WorldWideScience

Sample records for treatment margin assessment

  1. Modification of prostate implants based on postimplant treatment margin assessment

    International Nuclear Information System (INIS)

    Mueller, Amy; Wallner, Kent; Merrick, Gregory; Couriveau, Jacques; Sutlief, Steven; Butler, Wayne; Gong, Lixin; Cho, Paul

    2002-01-01

    Purpose: To quantify the extent of additional source placement needed to perfect an implant after execution by standard techniques, assuming that uniform 5 mm treatment margins (TMs) is the criteria for perfection. Materials and Methods: Ten consecutive, unselected patients treated with I-125 brachytherapy were studied. Source placement is planned just inside or outside of the prostatic margin, to achieve a minimum 5 mm TM and a central dose of 150%-200% of the prescription dose. The preimplant prostate volumes ranged from 24 to 85 cc (median: 35 cc). The number of sources implanted ranged from 48 to 102 (median: 63). Axial CT images were acquired within 2 h postoperatively for postimplant dosimetry. After completion of standard dosimetric calculations, the TMs were measured and tabulated at 45 deg. intervals around the prostate periphery at 0.0, 1.0, 2.0, and 3.0 cm planes. Sources were then added to the periphery to bring the TMs to a minimum of 5 mm at each measured TM, resulting in a modified implant. All margin modifications were done manually, without the aid of automated software. Results: Patients' original (unmodified) D90s ranged from 111% to 154%, with a median of 116%. The original V100s ranged from 94% to 99%, with a median of 96%. No patient required placement of additional sources to meet a minimum D90 of 90% or a minimum V100 of 80%. In contrast, patients required from 7 to 17 additional sources (median: 11) to achieve minimum 5 mm TMs around the entire prostatic periphery. Additional sources equaled from 12% to 24% of the initial number of sources placed (median: 17%). By adding sufficient peripheral sources to bring the TMs to a minimum 5 mm, patients' average V100 increased from 96% to 100%, and the average D90 increased from 124% to 160% of prescription dose. In the course of achieving a minimum 5 mm TM, the average treatment margin for all patients combined increased from 5.5 to 9.9 mm. The number of sources needed to bring the TMs to a minimum

  2. Modification of prostate implants based on postimplant treatment margin assessment.

    Science.gov (United States)

    Mueller, Amy; Wallner, Kent; Merrick, Gregory; Courveau, Jacques; Sutlief, Steven; Butler, Wayne; Gong, Lixin; Cho, Paul

    2002-12-01

    To quantify the extent of additional source placement needed to perfect an implant after execution by standard techniques, assuming that uniform 5 mm treatment margins (TMs) is the criteria for perfection. Ten consecutive, unselected patients treated with 1-125 brachytherapy were studied. Source placement is planned just inside or outside of the prostatic margin, to achieve a minimum 5 mm TM and a central dose of 150%-200% of the prescription dose. The preimplant prostate volumes ranged from 24 to 85 cc (median: 35 cc). The number of sources implanted ranged from 48 to 102 (median: 63). Axial CT images were acquired within 2 h postoperatively for postimplant dosimetry. After completion of standard dosimetric calculations, the TMs were measured and tabulated at 45 degrees intervals around the prostate periphery at 0.0, 1.0, 2.0, and 3.0 cm planes. Sources were then added to the periphery to bring the TMs to a minimum of 5 mm at each measured TM, resulting in a modified implant. All margin modifications were done manually, without the aid of automated software. Patients' original (unmodified) D90s ranged from 111% to 154%, with a median of 116%. The original V100s ranged from 94% to 99%, with a median of 96%. No patient required placement of additional sources to meet a minimum D90 of 90% or a minimum V100 of 80%. In contrast, patients required from 7 to 17 additional sources (median: 11) to achieve minimum 5 mm TMs around the entire prostatic periphery. Additional sources equaled from 12% to 24% of the initial number of sources placed (median: 17%). By adding sufficient peripheral sources to bring the TMs to a minimum 5 mm, patients' average V100 increased from 96% to 100%, and the average D90 increased from 124% to 160% of prescription dose. In the course of achieving a minimum 5 mm TM, the average treatment margin for all patients combined increased from 5.5 to 9.9 mm. The number of sources needed to bring the TMs to a minimum 5 mm was loosely correlated with the

  3. Circumferential resection margin (CRM) positivity after MRI assessment and adjuvant treatment in 189 patients undergoing rectal cancer resection.

    Science.gov (United States)

    Simpson, G S; Eardley, N; McNicol, F; Healey, P; Hughes, M; Rooney, P S

    2014-05-01

    The management of rectal cancer relies on accurate MRI staging. Multi-modal treatments can downstage rectal cancer prior to surgery and may have an effect on MRI accuracy. We aim to correlate the findings of MRI staging of rectal cancer with histological analysis, the effect of neoadjuvant therapy on this and the implications of circumferential resection margin (CRM) positivity following neoadjuvant therapy. An analysis of histological data and radiological staging of all cases of rectal cancer in a single centre between 2006 and 2011 were conducted. Two hundred forty-one patients had histologically proved rectal cancer during the study period. One hundred eighty-two patients underwent resection. Median age was 66.6 years, and male to female ratio was 13:5. R1 resection rate was 11.1%. MRI assessments of the circumferential resection margin in patients without neoadjuvant radiotherapy were 93.6 and 88.1% in patients who underwent neoadjuvant radiotherapy. Eighteen patients had predicted positive margins following chemoradiotherapy, of which 38.9% had an involved CRM on histological analysis. MRI assessment of the circumferential resection margin in rectal cancer is associated with high accuracy. Neoadjuvant chemoradiotherapy has a detrimental effect on this accuracy, although accuracy remains high. In the presence of persistently predicted positive margins, complete resection remains achievable but may necessitate a more radical approach to resection.

  4. Marginal Assessment of Crowns by the Aid of Parallel Radiography

    Directory of Open Access Journals (Sweden)

    Farnaz Fattahi

    2015-03-01

    Full Text Available Introduction: Marginal adaptation is the most critical item in long-term prognosis of single crowns. This study aimed to assess the marginal quality as well asthe discrepancies in marginal integrity of some PFM single crowns of posterior teeth by employing parallel radiography in Shiraz Dental School, Shiraz, Iran. Methods: In this descriptive study, parallel radiographies were taken from 200 fabricated PFM single crowns of posterior teeth after cementation and before discharging the patient. To calculate the magnification of the images, a metallic sphere with the thickness of 4 mm was placed in the direction of the crown margin on the occlusal surface. Thereafter, the horizontal and vertical space between the crown margins, the margin of preparations and also the vertical space between the crown margin and the bone crest were measured by using digital radiological software. Results: Analysis of data by descriptive statistics revealed that 75.5% and 60% of the cases had more than the acceptable space (50µm in the vertical (130±20µm and horizontal (90±15µm dimensions, respectively. Moreover, 85% of patients were found to have either horizontal or vertical gap. In 77% of cases, the margins of crowns invaded the biologic width in the mesial and 70% in distal surfaces. Conclusion: Parallel radiography can be expedient in the stage of framework try-in to yield some important information that cannot be obtained by routine clinical evaluations and may improve the treatment prognosis

  5. Assessment of seismic margin calculation methods

    International Nuclear Information System (INIS)

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.

    1989-03-01

    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs

  6. Complementary Safety Margin Assessment. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-10-15

    On March 11, 2011, a large part of the Japanese eastern coastal area was devastated by an earthquake, followed by an immense tsunami. As a result, thousands of people were killed, injured or made homeless. In the days that followed, the situation was further complicated because of the failing nuclear reactors on the Fukushima coast. The local environment suffered from radioactive releases, requiring evacuation zones, and generating international concerns about nuclear safety. In the wake of this disaster the European Union decided to assess safety on all operating nuclear reactors in its member states. This safety evaluation initiated by the European Union focusses on extreme natural hazards, beyond the standard safety evaluations which regularly have to be performed to demonstrate the safety of a nuclear power plant. Consequences of these extreme hazards for the Borssele NPP have been evaluated based on available safety analyses, supplemented by engineering judgement. In this way, the robustness of the existing plant has been assessed and possible measures to further increase the safety margins have been identified. This document presents the results of the Complementary Safety margin Assessment (CSA) performed for the NPP Borssele. The distinct difference between this report and former risk analysis reports in general and the existing Safety Report of the NPP Borssele is that the maximum resistance of the plant against redefined and more challenging events has been investigated, whereas traditionally the plant design is investigated against certain events that are determined on a historical basis. This different approach requires different analyses and studies, which in turn presents new insights into the robustness of the plant. This document has been prepared in the short time period between June 1 and October 31, 2011. If more time had been granted for this study, some of the subjects could have been pursued in greater depth. The EPZ project team has been

  7. Effect of respiratory trace shape on optimal treatment margin.

    Science.gov (United States)

    Winey, Brian; Wagar, Matthew; Ebe, Kazuyu; Popple, Richard; Lingos, Tania; Sher, David; Court, Laurence

    2011-06-01

    To evaluate the effect of target trajectory shape on the optimal treatment margin. Intensity-modulated radiation therapy and volumetric modulated arc therapy plans were created for three spherical targets (3, 5, and 7 cm diameter) simulated in exhalation phases, each with margins of 2, 4, 6, 8, and 10 mm to account for motion. The plans were delivered to a stationary 2D ion chamber array, and dose movies were obtained of the delivered doses. The dose movie frames were then displaced to simulate different respiratory traces. Five traces were used: sin2, sin4 sin6, and two patient traces. The optimal margin was defined as the margin for which the dose delivered to 95% of the target was closest to that obtained with no margin or motion. The equivalent uniform dose was also investigated as an alternative cost function. The optimal margin was always smaller than the peak-to-peak motion. When the respiratory trace spent less time in the inhale phases, the optimal margin was consistently smaller than when more time was spent in the inhale phases. The target size and treatment modality also affected the optimal margin. The necessary margin for targets that spend less time in the exhale phase (sin6) is 2-4 mm smaller than for targets that spend equal time in the inhale and exhale phases (sin).

  8. Estimation of marginal costs at existing waste treatment facilities.

    Science.gov (United States)

    Martinez-Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus; Riber, Christian; Kamuk, Bettina; Astrup, Thomas F

    2016-04-01

    address and include costs in existing waste facilities in decision-making may unintendedly lead to higher overall costs at societal level. To avoid misleading conclusions, economic assessment of alternative SWM solutions should not only consider potential costs associated with alternative treatment but also include marginal costs associated with existing facilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Circumferential resection margin in the modern treatment of rectal cancer].

    Science.gov (United States)

    Ihnát, P; Martínek, L; Ihnát Rudinská, L; Mitták, M; Vávra, P; Zonča, P

    2013-06-01

    In the last decades, the assessment of circumferential resection margin (CRM) has gained enormous importance in the management of patients with rectal carcinoma, not only in predicting the prognosis, but also in precise cancer staging, in multimodal treatment indications and in quality assessment of provided care. The authors present a review article containing CRM definition, describing the technique of CRM assessment, the effect of CRM status on the prognosis and quality of provided therapy. CRM assessment in the context of a multidisciplinary team is especially emphasised. The aspect of CRM has to be considered by the radiologist during cancer staging, the surgeon in the course of the operation, the pathologist during precise macroscopic and histopathological specimen evaluation, and the oncologist when deciding on neoadjuvant/adjuvant therapy administration. CRM nowadays represents a fundamental aspect in modern treatment of patients with rectal carcinoma. The introduction of CRM assessment into clinical practice has lead to more precise staging, better multimodal therapy indications, more precise surgical technique (total mesorectal excision), an increased rate of sphincter-saving resections, lowered local recurrence rates and improved patient survival.

  10. Target margins for random geometrical treatment uncertainties in conformal radiotherapy

    NARCIS (Netherlands)

    Bel, A.; van Herk, M.; Lebesque, J. V.

    1996-01-01

    In this study we investigate a method for positioning the margin required around the clinical target volume (CTV) to account for the random geometrical treatment uncertainties during conformal radiotherapy. These uncertainties are introduced by patient setup errors and CTV motion within the patient.

  11. Voltage stability margins assessment for Muscat power system

    Energy Technology Data Exchange (ETDEWEB)

    Ellithy, K.A.; Gastli, A. [Sultan Qaboos Univ., Dept. of Electrical Engineering and Electronics, Muscat (Oman); Al-Khusaibi, T. [Ministry of Housing and Electricity and Water, Muscat (Oman); Irving, M. [Brunel Univ., Dept. of Electrical Engineering and Electronics, Uxbridge (United Kingdom)

    2002-10-01

    Voltage instability problems in power systems today are, in many countries, one of the major concerns in power system planning and operation. This paper presents the assessment of voltage stability margins for Muscat power system under normal operating condition and under contingencies. The modal analysis method is applied to identify the weak buses in the system, which could lead to voltage instability. These weak buses are selected as the best locations for applying remedial actions to enhance the stability margins. The results show that the buses at South Batna load area are the weakest buses in the system. The results also show that an increase in load demand on that area without an adequate increase of reactive power could lead to voltage collapse. Shunt VAR compensations (remedial action) are installed at the weakest buses to enhance the system stability margins. The results presented in this paper are obtained using a MATLAB computer program developed by the authors. (Author)

  12. Margins in high temperature leak-before-break assessments

    International Nuclear Information System (INIS)

    Budden, P.J.; Hooton, D.G.

    1997-01-01

    Developments in the defect assessment procedure R6 to include high-temperature mechanisms in Leak-before-Break arguments are described. In particular, the effect of creep on the time available to detect a leak and on the crack opening area, and hence leak rate, is discussed. The competing influence of these two effects is emphasized by an example. The application to Leak-before-Break of the time-dependent failure assessment diagram approach for high temperature defect assessment is then outlined. The approach is shown to be of use in assessing the erosion of margins by creep

  13. Margins in high temperature leak-before-break assessments

    Energy Technology Data Exchange (ETDEWEB)

    Budden, P.J.; Hooton, D.G.

    1997-04-01

    Developments in the defect assessment procedure R6 to include high-temperature mechanisms in Leak-before-Break arguments are described. In particular, the effect of creep on the time available to detect a leak and on the crack opening area, and hence leak rate, is discussed. The competing influence of these two effects is emphasized by an example. The application to Leak-before-Break of the time-dependent failure assessment diagram approach for high temperature defect assessment is then outlined. The approach is shown to be of use in assessing the erosion of margins by creep.

  14. Seismic margin assessment for nuclear facilities of Kozloduy NPP

    International Nuclear Information System (INIS)

    Marinova, Bozhana

    2014-01-01

    In accordance with the decision of the European Commission and ENSREG Declaration of 13 May 2011, all nuclear power plants in the European Union were subjected to a stress test. The stress test is defined as a targeted reassessment of the safety margins of nuclear power plants in the light of the events which occurred at Fukushima: extreme natural events challenging the plant safety functions and leading to a severe accident. Seismic margins assessment is based on the analysis of the seismic resistance of the equipment, which is important for safety and participates in mitigation of accident scenarios. Seismic margin is determined on the basis of the prescribed limits of seismic accelerations that any nuclear facility can withstand without severe fuel damage and radioactive release into the environment. The determining of the weak points and boundary effects in case of seismic action is done based on the data from the seismic PSA Level 1. Based on the calculated median values of the probable seismic deviations, the ranges of probable seismic action have been determined for which the resistance of the different nuclear facilities is assessed. The safety margins re-assessment should define the nuclear facility ultimate capacity, i.e. to determine the values of accelerations for which the SSC failures would result in non-availability of the safety functions, and fuel damage would be inevitable. The assessment of this acceleration value is done using the data of the seismic analyses as performed on design stage, accounting for the dynamic response and actual spatial dimensions of the civil structures and for the materials properties. For the purpose of the KNPP nuclear facilities safety re-assessment, the seismic capacity is accepted to be determine by the value of seismic acceleration, for which it can be ascertained with 95% certainty that the safety factor obtained at the respective seismic acceleration is not lower than 1. The purpose of this report is to present

  15. WSEAT Shock Testing Margin Assessment Using Energy Spectra Final Report.

    Energy Technology Data Exchange (ETDEWEB)

    Sisemore, Carl; Babuska, Vit; Booher, Jason

    2018-02-01

    Several programs at Sandia National Laboratories have adopted energy spectra as a metric to relate the severity of mechanical insults to structural capacity. The purpose being to gain insight into the system's capability, reliability, and to quantify the ultimate margin between the normal operating envelope and the likely system failure point -- a system margin assessment. The fundamental concern with the use of energy metrics was that the applicability domain and implementation details were not completely defined for many problems of interest. The goal of this WSEAT project was to examine that domain of applicability and work out the necessary implementation details. The goal of this project was to provide experimental validation for the energy spectra based methods in the context of margin assessment as they relate to shock environments. The extensive test results concluded that failure predictions using energy methods did not agree with failure predictions using S-N data. As a result, a modification to the energy methods was developed following the form of Basquin's equation to incorporate the power law exponent for fatigue damage. This update to the energy-based framework brings the energy based metrics into agreement with experimental data and historical S-N data.

  16. Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique.

    Science.gov (United States)

    Brodin, N Patrik; Munck af Rosenschöld, Per; Blomstrand, Malin; Kiil-Berthlesen, Anne; Hollensen, Christian; Vogelius, Ivan R; Lannering, Birgitta; Bentzen, Søren M; Björk-Eriksson, Thomas

    2014-04-01

    We investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy. We included 17 pediatric medulloblastoma patients to represent the variability in tumor location relative to the hippocampal region. Treatment plans were generated using 3D conformal radiotherapy, hippocampal sparing intensity-modulated radiotherapy, and spot-scanned proton therapy, using 3 different treatment margins for the conformal tumor boost. Neurocognitive impairment risk was estimated based on dose-response models from pediatric CNS malignancy survivors and compared among different margins and treatment techniques. Mean hippocampal dose and corresponding risk of cognitive impairment were decreased with decreasing treatment margins (P < .05). The largest risk reduction, however, was seen when applying hippocampal sparing proton therapy-the estimated risk of impaired task efficiency (95% confidence interval) was 92% (66%-98%), 81% (51%-95%), and 50% (30%-70%) for 3D conformal radiotherapy, intensity-modulated radiotherapy, and proton therapy, respectively, for the smallest boost margin and 98% (78%-100%), 90% (60%-98%), and 70% (39%-90%) if boosting the whole posterior fossa. Also, the distance between the closest point of the planning target volume and the center of the hippocampus can be used to predict mean hippocampal dose for a given treatment technique. We estimate a considerable clinical benefit of hippocampal sparing radiotherapy. In choosing treatment margins, the tradeoff between margin size and risk of neurocognitive impairment quantified here should be considered.

  17. 76 FR 5518 - Antidumping Proceedings: Calculation of the Weighted Average Dumping Margin and Assessment Rate...

    Science.gov (United States)

    2011-02-01

    ... Weighted Average Dumping Margin and Assessment Rate in Certain Antidumping Duty Proceedings AGENCY: Import... regarding the calculation of the weighted average dumping margin and antidumping duty assessment rate in... regarding the calculation of the weighted average dumping margin and antidumping duty assessment rate in...

  18. 75 FR 81533 - Antidumping Proceedings: Calculation of the Weighted Average Dumping Margin and Assessment Rate...

    Science.gov (United States)

    2010-12-28

    ... Weighted Average Dumping Margin and Assessment Rate in Certain Antidumping Duty Proceedings AGENCY: Import... comments regarding the calculation of the weighted average dumping margin and antidumping duty assessment... calculated the weighted average margins of dumping using transaction-to-transaction comparisons, the...

  19. Hippocampal sparing radiotherapy for pediatric medulloblastoma: impact of treatment margins and treatment technique

    DEFF Research Database (Denmark)

    Brodin, N. Patrik; af Rosenschold, Per Munck; Blomstrand, Malin

    2014-01-01

    BackgroundWe investigated how varying the treatment margin and applying hippocampal sparing and proton therapy impact the risk of neurocognitive impairment in pediatric medulloblastoma patients compared with current standard 3D conformal radiotherapy.MethodsWe included 17 pediatric medulloblastoma...

  20. Assessment of Biomass Resources from Marginal Lands in APEC Economies

    Energy Technology Data Exchange (ETDEWEB)

    Milbrandt, A.; Overend, R. P.

    2009-08-01

    The goal of this study is to examine the marginal lands in Asia-Pacific Economic Cooperation (APEC) economies and evaluate their biomass productivity potential. Twelve categories of marginal lands are identified using the Global Agro-Ecological Zones system of the United Nations Food and Agriculture Organization.

  1. The effects of photodynamic laser therapy in the treatment of marginal chronic periodontitis

    Science.gov (United States)

    Chifor, Radu; Badea, Iulia; Avram, Ramona; Chifor, Ioana; Badea, Mîndra Eugenia

    2016-03-01

    The aim of this study was to assess the effects of the antimicrobial photodynamic laser therapy performed during the treatment of deep periodontal disease by using 40 MHz high frequency ultrasonography. The periodontal data recorded during the clinical examination before each treatment session were compared with volumetric changes of the gingiva measured on periodontal ultrasound images. The results show a significant decrease of gingival tissue inflammation proved both by a significant decrease of bleeding on probing as well as by a decrease of the gingival tissues volume on sites where the laser therapy was performed. Periodontal tissues that benefit of laser therapy besides classical non-surgical treatment showed a significant clinical improvement of periodontal status. Based on these findings we were able to conclude that the antimicrobial photodynamic laser therapy applied on marginal periodontium has important anti-inflamatory effect. The periodontal ultrasonography is a method which can provide useful data for assessing the volume changes of gingival tissues, allowing a precise monitoring of marginal periodontitis.

  2. Agrochemicals in field margins--assessing the impacts of herbicides, insecticides, and fertilizer on the common buttercup (Ranunculus acris).

    Science.gov (United States)

    Schmitz, Juliane; Schäfer, Karoline; Brühl, Carsten A

    2013-04-01

    The effects of herbicide, insecticide, and fertilizer inputs on the common buttercup Ranunculus acris in field margins were studied in an experimental field study. The test design allowed us to investigate the single and combined effects of repeated herbicide, insecticide, and fertilizer applications in successive growing seasons. To assess the effects of the agrochemical applications on R. acris, plant community assessments were carried out and a photodocumentation of the flowering intensity was performed over two years. In addition, the authors conducted a monitoring survey of R. acris in field margins in the proximity of the study site. In the field experiment, R. acris plant density decreased significantly with treatments including fertilizer. The herbicide caused a sublethal effect by reducing flower intensity by 85%. In the long run, both effects will result in a decline of R. acris and lead to shifts in plant communities in field margins. This was confirmed by the monitoring survey, where R. acris could hardly be observed in field margins directly adjacent to cereal fields, whereas in margins next to meadows the species was recorded frequently. Besides the implications for the plants, the sublethal effects may also affect many flower-visiting insects. The results indicate that the current risk assessment for nontarget plants is insufficiently protective for wild plant species in field margins and that consideration of sublethal effects is crucial to preserve biodiversity in agricultural landscapes. Copyright © 2013 SETAC.

  3. Assessment of Long-Run Marginal Costing of Transmission and ...

    African Journals Online (AJOL)

    Then using typical practical networks as case studies, this paper compares two different methods for the determination of the LRMC of transmission and distribution expansion/reinforcement: the average incremental cost (AIC) methodology and marginal incremental costs (MIC) techniques. Based on the results obtained, it is ...

  4. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV.

