both men and women. 13 Kung Fu practitioners, 10 men and three women, participated. Only the men, three advanced and seven intermediate, were considered for comparisons between levels. Reaction time values were obtained using two high speed cameras that recorded each strike at 2500 Hz. Force of impact was measured by a load cell. For comparisons of groups, force data were normalized by participant's body mass and height. Precision of the strikes was determined by a high speed pressure sensor. The results show that palm strikes were stronger than punches. Women in the study presented, on average, lower values of reaction time and force but higher values of precision than men. Advanced participants presented higher forces than intermediate participants. Significant negative correlations between the values of force and precision and the values of force and reaction time were also found.

  3. The Antibody-Secreting Cell Response to Infection: Kinetics and Clinical Applications

    Directory of Open Access Journals (Sweden)

    Michael J. Carter

    2017-06-01

    Full Text Available Despite the availability of advances in molecular diagnostic testing for infectious disease, there is still a need for tools that advance clinical care and public health. Current methods focus on pathogen detection with unprecedented precision, but often lack specificity. In contrast, the host immune response is highly specific for the infecting pathogen. Serological studies are rarely helpful in clinical settings, as they require acute and convalescent antibody testing. However, the B cell response is much more rapid and short-lived, making it an optimal target for determining disease aetiology in patients with infections. The performance of tests that aim to detect circulating antigen-specific antibody-secreting cells (ASCs has previously been unclear. Test performance is reliant on detecting the presence of ASCs in the peripheral blood. As such, the kinetics of the ASC response to infection, the antigen specificity of the ASC response, and the methods of ASC detection are all critical. In this review, we summarize previous studies that have used techniques to enumerate ASCs during infection. We describe the emergence, peak, and waning of these cells in peripheral blood during infection with a number of bacterial and viral pathogens, as well as malaria infection. We find that the timing of antigen-specific ASC appearance and disappearance is highly conserved across pathogens, with a peak response between day 7 and day 8 of illness and largely absent following day 14 since onset of symptoms. Data show a sensitivity of ~90% and specificity >80% for pathogen detection using ASC-based methods. Overall, the summarised work indicates that ASC-based methods may be very sensitive and highly specific for determining the etiology of infection and have some advantages over current methods. Important areas of research remain, including more accurate definition of the timing of the ASC response to infection, the biological mechanisms underlying variability

  4. What is the role of the consultant responsible for postgraduate education in the clinical department?

    DEFF Research Database (Denmark)

    Malling, B; Scherpbier, A J J A; Ringsted, C

    2007-01-01

    BACKGROUND: The organisation of specialist training is complex and involves many clinical departments. The position of consultants responsible for education (CRE) in specialist training at department level is poorly defined in the literature. AIMS: The aim of the study was to explore expectations...... of stakeholders concerning the role and position of a CRE in specialist training. METHOD: The role and position of the CRE was explored using focus group and semi-structured individual interviews. RESULTS: Knowledge of tasks and responsibilities was limited in all stakeholders except among CREs. The expectations...... of stakeholders to the CRE varied according to their position in the hospital hierarchy. In general terms the CRE was expected to assume overall responsibility for specialist training, promote a positive educational climate and secure quality of specialist training along with numerous administrative tasks. All...

  5. Genetic and clinical predictors of ovarian response in assisted reproductive technology

    Science.gov (United States)

    Wiweko, B.; Damayanti, I.; Suryandari, D.; Natadisastra, M.; Pratama, G.; Sumapraja, K.; Meutia, K.; Iffanolia, P.; Harzief, A. K.; Hestiantoro, A.

    2017-08-01

    Several factors are known to influence ovarian response to rFSH stimulation such as age, antral follicle count (AFC), and basal FSH level, Mutation of allele Ser680Asn in FSHR gene was responsible to ovarian resistance toward exogenous FSH. The aim of this study is to develop a prediction model of ovarian response to COS in IVF. This study was a prospective cohort study. One hundred and thirteen women undergoing their first cycle of IVF in Yasmin IVF Clinic Jakarta were recruited to this study. Clinical datas included were age, BMI, and AFC. Basal FSH and E2 as well as serum AMH was measured from peripheral blood taken at second day of cycle. Bsr-1 enzyme is used to identify the polymorphism in exon 10 position 680 with RFLP technique. Three genotype polymorphism, Asn/Asn (255 bp ribbon), Asn/Ser (97 bp and 158 bp), and Ser/Ser (97 bp, 158 bp, and 255 bp). AFC has the highest predictor for ovarian response with AUC 0.922 (CI 95% 0.833-1.000). AMH also showed high predicting value (AUC 0.843 CI 95% 0.663-1.000). The multivariate analysis revealed combination of AFC, AMH, age, and basal FSH is a good model for ovarian response prediction (AUC=0.97). No significant relation between Asn/Asn, Asn/Ser, or Ser/Ser genotype FSHR polymorphism with ovarian response (p = 0.866) and total dose of rRSH (p = 0.08). This study showed that model combination of AFC, AMH, patient’s age and basal FSH are very good to predict number of mature oocytes.

  6. Long-term clinical response to cardiac resynchronisation therapy under a multidisciplinary model.

    Science.gov (United States)

    O'Donnell, D; Lin, T; Swale, M; Rae, P; Flannery, D; Srivastava, P M

    2013-11-01

    Cardiac resynchronisation therapy (CRT) is established in the management of cardiac failure in patients with systolic dysfunction. Clinical response to CRT is not uniform, and response has been difficult to predict. Patient management within a high volume, multidisciplinary service focused on optimal delivery of CRT would improve response rates. Four hundred and thirty-five consecutive patients who underwent CRT under a multidisciplinary heart failure service were enrolled prospectively over a 5-year period. Medically optimised, symptomatic patients with an ejection fraction (EF) mechanical activation, and electrically to a site with maximal intrinsic intracardiac electrogram separation. Routine device and clinical follow up, as well as CRT optimisations, were performed at baseline and at 3-monthly intervals. Responders were defined as having an absolute reduction in left ventricular end-diastolic diameter >10% and an improvement in EF >5%. With a mean follow up of 53 ± 11 months, response rate to CRT was 81%. Mean EF improved from 26 ± 10% to 37 ± 11%, and mean left ventricular end-diastolic diameter reduced from 68.6 ± 9.2 mm to 57.8 ± 9.3 mm. Predictors of response were sinus rhythm, high dyssynchrony index and intrinsic electrical dyssynchrony >80 ms. Successful LV lead implantation at initial procedure was achieved in 99.1%, and at latest follow up 94.6% of initial LV leads were still active. CRT undertaken with a unit focus on optimal LV lead positioning and device optimisation, along with a multidisciplinary follow-up model, results in an excellent response rate to CRT. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  7. 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.

  8. 77 FR 38595 - Taking and Importing Marine Mammals; Precision Strike Weapon and Air-to-Surface Gunnery Training...

    Science.gov (United States)

    2012-06-28

    ... [email protected] . NMFS is not responsible for email comments sent to addresses other than the one.... citizens who engage in a specified activity (other than commercial fishing) within a specified geographical... launched from most USAF aircraft, which makes it an important element of the USAF's Global Strike Task...

  9. Case Report: Mass Casualty Lightning Strike at Ranger Training Camp.

    Science.gov (United States)

    Thompson, Shannon N; Wilson, Zachary W; Cole, Christopher B; Kennedy, Andrew R; Aycock, Ryan D

    2017-05-01

    Although lightning strikes are a rare occurrence, their significance cannot be ignored given military operations in the field during all types of weather. With proper medical management, patients with lightning injuries can return to duty. Information for this case report comes from eyewitness account at the 6th Ranger Training Battalion and from review of physician documentation from the 96th Medical Group, Eglin Air Force Base, Florida. A lightning strike injured 44 Ranger School participants during a training exercise on August 12, 2015, at Camp Rudder, Florida. These patients were triaged in the field and transported to emergency department of Eglin Air Force Base. Of the 44 casualties, 20 were admitted. All were returned to duty the following day. One patient had cardiac arrest. This patient, along with two others, was admitted to the intensive care unit. Seventeen other patients were admitted for observation for rhabdomyolysis and/or cardiac arrhythmias. One patient was admitted with suspected acute kidney injury indicated by an elevated creatinine. All patients, including those admitted to the intensive care unit, were released on the day following the lightning strike without restrictions and were allowed to return to duty with increased medical monitoring. This case report highlights the need for proper triage and recognition of lightning strike injury, coordination of care between field operations and emergency department personnel, and close follow-up for patients presenting with lightning injury. Symptoms, physical exam, and laboratory findings from rigorous training can be difficult to distinguish from those resulting from lightning injury. Secondary injuries resulting from blunt trauma from falls may have been prevented by the use of the lightning strike posture. Further analysis of procedures and standard operating protocols to mitigate risk during thunderstorms may be required to prevent lightning's effects on large groups of military personnel

  10. Implications of Incessant Strike Actions on the Implementation of Technical Education Programme in Nigeria

    Science.gov (United States)

    Adavbiele, J. A.

    2015-01-01

    This paper was designed to x-ray the implications of incessant strike actions on the implementation of Technical education programme in Nigeria. The paper took an exploratory view on the concept of strike actions in Nigeria with particular references on notable strike actions that have occurred in Nigeria. The types of strike were explained and…

  11. Childhood optic chiasm gliomas: radiographic response following radiotherapy and long-term clinical outcome

    International Nuclear Information System (INIS)

    Tao, May L.; Barnes, Patrick D.; Billett, Amy L.; Leong, Traci; Shrieve, Dennis C.; Scott, R. Michael; Tarbell, Nancy J.

    1997-01-01

    Purpose: In children with chiasmal gliomas, radiation therapy can arrest progressive visual and neurologic impairment. We examined the radiographic response and clinical outcomes after irradiation. Methods and Materials: Forty-two children (median age at diagnosis, 6.6 years) with chiasmal gliomas were managed as follows: 11 asymptomatic patients with neurofibromatosis-1 (NF-1) were observed only; 2 patients, less than 3 years old, underwent surgery and chemotherapy to delay irradiation; and 29 patients with progressive disease received radiation with or without prior surgery or chemotherapy. Time to radiographic response, long-term tumor control and late sequelae were reviewed for the 29 irradiated patients. Results: The probability of at least 50% radiographic response at 24 months after irradiation was 18.1% and increased to 38.2% by 48 months and 45.9% by 60 months. By actuarial analysis, the median time for such radiographic response was 62 months. For the 29 irradiated patients, the 10-year freedom from progression and overall survival rates were 100% and 89%, respectively (median follow-up for surviving patients, 108 months). Stabilization or improvement in vision occurred in 81% of 26 evaluable irradiated patients. Conclusions: Notable radiographic response may be observed years after irradiation. Radiation therapy provides excellent long-term tumor control and vision preservation or improvement in the majority of patients with progressive chiasmal gliomas

  12. Discourse analysis of newspaper coverage of the 2001/2002 Canterbury, New Zealand mental health nurses' strike.

    Science.gov (United States)

    Farrow, Tony L; O'Brien, Anthony J

    2005-09-01

    In late 2001 Canterbury, New Zealand mental health nurses undertook a variety of strike actions after stalled industrial negotiations with the local district health board. One response to these actions was the temporary reduction of many of the regions metal health services. Unsurprisingly, the print media responded by publicizing the crisis in mental health services on an almost daily basis. This paper reports on subsequent research into these print media representations of the industrial disputes, identifying themes of juxtaposed but largely deprecatory images of both mental health nursing and of consumers of services. Some professional nursing voices were given print space during the strike; however, these were largely incorporated into existing discourses rather than offering a nursing viewpoint on the strike. We, therefore, conclude by suggesting organizational efforts to focus on ways of ensuring that mental health nurses are seen as a legitimate authority by the media.

  13. Cross-talk between clinical and host-response parameters of periodontitis in smokers.

    Science.gov (United States)

    Nagarajan, R; Miller, C S; Dawson, D; Al-Sabbagh, M; Ebersole, J L

    2017-06-01

    Periodontal diseases are a major public health concern leading to tooth loss and have also been shown to be associated with several chronic systemic diseases. Smoking is a major risk factor for the development of numerous systemic diseases, as well as periodontitis. While it is clear that smokers have a significantly enhanced risk for developing periodontitis leading to tooth loss, the population varies regarding susceptibility to disease associated with smoking. This investigation focused on identifying differences in four broad sets of variables, consisting of: (i) host-response molecules; (ii) periodontal clinical parameters; (iii) antibody responses to periodontal pathogens and oral commensal bacteria; and (iv) other variables of interest, in a population of smokers with (n = 171) and without (n = 117) periodontitis. Bayesian network structured learning (BNSL) techniques were used to investigate potential associations and cross-talk between the four broad sets of variables. BNSL revealed two broad communities with markedly different topology between the populations of smokers, with and without periodontitis. Confidence of the edges in the resulting network also showed marked variations within and between the periodontitis and nonperiodontitis groups. The results presented validated known associations and discovered new ones with minimal precedence that may warrant further investigation and novel hypothesis generation. Cross-talk between the clinical variables and antibody profiles of bacteria were especially pronounced in the case of periodontitis and were mediated by the antibody response profile to Porphyromonas gingivalis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Predictors of Taiwanese baccalaureate nursing students' physio-psycho-social responses during clinical practicum.

    Science.gov (United States)

    Chen, Ya-Wen; Hung, Chich-Hsiu

    2014-01-01

    The nursing educational process may contribute to stress in nursing students, particularly during clinical rotations. This descriptive study explored the relationships between perceived stress, coping behaviors, personality traits, and physio-psycho-social responses in a clinical practicum among baccalaureate nursing students and identified predictors for physio-psycho-social responses. A cross-sectional design was employed. One hundred and one juniors enrolled in a four-year baccalaureate nursing program in Taiwan participated in this study. Four structured questionnaires were utilized to collect data. Multiple regression analysis showed that three predictors accounted for 53.2% of the variance in students' physio-psycho-social responses, including perceived stress, students' gender, and personality traits. The implication for nursing educators is providing immediate assistance and appropriate support to guide students through difficult learning when they need. Nursing instructors also should pay attention to students' gender-linked differences and be aware of individuals' personality traits, especially those with emotional instability, unsocial behaviors, and depressive signs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Single Pulse Electrical Stimulation to identify epileptogenic cortex: Clinical information obtained from early evoked responses.

    Science.gov (United States)

    Mouthaan, B E; van 't Klooster, M A; Keizer, D; Hebbink, G J; Leijten, F S S; Ferrier, C H; van Putten, M J A M; Zijlmans, M; Huiskamp, G J M

    2016-02-01

    Single Pulse Electrical Stimulation (SPES) probes epileptogenic cortex during electrocorticography. Two SPES responses are described: pathological delayed responses (DR, >100 ms) associated with the seizure onset zone (SOZ) and physiological early responses (ER, 80 Hz, in the SOZ and seizure propagation areas. We used data from 12 refractory epilepsy patients. SPES consisted of 10 pulses of 1 ms, 4-8 mA and 5s interval on adjacent electrodes pairs. Data were available at 2048 samples/s for six and 512 samples/s (22 bits) for eight patients and analyzed in the time-frequency (TF) and time-domain (TD). Electrodes with ERs were stronger associated with SOZ than non-SOZ electrodes. ERs with frequency content >80 Hz exist and are specific for SOZ channels. ERs evoked by stimulation of seizure onset electrodes were associated with electrodes involved in seizure propagation. Analysis of ERs can reveal aspects of pathology, manifested by association with seizure propagation and areas with high ER numbers that coincide with the SOZ. Not only DRs, but also ERs could have clinical value for mapping epileptogenic cortex and help to unravel aspects of the epileptic network. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Clinical Predictors of Response to Prednisone Plus Cyclophosphamide in Patients with Idiopathic Membranous Nephropathy.

    Science.gov (United States)

    Li, Shu; Wang, Ling; Zhang, Minfang; Zhou, Wenyan; Fang, Wei; Wang, Qin; Qi, Chaojun; Mou, Shan; Shao, Xinghua; Ni, Zhaohui

    2017-01-01

    Complete remission (CR) and partial remission (PR) are beneficial to the long-term outcome of patients with idiopathic membranous nephropathy (iMN). However, we are lacking in studies that evaluate the clinical predictors of response to treatment with prednisone plus cyclophosphamide (CP). The objectives of the study are to identify clinical factors that could predict clinical remission or relapse in patients with iMN who were treated with prednisone plus i.v. CP therapy. This retrospective study recruited a total of 102 eligible patients diagnosed with biopsy-proven iMN between January 2010 and December 2013 in our center. All subjects were treated with prednisone plus i.v. CP for at least 6 months. Primary outcome was remission, including both CR and PR. Demographic data and clinical data at baseline and month 3 of treatment with CP were assessed. The proportion of patients with remission (both CR and PR) was 82.4%, over an average follow-up duration of 15 (10-27.5) months. Fifty-two of them experienced a CR. Baseline proteinuria and the reduction of proteinuria at month 3 of CP treatment were independent predictors of remission (p 150, p proteinuria at baseline and high reduction of proteinuria at month 3 of treatment with CP were more likely to achieve remission and CR. The presence of only a PR may act as a useful predictor of relapse after completion of CP therapy. © 2016 S. Karger AG, Basel.

  17. Inflammatory mammary carcinoma in 12 dogs: Clinical features, cyclooxygenase-2 expression, and response to piroxicam treatment

    Science.gov (United States)

    de M. Souza, Carlos H.; Toledo-Piza, Evandro; Amorin, Renee; Barboza, Andrigo; Tobias, Karen M.

    2009-01-01

    Canine inflammatory mammary carcinoma (IMC) is a rare, locally aggressive, highly metastatic tumor that is poorly responsive to treatment. The purposes of this study were to retrospectively evaluate the history, signalment, and clinical signs of dogs with IMC; compare the outcome of affected dogs treated with traditional chemotherapy with those treated with piroxicam; evaluate Cox-2 expression of IMC cells; and correlate Cox-2 expression with outcome based on treatment. Strong cyclooxygenase-2 expression was present in all tumors. Improvement in clinical condition and disease stability was achieved in all dogs treated with piroxicam, with mean and median progression-free survival of 171 and 183 days, respectively. Median survival time of 3 dogs treated with doxorubicin-based protocols was 7 days, which was significantly less than that of dogs treated with piroxicam (median, 185 days). In conclusion, piroxicam should be considered as a single agent for the treatment of dogs with inflammatory mammary carcinoma. PMID:19436636

  18. Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab.

    Science.gov (United States)

    Chaput, N; Lepage, P; Coutzac, C; Soularue, E; Le Roux, K; Monot, C; Boselli, L; Routier, E; Cassard, L; Collins, M; Vaysse, T; Marthey, L; Eggermont, A; Asvatourian, V; Lanoy, E; Mateus, C; Robert, C; Carbonnel, F

    2017-06-01

    Ipilimumab, an immune checkpoint inhibitor targeting CTLA-4, prolongs survival in a subset of patients with metastatic melanoma (MM) but can induce immune-related adverse events, including enterocolitis. We hypothesized that baseline gut microbiota could predict ipilimumab anti-tumor response and/or intestinal toxicity. Twenty-six patients with MM treated with ipilimumab were prospectively enrolled. Fecal microbiota composition was assessed using 16S rRNA gene sequencing at baseline and before each ipilimumab infusion. Patients were further clustered based on microbiota patterns. Peripheral blood lymphocytes immunophenotypes were studied in parallel. A distinct baseline gut microbiota composition was associated with both clinical response and colitis. Compared with patients whose baseline microbiota was driven by Bacteroides (cluster B, n = 10), patients whose baseline microbiota was enriched with Faecalibacterium genus and other Firmicutes (cluster A, n = 12) had longer progression-free survival (P = 0.0039) and overall survival (P = 0.051). Most of the baseline colitis-associated phylotypes were related to Firmicutes (e.g. relatives of Faecalibacterium prausnitzii and Gemmiger formicilis), whereas no colitis-related phylotypes were assigned to Bacteroidetes. A low proportion of peripheral blood regulatory T cells was associated with cluster A, long-term clinical benefit and colitis. Ipilimumab led to a higher inducible T-cell COStimulator induction on CD4+ T cells and to a higher increase in serum CD25 in patients who belonged to Faecalibacterium-driven cluster A. Baseline gut microbiota enriched with Faecalibacterium and other Firmicutes is associated with beneficial clinical response to ipilimumab and more frequent occurrence of ipilimumab-induced colitis. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  19. Role of opsonins in clinical response to granulocyte transfusion in granulocytopenic patients

    International Nuclear Information System (INIS)

    Keusch, G.T.; Ambinder, E.P.; Kovacs, I.; Goldberg, J.D.; Phillips, D.M.; Holland, J.F.

    1982-01-01

    Fifty febrile severely granulocytopenic patients were given four daily transfusions of 2.2 X 10(10) normal donor granulocytes. Twenty-three responded clinically, although both responders and nonresponders were similar in clinical characteristics at the outset. This study examines the relation between serum opsonic activity before initiation of granulocyte administration and clinical response. Opsonic activity to three test organisms (Escherichia coli 286 and ON 2, and Staphylococcus aureus) and to 15 blood stream isolates from 14 patients was measured as serum-dependent uptake of heat-killed 14 C-labeled bacteria by normal donor leukopheresis granulocytes in an in vitro assay and compared with results obtained with a standard normal serum in each assay. At a concentration of 8 percent serum, all patient groups were equivalent to standard for the three test organisms. When rate-limiting concentrations of serum were employed, opsonic activity remained similar to standard for S. aureus in all patient groups and for the two E. coli strains in responders. In contrast, opsonins for E. coli decreased to 41 to 50 percent of standard in nonresponders. When patients with proved infection were separately analyzed, opsonin activity for E. coli was significantly greater in responders than nonresponders. Eight of 10 patients with 75 percent or greater of standard for opsonic activity against their own blood stream isolates also responded, whereas zero of four with less than 75 percent of standard had a favorable outcome. These results indicate that serum opsonic activity may be a determinant of clinical response to granulocyte transfusion in infected granulocytopenic patients. We conclude that opsonic activity should be assessed in such patients before granulocyte administration and suggest a trial of plasma infusion in opsonin-deficient patients

  20. Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists (Spanish Edition)

    International Nuclear Information System (INIS)

    2014-01-01

    The IAEA technical cooperation project Strengthening Medical Physics in Radiation Medicine was approved by the IAEA Board of Governors for the period 2009-2013 with the aim of ensuring the safe and effective diagnosis and treatment of patients. The IAEA, together with the World Health Organization and stakeholders from numerous medical physics professional societies worldwide, including the International Organization for Medical Physics (IOMP), the European Federation of Organisations for Medical Physics, the American Association of Physicists in Medicine (AAPM), the Latin American Medical Physics Association, the Asia-Oceania Federation of Organizations for Medical Physics, the European Society for Radiotherapy and Oncology, the European Commission and the International Radiation Protection Association, as well as regional counterparts from Africa, Asia, Europe and Latin America, met in Vienna in May 2009 to plan and coordinate the new project. A shortage of clinically qualified medical physicists (CQMPs), insufficient education and training (especially properly organized and coordinated clinical training), and lack of professional recognition were identified as the main problems to be addressed under this project. This publication was developed under the project framework in response to these findings. It aims, first, at defining appropriately and unequivocally the roles and responsibilities of a CQMP in specialties of medical physics related to the use of ionizing radiation, such as radiation therapy, nuclear medicine, and diagnostic and interventional radiology. Important, non-ionizing radiation imaging specialties, such as magnetic resonance and ultrasound, are also considered for completeness. On the basis of these tasks, this book provides recommended minimum requirements for the academic education and clinical training of CQMPs, including recommendations for their accreditation, certification and registration, along with continuing professional development

  1. Roles and Responsibilities, and Education and Training Requirements for Clinically Qualified Medical Physicists

    International Nuclear Information System (INIS)

    2013-01-01

    The IAEA technical cooperation project Strengthening Medical Physics in Radiation Medicine was approved by the IAEA Board of Governors for the period 2009-2013 with the aim of ensuring the safe and effective diagnosis and treatment of patients. The IAEA, together with the World Health Organization and stakeholders from numerous medical physics professional societies worldwide, including the International Organization for Medical Physics (IOMP), the European Federation of Organisations for Medical Physics, the American Association of Physicists in Medicine (AAPM), the Latin American Medical Physics Association, the Asia-Oceania Federation of Organizations for Medical Physics, the European Society for Radiotherapy and Oncology, the European Commission and the International Radiation Protection Association, as well as regional counterparts from Africa, Asia, Europe and Latin America, met in Vienna in May 2009 to plan and coordinate the new project. A shortage of clinically qualified medical physicists (CQMPs), insufficient education and training (especially properly organized and coordinated clinical training), and lack of professional recognition were identified as the main problems to be addressed under this project. This publication was developed under the project framework in response to these findings. It aims, first, at defining appropriately and unequivocally the roles and responsibilities of a CQMP in specialties of medical physics related to the use of ionizing radiation, such as radiation therapy, nuclear medicine, and diagnostic and interventional radiology. Important, non-ionizing radiation imaging specialties, such as magnetic resonance and ultrasound, are also considered for completeness. On the basis of these tasks, this book provides recommended minimum requirements for the academic education and clinical training of CQMPs, including recommendations for their accreditation, certification and registration, along with continuing professional development

  2. Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria

    DEFF Research Database (Denmark)

    Abdulla, S.; Adam, I.; Adjei, G. O.

    2015-01-01

    early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. Results: In total, 29,493 patients from 84 clinical trials were included.......020, compared to dihydroartemisinin-piperaquine). Conclusions: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides...

  3. Remarkable rates of lightning strike mortality in Malawi.

    Directory of Open Access Journals (Sweden)

    Monique Borgerhoff Mulder

    Full Text Available Livingstone's second mission site on the shore of Lake Malawi suffers very high rates of consequential lightning strikes. Comprehensive interviewing of victims and their relatives in seven Traditional Authorities in Nkhata Bay District, Malawi revealed that the annual rate of consequential strikes was 419/million, more than six times higher than that in other developing countries; the rate of deaths from lightning was 84/million/year, 5.4 times greater than the highest ever recorded. These remarkable figures reveal that lightning constitutes a significant stochastic source of mortality with potential life history consequences, but it should not deflect attention away from the more prominent causes of mortality in this rural area.

  4. Legal questions surrounding hunger strikes by detainees and prisoners.

    Science.gov (United States)

    Strauss, S A

    1991-01-01

    The 'right to die' is not of an absolute character but is subject to definite qualification. There are legal and social interests reflecting profound ethical values which militate against an absolute right on the part of a prisoner to die by means of a hunger strike. The declared policy of the South African authorities is that a prisoner who resorts to a hunger strike may not be subjected to force-feeding. This is in accordance with the 1975 Tokyo Declaration. Unfortunately the Declaration is silent on the question of whether a doctor may provide medical treatment once a hunger striker has reached the point where he is no longer capable of rational thought. In this article it is submitted that a doctor would be legally entitled to do so.

  5. Single Station System and Method of Locating Lightning Strikes

    Science.gov (United States)

    Medelius, Pedro J. (Inventor); Starr, Stanley O. (Inventor)

    2003-01-01

    An embodiment of the present invention uses a single detection system to approximate a location of lightning strikes. This system is triggered by a broadband RF detector and measures a time until the arrival of a leading edge of the thunder acoustic pulse. This time difference is used to determine a slant range R from the detector to the closest approach of the lightning. The azimuth and elevation are determined by an array of acoustic sensors. The leading edge of the thunder waveform is cross-correlated between the various acoustic sensors in the array to determine the difference in time of arrival, AT. A set of AT S is used to determine the direction of arrival, AZ and EL. The three estimated variables (R, AZ, EL) are used to locate a probable point of the lightning strike.

  6. HUNGER STRIKES AND FORCE-FEEDING IN PRISONS

    Directory of Open Access Journals (Sweden)

    Radu-Florin GEAMĂNU

    2016-05-01

    Full Text Available This study will try to give an overview and assess the international and European standards regarding the management of hunger strikes. We will analyse the international and European standards regarding the force-feeding a prisoner on a hunger strike. The paper will focus on the study of the ECtHR judgements regarding the force-feeding of hunger strikers. Also, we will address the U.S. case and the force-feeding of prisoners which is considered to be, in certain cases, an act of torture based on the international human rights standards. To close with, the study will attempt to go through the recent developments in the Romanian legislation, analysing the legislation and its conformity with the European principles and recommendations, bearing in mind the prohibition, in absolute terms, of torture or inhuman or degrading treatment or punishment.

  7. Dependence of alanine gel dosimeter response as a function of photon clinical beams dose rate

    International Nuclear Information System (INIS)

    Silva, Cleber Feijo; Campos, Leticia Lucente

    2013-01-01

    Gel dosimetry is a new area developed by Gore, it is ery useful for application in radiotherapy because using NMR imaging as evaluation technique is possible to evaluate three dimensional absorbed dose distribution. The measure technique is based on difference of ferrous (Fe 2+ ) and ferric (Fe 3+ ) ) ions concentration that can be measured also by spectrophotometry technique. The Alanine gel dosimeter was developed at IPEN. The alanine is an amino acid and tissue equivalent material that presents significant improvement on previous alanine dosimetry systems. The addition of Alanine increases the production of ferric ions in the solution. This work aims to study the dose rate dependence of photon clinical beams radiation on the alanine gel dosimeter optical response, as well as the response repeatability and gel production reproducibility, since this property is very important for characterization and standardization of any dosimeter. (author)

  8. Progressive encephalomyelitis with rigidity and myoclonus: a syndrome with diverse clinical features and antibody responses.

    Science.gov (United States)

    Shugaiv, Erkingül; Leite, Maria Isabel; Şehitoğlu, Elçin; Woodhall, Mark; Çavuş, Filiz; Waters, Patrick; İçöz, Sema; Birişik, Ömer; Uğurel, Elif; Ulusoy, Canan; Kürtüncü, Murat; Vural, Burçak; Vincent, Angela; Akman-Demir, Gulsen; Tüzün, Erdem

    2013-01-01

    To better characterize progressive encephalomyelitis with rigidity and myoclonus (PERM) syndrome and identify novel PERM phenotypes. The clinical features and antibody status of PERM patients were investigated using immunoblots, cell-based assays, RIA, protein macroarray and ELISA. Two patients with supratentorial involvement showed abnormal PET or EEG findings. One patient was discovered to have renal cell carcinoma, and protein macroarray revealed Ma3-antibodies. Another patient with leucine-rich, glioma-inactivated 1 (LGI1) and glutamic acid decarboxylase (GAD) antibodies showed a good response to immunotherapy. The heterogeneity of the immunological features suggests that PERM is caused by diverse pathogenic mechanisms. Seropositivity to well-characterized neuronal cell surface antigens might indicate a good treatment response. Copyright © 2013 S. Karger AG, Basel.

  9. Clinical manifestations and treatment response of steroid in pediatric Hashimoto encephalopathy.

    Science.gov (United States)

    Yu, Hee Joon; Lee, Jeehun; Seo, Dae Won; Lee, Munhyang

    2014-07-01

    Hashimoto encephalopathy is a steroid-responsive encephalopathy associated with elevated titers of antithyroid antibodies. Clinical symptoms are characterized by behavioral and cognitive changes, speech disturbance, seizures, myoclonus, psychosis, hallucination, involuntary movements, cerebellar signs, and coma. The standard treatment is the use of corticosteroids along with the treatment of any concurrent dysthyroidism. Other options are immunoglobulins and plasmapheresis. We described symptoms and outcomes on 3 teenage girls with Hashimoto encephalopathy. Presenting symptoms were seizure or altered mental status. One patient took levothyroxine due to hypothyroidism before presentation of Hashimoto encephalopathy. After confirmation of elevated antithyroid antibodies, all patients were treated with steroids. One patient needed plasmapheresis because of the lack of response to steroids and immunoglobulins. Hashimoto encephalopathy should be considered in any patient presenting with acute or subacute unexplained encephalopathy and seizures. Even though the use of steroids is the first line of treatment, plasmapheresis can rescue steroid-resistant patients. © The Author(s) 2013.

  10. Challenges of clinical trial design when there is lack of clinical equipoise: Use of a response-conditional crossover design

    NARCIS (Netherlands)

    C. Deng (Chunqin); K. Hanna (Kim); V. Bril (Vera); M.C. Dalakas (Marinos); P. Donofrio (Peter); P.A. van Doorn (Pieter); H.P. Hartung; I.S.J. Merkies (Ingemar)

    2012-01-01

    textabstractClinical equipoise is widely accepted as the basis of ethics in clinical research and requires investigators to be uncertain of the relative therapeutic merits of trial comparators. When clinical equipoise is in question, innovative trial designs are needed to reduce ethical tension

  11. Cryptococcal genotype influences immunologic response and human clinical outcome after meningitis.

    Science.gov (United States)

    Wiesner, Darin L; Moskalenko, Oleksandr; Corcoran, Jennifer M; McDonald, Tami; Rolfes, Melissa A; Meya, David B; Kajumbula, Henry; Kambugu, Andrew; Bohjanen, Paul R; Knight, Joseph F; Boulware, David R; Nielsen, Kirsten

    2012-01-01

    In sub-Saharan Africa, cryptococcal meningitis (CM) continues to be a predominant cause of AIDS-related mortality. Understanding virulence and improving clinical treatments remain important. To characterize the role of the fungal strain genotype in clinical disease, we analyzed 140 Cryptococcus isolates from 111 Ugandans with AIDS and CM. Isolates consisted of 107 nonredundant Cryptococcus neoformans var. grubii strains and 8 C. neoformans var. grubii/neoformans hybrid strains. Multilocus sequence typing (MLST) was used to characterize genotypes, yielding 15 sequence types and 4 clonal clusters. The largest clonal cluster consisted of 74 isolates. The results of Burst and phylogenetic analysis suggested that the C. neoformans var. grubii strains could be separated into three nonredundant evolutionary groups (Burst group 1 to group 3). Patient mortality was differentially associated with the different evolutionary groups (P = 0.04), with the highest mortality observed among Burst group 1, Burst group 2, and hybrid strains. Compared to Burst group 3 strains, Burst group 1 strains were associated with higher mortality (P = 0.02), exhibited increased capsule shedding (P = 0.02), and elicited a more pronounced Th(2) response during ex vivo cytokine release assays with strain-specific capsule stimulation (P = 0.02). The results of these analyses suggest that cryptococcal strain variation can be an important determinant of human immune responses and mortality. Cryptococcus neoformans is a common life-threatening human fungal pathogen that is responsible for an estimated 1 million cases of meningitis in HIV-infected patients annually. Virulence factors that are important in human disease have been identified, yet the impacts of the fungal strain genotype on virulence and outcomes of human infection remain poorly understood. Using an analysis of strain variation based on in vitro assays and clinical data from Ugandans living with AIDS and cryptococcal infection, we report

  12. Clinical value of MRI and acute madopar responsiveness test in diagnosing progressive supranuclear palsy

    Directory of Open Access Journals (Sweden)

    LI Xiao-hong

    2013-07-01

    Full Text Available Objective To investigate the MRI abnormalities and acute madopar responsiveness test in diagnosing progressive supranuclear palsy (PSP and Parkinson's disease (PD. Methods Seventeen patients with PSP and 17 gender and age matched patients with PD were studied with cranial MRI examinations and results of acute madopar responsiveness test, and the clinical manifestations of PSP were summarized. Results The atrophy of the midbrain tegmentum and hummingbird sign was demonstrated in all of the PSP patients in our study, but was not observed in the PD patients. The areas of the midbrain on mid-sagittal MRI in PSP patients [(77.35 ± 15.30 mm2] were significantly smaller than that in those with PD [(142.35 ± 31.49 mm2]. The average ratio of the area of the midbrain to the area of pons in the patients with PSP [(14.31 ± 2.47%] was significantly smaller than that in those with PD [(24.08 ± 4.73%; P = 0.000, for all]. According to the result of acute madopar responsiveness test, the maximum Unified Parkinson's Disease Rating Scale (UPDRS Ⅲ improvement rate of 2 patients with PSP and 16 patients with PD was more than 30% (χ2 = 23.142, P = 0.000. Conclusion The assessment of the mid-sagittal MRI and acute madopar responsiveness test may be a useful method to differentiate PSP from PD.

  13. Clinical presentation and pharmacotherapy response in social anxiety disorder: The effect of etiological beliefs.

    Science.gov (United States)

    Cohen, Jonah N; Potter, Carrie M; Drabick, Deborah A G; Blanco, Carlos; Schneier, Franklin R; Liebowitz, Michael R; Heimberg, Richard G

    2015-07-30

    Therapies for social anxiety disorder (SAD) leave many patients symptomatic at the end of treatment and little is known about predictors of treatment response. This study investigated the predictive relationship of patients' etiological attributions to initial clinical features and response to pharmacotherapy. One hundred thirty-seven individuals seeking treatment for SAD received 12 weeks of open treatment with paroxetine. Participants completed the Attributions for the Etiology of Social Anxiety Scale at baseline in addition to measures of social anxiety and depression at baseline and over the course of treatment. A latent class analysis suggested four profiles of etiological beliefs about one's SAD that may be characterized as: Familial Factors, Need to be Liked, Bad Social Experiences, and Diffuse Beliefs. Patients in the more psychosocially-driven classes, Need to be Liked and Bad Social Experiences, had the most severe social anxiety and depression at baseline. Patients in the Familial Factors class, who attributed their SAD to genetic, biological, and early life experiences, had the most rapid response to paroxetine.These results highlight the effect of biological and genetically-oriented etiological beliefs on pharmacological intervention, have implications for person-specific treatment selection, and identify potential points of intervention to augment treatment response. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. The relationship between visual orienting responses and clinical characteristics in children attending special education for the visually impaired.

    Science.gov (United States)

    Kooiker, Marlou J G; Pel, Johan J M; van der Steen, Johannes

    2015-05-01

    We recently introduced a method based on quantification of orienting responses toward visual stimuli to assess the quality of visual information processing in children. In the present study, we examined the relationship between orienting responses and factors that are associated with visual processing impairments in current clinical practice. Response time and fixation quality to visual features such as form, contrast, motion, and color stimuli were assessed in 104 children from 1 to 12 years attending special education for the visually impaired. Using regression analysis, we investigated whether these parameters were affected by clinical characteristics of children. Response times significantly depended on stimulus type. Responses to high-contrast cartoons were significantly slower in children with a clinical diagnosis of cerebral visual impairment. Fixation quality was significantly affected by visual acuity and nystagmus. The results suggest that the quantitative measurement of orienting responses is strongly related to cerebral visual impairment in children. © The Author(s) 2014.

  15. The clinical features of 17 patients with steroid-responsive encephalopathy associated with autoimmune thyroiditis

    Directory of Open Access Journals (Sweden)

    CHEN Hai

    2013-06-01

    Full Text Available Objective To investigate the onset pattern, clinical manifestations, laboratory findings and imaging features of 17 Chinese patients with steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT. Methods The clinical data of 17 SREAT patients were collected. Retrospective analysis of their clinical features, as well as their serum levels of anti-thyroid, cerebrospinal fluid (CSF biochemical indicators, MRI and therapy was performed. Results The initial symptoms of those patients were seizures (4 cases, psychiatric symptoms (4 cases, hypomnesis (4 cases, walking unsteadiness (2 cases, headache (2 cases and dysarthria (1 case. Three cases were acute onset, 5 cases subacute onset and 9 cases chronic onset. The anti-thyroid peroxidase antibody (anti-TPO of 17 cases were significantly increased, average (928.63 ± 406.28 × 10 3 IU/L. The anti?thyroglobulin antibody (anti-TG of 15 cases was increased, average (601.27 ± 1014.12 × 10 3 IU/L. The protein in CSF was mildly increased, average (513.75 ± 283.15 mg/L. The EEG of 5 patients presented slow wave and the EEG of 2 patients showed epileptiform discharge. The brain MRI of 11 patients showed multifocal lesions in frontal lobe, temporal lobe, parietal lobe, basal ganglia, centrum ovale, corpus callosum, thalamus, cerebellum, and brain stem. The findings of clinical immunological index and tumor markers were normal. Besides, the prognosis of 11 patients treated with methylprednisolone and 3 patients treated with dexamethasone were good. Recurrence occurred in 2 patients. Conclusion Basically, the clinical features of Chinese SREAT patients present seizures, hypomnesis and psychiatric symptoms associated with increased anti-thyroid and multifocal lesions in gray and white matter of brain.

  16. Association of Induction Infliximab Levels With Clinical Response in Perianal Crohn's Disease.

    Science.gov (United States)

    Davidov, Yana; Ungar, Bella; Bar-Yoseph, Haggai; Carter, Dan; Haj-Natour, Ola; Yavzori, Miri; Chowers, Yehuda; Eliakim, Rami; Ben-Horin, Shomron; Kopylov, Uri

    2017-05-01

    The association of infliximab [IFX] trough levels with clinical and endoscopic outcomes in inflammatory bowel disease is well established. However, there is scarce data regarding the association of perianal fistula response with IFX. The aim of this study was to establish whether early induction infliximab levels and anti-infliximab antibodies [ATIs] are associated with perianal fistula response. Consecutive CD patients with perianal fistulae that were treated with IFX between 2008 and 2016 were included in the study. Response was defined as cessation or significant improvement of fistula drainage. Patients with unavailable IFX level or ATI measurements and/or missing clinical follow-up at Week 14 were excluded. A total of 36 patients with perianal fistulae were included; 25/36 [69.4%] responded to treatment by Week 14. The median induction IFX levels at Weeks 2, 6 and 14 in the responders group at Week 14 were higher compared with those of the non-responders group [20/5.6 µg/mL, P = 0.0001; 13.3/2.55 µg/mL P = 0.0001; 4.1/0.14 µg/mL, P = 0.01]. On multivariate analysis, IFX leve at Weeks 2 and 6 were significantly associated with fistula response at Weeks 14 and 30. IFX drug levels of 9.25 µg/mL at Week 2 and 7.25 µg/mL at Week 6 were the best predictors of fistula response. High IFX trough levels during induction are associated with favorable fistula response to anti-TNF treatment. If validated in a larger prospective study, our findings may help guide anti-TNF treatment in patients with perianal CD, and suggest serum level-guided treatment escalation in non-responders or prompt changing of biologic treatment in non-responders. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

  17. Susceptibility of functional impairment scales to noncredible responses in the clinical evaluation of adult ADHD.

    Science.gov (United States)

    Fuermaier, Anselm B M; Tucha, Oliver; Koerts, Janneke; Butzbach, Marah; Weisbrod, Matthias; Aschenbrenner, Steffen; Tucha, Lara

    2017-11-23

    A growing body of research questions the reliance of symptom self-reports in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A recent study suggested that also impairment reports are vulnerable to noncredible responses, as derived from a simulation design using a global functional impairment scale. The present study aims to add evidence to this issue, by using an ADHD specific impairment scale in a simulation design on large samples. Impairment ratings on the Weiss Functional Impairment Rating Scale (WFIRS) of 62 patients with ADHD were compared to 142 healthy individuals who were instructed to show normal behavior. Furthermore, impairment ratings of patients with ADHD were compared to ratings of 330 healthy individuals who were randomly assigned to one of four simulation conditions that were instructed to complete the scale as if they had ADHD. Patients with ADHD reported higher levels of impairment than the healthy control group in all domains of life. Furthermore, individuals instructed to feign ADHD indicated higher levels of impairments in most domains of life compared to control participants and genuine patients with ADHD. The group differences between individuals feigning ADHD and individuals with genuine ADHD, however, were only small to moderate. Further analyses revealed that the WFRIS was not useful to successfully differentiate genuine from feigned ADHD. The present study confirms the conclusion that self-reported impairments are susceptible to noncredible responses and should be used with caution in the clinical evaluation of adult ADHD.

