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Sample records for track clinical pathway

  1. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Scholarly productivity for nursing clinical track faculty.

    Science.gov (United States)

    Tschannen, Dana; Anderson, Christine; Strobbe, Stephen; Bay, Esther; Bigelow, April; Dahlem, Chin Hwa Gina Y; Gosselin, Ann K; Pollard, Jennifer; Seng, Julia S

    2014-01-01

    Recent years have yielded substantial advancement by clinical track faculty in cohort expansion and collective contributions to the discipline of nursing. As a result, standards for progression and promotion for clinical faculty need to be more fully developed, articulated, and disseminated. Our school formed a task force to examine benchmarks for the progression and promotion of clinical faculty across schools of nursing, with the goal of guiding faculty, reviewers, and decision makers about what constitutes excellence in scholarly productivity. Results from analyses of curriculum vitae of clinical professors or associate professors at six universities with high research activity revealed a variety of productivity among clinical track members, which included notable diversity in the types of scholarly products. Findings from this project help quantify types of scholarship for clinical faculty at the time of promotion. This work provides a springboard for greater understanding of the contributions of clinical track faculty to nursing practice. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Tracking clinical competencies on the web.

    Science.gov (United States)

    Hobbs, Dan L

    2005-01-01

    The American Registry of Radiologic Technologists (ARRT) has defined several core examinations that student radiographers must perform to demonstrate competency. Furthermore, the ARRT has left the method of tracking competency exams to educators. This article describes a Web-based system that can be used to track clinical competencies. The pedagogy employed in designing a meaningful and successful Web site to track competencies can be overwhelming. Considerations include selecting software, the design and implementation process, and providing security to protect confidential information. The Web-based system described in this article is innovative, sensible and relatively easy to adopt. This tracking method provides faculty members with instantaneous access and a quick review of the student's competency examinations. Students' competency information for the entire program is contained in 1 electronic file. With minor modification, the system can be used in a variety of educational and administrative settings.

  4. Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2008-01-01

    Full Text Available Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway. Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD. Defined goals are (1 ambulation and liquid diet on the evening of the operative day; (2 out of bed (OOB at least 4 times on POD 1; (3 removal of Foley catheter on the morning of POD 2; (4 removal of Jackson Pratt drain on the afternoon of POD 2; (4 discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway. Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61% out of 36 fast track patients and 4 (16% out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days; P = .012. Age (median, 55 versus 57 years, tumor size (median, 2.5 versus 2.5 cm, readmission within 30 days (5.5% versus 5.1%, and complications (10.2% versus 13.8% were similar in the fast track patients and control, respectively. Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

  5. Wound care clinical pathway: a conceptual model.

    Science.gov (United States)

    Barr, J E; Cuzzell, J

    1996-08-01

    A clinical pathway is a written sequence of clinical processes or events that guides a patient with a defined problem toward an expected outcome. Clinical pathways are tools to assist with the cost-effective management of clinical outcomes related to specific problems or disease processes. The primary obstacles to developing clinical pathways for wound care are the chronic natures of some wounds and the many variables that can delay healing. The pathway introduced in this article was modeled upon the three phases of tissue repair: inflammatory, proliferative, and maturation. This physiology-based model allows clinicians to identify and monitor outcomes based on observable and measurable clinical parameters. The pathway design, which also includes educational and behavioral outcomes, allows the clinician to individualize the expected timeframe for outcome achievement based on individual patient criteria and expert judgement. Integral to the pathway are the "4P's" which help standardize the clinical processes by wound type: Protocols, Policies, Procedures, and Patient education tools. Four categories into which variances are categorized based on the cause of the deviation from the norm are patient, process/system, practitioner, and planning/discharge. Additional research is warranted to support the value of this clinical pathway in the clinical arena.

  6. Clinical track faculty: merits and issues.

    Science.gov (United States)

    Lee, Won-Hee; Kim, Cho Ja; Roh, Young Sook; Shin, Hyunsook; Kim, Mi Ja

    2007-01-01

    Clinical track faculty (CTF) has been in operation for more than two decades in the United States, and 12 of the top 20 schools of nursing with the highest National Institutes of Health funding in the United States have CTF in place. Yet, only limited articles have been published regarding the merits and issues related to its operation. This article examines the advantages/merits of establishing CTF in schools of nursing, discusses the qualification criteria and types of appointment for CTF, and analyzes issues related to operating CTF in Korea. A questionnaire survey and two workshops were conducted involving faculty from a college of nursing and clinical nurse managers from university-affiliated medical centers and community agencies. Most of the respondents indicated that establishing CTF was advantageous. Merits included the following: increasing reality-based clinical education and training; decreasing the reality shock of students; increasing student satisfaction; and linking education, practice, and research more effectively. Major issues were as follows: getting the approval of medical centers/universities; developing an agreement on CTF operation between the college of nursing and clinical agencies; clarifying types and criteria of appointment and promotion; and developing a statement on role and compensation policies. Most issues are similar to what U.S. schools of nursing have faced, except for the first one. In conclusion, establishing CTF in Korea appears to be highly desirable. Merits outweigh issues/concerns, and Korean nursing schools may look for an opportune time for obtaining the approval of medical centers/universities. Nursing schools in other countries that face a similar challenge of providing clinical teaching with high research performance may consider instituting CTF.

  7. Modelling and Decision Support of Clinical Pathways

    Science.gov (United States)

    Gabriel, Roland; Lux, Thomas

    The German health care market is under a rapid rate of change, forcing especially hospitals to provide high-quality services at low costs. Appropriate measures for more effective and efficient service provision are process orientation and decision support by information technology of clinical pathway of a patient. The essential requirements are adequate modelling of clinical pathways as well as usage of adequate systems, which are capable of assisting the complete path of a patient within a hospital, and preferably also outside of it, in a digital way. To fulfil these specifications the authors present a suitable concept, which meets the challenges of well-structured clinical pathways as well as rather poorly structured diagnostic and therapeutic decisions, by interplay of process-oriented and knowledge-based hospital information systems.

  8. Language pathway tracking: comparing nTMS-based DTI fiber tracking with a cubic ROIs-based protocol.

    Science.gov (United States)

    Negwer, Chiara; Sollmann, Nico; Ille, Sebastian; Hauck, Theresa; Maurer, Stefanie; Kirschke, Jan S; Ringel, Florian; Meyer, Bernhard; Krieg, Sandro M

    2017-03-01

    OBJECTIVE Diffusion tensor imaging (DTI) fiber tracking (FT) has been widely used in glioma surgery in recent years. It can provide helpful information about subcortical structures, especially in patients with eloquent space-occupying lesions. This study compared the newly developed navigated transcranial magnetic stimulation (nTMS)-based DTI FT of language pathways with the most reproducible protocol for language pathway tractography, using cubic regions of interest (ROIs) for the arcuate fascicle. METHODS Thirty-seven patients with left-sided perisylvian lesions underwent language mapping by repetitive nTMS. DTI FT was performed using the cubic ROIs-based protocol and the authors' nTMS-based DTI FT approach. The same minimal fiber length and fractional anisotropy were chosen (50 mm and 0.2, respectively). Both protocols were performed with standard clinical tractography software. RESULTS Both methods visualized language-related fiber tracts (i.e., corticonuclear tract, arcuate fascicle, uncinate fascicle, superior longitudinal fascicle, inferior longitudinal fascicle, arcuate fibers, commissural fibers, corticothalamic fibers, and frontooccipital fascicle) in all 37 patients. Using the cubic ROIs-based protocol, 39.9% of these language-related fiber tracts were detected in the examined patients, as opposed to 76.0% when performing nTMS-based DTI FT. For specifically tracking the arcuate fascicle, however, the cubic ROIs-based approach showed better results (97.3% vs 75.7% with nTMS-based DTI FT). CONCLUSIONS The cubic ROIs-based protocol was designed for arcuate fascicle tractography, and this study shows that it is still useful for this intention. However, superior results were obtained using the nTMS-based DTI FT for visualization of other language-related fiber tracts.

  9. A career path in clinical pathways.

    Science.gov (United States)

    Bower, K A

    1998-03-01

    Much like the development of a clinical path, the creation of a career path requires knowledge of patterns of behavior, needs for standardized education and skill development, along with variance analysis and individualized care. This nationally known nursing entrepreneur tells the story of her involvement in the development of case management and clinical pathways and how she turned that into a successful business that has changed how patient care is managed nationally and internationally.

  10. MODERN POSSIBILITIES OF SPECKLE TRACKING ECHOCARDIOGRAPHY IN CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    V. S. Nikiforov

    2017-01-01

    Full Text Available Speckle-tracking echocardiography is promising modern technique for evaluation of structural and functional changes in the myocardium. It evaluates the indicator of global longitudinal myocardial deformation, which is more sensitive than ejection fraction to early changes of left ventricular contractility. The diagnostic capabilities of speckle tracking echocardiography are reflected in clinical recommendations and consensus statements of European Society of Cardiology (ESC, European Association of Cardiovascular Imaging (EACVI and American Society of Echocardiography (ASE. The aim of this paper is describe basic principles of speckle tracking echocardiography and clinical applications of this new technology. Attention is paid to the use of speckle tracking echocardiography in such heart pathologies as heart failure, coronary heart disease and myocardial infarction, left ventricular hypertrophy in arterial hypertension, hypertrophic cardiomyopathy and amyloidosis of the heart, valvular heart disease, constrictive pericarditis and cancer therapy-induced cardiotoxicity.

  11. Radiology film tracking in a distributed clinical network

    International Nuclear Information System (INIS)

    Marquette, D.D.; Arrildt, W.

    1985-01-01

    This paper describes a system for tracking radiology films designed and installed at the Johns Hopkins Hospital. The installation of database and network capabilities in a large hospital environment provide the opportunity to extend to all nursing units and clinics access to the hospital's film tracking system. Ethernet communication technology allows communication to remote libraries. The integration of film tracking with scheduling and order entry systems in radiology make it possible to attain a high level of automated database interface and film jacket label production

  12. Error tracking in a clinical biochemistry laboratory

    DEFF Research Database (Denmark)

    Szecsi, Pal Bela; Ødum, Lars

    2009-01-01

    BACKGROUND: We report our results for the systematic recording of all errors in a standard clinical laboratory over a 1-year period. METHODS: Recording was performed using a commercial database program. All individuals in the laboratory were allowed to report errors. The testing processes were cl...

  13. Ontology modeling for generation of clinical pathways

    Directory of Open Access Journals (Sweden)

    Jasmine Tehrani

    2012-12-01

    Full Text Available Purpose: Increasing costs of health care, fuelled by demand for high quality, cost-effective healthcare has drove hospitals to streamline their patient care delivery systems. One such systematic approach is the adaptation of Clinical Pathways (CP as a tool to increase the quality of healthcare delivery. However, most organizations still rely on are paper-based pathway guidelines or specifications, which have limitations in process management and as a result can influence patient safety outcomes. In this paper, we present a method for generating clinical pathways based on organizational semiotics by capturing knowledge from syntactic, semantic and pragmatic to social level. Design/methodology/approach: The proposed modeling approach to generation of CPs adopts organizational semiotics and enables the generation of semantically rich representation of CP knowledge. Semantic Analysis Method (SAM is applied to explicitly represent the semantics of the concepts, their relationships and patterns of behavior in terms of an ontology chart. Norm Analysis Method (NAM is adopted to identify and formally specify patterns of behavior and rules that govern the actions identified on the ontology chart. Information collected during semantic and norm analysis is integrated to guide the generation of CPs using best practice represented in BPMN thus enabling the automation of CP. Findings: This research confirms the necessity of taking into consideration social aspects in designing information systems and automating CP. The complexity of healthcare processes can be best tackled by analyzing stakeholders, which we treat as social agents, their goals and patterns of action within the agent network. Originality/value: The current modeling methods describe CPs from a structural aspect comprising activities, properties and interrelationships. However, these methods lack a mechanism to describe possible patterns of human behavior and the conditions under which the

  14. TUW @ TREC Clinical Decision Support Track

    Science.gov (United States)

    2014-11-01

    and the ShARe/CLEF eHealth Evaluation Lab [8,3] running in 2013 and 2014. Here we briefly describe the goals of the first TREC Clinical Decision...Wendy W. Chapman, David Mart́ınez, Guido Zuccon, and João R. M. Palotti. Overview of the share/clef ehealth evalu- ation lab 2014. In Information Access...Zuccon. Overview of the share/clef ehealth evaluation lab 2013. In Information Access Evaluation. Multilinguality, Multimodality, and Visualization

  15. [Clinical pathway for hip fracture patients].

    Science.gov (United States)

    Sáez López, Pilar; Sánchez Hernández, Natalia; Paniagua Tejo, Sonsoles; Valverde García, José Antonio; Montero Díaz, Margarita; Alonso García, Noelia; Freites Esteve, Alfonso

    2015-01-01

    Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  16. Tracking Biocultural Pathways to Health Disparities: The Value of Biomarkers

    Science.gov (United States)

    Worthman, Carol M.; Costello, E. Jane

    2009-01-01

    Background Cultural factors and biomarkers are emerging emphases in social epidemiology that readily ally with human biology and anthropology. Persistent health challenges and disparities have established biocultural roots, and environment plays an integral role in physical development and function that form the bases of population health. Biomarkers have proven to be valuable tools for investigating biocultural bases of health disparities. Aims We apply recent insights from biology to consider how culture gets under the skin and evaluate the construct of embodiment. We analyze contrasting biomarker models and applications, and propose an integrated model for biomarkers. Three examples from the Great Smoky Mountains Study (GSMS) illustrate these points. Subjects and methods The longitudinal developmental epidemiological GSMS comprises a population-based sample of 1420 children with repeated measures including mental and physical health, life events, household conditions, and biomarkers for pubertal development and allostatic load. Results Analyses using biomarkers resolved competing explanations for links between puberty and depression, identified gender differences in stress at puberty, and revealed interactive effects of birthweight and postnatal adversity on risk for depression at puberty in girls. Conclusion An integrated biomarker model can both enrich epidemiology and illuminate biocultural pathways in population health. PMID:19381986

  17. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type...... of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section......, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements...

  18. Clinical pathways for inborn errors of metabolism: warranted and feasible

    Directory of Open Access Journals (Sweden)

    Demirdas Serwet

    2013-02-01

    Full Text Available Abstract Inborn errors of metabolism (IEMs are known for their low prevalence and multidisciplinary care mostly founded on expert opinion. Clinical pathways are multidisciplinary tools to organise care which provide a clear route to the best care and improve communication. In 2010 the Dutch Society for Children and Adults with an Inborn Error of Metabolism (VKS initiated development of clinical pathways for inborn errors of metabolism. In this letter to the editor we describe why it is warranted to develop clinical pathways for IEMs and shortly discuss the process of development for these pathways in the Netherlands.

  19. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surge......Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type...... of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section......, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements...

  20. Understanding implementation processes of clinical pathways and clinical practice guidelines in pediatric contexts: a study protocol

    Directory of Open Access Journals (Sweden)

    Scott Shannon D

    2011-12-01

    Full Text Available Abstract Background Canada is among the most prosperous nations in the world, yet the health and wellness outcomes of Canadian children are surprisingly poor. There is some evidence to suggest that these poor health outcomes are partly due to clinical practice variation, which can stem from failure to apply the best available research evidence in clinical practice, otherwise known as knowledge translation (KT. Surprisingly, clinical practice variation, even for common acute paediatric conditions, is pervasive. Clinical practice variation results in unnecessary medical treatments, increased suffering, and increased healthcare costs. This study focuses on improving health outcomes for common paediatric acute health concerns by evaluating strategies that improve KT and reduce clinical practice variation. Design/Methods Using a multiple case study design, qualitative and quantitative data will be collected from four emergency departments in western Canada. Data sources will include: pre- and post-implementation focus group data from multidisciplinary healthcare professionals; individual interviews with the local champions, KT intervention providers, and unit/site leaders/managers; Alberta Context Tool (ACT survey data; and aggregated patient outcome data. Qualitative and quantitative data will be systematically triangulated, and matrices will be built to do cross-case comparison. Explanations will be built about the success or lack of success of the clinical practice guidelines (CPG and clinical pathways (CPs uptake based upon the cross-case comparisons. Significance This study will generate new knowledge about the potential causal mechanisms and factors which shape implementation. Future studies will track the impact of the CPG/CPs implementation on children's health outcome, and healthcare costs.

  1. Advancing the educational and career pathway for clinical trials nurses.

    Science.gov (United States)

    Scott, Kathleen; White, Kathryn; Roydhouse, Jessica K

    2013-04-01

    Clinical trials nurses play a pivotal role in the conduct of clinical research, but the educational and career pathway for these nurses remains unclear. This article reports findings from a survey of nurses working in cancer clinical trials research in Australia. Most participants held postgraduate qualifications (42 of 61); however, clinical trials education was primarily attained through short professional development courses. Interest in pursuing trial-specific postgraduate education was high, but barriers were identified, including cost, time, and unclear benefit for career advancement. Job titles varied substantially, which is indicative of an unclear employment pathway. These findings suggest that initiatives to improve the educational and career pathway for clinical trials nurses are needed and should include the following: formal educational preparation, greater consistency in employment status, and clearer career progression. These strategies should be underpinned by broad professional recognition of the clinical trials nurse as a specialized nursing role. Copyright 2013, SLACK Incorporated.

  2. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

    OpenAIRE

    Lawal, Adegboyega K.; Rotter, Thomas; Kinsman, Leigh; Machotta, Andreas; Ronellenfitsch, Ulrich; Scott, Shannon D.; Goodridge, Donna; Plishka, Christopher; Groot, Gary

    2016-01-01

    textabstractClinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refin...

  3. Clinical Implications of Hedgehog Pathway Signaling in Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Daniel L. Suzman

    2015-09-01

    Full Text Available Activity in the Hedgehog pathway, which regulates GLI-mediated transcription, is important in organogenesis and stem cell regulation in self-renewing organs, but is pathologically elevated in many human malignancies. Mutations leading to constitutive activation of the pathway have been implicated in medulloblastoma and basal cell carcinoma, and inhibition of the pathway has demonstrated clinical responses leading to the approval of the Smoothened inhibitor, vismodegib, for the treatment of advanced basal cell carcinoma. Aberrant Hedgehog pathway signaling has also been noted in prostate cancer with evidence suggesting that it may render prostate epithelial cells tumorigenic, drive the epithelial-to-mesenchymal transition, and contribute towards the development of castration-resistance through autocrine and paracrine signaling within the tumor microenvironment and cross-talk with the androgen pathway. In addition, there are emerging clinical data suggesting that inhibition of the Hedgehog pathway may be effective in the treatment of recurrent and metastatic prostate cancer. Here we will review these data and highlight areas of active clinical research as they relate to Hedgehog pathway inhibition in prostate cancer.

  4. Inherited dystonias: clinical features and molecular pathways.

    Science.gov (United States)

    Weisheit, Corinne E; Pappas, Samuel S; Dauer, William T

    2018-01-01

    Recent decades have witnessed dramatic increases in understanding of the genetics of dystonia - a movement disorder characterized by involuntary twisting and abnormal posture. Hampered by a lack of overt neuropathology, researchers are investigating isolated monogenic causes to pinpoint common molecular mechanisms in this heterogeneous disease. Evidence from imaging, cellular, and murine work implicates deficiencies in dopamine neurotransmission, transcriptional dysregulation, and selective vulnerability of distinct neuronal populations to disease mutations. Studies of genetic forms of dystonia are also illuminating the developmental dependence of disease symptoms that is typical of many forms of the disease. As understanding of monogenic forms of dystonia grows, a clearer picture will develop of the abnormal motor circuitry behind this relatively common phenomenology. This chapter focuses on the current data covering the etiology and epidemiology, clinical presentation, and pathogenesis of four monogenic forms of isolated dystonia: DYT-TOR1A, DYT-THAP1, DYT-GCH1, and DYT-GNAL. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Critical success factors in implementing clinical pathways/case management.

    Science.gov (United States)

    Choo, J

    2001-07-01

    With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.

  6. A proposed clinical research support career pathway for noninvestigators.

    Science.gov (United States)

    Smith, Sheree; Gullick, Janice; Ballard, Jacqueline; Perry, Lin

    2018-03-08

    To discuss the international experience of clinical research support for noninvestigator roles and to propose a new pathway for Australia, to promote a sustainable research support workforce capable of delivering high-quality clinical research. Noninvestigator research support roles are currently characterized by an ad hoc approach to training, with limited role delineation and perceived professional isolation with implications for study completion rates and participant safety. A focused approach to developing and implementing research support pathways has improved patient recruitment, study completion, job satisfaction, and research governance. The Queensland and New South Wales state-based Nurses' Awards, the Australian Qualifications Framework, and a University Professional (Research) Staff Award. Research nurses in the clinical environment improve study coordination, adherence to study protocol, patient safety, and clinical care. A career pathway that guides education and outlines position descriptions and skill sets would enhance development of the research support workforce. This pathway could contribute to changing the patient outcomes through coordination and study completion of high-quality research. A wide consultative approach is required to determine a cost-effective and feasible approach to implementation and evaluation of the proposed pathway. © 2018 John Wiley & Sons Australia, Ltd.

  7. Organizing and implementing a multidisciplinary fast track oncology clinic.

    Science.gov (United States)

    Basta, Y L; Tytgat, K M A J; Greuter, H H; Klinkenbijl, J H G; Fockens, P; Strikwerda, J

    2017-11-01

    Patients with gastrointestinal malignancies often need multiple appointments with different medical specialists, causing waiting times to accrue. In our hospital, care is organized in a sequential manner, causing long waiting times. To reduce this, a fast track outpatient clinic (FTC) was implemented. The FTC was organized within the hospital's existing structure. Patient centered care was achieved by ensuring that the medical specialists visit the patient, implementing nurse coordinators and considering patient wishes and co-morbidities when formulating a treatment plan. A mandate from the board (Top-down), ensured cooperation between different medical departments and a change in resource allocation (i.e. medical staff); a horizontal clinic across a vertical departmental structure. Brainstorm sessions between the departments led by two physicians who were going to work at the FTC (Bottom-up), assured a swift implementation of the FTC. Since implementation in 2009, patient influx has tripled. Waiting time for an appointment and start of treatment was reduced from 2-4 weeks to 6 working days and from 12-14 weeks to 17 working days, respectively. This was achieved by re-allocating recourses, but without increasing existing resources. The combination of a top-down and bottom-up strategy ensured participation from all involved departments, a strong foundation and a shared vision on patient centered care. The FTC facilitates sharing information between different medical specialists through both proximity and a shared electronic patient record. The implementation of the FTC comprises a change in organization, but not a change in structure. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  8. Clinical Presentation and Outcome of Patients With Optic Pathway Glioma.

    Science.gov (United States)

    Robert-Boire, Viviane; Rosca, Lorena; Samson, Yvan; Ospina, Luis H; Perreault, Sébastien

    2017-10-01

    Optic pathway gliomas (OPGs) occur sporadically or in patients with neurofibromatosis type 1 (NF1). The purpose of this study was to evaluate the clinical presentation at diagnosis and at progression of patients with OPGs. We conducted a chart review of patients with OPGs diagnosed in a single center over a period of 15 years. Demographic data including age, sex, NF1 status, clinical presentation, and outcome were collected. Of the 40 patients who were identified, 23 had sporadic tumors (57.5%) and 17 had NF1-related tumors (42.5%). Among the children with NF1, there was a significant overrepresentation of girls (82.3%) (P = 0.02), while among the children without NF1, there were slightly more boys (56.5%) than girls (43.5%). The presence of nystagmus was strongly associated with sporadic optic pathway gliomas. Poor visual outcome was related to tumor affecting both optic pathways, hydrocephalus at diagnosis, and optic nerve atrophy. Of the 40 patients, five died of OPG complications (12.5%) and all had sporadic tumors. Our cohort is one of the largest with OPGs and a detailed description of the clinical presentation both at diagnosis and at progression. We observed a significant difference between sporadic and NF1 optic pathway gliomas in terms of demographics, clinical presentation, and outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

  10. Shared care and implementation of a pediatric clinical pathway

    DEFF Research Database (Denmark)

    Langfrits, Mette Sørensen; Thomsen, RW; Rubak, Jens Mørck

    with uncontrolled asthma should be followed at the pediatrics department. Study 2) An increased overall proportion of children with well-controlled asthma. Study 3) Favorable changes in the use of asthma medication. Study 4) Self-reported higher quality of life among children with asthma Material and methods...... specialist out-patient clinic at the pediatrics department at Viborg hospital or at one of 100 GPs in the Viborg area. At baseline the involved health care professionals participated in an introduction to the clinical pathway and treatment guide. Furthermore the clinical pathway and treatment guide...... Midten. We sincerely thank Lars G. Hansen (Head of Department of Pediatrics, Viborg Hospital) for his help and participation....

  11. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

    NARCIS (Netherlands)

    A.K. Lawal (Adegboyega K.); T. Rotter (Thomas); L. Kinsman (Leigh); A. Machotta (Andreas); U. Ronellenfitsch (Ulrich); S.D. Scott (Shannon D.); D. Goodridge (Donna); C. Plishka (Christopher); G. Groot (Gary)

    2016-01-01

    textabstractClinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in

  12. Clinical pathways for primary care: current use, interest and perceived usability.

    Science.gov (United States)

    Waters, Richard C; Toy, Jennifer M; Drechsler, Adam

    2018-02-26

    Translating clinical evidence to daily practice remains a challenge and may improve with clinical pathways. We assessed interest in and usability of clinical pathways by primary care professionals. An online survey was created. Interest in pathways for patient care and learning was assessed at start and finish. Participants completed baseline questions then pathway-associated question sets related to management of 2 chronic diseases. Perceived pathway usability was assessed using the system usability scale. Accuracy and confidence of answers was compared for baseline and pathway-assisted questions. Of 115 participants, 17.4% had used clinical pathways, the lowest of decision support tool types surveyed. Accuracy and confidence in answers significantly improved for all pathways. Interest in using pathways daily or weekly was above 75% for the respondents. There is low utilization of, but high interest in, clinical pathways by primary care clinicians. Pathways improve accuracy and confidence in answering written clinical questions.

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

    Science.gov (United States)

    Darrikhuma, I M

    1999-05-01

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

  14. Incorporating Topic Assignment Constraint and Topic Correlation Limitation into Clinical Goal Discovering for Clinical Pathway Mining

    Directory of Open Access Journals (Sweden)

    Xiao Xu

    2017-01-01

    Full Text Available Clinical pathways are widely used around the world for providing quality medical treatment and controlling healthcare cost. However, the expert-designed clinical pathways can hardly deal with the variances among hospitals and patients. It calls for more dynamic and adaptive process, which is derived from various clinical data. Topic-based clinical pathway mining is an effective approach to discover a concise process model. Through this approach, the latent topics found by latent Dirichlet allocation (LDA represent the clinical goals. And process mining methods are used to extract the temporal relations between these topics. However, the topic quality is usually not desirable due to the low performance of the LDA in clinical data. In this paper, we incorporate topic assignment constraint and topic correlation limitation into the LDA to enhance the ability of discovering high-quality topics. Two real-world datasets are used to evaluate the proposed method. The results show that the topics discovered by our method are with higher coherence, informativeness, and coverage than the original LDA. These quality topics are suitable to represent the clinical goals. Also, we illustrate that our method is effective in generating a comprehensive topic-based clinical pathway model.

  15. Preserving breastfeeding for the rehospitalized infant: a clinical pathway.

    Science.gov (United States)

    Spatz, Diane L; Goldschmidt, Karen A

    2006-01-01

    The benefits of feeding newborns with human milk are well established. Unfortunately some hospital practices do not support successful breastfeeding; practices such as early hospital discharge after birth, lack of appropriate follow-up primary care providers, and lack of access to breastfeeding support services can contribute to breastfeeding failure, as well as morbidity and mortality in the infant. Infants experiencing breastfeeding difficulties are sometimes admitted to the hospital with diagnoses such as hyperbilirubinemia/jaundice, dehydration/hypernatremia, rule out sepsis, and weight loss/failure to thrive. This article describes a clinical pathway developed with the express purpose of maintaining and enhancing lactation in mother-infant dyads experiencing breastfeeding difficulties. The goal of the pathway is to maintain lactation and breastfeeding while returning the infant to a state of health. A key focus of the pathway is milk transfer, a concept that is missing from much of the research on lactation difficulties. The pathway considers breastfeeding from both a maternal and an infant perspective, with a goal of preserving breastfeeding. It uses technology to support the breastfeeding process and could be useful for all practitioners working with mother-infant dyads experiencing breastfeeding difficulties.

  16. Technical experiences of implementing a wireless tracking and facial biometric verification system for a clinical environment

    Science.gov (United States)

    Liu, Brent; Lee, Jasper; Documet, Jorge; Guo, Bing; King, Nelson; Huang, H. K.

    2006-03-01

    By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).

  17. A new course in the clinical pathways for metabolic syndrome

    International Nuclear Information System (INIS)

    Kageyama, Shoko; Wada, Yumi; Nakamura, Rie

    2006-01-01

    Metabolic syndrome is consisted with multiple risk factors such as diabetes, dyslipidemia, and hypertension based on visceral fat accumulation, for the development of arteriosclerosis. We present, here, a clinical pathway for education of patients with metabolic syndrome. The program contains an adequate explanation of the high risk for arteriosclerosis to the patients, the measurement of visceral fat content by computed tomography, and several clinical examinations for the evaluation of arteriosclerotic lesions. We have presented this program on the ward of diabetes center in our hospital for patients diagnosed as having metabolic syndrome. Because the focus of education is to clarify understanding of the harmful effects of visceral fat and the benefits of its reduction, it might be a valuable tool to motivate and empower the patient and improve the patient's lifestyle. (author)

  18. A new course in the clinical pathways for metabolic syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kageyama, Shoko; Wada, Yumi; Nakamura, Rie [Sumitomo Hospital, Osaka, Osaka (Japan)

    2006-07-15

    Metabolic syndrome is consisted with multiple risk factors such as diabetes, dyslipidemia, and hypertension based on visceral fat accumulation, for the development of arteriosclerosis. We present, here, a clinical pathway for education of patients with metabolic syndrome. The program contains an adequate explanation of the high risk for arteriosclerosis to the patients, the measurement of visceral fat content by computed tomography, and several clinical examinations for the evaluation of arteriosclerotic lesions. We have presented this program on the ward of diabetes center in our hospital for patients diagnosed as having metabolic syndrome. Because the focus of education is to clarify understanding of the harmful effects of visceral fat and the benefits of its reduction, it might be a valuable tool to motivate and empower the patient and improve the patient's lifestyle. (author)

  19. Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA.

    Science.gov (United States)

    Yang, Xian; Han, Rui; Guo, Yike; Bradley, Jeremy; Cox, Benita; Dickinson, Robert; Kitney, Richard

    2012-01-01

    Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting

  20. Neuro-ophthalmological conditions: Study of the clinical care pathway.

    Science.gov (United States)

    Layat, I; Challe, G; LeHoang, P; Bodaghi, B; Touitou, V

    2017-06-01

    Neuro-ophthalmologic conditions require specialized multidisciplinary management, both medical and surgical, for patients affected by visual loss due to nervous system disease. The primary goal of this study is to define the specificity of neuro-ophthalmology within the realm of visual health. The secondary goal is to review clinical care pathways by studying the organization of management, in terms of accessibility to care and personalization of the care pathway. A field study was carried out from February to June 2015, within the ophthalmology service of the Pitié-Salpêtrière University Medical Center in Paris. A 30-minute interview with the patient before or after his or her neuro-ophthalmology consultation was performed, to describe the clinical care pathway. The medical records of interviewed patients were also analyzed. Seventeen care pathways (10 women and 7 men) were reviewed. The mean age at appearance of visual involvement was 44.5 years (±8.4 years). If we exclude 3 patients over 66 years and retired, 35.71% were active, 35.71% were disabled, and 28.57% were on sick leave. Ten patients (58.82%) met the criteria for admission to long-term care. The first step had been carried out by local private practitioners. The first physician seen was the general medicine physician (59%), then the private ophthalmologist on an emergency basis (17%). On average, patients went through 8 steps during their care pathway (from 6 to 10 steps) and 14 medical departments were involved. The study showed collaboration with the other services of the University Hospital Department of Vision and Disabilities (notably with the Fondation Rothschild, the Quinze-Vingts National Ophthalmology Hospital, and the Fondation Sainte-Marie). In addition to rehabilitation services, health care professionals participating in the outpatient care of the patients included an orthoptist (11.7%), a psychologist (11.7%), and an optician specializing in low vision for visual aids. Finally

  1. Pharmacists as Interprofessional Collaborators and Leaders through Clinical Pathways

    Directory of Open Access Journals (Sweden)

    Sherine Ismail

    2018-03-01

    Full Text Available Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs. We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets. Fifteen CPs leading to admissions in medical wards were developed and integrated into Computerized Prescriber Order Entry (CPOE sets. Tools and services included (1 reporting of creatinine clearance to guide optimum dosing; (2 advisory flags for dosing and infusion rates; (3 piloting of medication reconciliation and counseling services before discharge were initiated; (4 Arabic drug leaflets were designed to educate patients; and (5 five CPs were included in pragmatic randomized control trials with a clinical pharmacist as co-investigator. Clinical pharmacists conducted continuous orientation to various healthcare professionals throughout the process. CPs provide unique opportunities for establishing and evaluating patient-centered pharmaceutical services and allow clinical pharmacists to demonstrate interprofessional leadership in collaboration with multidisciplinary teams.

  2. Noninvasive Localization of Accessory Pathways in Wolff-Parkinson-White Syndrome by Three-Dimensional Speckle Tracking Echocardiography.

    Science.gov (United States)

    Ishizu, Tomoko; Seo, Yoshihiro; Igarashi, Miyako; Sekiguchi, Yukio; Machino-Ohtsuka, Tomoko; Ogawa, Kojiro; Kuroki, Kenji; Yamamoto, Masahiro; Nogami, Akihiko; Kawakami, Yasushi; Aonuma, Kazutaka

    2016-06-01

    We have developed a noninvasive isochrone activation imaging (AI) system with 3-dimensional (3D) speckle tracking echocardiography (STE), which allows visualization of the wavefront image of mechanical propagation of the accessory pathway (ACP) in Wolff-Parkinson-White syndrome. Patients with manifest Wolff-Parkinson-White syndrome were imaged in 3D-STE AI mode, which quantified the time from QRS onset to regional endocardial deformation. In 2 patients with left- and right-side ACP, we confirmed that intraoperative contact endocardial electric mapping and the 3D-STE AI system showed comparable images pre- and postablation. In normal heart assessment by 3D-echo AI, the earliest activation sites were found at the attachment of the papillary muscles in the left ventricle and midseptum in the right ventricle, and none showed earliest activation at the peri-atrioventricular valve annuli. An analyzer who was unaware of the clinical information assessed 39 ACP locations in 38 Wolff-Parkinson-White syndrome patients using 3D-STE. All showed abnormal perimitral or tricuspid annular activations, and the location of 34 ACP (87%) showed agreement with the successful ablation sites within a 2-o'clock range. Especially for left free wall ACP, 17/18 (94%) showed consistency with the ablation site within a 2 o'clock range. Among 15 ACP at the ventricular septum, 9 (60%) showed early local activation in both right and left sides of the septum. Isochrone AI with 3D-STE may be a promising noninvasive imaging tool to assess cardiac synchronized activation in normal hearts and detect abnormal breakthrough of mechanical activation from both atrioventricular annuli in Wolff-Parkinson-White syndrome. © 2016 American Heart Association, Inc.

  3. Tracking Hydrothermal Fluid Pathways from Surface Alteration Mineralogy: The Case of Licancura Geothermal Field, Northern Chile

    Science.gov (United States)

    Camus, E.; Elizalde, J. D.; Morata, D.; Wechsler, C.

    2017-12-01

    In geothermal systems alteration minerals are evidence of hot fluid flow, being present even in absence of other surface manifestations. Because these minerals result from the interaction between geothermal fluids and surrounding host rocks, they will provide information about features of thermal fluids as temperature, composition and pH, allowing tracking their changes and evolution. In this work, we study the Licancura Geothermal field located in the Andean Cordillera in Northern Chile. The combination of Principal Components Analysis on ASTER-L1T imagery and X Ray Diffraction (XRD) allow us to interpret fluid conditions and the areas where fluid flow took place. Results from red, green, blue color composite imagery show the presence of three types of secondary paragenesis. The first one corresponds to hematite and goethite, mainly at the east of the area, in the zone of eroded Pliocene volcanic edifices. The second one, mainly at the center of the area, highlighting propylitic alteration, includes minerals such as chlorite, illite, calcite, zeolites, and epidote. The third paragenesis, spatially related to the intersection between faults, represents advanced argillic alteration, includes minerals as alunite, kaolinite, and jarosite. XRD analysis support results from remote sensing techniques. These results suggest an acid pH hydrothermal fluid reaching temperatures at surface up to 80-100°C, which used faults as a conduit, originating advanced argillic minerals. The same fluid was, probably, responsible for propylitic paragenesis. However, iron oxides paragenesis identified in the area of eroded volcanoes probably corresponds to other processes associated with weathering rather than geothermal activity. In this work, we propose the applicability of remote sensing techniques as a first level exploration tool useful for high-altitude geothermal fields. Detailed clay mineral studies (XRD and SEM) would allow us to a better characterization of the geothermal fluid

  4. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review.

    Science.gov (United States)

    Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Machotta, Andreas; Ronellenfitsch, Ulrich; Scott, Shannon D; Goodridge, Donna; Plishka, Christopher; Groot, Gary

    2016-02-23

    Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.

  5. Clinical pathway for video-assisted thoracic surgery: the Hong Kong story.

    Science.gov (United States)

    Sihoe, Alan D L

    2016-02-01

    A clinical pathway provides a scheduled, objective protocol for the multi-disciplinary, evidence-based management of patients with a specific condition or undergoing a specific procedure. In implementing a clinical pathway for the care of patients receiving video-assisted thoracic surgery (VATS) in Hong Kong, many insights were gained into what makes a clinical pathway work: meticulous preparation and team-building are keys to success; the pathway must be constantly reviewed and revisions made in response to evolving clinical need; and data collection is a key element to allow auditing and clinical research. If these can be achieved, a clinical pathway delivers not only measurable improvements in patient outcomes, but also fundamentally complements clinical advances such as VATS. This article narrates the story of how the clinical pathway for VATS in Hong Kong was created and evolved, highlighting how the above lessons were learned.

  6. Can eye-tracking technology improve situational awareness in paramedic clinical education?

    Science.gov (United States)

    Williams, Brett; Quested, Andrew; Cooper, Simon

    2013-01-01

    Human factors play a significant part in clinical error. Situational awareness (SA) means being aware of one's surroundings, comprehending the present situation, and being able to predict outcomes. It is a key human skill that, when properly applied, is associated with reducing medical error: eye-tracking technology can be used to provide an objective and qualitative measure of the initial perception component of SA. Feedback from eye-tracking technology can be used to improve the understanding and teaching of SA in clinical contexts, and consequently, has potential for reducing clinician error and the concomitant adverse events.

  7. Evaluating the effect of clinical care pathways on quality of cancer care: analysis of breast, colon and rectal cancer pathways.

    Science.gov (United States)

    Bao, Han; Yang, Fengjuan; Su, Shaofei; Wang, Xinyu; Zhang, Meiqi; Xiao, Yaming; Jiang, Hao; Wang, Jiaying; Liu, Meina

    2016-05-01

    Substantial gaps exist between clinical practice and evidence-based cancer care, potentially leading to adverse clinical outcomes and decreased quality of life for cancer patients. This study aimed to evaluate the usefulness of clinical pathways as a tool for improving quality of cancer care, using breast, colon, and rectal cancer pathways as demonstrations. Newly diagnosed patients with invasive breast, colon, and rectal cancer were enrolled as pre-pathway groups, while patients with the same diagnoses treated according to clinical pathways were recruited for post-pathway groups. Compliance with preoperative core biopsy or fine-needle aspiration, utilization of sentinel lymph node biopsy, and proportion of patients whose tumor hormone receptor status was stated in pathology report were significantly increased after implementation of clinical pathway for breast cancer. For colon cancer, compliance with two care processes was significantly improved: surgical resection with anastomosis and resection of at least 12 lymph nodes. Regarding rectal cancer, there was a significant increase in compliance with preoperative evaluation of depth of tumor invasion, total mesorectal excision treatment of middle- or low-position rectal cancer, and proportion of patients who had undergone rectal cancer surgery whose pathology report included margin status. Moreover, total length of hospital stay was decreased remarkably for all three cancer types, and postoperative complications remained unchanged following implementation of the clinical pathways. Clinical pathways can improve compliance with standard care by implementing evidence-based quality indicators in daily practice, which could serve as a useful tool for narrowing the gap between clinical practice and evidence-based care.

  8. [Clinical pathway for management of patients with acute asthma attack].

    Science.gov (United States)

    Azuma, Naoto; Katada, Yoshinori; Kobayashi, Masaaki; Kojima, Makiko; Nakajima, Yumi; Shibano, Miyo; Tomita, Hitomi; Yamanaka, Takao; Harada, Yoshinori; Ishii, Taeko; Saeki, Yukihiko

    2008-11-01

    There have been few reports of clinical pathway (CP) for treatment of asthma attack, because patients with asthma always admit emergently and the severity varies. We introduced CP so that standard asthma treatment can be widely used, and investigated its clinical usefulness. We designed a new CP for treating asthma attack according to the guideline (Japanese guideline (JGL) and Global Initiative for Asthma (GINA)). 136 patients who admitted to our hospital due to asthma attack from January 1999 to November 2006, were enrolled our study. Excluding cases complicated with pneumonia, COPD or cardiac failure, we evaluated 46 cases treated with the CP comparing with 19 cases treated without the CP. The clinical evaluations include systemic and inhaled steroid use, FEV1.0%, history of asthma, and the duration of asthma attack. Furthermore, we investigated difference between cases with and without prolonged admission. While the rates of systemic and inhaled steroid use in cases without the CP were 57.9% and 52.6% respectively, those in cases with the CP were approximately 100%. Employing the CP, FEV 1.0% at discharge time was elevated from 71.7% to 76.3% and the duration of hospitalization was shortened from 14.2 days to 11.5 days. Mean age of the cases with prolonged admission was higher than the rest. The asthma CP is an effective way for the standard treatment according to the guideline to be used widely even by doctors who are not familiar with asthma treatment. It improves the efficacy of in-hospital treatment.

  9. Using location tracking data to assess efficiency in established clinical workflows.

    Science.gov (United States)

    Meyer, Mark; Fairbrother, Pamela; Egan, Marie; Chueh, Henry; Sandberg, Warren S

    2006-01-01

    Location tracking systems are becoming more prevalent in clinical settings yet applications still are not common. We have designed a system to aid in the assessment of clinical workflow efficiency. Location data is captured from active RFID tags and processed into usable data. These data are stored and presented visually with trending capability over time. The system allows quick assessments of the impact of process changes on workflow, and isolates areas for improvement.

  10. Registration of clinical volumes to beams-eye-view images for real-time tracking

    Energy Technology Data Exchange (ETDEWEB)

    Bryant, Jonathan H.; Rottmann, Joerg; Lewis, John H.; Mishra, Pankaj; Berbeco, Ross I., E-mail: rberbeco@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts 02115 (United States); Keall, Paul J. [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales 2006 (Australia)

    2014-12-15

    Purpose: The authors combine the registration of 2D beam’s eye view (BEV) images and 3D planning computed tomography (CT) images, with relative, markerless tumor tracking to provide automatic absolute tracking of physician defined volumes such as the gross tumor volume (GTV). Methods: During treatment of lung SBRT cases, BEV images were continuously acquired with an electronic portal imaging device (EPID) operating in cine mode. For absolute registration of physician-defined volumes, an intensity based 2D/3D registration to the planning CT was performed using the end-of-exhale (EoE) phase of the four dimensional computed tomography (4DCT). The volume was converted from Hounsfield units into electron density by a calibration curve and digitally reconstructed radiographs (DRRs) were generated for each beam geometry. Using normalized cross correlation between the DRR and an EoE BEV image, the best in-plane rigid transformation was found. The transformation was applied to physician-defined contours in the planning CT, mapping them into the EPID image domain. A robust multiregion method of relative markerless lung tumor tracking quantified deviations from the EoE position. Results: The success of 2D/3D registration was demonstrated at the EoE breathing phase. By registering at this phase and then employing a separate technique for relative tracking, the authors are able to successfully track target volumes in the BEV images throughout the entire treatment delivery. Conclusions: Through the combination of EPID/4DCT registration and relative tracking, a necessary step toward the clinical implementation of BEV tracking has been completed. The knowledge of tumor volumes relative to the treatment field is important for future applications like real-time motion management, adaptive radiotherapy, and delivered dose calculations.

  11. Real-time three-dimensional speckle tracking echocardiography: technical aspects and clinical applications

    Directory of Open Access Journals (Sweden)

    Sorrentino R

    2016-11-01

    Full Text Available Regina Sorrentino, Roberta Esposito, Enrica Pezzullo, Maurizio Galderisi Department of Advanced Biomedical Sciences, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy Abstract: Three-dimensional speckle tracking echocardiography (3D STE is a novel technique for the quantification of cardiac deformation based on tracking of ultrasonic speckles in gray scale full-volume 3D images. Developments in ultrasound technologies have made 3D speckle tracking widely available. Two-dimensional echocardiography has intrinsic limitations regarding estimation of left ventricular (LV volumes, ejection fraction, and LV mechanics, due to its inherent foreshortening errors and dependency on geometric models. The development of 3D echocardiography has improved reproducibility and accuracy. Data regarding the feasibility, accuracy, and clinical applications of 3D STE are rapidly assembling. From the tracking results, 3D STE derives several parameters, including longitudinal, circumferential and radial strain, as well as a combined assessment of longitudinal and circumferential strain, termed area strain. 3D STE can also quantify LV rotational movements such as rotation, twist, and torsion. 3D STE provides a better insight on global and regional myocardial deformation. Main applications include detection of subclinical myocardial involvement in heart failure, arterial hypertension, dyssynchrony, and ischemic heart disease. Emerging areas of application include a large spectrum of heart-involving systemic conditions, such as prediction of rejection in heart transplant patients, early detection of cardiotoxicity in patients receiving chemotherapy for cancer, and deeper physiological understanding of LV contraction mechanics in different types of athletes. Aim of this review is to discuss background, technical acquisition and processing aspects as well as recognized and developing clinical applications of this emerging

  12. Tracking of Short Distance Transport Pathways in Biological Tissues by Ultra-Small Nanoparticles

    Science.gov (United States)

    Segmehl, Jana S.; Lauria, Alessandro; Keplinger, Tobias; Berg, John K.; Burgert, Ingo

    2018-03-01

    In this work, ultra-small europium-doped HfO2 nanoparticles were infiltrated into native wood and used as trackers for studying penetrability and diffusion pathways in the hierarchical wood structure. The high electron density, laser induced luminescence, and crystallinity of these particles allowed for a complementary detection of the particles in the cellular tissue. Confocal Raman microscopy and high-resolution synchrotron scanning wide-angle X-ray scattering (WAXS) measurements were used to detect the infiltrated particles in the native wood cell walls. This approach allows for simultaneously obtaining chemical information of the probed biological tissue and the spatial distribution of the integrated particles. The in-depth information about particle distribution in the complex wood structure can be used for revealing transport pathways in plant tissues, but also for gaining better understanding of modification treatments of plant scaffolds aiming at novel functionalized materials.

  13. Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

    Science.gov (United States)

    Feyrer, R; Rösch, J; Weyand, M; Kunzmann, U

    2005-10-01

    Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.

  14. [Review of the initiation and development of the conception of clinical pathway].

    Science.gov (United States)

    Wang, Zhen-E; Shangguan, Qing-Miao; Wu, Ping

    2010-11-01

    Dupont, an American company, used the concept of "pathway" in industry to improve the quality of their products in 1957. In the 1970s, under the pressure of a rise in medical costs, some people realized the concept of the "key pathway" could be used in medicine too. In 1985, the Boston New England Medical Center Hospital (NEMC) succeeded in using the concept of the clinical pathway in medical practice, and afterwards the concept gradually found worldwide application. In 1996, the Fourth Military Medical University in China reported the application of clinical pathway in America. The West China Hospital began to try out the clinical pathway in 1998 and the concept gradually found application in China.

  15. An improved Bayesian tensor regularization and sampling algorithm to track neuronal fiber pathways in the language circuit.

    Science.gov (United States)

    Mishra, Arabinda; Anderson, Adam W; Wu, Xi; Gore, John C; Ding, Zhaohua

    2010-08-01

    The purpose of this work is to design a neuronal fiber tracking algorithm, which will be more suitable for reconstruction of fibers associated with functionally important regions in the human brain. The functional activations in the brain normally occur in the gray matter regions. Hence the fibers bordering these regions are weakly myelinated, resulting in poor performance of conventional tractography methods to trace the fiber links between them. A lower fractional anisotropy in this region makes it even difficult to track the fibers in the presence of noise. In this work, the authors focused on a stochastic approach to reconstruct these fiber pathways based on a Bayesian regularization framework. To estimate the true fiber direction (propagation vector), the a priori and conditional probability density functions are calculated in advance and are modeled as multivariate normal. The variance of the estimated tensor element vector is associated with the uncertainty due to noise and partial volume averaging (PVA). An adaptive and multiple sampling of the estimated tensor element vector, which is a function of the pre-estimated variance, overcomes the effect of noise and PVA in this work. The algorithm has been rigorously tested using a variety of synthetic data sets. The quantitative comparison of the results to standard algorithms motivated the authors to implement it for in vivo DTI data analysis. The algorithm has been implemented to delineate fibers in two major language pathways (Broca's to SMA and Broca's to Wernicke's) across 12 healthy subjects. Though the mean of standard deviation was marginally bigger than conventional (Euler's) approach [P. J. Basser et al., "In vivo fiber tractography using DT-MRI data," Magn. Reson. Med. 44(4), 625-632 (2000)], the number of extracted fibers in this approach was significantly higher. The authors also compared the performance of the proposed method to Lu's method [Y. Lu et al., "Improved fiber tractography with Bayesian

  16. Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care.

    Science.gov (United States)

    Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S

    2017-01-01

    The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.

  17. Creating an effort tracking tool to improve therapeutic cancer clinical trials workload management and budgeting.

    Science.gov (United States)

    James, Pam; Bebee, Patty; Beekman, Linda; Browning, David; Innes, Mathew; Kain, Jeannie; Royce-Westcott, Theresa; Waldinger, Marcy

    2011-11-01

    Quantifying data management and regulatory workload for clinical research is a difficult task that would benefit from a robust tool to assess and allocate effort. As in most clinical research environments, The University of Michigan Comprehensive Cancer Center (UMCCC) Clinical Trials Office (CTO) struggled to effectively allocate data management and regulatory time with frequently inaccurate estimates of how much time was required to complete the specific tasks performed by each role. In a dynamic clinical research environment in which volume and intensity of work ebbs and flows, determining requisite effort to meet study objectives was challenging. In addition, a data-driven understanding of how much staff time was required to complete a clinical trial was desired to ensure accurate trial budget development and effective cost recovery. Accordingly, the UMCCC CTO developed and implemented a Web-based effort-tracking application with the goal of determining the true costs of data management and regulatory staff effort in clinical trials. This tool was developed, implemented, and refined over a 3-year period. This article describes the process improvement and subsequent leveling of workload within data management and regulatory that enhanced the efficiency of UMCCC's clinical trials operation.

  18. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy.

    Science.gov (United States)

    Khan, Sitara G; Klettas, Dimitris; Kapetanakis, Stam; Monaghan, Mark J

    2016-03-01

    Cardiac resynchronisation therapy (CRT) can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain) has conventionally been assessed using tissue Doppler imaging (TDI), which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference ('speckles') in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT. © 2016 The authors.

  19. Clinical utility of speckle-tracking echocardiography in cardiac resynchronisation therapy

    Directory of Open Access Journals (Sweden)

    Sitara G Khan

    2016-05-01

    Full Text Available Cardiac resynchronisation therapy (CRT can profoundly improve outcome in selected patients with heart failure; however, response is difficult to predict and can be absent in up to one in three patients. There has been a substantial amount of interest in the echocardiographic assessment of left ventricular dyssynchrony, with the ultimate aim of reliably identifying patients who will respond to CRT. The measurement of myocardial deformation (strain has conventionally been assessed using tissue Doppler imaging (TDI, which is limited by its angle dependence and ability to measure in a single plane. Two-dimensional speckle-tracking echocardiography is a technique that provides measurements of strain in three planes, by tracking patterns of ultrasound interference (‘speckles’ in the myocardial wall throughout the cardiac cycle. Since its initial use over 15 years ago, it has emerged as a tool that provides more robust, reproducible and sensitive markers of dyssynchrony than TDI. This article reviews the use of two-dimensional and three-dimensional speckle-tracking echocardiography in the assessment of dyssynchrony, including the identification of echocardiographic parameters that may hold predictive potential for the response to CRT. It also reviews the application of these techniques in guiding optimal LV lead placement pre-implant, with promising results in clinical improvement post-CRT.

  20. The role of clinical pathway on the outcomes of ischemic stroke patients at Bethesda Hospital Yogyakarta

    Directory of Open Access Journals (Sweden)

    Francisca Diana Alexandra, Iwan Dwiprahasto, Rizaldy Pinzon

    2014-04-01

    Full Text Available Stroke becomes world health problem all over the world because it is the causal factor of high mortality and disability. Good and well-organized process of healthcare service will improve the outcome of the patients with stroke. Clinical pathway may be used as clear standard to help reduce unnecessary variations of medical treatment and measure. The study aimed at finding out the correlation between the use of clinical pathway and the outcome of the patients with ischemic stroke in Bethesda Hospital Yogyakarta. It was an observational and analytic study with cohort restorative study design. The author compared the outcomes of acute ischemic stroke between the group with clinical pathway and the group without the clinical pathway. Data was collected using consecutive sampling from the electronic registry and medical record data of the patients from January 1st, 2011 to December 31st, 2011. It was conducted to 124 patients with ischemic stroke assigned to two groups (the first groups of 62 patients with clinical pathway and the second groups of 62 patients without clinical pathway. The basic characteristics of the two groups were the same. The results of the analysis showed that there was a significant decrease in the incidence of complication and a significant increase in the use of antiplatelete drugs, antidiabetic drugs and statin as secondary preventive measure of the recurrent stroke. There was not any significant difference in the duration of the hospitalized healthcare, the financing and the mortality between the two observation groups. The study indicated that the use of the clinical pathway in the stroke treatment improved the outcome of the patients with stroke. It was necessary to conduct further study to evaluate the effectiveness of the clinical pathway in improving the outcome of the patients with bigger number of the subjects and the longer period of time.

  1. Effects of clinical pathways in the joint replacement: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Faggiano F

    2009-07-01

    Full Text Available Abstract Background A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs. Methods Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched. The search was performed from 1975 to 2007. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Jadad methodological approach and on the New Castle Ottawa Scale. Data analysis abided by the guidelines set out by The Cochrane Collaboration regarding statistical methods. Meta-analyses were performed using RevMan software, version 4.2. Results Twenty-two studies met the study inclusion criteria and were included in the meta-analysis for a total sample of 6,316 patients. The aggregate overall results showed significantly fewer patients suffering postoperative complications in the clinical pathways group when compared with the standard care group. A shorter length of stay in the clinical pathway group was also observed and lower costs during hospital stay were associated with the use of the clinical pathways. No significant differences were found in the rates of discharge to home. Conclusion The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way

  2. Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

    Science.gov (United States)

    Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

    2018-02-27

    Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley

  3. Real-time non-rigid target tracking for ultrasound-guided clinical interventions

    Science.gov (United States)

    Zachiu, C.; Ries, M.; Ramaekers, P.; Guey, J.-L.; Moonen, C. T. W.; de Senneville, B. Denis

    2017-10-01

    Biological motion is a problem for non- or mini-invasive interventions when conducted in mobile/deformable organs due to the targeted pathology moving/deforming with the organ. This may lead to high miss rates and/or incomplete treatment of the pathology. Therefore, real-time tracking of the target anatomy during the intervention would be beneficial for such applications. Since the aforementioned interventions are often conducted under B-mode ultrasound (US) guidance, target tracking can be achieved via image registration, by comparing the acquired US images to a separate image established as positional reference. However, such US images are intrinsically altered by speckle noise, introducing incoherent gray-level intensity variations. This may prove problematic for existing intensity-based registration methods. In the current study we address US-based target tracking by employing the recently proposed EVolution registration algorithm. The method is, by construction, robust to transient gray-level intensities. Instead of directly matching image intensities, EVolution aligns similar contrast patterns in the images. Moreover, the displacement is computed by evaluating a matching criterion for image sub-regions rather than on a point-by-point basis, which typically provides more robust motion estimates. However, unlike similar previously published approaches, which assume rigid displacements in the image sub-regions, the EVolution algorithm integrates the matching criterion in a global functional, allowing the estimation of an elastic dense deformation. The approach was validated for soft tissue tracking under free-breathing conditions on the abdomen of seven healthy volunteers. Contact echography was performed on all volunteers, while three of the volunteers also underwent standoff echography. Each of the two modalities is predominantly specific to a particular type of non- or mini-invasive clinical intervention. The method demonstrated on average an accuracy of

  4. A fast-track anaemia clinic in the Emergency Department: cost-analysis of intravenous iron administration for treating iron-deficiency anaemia.

    Science.gov (United States)

    Quintana-Díaz, Manuel; Muñoz-Romo, Raúl; Gómez-Ramírez, Susana; Pavía, José; Borobia, Alberto M; García-Erce, José A; Muñoz, Manuel

    2017-09-01

    A fast-track anaemia clinic (FTAC) for the management of moderate-to-severe iron-deficiency anaemia (IDA) was established in our Emergency Department in 2010. In this FTAC, the replacement of packed red cell transfusion by ferric carboxymaltose administration was proven to be safe and effective. The aim of this study was a cost-analysis of IDA management in the FTAC, comparing this management with the previous standard care pathway consisting of packed red cell transfusion, if needed, and referral to outpatient specialised care. A cost study was performed for patients with IDA who were at risk of requiring transfusion (haemoglobin costs in the FTAC were compared to those theoretically incurred if these patients had been managed using the standard care pathway. In addition, a sensitivity analysis considering variations of up to ±30% in ferric carboxymaltose and packed red cell acquisition costs was performed (49 possible scenarios). Between 2012 and 2015, 238 IDA patients were treated in the FTAC. The average treatment cost was € 594±337/patient in the FTAC group and € 672±301/patient in the standard care pathway group, with a saving of € 78±28/patient (95% CI, 22-133; pcosts in the FTAC (€ 480-722/patient), compared with those of the standard care pathway (€ 550-794/patient), resulted in significant cost-savings for all studied scenarios (€ 51-104/patient; pcost-saving compared with the standard care pathway.

  5. A national clinical quality program for Veterans Affairs catheterization laboratories (from the Veterans Affairs clinical assessment, reporting, and tracking program).

    Science.gov (United States)

    Maddox, Thomas M; Plomondon, Mary E; Petrich, Megan; Tsai, Thomas T; Gethoffer, Hans; Noonan, Gregory; Gillespie, Brian; Box, Tamara; Fihn, Stephen D; Jesse, Robert L; Rumsfeld, John S

    2014-12-01

    A "learning health care system", as outlined in a recent Institute of Medicine report, harnesses real-time clinical data to continuously measure and improve clinical care. However, most current efforts to understand and improve the quality of care rely on retrospective chart abstractions complied long after the provision of clinical care. To align more closely with the goals of a learning health care system, we present the novel design and initial results of the Veterans Affairs (VA) Clinical Assessment, Reporting, and Tracking (CART) program-a national clinical quality program for VA cardiac catheterization laboratories that harnesses real-time clinical data to support clinical care and quality-monitoring efforts. Integrated within the VA electronic health record, the CART program uses a specialized software platform to collect real-time patient and procedural data for all VA patients undergoing coronary procedures in VA catheterization laboratories. The program began in 2005 and currently contains data on 434,967 catheterization laboratory procedures, including 272,097 coronary angiograms and 86,481 percutaneous coronary interventions, performed by 801 clinicians on 246,967 patients. We present the initial data from the CART program and describe 3 quality-monitoring programs that use its unique characteristics-procedural and complications feedback to individual labs, coronary device surveillance, and major adverse event peer review. The VA CART program is a novel approach to electronic health record design that supports clinical care, quality, and safety in VA catheterization laboratories. Its approach holds promise in achieving the goals of a learning health care system. Published by Elsevier Inc.

