Actor and partner effects of coping on adjustment in couples undergoing assisted reproduction treatment

Directory of Open Access Journals (Sweden)

Aleksandra Kroemeke

2017-06-01

Full Text Available Background Infertility is a shared experience as it affects both partners. However, mutual dependencies between coping and adjustment at the couple level remain to be fully elucidated. The study attempted to address this issue using the Actor-Partner Interdependence Model (APIM to examine the actor effect (the extent to which an individual’s score on coping predicted their own level of depressive symptoms and life purpose and the partner effect (the extent to which an individual’s score on coping predicted the level of adjustment in the partner in couples undergoing assisted reproduction treatment (ART. Participants and procedure Coping strategies, depressive symptoms, and life purpose were assessed among 31 married couples (aged 27-38 years undergoing ART. The Brief COPE, CES-D, and PIL questionnaires were used. Data were analyzed by multilevel modeling (MLM. Results The results of MLM indicated that focus on positive and active coping had an actor effect with depressive symptoms and life purpose, respectively. The actor effect of evasive coping on depression was moderated by gender and significant only in women. The partner effect was demonstrated for evasive coping, social support seeking, and substance use – the first two were gender moderated and significant in men. Conclusions Coping efforts in the couple during infertility treatment are not only associated with the individual but also the partner’s adjustment to that situation. Although the focus on positive and active coping was associated with individual benefits, other coping strategies which have the function of a protective buffer may also result in the occurrence of side effects, especially in females.

Adjusted drug treatment is superior to renal sympathetic denervation in patients with true treatment-resistant hypertension.

Science.gov (United States)

Fadl Elmula, Fadl Elmula M; Hoffmann, Pavel; Larstorp, Anne C; Fossum, Eigil; Brekke, Magne; Kjeldsen, Sverre E; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjaer, Vibeke N; Rostrup, Morten; Os, Ingrid; Stenehjem, Aud; Høieggen, Aud

2014-05-01

We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10). The study was stopped early for ethical reasons because RDN had uncertain BP-lowering effect. Office SBP and diastolic BP in the drug-adjusted group changed from 160±14/88±13 mm Hg (±SD) at baseline to 132±10/77±8 mm Hg at 6 months (P<0.0005 and P=0.02, SBP and diastolic BP, respectively) and in the RDN group from 156±13/91±15 to 148±7/89±8 mm Hg (P=0.42 and P=0.48, SBP and diastolic BP, respectively). SBP and diastolic BP were significantly lower in the drug-adjusted group at 6 months (P=0.002 and P=0.004, respectively), and absolute changes in SBP were larger in the drug-adjusted group (P=0.008). Ambulatory BPs changed in parallel to office BPs. Our data suggest that adjusted drug treatment has superior BP lowering effects compared with RDN in patients with true TRH. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.

Siblings' Perceptions of Differential Treatment, Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model.

Science.gov (United States)

Loeser, Meghan K; Whiteman, Shawn D; McHale, Susan M

2016-08-01

Youth's perception of parents' differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth's maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth's depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth's perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings ( M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (-1 SD ) and average levels of fairness. At high levels of fairness (+1 SD ) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair, and in turn mitigating sibling jealousy and maladjustment.

Siblings’ Perceptions of Differential Treatment, Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model

Science.gov (United States)

Loeser, Meghan K.; Whiteman, Shawn D.; McHale, Susan M.

2016-01-01

Youth's perception of parents’ differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth's maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth's depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth's perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings (M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (−1 SD) and average levels of fairness. At high levels of fairness (+1 SD) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair, and in turn mitigating sibling jealousy and maladjustment. PMID:27867295

Army ants dynamically adjust living bridges in response to a cost-benefit trade-off.

Science.gov (United States)

Reid, Chris R; Lutz, Matthew J; Powell, Scott; Kao, Albert B; Couzin, Iain D; Garnier, Simon

2015-12-08

The ability of individual animals to create functional structures by joining together is rare and confined to the social insects. Army ants (Eciton) form collective assemblages out of their own bodies to perform a variety of functions that benefit the entire colony. Here we examine ‟bridges" of linked individuals that are constructed to span gaps in the colony's foraging trail. How these living structures adjust themselves to varied and changing conditions remains poorly understood. Our field experiments show that the ants continuously modify their bridges, such that these structures lengthen, widen, and change position in response to traffic levels and environmental geometry. Ants initiate bridges where their path deviates from their incoming direction and move the bridges over time to create shortcuts over large gaps. The final position of the structure depended on the intensity of the traffic and the extent of path deviation and was influenced by a cost-benefit trade-off at the colony level, where the benefit of increased foraging trail efficiency was balanced by the cost of removing workers from the foraging pool to form the structure. To examine this trade-off, we quantified the geometric relationship between costs and benefits revealed by our experiments. We then constructed a model to determine the bridge location that maximized foraging rate, which qualitatively matched the observed movement of bridges. Our results highlight how animal self-assemblages can be dynamically modified in response to a group-level cost-benefit trade-off, without any individual unit's having information on global benefits or costs.

8 CFR 1244.5 - Temporary treatment benefits for eligible aliens.

Science.gov (United States)

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Temporary treatment benefits for eligible aliens. 1244.5 Section 1244.5 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT... § 1244.5 Temporary treatment benefits for eligible aliens. (a) Prior to the registration period. Prior to...

Covariate Imbalance and Adjustment for Logistic Regression Analysis of Clinical Trial Data

Science.gov (United States)

Ciolino, Jody D.; Martin, Reneé H.; Zhao, Wenle; Jauch, Edward C.; Hill, Michael D.; Palesch, Yuko Y.

2014-01-01

In logistic regression analysis for binary clinical trial data, adjusted treatment effect estimates are often not equivalent to unadjusted estimates in the presence of influential covariates. This paper uses simulation to quantify the benefit of covariate adjustment in logistic regression. However, International Conference on Harmonization guidelines suggest that covariate adjustment be pre-specified. Unplanned adjusted analyses should be considered secondary. Results suggest that that if adjustment is not possible or unplanned in a logistic setting, balance in continuous covariates can alleviate some (but never all) of the shortcomings of unadjusted analyses. The case of log binomial regression is also explored. PMID:24138438

Adjusting slash pine growth and yield for silvicultural treatments

Science.gov (United States)

Stephen R. Logan; Barry D. Shiver

2006-01-01

With intensive silvicultural treatments such as fertilization and competition control now commonplace in today's slash pine (Pinus elliottii Engelm.) plantations, a method to adjust current growth and yield models is required to accurately account for yield increases due to these practices. Some commonly used ad-hoc methods, such as raising site...

A Threshold Model of Social Support, Adjustment, and Distress after Breast Cancer Treatment

Science.gov (United States)

Mallinckrodt, Brent; Armer, Jane M.; Heppner, P. Paul

2012-01-01

This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support…

A novel method to adjust efficacy estimates for uptake of other active treatments in long-term clinical trials.

Directory of Open Access Journals (Sweden)

John Simes

2010-01-01

Full Text Available When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials.We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction (P = 0.16 and an 11% reduction in cardiovascular disease events (P = 0.04. After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06 and 15% (P = 0.008, respectively.This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence-based estimates for other therapies, preserves comparisons between the

Incorporating indirect costs into a cost-benefit analysis of laparoscopic adjustable gastric banding.

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Finkelstein, Eric A; Allaire, Benjamin T; Dibonaventura, Marco Dacosta; Burgess, Somali M

2012-01-01

The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States: The quality-adjusted cost of care.

Science.gov (United States)

Younossi, Zobair M; Park, Haesuk; Dieterich, Douglas; Saab, Sammy; Ahmed, Aijaz; Gordon, Stuart C

2016-10-01

New direct-acting antiviral (DAA) therapy has dramatically increased cure rates for patients infected with hepatitis C virus (HCV), but has also substantially raised treatment costs. The aim of this analysis was to evaluate the therapeutic benefit and net costs (i.e. efficiency frontier) and the quality-adjusted cost of care associated with the evolution of treatment regimens for patients with HCV genotype 1 in the United States. A decision-analytic Markov model. Published literature and clinical trial data. Life Time. Third-party payer. This study compared four approved regimens in treatment-naïve genotype 1 chronic hepatitis C patients, including pegylated interferon and ribavirin (PR), first generation triple therapy (boceprevir + PR and telaprevir + PR), second generation triple therapy (sofosbuvir + PR and simeprevir + PR) and all-oral DAA regimens (ledipasvir/sofosbuvir and ombitasvir + paritaprevir/ritonavir + dasabuvir ± ribavirin). Quality-adjusted cost of care (QACC). QACC was defined as the increase in treatment cost minus the increase in the patient's quality-adjusted life years (QALYs) when valued at $50,000 per QALY. All-oral therapy improved the average sustained virologic response (SVR) rate to 96%, thereby offsetting the high drug acquisition cost of $85,714, which resulted in the highest benefit based on the efficiency frontier. Furthermore, while oral therapies increased HCV drug costs by $48,350, associated QALY gains decreased quality-adjusted cost of care by $14,120 compared to dual therapy. When the value of a QALY was varied from $100,000 to $300,000, the quality adjusted cost of care compared to dual therapy ranged from - $21,234 to - $107,861, - $89,007 to - $293,130, - $176,280 to - $500,599 for first generation triple, second generation triple, and all-oral therapies, respectively. Primary efficacy and safety measurements for drug regimens were sourced from clinical trials data rather than a real

The proposed 'concordance-statistic for benefit' provided a useful metric when modeling heterogeneous treatment effects.

Science.gov (United States)

van Klaveren, David; Steyerberg, Ewout W; Serruys, Patrick W; Kent, David M

2018-02-01

Clinical prediction models that support treatment decisions are usually evaluated for their ability to predict the risk of an outcome rather than treatment benefit-the difference between outcome risk with vs. without therapy. We aimed to define performance metrics for a model's ability to predict treatment benefit. We analyzed data of the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial and of three recombinant tissue plasminogen activator trials. We assessed alternative prediction models with a conventional risk concordance-statistic (c-statistic) and a novel c-statistic for benefit. We defined observed treatment benefit by the outcomes in pairs of patients matched on predicted benefit but discordant for treatment assignment. The 'c-for-benefit' represents the probability that from two randomly chosen matched patient pairs with unequal observed benefit, the pair with greater observed benefit also has a higher predicted benefit. Compared to a model without treatment interactions, the SYNTAX score II had improved ability to discriminate treatment benefit (c-for-benefit 0.590 vs. 0.552), despite having similar risk discrimination (c-statistic 0.725 vs. 0.719). However, for the simplified stroke-thrombolytic predictive instrument (TPI) vs. the original stroke-TPI, the c-for-benefit (0.584 vs. 0.578) was similar. The proposed methodology has the potential to measure a model's ability to predict treatment benefit not captured with conventional performance metrics. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimism, Social Support, and Adjustment in African American Women with Breast Cancer

Science.gov (United States)

Shelby, Rebecca A.; Crespin, Tim R.; Wells-Di Gregorio, Sharla M.; Lamdan, Ruth M.; Siegel, Jamie E.; Taylor, Kathryn L.

2013-01-01

Past studies show that optimism and social support are associated with better adjustment following breast cancer treatment. Most studies have examined these relationships in predominantly non-Hispanic White samples. The present study included 77 African American women treated for nonmetastatic breast cancer. Women completed measures of optimism, social support, and adjustment within 10-months of surgical treatment. In contrast to past studies, social support did not mediate the relationship between optimism and adjustment in this sample. Instead, social support was a moderator of the optimism-adjustment relationship, as it buffered the negative impact of low optimism on psychological distress, well-being, and psychosocial functioning. Women with high levels of social support experienced better adjustment even when optimism was low. In contrast, among women with high levels of optimism, increasing social support did not provide an added benefit. These data suggest that perceived social support is an important resource for women with low optimism. PMID:18712591

Counting the cost: estimating the economic benefit of pedophile treatment programs.

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Shanahan, M; Donato, R

2001-04-01

The principal objective of this paper is to identify the economic costs and benefits of pedophile treatment programs incorporating both the tangible and intangible cost of sexual abuse to victims. Cost estimates of cognitive behavioral therapy programs in Australian prisons are compared against the tangible and intangible costs to victims of being sexually abused. Estimates are prepared that take into account a number of problematic issues. These include the range of possible recidivism rates for treatment programs; the uncertainty surrounding the number of child sexual molestation offences committed by recidivists; and the methodological problems associated with estimating the intangible costs of sexual abuse on victims. Despite the variation in parameter estimates that impact on the cost-benefit analysis of pedophile treatment programs, it is found that potential range of economic costs from child sexual abuse are substantial and the economic benefits to be derived from appropriate and effective treatment programs are high. Based on a reasonable set of parameter estimates, in-prison, cognitive therapy treatment programs for pedophiles are likely to be of net benefit to society. Despite this, a critical area of future research must include further methodological developments in estimating the quantitative impact of child sexual abuse in the community.

Adjustments to financial benefits and contributions with effect from 1 January 2012

CERN Multimedia

2012-01-01

In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2010, June and December 2011, certain financial benefits and contributions impacting salaries and stipends have been adjusted with effect from 1 January 2012. 1)  Five-yearly review 2010 (decisions taken by Council in December 2010) In line with the second phase of Council decisions, increases of 1% and 2% have been applied to basic salaries in Career Path D and Career Paths E to G respectively1); In addition, Health Insurance Scheme contribution rates have been modified (from 4.27%) to 4.41% for the member and (from 6.59%) to 6.86% for the Organization. 2)  Package of measures towards restoring full funding of the Pension Fund (decisions taken by Council in June 2011) In accordance with Council decisions, the Organization’s contribution rate for new members of the Fund as of 1.1.2012 is 17%.  The provisions for current members remain unchanged. 3)&nb...

Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

Science.gov (United States)

Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

2000-04-01

To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the production of bromate. We applied clinical, epidemiologic, and toxicologic data on morbidity and mortality to calculate the net health benefit in DALYs. We estimated the median risk of infection with C. parvum as 10(-3)/person-year. Ozonation reduces the median risk in the baseline approximately 7-fold, but bromate is produced in a concentration above current guideline levels. However, the health benefits of preventing gastroenteritis in the general population and premature death in patients with acquired immunodeficiency syndrome outweigh health losses by premature death from renal cell cancer by a factor of > 10. The net benefit is approximately 1 DALY/million person-years. The application of DALYs in principle allows us to more explicitly compare the public health risks and benefits of different management options. In practice, the application of DALYs may be hampered by the substantial degree of uncertainty, as is typical for risk assessment.

A Longitudinal Examination of Couples’ Coping Strategies as Predictors of Adjustment to Breast Cancer

Science.gov (United States)

Kraemer, Lia M.; Stanton, Annette L.; Meyerowitz, Beth E.; Rowland, Julia H.; Ganz, Patricia A.

2011-01-01

This study’s goals were to examine coping strategies of women and their male partners as predictors of change in women’s adjustment over the year following breast cancer treatment and to test whether partners’ coping processes interact to predict adjustment. In a sample of women who had recently completed breast cancer treatment and were taking part in a psychoeducational intervention trial and their partners, patients’ and partners’ cancer-specific coping strategies were assessed at study entry (average of 10 months after diagnosis). Assessed at study entry and 20 months after diagnosis (n = 139 couples), dependent variables were women’s general (i.e., vitality, depressive symptoms, relationship satisfaction) and cancer-specific adjustment (i.e., cancer-specific distress, perceived benefits). Both patients’ and partners’ coping strategies at study entry predicted change in women’s adjustment at 20 months. Women’s use of approach-oriented coping strategies predicted improvement in their vitality and depressive symptoms, men’s use of avoidant coping predicted declining marital satisfaction for wives, and men’s approach-oriented strategies predicted an increase in women’s perception of cancer-related benefits. Patients’ and partners’ coping strategies also interacted to predict adjustment, such that congruent coping strategy use generally predicted better adaptation than did dissimilar coping. Findings highlight the utility of examining patients’ and partners’ coping strategies simultaneously. PMID:21928887

The outcome of adjusted accumulation dose of treatment of Graves' disease

International Nuclear Information System (INIS)

Gomi, Yukari; Inoue, Takeshi; Suzuki, Seiji; Hamada, Noboru; Yoshimura, Hiroshi; Ishikawa, Naofumi; Momotani, Naoko; Ito, Kunihiko.

1997-01-01

We evaluated the outcome of 131 I treatment of Graves' disease in two different protocols (old and new protocol) of adjusted accumulation dose from 1988 to 1995. Adjusted accumulation doses of patients with above 50 g thyroid weights were increased by 5-20 Gy/g tissue in new protocol compared to those in old one. In 166 patients treated with single and plural doses of 131 I treatment in 1990 (Group In), the therapeutic doses were calculated according to new protocol and in 130 patients in 1988 (Group Io), according to old one, modification of Quimby's formula. The patients treated with plural doses were classified as hyperthyroidism because the efficacies of the first treatments with 131 I were insufficient. At the 5-yr follow up, the incidence of hypothyroid in Group In was 9%, subclinical hypothyroid 17%, euthyroid 30%, subclinical hyperthyroid 7%, hyperthyroid 37%. In Group Io, 11% of the patients were hypothyroid, 6% subclinical hypothyroid, 29% euthyroid, 3% subclinical hyperthyroid, 51% hyperthyroid. The incidence of hyperthyroid in Group In was lower than that in Group Io (p 131 I in relation to the patients' thyroid weight shows some room for improvement. (author)

Longitudinal associations between sibling relationship quality, parental differential treatment, and children's adjustment.

Science.gov (United States)

Richmond, Melissa K; Stocker, Clare M; Rienks, Shauna L

2005-12-01

This study examined associations between changes in sibling relationships and changes in parental differential treatment and corresponding changes in children's adjustment. One hundred thirty-three families were assessed at 3 time points. Parents rated children's externalizing problems, and children reported on sibling relationship quality, parental differential treatment, and depressive symptoms. On average, older siblings were 10, 12, and 16 years old, and younger siblings were 8, 10, and 14 years old at Waves 1, 2, and 3, respectively. Results from hierarchical linear modeling indicated that as sibling relationships improved over time, children's depressive symptoms decreased over time. In addition, as children were less favored over their siblings over time, children's externalizing problems increased over time. Findings highlight the developmental interplay between the sibling context and children's adjustment. Copyright 2006 APA, all rights reserved).

Methodology of adjustment point in the post treatment of gaseous effluents

International Nuclear Information System (INIS)

Vizuet G, J.; Molina, G.

2005-01-01

The methodology to determine the adjustment points of the monitoring system of gaseous discharges is based on the stipulations of the 10CFR20, which are expressed in terms of limit concentrations for the outstanding radionuclides, and of dose limits for the individuals members of the public. Besides the points of liberation properly said, like they are the chimneys of the reactor buildings and of turbine, the points of adjustment of the monitoring instrumentation that watches in real time the discharge of the Treatment system of output gases, to the HVAC of the waste building; they also undergo to the same methodology, with the approaches previously described. (Author)

Women's perceived benefits of exercise during and after breast cancer treatment.

Science.gov (United States)

Bulmer, Sandra Minor; Howell, Jeremy; Ackerman, Louise; Fedric, Regan

2012-01-01

Empirical data support the benefits of physical activity for women who have been diagnosed with breast cancer. However, the experience of exercising during or after breast cancer treatment has not been fully documented. The purpose of the researchers in this study was to provide an in-depth description of women's experiences with exercising during or after their breast cancer treatments, specifically, their perceptions of the benefits they experienced as a result of participation in an individualized exercise program that included cardiovascular and resistance activities. Forty-five women who had been diagnosed with breast cancer within the previous two years were recruited from two oncology practices after electing to enroll in an exercise program. Data were collected between September 2006 and August 2007 through in-depth interviews at various stages in the exercise program and analyzed simultaneously using thematic analysis methods. Whether in treatment or post-treatment, women attributed psychological, physical, and social benefits to their participation in the exercise program. Participants credited the program with helping them to feel better, regain control over their bodies and their lives, manage their emotions, and prepare them to live healthfully going forward. These results provide insight into the specific ways women experience exercise during and after their breast cancer treatments.

Economic valuation of environmental benefits from wastewater treatment processes: an empirical approach for Spain.

Science.gov (United States)

Hernández-Sancho, Francesc; Molinos-Senante, María; Sala-Garrido, Ramón

2010-01-15

Economic research into the design and implementation of policies for the efficient management of water resources has been emphasized by the European Water Framework Directive (Directive 2000/60/EC). The efficient implementation of policies to prevent the degradation and depletion of water resources requires determining their value in social and economic terms and incorporating this information into the decision-making process. A process of wastewater treatment has many associated environmental benefits. However, these benefits are often not calculated because they are not set by the market, due to inadequate property rights, the presence of externalities, and the lack of perfect information. Nevertheless, the valuation of these benefits is necessary to justify a suitable investment policy and a limited number of studies exist on the subject of the economic valuation of environmental benefits. In this paper, we propose a methodology based on the estimation of shadow prices for the pollutants removed in a treatment process. This value represents the environmental benefit (avoided cost) associated with undischarged pollution. This is a pioneering approach to the economic valuation of wastewater treatment. The comparison of these benefits with the internal costs of the treatment process will provide a useful indicator for the feasibility of wastewater treatment projects. Copyright 2009 Elsevier B.V. All rights reserved.

Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia.

Science.gov (United States)

Sanghera, Sabina; Frew, Emma; Gupta, Janesh Kumar; Kai, Joe; Roberts, Tracy Elizabeth

2015-09-01

The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition's periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia.

31 CFR 29.345 - Cost-of-living adjustments.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Cost-of-living adjustments. 29.345 Section 29.345 Money and Finance: Treasury Office of the Secretary of the Treasury FEDERAL BENEFIT... Federal Benefit Payments § 29.345 Cost-of-living adjustments. Cost-of-living increases are applied...

Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort.

Directory of Open Access Journals (Sweden)

Rushina Cholera

Full Text Available Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population.We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9. We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012 and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active.The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments.In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

Refining cost-effectiveness analyses using the net benefit approach and econometric methods: an example from a trial of anti-depressant treatment.

Science.gov (United States)

Sabes-Figuera, Ramon; McCrone, Paul; Kendricks, Antony

2013-04-01

Economic evaluation analyses can be enhanced by employing regression methods, allowing for the identification of important sub-groups and to adjust for imperfect randomisation in clinical trials or to analyse non-randomised data. To explore the benefits of combining regression techniques and the standard Bayesian approach to refine cost-effectiveness analyses using data from randomised clinical trials. Data from a randomised trial of anti-depressant treatment were analysed and a regression model was used to explore the factors that have an impact on the net benefit (NB) statistic with the aim of using these findings to adjust the cost-effectiveness acceptability curves. Exploratory sub-samples' analyses were carried out to explore possible differences in cost-effectiveness. Results The analysis found that having suffered a previous similar depression is strongly correlated with a lower NB, independent of the outcome measure or follow-up point. In patients with previous similar depression, adding an selective serotonin reuptake inhibitors (SSRI) to supportive care for mild-to-moderate depression is probably cost-effective at the level used by the English National Institute for Health and Clinical Excellence to make recommendations. This analysis highlights the need for incorporation of econometric methods into cost-effectiveness analyses using the NB approach.

Quantifying women's stated benefit-risk trade-off preferences for IBS treatment outcomes.

Science.gov (United States)

Johnson, F Reed; Hauber, A Brett; Ozdemir, Semra; Lynd, Larry

2010-01-01

The Food and Drug Administration, currently, is exploring quantitative benefit-risk methods to support regulatory decision-making. A scientifically valid method for assessing patients' benefit-risk trade-off preferences is needed to compare risks and benefits in a common metric. The study aims to quantify the maximum acceptable risk (MAR) of treatment-related adverse events (AEs) that women with diarrhea-predominant irritable bowel syndrome (IBS) are willing to accept in exchange for symptom relief. A stated-choice survey was used to elicit trade-off preferences among constructed treatment profiles, each defined by symptom severity and treatment-related AEs. Symptom attributes included frequency of abdominal pain and discomfort, frequency of diarrhea, and frequency of urgency. AE attributes included frequency of mild-to-moderate constipation and the risk of four possible serious AEs. A Web-enabled survey was administered to 589 female US residents at least 18 years of age with a self-reported diagnosis of diarrhea-predominant IBS. Preference weights and MAR were estimated using mixed-logit methods. SUBJECTS were willing to accept higher risks of serious AEs in return for treatments offering better symptom control. For an improvement from the lowest to the highest of four benefit levels, subjects were willing to tolerate a 2.65% increase in impacted-bowel risk, but only a 1.34% increase in perforated-bowel risk. Variation in MARs across AE types is consistent with the relative seriousness of the AEs. Stated-preference methods offer a scientifically valid approach to quantifying benefit-risk trade-off preferences that can be used to inform regulatory decision-making.

Treatment decision making and adjustment to breast cancer: a longitudinal study.

Science.gov (United States)

Stanton, A L; Estes, M A; Estes, N C; Cameron, C L; Danoff-Burg, S; Irving, L M

1998-04-01

This study monitored women (N = 76) with breast cancer from diagnosis through 1 year, and tested constructs from subjective expected utility theory with regard to their ability to predict patients' choice of surgical treatment as well as psychological distress and well-being over time. Women's positive expectancies for the consequences of treatment generally were maintained in favorable perceptions of outcome in several realms (i.e., physician agreement, likelihood of cancer cure or recurrence, self-evaluation, likelihood of additional treatment, partner support for option, attractiveness to partner). Assessed before the surgical decision-making appointment, women's expectancies for consequences of the treatment options, along with age, correctly classified 94% of the sample with regard to election of mastectomy versus breast-conserving procedures. Calculated from the point of decision making to 3 months later, expectancy disconfirmations and value discrepancies concerning particular treatment consequences predicted psychological adjustment 3 months and 1 year after diagnosis.

Transforce lingual appliances pre-adjusted invisible appliances simplify treatment.

Science.gov (United States)

Clark, William John

2011-01-01

Transforce lingual appliances are designed to be used in conjunction with conventional fixed appliances. Lingual arch development is normally followed by bonded fixed appliances to detail the occlusion. Alternatively Transforce appliance treatment is an efficient method of preparing complex malocclusions prior to a finishing stage with invisible appliances. This approach is ideal for adult treatment, using light continuous forces for arch development with appliances that are comfortable to wear. Sagittal and Transverse appliances are designed for arch development in a range of sizes for contracted arches. They can be used to treat all classes of malocclusion and are pre-adjusted fixed/removable devices for non-compliance treatment. Force modules with nickel titanium coil springs enclosed in a tube deliver a gentle, biocompatible continuous force with a long range of action. They are excellent for mixed dentition and ideal for adult arch development. There are multiple sizes for upper and lower arch development and a sizing chart may be placed over a study model for correct selection, eliminating the need for laboratory work.

The clinical application and nursing experience of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus

Directory of Open Access Journals (Sweden)

YANG Li-rong

2012-02-01

Full Text Available Objective To introduce the application of adjustable shunt valve in treatment for patients with normal pressure hydrocephalus. Methods Twenty-four patients with normal pressure hydrocephalus implanted adjustable shunt valve underwent ventriculo-peritoneal shunt surgery and nursing care. Results After operation, cerebrospinal pressure was regulated for 0-6 (1.88 ± 1.52 times. Clinical symptoms were improved, especially in gait disturbance. Conclusion Treatment of normal pressure hydrocephalus with adjustable shunt valve can alleviate symptoms of hydrocephalus. It is especially suitable for patients with short course and secondary normal hydrocephalus patients.

Facilitating Treatment Decision Making Adjustment and Coping in Men Newly Diagnosed with Prostate Cancer

National Research Council Canada - National Science Library

Diefenbach, Michael

2003-01-01

The study evaluates an intervention designed to facilitate treatment decision making, adjustment, and coping among early-stage prostate cancer patients and their spouse/partners, in a randomized controlled trial...

Adjusting survival time estimates to account for treatment switching in randomized controlled trials--an economic evaluation context: methods, limitations, and recommendations.

Science.gov (United States)

Latimer, Nicholas R; Abrams, Keith R; Lambert, Paul C; Crowther, Michael J; Wailoo, Allan J; Morden, James P; Akehurst, Ron L; Campbell, Michael J

2014-04-01

Treatment switching commonly occurs in clinical trials of novel interventions in the advanced or metastatic cancer setting. However, methods to adjust for switching have been used inconsistently and potentially inappropriately in health technology assessments (HTAs). We present recommendations on the use of methods to adjust survival estimates in the presence of treatment switching in the context of economic evaluations. We provide background on the treatment switching issue and summarize methods used to adjust for it in HTAs. We discuss the assumptions and limitations associated with adjustment methods and draw on results of a simulation study to make recommendations on their use. We demonstrate that methods used to adjust for treatment switching have important limitations and often produce bias in realistic scenarios. We present an analysis framework that aims to increase the probability that suitable adjustment methods can be identified on a case-by-case basis. We recommend that the characteristics of clinical trials, and the treatment switching mechanism observed within them, should be considered alongside the key assumptions of the adjustment methods. Key assumptions include the "no unmeasured confounders" assumption associated with the inverse probability of censoring weights (IPCW) method and the "common treatment effect" assumption associated with the rank preserving structural failure time model (RPSFTM). The limitations associated with switching adjustment methods such as the RPSFTM and IPCW mean that they are appropriate in different scenarios. In some scenarios, both methods may be prone to bias; "2-stage" methods should be considered, and intention-to-treat analyses may sometimes produce the least bias. The data requirements of adjustment methods also have important implications for clinical trialists.

Benefit and harm of pregabalin in acute pain treatment

DEFF Research Database (Denmark)

Fabritius, M L; Strøm, C; Koyuncu, S

2017-01-01

Pregabalin has demonstrated anti-hyperalgesic properties and was introduced into acute pain treatment in 2001. Our aim was to evaluate the beneficial and harmful effects of pregabalin in postoperative pain management. We included randomized clinical trials investigating perioperative pregabalin......, Peto's odds ratio was 2.9 (1.2, 6.8; TSA adjusted confidence interval: 0.1, 97.1). Based on trials with low risk of bias, pregabalin may have a minimal opioid-sparing effect, but the risk of SAEs seems increased. However, the GRADE-rated evaluations showed only moderate to very low quality of evidence....... Consequently, a routine use of pregabalin for postoperative pain treatment cannot be recommended....

The cost-effectiveness, health benefits, and financial costs of new antiviral treatments for hepatitis C virus.

Science.gov (United States)

Rein, David B; Wittenborn, John S; Smith, Bryce D; Liffmann, Danielle K; Ward, John W

2015-07-15

New hepatitis C virus (HCV) treatments deliver higher cure rates with fewer contraindications, increasing demand for treatment and healthcare costs. The cost-effectiveness of new treatments is unknown. We conducted a microsimulation of guideline testing followed by alternative treatment regimens for HCV among the US population aged 20 and older to estimate cases identified, treated, sustained viral response, deaths, medical costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of different treatment options expressed as discounted lifetime costs and benefits from the healthcare perspective. Compared to treatment with pegylated interferon and ribavirin (PR), and a protease inhibitor for HCV genotype (G) 1 and PR alone for G2/3, treatment with PR and Sofosbuvir (PRS) for G1/4 and treatment with Sofosbuvir and ribavirin (SR) for G2/3 increased QALYs by 555 226, reduced deaths by 80 682, and increased costs by $26.2 billion at an ICER of $47 304 per QALY gained. As compared to PRS/SR, treating with an all oral regimen of Sofosbuvir and Simeprevir (SS) for G1/4 and SR for G2/3, increased QALYs by 1 110 451 and reduced deaths by an additional 164 540 at an incremental cost of $80.1 billion and an ICER of $72 169. In sensitivity analysis, where treatment with SS effectiveness was set to the list price of Viekira Pak and then Harvoni, treatment cost $24 921 and $25 405 per QALY gained as compared to PRS/SR. New treatments are cost-effectiveness per person treated, but pent-up demand for treatment may create challenges for financing. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

Directory of Open Access Journals (Sweden)

Flavia Alencar de Barros Suzuki

Full Text Available ABSTRACT INTRODUCTION: The difficulty in choosing the appropriate therapy for chronic tinnitus relates to the variable impact on the quality of life of affected patients and, thus, requires individualization of treatment. OBJECTIVE: To evaluate the effectiveness of using sound generators with individual adjustments to relieve tinnitus in patients unresponsive to previous treatments. METHODS: A prospective study of 10 patients with chronic tinnitus who were unresponsive to previous drug treatments, five males and five females, with ages ranging from 41 to 78 years. Bilateral sound generators (Reach 62 or Mind 9 models were used daily for at least 6 h during 18 months. The patients were evaluated at the beginning, after 1 month and at each 3 months until 18 months through acuphenometry, minimum masking level, the Tinnitus Handicap Inventory, visual analog scale, and the Hospital Anxiety and Depression Scale. The sound generators were adjusted at each visit. RESULTS: There was a reduction of Tinnitus Handicap Inventory in nine patients using a protocol with a customized approach, independent of psychoacoustic characteristics of tinnitus. The best response to treatment occurred in those with whistle-type tinnitus. A correlation among the adjustments and tinnitus loudness and minimum masking level was found. Only one patient, who had indication of depression by Hospital Anxiety and Depression Scale, did not respond to sound therapy. CONCLUSION: There was improvement in quality of life (Tinnitus Handicap Inventory, with good response to sound therapy using customized settings in patients who did not respond to previous treatments for tinnitus.

5 CFR 847.705 - Cost-of-living adjustments.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living adjustments. 847.705... FUND INSTRUMENTALITIES Computation of Benefits Under the Retroactive Provisions § 847.705 Cost-of-living adjustments. Cost-of-living adjustments are applied to the rate payable to the retiree or survivor...

Inverse probability weighting for covariate adjustment in randomized studies.

Science.gov (United States)

Shen, Changyu; Li, Xiaochun; Li, Lingling

2014-02-20

Covariate adjustment in randomized clinical trials has the potential benefit of precision gain. It also has the potential pitfall of reduced objectivity as it opens the possibility of selecting a 'favorable' model that yields strong treatment benefit estimate. Although there is a large volume of statistical literature targeting on the first aspect, realistic solutions to enforce objective inference and improve precision are rare. As a typical randomized trial needs to accommodate many implementation issues beyond statistical considerations, maintaining the objectivity is at least as important as precision gain if not more, particularly from the perspective of the regulatory agencies. In this article, we propose a two-stage estimation procedure based on inverse probability weighting to achieve better precision without compromising objectivity. The procedure is designed in a way such that the covariate adjustment is performed before seeing the outcome, effectively reducing the possibility of selecting a 'favorable' model that yields a strong intervention effect. Both theoretical and numerical properties of the estimation procedure are presented. Application of the proposed method to a real data example is presented. Copyright © 2013 John Wiley & Sons, Ltd.

8 CFR 244.5 - Temporary treatment benefits for eligible aliens.

Science.gov (United States)

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Temporary treatment benefits for eligible aliens. 244.5 Section 244.5 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION... for eligible aliens. (a) Prior to the registration period. Prior to the registration period...

Risk-benefit considerations in the treatment of relapsing-remitting multiple sclerosis

Directory of Open Access Journals (Sweden)

Lugaresi A

2013-06-01

Full Text Available Alessandra Lugaresi,1 Maria di Ioia,1 Daniela Travaglini,1 Erika Pietrolongo,1 Eugenio Pucci,2 Marco Onofrj11Department of Neuroscience and Imaging, University “G d’Annunzio”, Chieti, 2Operative Unit Neurologia ASUR Marche Area Vasta 3, Macerata, ItalyAbstract: Multiple sclerosis (MS is a chronic demyelinating disease of the central nervous system and mainly affects young adults. Its natural history has changed in recent years with the advent of disease-modifying drugs, which have been available since the early 1990s. The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. The aim of this review is to give a comprehensive overview of the main present and some future drugs for relapsing-remitting MS, including risk-benefit considerations, to enable readers to draw their own conclusions regarding the risk-benefit assessment of personalized treatment strategies, taking into account not only treatment-related but also disease-related risks. We performed a Medline literature search to identify studies on the treatment of MS with risk stratification and risk-benefit considerations. We focused our attention on studies of disease-modifying, immunomodulating, and immunosuppressive drugs, including monoclonal antibodies. Here we offer personal considerations, stemming from long-term experience in the treatment of MS and thorough discussions with other neurologists closely involved in the care of patients with the disease. MS specialists need to know not only the specific risks and benefits of single drugs, but also about drug interactions, either in simultaneous or serial combination therapy, and patient comorbidities, preferences, and fears. This has to be put into perspective, considering also the risks of untreated disease in patients with different clinical and radiological characteristics

5 CFR 831.702 - Adjustment of annuities.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adjustment of annuities. 831.702 Section... (CONTINUED) RETIREMENT Computation of Annuities § 831.702 Adjustment of annuities. (a)(1) An annuity which... benefit shall require a corresponding deduction in the civil service annuity. (3) Any cost-of-living...

[Exploring the Experience of Dysmenorrhea and Life Adjustments of Women Undergoing Traditional Chinese Medicine Treatment].

Science.gov (United States)

Tsai, Min-Min; Yang, Fu-Chi; Lee, Shih-Min; Huang, Chiu-Mieh

2016-08-01

Previous studies of women with dysmenorrhea have focused on menstrual attitudes, the characteristics of menstrual pain, and self-care behavior. Traditional Chinese Medicine (TCM) studies on dysmenorrhea, on the other hand, have focused on the efficacy and safety of TCM treatments. Few studies have investigated how women perceive their own TCM-treatment experience of dysmenorrhea. The objective of this study was to explore the experience of dysmenorrhea and life adjustments of women undergoing TCM treatment. A semi-structured interviewing guide was used to collect data. A total of 40 dysmenorrheal women participated in the study. Individual, in-depth interviews were conducted for about 60-90 minutes with each participant. Their speech tone, facial expressions, and gestures during the interview process were also observed and recorded. The findings were analyzed using content analysis via ATLAS. ti 5.2 software. The process that the participants used to adjust to dysmenorrhea were distinguished into four progressive stages: "tip of the iceberg", "ice-breaking", "tug-of-war", and "blending-in". Initially, the participants perceived the symptoms of dysmenorrhea as the "tip of the iceberg". They attempted to hide / ignore the initial pain until the problem gradually worsened to the point that the symptoms began to significantly affect various aspects of life. It was only then that the participants began to pay attention to the problem and to seek help from TCM practitioners, which we defined as the "ice-breaking" stage. If they encountered unexpected situations with regard to the treatment regimen, the participants entered the "tug-of-war" stage, during which they struggled over whether to continue with TCM treatments. Afterward, the participants gradually achieved a "blending-in" of new ideas, which allowed them to identify the strategies that best facilitated adjustment and rebalancing. Eventually, the participants achieved a new life balance. The outcomes of the

The struggle towards 'the New Normal': a qualitative insight into psychosexual adjustment to prostate cancer.

Science.gov (United States)

Hanly, Narelle; Mireskandari, Shab; Juraskova, Ilona

2014-07-30

Despite the growing body of literature which highlights the potential for significant and enduring side-effects of prostate cancer treatment, there is limited research exploring the experience of living with the treatment-induced side-effects such as sexual dysfunction, and their repercussions for men and their partners. The aim of this qualitative study was to explore factors influencing psychosexual adjustment, self-perception, and unmet information and support needs of prostate cancer patients and their partners. Twenty-one men, recruited via a prostate cancer support group newsletter, participated in face-to-face semi-structured interviews, which were subjected to thematic analysis. The qualitative analysis revealed three inter-connected main themes which contributed to men's psychosexual adjustment: i) Psychosexual impact, ii) Communication and support, and iii) Integration process. Men reported distressing sexual and urinary difficulties, tainted self-perception and altered intimate relationships. Receiving adequate information and support, and having good communication with their doctors and partners facilitated better adjustment to prostate cancer treatment. Coming to terms with the significant impact of treatment had involved making lifestyle changes, coping with emotional struggles and striving to accept and integrate their post-treatment "new normal" self and sexual life. The importance of adequate communication with health professionals and partners, especially regarding treatment effects on sexual function and rehabilitation options, was highlighted as a key factor facilitating the adjustment process. Prostate cancer patients would benefit from improved access to timely and tailored information and decision-making resources, ongoing multidisciplinary care, and support groups, as well as appropriate referrals for sexual and psychological counselling.

On certain aspects of reproductive function preservation and social adjustment following complex treatment for Hodgkin's disease in childhood

International Nuclear Information System (INIS)

Susuleva, N.A.; Il'yashenko, V.V.

1997-01-01

Data on the reproductive status and social adjustment of 443 children exposed to combined treatment of Hodgkin's disease according 3 different programs (from 1976 up to 1994). 1 program consists of chemoradiotherapy, 2 program includes the irradiation of zones of primary injury (cumulative dose up to 40 Gy), 3 program stipulates the irradiation of zones of primary injury at the cumulative dose 30 Gy. 258 patients reach the age of 18. It is shown that the treatment in childhood does not affect considerably the reproductive function and social adjustment

75 FR 48931 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-12

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... assistance and cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers....usda.gov ; or visit the TAA for Farmers' Web site: www.fas.usda.gov/itp/taa . Dated: July 30, 2010...

75 FR 48642 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-11

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program Staff, FAS, USDA... the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: July 30, 2010. John D. Brewer...

75 FR 49458 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-08-13

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... and cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program....gov ; or visit the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: August 3, 2010...

The Singer's and the Clinician's Perspective on Vitamin B12 Treatment for Vocal Benefits.

Science.gov (United States)

Shoffel-Havakuk, Hagit; Lava, Christian X; Hapner, Edie R; O'Dell, Karla; Reder, Lindsay; Johns, Michael M

2018-01-03

There is a belief among vocalists that there are voice benefits from vitamin B 12 treatment. Yet there are no previous reports regarding vitamin B 12 effects on voice. To assess the prevalence of vitamin B 12 use among singers and their beliefs regarding vitamin B 12 therapy. Anonymous online survey administered to singers, singing-teachers, speech-language pathologists, and laryngologists. A total of 192 participants completed the surveys; 128 singers (68 singing-teachers, 30 speech-language pathologists) and 64 laryngologists. Among singers, 12% have perceived voice benefits from vitamin B 12 treatment taken for any reason. Four percent used vitamin B 12 for voice benefits; all perceived voice benefits as a result. The leading voice benefits were improved stamina, reduced effort, confidence, and control. Nineteen percent of the singers would recommend vitamin B 12 treatment to a friend; 15% of the singing-teachers would recommend it to a student. Among laryngologists, 33% been asked by a singer to prescribe vitamin B 12 for voice benefits; 9% have prescribed it in the past. Yet only 3% would you recommend it to a patient. When asked "Do you believe vitamin B 12 therapy improves vocal performance?" 31% of the singers responded "Yes," compared with none in the laryngologists. When asked "Do you think the singing community believes vitamin B 12 therapy improves vocal performance?" 26% of the singers responded "Yes," compared with 53% of the laryngologists (P = 0.0002). There is a discrepancy between the singers' and the laryngologists' beliefs regarding vocal benefits perceived by vitamin B 12 . Blinded randomized trials are required to verify or refute this belief. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

75 FR 43485 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-07-26

... Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice... cash benefits. FOR FURTHER INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Staff, FAS... visit the TAA for Farmers' Web site: http://www.fas.usda.gov/itp/taa . Dated: July 14, 2010. John D...

Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial.

Science.gov (United States)

Kreutzer, Jeffrey S; Marwitz, Jennifer H; Sima, Adam P; Mills, Ana; Hsu, Nancy H; Lukow, Herman R

2018-05-24

Examine a psychoeducational and skill-building intervention's effectiveness for individuals after traumatic brain injury (TBI), using a two-arm, parallel, randomized, controlled trial with wait-listed control. The Resilience and Adjustment Intervention (RAI) targets adjustment challenges and emphasizes education, skill-building and psychological support. Overall, 160 outpatients were randomly assigned to a treatment or wait-list control (WLC) group. The manualized treatment was delivered in seven 1-h sessions. The Connor-Davidson Resilience Scale (CD-RISC) was the primary outcome measure. Secondary measures included the Mayo Portland Adaptability Inventory-4 (MPAI-4), Brief Symptom Inventory-18 (BSI-18) and 13-Item Stress Test. After adjusting for injury severity, education and time postinjury, the RAI group (N = 75) demonstrated a significantly greater increase in resilience (effect size = 1.03) compared to the WLC group (N = 73). Participants in the RAI group demonstrated more favourable scores on the MPAI-4 Adjustment and Ability Indices, BSI-18 and the 13-item Stress Test. However, only the CD-RISC and BSI-18 demonstrated a clinically significant difference. In addition, RAI participants demonstrated maintenance of gains from pre-treatment to 3-month follow-up; however, only the BSI-18 maintained a clinically significant difference. Investigation provided evidence that a resilience-focused intervention can improve psychological health and adjustment after TBI. Additional research is needed to ascertain the longer term benefits of intervention and the efficacy of alternative delivery methods (e.g., via telephone, Internet).

Comparing treatment effects after adjustment with multivariable Cox proportional hazards regression and propensity score methods

NARCIS (Netherlands)

Martens, Edwin P; de Boer, Anthonius; Pestman, Wiebe R; Belitser, Svetlana V; Stricker, Bruno H Ch; Klungel, Olaf H

PURPOSE: To compare adjusted effects of drug treatment for hypertension on the risk of stroke from propensity score (PS) methods with a multivariable Cox proportional hazards (Cox PH) regression in an observational study with censored data. METHODS: From two prospective population-based cohort

Limited cognitive benefits in Stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba.

Science.gov (United States)

Elsabagh, Sarah; Hartley, David E; File, Sandra E

2005-03-01

Gingko biloba has cognitive benefits both in populations suffering from dementia and after acute treatment in healthy volunteers, with some evidence indicating that those with poorer cognitive performance show greater benefit. We have previously found that 1 week of treatment with ginkgo improved attention, memory and mental flexibility in post-menopausal women, but the evidence for any beneficial effects of longer treatment is less well-established. The present study aimed to determine whether cognitive benefits, similar to those previously found after 1 week of treatment, would persist after 6 weeks of treatment, and whether those with poorer cognitive performance would benefit more. In a placebo-controlled, double-blind study, postmenopausal women (aged 51-67 years) were randomly allocated to receive a standardized extract of ginkgo (LI 1370, Lichtwer Pharma, Marlow, UK) (one capsule/day of 120 mg, n = 45) or matching placebo (n = 42) for 6 weeks. According to an established reproductive staging system, subjects were divided into those in the early (Stage +1; mean age 55 years) and late (Stage +2: mean age 61 years) stages of menopause. At baseline and after 6 weeks of treatment, subjects completed tests of mental flexibility, planning, memory and sustained attention, and ratings of mood, sleepiness, bodily and menopausal symptoms. The only significant effects of ginkgo were in the test of mental flexibility, in which there were significant menopausal stage-ginkgo interactions. This was because subjects in Stage +2 required fewer trials to complete the task and made fewer errors after ginkgo treatment, whereas those in Stage +1 showed no benefits. Subjects in Stage +2 had poorer performance at baseline compared to those in Stage +1 both in this task and the test of planning ability. The beneficial effects of ginkgo were limited to the test of mental flexibility and to those with poorer performance.

High-dose chemotherapy for patients with high-risk breast cancer: a clinical and economic assessment using a quality-adjusted survival analysis.

Science.gov (United States)

Marino, Patricia; Roché, Henri; Moatti, Jean-Paul

2008-04-01

The benefit of high-dose chemotherapy (HDC) has not been clearly demonstrated. It may offer disease-free survival improvement at the expense of major toxicity and increasing cost. We evaluated the trade-offs between toxicity, relapse, and costs using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis. The analysis was conducted in the context of a randomized trial (PEGASE 01) evaluating the benefit of HDC for 314 patients with high-risk breast cancer. A Q-TWiST analysis was first performed to compare HDC with standard chemotherapy. We then used the results of this Q-TWiST analysis to inform a cost per quality-adjusted life-year (QALY) comparison between treatments. Q-TWiST durations were in favor of HDC, whatever the weighting coefficients used for the analysis. This benefit was significant when the weighting coefficient related to the time spent after relapse was low (0.78), HDC offered no benefit. For intermediate values, the results depended on the weighting coefficient attributed to the toxicity period. The incremental cost per QALY ranged from 12,691euro/QALY to 26,439euro/QALY, according to the coefficients used to weight toxicity and relapse. The benefits of HDC outweigh the burdens of treatment for a wide range of utility coefficients. Economic impact is not a barrier to HDC diffusion in this situation. Nevertheless, no significant benefit was demonstrated for a certain range of utility values.

5 CFR 838.1017 - Cost-of-living adjustments.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living adjustments. 838.1017... Retirement Benefits § 838.1017 Cost-of-living adjustments. In cases where the court order apportions a... proper payment. That amount will be increased by future cost-of-living increases unless the court directs...

Psychological Adjustment to Lung Cancer: the role of self-compassion and social support

Directory of Open Access Journals (Sweden)

Rute Batista

2016-02-01

Full Text Available // Introduction: The impact of the diagnosis of an oncologic disease is well-known in terms of psychological adjustment and quality of life. On the other hand it is known that depressive symptoms may also overlap the physical symptoms of cancer and cancer treatment, which may interfere in their detection and appropriate treatment approach.   Objectives: The aim of the current study was to explore the relationship between psychological adjustment to lung cancer, self-compassion, social support and emotional negative states in patients with lung cancer.   Method: Fifty-five patients diagnosed with lung cancer (38 men and 17 women with ages ranging from 44 to 87 years old participated in the study. A set of self-report instruments was used: the Mini Mental Adjustment to Cancer Scale (MiniMac, the Self-compassion Scale (SCS; Neff, 2003, the Social Support Satisfaction Scale (SSSS and the Depression, Anxiety and Stress Scale (DASS-21.   Results: Significant correlations were found between psychological adjustment, psychopathology, emotion regulation strategies (self-compassion, and social support. The predictive models for psychological adjustment and stress related symptomatology include self-compassion and social support as significant predictive variables. Regarding the predictive model for depressive symptomatology, mindfulness seems to be the only significant predictor.   Conclusions: Our findings suggest that these patients may benefit, in their therapeutic approach, from the development of this kind of strategies (new ways of relating themselves with their emotional experiences and quality of their social networks in order to promote a better psychological adjustment to their clinical condition.

Obesity-related costs and the economic impact of laparoscopic adjustable gastric banding procedures: benefits in the Texas Employees Retirement System.

Science.gov (United States)

Perryman, M Ray; Gleghorn, Virginia

2010-01-01

To assess the return on investment (ROI) and economic impact of providing insurance coverage for the laparoscopic adjustable gastric banding (LAGB) procedure in classes II and III obese members of the Texas Employees Retirement System (ERS) and their dependents from payer, employer, and societal perspectives. Classes II and III obese employee members and their adult dependents were identified in a Texas ERS database using self-reported health risk assessment (HRA) data. Direct health costs and related absenteeism and mortality losses were estimated using data from previous research. A dynamic input-output model was then used to calculate overall economic effects by incorporating direct, indirect, and induced impacts. Direct health costs were inflation-adjusted to 2008 US dollars using the Consumer Price Index for Medical Care and other spending categories were similarly adjusted using relevant consumer and industrial indices. The future cost savings and other monetary benefits were discounted to present value using a real rate of 4.00%. From the payer perspective (ERS), the payback period for direct health costs associated with the LAGB procedure was 23-24 months and the annual return (over 5 years) was 28.8%. From the employer perspective (State of Texas), the costs associated with the LAGB procedure were recouped within 17-19 months (in terms of direct, indirect, and induced gains as they translated into State revenue) and the annual return (over 5 years) was 45.5%. From a societal perspective, the impact on total business activity for Texas (over 5 years) included gains of $195.3 million in total expenditures, $93.8 million in gross product, and 1354 person-years of employment. The analysis was limited by the following: reliance on other studies for methodology and use of a control sample; restriction of cost savings to 2.5 years which required out-of-sample forecasting; conservative assumptions related to the cost of the procedure; exclusion of presenteeism

Fat redistribution preferentially reflects the anti-inflammatory benefits of pioglitazone treatment.

Science.gov (United States)

Moon, Jae Hoon; Kim, Hae Jin; Kim, Soo Kyung; Kang, Eun Seok; Lee, Byung Wan; Ahn, Chul Woo; Lee, Hyun Chul; Cha, Bong-Soo

2011-02-01

Thiazoledinedione is known to have an anti-inflammatory effect besides a hypoglycemic effect. We investigated changes in high-sensitivity C-reactive protein (hsCRP), a proinflammatory marker, after pioglitazone treatment in association with the resulting changes in various metabolic and anthropometric parameters. A total of 93 type 2 diabetes mellitus patients (47 men and 46 women; mean age, 50.0 ± 10.8 years) who were being treated with a stable dose of sulfonylurea or metformin were enrolled in the study. Pioglitazone (15 mg/d) was added to their treatment regimen for 12 weeks, and metabolic and anthropometric measurements were taken before and after pioglitazone treatment. Pioglitazone treatment for 12 weeks decreased serum hsCRP levels (0.83 [1.14] to 0.52 [0.82] mg/L, P fasting glucose, P benefits of pioglitazone treatment. © 2011 Elsevier Inc. All rights reserved.

Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography

Science.gov (United States)

Jacklyn, Gemma; Glasziou, Paul; Macaskill, Petra; Barratt, Alexandra

2016-01-01

Background: Women require information about the impact of regularly attending screening mammography on breast cancer mortality and overdiagnosis to make informed decisions. To provide this information we aimed to meta-analyse randomised controlled trials adjusted for adherence to the trial protocol. Methods: Nine screening mammography trials used in the Independent UK Breast Screening Report were selected. Extending an existing approach to adjust intention-to-treat (ITT) estimates for less than 100% adherence rates, we conducted a random-effects meta-analysis. This produced a combined deattenuated prevented fraction and a combined deattenuated percentage risk of overdiagnosis. Results: In women aged 39–75 years invited to screen, the prevented fraction of breast cancer mortality at 13-year follow-up was 0.22 (95% CI 0.15–0.28) and it increased to 0.30 (95% CI 0.18–0.42) with deattenuation. In women aged 40–69 years invited to screen, the ITT percentage risk of overdiagnosis during the screening period was 19.0% (95% CI 15.2–22.7%), deattenuation increased this to 29.7% (95% CI 17.8–41.5%). Conclusions: Adjustment for nonadherence increased the size of the mortality benefit and risk of overdiagnosis by up to 50%. These estimates are more appropriate when developing quantitative information to support individual decisions about attending screening mammography. PMID:27124337

An updated PREDICT breast cancer prognostication and treatment benefit prediction model with independent validation.

Science.gov (United States)

Candido Dos Reis, Francisco J; Wishart, Gordon C; Dicks, Ed M; Greenberg, David; Rashbass, Jem; Schmidt, Marjanka K; van den Broek, Alexandra J; Ellis, Ian O; Green, Andrew; Rakha, Emad; Maishman, Tom; Eccles, Diana M; Pharoah, Paul D P

2017-05-22

PREDICT is a breast cancer prognostic and treatment benefit model implemented online. The overall fit of the model has been good in multiple independent case series, but PREDICT has been shown to underestimate breast cancer specific mortality in women diagnosed under the age of 40. Another limitation is the use of discrete categories for tumour size and node status resulting in 'step' changes in risk estimates on moving between categories. We have refitted the PREDICT prognostic model using the original cohort of cases from East Anglia with updated survival time in order to take into account age at diagnosis and to smooth out the survival function for tumour size and node status. Multivariable Cox regression models were used to fit separate models for ER negative and ER positive disease. Continuous variables were fitted using fractional polynomials and a smoothed baseline hazard was obtained by regressing the baseline cumulative hazard for each patients against time using fractional polynomials. The fit of the prognostic models were then tested in three independent data sets that had also been used to validate the original version of PREDICT. In the model fitting data, after adjusting for other prognostic variables, there is an increase in risk of breast cancer specific mortality in younger and older patients with ER positive disease, with a substantial increase in risk for women diagnosed before the age of 35. In ER negative disease the risk increases slightly with age. The association between breast cancer specific mortality and both tumour size and number of positive nodes was non-linear with a more marked increase in risk with increasing size and increasing number of nodes in ER positive disease. The overall calibration and discrimination of the new version of PREDICT (v2) was good and comparable to that of the previous version in both model development and validation data sets. However, the calibration of v2 improved over v1 in patients diagnosed under the age

20 CFR 725.704 - Notification of right to medical benefits; authorization of treatment.

Science.gov (United States)

2010-04-01

... Vocational Rehabilitation § 725.704 Notification of right to medical benefits; authorization of treatment. (a... is desirable or necessary in the best interest of the miner. The miner may change physicians or...

What is the benefit of treatment with multiple lines of chemotherapy for patients with metastatic breast cancer? A retrospective cohort study.

Science.gov (United States)

Bakker, J L; Wever, K; van Waesberghe, J H; Beeker, A; Meijers-Heijboer, H; Konings, I R; Verheul, H M W

2015-12-01

Despite the extensive clinical experience, it is still under debate to what extent patients with metastatic breast cancer (MBC) benefit from multiple lines of chemotherapy beyond standard first or second line treatment. Selection of patients with MBC who will benefit from treatment is crucial to improve outcome and reduce unnecessary toxicity. In this retrospective study, systemic treatment outcome for patients with metastatic MBC is being evaluated. We evaluated to what extent the clinical benefit of prior chemotherapy can predict the success of a subsequent treatment line. Ninety-one patients treated with chemotherapy for MBC between January 2005 and January 2009 were included in this study. Clinical characteristics of patients, choices of chemotherapy and response at first evaluation of every treatment line was evaluated based on radiologic and clinical data. Patients received multiple systemic cytotoxic and biological (combination) therapies. 30% of these patients received more than five consecutive systemic (combination) treatments. First line chemotherapy was mostly anthracycline-based, followed by taxanes, capecitabine and vinorelbine. The response rate (RR, complete response plus partial response according to RECIST 1.1) decreased from 20% (95% CI 11-28%) upon first line of treatment to 0% upon the fourth line. The clinical benefit rate (combining RR and stable disease) decreased from 85% (95% CI 78-93%) in the first to 54% (95% CI 26-67) upon the fourth line. 24% of the patients with clinical benefit at first evaluation did not receive a subsequent line of treatment when progressive disease occurred, while sixty-one percent of the patients with progressive disease at first evaluation of a treatment did not receive a subsequent line of chemotherapy. When applied, the efficacy of a subsequent line of treatment was similar for patients independent of previous treatment benefit. The clinical benefit at first evaluation from systemic treatment in MBC does not

End-of-treatment and serial PET imaging in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R: A paradigm shift in clinical decision making.

Science.gov (United States)

Melani, Christopher; Advani, Ranjana; Roschewski, Mark; Walters, Kelsey M; Chen, Clara C; Baratto, Lucia; Ahlman, Mark A; Miljkovic, Milos D; Steinberg, Seth M; Lam, Jessica; Shovlin, Margaret; Dunleavy, Kieron; Pittaluga, Stefania; Jaffe, Elaine S; Wilson, Wyndham H

2018-05-10

Dose-adjusted-EPOCH-R obviates the need for radiotherapy in most patients with primary mediastinal B-cell lymphoma. End-of-treatment PET, however, does not accurately identify patients at risk of treatment failure, thereby confounding clinical decision making. To define the role of PET in primary mediastinal B-cell lymphoma following dose-adjusted-EPOCH-R, we extended enrollment and follow-up on our published phase II trial and independent series. Ninety-three patients received dose-adjusted-EPOCH-R without radiotherapy. End-of-treatment PET was performed in 80 patients, of whom 57 received 144 serial scans. One nuclear medicine physician from each institution blindly reviewed all scans from their respective institution. End-of-treatment PET was negative (Deauville 1-3) in 55 (69%) patients with one treatment failure (8-year event-free and overall survival of 96.0% and 97.7%). Among 25 (31%) patients with a positive (Deauville 4-5) end-of-treatment PET, there were 5 (20%) treatment failures (8-year event-free and overall survival of 71.1% and 84.3%). Linear regression analysis of serial scans showed a significant decrease in SUVmax in positive end-of-treatment PET non-progressors compared to an increase in treatment failures. Among 6 treatment failures, the median end-of-treatment SUVmax was 15.4 (range, 1.9-21.3) and 4 achieved long-term remission with salvage therapy. Virtually all patients with a negative end-of-treatment PET following dose-adjusted-EPOCH-R achieved durable remissions and should not receive radiotherapy. Among patients with a positive end-of-treatment PET, only 5/25 (20%) had treatment-failure. Serial PET imaging distinguished end-of-treatment PET positive patients without treatment failure, thereby reducing unnecessary radiotherapy by 80%, and should be considered in all patients with an initial positive PET following dose-adjusted-EPOCH-R (NCT00001337). Copyright © 2018, Ferrata Storti Foundation.

Benefit requirements for substance use disorder treatment in state health insurance exchanges.

Science.gov (United States)

Tran Smith, Bikki; Seaton, Kathleen; Andrews, Christina; Grogan, Colleen M; Abraham, Amanda; Pollack, Harold; Friedmann, Peter; Humphreys, Keith

2018-01-01

Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations. How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls. Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey. States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used. Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.

The effect of ethnicity on different ways of expressing cardiovascular treatment benefits and patient decision-making.

Science.gov (United States)

Raval, Manjri; Goodyear-Smith, Felicity; Wells, Susan

2015-03-01

The way information is presented to communicate risk and treatment benefit affects patients' understanding and perception of their risk and can influence their decisions. To assess the effect of ethnicity on patient preferences for different ways of expressing risk and treatment benefits. Using tailored questionnaires, we surveyed Ma¯ori , Pacific and Indian peoples of known CVD risk to assess format preferences encouraging them to take medication or assist their understanding of possible treatment benefits. Statistical analysis determined any association of ethnicity with patient preferences. Of the 376 participants, 50% identified as New Zealand (NZ) European; 15% Maori ; 25% Pacific and 10% Indian ethnicity. Patients preferred positive framing of risk (66%). Relative risk was the format reported as most encouraging to take medication and to understand risk, with natural frequencies least preferable, although Pacific people significantly preferred natural frequencies (pmake decisions on treatment compared to NZ European/Other and Ma¯ori participants (pdecision-making should be considered when tailoring effective communication in primary care. However, individual preferences cannot be presumed and a combination of methods should routinely be used.

Internet-supported gathering of treatment data and patient benefits in psoriasis.

Science.gov (United States)

Langenbruch, A K; Schäfer, I; Franzke, N; Augustin, M

2010-05-01

Studies about health care of psoriasis patients in Germany are predominantly carried out in dermatological centres, which results in a certain selection bias. To collect data from other sources of patients, the German Centre of Health Services Research in Dermatology conducted a series of web-based studies. The extent of how data on health care on psoriasis gathered online vary from paper and pencil data is yet to be explored. 1 To collect reliable treatment and benefit online data from psoriasis patients in Germany. 2 To compare these with data gathered at dermatological centres. On the 'psoriasis-hilfe.de' web portal, psoriasis patients were asked to complete the online version of a questionnaire, which has already been used as a paper and pencil version in the national psoriasis study 'PsoHealth'. Subsequently, difference analyses were conducted between the two data sets. The PsoWeb sample (n = 1071) varies to a high extent from the PsoHealth sample (n = 2009) regarding the achievement of treatment goals and treatment satisfaction. Irrespective of age, sex and duration of disease, the online sample showed lower treatment satisfaction and fewer patient-defined benefits. The findings suggest that patients in the online sample are less satisfied with their health care, which also could have been their motive for participating online. It is important to gather data online because it increases the data pool and permits inclusion of people who are not incorporated in clinical settings. However, online data cannot directly replace data collected in clinics because they are also subject to selections.

20 CFR 10.420 - How are cost-of-living adjustments applied?

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How are cost-of-living adjustments applied... cost-of-living adjustments applied? (a) In cases of disability, a beneficiary is eligible for cost-of... the date the cost-of-living adjustment took effect. The employee's use of continuation of pay as...

An Adjustment Restriction on Fish Quota

NARCIS (Netherlands)

Dijk, van Diana; Hendrix, E.M.T.; Haijema, Rene; Groeneveld, R.A.; Ierland, van E.C.

2017-01-01

Management objectives of the European Union for North Sea fish stocks are shifting towards considering both biological sustainability and economic benefits. As part of multiannual management plans, an adjustment restriction on fish quota has been introduced. Its objective is to obtain an

Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

Science.gov (United States)

Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

2015-04-01

Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

Treatment-resistant depression in adolescents: is the addition of cognitive behavioral therapy of benefit?

Directory of Open Access Journals (Sweden)

Hetrick SE

2011-08-01

Full Text Available Sarah E Hetrick1, Georgina R Cox1, Sally N Merry21Orygen Youth Health Research Centre, Centre for Youth Mental Health, Melbourne, Parkville, Victoria, Australia; 2Werry Centre for Child and Adolescent Mental Health, Department of Psychological Medicine, The University of Auckland, Auckland, New ZealandBackground: Many young people with major depression fail first-line treatments. Treatment resistant depression has various definitions in the literature but typically assumes nonresponse to medication. In young people, cognitive behavioral therapy (CBT is the recommended firstline intervention, thus the definition of treatment resistance should be expanded. Therefore, our aim was to synthesize the existing evidence of any interventions for treatment-resistant depression, broadly defined, in children and adolescents and to investigate the effectiveness of CBT in this context. Methods: We used Cochrane Collaboration methodology, with electronic searches of Medline, PsycINFO, Embase, and the Cochrane Depression Anxiety and Neurosis Group trials registers. Only randomized controlled trials were included, and were assessed for risk of bias. Meta-analysis was undertaken where possible and appropriate.Results: Of 953 articles retrieved, four trials were eligible for inclusion. For one study, only the trial registration document was available, because the study was never completed. All other studies were well conducted with a low risk of bias, although one study had a high dropout rate. Two studies assessed the effect of adding CBT to medication. While an assertive trial of antidepressants does appear to lead to benefit, when compared with placebo, there was no significant advantage, in either study, or in a meta-analysis of data from these trials, that clearly demonstrated an additional benefit of CBT. The third trial showed little advantage of a tricyclic antidepressant over placebo in the context of an inpatient admission. Conclusion: Few randomized

Hormone therapy and radiotherapy for early prostate cancer: A utility-adjusted number needed to treat (NNT) analysis

International Nuclear Information System (INIS)

Jani, Ashesh B.; Kao, Johnny; Heimann, Ruth; Hellman, Samuel

2005-01-01

Purpose: To quantify, using the number needed to treat (NNT) methodology, the benefit of short-term (≤6 months) hormone therapy adjuvant to radiotherapy in the group of patients with early (clinical stage T1-T2c) prostate cancer. Methods and materials: The absolute biochemical control benefit for the use of hormones adjuvant to radiotherapy in early-stage disease was determined by literature review. A model was developed to estimate the utility-adjusted survival detriment due to the side effects of hormone therapy. The NNTs before and after the incorporation of hormone sequelae were computed; the sign and magnitude of the NNTs were used to gauge the effect of the hormones. Results: The absolute NNT analysis, based on summarizing the results of 8 reports including a total of 3652 patients, demonstrated an advantage to the addition of hormones for the general early-stage prostate cancer population as well as for all prognostic groups. After adjustment for hormone-induced functional loss, the advantage of hormones remained considerable in the high- and intermediate-risk groups, with the utility-adjusted NNT becoming weakened in the low-risk group when the utility compromise from complications of hormones was assumed to be considerable. Conclusions: Short-term hormone therapy seems to be beneficial for selected early-stage prostate cancer patients. The advantage seems to be greatest in the intermediate- and high-risk groups; with current follow-up, the side effects of hormones may outweigh their benefit in certain clinical situations in the favorable group. The present investigation demonstrates the significant role of the NNT technique for oncologic and radiotherapeutic management decisions when treatment complications need to be considered and balanced with the beneficial effects of the treatment

The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis treatment program.

Science.gov (United States)

Minor, Kyle S; Friedman-Yakoobian, Michelle; Leung, Y Jude; Meyer, Eric C; Zimmet, Suzanna V; Caplan, Brina; Monteleone, Thomas; Bryant, Caitlin; Guyer, Margaret; Keshavan, Matcheri S; Seidman, Larry J

2015-05-01

Functional impairments are debilitating concomitants of psychotic disorders and are present early in the illness course and, commonly, prior to psychosis onset. The factors affecting social and role functioning in early psychosis (EP) following treatment are unclear. We evaluated whether six months of participation in the PREP(R), Boston, EP treatment program, part of a public-academic community mental health center, was related to improvements in social and role functioning and whether premorbid adjustment in adolescence, baseline neurocognition, and depression symptoms predicted functional improvement. The Global Functioning Social and Role scales, MATRICS neurocognitive battery, and Calgary Depression Scale were assessed at baseline and six months during naturalistic treatment, while premorbid adjustment was measured at baseline. All participants were psychotic disorder patients in PREP(R) (n = 46 with social functioning and 47 with role functioning measures at both time points). Large improvements were observed in role functioning (d = 0.84) and medium to large improvements were observed in social functioning (d = 0.70). Models consisting of adolescent premorbid adjustment and change in depression symptoms predicted social and role functioning change, whereas neuropsychological functioning did not. Substantial improvements in social and role functioning were observed among this sample participating in a recovery-based EP program. The impact of clinical factors on social and role functioning was highlighted. Further studies of premorbid adjustment in adolescence and the treatment of depression in EP programs in controlled treatment trials are needed to confirm these findings. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Refractive accuracy with light-adjustable intraocular lenses.

Science.gov (United States)

Villegas, Eloy A; Alcon, Encarna; Rubio, Elena; Marín, José M; Artal, Pablo

2014-07-01

To evaluate efficacy, predictability, and stability of refractive treatments using light-adjustable intraocular lenses (IOLs). University Hospital Virgen de la Arrixaca, Murcia, Spain. Prospective nonrandomized clinical trial. Eyes with a light-adjustable IOL (LAL) were treated with spatial intensity profiles to correct refractive errors. The effective changes in refraction in the light-adjustable IOL after every treatment were estimated by subtracting those in the whole eye and the cornea, which were measured with a Hartmann-Shack sensor and a corneal topographer, respectively. The refractive changes in the whole eye and light-adjustable IOL, manifest refraction, and visual acuity were obtained after every light treatment and at the 3-, 6-, and 12-month follow-ups. The study enrolled 53 eyes (49 patients). Each tested light spatial pattern (5 spherical; 3 astigmatic) produced a different refractive change (Plight adjustments induced a maximum change in spherical power of the light-adjustable IOL of between -1.98 diopters (D) and +2.30 D and in astigmatism of up to -2.68 D with axis errors below 9 degrees. Intersubject variability (standard deviation) ranged between 0.10 D and 0.40 D. The 2 required lock-in procedures induced a small myopic shift (range +0.01 to +0.57 D) that depended on previous adjustments. Light-adjustable IOL implantation achieved accurate refractive outcomes (around emmetropia) with good uncorrected distance visual acuity, which remained stable over time. Further refinements in nomograms and in the treatment's protocol would improve the predictability of refractive and visual outcomes with these IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

19 CFR 201.205 - Salary adjustments.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt... of coverage, or a change in coverage, under a Federal benefits program requiring periodic deductions...

26 CFR 1.415(d)-1 - Cost-of-living adjustments.

Science.gov (United States)

2010-04-01

...)(A) dollar limitation pursuant to section 611(a)(1)(A) of the Economic Growth and Tax Relief... adjustments. (a) Defined benefit plans—(1) Dollar limitation—(i) Determination of adjusted limit. Under section 415(d)(1)(A), the dollar limitation described in section 415(b)(1)(A) applicable to defined...

Measuring the individual benefit of a medical or behavioral treatment using generalized linear mixed-effects models.

Science.gov (United States)

Diaz, Francisco J

2016-10-15

We propose statistical definitions of the individual benefit of a medical or behavioral treatment and of the severity of a chronic illness. These definitions are used to develop a graphical method that can be used by statisticians and clinicians in the data analysis of clinical trials from the perspective of personalized medicine. The method focuses on assessing and comparing individual effects of treatments rather than average effects and can be used with continuous and discrete responses, including dichotomous and count responses. The method is based on new developments in generalized linear mixed-effects models, which are introduced in this article. To illustrate, analyses of data from the Sequenced Treatment Alternatives to Relieve Depression clinical trial of sequences of treatments for depression and data from a clinical trial of respiratory treatments are presented. The estimation of individual benefits is also explained. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Science.gov (United States)

Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

2016-01-01

Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

Patients' Preferences Related to Benefits, Risks, and Formulations of Schizophrenia Treatment.

Science.gov (United States)

Levitan, Bennett; Markowitz, Michael; Mohamed, Ateesha F; Johnson, F Reed; Alphs, Larry; Citrome, Leslie; Bridges, John F P

2015-07-01

The objective of this study was to quantify patients' preferences related to benefits and risks of antipsychotic treatments for schizophrenia and to assess the relative importance of treatment attributes and adherence. Treatment-related preferences among U.S. residents with a self-reported physician diagnosis of schizophrenia were assessed via a discrete-choice experiment. Patients chose between competing hypothetical scenarios characterized by improvements in positive symptoms, negative symptoms, and social functioning; incidence of weight gain, extrapyramidal symptoms (EPS), hyperprolactinemia, and hyperglycemia; and medication formulation. Preferences were estimated by using a random-parameters logit model, and the impact of adherence was estimated with conditional logit models. The final sample consisted of 271 patients. Complete improvement in positive symptoms was the most preferred outcome (relative importance score of 10.0), followed by elimination of hyperglycemia (3.6, 95% confidence interval [CI]=2.6-4.6), improvement in negative symptoms (3.0, CI=1.6-4.3), reduced weight gain (2.6, CI=1.2-4.0), avoidance of hyperprolactinemia (1.7, CI=.9-2.6), improved social functioning (1.5, CI=.4-2.5), and avoidance of EPS (1.0, CI=.3-1.8). Patients judged a daily pill superior to monthly injections (p<.01) and monthly injections superior to injections every three months (p<.01) for adherent patients and monthly injections superior to a daily pill for nonadherent patients (p=.01). Persons who self-identified as having schizophrenia judged improvement in positive symptoms as the most important treatment benefit. Hyperglycemia was identified as the most important adverse event. Patients judged oral formulations to be better than monthly injections for adherent patients and monthly injections to be a better choice for nonadherent patients.

Ethics of treatment interruption trials in HIV cure research: addressing the conundrum of risk/benefit assessment

Science.gov (United States)

Henderson, Gail E; Peay, Holly L; Kroon, Eugene; Cadigan, Rosemary Jean; Meagher, Karen; Jupimai, Thidarat; Gilbertson, Adam; Fisher, Jill; Ormsby, Nuchanart Q; Chomchey, Nitiya; Phanuphak, Nittaya; Ananworanich, Jintanat; Rennie, Stuart

2018-01-01

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption (ATI), involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study nested in a Thai acute HIV research cohort. In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks. These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. PMID:29127137

Double-adjustment in propensity score matching analysis: choosing a threshold for considering residual imbalance.

Science.gov (United States)

Nguyen, Tri-Long; Collins, Gary S; Spence, Jessica; Daurès, Jean-Pierre; Devereaux, P J; Landais, Paul; Le Manach, Yannick

2017-04-28

Double-adjustment can be used to remove confounding if imbalance exists after propensity score (PS) matching. However, it is not always possible to include all covariates in adjustment. We aimed to find the optimal imbalance threshold for entering covariates into regression. We conducted a series of Monte Carlo simulations on virtual populations of 5,000 subjects. We performed PS 1:1 nearest-neighbor matching on each sample. We calculated standardized mean differences across groups to detect any remaining imbalance in the matched samples. We examined 25 thresholds (from 0.01 to 0.25, stepwise 0.01) for considering residual imbalance. The treatment effect was estimated using logistic regression that contained only those covariates considered to be unbalanced by these thresholds. We showed that regression adjustment could dramatically remove residual confounding bias when it included all of the covariates with a standardized difference greater than 0.10. The additional benefit was negligible when we also adjusted for covariates with less imbalance. We found that the mean squared error of the estimates was minimized under the same conditions. If covariate balance is not achieved, we recommend reiterating PS modeling until standardized differences below 0.10 are achieved on most covariates. In case of remaining imbalance, a double adjustment might be worth considering.

A framework for quantifying net benefits of alternative prognostic models.

Science.gov (United States)

Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

2012-01-30

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd.

A framework for quantifying net benefits of alternative prognostic models‡

Science.gov (United States)

Rapsomaniki, Eleni; White, Ian R; Wood, Angela M; Thompson, Simon G

2012-01-01

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd. PMID:21905066

Estimating the effect of treatment rate changes when treatment benefits are heterogeneous: antibiotics and otitis media.

Science.gov (United States)

Park, Tae-Ryong; Brooks, John M; Chrischilles, Elizabeth A; Bergus, George

2008-01-01

Contrast methods to assess the health effects of a treatment rate change when treatment benefits are heterogeneous across patients. Antibiotic prescribing for children with otitis media (OM) in Iowa Medicaid is the empirical example. Instrumental variable (IV) and linear probability model (LPM) are used to estimate the effect of antibiotic treatments on cure probabilities for children with OM in Iowa Medicaid. Local area physician supply per capita is the instrument in the IV models. Estimates are contrasted in terms of their ability to make inferences for patients whose treatment choices may be affected by a change in population treatment rates. The instrument was positively related to the probability of being prescribed an antibiotic. LPM estimates showed a positive effect of antibiotics on OM patient cure probability while IV estimates showed no relationship between antibiotics and patient cure probability. Linear probability model estimation yields the average effects of the treatment on patients that were treated. IV estimation yields the average effects for patients whose treatment choices were affected by the instrument. As antibiotic treatment effects are heterogeneous across OM patients, our estimates from these approaches are aligned with clinical evidence and theory. The average estimate for treated patients (higher severity) from the LPM model is greater than estimates for patients whose treatment choices are affected by the instrument (lower severity) from the IV models. Based on our IV estimates it appears that lowering antibiotic use in OM patients in Iowa Medicaid did not result in lost cures.

Patient benefit index (PBI) in the treatment of psoriasis--results of the National Care Study "PsoHealth".

Science.gov (United States)

Radtke, Marc Alexander; Schäfer, Ines; Blome, Christine; Augustin, Matthias

2013-04-01

Psoriasis vulgaris is a common disease that follows a chronic course. So far, few studies have addressed outcome methods which evaluate the benefits of drugs and medical devices by measuring patient preferences. Assessment of patients' outcomes using the "Patient benefit index" (PBI), a validated goal attainment scaling tool, in the treatment of psoriasis. Data were obtained within an epidemiological study in 2,009 patients with psoriasis vulgaris and/or psoriatic arthritis. Cross-sectional study in 133 nationwide German dermatological practices and hospital departments. The following were recorded a) in the doctors' questionnaire--previous treatments and diseases, clinical characteristics and psoriasis area and severity index (PASI), b) in the patients' questionnaire--quality of life (LQ), patient-relevant therapeutic benefits and satisfaction with care. On average, patients achieved a total PBI of 2.5±1.1. 86.7% of patients showed a more than minimum benefit (PBI>1). Patients treated with biologicals had a higher benefit (mean PBI 3.0) than patients in other groups (e.g. PBI 2.6 in systemics). PBI values indicate that systemic agents and biologics are of high therapeutic benefit to the vast majority of patients. The development of the PBI has enabled a decisive step to be taken in the area of scientifically-based outcome assessments.

Cost-benefit analysis of 3D conformal radiation therapy. Treatment of prostate cancer as a model

International Nuclear Information System (INIS)

Cho, K.H.; Khan, F.M.; Levitt, S.H.

1999-01-01

Three-dimensional conformal radiation therapy (3D-CRT) is a promising new treatment technique based on the principle that improved precision in both tumor definition and dose delivery will enhance outcomes by maximizing dose to the tumor area while minimizing dose to normal tissue. Using a cost-benefit analysis, in terms of outcomes, we first examined the overall risks and benefits of 3D-CRT. We then used the treatment of prostate cancer as a model to compare actual clinical outcomes reported between 3D-CRT and standard radiation therapy (SRT). Our analysis shows that application of 3D-CRT to the clinical setting remains difficult because of the continual difficulties of target definition, and that dose escalation cannot yet be justified on the basis of the lack of benefit found, and suggested increased late toxicity, in most of the dose escalation series compared with SRT. (orig.)

Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial.

Science.gov (United States)

Lam, Phillip H; Dooley, Daniel J; Fonarow, Gregg C; Butler, Javed; Bhatt, Deepak L; Filippatos, Gerasimos S; Deedwania, Prakash; Forman, Daniel E; White, Michel; Fletcher, Ross D; Arundel, Cherinne; Blackman, Marc R; Adamopoulos, Chris; Kanonidis, Ioannis E; Aban, Inmaculada B; Patel, Kanan; Aronow, Wilbert S; Allman, Richard M; Anker, Stefan D; Pitt, Bertram; Ahmed, Ali

2018-02-01

To examine associations of below-target and target dose of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial. Two thousand five hundred and sixty-nine patients with HFrEF (ejection fraction ≤35%) were randomized to below-target (5-10 mg/day) dose placebo (n = 1284) or enalapril (n = 1285). One month post-randomization, blind up-titration to target (20 mg/day) dose was attempted for both study drugs in 2458 patients. Among the 1444 patients who achieved dose up-titration (placebo, n = 748; enalapril, n = 696; mean dose for both groups, 20.0 mg/day), target dose enalapril (vs. target dose placebo) was associated with a 9% absolute lower risk of the combined endpoint of heart failure hospitalization or all-cause mortality [adjusted hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.60-0.81; P target dose (placebo, n = 486; enalapril, n = 528; mean dose for both groups, 8.8 mg/day), below-target dose enalapril (vs. below-target dose placebo) was associated with a 12% absolute lower risk of the combined endpoint of heart failure hospitalization or all-cause mortality (adjusted HR 0.68; 95% CI 0.57-0.81; P target (vs. below-target) dose had no association with the combined endpoint of heart failure hospitalization or all-cause mortality (adjusted HR 1.04; 95% CI 0.87-1.23; P = 0.695). In patients with HFrEF, the clinical benefits of ACE inhibitors appear to be similar at both below-target and target doses. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

Impact of sleep disturbance on patients in treatment for mental disorders

Directory of Open Access Journals (Sweden)

Kallestad Håvard

2012-10-01

Full Text Available Abstract Background In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics. Method 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses. Results Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment. Conclusion Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control.

Science.gov (United States)

Karlsson, Linda; Mesterton, Johan; Tepie, Maurille Feudjo; Intorcia, Michele; Overbeek, Jetty; Ström, Oskar

2017-09-21

Using Swedish and Dutch registry data for women initiating bisphosphonates, we evaluated two methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for differences in patient baseline characteristics. Each method has advantages and disadvantages; both are potential complements to clinical trial analyses. We evaluated methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for both observed and unobserved confounding. Swedish and Dutch registry data for women initiating zoledronate or oral bisphosphonates (OBPs; alendronate/risedronate) were used; the primary outcome was fracture. In adjusted direct comparisons (ADCs), regression and matching techniques were used to account for baseline differences in known risk factors for fracture (e.g., age, previous fracture, comorbidities). In an own-control analysis (OCA), for each treatment, fracture incidence in the first 90 days following treatment initiation (the baseline risk period) was compared with fracture incidence in the 1-year period starting 91 days after treatment initiation (the treatment exposure period). In total, 1196 and 149 women initiating zoledronate and 14,764 and 25,058 initiating OBPs were eligible in the Swedish and Dutch registries, respectively. Owing to the small Dutch zoledronate sample, only the Swedish data were used to compare fracture incidences between treatment groups. ADCs showed a numerically higher fracture incidence in the zoledronate than in the OBPs group (hazard ratio 1.09-1.21; not statistically significant, p > 0.05). For both treatment groups, OCA showed a higher fracture incidence in the baseline risk period than in the treatment exposure period, indicating a treatment effect. OCA showed a similar or greater effect in the zoledronate group compared with the OBPs group. ADC and OCA each possesses advantages and disadvantages. Combining both methods may provide an estimate of real

Does infertility cause marital benefit? An epidemiological study of 2250 women and men in fertility treatment

DEFF Research Database (Denmark)

Schmidt, Lone; Holstein, Bjørn; Christensen, Ulla

2005-01-01

OBJECTIVE: To investigate (i) marital benefit, e.g., that infertility has strengthen the marriage and brought the partners closer together among people beginning fertility treatment and (ii) communication and coping strategies as predictors of marital benefit 12 months later. METHODS: A prospective...... the infertility as a secret, difficult marital communication, and using active-avoidance coping (e.g., avoid being with pregnant women or children, turning to work to take mind off things) were among men significant predictors for low marital benefit. No significant predictors were identified among women...

Longitudinal Associations between Keeping a Secret and Psychosocial Adjustment in Adolescence

Science.gov (United States)

Frijns, Tom; Finkenauer, Catrin

2009-01-01

Increasing bodies of evidence suggest that keeping secrets may be detrimental to well-being and adjustment, whereas confiding secrets may alleviate the detriments of secrecy and benefit well-being and adjustment. However, few studies have addressed the consequences of keeping and confiding secrets simultaneously, and even fewer have done so…

Salmeterol/fluticasone stable-dose treatment compared with formoterol/budesonide adjustable maintenance dosing: impact on health-related quality of life

Directory of Open Access Journals (Sweden)

Williams Angela E

2007-07-01

Full Text Available Abstract Background Improving patients' health-related quality of life (HRQoL is recognized as a fundamental part of asthma management. The aims of this study were to evaluate the long-term efficacy (including symptom-free days and exacerbations and impact on HRQoL of a stable-dose regimen of salmeterol/fluticasone propionate (SAL/FP and an adjustable maintenance dosing (AMD regimen of formoterol/budesonide (FOR/BUD where treatment is adjusted based on symptoms [SAM40056]. Methods A total of 688 outpatients with asthma receiving regular low-dose inhaled corticosteroids (ICS plus a long-acting β2-agonist, or medium dose ICS alone participated in this randomized, double-blind, double-dummy, parallel-group, 1-year trial, which was conducted in 91 centers in 15 countries. Patients were randomized to receive 1 inhalation of SAL/FP 50/250 μg BID or 2 inhalations of FOR/BUD 6/200 μg BID during Weeks 1–4. For Weeks 5–52, patients meeting strict continuation criteria for stable asthma at Week 4 received AMD with FOR/BUD or stable-dose SAL/FP. Results The percentage of symptom-free days was significantly greater (58.8% vs 52.1%; p = 0.034 and the annual exacerbation rate was significantly lower (47%; p = 0.008 with stable-dose SAL/FP compared with FOR/BUD AMD. A total of 568 patients completed the Asthma Quality of Life Questionnaire (AQLQ at least once during the study. The mean change from baseline in AQLQ overall score was numerically greater with SAL/FP than FOR/BUD at week 28 and week 52, but did not reach statistical significance (p = 0.121 at Week 52. However, in a post hoc logistic regression analyses for any AQLQ improvement, significant benefits with SAL/FP were seen at both time points (p = 0.038 and p = 0.009, respectively. The minimally important difference of ≥ 0.5-point improvement in AQLQ overall score was achieved by a significantly greater number of patients receiving SAL/FP at Week 28 (68% vs 60%; p = 0.049; a trend for this

How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

Medline Plus

Full Text Available ... with depression and adjustment to my SCI? How do I deal with depression and adjustment to my ... can I apply for Social Security benefits? How do I find a rehabilitation facility? How can I ...

48 CFR 652.216-71 - Price Adjustment.

Science.gov (United States)

2010-10-01

...) The contract price may be increased or decreased in actual costs of direct service labor which result...] Government. Direct service labor costs include only the costs of wages and direct benefits (such as social... number] of this contract. Price adjustments will include only changes in direct service labor costs...

Investigating the benefits of molecular profiling of advanced non-small cell lung cancer tumors to guide treatments.

Science.gov (United States)

Alifrangis, Costi; Carter, Philip; Cereser, Biancastella; Chandrasinghe, Pramodh; Belluz, Lisa Del Bel; Lim, Eric; Moderau, Nina; Poyia, Fotini; Tabassum, Neha; Zhang, Hua; Krell, Jonathan; Stebbing, Justin

2018-02-27

In this study we utilized data on patient responses to guided treatments, and we evaluated their benefit for a non-small cell lung cancer cohort. The recommended therapies used were predicted using tumor molecular profiles that involved a range of biomarkers but primarily used immunohistochemistry markers. A dataset describing 91 lung non-small cell lung cancer patients was retrospectively split into two. The first group's drugs were consistent with a treatment plan whereby all drugs received agreed with their tumor's molecular profile. The second group each received one or more drug that was expected to lack benefit. We found that there was no significant difference in overall survival or mortality between the two groups. Patients whose treatments were predicted to be of benefit survived for an average of 402 days, compared to 382 days for those that did not ( P = 0.7934). In the matched treatment group, 48% of patients were deceased by the time monitoring had finished compared to 53% in the unmatched group ( P = 0.6094). The immunohistochemistry biomarker for the ERCC1 receptor was found to be a marker that could be used to predict future survival; ERCC1 loss was found to be predictive of poor survival.

Ethics of treatment interruption trials in HIV cure research: addressing the conundrum of risk/benefit assessment.

Science.gov (United States)

Henderson, Gail E; Peay, Holly L; Kroon, Eugene; Cadigan, Rosemary Jean; Meagher, Karen; Jupimai, Thidarat; Gilbertson, Adam; Fisher, Jill; Ormsby, Nuchanart Q; Chomchey, Nitiya; Phanuphak, Nittaya; Ananworanich, Jintanat; Rennie, Stuart

2018-04-01

Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption (ATI), involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study nested in a Thai acute HIV research cohort.In-depth interviews revealed central themes about decisions to join. Participants felt they possessed an important identity as members of the acute cohort, viewing their bodies as uniquely suited to both testing and potentially benefiting from HIV cure approaches. While acknowledging risks of ATI, most perceived they were given an opportunity to interrupt treatment, to test their own bodies and increase normalcy in a safe, highly monitored circumstance. They were motivated by potential benefits to themselves, the investigators and larger acute cohort, and others with HIV. They believed their own trial experiences and being able to give back to the community were sufficient to offset participation risks.These decisions were driven by the specific circumstances experienced by our participants. Judging risk/benefit ratios without appreciating these lived experiences can lead to false determinations of irrational decision- making. While this does not minimise vital oversight considerations about risk reduction and protection from harm, it argues for inclusion of a more participant-centered approach. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Patterns of Spillover Between Marital Adjustment and Parent-Child Conflict During Pediatric Cancer Treatment.

Science.gov (United States)

Fladeboe, Kaitlyn; Gurtovenko, Kyrill; Keim, Madelaine; Kawamura, Joy; King, Kevin M; Friedman, Debra L; Compas, Bruce E; Breiger, David; Lengua, Liliana J; Katz, Lynn Fainsilber

2018-03-17

 When a child is diagnosed with cancer, problems may arise in family relationships and negatively affect child adjustment. The current study examined patterns of spillover between marital and parent-child relationships to identify targets for intervention aimed at ameliorating family conflict.  Families (N = 117) were recruited from two US children's hospitals within 2-week postdiagnosis to participate in a short-term prospective longitudinal study. Children with cancer were 2-10 years old (M = 5.42 years, SD = 2.59). Primary caregivers provided reports of marital and parent-child conflict at 1-, 6-, and 12-month postdiagnosis.  Results indicated that a unidirectional model of spillover from the marital to the parent-child relationship best explained the data. In terms of specific temporal patterns, lower marital adjustment soon after diagnosis was associated with an increase in parent-child conflict 6 months later, though this pattern was not repeated in the latter 6 months of treatment.  Targeting problems in marital relationships soon after diagnosis may prevent conflict from developing in the parent-child relationship.

Helicobacter pylori eradication treatment does not benefit patients with nonulcer dyspepsia.

Science.gov (United States)

Froehlich, F; Gonvers, J J; Wietlisbach, V; Burnand, B; Hildebrand, P; Schneider, C; Saraga, E; Beglinger, C; Vader, J P

2001-08-01

The aim of this study was to assess the still controversial role of treatment of Helicobacter pylori (H. pylori) infection in patients with nonulcer dyspepsia. We conducted a double-blind, randomized, placebo-controlled, multicenter trial comparing the efficacy of 7 days of eradication treatment (lansoprazole 15 mg b.i.d., amoxicillin I g b.i.d., and clarithromycin 500 mg b.i.d.) with a control treatment (lansoprazole 15 mg b.i.d. and placebo) in H. pylori-infected patients with nonulcer dyspepsia. 13C breath tests were performed at baseline and during follow-up. We assessed patient symptoms, health status (based on the SF-12 questionnaire), patient satisfaction, drug consumption, health care consultation behavior, and absenteeism related to dyspepsia over a 1-yr period. A total of 74 patients randomized to eradication treatment and 70 patients randomized to placebo were compared. The rate of eradication of H. pylori infection was 75% in the active treatment group and 4% in the placebo group (p absenteeism or satisfaction with management of NUD. Patients receiving active treatment were more likely not to have had to use any dyspepsia treatment over the 12 months (60.8% vs 44.3%; p = 0.047). This study did not demonstrate any substantial benefit of curing H. pylori infection in patients with nonulcer dyspepsia. The study adds further evidence that H. pylori is not the main pathogenetic or therapeutic target in these patients.

75 FR 62760 - Trade Adjustment Assistance for Farmers

Science.gov (United States)

2010-10-13

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers... Farmers Program Review Committee, comprised of representatives from USDA's Office of the Chief Economist... program in order to be eligible for cash benefits. PRODUCERS CERTIFIED AS ELIGIBLE FOR TAA FOR FARMERS...

Oxytocin and potential benefits for obesity treatment.

Science.gov (United States)

Olszewski, Pawel K; Klockars, Anica; Levine, Allen S

2017-10-01

Laboratory animal experiments have consistently shown that oxytocin causes early termination of food intake, thereby promoting a decrease in body weight in a long term. Recent studies have also assessed some of oxytocin's effects on appetite and energy balance in humans. The present study examines the findings of the key basic research and of the few clinical studies published thus far in the context of potential benefits and challenges stemming from the use of oxytocin in obese patients. Basic research indicates the involvement of oxytocin in satiety, processing, in reducing a drive to eat for pleasure and because of psychosocial factors. Although the results of clinical studies are very scarce, they suggest that oxytocin administered intranasally in humans decreases energy-induced and reward-induced eating, supports cognitive control of food choices, and improves glucose homeostasis, and its effectiveness may be BMI dependent. Despite the wealth of basic research showing broad anorexigenic effects of oxytocin, clinical studies on oxytocin's therapeutic potential in obesity, are still in their infancy. Future implementation of oxytocin-based pharmacological strategies in controlling energy balance will likely depend on our ability to integrate diverse behavioral and metabolic effects of oxytocin in obesity treatment regimens.

Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients' acceptance of treatment?

Science.gov (United States)

Hux, J E; Naylor, C D

1995-01-01

Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction--"34% reduction in heart attacks"--88% of the patients assented to therapy. All other formats elicited significantly more refusals (p benefits are presented. Multiple complementary formats may be most appropriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit.

The Benefits of Continuous Leisure Participation in Relocation Adjustment Among Residents of Long-Term Care Facilities.

Science.gov (United States)

Lin, Li-Jung; Yen, Hsin-Yen

2018-03-19

The rising population of older adults is transforming Taiwan society. Although many long-term care facilities now operate for older adults, the transition from the home environment to long-term facilities may cause multiple issues, including relocation stress syndrome, for new residents. Autonomy is a critical element of the human experience. Leisure, as an expression of autonomy, has been shown to enhance self-image and promote feelings of competence and mastery. The aim of this study was to assess the relationship between participation in leisure activities and adjustment to residential care using the continuity theory. One hundred sixty-three qualified individuals from 11 long-term care institutions were recruited and completed the questionnaire. The sampling criteria for the study were age (55+ years), appropriate cognitive skills, and residency (less than 5 years). Interviews conducted by trained interviewers were used to collect data. Measured outcomes included leisure participation; physical, psychological, and social adjustments; and background information. Cluster analysis, descriptive analysis, multivariate analysis of variance, and least significant difference test were used in analysis. Type of admission (voluntary/mandated) and type of leisure participation significantly affected the level of relocation adjustment success. Four leisure behavior categories were identified, including reduced participation, expanded participation, active participation, and continuing participation. The participants in the active and continuing participation categories had significantly higher psychological adjustment than their peers in the reduced participation category. Moreover, the continuing participation category had a significantly better level of social adjustment than their expanded participation category peers. Continuous and active participation categories had a beneficial outcome in relocation adjustment. The findings support that, in general, residents of

Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

Science.gov (United States)

Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

2018-02-21

The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p reimbursement (p reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that

Adjustable perineal male sling using tissue expander as an effective treatment of post-prostatectomy urinary incontinence

Directory of Open Access Journals (Sweden)

Melih Balci

2015-04-01

Full Text Available Purpose To report our intermediate experience in treating patients with severe incontinence using an adjustable perineal male sling with a tissue expander. Materials and Methods An adjustable male sling procedure was performed on 21 patients with severe incontinence. The underlying etiology of urinary incontinence was radical prostatectomy in 13 patients, open prostatectomy in 5 patients and transurethral prostate resection in 3 patients. The difference between the classical and the adjustable sling is that in the latter there is a 25 mL tissue expander between the two layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via an inflation port, in case of recurrence or persistence of incontinence. Results The mean age of the patients was 66.2±7.3 (50-79 years and mean pad usage was 6.4±0.6 per day. The mean follow-up time was 40.1±23.2 (6-74 months. The balloon was postoperatively inflated on average with 11.6±5.7 (5-25 mL. After the mean 40.1 months of follow-up, 16 of the 21 patients (76.2% were dry (11 patients, 0 pads; 5 patients using safety pads, 3 patients (14% had mild and 2 (9.8% had moderate degree post-prostatectomy urinary incontinence (PPI. The average maximum urine flow rate of the patients was 15.6±4.7 (10-31 mL/s. No residual urine was found. In 2 patients, all parts of the device were removed due to infection and discomfort, and in 3 patients only the inflation component was removed due to local scrotal infection. Conclusions Our results show that using an adjustable perineal male sling with a tissue expander seems to be an efficient, and safe surgical treatment option in patients with PPI.

Quantifying Treatment Benefit in Molecular Subgroups to Assess a Predictive Biomarker.

Science.gov (United States)

Iasonos, Alexia; Chapman, Paul B; Satagopan, Jaya M

2016-05-01

An increased interest has been expressed in finding predictive biomarkers that can guide treatment options for both mutation carriers and noncarriers. The statistical assessment of variation in treatment benefit (TB) according to the biomarker carrier status plays an important role in evaluating predictive biomarkers. For time-to-event endpoints, the hazard ratio (HR) for interaction between treatment and a biomarker from a proportional hazards regression model is commonly used as a measure of variation in TB. Although this can be easily obtained using available statistical software packages, the interpretation of HR is not straightforward. In this article, we propose different summary measures of variation in TB on the scale of survival probabilities for evaluating a predictive biomarker. The proposed summary measures can be easily interpreted as quantifying differential in TB in terms of relative risk or excess absolute risk due to treatment in carriers versus noncarriers. We illustrate the use and interpretation of the proposed measures with data from completed clinical trials. We encourage clinical practitioners to interpret variation in TB in terms of measures based on survival probabilities, particularly in terms of excess absolute risk, as opposed to HR. Clin Cancer Res; 22(9); 2114-20. ©2016 AACR. ©2016 American Association for Cancer Research.

Mexican-Origin Parents’ Differential Treatment and Siblings’ Adjustment from Adolescence to Young Adulthood

Science.gov (United States)

McHale, Susan M.; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.

2016-01-01

Parents’ differential treatment is a common family dynamic that has been linked to youth’s well-being in childhood and adolescence in European American families. Much less is known, however, about this family process in other ethnic groups. We examined the longitudinal associations between parents’ differential treatment (PDT) and both depressive symptoms and risky behaviors of Mexican-origin sibling pairs from early adolescence through young adulthood. We also tested the moderating roles of cultural orientations as well as youth age, gender and sibling dyad gender constellation in these associations. Participants were mothers, fathers, and two siblings from 246 Mexican-origin families who participated in individual home interviews on 3 occasions over 8 years. Multilevel models revealed that, controlling for dyadic parent-child relationship qualities (i.e., absolute levels of warmth and conflict), adolescents who had less favorable treatment by mothers relative to their sibling reported more depressive symptoms and risky behavior, on average. Findings for fathers’ PDT emerged at the within-person level indicating that, on occasions when adolescents experienced less favorable treatment by fathers than usual, they reported more depressive symptoms and risky behavior. However, some of these effects were moderated by youth age and cultural socialization. For example, adolescents who experienced relatively less paternal warmth than their siblings also reported poorer adjustment, but this effect did not emerge for young adults; such an effect also was significant for unfavored youth with stronger but not weaker cultural orientations. PMID:27504752

A reconstructed melanoma data set for evaluating differential treatment benefit according to biomarker subgroups

Directory of Open Access Journals (Sweden)

Jaya M. Satagopan

2017-06-01

Full Text Available The data presented in this article are related to the research article entitled “Measuring differential treatment benefit across marker specific subgroups: the choice of outcome scale” (Satagopan and Iasonos, 2015 [1]. These data were digitally reconstructed from figures published in Larkin et al. (2015 [2]. This article describes the steps to digitally reconstruct patient-level data on time-to-event outcome and treatment and biomarker groups using published Kaplan-Meier survival curves. The reconstructed data set and the corresponding computer programs are made publicly available to enable further statistical methodology research.

Adolescent Leisure Dimensions, Psychosocial Adjustment, and Gender Effects

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Bradley, Graham L.; Inglis, Brad C.

2012-01-01

Leisure provides the context for much of adolescent behaviour and development. While both theory and research point to the benefits of participation in leisure activities that are highly structured, the association between structured leisure and psychosocial adjustment is not uniformly high. This paper presents a model of adolescent leisure…

Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage

DEFF Research Database (Denmark)

Eaton, Jeffrey W; Menzies, Nicolas A; Stover, John

2014-01-01

therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. METHODS: We used several independent mathematical models in four settings-South Africa (generalised...... epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits......, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μ...

Electromagnetic treatment to old Alzheimer's mice reverses β-amyloid deposition, modifies cerebral blood flow, and provides selected cognitive benefit.

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Gary W Arendash

Full Text Available Few studies have investigated physiologic and cognitive effects of "long-term" electromagnetic field (EMF exposure in humans or animals. Our recent studies have provided initial insight into the long-term impact of adulthood EMF exposure (GSM, pulsed/modulated, 918 MHz, 0.25-1.05 W/kg by showing 6+ months of daily EMF treatment protects against or reverses cognitive impairment in Alzheimer's transgenic (Tg mice, while even having cognitive benefit to normal mice. Mechanistically, EMF-induced cognitive benefits involve suppression of brain β-amyloid (Aβ aggregation/deposition in Tg mice and brain mitochondrial enhancement in both Tg and normal mice. The present study extends this work by showing that daily EMF treatment given to very old (21-27 month Tg mice over a 2-month period reverses their very advanced brain Aβ aggregation/deposition. These very old Tg mice and their normal littermates together showed an increase in general memory function in the Y-maze task, although not in more complex tasks. Measurement of both body and brain temperature at intervals during the 2-month EMF treatment, as well as in a separate group of Tg mice during a 12-day treatment period, revealed no appreciable increases in brain temperature (and no/slight increases in body temperature during EMF "ON" periods. Thus, the neuropathologic/cognitive benefits of EMF treatment occur without brain hyperthermia. Finally, regional cerebral blood flow in cerebral cortex was determined to be reduced in both Tg and normal mice after 2 months of EMF treatment, most probably through cerebrovascular constriction induced by freed/disaggregated Aβ (Tg mice and slight body hyperthermia during "ON" periods. These results demonstrate that long-term EMF treatment can provide general cognitive benefit to very old Alzheimer's Tg mice and normal mice, as well as reversal of advanced Aβ neuropathology in Tg mice without brain heating. Results further underscore the potential for EMF

[Laparoscopic adjustable gastric-banding treatment for morbid obesity our first year experience].

Science.gov (United States)

Iordache, N; Vizeteu, R; Iorgulescu, A; Zmeu, B; Iordache, M

2003-01-01

The authors present the results of a prospective study regarding their 1st year experience in laparoscopic adjustable gastric banding (LABG), which included 21 patients (5 males, 16 females), with an average age of 39 (between 20-53 years). The follow up was made at one and six months postoperative. The medium weight was 138 kg (between 95-172 kg), with a medium excess of body mass of 66.89 kg (extremes between 27.75 and 104 kg). The medium BMI (body mass index) was 48.9 (extremes: 34.5-66), 8 patients being superobese (BMI > 50). The average operating time was 120 min, all operations were finished laparosopically. Postoperative complications were: total disfagia (1 case), parietal suppuration (2 cases) and partial intragastric migration of the prosthesis (1 case). There were no deceased patients. The medium excess of body mass at 6 months after surgery was 46.57 (only 13 patients evaluated in this interval). After 6 months postoperative the comorbidities were healed at half of the patients. Although we do not benefit of a long time follow up, the favorable initial results permits us to state that LABG must find its place in the efforts of struggling against obesity and its consequences.

Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review

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Diederik C Bervoets

2015-07-01

Full Text Available Question: Is massage therapy effective for people with musculoskeletal disorders compared to any other treatment or no treatment? Design: Systematic review of randomised clinical trials. Participants: People with musculoskeletal disorders. Interventions: Massage therapy (manual manipulation of the soft tissues as a stand-alone intervention. Outcome: The primary outcomes were pain and function. Results: The 26 eligible randomised trials involved 2565 participants. The mean sample size was 95 participants (range 16 to 579 per study; 10 studies were considered to be at low risk of bias. Overall, low-to-moderate-level evidence indicated that massage reduces pain in the short term compared to no treatment in people with shoulder pain and osteoarthritis of the knee, but not in those with low back pain or neck pain. Furthermore, low-to-moderate-level evidence indicated that massage improves function in the short term compared to no treatment in people with low back pain, knee arthritis or shoulder pain. Low-to-very-low-level evidence from single studies indicated no clear benefits of massage over acupuncture, joint mobilisation, manipulation or relaxation therapy in people with fibromyalgia, low back pain and general musculoskeletal pain. Conclusions: Massage therapy, as a stand-alone treatment, reduces pain and improves function compared to no treatment in some musculoskeletal conditions. When massage is compared to another active treatment, no clear benefit was evident. [Bervoets DC, Luijsterburg PAJ, Alessie JJN, Buijs MJ, Verhagen AP (2015 Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of Physiotherapy 61: 106–116

Using a patient-centered approach to benefit-harm assessment in treatment decision-making: a case study in uveitis.

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Yu, Tsung; Holbrook, Janet T; Thorne, Jennifer E; Puhan, Milo A

2016-04-01

Synthesizing evidence from comparative effectiveness trials can be difficult because multiple outcomes of different importance are to be considered. The goal of this study was to demonstrate an approach to conducting quantitative benefit-harm assessment that considers patient preferences. We conducted a benefit-harm assessment using data from the Multicenter Uveitis Steroid Treatment Trial that compared corticosteroid implant versus systemic corticosteroids and immunosuppression in non-infectious intermediate, posterior, and panuveitis. We focused on clinical outcomes considered important to patients, including visual acuity, development of cataracts/glaucoma, need for eye surgery, prescription-requiring hypertension, hyperlipidemia, and infections. Patient preferences elicited in a recent survey were then incorporated into our assessment of the benefit-harm balance. Benefit-harm metrics were calculated for each time point that summarized the numbers of outcomes, caused or prevented by implant therapy versus systemic therapy if 1000 patients were treated. The benefit-harm metric was -129 (95% confidence interval: -242 to -14), -317 (-436 to -196), -390 (-514 to -264), and -526 (-687 to -368) at 6, 12, 18, and 24 months follow up, respectively, suggesting that systemic therapy may have a better benefit-harm balance. However, measures of quality of life for patients treated with implant therapy were found to be better than patients treated with systemic therapy over the same time period. Results of benefit-harm assessment were different from the prospectively collected quality of life data during trial follow up. Future studies should explore the reasons for such discrepancies and the strength and weakness of each method to assess treatment benefits and harms. Copyright © 2016 John Wiley & Sons, Ltd.

Who Benefits from Gender Responsive Treatment? Accounting for Abuse History on Longitudinal Outcomes for Women in Prison.

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Saxena, Preeta; Messina, Nena; Grella, Christine E

2014-04-01

This study explores outcome variation among women offenders who participated in gender-responsive substance abuse treatment (GRT). In order to identify subgroups of participants that may differentially benefit from this treatment, secondary analyses examined the interaction between randomization into GRT and a history of abuse (physical/sexual) on depression and number of substances used post- treatment. The sample consisted of 115 incarcerated women assessed at baseline and 6- and 12-months post parole. Longitudinal regression showed that women reporting abuse randomized into GRT had significantly reduced odds of depression ( OR = .29, p < .05, 95% CI = .10 - .86) and lowered rates of number of substances used ( IRR = .52, p < .05, 95% CI = 0.28-0.98), in comparison to those who reported abuse and were randomized to the non-GRT group. GRT for women offenders who have experienced prior abuse would maximize the benefits of the trauma-informed, gender-sensitive intervention.

Protocol for the saMS trial (supportive adjustment for multiple sclerosis: a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

Directory of Open Access Journals (Sweden)

McCrone Paul

2009-08-01

Full Text Available Abstract Background Multiple Sclerosis (MS is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a Cognitive Behavioural intervention compared to Supportive Listening to assist adjustment in the early stages of MS. Methods/Design This is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks, mid-therapy (week 5 of therapy, post-therapy (15 weeks and at six months (26 weeks and twelve months (52 weeks follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants' experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. Discussion This trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the

Correlation dynamics and international diversification benefits

DEFF Research Database (Denmark)

Christoffersen, Peter; Errunza, Vihang; Jacobs, Kris

2014-01-01

that it is possible to model co-movements for many countries simultaneously using BEKK, DCC, and DECO models. Empirically, we find that correlations have trended upward significantly for both DMs and EMs. Based on a time-varying measure of diversification benefits, we find that it is not possible to circumvent...... the increasing correlations in a long-only portfolio by adjusting the portfolio weights over time. However, we do find some evidence that adding EMs to a DM-only portfolio increases diversification benefits....

Correlation Dynamics and International Diversification Benefits

DEFF Research Database (Denmark)

Christoffersen, Peter; Errunza, Vihang R.; Jacobs, Kris

that it is possible to model co-movements for many countries simultaneously using BEKK, DCC, and DECO models. Empirically, we find that correlations have significantly trended upward for both DMs and EMs. Based on a time-varying measure of diversification benefit, we find that it is not possible in a long......-only portfolio to circumvent the increasing correlations by adjusting the portfolio weights over time. However, we do find some evidence that adding EMs to a DM-only portfolio increases diversification benefits....

Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes

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Hagen, Anja

2007-01-01

Full Text Available Scientific background: Poor compliance or adherence in drug therapy can cause increased morbidity, mortality and enormous costs in the healthcare system (in Germany annually approximately 10 billion euros. Different methods are used for enhancing the compliance or adherence. Research questions: The evaluation addresses the questions about existence, efficacy, cost-benefit relation as well as ethical-social and juridical implications of strategies for enhancing compliance or adherence in drug therapy with concomitant improvements in treatment outcomes. Methods: A systematic literature search was conducted in the medical, also health economic relevant, literature databases in January 2007, beginning from 2002. Systematic reviews on the basis of (randomised controlled trials (RCT concerning interventions to enhance compliance or adherence with regard to treatment outcomes as well as systematic reviews of health economic analyses were included in the evaluation. Additionally, it was also searched for publications which primarily considered ethical-social and juridical aspects of these interventions for the German context. Results: One systematic review with data for 57 RCT was included in the medical evaluation and one systematic review with data for six studies into the health economic evaluation. No publication primary concerning ethical-social or juridical implications could be identified. A significant positive effect on the treatment outcome was reported for 22 evaluated interventions. For many interventions the results can be classified as reliable: counseling with providing an information leaflet and compliance diary chart followed by phone consultation for helicobacter pylori positive patients, repeated counseling for patients with acute asthma symptoms, telephone calls to establish the level of compliance and to make recommendations based on that for the therapy of cardiovascular diseases, calls of an automated telephone system with phone

Hope, quality of life, and benefit from treatment in women having chemotherapy for platinum-resistant/refractory recurrent ovarian cancer: the gynecologic cancer intergroup symptom benefit study.

Science.gov (United States)

Sjoquist, Katrin M; Friedlander, Michael L; O'Connell, Rachel L; Voysey, Merryn; King, Madeleine T; Stockler, Martin R; Oza, Amit M; Gillies, Kim; Martyn, Julie K; Butow, Phyllis N

2013-01-01

Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12-16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio. Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r = 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r = -0.43) and depression (r = -0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49-0.96; p = .026). Conclusion. Trait hope and expectation of symptom benefit from chemotherapy appear to be distinct and independent of the aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefit from chemotherapy was not fulfilled were more likely to have scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy.

Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet

Science.gov (United States)

Selter, Jessica H.; Turner, Zahava; Doerrer, Sarah C.; Kossoff, Eric H.

2014-01-01

Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007-2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments lead to >50% further seizure reduction in-18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs. 15%, p = 0.08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). PMID:24859788

Mexican-origin parents' differential treatment and siblings' adjustment from adolescence to young adulthood.

Science.gov (United States)

Padilla, Jenny; McHale, Susan M; Updegraff, Kimberly A; Umaña-Taylor, Adriana J

2016-12-01

Parents' differential treatment is a common family dynamic that has been linked to youth's well-being in childhood and adolescence in European American families. Much less is known, however, about this family process in other ethnic groups. The authors examined the longitudinal associations between parents' differential treatment (PDT) and both depressive symptoms and risky behaviors of Mexican-origin sibling pairs from early adolescence through young adulthood. They also tested the moderating roles of cultural orientations as well as youth age, gender and sibling dyad gender constellation in these associations. Participants were mothers, fathers, and 2 siblings from 246 Mexican-origin families who participated in individual home interviews on 3 occasions over 8 years. Multilevel models revealed that, controlling for dyadic parent-child relationship qualities (i.e., absolute levels of warmth and conflict), adolescents who had less favorable treatment by mothers relative to their sibling reported more depressive symptoms and risky behavior, on average. Findings for fathers' PDT emerged at the within-person level indicating that, on occasions when adolescents experienced less favorable treatment by fathers than usual, they reported more depressive symptoms and risky behavior. However, some of these effects were moderated by youth age and cultural socialization. For example, adolescents who experienced relatively less paternal warmth than their siblings also reported poorer adjustment, but this effect did not emerge for young adults; such an effect also was significant for unfavored youth with stronger but not weaker cultural orientations. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Increasing the Benefit from Cost-Minimizing Loads via Centralized Adjustments

Directory of Open Access Journals (Sweden)

Antti Alahäivälä

2016-11-01

Full Text Available Several demand response (DR strategies rely on real-time pricing and selfish local optimization, which may not result in optimal electricity consumption patterns from the viewpoint of an energy supplier or a power system. Thus, this paper proposes a strategy enabling centralized adjustments to cost-minimize consumers’ load. By employing the strategy, an aggregator is able to alter electricity consumption in order to remove power imbalances and to participate in the balancing power market (BPM. In this paper, we focus on direct electric space heating (DESH loads that aim to minimize their heating cost locally. The consumers and an aggregator agree about an indoor temperature band, within which the aggregator is allowed to alter the temperature, and thus the electricity consumption. Centrally, the aggregator procures its electricity demand from a day-ahead (DA market by utilizing the allowed temperature band and employs the band later in real-time (RT operation for the balancing of its own imbalances or regulating power in the BPM.

Treating dysarthria following traumatic brain injury: investigating the benefits of commencing treatment during post-traumatic amnesia in two participants.

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McGhee, Hannah; Cornwell, Petrea; Addis, Paula; Jarman, Carly

2006-11-01

The aims of this preliminary study were to explore the suitability for and benefits of commencing dysarthria treatment for people with traumatic brain injury (TBI) while in post-traumatic amnesia (PTA). It was hypothesized that behaviours in PTA don't preclude participation and dysarthria characteristics would improve post-treatment. A series of comprehensive case analyses. Two participants with severe TBI received dysarthria treatment focused on motor speech deficits until emergence from PTA. A checklist of neurobehavioural sequelae of TBI was rated during therapy and perceptual and motor speech assessments were administered before and after therapy. Results revealed that certain behaviours affected the quality of therapy but didn't preclude the provision of therapy. Treatment resulted in physiological improvements in some speech sub-systems for both participants, with varying functional speech outcomes. These findings suggest that dysarthria treatment can begin and provide short-term benefits to speech production during the late stages of PTA post-TBI.

How do physicians weigh benefits and risks associated with treatments in patients with osteoarthritis in the United Kingdom?

Science.gov (United States)

Arden, Nigel K; Hauber, A Brett; Mohamed, Ateesha F; Johnson, F Reed; Peloso, Paul M; Watson, Douglas J; Mavros, Panagiotis; Gammaitoni, Arnold; Sen, Shuvayu S; Taylor, Stephanie D

2012-05-01

To quantify the relative importance that UK physicians attach to the benefits and risks of current drugs when making treatment decisions for patients with osteoarthritis (OA). Physicians treating at least 10 patients with OA per month completed an online discrete-choice experiment survey and answered 12 treatment-choice questions comparing medication profiles. Medication profiles were defined by 4 benefits (reduction in ambulatory pain, resting pain, stiffness, and difficulty doing daily activities) and 3 treatment-related risks [bleeding ulcer, stroke, and myocardial infarction (MI)]. Each physician made medication choices for 3 of 9 hypothetical patients (varied by age, history of MI, hypertension, and history of gastrointestinal bleeding). Importance weights were estimated using a random-parameters logit model. Treatment-related risks physicians were willing to accept in exchange for various reductions in ambulatory and resting pain also were calculated. The final sample was 475. A reduction in ambulatory pain from 75 mm to 25 mm (1.6 units) was 1.1 times as important as an increase in MI risk from 0% to 1.5% (1.5 units). The greatest importance was for eliminating a 3% treatment-related risk of MI or stroke. On average, physicians were willing to accept an increase in bleeding ulcer risk of 0.7% (95% CI 0.4%-1.7%) for a reduction in ambulatory pain of 75 mm to 50 mm. When presented with well-known benefits and risks of OA treatments, physicians placed greater importance on the risks than on the analgesic properties of the drug. This has implications for the reporting of the results of clinical research to physicians.

Benefits and harms of screening for and treatment of asymptomatic bacteriuria in pregnancy: a systematic review.

Science.gov (United States)

Angelescu, Konstanze; Nussbaumer-Streit, Barbara; Sieben, Wiebke; Scheibler, Fülöp; Gartlehner, Gerald

2016-11-02

Most European and North American clinical practice guidelines recommend screening for asymptomatic bacteriuria (ASB) as a routine pregnancy test. Antibiotic treatment of ASB in pregnant women is supposed to reduce maternal upper urinary tract infections (upper UTIs) and preterm labour. However, most studies supporting the treatment of ASB were conducted in the 1950s to 1980s. Because of subsequent changes in treatment options for ASB and UTI, the applicability of findings from these studies has come into question. Our systematic review had three objectives: firstly, to assess the patient-relevant benefits and harms of screening for ASB versus no screening; secondly, to compare the benefits and harms of different screening strategies; and thirdly, in case no reliable evidence on the overarching screening question was identified, to determine the benefits and harms of treatment of ASB. We systematically searched several bibliographic databases, trial registries, and other sources (up to 02/2016) for randomised controlled trials (RCTs) and prospective non-randomised trials. Two authors independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. As meta-analyses were not possible, we summarised the results qualitatively. We did not identify any eligible studies that investigated the benefits and harms of screening for ASB versus no screening or that compared different screening strategies. We identified four RCTs comparing antibiotics with no treatment or placebo in 454 pregnant women with ASB. The results of 2 studies published in the 1960s showed a statistically significant reduction in rates of pyelonephritis (odds ratio [OR] = 0.21, 95 % confidence interval [CI] 0.07-0.59) and lower UTI (OR = 0.10, 95 % CI 0.03-0.35) in women treated with antibiotics. By contrast, event rates reported by a recent study were not statistically significantly different, neither regarding pyelonephritis (0 % vs. 2.2 %; OR�

The Influence of God and Providence on Happiness and the Quality of Life of Patients Benefiting from Aesthetic Medicine Treatments in Poland.

Science.gov (United States)

Galęba, Anna; Bajurna, Beata

2015-08-01

The research reveals the impact of a belief in god and god's Providence on the happiness and quality of life of patients benefiting from aesthetic medicine treatments in Poland (country where over 90 % of society declare to be deeply devout). The work also examines age and sex of the patients benefiting from beauty treatments (botulinum toxin, fillers, medical peels and needle mesotherapy), their quality of life and also the impact of various factors, including God and Divine Providence on their happiness. The research shows the analysis of factors influencing the successes or failures in the past year and presents the comparison of patients who have benefited from the aesthetic medicine treatments (cosmetic medicine) to the common average Polish citizens.

Evaluating Expected Costs and Benefits of Granting Access to New Treatments on the Basis of Progression-Free Survival in Non-Small-Cell Lung Cancer.

Science.gov (United States)

Lakdawalla, Darius N; Chou, Jacquelyn W; Linthicum, Mark T; MacEwan, Joanna P; Zhang, Jie; Goldman, Dana P

2015-05-01

Surrogate end points may be used as proxy for more robust clinical end points. One prominent example is the use of progression-free survival (PFS) as a surrogate for overall survival (OS) in trials for oncologic treatments. Decisions based on surrogate end points may expedite regulatory approval but may not accurately reflect drug efficacy. Payers and clinicians must balance the potential benefits of earlier treatment access based on surrogate end points against the risks of clinical uncertainty. To present a framework for evaluating the expected net benefit or cost of providing early access to new treatments on the basis of evidence of PFS benefits before OS results are available, using non-small-cell lung cancer (NSCLC) as an example. A probabilistic decision model was used to estimate expected incremental social value of the decision to grant access to a new treatment on the basis of PFS evidence. The model analyzed a hypothetical population of patients with NSCLC who could be treated during the period between PFS and OS evidence publication. Estimates for delay in publication of OS evidence following publication of PFS evidence, expected OS benefit given PFS benefit, incremental cost of new treatment, and other parameters were drawn from the literature on treatment of NSCLC. Incremental social value of early access for each additional patient per month (in 2014 US dollars). For "medium-value" model parameters, early reimbursement of drugs with any PFS benefit yields an incremental social cost of more than $170,000 per newly treated patient per month. In contrast, granting early access on the basis of PFS benefit between 1 and 3.5 months produces more than $73,000 in incremental social value. Across the full range of model parameter values, granting access for drugs with PFS benefit between 3 and 3.5 months is robustly beneficial, generating incremental social value ranging from $38,000 to more than $1 million per newly treated patient per month, whereas access

Hope, Quality of Life, and Benefit From Treatment in Women Having Chemotherapy for Platinum-Resistant/Refractory Recurrent Ovarian Cancer: The Gynecologic Cancer Intergroup Symptom Benefit Study

Science.gov (United States)

Sjoquist, Katrin M.; Friedlander, Michael L.; O'Connell, Rachel L.; Voysey, Merryn; King, Madeleine T.; Stockler, Martin R.; Oza, Amit M.; Gillies, Kim; Martyn, Julie K.

2013-01-01

Purpose. Chemotherapy for platinum-resistant/refractory ovarian cancer is motivated by the hope of benefit. We sought to determine the relationships between: (a) trait hope, expectation of symptom benefit from chemotherapy, and anxiety and depression; (b) hope and perceived efficacy of chemotherapy; and (c) unfulfilled hope (where expectations for benefit are not fulfilled) and depression. Methods. Adult patients enrolled within stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study were included. Patient. Reported outcomes were collected from 126 women with predominantly platinum-resistant ovarian cancer at baseline, prior to the first four treatment cycles (12–16 weeks), and four weeks after completing chemotherapy or at disease progression, whichever came first. Associations were assessed with Spearman rank correlation coefficient (r) and odds ratio. Results. Trait hope and expectation of symptom benefit from chemotherapy were weakly correlated with each other (r = 0.25). Trait hope, but not expectation of symptom benefit, was negatively correlated with anxiety (r = −0.43) and depression (r = −0.50). The smaller the discrepancy between perceived and expected symptom benefit, the less likely the patient was to have scores indicative of depression (odds ratio: 0.68; 95% confidence interval: 0.49–0.96; p = .026). Conclusion. Trait hope and expectation of symptom benefit from chemotherapy appear to be distinct and independent of the aspects of quality of life and scores for depression. Hope did not appear to affect perceived efficacy of chemotherapy in alleviating symptoms, but women whose expectation of symptom benefit from chemotherapy was not fulfilled were more likely to have scores indicative of depression. It may be preferable to encourage hope toward achievable goals rather than toward benefits from chemotherapy. PMID:24107972

The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide

DEFF Research Database (Denmark)

Gradus, Jaimie L; Qin, Ping; Lincoln, Alisa K

2010-01-01

Adjustment disorder is a diagnosis given following a significant psychosocial stressor from which an individual has difficulty recovering. The individual's reaction to this event must exceed what would be observed among similar people experiencing the same stressor. Adjustment disorder is associa...... regression analyses revealed that those diagnosed with adjustment disorder had 12 times the rate of suicide as those without an adjustment disorder diagnosis, after controlling for history of depression diagnosis, marital status, income, and the matched factors....... is associated with suicidal ideation and suicide attempt. However the association between adjustment disorder and completed suicide has yet to be examined. The current study is a population-based case control study examining this association in the population of Denmark aged 15 to 90 years. All suicides...... in Denmark from 1994 to 2006 were included, resulting in 9,612 cases. For each case, up to 30 controls were matched on gender, exact date of birth, and calendar time, yielding 199,306 controls. Adjustment disorder diagnosis was found in 7.6% of suicide cases and 0.52% of controls. Conditional logistic...

Dietary and medication adjustments to improve seizure control in patients treated with the ketogenic diet.

Science.gov (United States)

Selter, Jessica H; Turner, Zahava; Doerrer, Sarah C; Kossoff, Eric H

2015-01-01

Unlike anticonvulsant drugs and vagus nerve stimulation, there are no guidelines regarding adjustments to ketogenic diet regimens to improve seizure efficacy once the diet has been started. A retrospective chart review was performed of 200 consecutive patients treated with the ketogenic diet at Johns Hopkins Hospital from 2007 to 2013. Ten dietary and supplement changes were identified, along with anticonvulsant adjustments. A total of 391 distinct interventions occurred, of which 265 were made specifically to improve seizure control. Adjustments led to >50% further seizure reduction in 18%, but only 3% became seizure-free. The benefits of interventions did not decrease over time. There was a trend towards medication adjustments being more successful than dietary modifications (24% vs 15%, P = .08). No single dietary change stood out as the most effective, but calorie changes were largely unhelpful (10% with additional benefit). © The Author(s) 2014.

Long-term benefit of electron beam radiation therapy in the treatment of scleredema of Buschke

Directory of Open Access Journals (Sweden)

Tijana Skrepnik, MD

2016-01-01

Conclusion: Scleredema of Buschke is a rare connective tissue disorder commonly treated with multimodal therapy, but it can be effectively and durably controlled with RT alone. This case report documents the durability of the benefit achieved with RT and suggests that RT should be considered earlier in the treatment of this disease.

Analysis of the clinical benefit of 5-fluorouracil and radiation treatment in locally advanced pancreatic cancer

International Nuclear Information System (INIS)

Fisher, Barbara J.; Perera, Francisco E.; Kocha, Walter; Tomiak, Anna; Taylor, Marianne; Vincent, Mark; Bauman, Glenn S.

1999-01-01

Purpose: To assess the palliative benefit of 5-fluorouracil (5-FU) and radiotherapy in patients with surgically unresectable localized pancreatic cancer. Methods and Materials: Twenty-five patients with locally advanced surgically unresectable symptomatic pancreatic cancer received 5-FU chemotherapy and local radiation therapy. They were retrospectively reviewed in regard to their clinical benefit response (a composite of measurement of pain assessment, weight, and Karnofsky performance status [KPS]), as well as radiological response, time to progression, and overall survival. Results: Median survival for the 25 patients was 9 months and median progression-free survival was 6 months. Thirty-two percent of patients survived in excess of 1 year. Analgesic requirements increased >50% in 2 patients and KPS deteriorated in 10 patients. Of the 13 remaining patients, 2 sustained a >7% weight loss and 2 gained weight post-treatment. Six patients improved in one parameter of analgesic consumption, weight loss or KPS without deteriorating in any others. Thus, the clinical benefit response index for 5-FU-radiation was 6/25 (24%). In terms of tumor response, 8 patients (44%) demonstrated a reduction in tumor volume post-treatment, 4 of whom (22%) experienced a >50% reduction. Four additional patients had radiologically stable disease. Conclusion: In this retrospective analysis, the clinical benefit response index for 5-FU-radiation was 24%, a value similar to the 23.8% reported for single agent gemcitabine. The median survival of 7 months was also similar to the 5.65 months reported for gemcitabine. The radiological partial response rate of 22% and the 1-year survival of 32% were higher for 5-FU-radiation than the reported values for gemcitabine. A randomized trial would be necessary to compare 5-FU-radiation to gemcitabine directly; however, from this review it did not appear that the overall palliative benefit of 5-FU-radiation was inferior to gemcitabine

The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa.

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Wierenga, Christina E; Hill, Laura; Knatz Peck, Stephanie; McCray, Jason; Greathouse, Laura; Peterson, Danika; Scott, Amber; Eisler, Ivan; Kaye, Walter H

2018-05-02

Novel treatments for adults with anorexia nervosa (AN) are lacking. Recent scientific advances have identified neurobiologically-driven temperament contributors to AN symptoms that may guide development of more effective treatments. This preliminary study evaluates the acceptability, feasibility and possible benefits of a multicenter open trial of an intensive 5-day neurobiologically-informed multifamily treatment for adults with AN and their supports (SU). The temperament-focused treatment combines psychoeducation of AN neurobiology and SU involvement to develop skills to manage traits contributing to disease chronicity. Fifty-four adults with AN and at least one SU (n = 73) received the 5-day treatment. Acceptability, feasibility, and attrition were measured post-treatment. Clinical outcome (BMI, eating disorder psychopathology, family function) was assessed post-treatment and at >3-month follow-up. The treatment had low attrition, with only one drop-out. Patients and SU rated the intervention as highly acceptable, and clinicians reported good feasibility. At post-treatment, patients demonstrated significantly increased BMI, reduced eating disorder psychopathology, and improved family function. Benefits were maintained in the 39 patients who completed follow-up assessment, with 62% reporting full or partial remission. Preliminary results are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary. © 2018 Wiley Periodicals, Inc.

Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

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Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

2017-09-01

Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

[Adjustment disorder and DSM-5: A review].

Science.gov (United States)

Appart, A; Lange, A-K; Sievert, I; Bihain, F; Tordeurs, D

2017-02-01

higher than for the adjustment disorder. According to their relevance and their content, we have split the articles into seven subcategories: 1. General description: most scientific articles generally describe the adjustment disorder as being a transition diagnosis, which is ambiguous, marginal and difficult to detect. The findings claim that only a few studies have been conducted on the adjustment disorder despite a high prevalence in the general population and in the clinical field. 2. the DSM-5 defined the adjustment disorder as a set of different outcomes and syndromes induced by stress after a difficult life event. While the link to other disorders has not been mentioned, the diagnosis of this disorder is no longer excluded or perceived as a secondary diagnosis. The DSM-5 faced criticism from three points of view: the operationalization of the concept of stress, the differential diagnosis and the description. 3. Prevalence: different samples have shown a significantly high prevalence of the adjustment disorder within the population. In addition to the psychiatric pain induced by difficult life events we need to emphasize the fact that 12.5 to 19.4 percent of the patients faced heavy and severe pathologies and depended on clinical care and treatment. 4. Etiology, comorbidity or associated symptomatology: the literature identified the tendency to commit suicide and stressful life events as being two fundamental characteristics of adjustment disorder. The third one is the personality profile. 5. that motivates researchers to focus on the adjustment disorder: the differentiation approach as to the major depression. Indeed, the aetiology, the symptomatology and the treatment differ from the adjustment disorder. 6. very recently, Dutch researchers have developed and validated the Diagnostic Interview Adjustment Disorder (DIAD). 7. in 2014, no data or meta-analysis recommended drug treatment in addition to therapy. In fact, several authors have demonstrated the

Adrenaline in anaphylaxis treatment. Balancing benefits and harms.

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Cervellin, Gianfranco; Sanchis-Gomar, Fabian; Lippi, Giuseppe

2016-06-01

Although anaphylaxis is a relatively common disorder, clinicians and scientists have debated on how to best define and manage this condition. The current recommendations are focused on the central role of adrenaline, but evidence in support of this therapeutic approach is modest, mainly for the lack of well-designed trials. Conversely, serious adverse effects are commonly reported following adrenaline use, especially when given intravenously. These include hypertension, ventricular arrhythmias, myocardial infarction, pulmonary edema. Anaphylaxis treatment, with special focus on adrenaline utilization, both in pre-hospital and in-hospital settings. Aim is to examine in depth the balance between benefits and harms of this important drug. Due to the lack of solid evidence supporting the use of adrenaline in patients with anaphylaxis, except in severe cases, the strength of recommendations should be readdressed, limiting administration to selected categories of patients. Caregivers should promptly act in pre-hospital setting, given the shortness of time and lack of technology. In the hospital setting, and more specifically in the ED, clinicians should consider the prompt use of adrenaline in severe anaphylaxis cases, but they should also be able to judiciously wait in the vast majority of milder anaphylactic reactions, which may resolve spontaneously.

Natural gas benefits

International Nuclear Information System (INIS)

1999-01-01

The General Auditor in the Netherlands studied the natural gas policy in the Netherlands, as has been executed in the past decades, in the period 1997-1999. The purpose of the study is to inform the Dutch parliament on the planning and the backgrounds of the natural gas policy and on the policy risks with respect to the benefits for the Dutch State, taking into account the developments in the policy environment. The final conclusion is that the proposed liberalization of the national natural gas market will result in a considerable deprivation of income for the State in case the benefit policy is not adjusted. This report includes a reaction of the Dutch Minister of Economic Affairs and an afterword of the General Auditor. In the appendix an outline is given of the natural gas policy

Strategies for diagnosis and treatment of suspected leptospirosis: a cost-benefit analysis.

Directory of Open Access Journals (Sweden)

Yupin Suputtamongkol

Full Text Available BACKGROUND: Symptoms and signs of leptospirosis are non-specific. Several diagnostic tests for leptospirosis are available and in some instances are being used prior to treatment of leptospirosis-suspected patients. There is therefore a need to evaluate the cost-effectiveness of the different treatment strategies in order to avoid misuse of scarce resources and ensure best possible health outcomes for patients. METHODS: The study population was adult patients, presented with uncomplicated acute febrile illness, without an obvious focus of infection or malaria or typical dengue infection. We compared the cost and effectiveness of 5 management strategies: 1 no patients tested or given antibiotic treatment; 2 all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3 lateral flow; 4 MCAT; 5 latex test. The framework used is a cost-benefit analysis, accounting for all direct medical costs in diagnosing and treating patients suspected of leptospirosis. Outcomes are measured in length of fever after treatment which is then converted to productivity losses to capture the full economic costs. FINDINGS: Empirical doxycycline treatment was the most efficient strategy, being both the least costly alternative and the one that resulted in the shortest duration of fever. The limited sensitivity of all three diagnostic tests implied that their use to guide treatment was not cost-effective. The most influential parameter driving these results was the cost of treating patients with complications for patients who did not receive adequate treatment as a result of incorrect diagnosis or a strategy of no-antibiotic-treatment. CONCLUSIONS: Clinicians should continue treating suspected cases of leptospirosis on an empirical basis. This conclusion holds true as long as policy makers are not prioritizing the reduction of use of antibiotics, in which case the use of the latex test would be

Adjustment disorder: current perspectives

Directory of Open Access Journals (Sweden)

Zelviene P

2018-01-01

Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model.

Science.gov (United States)

Megiddo, Itamar; Colson, Abigail; Chisholm, Dan; Dua, Tarun; Nandi, Arindam; Laxminarayan, Ramanan

2016-03-01

An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery. We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance. All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure. Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth

Case-Mix Adjustment of the Bereaved Family Survey.

Science.gov (United States)

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Air Emission Reduction Benefits of Biogas Electricity Generation at Municipal Wastewater Treatment Plants.

Science.gov (United States)

Gingerich, Daniel B; Mauter, Meagan S

2018-02-06

Conventional processes for municipal wastewater treatment facilities are energy and materially intensive. This work quantifies the air emission implications of energy consumption, chemical use, and direct pollutant release at municipal wastewater treatment facilities across the U.S. and assesses the potential to avoid these damages by generating electricity and heat from the combustion of biogas produced during anaerobic sludge digestion. We find that embedded and on-site air emissions from municipal wastewater treatment imposed human health, environmental, and climate (HEC) damages on the order of $1.63 billion USD in 2012, with 85% of these damages attributed to the estimated consumption of 19 500 GWh of electricity by treatment processes annually, or 0.53% of the US electricity demand. An additional 11.8 million tons of biogenic CO 2 are directly emitted by wastewater treatment and sludge digestion processes currently installed at plants. Retrofitting existing wastewater treatment facilities with anaerobic sludge digestion for biogas production and biogas-fueled heat and electricity generation has the potential to reduce HEC damages by up to 24.9% relative to baseline emissions. Retrofitting only large plants (>5 MGD), where biogas generation is more likely to be economically viable, would generate HEC benefits of $254 annually. These findings reinforce the importance of accounting for use-phase embedded air emissions and spatially resolved marginal damage estimates when designing sustainable infrastructure systems.

Teasing and social rejection among obese children enrolling in family-based behavioural treatment: effects on psychological adjustment and academic competencies.

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Gunnarsdottir, T; Njardvik, U; Olafsdottir, A S; Craighead, L W; Bjarnason, R

2012-01-01

The first objective was to determine the prevalence of psychological maladjustment (emotional and behavioural problems), low academic competencies and teasing/social rejection among obese Icelandic children enrolling in a family-based behavioural treatment. A second objective was to explore the degree to which teasing/social rejection specifically contributes to children's psychological adjustment and academic competencies when controlling for other variables, including demographics, children's physical activity, parental depression and life-stress. Participants were 84 obese children (mean body mass index-standard deviation score=3.11, age range=7.52-13.61 years). Height and weight, demographics and measures of children's psychological adjustment, academic competencies, teasing/social rejection and physical activity were collected from children, parents and teachers. Parental depression and life-stress was self-reported. Over half the children exceeded cutoffs indicating concern on at least one measure of behavioural or emotional difficulties. Children endorsed significant levels of teasing/social rejection, with almost half acknowledging they were not popular with same-gender peers. Parent reports of peer problems were even higher, with over 90% of both boys and girls being rated by their parents as having significant peer difficulties. However, rates of low academic competencies as reported by teachers were not different from those of the general population. In regression analyses controlling for other variables, self-reported teasing/social rejection emerged as a significant contributor to explaining both child psychological adjustment and academic competencies. The results indicate that among obese children enrolled in family-based treatment, self-reported teasing/social rejection is quite high and it is associated with poorer psychological adjustment as well as lower academic competencies. Parent reports corroborate the presence of substantial peer

Individual and crossover effects of stress on adjustment in medical student marriages.

Science.gov (United States)

Katz, J; Monnier, J; Libet, J; Shaw, D; Beach, S R

2000-07-01

High-stress individuals may benefit from social support, although their support providers may be adversely affected via stress crossover effects. Individual and crossover effects of perceived stress within medical student marriages (n = 30) were investigated. Perceived spousal support was positively associated with individuals' own marital and emotional adjustment, attenuating stress effects. With regard to crossover effects, medical students' perceived stress was significantly associated with their spouses' emotional adjustment. Further, medical students' own emotional adjustment fully mediated this crossover effect. Results suggest that the contagion of negative affect may serve as a key mechanism through which stress crossover effects operate in marriage.

Willingness to pay per quality-adjusted life year for life-saving treatments in Thailand.

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Nimdet, Khachapon; Ngorsuraches, Surachat

2015-10-05

To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) value for life-saving treatments and to determine factors affecting the WTP per QALY value. A cross-sectional survey with multistage sampling and face-to-face interviews. General population in the southern part of Thailand. A total of 600 individuals were included in the study. Only 554 (92.3%) responses were usable for data analyses. Participants were asked for the maximum amount of WTP value for life-saving treatments by an open-ended question. EQ-5D-3L and visual analogue scale (VAS) were used to estimate additional QALY. The amount of WTP values varied from 0 to 720,000 Baht/year (approximately 32 Baht=US$1). The averages of additional QALY obtained from VAS and EQ-5D-3L were only slightly different (0.872 and 0.853, respectively). The averages of WTP per QALY obtained from VAS and EQ-5D-3L were 244,720 and 243,120 Baht/QALY, respectively. As compared to male participants, female participants were more likely to pay less for an additional QALY (p=0.007). In addition, participants with higher household incomes tended to have higher WTP per QALY values (pper QALY value specifically for life-saving treatments, which would complement the current cost-effectiveness threshold used in Thailand and optimise patient access to innovative treatments or technologies. 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.

Modeling the fiscal costs and benefits of alternative treatment strategies in the United Kingdom for chronic hepatitis C.

Science.gov (United States)

Connolly, Mark P; Kotsopoulos, Nikos; Ustianowski, Andrew

2018-01-01

Hepatitis C (HCV) infection causes substantial direct health costs, but also impacts broader societal and governmental costs, such as tax revenue and social protection benefits. This study investigated the broader fiscal costs and benefits of curative interventions for chronic Hepatitis C (CHC) that allow individuals to avoid long-term HCV attributed health conditions. A prospective cohort model, assessing the long-term fiscal consequences of policy decisions, was developed for HCV infected individuals, following the generational accounting analytic framework that combines age-specific lifetime gross taxes paid and governmental transfers received (i.e. healthcare and social support costs). The analysis assessed the burden of a theoretical cohort of untreated HCV infected patients with the alternative of treating these patients with a highly efficacious curative intervention (ledipasvir/sofosbuvir [LDV/SOF]). It also compared treating patients at all fibrosis stages (Stages F0-F4) compared to late treatment (Stage F4). Based on projected lifetime work activity and taxes paid, the treated cohort paid an additional £5,900 per patient compared to the untreated cohort. Lifetime government disability costs of £97,555 and £125,359 per patient for treated cohort vs no treatment cohort were estimated, respectively. Lifetime direct healthcare costs in the treated cohort were £32,235, compared to non-treated cohort of £26,424, with an incremental healthcare costs increase of £5,901 per patient. The benefit cost ratio (BCR) of total government benefits and savings relative to government treatment costs (including LDV/SOF) ranged from 1.8-5.6. Treating patients early resulted in 77% less disability costs, 43% lower healthcare costs, and 33% higher tax revenue. The ability to cure Hepatitis C offers considerable fiscal benefits beyond direct medical costs and savings attributed to reduced disability costs, public allowances, and improved tax revenue. Changes in parameters

Exploring patient perception of success and benefit in self-management of breast cancer-related arm lymphoedema.

Science.gov (United States)

Jeffs, Eunice; Ream, Emma; Shewbridge, Amanda; Cowan-Dickie, Siobhan; Crawshaw, Diana; Huit, Martine; Wiseman, Theresa

2016-02-01

The aim of this study was to identify factors influencing patient perception of success and benefit with self-management of breast cancer-related lymphoedema (BCRL) and explore how patients decide whether their swollen limb has improved or deteriorated. This qualitative study used a Grounded Theory approach. Twenty-one women in the BCRL self-management phase participated in one in-depth interview exploring their experience and perspective on self-managing their BCRL. Seven enablers and blocks to self-management were identified: routine, recognising benefit of self-management and consequences of non-treatment, owning treatment, knowledge and understanding, problem-solving, time required for treatment and aesthetics of hosiery. Women determined treatment outcome by monitoring size, appearance, texture and internal sensations within the affected arm. Women who participated in this study showed varying degrees of acceptance and adjustment to life with lymphoedema. This appears to directly impact their ability to self-manage lymphoedema. Lymphoedema practitioners and oncology nurses have a valuable role providing knowledge and support to patients transitioning to independent self-care. A better understanding of factors facilitating patients to become experts in their condition may improve longer term outcomes and reduce cost pressures on lymphoedema services. Copyright © 2015 Elsevier Ltd. All rights reserved.

Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port.

Science.gov (United States)

Esquinas, C; Arance, I; Pamplona, J; Moraga, A; Dorado, J F; Angulo, J C

2018-04-08

Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both pATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Broad economic benefits of freight transportation infrastructure improvement.

Science.gov (United States)

2012-06-01

This project strives to introduce a novel way to quantify the broad re-organization benefits associated with an : improvement in the freight infrastructure. Using the approach based on 1) the technique known as Field of Influence, and : 2) RAS adjust...

Quality-adjusted life-years. Ethical implications for physicians and policymakers.

Science.gov (United States)

La Puma, J; Lawlor, E F

1990-06-06

Quality-adjusted life-years have been used in economic analyses as a measure of health outcomes, one that reflects both lives saved and patients' valuations of quality of life in alternative health states. The concept of "cost per quality-adjusted life year" as a guideline for resource allocation is founded on six ethical assumptions: quality of life can be accurately measured and used, utilitarianism is acceptable, equity and efficiency are compatible, projections of community preferences can substitute for individual preferences, the old have less "capacity to benefit" than the young, and physicians will not use quality-adjusted life-years as clinical maxims. Quality-adjusted life-years signal two shifts in the locus of control and the nature of the clinical encounter: first, formal expressions of community preferences and societal usefulness would counterbalance patient autonomy, and second, formal tools of resource allocation and applied decision analysis would counterbalance the use of clinical judgment. These shifts reflect and reinforce a new financial ethos in medical decision making. Presently using quality-adjusted life-years for health policy decisions is problematic and speculative; using quality-adjusted life-years at the bedside is dangerous.

A cost-benefit analysis of pre- and post-lambing anthelmintic treatments to twin-bearing ewes on commercial farms in the southern North Island of New Zealand.

Science.gov (United States)

Garland, C B; Leathwick, D M

2015-07-01

To conduct a cost-benefit analysis of the administration of anthelmintics to adult ewes around lambing. Production data from comparisons of different anthelmintic treatments with no treatment were used in a cost-benefit analysis. The data were from 14 trials (part of an experiment carried out on one farm in 1 year) conducted on sheep and beef farms (eight in 2011 and six in 2012) in the Wairarapa region of New Zealand. The cost structure involved the purchase price of products and the labour cost of administration. The four key benefits identified for the calculation of economic returns, relative to untreated ewes, were: increased value of ewes sold (culled) at weaning, additional lambs weaned related to ewe liveweight at mating, increased total weight of lamb weaned per ewe, and reduced number of ewes requiring removal of soiled wool at weaning due to a lower dag score. Commercial values for these variables as at December 2013 were used, with the measured production data, to calculate a net (NZ$) benefit for every treatment-trial combination. The economic return on treating ewes around lambing with anthelmintics was highly variable and across all trials treatment resulted in a financial loss in 18/38 (47%) groups of ewes. The mean net benefit from pre-lambing administration of a controlled release capsule (CRC) containing albendazole and abamectin was 5.36 (95% CI=-2.64 to 13.35) $/ewe, but overall was not different from zero (p=0.171). A breakdown of the overall gross benefit into its various components showed that weight of lamb weaned per ewe had the largest influence (a mean benefit of $5.68/ewe), followed by ewe liveweight pre-mating ($2.45/ewe), ewe liveweight at weaning ($0.66/ewe) and reduced dag score ($0.15/ewe). Other anthelmintic treatments all showed highly variable responses amongst trials, with some negative cost-benefits. There was no significant difference between any of the treatments except a short-acting oral treatment at tail-docking had a

Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review.

Science.gov (United States)

Bervoets, Diederik C; Luijsterburg, Pim A J; Alessie, Jeroen J N; Buijs, Martijn J; Verhagen, Arianne P

2015-07-01

Is massage therapy effective for people with musculoskeletal disorders compared to any other treatment or no treatment? Systematic review of randomised clinical trials. People with musculoskeletal disorders. Massage therapy (manual manipulation of the soft tissues) as a stand-alone intervention. The primary outcomes were pain and function. The 26 eligible randomised trials involved 2565 participants. The mean sample size was 95 participants (range 16 to 579) per study; 10 studies were considered to be at low risk of bias. Overall, low-to-moderate-level evidence indicated that massage reduces pain in the short term compared to no treatment in people with shoulder pain and osteoarthritis of the knee, but not in those with low back pain or neck pain. Furthermore, low-to-moderate-level evidence indicated that massage improves function in the short term compared to no treatment in people with low back pain, knee arthritis or shoulder pain. Low-to-very-low-level evidence from single studies indicated no clear benefits of massage over acupuncture, joint mobilisation, manipulation or relaxation therapy in people with fibromyalgia, low back pain and general musculoskeletal pain. Massage therapy, as a stand-alone treatment, reduces pain and improves function compared to no treatment in some musculoskeletal conditions. When massage is compared to another active treatment, no clear benefit was evident. Copyright © 2015 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Using animated computer-generated text and graphics to depict the risks and benefits of medical treatment.

Science.gov (United States)

Tait, Alan R; Voepel-Lewis, Terri; Brennan-Martinez, Colleen; McGonegal, Maureen; Levine, Robert

2012-11-01

Conventional print materials for presenting risks and benefits of treatment are often difficult to understand. This study was undertaken to evaluate and compare subjects' understanding and perceptions of risks and benefits presented using animated computerized text and graphics. Adult subjects were randomized to receive identical risk/benefit information regarding taking statins that was presented on an iPad (Apple Corp, Cupertino, Calif) in 1 of 4 different animated formats: text/numbers, pie chart, bar graph, and pictograph. Subjects completed a questionnaire regarding their preferences and perceptions of the message delivery together with their understanding of the information. Health literacy, numeracy, and need for cognition were measured using validated instruments. There were no differences in subject understanding based on the different formats. However, significantly more subjects preferred graphs (82.5%) compared with text (17.5%, Pbenefits offer an effective means to describe medical risk/benefit statistics. That understanding and satisfaction were significantly better when the format matched the individual's preference for message delivery is important and reinforces the value of "tailoring" information to the individual's needs and preferences. Copyright © 2012 Elsevier Inc. All rights reserved.

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

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Menezes Paulo R.

1993-01-01

Full Text Available A sample (n=124 of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

Directory of Open Access Journals (Sweden)

Paulo R. Menezes

1993-10-01

Full Text Available A sample (n=124 of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.

Benefits of peer support groups in the treatment of addiction

Directory of Open Access Journals (Sweden)

Tracy K

2016-09-01

Full Text Available Kathlene Tracy,1,2 Samantha P Wallace3 1Community Research and Recovery Program (CRRP, Department of Psychiatry, New York University School of Medicine, 2New York Harbor Healthcare System (NYHHS, New York, 3Department of Community Health Sciences, State University of New York Downstate School of Public Health, Brooklyn, NY, USA Objective: Peer support can be defined as the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Recently, there has been a dramatic rise in the adoption of alternative forms of peer support services to assist recovery from substance use disorders; however, often peer support has not been separated out as a formalized intervention component and rigorously empirically tested, making it difficult to determine its effects. This article reports the results of a literature review that was undertaken to assess the effects of peer support groups, one aspect of peer support services, in the treatment of addiction.Methods: The authors of this article searched electronic databases of relevant peer-reviewed research literature including PubMed and MedLINE.Results: Ten studies met our minimum inclusion criteria, including randomized controlled trials or pre-/post-data studies, adult participants, inclusion of group format, substance use-related, and US-conducted studies published in 1999 or later. Studies demonstrated associated benefits in the following areas: 1 substance use, 2 treatment engagement, 3 human immunodeficiency virus/hepatitis C virus risk behaviors, and 4 secondary substance-related behaviors such as craving and self-efficacy. Limitations were noted on the relative lack of rigorously tested empirical studies within the literature and inability to disentangle the effects of the group treatment that is often included as a component of other services

Risks and benefits in treatment of mediastinal abscess by endobronchial ultrasound-guided transbronchial needle aspiration.

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Tian, Lei; Krimsky, William S; Wu, Qingchen; Sun, Jiayuan

2017-07-01

Mediastinal abscess is a fatal condition, treatment of mediastinal abscess is with antibiotics and sometimes surgery for debridement and drainage. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe assessment and candidate treatment method of mediastinal lesions. This study aimed to HYPERLINK "javascript:void(0);" discuss risks and benefits in treatment of mediastinal abscess by EBUS-TBNA. We noticed a 56-year-old man with developed bilateral pneumonia and sepsis after puncture of mediastinal abscess by EBUS-TBNA. The patient was successfully treated with a combination of systemic anti-infection treatment and intracavitary administration of antibiotics, antifungal and repeated drainage and lavage via EBUS-TBNA, in 1 year follow-up without recurrence. This study indicated infection spread risk of mediastinal abscess after EBUS-TBNA, and mediastinal abscess was successfully cured by combination of systemic anti-infection and local intervention through EBUS-TBNA. EBUS-TBNA is a potential effective minimally invasive treatment for mediastinal abscess, and it is necessary to be aware of clinical complications after puncture of mediastinal infectious lesions by EBUS-TBNA. © 2015 John Wiley & Sons Ltd.

THE INFLUENCE OF CALCIUM HYPOCHLORITE DOSAGE ADJUSTMENT ON TAPIOCA WASTEWATER PRE-CHLORINATION TOWARD EFFICIENCY OF ACTIVATED SLUDGE TREATMENT

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Happy Mulyani

2016-11-01

Full Text Available The objectives of this research are to study about influence of calcium hypochlorite dosage adjustment on tapioca wastewater chlorination toward efficiency of activated sludge treatment especially at MLVSS profile and percentage of COD removal. This research mainly divided into pre-chlorination and activated sludge treatment. Pre-chlorination taken place for 60 minutes at pH 8. The variation of calcium hypochlorite dosages which used are 58, 59, and 60 mg/L. Pre-chlorination effluent with no free chlorine residual then becomes activated sludge treatment influent. Sampling has done each aeration time interval 0, 2, 4, and 6 hour for analysis of COD and MLVSS content. Research result generally shows that addition of aeration time for each variation of calcium hypochlorite dosage will increase MLVSS and decrease COD content. Smallest value of COD effluent could achieved in the activated sludge treatment with calcium hipochlorite dosage 60 mg/L addition at influent during 4 hours aeration time. Addition of 58 mg/l calcium hypochlorite results highest MLVSS and percentage of COD removal.

An evaluation of bias in propensity score-adjusted non-linear regression models.

Science.gov (United States)

Wan, Fei; Mitra, Nandita

2018-03-01

Propensity score methods are commonly used to adjust for observed confounding when estimating the conditional treatment effect in observational studies. One popular method, covariate adjustment of the propensity score in a regression model, has been empirically shown to be biased in non-linear models. However, no compelling underlying theoretical reason has been presented. We propose a new framework to investigate bias and consistency of propensity score-adjusted treatment effects in non-linear models that uses a simple geometric approach to forge a link between the consistency of the propensity score estimator and the collapsibility of non-linear models. Under this framework, we demonstrate that adjustment of the propensity score in an outcome model results in the decomposition of observed covariates into the propensity score and a remainder term. Omission of this remainder term from a non-collapsible regression model leads to biased estimates of the conditional odds ratio and conditional hazard ratio, but not for the conditional rate ratio. We further show, via simulation studies, that the bias in these propensity score-adjusted estimators increases with larger treatment effect size, larger covariate effects, and increasing dissimilarity between the coefficients of the covariates in the treatment model versus the outcome model.

Balancing risk and benefit for first-line treatment of metastatic colorectal cancer: a graphic communication tool for patients and physicians.

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Sanatani, Michael S; Vincent, Mark D

2007-01-01

Advances in the treatment of metastatic colorectal cancer have improved overall survival (OS); however, this might come at the cost of increased toxicity. Health-related quality of life, a significant concern closely related to toxicity and important when discussing palliative therapy, is infrequently assessed and reported in older clinical trials. As the number of tested regimens increases, the question arises on how to best present palliative treatment options. We present a simple way to compare treatment options in terms of potential risks and benefits. The literature was surveyed for reports of first-line systemic chemotherapies for metastatic colorectal cancer. The largest recent reports with detailed toxicity data were selected as representative for a regimen. Toxicity sum of a regimen was calculated as percent occurrences in the study cohort of severe adverse effects: diarrhea, mucositis, neurocutaneous conditions (excluding alopecia), vomiting, and febrile neutropenia. Limitations of toxicity reporting precluded inclusion of other or milder adverse events. Benefits (OS and progression-free survival [PFS]) were plotted graphically as benefit versus toxicity sum. Thirty-four regimens were found. Overall survival, PFS, and toxicity sum ranged from 8.9-24.7 months, 4.9-9.2 months, and 12-70 months, respectively. Weaknesses of our study include omission of some specific toxicities and of symptom control benefit, as well as heterogeneity of trial design and study populations. Furthermore, more recent OS data might reflect the availability of more lines of therapy rather than the effect of the first-line regimen, as comparison with PFS outcomes show. Our comparative tool helps physicians discuss the large number of available options with a patient in order to arrive at the treatment plan most appropriate to the individual and improve informed consent and disclosure, while highlighting limitations in available evidence.

Fathers of children with cancer: involvement, coping, and adjustment.

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Bennett Murphy, Laura M; Flowers, Stacy; McNamara, Kelly A; Young-Saleme, Tammi

2008-01-01

This study examined the role of fathers caring for children with cancer. Psychological adjustment, coping, and work patterns of mothers and fathers were described. Twenty fathers of children with cancer were compared with 20 mothers of children with cancer and 20 control fathers of healthy children. Questionnaire data were collected regarding coping, parental adjustment, child adjustment, and family involvement. Fathers did not differ from mothers or control fathers in terms of psychological adjustment or coping. However, fathers of children with cancer spent more hours at work and more hours caring for children than did control fathers. Paternal adjustment was significantly related to child adjustment only when the child had cancer. Coping was related to work outside the home for fathers and adjustment for mothers. Models of family adaptation may be different for fathers and mothers. Treatment teams must attend to the unique needs of fathers.

Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients

DEFF Research Database (Denmark)

Zemack, G.; Rommer, Bertil Roland

2008-01-01

OBJECTIVE: We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). METHODS: In a single-center retrospective study, 231 adjustable valves...

Sperm competition risk drives rapid ejaculate adjustments mediated by seminal fluid.

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Bartlett, Michael J; Steeves, Tammy E; Gemmell, Neil J; Rosengrave, Patrice C

2017-10-31

In many species, males can make rapid adjustments to ejaculate performance in response to sperm competition risk; however, the mechanisms behind these changes are not understood. Here, we manipulate male social status in an externally fertilising fish, chinook salmon ( Oncorhynchus tshawytscha ), and find that in less than 48 hr, males can upregulate sperm velocity when faced with an increased risk of sperm competition. Using a series of in vitro sperm manipulation and competition experiments, we show that rapid changes in sperm velocity are mediated by seminal fluid and the effect of seminal fluid on sperm velocity directly impacts paternity share and therefore reproductive success. These combined findings, completely consistent with sperm competition theory, provide unequivocal evidence that sperm competition risk drives plastic adjustment of ejaculate quality, that seminal fluid harbours the mechanism for the rapid adjustment of sperm velocity and that fitness benefits accrue to males from such adjustment.

A cluster-analytic profiling of heroin-dependent patients based on level, clinical adequacy, and patient-desired adjustment of buprenorphine dosage during buprenorphine-naloxone maintenance treatment in sixteen Spanish centers.

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Alcaraz, Saul; González-Saiz, Francisco; Trujols, Joan; Vergara-Moragues, Esperanza; Siñol, Núria; Pérez de Los Cobos, José

2018-06-01

Buprenorphine dosage is a crucial factor influencing outcomes of buprenorphine treatment for heroin use disorders. Therefore, the aim of the present study is to identify naturally occurring profiles of heroin-dependent patients regarding individualized management of buprenorphine dosage in clinical practice of buprenorphine-naloxone maintenance treatment. 316 patients receiving buprenorphine-naloxone maintenance treatment were surveyed at 16 Spanish centers during the stabilization phase of this treatment. Patients were grouped using cluster analysis based on three key indicators of buprenorphine dosage management: dose, adequacy according to physician, and adjustment according to patient. The clusters obtained were compared regarding different facets of patient clinical condition. Four clusters were identified and labeled as follows (buprenorphine average dose and percentage of participants in each cluster are given in brackets): "Clinically Adequate and Adjusted to Patient Desired Low Dosage" (2.60 mg/d, 37.05%); "Clinically Adequate and Adjusted to Patient Desired High Dosage" (10.71 mg/d, 29.18%); "Clinically Adequate and Patient Desired Reduction of Low Dosage" (3.38 mg/d, 20.0%); and "Clinically Inadequate and Adjusted to Patient Desired Moderate Dosage" (7.55 mg/d, 13.77%). Compared to patients from the other three clusters, participants in the latter cluster reported more frequent use of heroin and cocaine during last week, lower satisfaction with buprenorphine-naloxone as a medication, higher prevalence of buprenorphine-naloxone adverse effects and poorer psychological adjustment. Our results show notable differences between clusters of heroin-dependent patients regarding buprenorphine dosage management. We also identified a group of patients receiving clinically inadequate buprenorphine dosage, which was related to poorer clinical condition. Copyright © 2018 Elsevier B.V. All rights reserved.

The Complex Relationship between Antipsychotic-Induced Weight Gain and Therapeutic Benefits: A Systematic Review and Implications for Treatment

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Alex T. Raben

2018-01-01

Full Text Available Background: Antipsychotic-induced weight gain (AIWG and other adverse metabolic effects represent serious side effects faced by many patients with psychosis that can lead to numerous comorbidities and which reduce the lifespan. While the pathophysiology of AIWG remains poorly understood, numerous studies have reported a positive association between AIWG and the therapeutic benefit of antipsychotic medications.Objectives: To review the literature to (1 determine if AIWG is consistently associated with therapeutic benefit and (2 investigate which variables may mediate such an association.Data Sources: MEDLINE, Google Scholar, Cochrane Database and PsycINFO databases were searched for articles containing all the following exploded MESH terms: schizophrenia [AND] antipsychotic agents/neuroleptics [AND] (weight gain [OR] lipids [OR] insulin [OR] leptin [AND] treatment outcome. Results were limited to full-text, English journal articles.Results: Our literature search uncovered 31 independent studies which investigated an AIWG-therapeutic benefit association with a total of 6063 enrolled individuals diagnosed with schizophrenia or another serious mental illness receiving antipsychotic medications. Twenty-two studies found a positive association while, 10 studies found no association and one study reported a negative association. Study variables including medication compliance, sex, ethnicity, or prior antipsychotic exposure did not appear to consistently affect the AIWG-therapeutic benefit relationship. In contrast, there was some evidence that controlling for baseline BMI/psychopathology, duration of treatment and specific agent studied [i.e., olanzapine (OLZ or clozapine (CLZ] strengthened the relationship between AIWG and therapeutic benefit.Limitations: There were limitations of the reviewed studies in that many had small sample sizes, and/or were retrospective. The heterogeneity of the studies also made comparisons difficult and publication bias

Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review.

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Levy, Lauren L; Emer, Jason J

2012-01-01

Recent studies highlighting the psychological benefits of medical treatment for dermatological skin conditions have demonstrated a clear role for medical therapy in psychological health. Skin conditions, particularly those that are overtly visible, such as those located on the face, neck, and hands, often have a profound effect on the daily functioning of those affected. The literature documents significant emotional benefits using medical therapy in conditions such as acne, psoriasis, vitiligo, and rosacea, but there is little evidence documenting similar results with the use of cosmetic camouflage. Here we present a review highlighting the practical use of cosmetic camouflage makeup in patients with facial skin conditions and review its implications for psychological health. A search of the Medline and Scopus databases was performed to identify articles documenting the emotional benefit of cosmetic camouflage. Cosmetic camouflage provides a significant emotional benefit for patients with facial skin conditions, and this is substantiated by a literature review and personal experience. More clinical studies are needed to assess and validate the findings reported here. Patients with visible skin conditions have increased rates of depression, anxiety, and decreased self-esteem. It is prudent for us to consider therapies that can offer rapid and dramatic results, such as cosmetic camouflage.

A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy.

Science.gov (United States)

Ferrer-García, Marta; Gutiérrez-Maldonado, José; Pla-Sanjuanelo, Joana; Vilalta-Abella, Ferran; Riva, Giuseppe; Clerici, Massimo; Ribas-Sabaté, Joan; Andreu-Gracia, Alexis; Fernandez-Aranda, Fernando; Forcano, Laura; Riesco, Nadine; Sánchez, Isabel; Escandón-Nagel, Neli; Gomez-Tricio, Osane; Tena, Virginia; Dakanalis, Antonios

2017-11-01

A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

How Do I Deal with Depression and Adjustment to My Spinal Cord Injury?

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Full Text Available ... adjusting is to rebuild one's identity and to find a new balance in relationships. The stages of ... apply for Social Security benefits? How do I find a rehabilitation facility? How can I locate funding ...

[Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17].

Science.gov (United States)

Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys

2015-08-01

A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

Adjustment to Cancer: Anxiety and Distress (PDQ)

Science.gov (United States)

... with adjustment disorders. Individual (one-to-one) and group counseling have been shown to help cancer patients with ... to-one) counseling. Couple and family counseling. Crisis counseling. Group therapy. Self-help groups. Other treatments used to ...

Utility-adjusted analysis of the cost of palliative radiotherapy for bone metastases

International Nuclear Information System (INIS)

Barton, M.B.; Jacob, S.A.

2003-01-01

Palliative radiotherapy is effective in the treatment of bone metastases but is under-utilized, possibly because it is perceived to be expensive. We performed a cost-utility analysis of palliative radiotherapy for bone metastases, evaluating both the actual cost of radiotherapy as well as its impact on quality of life by adjusting for the variation in response to treatment. Hospital records between July 1991 and July 1996 were reviewed to ascertain the number of patients treated with palliative radiotherapy for bone metastases, the average number of fields of radiation delivered to each patient and the average duration of survival. Partial and complete response rates to palliative radiotherapy were obtained from a review of all published randomized controlled trials of radiation treatment of bone metastases. Utility values were assigned to the response rates, and an overall adjusted response rate to radiotherapy was derived. The cost of delivering a field of radiation was calculated. The total cost was divided by the total number of response months to give a utility-adjusted cost per month of palliative radiotherapy. The utility-adjusted cost per month of palliative radiotherapy of bone metastases was found to be AUS$ 100 per month or AUS$ 1200 per utility-adjusted life-year. This study demonstrates that, contrary to popular perception, palliative radiotherapy is a cost-effective treatment modality for bone metastases. Copyright (2003) Blackwell Science Pty Ltd

Comparison of various online IGRT strategies: The benefits of online treatment plan re-optimization

International Nuclear Information System (INIS)

Schulze, Derek; Liang, Jian; Yan, Di; Zhang Tiezhi

2009-01-01

Purpose: To compare the dosimetric differences of various online IGRT strategies and to predict potential benefits of online re-optimization techniques in prostate cancer radiation treatments. Materials and methods: Nine prostate patients were recruited in this study. Each patient has one treatment planning CT images and 10-treatment day CT images. Five different online IGRT strategies were evaluated which include 3D conformal with bone alignment, 3D conformal re-planning via aperture changes, intensity modulated radiation treatment (IMRT) with bone alignment, IMRT with target alignment and IMRT daily re-optimization. Treatment planning and virtual treatment delivery were performed. The delivered doses were obtained using in-house deformable dose mapping software. The results were analyzed using equivalent uniform dose (EUD). Results: With the same margin, rectum and bladder doses in IMRT plans were about 10% and 5% less than those in CRT plans, respectively. Rectum and bladder doses were reduced as much as 20% if motion margin is reduced by 1 cm. IMRT is more sensitive to organ motion. Large discrepancies of bladder and rectum doses were observed compared to the actual delivered dose with treatment plan predication. The therapeutic ratio can be improved by 14% and 25% for rectum and bladder, respectively, if IMRT online re-planning is employed compared to the IMRT bone alignment approach. The improvement of target alignment approach is similar with 11% and 21% dose reduction to rectum and bladder, respectively. However, underdosing in seminal vesicles was observed on certain patients. Conclusions: Online treatment plan re-optimization may significantly improve therapeutic ratio in prostate cancer treatments mostly due to the reduction of PTV margin. However, for low risk patient with only prostate involved, online target alignment IMRT treatment would achieve similar results as online re-planning. For all IGRT approaches, the delivered organ-at-risk doses may be

Lean VOC-Air Mixtures Catalytic Treatment: Cost-Benefit Analysis of Competing Technologies

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Gabriele Baldissone

2017-06-01

Full Text Available Various processing routes are available for the treatment of lean VOC-air mixtures, and a cost-benefit analysis is the tool we propose to identify the most suitable technology. Two systems have been compared in this paper, namely a “traditional” plant, with a catalytic fixed-bed reactor with a heat exchanger for heat recovery purposes, and a “non-traditional” plant, with a catalytic reverse-flow reactor, where regenerative heat recovery may be achieved thanks to the periodical reversal of the flow direction. To be useful for decisions-making, the cost-benefit analysis must be coupled to the reliability, or availability, analysis of the plant. Integrated Dynamic Decision Analysis is used for this purpose as it allows obtaining the full set of possible sequences of events that could result in plant unavailability, and, for each of them, the probability of occurrence is calculated. Benefits are thus expressed in terms of out-of-services times, that have to be minimized, while the costs are expressed in terms of extra-cost for maintenance activities and recovery actions. These variable costs must be considered together with the capital (fixed cost required for building the plant. Results evidenced the pros and cons of the two plants. The “traditional” plant ensures a higher continuity of services, but also higher operational costs. The reverse-flow reactor-based plant exhibits lower operational costs, but a higher number of protection levels are needed to obtain a similar level of out-of-service. The quantification of risks and benefits allows the stakeholders to deal with a complete picture of the behavior of the plants, fostering a more effective decision-making process. With reference to the case under study and the relevant operational conditions, the regenerative system was demonstrated to be more suitable to treat lean mixtures: in terms of time losses following potential failures the two technologies are comparable (Fixed bed

Maternal Zinc Intakes and Homeostatic Adjustments during Pregnancy and Lactation

Science.gov (United States)

Donangelo, Carmen Marino; King, Janet C.

2012-01-01

Zinc plays critical roles during embryogenesis, fetal growth, and milk secretion, which increase the zinc need for pregnancy and lactation. Increased needs can be met by increasing the dietary zinc intake, along with making homeostatic adjustments in zinc utilization. Potential homeostatic adjustments include changes in circulating zinc, increased zinc absorption, decreased zinc losses, and changes in whole body zinc kinetics. Although severe zinc deficiency during pregnancy has devastating effects, systematic reviews and meta-analysis of the effect of maternal zinc supplementation on pregnancy outcomes have consistently shown a limited benefit. We hypothesize, therefore, that zinc homeostatic adjustments during pregnancy and lactation improve zinc utilization sufficiently to provide the increased zinc needs in these stages and, therefore, mitigate immediate detrimental effects due to a low zinc intake. The specific questions addressed are the following: How is zinc utilization altered during pregnancy and lactation? Are those homeostatic adjustments influenced by maternal zinc status, dietary zinc, or zinc supplementation? These questions are addressed by critically reviewing results from published human studies on zinc homeostasis during pregnancy and lactation carried out in different populations worldwide. PMID:22852063

Using spiritually modified cognitive-behavioral therapy in substance dependence treatment: therapists' and clients' perceptions of the presumed benefits and limitations.

Science.gov (United States)

Hodge, David R; Lietz, Cynthia A

2014-11-01

Cognitive-behavioral therapy (CBT) that has been modified to incorporate clients' spiritual beliefs and practices has been used to treat a variety of problems. This study examines the utility of this modality with the treatment of alcohol dependence and other forms of substance abuse. Toward this end, six focus groups (three therapist groups and three client groups) were conducted to identify the presumed benefits and limitations of using spiritually modified CBT in substance dependence treatment. In terms of benefits, spiritually modified CBT was perceived to enhance outcomes through operationalizing horizontal and vertical sources of social support, divine coping resources, and spiritual motivation. Potential challenges include the risk of therapists inadvertently imposing their own beliefs during the modification process and the possibility of offending clients when conflicts in belief systems emerge, particularly in group setting. The article concludes by providing suggestions for incorporating spiritually modified CBT into treatment and develops a number of illustrative examples of spiritually modified CBT self-statements.

[Psychosocial adjustment in colorectal cancer patients undergoing chemotherapy or chemoradiotherapy].

Science.gov (United States)

Alvarado-Aguilar, Salvador; Guerra-Cruz, Hilda Griselda; Cupil-Rodríguez, Aura Lizbet; Calderillo-Ruiz, Germán; Oñate-Ocaña, Luis Fernando

2011-01-01

Psychosocial adaptation is a measurement that represents the patient's adjustment to those changes involved in their illness. We undertook this study to search for individual characteristics and clinical aspects associated with successful psychosocial adjustment in patients with colorectal cancer (CRC) undergoing (CT) chemotherapy or chemoradiotherapy (CRT). Seventy-five patients with CRC treated with CT or CRT in a cancer center were included. Psychosocial Adjustment to Illness Scale Self-Reporting (PAIS-SR) questionnaire was used as a measurement of psychosocial adjustment. Psychosocial adaptation was successful in 18 patients (24%) and unsuccessful in 57 patients (76%). Young patients, married patients and males showed lower psychosocial adaptation to disease. This is associated with the decrease in sexual relations, economic resources and psychological symptoms. Patients complained that they were unsatisfied due to the lack of disease and treatment information offered by the heath care team. In the process of adaptation, clinical features such as tumor location and treatment scheme are considered basic, as well as age, education, marital status. Areas such as sexuality, interpersonal and family relationships, economic status and emotional state of patients affected by the disease and treatments provide a deep complexity in the study of the psychosocial adaptation process in patients with CRC.

Cost-effectiveness analysis of potentially curative and combination treatments for hepatocellular carcinoma with person-level data in a Canadian setting.

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Thein, Hla-Hla; Isaranuwatchai, Wanrudee; Qiao, Yao; Wong, Kenny; Sapisochin, Gonzalo; Chan, Kelvin K W; Yoshida, Eric M; Earle, Craig C

2017-09-01

Patients with early-stage hepatocellular carcinoma (HCC) are potential candidates for curative treatments such as radiofrequency ablation (RFA), surgical resection (SR), or liver transplantation (LT), which have demonstrated a significant survival benefit. We aimed to estimate the cost-effectiveness of curative and combination treatment strategies among patients diagnosed with HCC during 2002-2010. This study used Ontario Cancer Registry-linked administrative data to estimate effectiveness and costs (2013 USD) of the treatment strategies from the healthcare payer's perspective. Multiple imputation by logistic regression was used to handle missing data. A net benefit regression approach of baseline important covariates and propensity score adjustment were used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 2,222 patients diagnosed with HCC, 10.5%, 14.1%, and 10.3% received RFA, SR, and LT monotherapy, respectively; 0.5-3.1% dual treatments; and 0.5% triple treatments. Compared with no treatment (53.2%), transarterial chemoembolization (TACE) + RFA (average $2,465, 95% CI: -$20,000-$36,600/quality-adjusted life years [QALY]) or RFA monotherapy ($15,553, 95% CI: $3,500-$28,500/QALY) appears to be the most cost-effective modality with lowest ICER value. The cost-effectiveness acceptability curve showed that if the relevant threshold was $50,000/QALY, RFA monotherapy and TACE+ RFA would have a cost-effectiveness probability of 100%. Strategies using LT delivered the most additional QALYs and became cost-effective at a threshold of $77,000/QALY. Our findings found that TACE+ RFA dual treatment or RFA monotherapy appears to be the most cost-effective curative treatment for patients with potential early stage of HCC in Ontario. These findings highlight the importance of identifying and measuring differential benefits, costs, and cost-effectiveness of alternative HCC curative treatments in

COORDINATING HOSPITAL AND COMMUNITY WORK ADJUSTMENT SERVICES. FINAL REPORT.

Science.gov (United States)

GOERTZEL, VICTOR; AND OTHERS

THE GOALS OF THIS STUDY WERE TO USE WORK TO HELP PATIENTS LEAVE THE CAMARILLO STATE HOSPITAL SOONER, BECOME A PART OF THE COMMUNITY, AND BECOME SELF-SUPPORTING. THE PROJECT SELECTED 146 SCHIZOPHRENIC MALES WHO HAD A HISTORY OF POOR WORK ADJUSTMENT. AS PART OF THE TREATMENT, THE MEN WERE PLACED IN THE HOSPITAL BAKERY. AFTER ADJUSTMENT TO THE WORK…

Covariate adjustments in randomized controlled trials increased study power and reduced biasedness of effect size estimation.

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Lee, Paul H

2016-08-01

This study aims to show that under several assumptions, in randomized controlled trials (RCTs), unadjusted, crude analysis will underestimate the Cohen's d effect size of the treatment, and an unbiased estimate of effect size can be obtained only by adjusting for all predictors of the outcome. Four simulations were performed to examine the effects of adjustment on the estimated effect size of the treatment and power of the analysis. In addition, we analyzed data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (older adults aged 65-94), an RCT with three treatment arms and one control arm. We showed that (1) the number of unadjusted covariates was associated with the effect size of the treatment; (2) the biasedness of effect size estimation was minimized if all covariates were adjusted for; (3) the power of the statistical analysis slightly decreased with the number of adjusted noise variables; and (4) exhaustively searching the covariates and noise variables adjusted for can lead to exaggeration of the true effect size. Analysis of the ACTIVE study data showed that the effect sizes adjusting for covariates of all three treatments were 7.39-24.70% larger than their unadjusted counterparts, whereas the effect size would be elevated by at most 57.92% by exhaustively searching the variables adjusted for. All covariates of the outcome in RCTs should be adjusted for, and if the effect of a particular variable on the outcome is unknown, adjustment will do more good than harm. Copyright © 2016 Elsevier Inc. All rights reserved.

Does Adjuvant Treatment With Ginkgo Biloba to Statins Have Additional Benefits in Patients With Dyslipidemia?

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Yu Fan

2018-06-01

Full Text Available Objective: Ginkgo biloba are widely used alone or in combination with other lipid-lowering agents in the treatment of dyslipidemia in China. We conducted this meta-analysis to investigate whether adjuvant treatment with ginkgo biloba leaves to statins has incremental benefits in patients with dyslipidemia.Methods: Potential studies were searched from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang database up to October 2017. Only randomized controlled trials (RCTs comparing the efficacy and safety of ginkgo biloba leaves plus statins versus statins alone in patients with dyslipidemia were included.Results: Eight RCTs involving 664 patients were included. Compared with statins therapy alone, combination of statins and ginkgo biloba leaves therapy achieved greater reductions in triglycerides [mean difference (MD -0.32 mmol/L; 95% confidence interval (CI -0.43 to -0.20], total cholesterol (MD -0.61 mmol/L; 95% CI -0.90 to -0.33, or low-density lipoprotein cholesterol (LDL-C (MD -0.32 mmol/L; 95% CI -0.48 to -0.16, and a greater increment in high-density lipoprotein cholesterol (MD 0.26 mmol/L; 95% CI 0.15 to 0.37. Subgroup analyses showed that ginkgo biloba leaves plus simvastatin appeared to achieve a greater reduction in serum levels of triglycerides, total cholesterol, and LDL-C than in combination with atorvastatin therapy.Conclusion: This meta-analysis suggests that adjuvant treatment with ginkgo biloba leaves appears to improve blood lipid parameters than statins therapy alone. More well-designed RCTs are needed to investigate the benefits of the combination of statins and ginkgo biloba leaves.

Association between employee benefits and frailty in community-dwelling older adults.

Science.gov (United States)

Avila-Funes, José Alberto; Paniagua-Santos, Diana Leticia; Escobar-Rivera, Vicente; Navarrete-Reyes, Ana Patricia; Aguilar-Navarro, Sara; Amieva, Hélène

2016-05-01

The phenotype of frailty has been associated with an increased vulnerability for the development of adverse health-related outcomes. The origin of frailty is multifactorial and financial issues could be implicated, as they have been associated with health status, well-being and mortality. However, the association between economic benefits and frailty has been poorly explored. Therefore, the objective was to determine the association between employee benefits and frailty. A cross-sectional study of 927 community-dwelling older adults aged 70 years and older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty was carried out. Employee benefits were established according to eight characteristics: bonus, profit sharing, pension, health insurance, food stamps, housing credit, life insurance, and Christmas bonus. Frailty was defined according to a slightly modified version of the phenotype proposed by Fried et al. Multinomial logistic regression models were run to determine the association between employee benefits and frailty adjusting by sociodemographic and health covariates. The prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor." Multinomial logistic regression analyses showed that employee benefits were statistically and independently associated with the frail subgroup (OR 0.85; 95% CI 0.74-0.98; P = 0.027) even after adjusting for potential confounders. Fewer employee benefits are associated with frailty. Supporting spreading employee benefits for older people could have a positive impact on the development of frailty and its consequences. Geriatr Gerontol Int 2016; 16: 606-611. © 2015 Japan Geriatrics Society.

A cost-benefit analysis of Wisconsin's screening, brief intervention, and referral to treatment program: adding the employer's perspective.

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Quanbeck, Andrew; Lang, Katharine; Enami, Kohei; Brown, Richard L

2010-02-01

A previous cost-benefit analysis found Screening, Brief Intervention, and Referral to Treatment (SBIRT) to be cost-beneficial from a societal perspective. This paper develops a cost-benefit model that includes the employer's perspective by considering the costs of absenteeism and impaired presenteeism due to problem drinking. We developed a Monte Carlo simulation model to estimate the costs and benefits of SBIRT implementation to an employer. We first presented the likely costs of problem drinking to a theoretical Wisconsin firm that does not currently provide SBIRT services. We then constructed a cost-benefit model in which the firm funds SBIRT for its employees. The net present value of SBIRT adoption was computed by comparing costs due to problem drinking both with and without the program. When absenteeism and impaired presenteeism costs were considered from the employer's perspective, the net present value of SBIRT adoption was $771 per employee. We concluded that implementing SBIRT is cost-beneficial from the employer's perspective and recommend that Wisconsin employers consider covering SBIRT services for their employees.

Employment benefits and job retention: evidence among patients with colorectal cancer.

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Veenstra, Christine M; Abrahamse, Paul; Wagner, Todd H; Hawley, Sarah T; Banerjee, Mousumi; Morris, Arden M

2018-03-01

A "health shock," that is, a large, unanticipated adverse health event, can have long-term financial implications for patients and their families. Colorectal cancer is the third most commonly diagnosed cancer among men and women and is an example of a specific health shock. We examined whether specific benefits (employer-based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer. In 2011-14, we surveyed patients with Stage III colorectal cancer from two representative SEER registries. The final sample was 1301 patients (68% survey response rate). For this study, we excluded 735 respondents who were not employed and 20 with unknown employment status. The final analytic sample included 546 respondents. Job retention in the year following diagnosis was assessed, and multivariable logistic regression was used to evaluate associations between job retention and access to specific employment benefits. Employer-based health insurance (OR = 2.97; 95% CI = 1.56-6.01; P = 0.003) and paid sick leave (OR = 2.93; 95% CI = 1.23-6.98; P = 0.015) were significantly associated with job retention, after adjusting for sociodemographic, clinical, geographic, and job characteristics. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Context Specificity of Post-Error and Post-Conflict Cognitive Control Adjustments

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Forster, Sarah E.; Cho, Raymond Y.

2014-01-01

There has been accumulating evidence that cognitive control can be adaptively regulated by monitoring for processing conflict as an index of online control demands. However, it is not yet known whether top-down control mechanisms respond to processing conflict in a manner specific to the operative task context or confer a more generalized benefit. While previous studies have examined the taskset-specificity of conflict adaptation effects, yielding inconsistent results, control-related performance adjustments following errors have been largely overlooked. This gap in the literature underscores recent debate as to whether post-error performance represents a strategic, control-mediated mechanism or a nonstrategic consequence of attentional orienting. In the present study, evidence of generalized control following both high conflict correct trials and errors was explored in a task-switching paradigm. Conflict adaptation effects were not found to generalize across tasksets, despite a shared response set. In contrast, post-error slowing effects were found to extend to the inactive taskset and were predictive of enhanced post-error accuracy. In addition, post-error performance adjustments were found to persist for several trials and across multiple task switches, a finding inconsistent with attentional orienting accounts of post-error slowing. These findings indicate that error-related control adjustments confer a generalized performance benefit and suggest dissociable mechanisms of post-conflict and post-error control. PMID:24603900

Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

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SONG Yingchun

2015-02-01

Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

Methodology of adjustment point in the post treatment of gaseous effluents; Metodologia del punto de ajuste en el post tratamiento de efluentes gaseosos

Energy Technology Data Exchange (ETDEWEB)

Vizuet G, J.; Molina, G. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico)]. e-mail: jvg@nuclear.inin.mx

2005-07-01

The methodology to determine the adjustment points of the monitoring system of gaseous discharges is based on the stipulations of the 10CFR20, which are expressed in terms of limit concentrations for the outstanding radionuclides, and of dose limits for the individuals members of the public. Besides the points of liberation properly said, like they are the chimneys of the reactor buildings and of turbine, the points of adjustment of the monitoring instrumentation that watches in real time the discharge of the Treatment system of output gases, to the HVAC of the waste building; they also undergo to the same methodology, with the approaches previously described. (Author)

Risk and benefit of dual antiplatelet treatment among nonrevascularized myocardial infarction patients in different age groups

DEFF Research Database (Denmark)

Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring

2017-01-01

revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all.......63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely...... among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted....

Cognitive behavioral treatment outcomes in adolescent ADHD.

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Antshel, Kevin M; Faraone, Stephen V; Gordon, Michael

2014-08-01

To assess the efficacy of cognitive behavioral therapy (CBT) for managing adolescent ADHD. A total of 68 adolescents with ADHD and associated psychiatric comorbidities completed a manualized CBT treatment protocol. The intervention used in the study was a downward extension of the Safren et al. program for adults with ADHD who have symptoms unresolved by medication. Outcome variables consisted of narrow band (ADHD) and broadband (e.g., mood, anxiety, conduct) symptom measures (Behavior Assessment System for Children-2nd edition and ADHD-Rating Scales) as well as functioning measures (parent/teacher ratings and several ecologically real-world measures). Treatment effects emerged on the medication dosage, parent rating of pharmacotherapy adherence, adolescent self-report of personal adjustment (e.g., self-esteem), parent and teacher ratings of inattentive symptoms, school attendance, school tardiness, parent report of peer, family and academic functioning and teacher report of adolescent relationship with teacher, academic progress, and adolescent self-esteem. Adolescents with ADHD with oppositional defiant disorder were rated by parents and teachers as benefiting less from the CBT intervention. Adolescents with ADHD and comorbid anxiety/depression were rated by parents and teachers as benefiting more from the CBT intervention. A downward extension of an empirically validated adult ADHD CBT protocol can benefit some adolescents with ADHD. © 2012 SAGE Publications.

Evaluating the Acoustic Benefits of Over-the-Rotor Acoustic Treatments Installed on the Advanced Noise Control Fan

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Gazella, Matthew R.; Takakura, Tamuto; Sutliff, Daniel L.; Bozak, Richard F.; Tester, Brian J.

2017-01-01

Over the last 15 years, over-the-rotor acoustic treatments have been evaluated by NASA with varying success. Recently, NASA has been developing the next generation of over-the-rotor acoustic treatments for fan noise reduction. The NASA Glenn Research Centers Advanced Noise Control Fan was used as a Low Technology Readiness Level test bed. A rapid prototyped in-duct array consisting of 50 microphones was employed, and used to correlate the in-duct analysis to the far-field acoustic levels and to validate an existing beam-former method. The goal of this testing was to improve the Technology Readiness Level of various over-the-rotor acoustic treatments by advancing the understanding of the physical mechanisms and projecting the far-field acoustic benefit.

Are gastroenterologists less tolerant of treatment risks than patients? Benefit-risk preferences in Crohn's disease management.

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Johnson, F Reed; Hauber, Brett; Özdemir, Semra; Siegel, Corey A; Hass, Steven; Sands, Bruce E

2010-10-01

Crohn's disease is a serious and debilitating gastrointestinal disorder with a high, unmet need for new treatments. Biologic agents have the potential to alter the natural course of Crohn's disease but present known risks of potential serious adverse events (SAEs). Previous studies have shown that patients are willing to accept elevated SAE risks in exchange for clinical efficacy. Gastroenterologists and patients may have similar goals of maximizing treatment benefit while minimizing risk; however, gastroenterologists may assess the relative importance of risk differently than patients. To (a) understand how gastroenterologists caring for patients with Crohn's disease balance benefits and risks in their treatment decisions and (b) compare their treatment preferences with those of adult patients with Crohn's disease. Both patient and gastroenterologist treatment preferences were elicited using a web-based, choice-format conjoint survey instrument. The conjoint questions required subjects to choose between 2 hypothetical treatment options with differing levels of treatment attributes. Patients evaluated the treatment options for themselves, and gastroenterologists evaluated the treatment options for each of 3 hypothetical patient types: (a) female aged 25 years with no history of Crohn's disease surgery (young), (b) male aged 45 years with 1 Crohn's disease surgery (middleaged), and (c) female older than 70 years with 4 Crohn's disease surgeries (older). Treatment attributes represented the expected outcomes of treatment: severity of daily symptoms, frequency of flare-ups, serious disease complications, oral steroid use, and the risks of 3 potentially fatal SAEs - lymphoma, serious or opportunistic infections, and progressive multifocal leukoencephalopathy (PML) - during 10 years of treatment. Maximum acceptable risk (MAR), defined as the highest level of SAE risk that subjects would accept in return for a given improvement in efficacy (i.e., the increase in

A reduction in public funding for fertility treatment--an econometric analysis of access to treatment and savings to government.

Science.gov (United States)

Chambers, Georgina M; Hoang, Van Phuong; Zhu, Rong; Illingworth, Peter J

2012-06-08

Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government's universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born. Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid. After controlling for underlying time trends and unobserved factors the policy change reduced the number of fresh embryo cycles by almost 8600 cycles over 12 months (a 16% reduction in cycles, p < 0.001). The policy effect was greatest on women aged 40 years and older (38% reduction in cycles, p < 0.001). Younger women engaged in relatively more anticipatory behaviour by bringing forward their fresh cycles to 2009. Frozen embryo cycles, which are approximately one quarter of the cost of a fresh cycle, were only marginally impacted by the policy. Utilisation of IUI cycles were not impacted by the policy. After adjusting for anticipatory behaviour, $76 million in Medicare benefits was saved in the 12 months after the policy change (0.47% of annual Medicare benefits). Between 1200 and 1500 ART conceived children were not born in 2010 as a consequence of the policy. The introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the

76 FR 66756 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance and...

Science.gov (United States)

2011-10-27

... received a certification of eligibility to apply for trade adjustment assistance benefits and such supply...; Coastal Lumber Company, Hacker Valley, WV: September 7, 2010 TA-W-80,422F; Coastal Lumber Company...

An experimental test for indirect benefits in Drosophila melanogaster

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Ödeen Anders

2007-03-01

Full Text Available Abstract Background Despite much empirical attention, tests for indirect benefits of mate choice have rarely considered the major components of sexual and nonsexual offspring fitness relevant to a population. Here we use a novel experimental design to test for the existence of any indirect benefits in a laboratory adapted population of D. melanogaster. Our experiment compared the fitness (mating success, longevity, and productivity of individuals possessing genomes that derived two generations previously from males that were either entirely successful (studs or wholly unsuccessful (duds at achieving mates in three subsequent rounds of mating trials. Results Males from the stud treatment were 30% more successful on average at securing mates than males from the dud treatment. In contrast, we found no difference between treatments in measures of productivity or of longevity when measured in a mixed-sex environment. In the absence of females, however, males in the stud treatment outlived males in the dud treatment. Conclusion Our results suggest that mating with successful males in this population provides an indirect benefit to females and that, at least in this environment, the benefit arises primarily through the production of more attractive male offspring. However, it is unclear whether this represents solely a traditional sexy sons benefit or whether there is an additional good genes component (with male offspring simply allocating their surplus condition to traits that enhance their mating success. The lack of any detectable differences in female fitness between the two treatments suggests the former, although the longevity advantage of males in the stud treatment when females were absent is consistent with the latter. Determining the effect of this indirect benefit on the evolution of female mate preferences (or resistance will require comparable data on the direct costs of mating with various males, and an understanding of how these costs

Medical benefits in young Norwegians and their parents, and the contribution of family health and socioeconomic status. The HUNT Study, Norway.

Science.gov (United States)

Pape, Kristine; Bjørngaard, Johan Håkon; De Ridder, Karin A A; Westin, Steinar; Holmen, Turid Lingaas; Krokstad, Steinar

2013-07-01

Family and intergenerational perspectives might contribute to a better understanding of why young people in many European countries experience work impairment and end up being dependent on public benefits for life sustenance. The aim of this cohort study was to explore the relationship between the receipt of medical benefits in parents and their young adult offspring and the contributions of family health and family socioeconomic status. Baseline information on the health of 7597 adolescents and their parents who participated in the HUNT Study 1995-1997 was linked to national registers to identify long-term receipt of medical benefits for parents (1992-1997) and adolescents as they entered adulthood (1998-2008). We used logistic regression to explore the association between parent and offspring receipt of medical benefits, adjusting for family health and socioeconomic status. Among adolescents, 13% received medical benefits from age 20-29. Adolescents whose parents had received medical benefits (26%) were more likely to receive such benefits themselves from age 20-29 compared with adolescents without benefit-receiving parents (age- and sex-adjusted odds ratio (OR) 2.16, 95 % confidence interval (CI) 1.86-2.49). Adjustment for family health reduced this estimate considerably (to OR 1.66, 95% CI 1.38-1.99), whereas adjustment for family socioeconomic status had less impact. Adolescents whose parents receive medical benefits enter adult working life with an elevated risk of health-related work exclusion. Family health vulnerability appears to be a key to understanding this association, suggesting that more attention to intergenerational continuities of health could be a way to prevent welfare dependence in future generations.

Addition of meloxicam to the treatment of bovine clinical mastitis results in a net economic benefit to the dairy farmer.

Science.gov (United States)

van Soest, Felix J S; Abbeloos, Elke; McDougall, Scott; Hogeveen, Henk

2018-04-01

Recently, it has been shown that the addition of meloxicam to standard antimicrobial therapy for clinical mastitis (CM) improves the conception rate of dairy cows contracting CM in the first 120 d in milk. The objective of our study was to assess whether this improved reproduction through additional treatment with meloxicam would result in a positive net economic benefit for the farmer. We developed a stochastic bio-economic simulation model, in which a dairy cow with CM in the first 120 d in milk was simulated. Two scenarios were simulated in which CM cases were treated with meloxicam in conjunction with antimicrobial therapy or with antimicrobial therapy alone. The scenarios differed for conception rates (31% with meloxicam or 21% without meloxicam) and for the cost of CM treatment. Sensitivity analyses were undertaken for the biological and economic components of the model to assess the effects of a wide range of inputs on inferences about the cost effectiveness of meloxicam treatment. Model results showed an average net economic benefit of €42 per CM case per year in favor of the meloxicam scenario. Cows in the no-meloxicam treatment scenario had higher returns on milk production, lower costs upon calving, and reduced costs of treatment. However, these did not outweigh the savings associated with lower feed intake, reduced number of inseminations, and the reduced culling rate. The net economic benefit favoring meloxicam therapy was a consequence of the better reproductive performance in the meloxicam scenario in which cows had a shorter calving to conception interval (132 vs. 143 d), a shorter intercalving interval (405 vs. 416 d), and fewer inseminations per conception (2.9 vs. 3.7) compared with cows in the no-meloxicam treatment scenario. This resulted in a shorter lactation, hence a lower lactational milk production (8,441 vs. 8,517 kg per lactation) with lower feeding costs in the meloxicam group. A lower culling rate (12 vs. 25%) resulted in lower

Adjustable Perineal Male Sling for the Treatment of Urinary Incontinence: Long-term Results.

Science.gov (United States)

Altan, Mesut; Asi, Tariq; Bilen, Cenk Yucel; Ergen, Ali

2017-08-01

To present the long-term results in patients with urinary incontinence who were treated with adjustable perineal male sling. An adjustable male sling procedure was performed in 45 patients with a mean age of 67.6 ± 7.8 years who had urinary incontinence. The mean period between primary prostatic surgery and the sling procedure was 36.7 months. The difference between the classical sling and the adjustable one is a 10 cm tissue expander between the 2 layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via this port, in case of recurrence or persistence of incontinence. Mean follow-up was 48 ± 29 months. Average operative time was 101.1 ± 25.5 minutes (45-150). Median daily pad use in these patients decreased from 8(2-12) to 1(0-10) (P dry rate was higher in patients with nonsevere incontinence compared to the others with severe incontinence (57.9% vs 23.1%, P = .029). Nevertheless, there was no significant difference in the case of total success rate (78.9% vs 57.7%, respectively; P = .135). Age was significantly greater in both complete dry group (71.1 ± 4.8 vs 65.4 ± 8.7) and total success group (70.1 ± 5.2 vs 62.4 ± 5.2) (P = .017 and P < .001, respectively). Adjustable male sling is an acceptable procedure with low complication rates especially in patients with mild and moderate incontinence. At the same time, this procedure may be offered to patients with previous incontinence surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Addition of Everolimus Post VEGFR Inhibition Treatment Failure in Advanced Sarcoma Patients Who Previously Benefited from VEGFR Inhibition: A Case Series

OpenAIRE

ElNaggar, Adam C.; Hays, John L.; Chen, James L.

2016-01-01

Background Patients with metastatic sarcoma who progress on vascular endothelial growth factor receptor inhibitors (VEGFRi) have limited treatment options. Upregulation of the mTOR pathway has been demonstrated to be a means of resistance to targeted VEGFRi in metastatic sarcoma. Patients and methods Retrospective cohort study to evaluate the clinical benefit at four months of combining mTOR inhibition (mTORi) via everolimus with VEGFRi in patients who have derived benefit from single-agent V...

Algorithm for lamotrigine dose adjustment before, during, and after pregnancy

DEFF Research Database (Denmark)

Sabers, A

2012-01-01

Sabers A. Algorithm for lamotrigine dose adjustment before, during, and after pregnancy. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01627.x. © 2011 John Wiley & Sons A/S. Background -  Treatment with lamotrigine (LTG) during pregnancy is associated with a pronounced risk of seizure deterior......Sabers A. Algorithm for lamotrigine dose adjustment before, during, and after pregnancy. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01627.x. © 2011 John Wiley & Sons A/S. Background -  Treatment with lamotrigine (LTG) during pregnancy is associated with a pronounced risk of seizure...

Self-adjustable glasses in the developing world

Directory of Open Access Journals (Sweden)

Murthy Gudlavalleti VS

2014-02-01

Full Text Available Venkata S Murthy Gudlavalleti,1 Komal Preet Allagh,1 Aashrai SV Gudlavalleti2 1Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, 2Centre for Chronic Disease Control, Public Health Foundation of India, New Delhi, India Abstract: Uncorrected refractive errors are the single largest cause of visual impairment globally. Refractive errors are an avoidable cause of visual impairment that are easily correctable. Provision of spectacles is a cost-effective measure. Unfortunately, this simple solution becomes a public health challenge in low- and middle-income countries because of the paucity of human resources for refraction and optical services, lack of access to refraction services in rural areas, and the cost of spectacles. Low-cost approaches to provide affordable glasses in developing countries are critical. A number of approaches has been tried to surmount the challenge, including ready-made spectacles, the use of focometers and self-adjustable glasses, among other modalities. Recently, self-adjustable spectacles have been validated in studies in both children and adults in developed and developing countries. A high degree of agreement between self-adjustable spectacles and cycloplegic subjective refraction has been reported. Self-refraction has also been found to be less prone to accommodative inaccuracy compared with non-cycloplegic autorefraction. The benefits of self-adjusted spectacles include: the potential for correction of both distance and near vision, applicability for all ages, the empowerment of lay workers, the increased participation of clients, augmented awareness of the mechanism of refraction, reduced costs of optical and refraction units in low-resource settings, and a relative reduction in costs for refraction services. Concerns requiring attention include a need for the improved cosmetic appearance of the currently available self-adjustable spectacles, an increased range of correction (currently

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

Science.gov (United States)

Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

2016-01-20

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). 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/

Psychotherapy for depression in claimants receiving wage replacement benefits: review of the evidence.

Science.gov (United States)

Ebrahim, Shanil

2014-01-01

To review the evidence on the provision of psychotherapy for claimants who are suffering from depression and receiving wage replacement benefits. A literature review was performed using PubMed and EMBASE. Results from three studies are discussed. The first is a systematic review and individual patient data meta-analysis of randomized controlled trials to assess the relative effectiveness of cognitive behavioral therapy (CBT) for depression in patients receiving disability benefits. A non-significant trend showed that the effect of CBT was greater in patients receiving benefits (34 patients) than those not receiving disability benefits (193 patients) on the Beck Depression Inventory; mean difference (95% confidence interval [CI]) = -4.46 (-12.21 to 3.30). The second study is an analysis of a large insurance administrative database consisting of 10,338 long-term disability claims for depression. Receipt of psychotherapy was associated with faster claim closure (hazard ratio = 1.42; 95% CI = 1.33 to 1.52). The third study evaluated the effectiveness of standard CBT vs work-focused CBT in 168 employees with common mental health problems (depression, anxiety and adjustment disorders). Employees receiving work-focused CBT returned to work 65 days earlier on average than those receiving standard CBT. Limited evidence shows that psychotherapy is effective in claimants suffering from depression who are in receipt of wage replacement benefits. At this time, clinicians and insurers should continue to recommend psychotherapy as a treatment management strategy for claimants with depression. Larger comparative trials, conducted in collaboration with disability insurers, will lead to increased confidence in estimates.

On adjustment for auxiliary covariates in additive hazard models for the analysis of randomized experiments

DEFF Research Database (Denmark)

Vansteelandt, S.; Martinussen, Torben; Tchetgen, E. J Tchetgen

2014-01-01

We consider additive hazard models (Aalen, 1989) for the effect of a randomized treatment on a survival outcome, adjusting for auxiliary baseline covariates. We demonstrate that the Aalen least-squares estimator of the treatment effect parameter is asymptotically unbiased, even when the hazard...... that, in view of its robustness against model misspecification, Aalen least-squares estimation is attractive for evaluating treatment effects on a survival outcome in randomized experiments, and the primary reasons to consider baseline covariate adjustment in such settings could be interest in subgroup......'s dependence on time or on the auxiliary covariates is misspecified, and even away from the null hypothesis of no treatment effect. We furthermore show that adjustment for auxiliary baseline covariates does not change the asymptotic variance of the estimator of the effect of a randomized treatment. We conclude...

Cost-Benefit Analysis of Nanoparticle Albumin-Bound Paclitaxel versus Solvent-Based Paclitaxel for the Treatment of Metastatic Breast Cancer in the United States

Science.gov (United States)

Vichansavakul, Kittaya

Breast cancer is the second leading cause of death among women in the US. Although early detection and treatment help to increase survival rates, some unfortunate patients develop metastatic breast cancer that has no cure. Palliative treatment is the main objective in this group of patients in order to prolong life and reduce toxicities from interventions. In the advancement of treatment for metastatic breast cancer, solvent-based paclitaxel has been widely used. However, solvent-based paclitaxel often causes adverse reactions. Therefore, researchers have developed a new chemotherapy based on nanotechnology. One of these drugs is the Nanoparticle albumin-bound Paclitaxel. This nanodrug aims to increase therapeutic index by reducing adverse reactions from solvents and to improve efficacy of conventional cytotoxic chemotherapy. Breast cancer is a disease with high epidemiological and economic burden. The treatment of metastatic breast cancer has not only high direct costs but also high indirect costs. Breast cancer affects mass populations, especially women younger than 50 years of age. It relates to high indirect costs due to lost productivity and premature death because the majority of these patients are in the workforce. Because of the high cost of breast cancer therapies and short survival rates, the question is raised whether the costs and benefits are worth paying or not. Due to the rising costs in healthcare and new financing policies that have been developed to address this issue, economic evaluation is an important aspect of the development and use of any new interventions. To guide policy makers on how to allocate limited healthcare resources in the most efficient and effective manner, many economic evaluation methods can be used to measure the costs, benefits, and impacts of healthcare innovations. Currently, economic evaluation and health outcomes studies have focused greatly on cost-effectiveness and cost-utility analysis. However, the previous studies

76 FR 66328 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance and...

Science.gov (United States)

2011-10-26

... received a certification of eligibility to apply for trade adjustment assistance benefits and such supply...-80,422E; Coastal Lumber Company, Hacker Valley, WV: September 7, 2010 TA-W-80,422F; Coastal Lumber...

Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

Directory of Open Access Journals (Sweden)

Matute-Cruz Petra

2009-04-01

Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

Brain natriuretic peptide precursor (NT-pro-BNP) levels predict for clinical benefit to sunitinib treatment in patients with metastatic renal cell carcinoma

International Nuclear Information System (INIS)

Papazisis, Konstantinos T; Kortsaris, Alexandros H; Kontovinis, Lukas F; Papandreou, Christos N; Kouvatseas, George; Lafaras, Christos; Antonakis, Evangelos; Christopoulou, Maria; Andreadis, Charalambos; Mouratidou, Despoina

2010-01-01

Sunitinib is an oral, multitargeted tyrosine kinase inhibitor that has been approved for the treatment of metastatic renal cell carcinoma. Although the majority of sunitinib-treated patients receive a clinical benefit, almost a third of the patients will not respond. Currently there is no available marker that can predict for response in these patients. We estimated the plasma levels of NT-pro-BNP (the N-terminal precursor of brain natriuretic peptide) in 36 patients that were treated with sunitinib for metastatic clear-cell renal carcinoma. From the 36 patients, 9 had progressive disease and 27 obtained a clinical benefit (objective response or disease stabilization). Increases in plasma NT-pro-BNP were strongly correlated to clinical outcome. Patients with disease progression increased plasma BNP at statistically significant higher levels than patients that obtained a clinical benefit, and this was evident from the first 15 days of treatment (a three-fold increase in patients with progressive disease compared to stable NT-pro-BNP levels in patients with clinical benefit, p < 0.0001). Median progression-free survival was 12.0 months in patients with less than 1.5 fold increases (n = 22) and 3.9 months in patients with more than 1.5 fold increases in plasma NT-pro-BNP (n = 13) (log-rank test, p = 0.001). This is the first time that a potential 'surrogate marker' has been reported with such a clear correlation to clinical benefit at an early time of treatment. Due to the relative small number of accessed patients, this observation needs to be further addressed on larger cohorts. More analyses, including multivariate analyses are needed before such an observation can be used in clinical practice

Identified adjustability dimensions when generating a product specific requirements specification by requirements reuse

DEFF Research Database (Denmark)

Hauksdóttir, Dagný; Mortensen, Niels Henrik; Nielsen, Poul Erik

2014-01-01

. An extensive state of the art is included to introduce the presented methods related to each adjustability dimensions. The options for implementing each adjustability dimensions in a requirement reuse approach are illustrated along with a discussion regarding the benefits and issues resulting from each option....... This discussion should help practitioners to better understand the possible methods that can be implemented and to design a user friendly and sustainable approach. A case study, describing how the dimensions are incorporated in two requirements reuse approaches, for Danfoss Solar Inverters (SI) and Danfoss...

Contraceptives with novel benefits.

Science.gov (United States)

Su, Ying; Lian, Qing-Quan; Ge, Ren-Shan

2012-01-01

Progesterone receptor (PR) agonists (progestins) and antagonists are developed for female contraceptives. However, non-contraceptive applications of newer progestins and PR modulators are being given more attention. The newer PR agonists including drospirenone, nomegestrol, trimegestone, dienogest and nestorone are being evaluated as contraceptives with health benefits because of their unique pharmacological properties. The selective PR modulators (SPRM; PR antagonists with PR agonistic properties) are under development not only for emergency contraception but also for other health benefits such as the treatment of endometritis and leiomyoma. After searching the literature from PubMed, clinicaltrials.gov and patent database, this review focuses on the effects and mechanisms of these progestins, and SPRMs as contraceptives with other health benefits. PR agonists and antagonists that have novel properties may generate better contraceptive effects with other health benefits.

Convexity Adjustments

DEFF Research Database (Denmark)

M. Gaspar, Raquel; Murgoci, Agatha

2010-01-01

A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

Neurologic music therapy improves executive function and emotional adjustment in traumatic brain injury rehabilitation.

Science.gov (United States)

Thaut, Michael H; Gardiner, James C; Holmberg, Dawn; Horwitz, Javan; Kent, Luanne; Andrews, Garrett; Donelan, Beth; McIntosh, Gerald R

2009-07-01

This study examined the immediate effects of neurologic music therapy (NMT) on cognitive functioning and emotional adjustment with brain-injured persons. Four treatment sessions were held, during which participants were given a pre-test, participated in 30 min of NMT that focused on one aspect of rehabilitation (attention, memory, executive function, or emotional adjustment), which was followed by post-testing. Control participants engaged in a pre-test, 30 min of rest, and then a post-test. Treatment participants showed improvement in executive function and overall emotional adjustment, and lessening of depression, sensation seeking, and anxiety. Control participants improved in emotional adjustment and lessening of hostility, but showed decreases in measures of memory, positive affect, and sensation seeking.

A therapeutic benefit from combining normobaric carbogen or oxygen with nicotinamide in fractionated X-ray treatments

International Nuclear Information System (INIS)

Kjellen, E.; Joiner, M.C.; Collier, J.M.; Johns, H.; Rojas, A.

1991-01-01

The ability of normobaric oxygen and carbogen (95 percent O 2 + 5 percent CO 2 ) combined with nicotinamide to enhance the radiosensitivity of two rodent adenocarcinomas and of mouse skin and kidneys was compared with the effects of radiation in air and without the drug. A comparison of the results in tumors and normal tissues showed that significant therapeutic benefit was obtained with normobaric oxygen and carbogen combined with nicotinamide. Toxic side effects of the treatment are unlikely, as prolonged administration of nicotinamide is well tolerated in man. The combination of normobaric carbogen with nicotinamide could be an effective method of enhancing tumor radiosensitivity in clinical radiotherapy where hypoxia limits the outcome of treatment. (author). 45 refs.; 4 fig.; 4 tabs

Operational and biological analyses of branched water-adjustment and combined treatment of wastewater from a chemical industrial park.