    Science.gov (United States)

    Tsai, Alexander C; Weiser, Sheri D; Petersen, Maya L; Ragland, Kathleen; Kushel, Margot B; Bangsberg, David R

    2010-12-01

    Depression strongly predicts nonadherence to human immunodeficiency virus (HIV) antiretroviral therapy, and adherence is essential to maintaining viral suppression. This suggests that pharmacologic treatment of depression may improve virologic outcomes. However, previous longitudinal observational analyses have inadequately adjusted for time-varying confounding by depression severity, which could yield biased estimates of treatment effect. Application of marginal structural modeling to longitudinal observation data can, under certain assumptions, approximate the findings of a randomized controlled trial. To determine whether antidepressant medication treatment increases the probability of HIV viral suppression. Community-based prospective cohort study with assessments conducted every 3 months. Community-based research field site in San Francisco, California. One hundred fifty-eight homeless and marginally housed persons with HIV who met baseline immunologic (CD4+ T-lymphocyte count, 13) inclusion criteria, observed from April 2002 through August 2007. Probability of achieving viral suppression to less than 50 copies/mL. Secondary outcomes of interest were probability of being on an antiretroviral therapy regimen, 7-day self-reported percentage adherence to antiretroviral therapy, and probability of reporting complete (100%) adherence. Marginal structural models estimated a 2.03 greater odds of achieving viral suppression (95% confidence interval [CI], 1.15-3.58; P = .02) resulting from antidepressant medication treatment. In addition, antidepressant medication use increased the probability of antiretroviral uptake (weighted odds ratio, 3.87; 95% CI, 1.98-7.58; P effect is likely attributable to improved adherence to a continuum of HIV care, including increased uptake and adherence to antiretroviral therapy.

  5. On the assessment of marginal life saving costs for risk acceptance criteria

    DEFF Research Database (Denmark)

    Fischer, Katharina; Virguez, Edgar; Sánchez-Silva, Mauricio

    2013-01-01

    During the evaluation of societal risk acceptance based on the Life Quality Index (LQI), the marginal life saving costs have to be assessed and compared with the Societal Willingness to Pay for a marginal increase in life safety. With this procedure, decisions on investments into different risk r...

  6. Estimation of marginal costs at existing waste treatment facilities

    DEFF Research Database (Denmark)

    Martinez Sanchez, Veronica; Hulgaard, Tore; Hindsgaul, Claus

    2016-01-01

    in a CHP (from -2 to 294€Mg-1 target fraction in the only Power case) and between 40 and 303€Mg-1 target fraction when no reaction happened in a CHP (from 35 to 296€Mg-1 target fraction in the only Power case). Although average costs at WtE facilities were highly influenced by energy selling prices...... (CHP) and another with only power generation (Power), affected by diversion strategies of five waste fractions (fibres, plastic, metals, organics and glass), named "target fractions". The study assumed three possible responses to waste diversion in the WtE facilities: (i) biomass was added to maintain...... times larger than average costs and dependent on the response in the WtE plant. Marginal cost of diversion were between 39 and 287€Mg-1 target fraction when biomass was added in a CHP (from 34 to 303€Mg-1 target fraction in the only Power case), between -2 and 300€Mg-1 target fraction when RDF was added...

  7. Margin Assessment in Renal Surgery Using a Handheld Optical Coherence Tomography Probe.

    Science.gov (United States)

    Ludwig, Wesley W; Wobker, Sara E; Ball, Mark W; Zysk, Adam M; Yemul, Kiran S; Pierorazio, Philip M; Gorin, Michael A; Allaf, Mohamad E

    2018-03-01

    To assess the use of a handheld optical coherence tomography (OCT) probe for the evaluation of intraoperative surgical margins during partial nephrectomy (PN). In an initial feasibility study, a radical nephrectomy specimen with a 9-cm tumor was cut into 19 sections, exposing 0 mm (n = 8), 1 mm (n = 6), and 2 mm (n = 5) gross margins. OCT was used to determine the margin width in each specimen. Second, a prospective ex vivo assessment of 15 PN tumor specimens was performed with OCT to determine margin status and to measure the attenuation coefficient of tumor and renal parenchyma. Median OCT margin width measurements for sectioned samples were 0 mm, 0.9 mm (range 0.7-2.9 mm), and 2.7 (range 1.65-2.8 mm) for grossly 0 mm (positive), 1 mm, and 2 mm margins, respectively. The difference between measurements from all margin groups was statistically significant (P probe to assess margins ex vivo during PN. OCT may reduce the need for intraoperative frozen section and aid in minimizing parenchymal excision. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Scientific Ocean Drilling to Assess Submarine Geohazards along European Margins

    Science.gov (United States)

    Ask, M. V.; Camerlenghi, A.; Kopf, A.; Morgan, J. K.; Ocean DrillingSeismic Hazard, P. E.

    2008-12-01

    Submarine geohazards are some of the most devastating natural events in terms of lives lost and economic impact. Earthquakes pose a big threat to society and infrastructure, but the understanding of their episodic generation is incomplete. Tsunamis are known for their potential of striking coastlines world-wide. Other geohazards originating below the sea surface are equally dangerous for undersea structures and the coastal population: submarine landslides and volcanic islands collapse with little warning and devastating consequences. The European scientific community has a strong focus on geohazards along European and nearby continental margins, especially given their high population densities, and long historic and prehistoric record of hazardous events. For example, the Mediterranean is surrounded by very densely-populated coastline and is the World's leading holiday destination, receiving up 30% of global tourism. In addition, its seafloor is criss-crossed by hydrocarbon pipelines and telecommunication cables. However, the governing processes and recurrence intervals of geohazards are still poorly understood. Examples include, but are not limited to, earthquakes and volcanic eruptions along the active tectonic margins of the Mediterranean and Sea of Marmara, landslides on both active and passive margins, and tsunamites and seismites in the sedimentary record that suggest a long history of similar events. The development of geophysical networks, drilling, sampling and long-term monitoring are crucial to the understanding of earthquake, landslide, and tsunami processes, and to mitigate the associated risks in densely populated and industrialized regions such as Europe. Scientific drilling, particularly in the submarine setting, offers a unique tool to obtain drill core samples, borehole measurements and long-term observations. Hence, it is a critical technology to investigate past, present, and possible future influences of hazardous processes in this area. The

  9. Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample.

    Science.gov (United States)

    Eyrich-Garg, Karin M; Cacciola, John S; Carise, Deni; Lynch, Kevin G; McLellan, A Thomas

    2008-10-01

    Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study's purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more severe psychosocial problems or histories than housed chronic substance users. Questions assessing homelessness were inserted into the Drug Evaluation Network System-a computer-assisted intake interview (including the Addiction Severity Index) implemented in addiction treatment programs across the U.S. Based on these data, clients were divided into four residential groups: literally homeless (n = 654), marginally housed (n = 1138), housed poor (n = 3119), and housed not poor (n = 718). Income, human capital (education level and acquisition of a trade/skill), substance use, mental health, and social support were examined. The literally homeless was not the poorest group, although these clients did spend the most money on substances. All four groups' incomes were positively related to amount of money spent on drugs, but only the marginally housed's income was related to money spent on alcohol. The literally homeless had the most severe alcohol, mental health, and social support problems. The literally homeless and marginally housed had similar incomes and human capital and the most severe cocaine problems. In general the housed poor and housed not poor fared better than the literally homeless and marginally housed groups. Practitioners should continue to intervene with the homeless and consider working with the marginally housed's social support systems. Future research should examine the marginally housed as an at-risk group for homelessness.

  10. Marginal and Internal Adaptation of Zirconia Crowns: A Comparative Study of Assessment Methods.

    Science.gov (United States)

    Cunali, Rafael Schlögel; Saab, Rafaella Caramori; Correr, Gisele Maria; Cunha, Leonardo Fernandes da; Ornaghi, Bárbara Pick; Ritter, André V; Gonzaga, Carla Castiglia

    2017-01-01

    Marginal and internal adaptation is critical for the success of indirect restorations. New imaging systems make it possible to evaluate these parameters with precision and non-destructively. This study evaluated the marginal and internal adaptation of zirconia copings fabricated with two different systems using both silicone replica and microcomputed tomography (micro-CT) assessment methods. A metal master model, representing a preparation for an all-ceramic full crown, was digitally scanned and polycrystalline zirconia copings were fabricated with either Ceramill Zi (Amann-Girrbach) or inCoris Zi (Dentslpy-Sirona), n=10. For each coping, marginal and internal gaps were evaluated by silicone replica and micro-CT assessment methods. Four assessment points of each replica cross-section and micro-CT image were evaluated using imaging software: marginal gap (MG), axial wall (AW), axio-occlusal angle (AO) and mid-occlusal wall (MO). Data were statistically analyzed by factorial ANOVA and Tukey test (a=0.05). There was no statistically significant difference between the methods for MG and AW. For AO, there were significant differences between methods for Amann copings, while for Dentsply-Sirona copings similar values were observed. For MO, both methods presented statistically significant differences. A positive correlation was observed determined by the two assessment methods for MG values. In conclusion, the assessment method influenced the evaluation of marginal and internal adaptation of zirconia copings. Micro-CT showed lower marginal and internal gap values when compared to the silicone replica technique, although the difference was not always statistically significant. Marginal gap and axial wall assessment points showed the lower gap values, regardless of ceramic system and assessment method used.

  11. Marginal and Internal Adaptation of Zirconia Crowns: A Comparative Study of Assessment Methods

    OpenAIRE

    Cunali, Rafael Schlögel; Saab, Rafaella Caramori; Correr, Gisele Maria; Cunha, Leonardo Fernandes da; Ornaghi, Bárbara Pick; Ritter, André V.; Gonzaga, Carla Castiglia

    2017-01-01

    Abstract Marginal and internal adaptation is critical for the success of indirect restorations. New imaging systems make it possible to evaluate these parameters with precision and non-destructively. This study evaluated the marginal and internal adaptation of zirconia copings fabricated with two different systems using both silicone replica and microcomputed tomography (micro-CT) assessment methods. A metal master model, representing a preparation for an all-ceramic full crown, was digitally...

  12. Comparison of seismic margin assessment and probabilistic risk assessment in seismic IPE

    International Nuclear Information System (INIS)

    Reed, J.W.; Kassawara, R.P.

    1993-01-01

    A comparison of technical requirements and managerial issues between seismic margin assessment (SMA) and seismic probabilistic risk assessment (SPRA) in a seismic Individual Plant Examination (IPE) is presented and related to requirements for an Unresolved Safety Issue (USI) A-46 review which is required for older nuclear power plants. Advantages and disadvantages are discussed for each approach. Technical requirements reviewed for a seismic IPE include: scope of plants covered, seismic input, scope of review, selection of equipment, required experience and training of engineers, walkdown procedure, evaluation of components, relay review, containment review, quality assurance, products, documentation requirements, and closure procedure. Managerial issues discussed include regulatory acceptability, compatibility with seismic IPE, compliance with seismic IPE requirements, ease of use by utilities, and relative cost

  13. Characterization of field margins in intensified agro-ecosystems-why narrow margins should matter in terrestrial pesticide risk assessment and management.

    Science.gov (United States)

    Hahn, Melanie; Lenhardt, Patrick P; Brühl, Carsten A

    2014-07-01

    Field margins are important seminatural habitats in agro-ecosystems, but they can be negatively affected by pesticide inputs via direct overspray and spray drift. In Germany, risk mitigation measures (like buffer zones) to reduce pesticide inputs in terrestrial noncrop habitats do not have to be put in place by farmers next to narrow field margins (Hedgerows were only occasionally recorded. Hence, narrow grassy field margins can represent a large part of the available seminatural habitats adjoining agricultural sites and potentially act as corridors between further habitat patches. For this reason, these margins should be protected from pesticide inputs, at least in landscapes under intensive agricultural use. Field margins are also the main, so-called nontarget habitat protected by the terrestrial risk assessment for plants and arthropods. With many (narrow) margins not considered relevant for risk management, the current practice for protecting the biodiversity from negative effects of pesticides seems questionable. More data on field margin constitution in Germany and other European countries is necessary to critically assess the current practice of pesticide risk assessment and management on a larger scale. © 2014 SETAC.

  14. Stall Margin Improvement in a Centrifugal Compressor through Inducer Casing Treatment

    Directory of Open Access Journals (Sweden)

    V. V. N. K. Satish Koyyalamudi

    2016-01-01

    Full Text Available The increasing trend of high stage pressure ratio with increased aerodynamic loading has led to reduction in stable operating range of centrifugal compressors with stall and surge initiating at relatively higher mass flow rates. The casing treatment technique of stall control is found to be effective in axial compressors, but very limited research work is published on the application of this technique in centrifugal compressors. Present research was aimed to investigate the effect of casing treatment on the performance and stall margin of a high speed, 4 : 1 pressure ratio centrifugal compressor through numerical simulations using ANSYS CFX software. Three casing treatment configurations were developed and incorporated in the shroud over the inducer of the impeller. The predicted performance of baseline compressor (without casing treatment was in good agreement with published experimental data. The compressor with different inducer casing treatment geometries showed varying levels of stall margin improvement, up to a maximum of 18%. While the peak efficiency of the compressor with casing treatment dropped by 0.8%–1% compared to the baseline compressor, the choke mass flow rate was improved by 9.5%, thus enhancing the total stable operating range. The inlet configuration of the casing treatment was found to play an important role in stall margin improvement.

  15. Developing tools to identify marginal lands and assess their potential for bioenergy production

    Science.gov (United States)

    Galatsidas, Spyridon; Gounaris, Nikolaos; Dimitriadis, Elias; Rettenmaier, Nils; Schmidt, Tobias; Vlachaki, Despoina

    2017-04-01

    The term "marginal land" is currently intertwined in discussions about bioenergy although its definition is neither specific nor firm. The uncertainty arising from marginal land classification and quantification is one of the major constraining factors for its potential use. The clarification of political aims, i.e. "what should be supported?" is also an important constraining factor. Many approaches have been developed to identify marginal lands, based on various definitions according to the management goals. Concerns have been frequently raised regarding the impacts of marginal land use on environment, ecosystem services and sustainability. Current tools of soil quality and land potentials assessment fail to meet the needs of marginal land identification and exploitation for biomass production, due to the lack of comprehensive analysis of interrelated land functions and their quantitative evaluation. Land marginality is determined by dynamic characteristics in many cases and may therefore constitute a transitional state, which requires reassessment in due time. Also, marginal land should not be considered simply a dormant natural resource waiting to be used, since it may already provide multiple benefits and services to society relating to wildlife, biodiversity, carbon sequestration, etc. The consequences of cultivating such lands need to be fully addressed to present a balanced view of their sustainable potential for bioenergy. This framework is the basis for the development of the SEEMLA tools, which aim at supporting the identification, assessment, management of marginal lands in Europe and the decision-making for sustainable biomass production of them using appropriate bioenergy crops. The tools comprise two applications, a web-based one (independent of spatial data) and a GIS-based application (land regionalization on the basis of spatial data), which both incorporate: - Land resource characteristics, restricting the cultivation of agricultural crops but

  16. Marginal Generation Technology in the Chinese Power Market towards 2030 Based on Consequential Life Cycle Assessment

    DEFF Research Database (Denmark)

    Zhao, Guangling; Guerrero, Josep M.; Pei, Yingying

    2016-01-01

    generation, which is the same scenario in the North and Northwest China Grid. In the Northeast, East, and Central China Grid, nuclear power gradually replaces coal-fired electricity and becomes the marginal technology. In the Southwest China Grid and the China Southern Power Grid, the marginal electricity......Electricity consumption is often the hotspot of life cycle assessment (LCA) of products, industrial activities, or services. The objective of this paper is to provide a consistent, scientific, region-specific electricity-supply-based inventory of electricity generation technology for national...... and regional power grids. Marginal electricity generation technology is pivotal in assessing impacts related to additional consumption of electricity. China covers a large geographical area with regional supply grids; these are arguably equally or less integrated. Meanwhile, it is also a country with internal...

  17. INFLUENCE OF POST-CURE TREATMENTS ON HARDNESS AND MARGINAL ADAPTATION OF COMPOSITE RESIN INLAY RESTORATIONS: AN IN VITRO STUDY

    Science.gov (United States)

    Poskus, Laiza Tatiana; Latempa, Antonio Marcelo Accetta; Chagas, Maurício Alves; da Silva, Eduardo Moreira; Leal, Mariana Pareira da Silva; Guimarães, José Guilherme Antunes

    2009-01-01

    Objectives: The purpose of this study was to evaluate the Vickers hardness number (VHN) and the in vitro marginal adaptation of inlay restorations of three hybrid composite resins (Filtek Z250, Opallis and Esthet-X) subjected to two post-cure treatments. Material and Methods: For the microhardness test, three different groups were prepared in accordance with the post-cure treatments: control group (only light cure for 40 s), autoclave group (light cure for 40 s + autoclave for 15 min at 130°C); and microwave group (light cure for 40 s + microwave for 3 min at 450 W). To assess the marginal adaptation, the composite resin was inserted incrementally into a mesial-occlusal-distal cavity brass mold and each increment light-cured for 40 s. A previous reading in micrometers was taken at the cervical wall, using a stereomicroscope magnifying glass equipped with a digital video camera and image-analysis software. Subsequently, the specimens were subjected to the post-cure treatments (autoclave and microwave) and a reading was taken again at the cervical wall. Data were compared using ANOVA for the hardness test, split-plot ANOVA for the adaptation assessment and Tukey's test for multiple comparisons. A significance level of 5% was adopted for all analyses. Results: The post-cure treatments increased the hardness of conventional composites (pinlay restorations (pinlays. Moreover, Filtek Z250 showed the best results, with higher hardness and lower gap values. PMID:20027437

  18. The impact of use of an intraoperative margin assessment device on re-excision rates.

    Science.gov (United States)

    Sebastian, Molly; Akbari, Stephanie; Anglin, Beth; Lin, Erin H; Police, Alice M

    2015-01-01

    Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P interest may include an analysis of the effect of using the device on the shavings intra-operatively.

  19. Correspondence between conventional and digitised radiographs for assessment of marginal bone.

    Science.gov (United States)

    Bahrami, Golnosh; Isidor, Flemming; Wenzel, Ann; Vaeth, Michael

    2013-01-01

    To compare reproducibility of marginal bone measurements in conventional film and digitised radiographs and to assess whether variations in reproducibility occurred in measurements taken in a longitudinal, epidemiological survey. Triplicate measurements of the marginal bone level and of remaining bone were obtained from film and digitised full-mouth radiographic surveys from 20 individuals who were examined three times at five-year intervals in a longitudinal study design. The digitalisation of the films was conducted by scanning the film with a flatbed scanner. The standard deviation (SD) of the triplicate measurements served as the statistic for reproducibility. The time spent for recording one radiographic survey, which consisted of 14 periapicals and 2 bitewings, was documented. Statistically significant differences existed in the reproducibility of marginal bone level measurements obtained at the first examination and the two subsequent examinations both for film and digitised radiographs (P < 0.05). The difference in marginal bone level measurements (film vs digitised) was 0.16 mm (SD = 0.45 mm). Similarly, the overall difference in measurements of the remaining bone was 0.12 mm (SD = 0.61 mm). Recording of a digitised survey lasted on average 5 min (SD = 1.5 min), while the recording of a film survey lasted on average 14 min (SD = 1 min). Digitising film is an acceptable method for the purpose of assessing the marginal bone level and will save time in longitudinal, epidemiological studies.

  20. Intraoperative Assessment of Surgical Margins of Oral Squamous Cell Carcinoma Using Frozen Sections: A Practical Clinicopathological Management for Recurrences

    Directory of Open Access Journals (Sweden)

    Shun Miyota

    2014-01-01

    Full Text Available Background. Local recurrence remains a challenging clinical issue for the treatment of oral squamous cell carcinoma (SCC. We analyzed retrospectively how effective the frozen section technique (FS was against recurrences of oral SCC. Methods. We screened 343 surgical samples from 236 patients who had oral SCC, carcinoma in situ (CIS, or epithelial dysplasia, and we followed up their clinical outcomes for at least 5 years. Histopathological states of surgical margins were compared between FS and surgical materials in relapse and relapse-free groups, respectively. Results. Among the 236 patients, 191 were classified into the relapse-free group, and 45 into the relapse group. FS was more frequently performed in the relapse-free group (128/191 than in the relapse group (83/152. Histopathologically, moderate dysplasia or CIS (borderline malignancies and SCC were recognized in 55 samples of the relapse-free group and in 57 of the relapse group. For those surgical margins with borderline malignancies, additional incisions were performed in 38 of the 55 relapse-free cases, which reduced to 20 from the 38 margins with borderline malignancies (47.4% reduction, and in 39 of the 57 relapse cases, which reduced to only 3 of 39 (7.7% reduction. Conclusions. The intraoperative assessment of surgical margins by FS is essential in preventing recurrences of oral mucosal malignancies.

  1. Assessing marginal, threshold and net effects of financial globalisation on financial development in Africa

    OpenAIRE

    Asongu, Simplice

    2017-01-01

    The present inquiry contributes to extant literature by simultaneously accounting for variations in financial development and financial globalisation in the assessment of hypothetical initial financial development conditions for the rewards of financial globalisation. For this purpose, we examine marginal, threshold and net effects of financial globalisation on financial development throughout the conditional distributions of financial development. The empirical evidence is based on contempor...

  2. Pricing implications of non-marginal budgetary impacts in health technology assessment : a conceptual model

    NARCIS (Netherlands)

    Howdon, Daniel David Henry; Lomas, James Richard Scott

    2017-01-01

    This paper introduces a framework by which to conceptualise the decision-making process in health technology assessment when the quantity of health forgone by acceptance is high enough such that the use of a single threshold based on the marginal productivity of the health care system is

  3. Deriving margins in prostate cancer radiotherapy treatment: comparison of neural network and fuzzy logic models.

    Science.gov (United States)

    Mzenda, Bongile; Gegov, Alexander; Brown, David J; Petrov, Nedyalko

    2012-01-01

    This study investigates the feasibility of using Artificial Neural Network (ANN) and fuzzy logic based techniques to select treatment margins for dynamically moving targets in the radiotherapy treatment of prostate cancer. The use of data from 15 patients relating error effects to the Tumour Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) radiobiological indices was contrasted against the use of data based on the prostate volume receiving 99% of the prescribed dose (V99%) and the rectum volume receiving more than 60Gy (V60). For the same input data, the results of the ANN were compared to results obtained using a fuzzy system, a fuzzy network and current clinically used statistical techniques. Compared to fuzzy and statistical methods, the ANN derived margins were found to be up to 2 mm larger at small and high input errors and up to 3.5 mm larger at medium input error magnitudes.

  4. Seismic Margin Assessment and Reinforcement of Safety-Related Equipment Considering its Anchorage Degradation

    International Nuclear Information System (INIS)

    Choi, Ho-Sam; Jung, Dong-Yeoul

    2012-01-01

    This paper describes the overall approach and review results of the Seismic Margin Assessment (SMA) for safety-related equipment considering anchorage degradation. The equipment seismic reinforcement performed following the SMA review results is also described. The SMA review was based on the methodology in EPRI Reports NP-6041 and NP-7498, and it was conducted using the data obtained from the USI A-46 seismic evaluation. The seismic margin earthquake selected for SMA review was based on the recommendations in EPRI NP-6041 and NUREG-1407, and it has a peak ground acceleration (PGA) of 0.3g. (author)

  5. Energy system analyses of the marginal energy technology in life cycle assessments

    DEFF Research Database (Denmark)

    Mathiesen, Brian Vad; Münster, Marie; Fruergaard, Thilde

    2007-01-01

    . The differences in applying energy system analysis compared to assum- ing a marginal electricity technology are illustrated. Through the analysis, the current recommended ap- proach of consequential LCA is challenged. In the conclusions, recommendations for identifying affected technologies for consequential LCAs......In life cycle assessments consequential LCA is used as the “state-of-the-art” methodology, which focuses on the consequences of decisions made in terms of system boundaries, allocation and selection of data, simple and dynamic marginal technology, etc.(Ekvall & Weidema 2004). In many LCA studies......, the energy demand applied is decisive for the results. In this extended abstract, consequential LCA methodology is examined with electricity as the case. The aim is to answer three questions: Which are the expected vs. the actual marginal electricity production technologies and what may be the future...

