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Sample records for track clinical pathway

  1. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway.

    Science.gov (United States)

    Muehling, Bernd M; Halter, Gisela L; Schelzig, Hubert; Meierhenrich, Rainer; Steffen, Peter; Sunder-Plassmann, Ludger; Orend, Karl-Heinz

    2008-07-01

    Fast track programs, multimodal therapy strategies, have been introduced in many surgical fields to minimize postoperative morbidity and mortality. In terms of lung resections no randomized controlled trials exist to evaluate such patient care programs. In a prospective, randomized controlled pilot study a conservative and fast track treatment regimen in patients undergoing lung resections was compared. Main differences between the two groups consisted in preoperative fasting (6h vs 2h) and analgesia (patient controlled analgesia vs patient controlled epidural analgesia). Study endpoints were pulmonary complications (pneumonia, atelectasis, prolonged air leak), overall morbidity and mortality. Analysis was performed in an intention to treat. Both study groups were similar in terms of age, sex, preoperative forced expiratory volume in one second (FEV(1)), American Society of Anesthesiologists score and operations performed. The rate of postoperative pulmonary complications was 35% in the conservative and 6.6% in the fast track group (p=0.009). A subgroup of patients with reduced preoperative FEV(1) (<75% of predicted value) experienced less pulmonary complications in the fast track group (55% vs 7%, p=0.023). Overall morbidity was not significantly different (46% vs 26%, p=0.172), mortality was comparable in both groups (4% vs 3%). We evaluated an optimized patient care program for patients undergoing lung resections in a prospective randomized pilot study. Using this fast track clinical pathway the rate of pulmonary complications could be significantly decreased as compared to a conservative treatment regimen; our results support the implementation of an optimized perioperative treatment in lung surgery in order to reduce pulmonary complications after major lung surgery.

  2. [Application of clinical nursing pathway in fast-track program of splenomegaly advanced schistosomiasis patients].

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    Zhou, Rui-hong; Liu, Jia-xin; Pan, Jie; Zhou, Lu; Liu, Ling; Li, Qin

    2015-10-01

    To evaluate the effect of clinical nursing pathway in fast-track program (FTS-CNP) in splenomegaly advanced schistosomiasis patients during the perioperative period. A total of 80 patients with splenomegaly advanced schistosomiasis who were treated with selective operation in the Affiliated Xiangyue Hospital of Hunan Institute of Parasitic Diseases from January, 2012 to December, 2014 were divided into an observation group (n = 40) and a control group (n = 40). FTS-CNP was implemented in the observation group, while the routine nursing was used in the control group. Then the physical rehabilitation and psychological health levels of the patients in the two groups post-operation were observed and compared. After the operation, the duration of first taking food [(14.67 ± 2.90) h], first anus exhausting [(25.30 ± 3.46) h], first off-bed activity [ (29.40 ± 5.57) h], as well as the duration of hospital stays [(19.00 ± 2.82) d] of patients in the observation group were all shorter than those of the patients in the control group [(44.50 ± 6.71) h, (52.80 ± 6.95) h, (35.05 ± 10.37) h, (25.08 ± 2.39) d, respectively] , and the incidence rate of postoperative complications (7.50%) of the former was lower than that of the latter (25.00%), and all the differences were statistically significant (all P observation group were lower than those of the patients in the control group (46.89 8.92, 47.06 ± 10.29), both differences were statistically significant (both P < 0.01). FTS-CNP can promote the physical and psychological recovery of the splenomegaly advanced schistosomiasis patients post-operation, and also can shorten the hospitals stays and reduce the complications.

  3. Finding metabolic pathways using atom tracking

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    Heath, Allison P.; Bennett, George N.; Kavraki, Lydia E.

    2010-01-01

    Motivation: Finding novel or non-standard metabolic pathways, possibly spanning multiple species, has important applications in fields such as metabolic engineering, metabolic network analysis and metabolic network reconstruction. Traditionally, this has been a manual process, but the large volume of metabolic data now available has created a need for computational tools to automatically identify biologically relevant pathways. Results: We present new algorithms for finding metabolic pathways, given a desired start and target compound, that conserve a given number of atoms by tracking the movement of atoms through metabolic networks containing thousands of compounds and reactions. First, we describe an algorithm that identifies linear pathways. We then present a new algorithm for finding branched metabolic pathways. Comparisons to known metabolic pathways demonstrate that atom tracking enables our algorithms to avoid many unrealistic connections, often found in previous approaches, and return biologically meaningful pathways. Our results also demonstrate the potential of the algorithms to find novel or non-standard pathways that may span multiple organisms. Availability: The software is freely available for academic use at: http://www.kavrakilab.org/atommetanet Contact: kavraki@rice.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:20421197

  4. 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.

  5. 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.

  6. A career path in clinical pathways.

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    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.

  7. [Combining clinical pathway and patient education approaches].

    Science.gov (United States)

    Bonnabel, Laurence; Huteau, Marie-Ève; Filhol, Nathalie; Clottes, Edwige; Massin, Julie; Quenet, François; Stoebner-Delbarre, Anne

    2016-01-01

    The integration of the therapeutic education of the patient into a clinical pathway approach helps to optimise nursing practice. Despite some limits, this method allows the position of the caregiver to evolve, going beyond the required methodological framework. It results in the emergence of several new educational facets which are essential for the patient and enable them to become a player in their own care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. 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.

  9. 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

  10. 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......-technicians collected blood samples. CONCLUSIONS: Each clinical laboratory should record errors in a structured manner. A relation database is a useful tool for the recording and extraction of data, as the database can be structured to reflect the workflow at each individual laboratory....... classified according to function, and errors were classified as pre-analytical, analytical, post-analytical, or service-related, and then further divided into descriptive subgroups. Samples were taken from hospital wards (38.6%), outpatient clinics (25.7%), general practitioners (29.4%), and other hospitals...

  11. Online treatment compliance checking for clinical pathways.

    Science.gov (United States)

    Huang, Zhengxing; Bao, Yurong; Dong, Wei; Lu, Xudong; Duan, Huilong

    2014-10-01

    Compliance checking for clinical pathways (CPs) is getting increasing attention in health-care organizations due to stricter requirements for cost control and treatment excellence. Many compliance measures have been proposed for treatment behavior inspection in CPs. However, most of them look at aggregated data seen from an external perspective, e.g. length of stay, cost, infection rate, etc., which may provide only a posterior impression of the overall conformance with the established CPs such that in-depth and in near real time checking on the compliance of the essential/critical treatment behaviors of CPs is limited. To provide clinicians real time insights into violations of the established CP specification and support online compliance checking, this article presents a semantic rule-based CP compliance checking system. In detail, we construct a CP ontology (CPO) model to provide a formal grounding of CP compliance checking. Using the proposed CPO, domain treatment constraints are modeled into Semantic Web Rule Language (SWRL) rules to specify the underlying treatment behaviors and their quantified temporal structure in a CP. The established SWRL rules are integrated with the CP workflow such that a series of applicable compliance checking and evaluation can be reminded and recommended during the pathway execution. The proposed approach can, therefore, provides a comprehensive compliance checking service as a paralleling activity to the patient treatment journey of a CP rather than an afterthought. The proposed approach is illustrated with a case study on the unstable angina clinical pathway implemented in the Cardiology Department of a Chinese hospital. The results demonstrate that the approach, as a feasible solution to provide near real time conformance checking of CPs, not only enables clinicians to uncover non-compliant treatment behaviors, but also empowers clinicians with the capability to make informed decisions when dealing with treatment compliance

  12. 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

  13. Waiting time at a fast-track diagnostic clinic

    NARCIS (Netherlands)

    Basta, Y. L.; Tytgat, K. M. A. J.; Klinkenbijl, J. H. G.; Fockens, P.; Smets, E. M. A.

    2016-01-01

    Purpose - Guidelines stating maximum waiting times fail to take cancer patients' expectations into account. Therefore, the purpose of this paper is to assess patients' expectations and experiences with their waiting time at a fast-track clinic. Design/methodology/approach - Patients were selected

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

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    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

  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. 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...

  17. [Evaluation of a clinical pathway for septic arthritis].

    Science.gov (United States)

    Merino Muñoz, R; Martín Vega, A; García Caballero, J; García-Consuegra Molina, J

    2007-07-01

    Clinical pathways are tools that coordinate clinical work, reducing interclinican variability and improving patient care and management. The use of clinical pathways in septic arthritis is appropriate, as this disease has a predictable course and there is considerable variation in its management. The aim of this study was to evaluate a septic arthritis clinical pathway 2 years after its introduction and to describe the characteristics of the patients included. Clinical pathway documents: pathway matrix sheet, variance form, parent information sheet, satisfaction survey and evaluation indicators sheet. Thirty-five patients were included, seven with a definitive diagnosis of septic arthritis and 28 with probable septic arthritis. No differences were found between the two groups, with good outcomes in both. Laboratory analyses were performed at admission in all patients, at discharge in 51 %, and at the end of treatment in 97 %. The indicators that best met the standard were clinical pathway coverage, performance of arthrocentesis/arthrotomy, and satisfaction with dealings with staff and the information received. The indicators furthest from the standard were admission shorter than 7 days (77 % vs > 95 %) and obtaining articular fluid prior to antibiotic therapy (76 % vs > 90 %). The clinical pathway is useful for standardizing the process of septic arthritis diagnosis and treatment. With adequate clinical support, application of this pathway allows decisions to be made on hospital discharge following the clinical criteria of improvement without worsening prognosis. Our immediate challenges are to reduce inpatient stay and to obtain synovial fluid before starting antibiotic therapy.

  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. A renal colic fast track pathway to improve waiting times and outcomes for patients presenting to the emergency department

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    Al Kadhi O

    2017-07-01

    Full Text Available Omar Al Kadhi,1 Kate Manley,1 Madhavi Natarajan,1 Valmiki Lutchmedial,2 Abbi Forsyth,2 Kate Tabrett,2 Jonathan Betteridge,2 William Finch,3 Heinrich Hollis4 1Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, 2Faculty of Medicine and Health Sciences, University of East Anglia, 3Department of Urology, 4Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK Introduction: Renal colic is commonly encountered in the emergency department (ED. We validated a fast track renal colic (FTRC initiative to decrease patient waiting times and streamline patient flow.Method: The FTRC pathway was devised according to the National Institute for Health and Care Excellence clinical summary criteria for the management of patients with suspected renal colic. ED triage nurses use the pathway to identify patients with likely renal colic suitable for fast track to analgesia, investigation and management. Investigations, diagnosis and patient demographics were recorded for 1157 consecutive patients coded as renal colic at a single-center ED over 12 months.Results: Three hundred and two patients were suitable for the FTRC pathway (26.1%, while 855 were seen by the ED clinicians prior to onward referral. Also, 83.9% of patients underwent computed tomography scan. In the FTRC group, 57.3% of patients had radiologically confirmed calculi versus 53.8% in the non-FTRC group (p=0.31. Alternative diagnoses among FTRC patients (2.6% included ovarian pathology (n=1, diverticulitis (n=2 and incidental renal cell carcinoma (n=2, while 26.1% had no identifiable pathology. No immediately life-threatening diagnoses were identified on imaging. Computed tomography scans performed in the non-FTRC group identified two ruptured abdominal aortic aneurysms and alternative diagnoses (2.57% including ovarian pathology (n=7, cholecystitis (n=2, incidental renal cell carcinoma (n=3 and inflammatory bowel

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

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    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.

  1. 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.

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

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    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.

  3. 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 or ...... the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders......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...... or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated...

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

    NARCIS (Netherlands)

    Demirdas, Serwet; van Kessel, Imke N.; Korndewal, Marjolein J.; Hollak, Carla E. M.; Meutgeert, Hanka; Klaren, Anja; van Rijn, Margreet; van Spronsen, Francjan J.; Bosch, Annet M.

    2013-01-01

    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

  5. Evaluating the effectiveness of a clinical tracking system for undergraduate nursing students.

    Science.gov (United States)

    Salyers, Vincent L; Carter, Lorraine; Antoniazzi, Clara; Johnson, Susan

    2013-01-01

    This study evaluated one commercially available clinical tracking system to determine its appropriateness for use within a school of nursing. Collecting documentation during undergraduate clinical experiences (e.g., type of patient care experience, diagnosis, skills completed, competencies met) is a challenging undertaking for students and faculty. Little research has been conducted to evaluate the effectiveness of clinical tracking systems. A convenience sample of students and faculty completed an end-of-course survey that measured their satisfaction with the clinical tracking system. Statistically significant (p utility, technical issues, capacity to identify regulatory body achieved competencies, and usefulness of records generated.There was also a statistically significant (p < .01) difference in overall satisfaction, with faculty much more satisfied with the system than students. The clinical tracking system was found by faculty and students to be user friendly. Faculty overall were more satisfied with the system than students.

  6. 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.

  7. 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.

  8. 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).

  9. A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board.

    Science.gov (United States)

    Williams, Sophie; Davies, Peter; Johnson, Blair; Iles, Stephen

    2018-03-23

    In 2009, a Respiratory Fast Track Clinic (RFTC) was introduced successfully by Southern District Health Board. Advancing on this model by incorporating further biopsy methods, we aimed to streamline our investigative cancer pathway. The RFTC introduction was bi-phasic with staggered introduction of computed tomography (CT), and then biopsy, to the first service appointment (FSA). Patients with suspected lung cancer were identified for a six-month period preceding the RFTC. The time for the diagnostic pathway was then contrasted to the two RTFC introductory phases. In total, 212 patients were investigated for suspected lung cancer. Endobronchial ultrasound (EBUS) was the most utilised biopsy method. Time from GP referral to FSA improved significantly (p=0.005). Similarly, time from FSA to diagnosis and treatment improved, median times reducing from 15 to 0 (p=improve survival if incorporated into the RFTC model.

  10. 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.

  11. 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.

  12. 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...

  13. 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

  14. 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)

  15. Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

    Directory of Open Access Journals (Sweden)

    Avinash Chaurasia

    2014-01-01

    Full Text Available Optimizing perioperative care to provide maximum benefit at minimum cost may be best achieved using a perioperative clinical pathway (PCP. Using our joint replacement surgical home (JSH model PCP, we examined length of stay (LOS following total joint arthroplasty (TJA to evaluate patient care optimization. We reviewed a spectrum of clinical measurements in 190 consecutive patients who underwent TJA. Patients who had surgery earlier in the week and who were earlier cases of the day had a significantly lower LOS than patients whose cases started both later in the week and later in the day. Patients discharged home had significantly lower LOS than those discharged to a secondary care facility. Patients who received regional versus general anesthesia had a significantly lower LOS. Scheduling patients discharged to home and who will likely receive regional anesthesia for the earliest morning slot and earlier in the week may help decrease overall LOS.

  16. Exploiting the WNT Signaling Pathway for Clinical Purposes.

    Science.gov (United States)

    Johnson, Mark L; Recker, Robert R

    2017-06-01

    The goal of this paper is to evaluate critically the literature published over the past 3 years regarding the Wnt signaling pathway. The Wnt pathway was found to be involved in bone biology in 2001-2002 with the discovery of a (G171V) mutation in the lipoprotein receptor-related protein 5 (LRP5) that resulted in high bone mass and another mutation that completely inactivated Lrp5 function and resulted in osteoporosis pseudoglioma syndrome (OPPG). The molecular biology has been complex, and very interesting. It has provided many opportunities for exploitation to develop new clinical treatments, particularly for osteoporosis. More clinical possibilities include: treatments for fracture healing, corticosteroid osteoporosis, osteogenesis imperfecta, and others. In addition, we wish to provide historical information coming from distant publications (~350 years ago) regarding bone biology that have been confirmed by study of Wnt signaling. A recent finding is the development of an antibody to sclerostin that is under study as a treatment for osteoporosis. Development of treatments for other forms of osteoporosis, such as corticosteroid osteoporosis, is also underway. The full range of the applications of the work is not yet been achieved.

  17. WaterlooClarke: TREC 2015 Clinical Decision Support Track

    Science.gov (United States)

    2015-11-20

    infertility treatment and ectopic pregnancy Processed example (filtering + one synonyms+boolean operators): (dysmenorrhea OR men- orrhalgia) AND... medical questions (diagnosis, test and treatment articles). The two different full-text search engines we adopted in order to search over the collection of...Abstract Clinical decision support systems help physicians with finding additional information about a partic- ular medical case. In this paper, we

  18. An ontology-based hierarchical semantic modeling approach to clinical pathway workflows.

    Science.gov (United States)

    Ye, Yan; Jiang, Zhibin; Diao, Xiaodi; Yang, Dong; Du, Gang

    2009-08-01

    This paper proposes an ontology-based approach of modeling clinical pathway workflows at the semantic level for facilitating computerized clinical pathway implementation and efficient delivery of high-quality healthcare services. A clinical pathway ontology (CPO) is formally defined in OWL web ontology language (OWL) to provide common semantic foundation for meaningful representation and exchange of pathway-related knowledge. A CPO-based semantic modeling method is then presented to describe clinical pathways as interconnected hierarchical models including the top-level outcome flow and intervention workflow level along a care timeline. Furthermore, relevant temporal knowledge can be fully represented by combing temporal entities in CPO and temporal rules based on semantic web rule language (SWRL). An illustrative example about a clinical pathway for cesarean section shows the applicability of the proposed methodology in enabling structured semantic descriptions of any real clinical pathway.

  19. 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.

  20. Dissecting the Cell Entry Pathway of Dengue Virus by Single-Particle Tracking in Living Cells

    NARCIS (Netherlands)

    van der Schaar, Hilde M.; Rust, Michael J.; Chen, Chen; van der Ende-Metselaar, Heidi; Wilschut, Jan; Zhuang, Xiaowei; Smit, Jolanda M.

    2008-01-01

    Dengue virus (DENV) is an enveloped RNA virus that causes the most common arthropod-borne infection worldwide. The mechanism by which DENV infects the host cell remains unclear. In this work, we used live-cell imaging and single-virus tracking to investigate the cell entry, endocytic trafficking,

  1. Design and implementation of a patient tracking and recall system for Branch Dental Clinic Monterey

    OpenAIRE

    Steele, Timothy P.

    1992-01-01

    Approved for public release; distribution is unlimited This thesis analyzes the information system requirements of Branch Dental Clinic, Monterey, and develops a computer application to automate the clinic's patient tracking and recall process. The application replaces an existing mainframe-based, single-file system with a PC-based, relational database management system that provides greater functionality, enables increased productivity, improves data integrity and accuracy, and includes ...

  2. [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.

  3. 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.

  4. A scoping review of adult chronic kidney disease clinical pathways for primary care.

    Science.gov (United States)

    Elliott, Meghan J; Gil, Sarah; Hemmelgarn, Brenda R; Manns, Braden J; Tonelli, Marcello; Jun, Min; Donald, Maoliosa

    2017-05-01

    Chronic kidney disease (CKD) affects ∼10% of the adult population. The majority of patients with CKD are managed by primary care physicians, and despite the availability of effective treatment options, the use of evidence-based interventions for CKD in this setting remains suboptimal. Clinical pathways have been identified as effective tools to guide primary care physicians in providing evidence-based care. We aimed to describe the availability, characteristics and credibility of clinical pathways for adult CKD using a scoping review methodology. We searched Medline, Embase, CINAHL and targeted Internet sites from inception to 31 October 2014 to identify studies and resources that identified adult CKD clinical pathways for primary care settings. Study selection and data extraction were independently performed by two reviewers. From 487 citations, 41 items were eligible for review: 7 published articles and 34 grey literature resources published between 2001 and 2014. Of the 41 clinical pathways, 32, 24 and 22% were from the UK, USA and Canada, respectively. The majority (66%, n = 31) of clinical pathways were static in nature (did not have an online interactive feature). The majority (76%) of articles/resources reported using one or more clinical practice guidelines as a resource to guide the clinical pathway content. Few articles described a dissemination and evaluation plan for the clinical pathway, but most reported the targeted end-users. Our scoping review synthesized available literature on CKD clinical pathways in the primary care setting. We found that existing clinical pathways are diverse in their design, content and implementation. These results can be used by researchers developing or testing new or existing clinical pathways and by practitioners and health system stakeholders who aim to implement CKD clinical pathways in clinical practice. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

  5. 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

  6. Acceptability of Fitbit for physical activity tracking within clinical care among men with prostate cancer.

    Science.gov (United States)

    Rosenberg, Dori; Kadokura, Elyse A; Bouldin, Erin D; Miyawaki, Christina E; Higano, Celestia S; Hartzler, Andrea L

    2016-01-01

    Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care.

  7. A dynamic cell entry pathway of respiratory syncytial virus revealed by tracking the quantum dot-labeled single virus.

    Science.gov (United States)

    Zheng, Lin Ling; Li, Chun Mei; Zhen, Shu Jun; Li, Yuan Fang; Huang, Cheng Zhi

    2017-06-14

    Studying the cell entry pathway at the single-particle level can provide detailed and quantitative information for the dynamic events involved in virus entry. Indeed, the viral entry dynamics cannot be monitored by static staining methods used in cell biology, and thus virus dynamic tracking could be useful in the development of effective antiviral strategies. Therefore, the aim of this work was to use a quantum dot-based single-particle tracking approach to monitor the cell entry behavior of the respiratory syncytial virus (RSV) in living cells. The time-lapse fluorescence imaging and trajectory analysis of the quantum dot-labeled RSV showed that RSV entry into HEp-2 cells consisted of a typical endocytosis trafficking process. Three critical events during RSV entry were observed according to entry dynamic and fluorescence colocalization analysis. Firstly, RSV was attached to lipid rafts of the cell membrane, and then it was efficiently delivered into the perinuclear region within 2 h post-infection, mostly moving and residing into the lysosome compartment. Moreover, the relatively slow velocity of RSV transport across the cytoplasm and the formation of the actin tail indicated actin-based RSV motility, which was also confirmed by the effects of cytoskeletal inhibitors. Taken together, these findings provided new insights into the RSV entry mechanism and virus-cell interactions in RSV infection that could be beneficial in the development of antiviral drugs and vaccines.

  8. Pathways to health and wellbeing for Pacific children--how are we tracking?

    Science.gov (United States)

    Savila, Fa'asisila; Rush, Elaine

    2014-10-17

    The government's 5-year strategy for improving Pacific people's health and wellbeing, 'Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

  9. Electromagnetic-Guided MLC Tracking Radiation Therapy for Prostate Cancer Patients: Prospective Clinical Trial Results.

    Science.gov (United States)

    Keall, Paul J; Colvill, Emma; O'Brien, Ricky; Caillet, Vincent; Eade, Thomas; Kneebone, Andrew; Hruby, George; Poulsen, Per R; Zwan, Benjamin; Greer, Peter B; Booth, Jeremy

    2018-02-06

    To report on the primary and secondary outcomes of a prospective clinical trial of electromagnetic-guided multileaf collimator (MLC) tracking radiation therapy for prostate cancer. Twenty-eight men with prostate cancer were treated with electromagnetic-guided MLC tracking with volumetric modulated arc therapy. A total of 858 fractions were delivered, with the dose per fraction ranging from 2 to 13.75 Gy. The primary outcome was feasibility, with success determined if >95% of fractions were successfully delivered. The secondary outcomes were (1) the improvement in beam-target geometric alignment, (2) the improvement in dosimetric coverage of the prostate and avoidance of critical structures, and (3) no acute grade ≥3 genitourinary or gastrointestinal toxicity. All 858 planned fractions were successfully delivered with MLC tracking, demonstrating the primary outcome of feasibility (P radiation therapy for prostate cancer is feasible. The patients received improved geometric targeting and delivered dose distributions that were closer to those planned than they would have received without electromagnetic-guided MLC tracking. No significant acute toxicity was observed. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. An Extended Model for Tracking Accumulation Pathways of Materials Using Input–Output Tables: Application to Copper Flows in Japan

    Directory of Open Access Journals (Sweden)

    Ryosuke Yokoi

    2018-03-01

    Full Text Available Recycling has become increasingly important as a means to mitigate not only waste issues but also problems related to primary resource use, such as a decrease in resource availability. In order to promote and plan future recycling efficiently, detailed information on the material stock in society is important. For a detailed analysis of material stocks, quantitative information on flows of a material, such as its accumulation pathways, final destinations, and its processing forms, are required. This paper develops a model for tracking accumulation pathways of materials using input–output tables (IOTs. The main characteristics of the proposed model are as follows: (1 accumulations in sectors other than the final demand sectors (i.e., endogenous sectors are explicitly evaluated, (2 accumulations as accompaniments to products, such as containers and packaging, are distinguished from the products, and (3 processing forms of materials are considered. The developed model is applied to analyze copper flows in Japan using the Japanese IOTs for the year 2011. The results show that accumulations of copper in endogenous sectors were not negligibly small (9.24% of the overall flow. Although accumulations of copper as accompaniments were very small, they may be larger for other materials that are largely used as containers or packaging. It was found that the destinations of copper showed different characteristics depending on the processing forms.

  11. Processing pathways in mental arithmetic--evidence from probabilistic fiber tracking.

    Directory of Open Access Journals (Sweden)

    Elise Klein

    Full Text Available Numerical cognition is a case of multi-modular and distributed cerebral processing. So far neither the anatomo-functional connections between the cortex areas involved nor their integration into established frameworks such as the differentiation between dorsal and ventral processing streams have been specified. The current study addressed this issue combining a re-analysis of previously published fMRI data with probabilistic fiber tracking data from an independent sample. We aimed at differentiating neural correlates and connectivity for relatively easy and more difficult addition problems in healthy adults and their association with either rather verbally mediated fact retrieval or magnitude manipulations, respectively. The present data suggest that magnitude- and fact retrieval-related processing seem to be subserved by two largely separate networks, both of them comprising dorsal and ventral connections. Importantly, these networks not only differ in localization of activation but also in the connections between the cortical areas involved. However, it has to be noted that even though seemingly distinct anatomically, these networks operate as a functionally integrated circuit for mental calculation as revealed by a parametric analysis of brain activation.

  12. Processing Pathways in Mental Arithmetic—Evidence from Probabilistic Fiber Tracking

    Science.gov (United States)

    Glauche, Volkmar; Weiller, Cornelius; Willmes, Klaus

    2013-01-01

    Numerical cognition is a case of multi-modular and distributed cerebral processing. So far neither the anatomo-functional connections between the cortex areas involved nor their integration into established frameworks such as the differentiation between dorsal and ventral processing streams have been specified. The current study addressed this issue combining a re-analysis of previously published fMRI data with probabilistic fiber tracking data from an independent sample. We aimed at differentiating neural correlates and connectivity for relatively easy and more difficult addition problems in healthy adults and their association with either rather verbally mediated fact retrieval or magnitude manipulations, respectively. The present data suggest that magnitude- and fact retrieval-related processing seem to be subserved by two largely separate networks, both of them comprising dorsal and ventral connections. Importantly, these networks not only differ in localization of activation but also in the connections between the cortical areas involved. However, it has to be noted that even though seemingly distinct anatomically, these networks operate as a functionally integrated circuit for mental calculation as revealed by a parametric analysis of brain activation. PMID:23383194

  13. Activity-based process mining for clinical pathways computer aided design.

    Science.gov (United States)

    Fernandez-Llatas, Carlos; Meneu, Teresa; Benedi, Jose Miguel; Traver, Vicente

    2010-01-01

    Current trends in health management improvement demand the standardization of care protocols to achieve better quality and efficiency. The use of Clinical Pathways is an emerging solution for that problem. However, current Clinical Pathways are big manuals written in natural language and highly affected by human subjectivity. These problems make the deployment and dissemination of them extremely difficult in real practice environments. In this work, a complete computer based architecture to help the representation and execution of Clinical Pathways is suggested. Furthermore, the difficulties inherent to the design of formal Clinical Pathways in this way requires new specific design tools to help making the system useful. Process Mining techniques can help to automatically infer processes definition from execution samples. Yet, the classical Process Mining paradigm is not totally compatible with the Clinical Pathways paradigm. In this paper, a pattern recognition algorithm based in an evolution of the Process Mining classical paradigm is presented and evaluated as a solution to this situation. The proposed algorithm is able to infer Clinical Pathways from execution logs to support the design of Clinical Pathways.

  14. 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.

  15. 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.

  16. 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

  17. Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

    Science.gov (United States)

    Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

    2014-07-01

    Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

  18. 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.

  19. Improvement in resource utilization after development of a clinical pathway for patients with pressure ulcers.

    Science.gov (United States)

    Dzwierzynski, W W; Spitz, K; Hartz, A; Guse, C; Larson, D L

    1998-11-01

    Clinical pathways are interdisciplinary patient care plans intended to reduce variance and improve quality of care while lowering health care cost. This study was undertaken to determine whether the development of a clinical pathway for care of patients with pressure ulcers can indeed decrease health care costs while preserving quality of care. A clinical pathway for surgical reconstruction of pressure ulcers was developed by standardizing the current practices of our plastic surgeon group. The pathway provided direction in optimal scheduling of physician interventions along with nursing, physical and occupational therapies, and spinal cord rehabilitation interventions. It covered all potential elements of patient care, including laboratory, radiology, dietary services, intravenous fluids, and use of specialty beds. It defined patient outcomes and outlined discharge planning. Pathways were distributed throughout all services caring for patients with pressure ulcers. Patient charts and billing data were reviewed for the 16-month periods before and after initiation of the pathway. No other significant changes in treatment occurred during this time frame. Ninety-seven patient charts were examined (54 before pathway and 43 after pathway implementation). Parameters evaluated included length of stay and total charges (including bed use, medications, laboratory tests, and radiology). Patient readmission rate was also examined. A significant reduction in patient length of stay and total charges was achieved after implementation of the clinical pathway. Reduction was seen not only for patients treated with flaps by plastic surgery but also for patients with pressure ulcers who were not specifically targeted such as those from other services. The readmission rate decreased slightly, although not significantly, after the pathway inception. Total cost saving was almost $11,000 per patient (23 percent). In conclusion, implementation of a clinical pathway, because it

  20. What is a clinical pathway? Development of a definition to inform the debate

    Directory of Open Access Journals (Sweden)

    Snow Pamela

    2010-05-01

    Full Text Available Abstract Background Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature. Methods We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1 identify publications exploring the definition of a clinical pathway; (2 derive draft criteria; (3 pilot test the criteria; and (4 modify criteria to maximise agreement between review authors. Results Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (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'; (4 the intervention had timeframes or criteria-based progression; and (5 the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. In all, 27 studies were included in the final review. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. The use of a robotic tibial rotation device and an electromagnetic tracking system to accurately reproduce the clinical dial test.

    Science.gov (United States)

    Stinton, S K; Siebold, R; Freedberg, H; Jacobs, C; Branch, T P

    2016-03-01

    The purpose of this study was to: (1) determine whether a robotic tibial rotation device and an electromagnetic tracking system could accurately reproduce the clinical dial test at 30° of knee flexion; (2) compare rotation data captured at the footplates of the robotic device to tibial rotation data measured using an electromagnetic sensor on the proximal tibia. Thirty-two unilateral ACL-reconstructed patients were examined using a robotic tibial rotation device that mimicked the dial test. The data reported in this study is only from the healthy legs of these patients. Torque was applied through footplates and was measured using servomotors. Lower leg motion was measured at the foot using the motors. Tibial motion was also measured through an electromagnetic tracking system and a sensor on the proximal tibia. Load-deformation curves representing rotational motion of the foot and tibia were compared using Pearson's correlation coefficients. Off-axis motions including medial-lateral translation and anterior-posterior translation were also measured using the electromagnetic system. The robotic device and electromagnetic system were able to provide axial rotation data and translational data for the tibia during the dial test. Motion measured at the foot was not correlated to motion of the tibial tubercle in internal rotation or in external rotation. The position of the tibial tubercle was 26.9° ± 11.6° more internally rotated than the foot at torque 0 Nm. Medial-lateral translation and anterior-posterior translation were combined to show the path of the tubercle in the coronal plane during tibial rotation. The information captured during a manual dial test includes both rotation of the tibia and proximal tibia translation. All of this information can be captured using a robotic tibial axial rotation device with an electromagnetic tracking system. The pathway of the tibial tubercle during tibial axial rotation can provide additional information about knee

  6. 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

  7. First clinical use of the EchoTrack guidance approach for radiofrequency ablation of thyroid gland nodules.

    Science.gov (United States)

    Franz, Alfred Michael; Seitel, Alexander; Bopp, Nasrin; Erbelding, Christian; Cheray, Dominique; Delorme, Stefan; Grünwald, Frank; Korkusuz, Hüdayi; Maier-Hein, Lena

    2017-06-01

    Percutaneous radiofrequency ablation (RFA) of thyroid nodules is an alternative to surgical resection that offers the benefits of minimal scars for the patient, lower complication rates, and shorter treatment times. Ultrasound (US) is the preferred modality for guiding these procedures. The needle is usually kept within the US scanning plane to ensure needle visibility. However, this restricts flexibility in both transducer and needle movement and renders the procedure difficult, especially for inexperienced users. Existing navigation solutions often involve electromagnetic (EM) tracking, which requires placement of an external field generator (FG) in close proximity of the intervention site in order to avoid distortion of the EM field. This complicates the clinical workflow as placing the FG while ensuring that it neither restricts the physician's workspace nor affects tracking accuracy is awkward and time-consuming. The EchoTrack concept overcomes these issues by combining the US probe and the EM FG in one modality, simultaneously providing both real-time US and tracking data without requiring the placement of an external FG for tracking. We propose a system and workflow to use EchoTrack for RFA of thyroid nodules. According to our results, the overall error of the EchoTrack system resulting from errors related to tracking and calibration is below 2 mm. Navigated thyroid RFA with the proposed concept is clinically feasible. Motion of internal critical structures relative to external markers can be up to several millimeters in extreme cases. The EchoTrack concept with its simple setup, flexibility, improved needle visualization, and additional guidance information has high potential to be clinically used for thyroid RFA.