Science.gov (United States)

Xu, Ming; Cao, Jiashun; Li, Chao; Tu, Yong; Wu, Haisuo; Liu, Weijing

2018-01-01

The combined biological processes of branched water-adjustment, chemical precipitation, hydrolysis acidification, secondary sedimentation, Anoxic/Oxic and activated carbon treatment were used for chemical industrial wastewater treatment in the Taihu Lake Basin. Full-scale treatment resulted in effluent chemical oxygen demand, total nitrogen, NH 3 -N and total phosphorus of 35.1, 5.20, 3.10 and 0.15 mg/L, respectively, with a total removal efficiency of 91.1%, 67.1%, 70.5% and 89.3%, respectively. In this process, short-circuited organic carbon from brewery wastewater was beneficial for denitrification and second-sulfate reduction. The concentration of effluent fluoride was 6.22 mg/L, which also met the primary standard. Gas Chromatography-Mass Spectrometry analysis revealed that many types of refractory compounds were present in the inflow. Microbial community analysis performed in the summer by PCR-denaturing gradient gel electrophoresis and MiSeq demonstrated that certain special functional bacteria, such as denitrificans, phosphorus-accumulating bacteria, sulfate- and perhafnate-reducing bacteria, aromatic compound-degrading bacteria and organic fluoride-degrading bacteria, present in the bio-tanks were responsible for the acceptable specific biological pollutant reduction achieved.

A cost-benefit analysis of bevacizumab in combination with paclitaxel in the first-line treatment of patients with metastatic breast cancer.

Science.gov (United States)

Montero, Alberto J; Avancha, Kiran; Glück, Stefan; Lopes, Gilberto

2012-04-01

Bevacizumab in combination with chemotherapy increases progression-free survival (PFS), but not overall survival when compared to chemotherapy alone in the treatment of metastatic breast cancer (MBC). Recently in November, 2011 the Food and drug administration revoked approval of bevacizumab in combination with paclitaxel for the treatment of MBC. The European Medicines Agency, in contrast, maintained its approval of bevacizumab in MBC. While neither agency considers health economics in their decision-making process, one of the greatest challenges in oncology practice today is to reconcile hard-won small incremental clinical benefits with exponentially rising costs. To inform policy-makers in the US, this study aimed to assess the cost-effectiveness of bevacizumab/paclitaxel in MBC, from a payer perspective. We created a decision analytical model using efficacy and adverse events data from the ECOG 2100 trial. Health utilities were derived from available literature. Costs were obtained from the Center for Medicare Services Drug Payment Table and Physician Fee Schedule and are represented in 2010 US dollars. Quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER) were calculated. Sensitivity analyses were performed. Bevacizumab added 0.49 years of PFS and 0.135 QALY with an incremental cost of $100,300, and therefore a cost of $204,000 per year of PFS gained and an ICER of $745,000 per QALY. The main drivers of the model were drug acquisition cost, PFS, and health utility values. Using a threshold of $150,000/QALY, drug price would have to be reduced by nearly 80% or alternatively PFS increased by 10 months to make bevacizumab cost-effective. The results of the model were robust in sensitivity analyses. Bevacizumab plus paclitaxel is not cost-effective in treating MBC. Value-based pricing and the development of biomarkers to improve patient selection are needed to better define the role of the drug in this population.

Adjustment to cancer: exploring patients' experiences of participating in a psychodramatic group intervention.

Science.gov (United States)

Menichetti, J; Giusti, L; Fossati, I; Vegni, E

2016-09-01

The main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it. © 2015 John Wiley & Sons Ltd.

Alternative Strategies to Achieve Cardiovascular Mortality Goals in China and India: A Microsimulation of Target- Versus Risk-Based Blood Pressure Treatment.

Science.gov (United States)

Basu, Sanjay; Yudkin, John S; Sussman, Jeremy B; Millett, Christopher; Hayward, Rodney A

2016-03-01

The World Health Organization aims to reduce mortality from chronic diseases including cardiovascular disease (CVD) by 25% by 2025. High blood pressure is a leading CVD risk factor. We sought to compare 3 strategies for treating blood pressure in China and India: a treat-to-target (TTT) strategy emphasizing lowering blood pressure to a target, a benefit-based tailored treatment (BTT) strategy emphasizing lowering CVD risk, or a hybrid strategy currently recommended by the World Health Organization. We developed a microsimulation model of adults aged 30 to 70 years in China and in India to compare the 2 treatment approaches across a 10-year policy-planning horizon. In the model, a BTT strategy treating adults with a 10-year CVD event risk of ≥ 10% used similar financial resources but averted ≈ 5 million more disability-adjusted life-years in both China and India than a TTT approach based on current US guidelines. The hybrid strategy in the current World Health Organization guidelines produced no substantial benefits over TTT. BTT was more cost-effective at $205 to $272/disability-adjusted life-year averted, which was $142 to $182 less per disability-adjusted life-year than TTT or hybrid strategies. The comparative effectiveness of BTT was robust to uncertainties in CVD risk estimation and to variations in the age range analyzed, the BTT treatment threshold, or rates of treatment access, adherence, or concurrent statin therapy. In model-based analyses, a simple BTT strategy was more effective and cost-effective than TTT or hybrid strategies in reducing mortality. © 2016 American Heart Association, Inc.

Quality-adjusted life years gained in patients aged over 65 years after total hip replacement

DEFF Research Database (Denmark)

Hørdam, Britta; Pedersen, P.U.; Søballe, Kjeld

2011-01-01

Background: Total hip replacement (THR) is an effective, but also cost-intensive health care procedure for the elderly. Because of demographic changes in Western Europe, THR-associated financial investment for health care has become a question of priorities in society. To provide a quantitative...... rationale for a discussion within Western European health care systems, we undertook a prospective assessment of the benefit of THR from the patients´ perspective and as measured by quality-adjusted life years (QALYs). Aim: To measure the difference in health related quality of life between an intervention...... treatment and telephone intervention. QALYs were calculated from measures of health-related quality of life using questionnaire SF-36. These scores were transformed to QALYs using a formula based on the method developed by Brazier (Brazier 1998). Results: Both the control and the intervention patients...

Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway

Directory of Open Access Journals (Sweden)

Jeroen P. Jansen

2011-01-01

Full Text Available Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg relative to celecoxib (200/400 mg, and the nonselective NSAIDs naproxen (1000 mg and diclofenac (150 mg in the initial treatment of ankylosing spondylitis in Norway. Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach. Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered. Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

Adjusting Pulse Amplitude During Transcutaneous Electrical Nerve Stimulation Does Not Provide Greater Hypoalgesia.

Science.gov (United States)

Bergeron-Vézina, Kayla; Filion, Camille; Couture, Chantal; Vallée, Élisabeth; Laroche, Sarah; Léonard, Guillaume

2018-03-01

Transcutaneous electrical nerve stimulation (TENS) is an electrotherapeutic modality commonly used in rehabilitation to relieve pain. Adjusting pulse amplitude (intensity) during TENS treatment has been suggested to overcome nerve habituation. However, it is still unclear if this procedure leads to greater hypoalgesia. The aim of this study was to determine if the hypoalgesic effect of TENS is greater when pulse amplitude is adjusted throughout the TENS treatment session in chronic low-back pain patients. Randomized double-blind crossover study. Recruitment and assessment were conducted at the Clinique universitaire de réadaptation de l'Estrie (CURE) of the Faculty of Medicine and Health Sciences of the Université de Sherbrooke. Twenty-one volunteers with chronic low-back pain were enrolled and completed this investigation. Each patient received two high-frequency TENS treatments on two separate sessions: (1) with adjustment of pulse amplitude and (2) without pulse amplitude adjustment. Pain intensity and unpleasantness were assessed before, during, and after TENS application with a 10 cm visual analog scale. Both TENS conditions (with and without adjustment of intensity) decreased pain intensity and unpleasantness when compared with baseline. No difference was observed between the two stimulation conditions for both pain intensity and unpleasantness. The current results suggest that adjustment of pulse amplitude during TENS application does not provide greater hypoalgesia in individuals with chronic low-back pain. Future studies are needed to confirm these findings in other pain populations.

Differential benefit risk assessment of DOACs in the treatment of venous thromboembolism: focus on dabigatran

Directory of Open Access Journals (Sweden)

Leung TS

2015-07-01

Full Text Available Timothy S Leung,1 Ernest H Law2 1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA Abstract: Venous thromboembolism includes deep vein thrombosis and pulmonary embolism and is a serious medical condition that requires anticoagulation as part of treatment. Currently, standard therapy consists of parenteral anticoagulation followed by a vitamin K antagonist (VKA. The pharmacokinetic and pharmacodynamic profiles of the direct oral anticoagulants (DOACs differ from VKAs, which overcome some of the limitations of VKAs and have practical implications on their use in clinical situations. Dabigatran is a prodrug that undergoes primarily renal elimination and does not affect cytochrome P450 enzymes. Assays to quantify the degree of anticoagulation and the therapeutic level of DOAC are either unavailable for routine clinical use or require specific calibration. Routine monitoring of DOACs is not recommended at this time. Dabigatran, rivaroxaban, and apixaban are DOACs that have been studied for treatment of venous thromboembolism. Clinical trials comparing DOACs with standard therapy have shown them to be non-inferior for acute and extended therapy. Each DOAC has a unique benefit and harm profile that should be considered prior to use. The distinguishing characteristics of dabigatran include a requirement of parenteral anticoagulation prior to acute treatment, clinical trial results comparing it with a VKA for extended treatment, association with upper gastrointestinal adverse events, and increased risk of gastrointestinal bleed. Rivaroxaban is the only DOAC that has once-daily dosing while apixaban is the only DOAC that has lower risk of overall, major, and gastrointestinal bleeding compared with VKA. A common drawback of DOACs is the lack of an available reversal agent. Clinical trials of

Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system.

Science.gov (United States)

Bergion, Viktor; Lindhe, Andreas; Sokolova, Ekaterina; Rosén, Lars

2018-04-01

Waterborne outbreaks of gastrointestinal diseases can cause large costs to society. Risk management needs to be holistic and transparent in order to reduce these risks in an effective manner. Microbial risk mitigation measures in a drinking water system were investigated using a novel approach combining probabilistic risk assessment and cost-benefit analysis. Lake Vomb in Sweden was used to exemplify and illustrate the risk-based decision model. Four mitigation alternatives were compared, where the first three alternatives, A1-A3, represented connecting 25, 50 and 75%, respectively, of on-site wastewater treatment systems in the catchment to the municipal wastewater treatment plant. The fourth alternative, A4, represented installing a UV-disinfection unit in the drinking water treatment plant. Quantitative microbial risk assessment was used to estimate the positive health effects in terms of quality adjusted life years (QALYs), resulting from the four mitigation alternatives. The health benefits were monetised using a unit cost per QALY. For each mitigation alternative, the net present value of health and environmental benefits and investment, maintenance and running costs was calculated. The results showed that only A4 can reduce the risk (probability of infection) below the World Health Organization guidelines of 10 -4 infections per person per year (looking at the 95th percentile). Furthermore, all alternatives resulted in a negative net present value. However, the net present value would be positive (looking at the 50 th percentile using a 1% discount rate) if non-monetised benefits (e.g. increased property value divided evenly over the studied time horizon and reduced microbial risks posed to animals), estimated at 800-1200 SEK (€100-150) per connected on-site wastewater treatment system per year, were included. This risk-based decision model creates a robust and transparent decision support tool. It is flexible enough to be tailored and applied to local

A Cost Benefit Analysis of an Active Travel Intervention with Health and Carbon Emission Reduction Benefits

Science.gov (United States)

Grams, Mark; Witten, Karen; Woodward, Alistair

2018-01-01

Active travel (walking and cycling) is beneficial for people’s health and has many co-benefits, such as reducing motor vehicle congestion and pollution in urban areas. There have been few robust evaluations of active travel, and very few studies have valued health and emissions outcomes. The ACTIVE before-and-after quasi-experimental study estimated the net benefits of health and other outcomes from New Zealand’s Model Communities Programme using an empirical analysis comparing two intervention cities with two control cities. The Programme funded investment in cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training. Using the modified Integrated Transport and Health Impacts Model, the Programme’s net economic benefits were estimated from the changes in use of active travel modes. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved due to reductions in cardiac disease, diabetes, cancer, and respiratory disease. Reductions in transport-related carbon emissions were also estimated and valued. Using a discount rate of 3.5%, the estimated benefit/cost ratio was 11:1 and was robust to sensitivity testing. It is concluded that when concerted investment is made in active travel in a city, there is likely to be a measurable, positive return on investment. PMID:29751618

Comparison of WIC benefit redemptions in Michigan indicates higher utilization among Arab American families.

Science.gov (United States)

Pooler, Jennifer; Gleason, Stacy F

2014-01-01

To assess Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit use across Arab American, Hispanic, and non-Arab/non-Hispanic families participating in the Michigan WIC program using point-of-sale Electronic Benefits Transfer data. Cross-sectional analysis using administrative data obtained from the Michigan WIC program, which collects Arab American ethnicity in addition to Hispanic ethnicity and race. Michigan. Families participating in the Michigan WIC program in March, 2012 (n = 152,989). Families redeeming all WIC benefits. Bivariate frequencies and multivariate logistic regression model identified characteristics of families associated with full redemption of WIC food benefits. About 12% of WIC families fully redeemed their benefits in March, 2012. Compared with non-Arab/non-Hispanic families, Arab American WIC families were significantly more likely to use all of their monthly WIC benefits, even after controlling for family characteristics (adjusted odds ratio, 3.6; 95% confidence interval, 3.4-3.8). Rates of redemption for Hispanic families, however, were the same as for non-Arab/non-Hispanic families (adjusted odds ratio, 1.0; 95% confidence interval, 0.9-1.0). State WIC programs moving toward implementation of Electronic Benefits Transfer should consider ways to enhance systems that would allow for more opportunities to conduct targeted analyses of benefit use across participant subpopulations. Findings point to low overall WIC benefit use. Additional research is needed to explore methods to increase benefit use among all WIC populations, including whether specific factors may contribute to higher redemptions among ethnic minorities, and whether they can be translated to other subpopulations. Copyright © 2014 Society for Nutrition Education and Behavior. All rights reserved.

75 FR 76256 - Amendments to Regulations Regarding Withdrawal of Applications and Voluntary Suspension of Benefits

Science.gov (United States)

2010-12-08

... later date based on the annual earnings report; Adjusting benefits to consider the effect of work and... amendments to the Act designed to restore the long-term balance of the program. Among the changes enacted was... percentage for each month they forego benefit payments after FRA. Workers who live to their average life...

Adjustment of the WACC with Subsidized Debt in the Presence of Corporate Taxes: The N-Period Case

Directory of Open Access Journals (Sweden)

Ignacio Vélez-Pareja

2005-10-01

Full Text Available In the Weighted Average Cost of Capital (WACC applied to the free cash flow (FCF, we assume that the cost of debt is the market, unsubsidized rate. With debt at the market rate and perfect capital markets, debt only creates value in the presence of taxes through the tax shield. In some cases, the firm may be able to obtain a loan at a rate that is below the market rate. With subsidized debt and taxes, there would be a benefit to debt financing, and the unleveraged and leveraged values of the cash flows would be unequal. The benefit of lower tax savings are offset by the benefit of the subsidy. These two benefits have to be introduced explicitly. In this paper we present the adjustments to the WACC with subsidized debt and taxes and the cost of leveraged equity for multiple periods. We demonstrate the analysis for both the WACC applied to the FCF and the WACC applied to the capital cash flow (CCF. We use the calculation of the Adjusted Present Value, APV, to consider both, the tax savings and the subsidy. We show how all the methods match.

Quantifying the Benefit of a Pathologic Complete Response After Neoadjuvant Chemoradiotherapy in the Treatment of Esophageal Cancer

International Nuclear Information System (INIS)

Scheer, Richard V.; Fakiris, Achilles J.; Johnstone, Peter A.S.

2011-01-01

Purpose: To better define the benefit of a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy in the treatment of esophageal and gastroesophageal cancer, we undertook a comprehensive review of the literature to derive a pooled analysis of crude survival data and quantify the survival benefit of pCR vs. residual disease at esophagectomy. Methods and Materials: In all, 22 articles were reviewed. Crude overall survival data, stratified by patients with pCR vs. those with residual disease at esophagectomy, were collected and analyzed using a chi-square analysis. The relative and absolute survival benefit of achieving a pCR were calculated and analyzed. Finally, stratified median survival times were also analyzed. Results: Overall survival for patients with pCR was 93.1%, 75.0%, and 50.0% at 2, 3, and 5 years, respectively, whereas it was 36.8%, 29.0%, and 22.6% for patients with residual tumor (p < 0.025). The mean relative survival benefit of pCR at 2, 3, and 5 years was 2.05, 2.35, and 2.84, respectively. The mean absolute survival benefit of pCR was 35.66%, 33.79%, and 33.20%, respectively. Median survival times for patients with pCR were significantly longer than for those with residual tumor (p = 0.011). Conclusion: In esophageal and gastroesophageal cancers, pCR seems to significantly increase overall survival in patients undergoing neoadjuvant chemoradiotherapy. Specifically, the data suggest that patients with pCR are two to three times more likely to survive than are those with residual tumor at esophagectomy. Moreover, these data suggest that 33-36% more patients survive when pCR is achieved than when it is not.

Ecological benefits of passive wetland treatment systems designed for acid mine drainage: With emphasis on watershed restoration

International Nuclear Information System (INIS)

McCleary, E.C.; Kepler, D.A.

1994-01-01

Western Pennsylvania has been a large source of coal for much of the US since the late 1800's. During the extraction of the coal resources, acid mine drainage (AMD) often resulted. AMD from abandoned discharges has effectively rendered thousands of kilometers of streams lifeless in the Appalachian coal region. Restoration of these streams has been limited in previous years primarily because of the lack of cost-effective treatment for AMD. Conventional treatment can treat AMD effectively but is costly to operate and maintain and is effective only when receiving human attention. Passive wetland treatment systems have proven to be the only realistic AMD treatment strategy, in terms of watershed restoration activities. If ecosystem health is the reason for implementing effluent standards then it can be reasonably argued that passive wetland treatment systems supply the most effective overall treatment, even if they do not meet one or more of the current effluent standards. Recent advancements in passive wetland treatment system technology have provided a management tool that could be used to treat the majority of AMD discharges cost-effectively, and when used strategically could reasonably be employed to restore the thousands of kilometers of AMD-affected streams in the coal regions of Appalachia. Secondary benefits that have been observed with passive wetland treatment systems suggest that these systems may be providing for accelerated ecological recovery independent of regulated effluent standards

Health benefits of increased walking for sedentary, generally healthy older adults: using longitudinal data to approximate an intervention trial.

Science.gov (United States)

Diehr, Paula; Hirsch, Calvin

2010-09-01

Older adults are often advised to walk more, but randomized trials have not conclusively established the benefits of walking in this age group. Typical analyses based on observational data may have biased results. Here, we propose a "limited-bias," more interpretable estimate of the health benefits to sedentary healthy older adults of walking more, using longitudinal data from the Cardiovascular Health Study. The number of city blocks walked per week, collected annually, was classified as sedentary (or=28). Analysis was restricted to persons sedentary and healthy in the first 2 years. In Year 3, some became more active (the treatment groups). Self-rated health at Year 5 (follow-up) was regressed on walking at Year 3, with additional covariates from Year 2, when all were sedentary. At follow-up, 83.5% of those active at baseline had excellent, very good, or good self-rated health, as compared with 63.9% of the sedentary, an apparent benefit of 19.6 percentage points. After covariate adjustment, the limited-bias estimate of the benefit was 11.2 percentage points (95% confidence interval 3.7-18.6). Ten different outcome measures showed a benefit, ranging from 5 to 11 percentage points. Estimates from other study designs were smaller, less interpretable, and potentially more biased. In longitudinal studies where walking and health are ascertained at every wave, limited-bias estimates can provide better estimates of the benefits of walking. A surprisingly small increase in walking was associated with meaningful health benefits.

Addressing the stimulant treatment gap: A call to investigate the therapeutic benefits potential of cannabinoids for crack-cocaine use.

Science.gov (United States)

Fischer, Benedikt; Kuganesan, Sharan; Gallassi, Andrea; Malcher-Lopes, Renato; van den Brink, Wim; Wood, Evan

2015-12-01

Crack-cocaine use is prevalent in numerous countries, yet concentrated primarily - largely within urban contexts - in the Northern and Southern regions of the Americas. It is associated with a variety of behavioral, physical and mental health and social problems which gravely affect users and their environments. Few evidence-based treatments for crack-cocaine use exist and are available to users in the reality of street drug use. Numerous pharmacological treatments have been investigated but with largely disappointing results. An important therapeutic potential for crack-cocaine use may rest in cannabinoids, which have recently seen a general resurgence for varied possible therapeutic usages for different neurological diseases. Distinct potential therapeutic benefits for crack-cocaine use and common related adverse symptoms may come specifically from cannabidiol (CBD) - one of the numerous cannabinoid components found in cannabis - with its demonstrated anxiolytic, anti-psychotic, anti-convulsant effects and potential benefits for sleep and appetite problems. The possible therapeutic prospects of cannabinoids are corroborated by observational studies from different contexts documenting crack-cocaine users' 'self-medication' efforts towards coping with crack-cocaine-related problems, including withdrawal and craving, impulsivity and paranoia. Cannabinoid therapeutics offer further benefits of being available in multiple formulations, are low in adverse risk potential, and may easily be offered in community-based settings which may add to their feasibility as interventions for - predominantly marginalized - crack-cocaine user populations. Supported by the dearth of current therapeutic options for crack-cocaine use, we are advocating for the implementation of a rigorous research program investigating the potential therapeutic benefits of cannabinoids for crack-cocaine use. Given the high prevalence of this grave substance use problem in the Americas, opportunities for

Quality of Life and Sexual Function Benefits of Long-Term Testosterone Treatment: Longitudinal Results From the Registry of Hypogonadism in Men (RHYME).

Science.gov (United States)

Rosen, Raymond C; Wu, Frederick; Behre, Hermann M; Porst, Hartmut; Meuleman, Eric J H; Maggi, Mario; Romero-Otero, Javier; Martinez-Salamanca, Juan I; Jones, Thomas Hugh; Debruyne, Frans M J; Kurth, Karl-Heinz; Hackett, Geoff I; Quinton, Richard; Stroberg, Peter; Reisman, Yacov; Pescatori, Edoardo S; Morales, Antonio; Bassas, Lluis; Cruz, Natalio; Cunningham, Glenn R; Wheaton, Olivia A

2017-09-01

The benefits and risks of long-term testosterone administration have been a topic of much scientific and regulatory interest in recent years. To assess long-term quality of life (QOL) and sexual function benefits of testosterone replacement therapy (TRT) prospectively in a diverse, multinational cohort of men with hypogonadism. A multinational patient registry was used to assess long-term changes associated with TRT in middle-age and older men with hypogonadism. Comprehensive evaluations were conducted at 6, 12, 24, and 36 months after enrollment into the registry. QOL and sexual function were evaluated by validated measures, including the Aging Males' Symptom (AMS) Scale and the International Index of Erectile Function (IIEF). A total of 999 previously untreated men with hypogonadism were enrolled at 25 European centers, 750 of whom received TRT at at least one visit during the period of observation. Patients on TRT reported rapid and sustained improvements in QOL, with fewer sexual, psychological, and somatic symptoms. Modest improvements in QOL and sexual function, including erectile function, also were noted in RHYME patients not on TRT, although treated patients showed consistently greater benefit over time in all symptom domains compared with untreated patients. AMS total scores for patients on TRT were 32.8 (95% confidence interval = 31.3-34.4) compared with 36.6 (95% confidence interval = 34.8-38.5) for untreated patients (P treatment. The major strengths are the large, diverse patient population being treated in multidisciplinary clinical settings. The major limitation is the frequency of switching from one formulation to another. Overall, we confirmed the broad and sustained benefits of TRT across major QOL dimensions, including sexual, somatic, and psychological health, which were sustained over 36 months in our treatment cohort. Rosen RC, Wu F, Behre H, et al. Quality of Life and Sexual Function Benefits Effects of Long-Term Testosterone Treatment

[Respiratory handicap. Recognition, evaluation and social benefits].

Science.gov (United States)

Marsac, J; Pujet, J C

1983-01-01

The medico-social aspects of respiratory handicap pose some perplexing problems, notably in their recognition, rigorous evaluation and in the granting of social security benefits. The clinical and respiratory function data should be standardised and classified according to type and significance of respiratory disease and also according to the degree of co-operation and understanding of the patient. The respiratory handicap should be evaluated after considering the functional disability engendered by the disorder and their socio-professional repercussions. The abnormality in the lungs should be measured by resting tests; the degree of disability by exercise studies; the socio-professional handicap by ergonometric tests to assess the scale of the demands and requirements of family and social and professional life, indeed the cultural and economic style of the individual concerned. Such combined studies would enable recognition of severe chronic respiratory handicap leading to decisions for exemption certificates, such as cases of severe respiratory failure in patients requiring supplementary treatment for oxygen therapy or assisted ventilation. The benefits and grants offered to those with respiratory handicaps would involve a number of rights relating to: care, work, costs of replacement of workers in the event of prolonged sick leave or the benefits of an invalidity pension. There will be other allowances such as invalidity cards, lodging special studies and other rights particularly relating to lodging and special equipment. The present scale is difficult to use both because of its lack of specificity and its ill-chosen terminology. For better balance between the handicap and the benefits offered, a common and more flexible system, with a printed table should be at hand for the doctor to use for certain decisions: long term illness, period of invalidity or early retirement because of medical incapacity. Within each table a sub-section should exist to allow for

Benefit and harm of intensive blood pressure treatment: Derivation and validation of risk models using data from the SPRINT and ACCORD trials.

Directory of Open Access Journals (Sweden)

Sanjay Basu

2017-10-01

Full Text Available Intensive blood pressure (BP treatment can avert cardiovascular disease (CVD events but can cause some serious adverse events. We sought to develop and validate risk models for predicting absolute risk difference (increased risk or decreased risk for CVD events and serious adverse events from intensive BP therapy. A secondary aim was to test if the statistical method of elastic net regularization would improve the estimation of risk models for predicting absolute risk difference, as compared to a traditional backwards variable selection approach.Cox models were derived from SPRINT trial data and validated on ACCORD-BP trial data to estimate risk of CVD events and serious adverse events; the models included terms for intensive BP treatment and heterogeneous response to intensive treatment. The Cox models were then used to estimate the absolute reduction in probability of CVD events (benefit and absolute increase in probability of serious adverse events (harm for each individual from intensive treatment. We compared the method of elastic net regularization, which uses repeated internal cross-validation to select variables and estimate coefficients in the presence of collinearity, to a traditional backwards variable selection approach. Data from 9,069 SPRINT participants with complete data on covariates were utilized for model development, and data from 4,498 ACCORD-BP participants with complete data were utilized for model validation. Participants were exposed to intensive (goal systolic pressure < 120 mm Hg versus standard (<140 mm Hg treatment. Two composite primary outcome measures were evaluated: (i CVD events/deaths (myocardial infarction, acute coronary syndrome, stroke, congestive heart failure, or CVD death, and (ii serious adverse events (hypotension, syncope, electrolyte abnormalities, bradycardia, or acute kidney injury/failure. The model for CVD chosen through elastic net regularization included interaction terms suggesting that older

Statin Treatment and Clinical Outcomes of Heart Failure Among Africans: An Inverse Probability Treatment Weighted Analysis.

Science.gov (United States)

Bonsu, Kwadwo Osei; Owusu, Isaac Kofi; Buabeng, Kwame Ohene; Reidpath, Daniel D; Kadirvelu, Amudha

2017-04-01

Randomized control trials of statins have not demonstrated significant benefits in outcomes of heart failure (HF). However, randomized control trials may not always be generalizable. The aim was to determine whether statin and statin type-lipophilic or -hydrophilic improve long-term outcomes in Africans with HF. This was a retrospective longitudinal study of HF patients aged ≥18 years hospitalized at a tertiary healthcare center between January 1, 2009 and December 31, 2013 in Ghana. Patients were eligible if they were discharged from first admission for HF (index admission) and followed up to time of all-cause, cardiovascular, and HF mortality or end of study. Multivariable time-dependent Cox model and inverse-probability-of-treatment weighting of marginal structural model were used to estimate associations between statin treatment and outcomes. Adjusted hazard ratios were also estimated for lipophilic and hydrophilic statin compared with no statin use. The study included 1488 patients (mean age 60.3±14.2 years) with 9306 person-years of observation. Using the time-dependent Cox model, the 5-year adjusted hazard ratios with 95% CI for statin treatment on all-cause, cardiovascular, and HF mortality were 0.68 (0.55-0.83), 0.67 (0.54-0.82), and 0.63 (0.51-0.79), respectively. Use of inverse-probability-of-treatment weighting resulted in estimates of 0.79 (0.65-0.96), 0.77 (0.63-0.96), and 0.77 (0.61-0.95) for statin treatment on all-cause, cardiovascular, and HF mortality, respectively, compared with no statin use. Among Africans with HF, statin treatment was associated with significant reduction in mortality. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Population-based cost-offset analyses for disorder-specific treatment of anorexia nervosa and bulimia nervosa in Germany.

Science.gov (United States)

Bode, Katharina; Götz von Olenhusen, Nina Maria; Wunsch, Eva-Maria; Kliem, Sören; Kröger, Christoph

2017-03-01

Previous research has shown that anorexia nervosa (AN) and bulimia nervosa (BN) are expensive illnesses to treat. To reduce their economic burden, adequate interventions need to be established. Our objective was to conduct cost-offset analyses for evidence-based treatment of eating disorders using outcome data from a psychotherapy trial involving cognitive behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for AN and a trial involving CBT for BN. Assuming a currently running, ideal healthcare system using a 12-month, prevalence-based approach and varying the willingness to participate in treatment, we investigated whether the potential financial benefits of AN- and BN-related treatment outweigh the therapy costs at the population level. We elaborated on a formula that allows calculating cost-benefit relationships whereby the calculation of the parameters is based on estimates from data of health institutions within the German healthcare system. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. The annual costs of an untreated eating disorder were 2.38 billion EUR for AN and 617.69 million EUR for BN. Independent of the willingness to participate in treatment, the cost-benefit relationships for the treatment remained constant at 2.51 (CBT) and 2.33 (FPT) for AN and 4.05 (CBT) for BN. This consistency implies that for each EUR invested in the treatment, between 2.33 and 4.05 EUR could be saved each year. Our findings suggest that the implementation of evidence-based psychotherapy treatments for AN and BN may achieve substantial cost savings at the population level. © 2017 Wiley Periodicals, Inc.

75 FR 71171 - Social Security Disability Program Demonstration Project: Benefit Offset National Demonstration...

Science.gov (United States)

2010-11-22

... project. Stage 2 Offset and Enhanced Benefits Counseling Treatment Group--We will assign approximately 3... treatment of earnings and the enhanced benefits counseling, depending on their treatment group. Alternate... Treatment Group be eligible for counseling services? A beneficiary assigned to this Stage 2 treatment group...

pH adjustment of human blood plasma prior to bioanalytical sample preparation

NARCIS (Netherlands)

Hendriks, G.; Uges, D. R. A.; Franke, J. P.

2008-01-01

pH adjustment in bioanalytical sample preparation concerning ionisable compounds is one of the most common sample treatments. This is often done by mixing an aliquot of the sample with a proper buffer adjusted to the proposed pH. The pH of the resulting mixture however, does not necessarily have to

Treatment Regimen, Surgical Outcome, and T-cell Differentiation Influence Prognostic Benefit of Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Cancer

NARCIS (Netherlands)

Wouters, Maartje C. A.; Komdeur, Fenne L.; Workel, Hagma H.; Klip, Harry G.; Plat, Annechien; Kooi, Neeltje M.; Wisman, G. Bea A.; Mourits, Marian J. E.; Arts, Henriette J. G.; Oonk, Maaike H. M.; Yigit, Refika; de Jong, Steven; Melief, Cornelis J. M.; Hollema, Harry; Duiker, Evelien W.; Daemen, Toos; de Bruyn, Marco; Nijman, Hans W.

2016-01-01

Purpose: Tumor-infiltrating lymphocytes (TIL) are associated with a better prognosis in high-grade serous ovarian cancer (HGSC). However, it is largely unknown how this prognostic benefit of TIL relates to current standard treatment of surgical resection and (neo-)adjuvant chemotherapy. To address

Survival among children and adults with sickle cell disease in Belgium: Benefit from hydroxyurea treatment.

Science.gov (United States)

Lê, Phu Quoc; Gulbis, Béatrice; Dedeken, Laurence; Dupont, Sophie; Vanderfaeillie, Anna; Heijmans, Catherine; Huybrechts, Sophie; Devalck, Christine; Efira, André; Dresse, Marie-Françoise; Rozen, Laurence; Benghiat, Fleur Samantha; Ferster, Alina

2015-11-01

To evaluate the survival of patients with sickle cell disease (SCD) recorded in the Belgian SCD Registry and to assess the impact of disease-modifying treatments (DMT). The Registry created in 2008 included patients of eight centers. All available data in 2008 were retrospectively encoded in the database. After 2008 and until 2012, all data were recorded prospectively for already registered patients as well as newly diagnosed subjects. Data were registered from neonatal screening or from diagnosis (first contact) until last follow-up or death. Data included diagnosis, demography, and outcome data. We collected data from 469 patients over a 5,110 patient years (PY) follow-up period. The global mortality rate was low (0.25/100 PY), although 13 patients died (2.8%) and was similar between children, adolescents (10-18 years), and young adults (P = 0.76). Out of the cohort, 185 patients received hydroxyurea at last follow-up (median duration of treatment: 10.3 years), 90 underwent hematopoietic stem cell transplantation (HSCT), 24 were chronically transfused, and 170 had never had any DMT. Hydroxyurea showed significant benefit on patients outcome as reflected by a lower mortality rate compared to transplanted individuals or people without DMT (0.14, 0.36, and 0.38 per 100 PY, respectively) and by higher Kaplan-Meier estimates of 15 year survival (99.4%) compared to HSCT (93.8%; P = 0.01) or no DMT groups (95.4%; P = 0.04). SCD mortality in Belgium is low with no increase observed in young adults. Patients treated with hydroxyurea demonstrate a significant benefit in survival when compared to those without DMT or transplanted. © 2015 Wiley Periodicals, Inc.

The impact of personality on adult patients' adjustability to orthodontic appliances.

Science.gov (United States)

Cooper-Kazaz, Rena; Ivgi, Inbal; Canetti, Laura; Bachar, Eytan; Tsur, Boaz; Chaushu, Stella; Shalish, Miriam

2013-01-01

To evaluate the impact of psychological traits on patients' choice of orthodontic appliances and their adjustability to orthodontic treatment. The sample consisted of 68 adult patients divided into three groups (28 buccal, 19 lingual, and 21 clear aligners). Prior to treatment participants filled out the Brief Symptom Inventory to assess symptoms of mental distress and the Narcissistic Vulnerability Scale to assess narcissistic personality traits. During the first week after appliance delivery and on day 14, patients completed a Health-Related Quality of Life questionnaire to assess their perception of pain and four areas of dysfunction. The correlation between personality traits and patients' reaction to treatment was evaluated. Somatization was the only trait that affected the choice of lingual and clear aligner appliance. Reduced self-esteem regulation was associated with increased pain in all patients, while exploitation was associated with pain in lingual patients. Narcissistic vulnerability slightly influenced patients' adaptability to orthodontic appliances. Although adjustability to lingual appliances was the most difficult, only two parameters were affected by personality features. In the buccal group, adjustability was affected by numerous parameters. Adaptation to the clear aligner appliance was relatively uneventful and least affected by psychological features. Anxious individuals tend to prefer lingual and clear aligner appliances. The selection of lingual and clear aligner appliances governs the patient's response and recovery process, leaving little room for the effect of psychological features. On the other hand, the buccal appliance allows for greater impact of personality traits on adjustability.

ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE

Directory of Open Access Journals (Sweden)

D. D. Shkarupa

2017-01-01

Full Text Available Introduction. The optimal tension of suburethral tape is an important component of effectiveness and safety of the surgery. By now, there is no common standardized guidance on the tensioning of the sling. There is a limited number of publications, devoted to adjustable systems with the ability to correct tape tension in postoperative period. To evaluate the effectiveness of this method, the long-term results of postoperative adjustment of the sling are necessary.Aim. To evaluate the results of complicated stress urinary incontinence (SUI surgical treatment using a transobturator adjustable sling Urosling (Lintex.Materials and methods. The study included 89 women with complicated SUI. All patients underwent the transobturator adjustable midurethral tape placement. The tension adjustment was performed during 3 days after surgery. Postoperative evaluation included vaginal examination, cough stress test, 1-h Pad-test, uroflowmetry, bladder ultrasound and post-void residual (PVR urine measurement, validated questionnaires (UDI-6, UIQ-7, ICIQ-SF, PICQ-12 and visual analogue scale (VAS.Results. Mean operative time was 15.74±7.49 min. The tension adjustment was performed in 45.0% (40/89 patients the next day after surgery. On the second day tension re-adjustment was required in 14,6% (13/89 patients. In 3.4% (3/89 women the tension was also tuned on the 3 day. The loosening of the sling was needed in 13.5% (12/89 patients. After adjustment, all patients were continent without any signs of bladder outlet obstruction (BOO. Mean follow-up was 14.3±2.1 months. The objective cure rate was 92.9%. There was no statistically significant difference in the urodynamic parameters. Assessment of patient satisfaction showed that 95.2% (80/84 of the patients were «very» or «very» satisfied.Conclusion. The adjustable transobturator suburethral tape Urosling allows to achieve high effectiveness of treatment in female patients with complicated SUI and to reduce the

Prospective analysis of principles and frequency of self-adjustment of insulin dose in people with diabetes type 1 before and after participation in a diabetes treatment and teaching programme.

Science.gov (United States)

Kramer, Guido; Kuniss, Nadine; Jörgens, Viktor; Lehmann, Thomas; Müller, Nicolle; Lorkowski, Stefan; Wolf, Gunter; Müller, Ulrich A; Kloos, Christof

2016-09-01

Insulin dose self-adjustment is an essential part of intensified insulin therapy - nowadays the routine treatment of type 1 diabetes (DM1). The aim of this study was to evaluate principles and frequency of insulin dose self-adjustments in people with DM1 before and one year after participating in a structured diabetes treatment and teaching programme (DTTP) and to determine to which extent the patients followed the way they had been trained. 72 people with DM1 were interviewed before participation in our inpatient (32/72) or outpatient (40/72) DTTP. Sixty-six participants (91.7%) were followed up after one year. The number of adaptations of the insulin dose by the patients was recorded from 28days of the patients' diary. The ability to find the correct dose was tested using five different examples. Metabolic control improved significantly after one year (7.9±1.0 to 7.5±0.8%, p=0.004). The participants performed 86.0±37.1 insulin dosage adaptations per 28days before the DTTP. After one year the frequency increased significantly to 99.1±30.7 per 28days (p=0.011). Before the DTTP, 42 of 72 patients (58.3%) adjusted their insulin dose to correct high blood glucose levels by adjustment rules (factor for correction or correction scheme) and 20 of 72 people (27.8%) by personal experience/feeling. One year after the DTTP, 73% (48/66) used adjustment rules. After participating in an structured education programme, patients adjusted their insulin dosage more frequently. Metabolic control improved despite the fact that many patients did not strictly apply the rules they had been trained for. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effects of the Tax Treatment of Fringe Benefits on Labor Market Segmentation.

Science.gov (United States)

Scott, Frank A.; And Others

1989-01-01

Argues that the provision of the same fringe benefits for all workers promotes labor market segmentation by inducing workers to sort themselves across the economy according to their demand for fringe benefits. (JOW)

Incremental ALARA cost/benefit computer analysis

International Nuclear Information System (INIS)

Hamby, P.

1987-01-01

Commonwealth Edison Company has developed and is testing an enhanced Fortran Computer Program to be used for cost/benefit analysis of Radiation Reduction Projects at its six nuclear power facilities and Corporate Technical Support Groups. This paper describes a Macro-Diven IBM Mainframe Program comprised of two different types of analyses-an Abbreviated Program with fixed costs and base values, and an extended Engineering Version for a detailed, more through and time-consuming approach. The extended engineering version breaks radiation exposure costs down into two components-Health-Related Costs and Replacement Labor Costs. According to user input, the program automatically adjust these two cost components and applies the derivation to company economic analyses such as replacement power costs, carrying charges, debt interest, and capital investment cost. The results from one of more program runs using different parameters may be compared in order to determine the most appropriate ALARA dose reduction technique. Benefits of this particular cost / benefit analysis technique includes flexibility to accommodate a wide range of user data and pre-job preparation, as well as the use of proven and standardized company economic equations

Effective intervention programming: improving maternal adjustment through parent education.

Science.gov (United States)

Farris, Jaelyn R; Bert, Shannon S Carothers; Nicholson, Jody S; Glass, Kerrie; Borkowski, John G

2013-05-01

This study assessed the secondary effects of a parent training intervention program on maternal adjustment, with a focus on understanding ways in which program efficacy differed for participants as a function of whether or not their children had behavior problems. Mothers (N = 99) of toddlers (2-3 years of age) were randomly assigned to receive one of three levels of intervention: (1) informational booklet (2) booklet + face-to-face parent training sessions, or (3) booklet + web-based parent training sessions. Findings indicated that all levels of intervention were associated with increases in maternal well-being for participants with typically developing children. Mothers of toddlers with behavior problems, however, did not benefit from receiving only the booklet but significantly benefitted from receiving either the face-to-face or web-based interventions. Findings are discussed in terms of efficient and efficacious program dissemination and the resulting implications for public policy.

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

OpenAIRE

Duncan, Larissa G.; Cohn, Michael A.; Chao, Maria T.; Cook, Joseph G.; Riccobono, Jane; Bardacke, Nancy

2017-01-01

Background Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. Methods This study?, the Prenatal Education About Reducing Labor Stress (PEARLS) s...

Qtc interval as a guide to select those patients with congestive heart failure and reduced left ventricular systolic function who will benefit from antiarrhythmic treatment with dofetilide

DEFF Research Database (Denmark)

Brendorp, B; Elming, H; Jun, L

2001-01-01

BACKGROUND: A prolonged QTc interval is considered a contraindication for class III antiarrhythmic drugs, but the influence of a normal or a slightly increased baseline QTc interval on the risk or benefit of treatment with a class III antiarrhythmic drug is not sufficiently clarified. METHODS...... limits is associated with a marked reduction of mortality in patients with CHF and left ventricular systolic dysfunction treated with dofetilide. This is a potentially important indication of which patients with CHF might benefit from prophylactic treatment with an antiarrhythmic drug....

Transfer adjustment experiences of underrepresented students of color in the sciences

Science.gov (United States)

Chang, June C.

Two-year colleges have long served as the starting point for many students in higher education and particularly those of underrepresented backgrounds. In recent years, these institutions have been called upon to help address the high attrition rates facing the science and mathematics disciplines by promoting interest development and transfer of underrepresented students in these fields. This study examined the adjustment experiences of underrepresented students of color after transferring from community colleges to a four-year university in the sciences. By employing qualitative interviews with students of African, Latino, Pacific Island, and Southeast Asian descent, students' perceptions of the sciences at the two- and four-year campus, adjustment process, and benefits and detriments of taking the transfer route were the focus of this research. The findings show that transfer students experience a very different science culture at each institutional type in terms of pedagogy and curriculum and interactions with classmates and faculty. While students witnessed a collaborative science culture at the community college, they faced a highly competitive and individualistic environment at the university. The greater the difference encountered, the more difficult were students' adjustment. Adjustment was aided in two primary ways: socialization experiences before transferring and the development of common identity groups with other students who shared similar backgrounds, goals, and struggles. These groups formed organically at the two-year college but were more difficult to forge at the university. When present, however, they served as niches, sites of validation, and counter spaces within the larger university setting. It appears that starting at the community college benefited most participants by providing a nurturing environment that fostered their commitment to science. Some students felt that they would have been dissuaded from pursuing their majors had they only

20 CFR 404.1201 - Scope of this subpart regarding coverage and wage reports and adjustments.

Science.gov (United States)

2010-04-01

... contributions; (5) What happens if a State fails to pay its contributions timely; (6) How errors in reports and... wage reports and adjustments. 404.1201 Section 404.1201 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Coverage of Employees of State and...

Principles and Reality of Proton Therapy Treatment Allocation

Energy Technology Data Exchange (ETDEWEB)

Bekelman, Justin E., E-mail: bekelman@uphs.upenn.edu [Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Asch, David A. [Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (United States); The Wharton School and Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Tochner, Zelig [Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Friedberg, Joseph [Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Vaughn, David J. [Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Rash, Ellen [Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Raksowski, Kevin [Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (United States); Hahn, Stephen M. [Department of Radiation Oncology, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

2014-07-01

Purpose: To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials: We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results: Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions: The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies.

Principles and Reality of Proton Therapy Treatment Allocation

International Nuclear Information System (INIS)

Bekelman, Justin E.; Asch, David A.; Tochner, Zelig; Friedberg, Joseph; Vaughn, David J.; Rash, Ellen; Raksowski, Kevin; Hahn, Stephen M.

2014-01-01

Purpose: To present the principles and rationale of the Proton Priority System (PROPS), a priority points framework that assigns higher scores to patients thought to more likely benefit from proton therapy, and the distribution of PROPS scores by patient characteristics Methods and Materials: We performed multivariable logistic regression to evaluate the association between PROPS scores and receipt of proton therapy, adjusted for insurance status, gender, race, geography, and the domains that inform the PROPS score. Results: Among 1529 adult patients considered for proton therapy prioritization during our Center's ramp-up phase of treatment availability, PROPS scores varied by age, diagnosis, site, and other PROPS domains. In adjusted analyses, receipt of proton therapy was lower for patients with non-Medicare relative to Medicare health insurance (commercial vs Medicare: adjusted odds ratio [OR] 0.47, 95% confidence interval [CI] 0.34-0.64; managed care vs Medicare: OR 0.40, 95% CI 0.28-0.56; Medicaid vs Medicare: OR 0.24, 95% CI 0.13-0.44). Proton Priority System score and age were not significantly associated with receipt of proton therapy. Conclusions: The Proton Priority System is a rationally designed and transparent system for allocation of proton therapy slots based on the best available evidence and expert opinion. Because the actual allocation of treatment slots depends mostly on insurance status, payers may consider incorporating PROPS, or its underlying principles, into proton therapy coverage policies

NET SALARY ADJUSTMENT

CERN Multimedia

Finance Division

2001-01-01

On 15 June 2001 the Council approved the correction of the discrepancy identified in the net salary adjustment implemented on 1st January 2001 by retroactively increasing the scale of basic salaries to achieve the 2.8% average net salary adjustment approved in December 2000. We should like to inform you that the corresponding adjustment will be made to your July salary. Full details of the retroactive adjustments will consequently be shown on your pay slip.

Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel.

Science.gov (United States)

Köves, Bela; Cai, Tommaso; Veeratterapillay, Rajan; Pickard, Robert; Seisen, Thomas; Lam, Thomas B; Yuan, Cathy Yuhong; Bruyere, Franck; Wagenlehner, Florian; Bartoletti, Riccardo; Geerlings, Suzanne E; Pilatz, Adrian; Pradere, Benjamin; Hofmann, Fabian; Bonkat, Gernot; Wullt, Björn

2017-12-01

People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view. We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

20 CFR 408.931 - How much will we withhold from your title II and title XVI benefits to recover a title VIII...

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How much will we withhold from your title II... and Overpayments Adjustment of Title II Benefits § 408.931 How much will we withhold from your title...-due benefits. (b)(1) We will collect the overpayment from current monthly benefits due in a month...

Population-based cost-offset estimation for the treatment of borderline personality disorder: projected costs in a currently running, ideal health system.

Science.gov (United States)

Wunsch, Eva-Maria; Kliem, Sören; Kröger, Christoph

2014-09-01

Borderline personality disorder (BPD) is considered one of the most expensive mental disorders in terms of direct and indirect costs. The aim of this study was to carry out a cost-offset estimation of disorder-specific psychotherapy for BPD at the population level. The study investigated whether the possible financial benefits of dialectical behavior therapy outweigh the therapy costs, assuming a currently running, ideal health system, and whether the estimated cost-benefit relationships change depending upon the number of patients willing to be treated. A formula was elaborated that allows the user to calculate cost-benefit relationships for various conservative or progressive scenarios, with different stages of individuals' willingness to be treated (10%-90%). The possible costs and benefits of BPD-related treatment were evaluated using a 12-month, prevalence-based approach. The annual costs for untreated BPD were 8.69 billion EUR annually. The cost-benefit relationship for the treatment remained constant at 1.52 for all scenarios, implying that for each EUR invested, 1.52 EUR can be gained within one year, independent of the willingness to be treated. Additional intangible benefits were calculated with the aid of Quality-Adjusted Life Years. Findings suggest that BPD-related treatment might well be efficient at the population level. Copyright © 2014 Elsevier Ltd. All rights reserved.

Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies.

Science.gov (United States)

Mandelblatt, Jeanne S; Stout, Natasha K; Schechter, Clyde B; van den Broek, Jeroen J; Miglioretti, Diana L; Krapcho, Martin; Trentham-Dietz, Amy; Munoz, Diego; Lee, Sandra J; Berry, Donald A; van Ravesteyn, Nicolien T; Alagoz, Oguzhan; Kerlikowske, Karla; Tosteson, Anna N A; Near, Aimee M; Hoeffken, Amanda; Chang, Yaojen; Heijnsdijk, Eveline A; Chisholm, Gary; Huang, Xuelin; Huang, Hui; Ergun, Mehmet Ali; Gangnon, Ronald; Sprague, Brian L; Plevritis, Sylvia; Feuer, Eric; de Koning, Harry J; Cronin, Kathleen A

2016-02-16

Controversy persists about optimal mammography screening strategies. To evaluate screening outcomes, taking into account advances in mammography and treatment of breast cancer. Collaboration of 6 simulation models using national data on incidence, digital mammography performance, treatment effects, and other-cause mortality. United States. Average-risk U.S. female population and subgroups with varying risk, breast density, or comorbidity. Eight strategies differing by age at which screening starts (40, 45, or 50 years) and screening interval (annual, biennial, and hybrid [annual for women in their 40s and biennial thereafter]). All strategies assumed 100% adherence and stopped at age 74 years. Benefits (breast cancer-specific mortality reduction, breast cancer deaths averted, life-years, and quality-adjusted life-years); number of mammograms used; harms (false-positive results, benign biopsies, and overdiagnosis); and ratios of harms (or use) and benefits (efficiency) per 1000 screens. Biennial strategies were consistently the most efficient for average-risk women. Biennial screening from age 50 to 74 years avoided a median of 7 breast cancer deaths versus no screening; annual screening from age 40 to 74 years avoided an additional 3 deaths, but yielded 1988 more false-positive results and 11 more overdiagnoses per 1000 women screened. Annual screening from age 50 to 74 years was inefficient (similar benefits, but more harms than other strategies). For groups with a 2- to 4-fold increased risk, annual screening from age 40 years had similar harms and benefits as screening average-risk women biennially from 50 to 74 years. For groups with moderate or severe comorbidity, screening could stop at age 66 to 68 years. Other imaging technologies, polygenic risk, and nonadherence were not considered. Biennial screening for breast cancer is efficient for average-risk populations. Decisions about starting ages and intervals will depend on population characteristics and the

Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising.

Science.gov (United States)

Kon, Rachel H; Russo, Mark W; Ory, Bridget; Mendys, Phil; Simpson, Ross J

2008-02-01

Statins are commonly used to reduce the risk of heart attacks and strokes. Despite the benefit and limited risks in properly identified patients, clinicians are often challenged by patient acceptance and adherence to these medications. To assess if patients and physicians may have unfounded safety concerns about hepatotoxicity from these medications, we surveyed physicians and patients. We found inconsistent liver function-monitoring practices as well as exaggerated fears of statin-induced hepatotoxicity. Patients who received risk information from their physician were more likely to accurately estimate hepatotoxic risk than patients receiving such information from other sources. We believe these misperceptions about the relative risk and benefits of statin therapy are propagated by direct-to-consumer advertising, which may emphasize potential adverse events relative to treatment benefits. These perceptions are likely to adversely affect statin adherence, and may be addressed by patient education.

Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

OpenAIRE

Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

2000-01-01

To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the produc...

Attitude Change When Presenting Science Museum Visitors with Risk-Benefit Information

Science.gov (United States)

Phelan, Siëlle; Specht, Inga; Schnotz, Wolfgang; Lewalter, Doris

2017-01-01

Visitors to modern science museums are likely to encounter exhibitions presenting conflicting information, such as risks and benefits of new scientific developments. Such exhibitions encourage visitors to reflect upon different sides of a story and to form or adjust their attitudes toward the topic on display. However, there is very little…

Impact of particulate air pollution on quality-adjusted life expectancy in Canada.