  6. Assessment of tsunami hazard to the U.S. Atlantic margin

    Science.gov (United States)

    ten Brink, Uri S.; Chaytor, Jason; Geist, Eric L.; Brothers, Daniel S.; Andrews, Brian D.

    2014-01-01

    Tsunami hazard is a very low-probability, but potentially high-risk natural hazard, posing unique challenges to scientists and policy makers trying to mitigate its impacts. These challenges are illustrated in this assessment of tsunami hazard to the U.S. Atlantic margin. Seismic activity along the U.S. Atlantic margin in general is low, and confirmed paleo-tsunami deposits have not yet been found, suggesting a very low rate of hazard. However, the devastating 1929 Grand Banks tsunami along the Atlantic margin of Canada shows that these events continue to occur. Densely populated areas, extensive industrial and port facilities, and the presence of ten nuclear power plants along the coast, make this region highly vulnerable to flooding by tsunamis and therefore even low-probability events need to be evaluated.

  7. Marginal Generation Technology in the Chinese Power Market towards 2030 Based on Consequential Life Cycle Assessment

    OpenAIRE

    Zhao, Guangling; Guerrero, Josep M.; Pei, Yingying

    2016-01-01

    Electricity consumption is often the hotspot of life cycle assessment (LCA) of products, industrial activities, or services. The objective of this paper is to provide a consistent, scientific, region-specific electricity-supply-based inventory of electricity generation technology for national and regional power grids. Marginal electricity generation technology is pivotal in assessing impacts related to additional consumption of electricity. China covers a large geographical area with regional...

  8. Head and Neck Margin Reduction With Adaptive Radiation Therapy: Robustness of Treatment Plans Against Anatomy Changes

    Energy Technology Data Exchange (ETDEWEB)

    Kranen, Simon van; Hamming-Vrieze, Olga; Wolf, Annelisa; Damen, Eugène [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands); Herk, Marcel van [Christie Hospital and University of Manchester, Manchester (United Kingdom); Sonke, Jan-Jakob, E-mail: j.sonke@nki.nl [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands)

    2016-11-01

    Purpose: We set out to investigate loss of target coverage from anatomy changes in head and neck cancer patients as a function of applied safety margins and to verify a cone beam computed tomography (CBCT)–based adaptive strategy with an average patient anatomy to overcome possible target underdosage. Methods and Materials: For 19 oropharyngeal cancer patients, volumetric modulated arc therapy treatment plans (2 arcs; simultaneous integrated boost, 70 and 54.25 Gy; 35 fractions) were automatically optimized with uniform clinical target volume (CTV)–to–planning target volume margins of 5, 3, and 0 mm. We applied b-spline CBCT–to–computed tomography (CT) deformable registration to allow recalculation of the dose on modified CT scans (planning CT deformed to daily CBCT following online positioning) and dose accumulation in the planning CT scan. Patients with deviations in primary or elective CTV coverage >2 Gy were identified as candidates for adaptive replanning. For these patients, a single adaptive intervention was simulated with an average anatomy from the first 10 fractions. Results: Margin reduction from 5 mm to 3 mm to 0 mm generally led to an organ-at-risk (OAR) mean dose (D{sub mean}) sparing of approximately 1 Gy/mm. CTV shrinkage was mainly seen in the elective volumes (up to 10%), likely related to weight loss. Despite online repositioning, substantial systematic errors were present (>3 mm) in lymph node CTV, the parotid glands, and the larynx. Nevertheless, the average increase in OAR dose was small: maximum of 1.2 Gy (parotid glands, D{sub mean}) for all applied margins. Loss of CTV coverage >2 Gy was found in 1, 3, and 7 of 73 CTVs, respectively. Adaptive intervention in 0-mm plans substantially improved coverage: in 5 of 7 CTVs (in 6 patients) to <2 Gy of initially planned. Conclusions: Volumetric modulated arc therapy head and neck cancer treatment plans with 5-mm margins are robust for anatomy changes and show a modest

  9. Head and Neck Margin Reduction With Adaptive Radiation Therapy: Robustness of Treatment Plans Against Anatomy Changes

    International Nuclear Information System (INIS)

    Kranen, Simon van; Hamming-Vrieze, Olga; Wolf, Annelisa; Damen, Eugène; Herk, Marcel van; Sonke, Jan-Jakob

    2016-01-01

    Purpose: We set out to investigate loss of target coverage from anatomy changes in head and neck cancer patients as a function of applied safety margins and to verify a cone beam computed tomography (CBCT)–based adaptive strategy with an average patient anatomy to overcome possible target underdosage. Methods and Materials: For 19 oropharyngeal cancer patients, volumetric modulated arc therapy treatment plans (2 arcs; simultaneous integrated boost, 70 and 54.25 Gy; 35 fractions) were automatically optimized with uniform clinical target volume (CTV)–to–planning target volume margins of 5, 3, and 0 mm. We applied b-spline CBCT–to–computed tomography (CT) deformable registration to allow recalculation of the dose on modified CT scans (planning CT deformed to daily CBCT following online positioning) and dose accumulation in the planning CT scan. Patients with deviations in primary or elective CTV coverage >2 Gy were identified as candidates for adaptive replanning. For these patients, a single adaptive intervention was simulated with an average anatomy from the first 10 fractions. Results: Margin reduction from 5 mm to 3 mm to 0 mm generally led to an organ-at-risk (OAR) mean dose (D mean ) sparing of approximately 1 Gy/mm. CTV shrinkage was mainly seen in the elective volumes (up to 10%), likely related to weight loss. Despite online repositioning, substantial systematic errors were present (>3 mm) in lymph node CTV, the parotid glands, and the larynx. Nevertheless, the average increase in OAR dose was small: maximum of 1.2 Gy (parotid glands, D mean ) for all applied margins. Loss of CTV coverage >2 Gy was found in 1, 3, and 7 of 73 CTVs, respectively. Adaptive intervention in 0-mm plans substantially improved coverage: in 5 of 7 CTVs (in 6 patients) to <2 Gy of initially planned. Conclusions: Volumetric modulated arc therapy head and neck cancer treatment plans with 5-mm margins are robust for anatomy changes and show a modest increase in OAR

  10. Treatment of intestinal pythiosis in a dog with a combination of marginal excision, chemotherapy, and immunotherapy.

    Science.gov (United States)

    Schmiedt, Chad W; Stratton-Phelps, Meri; Torres, Bryan T; Bell, Dennis; Uhl, Elizabeth W; Zimmerman, Shawn; Epstein, Jason; Cornell, Karen K

    2012-08-01

    A 1.5-year-old mixed-breed dog was examined because of a 1-month history of anorexia, vomiting, diarrhea, and weight loss. The dog was very thin on physical examination (body condition score, 3/9). Results of all diagnostic tests were within reference limits except intestinal thickening and lymphadenopathy were identified on abdominal ultrasound examination. During exploratory laparotomy, thickening at the ileocecal-colic junction and within the transverse colon and mesenteric lymphadenopathy were identified, and the ileocecal-colic junction was resected. Histopathologic evaluation of the ileocecal-colic junction and full-thickness biopsy specimens from other sites as well as results of a serum ELISA were diagnostic for gastrointestinal Pythium insidiosum infection. Pythiosis was initially treated medically with administration of itraconazole and terbinafine by mouth, but the colonic lesion was progressive with this regimen. Two months after diagnosis, a subtotal colectomy was performed; marginal excision (0.6 cm) was obtained at the aboral margin. The dog was treated with 3 doses of a pythiosis vaccine beginning approximately 2 weeks after surgery and was continued on itraconazole and terbinafine for 5 months. Parenteral and enteral nutrition as well as considerable general supportive care were required postoperatively. Six months after treatment, the dog had a normal serum ELISA titer. Two years after treatment, the dog had returned to preoperative weight and was clinically normal. This patient had an unusually positive therapeutic response to chronic, extensive, marginally excised gastrointestinal pythiosis.

  11. Shaved margin histopathology and imprint cytology for assessment of excision in canine mast cell tumors and soft tissue sarcomas.

    Science.gov (United States)

    Milovancev, Milan; Townsend, Kaitlin L; Gorman, Elena; Bracha, Shay; Curran, Katie; Russell, Duncan S

    2017-08-01

    To determine the feasibility and agreement of margin assessment by imprint cytology, shaved margin histopathology, and radial section histopathology in canine cutaneous and subcutaneous mast cell tumors (MCT) and soft tissue sarcomas (STS). Prospective clinical study. Three hundred and forty margins from 72 excised tumors (52 MCT and 20 STS) in 54 client-owned dogs. Imprint cytology samples were acquired by pressing glass slides to the cut surgical margin of the freshly excised surgical specimen. Shaved margin samples were obtained from the patient wound bed using a scalpel immediately prior to closure. Radial section histopathology was performed as part of routine histopathologic processing. All margins were assessed as either positive or negative for presence of tumor cells at the surgical margin. Agreement among methods was calculated using Fleiss Kappa coefficients and an association of method, margin direction, and tumor type with positive margin status was evaluated using a general linear mixed model. Positive margin detection rates differed for MCT (imprint cytology 21%, radial section histopathology 9%, and shaved margin histopathology 3%; P histopathology are feasible, but their results are frequently disparate from routine radial section histopathology. Future studies are needed to evaluate the correlation of each method with local recurrence rates. © 2017 The American College of Veterinary Surgeons.

  12. The effect of maximum bite force on marginal bone loss in mandibular overdenture treatment : an in vivo study

    NARCIS (Netherlands)

    van Kampen, F; Cune, M; van der Bilt, A; Bosman, F

    2005-01-01

    The impact of bite force on the marginal bone response around implants is a subject of debate. This study focused on the effect of maximum bite force on marginal bone levels in mandibular implant overdenture treatment. In addition, the effect of the sequence of 3 different loading conditions on

  13. Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma.

    Science.gov (United States)

    Minami, Yasunori; Minami, Tomohiro; Hagiwara, Satoru; Ida, Hiroshi; Ueshima, Kazuomi; Nishida, Naoshi; Murakami, Takamichi; Kudo, Masatoshi

    2017-12-01

    To assess the clinical feasibility of US-US image overlay fusion with evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Fifty-three patients with 68 HCCs measuring 0.9-4.0 cm who underwent RFA guided by US-US overlay image fusion were included in this retrospective study. By an overlay of pre-/postoperative US, the tumor image could be projected onto the ablative hyperechoic zone. Therefore, the ablative margin three-dimensionally could be shown during the RFA procedure. US-US image overlay was compared to dynamic CT a few days after RFA for assessment of early treatment response. Accuracy of graded response was calculated, and the performance of US-US image overlay fusion was compared with that of CT using a Kappa agreement test. Technically effective ablation was achieved in a single session, and 59 HCCs (86.8 %) succeeded in obtaining a 5-mm margin on CT. The response with US-US image overlay correctly predicted early CT evaluation with an accuracy of 92.6 % (63/68) (k = 0.67; 95 % CI: 0.39-0.95). US-US image overlay fusion can be proposed as a feasible guidance in RFA with a safety margin and predicts early response of treatment assessment with high accuracy. • US-US image overlay fusion visualizes the ablative margin during RFA procedure. • Visualizing the margin during the procedure can prompt immediate complementary treatment. • US image fusion correlates with the results of early evaluation CT.

  14. Market modeling for assessment of demand side programs using the marginal cost

    International Nuclear Information System (INIS)

    Papastamatiou, Panagiotis; Psarras, John

    2000-01-01

    Demand side management is nowadays considered as a functional step in the energy planning process. The criteria proposed for the assessment of the demand side programs (DSPs) are usually based on the balance between the marginal supply cost and the mean DSP cost. These criteria could not support the allotting of the invested capital to incentives for the consumers and advertising. This paper presents a methodology to support the utility planning at this point with more reliability. It proposes the expansion of the assessment criteria with the use of the marginal cost of the DSP. For the calculation of the DSP marginal cost, a dynamic model is developed and it is used for the simulation of the penetration of a DS Program. Using the 'least-cost' criterion as the decision rule for the simulation, the planner has a distribution of the available investment capital throughout the whole planning period. The use of the 'most-value' criterion supports the separation of the invested capital between incentives for the consumers and supportive expenses, e.g. advertising, marketing cost, etc. (Author)

  15. Safety Margin Assessment (SM2A): Stimulation for Further Development of BEPU Approaches?

    International Nuclear Information System (INIS)

    Zimmermann, Martin A.

    2013-01-01

    During recent years, many nuclear power plants underwent significant modifications, e.g. power up-rating. While compliance with all the deterministic acceptance criteria must be shown during the licensing process, the larger core inventory and the facts that the plant response might get closer to the limits after a power up-rate, suggest an increase of the core damage frequency (CDF) and other possible risk indicators. Hence, a framework to quantitatively assess a change in plant safety margin becomes very desirable. The Committee on the Safety of Nuclear Installations (CSNI) mandated the Safety Margin Action Plan expert group (SMAP) to develop a framework for the assessment of such changes to safety margin. This framework combines PSA and the analytical techniques developed in BEPU. CSNI then mandated the SM2A expert group to especially explore the practicability of the SMAP framework. This pilot study was completed end of 2010. An increase of the (conditional) probability of exceedance for a surrogate acceptance limit (PCT) indicating core damage was successfully evaluated for the selected sequences from several initiating event trees, and it was found that only a restricted number of sequences need to be analyzed. Based on the insights gained from this study, areas of methodology improvement have been identified and related proposals for further R and D work will be discussed. (authors)

  16. A Pareto analysis approach to assess relevant marginal CO{sub 2} footprint for petroleum products

    Energy Technology Data Exchange (ETDEWEB)

    Tehrani, Nejad M. Alireza, E-mail: alireza.tehraninejad@gmail.com

    2015-07-15

    Recently, linear programing (LP) models have been extended to track the marginal CO{sub 2} intensity of automotive fuels at the refinery gate. The obtained CO{sub 2} data are recommended for policy making because they capture the economic and environmental tensions as well as the processing effects related to oil products. However, they are proven to be extremely sensitive to small perturbations and therefore useless in practice. In this paper, we first investigate the theoretical reasons of this drawback. Then, we develop a multiple objective LP framework to assess relevant marginal CO{sub 2} footprints that preserve both defensibility and stability at a satisfactory level of acceptance. A case study illustrates this new methodology. - Highlights: • Refining LP models have limitations to provide useful marginal CO{sub 2} footprints. • A multi objective optimization framework is developed to assess relevant CO{sub 2} data. • Within a European Refinig industry, diesel is more CO{sub 2} intensive than gasoline.

  17. A margin-of-the-day online adaptive intensity-modulated radiotherapy strategy for cervical cancer provides superior treatment accuracy compared to clinically recommended margins: a dosimetric evaluation.

    Science.gov (United States)

    Ahmad, Rozilawati; Bondar, Luiza; Voet, Peter; Mens, Jan-Willem; Quint, Sandra; Dhawtal, Glenn; Heijmen, Ben; Hoogeman, Mischa

    2013-10-01

    To dosimetrically evaluate a margin-of-the-day (MoD) online adaptive intensity-modulated radiotherapy (IMRT) strategy for cervical cancer patients. The strategy is based on a single planning computed tomography (CT) scan and a pretreatment constructed IMRT plan library with incremental clinical target volumes (CTV)-to-planning target volumes (PTV) margins. For 14 patients, 9-10 variable bladder filling CT scans acquired at pretreatment and after 40 Gy were available. Bladder volume variability during the treatment course was recorded by twice-weekly US bladder-volume measurements. A MoD strategy that selects the best IMRT plan of the day from a library of plans with incremental margins in steps of 5 mm was compared with a clinically recommended population-based margin (15 mm). To compare the strategies, for each fraction that had a recorded US bladder-volume measurement, the CT scan with the nearest bladder volume was selected from the pretreatment CT series and from the CT series acquired after 40 Gy. A frequency-weighted average of the dose-volume histograms (DVH) parameters calculated for the two selected CT scans was used to estimate the DVH parameters of the fraction of interest. The 15-mm recommended margin resulted in cervix-uterus underdosage in six of 14 patients. Compared with the 15-mm margin, the MoD strategy resulted in significantly better cervix-uterus coverage (p = 0.008) without a significant difference in the sparing of rectum, bladder, and small bowel. For each patient, 3-8 (median 5) plans were needed in the library of plans for the MoD strategy. The required range of the MoD was 5-45 mm (median 15 mm). Twenty-five percent of all fractions could be treated with a MoD of 5 mm and 81% of all fractions could be treated with a MoD up to 25 mm. Compared with a clinically recommended margin, a simple online adaptive strategy resulted in better cervix-uterus coverage without compromising organs at risk sparing.

  18. Use of response envelopes for seismic margin assessment of reinforced concrete walls and slabs

    Energy Technology Data Exchange (ETDEWEB)

    Ile, Nicolas; Frau, Alberto, E-mail: alberto.frau@cea.fr

    2017-04-01

    Highlights: • Proposal of a method for application of the elliptical envelope to RC shell elements. • Proposal of new algorithms for the seismic margin evaluation for RC shell elements. • Verification of a RC wall 3D structure, using the proposed assessment approach. - Abstract: Seismic safety evaluations of existing nuclear facilities are usually based on the assumption of structural linearity. For the design basis earthquake (DBE), it is reasonable to apply a conventional evaluation of the seismic safety of building structures and carry out a linear elastic analysis to assess the load effects on structural elements. Estimating the seismic capacity of a structural element requires an estimation of the critical combination of responses acting in this structural element and compare this combination with the capacity of the element. By exploiting the response-spectrum-based procedure for predicting the response envelopes in linear structures formulated by Menun and Der Kiureghian (2000a), algorithms are developed for the seismic margin assessment of reinforced concrete shell finite elements. These algorithms facilitate the comparison of the response-spectrum-based envelopes to prescribed capacity surfaces for the purpose of assessing the safety margin of this kind of structures. The practical application of elliptical response envelopes in case of shell finite elements is based on the use of layer models such as those developed by Marti (1990), which transfer the generalized stress field to three layers under the assumption that the two outer layers carry membrane forces and the internal layer carries only the out-of-plane shears. The utility of the assessment approach is discussed with reference to a case study of a 3D structure made of reinforced concrete walls.

  19. Seismic safety margin assessment program (Annual safety research report, JFY 2010)

    International Nuclear Information System (INIS)

    Suzuki, Kenichi; Iijima, Toru; Inagaki, Masakatsu; Taoka, Hideto; Hidaka, Shinjiro

    2011-01-01

    Seismic capacity test data, analysis method and evaluation code provided by Seismic Safety Margin Assessment Program have been utilized for the support of seismic back-check evaluation of existing plants. The summary of the program in 2010 is as follows. 1. Component seismic capacity test and quantitative seismic capacity evaluation. Many seismic capacity tests of various snubbers were conducted and quantitative seismic capacities were evaluated. One of the emergency diesel generator partial-model seismic capacity tests was conducted and quantitative seismic capacity was evaluated. Some of the analytical evaluations of piping-system seismic capacities were conducted. 2. Analysis method for minute evaluation of component seismic response. The difference of seismic response of large components such as primary containment vessel and reactor pressure vessel when they were coupled with 3-dimensional FEM building model or 1-dimensional lumped mass building model, was quantitatively evaluated. 3. Evaluation code for quantitative evaluation of seismic safety margin of systems, structures and components. As the example, quantitative evaluation of seismic safety margin of systems, structures and components were conducted for the reference plant. (author)

  20. Safety assessment for the passive system of the nuclear power plants (NPPs) using safety margin estimation

    International Nuclear Information System (INIS)

    Woo, Tae-Ho; Lee, Un-Chul

    2010-01-01

    The probabilistic safety assessment (PSA) for gas-cooled nuclear power plants has been investigated where the operational data are deficient, because there is not any commercial gas-cooled nuclear power plant. Therefore, it is necessary to use the statistical data for the basic event constructions. Several estimations for the safety margin are introduced for the quantification of the failure frequency in the basic event, which is made by the concept of the impact and affordability. Trend of probability of failure (TPF) and fuzzy converter (FC) are introduced using the safety margin, which shows the simplified and easy configurations for the event characteristics. The mass flow rate in the natural circulation is studied for the modeling. The potential energy in the gravity, the temperature and pressure in the heat conduction, and the heat transfer rate in the internal stored energy are also investigated. The values in the probability set are compared with those of the fuzzy set modeling. Non-linearity of the safety margin is expressed by the fuzziness of the membership function. This artificial intelligence analysis of the fuzzy set could enhance the reliability of the system comparing to the probabilistic analysis.

  1. Assessment of unhealthy days of urban marginal inhabitants and effective factors in Mashhad, Iran

    Directory of Open Access Journals (Sweden)

    Maliheh Ziaee

    2016-01-01

    Full Text Available Background: The concept of the quality of life (HRQOL related to health and its determinants contain aspects of quality of life that clearly affect people’s physical or mental health. One of the newest ways to assess the health and also the quality of life-related to health is the self-assessed health of the individual. The aim of the present study was assessment of unhealthy days, self-reported health status, and its influencing factors on residents of the marginalpart of Mashhad, Iran. Methods: In the current cross-sectional study, 580 citizens of the marginal regions and slum areas of Mashhad city were enrolled through cluster sampling method using governmental health care services divisions. The Persian version of the questionnaire CDC HRQOL-4 was used to measure the unhealthy days. Data was analyzed using SPSS, version 11.5, running ANOVA, chi-square, and t-tests. P-value of less than 0.05 was considered as statistically significant. Results: In the present study, 359 persons (61% were women and the mean age of participants was 32.6±11.51 years. The means of unhealthy days, physically unhealthy days, mentally unhealthy days, and days with dysfunction were found to be 7.2, 2.8, 4.1, and 1.7 days, respectively. The unhealthiest days (physical and mental were seen in unemployed people and the best to excellent health days were seen in housewives. Conclusion: Unhealthy days and days with dysfunction were reported higher in slum inhabitants, especially female, low literacy, and housewife participants. Providing the education and employment facilities for people who live in marginal city areas might decrease the unhealthy days.Keywords: Unhealthy days; Health; Urban Marginal Inhabitants; Mashhad

  2. Trichotillomania: Assessment, Diagnosis, and Treatment

    Science.gov (United States)

    Kress, Victoria E. White; Kelly, Brandy L.; McCormick, Laura J.

    2004-01-01

    This article examines the assessment, diagnosis, and treatment of trichotillomania (the recurrent desire to pull out one's hair). The authors provide a brief review both of proposed etiologies of trichotillomania and of the diagnostic and assessment issues related to this disorder, and they discuss interventions and treatments that have been shown…

  3. Quantifying Appropriate PTV Setup Margins: Analysis of Patient Setup Fidelity and Intrafraction Motion Using Post-Treatment Megavoltage Computed Tomography Scans

    International Nuclear Information System (INIS)

    Drabik, Donata M.; MacKenzie, Marc A.; Fallone, Gino B.