  8. 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.

  9. Clinical pathways as instruments for risk and cost management in hospitals - a discussion paper.

    Science.gov (United States)

    Romeyke, Tobias; Stummer, Harald

    2012-02-29

    The distinctive characteristics of the German health system are medical progress and financial pressure-and this is especially true of the hospitals. These challenges must be met by strategic management instruments for quality assurance, and by reducing costs. This article presents the instrument "clinical pathway" (also known as "clinical treatment pathway") and describes the possibilities it offers, both for quality assurance and risk management, and for cost reduction. The clinical pathway presented here will be that for "multimodal pain therapy", as used in the context of acute inpatient care in Germany. A general presentation of the risks in hospital is followed by consideration of the risks associated with core processes. A comprehensive total cost analysis is performed for those patients who meet the pathway entry criteria and who fulfil the requirements for the structure of care provided within multimodal pain therapy. Multimodal pain therapy places high demands on the structural, procedural and outcome quality of the medical, nursing and therapeutic services provided, and these demands are reflected in high costs for the provision of this care. The treatment process involves many different professional groups. These complex interfaces can potentially generate risks, which can lead to the possibility of legal liability. A clinical pathway must structure the core process and then combine elements of quality assurance in order to optimise patient care and minimise risk. The examination of costs reveals significant potential savings (patients with clinical pathway: EUR 3086±212; patients without clinical pathway: EUR 3774±460; Mann-Whitney U test; p<0.001). For the managers of a hospital, the clinical pathway represents a strategic management instrument that can serve for continual cost control and cost reduction, and can contribute in the form of quality assurance towards a transparent provision of services.

  10. 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.)

  11. Adaptive pathway development for Fabry disease: a clinical approach.

    Science.gov (United States)

    Schuller, Yvonne; Arends, Maarten; Körver, Simon; Langeveld, Mirjam; Hollak, Carla E M

    2018-02-15

    Fabry disease (FD) is a rare X-chromosome-linked lysosomal storage disorder. Although initial expectations of enzyme replacement therapy (ERT) were high, it is now clear that real-world effectiveness is disappointing and evidence gathering has been inadequate. In retrospect, development of ERT for FD had several shortcomings. Little convincing evidence on the effectiveness existed at time of authorization. Also, post-marketing evaluation failed to generate sufficient and relevant data for adequate evaluation on effectiveness. Adaptive pathways might have benefitted ERT development by: (i) involving healthcare professionals, patients, health technology assessment bodies and payers in the development process; (ii) iterative development, starting with initial authorization in classical males; (iii) a clear real-world data collection plan; (iv) an independent disease registry; and (v) prescription control. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  12. 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.

  13. Effectiveness of a clinical pathway for the emergency treatment of patients with inborn errors of metabolism.

    Science.gov (United States)

    Zand, Dina J; Brown, Kathleen M; Lichter-Konecki, Uta; Campbell, Joyce K; Salehi, Vesta; Chamberlain, James M

    2008-12-01

    The goal was to measure the effectiveness of a clinical pathway for the emergency department care of patients with inborn errors of metabolism. Two years after the implementation of a multidisciplinary clinical pathway for patients with inborn errors of metabolism in our urban, academic, pediatric emergency department, we compared measures of timeliness and effectiveness for patients treated before the pathway with the same measures for patients treated after implementation of the pathway. Measures of timeliness included time to room, time to doctor, time to glucose infusion, and total emergency department length of stay. Measures of clinical effectiveness included the proportion of patients receiving adequate glucose infusions, proportion of patients admitted, inpatient length of stay, and proportion of patients requiring PICU admission. A total of 214 emergency department visits for patients with inborn errors of metabolism were analyzed, 90 before and 124 after initiation of the pathway. All measures of timeliness of care except total emergency department length of stay demonstrated significant improvement in comparisons of values before and after initiation of the pathway. Measures of clinical effectiveness also demonstrated significant improvements after initiation of the pathway. There was improvement in the proportion of patients who received adequate glucose infusions, with a decrease in the proportion of patients who required admission to the PICU. Emergency department length of stay, inpatient length of stay, and the proportion of patients admitted to the hospital were not affected. Most measures of timeliness and 2 measures of effectiveness showed improvement after implementation of an emergency department pathway for patients with inborn errors of metabolism. Therefore, a clinical pathway can improve the emergency care of patients with inborn errors of metabolism.

  14. 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.

  15. 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

  16. Creation of a RFID based real time tracking (R-RTT) system for small healthcare clinics.

    Science.gov (United States)

    Chen, Joseph C; Collins, Thomas J

    2012-12-01

    A well-managed healthcare system improves the quality of the patient experience. However, many small healthcare clinics have suboptimal systems for scheduling and locating patients and medical staff, delaying the relay of information and creating poor resource and room utilization. This paper proposes a Radio Frequency Identification (RFID)-based Real-Time Tracking (R-RTT) System for optimizing small healthcare facility operations, enabling further optimization of throughput time, room utilization, and patient flow. In the proposed scenario, RFID readers were equipped in strategic locations throughout the facility. Patients and medical staff were issued personalized RFID tags. When they pass through the reader's interrogation zone, it reads their RFID tag and sends the information to a central computer equipped with software capable of filtering the RFID data into useable information. A Visual Basic Application (VBA) program uses the information received from the ID tags to display the location of the patients and staff as they move throughout the facility. This increases their visibility within the facility by allowing medical staff to determine where their colleagues and patients are at all times. The VBA program was also able to record the data in order to track the time each stage of the appointment process takes to complete. The recorded time data can be broken into processes, making it easier to determine if it adds value. This data can then be transformed into a value stream map for further analysis and improvement.

  17. 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

  18. 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

  19. Comparison of RFID systems for tracking clinical interventions at the bedside.

    Science.gov (United States)

    Ohashi, Kumiko; Ota, Sakiko; Ohno-Machado, Lucila; Tanaka, Hiroshi

    2008-11-06

    In recent years, there have been high expectations for RFID technologies applied in the medical field, particularly for automatic identification and location of patients and medical supplies. However, few studies have measured the applicability of currently available RFID technologies in a medical environment. To determine the technical factors that affect the performance of RFID systems, we examined the performance of different types of tags for medications, medical equipment, nurses, and patients under different experimental conditions. Three kinds of passive RFID tags and one active RFID tag were used in our study. Passive tags were affected by materials such as liquid and metal. Tags based on 13.56MHz were most suited for identifying medications. Tag placement was one of the main factors involved in correct identification of nurses, patients, and medical equipment. The results of this study may help decision makers decide whether (which) RFID technologies are useful for tracking clinical workflow.

  20. DRUGS System Improving the Effects of Clinical Pathways: A Systematic Study.

    Science.gov (United States)

    Wang, Shan; Zhu, Xiaohe; Zhao, Xian; Lu, Yang; Yang, Zhifu; Qian, Xiaoliang; Li, Weiwei; Ma, Lixiazi; Guo, Huning; Wang, Jingwen; Wen, Aidong

    2016-03-01

    The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types (p DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % (p DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level.

  1. 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.

  2. The Graduate Medical Education Scholars Track: Developing Residents as Clinician-Educators During Clinical Training via a Longitudinal, Multimodal, and Multidisciplinary Track.

    Science.gov (United States)

    Ahn, James; Martin, Shannon K; Farnan, Jeanne M; Fromme, H Barrett

    2018-02-01

    Residency clinician-educator tracks have been created; however, they have generally been limited to a single discipline or program and experienced some challenges. The Graduate Medical Education Scholars Track (GMEST), an embedded longitudinal, multimodal, multidisciplinary clinician-educator track for residents, was piloted at the Pritzker School of Medicine, University of Chicago, in academic year 2014-2015. The GMEST is a two-year experience completed during residency training. The goal is to prepare trainees for academic careers as clinician-educators with a focus on medical education scholarship. This track is designed for residents from diverse training programs with variable clinical schedules and blends a live interactive program, asynchronous instruction and discussion, and overarching multimodal mentorship in medical education. Participants are expected to complete a capstone medical education project and submit it to institutional, regional, and/or national venues. Data gathered from the 2014-2016 and 2015-2017 cohorts demonstrated that 21/22 (95%) participants were satisfied with the GMEST curriculum, felt it was important to their development as future clinician-educators, and felt it would positively influence their ability to work in medical education. Further, 18/22 (82%) participants wished to pursue a career as a clinician-educator and in medical education leadership and/or scholarship. The authors will longitudinally track graduates' future career positions, projects, publications, and awards, and cross-match and compare GMEST graduates with non-GMEST residents interested in medical education. Faculty mentors, program directors, and the Medical Education, Research, Innovation, Teaching, and Scholarship community will be asked for feedback on the GMEST.

  3. Impact of fMRI-guided advanced DTI fiber tracking techniques on their clinical applications in patients with brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Kleiser, Raimund [University Hospital Zurich, Institute of Neuroradiology, Zuerich (Switzerland); Landes-Nervenklinik Wagner-Jauregg, Ooe. Gesundheits- und Spitals-AG, Institute of Radiology, Linz (Austria); Staempfli, Philipp [University Hospital Zurich, Institute of Neuroradiology, Zuerich (Switzerland); University and ETH Zurich, Institute for Biomedical Engineering, Zuerich (Switzerland); Valavanis, Anton; Kollias, Spyros [University Hospital Zurich, Institute of Neuroradiology, Zuerich (Switzerland); Boesiger, Peter [University and ETH Zurich, Institute for Biomedical Engineering, Zuerich (Switzerland)

    2010-01-15

    White matter tractography based on diffusion tensor imaging has become a well-accepted non-invasive tool for exploring the white matter architecture of the human brain in vivo. There exist two main key obstacles for reconstructing white matter fibers: firstly, the implementation and application of a suitable tracking algorithm, which is capable of reconstructing anatomically complex fascicular pathways correctly, as, e.g., areas of fiber crossing or branching; secondly, the definition of an appropriate tracking seed area for starting the reconstruction process. Large intersubject, anatomical variations make it difficult to define tracking seed areas based on reliable anatomical landmarks. An accurate definition of seed regions for the reconstruction of a specific neuronal pathway becomes even more challenging in patients suffering from space occupying pathological processes as, e.g., tumors due to the displacement of the tissue and the distortion of anatomical landmarks around the lesion. To resolve the first problem, an advanced tracking algorithm, called advanced fast marching, was applied in this study. The second challenge was overcome by combining functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) in order to perform fMRI-guided accurate definition of appropriate seed areas for the DTI fiber tracking. In addition, the performance of the tasks was controlled by a MR-compatible power device. Application of this combined approach to eight healthy volunteers and exemplary to three tumor patients showed that it is feasible to accurately reconstruct relevant fiber tracts belonging to a specific functional system. fMRI-guided advanced DTI fiber tracking has the potential to provide accurate anatomical and functional information for a more informed therapeutic decision making. (orig.)

  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. 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.

  6. Radio-frequency tracking of respiratory equipment: rationale and early experience at the Cleveland Clinic.

    Science.gov (United States)

    Stoller, James K; Roberts, Vincent; Matt, David; Chom, Leslie; Sasidhar, Madhu; Chatburn, Robert L

    2013-12-01

    When respiratory therapists (RTs) seek respiratory care equipment, finding it quickly is desirable, both to expedite patient care and to avert RTs wasting time. To optimize RTs' ability to quickly locate ventilators, we developed and implemented a radio-frequency identification (RFID) tagging system called eTrak. The Clinical Engineering and Information Technology groups at Cleveland Clinic collaboratively developed a Wi-Fi-based RFID program that used active RFID tags. Altogether, 218 ventilators, 82 noninvasive ventilators, and various non-respiratory equipment were tagged, beginning in March 2010. We calculated the difference in time required to locate equipment before versus after implementation. The eTrak system had a mean 145 log-ons per week over the first year of use, and was associated with a decreased time required for RTs to locate ventilators: median 18 min (range 1-45 min) versus 3 min (range 1-6 min) (P RFID tracking system for respiratory equipment shortened the time to locate ventilators and non-significantly improved RT satisfaction with finding equipment. RFID tagging of equipment warrants further investigation.

  7. [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.

  8. 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

  9. 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

  10. [Effect of clinical pathway of health education in patients with kidney transplantation].

    Science.gov (United States)

    Liu, Jia; Yan, Jin; Ye, Qifa; Ming, Yingzi; Cheng, Ke; Liu, Lifang; Yang, Ling; Wang, Yan

    2014-01-01

    To explore the effect of clinical pathway of health education in patients with kidney transplantation. A total of 116 patients with kidney transplantation were randomly divided into an experimental group and a control group (n=58 in each group). The patients in the control group received traditional health education, and the patients in the experimental group experienced the clinical pathway of health education. The effect of health education was assessed and compared. There was significant difference in the effect of health education between the two groups (Ppathway of health education in patients after kidney transplantation can significantly improve the effect of health education.

  11. Fast-track pathway for reduction of dislocated hip arthroplasty reduces surgical delay and length of stay

    DEFF Research Database (Denmark)

    Gromov, Kirill; Willendrup, Fatin; Palm, Henrik

    2015-01-01

    -track patients with a suspected dislocation (with no radiographic verification) were moved directly to the post-anesthesia care unit and then straight to the operating room. Dislocation was confirmed under fluoroscopy with reduction under general anesthesia. Surgical delay (in hours), LOS (in hours......), perioperative complications, and complications during the hospital stay were recorded. Dislocation status for fast-track patients (confirmed or unconfirmed by fluoroscopy) was also recorded. RESULTS: Both surgical delay (2.5 h vs. 4.1 h; p

  12. 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.

  13. 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

  14. 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

  15. Electronic Tracking of Patients in an Outpatient Ophthalmology Clinic to Improve Efficient Flow: A Feasibility Analysis and Benchmarking Study.

    Science.gov (United States)

    Singman, Eric L; Haberman, Chantal V; Appelbaum, Jeffrey; Tian, Jing; Shafer, Karen; Toerper, Matthew; Katz, Susanne; Kelsay, Maureen; Boland, Michael V; Greenbaum, Milton; Adelman, Rebecca; Thomas, Richard C; Vakili, Sharif

    2015-01-01

    Real-time location systems (RTLS) and Lean management approaches have been employed to improve patient flow in clinical settings. This study explored the feasibility of using these methodologies in an outpatient resident ophthalmology clinic. Patients, providers, and staff in Wilmer Eye Institute General Eye Services Clinic were provided RTLS tags to track their movement throughout the clinic after observational studies modeling flow were conducted. Tracking data guided changes for clinic processes based on Lean management approaches, including reorganization of the reception desk, consolidation of forms, creation of task sheets to improve communication, installation of door flags on examination rooms, and training the staff in service excellence. Tracking was repeated after changes were implemented. A patient satisfaction survey was also conducted prior to and after the changes. After intervention, significant increases were measured in the average time patients spent in the clinic (99.3 minutes vs 112.8 minutes). Significant decreases were seen in the times patients spent with the optometrists (15.4 minutes vs 12.1 minutes), testing (24.7 minutes vs 23.0 minutes), and together with both the attending and the resident (8.3 minutes vs 5.8 minutes). The patient satisfaction survey indicated improvements in patients' perception of the helpfulness/friendliness of the staff, the length of time patients perceived they waited, and overall clinic experience. Both RTLS and Lean management approaches may be feasible ways to track and improve patient flow and satisfaction if certain limitations can be overcome. This is the first published report describing these approaches applied to an academic ophthalmology clinic in the United States.

  16. Role of TWEAK/Fn14 signalling pathway in lupus nephritis and other clinical settings

    Directory of Open Access Journals (Sweden)

    Diego A. González-Sánchez

    2017-03-01

    Full Text Available Knowledge of the signalling pathways involved in various diseases has enabled advances in the understanding of pathophysiological, diagnostic and therapeutic models of several inflammatory and autoimmune diseases. Systemic lupus erythematosus is a widely studied autoimmune disease that can affect multiple organs, with a major impact on morbidity and mortality when it involves the kidneys. Over the past 10 years, interest in the role of the TWEAK/Fn14 signalling pathway in lupus nephritis, as well as other clinical settings, has increased. By reviewing the literature, this article assesses the role of this pathway in lupus nephritis, underlines the importance of TWEAK in urine (uTWEAK as a biomarker of the disease and stresses the favourable results published in the literature from the inhibition of the TWEAK/Fn14 pathway as a therapeutic target in experimental animal models, demonstrating its potential application in other settings. Results of ongoing clinical trials and future research will give us a better understanding of the real benefit of blocking this pathway in the clinical course of several conditions.

  17. Role of TWEAK/Fn14 signalling pathway in lupus nephritis and other clinical settings.

    Science.gov (United States)

    González-Sánchez, Diego A; Álvarez, Cristian M; Vásquez, Gloria; Gómez-Puerta, José A

    Knowledge of the signalling pathways involved in various diseases has enabled advances in the understanding of pathophysiological, diagnostic and therapeutic models of several inflammatory and autoimmune diseases. Systemic lupus erythematosus is a widely studied autoimmune disease that can affect multiple organs, with a major impact on morbidity and mortality when it involves the kidneys. Over the past 10 years, interest in the role of the TWEAK/Fn14 signalling pathway in lupus nephritis, as well as other clinical settings, has increased. By reviewing the literature, this article assesses the role of this pathway in lupus nephritis, underlines the importance of TWEAK in urine (uTWEAK) as a biomarker of the disease and stresses the favourable results published in the literature from the inhibition of the TWEAK/Fn14 pathway as a therapeutic target in experimental animal models, demonstrating its potential application in other settings. Results of ongoing clinical trials and future research will give us a better understanding of the real benefit of blocking this pathway in the clinical course of several conditions. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  18. A clinical pathway including psychotherapy approaches for managing emotional difficulties after acquired brain injury.

    Science.gov (United States)

    Coetzer, Rudi

    2009-11-01

    Emotional difficulties, such as anxiety and depression, are common after acquired brain injury in adults and can influence long-term outcome. Diagnosis in a brain injury context can be difficult. Ideally, rehabilitation approaches should consider the specific treatment of anxiety and depression as well and may include pharmacotherapy, individual psychotherapy, and family interventions. Psychotherapy, especially in regards to longer-term adjustment to brain injury, may have an important adjunctive role in treatment approaches, but adaptations of techniques may be needed. A clinical pathway is described which can help to raise clinicians awareness, as well as increase detection rates and consideration of the specific role of individual psychotherapy in this clinical population. However, an important caveat is that clinical pathways should not serve as a substitute, but rather a facilitator, for the process of reasoning about individual patients in everyday clinical practice.

  19. 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.

  20. 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

  1. Improving Clinical Trial Participant Tracking Tools Using Knowledge-anchored Design Methodologies.

    Science.gov (United States)

    Payne, Philip R O; Embi, Peter J; Johnson, Stephen B; Mendonca, Eneida; Starren, Justin

    2010-01-01

    OBJECTIVE: Rigorous human-computer interaction (HCI) design methodologies have not traditionally been applied to the development of clinical trial participant tracking (CTPT) tools. Given the frequent us of iconic HCI models in CTPTs, and prior evidence of usability problems associated with the use of ambiguous icons in complex interfaces, such approaches may be problematic. Presentation Discovery (PD), a knowledge-anchored HCI design method, has been previously demonstrated to improve the design of iconic HCI models. In this study, we compare the usability of a CTPT HCI model designed using PD and an intuitively designed CTPT HCI model. METHODS: An iconic CPTP HCI model was created using PD. The PD-generated and an existing iconic CTPT HCI model were subjected to usability testing, with an emphasis on task accuracy and completion times. Study participants also completed a qualitative survey instrument to evaluate subjective satisfaction with the two models. RESULTS: CTPT end-users reliably and reproducibly agreed on the visual manifestation and semantics of prototype graphics generated using PD. The performance of the PD-generated iconic HCI model was equivalent to an existing HCI model for tasks at multiple levels of complexity, and in some cases superior. This difference was particularly notable when tasks required an understanding of the semantic meanings of multiple icons. CONCLUSION: The use of PD to design an iconic CTPT HCI model generated beneficial results and improved end-user subjective satisfaction, while reducing task completion time. Such results are desirable in information and time intensive domains, such as clinical trials management.

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

    NARCIS (Netherlands)

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

    2013-01-01

    Aims and objectivesThe objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary clinical pathway. MethodsA single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of a

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

    NARCIS (Netherlands)

    Niemeijer, G.C.; Flikweert, E.; Trip, A.; Does, R.J.M.M.; Ahaus, K.T.B.; Boot, A.F.; Wendt, K.W.

    2013-01-01

    AIMS AND OBJECTIVES: The objective of this study was to show the usefulness of lean six sigma (LSS) for the development of a multidisciplinary clinical pathway. METHODS: A single centre, both retrospective and prospective, non-randomized controlled study design was used to identify the variables of

  4. Bayesian semiparametric regression models for evaluating pathway effects on continuous and binary clinical outcomes

    Science.gov (United States)

    Kim, Inyoung; Pang, Herbert; Zhao, Hongyu

    2013-01-01

    Many statistical methods for microarray data analysis consider one gene at a time, and they may miss subtle changes at the single gene level. This limitation may be overcome by considering a set of genes simultaneously where the gene sets are derived from prior biological knowledge. Limited work has been carried out in the regression setting to study the effects of clinical covariates and expression levels of genes in a pathway either on a continuous or on a binary clinical outcome. Hence, we propose a Bayesian approach for identifying pathways related to both types of outcomes. We compare our Bayesian approaches with a likelihood-based approach that was developed by relating a least squares kernel machine for nonparametric pathway effect with a restricted maximum likelihood for variance components. Unlike the likelihood-based approach, the Bayesian approach allows us to directly estimate all parameters and pathway effects. It can incorporate prior knowledge into Bayesian hierarchical model formulation and makes inference by using the posterior samples without asymptotic theory. We consider several kernels (Gaussian, polynomial, and neural network kernels) to characterize gene expression effects in a pathway on clinical outcomes. Our simulation results suggest that the Bayesian approach has more accurate coverage probability than the likelihood-based approach, and this is especially so when the sample size is small compared with the number of genes being studied in a pathway. We demonstrate the usefulness of our approaches through its applications to a type II diabetes mellitus data set. Our approaches can also be applied to other settings where a large number of strongly correlated predictors are present. PMID:22438129

  5. Use of a clinical information system to support the cancer pathway

    DEFF Research Database (Denmark)

    Mukai, Thomas; Vedsted, Peter; Bro, Flemming

    satisfactorily. This may lead to diagnostic delay, delay in treatment, lack of continuity and seamless pathways and low patient satisfaction. Objective: Our aim is to clarify to which degree clinical information support systems can provide GPs and Our aim is to clarify to which degree clinical information...... support systems can provide GPs and patients with on-time and updated information about agreed care pathways and to examine the effect on delay, use of and adherence to guidelines and doctor and patient satisfaction. Subjects and Methods: We intend to conduct two randomized controlled trials to measure...... an electronic questionnaire compared to using a paper questionnaire to create an extended data and feedback system. Results: Different outcome measures will be analyzed: Use of health care services, clinical satisfaction, patient experienced continuity, use of further tests and adherence to guidelines....

  6. Activation of Type I Interferon Pathway in Systemic Lupus Erythematosus: Association with Distinct Clinical Phenotypes

    Science.gov (United States)

    Karageorgas, Theophanis P.; Tseronis, Dimitrios D.; Mavragani, Clio P.

    2011-01-01

    Growing evidence over the last few years suggests a central role of type I IFN pathway in the pathogenesis of systemic autoimmune disorders. Data from clinical and genetic studies in patients with systemic lupus erythematosus (SLE) and lupus-prone mouse models, indicates that the type I interferon system may play a pivotal role in the pathogenesis of several lupus and associated clinical features, such as nephritis, neuropsychiatric and cutaneous lupus, premature atherosclerosis as well as lupus-specific autoantibodies particularly against ribonucleoproteins. In the current paper, our aim is to summarize the latest findings supporting the association of type I IFN pathway with specific clinical manifestations in the setting of SLE providing insights on the potential use of type I IFN as a therapeutic target. PMID:22162633

  7. 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.

  8. 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.

  9. 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...

  10. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......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...

  11. [Introduction and PDCA-Management of a Liaison-Clinical Pathway with Cancer Patients after a Curative Operation].

    Science.gov (United States)

    Ueda, Aiko; Saito, Takuya; Ueda, Mioko; Ijichi, Takeshi; Nakatsuka, Takumi; Matsumoto, Junya; Yamaga, Yoko; Hishikawa, Hidehiko; Tanaka, Hironori; Tanaka, Yoshito; Yamamichi, Keigo

    2015-10-01

    Our hospital was appointed as an Osaka designated cancer care hospital in April 2012. At that time, we introduced the same liaison-clinical pathway with cancer patients after a curative operation in all of Osaka. Based on the management of the plan-do-check-act cycle, we found problems in the clinical pathway. These problems included the following: the clinical pathway was not known, was complicated, was troubling for patients, and not well understood by doctors. To solve these problems, we planned and carried out the following five measures. The first was public information, followed by practice processes, informed consent, patient referral documents, and clinical pathway investigation reports. We were able to promote the use of the liaison-clinical pathway by constantly improving these measures.

  12. Application values of clinical nursing pathway in patients with acute cerebral hemorrhage.

    Science.gov (United States)

    Li, Weihua; Gao, Jianmei; Wei, Shufang; Wang, Donghai

    2016-02-01

    Acute cerebral hemorrhage accounts for approximately 25% of strokes for elderly patients. Consequently, treatments to improve prognosis should be identified. The aim of the present study was to examine the clinical values of the application of clinical nursing pathway for patients with acute cerebral hemorrhage. Between January 2013 and January 2015, 92 patients diagnosed with acute intracerebral hemorrhage were enrolled in the study based on the guidelines recommended for providing appropriate surgical or conservative treatment and the sequence of admission. The 92 patients were randomly divided into the control and observation groups. Patients in the control group underwent routine nursing mode prior to and after admission, and underwent clinical nursing path model (hierarchical partitioning prior to admission to hospital plus general professional program of nursing in hospital) was applied to the observation group. Barthel index scores for the observation group were significantly higher than that of the control group. The length of hospital stay for patients in the observation group was significantly lower while the average score for patients' satisfaction on nursing care while in hospital was significantly higher than that of the control group, with statistically significant differences (PFugl-Meyer scores after 6 months for the observation group were significantly higher, with statistically significant differences (P<0.05). In conclusion, application of the clinical nursing pathway for patients with acute cerebral hemorrhage significantly improved the clinical effects and nursing satisfaction, reduced adverse reactions, and had a greater clinical application value.

  13. Merging clinical pathway programs as part of overall health system mergers: a ten-step guide. Spectrum Health.

    Science.gov (United States)

    Schriefer, J; Engelhard, J; DiCesare, L; Miller, M; Schriefer, J

    2000-01-01

    Mergers, acquisitions, and reorganizations can be stressful and accompanied by ambivalence, confusion, and uncertainty. Providing clear and simple steps for merging clinical pathways may help organizations move through the transition process more smoothly. The ten steps according to which Spectrum Health merged its pathway program-conduct an inventory of previous efforts, plan for the ideal program, bring staff together early in the merger process, decide on a common format, standardize the development and revision process, standardize a reporting tool, create a clinical pathway manual, implement an educational plan, present the program to key customers, and appoint an advisory group-need not be done sequentially. The ten-step pathway merger program uses pathways as a means to improve the quality of the care provided, with a focus on multidisciplinary clinical pathway teamwork. Before the merger, the two hospital systems' pathway programs used different approaches to operations and pathway format. When the announcement to merge came in September 1997, steps to merge the clinical pathway programs began. More than two years into the merger, Spectrum Health continues to struggle with the evolution of the health system. Clinical pathways represent just one of the significant and extensive issues related to organizational mergers; organizational values, finances, vision, mission, customer relations, strategic priorities, and people issues are a few of the others. Focusing on merging programs such as clinical pathway programs can help put one large piece of the merger puzzle in place and reduce some of the ambiguity associated with all mergers. Executive support is critical to the success of the clinical pathway program.

  14. 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

  15. 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…

  16. Smart medical environment at the point of care: auto-tracking clinical interventions at the bed side using RFID technology.

    Science.gov (United States)

    Ohashi, Kumiko; Ota, Sakiko; Ohno-Machado, Lucila; Tanaka, Hiroshi

    2010-06-01

    We developed a wireless auto-tracking system for tracking clinical intervention such as drug administrations and blood tests at the patient bedside. The system can not only authenticate patients and nurses, but also confirm medications and provide relevant information, depending on the clinical situation and personnel location. We conducted a feasibility experiment and examined whether or not the system could work as a patient safety measure in terms of reducing misidentifications of patients and medical errors including wrong medication type, dose, time, and route. Also, the duration of clinical interventions in the system were measured to compare with the BCMA system. Moreover, we conducted a qualitative evaluation with nurses and received feedback clarifying their perceptions of the system. The results showed that the system correctly recognized medical staff, patient ID, and medication data in real time. With regards to workflow time, a significant reduction of time of clinical interventions was observed, when compared to a bar-coding system. In addition, on the nurses' evaluation, we received mostly positive comments although they also clarified some issues to consider with regards to operability and privacy issues. We concluded that the system had great potential for reducing medical errors and nurse workload with high efficiency. Copyright 2010 Elsevier Ltd. All rights reserved.

  17. Bilateral Internal Carotid Artery Segmental Agenesis: Embryology, Common Collateral Pathways, Clinical Presentation, and Clinical Importance of a Rare Condition.

    Science.gov (United States)

    Alexandre, Andrea M; Visconti, Emiliano; Schiarelli, Chiara; Frassanito, Paolo; Pedicelli, Alessandro

    2016-11-01

    Bilateral segmental agenesis of the internal carotid artery is a rare congenital anomaly. We present a case of bilateral internal carotid artery segmental agenesis in an asymptomatic 18-year-old man. Embryology, common collateral pathways, clinical presentation, and clinical importance of this condition are discussed. According to our review of the literature, this report is the first to describe bilateral internal carotid artery segmental agenesis in a patient studied with magnetic resonance imaging, computed tomography, Doppler ultrasonography, and digital subtraction angiography. An 18-year-old man presented to our hospital complaining of occasional mild headaches. Neurologic examination was unremarkable. Imaging findings consisted of bilateral segmental agenesis of the internal carotid arteries. Bilateral segmental agenesis of internal carotid artery may be completely asymptomatic and harmless, but associated conditions, such as cerebral aneurysms or abnormal collateral circulation, should alert clinicians to the possibilities of subarachnoid hemorrhage or cerebral ischemia. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. 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.

  19. 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.)

  20. Professional or administrative value patterns? Clinical pathways in medical problem-solving processes.

    Science.gov (United States)

    Holmberg, Leif

    2007-11-01

    A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current administrative level guidelines impose uniform structural features that meet the requirement for low task uncertainty. Within these structural constraints, physicians must organize medical problem-solving processes to meet any task uncertainty that may be encountered. Medical problem-solving processes with low task uncertainty need to be organized independently of processes with high task uncertainty. Each process must be evaluated according to different performance standards and needs to have autonomous administrative guideline models. Although clinical pathways seem appropriate when there is low task uncertainty, other kinds of guidelines are required when the task uncertainty is high.