Science.gov (United States)

Coyle, Douglas; Stieb, Dave; Burnett, Richard T; DeCivita, Paul; Krewski, Daniel; Chen, Yue; Thun, Michael J

Air pollution and premature death are important public health concerns. Analyses have repeatedly demonstrated that airborne particles are associated with increased mortality and estimates have been used to forecast the impact on life expectancy. In this analysis, we draw upon data from the American Cancer Society (ACS) cohort and literature on utility-based measures of quality of life in relation to health status to more fully quantify the effects of air pollution on mortality in terms of quality-adjusted life expectancy. The analysis was conducted within a decision analytic model using Monte Carlo simulation techniques. Outcomes were estimated based on projections of the Canadian population. A one-unit reduction in sulfate air pollution would yield a mean annual increase in Quality-Adjusted Life Years (QALYs) of 20,960, with gains being greater for individuals with lower educational status and for males compared to females. This suggests that the impact of reductions in sulfate air pollution on quality-adjusted life expectancy is substantial. Interpretation of the results is unclear. However, the potential gains in QALYs from reduced air pollutants can be contrasted to the costs of policies to bring about such reductions. Based on a tentative threshold for the value of health benefits, analysis suggests that an investment in Canada of over 1 billion dollars per annum would be an efficient use of resources if it could be demonstrated that this would reduce sulfate concentrations in ambient air by 1 microg/m(3). Further analysis can assess the efficiency of targeting such initiatives to communities that are most likely to benefit.

Benefits and risks of weight-loss treatment for older, obese women

Directory of Open Access Journals (Sweden)

Rossen LM

2013-02-01

Full Text Available Lauren M Rossen,1,2 Vanessa A Milsom,1,3 Kathryn R Middleton,1,4 Michael J Daniels,5,6 Michael G Perri1,71Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; 2National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA; 3Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; 4Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA; 5Department of Statistics, University of Florida, Gainesville, FL, USA; 6Division of Statistics and Scientific Computation, University of Texas at Austin, Austin, TX, USA; 7College of Public Health and Health Professions, University of Florida, Gainesville, FL, USABackground: A key issue in the treatment of obesity in older adults is whether the health benefits of weight loss outweigh the potential risks with respect to musculoskeletal injury.Objective: To compare change in weight, improvements in metabolic risk factors, and reported musculoskeletal adverse events in middle-aged (50–59 years and older (65–74 years, obese women.Materials and methods: Participants completed an initial 6-month lifestyle intervention for weight loss, comprised of weekly group sessions, followed by 12 months of extended care with biweekly contacts. Weight and fasting blood samples were assessed at baseline, month 6, and month 18; data regarding adverse events were collected throughout the duration of the study.Results: Both middle-aged (n = 162 and older (n = 56 women achieved significant weight reductions from baseline to month 6 (10.1 ± 0.68 kg and 9.3 ± 0.76 kg, respectively and maintained a large proportion of their losses at month 18 (7.6 ± 0.87 kg and 7.6 ± 1.3 kg, respectively; there were no significant differences between the two groups with respect to weight change. Older women further

Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

Science.gov (United States)

Graziani, Filippo; Karapetsa, Dimitra; Alonso, Bettina; Herrera, David

2017-10-01

Treatment of periodontitis aims at preventing further disease progression with the intentions to reduce the risk of tooth loss, minimize symptoms and perception of the disease, possibly restore lost periodontal tissue and provide information on maintaining a healthy periodontium. Therapeutic intervention includes introduction of techniques to change behavior, such as: individually tailored oral-hygiene instructions; a smoking-cessation program; dietary adjustment; subgingival instrumentation to remove plaque and calculus; local and systemic pharmacotherapy; and various types of surgery. No single treatment option has shown superiority, and virtually all types of mechanical periodontal treatment benefit from adjunctive antimicrobial chemotherapy. Periodontal treatment, because of the chronic nature of periodontitis, is a lifelong commitment to intricate oral-hygiene techniques, which, when properly implemented, will minimize the risk of disease initiation and progression. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Use of medications of questionable benefit in advanced dementia.

Science.gov (United States)

Tjia, Jennifer; Briesacher, Becky A; Peterson, Daniel; Liu, Qin; Andrade, Susan E; Mitchell, Susan L

2014-11-01

Advanced dementia is characterized by severe cognitive impairment and complete functional dependence. Patients' goals of care should guide the prescribing of medication during such terminal illness. Medications that do not promote the primary goal of care should be minimized. To estimate the prevalence of medications with questionable benefit used by nursing home residents with advanced dementia, identify resident- and facility-level characteristics associated with such use, and estimate associated medication expenditures. Cross-sectional study of medication use by nursing home residents with advanced dementia using a nationwide long-term care pharmacy database linked to the Minimum Data Set (460 facilities) between October 1, 2009, and September 30, 2010. Use of medication deemed of questionable benefit in advanced dementia based on previously published criteria and mean 90-day expenditures attributable to these medications per resident. Generalized estimating equations using the logit link function were used to identify resident- and facility-related factors independently associated with the likelihood of receiving medications of questionable benefit after accounting for clustering within nursing homes. Of 5406 nursing home residents with advanced dementia, 2911 (53.9%) received at least 1 medication with questionable benefit (range, 44.7% in the Mid-Atlantic census region to 65.0% in the West South Central census region). Cholinesterase inhibitors (36.4%), memantine hydrochloride (25.2%), and lipid-lowering agents (22.4%) were the most commonly prescribed. In adjusted analyses, having eating problems (adjusted odds ratio [AOR], 0.68; 95% CI, 0.59-0.78), a feeding tube (AOR, 0.58; 95% CI, 0.48-0.70), or a do-not-resuscitate order (AOR, 0.65; 95% CI, 0.57-0.75), and enrolling in hospice (AOR, 0.69; 95% CI, 0.58-0.82) lowered the likelihood of receiving these medications. High facility-level use of feeding tubes increased the likelihood of receiving these

Benefits and challenges of using service dogs for veterans with posttraumatic stress disorder.

Science.gov (United States)

Yarborough, Bobbi Jo H; Stumbo, Scott P; Yarborough, Micah T; Owen-Smith, Ashli; Green, Carla A

2018-04-26

Veterans with posttraumatic stress disorder (PTSD) are increasingly seeking service dogs to help them manage trauma-related symptoms, yet literature describing service dog use in this population is scant. The goal of this study was to document the benefits and challenges experienced by veterans with service dogs trained to assist with PTSD-related needs. Participants were veterans (N = 41) with service dogs, and their caregivers (n = 8), recruited through community-based service dog training agencies. We conducted in-depth interviews and observed training sessions as part of a larger study, and used thematic analysis to characterize data. Veterans reported that service dogs reduced hypervigilance by alerting and creating boundaries, and disrupted nightmares, improving sleep quality and duration. Dogs also helped veterans turn their attention away from invasive trauma-related thoughts. Additional reported benefits included improved emotional connections with others, increased community participation and physical activity, and reduced suicidal impulses and medication use. Demands of training, adjustment to life with a service dog, and delayed benefits were challenging for many veterans and caregivers. Veterans report that service dogs help reduce PTSD symptoms and facilitate recovery and realization of meaningful goals. Service dogs may be a reasonable option for veterans who are reluctant to pursue or persist with traditional evidence-based treatments. Additional rigorous research on the effectiveness of service dogs for this population is warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Perceived Sexual Benefits of Alcohol Use among Recent High School Graduates: Longitudinal Associations with Drinking Behavior and Consequences

Science.gov (United States)

Brady, Sonya S.; Wilkerson, J. Michael; Jones-Webb, Rhonda

2012-01-01

In this research study of 153 college-bound students, perceived sexual benefits of alcohol use were associated with greater drinking and related consequences during the senior year of high school and freshman year of college. Perceived benefits predicted drinking outcomes during fall after adjustment for gender, sensation seeking, parental…

Price regulation in the Spanish energy sectors: who benefits?

International Nuclear Information System (INIS)

Arocena, Pablo; Contin, Ignacio; Huerta, Emilio

2002-01-01

This paper analyses the distribution of benefits between firms and consumers due to the price regulation of the Spanish energy sectors (electricity, oil fuels and gas) during the decade 1987-1997. To that effect, we compare the actual evolution of energy prices with alternate benchmarks in order to assess the potential existence of a pro-industry or a pro-consumer bias in the pricing policies followed by the regulator. Our results show a pro-industry-biased regulatory context, where consumers benefited very little from price control. The successive price adjustments over time allowed the companies to keep all the productivity gains and cost reductions and to increase their profitability rates relative to those achieved in the manufacturing sector. (Author)

Price regulation in the Spanish energy sectors: who benefits?

Energy Technology Data Exchange (ETDEWEB)

Arocena, Pablo; Contin, Ignacio; Huerta, Emilio [Departamento de Gestion de Empresas, Universidad Publica de Navarra, Campus de Arrosadia. 31006, Pamplona (Spain); [Canterbury Business School, University of Kent Canterbury (United Kingdom)

2002-08-01

This paper analyses the distribution of benefits between firms and consumers due to the price regulation of the Spanish energy sectors (electricity, oil fuels and gas) during the decade 1987-1997. To that effect, we compare the actual evolution of energy prices with alternate benchmarks in order to assess the potential existence of a pro-industry or a pro-consumer bias in the pricing policies followed by the regulator. Our results show a pro-industry-biased regulatory context, where consumers benefited very little from price control. The successive price adjustments over time allowed the companies to keep all the productivity gains and cost reductions and to increase their profitability rates relative to those achieved in the manufacturing sector. (Author)

A comparison of individualized treatment guided by VeriStrat with standard of care treatment strategies in patients receiving second-line treatment for advanced non-small cell lung cancer: A cost-utility analysis.

Science.gov (United States)

Nelson, Richard E; Stenehjem, David; Akerley, Wallace

2013-12-01

Two therapies are appropriate as 2nd-line treatment of non-small cell lung cancer (NSCLC) patients: chemotherapy and epidermal growth factor receptor (EGFR) inhibitor therapy. VeriStrat, a serum proteomic test, can be used to guide treatment decisions for NSCLC patients. The test classifies patients as likely to benefit from either of these two treatment options. The objective of this research was to model the anticipated survival and cost-effectiveness of four different treatment strategies: chemotherapy for all patients (C-all), EGFR inhibitor for all (E-all), a performance status guided selection strategy (PS-guided), and a strategy guided by VeriStrat test results (V-guided). We developed a Markov model with the perspective of the U.S. health care system. Model inputs were taken from published literature for the base-case analysis. One-way and probabilistic sensitivity analyses were performed. The C-all treatment strategy showed the best overall survival outcome (10.1 months), followed by V-guided (9.6 months), PS-guided (9.2 months), and E-all (8.2 months) strategies. The incremental cost-effectiveness ratio (ICER) of a V-guided treatment strategy was $91,111 (vs. E-all) and $8462 (vs. PS-guided) per quality-adjusted life year (QALY). The ICER for C-all compared to V-guided was $105,616. This cost-utility analysis indicates that a treatment strategy guided by the VeriStrat test in patients receiving second-line therapy for NSCLC may experience an overall survival benefit at an incremental cost-effectiveness ratio that is reasonable when compared with other practices, including cancer treatments, generally covered in the U.S. health care system. However, treating all patients with chemotherapy yielded the greatest expected survival. Copyright © 2013. Published by Elsevier Ireland Ltd.

Lenalidomide in relapsed and refractory multiple myeloma disease: feasibility and benefits of long-term treatment.

Science.gov (United States)

Zago, Manola; Oehrlein, Katharina; Rendl, Corinna; Hahn-Ast, Corinna; Kanz, Lothar; Weisel, Katja

2014-12-01

Lenalidomide in combination with dexamethasone is an effective and well-established treatment of relapsed or refractory multiple myeloma (rrMM) disease. Due to the scarcity of reports assessing benefit and risk of long-term lenalidomide treatment in non-selected rrMM patients, we retrospectively analysed the long-term outcome in patients with rrMM treated with lenalidomide and dexamethasone. Sixty-seven patients (pts) who were treated with lenalidomide/dexamethasone for rrMM in the approved indication from 2007 to 2011 were included in this retrospective, single-centre analysis. Kaplan-Meier survival estimates were compared between total population, patients on lenalidomide for more than 12 months (mo) and patients discontinuing therapy earlier than 12 months. Median overall survival (OS) of the total patient population was 33.2 mo. OS of pts treated beyond 12 mo was 42.9 mo compared to 20.2 mo (p = 0.027) for pts stopping lenalidomide earlier than 12 mo for other reasons than progression disease (PD). OS of pts >12 mo on lenalidomide treatment did not significantly differ between pts who had received previous autologous transplantation, allogeneic transplantation or conventional therapy. Main non-hematologic toxicities were infections of grade 3/4 in 25 % and thrombembolic events of all grades in 18 % of patients. To the best of our knowledge, this is the first report on feasibility and efficacy of long-term lenalidomide treatment in a non-selected patient cohort. OS of pts >12 mo on lenalidomide is superior when compared to pts discontinued earlier for reasons other than PD. Our data confirm the current use of lenalidomide as a continuous long-term treatment strategy.

48 CFR 52.219-23 - Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns.

Science.gov (United States)

2010-10-01

... black college or university means an institution determined by the Secretary of Education to meet the... application was submitted. In this case, in order to receive the benefit of a price evaluation adjustment, an... integral part of such a college or university before November 14, 1986. Minority institution means an...

The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

Science.gov (United States)

Busch, Alisa B; Yoon, Frank; Barry, Colleen L; Azzone, Vanessa; Normand, Sharon-Lise T; Goldman, Howard H; Huskamp, Haiden A

2013-02-01

The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more

The effect of receiving supplementary UI benefits on unemployment duration

DEFF Research Database (Denmark)

Tomi, Kyyrä,; Pierpaolo, Parrotta,; Rosholm, Michael

2013-01-01

insurance benefit receipt. We find evidence of a negative in-treatment effect and a positive post-treatment effect, both of which vary across different groups of individuals. The resulting net effect on the expected unemployment duration is positive for some groups (e.g. married women) and negative......We consider the consequences of working part-time and receiving supplementary benefits for part-time unemployment in the Danish labor market. Following the timing-of-events approach we estimate causal effects of part-time work with supplementary benefits on the hazard rate out of unemployment...

A randomised trial of differentiated prednisolone treatment in active rheumatoid arthritis. Clinical benefits and skeletal side effects

DEFF Research Database (Denmark)

Hansen, M; Podenphant, J; Florescu, A

1999-01-01

OBJECTIVES: To study benefits and skeletal side effects of carefully monitored prednisolone treatment in patients with active rheumatoid arthritis. METHODS: One hundred and two patients with active rheumatoid arthritis were randomly allocated to treatment with disease modifying anti......-inflammatory drug (DMARD) alone or DMARD and prednisolone in a one year follow up study. Prednisolone was given in a dose regimen adapted to the disease activity of the individual patient. The mean dose was 6 mg and the mean cumulated dose was 2160 mg. Patients were followed up with disease activity parameters......, radiograph of the hands (Larsen score), and bone mineral density (BMD) of the lumbar spine, distal forearm and hand. At one year 26 patients had withdrawn from the investigation leaving 76 patients for evaluation. RESULTS: The results showed that disease activity in the prednisolone treated group was reduced...

Relationship between siblings and psychological adjustment in adolescents:

Directory of Open Access Journals (Sweden)

Karen Ripoll

2009-10-01

Full Text Available This study evaluated the effect of parent-child relationship quality (acceptance and differential treatment over dimensions of the quality of sibling relationships (warmth and conflict and psychological adjustment in 69 adolescent sibling dyads. The effects of parent-child relationships were evaluated both at the individual and dyadic levels. In older siblings, the father-child relationship had a significant effect on both their perception of warmth in the sibling relationship and psychological adjustment. In younger siblings, there was a significant dyadic effect of the older sibling’s perceived acceptance by mother on their perception of warmth in the sibling relationship. Results are analyzed based on the literature and questions for future research are proposed.

Evaluation of a treatment system type septic tank - filter anaerobic of upward flow for the residual waters of the ecological benefit of the coffee

International Nuclear Information System (INIS)

Sanchez C, Jose Alejandro

1997-01-01

Colombia is the first country in the production of soft coffee in the world. The benefit for humid way it makes that this quality of coffee is obtained; however, the high consumption of water in the process and the later discharge to the superficial or underground sources, they have generated an environmental problem of great magnitude. Also, the sources of water that they have been contaminated with the discharges of the liquid waste that come from benefit of coffee they present, among other, serious inconveniences to be used as supplying sources of drinkable water. In time of crop, the coffee areas and their superficial sources of water usually register high indexes of contamination like consequence of the discharges of residual waters that come from the benefit of the coffee. In the Departments of Quindio, Valle, Caldas, Antioquia, etc., they have been come executing investigations of the residuals treatment that are derived of the pulp removal of the coffee (via humid), for anaerobic methods with satisfactory results. This project had the collaboration of the Departmental Committee of Coffee of Antioquia and the Environmental Engineering of the Antioquia University and it is formulated toward the evaluation of a Anaerobic filter of Ascendant flow, FAFA, preceded of a septic tank (biological sedimentation), as a treatment system of the coffee residual waters, with a waste native of a ecological benefit area. The obtained results were satisfactory although the generated waste is very intermittent and in times that are not of coffee crop it doesn't take place; what hinders more the application of biological systems for its treatment

A cost-benefit analysis of a proposed overseas refugee latent tuberculosis infection screening and treatment program.

Science.gov (United States)

Wingate, La'Marcus T; Coleman, Margaret S; de la Motte Hurst, Christopher; Semple, Marie; Zhou, Weigong; Cetron, Martin S; Painter, John A

2015-12-01

This study explored the effect of screening and treatment of refugees for latent tuberculosis infection (LTBI) before entrance to the United States as a strategy for reducing active tuberculosis (TB). The purpose of this study was to estimate the costs and benefits of LTBI screening and treatment in United States bound refugees prior to arrival. Costs were included for foreign and domestic LTBI screening and treatment and the domestic treatment of active TB. A decision tree with multiple Markov nodes was developed to determine the total costs and number of active TB cases that occurred in refugee populations that tested 55, 35, and 20 % tuberculin skin test positive under two models: no overseas LTBI screening and overseas LTBI screening and treatment. For this analysis, refugees that tested 55, 35, and 20 % tuberculin skin test positive were divided into high, moderate, and low LTBI prevalence categories to denote their prevalence of LTBI relative to other refugee populations. For a hypothetical 1-year cohort of 100,000 refugees arriving in the United States from regions with high, moderate, and low LTBI prevalence, implementation of overseas screening would be expected to prevent 440, 220, and 57 active TB cases in the United States during the first 20 years after arrival. The cost savings associated with treatment of these averted cases would offset the cost of LTBI screening and treatment for refugees from countries with high (net cost-saving: $4.9 million) and moderate (net cost-saving: $1.6 million) LTBI prevalence. For low LTBI prevalence populations, LTBI screening and treatment exceed expected future TB treatment cost savings (net cost of $780,000). Implementing LTBI screening and treatment for United States bound refugees from countries with high or moderate LTBI prevalence would potentially save millions of dollars and contribute to United States TB elimination goals. These estimates are conservative since secondary transmission from tuberculosis cases

Process acceptance and adjustment techniques for Swiss automatic screw machine parts. Final report

International Nuclear Information System (INIS)

Robb, J.M.

1976-01-01

Product tolerance requirements for small, cylindrical, piece parts produced on swiss automatic screw machines have progressed to the reliability limits of inspection equipment. The miniature size, configuration, and tolerance requirements (plus or minus 0.0001 in.) (0.00254 mm) of these parts preclude the use of screening techniques to accept product or adjust processes during setup and production runs; therefore, existing means of product acceptance and process adjustment must be refined or new techniques must be developed. The purpose of this endeavor has been to determine benefits gained through the implementation of a process acceptance technique (PAT) to swiss automatic screw machine processes. PAT is a statistical approach developed for the purpose of accepting product and centering processes for parts produced by selected, controlled processes. Through this endeavor a determination has been made of the conditions under which PAT can benefit a controlled process and some specific types of screw machine processes upon which PAT could be applied. However, it was also determined that PAT, if used indiscriminately, may become a record keeping burden when applied to more than one dimension at a given machining operation

Development of adjustable head holder couch in H and H cancer radiation therapy

International Nuclear Information System (INIS)

Sim, Jae Goo; Song, Ki Won; Kim, Jin Man; Park, Myoung Hwan

2014-01-01

In case of all patients who receive radiation therapy, a treatment plan is established and all steps of treatment are planned in the same geometrical condition. In case of head and neck cancer patients who undergo simulated treatment through computed tomography (CT), patients are fixed onto a table for planning, but laid on the top of the treatment table in the radiation therapy room. This study excogitated and fabricated an adjustable holder for head and neck cancer patients to fix patient's position and geometrical discrepancies when performing radiation therapy on head and neck cancer patients, and compared the error before and after adjusting the position of patients due to difference in weight to evaluate the correlation between patients' weight and range of error. Computed tomography system(High Advantage, GE, USA) is used for phantom to maintain the supine position to acquire the images of the therapy site for IMRT. IMRT 4MV X-rays was used by applying the LINAC(21EX, Varian, U.S.A). Treatment planning system (Pinnacle, ver. 9.1h, Philips, Madison, USA) was used. The setup accuracy was compared with each measurement was repeated five times for each weight (0, 15, and 30Kg) and CBCT was performed 30 times to find the mean and standard deviation of errors before and after the adjustment of each weight. SPSS ver.19.0(SPSS Inc., Chicago, IL,USA) statistics program was used to perform the Wilcoxon Rank test for significance evaluation and the Spearman analysis was used as the tool to analyze the significance evaluation of the correlation of weight. As a result of measuring the error values from CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was 0.4±0.8 mm, 0.8±0.4 mm, 0 for 0Kg before the adjustment. In 15Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was 0.2±0.8 mm, 1.2±0.4 mm, 2.0±0.4 mm. After adjusting position was X,Y,Z axis was 0.2±0.4, 0.4±0.5 mm, 0.4±0.5 mm

Development of adjustable head holder couch in H and H cancer radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Sim, Jae Goo; Song, Ki Won; Kim, Jin Man; Park, Myoung Hwan [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2014-06-15

In case of all patients who receive radiation therapy, a treatment plan is established and all steps of treatment are planned in the same geometrical condition. In case of head and neck cancer patients who undergo simulated treatment through computed tomography (CT), patients are fixed onto a table for planning, but laid on the top of the treatment table in the radiation therapy room. This study excogitated and fabricated an adjustable holder for head and neck cancer patients to fix patient's position and geometrical discrepancies when performing radiation therapy on head and neck cancer patients, and compared the error before and after adjusting the position of patients due to difference in weight to evaluate the correlation between patients' weight and range of error. Computed tomography system(High Advantage, GE, USA) is used for phantom to maintain the supine position to acquire the images of the therapy site for IMRT. IMRT 4MV X-rays was used by applying the LINAC(21EX, Varian, U.S.A). Treatment planning system (Pinnacle, ver. 9.1h, Philips, Madison, USA) was used. The setup accuracy was compared with each measurement was repeated five times for each weight (0, 15, and 30Kg) and CBCT was performed 30 times to find the mean and standard deviation of errors before and after the adjustment of each weight. SPSS ver.19.0(SPSS Inc., Chicago, IL,USA) statistics program was used to perform the Wilcoxon Rank test for significance evaluation and the Spearman analysis was used as the tool to analyze the significance evaluation of the correlation of weight. As a result of measuring the error values from CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was 0.4±0.8 mm, 0.8±0.4 mm, 0 for 0Kg before the adjustment. In 15Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was 0.2±0.8 mm, 1.2±0.4 mm, 2.0±0.4 mm. After adjusting position was X,Y,Z axis was 0.2±0.4, 0.4±0.5 mm, 0.4±0.5 mm

Clinician-Reported Outcome Assessments of Treatment Benefit: Report of the ISPOR Clinical Outcome Assessment Emerging Good Practices Task Force.

Science.gov (United States)

Powers, John H; Patrick, Donald L; Walton, Marc K; Marquis, Patrick; Cano, Stefan; Hobart, Jeremy; Isaac, Maria; Vamvakas, Spiros; Slagle, Ashley; Molsen, Elizabeth; Burke, Laurie B

2017-01-01

A clinician-reported outcome (ClinRO) assessment is a type of clinical outcome assessment (COA). ClinRO assessments, like all COAs (patient-reported, observer-reported, or performance outcome assessments), are used to 1) measure patients' health status and 2) define end points that can be interpreted as treatment benefits of medical interventions on how patients feel, function, or survive in clinical trials. Like other COAs, ClinRO assessments can be influenced by human choices, judgment, or motivation. A ClinRO assessment is conducted and reported by a trained health care professional and requires specialized professional training to evaluate the patient's health status. This is the second of two reports by the ISPOR Clinical Outcomes Assessment-Emerging Good Practices for Outcomes Research Task Force. The first report provided an overview of COAs including definitions important for an understanding of COA measurement practices. This report focuses specifically on issues related to ClinRO assessments. In this report, we define three types of ClinRO assessments (readings, ratings, and clinician global assessments) and describe emerging good measurement practices in their development and evaluation. The good measurement practices include 1) defining the context of use; 2) identifying the concept of interest measured; 3) defining the intended treatment benefit on how patients feel, function, or survive reflected by the ClinRO assessment and evaluating the relationship between that intended treatment benefit and the concept of interest; 4) documenting content validity; 5) evaluating other measurement properties once content validity is established (including intra- and inter-rater reliability); 6) defining study objectives and end point(s) objectives, and defining study end points and placing study end points within the hierarchy of end points; 7) establishing interpretability in trial results; and 8) evaluating operational considerations for the implementation of

Benefit-risk analysis for the clinician: 'primum non nocere' revisited-the case for antipsychotics in the treatment of behavioural disturbances in dementia

NARCIS (Netherlands)

Naarding, P.; van Grevenstein, M.; Beekman, A.T.F.

2010-01-01

The results of clinical trials are often presented in a way that only highlights either the benefits or the risks of the treatment under study. Especially in older age, clinical psychiatric problems are often of complex nature, which requires integrating multiple sources of data to reach clinical

Experimental therapy of epilepsy with transcranial magnetic stimulation: lack of additional benefit with prolonged treatment

Directory of Open Access Journals (Sweden)

Brasil-Neto Joaquim P.

2004-01-01

Full Text Available OBJECTIVE: To investigate the effect of three months of low-frequency repetitive transcranial magnetic stimulation (rTMS treatment in intractable epilepsy. METHODS: Five patients (four males, one female; ages 6 to 50 years, were enrolled in the study; their epilepsy could not be controlled by medical treatment and surgery was not indicated. rTMS was performed twice a week for three months; patients kept records of seizure frequency for an equal period of time before, during, and after rTMS sessions. rTMS was delivered to the vertex with a round coil, at an intensity 5 % below motor threshold. During rTMS sessions, 100 stimuli (five series of 20 stimuli, with one-minute intervals between series were delivered at a frequency of 0.3 Hz. RESULTS: Mean daily number of seizures (MDNS decreased in three patients and increased in two during rTMS- one of these was treated for only one month; the best result was achieved in a patient with focal cortical dysplasia (reduction of 43.09 % in MDNS. In the whole patient group, there was a significant (p<0.01 decrease in MDNS of 22.8 %. CONCLUSION: Although prolonged rTMS treatment is safe and moderately decreases MDNS in a group of patients with intractable epilepsy, individual patient responses were mostly subtle and clinical relevance of this method is probably low. Our data suggest, however, that patients with focal cortical lesions may indeed benefit from this novel treatment. Further studies should concentrate on that patient subgroup.

Benefits of real-time gas management

International Nuclear Information System (INIS)

Nolty, R.; Dolezalek, D. Jr.

1994-01-01

In today's competitive gas gathering, processing, storage and transportation business environment, the requirements to do business are continually changing. These changes arise from government regulations such as the amendments to the Clean Air Act concerning the environment and FERC Order 636 concerning business practices. Other changes are due to advances in technology such as electronic flow measurement (EFM) and real-time communications capabilities within the gas industry. Gas gathering, processing, storage and transportation companies must be flexible in adapting to these changes to remain competitive. These dynamic requirements can be met with an open, real-time gas management computer information system. Such a system provides flexible services with a variety of software applications. Allocations, nominations management and gas dispatching are examples of applications that are provided on a real-time basis. By providing real-time services, the gas management system enables operations personnel to make timely adjustments within the current accounting period. Benefits realized from implementing a real-time gas management system include reduced unaccountable gas, reduced imbalance penalties, reduced regulatory violations, improved facility operations and better service to customers. These benefits give a company the competitive edge. This article discusses the applications provided, the benefits from implementing a real-time gas management system, and the definition of such a system

The economic benefits of reducing physical inactivity: an Australian example.

Science.gov (United States)

Cadilhac, Dominique A; Cumming, Toby B; Sheppard, Lauren; Pearce, Dora C; Carter, Rob; Magnus, Anne

2011-09-24

Physical inactivity has major impacts on health and productivity. Our aim was to estimate the health and economic benefits of reducing the prevalence of physical inactivity in the 2008 Australian adult population. The economic benefits were estimated as 'opportunity cost savings', which represent resources utilized in the treatment of preventable disease that are potentially available for re-direction to another purpose from fewer incident cases of disease occurring in communities. Simulation models were developed to show the effect of a 10% feasible, reduction target for physical inactivity from current Australian levels (70%). Lifetime cohort health benefits were estimated as fewer incident cases of inactivity-related diseases; deaths; and Disability Adjusted Life Years (DALYs) by age and sex. Opportunity costs were estimated as health sector cost impacts, as well as paid and unpaid production gains and leisure impacts from fewer disease events associated with reduced physical inactivity. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of physically active and inactive adults, and valued using the friction cost approach. The impact of an improvement in health status on unpaid household production and leisure time were modeled from time use survey data, as applied to the exposed and non-exposed population subgroups and valued by suitable proxy. Potential costs associated with interventions to increase physical activity were not included. Multivariable uncertainty analyses and univariate sensitivity analyses were undertaken to provide information on the strength of the conclusions. A 10% reduction in physical inactivity would result in 6,000 fewer incident cases of disease, 2,000 fewer deaths, 25,000 fewer DALYs and provide gains in working days (114,000), days of home-based production (180,000) while conferring a AUD96 million reduction in health sector costs. Lifetime potential opportunity cost savings in

Anticipated Benefits of Care (ABC): psychometrics and predictive value in psychiatric disorders.

Science.gov (United States)

Warden, D; Trivedi, M H; Carmody, T J; Gollan, J K; Kashner, T M; Lind, L; Crismon, M L; Rush, A J

2010-06-01

Attitudes and expectations about treatment have been associated with symptomatic outcomes, adherence and utilization in patients with psychiatric disorders. No measure of patients' anticipated benefits of treatment on domains of everyday functioning has previously been available. The Anticipated Benefits of Care (ABC) is a new, 10-item questionnaire used to measure patient expectations about the impact of treatment on domains of everyday functioning. The ABC was collected at baseline in adult out-patients with major depressive disorder (MDD) (n=528), bipolar disorder (n=395) and schizophrenia (n=447) in the Texas Medication Algorithm Project (TMAP). Psychometric properties of the ABC were assessed, and the association of ABC scores with treatment response at 3 months was evaluated. Evaluation of the ABC's internal consistency yielded Cronbach's alpha of 0.90-0.92 for patients across disorders. Factor analysis showed that the ABC was unidimensional for all patients and for patients with each disorder. For patients with MDD, lower anticipated benefits of treatment was associated with less symptom improvement and lower odds of treatment response [odds ratio (OR) 0.72, 95% confidence interval (CI) 0.57-0.87, p=0.0011]. There was no association between ABC and symptom improvement or treatment response for patients with bipolar disorder or schizophrenia, possibly because these patients had modest benefits with treatment. The ABC is the first self-report that measures patient expectations about the benefits of treatment on everyday functioning, filling an important gap in available assessments of attitudes and expectations about treatment. The ABC is simple, easy to use, and has acceptable psychometric properties for use in research or clinical settings.

Lifetime distributional effects of Social Security retirement benefits.

Science.gov (United States)

Smith, Karen; Toder, Eric; Iams, Howard

proceeds to buy either of two annuities that provide level payments from age 62 until death: a unisex annuity that is based on the average life expectancy of the birth cohort or an age-adjusted annuity that is based on the worker's own life expectancy. On the permanent income measure, OASI is generally more favorable to people in higher income quintiles. Moreover, it is particularly unfavorable to those in the lowest quintile. Because people in the lowest quintile have a shorter life expectancy, they receive OASI benefits for a shorter period. This group would receive greater benefits in retirement if they invested their payroll taxes in the age-adjusted annuity. OASI is more favorable to them than the unisex annuity, however, OASI is becoming more progressive in that the net benefits it provides drop more rapidly among higher income quintiles than lower ones. This article also examines how OASI affects individuals by educational attainment, race, and sex. On both the lifetime covered earnings and the permanent income measures, OASI is more favorable to workers with less education and more favorable to women. The results by race and ethnicity are mixed. When people are ranked by the present value of their shared lifetime covered earnings, OASI appears more favorable to non-Hispanic blacks and Hispanics than to non-Hispanic whites. When people are ranked by shared permanent income in retirement, however, OASI produces negative returns for both non-Hispanic blacks and non-Hispanic whites in the most recent birth cohorts, with non-Hispanic blacks faring relatively worse. The changes across cohorts occur partly because of changes in tax rates and benefits, but more importantly because of changing demographics and earnings patterns of the workforce. Of particular importance is the increasing share of beneficiaries who receive worker benefits instead of auxiliary benefits as wives or widows. OASI benefits are based on the lifetime covered earnings of current or former married

Intracranial Pressure-Guided Shunt Valve Adjustments with the Miethke Sensor Reservoir.

Science.gov (United States)

Antes, Sebastian; Stadie, Axel; Müller, Simon; Linsler, Stefan; Breuskin, David; Oertel, Joachim

2018-01-01

Telemetric intracranial pressure (ICP) monitoring seems to be a promising therapy-supporting option in shunt-treated patients. Benefits become obvious when headaches are unspecific and clinical symptoms cannot be related to possible overdrainage or underdrainage. In this study, we evaluated a new telemetric device to individually adjust shunt valves according to ICP measurements. Between December 2015 and November 2016, 25 patients with suspected suboptimal shunt valve settings underwent insertion of a telemetric ICP sensor (Sensor Reservoir; Christoph Miethke, Potsdam, Germany). Over a 1-year period, a total of 183 telemetric ICP measurements and 85 shunt valve adjustments were carried out. Retrospective statistic analyses focused on valve adjustments, ICP values, and clinical outcomes. ICP-guided valve adjustments positively changed the clinical state in 18 out of 25 patients. Clinical improvement over time was associated with significant changes of the valve settings and ICP values. Interestingly, a therapeutically normalized ICP profile was not automatically associated with clinical improvement. The Sensor Reservoir is an important and valuable tool for shunt-treated patients suffering from drainage-related problems. The possibility to simultaneously recognize and solve shunt problems represents the decisive advantage. Nevertheless, measurements with the Sensor Reservoir did not allow for the determination of default valve settings or universal target ICP values. Copyright © 2017 Elsevier Inc. All rights reserved.

Benefit of physiotherapeutic treatment in children with torticollis

DEFF Research Database (Denmark)

Hautopp, Lena Conny; Wester, Susanne; Bang, Birgitte

2014-01-01

and related pathology have been developed and validated. The aim of the present study was to monitor a cohort of children with torticollis using a standardised protocol including valid and reliable measurements. METHODS: A total of 136 infants diagnosed with torticollis and referred to physiotherapeutic...... months at inclusion and seven months at the end of the treatment period that comprised a median of five treatment sessions. Initially, 52% and 54% presented with ROM deficits in rotation and lateral flexion, respectively. After treatment, these parts were reduced to 6% and 14%, and the magnitudes...... in the majority (90%) of children with torticollis with less than ten physiotherapeutic treatment sessions. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

Directory of Open Access Journals (Sweden)

Syed Sulaiman Syed Azhar

2011-09-01

Full Text Available Abstract Background There is substantial evidence to support the association between tuberculosis (TB and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this. Methods An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group or conventional TB DOTS alone (comparison or DOTS group. At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate. Results A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when

The SCIDOTS Project: evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes.

Science.gov (United States)

Awaisu, Ahmed; Nik Mohamed, Mohamad Haniki; Mohamad Noordin, Noorliza; Abd Aziz, Noorizan; Syed Sulaiman, Syed Azhar; Muttalif, Abdul Razak; Ahmad Mahayiddin, Aziah

2011-09-23

There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this. An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate. A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB

26 CFR 1.415(a)-1 - General rules with respect to limitations on benefits and contributions under qualified plans.

Science.gov (United States)

2010-04-01

... and disability benefits); (vii) Section 1.415(b)-1(g)(3) (regarding adjustments to applicable... survivor and disability benefits under governmental plans); (viii) Section 1.415(c)-1(b)(2)(ii) and (3)(iii...)(5) (providing an alternative rule for inclusion of compensation after a severance from employment...

Individualized cardiovascular disease prevention in clinical practice : Estimation of benefit and cost

NARCIS (Netherlands)

Slob, MC

2017-01-01

For treatment decisions in clinical practice, group-level treatment effects need to be translated into benefit for an individual patient. In both the primary and secondary cardiovascular prevention setting (Chapter 2), patients differ widely in the risk for cardiovascular events, and the benefit

Are the ICD-10 or DSM-5 diagnostic systems able to define those who will benefit from treatment for depression?

Science.gov (United States)

Montgomery, Stuart

2016-08-01

Two widely used diagnostic systems, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are reviewed for their ability to define those who will benefit from active treatment rather than placebo. Both systems suffer from a weakness in defining symptoms sufficiently clearly to separate depression from normal mood variations in the general population. Consequently, normal individuals may be medicalized and defined as suffering from and treated for depression. Also, in mild depression, unlike moderate depression, a lack of significant separation of active treatment from placebo has been shown in individual double-blind, placebo-controlled studies and in meta-analyses of these treatment studies. Both systems would be more useful for treatment purposes if they provided a clearer symptomatic definition of moderate depression, as is widely used in pivotal regulatory standard efficacy studies.

39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

Science.gov (United States)

2010-07-01

... only be applied together with inflation-based limitation rate adjustments or when inflation-based... used in lieu of an inflation-based limitation rate adjustment. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority...

Seasonal adjustment methods and real time trend-cycle estimation

CERN Document Server

Bee Dagum, Estela

2016-01-01

This book explores widely used seasonal adjustment methods and recent developments in real time trend-cycle estimation. It discusses in detail the properties and limitations of X12ARIMA, TRAMO-SEATS and STAMP - the main seasonal adjustment methods used by statistical agencies. Several real-world cases illustrate each method and real data examples can be followed throughout the text. The trend-cycle estimation is presented using nonparametric techniques based on moving averages, linear filters and reproducing kernel Hilbert spaces, taking recent advances into account. The book provides a systematical treatment of results that to date have been scattered throughout the literature. Seasonal adjustment and real time trend-cycle prediction play an essential part at all levels of activity in modern economies. They are used by governments to counteract cyclical recessions, by central banks to control inflation, by decision makers for better modeling and planning and by hospitals, manufacturers, builders, transportat...

The benefit of low dose prophylaxis in the treatment of hemophilia: a focus on China.

Science.gov (United States)

Wu, Runhui; Luke, Koon Hung

2017-11-01

Currently full dose prophylaxis is the standard of care in the treatment of hemophilia (World Federation of Hemophilia). However, the high costs prevent the use of standard or intermediate dose prophylaxis in China and other developing countries. Low dose prophylaxis would be a viable alternative treatment. At present global research data on the use of low dose prophylaxis is limited. Areas covered: Since 2007, China has been developing low dose prophylaxis as a high priority (90 % of moderate and severe hemophilia boys suffer joint disease by age 6 - 9). 11 studies were successfully conducted and published results showing evidence of the benefits of low dose prophylaxis to reduce joint bleeding. This new knowledge has been implemented into clinical practice in China. However the long-term outcome of arthropathy remains unclear and obstacles in execution exist. Expert commentary: In 2016, the first phenotype-based individualized prophylaxis study using four escalating low dose regimens on severe Chinese hemophilia A boys (China Individualized Prophylaxis Study (CHIP China)) launched. Using the previously published and imminent CHIP data, the goal for China is to establish an effective escalating low dose prophylaxis protocol for use in China as a standard of care.

Annual Adjustment Factors

Data.gov (United States)

Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

A framework for quantifying net benefits of alternative prognostic models

OpenAIRE

Rapsomaniki, E.; White, I.R.; Wood, A.M.; Thompson, S.G.; Ford, I.

2012-01-01

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measure...

Effects of a Brief Psychoeducational Intervention for Family Conflict: Constructive Conflict, Emotional Insecurity and Child Adjustment.

Science.gov (United States)

Miller-Graff, Laura E; Cummings, E Mark; Bergman, Kathleen N

2016-10-01

The role of emotional security in promoting positive adjustment following exposure to marital conflict has been identified in a large number of empirical investigations, yet to date, no interventions have explicitly addressed the processes that predict child adjustment after marital conflict. The current study evaluated a randomized controlled trial of a family intervention program aimed at promoting constructive marital conflict behaviors thereby increasing adolescent emotional security and adjustment. Families (n = 225) were randomized into 1 of 4 conditions: Parent-Adolescent (n = 75), Parent-Only (n = 75), Self-Study (n = 38) and No Treatment (n = 37). Multi-informant and multi-method assessments were conducted at baseline, post-treatment and 6-month follow-up. Effects of treatment on destructive and constructive conflict behaviors were evaluated using multilevel models where observations were nested within individuals over time. Process models assessing the impact of constructive and destructive conflict behaviors on emotional insecurity and adolescent adjustment were evaluated using path modeling. Results indicated that the treatment was effective in increasing constructive conflict behaviors (d = 0.89) and decreasing destructive conflict behaviors (d = -0.30). For the Parent-Only Group, post-test constructive conflict behaviors directly predicted lower levels of adolescent externalizing behaviors at 6-month follow-up. Post-test constructive conflict skills also indirectly affected adolescent internalizing behaviors through adolescent emotional security. These findings support the use of a brief psychoeducational intervention in improving post-treatment conflict and emotional security about interparental relationships.

The impact of unemployment insurance benefits on the probability of migration of the unemployed.

Science.gov (United States)

Gose, E; Paul, C

1990-08-01

"By ignoring individual unemployment compensation benefits and conditions of job termination, past migration research has concluded that personal unemployment doubles the likelihood of interstate labor-force migration. Findings from the present study indicate that aggregating the unemployed, without adjusting for these two factors, overstates the probability of migration for the involuntarily unemployed benefit recipient and understates the likelihood of migration for the voluntarily unemployed benefit recipient. The results suggest that federal discretionary unemployment-compensation programs, which are implemented during recessionary periods, likely serve to retard out-migration of those who are involuntarily unemployed." Data are from a 1982 sample of unemployed U.S. workers. excerpt

Convexity Adjustments for ATS Models

DEFF Research Database (Denmark)

Murgoci, Agatha; Gaspar, Raquel M.

. As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

Open source modular ptosis crutch for the treatment of myasthenia gravis.

Science.gov (United States)

Saidi, Trust; Sivarasu, Sudesh; Douglas, Tania S

2018-02-01

Pharmacologic treatment of Myasthenia Gravis presents challenges due to poor tolerability in some patients. Conventional ptosis crutches have limitations such as interference with blinking which causes ocular surface drying, and frequent irritation of the eyes. To address this problem, a modular and adjustable ptosis crutch for elevating the upper eyelid in Myasthenia Gravis patients has been proposed as a non-surgical and low-cost solution. Areas covered: This paper reviews the literature on the challenges in the treatment of Myasthenia Gravis globally and focuses on a modular and adjustable ptosis crutch that has been developed by the Medical Device Laboratory at the University of Cape Town. Expert commentary: The new medical device has potential as a simple, effective and unobtrusive solution to elevate the drooping upper eyelid(s) above the visual axis without the need for medication and surgery. Access to the technology is provided through an open source platform which makes it available globally. Open access provides opportunities for further open innovation to address the current limitations of the device, ultimately for the benefit not only of people suffering from Myasthenia Gravis but also of those with ptosis from other aetiologies.

Effect of patient's life expectancy on the cost-effectiveness of treatment for ocular hypertension.

Science.gov (United States)

Kymes, Steven M; Plotzke, Michael R; Kass, Michael A; Boland, Michael V; Gordon, Mae O

2010-05-01

To assess the influence of expected life span on the cost-effectiveness of treating ocular hypertension to prevent primary open-angle glaucoma. We used a Markov simulation model to estimate the cost and benefit of ocular hypertension treatment over a person's remaining life. We examined the influence of age on the cost-effectiveness decision in 2 ways: (1) by evaluating specific age cohorts to assess the influence of age at the initiation of treatment; and (2) by evaluating the influence of a specific life span. At a willingness to pay $50,000/quality-adjusted life year to $100,000/quality-adjusted life year, treatment of people with a 2% or greater annual risk of developing glaucoma was cost-effective for people aged 45 years with a life expectancy of at least 18 remaining years. However, to be cost-effective, a person aged 55 years must have a life expectancy of 21 remaining years and someone aged 65 years must have a life expectancy of 23 remaining years. A person with ocular hypertension must have a life expectancy of at least 18 remaining years to justify treatment at a threshold of a 2% or greater annual risk of developing glaucoma. Persons at higher levels of risk require a life expectancy of 7 to 10 additional years to justify treatment.

School food cost-benefits: England.

Science.gov (United States)

Nelson, Michael

2013-06-01

To estimate the costs per relevant unit (pupils and meals) associated with improvements to school food and the potential economic and health gains that may result. Calculation of costs per relevant unit (pupils and meals) based on (i) Department for Education expenditure to support improvements in school food, 2005–2011 and (ii) measures of the changes in the number of pupils taking school lunch and the number of meals served over the same time period; plus examples of the use of linked data to predict longer-term economic and health outcomes of healthier eating at school. England. Local authorities, government departments and non-departmental public bodies. Analysis of investment over a 6-year period indicates that costs of setting up and maintaining a change organization such as the School Food Trust were low in relation to short-term benefits in nutrition and behaviour. Models that predict long-terms gains to the exchequer and to quality-adjusted life years need further elaboration. Modest levels of government investment in the delivery and promotion of healthier school food is likely to yield both short-term and long-term benefits in relation to nutrition, learning, economics and health.

Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice: A microsimulation screening analysis.

Science.gov (United States)

Carlsson, Sigrid V; de Carvalho, Tiago M; Roobol, Monique J; Hugosson, Jonas; Auvinen, Anssi; Kwiatkowski, Maciej; Villers, Arnauld; Zappa, Marco; Nelen, Vera; Páez, Alvaro; Eastham, James A; Lilja, Hans; de Koning, Harry J; Vickers, Andrew J; Heijnsdijk, Eveline A M

2016-11-15

Prostate-specific antigen (PSA) screening and concomitant treatment can be implemented in several ways. The authors investigated how the net benefit of PSA screening varies between common practice versus "good practice." Microsimulation screening analysis (MISCAN) was used to evaluate the effect on quality-adjusted life-years (QALYs) if 4 recommendations were followed: limited screening in older men, selective biopsy in men with elevated PSA, active surveillance for low-risk tumors, and treatment preferentially delivered at high-volume centers. Outcomes were compared with a base model in which annual screening started at ages 55 to 69 years and were simulated using data from the European Randomized Study of Screening for Prostate Cancer. In terms of QALYs gained compared with no screening, for 1000 screened men who were followed over their lifetime, recommended good practice led to 73 life-years (LYs) and 74 QALYs gained compared with 73 LYs and 56 QALYs for the base model. In contrast, common practice led to 78 LYs gained but only 19 QALYs gained, for a greater than 75% relative reduction in QALYs gained from unadjusted LYs gained. The poor outcomes for common practice were influenced predominantly by the use of aggressive treatment for men with low-risk disease, and PSA testing in older men also strongly reduced potential QALY gains. Commonly used PSA screening and treatment practices are associated with little net benefit. Following a few straightforward clinical recommendations, particularly greater use of active surveillance for low-risk disease and reducing screening in older men, would lead to an almost 4-fold increase in the net benefit of prostate cancer screening. Cancer 2016;122:3386-3393. © 2016 American Cancer Society. © 2016 American Cancer Society.

76 FR 34590 - Bankruptcy Filing Date Treated as Plan Termination Date for Certain Purposes; Guaranteed Benefits...

Science.gov (United States)

2011-06-14

...) determines which benefits are entitled to priority in ``priority category 3'' in the statutory hierarchy for... monthly figure is adjusted each year based on the contribution and wage base under the Social Security Act...

Treatment of early-stage prostate cancer among rural and urban patients.

Science.gov (United States)

Baldwin, Laura-Mae; Andrilla, C Holly A; Porter, Michael P; Rosenblatt, Roger A; Patel, Shilpen; Doescher, Mark P

2013-08-15

Geographic barriers and limited availability of cancer specialists may influence early prostate cancer treatment options for rural men. This study compares receipt of different early prostate cancer treatments between rural and urban patients. Using 2004-2006 SEER Limited-Use Data, 51,982 early prostate cancer patients were identified (T1c, T2a, T2b, T2c, T2NOS; no metastases) who were most likely to benefit from definitive treatment (rural-urban residence overall, and for different sociodemographic and cancer characteristics, and different states based on logistic regression analyses, using general estimating equation methods to account for clustering by county. Adjusted definitive treatment rates were lower for rural (83.7%) than urban (87.1%) patients with early-stage prostate cancer (P ≤ .01). Rural men were more likely than urban men to receive non-definitive surgical treatment and no initial treatment. The lowest definitive treatment rates were among rural subgroups: 70 to 74 years (73.9%), African Americans (75.6%), American Indians/Alaska Natives (77.8%), single/separated/divorced (76.8%), living in New Mexico (69.3%), and living in counties with persistent poverty (79.6%). Between 2004 and 2006, this adjusted analysis found that men who were living in rural areas were less likely to receive definitive treatment for their early-stage prostate cancer than those living in urban areas. Certain rural patient groups with prostate cancer need particular attention to ensure their access to appropriate treatment. Rural providers, rural health care systems, and cancer advocacy and support organizations should ensure resources are in place so that the most vulnerable rural groups (men between 60 and 74 years of age; African American men; men who are single, separated, or divorced; and men living in rural New Mexico) can make informed prostate cancer treatment choices based on their preferences. Copyright © 2013 American Cancer Society.

Expense and benefit of neoadjuvant treatment in squamous cell carcinoma of the esophagus

Directory of Open Access Journals (Sweden)

Hartmann Karl A

2001-11-01

Full Text Available Abstract Background The effectiveness of neoadjuvant treatment (NT prior to resection of squamous cell carcinoma of the esophagus (SCCE in terms of prolonged survival has not been proven by randomized trials. Facing considerable financial expenses and with concerns regarding the consumption of the patient's remaining survival time, this study aims to provide rationales for pretreating resection candidates. Methods From March 1986 to March 1999, patients undergoing resection for SCCE were documented prospectively. Since 1989, NT was offered to patients with mainly upper and middle third T3 or T4 tumors or T2 N1 stage who were fit for esophagectomy. Until 1993, NT consisted of chemotherapy. Since that time chemoradiation has also been applied. The parameters for expense and benefit of NT are costs, pretreatment time required, postoperative morbidity and mortality, clinical and histopathological response, and actuarial survival. Results Two hundred and three patients were treated, 170 by surgery alone and 33 by NT + surgery. Postoperative morbidity and mortality were 52% to 30% and 12% to 6%, respectively (p = n.s.. The response to NT was detected in 23 patients (70%. In 11 instances (33%, the primary tumor lesion was histopathologically eradicated. Survival following NT + surgery was significantly prolonged in node-positive patients with a median survival of 12 months to 19 months (p = 0.0193. The average pretreatment time was 113 ± 43 days, and reimbursement for NT to the hospital amounted to Euro 9.834. Conclusions NT did not increase morbidity and mortality. Expenses for pretreatment, particularly time and costs, are considerable. However, taking into account that the results are derived from a non-randomized study, patients with regionally advanced tumor stages seem to benefit, as seen by their prolonged survival.

The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.

Science.gov (United States)

Wang, Junming; Zhang, Hong; Chen, Wei; Li, Guigang

2012-01-01

Anophthalmia is associated with a range of psychosocial difficulties and hydroxyapatite orbital implant insertion and prosthesis wearing is the predominant rehabilitation therapy for anophthalmia. However, few articles have compared preoperative and postoperative psychosocial outcomes using standardized questionnaires. This study aimed to investigate the psychosocial benefits of hydroxyapatite orbital implant insertion and prosthesis wearing in this patient population. In all, 36 participants were tested preoperatively and 6-months postoperatively using standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and social avoidance (Derriford Appearance Scale-Short Form), and quality of life (World Health Organization Quality of Life Scale-Short Form). Before treatment, levels of depression were comparable with population norms; however, levels of general anxiety were slightly raised, levels of social anxiety, social avoidance, and quality of life were significantly poorer than population norms. Treatment resulted in significant improvement in psychosocial adjustment with improvements in all study variables for the participant group as a whole. Hydroxyapatite orbital implant insertion and prosthesis wearing offers significant improvements in psychological and physical functioning for patients with anophthalmia.