    2007-01-01

    Purpose: To present a technique that can be implemented in-house to evaluate the efficacy of immobilization and image-guided setup of patients with different treatment sites on helical tomotherapy. This technique uses an analysis of alignment shifts between kilovoltage computed tomography and post-treatment megavoltage computed tomography images. The determination of the shifts calculated by the helical tomotherapy software for a given site can then be used to define appropriate planning target volume internal margins. Methods and Materials: Twelve patients underwent post-treatment megavoltage computed tomography scans on a helical tomotherapy machine to assess patient setup fidelity and net intrafraction motion. Shifts were studied for the prostate, head and neck, and glioblastoma multiforme. Analysis of these data was performed using automatic and manual registration of the kilovoltage computed tomography and post-megavoltage computed tomography images. Results: The shifts were largest for the prostate, followed by the head and neck, with glioblastoma multiforme having the smallest shifts in general. It appears that it might be more appropriate to use asymmetric planning target volume margins. Each margin value reported is equal to two standard deviations of the average shift in the given direction. Conclusion: This method could be applied using individual patient post-image scanning and combined with adaptive planning to reduce or increase the margins as appropriate

  4. Life Cycle Assessment of Bioenergy from Lignocellulosic Crops Cultivated on Marginal Land in Europe

    Science.gov (United States)

    Rettenmaier, Nils; Schmidt, Tobias; Gärtner, Sven; Reinhardt, Guido

    2017-04-01

    Population growth and changing diets due to economic development lead to an additional demand for land for food and feed production. Slowly but surely turning into a mass market, also the cultivation of non-food biomass crops for fibre (bio-based products) and fuel (biofuels and bioenergy) is increasingly contributing to the pressure on global agricultural land. As a consequence, the already prevailing competition for land might even intensify over the next decades. Against this background, the possibilities of shifting the cultivation of non-food biomass crops to so-called 'marginal lands' are investigated. The EC-funded project 'Sustainable exploitation of biomass for bioenergy from marginal lands in Europe' (SEEMLA) aims at the establishment of suitable innovative land-use strategies for a sustainable production of bioenergy from lignocellulosic crops on marginal lands while improving general ecosystem services. For a complete understanding of the environmental benefits and drawbacks of the envisioned cultivation of bioenergy crops on marginal land, life cycle assessments (LCA) have proven to be a suitable and valuable tool. Thus, embedded into a comprehensive sustainability assessment, a screening LCA is carried out for the entire life cycles of the bioenergy carriers researched in SEEMLA. Investigated systems, on the one hand, include the specific field trials carried out by the SEEMLA partners in Ukraine, Greece and Germany. On the other hand, generic scenarios are investigated in order to derive reliable general statements on the environmental impacts of bioenergy from marginal lands in Europe. Investigated crops include woody and herbaceous species such as black locust, poplar, pine, willow and Miscanthus. Conversion technologies cover the use in a domestic or a district heating plant, power plant, CHP as well as the production of Fischer-Tropsch diesel (FT diesel) and lignocellulosic ethanol. Environmental impacts are compared to conventional reference

  5. A useful alternative approach for the treatment of well-demarcated Basal cell carcinoma: surgical excision and margin control with tzanck smear test.

    Science.gov (United States)

    Baba, Mete; Durdu, Murat; Seçkin, Deniz

    2010-05-01

    To analyze the accuracy of the Tzanck smear test (TST) for margin control in surgery for well-demarcated basal cell carcinoma (BCC). Twenty-one patients with well-demarcated BCC were included in this study. After local anesthesia, the tumors were excised. The pathologist examined the frozen sections. If the tumor cells were observed in the margin, a re-excision was done. This procedure was repeated until the margin was tumor free. After each excision, Tzanck smear samples were taken from the defect area. The samples obtained were stained with May-Grünwald-Giemsa and examined. The accuracy of TST was then analyzed by comparison of the TST results with those of frozen section examination. The sensitivity and specificity of TST for margin assessment were 1.00 (95% confidence interval (CI)=1.00-1.00) and 0.99 (95% CI=0.98-1.00), respectively. Positive and negative predictive values and the diagnostic accuracy for TST were 0.94 (95% CI=0.84-1.05), 1.00 (95% CI=1.00-1.00), and 1.00 (95% CI=0.99-1.00), respectively. No recurrences were observed in the average 2-year follow-up period. The high accuracy of TST for margin control is encouraging to develop a practical alternative approach for the treatment of well-demarcated BCC.

  6. Paniya Voices: A Participatory Poverty and Health Assessment among a marginalized South Indian tribal population

    Directory of Open Access Journals (Sweden)

    Harikrishnadas CK

    2010-03-01

    Full Text Available Abstract Background In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs, are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little 'voice' or power over their own situation. Methods/design We implemented a Participatory Poverty and Health Assessment (PPHA. We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area in a gram panchayat (lowest level decentralized territorial unit to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums. Preliminary findings Findings indicated that the Paniyas are caught in multiple 'vulnerability traps', that is, they view their situation as vicious cycles from which it is difficult to break free. Conclusion The PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities' health needs in an ethical and culturally appropriate manner.

  7. Paniya Voices: a Participatory Poverty and Health Assessment among a marginalized South Indian tribal population.

    Science.gov (United States)

    Mohindra, Ks; Narayana, D; Harikrishnadas, Ck; Anushreedha, Ss; Haddad, Slim

    2010-03-22

    In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little 'voice' or power over their own situation. We implemented a Participatory Poverty and Health Assessment (PPHA). We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender) using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area) in a gram panchayat (lowest level decentralized territorial unit) to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums. PRELIMINARY FINDINGS: Findings indicated that the Paniyas are caught in multiple 'vulnerability traps', that is, they view their situation as vicious cycles from which it is difficult to break free. The PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities' health needs in an ethical and culturally appropriate manner.

  8. Assessing soil quality and potential productivity - a basic approach to define and assess the marginality of land

    Science.gov (United States)

    Repmann, Frank; Gerwin, Werner; Freese, Dirk

    2017-04-01

    An ever growing demand for energy and the widely proposed switch from fossil fuels to more sustainable energy sources puts the cultivation and use of bioenergy plants into focus. However, bioenergy production on regular and fertile agricultural soils might conflict with the worldwide growing demand for food. To mitigate or omit this potential conflict, the use of low quality or marginal land for cultivation of bioenergy plants becomes favorable. Against this background the definition and assessment of land marginality and, respectively, the evaluation whether and to which extent specific areas are marginal and thus convenient for sustainable bioenergy production, becomes highly relevant. Within the framework of the EU funded Horizon 2020 project SEEMLA, we attempted to asses land marginality of designated test sites in the Ukraine, Greece and Germany by direct field survey. For that purpose, soil and site properties were investigated and evaluated by applying the Muencheberg Soil Quality Rating (SQR) method, developed at the Leibniz Centre for Agricultural Landscape Research (ZALF). The method deploys a comprehensive set of biogeophysical and chemical indicators to describe and finally evaluate the quality of the soil and site by a score ranging from 1 to 100 points. Field survey data were supported by additional laboratory tests on a representative set of soil samples. Practical field work and analysis of field and lab data from the investigated sites proved the applicability of the SQR method within the SEEMLA context. The SQR indices calculated from the field and lab data ranged from 2 to Germany, which differed considerably in respect to their characteristics. Correlating the site quality index to yield data reflecting yield estimations for common bioenergy plants such as willow (Salix sp.), black locust (Robinia pseudoacacia) and poplar (Populus sp.) cultivated at the respective test sites, revealed that SQR might additionally reflect the potential yield of

  9. Effect of surface treatment on marginal integrity of amalgam restorations (in vitro study).

    Science.gov (United States)

    Kamel, F M

    1995-07-01

    A total of 80 freshly extracted human molars, free from caries, cracks & decalcifications, were used in this study. Conservative class I cavities were prepared in the occlusal surface. Two types of amalgam alloys were used, high copper (Dispersalloy) & conventional (Velvalloy). The prepared cavities were classified into 5 groups, 16 each carve (C), carve & polish (CP), precarve burnish (BC), past-carve (CB) & pre post carve burnish (BCB). The specimens were thermally stressed using the stress fatigue device. The marginal integrity of the amalgam enamel interface were evaluated using SEM, for the four marginal quantities: 1--excellent margin, 2--open margins, 3--enamel fracture, and 4--amalgam fracture. The results of this study revealed that higher copper amalgam demonstrated superior marginal integrity than the conventional one. The pre-post carve burnish group showed the highest percentage of excellent margin than the other groups.

  10. Economic assessment of Operational Energy reduction options in a house using Marginal Benefit and Marginal Cost: A case in Bangi, Malaysia

    International Nuclear Information System (INIS)

    Wan Rahmah Mohd Zaki; Abdul Hadi Nawawi; Sabarinah Sh Ahmad

    2010-01-01

    Energy Efficient (EE) appliances such as Compact Fluorescent Light (CFL) bulbs and Renewable Energy (RE), namely solar Photovoltaic (PV) can help to reduce Operational Energy (OE) in a house. In addition, a house should also incorporate Passive Architecture (PA) design strategies which in the hot and humid tropical climate, mean avoiding direct heat gain, encouraging natural cross ventilation and optimising the abundant daylight. Nevertheless, reducing OE must also mean economic gain to households to encourage their participation. Common economic gauges such as Return on Investment, Payback Period, Cost Benefit Analysis, Life Cycle Assessment and Life Cycle Cost are not suitable to validate OE options in households. These economic gauges approach economic assessment as an end-result on the cost side of the product and may result for good intention to be shelved, primarily because EE equipment and RE have high capital cost compared with the alternatives. On the other hand, reducing OE in houses is actually a continual progression from the status quo and there is always a marginal gain in doing so. The challenge is to know how much is the marginal benefit against the marginal cost of investing in EE and RE. In Economics, the ratio of Marginal Cost (MC) and Marginal Benefits (MB) measure additional benefits of every additional costs of investment at a specific level of production and consumption; and Economists suggests that effective gain and loss should be compared to the status quo, i.e., Relative Position (RP). The Economics theories of MC, MB and RP are being adapted to measure the progression of reducing OE. The living/dining area in two types of houses: with and without PA design strategies are simulated to use conventional incandescent light bulbs and CFL as well as solar PV in lieu of the mains electricity supply. The power requirement for artificial lighting in every case is translated into monetary value and the ratio of MB against MC for each case shows

  11. Complementary Safety Margin Assessment f the Nuclear Installations of the research reactor in Petten, Netherlands

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-02-15

    On March 11, 2011, a large part of the Japanese eastern coastal area was devastated by an earthquake, followed by an immense tsunami. As a result, thousands of people were killed, injured or made homeless. In the days that followed, the situation was further complicated because of the failing nuclear reactors on the Fukushima coast. The local environment suffered from radioactive releases, requiring evacuation zones, and generating international concerns about nuclear safety. In the wake of this disaster the European Union decided to assess safety on all operating nuclear reactors in its member states. This safety evaluation initiated by the European Union focusses on extreme natural hazards, beyond the standard safety evaluations which regularly have to be performed to demonstrate the safety of a nuclear power plant. Consequences of these extreme hazards for the research reactor in Petten, Netherlands, have been evaluated based on available safety analyses, supplemented by engineering judgement. In this way, the robustness of the existing plant has been assessed and possible measures to further increase the safety margins have been identified. This document presents the results of the Complementary Safety margin Assessment (CSA) performed for the 'Onderzoekslocatie Petten'. The distinct difference between this report and former risk analysis reports in general and the existing Safety Report of the Petten reactor is that the maximum resistance of the plant against redefined and more challenging events has been investigated, whereas traditionally the plant design is investigated against certain events that are determined on a historical basis. This different approach requires different analyses and studies, which in turn presents new insights into the robustness of the plant. The main purpose of this report is to answer the questions posed by the Ministry of Economic Affairs, Agriculture and Innovation. It was decided to write at the same time a report in

  12. Treatment of Passive Component Reliability in Risk-Informed Safety Margin Characterization FY 2010 Report

    Energy Technology Data Exchange (ETDEWEB)

    Robert W Youngblood

    2010-09-01

    The Risk-Informed Safety Margin Characterization (RISMC) pathway is a set of activities defined under the U.S. Department of Energy (DOE) Light Water Reactor Sustainability Program. The overarching objective of RISMC is to support plant life-extension decision-making by providing a state-of-knowledge characterization of safety margins in key systems, structures, and components (SSCs). A technical challenge at the core of this effort is to establish the conceptual and technical feasibility of analyzing safety margin in a risk-informed way, which, unlike conventionally defined deterministic margin analysis, is founded on probabilistic characterizations of SSC performance.

  13. On the Margins of Pharmaceutical Citizenship: Not Taking HIV Medication in the "Treatment Revolution" Era.

    Science.gov (United States)

    Persson, Asha; Newman, Christy E; Mao, Limin; de Wit, John

    2016-09-01

    With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine's promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine-citizenship nexus in less-developed, resource-poor contexts. But how do we understand this relationship in resource-rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of individual and community health. Drawing on Ecks's concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV "treatment revolution" have the capacity to both demarginalize and marginalize people with HIV. © 2016 by the American Anthropological Association.

  14. 12 CFR 220.128 - Treatment of simultaneous long and short positions in the same margin account when put or call...

    Science.gov (United States)

    2010-01-01

    ... positions in the same margin account when put or call options or combinations thereof on such stock are also...) Interpretations § 220.128 Treatment of simultaneous long and short positions in the same margin account when put...), if there are simultaneous long and short positions in the same security in the same margin account...

  15. Seismic probabilistic risk assessment and seismic-margins studies for nuclear power plants. Technical report

    International Nuclear Information System (INIS)

    Hwang, H.H.M.

    1987-01-01

    This report presents a review of the seismic probabilistic risk assessment and seismic margins studies for nuclear power plants in the United States. The techniques employed in these studies are briefly described. A few comments on the evaluation of the fragility of structures and equipment are discussed. Seismic PRA is a systematic process to evaluate the safety of nuclear power plants. In the process, it integrates all the elements such as seismic hazard, component fragility and plant system. Thus, it provides the overall view of the safety of an entire plant under a seismic event. The major tasks of a seismic PRA such as the evaluation of hazard curves, component fragilities. The concept and technique embodied in seismic PRA for nuclear power plants can be applied to other types of engineering facilities

  16. Addiction treatment in deprived urban areas in EU countries: Accessibility of care for people from socially marginalized groups

    NARCIS (Netherlands)

    Welbel, Marta; Matanov, Aleksandra; Moskalewicz, Jacek; Barros, Henrique; Canavan, Reamonn; Gabor, Edina; Gaddini, Andrea; Greacen, Tim; Kluge, Ulrike; Lorant, Vincent; Esteban Pena, Mercedes; Schene, Aart H.; Soares, Joaquim J. F.; Strassmayr, Christa; Vondrackova, Petra; Priebe, Stefan

    2013-01-01

    Aim: This study examines the accessibility of addiction treatment within services providing mental health care and support for people from socially marginalized groups in deprived urban areas across EU countries. Methods: Services providing mental health care and support in deprived areas of 14 EU

  17. Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma

    Science.gov (United States)

    Milosevic, Rajko; Todorovic, Milena; Balint, Bela; Jevtic, Miodrag; Krstic, Miodrag; Ristanovic, Elizabeta; Antonijevic, Nebojsa; Pavlovic, Mirjana; Perunicic, Maja; Petrovic, Milan; Mihaljevic, Biljana

    2009-01-01

    AIM: To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS). METHODS: A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined. Splenectomy plus chemotherapy was applied in 20 patients, while splenectomy as a single treatment-option was performed in 10 patients. Prognostic factor and overall survival rate were analyzed. RESULTS: Complete remission (CR) was achieved in 20 (66.7%), partial remission (PR) in seven (23.3%), and lethal outcome due to disease progression occurred in three (10.0%) patients. Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank = 0.056, P > 0.05). Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions, as measured by computerized tomography and ultra-sound (t = 2.558, P = 0.018). Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244, P 0.05) effects on the OS. The expression of other antigens (immunohistochemistry) also had no effect on survival-rate, as measured by a χ2 test (P > 0.05). CONCLUSION: Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration; however, a larger controlled clinical study is required to confirm our findings. PMID:19705496

  18. Rapid diagnosis and intraoperative margin assessment of human lung cancer with fluorescence lifetime imaging microscopy

    Directory of Open Access Journals (Sweden)

    Mengyan Wang

    2017-12-01

    Full Text Available A method of rapidly differentiating lung tumor from healthy tissue is extraordinarily needed for both the diagnosis and the intraoperative margin assessment. We assessed the ability of fluorescence lifetime imaging microscopy (FLIM for differentiating human lung cancer and normal tissues with the autofluorescence, and also elucidated the mechanism in tissue studies and cell studies. A 15-patient testing group was used to compare FLIM results with traditional histopathology diagnosis. Based on the endogenous fluorescence lifetimes of the testing group, a criterion line was proposed to distinguish normal and cancerous tissues. Then by blinded examined 41 sections from the validation group of other 16 patients, the sensitivity and specificity of FLIM were determined. The cellular metabolism was studied with specific perturbations of oxidative phosphorylation and glycolysis in cell studies. The fluorescence lifetime of cancerous lung tissues is consistently lower than normal tissues, and this is due to the both decrease of reduced nicotinamide adenine dinucleotide (NADH and flavin adenine dinucleotide (FAD lifetimes. A criterion line of lifetime at 1920 ps can be given for differentiating human lung cancer and normal tissues.The sensitivity and specificity of FLIM for lung cancer diagnosis were determined as 92.9% and 92.3%. These findings suggest that NADH and FAD can be used to rapidly diagnose lung cancer. FLIM is a rapid, accurate and highly sensitive technique in the judgment during lung cancer surgery and it can be potential in earlier cancer detection.

  19. Incorporating latitudinal and central–marginal trends in assessing genetic variation across species ranges

    Science.gov (United States)

    Qinfeng Guo

    2012-01-01

    The genetic variation across a species’ range is an important factor in speciation and conservation, yet searching for general patterns and underlying causes remains challenging. While the majority of comparisons between central and marginal populations have revealed a general central–marginal (C-M) decline in genetic diversity, others show no clear pattern. Similarly...

  20. Assessment and Treatment of Paraphilias.

    Science.gov (United States)

    Seligman, Linda; Hardenburg, Stephanie A.

    2000-01-01

    Provides a description of the category of mental disorders called "paraphilias" and guidelines for assessment of people who present with paraphillic behavior. Includes a review of inventories that can facilitate diagnosis and description of paraphilias. Discusses effective approaches to treatment of these disorders as well as personal and…

  1. Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint.

    Science.gov (United States)

    Lu, Wei; Li, Yan-Hao; He, Xiao-Feng

    2010-03-28

    To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation. Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy. Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%), good in 16 cases (27.6%) and fair/poor in 5 cases (8.6%) according to the Macnab criteria. No severe complications were found throughout this study. Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.

  2. An evaluation of image quality for the assessment of the marginal bone level in panoramic radiography

    International Nuclear Information System (INIS)

    Aakesson, L.; Rohlin, M.

    1993-01-01

    A diagnostic image quality of panoramic radiographs originating from different clinics was examined. Two samples of 98 and 100 radiographs, respectively, were from a department of oral radiology. The radiographs of one of these samples were checked using immediate subjective analysis of the image quality before inclusion in the study whereas the radiographs of the other sample were randomly selected. A third sample consisted of radiographs from 20 randomly selected dental clinics. The subjective overall image quality of the whole panoramic radiograph was classified as adequate, marginal or inadequate. The three observers also assessed the reason for inferior image quality. The overall image quality of the radiographs was better for the checked sample from the department of oral radiology compared to the sample from the 20 dental clinics. The main reason for unacceptable image quality of the radiographs was too low density and/or contrast irrespective of sample. Other faults were incorrect positioning of the patient but in the sample from the 20 clinics improper film handling was also frequent. We conclude that image quality in panoramic radiography can be improved. Improvement of the image quality is a prerequisite if panoramic radiography in the future is to replace the full-mouth examination. 22 refs, 2 figs, 7 tabs

  3. Prostate and patient intrafraction motion: impact on treatment time-dependent planning margins for patients with endorectal balloon.

    Science.gov (United States)

    Steiner, Elisabeth; Georg, Dietmar; Goldner, Gregor; Stock, Markus

    2013-07-15

    To investigate intrafraction prostate and patient motion during different radiation therapy treatments as a function of treatment time; included were prostate patients with an endorectal balloon (ERB). Margins accounting for setup uncertainties and intrafraction motion were determined. The study included 17 patients undergoing prostate cancer radiation therapy. All patients received 3 fiducial gold markers implanted in the prostate and were then immobilized in the supine position with a knee support and treated with an ERB. Twelve patients with intermediate risk for pelvic lymph node metastases received intensity modulated radiation therapy (IMRT), and 5 patients at low risk received a 4-field box treatment. After setup based on skin marks, patients were imaged with a stereoscopic imaging system. If the marker displacement exceeded a 3-mm tolerance relative to planning computed tomography, patients were shifted and verification images were taken. All patients underwent additional imaging after treatment; IMRT patients also received additional imaging at halftime of treatment. Prostate and bone drifts were evaluated as a function of treatment time for more than 600 fractions, and margins were extracted. Patient motion evaluated by bone match was strongly patient dependent but in general was smallest in the superior-inferior (SI) direction. Prostate drifts were less patient dependent, showing an increase with treatment time in the SI and anterior-posterior (AP) directions. In the lateral (LAT) direction, the prostate stayed rather stable. Mean treatment times were 5.5 minutes for 4-field box, 10 minutes for 5-field boost IMRT, and 15 minutes or more for 9-field boost and 9-field pelvic IMRT treatments. Margins resulted in 2.2 mm, 3.9 mm, and 4.3 mm for 4-field box; 3.7 mm, 2.6 mm, and 3.6 mm for 5-field boost IMRT; 2.3 mm, 3.9 mm, and 6.2 mm for 9-field boost IMRT; and 4.2 mm, 5.1 mm, and 6.6 mm for 9-field pelvic IMRT in the LAT, SI, and AP directions, respectively

  4. Validation of micro-CT against the section method regarding the assessment of marginal leakage of sealants.

    NARCIS (Netherlands)

    Chen, X.; Cuijpers, V.M.J.I.; Fan, M.W.; Frencken, J.E.F.M.

    2012-01-01

    BACKGROUND: The aim of this study was to validate the micro-CT and related software against the section method using the stereomicroscope for marginal leakage assessment along the sealant-enamel interface. METHODS: Pits and fissures of the occlusal surface of 10 teeth were sealed with a

  5. Margin benefit assessment of the YGN 3 cycle 1 fxy error files for COLSS and CPC overall uncertainty analyses

    International Nuclear Information System (INIS)

    Yoon, Rae Young; In, Wang Kee; Auh, Geun Sun; Kim, Hee Cheol; Lee, Sang Keun

    1994-01-01

    Margin benefits are quantitatively assessed for the Yonggwang Unit 3 (YGN 3) Cycle 1 planar radial peaking factor (Fxy) error files for each time-in-life, i.e., BOC, IOC, MOC and EOC. The generic Fxy error file (FXYMEQO) is presently used for Yonggwang Unit 3 Cycle 1 COLSS (Core Operating Limit Supervisory System) and CPC (Core Protection Calculator) Overall Uncertainty Analyses (OUA). However, because this file is more conservative than the plant/cycle specific Fxy error files, COLSS and CPC thermal margins (DNB-OPM) for the generic Fxy error file are less than those of the plant/cycle specific Fxy error file. Therefore, the YGN 3 Cycle 1 Fxy error files were generated and analyzed by the modified codes for Yonggwang Plants. The YGN 3 Cycle 1 Fxy error files gave the increased thermal margin by about 1% for COLSS and CPC, respectively

  6. Complementary Safety Margin Assessment. Public version; Europees robuustheidsonderzoek voor kerncentrales. Publieksversie

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-10-15

    On March 11, 2011, a large part of the Japanese eastern coastal area was devastated by an earthquake, followed by an immense tsunami. As a result, thousands of people were killed, injured or made homeless. In the days that followed, the situation was further complicated because of the failing nuclear reactors on the Fukushima coast. The local environment suffered from radioactive releases, requiring evacuation zones, and generating international concerns about nuclear safety. In the wake of this disaster the European Union decided to assess safety on all operating nuclear reactors in its member states. This safety evaluation initiated by the European Union focusses on extreme natural hazards, beyond the standard safety evaluations which regularly have to be performed to demonstrate the safety of a nuclear power plant. Consequences of these extreme hazards for the Borssele NPP have been evaluated based on available safety analyses, supplemented by engineering judgement. In this way, the robustness of the existing plant has been assessed and possible measures to further increase the safety margins have been identified. This document presents the results of the Complementary Safety margin Assessment (CSA) performed for the NPP Borssele. The distinct difference between this report and former risk analysis reports in general and the existing Safety Report of the NPP Borssele is that the maximum resistance of the plant against redefined and more challenging events has been investigated, whereas traditionally the plant design is investigated against certain events that are determined on a historical basis. This different approach requires different analyses and studies, which in turn presents new insights into the robustness of the plant. This document has been prepared in the short time period between June 1 and October 31, 2011. If more time had been granted for this study, some of the subjects could have been pursued in greater depth. The EPZ project team has been

  7. Importance of margin width in breast-conserving treatment of early breast cancer

    DEFF Research Database (Denmark)

    Bodilsen, Anne; Bjerre, Karsten; Offersen, Birgitte V

    2016-01-01

    BACKGROUND AND METHOD: The association between margin width and ipsilateral breast tumour recurrence (IBTR, defined as invasive recurrence) was investigated in a population-based nationwide cohort of 11,900 patients undergoing breast-conserving therapy for invasive cancer. RESULTS: The median...