  18. Bread Affects Clinical Parameters and Induces Gut Microbiome-Associated Personal Glycemic Responses.

    Science.gov (United States)

    Korem, Tal; Zeevi, David; Zmora, Niv; Weissbrod, Omer; Bar, Noam; Lotan-Pompan, Maya; Avnit-Sagi, Tali; Kosower, Noa; Malka, Gal; Rein, Michal; Suez, Jotham; Goldberg, Ben Z; Weinberger, Adina; Levy, Avraham A; Elinav, Eran; Segal, Eran

    2017-06-06

    Bread is consumed daily by billions of people, yet evidence regarding its clinical effects is contradicting. Here, we performed a randomized crossover trial of two 1-week-long dietary interventions comprising consumption of either traditionally made sourdough-leavened whole-grain bread or industrially made white bread. We found no significant differential effects of bread type on multiple clinical parameters. The gut microbiota composition remained person specific throughout this trial and was generally resilient to the intervention. We demonstrate statistically significant interpersonal variability in the glycemic response to different bread types, suggesting that the lack of phenotypic difference between the bread types stems from a person-specific effect. We further show that the type of bread that induces the lower glycemic response in each person can be predicted based solely on microbiome data prior to the intervention. Together, we present marked personalization in both bread metabolism and the gut microbiome, suggesting that understanding dietary effects requires integration of person-specific factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. The role of clinical decision support in pharmacist response to drug-interaction alerts.

    Science.gov (United States)

    Miller, Luke; Steinmetz Pater, Karen; Corman, Shelby

    2015-01-01

    With over 100,000 different types of drug-drug interactions health care professionals rely heavily on automated drug-interaction alerts. Substantial variance in drug-interaction alerts yields opportunities for the use of clinical decision support (CDS) as a potential benefit to pharmacists. The purpose of this research was to determine whether decision support during dispensing impacts pharmacist response to drug-interaction alerts. A brief survey was administered to pharmacists in the community consisting of three patient cases, each containing three drug-drug interactions of varying severity. For each interaction, pharmacists were asked how they would respond, one group of pharmacists was randomly assigned to receive CDS while the other group did not. There were no significant differences in pharmacist response to alerts between the two groups. The control group did appear to be more likely to consult a drug reference, but this difference was not significant. While this study did not demonstrate a significant difference, drug-interaction alerts are still an area where improvements could be made. Advancements have the potential to reduce risk to patients and limit unnecessary hospital admissions. This study suggests that this level of clinical decision support has limited impact, but may prove beneficial by reducing the need to consult additional references. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Effects of oral clenbuterol on the clinical and inflammatory response to endotoxaemia in the horse.

    Science.gov (United States)

    Cudmore, L A; Muurlink, T; Whittem, T; Bailey, S R

    2013-06-01

    Pro-inflammatory cytokines, such as IL-1β and TNFα, play a major role in activating leukocytes and endothelial cells during the systemic inflammatory response to endotoxin in the horse. β2 agonist drugs, such as clenbuterol, inhibit leukocyte activation. This study aimed to determine the effects of oral clenbuterol on clinical and leukocyte responses, including production of TNFα, in an in vivo endotoxin challenge model. In a randomised crossover design, horses received either clenbuterol or a placebo product prior to the administration of low dose endotoxin (30 ng/kg over 30 min). Clinical signs were measured and leukocyte counts and serial blood samples were obtained over 6 h. Pre-treatment with oral clenbuterol (0.8 μg/kg) significantly reduced (P=0.046) the peak rectal temperature and the peak plasma TNFα concentration (P=0.026) following endotoxin challenge. These data suggest that oral clenbuterol at the therapeutic dose has anti-inflammatory effects in horses challenged with a low dose of endotoxin. Copyright © 2013. Published by Elsevier India Pvt Ltd.

  1. Micro-RNAs as Potential Predictors of Response to Breast Cancer Systemic Therapy: Future Clinical Implications

    Science.gov (United States)

    Campos-Parra, Alma D.; Cuamani Mitznahuatl, Gerardo; Pedroza-Torres, Abraham; Vázquez Romo, Rafael; Porras Reyes, Fany Iris; López-Urrutia, Eduardo; Pérez-Plasencia, Carlos

    2017-01-01

    Despite advances in diagnosis and new treatments such as targeted therapies, breast cancer (BC) is still the most prevalent tumor in women worldwide and the leading cause of death. The principal obstacle for successful BC treatment is the acquired or de novo resistance of the tumors to the systemic therapy (chemotherapy, endocrine, and targeted therapies) that patients receive. In the era of personalized treatment, several studies have focused on the search for biomarkers capable of predicting the response to this therapy; microRNAs (miRNAs) stand out among these markers due to their broad spectrum or potential clinical applications. miRNAs are conserved small non-coding RNAs that act as negative regulators of gene expression playing an important role in several cellular processes, such as cell proliferation, autophagy, genomic stability, and apoptosis. We reviewed recent data that describe the role of miRNAs as potential predictors of response to systemic treatments in BC. Furthermore, upon analyzing the collected published information, we noticed that the overexpression of miR-155, miR-222, miR-125b, and miR-21 predicts the resistance to the most common systemic treatments; nonetheless, the function of these particular miRNAs must be carefully studied and further analyses are still necessary to increase knowledge about their role and future potential clinical uses in BC. PMID:28574440

  2. Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients.

    Science.gov (United States)

    Hiotis, Spiros P; Weber, Sharon M; Cohen, Alfred M; Minsky, Bruce D; Paty, Phillip B; Guillem, Jose G; Wagman, Raquel; Saltz, Leonard B; Wong, W Douglas

    2002-02-01

    Patients with transmural or node-positive rectal cancer benefit from the addition of chemoradiation to surgical resection. Administration of the chemoradiation (combined modality therapy) preoperatively has gained popularity in recent years. Some patients undergo apparent complete tumor regression after preoperative combined modality therapy, and controversy exists about the proper management of these patients. Some investigators have proposed that such patients should simply be observed and not undergo resection. The purpose of this study was to determine the significance of clinical complete response to preoperative combined modality therapy. Specifically, we have attempted to determine the frequency with which a clinical complete response (based on the absence of detectable tumor on preoperative digital rectal examination and proctoscopy) correlates with a pathologic complete response (based on the absence of cancer cells in the resected specimen). A retrospective review of the clinical and pathologic characteristics of 488 patients from the Memorial Sloan-Kettering prospective colorectal database who received preoperative chemoradiation followed by resection for primary rectal cancer was performed. The indications for preoperative therapy included clinical or ultrasound T3 or T4 tumors or node-positive disease. The clinical complete response rate to preoperative therapy was 19%. All patients underwent resection subsequent to preoperative therapy regardless of response. The pathologic complete response rate among all patients was 10%. The pathologic complete response rate among clinical complete responders was 25%. Clinical complete response was a significant predictive factor for pathologic complete response, but the majority (75%) of clinical complete responders had persistent foci of tumor that were not detectable on preoperative examination or proctoscopy. Clinical complete response to preoperative therapy as determined by preoperative digital rectal

  3. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    Directory of Open Access Journals (Sweden)

    Omid Asemani

    2015-09-01

    Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

  4. Pharmacogenetic markers to predict the clinical response to methotrexate in south Indian Tamil patients with psoriasis.

    Science.gov (United States)

    Indhumathi, S; Rajappa, Medha; Chandrashekar, Laxmisha; Ananthanarayanan, P H; Thappa, D M; Negi, V S

    2017-08-01

    Despite the advent of several new systemic therapies, methotrexate remains the gold standard for the treatment of moderate to severe psoriasis. However, there exists a significant heterogeneity in individual response to methotrexate. There are no consistently reliable markers to predict methotrexate treatment response till date. We aimed to demonstrate the association of certain genetic variants in the HLA (HLA-A2, HLA-B17, and HLA-Cw6) and the non-HLA genes including T-helper (Th)-1, Th-2, Th-17 cytokine genes (IFN-γ, IL-2, IL-4, IL-10, IL-12B, and IL-23R), and T-regulatory gene (FOXP3) with the methotrexate treatment response in South Indian Tamil patients with psoriasis. Of the 360 patients recruited, 189 patients with moderate to severe psoriasis were treated with methotrexate. Of the 189 patients, 132 patients responded to methotrexate and the remaining 57 patients were non-responders. We analyzed the association of aforesaid polymorphisms with the methotrexate treatment outcome using binary logistic regression. We observed that there were significant differences between genotype frequencies of HLA-Cw6 and FOXP3 (rs3761548) among the responders compared to non-responders, with conservative estimation. We observed that pro-inflammatory cytokines such as IFN-γ, IL-2, IL-12, and IL-23 were markedly reduced with the use of methotrexate, in comparison to the baseline levels, while the plasma IL-4 levels were increased posttreatment. Our results serve as preliminary evidence for the clinical use of genetic markers as predictors of response to methotrexate in psoriasis. This might aid in the future in the development of a point-of-care testing (POCT) gene chip, to predict optimal treatment response in patients with psoriasis, based on their individual genotypic profile.

  5. Analysis of clinical factors for pathological complete response after preoperative neoadjuvant chemoradiotherapy for rectal cancer

    International Nuclear Information System (INIS)

    Ayiguli Hare; Palida Apizi; Iskandar Abulimiti; Zhang Jinrong; Tian Hanhan

    2014-01-01

    Objective: To evaluate the clinical factors associated with pathological complete response (pCR) after preoperative neoadjuvant chemoradiotherapy for rectal cancer. Methods: A retrospective analysis was performed on the clinical data of 116 patients with rectal cancer, who underwent neoadjuvant chemoradiotherapy followed by radical surgery from January 2009 to December 2012. All patients received pelvic intensity-modulated radiotherapy (50 Gy/25 fractions) with concurrent fluorouracil based chemotherapy and then underwent radical surgery 4-8 weeks later. The clinical factors associated with pCR or non-pCR were analyzed by Logistic regression. Results: Of the 116 patients, 20 (17.2%) achieved a pCR after neoadjuvant chemoradiotherapy. The univariate analysis showed that percentage of circumference of the rectal tube invaded by the tumor, preoperative serum carcinoembryonic antigen (CEA) level, T stage, N stage, distance from the anal verge, degree of tumor differentiation, and maximum tumor diameter were associated with pCR or non-pCR after neoadjuvant chemoradiotherapy for rectal cancer. The multivariate analysis revealed that percentage of circumference of the rectal tube invaded by the tumor, preoperative serum CEA level,and T stage were predictive factors for pCR or non-pCR after neoadjuvant chemoradiotherapy for rectal cancer. Conclusions: Non-circumferential tumor (percentage of circumference of the rectal tube invaded by the tumor <75 %), low CEA level, and early T stage before treatment may be associated with pCR after neoadjuvant chemoradiotherapy for rectal cancer. (authors)

  6. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations

    Directory of Open Access Journals (Sweden)

    Hunmin Kim

    2011-11-01

    Full Text Available Primary hypokalemic periodic paralysis (HOKPP is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1S p.Arg528His and SCN4A p.Arg672His. Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

  7. Assessment of the response of tumours to radiation: clinical and experimental studies

    International Nuclear Information System (INIS)

    Suit, H.D.; Walker, A.M.

    1980-01-01

    There is an important and active research programme at the laboratory and clinical level to develop indicators of the ultimate local response of tumours to radiation. In order to be of great value clinically indicators should yield a high true positivity and a low false positivity so that revisions of therapeutic strategy will be made only when there is a real need for such a change. The available data in the literature from the clinical studies, when analysed in terms of the true and false positive rates, indicate that the extent of regression at the completion of external beam therapy is not a useful prognostic indicator. This pertains to populations of tumour of a specific histopathological type, tumour size and anatomic site. Studies of laboratory animal tumour models have shown that regression patterns may be useful prognostic indicators for a tumour which is characterized by moderate immunogenicity and where there is close correlation between complete regression and permanent control. In contrast for tumours which are weakly or nonimmunogenic and which regress completely even at low tumour control probabilities, the pattern of regression has not been demonstrated to be of prognostic value. (author)

  8. Inflammatory responses after laparoscopic uterine myomectomy compared to open surgery in current clinical practice

    International Nuclear Information System (INIS)

    Holub, Z.; Kliment, L.; Jabor, A.; Sprongl, L.

    2006-01-01

    Objective was to determine the differences in inflammatory response and clinical outcome of current clinical practice in women undergoing laparoscopic myomectomy (LM) and abdominal myomectomy (AM) for symptomatic fibroid. A total of 36 women entered the study between October 2004 to June 2005 at the Department of Gynecology and Obstetrics and the Endosopy Training Center at the Baby Friendly Hospital in Klando, Czech Republic, based upon an ultrasonographic assessment size of dominant fibroid (DM) before surgery. All women were allocated to one of 2 groups: group 1 (n=17), DM -6cm, treated with open myomectomy. Surgical characteristics, hospital stay and complications were analyzed. Blood samples for assay of the acute phase reactants and markers of tissue trauma [C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid kinase (CK)] were taken preoperatively and on the first and third postoperative day. The difference between the groups in mean size of DM was statistically significant (4.8 cm in group 1 versus 6.9 cm in group 2, p<0.05). Statistically, significant differences were found between the compared groups in intra-operative blood loss (p<0.05) and length of hospital stay (p<0.001). No complication was reported after LM. There were significantly higher levels of CRP, IL-6, SAA, WBC and CK in both groups after surgery. Increased levels of IL-6, WBC and CK were greatest on the first postoperative day in the open group. The serum CRP, IL-6, SAA, WBC, CK and the fall in the hemoglobin were statistically different between the 2 groups. Compared with open myomectomy, LM was associated with a less intensive inflammatory response and a more favorable clinical outcome. (author)

  9. Clinical profile of congenital adrenal hyperplasia and short-term response to treatment

    International Nuclear Information System (INIS)

    Lal, S.; Lal, S.; Jamro, B.U.; Jamro, S.

    2015-01-01

    To determine the clinical presentation of congenital adrenal hyperplasia and short- term response to treatment. Background: Congenital adrenal hyperplasia (CAH) is a genetic disorder which usually presents with life threatening emergencies. Awareness of physicians regarding these presentations is an essential for early diagnosis and lifesaving treatment. In view of the prevalence of the condition as reported from tertiary care centers within the country and other parts of the globe, we had carried out a study in the paediatric department of Shaheed Mohtrama Benazir Bhutto Medical University Larkana. Material and Methods: The study was conducted over a period of one year from July 2012 to June 2013. All infants presenting with vomiting, dehydration, shock, failure to thrive and ambiguous genitalia were examined and investigated thoroughly. The diagnosis was based upon a raised level of serum 17 OHP in a child with suggestive clinical features. Results: A total of 40 children were diagnosed to have CAH during the study period. The major presenting features were vomiting in 13 (32.5%), ambiguous genitalia 17 (42.5%), vomiting and ambiguous genitalia 10 (25%), shock 5(12.5%) and failure to thrive in 13 (32.5%) of cases. All the patients were followed up after initiation of treatment and good response was observed to short-term treatment. Conclusion: This study highlights the importance of common clinical features like vomiting, unreasonable dehydration, shock and ambiguous genitalia being the presenting features of CAH and the effectiveness of replacement therapy in amending life threatening emergencies due to this condition. (author)

  10. A 'joint venture' model of recontacting in clinical genomics: challenges for responsible implementation.

    Science.gov (United States)

    Dheensa, Sandi; Carrieri, Daniele; Kelly, Susan; Clarke, Angus; Doheny, Shane; Turnpenny, Peter; Lucassen, Anneke

    2017-07-01

    Advances in genomics often lead healthcare professionals (HCPs) to learn new information, e.g., about reinterpreted variants that could have clinical significance for patients seen previously. A question arises of whether HCPs should recontact these former patients. We present some findings interrogating the views of patients (or parents of patients) with a rare or undiagnosed condition about how such recontacting might be organised ethically and practically. Forty-one interviews were analysed thematically. Participants suggested a 'joint venture' model in which efforts to recontact are shared with HCPs. Some proposed an ICT-approach involving an electronic health record that automatically alerts them to potentially relevant updates. The need for rigorous privacy controls and transparency about who could access their data was emphasised. Importantly, these findings highlight that the lack of clarity about recontacting is a symptom of a wider problem: the lack of necessary infrastructure to pool genomic data responsibly, to aggregate it with other health data, and to enable patients/parents to receive updates. We hope that our findings will instigate a debate about the way responsibilities for recontacting under any joint venture model could be allocated, as well as the limitations and normative implications of using ICT as a solution to this intractable problem. As a first step to delineating responsibilities in the clinical setting, we suggest HCPs should routinely discuss recontacting with patients/parents, including the new information that should trigger a HCP to initiate recontact, as part of the consent process for genetic testing. Copyright © 2017 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

  11. Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic.

    Science.gov (United States)

    Dahlem, Chin Hwa Y; Horstman, Molly J; Williams, Brent C

    2016-01-01

    To describe the development, implementation, and preliminary evaluation of Opioid Overdose Response Protocol using intranasal (IN) naloxone in a homeless shelter. Opioid Overdose Response Protocol and training curriculum were developed using the Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution (OEND) flow chart, the American Heart Association (AHA) simplified adult basic life support algorithm, and resources through Harms Reduction Coalition. Intranasal naloxone offers a safe and effective method for opioid reversal. To combat the rising incidence of opioid overdose, IN naloxone should be made available at homeless shelters and other facilities with high frequency of opioid overdose, including the training of appropriate staff. This project has demonstrated the effective training and implementation of an Opioid Overdose Response Protocol, based on feedback received from cardiopulmonary resuscitation (CPR) trained nonhealthcare staff. Nurse practitioners (NPs), with our focus on patient care, prevention, and education, are well suited to the deployment of this life-saving protocol. NPs are in critical positions to integrate opioid overdose prevention education and provide naloxone rescue kits in clinical practices. ©2015 American Association of Nurse Practitioners.

  12. Clinical and molecular response to interferon-α therapy in essential thrombocythemia patients with CALR mutations.

    Science.gov (United States)

    Verger, Emmanuelle; Cassinat, Bruno; Chauveau, Aurélie; Dosquet, Christine; Giraudier, Stephane; Schlageter, Marie-Hélène; Ianotto, Jean-Christophe; Yassin, Mohammed A; Al-Dewik, Nader; Carillo, Serge; Legouffe, Eric; Ugo, Valerie; Chomienne, Christine; Kiladjian, Jean-Jacques

    2015-12-10

    Myeloproliferative neoplasms are clonal disorders characterized by the presence of several gene mutations associated with particular hematologic parameters, clinical evolution, and prognosis. Few therapeutic options are available, among which interferon α (IFNα) presents interesting properties like the ability to induce hematologic responses (HRs) and molecular responses (MRs) in patients with JAK2 mutation. We report on the response to IFNα therapy in a cohort of 31 essential thrombocythemia (ET) patients with CALR mutations (mean follow-up of 11.8 years). HR was achieved in all patients. Median CALR mutant allelic burden (%CALR) significantly decreased from 41% at baseline to 26% after treatment, and 2 patients even achieved complete MR. In contrast, %CALR was not significantly modified in ET patients treated with hydroxyurea or aspirin only. Next-generation sequencing identified additional mutations in 6 patients (affecting TET2, ASXL1, IDH2, and TP53 genes). The presence of additional mutations was associated with poorer MR on CALR mutant clones, with only minor or no MRs in this subset of patients. Analysis of the evolution of the different variant allele frequencies showed that the mutated clones had a differential sensitivity to IFNα in a given patient, but no new mutation emerged during treatment. In all, this study shows that IFNα induces high rates of HRs and MRs in CALR-mutated ET, and that the presence of additional nondriver mutations may influence the MR to therapy. © 2015 by The American Society of Hematology.

  13. CCR 20th Anniversary Commentary: Immune-Related Response Criteria--Capturing Clinical Activity in Immuno-Oncology.

    Science.gov (United States)

    Hoos, Axel; Wolchok, Jedd D; Humphrey, Rachel W; Hodi, F Stephen

    2015-11-15

    To evaluate antitumor responses to chemotherapeutic agents, investigators would typically rely upon Response Evaluation Criteria in Solid Tumors (RECIST) or modified WHO criteria, which do not comprehensively capture responses with immunotherapeutic agents. In the December 1, 2009, issue of Clinical Cancer Research, Wolchok and colleagues reported their development of novel criteria, designated "Immune-related Response Criteria" (irRC), designed to better capture the response patterns observed with immunotherapies. Broad use of the irRC since then has allowed for a more comprehensive evaluation of immunotherapies in clinical trials, indicating that their concepts can be used in conjunction with either RECIST or WHO, and has shown irRC to be a powerful tool for improved clinical investigation. See related article by Wolchok et al., Clin Cancer Res 2009;15(23) December 1, 2009;7412-20. ©2015 American Association for Cancer Research.

  14. Review of clinical studies on dendritic cell-based vaccination of patients with malignant melanoma: assessment of correlation between clinical response and vaccine parameters

    DEFF Research Database (Denmark)

    Engell-Noerregaard, Lotte; Hansen, Troels Holz; Andersen, Mads Hald

    2009-01-01

    which in the disseminated stage have a very poor prognosis and only limited treatment options with moderate effectiveness. Herein we describe the results of a focused search of recently published clinical studies on dendritic cell vaccination in melanoma and review different vaccine parameters which...... schedules among the published studies, which were not considered in order to be able to process and group the data....... are frequently claimed to have a possible influence on clinical response. These parameters include performance status, type of antigen, DC maturation status, route of vaccine administration, use of adjuvant, and vaccine induced immune response. In total, 38 articles found through Medline search, have been...

  15. Trust, moral responsibility, the self, and well-ordered societies: the importance of basic philosophical concepts for clinical ethics.

    Science.gov (United States)

    Mccullough, Laurence B

    2002-02-01

    Although the work of clinical ethics is intensely practical, it employs and presumes philosophical concepts from the central branches of philosophy, including metaphysics, epistemology, ethics, and political philosophy. This essay introduces this issue in the Journal on clinical ethics by considering how the papers and book reviews included in it illuminate four such concepts: trust, moral responsibility, the self and well-ordered societies.

  16. An Exploration of Clinical Psychology's Response to Parental Bereavement in Adults with Intellectual Disability

    Science.gov (United States)

    Irwin, Lynn; O'Malley, Grace; Neelofur, Shazia; Guerin, Suzanne

    2017-01-01

    Background: The dearth of literature regarding how or when to intervene when an adult with intellectual disability is bereaved may impede clinical practice; this study therefore aimed to explore the current clinical psychology response, so as to enhance understanding of the role of the profession in supporting grief within this population. Method:…

  17. Functional Brain Activation in Response to a Clinical Vestibular Test Correlates with Balance.

    Science.gov (United States)

    Noohi, Fatemeh; Kinnaird, Catherine; DeDios, Yiri; Kofman, Igor S; Wood, Scott; Bloomberg, Jacob; Mulavara, Ajitkumar; Seidler, Rachael

    2017-01-01

    The current study characterizes brain fMRI activation in response to two modes of vestibular stimulation: Skull tap and auditory tone burst. The auditory tone burst has been used in previous studies to elicit either a vestibulo-spinal reflex [saccular-mediated colic Vestibular Evoked Myogenic Potentials (cVEMP)], or an ocular muscle response [utricle-mediated ocular VEMP (oVEMP)]. Research suggests that the skull tap elicits both saccular and utricle-mediated VEMPs, while being faster and less irritating for subjects than the high decibel tones required to elicit VEMPs. However, it is not clear whether the skull tap and auditory tone burst elicit the same pattern of brain activity. Previous imaging studies have documented activity in the anterior and posterior insula, superior temporal gyrus, inferior parietal lobule, inferior frontal gyrus, and the anterior cingulate cortex in response to different modes of vestibular stimulation. Here we hypothesized that pneumatically powered skull taps would elicit a similar pattern of brain activity as shown in previous studies. Our results provide the first evidence of using pneumatically powered skull taps to elicit vestibular activity inside the MRI scanner. A conjunction analysis revealed that skull taps elicit overlapping activation with auditory tone bursts in the canonical vestibular cortical regions. Further, our postural control assessments revealed that greater amplitude of brain activation in response to vestibular stimulation was associated with better balance control for both techniques. Additionally, we found that skull taps elicit more robust vestibular activity compared to auditory tone bursts, with less reported aversive effects, highlighting the utility of this approach for future clinical and basic science research.

  18. Clinical Responses to Atomoxetine in Attention-Deficit/Hyperactivity Disorder: The Integrated Data Exploratory Analysis (IDEA) Study

    Science.gov (United States)

    Newcorn, Jeffrey H.; Sutton, Virginia K.; Weiss, Margaret D.; Sumner, Calvin R.

    2009-01-01

    Data from six randomized controlled trials in the U.S. reveal that 47 percent of patients aged six to 18 years showed a much improved clinical response to atomoxetine as a treatment for attention deficit hyperactivity disorder while 40 percent did not have a response. Augmenting or switching treatment in non-responders by week 4 is suggested.

  19. Interactions of Low-Frequency, Pulsed Electromagnetic Fields with Living Tissue: Biochemical Responses and Clinical Results

    DEFF Research Database (Denmark)

    Rahbek, Ulrik L.; Tritsaris, Katerina; Dissing, Steen

    2005-01-01

    fields. PEMF is widely used for treating fractures and non-unions as well as for treating diseases of the joints. Furthermore, new research has suggested that the technology can be used for nerve regeneration and wound healing although conclusive clinical trials, besides those for fracture healing......, are still lacking. Despite the apparent success of the PEMF technology very little is known regarding the coupling between pulsed electrical fields and biochemical events leading to cellular responses. Insight into this research area is therefore of great importance. In this review we describe the physical...... properties of PEMF-induced electrical fields and explain the typical set up for coils and pulse patterns. Furthermore, we discuss possible models that can account for mechanisms by which induced electric fields are able to enhance cellular signaling. We have emphasized the currently well-documented effects...

  20. Belief in a concerned god predicts response to treatment for adults with clinical depression.

    Science.gov (United States)

    Murphy, Patricia E; Fitchett, George

    2009-09-01

    Belief in a concerned God has been shown to be associated with lower depression through the mediation of hopelessness. This study hypothesized that this relationship would also be true longitudinally. Shortly after admission to treatment and 8 weeks later, 136 adults with clinical depression completed the Beck Depression Inventory, the Beck Hopelessness Scale, and the Religious Well-Being Scale (RWB). Logistic regression models supported an association of baseline RWB, but not baseline hopelessness, with a 50% reduction in symptoms after 8 weeks. Persons in the upper third of RWB at admission were 75% more likely to have a response to treatment than persons in the lower third. Clinicians need to be aware of the role of religion for their clients.

  1. Catatonia in DSM 5: controversies regarding its psychopathology, clinical presentation and treatment response.

    Science.gov (United States)

    Ungvari, Gabor S

    2014-12-01

    Over the past two decades, there has been an upsurge of interest in catatonia, which is reflected in the attention it received in DSM 5, where it appears as a separate subsection of the Schizophrenia Spectrum and Other Psychotic Disorders (APA, 2013). This commentary argues that due to the lack of solid scientific evidence, the extended coverage of catatonia in DSM 5 was a premature, and consequently, a necessarily ambiguous decision. The psychopathological foundations of the modern catatonia concept are lacking therefore its boundaries are fuzzy. There are only a few, methodologically sound clinical, treatment response and small-scale neurobiological studies. The widely recommended use of benzodiazepines for the treatment of catatonia is based on case reports and open-label studies instead of placebo-controlled, randomized trials. In conclusion, the catatonic concept espoused by DSM 5 is necessarily vague reflecting the current state of knowledge.

  2. The photopic ERG luminance-response function (photopic hill): method of analysis and clinical application.

    Science.gov (United States)

    Rufiange, Marianne; Dassa, Justine; Dembinska, Olga; Koenekoop, Robert K; Little, John M; Polomeno, Robert C; Dumont, Marie; Chemtob, Sylvain; Lachapelle, Pierre

    2003-06-01

    With progressively brighter stimuli, the amplitude of the photopic b-wave first increases, briefly saturates and then decreases gradually to reach a plateau, where the amplitude of the b-wave equals that of the a-wave; a phenomenon previously presented as the photopic hill. The unique presentation of this luminance-response function seriously complicates its analysis with curve fitting equations such as that of Naka-Rushton used for scotopic electroretinogram. We report a method of analysis of the photopic hill based on easily identifiable and reproducible features of the ascending and descending limbs of this function. The clinical usefulness of these parameters is illustrated with selected cases of retinal disorders.

  3. Quick Detection of FKS1 Mutations Responsible for Clinical Echinocandin Resistance in Candida albicans.

    Science.gov (United States)

    Dudiuk, Catiana; Gamarra, Soledad; Jimenez-Ortigosa, Cristina; Leonardelli, Florencia; Macedo, Daiana; Perlin, David S; Garcia-Effron, Guillermo

    2015-07-01

    A rapid molecular-based assay for the detection of the Candida albicans FKS1 gene mutations responsible for resistance to echinocandin drugs was designed and evaluated. The assay consisted of a multiplexed PCR set of 5 tubes able to detect the most commonly described resistance mechanism, including FKS1 hot spot 1 and hot spot 2 mutations. The performance and specificity of the assay was evaluated using a double-blinded panel of 50 C. albicans strains. The assay showed a sensitivity of 96% and was able to detect all homozygous mutants included in the collection of strains, demonstrating that it is a robust, quick, and labor-saving method that is suitable for a routine clinical diagnostic laboratory. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  4. Local and systemic immune response in pigs during subclinical and clinical swine influenza infection.

    Science.gov (United States)

    Pomorska-Mól, M; Kwit, K; Markowska-Daniel, I; Kowalski, C; Pejsak, Z

    2014-10-01

    Local and systemic immune responses in pigs intranasally (IN) and intratracheally (IT) inoculated with swine influenza virus (SIV) were studied. No clinical signs were observed in IN-inoculated pigs, while IT-inoculated pigs developed typical signs of influenza. Significantly higher titres of specific antibodies and changes of haematological parameters were found only in IT-inoculated pigs. Because positive correlations between viral titre, local cytokine concentration, and lung pathology have been observed, we hypothesise that both viral load and the local secretion of cytokines play a role in the induction of lung lesions. It could be that a higher replication of SIV stimulates immune cells to secrete higher amounts of cytokines. The results of the present study indicate that pathogenesis of SIV is dependent on both, the damage caused to the lung parenchyma directly by virus, and the effects on the cells of the host's immune system. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Early response predicts subsequent response to olanzapine long-acting injection in a randomized, double-blind clinical trial of treatment for schizophrenia.

    Science.gov (United States)

    Ascher-Svanum, Haya; Zhao, Fangyi; Detke, Holland C; Nyhuis, Allen W; Lawson, Anthony H; Stauffer, Virginia L; Montgomery, William; Witte, Michael M; McDonnell, David P

    2011-09-23

    In patients with schizophrenia, early non-response to oral antipsychotic therapy robustly predicts subsequent non-response to continued treatment with the same medication. This study assessed whether early response predicted later response when using a long-acting injection (LAI) antipsychotic. Data were taken from an 8-week, randomized, double-blind, placebo-controlled study of olanzapine LAI in acutely ill patients with schizophrenia (n = 233). Early response was defined as ≥ 30% improvement from baseline to Week 4 in Positive and Negative Syndrome Scale (PANSS0-6) Total score. Subsequent response was defined as ≥ 40% baseline-to-endpoint improvement in PANSS0-6 Total score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy were calculated. Clinical and functional outcomes were compared between Early Responders and Early Non-responders. Early response/non-response to olanzapine LAI predicted later response/non-response with high sensitivity (85%), specificity (72%), PPV (78%), NPV (80%), and overall accuracy (79%). Compared to Early Non-responders, Early Responders had significantly greater improvement in PANSS0-6 Total scores at all time points and greater baseline-to-endpoint improvement in PANSS subscale scores, Quality of Life Scale scores, and Short Form-36 Health Survey scores (all p ≤ .01). Among Early Non-responders, 20% demonstrated response by Week 8. Patients who lacked early improvement (at Week 4) in Negative Symptoms and Disorganized Thoughts were more likely to continue being non-responders at Week 8. Among acutely ill patients with schizophrenia, early response predicted subsequent response to olanzapine LAI. Early Responders experienced significantly better clinical and functional outcomes than Early Non-responders. Findings are consistent with previous research on oral antipsychotics. F1D-MC-HGJZ: Comparison of Intramuscular Olanzapine Depot With Placebo in the Treatment of

  6. Clinical diagnosis of polycystic ovarian syndrome and response to metformin therapy

    International Nuclear Information System (INIS)

    Tariq, N.; Ayub, R.; Alam, A.Y.; Raees, S.R.

    2007-01-01

    To determine the accuracy of diagnosing polycystic ovarian syndrome (PCOS) predominantly on clinical features and the response to metformin therapy. Women fulfilling the inclusion criteria (oligo/hypomenorrhea, infertility, weight gain, hyperandrogenism) were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in both or one ovary without presence of mature follicle was the cutoff number for positive ultrasound. Thyroid stimulating hormone levels were performed in all patients, and patients with abnormal levels were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were again evaluated for response to metformin therapy and those who failed to conceive were given clomiphene citrate along with metformin. Fertility was re-evaluated at the end of one year. At the start of the study, 81% women had menstrual irregularity and 84% had infertility. Hirsutism was seen in 72% while history of weight gain was present in 62% of patients. Ultrasound evidence of polycystic ovaries was seen in 93% of women. After 6 months of metformin therapy, 80% patients had achieved correction in their menstrual irregularity. After 6 months on metformin alone, 51% patients conceived while an additional 20% conceived on both metformin and clomiphene citrate during next 6 months. Overall fertility rate was 71% at the end of one year. There was statistically significant change in pre-treatment and post-treatment BMI. Combination of three or more of the clinical features (irregular cycles, history of weight gain, infertility and hirsutism) provide an appropriate basis for the diagnosis of PCOS. Metformin alone was an effective treatment for PCOS in this series. (author)

  7. Clinical, histopathological and metabolic responses following exercise in Arabian horses with a history of exertional rhabdomyolysis.

    Science.gov (United States)

    McKenzie, E C; Eyrich, L V; Payton, M E; Valberg, S J

    2016-10-01

    A previous report suggests a substantial incidence of exertional rhabdomyolysis (ER) in Arabian horses performing endurance racing. This study compared formalin histopathology and clinical and metabolic responses to a standardised field exercise test (SET) between Arabians with and without ER. Arabian horses with (n = 10; age 15.4 ± 5.6 years) and without (n = 9; 12.9 ± 6.1 years) prior ER were stall-rested for 24-48 h, after which paired ER and control horses were fitted with a telemetric ECG and performed a 47 min submaximal SET. Plasma glucose, lactate, electrolyte and total protein concentrations and packed cell volume were measured before and immediately after exercise. Blood and percutaneous gluteal muscle samples were also obtained before and 3 h after exercise for measurement of plasma creatine kinase (CK) activity and muscle glycogen concentration, respectively. Histopathologic analysis of formalin-fixed pre-exercise muscle sections was performed. Data were analyzed by ANOVA and non-parametric tests (P horses displayed clinical signs of ER during exercise, and plasma CK increased similarly in ER and control Arabians. Muscle glycogen, heart rate, and remaining plasma variables did not differ between horses with ER and control horses. Horses with ER had more internalised nuclei in mature myofibers, more aggregates of cytoplasmic glycogen and desmin, and higher myopathic scores than control horses. Although many horses with ER had histopathologic evidence of chronic myopathy, muscle glycogen concentrations and metabolic exercise responses were normal. Results did not support a consistent metabolic myopathy or a glycogen storage disorder in Arabians with ER. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Comprehensive Analysis of MGMT Promoter Methylation: Correlation with MGMT Expression and Clinical Response in GBM

    Science.gov (United States)

    Shah, Nameeta; Lin, Biaoyang; Sibenaller, Zita; Ryken, Timothy; Lee, Hwahyung; Yoon, Jae-Geun; Rostad, Steven; Foltz, Greg

    2011-01-01

    O6-methylguanine DNA-methyltransferase (MGMT) promoter methylation has been identified as a potential prognostic marker for glioblastoma patients. The relationship between the exact site of promoter methylation and its effect on gene silencing, and the patient's subsequent response to therapy, is still being defined. The aim of this study was to comprehensively characterize cytosine-guanine (CpG) dinucleotide methylation across the entire MGMT promoter and to correlate individual CpG site methylation patterns to mRNA expression, protein expression, and progression-free survival. To best identify the specific MGMT promoter region most predictive of gene silencing and response to therapy, we determined the methylation status of all 97 CpG sites in the MGMT promoter in tumor samples from 70 GBM patients using quantitative bisulfite sequencing. We next identified the CpG site specific and regional methylation patterns most predictive of gene silencing and improved progression-free survival. Using this data, we propose a new classification scheme utilizing methylation data from across the entire promoter and show that an analysis based on this approach, which we call 3R classification, is predictive of progression-free survival (HR  = 5.23, 95% CI [2.089–13.097], pmethylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) test based on the 3R classification and show that this test is both feasible in the clinical setting and predictive of progression free survival (HR  = 3.076, 95% CI [1.301–7.27], p = 0.007). We discuss the potential advantages of a test based on this promoter-wide analysis and compare it to the commonly used methylation-specific PCR test. Further prospective validation of these two methods in a large independent patient cohort will be needed to confirm the added value of promoter wide analysis of MGMT methylation in the clinical setting. PMID:21249131

  9. Empirically derived personality subtyping for predicting clinical symptoms and treatment response in bulimia nervosa.

    Science.gov (United States)

    Haynos, Ann F; Pearson, Carolyn M; Utzinger, Linsey M; Wonderlich, Stephen A; Crosby, Ross D; Mitchell, James E; Crow, Scott J; Peterson, Carol B

    2017-05-01

    Evidence suggests that eating disorder subtypes reflecting under-controlled, over-controlled, and low psychopathology personality traits constitute reliable phenotypes that differentiate treatment response. This study is the first to use statistical analyses to identify these subtypes within treatment-seeking individuals with bulimia nervosa (BN) and to use these statistically derived clusters to predict clinical outcomes. Using variables from the Dimensional Assessment of Personality Pathology-Basic Questionnaire, K-means cluster analyses identified under-controlled, over-controlled, and low psychopathology subtypes within BN patients (n = 80) enrolled in a treatment trial. Generalized linear models examined the impact of personality subtypes on Eating Disorder Examination global score, binge eating frequency, and purging frequency cross-sectionally at baseline and longitudinally at end of treatment (EOT) and follow-up. In the longitudinal models, secondary analyses were conducted to examine personality subtype as a potential moderator of response to Cognitive Behavioral Therapy-Enhanced (CBT-E) or Integrative Cognitive-Affective Therapy for BN (ICAT-BN). There were no baseline clinical differences between groups. In the longitudinal models, personality subtype predicted binge eating (p = 0.03) and purging (p = 0.01) frequency at EOT and binge eating frequency at follow-up (p = 0.045). The over-controlled group demonstrated the best outcomes on these variables. In secondary analyses, there was a treatment by subtype interaction for purging at follow-up (p = 0.04), which indicated a superiority of CBT-E over ICAT-BN for reducing purging among the over-controlled group. Empirically derived personality subtyping appears to be a valid classification system with potential to guide eating disorder treatment decisions. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:506-514). © 2016 Wiley Periodicals, Inc.

  10. Reliability of video-based quantification of the knee- and hip angle at foot strike during running

    DEFF Research Database (Denmark)

    Damsted, Camma; Oestergaard Nielsen, Rasmus; Larsen, Lars Henrik

    2014-01-01

    INTRODUCTION: In clinical practice, joint kinematics during running are primarily quantified by two-dimensional (2D) video recordings and motion-analysis software. The applicability of this approach depends on the clinicians' ability to quantify kinematics in a reliable manner. The reliability...... of quantifying knee- and hip angles at foot strike is uninvestigated. OBJECTIVE: To investigate the intra- and inter-rater reliability within and between days of clinicians' ability to quantify the knee- and hip angles at foot strike during running. METHODS: Eighteen recreational runners were recorded twice...... using a clinical 2D video setup during treadmill running. Two blinded raters quantified joint angles on each video twice with freeware motion analysis software (Kinovea 0.8.15). RESULTS: The range from the lower prediction limit to the upper prediction limit of the 95% prediction interval varied three...

  11. RARtool: A MATLAB Software Package for Designing Response-Adaptive Randomized Clinical Trials with Time-to-Event Outcomes.

    Science.gov (United States)

    Ryeznik, Yevgen; Sverdlov, Oleksandr; Wong, Weng Kee

    2015-08-01

    Response-adaptive randomization designs are becoming increasingly popular in clinical trial practice. In this paper, we present RARtool , a user interface software developed in MATLAB for designing response-adaptive randomized comparative clinical trials with censored time-to-event outcomes. The RARtool software can compute different types of optimal treatment allocation designs, and it can simulate response-adaptive randomization procedures targeting selected optimal allocations. Through simulations, an investigator can assess design characteristics under a variety of experimental scenarios and select the best procedure for practical implementation. We illustrate the utility of our RARtool software by redesigning a survival trial from the literature.

  12. Optical signal response pf the alanine gel solution for photons and electrons clinical beams

    International Nuclear Information System (INIS)

    Silva, Cleber Feijo; Campos, Leticia Lucente

    2009-01-01

    Alanine gel dosimeter is a new gel material developed at IPEN that presents significant improvement on previous alanine systems developed by Costa (1994). The measure technique is based on the transformation of ferrous ions (Fe 2+ ) in ferric ions (Fe 3+ ) after irradiation. The DL-Alanine (C 3 H 7 NO 2 ) is an aminoacid tissue equivalent that improves the production of ferric ions in the solution. This work aims to study the comparison of optical signal response of the alanine gel solution for photons and electrons clinical beams. It was observed that the calibration factor can be considered independent of quality of the radiation for photons and electrons clinical beams. Therefore, it can be used the same calibration factor for evaluating the absorbed dose in photons and electrons fields in the energy of 6 MeV. Alanine Gel Dosimeter presents good performance and can be useful as alternative dosimeter in the radiotherapy area using MRI technique for 3D dose distribution evaluation. (author)

  13. Parkinson's disease associated with 22q11.2 deletion: Clinical characteristics and response to treatment.

    Science.gov (United States)

    Dufournet, B; Nguyen, K; Charles, P; Grabli, D; Jacquette, A; Borg, M; Danaila, T; Mutez, E; Drapier, S; Colin, O; Eusebio, A; Philip, N; Azulay, J P

    2017-06-01

    While it is known that 22q11.2 microdeletions (22q11.2-del) increase the risk of Parkinson's disease (PD), the characteristics of PD associated with 22q11.2-del have not been specifically explored. This report aimed to assess the clinical characteristics and treatment responses of PD patients with 22q11.2-del, and to describe any features that might lead neurologists to investigate the comorbidity. Nine PD patients (eight men, one woman) with 22q11.2-del were followed at seven centers of the French PD Expert Network (Ns-Park). PD diagnosis was made before 22q11.2-del diagnosis in seven cases; their main characteristics were early onset (32-48 years) and good initial levodopa sensitivity, but with a course characterized by severe and early-onset levodopa-induced motor complications and psychiatric manifestations. Three patients received deep brain stimulation (DBS) that was effective. Searching for 22q11.2-del in PD patients presenting with suggestive features is relevant as the clinical presentation is similar to idiopathic PD, but with other associated characteristics, including a severe evolution. Results with DBS are similar to those reported for idiopathic PD. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Idiopathic thrombocytopenic purpura (ITP) in Ethiopian children: clinical findings and response to therapy.