Benefit of slow titration of paroxetine to treat depression in the elderly.

Science.gov (United States)

Olgiati, Paolo; Bajo, Emanuele; Serretti, Alessandro

2014-11-01

Paroxetine is commonly used to treat depression in the elderly; however, titration issues have been raised. Rapid titration may lead to increased anxiety and early dropout. The aim of this cost-utility analysis was to compare the potential benefit of standard (10 mg the first day) versus slow titration (2.5 mg gradually increased). Clinical analysis was based on a naturalistic trial integrated with a decision-analytic model representing second treatments for those who initially did not respond and for dropout cases. Treatment setting was a public outpatient center for mental disorders in Italy. Service use data were estimated from best practice guidelines, whereas costs (Euros; 2012) were retrieved from Italian official sources. Slow titration approach produced 0.031 more quality-adjusted life years (remission rate: 57% vs 44% in standard titration group) at an incremental cost of €5.53 (generic paroxetine) and €54.54 (brand paroxetine syrup). Incremental cost-effectiveness ratio (ICER) values were €159 and €1768, respectively, in favor of slow titration approach. Cost-effectiveness threshold, defined as ICER titration of paroxetine in older depressed patients. However, these findings, in part based on simulated data, need to be replicated in clinical trials. Copyright © 2014 John Wiley & Sons, Ltd.

Cost-benefit and risk-benefit assessment for nuclear power plants

International Nuclear Information System (INIS)

Eichholz, G.G.

1976-01-01

A cost benefit assessment is an essential part of the Environmental Impact Statement submitted as part of the licensing considerations for a nuclear facility. Such an assessment forms part of the initial decision to build a nuclear facility, enters critically into the selection of a suitable site, and ultimately forms part of the design procedures to optimize engineering solutions to deal with waste-heat dissipation, treatment methods for radioactive effluent control, and land and site use. Whereas the initial decision usually can be made in purely economic terms, the latter stages involve environmental and social issues that are not readily quantified and involve a qualitative judgment of what constitutes the least, readily achievable impact. The radiological impact of the plant on the surrounding population from the release of low-level effluents can be quantified and treated as a financial ''cost.'' Alternatively it can be treated as a ''risk'' and related to other risks modern man is subjected to and can be used as a means to establish site boundaries. Both cost-benefit and risk-benefit analyses represent essentially optimization approaches to the problem of making nuclear power plants economically competitive, socially and politically acceptable, and as safe or innocuous as one can reasonably make them

Tackling the chronic disease burden: are there co-benefits from climate policy measures?

Science.gov (United States)

Vandenberghe, Désirée; Albrecht, Johan

2018-04-26

Each year, non-communicable diseases (NCDs) kill 40 million people worldwide and impose an estimated economic burden of $600 billion. Without effective policymaking, NCDs will continue to undermine health and economic systems globally. We propose that climate policy measures-such as carbon pricing-can yield significant health-related co-benefits aside from their intended greenhouse gas emission reduction. We simulate three carbon tax scenarios in the energy and food sector in Belgium and assess the resulting health-related co-benefits. These benefits originate from decreased exposure to two leading NCD risk factors: fine particulate matter and dietary regimes excessive in animal products. The carbon tax could prevent 42,300-78,800 Disability-Adjusted Life Years in Belgium, or save 0.6-1.1% of total health care expenditure and an additional 0.06-0.12% of Belgian GDP. We conclude that these health-related co-benefits should be included in the cost-benefit analysis of carbon pricing.

Predicting the benefit of binaural cue preservation in bilateral directional processing schemes for listeners with impaired hearing

DEFF Research Database (Denmark)

Brand, Thomas; Hauth, Christopher; Wagener, Kirsten C.

2018-01-01

Linked pairs of hearing aids offer various possibilities for directional processing providing adjustable trade-off between improving signal-to-noise ratio and preserving binaural listening. The benefit depends on the processing scheme, the acoustic scenario, and the listener’s ability to exploit...... fine structure. BSIM revealed a benefit due to binaural processing in well-performing listeners when processing provided low-frequency interaural timing cues....

Therapeutic benefit in patients switching tolterodine to other novel antimuscarinic agents.

Science.gov (United States)

Sánchez-Ballester, F; Miranda, P; Lizarraga, I; Rejas, J; Arumi, D

2014-04-01

To explore in the daily clinical practice setting that antimuscarinic, Fesoterodine or Solifenacin, provides a greater clinical benefit after changing their prior Overactive Bladder (OAB) therapy with tolterodine extended-release (ER) to other novel antimuscarinic agents. A post-hoc analysis of data from an observational multicenter, cross-sectional, retrospective study. Adult patients of both sexes, with OAB and OAB-V8 score≥8, who switched to fesoterodine or solifenacin within the 3-4 months before study visit from their prior tolterodine-ER-based therapy due to poor response were included. 92 patients were selected for each treatment group, matched (1:1) according to conditioned probability using the propensity score. Benefit of treatment change perceived by the physician and patient was evaluated by means of the Clinical Global Impression of Improvement subscale (CGI-I) and Treatment Benefit Scale (TBS), respectively. Degree of worry, bother and interference with daily living activities due to urinary symptoms, level of satisfaction, and preference for current treatment were also assessed. Fesoterodine provided a significantly greater improvement than solifenacina in terms of therapeutic benefit perceived by the physician according to ICG-I. 96.7% of the patients on fesoterodine treatment vs. 81.6% of the solifenacin group showed a score of improvement in TBS (P<.05). Fesoterodine was also better rated than solifenacin with regard to satisfaction and preference for the new treatment (93.4 vs. 78.2% P<.05). In daily clinical practice the switch from tolterodine LP to fesoterodine seems to provide greater benefits both from the physician's and the patient's point of view compared with those provided by solifenacin. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

Costs and benefits of direct-to-consumer advertising: the case of depression.

Science.gov (United States)

Block, Adam E

2007-01-01

Direct-to-consumer advertising (DTCA) is legal in the US and New Zealand, but illegal in the rest of the world. Little or no research exists on the social welfare implications of DTCA. To quantify the total costs and benefits associated with both appropriate and inappropriate care due to DTCA, for the case of depression. A cost-benefit model was developed using parameter estimates from available survey, epidemiological and experimental data. The model estimates the total benefits and costs (year 2002 values) of new appropriate and inappropriate care stimulated by DTCA for depression. Uncertainty in model parameters is addressed with sensitivity analyses. This study provides evidence that 94% of new antidepressant use due to DTCA is from non-depressed individuals. However, the average health benefit to each new depressed user is 63-fold greater than the cost per treatment, creating a positive overall social welfare effect; a net benefit of >72 million US dollars. This analysis suggests that DTCA may lead to antidepressant treatment in 15-fold as many non-depressed people as depressed people. However, the costs of treating non-depressed people may be vastly outweighed by the much larger benefit accruing to treated depressed individuals. The cost-benefit ratio can be improved through better targeting of advertisements and higher quality treatment of depression.

A counterfactual p-value approach for benefit-risk assessment in clinical trials.

Science.gov (United States)

Zeng, Donglin; Chen, Ming-Hui; Ibrahim, Joseph G; Wei, Rachel; Ding, Beiying; Ke, Chunlei; Jiang, Qi

2015-01-01

Clinical trials generally allow various efficacy and safety outcomes to be collected for health interventions. Benefit-risk assessment is an important issue when evaluating a new drug. Currently, there is a lack of standardized and validated benefit-risk assessment approaches in drug development due to various challenges. To quantify benefits and risks, we propose a counterfactual p-value (CP) approach. Our approach considers a spectrum of weights for weighting benefit-risk values and computes the extreme probabilities of observing the weighted benefit-risk value in one treatment group as if patients were treated in the other treatment group. The proposed approach is applicable to single benefit and single risk outcome as well as multiple benefit and risk outcomes assessment. In addition, the prior information in the weight schemes relevant to the importance of outcomes can be incorporated in the approach. The proposed CPs plot is intuitive with a visualized weight pattern. The average area under CP and preferred probability over time are used for overall treatment comparison and a bootstrap approach is applied for statistical inference. We assess the proposed approach using simulated data with multiple efficacy and safety endpoints and compare its performance with a stochastic multi-criteria acceptability analysis approach.

Fractional CO₂ laser treatment of caesarean section scars

DEFF Research Database (Denmark)

Karmisholt, Katrine E; Taudorf, Elisabeth H; Wulff, Camilla B

2017-01-01

BACKGROUND AND OBJECTIVES: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars. MATERIALS...... AND METHODS: A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar...... Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction. RESULTS: Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0...

NWP-Based Adjustment of IMERG Precipitation for Flood-Inducing Complex Terrain Storms: Evaluation over CONUS

Directory of Open Access Journals (Sweden)

Xinxuan Zhang

2018-04-01

Full Text Available This paper evaluates the use of precipitation forecasts from a numerical weather prediction (NWP model for near-real-time satellite precipitation adjustment based on 81 flood-inducing heavy precipitation events in seven mountainous regions over the conterminous United States. The study is facilitated by the National Center for Atmospheric Research (NCAR real-time ensemble forecasts (called model, the Integrated Multi-satellitE Retrievals for GPM (IMERG near-real-time precipitation product (called raw IMERG and the Stage IV multi-radar/multi-sensor precipitation product (called Stage IV used as a reference. We evaluated four precipitation datasets (the model forecasts, raw IMERG, gauge-adjusted IMERG and model-adjusted IMERG through comparisons against Stage IV at six-hourly and event length scales. The raw IMERG product consistently underestimated heavy precipitation in all study regions, while the domain average rainfall magnitudes exhibited by the model were fairly accurate. The model exhibited error in the locations of intense precipitation over inland regions, however, while the IMERG product generally showed correct spatial precipitation patterns. Overall, the model-adjusted IMERG product performed best over inland regions by taking advantage of the more accurate rainfall magnitude from NWP and the spatial distribution from IMERG. In coastal regions, although model-based adjustment effectively improved the performance of the raw IMERG product, the model forecast performed even better. The IMERG product could benefit from gauge-based adjustment, as well, but the improvement from model-based adjustment was consistently more significant.

Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood.

Science.gov (United States)

Moura-Ramos, Mariana; Gameiro, Sofia; Canavarro, Maria Cristina; Soares, Isabel; Almeida-Santos, Teresa

2016-05-01

The emotional adjustment of couples undergoing assisted reproductive technology (ART) treatments has been widely studied; however, it remains unclear whether infertility history contributes to couples' adjustment. This study examined the impact of infertility history (duration of infertility and number of previous ART treatment cycles) on the emotional adjustment of couples undergoing an ART cycle and the mediating effect of importance of parenthood on that association. In this cross-sectional study, 70 infertile couples (70 women and 70 men) completed self-report questionnaires assessing emotional adjustment and infertility stress during the hormonal stimulation phase of an ART cycle. Path models accounting for the dyadic nature of the data examined the direct and indirect effects (by affecting representations about parenthood and childlessness) of infertility history on emotional adjustment. The number of previous cycles affected men's, but not women's, emotional adjustment by affecting the representations on the importance of parenthood and of childlessness. Duration of infertility had the opposite effect, as couples with longer infertility reported heightened importance of parenthood, which negatively affected their emotional adjustment. Infertility history was associated with emotional adjustment in men and women, although these associations were complex. The results suggest that progression through treatment is harder for those men and women who attribute higher importance to being parents, which is aggravated by longer infertility. What is already known about the subject? Infertility is an unexpected and stressful life event Assisted reproductive treatments (ART) are emotionally demanding What does this study add? The influence of infertility history on adjustment is mediated by the importance of parenthood Men and women are affected by their past history of infertility differently. © 2015 The Authors. British Journal of Health Psychology published by John

The Persian Version of Fertility Adjustment Scale: Psychometric Properties

Directory of Open Access Journals (Sweden)

Asma Tiyuri

2018-05-01

Full Text Available Background Infertility is a common clinical problem. Psychological adjustment to infertility refers to changing the viewpoint and attitude of an infertile person toward infertility problems, treatments and possible outcomes. The present study aims to prepare a valid and reliable scale for assessing the psychological adjustment to infertility, by determining the cultural adaptation, validity and reliability of the Persian version of the Fertility Adjustment Scale. Materials and Methods This is a cross-sectional study performed to localize and validate the Fertility Adjustment Scale, in which 40 infertile women and 40 healthy subjects (fertile or having children were detected by a gynecolo- gist and the subjects who completed the Fertility Adjustment Scale (FAS questionnaire were recruited. This study had four steps: in the first step, the literature was reviewed, in the second step, the scale was translated, in the third step, the content and construct validity indicators were calculated, and in the fourth step, reliability of the scale was validated. Results The mean (± SE and range of fertility adjustment total scores in the infertile group and the control group were 43.2 (1.2 and 27-57 and 42.3 (1.5 and 18-57, respectively (P=0.623. The content validity was good according to Con- tent Validity Index score (0.7-0.8. A two-component structure was extracted from factor analysis which approximately justifies 52.0% of the cumulative variations. A Cronbach’s alpha value of 0.68 showed moderate reliability. Conclusion The results of this study revealed that the infertility adjustment scale is a useful tool for the analysis of psy- chological reactions towards infertility problems and evaluation of the consequences of treating this social-clinical problem.

The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs*

Science.gov (United States)

Eisenhauer, Philipp; Heckman, James J.; Vytlacil, Edward

2015-01-01

The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college. PMID:26709315

The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs.

Science.gov (United States)

Eisenhauer, Philipp; Heckman, James J; Vytlacil, Edward

2015-04-01

The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college.

Ants avoid superinfections by performing risk-adjusted sanitary care.

Science.gov (United States)

Konrad, Matthias; Pull, Christopher D; Metzler, Sina; Seif, Katharina; Naderlinger, Elisabeth; Grasse, Anna V; Cremer, Sylvia

2018-03-13

Being cared for when sick is a benefit of sociality that can reduce disease and improve survival of group members. However, individuals providing care risk contracting infectious diseases themselves. If they contract a low pathogen dose, they may develop low-level infections that do not cause disease but still affect host immunity by either decreasing or increasing the host's vulnerability to subsequent infections. Caring for contagious individuals can thus significantly alter the future disease susceptibility of caregivers. Using ants and their fungal pathogens as a model system, we tested if the altered disease susceptibility of experienced caregivers, in turn, affects their expression of sanitary care behavior. We found that low-level infections contracted during sanitary care had protective or neutral effects on secondary exposure to the same (homologous) pathogen but consistently caused high mortality on superinfection with a different (heterologous) pathogen. In response to this risk, the ants selectively adjusted the expression of their sanitary care. Specifically, the ants performed less grooming and more antimicrobial disinfection when caring for nestmates contaminated with heterologous pathogens compared with homologous ones. By modulating the components of sanitary care in this way the ants acquired less infectious particles of the heterologous pathogens, resulting in reduced superinfection. The performance of risk-adjusted sanitary care reveals the remarkable capacity of ants to react to changes in their disease susceptibility, according to their own infection history and to flexibly adjust collective care to individual risk.

Antecedents, Consequences, and Mechanisms: On the Longitudinal Interplay Between Academic Self-Enhancement and Psychological Adjustment.

Science.gov (United States)

Dufner, Michael; Reitz, Anne K; Zander, Lysann

2015-10-01

We investigated the reciprocal associations between academic self-enhancement and key indicators of intra- and interpersonal adjustment as well as the role of self-esteem as a mediator. This longitudinal study involved three assessments in a sample of 709 German children and adolescents (Mage  = 11.83; 54% female) over the course of one academic year. We assessed self-reported subjective well-being as an indicator of intrapersonal adjustment and peer-reported popularity as an indicator of interpersonal adjustment. We computed cross-lagged and longitudinal mediational analyses. Academic self-enhancement prospectively predicted high subsequent well-being and popularity. Vice versa, well-being and popularity prospectively predicted high subsequent levels of self-enhancement. High self-esteem mediated the longitudinal associations between self-enhancement and well-being in both directions, but not the links between self-enhancement and popularity. Self-enhancement and adjustment are bidirectionally linked: Self-enhancement entails intrapersonal and interpersonal benefits; at the same time, adjustment in both domains fosters self-enhancement. In terms of intrapersonal, but not interpersonal adjustment, self-esteem seems to serve as a linchpin, accounting for all longitudinal associations. Furthermore, we present evidence indicating that self-enhancement indicators that are based on difference scores (instead of residuals) are problematic and might have led to negatively biased results in the literature. © 2014 Wiley Periodicals, Inc.

Cost-benefit analysis for waste segregation at Lawrence Livermore National Laboratory

International Nuclear Information System (INIS)

1992-02-01

This report presents a cost-benefit analysis for the segregation of mixed, hazardous, and nonhazardous wastes at Lawrence Livermore National Laboratory (LLNL). The cost-benefit analysis was conducted to determine if current waste segregation practices and additional candidates for waste segregation at LLNL might have the potential for significant waste source reduction and annual savings in treatment and disposal costs. In the following cost-benefit analysis, capital costs and recurring costs of waste segregation practices are compared to the economic benefits of savings in treatment and disposal costs. Indirect or overhead costs associated with these wastes are not available and have not been included. Not considered are additional benefits of waste segregation such as decreased potential for liability to LLNL for adverse environmental effects, improved worker safety, and enhanced LLNL image within the community because of environmental improvement. The economic evaluations in this report are presented on a Lab-wide basis. All hazardous wastes generated by a program are turned over to the Hazardous Waste Management (HWM) group, which is responsible for the storage, treatment, or disposal of these wastes and funded funded directly for this work

Benefits for employees with children with ADHD: findings from the Collaborative Employee Benefit Study.

Science.gov (United States)

Perrin, James M; Fluet, Chris; Kuhlthau, Karen A; Anderson, Betsy; Wells, Nora; Epstein, Susan; Allen, Debby; Tobias, Carol

2005-02-01

Parents of most children with attention-deficit hyperactivity disorder (ADHD) are employed. Employers have interest in decreasing employee absenteeism and improving workplace productivity, partly through employee benefits. The authors interviewed employers to (1) determine how they view the needs of employees with children with ADHD and (2) identify benefits that might help employees with children with ADHD. The authors carried out a systematic interview study of mainly family-friendly, large employers in four U.S. urban markets (Boston, Cleveland, Miami, Seattle). Multidisciplinary interview teams used a protocol to gather basic company information, benefit philosophy, current insurance and other employee benefits, and knowledge of ADHD and its impacts on employees. Initially, the interview team and then the larger project team reviewed all protocols for common themes. The authors interviewed staff of 41 employers (human resource managers, work/life program directors, benefits directors). Only 15 of 41 interviewees knew about ADHD, its prevalence, or its effects on parents. They had little knowledge of how differences in managed behavioral health may affect families' access to diagnostic and treatment services for ADHD, although most had experience with primary care management of depression among employees. Employers offer a variety of other benefits, including work/life and employee assistance programs, occasionally providing employees help with caring for a child with a mental health condition, on-site parent training programs, or assistance with child care. Other potentially useful employee benefits include flexible work and leave policies and information and referral services that can link parents with community programs. Although employers have limited awareness of ADHD and its potential effect on employees' work, this study identified opportunities to improve both health insurance and other benefits for employees with children with ADHD.

Use of the adjustable trans-obturator male sling system for the ...

African Journals Online (AJOL)

M.S. El Badry

2016-03-25

Mar 25, 2016 ... procedure for the treatment of male urinary incontinence. It has the advantage of ... However, a lack of postoperative adjustment and the risk of dis- location of the ... of male SUI due to different etiological factors. Subjects and ...

Applied behavior analysis programs for autism: sibling psychosocial adjustment during and following intervention use.

Science.gov (United States)

Cebula, Katie R

2012-05-01

Psychosocial adjustment in siblings of children with autism whose families were using a home-based, applied behavior analysis (ABA) program was compared to that of siblings in families who were not using any intensive autism intervention. Data gathered from parents, siblings and teachers indicated that siblings in ABA families experienced neither significant drawbacks nor benefits in terms of their behavioral adjustment, sibling relationship quality and self-concept compared to control group siblings, either during or following intervention use. Parents and siblings perceived improvements in sibling interaction since the outset of ABA, with parents somewhat more positive in their views than were siblings. Social support was associated with better sibling outcomes in all groups. Implications for supporting families using ABA are considered.

The economic benefit of treating subclinical Streptococcus agalactiae mastitis in lactating cows.

Science.gov (United States)

Yamagata, M; Goodger, W J; Weaver, L; Franti, C

1987-12-15

The economic benefits of treating lactating cows for Streptococcus agalactiae mastitis were studied at a large (689 milking cows) central California dairy. Postcure milk production of case cows (infected, treated, and cured) was compared with production of paired control cows (uninfected) and was matched for yield, days in milk, days in gestation, and parity. A simulation was used to plot expected lactation curves for mastitic cows (infected, not treated) with characteristics similar to those of each control cow, and these curves were compared with actual case-cow lactation curves. The difference in actual and expected production was used to calculate net economic benefits of treatment. Comparison of expected with actual production indicated a net benefit from treatment of $396/cow for cows treated in early lactation and $237 for cows treated in midlactation, but a net loss of $55 for cows treated in late lactation. Lactation number did not have a significant impact on economic benefits of treatment. In contrast to other studies indicating no economic benefit from treating mastitis during lactation, this study's positive results may have been attributable to the high cure rate (98%) and the subclinical form of mastitis being treated. Streptococcus agalactiae mastitis treatment during early and midlactation would appear to be an economically justifiable option for dairy managers.

Metric-adjusted skew information

DEFF Research Database (Denmark)

Liang, Cai; Hansen, Frank

2010-01-01

on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 ...We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... of (unbounded) metric-adjusted skew information....

ADJUSTABLE CHIP HOLDER

DEFF Research Database (Denmark)

2009-01-01

An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

Improvement of the cost-benefit analysis algorithm for high-rise construction projects

Directory of Open Access Journals (Sweden)

Gafurov Andrey

2018-01-01

Full Text Available The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the “Project analysis scenario” flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

Improvement of the cost-benefit analysis algorithm for high-rise construction projects

Science.gov (United States)

Gafurov, Andrey; Skotarenko, Oksana; Plotnikov, Vladimir

2018-03-01

The specific nature of high-rise investment projects entailing long-term construction, high risks, etc. implies a need to improve the standard algorithm of cost-benefit analysis. An improved algorithm is described in the article. For development of the improved algorithm of cost-benefit analysis for high-rise construction projects, the following methods were used: weighted average cost of capital, dynamic cost-benefit analysis of investment projects, risk mapping, scenario analysis, sensitivity analysis of critical ratios, etc. This comprehensive approach helped to adapt the original algorithm to feasibility objectives in high-rise construction. The authors put together the algorithm of cost-benefit analysis for high-rise construction projects on the basis of risk mapping and sensitivity analysis of critical ratios. The suggested project risk management algorithms greatly expand the standard algorithm of cost-benefit analysis in investment projects, namely: the "Project analysis scenario" flowchart, improving quality and reliability of forecasting reports in investment projects; the main stages of cash flow adjustment based on risk mapping for better cost-benefit project analysis provided the broad range of risks in high-rise construction; analysis of dynamic cost-benefit values considering project sensitivity to crucial variables, improving flexibility in implementation of high-rise projects.

Data analysis-based autonomic bandwidth adjustment in software defined multi-vendor optical transport networks.

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Li, Yajie; Zhao, Yongli; Zhang, Jie; Yu, Xiaosong; Jing, Ruiquan

2017-11-27

Network operators generally provide dedicated lightpaths for customers to meet the demand for high-quality transmission. Considering the variation of traffic load, customers usually rent peak bandwidth that exceeds the practical average traffic requirement. In this case, bandwidth provisioning is unmetered and customers have to pay according to peak bandwidth. Supposing that network operators could keep track of traffic load and allocate bandwidth dynamically, bandwidth can be provided as a metered service and customers would pay for the bandwidth that they actually use. To achieve cost-effective bandwidth provisioning, this paper proposes an autonomic bandwidth adjustment scheme based on data analysis of traffic load. The scheme is implemented in a software defined networking (SDN) controller and is demonstrated in the field trial of multi-vendor optical transport networks. The field trial shows that the proposed scheme can track traffic load and realize autonomic bandwidth adjustment. In addition, a simulation experiment is conducted to evaluate the performance of the proposed scheme. We also investigate the impact of different parameters on autonomic bandwidth adjustment. Simulation results show that the step size and adjustment period have significant influences on bandwidth savings and packet loss. A small value of step size and adjustment period can bring more benefits by tracking traffic variation with high accuracy. For network operators, the scheme can serve as technical support of realizing bandwidth as metered service in the future.

A Bayesian approach to probabilistic sensitivity analysis in structured benefit-risk assessment.

Science.gov (United States)

Waddingham, Ed; Mt-Isa, Shahrul; Nixon, Richard; Ashby, Deborah

2016-01-01

Quantitative decision models such as multiple criteria decision analysis (MCDA) can be used in benefit-risk assessment to formalize trade-offs between benefits and risks, providing transparency to the assessment process. There is however no well-established method for propagating uncertainty of treatment effects data through such models to provide a sense of the variability of the benefit-risk balance. Here, we present a Bayesian statistical method that directly models the outcomes observed in randomized placebo-controlled trials and uses this to infer indirect comparisons between competing active treatments. The resulting treatment effects estimates are suitable for use within the MCDA setting, and it is possible to derive the distribution of the overall benefit-risk balance through Markov Chain Monte Carlo simulation. The method is illustrated using a case study of natalizumab for relapsing-remitting multiple sclerosis. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The 4C framework for making reasonable adjustments for people with learning disabilities.

Science.gov (United States)

Marsden, Daniel; Giles, Rachel

2017-01-18

Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of

Cardiovascular Benefits of Dark Chocolate?

Science.gov (United States)

Higginbotham, Erin; Taub, Pam R

2015-12-01

The use of cacao for health benefits dates back at least 3000 years. Our understanding of cacao has evolved with modern science. It is now felt based on extensive research the main health benefits of cacao stem from epicatechin, a flavanol found in cacao. The process of manufacturing dark chocolate retains epicatechin, whereas milk chocolate does not contain significant amounts of epicatechin. Thus, most of the current research studies are focused on dark chocolate. Both epidemiological and clinical studies suggest a beneficial effect of dark chocolate on blood pressure, lipids, and inflammation. Proposed mechanisms underlying these benefits include enhanced nitric oxide bioavailability and improved mitochondrial structure/function. Ultimately, further studies of this promising compound are needed to elucidate its potential for prevention and treatment of cardiovascular and metabolic diseases as well as other diseases that have underlying mechanisms of mitochondrial dysfunction and nitric oxide deficiency.

Sustained Benefits of Exercise-based Motivational Interviewing, but Only among Nonusers of Opioids in Patients with Fibromyalgia.

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Kim, Sunghye; Slaven, James E; Ang, Dennis C

2017-04-01

Given the known side effects of opioids and their potential effects on cognition, we sought to evaluate the benefits of motivational interviewing (MI) to promote physical activity on 2 subsets of participants with fibromyalgia (FM): nonusers and users of opioids. This was a secondary data analysis of a 36-week randomized controlled trial to assess the efficacy of MI to promote physical activity among participants with FM. Participants were randomized to 1 of 2 treatment arms: 6 phone-based MI sessions (n = 107) or 6 sessions of FM self-management instructions [attention control (AC), n = 109]. The primary outcomes were changes in physical function (Medical Outcomes Study Short Form-36), pain severity (Brief Pain Inventory), global FM symptom severity (Fibromyalgia Impact Questionnaire), and the amount of light to moderate physical activity (LMPA) from baseline to each followup visit. At study entry, subjects were categorized as opioid nonusers versus users. Repeated measures ANOVA was used to assess treatment effects adjusting for potential confounders. Of the 216 participants, 145 (67%) were nonusers and 71 (33%) were opioid users. Among nonusers, MI was associated with improved physical function, reduced pain severity, and global FM severity, and increased LMPA at 6-month followup. Among opioid users, there were no significant differences in any outcome measures between the MI and AC groups. Exercise-based MI was associated with sustained clinical benefits 6 months after completion of therapy, but only for those who were not taking opioids.

Evaluating the UK and Dutch defined benefit policies using the holistic balance sheet framework

NARCIS (Netherlands)

Chen, Z.; Pelsser, A.; Ponds, E.H.M.

This paper compares the UK and Dutch occupational defined-benefit pension policies using the holistic balance sheet (HBS) framework. The UK DB pension system differs from the Dutch one in terms of the steering tools and adjustment mechanisms. In addition to the sponsor guarantee, the UK system has

Intensified multifactorial treatment of patients with Type 2 diabetes

DEFF Research Database (Denmark)

Pedersen, Oluf

2009-01-01

By influencing the standards of diabetes care and treatment guidelines throughout the world, the results of recent long-term risk factor interventions in Type 2 diabetes (T2D) have likely contributed to the improved health outcomes and induced a decline in mortality in people with T2D. Although we...... have a need for even more evidence to support early, individualized, and intensive management of all known modifiable risk factors, we have now reached an era in T2D care where the critical challenges appear to be to translate the insights, knowledge and benefits to patients in the community setting....... Current surveys show slow progress in achieving treatment goals and in the use of recommended drugs and adjustments of lifestyle for the prevention of vascular complications in diabetes. The resistance and barriers among medical professionals and patients likely have multiple causes. The present review...

Occlusal adjustment using the bite plate-induced occlusal position as a reference position for temporomandibular disorders: a pilot study

Directory of Open Access Journals (Sweden)

Chiwata Ichiro

2010-03-01

Full Text Available Abstract Background Many researchers have not accepted the use of occlusal treatments for temporomandibular disorders (TMDs. However, a recent report described a discrepancy between the habitual occlusal position (HOP and the bite plate-induced occlusal position (BPOP and discussed the relation of this discrepancy to TMD. Therefore, the treatment outcome of evidence-based occlusal adjustments using the bite plate-induced occlusal position (BPOP as a muscular reference position should be evaluated in patients with TMD. Methods The BPOP was defined as the position at which a patient voluntarily closed his or her mouth while sitting in an upright posture after wearing an anterior flat bite plate for 5 minutes and then removing the plate. Twenty-one patients with TMDs underwent occlusal adjustment using the BPOP. The occlusal adjustments were continued until bilateral occlusal contacts were obtained in the BPOP. The treatment outcomes were evaluated using the subjective dysfunction index (SDI and the Helkimo Clinical Dysfunction Index (CDI before and after the occlusal adjustments; the changes in these two indices between the first examination and a one-year follow-up examination were then analyzed. In addition, the difference between the HOP and the BPOP was three-dimensionally measured before and after the treatment. Results The percentage of symptom-free patients after treatment was 86% according to the SDI and 76% according to the CDI. The changes in the two indices after treatment were significant (p 0.1. Conclusion Although the results of the present study should be confirmed in other studies, a randomized clinical trial examining occlusal adjustments using the BPOP as a reference position appears to be warranted.

Repatriation Adjustment: Literature Review

Directory of Open Access Journals (Sweden)

Gamze Arman

2009-12-01

Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

Metabolic adjustments with the development, treatment, and recurrence of obesity in obesity-prone rats.

Science.gov (United States)

MacLean, Paul S; Higgins, Janine A; Johnson, Ginger C; Fleming-Elder, Brooke K; Peters, John C; Hill, James O

2004-08-01

Obesity is reaching epidemic proportions and predisposes afflicted individuals to several comorbidities. For these individuals, losing weight has proven to be an easier feat than maintaining a reduced weight. In obesity-prone rats, we examined if there is a metabolic propensity to regain weight after a period of significant weight loss. Twenty-four-hour energy expenditure (EE), sleeping metabolic rate (SMR), and nonprotein respiratory quotient (NPRQ) were obtained by indirect calorimetry with urinary nitrogen analysis and normalized to fat mass (FM) and fat-free mass (FFM) acquired by dual-energy X-ray absorptiometry. Obesity-prone rats were examined after free access to a high-fat diet for 16 wk to establish the obese state. They were again examined after 2 wk of calorie restriction, which reduced body weight (14%) and FM (32%). Rats were again examined after a further 8 wk of intake-regulated weight maintenance or ad libitum feeding that led to weight regain. Metabolic data were compared with preobese and age-matched controls. Weight loss suppressed EE and SMR beyond what was expected for the change in metabolic mass. This elevated metabolic efficiency persisted throughout weight maintenance but resolved after 8 wk of regain. Adjusted NPRQ values were elevated in weight-maintained and weight-regaining rats, suggesting a preference for carbohydrate utilization. These data support the concept that weight reduction in obesity is accompanied by metabolic adjustments beyond the drive to consume calories that predispose to weight regain, and some aspects of this adjustment persist with prolonged weight maintenance and during weight regain.

Relationship on the Relational Benefit Effect of Oil Products on Customer Satisfaction

Directory of Open Access Journals (Sweden)

Jing Muxue

2017-01-01

Full Text Available In order to find out the relationship of relational benefit effect of oil products on customer satisfaction, the local fractional algorithm is proposed in this paper for data analysis. It is investigated the adjustment effect of alternative brand competitiveness and customer characteristics to this mechanism. The results show that the proposed algorithm can thus improve overall system performance substantially.

The economic benefits of reducing physical inactivity: an Australian example

Directory of Open Access Journals (Sweden)

Cumming Toby B

2011-09-01

Full Text Available Abstract Background Physical inactivity has major impacts on health and productivity. Our aim was to estimate the health and economic benefits of reducing the prevalence of physical inactivity in the 2008 Australian adult population. The economic benefits were estimated as 'opportunity cost savings', which represent resources utilized in the treatment of preventable disease that are potentially available for re-direction to another purpose from fewer incident cases of disease occurring in communities. Methods Simulation models were developed to show the effect of a 10% feasible, reduction target for physical inactivity from current Australian levels (70%. Lifetime cohort health benefits were estimated as fewer incident cases of inactivity-related diseases; deaths; and Disability Adjusted Life Years (DALYs by age and sex. Opportunity costs were estimated as health sector cost impacts, as well as paid and unpaid production gains and leisure impacts from fewer disease events associated with reduced physical inactivity. Workforce production gains were estimated by comparing surveyed participation and absenteeism rates of physically active and inactive adults, and valued using the friction cost approach. The impact of an improvement in health status on unpaid household production and leisure time were modeled from time use survey data, as applied to the exposed and non-exposed population subgroups and valued by suitable proxy. Potential costs associated with interventions to increase physical activity were not included. Multivariable uncertainty analyses and univariate sensitivity analyses were undertaken to provide information on the strength of the conclusions. Results A 10% reduction in physical inactivity would result in 6,000 fewer incident cases of disease, 2,000 fewer deaths, 25,000 fewer DALYs and provide gains in working days (114,000, days of home-based production (180,000 while conferring a AUD96 million reduction in health sector costs

Sleep benefit in Parkinson's disease: time to revive an enigma?

Science.gov (United States)

van Gilst, Merel M; Louter, Maartje; Baumann, Christian R; Bloem, Bastiaan R; Overeem, Sebastiaan

2012-01-01

Some patients with Parkinson's disease (PD) reportedly experience 'sleep benefit': an improved motor functioning upon awaking in the morning. In this questionnaire study, 114 out of 243 consecutive outpatients with PD (46.9%) subjectively experienced sleep benefit. Among those patients that regularly took an afternoon nap, 33.7% experienced sleep benefit after the nap as well. Between patients with and without sleep benefit, there were no differences in demographic or clinical variables, including age, disease duration, dopaminergic treatment, and nocturnal sleep quality. Sleep benefit remains an intriguing but elusive phenomenon, which deserves renewed attention and further research.

Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models.

Science.gov (United States)

Eaton, Jeffrey W; Menzies, Nicolas A; Stover, John; Cambiano, Valentina; Chindelevitch, Leonid; Cori, Anne; Hontelez, Jan A C; Humair, Salal; Kerr, Cliff C; Klein, Daniel J; Mishra, Sharmistha; Mitchell, Kate M; Nichols, Brooke E; Vickerman, Peter; Bakker, Roel; Bärnighausen, Till; Bershteyn, Anna; Bloom, David E; Boily, Marie-Claude; Chang, Stewart T; Cohen, Ted; Dodd, Peter J; Fraser, Christophe; Gopalappa, Chaitra; Lundgren, Jens; Martin, Natasha K; Mikkelsen, Evelinn; Mountain, Elisa; Pham, Quang D; Pickles, Michael; Phillips, Andrew; Platt, Lucy; Pretorius, Carel; Prudden, Holly J; Salomon, Joshua A; van de Vijver, David A M C; de Vlas, Sake J; Wagner, Bradley G; White, Richard G; Wilson, David P; Zhang, Lei; Blandford, John; Meyer-Rath, Gesine; Remme, Michelle; Revill, Paul; Sangrujee, Nalinee; Terris-Prestholt, Fern; Doherty, Meg; Shaffer, Nathan; Easterbrook, Philippa J; Hirnschall, Gottfried; Hallett, Timothy B

2014-01-01

New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. We used several independent mathematical models in four settings-South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP. In South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per μL or less ranged from $237 to $1691 per

Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.

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Najafzadeh, M; Kim, S C; Patterson, C; Schneeweiss, S; Katz, J N; Brick, G W; Ready, J E; Polinski, J M; Patorno, E

2015-10-26

The 9th edition of the American College of Chest Physicians' Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk-benefit ratio of "patient-important" outcomes. However, little is known about patients' perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients' understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery. A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women's Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method. Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their

Do elderly patients benefit from surgery in addition to radiotherapy for treatment of metastatic spinal cord compression?

International Nuclear Information System (INIS)

Rades, D.; Huttenlocher, S.; Evers, J.N.; Bajrovic, A.; Karstens, J.H.; Rudat, V.; Schild, S.E.

2012-01-01

Treatment of elderly cancer patients has gained importance. One question regarding the treatment of metastatic spinal cord compression (MSCC) is whether elderly patients benefit from surgery in addition to radiotherapy? In attempting to answer this question, we performed a matched-pair analysis comparing surgery followed by radiotherapy to radiotherapy alone. Data from 42 elderly (age > 65 years) patients receiving surgery plus radiotherapy (S + RT) were matched to 84 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for ten potential prognostic factors and compared regarding motor function, local control, and survival. Additional matched-pair analyses were performed for the subgroups of patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS, n = 81) and receiving laminectomy (LE, n = 45). Improvement of motor function occurred in 21% after S + RT and 24% after RT (p = 0.39). The 1-year local control rates were 81% and 91% (p = 0.44), while the 1-year survival rates were 46% and 39% (p = 0.71). In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred in 22% after DDSS + RT and 24% after RT alone (p = 0.92). The 1-year local control rates were 95% and 89% (p = 0.62), and the 1-year survival rates were 54% and 43% (p = 0.30). In the matched-pair analysis of patients receiving LE, improvement of motor function occurred in 20% after LE + RT and 23% after RT alone (p = 0.06). The 1-year local control rates were 50% and 92% (p = 0.33). The 1-year survival rates were 32% and 32% (p = 0.55). Elderly patients with MSCC did not benefit from surgery in addition to radiotherapy regarding functional outcome, local control of MSCC, or survival. (orig.)

HIV Treatment and Prevention: A Simple Model to Determine Optimal Investment.

Science.gov (United States)

Juusola, Jessie L; Brandeau, Margaret L

2016-04-01

To create a simple model to help public health decision makers determine how to best invest limited resources in HIV treatment scale-up and prevention. A linear model was developed for determining the optimal mix of investment in HIV treatment and prevention, given a fixed budget. The model incorporates estimates of secondary health benefits accruing from HIV treatment and prevention and allows for diseconomies of scale in program costs and subadditive benefits from concurrent program implementation. Data sources were published literature. The target population was individuals infected with HIV or at risk of acquiring it. Illustrative examples of interventions include preexposure prophylaxis (PrEP), community-based education (CBE), and antiretroviral therapy (ART) for men who have sex with men (MSM) in the US. Outcome measures were incremental cost, quality-adjusted life-years gained, and HIV infections averted. Base case analysis indicated that it is optimal to invest in ART before PrEP and to invest in CBE before scaling up ART. Diseconomies of scale reduced the optimal investment level. Subadditivity of benefits did not affect the optimal allocation for relatively low implementation levels. The sensitivity analysis indicated that investment in ART before PrEP was optimal in all scenarios tested. Investment in ART before CBE became optimal when CBE reduced risky behavior by 4% or less. Limitations of the study are that dynamic effects are approximated with a static model. Our model provides a simple yet accurate means of determining optimal investment in HIV prevention and treatment. For MSM in the US, HIV control funds should be prioritized on inexpensive, effective programs like CBE, then on ART scale-up, with only minimal investment in PrEP. © The Author(s) 2015.

MRI-only treatment planning: benefits and challenges

Science.gov (United States)

Owrangi, Amir M.; Greer, Peter B.; Glide-Hurst, Carri K.

2018-03-01

Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in the accuracy of target delineation in MRI-guided radiation therapy may improve clinical outcomes in a variety of cancer types. However, some considerations should be recognized including patient motion during image acquisition and geometric accuracy of images. Moreover, MR-compatible immobilization devices need to be used when acquiring images in the treatment position while minimizing patient motion during the scan time. Finally, synthetic CT images (i.e. electron density maps) and digitally reconstructed radiograph images should be generated from MRI images for dose calculation and image guidance prior to treatment. A short review of the concepts and techniques that have been developed for implementation of MRI-only workflows in radiation therapy is provided in this document.

Ketogenic diet effects on cognition, mood, and psychosocial adjustment in children

NARCIS (Netherlands)

Lambrechts, D.A.; Bovens, M.J.; Parra, de la N.; Hendriksen, J.G.M.; Aldenkamp, A.P.; Majoie, H.J.M.

2013-01-01

Introduction The ketogenic diet (KD) is increasingly used for the treatment of refractory epilepsy. The aim of this study was to evaluate possible adverse effects of the diet on cognition, behavior, psychosocial adjustment, and quality of life in school-aged children and adolescents. Method Fifteen

Belgium: risk adjustment and financial responsibility in a centralised system.

Science.gov (United States)

Schokkaert, Erik; Van de Voorde, Carine

2003-07-01

Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same time the sickness funds have powerful tools for risk selection, because they also dominate the market for supplementary health insurance. The present risk-adjustment system is based on the results of a regression analysis with aggregate data. The main proclaimed purpose of this system is to guarantee a fair treatment to all the sickness funds. Until now the danger of risk selection has not been taken seriously. Consumer mobility has remained rather low. However, since the degree of financial responsibility is programmed to increase in the near future, the potential profits from cream skimming will increase.

Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma

International Nuclear Information System (INIS)

Ludwig, Johannes M.; Xing, Minzhi; Zhang, Di; Kim, Hyun S.

2017-01-01

To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 ( 90 Y)-radioembolization for hepatocellular carcinoma (HCC). Studies comparing conventional (c)TACE versus 90 Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus 90 Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests. Fourteen studies comparing DEB-TACE or 90 Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over 90 Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate. DEB-TACE and 90 Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to 90 Y-radioembolization but direct comparison is warranted for further evaluation. (orig.)

Development of the measure of ovarian symptoms and treatment concerns: aiming for optimal measurement of patient-reported symptom benefit with chemotherapy for symptomatic ovarian cancer.

Science.gov (United States)

King, Madeleine T; Stockler, Martin R; Butow, Phyllis; O'Connell, Rachel; Voysey, Merryn; Oza, Amit M; Gillies, Kim; Donovan, Heidi S; Mercieca-Bebber, Rebecca; Martyn, Julie; Sjoquist, Katrin; Friedlander, Michael L

2014-06-01

The aim of this study was to determine the optimal patient-reported outcome measure (PROM) for assessing symptom benefit in trials of palliative chemotherapy for women with symptomatic ovarian cancer. Candidate PROMs were EORTC QLQ-C30 plus ovarian-specific QLQ-OV28, Functional Assessment of Cancer Therapy-Ovarian (FACT-O), FACT Ovarian Symptom Index (FOSI), and gynecologic cancer-specific Symptom Representation Questionnaire. Predefined optimality criteria were inclusion of all symptoms necessary for the specified purpose, recall period covering typical length of palliative chemotherapy, numerical item rating scales, and all necessary symptoms included in a single symptom index. Qualitative and quantitative methods were applied to data from stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study to determine the set of necessary symptoms and to objectively assess candidate PROMs against the optimality criteria. Ten necessary symptoms were identified: pain, fatigue, abdominal bloating/discomfort, sleep disturbance, bowel disturbance, nausea and vomiting, shortness of breath, poor appetite, urinary symptoms, and weight changes. Although QLQ-C30 and QLQ-OV28 together cover all these symptoms, they split them into numerous scales, dissipating potential symptom-benefit signal. Conversely, FACT-O does not cover all necessary symptoms and contains many other HRQoL-related items and treatment side effects, diluting potential symptom-benefit signal when summed into scales. Item response scales and composite scoring of all candidate PROMs were suboptimal to our specific purpose. We therefore developed a new PROM, the Measure of Ovarian Symptoms and Treatment (MOST) concerns, to provide optimal measurement for the specified purpose. This article documents the development of the MOST, a new PROM designed to assess patient-reported benefits and burden as end points in clinical trials of palliative chemotherapy for women with symptomatic ovarian cancer. The validity

Cost-benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.

Science.gov (United States)

Bergevin, Anna; Zick, Cathleen D; McVicar, Stephanie Browning; Park, Albert H

2015-12-01

In this study, we estimate an ex ante cost-benefit analysis of a Utah law directed at improving early cytomegalovirus (CMV) detection. We use a differential cost of treatment analysis for publicly insured CMV-infected infants detected by a statewide hearing-directed CMV screening program. Utah government administrative data and multi-hospital accounting data are used to estimate and compare costs and benefits for the Utah infant population. If antiviral treatment succeeds in mitigating hearing loss for one infant per year, the public savings will offset the public costs incurred by screening and treatment. If antiviral treatment is not successful, the program represents a net cost, but may still have non-monetary benefits such as accelerated achievement of diagnostic milestones. The CMV education and treatment program costs are modest and show potential for significant cost savings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Social Security cost-of-living adjustments and the Consumer Price Index.

Science.gov (United States)

Burdick, Clark; Fisher, Lynn

2007-01-01

OASDI benefits are indexed for inflation to protect beneficiaries from the loss of purchasing power implied by inflation. In the absence of such indexing, the purchasing power of Social Security benefits would be eroded as rising prices raise the cost of living. By statute, cost-of-living adjustments (COLAs) for Social Security benefits are calculated using the Bureau of Labor Statistics (BLS) Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). Some argue that this index does not accurately reflect the inflation experienced by the elderly population and should be changed to an elderly-specific price index such as the Experimental Consumer Price Index for Americans 62 Years of Age and Older, often referred to as the Consumer Price Index for the Elderly (CPI-E). Others argue that the measure of inflation underlying the COLA is technically biased, causing it to overestimate changes in the cost of living. This argument implies that current COLAs tend to increase, rather than merely maintain, the purchasing power of benefits over time. Potential bias in the CPI as a cost-of-living index arises from a number of sources, including incomplete accounting for the ability of consumers to substitute goods or change purchasing outlets in response to relative price changes. The BLS has constructed a new index called the Chained Consumer Price Index for All Urban Consumers (C-CPI-U) that better accounts for those consumer adjustments. Price indexes are not true cost-of-living indexes, but approximations of cost-of-living indexes (COLI). The Bureau of Labor Statistics (2006a) explains the difference between the two: As it pertains to the CPI, the COLI for the current month is based on the answer to the following question: "What is the cost, at this month ' market prices, of achieving the standard of living actually attained in the base period?" This cost is a hypothetical expenditure-the lowest expenditure level necessary at this month's prices to achieve the

p95HER2 Methionine 611 Carboxy-Terminal Fragment Is Predictive of Trastuzumab Adjuvant Treatment Benefit in the FinHer Trial.

Science.gov (United States)

Sperinde, Jeff; Huang, Weidong; Vehtari, Aki; Chenna, Ahmed; Kellokumpu-Lehtinen, Pirkko-Liisa; Winslow, John; Bono, Petri; Lie, Yolanda S; Petropoulos, Christos J; Weidler, Jodi; Joensuu, Heikki

2018-03-13

Purpose: Expression of p95HER2 (p95), a truncated form of the HER2 receptor, which lacks the trastuzumab binding site but retains kinase activity, has been reported as a prognostic biomarker for poor outcomes in patients with trastuzumab-treated HER2-positive metastatic breast cancer. The impact of p95 expression on trastuzumab treatment efficacy in early HER2-positive breast cancer is less clear. In the current study, p95 was tested as a predictive marker of trastuzumab treatment benefit in the HER2-positive subset of the FinHer adjuvant phase III trial. Experimental Design: In the FinHer trial, 232 patients with HER2-positive early breast cancer were randomized to receive chemotherapy plus 9 weeks of trastuzumab or no trastuzumab treatment. Quantitative p95 protein expression was measured in formalin-fixed paraffin-embedded samples using the p95 VeraTag assay (Monogram Biosciences), specific for the M611 form of p95. Quantitative HER2 protein expression was measured using the HERmark assay (Monogram Biosciences). Distant disease-free survival (DDFS) was used as the primary outcome measure. Results: In the arm receiving chemotherapy only, increasing log 10 (p95) correlated with shorter DDFS (HR, 2.0; P = 0.02). In the arm receiving chemotherapy plus trastuzumab ( N = 95), increasing log 10 (p95) was not correlated with a shorter DDFS. In a combined analysis of both treatment arms, high breast tumor p95 content was significantly correlated with trastuzumab treatment benefit in multivariate models (interaction P = 0.01). Conclusions: A high p95HER2/HER2 ratio identified patients with metastatic breast cancer with poor outcomes on trastuzumab-based therapies. Further investigation of the p95HER2/HER2 ratio as a potential prognostic or predictive biomarker for HER2-targeted therapy is warranted. Clin Cancer Res; 1-7. ©2018 AACR. ©2018 American Association for Cancer Research.

Symptom and Problem Focused Coping Strategies of Business Women Expatriates and their Socio-Cultural Adjustment in Hong Kong

DEFF Research Database (Denmark)

Selmer, Jan; Leung, Alicia S.M.

2007-01-01

strategies may make them less well adjusted to a host location. Originality/value - Women still represent a relatively untapped source for expatriation and the research on female business expatriates is still inadequate in many respects.  An important issue examined by this study is how women cope......Purpose - The purpose of this study is to explore coping strategies of female business expatriates and to examine how these strategies are associated with the women's international adjustment. Design/methodology/approach - Data were collected through mail surveys to Western female business...... in Hong Kong could have contributed to the unanticipated findings that there was no association between problem focused coping strategies and any type of adjustment studied. Through cross-cultural training, female business expatriates could benefit from being informed that applying symptom focused coping...

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries.

Science.gov (United States)

Kahan, Brennan C; Koulenti, Desponia; Arvaniti, Kostoula; Beavis, Vanessa; Campbell, Douglas; Chan, Matthew; Moreno, Rui; Pearse, Rupert M

2017-07-01

As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p analysis including only high-risk patients yielded similar findings. We did not identify any survival benefit from critical care admission following surgery.

Faraday cup with nanosecond response and adjustable impedance for fast electron beam characterization

International Nuclear Information System (INIS)

Hu Jing; Rovey, Joshua L.

2011-01-01

A movable Faraday cup design with simple structure and adjustable impedance is described in this work. This Faraday cup has external adjustable shunt resistance for self-biased measurement setup and 50 Ω characteristic impedance to match with 50 Ω standard BNC coaxial cable and vacuum feedthroughs for nanosecond-level pulse signal measurements. Adjustable shunt resistance allows self-biased measurements to be quickly acquired to determine the electron energy distribution function. The performance of the Faraday cup is validated by tests of response time and amplitude of output signal. When compared with a reference source, the percent difference of the Faraday cup signal fall time is less than 10% for fall times greater than 10 ns. The percent difference of the Faraday cup signal pulse width is below 6.7% for pulse widths greater than 10 ns. A pseudospark-generated electron beam is used to compare the amplitude of the Faraday cup signal with a calibrated F-70 commercial current transformer. The error of the Faraday cup output amplitude is below 10% for the 4-14 kV tested pseudospark voltages. The main benefit of this Faraday cup is demonstrated by adjusting the external shunt resistance and performing the self-biased method for obtaining the electron energy distribution function. Results from a 4 kV pseudospark discharge indicate a ''double-humped'' energy distribution.

Faraday cup with nanosecond response and adjustable impedance for fast electron beam characterization.

Science.gov (United States)

Hu, Jing; Rovey, Joshua L

2011-07-01

A movable Faraday cup design with simple structure and adjustable impedance is described in this work. This Faraday cup has external adjustable shunt resistance for self-biased measurement setup and 50 Ω characteristic impedance to match with 50 Ω standard BNC coaxial cable and vacuum feedthroughs for nanosecond-level pulse signal measurements. Adjustable shunt resistance allows self-biased measurements to be quickly acquired to determine the electron energy distribution function. The performance of the Faraday cup is validated by tests of response time and amplitude of output signal. When compared with a reference source, the percent difference of the Faraday cup signal fall time is less than 10% for fall times greater than 10 ns. The percent difference of the Faraday cup signal pulse width is below 6.7% for pulse widths greater than 10 ns. A pseudospark-generated electron beam is used to compare the amplitude of the Faraday cup signal with a calibrated F-70 commercial current transformer. The error of the Faraday cup output amplitude is below 10% for the 4-14 kV tested pseudospark voltages. The main benefit of this Faraday cup is demonstrated by adjusting the external shunt resistance and performing the self-biased method for obtaining the electron energy distribution function. Results from a 4 kV pseudospark discharge indicate a "double-humped" energy distribution.