  8. Performance of the marginal structural cox model for estimating individual and joined effects of treatments given in combination.

    Science.gov (United States)

    Lusivika-Nzinga, Clovis; Selinger-Leneman, Hana; Grabar, Sophie; Costagliola, Dominique; Carrat, Fabrice

    2017-12-04

    The Marginal Structural Cox Model (Cox-MSM), an alternative approach to handle time-dependent confounder, was introduced for survival analysis and applied to estimate the joint causal effect of two time-dependent nonrandomized treatments on survival among HIV-positive subjects. Nevertheless, Cox-MSM performance in the case of multiple treatments has not been fully explored under different degree of time-dependent confounding for treatments or in case of interaction between treatments. We aimed to evaluate and compare the performance of the marginal structural Cox model (Cox-MSM) to the standard Cox model in estimating the treatment effect in the case of multiple treatments under different scenarios of time-dependent confounding and when an interaction between treatment effects is present. We specified a Cox-MSM with two treatments including an interaction term for situations where an adverse event might be caused by two treatments taken simultaneously but not by each treatment taken alone. We simulated longitudinal data with two treatments and a time-dependent confounder affected by one or the two treatments. To fit the Cox-MSM, we used the inverse probability weighting method. We illustrated the method to evaluate the specific effect of protease inhibitors combined (or not) to other antiretroviral medications on the anal cancer risk in HIV-infected individuals, with CD4 cell count as time-dependent confounder. Overall, Cox-MSM performed better than the standard Cox model. Furthermore, we showed that estimates were unbiased when an interaction term was included in the model. Cox-MSM may be used for accurately estimating causal individual and joined treatment effects from a combination therapy in presence of time-dependent confounding provided that an interaction term is estimated.

  9. Comparative risk assessment of carcinogens in alcoholic beverages using the margin of exposure approach.

    Science.gov (United States)

    Lachenmeier, Dirk W; Przybylski, Maria C; Rehm, Jürgen

    2012-09-15

    Alcoholic beverages have been classified as carcinogenic to humans. As alcoholic beverages are multicomponent mixtures containing several carcinogenic compounds, a quantitative approach is necessary to compare the risks. Fifteen known and suspected human carcinogens (acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethanol, ethyl carbamate, formaldehyde, furan, lead, 4-methylimidazole, N-nitrosodimethylamine, ochratoxin A and safrole) occurring in alcoholic beverages were identified based on monograph reviews by the International Agency for Research on Cancer. The margin of exposure (MOE) approach was used for comparative risk assessment. MOE compares a toxicological threshold with the exposure. MOEs above 10,000 are judged as low priority for risk management action. MOEs were calculated for different drinking scenarios (low risk and heavy drinking) and different levels of contamination for four beverage groups (beer, wine, spirits and unrecorded alcohol). The lowest MOEs were found for ethanol (3.1 for low risk and 0.8 for heavy drinking). Inorganic lead and arsenic have average MOEs between 10 and 300, followed by acetaldehyde, cadmium and ethyl carbamate between 1,000 and 10,000. All other compounds had average MOEs above 10,000 independent of beverage type. Ethanol was identified as the most important carcinogen in alcoholic beverages, with clear dose response. Some other compounds (lead, arsenic, ethyl carbamate, acetaldehyde) may pose risks below thresholds normally tolerated for food contaminants, but from a cost-effectiveness point of view, the focus should be on reducing alcohol consumption in general rather than on mitigative measures for some contaminants that contribute only to a limited extent (if at all) to the total health risk. Copyright © 2012 UICC.

  10. Test characteristics of high frequency ultrasound in the pre-operative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing Mohs micrographic surgery

    Science.gov (United States)

    Jambusaria-Pahlajani, Anokhi; Schmults, Chrysalyne D.; Miller, Christopher J.; Shin, Daniel; Williams, Jennifer; Kurd, Shanu K; Gelfand, Joel M.

    2015-01-01

    Background Non-invasive techniques to assess subclinical spread of non-melanoma skin cancer (NMSC) may improve surgical precision. High frequency ultrasound (HIFU) has shown promise to evaluate the extent of NMSC. Objective To determine the accuracy of HIFU to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) prior to Mohs micrographic surgery (MMS). Methods We enrolled 100 patients with invasive SCC or BCC. Prior to the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of HIFU was subsequently tested by comparison to pathology from frozen sections. Results The test characteristics of the ultrasound were sensitivity= 32%, specificity= 88%, positive predictive value= 47%, and negative predictive value=79%. Subgroup analyses demonstrated improved test characteristics for tumors larger than the median (area >1.74 cm2). Qualitative analyses showed that HIFU was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. Conclusions HIFU requires additional refinements to improve the preoperative determination of tumor extent prior to surgical treatment of NMSC. PMID:19018815

  11. Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing Mohs micrographic surgery.

    Science.gov (United States)

    Jambusaria-Pahlajani, Anokhi; Schmults, Chrysalyne D; Miller, Christopher J; Shin, Daniel; Williams, Jennifer; Kurd, Shanu K; Gelfand, Joel M

    2009-01-01

    Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm(2)). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC.

  12. Application of the Integrated Safety Assessment methodology to safety margins. Dynamic Event Trees, Damage Domains and Risk Assessment

    International Nuclear Information System (INIS)

    Ibánez, L.; Hortal, J.; Queral, C.; Gómez-Magán, J.; Sánchez-Perea, M.; Fernández, I.; Meléndez, E.; Expósito, A.; Izquierdo, J.M.; Gil, J.; Marrao, H.; Villalba-Jabonero, E.

    2016-01-01

    The Integrated Safety Assessment (ISA) methodology, developed by the Consejo de Seguridad Nuclear, has been applied to an analysis of Zion NPP for sequences with Loss of the Component Cooling Water System (CCWS). The ISA methodology proposal starts from the unfolding of the Dynamic Event Tree (DET). Results from this first step allow assessing the sequence delineation of standard Probabilistic Safety Analysis results. For some sequences of interest of the outlined DET, ISA then identifies the Damage Domain (DD). This is the region of uncertain times and/or parameters where a safety limit is exceeded, which indicates the occurrence of certain damage situation. This paper illustrates application of this concept obtained simulating sequences with MAAP and with TRACE. From information of simulation results of sequence transients belonging to the DD and the time-density probability distributions of the manual actions and of occurrence of stochastic phenomena, ISA integrates the dynamic reliability equations proposed to obtain the sequence contribution to the global Damage Exceedance Frequency (DEF). Reported results show a slight increase in the DEF for sequences investigated following a power uprate from 100% to 110%. This demonstrates the potential use of the method to help in the assessment of design modifications. - Highlights: • This paper illustrates an application of the ISA methodology to safety margins. • Dynamic Event Trees are useful tool for verifying the standard PSA Event Trees. • The ISA methodology takes into account the uncertainties in human action times. • The ISA methodology shows the Damage Exceedance Frequency increase in power uprates.

  13. Marginal Generation Technology in the Chinese Power Market towards 2030 Based on Consequential Life Cycle Assessment

    DEFF Research Database (Denmark)

    Zhao, Guangling; Guerrero, Josep M.; Pei, Yingying

    2016-01-01

    generation, which is the same scenario in the North and Northwest China Grid. In the Northeast, East, and Central China Grid, nuclear power gradually replaces coal-fired electricity and becomes the marginal technology. In the Southwest China Grid and the China Southern Power Grid, the marginal electricity...... imbalances in regional energy supply and demand. Therefore, we suggest an approach to achieve a geographical subdivision of the Chinese electricity grid, corresponding to the interprovincial regional power grids, namely the North, the Northeast, the East, the Central, the Northwest, and the Southwest China...

  14. Radiographic assessment of changes in marginal bone around endosseous implants supporting mandibular overdentures

    NARCIS (Netherlands)

    Batenburg, RHK; Meijer, HJA; Geraets, WGM; van der Stelt, PF

    Objectives: To evaluate the reliability of a new method for quantification of radiographic changes in the marginal bone around implants. Methods: Three groups of seven patients treated with an overdenture supported by two endosseous implants (Branemark, n = 7 patients; IMZ, n = 7 patients; ITI

  15. The NEET and Hikikomori spectrum: Assessing the risk and consequences of becoming culturally marginalized.

    Directory of Open Access Journals (Sweden)

    Yukiko eUchida

    2015-08-01

    Full Text Available An increasing number of young people are becoming socially and economically marginalized in Japan under economic stagnation and pressures to be more globally competitive as a post-industrial economy. The phenomena of NEET / Hikikomori (social withdrawal have attracted global attention in recent years. Though the behavioral symptoms of NEET and Hikikomori can be differentiated, some commonalities in psychological features can be found. Specifically, we believe that both NEET and Hikikomori show psychological tendencies that deviate from those governed by mainstream cultural attitudes, values, and behaviors with the difference between NEET and Hikikomori being largely a matter of degree. In this study, we developed a NEET-Hikikomori risk factors (NHR Scale that treats NEET / Hikikomori not as a set of distinct diagnoses but as a spectrum of psychological tendencies associated with the risk of being marginalized in society. Based on this idea, we identified three related risk factors in our NHR Spectrum scale: 1 Freeter lifestyle preference¬¬, which in Japan refers to the tendency of consciously choosing not to work despite job availabilities ―, 2 a lack of self-competence, and 3 having unclear ambitions for the future (Study 1. Study 2 investigated and confirmed the validity of the scale examining NHR differences between occupational groups. The results suggested that NHR is related to psychological tendencies common in the marginalized segments of society. The relationship between these psychological tendencies and actually becoming marginalized across cultures is discussed.

  16. The NEET and Hikikomori spectrum: Assessing the risks and consequences of becoming culturally marginalized.

    Science.gov (United States)

    Uchida, Yukiko; Norasakkunkit, Vinai

    2015-01-01

    An increasing number of young people are becoming socially and economically marginalized in Japan under economic stagnation and pressures to be more globally competitive in a post-industrial economy. The phenomena of NEET/Hikikomori (occupational/social withdrawal) have attracted global attention in recent years. Though the behavioral symptoms of NEET and Hikikomori can be differentiated, some commonalities in psychological features can be found. Specifically, we believe that both NEET and Hikikomori show psychological tendencies that deviate from those governed by mainstream cultural attitudes, values, and behaviors, with the difference between NEET and Hikikomori being largely a matter of degree. In this study, we developed a NEET-Hikikomori Risk Factors (NHR) scale that treats NEET/Hikikomori not as a set of distinct diagnoses, but as a spectrum of psychological tendencies associated with the risk of being marginalized in society. Based on this idea, we identified three related risk factors in our NHR spectrum scale: (1) Freeter lifestyle preference, which in Japan refers to the tendency to consciously choose to not work despite job availabilities, (2) a lack of self-competence, and (3) having unclear ambitions for the future (Study 1). Study 2 investigated and confirmed the validity of the scale by examining NHR differences between occupational groups. The results suggested that NHR is related to psychological tendencies common in the marginalized segments of society. The relationship between these psychological tendencies and actually becoming marginalized across cultures is discussed.

  17. Wavelet and multitaper coherence methods for assessing the elastic thickness of the Irish Atlantic margin

    Science.gov (United States)

    Daly, E.; Brown, C.; Stark, C. P.; Ebinger, C. J.

    2004-11-01

    There have been some inconsistencies in estimates of the effective elastic thickness of the continental lithosphere Te based upon admittance or coherence relationships between gravity and topography. This paper compares multitaper and wavelet methods to analyse the coherence between Bouguer gravity and bathymetric data over the Irish Atlantic margin. The analyses show that similar lateral Te variations can be recovered from the data, but demonstrate that the size of the data window can give rise to a significant downward bias in Te estimates. A seismically constrained 3-D gravity inversion over the Rockall basin shows the presence of surface and subsurface loads whose ratio is loosely correlated with load ratio variations generated from the wavelet coherence method. The Te and load ratio, f variations can be plausibly related to major geological structures on the margin. If the load ratio variations can be interpreted geologically, it implies that spectral based methods to estimate effective elastic thickness must incorporate subsurface loads within the underlying theoretical model. On the Irish Atlantic margin, Te is generally low (6-18 km) and is associated with a NE-SW Caledonian trend. The weakest lithosphere is in the southern Rockall basin, Porcupine bank and Porcupine basin and the strongest lithosphere is along the Rockall-Hatton region. The low Te values are consistent with results from other passive margins. The reasons for such low Te values on the Irish Atlantic margin remain unclear, but may be the consequence of Te being frozen into the lithosphere when loads were emplaced during continental breakup and temperature gradients were high. The process of sedimentation and the presence of fluids may be contributory factors. There is an indication of a geological and rheological divide between the Rockall-Hatton region and the Rockall basin, possibly associated with the Caledonian orogenic front.

  18. Defining a positive circumferential resection margin in oesophageal cancer and its implications for adjuvant treatment.

    Science.gov (United States)

    O'Neill, J R; Stephens, N A; Save, V; Kamel, H M; Phillips, H A; Driscoll, P J; Paterson-Brown, S

    2013-07-01

    A positive circumferential resection margin (CRM) has been associated with a poorer prognosis in oesophageal and oesophagogastric junctional (OGJ) cancer. The College of American Pathologists defines the CRM as positive if tumour cells are present at the margin, whereas the Royal College of Pathologists also include tumour cells within 1 mm of this margin. The relevance of these differences is not clear and no study has investigated the impact of adjuvant therapy. The aim was to identify the optimal definition of an involved CRM in patients undergoing resection for oesophageal or OGJ cancer, and to determine whether adjuvant radiotherapy improved survival in patients with an involved CRM. This was a single-centre retrospective study of patients who had undergone attempted curative resection for a pathological T3 oesophageal or OGJ cancer. Clinicopathological variables and distance from the tumour to the CRM, measured to ± 0.1 mm, were correlated with survival. A total of 226 patients were included. Sex (P = 0·018), tumour differentiation (P = 0·019), lymph node status (P CRM distance (P = 0·042) were independently predictive of prognosis. No significant survival difference was observed between positive CRM 0-mm and 0·1-0·9-mm groups after controlling for other prognostic variables. Both groups had poorer survival than matched patients with a CRM at least 1 mm clear of tumour cells. Among patients with a positive CRM of less than 1 mm, those undergoing observation alone had a median survival of 18·6 months, whereas survival was a median of 10 months longer in patients undergoing adjuvant radiotherapy, but otherwise matched for prognostic variables (P = 0·009). A positive CRM of 1 mm or less should be regarded as involved. Adjuvant radiotherapy confers a significant survival benefit in selected patients with an involved CRM. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

  19. Hormesis: from marginalization to mainstream A case for hormesis as the default dose-response model in risk assessment

    International Nuclear Information System (INIS)

    Calabrese, Edward J.

    2004-01-01

    The paper provides an account of how the hormetic dose response has emerged in recent years as a serious dose-response model in toxicology and risk assessment after decades of extreme marginalization. In addition to providing the toxicological basis of this dose-response revival, the paper reexamines the concept of a default dose model in toxicology and risk assessment and makes the argument that the hormetic model satisfies criteria (e.g., generalizability, frequency, application to risk assessment endpoints, false positive/negative potential, requirements for hazard assessment, reliability of estimating risks, capacity for validation of risk estimates, public health implications of risk estimates) for such a default model better than its chief competitors, the threshold and linear at low dose models. The selection of the hormetic model as the default model in risk assessment for noncarcinogens and specifically for carcinogens would have a profound impact on the practice of risk assessment and its societal implications

  20. The Treatment Effectiveness Assessment (TEA

    Directory of Open Access Journals (Sweden)

    Ling W

    2013-09-01

    Full Text Available Walter Ling,1 David Farabee,1 Dagmar Liepa,2 Li-Tzy Wu3 1Integrated Substance Abuse Programs, University of California, Los Angeles, CA, 2Valley Care Medical Center, Panorama City, CA, 3Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA We have been surprised and gratified by the readers’ responses to our article, The Treatment Effectiveness Assessment (TEA: an efficient, patient-centered instrument for evaluating progress in recovery from addiction, which was published in December 2012.1 In the six months since that time, we have received numerous questions and observations about the article, and about the TEA instrument. Respondents were clinicians: physicians, counselors, therapists, nurses; as well as administrators and policy makers.  View original paper by Ling W, Farabee D, Liepa D, Wu LT. 

  1. Clinical assessment of human breast cancer margins with wide-field optical coherence micro-elastography (Conference Presentation)

    Science.gov (United States)

    Allen, Wes M.; Chin, Lixin; Wijesinghe, Philip; Kirk, Rodney W.; Latham, Bruce; Sampson, David D.; Saunders, Christobel M.; Kennedy, Brendan F.

    2017-02-01

    Breast cancer has the second highest mortality rate of all cancers in females. Surgical excision of malignant tissue forms a central component of breast-conserving surgery (BCS) procedures. Incomplete excision of malignant tissue is a major issue in BCS with typically 20 - 30% cases requiring a second surgical procedure due to postoperative detection of tumor in the margin. A major challenge for surgeons during BCS is the lack of effective tools to assess the surgical margin intraoperatively. Such tools would enable the surgeon to more effectively remove all tumor during the initial surgery, hence reducing re-excision rates. We report advances in the development of a new tool, optical coherence micro-elastography, which forms images, known as elastograms, based on mechanical contrast within the tissue. We demonstrate the potential of this technique to increase contrast between malignant tumor and healthy stroma in elastograms over OCT images. We demonstrate a key advance toward clinical translation by conducting wide-field imaging in intraoperative time frames with a wide-field scanning system, acquiring mosaicked elastograms with overall dimensions of 50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. We describe this wide-field imaging system, and demonstrate its operation by presenting wide-field optical coherence tomography images and elastograms of a tissue mimicking silicone phantom and a number of representative freshly excised human breast specimens. Our results demonstrate the feasibility of scanning large areas of lumpectomies, which is an important step towards practical intraoperative margin assessment.

  2. Using the transformative paradigm to conduct a mixed methods needs assessment of a marginalized community: Methodological lessons and implications.

    Science.gov (United States)

    Jackson, Karen Moran; Pukys, Suzy; Castro, Andrene; Hermosura, Lorna; Mendez, Joanna; Vohra-Gupta, Shetal; Padilla, Yolanda; Morales, Gabriela

    2018-02-01

    We explore opportunities as well as challenges associated with conducting a mixed methods needs assessment using a transformative paradigm. The transformative paradigm is a research framework that centers the experiences of marginalized communities, includes analysis of power differentials that have led to marginalization, and links research findings to actions intended to mitigate disparities. We argue that a community needs assessment is a natural fit for the use of a transformative framework, serving as an entry-point for the development of responsive programmatic and funding decisions. Based on a case study of efforts initiated by a local community health foundation to document disparities in their city, we show how an evaluation team used principles aligned with the transformative framework to guide the design and implementation of a community needs assessment. The needs assessment provided a better understanding of the power of community relationships, demonstrated how lack of trust can continue to constrain community voices, and revealed why agencies must actively support a social justice framework beyond the end of an assessment to ensure transformative change. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. A mandibulectomia marginal no tratamento dos tumores de loja amigdalina e região retromolar Marginal mandibulectomy in the surgical treatment of tonsil and retromolar trigone tumours

    Directory of Open Access Journals (Sweden)

    Maria Beatriz Nogueira Pascoal

    2007-04-01

    Full Text Available A ressecção do ramo ascendente da mandíbula ocasiona um déficit funcional e estético considerável. OBJETIVO: Comparar a mandibulectomia marginal e segmentar de tumores avançados de loja amigdalina e região retromolar sem envolvimento ósseo mandibular detectado no período pré-operatório, em relação à sobrevida e recidiva loco-regional. Forma de Estudo: Estudo de coorte contemporânea com corte transversal. MATERIAL E MÉTODO: Compararam-se 20 pacientes tratados com mandibulectomia marginal e 22 tratados com mandibulectomia segmentar de outubro de 1994 a dezembro de 2001 em serviço de referência em Cirurgia de Cabeça e Pescoço. RESULTADOS: Dos 20 pacientes tratados com mandibulectomia marginal, 35% morreram com doença, 15% por recidiva local, 15% por recidiva regional e 5% por recidiva loco-regional. Dos 22 pacientes tratados com mandibulectomia segmentar 45,4% morreram pela doença, sendo 31,8% por recidiva local e 13,6% por recidiva à distância. Na análise pelo método de Kaplan-Meier o grupo tratado com mandibulectomia marginal apresentou uma taxa de 55%, e o grupo tratado com ressecção segmentar 45% com p= 0,8329. CONCLUSÕES: A análise dos dois grupos evidenciou que a conservação do ramo ascendente da mandíbula, mesmo em lesões avançadas, sem envolvimento mandibular, não aumenta o índice de recidiva.Resection of the ascending ramus of the mandible can result in considerable functional and esthetic damage. AIM: To compare the survival rate and local and regional recurrence in marginal and segmental mandibulectomy for advanced tonsil and retromolar trigone tumours with no mandibular invasion. PLACE AND PERIOD: Reference Head & Neck Service, between October 1994 and December 2001. MATERIAL AND METHOD: 20 stage IV patients undergoing marginal mandibulectomy and 22 undergoing segmental mandibulectomy were compared. CASE STUDY: a contemporary cross-sectional cohort study. RESULTS: Of 20 patients undergoing marginal

  4. A generalized framework for assessment of safety margins in nuclear power plants

    International Nuclear Information System (INIS)

    Gavrilas, M.; Youngblood, B.; Prelewicz, D.; Meyer, Jim

    2004-01-01

    The protection of public health and safety, and the environment from inadvertent releases of radioactive materials from nuclear power plants relies on the implementation of the defense-in-depth strategy. The term defense-in-depth evolved historically, and thus its application has not always been uniform. The use of the term in the context of the U.S. Nuclear Regulatory Commission (NRC) safety philosophy entails the reliance of a nuclear facility on successive compensatory measures in preventing accidents or mitigating damage caused by malfunctions, accidents, or naturally occurring events. The introduction of probabilistic risk analyses with NUREG-74/014 and subsequent evolution in risk assessment techniques, are leading to the implementation of risk informed regulation to ensure the safety of the public and the environment. Risk informed regulation minimizes the likelihood of overlooking potentially significant accident sequences while limiting unnecessary burdens imposed on licensees. The proposed framework merges fundamental elements of safety regulation: defense-in depth, safety margins and probabilistic risk. It formalizes the relationship between probabilistic risk assessment (PRA) methods and data, and deterministic analyses in a manner consistent with NRC's defense-in-depth philosophy. Succinctly put, the likelihood and consequences of accident scenarios are considered simultaneously and quantified by a plant safety metric. The integration of these fundamental elements into a practically applicable safety framework is consistent with the NRC policy statement on use of probabilistic risk assessment methods and the November 2002 Regulatory Guide on risk informed decisions on plant-specific changes to the licensing basis. Safety information resulting from the application of the framework supersedes traditional safety figures of merit. Safety quantifiers, referred herein as safety indices, expand on the qualifier outcomes that currently accompany fault tree

  5. Proposal of new upper airway margins in children assessed by CBCT

    DEFF Research Database (Denmark)

    Anandarajah, S; Abdalla, Y; Dudhia, R

    2015-01-01

    OBJECTIVES: Recently, studies have performed three-dimensional analyses of upper airways in children. However, there was a lack of airway delineation according to anatomical boundaries and/or easily mobile soft-tissue landmarks were used. The aim of the present study was to define new upper airway...... identifiable bony landmarks to delineate the upper airway on cone beam scans of children and was found to be reliable and reproducible....... later. RESULTS: The new airway margins were defined superiorly by a line passing through the palatal plane (anterior nasal spine to posterior nasal spine) extending to the posterior wall of the pharynx, inferiorly by a line passing from the anterosuperior edge of C4 to menton, anteriorly by a line...