    Science.gov (United States)

    Bedri, A; Abebe, E

    1995-04-01

    This retrospective study provides information on the clinical findings and response to therapy in Ethiopian children with idiopathic thrombocytopenic purpura. Forty-nine cases of idiopathic thrombocytopenic purpura admitted to the teaching hospital, Ethio-Swedish Children's Hospital (ESCH) in Addis Abeba, Ethiopia between January 1982 and December 1993 were studied. Among these were 31 females and 18 males with a female to male ratio of 1.9:1. The age range was three to 12 years with a mean of seven years. The commonest presenting clinical features were petechiae, epistaxis, gingival and gastro-intestinal bleeding. Twenty-nine patients were treated with prednisolone, out of whom, 27 attained absolute remission. Twenty patients were observed and managed conservatively and attained spontaneous remission. One child went on to develop chronic idiopathic thrombocytopenic purpura and underwent splenectomy after immunosuppressive treatment failure, while another child is still being followed up with recurrent episodes of thrombocytopenia and epistaxis. No mortality was noted in the review of these series of patients.

  15. Exosomal miRNAs in hepatocellular carcinoma development and clinical responses.

    Science.gov (United States)

    Li, Shuangshuang; Yao, Jiping; Xie, Mingjie; Liu, Yanning; Zheng, Min

    2018-04-11

    Hepatocellular carcinoma remains the sixth most lethal malignancy in the world. While HCC is often diagnosed via current biomarkers at a late stage, early detection of HCC has proven to be very difficult. Recent studies have focused on using exosomal miRNAs in clinical diagnostics and therapeutics, because they have improved stability in exosomes than as free miRNAs themselves. Exosomal miRNAs act through novel mechanisms for inducing cellular responses in a variety of biological circumstances. Dysregulated expression of miRNAs in exosomes can also accelerate HCC progression, including cell proliferation and metastasis, via alteration of a network of genes. Growing evidence demonstrates that exosomal miRNAs can affect many aspects of physiological and pathological conditions in HCC and indicates that miRNAs in exosomes can not only serve as sensitive biomarkers for cancer diagnostics and recurrence but can also potentially be used as therapeutics to target HCC progression. In this review, we summarize the latest findings between exosomal miRNAs and HCC, in order to better comprehend the functions and applications in HCC. Moreover, we discuss critical issues to consider when developing anti-tumor exosomal miRNAs as a novel therapeutic strategy for treating HCC in the clinic.

  16. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis.

    Science.gov (United States)

    Andersson, M; Kolodziej, B; Andersson, R E

    2017-10-01

    The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment. Patients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment. The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020). AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  17. Cannabis induces a clinical response in patients with Crohn's disease: a prospective placebo-controlled study.

    Science.gov (United States)

    Naftali, Timna; Bar-Lev Schleider, Lihi; Dotan, Iris; Lansky, Ephraim Philip; Sklerovsky Benjaminov, Fabiana; Konikoff, Fred Meir

    2013-10-01

    The marijuana plant Cannabis sativa has been reported to produce beneficial effects for patients with inflammatory bowel diseases, but this has not been investigated in controlled trials. We performed a prospective trial to determine whether cannabis can induce remission in patients with Crohn's disease. We studied 21 patients (mean age, 40 ± 14 y; 13 men) with Crohn's Disease Activity Index (CDAI) scores greater than 200 who did not respond to therapy with steroids, immunomodulators, or anti-tumor necrosis factor-α agents. Patients were assigned randomly to groups given cannabis, twice daily, in the form of cigarettes containing 115 mg of Δ9-tetrahydrocannabinol (THC) or placebo containing cannabis flowers from which the THC had been extracted. Disease activity and laboratory tests were assessed during 8 weeks of treatment and 2 weeks thereafter. Complete remission (CDAI score, cannabis group (45%) and 1 of 10 in the placebo group (10%; P = .43). A clinical response (decrease in CDAI score of >100) was observed in 10 of 11 subjects in the cannabis group (90%; from 330 ± 105 to 152 ± 109) and 4 of 10 in the placebo group (40%; from 373 ± 94 to 306 ± 143; P = .028). Three patients in the cannabis group were weaned from steroid dependency. Subjects receiving cannabis reported improved appetite and sleep, with no significant side effects. Although the primary end point of the study (induction of remission) was not achieved, a short course (8 weeks) of THC-rich cannabis produced significant clinical, steroid-free benefits to 10 of 11 patients with active Crohn's disease, compared with placebo, without side effects. Further studies, with larger patient groups and a nonsmoking mode of intake, are warranted. ClinicalTrials.gov, NCT01040910. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  18. Mechanistic correlates of clinical responses to omalizumab in the setting of oral immunotherapy for milk allergy.

    Science.gov (United States)

    Frischmeyer-Guerrerio, Pamela A; Masilamani, Madhan; Gu, Wenjuan; Brittain, Erica; Wood, Robert; Kim, Jennifer; Nadeau, Kari; Jarvinen, Kirsi M; Grishin, Alexander; Lindblad, Robert; Sampson, Hugh A

    2017-10-01

    In our recent clinical trial, the addition of omalizumab to oral immunotherapy (OIT) for milk allergy improved safety, but no significant clinical benefit was detected. We sought to investigate mechanisms by which omalizumab modulates immunity in the context of OIT and to identify baseline biomarkers that predict subgroups of patients most likely to benefit from omalizumab. Blood was obtained at baseline and multiple time points during a placebo-controlled trial of OIT for milk allergy in which subjects were randomized to receive omalizumab or placebo. Immunologic outcomes included measurement of basophil CD63 expression and histamine release and casein-specific CD4 + regulatory T-cell proliferation. Biomarkers were analyzed in relationship to measurements of safety and efficacy. Milk-induced basophil CD63 expression was transiently reduced in whole blood samples from both omalizumab- and placebo-treated subjects. However, IgE-dependent histamine release increased in washed cell preparations from omalizumab- but not placebo-treated subjects. No increase in regulatory T-cell frequency was evident in either group. Subjects with lower rates of adverse reactions, regardless of arm, experienced better clinical outcomes. Pre-OIT basophil reactivity positively associated with occurrence of symptoms during OIT, whereas the baseline milk IgE/total IgE ratio correlated with the likelihood of achieving sustained unresponsiveness. A combination of baseline basophil and serologic biomarkers defined a subset of patients in which adjunctive therapy with omalizumab was associated with attainment of sustained unresponsiveness and a reduction in adverse reactions. Combining omalizumab therapy with milk OIT led to distinct alterations in basophil reactivity but not T-cell responses. Baseline biomarkers can identify subjects most likely to benefit from adjunctive therapy with omalizumab. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  19. Genetic basis for clinical response to CTLA-4 blockade in melanoma.

    Science.gov (United States)

    Snyder, Alexandra; Makarov, Vladimir; Merghoub, Taha; Yuan, Jianda; Zaretsky, Jesse M; Desrichard, Alexis; Walsh, Logan A; Postow, Michael A; Wong, Phillip; Ho, Teresa S; Hollmann, Travis J; Bruggeman, Cameron; Kannan, Kasthuri; Li, Yanyun; Elipenahli, Ceyhan; Liu, Cailian; Harbison, Christopher T; Wang, Lisu; Ribas, Antoni; Wolchok, Jedd D; Chan, Timothy A

    2014-12-04

    Immune checkpoint inhibitors are effective cancer treatments, but molecular determinants of clinical benefit are unknown. Ipilimumab and tremelimumab are antibodies against cytotoxic T-lymphocyte antigen 4 (CTLA-4). Anti-CTLA-4 treatment prolongs overall survival in patients with melanoma. CTLA-4 blockade activates T cells and enables them to destroy tumor cells. We obtained tumor tissue from patients with melanoma who were treated with ipilimumab or tremelimumab. Whole-exome sequencing was performed on tumors and matched blood samples. Somatic mutations and candidate neoantigens generated from these mutations were characterized. Neoantigen peptides were tested for the ability to activate lymphocytes from ipilimumab-treated patients. Malignant melanoma exomes from 64 patients treated with CTLA-4 blockade were characterized with the use of massively parallel sequencing. A discovery set consisted of 11 patients who derived a long-term clinical benefit and 14 patients who derived a minimal benefit or no benefit. Mutational load was associated with the degree of clinical benefit (P=0.01) but alone was not sufficient to predict benefit. Using genomewide somatic neoepitope analysis and patient-specific HLA typing, we identified candidate tumor neoantigens for each patient. We elucidated a neoantigen landscape that is specifically present in tumors with a strong response to CTLA-4 blockade. We validated this signature in a second set of 39 patients with melanoma who were treated with anti-CTLA-4 antibodies. Predicted neoantigens activated T cells from the patients treated with ipilimumab. These findings define a genetic basis for benefit from CTLA-4 blockade in melanoma and provide a rationale for examining exomes of patients for whom anti-CTLA-4 agents are being considered. (Funded by the Frederick Adler Fund and others.).

  20. Response to written feedback of clinical data within a longitudinal study: a qualitative study exploring the ethical implications

    Directory of Open Access Journals (Sweden)

    Wyke Sally

    2011-01-01

    Full Text Available Abstract Background There is a growing ethical imperative to feedback research results to participants but there remains a striking lack of empirical research on how people respond to individualised feedback. We sought to explore longitudinal study participants' response to receiving individual written feedback of weight-related and blood results, and to consider the balance of harms against benefits. Methods A qualitative study with face-to-face and telephone interviews conducted with 50 men and women who had participated in the fifth and most recent wave of the cohort study 'West of Scotland Twenty-07' and received a feedback letter containing body mass index (BMI, body fat percentage, cholesterol and glycated haemoglobin A1c (HbA1c results. Results Expectations of, and response to, the feedback of their individual results varied. Whilst half of the participants were on the whole 'pleased' with their results or held neutral views, half reported negative responses such as 'shock' or 'concern', particularly in relation to the weight-related results. Participants who were overweight and obese used the most negative language about their results, with some being quite distressed and reporting feelings of powerlessness, low self-image and anxiety over future health. Nevertheless, some people reported having implemented lifestyle changes in direct response to the feedback, resulting in significant weight-loss and/or dietary improvements. Others reported being motivated to change their behaviour. Age and gender differences were apparent in these narratives of behaviour change. Conclusions The potential harm caused to some participants may be balanced against the benefit to others. More evaluation of the impact of the format, content and means of individualised feedback of research findings in non-trial studies is required given the growing ethical imperative to offer participants a choice of receiving their results, and the likelihood that a high

  1. Would artificial neural networks implemented in clinical wards help nephrologists in predicting epoetin responsiveness?

    Directory of Open Access Journals (Sweden)

    Marone Claudio

    2006-09-01

    Full Text Available Abstract Background Due to its strong intra- and inter-individual variability, predicting the ideal erythropoietin dose is a difficult task. The aim of this study was to re-evaluate the impact of the main parameters known to influence the responsiveness to epoetin beta and to test the performance of artificial neural networks (ANNs in predicting the dose required to reach the haemoglobin target and the monthly dose adjustments. Methods We did a secondary analysis of the survey on Anaemia Management in dialysis patients in Switzerland; a prospective, non-randomized observational study, enrolling 340 patients of 26 centres and in order to have additional information about erythropoietin responsiveness, we included a further 92 patients from the Renal Services of the Ente Ospedaliero Cantonale, Bellinzona, Switzerland. The performance of ANNs in predicting the epoetin dose was compared with that of linear regressions and of nephrologists in charge of the patients. Results For a specificity of 50%, the sensitivity of ANNs compared with linear regressions in predicting the erythropoietin dose to reach the haemoglobin target was 78 vs. 44% (P P P Conclusion In predicting the erythropoietin dose required for an individual patient and the monthly dose adjustments ANNs are superior to nephrologists' opinion. Thus, ANN may be a useful and promising tool that could be implemented in clinical wards to help nephrologists in prescribing erythropoietin.

  2. Cryptosporidiosis in HIV/AIDS patients in Kenya: clinical features, epidemiology, molecular characterization and antibody responses.

    Science.gov (United States)

    Wanyiri, Jane W; Kanyi, Henry; Maina, Samuel; Wang, David E; Steen, Aaron; Ngugi, Paul; Kamau, Timothy; Waithera, Tabitha; O'Connor, Roberta; Gachuhi, Kimani; Wamae, Claire N; Mwamburi, Mkaya; Ward, Honorine D

    2014-08-01

    We investigated the epidemiological and clinical features of cryptosporidiosis, the molecular characteristics of infecting species and serum antibody responses to three Cryptosporidium-specific antigens in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in Kenya. Cryptosporidium was the most prevalent enteric pathogen and was identified in 56 of 164 (34%) of HIV/AIDS patients, including 25 of 70 (36%) with diarrhea and 31 of 94 (33%) without diarrhea. Diarrhea in patients exclusively infected with Cryptosporidium was significantly associated with the number of children per household, contact with animals, and water treatment. Cryptosporidium hominis was the most prevalent species and the most prevalent subtype family was Ib. Patients without diarrhea had significantly higher serum IgG levels to Chgp15, Chgp40 and Cp23, and higher fecal IgA levels to Chgp15 and Chgp40 than those with diarrhea suggesting that antibody responses to these antigens may be associated with protection from diarrhea and supporting further investigation of these antigens as vaccine candidates. © The American Society of Tropical Medicine and Hygiene.

  3. A type of sample size design in cancer clinical trials for response rate estimation.

    Science.gov (United States)

    Liu, Junfeng

    2011-01-01

    During the early stage of cancer clinical trials, when it is not convenient to construct an explicit hypothesis testing, a study on a new therapy often calls for a response rate (p) estimation concurrently with or right before a typical phase II study. We consider a two-stage process, where the acquired information from Stage I (with a small sample size (m)) would be utilized for sample size (n) recommendation for Stage II study aiming for a more accurate estimation. Once a sample size design and a parameter estimation protocol are applied, we study the overall utility (cost-effectiveness) in connection with the cost due to patient recruitment and treatment as well as the loss due to mean squared error from parameter estimation. Two approaches will be investigated including the posterior mixture method (a Bayesian approach) and the empirical variance method (a frequentist approach). We also discuss response rate estimation under truncated parameter space using maximum likelihood estimation with regard to sample size and mean squared error. The profiles of p-specific expected sample size, mean squared error and risk under different approaches motivate us to introduce the concept of "admissible sample size (design)". Copyright © 2010 Elsevier Inc. All rights reserved.

  4. [Clinical Applications of Peripheral Markers of Response in Antidepressant Treatment: Neurotrophins and Cytokines].

    Science.gov (United States)

    Bermúdez, Constanza Mendoza

    2012-03-01

    Explanatory theories of depression have advanced in recent decades from the monoaminergic hypothesis to neurogenesis alterations to the neurohormonal hypothesis that includes the dysfunction of the inflammatory response. Currently there is a growing interest in the development of biomarkers that can contribute to diagnosis and proper treatment. To describe the role of neurotrophins such as brain-derived neurotrophic factor (BDNF) and cytokines in the pathophysiology of depressive disorder in addition to reviewing and analyzing evidence about their clinical application as biomarkers of antidepressant therapy. Relevant data research in several databases. In recent years evidence of alterations in neurogenesis mediated by the expression of BDNF in the hippocampus in the pathophysiology of depression has increased and there is ample evidence that BDNF is a marker of the diagnosis of depressive disorder and also of treatment effectiveness. There is little information about other neurotrophins. There has also been increased interest in relation to depression as an "inflammatory disease" and the link with cytokines in its pathogenesis. Evidence has been found for the usefulness of some cytokines especially IL-1 (interleukin 1), IL-6 (interleukin 6), and TNF (tumor necrosis factor) as biomarkers of antidepressant drug response in humans. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  5. Simulating Blade-Strike on Fish passing through Marine Hydrokinetic Turbines

    Energy Technology Data Exchange (ETDEWEB)

    Romero Gomez, Pedro DJ; Richmond, Marshall C.

    2014-06-16

    The study reported here evaluated the occurrence, frequency, and intensity of blade strike of fish on an axial-flow marine hydrokinetic turbine by using two modeling approaches: a conventional kinematic formulation and a proposed Lagrangian particle- based scheme. The kinematic model included simplifying assumptions of fish trajectories such as distribution and velocity. The proposed method overcame the need for such simplifications by integrating the following components into a computational fluid dynamics (CFD) model: (i) advanced eddy-resolving flow simulation, (ii) generation of ambient turbulence based on field data, (iii) moving turbine blades in highly transient flows, and (iv) Lagrangian particles to mimic the potential fish pathways. The test conditions to evaluate the blade-strike probability and fish survival rate were: (i) the turbulent environment, (ii) the fish size, and (iii) the approaching flow velocity. The proposed method offered the ability to produce potential fish trajectories and their interaction with the rotating turbine. Depending upon the scenario, the percentile of particles that registered a collision event ranged from 6% to 19% of the released sample size. Next, by using a set of experimental correlations of the exposure-response of living fish colliding with moving blades, the simulated collision data were used as input variables to estimate the survival rate of fish passing through the operating turbine. The resulting survival rates were greater than 96% in all scenarios, which is comparable to or better than known survival rates for conventional hydropower turbines. The figures of strike probability and mortality rate were amplified by the kinematic model. The proposed method offered the advantage of expanding the evaluation of other mechanisms of stress and injury on fish derived from hydrokinetic turbines and related devices.

  6. Aseismic strike-slip associated with the 2007 dike intrusion episode in Tanzania

    Science.gov (United States)

    Himematsu, Yuji; Furuya, Masato

    2015-08-01

    In July 2007, an earthquake swarm initiated in northern Tanzania near Lake Natron and lasted for about two months. Mt. Oldoinyo Lengai, located to the southwest of the swarm, began to erupt effusively about a month prior to the swarm, and increased its eruption intensity on September when the swarm almost ceased. Several previous studies have already reported the crustal deformation signals associated with the swarm using Interferometric Synthetic Aperture Radar (InSAR). However, nearly all the published data are based on the C-band ENVISAT/ASAR images acquired only from the descending path. We use the L-band ALOS/PALSAR images acquired from both ascending and descending paths, which allow us to examine the deformation signals in more detail. In addition to the InSAR data, we employ the offset-tracking technique to detect the signals along the azimuth direction. Using InSAR and offset-tracking data, we obtain the full 3D displacement fields associated with the episode. Besides the horizontal extension and subsidence signals due to the dike intrusion as already reported, the inferred full 3D displacements further indicate that the subsiding zone was horizontally moving by ~ 48 cm toward SSW. To explain the displacements, we performed fault source modeling, assuming an elastic half space. The fault slip distribution indicates that the contribution of the strike-slip component is about 20% of total moment release. Because almost all the focal mechanisms of earthquakes during the 2007 event indicate nearly pure normal faulting, aseismic strike-slip must have been responsible for the horizontal movement of the subsiding zone. The strike-slip at the shallowest depths suggests the presence of transtensive stress, which seems to be reasonable to generate the relay zones that are widely observed in the East African Rift. We also confirmed that the stress changes due to the dike intrusion were consistent with the inferred fault slip distributions.

  7. Recent geodynamics of major strike-slip zones

    Directory of Open Access Journals (Sweden)

    Vladimir G. Trifonov

    2015-09-01

    In all of the cases mentioned above, strike-slip deformation was expressed only or mainly during strong earthquakes. At other times, the rate of its accumulation was small and the dominant stress conditions led to transverse shortening, rarely resulting in local lengthening of the tectonic zone. These variations are caused by the tectonic peculiarities of these zones. The sinistral component of the deformation is related to the shift of the Arabian Plate relative to the African one, but also the transverse component is related to the continental slope and is expressed by the Coastal range shortening that exists in the El Ghab segment zone. There is not only a dextral deformation component, but also a transverse component, expressed by shortening of the Fergana and Talas ranges existing in the Talas-Fergana fault zone. In both zones, the shortening component became appreciable or dominant when the strike-slip deformation rate decreased. Similar, but more local, relationships were expressed in the epicentral area of the 2003 Altai earthquake and in the Western Palmyrides.

  8. Onset of aseismic creep on major strike-slip faults

    KAUST Repository

    Çakir, Ziyadin

    2012-10-02

    Time series analysis of spaceborne synthetic aperture radar (SAR) data, GPS measurements, and fi eld observations reveal that the central section of the Izmit (Turkey) fault that slipped with a supershear rupture velocity in the A.D. 1999, Mw7.4, Izmit earthquake began creeping aseismically following the earthquake. Rapid initial postseismic afterslip decayed logarithmically with time and appears to have reached a steady rate comparable to the preearthquake full fault-crossing rate, suggesting that it may continue for decades and possibly until late in the earthquake cycle. If confi rmed by future monitoring, these observations identify postseismic afterslip as a mechanism for initiating creep behavior along strike-slip faults. Long-term afterslip and/or creep has signifi cant implications for earthquake cycle models, recurrence intervals of large earthquakes, and accordingly, seismic hazard estimation along mature strike-slip faults, in particular for Istanbul which is believed to lie adjacent to a seismic gap along the North Anatolian fault in the Sea of Marmara. © 2012 Geological Society of America.

  9. Comprehensive analysis of MGMT promoter methylation: correlation with MGMT expression and clinical response in GBM.

    Directory of Open Access Journals (Sweden)

    Nameeta Shah

    Full Text Available O⁶-methylguanine DNA-methyltransferase (MGMT promoter methylation has been identified as a potential prognostic marker for glioblastoma patients. The relationship between the exact site of promoter methylation and its effect on gene silencing, and the patient's subsequent response to therapy, is still being defined. The aim of this study was to comprehensively characterize cytosine-guanine (CpG dinucleotide methylation across the entire MGMT promoter and to correlate individual CpG site methylation patterns to mRNA expression, protein expression, and progression-free survival. To best identify the specific MGMT promoter region most predictive of gene silencing and response to therapy, we determined the methylation status of all 97 CpG sites in the MGMT promoter in tumor samples from 70 GBM patients using quantitative bisulfite sequencing. We next identified the CpG site specific and regional methylation patterns most predictive of gene silencing and improved progression-free survival. Using this data, we propose a new classification scheme utilizing methylation data from across the entire promoter and show that an analysis based on this approach, which we call 3R classification, is predictive of progression-free survival (HR  = 5.23, 95% CI [2.089-13.097], p<0.0001. To adapt this approach to the clinical setting, we used a methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA test based on the 3R classification and show that this test is both feasible in the clinical setting and predictive of progression free survival (HR  = 3.076, 95% CI [1.301-7.27], p = 0.007. We discuss the potential advantages of a test based on this promoter-wide analysis and compare it to the commonly used methylation-specific PCR test. Further prospective validation of these two methods in a large independent patient cohort will be needed to confirm the added value of promoter wide analysis of MGMT methylation in the clinical

  10. Depth of Response in Multiple Myeloma: A Pooled Analysis of Three PETHEMA/GEM Clinical Trials.

    Science.gov (United States)

    Lahuerta, Juan-Jose; Paiva, Bruno; Vidriales, Maria-Belen; Cordón, Lourdes; Cedena, Maria-Teresa; Puig, Noemi; Martinez-Lopez, Joaquin; Rosiñol, Laura; Gutierrez, Norma C; Martín-Ramos, María-Luisa; Oriol, Albert; Teruel, Ana-Isabel; Echeveste, María-Asunción; de Paz, Raquel; de Arriba, Felipe; Hernandez, Miguel T; Palomera, Luis; Martinez, Rafael; Martin, Alejandro; Alegre, Adrian; De la Rubia, Javier; Orfao, Alberto; Mateos, María-Victoria; Blade, Joan; San-Miguel, Jesus F

    2017-09-01

    Purpose To perform a critical analysis on the impact of depth of response in newly diagnosed multiple myeloma (MM). Patients and Methods Data were analyzed from 609 patients who were enrolled in the GEM (Grupo Español de Mieloma) 2000 and GEM2005MENOS65 studies for transplant-eligible MM and the GEM2010MAS65 clinical trial for elderly patients with MM who had minimal residual disease (MRD) assessments 9 months after study enrollment. Median follow-up of the series was 71 months. Results Achievement of complete remission (CR) in the absence of MRD negativity was not associated with prolonged progression-free survival (PFS) and overall survival (OS) compared with near-CR or partial response (median PFS, 27, 27, and 29 months, respectively; median OS, 59, 64, and 65 months, respectively). MRD-negative status was strongly associated with prolonged PFS (median, 63 months; P < .001) and OS (median not reached; P < .001) overall and in subgroups defined by prior transplantation, disease stage, and cytogenetics, with prognostic superiority of MRD negativity versus CR particularly evident in patients with high-risk cytogenetics. Accordingly, Harrell C statistics showed higher discrimination for both PFS and OS in Cox models that included MRD (as opposed to CR) for response assessment. Superior MRD-negative rates after different induction regimens anticipated prolonged PFS. Among 34 MRD-negative patients with MM and a phenotypic pattern of bone marrow involvement similar to monoclonal gammopathy of undetermined significance at diagnosis, the probability of "operational cure" was high; median PFS was 12 years, and the 10-year OS rate was 94%. Conclusion Our results demonstrate that MRD-negative status surpasses the prognostic value of CR achievement for PFS and OS across the disease spectrum, regardless of the type of treatment or patient risk group. MRD negativity should be considered as one of the most relevant end points for transplant-eligible and elderly fit patients

  11. Biochemical and clinical responses of Common Eiders to implanted satellite transmitters

    Science.gov (United States)

    Latty, Christopher J.; Hollmen, Tuula E.; Petersen, Margaret; Powell, Abby; Andrews, Russel D.

    2016-01-01

    Implanted biologging devices, such as satellite-linked platform transmitter terminals (PTTs), have been used widely to delineate populations and identify movement patterns of sea ducks. Although in some cases these ecological studies could reveal transmitter effects on behavior and mortality, experiments conducted under controlled conditions can provide valuable information to understand the influence of implanted tags on health and physiology. We report the clinical, mass, biochemical, and histological responses of captive Common Eiders (Somateria mollissima) implanted with PTTs with percutaneous antennas. We trained 6 individuals to dive 4.9 m for their food, allowed them to acclimate to this dive depth, and implanted them with PTTs. We collected data before surgery to establish baselines, and for 3.5 mo after surgery. The first feeding dive took place 22 hr after surgery, with 5 of 6 birds diving to the bottom within 35 hr of surgery. Plumage waterproofing around surgical sites was reduced ≤21 days after surgery. Mass; albumin; albumin:globulin ratio; aspartate aminotransferase; β1-, β2-, and γ-globulins; creatine kinase; fecal glucocorticoid metabolites; heterophil:lymphocyte ratio; and packed cell volume changed from baseline on one or more of the postsurgery sampling dates, and some changes were still evident 3.5 mo after surgery. Our findings show that Common Eiders physiologically responded for up to 3.5 mo after surgical implantation of a PTT, with the greatest response occurring within the first few weeks of implantation. These responses support the need for postsurgery censor periods for satellite telemetry data and should be considered when designing studies and analyzing information from PTTs in sea ducks.

  12. [Cryptogenic West syndrome: Clinical profile, response to treatment and prognostic factors].

    Science.gov (United States)

    Calderón Romero, María; Arce Portillo, Elena; López Lobato, Mercedes; Muñoz Cabello, Beatriz; Blanco Martínez, Bárbara; Madruga Garrido, Marcos; Alonso Luego, Olga

    2017-12-06

    West syndrome (WS) is an age-dependent epileptic encephalopathy in which the prognosis varies according to the, not always identified, underlying origin. To define the profile of cryptogenic (a least studied isolated sub-group) WS, in Spain. To study its outcome, response to different treatments, and to establish prognostic factors. The study included a review of the medical records of 16 patients diagnosed with cryptogenic WS during the period, 2000-2015. The mean follow-up time was 6.6 years, with a minimum of 2 years. The large majority (11/16) were male. The mean age at onset was 6 months, and 6/16 had a family history of idiopathic epilepsy. The first line treatment with vigabatrin had an electrical-clinical response in 5/16 patients, with the remaining cases responding to adrenocorticotropic hormone (ACTH). Almost half (44%) of the patients progressed to other types of epilepsy, with no difference between those treated with vigabatrin or ACTH. A greater number of adverse effects were obtained with ACTH, with no retinal involvement being observed with vigabatrin. The aetiological cause was found in 2/16. Being female, late onset, and early control of the hypsarrhythmia, were factors of a good prognosis. The overall prognosis of cryptogenic WS was more serious than expected. Although the incidence of Lennox-Gastaut syndrome was low, the progression to focal epilepsy was the most common, with it appearing within the first 2 years of the diagnosis. The initial response to vigabatrin was lower than expected, but the long-term result was comparable to ACTH. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. Influence of strike object grounding on close lightning electric fields

    Science.gov (United States)

    Baba, Yoshihiro; Rakov, Vladimir A.

    2008-06-01

    Using the finite difference time domain (FDTD) method, we have calculated vertical electric field Ez, horizontal (radial) electric field Eh, and azimuthal magnetic field Hϕ produced on the ground surface by lightning strikes to 160-m- and a 553-m-high conical strike objects representing the Peissenberg tower (Germany) and the CN Tower (Canada), respectively. The fields were computed for a typical subsequent stroke at distances d' from the bottom of the object ranging from 5 to 100 m for the 160-m tower and from 10 to 300 m for the 553-m tower. Grounding of the 160-m object was assumed to be accomplished by its underground basement represented by a 10-m-radius and 8-m-long perfectly conducting cylinder with or without a reference ground plane located 2 m below. The reference ground plane simulates, to some extent, a higher-conducting ground layer that is expected to exist below the water table. The configuration without reference ground plane actually means that this plane is present, but is located at an infinitely large depth. Grounding of the 553-m object was modeled in a similar manner but in the absence of reference ground plane only. In all cases considered, waveforms of Eh and Hϕ are not much influenced by the presence of strike object, while waveforms of Ez are. Waveforms of Ez are essentially unipolar (as they are in the absence of strike object) when the ground conductivity σ is 10 mS/m (the equivalent transient grounding impedance is several ohms) or greater. Thus, for the CN Tower, for which σ ≥ 10 mS/m, the occurrence of Ez polarity change is highly unlikely. For the 160-m tower and for σ = 1 and 0.1 mS/m, waveforms of Ez become bipolar (exhibit polarity change) at d' ≤ 10 m and d' ≤ 50 m, respectively, regardless of the presence of the reference ground plane. The corresponding equivalent transient grounding impedances are about 30 and 50 Ω in the absence of the reference ground plane and smaller than 10 Ω in the presence of the reference

  14. GENetic and clinical Predictors Of treatment response in Depression: the GenPod randomised trial protocol

    Directory of Open Access Journals (Sweden)

    O'Donovan Michael

    2008-05-01

    Full Text Available Abstract Background The most effective pharmacological treatments for depression inhibit the transporters that reuptake serotonin (Selective Serotonin Reuptake Inhibitors – SSRIs and noradrenaline (Noradrenaline Reuptake Inhibitors – NaRIs into the presynaptic terminal. There is evidence to suggest that noradrenaline and serotonin enhancing drugs work through separate mechanisms to produce their clinical antidepressant action. Although most of the current evidence suggests there is little difference in overall efficacy between SSRIs and NaRIs, there are patients who respond to one class of compounds and not another. This suggests that treatment response could be predicted by genetic and/or clinical characteristics. Firstly, this study aims to investigate the influence of a polymorphism (SLC6A4 in the 5HT transporter in altering response to SSRI medication. Secondly, the study will investigate whether those with more severe depression have a better response to NaRIs than SSRIs. Methods/design The GenPod trial is a multi-centre randomised controlled trial. GPs referred patients aged between 18–74 years presenting with a new episode of depression, who did not have any medical contraindications to antidepressant medication and who had no history of psychosis or alcohol/substance abuse. Patients were interviewed to ascertain their suitability for the study. Eligible participants (with a primary diagnosis of depression according to ICD10 criteria and a Beck Depression Inventory (BDI score > 14 were randomised to receive one of two antidepressant treatments, either the SSRI Citalopram or the NaRI Reboxetine, stratified according to severity. The final number randomised to the trial was 601. Follow-up assessments took place at 2, 6 and 12 weeks following randomisation. Primary outcome was measured at 6 weeks by the BDI. Outcomes will be analysed on an intention-to-treat basis and will use multiple regression models to compare treatments

  15. High-Velocity Impact Behaviour of Prestressed Composite Plates under Bird Strike Loading

    Directory of Open Access Journals (Sweden)

    Sebastian Heimbs

    2012-01-01

    Full Text Available An experimental and numerical analysis of the response of laminated composite plates under high-velocity impact loads of soft body gelatine projectiles (artificial birds is presented. The plates are exposed to tensile and compressive preloads before impact in order to cover realistic loading conditions of representative aeronautic structures under foreign object impact. The modelling methodology for the composite material, delamination interfaces, impact projectile, and preload using the commercial finite element code Abaqus are presented in detail. Finally, the influence of prestress and of different delamination modelling approaches on the impact response is discussed and a comparison to experimental test data is given. Tensile and compressive preloading was found to have an influence on the damage pattern. Although this general behaviour could be predicted well by the simulations, further numerical challenges for improved bird strike simulation accuracy are highlighted.

  16. The Diffusion of Strikes: A Dyadic Analysis of Economic Sectors in the Netherlands, 1995–2007

    NARCIS (Netherlands)

    Jansen, Giedo; Sluiter, Roderick; Akkerman, Agnes

    2016-01-01

    This study examines the extent to which strikes diffuse across sectors and to what extent this diffusion of strikes can be explained by similarities and interdependencies between sectors. For this purpose, the authors examine a unique temporally disaggregated and dyadic database on strikes in Dutch

  17. The Right to Strike in Public Employment. Key Issues Series--No. 15. Second Edition, Revised.

    Science.gov (United States)

    Sterret, Grace; Aboud, Antone

    Since the 1960s, the number of strikes by public employees, especially local government employees, has increased, and the number of employees belonging to unions or associations has about tripled. Recently, attention has been focused on strikes by public employees as a result of the strike in 1981 by air traffic controllers and their subsequent…

  18. Causes of falls of hangingwall over gullies adjacent to stabilizing strike pillars

    CSIR Research Space (South Africa)

    Turner, PA

    1987-08-01

    Full Text Available This report discusses the occurrence of falls of ground in strike gullies. Falls of hangingwall over strike gullies on the up-dip side of strike stabilizing pillars in longwall mining systems were investigated. Gullies were examined in both...

  19. Strikes in France and the Netherlands; A Comparison of Labour Market Institutions

    NARCIS (Netherlands)

    Butter, den F.A.G.; Koppes, S.Y.

    2003-01-01

    Strikes as a consequence of labour conflicts occur about 28 times as much in France as in the Netherlands. This paper examines the institutional differences underlying these differences in strike activity. Our empirical analysis shows that strike activity is high in France if workers were successful

  20. The 20th anniversary of interleukin-2 therapy: bimodal role explaining longstanding random induction of complete clinical responses

    International Nuclear Information System (INIS)

    Coventry, Brendon J; Ashdown, Martin L

    2012-01-01

    This year marks the twentieth anniversary of the approval by the US Food and Drug Administration of interleukin-2 (IL2) for use in cancer therapy, initially for renal cell carcinoma and later for melanoma. IL2 therapy for cancer has stood the test of time, with continued widespread use in Europe, parts of Asia, and the US. Clinical complete responses are variably reported at 5%–20% for advanced malignant melanoma and renal cell carcinoma, with strong durable responses and sustained long-term 5–10-year survival being typical if complete responses are generated. The literature was reviewed for the actions and clinical effects of IL2 on subsets of T cells. The influence of IL2 on clinical efficacy was also sought. The review revealed that IL2 is capable of stimulating different populations of T cells in humans to induce either T effector or T regulatory responses. This apparent “functional paradox” has confounded a clear understanding of the mechanisms behind the clinical effects that are observed during and following administration of IL2 therapy. An average complete response rate of around 7% in small and large clinical trials using IL2 for advanced renal cell carcinoma and malignant melanoma has been shown from a recent review of the literature. This review considers the published literature concerning the actions and emerging clinical effects of IL2 therapy, spanning its 20-year period in clinical use. It further details some of the recently described “bimodal” effects of IL2 to explain the apparent functional paradox, and how IL2 might be harnessed to emerge rapidly as a much more effective and predictable clinical agent in the near future

  1. Clinical response, pharmacokinetics, development of human anti-chimaeric antibodies, and synovial tissue response to rituximab treatment in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Thurlings, R. M.; Teng, O.; Vos, K.; Gerlag, D. M.; Aarden, L.; Stapel, S. O.; van Laar, J. M.; Tak, P. P.; Wolbink, G. J.

    2010-01-01

    To analyse whether persistence of synovial B lineage cells and lack of clinical response to rituximab treatment in patients with rheumatoid arthritis (RA) are associated with low rituximab serum levels and anti-rituximab antibody (ARA) formation. Fifty-eight patients with RA were treated with

  2. Clinical response, pharmacokinetics, development of human anti-chimaeric antibodies, and synovial tissue response to rituximab treatment in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Thurlings, R.M.; Teng, O.; Vos, K.; Gerlag, D.M.; Aarden, L.; Stapel, S.O.; van Laar, J.M.; Tak, P.P.; Wolbink, G.J.

    2010-01-01

    Objectives: To analyse whether persistence of synovial B lineage cells and lack of clinical response to rituximab treatment in patients with rheumatoid arthritis (RA) are associated with low rituximab serum levels and anti-rituximab antibody (ARA) formation. Methods: Fifty-eight patients with RA

  3. Finance leadership imperatives in clinical redesign.

    Science.gov (United States)

    Harris, John; Holm, Craig E; Inniger, Meredith C

    2015-03-01

    As physicians embrace their roles in managing healthcare costs and quality, finance leaders should seize the opportunity to engage physicians in clinical care redesign to ensure both high-quality performance and efficient resource use. Finance leaders should strike a balance between risk and reward to achieve a portfolio of clinical initiatives that is organizationally sustainable and responsive to current external drivers of payment changes. Because these initiatives should be driven by physicians, the new skill set of finance leaders should include an emphasis on relationship building to achieve consensus and drive change across an organization.

  4. Analysis of heel pad tissues mechanics at the heel strike in bare and shod conditions.

    Science.gov (United States)

    Fontanella, C G; Forestiero, A; Carniel, E L; Natali, A N

    2013-04-01

    A combined experimental and numerical approach is used to investigate the interaction phenomena occurring between foot and footwear during the heel strike phase of the gait. Two force platforms are utilised to evaluate the ground reaction forces of a subject in bare and shod walking. The reaction forces obtained from the experimental tests are assumed as loading conditions for the numerical analyses using three dimensional models of the heel region and of the running shoe. The heel pad region, as fat and skin tissues, is described by visco-hyperelastic and fibre-reinforced hyperelastic formulations respectively and bone region by a linear orthotropic formulation. Different elastomeric foams are considered with regard to the outsole, the midsole and the insole layers. The mechanical properties are described by a hyperfoam formulation. The evaluation of the mechanical behaviour of the heel pad tissues at the heel strike in bare and shod conditions is performed considering different combinations of materials for midsole and insole layers. Results allow for the definition of the influence of different material characteristics on the mechanical response of the heel pad region, in particular showing the compressive stress differentiation in the bare and shod conditions. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  5. Legal and ethical implications of medically enforced feeding of detained asylum seekers on hunger strike.

    Science.gov (United States)

    Kenny, Mary A; Silove, Derrick M; Steel, Zachary

    2004-03-01

    The current practice of non-consensual medical treatment of hunger-striking asylum seekers in detention needs closer inquiry. An Australian Government regulation empowers the Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) to authorise non-consensual medical treatment for a person in immigration detention if they are at risk of physical harm, but there are doubts about whether the regulation would withstand legal challenge. Authorisation by DIMIA does not compel medical practitioners to enforce treatment if such action is contrary to their "ethical, moral or religious convictions". The World Medical Association has established guidelines for doctors involved in managing people on hunger strikes. The Declaration of Tokyo (1975) and the Declaration of Malta (1991) both prohibit the use of non-consensual force-feeding of hunger strikers who are mentally competent. If called upon to treat hunger strikers, medical practitioners should be aware of their ethical and legal responsibilities, and that they should act independently of government or institutional interests.

  6. Striking Seasonality in the Secular Warming of the Northern Continents: Structure and Mechanisms

    Science.gov (United States)

    Nigam, S.; Thomas, N. P.

    2017-12-01

    The linear trend in twentieth-century surface air temperature (SAT)—a key secular warming signal— exhibits striking seasonal variations over Northern Hemisphere continents; SAT trends are pronounced in winter and spring but notably weaker in summer and fall. The SAT trends in historical twentieth-century climate simulations informing the Intergovernmental Panel for Climate Change's Fifth Assessment show varied (and often unrealistic) strength and structure, and markedly weaker seasonal variation. The large intra-ensemble spread of winter SAT trends in some historical simulations was surprising, especially in the context of century-long linear trends, with implications for the detection of the secular warming signal. The striking seasonality of observed secular warming over northern continents warrants an explanation and the representation of related processes in climate models. Here, the seasonality of SAT trends over North America is shown to result from land surface-hydroclimate interactions and, to an extent, also from the secular change in low-level atmospheric circulation and related thermal advection. It is argued that the winter dormancy and summer vigor of the hydrologic cycle over middle- to high-latitude continents permit different responses to the additional incident radiative energy from increasing greenhouse gas concentrations. The seasonal cycle of climate, despite its monotony, provides an expanded phase space for the exposition of the dynamical and thermodynamical processes generating secular warming, and an exceptional cost-effective opportunity for benchmarking climate projection models.