  6. PI3K/AKT/mTOR Pathway in Ovarian Cancer Treatment: Are We on the Right Track?

    Science.gov (United States)

    Gasparri, Maria Luisa; Bardhi, Erlisa; Ruscito, Ilary; Papadia, Andrea; Farooqi, Ammad Ahmad; Marchetti, Claudia; Bogani, Giorgio; Ceccacci, Irene; Mueller, Michael D; Benedetti Panici, Pierluigi

    2017-10-01

    The high recurrence rate and the low overall survival in ovarian cancer suggest that a more specific therapeutic approach in addition to conventional treatment is required. Translational and clinical research is investigating new molecular targets in order to find an alternative way to affect tumor growth and to minimize the overlap of toxicity of antiblastic agents. Given its implication in many cellular activities including regulation of cell growth, motility, survival, proliferation, protein synthesis, autophagy, transcription, as well as angiogenesis, PI3K/AKT/mTOR is one of the most investigated intracellular signaling pathways. A dis-regulation of this pathway has been shown in several tumors, including ovarian cancer. In this setting, mTor proteins represent a potential target for inhibitors, which could ultimately play a pivotal role in counteracting cellular proliferation. Recently, mTor inhibitors have been approved in the treatment of pancreatic neuroendocrine tumors, mantle cell lymphoma and renal cancer. Clinical trials have assessed the safety of these drugs in ovarian cancer patients. Ongoing phase I and II studies are evaluating the oncologic outcome of mTor inhibitor treatment and its effect in combination with conventional chemotherapy and target agents.

  7. Clinically viable magnetic poly(lactide-co-glycolide) (PLGA) particles for MRI-based cell tracking

    Science.gov (United States)

    Granot, Dorit; Nkansah, Michael K.; Bennewitz, Margaret F.; Tang, Kevin S.; Markakis, Eleni A.; Shapiro, Erik M.

    2013-01-01

    Purpose To design, fabricate, characterize and in vivo assay clinically viable magnetic particles for MRI-based cell tracking. Methods PLGA encapsulated magnetic nano- and microparticles were fabricated. Multiple biologically relevant experiments were performed to assess cell viability, cellular performance and stem cell differentiation. In vivo MRI experiments were performed to separately test cell transplantation and cell migration paradigms, as well as in vivo biodegradation. Results Highly magnetic nano- (~100 nm) and microparticles (~1–2 μm) were fabricated. Magnetic cell labeling in culture occurred rapidly achieving 3–50 pg Fe/cell at 3 hrs for different particles types, and >100 pg Fe/cell after 10 hours, without the requirement of a transfection agent, and with no effect on cell viability. The capability of magnetically labeled mesenchymal or neural stem cells to differentiate down multiple lineages, or for magnetically labeled immune cells to release cytokines following stimulation, was uncompromised. An in vivo biodegradation study revealed that NPs degraded ~80% over the course of 12 weeks. MRI detected as few as 10 magnetically labeled cells, transplanted into the brains of rats. Also, these particles enabled the in vivo monitoring of endogenous neural progenitor cell migration in rat brains over 2 weeks. Conclusion The robust MRI properties and benign safety profile of these particles make them promising candidates for clinical translation for MRI-based cell tracking. PMID:23568825

  8. CSF Proteomics Identifies Specific and Shared Pathways for Multiple Sclerosis Clinical Subtypes.

    Directory of Open Access Journals (Sweden)

    Timucin Avsar

    Full Text Available Multiple sclerosis (MS is an immune-mediated, neuro-inflammatory, demyelinating and neurodegenerative disease of the central nervous system (CNS with a heterogeneous clinical presentation and course. There is a remarkable phenotypic heterogeneity in MS, and the molecular mechanisms underlying it remain unknown. We aimed to investigate further the etiopathogenesis related molecular pathways in subclinical types of MS using proteomic and bioinformatics approaches in cerebrospinal fluids of patients with clinically isolated syndrome, relapsing remitting MS and progressive MS (n=179. Comparison of disease groups with controls revealed a total of 151 proteins that are differentially expressed in clinically different MS subtypes. KEGG analysis using PANOGA tool revealed the disease related pathways including aldosterone-regulated sodium reabsorption (p=8.02x10-5 which is important in the immune cell migration, renin-angiotensin (p=6.88x10-5 system that induces Th17 dependent immunity, notch signaling (p=1.83x10-10 pathway indicating the activated remyelination and vitamin digestion and absorption pathways (p=1.73x10-5. An emerging theme from our studies is that whilst all MS clinical forms share common biological pathways, there are also clinical subtypes specific and pathophysiology related pathways which may have further therapeutic implications.

  9. Evaluating Dopamine Reward Pathway in ADHD; clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Kollins, S.H., Wigal, t.L.; Newcorn, J.H.; Telang, F.; Fowler, J.S.; Zhu, W.; Logan, J.; Ma, Y.; Pradhan, K.; Wong, C.T.; Swanson, J.M.

    2009-09-09

    Attention-deficit/hyperactivity disorder (ADHD) - characterized by symptoms of inattention and hyperactivity-impulsivity - is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). We used positron emission tomography to measure dopamine synaptic markers (transporters and D{sub 2}/D{sub 3} receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [{sup 11}C]cocaine and for D{sub 2}/D{sub 3} receptors using [{sup 11}C]raclopride, quantified as binding potential (distribution volume ratio -1). For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P < .005) in regions of the dopamine reward pathway in the left side of the brain. Region-of-interest analyses corroborated these findings. The mean (95% confidence interval [CI] of mean difference) for DAT in the nucleus accumbens for controls was 0.71 vs 0.63 for those with ADHD (95% CI, 0.03-0.13, P = .004) and in the midbrain for controls was 0.16 vs 0.09 for those with ADHD (95% CI, 0.03-0.12; P {le} .001); for D{sub 2}/D{sub 3} receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D{sub 2}/D{sub 3} for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0

  10. Evaluating Dopamine Reward Pathway in ADHD; clinical implications

    International Nuclear Information System (INIS)

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Kollins, S.H.; Wigal, T.L.; Newcorn, J.H.; Telang, F.; Fowler, J.S.; Zhu, W.; Logan, J.; Ma, Y.; Pradhan, K.; Wong, C.T.; Swanson, J.M.

    2009-01-01

    Attention-deficit/hyperactivity disorder (ADHD) - characterized by symptoms of inattention and hyperactivity-impulsivity - is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). We used positron emission tomography to measure dopamine synaptic markers (transporters and D 2 /D 3 receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [ 11 C]cocaine and for D 2 /D 3 receptors using [ 11 C]raclopride, quantified as binding potential (distribution volume ratio -1). For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P 2 /D 3 receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D 2 /D 3 for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0.10-0.56; P = .005) and differences in D 2 /D 3 in the hypothalamic region, with controls having a mean of 0.12 vs 0.05 for those with ADHD (95% CI, 0.02-0.12; P = .004). Ratings of attention correlated with D 2 /D 3 in the accumbens (r = 0.35; 95% CI, 0.15-0.52; P = .001), midbrain (r = 0.35; 95% CI, 0.14-0.52; P = .001), caudate (r = 0.32; 95% CI, 0.11-0.50; P = .003), and hypothalamic (r = 0.31; CI, 0.10-0.49; P = .003) regions and with DAT in the midbrain

  11. SU-G-JeP1-05: Clinical Impact of MLC Tracking for Lung SABR

    Energy Technology Data Exchange (ETDEWEB)

    Caillet, V; Colvill, E [Faculty of Medecine, The University of Sydney, Sydney, NSW (Australia); Royal North Shore Hospital, Sydney, NSW (Australia); Szymura, K; Stevens, M; Booth, J [Royal North Shore Hospital, Sydney, NSW (Australia); Keall, P [Faculty of Medecine, The University of Sydney, Sydney, NSW (Australia)

    2016-06-15

    Purpose: The objective of this study was to investigate the dosimetric benefits of multi-leaf collimator (MLC) tracking for lung SABR treatments in end-to-end clinically realistic planning and delivery scenarios. Methods: The clinical benefits of MLC tracking were assessed using previously delivered treatment plans and physical experiments. The 10 most recent single lesion lung SABR patients were re-planned following a 4D-GTV-based real-time adaptive protocol (PTV defined as the end-of-exhalation GTV plus 5.0 mm margins). The plans were delivered on a Trilogy Varian linac. Electromagnetic transponders (Calypso, Varian Medical Systems, USA) were embedded into a programmable moving phantom (HexaMotion platform) tracked with the Varian Calypso system. For each physical experiment, the MLC positions were collected and used as input for dose reconstruction. For both planned and physical experiments, the OAR dose metrics from the conventional and real-time adaptive SABR plans (Mean Lung Dose (MLD), V20 for lung, and near-maximum dose (D2%) for spine and heart) were statistically compared. The Wilcoxon test was used to compare plan and physical experiment dose metrics. Results: While maintaining target coverage, percentage reductions in dose metrics to the OARs were observed for both planned and physical experiments. Comparing the two plans showed MLD percentage reduction (MLDr) of 25.4% (absolute differences of 1.41 Gy) and 28.9% (1.29%) for the V20r. D2% percentage reduction for spine and heart were respectively 27.9% (0.3 Gy) and 20.2% (0.3 Gy). For the physical experiments, MLDr was 23.9% (1.3 Gy), and V20r 37.4% (1.6%). D2% reduction for spine and heart were respectively 27.3% (0.3 Gy) and 19.6% (0.3 Gy). For both plans and physical experiments, significant OAR dose differences (p<0.05) were found between the conventional SABR and real-time adaptive plans. Conclusion: Application of MLC tracking for lung SABR patients has the potential to reduce the dose to OARs

  12. SU-E-T-183: Clinical Quality Assurance Workflow for Dynamic Tumor Tracking Radiation Dose Delivery

    International Nuclear Information System (INIS)

    Mamalui-Hunter, M; Su, Z; Li, Z

    2015-01-01

    Purpose: One of the most important aspects of implementation of new treatment modalities is an ‘end-to-end’ verification of the treatment process. Radiation treatment based on dynamic tracking of a tumor is highly patient-specific, therefore, special attention should be paid to quality assurance of the treatment delivery. Our goal was to design the clinical workflow that ensures accurate delivery of the planned dose using the Dynamic Target Tracking option of VeroTM (BrainLab,MHI) linac. Methods: A patient simulation is designed to include a pre-treatment session to verify whether the system can reliably track the motion of the implanted marker and build the 4D model of the target motion. The external surrogate and target motion patterns are recorded in the ExactracTM log files. In this work, a spectrum of custom marker and external surrogate motion trajectories closely resembling the patient specific motion patterns was used. 1mm thick/11mm long VisicoilTM marker was placed 15 and 20mm from the center of the spherical tissue equivalent target (centroid to centroid distance) in the 4D motion phantom (CIRSTM). 3D conformal (3 mm block margin) SBRT plans were delivered to 2 moving targets in the phantom: 1) 20mm diameter target that allows ion chamber dose measurement and 2) 25mm target that allows using film to measure CAX dose (GafchromicTM EBT3 used). The measured dose was compared to the iPlanTM TPS results using MonteCarlo algorithm (1% variance, Dose-to-water). Results: On average, film shows 98.9% pass using gamma criterion for 2% and 2mm DTA, 94.3% match for 2% and 1 mm DTA, 98% pass for 1% and 2 mm DTA however only 88% points passing for 1% and 1 mm DTA. Ion chamber measurements agreed with the calculation within 1.5%. Conclusion: The clinical QA workflow was designed for SBRT delivery using real-time tumor tracking on VeroTM linac

  13. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING.

    Science.gov (United States)

    Franco, Matheus Cavalcante; Nakao, Frank Shigueo; Rodrigues, Rodrigo; Maluf-Filho, Fauze; Paulo, Gustavo Andrade de; Libera, Ermelindo Della

    2015-12-01

    Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  14. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Matheus Cavalcante FRANCO

    2015-12-01

    Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  15. Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study.

    Science.gov (United States)

    Wichmann, Matthias W; Eben, Ricarda; Angele, Martin K; Brandenburg, Franzis; Goetz, Alwin E; Jauch, Karl-Walter

    2007-07-01

    Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery. Forty patients underwent either conventional or fast-track rehabilitation after colorectal surgery. In addition to clinical parameters (return of gastrointestinal function, food intake, pain score, complication rates and postoperative length of stay), we determined parameters of perioperative immunity by flow cytometry (lymphocyte subgroups) and enzyme-linked immunosorbent assay (interleukin-6). Our findings indicate a better-preserved cell-mediated immune function (T cells, T-helper cells, natural killer cells) after fast-track rehabilitation, whereas the pro-inflammatory response (C-reactive protein, interleukin-6) was unchanged in both study groups. Furthermore, we detected a significantly faster return of gastrointestinal function (first bowel movement P<0.001, food intake P<0.05), significantly reduced pain scores in the postoperative course (P < 0.05) and a significantly shorter length of postoperative stay (P<0.001) in patients undergoing fast-track rehabilitation. Fast-track rehabilitation after colorectal surgery results in better-preserved cell-mediated immunity when compared with conventional postoperative care. Furthermore, patients undergoing fast-track rehabilitation suffer from less pain and have a faster return of gastrointestinal function in the postoperative course. In addition, postoperative length of hospital stay was significantly shorter in fast-track patients.

  16. The glenoid track: a review of the clinical relevance, method of calculation and current evidence behind this method

    Energy Technology Data Exchange (ETDEWEB)

    Younan, Yara; Wong, Philip K.; Umpierrez, Monica; Gonzalez, Felix; Singer, Adam Daniel [Emory University Hospital, Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Karas, Spero [Emory University Hospital, Department of Orthopedic Surgery, Atlanta, GA (United States); Jose, Jean [University of Miami, Department of Radiology, Miami, FL (United States)

    2017-12-15

    In the setting of bipolar bone injury, orthopedic surgeons are currently making use of the glenoid track method to guide surgical management. Using preoperative CT or MR imaging, this method allows the identification of patients who are more likely to fail a primary capsuloligamentous Bankart repair. As the glenoid track method becomes increasingly used in preoperative planning, it is important for the radiologist to become familiar with its concept and method of calculation. This review article aims to concisely summarize the current literature and the clinical implications of the glenoid track method. (orig.)

  17. SU-F-T-100: Development and Implementation of a Treatment Planning Tracking System Into the Radiation Oncology Clinic

    International Nuclear Information System (INIS)

    Kabat, C; Cline, K; Li, Y; Ha, C; Stathakis, S

    2016-01-01

    Purpose: With increasing numbers of cancer patients being diagnosed and the complexity of radiotherapy treatments rising it’s paramount that patient plan development continues to stay fluid within the clinic. In order to maintain a high standard of care and clinical efficiency the establishment of a tracking system for patient plan development allows healthcare providers to view real time plan progression and drive clinical workflow. In addition, it provides statistical datasets which can further identify inefficiencies within the clinic. Methods: An application was developed utilizing Microsoft’s ODBC SQL database engine to track patient plan status throughout the treatment planning process while also managing key factors pertaining to the patient’s treatment. Pertinent information is accessible to staff in many locations, including tracking monitors within dosimetry, the clinic network for both computers and handheld devices, and through email notifications. Plans are initiated with a CT and continually tracked through planning stages until final approval by staff. Patient’s status is dynamically updated by the physicians, dosimetrists, and medical physicists based on the stage of the patient’s plan. Results: Our application has been running over a six month period with all patients being processed through the system. Modifications have been made to allow for new features to be implemented along with additional tracking parameters. Based on in-house feedback, the application has been supportive in streamlining patient plans through the treatment planning process and data has been accumulating to further improve procedures within the clinic. Conclusion: Over time the clinic will continue to track data with this application. As data accumulates the clinic will be able to highlight inefficiencies within the workflow and adapt accordingly. We will add in new features to help support the treatment planning process in the future.

  18. SU-F-T-100: Development and Implementation of a Treatment Planning Tracking System Into the Radiation Oncology Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Kabat, C; Cline, K; Li, Y; Ha, C; Stathakis, S [University of Texas HSC SA, San Antonio, TX (United States)

    2016-06-15

    Purpose: With increasing numbers of cancer patients being diagnosed and the complexity of radiotherapy treatments rising it’s paramount that patient plan development continues to stay fluid within the clinic. In order to maintain a high standard of care and clinical efficiency the establishment of a tracking system for patient plan development allows healthcare providers to view real time plan progression and drive clinical workflow. In addition, it provides statistical datasets which can further identify inefficiencies within the clinic. Methods: An application was developed utilizing Microsoft’s ODBC SQL database engine to track patient plan status throughout the treatment planning process while also managing key factors pertaining to the patient’s treatment. Pertinent information is accessible to staff in many locations, including tracking monitors within dosimetry, the clinic network for both computers and handheld devices, and through email notifications. Plans are initiated with a CT and continually tracked through planning stages until final approval by staff. Patient’s status is dynamically updated by the physicians, dosimetrists, and medical physicists based on the stage of the patient’s plan. Results: Our application has been running over a six month period with all patients being processed through the system. Modifications have been made to allow for new features to be implemented along with additional tracking parameters. Based on in-house feedback, the application has been supportive in streamlining patient plans through the treatment planning process and data has been accumulating to further improve procedures within the clinic. Conclusion: Over time the clinic will continue to track data with this application. As data accumulates the clinic will be able to highlight inefficiencies within the workflow and adapt accordingly. We will add in new features to help support the treatment planning process in the future.

  19. Tracking the workforce: the American Society of Clinical Oncology workforce information system.

    Science.gov (United States)

    Kirkwood, M Kelsey; Kosty, Michael P; Bajorin, Dean F; Bruinooge, Suanna S; Goldstein, Michael A

    2013-01-01

    In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. THE WIS REPORT IS COMPOSED OF THREE SECTIONS: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages.

  20. Tracking the Workforce: The American Society of Clinical Oncology Workforce Information System

    Science.gov (United States)

    Kirkwood, M. Kelsey; Kosty, Michael P.; Bajorin, Dean F.; Bruinooge, Suanna S.; Goldstein, Michael A.

    2013-01-01

    Purpose: In anticipation of oncologist workforce shortages projected as part of a 2007 study, the American Society of Clinical Oncology (ASCO) worked with a contractor to create a workforce information system (WIS) to assemble the latest available data on oncologist supply and cancer incidence and prevalence. ASCO plans to publish findings annually, reporting on new data and tracking trends over time. Methods: The WIS report is composed of three sections: supply, new entrants, and cancer incidence and prevalence. Tabulations of the number of oncologists in the United States are derived mainly from the American Medical Association Physician Masterfile. Information on fellows and residents in the oncology workforce pipeline come from published sources such as Journal of the American Medical Association. Incidence and prevalence estimates are published by the American Cancer Society and National Cancer Institute. Results: The WIS reports a total of 13,084 oncologists working in the United States in 2011. Oncologists are defined as those physicians who designate hematology, hematology/oncology, or medical oncology as their specialty. The WIS compares the characteristics of these oncologists with those of all physicians and tracks emerging trends in the physician training pipeline. Conclusion: Observing characteristics of the oncologist workforce over time allows ASCO to identify, prioritize, and evaluate its workforce initiatives. Accessible figures and reports generated by the WIS can be used by ASCO and others in the oncology community to advocate for needed health care system and policy changes to help offset future workforce shortages. PMID:23633965

  1. [Analysis of Applying Chinese Medical Clinical Pathway for Treating Attention-deficit Hyperactivity Disorder].

    Science.gov (United States)

    Guo, Yu-qing; Han, Xin-min; Zhu, Xian-kang; Zhou, Zheng; Ma, Bing-xiang; Zhang, Bao-qing; Li, Yan-ning; Feng, Yu-lin; Xue, Zheng; Wang, Yong-hong; Li, Yi-min; Jiang, Zhi-mei; Xu, Jin-xing; Yue, Wei-zhen; Xiang, Xi-xiong

    2015-12-01

    To evaluate the application effect of Chinese medical clinical pathway for treating attention-deficit hyperactivity disorder (ADHD), and to provide evidence for further improving clinical pathways. Totally 270 ADHD children patients were recruited and treated at pediatrics clinics of 9 cooperative hospitals from December 2011 to December 2012. The treatment course for all was 3 months. Scores of attention deficit and hyperactivity rating scale, scores of behavior, Conners index of hyperactivity (CIH), and Chinese medical syndrome scores were compared between before and after treatment. The efficacy difference in various sexes, ages, and disease courses were evaluated by judging standards for Chinese medical syndrome and ADHD. Fifteen children patients who entered clinical pathway dropped out, and the rest 255 completed this trial. Compared with before treatment, total scores of attention deficit and hyperactivity rating scale, scores of attention deficit and hyperactivity rating scale, CIH, and Chinese medical syndrome scores obviously decreased (all P < 0.01). The total effective rate in disease efficacy was 87.8% (224/255 cases), and the total effective rate in Chinese medical syndrome curative effect was 87.5% (223/255 cases). The clinical curative effect was not influenced by age, gender, or course of disease when statistically analyzed from judging standards for Chinese medical syndrome or for disease efficacy. Intervention by Chinese medical clinical pathway could improve ADHD patients' symptoms, and its efficacy was not influenced by sex, age, or course of disease.

  2. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

    2013-05-22

    The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process

  3. CLINICAL PATHWAYS IN 17 EUROPEAN UNION COUNTRIES: A SURVEY OF EXPERT OPINIONS

    Directory of Open Access Journals (Sweden)

    Don Hindle

    2004-11-01

    Full Text Available Background. The main focus of the survey is on the extent to which clinical pathways are being used, and whether it might provide a basis for improved service planning and consequently strategic asset planning in health care.Methods. In the first stage, our aim was to make contact with one agency in each country (the primary agency below that would be able to provide contacts within that country with a mix of experts from each of the following types of agencies: Health sector government regulator, Health care purchasing (insurance agencies, Senior clinical managers in hospitals, Senior clinical managers in non-hospital care provider agencies (eg, home care, or primary medical care, Health professional societies (preferably medical and nursing, Accreditation or audit agencies, Consumer associations and Public or private agencies concerned with health facilities development. Definitions of these agencies and other terms were attached to the questionnaire itself. We would then ask the primary agency to choose the experts that were most likely to be aware of clinical pathway use. The persons thus contacted would then be asked to complete the questionnaire and send it back to the researchers. The aim was not to attempt to establish a random sample, but rather to target well-informed people.Results. 51 completed questionnaires were provided by largely self-selected experts from 17 EU countries. Respondents reported that pathways are important and becoming increasingly widely used (although the rate of progress is highly variable, the main constraints to their use are a cultural aversion among doctors and little encouragement from external parties, and there is growing recognition that multi-setting pathways have the greatest potential value.Conclusions. More needs to be done to achieve a common understanding of the ideas of pathways, strategic asset planning, and the interrelationships. Systems problems need systems solutions. In the case of clinical

  4. Initial assessment of tumor tracking with a gimbaled linac system in clinical circumstances: A patient simulation study

    International Nuclear Information System (INIS)

    Depuydt, Tom; Poels, Kenneth; Verellen, Dirk; Engels, Benedikt; Collen, Christine; Haverbeke, Chloe; Gevaert, Thierry; Buls, Nico; Van Gompel, Gert; Reynders, Truus; Duchateau, Michael; Tournel, Koen; Boussaer, Marlies; Steenbeke, Femke; Vandenbroucke, Frederik; De Ridder, Mark

    2013-01-01

    Purpose: To have an initial assessment of the Vero Dynamic Tracking workflow in clinical circumstances and quantify the performance of the tracking system, a simulation study was set up on 5 lung and liver patients. Methods and materials: The preparatory steps of a tumor tracking treatment, based on fiducial markers implanted in the tumor, were executed allowing pursuit of the tumor with the gimbaled linac and monitoring X-rays acquisition, however, without activating the 6 MV beam. Data were acquired on workflow time-efficiency, tracking accuracy and imaging exposure. Results: The average time between the patient entering the treatment room and the first treatment field was about 9 min. The time for building the correlation model was 3.2 min. Tracking errors of 0.55 and 0.95 mm (1σ) were observed in PAN/TILT direction and a 2D range of 3.08 mm. A skin dose was determined of 0.08 mGy/image, with a source-to-skin distance of 900 mm and kV exposure of 1 mAs. On average 1.8 mGy/min kV skin dose was observed for 1 Hz monitoring. Conclusion: The Vero tracking solution proved to be fully functional and showed performance comparable with other real-time tracking systems

  5. Clinical pathway across tertiary and community care after an interventional cardiology procedure.

    Science.gov (United States)

    Doran, K; Sampson, B; Staus, R; Ahern, C; Schiro, D

    1997-01-01

    Many patients who receive medical interventional cardiology procedures at a tertiary hospital live outside the metropolitan area and may experience fragmentation in care, less emotional support by family members, inaccurate and delayed communication, and lack of educational follow-up on discharge from the hospital. A clinical pathway titled "Heart Health Care Patterns" was developed to link acute phase, recovery phase, rehabilitation phase, and enhancement/maintenance phase. The 12-month clinical pathway combines Gordon's Functional Health Patterns and the Omaha System developed by the Omaha Visiting Nurse Association. The rating scale for outcomes assesses the patient at different phases to provide objective data and information throughout the year.

  6. Experimenting Clinical Pathways in General Practice: a Focus Group Investigation with Italian General Practitioners

    Science.gov (United States)

    Zannini, Lucia; Cattaneo, Cesarina; Peduzzi, Paolo; Lopiccoli, Silvia; Auxilia, Francesco

    2012-01-01

    Background Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment. Acknowledgments the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers. PMID:25181354

  7. Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

    Directory of Open Access Journals (Sweden)

    Lucia Zannini

    2012-07-01

    Full Text Available Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB, Italy, to develop general practitioners’ (GPs care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i clinical pathways can result in GPs working in a more efficient and effective fashion; ii they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

  8. Disease-specific clinical pathways - are they feasible in primary care? A mixed-methods study.

    Science.gov (United States)

    Grimsmo, Anders; Løhre, Audhild; Røsstad, Tove; Gjerde, Ingunn; Heiberg, Ina; Steinsbekk, Aslak

    2018-04-12

    To explore the feasibility of disease-specific clinical pathways when used in primary care. A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings. Primary care and specialist care collaborating to manage care coordination. Primary-care representatives expressed that their patients often have complex health and social needs that clinical pathways guidelines seldom consider. The representatives experienced that COPD, heart failure, stroke and hip fracture, frequently seen in hospitals, appear in low numbers in primary care. The quantitative study confirmed the extensive complexity among home healthcare nursing patients and demonstrated that, for each of the four selected diagnoses, a homecare nurse on average is responsible for preparing reception of the patient at home after discharge from hospital, less often than every other year. The feasibility of disease-specific pathways in primary care is limited, both from a clinical and organisational perspective, for patients with complex needs. The low prevalence in primary care of patients with important chronic conditions, needing coordinated care after hospital discharge, constricts transferring tasks from specialist care. Generic clinical pathways are likely to be more feasible and efficient for patients in this setting. Key points Clinical pathways in hospitals apply to single-disease guidelines, while more than 90% of the patients discharged to community health care for follow-up have multimorbidity. Primary care has to manage the health care of the patient holistically, with all his or her complex needs. Patients most frequently admitted to hospitals, i.e. patients with COPD

  9. Wearable Internet of Things - from human activity tracking to clinical integration.

    Science.gov (United States)

    Kumari, Poonam; Lopez-Benitez, Miguel; Gyu Myoung Lee; Tae-Seong Kim; Minhas, Atul S

    2017-07-01

    Wearable devices for human activity tracking have been emerging rapidly. Most of them are capable of sending health statistics to smartphones, smartwatches or smart bands. However, they only provide the data for individual analysis and their data is not integrated into clinical practice. Leveraging on the Internet of Things (IoT), edge and cloud computing technologies, we propose an architecture which is capable of providing cloud based clinical services using human activity data. Such services could supplement the shortage of staff in primary healthcare centers thereby reducing the burden on healthcare service providers. The enormous amount of data created from such services could also be utilized for planning future therapies by studying recovery cycles of existing patients. We provide a prototype based on our architecture and discuss its salient features. We also provide use cases of our system in personalized and home based healthcare services. We propose an International Telecommunication Union based standardization (ITU-T) for our design and discuss future directions in wearable IoT.

  10. Next-generation mTOR inhibitors in clinical oncology: how pathway complexity informs therapeutic strategy.

    LENUS (Irish Health Repository)

    Wander, Seth A

    2011-04-01

    Mammalian target of rapamycin (mTOR) is a PI3K-related kinase that regulates cell growth, proliferation, and survival via mTOR complex 1 (mTORC1) and mTORC2. The mTOR pathway is often aberrantly activated in cancers. While hypoxia, nutrient deprivation, and DNA damage restrain mTORC1 activity, multiple genetic events constitutively activate mTOR in cancers. Here we provide a brief overview of the signaling pathways up- and downstream of mTORC1 and -2, and discuss the insights into therapeutic anticancer targets - both those that have been tried in the clinic with limited success and those currently under clinical development - that knowledge of these pathways gives us.

  11. Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study

    NARCIS (Netherlands)

    Kolk, M. van der; Boogaard, M.H.W.A. van den; Becking-Verhaar, F.; Custers, H.; Hoeven, H. van der; Pickkers, P.; Laarhoven, K. van

    2017-01-01

    INTRODUCTION: Medical and nursing protocols in perioperative care for pancreaticoduodenectomy are mainly mono-disciplinary, limiting their integration and transparency in a continuous health care system. The aims of this study were to evaluate adherence to a multidisciplinary clinical pathway for

  12. Feasibility of a Clinical Pathway with Early Oral Intake and Discharge for Laparoscopic Gastrectomy.

    Science.gov (United States)

    Nakagawa, M; Tomii, C; Inokuchi, M; Otsuki, S; Kojima, K

    2017-12-01

    Although some studies have reported the safety of early oral intake after gastrectomy, it still remains controversial. This study focused on the feasibility of a clinical pathway with early oral intake and discharge setting for exclusively laparoscopic distal gastrectomy. A clinical pathway was applied to 403 patients until December 2014. In the protocol, patients are allowed to take a sip of water and a soft diet on the first and second days after the operation, respectively, and the discharge day is set as the fifth to seventh day after the operation. Clinicopathological variables were prospectively collected, and risk factors for discharge variances were analyzed. The completion rate of the clinical pathway was 76.9%. There were five re-admissions (1.2%). The overall morbidity rate was 18% ( n = 72), and major complications (Clavien-Dindo IIIa or greater) occurred in 13 patients (3%). Complications were the causes for discharge variances in 68 cases (73%), while the attending surgeons' judgment was the cause in 25 cases (27%). On multivariate analysis, age (odds ratio = 2.23, 95% confidence interval = 1.38-3.60, p = 0.001) and operative time (odds ratio = 2.38, 95% confidence interval = 1.45-3.98, p = 0.001) were independent risk factors for discharge variances. A high completion rate of a clinical pathway with early oral intake and discharge setting for laparoscopic distal gastrectomy was achievable with an acceptably low re-admission rate. Laparoscopic distal gastrectomy is recommended as a first step for a clinical pathway with an early oral intake and discharge protocol.

  13. Evaluating glymphatic pathway function utilizing clinically relevant intrathecal infusion of CSF tracer.

    Science.gov (United States)

    Yang, Lijun; Kress, Benjamin T; Weber, Harris J; Thiyagarajan, Meenakshisundaram; Wang, Baozhi; Deane, Rashid; Benveniste, Helene; Iliff, Jeffrey J; Nedergaard, Maiken

    2013-05-01

    Neurodegenerative diseases such as Alzheimer's are associated with the aggregation of endogenous peptides and proteins that contribute to neuronal dysfunction and loss. The glymphatic system, a brain-wide perivascular pathway along which cerebrospinal fluid (CSF) and interstitial fluid (ISF) rapidly exchange, has recently been identified as a key contributor to the clearance of interstitial solutes from the brain, including amyloid β. These findings suggest that measuring changes in glymphatic pathway function may be an important prognostic for evaluating neurodegenerative disease susceptibility or progression. However, no clinically acceptable approach to evaluate glymphatic pathway function in humans has yet been developed. Time-sequenced ex vivo fluorescence imaging of coronal rat and mouse brain slices was performed at 30-180 min following intrathecal infusion of CSF tracer (Texas Red- dextran-3, MW 3 kD; FITC- dextran-500, MW 500 kD) into the cisterna magna or lumbar spine. Tracer influx into different brain regions (cortex, white matter, subcortical structures, and hippocampus) in rat was quantified to map the movement of CSF tracer following infusion along both routes, and to determine whether glymphatic pathway function could be evaluated after lumbar intrathecal infusion. Following lumbar intrathecal infusions, small molecular weight TR-d3 entered the brain along perivascular pathways and exchanged broadly with the brain ISF, consistent with the initial characterization of the glymphatic pathway in mice. Large molecular weight FITC-d500 remained confined to the perivascular spaces. Lumbar intrathecal infusions exhibited a reduced and delayed peak parenchymal fluorescence intensity compared to intracisternal infusions. Lumbar intrathecal contrast delivery is a clinically useful approach that could be used in conjunction with dynamic contrast enhanced MRI nuclear imaging to assess glymphatic pathway function in humans.

  14. Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities.

    Science.gov (United States)

    Misky, Gregory J; Carlson, Todd; Thompson, Elaina; Trujillo, Toby; Nordenholz, Kristen

    2014-07-01

    Acute venous thromboembolism (VTE) is prevalent, expensive, and deadly. Published data at our institution identified significant VTE care variation based on payer source. We developed a VTE clinical pathway to standardize care, decrease hospital utilization, provide education, and mitigate disparities. Target population for our interdisciplinary pathway was acute medical VTE patients. The intervention included order sets, system-wide education, follow-up phone calls, and coordinated posthospital care. Study data (n = 241) were compared to historical data (n = 234), evaluating outcomes of hospital admission, length of stay (LOS), and reutilization, stratified by payer source. A total of 241 patients entered the VTE clinical care pathway: 107 with deep venous thrombosis (44.4%) and 134 with a pulmonary embolism (55.6%). Within the pathway, uninsured VTE patients were admitted at a lower rate than insured patients (65.9 vs 79.1%; P = 0.032). LOS decreased from 4.4 to 3.1 days (P historical patients (9.4%, P = 0.254). Individual cost of care decreased from $7610 to $5295 (P cost, particularly among uninsured patients. Results of this novel study demonstrate a model for improving transitional care coordination with local community health clinics and delivering care to vulnerable populations. Other disease populations may benefit from the development of a similar model. © 2014 Society of Hospital Medicine.

  15. A survey of head movement during clinical brain SPECT using an optical tracking system

    International Nuclear Information System (INIS)

    Pandos, G.; Barnden, L.; Lineage, H.; Smith, T.; Unger, S.

    2002-01-01

    Full text: The aim of this study was to survey patient motion during clinical brain SPECT using a commercial motion detection system called Polaris. Polaris is an optical tracker that remotely tracks head position and orientation via a small target attached to the patient. Its accuracy for position measurement is 1mm or 1 degree (deg), 33% moved > 2mm or 2deg and 10% moved > 4mm or 4deg. 65% of subjects moved 3 or more times. Motion in the D and P groups was equally likely to be small (<3mm or <3deg) or large and equally likely to occur early or late during acquisition. Motion in the N, F and C groups was less likely to be large and for N and F more likely to occur late in the acquisition suggesting fatigue was the main cause. The most common large movements were anterior-posterior translations and axial (Z) rotations. Significant head movement is common in brain SPECT, particularly in dementia and psychiatric subjects, and accurate motion correction is desirable to maintain image quality. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  16. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...... of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...

  17. The Danish Head and Neck Cancer fast-track program

    DEFF Research Database (Denmark)

    Roennegaard, Anders B.; Rosenberg, Tine; Bjørndal, Kristine

    2018-01-01

    -track clinical pathway solutions. Objectives: The objectives of this study were 1) to present the setup of the head and neck cancer (HNC) fast-track program at Odense University Hospital (OUH) as an example of the Danish model and 2) to present patient characteristics, diagnostic outcome, cancer detection rate...

  18. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction

    OpenAIRE

    Dautremont, Jonathan F; Rudmik, Luke R; Yeung, Justin; Asante, Tiffany; Nakoneshny, Steve C; Hoy, Monica; Lui, Amanda; Chandarana, Shamir P; Matthews, Thomas W; Schrag, Christiaan; Dort, Joseph C

    2013-01-01

    Background The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction. Methods This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate...

  19. Research fellowship programs as a pathway for training independent clinical pharmacy scientists.

    Science.gov (United States)

    Mueller, Eric W; Bishop, Jeffrey R; Kanaan, Abir O; Kiser, Tyree H; Phan, Hanna; Yang, Katherine Y

    2015-03-01

    The American College of Clinical Pharmacy (ACCP) Research Affairs Committee published a commentary in 2013 on training clinical pharmacy scientists in the context of changes in economic, professional, political, and research environments. The commentary centered on the opportunities for pharmacists in clinical/translational research including strategies for ACCP, colleges of pharmacy, and the profession to increase the number and impact of clinical pharmacy scientists. A postdoctoral fellowship is cited as a current training pathway, capable of producing independent and productive pharmacy researchers. However, a decline in the number of programs, decreased funding availability, and variability in fellowship program activities and research focus have brought into question the relevance of this research training pathway to meet demand and opportunities. In response to these points, this commentary examines the state of research fellowship training including the current ACCP research fellowship review process, the need for standardization of research fellowship programs, and strategies to strengthen and promote research fellowships as relevant researcher training pathways. © 2015 Pharmacotherapy Publications, Inc.

  20. Current therapeutic interventions in the glycation pathway: evidence from clinical studies.

    Science.gov (United States)

    Engelen, L; Stehouwer, C D A; Schalkwijk, C G

    2013-08-01

    The increased formation of advanced glycation endproducts (AGEs) constitutes a potential mechanism of hyperglycaemia-induced micro- and macrovascular disease in diabetes. In vitro and animal experiments have shown that various interventions can inhibit formation and/or actions of AGEs, in particular the specific AGE inhibitor aminoguanidine and the AGEs crosslink breaker alagebrium, and the B vitamins pyridoxamine and thiamine, and the latter's synthetic derivative, benfotiamine. The potential clinical value of these interventions, however, remains to be established. The present review provides, from the clinical point of view, an overview of current evidence on interventions in the glycation pathway relating to (i) the clinical benefits of specific AGE inhibitors and AGE breakers and (ii) the potential AGE-inhibiting effects of therapies developed for purposes unrelated to the glycation pathway. We found that safety and/or efficacy in clinical studies with the specific AGE inhibitor, aminoguanidine and the AGE breaker, alagebrium, appeared to be a concern. The clinical evidence on the potential AGE-inhibiting effects of B vitamins is still limited. Finally, current evidence for AGE inhibition by therapies developed for purposes unrelated to glycation is limited due to a large heterogeneity in study designs and/or measurement techniques, which have often been sub-optimal. We conclude that, clinical evidence on interventions to inhibit formation and/or action of AGEs is currently weak and unconvincing. © 2012 Blackwell Publishing Ltd.

  1. Pros and Cons of Clinical Pathway Software Management: A Qualitative Study.

    Science.gov (United States)

    Aarnoutse, M F; Brinkkemper, S; de Mul, M; Askari, M

    2018-01-01

    In this study we aimed to assess the perceived effectiveness of clinical pathway management software for healthcare professionals. A case study on the clinical pathway management software program Check-It was performed in three departments at an academic medical center. Four months after the implementation of the software, interviews were held with healthcare professionals who work with the system. The interview questions were posed in a semi-structured interview format and the participant were asked about the perceived positive or negative effects of Check-It, and whether they thought the software is effective for them. The interviews were recorded and transcribed based on grounded theory, using different coding techniques. Our results showed fewer overlooked tasks, pre-filled orders and letters, better overview, and increased protocol insight as positive aspects of using the software. Being not flexible enough was experienced as a negative aspect.

  2. Process mining routinely collected electronic health records to define real-life clinical pathways during chemotherapy.

    Science.gov (United States)

    Baker, Karl; Dunwoodie, Elaine; Jones, Richard G; Newsham, Alex; Johnson, Owen; Price, Christopher P; Wolstenholme, Jane; Leal, Jose; McGinley, Patrick; Twelves, Chris; Hall, Geoff

    2017-07-01

    There is growing interest in the use of routinely collected electronic health records to enhance service delivery and facilitate clinical research. It should be possible to detect and measure patterns of care and use the data to monitor improvements but there are methodological and data quality challenges. Driven by the desire to model the impact of a patient self-test blood count monitoring service in patients on chemotherapy, we aimed to (i) establish reproducible methods of process-mining electronic health records, (ii) use the outputs derived to define and quantify patient pathways during chemotherapy, and (iii) to gather robust data which is structured to be able to inform a cost-effectiveness decision model of home monitoring of neutropenic status during chemotherapy. Electronic Health Records at a UK oncology centre were included if they had (i) a diagnosis of metastatic breast cancer and received adjuvant epirubicin and cyclosphosphamide chemotherapy or (ii) colorectal cancer and received palliative oxaliplatin and infusional 5-fluorouracil chemotherapy, and (iii) were first diagnosed with cancer between January 2004 and February 2013. Software and a Markov model were developed, producing a schematic of patient pathways during chemotherapy. Significant variance from the assumed care pathway was evident from the data. Of the 535 patients with breast cancer and 420 with colorectal cancer there were 474 and 329 pathway variants respectively. Only 27 (5%) and 26 (6%) completed the planned six cycles of chemotherapy without having unplanned hospital contact. Over the six cycles, 169 (31.6%) patients with breast cancer and 190 (45.2%) patients with colorectal cancer were admitted to hospital. The pathways of patients on chemotherapy are complex. An iterative approach to addressing semantic and data quality issues enabled the effective use of routinely collected patient records to produce accurate models of the real-life experiences of chemotherapy patients and

  3. Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability.

    Science.gov (United States)

    Shaha, James S; Cook, Jay B; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

    2016-11-16

    Glenoid and humeral bone loss are well-described risk factors for failure of arthroscopic shoulder stabilization. Recently, consideration of the interactions of these types of bone loss (bipolar bone loss) has been used to determine if a lesion is "on-track" or "off-track." The purpose of this study was to study the relationship of the glenoid track to the outcomes of arthroscopic Bankart reconstructions. Over a 2-year period, 57 shoulders that were treated with an isolated, primary arthroscopic Bankart reconstruction performed at a single facility were included in this study. The mean patient age was 25.5 years (range, 20 to 42 years) at the time of the surgical procedure, and the mean follow-up was 48.3 months (range, 23 to 58 months). Preoperative magnetic resonance imaging was used to determine glenoid bone loss and Hill-Sachs lesion size and location and to measure the glenoid track to classify the shoulders as on-track or off-track. Outcomes were assessed according to shoulder stability on examination and subjective outcome. There were 10 recurrences (18%). Of the 49 on-track patients, 4 (8%) had treatment that failed compared with 6 (75%) of 8 off-track patients (p = 0.0001). Six (60%) of 10 patients with recurrence of instability were off-track compared with 2 (4%) of 47 patients in the stable group (p = 0.0001). The positive predictive value of an off-track measurement was 75% compared with 44% for the predictive value of glenoid bone loss of >20%. The application of the glenoid track concept to our cohort was superior to using glenoid bone loss alone with regard to predicting postoperative stability. This method of assessment is encouraged as a routine part of the preoperative evaluation of all patients under consideration for arthroscopic anterior stabilization. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  4. Development and implementation of a clinical pathway approach to simulation-based training for foregut surgery.

    Science.gov (United States)

    Miyasaka, Kiyoyuki W; Buchholz, Joseph; LaMarra, Denise; Karakousis, Giorgos C; Aggarwal, Rajesh

    2015-01-01

    Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up. The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation "pathway" repeated on days 1 and 3. The "pathway" is a series of simulated preoperative, intraoperative, and postoperative encounters in following up a single patient through a disease process. The resident sees a standardized patient in the clinic presenting with distal gastric cancer and then enters an operating room to perform a gastrojejunostomy on a porcine tissue model. Finally, the resident engages in a simulated postoperative visit. All encounters are rated by faculty members and the residents themselves, using standardized assessment forms endorsed by the American Board of Surgery. A total of 18 first-year residents underwent this curriculum. Faculty ratings of overall operative performance significantly improved following the 3-day module. Ratings of preoperative and postoperative performance were not significantly changed in 3 days. Resident self-ratings significantly improved for all encounters assessed, as did reported confidence in meeting the defined learning objectives. Conventional surgical simulation training focuses on technical skills in isolation. Our novel "pathway" curriculum targets an important gap in training methodologies by placing both technical and nontechnical skills in their clinical context as part of managing a surgical patient. Results indicate consistent improvements in assessments of performance as well as confidence and support its continued usage to educate surgery residents

  5. Clinical Accuracy of the Respiratory Tumor Tracking System of the CyberKnife: Assessment by Analysis of Log Files

    International Nuclear Information System (INIS)

    Hoogeman, Mischa; Prevost, Jean-Briac; Nuyttens, Joost; Poell, Johan; Levendag, Peter; Heijmen, Ben

    2009-01-01

    Purpose: To quantify the clinical accuracy of the respiratory motion tracking system of the CyberKnife treatment device. Methods and Materials: Data in log files of 44 lung cancer patients treated with tumor tracking were analyzed. Errors in the correlation model, which relates the internal target motion with the external breathing motion, were quantified. The correlation model error was compared with the geometric error obtained when no respiratory tracking was used. Errors in the prediction method were calculated by subtracting the predicted position from the actual measured position after 192.5 ms (the time lag to prediction in our current system). The prediction error was also measured for a time lag of 115 ms and a new prediction method. Results: The mean correlation model errors were less than 0.3 mm. Standard deviations describing intrafraction variations around the whole-fraction mean error were 0.2 to 1.9 mm for cranio-caudal, 0.1 to 1.9 mm for left-right, and 0.2 to 2.5 mm for anterior-posterior directions. Without the use of respiratory tracking, these variations would have been 0.2 to 8.1 mm, 0.2 to 5.5 mm, and 0.2 to 4.4 mm. The overall mean prediction error was small (0.0 ± 0.0 mm) for all directions. The intrafraction standard deviation ranged from 0.0 to 2.9 mm for a time delay of 192.5 ms but was halved by using the new prediction method. Conclusions: Analyses of the log files of real clinical cases have shown that the geometric error caused by respiratory motion is substantially reduced by the application of respiratory motion tracking.

  6. Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance.

    Science.gov (United States)

    Vardy, J; Jenkins, P J; Clark, K; Chekroud, M; Begbie, K; Anthony, I; Rymaszewski, L A; Ireland, A J

    2014-06-13

    Collaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance. A retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change. An ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system. 2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol. Time for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance. Where plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment. This process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries. 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.

  7. Tumour angiogenesis pathways: related clinical issues and implications for nuclear medicine imaging

    International Nuclear Information System (INIS)

    Wiele, Christophe van de; De Winter, Olivier; Dierckx, Rudi Andre; Oltenfreiter, Ruth; Slegers, Guido; Signore, Alberto

    2002-01-01

    Tumour angiogenesis is essential for growth, invasion and metastasis. Retrospective studies suggest that it is an independent prognostic factor that merits prospective validation. Furthermore, as tumour blood vessels show many differences from normal vessels and are not genetically unstable, they form a key area for therapy development. However, as anti-angiogenic therapy is primarily cytostatic and not cytotoxic, novel tailor-made specific end-points for treatment monitoring are required. In this regard, suitable molecular parameters for imaging tumour angiogenesis by means of nuclear medicine are being explored. Here we review current knowledge on the multiple pathways controlling tumour angiogenesis and try to assess which are the most clinically relevant for nuclear medicine imaging. Parameters that may influence the imaging potential of radiopharmaceuticals for angiogenesis imaging such as molecular weight and structure, their targeted location within the tumour and their usefulness in terms of specificity and constancy of the targeted molecular pathway are discussed. (orig.)

  8. Improving outcomes following penetrating colon wounds: application of a clinical pathway.

    Science.gov (United States)

    Miller, Preston R; Fabian, Timothy C; Croce, Martin A; Magnotti, Louis J; Elizabeth Pritchard, F; Minard, Gayle; Stewart, Ronald M

    2002-06-01

    During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion. More destructive injuries were

  9. Real-time non-rigid target tracking for ultrasound-guided clinical interventions

    NARCIS (Netherlands)

    Zachiu, Cornel; Ries, Mario G; Ramaekers, Pascal; Guey, Jean-Luc; Moonen, Chrit T W; de Senneville, Baudouin Denis

    2017-01-01

    Biological motion is a problem for non- or mini-invasive interventions when conducted in mobile/deformable organs due to the targeted pathology moving/deforming with the organ. This may lead to high miss rates and/or incomplete treatment of the pathology. Therefore, real-time tracking of the target

  10. User Resistance and Trust in a Clinical RFID Employee Location Tracking Information System

    Science.gov (United States)

    Wong, Wilson

    2013-01-01

    User resistance has been identified as a factor in information systems implementation failures in the health care industry. RFID, radio frequency identification, is being incorporated into new health care information systems in order to effect cost reductions by tracking, identifying and monitoring individuals and medical items. This is the first…

  11. The usefulness of lean six sigma to the development of a clinical pathway for hip fractures.

    Science.gov (United States)

    Niemeijer, Gerard C; Flikweert, Elvira; Trip, Albert; Does, Ronald J M M; Ahaus, Kees T B; Boot, Anja F; Wendt, Klaus W

    2013-10-01

    The objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary clinical pathway. A single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of a prolonged length of stay (LOS) for hip fractures in the elderly and to measure the effect of the process improvements--with the aim of improving efficiency of care and reducing the LOS. The project identified several variables influencing LOS, and interventions were designed to improve the process of care. Significant results were achieved by reducing both the average LOS by 4.2 days (-31%) and the average duration of surgery by 57 minutes (-36%). The average LOS of patients discharged to a nursing home reduced by 4.4 days. The findings of this study show a successful application of LSS methodology within the development of a clinical pathway. Further research is needed to explore the effect of the use of LSS methodology at clinical outcome and quality of life. © 2012 John Wiley & Sons Ltd.

  12. Cost-effectiveness analysis of a postoperative clinical care pathway in head and neck surgery with microvascular reconstruction.

    Science.gov (United States)

    Dautremont, Jonathan F; Rudmik, Luke R; Yeung, Justin; Asante, Tiffany; Nakoneshny, Steve C; Hoy, Monica; Lui, Amanda; Chandarana, Shamir P; Matthews, Thomas W; Schrag, Christiaan; Dort, Joseph C

    2013-12-19

    The objective of this study is to evaluate the cost-effectiveness of a postoperative clinical care pathway for patients undergoing major head and neck oncologic surgery with microvascular reconstruction. This is a comparative trial of a prospective treatment group managed on a postoperative clinical care pathway and a historical group managed prior to pathway implementation. Effectiveness outcomes evaluated were total hospital days, return to OR, readmission to ICU and rate of pulmonary complications. Costing perspective was from the government payer. 118 patients were included in the study. All outcomes demonstrated that the postoperative pathway group was both more effective and less costly, and is therefore a dominant clinical intervention. The overall mean pre- and post-pathway costs are $22,733 and $16,564 per patient, respectively. The incremental cost reduction associated with the postoperative pathway was $6,169 per patient. Implementing the postoperative clinical care pathway in patients undergoing head and neck oncologic surgery with reconstruction resulted in improved clinical outcomes and reduced costs.

  13. Clinical translation of photobiomodulation therapy using evidences from precision molecular pathway analyses (Conference Presentation)

    Science.gov (United States)

    Arany, Praveen

    2017-02-01

    Can `light' be a Drug? To satisfy this definition as a pharmaceutical agent, light must be absorbed and change bodily function. Much evidence from our understanding of our visual cycle and Vitamin D metabolism have all noted this phenomenon. Advances in optophotonic technologies along with a better understanding of light-tissue interactions, especially in in vivo optical imaging and optogenetics, are spearheading the popularity of biophotonics in biology and medicine. The use of lasers and light devices at high doses in dermatology, ophthalmology, oncology and dentistry are now considered mainstream for certain clinical applications such as surgery, skin rejuvenation, ocular and soft tissue recontouring, anti-tumor and anti-microbial photodynamic therapy. In contrast, therapeutic use of low dose biophotonics devices is called Low Level Light / Laser Therapy (LLLT), now termed Photobiomodulation (PBM) Therapy. This therapy is defined as a non-thermal use of non-ionizing forms of electromagnetic radiation to alleviate pain, inflammation, modulating the immune responses and promoting wound healing and tissue regeneration. Surprisingly, despite vast volumes of scientific literature from both clinical and laboratory studies noting the phenomenological evidences for this innovative therapy, limited mechanistic insights have prevented the development of rigorous, reproducible clinical protocols. This presentation will outline our current efforts at ongoing efforts in our group to assess molecular pathways and precisely define clinical treatment variables to enable clinical translation with PBM therapies.

  14. Clinical Pathway and Monthly Feedback Improve Adherence to Antibiotic Guideline Recommendations for Community-Acquired Pneumonia.

    Directory of Open Access Journals (Sweden)

    Maher Almatar

    Full Text Available Compliance with community-acquired pneumonia (CAP guidelines remains poor despite a substantial body of evidence indicating that guideline-concordant care improves patient outcomes. The aim of this study was to compare the relative effectiveness of a general educational and a targeted emergency department intervention on improving physicians' concordance with CAP guidelines.Two distinct interventions were implemented over specific time periods. The first intervention was educational, focusing on the development of local CAP guidelines and their dissemination through hospital-wide educational programmes. The second intervention was a targeted one for the emergency department, where a clinical pathway for the initial management of CAP patients was introduced, followed by monthly feedback to the emergency department (ED physicians about concordance rates with the guidelines. Data on the concordance rate to CAP guidelines was collected from a retrospective chart review.A total of 398 eligible patient records were reviewed to measure concordance to CAP guidelines over the study period. Concordance rates during the baseline and educational intervention periods were similar (28.1% vs. 31.2%; p > 0.05. Significantly more patients were treated in accordance with the CAP guidelines after the ED focused intervention when compared to the baseline (61.5% vs. 28.1%; p < 0.05 or educational period (61.5% vs. 31.2%; p < 0.05.A targeted intervention with a CAP clinical pathway and monthly feedback was a successful strategy to increase adherence to empirical antibiotic recommendations in CAP guidelines.

  15. Tracking the footsteps: a constructivist grounded theory of the clinical reasoning processes that registered nurses use to recognise delirium.

    Science.gov (United States)

    El Hussein, Mohamed; Hirst, Sandra

    2016-02-01

    To construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognise delirium while caring for older adults in acute care settings. Delirium is often under-recognised in acute care settings; this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' clinical reasoning processes in complex situations such as delirium recognition. Seventeen registered nurses working in acute care settings were interviewed. Concurrent data collection and analysis, constant comparative analysis and theoretical sampling were conducted in 2013-2014. A grounded theory approach was used to analyse interview data about the clinical reasoning processes of registered nurse in acute hospital settings. The core category that emerged from data was 'Tracking the footsteps'. This refers to the common clinical reasoning processes that registered nurses in this study used to recognise delirium in older adults in acute care settings. It depicted the process of continuously trying to catch the state of delirium in older adults. Understanding the clinical reasoning processes that contribute to delirium under-recognition provides a strategy by which this problem can be brought to the forefront of awareness and intervention by registered nurses. Registered nurses could draw from the various processes identified in this research to develop their clinical reasoning practice to enhance their effective assessment strategies. Delirium recognition by registered nurses will contribute to quality care to older adults. © 2016 John Wiley & Sons Ltd.

  16. Symptom severity prediction from neuropsychiatric clinical records: Overview of 2016 CEGS N-GRID shared tasks Track 2.

    Science.gov (United States)

    Filannino, Michele; Stubbs, Amber; Uzuner, Özlem

    2017-11-01

    The second track of the CEGS N-GRID 2016 natural language processing shared tasks focused on predicting symptom severity from neuropsychiatric clinical records. For the first time, initial psychiatric evaluation records have been collected, de-identified, annotated and shared with the scientific community. One-hundred-ten researchers organized in twenty-four teams participated in this track and submitted sixty-five system runs for evaluation. The top ten teams each achieved an inverse normalized macro-averaged mean absolute error score over 0.80. The top performing system employed an ensemble of six different machine learning-based classifiers to achieve a score 0.86. The task resulted to be generally easy with the exception of two specific classes of records: records with very few but crucial positive valence signals, and records describing patients predominantly affected by negative rather than positive valence. Those cases proved to be very challenging for most of the systems. Further research is required to consider the task solved. Overall, the results of this track demonstrate the effectiveness of data-driven approaches to the task of symptom severity classification. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. An Interactive Platform to Visualize Data-Driven Clinical Pathways for the Management of Multiple Chronic Conditions.

    Science.gov (United States)

    Zhang, Yiye; Padman, Rema

    2017-01-01

    Patients with multiple chronic conditions (MCC) pose an increasingly complex health management challenge worldwide, particularly due to the significant gap in our understanding of how to provide coordinated care. Drawing on our prior research on learning data-driven clinical pathways from actual practice data, this paper describes a prototype, interactive platform for visualizing the pathways of MCC to support shared decision making. Created using Python web framework, JavaScript library and our clinical pathway learning algorithm, the visualization platform allows clinicians and patients to learn the dominant patterns of co-progression of multiple clinical events from their own data, and interactively explore and interpret the pathways. We demonstrate functionalities of the platform using a cluster of 36 patients, identified from a dataset of 1,084 patients, who are diagnosed with at least chronic kidney disease, hypertension, and diabetes. Future evaluation studies will explore the use of this platform to better understand and manage MCC.

  18. SU-E-J-59: Feasibility of Markerless Tumor Tracking by Sequential Dual-Energy Fluoroscopy On a Clinical Tumor Tracking System

    Energy Technology Data Exchange (ETDEWEB)

    Dhont, J; Poels, K; Verellen, D; Tournel, K; Gevaert, T; Steenbeke, F; Burghelea, M; De Ridder, M [Department of Radiotherapy, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2015-06-15

    Purpose: To evaluate the feasibility of markerless tumor tracking through the implementation of a novel dual-energy imaging approach into the clinical dynamic tracking (DT) workflow of the Vero SBRT system. Methods: Two sequential 20 s (11 Hz) fluoroscopy sequences were acquired at the start of one fraction for 7 patients treated for primary and metastatic lung cancer with DT on the Vero system. Sequences were acquired using 2 on-board kV imaging systems located at ±45° from the MV beam axis, at respectively 60 kVp (3.2 mAs) and 120 kVp (2.0 mAs). Offline, a normalized cross-correlation algorithm was applied to match the high (HE) and low energy (LE) images. Per breathing phase (inhale, exhale, maximum inhale and maximum exhale), the 5 best-matching HE and LE couples were extracted for DE subtraction. A contrast analysis according to gross tumor volume was conducted based on contrast-to-noise ratio (CNR). Improved tumor visibility was quantified using an improvement ratio. Results: Using the implanted fiducial as a benchmark, HE-LE sequence matching was effective for 13 out of 14 imaging angles. Overlying bony anatomy was removed on all DE images. With the exception of two imaging angles, the DE images showed no significantly improved tumor visibility compared to HE images, with an improvement ratio averaged over all patients of 1.46 ± 1.64. Qualitatively, it was observed that for those imaging angles that showed no significantly improved CNR, the tumor tissue could not be reliably visualized on neither HE nor DE images due to a total or partial overlap with other soft tissue. Conclusion: Dual-energy subtraction imaging by sequential orthogonal fluoroscopy was shown feasible by implementing an additional LE fluoroscopy sequence. However, for most imaging angles, DE images did not provide improved tumor visibility over single-energy images. Optimizing imaging angles is likely to improve tumor visibility and the efficacy of dual-energy imaging. This work was in

  19. Tracking the pathway of diesel exhaust particles from the nose to the brain by X-ray florescence analysis

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, Yasuto [Department of Urban and Environmental Engineering, Kyoto University, Katsura, Nishigyo-ku, Kyoto 606-8501 (Japan)], E-mail: y.matsui@health.env.kyoto-u.ac.jp; Sakai, Nobumitsu [Department of Urban and Environmental Engineering, Kyoto University, Katsura, Nishigyo-ku, Kyoto 606-8501 (Japan)], E-mail: sakai@health.env.kyoto-u.ac.jp; Tsuda, Akira [Molecular and Integrative Physiological Sciences, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115 (United States)], E-mail: atsuda@hsph.harvard.edu; Terada, Yasuko [JASRI, SPring-8, 1-1-1 Kouto, Sayo, Sayo-gun, Hyogo 679-5148 (Japan)], E-mail: yterada@spring8.or.jp; Takaoka, Masaki [Department of Urban and Environmental Engineering, Kyoto University, Katsura, Nishigyo-ku, Kyoto 606-8501 (Japan)], E-mail: takaoka@epsehost.env.kyoto-u.ac.jp; Fujimaki, Hidekazu [Division of Environmental Health Sciences, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506 (Japan)], E-mail: fujimaki@nies.go.jp; Uchiyama, Iwao [Department of Urban and Environmental Engineering, Kyoto University, Katsura, Nishigyo-ku, Kyoto 606-8501 (Japan)], E-mail: uchiyama@health.env.kyoto-u.ac.jp

    2009-08-15

    Studies have shown that exposure to nano-sized particles (< 50 nm) result in their translocation to the central nervous system through the olfactory nerve. Translocation commonly occurs via inhalation, ingestion and skin uptake. Little information is available on the specific pathway of cellular localization of nano-sized particles in the olfactory bulb. The nano-sized particles entrance into the postsynaptics cell is of particular interest because the mitral cell projects to the central nucleus of the amygdala and the piriform cortex. Therefore, our objective in this follow-up study has been to determine whether or not the mitral cells project nano-sized particles to the brain. Nano-sized particles in this study were generated using diesel exhaust. Lab mice were exposed for a period of 4 weeks. We employed synchrotron radiation (SPring-8, Japan) to determine the concentration levels of metal in the olfactory neuron pathway. Metal levels were assayed by mapping, using X-ray fluorescence analysis. The major metal components measured in the filter that collected the inhaled diesel exhaust particles were calcium, copper, iron, nickel and zinc. Our studies reveal an increase in the amount of nano-sized particles in the glomerular layer as well as in the neurons in the olfactory epithelium. Higher levels of nickel and iron were found in the olfactory epithelium's lamina propria mucosae in comparison to that in the control group. Higher levels of iron also were observed in the glomerular layer. Our studies do not clarify the specifics of metal adhesion and detachment. This remains to be one of the key issues requiring further clarification.