  1. Clinical development of VEGF signaling pathway inhibitors in childhood solid tumors.

    Science.gov (United States)

    Glade Bender, Julia; Yamashiro, Darrell J; Fox, Elizabeth

    2011-01-01

    Angiogenesis is a target shared by both adult epithelial cancers and the mesenchymal or embryonal tumors of childhood. Development of antiangiogenic agents for the pediatric population has been complicated by largely theoretical concern for toxicities specific to the growing child and prioritization among the many antiangiogenic agents being developed for adults. This review summarizes the mechanism of action and preclinical data relevant to childhood cancers and early-phase clinical trials in childhood solid tumors. Single-agent adverse event profiles in adults and children are reviewed with emphasis on cardiovascular, bone health, and endocrine side effects. In addition, pharmacological factors that may be relevant for prioritizing clinical trials of these agents in children are reviewed. Considerations for further clinical evaluation should include preclinical data, relative potency, efficacy in adults, and the current U.S. Food and Drug Administration approval status. Toxicity profiles of vascular endothelial growth factor (VEGF) signaling pathway inhibitors may be age dependent and ultimately, their utility in the treatment of childhood cancer will require combination with standard cytotoxic drugs or other molecularly targeted agents. In combination studies, toxicity profiles, potential drug interactions, and late effects must be considered. Studies to assess the long-term impact of VEGF signaling pathway inhibitors on cardiovascular, endocrine, and bone health in children with cancer are imperative if these agents are to be administered to growing children and adolescents with newly diagnosed cancers.

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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.

  7. 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...

  8. 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.)

  9. 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.)

  10. 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.

  11. 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.

  12. Non-invasive high-resolution tracking of human neuronal pathways: diffusion tensor imaging at 7T with 1.2 mm isotropic voxel size

    Science.gov (United States)

    Lützkendorf, Ralf; Hertel, Frank; Heidemann, Robin; Thiel, Andreas; Luchtmann, Michael; Plaumann, Markus; Stadler, Jörg; Baecke, Sebastian; Bernarding, Johannes

    2013-03-01

    Diffusion tensor imaging (DTI) allows characterizing and exploiting diffusion anisotropy effects, thereby providing important details about tissue microstructure. A major application in neuroimaging is the so-called fiber tracking where neuronal connections between brain regions are determined non-invasively by DTI. Combining these neural pathways within the human brain with the localization of activated brain areas provided by functional MRI offers important information about functional connectivity of brain regions. However, DTI suffers from severe signal reduction due to the diffusion-weighting. Ultra-high field (UHF) magnetic resonance imaging (MRI) should therefore be advantageous to increase the intrinsic signal-to-noise ratio (SNR). This in turn enables to acquire high quality data with increased resolution, which is beneficial for tracking more complex fiber structures. However, UHF MRI imposes some difficulties mainly due to the larger B1 inhomogeneity compared to 3T MRI. We therefore optimized the parameters to perform DTI at a 7 Tesla whole body MR scanner equipped with a high performance gradient system and a 32-channel head receive coil. A Stesjkal Tanner spin-echo EPI sequence was used, to acquire 110 slices with an isotropic voxel-size of 1.2 mm covering the whole brain. 60 diffusion directions were scanned which allows calculating the principal direction components of the diffusion vector in each voxel. The results prove that DTI can be performed with high quality at UHF and that it is possible to explore the SNT benefit of the higher field strength. Combining UHF fMRI data with UHF DTI results will therefore be a major step towards better neuroimaging methods.

  13. Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment.

    Science.gov (United States)

    Bouamrane, Matt-Mouley; Mair, Frances S

    2014-11-19

    Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet. We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board. In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts. The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context - including performance targets - promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation

  14. Clinical pathway for acute exacerbations of chronic obstructive pulmonary disease: method development and five years of experience

    Directory of Open Access Journals (Sweden)

    Nishimura K

    2011-06-01

    Full Text Available Koichi Nishimura1, Maya Yasui2, Takashi Nishimura2, Toru Oga31Department of Internal Medicine, Kaikoukai Jousai Hospital, Aichi, Japan; 2Kyoto-Katsura Hospital, Kyoto, Japan; 3Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, JapanBackground: Randomized controlled trials, evidence-based medicine, clinical guidelines, and total quality management are some of the approaches used to render science-based health care services. The clinical pathway for hospitalized patients suffering from acute exacerbations of chronic obstructive pulmonary disease (AECOPD is poorly established, although a clinical pathway is an integral part of total quality management.Aim: To evaluate the outcomes of patients hospitalized with AECOPD in Japan, treated with a clinical pathway following published guidelines.Methods: Prospective data were collected for patients with AECOPD admitted to a general hospital over a 5-year period since 2003. The clinical pathway was designed to establish general rules for the entire treatment protocol. The clinical pathway indicates which treatments and interventions should be performed, and when. In this study, health care providers were required to check the clinical pathway sheets to determine the next step of treatment.Results: This study analyzed 276 hospitalizations in 165 patients. The clinical pathway was interrupted and defined as a dropout in 45 cases (16.3%. Nine patients died during hospitalization (3.3%. Oxygen was administered in 232 hospitalizations (84.1%. Noninvasive positive pressure ventilation (NPPV treatment was administered in 110 hospitalizations (39.9%. The rate of intubation in those cases where NPPV treatment had been administered was 8.2% (9 cases out of 110. The average length of stay (LOS was 20.3 days, and the median value was 15 days. The LOS was longer than 30 days in 34 admissions (12.3%, mainly due to complications.Conclusion: AECOPD can be

  15. Using Meta-data to Search for Clinical Records: RMIT at TREC 2012 Medical Track

    Science.gov (United States)

    2012-11-01

    coagulant, nos” hip admit treated ”ct angiography” admit ”chest pain” assessed patients ”physical therapy” children received ” cerebral palsy ” admit...rmit.edu.au david.martinez@nicta.edu.au Abstract Clinical records contain International Classification of Dis- eases (ICD) codes summarizing the primary and...Development Activity (ARDA). U.S. Government or Federal Rights License 14. ABSTRACT Clinical records contain International Classification of Diseases

  16. Clinically relevant characterization of lung adenocarcinoma subtypes based on cellular pathways: an international validation study.

    Directory of Open Access Journals (Sweden)

    Christopher M Bryant

    Full Text Available Lung adenocarcinoma (AD represents a predominant type of lung cancer demonstrating significant morphologic and molecular heterogeneity. We sought to understand this heterogeneity by utilizing gene expression analyses of 432 AD samples and examining associations between 27 known cancer-related pathways and the AD subtype, clinical characteristics and patient survival. Unsupervised clustering of AD and gene expression enrichment analysis reveals that cell proliferation is the most important pathway separating tumors into subgroups. Further, AD with increased cell proliferation demonstrate significantly poorer outcome and an increased solid AD subtype component. Additionally, we find that tumors with any solid component have decreased survival as compared to tumors without a solid component. These results lead to the potential to use a relatively simple pathological examination of a tumor in order to determine its aggressiveness and the patient's prognosis. Additional results suggest the ability to use a similar approach to determine a patient's sensitivity to targeted treatment. We then demonstrated the consistency of these findings using two independent AD cohorts from Asia (N = 87 and Europe (N = 89 using the identical analytic procedures.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. Clinic value of two-dimensional speckle tracking combined with adenosine stress echocardiography for assessment of myocardial viability.

    Science.gov (United States)

    Ran, Hong; Zhang, Ping-Yang; Fang, Ling-Ling; Ma, Xiao-Wu; Wu, Wen-Fang; Feng, Wang-Fei

    2012-07-01

    To evaluate whether myocardial strain under adenosine stress calculated from two-dimensional echocardiography by automatic frame-by-frame tracking of natural acoustic markers enables objective description of myocardial viability in clinic. Two-dimensional echocardiography and two-dimensional speckle tracking imaging (2D STI) at rest were performed first and once again after adenosine was infused at 140 ug/kg/min over a period of 6 minutes in 36 stable patients with previous myocardial infarction. Then radionuclide myocardial perfusion/metabolic imaging served as the "gold standard" to define myocardial viability was given in all patients within 1 day. Two-dimensional speckle tracking images were acquired at rest and after adenosine administration. An automatic frame-by-frame tracking system of natural acoustic echocardiographic markers was used to calculate 2D strain variables including peak-systolic circumferential strain (CS(peak-sys)), radial strain (RS(peak-sys)), and longitudinal strain (LS(peak-sys)). Those segments with abnormal motion from visual assessment of two-dimensional echocardiography were selected for further study. As a result, 126 regions were viable whereas 194 were nonviable among 320 abnormal motion segments in 36 patients according to radionuclide imaging. At rest, there were no significant changes of 2D strain between the viable and nonviable myocardium. After adenosine administration (140 ug/kg/min), CS(peak-sys) had a little change of the viable myocardium while RS(peak-sys) and LS(peak-sys) increased significantly compared with those at rest. In nonviable group, CS(peak-sys), RS(peak-sys), and LS(peak-sys) had no significant changes during adenosine administration. After adenosine administration, RS(peak-sys) and LS(peak-sys) in viable group increased significantly compared with nonviable group. Obtained strain data were highly reproducible and affected in small intraobserver and interobserver variabilities. A change of radial strain more

  2. Pathways into psychopathology: Modeling the effects of trait emotional intelligence, mindfulness, and irrational beliefs in a clinical sample

    OpenAIRE

    Petrides, K. V.; Gómez, M. G.; Pérez-González, J. C.

    2017-01-01

    We investigated possible pathways into mental illness via the combined effects of trait emotional intelligence (trait EI), mindfulness, and irrational beliefs. The sample comprised 121 psychiatric outpatients (64.5% males, mean age = 38.8 years) with a variety of formal clinical diagnoses. Psychopathology was operationalized by means of 3 distinct indicators from the Millon Clinical Multi-Axial Inventory (mild pathology, severe pathology, and clinical symptomatology). A structural equation mo...

  3. 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

  4. 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.

  5. The importance of physical activity in osteoporosis. From the molecular pathways to the clinical evidence.

    Science.gov (United States)

    Castrogiovanni, Paola; Trovato, Francesca Maria; Szychlinska, Marta Anna; Nsir, Houda; Imbesi, Rosa; Musumeci, Giuseppe

    2016-11-01

    Osteoporosis is a very common bone disorder characterized by low bone mass and signs of deterioration, responsible for bone fragility typical in this pathology. The risk factors for the onset of osteoporosis are many and different from each other. Some of them cannot be modified, such as age, hereditary diseases and endocrine diseases. Others are modifiable, so that prevention is an advisable tool to reduce the incidence of osteoporosis. Among preventive tools, physical activity is certainly a valid instrument of prevention, in fact physical activity contributes to a healthy energy balance and increases muscle mass and bone mass. In the present narrative review, we wanted to pay attention to the possible influence of physical activity on the pathophysiological molecular pathways of osteoporosis and to the use of different exercise training in treatment of osteoporosis. From the literature analyzed, in relation to the effects of physical activity on bone metabolism, it is shown that exercise acts on molecular pathways of bone remodeling involving all cellular types of bone tissue. In relation to clinical trials adopted in patients with osteoporosis, it is evident that a multi-component training, including aerobic activity and other types of training (resistance and/or strength exercises), is the best kind of exercise in improving bone mass and bone metabolism in older adults and especially osteopoenic and osteoporotic women. With regard to whole-body-vibration training, it seems to be a valid alternative to current methods due to its greater adaptability to patients. In conclusion, physical activity, whatever the adopted training, always has beneficial effects on patients suffering from osteoporosis, and not only on bone homeostasis but on the whole skeletal muscle system.

  6. 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

  7. 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....

  8. Peptide inhibitor of complement C1 (PIC1, a novel suppressor of classical pathway activation: mechanistic studies and clinical potential

    Directory of Open Access Journals (Sweden)

    Julia A Sharp

    2014-08-01

    Full Text Available The classical pathway of complement plays multiple physiological roles including modulating immunological effectors initiated by adaptive immune responses as well as an essential homeostatic role in the clearance of damaged self-antigens. However, dysregulated classical pathway activation is associated with antibody-initiated, inflammatory diseases processes like cold agglutinin disease (CAD, acute intravascular hemolytic transfusion reaction (AIHTR and acute/hyperacute transplantation rejection. To date, only one putative classical pathway inhibitor, C1 esterase inhibitor (C1-INH, is currently commercially available and its only approved indication is for replacement treatment in hereditary angioedema (HAE, which is predominantly a kinin pathway disease. Given the variety of disease conditions in which the classical pathway is implicated, development of therapeutics that specifically inhibit complement initiation represents a major unmet medical need. Our laboratory has identified a peptide that specifically inhibits the classical and lectin pathways of complement. In vitro studies have demonstrated that these Peptide Inhibitors of Complement C1 (PIC1 bind to the collagen-like region of the initiator molecule of the classical pathway, C1q. PIC1 binding to C1q blocks activation of the associated serine proteases (C1s-C1r-C1r-C1s and subsequent downstream complement activation. Rational design optimization of PIC1 has resulted in the generation of a highly potent derivative of fifteen amino acids. PIC1 inhibits classical pathway mediated complement activation in ABO incompatibility in vitro as well as inhibiting classical pathway activation in vivo in rats. This review will focus on the pre-clinical development of PIC1 and discuss its potential as a therapeutic in antibody-mediated classical pathway disease, specifically AIHTR.

  9. 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

  10. Identifying and classifying indicators affected by performing clinical pathways in hospitals: a scoping review.

    Science.gov (United States)

    Shabaninejad, Hosein; Alidoost, Saeide; Delgoshaei, Bahram

    2018-03-01

    To analyse the evidence regarding indicators affected by clinical pathways (CPW) in hospitals and offer suggestions for conducting comprehensive systematic reviews. We conducted a systematic scoping review and searched the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OVID, Science Direct, ProQuest, EMBASE and PubMed. We also reviewed the reference lists of included studies. The criteria for inclusion of studies included experimental and quasi-experimental studies, implementing CPW in secondary and tertiary hospitals and investigating at least one indicator. Quality of included studies was assessed by two authors independently using the Critical Appraisal Skills Program for clinical trials and cohort studies and the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. Forty-seven out of 2191 studies met the eligibility and inclusion criteria. The majority of included studies had pretest-posttest quasi-experimental design and had been done in developed countries, especially the United States. The investigation of evidence resulted in identifying 62 indicators which were classified into three categories: input indicators, process and output indicators and outcome indicators. Outcome indicators were more frequent than other indicators. Complication rate, hospital costs and length of hospital stay were dominant in their own category. Indicators such as quality of life and adherence to guidelines have been considered in studies that were done in recent years. Implementing CPW can affect different types of indicators such as input, process, output and outcome indicators, although outcome indicators capture more attention than other indicators. Patient-related indicators were dominant outcome indicators, whereas professional indicators and organizational factors were considered less extensively. WHAT IS KNOWN ABOUT THE TOPIC?: WHAT DOES THIS ARTICLE ADD?

  11. Partnerships and Pathways of Dissemination: The NIDA-SAMHSA Blending Initiative in the Clinical Trials Network

    Science.gov (United States)

    Martino, Steve; Brigham, Gregory S.; Higgins, Christine; Gallon, Steve; Freese, Thomas E.; Albright, Lonnetta M.; Hulsey, Eric G.; Krom, Laurie; Storti, Susan A.; Perl, Harold; Nugent, Cathrine D.; Pintello, Denise; Condon, Timothy P.

    2010-01-01

    Since 2001, the National Drug Abuse Treatment Clinical Trials Network (CTN) has worked to put the results of its trials into the hands of community treatment programs, in large part through its participation in the National Institute on Drug Abuse - Substance Abuse and Mental Health Services Administration Blending Initiative and its close involvement with the Center for Substance Abuse Treatment’s Addiction Technology Transfer Centers. This article describes 1) the CTN’s integral role in the Blending Initiative, 2) key partnerships and dissemination pathways through which the results of CTN trials are developed into blending products and then transferred to community treatment programs, and 3) three blending initiatives involving buprenorphine, motivational incentives, and motivational interviewing. The Blending Initiative has resulted in high utilization of its products, preparation of over 200 regional trainers, widespread training of service providers in most U.S. States, Puerto Rico, and the U.S. Virgin Islands, and movement toward the development of web-based implementation supports and technical assistance. Implications for future directions of the Blending Initiative and opportunities for research are discussed. PMID:20307793

  12. 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.

  13. 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

  14. 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

  15. Role of clinical pathway in improving the quality of care for patients with faecal incontinence: A randomised trial.

    Science.gov (United States)

    Hussain, Zeiad I; Lim, Michael; Stojkovic, Stevan

    2017-02-06

    To assess the development and implementation of the Integrated Rapid Assessment and Treatment (IRAT) pathway for the management of patients with fecal incontinence and measure its impact on patients' care. Patients referred to the colorectal unit in our hospital for the management of faecal incontinence were randomised to either the Standard Care pathway or the newly developed IRAT pathway in this feasibility study. The IRAT pathway is designed to provide a seamless multidisciplinary care to patients with faecal incontinence in a timely fashion. On the other hand, patients in the Standard Pathway were managed in the general colorectal clinic. Percentage improvements in St. Marks Incontinence Score, Cleveland Clinic Incontinence Score and Rockwood Faecal Incontinence Quality of Life Scale after completion of treatment in both groups were the primary outcome measures. Secondary endpoints were the time required to complete the management and patients' satisfaction score. χ 2 , Mann-Whitney-U and Kendall tau-c correlation coefficient tests were used for comparison of outcomes of the two study groups. A P value of 0.05 or less was considered significant. Thirty-nine patients, 34 females, consented to participate. Thirty-one (79.5%) patients completed the final assessment and were included in the outcome analysis. There was no significant difference in the quality of life scales and incontinence scores. Patients in the IRAT pathway were more satisfied with the time required to complete management ( P = 0.033) and had stronger agreement that all aspects of their problem were covered ( P = 0.006). Despite of the lack of significant difference in outcome measures, the new pathway has positively influenced patient's mindset, which was reflected in a higher satisfaction score.

  16. Combined AKT and MEK Pathway Blockade in Pre-Clinical Models of Enzalutamide-Resistant Prostate Cancer.

    Science.gov (United States)

    Toren, Paul; Kim, Soojin; Johnson, Fraser; Zoubeidi, Amina

    2016-01-01

    Despite recent improvements in patient outcomes using newer androgen receptor (AR) pathway inhibitors, treatment resistance in castrate resistant prostate cancer (CRPC) continues to remain a clinical problem. Co-targeting alternate resistance pathways are of significant interest to treat CRPC and delay the onset of resistance. Both the AKT and MEK signaling pathways become activated as prostate cancer develops resistance to AR-targeted therapies. This pre-clinical study explores co-targeting these pathways in AR-positive prostate cancer models. Using various in vitro models of prostate cancer disease states including androgen dependent (LNCaP), CRPC (V16D and 22RV1) and ENZ-resistant prostate cancer (MR49C and MR49F), we evaluate the relevance of targeting both AKT and MEK pathways. Our data reveal that AKT inhibition induces apoptosis and inhibits cell growth in PTEN null cell lines independently of their sensitivity to hormone therapy; however, AKT inhibition had no effect on the PTEN positive 22RV1 cell line. Interestingly, we found that MEK inhibition had greater effect on 22RV1 cells compared to LNCaP, V16D or ENZ-resistant cells MR49C and MR49F cells. In vitro, combination AKT and MEK blockade had evidence of synergy observed in some cell lines and assays, but this was not consistent across all results. In vivo, the combination of AKT and MEK inhibition resulted in more consistent tumor growth inhibition of MR49F xenografts and longer disease specific survival compared to AKT inhibitor monotherapy. As in our in vitro study, 22RV1 xenografts were more resistant to AKT inhibition while they were more sensitive to MEK inhibition. Our results suggest that targeting AKT and MEK in combination may be a valuable strategy in prostate cancer when both pathways are activated and further support the importance of characterizing the dominant oncogenic pathway in each patient's tumor in order to select optimal therapy.

  17. Slab track

    OpenAIRE

    Golob, Tina

    2014-01-01

    The last 160 years has been mostly used conventional track with ballasted bed, sleepers and steel rail. Ensuring the high speed rail traffic, increasing railway track capacities, providing comfortable and safe ride as well as high reliability and availability railway track, has led to development of innovative systems for railway track. The so-called slab track was first built in 1972 and since then, they have developed many different slab track systems around the world. Slab track was also b...

  18. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines.

    Science.gov (United States)

    Butow, Phyllis; Price, Melanie A; Shaw, Joanne M; Turner, Jane; Clayton, Josephine M; Grimison, Peter; Rankin, Nicole; Kirsten, Laura

    2015-09-01

    A clinical pathway for anxiety and depression in adult cancer patients was developed to guide best practice in Australia. The pathway was based on a rapid review of existing guidelines, systematic reviews and meta-analyses, stakeholder interviews, a Delphi process with 87 multidisciplinary stakeholders and input from a multidisciplinary advisory panel. The pathway recommends formalized routine screening for anxiety and depression in patients with cancer at key points in the patient's journey. The Edmonton Symptom Assessment System or distress thermometer with problem checklist is recommended as brief screening tools, combined with a more detailed tool, such as the Hospital Anxiety and Depression Scale, to identify possible cases. A structured clinical interview will be required to confirm diagnosis. When anxiety or depression is identified, it is recommended that one person in a treating team takes responsibility for coordinating appropriate assessment, referral and follow-up (not necessarily carrying these out themselves). A stepped care model of intervention is proposed, beginning with the least intensive available that is still likely to provide significant health gain. The exact intervention, treatment length and follow-up timelines, as well as professionals involved, are provided as a guide only. Each service should identify their own referral network based on local resources and current service structure, as well as patient preference. This clinical pathway will assist cancer services to design their own systems to detect and manage anxiety and depression in their patients, to improve the quality of care. Copyright © 2015 John Wiley & Sons, Ltd.

  19. 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

  20. 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.

  1. 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.

  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. 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

    collimator tracking was implemented for 15 patients in a prostate cancer radiation therapy trial; in total, 513 treatment fractions were delivered. During each treatment fraction, the prostate trajectory and treatment MLC positions were collected. These data were used as input for dose reconstruction......PURPOSE: To test the hypothesis that multileaf collimator (MLC) tracking improves the consistency between the planned and delivered dose compared with the dose without MLC tracking, in the setting of a prostate cancer volumetric modulated arc therapy trial. METHODS AND MATERIALS: Multileaf...

  4. Combined targeting of EGFR-dependent and VEGF-dependent pathways: rationale, preclinical studies and clinical applications.

    Science.gov (United States)

    Tortora, Giampaolo; Ciardiello, Fortunato; Gasparini, Giampietro

    2008-09-01

    Cellular heterogeneity, redundancy of molecular pathways and effects of the microenvironment contribute to the survival, motility and metastasis of cells in solid tumors. It is unlikely that tumors are entirely dependent on only one abnormally activated signaling pathway; consequently, treatment with an agent that interferes with a single target may be insufficient. Combined blockade of functionally linked and relevant multiple targets has become an attractive therapeutic strategy. The EGFR and ERBB2 (HER2) pathways and VEGF-dependent angiogenesis have a pivotal role in cancer pathogenesis and progression. Robust experimental evidence has shown that these pathways are functionally linked and has demonstrated a suggested role for VEGF in the acquired resistance to anti-ERBB drugs when these receptors are pharmacologically blocked. Combined inhibition of ERBB and VEGF signaling interferes with a molecular feedback loop responsible for acquired resistance to anti-ERBB agents and promotes apoptosis while ablating tumor-induced angiogenesis. To this aim, either two agents highly selective against VEGF and ERBB respectively, or, alternatively, a single multitargeted agent, can be used. Preclinical studies have proven the efficacy of both these approaches and early clinical studies have provided encouraging results. This Review discusses the experimental rationale for, preclinical studies of and clinical trials on combined blockade of ERBB and VEGF signaling.

  5. Does the CONSORT checklist for abstracts improve the quality of reports of randomized controlled trials on clinical pathways?

    Science.gov (United States)

    Cui, Qi; Tian, Jinhui; Song, Xuping; Yang, Kehu

    2014-12-01

    The extension of the Consolidated Standards of Reporting Trials (CONSORT) statement provides reporting guidelines to improve the reporting quality of randomized controlled trials (RCTs). This present study was aim to assess the reporting quality of abstracts of RCTs on clinical pathway. Eight databases were searched from inception to November 2012 to identify RCTs. We extracted basic information and CONSORT items from abstracts. Each abstract was assessed independently by two reviewers. Statistical analyses were performed with SPSS 13.0. Level of significance was set at P CONSORT), but only the numbers of randomized (P = 0.003) changed in Chinese abstracts. The reporting quality of abstracts of RCTs on clinical pathway still should be improved. After the publication of CONSORT for abstracts guideline, the RCT abstracts reporting quality were improvement to some extent. The abstracts in Chinese journals showed non-adherence to the CONSORT for abstracts guidelines. © 2014 John Wiley & Sons, Ltd.

  6. Rural generalism and the Queensland Health pathway--implications for rural clinical supervisors, placements and rural medical education providers.

    Science.gov (United States)

    Kitchener, Scott

    2013-01-01

    The lifeline for country medicine' was the description by the Rural Doctors Association of Australia of the Queensland Health Rural Generalist Pathway (RGP). The program promises to redress rural medical workforce issues in Queensland. It may fulfil these promises, but only with the support of rural clinical supervisors and medical educators adapting to new expectations of competencies, of training structure and endpoints of training. These adaptations will be a key element of the RGP success, particularly as other states adopt the approach. This article outlines the lessons learnt and adaptations made by clinical supervisors and medical educators in the Queensland Rural Medical Education group, to deliver the Rural Pathway of the Australian General Practice Training program since the first registrars identifying as RGP appeared in this program in 2006.

  7. Improving Tracheostomy Care Delivery: Instituting Clinical Care Pathways and Nursing Education to Improve Patient Outcomes.

    Science.gov (United States)

    Colandrea, Maria; Eckardt, Patricia

    2016-01-01

    The complication rates for tracheostomy patients could be serious and life threatening. As a result, length of stay (LOS) increases and patient outcomes can be negatively impacted. Examples of complications include accidental decannulation, bleeding and total occlusion. Studies suggest there is an inconsistency in tracheostomy care among providers and institutions. Other studies suggest stronger patient outcomes can result from improved staff training and appropriate protocols. The purpose of this study was to develop and test a clinical care pathway (CCP) and nursing education program to improve tracheostomy patient outcomes. The use of a CCP and nursing education program at a tertiary VA Medical Center will: decrease length of stay (LOS). decrease 30 day tracheostomy readmissions. increase patient's readiness for discharge. increase nurses' comfort level with performing tracheostomy care. increase nurses' overall competence with performing tracheostomy care. A quasi-experimental pilot study examining the effect of a CCP compared LOS and complication rates of tracheostomy patients from admission to discharge. The population included veterans from a mid-Atlantic VA Medical Center. This study involved three phases. Phase 1: Administer the Readiness for Hospital Discharge Scale (RHDS) to tracheostomy patients' preintervention. Phase 2: Provide nurses with an educational program pre and post test assessment. Phase 3: Implement the CCP and evaluate patients' readiness for discharge. Comparing the pre-intervention sample of veterans (n = 10) to the post-intervention sample (n = 6), there was an increase in LOS by 1 day. There was a 15 point increase in RHDS from 165 (SD 25.8) to 180 (SD 14.42). This pilot was underpowered with an n = 6, so there was no significant difference in LOS and 30 day readmission rates. Bootstrapping of sample resulted in RHDS p = . 039 and readmission p = .007. A paired-samples t-test was conducted to assess nurses' competence in performing

  8. 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

  9. [Clinical pathway, quality circle and standard operating procedures as tools for quality management in the trauma suite].

    Science.gov (United States)

    Wurmb, Thomas; Frühwald, Peter; Roewer, Norbert; Brederlau, Jörg

    2009-01-01

    In each hospital the trauma resuscitation room in emergency departments is one of the areas with the highest rate of critical incidents. Delayed and insufficient medical interventions have a high impact on negative patient outcomes. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process. This can be achieved by implementing an algorithm-based structured work flow. In this context some elements of quality management are well-established in clinical practice. In the present study we describe the implementation of a clinical pathway and an interdisciplinary quality circle to improve management of the trauma patient.

  10. 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.

  11. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Jost, Sarah C. [Swedish Neuroscience Institute, Department of Neurosurgery, Seattle, WA (United States); Ackerman, Joseph W. [Washington University School of Medicine, Department of Radiology, 660 South Euclid Ave., Box 8131, St. Louis, MO (United States); Garbow, Joel R. [Washington University School of Medicine, Department of Radiology, 660 South Euclid Ave., Box 8131, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, St. Louis, MO (United States); Manwaring, Linda P. [Washington University School of Medicine, Department of Pediatrics, St. Louis, MO (United States); Washington University School of Medicine, Department of Genetics and Genomic Medicine, St. Louis, MO (United States); Gutmann, David H. [Washington University School of Medicine, Department of Neurology, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, St. Louis, MO (United States); McKinstry, Robert C. [Washington University School of Medicine, Department of Radiology, 660 South Euclid Ave., Box 8131, St. Louis, MO (United States); Washington University School of Medicine, Department of Pediatrics, St. Louis, MO (United States)

    2008-12-15

    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 {mu}m{sup 2}/ms and mean permeability values of 2.10 ml/min per 100 cm{sup 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.)

  13. 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.

  14. Clinical evidence of traditionalvsfast 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

    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. 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. 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. 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. IV. Case series, low-quality cohort or case-control studies.

  15. 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.

  16. CORRELATION OF MRI GRADING OF BONE STRESS INJURIES WITH CLINICAL RISK FACTORS AND RETURN TO PLAY: A 5-YEAR PROSPECTIVE STUDY IN COLLEGIATE TRACK AND FIELD ATHLETES

    Science.gov (United States)

    Nattiv, Aurelia; Kennedy, Gannon; Barrack, Michelle T.; Abdelkerim, Ashraf; Goolsby, Marci A.; Arends, Julie C.; Seeger, Leanne L.

    2015-01-01

    Background Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time. Purpose To examine the relationships between MRI grading of bone stress injury with clinical risk factors and time to return to sport in collegiate track and field athletes. Study Design Prospective cohort over 5 years. Methods Two hundred and eleven male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had a pre-participation history, physical exam, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns and prior injuries, as well as a 3-day diet record. Dual energy X-ray absorptiometry was obtained at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiographs were negative, MRI was obtained. Bone stress injuries were evaluated by two independent radiologists utilizing an MRI grading system. MRI grading and risk factors were evaluated to identify predictors of time to return to sport. Results Thirty-four (12 males, 22 females) of the 211 collegiate athletes sustained 61 bone stress injuries during the 5-year study period. The average prospective assessment for participants was 2.1 years. MRI grade and total body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport in the multiple regression model. Specifically, the higher the MRI grade, the longer the recovery time (pstress injuries in track and field athletes. Knowledge of these risk factors, as well as nutritional and menstrual factors, can be clinically useful in determining time to return to sport. PMID:23825184

  17. A data mining approach for identifying pathway-gene biomarkers for predicting clinical outcome: A case study of erlotinib and sorafenib.

    Directory of Open Access Journals (Sweden)

    David G Covell

    Full Text Available A novel data mining procedure is proposed for identifying potential pathway-gene biomarkers from preclinical drug sensitivity data for predicting clinical responses to erlotinib or sorafenib. The analysis applies linear ridge regression modeling to generate a small (N~1000 set of baseline gene expressions that jointly yield quality predictions of preclinical drug sensitivity data and clinical responses. Standard clustering of the pathway-gene combinations from gene set enrichment analysis of this initial gene set, according to their shared appearance in molecular function pathways, yields a reduced (N~300 set of potential pathway-gene biomarkers. A modified method for quantifying pathway fitness is used to determine smaller numbers of over and under expressed genes that correspond with favorable and unfavorable clinical responses. Detailed literature-based evidence is provided in support of the roles of these under and over expressed genes in compound efficacy. RandomForest analysis of potential pathway-gene biomarkers finds average treatment prediction errors of 10% and 22%, respectively, for patients receiving erlotinib or sorafenib that had a favorable clinical response. Higher errors were found for both compounds when predicting an unfavorable clinical response. Collectively these results suggest complementary roles for biomarker genes and biomarker pathways when predicting clinical responses from preclinical data.

  18. 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.

  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...