  6. The inclusion of weld residual stress in fracture margin assessments of embrittled nuclear reactor pressure vessels

    International Nuclear Information System (INIS)

    Dickson, T.L.; Bass, B.R.; McAfee, W.J.

    1998-01-01

    Analyses were performed to determine the impact of weld residual stresses in a reactor pressure vessel (RPV) on (1) the generation of pressure temperature (P-T) curves required for maintaining specified fracture prevention margins during nuclear plant startup and shutdown, and (2) the conditional probability of vessel failure due to pressurized thermal shock (PTS) loading. The through wall residual stress distribution in an axially oriented weld was derived using measurements taken from a shell segment of a canceled RPV and finite element thermal stress analyses. The P-T curve derived from the best estimate load analysis and a t / 8 deep flaw, based on K Ic , was less limiting than the one derived from the current methodology prescribed in the ASME Boiler and Pressure Vessel Code. The inclusion of the weld residual stresses increased the conditional probability of cleavage fracture due to PTS loading by a factor ranging from 2 to 4

  7. Reliability-based approaches for safety margin assessment in the French nuclear industry

    International Nuclear Information System (INIS)

    Ardillon, E.; Barthelet, B.; Meister, E.; Cambefort, P.; Hornet, P.; Le Delliou, P.

    2003-01-01

    The prevention of the fast fracture damage of the mechanical equipment important for the safety of nuclear islands of the French PWR relies on deterministic rules. These rules include flaw acceptance criteria involving safety factors applied to characteristic values (implicit margins) of the physical variables. The sets of safety factors that are currently under application in the industrial analyses with the agreement of the Safety Authority, are distributed across the two main physical parameters and have partly been based on a semi-probabilistic approach. After presenting the generic probabilistic pro-codification approach this paper shows its application to the evaluation of the performances of the existing regulatory flaw acceptance criteria. This application can be carried out in a realistic manner or in a more simplified one. These two approaches are applied to representative mechanical components. Their results are consistent. (author)

  8. A Hold-down Margin Assessment using Statistical Method for the PWR Fuel Assembly

    International Nuclear Information System (INIS)

    Jeon, S. Y.; Park, N. K.; Lee, K. S.; Kim, H. K.

    2007-01-01

    The hold-down springs provide an acceptable hold down force against hydraulic uplift force absorbing the length change of the fuel assembly relative to the space between the upper and lower core plates in PWR. These length changes are mainly due to the thermal expansion, irradiation growth and creep down of the fuel assemblies. There are two kinds of hold-down springs depending on the different design concept of the reactor internals of the PWR in Korea, one is a leaf-type hold down spring for Westinghouse type plants and the other is a coil-type hold-down spring for OPR1000 (Optimized Power Reactor 1000). There are four sets of hold-down springs in each fuel assembly for leaf type hold-down spring and each set of the hold-down springs consists of multiple tapered leaves to form a cantilever leaf spring set. The length, width and thickness of the spring leaves are selected to provide the desired spring constant, deflection range, and hold down force. There are four coil springs in each fuel assembly for coil-type hold-down spring. In this study, the hold-down forces and margins were calculated for the leaf-type and coil-type hold-down springs considering geometrical data of the fuel assembly and its components, length changes of the fuel assembly due to thermal expansion, irradiation growth, creep, and irradiation relaxation. The hold-down spring forces were calculated deterministically and statistically to investigate the benefit of the statistical calculation method in view of hold-down margin. The Monte-Carlo simulation method was used for the statistical hold down force calculation

  9. What is the role for the circumferential margin in the modern treatment of rectal cancer?

    NARCIS (Netherlands)

    Nagtegaal, I.D.; Quirke, P.

    2008-01-01

    PURPOSE: Treatment of rectal cancer has changed dramatically over the last decade. The worldwide introduction of total mesorectal excision in combination with the increasing use of radio(chemo)-therapy has led to an improved prognosis. One of the main prognostic factors in rectal cancer is the

  10. Treatment outcomes in patients with extranodal marginal zone B-cell lymphoma of the lung.

    Science.gov (United States)

    Lee, Hyun; Yang, Bumhee; Nam, Boda; Jeong, Byeong-Ho; Shin, Sumin; Zo, Jae Il; Shim, Young Mog; Kwon, O Jung; Lee, Kyung Soo; Kim, Hojoong

    2017-07-01

    To evaluate clinical presentations, treatment modalities, and outcomes of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma by stage strata. We retrospectively reviewed 51 patients diagnosed with pulmonary MALT lymphoma between January 2003 and December 2015. To compare treatment modalities and outcomes, we stratified the patients into low-stage (IE/IIE) and high-stage (IIIE/IVE) groups using modified Ann Arbor staging. Progression-free survival was estimated using Kaplan-Meier curves, and differences were compared using the log-rank test. A hazard ratio of progression by stage strata, adjusted for other clinical variables, was determined using a Cox adjusted proportional hazards model. The majority of patients had stage IE disease (76.5%; 39 of 51). With advancing stage, patients were more likely to have respiratory and B symptoms and higher International Prognostic Index scores. The most common treatment modality was surgical resection in low-stage patients (33 of 43) and chemotherapy in high-stage patients (7 of 8). At a median follow-up of 40.7 months, progression-free survival was longer for low-stage patients (median, 40.7 months vs 24.9 months; P MALT lymphoma, for which the mainstay of treatment is surgical resection, might be indolent. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  11. Novel fracture technology proves marginal Viking prospect economic, part I: Implementation of fracture treatments

    Energy Technology Data Exchange (ETDEWEB)

    Rylance, M.; Haidar, S.; Sykes, G.; Pyecroft, J.

    1996-12-31

    This paper describes the implementation of a twin propped fracture stimulation treatment, carried out on the 49/17-12 exploration well of the Viking Wx structure, in the Southern North Sea (SNS). Initial appraisal of the potential field development was disappointing, the well flowing at a rate of only 8.5 MM.scf/d, indicating a field development to be uneconomic. Stimulation by a joint Conoco/BPX team, employing novel fracturing technology, provided dramatic increases in production to ca. 43.5 MM.scf/d with less applied drawdown. The design approaches employed during these treatments could have potential for widespread application to other SNS gas fields. In this paper critical pre-treatment testing and reasoning behind operational decisions are discussed. In a companion paper the post stimulation rates/testing and well clean-up are described. Several key aspects of these treatments included: the use of two stacked fractures in order to successfully place proppant across the entire 830 ft reservoir section; the use of a Step Down Test (SDT) to identify the nature of high near wellbore pressure losses and subsequent removal using sand slugs; the use of a newly developed dual-coat partially curable Resin Coated Proppant (RCP) product, never previously utilized in the field, to minimize the opportunity for prolonged proppant back production and a seawater Mini-Frac to attempt to help identify the true in-situ permeability. Finally, the use of a Surface Read-Out (SRO) gauge enabled real-time decision making to optimize the treatment schedule.

  12. Label-free hyperspectral imaging and quantification methods for surgical margin assessment of tissue specimens of cancer patients.

    Science.gov (United States)

    Fei, Baowei; Guolan Lu; Halicek, Martin T; Wang, Xu; Zhang, Hongzheng; Little, James V; Magliocca, Kelly R; Patel, Mihir; Griffith, Christopher C; El-Deiry, Mark W; Chen, Amy Y

    2017-07-01

    Hyperspectral imaging (HSI) is a relatively new modality in medicine and can have many potential applications. In this study, we developed label-free hyperspectral imaging for tumor margin assessment. HSI data, hypercube (x,y,λ), consists of a series of images of the same field of view that are acquired at different wavelengths. Every pixel in the hypercube has an optical spectrum. We collected surgical tissue specimens from 16 human subjects who underwent head and neck (H&N) cancer surgery. We acquired both HSI, autofluorescence images, and fluorescence images with 2-NBDG and proflavine from the specimens. Digitized histologic slides were examined by an H&N pathologist. We developed image preprocessing and classification methods for HSI data and differentiate cancer from benign tissue. The hyperspectral imaging and classification method was able to distinguish between cancer and normal tissue from oral cavity with an average accuracy of 90±8%, sensitivity of 89±9%, and specificity of 91±6%. This study suggests that label-free hyperspectral imaging has great potential for surgical margin assessment in tissue specimens of H&N cancer patients. Further development of the imaging technology and quantification methods is warranted for its application in image-guided surgery.

  13. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    Directory of Open Access Journals (Sweden)

    Hart Vern P

    2011-10-01

    Full Text Available Abstract Background In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Methods Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. Results The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each

  14. High-frequency ultrasound for intraoperative margin assessments in breast conservation surgery: a feasibility study

    International Nuclear Information System (INIS)

    Doyle, Timothy E; Neumayer, Leigh A; Factor, Rachel E; Ellefson, Christina L; Sorensen, Kristina M; Ambrose, Brady J; Goodrich, Jeffrey B; Hart, Vern P; Jensen, Scott C; Patel, Hemang

    2011-01-01

    In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate

  15. Comparison of marginal bone loss and implant success between axial and tilted implants in maxillary All-on-4 treatment concept rehabilitations after 5 years of follow-up.

    Science.gov (United States)

    Hopp, Milena; de Araújo Nobre, Miguel; Maló, Paulo

    2017-10-01

    There is need for more scientific and clinical information on longer-term outcomes of tilted implants compared to implants inserted in an axial position. Comparison of marginal bone loss and implant success after a 5-year follow-up between axial and tilted implants inserted for full-arch maxillary rehabilitation. The retrospective clinical study included 891 patients with 3564 maxillary implants rehabilitated according to the All-on-4 treatment concept. The follow-up time was 5 years. Linear mixed-effect models were performed to analyze the influence of implant orientation (axial/tilted) on marginal bone loss and binary logistic regression to assess the effect of patient characteristics on occurrence of marginal bone loss >2.8 mm. Only those patients with measurements of at least one axial and one tilted implant available were analyzed. This resulted in a data set of 2379 implants (1201 axial, 1178 tilted) in 626 patients (=reduced data set). Axial and tilted implants showed comparable mean marginal bone losses of 1.14 ± 0.71 and 1.19 ± 0.82 mm, respectively. Mixed model analysis indicated that marginal bone loss levels at 5 years follow up was not significantly affected by the orientation (axial/tilted) of the implants in the maxillary bone. Smoking and female gender were associated with marginal bone loss >2.8 mm in a logistic regression analysis. Five-year implant success rates were 96%. The occurrence of implant failure showed to be statistically independent from orientation. Within the limitations of this study and considering a follow-up time of 5 years, it can be concluded that tilted implants behave similarly with regards to marginal bone loss and implant success in comparison to axial implants in full-arch rehabilitation of the maxilla. Longer-term outcomes (10 years +) are needed to verify this result. © 2017 Wiley Periodicals, Inc.

  16. Value of the magnetic resonance imaging in the assessment of the circumferential resection margin (CRM) in patients with rectal cancer

    International Nuclear Information System (INIS)

    Seehaus, A.; Fatal Jaef, V.; Pietrani, M.; Ocantos, J.

    2009-01-01

    Purpose: To determine whether magnetic resonance imaging (MRI) can predict tumor involvement of the circumferential resection margin (CRM) in patients with rectal cancer. Materials and methods: Between april 2005 and march 2008, 70 consecutive patients (mean age 64, range 34-78 years), 40 F and 30 M, with endoscopy and biopsy- proven middle and lower rectal cancer. Non contrast enhanced MRI was performed on a Siemens Avanto 1.5 T. A phased array coil was used and T2 weighted thin section sequences (TR/TE 4200/88, slice thickness 3mm, gap 0, matrix 256 x 256, field of view 150 x 150 mm) were performed in axial, sagittal and coronal orientations. Patients received a 150 ml glycerin enema before examination. No air insufflations or intramuscular antispasmodic was used. The shortest distance from the tumor edge to the circumferential margin was measured. A distance ≤ ?2 mm, analyzed in axial slices, was considered as definition of circumferential margin involvement. Results: The CRM was 2 mm in both MRI and histopathological findings in 26 patients. In 8 cases the CRM was shorter on MRI than in histopathological sections. In 32 patients the CRM was respected in both exams and 4 patients were considered positive on histopathological findings but negative in MRI. The sensitivity, specificity, positive and negative predictive values for prediction of tumor involvement of CRM were 86%, 80%, 76% and 88%, respectively. Conclusions: MRI gives reliable information on tumor involvement of the CRM in patients with rectal cancer. This may provide accurate identification of an important prognostic risk factor in patients prior to surgical treatment. (authors) [es

  17. Craniocaudal Safety Margin Calculation Based on Interfractional Changes in Tumor Motion in Lung SBRT Assessed With an EPID in Cine Mode

    International Nuclear Information System (INIS)

    Ueda, Yoshihiro; Miyazaki, Masayoshi; Nishiyama, Kinji; Suzuki, Osamu; Tsujii, Katsutomo; Miyagi, Ken

    2012-01-01

    Purpose: To evaluate setup error and interfractional changes in tumor motion magnitude using an electric portal imaging device in cine mode (EPID cine) during the course of stereotactic body radiation therapy (SBRT) for non–small-cell lung cancer (NSCLC) and to calculate margins to compensate for these variations. Materials and Methods: Subjects were 28 patients with Stage I NSCLC who underwent SBRT. Respiratory-correlated four-dimensional computed tomography (4D-CT) at simulation was binned into 10 respiratory phases, which provided average intensity projection CT data sets (AIP). On 4D-CT, peak-to-peak motion of the tumor (M-4DCT) in the craniocaudal direction was assessed and the tumor center (mean tumor position [MTP]) of the AIP (MTP-4DCT) was determined. At treatment, the tumor on cone beam CT was registered to that on AIP for patient setup. During three sessions of irradiation, peak-to-peak motion of the tumor (M-cine) and the mean tumor position (MTP-cine) were obtained using EPID cine and in-house software. Based on changes in tumor motion magnitude (∆M) and patient setup error (∆MTP), defined as differences between M-4DCT and M-cine and between MTP-4DCT and MTP-cine, a margin to compensate for these variations was calculated with Stroom’s formula. Results: The means (±standard deviation: SD) of M-4DCT and M-cine were 3.1 (±3.4) and 4.0 (±3.6) mm, respectively. The means (±SD) of ∆M and ∆MTP were 0.9 (±1.3) and 0.2 (±2.4) mm, respectively. Internal target volume-planning target volume (ITV-PTV) margins to compensate for ∆M, ∆MTP, and both combined were 3.7, 5.2, and 6.4 mm, respectively. Conclusion: EPID cine is a useful modality for assessing interfractional variations of tumor motion. The ITV-PTV margins to compensate for these variations can be calculated.

  18. Secondary malignancies from prostate cancer radiation treatment: a risk analysis of the influence of target margins and fractionation patterns.

    Science.gov (United States)

    Daşu, Alexandru; Toma-Daşu, Iuliana; Franzén, Lars; Widmark, Anders; Nilsson, Per

    2011-03-01

    This study explores the implications for cancer induction of treatment details such as fractionation, planning target volume (PTV) definition, and interpatient variations, which are relevant for the radiation treatment of prostate carcinomas. Treatment planning data from 100 patients have been analyzed with a risk model based on the United Nations Scientific Committee on the Effects of Atomic Radiation competition model. The risk model can account for dose heterogeneity and fractionation effects characteristic for modern radiotherapy. Biologically relevant parameters from clinical and experimental data have been used with the model. The results suggested that changes in prescribed dose could lead to a modification of the risks for individual organs surrounding the clinical target volume (CTV) but that the total risk appears to be less affected by changes in the target dose. Larger differences are observed for modifications of the margins between the CTV and the PTV because these have direct impact onto the dose level and dose heterogeneity in the healthy tissues surrounding the CTV. Interpatient anatomic variations also have to be taken into consideration for studies of the risk for cancer induction from radiotherapy. The results have shown the complex interplay between the risk for secondary malignancies, the details of the treatment delivery, and the patient heterogeneity that may influence comparisons between the long-term effects of various treatment techniques. Nevertheless, absolute risk levels seem very small and comparable to mortality risks from surgical interventions, thus supporting the robustness of radiation therapy as a successful treatment modality for prostate carcinomas. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Electrical impedance map (EIM) for margin assessment during robot-assisted laparoscopic prostatectomy (RALP) using a microendoscopic probe

    Science.gov (United States)

    Mahara, Aditya; Khan, Shadab; Schned, Alan R.; Hyams, Elias S.; Halter, Ryan J.

    2015-03-01

    Positive surgical margins (PSMs) found following prostate cancer surgery are a significant risk factor for post-operative disease recurrence. Noxious adjuvant radiation and chemical-based therapies are typically offered to men with PSMs. Unfortunately, no real-time intraoperative technology is currently available to guide surgeons to regions of suspicion during the initial prostatectomy where immediate surgical excisions could be used to reduce the chance of PSMs. A microendoscopic electrical impedance sensing probe was developed with the intention of providing real-time feedback regarding margin status to surgeons during robot-assisted laparoscopic prostatectomy (RALP) procedures. A radially configured 17-electrode microendoscopic probe was designed, constructed, and initially evaluated through use of gelatin-based phantoms and an ex vivo human prostate specimen. Impedance measurements are recorded at 10 frequencies (10 kHz - 100 kHz) using a high-speed FPGA-based electrical impedance tomography (EIT) system. Tetrapolar impedances are recorded from a number of different electrode configurations strategically chosen to sense tissue in a pre-defined sector underlying the probe face. A circular electrical impedance map (EIM) with several color-coded pie-shaped sectors is created to represent the impedance values of the probed tissue. Gelatin phantom experiments show an obvious distinction in the impedance maps between high and low impedance regions. Similarly, the EIM generated from the ex vivo prostate case shows distinguishing features between cancerous and benign regions. Based on successful development of this probe and these promising initial results, EIMs of additional prostate specimens are being collected to further evaluate this approach for intraoperative surgical margin assessment during RALP procedures.

  20. Training Needs for Substance Abuse Treatment and Assessment among Rehabilitation Counselors: California State Project

    Science.gov (United States)

    Ong, Lee Za; Lee, Dal-Yob; Cha, Grace; Arokiasamy, Charles

    2008-01-01

    One hundred rehabilitation counselors in California reported that about 90% of consumers with whom they worked with had substance abuse and cooccurring issues, yet about half rated their graduate training in substance abuse treatment and assessment as poor and their practices as marginally proficient. The correlation analysis revealed that…

  1. Financial globalisation and financial development in Africa: assessing marginal, threshold and net effects

    OpenAIRE

    Simplice Asongu; Lieven De Moor

    2015-01-01

    The present inquiry contributes to extant literature by simultaneously accounting for variations in financial development and financial globalisation in the assessment of hypothetical initial financial development conditions for the rewards of financial globalisation. The policy relevance for assessing these variations simultaneously builds on the intuition that, thresholds for financial development benefits of financial globalisation may also be contingent on initial levels of financial deve...

  2. A new assessment method for demonstrating the sufficiency of the safety assessment and the safety margins of the geological disposal system

    International Nuclear Information System (INIS)

    Ohi, Takao; Kawasaki, Daisuke; Chiba, Tamotsu; Takase, Toshio; Hane, Koji

    2013-01-01

    A new method for demonstrating the sufficiency of the safety assessment and safety margins of the geological disposal system has been developed. The method is based on an existing comprehensive sensitivity analysis method and can systematically identify the successful conditions, under which the dose rate does not exceed specified safety criteria, using analytical solutions for nuclide migration and the results of a statistical analysis. The successful conditions were identified using three major variables. Furthermore, the successful conditions at the level of factors or parameters were obtained using relational equations between the variables and the factors or parameters making up these variables. In this study, the method was applied to the safety assessment of the geological disposal of transuranic waste in Japan. Based on the system response characteristics obtained from analytical solutions and on the successful conditions, the classification of the analytical conditions, the sufficiency of the safety assessment and the safety margins of the disposal system were then demonstrated. A new assessment procedure incorporating this method into the existing safety assessment approach is proposed in this study. Using this procedure, it is possible to conduct a series of safety assessment activities in a logical manner. (author)

  3. Sustainability assessment of advanced wastewater treatment technologies

    DEFF Research Database (Denmark)

    Høibye, Linda; Clauson-Kaas, Jes; Wenzel, Henrik

    2008-01-01

    As a consequence of the EU Water Framework Directive more focus is now on discharges of hazardous substances from wastewater treatment plants and sewers. Thus, many municipalities in Denmark may have to adopt to future advanced treatment technologies. This paper describes a holistic assessment......, which includes technical, economical and environmental aspects. The technical and economical assessment is performed on 5 advanced treatment technologies: sand filtration, ozone treatment, UV exclusively for disinfection of pathogenic microorganisms, membrane bioreactor (MBR) and UV in combination...... and three advanced treatment methods; sand filtration, ozone treatment and MBR. The technical and economic assessment showed that UV solely for disinfection purposes or ozone treatment is the most advantageous advanced treatment methods if the demands are restricted to pathogenic microorganisms. In terms...

  4. Sustainability assessment of advanced wastewater treatment technologies

    DEFF Research Database (Denmark)

    Høibye, Linda; Clauson-Kaas, Jes; Wenzel, Henrik

    2007-01-01

    As a consequence of the EU Water Framwork Directive, more focus is now on discharges of hazardous substances from wastewater treatment plants and sewers. Thus, many municipalities in Denmark may have to adopt to future advenced treatment technologies. This paper describes a holistic assessment......, which includes technical, economic and environmental aspects. The technical and economic assessment is performed on 5 advanced treatment technologies: sand filtration, ozone treatment, UV exclusively for disinfection of pathogenic microorganisms, Membrane Bioreactor (MBR), and UV in combination...... and three advanced treatment methods: sand filtration, ozone treatment and MBR. The technical and economic assessment showed that UV solely for disinfection purposes or ozone treatment are the most advantageous advanved treatment methods if the demands are restricted to pathogenic microorganisms. In terms...

  5. Label-free optical imaging technologies for rapid translation and use during intraoperative surgical and tumor margin assessment

    Science.gov (United States)

    Boppart, Stephen A.; Brown, J. Quincy; Farah, Camile S.; Kho, Esther; Marcu, Laura; Saunders, Christobel M.; Sterenborg, Henricus J. C. M.