  20. A cluster randomized trial to assess the effect of clinical pathways for patients with stroke: results of the clinical pathways for effective and appropriate care study

    Directory of Open Access Journals (Sweden)

    Panella Massimiliano

    2012-07-01

    Full Text Available Abstract Background Clinical pathways (CPs are used to improve the outcomes of acute stroke, but their use in stroke care is questionable, because the evidence on their effectiveness is still inconclusive. The objective of this study was to evaluate whether CPs improve the outcomes and the quality of care provided to patients after acute ischemic stroke. Methods This was a multicentre cluster-randomized trial, in which 14 hospitals were randomized to the CP arm or to the non intervention/usual care (UC arm. Healthcare workers in the CP arm received 3 days of training in quality improvement of CPs and in use of a standardized package including information on evidence-based key interventions and indicators. Healthcare workers in the usual-care arm followed their standard procedures. The teams in the CP arm developed their CPs over a 6-month period. The primary end point was mortality. Secondary end points were: use of diagnostic and therapeutic procedures, implementation of organized care, length of stay, re-admission and institutionalization rates after discharge, dependency levels, and complication rates. Results Compared with the patients in the UC arm, the patients in the CP arm had a significantly lower risk of mortality at 7 days (OR = 0.10; 95% CI 0.01 to 0.95 and significantly lower rates of adverse functional outcomes, expressed as the odds of not returning to pre-stroke functioning in their daily life (OR = 0.42; 95 CI 0.18 to 0.98. There was no significant effect on 30-day mortality. Compared with the UC arm, the hospital diagnostic and therapeutic procedures were performed more appropriately in the CP arm, and the evidence-based key interventions and organized care were more applied in the CP arm. Conclusions CPs can significantly improve the outcomes of patients with ischemic patients with stroke, indicating better application of evidence-based key interventions and of diagnostic and therapeutic procedures. This study tested a new

  1. A peer review process as part of the implementation of clinical pathways in radiation oncology: Does it improve compliance?

    Science.gov (United States)

    Gebhardt, Brian J; Heron, Dwight E; Beriwal, Sushil

    Clinical pathways are patient management plans that standardize evidence-based practices to ensure high-quality and cost-effective medical care. Implementation of a pathway is a collaborative process in our network, requiring the active involvement of physicians. This approach promotes acceptance of pathway recommendations, although a peer review process is necessary to ensure compliance and to capture and approve off-pathway selections. We investigated the peer review process and factors associated with time to completion of peer review. Our cancer center implemented radiation oncology pathways for every disease site throughout a large, integrated network. Recommendations are written based upon national guidelines, published literature, and institutional experience with evidence evaluated hierarchically in order of efficacy, toxicity, and then cost. Physicians enter decisions into an online, menu-driven decision support tool that integrates with medical records. Data were collected from the support tool and included the rate of on- and off-pathway selections, peer review decisions performed by disease site directors, and time to complete peer review. A total of 6965 treatment decisions were entered in 2015, and 605 (8.7%) were made off-pathway and were subject to peer review. The median time to peer review decision was 2 days (interquartile range, 0.2-6.8). Factors associated with time to peer review decision >48 hours on univariate analysis include disease site (P peer review (P 48 hours. Clinical pathways are an integral tool for standardizing evidence-based care throughout our large, integrated network, with 91.3% of all treatment decisions being made as per pathway. The peer review process was feasible, with peer review of treatment decisions encourages compliance with clinical pathway recommendations. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  2. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene

    2013-01-01

    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... to provide immediate advice and support. CONCLUSION: The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS...

  3. Clinical decision-making tools for exam selection, reporting and dose tracking

    International Nuclear Information System (INIS)

    Brink, James A.

    2014-01-01

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  4. Clinical decision-making tools for exam selection, reporting and dose tracking

    Energy Technology Data Exchange (ETDEWEB)

    Brink, James A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  5. Approaches to veterinary education--tracking versus a final year broad clinical experience. Part one: effects on career outcome.

    Science.gov (United States)

    Klosterman, E S; Kass, P H; Walsh, D A

    2009-08-01

    This is the first of two papers that provide extensive data and analysis on the two major approaches to clinical veterinary education, which either provide students with experience of a broad range of species (often defined as omni/general clinical competence), or just a few species (sometimes just one), usually termed 'tracking'. Together the two papers provide a detailed analysis of these two approaches for the first time. The responsibilities of veterinary medicine and veterinary education are rapidly increasing throughoutthe globe. It is critical for all in veterinary education to reassess the approaches that have been used, and evaluate on a school-by-school basis which may best meet its expanding and ever-deepening responsibilities.

  6. Using the web for recruitment, screen, tracking, data management, and quality control in a dietary assessment clinical validation trial.

    Science.gov (United States)

    Arab, Lenore; Hahn, Harry; Henry, Judith; Chacko, Sara; Winter, Ashley; Cambou, Mary C

    2010-03-01

    Screening and tracking subjects and data management in clinical trials require significant investments in manpower that can be reduced through the use of web-based systems. To support a validation trial of various dietary assessment tools that required multiple clinic visits and eight repeats of online assessments, we developed an interactive web-based system to automate all levels of management of a biomarker-based clinical trial. The "Energetics System" was developed to support 1) the work of the study coordinator in recruiting, screening and tracking subject flow, 2) the need of the principal investigator to review study progress, and 3) continuous data analysis. The system was designed to automate web-based self-screening into the trial. It supported scheduling tasks and triggered tailored messaging for late and non-responders. For the investigators, it provided real-time status overviews on all subjects, created electronic case reports, supported data queries and prepared analytic data files. Encryption and multi-level password protection were used to insure data privacy. The system was programmed iteratively and required six months of a web programmer's time along with active team engagement. In this study the enhancement in speed and efficiency of recruitment and quality of data collection as a result of this system outweighed the initial investment. Web-based systems have the potential to streamline the process of recruitment and day-to-day management of clinical trials in addition to improving efficiency and quality. Because of their added value they should be considered for trials of moderate size or complexity. Copyright 2009 Elsevier Inc. All rights reserved.

  7. Experiences of women with a diagnosis of breast cancer: a clinical pathway approach.

    Science.gov (United States)

    Lindop, E; Cannon, S

    2001-06-01

    The study presented in this paper formed the first part of a large survey of breast cancer patients in one health authority in England, UK looking at individual needs expressed by women with a diagnosis of breast cancer. The paper provides an account of the experiences of 12 women with a diagnosis of breast cancer. The women represent a wide age range and different stages of illness. The transcribed accounts of the women were analysed by means of Qualitative Solutions and Research, Non-Numerical Unstructured Data Indexing Searching and Theorising (QSR*NUDIST). The study examined the individual experiences of women with a diagnosis of breast cancer and its aftermath as they passed through different stages related to it. The women's experiences are presented within the conceptual framework of the clinical pathway and their accounts represent their journey along the pathway. Various significant points in this journey are portrayed representing the women's reactions to diagnosis, treatment, femininity and body image, support, family and friends, information and after care.

  8. The TGF-β/Smad4 Signaling Pathway in Pancreatic Carcinogenesis and Its Clinical Significance

    Directory of Open Access Journals (Sweden)

    Sunjida Ahmed

    2017-01-01

    Full Text Available Pancreatic ductal adenocarcinoma (PDAC is one of the most fatal human cancers due to its complicated genomic instability. PDAC frequently presents at an advanced stage with extensive metastasis, which portends a poor prognosis. The known risk factors associated with PDAC include advanced age, smoking, long-standing chronic pancreatitis, obesity, and diabetes. Its association with genomic and somatic mutations is the most important factor for its aggressiveness. The most common gene mutations associated with PDAC include KRas2, p16, TP53, and Smad4. Among these, Smad4 mutation is relatively specific and its inactivation is found in more than 50% of invasive pancreatic adenocarcinomas. Smad4 is a member of the Smad family of signal transducers and acts as a central mediator of transforming growth factor beta (TGF-β signaling pathways. The TGF-β signaling pathway promotes many physiological processes, including cell growth, differentiation, proliferation, fibrosis, and scar formation. It also plays a major role in the development of tumors through induction of angiogenesis and immune suppression. In this review, we will discuss the molecular mechanism of TGF-β/Smad4 signaling in the pathogenesis of pancreatic adenocarcinoma and its clinical implication, particularly potential as a prognostic factor and a therapeutic target.

  9. The “CROMa” Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure

    Directory of Open Access Journals (Sweden)

    Mauro Capocci

    2014-01-01

    Full Text Available Aim. To describe 7 years of activity of “CROMa” (Coordination of Research on Osteonecrosis of the Jaws project of “Sapienza” University of Rome. Materials and Methods. A preventive and therapeutic care pathway was created for patients with bisphosphonates (BPs exposure. Demographic, social, behavioural, pharmacological, and clinical variables were registered in a dedicated database. Results. In the project, 502 patients, 403 females and 99 males, were observed. Bone pathologies were 79% osteometabolic diseases (OMD and 21% metastatic cancer (CA. Females were 90% in OMD group and 41% in CA. BP administration was 54% oral, 31% IV, and 11% IM; 89% of BPs were amino-BP and 11% non-amino-BP. Consistently with bone pathology (OMD/CA, alendronate appears to be prevalent for OMD (40% relative, while zoledronate was indicated in 92% of CA patients. Out of 502 cases collected, 28 BRONJ were detected: 17 of them were related to IV BP treatment. Preventive oral assessment was required for 50% of CA patients and by 4% of OMD patients. Conclusions. The proposed care pathway protocols for BP exposed patients appeared to be useful to meet treatment and preventive needs, in both oncological and osteometabolic diseases patients. Patients’ and physicians’ prevention awareness can be the starting point of a multilevel prevention system.

  10. A comparison of commercial and custom-made electronic tracking systems to measure patient flow through an ambulatory clinic.

    Science.gov (United States)

    Vakili, Sharif; Pandit, Ravi; Singman, Eric L; Appelbaum, Jeffrey; Boland, Michael V

    2015-10-29

    Understanding how patients move through outpatient clinics is important for optimizing clinic processes. This study compares the costs, benefits, and challenges of two clinically important methods for measuring patient flow: (1) a commercial system using infrared (IR) technology that passively tracks patient movements and (2) a custom-built, low cost, networked radio frequency identification (RFID) system that requires active swiping by patients at proximity card readers. Readers for both the IR and RFID systems were installed in the General Eye Service of the Wilmer Eye Institute. Participants were given both IR and RFID tags to measure the time they spent in various clinic stations. Simultaneously, investigators recorded the times at which patients moved between rooms. These measurements were considered the standard against which the other methods were compared. One hundred twelve patients generated a total of 252 events over the course of 6 days. The proportion of events successfully recorded by the RFID system (83.7%) was significantly greater than that obtained with the IR system (75.4%, p RFID system). There was no statistical difference between the IR, RFID, and manual time measurements (p > 0.05 for all comparisons). Both RFID and IR methods are effective at providing patient flow information. The custom-made RFID system was as accurate as IR and was installed at about 10% the cost. Given its significantly lower costs, the RFID option may be an appealing option for smaller clinics with more limited budgets.

  11. Surveying for migration pathways in the granitic rock using nuclear track detectors, autoradiography and digital image analysis as an aid to construct the basis for heterogeneous diffusion modeling

    International Nuclear Information System (INIS)

    Kemppainen, M.; Oila, E.; Siitari-Kauppi, M.

    2001-01-01

    Radioelement migration within a rock matrix under natural long-term conditions is a complex process controlled by various parameters. Pure physical parameters such as porosity, hydraulic conductivity and diffusivity are usually sufficient to describe transport in well-defined laboratory systems. In natural rock matrices transport is influenced by physical pore properties such as pore size distribution, connectivity, tortuosity, constrictivity and petrological and chemical nature and charge on the fluid-rock interface. The overall characterization of heterogeneous rock structures is needed for the accurate heterogeneous diffusion modeling. Here we describe a method for the detection of α-particles from uranium in cm-scale rock samples based on the analysis of the tracks formed in organic polymer, CR-39. On the other hand the uranium tracks were compared with the migration pathways and porosity distribution produced with the 14 C-polymethylmethacrylate impregnation method ( 14 C-PMMA). For analyzing mineral specific uranium occurrence and porosities the staining methods were used to produce the mineral map of the rock sample. Digital image analysis techniques were applied to the different cm-scale pictures of rock samples. Scanning electron microscopy and energy dispersive X-ray analysis (SEM/EDS) were performed in order both to study the pore apertures of grain boundaries and fissures in greater detail and to detect the uranium phases. The high uranium content was found to be congruent with the porous mineral phases; altered plagioclase and biotite grains, and the intra- and intergranular fissures detected with the 14 C-PMMA technique. Plenty of microfractures transsecting potassium feldspar and quartz grains were filled with calcite together with precipitated uranium. Copyright (2001) Material Research Society

  12. A cluster randomized controlled trial of a clinical pathway for hospital treatment of heart failure: study design and population

    Directory of Open Access Journals (Sweden)

    Gardini Andrea

    2007-11-01

    Full Text Available Abstract Background The hospital treatment of heart failure frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality and economic cost of this disorder. Consequently the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. Despite enthusiasm and diffusion, the widespread acceptance of clinical pathways remain questionable because very little prospective controlled data demonstrated their effectiveness. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was designed in order to conduct a rigorous evaluation of clinical pathways in hospital treatment of acute heart failure. The primary objective of the trial was to evaluate the effectiveness of the implementation of clinical pathways for hospital treatment of heart failure in Italian hospitals. Methods/design Two-arm, cluster-randomized trial. 14 community hospitals were randomized either to arm 1 (clinical pathway: appropriate use of practice guidelines and supplies of drugs and ancillary services, new organization and procedures, patient education, etc. or to arm 2 (no intervention, usual care. 424 patients sample (212 in each group, 80% of power at the 5% significance level (two-sided. The primary outcome measure is in-hospital mortality. We will also analyze the impact of the clinical pathways comparing the length and the appropriateness of the stay, the rate of unscheduled readmissions, the customers' satisfaction and the costs treating the patients with the pathways and with the current practice along all the observation period. The quality of the care will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and by measuring key quality indicators at discharge. Discussion This paper examines the design of the evaluation of a complex

  13. The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities.

    LENUS (Irish Health Repository)

    Tsakanikos, Elias

    2011-04-27

    The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.

  14. Aligning Event Logs to Task-Time Matrix Clinical Pathways in BPMN for Variance Analysis.

    Science.gov (United States)

    Yan, Hui; Van Gorp, Pieter; Kaymak, Uzay; Lu, Xudong; Ji, Lei; Chiau, Choo Chiap; Korsten, Hendrikus H M; Duan, Huilong

    2018-03-01

    Clinical pathways (CPs) are popular healthcare management tools to standardize care and ensure quality. Analyzing CP compliance levels and variances is known to be useful for training and CP redesign purposes. Flexible semantics of the business process model and notation (BPMN) language has been shown to be useful for the modeling and analysis of complex protocols. However, in practical cases one may want to exploit that CPs often have the form of task-time matrices. This paper presents a new method parsing complex BPMN models and aligning traces to the models heuristically. A case study on variance analysis is undertaken, where a CP from the practice and two large sets of patients data from an electronic medical record (EMR) database are used. The results demonstrate that automated variance analysis between BPMN task-time models and real-life EMR data are feasible, whereas that was not the case for the existing analysis techniques. We also provide meaningful insights for further improvement.

  15. Feasibility of using microbeads with holographic barcodes to track DNA specimens in the clinical molecular laboratory

    Directory of Open Access Journals (Sweden)

    Jason D. Merker

    2013-07-01

    Full Text Available We demonstrate the feasibility of using glass microbeads with a holographic barcode identifier to track DNA specimens in the molecular pathology laboratory. These beads can be added to peripheral blood specimens and are carried through automated DNA extraction protocols that use magnetic glass particles. We found that an adequate number of microbeads are consistently carried over during genomic DNA extraction to allow specimen identification, that the beads do not interfere with the performance of several different molecular assays, and that the beads and genomic DNA remain stable when stored together under regular storage conditions in the molecular pathology laboratory. The beads function as an internal, easily readable specimen barcode. This approach may be useful for identifying DNA specimens and reducing errors associated with molecular laboratory testing.

  16. Linking ClinicalTrials.gov and PubMed to track results of interventional human clinical trials.

    Directory of Open Access Journals (Sweden)

    Vojtech Huser

    Full Text Available OBJECTIVE: In an effort to understand how results of human clinical trials are made public, we analyze a large set of clinical trials registered at ClinicalTrials.gov, the world's largest clinical trial registry. MATERIALS AND METHODS: We considered two trial result artifacts: (1 existence of a trial result journal article that is formally linked to a registered trial or (2 the deposition of a trial's basic summary results within the registry. RESULTS: The study sample consisted of 8907 completed, interventional, phase 2-or-higher clinical trials that were completed in 2006-2009. The majority of trials (72.2% had no structured trial-article link present. A total of 2367 trials (26.6% deposited basic summary results within the registry. Of those, 969 trials (10.9% were classified as trials with extended results and 1398 trials (15.7% were classified as trials with only required basic results. The majority of the trials (54.8% had no evidence of results, based on either linked result articles or basic summary results (silent trials, while a minimal number (9.2% report results through both registry deposition and publication. DISCUSSION: Our study analyzes the body of linked knowledge around clinical trials (which we refer to as the "trialome". Our results show that most trials do not report results and, for those that do, there is minimal overlap in the types of reporting. We identify several mechanisms by which the linkages between trials and their published results can be increased. CONCLUSION: Our study shows that even when combining publications and registry results, and despite availability of several information channels, trial sponsors do not sufficiently meet the mandate to inform the public either via a linked result publication or basic results submission.

  17. Clinical Pathways: A Catalyst for the Adoption of Hypofractionation for Early-Stage Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Bhavana V.; Rajagopalan, Malolan S.; Heron, Dwight E.; Flickinger, John C.; Beriwal, Sushil, E-mail: beriwals@upmc.edu

    2015-11-15

    Purpose: Hypofractionated whole-breast irradiation (HF-WBI) remains underutilized in the United States despite support by multiple clinical trials. We evaluated the success of iterative modifications of our breast cancer clinical pathway on the adoption of HF-WBI in a large, integrated radiation oncology network. Methods and Materials: The breast clinical pathway was modified in January 2011 (Amendment 1) to recommend HF-WBI as the first option for women ≥70 of age with stages 0 to IIA, while maintaining conventional fractionation (CF) as a pathway-concordant secondary option. In January 2013 (Amendment 2), the pathway's HF-WBI recommendation was extended to women ≥50 years of age. In January 2014 (Amendment 3), the pathway mandated HF-WBI as the only pathway-concordant option in women ≥50 years of age, and all pathway-discordant plans were subject to peer review and justification. Women ≥50 years of age with ductal carcinoma in situ or invasive breast cancer who underwent breast conserving surgery and adjuvant WBI were included in this analysis. Results: We identified 5112 patients from 2009 to 2014 who met inclusion criteria. From 2009 to 2012, the overall HF-WBI use rate was 8.3%. Following Amendments 2 and 3 (2013 and 2014, respectively), HF-WBI use significantly increased to 21.8% (17.3% in the community, 39.7% at academic sites) and 76.7% (75.5% in the community, 81.4% at academic sites), respectively (P<.001). Compared to 2009 to 2012, the relative risk of using HF-WBI was 7.9 (95% confidence interval: 7.1-8.6, P<.001) and 10.7 (95% CI: 10.3-11.0, P<.001), respectively, after Amendments 2 and 3, respectively. Age ≥70 and treatment at an academic site increased the likelihood of receiving HF-WBI in 2009 to 2012 and following Amendment 2 (P<.001). Conclusions: This study demonstrates the transformative effect of a clinical pathway on patterns of care for breast radiation therapy. Although our initial HF-WBI use rate was low (8%-22%) and

  18. Clinical Pathways: A Catalyst for the Adoption of Hypofractionation for Early-Stage Breast Cancer

    International Nuclear Information System (INIS)

    Chapman, Bhavana V.; Rajagopalan, Malolan S.; Heron, Dwight E.; Flickinger, John C.; Beriwal, Sushil

    2015-01-01

    Purpose: Hypofractionated whole-breast irradiation (HF-WBI) remains underutilized in the United States despite support by multiple clinical trials. We evaluated the success of iterative modifications of our breast cancer clinical pathway on the adoption of HF-WBI in a large, integrated radiation oncology network. Methods and Materials: The breast clinical pathway was modified in January 2011 (Amendment 1) to recommend HF-WBI as the first option for women ≥70 of age with stages 0 to IIA, while maintaining conventional fractionation (CF) as a pathway-concordant secondary option. In January 2013 (Amendment 2), the pathway's HF-WBI recommendation was extended to women ≥50 years of age. In January 2014 (Amendment 3), the pathway mandated HF-WBI as the only pathway-concordant option in women ≥50 years of age, and all pathway-discordant plans were subject to peer review and justification. Women ≥50 years of age with ductal carcinoma in situ or invasive breast cancer who underwent breast conserving surgery and adjuvant WBI were included in this analysis. Results: We identified 5112 patients from 2009 to 2014 who met inclusion criteria. From 2009 to 2012, the overall HF-WBI use rate was 8.3%. Following Amendments 2 and 3 (2013 and 2014, respectively), HF-WBI use significantly increased to 21.8% (17.3% in the community, 39.7% at academic sites) and 76.7% (75.5% in the community, 81.4% at academic sites), respectively (P<.001). Compared to 2009 to 2012, the relative risk of using HF-WBI was 7.9 (95% confidence interval: 7.1-8.6, P<.001) and 10.7 (95% CI: 10.3-11.0, P<.001), respectively, after Amendments 2 and 3, respectively. Age ≥70 and treatment at an academic site increased the likelihood of receiving HF-WBI in 2009 to 2012 and following Amendment 2 (P<.001). Conclusions: This study demonstrates the transformative effect of a clinical pathway on patterns of care for breast radiation therapy. Although our initial HF-WBI use rate was low (8%-22%) and

  19. A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways.

    Science.gov (United States)

    Dong, W; Huang, Z

    2015-01-01

    Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation. This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors. The filed study data is provided by ten clinical experts of a Chinese hospital. 23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation. The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.

  20. Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

    Science.gov (United States)

    Burrows, L; Lesser, T H; Kasbekar, A V; Roland, N; Billing, M

    2017-05-01

    To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders. The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service. In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent). Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

  1. Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: Clinical outcome

    International Nuclear Information System (INIS)

    Voort van Zyp, Noelle C. van der; Prevost, Jean-Briac; Hoogeman, Mischa S.; Praag, John; Holt, Bronno van der; Levendag, Peter C.; Klaveren, Robertus J. van; Pattynama, Peter; Nuyttens, Joost J.

    2009-01-01

    Purpose: To report the clinical outcome of treatment using real-time tumor tracking for 70 patients with inoperable stage I non-small cell lung cancer (NSCLC). Materials and methods: Seventy inoperable patients with peripherally located early-stage NSCLC were treated with 45 or 60 Gy in three fractions using CyberKnife. Pathology was available in 51% of patients. Thirty-nine patients had a T1-tumor and 31 had a T2-tumor. Markers were placed using the vascular, percutaneous intra-, or extra-pulmonary approach, depending on the risk of pneumothorax. Results: The actuarial 2-year local control rate for patients treated with 60 Gy was 96%, compared to 78% for patients treated with a total dose of 45 Gy (p = 0.197). All local recurrences (n = 4) occurred in patients with T2-tumors. Overall survival for the whole group at two years was 62% and the cause specific survival was 85%. The median follow-up was 15 months. Grade 3 toxicity occurred in two patients (3%) after marker placement. Treatment-related late grade 3 toxicity occurred in 7 patients (10%). No grade ≥4 toxicity occurred. Conclusion: Excellent local control of 96% at 1- and 2-years was achieved using 60 Gy in three fractions for NSCLC patients treated with the real-time tumor tracking. Toxicity was low.

  2. Which factors are important for the successful development and implementation of clinical pathways? A qualitative study.

    Science.gov (United States)

    De Allegri, Manuela; Schwarzbach, Matthias; Loerbroks, Adrian; Ronellenfitsch, Ulrich

    2011-03-01

    Clinical pathways (CPs) are detailed longitudinal care plans delineating measures to be conducted during a patient's treatment. Although positive effects on resource consumption and quality of care have been shown, CPs are still underutilised in many clinical settings because their development and implementation are difficult. Evidence underpinning successful development and implementation is sparse. The authors conducted semistructured face-to-face interviews with key staff members involved in the design and implementation of CPs in a large surgery department. Interviewees were asked to provide opinions on various issues, which were previously identified as potentially important in CP development and implementation. The transcribed text was read and coded independently by two researchers. Respondents highlighted the importance of a multidisciplinary participatory approach for CP design and implementation. There was a strong initial fear of losing individual freedom of treatment, which subsided after people worked with CPs in clinical everyday life. It was appreciated that the project originated from people at different levels of the department's hierarchy. Likewise, it was felt that CP implementation granted more autonomy to lower-level staff. The structured qualitative approach of this study provides information on what issues are considered important by staff members for CP design and implementation. Whereas some concepts such as the importance of a multidisciplinary approach or continuous feedback of results are known from theories, others such as strengthening the authority especially of lower-level health professionals through CPs have not been described so far. Many of the findings point towards strong interactions between factors important for CP implementation and a department's organisational structure.

  3. A cluster randomized trial to assess the impact of clinical pathways for patients with stroke: rationale and design of the Clinical Pathways for Effective and Appropriate Care Study [NCT00673491

    Directory of Open Access Journals (Sweden)

    Barbieri Antonella

    2008-11-01

    Full Text Available Abstract Background Patients with stroke should have access to a continuum of care from organized stroke units in the acute phase, to appropriate rehabilitation and secondary prevention measures. Moreover to improve the outcomes for acute stroke patients from an organizational perspective, the use of multidisciplinary teams and the delivery of continuous stroke education both to the professionals and to the public, and the implementation of evidence-based stroke care are recommended. Clinical pathways are complex interventions that can be used for this purpose. However in stroke care the use of clinical pathways remains questionable because little prospective controlled data has demonstrated their effectiveness. The purpose of this study is to determine whether clinical pathways could improve the quality of the care provided to the patients affected by stroke in hospital and through the continuum of the care. Methods Two-arm, cluster-randomized trial with hospitals and rehabilitation long-term care facilities as randomization units. 14 units will be randomized either to arm 1 (clinical pathway or to arm 2 (no intervention, usual care. The sample will include 238 in each group, this gives a power of 80%, at 5% significance level. The primary outcome measure is 30-days mortality. The impact of the clinical pathways along the continuum of care will also be analyzed by comparing the length of hospital stay, the hospital re-admissions rates, the institutionalization rates after hospital discharge, the patients' dependency levels, and complication rates. The quality of the care provided to the patients will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and rehabilitation, and by the use of key quality indicators at discharge. The implementation of organized care will be also evaluated. Conclusion The management of patients affected by stroke involves the expertise of several professionals, which can

  4. Experimental application of Business Process Management technology to manage clinical pathways: a pediatric kidney transplantation follow up case.

    Science.gov (United States)

    Andellini, Martina; Fernandez Riesgo, Sandra; Morolli, Federica; Ritrovato, Matteo; Cosoli, Piero; Petruzzellis, Silverio; Rosso, Nicola

    2017-11-03

    To test the application of Business Process Management technology to manage clinical pathways, using a pediatric kidney transplantation as case study, and to identify the benefits obtained from using this technology. Using a Business Process Management platform, we implemented a specific application to manage the clinical pathway of pediatric patients, and monitored the activities of the coordinator in charge of the case management during a 6-month period (from June 2015 to November 2015) using two methodologies: the traditional procedure and the one under study. The application helped physicians and nurses to optimize the amount of time and resources devoted to management purposes. In particular, time reduction was close to 60%. In addition, the reduction of data duplication, the integrated event management and the efficient data collection improved the quality of the service. The use of Business Process Management technology, usually related to well-defined processes with high management costs, is an established procedure in multiple environments; its use in healthcare, however, is innovative. The use of already accepted clinical pathways is known to improve outcomes. The combination of these two techniques, well established in their respective areas of application, could represent a revolution in clinical pathway management. The study has demonstrated that the use of this technology in a clinical environment, using a proper architecture and identifying a well-defined process, leads to real benefits in terms of resources optimization and quality improvement.

  5. Interconnecting smartphone, image analysis server, and case report forms in clinical trials for automatic skin lesion tracking in clinical trials

    Science.gov (United States)

    Haak, Daniel; Doma, Aliaa; Gombert, Alexander; Deserno, Thomas M.

    2016-03-01

    Today, subject's medical data in controlled clinical trials is captured digitally in electronic case report forms (eCRFs). However, eCRFs only insufficiently support integration of subject's image data, although medical imaging is looming large in studies today. For bed-side image integration, we present a mobile application (App) that utilizes the smartphone-integrated camera. To ensure high image quality with this inexpensive consumer hardware, color reference cards are placed in the camera's field of view next to the lesion. The cards are used for automatic calibration of geometry, color, and contrast. In addition, a personalized code is read from the cards that allows subject identification. For data integration, the App is connected to an communication and image analysis server that also holds the code-study-subject relation. In a second system interconnection, web services are used to connect the smartphone with OpenClinica, an open-source, Food and Drug Administration (FDA)-approved electronic data capture (EDC) system in clinical trials. Once the photographs have been securely stored on the server, they are released automatically from the mobile device. The workflow of the system is demonstrated by an ongoing clinical trial, in which photographic documentation is frequently performed to measure the effect of wound incision management systems. All 205 images, which have been collected in the study so far, have been correctly identified and successfully integrated into the corresponding subject's eCRF. Using this system, manual steps for the study personnel are reduced, and, therefore, errors, latency and costs decreased. Our approach also increases data security and privacy.

  6. Can eye-tracking technology improve situational awareness in paramedic clinical education?

    OpenAIRE

    Williams, Brett; Cooper,Simon; Quested,Andrew

    2013-01-01

    Brett Williams,1 Andrew Quested,1 Simon Cooper21Department of Community Emergency Health and Paramedic Practice, 2School of Nursing and Midwifery, Berwick, Monash University, Frankston, VIC, AustraliaAbstract: Human factors play a significant part in clinical error. Situational awareness (SA) means being aware of one's surroundings, comprehending the present situation, and being able to predict outcomes. It is a key human skill that, when properly applied, is associated with reducing ...

  7. Study on the clinical application of pulsed DC magnetic technology for tracking of intraoperative head motion during frameless stereotaxy

    Directory of Open Access Journals (Sweden)

    Stendel Rüdiger

    2006-04-01

    Full Text Available Abstract Background Tracking of post-registration head motion is one of the major problems in frameless stereotaxy. Various attempts in detecting and compensating for this phenomenon rely on a fixed reference device rigidly attached to the patient's head. However, most of such reference tools are either based on an invasive fixation technique or have physical limitations which allow mobility of the head only in a restricted range of motion after completion of the registration procedure. Methods A new sensor-based reference tool, the so-called Dynamic Reference Frame (DRF which is designed to allow an unrestricted, 360° range of motion for the intraoperative use in pulsed DC magnetic navigation was tested in 40 patients. Different methods of non-invasive attachment dependent on the clinical need and type of procedure, as well as the resulting accuracies in the clinical application have been analyzed. Results Apart from conventional, completely rigid immobilization of the head (type A, four additional modes of head fixation and attachment of the DRF were distinguished on clinical grounds: type B1 = pin fixation plus oral DRF attachment; type B2 = pin fixation plus retroauricular DRF attachment; type C1 = free head positioning with oral DRF; and type C2 = free head positioning with retroauricular DRF. Mean fiducial registration errors (FRE were as follows: type A interventions = 1.51 mm, B1 = 1.56 mm, B2 = 1.54 mm, C1 = 1.73 mm, and C2 = 1.75 mm. The mean position errors determined at the end of the intervention as a measure of application accuracy were: 1.45 mm in type A interventions, 1.26 mm in type B1, 1.44 mm in type B2, 1.86 mm in type C1, and 1.68 mm in type C2. Conclusion Rigid head immobilization guarantees most reliable accuracy in various types of frameless stereotaxy. The use of an additional DRF, however, increases the application scope of frameless stereotaxy to include e.g. procedures in which rigid pin fixation of the cranium is

  8. Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation

    Directory of Open Access Journals (Sweden)

    Masters IB

    2010-11-01

    Full Text Available Abstract Background Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. Methods/Design We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250 fulfilling inclusion criteria (new patients with chronic cough are randomised (allocation concealed to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks or usual care (existing care until review by specialist at 6 weeks. Cough diary, cough-specific quality of life (QOL and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses. A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. Discussion The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years. This study will provide additional evidence on the optimal management of chronic cough in children. Trial registration ACTRN12607000526471

  9. A novel model to combine clinical and pathway-based transcriptomic information for the prognosis prediction of breast cancer.

    Directory of Open Access Journals (Sweden)

    Sijia Huang

    2014-09-01

    Full Text Available Breast cancer is the most common malignancy in women worldwide. With the increasing awareness of heterogeneity in breast cancers, better prediction of breast cancer prognosis is much needed for more personalized treatment and disease management. Towards this goal, we have developed a novel computational model for breast cancer prognosis by combining the Pathway Deregulation Score (PDS based pathifier algorithm, Cox regression and L1-LASSO penalization method. We trained the model on a set of 236 patients with gene expression data and clinical information, and validated the performance on three diversified testing data sets of 606 patients. To evaluate the performance of the model, we conducted survival analysis of the dichotomized groups, and compared the areas under the curve based on the binary classification. The resulting prognosis genomic model is composed of fifteen pathways (e.g., P53 pathway that had previously reported cancer relevance, and it successfully differentiated relapse in the training set (log rank p-value = 6.25e-12 and three testing data sets (log rank p-value < 0.0005. Moreover, the pathway-based genomic models consistently performed better than gene-based models on all four data sets. We also find strong evidence that combining genomic information with clinical information improved the p-values of prognosis prediction by at least three orders of magnitude in comparison to using either genomic or clinical information alone. In summary, we propose a novel prognosis model that harnesses the pathway-based dysregulation as well as valuable clinical information. The selected pathways in our prognosis model are promising targets for therapeutic intervention.

  10. Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

    NARCIS (Netherlands)

    Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

    2005-01-01

    Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

  11. Feature tracking CMR reveals abnormal strain in preclinical arrhythmogenic right ventricular dysplasia/ cardiomyopathy: a multisoftware feasibility and clinical implementation study.

    Science.gov (United States)

    Bourfiss, Mimount; Vigneault, Davis M; Aliyari Ghasebeh, Mounes; Murray, Brittney; James, Cynthia A; Tichnell, Crystal; Mohamed Hoesein, Firdaus A; Zimmerman, Stefan L; Kamel, Ihab R; Calkins, Hugh; Tandri, Harikrishna; Velthuis, Birgitta K; Bluemke, David A; Te Riele, Anneline S J M

    2017-09-01

    Regional right ventricular (RV) dysfunction is the hallmark of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C), but is currently only qualitatively evaluated in the clinical setting. Feature Tracking Cardiovascular Magnetic Resonance (FT-CMR) is a novel quantitative method that uses cine CMR to calculate strain values. However, most prior FT-CMR studies in ARVD/C have focused on global RV strain using different software methods, complicating implementation of FT-CMR in clinical practice. We aimed to assess the clinical value of global and regional strain using FT-CMR in ARVD/C and to determine differences between commercially available FT-CMR software packages. We analyzed cine CMR images of 110 subjects (39 overt ARVD/C [mutation+/phenotype+], 40 preclinical ARVD/C [mutation+/phenotype-] and 31 control) for global and regional (subtricuspid, anterior, apical) RV strain in the horizontal longitudinal axis using four FT-CMR software methods (Multimodality Tissue Tracking, TomTec, Medis and Circle Cardiovascular Imaging). Intersoftware agreement was assessed using Bland Altman plots. For global strain, all methods showed reduced strain in overt ARVD/C patients compared to control subjects (p  0.275). For regional strain, overt ARVD/C patients showed reduced strain compared to control subjects in all segments which reached statistical significance in the subtricuspid region for all software methods (p < 0.037), in the anterior wall for two methods (p < 0.005) and in the apex for one method (p = 0.012). Preclinical subjects showed abnormal subtricuspid strain compared to control subjects using one of the software methods (p = 0.009). Agreement between software methods for absolute strain values was low (Intraclass Correlation Coefficient = 0.373). Despite large intersoftware variability of FT-CMR derived strain values, all four software methods distinguished overt ARVD/C patients from control subjects by both global and subtricuspid

  12. Fast track-hoftealloplastik

    DEFF Research Database (Denmark)

    Hansen, Torben Bæk; Gromov, Kirill; Kristensen, Billy B

    2017-01-01

    Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased...... morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden....

  13. Navigating the clinical trial pathway: Conception, design, execution, and results dissemination.

    Science.gov (United States)

    Sampalis, John S; Watson, Joanne; Boukas, Stella; Boukas, Marianna; Harvey, Natalie; Machado, Sanjay; Bordeleau, Michel; Rampakakis, Emmanouil

    2017-03-01

    Dr Sampalis is founder, Chief Executive Officer, and Chief Scientific Officer of JSS Medical Research Inc, founded in 1997. He is a tenured professor of Surgery and Epidemiology & Biostatistics of McGill University, the University of Montreal and University of Laval. Recognized as a leading clinical epidemiologist and one of the top trauma researchers in Canada, he possesses extensive expertise in health services research, clinical trials, and offers services as a Research and Epidemiological Consultant for numerous pharmaceutical companies, hospitals and government organizations and agencies. Mrs. Watson holds a M.Sc. in Pharmacology from Dalhousie University, and a B.Sc. from the University of Western Ontario. Her experience extends to all facets of the CRO business, and multiple therapeutic areas. She co-founded, in 1992, Integrated Research Inc, a full-service contract research organization, and served as its President and Chief Executive Officer, until merging with JSS Medical Research Inc in 2014. Mrs. Watson currently holds the position of Chief Business Officer, and is head of the business development team. Mrs. Boukas has been working with the JSS Medical Research team since its inception in the 1990s. She holds a B.A. in Psychology from McGill University with training in Epidemiology and Biostatistics, and is certified by the Society of Clinical Research Associates (SOCRA) as a Certified Clinical Research Professional (CCRP). She has over 25 years' of experience in medical research management. Currently Chief Operations Officer, Mrs. Boukas has been essential in structuring and implementing programs at JSS Medical Research Inc to facilitate project management, site recruitment, data capture and study tracking. Mrs. Boukas holds a B.A. from McGill University, a Certificate in Technical Communications from Concordia University and has received compliance training from SNC Lavalin Pharma (SLP) and SOCRA. She has over twenty-five years' experience in

  14. DTI fiber tractography of cerebro-cerebellar pathways and clinical evaluation of ataxia in childhood posterior fossa tumor survivors.

    Science.gov (United States)

    Oh, Myung Eun; Driever, Pablo Hernáiz; Khajuria, Rajiv K; Rueckriegel, Stefan Mark; Koustenis, Elisabeth; Bruhn, Harald; Thomale, Ulrich-Wilhelm

    2017-01-01

    Pediatric posterior fossa (PF) tumor survivors experience long-term motor deficits. Specific cerebrocerebellar connections may be involved in incidence and severity of motor dysfunction. We examined the relationship between long-term ataxia as well as fine motor function and alteration of differential cerebellar efferent and afferent pathways using diffusion tensor imaging (DTI) and tractography. DTI-based tractography was performed in 19 patients (10 pilocytic astrocytoma (PA) and 9 medulloblastoma patients (MB)) and 20 healthy peers. Efferent Cerebello-Thalamo-Cerebral (CTC) and afferent Cerebro-Ponto-Cerebellar (CPC) tracts were reconstructed and analyzed concerning fractional anisotropy (FA) and volumetric measurements. Clinical outcome was assessed with the International Cooperative Ataxia Rating Scale (ICARS). Kinematic parameters of fine motor function (speed, automation, variability, and pressure) were obtained by employing a digitizing graphic tablet. ICARS scores were significantly higher in MB patients than in PA patients. Poorer ICARS scores and impaired fine motor function correlated significantly with volume loss of CTC pathway in MB patients, but not in PA patients. Patients with pediatric post-operative cerebellar mutism syndrome showed higher loss of CTC pathway volume and were more atactic. CPC pathway volume was significantly reduced in PA patients, but not in MB patients. Neither relationship was observed between the CPC pathway and ICARS or fine motor function. There was no group difference of FA values between the patients and healthy peers. Reduced CTC pathway volumes in our cohorts were associated with severity of long-term ataxia and impaired fine motor function in survivors of MBs. We suggest that the CTC pathway seems to play a role in extent of ataxia and fine motor dysfunction after childhood cerebellar tumor treatment. DTI may be a useful tool to identify relevant structures of the CTC pathway and possibly avoid surgically induced long

  15. Implementation of a clinical pathway for emergency department out-patient management of deep vein thrombosis.

    LENUS (Irish Health Repository)

    Kidney, R

    2010-09-01

    There is good evidence demonstrating that outpatient management of deep venous thrombosis (DVT) is feasible and safe. However, few emergency departments in Ireland have implemented care pathways for outpatient management of DVT. The aim of this study was to examine the safety and efficacy of implementing an Emergency Department (ED)- care pathway for outpatient management of patients with DVT. A retrospective observational study of this care pathway introduced at our institution was performed. The primary outcome measure was the number of hospital admissions avoided by using the care pathway. Two hundred and eighty-four patients presenting to the ED with suspected lower limb DVT, were managed using the care pathway over a 6 month period. Forty-nine patients (17%) had a DVT diagnosed. Thirty-nine patients (81%) were suitable for outpatient DVT management. Ten patients (19%) were admitted to hospital. At 3 months there were no reported cases of the following complications: missed DVT, pulmonary embolism or death.

  16. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center.

    Science.gov (United States)

    Vosler, Peter S; Kass, Jason I; Wang, Eric W; Snyderman, Carl H

    2016-11-01

    We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. Single prospective analysis with historical control. Tertiary academic hospital. Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  17. Development and clinical evaluation of automatic fiducial detection for tumor tracking in cine megavoltage images during volumetric modulated arc therapy

    International Nuclear Information System (INIS)

    Azcona, Juan Diego; Li Ruijiang; Mok, Edward; Hancock, Steven; Xing Lei

    2013-01-01

    Purpose: Real-time tracking of implanted fiducials in cine megavoltage (MV) imaging during volumetric modulated arc therapy (VMAT) delivery is complicated due to the inherent low contrast of MV images and potential blockage of dynamic leaves configurations. The purpose of this work is to develop a clinically practical autodetection algorithm for motion management during VMAT. Methods: The expected field-specific segments and the planned fiducial position from the Eclipse (Varian Medical Systems, Palo Alto, CA) treatment planning system were projected onto the MV images. The fiducials were enhanced by applying a Laplacian of Gaussian filter in the spatial domain for each image, with a blob-shaped object as the impulse response. The search of implanted fiducials was then performed on a region of interest centered on the projection of the fiducial when it was within an open field including the case when it was close to the field edge or partially occluded by the leaves. A universal template formula was proposed for template matching and normalized cross correlation was employed for its simplicity and computational efficiency. The search region for every image was adaptively updated through a prediction model that employed the 3D position of the fiducial estimated from the localized positions in previous images. This prediction model allowed the actual fiducial position to be tracked dynamically and was used to initialize the search region. The artifacts caused by electronic interference during the acquisition were effectively removed. A score map was computed by combining both morphological information and image intensity. The pixel location with the highest score was selected as the detected fiducial position. The sets of cine MV images taken during treatment were analyzed with in-house developed software written in MATLAB (The Mathworks, Inc., Natick, MA). Five prostate patients were analyzed to assess the algorithm performance by measuring their positioning

  18. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application

    Directory of Open Access Journals (Sweden)

    Romilly E. Hodges

    2015-01-01

    Full Text Available Research into human biotransformation and elimination systems continues to evolve. Various clinical and in vivo studies have been undertaken to evaluate the effects of foods and food-derived components on the activity of detoxification pathways, including phase I cytochrome P450 enzymes, phase II conjugation enzymes, Nrf2 signaling, and metallothionein. This review summarizes the research in this area to date, highlighting the potential for foods and nutrients to support and/or modulate detoxification functions. Clinical applications to alter detoxification pathway activity and improve patient outcomes are considered, drawing on the growing understanding of the relationship between detoxification functions and different disease states, genetic polymorphisms, and drug-nutrient interactions. Some caution is recommended, however, due to the limitations of current research as well as indications that many nutrients exert biphasic, dose-dependent effects and that genetic polymorphisms may alter outcomes. A whole-foods approach may, therefore, be prudent.

  19. Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project.

    Science.gov (United States)

    Lord, J; Willis, S; Eatock, J; Tappenden, P; Trapero-Bertran, M; Miners, A; Crossan, C; Westby, M; Anagnostou, A; Taylor, S; Mavranezouli, I; Wonderling, D; Alderson, P; Ruiz, F

    2013-12-01

    National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from

  20. A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

    Science.gov (United States)

    2006-01-01

    RT respiratory therapy ; PT physical therapy ; OT occupational therapy ; GCS Glasgow Coma Scale. 808 S.R. Todd et al. / The American Journal of...Morbidity form rib fractures increases after age 45. J Am Coll Surg 2003;196:549–55. [14] Pierson DJ, Kacmarek R. Foundations of Respiratory Care. New...Papers presented A multidisciplinary clinical pathway decreases rib fracture –associated infectious morbidity and mortality in high-risk trauma

  1. A cluster randomised trial to assess the impact of clinical pathways on AMI management in rural Australian emergency departments

    Directory of Open Access Journals (Sweden)

    Snow Pamela C

    2009-05-01

    Full Text Available Abstract Background People living in rural Australia are more likely to die in hospital following an acute myocardial infarction than those living in major cities. While several factors, including time taken to access hospital care, contribute to this risk, it is also partially attributable to the lower uptake of evidence-based guidelines for the administration of thrombolytic drugs in rural emergency departments where up to one-third of eligible patients do not receive this life-saving intervention. Clinical pathways have the potential to link evidence to practice by integrating guidelines into local systems, but their impact has been hampered by variable implementation strategies and sub-optimal research designs. The purpose of this study is to determine the impact of a five-step clinical pathways implementation process on the timely and efficient administration of thrombolytic drugs for acute myocardial infarctions managed in rural Australian emergency departments. Methods/Design The design is a two-arm, cluster-randomised trial with rural hospital emergency departments that treat and do not routinely transfer acute myocardial infarction patients. Six rural hospitals in the state of Victoria will participate, with three in the intervention group and three in the control group. Intervention hospitals will participate in a five-step clinical pathway implementation process: engagement of clinicians, pathway development according to local resources and systems, reminders, education, and audit and feedback. Hospitals in the control group will each receive a hard copy of Australian national guidelines for chest pain and acute myocardial infarction management. Each group will include 90 cases to give a power of 80% at 5% significance level for the two primary outcome measures: proportion of those eligible for thrombolysis receiving the drug and time to delivery of thrombolytic drug. Discussion Improved compliance with thrombolytic guidelines via

  2. Track B Clinical Science

    OpenAIRE

    Kyrychenko, T.; Dubynska, G.; Koval, T.; Kaidashev, I.; Korshenko, V.; Rono, K.; Kibuuka, H.; Maganga, L.; Kosgei, J.; Sekiziyivu, A.; Sanga, E.; Ngetich, E.; Bolen Valenzuela, A.; Michael, N.; Robb, M.

    2012-01-01

    Background Toll-like receptors (TLRs) are transmembrane receptors that activate cells of the innate immune systems upon recognition of pathogen-associated molecular patterns. The TLR4 is an essential component of the innate immune response to various microorganisms. We investigated the impact of TLR4 polymorphism on development of opportunistic diseases in HIV-infected patients. Methods The presence of TLR4 Asp299Gly single nucleotide polymorphisms (SNPs) was determined in a cohort of 180 ant...

  3. Learning pathways during clinical placement of physiotherapy students: a Malaysian experience of using learning contracts and reflective diaries

    Directory of Open Access Journals (Sweden)

    Ayiesah Ramli

    2013-07-01

    Full Text Available Purpose: Learning contracts and reflective diaries are educational tools that have been recently introduced to physiotherapy students from Malaysia during clinical education. It is unclear how students perceive the experience of using a learning contract and reflective diary. This study explores the learning pathways of the students after using a learning contract and a reflective diary for the first time in their clinical placement. Methods: A total of 26 final-year physiotherapy students completed a learning contract and a reflective diary during clinical placements. Two researchers explored the data qualitatively by the thematic content analysis method using NVivo. Results: A total of four and six main learning themes were identified from the data of the students through a learning contract and reflective diary. Conclusion: These learning themes reflected the views of the students about what they have considered to be important learning pathways during their clinical placements. They give valuable insights into the experiences and opinions of students during their clinical education process, which should be useful for enhancing teaching and learning methods in physiotherapy education.

  4. Clinical evidence on the magnitude of change in growth pathway activity in relation to Tamoxifen resistance is required.

    Science.gov (United States)

    Mansouri, Sepideh; Farahmand, Leila; Teymourzadeh, Azin; Majidzadeh-A, Keivan

    2017-08-08

    Despite prolonged disease-free survival and overall survival rates in estrogen receptor (ER)-positive patients undergoing adjuvant treatment, Tamoxifen therapy tends to fail due to eventual acquisition of resistance. Although numerous studies have emphasized the role of receptor tyrosine kinases (RTKs) in the development of Tamoxifen resistance, inadequate clinical evidence is available regarding the alteration of biomarker expression during acquired resistance, thus undermining the validity of the findings. Results of two meta-analyses investigating the effect of HER2 status on the prognosis of Tamoxifen-receiving patients have demonstrated that despite HER2-negative patients having longer disease-free survival; there is no difference in overhaul survival between the two groups. Furthermore, due to the intricate molecular interactions among estrogen receptors including ERα36, ERα66, and also RTKs, it is not surprising that RTK suppression does not restore Tamoxifen sensitivity. In considering such a complex network, we speculate that by the time HER2/EGFR is suppressed via targeted therapies, activation of ERα66 and ERα36 initiate molecular signaling pathways downstream of RTKs, thereby enhancing cell proliferation even in the presence of both Tamoxifen and RTK inhibitors. Although clinical findings regarding the molecular pathways downstream of RTKs have been thoroughly discussed in this review, further clinical studies are required in determining a consistency between preclinical and clinical findings. Discovering the best targets in preventing tumor progression requires thorough comprehension of estrogen-dependent and estrogen-independent pathways during Tamoxifen resistance development. Indeed, exploring additional clinically-proven targets would allow for better characterized treatments being available for breast cancer patients. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. Diffusion-weighted and dynamic contrast-enhanced imaging as markers of clinical behavior in children with optic pathway glioma

    International Nuclear Information System (INIS)

    Jost, Sarah C.; Ackerman, Joseph W.; Garbow, Joel R.; Manwaring, Linda P.; Gutmann, David H.; McKinstry, Robert C.

    2008-01-01

    Optic pathway gliomas (OPGs) are common pediatric brain tumors that pose significant clinical challenges with regard to predicting which tumors are likely to become symptomatic and require treatment. These tumors can arise sporadically or in the context of the inherited cancer predisposition syndrome neurofibromatosis type 1 (NF1). Few studies have suggested biological or imaging markers that predict the clinical course of this disease. In this cross-sectional study, we hypothesized that the clinical behavior of OPGs in children can be differentiated by diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) MRI. A total of 27 children with OPG were studied using DW and DCE MRI protocols. Diffusivity and permeability were calculated and correlated with the clinical behavior the OPG. Mean diffusivity values of 1.39 μm 2 /ms and mean permeability values of 2.10 ml/min per 100 cm 3 of tissue were measured. Clinically aggressive OPGs had significantly higher mean permeability values (P = 0.05) than clinically stable tumors. In addition, there was a strong correlation between clinical aggressiveness and the absence of NF1 (P < 0.01). These results suggest that DCE MRI might be a useful biomarker for clinically aggressive OPG, which should be confirmed in larger prospective longitudinal studies. (orig.)

  6. Clinical and prognostic value of the C-Met/HGF signaling pathway in cervical cancer.

    Science.gov (United States)

    Boromand, Nadia; Hasanzadeh, Malihe; ShahidSales, Soodabeh; Farazestanian, Marjaneh; Gharib, Masoumeh; Fiuji, Hamid; Behboodi, Negin; Ghobadi, Niloofar; Hassanian, Seyed Mahdi; Ferns, Gordon A; Avan, Amir

    2018-06-01

    Aberrant activation of the HGF/c-Met signalling pathway is reported to be associated with cell proliferation, progression, and metastasis features of several tumor types, including cervical cancer, suggesting that it may be of potential value as a novel therapeutic target. Furthermore, HPV-positive patients had a higher serum level of HGF or c-Met protein, compared with HPV-negative patients. c-Met or HGF overexpression in lesions of cervical cancer is reported to be related to a poorer prognosis, and hence this may be of value as a prognostic and predictive biomarker. Several approaches have been developed for targeting HGF and/or c-Met. One of these is crizotinib (a dual c-Met/ALK inhibitor). This has been approved by FDA for the treatment of lung-cancer. Further investigations are required to evaluate and optimize the use of c-Met inhibitors in cervical cancer or parallel targeting signalling pathway associated/activated via MET/HGF pathway. The main aim of current review was to give an overview of the potential of the c-Met/HGF pathway as a prognostic, or predictive biomarker in cervical cancer. © 2017 Wiley Periodicals, Inc.

  7. Indirect Effects of the Fast Track Intervention on Conduct Disorder Symptoms and Callous-Unemotional Traits: Distinct Pathways Involving Discipline and Warmth.

    Science.gov (United States)

    Pasalich, Dave S; Witkiewitz, Katie; McMahon, Robert J; Pinderhughes, Ellen E

    2016-04-01

    Little is known about intervening processes that explain how prevention programs improve particular youth antisocial outcomes. We examined whether parental harsh discipline and warmth in childhood differentially account for Fast Track intervention effects on conduct disorder (CD) symptoms and callous-unemotional (CU) traits in early adolescence. Participants included 891 high-risk kindergarteners (69% male; 51% African American) from urban and rural United States communities who were randomized into either the Fast Track intervention (n = 445) or non-intervention control (n = 446) groups. The 10-year intervention included parent management training and other services (e.g., social skills training, universal classroom curriculum) targeting various risk factors for the development of conduct problems. Harsh discipline (Grades 1 to 3) and warmth (Grades 1 and 2) were measured using parent responses to vignettes and direct observations of parent-child interaction, respectively. Parents reported on children's CD symptoms in Grade 6 and CU traits in Grade 7. Results demonstrated indirect effects of the Fast Track intervention on reducing risk for youth antisocial outcomes. That is, Fast Track was associated with lower scores on harsh discipline, which in turn predicted decreased levels of CD symptoms. In addition, Fast Track was associated with higher scores on warmth, which in turn predicted reduced levels of CU traits. Our findings inform developmental and intervention models of youth antisocial behavior by providing evidence for the differential role of harsh discipline and warmth in accounting for indirect effects of Fast Track on CD symptoms versus CU traits, respectively.

  8. The PD1:PD-L1/2 Pathway from Discovery to Clinical Implementation.

    Science.gov (United States)

    Bardhan, Kankana; Anagnostou, Theodora; Boussiotis, Vassiliki A

    2016-01-01

    The immune system maintains a critically organized network to defend against foreign particles, while evading self-reactivity simultaneously. T lymphocytes function as effectors and play an important regulatory role to orchestrate the immune signals. Although central tolerance mechanism results in the removal of the most of the autoreactive T cells during thymic selection, a fraction of self-reactive lymphocytes escapes to the periphery and pose a threat to cause autoimmunity. The immune system evolved various mechanisms to constrain such autoreactive T cells and maintain peripheral tolerance, including T cell anergy, deletion, and suppression by regulatory T cells (T Regs ). These effects are regulated by a complex network of stimulatory and inhibitory receptors expressed on T cells and their ligands, which deliver cell-to-cell signals that dictate the outcome of T cell encountering with cognate antigens. Among the inhibitory immune mediators, the pathway consisting of the programed cell death 1 (PD-1) receptor (CD279) and its ligands PD-L1 (B7-H1, CD274) and PD-L2 (B7-DC, CD273) plays an important role in the induction and maintenance of peripheral tolerance and for the maintenance of the stability and the integrity of T cells. However, the PD-1:PD-L1/L2 pathway also mediates potent inhibitory signals to hinder the proliferation and function of T effector cells and have inimical effects on antiviral and antitumor immunity. Therapeutic targeting of this pathway has resulted in successful enhancement of T cell immunity against viral pathogens and tumors. Here, we will provide a brief overview on the properties of the components of the PD-1 pathway, the signaling events regulated by PD-1 engagement, and their consequences on the function of T effector cells.

  9. The PD1: PD-L1/2 pathway from discovery to clinical implementation

    Directory of Open Access Journals (Sweden)

    Kankana Bardhan

    2016-12-01

    Full Text Available The immune system has the difficult challenge of discerning and defending against a diversity of microbial pathogens, while simultaneously avoiding self-reactivity. T lymphocytes function as effectors and regulators of the immune system. While central tolerance mechanism results in deletion of the majority of self-reactive T lymphocytes during thymic selection, a fraction of self reactive lymphocytes escapes to the periphery and retains the potential to inflict destructive autoimmune pathology. The immune system evolved various mechanisms to restrain such auto-reactive T cells and maintain peripheral tolerance, including T cell anergy, deletion, and suppression by regulatory T cells (TRegs. These effects are regulated by a complex network of stimulatory and inhibitory receptors expressed on T cells and their ligands, which deliver cell-to-cell signals that dictate the outcome of T cell encountering with cognate antigens. Among the inhibitory immune mediators, the pathway consisting of the programmed cell death 1 (PD-1 receptor (CD279 and its ligands PD-L1 (B7-H1, CD274 and PD-L2 (B7-DC; CD273 plays a vital role in the induction and maintenance of peripheral tolerance and for the maintenance of T cell homeostasis. In contrast to its beneficial role in self-tolerance, the PD-1: PD-L1/L2 pathway mediates potent inhibitory signals that prevent the expansion and function of T effector cells and have detrimental effects on antiviral and antitumor immunity. Therapeutic targeting of this pathway has resulted in successful enhancement of T cell immunity against viral pathogens and tumors. Here, we will provide a brief overview on the properties of the components of the PD-1 pathway, the signaling events that are regulated by PD-1 triggering, and their consequences on the function of T effector cells.

  10. Evaluating glymphatic pathway function utilizing clinically relevant intrathecal infusion of CSF tracer

    OpenAIRE

    Yang, Lijun; Kress, Benjamin T; Weber, Harris J; Thiyagarajan, Meenakshisundaram; Wang, Baozhi; Deane, Rashid; Benveniste, Helene; Iliff, Jeffrey J; Nedergaard, Maiken

    2013-01-01

    Background Neurodegenerative diseases such as Alzheimer?s are associated with the aggregation of endogenous peptides and proteins that contribute to neuronal dysfunction and loss. The glymphatic system, a brain-wide perivascular pathway along which cerebrospinal fluid (CSF) and interstitial fluid (ISF) rapidly exchange, has recently been identified as a key contributor to the clearance of interstitial solutes from the brain, including amyloid ?. These findings suggest that measuring changes i...

  11. Do Vocational Pathways Improve Higher Education Access for Women and Men from Less Privileged Social Backgrounds? : A Comparison of Vocational Tracks to Higher Education in France and Switzerland

    OpenAIRE

    Imdorf, Christian; Koomen, Maarten; Murdoch, Jake; Guégnard, Christine

    2017-01-01

    International audience; Educational policy developments in France and Switzerland have increased eligibility for higher education. This paper explores the extent to which vocationally orientated pathways to higher education reduce social inequalities in France and Switzerland. More specifically, we analyse how the vocational pathway facilitates access to higher education for male and female students from lower cultural capital backgrounds. We refer to gender theory to link young people's subj...

  12. Automated systems for the de-identification of longitudinal clinical narratives: Overview of 2014 i2b2/UTHealth shared task Track 1.