  20. Clinical protocols for {sup 31}P MRS of the brain and their use in evaluating optic pathway gliomas in children

    Energy Technology Data Exchange (ETDEWEB)

    Novak, Jan, E-mail: j.novak@bham.ac.uk [School of Cancer Sciences, University of Birmingham, Birmingham (United Kingdom); Birmingham Children' s Hospital, Birmingham (United Kingdom); Wilson, Martin, E-mail: martin@pipegrep.co.uk [School of Cancer Sciences, University of Birmingham, Birmingham (United Kingdom); Birmingham Children' s Hospital, Birmingham (United Kingdom); MacPherson, Lesley, E-mail: lesley.macpherson@bch.nhs.uk [Birmingham Children' s Hospital, Birmingham (United Kingdom); Arvanitis, Theodoros N., E-mail: t.arvanitis@bham.ac.uk [Birmingham Children' s Hospital, Birmingham (United Kingdom); School of Electronic, Electrical and Computer Engineering, University of Birmingham, Birmingham (United Kingdom); Davies, Nigel P., E-mail: nigel.davies@nhs.net [School of Cancer Sciences, University of Birmingham, Birmingham (United Kingdom); Birmingham Children' s Hospital, Birmingham (United Kingdom); University Hospitals Birmingham NHS Foundation Trust, Medical Physics RRPPS, Birmingham (United Kingdom); Peet, Andrew C., E-mail: a.peet@bham.ac.uk [School of Cancer Sciences, University of Birmingham, Birmingham (United Kingdom); Birmingham Children' s Hospital, Birmingham (United Kingdom)

    2014-02-15

    Introduction: In vivo {sup 31}P Magnetic Resonance Spectroscopy (MRS) measures phosphorus-containing metabolites that play an essential role in many disease processes. An advantage over {sup 1}H MRS is that total choline can be separated into phosphocholine and glycerophosphocholine which have opposite associations with tumour grade. We demonstrate {sup 31}P MRS can provide robust metabolic information on an acceptable timescale to yield information of clinical importance. Methods: All MRI examinations were carried out on a 3T whole body scanner with all {sup 31}P MRS scans conducted using a dual-tuned {sup 1}H/{sup 31}P head coil. Once optimised on phantoms, the protocol was tested in six healthy volunteers (four male and two female, mean age: 25 ± 2.7). {sup 31}P MRS was then implemented on three children with optic pathway gliomas. Results: {sup 31}P MRS on volunteers showed that a number of metabolite ratios varied significantly (p < 0.05 ANOVA) across different structures of the brain, whereas PC/GPC did not. Standard imaging showed the optic pathway gliomas were enhancing on T1-weighted imaging after contrast injection and have high tCho on {sup 1}H MRS, both of which are associated with high grade lesions. {sup 31}P MRS showed the phosphocholine/glycerophosphocholine ratio to be low (<0.6) which suggests low grade tumours in keeping with their clinical behaviour and the histology of most biopsied optic pathway gliomas. Conclusion: {sup 31}P MRS can be implemented in the brain as part of a clinical protocol to provide robust measurement of important metabolites, in particular providing a greater understanding of cases where tCho is raised on {sup 1}H MRS.

  1. A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

    Science.gov (United States)

    Cheng, Tsung-Mei

    2013-05-01

    Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

  2. The Use of Technology in Participant Tracking and Study Retention: Lessons Learned From a Clinical Trials Network Study.

    Science.gov (United States)

    Mitchell, Shannon Gwin; Schwartz, Robert P; Alvanzo, Anika A H; Weisman, Monique S; Kyle, Tiffany L; Turrigiano, Eva M; Gibson, Martha L; Perez, Livangelie; McClure, Erin A; Clingerman, Sara; Froias, Autumn; Shandera, Danielle R; Walker, Robrina; Babcock, Dean L; Bailey, Genie L; Miele, Gloria M; Kunkel, Lynn E; Norton, Michael; Stitzer, Maxine L

    2015-01-01

    The growing use of newer communication and Internet technologies, even among low-income and transient populations, require research staff to update their outreach strategies to ensure high follow-up and participant retention rates. This paper presents the views of research assistants on the use of cell phones and the Internet to track participants in a multisite randomized trial of substance use disorder treatment. Preinterview questionnaires exploring tracking and other study-related activities were collected from 21 research staff across the 10 participating US sites. Data were then used to construct a semistructured interview guide that, in turn, was used to interview 12 of the same staff members. The questionnaires and interview data were entered in Atlas.ti and analyzed for emergent themes related to the use of technology for participant-tracking purposes. Study staff reported that most participants had cell phones, despite having unstable physical addresses and landlines. The incoming call feature of most cell phones was useful for participants and research staff alike, and texting proved to have additional benefits. However, reliance on participants' cell phones also proved problematic. Even homeless participants were found to have access to the Internet through public libraries and could respond to study staff e-mails. Some study sites opened generic social media accounts, through which study staff sent private messages to participants. However, the institutional review board (IRB) approval process for tracking participants using social media at some sites was prohibitively lengthy. Internet searches through Google, national paid databases, obituaries, and judiciary Web sites were also helpful tools. Research staff perceive that cell phones, Internet searches, and social networking sites were effective tools to achieve high follow-up rates in drug abuse research. Studies should incorporate cell phone, texting, and social network Web site information on

  3. The Alberta Hip and Knee Replacement Project: a model for health technology assessment based on comparative effectiveness of clinical pathways.

    Science.gov (United States)

    Gooch, Katherine L; Smith, Douglas; Wasylak, Tracy; Faris, Peter D; Marshall, Deborah A; Khong, Hoa; Hibbert, Julie E; Parker, Robyn D; Zernicke, Ronald F; Beaupre, Lauren; Pearce, Tim; Johnston, D W C; Frank, Cyril B

    2009-04-01

    The Alberta Hip and Knee Replacement Project developed a new evidence-based clinical pathway (NCP) for total hip (THR) and knee (TKR) replacement. The aim was to facilitate the delivery of services in a timely and cost-effective manner while achieving the highest quality of care for the patient across the full continuum of care from patient referral to an orthopedic surgeon through surgery, recovery, and rehabilitation. The purpose of this article is to provide an overview of the study design, rationale, and execution of this project as a model for health technology assessment based on comparative effectiveness of alternative clinical pathways. A pragmatic randomized controlled trial study design was used to evaluate the NCP compared with the standard of care (SOC) for these procedures. The pragmatic study design was selected as a rigorous approach to produce high quality evidence suitable for informing decisions between relevant interventions in real clinical practice. The NCP was evaluated in three of the nine regional health authorities (RHAs) in Alberta with dedicated central intake clinics offering multidisciplinary care teams, constituting 80 percent of THR and TKR surgeries performed annually in Alberta. Patients were identified in the offices of twenty orthopedic surgeons who routinely performed THR or TKR surgeries. Evaluation outcome measures were based on the six dimensions of the Alberta Quality Matrix for Health (AQMH): acceptability, accessibility, appropriateness, effectiveness, efficiency and safety. Data were collected prospectively through patient self-completed questionnaires at baseline and 3 and 12 months after surgery, ambulatory and inpatient chart reviews, and electronic administrative data. The trial design was successful in establishing similar groups for rigorous evaluation. Of the 4,985 patients invited to participate, 69 percent of patients consented. A total of 3,434 patients were randomized: 1,712 to SOC and 1,722 to the NCP. The

  4. Outcome predictors of empirical slow pathway modulation: clinical and procedural characteristics and long-term follow-up.

    Science.gov (United States)

    Pott, Christian; Wegner, Felix K; Bögeholz, Nils; Frommeyer, Gerrit; Dechering, Dirk G; Zellerhoff, Stephan; Kochhäuser, Simon; Milberg, Peter; Köbe, Julia; Wasmer, Kristina; Breithardt, Günter; Mönnig, Gerold; Eckardt, Lars

    2015-11-01

    Catheter-based modulation of the slow pathway is the first-line therapy of atrioventricular nodal reentrant tachycardia (AVNRT), the most common supraventricular tachycardia (SVT). In patients with a typical history, in whom AVNRT is not inducible during an electrophysiological study, the current guidelines allow consideration of empirical slow pathway modulation (ESPM) under the precondition that both, dual nodal pathway physiology (DNPP) and an ECG documentation compatible with AVNRT exist. This recommendation is based on small series. Furthermore, it is unknown whether ESPM is beneficial in the presence of ECG documentation but the absence of DNPP or vice versa in the presence of DNPP but absence of ECG documentation. Out of 3003 patients who underwent slow pathway modulation from 1993 to 2013, we included 116 patients (68 female; median age 47.0 years) with symptomatic tachycardia who had non-inducible SVT. All patients either had ECG documentation of SVT (66 %) or DNPP (89 %) or both (54 %). All patients underwent ESPM. No severe complications occurred. After a follow-up time of 64 ± 5.3 months, 81 % of all patients had benefited from ESPM (49 % freedom of symptoms, 32 % improvement). In patients with ECG documentation but absence of DNPP 100 % benefited (85 % freedom of symptoms; 15 % improvement). In patients with DNPP but absence of ECG documentation 75 % benefited (40 % freedom of symptoms, 35 % improvement). In a large cohort of patients, ESPM is a safe procedure that improves clinical symptoms in the majority of patients during long-term follow-up. We show for the first time that this also applies for cases where there is no DNPP but a characteristic ECG documentation, and vice versa.

  5. 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

  6. 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.

  7. The quality of the evidence base for clinical pathway effectiveness: Room for improvement in the design of evaluation trials

    Science.gov (United States)

    2012-01-01

    Background The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs. Methods An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported. Results Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70 %) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base. Conclusions Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals. PMID:22709274

  8. The use of an integrated care pathway for evidence-based practice and clinical governance in abortion care.

    Science.gov (United States)

    Graham, O; Jayadeva, P; Guthrie, K

    2010-05-01

    The aim of the study was to assess the effectiveness of an integrated care pathway (ICP) for delivery of evidence-based practice in abortion care. All women re-admitted after an abortion had their records audited for adherence to national and local guidelines using information in the ICP and general gynaecology case notes. A total of 100 women were re-admitted into the gynaecological wards of hospitals in Hull and East Riding of Yorkshire after an abortion, between January 2000 and December 2006. Out of 8,476 medical or surgical induced abortions undertaken at 14 weeks gestation or under, the overall readmission rate was 1.2%. The ICP showed that 97% of women had chlamydia screening prior to the abortion; all women had a contraceptive discussion and 43% left using a long-acting reversible method of contraception (LARC). However, data outside the care pathway was not documented, and hence the standard of care given on readmission was difficult to locate and variable in quality. The ICP clinical record is demonstrated to be a useful tool for high quality record-keeping and ensuring all patients receive the same standard of pre-assessment care. Although this service has an acceptably low-risk profile in terms of re-admission, we propose the addition of a re-admission episode to the current ICP to further enhance clinical care post-abortion.

  9. Effects of performance-based compensation and faculty track on the clinical activity, research portfolio, and teaching mission of a large academic department of medicine.

    Science.gov (United States)

    Tarquinio, Gregg T; Dittus, Robert S; Byrne, Daniel W; Kaiser, Allen; Neilson, Eric G

    2003-07-01

    Academic departments of medicine must compete effectively for extramural research support and access to patients while preserving their teaching mission. There is not much literature describing plausible mechanisms for ensuring success. The authors describe the design, implementation, and testing of a performance-based compensation plan in a department of medicine that is closely linked to the faculty appointment track. Over a three-year period, the changes this plan effected in research portfolio, clinical enterprise, and faculty satisfaction as well as the teaching perceptions of students and housestaff were measured. The compound annual growth rate (CAGR) for clinical work grew 40% faster after plan implementation. Federal funding increased at a CAGR that was 170% greater than before. The department halved its award rankings at the National Institutes of Health and faculty satisfaction improved compared with the former method of compensation. Faculty who better understood the plan were more satisfied with the conversion. High measures of teaching quality were maintained by faculty with no apparent change in satisfaction among students or housestaff. This performance-based compensation plan with its emphasis on the objectives of career orientation and faculty track assignment strengthened the opportunity to grow both clinical productivity and the funded research portfolio.

  10. 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

  11. 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

  12. 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.

  13. Pathways to clinical CLARITY: volumetric analysis of irregular, soft, and heterogeneous tissues in development and disease.

    Science.gov (United States)

    Hsueh, Brian; Burns, Vanessa M; Pauerstein, Philip; Holzem, Katherine; Ye, Li; Engberg, Kristin; Wang, Ai-Chi; Gu, Xueying; Chakravarthy, Harini; Arda, H Efsun; Charville, Gregory; Vogel, Hannes; Efimov, Igor R; Kim, Seung; Deisseroth, Karl

    2017-07-19

    Three-dimensional tissue-structural relationships are not well captured by typical thin-section histology, posing challenges for the study of tissue physiology and pathology. Moreover, while recent progress has been made with intact methods for clearing, labeling, and imaging whole organs such as the mature brain, these approaches are generally unsuitable for soft, irregular, and heterogeneous tissues that account for the vast majority of clinical samples and biopsies. Here we develop a biphasic hydrogel methodology, which along with automated analysis, provides for high-throughput quantitative volumetric interrogation of spatially-irregular and friable tissue structures. We validate and apply this approach in the examination of a variety of developing and diseased tissues, with specific focus on the dynamics of normal and pathological pancreatic innervation and development, including in clinical samples. Quantitative advantages of the intact-tissue approach were demonstrated compared to conventional thin-section histology, pointing to broad applications in both research and clinical settings.

  14. Particle tracking

    CERN Document Server

    Safarík, K; Newby, J; Sørensen, P

    2002-01-01

    In this lecture we will present a short historical overview of different tracking detectors. Then we will describe currently used gaseous and silicon detectors and their performance. In the second part we will discuss how to estimate tracking precision, how to design a tracker and how the track finding works. After a short description of the LHC the main attention is drawn to the ALICE experiment since it is dedicated to study new states in hadronic matter at the LHC. The ALICE tracking procedure is discussed in detail. A comparison to the tracking in ATLAS, CMS and LHCb is given. (5 refs).

  15. Development and implementation of an online clinical pathway for adult chronic kidney disease in primary care: a mixed methods study.

    Science.gov (United States)

    Donald, Maoliosa; McBrien, Kerry; Jackson, Wes; Manns, Braden J; Tonelli, Marcello; King-Shier, Kathryn; Jindal, Kailash; Lewanczuk, Richard Z; Scott-Douglas, Nairne; Braun, Ted; Straus, Sharon E; Naugler, Christopher; Elliott, Meghan J; Jun, Min; Hemmelgarn, Brenda R

    2016-08-17

    Primary care physicians and other primary health care professionals from Alberta, Canada identified a clinical pathway as a potential tool to facilitate uptake of clinical practice guidelines for the diagnosis, management and referral of adults with chronic kidney disease. We describe the development and implementation of a chronic kidney disease clinical pathway (CKD-CP; www.ckdpathway.ca ). The CKD-CP was developed and implemented based on the principles of the Knowledge-To-Action Cycle framework. We used a mixed methods approach to identify the usability and feasibility of the CKD-CP. This included individual interviews, an online survey and website analytics, to gather data on barriers and facilitators to use, perceived usefulness and characteristics of users. Results are reported using conventional qualitative content analysis and descriptive statistics. Eighteen individual interviews were conducted with primary care physicians, nephrologists, pharmacists and nurse practitioners to identify themes reflecting both barriers and facilitators to integrating the CKD-CP into clinical practice. Themes identified included: communication, work efficiency and confidence. Of the 159 participants that completed the online survey, the majority (52 %) were first time CKD-CP users. Among those who had previously used the CKD-CP, 94 % agreed or strongly agreed that the pathway was user friendly, provided useful information and increased their knowledge and confidence in the care of patients with CKD. Between November 2014 and July 2015, the CKD-CP website had 10,710 visits, 67 % of which were new visitors. The 3 most frequently visited web pages were home, diagnose and medical management. Canada, Indonesia and the United States were the top 3 countries accessing the website during the 9 month period. An interactive, online, point-of-care tool for primary care providers can be developed and implemented to assist in the care of patients with CKD. Our findings are important

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

    Science.gov (United States)

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

    2015-01-01

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

  17. Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes.

    Science.gov (United States)

    Nattiv, Aurelia; Kennedy, Gannon; Barrack, Michelle T; Abdelkerim, Ashraf; Goolsby, Marci A; Arends, Julie C; Seeger, Leanne L

    2013-08-01

    Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time. To examine the relationships between MRI grading of bone stress injuries with clinical risk factors and time to return to sport in collegiate track and field athletes. Cohort study (prognosis); Level of evidence, 2. A total of 211 male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had preparticipation history, physical examination, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns, and prior injuries, as well as a 3-day diet record. Dual-energy X-ray absorptiometry was performed at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiograph findings were negative, MRI was performed. Bone stress injuries were evaluated by 2 independent radiologists utilizing an MRI grading system. The MRI grading and risk factors were evaluated to identify predictors of time to return to sport. Thirty-four of the athletes (12 men, 22 women) sustained 61 bone stress injuries during the 5-year study period. The mean prospective assessment for participants was 2.7 years. In the multiple regression model, MRI grade and total-body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport. Specifically, the higher the MRI grade (P = .004) and lower the BMD (P = .030), the longer the recovery time. Location of the bone injury at predominantly trabecular sites of the femoral neck, pubic bone, and sacrum was also associated with a prolonged time to return to sport. Female athletes with oligomenorrhea and amenorrhea had bone stress injuries of higher MRI grades compared with

  18. [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.

  19. 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.

  20. 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

  1. Satellite tracking of the migratory pathways of the first-year Lesser Black-backed Gulls Larus fuscus departing from the breeding grounds of different subspecies

    DEFF Research Database (Denmark)

    Pütz, Klemens; Rahbek, Carsten; Saurola, Pertti

    2007-01-01

    of the other subspecies. In addition, first-year birds from cross-breeding experiments between the two subspecies (fuscus x intermedius) were also equipped with satellite transmitters. In total, eleven first-year birds were successfully tracked during their initial autumn migration, at least one from each...... study group. First-year birds from the Danish intermedius subspecies migrated either southwest along the coast of the North Sea or through central Europe to Algeria. By contrast, first-year birds from the Finnish fuscus subspecies migrated on a south-southeastern course towards Ukraine and the Bosporus......The migratory behaviour of two Lesser Black-backed Gull Larus fuscus subspecies, fuscus and intermedius, was studied using satellite telemetry. To this end, first-year birds were equipped with satellite transmitters and released either at their natal site, or after transferring to a breeding site...

  2. 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.

  3. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis

    the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing...

  4. The clinical relationship between the slug-mediated Puma/p53 signaling pathway and radiotherapy resistance in nasopharyngeal carcinoma.

    Science.gov (United States)

    Xu, T; Yuan, Y; Xiao, D-J

    2017-03-01

    To explore the clinical relationship between the Slug-mediated Puma/p53 signaling pathway and radiotherapy resistance in nasopharyngeal carcinoma. Forty surgical specimens were collected from nasopharyngeal carcinoma patients treated at our hospital between February 2010 and February 2015. Twenty patients with poorly differentiated nasopharyngeal carcinoma with and without radiotherapy resistance were included in the experimental and control groups, respectively. Slug, Puma, and p53 expression were quantified in all tissues using fluorescence quantitative polymerase chain reaction, enzyme-linked immunosorbent assay (ELISA), Western blotting, and immunohistochemistry. Slug and p53 mRNA levels were significantly higher in the experimental group than in the control group (p control group (p Slug protein expression was significantly higher in the experimental group (6.07 ± 0.203 μg/L) than in the control group (1.24 ± 0.171 μg/L) (p control group (0.63 ± 0.101 μg/L) (p control group (3.37 ± 0.112 μg/L) (v Slug, Puma, and p53-positive cells in the experimental group and the control group were quantified; these values confirmed the ELISA and Western blot findings. Slug downregulated the Puma protein expression signaling pathway and promoted radiotherapy resistance in poorly differentiated squamous cell carcinoma tissue, in a p53-independent manner.

  5. 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.

  6. 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/

  7. 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)

    2014-10-01

    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...Annual report 3. DATES COVERED 30 Sep 2013 - 29 Sep 2014 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER The Fanconi Anemia BRCA Pathway as a Predictor of...gene. Women with BRCA1/2 mutations are known to have an improved overall survival compared to women with sporadic ovarian carcinoma. The FA- BRCA pathway

  8. 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.

  9. [ANMCO/AICO/AIOM Consensus document: Clinical and management pathways in cardio-oncology].

    Science.gov (United States)

    Tarantini, Luigi; Gulizia, Michele Massimo; Di Lenarda, Andrea; Maurea, Nicola; Abrignani, Maurizio Giuseppe; Bisceglia, Irma; Bovelli, Daniella; De Gennaro, Luisa; Del Sindaco, Donatella; Macera, Francesca; Parrini, Iris; Radini, Donatella; Russo, Giulia; Scardovi, Angela Beatrice; Inno, Alessandro

    2017-01-01

    In Italy, cardiovascular diseases and cancer are the leading causes of death. Both diseases share the same risk factors and, having the highest incidence and prevalence in the elderly, they often coexist in the same individual. Furthermore, the enhanced survival of cancer patients registered in the last decades and linked to early diagnosis and improvement of care, not infrequently exposes them to the appearance of ominous cardiovascular complications due to the deleterious effects of cancer treatment on the heart and circulatory system. The above considerations have led to the development of a new branch of clinical cardiology based on the principles of multidisciplinary collaboration between cardiologists and oncologists: Cardio-oncology, which aims to find solutions to the prevention, monitoring, diagnosis and treatment of heart damage induced by cancer care in order to pursue, in the individual patient, the best possible care for cancer while minimizing the risk of cardiac toxicity. In this consensus document we provide practical recommendations on how to assess, monitor, treat and supervise the candidate or patient treated with potentially cardiotoxic cancer therapy in order to treat cancer and protect the heart at all stages of the oncological disease.

  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. Fast-track surgery combined with laparoscopy could improve postoperative recovery of low-risk rectal cancer patients: a randomized controlled clinical trial.

    Science.gov (United States)

    Feng, Fan; Li, Xiao Hua; Shi, Hai; Wu, Guo Sheng; Zhang, Hong Wei; Liu, Xiao Nan; Zhao, Qing Chuan

    2014-06-01

    In this study we aimed to assess the feasibility and safety of fast-track surgery (FTS) combined with laparoscopy for treating patients with rectal cancer and compare the results with those of the conventional perioperative intervention group. A total of 120 patients with rectal cancer were prospectively randomly assigned to the FTS combined with laparoscopy group and the conventional perioperative intervention plus laparoscopy group from November 2011 to November 2012. All patients received radical anterior resection with total mesorectal excision. Their baseline characteristics and the perioperative outcomes were recorded for analyses. Compared with the conventional perioperative intervention group, the fast-track protocol combined with laparoscopy could shorten the time to the first flatus (53.44 ± 23.64 h vs 67.85 ± 20.12 h, P = 0.001) and first defecation (65.23 ± 22.24 h vs 86.98 ± 24.85 h, P = 0.000) after operation, accelerate the decrease of white blood cell count (P laparoscopy may accelerate the clinical recovery of patients with rectal cancer after surgery. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  12. 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.

  13. 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 cine estimates of longitudinal (r = 0.81 and r = -0.81), circumferential (r = 0.87 and r = -0.85), and radial (r = -0.76 and r = 0.81) strain (p cine (feature tracking) estimates of longitudinal (r = 0.85 and -0.83), circumferential (r = 0.88 and r = -0.87), and radial strain (r = -0.79 and r = 0.84, p 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.

  14. 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.

  15. Tracking the luminal exposure and lymphatic drainage pathways of intravaginal and intrarectal inocula used in nonhuman primate models of HIV transmission.

    Science.gov (United States)

    Smedley, Jeremy; Turkbey, Baris; Bernardo, Marcelino L; Del Prete, Gregory Q; Estes, Jacob D; Griffiths, Gary L; Kobayashi, Hisataka; Choyke, Peter L; Lifson, Jeffrey D; Keele, Brandon F

    2014-01-01

    Over 80% of sexual HIV-1 transmissions originate from a single viral variant, but the underlying basis for this transmission bottleneck remains to be elucidated. Nonhuman primate models of mucosal virus transmission allow opportunities to gain insight into the basis of this mucosal bottleneck. We used simulated inocula consisting of either non-infectious vital dye or contrast dye with non-invasive magnetic resonance imaging (MRI) to visualize mucosal exposure and passive lymphatic drainage patterns following vaginal and rectal exposures in Indian origin rhesus macaques. Results revealed a limited overall distance of dye coverage from the anal verge following 1 ml (n = 8) intrarectally administered, which greatly increased with a 3 ml (n = 8) volume. Intravaginal dye exposure using 2 ml revealed complete coverage of the mucosa of the vagina and ectocervix, however dye was not detectable in the endocervix, uterus, fallopian tubes or ovaries in nuliparous sexually mature rhesus macaques (n = 9). In addition, following submucosal and intranodal injections of vital dye or MRI contrast dye in the rectum (n = 9), or distal and proximal vagina (n = 4), the lymphatic drainage pathways were identified as first the internal then common iliac chain followed by para-aortic lymph nodes. Drainage from the distal descending colon (n = 8) was via the para-colonic lymph nodes followed by the inferior mesenteric and para-aortic lymph nodes. Analysis after vaginal challenge with infectious SIVmac239 followed by euthanasia at day 3 revealed a pattern of viral dissemination consistent with the imaging results. These results provide insights into potential patterns of viral dissemination that can help guide efforts to better elucidate the earliest events of virus transmission and potential intervention strategies.

  16. Tracking the luminal exposure and lymphatic drainage pathways of intravaginal and intrarectal inocula used in nonhuman primate models of HIV transmission.

    Directory of Open Access Journals (Sweden)

    Jeremy Smedley

    Full Text Available Over 80% of sexual HIV-1 transmissions originate from a single viral variant, but the underlying basis for this transmission bottleneck remains to be elucidated. Nonhuman primate models of mucosal virus transmission allow opportunities to gain insight into the basis of this mucosal bottleneck. We used simulated inocula consisting of either non-infectious vital dye or contrast dye with non-invasive magnetic resonance imaging (MRI to visualize mucosal exposure and passive lymphatic drainage patterns following vaginal and rectal exposures in Indian origin rhesus macaques. Results revealed a limited overall distance of dye coverage from the anal verge following 1 ml (n = 8 intrarectally administered, which greatly increased with a 3 ml (n = 8 volume. Intravaginal dye exposure using 2 ml revealed complete coverage of the mucosa of the vagina and ectocervix, however dye was not detectable in the endocervix, uterus, fallopian tubes or ovaries in nuliparous sexually mature rhesus macaques (n = 9. In addition, following submucosal and intranodal injections of vital dye or MRI contrast dye in the rectum (n = 9, or distal and proximal vagina (n = 4, the lymphatic drainage pathways were identified as first the internal then common iliac chain followed by para-aortic lymph nodes. Drainage from the distal descending colon (n = 8 was via the para-colonic lymph nodes followed by the inferior mesenteric and para-aortic lymph nodes. Analysis after vaginal challenge with infectious SIVmac239 followed by euthanasia at day 3 revealed a pattern of viral dissemination consistent with the imaging results. These results provide insights into potential patterns of viral dissemination that can help guide efforts to better elucidate the earliest events of virus transmission and potential intervention strategies.

  17. [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.

  18. 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.

  19. Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways

    NARCIS (Netherlands)

    Sluis, G. van der; Goldbohm, R.A.; Elings, J.E.; Nijhuis-Van der Sanden, M.W.G.; Akkermans, R.P.; Bimmel, R.; Hoogeboom, T.J.; Meeteren, N.L. van

    2017-01-01

    AIMS: To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway. PATIENTS AND METHODS: All patients (n = 682, 73% women, mean

  20. The Bering Target Tracking Instrumentation

    DEFF Research Database (Denmark)

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

    2003-01-01

    '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...... is inside the telescope FOV. During the telescope observation time, the ASC will constantly control the folding mirror to correctly position the target at the center of the telescope, basically performing a standard telescope tracking service. The telescope will alter the initial target acquisition track...

  1. Dynamic tracking of magnetic nanoparticles for mapping microvascular networks using a clinical 1.5 T magnetic resonance scanner

    Science.gov (United States)

    Olamaei, Nina; Cheriet, Farida; Deschênes, Sylvain; Martel, Sylvain

    2014-05-01

    Being able to visualize blood vessels with an inner diameter of less than 150 μm is the present limit of modern medical imaging modalities and it becomes an important issue to advance state-of-the-art medical imaging, diagnostics, surgery, and targeted interventions. In cancer therapy, such capability would provide the information required for new delivery methods such as magnetic resonance navigation to navigate therapeutic agents along a planned trajectory deeper in the vasculature and hence closer to the region to be treated for enhancing the therapeutic index. To demonstrate the possibility of gathering images of microvascular networks dynamically and beyond the limitation of medical imaging modalities, the susceptibility artifact was used as the contrast mechanism in magnetic resonance imaging (MRI) to detect magnetic micro-aggregations of iron-oxide nanoparticles (150 ± 20 μm in diameter) as they were injected in a 2D synthetic microvascular network. Magnetic entities cause susceptibility artifacts in the images by disrupting the MRI's homogeneous magnetic field in a much larger scale than their actual size. The position of the artifact reflects the position of the aggregations in the vascular system. The calculated positions of discrete-time scans were extracted and assembled to build up the distribution of the vascular network. The results suggest that this method could be used to gather images of blood vessels beyond the spatial resolution of clinical medical imaging modalities with a measured average error confirmed on a 2D reconstruction of the micro-vessels of approximately half of a pixel's size.

  2. CNGB3-Achromatopsia Clinical Trial With CNTF: Diminished Rod Pathway Responses With No Evidence of Improvement in Cone Function

    Science.gov (United States)

    Zein, Wadih M.; Jeffrey, Brett G.; Wiley, Henry E.; Turriff, Amy E.; Tumminia, Santa J.; Tao, Weng; Bush, Ronald A.; Marangoni, Dario; Wen, Rong; Wei, Lisa L.; Sieving, Paul A.

    2014-01-01

    Purpose. Ciliary neurotrophic factor (CNTF) protects rod photoreceptors from retinal degenerative disease in multiple nonhuman models. Thus far, CNTF has failed to demonstrate rod protection in trials for human retinitis pigmentosa. Recently, CNTF was found to improve cone photoreceptor function in a canine CNGB3 achromatopsia model. This study explores whether this finding translates to humans with CNGB3 achromatopsia. Methods. A five-subject, open-label Phase I/II study was initiated by implanting intraocular microcapsules releasing CNTF (nominally 20 ng/d) into one eye each of CNGB3 achromat participants. Fellow eyes served as untreated controls. Subjects were followed for 1 year. Results. Pupil constriction in treated eyes gave evidence of intraocular CNTF release. Additionally, scotopic ERG responses were reduced, and dark-adapted psychophysical absolute thresholds were increased, attributable to diminished rod or rod pathway activity. Optical coherence tomography revealed that the cone-rich fovea underwent structural changes as the foveal hyporeflective zone (HRZ) became diminished in CNTF-treated eyes. No objectively measurable enhancement of cone function was found by assessments of visual acuity, mesopic increment sensitivity threshold, or the photopic ERG. Careful measurements of color hue discrimination showed no change. Nonetheless, subjects reported beneficial changes of visual function in the treated eyes, including reduced light sensitivity and aversion to bright light, which may trace to decreased effective ambient light from the pupillary constriction; further they noted slowed adaptation to darkness, consistent with CNTF action on rod photoreceptors. Conclusions. Ciliary neurotrophic factor did not measurably enhance cone function, which reveals a species difference between human and canine CNGB3 cones in response to CNTF. (ClinicalTrials.gov number, NCT01648452.) PMID:25205868

  3. 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

  4. Molecular pathways

    DEFF Research Database (Denmark)

    Cox, Thomas R; Erler, Janine Terra

    2014-01-01

    that 45% of deaths in the developed world are linked to fibrotic disease. Fibrosis and cancer are known to be inextricably linked; however, we are only just beginning to understand the common and overlapping molecular pathways between the two. Here, we discuss what is known about the intersection...... of fibrosis and cancer, with a focus on cancer metastasis, and highlight some of the exciting new potential clinical targets that are emerging from analysis of the molecular pathways associated with these two devastating diseases. Clin Cancer Res; 20(14); 3637-43. ©2014 AACR....