The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study.

Science.gov (United States)

Mytton, Oliver T; Jackson, Christopher; Steinacher, Arno; Goodman, Anna; Langenberg, Claudia; Griffin, Simon; Wareham, Nick; Woodcock, James

2018-03-01

being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40-45 years at baseline. Over the life of the cohort (i.e., followed from 40-45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0-4.7) per head of population and increasing survival by 3.3 days (2.5-4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7-6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7-4.0] days; 5.1 [3.4-7.1] additional days lived per head of population versus 3.3 [2.1-4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., 'maximum potential' scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future

Cannabinoid hyperemesis syndrome: potential mechanisms for the benefit of capsaicin and hot water hydrotherapy in treatment.

Science.gov (United States)

Richards, John R; Lapoint, Jeff M; Burillo-Putze, Guillermo

2018-01-01

Cannabinoid hyperemesis syndrome is a clinical disorder that has become more prevalent with increasing use of cannabis and synthetic cannabinoids, and which is difficult to treat. Standard antiemetics commonly fail to alleviate the severe nausea and vomiting characteristic of the syndrome. Curiously, cannabinoid hyperemesis syndrome patients often report dramatic relief of symptoms with hot showers and baths, and topical capsaicin. In this review, we detail the pharmacokinetics and pharmacodynamics of capsaicin and explore possible mechanisms for its beneficial effect, including activation of transient receptor potential vanilloid 1 and neurohumoral regulation. Putative mechanisms responsible for the benefit of hot water hydrotherapy are also investigated. An extensive search of PubMed, OpenGrey, and Google Scholar from inception to April 2017 was performed to identify known and theoretical thermoregulatory mechanisms associated with the endocannabinoid system. The searches resulted in 2417 articles. These articles were screened for relevant mechanisms behind capsaicin and heat activation having potential antiemetic effects. References from the selected articles were also hand-searched. A total of 137 articles were considered relevant and included. Capsaicin: Topical capsaicin is primarily used for treatment of neuropathic pain, but it has also been used successfully in some 20 cases of cannabinoid hyperemesis syndrome. The pharmacokinetics and pharmacodynamics of capsaicin as a transient receptor potential vanilloid 1 agonist may explain this effect. Topical capsaicin has a longer half-life than oral administration, thus its potential duration of benefit is longer. Capsaicin and transient receptor potential vanilloid 1: Topical capsaicin binds and activates the transient receptor potential vanilloid 1 receptor, triggering influx of calcium and sodium, as well as release of inflammatory neuropeptides leading to transient burning, stinging, and itching. This elicits

Benefits and Burdens of Participation in a Longitudinal Clinical Trial

Science.gov (United States)

Lazovski, Jaime; Losso, Marcelo; Krohmal, Benjamin; Emanuel, Ezekiel J.; Grady, Christine; Wendler, David

2010-01-01

systematic data on the impact that longitudinal clinical trials have on patient participants are needed to ensure that all the risks and potential benefits of participating in clinical research are properly evaluated and disclosed. Recognizing the lack of systematic data on this topic, we surveyed 582 individuals from Argentina, Brazil, and Thailand who were participating in the ESPRIT study, a Phase III randomized trial of interleukin-2 in HIV disease. Respondents were asked about the benefits and burdens of participating in ESPRIT using a self-administered survey. We found that 91% of respondents in the IL-2 treatment arm and 79% in the no IL-2 control arm reported medical benefits from their participation. In addition, 68% in the IL-2 treatment arm and 60% of the no IL-2 controls reported non-medical benefits. Thirteen percent of the IL-2 respondents and 5% of the non-IL2 respondents reported problems with their jobs due to study participation. Given that respondents, including those in the control arm, reported medical and non-medical benefits and burdens from their research participation, investigators and review committees should be aware of and respond to the potential for research participants to experience benefits and burdens that are unrelated to the intervention being tested. PMID:19754238

Students' benefits and barriers to mental health help-seeking

Science.gov (United States)

Vidourek, Rebecca A.; King, Keith A.; Nabors, Laura A.; Merianos, Ashley L.

2014-01-01

Stigma is recognized as a potential barrier to seeking help for a mental health disorder. The present study assessed college students' perceived benefits and barriers to obtaining mental health treatment and stigma-related attitudes via a four-page survey. A total of 682 students at one Midwestern university participated in the study. Findings indicated that females perceived a greater number of benefits to having participated in mental health services and held significantly lower stigma-related attitudes than did males. Students who had ever received mental health services reported significantly more barriers to treatment than did students who had never received services. Health professionals should target students with educational programs about positive outcomes related to receiving mental health services and work with treatment centers to reduce barriers for receiving services. PMID:25750831

Economic benefits of methylmercury exposure control in Europe: Monetary value of neurotoxicity prevention

Science.gov (United States)

2013-01-01

Background Due to global mercury pollution and the adverse health effects of prenatal exposure to methylmercury (MeHg), an assessment of the economic benefits of prevented developmental neurotoxicity is necessary for any cost-benefit analysis. Methods Distributions of hair-Hg concentrations among women of reproductive age were obtained from the DEMOCOPHES project (1,875 subjects in 17 countries) and literature data (6,820 subjects from 8 countries). The exposures were assumed to comply with log-normal distributions. Neurotoxicity effects were estimated from a linear dose-response function with a slope of 0.465 Intelligence Quotient (IQ) point reduction per μg/g increase in the maternal hair-Hg concentration during pregnancy, assuming no deficits below a hair-Hg limit of 0.58 μg/g thought to be safe. A logarithmic IQ response was used in sensitivity analyses. The estimated IQ benefit cost was based on lifetime income, adjusted for purchasing power parity. Results The hair-mercury concentrations were the highest in Southern Europe and lowest in Eastern Europe. The results suggest that, within the EU, more than 1.8 million children are born every year with MeHg exposures above the limit of 0.58 μg/g, and about 200,000 births exceed a higher limit of 2.5 μg/g proposed by the World Health Organization (WHO). The total annual benefits of exposure prevention within the EU were estimated at more than 600,000 IQ points per year, corresponding to a total economic benefit between €8,000 million and €9,000 million per year. About four-fold higher values were obtained when using the logarithmic response function, while adjustment for productivity resulted in slightly lower total benefits. These calculations do not include the less tangible advantages of protecting brain development against neurotoxicity or any other adverse effects. Conclusions These estimates document that efforts to combat mercury pollution and to reduce MeHg exposures will have very substantial

Estimating the Costs and Benefits of EMU : The Impact of External Shocks on Labour Markets

NARCIS (Netherlands)

Belke, A.; Gros, D.

1997-01-01

Discussions of the economic costs and benefits of EMU usually take as their basis the optimum currency area (OCA) approach. This approach starts from the premise that when an external shock hits the economy, it is easier to adjust the exchange rate than domestic prices or wages. Most economists

QUANTIFYING BENEFITS FOR COST-BENEFIT ANALYSIS

OpenAIRE

Attila GYORGY; Nicoleta VINTILA; Florian GAMAN

2014-01-01

Cost Benefit Analysis is one of the most widely used financial tools to select future investment projects in public and private sector. This method is based on comparing costs and benefits in terms of constant prices. While costs are easier to predict and monetize, the benefits should be identified not only in direct relation with the investment, but also widening the sphere of analysis to indirect benefits experienced by the community from the neighbourhood or the whole society. During finan...

A systematic review on recurrent respiratory papillomatosis: clinical effect and duration of benefit of different treatment modalities

Directory of Open Access Journals (Sweden)

Elina Kiverniti

2011-12-01

Full Text Available The aim of this study is to compare different modalities used for the treatment of recurrent respiratory papillomatosis (RRP in adults and children in terms of their clinical effect and the duration of benefit. Systematic review of papers was written in the English language and published between 1977 and 2007. Outcomes are number of patients with a clinical response and length of time the response lasted for. We found 28 useful studies. There were 1,045 subjects, 416 children and 339 adults who underwent different treatments for RRP between 1976 and 2007. The methods used consisted of cidofovir, interferon, surgical excision, indole-3-carbinol, acyclovir, mumps vaccine, and photodynamic therapy. 62.5% of patients had a complete response on cidofovir (11 studies, 45.14% on interferon (8 studies, 33.33% on I3C (2 studies, 44.36% after surgery (5 studies, 77.55% after the mumps vaccine (1 study, 100% on acyclovir (1 study, and 9.09% after photodynamic therapy (1 study. The effect of different modalities lasted between 9 and 27 months. In conclusion, it is impossible to reach any reliable conclusions as to which method is the most durable and effective. There is a great need for randomised control multicentre trials on the treatment of RRP, so that reliable results can be produced.

Production benefits from pre- and post-lambing anthelmintic treatment of ewes on commercial farms in the southern North Island of New Zealand.

Science.gov (United States)

Miller, C M; Ganesh, S; Garland, C B; Leathwick, D M

2015-07-01

To measure the magnitude and variability in production responses to anthelmintic treatments administered to adult ewes around lambing. Ewes carrying twin lambs, from sheep and beef farms (eight in Year 1 and six in Year 2) in the Wairarapa region of New Zealand, were enrolled in 14 trials (part of an experiment carried out on one farm in one year). Experiment 1 compared ewes treated 2-4 weeks pre-lambing with a controlled release capsule (CRC) containing abamectin, albendazole, Se and Co, to ewes injected pre-lambing with a long-acting Se plus vitamin B12 product, and to untreated ewes. Experiment 2 included these treatments, plus a CRC administered at pregnancy scanning. Experiment 3 included the same treatments as Experiment 1, plus administration of a CRC containing albendazole, Se and Co, injectable moxidectin or oral derquantel plus abamectin, all administered pre-lambing, or oral derquantel plus abamectin administered 4-6 weeks after lambing. Variables compared were ewe liveweight at weaning and pre-mating, lamb liveweight at weaning, total weight of lamb weaned per ewe and ewe dag score at weaning. Ewes treated with a CRC pre-lambing were heavier than untreated ewes (mean 3.2 kg) at weaning in 12/14 trials, and pre-mating (mean 2.8 kg) in 9/14 trials (pewes the mean difference was 2.8 kg pre-lambing (9/14 trials) and 1.7 kg pre-weaning (6/14 trials). Lambs reared by treated ewes were heavier (mean 1.55 kg) at weaning in 6/14 trials (pewe (p=0.507). Variation in weight of lamb weaned per ewe was largely explained by differences in lamb survival from birth to weaning (p0.65). Treatment of ewes with a CRC at pregnancy scanning was neither better nor worse than a pre-lambing treatment (p=0.065). There was no difference in the response from treatment with either of the two CRC or moxidectin. Treatment with short-acting oral anthelmintics resulted in no consistent benefit. Anthelmintic treatments administered to ewes around lambing resulted in variable responses

A framework for quantifying net benefits of alternative prognostic models

DEFF Research Database (Denmark)

Rapsomaniki, Eleni; White, Ian R; Wood, Angela M

2012-01-01

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit......) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk...... reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple...

The Relationship Between Psychosocial Adjustment and Coping Strategies Among Patients With Multiple Sclerosis in Turkey.

Science.gov (United States)

Okanli, Ayse; Tanriverdi, Derya; Ipek Coban, Gülay; Asi Karakaş, Sibel

Multiple sclerosis (MS) is a disease with significant psychosocial adjustment challenges. The objective of the study was to assess the psychosocial adjustment and coping strategies in patients with MS and to put forth the relationships between them. The sample group comprised 85 outpatients with MS who were admitted to the Neurology Clinic of a university hospital for treatment between October 2007 and July 2008. Data were acquired via an information form and the Psychosocial Adjustment to Illness Scale and Coping Strategy Indicator. It was determined that 55% of the patients had poor psychosocial adjustment levels. Statistically significant relationship was found between Psychosocial Adjustment to Illness Scale-Self-Report and problem solving as well as seeking social support coping strategies ( p Psychosocial adjustment got worse with decreasing problem-solving and seeking-social support coping strategies of patients. The psychosocial adjustment to MS of patients is closely related with effective coping strategies. The results have emphasized the significant role of mental health and social services and coping strategies regarding the comprehensive care needs of these patients.

Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition.

Science.gov (United States)

Israelashvili, Moshe

2012-12-01

The DSM classification of an adjustment disorder is frequently criticized for not being well differentiated from other disorders. A possible reason for this is the vague definition of the term adjustment in social science literature. Hence, the current paper discusses the definition of adjustment and its implications for understanding maladjustment. Differential definitions of the terms adjustment, adaptation, socialization and coping are outlined, leading to the proposition that each one of them represents a different type of demand that is imposed on an individual who encounters a transitional event. Moreover, the four types of demands might be the possible sources of maladjustment. Helping people in transition requires an identification of the source, or combination of sources, that have led to the adjustment problem first, followed by the implementation of an adequate helping approach.

Incomes and Outcomes: Social Security Disability Benefits in First-Episode Psychosis.

Science.gov (United States)

Rosenheck, Robert A; Estroff, Sue E; Sint, Kyaw; Lin, Haiqun; Mueser, Kim T; Robinson, Delbert G; Schooler, Nina R; Marcy, Patricia; Kane, John M

2017-09-01

Social Security Administration (SSA) disability benefits are an important source of income for people with psychoses and confer eligibility for health insurance. The authors examined the impact of coordinated specialty care on receipt of such benefits in first-episode psychosis, along with the correlates and consequences of receiving them. The Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 34-site cluster-randomized trial, compared NAVIGATE, a coordinated specialty care program, to usual community care over 2 years. Receipt of SSA benefits and clinical outcomes were assessed at program entry and every 6 months for 2 years. Piecewise regression analysis was used to identify relative change in outcome trajectories after receipt of disability benefits. Among 399 RAISE-ETP participants, 36 (9%) were receiving SSA disability benefits at baseline; of the remainder, 124 (34.1%) obtained benefits during the 2-year study period. The NAVIGATE intervention improved quality of life, symptoms, and employment but did not significantly reduce the likelihood of receiving SSA disability benefits. Obtaining benefits was predicted by more severe psychotic symptoms and greater dysfunction and was followed by increased total income but fewer days of employment, reduced motivation (e.g., sense of purpose, greater anhedonia), and fewer days of intoxication. A 2-year coordinated specialty care intervention did not reduce receipt of SSA disability benefits. There were some advantages for those who obtained SSA disability benefits over the 2-year treatment period, but there were also some unintended adverse consequences. Providing income supports without impeding recovery remains an important policy challenge.

Benefits in behavioral health carve-out plans of Fortune 500 firms.

Science.gov (United States)

Merrick, E L; Garnick, D W; Horgan, C M; Goldin, D; Hodgkin, D; Sciegaj, M

2001-07-01

This study examined the prevalence and nature of behavioral health carve-out contracts among Fortune 500 firms in 1997. A survey was conducted of 498 companies that were listed as Fortune 500 firms in 1994 or 1995. A total of 336 firms (68 percent) responded to the survey. Univariate analyses were used to analyze prevalence, types, and amounts of covered services, cost sharing, and benefit limits. A total of 132 firms reported contracting with managed behavioral health organizations; 124 firms answered benefits questions about covered services, cost-sharing levels, and annual and lifetime limits. Most of the plans covered a broad range of services. Cost sharing was typically required, and for inpatient care it was often substantial. Fifteen percent of the firms offered mental health benefits that were below the limits defined in this study as minimal benefit levels, and 34 percent offered substance abuse treatment benefits that fell below minimal levels. The most generous mental health benefits and substance abuse treatment benefits, defined as no limits or a lifetime limit only of $1 million or more, were offered by 31 percent and 20 percent of the firms, respectively. The carve-out contracts of the Fortune 500 firms in this study typically covered a wide range of services, and the benefits appeared generous relative to those reported for other integrated and carve-out plans. However, these benefits generally did not reach the level of parity with typical medical benefits, nor did they fully protect enrollees from the risk of catastrophic expenditures.

Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

Directory of Open Access Journals (Sweden)

Anna Barata

Full Text Available OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD on highly active antiretroviral treatment (HAART have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group with 39 HIV-1 infected patients without LD (non-LD group. All participants were on HAART. The Beck Depression Inventory (BDI, the State and Trait Anxiety Inventory (STAI and the Goldberg Health Questionnaire (GHQ-60 were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009 and worse work adjustment (p = 0.019 than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

A structural model for stress, coping, and psychosocial adjustment: A multi-group analysis by stages of survivorship in Korean women with breast cancer.

Science.gov (United States)

Jang, Miyoung; Kim, Jiyoung

2018-04-01

Prospective studies have examined factors directly affecting psychosocial adjustment during breast cancer treatment. Survivorship stage may moderate a direct effect of stress on psychosocial adjustment. This study aimed to examine relationships between stress, social support, self-efficacy, coping, and psychosocial adjustment to construct a model of the effect pathways between those factors, and determine if survivorship stage moderates those effects. Six hundred people with breast cancer completed questionnaires. Examined stages of survivorship after treatment were as follows: acute (i.e., 5 years). Stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), self-efficacy (New General Self Efficacy Scale), coping (Ways of Coping Checklist), and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report-Korean Version) were measured. Self-efficacy significantly correlated with psychosocial adjustment in the acute survival stage (γ = -0.37, P psychosocial adjustment was greater in the acute (γ = -0.42, P psychosocial adjustment was stronger in the lasting survival stage (β = 0.42, P psychosocial adjustment of female breast cancer patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

Educating patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review.

Science.gov (United States)

Gay, C; Chabaud, A; Guilley, E; Coudeyre, E

2016-06-01

Highlight the role of patient education about physical activity and exercise in the treatment of hip and knee osteoarthritis (OA). Systematic literature review from the Cochrane Library, PubMed and Wiley Online Library databases. A total of 125 items were identified, including 11 recommendations from learned societies interested in OA and 45 randomized controlled trials addressing treatment education and activity/exercise for the treatment of hip and knee osteoarthritis. In the end, 13 randomized controlled trials and 8 recommendations were reviewed (1b level of evidence). Based on the analysis, it was clear that education, exercise and weight loss are the pillars of non-pharmacological treatments. These treatments have proven to be effective but require changes in patient behaviour that are difficult to obtain. Exercise and weight loss improve function and reduce pain. Education potentiates compliance to exercise and weight loss programs, thereby improving their long-term benefits. Cost efficiency studies have found a reduction in medical visits and healthcare costs after 12 months because of self-management programs. Among non-surgical treatment options for hip and knee osteoarthritis, the most recent guidelines focus on non-pharmacological treatment. Self-management for general physical activity and exercise has a critical role. Programs must be personalized and adjusted to the patient's phenotype. This development should help every healthcare professional adapt the care they propose to each patient. Registration number for the systematic review: CRD42015032346. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus {sup 90}Y-radioembolization for hepatocellular carcinoma

Energy Technology Data Exchange (ETDEWEB)

Ludwig, Johannes M.; Xing, Minzhi [Yale School of Medicine, Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, New Haven, CT (United States); Zhang, Di [University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (United States); Kim, Hyun S. [Yale School of Medicine, Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, New Haven, CT (United States); Yale School of Medicine, Yale Cancer Center, New Haven, CT (United States)

2017-05-15

To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 ({sup 90}Y)-radioembolization for hepatocellular carcinoma (HCC). Studies comparing conventional (c)TACE versus {sup 90}Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus {sup 90}Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests. Fourteen studies comparing DEB-TACE or {sup 90}Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over {sup 90}Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate. DEB-TACE and {sup 90}Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to {sup 90}Y-radioembolization but direct comparison is warranted for further evaluation. (orig.)

Adjustable Pitot Probe

Science.gov (United States)

Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

1991-01-01

Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

How does the employer contribution for the federal employees health benefits program influence plan selection?

Science.gov (United States)

Florence, Curtis S; Thorpe, Kenneth E

2003-01-01

Market reform of health insurance is proposed to increase coverage and reduce growth in spending by providing an incentive to choose low-cost plans. However, having a choice of plans could result in risk segmentation. Risk-adjusted payments have been proposed to address risk segmentation but are criticized as ineffective. An alternative to risk adjustment is to subsidize premiums, as in the Federal Employees Health Benefits Program (FEHBP). Subsidizing premiums may also increase total premium spending. We find that there is little risk segmentation in the FEHBP and that reducing the premium subsidy would lower government premium spending and slightly increase risk segmentation.

Worksite adjustments and work ability among employed cancer survivors.

Science.gov (United States)

Torp, Steffen; Nielsen, Roy A; Gudbergsson, Sævar B; Dahl, Alv A

2012-09-01

This study was conducted to determine how many cancer survivors (CSs) make worksite adjustments and what kinds of adjustments they make. Changes in work ability among employed CSs were explored, and clinical, sociodemographic, and work-related factors associated with the current total work ability were studied. CSs of the ten most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15-39 months after being diagnosed with cancer. Included in the analyses were all participants who worked both at the time of diagnosis and at the time of the survey and who had not changed their labor force status since diagnosis (n = 563). The current total work ability was compared to the lifetime best (0-10 score). Twenty-six percent of the employed CSs had made adjustments at work, and the most common adjustment was changing the number of work hours per week. Despite the fact that 31% and 23% reported reduced physical and mental work abilities, respectively, more than 90% of the CSs reported that they coped well with their work demands. The mean total work ability score was high (8.6) among both men and women. Being self-employed and working part-time at the time of diagnosis showed significant negative correlations with total work ability, while a favorable psychosocial work environment showed a significant positive correlation. CSs with low work ability were more often in contact with the occupational health service and also made more worksite adjustments than others. The prospects of future work life seem optimistic for Norwegian employed CSs who return to work relatively soon after primary treatment.

The Association of Benefit Finding to Psychosocial and Health Behavior Adaptation Among HIV+ Men and Women

Science.gov (United States)

Littlewood, Rae A.; Vanable, Peter A.; Carey, Michael P.; Blair, Donald C.

2008-01-01

Psychological and behavioral adaptation to HIV is integral to long-term survival. Although most research on coping with HIV has focused on factors associated with poor adaptation, recent research has expanded to include positive concomitants of adaptation, such as benefit finding. This study examined the occurrence of benefit finding among HIV+ men and women and evaluated the potential relevance of benefit finding to positive health behavior and psychosocial adaptation. HIV+ participants (N = 221) recruited during outpatient care completed self-report assessments of benefit finding, social support, depression, HAART adherence, substance use, and physical activity. In a series of multivariate analyses that controlled for demographic and health status variables, benefit finding was associated with lower depression scores, greater social support, and more physical activity, but showed no association to HAART adherence or substance use. The association of benefit finding to depression was partially mediated by differences in social support. Thus, benefit finding may improve psychological adjustment by motivating patients who experience stress-related growth to seek improved social support. PMID:18157689

Context matters: the benefits and costs of expressing positive emotion among survivors of childhood sexual abuse.

Science.gov (United States)

Bonanno, George A; Colak, Deniz M; Keltner, Dacher; Shiota, Michelle N; Papa, Anthony; Noll, Jennie G; Putnam, Frank W; Trickett, Penelope K

2007-11-01

Positive emotions promote adjustment to aversive life events. However, evolutionary theory and empirical research on trauma disclosure suggest that in the context of stigmatized events, expressing positive emotions might incur social costs. To test this thesis, the authors coded genuine (Duchenne) smiling and laughter and also non-Duchenne smiling from videotapes of late-adolescent and young adult women, approximately half with documented histories of childhood sexual abuse (CSA), as they described the most distressing event of their lives. Consistent with previous studies, genuine positive emotional expression was generally associated with better social adjustment two years later. However, as anticipated, CSA survivors who expressed positive emotion in the context of describing a past CSA experience had poorer long-term social adjustment, whereas CSA survivors who expressed positive emotion while describing a nonabuse experience had improved social adjustment. These findings suggest that the benefits of positive emotional expression may often be context specific.

38 CFR 3.556 - Adjustment on discharge or release.

Science.gov (United States)

2010-07-01

... veteran whose award was reduced under § 3.551(b) is placed on non-bed care status or other authorized... hospital benefits. A discharge for disciplinary reasons or because of the patient's refusal to accept, neglect of or obstruction of treatment; refusal to accept transfer, or failure to return from authorized...

Sibling comparison of differential parental treatment in adolescence: gender, self-esteem, and emotionality as mediators of the parenting-adjustment association.

Science.gov (United States)

Feinberg, M E; Neiderhiser, J M; Simmens, S; Reiss, D; Hetherington, E M

2000-01-01

This study employs findings from social comparison research to investigate adolescents' comparisons with siblings with regard to parental treatment. The sibling comparison hypothesis was tested on a sample of 516 two-child families by examining whether gender, self-esteem, and emotionality-which have been found in previous research to moderate social comparison-also moderate sibling comparison as reflected by siblings' own evaluations of differential parental treatment. Results supported a moderating effect for self-esteem and emotionality but not gender. The sibling comparison process was further examined by using a structural equation model in which parenting toward each child was associated with the adjustment of that child and of the child's sibling. Evidence of the "sibling barricade" effect-that is, parenting toward one child being linked with opposite results on the child's sibling as on the target child-was found in a limited number of cases and interpreted as reflecting a sibling comparison process. For older siblings, emotionality and self-esteem moderated the sibling barricade effect but in the opposite direction as predicted. Results are discussed in terms of older siblings' increased sensitivity to parenting as well as the report of differential parenting reflecting the child's level of comfort and benign understanding of differential parenting, which buffers the child against environmental vicissitudes evoking sibling comparison processes.

Cannabis and neuropsychiatry, 1: benefits and risks.

Science.gov (United States)

Andrade, Chittaranjan

2016-05-01

Cannabis is popularly believed to be a relatively benign substance. Cannabis is also considered to have potential medical benefits, and medical marijuana has been legislated in many parts of the world. However, a recent meta-analysis found that cannabinoids were associated with only modest benefits for chemotherapy-related nausea and vomiting, small and inconsistent benefits for pain and spasticity, and inconclusive benefits for other indications such as improvement of appetite and weight, reduction in tic severity, and improvement of mood or sleep. On the flip side, cannabinoids and cannabis have acute and long-term adverse effects. In randomized controlled trials, cannabinoids increase the risk of total adverse events, serious adverse events, and dropout due to adverse events. Cannabis impairs cognition, and driving after cannabis use is associated with an increased risk of traffic accidents, including fatal accidents. Long-term cannabis use may lead to dependence, respiratory conditions, psychosis, and possibly cancer, as well. Cannabis use during pregnancy may compromise certain pregnancy outcomes such as fetal growth, and use during adolescence may compromise neurodevelopment, social adjustment, and vocational success. The composition and bioavailability of cannabis vary across preparations of the substance and routes of administration; this limits the ability to generalize the findings of studies. The findings of older research may no longer apply to current strains of cannabis that are higher in psychotogenic content. It is important for medical professionals and the lay public to understand the limitations of the efficacy data and the seriousness of the risks associated with cannabis use in medical and recreational contexts. © Copyright 2016 Physicians Postgraduate Press, Inc.

Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers.

Science.gov (United States)

Vieira, E R; Albuquerque-Oliveira, P R; Barbosa-Branco, A

2011-05-14

To evaluate the prevalence and characteristics of disability benefits due to musculoskeletal disorders (MSD) granted to Brazilian private sector workers. This was a population-based epidemiological study of MSD-related benefits among registered private sector workers (n=32 959 329). The prevalence (benefits/10 000 workers/year) of work disability benefits was calculated by gender, age, state, Human Development Index (HDI), economic activity, MSD type and work-relatedness. The prevalence of MSD-related benefits in Brazil among registered private sector workers in 2008 was 93.6/10 000 workers. The prevalence increased with age, and was higher for women (112.2) than for men (88.1), although the former had shorter benefit duration. The gender-adjusted prevalence by state varied from 16.6 to 90.3 for non-work-related, and from 7.8 to 59.6 for work-related benefits. The Brazilian states with a high-very high HDI had the highest prevalence. The top four most common types of MSD-related benefits were due to back pain, intervertebral disc disorders, sinovitis/tenosynovitis and shoulder disorders. MSD is a frequent cause of work disability in Brazil. There were differences in prevalence among economic activities and between states grouped by HDI. This study demonstrates that further evaluation of the contributing factors associated with MSD-related disability benefits is required. Factors that should be considered include production processes, political organisation, socioeconomic and educational characteristics, the compensation and recording systems, and employee-employer power relationships. These factors may play an important role in the prevalence of MSD-related disability benefits, especially in countries with large socioeconomic iniquities such as Brazil.

Bayesian approach to data adjustment and its applications in reactor physics

International Nuclear Information System (INIS)

Nir, I.

1980-01-01

A recently proposed method, dealing with the treatment of uncertainties and discrepancies among different sets of data measuring the same variables, is considered. The method is based on Bayesian principles and the concept of information entropy. It extracts from the data an estimation of negligence errors, which are then removed to adjust the original data. The adjusted data, now mutually-consistent, are unified to yield an enlarged ensemble, from which improved estimates of the variables can then be made. The adjustment procedure is developed for the most general case of any number of data sets and variables, with or without available prior information on the negligence errors. A measure of the adjustment quality is devised. It is used to assess the likelihood of suspected negligence error sources and the reliability of the prior. The validity of the method is demonstrated in two ways: first, it is shown that in the appropriate limits, the proposed formalism reduces to well established results. Secondly, the method is applied to specific examples of adjusting fast reactor group cross-sections and integral measurements. It is shown that the method can reproduce, to a large degree, the results of detailed re-evaluation and revision of inconsistent data, while not using these detailed information, and thus, proves the usefulness of the method in estimating negligence errors and identifying their sources

[Cognitive impairments in alcohol dependence: From screening to treatment improvements].

Science.gov (United States)

Cabé, N; Laniepce, A; Ritz, L; Lannuzel, C; Boudehent, C; Vabret, F; Eustache, F; Beaunieux, H; Pitel, A-L

2016-02-01

an extensive cognitive examination conducted by a neuropsychologist. The presence of cognitive dysfunctions in patients early in abstinence should encourage clinicians to adjust the modalities of the treatment. The fact to favor recovery of cognitive functions and brain volumes with abstinence or drastic reduction of alcohol consumption could be a first way to make it possible for patients to be cognitively able to benefit from treatment. Further studies are required to determine whether specifically designed cognitive remediation could boost (accelerate or increase) the recovery of brain functioning. Additionally, a potential effect of thiamine to limit alcohol-related cognitive deficits before the development of neurological complications remains to be determined. In this review, we presented the pattern of structural brain damage and the associated cognitive and motor impairments in alcohol-dependent patients. We then emphasized the harmful effects of neuropsychological deficits in the management of these patients. We also pointed how relevant it is to screen patients with neuropsychological impairments and we focused on the presentation of two brief screening tools for cognitive impairments, especially designed for alcohol-related deficits or not. Finally, we reported how these neuropsychological impairments could be taken into consideration the treatment of alcohol addiction by adjusting its timing and modalities. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

The Cascade of Care for an Australian Community-Based Hepatitis C Treatment Service.

Directory of Open Access Journals (Sweden)

Amanda J Wade

Full Text Available Hepatitis C treatment uptake in Australia is low. To increase access to hepatitis C virus treatment for people who inject drugs, we developed a community-based, nurse-led service that linked a viral hepatitis service in a tertiary hospital to primary care clinics, and resulted in hepatitis C treatment provision in the community.A retrospective cohort study of patients referred to the community hepatitis service was undertaken to determine the cascade of care. Logistic regression analyses were used to identify predictors of hepatitis C treatment uptake.Four hundred and sixty-two patients were referred to the community hepatitis service; 344 attended. Among the 279 attendees with confirmed chronic hepatitis C, 257 (99% reported ever injecting drugs, and 124 (48% injected in the last month. Of 201 (72% patients who had their fibrosis staged, 63 (31% had F3-F4 fibrosis. Fifty-five patients commenced hepatitis C treatment; 26 (47% were current injectors and 25 (45% had F3-F4 fibrosis. Nineteen of the 27 (70% genotype 1 patients and 14 of the 26 (54% genotype 3 patients eligible for assessment achieved a sustained virologic response. Advanced fibrosis was a significant predictor of treatment uptake in adjusted analysis (AOR 2.56, CI 1.30-5.00, p = 0.006.Our community hepatitis service produced relatively high rates of fibrosis assessment, hepatitis C treatment uptake and cure, among people who inject drugs. These findings highlight the potential benefits of providing community-based hepatitis C care to people who inject drugs in Australia-benefits that should be realised as direct-acting antiviral agents become available.

Active epilepsy prevalence, the treatment gap, and treatment gap risk profile in eastern China: A population-based study.

Science.gov (United States)

Ding, Xiaoyan; Zheng, Yang; Guo, Yi; Shen, Chunhong; Wang, Shan; Chen, Feng; Yan, Shengqiang; Ding, Meiping

2018-01-01

We measured the prevalence of active epilepsy and investigated the treatment gap and treatment gap risk profile in eastern China. This was a cross-sectional population-based survey conducted in Zhejiang, China, from October 2013 to March 2014. A total 54,976 people were selected using multi-stage cluster sampling. A two-stage questionnaire-based process was used to identify patients with active epilepsy and to record their demographic, socioeconomic, and epilepsy-related features. Logistic regression analysis was used to analyze risk factors of the treatment gap in eastern China, as adjusted for age and sex. We interviewed 50,035 people; 118 had active epilepsy (2.4‰), among which the treatment gap was 58.5%. In multivariate analysis, failure to receive appropriate antiepileptic treatment was associated with higher seizure frequency of 12-23 times per year (adjusted odds ratio=6.874; 95% confidence interval [CI]=2.372-19.918), >24 times per year (adjusted odds ratio=19.623; 95% CI=4.999-77.024), and a lack of health insurance (adjusted odds ratio=7.284; 95% CI=1.321-40.154). Eastern China has relatively lower prevalence of active epilepsy and smaller treatment gap. Interventions aimed at reducing seizure frequency, improving the health insurance system should be investigated as potential targets to further bridge the treatment gap. Copyright © 2017 Elsevier Inc. All rights reserved.

Senior Benefits

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Information Medicaid Public Health Centers Temporary "Cash" Assistance Senior Benefits Program GovDelivery Skip Navigation Links Health and Social Services > Public Assistance > Senior Benefits Page Content Senior Benefits Senior Benefits Logo Senior Benefits Fact Sheet - June, 2016 Reduction Information

Weight loss, leukopenia and thrombocytopenia associated with sustained virologic response to Hepatitis C treatment

Science.gov (United States)

Suwantarat, Nuntra; Tice, Alan D.; Khawcharoenporn, Thana; Chow, Dominic C.

2010-01-01

OBJECTIVE: To identify apparent adverse effects of treatment of chronic hepatitis C and their relationship to sustained virologic response (SVR). METHODS: A retrospective study was conducted of all Hepatitis C virus (HCV)-infected patients treated with pegylated interferon and ribavirin in an academic ambulatory infectious disease practice. Clinical and laboratory characteristics were compared between patients with SVR and without SVR. RESULTS: Fifty-four patients completed therapy with the overall SVR rate of 76%. SVR was associated with genotype non-1 (P=0.01), weight loss more than 5 kilograms (P=0.04), end of treatment leukopenia (P=0.02) and thrombocytopenia (P=0.05). In multivariate analysis, SVR was significant associated with HCV genotype non-1 (Adjusted Odd Ratio [AOR] 15.22; CI 1.55 to 149.72; P=0.02), weight loss more than 5 kilograms, (AOR 5.74; CI 1.24 to 26.32; P=0.04), and end of treatment white blood cell count level less than 3 X 103 cells/µl (AOR 9.09; CI 1.59 to 52.63; P=0.02). Thrombocytopenia was not significant after adjustment. Other factors including age, gender, ethnicity, injection drug use, viral load, anemia, alanine transaminase level, and liver histology did not reach statistical significance. CONCLUSION: Besides non-1 genotype, SVR was found to be independently associated with weight loss during therapy, and leukopenia at the end of HCV treatment. These correlations suggest continuation of therapy despite adverse effects, may be of benefit. PMID:20107528

Incremental predictive validity of the Addiction Severity Index psychiatric composite score in a consecutive cohort of patients in residential treatment for drug use disorders.

Science.gov (United States)

Thylstrup, Birgitte; Bloomfield, Kim; Hesse, Morten

2018-01-01

The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care. All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000-2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N=5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12years after discharge. A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR]=3.44, psuicide (SHR=11.45, pdrug use disorders who could benefit from additional mental health treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Structure, health benefits, antioxidant property and processing and ...

African Journals Online (AJOL)

Structure, health benefits, antioxidant property and processing and storage of carotenoids. ... It is sensitive to heat, light and oxygen. Enzymatic ... Thermal treatment and freezing increases the extractability of b-carotene from the food matrices.

Romidepsin for the treatment of relapsed/refractory peripheral T cell lymphoma: prolonged stable disease provides clinical benefits for patients in the pivotal trial

Directory of Open Access Journals (Sweden)

Francine Foss

2016-03-01

Full Text Available Abstract Background Achievement of durable responses in patients with relapsed/refractory peripheral T cell lymphoma (PTCL is challenging with current therapies, and there are few data regarding the potential benefits of continuing treatment in patients with the best response of stable disease (SD. Histone deacetylase inhibitors are a novel class of drugs with activity in T cell malignancies. Romidepsin was approved by the US Food and Drug Administration for the treatment of relapsed/refractory PTCL based on a pivotal trial demonstrating an objective response rate of 25 % (33/130, including 15 % with confirmed/unconfirmed complete response and a median duration of response of 28 months. Our objective was to further study the clinical benefits of romidepsin in patients that had the best response of SD. Methods Patients with PTCL relapsed/refractory to ≥1 prior therapy were treated with the approved dose of 14 mg/m2 romidepsin on days 1, 8, and 15 of six 28-day cycles; patients with SD or response after cycle 6 were allowed to continue on study until progression. By protocol amendment, patients treated for ≥12 cycles could receive maintenance dosing twice per cycle; after cycle 24, dosing could be further reduced to once per cycle in those who had received maintenance dosing for ≥6 months. Results Of the 32 patients (25 % with the best response of SD, 22 had SD for ≥90 days (SD90; cycle 4 response assessment. The longest SD was >3 years in a patient who received maintenance dosing of 14 mg/m2 on days 1 and 15 beginning in cycle 13. Patients with the best response of SD90 or partial response achieved similar overall and progression-free survival. Prolonged dosing of romidepsin was well tolerated. Conclusions We concluded that patients who achieve SD may consider continuing treatment because the clinical benefits of romidepsin may extend beyond objective responses. Trial registration NCT00426764

Adolescent Mothers' Adjustment to Parenting.

Science.gov (United States)

Samuels, Valerie Jarvis; And Others

1994-01-01

Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

76 FR 75562 - Notice of a Change in Status of an Extended Benefit (EB) Period for Pennsylvania

Science.gov (United States)

2011-12-02

... Extended Benefit (EB) Period for Pennsylvania AGENCY: Employment and Training Administration, Labor. ACTION... Pennsylvania. The following changes have occurred since the publication of the last notice regarding the State... three month average, seasonally- adjusted total unemployment rate for Pennsylvania rose to exceed the 8...

Adjustment of Married Couples with Different Citizenship in Selected Municipalities of Batangas Province, Philippines

Directory of Open Access Journals (Sweden)

Loida F. Tungao

2015-11-01

Full Text Available This study was designed to assess the adjustment of married couples with different citizenship in selected municipalities of Batangas Province. The respondents were 174 mixed-marriage couples that were chosen through purposive convenient sampling. This study determined the profile of the respondents in terms of sex, age, nationality, nationality of partner, place of residency and length of relationship. A descriptive method of research was utilized and survey-questionnaire was its main tool. Questionnaires were distributed to the respondents and were retrieved to be tallied, tabulated, interpreted and analyzed. The statistical treatments used in the study were frequency and percentage, weighted mean and chi-square. Results showed that most of the respondents are female, 27 – 30 years old and are Filipinos with American, Schweiz, New Zealander, Japanese, Thai, British, German and Italian partners. Most are from rural areas and have relationship length of 4-7 years. Further, demographical adjustment showed that most are adjusted in both cultural and financial aspect; while psychological adjustment depicted that most are adjusted on psychosocial aspect and highly adjusted on emotional aspect. Correlating the profile and demographical adjustment of respondents showed significant relationship except for the place of residency while the profile and psychological adjustment of respondents also depicted significant relationship. Moreover, the implication of the findings of the study to the Filipino community is discussed thoroughly to guide couples to constructively look at their strengths and adjust on their differences with each other.

Parental Divorce and Children's Adjustment.

Science.gov (United States)

Lansford, Jennifer E

2009-03-01

This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

Verification of the sensitivity of functional scores for treatment results - Substantial clinical benefit thresholds for the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).

Science.gov (United States)

Kasai, Yuichi; Fukui, Mitsuru; Takahashi, Kazuhisa; Ohtori, Seiji; Takeuchi, Daisaku; Hashizume, Hiroshi; Kanamori, Masahiko; Hosono, Noboru; Kanchiku, Tsukasa; Wada, Eiji; Sekiguchi, Miho; Konno, Shinichi; Kawakami, Mamoru

2017-07-01

Validity and reliability of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) had already been verified as the patients' self-rating assessment of low back pain and lumbar spinal disease and, the present study demonstrated the responsiveness of this measure. 192 subjects who were determined by medical instructors of the Japanese Society for Spine Surgery and Related Research were analyzed. They had completed a series of treatment and both surveys before and after the treatment. Authors investigated rates of concordance between assessment by physicians and subjective assessment by patients. The mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum values for pre-treatment, post-treatment, and acquired points were calculated, and then, we also investigated the trend between subjective assessment by patients and mean acquired points for each JOABPEQ domain and substantial clinical benefit thresholds for the JOABPEQ. Symptom changes as assessed by physicians did not coincide with those by patients, and acquired points in each JOABPEQ domain were significantly increased with improved self-rating by patients. In addition, patients who rated symptom changes as "slightly improved" showed a mean acquired points of ≥20, and those reporting "improved" showed a 25th percentile points of the acquired points of ≥20 approximately. A significant correlation was noted between the self-rating of patients and acquired points JOABPEQ, suggesting that ≥20 acquired points can be interpreted as substantial clinical benefit thresholds for the JOABPEQ. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

The Estimated Health and Economic Benefits of Three Decades of Polio Elimination Efforts in India.

Science.gov (United States)

Nandi, Arindam; Barter, Devra M; Prinja, Shankar; John, T Jacob

2016-08-07

In March 2014, India, the country with historically the highest burden of polio, was declared polio free, with no reported cases since January 2011. We estimate the health and economic benefits of polio elimination in India with the oral polio vaccine (OPV) during 1982-2012. Based on a pre-vaccine incidence rate, we estimate the counterfactual burden of polio in the hypothetical absence of the national polio elimination program in India. We attribute differences in outcomes between the actual (adjusted for under-reporting) and hypothetical counterfactual scenarios in our model to the national polio program. We measure health benefits as averted polio incidence, deaths, and disability adjusted life years (DALYs). We consider two methods to measure economic benefits: the value of statistical life approach, and equating one DALY to the Gross National Income (GNI) per capita. We estimate that the National Program against Polio averted 3.94 million (95% confidence interval [CI]: 3.89-3.99 million) paralytic polio cases, 393,918 polio deaths (95% CI: 388,897- 398,939), and 1.48 billion DALYs (95% CI: 1.46-1.50 billion). We also estimate that the program contributed to a $1.71 trillion (INR 76.91 trillion) gain (95% CI: $1.69-$1.73 trillion [INR 75.93-77.89 trillion]) in economic productivity between 1982 and 2012 in our base case analysis. Using the GNI and DALY method, the economic gain from the program is estimated to be $1.11 trillion (INR 50.13 trillion) (95% CI: $1.10-$1.13 trillion [INR 49.50-50.76 trillion]) over the same period. India accrued large health and economic benefits from investing in polio elimination efforts. Other programs to control/eliminate more vaccine-preventable diseases are likely to contribute to large health and economic benefits in India.

[Cost effectiveness in treatment of acute myeloid leukemia].

Science.gov (United States)

Nordmann, P; Schaffner, A; Dazzi, H

2000-12-23

Although the rise in health costs is a widely debated issue, in Switzerland it was until recently taken for granted that patients are given the best available treatment regardless of cost. An example of a disease requiring costly treatment is acute myelogenous leukaemia (AML). To relate cost to benefit we calculated expenditure per life years gained. To assess costs we determined the real cost of treatment up to total remission, followed by consolidation or withdrawal of treatment or death. For survival time exceeding the 2-year observation period we used data from recent literature. The average cost of treatment ranges up to 107,592 Swiss francs (CHF). In 1997 we treated 23 leukaemia patients at Zurich University Hospital and gained a total of 210 life years. This represents an average cost of CHF 11,741 per life year gained. Chief cost items were therapy and personnel costs for nursing staff, followed by hotel business and personnel costs for doctors and diagnosis. Our results for AML treatment are far removed from the $61,500 ranging up to $166,000 discussed in the literature as the "critical" QALY (quality adjusted life years) value. This is the first time the actual costs of AML therapy have been shown for a Swiss cohort. Despite high initial treatment costs and success only in a limited number of patients, the expenditure per QALY is surprisingly low and shows clearly the effectiveness of apparently costly acute medicine.

Air pollution-related health and climate benefits of clean cookstove programs in Mozambique

Science.gov (United States)

Anenberg, Susan C.; Henze, Daven K.; Lacey, Forrest; Irfan, Ans; Kinney, Patrick; Kleiman, Gary; Pillarisetti, Ajay

2017-02-01

Approximately 95% of households in Mozambique burn solid fuels for cooking, contributing to elevated indoor and outdoor fine particulate matter (PM2.5) concentrations and subsequent health and climate impacts. Little is known about the potential health and climate benefits of various approaches for expanding the use of cleaner stoves and fuels in Mozambique. We use state-of-the-science methods to provide a first-order estimation of potential air pollution-related health and climate benefits of four illustrative scenarios in which traditional cooking fires and stoves are displaced by cleaner and more efficient technologies. For rural areas, we find that a 10% increase in the number of households using forced draft wood-burning stoves could achieve >2.5 times more health benefits from reduced PM2.5 exposure (200 avoided premature deaths and 14 000 avoided disability adjusted life years, DALYs, over a three-year project lifetime) compared to natural draft stoves in the same households, assuming 70% of households use the new technology for both cases. Expanding use of LPG stoves to 10% of households in five major cities is estimated to avoid 160 premature deaths and 11 000 DALYs from reduced PM2.5 exposure for a three-year intervention, assuming 60% of households use the new stove. Advanced charcoal stoves would achieve ∽80% of the PM2.5-related health benefits of LPG stoves. Approximately 2%-5% additional health benefits would result from reduced ambient PM2.5, depending on the scenario. Although climate impacts are uncertain, we estimate that all scenarios would reduce expected climate change-related temperature increases from continued solid fuel use by 4%-6% over the next century. All results are based on an assumed adjustment factor of 0.8 to convert from laboratory-based emission reduction measurements to exposure reductions, which could be optimistic in reality given potential for continued use of the traditional stove. We conclude that cleaner cooking stoves

Comparative Benefits and Harms of Complementary and Alternative Medicine Therapies for Initial Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis.

Science.gov (United States)

Asher, Gary N; Gartlehner, Gerald; Gaynes, Bradley N; Amick, Halle R; Forneris, Catherine; Morgan, Laura C; Coker-Schwimmer, Emmanuel; Boland, Erin; Lux, Linda J; Gaylord, Susan; Bann, Carla; Pierl, Christiane Barbara; Lohr, Kathleen N

2017-12-01

To report the comparative benefits and harms of exercise and complementary and alternative medicine (CAM) treatments with second-generation antidepressants (SGA) for major depressive disorder (MDD). Systematic review and meta-analysis. Outpatient clinics. Adults, aged 18 years and older, with MDD receiving an initial treatment attempt with SGA. Any CAM or exercise intervention compared with an SGA. Treatment response, remission, change in depression rating, adverse events, treatment discontinuation, and treatment discontinuation due to adverse events. We found 22 randomized controlled trials for direct comparisons and 127 trials for network meta-analyses, including trials of acupuncture, omega-3 fatty acids, S-adenosyl methionine, St. John's wort, and exercise. For most treatment comparisons, we found no differences between treatment groups for response and remission. However, the risk of bias of these studies led us to conclude that the strength of evidence for these findings was either low or insufficient. The risk of treatment harms and treatment discontinuation attributed to adverse events was higher for selective serotonin receptor inhibitors than for St. John's wort. Although we found little difference in the comparative efficacy of most CAM therapies or exercise and SGAs, the overall poor quality of the available evidence base tempers any conclusions that we might draw from those trials. Future trials should incorporate patient-oriented outcomes, treatment expectancy, depressive severity, and harms assessments into their designs; antidepressants should be administered over their full dosage ranges; and larger trials using methods to reduce sampling bias are needed.

Do young adults with bipolar disorder benefit from early intervention?

DEFF Research Database (Denmark)

Kessing, Lars Vedel; Hansen, Hanne Vibe; Christensen, Ellen Margrethe

2014-01-01

BACKGROUND: It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar...... disorder aged 18-25 years to that of patients aged 26 years or older. METHODS: Patients were randomised to early treatment in a specialised outpatient mood disorder clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation. RESULTS: A total of 158 patients with mania/bipolar...... different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group psychoeducation....

Variational assimilation of streamflow into operational distributed hydrologic models: effect of spatiotemporal adjustment scale

Science.gov (United States)

Lee, H.; Seo, D.-J.; Liu, Y.; Koren, V.; McKee, P.; Corby, R.

2012-01-01

State updating of distributed rainfall-runoff models via streamflow assimilation is subject to overfitting because large dimensionality of the state space of the model may render the assimilation problem seriously under-determined. To examine the issue in the context of operational hydrology, we carry out a set of real-world experiments in which streamflow data is assimilated into gridded Sacramento Soil Moisture Accounting (SAC-SMA) and kinematic-wave routing models of the US National Weather Service (NWS) Research Distributed Hydrologic Model (RDHM) with the variational data assimilation technique. Study basins include four basins in Oklahoma and five basins in Texas. To assess the sensitivity of data assimilation performance to dimensionality reduction in the control vector, we used nine different spatiotemporal adjustment scales, where state variables are adjusted in a lumped, semi-distributed, or distributed fashion and biases in precipitation and potential evaporation (PE) are adjusted hourly, 6-hourly, or kept time-invariant. For each adjustment scale, three different streamflow assimilation scenarios are explored, where streamflow observations at basin interior points, at the basin outlet, or at both interior points and the outlet are assimilated. The streamflow assimilation experiments with nine different basins show that the optimum spatiotemporal adjustment scale varies from one basin to another and may be different for streamflow analysis and prediction in all of the three streamflow assimilation scenarios. The most preferred adjustment scale for seven out of nine basins is found to be the distributed, hourly scale, despite the fact that several independent validation results at this adjustment scale indicated the occurrence of overfitting. Basins with highly correlated interior and outlet flows tend to be less sensitive to the adjustment scale and could benefit more from streamflow assimilation. In comparison to outlet flow assimilation, interior flow

Laparoscopic Adjustable Gastric Banding and Hypoglycemia

Directory of Open Access Journals (Sweden)

Sigrid Bairdain

2013-01-01

Full Text Available Obesity is commonplace, and surgical treatment usually includes Roux-en-Y gastric bypasses (RYGBs. RYGBs have the most documented side effects including vitamin deficiencies, rebound weight gain, and symptomatic hypoglycemia; fewer series exist describing hypoglycemia following other bariatric operations. We reviewed all patients undergoing laparoscopic adjustable gastric banding (LAGB at our institution between 2008 and 2012. Three patients were identified to have symptomatic hypoglycemia following LAGB. Mean time from surgery was 33 months (range 14–45 months, and mean weight loss was 32.7 kg (range 15.9–43.1 kg. None of the patients had preexisting diabetes. Therefore, symptomatic hypoglycemia should be investigated irrespective of bariatric operation.

Adjustable collimator

International Nuclear Information System (INIS)

Carlson, R.W.; Covic, J.; Leininger, G.

1981-01-01

In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

Hope, Quality of Life, and Benefit From Treatment in Women Having Chemotherapy for Platinum-Resistant/Refractory Recurrent Ovarian Cancer: The Gynecologic Cancer Intergroup Symptom Benefit Study

OpenAIRE

Sjoquist, Katrin M.; Friedlander, Michael L.; O'Connell, Rachel L.; Voysey, Merryn; King, Madeleine T.; Stockler, Martin R.; Oza, Amit M.; Gillies, Kim; Martyn, Julie K.; Butow, Phyllis N.