    Science.gov (United States)

    Stubbs, Amber; Kotfila, Christopher; Uzuner, Özlem

    2015-12-01

    The 2014 i2b2/UTHealth Natural Language Processing (NLP) shared task featured four tracks. The first of these was the de-identification track focused on identifying protected health information (PHI) in longitudinal clinical narratives. The longitudinal nature of clinical narratives calls particular attention to details of information that, while benign on their own in separate records, can lead to identification of patients in combination in longitudinal records. Accordingly, the 2014 de-identification track addressed a broader set of entities and PHI than covered by the Health Insurance Portability and Accountability Act - the focus of the de-identification shared task that was organized in 2006. Ten teams tackled the 2014 de-identification task and submitted 22 system outputs for evaluation. Each team was evaluated on their best performing system output. Three of the 10 systems achieved F1 scores over .90, and seven of the top 10 scored over .75. The most successful systems combined conditional random fields and hand-written rules. Our findings indicate that automated systems can be very effective for this task, but that de-identification is not yet a solved problem. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study

    Science.gov (United States)

    Castorina, Sergio; Guglielmino, Claudia; Castrogiovanni, Paola; Szychlinska, Marta Anna; Ioppolo, Francesco; Massimino, Paolo; Leonardi, Pietro; Maci, Christian; Iannuzzi, Maurizio; Di Giunta, Angelo; Musumeci, Giuseppe

    2017-01-01

    Summary Background During the last years, programs to enhance postoperative recovery and decrease morbidity after total knee arthroplasty, have been developed across a variety of surgical procedures and referred to as “Fast-Track Surgery”. In this study we aimed to find some answers in the management of osteoarthritic patients subjected to total knee arthroplasty, by using the Fast-Track methodology. To this purpose we evaluated parameters such as early mobilization of patients, better pain management, bleeding, possible complications, reduced hospitalization time, an overall improved recovery and patient satisfaction. Methods 132 patients were selected, of which, 95 treated with “Fast Track” method and 37 treated with traditional method (control group). All the patients were hospitalized and underwent the same rehabilitation program for the first three days after surgery. Results In both groups, the parameters of pain and deformity demonstrated the most rapid improvement, while those of function and movement were normalized as gradual and progressive improvement over the next 2 months. The different functional test used (Barthel, MRC, VAS) showed that the mean values were significantly greater in Fast Track group when compared to the control. Conclusion The results of the study confirm that the application of the Fast Track protocol in orthopaedics after total knee replacement results in rapid post-surgery recovery. Level of evidence IV. Case series, low-quality cohort or case-control studies. PMID:29387645

  14. New methods for clinical pathways-Business Process Modeling Notation (BPMN) and Tangible Business Process Modeling (t.BPM).

    Science.gov (United States)

    Scheuerlein, Hubert; Rauchfuss, Falk; Dittmar, Yves; Molle, Rüdiger; Lehmann, Torsten; Pienkos, Nicole; Settmacher, Utz

    2012-06-01

    Clinical pathways (CP) are nowadays used in numerous institutions, but their real impact is still a matter of debate. The optimal design of a clinical pathway remains unclear and is mainly determined by the expectations of the individual institution. The purpose of the here described pilot project was the development of two CP (colon and rectum carcinoma) according to Business Process Modeling Notation (BPMN) and Tangible Business Process Modeling (t.BPM). BPMN is an established standard for business process modelling in industry and economy. It is, in the broadest sense, a computer programme which enables the description and a relatively easy graphical imaging of complex processes. t.BPM is a modular construction system of the BPMN symbols which enables the creation of an outline or raw model, e.g. by placing the symbols on a spread-out paper sheet. The thus created outline can then be transferred to the computer and further modified as required. CP for the treatment of colon and rectal cancer have been developed with support of an external IT coach. The pathway was developed in an interdisciplinary and interprofessional manner (55 man-days over 15 working days). During this time, necessary interviews with medical, nursing and administrative staffs were conducted as well. Both pathways were developed parallel. Subsequent analysis was focussed on feasibility, expenditure, clarity and suitability for daily clinical practice. The familiarization with BPMN was relatively quick and intuitive. The use of t.BPM enabled the pragmatic, effective and results-directed creation of outlines for the CP. The development of both CP was finished from the diagnostic evaluation to the adjuvant/neoadjuvant therapy and rehabilitation phase. The integration of checklists, guidelines and important medical or other documents is easily accomplished. A direct integration into the hospital computer system is currently not possible for technical reasons. BPMN and t.BPM are sufficiently

  15. The Fanconi Anemia BRCA Pathway as a Predictor of Benefit from Bevacizumab in a Large Phase 3 Clinical Trial in Ovarian Cancer

    Science.gov (United States)

    2014-12-01

    1 AWARD NUMBER: W81XWH-13-1-0421 TITLE: The Fanconi Anemia BRCA Pathway as a Predictor of Benefit from Bevacizumab in a Large Phase III Clinical...DATES COVERED 30Sep2013 - 29Sep2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-13-1-0421 The Fanconi Anemia BRCA Pathway as a Predictor of...another upfront clinical trial GOG262. We found that germline or somatic mutations in the BRCA- Fanconi anemia pathway was significantly associated with

  16. Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates.

    Science.gov (United States)

    Truong, Cynthia Y; Gombar, Saurabh; Wilson, Richard; Sundararajan, Gopalakrishnan; Tekic, Natasa; Holubar, Marisa; Shepard, John; Madison, Alexandra; Tompkins, Lucy; Shah, Neil; Deresinski, Stan; Schroeder, Lee F; Banaei, Niaz

    2017-05-01

    Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days ( P difficile results. Real-time electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates. Copyright © 2017 American Society for Microbiology.

  17. Natural history of hepatic metastases from colorectal cancer--pathobiological pathways with clinical significance.

    Science.gov (United States)

    Paschos, Konstantinos A; Majeed, Ali W; Bird, Nigel C

    2014-04-14

    Colorectal cancer hepatic metastases represent the final stage of a multi-step biological process. This process starts with a series of mutations in colonic epithelial cells, continues with their detachment from the large intestine, dissemination through the blood and/or lymphatic circulation, attachment to the hepatic sinusoids and interactions with the sinusoidal cells, such as sinusoidal endothelial cells, Kupffer cells, stellate cells and pit cells. The metastatic sequence terminates with colorectal cancer cell invasion, adaptation and colonisation of the hepatic parenchyma. All these events, termed the colorectal cancer invasion-metastasis cascade, include multiple molecular pathways, intercellular interactions and expression of a plethora of chemokines and growth factors, and adhesion molecules, such as the selectins, the integrins or the cadherins, as well as enzymes including matrix metalloproteinases. This review aims to present recent advances that provide insights into these cell-biological events and emphasizes those that may be amenable to therapeutic targeting.

  18. Learning Effective Treatment Pathways for Type-2 Diabetes from a clinical data warehouse.

    Science.gov (United States)

    Vashisht, Rohit; Jung, Ken; Shah, Nigam

    2016-01-01

    Treatment guidelines for management of type-2 diabetes mellitus (T2DM) are controversial because existing evidence from randomized clinical trials do not address many important clinical questions. Data from Electronic Medical Records (EMRs) has been used to profile first line therapy choices, but this work did not elucidate the factors underlying deviations from current treatment guidelines and the relative efficacy of different treatment options. We have used data from the Stanford Hospital to attempt to address these issues. Clinical features associated with the initial choice of treatment were effectively re-discovered using a machine learning approach. In addition, the efficacies of first and second line treatments were evaluated using Cox proportional hazard models for control of Hemoglobin A 1c . Factors such as acute kidney disorder and liver disorder were predictive of first line therapy choices. Sitagliptin was the most effective second-line therapy, and as effective as metformin as a first line therapy.

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

    Directory of Open Access Journals (Sweden)

    Aurea Lima

    2015-06-01

    Full Text Available 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.

  20. Multileaf Collimator Tracking Improves Dose Delivery for Prostate Cancer Radiation Therapy: Results of the First Clinical Trial

    DEFF Research Database (Denmark)

    Colvill, Emma; Booth, Jeremy T; O'Brien, Ricky T

    2015-01-01

    was tested for each dose-volume value via analysis of variance using the F test. RESULTS: Of the 513 fractions delivered, 475 (93%) were suitable for analysis. The mean difference and standard deviation between the planned and treated MLC tracking doses and the planned and without-MLC tracking doses for all...... 475 fractions were, respectively, PTV D99% -0.8% ± 1.1% versus -2.1% ± 2.7%; CTV D99% -0.6% ± 0.8% versus -0.6% ± 1.1%; rectum V65% 1.6% ± 7.9% versus -1.2% ± 18%; and bladder V65% 0.5% ± 4.4% versus -0.0% ± 9.2% (P

  1. Probabilistic fiber tracking of the language and motor white matter pathways of the supplementary motor area (SMA) in patients with brain tumors.

    Science.gov (United States)

    Jenabi, Mehrnaz; Peck, Kyung K; Young, Robert J; Brennan, Nicole; Holodny, Andrei I

    2014-12-01

    Accurate localization of anatomically and functionally separate SMA tracts is important to improve planning prior to neurosurgery. Using fMRI and probabilistic DTI techniques, we assessed the connectivity between the frontal language area (Broca's area) and the rostral pre-SMA (language SMA) and caudal SMA proper (motor SMA). Twenty brain tumor patients completed motor and language fMRI paradigms and DTI. Peaks of functional activity in the language SMA, motor SMA and Broca's area were used to define seed regions for probabilistic tractography. fMRI and probabilistic tractography identified separate and unique pathways connecting the SMA to Broca's area - the language SMA pathway and the motor SMA pathway. For all subjects, the language SMA pathway had a larger number of voxels (PProbabilistic tractography can identify unique white matter tracts that connect language SMA and motor SMA to Broca's area. The language SMA is more significantly connected to Broca's area than is the motor subdivision of the SMA proper. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  2. Age-related location of manifest accessory pathway and clinical consequences.

    Science.gov (United States)

    Brembilla-Perrot, Béatrice; Huttin, Olivier; Olivier, Arnaud; Sellal, Jean Marc; Villemin, Thibaut; Manenti, Vladimir; Moulin-Zinsch, Anne; Marçon, François; Simon, Gauthier; Andronache, Marius; Beurrier, Daniel; de Chillou, Christian; Girerd, Nicolas

    2015-01-01

    Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location. Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients. AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP. AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.

  3. [Preneoplasias of ovarian carcinoma: biological and clinical aspects of different pathways of tumorigenesis].

    Science.gov (United States)

    Staebler, A

    2011-11-01

    Ovarian carcinomas consist of a heterogeneous group of malignant epithelial neoplasms with specific pathogenic mechanisms. This review provides a brief introduction to the different pathways of tumor progression and the associated molecular changes. However, the main focus will be on two areas with major paradigm shifting developments in recent years. Mutational analysis of ovarian clear cell carcinomas, endometrioid carcinomas and endometriotic lesions identified mutations in the ARID1A gene as common and early genetic changes in carcinomas with associated endometriosis and in atypical endometriosis itself. Extensive pathological work-up of the fallopian tubes of BRCA1/2 mutation carriers have demonstrated the existence of serous tubal intraepithelial carcinomas (STIC). Further studies showed that this lesion can also be found in 50-60% of patients with serous ovarian carcinomas without BRCA1/2 germline mutations. Pre-precursors which share the p53 mutations with STICs but proliferate very little are called p53-signatures and provide conclusive evidence that STICs develop in the fallopian tubes.

  4. How Effective Are Clinical Pathways With and Without Online Peer-Review? An Analysis of Bone Metastases Pathway in a Large, Integrated National Cancer Institute-Designated Comprehensive Cancer Center Network

    Energy Technology Data Exchange (ETDEWEB)

    Beriwal, Sushil, E-mail: beriwals@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Rajagopalan, Malolan S.; Flickinger, John C.; Rakfal, Susan M. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States); Rodgers, Edwin [Via Oncology, Pittsburgh, PA (United States); Heron, Dwight E. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA (United States)

    2012-07-15

    Purpose: Clinical pathways are an important tool used to manage the quality in health care by standardizing processes. This study evaluated the impact of the implementation of a peer-reviewed clinical pathway in a large, integrated National Cancer Institute-Designated Comprehensive Cancer Center Network. Methods: In 2003, we implemented a clinical pathway for the management of bone metastases with palliative radiation therapy. In 2009, we required the entry of management decisions into an online tool that records pathway choices. The pathway specified 1 or 5 fractions for symptomatic bone metastases with the option of 10-14 fractions for certain clinical situations. The data were obtained from 13 integrated sites (3 central academic, 10 community locations) from 2003 through 2010. Results: In this study, 7905 sites were treated with 64% of courses delivered in community practice and 36% in academic locations. Academic practices were more likely than community practices to treat with 1-5 fractions (63% vs. 23%; p < 0.0001). The number of delivered fractions decreased gradually from 2003 to 2010 for both academic and community practices (p < 0.0001); however, greater numbers of fractions were selected more often in community practices (p < 0.0001). Using multivariate logistic regression, we found that a significantly greater selection of 1-5 fractions developed after implementation online pathway monitoring (2009) with an odds ratio of 1.2 (confidence interval, 1.1-1.4) for community and 1.3 (confidence interval, 1.1-1.6) for academic practices. The mean number of fractions also decreased after online peer review from 6.3 to 6.0 for academic (p = 0.07) and 9.4 to 9.0 for community practices (p < 0.0001). Conclusion: This is one of the first studies to examine the efficacy of a clinical pathway for radiation oncology in an integrated cancer network. Clinical pathway implementation appears to be effective in changing patterns of care, particularly with online clinical

  5. How Effective Are Clinical Pathways With and Without Online Peer-Review? An Analysis of Bone Metastases Pathway in a Large, Integrated National Cancer Institute–Designated Comprehensive Cancer Center Network

    International Nuclear Information System (INIS)

    Beriwal, Sushil; Rajagopalan, Malolan S.; Flickinger, John C.; Rakfal, Susan M.; Rodgers, Edwin; Heron, Dwight E.

    2012-01-01

    Purpose: Clinical pathways are an important tool used to manage the quality in health care by standardizing processes. This study evaluated the impact of the implementation of a peer-reviewed clinical pathway in a large, integrated National Cancer Institute–Designated Comprehensive Cancer Center Network. Methods: In 2003, we implemented a clinical pathway for the management of bone metastases with palliative radiation therapy. In 2009, we required the entry of management decisions into an online tool that records pathway choices. The pathway specified 1 or 5 fractions for symptomatic bone metastases with the option of 10–14 fractions for certain clinical situations. The data were obtained from 13 integrated sites (3 central academic, 10 community locations) from 2003 through 2010. Results: In this study, 7905 sites were treated with 64% of courses delivered in community practice and 36% in academic locations. Academic practices were more likely than community practices to treat with 1–5 fractions (63% vs. 23%; p < 0.0001). The number of delivered fractions decreased gradually from 2003 to 2010 for both academic and community practices (p < 0.0001); however, greater numbers of fractions were selected more often in community practices (p < 0.0001). Using multivariate logistic regression, we found that a significantly greater selection of 1–5 fractions developed after implementation online pathway monitoring (2009) with an odds ratio of 1.2 (confidence interval, 1.1–1.4) for community and 1.3 (confidence interval, 1.1–1.6) for academic practices. The mean number of fractions also decreased after online peer review from 6.3 to 6.0 for academic (p = 0.07) and 9.4 to 9.0 for community practices (p < 0.0001). Conclusion: This is one of the first studies to examine the efficacy of a clinical pathway for radiation oncology in an integrated cancer network. Clinical pathway implementation appears to be effective in changing patterns of care, particularly with

  6. Rationale, design and methods for the RIGHT Track Health Study: pathways from childhood self-regulation to cardiovascular risk in adolescence

    Directory of Open Access Journals (Sweden)

    Laurie Wideman

    2016-06-01

    Full Text Available Abstract Background Cardiovascular risk factors during adolescence—including obesity, elevated lipids, altered glucose metabolism, hypertension, and elevated low-grade inflammation—is cause for serious concern and potentially impacts subsequent morbidity and mortality. Despite the importance of these cardiovascular risk factors, very little is known about their developmental origins in childhood. In addition, since adolescence is a time when individuals are navigating major life changes and gaining increasing autonomy from their parents or parental figures, it is a period when control over their own health behaviors (e.g. drug use, sleep, nutrition also increases. The primary aim of this paper is to describe the rationale, design and methods for the RIGHT Track Health Study. This study examines self-regulation as a key factor in the development of cardiovascular risk, and further explores health behaviors as an explanatory mechanism of this association. We also examine potential moderators (e.g. psychosocial adversities such as harsh parenting of this association. Method/design RIGHT Track is a longitudinal study that investigates social and emotional development. The RIGHT Track Health Study prospectively follows participants from age 2 through young adulthood in an effort to understand how self-regulatory behavior throughout childhood alters the trajectories of various cardiovascular risk factors during late adolescence via health behaviors. Individuals from RIGHT Track were re-contacted and invited to participate in adolescent data collection (~16.5, 17.5 and 18+ years old. Individuals completed assessments of body composition, anthropometric indicators, fitness testing (via peak oxygen consumption, heart rate variability during orthostatic challenge, 7-day accelerometry for physical activity and sleep, 24-h dietary recalls, and blood analysis for biomarkers related to metabolic syndrome, inflammatory status and various hormones and

  7. Rationale, design and methods for the RIGHT Track Health Study: pathways from childhood self-regulation to cardiovascular risk in adolescence.

    Science.gov (United States)

    Wideman, Laurie; Calkins, Susan D; Janssen, James A; Lovelady, Cheryl A; Dollar, Jessica M; Keane, Susan P; Perrin, Eliana M; Shanahan, Lilly

    2016-06-01

    Cardiovascular risk factors during adolescence-including obesity, elevated lipids, altered glucose metabolism, hypertension, and elevated low-grade inflammation-is cause for serious concern and potentially impacts subsequent morbidity and mortality. Despite the importance of these cardiovascular risk factors, very little is known about their developmental origins in childhood. In addition, since adolescence is a time when individuals are navigating major life changes and gaining increasing autonomy from their parents or parental figures, it is a period when control over their own health behaviors (e.g. drug use, sleep, nutrition) also increases. The primary aim of this paper is to describe the rationale, design and methods for the RIGHT Track Health Study. This study examines self-regulation as a key factor in the development of cardiovascular risk, and further explores health behaviors as an explanatory mechanism of this association. We also examine potential moderators (e.g. psychosocial adversities such as harsh parenting) of this association. RIGHT Track is a longitudinal study that investigates social and emotional development. The RIGHT Track Health Study prospectively follows participants from age 2 through young adulthood in an effort to understand how self-regulatory behavior throughout childhood alters the trajectories of various cardiovascular risk factors during late adolescence via health behaviors. Individuals from RIGHT Track were re-contacted and invited to participate in adolescent data collection (~16.5, 17.5 and 18(+) years old). Individuals completed assessments of body composition, anthropometric indicators, fitness testing (via peak oxygen consumption), heart rate variability during orthostatic challenge, 7-day accelerometry for physical activity and sleep, 24-h dietary recalls, and blood analysis for biomarkers related to metabolic syndrome, inflammatory status and various hormones and cytokines. Individuals also completed extensive self

  8. Evaluation of magnocellular pathway abnormalities in schizophrenia: a frequency doubling technology study and clinical implications

    Directory of Open Access Journals (Sweden)

    Fabiana Benites Vaz de Lima

    2013-04-01

    Full Text Available BACKGROUND: Visual processing deficits have been reported for patients with schizophrenia. Previous studies demonstrated differences in early-stage processing of schizophrenics, although the nature, extent, and localization of the disturbance are unknown. The magnocellular and parvocellular visual pathways are associated with transient and sustained channels, but their respective contributions to schizophrenia-related visual deficits remains controversial. PURPOSE: The aim of this study was to evaluate magnocellular dysfunction in schizophrenia using frequency doubling technology. METHODS: Thirty-one patients with schizophrenia and 34 healthy volunteers were examined. Frequency doubling technology testing was performed in one session, consisting of a 15-minute screening strategy followed by the C-20 program for frequency doubling technology. RESULTS: Schizophrenic patients showed lower global mean sensitivity (30,97 ± 2,25 dB compared with controls (32,17 ± 3,08 dB, p<0.009. Although there was no difference in the delta sensitivity of hemispheres, there was a difference in sensitivity analysis of the fibers crossing the optic chiasm, with lower mean sensitivity in the patient group (28,80 dB versus controls (30,66 dB. The difference was higher in fibers that do not cross the optic chiasm, with lower mean sensitivity in patients (27,61 dB versus controls (30,26 dB, p<0.005. CONCLUSIONS: Our results suggest that there are differences between global sensitivity and fiber sensitivity measured by frequency doubling technology. The different sensitivity of fibers that do not cross the optic chiasm is consistent with most current etiological hypotheses for schizophrenia. The decreased sensitivity responses in the optic radiations may significantly contribute to research assessing early-stage visual processing deficits for patients with schizophrenia.

  9. The Dentato-Rubro-Olivary Tract: Clinical Dimension of This Anatomical Pathway

    Directory of Open Access Journals (Sweden)

    Fadil Khoyratty

    2013-01-01

    Full Text Available Symptomatic palatal tremor is potentially the result of a lesion in the triangle of Guillain-Mollaret (1931 and is associated with hypertrophic olivary degeneration (HOD which has characteristic MR findings. The triangle is defined by dentate efferents ascending through the superior cerebellar peduncle and crossing in the decussation of the brachium conjunctivum inferior to the red nucleus, to finaliy reach the inferior olivary nucleus (ION via the central tegmental tract. The triangle is completed by ION decussating efferents terminating on the original dentate nucleus via the inferior cerebellar peduncle. We can demonstrate the anatomy of this anatomical triangle using a clinical case of palatal tremor presenting with bilateral subjective pulsatile tinnitus along with the pathognomonic MR findings previously described. The hyperintense T2 signal in these patients may be permanent, but the hypertrophied olive normally regresses after 4 years. The temporal relationship between the evolution of the histopathology and the development of the palatal tremor remains unknown as does the natural history of the tremor. Botox injection at the level of tensor and levator veli palatini insertion have been used to treat patients with disabling tremor synchronous tinnitus. A lesion involving the triangle can have a quite varied clinical expression.

  10. Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study.

    Science.gov (United States)

    Willeit, Johann; Geley, Theresa; Schöch, Johannes; Rinner, Heinrich; Tür, Andreas; Kreuzer, Hans; Thiemann, Norbert; Knoflach, Michael; Toell, Thomas; Pechlaner, Raimund; Willeit, Karin; Klingler, Natalie; Praxmarer, Silvia; Baubin, Michael; Beck, Gertrud; Berek, Klaus; Dengg, Christian; Engelhardt, Klaus; Erlacher, Thomas; Fluckinger, Thomas; Grander, Wilhelm; Grossmann, Josef; Kathrein, Hermann; Kaiser, Norbert; Matosevic, Benjamin; Matzak, Heinrich; Mayr, Markus; Perfler, Robert; Poewe, Werner; Rauter, Alexandra; Schoenherr, Gudrun; Schoenherr, Hans-Robert; Schinnerl, Adolf; Spiss, Heinrich; Thurner, Theresa; Vergeiner, Gernot; Werner, Philipp; Wöll, Ewald; Willeit, Peter; Kiechl, Stefan

    2015-01-01

    Intravenous thrombolysis for ischaemic stroke remains underused worldwide. We aimed to assess whether our statewide comprehensive stroke management programme would improve thrombolysis use and clinical outcome in patients. In 2008-09, we designed the Tyrol Stroke Pathway, which provided information campaigns for the public and standardised the entire treatment pathway from stroke onset to outpatient rehabilitation. It was commenced in Tyrol, Austria, as a long-term routine-care programme and aimed to include all patients with stroke in the survey area. We focused on thrombolysis use and outcome in the first full 4 years of implementation (2010-13). We enrolled 4947 (99%) of 4992 patients with ischaemic stroke who were admitted to hospitals in Tyrol; 675 (14%) of the enrollees were treated with alteplase. Thrombolysis administration in Tyrol increased after programme implementation, from 160 of 1238 patients (12·9%, 95% CI 11·1-14·9) in 2010 to 213 of 1266 patients (16·8%, 14·8-19·0) in 2013 (ptrend 2010-13stroke programmes, thrombolysis administration remained stable or declined between 2010 and 2013 (mean reduction 14·4%, 95% CI 10·9-17·9). Although the 3-month mortality was not affected by our programme (137 [13%] of 1060 patients in 2010 vs 143 [13%] of 1069 patients in 2013), 3-month functional outcome significantly improved (modified Rankin Scale score 0-1 in 375 [40%] of 944 patients in 2010 vs 493 [53%] of 939 in 2013; score 0-2 in 531 [56%] patients in 2010 and 615 [65%] in 2013; ptrend 2010-13stroke management programme, thrombolysis administration increased and clinical outcome significantly improved, although mortality did not change. We hope that these results will guide health authorities and stroke physicians elsewhere when implementing similar programmes for patients with stroke. Reformpool of the Tyrolean Health Care Fund. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. [Development of a clinical pathway for the attention of patients with amyotrophic lateral sclerosis in a regional network. ALS Assistance Network-Comunidad de Madrid].

    Science.gov (United States)

    Rodríguez de Rivera, F J; Grande, M; García-Caballero, J; Muñoz-Blanco, J; Mora, J; Esteban, J; Guerrero, A; Matias-Guiu, J; de Andrés-Colsa, R; Buey, C; Díez-Tejedor, E

    2007-01-01

    Amyotrophic lateral sclerosis (ALS) requires complex multidisciplinary attention. Clinical pathways are assistance plans for certain diseases with a predictable course. These plans are established in isolated centers, not in multicenter regions. The aim is to develop a clinical pathway capable of organizing and homogenizing assistance given in ALS Assistance Network-Comunidad de Madrid which is made up of five hospitals, from the beginning until the end of the disease. In successive meetings, neurologists of these hospitals and members of the Madrid Health Service evaluated published therapeutic guidelines and other documents used in ALS assistance. A clinical pathway was developed adapting this information to social-health care conditions in the Comunidad de Madrid following the FOCUS-PDCA model. A clinical pathway was created consisting of a scientist-technical framework which arranges the attention in relationship to the diagnosis and treatment, according to the degree of disease progression and a chronogram. This is accompanied by several patient information documents on the disease and the tests that are required, and a patient assistance evaluation form. The standards are established to reach and to promote 354 constant improvement in patient care. Clinical pathway for the ALS assistance in a regional network organizes the attention and cares that the patients must receive from the beginning to the end of the disease. This arrangement and homogenization of the attention improves the quality of patient care, diminishes variability and rationalizes the use of the health care resources.

  12. Guidelines and Pathways for Clinical Practice in Tendinopathy: Their Role and Development.

    Science.gov (United States)

    Morrissey, Dylan

    2015-11-01

    Tendinopathy has significant consequences for both the athletic population and, more importantly, those who exercise for health or engage in physical activity as part of their occupation. That we are now able to perform high-quality evidence syntheses based on robust primary evidence for a wide range of conditions and therapeutic approaches is a credit to the pioneers who have driven the evidence explosion, and an inspiration for those striving to emulate and build on their achievements. How do we take that evidence and apply it in the clinical setting to individual patients? How do we adjust our decision-making schema in response to the presented information and challenges? J Orthop Sports Phys Ther 2015;45(11):819-822. doi:10.2519/jospt.2015.0111.

  13. Advancing clinical development pathways for new CFTR modulators in cystic fibrosis.

    Science.gov (United States)

    Mayer-Hamblett, Nicole; Boyle, Michael; VanDevanter, Donald

    2016-05-01

    Cystic fibrosis (CF) is a life-shortening genetic disease affecting approximately 70,000 individuals worldwide. Until recently, drug development efforts have emphasised therapies treating downstream signs and symptoms resulting from the underlying CF biological defect: reduced function of the CF transmembrane conductance regulator (CFTR) protein. The current CF drug development landscape has expanded to include therapies that enhance CFTR function by either restoring wild-type CFTR protein expression or increasing (modulating) the function of mutant CFTR proteins in cells. To date, two systemic small-molecule CFTR modulators have been evaluated in pivotal clinical trials in individuals with CF and specific mutant CFTR genotypes that have led to regulatory review and/or approval. Advances in the discovery of CFTR modulators as a promising new class of therapies have been impressive, yet work remains to develop highly effective, disease-modifying modulators for individuals of all CF genotypes. The objectives of this review are to outline the challenges and opportunities in drug development created by systemic genotype-specific CFTR modulators, highlight the advantages of sweat chloride as an established biomarker of CFTR activity to streamline early-phase development and summarise options for later phase clinical trial designs that respond to the adoption of approved genotype-specific modulators into standard of care. An optimal development framework will be needed to move the most promising therapies efficiently through the drug development pipeline and ultimately deliver efficacious and safe therapies to all individuals with CF. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Pathway of care among patients with Dhat syndrome attending a psychosexual clinic in tertiary care center in North India

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2016-01-01

    Full Text Available Aim: The aim of this study was to understand the pathway to care among patients with Dhat syndrome and to study the factors leading to delay in seeking professional psychiatric help. Materials and Methods: Forty-seven patients diagnosed with Dhat syndrome as per the International Classification of Diseases-10 criteria were assessed for sociodemographic and clinical details and information regarding previous treatment taken to determine the pathways to care at their first contact with the outpatient psychosexual clinic. Results: Majority of the patients were single (70.2%, received formal education for at least more than 10 years (66.0%, were employed (59.6%, followers of Hinduism (68.1 and from middle socio-economic class (59.6%, nuclear family setup (53.2%, and rural locality (63.8%. Comorbidity in the form of any psychiatric illness or sexual dysfunction was present on 61.7% of the patients. The mean age at onset of symptoms of Dhat syndrome was 20.38 years (standard deviation [SD] - 6.91. The mean duration of symptoms of Dhat before the patients presented to our psychosexual clinic was 6.78 years (SD - 6.94 while the mean number of agencies/help contacted before was 2.85 (SD - 1.40; range: 1–5. The favorite choice for the first contact was indigenous practitioners, followed by asking for help from friends or relatives, allopathic doctors, and traditional faith healers or pharmacists. The preference to visit indigenous practitioners gradually declined at each stage. Ayurvedic doctors remained the most preferred among all indigenous practitioners. The absence of any comorbid sexual dysfunction in patients with Dhat syndrome predicted an earlier visit to our center as compared to the patients with any comorbid sexual dysfunction. Conclusions: Majority of the patients with Dhat syndrome present very late to specialized psychosexual clinics. There is a need for improving the sexual knowledge and attitude at the community level which will

  15. Clinical pathway for patients with Chronic Myeloid Leukaemia: The Euriclea Project.

    Science.gov (United States)

    Botti, Stefano; Gargiulo, Gianpaolo; Bombaci, Felice; Artioli, Giovanna; Cosentino, Chiara; Pignatelli, Adriana Concetta; Torino, Daniela; Lionetti, Maria Marcella; Samarani, Emanuela; Cappucciati, Lorella; Bordiga, Paola; Diodati, Antonella; Caffarri, Cristiana; Rosini, Irene; Pane, Fabrizio

    2017-07-18

    The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence. The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients. A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers.  Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis. Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.

  16. Radiology image perception and observer performance: How does expertise and clinical information alter interpretation? Stroke detection explored through eye-tracking

    Science.gov (United States)

    Cooper, Lindsey; Gale, Alastair; Darker, Iain; Toms, Andoni; Saada, Janak

    2009-02-01

    Historically, radiology research has been dominated by chest and breast screening. Few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans. Additionally, no studies at the time of writing have explored the interpretation of stroke images; from novices through to experienced practitioners using eye movement analysis. Finally, there appears a lack of evidence on the clinical effects of radiology reports and their influence on image appraisal and clinical diagnosis. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Eight predetermined clinical cases, five images per case, were presented to participants (novices, trainee, and radiologists; n=8). The presence or absence of abnormalities was rated on a five-point Likert scale and their locations reported. Half cases of the cases were accompanied by clinical information; half were not, to assess the impact of information on observer performance. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. Experts spent more time in challenging areas of interest (AOI) than novices and trainee, and were more confident unless a lesion was large and obvious. The time to first AOI fixation differed by size, shape and clarity of lesion. 'Time to lesion' dropped significantly when recognition appeared to occur between slices. The influence of clinical information was minimal.

  17. [Establishment and testing practice of an integrative medical pathway for clinical management of acute myocardial infarction].

    Science.gov (United States)

    Wang, Lei; Zhang, Min-zhou; Zhang, Jun

    2011-01-01

    To establish an integrative medical approach (IMA) for clinical management of acute myocardial infarction (AMI), and to test its efficacy. IMA was preliminarily established according to the guidelines and based on the Chinese medical therapy of benefiting vital qi and promoting blood circulation. And adopting non-synchronous queue design, AMI patients were assigned to the IMA group (71 cases) and the non-IMA group (70 cases), they were managed following or didn't follow the established IMA respectively. The total hospitalization time (THT), the ICU indwelling time (ICUD) and the total medical expenditure (TME) of patients were compared between groups. Moreover, for patients received primary PCI, the time for door-to-balloon (DTB) was compared in addition. Comparisons between groups showed that THT in the IMA group was shorter than that in the non-IMA group (9.80 +/- 5.62 days vs. 12.01 +/- 7. 35 days , P < 0.05); but the difference of TME between groups was insignificant. For those received PCT, the DTB in the IMA group was shorter than that in the non-IMA group in terms of DTB time (82.56 +/- 17.36 min vs. 119.19 +/- 30.88 min, P < 0.01), THT (9.69 +/- 5.59 vs. 13.34 +/- 7.49 days, P < 0.01) and TME. Practicing IMA for AMI, which was established based on Chinese medical therapy of benefiting vital qi and promoting blood circulation, could shorten the hospitalization time of patients, reduce the DTB time and TME in patients receiving primary PCI; fully displays its significance in hospital administration and quality control on AMI.

  18. Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway.

    Science.gov (United States)

    Jabbour, Mona; Reid, S; Polihronis, C; Cloutier, P; Gardner, W; Kennedy, A; Gray, C; Zemek, R; Pajer, K; Barrowman, N; Cappelli, M

    2016-07-07

    While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP. This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites. This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP

  19. Ultrastructural characterization of mesenchymal stromal cells labeled with ultrasmall superparamagnetic iron-oxide nanoparticles for clinical tracking studies

    DEFF Research Database (Denmark)

    Hansen, Louise; Hansen, Alastair B; Mathiasen, Anders B

    2014-01-01

    INTRODUCTION: To evaluate survival and engraftment of mesenchymal stromal cells (MSCs) in vivo, it is necessary to track implanted cells non-invasively with a method, which does not influence cellular ultrastructure and functional characteristics. Iron-oxide particles have been applied for cell...... sequence of trans-activator of transcription (TAT) (IODEX-TAT) and evaluate the effect of labeling on ultrastructure, viability, phenotype and proliferative capacity of the cells. MATERIALS AND METHODS: MSCs were labeled with 5 and 10 μg IODEX-TAT/10(5) cells for 2, 6 and 21 hours. IODEX-TAT uptake...... and cellular ultrastructure were determined by electron microscopy. Cell viability was determined by propidium iodide staining and cell proliferation capacity by 5-bromo-2-deoxyuridine (BrdU) incorporation. Maintenance of stem cell surface markers was determined by flow cytometry. Results. IODEX-TAT labeling...

  20. In Situ Tracking Kinetic Pathways of Li+/Na+ Substitution during Ion-Exchange Synthesis of LixNa1.5-xVOPO4F0.5.

    Science.gov (United States)

    Park, Young-Uk; Bai, Jianming; Wang, Liping; Yoon, Gabin; Zhang, Wei; Kim, Hyungsub; Lee, Seongsu; Kim, Sung-Wook; Looney, J Patrick; Kang, Kisuk; Wang, Feng

    2017-09-13

    Ion exchange is a ubiquitous phenomenon central to wide industrial applications, ranging from traditional (bio)chemical separation to the emerging chimie douce synthesis of materials with metastable structure for batteries and other energy applications. The exchange process is complex, involving substitution and transport of different ions under non-equilibrium conditions, and thus difficult to probe, leaving a gap in mechanistic understanding of kinetic exchange pathways toward final products. Herein, we report in situ tracking kinetic pathways of Li + /Na + substitution during solvothermal ion-exchange synthesis of Li x Na 1.5-x VOPO 4 F 0.5 (0 ≤ x ≤ 1.5), a promising multi-Li polyanionic cathode for batteries. The real-time observation, corroborated by first-principles calculations, reveals a selective replacement of Na + by Li + , leading to peculiar Na + /Li + /vacancy orderings in the intermediates. Contradicting the traditional belief of facile topotactic substitution via solid solution reaction, an abrupt two-phase transformation occurs and predominantly governs the kinetics of ion exchange and transport in the 1D polyanionic framework, consequently leading to significant difference of Li stoichiometry and electrochemical properties in the exchanged products. The findings may help to pave the way for rational design of ion exchange synthesis for making new materials.

  1. Use of a clinical pathway to improve the acute management of vaso-occlusive crisis pain in pediatric sickle cell disease.

    Science.gov (United States)

    Ender, Katherine L; Krajewski, Jennifer A; Babineau, John; Tresgallo, Mary; Schechter, William; Saroyan, John M; Kharbanda, Anupam

    2014-04-01

    The most common, debilitating morbidity of sickle cell disease (SCD) is vaso-occlusive crisis (VOC) pain. Although guidelines exist for its management, they are generally not well-followed, and research in other pediatric diseases has shown that clinical pathways improve care. The purpose of our study was to determine whether a clinical pathway improves the acute management of sickle cell vaso-occlusive crisis (VOC) pain in the pediatric emergency department (PED). Pain management practices were prospectively investigated before and after the initiation of a clinical pathway in the PED of an urban, tertiary care center with 50,000 ED visits per year and approximately 200 active sickle cell patients. The pathway included instructions for triage, monitoring, medication administration, and timing of assessments and interventions. Data were eligible from 35 pre-pathway and 33 post-pathway visits. Primary outcome was time interval to administration of first analgesic medication. Statistical analysis was by Student's t-test, using natural-log-transformed data for outcomes with skewed distribution curves. Time interval to first analgesic improved from 74 to 42 minutes (P = 0.012) and to first opioid from 94 to 46 minutes (P = 0.013). The percentage of patients who received ketorolac increased from 57% to 82% (P = 0.03). Decrease in time interval to subsequent pain score assessment was not statistically significant (110 to 72 minutes (P = 0.07)), and change in pain score was not different (P = 0.25). The use of a clinical pathway for sickle cell VOC in the PED can improve important aspects of pain management and merits further investigation and implementation. © 2013 Wiley Periodicals, Inc.

  2. Characteristics and outcome in patients with non-specific symptoms and signs of cancer referred to a fast track cancer patient pathway; a retrospective cohort study

    DEFF Research Database (Denmark)

    Jørgensen, Sara Falk; Ravn, Pernille; Thorsen, Søren

    2017-01-01

    Background: In 2012 a new cancer patient pathway for patients with non-specific symptoms and signs of cancer (NSSC-CPP) was introduced in Denmark. Limited information is available about the patients referred to the NSSC-CPP and the investigational course. The aim was to describe the population...... and the investigational course, estimate the prevalence of cancer and one-year mortality, and identify factors associated with a subsequent cancer diagnosis in patients referred to the NSSC-CPP. Method: This cohort study included patients with at least one visit at the NSSC-CPP at North Zealand Hospital in Denmark (NOH......) from October 1st 2013 to September 30th 2014. Data was based on retrospective reviews of the patient files. Logistic regression identified factors associated with a subsequent cancer diagnosis. Multivariate analyses were adjusted by age, gender, smoking status and alcohol consumption. Kaplan...

  3. Clinical feasibility and validation of 3D principal strain analysis from cine MRI: comparison to 2D strain by MRI and 3D speckle tracking echocardiography.

    Science.gov (United States)

    Satriano, Alessandro; Heydari, Bobak; Narous, Mariam; Exner, Derek V; Mikami, Yoko; Attwood, Monica M; Tyberg, John V; Lydell, Carmen P; Howarth, Andrew G; Fine, Nowell M; White, James A

    2017-12-01

    Two-dimensional (2D) strain analysis is constrained by geometry-dependent reference directions of deformation (i.e. radial, circumferential, and longitudinal) following the assumption of cylindrical chamber architecture. Three-dimensional (3D) principal strain analysis may overcome such limitations by referencing intrinsic (i.e. principal) directions of deformation. This study aimed to demonstrate clinical feasibility of 3D principal strain analysis from routine 2D cine MRI with validation to strain from 2D tagged cine analysis and 3D speckle tracking echocardiography. Thirty-one patients undergoing cardiac MRI were studied. 3D strain was measured from routine, multi-planar 2D cine SSFP images using custom software designed to apply 4D deformation fields to 3D cardiac models to derive principal strain. Comparisons of strain estimates versus those by 2D tagged cine, 2D non-tagged cine (feature tracking), and 3D speckle tracking echocardiography (STE) were performed. Mean age was 51 ± 14 (36% female). Mean LV ejection fraction was 66 ± 10% (range 37-80%). 3D principal strain analysis was feasible in all subjects and showed high inter- and intra-observer reproducibility (ICC range 0.83-0.97 and 0.83-0.98, respectively-p analysis is feasible using routine, multi-planar 2D cine MRI and shows high reproducibility with strong correlations to 2D conventional strain analysis and 3D STE-based analysis. Given its independence from geometry-related directions of deformation this technique may offer unique benefit for the detection and prognostication of myocardial disease, and warrants expanded investigation.

  4. Reduced in-hospital mortality for heart failure with clinical pathways: the results of a cluster randomised controlled trial.

    Science.gov (United States)

    Panella, M; Marchisio, S; Demarchi, M L; Manzoli, L; Di Stanislao, F

    2009-10-01

    Hospital treatment of heart failure (HF) frequently does not follow published guidelines, potentially contributing to HF high morbidity, mortality and economic cost. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was undertaken to determine how clinical pathways (CP) for hospital treatment of HF affected care variability, guidelines adherence, in-hospital mortality and outcomes at discharge. Methods/ Two-arm, cluster-randomised trial. Fourteen community hospitals were randomised either to the experimental arm (CP: appropriate therapeutic guidelines use, new organisation and procedures, patient education) or to the control arm (usual care). The main outcome was in-hospital mortality; secondary outcomes were length and appropriateness of the stay, rate of unscheduled readmissions, customer satisfaction, usage of diagnostic and therapeutic procedures during hospital stay and quality indicators at discharge. All outcomes were measured using validated instruments available in literature. In-hospital mortality was 5.6% in the experimental arm (n = 12); 15.4% in controls (n = 33, p = 0.001). In CP and usual care groups, the mean rates of unscheduled readmissions were 7.9% and 13.9%, respectively. Adjusting for age, smoking, New York Heart Association score, hypertension and source of referral, patients in the CP group, as compared to controls, had a significantly lower risk of in-hospital death (OR 0.18; 95% CI 0.07 to 0.46) and unscheduled readmissions (OR 0.42; 95% CI 0.20 to 0.87). No differences were found between CP and control with respect to the appropriateness of the stay, costs and patient's satisfaction. Except for electrocardiography, all recommended diagnostic procedures were used more in the CP group. Similarly, pharmaceuticals use was significantly greater in CP, with the exception of diuretics and anti-platelets agents. The introduction of a specifically tailored CP for the hospital

  5. Double attention bias for positive and negative emotional faces in clinical depression: evidence from an eye-tracking study.

    Science.gov (United States)

    Duque, Almudena; Vázquez, Carmelo

    2015-03-01

    According to cognitive models, attentional biases in depression play key roles in the onset and subsequent maintenance of the disorder. The present study examines the processing of emotional facial expressions (happy, angry, and sad) in depressed and non-depressed adults. Sixteen unmedicated patients with Major Depressive Disorder (MDD) and 34 never-depressed controls (ND) completed an eye-tracking task to assess different components of visual attention (orienting attention and maintenance of attention) in the processing of emotional faces. Compared to ND, participants with MDD showed a negative attentional bias in attentional maintenance indices (i.e. first fixation duration and total fixation time) for sad faces. This attentional bias was positively associated with the severity of depressive symptoms. Furthermore, the MDD group spent a marginally less amount of time viewing happy faces compared with the ND group. No differences were found between the groups with respect to angry faces and orienting attention indices. The current study is limited by its cross-sectional design. These results support the notion that attentional biases in depression are specific to depression-related information and that they operate in later stages in the deployment of attention. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Improved efficiency in clinical workflow of reporting measured oncology lesions via PACS-integrated lesion tracking tool.

    Science.gov (United States)

    Sevenster, Merlijn; Travis, Adam R; Ganesh, Rajiv K; Liu, Peng; Kose, Ursula; Peters, Joost; Chang, Paul J

    2015-03-01

    OBJECTIVE. Imaging provides evidence for the response to oncology treatment by the serial measurement of reference lesions. Unfortunately, the identification, comparison, measurement, and documentation of several reference lesions can be an inefficient process. We tested the hypothesis that optimized workflow orchestration and tight integration of a lesion tracking tool into the PACS and speech recognition system can result in improvements in oncologic lesion measurement efficiency. SUBJECTS AND METHODS. A lesion management tool tightly integrated into the PACS workflow was developed. We evaluated the effect of the use of the tool on measurement reporting time by means of a prospective time-motion study on 86 body CT examinations with 241 measureable oncologic lesions with four radiologists. RESULTS. Aggregated measurement reporting time per lesion was 11.64 seconds in standard workflow, 16.67 seconds if readers had to register measurements de novo, and 6.36 seconds for each subsequent follow-up study. Differences were statistically significant (p workflow-integrated lesion management tool, especially for patients with multiple follow-up examinations, reversing the onetime efficiency penalty at baseline registration.

  7. [Results following the implementation of a clinical pathway in the process of care to elderly patients with osteoporotic hip fracture in a second level hospital].

    Science.gov (United States)

    Sánchez-Hernández, N; Sáez-López, P; Paniagua-Tejo, S; Valverde-García, J A

    2016-01-01

    To evaluate the efficiency of a clinical pathway in the management of elderly patients with fragility hip fracture in a second level hospital in terms of length of stay time to surgery, morbidity, hospital mortality, and improved functional outcome. A comparative and prospective study was carried out between two groups of patients with hip fracture aged 75 and older prior to 2010 (n=216), and after a quality improvement intervention in 2013 (n=196). A clinical pathway based on recent scientific evidence was implemented. The degree of compliance with the implemented measures was quantified. The characteristics of the patients in both groups were similar in age, gender, functional status (Barthel Index) and comorbidity (Charlson Index). Median length of stay was reduced by more than 45% in 2013 (16.61 vs. 9.08 days, p=.000). Also, time to surgery decreased 29.4% in the multidisciplinary intervention group (6.23 vs. 4.4 days, p=.000). Patients assigned to the clinical pathway group showed higher medical complications rate (delirium, malnutrition, anaemia and electrolyte disorders), but a lower hospital mortality (5.10 vs. 2.87%, p>.005). The incidence of surgical wound infection (p=.031) and functional efficiency (p=.001) also improved in 2013. An increased number of patients started treatment for osteoporosis (14.80 vs. 76.09%, p=.001) after implementing the clinical pathway. The implementation of a clinical pathway in the care process of elderly patients with hip fracture reduced length of stay and time to surgery, without a negative impact on associated clinical and functional outcomes. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  8. Implementation of a guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT: protocol of a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    Trudy Rebbeck

    2016-04-01

    Discussion: This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system.

  9. Particle tracking

    International Nuclear Information System (INIS)

    Mais, H.; Ripken, G.; Wrulich, A.; Schmidt, F.

    1986-02-01

    After a brief description of typical applications of particle tracking in storage rings and after a short discussion of some limitations and problems related with tracking we summarize some concepts and methods developed in the qualitative theory of dynamical systems. We show how these concepts can be applied to the proton ring HERA. (orig.)

  10. Timber tracking

    DEFF Research Database (Denmark)

    Düdder, Boris; Ross, Omry

    2017-01-01

    Managing and verifying forest products in a value chain is often reliant on easily manipulated document or digital tracking methods - Chain of Custody Systems. We aim to create a new means of tracking timber by developing a tamper proof digital system based on Blockchain technology. Blockchain...

  11. Following patient pathways to psycho-oncological treatment: Identification of treatment needs by clinical staff and electronic screening.

    Science.gov (United States)

    Loth, Fanny L; Meraner, Verena; Holzner, Bernhard; Singer, Susanne; Virgolini, Irene; Gamper, Eva M

    2018-04-01

    In this retrospective investigation of patient pathways to psycho-oncological treatment (POT), we compared the number of POT referrals before and after implementation of electronic screening for POT needs and investigated psychosocial predictors for POT wish at a nuclear medicine department. We extracted medical chart information about number of referrals and extent of follow-up contacts. During standard referral (November 2014 to October 2015), POT needs were identified by clinical staff only. In the screening-assisted referral period (November 2015 to October 2016), identification was supported by electronic screening for POT needs. Psychosocial predictors for POT wish were examined using logistic regression. We analysed data from 487 patients during standard referral (mean age 56.4 years; 60.2% female, 88.7% thyroid carcinoma or neuroendocrine tumours) of which 28 patients (5.7%) were referred for POT. Of 502 patients in the screening-assisted referral period (mean age 57.0 years; 55.8% female, 86.6% thyroid carcinoma or neuroendocrine tumours), 69 (13.7%) were referred for POT. Of these, 36 were identified by psycho-oncological (PO) screening and 33 by clinical staff. After PO-screening implementation, referrals increased by a factor of 2.4. The strongest predictor of POT wish was depressive mood (P patients visited the PO outpatient unit additionally to inpatient PO consultations. Our results provide evidence from a real-life setting that PO screening can foster POT referrals, reduce barriers to express the POT wish, and hence help to meet psychosocial needs of this specific patient group. Differences between patients' needs, wish, and POT uptake should be further investigated. © 2018 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

  12. Effect of Risk Acceptance for Bundled Care Payments on Clinical Outcomes in a High-Volume Total Joint Arthroplasty Practice After Implementation of a Standardized Clinical Pathway.

    Science.gov (United States)

    Kee, James R; Edwards, Paul K; Barnes, Charles L

    2017-08-01

    The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities. This practice implemented a standardized CP focused on patient education, managing patient expectations, and maximizing cost outcomes. We retrospectively reviewed all primary total joint arthroplasty patients during the initial 2-year "at risk" period for both BPCI and API and determined discharge disposition, LOS, and readmission rate. During the "at risk" period, the average LOS decreased in our total joint arthroplasty patients and our patients discharged home >94%. Patients within the BPCI group had a decreased discharge to home and decreased readmission rates after total hip arthroplasty, but also tended to be older than both API and nonbundled payment patients. While participating in the BPCI and API, continued use of a standardized CP in a high-performing, high-volume total joint practice resulted in maintenance of a low-average LOS. In addition, BPCI patients had similar outcomes after total knee arthroplasty, but had decreased rates of discharge to home and readmission after total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Development and implementation of a clinical pathway for cardiac surgery in the intensive care unit: Effects on protocol adherence.

    Science.gov (United States)

    van der Kolk, Marion; van den Boogaard, Mark; Ter Brugge-Speelman, Corine; Hol, Jeroen; Noyez, Luc; van Laarhoven, Kees; van der Hoeven, Hans; Pickkers, Peter

    2017-12-01

    Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients. This is a pre-post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU-nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report. A tailored implementation strategy was used. Primary outcome measure was protocol adherence above 80% on the domains of blood pressure control, action on chest tube blood loss and electrolyte control within the CP. In a 4-month period, 84 consecutive CP patients were included and compared with 162 matched control patients admitted in the year before implementation; 3 patients were excluded. Propensity score was used as matching parameter. CP patients were more likely to receive early adequate treatment for derangements in electrolytes (96% vs 47%, P blueprint for the implementation and use of a CP in low-volume high complex surgery. © 2017 John Wiley & Sons, Ltd.

  14. Noninvasive in vivo tracking of mesenchymal stem cells and evaluation of cell therapeutic effects in a murine model using a clinical 3.0 T MRI.

    Science.gov (United States)

    Drey, Florian; Choi, Yeong-Hoon; Neef, Klaus; Ewert, Birgit; Tenbrock, Arne; Treskes, Philipp; Bovenschulte, Henning; Liakopoulos, Oliver J; Brenkmann, Meike; Stamm, Christof; Wittwer, Thorsten; Wahlers, Thorsten

    2013-01-01

    Cardiac cell therapy with mesenchymal stem cells (MSCs) represents a promising treatment approach for end-stage heart failure. However, little is known about the underlying mechanisms and the fate of the transplanted cells. The objective of the presented work is to determine the feasibility of magnetic resonance imaging (MRI) and in vivo monitoring after transplantation into infarcted mouse hearts using a clinical 3.0 T MRI device. The labeling procedure of bone marrow-derived MSCs with micron-sized paramagnetic iron oxide particles (MPIOs) did not affect the viability of the cells and their cell type-defining properties when compared to unlabeled cells. Using a clinical 3.0 T MRI scanner equipped with a dedicated small animal solenoid coil, 10(5) labeled MSCs could be detected and localized in the mouse hearts for up to 4 weeks after intramyocardial transplantation. Weekly ECG-gated scans using T1-weighted sequences were performed, and left ventricular function was assessed. Histological analysis of hearts confirmed the survival of labeled MSCs in the target area up to 4 weeks after transplantation. In conclusion, in vivo tracking of labeled MSCs using a clinical 3.0 T MRI scanner is feasible. In combination with assessment of heart function, this technology allows the monitoring of the therapeutic efficacy of regenerative therapies in a small animal model.

  15. KISTI at TREC 2014 Clinical Decision Support Track: Concept-based Document Re-ranking to Biomedical Information Retrieval

    Science.gov (United States)

    2014-11-01

    sematic type. Injury or Poisoning inpo T037 Anatomical Abnormality anab T190 Given a document D, a concept vector = {1, 2, … , ...integrating biomedical terminology . Nucleic acids research 32, Database issue (2004), 267–270. 5. Chapman, W.W., Hillert, D., Velupillai, S., et...Conference (TREC), (2011). 9. Koopman, B. and Zuccon, G. Understanding negation and family history to improve clinical information retrieval. Proceedings

  16. Making tracks

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1986-10-15

    In many modern tracking chambers, the sense wires, rather than being lined up uniformly, are grouped into clusters to facilitate the pattern recognition process. However, with higher energy machines providing collisions richer in secondary particles, event reconstruction becomes more complicated. A Caltech / Illinois / SLAC / Washington group developed an ingenious track finding and fitting approach for the Mark III detector used at the SPEAR electron-positron ring at SLAC (Stanford). This capitalizes on the detector's triggering, which uses programmable logic circuits operating in parallel, each 'knowing' the cell patterns for all tracks passing through a specific portion of the tracker (drift chamber)

  17. Clinical Relevance of Kynurenine Pathway in HIV/AIDS : An Immune Checkpoint at the Crossroads of Metabolism and Inflammation

    NARCIS (Netherlands)

    Routy, Jean-Pierre; Mehraj, Vikram; Vyboh, Kishanda; Cao, Wei; Kema, Ido; Jenabian, Mohammad-Ali

    2015-01-01

    Tryptophan degradation along the kynurenine pathway is associated with a wide variety of pathophysiological processes, of which tumor tolerance and immune dysfunction in several chronic viral infections including HIV are well known. The kynurenine pathway is at the crossroads of metabolism and

  18. Why tracks

    International Nuclear Information System (INIS)

    Burchart, J.; Kral, J.

    1979-01-01

    A comparison is made of two methods of determining the age of rocks, ie., the krypton-argon method and the fission tracks method. The former method is more accurate but is dependent on the temperature and on the grain size of the investigated rocks (apatites, biotites, muscovites). As for the method of fission tracks, the determination is not dependent on grain size. This method allows dating and the determination of uranium concentration and distribution in rocks. (H.S.)

  19. A clinical measure of suicidal ideation, suicidal behavior, and associated symptoms in bipolar disorder: Psychometric properties of the Concise Health Risk Tracking Self-Report (CHRT-SR).

    Science.gov (United States)

    Ostacher, Michael J; Nierenberg, Andrew A; Rabideau, Dustin; Reilly-Harrington, Noreen A; Sylvia, Louisa G; Gold, Alexandra K; Shesler, Leah W; Ketter, Terence A; Bowden, Charles L; Calabrese, Joseph R; Friedman, Edward S; Iosifescu, Dan V; Thase, Michael E; Leon, Andrew C; Trivedi, Madhukar H

    2015-12-01

    People with bipolar disorder are at high risk of suicide, but no clinically useful scale has been validated in this population. The aim of this study was to evaluate the psychometric properties in bipolar disorder of the 7- and 12-item versions of the Concise Health Risk Tracking Self-Report (CHRT-SR), a scale measuring suicidal ideation, suicidal behavior, and associated symptoms. The CHRT was administered to 283 symptomatic outpatients with bipolar I or II disorder who were randomized to receive lithium plus optimized personalized treatment (OPT), or OPT without lithium in a six month longitudinal comparative effectiveness trial. Participants were assessed using structured diagnostic interviews, clinician-rated assessments, and self-report questionnaires. The internal consistency (Cronbach α) was 0.80 for the 7-item CHRT-SR and 0.90 for the 12-item CHRT-SR with a consistent factor structure, and three independent factors (current suicidal thoughts and plans, hopelessness, and perceived lack of social support) for the 7-item version. CHRT-SR scores are correlated with measures of depression, functioning, and quality of life, but not with mania scores. The 7- and 12-item CHRT-SR both had excellent psychometric properties in a sample of symptomatic subjects with bipolar disorder. The scale is highly correlated with depression, functioning, and quality of life, but not with mania. Future research is needed to determine whether the CHRT-SR will be able to predict suicide attempts in clinical practice. Published by Elsevier Ltd.

  20. Clinical development of galunisertib (LY2157299 monohydrate, a small molecule inhibitor of transforming growth factor-beta signaling pathway

    Directory of Open Access Journals (Sweden)

    Herbertz S

    2015-08-01

    Full Text Available Stephan Herbertz,1 J Scott Sawyer,2 Anja J Stauber,2 Ivelina Gueorguieva,3 Kyla E Driscoll,4 Shawn T Estrem,2 Ann L Cleverly,3 Durisala Desaiah,2 Susan C Guba,2 Karim A Benhadji,2 Christopher A Slapak,2 Michael M Lahn21Lilly Deutschland GmbH, Bad Homburg, Germany; 2Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA; 3Lilly Research Laboratories, Eli Lilly and Company, Windlesham, Surrey, UK; 4Lilly Research Laboratories, Eli Lilly and Company, New York, NY, USA Abstract: Transforming growth factor-beta (TGF-β signaling regulates a wide range of biological processes. TGF-β plays an important role in tumorigenesis and contributes to the hallmarks of cancer, including tumor proliferation, invasion and metastasis, inflammation, angiogenesis, and escape of immune surveillance. There are several pharmacological approaches to block TGF-β signaling, such as monoclonal antibodies, vaccines, antisense oligonucleotides, and small molecule inhibitors. Galunisertib (LY2157299 monohydrate is an oral small molecule inhibitor of the TGF-β receptor I kinase that specifically downregulates the phosphorylation of SMAD2, abrogating activation of the canonical pathway. Furthermore, galunisertib has antitumor activity in tumor-bearing animal models such as breast, colon, lung cancers, and hepatocellular carcinoma. Continuous long-term exposure to galunisertib caused cardiac toxicities in animals requiring adoption of a pharmacokinetic/pharmacodynamic-based dosing strategy to allow further development. The use of such a pharmacokinetic/pharmacodynamic model defined a therapeutic window with an appropriate safety profile that enabled the clinical investigation of galunisertib. These efforts resulted in an intermittent dosing regimen (14 days on/14 days off, on a 28-day cycle of galunisertib for all ongoing trials. Galunisertib is being investigated either as monotherapy or in combination with standard antitumor regimens (including nivolumab

  1. A comprehensive intervention following the clinical pathway of eating and swallowing disorder in the elderly with dementia: historically controlled study.

    Science.gov (United States)

    Arahata, Masahisa; Oura, Makoto; Tomiyama, Yuka; Morikawa, Naoe; Fujii, Hatsue; Minani, Shinji; Shimizu, Yukihiro

    2017-07-14

    Eating problems in patients with advanced dementia are strongly associated with their deteriorating survival. Food and drink intake in people with dementia may be supported by specific interventions, but the effectiveness of such interventions is backed by almost no evidence. However, comprehensive geriatric assessment (CGA) might potentially clarify the etiology of decreased oral intake in people with dementia; thus improving their clinical outcomes. This study was a single-arm, non-randomized trial that included historically controlled patients for comparison. We defined elderly patients with both severely decreased oral intake depending on artificial hydration and/or nutrition (AHN) and dementia as "Eating and Swallowing Disorder of the Elderly with Dementia (ESDED)". In the intervention group, participants received CGA through the original clinical pathway with multidisciplinary interventions. This was followed by individualized therapeutic interventions according to assessment of the etiology of their eating problems. During the intervention period (between 1st April 2013 and 31st March 2015), 102 cases of ESDED were enrolled in the study and 90 patients had completed receiving CGA. Conversely, 124 ESDED patient controls were selected from the same hospital enrolled during the historical period (between 1st April 2011 and 31st March 2012). Most participants in both groups were bedridden with severe cognitive impairment. For the intervention group, an average of 4.3 interventional strategies was recommended per participant after CGA. Serological tests, diagnostic imaging and other diagnostic examinations were much more frequently performed in the intervention group. Recovery rate from ESDED in the intervention group was significantly higher than that in the historical group (51% v.s. 34%, respectively, P = 0.02). The 1-year AHN-free survival in the intervention group was significantly higher than that in the historical group (28% v.s. 15%, respectively, P

  2. A combined hands-on teaching programme and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes.

    Science.gov (United States)

    Edwards, Timothy; Cook, Alistair; Salamonsen, Matthew; Bashirzadeh, Farzad; Fielding, David

    2017-11-01

    Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands-on teaching programme followed by procedure supervision that enabled many operators to perform such procedures. This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013). A total of 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post-pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P < 0.003). The use of pleural ultrasound increased dramatically (72.5 vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, P < 0.01). This improvement occurred using many supervised operators who completed the hands-on teaching programme (n = 32) and followed the pleural pathway (127 of 146 procedures). The instigation of a clinical pathway focused on the use of bedside pleural ultrasound, and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff. © 2017 Royal Australasian College of Physicians.