  5. Tracking Information

    NARCIS (Netherlands)

    van Benthem, J.; Bimbó, K.

    2016-01-01

    Depending on a relevant task at hand, information can be represented at different levels, less or more detailed, each supporting its own appropriate logical languages. We discuss a few of these levels and their connections, and investigate when and how information growth at one level can be tracked

  6. 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.

  7. Tracking Porters

    DEFF Research Database (Denmark)

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

    2015-01-01

    Anthropology attempts to gain insight into people's experiential life-worlds through long-term fieldwork. The quality of anthropological knowledge production, however, does not depend solely on the duration of the stay in the field, but also on a particular way of seeing social situations. The an...... 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....

  8. Topical Insulin Accelerates Wound Healing in Diabetes by Enhancing the AKT and ERK Pathways: A Double-Blind Placebo-Controlled Clinical Trial

    Science.gov (United States)

    Lima, Maria H. M.; Caricilli, Andréa M.; de Abreu, Lélia L.; Araújo, Eliana P.; Pelegrinelli, Fabiana F.; Thirone, Ana C. P.; Tsukumo, Daniela M.; Pessoa, Ana Flávia M.; dos Santos, Marinilce F.; de Moraes, Maria A.; Carvalheira, José B. C.; Velloso, Lício A.; Saad, Mario J. A.

    2012-01-01

    Background Wound healing is impaired in diabetes mellitus, but the mechanisms involved in this process are virtually unknown. Proteins belonging to the insulin signaling pathway respond to insulin in the skin of rats. Objective The purpose of this study was to investigate the regulation of the insulin signaling pathway in wound healing and skin repair of normal and diabetic rats, and, in parallel, the effect of a topical insulin cream on wound healing and on the activation of this pathway. Research Design and Methods We investigated insulin signaling by immunoblotting during wound healing of control and diabetic animals with or without topical insulin. Diabetic patients with ulcers were randomized to receive topical insulin or placebo in a prospective, double-blind and placebo-controlled, randomized clinical trial (NCT 01295177) of wound healing. Results and Conclusions Expression of IR, IRS-1, IRS-2, SHC, ERK, and AKT are increased in the tissue of healing wounds compared to intact skin, suggesting that the insulin signaling pathway may have an important role in this process. These pathways were attenuated in the wounded skin of diabetic rats, in parallel with an increase in the time of complete wound healing. Upon topical application of insulin cream, the wound healing time of diabetic animals was normalized, followed by a reversal of defective insulin signal transduction. In addition, the treatment also increased expression of other proteins, such as eNOS (also in bone marrow), VEGF, and SDF-1α in wounded skin. In diabetic patients, topical insulin cream markedly improved wound healing, representing an attractive and cost-free method for treating this devastating complication of diabetes. Trial Registration ClinicalTrials.gov NCT01295177 PMID:22662132

  9. Dosimetric and clinical effects of interfraction and intrafraction correlation errors during marker-based real-time tumor tracking for liver SBRT.

    Science.gov (United States)

    Kurosu, Keita; Sumida, Iori; Suzuki, Osamu; Shiomi, Hiroya; Ota, Seiichi; Otani, Keisuke; Tamari, Keisuke; Seo, Yuji; Ogawa, Kazuhiko

    2018-03-01

    Correlation model error (CME) between the internal target and the external surrogate, and marker-tumor correlation error (MTCE) between the tumor and the implanted marker occur during marker-based real-time tumor tracking. The effects of these intrafraction and interfraction errors on the dose coverage in the clinical target volume (CTV) and on tumor control probability (TCP) for hepatocellular carcinoma (HCC) were evaluated in this study. Eight HCC patients treated with non-isocentric dose delivery by a robotic radiosurgery system were enrolled. The CMEs were extracted from the treatment log file, and the MTCEs were calculated from the preceding study. The CMEs and MTCEs were randomly added to each beam's robot position, and the changes in the TCP and the 2%, 95% and 99% dose coverage values for the CTV (D2, D95 and D99) were simulated. The data were statistically analyzed as a function of the CTV to planning target volume (PTV) margin, the dose fraction and the marker-tumor distance. Significant differences were observed in the majority of the CTV D2, D95 and D99 values and the TCP values. However, a linear regression revealed that ∆CTV D2, D95 and D99 have a weak correlation with ∆TCP. A dose-difference metric would be unable to detect a critical error for tumor control if the coverage changes for the CTV and ∆TCP were weakly correlated. Because the simulated TCP-based parameter determination was based on the dose simulation, including predicted interfraction and intrafraction errors, we concluded that a 95th percentile TCP-based parameter determination would be a robust strategy for ensuring tumor control while reducing doses to normal structures.

  10. Guideline Recommended Medical Therapy for Cardiovascular Diseases in the Obese: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program.

    Science.gov (United States)

    Valle, Javier A; O'Donnell, Colin I; Armstrong, Ehrin J; Bradley, Steven M; Maddox, Thomas M; Ho, P Michael

    2016-05-16

    Stigma against the obese is well described in health care and may contribute to disparities in medical decision-making. It is unknown whether similar disparity exists for obese patients in cardiovascular care. We evaluated the association between body mass index (BMI) and prescription of guideline-recommended medications in patients undergoing elective percutaneous coronary intervention. Using data from the Veterans Affairs Clinical Assessment, Reporting, and Tracking System Program, we identified patients undergoing elective percutaneous coronary intervention from 2007 to 2012, stratifying them by category of BMI. We described rates of prescription for class I guideline recommended medications for each BMI category (normal, overweight, and obese). Multivariable logistic regression assessed the association between BMI category and medication prescription. Seventeen thousand thirty-seven patients were identified, with 35.3% having overweight BMI, and 50.8% obese BMI. Obese patients were more likely than normal BMI patients to be prescribed β-blockers (OR 1.34), statins (OR 1.39), or ACE/ARB (odds ratio [OR] 1.52; all significant) when indicated. Overweight patients were more likely than normal BMI patients to be prescribed statins (OR 1.29) and angiotensin-converting enzymes/angiotensin II receptor blockers (OR 1.41) when indicated. There was no association between BMI category and prescription of anticoagulants. Over 85% of patients undergoing elective percutaneous coronary intervention in the Veterans Affairs are overweight or obese. Rates of guideline-indicated medication prescription were cardiovascular conditions. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. 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

  12. 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

  13. INNER TRACKING

    CERN Multimedia

    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...

  14. 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

  15. 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.

  16. An assessment of clinical pathways and missed opportunities for the diagnosis of nodular melanoma versus superficial spreading melanoma.

    Science.gov (United States)

    Cicchiello, Mark; Lin, Matthew J; Pan, Yan; McLean, Catriona; Kelly, John W

    2016-05-01

    Missed opportunities in the diagnosis of nodular melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. NM contributes disproportionately to melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated. © 2015 The Australasian College of Dermatologists.

  17. Genetic variants in the fibroblast growth factor pathway as potential markers of ovarian cancer risk, therapeutic response, and clinical outcome.

    Science.gov (United States)

    Meng, Qing H; Xu, Enping; Hildebrandt, Michelle A T; Liang, Dong; Lu, Karen; Ye, Yuanqing; Wagar, Elizabeth A; Wu, Xifeng

    2014-01-01

    The fibroblast growth factor (FGF) and FGF receptor (FGFR) axis plays a critical role in tumorigenesis, but little is known of its influence in ovarian cancer. We sought to determine the association of genetic variants in the FGF pathway with risk, therapeutic response, and survival of patients with ovarian cancer. We matched 339 non-Hispanic white ovarian cancer cases with 349 healthy controls and genotyped them for 183 single-nucleotide polymorphisms (SNPs) from 24 FGF (fibroblast growth factor) and FGFR (fibroblast growth factor receptor) genes. Genetic associations for the main effect, gene-gene interactions, and the cumulative effect were determined. Multiple SNPs in the FGF-FGFR axis were associated with an increased risk of ovarian cancer. In particular, FGF1 [fibroblast growth factor 1 (acidic)] SNP rs7727832 showed the most significant association with ovarian cancer (odds ratio, 2.27; 95% CI, 1.31-3.95). Ten SNPs were associated with a reduced risk of ovarian cancer. FGF18 (fibroblast growth factor 18) SNP rs3806929, FGF7 (fibroblast growth factor 7) SNP rs9920722, FGF23 (fibroblast growth factor 23) SNP rs12812339, and FGF5 (fibroblast growth factor 5) SNP rs3733336 were significantly associated with a favorable treatment response, with a reduction of risk of nonresponse of 40% to 60%. Eleven SNPs were significantly associated with overall survival. Of these SNPs, FGF23 rs7961824 was the most significantly associated with improved prognosis (hazard ratio, 0.55; 95% CI, 0.39-0.78) and was associated with significantly longer survival durations, compared with individuals with the common genotype at this locus (58.1 months vs. 38.0 months, P = 0.005). Survival tree analysis revealed FGF2 rs167428 as the primary factor contributing to overall survival. Significant associations of genetic variants in the FGF pathway were associated with ovarian cancer risk, therapeutic response, and survival. The discovery of multiple SNPs in the FGF-FGFR pathway provides a

  18. 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 ...

  19. 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...

  20. Pathway Targeted Immunotherapy: Rationale and Evidence of Durable Clinical Responses with a Novel, EGF-directed Agent for Advanced NSCLC.

    Science.gov (United States)

    Rosell, Rafael; Neninger, Elia; Nicolson, Marianne; Huber, Rudolf M; Thongprasert, Sumitra; Parikh, Purvish M; D'Hondt, Erik

    2016-11-01

    Abnormalities in the epidermal growth factor (EGF) and EGFR pathway promote progression of NSCLC. Immunization with EGF vaccine induces specific, neutralizing anti-EGF antibodies that prevent binding of the ligand to its receptor. This concept of pathway targeted immunotherapy (PTI) was validated in vitro by dose-related suppression of EGFR, Akt, and Erk1/2 phosphorylation in cell lines with different mutations. A randomized phase II trial showed improved overall survival (OS) in subgroups with advanced NSCLC showing a clear immunologic response. By per-protocol analysis of the ensuing phase IIb trial, patients receiving EGF PTI survived 3 months longer than controls (12.43 versus 9.43 months; hazard ratio = 0.77 [95% confidence interval, 0.61-0.98]). These data were confirmed in a larger trial showing an OS benefit over control of >3 months. The variable most strongly correlated with efficacy was circulating EGF at enrolment. Patients with serum EGF levels >250 pg/mL benefited most from treatment with EGF PTI. Of 188 patients tested, 94 were above this biomarker threshold. The OS benefit from active versus control treatment was 6.7 months. More than 15% of patients had responses for >5 years. Long-term survivors are seen in all EGF PTI trials. Treatment is well-tolerated, induces high anti-EGF antibody titers, reduces levels of circulating serum EGF, achieves durable responses, and significantly prolongs OS. A threshold of 250 pg/mL has been set to enrich the study population in the ongoing pivotal trial. This biomarker-guided study in an enriched population of patients with both squamous and nonsquamous stage IV NSCLC aims to replicate the favorable efficacy/tolerability balance of earlier studies. Copyright © 2016 International Association for the Study of Lung Cancer. All rights reserved.

  1. Semantic Audio Track Mixer

    OpenAIRE

    Uhle, C.; Herre, J.; Ridderbusch, F.; Popp, H.

    2011-01-01

    An audio mixer for mixing a plurality of audio tracks to a mixture signal comprises a semantic command interpreter (30; 35) for receiving a semantic mixing command and for deriving a plurality of mixing parameters for the plurality of audio tracks from the semantic mixing command; an audio track processor (70; 75) for processing the plurality of audio tracks in accordance with the plurality of mixing parameters; and an audio track combiner (76) for combining the plurality of audio tracks proc...

  2. Changing doctors' behaviours: an educational program to disseminate a new clinical pathway for the hospital management of hip fractures in elderly patients in the Lazio Region, Italy.

    Science.gov (United States)

    Ciaschi, Alma; Caprara, Andrea; Gillespie, Francesca; Furnari, Giacomo; Mamede, Sílvia

    2011-08-01

    Concerns with patient safety have increased interest in approaches to improving doctors' performance, yet dissemination of clinical guidelines and conventional continuing medical education have often failed. This study investigated the effects of an educational program based on reflection upon experience on the quality of care for patients with hip fracture in Lazio, Italy. Five hospitals participated. The study consisted of the development of a clinical pathway, a preparatory phase and the educational intervention itself, which comprised a course followed by monthly audits with reflection on practice, guided by analysis of patients' charts. Data on the quality of care for patients with hip fracture were collected from the routine information system for the period before and after the intervention. There was a significant increase in the proportion of patients who underwent surgery within 48 hours of admission (from 7% in 2006 to 26.4% in 2007) and a significant reduction in the average length of hospital stay (from 18.8 to 16.4 days). Some process indicators of quality of care were high after the intervention, though non-recommended practices were still routinely used (e.g. urinary catheterization in 72.2% of patients). There were differences in the changes when comparing hospitals. An educational intervention that combined the dissemination of a clinical pathway with external auditing geared to reflection upon practice was effective in promoting changes in doctors' behaviours. The persistence of non-recommended practices and the variation among hospitals indicate that multiple factors influence performance and affect the effectiveness of interventions. © 2010 Blackwell Publishing Ltd.

  3. 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

  4. Piloting the development of a cost-effective evidence-informed clinical pathway: managing hypertension in Jordanian primary care.

    Science.gov (United States)

    Chalkidou, Kalipso; Lord, Joanne; Obeidat, Nour A; Alabbadi, Ibriham A; Stanley, Adrian G; Bader, Rania; Momani, Aiman; O'Mahony, Rachel M; Qatami, Lara; Cutler, Derek

    2011-04-01

    The UK's National Institute for Health and Clinical Excellence (NICE) and the Jordan office of the Medicines Transparency Alliance embarked on a pilot project to design an evidence-based guideline for cost-effective pharmacological treatment of essential hypertension in Jordan. The project's objectives were to directly address a major health problem for Jordan by producing a guideline; and to delineate the strengths and weaknesses of Jordan's healthcare process to allow similar future efforts to be planned more efficiently. The pilot spanned a period of approximately 8 months. Activities were overseen by local technical and guideline development teams, as well as experts from NICE. NICE's hypertension guidelines and economic model were used as a starting point. Parameters in the economic model were adjusted according to input and feedback from local experts with regards to Jordanian physician and patient practices, resource costs, and quality of life estimates. The results of the economic model were integrated with the updated available clinical trial literature. The outputs of the economic model were used to inform recommendations, in the form of a clinical algorithm. A report of the process and the strengths and weaknesses observed was developed, and recommendations for improvements were made. The pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes.

  5. Prospective study in a porcine model of sarcoptes scabiei indicates the association of Th2 and Th17 pathways with the clinical severity of scabies.

    Science.gov (United States)

    Mounsey, Kate E; Murray, Hugh C; Bielefeldt-Ohmann, Helle; Pasay, Cielo; Holt, Deborah C; Currie, Bart J; Walton, Shelley F; McCarthy, James S

    2015-03-01

    Understanding of scabies immunopathology has been hampered by the inability to undertake longitudinal studies in humans. Pigs are a useful animal model for scabies, and show clinical and immunologic changes similar to those in humans. Crusted scabies can be readily established in pigs by treatment with the glucocorticoid dexamethasone (Dex). Prospective study of 24 pigs in four groups: a) Scabies+/Dex+, b) Scabies+/Dex-, c) Scabies-/Dex+ and d) Scabies-/Dex-. Clinical symptoms were monitored. Histological profiling and transcriptional analysis of skin biopsies was undertaken to compare changes in cell infiltrates and representative cytokines. A range of clinical responses to Sarcoptes scabiei were observed in Dex treated and non-immunosuppressed pigs. An association was confirmed between disease severity and transcription of the Th2 cytokines IL-4 and IL-13, and up-regulation of the Th17 cytokines IL-17 and IL-23 in pigs with crusted scabies. Immunohistochemistry revealed marked infiltration of lymphocytes and mast cells, and strong staining for IL-17. While an allergic Th2 type response to scabies has been previously described, these results suggest that IL-17 related pathways may also contribute to immunopathology of crusted scabies. This may lead to new strategies to protect vulnerable subjects from contracting recurrent crusted scabies.

  6. Prospective study in a porcine model of sarcoptes scabiei indicates the association of Th2 and Th17 pathways with the clinical severity of scabies.

    Directory of Open Access Journals (Sweden)

    Kate E Mounsey

    2015-03-01

    Full Text Available BACKGROUND: Understanding of scabies immunopathology has been hampered by the inability to undertake longitudinal studies in humans. Pigs are a useful animal model for scabies, and show clinical and immunologic changes similar to those in humans. Crusted scabies can be readily established in pigs by treatment with the glucocorticoid dexamethasone (Dex. METHODOLOGY/ PRINCIPAL FINDINGS: Prospective study of 24 pigs in four groups: a Scabies+/Dex+, b Scabies+/Dex-, c Scabies-/Dex+ and d Scabies-/Dex-. Clinical symptoms were monitored. Histological profiling and transcriptional analysis of skin biopsies was undertaken to compare changes in cell infiltrates and representative cytokines. A range of clinical responses to Sarcoptes scabiei were observed in Dex treated and non-immunosuppressed pigs. An association was confirmed between disease severity and transcription of the Th2 cytokines IL-4 and IL-13, and up-regulation of the Th17 cytokines IL-17 and IL-23 in pigs with crusted scabies. Immunohistochemistry revealed marked infiltration of lymphocytes and mast cells, and strong staining for IL-17. CONCLUSIONS/ SIGNIFICANCE: While an allergic Th2 type response to scabies has been previously described, these results suggest that IL-17 related pathways may also contribute to immunopathology of crusted scabies. This may lead to new strategies to protect vulnerable subjects from contracting recurrent crusted scabies.

  7. Fluoroscopic tracking of multiple implanted fiducial markers using multiple object tracking

    International Nuclear Information System (INIS)

    Tang Xiaoli; Sharp, Greg C; Jiang, Steve B

    2007-01-01

    When treating mobile tumors using techniques such as beam gating or beam tracking, precise localization of tumor position is required, which is often realized by fluoroscopically tracking implanted fiducial markers. Multiple markers placed inside or near a tumor are often preferred to a single marker for the sake of accuracy. In this work, we propose a marker tracking system that can track multiple markers simultaneously, without confusing them, and that is also robust enough to continue tracking even when the markers are moving behind bony anatomy. The integrated radiotherapy imaging system (IRIS), developed at the Massachusetts General Hospital (MGH), was used to take fluoroscopy videos for marker tracking. The tracking system integrates marker detection with a multiple object tracking process, inspired by the multiple hypothesis marker tracking (MHT) process. It also utilizes breathing pattern information to help tracking. Four criteria are used to identify tracking failure, and when tracking failure occurs, the system can immediately inform the user. (In the clinical environment, the system would immediately disable the treatment beam.) In this paper, two liver patients with implanted fiducial markers were studied, and the studies were performed retrospectively to assess the effectiveness of the new tracking system. For both patients, LAT and AP fluoroscopic videos were studied. In order to better test the proposed tracking system, artificial markers were added around the real markers to disturb the tracking of the real markers. The performance of the proposed system was compared to that of a conventional tracking system (one that did not use multiple object tracking). The performance of the new system was also investigated with and without consideration of the breathing pattern information. We found that the conventional tracking system can easily miss tracking markers in the presence of artificial markers, and it cannot detect the tracking failures. On the

  8. The melanomas: a synthesis of epidemiological, clinical, histopathological, genetic, and biological aspects, supporting distinct subtypes, causal pathways, and cells of origin

    Science.gov (United States)

    Whiteman, David C.; Pavan, William J; Bastian, Boris C.

    2012-01-01

    Summary Converging lines of evidence from varied scientific disciplines suggest that cutaneous melanomas comprise biologically distinct subtypes that arise through multiple causal pathways. Understanding the respective relationships of each subtype with etiologic factors such as UV radiation and constitutional factors is the first necessary step toward developing refined prevention strategies for the specific forms of melanoma. Furthermore, classifying this disease precisely into biologically distinct subtypes is the key to developing mechanism- based treatments, as highlighted by recent discoveries. In this review, we outline the historical developments that underpin our understanding of melanoma heterogeneity, and we do this from the perspectives of clinical presentation, histopathology, epidemiology, molecular genetics, and developmental biology. We integrate the evidence from these separate trajectories to catalog the emerging major categories of melanomas and conclude with important unanswered questions relating to the development of melanoma and its cells of origin. PMID:21707960

  9. 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.

  10. 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.

  11. Integrative miRNA and mRNA analysis in penile carcinomas reveals markers and pathways with potential clinical impact

    DEFF Research Database (Denmark)

    Kuasne, Hellen; Barros-Filho, Mateus Camargo; Busso-Lopes, Ariane F

    2017-01-01

    Penile carcinoma (PeCa) is an important public health issue in poor and developing countries, and has only recently been explored in terms of genetic and epigenetic studies. Integrative data analysis is a powerful method for the identification of molecular drivers involved in cancer development a......, an integrative analysis using mRNA and miRNA profiles revealed markers related with tumor development and progression. Furthermore, MMP1 expression level was a predictive marker for lymph node metastasis in patients with PeCa....... and PPARG and hsa-miR-31-5p, hsa-miR-224-5p, and hsa-miR-223-3p were able to distinguish tumors from NPT with high sensitivity and specificity. Higher MMP1 expression was detected as a better predictor of lymph node metastasis than the clinical-pathological data. In addition, PPARG and EGFR were highlighted...

  12. ANMCO/AIOM/AICO Consensus Document on clinical and management pathways of cardio-oncology: executive summary.

    Science.gov (United States)

    Tarantini, Luigi; Massimo Gulizia, Michele; Di Lenarda, Andrea; Maurea, Nicola; Giuseppe Abrignani, Maurizio; Bisceglia, Irma; Bovelli, Daniella; De Gennaro, Luisa; Del Sindaco, Donatella; Macera, Francesca; Parrini, Iris; Radini, Donatella; Russo, Giulia; Beatrice Scardovi, Angela; Inno, Alessandro

    2017-05-01

    Cardiovascular disease and cancer are leading causes of death. Both diseases share the same risk factors and, having the highest incidence and prevalence in the elderly, they often coexist in the same individual. Furthermore, the enhanced survival of cancer patients registered in the last decades and linked to early diagnosis and improvement of care, not infrequently exposes them to the appearance of ominous cardiovascular complications due to the deleterious effects of cancer treatment on the heart and circulatory system. The above considerations have led to the development of a new branch of clinical cardiology based on the principles of multidisciplinary collaboration between cardiologists and oncologists: Cardio-oncology, which aims to find solutions to the prevention, monitoring, diagnosis and treatment of heart damage induced by cancer care in order to pursue, in the individual patient, the best possible care for cancer while minimizing the risk of cardiac toxicity. In this consensus document we provide practical recommendations on how to assess, monitor, treat and supervise the candidate or patient treated with potentially cardiotoxic cancer therapy in order to treat cancer and protect the heart at all stages of the oncological disease. Cardiovascular diseases and cancer often share the same risk factors and can coexist in the same individual. Such possibility is amplified by the deleterious effects of cancer treatment on the heart. The above considerations have led to the development of a new branch of clinical cardiology, based on multidisciplinary collaboration between cardiologist and oncologist: the cardio-oncology. It aims to prevent, monitor, and treat heart damages induced by cancer therapies in order to achieve the most effective cancer treatment, while minimizing the risk of cardiac toxicity. In this paper, we provide practical recommendations on how to assess, monitor, treat and supervise patients treated with potential cardiotoxic cancer

  13. 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.

  14. 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.

  15. Two-dimensional speckle tracking for the assessment of coronary artery disease during dobutamine stress echo: clinical tool or merely research method.

    Science.gov (United States)

    Aggeli, Constantina; Lagoudakou, Stauroula; Felekos, Ioannis; Panagopoulou, Vasiliki; Kastellanos, Stellios; Toutouzas, Konstantinos; Roussakis, George; Tousoulis, Dimitris

    2015-10-24

    Two-dimensional speckle tracking provides valuable information for regional wall motion abnormalities. The purpose of this study was to determine the diagnostic value of left ventricular longitudinal strain and torsion to diagnose coronary artery disease during dobutamine stress echocardiography. We studied 100 patients (mean age 60.8 ± 10.7 years, 72 male) with known or suspected coronary artery disease, excluding those with prior history of transmural infraction. All of them underwent dobutamine stress echo and coronary angiography within one month. Wall-motion score index, left ventricular global longitudinal strain and torsion were measured at rest and peak stress. Additionally, the respective differences between rest and stress were also calculated. Optimal cut-offs were derived from receiver operating characteristic curves for strain and torsion values. Mean left ventricular ejection fraction was 55 ± 5.4 %. Coronary angiography revealed significant lesions in 67 patients. Values regarding sensitivity, and specificity for wall motion score index difference were 78 % and 88 % respectively (area under curve 0.84). Global longitudinal strain difference (median 0.5 %) illustrated 81 % sensitivity and 72 % specificity for disease detection (area under curve 0.80, cut-off value ≤0 %). The respective values for torsion difference (median 4.7°) were 81 % and 82 % (area under curve 0.76, cut-off value ≤6.5°). Combination of wall motion score index difference and torsion difference for disease detection showed 91 % sensitivity and 79 % specificity (area under curve 0.85). The implementation of speckle tracking during dobutamine stress echo could serve as an adjunct method for coronary artery disease assessment, providing quantitative diagnostic information.

  16. 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

  17. 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.

  18. 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.

  19. Eye Tracking for Everyone

    OpenAIRE

    Kellnhofer, Petr; Bhandarkar, Suchendra; Khosla, Aditya; Kannan, Harini D.; Matusik, Wojciech; Torralba, Antonio

    2016-01-01

    From scientific research to commercial applications, eye tracking is an important tool across many domains. Despite its range of applications, eye tracking has yet to become a pervasive technology. We believe that we can put the power of eye tracking in everyone's palm by building eye tracking software that works on commodity hardware such as mobile phones and tablets, without the need for additional sensors or devices. We tackle this problem by introducing GazeCapture, the first large-scale ...

  20. HLT Track Reconstruction Performance

    CERN Document Server

    The ATLAS Collaboration

    2009-01-01

    This note reviews the tracking algorithms used at the L2 and Event Filter stages of the High Level Trigger of ATLAS. The tracking performance (efficiency, resolution) is studied for different topologies (single tracks, high and low pt jets) using simulated data. Detailed information on the execution time of the algorithms is also given.

  1. Performance of ATLAS tracking

    CERN Document Server

    Roe, Shaun; The ATLAS collaboration

    2017-01-01

    Run-2 of the Large Hadron Collider (LHC) has provided new challenges to track and vertex reconstruction with higher centre-of-mass energies and luminosity leading to increasingly high-multiplicity envi-ronments. This talk provides an overview of the tracking performance, highlighting tracking improvements due to the Insertable B-Layer (IBL) and the introduction of time-dependent alignment.

  2. 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.

  3. The pre-clinical absorption, distribution, metabolism and excretion properties of IPI-926, an orally bioavailable antagonist of the hedgehog signal transduction pathway.

    Science.gov (United States)

    Smith, Sherri; Hoyt, Jennifer; Whitebread, Nigel; Manna, Joseph; Peluso, Marisa; Faia, Kerrie; Campbell, Veronica; Tremblay, Martin; Nair, Somarajan; Grogan, Michael; Castro, Alfredo; Campbell, Matthew; Ferguson, Jeanne; Arsenault, Brendan; Nevejans, Jylle; Carter, Bennett; Lee, John; Dunbar, Joi; McGovern, Karen; Read, Margaret; Adams, Julian; Constan, Alexander; Loewen, Gordon; Sydor, Jens; Palombella, Vito; Soglia, John

    2013-10-01

    1. IPI-926 is a novel semisynthetic cyclopamine derivative that is a potent and selective Smoothened inhibitor that blocks the hedgehog signal transduction pathway. 2. The in vivo clearance of IPI-926 is low in mouse and dog and moderate in monkey. The volume of distribution is high across species. Oral bioavailability ranges from moderate in monkey to high in mouse and dog. Predicted human clearance using simple allometry is low (24 L h(-1)), predicted volume of distribution is high (469 L) and predicted half-life is long (20 h). 3. IPI-926 is highly bound to plasma proteins and has minimal interaction with human α-1-acid glycoprotein. 4. In vitro metabolic stability ranges from stable to moderately stable. Twelve oxidative metabolites were detected in mouse, rat, dog, monkey and human liver microsome incubations and none were unique to human. 5. IPI-926 is not a potent reversible inhibitor of CYP1A2, 2C8, 2C9 or 3A4 (testosterone). IPI-926 is a moderate inhibitor of CYP2C19, 2D6 and 3A4 (midazolam) with KI values of 19, 16 and 4.5 µM, respectively. IPI-926 is both a substrate and inhibitor (IC50 = 1.9 µM) of P-glycoprotein. 6. In summary, IPI-926 has desirable pre-clinical absorption, distribution, metabolism and excretion properties.

  4. 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

  5. Tracking by Neural Nets

    CERN Document Server

    Jofrehei, Arash

    2015-01-01

    Current track reconstruction 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 tracking efficiency is 100 percent for that while by using real data we would probably be limited to current efficiency. The fact that this approach can be a lot faster and even more efficient than current methods by using simulation data can make it a great alternative for current track reconstruction methods used in both triggering and tracking.

  6. Advanced Tracking of Vehicles

    DEFF Research Database (Denmark)

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

    2005-01-01

    With the continued advances in wireless communications, geo-location technologies, and consumer electronics, it is becoming possible to accurately track the time-varying location of each vehicle in a population of vehicles. This paper reports on ongoing research that has as it objective to develop...... 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...... and server-side updates. This is achieved by designing, prototyping, and testing novel tracking techniques that exploit knowledge of the road network and past movement. These resulting tracking techniques are to support mobile services that rely on the existence of a central server that continuously tracks...

  7. 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.

  8. 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

  9. [Reconstruction method of language pathways in the preoperative planning of brain tumor surgery].

    Science.gov (United States)

    Yan, Jing; Lu, Junfeng; Cheng, Jingliang; Wu, Jinsong; Zhang, Jie; Wang, Chaoyan; Nie, Yunfei; Pang, Beibei; Liu, Xianzhi

    2015-05-01

    To propose a clinically practical and simple fiber tracking method for language pathways, and to explore its feasibility in preoperative planning for brain tumors adjacent to the language cortex. Diffusion tensor imaging was examined in 18 healthy subjects and 13 patients with brain tumors adjacent to the language cortex between December 2013 and June 2014. The associated fibers of language pathways were reconstructed using a commercial software (Syngo workstation). Firstly, the feasibility of fiber tracking method for language pathways in healthy subjects were studied, and then its application was assessed in patients with brain tumors. The anatomic relationship between tumors and the associated fibers was analyzed. By selecting appropriate regions of interest, the associated fibers in the dorsal pathways (superior longitudinal fasciculus/arcuate fasciculus, including both direct and indirect pathways) and ventral pathways (uncinate fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus and inferiorfronto-occipital fasciculus) were reconstructed in all 18 healthy subjects. In patients with brain tumors, the relationship between the tumors and adjacent associated fibers were divided into two types: adjacent associated fibers could be displaced or separated, and involved the superior longitudinal fasciculus/arcuate fasciculus (n=6), middle longitudinal fasciculus (n=4), uncinate fasciculus (n=3), inferior longitudinal fasciculus (n=3) and inferiorfronto-occipital fasciculus (n=2); alternatively, the adjacent associated fibers were infiltrated or destroyed, and involved the inferiorfronto-occipital fasciculus (n=10), uncinate fasciculus (n=8), middle longitudinal fasciculus (n=5), inferior longitudinal fasciculus (n=4) and superior longitudinal fasciculus/arcuate fasciculus (n=3). The associated fibers of language pathways could be visualized rapidly and in real-time by fiber tracking technology based on diffusion tensor imaging. This is

  10. WSU-IR at TREC 2015 Clinical Decision Support Track: Joint Weighting of Explicit and Latent Medical Query Concepts from Diverse Sources

    Science.gov (United States)

    2015-11-20

    ture, is fairly common in clinical practice. Such queries typically correspond to complex information needs, which involve a large number of concepts...or Symptom – Therapeutic or Preventive Procedure This list was obtained from an initial list of 16 semantic types in [9] through backward elimination...semantic concepts from different sources is an effective strategy for CDS retrieval models. References 1. A. R. Aronson. Effective mapping of biomedical

  11. 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.