  7. Cerebral venous thrombosis in Saudi Arabia. Clinical variables, response to treatment, and outcome

    International Nuclear Information System (INIS)

    Kajtazi, Naim I; Arulneyam, Jayanthi C; AlSenani, Fahmi M; Zimmerman, Valerie A; AlShami, Sadiq Y

    2009-01-01

    To investigate cerebral venous thrombosis (CVTR) clinical presentations, risk factors, and response to treatment in Saudi Arabia. Retrospective analysis of the King Farad Medical City, Riyadh, acute stroke database from April 2005 through February 2008 revealed 22 patients with CVTR. Hyper coagulable work-up and neuroimaging were performed. Sixteen patients were female (72.7%), and the median age was 35 years. Clinical presentations included: headache (77.3%), seizures (54.5%), focal neurological signs (54.5%), and decreased level of consciousness (50%). Over two-thirds (n=11; 69%) of female patients had a history of oral contraceptive use, which was the most common risk factor. Protein S deficiency (n=3), anti phospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n=1), rhinocerebral mucormycosis (n=1), leukemia (n=1), non-Hodgkin's lymphoma (n=1), sepsis (n=1), and unknown (n=6) were causes. Affected areas included superior sagittal (n=13), transverse (n=16), sigmoid (n=14), straight (n=6), and cavernous sinus (n=1); internal cerebral vein (n=2); vein of Galen (n=3); cortical veins (n=10); and internal jugular vein (n=12). Two patients had quadriparesis, and 2 patients died. The remainder (n=18, 81.8%) improved. Bilateral hemorrhagic presentation or venous infarction, deep venous system thrombosis, and underlying malignancy had less favorable results. Presentations in our series were similar to those in other reports, although altered consciousness and seizures were more common. Cortical vein involvement was also higher than commonly reported. Oral contraceptive use was a primary risk factor in female patients. Outcomes were favorable in 81.8% of patients. (author)

  8. Discordant Immune Response with Antiretroviral Therapy in HIV-1: A Systematic Review of Clinical Outcomes.

    Science.gov (United States)

    Kelly, Christine; Gaskell, Katherine M; Richardson, Marty; Klein, Nigel; Garner, Paul; MacPherson, Peter

    2016-01-01

    A discordant immune response (DIR) is a failure to satisfactorily increase CD4 counts on ART despite successful virological control. Literature on the clinical effects of DIR has not been systematically evaluated. We aimed to summarise the risk of mortality, AIDS and serious non-AIDS events associated with DIR with a systematic review. The protocol is registered with the Centre for Review Dissemination, University of York (registration number CRD42014010821). Included studies investigated the effect of DIR on mortality, AIDS, or serious non-AIDS events in cohort studies or cohorts contained in arms of randomised controlled trials for adults aged 16 years or older. DIR was classified as a suboptimal CD4 count (as defined by the study) despite virological suppression following at least 6 months of ART. We systematically searched PubMed, Embase, and the Cochrane Library to December 2015. Risk of bias was assessed using the Cochrane tool for assessing risk of bias in cohort studies. Two authors applied inclusion criteria and one author extracted data. Risk ratios were calculated for each clinical outcome reported. Of 20 studies that met the inclusion criteria, 14 different definitions of DIR were used. Risk ratios for mortality in patients with and without DIR ranged between 1.00 (95% CI 0.26 to 3.92) and 4.29 (95% CI 1.96 to 9.38) with the majority of studies reporting a 2 to 3 fold increase in risk. DIR is associated with a marked increase in mortality in most studies but definitions vary widely. We propose a standardised definition to aid the development of management options for DIR.

  9. Dose-response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial.

    Science.gov (United States)

    Edinger, Jack D; Wohlgemuth, William K; Radtke, Rodney A; Coffman, Cynthia J; Carney, Colleen E

    2007-02-01

    To determine the optimal number of therapist-guided Cognitive-Behavioral Insomnia Therapy (CBT) sessions required for treating primary sleep-maintenance insomnia. Randomized, parallel-group, clinical trial at a single academic medical center. Outpatient treatment lasted 8 weeks with final follow-up conducted at 6 months. 86 adults (43 women; mean age 55.4 +/- 9.7 years) with primary sleep-maintenance insomnia (nightly mean wake time after sleep onset [WASO] = 93.4 +/- 44.5 minutes). One (week 1), 2 (weeks 1 and 5), 4 (biweekly), or 8 (weekly) individual CBT sessions scheduled over an 8-week treatment phase, compared with an 8-week no-treatment waiting period (WL). Sleep diary and actigraphy measures of total sleep time, onset latency, WASO, total wake time, and sleep efficiency, as well as questionnaire measures of global insomnia symptoms, sleep related self-efficacy, and mood. Statistical tests of subjective/objective sleep measures favored the 1- and 4-session CBT doses over the other CBT doses and WL control. However, comparisons of pretreatment data with data acquired at the 6-month follow-up showed only the 4-session group showed significant long-term improvements in objective wake time and sleep efficiency measures. Additionally, 58.3% of the patients receiving 4 CBT sessions met criteria for clinically significant improvement by the end of treatment compared to 43.8% of those receiving 1 CBT session, 22.2% of those provided 2 sessions, 35.3% of those receiving 8 sessions, and 9.1% of those in the control condition. Findings suggest that 4 individual, biweekly sessions represents the optimal dosing for the CBT intervention tested. Additional dose-response studies are warranted to test CBT models that contain additional treatment components or are delivered via group therapy.

  10. Refractory myasthenia gravis – clinical profile, comorbidities and response to rituximab

    Science.gov (United States)

    Sudulagunta, Sreenivasa Rao; Sepehrar, Mona; Sodalagunta, Mahesh Babu; Settikere Nataraju, Aravinda; Bangalore Raja, Shiva Kumar; Sathyanarayana, Deepak; Gummadi, Siddharth; Burra, Hemanth Kumar

    2016-01-01

    Introduction: Myasthenia gravis (MG) is an antibody mediated autoimmune neuromuscular disorder characterized by fatigable muscle weakness. A proportion of myasthenia gravis patients are classified as refractory due to non responsiveness to conventional treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and features of patients with MG and mode of management using rituximab and complications. Methods: Data of myasthenia gravis patients admitted or presented to outpatient department (previous medical records) with MG between January 2008 and January 2016 were included. A total of 512 patients fulfilled the clinical and diagnostic criteria of myasthenia gravis of which 76 patients met the diagnostic certainty for refractory myasthenia gravis and were evaluated. Results: Out of 76 refractory MG patients, 53 (69.73%) patients fulfilled all the three defined criteria. The median age of onset of the refractory MG group was 36 years with a range of 27–53 years. In our study 25 patients (32.89%) belonged to the age group of 21–30 years. Anti-MuSK antibodies were positive in 8 non-refractory MG patients (2.06%) and 36 refractory MG patients (47.36%). Mean HbA1C was found to be 8.6±2.33. The dose of administered prednisone decreased by a mean of 59.7% (p=3.3x10–8) to 94.6% (p=2.2x10–14) after the third cycle of rituximab treatment. Conclusion: The refractory MG patients are most commonly female with an early age of onset, anti-MuSK antibodies, and thymomas. Refractory MG patients have higher prevalence and poor control (HbA1C >8%) of diabetes mellitus and dyslipidemia probably due to increased steroid usage. Rituximab is very efficient in treatment of refractory MG with adverse effects being low. PMID:27790079

  11. Discordant Immune Response with Antiretroviral Therapy in HIV-1: A Systematic Review of Clinical Outcomes

    Science.gov (United States)

    Kelly, Christine; Gaskell, Katherine M.; Richardson, Marty; Klein, Nigel; Garner, Paul; MacPherson, Peter

    2016-01-01

    Background A discordant immune response (DIR) is a failure to satisfactorily increase CD4 counts on ART despite successful virological control. Literature on the clinical effects of DIR has not been systematically evaluated. We aimed to summarise the risk of mortality, AIDS and serious non-AIDS events associated with DIR with a systematic review. Methods The protocol is registered with the Centre for Review Dissemination, University of York (registration number CRD42014010821). Included studies investigated the effect of DIR on mortality, AIDS, or serious non-AIDS events in cohort studies or cohorts contained in arms of randomised controlled trials for adults aged 16 years or older. DIR was classified as a suboptimal CD4 count (as defined by the study) despite virological suppression following at least 6 months of ART. We systematically searched PubMed, Embase, and the Cochrane Library to December 2015. Risk of bias was assessed using the Cochrane tool for assessing risk of bias in cohort studies. Two authors applied inclusion criteria and one author extracted data. Risk ratios were calculated for each clinical outcome reported. Results Of 20 studies that met the inclusion criteria, 14 different definitions of DIR were used. Risk ratios for mortality in patients with and without DIR ranged between 1.00 (95% CI 0.26 to 3.92) and 4.29 (95% CI 1.96 to 9.38) with the majority of studies reporting a 2 to 3 fold increase in risk. Conclusions DIR is associated with a marked increase in mortality in most studies but definitions vary widely. We propose a standardised definition to aid the development of management options for DIR. PMID:27284683

  12. Discordant Immune Response with Antiretroviral Therapy in HIV-1: A Systematic Review of Clinical Outcomes.

    Directory of Open Access Journals (Sweden)

    Christine Kelly

    Full Text Available A discordant immune response (DIR is a failure to satisfactorily increase CD4 counts on ART despite successful virological control. Literature on the clinical effects of DIR has not been systematically evaluated. We aimed to summarise the risk of mortality, AIDS and serious non-AIDS events associated with DIR with a systematic review.The protocol is registered with the Centre for Review Dissemination, University of York (registration number CRD42014010821. Included studies investigated the effect of DIR on mortality, AIDS, or serious non-AIDS events in cohort studies or cohorts contained in arms of randomised controlled trials for adults aged 16 years or older. DIR was classified as a suboptimal CD4 count (as defined by the study despite virological suppression following at least 6 months of ART. We systematically searched PubMed, Embase, and the Cochrane Library to December 2015. Risk of bias was assessed using the Cochrane tool for assessing risk of bias in cohort studies. Two authors applied inclusion criteria and one author extracted data. Risk ratios were calculated for each clinical outcome reported.Of 20 studies that met the inclusion criteria, 14 different definitions of DIR were used. Risk ratios for mortality in patients with and without DIR ranged between 1.00 (95% CI 0.26 to 3.92 and 4.29 (95% CI 1.96 to 9.38 with the majority of studies reporting a 2 to 3 fold increase in risk.DIR is associated with a marked increase in mortality in most studies but definitions vary widely. We propose a standardised definition to aid the development of management options for DIR.

  13. Early response predicts subsequent response to olanzapine long-acting injection in a randomized, double-blind clinical trial of treatment for schizophrenia

    Directory of Open Access Journals (Sweden)

    Stauffer Virginia L

    2011-09-01

    Full Text Available Abstract Background In patients with schizophrenia, early non-response to oral antipsychotic therapy robustly predicts subsequent non-response to continued treatment with the same medication. This study assessed whether early response predicted later response when using a long-acting injection (LAI antipsychotic. Methods Data were taken from an 8-week, randomized, double-blind, placebo-controlled study of olanzapine LAI in acutely ill patients with schizophrenia (n = 233. Early response was defined as ≥30% improvement from baseline to Week 4 in Positive and Negative Syndrome Scale (PANSS0-6 Total score. Subsequent response was defined as ≥40% baseline-to-endpoint improvement in PANSS0-6 Total score. Sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV, and predictive accuracy were calculated. Clinical and functional outcomes were compared between Early Responders and Early Non-responders. Results Early response/non-response to olanzapine LAI predicted later response/non-response with high sensitivity (85%, specificity (72%, PPV (78%, NPV (80%, and overall accuracy (79%. Compared to Early Non-responders, Early Responders had significantly greater improvement in PANSS0-6 Total scores at all time points and greater baseline-to-endpoint improvement in PANSS subscale scores, Quality of Life Scale scores, and Short Form-36 Health Survey scores (all p ≤ .01. Among Early Non-responders, 20% demonstrated response by Week 8. Patients who lacked early improvement (at Week 4 in Negative Symptoms and Disorganized Thoughts were more likely to continue being non-responders at Week 8. Conclusions Among acutely ill patients with schizophrenia, early response predicted subsequent response to olanzapine LAI. Early Responders experienced significantly better clinical and functional outcomes than Early Non-responders. Findings are consistent with previous research on oral antipsychotics. Clinical Trials Registry F1D

  14. Electrical Characterizations of Lightning Strike Protection Techniques for Composite Materials

    Science.gov (United States)

    Szatkowski, George N.; Nguyen, Truong X.; Koppen, Sandra V.; Ely, Jay J.; Mielnik, John J.

    2009-01-01

    The growing application of composite materials in commercial aircraft manufacturing has significantly increased the risk of aircraft damage from lightning strikes. Composite aircraft designs require new mitigation strategies and engineering practices to maintain the same level of safety and protection as achieved by conductive aluminum skinned aircraft. Researchers working under the NASA Aviation Safety Program s Integrated Vehicle Health Management (IVHM) Project are investigating lightning damage on composite materials to support the development of new mitigation, diagnosis & prognosis techniques to overcome the increased challenges associated with lightning protection on composite aircraft. This paper provides an overview of the electrical characterizations being performed to support IVHM lightning damage diagnosis research on composite materials at the NASA Langley Research Center.

  15. A Probabilistic, Facility-Centric Approach to Lightning Strike Location

    Science.gov (United States)

    Huddleston, Lisa L.; Roeder, William p.; Merceret, Francis J.

    2012-01-01

    A new probabilistic facility-centric approach to lightning strike location has been developed. This process uses the bivariate Gaussian distribution of probability density provided by the current lightning location error ellipse for the most likely location of a lightning stroke and integrates it to determine the probability that the stroke is inside any specified radius of any location, even if that location is not centered on or even with the location error ellipse. This technique is adapted from a method of calculating the probability of debris collisionith spacecraft. Such a technique is important in spaceport processing activities because it allows engineers to quantify the risk of induced current damage to critical electronics due to nearby lightning strokes. This technique was tested extensively and is now in use by space launch organizations at Kennedy Space Center and Cape Canaveral Air Force Station. Future applications could include forensic meteorology.

  16. Sequential Objective Structured Clinical Examination based on item response theory in Iran

    Directory of Open Access Journals (Sweden)

    Sara Mortaz Hejri

    2017-09-01

    Full Text Available Purpose In a sequential objective structured clinical examination (OSCE, all students initially take a short screening OSCE. Examinees who pass are excused from further testing, but an additional OSCE is administered to the remaining examinees. Previous investigations of sequential OSCE were based on classical test theory. We aimed to design and evaluate screening OSCEs based on item response theory (IRT. Methods We carried out a retrospective observational study. At each station of a 10-station OSCE, the students’ performance was graded on a Likert-type scale. Since the data were polytomous, the difficulty parameters, discrimination parameters, and students’ ability were calculated using a graded response model. To design several screening OSCEs, we identified the 5 most difficult stations and the 5 most discriminative ones. For each test, 5, 4, or 3 stations were selected. Normal and stringent cut-scores were defined for each test. We compared the results of each of the 12 screening OSCEs to the main OSCE and calculated the positive and negative predictive values (PPV and NPV, as well as the exam cost. Results A total of 253 students (95.1% passed the main OSCE, while 72.6% to 94.4% of examinees passed the screening tests. The PPV values ranged from 0.98 to 1.00, and the NPV values ranged from 0.18 to 0.59. Two tests effectively predicted the results of the main exam, resulting in financial savings of 34% to 40%. Conclusion If stations with the highest IRT-based discrimination values and stringent cut-scores are utilized in the screening test, sequential OSCE can be an efficient and convenient way to conduct an OSCE.

  17. Chronic renal failure and sexual functioning: clinical status versus objectively assessed sexual response.

    Science.gov (United States)

    Toorians, A W; Janssen, E; Laan, E; Gooren, L J; Giltay, E J; Oe, P L; Donker, A J; Everaerd, W

    1997-12-01

    Sexual dysfunctions are common among patients with chronic renal failure. The prevalence was assessed in a population of 281 patients (20-60 years), and it was attempted to determine whether their mode of treatment (haemodialysis, peritoneal dialysis, or kidney transplantation), or biochemical and endocrine variables and neuropathy affect sexual functioning. Patients with rheumatoid arthritis served as a comparison group. Assessment included clinical history, physical and laboratory examinations, questionnaires measuring erotosexual dysfunctions, and a psychophysiological test procedure. The latter is a laboratory method which measures, in a waking state, subjective and physiological sexual arousal. Men on haemodialysis or peritoneal dialysis suffered significantly more often from 'Hypoactive Sexual Desire Disorder', 'Sexual Aversion Disorder' and 'Inhibited Male Orgasm' than men with kidney transplantation or rheumatoid arthritis. Interestingly, the prevalence of 'Male Erectile Disorder' did not differ significantly between the four groups and ranged between 17 and 43%. Of the women, transplanted patients suffered significantly less from 'Hypoactive Sexual Desire Disorder' than the other three groups; the prevalence of other sexual dysfunctions did not differ between the groups. Although 'Male Erectile Disorder' and 'Female Sexual Arousal Disorder' had a relatively high prevalence there were no differences in the four groups of patients in genital responses during psychophysiological testing. Genital responses during psychophysiological assessment had no relationship to the duration of renal replacement treatment, biochemical/endocrine variables, or the presence/ absence of neuropathy. The prevalence of sexual dysfunction was high. Sexual dysfunction in men on haemodialysis or peritoneal dialysis was not so much due to erectile failure but largely to loss of sexual interest, subjectively ascribed to fatigue. The latter was also found in women on haemodialysis or

  18. Group differences in physician responses to handheld presentation of clinical evidence: a verbal protocol analysis

    Directory of Open Access Journals (Sweden)

    Pavlovic Nada J

    2007-07-01

    Full Text Available Abstract Background To identify individual differences in physicians' needs for the presentation of evidence resources and preferences for mobile devices. Methods Within-groups analysis of responses to semi-structured interviews. Interviews consisted of using prototypes in response to task-based scenarios. The prototypes were implemented on two different form factors: a tablet style PC and a pocketPC. Participants were from three user groups: general internists, family physicians and medicine residents, and from two different settings: urban and semi-urban. Verbal protocol analysis, which consists of coding utterances, was conducted on the transcripts of the testing sessions. Statistical relationships were investigated between staff physicians' and residents' background variables, self-reported experiences with the interfaces, and verbal code frequencies. Results 47 physicians were recruited from general internal medicine, family practice clinics and a residency training program. The mean age of participants was 42.6 years. Physician specialty had a greater effect on device and information-presentation preferences than gender, age, setting or previous technical experience. Family physicians preferred the screen size of the tablet computer and were less concerned about its portability. Residents liked the screen size of the tablet, but preferred the portability of the pocketPC. Internists liked the portability of the pocketPC, but saw less advantage to the large screen of the tablet computer (F[2,44] = 4.94, p = .012. Conclusion Different types of physicians have different needs and preferences for evidence-based resources and handheld devices. This study shows how user testing can be incorporated into the process of design to inform group-based customization.

  19. Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies

    Directory of Open Access Journals (Sweden)

    Stefan eNiewiesk

    2014-09-01

    Full Text Available Neonates have an immature immune system which cannot adequately protect against infectious diseases. Early in life, immune protection is accomplished by maternal antibodies transferred from mother to offspring. However, decaying maternal antibodies inhibit vaccination as is examplified by the inhibition of seroconversion after measles vaccination. This phenomenon has been described in both human and veterinary medicine and is independent of the type of vaccine being used. This review will discuss the use of animal models for vaccine research. I will review clinical solutions for inhibition of vaccination by maternal antibodies, and the testing and development of potentially effective vaccines. These are based on new mechanistic insight about the inhibitory mechanism of maternal antibodies. Maternal antibodies inhibit the generation of antibodies whereas the T cell response is usually unaffected. B cell inhibition is mediated through a cross-link between B-cell receptor (BCR with the Fcg receptor IIB (FcgRIIB by a vaccine-antibody complex. In animal experiments, this inhibition can be partially overcome by injection of a vaccine-specific monoclonal IgM antibody. IgM stimulates the B-cell directly through cross-linking the BCR via complement protein C3d and antigen to the complement receptor 2 (CR2 signaling complex. In addition, it was shown that interferon alpha binds to the CD21 chain of CR2 as well as the interferon receptor and that this dual receptor usage drives B cell responses in the presence of maternal antibodies. In lieu of immunizing the infant the concept of maternal immunization as a strategy to protect neonates has been proposed. This approach would still not solve the question of how to immunize in the presence of maternal antibodies but would defer the time of infection to an age where infection might not have such a detrimental outcome as in neonates. I will review successful examples and potential challenges of implementing

  20. Precision Strike Training in Lean Manufacturing: A Workplace Literacy Guidebook [and] Final Report on Precision Strike Workplace Literacy Training at CertainTeed Corporation.

    Science.gov (United States)

    National Alliance of Business, Inc., Washington, DC.

    CertainTeed's Precision Strike training program was designed to close the gaps between the current status of its workplace and where that work force needed to be to compete successfully in global markets. Precision Strike included Skills and Knowledge in Lifelong Learning (SKILL) customized, computerized lessons in basic skills, one-on-one…

  1. Single Pulse Electrical Stimulation to identify epileptogenic cortex : Clinical information obtained from early evoked responses

    NARCIS (Netherlands)

    Mouthaan, B.E.; van 't Klooster, M.A.; Keizer, D.; Hebbink, G.J.; Leijten, F.S.S.; Ferrier, C.H.; van Putten, M.J.A.M.; Zijlmans, M.; Huiskamp, G.J.M.

    Objective: Single Pulse Electrical Stimulation (SPES) probes epileptogenic cortex during electrocorticography. Two SPES responses are described: pathological delayed responses (DR, >100 ms) associated with the seizure onset zone (SOZ) and physiological early responses (ER, <100 ms) that map cortical

  2. THE EFFECTS OF HEIGHT AND DISTANCE ON THE FORCE PRODUCTION AND ACCELERATION IN MARTIAL ARTS STRIKES

    Directory of Open Access Journals (Sweden)

    Cynthia A. Bir

    2009-11-01

    Full Text Available Almost all cultures have roots in some sort of self defence system and yet there is relatively little research in this area, outside of a sports related environment. This project investigated different applications of strikes from Kung Fu practitioners that have not been addressed before in the literature. Punch and palm strikes were directly compared from different heights and distances, with the use of a load cell, accelerometers, and high speed video. The data indicated that the arm accelerations of both strikes were similar, although the force and resulting acceleration of the target were significantly greater for the palm strikes. Additionally, the relative height at which the strike was delivered was also investigated. The overall conclusion is that the palm strike is a more effective strike for transferring force to an object. It can also be concluded that an attack to the chest would be ideal for maximizing impact force and moving an opponent off balance

  3. Immune activation underlies a sustained clinical response to Yttrium-90 radioembolisation in hepatocellular carcinoma.

    Science.gov (United States)

    Chew, Valerie; Lee, Yun Hua; Pan, Lu; Nasir, Nurul J M; Lim, Chun Jye; Chua, Camillus; Lai, Liyun; Hazirah, Sharifah Nur; Lim, Tony Kiat Hon; Goh, Brian K P; Chung, Alexander; Lo, Richard H G; Ng, David; Filarca, Rene L F; Albani, Salvatore; Chow, Pierce K H

    2018-02-13

    Yttrium-90 (Y90)-radioembolisation (RE) significantly regresses locally advanced hepatocellular carcinoma and delays disease progression. The current study is designed to deeply interrogate the immunological impact of Y90-RE, which elicits a sustained therapeutic response. Time-of-flight mass cytometry and next-generation sequencing (NGS) were used to analyse the immune landscapes of tumour-infiltrating leucocytes (TILs), tumour tissues and peripheral blood mononuclear cells (PBMCs) at different time points before and after Y90-RE. TILs isolated after Y90-RE exhibited signs of local immune activation: higher expression of granzyme B (GB) and infiltration of CD8 + T cells, CD56 + NK cells and CD8 + CD56 + NKT cells. NGS confirmed the upregulation of genes involved in innate and adaptive immune activation in Y90-RE-treated tumours. Chemotactic pathways involving CCL5 and CXCL16 correlated with the recruitment of activated GB + CD8 + T cells to the Y90-RE-treated tumours. When comparing PBMCs before and after Y90-RE, we observed an increase in tumour necrosis factor-α on both the CD8 + and CD4 + T cells as well as an increase in percentage of antigen-presenting cells after Y90-RE, implying a systemic immune activation. Interestingly, a high percentage of PD-1 + /Tim-3 + CD8 + T cells coexpressing the homing receptors CCR5 and CXCR6 denoted Y90-RE responders. A prediction model was also built to identify sustained responders to Y90-RE based on the immune profiles from pretreatment PBMCs. High-dimensional analysis of tumour and systemic immune landscapes identified local and systemic immune activation that corresponded to the sustained response to Y90-RE. Potential biomarkers associated with a positive clinical response were identified and a prediction model was built to identify sustained responders prior to treatment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is

  4. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

    Science.gov (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A

    2011-04-01

    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  5. DBH gene as predictor of response in a cocaine vaccine clinical trial.

    Science.gov (United States)

    Kosten, Thomas R; Domingo, Coreen B; Hamon, Sara C; Nielsen, David A

    2013-04-29

    We examined a pharmacogenetic association of the dopamine β-hydroxylase (DBH) gene with a response to an anti-cocaine vaccine that was tested in a recent clinical trial. This gene is associated with cocaine-induced paranoia, which has a slower onset than the euphoria from cocaine. The vaccine reduced euphoria by slowing the entry of cocaine into the brain, but it may not reduce aversive symptoms like paranoia. A 16-week Phase IIb randomized double-blind placebo-controlled trial of 114 cocaine and opioid dependent subjects who received five vaccinations over the first 12 weeks was examined. We genotyped 71 subjects for the rs1611115 (-1021C>T) variant of the DBH gene and compared vaccine to placebo subjects on cocaine-free urines. Using repeated measures analysis of variance, corrected for population structure, vaccine pharmacotherapy reduced cocaine positive urines significantly based on DBH genotype. Patients with the low DβH level genotype dropped from 77% to 51% on vaccine (p=0.0001), while those with the normal DβH level genotype dropped from 83% to 72%. Placebo showed no effect on cocaine use overall or by genotype. This study indicates that a patient's DBH genotype could be used to identify a subset of individuals for whom vaccine treatment may be an effective pharmacotherapy for cocaine dependence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  6. Radiation dose responses for chemoradiation therapy of pancreatic cancer: an analysis of compiled clinical data using biophysical models.

    Science.gov (United States)

    Moraru, Ion C; Tai, An; Erickson, Beth; Li, X Allen

    2014-01-01

    We analyzed recent clinical data obtained from chemoradiation of unresectable, locally advanced pancreatic cancer (LAPC) in order to examine possible benefits from radiation therapy dose escalation. A modified linear quadratic model was used to fit clinical tumor response and survival data of chemoradiation treatments for LAPC reported from 20 institutions. Biophysical radiosensitivity parameters were extracted from the fits. Examination of the clinical data demonstrated an enhancement in tumor response with higher irradiation dose, an important clinical result for palliation and quality of life. Little indication of improvement in 1-year survival with increased radiation dose was observed. Possible dose escalation schemes are proposed based on calculations of the biologically effective dose required for a 50% tumor response rate. Based on the evaluation of tumor response data, the escalation of radiation dose presents potential clinical benefits which when combined with normal tissue complication analyses may result in improved treatment outcome for locally advanced pancreatic cancer patients. Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  7. [Clinical characteristics and prognosis analysis of vitamin B6 responsive infantile spasms].

    Science.gov (United States)

    Xue, Jiao; Yang, Zhixian; Wu, Ye; Xiong, Hui; Zhang, Yuehua; Liu, Xiaoyan

    2016-02-01

    To analyze clinical characteristics, treatment and prognosis in a cohort of children with vitamin B6 responsive infantile spasms. Ten patients were diagnosed as vitamin B6 responsive infantile spasms in Peking University First Hospital between January 2012 and May 2015.The clinical manifestations, diagnosis and treatment process, video-electroencephalogram, magnetic resonance imaging (MRI), epilepsy related genes and prognosis were retrospectively analyzed. Of the 10 patients, 5 were male, and 5 were female. Eight of them were normal at birth, and the other 2 patients had intracranial hemorrhage or anoxia.The age of epilepsy onset was from 3.5 to 8.0 months.All patients presented spasms primarily.Interictal electroencephalogram (EEG) showed hypsarrhythmia at seizures onset. MRI showed normal in 8 patients, and subarachnoid hemorrhage or multiple encephalomalacia foci after hemorrhage respectively in the other 2 patients. The results of blood biochemical, cerebrospinal fluid examination and urinary metabolic screening were negative. Epilepsy related genes including ALDH7A1 gene analysis showed wild type in all patients. Two patients were classified as symptomatic and eight might be idiopathic or cryptogenic. The initial dose of vitamin B6 was 10.0 mg/(kg·d). The interval between seizures onset and taking vitamin B6 was 0 to 4.0 months. Seizures disappeared completely within a week after administration of vitamin B6 in 9 patients and in 1.5 months in one patient.Of the 8 patients whose seizures were controlled completely during the follow-up period, 7 patients' EEG recovered within 1.5 to 4.0 months and then continued to be normal. The EEG of the rest of a patient returned to normal, but showed abnormal discharges after stopping taking vitamin B6. Two patients' EEG continued abnormal and seizures recurred due to vitamin B6 withdrawal. At the last follow-up, seizures were controlled in all patients. Drug treatment in one case had stopped. Vitamin B6 was used in 9

  8. Serial diffusion-weighted MRI correlates with clinical course and treatment response in children with intracranial pus collections

    International Nuclear Information System (INIS)

    Fanning, Noel F.; Laffan, Eoghan E.; Shroff, Manohar M.

    2006-01-01

    Accurate assessment of treatment response in children with intracranial pus collections is vital to guide appropriate therapy and reduce morbidity and mortality. To correlate serial MR-measurable changes in diffusion-weighted imaging (DWI) with clinical response to treatment. We retrospectively reviewed clinical notes, conventional MR sequences and DWI in eight children with intracranial pus collections. Trace DWI signal intensity and apparent diffusion coefficient (ADC) values were compared at three time points: at initial diagnosis (eight children, 13 collections), at follow-up during continued clinical infection (three children, sp collections), and at follow-up when clinical infection had resolved (seven children, 12 collections). At initial diagnosis all patients were septic and collections showed restricted diffusion (mean ADC 0.61±0.15 x 10 -3 mm 2 /s). Patients with persistent clinical sepsis at follow-up DWI had collections with persistent low ADC values (0.66±0.21 x 10 -3 mm 2 /s), significantly (P -3 mm 2 /s, P<0.01) compared both to patients with signs of continued sepsis and to normal gray matter values. Persistent restricted diffusion in pus collections correlates with continued sepsis. Treatment response is associated with clinical resolution of sepsis and ADC value elevation significantly above normal gray matter values. (orig.)

  9. Visual analogical well-being scale for sleep apnea patients: validity and responsiveness : a test for clinical practice.

    Science.gov (United States)

    Masa, Juan F; Jiménez, Antonio; Durán, Joaquín; Carmona, Carmen; Monasterio, Carmen; Mayos, Mercedes; Terán, Joaquín; Barbé, Ferrán; Rubio, Manuela; Failde, Inmaculada; Mota, Manuel; Montserrat, José M

    2011-09-01

    Health-related quality-of-life (HRQL) tests used in sleep apnea-hypopnea syndrome (SAHS) are time-consuming, complicating their application in clinical practice. The objective was to examine the validity and responsiveness of a simple visual analogical well-being scale (VAWS) for the clinical use. The subjects proceed from a cohort of SAHS patients treated with CPAP for 12 weeks. We correlated the VAWS with other HRQL tests, related clinical and polysomnographic measures to concurrent and construct validities. Responsiveness by: (1) comparison of HRQL tests between before and after treatment and effect size. (2) Association of the change with treatment between VAWS with other HRQL tests and between VAWS with clinical parameters. At baseline, VAWS correlated with all HRQL tests but better with functional outcomes in sleep questionnaires (FOSQ) and European quality-of-life questionnaire (EuroQol) thermometer. VAWS and FOSQ correlated better with clinical variables than other HRQL tests. VAWS captures the magnitude change with treatment similarly to FOSQ but better than other HRQL tests. VAWS is a very simple test which measures HRQL in SAHS. It could be a useful tool in clinical practice, primarily for the responsiveness of treatment.

  10. Clinical trials using IFN-α as a vaccine adjuvant: new strategies for the molecular monitoring of the immune response

    International Nuclear Information System (INIS)

    Belardelli, F.; Arico, E.; Marincola, F.; Wang, E.

    2009-01-01

    The main general objective of this project was to define immunotherapy protocols based on the new concept of using IFN-a as and immune adjuvant, developing innovative methodologies suitable for predicting and monitoring the immunological and clinical responses. Specific aim of developing new micro arrays technologies particularly suitable for a molecular tracking and prediction of the response to IFN of cytokine-treated patients

  11. Emotional responses to images of food in adults with an eating disorder: a comparative study with healthy and clinical controls.

    Science.gov (United States)

    Hay, Phillipa; Katsikitis, Mary

    2014-08-01

    Emotive responses to foods in people with eating disorders are incompletely understood in relation to whether the extent of emotional response is due to the eating disorder or non-specific emotional states. The aims of the present study were to investigate negative and positive emotive responses to food images in adults with an eating disorder, and to compare responses to a (i) healthy and a (ii) clinic (psychiatry) control group. Participants viewed 20 images (16 of foods previously found to evoke fear, disgust and happiness and 4 neutral images) at half-minute intervals and rated emotive responses on 3 visual analogue scales for each image. Participants with an eating disorder (n=26) were found to have significantly increased negative emotive (disgust and fear) responses and reduced positive (happiness) responses to the images compared to the 20 clinic and 61 healthy participants. Differences between groups remained significant when controlling for baseline levels of fear, disgust and happiness. Thus, the emotive responses to foods did not appear due to non-specific increases in anxiety or depression but rather was due to the presence of an eating disorder. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. RESPONSES OF OYSTER (CRASSOSTREA VIRGINICA) HEMOCYTES TO NONPATHOGENIC AND CLINICAL ISOLATES OF VIBRIO PARAHAEMOLYTICUS

    Science.gov (United States)

    Bacterial uptake by oysters (Crassostrea virginica) and bactericidal activity of oyster hemocytes were studied using four environmental isolates and three clinical isolates of Vibrio parahaemolyticus. Clinical isolates (2030, 2062, 2107) were obtained from gastroenteritis patien...

  13. Neuroinflammatory responses to traumatic brain injury: etiology, clinical consequences, and therapeutic opportunities

    Directory of Open Access Journals (Sweden)

    Lozano D

    2015-01-01

    Full Text Available Diego Lozano,* Gabriel S Gonzales-Portillo,* Sandra Acosta, Ike de la Pena, Naoki Tajiri, Yuji Kaneko, Cesar V Borlongan Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA *These authors contributed equally to this work Abstract: Traumatic brain injury (TBI is a serious public health problem accounting for 1.4 million emergency room visits by US citizens each year. Although TBI has been traditionally considered an acute injury, chronic symptoms reminiscent of neurodegenerative disorders have now been recognized. These progressive neurodegenerative-like symptoms manifest as impaired motor and cognitive skills, as well as stress, anxiety, and mood affective behavioral alterations. TBI, characterized by external bumps or blows to the head exceeding the brain’s protective capacity, causes physical damage to the central nervous system with accompanying neurological dysfunctions. The primary impact results in direct neural cell loss predominantly exhibiting necrotic death, which is then followed by a wave of secondary injury cascades including excitotoxicity, oxidative stress, mitochondrial dysfunction, blood–brain barrier disruption, and inflammation. All these processes exacerbate the damage, worsen the clinical outcomes, and persist as an evolving pathological hallmark of what we now describe as chronic TBI. Neuroinflammation in the acute stage of TBI mobilizes immune cells, astrocytes, cytokines, and chemokines toward the site of injury to mount an antiinflammatory response against brain damage; however, in the chronic stage, excess activation of these inflammatory elements contributes to an “inflamed” brain microenvironment that principally contributes to secondary cell death in TBI. Modulating these inflammatory cells by changing their phenotype from proinflammatory to antiinflammatory would likely promote therapeutic effects on TBI. Because neuroinflammation occurs at

  14. San Andreas-sized Strike-slip Fault on Europa

    Science.gov (United States)

    1998-01-01

    This mosaic of the south polar region of Jupiter's moon Europa shows the northern 290 kilometers (180 miles) of a strike-slip fault named Astypalaea Linea. The entire fault is about 810 kilometers (500 miles) long, about the size of the California portion of the San Andreas fault, which runs from the California-Mexico border north to the San Francisco Bay. In a strike-slip fault, two crustal blocks move horizontally past one another, similar to two opposing lanes of traffic. Overall motion along the fault seems to have followed a continuous narrow crack along the feature's entire length, with a path resembling steps on a staircase crossing zones that have been pulled apart. The images show that about 50 kilometers (30 miles) of displacement have taken place along the fault. The fault's opposite sides can be reconstructed like a puzzle, matching the shape of the sides and older, individual cracks and ridges broken by its movements. [figure removed for brevity, see original site] The red line marks the once active central crack of the fault. The black line outlines the fault zone, including material accumulated in the regions which have been pulled apart. Bends in the fault have allowed the surface to be pulled apart. This process created openings through which warmer, softer ice from below Europa's brittle ice shell surface, or frozen water from a possible subsurface ocean, could reach the surface. This upwelling of material formed large areas of new ice within the boundaries of the original fault. A similar pulling-apart phenomenon can be observed in the geological trough surrounding California's Salton Sea, in Death Valley and the Dead Sea. In those cases, the pulled-apart regions can include upwelled materials, but may be filled mostly by sedimentary and eroded material from above. One theory is that fault motion on Europa is induced by the pull of variable daily tides generated by Jupiter's gravitational tug on Europa. Tidal tension opens the fault and

  15. Clinical Factors Predicting the Pathologic Tumor Response after Preoperative Concurrent Chemoradiotherapy for Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hae; Lee, Kyung Ja [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2008-12-15

    The objective of this retrospective study was to identify predictive factors for the complete pathologic response and tumor down staging after preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. Materials and Methods: Between the years 2000 and 2008, 39 patients with newly diagnosed rectal cancer without prior evidence of distant metastasis received preoperative concurrent chemoradiotherapy followed by surgery. The median radiation dose was 50.4 Gy (range, 45-59.4 Gy). Thirty-eight patients received concurrent infusional 5-fluorouracil and leucovorin, while one patient received oral capecitabine twice daily during radiotherapy. Results: A complete pathologic response (CR) was demonstrated in 12 of 39 patients (31%), while T-downstaging was observed in 24 of 39 patients (63%). N-downstaging was observed in 18 of 28 patients (64%), with a positive node in the CT scan or ultrasound. Two patients with clinical negative nodes were observed in surgical specimens. The results from a univariate analysis indicated that the tumor circumferential extent was less than 50% (p=0.031). Moreover, the length of the tumor was less than 5 cm (p=0.004), while the post-treatment carcinoembryonic antigen (CEA) levels were less than or equal to 3.0 ng/mL (p=0.015) and were significantly associated with high pathologic CR rates. The univariate analysis also indicated that the adenocarcinoma (p=0.045) and radiation dose greater than or equal to 50 Gy (p=0.021) were significantly associated with high T-downstaging, while a radiotherapy duration of less than or equal to 42 days (p=0.018) was significantly associated with N-downstaging. The results from the multivariate analysis indicated that the lesser circumferential extent of the tumor (hazard ratio [HR], 0.150; p=0.028) and shorter tumor length (HR, 0.084; p=0.005) independently predicted a higher pathologic CR. The multivariate analysis also indicated that a higher radiation dose was significantly associated

  16. Impact of responsive insertion technology (RIT) on reducing discomfort during colonoscopy: randomized clinical trial.

    Science.gov (United States)

    Pasternak, Artur; Szura, Miroslaw; Solecki, Rafal; Matyja, Maciej; Szczepanik, Antoni; Matyja, Andrzej

    2017-05-01

    In many countries, colonoscopies for colorectal cancer screening are performed without sedation due to the cost. Changes in the structure of the endoscopes are designed to facilitate the colonoscopic examination, reduce the duration of the procedure, and improve the imaging of the intestinal lumen. The variable stiffness of the endoscope and the recently introduced responsive insertion technology (RIT) are features aimed at easing colonoscope insertion and reducing the discomfort and pain during the examination. The aim of the study is to analyze whether the new RIT system can improve the practice of colonoscopy under no anesthesia with respect to the widely available variable stiffness colonoscopes. This analysis included 647 patients who underwent complete colonoscopy in the screening program. All colonoscopies were performed without sedation. Olympus series 180 and 190 endoscopes equipped with a magnetic positioning system were used. Group I included patients who were examined using endoscopes equipped with responsive insertion technology (RIT), and group II included patients who were examined using conventional variable stiffness colonoscopies. The main objective was to evaluate the cecal intubation time, the number of loops, the requirement to apply manual pressure to different areas of the abdomen and the degree of discomfort and pain expressed on a visual analogue scale (VAS). ClinicalTrials.gov number, NCT01688557. Group I consisted of 329 patients, and group II included 318 patients. The mean age of the patients was 58.4 years (SD ± 4.21). Both groups were compared in terms of age, sex, and BMI. The mean cecal intubation time was 209 s in group I and 224 s in group II (p < 0.05). Increased loop formation was observed upon endoscope insertion in group II (1.7 vs. 1.35) (p < 0.05) and required more manual pressure to the abdomen (2.2 vs. 1.7) (p = 0.001). In group I, less discomfort and pain, as graded on a VAS (2.3 vs. 2.6), were noted. The

  17. Effect of public transport strikes on air pollution levels in Barcelona (Spain).

    Science.gov (United States)

    Basagaña, Xavier; Triguero-Mas, Margarita; Agis, David; Pérez, Noemí; Reche, Cristina; Alastuey, Andrés; Querol, Xavier

    2018-01-01

    Public transport strikes can lead to an increase of the number of private vehicle trips, which in turn can increase air pollution levels. We aimed to estimate the change in air pollution concentrations during public transport strikes in the city of Barcelona (Spain). Data on strikes of the metro, train or bus systems were collected from government records (2005-2016). We collected daily concentrations of NOx; particulate matter with an aerodynamic diameter smaller than 10μm (PM10), 2.5μm (PM2.5), and 1μm (PM1); particle number concentration (N); black carbon (BC) and CO from research and official monitoring stations. We fitted linear regression models for each pollutant with the strike indicator as an independent variable, and models were adjusted for day of the week, month, year, and holiday periods. During the study period, there were 208days affected by a strike of the metro (28), train (106) or bus (91) systems. Half of the strikes were partial, most of them were single-day strikes, there was little overlap between strikes of the different transport systems, and all strikes had to comply with mandatory minimal services. When pooling all types of strikes, NOx and BC showed higher levels during strike days in comparison with non-strike days (increase between 4.1% and 7.7%, with higher increases for NO). The increases in these concentrations were more evident during full day and multiday metro strikes. In conclusion, alterations in public transport have consequences on air quality. This highlights the importance of public transport in reducing air pollution concentrations in cities. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial.