  3. [Retrospective Analysis of the Afatinib Clinical Pathway during the 28-Day Introductory Period-The Japanese Style of Collaborative Drug Therapy Management(J-CDTM)].

    Science.gov (United States)

    Iwata, Kaori; Ryota, Noriko; Hikita, Ami; Sando, Masumi; Suzuki, Hidekazu; Tamiya, Motohiro; Azuma, Yuichiro; Tani, Eriko; Hamaguchi, Masanari; Tanaka, Ayako; Shiroyama, Takayuki; Morishita, Naoko; Okamoto, Norio; Futagami, Sumiko; Hirashima, Tomonori

    2015-08-01

    Afatinib is a newly approved second-generation epidermal growth factor receptor-tyrosine kinase inhibito r(EGFR-TKI). Afatinib has been shown to prolongthe overall survival of patients with non-small cell lungcancer (NSCLC) with EGFR mutations compared with the standard chemotherapy. However, Grade 3 or 4 toxicities, includingdiarrhea, rash, paronychia, and stomatitis, have been observed more frequently in patients treated with afatinib than in those treated with first-generation EGFR-TKIs. Accordingly, our institution developed an afatinib clinical pathway (the afatinib pathway), which was designed by certified nurses, medical physicians, and certified pharmacists, with the goal of reducing the severity of diarrhea and rash that occur most frequently duringthe 28-day introductory period of afatinib treatment. Between May and October 2014, afatinib was administered accordingto the afatinib pathway to 14 patients with NSCLC and EGFR mutations. Of these patients, only one (7.1%) experienced Grade 3 diarrhea. No other patient experienced Grade 3 or 4 toxicity. The afatinib pathway was effective in reducingthe severities of the diarrhea and rash duringthe 28-day introductory period of the afatinib treatment. Our implementation of the afatinib pathway could be considered the Japanese style of collaborative drugtherapy management (J-CDTM).

  4. Determination of absorbed dose to water in a clinical carbon ion beam by means of fluorescent nuclear track detectors, ionization chambers, and water calorimetry

    Energy Technology Data Exchange (ETDEWEB)

    Osinga-Blaettermann, Julia-Maria

    2016-12-20

    Until now, dosimetry of carbon ions with ionization chambers has not reached the same level of accuracy as of high-energy photons. This is mainly caused by the threefold higher uncertainty of the k{sub Q,Q{sub 0}}-factor of ionization chambers, which is derived by calculations due to a lack of experimental data. The current thesis comprises two major aims with respect to the dosimetry of carbon ion beams: first, the investigation of the potential of fluorescent nuclear track detectors for fluence-based dosimetry and second, the experimental determination of the k{sub Q,Q{sub 0}}-factor. The direct comparison of fluence- and ionization-based measurements has shown a significant discrepancy of 4.5 %, which re-opened the discussion on the accuracy of calculated k{sub Q,Q{sub 0}}-factors. Therefore, absorbed dose to water measurements by means of water calorimetry have been performed allowing for the direct calibration of ionization chambers and thus for the experimental determination of k{sub Q,Q{sub 0}}. For the first time it could be shown that the experimental determination of k{sub Q,Q{sub 0}} for carbon ion beams is achievable with a standard measurement uncertainty of 0.8 %. This corresponds to a threefold reduction of the uncertainty compared to calculated values and therefore enables to significantly decrease the overall uncertainty related to ionization-based dosimetry of clinical carbon ion beams.

  5. Online Tracking

    Science.gov (United States)

    ... can disable blocking on those sites. Tagged with: computer security , cookies , Do Not Track , personal information , privacy June ... email Looking for business guidance on privacy and ... The Federal Trade Commission (FTC) is the nation’s consumer protection agency. The FTC works to prevent fraudulent, deceptive ...

  6. DMPD: Innate immunity and toll-like receptors: clinical implications of basic scienceresearch. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 15069387 Innate immunity and toll-like receptors: clinical implications of basic science...te immunity and toll-like receptors: clinical implications of basic scienceresearch. PubmedID 15069387 Title... Innate immunity and toll-like receptors: clinical implications of basic sciencer

  7. A new study on diffusion tensor imaging of the whole visual pathway fiber bundle and clinical application

    Institute of Scientific and Technical Information of China (English)

    TAO Xiao-feng; WANG Zhong-qiu; GONG Wan-qing; JIANG Qing-jun; SHI Zeng-ru

    2009-01-01

    Background With conventional imaging methods only the morphous of the visual nerve fiber bundles can be demonstrated, while the earlier period functional changes can not be demonstrated. We hypothesized that diffusion tensor imaging (DTI) would demonstrated the whole optic never fiber bundle and visual pathway and the earlier period functional changes. The purpose of the present study was to evaluate the application of DTI technique in the demonstration of the whole optic never fiber bundle and visual pathway, and the influence of orbital tumors on them. Methods GE 1.5T signa HD MR System, and the software package DTV2 were adopted. The total 45 subjects were enrolled, including 15 volunteers and 30 patients. All patients had ocular proptosis from minor to major. Seven patients had visual acuity decrescence. Results The nerve fiber bundles, e.g. optic chiasma, optic tract and optic radiation in posterior visual pathway were well demonstrated in all cases. Wherein, the intact whole visual pathway fiber bundles were clearly revealed in 10 volunteers and 17 patients, and optic nerve was not wholly revealed in the rest of the subjects. Shift of optic nerve caused by compression and partial deformation were seen in 7 patients with orbital tumor. In 6 of 7 patients, DTI displayed significant abscise and deformation of visual nerve. Chi-square test indicated significant correlation between visual acuity decrescence and DTI visual nerve non-display. Conclusions Visual nerve fiber bundles and the whole visual pathway were visualized in most of patients with DTI. It might be an effective method of providing imaging evidence for visual nerve fiber earlier period functional changes, and laid a foundation for the study in other cranial nerves.

  8. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)

    NARCIS (Netherlands)

    Vlug, Malaika S.; Wind, Jan; Hollmann, Markus W.; Ubbink, Dirk T.; Cense, Huib A.; Engel, Alexander F.; Gerhards, Michael F.; van Wagensveld, Bart A.; van der Zaag, Edwin S.; van Geloven, Anna A. W.; Sprangers, Mirjam A. G.; Cuesta, Miguel A.; Bemelman, Willem A.; Preckel, Benedikt; Bossuyt, Patrick; Gouma, Dirk; van Berge Henegouwen, Mark; Fuhring, Jan; van Lenthe, Ineke Picard; Bakker, Chris; King-Kalimanis, Bellinda; Hofland, Jan; Dejong, Cornelis; van Dam, Ronald; van der Peet, Donald; van Zalingen, Edith; Noordhuis, Astrid; de Jong, Dick; Goei, T. Hauwy; de Stoppelaar, Erica; van den Dongen, Marjon; van Tets, Willem; van den Elsen, Maarten; Swart, Annemiek; deWit, Laurens; Siepel, Muriel; Molly, Glaresa; Juttmann, Jan; Clevers, Wilfred; Bieleman, Andrea; Coenen, Ludo; Bonekamp, Elly; van Abeelen, Jacobus; van Iterson-de Jong, Diana; Krombeen, Margriet

    2011-01-01

    To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of

  9. Clinical prognostic significance and pro-metastatic activity of RANK/RANKL via the AKT pathway in endometrial cancer.

    Science.gov (United States)

    Wang, Jing; Liu, Yao; Wang, Lihua; Sun, Xiao; Wang, Yudong

    2016-02-02

    RANK/RANKL plays a key role in metastasis of certain malignant tumors, which makes it a promising target for developing novel therapeutic strategies for cancer. However, the prognostic value and pro-metastatic activity of RANK in endometrial cancer (EC) remain to be determined. Thus, the present study investigated the effect of RANK on the prognosis of EC patients, as well as the pro-metastatic activity of EC cells. The results indicated that those with high expression of RANK showed decreased overall survival and progression-free survival. Statistical analysis revealed the positive correlations between RANK/RANKL expression and metastasis-related factors. Additionally, RANK/RANKL significantly promoted cell migration/invasion via activating AKT/β-catenin/Snail pathway in vitro. However, RANK/RANKL-induced AKT activation could be suppressed after osteoprotegerin (OPG) treatment. Furthermore, the combination of medroxyprogesterone acetate (MPA) and RANKL could in turn attenuate the effect of RANKL alone. Similarly, MPA could partially inhibit the RANK-induced metastasis in an orthotopic mouse model via suppressing AKT/β-catenin/Snail pathway. Therefore, therapeutic inhibition of MPA in RANK/RANKL-induced metastasis was mediated by AKT/β-catenin/Snail pathway both in vitro and in vivo, suggesting a potential target of RANK for gene-based therapy for EC.

  10. TH-AB-202-12: The First Clinical Implementation of a Real-Time Six Degree of Freedom Tracking System During Radiation Therapy

    International Nuclear Information System (INIS)

    Nguyen, D; Kim, J; O’Brien, R; Huang, C; Keall, P; Booth, J; Greer, P; Martin, J; Legge, K; Poulsen, P

    2016-01-01

    Purpose: In current practice, imaging is typically performed prior to treatment; the cancer target motion during treatment is unknown. We present the first clinical implementation of real time Kilovoltage Intrafraction Monitoring (KIM) system which tracks the cancer target translational and rotational motions during treatment. Methods: KIM technology: KIM estimates the 3D position of the target tumour based on segmented 2D positions of the three implanted fiducials in each of the kV images (125 kV, 10 mA at 11 fps) taken continuously during the treatment arc. The 2D-3D target estimation is based on a probability distribution function, obtained during pre-treatment CBCT. Rotations about each axis with the centroid of the markers as the pivot were calculated using the iterative closest point algorithm in real time. Patient: A patient with prostate adenocarcinoma undergoing stereotactic body radiotherapy (SBRT) with 36.25 Gy delivered in 5 fractions (Varian TrueBeam, 6X, VMAT) was enrolled in the study. The trial complies with Australian ethical and regulatory standards. Results: Of the 5 fractions of treatment the patient received, KIM was utilised successfully in 4 fractions with 3 couch shifts due to large persistent prostate movements (>2mm for more than 5 seconds). KIM translational accuracy and precision in comparison with post treatment kV-MV triangulation are 0.28±0.59 mm, −0.19±0.25 mm and 0.23±0.69 mm in the Left-Right, Superior-Inferior and Anterior-Posterior directions, respectively. KIM rotational accuracy as compared with triangulation is: 0.429°±2.22°, −0.44°±4.7° and 0.06°±1.08° in the roll, pitch and yaw direction, respectively. Conclusion: The first six degree of freedom KIM system was successfully implemented clinically. The presented KIM system has sub-millimeters accuracy and precision in all three translational axes, and less than 1° of mean error in all three rotational axes. Acknowledgement: This work is supported by Cancer

  11. TH-AB-202-12: The First Clinical Implementation of a Real-Time Six Degree of Freedom Tracking System During Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, D; Kim, J; O’Brien, R; Huang, C; Keall, P [University of Sydney, Sydney, NSW (Australia); Booth, J [Royal North Shore Hospital, Sydney (Australia); Greer, P; Martin, J [Calvary Mater Newcastle, Newcastle (Australia); Legge, K [University of Newcastle, Callaghan, NSW (Australia); Poulsen, P [Aarhus University Hospital, Aarhus (Denmark)

    2016-06-15

    Purpose: In current practice, imaging is typically performed prior to treatment; the cancer target motion during treatment is unknown. We present the first clinical implementation of real time Kilovoltage Intrafraction Monitoring (KIM) system which tracks the cancer target translational and rotational motions during treatment. Methods: KIM technology: KIM estimates the 3D position of the target tumour based on segmented 2D positions of the three implanted fiducials in each of the kV images (125 kV, 10 mA at 11 fps) taken continuously during the treatment arc. The 2D-3D target estimation is based on a probability distribution function, obtained during pre-treatment CBCT. Rotations about each axis with the centroid of the markers as the pivot were calculated using the iterative closest point algorithm in real time. Patient: A patient with prostate adenocarcinoma undergoing stereotactic body radiotherapy (SBRT) with 36.25 Gy delivered in 5 fractions (Varian TrueBeam, 6X, VMAT) was enrolled in the study. The trial complies with Australian ethical and regulatory standards. Results: Of the 5 fractions of treatment the patient received, KIM was utilised successfully in 4 fractions with 3 couch shifts due to large persistent prostate movements (>2mm for more than 5 seconds). KIM translational accuracy and precision in comparison with post treatment kV-MV triangulation are 0.28±0.59 mm, −0.19±0.25 mm and 0.23±0.69 mm in the Left-Right, Superior-Inferior and Anterior-Posterior directions, respectively. KIM rotational accuracy as compared with triangulation is: 0.429°±2.22°, −0.44°±4.7° and 0.06°±1.08° in the roll, pitch and yaw direction, respectively. Conclusion: The first six degree of freedom KIM system was successfully implemented clinically. The presented KIM system has sub-millimeters accuracy and precision in all three translational axes, and less than 1° of mean error in all three rotational axes. Acknowledgement: This work is supported by Cancer

  12. Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process.

    Science.gov (United States)

    Shaw, Joanne M; Price, Melanie A; Clayton, Josephine M; Grimison, Peter; Shaw, Tim; Rankin, Nicole; Butow, Phyllis N

    2016-01-01

    People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context. A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the Likert scale. Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings. This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.

  13. A putative biomarker signature for clinically effective AKT inhibition: correlation of in vitro, in vivo and clinical data identifies the importance of modulation of the mTORC1 pathway.

    Science.gov (United States)

    Cheraghchi-Bashi, Azadeh; Parker, Christine A; Curry, Ed; Salazar, Jean-Frederic; Gungor, Hatice; Saleem, Azeem; Cunnea, Paula; Rama, Nona; Salinas, Cristian; Mills, Gordon B; Morris, Shannon R; Kumar, Rakesh; Gabra, Hani; Stronach, Euan A

    2015-12-08

    Our identification of dysregulation of the AKT pathway in ovarian cancer as a platinum resistance specific event led to a comprehensive analysis of in vitro, in vivo and clinical behaviour of the AKT inhibitor GSK2141795. Proteomic biomarker signatures correlating with effects of GSK2141795 were developed using in vitro and in vivo models, well characterised for related molecular, phenotypic and imaging endpoints. Signatures were validated in temporally paired biopsies from patients treated with GSK2141795 in a clinical study. GSK2141795 caused growth-arrest as single agent in vitro, enhanced cisplatin-induced apoptosis in vitro and reduced tumour volume in combination with platinum in vivo. GSK2141795 treatment in vitro and in vivo resulted in ~50-90% decrease in phospho-PRAS40 and 20-80% decrease in fluoro-deoxyglucose (FDG) uptake. Proteomic analysis of GSK2141795 in vitro and in vivo identified a signature of pathway inhibition including changes in AKT and p38 phosphorylation and total Bim, IGF1R, AR and YB1 levels. In patient biopsies, prior to treatment with GSK2141795 in a phase 1 clinical trial, this signature was predictive of post-treatment changes in the response marker CA125. Development of this signature represents an opportunity to demonstrate the clinical importance of AKT inhibition for re-sensitisation of platinum resistant ovarian cancer to platinum.

  14. The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial.

    Science.gov (United States)

    Flikweert, Elvira R; Izaks, Gerbrand J; Knobben, Bas A S; Stevens, Martin; Wendt, Klaus

    2014-05-30

    Hip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect. A comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann-Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group. The intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other

  15. Latent tracks in polymeric etched track detectors

    International Nuclear Information System (INIS)

    Yamauchi, Tomoya

    2013-01-01

    Track registration properties in polymeric track detectors, including Poly(allyl diglycol carbonate), Bispenol A polycarbonate, Poly(ethylen terephtarate), and Polyimide, have been investigated by means of Fourie transform Infararede FT-IR spectrometry. Chemical criterion on the track formation threshold has been proposes, in stead of the conventional physical track registration models. (author)

  16. Tracking telecommuting

    Energy Technology Data Exchange (ETDEWEB)

    Stastny, P.

    2007-03-15

    Many employees are now choosing to work from home using laptops and telephones. Employers in the oil and gas industry are now reaping a number of benefits from their telecommuting employees, including increased productivity; higher levels of employee satisfaction, and less absenteeism. Providing a telecommunication option can prove to be advantageous for employers wishing to hire or retain employees. Telecommuting may also help to reduce greenhouse gas (GHG) emissions. This article provided details of Teletrips Inc., a company that aids in the production of corporate social responsibility reports. Teletrips provides reports that document employee savings in time, vehicle depreciation maintenance, and gasoline costs. Teletrips currently tracks 12 companies in Calgary, and plans to grow through the development of key technology partnerships. The company is also working with the federal government to provide their clients with emission trading credits, and has forged a memorandum of understanding with the British Columbia government for tracking emissions. Calgary now openly supports telecommuting and is encouraging businesses in the city to adopt telecommuting on a larger scale. It was concluded that the expanding needs for road infrastructure and the energy used by cars to move workers in and out of the city are a massive burden to the city's tax base. 1 fig.

  17. INNER TRACKING

    CERN Document Server

    P. Sharp

    The CMS Inner Tracking Detector continues to make good progress. The Objective for 2006 was to complete all of the CMS Tracker sub-detectors and to start the integration of the sub-detectors into the Tracker Support Tube (TST). The Objective for 2007 is to deliver to CMS a completed, installed, commissioned and calibrated Tracking System (Silicon Strip and Pixels) aligned to < 100µ in April 2008 ready for the first physics collisions at LHC. In November 2006 all of the sub-detectors had been delivered to the Tracker Integration facility (TIF) at CERN and the tests and QA procedures to be carried out on each sub-detector before integration had been established. In December 2006, TIB/TID+ was integrated into TOB+, TIB/TID- was being prepared for integration, and TEC+ was undergoing tests at the final tracker operating temperature (-100 C) in the Lyon cold room. In February 2007, TIB/TID- has been integrated into TOB-, and the installation of the pixel support tube and the services for TI...

  18. S.E. Mitchell Vascular Anomalies Flow Chart (SEMVAFC): A visual pathway combining clinical and imaging findings for classification of soft-tissue vascular anomalies

    International Nuclear Information System (INIS)

    Tekes, A.; Koshy, J.; Kalayci, T.O.; Puttgen, K.; Cohen, B.; Redett, R.; Mitchell, S.E.

    2014-01-01

    Classification of vascular anomalies (VAs) is challenging due to overlapping clinical symptoms, confusing terminology in the literature and unfamiliarity with this complex entity. It is important to recognize that VAs include two distinct entities, vascular tumours (VTs) and vascular malformations (VaMs). In this article, we describe SE Mitchell Vascular Anomalies Flow Chart (SEMVAFC), which arises from a multidisciplinary approach that incorporates clinical symptoms, physical examination and magnetic resonance imaging (MRI) findings to establish International Society for the Study of Vascular Anomalies (ISSVA)-based classification of the VAs. SEMVAFC provides a clear visual pathway for physicians to accurately diagnose Vas, which is important as treatment, management, and prognosis differ between VTs and VaMs

  19. Physiotherapy co-management of rheumatoid arthritis: identification of red flags, significance to clinical practice and management pathways.

    Science.gov (United States)

    Briggs, Andrew M; Fary, Robyn E; Slater, Helen; Ranelli, Sonia; Chan, Madelynn

    2013-12-01

    Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease. Physiotherapy interventions for people with RA are predominantly targeted at ameliorating disability resulting from articular and peri-articular manifestations of the disease and providing advice and education to improve functional capacity and quality of life. To ensure safe and effective care, it is critical that physiotherapists are able to identify potentially serious articular and peri-articular manifestations of RA, such as instability of the cervical spine. Additionally, as primary contact professionals, it is essential that physiotherapists are aware of the potentially serious extra-articular manifestations of RA. This paper provides an overview of the practice-relevant manifestations associated with RA that might warrant further investigation by a medical practitioner (red flags), their relevance to physiotherapy practice, and recommended management pathways. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Tracking Porters

    DEFF Research Database (Denmark)

    Bruun, Maja Hojer; Krause-Jensen, Jakob; Saltofte, Margit

    2015-01-01

    . In this chapter, we argue that although anthropology has its specific methodology – including a myriad of ethnographic data-gathering tools, techniques, analytical approaches and theories – it must first and foremost be understood as a craft. Anthropology as craft requires a specific ‘anthropological sensibility......’ that differs from the standardized procedures of normal science. To establish our points we use an example of problem-based project work conducted by a group of Techno-Anthropology students at Aalborg University, we focus on key aspects of this craft and how the students began to learn it: For two weeks...... the students followed the work of a group of porters. Drawing on anthropological concepts and research strategies the students gained crucial insights about the potential effects of using tracking technologies in the hospital....

  1. Fibre tracking

    International Nuclear Information System (INIS)

    Gaillard, J.M.

    1994-03-01

    A large-size scintillating plastic fibre tracking detector was built as part of the upgrade of the UA2 central detector at the SPS proton-antiproton collider. The cylindrical fibre detector of average radius of 40 cm consisted of 60000 plastic fibres with an active length of 2.1 m. One of the main motivations was to improve the electron identification. The fibre ends were bunched to be coupled to read-out systems of image intensifier plus CCD, 32 in total. The quality and the reliability of the UA2 fibre detector performance exceeded expectations throughout its years of operation. A few examples of the use of image intensifiers and of scintillating fibres in biological instrumentation are described. (R.P.) 11 refs., 15 figs., 2 tabs

  2. Putting Research Findings into Clinical Practice; Feasibility of integrated evidence-based care pathways in otorhinolaryngology head and neck surgery at Sultan Qaboos University Hospital, Oman

    Directory of Open Access Journals (Sweden)

    Deepa Bhargava

    2012-05-01

    Full Text Available Objectives: A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice (EBP. This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. Methods: A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital (SQUH, Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Results: Of those polled, 90% (95% confidence interval (CI 85–95% either strongly agreed or agreed that evidence-based practice protocols (EBPP could help in decision making. A total of 87.4% of participants (95% CI 81.8–93% either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants (95% CI 87.2–96.4% would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. Conclusions: The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care.

  3. Orchestrating care through the fast-track perspective: Orthopaedic nurses’ perceptions and experiences of providing individualised nursing care in older patients’ standardised fast-track programmes after total hip or knee replacement

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Frederiksen, Kirsten

    2017-01-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised...... fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim...... and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying...

  4. Mental Health Support Provided Throughout the Bariatric Surgery Clinical Pathway in French Specialized Care Centers for Obesity.

    Science.gov (United States)

    Lamore, Kristopher; Kaci, Sandra S; Czernichow, Sébastien; Bretault, Marion; Bouillot, Jean-Luc; Naudé, Anne-Jeanne; Gribe-Ouaknine, Sandra; Carette, Claire; Flahault, Cécile

    2017-03-01

    Pre-operative psychological assessment is recommended by international guidelines for bariatric surgery candidates. Thereby, service teams caring for bariatric patients should include at least one mental health provider (e.g., a psychologist or psychiatrist). The objective of this study was to evaluate the psychology and psychiatry resources and practices in the 37 specialized obesity centers (CSOs) created by the French Ministry of Health. CSO coordinators were contacted by e-mail to collect general information on the centers (e.g., number of bariatric operations). Secondly, psychologists and psychiatrists of each center completed an anonymous questionnaire assessing their professional practices and their organization of care pathways. The vast majority of CSO coordinators (81%, n = 26/32) answered our survey. These results show significant differences and shortages in terms of the psychology/psychiatry resources available. Most of the psychologists (n = 26/31) and psychiatrists (n = 10/10) stated that they systematically meet new patients only before surgery (56%) or both before and after the operation (30%); however, some psychologists and psychiatrists (14%) do not systematically meet all the patients (before and/or after surgery). Nevertheless, all the professionals provide psychology assessments, and about 75% of them offer a psychological follow-up, indicating a similarity regarding the practices of psychologists and psychiatrists. Our results highlight the place of psychological/psychiatric evaluations in French CSOs and emphasize the absence of mental health providers in several of these services. Post-operative psychological follow-up is not usually provided. It would be appropriate to create clear recommendations for post-operative psychological or psychiatric long-term follow-up.

  5. Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery.

    Science.gov (United States)

    Grant, Michael C; Hanna, Andrew; Benson, Andrew; Hobson, Deborah; Wu, Christopher L; Yuan, Christina T; Rosen, Michael; Wick, Elizabeth C

    2018-03-01

    Our aim was to determine whether the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery after Surgery (ERAS) program. Enhanced Recovery after Surgery programs involve the application of bundled best practices to improve the value of perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. Development of dedicated teams of anesthesia providers was a component of ERAS implementation. Intraoperative provider team networks (surgeons, anesthesiologists, and certified registered nurse anesthetists) were developed for all cases before and after implementation of colorectal ERAS. Four measures of centrality were analyzed in each network based on case assignments, and these measures were correlated with both rates of process measure compliance and clinical outcomes. Enhanced Recovery after Surgery provider teams led to a decrease in the closeness of anesthesiologists (p = 0.04) and significant increase in the clustering coefficient of certified registered nurse anesthetists (p = 0.005) compared with the pre-ERAS network. There was no significant change in centrality among surgeons (p = NS for all measures). Enhanced Recovery after Surgery designation among anesthesiologists and nurse anesthetists-whereby individual providers received an in-service on protocol elements and received compliance data was strongly associated with high compliance (>0.6 of measures; p < 0.001 for each group). In addition, high compliance was associated with a significant reduction in length of stay (p < 0.01), surgical site infection (p < 0.002), and morbidity (p < 0.009). Dedicated operating room teams led to increased centrality among anesthesia providers, which in turn not only increased compliance, but also improved several clinical outcomes. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights

  6. Tracking Boulders

    Science.gov (United States)

    2006-01-01

    13 March 2006 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a portion of a trough in the Sirenum Fossae region. On the floor and walls of the trough, large -- truck- to house-sized -- boulders are observed at rest. However, there is evidence in this image for the potential for mobility. In the central portion of the south (bottom) wall, a faint line of depressions extends from near the middle of the wall, down to the rippled trough floor, ending very near one of the many boulders in the area. This line of depressions is a boulder track; it indicates the path followed by the boulder as it trundled downslope and eventually came to rest on the trough floor. Because it is on Mars, even when the boulder is sitting still, this once-rolling stone gathers no moss. Location near: 29.4oS, 146.6oW Image width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Summer

  7. INNER TRACKING

    CERN Multimedia

    P. Sharp

    The CMS Inner Tracking Detector continues to make good progress. The successful commissioning of ~ 25% of the Silicon Strip Tracker was completed in the Tracker Integration Facility (TIF) at CERN in July 2007 and the Tracker has since been prepared for moving and installation into CMS at P5. The Tracker was ready to move on schedule in September 2007. The Installation of the Tracker cooling pipes and LV cables between Patch Panel 1 (PP1) on the inside the CMS magnet cryostat, and the cooling plants and power system racks on the balconies has been completed. The optical fibres from PP1 to the readout FEDs in the USC have been installed, together with the Tracker cable channels, in parallel with the installation of the EB/HB services. All of the Tracker Safety, Power, DCS and the VME Readout Systems have been installed at P5 and are being tested and commissioned with CMS. It is planned to install the Tracker into CMS before Christmas. The Tracker will then be connected to the pre-installed services on Y...

  8. INNER TRACKING

    CERN Multimedia

    P. Sharp

    The CMS Inner Tracking Detector continues to make good progress. The successful commissioning of ~ 25% of the Silicon Strip Tracker was completed in the Tracker Integration Facility (TIF) at CERN on 18 July 2007 and the Tracker has since been prepared for moving and installation into CMS at P5. The Tracker will be ready to move on schedule in September 2007. The Installation of the Tracker cooling pipes and LV cables between Patch Panel 1 (PP1) on the inside the CMS magnet cryostat, and the cooling plants and power system racks on the balconies has been completed. The optical fibres from PP1 to the readout FEDs in the USC will be installed in parallel with the installation of the EB/HB services, and will be completed in October. It is planned to install the Tracker into CMS at the end of October, after the completion of the installation of the EB/HB services. The Tracker will then be connected to the pre-installed services on YB0 and commissioned with CMS in December. The FPix and BPix continue to make ...

  9. Early drug development of inhibitors of the insulin-like growth factor-I receptor pathway: lessons from the first clinical trials.

    Science.gov (United States)

    Rodon, Jordi; DeSantos, Victoria; Ferry, Robert Jean; Kurzrock, Razelle

    2008-09-01

    The insulin-like growth factor-I receptor (IGF-IR) was first cloned in 1986. Since then, intense work has defined classic phosphorelays activated via the IGF-IR, which regulate cell proliferation, apoptosis, motility, and fate. The understanding of the roles of hormones in cancer and the growth hormone-IGF-IGF-binding protein axis specifically has yield to a second wave of development: the design of specific inhibitors that interrupt the signaling associated with this axis. The ability to manipulate these pathways holds not only significant therapeutic implications but also increase the chance of deeper insight about the role of the axis in carcinogenesis and metastasis. Nowadays, >25 molecules with the same goal are at different stages of development. Here, we review the clinical and preclinical experience with the two most-investigated strategies, tyrosine kinase inhibitors and monoclonal antibodies, and the advantages and disadvantages of each strategy, as well as other alternatives and possible drug combinations. We also review the biomarkers explored in the first clinical trials, the strategies that have been explored thus far, and the clinical trials that are going to explore their role in cancer treatment.

  10. Determining Clinically Relevant Changes in Community Walking Metrics to Be Tracked by the VA as Part of Routine Care in Lower Limb Amputee Veterans

    Science.gov (United States)

    2017-10-01

    Relevant Changes in Community Walking Metrics to Be Tracked by the VA as Part of Routine Care in Lower Limb Amputee Veterans 5c. PROGRAM ELEMENT ... poster presentation at the Association of Academic Physiatrists annual conference in Las Vegas. They are receiving value research and technical...writing experience. How were the results disseminated to communities of interest? A poster presentation was presented at the Association of Academic

  11. Panduan Praktek Klinis dan Clinical Pathway Sebagai Solusi Efisiensi Pembiayaan Diagnosa Hernia Inguinalis, Appendisitis, dan Sectio Caesarea di RSI Gondanglegi

    Directory of Open Access Journals (Sweden)

    Farida Rozany

    2017-07-01

    Full Text Available Aim of this study are to describing factors inefficient in health insurance program in RSI Gondanglegi especially for operatif procedure. This research was conducted with descriptive analysis method. Starting with the observation in the medical record at diagnosis in the case above, and compare with form details the cost of the patients in the period from the first quarter of 2016. The results obtained financing on medical services and medicines. By making the policy of medical services and medicines for patients health insurance, standards of clinical care, effective communication of team with related units, and an increase in the type of hospital grade is expected to improve the efficiency of implementation in RSIG.

  12. Expression and clinical significance of the HIF-1a/ET-2 signaling pathway during the development and treatment of polycystic ovary syndrome.

    Science.gov (United States)

    Wang, Fan; Zhang, Zhenghong; Wang, Zhaokai; Xiao, Kaizhuan; Wang, Qing; Su, Jingqian; Wang, Zhengchao

    2015-04-01

    Polycystic ovary syndrome (PCOS) is a major health problem in reproductive-aged women worldwide, but the precise pathogenesis of PCOS remains unclear. Our previous study revealed that hypoxia-inducible factor (HIF)-1a mediated endothelin (ET)-2 signaling plays an important role in ovulation in rats. Therefore, the present study used a PCOS rat model to test the hypotheses that HIF-1a signaling is expressed and inhibited in ovaries during PCOS formation and that the HIF-1a/ET-2 signaling pathway is a target of dimethyldiguanide (DMBG) in the clinical treatment of PCOS. First, the development of a PCOS model and the effect of DMBG treatment were examined through ovarian histology and serum hormone levels, which were consistent with previous reports. Second, HIF-1a and ET-2 expression were detected by immunohistochemistry and western blot. The results showed decreased HIF-1a/ET-2 expression in the ovaries of PCOS rats, whereas DMBG treatment reversed the protein decreases and improved the PCOS symptoms. Third, to understand the molecular mechanism, HIF-1a/ET-2 mRNA expression was also examined. Interestingly, HIF-1a mRNA increased in the ovaries of PCOS rats, while ET-2 mRNA decreased, indicating that HIF-1a protein degradation may be involved in POCS development and treatment. Finally, HIF prolyl hydroxylase (PHD) activity was examined to further clarify the contribution of HIF-1a signaling to the development and treatment of PCOS. The results suggested that the inhibition of HIF-1a/ET-2 signaling may be caused by increased PHD activity in PCOS. DMBG-treated PCOS may further activate HIF-1a signaling at least partly through inhibiting PHD activity. Taken together, these results indicate that HIF-1a signaling is inhibited in a PCOS rat model through increasing PHD activity. DMBG treatment improved PCOS by rescuing this pathway, suggesting that HIF-1a signaling plays an important role in the development and treatment of PCOS. This HIF-1a-mediated ET-2 signaling pathway

  13. Dynamic kirigami structures for integrated solar tracking

    Science.gov (United States)

    Lamoureux, Aaron; Lee, Kyusang; Shlian, Matthew; Forrest, Stephen R.; Shtein, Max

    2015-01-01

    Optical tracking is often combined with conventional flat panel solar cells to maximize electrical power generation over the course of a day. However, conventional trackers are complex and often require costly and cumbersome structural components to support system weight. Here we use kirigami (the art of paper cutting) to realize novel solar cells where tracking is integral to the structure at the substrate level. Specifically, an elegant cut pattern is made in thin-film gallium arsenide solar cells, which are then stretched to produce an array of tilted surface elements which can be controlled to within ±1°. We analyze the combined optical and mechanical properties of the tracking system, and demonstrate a mechanically robust system with optical tracking efficiencies matching conventional trackers. This design suggests a pathway towards enabling new applications for solar tracking, as well as inspiring a broader range of optoelectronic and mechanical devices. PMID:26348820

  14. Instruction-based clinical eye-tracking study on the visual interpretation of divergence: How do students look at vector field plots?

    Science.gov (United States)

    Klein, P.; Viiri, J.; Mozaffari, S.; Dengel, A.; Kuhn, J.

    2018-06-01

    Relating mathematical concepts to graphical representations is a challenging task for students. In this paper, we introduce two visual strategies to qualitatively interpret the divergence of graphical vector field representations. One strategy is based on the graphical interpretation of partial derivatives, while the other is based on the flux concept. We test the effectiveness of both strategies in an instruction-based eye-tracking study with N =41 physics majors. We found that students' performance improved when both strategies were introduced (74% correct) instead of only one strategy (64% correct), and students performed best when they were free to choose between the two strategies (88% correct). This finding supports the idea of introducing multiple representations of a physical concept to foster student understanding. Relevant eye-tracking measures demonstrate that both strategies imply different visual processing of the vector field plots, therefore reflecting conceptual differences between the strategies. Advanced analysis methods further reveal significant differences in eye movements between the best and worst performing students. For instance, the best students performed predominantly horizontal and vertical saccades, indicating correct interpretation of partial derivatives. They also focused on smaller regions when they balanced positive and negative flux. This mixed-method research leads to new insights into student visual processing of vector field representations, highlights the advantages and limitations of eye-tracking methodologies in this context, and discusses implications for teaching and for future research. The introduction of saccadic direction analysis expands traditional methods, and shows the potential to discover new insights into student understanding and learning difficulties.

  15. Calcium Signaling Pathway Is Associated with the Long-Term Clinical Response to Selective Serotonin Reuptake Inhibitors (SSRI and SSRI with Antipsychotics in Patients with Obsessive-Compulsive Disorder.

    Directory of Open Access Journals (Sweden)

    Hidehiro Umehara

    Full Text Available Selective serotonin reuptake inhibitors (SSRI are established first-line pharmacological treatments for obsessive-compulsive disorder (OCD, while antipsychotics are used as an augmentation strategy for SSRI in OCD patients who have either no response or a partial response to SSRI treatment. The goal of the present study was to identify genetic variants and pathways that are associated with the long-term clinical response of OCD patients to SSRI or SSRI with antipsychotics.We first performed a genome-wide association study of 96 OCD patients to examine genetic variants contributing to the response to SSRI or SSRI with antipsychotics. Subsequently, we conducted pathway-based analyses by using Improved Gene Set Enrichment Analysis for Genome-wide Association Study (i-GSEA4GWAS to examine the combined effects of genetic variants on the clinical response in OCD.While we failed to detect specific genetic variants associated with clinical responses to SSRI or to SSRI with an atypical antipsychotic at genome-wide levels of significance, we identified 8 enriched pathways for the SSRI treatment response and 5 enriched pathways for the treatment response to SSRI with an antipsychotic medication. Notably, the calcium signaling pathway was identified in both treatment responses.Our results provide novel insight into the molecular mechanisms underlying the variability in clinical response to SSRI and SSRI with antipsychotics in OCD patients.

  16. Orchestrating care through the fast-track perspective: A qualitative content analysis of the provision of individualised nursing care in orthopaedic fast-track programmes.

    Science.gov (United States)

    Berthelsen, Connie Bøttcher; Frederiksen, Kirsten

    2017-02-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion criteria to maintain the effective elements in the programme and to facilitate nurses' opportunities to offer individual care, thereby ensuring that fragile patients have access to other possibilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Solar tracking system

    Science.gov (United States)

    Okandan, Murat; Nielson, Gregory N.

    2016-07-12

    Solar tracking systems, as well as methods of using such solar tracking systems, are disclosed. More particularly, embodiments of the solar tracking systems include lateral supports horizontally positioned between uprights to support photovoltaic modules. The lateral supports may be raised and lowered along the uprights or translated to cause the photovoltaic modules to track the moving sun.

  18. EXPRESSION OF E-CADHERIN AND WNT PATHWAY PROTEINS BETACATENIN, APC, TCF-4 AND SURVIVIN IN GASTRIC ADENOCARCINOMA: CLINICAL AND PATHOLOGICAL IMPLICATION.

    Science.gov (United States)

    Lins, Rodrigo Rego; Oshima, Celina Tizuko Fujiyama; Oliveira, Levindo Alves de; Silva, Marcelo Souza; Mader, Ana Maria Amaral Antonio; Waisberg, Jaques

    2016-01-01

    Gastric cancer is the fifth most frequent cancer and the third most common cause of cancer-related deaths worldwide.It has been reported that Wnt/ betacatenin pathway is activated in 30-50% of these tumors. However,the deregulation of this pathway has not been fully elucidated. To determine the expression of E-cadherin, betacatenin, APC, TCF-4 and survivin proteins in gastric adenocarcinoma tissues and correlate with clinical and pathological parameters. Seventy-one patients with gastric adenocarcinoma undergoing gastrectomy were enrolled. The expression of E-cadherin, betacatenin, APC, TCF-4 and survivin proteins was detected by immunohistochemistryand related to the clinical and pathological parameters. The expression rates of E-cadherin in the membrane was 3%; betacatenin in the cytoplasm and nucleus were 23,4% and 3,1% respectively; APC in the cytoplasm was 94,6%; TCF-4 in the nucleus was 19,4%; and survivin in the nucleus 93,9%. The expression rate of E-cadherin was correlated with older patients (p=0,007), while betacatenin with tumors citoplasma e 3,1% no núcleo; APC em 94,6% no citoplasma; TCF-4 em19,4% no núcleo; e survivina em 93,9% no núcleo. Houve relação entre expressão da proteína E-caderina com a idade mais avançada (p=0,007); betacatenina com tumores <5 cm de diâmetro (p=0,041);APC com tumores proximais (p=0,047); e TCF-4 com tipo difuso da classificação de Lauren (p=0,017) e com o grau de penetração tumoral (p=0,002). A via Wnt/betacatenina não está envolvida na carcinogênese gástrica. Porém, a frequência elevada de survivina permite sugerir que outras vias sinalizadoras devam estar envolvidas na transformação do tecido gástrico.

  19. Tracking Clean Energy Progress 2013

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-06-01

    Tracking Clean Energy Progress 2013 (TCEP 2013) examines progress in the development and deployment of key clean energy technologies. Each technology and sector is tracked against interim 2020 targets in the IEA Energy Technology Perspectives 2012 2°C scenario, which lays out pathways to a sustainable energy system in 2050. Stark message emerge: progress has not been fast enough; large market failures are preventing clean energy solutions from being taken up; considerable energy efficiency remains untapped; policies need to better address the energy system as a whole; and energy-related research, development and demonstration need to accelerate. Alongside these grim conclusions there is positive news. In 2012, hybrid-electric vehicle sales passed the 1 million mark. Solar photovoltaic systems were being installed at a record pace. The costs of most clean energy technologies fell more rapidly than anticipated.

  20. Integrated analysis of oral tongue squamous cell carcinoma identifies key variants and pathways linked to risk habits, HPV, clinical parameters and tumor recurrence [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Neeraja Krishnan

    2015-11-01

    Full Text Available Oral tongue squamous cell carcinomas (OTSCC are a homogeneous group of tumors characterized by aggressive behavior, early spread to lymph nodes and a higher rate of regional failure. Additionally, the incidence of OTSCC among younger population (<50yrs is on the rise; many of whom lack the typical associated risk factors of alcohol and/or tobacco exposure. We present data on single nucleotide variations (SNVs, indels, regions with loss of heterozygosity (LOH, and copy number variations (CNVs from fifty-paired oral tongue primary tumors and link the significant somatic variants with clinical parameters, epidemiological factors including human papilloma virus (HPV infection and tumor recurrence. Apart from the frequent somatic variants harbored in TP53, CASP8, RASA1, NOTCH and CDKN2A genes, significant amplifications and/or deletions were detected in chromosomes 6-9, and 11 in the tumors. Variants in CASP8 and CDKN2A were mutually exclusive. CDKN2A, PIK3CA, RASA1 and DMD variants were exclusively linked to smoking, chewing, HPV infection and tumor stage. We also performed a whole-genome gene expression study that identified matrix metalloproteases to be highly expressed in tumors and linked pathways involving arachidonic acid and NF-k-B to habits and distant metastasis, respectively. Functional knockdown studies in cell lines demonstrated the role of CASP8 in a HPV-negative OTSCC cell line. Finally, we identified a 38-gene minimal signature that predicts tumor recurrence using an ensemble machine-learning method. Taken together, this study links molecular signatures to various clinical and epidemiological factors in a homogeneous tumor population with a relatively high HPV prevalence.

  1. Hospital Medicine Resident Training Tracks: Developing the Hospital Medicine Pipeline.

    Science.gov (United States)

    Sweigart, Joseph R; Tad-Y, Darlene; Kneeland, Patrick; Williams, Mark V; Glasheen, Jeffrey J

    2017-03-01

    Hospital medicine (HM) is rapidly evolving into new clinical and nonclinical roles. Traditional internal medicine (IM) residency training likely does not optimally prepare residents for success in HM. Hospital medicine residency training tracks may offer a preferred method for specialized HM education. Internet searches and professional networks were used to identify HM training tracks. Information was gathered from program websites and discussions with track directors. The 11 HM tracks at academic medical centers across the United States focus mostly on senior residents. Track structure and curricular content are determined largely by the structure and curricula of the IM residency programs in which they exist. Almost all tracks feature experiential quality improvement projects. Content on healthcare economics and value is common, and numerous track leaders report this content is expanding from HM tracks into entire residency programs. Tracks also provide opportunities for scholarship and professional development, such as workshops on abstract creation and job procurement skills. Almost all tracks include HM preceptorships as well as rotations within various disciplines of HM. HM residency training tracks focus largely on quality improvement, health care economics, and professional development. The structures and curricula of these tracks are tightly linked to opportunities within IM residency programs. As HM continues to evolve, these tracks likely will expand to bridge clinical and extra-clinical gaps between traditional IM training and contemporary HM practice. Journal of Hospital Medicine 2017;12:173-176. © 2017 Society of Hospital Medicine

  2. Evaluación del impacto de una trayectoria clínica sobre el ictus isquémico Impact of a clinical pathway for stroke patients

    Directory of Open Access Journals (Sweden)

    Margarita Esteve

    2004-06-01

    Full Text Available Objetivo: Evaluar el impacto de la introducción de una trayectoria clínica sobre la atención a los pacientes con un ictus isquémico. Métodos: Se diseñó un estudio de intervención, controlado, sin asignación aleatoria, de seguimiento de 2 cohortes de pacientes, no coincidentes en el tiempo, correspondiente a los períodos inmediatamente anterior (grupo PRE o control y posterior (grupo POST o intervención a la introducción de la trayectoria clínica. Las principales medidas del resultado fueron: a indicadores de calidad asistencial; b mejora en la capacidad funcional (índice de Barthel y la función neurológica (escala Canadiense; c complicaciones intrahospitalarias; d satisfacción, y e estancia media. Resultados: Se reclutó a 139 pacientes, 69 correspondientes al período PRE y 70 al período POST, sin que se observaran diferencias significativas al ingreso entre ambos grupos. Se constató una reducción del 36,5% en el tiempo transcurrido desde el ingreso hasta el inicio de la movilización, aunque no se observaron diferencias significativas en los otros indicadores de calidad ni en el incremento de la función neurológica o la capacidad funcional. El porcentaje de individuos con alguna complicación durante el ingreso fue del 44,6% en el período PRE y del 28,6% en el período POST (p = 0,039. No se observaron diferencias significativas en la valoración global del cuestionario de satisfacción, pero los pacientes del período POST presentaron una mayor satisfacción en las dimensiones «información recibida» y «profesionalidad y confianza». La estancia media se redujo de 11 a 10 días. Conclusiones: La introducción de la trayectoria clínica del ictus isquémico puede contribuir a reducir el número de complicaciones y los días de estancia, así como mejorar la calidad de la atención y la satisfacción de los pacientes.Objective: To assess the impact of the implementation of a clinical pathway for stroke patients

  3. Pathways to child and adolescent psychiatric clinics: a multilevel study of the significance of ethnicity and neighbourhood social characteristics on source of referral

    Directory of Open Access Journals (Sweden)

    Rydelius Per-Anders

    2011-03-01

    Full Text Available Abstract Background In the Swedish society, as in many other societies, many children and adolescents with mental health problems do not receive the help they need. As the Swedish society becomes increasingly multicultural, and as ethnic and economic residential segregation become more pronounced, this study utilises ethnicity and neighbourhood context to examine referral pathways to child and adolescent psychiatric (CAP clinics. Methods The analysis examines four different sources of referrals: family referrals, social/legal agency referrals, school referrals and health/mental health referrals. The referrals of 2054 children aged 11-19 from the Stockholm Child-Psychiatric Database were studied using multilevel logistic regression analyses. Results Results indicate that ethnicity played an important role in how children and adolescents were referred to CAP-clinics. Family referrals were more common among children and adolescents with a Swedish background than among those with an immigrant background. Referrals by social/legal agencies were more common among children and adolescents with African and Asian backgrounds. Children with Asian or South American backgrounds were more likely to have been referred by schools or by the health/mental health care sector. A significant neighbourhood effect was found in relation to family referrals. Children and adolescents from neighbourhoods with low levels of socioeconomic deprivation were more likely to be referred to CAP-clinics by their families in comparison to children from other neighbourhoods. Such differences were not found in relation in relation to the other sources of referral. Conclusions This article reports findings that can be an important first step toward increasing knowledge on reasons behind differential referral rates and uptake of psychiatric care in an ethnically diverse Swedish sample. These findings have implications for the design and evaluation of community mental health outreach

  4. Persistent Aerial Tracking

    KAUST Repository

    Mueller, Matthias

    2016-01-01

    persistent, robust and autonomous object tracking system for unmanned aerial vehicles (UAVs) called Persistent Aerial Tracking (PAT). A computer vision and control strategy is applied to a diverse set of moving objects (e.g. humans, animals, cars, boats, etc

  5. Renewable Energy Tracking Systems

    Science.gov (United States)

    Renewable energy generation ownership can be accounted through tracking systems. Tracking systems are highly automated, contain specific information about each MWh, and are accessible over the internet to market participants.

  6. Forward tracking detectors

    Indian Academy of Sciences (India)

    Abstract. Forward tracking is an essential part of a detector at the international linear collider (ILC). The requirements for forward tracking are explained and the proposed solutions in the detector concepts are shown.

  7. CareTrack Kids—part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development

    Science.gov (United States)

    Wiles, Louise K; Hooper, Tamara D; Hibbert, Peter D; White, Les; Mealing, Nicole; Jaffe, Adam; Cowell, Christopher T; Runciman, William B; Goldstein, Stan; Hallahan, Andrew R; Wakefield, John G; Murphy, Elisabeth; Lau, Annie; Wheaton, Gavin; Williams, Helena M; Hughes, Clifford; Braithwaite, Jeffrey

    2015-01-01

    Introduction Despite the widespread availability of clinical guidelines, considerable gaps remain between the care that is recommended (appropriate care) and the care provided. This protocol describes a research methodology to develop clinical indicators for appropriate care for common paediatric conditions. Methods and analysis We will identify conditions amenable to population-level appropriateness of care research and develop clinical indicators for each condition. Candidate conditions have been identified from published research; burden of disease, prevalence and frequency of presentation data; and quality of care priority lists. Clinical indicators will be developed through searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts will review the indicators using a wiki-based approach and modified Delphi process. A formative evaluation of the wiki process will be undertaken. Ethics and dissemination Human Research Ethics Committee approvals have been received from Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Health Network (South Australia). Applications are under review with Macquarie University and the Royal Australian College of General Practitioners. We will submit the results of the study to relevant journals and offer national and international presentations. PMID:25854976

  8. Advanced Tracking of Vehicles

    DEFF Research Database (Denmark)

    Jensen, Christian Søndergaard; Li, K.-J.; Pakalnis, Stardas

    2005-01-01

    efficient tracking techniques. More specifically, while almost all commercially available tracking solutions simply offer time-based sampling of positions, this paper's techniques aim to offer a guaranteed tracking accuracy for each vehicle at the lowest possible costs, in terms of network traffic...

  9. User interface design for mobile-based sexual health interventions for young people: design recommendations from a qualitative study on an online Chlamydia clinical care pathway.

    Science.gov (United States)

    Gkatzidou, Voula; Hone, Kate; Sutcliffe, Lorna; Gibbs, Jo; Sadiq, Syed Tariq; Szczepura, Ala; Sonnenberg, Pam; Estcourt, Claudia

    2015-08-26

    The increasing pervasiveness of mobile technologies has given potential to transform healthcare by facilitating clinical management using software applications. These technologies may provide valuable tools in sexual health care and potentially overcome existing practical and cultural barriers to routine testing for sexually transmitted infections. In order to inform the design of a mobile health application for STIs that supports self-testing and self-management by linking diagnosis with online care pathways, we aimed to identify the dimensions and range of preferences for user interface design features among young people. Nine focus group discussions were conducted (n = 49) with two age-stratified samples (16 to 18 and 19 to 24 year olds) of young people from Further Education colleges and Higher Education establishments. Discussions explored young people's views with regard to: the software interface; the presentation of information; and the ordering of interaction steps. Discussions were audio recorded and transcribed verbatim. Interview transcripts were analysed using thematic analysis. Four over-arching themes emerged: privacy and security; credibility; user journey support; and the task-technology-context fit. From these themes, 20 user interface design recommendations for mobile health applications are proposed. For participants, although privacy was a major concern, security was not perceived as a major potential barrier as participants were generally unaware of potential security threats and inherently trusted new technology. Customisation also emerged as a key design preference to increase attractiveness and acceptability. Considerable effort should be focused on designing healthcare applications from the patient's perspective to maximise acceptability. The design recommendations proposed in this paper provide a valuable point of reference for the health design community to inform development of mobile-based health interventions for the diagnosis

  10. Bitter gourd (Momordica charantia) as a rich source of bioactive components to combat cancer naturally: Are we on the right track to fully unlock its potential as inhibitor of deregulated signaling pathways.

    Science.gov (United States)

    Farooqi, Ammad Ahmad; Khalid, Sumbul; Tahir, Fatima; Sabitaliyevich, Uteuliev Yerzhan; Yaylim, Ilhan; Attar, Rukset; Xu, Baojun

    2018-05-10

    Research over decades has progressively explored pharmacological actions of bitter gourd (Momordica charantia). Biologically and pharmacologically active molecules isolated from M. charantia have shown significant anti-cancer activity in cancer cell lines and xenografted mice. In this review spotlight was set on the bioactive compounds isolated from M. charantia that effectively inhibited cancer development and progression via regulation of protein network in cancer cells. We summarize most recent high-quality research work in cancer cell lines and xenografted mice related to tumor suppressive role-play of M. charantia and its bioactive compounds. Although M. charantia mediated health promoting, anti-diabetic, hepatoprotective, anti-inflammatory effects have been extensively investigated, there is insufficient information related to regulation of signaling networks by bioactive molecules obtained from M. charantia in different cancers. M. charantia has been shown to modulate AKT/mTOR/p70S6K signaling, p38MAPK-MAPKAPK-2/HSP-27 pathway, cell cycle regulatory proteins and apoptosis-associated proteins in different cancers. However, still there are visible knowledge gaps related to the drug targets in different cancers because we have not yet developed comprehensive understanding of the M. charantia mediated regulation of signal transduction pathways. To explore these questions, experimental platforms are needed that can prove to be helpful in getting a step closer to personalized medicine. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Tracks: Nurses and the Tracking Network

    Centers for Disease Control (CDC) Podcasts

    This podcast highlights the utility of the National Environmental Public Health Tracking Network for nurses in a variety of work settings. It features commentary from the American Nurses Association and includes stories from a public health nurse in Massachusetts.

  12. Tracks: Nurses and the Tracking Network

    Centers for Disease Control (CDC) Podcasts

    2012-06-06

    This podcast highlights the utility of the National Environmental Public Health Tracking Network for nurses in a variety of work settings. It features commentary from the American Nurses Association and includes stories from a public health nurse in Massachusetts.  Created: 6/6/2012 by National Center for Environmental Health (NCEH)/Division of Environmental Hazards and Health Effects (DEHHE)/Environmental Health Tracking Branch (EHTB).   Date Released: 6/6/2012.

  13. A novel flexible clinical multiphoton tomograph for early melanoma detection, skin analysis, testing of anti-age products, and in situ nanoparticle tracking

    Science.gov (United States)

    Weinigel, Martin; Breunig, Hans Georg; Gregory, Axel; Fischer, Peter; Kellner-Höfer, Marcel; Bückle, Rainer; König, Karsten

    2010-02-01

    High-resolution 3D microscopy based on multiphoton induced autofluorescence and second harmonic generation have been introduced in 1990. 13 years later, CE-marked clinical multiphoton systems for 3D imaging of human skin with subcellular resolution have first been launched by JenLab company with the tomography DermaInspect®. This year, the second generation of clinical multiphoton tomographs was introduced. The novel multiphoton tomograph MPTflex, equipped with a flexible articulated optical arm, provides an increased flexibility and accessibility especially for clinical and cosmetical examinations. Improved image quality and signal to noise ratio (SNR) are achieved by a very short source-drain spacing, by larger active areas of the detectors and by single photon counting (SPC) technology. Shorter image acquisition time due to improved image quality reduces artifacts and simplifies the operation of the system. The compact folded optical design and the light-weight structure of the optical head eases the handling. Dual channel detectors enable to distinguish between intratissue elastic fibers and collagenous structures simultaneously. Through the use of piezo-driven optics a stack of optical cross-sections (optical sectioning) can be acquired and 3D imaging can be performed. The multiphoton excitation of biomolecules like NAD(P)H, flavins, porphyrins, elastin, and melanin is done by picojoule femtosecond laser pulses from an tunable turn-key femtosescond near infrared laser system. The ability for rapid high-quality image acquisition, the user-friendly operation of the system and the compact and flexible design qualifies this system to be used for melanoma detection, diagnostics of dermatological disorders, cosmetic research and skin aging measurements as well as in situ drug monitoring and animal research.

  14. Businesses Partner with Schools, Community to Create Alternative Career Pathways

    Science.gov (United States)

    Overman, Stephenie

    2012-01-01

    Business, education and community leaders are working together to create alternative career pathways for young people who are not profiting from the four-year college track. The new Pathways to Prosperity Network brings together the Pathways to Prosperity Project at Harvard Graduate School of Education (HGSE), Jobs for the Future (JFF) and six…

  15. The relationship between the PD-1/PD-L1 pathway and DNA mismatch repair in cervical cancer and its clinical significance

    Directory of Open Access Journals (Sweden)

    Feng YC

    2018-01-01

    Full Text Available Yang-chun Feng,1,2 Wen-li Ji,3 Na Yue,3 Yan-chun Huang,2 Xiu-min Ma1 1Clinical Laboratory Center, The First Affiliated Hospital of Xinjiang Medical University, 2Clinical Laboratory Center, 3Clinical Pathology Center, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, People’s Republic of China Background: According to recent clinical observations, deficient DNA mismatch repair (dMMR is capable of improving antitumor effects of the PD-1/PD-L1 pathway, suggesting that dMMR may act as a prognostic indicator of PD-1/PD-L1 antibody drugs. In this study, we examined the dMMR and PD-1/PD-L1 expression, as well as explored the correlation of dMMR status with PD-1/PD-L1 expression in cervical cancer patients, in order to optimize cervical cancer patient selection for PD-1/PD-L1 antibody drug treatment, which is helpful to avoid adverse effects and keep costs manageable. Methods: Sixty-six tissue samples from patients with squamous cell carcinoma were collected, and data of their clinical characteristics were also gathered. Based on these samples, the expression levels of MLH1, MSH2, and PD-L1 in cancer cells were tested by immunohistochemical assay (IHC. Moreover, PD-1/PD-L1 expression in tumor-invading lymphocytes (TILs was detected by IHC as well. Six single-nucleotide-repeat markers of microsatellite instability (MSI, including NR-27, MONO-27, BAT-25, NR-24, NR-21, and BAT-26, were tested by capillary electrophoresis sequencer analysis. According to expression of MLH1, MSH2 and the MSI test, all 66 cases were divided into dMMR or proficient DNA mismatch repair (pMMR groups. The comparisons of dMMR and PD-L1 in cancer cells and of PD-1/PD-L1 in TILs were conducted categorized by age, childbearing history, history of abortion, ethnicity, and cancer cell differentiation subgroup. Furthermore, PD-L1 levels in cancer cells and PD-1/PD-L1 in TILs were analyzed and compared in both dMMR and pMMR subgroups. Results: Of the patient samples, 25

  16. Pathway cross-talk network analysis identifies critical pathways in neonatal sepsis.

    Science.gov (United States)

    Meng, Yu-Xiu; Liu, Quan-Hong; Chen, Deng-Hong; Meng, Ying

    2017-06-01

    Despite advances in neonatal care, sepsis remains a major cause of morbidity and mortality in neonates worldwide. Pathway cross-talk analysis might contribute to the inference of the driving forces in bacterial sepsis and facilitate a better understanding of underlying pathogenesis of neonatal sepsis. This study aimed to explore the critical pathways associated with the progression of neonatal sepsis by the pathway cross-talk analysis. By integrating neonatal transcriptome data with known pathway data and protein-protein interaction data, we systematically uncovered the disease pathway cross-talks and constructed a disease pathway cross-talk network for neonatal sepsis. Then, attract method was employed to explore the dysregulated pathways associated with neonatal sepsis. To determine the critical pathways in neonatal sepsis, rank product (RP) algorithm, centrality analysis and impact factor (IF) were introduced sequentially, which synthetically considered the differential expression of genes and pathways, pathways cross-talks and pathway parameters in the network. The dysregulated pathways with the highest IF values as well as RPpathways in neonatal sepsis. By integrating three kinds of data, only 6919 common genes were included to perform the pathway cross-talk analysis. By statistic analysis, a total of 1249 significant pathway cross-talks were selected to construct the pathway cross-talk network. Moreover, 47 dys-regulated pathways were identified via attract method, 20 pathways were identified under RPpathways with the highest IF were also screened from the pathway cross-talk network. Among them, we selected 8 common pathways, i.e. critical pathways. In this study, we systematically tracked 8 critical pathways involved in neonatal sepsis by integrating attract method and pathway cross-talk network. These pathways might be responsible for the host response in infection, and of great value for advancing diagnosis and therapy of neonatal sepsis. Copyright © 2017

  17. The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation.

    Science.gov (United States)

    Rotter, Thomas; Plishka, Christopher; Hansia, Mohammed Rashaad; Goodridge, Donna; Penz, Erika; Kinsman, Leigh; Lawal, Adegboyega; O'Quinn, Sheryl; Buchan, Nancy; Comfort, Patricia; Patel, Prakesh; Anderson, Sheila; Winkel, Tanya; Lang, Rae Lynn; Marciniuk, Darcy D

    2017-11-28

    Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context. We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context. We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis. Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017

  18. Variation in 'fast-track' referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites.

    Science.gov (United States)

    Zhou, Y; Mendonca, S C; Abel, G A; Hamilton, W; Walter, F M; Johnson, S; Shelton, J; Elliss-Brookes, L; McPhail, S; Lyratzopoulos, G

    2018-01-01

    In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. We examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness.