  12. Pathways and mechanisms in adolescence contribute to adult health inequalities

    DEFF Research Database (Denmark)

    Due, Pernille; Krølner, Rikke; Rasmussen, Mette

    2011-01-01

    AIMS: This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential vulnerab......AIMS: This paper presents a model that encompasses pathways and mechanisms working over adolescence that contribute to adult health inequalities. We review evidence on the four mechanisms: socially differential exposure, tracking, socially differential tracking, and socially differential...... in adolescence and track into adulthood, with higher risks of adverse outcomes among individuals from lower socioeconomic positions. Adolescent health behaviours track into adulthood. Smoking, physical activity, and especially fruit and vegetable intake are socially patterned, while evidence for social...... the social patterning of the above indicators over time or studied social vulnerability of these indicators from adolescence to adulthood. However, all four mechanisms seem to be active in establishing social differences in adult educational attainment. CONCLUSIONS: We find the Adolescent Pathway Model...

  13. Pre-operative functional mobility as an independent determinant of inpatient functional recovery after total knee arthroplasty during three periods that coincided with changes in clinical pathways.

    Science.gov (United States)

    van der Sluis, G; Goldbohm, R A; Elings, J E; Nijhuis-van der Sanden, M W; Akkermans, R P; Bimmel, R; Hoogeboom, T J; van Meeteren, N L

    2017-02-01

    To investigate whether pre-operative functional mobility is a determinant of delayed inpatient recovery of activities (IRoA) after total knee arthroplasty (TKA) in three periods that coincided with changes in the clinical pathway. All patients (n = 682, 73% women, mean age 70 years, standard deviation 9) scheduled for TKA between 2009 and 2015 were pre-operatively screened for functional mobility by the Timed-up-and-Go test (TUG) and De Morton mobility index (DEMMI). The cut-off point for delayed IRoA was set on the day that 70% of the patients were recovered, according to the Modified Iowa Levels of Assistance Scale (mILAS) (a 5-item activity scale). In a multivariable logistic regression analysis, we added either the TUG or the DEMMI to a reference model including established determinants. Both the TUG (Odds Ratio (OR) 1.10 per second, 95% confidence intervals (CI) 1.06 to 1.15) and the DEMMI (OR 0.96 per point on the 100-point scale, 95% CI 0.95 to 0.98) were statistically significant determinants of delayed IRoA in a model that also included age, BMI, ASA score and ISAR score. These associations did not depend on the time period during which the TKA took place, as assessed by tests for interaction. Functional mobility, as assessed pre-operatively by the TUG and DEMMI, is an independent and stable determinant of delayed inpatient recovery of activities after TKA. Future research, focusing on improvement of pre-operative functional mobility through tailored physiotherapy intervention, should indicate whether such intervention enhances post-operative recovery among high-risk patients. Cite this article: Bone Joint J 2017;99-B:211-17. ©2017 The British Editorial Society of Bone & Joint Surgery.

  14. Eye Tracking Young Children with Autism

    OpenAIRE

    Sasson, Noah J.; Elison, Jed T.

    2012-01-01

    The rise of accessible commercial eye-tracking systems has fueled a rapid increase in their use in psychological and psychiatric research. By providing a direct, detailed and objective measure of gaze behavior, eye-tracking has become a valuable tool for examining abnormal perceptual strategies in clinical populations and has been used to identify disorder-specific characteristics1, promote early identification2, and inform treatment3. In particular, investigators of autism spectrum disorders...

  15. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis

    , pain medication with only oral analgesics. Two trained physiotherapists assessed all patients on postoperative day 1 (POD 1) and on the day of discharge (DOD) for: Independence in three basic functions of transfer and ambulation: 1) Get in and out of bed, 2) Sit to stand from a chair and 3) Walking......  Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections...... the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing...

  16. Nanoscale three-dimensional single particle tracking.

    Science.gov (United States)

    Dupont, Aurélie; Lamb, Don C

    2011-11-01

    Single particle tracking (SPT) in biological systems is a quickly growing field. Many new technologies are being developed providing new tracking capabilities, which also lead to higher demands and expectations for SPT. Following a single biomolecule as it performs its function provides quantitative mechanistic information that cannot be obtained in classical ensemble methods. From the 3D trajectory, information is available over the diffusional behavior of the particle and precise position information can also be used to elucidate interactions of the tracked particle with its surroundings. Thus, three-dimensional (3D) SPT is a very valuable tool for investigating cellular processes. This review presents recent progress in 3D SPT, from image-based techniques toward more sophisticated feedback approaches. We focus mainly on the feedback technique known as orbital tracking. We present here a modified version of the original orbital tracking in which the intensities from two z-planes are simultaneously measured allowing a concomitant wide-field imaging. The system can track single particles with a precision down to 5 nm in the x-y plane and 7 nm in the axial direction. The capabilities of the system are demonstrated using single virus tracing to follow the infection pathway of Prototype Foamy Virus in living cells.

  17. 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…

  18. 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...

  19. CWI at TREC 2012, KBA track and Session Track

    NARCIS (Netherlands)

    S. Araújo (Samur); C. Boscarino (Corrado); G.G. Gebremeskel (Gebre); J. He (Jiyin); A.P. de Vries (Arjen); E.M. Voorhees; L. P. Buckland (Buckland, Lori P.)

    2013-01-01

    htmlabstractWe participated in two tracks: Knowledge Base Acceleration (KBA) Track and Session Track. In the KBA track, we focused on experi- menting with different approaches as it is the first time the track is launched. We experimented with supervised and unsupervised re- trieval models. Our

  20. 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

  1. 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

  2. Incentives from Curriculum Tracking

    Science.gov (United States)

    Koerselman, Kristian

    2013-01-01

    Curriculum tracking creates incentives in the years before its start, and we should therefore expect test scores to be higher during those years. I find robust evidence for incentive effects of tracking in the UK based on the UK comprehensive school reform. Results from the Swedish comprehensive school reform are inconclusive. Internationally, I…

  3. UWB Tracking Software Development

    Science.gov (United States)

    Gross, Julia; Arndt, Dickey; Ngo, Phong; Phan, Chau; Dusl, John; Ni, Jianjun; Rafford, Melinda

    2006-01-01

    An Ultra-Wideband (UWB) two-cluster Angle of Arrival (AOA) tracking prototype system is currently being developed and tested at NASA Johnson Space Center for space exploration applications. This talk discusses the software development efforts for this UWB two-cluster AOA tracking system. The role the software plays in this system is to take waveform data from two UWB radio receivers as an input, feed this input into an AOA tracking algorithm, and generate the target position as an output. The architecture of the software (Input/Output Interface and Algorithm Core) will be introduced in this talk. The development of this software has three phases. In Phase I, the software is mostly Matlab driven and calls C++ socket functions to provide the communication links to the radios. This is beneficial in the early stage when it is necessary to frequently test changes in the algorithm. Phase II of the development is to have the software mostly C++ driven and call a Matlab function for the AOA tracking algorithm. This is beneficial in order to send the tracking results to other systems and also to improve the tracking update rate of the system. The third phase is part of future work and is to have the software completely C++ driven with a graphics user interface. This software design enables the fine resolution tracking of the UWB two-cluster AOA tracking system.

  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. Eye-Tracking

    Directory of Open Access Journals (Sweden)

    Gabriela GROSSECK

    2006-01-01

    Full Text Available Eye-tracking: one of the newest and most efficient methods of improving on-line marketing communication is called eye-tracking. Marketers have borrowed this technique, usually used in psychological and medical research, in order to study web users with the help of a video camera incorporated in the monitor.

  6. 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.

  7. Biological Pathways

    Science.gov (United States)

    Skip to main content Biological Pathways Fact Sheet Enter Search Term(s): Español Research Funding An Overview Bioinformatics Current Grants Education and Training Funding Extramural Research News Features ...

  8. 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....

  9. Different clinical importance of FLT3 internal tandem duplications in AML according to FAB classification: possible existence of distinct leukemogenesis involving monocyte differentiation pathway.

    Science.gov (United States)

    Koh, Youngil; Park, Juwon; Ahn, Kwang-Sung; Kim, Inho; Bang, Soo-Mee; Lee, Jae-Hoon; Yoon, Sung-Soo; Soon Lee, Dong; Yiul Lee, Young; Park, Seonyang; Kim, Byung-Kook

    2009-11-01

    Impact of FLT3 receptor tyrosine kinase activation via internal tandem duplication (ITD) of the juxtamembrane region on outcome of acute myeloid leukemia (AML) is still controversial. Recent researches reveal a role of FLT3 in monocyte differentiation in hematopoiesis. We analyzed the clinical impact of FLT3 alterations in adult AML patients excluding acute promyelocytic leukemia (APL) who received induction chemotherapy according to morphologic classification. Retrospective review of medical records from three centers in Korea between 1997 and 2007 was performed. Polymerase chain reaction was performed on genomic DNA derived from blood samples of patients before induction chemotherapy for FLT3-ITD detection. We assessed overall survival (OS), first disease-free survival (1-DFS), and response to induction chemotherapy. One hundred eighty-four patients (median age 49.1 years, range 16.0-76.5) with AML excluding APL received induction chemotherapy from three centers. FLT3-ITD was detected in 22 patients. One hundred forty-one patients were below age 60. One hundred seventy-nine patients received induction chemotherapy with cytarabine and idarubicin (AId) regimen. One hundred nineteen patients achieved complete remission (CR) after first induction chemotherapy. FLT3-ITD was not related to achievement of CR. 1-DFS was longer in patients without FLT3-ITD (median 1-DFS 16.5 vs. 8.5 months, p = 0.025). 1-DFS was not different according to FLT3-ITD status in nonmonocyte lineage leukemia (p = 0.355), while 1-DFS was shorter in monocyte lineage leukemia for FLT3-ITD positive patients (20.9 vs. 2.4 months, p < 0.001). FLT3-ITD had no impact on OS except for monocyte lineage, where OS was significantly shorter in FLT3-ITD positive group (39.4 vs. 6.0 months, p = 0.026). Moreover FLT3-ITD was stronger prognostic factors in monocyte lineage AML than risk stratification based on cytogenetics. Status of FLT3-ITD should be analyzed differently in AML patients according to

  10. 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.

  11. Scale adaptive compressive tracking.

    Science.gov (United States)

    Zhao, Pengpeng; Cui, Shaohui; Gao, Min; Fang, Dan

    2016-01-01

    Recently, the compressive tracking (CT) method (Zhang et al. in Proceedings of European conference on computer vision, pp 864-877, 2012) has attracted much attention due to its high efficiency, but it cannot well deal with the scale changing objects due to its constant tracking box. To address this issue, in this paper we propose a scale adaptive CT approach, which adaptively adjusts the scale of tracking box with the size variation of the objects. Our method significantly improves CT in three aspects: Firstly, the scale of tracking box is adaptively adjusted according to the size of the objects. Secondly, in the CT method, all the compressive features are supposed independent and equal contribution to the classifier. Actually, different compressive features have different confidence coefficients. In our proposed method, the confidence coefficients of features are computed and used to achieve different contribution to the classifier. Finally, in the CT method, the learning parameter λ is constant, which will result in large tracking drift on the occasion of object occlusion or large scale appearance variation. In our proposed method, a variable learning parameter λ is adopted, which can be adjusted according to the object appearance variation rate. Extensive experiments on the CVPR2013 tracking benchmark demonstrate the superior performance of the proposed method compared to state-of-the-art tracking algorithms.

  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. Eye tracking young children with autism.

    Science.gov (United States)

    Sasson, Noah J; Elison, Jed T

    2012-03-27

    The rise of accessible commercial eye-tracking systems has fueled a rapid increase in their use in psychological and psychiatric research. By providing a direct, detailed and objective measure of gaze behavior, eye-tracking has become a valuable tool for examining abnormal perceptual strategies in clinical populations and has been used to identify disorder-specific characteristics, promote early identification, and inform treatment. In particular, investigators of autism spectrum disorders (ASD) have benefited from integrating eye-tracking into their research paradigms. Eye-tracking has largely been used in these studies to reveal mechanisms underlying impaired task performance and abnormal brain functioning, particularly during the processing of social information. While older children and adults with ASD comprise the preponderance of research in this area, eye-tracking may be especially useful for studying young children with the disorder as it offers a non-invasive tool for assessing and quantifying early-emerging developmental abnormalities. Implementing eye-tracking with young children with ASD, however, is associated with a number of unique challenges, including issues with compliant behavior resulting from specific task demands and disorder-related psychosocial considerations. In this protocol, we detail methodological considerations for optimizing research design, data acquisition and psychometric analysis while eye-tracking young children with ASD. The provided recommendations are also designed to be more broadly applicable for eye-tracking children with other developmental disabilities. By offering guidelines for best practices in these areas based upon lessons derived from our own work, we hope to help other investigators make sound research design and analysis choices while avoiding common pitfalls that can compromise data acquisition while eye-tracking young children with ASD or other developmental difficulties.

  14. Real-time tumor tracking in the lung using an electromagnetic tracking system.

    Science.gov (United States)

    Shah, Amish P; Kupelian, Patrick A; Waghorn, Benjamin J; Willoughby, Twyla R; Rineer, Justin M; Mañon, Rafael R; Vollenweider, Mark A; Meeks, Sanford L

    2013-07-01

    To describe the first use of the commercially available Calypso 4D Localization System in the lung. 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(2)) were tabulated for all 42 tracks. 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. 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 necessary to create a clinical daily-use system to assist with actual

  15. 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)

  16. Agency Correspondence Tracking System (ACTS)

    Data.gov (United States)

    US Agency for International Development — Agency Correspondence Tracking System: is an executive correspondence tracking system for the Administrator. It collects and organizes information on reports...

  17. 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,…

  18. Applied eye tracking research

    NARCIS (Netherlands)

    Jarodzka, Halszka

    2011-01-01

    Jarodzka, H. (2010, 12 November). Applied eye tracking research. Presentation and Labtour for Vereniging Gewone Leden in oprichting (VGL i.o.), Heerlen, The Netherlands: Open University of the Netherlands.

  19. 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.

  20. 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.

  1. LHCb VELO Tracking Resolutions

    CERN Multimedia

    Alexander, Michael

    2011-01-01

    The excellent tracking performance of the Vertex Locator (VELO) at LHCb is presented. The resolutions it achieves on single hits, impact parameters, and primary vertex positions are shown, with particular attention paid to measurement of impact parameters.

  2. 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...

  3. 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...

  4. 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...

  5. MARS PATHFINDER RADIO TRACKING

    Data.gov (United States)

    National Aeronautics and Space Administration — The Mars Pathfinder (MPF) Radio Science (RS) data archive contains both raw radio tracking data collected during the surface lifetime of the MPF Lander and results...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. LIMSI @ 2014 Clinical Decision Support Track

    Science.gov (United States)

    2014-11-01

    34genetic complementation test" [MeSH Terms] OR " maternal serum screening tests" [MeSH Terms] OR "mutagenicity tests" [MeSH Terms] OR "radioim...e.g. "female"[MeSH terms]. For the age groups, we only kept 5 groups: Infant, Child, Adolescent , Adult and Aged_80_and_over. For each age group the

  11. 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

  12. TUW @ TREC Clinical Decision Support Track

    Science.gov (United States)

    2014-11-01

    decided to experiment with different search models and indexing possibilities, trying to build a initial foun- dation for our future participation next...Foundation. The default search model of Lucene is the Vector Space Model ( VSM ), and it was used with the default parameters. As for Run1, six runs were...system. In any case, a detailed investigation of the performance of these two runs need to be carried in the future . Run2 and Run3 were our best runs

  13. 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...

  14. 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.

  15. Nuclear tracks in solids

    International Nuclear Information System (INIS)

    Espinosa G, G.

    1994-01-01

    The main purpose of this book is to dispose within reach of young professionals in the fields of Physics, Biology, Chemistry, Medicine, Geology, Earth Sciences and Ecology between others, the basis of the Solid State Nuclear Track Methodology (SSNTM). The contents of this book is distributed as follows: Chapter 1, occurs the basic aspects on the formation of tracks in solid state materials. Chapter 2 analyzes the formation of the solid state nuclear tracks in order to three fundamental steps in the process: ionizing radiation, chemical revealed of the track and characterization and reading of the tracks. In the chapter 3, was made an analysis of the possible materials like detecting for tracks, describing the experimental process for the parameters optimization and they are also specified the characteristics of the instrumentation developed for the STD. In the chapter 4, the results obtained in applications are shown specify of the STD, where it was made emphasis in the evaluation of radon within the city and the determination of profiles and pollutants of transuranic radioactive materials. In the chapter 5, it was made an analysis of the applications of the STD as well as their future perspectives in the fields of the science and the technology. Finally, in the conclusions summary the excellent aspects of each one of the chapters and the general results are presented. (Author)

  16. 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.

  17. Feasibility of fast-track elements in pediatric surgery.

    Science.gov (United States)

    Reismann, M; Arar, M; Hofmann, A; Schukfeh, N; Ure, B

    2012-02-01

    We recently showed that fast-track pathways could be applied to only one third of patients undergoing routine pediatric surgery. The aim of this study was to investigate various fast-track elements in various procedure types irrespective of the applicability of a whole fast-track pathway. Patients undergoing routine surgical procedures from April 2009 to April 2010 were included in the study. 11 groups of procedures were differentiated and quality criteria were established for 8 fast-track elements: analgesia, postoperative nutrition, postoperative mobilization, applicability of minimally invasive surgery when appropriate, hospital stay, postoperative symptoms, complications, and parental evaluation. A fast-track element was considered as successfully applied if used in at least 75% of patients. The hospital stay was compared with data from the German reimbursement system (G-DRG). A total of 203 patients were included. Optimal analgesia was achieved in all procedure types except in oncologic surgery (58%) and ureteral reimplantation (71%). Significant nausea and vomiting occurred only after Kasai operation and "other laparoscopic procedures". Early nutrition was achieved in all procedures except after fundoplication (67%) and Kasai operation (62%). Early postoperative mobilization was not successful after hypospadias repair (40%) and ureteral reimplantation (43%). Minimally invasive techniques could not be applied in 48% of thoracic procedures and in 58% of oncological patients. There were no fast-track associated complications. In 4 of 11 procedure types, the mean hospital stay was significantly reduced compared to G-DRG data. There were 4 readmissions (2%). 2 weeks after discharge 94% of interviewed parents evaluated fast-track treatment as excellent. Fast-track elements in pediatric surgery increase patient comfort, reduce hospital stay, and achieve a high patient satisfaction. We wish to emphasize the benefits of using fast-track elements irrespective of

  18. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

    Full Text Available Abstract Background The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes. Methods A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009 Women with ≥2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS, success rate of vaginal birth after caesarean section (VBAC; proportion on women opting for elective repeat caesarean section (ERCS and their perinatal outcomes. Results A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum was 1.01234. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8% reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH ( Conclusions Besides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

  19. Time to return to full training is delayed and recurrence rate is higher in intratendinous ('c') acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification.

    Science.gov (United States)

    Pollock, Noel; Patel, Anish; Chakraverty, Julian; Suokas, Anu; James, Stephen L J; Chakraverty, Robin

    2016-03-01

    The British Athletics Muscle Injury Classification describes acute muscle injuries and their anatomical site within muscle based on MRI parameters of injury extent. It grades injuries from 0 to 4 and classifies location based on a myofascial (a), musculotendinous (b) or intratendinous (c) description. This is a retrospective cohort study that assessed time to return to full training (TRFT) and injury recurrence in the different British Athletics classifications for hamstring injuries sustained by elite track and field (T&F) athletes over a 4-year period. The electronic medical records (EMRs) of 230 elite British T&F athletes were reviewed. Athletes who sustained an acute hamstring injury, with MRI investigation within 7 days of injury, were included. MRI were graded by two musculoskeletal radiologists using the British Athletics Muscle Injury Classification. The EMRs were reviewed by 2 sports physicians, blinded to the new classification; TRFT and injury recurrence were recorded. There were 65 hamstring injuries in 44 athletes (24±4.4 years; 28 male, 16 female). TRFT differed among grades (pinjuries and 'c' injuries took significantly longer and grade 0 injuries took less TRFT. There were 12 re-injuries; the injury recurrence rate was significantly higher in intratendinous (c) injuries (pinjury rate between number grades 1-3, hamstring muscle affected, location (proximal vs central vs distal), age or sex. This study describes the clinical application of the British Athletics Muscle Injury Classification. Different categories of hamstring injuries had different TRFT and recurrence rate. Hamstring injuries that extend into the tendon ('c') are more prone to re-injury and delay TRFT. 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/

  20. 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

    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......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...

  1. 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...

  2. Deep 6-DOF Tracking.

    Science.gov (United States)

    Garon, Mathieu; Lalonde, Jean-Francois

    2017-11-01

    We present a temporal 6-DOF tracking method which leverages deep learning to achieve state-of-the-art performance on challenging datasets of real world capture. Our method is both more accurate and more robust to occlusions than the existing best performing approaches while maintaining real-time performance. To assess its efficacy, we evaluate our approach on several challenging RGBD sequences of real objects in a variety of conditions. Notably, we systematically evaluate robustness to occlusions through a series of sequences where the object to be tracked is increasingly occluded. Finally, our approach is purely data-driven and does not require any hand-designed features: robust tracking is automatically learned from data.

  3. 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...

  4. 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...

  5. 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.

  6. Search for disappearing tracks

    CERN Document Server

    INSPIRE-00024550

    2015-01-01

    We present a search for long-lived charged particles that decay within the CMS detector and produce the signature of a disappearing track. Disappearing tracks are identified as those with little or no associated calorimeter energy deposits and with missing hits in the outer layers of the tracker. The search uses proton-proton collision data recorded at $\\sqrt{s} = 8$ TeV that corresponds to an integrated luminosity of 19.5 fb$^{-1}$. The results of the search are interpreted in the context of the anomaly-mediated supersymmetry breaking model and in terms of the phenomenological MSSM.

  7. 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.

  8. Spin tracking in RHIC

    Energy Technology Data Exchange (ETDEWEB)

    Luccio, A.U. [Brookhaven National Lab., Upton, NY (United States); Katayama, T. [Univ. of Tokyo (Japan); Wu, H. [Riken Inst., Tokyo (Japan)

    1997-07-01

    In the acceleration of polarized protons in RHIC many spin depolarizing resonances are encountered. Helical Siberian snakes will be used to overcome depolarizing effects. The behavior of polarization can be studied by numerical tracking in a model accelerator. That allows one to check the strength of the resonances, to study the effect of snakes, to find safe lattice tune regions, and finally to study the operation of special devices like spin flippers. In this paper the authors describe numerical spin tracking. Results show that, for the design corrected distorted orbit and the design beam emittance, the polarization of the beam will be preserved in the whole range of proton energies in RHIC.

  9. Object Tracking with RFID

    Science.gov (United States)

    Yamada, Kou; Uchida, Seiichi; Taniguchi, Rin-Ichiro

    This paper reports a new method for visual tracking of humans using active RFID technology. Previous studies were based on the assumption that the radio intensity from an RFID tag will be linearly proportional to the distance between the tag and the antenna or will remain unchanged; however, in reality, the intensity fluctuates significantly and changes drastically with a small change in the environment. The proposed method helps to overcome this problem by using only accurate binary information that reveals whether the target person is close to the antenna. Several experimental results have shown that the information from the RFID tag was useful for reliable tracking of humans.

  10. Military tracked vehicles

    CERN Document Server

    Hansen, Grace

    2016-01-01

    Tracked vehicles are important to militaries around the world, since they're usually supporting and carrying ground troops. Readers will learn what tracks are and why they're necessary for large, frontline battle tanks like the Bradley M2 Abrams. Big full-bleed photographs, new glossary terms, and a close up look at a vehicle will keep readers wanting more! Aligned to Common Core Standards and correlated to state standards. Abdo Kids Jumbo is an imprint of Abdo Kids, a division of ABDO.

  11. 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.)

  12. 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

  13. How to make a specific diagnosis of panniculitis on clinical grounds alone: an integrated pathway of general criteria and specific findings.

    Science.gov (United States)

    Borroni, G; Giorgini, C; Tomasini, C; Brazzelli, V

    2013-08-01

    A clinical approach to the vexing problem of diagnosis of panniculitis is traced in this paper, in order to obtain from the clinical findings, history and laboratory data of the patient useful, detailed and precise information, essential to address dermatologists to a specific clinical diagnosis of panniculitis. This approach is created in the same way as when a dermatologist faces any other dermatological disease, be it inflammatory or neoplastic. A common behavior in case of panniculitis is in fact just to take an adequate biopsy and wait for the pathologist report. This is indeed a limitation both for the dermatologist and above all for the pathologist, who is in tremendous need for detailed clinical information before signing his report. The most common types of panniculitides, taking into account their main clinical diagnostic criteria, will be considered. In particular, Erythema Nodosum, Panniculitides in Sarcoidosis, Pancreatic Panniculitis, Lupus Panniculitis, Erythema Induratum/Nodular Vasculitis and Weber-Christian Panniculitis/Rothman-Makai Pannicultis will be analyzed. Every chapter will consider general criteria (epidemiology, age and gender, distribution of the lesions, laboratory findings) and specific findings (characteristics of the lesions, i.e. redness, pain, tenderness, evolution, ulceration, sites of involvement) as well as comorbidities and systemic signs and symptoms. Detailed analysis of the general criteria integrated with the specific findings will allow the clinicians to reach a clinical diagnosis with a high degree of confidence.

  14. 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.

  15. 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…

  16. 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…

  17. 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 ...

  18. Tracking Self into Place

    Science.gov (United States)

    Piersol, Laura

    2010-01-01

    In an effort to figure out what it means to educate "ecologically," I decided to track down some of the stories that I was living, telling and making as an educator. I ended up lost in the house of environmental education, stuck within the rooms of ecological science and political advocacy. Outside on the lawn sat the story of place…

  19. 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

  20. Forward tracking detectors

    Indian Academy of Sciences (India)

    In order to get a forward tracking that fulfils the needs, it has to be implemented in the design of the detectors from the beginning. Past experience shows that this part was often underestimated and upgrades at a later stage could not deliver the required performance because the needed space was already taken by other ...

  1. Tracking Virtual Trajectories

    Science.gov (United States)

    Stone, Leland S.; Beutter, Brent R.; Lorenceau, Jean D.; Null, Cynthia H. (Technical Monitor)

    1996-01-01

    Current models of smooth pursuit eye movements assume that it is largely driven by retinal image motion. We tested this hypothesis by measuring pursuit of elliptical motion (3.2s, 0.9 Hz, 1.4 deg x 1.6 deg, 4 randomly interleaved phases) of either a small spot ("real" motion) or of a line-figure diamond viewed through apertures such that only the motion of four isolated oblique line segments was visible ("virtual" motion). Each segment moved sinusoidally along a linear trajectory yet subjects perceived a diamond moving along an elliptical path behind the aperture. We found, as expected, that real motion produced accurate tracking (N = 2) with mean gain (over horizontal and vertical) of 0.9, mean phase of -6 deg (lag), mean relative phase (H vs V) of 90 +/- 8 deg (RMS error). Virtual motion behind an X-shaped aperture (N= 4 with one naive) yielded a mean gain of 0.7, mean phase of -11 deg, mean relative phase of 87 +/- 15 deg. We also measured pursuit with the X-shaped aperture using a higher segment luminance which prevents the segments from being grouped into a coherently moving diamond while keeping the motion otherwise identical. In this incoherent case, the same four subjects no longer showed consistent elliptical tracking (RMS error in relative phase rose to 60 deg) suggesting that perceptual coherence is critical. Furthermore, to rule out tracking of the centroid, we also used vertical apertures so that all segment motion was vertical (N = 3). This stimulus still produced elliptical tracking (mean relative phase of 84 +/- 19 deg), albeit with a lower gain (0.6). These data show that humans can track moving objects reasonably accurately even when the trajectory can only be derived by spatial integration of motion signals. Models that merely seek to minimize retinal or local stimulus motion cannot explain these results.

  2. Better features to track by estimating the tracking convergence region

    NARCIS (Netherlands)

    Zivkovic, Z.; van der Heijden, Ferdinand; Kasturi, R.; Laurendeau, D.; Suen, C.

    2002-01-01

    Reliably tracking key points and textured patches from frame to frame is the basic requirement for many bottom- up computer vision algorithms. The problem of selecting the features that can be tracked well is addressed here. The Lucas- Kcsnade tracking procedure is commonly used. We propose a method

  3. mechanical sun mechanical sun-tracking techn tracking techn power ...

    African Journals Online (AJOL)

    User

    MECHANICAL SUN-TRACKING TECHN. TRACKING TECHN. POWER POINT TRACKING OF. D. B. N.. 1,2,3DEPARTMENT OF ELECTRICAL. Email addresses addresses addresses: 1 damian.nnadi@unn.edu.ng. ABSTRACT. This paper elucidates a single axis. This paper elucidates a single axis solar tracker syst.

  4. 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

  5. Illuminating the pathway for the next generation of cardiovascular medicine practitioners and researchers: Highlights of the Joint PASCAR-SCC clinical symposium on hypertension and heart failure, Cameroon.

    Science.gov (United States)

    Abanda, Martin H; Dzudie, Anastase; Hamadou, Ba; Monkam, Yves; Luma, Henry; Douala, Marie Solange; Nganhyim, Loryane; Dzekem, Bonaventure S; Nana, Theophile N; Nel, George; Mocumbi, Ana O; Stewart, Simon; Sliwa, Karen; Priso, Eugene Belley

    The Pan-African Society of Cardiology roadmap aims to achieve a 25% control of hypertension by the year 2025. Whether this is attainable or not depends largely on the capacity of healthcare providers and policy makers to address the rising prevalence of hypertension and its complications, including heart failure. Task sharing is fundamental in optimising hypertension control. The Clinical Research Education, Networking and Consultancy (CRENC) engaged with the Pan-African Society of Cardiology (PASCAR) and the Cameroon Cardiac Society (SCC) in a joint hypertension and heart failure symposium at the Douala General Hospital in 2016. The primary aims were to foster clinical research in cardiovascular medicine by raising awareness on cardiovascular diseases, to provide evidence-based training of an international standard, to encourage the conduction and dissemination of high-quality research, and to build programmes for continuing medical education. The secondary aim was to potentiate the 2nd Douala Research and Scientific Days. The symposium, which featured didactic lectures interspaced with oral/poster abstract presentations and a clinical visit, culminated in the launching of the book Heart of Africa, and the Young Investigator award. It is hoped that these served to capacitate existing cardiovascular structures, breed the next generation of cardiovascular physicians and researchers, and imprint a trail of clinical research excellence to be emulated in Cameroon and beyond.

  6. 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.

  7. 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...

  8. 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...

  9. Tracking migrating birds

    DEFF Research Database (Denmark)

    Willemoes, Mikkel

    and many experiments are only becoming possible with the current development of tracking technologies. During this thesis work I have been tracking the poorly known movements of several species of long-distance migrants and document highly complex migration patterns. In three manuscripts these movements......, and conclude that the currently believed theoretical framework is insufficient to explain the observed performance. The other study investigates the ability of a displaced experienced migrant to navigate back to the normal migration route. It documents the capability, but also finds interesting patterns...... were related to the yearly progression of an environmental surrogate for food availability along the course of migration. In one species, with multiple, different non-breeding staging sites, environmental conditions explain movements well and also how yearly differences explain differences in timing...

  10. 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.

  11. 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.

  12. Fast motion-including dose error reconstruction for VMAT with and without MLC tracking

    DEFF Research Database (Denmark)

    Ravkilde, Thomas; Keall, Paul J.; Grau, Cai

    2014-01-01

    Multileaf collimator (MLC) tracking is a promising and clinically emerging treatment modality for radiotherapy of mobile tumours. Still, new quality assurance (QA) methods are warranted to safely introduce MLC tracking in the clinic. The purpose of this study was to create and experimentally...... validate a simple model for fast motion-including dose error reconstruction applicable to intrafractional QA of MLC tracking treatments of moving targets. MLC tracking experiments were performed on a standard linear accelerator with prototype MLC tracking software guided by an electromagnetic transponder...

  13. Labeling uncertainty in multitarget tracking

    NARCIS (Netherlands)

    Aoki, E.H.; Mandal, Pranab K.; Svensson, Lennart; Boers, Y.; Bagchi, Arunabha

    In multitarget tracking, the problem of track labeling (assigning labels to tracks) is an ongoing research topic. The existing literature, however, lacks an appropriate measure of uncertainty related to the assigned labels that has a sound mathematical basis as well as clear practical meaning to the

  14. 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...