    Science.gov (United States)

    Nilsson, Ulrica

    2009-01-01

    To evaluate the effect of bed rest with music on the first postoperative day to decrease stress for patients who have undergone heart surgery. A repeated-measures randomized controlled trial was used. The study took place in a cardiothoracic intermediary unit of a university hospital in Sweden. Fifty-eight patients who had undergone open coronary artery bypass grafting or aortic valve replacement surgery were included. Stress response was assessed by determining the serum cortisol, heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels. At 12:00 noon on postoperative day 1, patients were allocated to receive 30 minutes of uninterrupted bed rest with music and then 30 minutes of bed rest or alternatively 60 minutes of uninterrupted bed rest. The music was soft and relaxing, included different melodies in new-age style, played with a volume at 50 to 60 dB, and distributed through a music pillow connected to an MP3 player. After 30 minutes of bed rest, there was a significant difference in s-cortisol levels between the groups; 484. 4 mmol/L in the music group versus 618.8 mmol/L in the control group (P < .02). However, this difference in s-cortisol levels was not found 30 minutes later (ie, after a total of 60 minutes). There was no difference in heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels between the groups. There is sufficient practical evidence of stress reduction to suggest that a proposed regimen of listening to music while resting in bed after open heart surgery be put into clinical use.

  19. The Clinical Response to Gluten Challenge: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Maaike J. Bruins

    2013-11-01

    Full Text Available The aim of this review was to identify, evaluate and summarize all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease (CD on a gluten-free diet. We evaluated the effect of gluten challenge on changes in symptoms, intestinal mucosa histology, and serum antibodies. A systematic electronic search was performed for studies published as of 1966 using PubMed and Scopus databases. In the reviewed studies, doses ranged from 0.2 to 30 g/day of wheat gluten or comprised a gluten-containing diet. The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis.

  20. Correlation between clinical symptoms and peripheral immune response in HAM/TSP.

    Science.gov (United States)

    da Silva Dias, George Alberto; Sousa, Rita Catarina Medeiros; Gomes, Letícia Figueiredo; Caldas, Cezar Augusto Muniz; Nassiri, Reza; Quaresma, Juarez Antônio Simões; Fuzii, Hellen Thais

    2016-03-01

    HTLV-1 infects principally CD4+ T cells that are the main reservoirs of the virus in vivo, which play an important role in the immunological response. Most of the infected patients are asymptomatic. However, 2-3% of patients will develop HAM/TSP or Adult T lymphoma. HAM/TSP is a chronic inflammatory disease of the central nervous system, which is characterized by unremitting myelopathic symptoms. Studies have shown that cytokines levels alterations (IFN-γ and TNF-α) were associated with tissue injury in HAM/TSP. The aims of this study were to compare the gene expression of IFN-γ, IL-4 and IL-10 of asymptomatic and HAM/TSP HTLV-1 infected patients, and to correlate the gene expression with those of clinical symptoms. 28 subjects were included, 20 asymptomatic HTLV-1 and 8 with HAM/TSP. Spasticity was evaluated using the Modified Ashworth Scale and the degree of walking aid was classified on a progressive scale. The relative gene expression of IFN-γ, IL-4, and IL-10 was measured by Real-Time PCR. Results showed high gene expression of IFN-γ for all patients, but it was higher among HAM/TSP. A significant correlation was observed between IFN-γ gene expression and the degree of walking aid, and IFN-γ gene expression was higher among wheelchair users compared to non-wheelchair users. No association was found with IL-4 and IL-10. These findings indicate that HAM/TSP patients express higher amounts of IFN-γ than asymptomatic patients, and more importantly, the expression of this cytokine was strongly correlated with the need of walking aid. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Steroid-induced periorificial dermatitis in children--clinical features and response to azelaic acid.

    Science.gov (United States)

    Jansen, Thomas; Melnik, Bodo C; Schadendorf, Dirk

    2010-01-01

    Periorificial dermatitis, a common skin disease in young women, has been occasionally reported in children. This study elaborates the clinical features of periorificial dermatitis in children as well as possible pathogenetic factors and the response to 20% azelaic acid cream. A total of 10 children aged 3 to 12 (mean 7.7) years suffering from nongranulomatous periorificial dermatitis for 3 to 7 (mean 4.9) months were evaluated, and dermatologic examination was carried out. Pretreatment was documented. Skin prick tests with a panel of six common inhalative allergens and patch tests with the European Standard Series were performed. An association between atopy and periorificial dermatitis was evaluated, and patients were screened for skin colonization by fungi, bacteria, and Demodex mites. They were treated with 20% azelaic acid cream, which was topically applied twice daily on all affected areas, until complete resolution was achieved. Treatment period was followed by an individual observation period. Periorificial dermatitis had developed in typical distribution and morphology. In all patients, low- to high-potency topical corticosteroids had been used on the face prior to manifestation. Atopy was found in half of the patients. Allergological, bacteriological, and mycological examinations did not reveal pathologic results. Demodex mites could not be demonstrated by skin surface biopsy. Treatment with 20% azelaic acid cream led to complete resolution of skin lesions after 4 to 8 (mean 5.4) weeks in all patients. Transient exacerbation of skin condition with a peak between the 2nd and 6th day of treatment could be observed in three patients. Side effects of 20% azelaic acid cream were registered in six patients and were predominantly present in the first 2 weeks of treatment. Side effects were minimal and became rarer with ongoing treatment. No recurrences were seen within a follow-up period of 2 to 8 (mean 4.4) months. Treatment with 20% azelaic acid cream could

  2. Stress response of a clinical Enterococcus faecalis isolate subjected to a novel antimicrobial surface coating.

    Science.gov (United States)

    Clauss-Lendzian, Emanuel; Vaishampayan, Ankita; de Jong, Anne; Landau, Uwe; Meyer, Carsten; Kok, Jan; Grohmann, Elisabeth

    2018-03-01

    Emerging antibiotic resistance among pathogenic bacteria, paired with their ability to form biofilms on medical and technical devices, represents a serious problem for effective and long-term decontamination in health-care environments and gives rise to an urgent need for new antimicrobial materials. Here we present the impact of AGXX ® , a novel broad-spectrum antimicrobial surface coating consisting of micro-galvanic elements formed by silver and ruthenium, on the transcriptome of Enterococcus faecalis. A clinical E. faecalis isolate was subjected to metal stress by growing it for different periods in presence of the antimicrobial coating or silver-coated steel meshes. Subsequently, total RNA was isolated and next-generation RNA sequencing was performed to analyze variations in gene expression in presence of the antimicrobial materials with focus on known stress genes. Exposure to the antimicrobial coating had a large impact on the transcriptome of E. faecalis. After 24min almost 1/5 of the E. faecalis genome displayed differential expression. At each time-point the cop operon was strongly up-regulated, providing indirect evidence for the presence of free Ag + -ions. Moreover, exposure to the antimicrobial coating induced a broad general stress response in E. faecalis. Genes coding for the chaperones GroEL and GroES and the Clp proteases, ClpE and ClpB, were among the top up-regulated heat shock genes. Differential expression of thioredoxin, superoxide dismutase and glutathione synthetase genes indicates a high level of oxidative stress. We postulate a mechanism of action where the combination of Ag + -ions and reactive oxygen species generated by AGXX ® results in a synergistic antimicrobial effect, superior to that of conventional silver coatings. Copyright © 2017 Elsevier GmbH. All rights reserved.

  3. The Clinical Response to Gluten Challenge: A Review of the Literature

    Science.gov (United States)

    Bruins, Maaike J.

    2013-01-01

    The aim of this review was to identify, evaluate and summarize all relevant studies reporting on the clinical response to gluten challenge by adult or pediatric patients with suspected or diagnosed coeliac disease (CD) on a gluten-free diet. We evaluated the effect of gluten challenge on changes in symptoms, intestinal mucosa histology, and serum antibodies. A systematic electronic search was performed for studies published as of 1966 using PubMed and Scopus databases. In the reviewed studies, doses ranged from 0.2 to 30 g/day of wheat gluten or comprised a gluten-containing diet. The onset of symptoms upon gluten intake varied largely from days to months and did not parallel serum antibody or histological changes. Within 3 months of gluten challenge, 70%–100% of pediatric CD patients became positive for AGA-IgA and EMA-IgA antibodies and 50%–70% for AGA-IgG. A limited number of trials suggest that no more than half of adult patients developed positive AGA-IgA, EMA-IgA, tTG-IgA or DGP-IgA/IgG titers. Approximately 50%–100% of pediatric and adult patients experienced mucosal relapse of gluten provocation within 3 months, which was preceded by increased mucosal intra-epithelial lymphocytes within several days of challenge. A 3-month high-dose gluten challenge should be suitable to diagnose the majority of CD patients. In some cases prolonged challenge may be needed to verify diagnosis. Combination testing for antibodies and mucosal histology may fasten the diagnosis. PMID:24284613

  4. Differential clinical characteristics, medication usage, and treatment response of bipolar disorder in the US versus The Netherlands and Germany

    NARCIS (Netherlands)

    Post, Robert M.; Leverich, Gabriele S.; Altshuler, Lori L.; Frye, Mark A.; Suppes, Trisha; Keck, Paul E.; McElroy, Susan L.; Nolen, Willem A.; Kupka, Ralph; Grunze, Heinz; Walden, Joerg; Rowe, Mike

    Increased early-onset bipolar illness was seen in the US compared with the Netherlands and Germany (abbreviated here as Europe), but other clinical characteristics, medication use, and treatment response have not been systematically explored. Outpatients with bipolar disorder were treated

  5. Differential clinical characteristics, medication usage, and treatment response of bipolar disorder in the US versus The Netherlands and Germany

    NARCIS (Netherlands)

    Post, R.M.; Leverich, G.S.; Altshuler, L.L.; Frye, M.A.; Suppes, T.; Keck, P.E.; McElroy, S.L.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Walden, J.; Rowe, M.

    2011-01-01

    Increased early-onset bipolar illness was seen in the US compared with the Netherlands and Germany (abbreviated here as Europe), but other clinical characteristics, medication use, and treatment response have not been systematically explored. Outpatients with bipolar disorder were treated

  6. Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus.

    Science.gov (United States)

    Michalowicz, Bryan S; Hyman, Leslie; Hou, Wei; Oates, Thomas W; Reddy, Michael; Paquette, David W; Katancik, James A; Engebretson, Steven P

    2014-12-01

    Type 2 diabetes mellitus (T2DM) is a growing health problem worldwide. People with T2DM are at risk of experiencing periodontitis and likely require treatment. Using data from the national multicenter Diabetes and Periodontal Therapy Trial (DPTT), the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy. The DPTT investigators randomly assigned adults with T2DM (hemoglobin A1c [HbA1c] ≥ 7 percent and periodontitis to receive immediate or delayed therapy (scaling and root planing, oral hygiene instruction, chlorhexidine rinse). The investigators assessed probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and medical conditions at baseline, three months and six months. Six-month changes in mean PD, CAL and BOP defined the treatment response. Complete data were available for 473 of 514 DPTT participants. The authors used multiple regression models to evaluate participant-level factors associated with the response. More severe baseline PD, CAL and BOP were associated with greater improvements in these same measurements (P 30 kilograms per square meter) experienced greater reductions in PD and BOP than did participants who were not obese (P diabetes duration, and smoking were not associated with change in any outcome (P > .1). In patients with T2DM, baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy. Body mass index and Hispanic ethnicity-but not glycemic control, diabetes duration or smoking-also may be useful in predicting clinical changes in this population.

  7. Filarial-specific antibody response in East African bancroftian filariasis: effects of host infection, clinical disease, and filarial endemicity

    DEFF Research Database (Denmark)

    Jaoko, Walter G; Simonsen, Paul E; Meyrowitsch, Dan W

    2006-01-01

    The effect of host infection, chronic clinical disease, and transmission intensity on the patterns of specific antibody responses in Bancroftian filariasis was assessed by analyzing specific IgG1, IgG2, IgG3, IgG4, and IgE profiles among adults from two communities with high and low Wuchereria...

  8. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials

    NARCIS (Netherlands)

    Cherpanath, Thomas G. V.; Hirsch, Alexander; Geerts, Bart F.; Lagrand, Wim K.; Leeflang, Mariska M.; Schultz, Marcus J.; Groeneveld, A. B. Johan

    2016-01-01

    Passive leg raising creates a reversible increase in venous return allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings potentially affecting the diagnostic performance of passive leg raising. Therefore we performed a

  9. Responsiveness and Minimal Clinically Important Change of the Pain Disability Index in Patients With Chronic Back Pain

    NARCIS (Netherlands)

    Soer, Remko; Reneman, Michiel F.; Vroomen, Patrick C. A. J.; Stegeman, Patrick; Coppes, Maarten H.

    2012-01-01

    Study Design. Prospective cohort study. Objective. The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the Pain Disability Index (PDI) in patients with chronic back pain (CBP). Summary of Background Data. Treatment of patients with CBP is

  10. Partial response to biotin therapy in a patient with holocarboxylase synthetase deficiency: clinical, biochemical, and molecular genetic aspects

    NARCIS (Netherlands)

    Santer, R.; Muhle, H.; Suormala, T.; Baumgartner, E. R.; Duran, M.; Yang, X.; Aoki, Y.; Suzuki, Y.; Stephani, U.

    2003-01-01

    We report the clinical course and biochemical findings of a 10-year-old, mentally retarded girl with late-onset holocarboxylase synthetase (HCS, gene symbol HLCS) deficiency and only partial response to biotin. On treatment, even with an unusually high dose of 200mg/day, activities of the

  11. Bacille Calmette-Guerin (BCG) vaccination at birth and antibody responses to childhood vaccines. A randomised clinical trial

    NARCIS (Netherlands)

    Nissen, T.N.; Birk, N.M.; Smits, G.; Jeppesen, D.L.; Stensballe, L.G.; Netea, M.G.; Klis, F. van der; Benn, C.S.; Pryds, O.

    2017-01-01

    INTRODUCTION: BCG vaccination has been associated with beneficial non-specific effects on child health. Some immunological studies have reported heterologous effects of vaccines on antibody responses to heterologous vaccines. Within a randomised clinical trial of Bacille Calmette-Guerin (BCG)

  12. Dynamic transcriptional signatures and network responses for clinical symptoms in influenza-infected human subjects using systems biology approaches.

    Science.gov (United States)

    Linel, Patrice; Wu, Shuang; Deng, Nan; Wu, Hulin

    2014-10-01

    Recent studies demonstrate that human blood transcriptional signatures may be used to support diagnosis and clinical decisions for acute respiratory viral infections such as influenza. In this article, we propose to use a newly developed systems biology approach for time course gene expression data to identify significant dynamically response genes and dynamic gene network responses to viral infection. We illustrate the methodological pipeline by reanalyzing the time course gene expression data from a study with healthy human subjects challenged by live influenza virus. We observed clear differences in the number of significant dynamic response genes (DRGs) between the symptomatic and asymptomatic subjects and also identified DRG signatures for symptomatic subjects with influenza infection. The 505 common DRGs shared by the symptomatic subjects have high consistency with the signature genes for predicting viral infection identified in previous works. The temporal response patterns and network response features were carefully analyzed and investigated.

  13. Immunogenicity, adalimumab levels and clinical response in ankylosing spondylitis patients during 24 weeks of follow-up.

    Science.gov (United States)

    Kneepkens, Eva L; Wei, James Cheng-Chung; Nurmohamed, Michael T; Yeo, Kai-Jieh; Chen, C Y; van der Horst-Bruinsma, Irene E; van der Kleij, Desiree; Rispens, Theo; Wolbink, Gertjan; Krieckaert, Charlotte L M

    2015-02-01

    Immunogenicity influences adalimumab levels and therefore clinical response in patients with rheumatic diseases. To study the relationship between clinical response, adalimumab levels and antidrug antibodies (ADAb) in ankylosing spondylitis (AS). Observational cohort study of 115 consecutive AS patients treated with adalimumab in the Netherlands (n=85) and Taiwan (n=30), monitored during 24 weeks. Adalimumab levels and ADAb titres were determined using an ELISA and an antigen binding test (ABT), respectively, designed by Sanquin Research, Amsterdam. Response to adalimumab treatment was defined as a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) response, and disease activity was measured using the Ankylosing Spondylitis Disease Activity Score using C-reactive protein (CRP) (ASDAS). At baseline, median BASDAI (IQR) was 6.4 (4.5-7.6) and mean ASDAS (SD) was 3.5 (1.0). After 24 weeks, 49 (42.6%) patients were BASDAI50 responders and mean ASDAS (SD) for responders was 1.5 (1.0) vs 2.6 (1.0) for non-responders (p100 AU/mL). In these patients, CRP and erythrocyte sedimentation rate remained elevated during treatment. Adalimumab levels are related to clinical response in AS patients measured with ASDAS and are influenced by ADAb detectable with an ABT. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. The assessment of lethal propeller strike injuries in sea mammals.

    Science.gov (United States)

    Byard, Roger W; Winskog, Calle; Machado, Aaron; Boardman, Wayne

    2012-04-01

    Assessment of injuries in marine mammals may be required to help authorities determine whether human activity was involved. Three cases of marine animal deaths involving propeller blade strikes are reported to demonstrate characteristic features of such cases and diagnostic difficulties that may occur. Case 1: A juvenile New Zealand fur seal (Arctocephalus forsteri) suffered two parallel linear incised wounds of the flank and died following small intestinal herniation. Case 2: An Indo-Pacific bottlenose dolphin neonate (Tursiops aduncus) died from a deeply incised wound of the left side of the head with shattering of the skull and laceration of the underlying brain.Case 3: An adult female Indo-Pacific bottlenose dolphin (T. aduncus) died from two parallel chop wounds to the torso with opening of the thoracic and abdominal cavities with fractures of the ribs and vertebrae. Given that some animals may recover, and that the carcasses of those that are killed may simply not be found or reported, it is impossible to provide an estimate of the incidence of this type of injury amongst wild sea mammals. In cases that do come to forensic attention accurate evaluation of the type of injury may potentially have great medicolegal significance. Post-mortem putrefaction and post-mortem feeding by other sea animals may complicate assessments. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. Cellular nonlinear networks for strike-point localization at JET

    Science.gov (United States)

    Arena, P.; Fortuna, L.; Bruno, M.; Vagliasindi, G.; Murari, A.; Andrew, P.; Mazzitelli, G.

    2005-11-01

    At JET, the potential of fast image processing for real-time purposes is thoroughly investigated. Particular attention is devoted to smart sensors based on system on chip technology. The data of the infrared cameras were processed with a chip implementing a cellular nonlinear network (CNN) structure so as to support and complement the magnetic diagnostics in the real-time localization of the strike-point position in the divertor. The circuit consists of two layers of complementary metal-oxide semiconductor components, the first being the sensor and the second implementing the actual CNN. This innovative hardware has made it possible to determine the position of the maximum thermal load with a time resolution of the order of 30 ms. Good congruency has been found with the measurement from the thermocouples in the divertor, proving the potential of the infrared data in locating the region of the maximum thermal load. The results are also confirmed by JET magnetic codes, both those used for the equilibrium reconstructions and those devoted to the identification of the plasma boundary.

  16. Cellular nonlinear networks for strike-point localization at JET

    International Nuclear Information System (INIS)

    Arena, P.; Fortuna, L.; Bruno, M.; Vagliasindi, G.; Murari, A.; Andrew, P.; Mazzitelli, G.

    2005-01-01

    At JET, the potential of fast image processing for real-time purposes is thoroughly investigated. Particular attention is devoted to smart sensors based on system on chip technology. The data of the infrared cameras were processed with a chip implementing a cellular nonlinear network (CNN) structure so as to support and complement the magnetic diagnostics in the real-time localization of the strike-point position in the divertor. The circuit consists of two layers of complementary metal-oxide semiconductor components, the first being the sensor and the second implementing the actual CNN. This innovative hardware has made it possible to determine the position of the maximum thermal load with a time resolution of the order of 30 ms. Good congruency has been found with the measurement from the thermocouples in the divertor, proving the potential of the infrared data in locating the region of the maximum thermal load. The results are also confirmed by JET magnetic codes, both those used for the equilibrium reconstructions and those devoted to the identification of the plasma boundary

  17. Conventional Prompt Global Strike and Long-Range Ballistic Missiles: Background and Issues

    Science.gov (United States)

    2016-02-24

    Silver Bullet? Asking the Right Questions About Conventional Prompt Global Strike (Washington, DC: Carneige Endowment for International Peace, 2013), pp...124 James M. Acton, Silver Bullet? Asking the Right Questions About Prompt Global Strike (Washington, DC: Carnegie Endowment for International Peace, 2013), pp. 120-129. ...Conventional Prompt Global Strike and Long-Range Ballistic Missiles: Background and Issues Amy F. Woolf Specialist in Nuclear Weapons Policy

  18. Vessel Strike of Whales in Australia: The Challenges of Analysis of Historical Incident Data

    Directory of Open Access Journals (Sweden)

    David Peel

    2018-03-01

    Full Text Available Death or injury to whales from vessel strike is one of the primary threats to whale populations worldwide. However, quantifying the rate of occurrence of these collisions is difficult because many incidents are not detected (particularly from large vessels and therefore go unreported. Furthermore, varying reporting biases occur related to species identification, spatial coverage of reports and type of vessels involved. The International Whaling Commission (IWC has compiled a database of the worldwide occurrence of vessel strikes to cetaceans, within which Australia constitutes ~7% (35 reports of the reported worldwide (~471 reports vessel strike records involving large whales. Worldwide records consist largely of modern reports within the last two decades and historical evaluation of ship strike reports has mainly focused on the Northern Hemisphere. To address this we conducted a search of historical national and international print media archive databases to discover reports of vessel strikes globally, although with a focus on Australian waters. A significant number of previously unrecorded reports of vessel strikes were found for both Australia (76 and worldwide (140, resulting in a revised estimate of ~15% of global vessel strikes occurring in Australian waters. This detailed collation and analysis of vessel strike data in an Australian context has contributed to our knowledge of the worldwide occurrence of vessel strikes and challenges the notion that vessel strikes were historically rare in Australia relative to the rest of the world. The work highlights the need to examine historical records to provide context around current anthropogenic threats to marine fauna and demonstrates the importance of formalized reporting structures for effective collation of vessel strike reports. This paper examines the issues and biases in analysis of vessel strike data in general that would apply to any jurisdiction. Using the Australian data as an example

  19. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł

    2009-08-01

    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  20. ‘The Nairobi General Strike [1950]: from protest to insurgency’

    OpenAIRE

    Hyde, David

    2002-01-01

    The Nairobi General Strike [1950] was the culmination of Kenya’s post war strike wave and urban upheaval. An unprecedented upsurge occurred with the general strikes in Mombasa [1947] led by the African Workers Federation [A.W.F.] and in Nairobi by the East African Trades Union Congress [E.A.T.U.C.]. While this has been termed and treated as a city wide strike, there is enough evidence to suggest a movement that went some way beyond Nairobi. The extent of the cohesion and reciprocal impacts am...

  1. Operational Functions to Achieve Synergy between Special Operations and Precision Strike

    National Research Council Canada - National Science Library

    Huff, William M

    2005-01-01

    ...). The paper describes the operational functions required from the appointed operational commander and his staff to achieve synergism through the combination of special operations and precision strike...

  2. [Taking personal responsibility in practice: what does it mean?--Insights into daily clinical routines].

    Science.gov (United States)

    Hansen, Leonhard

    2012-01-01

    In our society, taking personal responsibility is basically regarded as a key step to adopting a more active lifestyle. In health care, however, personal responsibility is primarily equated with higher levels of financial contribution from patients. Obviously, the individual's responsibility for his or her health and towards the mutually supportive community is a highly emotional and ideological issue, so the debate is usually rather heated. This is, however, at odds with the "empowered patient" concept. In the present paper "personal responsibility in practice" will be understood to include both physician and patient responsibility. Examples will be employed to demonstrate that, on an individual level, physicians are responsible for diagnosing and treating their patients as indicated and that, on a collective level, they are expected to make responsible use of the resources allocated. Here, patient responsibility will be defined as both taking care for one's own health and the individual's obligation to contribute to the maintenance of our solidarity-based health care system. The tensions between solidarity and subsidiarity and personal responsibility, respectively, will be outlined, and a readjustment of the relation between external support and individual strengths, between solidarity and personal responsibility in terms of Sect. 1 of the Social Book Code V will be advocated. Copyright © 2012. Published by Elsevier GmbH.

  3. A systematic review on the effect of sweeteners on glycemic response and clinically relevant outcomes

    Directory of Open Access Journals (Sweden)

    Wiebe Natasha

    2011-11-01

    Full Text Available Abstract Background The major metabolic complications of obesity and type 2 diabetes may be prevented and managed with dietary modification. The use of sweeteners that provide little or no calories may help to achieve this objective. Methods We did a systematic review and network meta-analysis of the comparative effectiveness of sweetener additives using Bayesian techniques. MEDLINE, EMBASE, CENTRAL and CAB Global were searched to January 2011. Randomized trials comparing sweeteners in obese, diabetic, and healthy populations were selected. Outcomes of interest included weight change, energy intake, lipids, glycated hemoglobin, markers of insulin resistance and glycemic response. Evidence-based items potentially indicating risk of bias were assessed. Results Of 3,666 citations, we identified 53 eligible randomized controlled trials with 1,126 participants. In diabetic participants, fructose reduced 2-hour blood glucose concentrations by 4.81 mmol/L (95% CI 3.29, 6.34 compared to glucose. Two-hour blood glucose concentration data comparing hypocaloric sweeteners to sucrose or high fructose corn syrup were inconclusive. Based on two ≤10-week trials, we found that non-caloric sweeteners reduced energy intake compared to the sucrose groups by approximately 250-500 kcal/day (95% CI 153, 806. One trial found that participants in the non-caloric sweetener group had a decrease in body mass index compared to an increase in body mass index in the sucrose group (-0.40 vs 0.50 kg/m2, and -1.00 vs 1.60 kg/m2, respectively. No randomized controlled trials showed that high fructose corn syrup or fructose increased levels of cholesterol relative to other sweeteners. Conclusions Considering the public health importance of obesity and its consequences; the clearly relevant role of diet in the pathogenesis and maintenance of obesity; and the billions of dollars spent on non-caloric sweeteners, little high-quality clinical research has been done. Studies are

  4. A systematic review on the effect of sweeteners on glycemic response and clinically relevant outcomes.

    Science.gov (United States)

    Wiebe, Natasha; Padwal, Raj; Field, Catherine; Marks, Seth; Jacobs, Rene; Tonelli, Marcello

    2011-11-17

    The major metabolic complications of obesity and type 2 diabetes may be prevented and managed with dietary modification. The use of sweeteners that provide little or no calories may help to achieve this objective. We did a systematic review and network meta-analysis of the comparative effectiveness of sweetener additives using Bayesian techniques. MEDLINE, EMBASE, CENTRAL and CAB Global were searched to January 2011. Randomized trials comparing sweeteners in obese, diabetic, and healthy populations were selected. Outcomes of interest included weight change, energy intake, lipids, glycated hemoglobin, markers of insulin resistance and glycemic response. Evidence-based items potentially indicating risk of bias were assessed. Of 3,666 citations, we identified 53 eligible randomized controlled trials with 1,126 participants. In diabetic participants, fructose reduced 2-hour blood glucose concentrations by 4.81 mmol/L (95% CI 3.29, 6.34) compared to glucose. Two-hour blood glucose concentration data comparing hypocaloric sweeteners to sucrose or high fructose corn syrup were inconclusive. Based on two ≤10-week trials, we found that non-caloric sweeteners reduced energy intake compared to the sucrose groups by approximately 250-500 kcal/day (95% CI 153, 806). One trial found that participants in the non-caloric sweetener group had a decrease in body mass index compared to an increase in body mass index in the sucrose group (-0.40 vs 0.50 kg/m2, and -1.00 vs 1.60 kg/m2, respectively). No randomized controlled trials showed that high fructose corn syrup or fructose increased levels of cholesterol relative to other sweeteners. Considering the public health importance of obesity and its consequences; the clearly relevant role of diet in the pathogenesis and maintenance of obesity; and the billions of dollars spent on non-caloric sweeteners, little high-quality clinical research has been done. Studies are needed to determine the role of hypocaloric sweeteners in a wider

  5. Does achieving clinical response prevent work stoppage or work absence among employed patients with early rheumatoid arthritis?

    Science.gov (United States)

    Zhang, Wei; Sun, Huiying; Emery, Paul; Sato, Reiko; Singh, Amitabh; Freundlich, Bruce; Anis, Aslam H

    2012-02-01

    To evaluate the impact of clinical response on work stoppage or work absence among employed people with early RA. First-year data from the combination of MTX and etanercept trial was used. The analyses were restricted to the 205 patients working full or part time at baseline who answered questions on whether they stopped working or missed days from work in one or more of the four follow-up visits. Work stoppage referred to the first occurrence of subjects reporting stopping work. Work absence was defined as whether patients reported missed days from work. Clinical response and activity state considered included the ACR and European League against Rheumatism response criteria, 28-joint DAS (DAS-28) remission and the minimum clinically important difference of the HAQ score. After adjustment for baseline characteristics, ACR70 responders were 72% less likely to stop working and 55% less likely to miss work than ACR20 non-responders (P  3.2 (P < 0.05). Moderate improvements did not appear to effect work stoppage or missed days after adjustments. Results suggest that achieving clinical remission or major improvement might be necessary to significantly impact work outcomes.

  6. Cytokine responses to Staphylococcus aureus bloodstream infection differ between patient cohorts that have different clinical courses of infection.

    Science.gov (United States)

    McNicholas, Sinead; Talento, Alida Fe; O'Gorman, Joanne; Hannan, Margaret M; Lynch, Maureen; Greene, Catherine M; Humphreys, Hilary; Fitzgerald-Hughes, Deirdre

    2014-11-15

    The clinical course of Staphylococcus aureus bloodstream infection is unpredictable and bacterial virulence, host immune response and patient characteristics are among the factors that contribute to the clinical course of infection. To investigate the relationship between cytokine response and clinical outcome, circulating cytokine levels were investigated in response to S. aureus bloodstream infection in patients with different clinical courses of infection. A prospective study was carried out in 61 patients with S. aureus bloodstream infection and circulating levels of IL-6, GRO-γ, RANTES and leptin were assessed over the course of the infection. Levels were compared in patients with complicated courses of infection (e.g. infective endocarditis) versus uncomplicated courses of S. aureus bloodstream infection and methicillin-resistant S. aureus Vs methicillin-susceptible S. aureus infection. Significantly lower leptin levels (p < 0.05) and significantly higher IL-6 levels (p < 0.05) were detected at laboratory diagnosis in patients with complicated compared to uncomplicated S. aureus bloodstream infection. Significantly higher levels of GRO-γ were associated with MRSA infection compared to MSSA infection. IL-6 may be an early inflammatory marker of complicated S. aureus bloodstream infection. Leptin may be protective against the development of a complicated S. aureus bloodstream infection.

  7. RESPONSES OF OYSTERS AND THEIR HEMOCYTES TO CLINICAL AND ENVIRONMENTAL ISOLATES OF VIBRIO PARAHAEMOLYTICUS

    Science.gov (United States)

    Interactions of Vibrio parahaemolyticus with oysters and oyster hemocytes were studied using three environmental isolates (1094, 1163 and ATCC 17802) and three clinical isolates (2030, 2062, 2107). Clinical isolates were from patients who became ill during the June 1998 food pois...

  8. Human macrophage responses to clinical isolates from the Mycobacterium tuberculosis complex discriminate between ancient and modern lineages.

    Directory of Open Access Journals (Sweden)

    Damien Portevin

    2011-03-01

    Full Text Available The aim of the present study was to determine whether there is a correlation between phylogenetic relationship and inflammatory response amongst a panel of clinical isolates representative of the global diversity of the human Mycobacterium tuberculosis Complex (MTBC. Measurement of cytokines from infected human peripheral blood monocyte-derived macrophages revealed a wide variation in the response to different strains. The same pattern of high or low response to individual strains was observed for different pro-inflammatory cytokines and chemokines, and was conserved across multiple human donors. Although each major phylogenetic lineage of MTBC included strains inducing a range of cytokine responses, we found that overall inflammatory phenotypes differed significantly across lineages. In particular, comparison of evolutionarily modern lineages demonstrated a significant skewing towards lower early inflammatory response. The differential response to ancient and modern lineages observed using GM-CSF derived macrophages was also observed in autologous monocyte-derived dendritic cells and murine bone marrow-derived macrophages, but not in human unfractionated peripheral blood mononuclear cells. We hypothesize that the reduced immune responses to modern lineages contribute to more rapid disease progression and transmission, which might be a selective advantage in the context of expanding human populations. In addition to the lineage effects, the large strain-to-strain variation in innate immune responses elicited by MTBC will need to be considered in tuberculosis vaccine development.

  9. The Chinese nuclear arsenal and its second-strike capability

    International Nuclear Information System (INIS)

    Cabestan, Jean-Pierre

    2013-03-01

    It is well known that China possesses a second- strike capability, but a great deal of uncertainty persists on the subject. Over the last few years, without officially adjusting its doctrine, China has nonetheless defined its objectives. In April 2010, the People's Liberation Army Daily indicated that China needed such a capability and contended that ballistic missile submarines (SSBNs) would constitute the safest means of delivery. In the same year, the IISS estimated that the People's Liberation Army was in possession of 90 ICBMs (66 ground-based missiles and 24 SLBMs) and 400 IRBM mainly aimed at Taiwan and Japan. The Pentagon's 2012 report proposed 50-75 ICBMs and 80 -120 IRBM and MRBM. While it is established that the People's Liberation Army is developing Jin class submarines (type-094, of which there are currently two in service, which will soon rise to five) and is developing solid-propellant missiles, which could be activated more quickly, not a great deal is known about the progress of these two projects. The JL-2 (7400 km), which is mounted on SSBNs, is still being tested. In parallel, the traditional principle to which China adheres - no first use of nuclear weapons - seems to have been slightly dented. Thus, in January 2011, the Japanese press agency Kyodo (relayed by Stratfor) reported that the People's Liberation Army had lowered the threshold for use of its strategic weapons: it could henceforth envisage a preventive nuclear strike against a nuclear power that had by conventional means destroyed key strategic targets on its territory, such as a nuclear power station, a dam, or a large city, having provided prior warning to the aggressor. But what most worries the U.S. and its Asian allies, particularly the Japanese, is the quasi-total opacity of the Chinese military nuclear programme. While in April 2010, the United States and Russia signed a treaty limiting their number of strategic weapons to 1550 by 2018, China considers

  10. Effect of nonsurgical periodontal treatment on clinical response and glycemic control in type 2 diabetic patients with periodontitis: Controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Ajitha Kanduluru

    2014-01-01

    Full Text Available Background: Type 2 diabetes mellitus (type 2 DM and chronic periodontitis are common chronic diseases in adults in the world population. Once periodontal disease is established, the chronic nature of this infection may contribute to worsening of diabetic status leading to more severe diabetes-related complications. It has been proposed that the relation of periodontitis and diabetes is bidirectional. Objectives: The objective was to compare the clinical response and glycemic control in type 2 DM patients with periodontitis, before and after the nonsurgical periodontal treatment with controls. Materials and Methods: A total 70 type 2 DM patients with chronic generalized moderate periodontitis was divided into 2 groups. Treatment group (35 received one stage full mouth scaling and root planning plus oral hygiene instructions; the control group (35 received only oral hygiene instructions. At baseline, 1 st month and 3 rd month, the clinical periodontal parameters (plaque index [PI], gingival index [GI], pocket depth [PD], clinical attachment loss [CAL], gingival recession [GR], and bleeding on probing [BOP] and glycemic parameters (fasting blood sugar [FBS], and postprandial blood sugar [PPBS] were recorded, whereas the glycated hemoglobin (HbA1c was recorded only at baseline and 3rd month. The collected data were subjected to statistical analysis. Results: When comparing the mean scores of clinical parameters for both the groups, there was a significant difference in all clinical parameters, that is, mean PI, GI, BOP, PD, CAL scores except mean GR, whereas for the glycemic parameters, there was a significant difference in mean FBS; PPBS values and no significant difference in mean percentage of HbA1c for treatment group at 3 rd month follow-up. Conclusion: Findings of the present study showed that nonsurgical periodontal treatment resulted in lower glycemic levels and the reduction of clinical parameters of periodontal infection, confirming the

  11. Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis.

    Science.gov (United States)

    Tomlinson, Jonathon

    2015-06-11

    After widely publicised investigations into excess patient deaths at Mid Staffordshire hospital the UK government commissioned reports from Robert Francis QC and Professor Don Berwick. Among their recommendations to improve the quality and safety of patient care were lifelong learning, professional support and 'just culture'. Clinical supervision is in an excellent position to support these activities but opportunities are in danger of being squeezed out by regulatory and managerial demands. Doctors who have completed their training are responsible for complex professional judgements for which narrative supervision is particularly helpful. With reference to the literature and my own practice I propose that all practicing clinicians should have regular clinical supervision. Clinical supervision has patient-safety and the quality of patient care as its primary purposes. After training is completed, doctors may practice for the rest of their career without any clinical supervision, the implication being that the difficulties dealt with in clinical supervision are no longer difficulties, or are better dealt with some other way. Clinical supervision is sufficiently flexible to be adapted to the needs of experienced clinicians as its forms can be varied, though its functions remain focused on patient safety, good quality clinical care and professional wellbeing. The evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions. Among supervision's different forms, narrative-based-supervision is particularly useful as it has been developed for clinicians who have completed their training. It provides ways to explore the complexity of clinical judgements and encourages doctors to question one another's authority in a supportive culture. To be successful, supervision should also be professionally led and

  12. Assessment of performing an MST strike in Tank 21H

    Energy Technology Data Exchange (ETDEWEB)

    Poirier, Michael R.

    2014-09-29

    Previous Savannah River National Laboratory (SRNL) tank mixing studies performed for the Small Column Ion Exchange (SCIX) project have shown that 3 Submersible Mixer Pumps (SMPs) installed in Tank 41 are sufficient to support actinide removal by MST sorption as well as subsequent resuspension and removal of settled solids. Savannah River Remediation (SRR) is pursuing MST addition into Tank 21 as part of the Large Tank Strike (LTS) project. The preliminary scope for LTS involves the use of three standard slurry pumps (installed in N, SE, and SW risers) in a Type IV tank. Due to the differences in tank size, internal interferences, and pump design, a separate mixing evaluation is required to determine if the proposed configuration will allow for MST suspension and strontium and actinide sorption. The author performed the analysis by reviewing drawings for Tank 21 [W231023] and determining the required cleaning radius or zone of influence for the pumps. This requirement was compared with previous pilot-scale MST suspension data collected for SCIX that determined the cleaning radius, or zone of influence, as a function of pump operating parameters. The author also reviewed a previous Tank 50 mixing analysis that examined the ability of standard slurry pumps to suspend sludge particles. Based on a review of the pilot-scale SCIX mixing tests and Tank 50 pump operating experience, three standard slurry pumps should be able to suspend sludge and MST to effectively sorb strontium and actinides onto the MST. Using the SCIX data requires an assumption about the impact of cooling coils on slurry pump mixing. The basis for this assumption is described in this report. Using the Tank 50 operating experience shows three standard slurry pumps should be able to suspend solids if the shear strength of the settled solids is less than 160 Pa. Because Tank 21 does not contain cooling coils, the shear strength could be larger.

  13. Association between frequent cardiac resynchronization therapy optimization and long-term clinical response: a post hoc analysis of the Clinical Evaluation on Advanced Resynchronization (CLEAR) pilot study

    Science.gov (United States)

    Delnoy, Peter Paul; Ritter, Philippe; Naegele, Herbert; Orazi, Serafino; Szwed, Hanna; Zupan, Igor; Goscinska-Bis, Kinga; Anselme, Frederic; Martino, Maria; Padeletti, Luigi

    2013-01-01

    Aims The long-term clinical value of the optimization of atrioventricular (AVD) and interventricular (VVD) delays in cardiac resynchronization therapy (CRT) remains controversial. We studied retrospectively the association between the frequency of AVD and VVD optimization and 1-year clinical outcomes in the 199 CRT patients who completed the Clinical Evaluation on Advanced Resynchronization study. Methods and results From the 199 patients assigned to CRT-pacemaker (CRT-P) (New York Heart Association, NYHA, class III/IV, left ventricular ejection fraction failure-related hospitalization, NYHA functional class, and Quality of Life score, at 1 year. Systematic CRT optimization was associated with a higher percentage of improved patients based on the composite endpoint (85% in Group 1 vs. 61% in Group 2, P < 0.001), with fewer deaths (3% in Group 1 vs. 14% in Group 2, P = 0.014) and fewer hospitalizations (8% in Group 1 vs. 23% in Group 2, P = 0.007), at 1 year. Conclusion These results further suggest that AVD and VVD frequent optimization (at implant, at 3 and 6 months) is associated with improved long-term clinical response in CRT-P patients. PMID:23493410

  14. Left-Lateral Strike-Slip Faulting in the East Alborz, NE Iran

    Science.gov (United States)

    Hollingsworth, J.; Walker, R.; Jackson, J.; Bolourchi, M. J.; Eshraghi, S. A.

    2006-12-01

    The East Alborz mountains of NE Iran are actively deforming as a result of Arabia-Eurasia collision. We combine observations of the geomorphology made using high resolution satellite, topographic and field data, with historical and recent seismicity to map major active faults in this poorly studied region. Deformation on the north side of the range occurs by range-normal shortening on the Khazar thrust fault, which separates Central Iran from the South Caspian. South of the range, deformation involves both left-lateral slip on the previously undocumented Shahrud fault system, which comprises several range-bounding fault segments, and shortening on (probably minor) thrust faults. Faulting south of the range is responsible for major historical earthquakes at Damghan (856AD) and Shahrud (1890). Deformation accommodated across the East Alborz is estimated from the difference in GPS velocities north and south of the range. South of the Alborz, northward GPS velocities across Central Iran decrease eastwards and the strike of the deforming belt changes to become more sub-parallel to the direction of South Caspian- Iran relative motion. This reduces the shortening component across the East Alborz, resulting in lower elevations between 54--57°E. West of 55.5°E, the more arc-normal shortening is achieved by partitioning of deformation onto the Khazar thrust (~1 mm/yr) and the Astaneh and Firuzkuh strike-slip faults (~3 mm/yr). East of 55.5°E, the Khazar fault ends and East Alborz deformation is accommodated primarily on the left-lateral Shahrud fault system, which may slip up to 3~mm/yr. Due to the long gap in seismicity along the eastern Shahrud fault system, the city of Jajarm (15,000 pop.) is considered at high risk from future earthquakes.