  19. Environmental Public Health Tracking

    Centers for Disease Control (CDC) Podcasts

    In this podcast series, CDC scientists address frequently asked questions about the National Environmental Public Health Tracking Network, including using and applying data, running queries, and much more.

  20. DCS Budget Tracking System

    Data.gov (United States)

    Social Security Administration — DCS Budget Tracking System database contains budget information for the Information Technology budget and the 'Other Objects' budget. This data allows for monitoring...

  1. Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation-diffusion tensor imaging fiber tracking approach.

    Science.gov (United States)

    Sollmann, Nico; Wildschuetz, Noémie; Kelm, Anna; Conway, Neal; Moser, Tobias; Bulubas, Lucia; Kirschke, Jan S; Meyer, Bernhard; Krieg, Sandro M

    2018-03-01

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [r s ]; 50% FAT: r s = -0.8660; 75% FAT: r s = -0.8660) or surgery-related permanent paresis (50% FAT: r s = -0.7656; 75% FAT: r s = -0.6763). CONCLUSIONS

  2. Developing Family Psychoeducational Treatments for Patients with Bipolar and Other Severe Psychiatric Disorders: A Pathway from Basic Research to Clinical Trials.

    Science.gov (United States)

    Miklowitz, David J.; Hooley, Jill M.

    1998-01-01

    Describes the development pathway of family treatments for patients with severe and persistent psychiatric disorders in a population for whom family attributes have prognostic importance. The methodological complexities of psychosocial treatment studies are many. Moreover, the results of these studies often reflect interactions between treatment,…

  3. Can Tracking Improve Learning?

    Science.gov (United States)

    Duflo, Esther; Dupas, Pascaline; Kremer, Michael

    2009-01-01

    Tracking students into different classrooms according to their prior academic performance is controversial among both scholars and policymakers. If teachers find it easier to teach a homogeneous group of students, tracking could enhance school effectiveness and raise test scores of both low- and high-ability students. If students benefit from…

  4. Attitude and position tracking

    CSIR Research Space (South Africa)

    Candy, LP

    2011-01-01

    Full Text Available Several applications require the tracking of attitude and position of a body based on velocity data. It is tempting to use direction cosine matrices (DCM), for example, to track attitude based on angular velocity data, and to integrate the linear...

  5. Solid state track detectors

    International Nuclear Information System (INIS)

    Reuther, H.

    1976-11-01

    This paper gives a survey of the present state of the development and the application of solid state track detectors. The fundamentals of the physical and chemical processes of the track formation and development are explained, the different detector materials and their registration characteristics are mentioned, the possibilities of the experimental practice and the most variable applications are discussed. (author)

  6. Track Starter's Guide.

    Science.gov (United States)

    Dailey, Charles H.; Rankin, Kelly D.

    This guide was developed to serve both the novice and experienced starter in track and field events. Each year in the United States, runners encounter dozens of different starters' mannerisms as they travel to track meets in various towns and states. The goal of any competent and conscientious starter is to insure that all runners receive a fair…

  7. Large scale tracking algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Hansen, Ross L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Love, Joshua Alan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Melgaard, David Kennett [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Karelitz, David B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Pitts, Todd Alan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Zollweg, Joshua David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Anderson, Dylan Z. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Nandy, Prabal [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Whitlow, Gary L. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Bender, Daniel A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Byrne, Raymond Harry [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-01-01

    Low signal-to-noise data processing algorithms for improved detection, tracking, discrimination and situational threat assessment are a key research challenge. As sensor technologies progress, the number of pixels will increase signi cantly. This will result in increased resolution, which could improve object discrimination, but unfortunately, will also result in a significant increase in the number of potential targets to track. Many tracking techniques, like multi-hypothesis trackers, suffer from a combinatorial explosion as the number of potential targets increase. As the resolution increases, the phenomenology applied towards detection algorithms also changes. For low resolution sensors, "blob" tracking is the norm. For higher resolution data, additional information may be employed in the detection and classfication steps. The most challenging scenarios are those where the targets cannot be fully resolved, yet must be tracked and distinguished for neighboring closely spaced objects. Tracking vehicles in an urban environment is an example of such a challenging scenario. This report evaluates several potential tracking algorithms for large-scale tracking in an urban environment.

  8. Controlled ion track etching

    Science.gov (United States)

    George, J.; Irkens, M.; Neumann, S.; Scherer, U. W.; Srivastava, A.; Sinha, D.; Fink, D.

    2006-03-01

    It is a common practice since long to follow the ion track-etching process in thin foils via conductometry, i.e . by measurement of the electrical current which passes through the etched track, once the track breakthrough condition has been achieved. The major disadvantage of this approach, namely the absence of any major detectable signal before breakthrough, can be avoided by examining the track-etching process capacitively. This method allows one to define precisely not only the breakthrough point before it is reached, but also the length of any non-transient track. Combining both capacitive and conductive etching allows one to control the etching process perfectly. Examples and possible applications are given.

  9. Why we are tracking

    DEFF Research Database (Denmark)

    Tække, Jesper

    2015-01-01

    In this short essay, concerning why we are tracking, I will try to frame tracking as an evolutionary developed skill that humans need to survive. From an evolutionary point zero life must reflect upon itself in regard to its surrounding world as a kind of societal self-synchronization in this reg......In this short essay, concerning why we are tracking, I will try to frame tracking as an evolutionary developed skill that humans need to survive. From an evolutionary point zero life must reflect upon itself in regard to its surrounding world as a kind of societal self......-synchronization in this regard (Spencer 1890, Luhmann 2000, Tække 2014, 2011). I was inspired by Jill Walker Rettberg’s book: “Seeing Ourselves through Technology” and her presentation at the seminar: “Tracking Culture” arranged by Anders Albrechtslund in Aarhus January 2015....

  10. The Bering Target Tracking Instrumentation

    DEFF Research Database (Denmark)

    Denver, Troelz; Jørgensen, John Leif; Betto, Maurizio

    2003-01-01

    The key science instrument on the Bering satellite mission is a relative small telescope with an entrance aperture of 300 mm and a focal length between 500 and 1000 mm. The detection of potential targets is performed by one of the target scanning advanced stellar compasses (ASCs). This procedure...... results in a simple prioritized list of right ascension, declination, proper motion and intensity of each prospective target. The telescope itself has a dedicated ASC Camera Head Unit (CHU) mounted on the secondary mirror, largely co-aligned with the telescope. This CHU accurately determines the telescope......'s pointing direction. To achieve fast tracking over a large solid angle, the telescope pointing is achieved by means of a folding mirror in the optical pathway. When a prospective target approaches the telescope FOV, the ASC on the secondary will guide the folding mirror into position such that the target...

  11. Persistent Aerial Tracking

    KAUST Repository

    Mueller, Matthias

    2016-04-13

    In this thesis, we propose a new aerial video dataset and benchmark for low altitude UAV target tracking, as well as, a photo-realistic UAV simulator that can be coupled with tracking methods. Our benchmark provides the rst evaluation of many state of-the-art and popular trackers on 123 new and fully annotated HD video sequences captured from a low-altitude aerial perspective. Among the compared trackers, we determine which ones are the most suitable for UAV tracking both in terms of tracking accuracy and run-time. We also present a simulator that can be used to evaluate tracking algorithms in real-time scenarios before they are deployed on a UAV "in the field", as well as, generate synthetic but photo-realistic tracking datasets with free ground truth annotations to easily extend existing real-world datasets. Both the benchmark and simulator will be made publicly available to the vision community to further research in the area of object tracking from UAVs. Additionally, we propose a persistent, robust and autonomous object tracking system for unmanned aerial vehicles (UAVs) called Persistent Aerial Tracking (PAT). A computer vision and control strategy is applied to a diverse set of moving objects (e.g. humans, animals, cars, boats, etc.) integrating multiple UAVs with a stabilized RGB camera. A novel strategy is employed to successfully track objects over a long period, by \\'handing over the camera\\' from one UAV to another. We integrate the complete system into an off-the-shelf UAV, and obtain promising results showing the robustness of our solution in real-world aerial scenarios.

  12. Reducing Delay in Diagnosis: Multistage Recommendation Tracking.

    Science.gov (United States)

    Wandtke, Ben; Gallagher, Sarah

    2017-11-01

    The purpose of this study was to determine whether a multistage tracking system could improve communication between health care providers, reducing the risk of delay in diagnosis related to inconsistent communication and tracking of radiology follow-up recommendations. Unconditional recommendations for imaging follow-up of all diagnostic imaging modalities excluding mammography (n = 589) were entered into a database and tracked through a multistage tracking system for 13 months. Tracking interventions were performed for patients for whom completion of recommended follow-up imaging could not be identified 1 month after the recommendation due date. Postintervention compliance with the follow-up recommendation required examination completion or clinical closure (i.e., biopsy, limited life expectancy or death, or subspecialist referral). Baseline radiology information system checks performed 1 month after the recommendation due date revealed timely completion of 43.1% of recommended imaging studies at our institution before intervention. Three separate tracking interventions were studied, showing effectiveness between 29.0% and 57.8%. The multistage tracking system increased the examination completion rate to 70.5% (a 52% increase) and reduced the rate of unknown follow-up compliance and the associated risk of delay in diagnosis to 13.9% (a 74% decrease). Examinations completed after tracking intervention generated revenue of 4.1 times greater than the labor cost. Performing sequential radiology recommendation tracking interventions can substantially reduce the rate of unknown follow-up compliance and add value to the health system. Unknown follow-up compliance is a risk factor for delay in diagnosis, a form of preventable medical error commonly identified in malpractice claims involving radiologists and office-based practitioners.

  13. Real-Time Tumor Tracking in the Lung Using an Electromagnetic Tracking System

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Amish P., E-mail: Amish.Shah@orlandohealth.com [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States); Kupelian, Patrick A.; Waghorn, Benjamin J.; Willoughby, Twyla R.; Rineer, Justin M.; Mañon, Rafael R.; Vollenweider, Mark A.; Meeks, Sanford L. [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States)

    2013-07-01

    Purpose: To describe the first use of the commercially available Calypso 4D Localization System in the lung. Methods and Materials: Under an institutional review board-approved protocol and an investigational device exemption from the US Food and Drug Administration, the Calypso system was used with nonclinical methods to acquire real-time 4-dimensional lung tumor tracks for 7 lung cancer patients. The aims of the study were to investigate (1) the potential for bronchoscopic implantation; (2) the stability of smooth-surface beacon transponders (transponders) after implantation; and (3) the ability to acquire tracking information within the lung. Electromagnetic tracking was not used for any clinical decision making and could only be performed before any radiation delivery in a research setting. All motion tracks for each patient were reviewed, and values of the average displacement, amplitude of motion, period, and associated correlation to a sinusoidal model (R{sup 2}) were tabulated for all 42 tracks. Results: For all 7 patients at least 1 transponder was successfully implanted. To assist in securing the transponder at the tumor site, it was necessary to implant a secondary fiducial for most transponders owing to the transponder's smooth surface. For 3 patients, insertion into the lung proved difficult, with only 1 transponder remaining fixed during implantation. One patient developed a pneumothorax after implantation of the secondary fiducial. Once implanted, 13 of 14 transponders remained stable within the lung and were successfully tracked with the tracking system. Conclusions: Our initial experience with electromagnetic guidance within the lung demonstrates that transponder implantation and tracking is achievable though not clinically available. This research investigation proved that lung tumor motion exhibits large variations from fraction to fraction within a single patient and that improvements to both transponder and tracking system are still

  14. TUW @ TREC Clinical Decision Support Track 2015

    Science.gov (United States)

    2015-11-20

    between 2003 and 2013, and the ShARe/CLEF eHealth Evaluation Lab [15,3,11,12] running since 2013. Here we briefly describe the participation of Vienna...Mart́ınez, G. Zuccon, and J. R. M. Palotti. Overview of the share/clef ehealth evaluation lab 2014. In Information Access Evaluation. Mul- tilinguality...Symposium, IIiX ’14, pages 283–286. ACM, 2014. 11. J. Palotti, G. Zuccon, L. Goeuriot, L. Kelly, A. Hanbury, G. Jones, M. Lupu, and P. Pecina. Clef ehealth

  15. Motion Tracking for Medical Imaging: A Non-Visible Structured Light Tracking Approach

    DEFF Research Database (Denmark)

    Olesen, Oline Vinter; Paulsen, Rasmus Reinhold; Højgaard, Liselotte

    2012-01-01

    We present a system for head motion tracking in 3D brain imaging. The system is based on facial surface reconstruction and tracking using a structured light (SL) scanning principle. The system is designed to fit into narrow 3D medical scanner geometries limiting the field of view. It is tested......, is that it is not necessary to place markers on the patient. This provides a simpler workflow and eliminates uncertainties related to marker attachment and stability. We show proof of concept of a marker less tracking system especially designed for clinical use with promising results....... in a clinical setting on the high resolution research tomograph (HRRT), Siemens PET scanner with a head phantom and volunteers. The SL system is compared to a commercial optical tracking system, the Polaris Vicra system, from NDI based on translatory and rotary ground truth motions of the head phantom...

  16. Solid state nuclear track detectors

    International Nuclear Information System (INIS)

    Medeiros, J.A.; Carvalho, M.L.C.P. de

    1992-12-01

    Solid state nuclear track detectors (SSNTD) are dielectric materials, crystalline or vitreous, which registers tracks of charged nuclear particles, like alpha particles or fission fragments. Chemical etching of the detectors origin tracks that are visible at the optical microscope: track etching rate is higher along the latent track, where damage due to the charged particle increase the chemical potential, and etching rate giving rise to holes, the etched tracks. Fundamental principles are presented as well as some ideas of main applications. (author)

  17. Molecular Pathways

    Science.gov (United States)

    Lok, Benjamin H.; Powell, Simon N.

    2012-01-01

    The Rad52 protein was largely ignored in humans and other mammals when the mouse knockout revealed a largely “no-effect” phenotype. However, using synthetic lethal approaches to investigate context dependent function, new studies have shown that Rad52 plays a key survival role in cells lacking the function of the BRCA1-BRCA2 pathway of homologous recombination. Biochemical studies also showed significant differences between yeast and human Rad52, in which yeast Rad52 can promote strand invasion of RPA-coated single-stranded DNA in the presence of Rad51, but human Rad52 cannot. This results in the paradox of how is human Rad52 providing Rad51 function: presumably there is something missing in the biochemical assays that exists in-vivo, but the nature of this missing factor is currently unknown. Recent studies have suggested that Rad52 provides back-up Rad51 function for all members of the BRCA1-BRCA2 pathway, suggesting that Rad52 may be a target for therapy in BRCA pathway deficient cancers. Screening for ways to inhibit Rad52 would potentially provide a complementary strategy for targeting BRCA-deficient cancers in addition to PARP inhibitors. PMID:23071261

  18. Track Loading Vehicle - TLV

    Data.gov (United States)

    Federal Laboratory Consortium — The TLV is designed to apply forces close to the strength limits of the rails and other track structure components, such as ties, rail fasteners, and ballast, while...

  19. Procurement Tracking System (PTS)

    Data.gov (United States)

    Office of Personnel Management — The Procurement Tracking System (PTS) is used solely by the procurement staff of the Office of the Inspector General (OIG) at the U.S. Office of Personnel Management...

  20. Financial Disclosure Tracking System

    Data.gov (United States)

    US Agency for International Development — USAID's FDTS identifies personal service contractors and local employees who should file disclosure reports. It tracks late filers and identifies those who must take...

  1. Case Analysis Tracking System

    Data.gov (United States)

    National Archives and Records Administration — CATS tracks Public and Federal Agency Reference Requests for OPF (Official Personnel Folder) , EMF (Employee Medical Folder), and eOPF (electronic Official Personnel...

  2. Matter Tracking Information System -

    Data.gov (United States)

    Department of Transportation — The Matter Tracking Information System (MTIS) principle function is to streamline and integrate the workload and work activity generated or addressed by our 300 plus...

  3. LHCb on track

    CERN Document Server

    2006-01-01

    On 7 and 8 June 2006, the last large component of the LHCb experiment was lowered into the cavern. This 10-tonne, 18-metre long metal structure known as 'the bridge' will support the LHCb tracking system.

  4. Human Capital Tracking Tool -

    Data.gov (United States)

    Department of Transportation — AVS is now required to collect, track, and report on data from the following Flight, Business and Workforce Plan. The Human Resource Management’s Performance Target...

  5. Energy Tracking Software Platform

    Energy Technology Data Exchange (ETDEWEB)

    Ryan Davis; Nathan Bird; Rebecca Birx; Hal Knowles

    2011-04-04

    Acceleration has created an interactive energy tracking and visualization platform that supports decreasing electric, water, and gas usage. Homeowners have access to tools that allow them to gauge their use and track progress toward a smaller energy footprint. Real estate agents have access to consumption data, allowing for sharing a comparison with potential home buyers. Home builders have the opportunity to compare their neighborhood's energy efficiency with competitors. Home energy raters have a tool for gauging the progress of their clients after efficiency changes. And, social groups are able to help encourage members to reduce their energy bills and help their environment. EnergyIT.com is the business umbrella for all energy tracking solutions and is designed to provide information about our energy tracking software and promote sales. CompareAndConserve.com (Gainesville-Green.com) helps homeowners conserve energy through education and competition. ToolsForTenants.com helps renters factor energy usage into their housing decisions.

  6. Jet Car Track Site

    Data.gov (United States)

    Federal Laboratory Consortium — Located in Lakehurst, New Jersey, the Jet Car Track Site supports jet cars with J57 engines and has a maximum jet car thrust of 42,000 pounds with a maximum speed of...

  7. Clinical- and cost-effectiveness of the STAR care pathway compared to usual care for patients with chronic pain after total knee replacement: study protocol for a UK randomised controlled trial.

    Science.gov (United States)

    Wylde, Vikki; Bertram, Wendy; Beswick, Andrew D; Blom, Ashley W; Bruce, Julie; Burston, Amanda; Dennis, Jane; Garfield, Kirsty; Howells, Nicholas; Lane, Athene; McCabe, Candy; Moore, Andrew J; Noble, Sian; Peters, Tim J; Price, Andrew; Sanderson, Emily; Toms, Andrew D; Walsh, David A; White, Simon; Gooberman-Hill, Rachael

    2018-02-21

    Approximately 20% of patients experience chronic pain after total knee replacement. There is little evidence for effective interventions for the management of this pain, and current healthcare provision is patchy and inconsistent. Given the complexity of this condition, multimodal and individualised interventions matched to pain characteristics are needed. We have undertaken a comprehensive programme of work to develop a care pathway for patients with chronic pain after total knee replacement. This protocol describes the design of a randomised controlled trial to evaluate the clinical- and cost-effectiveness of a complex intervention care pathway compared with usual care. This is a pragmatic two-armed, open, multi-centred randomised controlled trial conducted within secondary care in the UK. Patients will be screened at 2 months after total knee replacement and 381 patients with chronic pain at 3 months postoperatively will be recruited. Recruitment processes will be optimised through qualitative research during a 6-month internal pilot phase. Patients are randomised using a 2:1 intervention:control allocation ratio. All participants receive usual care as provided by their hospital. The intervention comprises an assessment clinic appointment at 3 months postoperatively with an Extended Scope Practitioner and up to six telephone follow-up calls over 12 months. In the assessment clinic, a standardised protocol is followed to identify potential underlying causes for the chronic pain and enable appropriate onward referrals to existing services for targeted and individualised treatment. Outcomes are assessed by questionnaires at 6 and 12 months after randomisation. The co-primary outcomes are pain severity and pain interference assessed using the Brief Pain Inventory at 12 months after randomisation. Secondary outcomes relate to resource use, function, neuropathic pain, mental well-being, use of pain medications, satisfaction with pain relief, pain frequency, capability

  8. Function integrated track system

    OpenAIRE

    Hohnecker, Eberhard

    2010-01-01

    The paper discusses a function integrated track system that focuses on the reduction of acoustic emissions from railway lines. It is shown that the combination of an embedded rail system (ERS), a sound absorbing track surface, and an integrated mini sound barrier has significant acoustic advantages compared to a standard ballast superstructure. The acoustic advantages of an embedded rail system are particularly pronounced in the case of railway bridges. Finally, it is shown that a...

  9. Temperature responsive track membranes

    International Nuclear Information System (INIS)

    Omichi, H.; Yoshido, M.; Asano, M.; Tamada, H.

    1994-01-01

    A new track membrane was synthesized by introducing polymeric hydrogel to films. Such a monomer as amino acid group containing acryloyl or methacryloyl was either co-polymerized with diethylene glycol-bis-ally carbonate followed by on beam irradiation and chemical etching, or graft co-polymerized onto a particle track membrane of CR-39. The pore size was controlled in water by changing the water temperature. Some films other than CR-39 were also examined. (author). 11 refs, 7 figs

  10. Material Tracking Using LANMAS

    International Nuclear Information System (INIS)

    Armstrong, F.

    2010-01-01

    LANMAS is a transaction-based nuclear material accountability software product developed to replace outdated and legacy accountability systems throughout the DOE. The core underlying purpose of LANMAS is to track nuclear materials inventory and report transactions (movement, mixing, splitting, decay, etc.) to the Nuclear Materials Management and Safeguards System (NMMSS). While LANMAS performs those functions well, there are many additional functions provided by the software product. As a material is received onto a site or created at a site, its entire lifecycle can be tracked in LANMAS complete to its termination of safeguards. There are separate functions to track material movements between and within material balance areas (MBAs). The level of detail for movements within a MBA is configurable by each site and can be as high as a site designation or as detailed as building/room/rack/row/position. Functionality exists to track the processing of materials, either as individual items or by modeling a bulk process as an individual item to track inputs and outputs from the process. In cases where sites have specialized needs, the system is designed to be flexible so that site specific functionality can be integrated into the product. This paper will demonstrate how the software can be used to input material into an account and track it to its termination of safeguards.

  11. Development of etched nuclear tracks

    International Nuclear Information System (INIS)

    Somogyi, G.

    1980-01-01

    The theoretical description of the evolution of etched tracks in solid state nuclear track detectors is considered for different initial conditions, for the cases of constant and varying track etch rates, isotropic and anisotropic bulk etching as well as for thick and thin detectors. It is summarized how one can calculate the main parameters of etch-pit geometry, the track length, the axes of a surface track opening, track profile and track contour. The application of the theory of etch-track evolution is demonstrated with selected practical problems. Attention is paid to certain questions related to the determination of unknown track parameters and calculation of surface track sizes. Finally, the theory is extended to the description of the perforation and etch-hole evolution process in thin detectors, which is of particular interest for track radiography and nuclear filter production. (orig.)

  12. Development of etched nuclear tracks

    International Nuclear Information System (INIS)

    Somogyi, G.

    1979-01-01

    The theoretical description of the evolution of etched tracks in solid state nuclear track detectors is considered for different initial conditions, for the cases of constant and varying track etch rates, isotopic and unisotropic bulk etching as well as for thick and thin detectors. It is summarized how the main parameters of etch-pit geometry, the track length, the axes of a surface track opening, the track profile and the track contour can be calculated. The application of the theory of etch-track evolution is demonstrated with selected practical problems. Attention is paid to certain questions related to the determination of unknown track parameters and calculation of surface track sizes. Finally, the theory is extended to the description of the perforation and etch-hole evolution process in thin detectors, which is of particular interest for track radiography and nuclear filter production. (author)

  13. Clinical value and potential pathways of miR-183-5p in bladder cancer: A study based on miRNA-seq data and bioinformatics analysis.

    Science.gov (United States)

    Gao, Jia-Min; Huang, Lin-Zhen; Huang, Zhi-Guang; He, Rong-Quan

    2018-04-01

    The clinicopathological value and exploration of the potential molecular mechanism of microRNA-183-5p (miR-183-5p) have been investigated in various cancers; however, to the best of the author's knowledge, no similar research has been reported for bladder cancer. In the present study, it was revealed that the expression level of miR-183-5p was notably increased in bladder cancer tissues compared with adjacent non-cancerous tissues (P=0.001) and was markedly increased in the tissue samples of papillary, pathological T stage (T0-T2) and pathological stage (I-II) compared with tissue samples of their counterparts (P=0.05), according to data from The Cancer Genome Atlas. Receiver operating characteristic analysis revealed the robust diagnostic value of miR-183-5p for distinguishing bladder cancer from non-cancerous bladder tissues (area under curve=0.948; 95% confidence interval: 0.919-0.977). Amplification and deep deletion of miR-183-5p were indicated by cBioPortal, accounting for 1% (4/412) of bladder cancer cases. Data from YM500v3 demonstrated that compared with other cancers, bladder cancer exhibited high expression levels of miR-183-5p, and miR-183-5p expression in primary solid tumors was much higher compared with solid normal tissues. A meta-analysis indicated that miR-183-5p was more highly expressed in bladder cancer samples compared with normal counterparts. A total of 88 potential target genes of miR-183-5p were identified, 13 of which were discerned as hub genes by protein-protein interaction. The epithelial-to-mesenchymal transition pathway was the most significantly enriched pathway by FunRich (P=0.0001). In summary, miR-183-5p may participate in the tumorigenesis and development of bladder cancer via certain signaling pathways, particularly the epithelial-to-mesenchymal transition pathway. However, the exact molecular mechanism of miR-183-5p in bladder cancer must be validated by in vitro and in vivo experiments.

  14. Large angle tracking and high discriminating tracking in nuclear emulsion

    International Nuclear Information System (INIS)

    Matsuo, Tomokazu; Shibuya, Hiroshi; Ogawa, Satoru; Fukuda, Tsutomu; Mikado, Shoji

    2015-01-01

    Nuclear emulsion is a high resolution and re-analyzable detector. Conventional “Track Selector” which have angle acceptance |tan θ|<0.6 are widely used to find tracks in emulsion. We made a new track selector “Fine Track Selector” (FTS) which has large angle acceptance and high discriminating ability. The FTS reduces fake tracks using new algorithms, navigation etc. FTS also keeps finding efficiency of tracks around 90% in an angle range of |tan θ| < 3.5. FTS was applied to the τ candidate in OPERA and no additional tracks found. FTS will be useful to our new J-PARC emulsion experiment.

  15. Pathways to youth homelessness.

    Science.gov (United States)

    Martijn, Claudine; Sharpe, Louise

    2006-01-01

    Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the sample 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative samples, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each individual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the sample. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire sample. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the sample; (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses; and (3) crime did not precede homelessness for all but one youth; however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service

  16. MO-FG-BRD-01: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: Introduction and KV Tracking

    International Nuclear Information System (INIS)

    Fahimian, B.

    2015-01-01

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow

  17. MO-FG-BRD-02: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: MV Tracking

    Energy Technology Data Exchange (ETDEWEB)

    Berbeco, R. [Brigham and Women’s Hospital and Dana-Farber Cancer Institute (United States)

    2015-06-15

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow.

  18. MO-FG-BRD-04: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: MR Tracking

    Energy Technology Data Exchange (ETDEWEB)

    Low, D. [University of California Los Angeles: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: MR Tracking (United States)

    2015-06-15

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow.

  19. MO-FG-BRD-03: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: EM Tracking

    Energy Technology Data Exchange (ETDEWEB)

    Keall, P. [University of Sydney (Australia)

    2015-06-15

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow.

  20. MO-FG-BRD-01: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: Introduction and KV Tracking

    Energy Technology Data Exchange (ETDEWEB)

    Fahimian, B. [Stanford University (United States)

    2015-06-15

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow.

  1. MO-FG-BRD-04: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: MR Tracking

    International Nuclear Information System (INIS)

    Low, D.

    2015-01-01

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow

  2. MO-FG-BRD-03: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: EM Tracking

    International Nuclear Information System (INIS)

    Keall, P.

    2015-01-01

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow

  3. MO-FG-BRD-02: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management: MV Tracking

    International Nuclear Information System (INIS)

    Berbeco, R.

    2015-01-01

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow

  4. Clean tracks for ATLAS

    CERN Multimedia

    2006-01-01

    First cosmic ray tracks in the integrated ATLAS barrel SCT and TRT tracking detectors. A snap-shot of a cosmic ray event seen in the different layers of both the SCT and TRT detectors. The ATLAS Inner Detector Integration Team celebrated a major success recently, when clean tracks of cosmic rays were detected in the completed semiconductor tracker (SCT) and transition radiation tracker (TRT) barrels. These tracking tests come just months after the successful insertion of the SCT into the TRT (See Bulletin 09/2006). The cosmic ray test is important for the experiment because, after 15 years of hard work, it is the last test performed on the fully assembled barrel before lowering it into the ATLAS cavern. The two trackers work together to provide millions of channels so that particles' tracks can be identified and measured with great accuracy. According to the team, the preliminary results were very encouraging. After first checks of noise levels in the final detectors, a critical goal was to study their re...

  5. [Clinical features, care pathways and behaviors of patients with high level of cardiovascular risk: transversal study in south-west region of France].

    Science.gov (United States)

    Gay, Bernard; Couffinhal, Thierry; Saillour-Glénisson, Florence; Sevin, Floriane; Kret, Marion; Michel, Philippe

    2013-11-01

    To screen and to follow-up the patients with high cardiovascular risk in general practice may amplify the decrease of the cardiovascular morbi-mortality observed since a few years. The objective of this study is to identify the patients with high cardiovascular risk and to describe the management of these patients by general practitioners in Aquitaine. Transversal study of a sample of patients from 18 to 70 years old with high cardiovascular risk (combining at least 3 factors), included by voluntary general practitioners (GP). Forty-seven GP included 102 patients, presenting on average 3.7 risk factors among which 2.6 modifiable. The target values were reached for 59 % of patients with high blood pressure, 56 % of patients with diabetes and 53 % of patients with high cholesterol level. The analysis of care pathways identified the cardiologist as the privileged interlocutor. The doctors thought that seven patients out of 10 could change their risk behaviors. For the patients, the scale of declared importance to change was 6.6 on 10 for tobacco, 6.0 for food habits and 6.2 for physical activity. The confidence in their capacity to change was 3.8 on 10 for the tobacco, 5.2 for the food habits and 4.7 for the physical activity. Although doctors' sample is not representative, these results give an original overview of the management of patients with high cardiovascular risk and their care pathways. Medical treatments were globally in accordance with guidelines. The difficulty to change risk behaviors illustrates the necessity of patient therapeutic education. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. MRI with fibre tracking in Cogan congenital oculomotor apraxia

    Energy Technology Data Exchange (ETDEWEB)

    Merlini, Laura [University Hospital of Geneva, Pediatric Radiology, Geneva (Switzerland); Vargas, Maria I. [University Hospital of Geneva, Neuroradiology, Geneva (Switzerland); Haller, Raoul de [University Hospital of Geneva, Pediatric Ophthalmology, Geneva (Switzerland); Rilliet, Benedict [University Hospital of Geneva, Pediatric Neurosurgery, Geneva (Switzerland); Fluss, Joel [University Hospital of Geneva, Pediatric Neurology, Geneva (Switzerland)

    2010-10-15

    Congenital ocular motor apraxia (COMA) occasionally shares with Joubert syndrome (JS) and related disorders (JSRDs) a peculiar malformation, the 'molar tooth sign' (MTS). In JSRDs, the absence of superior cerebellar peduncles (SCP) decussation is reported. To investigate whether COMA demonstrates similar abnormal axonal pathways. Eight healthy age-matched controls, three children with clinical COMA and one child with clinical JSRD underwent examination with a 1.5-T MRI scanner. Diffusion-weighted imaging (DWI), colour-coded fractional anisotropy maps and three-dimensional diffusion tensor imaging (DTI) tractography of the cerebellorubral network were analyzed. On DTI cartography, the 'red dot' originally supposed to represent the SCP decussation in the midbrain was present in controls as well in those with COMA but absent in the single case with JS. In none of the subjects including controls was 3-D FT able to depict the SCP decussation. When seeded, the red dot resulted in the ventral tegmental decussation (VTD). It was normal in controls and in patients with COMA but was absent in our single patient with JSRD. MTS was identified in alla patients with COMA and in the patient with JSRD. MTS can be present in both COMA and JSRD but the underlying anatomy depicted by fibre tracking is distinct. The main difference is the integrity of the VTD in COMA. (orig.)

  7. EYE GAZE TRACKING

    DEFF Research Database (Denmark)

    2017-01-01

    This invention relates to a method of performing eye gaze tracking of at least one eye of a user, by determining the position of the center of the eye, said method comprising the steps of: detecting the position of at least three reflections on said eye, transforming said positions to spanning...... a normalized coordinate system spanning a frame of reference, wherein said transformation is performed based on a bilinear transformation or a non linear transformation e.g. a möbius transformation or a homographic transformation, detecting the position of said center of the eye relative to the position...... of said reflections and transforming this position to said normalized coordinate system, tracking the eye gaze by tracking the movement of said eye in said normalized coordinate system. Thereby calibration of a camera, such as knowledge of the exact position and zoom level of the camera, is avoided...

  8. Negotiating Family Tracking

    DEFF Research Database (Denmark)

    Albrechtslund, Anders; Bøge, Ask Risom; Sonne Damkjær, Maja

    This presentation explores the question: What motivates the use of tracking technologies in families, and how does the use transform the relations between parent and child? The purpose is to investigate why tracking technologies are used in families and how these technologies potentially change...... the relation between parents and children. The use of tracking technologies in families implicate negotiations about the boundaries of trust and intimacy in parent-child relations which can lead to strategies of resistance or modification (Fotel and Thomsen, 2004; Rooney, 2010; Steeves and Jones, 2010......). In the presentation, we report from a qualitative study that focuses on intergenerational relations. The study draws on empirical data from workshops with Danish families as well as individual and group interviews. We aim to gain insights about the sharing habits and negotiations in intimate family relations...

  9. Nanoscale measurements of proton tracks using fluorescent nuclear track detectors

    Energy Technology Data Exchange (ETDEWEB)

    Sawakuchi, Gabriel O., E-mail: gsawakuchi@mdanderson.org; Sahoo, Narayan [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 and Graduate School of Biomedical Sciences, The University of Texas, Houston, Texas 77030 (United States); Ferreira, Felisberto A. [Department of Nuclear Physics, University of Sao Paulo, SP 05508-090 (Brazil); McFadden, Conor H. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Hallacy, Timothy M. [Biophysics Program, Harvard University, Cambridge, Massachusetts 02138 (United States); Granville, Dal A. [Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Ontario K1H 8L6 (Canada); Akselrod, Mark S. [Crystal Growth Division, Landauer, Inc., Stillwater, Oklahoma 74074 (United States)

    2016-05-15

    Purpose: The authors describe a method in which fluorescence nuclear track detectors (FNTDs), novel track detectors with nanoscale spatial resolution, are used to determine the linear energy transfer (LET) of individual proton tracks from proton therapy beams by allowing visualization and 3D reconstruction of such tracks. Methods: FNTDs were exposed to proton therapy beams with nominal energies ranging from 100 to 250 MeV. Proton track images were then recorded by confocal microscopy of the FNTDs. Proton tracks in the FNTD images were fit by using a Gaussian function to extract fluorescence amplitudes. Histograms of fluorescence amplitudes were then compared with LET spectra. Results: The authors successfully used FNTDs to register individual proton tracks from high-energy proton therapy beams, allowing reconstruction of 3D images of proton tracks along with delta rays. The track amplitudes from FNTDs could be used to parameterize LET spectra, allowing the LET of individual proton tracks from therapeutic proton beams to be determined. Conclusions: FNTDs can be used to directly visualize proton tracks and their delta rays at the nanoscale level. Because the track intensities in the FNTDs correlate with LET, they could be used further to measure LET of individual proton tracks. This method may be useful for measuring nanoscale radiation quantities and for measuring the LET of individual proton tracks in radiation biology experiments.

  10. Modulation of the Interleukin-21 Pathway with Interleukin-4 Distinguishes Common Variable Immunodeficiency Patients with More Non-infectious Clinical Complications.

    Science.gov (United States)

    Desjardins, Marylin; Béland, Marianne; Dembele, Marieme; Lejtenyi, Duncan; Drolet, Jean-Phillipe; Lemire, Martine; Tsoukas, Christos; Ben-Shoshan, Moshe; Noya, Francisco J D; Alizadehfar, Reza; McCusker, Christine T; Mazer, Bruce D

    2018-01-01

    Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and clinical manifestations such as infections, autoimmunity, and malignancy. We sought to determine if responsiveness to interleukin-21 (IL-21), a key cytokine for B cell differentiation, correlates with distinct clinical phenotypes in CVID. CVID subjects were recruited through the Canadian Primary Immunodeficiency Evaluative Survey registry. Peripheral blood mononuclear cells were cultured with anti-CD40 ± interferon-gamma, interleukin-4 (IL-4), IL-21, and/or IL-4+IL-21. B cell subpopulations and IgG production were determined at baseline and day 7 by flow cytometry and ELISA. Clinical complications were compared using contingency tables. CVID subjects exhibited decreased CD27 + B cells and IgG production after 7 days of stimulation with anti-CD40+IL-21 (p  2% class-switched memory B cells at baseline. The IL-4 and IL-21 in vitro assays distinguish two groups of CVID subjects and can be used with baseline B cell subpopulation phenotyping to better identify patients experiencing more vs. fewer clinical non-infectious complications and potentially to modulate therapy.

  11. Fast Compressive Tracking.

    Science.gov (United States)

    Zhang, Kaihua; Zhang, Lei; Yang, Ming-Hsuan

    2014-10-01

    It is a challenging task to develop effective and efficient appearance models for robust object tracking due to factors such as pose variation, illumination change, occlusion, and motion blur. Existing online tracking algorithms often update models with samples from observations in recent frames. Despite much success has been demonstrated, numerous issues remain to be addressed. First, while these adaptive appearance models are data-dependent, there does not exist sufficient amount of data for online algorithms to learn at the outset. Second, online tracking algorithms often encounter the drift problems. As a result of self-taught learning, misaligned samples are likely to be added and degrade the appearance models. In this paper, we propose a simple yet effective and efficient tracking algorithm with an appearance model based on features extracted from a multiscale image feature space with data-independent basis. The proposed appearance model employs non-adaptive random projections that preserve the structure of the image feature space of objects. A very sparse measurement matrix is constructed to efficiently extract the features for the appearance model. We compress sample images of the foreground target and the background using the same sparse measurement matrix. The tracking task is formulated as a binary classification via a naive Bayes classifier with online update in the compressed domain. A coarse-to-fine search strategy is adopted to further reduce the computational complexity in the detection procedure. The proposed compressive tracking algorithm runs in real-time and performs favorably against state-of-the-art methods on challenging sequences in terms of efficiency, accuracy and robustness.

  12. Tracking Your Development

    CERN Document Server

    Hennum, Kelly M

    2011-01-01

    This book provides you with the means to set development goals and to track your progress on achieving them. It can help you efficiently gather and make sense of information about your progress and avoid common pitfalls that can block your development. Tracking your development can be captures in a few steps: articulating your goal, creating an action plan, gathering information about your behavior, indentifying barriers and support, and revising your action plan. Taking these steps will greatly increase the likelihood of achieving your goals.

  13. A comparison of two clinical correlation models used for real-time tumor tracking of semi-periodic motion: A focus on geometrical accuracy in lung and liver cancer patients

    International Nuclear Information System (INIS)

    Poels, Kenneth; Dhont, Jennifer; Verellen, Dirk; Blanck, Oliver; Ernst, Floris; Vandemeulebroucke, Jef; Depuydt, Tom; Storme, Guy; De Ridder, Mark

    2015-01-01

    Purpose: A head-to-head comparison of two clinical correlation models with a focus on geometrical accuracy for internal tumor motion estimation during real-time tumor tracking (RTTT). Methods and materials: Both the CyberKnife (CK) and the Vero systems perform RTTT with a correlation model that is able to describe hysteresis in the breathing motion. The CK dual-quadratic (DQ) model consists of two polynomial functions describing the trajectory of the tumor for inhale and exhale breathing motion, respectively. The Vero model is based on a two-dimensional (2D) function depending on position and speed of the external breathing signal to describe a closed-loop tumor trajectory. In this study, 20 s of internal motion data, using an 11 Hz (on average) full fluoroscopy (FF) sequence, was used for training of the CK and Vero models. Further, a subsampled set of 15 internal tumor positions (15p) equally spread over the different phases of the breathing motion was used for separate training of the CK DQ model. Also a linear model was trained using 15p and FF tumor motion data. Fifteen liver and lung cancer patients, treated on the Vero system with RTTT, were retrospectively evaluated comparing the CK FF, CK 15p and Vero FF models using an in-house developed simulator. The distance between estimated target position and the tumor position localized by X-ray imaging was measured in the beams-eye view (BEV) to calculate the 95th percentile BEV modeling errors (ME 95,BEV ). Additionally, the percentage of ME 95,BEV smaller than 5 mm (P 5mm ) was determined for all correlation models. Results: In general, no significant difference (p > 0.05, paired t-test) was found between the CK FF and Vero models. Based on patient-specific evaluation of the geometrical accuracy of the linear, CK DQ and Vero correlation models, no statistical necessity (p > 0.05, two-way ANOVA) of including hysteresis in correlation models was proven, although during inhale breathing motion, the linear model

  14. Bimodal Modulation of Ipsilateral Spinal-Coeruleo-Spinal Pathway in CRPS: A Novel Model for Explaining Different Clinical Features of the Syndrome.

    Science.gov (United States)

    Carcamo, Cesar R

    2015-08-01

    The objective is to present a hypothesis to explain the sensory, autonomic, and motor disturbances associated with complex regional pain syndrome (CRPS) syndrome. The author reviewed the available and relevant literature, which was supplemented with research on experimental animal models, with a focus on how they may translate into humans, particularly in areas about pathophysiologic mechanisms of CRPS. We propose that different CRPS subtypes may result from facilitative or inhibitory influences exerted by the spinal-coeruleo-spinal pathway in three sites at the spinal cord: the dorsal horn (DH), intermediolateral cell column (IML) and ventral horn (VH). A facilitatory influence over DH may have a pronociceptive effect that explains exacerbated pain, sensory disturbances, and spreading sensitization and neuroinflammation. Conversely, a facilitatory influence over preganglionic neurons located in IML cell column may increase sympathetic outflow with peripheral vasoconstriction, which leads to cold skin, ipsilateral limb ischaemia, and sympathetically maintained pain (SMP). For patients presenting with these symptoms, a descending inhibitory influence would be predicted to result in decreased sympathetic outflow and warm skin, as well as impairment of peripheral vasoconstrictor reflexes. Finally, a descending inhibitory influence over VH could explain muscle weakness and decreased active range of motion, while also facilitating motor reflexes, tremor and dystonia. The proposed model provides a mechanistically based diagnostic scheme for classifying and explaining the sensory, autonomic and motor disturbances associated with CRPS syndrome. Wiley Periodicals, Inc.

  15. Fiber tracking for brain tumor

    International Nuclear Information System (INIS)

    Yamada, Kei; Nakamura, Hisao; Ito, Hirotoshi; Tanaka, Osamu; Kubota, Takao; Yuen, Sachiko; Kizu, Osamu; Nishimura, Tsunehiko

    2003-01-01

    The purpose of this study was to validate an innovative scanning method for patients diagnosed with brain tumors. Using a 1.5 Tesla whole body magnetic resonance (MR) imager, 23 patients with brain tumors were scanned. The recorded data points of the diffusion-tensor imaging (DTI) sequences were 128 x 37 with the parallel imaging technique. The parallel imaging technique was equivalent to a true resolution of 128 x 74. The scan parameters were repetition time (TR)=6000, echo time (TE)=88, 6 averaging with a b-value of 800 s/mm 2 . The total scan time for DTI was 4 minutes and 24 seconds. DTI scans and subsequent fiber tracking were successfully applied in all cases. All fiber tracts on the contralesional side were visualized in the expected locations. Fiber tracts on the lesional side had varying degrees of displacement, disruption, or a combination of displacement and disruption due to the tumor. Tract disruption resulted from direct tumor involvement, compression upon the tract, and vasogenic edema surrounding the tumor. This DTI method using a parallel imaging technique allows for clinically feasible fiber tracking that can be incorporated into a routine MR examination. (author)

  16. Second sound tracking system

    Science.gov (United States)

    Yang, Jihee; Ihas, Gary G.; Ekdahl, Dan

    2017-10-01

    It is common that a physical system resonates at a particular frequency, whose frequency depends on physical parameters which may change in time. Often, one would like to automatically track this signal as the frequency changes, measuring, for example, its amplitude. In scientific research, one would also like to utilize the standard methods, such as lock-in amplifiers, to improve the signal to noise ratio. We present a complete He ii second sound system that uses positive feedback to generate a sinusoidal signal of constant amplitude via automatic gain control. This signal is used to produce temperature/entropy waves (second sound) in superfluid helium-4 (He ii). A lock-in amplifier limits the oscillation to a desirable frequency and demodulates the received sound signal. Using this tracking system, a second sound signal probed turbulent decay in He ii. We present results showing that the tracking system is more reliable than those of a conventional fixed frequency method; there is less correlation with temperature (frequency) fluctuation when the tracking system is used.

  17. Eye tracking social preferences

    NARCIS (Netherlands)

    Jiang, Ting; Potters, Jan; Funaki, Yukihiko

    We hypothesize that if people are motivated by a particular social preference, then choosing in accordance with this preference will lead to an identifiable pattern of eye movements. We track eye movements while subjects make choices in simple three-person distribution experiments. We characterize

  18. Tracking, say, SKYPE Locations

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Tracking, say, SKYPE Locations. Real Time Communication: Peer-to-Peer (P2P). Datagram flows between the two conversing partners; Exposes the IP addresses of all the participants to one another. If A knows B's VoIP ID, she can establish a call with Bob & obtain his current ...

  19. Energy Tracking Diagrams

    Science.gov (United States)

    Scherr, Rachel E.; Harrer, Benedikt W.; Close, Hunter G.; Daane, Abigail R.; DeWater, Lezlie S.; Robertson, Amy D.; Seeley, Lane; Vokos, Stamatis

    2016-01-01

    Energy is a crosscutting concept in science and features prominently in national science education documents. In the "Next Generation Science Standards," the primary conceptual learning goal is for learners to conserve energy as they "track" the transfers and transformations of energy within, into, or out of the system of…

  20. Dust Devil Tracks

    Science.gov (United States)

    2002-01-01

    (Released 8 May 2002) The Science This image, centered near 50.0 S and 17.7 W displays dust devil tracks on the surface. Most of the lighter portions of the image likely have a thin veneer of dust settled on the surface. As a dust devil passes over the surface, it acts as a vacuum and picks up the dust, leaving the darker substrate exposed. In this image there is a general trend of many of the tracks running from east to west or west to east, indicating the general wind direction. There is often no general trend present in dust devil tracks seen in other images. The track patterns are quite ephemeral and can completely change or even disappear over the course of a few months. Dust devils are one of the mechanisms that Mars uses to constantly pump dust into the ubiquitously dusty atmosphere. This atmospheric dust is one of the main driving forces of the present Martian climate. The Story Vrrrrooooooooom. Think of a tornado, the cartoon Tasmanian devil, or any number of vacuum commercials that powerfully suck up swirls of dust and dirt. That's pretty much what it's like on the surface of Mars a lot of the time. Whirlpools of wind called

  1. Track Dynamics Program

    Science.gov (United States)

    1978-10-01

    8 Track Bushing Research, . . . . . . . . . . . * . . . 8 Advanced frack Concept Development ..... . . . . . 9 TECHNICAL DISCUSSION...machine design effort was conducted. The design which was developed has separate servocontrolled hydraulic actuators to apply radial...back bending-but, in the order and magnitude of the way the torsional stress is incurred in service. This suggests a programable, hydraulically actuated

  2. Tracking Politics with POWER

    Science.gov (United States)

    Moreira, Silvio; Batista, David S.; Carvalho, Paula; Couto, Francisco M.; Silva, Mario J.

    2013-01-01

    Purpose: POWER is an ontology of political processes and entities. It is designed for tracking politicians, political organizations and elections, both in mainstream and social media. The aim of this paper is to propose a data model to describe political agents and their relations over time. Design/methodology/approach: The authors propose a data…

  3. Stem cell tracking using iron oxide nanoparticles

    Directory of Open Access Journals (Sweden)

    Bull E

    2014-03-01

    Full Text Available Elizabeth Bull,1 Seyed Yazdan Madani,1 Roosey Sheth,1 Amelia Seifalian,1 Mark Green,2 Alexander M Seifalian1,31UCL Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, London, 2Department of Physics, King’s College London, Strand Campus, London, UK; 3Royal Free London National Health Service Foundation Trust Hospital, London, UKAbstract: Superparamagnetic iron oxide nanoparticles (SPIONs are an exciting advancement in the field of nanotechnology. They expand the possibilities of noninvasive analysis and have many useful properties, making them potential candidates for numerous novel applications. Notably, they have been shown that they can be tracked by magnetic resonance imaging (MRI and are capable of conjugation with various cell types, including stem cells. In-depth research has been undertaken to establish these benefits, so that a deeper level of understanding of stem cell migratory pathways and differentiation, tumor migration, and improved drug delivery can be achieved. Stem cells have the ability to treat and cure many debilitating diseases with limited side effects, but a main problem that arises is in the noninvasive tracking and analysis of these stem cells. Recently, researchers have acknowledged the use of SPIONs for this purpose and have set out to establish suitable protocols for coating and attachment, so as to bring MRI tracking of SPION-labeled stem cells into common practice. This review paper explains the manner in which SPIONs are produced, conjugated, and tracked using MRI, as well as a discussion on their limitations. A concise summary of recently researched magnetic particle coatings is provided, and the effects of SPIONs on stem cells are evaluated, while animal and human studies investigating the role of SPIONs in stem cell tracking will be explored.Keywords: stem cells, nanoparticle, magnetic

  4. Effect of track etch rate on geometric track characteristics for polymeric track detectors

    International Nuclear Information System (INIS)

    Abdel-Naby, A.A.; El-Akkad, F.A.

    2001-01-01

    Analysis of the variable track etch rate on geometric track characteristic for polymeric track detectors has been applied to the case of LR-155 II SSNTD. Spectrometric characteristics of low energy alpha particles response by the polymeric detector have been obtained. The track etching kinematics theory of development of minor diameter of the etched tracks has been applied. The calculations show that, for this type of detector, the energy dependence of the minor track diameter d is linear for small-etched removal layer h. The energy resolution gets better for higher etched removal layer

  5. Hedgehog pathway inhibitor in combination with radiation therapy for basal cell carcinomas of the head and neck. First clinical experience with vismodegib for locally advanced disease

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, Bjoern; Roedel, Claus; Balermpas, Panagiotis [University Hospital Johann Wolfgang Goethe University, Department of Radiation Oncology, Frankfurt (Germany); Meissner, Markus [University Hospital Johann Wolfgang Goethe University, Department of Dermatology, Frankfurt (Germany); Ghanaati, Shahram [University Hospital Johann Wolfgang Goethe University, Department of Craniofacial and Plastic Surgery, Frankfurt (Germany); Burck, Iris [University Hospital Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany)

    2016-01-15

    Definitive radiotherapy and vismodegib, an oral inhibitor of the hedgehog pathway, are both established treatment options for locally advanced basal cell carcinomas (BCC). Both have shown good results in local tumor control; however, the effects concerning advanced tumors are often not of a lasting nature and to date no systematic data about the combination of the two modalities are available. We retrospectively analyzed four patients who received vismodegib and radiotherapy in combination. Radiation doses varied between 50.4 Gy and 66.0 Gy. Three patients had recurrent BCC. One patient had locoregional lymph node involvement. Vismodegib was taken once a day (150 mg) during the entire time of irradiation and beyond upon instructions of the attending dermatologist. In three cases a persistent complete response was observed, in one case the tumor remained stable for approximately 6 months until further tumor progression was documented. The combined therapy was well tolerated in all cases. No exceptional side effects pointing at a drug-radiation interaction were observed. The combination of vismodegib and radiation seems feasible and the initial results are promising. In our cohort, there was no increase in unexpected side effects. Further research is needed to evaluate the significance of this combined therapy. (orig.) [German] Sowohl definitive Radiotherapie als auch Vismodegib, ein oraler Inhibitor der Hedgehog-Signalkaskade, sind etablierte Behandlungsoptionen fuer lokal fortgeschrittene Basalzellkarzinome (BCC). Beide Therapien zeigen fuer sich gute Ansprechraten, aber die lokale Tumorkontrolle ist oft nicht dauerhaft und bis heute existieren kaum Daten ueber eine Kombination der beiden Modalitaeten. Wir analysierten retrospektiv vier Patientenfaelle nach simultaner Applikation von Vismodegib und Bestrahlung. Die Bestrahlungsdosis variierte zwischen 50,4 Gy und 66,0 Gy. Drei der Patienten hatten ein rezidiviertes BCC. Ein Patient hatte einen befallenen regionalen

  6. Formal consensus to identify clinically important changes in management resulting from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway.

    Science.gov (United States)

    Pufulete, Maria; Brierley, Rachel C; Bucciarelli-Ducci, Chiara; Greenwood, John P; Dorman, Stephen; Anderson, Richard A; Harris, Jessica; McAlindon, Elisa; Rogers, Chris A; Reeves, Barnaby C

    2017-06-22

    To define important changes in management arising from the use of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. Formal consensus study using literature review and cardiologist expert opinion to formulate consensus statements and setting up a consensus panel to review the statements (by completing a web-based survey, attending a face-to-face meeting to discuss survey results and modify the survey to reflect group discussion and completing the modified survey to determine which statements were in consensus). Formulation of consensus statements: four cardiologists (two CMR and two interventional) and six non-clinical researchers. Formal consensus: seven cardiologists (two CMR and three interventional, one echocardiography and one heart failure). Forty-nine additional cardiologists completed the modified survey. Thirty-seven draft statements describing changes in management following CMR were generated; these were condensed into 12 statements and reviewed through the formal consensus process. Three of 12 statements were classified in consensus in the first survey; these related to the role of CMR in identifying the cause of out-of-hospital cardiac arrest, providing a definitive diagnosis in patients found to have unobstructed arteries on angiography and identifying patients with left ventricular thrombus. Two additional statements were in consensus in the modified survey, relating to the ability of CMR to identify patients who have a poor prognosis after PPCI and assess ischaemia and viability in patients with multivessel disease. There was consensus that CMR leads to clinically important changes in management in five subgroups of patients who activate the PPCI pathway. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. The Glymphatic Pathway.

    Science.gov (United States)

    Benveniste, Helene; Lee, Hedok; Volkow, Nora D

    2017-01-01

    The overall premise of this review is that cerebrospinal fluid (CSF) is transported within a dedicated peri-vascular network facilitating metabolic waste clearance from the central nervous system while we sleep. The anatomical profile of the network is complex and has been defined as a peri-arterial CSF influx pathway and peri-venous clearance routes, which are functionally coupled by interstitial bulk flow supported by astrocytic aquaporin 4 water channels. The role of the newly discovered system in the brain is equivalent to the lymphatic system present in other body organs and has been termed the "glymphatic pathway" or "(g)lymphatics" because of its dependence on glial cells. We will discuss and review the general anatomy and physiology of CSF from the perspective of the glymphatic pathway, a discovery which has greatly improved our understanding of key factors that control removal of metabolic waste products from the central nervous system in health and disease and identifies an additional purpose for sleep. A brief historical and factual description of CSF production and transport will precede the ensuing discussion of the glymphatic system along with a discussion of its clinical implications.

  8. Vehicle track interaction safety standards

    Science.gov (United States)

    2014-04-02

    Vehicle/Track Interaction (VTI) Safety Standards aim to : reduce the risk of derailments and other accidents attributable : to the dynamic interaction between moving vehicles and the : track over which they operate. On March 13, 2013, the Federal : R...

  9. Quality Assurance Training Tracking (QATTS)

    Data.gov (United States)

    U.S. Environmental Protection Agency — This is metadata documentation for the Quality Assurance Training Tracking System (QATTS) which tracks Quality Assurace training given by R7 QA staff to in-house...

  10. Diagnostic histochemistry and clinical-pathological testings as molecular pathways to pathogenesis and treatment of the ageing neuromuscular system: a personal view.

    Science.gov (United States)

    Engel, W King

    2015-04-01

    Ageing of the neuromuscular system in elderhood ingravescently contributes to slowness, weakness, falling and death, often accompanied by numbness and pain. This article is to put in perspective examples from a half-century of personal and team neuromuscular histochemical-pathological and clinical-pathological research, including a number of lucky and instructive accomplishments identifying new treatments and new diseases. A major focus currently is on some important, still enigmatic, aspects of the ageing neuromuscular system. It is also includes some of the newest references of others on various closely-related aspects of this ageing system. The article may help guide others in their molecular-based endeavors to identify paths leading to discovering new treatments and new pathogenic aspects. These are certainly needed - our ageing and unsteady constituents are steadily increasing. This article is part of a Special Issue entitled: Neuromuscular Diseases: Pathology and Molecular Pathogenesis. Copyright © 2014. Published by Elsevier B.V.

  11. Intraoperative visualization and assessment of electromagnetic tracking error

    Science.gov (United States)

    Harish, Vinyas; Ungi, Tamas; Lasso, Andras; MacDonald, Andrew; Nanji, Sulaiman; Fichtinger, Gabor

    2015-03-01

    Electromagnetic tracking allows for increased flexibility in designing image-guided interventions, however it is well understood that electromagnetic tracking is prone to error. Visualization and assessment of the tracking error should take place in the operating room with minimal interference with the clinical procedure. The goal was to achieve this ideal in an open-source software implementation in a plug and play manner, without requiring programming from the user. We use optical tracking as a ground truth. An electromagnetic sensor and optical markers are mounted onto a stylus device, pivot calibrated for both trackers. Electromagnetic tracking error is defined as difference of tool tip position between electromagnetic and optical readings. Multiple measurements are interpolated into the thin-plate B-spline transform visualized in real time using 3D Slicer. All tracked devices are used in a plug and play manner through the open-source SlicerIGT and PLUS extensions of the 3D Slicer platform. Tracking error was measured multiple times to assess reproducibility of the method, both with and without placing ferromagnetic objects in the workspace. Results from exhaustive grid sampling and freehand sampling were similar, indicating that a quick freehand sampling is sufficient to detect unexpected or excessive field distortion in the operating room. The software is available as a plug-in for the 3D Slicer platforms. Results demonstrate potential for visualizing electromagnetic tracking error in real time for intraoperative environments in feasibility clinical trials in image-guided interventions.

  12. What Difference Does Patient and Public Involvement Make and What Are Its Pathways to Impact? Qualitative Study of Patients and Researchers from a Cohort of Randomised Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Louise Dudley

    Full Text Available Patient and public involvement (PPI is advocated in clinical trials yet evidence on how to optimise its impact is limited. We explored researchers' and PPI contributors' accounts of the impact of PPI within trials and factors likely to influence its impact.Semi-structured qualitative interviews with researchers and PPI contributors accessed through a cohort of randomised clinical trials. Analysis of transcripts of audio-recorded interviews was informed by the principles of the constant comparative method, elements of content analysis and informant triangulation.We interviewed 21 chief investigators, 10 trial managers and 17 PPI contributors from 28 trials. The accounts of informants within the same trials were largely in agreement. Over half the informants indicted PPI had made a difference within a trial, through contributions that influenced either an aspect of a trial, or how researchers thought about a trial. According to informants, the opportunity for PPI to make a difference was influenced by two main factors: whether chief investigators had goals and plans for PPI and the quality of the relationship between the research team and the PPI contributors. Early involvement of PPI contributors and including them in responsive (e.g. advisory groups and managerial (e.g. trial management groups roles were more likely to achieve impact compared to late involvement and oversight roles (e.g. trial steering committees.Those seeking to enhance PPI in trials should develop goals for PPI at an early stage that fits the needs of the trial, plan PPI implementation in accordance with these goals, invest in developing good relationships between PPI contributors and researchers, and favour responsive and managerial roles for contributors in preference to oversight-only roles. These features could be used by research funders in judging PPI in trial grant applications and to inform policies to optimise PPI within trials.