    2018-02-01

    The biannual International Conference on Biophotonics was recently held on April 30 to May 1, 2017, in Fremantle, Western Australia. This continuing conference series brought together key opinion leaders in biophotonics to present their latest results and, importantly, to participate in discussions on the future of the field and what opportunities exist when we collectively work together for using biophotonics for biological discovery and medical applications. One session in this conference, entitled "Tumor Margin Identification: Critiquing Technologies," challenged invited speakers and attendees to review and critique representative label-free optical imaging technologies and their application for intraoperative assessment and guidance in surgical oncology. We are pleased to share a summary in this outlook paper, with the intent to motivate more research inquiry and investigations, to challenge these and other optical imaging modalities to evaluate and improve performance, to spur translation and adoption, and ultimately, to improve the care and outcomes of patients.

  6. Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients

    Science.gov (United States)

    Fei, Baowei; Lu, Guolan; Wang, Xu; Zhang, Hongzheng; Little, James V.; Patel, Mihir R.; Griffith, Christopher C.; El-Diery, Mark W.; Chen, Amy Y.

    2017-08-01

    A label-free, hyperspectral imaging (HSI) approach has been proposed for tumor margin assessment. HSI data, i.e., hypercube (x,y,λ), consist of a series of high-resolution images of the same field of view that are acquired at different wavelengths. Every pixel on an HSI image has an optical spectrum. In this pilot clinical study, a pipeline of a machine-learning-based quantification method for HSI data was implemented and evaluated in patient specimens. Spectral features from HSI data were used for the classification of cancer and normal tissue. Surgical tissue specimens were collected from 16 human patients who underwent head and neck (H&N) cancer surgery. HSI, autofluorescence images, and fluorescence images with 2-deoxy-2-[(7-nitro-2,1,3-benzoxadiazol-4-yl)amino]-D-glucose (2-NBDG) and proflavine were acquired from each specimen. Digitized histologic slides were examined by an H&N pathologist. The HSI and classification method were able to distinguish between cancer and normal tissue from the oral cavity with an average accuracy of 90%±8%, sensitivity of 89%±9%, and specificity of 91%±6%. For tissue specimens from the thyroid, the method achieved an average accuracy of 94%±6%, sensitivity of 94%±6%, and specificity of 95%±6%. HSI outperformed autofluorescence imaging or fluorescence imaging with vital dye (2-NBDG or proflavine). This study demonstrated the feasibility of label-free, HSI for tumor margin assessment in surgical tissue specimens of H&N cancer patients. Further development of the HSI technology is warranted for its application in image-guided surgery.

  7. Assessment and Treatment of Pain during Treatment of Buruli Ulcer

    NARCIS (Netherlands)

    de Zeeuw, Janine; Alferink, Marike; Barogui, Yves T.; Sopoh, Ghislain; Phillips, Richard O.; van der Werf, Tjip S.; Loth, Susanne; Molenbuur, Bouwe; Plantinga, Mirjam; Ranchor, Adelita V.; Stienstra, Ymkje

    Background Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain

  8. From a Marginal Institution to Institutional Marginalization. Developments in the Treatment of Criminal Children in the Dutch Prison System. 1833-1884.

    Science.gov (United States)

    Leonards, Chris

    1990-01-01

    Examines the overhaul of the treatment of Dutch criminal children between 1830 and 1880. Discusses reforms taken, including the placing of children considered reeducable in separate youth prisons. Argues that private institutions, like the Dutch Prison Society, sponsored these reforms. Analyzes the success rate of educating these children. (DB)

  9. Beyond designed functional margins in CANDU type NPP. Radioactive nuclei assessment in an LOCA type accident

    Directory of Open Access Journals (Sweden)

    Budu Andrei Razvan

    2015-01-01

    Full Text Available European Union's energy roadmap up to year 2050 states that in order to have an efficient and sustainable economy, with minimum or decreasing greenhouse gas emissions, along with use of renewable resources, each constituent state has the option for nuclear energy production as one desirable option. Every scenario considered for tackling climate change issues, along with security of supply positions the nuclear energy as a recommended option, an option that is highly competitive with respect to others. Nuclear energy, along with other renewable power sources are considered to be the main pillars in the energy sector for greenhouse gas emission mitigation at European level. European Union considers that nuclear energy must be treated as a highly recommended option since it can contribute to security of energy supply. Romania showed excellent track-records in operating in a safe and economically sound manner of Cernavoda NPP Units 1&2. Both Units are in top 10 worldwide in terms of capacity factor. Due to Romania's need to ensure the security of electricity supply, to meet the environmental targets and to move to low carbon generation technologies, Cernavoda Units 3&4 Project appears as a must. This Project was started in 2010 and it is expected to have the Units running by 2025. Cost effective and safety operation of a Nuclear Power Plant is made taking into consideration functional limits of its equipment. As common practice, every nuclear reactor type (technology used is tested according to the worse credible accident or equipment failure that can occur. For CANDU type reactor, this is a Loss of Cooling Accident (LOCA. In a LOCA type accident in a CANDU NPP, using RELAP/SCDAP code for fuel bundle damage assessment the radioactive nuclei are to be quantified. Recently, CANDU type NPP accidents are studied using the RELAP/SCDAP code only. The code formerly developed for PWR type reactors was adapted for the CANDU geometry and can assess the

  10. Quality of life assessment of implant-retained overdentures and fixed metal-acrylic resin prostheses in patients with marginal mandibulectomy.

    Science.gov (United States)

    Karayazgan-Saracoglu, Banu; Atay, Arzu; Korkmaz, Cumhur; Gunay, Yumushan

    2017-10-01

    Several factors affect the prosthetic outcome of patients with mandibular defects. However, it is questionable whether fixed or removable implant-supported prostheses meet the expectations and satisfaction of the patients. The perspectives of these patients are important in managing the prosthetic treatment strategies. The purpose of this prospective clinical study was to evaluate the satisfaction and oral health-related quality of life of patients with marginal mandibulectomies with implant-retained overdentures and fixed metal-acrylic resin prostheses. Twenty-two participants with marginal mandibulectomies were included in the study. They completed an oral health impact profile questionnaire designed for patients with edentulism (OHIP-Edent) for the assessment of quality of life and visual analog scales (VASs) to validate their general satisfaction before treatment. Ten participants received 4 implant-retained fixed metal-acrylic resin prostheses, whereas 12 participants were treated with 2 implant-supported overdentures. Six months after delivery of their prostheses, the participants completed the OHIP-Edent questionnaire and VAS again. For the statistical analyses, Student t tests together with descriptive statistics (mean, standard deviation, frequency) were used in the 2 intergroup parameter comparisons that showed normal distribution. The Mann-Whitney U test and Kruskal-Wallis test were used for intergroup comparisons, and the Wilcoxon signed rank test was used for intragroup comparisons. Compared with pretreatment mean values, a statistically significant (P<.05) decrease in mean scores of all OHIP-Edent values and an increase in VAS scores were found in both groups. After patients were treated, their OHIP-Edent values in the group with an overdenture prosthesis were higher than those in the group with a fixed metal-acrylic resin prosthesis (P<.05). These results demonstrate that implant-retained overdentures and fixed metal-acrylic resin prostheses provide

  11. The Role of Seminal Vesicle Motion in Target Margin Assessment for Online Image-Guided Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Liang Jian; Wu Qiuwen; Yan Di

    2009-01-01

    Purpose: For patients with intermediate- and high-risk prostate cancer, the seminal vesicles (SVs) are included in the clinical target volume (CTV). The purposes of this study are to investigate interfraction motion characteristics of the SVs and determine proper margins for online computed tomography image guidance. Methods and Materials: Twenty-four patients, each with 16 daily helical computed tomography scans, were included in this study. A binary image mask was used for image registration to determine daily organ motion. Two online image-guided radiotherapy strategies (prostate only and prostate + SVs) were simulated in a hypofractionated scheme. Three margin designs were studied for both three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT). In prostate-only guidance, Margin A was uniformly applied to the whole CTV, and Margin B was applied to the SVs with a fixed 3-mm prostate margin. In prostate plus SV guidance, Margin C was uniformly applied to the CTV. The minimum margins were sought to satisfy the criterion that minimum cumulative CTV dose be more than those of the planning target volume in the plan for greater than 95% of patients. Results: The prostate and SVs move significantly more in the anterior-posterior and superior-inferior than right-left directions. The anterior-posterior motion of the prostate and SVs correlated (R 2 = 0.7). The SVs move significantly more than the prostate. The minimum margins found were 2.5 mm for three-dimensional conformal radiotherapy and 4.5, 4.5, and 3.0 mm for Margins A, B, and C for IMRT, respectively. Margins for IMRT were larger, but the irradiated volume and doses to critical structures were smaller. Minimum margins of 4.5 mm to the SVs and 3 mm to the prostate are recommended for IMRT with prostate-only guidance. Conclusions: The SVs move independently from the prostate gland, and additional margins are necessary for image-guided radiotherapy

  12. One-half of Korean adults studied had marginal vitamin B12status assessed by plasma vitamin B12.

    Science.gov (United States)

    Kim, Young-Nam; Hwang, Ji Hyeon; Cho, Youn-Ok

    2018-02-01

    Information is limited on the current vitamin B 12 status of South Koreans, including the results of biochemical indices. The objective of this study was to assess vitamin B 12 status with vitamin B 12 intake, major food sources, and plasma vitamin B 12 concentration in Korean adults. We hypothesized that vitamin B 12 intake and status would be different between sex and age groups. Three consecutive 24-hour recalls and fasting blood samples were obtained from healthy 20- to 64-year-old adults (N=141). The dietary vitamin B 12 intake of the men (10.77±6.11 μg/d) was significantly higher than that of the women (7.93±5.01 μg/d). The mean dietary vitamin B 12 intake was significantly lower in the subjects aged 20-29 years than in the subjects aged 50-64 years. Only 2.1% of the subjects consumed less vitamin B 12 than the estimated average requirement for Koreans. The top 4 major food sources of vitamin B 12 were seafood, which provided 35.36% of the dietary vitamin B 12 intake. There was no significant difference in plasma vitamin B 12 concentration between sex and among age groups. Approximately 17% of total subjects had a plasma vitamin B 12 concentration vitamin B 12 deficiency, and 36.2% had marginal vitamin B 12 status (125 to vitamin B 12 intake was affected by both sex and age. However, plasma vitamin B 12 concentration did not differ between sex and among age groups. One-half of the subjects had marginal vitamin B 12 status using plasma vitamin B 12 . Copyright © 2017. Published by Elsevier Inc.

  13. Implicit Treatment of Technical Specification and Thermal Hydraulic Parameter Uncertainties in Gaussian Process Model to Estimate Safety Margin

    Directory of Open Access Journals (Sweden)

    Douglas A. Fynan

    2016-06-01

    Full Text Available The Gaussian process model (GPM is a flexible surrogate model that can be used for nonparametric regression for multivariate problems. A unique feature of the GPM is that a prediction variance is automatically provided with the regression function. In this paper, we estimate the safety margin of a nuclear power plant by performing regression on the output of best-estimate simulations of a large-break loss-of-coolant accident with sampling of safety system configuration, sequence timing, technical specifications, and thermal hydraulic parameter uncertainties. The key aspect of our approach is that the GPM regression is only performed on the dominant input variables, the safety injection flow rate and the delay time for AC powered pumps to start representing sequence timing uncertainty, providing a predictive model for the peak clad temperature during a reflood phase. Other uncertainties are interpreted as contributors to the measurement noise of the code output and are implicitly treated in the GPM in the noise variance term, providing local uncertainty bounds for the peak clad temperature. We discuss the applicability of the foregoing method to reduce the use of conservative assumptions in best estimate plus uncertainty (BEPU and Level 1 probabilistic safety assessment (PSA success criteria definitions while dealing with a large number of uncertainties.

  14. Pseudodysplastic epithelial artefacts associated with oral mucosa CO2 laser excision: an assessment of margin status.

    Science.gov (United States)

    Seoane, J; Caballero, T G; Urizar, J M A; Almagro, M; Mosquera, A G; Varela-Centelles, P

    2010-08-01

    Using a CO(2) laser beam for biopsy is compromised by thermal cytological artefacts that could be critical when assessing dysplastic changes, as they may simulate cytological atypia. This study examined wounds caused by CO(2) laser, evaluating their size and features, utilizing 25 Sprage rats randomly allocated to five groups: four glossectomized using a CO(2) laser at 3, 6, 9 and 12 W and a control group treated with a conventional scalpel. Samples were prepared in 4 microm sections, stained, and studied double-blind by two pathologists. The artefacts identified included cellular and nuclear polymorphism, nuclear hyperchromatism and loss of intercellular adherence; they were mainly located in the basal and suprabasal layers of the oral epithelium. Number of artefacts per specimen did not differ between experimental groups. The width of epithelial damage adjacent to the laser incisions revealed 298.7+/-150.7 microm of damaged tissue (range 100-750 microm), with no differences between low (3 W) and high wattages (6, 9 and 12 W) (X(i)-X(j)=41.6; 95% CI=-125.1 to 208.4). No changes were observed in the control group. CO(2) laser (3-12 W) generates epithelial damage that can simulate light dysplasia with atypias mainly affecting basal and suprabasal layers that may lead to erroneous therapy. Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Trichotillomania: Behavioral Assessment and Treatment Interventions

    Science.gov (United States)

    Kell, Brandy L.; Kress, Victoria E.

    2006-01-01

    This article examines the behavioral treatment of Trichotillomania. A brief overview of the diagnosis and assessment of Trichotillomania is provided. Guidelines for a structured clinical evaluation when working with people diagnosed with Trichotillomania are supplied. The most effective behavioral interventions and treatments for working with…

  16. Marginal Matter

    Science.gov (United States)

    van Hecke, Martin

    2013-03-01

    All around us, things are falling apart. The foam on our cappuccinos appears solid, but gentle stirring irreversibly changes its shape. Skin, a biological fiber network, is firm when you pinch it, but soft under light touch. Sand mimics a solid when we walk on the beach but a liquid when we pour it out of our shoes. Crucially, a marginal point separates the rigid or jammed state from the mechanical vacuum (freely flowing) state - at their marginal points, soft materials are neither solid nor liquid. Here I will show how the marginal point gives birth to a third sector of soft matter physics: intrinsically nonlinear mechanics. I will illustrate this with shock waves in weakly compressed granular media, the nonlinear rheology of foams, and the nonlinear mechanics of weakly connected elastic networks.

  17. Response assessment with the CXCR4-directed positron emission tomography tracer [68Ga]Pentixafor in a patient with extranodal marginal zone lymphoma of the orbital cavities.

    Science.gov (United States)

    Herhaus, Peter; Habringer, Stefan; Vag, Tibor; Steiger, Katja; Slotta-Huspenina, Julia; Gerngroß, Carlos; Wiestler, Benedikt; Wester, Hans-Jürgen; Schwaiger, Markus; Keller, Ulrich

    2017-12-01

    CXCR4 belongs to the family of chemokine receptors. Together with its sole known ligand CXCL12 (SDF-1alpha), it has a pivotal role during organogenesis and for homing of hematopoietic stem cells. CXCR4 is overexpressed in various malignancies, and this is often associated with poor prognosis. Therefore, molecular imaging of CXCR4 bears a great potential for diagnostics and selecting patients for CXCR4-directed therapies. The CXCR4-directed positron emission tomography (PET) tracer [ 68 Ga]Pentixafor has been shown to visualize CXCR4 expression in various malignancies in vivo. Whereas this tracer has limitations compared to 18 F-Fluorodeoxyglucose ([ 18 F]FDG) in diagnostic PET imaging in peripheral tumour lesions, it might add valuable information in routine diagnostics and response assessment of tumours in close proximity to the central nervous system (CNS) and malignancies within this organ. As a proof-of-concept, we performed [ 68 Ga]Pentixafor PET imaging in a patient with extranodal marginal zone lymphoma (MZL) of the orbital cavities at diagnosis and for post-therapy response assessment. Compared to routinely conducted [ 18 F]FDG PET, the lymphoma lesions determined by magnetic resonance imaging (MRI) showed high tracer accumulation at diagnosis, which decreased upon treatment. We therefore propose that imaging of CXCR4 with [ 68 Ga]Pentixafor is a potential diagnostic tool for tumours close to or within the CNS and suggest this being studied in clinical trials.

  18. Assessment of stability during gait in patients with spinal deformity-A preliminary analysis using the dynamic stability margin.

    Science.gov (United States)

    Simon, Anne-Laure; Lugade, Vipul; Bernhardt, Kathie; Larson, A Noelle; Kaufman, Kenton

    2017-06-01

    Daily living activities are dynamic, requiring spinal motion through space. Current assessment of spinal deformities is based on static measurements from full-spine standing radiographs. Tools to assess dynamic stability during gait might be useful to enhance the standard evaluation. The aim of this study was to evaluate gait dynamic imbalance in patients with spinal deformity using the dynamic stability margin (DSM). Twelve normal subjects and 17 patients with spinal deformity were prospectively recruited. A kinematic 3D gait analysis was performed for the control group (CG) and the spinal deformity group (SDG). The DSM (distance between the extrapolated center of mass and the base of support) and time-distance parameters were calculated for the right and left side during gait. The relationship between DSM and step length was assessed using three variables: gait stability, symmetry, and consistency. Variables' accuracy was validated by a discriminant analysis. Patients with spinal deformity exhibited gait instability according to the DSM (0.25m versus 0.31m) with decreased velocity (1.1ms -1 versus 1.3ms -1 ) and decreased step length (0.32m versus 0.38m). According to the discriminant analysis, gait stability was the more accurate variable (area under the curve AUC=0.98) followed by gait symmetry and consistency. However, gait consistency showed 100% of specificity, sensitivity, and accuracy of precision. The DSM showed that patients with spinal malalignment exhibit decreased gait stability, symmetry, and consistency besides gait time-distance parameter changes. Additional work is required to determine how to apply the DSM for preoperative and postoperative spinal deformity management. Copyright © 2017. Published by Elsevier B.V.

  19. A margin-of-exposure approach to assessment of noncancer risks of dioxins based on human exposure and response data.

    Science.gov (United States)

    Aylward, Lesa L; Goodman, Julie E; Charnley, Gail; Rhomberg, Lorenz R

    2008-10-01

    Risk assessment of human environmental exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/PCDFs) and other dioxin-like compounds is complicated by several factors, including limitations in measuring intakes because of the low concentrations of these compounds in foods and the environment and interspecies differences in pharmacokinetics and responses. We examined the feasibility of relying directly on human studies of exposure and potential responses to PCDD/PCDFs and related compounds in terms of measured lipid-adjusted concentrations to assess margin of exposure (MOE) in a quantitative, benchmark dose (BMD)-based framework using representative exposure and selected response data sets. We characterize estimated central tendency and upper-bound general U.S. population lipid-adjusted concentrations of PCDD/PCDFs from the 1970s and early 2000s based on available data sets. Estimates of benchmark concentrations for three example responses of interest (induction of cytochrome P4501A2 activity, dental anomalies, and neonatal thyroid hormone alterations) were derived based on selected human studies. The exposure data sets indicate that current serum lipid concentrations in young adults are approximately 6- to 7-fold lower than 1970s-era concentrations. Estimated MOEs for each end point based on current serum lipid concentrations range from 100 for dental anomalies-approximately 6-fold greater than would have existed during the 1970s. Human studies of dioxin exposure and outcomes can be used in a BMD framework for quantitative assessments of MOE. Incomplete exposure characterization can complicate the use of such studies in a BMD framework.

  20. Assessment and Treatment of Pain during Treatment of Buruli Ulcer.

    Directory of Open Access Journals (Sweden)

    Janine de Zeeuw

    Full Text Available Buruli ulcer (BU is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149 of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11 were audio-taped, transcribed verbatim and qualitatively analyzed.In 113 (84% of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.

  1. Behavioral Assessment and Treatment of Pediatric Headache

    Science.gov (United States)

    Andrasik, Frank; Schwartz, Mark S.

    2006-01-01

    Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are…

  2. Assessment and treatment of social phobia.

    Science.gov (United States)

    Antony, M M

    1997-10-01

    Social phobia is an anxiety disorder characterized by heightened fear and avoidance of one or more social or performance situations, including public speaking, meeting new people, eating or writing in front of others, and attending social gatherings. People with social phobia are typically anxious about the possibility that others will evaluate them negatively and/or notice symptoms of their anxiety. Social phobia affects up to 13% of individuals at some time in their lives and is usually associated with at least moderate functional impairment. Research on the nature and treatment of social phobia has increased dramatically over the past decade. As with many of the anxiety disorders, sensitive assessment instruments and effective treatments now exist for people suffering from heightened social anxiety. Typical assessment strategies include clinical interviews, behavioural assessments, monitoring diaries, and self-report questionnaires. Treatments with demonstrated efficacy for social phobia include pharmacotherapy (for example, phenelzine, moclobemide, selective serotonin reuptake inhibitor [SSRI] medications) and cognitive behaviour therapy (CBT) (for example, cognitive restructuring, in vivo exposure, social skills training). Although preliminary comparative studies suggest that both approaches are about equally effective in the short term, each approach has advantages and disadvantages over the other. Trials examining combined psychological and pharmacological treatments are now under way, although no published data on the relative efficacy of combined treatments are currently available.

  3. The Red Sea structural architecture assessment based on yield strength spatial variations and Arabian margin preexisting structures

    Science.gov (United States)

    Alotaibi, T.; Furlong, K. P.

    2016-12-01

    Rift initiation and localization might reflect spatial changes in the lithospheric yield strength. However, this does not appear to be the case in the Red Sea extensional system where fission track analysis shows no significant changes in the geothermal gradient prior to the Red Sea rift onset. In contrast, though the whole Red Sea rift initiated 25 Ma ago, its extensional architecture changes dramatically along strike from narrow localized spreading in the south to asymmetrical diffuse extension north of 21° latitude. This onset of diffuse extension has been recorded in the north-western Arabian margin as old as 33 Ma. Such diversity in the extensional style might reflect along strike yield strength variations as a consequence of the geological setting in the Arabian margin. The north-western Arabian basin, which is part of the Arabian margin, bounded by Qiba high from the east, the Arabian shield from the south and the west and Syrian plateau from the north. The basin accommodates part of the Red Sea diffuse extension and has a preexisting structural architecture represented in the Cenozoic failed rift that called Sarhan graben. Our goal is to analyze the current lithospheric yield strength spatial variations along the Red Sea rift and emphasize their relationship with the Arabian margin structural architecture. We hypothesize that the north-western Arabian margin's lithospheric weakness and structural diversity are playing an important role in producing region of diffuse extension by their interaction with the forces applied by far field stresses represented by the New Tethys slab pull. On the other hand, the south-western Arabian margin interacts with the far field stresses as a single strong block in which led to localize the extension in the southern Red Sea. Our work may improve the scientific community understanding for how rifts initiate and evolve over time.

  4. Treatment of splenic marginal zone lymphoma of the CNS with high-dose therapy and allogeneic stem cell transplantation

    OpenAIRE

    Busemann Christoph; Gudzuhn Andrej; Hirt Carsten; Kirsch Michael; Vogelgesang Silke; Schmidt Christian A; Dölken Gottfried; Krüger William H

    2012-01-01

    Abstract Therapy of indolent lymphomas with involvement of the central nervous system (CNS) has not been standardized so far. A 42-year old male patient presented with neurological signs because of leukemic splenic marginal zone lymphoma (SMZL) manifested in bone marrow, lymph nodes and CNS. Due to the aggressiveness of the disease and the young age of the patient, an intensive immunochemotherapy followed by high-dose therapy with busulfan, thiotepa and fludarabine and subsequent unrelated al...

  5. Long-term radiographic evaluation of risk factors related to implant treatment: suggestion for alternative statistical analysis of marginal bone loss.