  15. Simultaneous Electromagnetic Tracking and Calibration for Dynamic Field Distortion Compensation.

    Science.gov (United States)

    Sadjadi, Hossein; Hashtrudi-Zaad, Keyvan; Fichtinger, Gabor

    2016-08-01

    Electromagnetic (EM) tracking systems are highly susceptible to field distortion. The interference can cause measurement errors up to a few centimeters in clinical environments, which limits the reliability of these systems. Unless corrected for, this measurement error imperils the success of clinical procedures. It is therefore fundamental to dynamically calibrate EM tracking systems and compensate for measurement error caused by field distorting objects commonly present in clinical environments. We propose to combine a motion model with observations of redundant EM sensors and compensate for field distortions in real time. We employ a simultaneous localization and mapping technique to accurately estimate the pose of the tracked instrument while creating the field distortion map. We conducted experiments with six degrees-of-freedom motions in the presence of field distorting objects in research and clinical environments. We applied our approach to improve the EM tracking accuracy and compared our results to a conventional sensor fusion technique. Using our approach, the maximum tracking error was reduced by 67% for position measurements and by 64% for orientation measurements. Currently, clinical applications of EM trackers are hampered by the adverse distortion effects. Our approach introduces a novel method for dynamic field distortion compensation, independent from preoperative calibrations or external tracking devices, and enables reliable EM navigation for potential applications.

  16. 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.)

  17. SOFIA tracking image simulation

    Science.gov (United States)

    Taylor, Charles R.; Gross, Michael A. K.

    2016-09-01

    The Stratospheric Observatory for Infrared Astronomy (SOFIA) tracking camera simulator is a component of the Telescope Assembly Simulator (TASim). TASim is a software simulation of the telescope optics, mounting, and control software. Currently in its fifth major version, TASim is relied upon for telescope operator training, mission planning and rehearsal, and mission control and science instrument software development and testing. TASim has recently been extended for hardware-in-the-loop operation in support of telescope and camera hardware development and control and tracking software improvements. All three SOFIA optical tracking cameras are simulated, including the Focal Plane Imager (FPI), which has recently been upgraded to the status of a science instrument that can be used on its own or in parallel with one of the seven infrared science instruments. The simulation includes tracking camera image simulation of starfields based on the UCAC4 catalog at real-time rates of 4-20 frames per second. For its role in training and planning, it is important for the tracker image simulation to provide images with a realistic appearance and response to changes in operating parameters. For its role in tracker software improvements, it is vital to have realistic signal and noise levels and precise star positions. The design of the software simulation for precise subpixel starfield rendering (including radial distortion), realistic point-spread function as a function of focus, tilt, and collimation, and streaking due to telescope motion will be described. The calibration of the simulation for light sensitivity, dark and bias signal, and noise will also be presented

  18. 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

  19. Tracking communications change

    International Nuclear Information System (INIS)

    Latimer, Cole

    2010-01-01

    While personal communications on a minesite is critical, the additional equipment and weight miners are forced to contend with hampers work. Often bulky, and fairly heavy, mining communications equipment has not been known for its lightweight manufacture. To overcome this and give miners some relief, NL Technologies has developed a two way messaging and tracking device that is incorporated into their existing cap lamps, the Northern Light Cap Lamp, to service this communications need

  20. 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

    International Nuclear Information System (INIS)

    Schulze, Bjoern; Roedel, Claus; Balermpas, Panagiotis; Meissner, Markus; Ghanaati, Shahram; Burck, Iris

    2016-01-01

    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.) [de

  1. Track based Alignment of the ATLAS Inner Detector Tracking System

    CERN Document Server

    Schieck, J; The ATLAS collaboration

    2011-01-01

    ATLAS is a multipurpose experiment that records the LHC collisions. In order to reconstruct trajectories of charged particle, ATLAS is equipped with a tracking system built using different technologies, silicon planar sensors (pixel and microstrips) and drift‐tube detectors. In order to achieve its scientific goals, the ATLAS tracking system requires to determine accurately its almost 700,000 degrees of freedom. The demanded precision for the alignment of the silicon sensors is below 10 micrometers. This implies to use a large sample of high momentum and isolated tracks. The high level trigger selects and stores those tracks in a calibration stream. Tracks from cosmic trigger during empty LHC bunches are also used as input for the alignment. The implementation of the track based alignment within the ATLAS software unifies different alignment approaches and allows the alignment of all tracking subsystems together. Primary vertexing and beam spot constraints have been implemented, as well as constraints on th...

  2. Fuzzy Logic Particle Tracking

    Science.gov (United States)

    2005-01-01

    A new all-electronic Particle Image Velocimetry technique that can efficiently map high speed gas flows has been developed in-house at the NASA Lewis Research Center. Particle Image Velocimetry is an optical technique for measuring the instantaneous two component velocity field across a planar region of a seeded flow field. A pulsed laser light sheet is used to illuminate the seed particles entrained in the flow field at two instances in time. One or more charged coupled device (CCD) cameras can be used to record the instantaneous positions of particles. Using the time between light sheet pulses and determining either the individual particle displacements or the average displacement of particles over a small subregion of the recorded image enables the calculation of the fluid velocity. Fuzzy logic minimizes the required operator intervention in identifying particles and computing velocity. Using two cameras that have the same view of the illumination plane yields two single exposure image frames. Two competing techniques that yield unambiguous velocity vector direction information have been widely used for reducing the single-exposure, multiple image frame data: (1) cross-correlation and (2) particle tracking. Correlation techniques yield averaged velocity estimates over subregions of the flow, whereas particle tracking techniques give individual particle velocity estimates. For the correlation technique, the correlation peak corresponding to the average displacement of particles across the subregion must be identified. Noise on the images and particle dropout result in misidentification of the true correlation peak. The subsequent velocity vector maps contain spurious vectors where the displacement peaks have been improperly identified. Typically these spurious vectors are replaced by a weighted average of the neighboring vectors, thereby decreasing the independence of the measurements. In this work, fuzzy logic techniques are used to determine the true

  3. 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.

  4. Quality of Slab Track Construction – Track Alignment Design and Track Geometry

    OpenAIRE

    Šestáková Janka

    2015-01-01

    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.

  5. Gray Reflections: Poetry as a Pathway to Nursing Student Empathy and the Creation of Meaning in a Long-Term-Care Clinical Practicum.

    Science.gov (United States)

    Adams, Sara B; Scott, Linda D

    2018-02-01

    The unique needs of the aging adult require caregivers who can completely comprehend the experience of this population. Purposefully educating nursing students to enhance development of empathy is crucial for the provision of adequate care. Innovative pedagogical strategies that produce opportunities for nursing students to reflect on patient care experiences are an opportunity for educators to guide the creation of meaning in practice for nursing students. The use of poetry reading and writing enhances the student reflective process in clinical practicum environments and may serve as a strategy to support empathic development in nursing students.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. Description and analysis of clinical pathways for oesophago-gastric adenocarcinoma, in 10 European countries (the EURECCA upper gastro intestinal group - European Registration of Cancer Care).

    Science.gov (United States)

    Messager, M; de Steur, W; Boelens, P G; Jensen, L S; Mariette, C; Reynolds, J V; Osorio, J; Pera, M; Johansson, J; Kołodziejczyk, P; Roviello, F; De Manzoni, G; Mönig, S P; Allum, W H

    2016-09-01

    Outcomes for patients with oesophago-gastric cancer are variable across Europe. The reasons for this variability are not clear. The aim of this study was to describe and analyse clinical pathways to understand differences in service provision for oesophageal and gastric cancer in the countries participating in the EURECCA Upper GI group. A questionnaire was devised to assess clinical presentation, diagnosis, staging, treatment, pathology, follow-up and service frameworks across Europe for patients with oesophageal and gastric cancer. The questionnaire was issued to experts from 14 countries. The responses were analysed quantitatively and qualitatively and compared. The response rate was (10/14) 71.4%. The approach to diagnosis was similar. Most countries established a diagnosis within 3 weeks of presentation. However, there were different approaches to staging with variable use of endoscopic ultrasound reflecting availability. There has been centralisation of treatments in most countries for oesophageal surgery. The most consistent area was the approach to pathology. There were variations in access to specialist nurse and dietitian support. Although most countries have multidisciplinary teams, their composition and frequency of meetings varied. The two main areas of significant difference were research and audit and overall service provision. Observations on service framework indicated that limited resources restricted many of the services. The principle approaches to diagnosis, treatment and pathology were similar. Factors affecting the quality of patient experience were variable. This may reflect availability of resources. Standard pathways of care may enhance both the quality of treatment and patient experience. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. 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.

  12. 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.

  13. 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.

  14. Chemical cloud tracking systems

    Science.gov (United States)

    Grim, Larry B.; Gruber, Thomas C., Jr.; Marshall, Martin; Rowland, Brad

    2002-02-01

    This paper describes the Chemical Cloud Tracking System (CCTS) which has been installed at Dugway Proving Ground. The CCTS allows mapping of chemical clouds in real time from a safe standoff distance. The instruments used are passive standoff chemical agent detectors (FTIRs). Each instrument individually can only measure the total of all the chemical in its line-of-site; the distance to the cloud is unknown. By merging data from multiple vantage points (either one instrument moving past the cloud or two or more instruments spaced so as to view the cloud from different directions) a map of the cloud locations can be generated using tomography. To improve the sensitivity and accuracy of the cloud map, chemical point sensors can be added to the sensor array being used. The equipment required for the CCTS is commercially available. Also, the data fusion techniques (tomography) have been demonstrated previously in the medical field. The Chemical Cloud Tracking System can monitor the movement of many chemical clouds of either military or industrial origin. Since the technique is standoff, the personnel are not exposed to toxic hazards while they follow the cloud. Also, the equipment works on-the-move which allows rapid response to emergency situations (plant explosions, tanker car accidents, chemical terrorism, etc.).

  15. Track finding using GPUs

    CERN Document Server

    Schmitt, C; The ATLAS collaboration

    2011-01-01

    Track finding using GPUs The reconstruction and simulation of collision events is a major task in modern HEP experiments involving several ten thousands of standard CPUs. On the other hand the graphics processors (GPUs) have become much more powerful and are by far outperforming the standard CPUs in terms of floating point operations due to their massive parallel approach. The usage of these GPUs could therefore significantly reduce the overall reconstruction time per event or allow for the usage of more sophisticated algorithms. In this contribution the track finding in the ATLAS experiment will be used as an example on how the GPUs can be used in this context: the seed finding alone shows already a speed increase of one order of magnitude compared to the same implementation on a standard CPU. On the other hand the implementation on the GPU requires a change in the algorithmic flow to allow the code to work in the rather limited environment on the GPU in terms of memory, cache, and transfer speed from and to...

  16. 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

  17. Tracking in Object Action Space

    DEFF Research Database (Denmark)

    Krüger, Volker; Herzog, Dennis

    2013-01-01

    -dependent or as, e.g., in the case of a pointing direction convey important information. One common way to achieve recognition is by using 3D human body tracking followed by action recognition based on the captured tracking data. For the kind of scenarios considered here we would like to argue that 3D body...... tracking and action recognition should be seen as an intertwined problem that is primed by the objects on which the actions are applied. In this paper, we are looking at human body tracking and action recognition from a object-driven perspective. Instead of the space of human body poses we consider...... 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...

  18. Coordinated Analyses of Diverse Components in Whole Stardust Cometary Tracks

    Science.gov (United States)

    Nakamura-Messenger, K.; Keller, L. P.; Messenger, S.; Clemett, S. J.; Nguyen, A. N.; Frank, D.

    2012-01-01

    Analyses of samples returned from Comet Wild-2 by the Stardust spacecraft have resulted in a number of surprising findings that show the origins of comets are more complex than previously suspected [1]. Stardust aerogel tracks show considerable compositional diversity and the degree of impact related thermal modification and destruction is also highly variable. We are performing systematic examinations of entire Stardust tracks to discern the representative mineralogy and origins of comet Wild 2 components and to search for well preserved fine grained materials. Previously, we used ultramicrotomy to prepare sequential thin sections of entire "carrot" and "bulbous" type tracks along their axis while preserving their original shapes [2]. This technique allows us to characterize the usually well-preserved terminal particle (TP), but also any associated, fine-grained fragments that were shed along the track pathway. This report focuses on coordinated analyses of surviving indigenous cometary materials (crystalline and amorphous) along the aerogel track walls, their interaction with aerogel during collection and comparisons with their TPs. We examined the distribution of fragments throughout the track from the entrance hole to the TP.

  19. Fast left ventricle tracking using localized anatomical affine optical flow.

    Science.gov (United States)

    Queirós, Sandro; Vilaça, João L; Morais, Pedro; Fonseca, Jaime C; D'hooge, Jan; Barbosa, Daniel

    2017-11-01

    In daily clinical cardiology practice, left ventricle (LV) global and regional function assessment is crucial for disease diagnosis, therapy selection, and patient follow-up. Currently, this is still a time-consuming task, spending valuable human resources. In this work, a novel fast methodology for automatic LV tracking is proposed based on localized anatomically constrained affine optical flow. This novel method can be combined to previously proposed segmentation frameworks or manually delineated surfaces at an initial frame to obtain fully delineated datasets and, thus, assess both global and regional myocardial function. Its feasibility and accuracy were investigated in 3 distinct public databases, namely in realistically simulated 3D ultrasound, clinical 3D echocardiography, and clinical cine cardiac magnetic resonance images. The method showed accurate tracking results in all databases, proving its applicability and accuracy for myocardial function assessment. Moreover, when combined to previous state-of-the-art segmentation frameworks, it outperformed previous tracking strategies in both 3D ultrasound and cardiac magnetic resonance data, automatically computing relevant cardiac indices with smaller biases and narrower limits of agreement compared to reference indices. Simultaneously, the proposed localized tracking method showed to be suitable for online processing, even for 3D motion assessment. Importantly, although here evaluated for LV tracking only, this novel methodology is applicable for tracking of other target structures with minimal adaptations. Copyright © 2017 John Wiley & Sons, Ltd.

  20. 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)...

  1. 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...

  2. 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.

  3. Health Research Information Tracking System

    Data.gov (United States)

    US Agency for International Development — The Health Research Information Tracking System (HRIT) is an expansion of the Child Health Research database that collects and maintains categorization, description,...

  4. The "mommy tenure track".

    Science.gov (United States)

    Draznin, Julia

    2004-04-01

    For years women have been fighting for equity in the academic work place, but this acceptance comes at a price. Balancing work and family obligations have proven to be an awkward task where maximal satisfaction and gratification in both are not easily attained. Junior-level faculty have the arduous charge of being most productive and prolific exactly during their child-raising years. If our society wants to produce and maintain women professionals, then academic institutions have to be more generous and tolerant in the short-term for a long-term gain. The author proposes a "mommy tenure track" in which primary caregivers of infants are allowed to temporarily postpone their tenure clock. She also cites innovative initiatives being carried out at one institution to help women, including young mothers, with their academic careers and promotions.

  5. 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.

  6. 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

  7. Geo Issue Tracking System

    Science.gov (United States)

    Khakpour, Mohammad; Paulik, Christoph; Hahn, Sebastian

    2016-04-01

    Communication about remote sensing data quality between data providers and users as well as between the users is often difficult. The users have a hard time figuring out if a product has known problems over their region of interest and data providers have to spend a lot of effort to make this information available, if it exists. Scientific publications are one tool for communicating with the users base but they are static and mostly one way. As a data provider it is also often difficult to make feedback, received from users, available to the complete user base. The Geo Issue Tracking System (GeoITS) is an Open Source Web Application which has been developed to mitigate these problems. GeoITS combines a mapping interface (Google Maps) with a simple wiki platform. It allows users to give region specific feedback on a remote sensing product by drawing a polygon on the map and describing the problems they had using the remote sensing product in this area. These geolocated wiki entries are then viewable by other users as well as the data providers which can modify and extend the entries. In this way the conversations between the users and the data provider are no longer hidden in e.g. emails but open for all users of the dataset. This new kind of communication platform can enable better cooperation between users and data providers. It will also provide data providers with the ability to track problems their dataset might have in certain areas and resolve them with new product releases. The source code is available via http://github.com/TUW-GEO/geoits_dev A running instance can be tried at https://geoits.herokuapp.com/

  8. In patients undergoing fast track total knee arthroplasty, addition of buprenorphine to a femoral nerve block has no clinical advantage: A prospective, double-blinded, randomized, placebo controlled trial.

    Science.gov (United States)

    van Beek, Rienk; Zonneveldt, Harry J; van der Ploeg, Tjeerd; Steens, Jeroen; Lirk, Phillip; Hollmann, Marcus W

    2017-07-01

    Several adjuvants have been proposed to prolong the effect of peripheral nerve blocks, one of which is buprenorphine. In this randomized double blinded placebo controlled trial we studied whether the addition of buprenorphine to a femoral nerve block prolongs analgesia in patients undergoing total knee arthroplasty in a fast track surgery protocol. The treatment group (B) was given an ultrasound-guided femoral nerve block with ropivacaine 0.2% and 0.3mg buprenorphine. We choose to use 2 control groups. Group R was given a femoral nerve block with ropivacaine 0.2% only. Group S also received 0.3 mg buprenorphine subcutaneously. Only patients with a successful block were enrolled in the study. We found no difference in our primary outcome parameter of time to first rescue analgesic. We found lower opioid use and better sleep quality the first postoperative night in patients receiving buprenorphine perineurally or subcutaneously. Buprenorphine did not lead to any significant change in pain or mobilization. We found a high overall incidence of nausea and vomiting. In patients undergoing total knee arthroplasty, in the setting of a fast track surgery protocol, the addition of buprenorphine to a femoral nerve block did not prolong analgesia.

  9. Dynamic comparison of different types of slab tracks and ballasted track using a flexible track model

    OpenAIRE

    Blanco-Lorenzo, Julio; Santamaría Manrique, Javier; García Vadillo, Ernesto; Oyarzabal de Celis, Olatz

    2011-01-01

    The dynamic performance of a ballasted track and three types of slab tracks is analysed and compared by means of a comprehensive dynamic model of the train-track system, generated using two commercial analysis software packages: the commercial Multibody System (MBS) analysis software SIMPACK and the Finite Element Method (FEM) analysis software NASTRAN. The use of a commercial MBS software makes it possible to include in a reliable way models of advanced non-linear wheel-rail contact, as well...

  10. 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

  11. Eye-tracking technology in medical education: A systematic review.

    Science.gov (United States)

    Ashraf, Hajra; Sodergren, Mikael H; Merali, Nabeel; Mylonas, George; Singh, Harsimrat; Darzi, Ara

    2018-01-01

    Eye-tracking technology is an established research tool within allied industries such as advertising, psychology and aerospace. This review aims to consolidate literature describing the evidence for use of eye-tracking as an adjunct to traditional teaching methods in medical education. A systematic literature review was conducted in line with STORIES guidelines. A search of EMBASE, OVID MEDLINE, PsycINFO, TRIP database, and Science Direct was conducted until January 2017. Studies describing the use of eye-tracking in the training, assessment, and feedback of clinicians were included in the review. Thirty-three studies were included in the final qualitative synthesis. Three studies were based on the use of gaze training, three studies on the changes in gaze behavior during the learning curve, 17 studies on clinical assessment and six studies focused on the use of eye-tracking methodology as a feedback tool. The studies demonstrated feasibility and validity in the use of eye-tracking as a training and assessment method. Overall, eye-tracking methodology has contributed significantly to the training, assessment, and feedback practices used in the clinical setting. The technology provides reliable quantitative data, which can be interpreted to give an indication of clinical skill, provide training solutions and aid in feedback and reflection. This review provides a detailed summary of evidence relating to eye-tracking methodology and its uses as a training method, changes in visual gaze behavior during the learning curve, eye-tracking methodology for proficiency assessment and its uses as a feedback tool.

  12. 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.

  13. 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…

  14. Fatigue effects on tracking performance

    NARCIS (Netherlands)

    Huysmans, M.A.; Hoozemans, M.; Beek, A.J. van der; Looze, M.P. de; Dieën, J.H. van

    2006-01-01

    The objective of the present study was to test the effect of fatigue on task performance in a tracking task performed with a computer mouse. Participants performed a two-minute tracking task twice before and once immediately after a fatiguing wrist extension protocol. Results indicate that the mean

  15. 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...

  16. Patient Treatment Tracking Chart

    Science.gov (United States)

    ... the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival Golden Age Games Summer Sports Clinic Training - Exposure - Experience (TEE) Tournament ...

  17. Adaptive Maneuvering Target Tracking Algorithm

    Directory of Open Access Journals (Sweden)

    Chunling Wu

    2014-07-01

    Full Text Available Based on the current statistical model, a new adaptive maneuvering target tracking algorithm, CS-MSTF, is presented. The new algorithm keep the merits of high tracking precision that the current statistical model and strong tracking filter (STF have in tracking maneuvering target, and made the modifications as such: First, STF has the defect that it achieves the perfect performance in maneuvering segment at a cost of the precision in non-maneuvering segment, so the new algorithm modified the prediction error covariance matrix and the fading factor to improve the tracking precision both of the maneuvering segment and non-maneuvering segment; The estimation error covariance matrix was calculated using the Joseph form, which is more stable and robust in numerical. The Monte- Carlo simulation shows that the CS-MSTF algorithm has a more excellent performance than CS-STF and can estimate efficiently.

  18. Feature tracking measurement of dyssynchrony from cardiovascular magnetic resonance cine acquisitions: comparison with echocardiographic speckle tracking.

    Science.gov (United States)

    Onishi, Toshinari; Saha, Samir K; Ludwig, Daniel R; Onishi, Tetsuari; Marek, Josef J; Cavalcante, João L; Schelbert, Erik B; Schwartzman, David; Gorcsan, John

    2013-10-17

    Analysis of left ventricular (LV) mechanical dyssynchrony may provide incremental prognostic information regarding cardiac resynchronization therapy (CRT) response in addition to QRS width alone. Our objective was to quantify LV dyssynchrony using feature tracking post processing of routine cardiovascular magnetic resonance (CMR) cine acquisitions (FT-CMR) in comparison to speckle tracking echocardiography. We studied 72 consecutive patients who had both steady-state free precession CMR and echocardiography. Mid-LV short axis CMR cines were analyzed using FT-CMR software and compared with echocardiographic speckle tracking radial dyssynchrony (time difference between the anteroseptal and posterior wall peak strain). Radial dyssynchrony analysis was possible by FT-CMR in all patients, and in 67 (93%) by echocardiography. Dyssynchrony by FT-CMR and speckle tracking showed limits of agreement of strain delays of ± 84 ms. These were large (up to 100% or more) relative to the small mean delays measured in more synchronous patients, but acceptable (mainly 200 ms. Radial dyssynchrony was significantly greater in wide QRS patients than narrow QRS patients by both FT-CMR (radial strain delay 230 ± 94 vs. 77 ± 92* ms) and speckle tracking (radial strain delay 242 ± 101 vs. 75 ± 88* ms, all *p acquisitions which, at least for the patients with more marked dyssynchrony, showed reasonable agreement with those from speckle tracking echocardiography. The clinical usefulness of the method, for example in predicting prognosis in CRT patients, remains to be investigated.

  19. 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.

  20. 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 probabilistic than in deterministic tracking (p

  1. 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

  2. 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.

  3. 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

  4. 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)

  5. 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.

  6. 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

  7. Track inspection planning and risk measurement analysis.

    Science.gov (United States)

    2014-11-01

    This project models track inspection operations on a railroad network and discusses how the inspection results can : be used to measure the risk of failure on the tracks. In particular, the inspection times of the tracks, inspection frequency of the ...

  8. 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,...

  9. 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...

  10. 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

  11. 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.

  12. Sun Tracking Systems: A Review

    Science.gov (United States)

    Lee, Chia-Yen; Chou, Po-Cheng; Chiang, Che-Ming; Lin, Chiu-Feng

    2009-01-01

    The output power produced by high-concentration solar thermal and photovoltaic systems is directly related to the amount of solar energy acquired by the system, and it is therefore necessary to track the sun's position with a high degree of accuracy. Many systems have been proposed to facilitate this task over the past 20 years. Accordingly, this paper commences by providing a high level overview of the sun tracking system field and then describes some of the more significant proposals for closed-loop and open-loop types of sun tracking systems. PMID:22412341

  13. ATLAS FTK: Fast Track Trigger

    CERN Document Server

    Amerio, S; The ATLAS collaboration; Andreazza, A; Annovi, A; Beretta, M; Bevacqua, V; Bogdan, M; Bossini, E; Boveia, A; Cavaliere, V; Canelli, F; Blazey, G; Cervigni, F; Cheng, Y; Citterio, M; Crescioli, F; Dell’Orso, M; Drake, G; Dunford, M; Giannetti, P; Giorgi, F; Hoff, J; Kapliy, A; Kasten, M; Kim, Y K; Kimura, N; Lanza, A; Liberali, V; Liu, T; Magalotti, D; McCarn, A; Melachrinos, C; Meroni, C; Negri, A; Neubauer, M; Penning, B; Piendibene, M; Proudfoot, J; Riva, M; Roda, C; Sabatini, F; Sacco, I; Shochet, M; Stabile, A; Tang, F; Tang, J; Tripiccione, R; Tuggle, J; Vercesi, V; Verzocchi, M; Villa, M; Vitillo, R A; Volpi, G; Webster, J; Wu, J; Yorita, K; Zhang, J

    2011-01-01

    A track reconstruction system for the trigger of the ATLAS detector at the Large Hadron Collider is described. The Fast Tracker is a highly parallel hardware system designed to operate at the Level-1 trigger output rate. It will provide high-quality tracks reconstructed over the entire inner detector by the start of processing in the Level-2 trigger. The system is based on associative memories for pattern recognition and fast FPGA’s for track reconstruction. Its design and expected performance under instantaneous luminosities up to 3 × 10^34/cm^2/s are discussed.

  14. GPS Navigation and Tracking Device

    OpenAIRE

    Yahya Salameh Khraisat; Mohammad Al-Khateeb; Yahya Abu-Alreesh; Anas Ayyash; Osama Lahlouh

    2011-01-01

    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...

  15. 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.

  16. 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.

  17. The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample:an eye-tracking study

    OpenAIRE

    Sharpe, Emma; Wallis, Deborah J.; Ridout, Nathan

    2016-01-01

    This study aimed to: i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; ii) examine if the bias occurs during initial orientation or later strategic processing; and iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional d...

  18. 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.

  19. Speckle Tracking Imaging in Normal Stress Echocardiography.

    Science.gov (United States)

    Leitman, Marina; Tyomkin, Vladimir; Peleg, Eli; Zyssman, Izhak; Rosenblatt, Simcha; Sucher, Edgar; Gercenshtein, Vered; Vered, Zvi

    2017-04-01

    Exercise stress echocardiography is a widely used modality for the diagnosis and follow-up of patients with coronary artery disease. During the last decade, speckle tracking imaging has been used increasingly for accurate evaluation of cardiac function. This work aimed to assess speckle-tracking imaging parameters during nonischemic exercise stress echocardiography. During 2011 to 2014 we studied 46 patients without history of coronary artery disease, who completed exercise stress echocardiography protocol, had normal left ventricular function, a nonischemic response, and satisfactory image quality. These exams were analyzed with speckle-tracking imaging software at rest and at peak exercise. Peak strain and time-to-peak strain were measured at rest and after exercise. Clinical follow-up included a telephone contact 1 to 3 years after stress echo exam, confirming freedom from coronary events during this time. Global and regional peak strain increased following exercise. Time-to-peak global and regional strain and time-to-peak strain adjusted to the heart rate were significantly shorter in all segments after exercise. Rest-to-stress ratio of time-to-peak strain adjusted to the heart rate was 2.0 to 2.8. Global and regional peak strain rise during normal exercise echocardiography. Peak global and regional strain occur before or shortly after aortic valve closure at rest and after exercise, and the delay is more apparent at the basal segments. Time-to-peak strain normally shortens significantly during exercise; after adjustment to heart rate it shortens by a ratio of 2.0 to 2.8. These data may be useful for interpretation of future exercise stress speckle-tracking echocardiography studies. © 2016 by the American Institute of Ultrasound in Medicine.

  20. 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.

  1. 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)

  2. 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.

  3. 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...

  4. 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.

  5. 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...

  6. Air Pollution Tracking using PDEs

    African Journals Online (AJOL)

    ,. Polluted Zones, Positive Finite Difference Scheme. 1. Introduction. In this work we propose a mathematical model that can be used to track the movement of pollutant material in the atmosphere. Such models are important tools for planning ...

  7. Birth Defects Research and Tracking

    Science.gov (United States)

    ... Environmental public health tracking is the ongoing collection, integration, analysis, interpretation, and dissemination of data on environmental ... 2016) Key Findings: Gastroschisis – a Serious Birth Defect – Continues to Increase New CDC research shows that the ...

  8. VP Simulation and Track Reconstruction

    CERN Document Server

    Bird, T; Callot, O; Coco, V; Collins, P; Evans, T; Head, T; Hennessy, K; Hulsbergen, W; Hynds, D; Jalocha, P; John, M; Ketel, T; Kucharczyk, M; Martinez-Santos, D; Qian, W; Rinnert, K; Schindler, H; Skwarnicki, T; Snoek, H; Tsopelas, P; Vieira, D

    2013-01-01

    This note provides a comprehensive overview of the material description, event model, and the digitisation and track reconstruction algorithms used for simulating the upgraded pixel-based Vertex Locator.

  9. 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...

  10. 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.

  11. 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

  12. 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

  13. 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)

  14. Multi-track Map Matching

    OpenAIRE

    Javanmard, Adel; Haridasan, Maya; Zhang, Li

    2012-01-01

    We study algorithms for matching user tracks, consisting of time-ordered location points, to paths in the road network. Previous work has focused on the scenario where the location data is linearly ordered and consists of fairly dense and regular samples. In this work, we consider the \\emph{multi-track map matching}, where the location data comes from different trips on the same route, each with very sparse samples. This captures the realistic scenario where users repeatedly travel on regular...

  15. 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.

  16. 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 ...

  17. 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.

  18. Intrafractional Tracking Accuracy of a Transperineal Ultrasound Image Guidance System for Prostate Radiotherapy.

    Science.gov (United States)

    Yu, Amy S; Najafi, Mohammad; Hristov, Dimitre H; Phillips, Tiffany

    2017-12-01

    The aim of this study is to evaluate the tracking accuracy of a commercial ultrasound system under relevant treatment conditions and demonstrate its clinical utility for detecting significant treatment deviations arising from inadvertent intrafractional target motion. A multimodality male pelvic phantom was used to simulate prostate image-guided radiotherapy with the system under evaluation. Target motion was simulated by placing the phantom on a motion platform. The tracking accuracy of the ultrasound system was evaluated using an independent optical tracking system under the conditions of beam-on, beam-off, poor image quality with an acoustic shadow introduced, and different phantom motion cycles. The time delay between the ultrasound-detected and actual phantom motion was investigated. A clinical case example of prostate treatment is presented as a demonstration of the utility of the system in practice. Time delay between the motion phantom and ultrasound tracking system is 223 ± 45.2 milliseconds including video and optical tracking system frame rates. The tracking accuracy and precision were better with a longer period. The precision of ultrasound tracking performance in the axial (superior-inferior) direction was better than that in the lateral (left-right) direction (root mean square errors are 0.18 and 0.25 mm, respectively). The accuracy of ultrasound tracking performance in the lateral direction was better than that in the axial direction (the mean position errors are 0.23 and 0.45 mm, respectively). Interference by radiation and image quality do not affect tracking ability significantly. Further, utilizing the tracking system as part of a clinical study for prostate treatment further verified the accuracy and clinical appropriateness. It is feasible to use transperineal ultrasound daily to monitor prostate motion during treatment. Our results verify the accuracy and precision of an ultrasound system under typical external beam treatment conditions and

  19. Tracking the implementation of NCCLS M100-S12 expanded-spectrum cephalosporin MIC breakpoints for nonmeningeal isolates of Streptococcus pneumoniae by clinical laboratories in the United States during 2002 and 2003

    Directory of Open Access Journals (Sweden)

    Thornsberry Clyde

    2004-01-01

    Full Text Available Abstract Background The Performance Standards for Antimicrobial Susceptibility Testing, Twelfth Informational Supplement, M100-S12, published by the National Committee for Clinical Laboratory Standards (NCCLS in January 2002 introduced distinct minimum inhibitory concentration (MIC interpretative breakpoints for ceftriaxone, cefotaxime, and cefepime for nonmeningeal isolates of Streptococcus pneumoniae. Previously, a single set of interpretative breakpoints was used for both meningeal and nonmeningeal isolates. Methods To estimate the rate of adoption of the M100-S12 interpretive breakpoints by clinical laboratories, antimicrobial susceptibility test results for ceftriaxone and cefotaxime from nonmeningeal S. pneumoniae isolates were studied using data collected from January 2002 to June 2003 by The Surveillance Network® Database – USA (TSN®, an electronic surveillance database. Results Of the 262 laboratories that provided data that could be evaluated, 67.6% had adopted the M100-S12 breakpoints one and one-half years after they were published. Conclusions The NCCLS M100-S12 recommendation to interpret MICs to expanded-spectrum cephalosporins using two distinct sets of breakpoints for meningeal and nonmeningeal isolates of S. pneumoniae was steadily implemented by clinical microbiology laboratories in the United States following their initial publication in January 2002. The use of these new breakpoints more accurately reflects the clinical activities of expanded-spectrum cephalosporins than did the single set of interpretative breakpoints previously used for both meningeal and nonmeningeal isolates.