  13. Single track coincidence measurements of fluorescent and plastic nuclear track detectors in therapeutic carbon beams

    International Nuclear Information System (INIS)

    Osinga, J-M; Jäkel, O; Ambrožová, I; Brabcová, K Pachnerová; Davídková, M; Akselrod, M S; Greilich, S

    2014-01-01

    In this paper we present a method for single track coincidence measurements using two different track detector materials. We employed plastic and fluorescent nuclear track detectors (PNTDs and FNTDs) in the entrance channel of a monoenergetic carbon ion beam covering the therapeutic energy range from 80 to 425 MeV/u. About 99% of all primary particle tracks detected by both detectors were successfully matched, while 1% of the particles were only detected by the FNTDs because of their superior spatial resolution. We conclude that both PNTDs and FNTDs are suitable for clinical carbon beam dosimetry with a detection efficiency of at least 98.82% and 99.83% respectively, if irradiations are performed with low fluence in the entrance channel of the ion beam. The investigated method can be adapted to other nuclear track detectors and offers the possibility to characterize new track detector materials against well-known detectors. Further, by combining two detectors with a restricted working range in the presented way a hybrid-detector system can be created with an extended and optimized working range

  14. Processing of plastic track detectors

    International Nuclear Information System (INIS)

    Somogyi, G.

    1977-01-01

    A survey of some actual problems of the track processing methods available at this time for plastics is presented. In the case of the conventional chemical track-etching technique, mainly the etching situations related to detector geometry, and the relationship between registration sensitivity and the etching parameters are considered. Special attention is paid to the behaviour of track-revealing by means of electrochemical etching. Finally, some properties of a promising new track processing method based on graft polymerization are discussed. (author)

  15. Processing of plastic track detectors

    International Nuclear Information System (INIS)

    Somogyi, G.

    1976-01-01

    A survey of some actual problems of the track processing methods available at this time for plastics is presented. In the case of the conventional chemical track etching technique mainly the etching situations related to detector geometry and the relationship of registration sensitivity and the etching parameters are considered. A special attention is paid to the behaviour of track revealing by means of electrochemical etching. Finally, some properties of a promising new track processing method based on graft polymerization is discussed. (orig.) [de

  16. Tracking change over time

    Science.gov (United States)

    ,

    2011-01-01

    Landsat satellites capture images of Earth from space-and have since 1972! These images provide a long-term record of natural and human-induced changes on the global landscape. Comparing images from multiple years reveals slow and subtle changes as well as rapid and devastating ones. Landsat images are available over the Internet at no charge. Using the free software MultiSpec, students can track changes to the landscape over time-just like remote sensing scientists do! The objective of the Tracking Change Over Time lesson plan is to get students excited about studying the changing Earth. Intended for students in grades 5-8, the lesson plan is flexible and may be used as a student self-guided tutorial or as a teacher-led class lesson. Enhance students' learning of geography, map reading, earth science, and problem solving by seeing landscape changes from space.

  17. Structural Sparse Tracking

    KAUST Repository

    Zhang, Tianzhu

    2015-06-01

    Sparse representation has been applied to visual tracking by finding the best target candidate with minimal reconstruction error by use of target templates. However, most sparse representation based trackers only consider holistic or local representations and do not make full use of the intrinsic structure among and inside target candidates, thereby making the representation less effective when similar objects appear or under occlusion. In this paper, we propose a novel Structural Sparse Tracking (SST) algorithm, which not only exploits the intrinsic relationship among target candidates and their local patches to learn their sparse representations jointly, but also preserves the spatial layout structure among the local patches inside each target candidate. We show that our SST algorithm accommodates most existing sparse trackers with the respective merits. Both qualitative and quantitative evaluations on challenging benchmark image sequences demonstrate that the proposed SST algorithm performs favorably against several state-of-the-art methods.

  18. The track nanotechnology

    International Nuclear Information System (INIS)

    Waheed, A.; Forsyth, D.; Watts, A.; Saad, A.F.; Mitchell, G.R.; Farmer, M.; Harris, P.J.F.

    2009-01-01

    The discipline now called Solid State Nuclear Track Detection (SSNTD) dates back to 1958 and has its roots in the United Kingdom. Its strength stems chiefly from factors such as its simplicity, small geometry, permanent maintenance of the nuclear record and other diversified applications. A very important field with exciting applications reported recently in conjuction with the nuclear track technique is nanotechnology, which has applications in biology, chemistry, industry, medicare and health, information technology, biotechnology, and metallurgical and chemical technologies. Nanotechnology requires material design followed by the study of the quantum effects for final produced applications in sensors, medical diagnosis, information technology to name a few. We, in this article, present a review of past and present applications of SSNTD suggesting ways to apply the technique in nanotechnology, with special reference to development of nanostructure for applications utilising nanowires, nanofilters and sensors.

  19. The track nanotechnology

    Energy Technology Data Exchange (ETDEWEB)

    Waheed, A. [British Institute of Technology and E-Commerce, London E7 9HZ (United Kingdom); Physics Department, University of Reading, Reading RG6 6AF (United Kingdom); Forsyth, D., E-mail: dforsyth@bite.ac.u [British Institute of Technology and E-Commerce, London E7 9HZ (United Kingdom); Watts, A. [Department of Physics, UCL, London Centre of Nanotechnology (LCN), 17-19 Gordon Street, London WC1H OAH (United Kingdom); Saad, A.F. [Physics Department, Faculty of Science, Garyounis University, Benghazi (Libyan Arab Jamahiriya); Mitchell, G.R. [British Institute of Technology and E-Commerce, London E7 9HZ (United Kingdom); Physics Department, University of Reading, Reading RG6 6AF (United Kingdom); Farmer, M. [British Institute of Technology and E-Commerce, London E7 9HZ (United Kingdom); Harris, P.J.F. [Physics Department, University of Reading, Reading RG6 6AF (United Kingdom)

    2009-10-15

    The discipline now called Solid State Nuclear Track Detection (SSNTD) dates back to 1958 and has its roots in the United Kingdom. Its strength stems chiefly from factors such as its simplicity, small geometry, permanent maintenance of the nuclear record and other diversified applications. A very important field with exciting applications reported recently in conjuction with the nuclear track technique is nanotechnology, which has applications in biology, chemistry, industry, medicare and health, information technology, biotechnology, and metallurgical and chemical technologies. Nanotechnology requires material design followed by the study of the quantum effects for final produced applications in sensors, medical diagnosis, information technology to name a few. We, in this article, present a review of past and present applications of SSNTD suggesting ways to apply the technique in nanotechnology, with special reference to development of nanostructure for applications utilising nanowires, nanofilters and sensors.

  20. Thermal Tracking of Sports Players

    DEFF Research Database (Denmark)

    Gade, Rikke; Moeslund, Thomas B.

    2014-01-01

    We present here a real-time tracking algorithm for thermal video from a sports game. Robust detection of people includes routines for handling occlusions and noise before tracking each detected person with a Kalman filter. This online tracking algorithm is compared with a state-of-the-art offline...

  1. Minimum Tracking Error Volatility

    OpenAIRE

    Luca RICCETTI

    2010-01-01

    Investors assign part of their funds to asset managers that are given the task of beating a benchmark. The risk management department usually imposes a maximum value of the tracking error volatility (TEV) in order to keep the risk of the portfolio near to that of the selected benchmark. However, risk management does not establish a rule on TEV which enables us to understand whether the asset manager is really active or not and, in practice, asset managers sometimes follow passively the corres...

  2. Tracking Online Trails

    Science.gov (United States)

    Qi, Man; Edgar-Nevill, Denis; Wang, Yongquan; Xu, Rongsheng

    Traceability is a key to the investigation of the internet criminal and a cornerstone of internet research. It is impossible to prevent all internet misuse but may be possible to identify and trace the users, and then take appropriate action. This paper presents the value of traceability within the email/-newsposting utilities, the technologies being using to hide identities, the difficulties in locating the traceable data and the challenges in tracking online trails.

  3. The fission track method

    International Nuclear Information System (INIS)

    Hansen, K.

    1990-01-01

    During the last decade fission track (FT) analysis has evolved as an important tool in exploration for hydrocarbon resources. Most important is this method's ability to yield information about temperatures at different times (history), and thus relate oil generation and time independently of other maturity parameters. The purpose of this paper is to introduce the basics of the method and give an example from the author's studies. (AB) (14 refs.)

  4. Tracking environmental costs

    International Nuclear Information System (INIS)

    Blahutova, Z.

    2011-01-01

    Tracking Environmental Costs and Investments in SAP will provide us with a managerial tool that will help us understand better the magnitude of the financial resources we are dedicating to environmental protection activities and investments. Environmental Cost Accounting is a new project in Slovenske Elektrarne that will be particularly valuable for the Company's environmental management initiatives, such as waste monitoring, cleaner production, eco-design and environmental management systems; its launch is expected in September. (author)

  5. Patient tracking system

    International Nuclear Information System (INIS)

    Chapman, L.J.; Hakimi, R.; Salehi, D.; McCord, T.; Zionczkowski, B.; Churchill, R.

    1987-01-01

    This exhibit describes computer applications in monitoring patient tracking in radiology and the collection of management information (technologist productivity, patient waiting times, repeat rate, room utilization) and quality assurance information. An analysis of the reports that assist in determining staffing levels, training needs, and patient scheduling is presented. The system is designed to require minimal information input and maximal information output to assist radiologists, quality assurance coordinators, and management personnel in departmental operations

  6. Maximum power point tracking

    International Nuclear Information System (INIS)

    Enslin, J.H.R.

    1990-01-01

    A well engineered renewable remote energy system, utilizing the principal of Maximum Power Point Tracking can be m ore cost effective, has a higher reliability and can improve the quality of life in remote areas. This paper reports that a high-efficient power electronic converter, for converting the output voltage of a solar panel, or wind generator, to the required DC battery bus voltage has been realized. The converter is controlled to track the maximum power point of the input source under varying input and output parameters. Maximum power point tracking for relative small systems is achieved by maximization of the output current in a battery charging regulator, using an optimized hill-climbing, inexpensive microprocessor based algorithm. Through practical field measurements it is shown that a minimum input source saving of 15% on 3-5 kWh/day systems can easily be achieved. A total cost saving of at least 10-15% on the capital cost of these systems are achievable for relative small rating Remote Area Power Supply systems. The advantages at larger temperature variations and larger power rated systems are much higher. Other advantages include optimal sizing and system monitor and control

  7. Women's Work Pathways Across the Life Course.

    Science.gov (United States)

    Damaske, Sarah; Frech, Adrianne

    2016-04-01

    Despite numerous changes in women's employment in the latter half of the twentieth century, women's employment continues to be uneven and stalled. Drawing from data on women's weekly work hours in the National Longitudinal Survey of Youth (NLSY79), we identify significant inequality in women's labor force experiences across adulthood. We find two pathways of stable full-time work for women, three pathways of part-time employment, and a pathway of unpaid labor. A majority of women follow one of the two full-time work pathways, while fewer than 10% follow a pathway of unpaid labor. Our findings provide evidence of the lasting influence of work-family conflict and early socioeconomic advantages and disadvantages on women's work pathways. Indeed, race, poverty, educational attainment, and early family characteristics significantly shaped women's work careers. Work-family opportunities and constraints also were related to women's work hours, as were a woman's gendered beliefs and expectations. We conclude that women's employment pathways are a product of both their resources and changing social environment as well as individual agency. Significantly, we point to social stratification, gender ideologies, and work-family constraints, all working in concert, as key explanations for how women are "tracked" onto work pathways from an early age.

  8. Analysis of homeobox gene action may reveal novel angiogenic pathways in normal placental vasculature and in clinical pregnancy disorders associated with abnormal placental angiogenesis.

    Directory of Open Access Journals (Sweden)

    Padma eMurthi

    2014-06-01

    Full Text Available Homeobox genes are essential for both the development of the blood and lymphatic vascular systems, as well as for their maintenance in the adult. Homeobox genes comprise an important family of transcription factors, which are characterised by a well conserved DNA binding motif; the homeodomain. The specificity of the homeodomain allows the transcription factor to bind to the promoter regions of batteries of target genes and thereby regulates their expression. Target genes identified for homeodomain proteins have been shown to control fundamental cell processes such as proliferation, differentiation and apoptosis. We and others have reported that homeobox genes are expressed in the placental vasculature, but our knowledge of their downstream target genes is limited. This review highlights the importance of studying the cellular and molecular mechanisms by which homeobox genes and their downstream targets may regulate important vascular cellular processes such as proliferation, migration, and endothelial tube formation, which are essential for placental vasculogenesis and angiogenesis. A better understanding of the molecular targets of homeobox genes may lead to new therapies for aberrant angiogenesis associated with clinically important pregnancy pathologies, including fetal growth restriction and preeclampsia.

  9. NMR Isotope Tracking Reveals Cascade Steps in Carbohydrate Conversion by Sn-Beta

    DEFF Research Database (Denmark)

    Elliot, Samuel Gilbert; Taarning, Esben; Madsen, Robert

    2017-01-01

    Quantitative isotope tracking studies were used to investigate the reaction pathways occurring for Sn-Beta catalyzed carbohydrate conversion to various alpha-hydroxy esters. Experimental insight into the conversion of pentoses was sought (i) by identifying pathways based on isotope patterns in th...

  10. Pennsylvania Source Term Tracking System

    International Nuclear Information System (INIS)

    1992-08-01

    The Pennsylvania Source Term Tracking System tabulates surveys received from radioactive waste generators in the Commonwealth of radioactive waste is collected each quarter from generators using the Low-Level Radioactive Waste Management Quarterly Report Form (hereafter called the survey) and then entered into the tracking system data base. This personal computer-based tracking system can generate 12 types of tracking reports. The first four sections of this reference manual supply complete instructions for installing and setting up the tracking system on a PC. Section 5 presents instructions for entering quarterly survey data, and Section 6 discusses generating reports. The appendix includes samples of each report

  11. Simultaneous tracking and activity recognition

    DEFF Research Database (Denmark)

    Manfredotti, Cristina Elena; Fleet, David J.; Hamilton, Howard J.

    2011-01-01

    be used to improve the prediction step of the tracking, while, at the same time, tracking information can be used for online activity recognition. Experimental results in two different settings show that our approach 1) decreases the error rate and improves the identity maintenance of the positional......Many tracking problems involve several distinct objects interacting with each other. We develop a framework that takes into account interactions between objects allowing the recognition of complex activities. In contrast to classic approaches that consider distinct phases of tracking and activity...... tracking and 2) identifies the correct activity with higher accuracy than standard approaches....

  12. Quality of Slab Track Construction – Track Alignment Design and Track Geometry

    Directory of Open Access Journals (Sweden)

    Šestáková Janka

    2015-05-01

    Full Text Available The slab track superstructure design (without ballast is a perspective construction especially for building tunnels and bridges in the modernized sections of railway tracks in Slovakia. Monitoring of the structure described in this article is focused on the transition areas between standard structure with ballast and slab track construction.

  13. Quality of Slab Track Construction - Track Alignment Design and Track Geometry

    Science.gov (United States)

    Šestáková, Janka

    2015-05-01

    The slab track superstructure design (without ballast) is a perspective construction especially for building tunnels and bridges in the modernized sections of railway tracks in Slovakia. Monitoring of the structure described in this article is focused on the transition areas between standard structure with ballast and slab track construction.

  14. Pathway Distiller - multisource biological pathway consolidation.

    Science.gov (United States)

    Doderer, Mark S; Anguiano, Zachry; Suresh, Uthra; Dashnamoorthy, Ravi; Bishop, Alexander J R; Chen, Yidong

    2012-01-01

    One method to understand and evaluate an experiment that produces a large set of genes, such as a gene expression microarray analysis, is to identify overrepresentation or enrichment for biological pathways. Because pathways are able to functionally describe the set of genes, much effort has been made to collect curated biological pathways into publicly accessible databases. When combining disparate databases, highly related or redundant pathways exist, making their consolidation into pathway concepts essential. This will facilitate unbiased, comprehensive yet streamlined analysis of experiments that result in large gene sets. After gene set enrichment finds representative pathways for large gene sets, pathways are consolidated into representative pathway concepts. Three complementary, but different methods of pathway consolidation are explored. Enrichment Consolidation combines the set of the pathways enriched for the signature gene list through iterative combining of enriched pathways with other pathways with similar signature gene sets; Weighted Consolidation utilizes a Protein-Protein Interaction network based gene-weighting approach that finds clusters of both enriched and non-enriched pathways limited to the experiments' resultant gene list; and finally the de novo Consolidation method uses several measurements of pathway similarity, that finds static pathway clusters independent of any given experiment. We demonstrate that the three consolidation methods provide unified yet different functional insights of a resultant gene set derived from a genome-wide profiling experiment. Results from the methods are presented, demonstrating their applications in biological studies and comparing with a pathway web-based framework that also combines several pathway databases. Additionally a web-based consolidation framework that encompasses all three methods discussed in this paper, Pathway Distiller (http://cbbiweb.uthscsa.edu/PathwayDistiller), is established to allow

  15. Thermal Tracking of Sports Players

    Directory of Open Access Journals (Sweden)

    Rikke Gade

    2014-07-01

    Full Text Available We present here a real-time tracking algorithm for thermal video from a sports game. Robust detection of people includes routines for handling occlusions and noise before tracking each detected person with a Kalman filter. This online tracking algorithm is compared with a state-of-the-art offline multi-target tracking algorithm. Experiments are performed on a manually annotated 2-minutes video sequence of a real soccer game. The Kalman filter shows a very promising result on this rather challenging sequence with a tracking accuracy above 70% and is superior compared with the offline tracking approach. Furthermore, the combined detection and tracking algorithm runs in real time at 33 fps, even with large image sizes of 1920 × 480 pixels.

  16. Thermal tracking of sports players.

    Science.gov (United States)

    Gade, Rikke; Moeslund, Thomas B

    2014-07-29

    We present here a real-time tracking algorithm for thermal video from a sports game. Robust detection of people includes routines for handling occlusions and noise before tracking each detected person with a Kalman filter. This online tracking algorithm is compared with a state-of-the-art offline multi-target tracking algorithm. Experiments are performed on a manually annotated 2-minutes video sequence of a real soccer game. The Kalman filter shows a very promising result on this rather challenging sequence with a tracking accuracy above 70% and is superior compared with the offline tracking approach. Furthermore, the combined detection and tracking algorithm runs in real time at 33 fps, even with large image sizes of 1920 × 480 pixels.

  17. Influence of tracks densities in solid state nuclear track detectors

    International Nuclear Information System (INIS)

    Guedes O, S.; Hadler N.; Lunes, P.; Saenz T, C.

    1996-01-01

    When Solid State Nuclear Track Detectors (SSNTD) is employed to measure nuclear tracks produced mainly by fission fragments and alpha particles, it is considered that the tracks observation work is performed under an efficiency, ε 0 , which is independent of the track density (number of tracks/area unit). There are not published results or experimental data supporting such an assumption. In this work the dependence of ε 0 with track density is studied basing on experimental data. To perform this, pieces of CR-39 cut from a sole 'mother sheet' were coupled to thin uranium films for different exposition times and the resulting ratios between track density and exposition time were compared. Our results indicate that ε 0 is constant for track densities between 10 3 and 10 5 cm -2 . At our etching conditions track overlapping makes impossible the counting for densities around 1.7 x 10 5 cm -2 . For track densities less than 10 3 cm -2 , ε 0 , was not observed to be constant. (authors). 4 refs., 2 figs

  18. Pyrometer with tracking balancing

    Science.gov (United States)

    Ponomarev, D. B.; Zakharenko, V. A.; Shkaev, A. G.

    2018-04-01

    Currently, one of the main metrological noncontact temperature measurement challenges is the emissivity uncertainty. This paper describes a pyrometer with emissivity effect diminishing through the use of a measuring scheme with tracking balancing in which the radiation receiver is a null-indicator. In this paper the results of the prototype pyrometer absolute error study in surfaces temperature measurement of aluminum and nickel samples are presented. There is absolute error calculated values comparison considering the emissivity table values with errors on the results of experimental measurements by the proposed method. The practical implementation of the proposed technical solution has allowed two times to reduce the error due to the emissivity uncertainty.

  19. Track reconstruction at the ILC: the ILD tracking software

    International Nuclear Information System (INIS)

    Gaede, Frank; Aplin, Steven; Rosemann, Christoph; Voutsinas, Georgios; Glattauer, Robin

    2014-01-01

    One of the key requirements for Higgs physics at the International Linear Collider ILC is excellent track reconstruction with very good momentum and impact parameter resolution. ILD is one of the two detector concepts at the ILC. Its central tracking system comprises of an outer Si-tracker, a highly granular TPC, an intermediate silicon tracker and a pixel vertex detector, and it is complemented by silicon tracking disks in the forward direction. Large hit densities from beam induced coherent electron-positron pairs at the ILC pose an additional challenge to the pattern recognition algorithms. We present the recently developed new ILD tracking software, the pattern recognition algorithms that are using clustering techniques, Cellular Automatons and Kalman filter based track extrapolation. The performance of the ILD tracking system is evaluated using a detailed simulation including dead material, gaps and imperfections.

  20. Fast-Track Management of Patients Undergoing Proximal Pancreatic Resection

    Science.gov (United States)

    French, JJ; Mansfield, SD; Jaques, K; Jaques, BC; Manas, DM; Charnley, RM

    2009-01-01

    INTRODUCTION To avoid the risk of complications of biliary drainage, a feasibility study was carried out to determine whether it might be possible to fast-track surgical treatment, with resection before biliary drainage, in jaundiced patients with proximal pancreatic/peri-ampullary malignancy. PATIENTS AND METHODS Over an 18-month period, based on their presenting bilirubin levels and other logistical factors, all jaundiced patients who might be suitable for fast-track management were identified. Data on complications and hospital stay were compared with those patients in whom a conventional pathway (with biliary drainage) was used during the same time period. Data were also compared with a group of patients from the preceding 6 months. RESULTS Nine patients were fast-tracked and 49 patients treated in the conventional pathway. Fast-track patients mean (SD) serum bilirubin level was 265 μmol/l (81.6) at the time of the operation compared to 43 μmol/l (51.3; P ≥ 0.0001) in conventional patients. Mean (SD) of time from referral to operation, 14 days (9) versus 59 days (36.9), was significantly shorter in fast-track patients than conventional patients (P ≤ 0.0001). Length of hospital stay mean (SD) at 17 (6) days versus 22 days (19.6; P = 0.2114), surgical complications and mortality in fast-track patients were similar to conventional patients. Prior to surgery, the 49 conventional patients underwent a total of 73 biliary drainage procedures resulting in seven major complications. Comparison with the group of patients from the previous 6 months indicated that the conventional group were not disadvantaged. CONCLUSIONS Fast-track management by resection without biliary drainage of selected patients with distal biliary strictures is safe and has the potential to reduce the waiting time to surgery, overall numbers of biliary drainage procedures and the complications thereof. PMID:19220943

  1. Describing the characteristics, treatment pathways, outcomes, and costs of people with persistent noncancer pain managed by community pain clinics and generating an indicative estimate of cost-effectiveness: feasibility study protocol

    Directory of Open Access Journals (Sweden)

    AlAujan S

    2016-05-01

    Full Text Available Shiekha AlAujan,1 Saja AlMazrou,1 Roger D Knaggs,1,2 Rachel A Elliott11Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, Nottingham, UK; 2Pharmacy Department and Pain Management Service, Nottingham University Hospitals NHS Trust, Nottingham, UKBackground: Low back pain (LBP and fibromyalgia (FM, also known as chronic widespread pain (CWP, are highly prevalent chronic painful conditions that have substantial impact on patients, health care systems, and society. Diagnosis is complex and management strategies are associated with various levels of evidence for effectiveness and cost-effectiveness. Multidisciplinary pain services have been shown to be effective in some settings and therefore are recommended by clinical practice guidelines as a rational treatment option to manage these patients. Knowing that these services are resource intensive, evidence is needed to demonstrate their cost-effectiveness. This study aims to describe the management of patients with LBP and FM in two community pain clinics to derive an indicative estimate of cost-effectiveness compared with standard practice.Methods: This is a prospective observational multicenter study, using patient-level data. The data from this study will be combined with modelling of the long-term economic impact of community pain clinics in treating people with LBP and FM. Newly referred patients with LBP and FM who provide written consent will be included. We will collect data on functional disability, pain intensity, quality of life, and health resource utilization. Follow-up data at the 3- and 6-month points will be collected by patient-completed questionnaires and health care contact diaries. Health care resource use from diaries will be compared with patient electronic records to assess the agreement between these recording methods. Patient cohort characteristics, treatment pathways, resource use, and outcomes derived from this study will

  2. Classifications of track structures

    International Nuclear Information System (INIS)

    Paretzke, H.G.

    1984-01-01

    When ionizing particles interact with matter they produce random topological structures of primary activations which represent the initial boundary conditions for all subsequent physical, chemical and/or biological reactions. There are two important aspects of research on such track structures, namely their experimental or theoretical determination on one hand and the quantitative classification of these complex structures which is a basic pre-requisite for the understanding of mechanisms of radiation actions. This paper deals only with the latter topic, i.e. the problems encountered in and possible approaches to quantitative ordering and grouping of these multidimensional objects by their degrees of similarity with respect to their efficiency in producing certain final radiation effects, i.e. to their ''radiation quality.'' Various attempts of taxonometric classification with respect to radiation efficiency have been made in basic and applied radiation research including macro- and microdosimetric concepts as well as track entities and stopping power based theories. In this paper no review of those well-known approaches is given but rather an outline and discussion of alternative methods new to this field of radiation research which have some very promising features and which could possibly solve at least some major classification problems

  3. Care principles at four fast-track arthroplasty departments in Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Solgaard, Søren; Hansen, Torben B

    2010-01-01

    The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery.......The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery....

  4. Development of nuclear track detectors

    International Nuclear Information System (INIS)

    Somogyi, Gyoergy

    1985-01-01

    The birth and development of two decades of a new nuclear detection method is briefly summarized by one of the first inventors. The main steps of the development and broadening application of nuclear solid state track detectors are described underlying the contribution and main results of the research group of ATOMKI, Hungary (i.e. the finding of the proper plastic materials for track detectors, the discovery of correlations between the track diameter and the particle energy, the increasing of energy resolution, explanation of the track developing process, elaboration of new electrochemical track analyzing methods and automatic track analyzers). Recently, this detecting technique has grown to the phase of the industrial mass production and broad application in radiogeochemistry, mining, radioecology, personal monitoring in nuclear power plants, etc. (D.Gy.)

  5. Tracking by Machine Learning Methods

    CERN Document Server

    Jofrehei, Arash

    2015-01-01

    Current track reconstructing methods start with two points and then for each layer loop through all possible hits to find proper hits to add to that track. Another idea would be to use this large number of already reconstructed events and/or simulated data and train a machine on this data to find tracks given hit pixels. Training time could be long but real time tracking is really fast Simulation might not be as realistic as real data but tacking has been done for that with 100 percent efficiency while by using real data we would probably be limited to current efficiency.

  6. Tracks: EPHT Massachusetts Case Study

    Centers for Disease Control (CDC) Podcasts

    This podcast highlights the Massachusetts Environmental Public Health Tracking Network and features commentary from Massachusetts Department of Public Health Associate Health Commissioner Suzanne Condon.

  7. Reasonable Accommodation Information Tracking System

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Reasonable Accommodation Information Tracking System (RAITS) is a case management system that allows the National Reasonable Accommodation Coordinator (NRAC) and...

  8. Applications of nuclear track detectors

    International Nuclear Information System (INIS)

    Medveczky, L.

    1980-01-01

    The results of a scientific research-work are summarized. Nuclear track detectors were used for new applications or in unusual ways. Photographic films, nuclear emulsions and dielectric track detectors were investigated. The tracks were detected by optical microscopy. Empirical formulation has been derived for the neutron sensitivity of certain dielectric materials. Methods were developed for leak testing of closed alpha emitting sources. New procedures were found for the application and evaluation of track detector materials. The results were applied in the education, personnel dosimetry, radon dosimetry etc. (R.J.)

  9. Official Union Time Tracking System

    Data.gov (United States)

    Social Security Administration — Official Union Time Tracking System captures the reporting and accounting of the representational activity for all American Federation of Government Employees (AFGE)...

  10. Aberrant Signaling Pathways in Glioma

    International Nuclear Information System (INIS)

    Nakada, Mitsutoshi; Kita, Daisuke; Watanabe, Takuya; Hayashi, Yutaka; Teng, Lei; Pyko, Ilya V.; Hamada, Jun-Ichiro

    2011-01-01

    Glioblastoma multiforme (GBM), a WHO grade IV malignant glioma, is the most common and lethal primary brain tumor in adults; few treatments are available. Median survival rates range from 12–15 months. The biological characteristics of this tumor are exemplified by prominent proliferation, active invasiveness, and rich angiogenesis. This is mainly due to highly deregulated signaling pathways in the tumor. Studies of these signaling pathways have greatly increased our understanding of the biology and clinical behavior of GBM. An integrated view of signal transduction will provide a more useful approach in designing novel therapies for this devastating disease. In this review, we summarize the current understanding of GBM signaling pathways with a focus on potential molecular targets for anti-signaling molecular therapies

  11. Solar tracking system

    Science.gov (United States)

    White, P. R.; Scott, D. R. (Inventor)

    1981-01-01

    A solar tracker for a solar collector is described in detail. The collector is angularly oriented by a motor wherein the outputs of two side-by-side photodetectors are discriminated as to three ranges: a first corresponding to a low light or darkness condition; a second corresponding to light intensity lying in an intermediate range; and a third corresponding to light above an intermediate range, direct sunlight. The first output drives the motor to a selected maximum easterly angular position; the second enables the motor to be driven westerly at the Earth rotational rate; and the third output, the separate outputs of the two photodetectors, differentially controls the direction of rotation of the motor to effect actual tracking of the Sun.

  12. Tracks: A National Environmental Public Health Tracking Network Overview

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Mike McGeehin, Director of CDC's Division of Environmental Hazards and Health Effects, provides an overview of the National Environmental Public Health Tracking Network. It highlights the Tracking Network's goal, how it will improve public health, its audience, and much more.

  13. Urbanism on Track : Application of tracking technologies in urbanism

    NARCIS (Netherlands)

    Van der Hoeven, F.D.; Van Schaick, J.; Van der Spek, S.C.; Smit, M.G.J.

    2008-01-01

    Tracking technologies such as GPS, mobile phone tracking, video and RFID monitoring are rapidly becoming part of daily life. Technological progress offers huge possibilities for studying human activity patterns in time and space in new ways. Delft University of Technology (TU Delft) held an

  14. Tracking in Object Action Space

    DEFF Research Database (Denmark)

    Krüger, Volker; Herzog, Dennis

    2013-01-01

    the space of the object affordances, i.e., the space of possible actions that are applied on a given object. This way, 3D body tracking reduces to action tracking in the object (and context) primed parameter space of the object affordances. This reduces the high-dimensional joint-space to a low...

  15. Track counting in radon dosimetry

    International Nuclear Information System (INIS)

    Fesenbeck, Ingo; Koehler, Bernd; Reichert, Klaus-Martin

    2013-01-01

    The newly developed, computer-controlled track counting system is capable of imaging and analyzing the entire area of nuclear track detectors. The high optical resolution allows a new analysis approach for the process of automated counting using digital image processing technologies. This way, higher exposed detectors can be evaluated reliably by an automated process as well. (orig.)

  16. Graph Model Based Indoor Tracking

    DEFF Research Database (Denmark)

    Jensen, Christian Søndergaard; Lu, Hua; Yang, Bin

    2009-01-01

    The tracking of the locations of moving objects in large indoor spaces is important, as it enables a range of applications related to, e.g., security and indoor navigation and guidance. This paper presents a graph model based approach to indoor tracking that offers a uniform data management...

  17. Making Sense of Dinosaur Tracks

    Science.gov (United States)

    MacKenzie, Ann Haley; McDowell, Brian

    2012-01-01

    What do paleontologists, dinosaur tracks, and the nature of science have in common? They're combined here in an inquiry activity where students use methods of observation and inference to devise evidence-based explanations for the data they collect about dinosaur tracks, much like the methods used by paleontologists. Students then debate the…

  18. CONTRACT ADMINISTRATIVE TRACKING SYSTEM (CATS)

    Science.gov (United States)

    The Contract Administrative Tracking System (CATS) was developed in response to an ORD NHEERL, Mid-Continent Ecology Division (MED)-recognized need for an automated tracking and retrieval system for Cost Reimbursable Level of Effort (CR/LOE) Contracts. CATS is an Oracle-based app...

  19. Satellite and acoustic tracking device

    KAUST Repository

    Berumen, Michael L.

    2014-02-20

    The present invention relates a method and device for tracking movements of marine animals or objects in large bodies of water and across significant distances. The method and device can track an acoustic transmitter attached to an animal or object beneath the ocean surface by employing an unmanned surface vessel equipped with a hydrophone array and GPS receiver.

  20. Satellite and acoustic tracking device

    KAUST Repository

    Berumen, Michael L.; De la Torre, Pedro

    2014-01-01

    The present invention relates a method and device for tracking movements of marine animals or objects in large bodies of water and across significant distances. The method and device can track an acoustic transmitter attached to an animal or object beneath the ocean surface by employing an unmanned surface vessel equipped with a hydrophone array and GPS receiver.

  1. Particle Filter Tracking without Dynamics

    Directory of Open Access Journals (Sweden)

    Jaime Ortegon-Aguilar

    2007-01-01

    Full Text Available People tracking is an interesting topic in computer vision. It has applications in industrial areas such as surveillance or human-machine interaction. Particle Filters is a common algorithm for people tracking; challenging situations occur when the target's motion is poorly modelled or with unexpected motions. In this paper, an alternative to address people tracking is presented. The proposed algorithm is based in particle filters, but instead of using a dynamical model, it uses background subtraction to predict future locations of particles. The algorithm is able to track people in omnidirectional sequences with a low frame rate (one or two frames per second. Our approach can tackle unexpected discontinuities and changes in the direction of the motion. The main goal of the paper is to track people from laboratories, but it has applications in surveillance, mainly in controlled environments.

  2. NucliTrack: an integrated nuclei tracking application.

    Science.gov (United States)

    Cooper, Sam; Barr, Alexis R; Glen, Robert; Bakal, Chris

    2017-10-15

    Live imaging studies give unparalleled insight into dynamic single cell behaviours and fate decisions. However, the challenge of reliably tracking single cells over long periods of time limits both the throughput and ease with which such studies can be performed. Here, we present NucliTrack, a cross platform solution for automatically segmenting, tracking and extracting features from fluorescently labelled nuclei. NucliTrack performs similarly to other state-of-the-art cell tracking algorithms, but NucliTrack's interactive, graphical interface makes it significantly more user friendly. NucliTrack is available as a free, cross platform application and open source Python package. Installation details and documentation are at: http://nuclitrack.readthedocs.io/en/latest/ A video guide can be viewed online: https://www.youtube.com/watch?v=J6e0D9F-qSU Source code is available through Github: https://github.com/samocooper/nuclitrack. A Matlab toolbox is also available at: https://uk.mathworks.com/matlabcentral/fileexchange/61479-samocooper-nuclitrack-matlab. sam@socooper.com. Supplementary data are available at Bioinformatics online. © The Author(s) 2017. Published by Oxford University Press.

  3. A new pathway to product standardization.

    Science.gov (United States)

    Whitcomb, J

    2000-06-01

    As the benefits of product standardization become more evident in improved financial, managerial, and clinical outcomes, tools to make the process easier will be in demand. Once a standardization program is established, e-commerce offers tools to keep it on track.

  4. Rising utilization of inpatient pediatric asthma pathways.

    Science.gov (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

    2018-02-01

    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  5. A novel track imaging system as a range counter

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Z. [National Institute of Radiological Sciences (Japan); Matsufuji, N. [National Institute of Radiological Sciences (Japan); Tokyo Institute of Technology (Japan); Kanayama, S. [Chiba University (Japan); Ishida, A. [National Institute of Radiological Sciences (Japan); Tokyo Institute of Technology (Japan); Kohno, T. [Tokyo Institute of Technology (Japan); Koba, Y.; Sekiguchi, M.; Kitagawa, A.; Murakami, T. [National Institute of Radiological Sciences (Japan)

    2016-05-01

    An image-intensified, camera-based track imaging system has been developed to measure the tracks of ions in a scintillator block. To study the performance of the detector unit in the system, two types of scintillators, a dosimetrically tissue-equivalent plastic scintillator EJ-240 and a CsI(Tl) scintillator, were separately irradiated with carbon ion ({sup 12}C) beams of therapeutic energy from HIMAC at NIRS. The images of individual ion tracks in the scintillators were acquired by the newly developed track imaging system. The ranges reconstructed from the images are reported here. The range resolution of the measurements is 1.8 mm for 290 MeV/u carbon ions, which is considered a significant improvement on the energy resolution of the conventional ΔE/E method. The detector is compact and easy to handle, and it can fit inside treatment rooms for in-situ studies, as well as satisfy clinical quality assurance purposes.

  6. Double Tracks closure report

    International Nuclear Information System (INIS)

    1997-06-01

    This report describes the remediation activities performed and the results of postremediation radiation surveys conducted at the Double Tracks site, located on Range 71 North, of the Nellis Air Force Range (NAFR) in southern Nevada. This remediation was conducted from June to August 1996 in accordance with the Interim Corrective Action Plan (ICAP) to remediate the site to an acceptable risk to human health and the environment. Soil with a total transuranic activity greater than 200 picoCuries per gram (pCi/g) was excavated, shipped to the Nevada Test Site (NTS), and disposed at the Area 3 Radioactive Waste Management Site (RWMS). A total of 52.3 grams of plutonium (Pu) with an activity of 5.12 Curies was disposed. The concrete pad at ground zero (GZ) was broken up, placed in a Sealand reg-sign container, and shipped to the NTS Area 6 decontamination pad. Additionally, approximately 10 m 3 (350 ft 3 ) of soil containing small chips of concrete was shipped to the NTS Area 6 decontamination pad. The concrete and soil/concrete mixture will be further characterized prior to disposal. At the time this report was written, characterization samples were being collected, with analytical results expected in January 1997. It is anticipated that the material will be disposed in mid-1997. This remediation is an interim action because final cleanup levels have not been established

  7. Survival pathways under stress

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. Survival pathways under stress. Bacteria survive by changing gene expression. pattern. Three important pathways will be discussed: Stringent response. Quorum sensing. Proteins performing function to control oxidative damage.

  8. Tracking Accuracy of a Real-Time Fiducial Tracking System for Patient Positioning and Monitoring in Radiation Therapy

    International Nuclear Information System (INIS)

    Shchory, Tal; Schifter, Dan; Lichtman, Rinat; Neustadter, David; Corn, Benjamin W.

    2010-01-01

    Purpose: In radiation therapy there is a need to accurately know the location of the target in real time. A novel radioactive tracking technology has been developed to answer this need. The technology consists of a radioactive implanted fiducial marker designed to minimize migration and a linac mounted tracking device. This study measured the static and dynamic accuracy of the new tracking technology in a clinical radiation therapy environment. Methods and Materials: The tracking device was installed on the linac gantry. The radioactive marker was located in a tissue equivalent phantom. Marker location was measured simultaneously by the radioactive tracking system and by a Microscribe G2 coordinate measuring machine (certified spatial accuracy of 0.38 mm). Localization consistency throughout a volume and absolute accuracy in the Fixed coordinate system were measured at multiple gantry angles over volumes of at least 10 cm in diameter centered at isocenter. Dynamic accuracy was measured with the marker located inside a breathing phantom. Results: The mean consistency for the static source was 0.58 mm throughout the tested region at all measured gantry angles. The mean absolute position error in the Fixed coordinate system for all gantry angles was 0.97 mm. The mean real-time tracking error for the dynamic source within the breathing phantom was less than 1 mm. Conclusions: This novel radioactive tracking technology has the potential to be useful in accurate target localization and real-time monitoring for radiation therapy.

  9. Optical Tracking Technology in Stereotactic Radiation Therapy

    International Nuclear Information System (INIS)

    Wagner, Thomas H.; Meeks, Sanford L.; Bova, Frank J.; Friedman, William A.; Willoughby, Twyla R.; Kupelian, Patrick A.; Tome, Wolfgang

    2007-01-01

    The last decade has seen the introduction of advanced technologies that have enabled much more precise application of therapeutic radiation. These relatively new technologies include multileaf collimators, 3-dimensional conformal radiotherapy planning, and intensity modulated radiotherapy in radiotherapy. Therapeutic dose distributions have become more conformal to volumes of disease, sometimes utilizing sharp dose gradients to deliver high doses to target volumes while sparing nearby radiosensitive structures. Thus, accurate patient positioning has become even more important, so that the treatment delivered to the patient matches the virtual treatment plan in the computer treatment planning system. Optical and image-guided radiation therapy systems offer the potential to improve the precision of patient treatment by providing a more robust fiducial system than is typically used in conventional radiotherapy. The ability to accurately position internal targets relative to the linac isocenter and to provide real-time patient tracking theoretically enables significant reductions in the amount of normal tissue irradiated. This report reviews the concepts, technology, and clinical applications of optical tracking systems currently in use for stereotactic radiation therapy. Applications of radiotherapy optical tracking technology to respiratory gating and the monitoring of implanted fiducial markers are also discussed

  10. The Clinician-Educator Pathway in Radiology: An Analysis of Institutional Promotion Criteria.

    Science.gov (United States)

    Jhala, Khushboo; Kim, Jisoo; Chetlen, Alison; Nickerson, Joshua P; Lewis, Petra J

    2017-12-01

    To provide radiology departmental promotional committees and vice chairs of education with a more global perspective on the types of academic activity valued by institutions to aid in their faculty mentoring and standardizing of the Clinician-Educator (ClinEd) pathway. Ninety-two research schools were ranked into three tiers. Ranking was correlated with the presence of a ClinEd track. Thirty promotion documents (ten from each tier) were analyzed to identify common criteria. Differences in guidelines between tiers were assessed by the frequency distribution of criteria. Tier 1 had a significantly greater proportion of schools with a ClinEd track than tier 2 (73% versus 44%, p < 0.05). Thirty-nine criteria were identified and organized into four categories teaching (13), scholarship (12), service/clinical excellence (7), and research (7). The top five included meeting presentations, trainee evaluations, leadership in committees, development of teaching methodologies and materials, and publication of book chapters. First and second tier schools were most similar in frequency distribution. The criteria for the ClinEd promotion track still vary across institutions, though many commonalities exist. A handful of innovative criteria reflect the changing structure of modern health care systems, such as incorporation of online teaching modules and quality improvement efforts. As health care changes, guidelines and incentive structures for faculty should change as well. The information gathered may provide promotion committees with a more global perspective on the types of academic activity valued by modern-day institutions to aid in the national standardization of this pathway and to assist in faculty mentoring. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Delirium in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Kurbegovic, Sorel; Andersen, Jens; Krenk, Lene

    2015-01-01

    BACKGROUND: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously...... demonstrated to enhance recovery and reduce morbidity. METHODS: Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. RESULTS: Total median length of hospital stay...... postoperative recovery program may decrease the risk and duration of PD after colonic surgery....

  12. The DOe Silicon Track Trigger

    International Nuclear Information System (INIS)

    Steinbrueck, Georg

    2003-01-01

    We describe a trigger preprocessor to be used by the DOe experiment for selecting events with tracks from the decay of long-lived particles. This Level 2 impact parameter trigger utilizes information from the Silicon Microstrip Tracker to reconstruct tracks with improved spatial and momentum resolutions compared to those obtained by the Level 1 tracking trigger. It is constructed of VME boards with much of the logic existing in programmable processors. A common motherboard provides the I/O infrastructure and three different daughter boards perform the tasks of identifying the roads from the tracking trigger data, finding the clusters in the roads in the silicon detector, and fitting tracks to the clusters. This approach provides flexibility for the design, testing and maintenance phases of the project. The track parameters are provided to the trigger framework in 25 μs. The effective impact parameter resolution for high-momentum tracks is 35 μm, dominated by the size of the Tevatron beam

  13. Alternate Double Single Track Lines

    Energy Technology Data Exchange (ETDEWEB)

    Moraga Contreras, P.; Grande Andrade, Z.; Castillo Ron, E.

    2016-07-01

    The paper discusses the advantages and shortcomings of alternate double single track (ADST) lines with respect to double track lines for high speed lines. ADST lines consists of sequences of double and single track segments optimally selected in order to reduce the construction and maintenance costs of railway lines and to optimize the timetables used to satisfy a given demand. The single tracks are selected to coincide with expensive segments (tunnels and viaducts) and the double tracks are chosen to coincide with flat areas and only where they are necessary. At the same time, departure times are adjusted for trains to cross at the cheap double track segments. This alternative can be used for new lines and also for existing conventional lines where some new tracks are to be constructed to reduce travel time (increase speed). The ADST proposal is illustrated with some examples of both types (new lines and where conventional lines exist), including the Palencia-Santander, the Santiago-Valparaíso-Viña del Mar and the Dublin-Belfast lines, where very important reductions (90 %) are obtained, especially where a railway infrastructure already exist. (Author)

  14. ANNOTATION SUPPORTED OCCLUDED OBJECT TRACKING

    Directory of Open Access Journals (Sweden)

    Devinder Kumar

    2012-08-01

    Full Text Available Tracking occluded objects at different depths has become as extremely important component of study for any video sequence having wide applications in object tracking, scene recognition, coding, editing the videos and mosaicking. The paper studies the ability of annotation to track the occluded object based on pyramids with variation in depth further establishing a threshold at which the ability of the system to track the occluded object fails. Image annotation is applied on 3 similar video sequences varying in depth. In the experiment, one bike occludes the other at a depth of 60cm, 80cm and 100cm respectively. Another experiment is performed on tracking humans with similar depth to authenticate the results. The paper also computes the frame by frame error incurred by the system, supported by detailed simulations. This system can be effectively used to analyze the error in motion tracking and further correcting the error leading to flawless tracking. This can be of great interest to computer scientists while designing surveillance systems etc.

  15. Pathways Intern Report

    Science.gov (United States)

    Huggett, Daniel James

    2017-01-01

    The National Aeronautics and Space Administration (NASA) provides a formal training program for prospective employees titled, Pathways Intern Employment. The Pathways program targets graduate and undergraduate students who strive to become an active contributor to NASA's goal of space exploration. The report herein provides an account of Daniel Huggett's Pathways experience for the Spring and Summer 2017 semesters.

  16. Neurophysiology and itch pathways.

    Science.gov (United States)

    Schmelz, Martin

    2015-01-01

    As we all can easily differentiate the sensations of itch and pain, the most straightforward neurophysiologic concept would consist of two specific pathways that independently encode itch and pain. Indeed, a neuronal pathway for histamine-induced itch in the peripheral and central nervous system has been described in animals and humans, and recently several non-histaminergic pathways for itch have been discovered in rodents that support a dichotomous concept differentiated into a pain and an itch pathway, with both pathways being composed of different "flavors." Numerous markers and mediators have been found that are linked to itch processing pathways. Thus, the delineation of neuronal pathways for itch from pain pathways seemingly proves that all sensory aspects of itch are based on an itch-specific neuronal pathway. However, such a concept is incomplete as itch can also be induced by the activation of the pain pathway in particular when the stimulus is applied in a highly localized spatial pattern. These opposite views reflect the old dispute between specificity and pattern theories of itch. Rather than only being of theoretic interest, this conceptual problem has key implication for the strategy to treat chronic itch as key therapeutic targets would be either itch-specific pathways or unspecific nociceptive pathways.

  17. A study of the transition pathways of school level scholarship ...

    African Journals Online (AJOL)

    This study tracked the progress of alumni of an educational intervention two or three years post school, in order to investigate their pathways to their destinations of work and study. Forty percent of the alumni were successfully traced, and asked to fill in an online questionnaire. Of the 104 traced alumni, 80% reported good ...

  18. Kalman Filter Track Fits and Track Breakpoint Analysis

    CERN Document Server

    Astier, Pierre; Cousins, R D; Letessier-Selvon, A A; Popov, B A; Vinogradova, T G; Astier, Pierre; Cardini, Alessandro; Cousins, Robert D.; Letessier-Selvon, Antoine; Popov, Boris A.; Vinogradova, Tatiana

    2000-01-01

    We give an overview of track fitting using the Kalman filter method in the NOMAD detector at CERN, and emphasize how the wealth of by-product information can be used to analyze track breakpoints (discontinuities in track parameters caused by scattering, decay, etc.). After reviewing how this information has been previously exploited by others, we describe extensions which add power to breakpoint detection and characterization. We show how complete fits to the entire track, with breakpoint parameters added, can be easily obtained from the information from unbroken fits. Tests inspired by the Fisher F-test can then be used to judge breakpoints. Signed quantities (such as change in momentum at the breakpoint) can supplement unsigned quantities such as the various chisquares. We illustrate the method with electrons from real data, and with Monte Carlo simulations of pion decays.

  19. Neural network tracking and extension of positive tracking periods

    Science.gov (United States)

    Hanan, Jay C.; Chao, Tien-Hsin; Moreels, Pierre

    2004-04-01

    Feature detectors have been considered for the role of supplying additional information to a neural network tracker. The feature detector focuses on areas of the image with significant information. Basically, if a picture says a thousand words, the feature detectors are looking for the key phrases (keypoints). These keypoints are rotationally invariant and may be matched across frames. Application of these advanced feature detectors to the neural network tracking system at JPL has promising potential. As part of an ongoing program, an advanced feature detector was tested for augmentation of a neural network based tracker. The advance feature detector extended tracking periods in test sequences including aircraft tracking, rover tracking, and simulated Martian landing. Future directions of research are also discussed.

  20. CDC National Environmental Public Health Tracking Network (Tracking Network)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Environmental Public Health Tracking Network is a system of integrated health, exposure, and hazard information and data from a variety of national,...

  1. Using project management methodology to plan and track inpatient care.

    Science.gov (United States)

    Kaufman, Darren S

    2005-08-01

    Effective care of each patient throughout a hospital admission involves executing a specific set of tasks to produce a favorable outcome within an appropriate time frame. The ProjectRounds methodology, which can be implemented using widely available software, incorporates the principles of project management in planning and control hospital inpatient care. It consists of four stages--clinical assessment, planning, scheduling, and tracking. OVERVIEW OF PROJECTROUNDS AND EXAMPLE: As an example, a 68-year-old-man is admitted with pneumonia. In clinical assessment, the admitting physician uses an assessment tool that prompts her to list all the patient's clinical issues, define the conditions that need to be met to discharge the patient, highlight special problems, and list any consultations, diagnostic tests, and procedures that are planned. In planning, the work breakdown structure--a tabulation of all the tasks in the "project" (the admission)--is created. In scheduling, a project schedule is generated, and in tracking, the clinical team evaluates and monitors the project's course. During interdisciplinary clinical rounds, the progress of the patient's hospital care can be tracked and quantified by employing the percent complete method. Tracking can be used as a "dashboard," providing a concise summary of the care that needs to be and has been rendered to the patient. Applying the tenets of project management can optimize the process of providing health care to hospital inpatients.

  2. Visual object recognition and tracking

    Science.gov (United States)

    Chang, Chu-Yin (Inventor); English, James D. (Inventor); Tardella, Neil M. (Inventor)

    2010-01-01

    This invention describes a method for identifying and tracking an object from two-dimensional data pictorially representing said object by an object-tracking system through processing said two-dimensional data using at least one tracker-identifier belonging to the object-tracking system for providing an output signal containing: a) a type of the object, and/or b) a position or an orientation of the object in three-dimensions, and/or c) an articulation or a shape change of said object in said three dimensions.

  3. Track membranes, production, properties, applications

    International Nuclear Information System (INIS)

    Oganesjan, Yu.Ts.

    1994-01-01

    The problems of producing track membranes on heavy ion beams of the Flerov Laboratory are considered. The parameters of the running accelerators and equipment for the irradiation of polymer foils are presented. The process of production of track membranes based on different polymeric materials and various applications of the membranes are described. Special attention is given to the principally new applications and devices developed at the Laboratory. This report presents the results obtained by a big group of scientists and engineers working in the field of elaboration, investigation and application of track membranes (author). 21 refs, 20 figs, 1 tab

  4. Cluster analysis of track structure

    International Nuclear Information System (INIS)

    Michalik, V.

    1991-01-01

    One of the possibilities of classifying track structures is application of conventional partition techniques of analysis of multidimensional data to the track structure. Using these cluster algorithms this paper attempts to find characteristics of radiation reflecting the spatial distribution of ionizations in the primary particle track. An absolute frequency distribution of clusters of ionizations giving the mean number of clusters produced by radiation per unit of deposited energy can serve as this characteristic. General computation techniques used as well as methods of calculations of distributions of clusters for different radiations are discussed. 8 refs.; 5 figs

  5. Tracks: A National Environmental Public Health Tracking Network Overview

    Centers for Disease Control (CDC) Podcasts

    2009-08-04

    In this podcast, Dr. Mike McGeehin, Director of CDC's Division of Environmental Hazards and Health Effects, provides an overview of the National Environmental Public Health Tracking Network. It highlights the Tracking Network's goal, how it will improve public health, its audience, and much more.  Created: 8/4/2009 by Centers for Disease Control and Prevention (CDC).   Date Released: 8/4/2009.

  6. Robust track fitting in the Belle II inner tracking detector

    International Nuclear Information System (INIS)

    Nadler, Moritz; Frühwirth, Rudolf

    2012-01-01

    Track fitting in the new inner tracker of the Belle II experiment uses the GENFIT package. In the latter both a standard Kalman filter and a robust extension, the deterministic annealing filter (DAF), are implemented. This contribution presents the results of a simulation experiment which examines the performance of the DAF in the inner tracker, in terms of outlier detection ability and of the impact of different kinds of background on the quality of the fitted tracks.

  7. Decontaminate feature for tracking: adaptive tracking via evolutionary feature subset

    Science.gov (United States)

    Liu, Qiaoyuan; Wang, Yuru; Yin, Minghao; Ren, Jinchang; Li, Ruizhi

    2017-11-01

    Although various visual tracking algorithms have been proposed in the last 2-3 decades, it remains a challenging problem for effective tracking with fast motion, deformation, occlusion, etc. Under complex tracking conditions, most tracking models are not discriminative and adaptive enough. When the combined feature vectors are inputted to the visual models, this may lead to redundancy causing low efficiency and ambiguity causing poor performance. An effective tracking algorithm is proposed to decontaminate features for each video sequence adaptively, where the visual modeling is treated as an optimization problem from the perspective of evolution. Every feature vector is compared to a biological individual and then decontaminated via classical evolutionary algorithms. With the optimized subsets of features, the "curse of dimensionality" has been avoided while the accuracy of the visual model has been improved. The proposed algorithm has been tested on several publicly available datasets with various tracking challenges and benchmarked with a number of state-of-the-art approaches. The comprehensive experiments have demonstrated the efficacy of the proposed methodology.

  8. High-definition fiber tracking for assessment of neurological deficit in a case of traumatic brain injury: finding, visualizing, and interpreting small sites of damage.

    Science.gov (United States)

    Shin, Samuel S; Verstynen, Timothy; Pathak, Sudhir; Jarbo, Kevin; Hricik, Allison J; Maserati, Megan; Beers, Sue R; Puccio, Ava M; Boada, Fernando E; Okonkwo, David O; Schneider, Walter

    2012-05-01

    For patients with traumatic brain injury (TBI), current clinical imaging methods generally do not provide highly detailed information about the location of axonal injury, severity of injury, or expected recovery. In a case of severe TBI, the authors applied a novel high-definition fiber tracking (HDFT) to directly visualize and quantify the degree of axonal fiber damage and predict functional deficits due to traumatic axonal injury and loss of cortical projections. This 32-year-old man sustained a severe TBI. Computed tomography and MRI revealed an area of hemorrhage in the basal ganglia with mass effect, but no specific information on the location of axonal injury could be obtained from these studies. Examinations of the patient at Week 3 and Week 8 after TBI revealed motor weaknesses of the left extremities. Four months postinjury, 257-direction diffusion spectrum imaging and HDFT analysis was performed to evaluate the degree of axonal damage in the motor pathway and quantify asymmetries in the left and right axonal pathways. High-definition fiber tracking was used to follow corticospinal and corona radiata pathways from the cortical surface to the midbrain and quantify projections from motor areas. Axonal damage was then localized by assessing the number of descending fibers at the level of the cortex, internal capsule, and midbrain. The motor deficit apparent in the clinical examinations correlated with the axonal losses visualized using HDFT. Fiber loss estimates at 4 months postinjury accurately predicted the nature of the motor deficits (severe, focal left-hand weakness) when other standard clinical imaging modalities did not. A repeat scan at 10 months postinjury, when edema and hemorrhage had receded, replicated the fiber loss. Using HDFT, the authors accurately identified the presence and location of damage to the underlying white matter in this patient with TBI. Detailed information of injury provided by this novel technique holds future potential for

  9. A gene expression signature of RAS pathway dependence predicts response to PI3K and RAS pathway inhibitors and expands the population of RAS pathway activated tumors.

    Science.gov (United States)

    Loboda, Andrey; Nebozhyn, Michael; Klinghoffer, Rich; Frazier, Jason; Chastain, Michael; Arthur, William; Roberts, Brian; Zhang, Theresa; Chenard, Melissa; Haines, Brian; Andersen, Jannik; Nagashima, Kumiko; Paweletz, Cloud; Lynch, Bethany; Feldman, Igor; Dai, Hongyue; Huang, Pearl; Watters, James

    2010-06-30

    Hyperactivation of the Ras signaling pathway is a driver of many cancers, and RAS pathway activation can predict response to targeted therapies. Therefore, optimal methods for measuring Ras pathway activation are critical. The main focus of our work was to develop a gene expression signature that is predictive of RAS pathway dependence. We used the coherent expression of RAS pathway-related genes across multiple datasets to derive a RAS pathway gene expression signature and generate RAS pathway activation scores in pre-clinical cancer models and human tumors. We then related this signature to KRAS mutation status and drug response data in pre-clinical and clinical datasets. The RAS signature score is predictive of KRAS mutation status in lung tumors and cell lines with high (> 90%) sensitivity but relatively low (50%) specificity due to samples that have apparent RAS pathway activation in the absence of a KRAS mutation. In lung and breast cancer cell line panels, the RAS pathway signature score correlates with pMEK and pERK expression, and predicts resistance to AKT inhibition and sensitivity to MEK inhibition within both KRAS mutant and KRAS wild-type groups. The RAS pathway signature is upregulated in breast cancer cell lines that have acquired resistance to AKT inhibition, and is downregulated by inhibition of MEK. In lung cancer cell lines knockdown of KRAS using siRNA demonstrates that the RAS pathway signature is a better measure of dependence on RAS compared to KRAS mutation status. In human tumors, the RAS pathway signature is elevated in ER negative breast tumors and lung adenocarcinomas, and predicts resistance to cetuximab in metastatic colorectal cancer. These data demonstrate that the RAS pathway signature is superior to KRAS mutation status for the prediction of dependence on RAS signaling, can predict response to PI3K and RAS pathway inhibitors, and is likely to have the most clinical utility in lung and breast tumors.

  10. A gene expression signature of RAS pathway dependence predicts response to PI3K and RAS pathway inhibitors and expands the population of RAS pathway activated tumors

    Directory of Open Access Journals (Sweden)

    Paweletz Cloud

    2010-06-01

    Full Text Available Abstract Background Hyperactivation of the Ras signaling pathway is a driver of many cancers, and RAS pathway activation can predict response to targeted therapies. Therefore, optimal methods for measuring Ras pathway activation are critical. The main focus of our work was to develop a gene expression signature that is predictive of RAS pathway dependence. Methods We used the coherent expression of RAS pathway-related genes across multiple datasets to derive a RAS pathway gene expression signature and generate RAS pathway activation scores in pre-clinical cancer models and human tumors. We then related this signature to KRAS mutation status and drug response data in pre-clinical and clinical datasets. Results The RAS signature score is predictive of KRAS mutation status in lung tumors and cell lines with high (> 90% sensitivity but relatively low (50% specificity due to samples that have apparent RAS pathway activation in the absence of a KRAS mutation. In lung and breast cancer cell line panels, the RAS pathway signature score correlates with pMEK and pERK expression, and predicts resistance to AKT inhibition and sensitivity to MEK inhibition within both KRAS mutant and KRAS wild-type groups. The RAS pathway signature is upregulated in breast cancer cell lines that have acquired resistance to AKT inhibition, and is downregulated by inhibition of MEK. In lung cancer cell lines knockdown of KRAS using siRNA demonstrates that the RAS pathway signature is a better measure of dependence on RAS compared to KRAS mutation status. In human tumors, the RAS pathway signature is elevated in ER negative breast tumors and lung adenocarcinomas, and predicts resistance to cetuximab in metastatic colorectal cancer. Conclusions These data demonstrate that the RAS pathway signature is superior to KRAS mutation status for the prediction of dependence on RAS signaling, can predict response to PI3K and RAS pathway inhibitors, and is likely to have the most clinical

  11. Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients involving dedicated early rehabilitation intervention programs: design of a prospective, multi-centre, non-randomised clinical trial.

    NARCIS (Netherlands)

    Kosar, S.; Seelen, H.A.M.; Hemmen, B.; Evers, S.M.; Brink, P.R.