  15. On the failure behaviour to striking bow penetration of impacted marine-steel structures

    Directory of Open Access Journals (Sweden)

    Prabowo Aditya Rio

    2018-04-01

    Full Text Available Demands for water transportation modes are continuously increasing as rapid economic and industrial growths in the recent decade. Ship as representative of the water transportation is generally needed to carry various products from one location to another. Besides as product carrier, ship also acts as public facility to transport human across islands for number of reasons, such as tourism and vehicle. Considering its importance, structural damage due to accidental loads or so-called impact can cause unacceptable casualties which threat ship passenger, shipping industry and maritime environment in same time. The most frequent impact phenomena occur in forms of collision and grounding, which are targeting side structure and double bottom consecutively. However, since responses of the impacts on structure are highly nonlinear and vary due to development of ship structures, sustainable analysis as an update of pioneer calculation can be beneficial as rational reference for improving safety and navigational instruments. This work aims to assess failures of the side structures subjected to penetration of striking bow in ship-ship collision scenario. Locations of impact are idealized to happen on after-end, midsection and fore-end to provide complete assessment. Striking bow is to be deployed by varying input velocity to observe significance of the fractures on the side structure. This configuration is implemented on the designed collision scenario, and later calculated using nonlinear finite element method (NLFEM. Summary of the solution indicated that the midsection produced the highest resistance against side collision. Breaching of the inner shell was successfully avoided on the fore-end, but the critical damage to the cargo was observed during bow penetration to the after-end region. This location was recommended to be added by longitudinal framing to increase its resistance against ship collision.

  16. On the failure behaviour to striking bow penetration of impacted marine-steel structures

    Science.gov (United States)

    Prabowo, Aditya Rio; Muttaqie, Teguh; Sohn, Jung Min; Bae, Dong Myung; Setiyawan, Agus

    2018-04-01

    Demands for water transportation modes are continuously increasing as rapid economic and industrial growths in the recent decade. Ship as representative of the water transportation is generally needed to carry various products from one location to another. Besides as product carrier, ship also acts as public facility to transport human across islands for number of reasons, such as tourism and vehicle. Considering its importance, structural damage due to accidental loads or so-called impact can cause unacceptable casualties which threat ship passenger, shipping industry and maritime environment in same time. The most frequent impact phenomena occur in forms of collision and grounding, which are targeting side structure and double bottom consecutively. However, since responses of the impacts on structure are highly nonlinear and vary due to development of ship structures, sustainable analysis as an update of pioneer calculation can be beneficial as rational reference for improving safety and navigational instruments. This work aims to assess failures of the side structures subjected to penetration of striking bow in ship-ship collision scenario. Locations of impact are idealized to happen on after-end, midsection and fore-end to provide complete assessment. Striking bow is to be deployed by varying input velocity to observe significance of the fractures on the side structure. This configuration is implemented on the designed collision scenario, and later calculated using nonlinear finite element method (NLFEM). Summary of the solution indicated that the midsection produced the highest resistance against side collision. Breaching of the inner shell was successfully avoided on the fore-end, but the critical damage to the cargo was observed during bow penetration to the after-end region. This location was recommended to be added by longitudinal framing to increase its resistance against ship collision.

  17. In the Hot Seat: STS-115 Lightning Strike Stand Down Debate - NASA Case Study

    Science.gov (United States)

    Kummer, Lizette; Stevens, Jennifer

    2016-01-01

    There is no way the PIC's could have seen any current' was the gist of Mike Griffin's assessment. Griffin was the NASA Administrator at the time. The buck stopped at his desk. Holding a napkin out to Pat Lampton, Griffin showed Lampton the calculations he'd made over dinner that predicted that the Pyrotechnic Initiator Controllers (PIC's) at the base of the Space Shuttle Solid Rocket Boosters (SRBs) were fine. A lightning strike the day before, the worst ever experienced with a Space Shuttle on the launch pad, caused a halt to the launch count down as technicians, engineers, and managers scrambled identify any damage to the launch system. SRB technicians and engineers assessed the data against their Lightning Strike Re-Test Requirements, determining that all but one of the requirements could be checked if they resumed the countdown. For the one remaining requirement, testing the integrity of the PIC's would require 96 hours to set up, test, and reassemble. The engineers were convinced that there was no way to do calculations to show the PIC's were okay. The only option was to stand down. It was SRB Deputy Project Manager (PM) Pat Lampton's responsibility to decide what the SRB project position needed to be to certify that their hardware was safe to fly. He had to communicate that decision to the Mission Management Team (MMT) as a Go or No Go position to resume the count down. If the answer was Go they could still meet a delayed, but acceptable launch schedule. If the answer was No Go, rescheduling the launch would be a grueling shuffling of hardware, personnel, and mission timelines to accommodate Russian missions to the Space Station, supplies for the launch, and personnel manning launch operations. On top of that, Hurricane Ernesto was spinning off the coast of Florida, threatening the need for the Shuttle to roll back to the hangar if they waited too long.

  18. Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

    Science.gov (United States)

    Grilo, C. M.; White, M. A.; Wilson, G. T.; Gueorguieva, R.; Masheb, R. M.

    2011-01-01

    Background We examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL). Method Altogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ≥70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes. Results Rapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss. Conclusions Rapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment. PMID:21923964

  19. Clinical responses after total body irradiation by over permissible dose of γ-rays in one time

    International Nuclear Information System (INIS)

    Jiang Benrong; Wang Guilin; Liu Huilan; Tang Xingsheng; Ai Huisheng

    1990-01-01

    The clinical responses of patients after total body over permissilbe dose γ-ray irradiation were observed and analysed. The results showed: when the dose was above 5 cGy, there was some immunological depression, but no significant change in hematopoietic functions. 5 cases showed some transient changes of ECG, perhaps due to vagotonia caused by psychological imbalance, One case vomitted 3-4 times after 28 cGy irradiation, this suggested that a few times of vomitting had no significance in the estimation of the irradiated dose and the whole clinical manifestations must be concretely analysed

  20. Natural history and clinical response: “It’s the virus, stupid, or is it the host?”

    Science.gov (United States)

    2012-01-01

    Summary A major goal of modern medicine is the application of personalized therapies, consisting of decisions and practices tailored to the individual patient. Information about genetic variants, either mutant or polymorphic, represents the basis for the development of this clinical approach. Recently, several independent genome-wide association studies (GWAS) have identified two single nucleotide polymorphisms (SNPs) on the IL28B locus associated with HCV containment, spontaneous clearance, treatment response, and disease progression. In this minireview we will concisely discuss some critical genetic concepts that may have possible implications for clinical decisions in the treatment of HCV infection. PMID:23173731

  1. Role of N-S strike-slip faulting in structuring of north-eastern Tunisia; geodynamic implications

    Science.gov (United States)

    Arfaoui, Aymen; Soumaya, Abdelkader; Ben Ayed, Noureddine; Delvaux, Damien; Ghanmi, Mohamed; Kadri, Ali; Zargouni, Fouad

    2017-05-01

    Three major compressional events characterized by folding, thrusting and strike-slip faulting occurred in the Eocene, Late Miocene and Quaternary along the NE Tunisian domain between Bou Kornine-Ressas-Msella and Cap Bon Peninsula. During the Plio-Quaternary, the Grombalia and Mornag grabens show a maximum of collapse in parallelism with the NNW-SSE SHmax direction and developed as 3rd order distensives zones within a global compressional regime. Using existing tectonic and geophysical data supplemented by new fault-kinematic observations, we show that Cenozoic deformation of the Mesozoic sedimentary sequences is dominated by first order N-S faults reactivation, this sinistral wrench system is responsible for the formation of strike-slip duplexes, thrusts, folds and grabens. Following our new structural interpretation, the major faults of N-S Axis, Bou Kornine-Ressas-Messella (MRB) and Hammamet-Korbous (HK) form an N-S first order compressive relay within a left lateral strike-slip duplex. The N-S master MRB fault is dominated by contractional imbricate fans, while the parallel HK fault is characterized by a trailing of extensional imbricate fans. The Eocene and Miocene compression phases in the study area caused sinistral strike-slip reactivation of pre-existing N-S faults, reverse reactivation of NE-SW trending faults and normal-oblique reactivation of NW-SE faults, creating a NE-SW to N-S trending system of east-verging folds and overlaps. Existing seismic tomography images suggest a key role for the lithospheric subvertical tear or STEP fault (Slab Transfer Edge Propagator) evidenced below this region on the development of the MRB and the HK relay zone. The presence of extensive syntectonic Pliocene on top of this crustal scale fault may be the result of a recent lithospheric vertical kinematic of this STEP fault, due to the rollback and lateral migration of the Calabrian slab eastward.

  2. [Good clinical practices in clinical trials: the responsibility of the researcher. A survey of 827 hospital physicians (I). Availability. Monitoring. Safety. Contract].

    Science.gov (United States)

    Dal-Ré, R

    1993-03-06

    The Law of Medicaments establishes that clinical trials (CT) with drugs must be carried out following the of Good Clinical Practice guidelines (GCP). The attitude of hospital physicians to the GCP prior to its implementation as mandatory in accordance with Spanish legislation was considered to be of interest. An anonymous survey was used with closed response questions. Questions referring to the responsibilities of the investigator included in the GCP were included. From December 1988 to February 1990 the survey was distributed among 1,706 hospital medical staff members, of any specialty, who had or had not participated in CT. In this article the results of the questions regarding the availability of the investigative team, CT monitorization, management of adverse reactions, the safety of the participants in the CT and the contract between the sponsor and the researcher are presented. A total of 827 hospital doctors replied to the survey. Fifty-nine percent had intervened in CT with drugs. At least 94% of those surveyed considered that the researcher must have the time and number of eligible patients which the CT requires. There was high acceptance (> or = 78%) of the clinical audits to be performed by the health authorities and the sponsor company of the CT. The need of urgent communication of the severe adverse reactions is admitted by a great majority (> or = 95%) of those surveyed. Eighty-five percent believe that patients should be insured against damage derived from CT with 76% considering that the investigator should sign a contract with the sponsor; 68% and 59% would hand in a copy of the same to the CT committee and the remainder of the research team, respectively. According to the Good Clinical Practice dealt with in this article, the responsibilities of the investigator have been widely accepted by the hospital physicians surveyed, therefore no problems should be expected upon the implementation of the same in this country. However, the economic

  3. Human metabolic response to systemic inflammation: assessment of the concordance between experimental endotoxemia and clinical cases of sepsis/SIRS.

    Science.gov (United States)

    Kamisoglu, Kubra; Haimovich, Beatrice; Calvano, Steve E; Coyle, Susette M; Corbett, Siobhan A; Langley, Raymond J; Kingsmore, Stephen F; Androulakis, Ioannis P

    2015-03-03

    Two recent, independent, studies conducted novel metabolomics analyses relevant to human sepsis progression; one was a human model of endotoxin (lipopolysaccharide (LPS)) challenge (experimental endotoxemia) and the other was community acquired pneumonia and sepsis outcome diagnostic study (CAPSOD). The purpose of the present study was to assess the concordance of metabolic responses to LPS and community-acquired sepsis. We tested the hypothesis that the patterns of metabolic response elicited by endotoxin would agree with those in clinical sepsis. Alterations in the plasma metabolome of the subjects challenged with LPS were compared with those of sepsis patients who had been stratified into two groups: sepsis patients with confirmed infection and non-infected patients who exhibited systemic inflammatory response syndrome (SIRS) criteria. Common metabolites between endotoxemia and both these groups were individually identified, together with their direction of change and functional classifications. Response to endotoxemia at the metabolome level elicited characteristics that agree well with those observed in sepsis patients despite the high degree of variability in the response of these patients. Moreover, some distinct features of SIRS have been identified. Upon stratification of sepsis patients based on 28-day survival, the direction of change in 21 of 23 metabolites was the same in endotoxemia and sepsis survival groups. The observed concordance in plasma metabolomes of LPS-treated subjects and sepsis survivors strengthens the relevance of endotoxemia to clinical research as a physiological model of community-acquired sepsis, and gives valuable insights into the metabolic changes that constitute a homeostatic response. Furthermore, recapitulation of metabolic differences between sepsis non-survivors and survivors in LPS-treated subjects can enable further research on the development and assessment of rational clinical therapies to prevent sepsis mortality

  4. Evaluation of the tip-bending response in clinically used endoscopes

    NARCIS (Netherlands)

    Rozeboom, Esther D.; Reilink, Rob; Schwartz, Matthijs P.; Fockens, Paul; Broeders, Ivo A. M. J.

    2016-01-01

    Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current

  5. Evaluation of the tip-bending response in clinically used endoscopes

    NARCIS (Netherlands)

    Rozeboom, Esther; Reilink, Rob; Schwartz, Matthijs P.; Fockens, Paul; Broeders, Ivo Adriaan Maria Johannes

    Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current

  6. Magnitude of placebo response and response variance in antidepressant clinical trials using structured, taped and appraised rater interviews compared to traditional rating interviews.

    Science.gov (United States)

    Khan, Arif; Faucett, James; Brown, Walter A

    2014-04-01

    The high failure rate of antidepressant clinical trials is due in part to a high magnitude of placebo response and considerable variance in placebo response. In some recent trials enhanced patient interview techniques consisting of Structured Interview Guide for the Montgomery-Asberg Depression Rating Scale (SIGMA) interviews, audiotaping of patient interviews and 'central' appraisal with Rater Applied Performance Scale (RAPS) criteria have been implemented in the hope of increasing reliability and thus reducing the placebo response. However, the data supporting this rationale for a change in patient interview technique are sparse. We analyzed data from depressed patients assigned to placebo in antidepressant clinical trials conducted at a single research site between 2008 and 2012. Three trials included 34 depressed patients undergoing SIGMA depression interviews with taping and RAPS appraisal and 4 trials included 128 depressed patients using traditional interview methods. Using patient level data we assessed the mean decrease in total MADRS scores and the variability of the decrease in MADRS scores in trials using SIGMA interviews versus trials using traditional interviews. Mean decrease in total MADRS score was significantly higher in the 3 trials that used SIGMA interviews compared to the 4 trials using traditional interviews (M = 13.0 versus 8.3, t(df = 160) = 2.04, p = 0.047). Furthermore, trials using SIGMA had a larger magnitude of response variance based on Levene's test for equality of variance (SD = 12.3 versus 9.4, F = 7.3, p = 0.008). The results of our study suggest that enhanced patient interview techniques such as SIGMA interviews, audiotaping and RAPS appraisal may not result in the intended effect of reducing the magnitude of placebo response and placebo variance. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Responsible Translation of Stem Cell Research: An Assessment of Clinical Trial Registration and Publications

    OpenAIRE

    Fung, Moses; Yuan, Yan; Atkins, Harold; Shi, Qian; Bubela, Tania

    2017-01-01

    Summary We assessed the extent to which the publication of clinical trial results of innovative cell-based interventions reflects International Society for Stem Cell Research best practice guidelines. We assessed: (1) characteristics and time to publication of completed trials; (2) quality of reported trials; and (3) results of published trials. We identified and analyzed publications from 1,052 novel stem cell clinical trials: 179 (45.4%) of 393 completed trials had published results; 48 tri...

  8. pRRophetic: an R package for prediction of clinical chemotherapeutic response from tumor gene expression levels.

    Directory of Open Access Journals (Sweden)

    Paul Geeleher

    Full Text Available We recently described a methodology that reliably predicted chemotherapeutic response in multiple independent clinical trials. The method worked by building statistical models from gene expression and drug sensitivity data in a very large panel of cancer cell lines, then applying these models to gene expression data from primary tumor biopsies. Here, to facilitate the development and adoption of this methodology we have created an R package called pRRophetic. This also extends the previously described pipeline, allowing prediction of clinical drug response for many cancer drugs in a user-friendly R environment. We have developed several other important use cases; as an example, we have shown that prediction of bortezomib sensitivity in multiple myeloma may be improved by training models on a large set of neoplastic hematological cell lines. We have also shown that the package facilitates model development and prediction using several different classes of data.

  9. Bread making technology influences postprandial glucose response: a review of the clinical evidence.

    Science.gov (United States)

    Stamataki, Nikoleta S; Yanni, Amalia E; Karathanos, Vaios T

    2017-04-01

    Lowering postprandial glucose and insulin responses may have significant beneficial implications for prevention and treatment of metabolic disorders. Bread is a staple food consumed worldwide in a daily basis, and the use of different baking technologies may modify the glucose and insulin response. The aim of this review was to critically record the human studies examining the application of different bread making processes on postprandial glucose and insulin response to bread. Literature is rich of results which show that the use of sourdough fermentation instead of leavening with Saccharomyces cerevisiae is able to modulate glucose response to bread, whereas evidence regarding its efficacy on lowering postprandial insulin response is less clear. The presence of organic acids is possibly involved, but the exact mechanism of action is still to be confirmed. The reviewed data also revealed that the alteration of other processing conditions (method of cooking, proofing period, partial baking freezing technology) can effectively decrease postprandial glucose response to bread, by influencing physical structure and retrogradation of starch. The development of healthier bread products that benefit postprandial metabolic responses is crucial and suggested baking conditions can be used by the bread industry for the promotion of public health.

  10. Pre/post-strike atmospheric assessment system (PAAS)

    International Nuclear Information System (INIS)

    Peglow, S. G.; Molitoris, J. D.

    1997-01-01

    The Pre/Post-Strike Atmospheric Assessment System was proposed to show the importance of local meteorological conditions in the vicinity of a site suspected of storing or producing toxic agents and demonstrate a technology to measure these conditions, specifically wind fields. The ability to predict the collateral effects resulting from an attack on a facility containing hazardous materials is crucial to conducting effective military operations. Our study approach utilized a combination of field measurements with dispersion modeling to better understand which variables in terrain and weather were most important to collateral damage predictions. To develop the PAAS wind-sensing technology, we utilized a combination of emergent and available technology from micro-Doppler and highly coherent laser systems. The method used for wind sensing is to probe the atmosphere with a highly coherent laser beam. As the beam probes, light is back-scattered from particles entrained in the air to the lidar transceiver and detected by the instrument. Any motion of the aerosols with a component along the beam axis leads to a Doppler shift of the received light. Scanning in a conical fashion about the zenith results in a more accurate and two-dimensional measurement of the wind velocity. The major milestones in the benchtop system development were to verify the design by demonstrating the technique in the laboratory, then scale the design down to a size consistent with a demonstrator unit which could be built to take data in the field. The micro-Doppler heterodyne system we developed determines absolute motion by optically mixing a reference beam with the return signal and has shown motion sensitivity to better than 1 cm/s. This report describes the rationale, technical approach and laboratory testing undertaken to demonstrate the feasibility and utility of a system to provide local meteorological data and predict atmospheric particulate motion. The work described herein was funded by

  11. Optical and energy dependent response of the alanine gel solution produced at IPEN to clinical photons and electrons beams

    International Nuclear Information System (INIS)

    Silva, Cleber F.

    2011-01-01

    The DL-Alanine (C 3 H 7 NO 2 ) is an amino acid tissue equivalent traditionally used as standard dosimetric material in EPR dosimetry. Recently, it has been studied to be applied in gel dosimetry, considering that the addition of Alanine in the Fricke gel solution improves the production of ferric ions radiation induced. The spectrophotometric evaluation technique can be used comparing the two spectrum wavelengths bands: 457 nm band that corresponds to ferrous ions and 588 nm band that corresponds to ferric ions concentration to evaluate the dosimetric properties of this material. The performance of the Alanine gel solution developed at IPEN has been firstly studied using the spectrophotometric technique aiming to apply this material to 3D clinical doses evaluations using MRI technique. In this work, the optical and the energy dependent response of this solution submitted to clinical photons and electrons beams were studied. Different batches of gel solutions were prepared and maintained at low temperature during 12 h to solidification. Before irradiation, the samples were maintained during 1 h at room temperature. The photons and electrons irradiations were carried out using a Varian 2100C Medical Linear Accelerator of the Radiotherapy Department of the Hospital das Clinicas of the University of Sao Paulo with absorbed doses between 1 and 40 Gy; radiation field of 10 x 10 cm 2 ; photon energies of 6 MeV and 15 MeV; and electron with energies between 6 and 15 MeV. The obtained results indicate that signal response dependence for clinical photons and electrons beams, to the same doses, for Alanine gel dosimeter is better than 3.6 % (1σ), and the energy dependence response, to the same doses, is better 3% (1σ) for both beams. These results indicate that the same calibration factor can be used and the optical response is energy independent in the studied dose range and clinical photons and electrons beams energies. (author)

  12. From the Consulting Room to the Court Room? Taking the Clinical Model of Responsibility Without Blame into the Legal Realm

    Science.gov (United States)

    Lacey, Nicola; Pickard, Hanna

    2013-01-01

    Within contemporary penal philosophy, the view that punishment can only be justified if the offender is a moral agent who is responsible and hence blameworthy for their offence is one of the few areas on which a consensus prevails. In recent literature, this precept is associated with the retributive tradition, in the modern form of ‘just deserts’. Turning its back on the rehabilitative ideal, this tradition forges a strong association between the justification of punishment, the attribution of responsible agency in relation to the offence, and the appropriateness of blame. By contrast, effective clinical treatment of disorders of agency employs a conceptual framework in which ideas of responsibility and blameworthiness are clearly separated from what we call ‘affective blame’: the range of hostile, negative attitudes and emotions that are typical human responses to criminal or immoral conduct. We argue that taking this clinical model of ‘responsibility without blame’ into the legal realm offers new possibilities. Theoretically, it allows for the reconciliation of the idea of ‘just deserts’ with a rehabilitative ideal in penal philosophy. Punishment can be reconceived as consequences—typically negative but occasionally not, so long as they are serious and appropriate to the crime and the context—imposed in response to, by reason of, and in proportion to responsibility and blameworthiness, but without the hard treatment and stigma typical of affective blame. Practically, it suggests how sentencing and punishment can better avoid affective blame and instead further rehabilitative and related ends, while yet serving the demands of justice. PMID:24771953

  13. RET Fusion Lung Carcinoma: Response to Therapy and Clinical Features in a Case Series of 14 Patients.

    Science.gov (United States)

    Sarfaty, Michal; Moore, Assaf; Neiman, Victoria; Dudnik, Elizabeth; Ilouze, Maya; Gottfried, Maya; Katznelson, Rivka; Nechushtan, Hovav; Sorotsky, Hadas Gantz; Paz, Keren; Katz, Amanda; Saute, Milton; Wolner, Mira; Moskovitz, Mor; Miller, Vincent; Elvin, Julia; Lipson, Doron; Ali, Siraj; Gutman, Lior Soussan; Dvir, Addie; Gordon, Noa; Peled, Nir

    2017-07-01

    RET (rearranged during transfection) fusions have been reported in 1% to 2% of lung adenocarcinoma (LADC) cases. In contrast, KIF5B-RET and CCDC6-RET fusion genes have been identified in 70% to 90% and 10% to 25% of tumors, respectively. The natural history and management of RET-rearranged LADC are still being delineated. We present a series of 14 patients with RET-rearranged LADC. The response to therapy was assessed by the clinical response and an avatar model in 2 cases. Patients underwent chemotherapy, targeted therapy, and immunotherapy. A total of 14 patients (8 women; 10 never smokers; 4 light smokers; mean age, 57 years) were included. KIF5B-RET and CCDC6-RET variants were diagnosed in 10 and 4 cases, respectively. Eight patients had an early disseminated manifestation, seven with KIF5B-RET rearranged tumor. The features of this subset included bilateral miliary lung metastases, bone metastases, and unusual early visceral abdominal involvement. One such patient demonstrated an early and durable complete response to cabozantinib for 7 months. Another 2 patients treated with cabozantinib experienced a partial response, with rapid significant clinical improvement. Four patients with tumors harboring CCDC6-RET and KIF5B-RET fusions showed pronounced and durable responses to platinum-based chemotherapy that lasted for 8 to 15 months. Two patients' tumors showed programmed cell death ligand 1-positive staining but did not respond to pembrolizumab. The median overall survival was 22.8 months. RET-rearranged LADC in our series tended to occur as bilateral disease with early visceral involvement, especially with KIF5B fusion. Treatment with cabozantinib achieved responses, including 1 complete response. However, further studies are required in this group of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. The balancing act between the constitutional right to strike and the ...

    African Journals Online (AJOL)

    While the South African Constitution enshrines both children's right to a basic education and teachers' right to strike, conflict between these two often occurs when the way in which teachers' unions conduct strike actions detracts from learners' education. This article identifies the parties affected by industrial action in the ...

  15. Expert Anticipatory Skill in Striking Sports: A Review and a Model

    Science.gov (United States)

    Muller, Sean; Abernethy, Bruce

    2012-01-01

    Expert performers in striking sports can hit objects moving at high speed with incredible precision. Exceptionally well developed anticipation skills are necessary to cope with the severe constraints on interception. In this paper, we provide a review of the empirical evidence regarding expert interception in striking sports and propose a…

  16. Factors affecting defensive strike behavior in Brown Treesnakes (Boiga irregularis) provoked by humans

    Science.gov (United States)

    Spencer, McKayka M.; Lardner, Bjorn; Mazurek, M.J.; Reed, Robert N.

    2015-01-01

    Striking is a typical antipredator defense exhibited by many species of snakes. While trapping Brown Treesnakes (Boiga irregularis) on Guam, we observed that snakes most frequently struck at an approaching person at a site where snakes had been trapped, marked, and handled in the past. Using a combination of between-sites and within-site comparisons, we assessed if the propensity to strike was correlated with capture histories (both recent and long-term), snake size, body condition (a proxy to nutritional stress), sex, or tail condition (broken or intact), while controlling for confounding variables. We confirmed that propensity to strike was higher at the site where we had been conducting capture-mark-recapture for several years. However, we were unable to demonstrate a correlation between striking tendencies and individual recent or long-term capture histories. The only morphological covariate that had an effect on strike propensity was sex, with females striking more often than males. After removing the site effect from our model, we found that snakes missing parts of their tails were more likely to strike than snakes with intact tails. We have yet to identify the factor(s) that cause the pronounced difference across sites in snake propensity to strike, and data from additional sites might help elucidate any geographical patterns.

  17. The dark side of solidarity: social norms and social relations in the aftermath of strikes

    NARCIS (Netherlands)

    Thommes, Kirsten; Akkerman, Agnes; Torenvlied, René; Born, Marieke

    2014-01-01

    This paper studies how employees anticipate change in social relations after a strike in their organisation. We hypothesise that two group norms affect employees' fear that a strike deteriorates the social relations with their colleagues. We distinguish between two different norms associated with a

  18. The dark side of solidarity. The impact of norms on the aftermath of strikes

    NARCIS (Netherlands)

    Thommes, K; Akkerman, A.; Torenvlied, R.

    2014-01-01

    This paper studies how employees anticipate change in social relations after a strike in their organisation. We hypothesise that two group norms affect employees' fear that a strike deteriorates the social relations with their colleagues. We distinguish between two different norms associated with a

  19. Variation in Foot Strike Patterns among Habitually Barefoot and Shod Runners in Kenya.

    Science.gov (United States)

    Lieberman, Daniel E; Castillo, Eric R; Otarola-Castillo, Erik; Sang, Meshack K; Sigei, Timothy K; Ojiambo, Robert; Okutoyi, Paul; Pitsiladis, Yannis

    2015-01-01

    Runners are often categorized as forefoot, midfoot or rearfoot strikers, but how much and why do individuals vary in foot strike patterns when running on level terrain? This study used general linear mixed-effects models to explore both intra- and inter-individual variations in foot strike pattern among 48 Kalenjin-speaking participants from Kenya who varied in age, sex, body mass, height, running history, and habitual use of footwear. High speed video was used to measure lower extremity kinematics at ground contact in the sagittal plane while participants ran down 13 meter-long tracks with three variables independently controlled: speed, track stiffness, and step frequency. 72% of the habitually barefoot and 32% of the habitually shod participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently and who used lower step frequencies. There was no effect of sex, age, height or weight on foot strike angle, but individuals were more likely to midfoot or forefoot strike when they ran on a stiff surface, had a high preferred stride frequency, were habitually barefoot, and had more experience running. It is hypothesized that strike type variation during running, including a more frequent use of forefoot and midfoot strikes, used to be greater before the introduction of cushioned shoes and paved surfaces.

  20. The Balancing Act between the Constitutional Right to Strike and the Constitutional Right to Education

    Science.gov (United States)

    Deacon, H. J.

    2014-01-01

    While the South African Constitution enshrines both children's right to a basic education and teachers' right to strike, conflict between these two often occurs when the way in which teachers' unions conduct strike actions detracts from learners' education. This article identifies the parties affected by industrial action in the school context,…

  1. The Implications of Granting New Jersey Teachers the Right to Strike: A Public Policy Statement.

    Science.gov (United States)

    Lisella, Carmine; Schwartz, Patricia

    Strikes are generally accepted as legitimate prerogatives of employees bargaining with employers in the private sector. Two broad questions must be answered when considering whether the right to strike should be granted public employees, including teachers. First, what are the distinctions between the public and private sectors that can reasonably…

  2. Are physicians' strikes ever morally justifiable? A call for a return to ...

    African Journals Online (AJOL)

    Though physicians strike provides an opportunity to generate more knowledge about the process in which legitimacy of an organization can be restored, it meets with a great deal of resistance not only by the public but from within the medical profession. This paper critically examines the legitimacy of strike by medical ...

  3. Major Burn Injury From Lightning Strike: A Case Report and Review ...

    African Journals Online (AJOL)

    BACKGROUND: Lightning has been viewed as a sign of the anger of the “gods” from Greek mythology. Among Yorubas, thunderstorm is regarded as anger from the god of thunder, “Sango” who could strike anybody anywhere to vent his anger at someone who has committed some form of atrocity. When lightning strikes, it ...

  4. Batter's Choice: Lessons for Teaching Tactics in a Modified Striking/Fielding Game

    Science.gov (United States)

    Sinclair, Christina

    2004-01-01

    When played in their standard form, striking/fielding games are often a favorite among elementary students; yet they allow for only limited participation, which is contradictory to quality physical education. This article presents a sequence of lessons leading to Batter's Choice, a modified striking/fielding game, designed to maximize the…

  5. Strike type variation among Tarahumara Indians in minimal sandals versus conventional running shoes

    Directory of Open Access Journals (Sweden)

    Daniel E. Lieberman

    2014-06-01

    Conclusion: These data reinforce earlier studies that there is variation among foot strike patterns among minimally shod runners, but also support the hypothesis that foot stiffness and important aspects of running form, including foot strike, differ between runners who grow up using minimal versus modern, conventional footwear.

  6. A rapid assessment of species-specific bird strike risk at the Kotoka ...

    African Journals Online (AJOL)

    A rapid assessment of species-specific bird strike risk at the Kotoka International Airport in Accra, Ghana. ... We conclude that wildlife management to avert the risk of bird strikes could be successfully achieved by adopting both proactive and reactive measures to reduce the presence of problem species at the aerodrome.

  7. Lightning Strikes and Thunder Claps: The Strategic Bomber and Air Superiority

    Science.gov (United States)

    2012-12-01

    Views November–December 2012 Air & Space Power Journal | 137 Lightning Strikes and Thunder Claps The Strategic Bomber and Air Superiority Maj Wade S...2012 to 00-00-2012 4. TITLE AND SUBTITLE Lightning Strikes and Thunder Claps: The Strategic Bomber and Air Superiority 5a. CONTRACT NUMBER 5b

  8. Variation in Foot Strike Patterns among Habitually Barefoot and Shod Runners in Kenya.

    Directory of Open Access Journals (Sweden)

    Daniel E Lieberman

    Full Text Available Runners are often categorized as forefoot, midfoot or rearfoot strikers, but how much and why do individuals vary in foot strike patterns when running on level terrain? This study used general linear mixed-effects models to explore both intra- and inter-individual variations in foot strike pattern among 48 Kalenjin-speaking participants from Kenya who varied in age, sex, body mass, height, running history, and habitual use of footwear. High speed video was used to measure lower extremity kinematics at ground contact in the sagittal plane while participants ran down 13 meter-long tracks with three variables independently controlled: speed, track stiffness, and step frequency. 72% of the habitually barefoot and 32% of the habitually shod participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently and who used lower step frequencies. There was no effect of sex, age, height or weight on foot strike angle, but individuals were more likely to midfoot or forefoot strike when they ran on a stiff surface, had a high preferred stride frequency, were habitually barefoot, and had more experience running. It is hypothesized that strike type variation during running, including a more frequent use of forefoot and midfoot strikes, used to be greater before the introduction of cushioned shoes and paved surfaces.

  9. Labor Conflict on the National Stage: Metaphoric Lenses in Israel's Teachers' Strike

    Science.gov (United States)

    Shenkar, Miriam; Shenkar, Oded

    2011-01-01

    Teachers often embed their labor demands within a broader context to claim high moral ground and build community support. We analyze a recent teachers' strike in Israel, looking at how the strike played out in a country where the challenges of globalization collided with a socialist legacy in the face of an existential threat. The analysis reveals…

  10. Early response assessment in patients with multiple myeloma during anti-angiogenic therapy using arterial spin labelling: first clinical results

    Energy Technology Data Exchange (ETDEWEB)

    Fenchel, Michael [Eberhard-Karls University, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Eberhard-Karls University, Department of Diagnostic and Interventional Neuroradiology, Tuebingen (Germany); Konaktchieva, Marina [Eberhard-Karls University, Department of Internal Medicine, Gastroenterology, Tuebingen (Germany); Weisel, Katja; Kraus, Sabina [Eberhard-Karls University, Department of Internal Medicine, Hematology, Tuebingen (Germany); Brodoefel, Harald; Claussen, Claus D.; Horger, Marius [Eberhard-Karls University, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2010-12-15

    To determine if arterial-spin-labelling (ASL) MRI can reliably detect early response to anti-angiogenic therapy in patients with multiple myeloma by comparison with clinical/haematological response. Nineteen consecutive patients (10 men; mean age 63.5 {+-} 9.1 years) were included in the present study. Inclusion criteria were diagnosis of stage III multiple myeloma and clinical indication for therapeutical administration of bortezomib or lenalidomide. We performed MRI on 3.0T MR in the baseline setting, 3 weeks after onset of therapy and after 8 weeks. Clinical responses were determined on the basis of international uniform response criteria in correlation with haematological parameters and medium-term patient outcome. MRI studies were performed after approval by the local institutional review board. Fifteen patients responded to anti-myeloma therapy; 4/19 patients were non-responders to therapy. Mean tumour perfusion assessed by ASL-MRI in a reference lesion was 220.7 {+-} 132.5 ml min{sup -1} 100 g{sup -1} at baseline, and decreased to 125.7 {+-} 86.3 (134.5 {+-} 150.9) ml min{sup -1} 100 g{sup -1} 3 (8) weeks after onset of therapy (P < 0.02). The mean decrease in paraproteinaemia at week 3 (8) was 52.3 {+-} 47.7% (58.2 {+-} 58.7%), whereas {beta}2-microglobulinaemia decreased by 20.3 {+-} 53.1% (23.3 {+-} 57.0%). Correlation of ASL perfusion with outcome was significant (P = 0.0037). ASL tumour perfusion measurements are a valuable surrogate parameter for early assessment of response to novel anti-angiogenic therapy. (orig.)

  11. Establishing Clinical Cutoffs for Response and Remission on the Screen for Child Anxiety Related Emotional Disorders (SCARED).

    Science.gov (United States)

    Caporino, Nicole E; Sakolsky, Dara; Brodman, Douglas M; McGuire, Joseph F; Piacentini, John; Peris, Tara S; Ginsburg, Golda S; Walkup, John T; Iyengar, Satish; Kendall, Philip C; Birmaher, Boris

    2017-08-01

    To determine optimal percent reduction and raw score cutoffs on the parent- and child-report Screen for Child Anxiety Related Emotional Disorders (SCARED) for predicting treatment response and remission among youth with anxiety disorders. Data were obtained from youth (N = 438; 7-17 years old) who completed treatment in the Child/Adolescent Anxiety Multimodal treatment Study, a multisite, randomized clinical trial that examined the relative efficacy of medication (sertraline), cognitive-behavioral therapy (Coping Cat), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The parent- and youth-report SCARED were administered at pre- and posttreatment. Quality receiver operating characteristic methods evaluated the performance of various SCARED percent reduction and absolute cutoff scores in predicting treatment response and remission, as defined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule. Reductions of 55% on the SCARED-Parent and 50% on the SCARED-Youth optimally predicted treatment response. Posttreatment absolute raw scores of 10 (SCARED-Parent) and 12 (SCARED-Youth) optimally predicted remission in the total sample, although separate SCARED-Parent cutoffs for children (12-13) and adolescents (9) showed greatest quality of efficiency. Each cutoff significantly predicted response and remission at 6-month follow-up. Results serve as guidelines for operationalizing treatment response and remission on the SCARED, which could help clinicians systematically monitor treatment outcomes of youth with anxiety disorders in a cost- and time-efficient manner. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov/; NCT00052078. Copyright © 2017 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Neurophysiological and clinical responses to rituximab in patients with anti-MAG polyneuropathy.

    Science.gov (United States)

    Zara, Gabriella; Zambello, Renato; Ermani, M

    2011-12-01

    Rituximab treatment has shown clinical improvement in anti-myelin associated glycoprotein (MAG) polyneuropathy. We analyzed scores of clinical scales and the most sensitive electrophysiological parameters before and after immunomodulating treatment with rituximab in a group of patients affected by anti-MAG demyelinating polyneuropathy. Clinical scores, the percentage of CD20 B-lymphocytes, anti-MAG antibody titers and electrophysiological data in 7 patients with anti-MAG polyneuropathy were analyzed. The patients were examined before a cycle with rituximab, 6, 12 and 24 months after the end of the treatment. Two patients were treated with rituximab additional cycles and re-evaluated 48 months after the first treatment. There were no evident correlation between anti-MAG serum antibody titers or clinical scales and electrodiagnostic data. Significant decrease in the proportion of CD20 B-lymphocytes was observed. Significant anti-MAG antibodies titers reduction was detected after re-treatment. At follow-up, pinprik sensation and two point discrimination presented a significant improvement compared with the score before treatment. In our patients, rituximab did not improve any electrophysiological data. No correlation with anti-MAG serum antibodies course was found. With rituximab only pin sensibility improved. Rituximab re-treatment significantly reduces anti-MAG serum antibodies titers but improves only small fibers sensibility. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Responsible Translation of Stem Cell Research: An Assessment of Clinical Trial Registration and Publications.

    Science.gov (United States)

    Fung, Moses; Yuan, Yan; Atkins, Harold; Shi, Qian; Bubela, Tania

    2017-05-09

    We assessed the extent to which the publication of clinical trial results of innovative cell-based interventions reflects International Society for Stem Cell Research best practice guidelines. We assessed: (1) characteristics and time to publication of completed trials; (2) quality of reported trials; and (3) results of published trials. We identified and analyzed publications from 1,052 novel stem cell clinical trials: 179 (45.4%) of 393 completed trials had published results; 48 trials were registered by known stem cell tourism clinics, none of which reported results. Completed non-industry-sponsored trials initially published more rapidly, but differences with industry-sponsored trials decreased over time. Most publications reported safety, and 67.3% (mainly early-stage trials) reported positive outcomes. A higher proportion of industry trials reported positive efficacy. Heightened patient expectations for stem cell therapies give rise to ethical obligations for the transparent conduct of clinical trials. Reporting guidelines need to be developed that are specific to early-phase clinical trials. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  14. Commentary: Compliance education and training: a need for new responses in clinical research.

    Science.gov (United States)

    Steinberg, Mindy J; Rubin, Elaine R

    2010-03-01

    Increasing regulatory mandates, heightened concerns about compliance, accountability, and liability, as well as a movement toward organizational integration are prompting assessment and transformation in education and training programs at academic health centers, particularly with regard to clinical research compliance. Whereas education and training have become a major link between all research and compliance functions, the infrastructure to support and sustain these activities has not been examined in any systematic, comprehensive fashion, leaving many critical interrelated issues unaddressed. Through a series of informal interviews in late 2008 with chief compliance officers and other senior leadership at 10 academic health centers, the authors studied the organization, management, and administration of clinical research compliance education and training programs. The interviews revealed that while clinical research compliance education and training are undergoing growth and expansion to accommodate a rapidly changing regulatory environment and research paradigm, there are no strategies or models for development. The decentralization of education and training is having serious consequences for leadership, resources, and effectiveness. The authors recommend that leaders of academic health centers conduct a comprehensive analysis of clinical research compliance education and training as clinical trials administration undergoes change, focusing on strategic planning, communication, collaboration across the institution, and program evaluation.

  15. A sheeppox outbreak in Morocco: isolation and identification of virus responsible for the new clinical form of disease.

    Science.gov (United States)

    Zro, Khalil; Zakham, Fathiah; Melloul, Marouane; El Fahime, Elmostafa; Ennaji, Moulay Mustapha

    2014-01-27

    Sheeppoxvirus (SPPV) is a member of the Capripoxvirus genus of the Poxviridae family, which causes significant economic losses in Morocco. The resurgence of the sheeppox disease during 2010 was characterized by an emergence of a classical nodular form for the first time in Morocco. However, little is known about the virus strain responsible for nodular form. In this study, thirty three sheep, from the eastern region of Morocco, clinically infected were examined and dead animals were autopsied.A rapid diagnostic assay for SPPV using different type of clinical samples would be useful for outbreak management. The aim of this work was to isolate the virus strain responsible for nodular form and we identified and compared by phylogenetic analysis the field strain with Moroccan vaccine strain targeting the thymidine kinase (TK) gene and the chemokine analogue receptor of interleukin (IL8) gene. Further, it was important to investigate and validate a real-time PCR using different clinical and post-mortem samples to manage epidemic sheeppox disease. The nodular form of sheeppox disease observed in Morocco was clinically characterized by fever, depression, lacrimation, diarrhea in lambs and nodule. At necropsy, the most affected organ was the lung. The etiological strain was successfully isolated from lung nodule in a dead lamb and was identified by using real-time PCR that has been tested and validated on different types of clinical and post mortem samples from naturally infected animals. Sequence and phylogenetic analysis of TK and IL8 gene showed that there was a very close relationship between field and vaccine strain. They were clustered within other SPPV strains. In the current study, we show for the first time the nodular form of sheeppox in Morocco. We demonstrate a robust real-time PCR-based diagnostic assay to detect the sheeppox virus in multiple sample that can be implemented to efficiently manage the disease outbreak. Our study also offers the prospect for

  16. Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy

    DEFF Research Database (Denmark)

    Toftmann Hansen, Charlotte; Pedersen, Per T.; Jensen, Bo Amdi

    Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy.......Value of the free light chain analysis in the clinical evaluation of response in multiple myeloma patients receiving anti-myeloma therapy....

  17. Hydroxyurea responses in clinically varied beta, HbE-beta thalassaemia and sickle cell anaemia patients of Eastern India.