  20. 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.

  1. 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.

  2. Track based alignment of the ATLAS Inner Detector tracking system

    CERN Document Server

    Romero, E; The ATLAS collaboration

    2011-01-01

    ATLAS   is   a   multipurpose   experiment   that   records   the   LHC   collisions.   In   order   to   reconstruct   trajectories   of   charged   particle,   ATLAS   is   equipped   with   a   tracking   system   built   using   different   technologies,   silicon   planar   sensors   (pixel   and   microstrips)   and   drift-­‐tube   detectors.   In   order   to   achieve  its  scientific  goals,  the  ATLAS  tracking  system  requires  to  determine  accurately  its  almost   700,000   degrees   of   freedom.   The   demanded   precision   for   the   alignment   of   the   silicon   sensors   is   below   10   micrometers.   This   implies   to   use   a   large   sample   of   high   momentum   and   isolated   tracks.   The   high   level   trigger   selects   and   stores   those   tracks   in   a   calibration   stream.   Tracks   from   cosmic   trigger   during   empty   LHC   bunches   a...

  3. 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

  4. 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.

  5. 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....

  6. 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....

  7. The latest progress of fission track analysis

    International Nuclear Information System (INIS)

    Wang Shicheng

    1996-01-01

    Fission track analysis as a new nuclear track technique is based on fission track annealing in mineral and is used for oil and gas exploration successfully. The west part of China is the main exploration for oil and gas. The oil and gas basins there experienced much more complicated thermal history and higher paleotemperature. In order to apply fission track analysis to these basins, following work was be carried out: 1. The decomposition of grain age distribution of zircon fission tracks. 2. Study on thermal history of Ordos basin using zircon fission track analysis. 3. The fission track study on the Qiang Tang basin in tibet

  8. 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.

  9. Feature Tracking Using Reeb Graphs

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Gunther H.; Bremer, Peer-Timo; Day, Marcus S.; Bell, John B.; Pascucci, Valerio

    2010-08-02

    Tracking features and exploring their temporal dynamics can aid scientists in identifying interesting time intervals in a simulation and serve as basis for performing quantitative analyses of temporal phenomena. In this paper, we develop a novel approach for tracking subsets of isosurfaces, such as burning regions in simulated flames, which are defined as areas of high fuel consumption on a temperature isosurface. Tracking such regions as they merge and split over time can provide important insights into the impact of turbulence on the combustion process. However, the convoluted nature of the temperature isosurface and its rapid movement make this analysis particularly challenging. Our approach tracks burning regions by extracting a temperature isovolume from the four-dimensional space-time temperature field. It then obtains isosurfaces for the original simulation time steps and labels individual connected 'burning' regions based on the local fuel consumption value. Based on this information, a boundary surface between burning and non-burning regions is constructed. The Reeb graph of this boundary surface is the tracking graph for burning regions.

  10. 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.

  11. 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.

  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. Locomotive track detection for underground

    Science.gov (United States)

    Ma, Zhonglei; Lang, Wenhui; Li, Xiaoming; Wei, Xing

    2017-08-01

    In order to improve the PC-based track detection system, this paper proposes a method to detect linear track for underground locomotive based on DSP + FPGA. Firstly, the analog signal outputted from the camera is sampled by A / D chip. Then the collected digital signal is preprocessed by FPGA. Secondly, the output signal of FPGA is transmitted to DSP via EMIF port. Subsequently, the adaptive threshold edge detection, polar angle and radius constrain based Hough transform are implemented by DSP. Lastly, the detected track information is transmitted to host computer through Ethernet interface. The experimental results show that the system can not only meet the requirements of real-time detection, but also has good robustness.

  14. Fuzzy logic particle tracking velocimetry

    Science.gov (United States)

    Wernet, Mark P.

    1993-01-01

    Fuzzy logic has proven to be a simple and robust method for process control. Instead of requiring a complex model of the system, a user defined rule base is used to control the process. In this paper the principles of fuzzy logic control are applied to Particle Tracking Velocimetry (PTV). Two frames of digitally recorded, single exposure particle imagery are used as input. The fuzzy processor uses the local particle displacement information to determine the correct particle tracks. Fuzzy PTV is an improvement over traditional PTV techniques which typically require a sequence (greater than 2) of image frames for accurately tracking particles. The fuzzy processor executes in software on a PC without the use of specialized array or fuzzy logic processors. A pair of sample input images with roughly 300 particle images each, results in more than 200 velocity vectors in under 8 seconds of processing time.

  15. 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.

  16. 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.

  17. Simultaneous tracking and activity recognition

    DEFF Research Database (Denmark)

    Manfredotti, Cristina Elena; Fleet, David J.; Hamilton, Howard J.

    2011-01-01

    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...... recognition, our framework performs these two tasks simultaneously. In particular, we adopt a Bayesian standpoint where the system maintains a joint distribution of the positions, the interactions and the possible activities. This turns out to be advantegeous, as information about the ongoing activities can...

  18. Stem cell tracking by nanotechnologies.

    Science.gov (United States)

    Villa, Chiara; Erratico, Silvia; Razini, Paola; Fiori, Fabrizio; Rustichelli, Franco; Torrente, Yvan; Belicchi, Marzia

    2010-03-12

    Advances in stem cell research have provided important understanding of the cell biology and offered great promise for developing new strategies for tissue regeneration. The beneficial effects of stem cell therapy depend also by the development of new approachs for the track of stem cells in living subjects over time after transplantation. Recent developments in the use of nanotechnologies have contributed to advance of the high-resolution in vivo imaging methods, including positron emission tomography (PET), single-photon emission tomography (SPECT), magnetic resonance (MR) imaging, and X-Ray computed microtomography (microCT). This review examines the use of nanotechnologies for stem cell tracking.

  19. mechanical sun mechanical sun-tracking techn tracking techn power

    African Journals Online (AJOL)

    User

    Dependent Resistor) as sensors. depends on sunlight intensity (i intensity increases). A 2.5V input resistance varies, the voltage across it v sensor which receives the most light highest output voltage. The sensor u five of such tracking sensors which fixed 36o to each other. The sixth senso feedback sensor is movable and is ...

  20. Track way distance and cover as risk factors for lameness in Danish dairy cows

    DEFF Research Database (Denmark)

    Burow, Elke; Thomsen, Peter Thorup; Rousing, Tine

    2014-01-01

    analysis with a multi-level model structure. The probability for lameness did not change with track distance but increased with no (odds 4.0 times higher) or only partly prepared (odds 3.8 times higher) cover compared to prepared cover. In conclusion, we found that having a cover on the track way......This study investigates the effect of length and cover of track ways between barn and pasture on lameness in Danish dairy cows. We hypothesised that short track distances would be associated with a lower lameness probability of dairy cows compared to longer distances and that track ways...... for their lameness status. The cows were further clinically examined for claw conformation and hock integument. Information on breed and parity per cow and size per herd was extracted from a national data base. Track way distance ranged from 0 to 700 m and was categorised as (1)

  1. Prospective Tracking and Analysis of Traumatic Brain Injury in Veterans and Military Personnel.

    Science.gov (United States)

    Licona, Nytzia E; Chung, Joyce S; Poole, John H; Salerno, Rose M; Laurenson, Nancy M; Harris, Odette A

    2017-02-01

    To describe the ongoing Clinical Tracking Form (CTF) study of the Defense and Veterans Brain Injury Center (DVBIC). Prospective longitudinal study. Data at baseline and postinjury are collected on participants through interview and questionnaire, review of medical records, and periodic follow-ups throughout their lifetime. A regional DVBIC site located at a Veterans Affairs Medical Center. Participants (N=211; age range, 18-75y) were enrolled between January 1, 2005, and December 31, 2012, at a regional DVBIC site. Not applicable. Injury information, functioning, and psychological health. Sixty percent of 211 participants were identified as having severe traumatic brain injuries (TBIs), 14% moderate TBIs, and 26% mild TBIs. Of these 211 participants, 79% sustained closed head injuries, 15% penetrating head injuries, and 6% were not reported. Comparing the severity of TBI in combat versus stateside situations, most of the mild injuries (71%) occurred in combat locations, while most of the severe injuries (62%) occurred in the United States. Among those injured in combat, blast-related TBIs (82%) greatly outnumbered non-blast-related TBIs, regardless of severity. The CTF study serves as a significant resource of data to understand the effect and outcomes of TBI in the military population. The lifelong experience of military veterans across the full spectrum of TBI and recovery will be recorded through the CTF, and will translate into more informed clinical decisions and educational efforts to guide future research pathways. Copyright © 2016 American Congress of Rehabilitation Medicine. All rights reserved.

  2. Particle tracking in the eastern Irish Sea

    Science.gov (United States)

    Wolf, Judith; Amoudry, Karen; Phillips, Hazel; Brown, Jenny

    2017-04-01

    The unstructured grid finite volume community ocean model (FVCOM) has been applied to the west coast of the UK, in order to examine the circulation and transport in the eastern Irish Sea. Tides, freshwater river discharge and meteorological forcing for the year 2008 were used to force the baroclinic hydrodynamic circulation. The hydrodynamics of the Irish Sea are largely governed by the semidiurnal tide, which has a tidal range reaching 10m at Liverpool is the eastern Irish Sea. Tidal currents reach 1 ms-1 over the majority of the area, which means that much of Irish Sea is vertically well-mixed throughout the year period, with a few areas affected by seasonal stratification, such as the cyclonic gyre in the deep channel off Ireland in the western Irish Sea which experiences thermal stratification in summer. In Liverpool Bay, horizontal density gradients, created through freshwater influence from estuaries along the coastline interact with the strong tidal current to produce a phenomenon known as strain-induced periodic stratification (SIPS). There are water quality concerns due to the tendency to eutrophication, as the area is often exposed to industrial pollution and excess nutrients from effluent waters and rivers. There is also concern about the fate of radioactive materials discharged from the Sellafield nuclear reprocessing plant since 1952. In addition to the present discharges from the site, it has been estimated that it is likely that all of the americium and plutonium and around 10% of the caesium entering the Irish Sea were originally assimilated into deposits of silt and mud sediments; this material may be regarded as a considerable potential source of radionuclides. Determining suspended sediment pathways in this region is important in order to identify potential areas vulnerable to deposition of radioactive material, particularly as radionuclide uptake onto sediments takes place in the offshore 'mud patch' before returning to the coast to be deposited

  3. Investigation and Quantification of Water Track Networks in Boreal Regions Using Remote Sensing and Geophysical Data

    Science.gov (United States)

    Mendbayar, U.; Misra, D.; Gupta, T.; Ghosh, T.

    2015-12-01

    Water tracks are the most prominent drainage pathways that route water through the soil over permafrost in the polar environment and thus play a major role in hydrology, geomorphology, and geochemistry of the polar ecosystem. Existing literature on water tracks is limited and is largely confined to tundra areas devoid of vegetation. The objective of this study is to initiate the investigation of water tracks in thickly vegetated boreal regions, many of which contain predominant engineered infrastructures. The ancillary objectives include the development of methods for mapping the distribution of water tracks in boreal regions and a preliminary analysis of the geotechnical impacts of water track interception on infrastructures. The study area is Goldstream Road in Fairbanks, Alaska. This road experiences high amounts of damage, possibly due to interception of prominent water tracks. To investigate the road damage, the Alaska Department of Transportation has collected geophysical data in 2012. We plan to create a water track distribution map around the Goldstream Road using high-spatial-and-spectral-resolution remote sensing imagery and correlate it with the geophysical data from 2012. We have collected ground data from two water tracks: one in a residence in Fairbanks and the other besides the Goldstream Road. The two tracks vary greatly in size and features. Both water tracks revealed different yet quite promising characteristics. These findings will be used to extract other water tracks from remotely sensed images of the Goldstream Road area. So far, a 2010 SPOT 5 image (2.5m x 2.5 m), an aerial orthophoto (14 cm x 14 cm) and a DEM (57 cm x 57 cm) from September 2014 have been acquired. Normalized Difference Vegetation Index (NDVI) processing was performed on the 2010 SPOT 5 image. A detailed water track database was created and water tracks are being manually digitized from the available imagery and Web Mapping Services (WMS). As a test, using FLIR, handheld

  4. Status and perspectives of non invasive cell tracking; Status und Zukunft des nichtinvasiven Zell-Trackings

    Energy Technology Data Exchange (ETDEWEB)

    Kiessling, F.; Semmler, W. [Abt. Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg (Germany)

    2005-07-01

    The interaction of different cells is an important regulator in the development of many diseases, including cancer. Some cells are recruited directly from the local tissue environment, others reach the pathological focus via the circulation. Using non-invasive cell tracking methods, the distribution and migration of labeled cells can be studied in experimental animal models, and the role of these cells on the pathogenesis of disease can thus be elucidated. Scintigraphy and SPECT, and especially MRI and optical imaging, are frequently used for this purpose. Studies are mostly performed with macrophages and granulocytes (inflammatory cells), which accumulate in nephritis, encephalitis, and tumors. At present, the understanding of progenitor cell migration and differentiation is gaining increasing interest in neurological disorders (for example Parkinson's disease) and in cardiac diseases (for example myocardial infarction). Non-invasive cell tracking is already established in basic research; in the future, a clinical application of cell tracking is foreseeable in the framework of cell therapy. (orig.)

  5. The study of nuclear tracks in crystals

    International Nuclear Information System (INIS)

    Perelygin, V.P.

    1993-01-01

    The problem of fast heavy nuclei track registration and track stability in natural and artificial crystals is generally discussed in the frame of four - zone model of tracks, first suggested in 1972. The results on sensitivity calibrations of the crystals, the efficiency of particle registration, the sources of background, the thermal stability of latent tracks, the uranium content in crystals are reviewed. The data on tracks age and fossil galactic cosmic ray nuclei tracks in crystals provide a very important information about the nucleosynthesis processes in our Galaxy, about the history of the Earth and about the charge and energy spectra of cosmic ray nuclei with Z > 26 averaged over time intervals up to 200 M.Y. The dependence of volume etchable track length (VETL) on threshold annealing procedure and track orientation in crystal lattice suppose to be very important for fossil and fresh track studies. (Author)

  6. Status and perspectives of non invasive cell tracking

    International Nuclear Information System (INIS)

    Kiessling, F.; Semmler, W.

    2005-01-01

    The interaction of different cells is an important regulator in the development of many diseases, including cancer. Some cells are recruited directly from the local tissue environment, others reach the pathological focus via the circulation. Using non-invasive cell tracking methods, the distribution and migration of labeled cells can be studied in experimental animal models, and the role of these cells on the pathogenesis of disease can thus be elucidated. Scintigraphy and SPECT, and especially MRI and optical imaging, are frequently used for this purpose. Studies are mostly performed with macrophages and granulocytes (inflammatory cells), which accumulate in nephritis, encephalitis, and tumors. At present, the understanding of progenitor cell migration and differentiation is gaining increasing interest in neurological disorders (for example Parkinson's disease) and in cardiac diseases (for example myocardial infarction). Non-invasive cell tracking is already established in basic research; in the future, a clinical application of cell tracking is foreseeable in the framework of cell therapy. (orig.)

  7. AGATA - Advanced GAmma Tracking Array

    Energy Technology Data Exchange (ETDEWEB)

    Akkoyun, S. [Department of Physics, Faculty of Science, Ankara University, 06100 Tandogan, Ankara (Turkey); Algora, A. [IFIC, CSIC-Universitat de Valencia, E-46980 Paterna (Spain); Alikhani, B. [IKP, TU Darmstadt, Schlossgartenstrasse 9, D-64289 Darmstadt (Germany); Ameil, F. [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, D-64291 Darmstadt (Germany); Angelis, G. de [INFN Laboratori Nazionali di Legnaro, IT-35020 Padova (Italy); Arnold, L. [Universite de Strasbourg, IPHC, 23 rue du Loess, 67037 Strasbourg (France); CNRS, UMR 7178, 67037 Strasbourg (France); Astier, A. [CSNSM, CNRS, IN2P3, Universite Paris-Sud, F-91405 Orsay (France); Atac, A. [Department of Physics, Faculty of Science, Ankara University, 06100 Tandogan, Ankara (Turkey); Department of Physics and Astronomy, Uppsala University, Uppsala (Sweden); Royal Institute of Technology, SE-10691 Stockholm (Sweden); Aubert, Y. [IPNO, CNRS/IN2P3, Universite Paris-Sud, F-91406 Orsay (France); Aufranc, C. [Universite de Lyon, Universite Lyon 1, CNRS-IN2P3, Institut de Physique Nucleaire de Lyon, F-69622 Villeurbanne (France); Austin, A. [STFC Daresbury Laboratory, Daresbury, Warrington WA4 4AD (United Kingdom); Aydin, S. [INFN Sezione di Padova, IT-35131 Padova (Italy); Azaiez, F. [IPNO, CNRS/IN2P3, Universite Paris-Sud, F-91406 Orsay (France); Badoer, S. [INFN Laboratori Nazionali di Legnaro, IT-35020 Padova (Italy); Balabanski, D.L. [Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, Sofia (Bulgaria); Barrientos, D. [IFIC, CSIC-Universitat de Valencia, E-46980 Paterna (Spain); and others

    2012-03-11

    The Advanced GAmma Tracking Array (AGATA) is a European project to develop and operate the next generation {gamma}-ray spectrometer. AGATA is based on the technique of {gamma}-ray energy tracking in electrically segmented high-purity germanium crystals. This technique requires the accurate determination of the energy, time and position of every interaction as a {gamma} ray deposits its energy within the detector volume. Reconstruction of the full interaction path results in a detector with very high efficiency and excellent spectral response. The realisation of {gamma}-ray tracking and AGATA is a result of many technical advances. These include the development of encapsulated highly segmented germanium detectors assembled in a triple cluster detector cryostat, an electronics system with fast digital sampling and a data acquisition system to process the data at a high rate. The full characterisation of the crystals was measured and compared with detector-response simulations. This enabled pulse-shape analysis algorithms, to extract energy, time and position, to be employed. In addition, tracking algorithms for event reconstruction were developed. The first phase of AGATA is now complete and operational in its first physics campaign. In the future AGATA will be moved between laboratories in Europe and operated in a series of campaigns to take advantage of the different beams and facilities available to maximise its science output. The paper reviews all the achievements made in the AGATA project including all the necessary infrastructure to operate and support the spectrometer.

  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. 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...

  10. Siamese Instance Search for Tracking

    NARCIS (Netherlands)

    Tao, R.; Gavves, E.; Smeulders, A.W.M.

    2016-01-01

    In this paper we present a tracker, which is radically different from state-of-the-art trackers: we apply no model updating, no occlusion detection, no combination of trackers, no geometric matching, and still deliver state-of-the-art tracking performance, as demonstrated on the popular online

  11. Bubble chamber: colour enhanced tracks

    CERN Document Server

    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.

  12. 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 combin...

  13. Tracking and vertexing at ATLAS

    OpenAIRE

    Ferrari, Pamela

    2007-01-01

    Several algorithms for tracking and for primary and secondary vertex reconstruction have been developed by the ATLAS collaboration following different approaches. This has allowed a thorough cross-check of the performances of the algorithms and of the reconstruction software. The results of the most recent studies on this topic are discussed and compared.

  14. 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

  15. 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.

  16. 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…

  17. The GEM Silicon Tracking System

    International Nuclear Information System (INIS)

    Mills, G.B.

    1993-01-01

    The GEM Collaboration has produced a baseline design for the GEM detector. The baseline design of the GEM Silicon Tracking System (STS) is discussed in this article. Mechanical and electrical engineering progress on the GEM STS is described. Results from simulations of detector performance and the implications on engineering issues are described

  18. 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...

  19. 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.

  20. 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

  1. Students paperwork tracking system (SPATRASE)

    Science.gov (United States)

    Ishak, I. Y.; Othman, M. B.; Talib, Rahmat; Ilyas, M. A.

    2017-09-01

    This paper focused on a system for tracking the status of the paperwork using the Near Field Communication (NFC) technology and mobile apps. Student paperwork tracking system or known as SPATRASE was developed to ease the user to track the location status of the paperwork. The current problem faced by the user is the process of approval paperwork takes around a month or more. The process took around a month to get full approval from the department because of many procedures that need to be done. Nevertheless, the user cannot know the location status of the paperwork immediately because of the inefficient manual system. The submitter needs to call the student affairs department to get the information about the location status of the paperwork. Thus, this project was purposed as an alternative to solve the waiting time of the paperwork location status. The prototype of this system involved the hardware and software. The project consists of NFC tags, RFID Reader, and mobile apps. At each checkpoint, the RFID Reader was placed on the secretary desk. While the system involved the development of database using Google Docs that linked to the web server. After that, the submitter received the URL link and be directed to the web server and mobile apps. This system is capable of checking their location status tracking using mobile apps and Google Docs. With this system, it makes the tracking process become efficient and reliable to know the paperwork at the exact location. Thus, it is preventing the submitter to call the department all the time. Generally, this project is fully functional and we hope it can help Universiti Tun Hussein Onn Malaysia (UTHM) to overcome the problem of paperwork missing and location of the paperwork.

  2. De-identification of psychiatric intake records: Overview of 2016 CEGS N-GRID shared tasks Track 1.

    Science.gov (United States)

    Stubbs, Amber; Filannino, Michele; Uzuner, Özlem

    2017-11-01

    The 2016 CEGS N-GRID shared tasks for clinical records contained three tracks. Track 1 focused on de-identification of a new corpus of 1000 psychiatric intake records. This track tackled de-identification in two sub-tracks: Track 1.A was a "sight unseen" task, where nine teams ran existing de-identification systems, without any modifications or training, on 600 new records in order to gauge how well systems generalize to new data. The best-performing system for this track scored an F1 of 0.799. Track 1.B was a traditional Natural Language Processing (NLP) shared task on de-identification, where 15 teams had two months to train their systems on the new data, then test it on an unannotated test set. The best-performing system from this track scored an F1 of 0.914. The scores for Track 1.A show that unmodified existing systems do not generalize well to new data without the benefit of training data. The scores for Track 1.B are slightly lower than the 2014 de-identification shared task (which was almost identical to 2016 Track 1.B), indicating that these new psychiatric records pose a more difficult challenge to NLP systems. Overall, de-identification is still not a solved problem, though it is important to the future of clinical NLP. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Vehicle Tracking System, Vehicle Infrastructure Provided with Vehicle Tracking System and Method for Tracking

    NARCIS (Netherlands)

    Papp, Z.; Doodeman, G.J.N.; Nelisse, M.W.; Sijs, J.; Theeuwes, J.A.C.; Driessen, B.J.F.

    2010-01-01

    A vehicle tracking system is described comprising - a plurality of sensor nodes (10) that each provide a message (D) indicative for an occupancy status of a detection area of an vehicle infrastructure monitored by said sensor node, said sensor nodes (10) being arranged in the vehicle infrastructure

  4. Speckle tracking echocardiography in mature Irish Wolfhound dogs

    DEFF Research Database (Denmark)

    Westrup, Ulrik; McEvoy, Fintan

    2013-01-01

    Two-dimensional strain measurements obtained by speckle tracking echocardiography (STE) have been reported in both humans and dogs. Incorporation of this technique into canine clinical practice requires the availability of measurements from clinically normal dogs, ideally of the same breed, taken...... under normal clinical conditions.The aims of this prospective study were to assess if it is possible to obtain STE data during a routine echocardiographic examination in Irish Wolfhound dogs and that these data will provide reference values and an estimation of measurement error....

  5. Comparing eye movements during position tracking and identity tracking: No evidence for separate systems.

    Science.gov (United States)

    Wu, Chia-Chien; Wolfe, Jeremy M

    2018-02-01

    There is an ongoing debate as to whether people track multiple moving objects in a serial fashion or with a parallel mechanism. One recent study compared eye movements when observers tracked identical objects (Multiple Object Tracking-MOT task) versus when they tracked the identities of different objects (Multiple Identity Tracking-MIT task). Distinct eye-movement patterns were found and attributed to two separate tracking systems. However, the same results could be caused by differences in the stimuli viewed during tracking. In the present study, object identities in the MIT task were invisible during tracking, so observers performed MOT and MIT tasks with identical stimuli. Observer were able to track either position and identity depending on the task. There was no difference in eye movements between position tracking and identity tracking. This result suggests that, while observers can use different eye-movement strategies in MOT and MIT, it is not necessary.

  6. The relationship between fission track length and track density in apatite

    International Nuclear Information System (INIS)

    Laslett, G.M.; Gleadow, A.J.W.; Duddy, I.R.

    1984-01-01

    Fission track dating is based upon an age equation derived from a random line segment model for fission tracks. This equation contains the implicit assumption of a proportional relationship between the true mean length of fission tracks and their track density in an isotropic medium. Previous experimental investigation of this relationship for both spontaneous and induced tracks in apatite during progressive annealment model in an obvious fashion. Corrected equations relating track length and density for apatite, an anisotropic mineral, show that the proportionality in this case is between track density and a length factor which is a generalization of the mean track length combining the actual length and crystallographic orientation of the track. This relationship has been experimentally confirmed for induced tracks in Durango apatite, taking into account bias in sampling of the track lengths, and the effect of the bulk etching velocity. (author)

  7. Knowledge as Fact-Tracking True Belief

    Directory of Open Access Journals (Sweden)

    Fred Adams

    Full Text Available ABSTRACT Drawing inspiration from Fred Dretske, L. S. Carrier, John A. Barker, and Robert Nozick, we develop a tracking analysis of knowing according to which a true belief constitutes knowledge if and only if it is based on reasons that are sensitive to the fact that makes it true, that is, reasons that wouldn’t obtain if the belief weren’t true. We show that our sensitivity analysis handles numerous Gettier-type cases and lottery problems, blocks pathways leading to skepticism, and validates the epistemic closure thesis that correct inferences from known premises yield knowledge of the conclusions. We discuss the plausible views of Ted Warfield and Branden Fitelson regarding cases of knowledge acquired via inference from false premises, and we show how our sensitivity analysis can account for such cases. We present arguments designed to discredit putative counterexamples to sensitivity analyses recently proffered by Tristan Haze, John Williams and Neil Sinhababu, which involve true statements made by untrustworthy informants and strange clocks that sometimes display the correct time while running backwards. Finally, we show that in virtue of employing the paradox-free subjunctive conditionals codified by Relevance Logic theorists instead of the paradox-laden subjunctive conditionals codified by Robert Stalnaker and David Lewis.

  8. Single Molecule Analysis of Resection Tracks.

    Science.gov (United States)

    Huertas, Pablo; Cruz-García, Andrés

    2018-01-01

    Homologous recombination is initiated by the so-called DNA end resection, the 5'-3' nucleolytic degradation of a single strand of the DNA at each side of the break. The presence of resected DNA is an obligatory step for homologous recombination. Moreover, the amount of resected DNA modulates the prevalence of different recombination pathways. In different model organisms, there are several published ways to visualize and measure with more or less detail the amount of DNA resected. In human cells, however, technical constraints hampered the study of resection at high resolution. Some information might be gathered from the study of endonuclease-created DSBs, in which the resection of breaks at known sites can be followed by PCR or ChIP. In this chapter, we describe in detail a novel assay to study DNA end resection in breaks located on unknown positions. Here, we use ionizing radiation to induce double-strand breaks, but the same approach can be used to monitor resection induced by different DNA damaging agents. By modifying the DNA-combing technique, used for high-resolution replication analyses, we can measure resection progression at the level of individual DNA fibers. Thus, we named the method Single Molecule Analysis of Resection Tracks (SMART). We use human cells in culture as a model system, but in principle the same approach would be feasible to any model organism adjusting accordingly the DNA isolation part of the protocol.

  9. Tracking the allocation of attention using human pupillary oscillations

    Directory of Open Access Journals (Sweden)

    Marnix eNaber

    2013-12-01

    Full Text Available The muscles that control the pupil are richly innervated by the autonomic nervous system. While there are central pathways that drive pupil dilations in relation to arousal, there is no anatomical evidence that cortical centers involved with visual selective attention innervate the pupil. In this study, we show that such connections must exist. Specifically, we demonstrate a novel Pupil Frequency Tagging (PFT method, where oscillatory changes in stimulus brightness over time are mirrored by pupil constrictions and dilations. We find that the luminance induced pupil oscillations are enhanced when covert attention is directed to the flicker stimulus and when targets are correctly detected in an attentional tracking task. These results suggest that the amplitudes of pupil responses closely follow the allocation of focal visual attention and the encoding of stimuli. PFT provides a new opportunity to study top down visual attention itself as well as identifying the pathways and mechanisms that support this unexpected phenomenon.

  10. VT - Environmental Public Health Tracking Data Explorer

    Data.gov (United States)

    Vermont Center for Geographic Information — What is Environmental Public Health Tracking?Tracking is an ongoing national effort to better understand how environmental hazards can contribute to certain...

  11. Percentage of Fast-Track Receipts

    Data.gov (United States)

    Social Security Administration — The dataset provides the percentage of fast-track receipts by state during the reporting fiscal year. Fast-tracked cases consist of those cases identified as Quick...

  12. Detection and Tracking as a Seamless Process

    National Research Council Canada - National Science Library

    Stone, Lawrence

    2004-01-01

    ...., bearing, position, or velocity. This estimate (contact) is sent to a tracking system that determines whether the contact should be associated with an existing track or used to generate a new one...

  13. Audit Follow-up Tracking System (AFTS)

    Data.gov (United States)

    Office of Personnel Management — The Audit Follow-up Tracking System (AFTS) is used to track, monitor, and report on audits and open recommendations of the U.S. Office of Personnel Management (OPM)...

  14. Real Property Project Tracking System (RPPTS)

    Data.gov (United States)

    Department of Veterans Affairs — The Real Property Project Tracking System (RPPTS), formerly known as the Lease/Project Tracking (LEASE) database, contains information about lease and land projects...

  15. Oil Spill Incident Tracking [ds394

    Data.gov (United States)

    California Department of Resources — The Office of Spill Prevention and Response (OSPR) Incident Tracking Database is a statewide oil spill tracking information system. The data are collected by OSPR...

  16. GRIP FLIGHT TRACKS AND ANIMATIONS V1

    Data.gov (United States)

    National Aeronautics and Space Administration — The GRIP Flight Tracks and Animations dataset includes both KML files and animation files. The KML files use Google Earth to show the flight tracks on a map. The...

  17. Keeping Track of Your Blood Sugar

    Science.gov (United States)

    ... Search English Español Keeping Track of Your Blood Sugar KidsHealth / For Teens / Keeping Track of Your Blood ... levels regularly. Why Should I Check My Blood Sugar Levels? Keeping an eye on blood sugar levels ...

  18. LATTE - Log and Time Tracking for Elections

    Data.gov (United States)

    Office of Personnel Management — LATTE - Log and Time Tracking for Elections is a time tracking and voucher preparation system used to schedule employees to cover elections, to document their time...

  19. Optimization Problems in Multitarget/Multisensor Tracking

    National Research Council Canada - National Science Library

    Poore, Aubrey

    1997-01-01

    The ever-increasing demand in surveillance is to produce highly accurate target and track identification and estimation in real-time, even for dense target scenarios and in regions of high track contention...

  20. Oil Spill Incident Tracking [ds394

    Data.gov (United States)

    California Natural Resource Agency — The Office of Spill Prevention and Response (OSPR) Incident Tracking Database is a statewide oil spill tracking information system. The data are collected by OSPR...