    2009-01-01

    ABSTRACT: BACKGROUND: In conventional multi-trauma care service (CTCS), patients are admitted to hospital via the accident & emergency room. After surgery they are transferred to the IC-unit followed by the general surgery ward. Ensuing treatment takes place in a hospital's outpatient clinic, a

  12. The ATLAS Track Extrapolation Package

    CERN Document Server

    Salzburger, A

    2007-01-01

    The extrapolation of track parameters and their associated covariances to destination surfaces of different types is a very frequent process in the event reconstruction of high energy physics experiments. This is amongst other reasons due to the fact that most track and vertex fitting techniques are based on the first and second momentum of the underlying probability density distribution. The correct stochastic or deterministic treatment of interactions with the traversed detector material is hereby crucial for high quality track reconstruction throughout the entire momentum range of final state particles that are produced in high energy physics collision experiments. This document presents the main concepts, the algorithms and the implementation of the newly developed, powerful ATLAS track extrapolation engine. It also emphasises on validation procedures, timing measurements and the integration into the ATLAS offline reconstruction software.

  13. Track formation. Principles and applications

    International Nuclear Information System (INIS)

    Monnin, M.

    1978-01-01

    The principles and technical aspects of track formation in insulating solids are first described. The characteristics of dialectic track detection are discussed from the technical point of view: the nature of the detectors, the chemical treatment, the sensitivity and the environmental conditions of use. The applications are reviewed. The principle of each type of applied research is described and then the applications are listed. When used as a detector, nuclear tracks can provide valuable information in a number of fields: element content determination and wrapping, imaging, radiation dosimetry, environmental studies, technological uses and miscellaneous other applications. The track-formation process can also be used for making well-defined holes; this method allows other applications which are also described. Finally, some possible future applications are mentioned. (author)

  14. Tracking Code for Microwave Instability

    International Nuclear Information System (INIS)

    Heifets, S.; SLAC

    2006-01-01

    To study microwave instability the tracking code is developed. For bench marking, results are compared with Oide-Yokoya results [1] for broad-band Q = 1 impedance. Results hint to two possible mechanisms determining the threshold of instability

  15. Particle tracking at the SSC

    International Nuclear Information System (INIS)

    Freeman, J.E.; Williams, H.H.

    1984-01-01

    The intent of this study was to get some idea of how difficult tracking will be at √s = 40 TeV for events involving momentum transfers in the vicinity of several hundred GeV. While some studies have been done to determine the minimum separation between two random tracks as a function of radius, the authors know of no previous study in this energy range which has considered the ''observability'' of a track along its entire path length, including the effects of magnetic field and finite double track resolution. They have not considered the effects of pileup due to multiple events, concentrating instead of the inherent difficulties of single high p/sub T/ events

  16. ACED Federal Grant Contractor Tracking

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Dataset includes grant, project, and contractor awarded which are tracked for ensuring Davis-Bacon Act compliance where applicable. The 1931 Davis-Bacon Act...

  17. Dynamic Ocean Track System Plus -

    Data.gov (United States)

    Department of Transportation — Dynamic Ocean Track System Plus (DOTS Plus) is a planning tool implemented at the ZOA, ZAN, and ZNY ARTCCs. It is utilized by Traffic Management Unit (TMU) personnel...

  18. GARFOGIS_DATA_TRACKING.xlsm

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This spreadsheet is the central tracking document and inventory of "official" GIS datasets in development, published, or archived at the Greater Atlantic Regional...

  19. Calibration of Nuclear Track Detectors

    International Nuclear Information System (INIS)

    Vukovic, J.B; Antanasijevic, R.; Novakovic, V.; Tasic, M.

    1998-01-01

    In this work we compare some of our preliminary results relating to the calibration Nuclear Track Detectors (NTD) with corresponding results obtained from other participants at the First International Intercomparison of Image Analyzers (III 97/98). Thirteen laboratories from Algeria, China, Czech Rep., France. Germany, Greece, Hungary, India, Italy, Mexico, Saudi Arabia, Slovenia and Yugoslavia participated in the III A 97/98. The NTD was 'Tustrack', Bristol. This type of CR-39 detector was etched by the organizer (J.Paltarey of al, Atomic Energy Research Institute, HPD, Budapest, Hungary). Etching condition was: 6N NaOH, 70 0C . Seven series detectors were exposed with the sources: B(n,a)Li, Am-241, Pu-Be(n,p), Radon and Am-Cm-Pu. Following parameters of exposed detectors were measured: track density of different sorts of tracks (circular, elliptical, track overlapping, their diameters, major and minor axis and other). (authors)

  20. Precise object tracking under deformation

    International Nuclear Information System (INIS)

    Saad, M.H

    2010-01-01

    The precise object tracking is an essential issue in several serious applications such as; robot vision, automated surveillance (civil and military), inspection, biomedical image analysis, video coding, motion segmentation, human-machine interface, visualization, medical imaging, traffic systems, satellite imaging etc. This frame-work focuses on the precise object tracking under deformation such as scaling , rotation, noise, blurring and change of illumination. This research is a trail to solve these serious problems in visual object tracking by which the quality of the overall system will be improved. Developing a three dimensional (3D) geometrical model to determine the current pose of an object and predict its future location based on FIR model learned by the OLS. This framework presents a robust ranging technique to track a visual target instead of the traditional expensive ranging sensors. The presented research work is applied to real video stream and achieved high precession results.

  1. GPS Navigation and Tracking Device

    Directory of Open Access Journals (Sweden)

    Yahya Salameh Khraisat

    2011-10-01

    Full Text Available Since the introduction of GPS Navigation systems in the marketplace, consumers and businesses have been coming up with innovative ways to use the technology in their everyday life. GPS Navigation and Tracking systems keep us from getting lost when we are in strange locations, they monitor children when they are away from home, keep track of business vehicles and can even let us know where a philandering partner is at all times. Because of this we attend to build a GPS tracking device to solve the mentioned problems. Our work consists of the GPS module that collects data from satellites and calculates the position information before transmitting them to the user’s PC (of Navigation system or observers (of Tracking System using wireless technology (GSM.

  2. Manifold Regularized Correlation Object Tracking.

    Science.gov (United States)

    Hu, Hongwei; Ma, Bo; Shen, Jianbing; Shao, Ling

    2018-05-01

    In this paper, we propose a manifold regularized correlation tracking method with augmented samples. To make better use of the unlabeled data and the manifold structure of the sample space, a manifold regularization-based correlation filter is introduced, which aims to assign similar labels to neighbor samples. Meanwhile, the regression model is learned by exploiting the block-circulant structure of matrices resulting from the augmented translated samples over multiple base samples cropped from both target and nontarget regions. Thus, the final classifier in our method is trained with positive, negative, and unlabeled base samples, which is a semisupervised learning framework. A block optimization strategy is further introduced to learn a manifold regularization-based correlation filter for efficient online tracking. Experiments on two public tracking data sets demonstrate the superior performance of our tracker compared with the state-of-the-art tracking approaches.

  3. Precise Object Tracking under Deformation

    International Nuclear Information System (INIS)

    Saad, M.H.

    2010-01-01

    The precise object tracking is an essential issue in several serious applications such as; robot vision, automated surveillance (civil and military), inspection, biomedical image analysis, video coding, motion segmentation, human-machine interface, visualization, medical imaging, traffic systems, satellite imaging etc. This framework focuses on the precise object tracking under deformation such as scaling, rotation, noise, blurring and change of illumination. This research is a trail to solve these serious problems in visual object tracking by which the quality of the overall system will be improved. Developing a three dimensional (3D) geometrical model to determine the current pose of an object and predict its future location based on FIR model learned by the OLS. This framework presents a robust ranging technique to track a visual target instead of the traditional expensive ranging sensors. The presented research work is applied to real video stream and achieved high precession results. xiiiThe precise object tracking is an essential issue in several serious applications such as; robot vision, automated surveillance (civil and military), inspection, biomedical image analysis, video coding, motion segmentation, human-machine interface, visualization, medical imaging, traffic systems, satellite imaging etc. This framework focuses on the precise object tracking under deformation such as scaling, rotation, noise, blurring and change of illumination. This research is a trail to solve these serious problems in visual object tracking by which the quality of the overall system will be improved. Developing a three dimensional (3D) geometrical model to determine the current pose of an object and predict its future location based on FIR model learned by the OLS. This framework presents a robust ranging technique to track a visual target instead of the traditional expensive ranging sensors. The presented research work is applied to real video stream and achieved high

  4. Tracked vehicles in hazardous environments

    International Nuclear Information System (INIS)

    Jones, S.; Walton, P.J.

    1993-01-01

    A programme of remote inspections has been conducted on the Magnox steel reactor pressure vessel at Trawsfynydd Power Station using climbing vehicles. Tracked remotely operated vehicles supported the inspection programme by assisting with the delivery and recovery of the climbing vehicles and facilitating the use of various accessory packages. This paper presents details of the support project, the tracked vehicles and of the uses made of them during the inspection programme. (author)

  5. Kalman Orbit Optimized Loop Tracking

    Science.gov (United States)

    Young, Lawrence E.; Meehan, Thomas K.

    2011-01-01

    Under certain conditions of low signal power and/or high noise, there is insufficient signal to noise ratio (SNR) to close tracking loops with individual signals on orbiting Global Navigation Satellite System (GNSS) receivers. In addition, the processing power available from flight computers is not great enough to implement a conventional ultra-tight coupling tracking loop. This work provides a method to track GNSS signals at very low SNR without the penalty of requiring very high processor throughput to calculate the loop parameters. The Kalman Orbit-Optimized Loop (KOOL) tracking approach constitutes a filter with a dynamic model and using the aggregate of information from all tracked GNSS signals to close the tracking loop for each signal. For applications where there is not a good dynamic model, such as very low orbits where atmospheric drag models may not be adequate to achieve the required accuracy, aiding from an IMU (inertial measurement unit) or other sensor will be added. The KOOL approach is based on research JPL has done to allow signal recovery from weak and scintillating signals observed during the use of GPS signals for limb sounding of the Earth s atmosphere. That approach uses the onboard PVT (position, velocity, time) solution to generate predictions for the range, range rate, and acceleration of the low-SNR signal. The low- SNR signal data are captured by a directed open loop. KOOL builds on the previous open loop tracking by including feedback and observable generation from the weak-signal channels so that the MSR receiver will continue to track and provide PVT, range, and Doppler data, even when all channels have low SNR.

  6. Silicon Tracking Upgrade at CDF

    International Nuclear Information System (INIS)

    Kruse, M.C.

    1998-04-01

    The Collider Detector at Fermilab (CDF) is scheduled to begin recording data from Run II of the Fermilab Tevatron in early 2000. The silicon tracking upgrade constitutes both the upgrade to the CDF silicon vertex detector (SVX II) and the new Intermediate Silicon Layers (ISL) located at radii just beyond the SVX II. Here we review the design and prototyping of all aspects of these detectors including mechanical design, data acquisition, and a trigger based on silicon tracking

  7. MO-FG-BRD-00: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow.

  8. MO-FG-BRD-00: Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management

    International Nuclear Information System (INIS)

    2015-01-01

    Intrafraction target motion is a prominent complicating factor in the accurate targeting of radiation within the body. Methods compensating for target motion during treatment, such as gating and dynamic tumor tracking, depend on the delineation of target location as a function of time during delivery. A variety of techniques for target localization have been explored and are under active development; these include beam-level imaging of radio-opaque fiducials, fiducial-less tracking of anatomical landmarks, tracking of electromagnetic transponders, optical imaging of correlated surrogates, and volumetric imaging within treatment delivery. The Joint Imaging and Therapy Symposium will provide an overview of the techniques for real-time imaging and tracking, with special focus on emerging modes of implementation across different modalities. In particular, the symposium will explore developments in 1) Beam-level kilovoltage X-ray imaging techniques, 2) EPID-based megavoltage X-ray tracking, 3) Dynamic tracking using electromagnetic transponders, and 4) MRI-based soft-tissue tracking during radiation delivery. Learning Objectives: Understand the fundamentals of real-time imaging and tracking techniques Learn about emerging techniques in the field of real-time tracking Distinguish between the advantages and disadvantages of different tracking modalities Understand the role of real-time tracking techniques within the clinical delivery work-flow

  9. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been...

  10. A blueprint for multidisciplinary fast track gastrointestinal oncology care

    NARCIS (Netherlands)

    Basta, Y.L.

    2017-01-01

    In this thesis, we have evaluated the implementation of two key concepts of the Gastro Intestinal oncology Center Amsterdam (GIOCA): multidisciplinary teams (MDT) and the fast delivery of care in fast track clinics (FTC). The first part of this thesis investigates the value of multidisciplinary

  11. CASA: tracking the past and plotting the future.

    Science.gov (United States)

    Gallagher, M T; Smith, D J; Kirkman-Brown, J C

    2018-05-29

    The human semen sample carries a wealth of information of varying degrees of accessibility ranging from the traditional visual measures of count and motility to those that need a more computational approach, such as tracking the flagellar waveform. Although computer-aided sperm analysis (CASA) options are becoming more widespread, the gold standard for clinical semen analysis requires trained laboratory staff. In this review we characterise the key attitudes towards the use of CASA and set out areas in which CASA should, and should not, be used and improved. We provide an overview of the current CASA landscape, discussing clinical uses as well as potential areas for the clinical translation of existing research technologies. Finally, we discuss where we see potential for the future of CASA, and how the integration of mathematical modelling and new technologies, such as automated flagellar tracking, may open new doors in clinical semen analysis.

  12. Modular and Stochastic Approaches to Molecular Pathway Models of ATM, TGF beta, and WNT Signaling

    Science.gov (United States)

    Cucinotta, Francis A.; O'Neill, Peter; Ponomarev, Artem; Carra, Claudio; Whalen, Mary; Pluth, Janice M.

    2009-01-01

    Deterministic pathway models that describe the biochemical interactions of a group of related proteins, their complexes, activation through kinase, etc. are often the basis for many systems biology models. Low dose radiation effects present a unique set of challenges to these models including the importance of stochastic effects due to the nature of radiation tracks and small number of molecules activated, and the search for infrequent events that contribute to cancer risks. We have been studying models of the ATM, TGF -Smad and WNT signaling pathways with the goal of applying pathway models to the investigation of low dose radiation cancer risks. Modeling challenges include introduction of stochastic models of radiation tracks, their relationships to more than one substrate species that perturb pathways, and the identification of a representative set of enzymes that act on the dominant substrates. Because several pathways are activated concurrently by radiation the development of modular pathway approach is of interest.

  13. Coding gaze tracking data with chromatic gradients for VR Exposure Therapy

    DEFF Research Database (Denmark)

    Herbelin, Bruno; Grillon, Helena; De Heras Ciechomski, Pablo

    2007-01-01

    This article presents a simple and intuitive way to represent the eye-tracking data gathered during immersive virtual reality exposure therapy sessions. Eye-tracking technology is used to observe gaze movements during vir- tual reality sessions and the gaze-map chromatic gradient coding allows to...... is fully compatible with different VR exposure systems and provides clinically meaningful data....

  14. Fast and Practical Head Tracking in Brain Imaging with Time-of-Flight Camera

    DEFF Research Database (Denmark)

    Wilm, Jakob; Olesen, Oline Vinter; Jensen, Rasmus Ramsbøl

    2013-01-01

    scanners. Particularly in MRI and PET, the newest generation of TOF cameras could become a method of tracking small and large scale patient movement in a fast and user friendly way required in clinical environments. We present a novel methodology for fast tracking from TOF point clouds without the need...

  15. Multisensor Distributed Track Fusion AlgorithmBased on Strong Tracking Filter and Feedback Integration1)

    Institute of Scientific and Technical Information of China (English)

    YANGGuo-Sheng; WENCheng-Lin; TANMin

    2004-01-01

    A new multisensor distributed track fusion algorithm is put forward based on combiningthe feedback integration with the strong tracking Kalman filter. Firstly, an effective tracking gateis constructed by taking the intersection of the tracking gates formed before and after feedback.Secondly, on the basis of the constructed effective tracking gate, probabilistic data association andstrong tracking Kalman filter are combined to form the new multisensor distributed track fusionalgorithm. At last, simulation is performed on the original algorithm and the algorithm presented.

  16. Stem Cell Tracking Technologies for Neurological Regenerative Medicine Purposes

    Directory of Open Access Journals (Sweden)

    Yongtao Zheng

    2017-01-01

    Full Text Available The growing field of stem cell therapy is moving toward clinical trials in a variety of applications, particularly for neurological diseases. However, this translation of cell therapies into humans has prompted a need to create innovative and breakthrough methods for stem cell tracing, to explore the migration routes and its reciprocity with microenvironment targets in the body, to monitor and track the outcome after stem cell transplantation therapy, and to track the distribution and cell viability of transplanted cells noninvasively and longitudinally. Recently, a larger number of cell tracking methods in vivo were developed and applied in animals and humans, including magnetic resonance imaging, nuclear medicine imaging, and optical imaging. This review has been intended to summarize the current use of those imaging tools in tracking stem cells, detailing their main features and drawbacks, including image resolution, tissue penetrating depth, and biosafety aspects. Finally, we address that multimodality imaging method will be a more potential tracking tool in the future clinical application.

  17. Comparison of probabilistic and deterministic fiber tracking of cranial nerves.

    Science.gov (United States)

    Zolal, Amir; Sobottka, Stephan B; Podlesek, Dino; Linn, Jennifer; Rieger, Bernhard; Juratli, Tareq A; Schackert, Gabriele; Kitzler, Hagen H

    2017-09-01

    OBJECTIVE The depiction of cranial nerves (CNs) using diffusion tensor imaging (DTI) is of great interest in skull base tumor surgery and DTI used with deterministic tracking methods has been reported previously. However, there are still no good methods usable for the elimination of noise from the resulting depictions. The authors have hypothesized that probabilistic tracking could lead to more accurate results, because it more efficiently extracts information from the underlying data. Moreover, the authors have adapted a previously described technique for noise elimination using gradual threshold increases to probabilistic tracking. To evaluate the utility of this new approach, a comparison is provided with this work between the gradual threshold increase method in probabilistic and deterministic tracking of CNs. METHODS Both tracking methods were used to depict CNs II, III, V, and the VII+VIII bundle. Depiction of 240 CNs was attempted with each of the above methods in 30 healthy subjects, which were obtained from 2 public databases: the Kirby repository (KR) and Human Connectome Project (HCP). Elimination of erroneous fibers was attempted by gradually increasing the respective thresholds (fractional anisotropy [FA] and probabilistic index of connectivity [PICo]). The results were compared with predefined ground truth images based on corresponding anatomical scans. Two label overlap measures (false-positive error and Dice similarity coefficient) were used to evaluate the success of both methods in depicting the CN. Moreover, the differences between these parameters obtained from the KR and HCP (with higher angular resolution) databases were evaluated. Additionally, visualization of 10 CNs in 5 clinical cases was attempted with both methods and evaluated by comparing the depictions with intraoperative findings. RESULTS Maximum Dice similarity coefficients were significantly higher with probabilistic tracking (p cranial nerves. Probabilistic tracking with a gradual

  18. A fast track path improves access to palliative care for people with learning disabilities.

    Science.gov (United States)

    Whitington, Jane; Ma, Peng

    People with learning disabilities often experience inequalities in accessing general health services. This group, their families and carers need access to effective palliative care when facing a life limiting illness. This article describes the development and implementation of a fast track referral pathway for people with learning disabilities at St Francis Hospice in Essex. Our aim is to share this pathway so others can replicate the collaborative working to improve access to palliative care services for this group.

  19. Buckling analysis of continuous welded rail track

    NARCIS (Netherlands)

    Van, M.A.

    1996-01-01

    Continuous welded rail track, compared to jointed track not only reduces maintenance costs, but also increases life time of track components and the comfort of passengers. Since expansion of the rails is hardly possible in CWR-track, a temperature increase will result in high compressive stresses

  20. Expectations on Track? High School Tracking and Adolescent Educational Expectations

    DEFF Research Database (Denmark)

    Karlson, Kristian Bernt

    2015-01-01

    This paper examines the role of adaptation in expectation formation processes by analyzing how educational tracking in high schools affects adolescents' educational expectations. I argue that adolescents view track placement as a signal about their academic abilities and respond to it in terms...... of modifying their educational expectations. Applying a difference-in-differences approach to the National Educational Longitudinal Study of 1988, I find that being placed in an advanced or honors class in high school positively affects adolescents’ expectations, particularly if placement is consistent across...... subjects and if placement contradicts tracking experiences in middle school. My findings support the hypothesis that adolescents adapt their educational expectations to ability signals sent by schools....

  1. Developing an electronic system to manage and track emergency medications.

    Science.gov (United States)

    Hamm, Mark W; Calabrese, Samuel V; Knoer, Scott J; Duty, Ashley M

    2018-03-01

    The development of a Web-based program to track and manage emergency medications with radio frequency identification (RFID) is described. At the Cleveland Clinic, medication kit restocking records and dispense locations were historically documented using a paper record-keeping system. The Cleveland Clinic investigated options to replace the paper-based tracking logs with a Web-based program that could track the real-time location and inventory of emergency medication kits. Vendor collaboration with a board of pharmacy (BOP) compliance inspector and pharmacy personnel resulted in the creation of a dual barcoding system using medication and pocket labels. The Web-based program was integrated with a Cleveland Clinic-developed asset tracking system using active RFID tags to give the real-time location of the medication kit. The Web-based program and the asset tracking system allowed identification of kits nearing expiration or containing recalled medications. Conversion from a paper-based system to a Web-based program began in October 2013. After 119 days, data were evaluated to assess the success of the conversion. Pharmacists spent an average of 27 minutes per day approving medication kits during the postimplementation period versus 102 minutes daily using the paper-based system, representing a 74% decrease in pharmacist time spent on this task. Prospective reports are generated monthly to allow the manager to assess the expected workload and adjust staffing for the next month. Implementation of a BOP-approved Web-based system for managing and tracking emergency medications with RFID integration decreased pharmacist review time, minimized compliance risk, and increased access to real-time data. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  2. Central and forward tracking collaboration

    International Nuclear Information System (INIS)

    Foster, R.; Hanson, G.; Luehring, F.; Luo, X.; Martin, B.; Ogren, H.; Rust, D.R.; Wente, E.; Adrian, B.; Alexander, D.; Ells, F.; Erdos, E.; Ford, W.T.; Johnson, D.; Lohner, M.; Rankin, P.; Schultz, G.; Newcomer, F.M.; Van Berg, R.; Williams, H.H.; Arai, Y.; Hess, D.; Kadyk, J.A.; Palounek, A.P.T.; Wise, J.; Chapman, J.W.; Dunn, A.; Edwards, M.; Hiddleston, J.W.; Payne, B.T.; Amery, C.A.; Bailey, J.M.; Dainton, J.B.; Gabathuler, E.; Maxfield, S.J.; Morton, J.M.; Muir, A.; Patel, G.D.; Sanders, P.; Raine, C.; Saxon, D.H.; Hackworth, D.T.; Swensrud, R.L.; Newfield, S.; Sadler, C.; Va'vra, J.

    1991-01-01

    The goal of this subsystem R ampersand D project is to carry out a detailed study and design of a complete wire chamber tracking system covering pseudorapidity |η| ≤ 2.5 in a solenoidal detector for the SSC. Most of our group are now part of the Solenoidal Detector Collaboration (SDC), so the work has evolved into developing a tracking system conceptual design for the SDC detector. The design discussed in this report uses straw tube drift chambers for the central tracking region. Because of the high rates in the SSC environment, a small cell design is needed for wire chambers in the central region. Straw tubes as small cells offer many advantages because the sense wire is enclosed in a continuous cathode, and the wire tension due to the sense wire only can be supported without a massive structure. The straw tubes are grouped together to form superlayers in order to provide local track segments. The superlayers are composed of modules consisting of about two hundred straw tubes enclosed in a carbon fiber composite shell. Straw tubes have been used in previous experiments for small vertex drift chambers. However, they have never before been used for a large tracking system

  3. Track structure in biological models.

    Science.gov (United States)

    Curtis, S B

    1986-01-01

    High-energy heavy ions in the galactic cosmic radiation (HZE particles) may pose a special risk during long term manned space flights outside the sheltering confines of the earth's geomagnetic field. These particles are highly ionizing, and they and their nuclear secondaries can penetrate many centimeters of body tissue. The three dimensional patterns of ionizations they create as they lose energy are referred to as their track structure. Several models of biological action on mammalian cells attempt to treat track structure or related quantities in their formulation. The methods by which they do this are reviewed. The proximity function is introduced in connection with the theory of Dual Radiation Action (DRA). The ion-gamma kill (IGK) model introduces the radial energy-density distribution, which is a smooth function characterizing both the magnitude and extension of a charged particle track. The lethal, potentially lethal (LPL) model introduces lambda, the mean distance between relevant ion clusters or biochemical species along the track. Since very localized energy depositions (within approximately 10 nm) are emphasized, the proximity function as defined in the DRA model is not of utility in characterizing track structure in the LPL formulation.

  4. The MAJORANA Parts Tracking Database

    Energy Technology Data Exchange (ETDEWEB)

    Abgrall, N. [Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, CA (United States); Aguayo, E. [Pacific Northwest National Laboratory, Richland, WA (United States); Avignone, F.T. [Department of Physics and Astronomy, University of South Carolina, Columbia, SC (United States); Oak Ridge National Laboratory, Oak Ridge, TN (United States); Barabash, A.S. [Institute for Theoretical and Experimental Physics, Moscow (Russian Federation); Bertrand, F.E. [Oak Ridge National Laboratory, Oak Ridge, TN (United States); Brudanin, V. [Joint Institute for Nuclear Research, Dubna (Russian Federation); Busch, M. [Department of Physics, Duke University, Durham, NC (United States); Triangle Universities Nuclear Laboratory, Durham, NC (United States); Byram, D. [Department of Physics, University of South Dakota, Vermillion, SD (United States); Caldwell, A.S. [South Dakota School of Mines and Technology, Rapid City, SD (United States); Chan, Y-D. [Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, CA (United States); Christofferson, C.D. [South Dakota School of Mines and Technology, Rapid City, SD (United States); Combs, D.C. [Department of Physics, North Carolina State University, Raleigh, NC (United States); Triangle Universities Nuclear Laboratory, Durham, NC (United States); Cuesta, C.; Detwiler, J.A.; Doe, P.J. [Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, WA (United States); Efremenko, Yu. [Department of Physics and Astronomy, University of Tennessee, Knoxville, TN (United States); Egorov, V. [Joint Institute for Nuclear Research, Dubna (Russian Federation); Ejiri, H. [Research Center for Nuclear Physics and Department of Physics, Osaka University, Ibaraki, Osaka (Japan); Elliott, S.R. [Los Alamos National Laboratory, Los Alamos, NM (United States); and others

    2015-04-11

    The MAJORANA DEMONSTRATOR is an ultra-low background physics experiment searching for the neutrinoless double beta decay of {sup 76}Ge. The MAJORANA Parts Tracking Database is used to record the history of components used in the construction of the DEMONSTRATOR. The tracking implementation takes a novel approach based on the schema-free database technology CouchDB. Transportation, storage, and processes undergone by parts such as machining or cleaning are linked to part records. Tracking parts provide a great logistics benefit and an important quality assurance reference during construction. In addition, the location history of parts provides an estimate of their exposure to cosmic radiation. A web application for data entry and a radiation exposure calculator have been developed as tools for achieving the extreme radio-purity required for this rare decay search.

  5. The MAJORANA Parts Tracking Database

    Science.gov (United States)

    Abgrall, N.; Aguayo, E.; Avignone, F. T.; Barabash, A. S.; Bertrand, F. E.; Brudanin, V.; Busch, M.; Byram, D.; Caldwell, A. S.; Chan, Y.-D.; Christofferson, C. D.; Combs, D. C.; Cuesta, C.; Detwiler, J. A.; Doe, P. J.; Efremenko, Yu.; Egorov, V.; Ejiri, H.; Elliott, S. R.; Esterline, J.; Fast, J. E.; Finnerty, P.; Fraenkle, F. M.; Galindo-Uribarri, A.; Giovanetti, G. K.; Goett, J.; Green, M. P.; Gruszko, J.; Guiseppe, V. E.; Gusev, K.; Hallin, A. L.; Hazama, R.; Hegai, A.; Henning, R.; Hoppe, E. W.; Howard, S.; Howe, M. A.; Keeter, K. J.; Kidd, M. F.; Kochetov, O.; Konovalov, S. I.; Kouzes, R. T.; LaFerriere, B. D.; Leon, J. Diaz; Leviner, L. E.; Loach, J. C.; MacMullin, J.; Martin, R. D.; Meijer, S. J.; Mertens, S.; Miller, M. L.; Mizouni, L.; Nomachi, M.; Orrell, J. L.; O`Shaughnessy, C.; Overman, N. R.; Petersburg, R.; Phillips, D. G.; Poon, A. W. P.; Pushkin, K.; Radford, D. C.; Rager, J.; Rielage, K.; Robertson, R. G. H.; Romero-Romero, E.; Ronquest, M. C.; Shanks, B.; Shima, T.; Shirchenko, M.; Snavely, K. J.; Snyder, N.; Soin, A.; Suriano, A. M.; Tedeschi, D.; Thompson, J.; Timkin, V.; Tornow, W.; Trimble, J. E.; Varner, R. L.; Vasilyev, S.; Vetter, K.; Vorren, K.; White, B. R.; Wilkerson, J. F.; Wiseman, C.; Xu, W.; Yakushev, E.; Young, A. R.; Yu, C.-H.; Yumatov, V.; Zhitnikov, I.

    2015-04-01

    The MAJORANA DEMONSTRATOR is an ultra-low background physics experiment searching for the neutrinoless double beta decay of 76Ge. The MAJORANA Parts Tracking Database is used to record the history of components used in the construction of the DEMONSTRATOR. The tracking implementation takes a novel approach based on the schema-free database technology CouchDB. Transportation, storage, and processes undergone by parts such as machining or cleaning are linked to part records. Tracking parts provide a great logistics benefit and an important quality assurance reference during construction. In addition, the location history of parts provides an estimate of their exposure to cosmic radiation. A web application for data entry and a radiation exposure calculator have been developed as tools for achieving the extreme radio-purity required for this rare decay search.

  6. AHF Booster Tracking with SIMPSONS.

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, D. E. (David E.); Neri, F. (Filippo)

    2002-01-01

    The booster lattice for the Advanced Hydrotest Facility at Los Alamos was tracked in 3-D with the program SIMPSONS, using the full, symplectic lattice from TEAPOT, using the full set of magnet and misalignment errors, as well as full space-charge effects. The only corrections included were a rough closed-orbit correction and chromaticity correction. The lattice was tracked for an entire booster cycle, from multi-turn injection through acceleration to the top energy of 4 GeV, approximately 99,000 turns. An initial injection intensity of 4x1Ol2, injected in 25 turns, resulted in a final intensity of 3 . 2 {approx} 1 0a' {approx}t 4 GeV. Results of the tracking, including emittance growth, particle loss, and particle tune distributions are presented.

  7. AHF Booster Tracking with SIMPSONS

    International Nuclear Information System (INIS)

    Johnson, D.E.; Neri, F.

    2002-01-01

    The booster lattice for the Advanced Hydrotest Facility at Los Alamos was tracked in 3-D with the program SIMPSONS, using the full, symplectic lattice from TEAPOT, using the full set of magnet and misalignment errors, as well as full space-charge effects. The only corrections included were a rough closed-orbit correction and chromaticity correction. The lattice was tracked for an entire booster cycle, from multi-turn injection through acceleration to the top energy of 4 GeV, approximately 99,000 turns. An initial injection intensity of 4x1Ol2, injected in 25 turns, resulted in a final intensity of 3 . 2 ∼ 1 0a' ∼t 4 GeV. Results of the tracking, including emittance growth, particle loss, and particle tune distributions are presented.

  8. SU-G-JeP1-11: Feasibility Study of Markerless Tracking Using Dual Energy Fluoroscopic Images for Real-Time Tumor-Tracking Radiotherapy System

    Energy Technology Data Exchange (ETDEWEB)

    Shiinoki, T; Shibuya, K [Yamaguchi University, Ube, Yamaguchi (Japan); Sawada, A [Kyoto college of medical science, Nantan, Kyoto (Japan); Uehara, T; Yuasa, Y; Koike, M; Kawamura, S [Yamaguchi University Hospital, Ube, Yamaguchi (Japan)

    2016-06-15

    tracking accuracy using proposed dual energy subtraction images for clinical cases.

  9. Magnetic Launch Assist Experimental Track

    Science.gov (United States)

    1999-01-01

    In this photograph, a futuristic spacecraft model sits atop a carrier on the Magnetic Launch Assist System, formerly known as the Magnetic Levitation (MagLev) System, experimental track at the Marshall Space Flight Center (MSFC). Engineers at MSFC have developed and tested Magnetic Launch Assist technologies that would use magnetic fields to levitate and accelerate a vehicle along a track at very high speeds. Similar to high-speed trains and roller coasters that use high-strength magnets to lift and propel a vehicle a couple of inches above a guideway, a Magnetic Launch Assist system would electromagnetically drive a space vehicle along the track. A full-scale, operational track would be about 1.5-miles long and capable of accelerating a vehicle to 600 mph in 9.5 seconds. This track is an advanced linear induction motor. Induction motors are common in fans, power drills, and sewing machines. Instead of spinning in a circular motion to turn a shaft or gears, a linear induction motor produces thrust in a straight line. Mounted on concrete pedestals, the track is 100-feet long, about 2-feet wide, and about 1.5-feet high. The major advantages of launch assist for NASA launch vehicles is that it reduces the weight of the take-off, the landing gear, the wing size, and less propellant resulting in significant cost savings. The US Navy and the British MOD (Ministry of Defense) are planning to use magnetic launch assist for their next generation aircraft carriers as the aircraft launch system. The US Army is considering using this technology for launching target drones for anti-aircraft training.

  10. Pathways from Poverty.

    Science.gov (United States)

    Baldwin, Barbara, Ed.

    1995-01-01

    Articles in this theme issue are based on presentations at the Pathways from Poverty Workshop held in Albuquerque, New Mexico, on May 18-25, 1995. The event aimed to foster development of a network to address rural poverty issues in the Western Rural Development Center (WRDC) region. Articles report on outcomes from the Pathways from Poverty…

  11. Behavioral characteristics and neurobiological substrates shared by Pavlovian sign-tracking and drug abuse.

    Science.gov (United States)

    Tomie, Arthur; Grimes, Kathryn L; Pohorecky, Larissa A

    2008-06-01

    Drug abuse researchers have noted striking similarities between behaviors elicited by Pavlovian sign-tracking procedures and prominent symptoms of drug abuse. In Pavlovian sign-tracking procedures, repeated paired presentations of a small object (conditioned stimulus, CS) with a reward (unconditioned stimulus, US) elicits a conditioned response (CR) that typically consists of approaching the CS, contacting the CS, and expressing consummatory responses at the CS. Sign-tracking CR performance is poorly controlled and exhibits spontaneous recovery and long-term retention, effects that resemble relapse. Sign-tracking resembles psychomotor activation, a syndrome of behavioral responses evoked by addictive drugs, and the effects of sign-tracking on corticosterone levels and activation of dopamine pathways resemble the neurobiological effects of abused drugs. Finally, the neurobiological profile of individuals susceptible to sign-tracking resembles the pathophysiological profile of vulnerability to drug abuse, and vulnerability to sign-tracking predicts vulnerability to impulsive responding and alcohol self-administration. Implications of sign-tracking for models of drug addiction are considered.

  12. Tracking System : Suaineadh satellite experiment

    OpenAIRE

    Brengesjö, Carl; Selin, Martine

    2011-01-01

    The purpose of this bachelor thesis is to present a tracking system for the Suaineadh satellite experiment. The experiment is a part of the REXUS (Rocket EXperiments for University Students) program and the objective is to deploy a foldable web in space. The assignment of this thesis is to develop a tracking system to find the parts from the Suaineadh experiment that will land on Earth. It is important to find the parts and recover all the data that the experiment performed during the travel ...

  13. ATLAS FTK Fast Track Trigger

    CERN Document Server

    Iizawa, T; The ATLAS collaboration

    2014-01-01

    The Fast TracKer (FTK) will perform global track reconstruction after each Level-1 trigger accept signal to enable the software-based higher level trigger to have early access to tracking information. FTK is a dedicated processor based on a mixture of advanced technologies. Modern, powerful Field Programmable Gate Arrays (FPGAs) form an important part of the system architecture, and the large level of computing power required for pattern recognition is provided by incorporating standard-cell ASICs named Associative Memory (AM). Motivation and the architecture of the FTK system will be presented, and the status of hardware and simulation will be following.

  14. Fission tracks diameters in glasses

    International Nuclear Information System (INIS)

    Garzon Ruiperez, L.; Veiguela, J.

    1974-01-01

    Standard glass microscope slides have been irradiated with fission fragments from the uranium. The etching track conditions have been the same for the series, having changed the etching time only for each specimen. For each glass, a minimum of 250 measurements of the tracks diameters have been made, the distributions of which are the bimodal type. Diameters-etching dependence with time is roughly lineal. Energy determinations have been made with the help of the diameters-energy relations. The calculated values agree very well with the know ones. (author) [es

  15. Markerless 3D Face Tracking

    DEFF Research Database (Denmark)

    Walder, Christian; Breidt, Martin; Bulthoff, Heinrich

    2009-01-01

    We present a novel algorithm for the markerless tracking of deforming surfaces such as faces. We acquire a sequence of 3D scans along with color images at 40Hz. The data is then represented by implicit surface and color functions, using a novel partition-of-unity type method of efficiently...... the scanned surface, using the variation of both shape and color as features in a dynamic energy minimization problem. Our prototype system yields high-quality animated 3D models in correspondence, at a rate of approximately twenty seconds per timestep. Tracking results for faces and other objects...

  16. Self-Tracking: Reflections from the BodyTrack Project.

    Science.gov (United States)

    Wright, Anne

    2016-07-06

    Based on the author's experiences the practice of self-tracking can empower individuals to explore and address issues in their lives. This work is inspired by examples of people who have reclaimed their wellness through an iterative process of noticing patterns of ups and downs, trying out new ideas and strategies, and observing the results. In some cases, individuals have realized that certain foods, environmental exposures, or practices have unexpected effects for them, and that adopting custom strategies can greatly improve quality of life, overcoming chronic problems. Importantly, adopting the role of investigator of their own situation appears to be transformative: people who embarked on this path changed their relationship to their health situation even before making discoveries that helped lead to symptom improvement. The author co-founded the BodyTrack project in 2010 with the goal of empowering a broader set of people to embrace this investigator role in their own lives and better address their health and wellness concerns, particularly those with complex environmental or behavioral components. The core of the BodyTrack system is an open source web service called Fluxtream ( https://fluxtream.org ) that allows users to aggregate, visualize, and reflect on data from myriad sources on a common timeline. The project is also working to develop and spread peer coaching practices to help transfer the culture and skills of self-tracking while mentoring individuals in how to self-assess their own situation and guide the process for themselves.

  17. THE CORRELATED TRACK RECEIVER OF TONE TRACK CIRCUITS

    Directory of Open Access Journals (Sweden)

    K. V. Goncharov

    2011-05-01

    Full Text Available The work is devoted to further improvement of processing algorithm of checking signals of rail line. The simulation modeling of correlation track receiver of tone rail circuits has been executed; the benchmark analysis of correlation receiver and direct amplifier receiver has been executed.

  18. Crystallization Pathways in Biomineralization

    Science.gov (United States)

    Weiner, Steve; Addadi, Lia

    2011-08-01

    A crystallization pathway describes the movement of ions from their source to the final product. Cells are intimately involved in biological crystallization pathways. In many pathways the cells utilize a unique strategy: They temporarily concentrate ions in intracellular membrane-bound vesicles in the form of a highly disordered solid phase. This phase is then transported to the final mineralization site, where it is destabilized and crystallizes. We present four case studies, each of which demonstrates specific aspects of biological crystallization pathways: seawater uptake by foraminifera, calcite spicule formation by sea urchin larvae, goethite formation in the teeth of limpets, and guanine crystal formation in fish skin and spider cuticles. Three representative crystallization pathways are described, and aspects of the different stages of crystallization are discussed. An in-depth understanding of these complex processes can lead to new ideas for synthetic crystallization processes of interest to materials science.

  19. Measuring Cutaneous Lesions: Trends in Clinical Practice.

    Science.gov (United States)

    Zhang, Shali; Blalock, Travis W

    2018-03-01

    Knowing the size of a cutaneous lesion can be important for tracking its progression over time, selecting the proper treatment modality, surgical planning, determining prognosis, and accurate billing. However, providers vary in their consistency, accuracy, and methods of measuring cutaneous lesions. To investigate the clinical practices of US dermatologists and dermatologic surgeons regarding how they determine the size of cutaneous lesions. A survey was electronically distributed to members of the American Society for Dermatologic Surgery. Four hundred twenty-six dermatologists completed the online survey. When a lesion is suspected to be malignant, 85% of respondents obtained exact measurements most, if not all, of the time; however, only 8% did for benign lesions. Most providers determined lesion sizes themselves rather than delegating to staff. When performing visual estimation, approximately three-quarters believed that they were accurate to within 1 to 2 mm. The top reasons for obtaining exact measurements were for tracking atypical pigmented lesions, determining treatment pathways, and accurate billing. The majority of respondents believed that lesion size affected management decisions; however, the need for exact measurement remains controversial, particularly for benign lesions. Future studies may investigate whether taking exact versus estimated measurements has an effect on outcomes.

  20. Kinematic MR imaging of the knee for evaluating patellar tracking

    International Nuclear Information System (INIS)

    Shellock, F.G.; Mink, J.H.; Fox, J.

    1988-01-01

    A new technique to evaluate patellar tracking uses MR imaging and a specially designed positioning device (MEDRAD). T1-weighted, axial plane imaging was performed on both knees at the following joint angles: 0 0 , 5 0 , 10 0 , 15 0 , 20 0 , 25 0 , and 30 0 . The total examination time was approximately 12 minutes. Images were viewed in a cine loop to produce a kinematic study that depicted the relationship of the patella to the trochlear groove during the different angles of knee flexion. To date, 102 subjects (204 knees) have been examined. Dislocation, subluxatino, lateral tilt, lateral and medial displacement of the patella, and normal patellar tracking could all be identified with this technique. Abnormal configurations of the patella and/or trochlear groove were also clearly demonstrated. In conclusion, kinematic MR imaging of the knee provided important clinical information concerning patellar tracking and other related abnormalities of the patellofemoral joint

  1. Large Radius Tracking at the ATLAS Experiment

    CERN Document Server

    Lutz, Margaret Susan; The ATLAS collaboration

    2017-01-01

    Many exotics and SUSY models include particles which are long lived resulting in decays which are highly displaced from the proton-proton interaction point (IP). The standard track reconstruction algorithm used by the ATLAS collaboration is optimized for tracks from “primary” particles, which originate close to the IP. Thus, tight restrictions on the transverse and longitudinal impact parameters, as well as on several other tracking variables, are applied to improve the track reconstruction performance and to reduce the fake rate. This track reconstruction is very efficient for primary particles, but not for the non-prompt particles mentioned above.  In order to reconstruct tracks with large impact parameters due to displaced decays, a tracking algorithm has been optimized to re-run with loosened requirements over the hits left over after standard track reconstruction has finished. Enabling this “retracking” has significantly increased the efficiency of reconstructing tracks from displaced decays, wh...

  2. Can smartwatches replace smartphones for posture tracking?

    Science.gov (United States)

    Mortazavi, Bobak; Nemati, Ebrahim; VanderWall, Kristina; Flores-Rodriguez, Hector G; Cai, Jun Yu Jacinta; Lucier, Jessica; Naeim, Arash; Sarrafzadeh, Majid

    2015-10-22

    This paper introduces a human posture tracking platform to identify the human postures of sitting, standing or lying down, based on a smartwatch. This work develops such a system as a proof-of-concept study to investigate a smartwatch's ability to be used in future remote health monitoring systems and applications. This work validates the smartwatches' ability to track the posture of users accurately in a laboratory setting while reducing the sampling rate to potentially improve battery life, the first steps in verifying that such a system would work in future clinical settings. The algorithm developed classifies the transitions between three posture states of sitting, standing and lying down, by identifying these transition movements, as well as other movements that might be mistaken for these transitions. The system is trained and developed on a Samsung Galaxy Gear smartwatch, and the algorithm was validated through a leave-one-subject-out cross-validation of 20 subjects. The system can identify the appropriate transitions at only 10 Hz with an F-score of 0.930, indicating its ability to effectively replace smart phones, if needed.

  3. Results of a phase I pilot clinical trial examining the effect of plant-derived resveratrol and grape powder on Wnt pathway target gene expression in colonic mucosa and colon cancer

    International Nuclear Information System (INIS)

    Nguyen, Anthony V; Martinez, Micaela; Stamos, Michael J; Moyer, Mary P; Planutis, Kestutis; Hope, Christopher; Holcombe, Randall F

    2009-01-01

    Resveratrol exhibits colon cancer prevention activity in animal models; it is purported to have this activity in humans and inhibit a key signaling pathway involved in colon cancer initiation, the Wnt pathway, in vitro. A phase I pilot study in patients with colon cancer was performed to evaluate the effects of a low dose of plant-derived resveratrol formulation and resveratrol-containing freeze-dried grape powder (GP) on Wnt signaling in the colon. Eight patients were enrolled and normal colonic mucosa and colon cancer tissue were evaluated by Wnt pathway-specific microarray and quantitative real-time polymerase chain reaction (qRT-PCR) pre- and post-exposure to resveratrol/GP. Based on the expression of a panel of Wnt target genes, resveratrol/GP did not inhibit the Wnt pathway in colon cancer but had significant (p < 0.03) activity in inhibiting Wnt target gene expression in normal colonic mucosa. The greatest effect on Wnt target gene expression was seen following ingestion of 80 g of GP per day (p < 0.001). These results were confirmed with qRT-PCR of cyclinD1 and axinII. The inhibitory effect of GP on Wnt signal throughput was confirmed in vitro with a normal colonic mucosa-derived cell line. These data suggest that GP, which contains low dosages of resveratrol in combination with other bioactive components, can inhibit the Wnt pathway in vivo and that this effect is confined to the normal colonic mucosa. Further study of dietary supplementation with resveratrol-containing foods such as whole grapes or GP as a potential colon cancer preventive strategy is warranted. NCT00256334

  4. PHENIX central arm tracking detectors

    International Nuclear Information System (INIS)

    Adcox, K.; Ajitanand, N.N.; Alexander, J.; Autrey, D.; Averbeck, R.; Azmoun, B.; Barish, K.N.; Baublis, V.V.; Belkin, R.; Bhaganatula, S.; Biggs, J.C.; Borland, D.; Botelho, S.; Bryan, W.L.; Burward-Hoy, J.; Butsyk, S.A.; Chang, W.C.; Christ, T.; Dietzsch, O.; Drees, A.; Rietz, R. du; El Chenawi, K.; Evseev, V.A.; Fellenstein, J.; Ferdousi, T.; Fraenkel, Z.; Franz, A.; Fung, S.Y.; Gannon, J.; Garpman, S.; Godoi, A.L.; Greene, S.V.; Gustafsson, H.-A.; Harder, J.; Hemmick, T.K.; Heuser, J.M.; Holzmann, W.; Hutter, R.; Issah, M.; Ivanov, V.I.; Jacak, B.V.; Jagadish, U.; Jia, J.; Johnson, S.C.; Kandasamy, A.; Kann, M.R.; Kelley, M.A.; Khanzadeev, A.V.; Khomutnikov, A.; Komkov, B.G.; Kopytine, M.L.; Kotchenda, L.; Kotchetkov, D.; Kozlov, V.S.; Kravtsov, P.A.; Kudin, L.G.; Kuriatkov, V.V.; Lacey, R.; Lauret, J.; Lebedev, A.; Lebedev, V.D.; Li, X.H.; Libby, B.; Liccardi, W.; Machnowski, R.; Mahon, J.; Markushin, D.G.; Matathias, F.; Marx, M.D.; Messer, F.; Miftakhov, N.M.; Milan, J.; Miller, T.E.; Milov, A.; Minuzzo, K.; Mioduszewski, S.; Mitchell, J.T.; Muniruzzamann, M.; Nandi, B.K.; Negrin, J.; Nilsson, P.; Nystrand, J.; O'Brien, E.; O'Connor, P.; Oskarsson, A.; Oesterman, L.; Otterlund, I.; Pancake, C.E.; Pantuev, V.S.; Petersen, R.; Pinkenburg, C.H.; Pisani, R.P.; Purwar, A.K.; Rankowitz, S.; Ravinovich, I.; Riabov, V.G.; Riabov, Yu.G.; Rosati, M.; Rose, A.A.; Roschin, E.V.; Samsonov, V.M.; Sangster, T.C.; Seto, R.; Silvermyr, D.; Sivertz, M.; Smith, M.; Solodov, G.P.; Stenlund, E.; Takagui, E.M.; Tarakanov, V.I.; Tarasenkova, O.P.; Thomas, J.L.; Trofimov, V.A.; Tserruya, I.; Tydesjoe, H.; Velkovska, J.; Velkovsky, M.; Vishnevskii, V.I.; Vorobyov, A.A.; Vznuzdaev, E.A.; Vznuzdaev, M.; Wang, H.Q.; Weimer, T.; Wolniewicz, K.; Wu, J.; Xie, W.; Young, G.R.

    2003-01-01

    The PHENIX tracking system consists of Drift Chambers (DC), Pad Chambers (PC) and the Time Expansion Chamber (TEC). PC1/DC and PC2/TEC/PC3 form the inner and outer tracking units, respectively. These units link the track segments that transverse the RICH and extend to the EMCal. The DC measures charged particle trajectories in the r-phi direction to determine p T of the particles and the invariant mass of particle pairs. The PCs perform 3D spatial point measurements for pattern recognition and longitudinal momentum reconstruction and provide spatial resolution of a few mm in both r-phi and z. The TEC tracks particles passing through the region between the RICH and the EMCal. The design and operational parameters of the detectors are presented and running experience during the first year of data taking with PHENIX is discussed. The observed spatial and momentum resolution is given which imposes a limitation on the identification and characterization of charged particles in various momentum ranges

  5. Eye tracking for visual marketing

    NARCIS (Netherlands)

    Wedel, M.; Pieters, R.

    2008-01-01

    We provide the theory of visual attention and eye-movements that serves as a basis for evaluating eye-tracking research and for discussing salient and emerging issues in visual marketing. Motivated from its rising importance in marketing practice and its potential for theoretical contribution, we

  6. Deformable Models for Eye Tracking

    DEFF Research Database (Denmark)

    Vester-Christensen, Martin; Leimberg, Denis; Ersbøll, Bjarne Kjær

    2005-01-01

    A deformable template method for eye tracking on full face images is presented. The strengths of the method are that it is fast and retains accuracy independently of the resolution. We compare the me\\$\\backslash\\$-thod with a state of the art active contour approach, showing that the heuristic...

  7. DMIR on Microblog Track 2011

    NARCIS (Netherlands)

    W. Li; A.P. de Vries (Arjen); C. Eickhoff (Carsten)

    2011-01-01

    htmlabstractIn this paper we present our work on Microblog Track of TREC 2011. We tried two methods to tackle the problem of tweets retrieval, namely EMAX and RTB. The first method EMAX is mainly based on the intuition that not only should retrieved tweets contain the keywords in given queries but

  8. Tracks: EPHT Massachusetts Case Study

    Centers for Disease Control (CDC) Podcasts

    2009-07-20

    This podcast highlights the Massachusetts Environmental Public Health Tracking Network and features commentary from Massachusetts Department of Public Health Associate Health Commissioner Suzanne Condon.  Created: 7/20/2009 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/20/2009.

  9. Emergency Brake for Tracked Vehicles

    Science.gov (United States)

    Green, G. L.; Hooper, S. L.

    1986-01-01

    Caliper brake automatically stops tracked vehicle as vehicle nears end of travel. Bar on vehicle, traveling to right, dislodges block between brake pads. Pads then press against bar, slowing vehicle by friction. Emergencybraking system suitable for elevators, amusement rides and machine tools.

  10. Tracking sentence planning and production.

    Science.gov (United States)

    Kemper, Susan; Bontempo, Daniel; McKedy, Whitney; Schmalzried, RaLynn; Tagliaferri, Bruno; Kieweg, Doug

    2011-03-01

    To assess age differences in the costs of language planning and production. A controlled sentence production task was combined with digital pursuit rotor tracking. Participants were asked to track a moving target while formulating a sentence using specified nouns and verbs and to continue to track the moving target while producing their response. The length of the critical noun phrase (NP) as well as the type of verb provided were manipulated. The analysis indicated that sentence planning was more costly than sentence production, and sentence planning costs increased when participants had to incorporate a long NP into their sentence. The long NPs also tended to be shifted to the end of the sentence, whereas short NPs tended to be positioned after the verb. Planning or producing responses with long NPs was especially difficult for older adults, although verb type and NP shift had similar costs for young and older adults. Pursuit rotor tracking during controlled sentence production reveals the effects of aging on sentence planning and production.

  11. ATLAS FTK: Fast Track Trigger

    CERN Document Server

    Volpi, Guido; The ATLAS collaboration

    2015-01-01

    An overview of the ATLAS Fast Tracker processor is presented, reporting the design of the system, its expected performance, and the integration status. The next LHC runs, with a significant increase in instantaneous luminosity, will provide a big challenge to the trigger and data acquisition systems of all the experiments. An intensive use of the tracking information at the trigger level will be important to keep high efficiency in interesting events, despite the increase in multiple p-p collisions per bunch crossing (pile-up). In order to increase the use of tracks within the High Level Trigger (HLT), the ATLAS experiment planned the installation of an hardware processor dedicated to tracking: the Fast TracKer (FTK) processor. The FTK is designed to perform full scan track reconstruction at every Level-1 accept. To achieve this goal, the FTK uses a fully parallel architecture, with algorithms designed to exploit the computing power of custom VLSI chips, the Associative Memory, as well as modern FPGAs. The FT...

  12. Whose track is it anyway?

    DEFF Research Database (Denmark)

    Flora, Janne; Andersen, Astrid Oberborbeck

    2017-01-01

    tracked their hunting routes, registered animals caught and observed, and photographed and videoed important places, events, and other phenomena they found interesting and relevant to register. This essay describes the conception and implementation of Piniariarneq, and uses this experience as a lens...

  13. Fast-Track Teacher Recruitment.

    Science.gov (United States)

    Grant, Franklin Dean

    2001-01-01

    Schools need a Renaissance human-resources director to implement strategic staffing and fast-track teacher-recruitment plans. The HR director must attend to customer satisfaction, candidate supply, web-based recruitment possibilities, stabilization of newly hired staff, retention of veteran staff, utilization of retired employees, and latest…

  14. Bubble chamber: colour enhanced tracks

    CERN Multimedia

    1998-01-01

    This artistically-enhanced image of real particle tracks was produced in the Big European Bubble Chamber (BEBC). Liquid hydrogen is used to create bubbles along the paths of the particles as a piston expands the medium. A magnetic field is produced in the detector causing the particles to travel in spirals, allowing charge and momentum to be measured.

  15. Migration pathways in soils

    International Nuclear Information System (INIS)

    Gronow, J.R.

    1986-01-01

    This study looked at diffusive migration through three types of deformation; the projectile pathways, hydraulic fractures of the sediments and faults, and was divided into three experimental areas: autoradiography, the determination of diffusion coefficients and electron microscopy of model projectile pathways in clay. For the autoradiography, unstressed samples were exposed to two separate isotopes, Pm-147 (a possible model for Am behaviour) and the poorly sorbed iodide-125. The results indicated that there was no enhanced migration through deformed kaolin samples nor through fractured Great Meteor East (GME) sediment, although some was evident through the projectile pathways in GME and possibly through the GME sheared samples. The scanning electron microscopy of projectile pathways in clay showed that emplacement of a projectile appeared to have no effect on the orientation of particles at distances greater than two projectile radii from the centre of a projectile pathway. It showed that the particles were not simply aligned with the direction of motion of the projectile but that, the closer to the surface of a particular pathway, the closer the particles lay to their original orientation. This finding was of interest from two points of view: i) the ease of migration of a pollutant along the pathway, and ii) possible mechanisms of hole closure. It was concluded that, provided that there is no advective migration, the transport of radionuclides through sediments containing these defects would not be significantly more rapid than in undeformed sediments. (author)

  16. Is There Volume Transmission Along Extracellular Fluid Pathways Corresponding to the Acupuncture Meridians?

    Directory of Open Access Journals (Sweden)

    Weibo Zhang

    2017-02-01

    Full Text Available Volume transmission is a new major communication signaling via extracellular fluid (interstitial fluid pathways. It was proposed by the current authors that such pathways can explain the meridian phenomena and acupuncture effects. To investigate whether meridian-like structures exist in fish body and operate via volume transmission in extracellular fluid pathways, we injected alcian blue (AB under anesthesia into Gephyrocharax melanocheir, which has a translucent body. The migration of AB could be seen directly and was recorded by a digital camera. The fish was then embedded and cut transversely to observe the position of tracks in three dimensions. Eight longitudinal threadlike blue tracks were recognized on the fish. The positions of these threadlike tracks were similar to meridians on the human body. Transverse sections showed that these tracks distributed to different layers of distinct subcutaneous loose connective tissues and intermuscular septa. Lymphatic vessels were sometimes associated with the extracellular blue tracks where the migration of AB occurred. Extracellular fluid pathways were found on fish through their transport of AB. These pathways operating via volume transmission appeared to be similar in positions and functions to the acupuncture meridians in Chinese medicine.

  17. A strategy for evaluating pathway analysis methods.

    Science.gov (United States)

    Yu, Chenggang; Woo, Hyung Jun; Yu, Xueping; Oyama, Tatsuya; Wallqvist, Anders; Reifman, Jaques

    2017-10-13

    Researchers have previously developed a multitude of methods designed to identify biological pathways associated with specific clinical or experimental conditions of interest, with the aim of facilitating biological interpretation of high-throughput data. Before practically applying such pathway analysis (PA) methods, we must first evaluate their performance and reliability, using datasets where the pathways perturbed by the conditions of interest have been well characterized in advance. However, such 'ground truths' (or gold standards) are often unavailable. Furthermore, previous evaluation strategies that have focused on defining 'true answers' are unable to systematically and objectively assess PA methods under a wide range of conditions. In this work, we propose a novel strategy for evaluating PA methods independently of any gold standard, either established or assumed. The strategy involves the use of two mutually complementary metrics, recall and discrimination. Recall measures the consistency of the perturbed pathways identified by applying a particular analysis method to an original large dataset and those identified by the same method to a sub-dataset of the original dataset. In contrast, discrimination measures specificity-the degree to which the perturbed pathways identified by a particular method to a dataset from one experiment differ from those identifying by the same method to a dataset from a different experiment. We used these metrics and 24 datasets to evaluate six widely used PA methods. The results highlighted the common challenge in reliably identifying significant pathways from small datasets. Importantly, we confirmed the effectiveness of our proposed dual-metric strategy by showing that previous comparative studies corroborate the performance evaluations of the six methods obtained by our strategy. Unlike any previously proposed strategy for evaluating the performance of PA methods, our dual-metric strategy does not rely on any ground truth

  18. Pseudocolor techniques for differentiation of nuclear tracks

    International Nuclear Information System (INIS)

    Camacho, S.; Laville, A.; Peralta-Fabi, R.; Lira, J.

    1984-01-01

    Two types of tracks left by 4 He particles at different angles of incidence to CA8015 detectors were successfully discriminated by an SEM coupled to a micro-computer image processing system. To achieve this end, a track signature is defined based on the image's gray level distribution which results from the interaction between the track profile and the electron beam. The principles of track signature extraction, determination of discriminant functions and the design of the ad hoc supervised classifier are described. Finally the possibility of obtaining the track profile through digital analysis of track signatures is discussed. (author)

  19. D0 central tracking chamber performance studies

    International Nuclear Information System (INIS)

    Pizzuto, D.

    1991-12-01

    The performance of the completed DO central tracking chamber was studied using cosmic rays at the State University of New York at Stony Brook. Also studied was a prototype tracking chamber identical in design to the completed DO tracking chamber. The prototype chamber was exposed to a collimated beam of 150 GeV pions at the Fermilab NWA test facility. Results indicate an RΦ tracking resolution compatible with the limitations imposed by physical considerations, excellent 2 track resolution, and a high track reconstruction efficiency along with a good rejection power against γ → e + e - events

  20. Robotic vehicle with multiple tracked mobility platforms

    Science.gov (United States)

    Salton, Jonathan R [Albuquerque, NM; Buttz, James H [Albuquerque, NM; Garretson, Justin [Albuquerque, NM; Hayward, David R [Wetmore, CO; Hobart, Clinton G [Albuquerque, NM; Deuel, Jr., Jamieson K.

    2012-07-24

    A robotic vehicle having two or more tracked mobility platforms that are mechanically linked together with a two-dimensional coupling, thereby forming a composite vehicle of increased mobility. The robotic vehicle is operative in hazardous environments and can be capable of semi-submersible operation. The robotic vehicle is capable of remote controlled operation via radio frequency and/or fiber optic communication link to a remote operator control unit. The tracks have a plurality of track-edge scallop cut-outs that allow the tracks to easily grab onto and roll across railroad tracks, especially when crossing the railroad tracks at an oblique angle.