    Science.gov (United States)

    Chatterjee, Tridip; Chakravarty, Amit; Chakravarty, Sudipa

    2018-02-17

    The haematological and clinical response to hydroxyurea was estimated in HbE-beta, beta thalassaemia and sickle cell anaemia patients of Eastern India, with variable clinical severity and transfusion requirement to determine whether hydroxyurea can help these patients to maintain their steady haemoglobin level without blood transfusions. Three hundred patients (189 HbE-beta thalassaemia, 95 beta thalassaemia and 16 other haemoglobinopathies including sickle cell anaemia) were selected for hydroxyurea therapy and were followed up for 48-60 months. Results suggest significant response to hydroxyurea therapy in 19 beta and 99 HbE-beta patients in the transfusion-dependent group (GR-I). All of them became transfusion-independent while on hydroxyurea therapy. The majority of responding patients were IVS1-5(G-C) in one of their alleles in HbE-beta cases (83 out of 119). Though IVS1-5(G-C) was found to be the commonest mutation in our selected patients, the mutational background of the patients does not found to have any significant correlation with the response category towards hydroxyurea as per the results observed in our study. But, the drug works pretty well in most of the transfusion-dependent patients, as these patients were withdrawn from regular blood transfusion. At the same time, partial or no response to the drug hydroxyurea was also recorded in our study.

  18. CLINICAL FEATURES AND TREATMENT RESPONSE OF IMMUNE THROMBOCYTOPENIC PURPURA IN INFANTS

    Directory of Open Access Journals (Sweden)

    A. Ramyar N. Kalantari

    2007-09-01

    Full Text Available To determine the clinical features and treatment outcomes of infant with immune thrombo-cytopenic purpura (ITP. Retrospective analysis of 96 infant ITP patients treated from 1995 to 2005. The data abstracted comprised age, gender, clinical features, and treatment outcomes. The 56 male and 40 female infants had a median age of 3 months. Eighty presented with purpura, sixteen with active mucosal bleeding. The median platelet count was 13000 /l. Seventy-seven infants received intravenous immunoglobulin (IVIG, eighteen steroids and one patient was observed. Ninty-sex (96% responds to a single course of treatment. Infant with ITP respond favorably to treatment.

  19. Response to Bodin and Grote regarding postdoctoral recruitment in clinical neuropsychology.

    Science.gov (United States)

    Nelson, Aaron; Bilder, Robert M; O'Connor, Margaret; Brandt, Jason; Weintraub, Sandra; Bauer, Russell M

    2016-07-01

    Bodin and Grote convey their opinion that the field of clinical neuropsychology would be best served by a match system for recruitment into postdoctoral training. We critically review their arguments and offer an alternative point of view. Our view considers the current state of the match system in neuropsychology, incorporates comparisons with other disciplines that rely on a match system, and addresses the role of postdoctoral training and the specialization that takes shape at this level. We make recommendations aimed at promoting greater unity among postdoctoral training programs with the goal of focusing leadership efforts on advancing our shared mission of providing the highest quality training in clinical neuropsychology.

  20. Developing personal values: trainees' attitudes toward strikes by health care providers.

    Science.gov (United States)

    Li, Su-Ting T; Srinivasan, Malathi; Der-Martirosian, Claudia; Kravitz, Richard L; Wilkes, Michael S

    2011-05-01

    Worldwide, health care providers use strikes and job actions to influence policy. For health care providers, especially physicians, strikes create an ethical tension between an obligation to care for current patients (e.g., to provide care and avoid abandonment) and an obligation to better care for future patients by seeking system improvements (e.g., improvements in safety, to access, and in the composition and strength of the health care workforce). This tension is further intensified when the potential benefit of a strike involves professional self-interest and the potential risk involves patient harm or death. By definition, trainees are still forming their professional identities and values, including their opinions on fair wages, health policy, employee benefits, professionalism, and strikes. In this article, the authors explore these ethical tensions, beginning with a discussion of reactions to a potential 2005 nursing strike at the University of California, Davis, Medical Center. The authors then propose a conceptual model describing factors that may influence health care providers' decisions to strike (including personal ethics, personal agency, and strike-related context). In particular, the authors explore the relationship between training level and attitudes toward taking a job action, such as going on strike. Because trainees' attitudes toward strikes continue to evolve during training, the authors maintain that open discussion around the ethics of health care professionals' strikes and other methods of conflict resolution should be included in medical education to enhance professionalism and systems-based practice training. The authors include sample case vignettes to help initiate these important discussions. Copyright © by the Association of American medical Colleges.

  1. SU-E-T-278: Study of MAGIC-F Gel and PENELOPE Code Simulation Response for Clinical Electron Beams.

    Science.gov (United States)

    Pianoschi, T; Alva-Sánchez, M; Santanna, M; César, D; Nicolucci, P

    2012-06-01

    To evaluate the response of MAGIC-f gel through dose response curves, percentage depth dose (PDD) and beam profile for clinical electron beams. Glass tubes (Vacutainer ®), with 6 cm length and 0.5 cm radius, with MAGIC-f were positioned inside a water phantom to study the gel response with doses from 0.5 Gy to 20 Gy in electron beams of 6, 9 e 12 MeV. Glass tubes of 20 cm length and 1 cm radius and PMMA phantoms of 10 × 5 × 5 cm 3 were used to PDD and beam profiles determinations, respectively, with a maximum dose of 2 Gy to the gel. The samples were analyzed through magnetic resonance imaging (MRI) with a 3 T tomography using a head coil, multiple spin echo sequence with 16 echos, TE 15ms and TR 4000ms. The MAGIC-f response was simulated with PENELOPE Monte Carlo code in the same geometry used in the irradiations. The results obtained with MAGIC-f and PENELOPE were compared with clinical data. Calibration curves for MAGIC-f showed a linear behavior, with correlation coefficient of 0.99, for all energies. The PDD and beam profile curves obtained with MAGIC-f presented differences lower than 1.5% and 3.0%, respectively, when compared to clinical data. Results obtained by PENELOPE and clinical data showed differences up to 1.0% and 1.5%, respectively, for PDD and profile curves. The dosimetric parameters for electron beams obtained experimentally with MAGIC-f and with PENELOPE code showed similar results to the clinical data. From the results it can be inferred that MAGIC-f can be used as a complementary dosimetric tool for electron beams due to its characteristics of high spatial resolution and the ability to construct tridimensional dose distributions. Also PENELOPE can be used to study MAGIC-f gel response in electron beams. © 2012 American Association of Physicists in Medicine.

  2. Clinical responsiveness of self-report functional assessment measures for children with juvenile idiopathic arthritis undergoing intraarticular corticosteroid injections.

    Science.gov (United States)

    Brown, G Ted; Wright, F Virginia; Lang, Bianca A; Birdi, Nina; Oen, Kim; Stephens, Derek; McComas, Joan; Feldman, Brian M

    2005-12-15

    The Childhood Health Assessment Questionnaire (CHAQ), Juvenile Arthritis Functional Assessment Report (JAFAR), and Juvenile Arthritis Functional Status Index (JASI) are widely used functional measures for juvenile idiopathic arthritis (JIA) that differ in content, format, and completion time. We compared the responsiveness and child-parent agreement of the JAFAR, CHAQ, and JASI in a prospective, multicenter study. Children and adolescents from 5 rheumatology centers were enrolled. Subjects were about to undergo therapy (intraarticular corticosteroid injections [IAS] and methotrexate or hip surgery (MTX/hip]) expected to produce a functional improvement. All subjects were studied before the intervention and at 6 weeks and 6 months posttreatment. At each study visit, the 3 measures were administered in randomized, balanced order to both parents and children. A total of 92 subjects (mean age 12.8 years) were enrolled in the study, 74 of which were in the IAS group. The responsiveness of all 3 measures was moderate to strong. The standardized response mean at 6 weeks for the IAS group on the JAFAR, CHAQ, and JASI was 0.41 (95% confidence interval [95% CI] 0.18, 0.64), 0.70 (95% CI 0.47, 0.93), and 0.36 (95% CI 0.13, 0.59), respectively. The CHAQ was somewhat more responsive to change at 6 weeks (IAS group: relative efficiency 0.34 [JAFAR], 0.27 [JASI]), but less responsive at 6 months (MTX/hip group: relative efficiency 5.1 [JAFAR], 3.9 [JASI]). All 3 questionnaires showed acceptable parent-child agreement, and overall, there were few differences between the 3 questionnaires. The functional outcome measures currently used for JIA are all adequately responsive for use in trials or in the clinic setting. The choice of which measure to use should therefore be based on the time available for completion, the intended clinical/research use, and the depth of content required.

  3. HPV16 E7 DNA tattooing: safety, immunogenicity, and clinical response in patients with HPV-positive vulvar intraepithelial neoplasia.

    Science.gov (United States)

    Samuels, Sanne; Marijne Heeren, A; Zijlmans, Henry J M A A; Welters, Marij J P; van den Berg, Joost H; Philips, Daisy; Kvistborg, Pia; Ehsan, Ilina; Scholl, Suzy M E; Nuijen, Bastiaan; Schumacher, Ton N M; van Beurden, Marc; Jordanova, Ekaterina S; Haanen, John B A G; van der Burg, Sjoerd H; Kenter, Gemma G

    2017-09-01

    Usual type vulvar intraepithelial neoplasia (uVIN) is caused by HPV, predominantly type 16. Several forms of HPV immunotherapy have been studied, however, clinical results could be improved. A novel intradermal administration route, termed DNA tattooing, is superior in animal models, and was tested for the first time in humans with a HPV16 E7 DNA vaccine (TTFC-E7SH). The trial was designed to test safety, immunogenicity, and clinical response of TTFC-E7SH in twelve HPV16 + uVIN patients. Patients received six vaccinations via DNA tattooing. The first six patients received 0.2 mg TTFC-E7SH and the next six 2 mg TTFC-E7SH. Vaccine-specific T-cell immunity was evaluated by IFNγ-ELISPOT and multiparametric flow cytometry. Only grade I-II adverse events were observed upon TTFC-E7SH vaccination. The ELISPOT analysis showed in 4/12 patients a response to the peptide pool containing shuffled E7 peptides. Multiparametric flow cytometry showed low CD4 + and/or CD8 + T-cell responses as measured by increased expression of PD-1 (4/12 in both), CTLA-4 (2/12 and 3/12), CD107a (5/12 and 4/12), or the production of IFNγ (2/12 and 1/12), IL-2 (3/12 and 4/12), TNFα (2/12 and 1/12), and MIP1β (3/12 and 6/12). At 3 months follow-up, no clinical response was observed in any of the twelve vaccinated patients. DNA tattoo vaccination was shown to be safe. A low vaccine-induced immune response and no clinical response were observed in uVIN patients after TTFC-E7SH DNA tattoo vaccination. Therefore, a new phase I/II trial with an improved DNA vaccine format is currently in development for patients with uVIN.

  4. Striking the Right Chord: Signaling Enigma during Root Gravitropism

    Directory of Open Access Journals (Sweden)

    Manjul Singh

    2017-07-01

    Full Text Available Plants being sessile can often be judged as passive acceptors of their environment. However, plants are actually even more active in responding to the factors from their surroundings. Plants do not have eyes, ears or vestibular system like animals, still they “know” which way is up and which way is down? This is facilitated by receptor molecules within plant which perceive changes in internal and external conditions such as light, touch, obstacles; and initiate signaling pathways that enable the plant to react. Plant responses that involve a definite and specific movement are called “tropic” responses. Perhaps the best known and studied tropisms are phototropism, i.e., response to light, and geotropism, i.e., response to gravity. A robust root system is vital for plant growth as it can provide physical anchorage to soil as well as absorb water, nutrients and essential minerals from soil efficiently. Gravitropic responses of both primary as well as lateral root thus become critical for plant growth and development. The molecular mechanisms of root gravitropism has been delved intensively, however, the mechanism behind how the potential energy of gravity stimulus converts into a biochemical signal in vascular plants is still unknown, due to which gravity sensing in plants still remains one of the most fascinating questions in molecular biology. Communications within plants occur through phytohormones and other chemical substances produced in plants which have a developmental or physiological effect on growth. Here, we review current knowledge of various intrinsic signaling mechanisms that modulate root gravitropism in order to point out the questions and emerging developments in plant directional growth responses. We are also discussing the roles of sugar signals and their interaction with phytohormone machinery, specifically in context of root directional responses.

  5. Clinical risk factors associated with anti-epileptic drug responsiveness in canine epilepsy.

    Directory of Open Access Journals (Sweden)

    Rowena M A Packer

    Full Text Available The nature and occurrence of remission, and conversely, pharmacoresistance following epilepsy treatment is still not fully understood in human or veterinary medicine. As such, predicting which patients will have good or poor treatment outcomes is imprecise, impeding patient management. In the present study, we use a naturally occurring animal model of pharmacoresistant epilepsy to investigate clinical risk factors associated with treatment outcome. Dogs with idiopathic epilepsy, for which no underlying cause was identified, were treated at a canine epilepsy clinic and monitored following discharge from a small animal referral hospital. Clinical data was gained via standardised owner questionnaires and longitudinal follow up data was gained via telephone interview with the dogs' owners. At follow up, 14% of treated dogs were in seizure-free remission. Dogs that did not achieve remission were more likely to be male, and to have previously experienced cluster seizures. Seizure frequency or the total number of seizures prior to treatment were not significant predictors of pharmacoresistance, demonstrating that seizure density, that is, the temporal pattern of seizure activity, is a more influential predictor of pharmacoresistance. These results are in line with clinical studies of human epilepsy, and experimental rodent models of epilepsy, that patients experiencing episodes of high seizure density (cluster seizures, not just a high seizure frequency pre-treatment, are at an increased risk of drug-refractoriness. These data provide further evidence that the dog could be a useful naturally occurring epilepsy model in the study of pharmacoresistant epilepsy.

  6. Population Modeling of Selexipag Pharmacokinetics and Clinical Response Parameters in Patients With Pulmonary Arterial Hypertension

    Science.gov (United States)

    Machacek, M; Lott, D; Hurst, N; Bruderer, S; Dingemanse, J

    2017-01-01

    Selexipag (Uptravi) is an oral selective IP prostacyclin receptor agonist approved for the treatment of pulmonary arterial hypertension (PAH). The pivotal GRIPHON study was the largest clinical study ever conducted in PAH patients, providing long‐term data from 1,156 patients. PAH comedication did not affect exposure to selexipag, while exposure to its active metabolite ACT‐333679 was reduced by 30% when taken in combination, clinically not relevant in the context of individual dose up‐titration. Using log‐linear regression models linking model‐predicted steady‐state exposure to pharmacodynamics (PD), exposure to selexipag and ACT‐333679 showed some statistically significant, albeit not clinically relevant, effects on exercise capacity, laboratory values, and the occurrence of prostacyclin‐related adverse events, but not on vital signs or adverse events denoting hemorrhage. Using suitable modeling techniques, the GRIPHON study yielded clinically relevant data with limited burden of pharmacokinetics (PK) blood sampling, demonstrating that PK/PD modeling enables firm conclusions even with sparse PK and PD sampling. PMID:28556581

  7. Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy

    Directory of Open Access Journals (Sweden)

    Agozzino M

    2017-02-01

    Full Text Available Marina Agozzino,1 Cecilia Noal,2 Francesco Lacarrubba,3 Marco Ardigò4 1Dermatology Unit, Second University of Naples, Naples, 2Dermatology Unit, University of Trieste, Trieste, 3Dermatology Clinic, University of Catania, Catania, 4Clinical Dermatology Department, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy Abstract: Reflectance confocal microscopy (RCM evaluation of inflammatory skin diseases represents a relatively new technique that, during the past 5 years, has attracted increasing interest, with consequent progressive increment of publications in literature. The success of RCM is directly related to the high need for noninvasive techniques able to both reduce the number of skin biopsies and support clinical diagnosis and patient management. RCM helps to visualize microscopic descriptors of plaque psoriasis (PP with good reproducibility between observers and a high grade of correspondence with histopathology. Several clinical tests are used for the therapeutic management of PP, but they are limited by subjective interpretation. Skin biopsy presents objective interpretation, but the procedure is invasive and not repeatable. RCM has been used not only for the evaluation of skin cancer or inflammatory skin diseases, but also for monitoring the efficacy of different treatments in PP. In this review, we present some examples of RCM applications in therapeutic psoriasis follow-up. Keywords: reflectance confocal microscopy, psoriasis noninvasive follow-up, psoriasis monitoring

  8. The porcine acute phase protein response to acute clinical and subclinical experimental infection with Streptococcus suis

    DEFF Research Database (Denmark)

    Sørensen, Nanna Skall; Tegtmeier, C.; Andresen, Lars Ole

    2006-01-01

    .i.), until the pigs were killed and autopsied on day 14 p.i. Clinical signs (fever and lameness) were observed in four of the five inoculated pigs from day 2 p.i., and these pigs also had arthritic lesions at autopsy. CRP and SAA showed fast increases in serum concentrations, CRP being elevated from days 1...

  9. Cultural Responsivity in Clinical Psychology Graduate Students: A Developmental Approach to the Prediction of Learning

    Science.gov (United States)

    Berrin, Sebastian Everett

    2010-01-01

    This study used a mixed-method approach to examine students' experiences in multicultural training and their opinions about various aspects of their course(s). A developmental model of learning was employed to analyze results. More specifically, this study explored the relationship between clinical psychology doctoral students' self-reported…

  10. Pain response of healthy workers following a Functional Capacity Evaluation and implications for clinical interpretation

    NARCIS (Netherlands)

    Soer, Remko; Groothoff, Johan W.; Geertzen, Jan H. B.; van der Schans, Cees P.; Reesink, David D.; Reneman, Michiel F.

    Background and aim Functional Capacity Evaluations (FCEs) are used to quantify physical aspects of work capacity. Safety is a critical issue for clinical use of an FCE. Patients with Chronic Low Back Pain (CLBP) are known to report a temporary increase in pain following an FCE, but it is not known

  11. Ethics and evidence-based medicine: fallibility and responsibility in clinical science

    National Research Council Canada - National Science Library

    Goodman, Kenneth W

    2003-01-01

    ... to their "clinical judgment." This tension- between efforts to make medical practice more scientific and the suspicions of many clinicians- has caused one of the greatest practical and ethical challenges in the history of the health professions. This incisive book reviews the history and conceptual origins of evidence-based practice and discusses ...

  12. Response of chronic gingivitis to hygiene therapy and experimental gingivitis. Clinical, microbiological and metabonomic changes.

    Science.gov (United States)

    Klukowska, Malgorzata; Goyal, C Ram; Khambe, Deepa; Cannon, Michael; Miner, Melanie; Gurich, Nataliya; Circello, Ben; Huggins, Tom; Barker, Matthew L; Furnish, Carrie; Conde, Erinn; Hoke, Phyllis; Haught, Chris; Xie, Sancai; White, Donald J

    2015-10-01

    To compare the clinical, microbiological and metabonomic profiles of subjects with high and low levels of chronic gingival bleeding during a controlled oral hygiene regimen intervention including sequential phases of rigorous therapeutic oral hygiene followed by experimental gingivitis (EG). Two cohorts of qualified study subjects with differences in gingival bleeding on probing levels at their baseline clinical examination were entered into the study. These two cohorts were followed through three separate study phases including a 1-week baseline phase, a 2-week phase of rigorous oral hygiene including dental prophylaxis, and a 3-week EG phase of no oral hygiene to encourage relapse of gingivitis. The 58 subjects were assessed during each phase of the study for clinical presentation of gingivitis and concurrently had plaque sampled for real-time polymerase chain reaction (RTPCR) microbiological characterization and salivary lavage samples for 'systems biology' metabonomics assessment by 1H-NMR. Subjects presenting with different levels of gingival bleeding on probing when they entered the study responded differently to rigorous oral hygiene and EG. Specifically, the high bleeding cohort responded sluggishly to rigorous oral hygiene and exhibited markedly greater relapse to gingivitis during EG. RTPCR analysis showed changes in bacterial populations that were associated with study phases, particularly the increases in putative periodontal pathogens during EG. However, the microbiological profiles of high- and low-susceptibility gingival bleeding patients were largely similar. Metabonomic analysis likewise revealed significant changes in metabolite composition during study phases associated with differences in plaque toxicity, especially the short chain carboxylic acids propionate and n-butyrate, which tracked clinical changes in gingivitis severity. Systems analysis of metabonomic changes suggested differences between cohorts, although analysis to date has not

  13. Validation of the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI): characterizing disease severity and assessing responsiveness to clinical change

    Science.gov (United States)

    Anyanwu, C.O.; Fiorentino, D.; Chung, L.; Dzuong, C.; Wang, Y.; Okawa, J.; Carr, K.; Propert, K.J.; Werth, V.P.

    2015-01-01

    Summary Background The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) was developed for use in clinical trials and longitudinal patient assessment. Objectives To characterize disease severity using the CDASI and assess responsiveness of this instrument to clinically meaningful changes in disease activity. Methods Patients with cutaneous dermatomyositis at the University of Pennsylvania (UPenn, n = 93) and Stanford University (Stanford, n = 106) were prospectively evaluated using the CDASI, physician global assessment (PGA) Likert scales, and visual analog scale (VAS). Data was analyzed using logistic regression models and receiver operating characteristic curves to select cut-offs. Results Baseline CDASI activity scores for the patients evaluated at UPenn ranged from 0 to 47 (median 17), and baseline PGA VAS scores ranged from 0 to 9.6 (median 1.1). At UPenn a CDASI activity score of 19 differentiated mild from moderate and severe disease. At Stanford baseline CDASI scores ranged from 0 to 48 (median 21), baseline PGA VAS scores ranged from 0 to 9.7 (median 4.2) and CDASI activity scores of 14 or less characterized mild disease. When a 2 cm change in the PGA VAS was regarded as a clinically significant improvement, a 4-point (UPenn) or 5-point (Stanford) change in CDASI reflected a minimal clinically significant response. Conclusions The CDASI is a valid and responsive measure that can be used to characterize cutaneous dermatomyositis severity and detect improvement in disease activity. Variations in cutoffs may be due to differences in disease severity between the two populations or inter-rater variations in use of the external gold measures. PMID:25994337

  14. Proteomics insights into DNA damage response and translating this knowledge to clinical strategies

    DEFF Research Database (Denmark)

    von Stechow, Louise; Olsen, Jesper V

    2017-01-01

    Genomic instability is a critical driver in the process of cancer formation. At the same time, inducing DNA damage by irradiation or genotoxic compounds constitutes a key therapeutic strategy to kill fast-dividing cancer cells. Sensing of DNA lesions initiates a complex set of signalling pathways......, collectively known as the DNA damage response (DDR). Deciphering DDR signalling pathways with high-throughput technologies could provide insights into oncogenic transformation, metastasis formation and therapy responses, and could build a basis for better therapeutic interventions in cancer treatment. Mass...

  15. Exploring links between genotypes, phenotypes, and clinical predictors of response to early intensive behavioural intervention in Autism Spectrum Disorder

    Directory of Open Access Journals (Sweden)

    Valsamma eEapen

    2013-09-01

    Full Text Available Autism Spectrum Disorder (ASD is amongst the most familial of psychiatric disorders. Twin and family studies have demonstrated a monozygotic concordance rate of 70–90%, dizygotic concordance of around 10% and more than a 20-fold increase in risk for first-degree relatives. Despite major advances in the genetics of autism, the relationship between different aspects of the behavioural and cognitive phenotype and their underlying genetic liability is still unclear. This is complicated by the heterogeneity of autism, which exists at both genetic and phenotypic levels. Given this heterogeneity, one method to find homogeneous entities and link these with specific genotypes would be to pursue endophenotypes. Evidence from neuroimaging, eye tracking and electrophysiology studies supports the hypothesis that, building on genetic vulnerability, ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers. This results in abnormal development of the neurocircuitry responsible for social cognition, which in turn adversely affects later behavioural and functional domains dependent on these early processes, such as language development. Such a model begets a heterogeneous clinical phenotype, and is also supported by studies demonstrating better clinical outcomes with earlier treatment. Treatment response following intensive early behavioural intervention in ASD is also distinctly variable; however, relatively little is known about specific elements of the clinical phenotype that may predict response to current behavioural treatments. This paper overviews the literature regarding genotypes, phenotypes and predictors of response to behavioural intervention in ASD and presents suggestions for future research to explore linkages between these that would enable better identification of, and increased treatment efficacy for, ASD.

  16. A Prediction Algorithm for Drug Response in Patients with Mesial Temporal Lobe Epilepsy Based on Clinical and Genetic Information.

    Science.gov (United States)

    Silva-Alves, Mariana S; Secolin, Rodrigo; Carvalho, Benilton S; Yasuda, Clarissa L; Bilevicius, Elizabeth; Alvim, Marina K M; Santos, Renato O; Maurer-Morelli, Claudia V; Cendes, Fernando; Lopes-Cendes, Iscia

    2017-01-01

    Mesial temporal lobe epilepsy is the most common form of adult epilepsy in surgical series. Currently, the only characteristic used to predict poor response to clinical treatment in this syndrome is the presence of hippocampal sclerosis. Single nucleotide polymorphisms (SNPs) located in genes encoding drug transporter and metabolism proteins could influence response to therapy. Therefore, we aimed to evaluate whether combining information from clinical variables as well as SNPs in candidate genes could improve the accuracy of predicting response to drug therapy in patients with mesial temporal lobe epilepsy. For this, we divided 237 patients into two groups: 75 responsive and 162 refractory to antiepileptic drug therapy. We genotyped 119 SNPs in ABCB1, ABCC2, CYP1A1, CYP1A2, CYP1B1, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4, and CYP3A5 genes. We used 98 additional SNPs to evaluate population stratification. We assessed a first scenario using only clinical variables and a second one including SNP information. The random forests algorithm combined with leave-one-out cross-validation was used to identify the best predictive model in each scenario and compared their accuracies using the area under the curve statistic. Additionally, we built a variable importance plot to present the set of most relevant predictors on the best model. The selected best model included the presence of hippocampal sclerosis and 56 SNPs. Furthermore, including SNPs in the model improved accuracy from 0.4568 to 0.8177. Our findings suggest that adding genetic information provided by SNPs, located on drug transport and metabolism genes, can improve the accuracy for predicting which patients with mesial temporal lobe epilepsy are likely to be refractory to drug treatment, making it possible to identify patients who may benefit from epilepsy surgery sooner.

  17. Exploring Links between Genotypes, Phenotypes, and Clinical Predictors of Response to Early Intensive Behavioral Intervention in Autism Spectrum Disorder.

    Science.gov (United States)

    Eapen, Valsamma; Crnčec, Rudi; Walter, Amelia

    2013-09-11

    Autism spectrum disorder (ASD) is amongst the most familial of psychiatric disorders. Twin and family studies have demonstrated a monozygotic concordance rate of 70-90%, dizygotic concordance of around 10%, and more than a 20-fold increase in risk for first-degree relatives. Despite major advances in the genetics of autism, the relationship between different aspects of the behavioral and cognitive phenotype and their underlying genetic liability is still unclear. This is complicated by the heterogeneity of autism, which exists at both genetic and phenotypic levels. Given this heterogeneity, one method to find homogeneous entities and link these with specific genotypes would be to pursue endophenotypes. Evidence from neuroimaging, eye tracking, and electrophysiology studies supports the hypothesis that, building on genetic vulnerability, ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers. This results in abnormal development of the neurocircuitry responsible for social cognition, which in turn adversely affects later behavioral and functional domains dependent on these early processes, such as language development. Such a model begets a heterogeneous clinical phenotype, and is also supported by studies demonstrating better clinical outcomes with earlier treatment. Treatment response following intensive early behavioral intervention in ASD is also distinctly variable; however, relatively little is known about specific elements of the clinical phenotype that may predict response to current behavioral treatments. This paper overviews the literature regarding genotypes, phenotypes, and predictors of response to behavioral intervention in ASD and presents suggestions for future research to explore linkages between these that would enable better identification of, and increased treatment efficacy for, ASD.

  18. The lupus impact tracker is responsive to changes in clinical activity measured by the systemic lupus erythematosus responder index.

    Science.gov (United States)

    Devilliers, H; Bonithon-Kopp, C; Jolly, M

    2017-04-01

    Objective The lupus impact tracker (LIT) is a 10-item patient reported outcome tool to measure the impact of systemic lupus erythematosus or its treatment on patients' daily lives. Herein, we describe the responsiveness of the LIT and LupusQoL to changes in disease activity, using the systemic lupus erythematosus responder index (SRI). Methods A total of 325 adult systemic lupus erythematosus patients were enrolled in an observational, longitudinal, multicentre study, conducted across the USA and Canada. Data (demographics, LIT, LupusQoL, BILAG, SELENA-SLEDAI) were obtained three months apart. Modified SRI was defined as: a decrease in SELENA-SLEDAI (4 points); no new BILAG A, and no greater than one new BILAG B; and no increase in the physician global assessment. Standardised response mean and effect size for LIT and LupusQoL domains were calculated among SRI responders and non-responders. Wilcoxon's test was used to compare the LIT and LupusQoL variation by SRI responder status. Results Of the participants 90% were women, 53% were white, 33% were of African descendant and 17% were Hispanic. Mean (SD) age and SELENA-SLEDAI at baseline were 42.3 (16.2) years and 4.3 (3.8), respectively. Mean (SD) LIT score at baseline was 39.4 (22.9). LIT standardised response mean (effect size) among SRI responders and non-responders were -0.69 (-0.36) and -0.20 (-0.12), respectively ( P = 0.02). For LupusQoL, two domains were responsive to SRI: standardised response mean (effect size) for physical health and pain domains were 0.42 (0.23) and 0.65 (0.44), respectively. Conclusions LIT is moderately responsive to SRI in patients with systemic lupus erythematosus. Inclusion of this tool in clinical care and clinical trials may provide further insights into its responsiveness. This is the first systemic lupus erythematosus patient reported outcome tool to be evaluated against composite responder index (SRI) used in clinical trials.

  19. Clinical and ultrasound evaluation of the response to tocilizumab treatment in patients with rheumatoid arthritis: a case series.

    Science.gov (United States)

    Epis, Oscar; Filippucci, Emilio; Delle Sedie, Andrea; De Matthaeis, Anna; Bruschi, Eleonora

    2014-05-01

    This case series evaluates the clinical and ultrasound response to tocilizumab treatment in patients with rheumatoid arthritis (RA). Six patients with active RA (DAS28 ≥ 3.2) for ≥6 months, refractory to conventional DMARDs or anti-TNF agents, received tocilizumab 8 mg/kg every 4 weeks, as monotherapy or in combination with DMARDs, for 6 months. The following clinical parameters were assessed monthly: number of tender joints (28 and 44 joints), number of swollen joints (28 and 44 joints), DAS28-ESR, DAS28-CRP, VAS score, global health status, health assessment questionnaire, patient global assessment of disease activity, physician global assessment of disease activity, functional assessment of chronic illness therapy (FACIT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All patients also underwent a gray-scale ultrasonography (US) assessment with power Doppler evaluation at each visit. All clinical parameters improved during the study, versus baseline. This improvement was statistically significant for most parameters 2 months following tocilizumab initiation and was sustained to the end of the observation period. The number of tender joints (44-joint evaluation), the FACIT score, and ESR and CRP concentrations were significantly improved versus baseline values after the first month of tocilizumab treatment. The course of US evaluations mirrored that of clinical parameters; a faster and more evident response was observed for foot joints, with respect to hand joints. This case series suggested the rapid clinical benefit of tocilizumab. Ultrasound assessment showed that the onset of this effect was faster in the foot joints than in the hand joints.

  20. Octreotide in Intestinal Lymphangiectasia: Lack of a Clinical Response and Failure to Alter Lymphatic Function in a Guinea Pig Model

    Directory of Open Access Journals (Sweden)

    S Makhija

    2004-01-01

    Full Text Available Intestinal lymphangiectasia, which can be classified as primary or secondary, is an unusual cause of protein-losing enteropathy. The main clinical features include edema, fat malabsorption, lymphopenia and hypoalbuminemia. Clinical management generally includes a low-fat diet and supplementation with medium chain triglycerides. A small number of recent reports advocate the use of octreotide in intestinal lymphangiectasia. It is unclear why octreotide was used in these studies; although octreotide can alter splanchnic blood flow and intestinal motility, its actions on lymphatic function has never been investigated. A case of a patient with intestinal lymphangiectasia who required a shunt procedure after failing medium chain triglycerides and octreotide therapy is presented. During the management of this case, all existing literature on intestinal lymphangiectasia and all the known actions of octreotide were reviewed. Because some of the case reports suggested that octreotide may improve the clinical course of intestinal lymphangiectasia by altering lymphatic function, a series of experiments were undertaken to assess this. In an established guinea pig model, the role of octreotide in lymphatic function was examined. In this model system, the mesenteric lymphatic vessels responded to 5-hydroxytryptamine with a decrease in constriction frequency, while histamine administration markedly increased lymphatic constriction frequency. Octreotide failed to produce any change in lymphatic function when a wide range of concentrations were applied to the mesenteric lymphatic vessel preparation. In conclusion, in this case, octreotide failed to induce a clinical response and laboratory studies showed that octreotide did not alter lymphatic function. Thus, the mechanisms by which octreotide induced clinical responses in the cases reported elsewhere in the literature remain unclear, but the present study suggests that it does not appear to act via increasing

  1. Can a physician predict the clinical response to first-line immunomodulatory treatment in relapsing–remitting multiple sclerosis?

    Directory of Open Access Journals (Sweden)

    Mezei Z

    2012-10-01

    Full Text Available Zsolt Mezei,1 Daniel Bereczki,1,2 Lilla Racz,1 Laszlo Csiba,1 Tunde Csepany11Department of Neurology, University of Debrecen, Debrecen, Hungary; 2Department of Neurology, Semmelweis University, Budapest, HungaryBackground: Decreased relapse rate and slower disease progression have been reported with long-term use of immunomodulatory treatments (IMTs, interferon beta or glatiramer acetate in relapsing–remitting multiple sclerosis. There are, however, patients who do not respond to such treatments, and they can be potential candidates for alternative therapeutic approaches.Objective: To identify clinical factors as possible predictors of poor long-term response.Methods: A 9-year prospective, continuous follow-up at a single center in Hungary to assess clinical efficacy of IMT.Results: In a patient group of 81 subjects with mean IMT duration of 54 ± 33 months, treatment efficacy expressed as annual relapse rate and change in clinical severity from baseline did not depend on the specific IMT (any of the interferon betas or glatiramer acetate, and on mono- or multifocal features of the initial appearance of the disease. Responders had shorter disease duration and milder clinical signs at the initiation of treatment. Relapse-rate reduction in the initial 2 years of treatment predicted clinical efficacy in subsequent years.Conclusion: Based on these observations, we suggest that a 2-year trial period is sufficient to decide on the efficacy of a specific IMT. For those with insufficient relapse reduction in the first 2 years of treatment, a different IMT or other therapeutic approaches should be recommended.Keywords: multiple sclerosis, immunomodulatory, EDSS, relapse, response

  2. Preschool children's response to behavioural parent training and parental predictors of outcome in routine clinical care

    NARCIS (Netherlands)

    van der Veen-Mulders, Lianne; Hoekstra, Pieter J; Nauta, Maaike H; van den Hoofdakker, Barbara J

    OBJECTIVE: To investigate the effectiveness of behavioral parent training (BPT) for preschool children with disruptive behaviours and to explore parental predictors of response. METHODS: Parents of 68 preschool children, aged between 2.7 and 5.9 years, participated in BPT. We evaluated the changes

  3. Clinical and histological responses of congenital melanocytic nevi after single treatment with Q-switched lasers

    NARCIS (Netherlands)

    Grevelink, JM; vanLeeuwen, RL; Anderson, RR; Byers, HR

    Background: Laser irradiation of congenital melanocytic nevi is a controversial treatment. Recurrence of lesions after laser treatment appears to be the rule, and the effects of laser irradiation on cellular biological behavior and the possible mutagenic responses of nevomelanocytes that have

  4. Acute Vasodilator Response in Pediatric Pulmonary Arterial Hypertension : Current Clinical Practice From the TOPP Registry

    NARCIS (Netherlands)

    Douwes, Johannes M.; Humpl, Tilman; Bonnet, Damien; Beghetti, Maurice; Ivy, D. Dunbar; Berger, Rolf M. F.

    2016-01-01

    BACKGROUND In pulmonary arterial hypertension (PAH), acute vasodilator response testing (AVT) is considered important to identify adult patients with favorable prognosis using calcium-channel blocker (CCB) therapy. However, in pediatric PAH, criteria used to identify acute responders and CCB use are

  5. Immune responses to adenoviruses: viral evasion mechanisms and their implications for the clinic.

    Science.gov (United States)

    Wold, W S; Doronin, K; Toth, K; Kuppuswamy, M; Lichtenstein, D L; Tollefson, A E

    1999-08-01

    Adenoviruses encode proteins that block responses to interferons, intrinsic cellular apoptosis, killing by CD8(+) cytotoxic T lymphocytes and killing by the death ligands TNF, Fas ligand and TRAIL. The viral proteins are believed to prolong acute and persistent adenovirus infections. The proteins may prove useful in protecting adenovirus gene therapy vectors and transplanted cells from the immune system.

  6. Final diagnosis of patients with clinically suspected vestibular neuritis showing normal caloric response.

    Science.gov (United States)

    Ahn, Sung Hwan; Shin, Jung Eun; Kim, Chang-Hee

    2017-07-01

    Vestibular neuritis is one of the most common peripheral causes of acute vestibular syndrome, of which the diagnosis is generally based on a comprehensive interpretation of clinical and laboratory findings following reasonable exclusion of other disorders. This study aimed to investigate the final diagnosis of patients admitted to hospital under the clinical impression of vestibular neuritis who showed no unilateral caloric paresis. Forty-five patients who visited the emergency department with isolated acute spontaneous vertigo were included. Among them, six patients (13%) developed definitive spontaneous vertigo lasting longer than 20min again after discharge from hospital, accompanied by hearing loss, which was audiometrically documented, leading to a final diagnosis of definite Ménière's disease. Nine patients (20%) revisited our clinic with recurrent episodic vertigo without any documented hearing loss or auditory symptoms such as hearing loss, tinnitus or ear fullness, which led to a final diagnosis of possible Ménière's disease. In four patients (9%), initial spontaneous vertigo and nystagmus changed to positional vertigo and nystagmus on the second hospital day. In 26 patients (58%), neither another episode of vertigo nor auditory symptoms developed during follow-up period (7-92months), a condition to which the authors gave an arbitrary diagnosis of "mild unilateral vestibular deficit". In conclusion, patients admitted to hospital under clinical impression of vestibular neuritis may have various final diagnoses, and "mild unilateral vestibular deficit" was the most common final diagnosis among patients who did not meet the diagnostic criteria of vestibular neuritis. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. "Clinical-CT mismatch" and the response to systemic thrombolytic therapy in acute ischemic stroke.

    Science.gov (United States)

    Kent, David M; Hill, Michael D; Ruthazer, Robin; Coutts, Shelagh B; Demchuk, Andrew M; Dzialowski, Imanuel; Wunderlich, Olaf; von Kummer, Rudiger

    2005-08-01

    Mismatch between clinical deficits and imaging lesions in acute stroke has been proposed as a method of identifying patients who have hypoperfused but still have viable brain, and may be especially apt to respond to reperfusion therapy. We explored this hypothesis using a combined database including 4 major clinical trials of intravenous (IV) thrombolytic therapy. To determine what the radiological correlates of a "matched" functional deficit are, we calculated the relationship between the ASPECT score of the 24-hour (follow-up) CT scan and the 24-hour National Institutes of Health Stroke Scale (NIHSS) score on the subsample with ASPECT scores performed at this time (n=820). Based on this empirical relationship, we computed the absolute difference between the observed baseline ASPECT score and the "expected" score (ie, matched) based on baseline NIHSS for all patients (n=2131). We tested whether patients with better than expected baseline ASPECTS were more likely to benefit from IV recombinant tissue plasminogen activation (rtPA). At 24 hours, there was a strong, linear, negative correlation between NIHSS and ASPECTS (r2=0.33, P<0.0001); on average, an increase of 10 points on NIHSS corresponded to a decrease of approximately 3 points on ASPECTS. At baseline, the average degree of mismatch between the observed and "expected" ASPECTS was 2.1 points (interquartile range, 1.0 to 3.4). However, multiple analyses failed to reveal a consistent relationship between the degree of clinical-CT mismatch at baseline and a patient's likelihood of benefiting from IV rtPA. Clinical-CT mismatch using ASPECT scoring does not reliably identify patients more or less likely to benefit from IV rtPA.

  8. Growth Patterns of HIV Infected Indian Children in Response to ART: A Clinic Based Cohort Study.

    Science.gov (United States)

    Parchure, Ritu S; Kulkarni, Vinay V; Darak, Trupti S; Mhaskar, Rahul; Miladinovic, Branko; Emmanuel, Patricia J

    2015-06-01

    To describe catch-up growth after antiretroviral therapy (ART) initiation among children living with human immunodeficiency virus (CLHIV), attending a private clinic in India. This is a retrospective analysis of data of CLHIV attending Prayas clinic, Pune, India. Height and weight z scores (HAZ, WAZ) were calculated using WHO growth charts. Catch-up growth post-ART was assessed using a mixed method model in cases where baseline and at least one subsequent follow-up HAZ/WAZ were available. STATA 12 was used for statistical analysis. During 1998 to 2011, 466 children were enrolled (201 girls and 265 boys; median age = 7 y). A total of 302 children were ever started on ART; of which 73 and 76 children were included for analysis for catch up growth in WAZ and HAZ respectively. Median WAZ and HAZ increased from -2.14 to -1.34 (p = 0.007) and -2.42 to -1.94 (p = 0.34), respectively, 3 y post ART. Multivariable analysis using mixed model (adjusted for gender, guardianship, baseline age, baseline WAZ/HAZ, baseline and time varying WHO clinical stage) showed gains in WAZ (coef = 0.2, 95 % CI: -0.06 to 0.46) and HAZ (coef = 0.49, 95 % CI: 0.21 to 0.77) with time on ART. Lower baseline WAZ/HAZ and older age were associated with impaired catch-up growth. Children staying in institutions and with baseline advanced clinical stage showed higher gain in WAZ. The prevalence of stunting and underweight was high at ART initiation. Sustained catch-up growth was seen with ART. The study highlights the benefit of early ART in achieving normal growth in CLHIV.

  9. A clinical trial comparing the responses of animal tumors receiving heat sensitizing drugs prior to whole body hyperthermia

    International Nuclear Information System (INIS)

    Klein, M.K.; Forsyth, K.; Dewhirst, M.W.; Fuller, D.J.M.

    1984-01-01

    Whole body hyperthermia (WBH) has rarely been found effective in inducing complete tumor responses. Recent in vitro studies showing that heat sensitizion is possible have renewed interest in this field. In this protocol, WBH is induced via a commercially available inductive device and maintained at 42 0 C for thirty minutes. The heat sensitizing drugs, difluoromethylornithine (DFMO) methylglyoxal bis (guanylhydrazone) (MGBG) are administered 48 hours before, in accordance with in vitro studies. Goals of the study include evaluation of normal tissue toxicity and tumor response. Two normal dogs were treated to study acute toxicities before inception of the clinical trial. The gastrointestinal and hematopoietic systems were used to monitor toxicities using systems review and serial bloodwork. These studies and preliminary clinical results of observed tumor regression in dogs with lymphomas are discussed. Consistent changes in all patients included elevations in liver enzymes, creatine phosphokinase (CPK), and white blood cell counts, as well as, decreases in platelet counts. All changes were transient and clinical signs were not associated with them. Tumor volume reductions from 25% to 74% have been documented

  10. Improvement in latent variable indirect response joint modeling of a continuous and a categorical clinical endpoint in rheumatoid arthritis.

    Science.gov (United States)

    Hu, Chuanpu; Zhou, Honghui

    2016-02-01

    Improving the quality of exposure-response modeling is important in clinical drug development. The general joint modeling of multiple endpoints is made possible in part by recent progress on the latent variable indirect response (IDR) modeling for ordered categorical endpoints. This manuscript aims to investigate, when modeling a continuous and a categorical clinical endpoint, the level of improvement achievable by joint modeling in the latent variable IDR modeling framework through the sharing of model parameters for the individual endpoints, guided by the appropriate representation of drug and placebo mechanism. This was illustrated with data from two phase III clinical trials of intravenously administered mAb X for the treatment of rheumatoid arthritis, with the 28-joint disease activity score (DAS28) and 20, 50, and 70% improvement in the American College of Rheumatology (ACR20, ACR50, and ACR70) disease severity criteria were used as efficacy endpoints. The joint modeling framework led to a parsimonious final model with reasonable performance, evaluated by visual predictive check. The results showed that, compared with the more common approach of separately modeling the endpoints, it is possible for the joint model to be more parsimonious and yet better describe the individual endpoints. In particular, the joint model may better describe one endpoint through subject-specific random effects that would not have been estimable from data of this endpoint alone.

  11. Comparison of the Calibration Standards of Three Commercially Available Multiplex Kits for Human Cytokine Measurement to WHO Standards Reveals Striking Differences

    Directory of Open Access Journals (Sweden)

    Ivan M. Roitt

    2008-01-01

    Full Text Available Serum parameters as indicators for the efficacy of therapeutic drugs are currently in the focus of intensive research. The induction of certain cytokines (or cytokine patterns is known to be related to the status of the immune response e.g. in regulating the TH1/TH2 balance. Regarding their potential value as surrogate parameters in clinical trials and subsequently for the assignment of treatment effi cacy, the accurate and reliable determination of cytokines in patient serum is mandatory. Because serum samples are precious and limited, test methods—like the xMAP multiplex technology—that allow for the simultaneous determination of a variety of cytokines from only a small sample aliquot, can offer great advantages.We here have compared multiplex kits from three different manufactures and found striking differences upon standardizing using WHO standards for selected cytokines. We therefore extended our xMAP multiplex measurements investigations to an ex-vivo situation by testing serum samples and found that the cytokine amounts measured was critically influenced by the actual kit used. The presented data indicate that statements regarding the quantitive determination of cytokines—and therefore their use as biomarkers—in serum samples have to be interpreted with caution.

  12. Propagation of strike-slip faults across Holocene volcano-sedimentary deposits, Pasto, Colombia

    Science.gov (United States)

    Rovida, Andrea; Tibaldi, Alessandro

    2005-10-01

    This study contributes to the understanding of shear failure development on the basis of macroscopic field data collected in latest Pleistocene-Holocene pyroclastic and fluvio-lacustrine deposits in the Pasto Valley, SW Colombia. Here there is a pervasive system of microfaults and joints. Right-lateral strike-slip microfaults strike N065°, whereas left-lateral strike-slip microfaults strike N120°. Three main joint sets strike N, N065° and N020° in decreasing order of frequency. Stress computation gives a horizontal σ1 trending ˜N060° and a horizontal σ3 trending ˜N150°, consistent with earthquake focal mechanisms and stress inversion of main faults. Synthetic shears dominate resulting from nucleation of older cracks. In the basement cropping out northeast of Pasto, the NE- to ENE-striking Buesaco, Aranda and Pasto Faults show evidence of latest Pleistocene-Holocene right-lateral strike-slip motions. The structures in the Pasto Valley can be interpreted as a Mode III damage zone representing the up-dip propagation of the main faults across the young volcano-sedimentary deposits.

  13. Collective Labor Disputes and Strikes in Russia: The Impact of Judicial Precedents and Enforcement

    Directory of Open Access Journals (Sweden)

    Elena Gerasimova

    2017-01-01

    Full Text Available The right to strike is recognized in the Constitution and the Labor Code of the Russian Federation as a means to resolve collective labor disputes. However, in Russia labor protests come up for discussion much more frequently than strikes. In recent years the number of labor protests in Russia, including various forms of work stoppage, has increased significantly compared to previous years, but the number of legally constituted collective labor disputes and strikes has remained very low. The legislation on resolution of collective labor disputes and mounting strikes is quite restrictive in Russia, and its enforcement also encourages employees to seek alternative ways to settle collective labor conflicts. There is little empirical research on the judicial implementation of these norms and its influence on the enforcement of legislation. Therefore, this paper analyses the reasoning of courts in cases on the legality of strikes, their interpretations of the law, and the impact these decisions have on the enforcement of the legislation on resolution of collective labor disputes and strikes. Our conclusion is that the courts act as another restrictive influence on the resolution of collective labor disputes and the exercise of the right to strike in Russia.

  14. A simple field method to identify foot strike pattern during running.

    Science.gov (United States)

    Giandolini, Marlène; Poupard, Thibaut; Gimenez, Philippe; Horvais, Nicolas; Millet, Guillaume Y; Morin, Jean-Benoît; Samozino, Pierre

    2014-05-07

    Identifying foot strike patterns in running is an important issue for sport clinicians, coaches and footwear industrials. Current methods allow the monitoring of either many steps in laboratory conditions or only a few steps in the field. Because measuring running biomechanics during actual practice is critical, our purpose is to validate a method aiming at identifying foot strike patterns during continuous field measurements. Based on heel and metatarsal accelerations, this method requires two uniaxial accelerometers. The time between heel and metatarsal acceleration peaks (THM) was compared to the foot strike angle in the sagittal plane (αfoot) obtained by 2D video analysis for various conditions of speed, slope, footwear, foot strike and state of fatigue. Acceleration and kinematic measurements were performed at 1000Hz and 120Hz, respectively, during 2-min treadmill running bouts. Significant correlations were observed between THM and αfoot for 14 out of 15 conditions. The overall correlation coefficient was r=0.916 (Pfoot strike except for extreme forefoot strike during which the heel rarely or never strikes the ground, and for different footwears and states of fatigue. We proposed a classification based on THM: FFS<-5.49ms

  15. Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation

    Directory of Open Access Journals (Sweden)

    Coventry BJ

    2012-05-01

    Full Text Available Brendon J Coventry, Martin L AshdownDiscipline of Surgery, University of Adelaide, Royal Adelaide Hospital and Faculty of Medicine, University of Melbourne, AustraliaAbstract: Over 50 years of cancer therapy history reveals complete clinical responses (CRs from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static. However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained?Over some 20 years, realization that (1 chronic inflammation is intricately associated with cancer, and (2 the immune system is delicately balanced between responsiveness and tolerance of cancer, provides a greatly significant insight into ways cancer might be more effectively treated. In this review, divergent aspects from the largely segmented literature and recent conferences are drawn together to provide observations revealing some emerging reasoning, in terms of "final common pathways" of cancer cell damage, immune stimulation, and auto-vaccination events, ultimately leading to cancer cell destruction. Created from this is a unifying overarching concept to explain why multiple approaches to cancer therapy can provide complete responses at almost equivalent rates. This "missing" aspect provides a reasoned explanation for what has, and is being, increasingly reported in the mainstream literature – that inflammatory and immune responses appear intricately associated with, if not causative of, complete responses induced by divergent forms of cancer therapy. Curiously, whether by chemotherapy, radiation, surgery, or other means, therapy-induced cell injury results, leaving inflammation and immune system stimulation as a final common denominator across all of these mechanisms of cancer

  16. Clinical complete response (cCR) after neoadjuvant chemoradiotherapy and conservative treatment in rectal cancer. Findings from the ACCORD 12/PRODIGE 2 randomized trial.

    Science.gov (United States)

    Gérard, Jean-Pierre; Chamorey, Emmanuel; Gourgou-Bourgade, Sophie; Benezery, Karène; de Laroche, Guy; Mahé, Marc-André; Boige, Valérie; Juzyna, Béata

    2015-05-01

    During the ACCORD 12 randomized trial, an evaluation of the clinical tumor response was prospectively performed after neoadjuvant chemoradiotherapy. The correlations between clinical complete response and patient characteristics and treatment outcomes are reported. Between 2005 and 2008 the Accord 12 trial accrued 598 patients with locally advanced rectal cancer and compared two different neoadjuvant chemoradiotherapies (Capox 50: capecitabine+oxaliplatin+50Gy vs Cap 45: capecitabine+45Gy). An evaluation of the clinical tumor response with rectoscopy and digital rectal examination was planned before surgery. A score to classify tumor response was used adapted from the RECIST definition: complete response: no visible or palpable tumor; partial response, stable and progressive disease. The clinical tumor response was evaluable in 201 patients. Score was: complete response: 8% (16 patients); partial response: 68% (137 patients); stable: 21%; progression: 3%. There was a trend toward more complete response in the Capox 50 group (9.3% vs 6.7% with Cap 45). In the whole cohort of 201 pts complete response was significantly more frequent in T2 tumors (28%; p=0.025); tumors <4cm in diameter (14%; p=0.017), less than half rectal circumference and with a normal CEA level. Clinical complete response observed in 16 patients was associated with more conservative treatment (p=0.008): 2 patients required an abdomino-perineal resection, 11 an anterior resection and 3 patients benefited from organ preservation (2 local excision, 1 "watch and wait". A complete response was associated with more ypT0 (73%; p<0.001); ypNO (92%); R0 circumferential margin (100%). These data support the hypothesis that a clinical complete response assessed using rectoscopy and digital rectal examination after neoadjuvant therapy may increase the chance of a sphincter or organ preservation in selected rectal cancers. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Optical Mammography in Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy: Individual Clinical Response Index.

    Science.gov (United States)

    Anderson, Pamela G; Kalli, Sirishma; Sassaroli, Angelo; Krishnamurthy, Nishanth; Makim, Shital S; Graham, Roger A; Fantini, Sergio

    2017-10-01

    We present an optical mammography study that aims to develop quantitative measures of pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Such quantitative measures are based on the concentrations of oxyhemoglobin ([HbO 2 ]), deoxyhemoglobin ([Hb]), total hemoglobin ([HbT]), and hemoglobin saturation (SO 2 ) in breast tissue at the tumor location and at sequential time points during chemotherapy. Continuous-wave, spectrally resolved optical mammography was performed in transmission and parallel-plate geometry on 10 patients before treatment initiation and at each NAC administration (mean number of optical mammography sessions: 12, range: 7-18). Data on two patients were discarded for technical reasons. The patients were categorized as responders (R, >50% decrease in tumor size), or nonresponders (NR, mammography is a promising tool to assess individual response to NAC at therapy midpoint to guide further decision making for neoadjuvant therapy. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  18. Costs and benefits of self-efficacy: Differences of the stress response and clinical implications.

    Science.gov (United States)

    Schönfeld, P; Preusser, F; Margraf, J

    2017-04-01

    Encounters with stressors induce diverse idiosyncratic neuroendocrine, behavioral and psychological reactions across people. Perceived self-efficacy can alter autonomic responses and their effects on mental health. The beneficial effects of self-efficacy in buffering physiological arousal, enhancing performance, and diminishing psychopathological symptoms have been observed in diverse contexts. We show that the role of self-efficacy is not uniformly beneficial, and that higher levels of self-efficacy can sometimes lead to increases in neuroendocrine and psychological stress responses and decreases in performance, a phenomenon that has been widely neglected. We discuss specific conditions under which self-efficacy effects do not uniformly ameliorate or prevent the consequences of stress. These conditions suggest that therapeutic interventions need not always promote self-efficacy in principal. Simultaneously, they to do suggest that keeping self-efficacy high might be disadvantageous or detrimental. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Dramatic Clinical Response of Relapsed Metastatic Extramammary Paget’s Disease to Trastuzumab Monotherapy

    Directory of Open Access Journals (Sweden)

    S. Wakabayashi

    2012-01-01

    Full Text Available We report the first case of 68-year-old Japanese woman with metastatic HER2-positive extramammary Paget’s disease that showed the validity of trastuzumab monotherapy. We administered trastuzumab at a loading dose of 8 mg/kg i.v., followed by a 6 mg/kg maintenance dose every three weeks according to a protocol for HER2-positive metastatic breast cancers and a near-complete response was achieved after the tenth infusion. The patient experienced a moderate headache and flushing during the first infusion, but had no advanced effects during subsequent infusions with ibuprofen and d-chlorpheniramine maleate. Given the dramatic response, the patient has had 17 infusions of trastuzumab with no disease progression. Thus, trastuzumab has few side effects and is well tolerated for elderly patients. It may become a new choice of the adjubant therapy of this disease.

  20. Different Candida parapsilosis clinical isolates and lipase deficient strain trigger an altered cellular immune response.

    Science.gov (United States)

    Tóth, Renáta; Alonso, Maria F; Bain, Judith M; Vágvölgyi, Csaba; Erwig, Lars-Peter; Gácser, Attila

    2015-01-01

    Numerous human diseases can be associated with fungal infections either as potential causative agents or as a result of changed immune status due to a primary disease. Fungal infections caused by Candida species can vary from mild to severe dependent upon the site of infection, length of exposure, and past medical history. Patients with impaired immune status are at increased risk for chronic fungal infections. Recent epidemiologic studies have revealed the increasing incidence of candidiasis caused by non-albicans species such as Candida parapsilosis. Due to its increasing relevance we chose two distinct C. parapsilosis strains, to describe the cellular innate immune response toward this species. In the first section of our study we compared the interaction of CLIB 214 and GA1 cells with murine and human macrophages. Both strains are commonly used to investigate C. parapsilosis virulence properties. CLIB 214 is a rapidly pseudohyphae-forming strain and GA1 is an isolate that mainly exists in a yeast form. Our results showed, that the phagocyte response was similar in terms of overall uptake, however differences were observed in macrophage migration and engulfment of fungal cells. As C. parapsilosis releases extracellular lipases in order to promote host invasion we further investigated the role of these secreted components during the distinct stages of the phagocytic process. Using a secreted lipase deficient mutant strain and the parental strain GA1 individually and simultaneously, we confirmed that fungal secreted lipases influence the fungi's virulence by detecting altered innate cellular responses. In this study we report that two isolates of a single species can trigger markedly distinct host responses and that lipase secretion plays a role on the cellular level of host-pathogen interactions.

  1. Different Candida parapsilosis clinical isolates and lipase deficient strain trigger an altered cellular immune response

    Directory of Open Access Journals (Sweden)

    Renata eToth

    2015-10-01

    Full Text Available Numerous human diseases can be associated with fungal infections either as potential causative agents or as a result of changed immune status due to a primary disease. Fungal infections caused by Candida species can vary from mild to severe dependent upon the site of infection, length of exposure and past medical history. Patients with impaired immune status are at increased risk for chronic fungal infections. Recent epidemiologic studies have revealed the increasing incidence of candidiasis caused by non-albicans species such as C. parapsilosis. Due to its increasing relevance we chose two distinct C. parapsilosis strains, to describe the cellular innate immune response towards this species. In the first section of our study we compared the interaction of CLIB 214 and GA1 cells with murine and human macrophages. Both strains are commonly used to investigate C. parapsilosis virulence properties. CLIB 214 is a rapidly pseudohyphae-forming strain and GA1 is an isolate that mainly exists in a yeast form. Our results showed, that the phagocyte response was similar in terms of overall uptake, however differences were observed in macrophage migration and engulfment of fungal cells. As C. parapsilosis releases extracellular lipases in order to promote host invasion we further investigated the role of these secreted components during the distinct stages of the phagocytic process. Using a secreted lipase deficient mutant strain and the parental strain GA1 individually and simultaneously, we confirmed that fungal secreted lipases influence the fungi’s virulence by detecting altered innate cellular responses.In this study we report that two isolates of a single species can trigger markedly distinct host responses and that lipase secretion plays a role on the cellular level of host pathogen interactions.

  2. Modulation of host immune responses by clinically relevant human DNA and RNA viruses.

    Science.gov (United States)

    Brander, C; Walker, B D

    2000-08-01

    Numerous mechanisms allow viruses to evade host immune surveillance, and new evasion strategies continue to be identified. In addition to interference with antigen processing and presentation, direct viral modulation of host immune responses can also be achieved by altering the host cytokine milieu and the development of immunoregulatory cells. A better understanding of these viral evasion strategies will help to define critical host defense mechanisms and will lead to novel immune-based therapeutic strategies in the future.

  3. Latent hypothyreosis as a clinical biomarker for therapy response under abiraterone acetate therapy.

    Science.gov (United States)

    Heidegger, Isabel; Nagele, Udo; Pircher, Andreas; Pichler, Renate; Horninger, Wolfgang; Bektic, Jasmin

    2014-01-01

    Abiraterone acetate (AA) is a selective oral inhibitor of Steroid-17α-Hydroxylase, for patients with castration-resistant prostate cancer. Not all patients respond to therapy, however, there are no biomarkers predicting response to AA therapy. The aim of the present study was the identification of a biomarker for patients who are likely to respond to AA therapy. We measured thyroid parameters in a collective of 30 patients before and during AA therapy. For statistical analyses, paired and unpaired t-tests were used. During AA therapy, responders developed a significant increase in thyroid stimulating hormone (TSH) compared to non-responders (p=0.03). In the subgroup of responders, 16 out of 21 patients (76.1%) had a significant increase in TSH level (p=0.001), suggesting that TSH increase is predictive of therapy response. Non-responders showed no change in TSH level during AA therapy. Hypothyreosis may serve as a simple predictive biomarker for therapy response under AA therapy.

  4. Long lasting clinical response to chemotherapy for advanced uterine leiomyosarcoma: a case report.

    Science.gov (United States)

    Ridolfi, Claudio; Pasini, Giuseppe; Drudi, Fabrizio; Barzotti, Eleonora; Santelmo, Carlotta; Polselli, Antonio; Ravaioli, Alberto

    2013-01-24

    Uterine leiomyosarcoma is one of the most frequent uterine sarcomas. In the metastatic setting it is sensitive to doxorubicin, ifosfamide, gemcitabine, docetaxel and a few other drugs, but time to progression is generally short. For this reason prognosis is often poor and there are few reports in the literature of long responders. We report a case of a 40-year-old Caucasian woman with metastatic uterine leiomyosarcoma who began treatment six years before the presentation of this case report and for the following six years underwent ten lines of chemotherapy, achieving excellent results and a good quality of life. Among the treatments administered we observed a long response to temolozomide, an unconventional drug for this kind of disease. Although there are few chemotherapeutic options for the management of metastatic uterine leiomyosarcoma, a small number of patients have an unexpected long lasting response to treatment. For this reason further research is needed to identify new therapeutic agents and the predictive factors for the achievement of response.

  5. Long lasting clinical response to chemotherapy for advanced uterine leiomyosarcoma: a case report

    Directory of Open Access Journals (Sweden)

    Ridolfi Claudio

    2013-01-01

    Full Text Available Abstract Introduction Uterine leiomyosarcoma is one of the most frequent uterine sarcomas. In the metastatic setting it is sensitive to doxorubicin, ifosfamide, gemcitabine, docetaxel and a few other drugs, but time to progression is generally short. For this reason prognosis is often poor and there are few reports in the literature of long responders. Case presentation We report a case of a 40-year-old Caucasian woman with metastatic uterine leiomyosarcoma who began treatment six years before the presentation of this case report and for the following six years underwent ten lines of chemotherapy, achieving excellent results and a good quality of life. Among the treatments administered we observed a long response to temolozomide, an unconventional drug for this kind of disease. Conclusion Although there are few chemotherapeutic options for the management of metastatic uterine leiomyosarcoma, a small number of patients have an unexpected long lasting response to treatment. For this reason further research is needed to identify new therapeutic agents and the predictive factors for the achievement of response.

  6. Graphic display of radiobiological effects on dose response models and its application for clinical optimization

    International Nuclear Information System (INIS)

    Aoki, Yukimasa; Onogi, Yuzou; Nakagawa, Keiichi; Akanuma, Atsuo; Iio, Masahiro; Sakata, Kouichi; Karasawa, Katsuyuki; Kaneko, Katsutaro.

    1988-01-01

    Both physical dose distribution and radiobiological effect should be required for radiotherapy optimization, however, there is a tendency that they are handled separately and that the former is processed in the shape of dose distribution and the latter is estimated quantitatively as point values. Those two parameters are combined in the iso-TDF map, where various responses of organs are not considered. In this study, the iso-effect distribution and the dose distributions are compared to investigate optimization for radiation treatment. A computer program is developed to construct an image of iso-effect from both various response values of internal organs and a certain physical dose and to show the integral value of certain region of interest. NSD-TDF model and LQ model are adopted and presumptive cases of esophagus cancer and pituitary tumor are employed. The results show that the effect to normal tissues increases with one port a day technique compared with plural ports a day technique and the latter is most preferable in both cases. It will require a proper weighting function to establish a generalized parameter for both spatial and chronological optimization by integrating dose and biological effect. The volume effect in biological responses will be argued with three dimensional implementation of this program. (author)

  7. Gender frames and collective action: Configurations of masculinity in the Pittston Coal strike

    Energy Technology Data Exchange (ETDEWEB)

    Beckwith, K. [College Wooster, Wooster, OH (United States)

    2001-06-01

    This article develops the concept of gender frame for understanding major transformations in the collective action repertoires of social movements. Focusing on the United Mine Workers of America (UMWA) strike against the Pittston Coal Group (1989-90), the article discusses the UMWA's traditional collective action repertoire and its innovation of nonviolent protest, widely employed during the strike. Interviews with major activists and UMWA staff and officers illustrate how the UMWA employed a gender frame of mining masculinities to initiate the new nonviolent strike action. The article concludes by suggesting how collective action repertoires and framing are linked and encouraging future research on gender frames in social movements.

  8. Diagnostic clinical and laboratory findings in response to predetermining bacterial pathogen: data from the Meningitis Registry.

    Directory of Open Access Journals (Sweden)

    Maria Karanika

    Full Text Available BACKGROUND: Childhood meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis. METHODOLOGY AND PRINCIPAL FINDINGS: During the 32 year period, 2477 cases of probable bacterial meningitis (BM were collected from the Meningitis Registry (MR. Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta and SPSS (version 15.0-Chicago software. Statistically significant (p or = 15000/microL (OR 2.19 with a PPV of 77.8% (95%CI 40.0-97.2. For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61, age > or = 1 year (OR 2.04, absence of headache (OR 3.01, CSF Glu < 40 mg/dL (OR 3.62 and peripheral WBC < 15,000/microL (OR 1.74 with a PPV of 58.5% (95%CI 42.1-73.7. CONCLUSIONS: The use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.

  9. Correlation between ability of biofilm formation with their responsible genes and MDR patterns in clinical and environmental Acinetobacter baumannii isolates.

    Science.gov (United States)

    Bardbari, Ali Mohammadi; Arabestani, Mohammad Reza; Karami, Manoochehr; Keramat, Fariba; Alikhani, Mohammad Yousef; Bagheri, Kamran Pooshang

    2017-07-01

    Acinetobacter baumannii potential to form biofilm and exhibit multiple antibiotic resistances may be responsible in its survival in hospital environment. Accordingly, our study was aimed to determine the correlation between ability of biofilm formation and the frequency of biofilm related genes with antibiotic resistance phenotypes, and also the categorization of their patterns in clinical and environmental isolates. A total of 75 clinical and 32 environmental strains of the A. baumannii were collected and identified via API 20NE. Antibiotic susceptibility was evaluated by disk diffusion and microdilution broth methods. Biofilm formation assay was performed by microtiter plate method. OXA types and biofilm related genes including Bla OXA-51 , Bla OXA-23 , Bla OXA-24 , Bla OXA-58 , bap, bla PER-1 , and ompA were amplified by PCR. The rate of MDR A. baumannii in clinical isolates (100%) was higher than environmental (81.2%) isolates (p baumannii isolates was associated with biofilm formation. There was a significant correlation between multiple drug resistance and biofilm formation. The clinical isolates had a higher ability to form strong biofilms compared to the environmental samples. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Clinical Research in Vulnerable Populations: Variability and Focus of Institutional Review Boards' Responses.

    Directory of Open Access Journals (Sweden)

    Bärbel Kästner

    Full Text Available Children and patients with cognitive deficits may find it difficult to understand the implication of research. In the European Union (EU, clinical studies outside the EU directives concerning medicinal products or medical devices, i.e., "miscellaneous clinical studies", have no legally mandated timelines for institutional review boards' (IRB decisions.To evaluate the review process of IRBs for two different "miscellaneous" multicenter clinical research protocols involving vulnerable subjects (children and adult stroke patients.Descriptive and comparative statistics. Protocol 1 is a prospective, multicenter, cross-sectional screening study of a symptomatic pediatric population at risk for Fabry disease involving genetic testing (NCT02152189. Protocol 2 is a prospective, multicenter, randomized, controlled, open-label, blinded endpoint post-market study to evaluate the effectiveness of stent retrievers (NCT02135926. After having obtained positive initial IRB votes at the main study site, both protocols were subsequently submitted to the remaining IRBs.Protocol 1 was submitted to 19 IRBs. No IRB objected to the study. Median time-to-final vote was 34 (IQR 10-65; range 0 to 130 days. Two IRBs accepted the coordinating center's IRB votes without re-evaluation. Changes to the informed consent documents were asked by 7/19 IRBs, amendments to the protocol by 2. Protocol 2 was submitted to 16 IRBs. Fifteen decisions were made. No IRB objected to the study. Median time-to final vote was 59 (IQR 10 to 65; range 0 to 128 days, which was not statistically significantly different compared with protocol 1 (Wilcoxon test. Two IRBs accepted a previous IRB decision and did not conduct an independent review. Eight/16 IRBs required changes to the informed consent documents; two IRBs recommended an amendment of the protocol.Both clinical research protocols involving vulnerable populations were well accepted. IRB workflows and decision times varied substantially

  11. Association of Body Composition and Other Clinical Factors with Incomplete Immune Response after Highly Active Antiretroviral Therapy.

    Science.gov (United States)

    Sun, Peng-Tao; Yu, Wei; Li, Tai-Sheng; Lin, Qiang; Guo, Fu-Ping; Zhou, Xiao-Hong; Du, Gui-Ying; Xu, Ying; Guan, Wen-Min

    2017-08-20

    Objective To explore whether baseline body composition and other clinical factors are associated with incomplete immune response after highly active antiretroviral therapy(HAART)in Chinese men with human immunodeficiency virus(HIV)or acquired immunodeficiency syndrome(AIDS).Methods A retrospective study was conducted among HIV/AIDS male patients who achieved viral suppression(maintained HIV-1 RNA levelsimmune responses(CD4 cell countimmune response(CD4 cell count≥350 cells/μl)and the incomplete immune response(CD4 cell countimmune response in patients with sustained viral suppression.Results Totally 84 HIV/AIDS male patients with viral suppression were included in this study.There were statistical differences between these two groups in terms of age(Z=-2.479,P=0.013),baseline BMI(t=2.030,P=0.045),LMI(t=2.200,P=0.029),and CD4 cell count(Z=6.416,P=0.000).However,there was no statistical differences in viral load,FMI,body bone mineral content/height,HAART duration,and HAART regimen(all P>0.05).BMI[OR=0.742,95% confidence interval(CI)=0.554-0.993,P=0.044],LMI(OR=0.459,95% CI=0.249-0.844,P=0.012),HAART duration(OR=10.161,95% CI=1.110-93.052,P=0.040),baseline CD4 cell count(OR=80.051,95% CI=8.396-762.563,P=0.000)were significantly associated with incomplete immune response.Age(OR=1.497,95% CI=0.213-10.505,P=0.685),viral load(OR=0.333,95% CI=0.071-1.572,P=0.164),FMI(OR=0.797,95% CI=0.546-1.164,P=0.240),body bone mineral content/height(OR=1.145,95% CI=0.037-35.676,P=0.938)and HAART regimen(OR=0.430,95% CI=0.159-1.159,P=0.095)were not associated with incomplete immune response.Conclusions Baseline CD4 cell count and HAART duration may affect immune response.Patients with higher baseline BMI or higher LMI may be less likely to develop incomplete immune response.Baseline FMI and body bone mineral content/height ratio are not associated with incomplete immune response.

  12. DNA Mismatch Repair Deficiency in Rectal Cancer: Benchmarking Its Impact on Prognosis, Neoadjuvant Response Prediction, and Clinical Cancer Genetics.

    Science.gov (United States)

    de Rosa, Nicole; Rodriguez-Bigas, Miguel A; Chang, George J; Veerapong, Jula; Borras, Ester; Krishnan, Sunil; Bednarski, Brian; Messick, Craig A; Skibber, John M; Feig, Barry W; Lynch, Patrick M; Vilar, Eduardo; You, Y Nancy

    2016-09-01

    DNA mismatch repair deficiency (dMMR) hallmarks consensus molecular subtype 1 of colorectal cancer. It is being routinely tested, but little is known about dMMR rectal cancers. The efficacy of novel treatment strategies cannot be established without benchmarking the outcomes of dMMR rectal cancer with current therapy. We aimed to delineate the impact of dMMR on prognosis, the predicted response to fluoropyrimidine-based neoadjuvant therapy, and implications of germline alterations in the MMR genes in rectal cancer. Between 1992 and 2012, 62 patients with dMMR rectal cancers underwent multimodality therapy. Oncologic treatment and outcomes as well as clinical genetics work-up were examined. Overall and rectal cancer-specific survival were calculated by the Kaplan-Meier method. The median age at diagnosis was 41 years. MMR deficiency was most commonly due to alterations in MSH2 (53%) or MSH6 (23%). After a median follow-up of 6.8 years, the 5-year rectal cancer-specific survival was 100% for stage I and II, 85.1% for stage III, and 60.0% for stage IV disease. Fluoropyrimidine-based neoadjuvant chemoradiation was associated with a complete pathologic response rate of 27.6%. The extent of surgical resection was influenced by synchronous colonic disease at presentation, tumor height, clinical stage, and pelvic radiation. An informed decision for a limited resection focusing on proctectomy did not compromise overall survival. Five of the 11 (45.5%) deaths during follow-up were due to extracolorectal malignancies. dMMR rectal cancer had excellent prognosis and pathologic response with current multimodality therapy including an individualized surgical treatment plan. Identification of a dMMR rectal cancer should trigger germline testing, followed by lifelong surveillance for both colorectal and extracolorectal malignancies. We herein provide genotype-specific outcome benchmarks for comparison with novel interventions. © 2016 by American Society of Clinical Oncology.

  13. A personalized BEST: characterization of latent clinical classes of nonischemic heart failure that predict outcomes and response to bucindolol.

    Directory of Open Access Journals (Sweden)

    David P Kao

    Full Text Available Heart failure patients with reduced ejection fraction (HFREF are heterogenous, and our ability to identify patients likely to respond to therapy is limited. We present a method of identifying disease subtypes using high-dimensional clinical phenotyping and latent class analysis that may be useful in personalizing prognosis and treatment in HFREF.A total of 1121 patients with nonischemic HFREF from the β-blocker Evaluation of Survival Trial were categorized according to 27 clinical features. Latent class analysis was used to generate two latent class models, LCM A and B, to identify HFREF subtypes. LCM A consisted of features associated with HF pathogenesis, whereas LCM B consisted of markers of HF progression and severity. The Seattle Heart Failure Model (SHFM Score was also calculated for all patients. Mortality, improvement in left ventricular ejection fraction (LVEF defined as an increase in LVEF ≥5% and a final LVEF of 35% after 12 months, and effect of bucindolol on both outcomes were compared across HFREF subtypes. Performance of models that included a combination of LCM subtypes and SHFM scores towards predicting mortality and LVEF response was estimated and subsequently validated using leave-one-out cross-validation and data from the Multicenter Oral Carvedilol Heart Failure Assessment Trial.A total of 6 subtypes were identified using LCM A and 5 subtypes using LCM B. Several subtypes resembled familiar clinical phenotypes. Prognosis, improvement in LVEF, and the effect of bucindolol treatment differed significantly between subtypes. Prediction improved with addition of both latent class models to SHFM for both 1-year mortality and LVEF response outcomes.The combination of high-dimensional phenotyping and latent class analysis identifies subtypes of HFREF with implications for prognosis and response to specific therapies that may provide insight into mechanisms of disease. These subtypes may facilitate development of personalized

  14. Network Mechanisms of Clinical Response to Transcranial Magnetic Stimulation in Posttraumatic Stress Disorder and Major Depressive Disorder.

    Science.gov (United States)

    Philip, Noah S; Barredo, Jennifer; van 't Wout-Frank, Mascha; Tyrka, Audrey R; Price, Lawrence H; Carpenter, Linda L

    2018-02-01

    Repetitive transcranial magnetic stimulation (TMS) therapy can modulate pathological neural network functional connectivity in major depressive disorder (MDD). Posttraumatic stress disorder is often comorbid with MDD, and symptoms of both disorders can be alleviated with TMS therapy. This is the first study to evaluate TMS-associated changes in connectivity in patients with comorbid posttraumatic stress disorder and MDD. Resting-state functional connectivity magnetic resonance imaging was acquired before and after TMS therapy in 33 adult outpatients in a prospective open trial. TMS at 5 Hz was delivered, in up to 40 daily sessions, to the left dorsolateral prefrontal cortex. Analyses used a priori seeds relevant to TMS, posttraumatic stress disorder, or MDD (subgenual anterior cingulate cortex [sgACC], left dorsolateral prefrontal cortex, hippocampus, and basolateral amygdala) to identify imaging predictors of response and to evaluate clinically relevant changes in connectivity after TMS, followed by leave-one-out cross-validation. Imaging results were explored using data-driven multivoxel pattern activation. More negative pretreatment connectivity between the sgACC and the default mode network predicted clinical improvement, as did more positive amygdala-to-ventromedial prefrontal cortex connectivity. After TMS, symptom reduction was associated with reduced connectivity between the sgACC and the default mode network, left dorsolateral prefrontal cortex, and insula, and reduced connectivity between the hippocampus and the salience network. Multivoxel pattern activation confirmed seed-based predictors and correlates of treatment outcomes. These results highlight the central role of the sgACC, default mode network, and salience network as predictors of TMS response and suggest their involvement in mechanisms of action. Furthermore, this work indicates that there may be network-based biomarkers of clinical response relevant to these commonly comorbid disorders

  15. Bioprinted 3D Primary Liver Tissues Allow Assessment of Organ-Level Response to Clinical Drug Induced Toxicity In Vitro.

    Directory of Open Access Journals (Sweden)

    Deborah G Nguyen

    Full Text Available Modeling clinically relevant tissue responses using cell models poses a significant challenge for drug development, in particular for drug induced liver injury (DILI. This is mainly because existing liver models lack longevity and tissue-level complexity which limits their utility in predictive toxicology. In this study, we established and characterized novel bioprinted human liver tissue mimetics comprised of patient-derived hepatocytes and non-parenchymal cells in a defined architecture. Scaffold-free assembly of different cell types in an in vivo-relevant architecture allowed for histologic analysis that revealed distinct intercellular hepatocyte junctions, CD31+ endothelial networks, and desmin positive, smooth muscle actin negative quiescent stellates. Unlike what was seen in 2D hepatocyte cultures, the tissues maintained levels of ATP, Albumin as well as expression and drug-induced enzyme activity of Cytochrome P450s over 4 weeks in culture. To assess the ability of the 3D liver cultures to model tissue-level DILI, dose responses of Trovafloxacin, a drug whose hepatotoxic potential could not be assessed by standard pre-clinical models, were compared to the structurally related non-toxic drug Levofloxacin. Trovafloxacin induced significant, dose-dependent toxicity at clinically relevant doses (≤ 4uM. Interestingly, Trovafloxacin toxicity was observed without lipopolysaccharide stimulation and in the absence of resident macrophages in contrast to earlier reports. Together, these results demonstrate that 3D bioprinted liver tissues can both effectively model DILI and distinguish between highly related compounds with differential profile. Thus, the combination of patient-derived primary cells with bioprinting technology here for the first time demonstrates superior performance in terms of mimicking human drug response in a known target organ at the tissue level.

  16. Are self-report scales as effective as clinician rating scales in measuring treatment response in routine clinical practice?

    Science.gov (United States)

    Zimmerman, Mark; Walsh, Emily; Friedman, Michael; Boerescu, Daniela A; Attiullah, Naureen

    2018-01-01

    Recent treatment guidelines have suggested that outcome should be measured in routine clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared three self-report scales of depressive symptoms and the two most widely used clinician administered scales in treatment studies in their sensitivity to change and evaluation of treatment response in depressed patients treated in routine practice. At baseline and 4-month follow-up 153 depressed outpatients with DSM-IV MDD completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology-Self-report version (QIDS-SR), and Patient Health Questionnaire (PHQ-9). The patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS). On each scale treatment response was defined as a 50% or greater reduction in scores from baseline. While there were some differences in the percentage of patients considered to be responders on the different scales, a large effect size was found for each scale, with little variability amongst the scales. The level of agreement between the three self-report scales and the clinician rating scales was approximately the same LIMITATIONS: The present study was conducted in a single clinical practice in which the majority of the patients were white, female, and had health insurance. When measuring outcome in clinical practice the magnitude of change in depressive symptoms is as great on self-report scales as on clinician rating scales. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. [Deaths in swine by a lightning strike in the sty].

    Science.gov (United States)

    Appel, G

    1991-05-01

    It is reported on deaths of pigs due to lightning stroke in the barn. During a severe thunder storm 11 clinically healthy pigs with an average weight of approx. 22 kg died simultaneously and suddenly in the barn. The animals were kept on a floor of metal slats. The pens were separated by metal bars. A water pipe leading into the barn from outside had contact to the bars. Two pigs were submitted for an examination approx. three hours post mortem. The macroscopic and microscopic necropsy findings are described.

  18. Responses to Bacteria, Virus, and Malaria Distinguish the Etiology of Pediatric Clinical Pneumonia.

    Science.gov (United States)

    Valim, Clarissa; Ahmad, Rushdy; Lanaspa, Miguel; Tan, Yan; Acácio, Sozinho; Gillette, Michael A; Almendinger, Katherine D; Milner, Danny A; Madrid, Lola; Pellé, Karell; Harezlak, Jaroslaw; Silterra, Jacob; Alonso, Pedro L; Carr, Steven A; Mesirov, Jill P; Wirth, Dyann F; Wiegand, Roger C; Bassat, Quique

    2016-02-15

    Plasma-detectable biomarkers that rapidly and accurately diagnose bacterial infections in children with suspected pneumonia could reduce the morbidity of respiratory disease and decrease the unnecessary use of antibiotic therapy. Using 56 markers measured in a multiplexed immunoassay, we sought to identify proteins and protein combinations that could discriminate bacterial from viral or malarial diagnoses. We selected 80 patients with clinically diagnosed pneumonia (as defined by the World Health Organization) who also met criteria for bacterial, viral, or malarial infection based on clinical, radiographic, and laboratory results. Ten healthy community control subjects were enrolled to assess marker reliability. Patients were subdivided into two sets: one for identifying potential markers and another for validating them. Three proteins (haptoglobin, tumor necrosis factor receptor 2 or IL-10, and tissue inhibitor of metalloproteinases 1) were identified that, when combined through a classification tree signature, accurately classified patients into bacterial, malarial, and viral etiologies and misclassified only one patient with bacterial pneumonia from the validation set. The overall sensitivity and specificity of this signature for the bacterial diagnosis were 96 and 86%, respectively. Alternative combinations of markers with comparable accuracy were selected by support vector machine and regression models and included haptoglobin, IL-10, and creatine kinase-MB. Combinations of plasma proteins accurately identified children with a respiratory syndrome who were likely to have bacterial infections and who would benefit from antibiotic therapy. When used in conjunction with malaria diagnostic tests, they may improve diagnostic specificity and simplify treatment decisions for clinicians.

  19. Benefits of plasma rich in growth factors (PRGF) in skin photodamage: clinical response and histological assessment.

    Science.gov (United States)

    Díaz-Ley, B; Cuevast, J; Alonso-Castro, L; Calvo, M I; Ríos-Buceta, L; Orive, G; Anitua, E; Jaén, P

    2015-01-01

    Skin ageing is characterized by small and fine wrinkles, roughness, laxity, and pigmentation as a result of epidermal thinning, collagen degradation, dermal atrophy, and fewer fibroblasts. Plasma rich in growth factors (PRGF) is an autologous plasma preparation enriched in proteins obtained from patient's own blood aimed at accelerating tissue repair and regeneration. To evaluate the benefits of PRGF in skin photodamage, 10 healthy volunteers were treated with three consecutive intradermal injections of PRGF in the facial area. Clinical outcomes and histological analysis were performed. A statistically significant increase in the epidermis and papillary dermis thickness was seen after PRGF treatment (p < 0.001). Skin thickening was observed in all patients studied, being more intense in the group of patients with photodamage (p < 0.001). After PRGF treatment, a reduction of the average area fraction of solar elastosis was observed in patients with clinical and histological signs of skin photodamage (p < 0.05).No changeswere observed in the number of CD31, XIIIa factor, cKit, CD10, nor p53-positive cells. The improvement score after PRGF use was 0.75 (9/12) for the group of patients with signs of skin photodamage. Intradermal PRGF infiltration appears to be an effective treatment for the photodamaged skin. © 2015 Wiley Periodicals, Inc.

  20. Chemical Profiling of Primary Mesothelioma Cultures Defines Subtypes with Different Expression Profiles and Clinical Responses.

    Science.gov (United States)

    Schunselaar, Laurel M; Quispel-Janssen, Josine M M F; Kim, Yongsoo; Alifrangis, Constantine; Zwart, Wilbert; Baas, Paul; Neefjes, Jacques

    2018-04-01

    Purpose: Finding new treatment options for patients with malignant pleural mesothelioma is challenging due to the rarity and heterogeneity of this cancer type. The absence of druggable targets further complicates the development of new therapies. Current treatment options are therefore limited, and prognosis remains poor. Experimental Design: We performed drug screening on primary mesothelioma cultures to guide treatment decisions of corresponding patients that were progressive after first- or second-line treatment. Results: We observed a high concordance between in vitro results and clinical outcomes. We defined three subgroups responding differently to the anticancer drugs tested. In addition, gene expression profiling yielded distinct signatures that segregated the differently responding subgroups. These genes signatures involved various pathways, most prominently the fibroblast growth factor pathway. Conclusions: Our primary mesothelioma culture system has proved to be suitable to test novel drugs. Chemical profiling of primary mesothelioma cultures allows personalizing treatment for a group of patients with a rare tumor type where clinical trials are notoriously difficult. This personalized treatment strategy is expected to improve the poor prospects of patients with mesothelioma. Clin Cancer Res; 24(7); 1761-70. ©2017 AACR See related commentary by John and Chia, p. 1513 . ©2017 American Association for Cancer Research.