    Science.gov (United States)

    Hasegawa, Masakazu; Hotta, Yasunori; Hoshino, Takahiro; Ito, Koji; Komatsu, Shinichi; Saito, Takashi

    2016-10-01

    Secular change in marginal bone loss (MBL), which is the index adopted for implant success criteria, has often been used to evaluate risk factors. However, the need to revise these criteria has recently been indicated due to rapid developments in implant treatment. The purpose of this study was to evaluate risk factors by analyzing MBL with an alternative statistical method. The analyses were performed on the outcomes of 366 patients with 1,902 implants during an average follow-up period of 84.8 months (with a maximum follow-up of 258 months). Instead of evaluating annual MBL, time was calculated as one of the explanatory variables because the correlation between MBL and time was small (correlation coefficient of 0.09010). Analysis of covariance (ANCOVA) was used for exploratory assessment of each factor, and multiple regression analysis was then utilized to identify risk factors. The multiple regression analysis was performed twice, once among all implants and another in which one implant per patient was randomly selected. As a result of multiple regression analysis, smoking habits showed a significant effect on MBL. Age, sex, diabetes mellitus, implant positions, guided bone regeneration, and sinus floor elevation did not affect MBL. IMZ ® implants were associated with significantly higher MBL than were ANKYLOS ® and SPI ® implants. There was no significant difference between Straumann ® and other implants. Our results showed that another statistical process, which eliminated the effect of time rather than comparing annual MBL, could be applied to evaluate MBL because the correlation between MBL and time was small. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. A strategy for the use of image-guided radiotherapy (IGRT) on linear accelerators and its impact on treatment margins for prostate cancer patients

    International Nuclear Information System (INIS)

    Nairz, Olaf; Deutschmann, Heinz; Zehentmayr, Franz; Sedlmayer, Felix; Paracelsus Medical University Salzburg; Merz, Florian; Kopp, Peter; Schoeller, Helmut; Wurstbauer, Karl; Kametriser, Gerhard

    2008-01-01

    In external beam radiotherapy of prostate cancer, the consideration of various systematic error types leads to wide treatment margins compromising normal tissue tolerance. We investigated if systematic set-up errors can be reduced by a set of initial image-guided radiotherapy (IGRT) sessions. 27 patients received daily IGRT resulting in a set of 882 cone-beam computed tomographies (CBCTs). After matching to bony structures, we analyzed the dimensions of remaining systematic errors from zero up to six initial IGRT sessions and aimed at a restriction of daily IGRT for 10% of all patients. For threshold definition, we determined the standard deviations (SD) of the shift corrections and selected patients out of this range for daily image guidance. To calculate total treatment margins, we demanded for a cumulative clinical target volume (CTV) coverage of at least 95% of the specified dose in 90% of all patients. The gain of accuracy was largest during the first three IGRTs. In order to match precision and workload criteria, thresholds for the SD of the corrections of 3.5 mm, 2.0 mm and 4.5 mm in the left-right (L-R), cranial-caudal (C-C), and anterior-posterior (A-P) direction, respectively, were identified. Including all other error types, the total margins added to the CTV amounted to 8.6 mm in L-R, 10.4 mm in C-C, and 14.4 mm in A-P direction. Only initially performed IGRT might be helpful for eliminating gross systematic errors especially after virtual simulation. However, even with daily IGRT performance, a substantial PTV margin reduction is only achievable by matching internal markers instead of bony anatomical structures. (orig.)

  7. A strategy for the use of image-guided radiotherapy (IGRT) on linear accelerators and its impact on treatment margins for prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Nairz, Olaf; Deutschmann, Heinz; Zehentmayr, Franz; Sedlmayer, Felix [Landeskrankenhaus Salzburg, Paracelsus Medical University Salzburg (Austria). University Clinic for Radiotherapy and Radio-Oncology]|[Paracelsus Medical University Salzburg (Austria). RadART - Inst. for Research and Development on Advanced Radiation Technologies; Merz, Florian; Kopp, Peter; Schoeller, Helmut; Wurstbauer, Karl; Kametriser, Gerhard [Landeskrankenhaus Salzburg, Paracelsus Medical University Salzburg (Austria). University Clinic for Radiotherapy and Radio-Oncology

    2008-12-15

    In external beam radiotherapy of prostate cancer, the consideration of various systematic error types leads to wide treatment margins compromising normal tissue tolerance. We investigated if systematic set-up errors can be reduced by a set of initial image-guided radiotherapy (IGRT) sessions. 27 patients received daily IGRT resulting in a set of 882 cone-beam computed tomographies (CBCTs). After matching to bony structures, we analyzed the dimensions of remaining systematic errors from zero up to six initial IGRT sessions and aimed at a restriction of daily IGRT for 10% of all patients. For threshold definition, we determined the standard deviations (SD) of the shift corrections and selected patients out of this range for daily image guidance. To calculate total treatment margins, we demanded for a cumulative clinical target volume (CTV) coverage of at least 95% of the specified dose in 90% of all patients. The gain of accuracy was largest during the first three IGRTs. In order to match precision and workload criteria, thresholds for the SD of the corrections of 3.5 mm, 2.0 mm and 4.5 mm in the left-right (L-R), cranial-caudal (C-C), and anterior-posterior (A-P) direction, respectively, were identified. Including all other error types, the total margins added to the CTV amounted to 8.6 mm in L-R, 10.4 mm in C-C, and 14.4 mm in A-P direction. Only initially performed IGRT might be helpful for eliminating gross systematic errors especially after virtual simulation. However, even with daily IGRT performance, a substantial PTV margin reduction is only achievable by matching internal markers instead of bony anatomical structures. (orig.)

  8. SU-E-T-05: 4D Measurement-Guided Dose Reconstruction (4D-MGDR) in End-End Quality Assurance (E2E QA) for Assessing Safety Margin in Radiosurgery (SRS) From Clinical Perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Chan, M; Leung, R; Wong, M; Lee, V; Law, G; Lee, K; Tung, S [Tuen Mun Hospital, Hong Kong (China); Blanck, O [University Clinic Schleswig-Holstein, Kiel (Germany)

    2015-06-15

    Purpose: To assess the plan robustness and safety margin in SRS from 4DMGDR in E2E QA based on clinical objectives. Methods: OCTAVIUS SRS 1000 detector array and 4D phantom (PTW, Freiburg, Germany) were used to measure 5 coplanar SRS plans with 1 and 2 mm planning target volume (PTV). 3 targets were clinical, and 2 were virtual simulated to be 1mm from the brainstem (BS), and between chiasm (CS) and optic nerve (ON). Planning was done on Monaco v5.0 (Elekta, Maryland Heights, MO) to achieve 95–99% PTV and 100% gross tumor volume (GTV) prescription dose coverage. CBCT setup of the 4D phantom by 6D robotic couch was performed as for real patient. 4D-MGDR in patient CT and dosimetric analysis were performed in PTW Verisoft v6.1. The safety margin that achieved 100% GTV coverage was determined, and doses to 2% (D2%) of BS, ON and CS were assessed from E2E QA. Results: 100% GTV coverage was achieved with 1mm margin for 2 plans and 2mm margin for all plans. 98.3% and 99.4% GTV coverage were found in E2E QA for 1mm PTVs that either had sharp changing contour, or was nearby CS and ON or BS, and had either low planned minimum GTV dose (∼101% of the prescribed dose vs.∼106%) or compromised PTV coverage (95% vs. 99%). D2% to CS obtained with 4D-MGDR for one virtual target were 18.8Gy for 1mm PTV and 19.2Gy for 2mm PTV, exceeding the planned tolerance of 18Gy/3 fractions for prescription dose of 24Gy. Conclusion: 1mm margin is generally sufficient for dose planning and machine delivery errors. Irregular GTV with just enough dose coverage to spare critical organs may need 2mm margin at the costs of possible higher organ doses. 4D MGDR in an E2E QA approach can put the treatment plan evaluation in clinical perspectives.

  9. Cadmium assessment on the intertidal water margins from the Óbidos Lagoon (western coast of Portugal

    Directory of Open Access Journals (Sweden)

    Marcia S.S. Santos

    2014-04-01

    Full Text Available The Óbidos Lagoon is the largest shallow coastal lagoon in Portugal. Like any other brackish water system, it has been potentially exposed to different sources of contamination (e.g. livestock farming, domestic and industrial sewage. Trace metals are persistent elements present in the water and sediments in their elemental and organic/inorganic forms. In fact, Cadmium is extremely pollutant due to its great solubility in water and high toxicity for organisms. Also, it is classified as a priority substance according to the European Union Water Frame directive. In this context, a seasonal environmental monitoring program was implemented in the intertidal water margins of the Óbidos Lagoon to assess the presence of Cadmium. In 2009 and 2010, eight sampling stations (S distributed on the shores of the Óbidos Lagoon were chosen and water and sediments were seasonally collected. In all samples, cadmium concentrations were analyzed by Atomic Absorption Spectrometry, with Graphite Furnace Technique. Cadmium dissolved in the water samples was only detected during summer months, with the highest values in the Barrosa’s arm (S3: 0.35 mg/l in 2009, and at the station further downstream (S1: 0.19 mg/l in 2010. In the suspended fraction of the water samples the trace metal was detectable in all seasons, with the maximum concentration at the Barrosa’s arm (S4: 1.04 mg/l in the winter of 2010. Cadmium was not detectable in the sediments during the summers and was sporadically present in the autumn and in the winter of 2009. The highest concentration in the sediments was observed at the Barrosa´s arm (S4: 140.78 mg/kg in the spring of 2010. As a whole, cadmium contamination appears to be mostly focused on the inner areas of the lagoon, at the Barrosa´s arm, but a clear seasonal pattern of variation was not detectable. These results allow a better understanding of the environmental quality of this ecosystem and may assist in the definition of coastal

  10. Intraoperative pancreatoscopy with narrow band imaging: a novel method for assessment of resection margins in case of intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Yelamali, Arun; Mansard, Magnus Jayaraj; Dama, Rohit; Rebela, Pradeep; Rao, Guduru Venkat; Reddy, Duvvuru Nageshwar

    2012-12-01

    Intraductal papillary mucinous neoplasm (IPMN) is characterized by intraductal proliferation of neoplastic mucinous cells with a variable extent along the main duct or its branches. The lesion may be continuous or discontinuous. Skip lesions have been described in about 6-19% of cases. Complete resection without leaving behind any skip lesions is important, to such an extent that many groups suggest even total pancreatectomy, a major and morbid surgery. A 40 year-male patient with chronic pancreatitis presented with recent-onset diabetes mellitus and weight loss. Ultrasound and computed tomography (CT) scan showed a cystic lesion in the head and uncinate process of pancreas. Peroral pancreatoscopy showed villous projections with dilated tortuous vessel in the head, suspicious of IPMN. The duct beyond pancreatic head could not be visualized and remained unassessed. At pancreatoduodenectomy, pancreatoscopy with narrow band imaging (NBI) was done using flexible pancreatoscope through the cut end of the duct at the neck to assess the duct in the body and tail. Pancreatoscopy with NBI showed a normal-looking resection margin and a skip lesion 1 cm beyond it. The revised resection margin confirmed the skip lesion on frozen section and also that the fresh cut margin was negative. The remaining duct in the body and tail was normal on pancreatoscopy. Total clearance of the disease could be achieved without a major procedure such as total pancreatectomy. Intraoperative pancreatoscopy, especially with NBI, is a good diagnostic tool for IPMN and also helps in intraoperative decision-making of the resection margins.

  11. TU-H-CAMPUS-JeP2-04: Deriving Delivered Doses to Assess the Viability of 2.5 Mm Margins in Head and Neck SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Lin, S [Cleveland State University, Cleveland, OH (United States); Shang, Q; Godley, A [Cleveland Clinic, Cleveland, OH (United States); Pirozzi, S [MIM Software, Cleveland, OH (United States)

    2016-06-15

    Purpose: To calculate the delivered dose for head and neck SBRT patients using pre-treatment images. This delivered dose was then used to determine the viability of 2.5 mm margins. Methods: Daily cone beam CTs (CBCTs) were collected for 20 patients along with a planning CT, planned dose, and planning structures. The day 1 CBCT was aligned to the planning CT using the treatment shifts (six degrees of freedom) and then the dose and contours were transferred to the CBCT. The day 1 CBCT becomes the reference image for days 2–5. The day 2–5 CBCTs were also aligned to the planning CT using the treatment shifts given and the dose transferred. The day 2–5 CBCTs were then deformably registered to the day 1 CBCT. The doses delivered on days 2–5 were then deformed to the day 1 CBCT where they could be accumulated. This was achieved with MIM 6.5.1 (MIM Software, Cleveland OH). The accumulated doses for the 20 patients were evaluated against the planned doses using the initial planning criteria as points of comparison. Results: The delivered CTV dose conformed to the planned 98.6% coverage, with an average decrease of 2.6% between planned and delivered coverage. This implies the 2.5 mm margin was sufficient. Larger CTVs correlated to smaller differences between planned and delivered coverage. Delivered dose to critical structures including the spinal cord, mandible, brain, brainstem, and larynx was acceptable, with differences between planned and delivered max dose <5% on average. Similarly for the parotid glands, globes, cochlear, optic nerve, lens, and submandibular glands, differences between planned and delivered doses were generally <5%. Conclusion: The 2.5 mm margin provided acceptable CTV coverage, adequately accounting for setup errors. Organ at risk sparing was also satisfactory. Small tumor volumes (<20 cc) may require a larger margin to treat effectively.

  12. Set-up errors analyses in IMRT treatments for nasopharyngeal carcinoma to evaluate time trends, PTV and PRV margins

    Energy Technology Data Exchange (ETDEWEB)

    Mongioj, Valeria (Dept. of Medical Physics, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)), e-mail: valeria.mongioj@istitutotumori.mi.it; Orlandi, Ester (Dept. of Radiotherapy, Fondazione IRCCS Istituto Nazionale Tumori, Milan (Italy)); Palazzi, Mauro (Dept. of Radiotherapy, A.O. Niguarda Ca' Granda, Milan (Italy)) (and others)

    2011-01-15

    Introduction. The aims of this study were to analyze the systematic and random interfractional set-up errors during Intensity Modulated Radiation Therapy (IMRT) in 20 consecutive nasopharyngeal carcinoma (NPC) patients by means of Electronic Portal Images Device (EPID), to define appropriate Planning Target Volume (PTV) and Planning Risk Volume (PRV) margins, as well as to investigate set-up displacement trend as a function of time during fractionated RT course. Material and methods. Before EPID clinical implementation, an anthropomorphic phantom was shifted intentionally 5 mm to all directions and the EPIs were compared with the digitally reconstructed radiographs (DRRs) to test the system's capability to recognize displacements observed in clinical studies. Then, 578 clinical images were analyzed with a mean of 29 images for each patient. Results. Phantom data showed that the system was able to correct shifts with an accuracy of 1 mm. As regards clinical data, the estimated population systematic errors were 1.3 mm for left-right (L-R), 1 mm for superior-inferior (S-I) and 1.1 mm for anterior-posterior (A-P) directions, respectively. Population random errors were 1.3 mm, 1.5 mm and 1.3 mm for L-R, S-I and A-P directions, respectively. PTV margin was at least 3.4, 3 and 3.2 mm for L-R, S-I and A-P direction, respectively. PRV margins for brainstem and spinal cord were 2.3, 2 and 2.1 mm and 3.8, 3.5 and 3.2 mm for L-R, A-P and S-I directions, respectively. Set-up error displacements showed no significant changes as the therapy progressed (p>0.05), although displacements >3 mm were found more frequently when severe weight loss or tumor nodal shrinkage occurred. Discussion. These results enable us to choose margins that guarantee with sufficient accuracy the coverage of PTVs and organs at risk sparing. Collected data confirmed the need for a strict check of patient position reproducibility in case of anatomical changes

  13. Time Domain Stability Margin Assessment of the NS Space Launch System GN&C Design for Exploration Mission One

    Science.gov (United States)

    Clements, Keith; Wall, John

    2017-01-01

    The baseline stability margins for NASA's Space Launch System (SLS) launch vehicle were generated via the classical approach of linearizing the system equations of motion and determining the gain and phase margins from the resulting frequency domain model. To improve the fidelity of the classical methods, the linear frequency domain approach can be extended by replacing static, memoryless nonlinearities with describing functions. This technique, however, does not address the time varying nature of the dynamics of a launch vehicle in flight. An alternative technique for the evaluation of the stability of the nonlinear launch vehicle dynamics along its trajectory is to incrementally adjust the gain and/or time delay in the time domain simulation until the system exhibits unstable behavior. This technique has the added benefit of providing a direct comparison between the time domain and frequency domain tools in support of simulation validation.

  14. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    Energy Technology Data Exchange (ETDEWEB)

    Krammer, Julia [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Price, Elissa R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, CA (United States); Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Murray, Melissa P. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Schoenberg, Stefan O. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2017-11-15

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  15. Life cycle assessment of electronic waste treatment.

    Science.gov (United States)

    Hong, Jinglan; Shi, Wenxiao; Wang, Yutao; Chen, Wei; Li, Xiangzhi

    2015-04-01

    Life cycle assessment was conducted to estimate the environmental impact of electronic waste (e-waste) treatment. E-waste recycling with an end-life disposal scenario is environmentally beneficial because of the low environmental burden generated from human toxicity, terrestrial ecotoxicity, freshwater ecotoxicity, and marine ecotoxicity categories. Landfill and incineration technologies have a lower and higher environmental burden than the e-waste recycling with an end-life disposal scenario, respectively. The key factors in reducing the overall environmental impact of e-waste recycling are optimizing energy consumption efficiency, reducing wastewater and solid waste effluent, increasing proper e-waste treatment amount, avoiding e-waste disposal to landfill and incineration sites, and clearly defining the duties of all stakeholders (e.g., manufacturers, retailers, recycling companies, and consumers). Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Dual in vivo Photoacoustic and Fluorescence Imaging of HER2 Expression in Breast Tumors for Diagnosis, Margin Assessment, and Surgical Guidance

    Directory of Open Access Journals (Sweden)

    Azusa Maeda

    2015-01-01

    Full Text Available Biomarker-specific imaging probes offer ways to improve molecular diagnosis, intraoperative margin assessment, and tumor resection. Fluorescence and photoacoustic imaging probes are of particular interest for clinical applications because the combination enables deeper tissue penetration for tumor detection while maintaining imaging sensitivity compared to a single optical imaging modality. Here we describe the development of a human epidermal growth factor receptor 2 (HER2-targeting imaging probe to visualize differential levels of HER2 expression in a breast cancer model. Specifically, we labeled trastuzumab with Black Hole Quencher 3 (BHQ3 and fluorescein for photoacoustic and fluorescence imaging of HER2 overexpression, respectively. The dual-labeled trastuzumab was tested for its ability to detect HER2 overexpression in vitro and in vivo. We demonstrated an over twofold increase in the signal intensity for HER2-overexpressing tumors in vivo, compared to low–HER2-expressing tumors, using photoacoustic imaging. Furthermore, we demonstrated the feasibility of detecting tumors and positive surgical margins by fluorescence imaging. These results suggest that multimodal HER2-specific imaging of breast cancer using the BHQ3-fluorescein trastuzumab enables molecular-level detection and surgical margin assessment of breast tumors in vivo. This technique may have future clinical impact for primary lesion detection, as well as intraoperative molecular-level surgical guidance in breast cancer.

  17. Problematic cybersex: Conceptualization, assessment, and treatment.

    Science.gov (United States)

    Wéry, A; Billieux, J

    2017-01-01

    Problematic involvement in cybersex is generally considered to be an excessive and uncontrolled use of online sexual activities associated with tangible negative outcomes and functional impairment. To date, there is no consensus in the literature regarding the conceptualization and labeling of this disorder, or of its diagnosis and assessment (e.g., screening questionnaires and diagnostic criteria). Through a systematic examination of the literature, we emphasize that problematic cybersex is an umbrella construct that regroups various types of distinct dysfunctional online behaviors. Despite a considerable increase in studies on problematic cybersex, no clear diagnostic guidelines exist for clinicians and researchers. Moreover, the factors involved in the development and maintenance of the disorder remain poorly examined, and the evidence regarding valid assessment and treatment are lacking. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Marginal kidney donor

    Directory of Open Access Journals (Sweden)

    Ganesh Gopalakrishnan

    2007-01-01

    Full Text Available Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.

  19. Life cycle assessment of electronic waste treatment

    International Nuclear Information System (INIS)

    Hong, Jinglan; Shi, Wenxiao; Wang, Yutao; Chen, Wei; Li, Xiangzhi

    2015-01-01

    Highlights: • Life cycle assessment of electronic waste recycling is quantified. • Key factors for reducing the overall environmental impact are indentified. • End-life disposal processes provide significant environmental benefits. • Efficiently reduce the improper disposal amount of e-waste is highly needed. • E-waste incineration can generate significant environmental burden. - Abstract: Life cycle assessment was conducted to estimate the environmental impact of electronic waste (e-waste) treatment. E-waste recycling with an end-life disposal scenario is environmentally beneficial because of the low environmental burden generated from human toxicity, terrestrial ecotoxicity, freshwater ecotoxicity, and marine ecotoxicity categories. Landfill and incineration technologies have a lower and higher environmental burden than the e-waste recycling with an end-life disposal scenario, respectively. The key factors in reducing the overall environmental impact of e-waste recycling are optimizing energy consumption efficiency, reducing wastewater and solid waste effluent, increasing proper e-waste treatment amount, avoiding e-waste disposal to landfill and incineration sites, and clearly defining the duties of all stakeholders (e.g., manufacturers, retailers, recycling companies, and consumers)

  20. Life cycle assessment of electronic waste treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jinglan, E-mail: hongjing@sdu.edu.cn [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Shandong University Climate Change and Health Center, Public Health School, Shandong University, Jinan 250012 (China); Shi, Wenxiao [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Wang, Yutao [School of Life Science, Shandong University, Shanda South Road 27, Jinan 250100 (China); Chen, Wei [Shandong Provincial Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Jinan 250100 (China); Li, Xiangzhi, E-mail: xiangzhi@sdu.edu.cn [School of Medicine, Shandong University, Jinan 250012 (China)

    2015-04-15

    Highlights: • Life cycle assessment of electronic waste recycling is quantified. • Key factors for reducing the overall environmental impact are indentified. • End-life disposal processes provide significant environmental benefits. • Efficiently reduce the improper disposal amount of e-waste is highly needed. • E-waste incineration can generate significant environmental burden. - Abstract: Life cycle assessment was conducted to estimate the environmental impact of electronic waste (e-waste) treatment. E-waste recycling with an end-life disposal scenario is environmentally beneficial because of the low environmental burden generated from human toxicity, terrestrial ecotoxicity, freshwater ecotoxicity, and marine ecotoxicity categories. Landfill and incineration technologies have a lower and higher environmental burden than the e-waste recycling with an end-life disposal scenario, respectively. The key factors in reducing the overall environmental impact of e-waste recycling are optimizing energy consumption efficiency, reducing wastewater and solid waste effluent, increasing proper e-waste treatment amount, avoiding e-waste disposal to landfill and incineration sites, and clearly defining the duties of all stakeholders (e.g., manufacturers, retailers, recycling companies, and consumers)

  1. Treatment simulations with a statistical deformable motion model to evaluate margins for multiple targets in radiotherapy for high-risk prostate cancer

    International Nuclear Information System (INIS)

    Thörnqvist, Sara; Hysing, Liv B.; Zolnay, Andras G.; Söhn, Matthias; Hoogeman, Mischa S.; Muren, Ludvig P.; Bentzen, Lise; Heijmen, Ben J.M.

    2013-01-01

    Background and purpose: Deformation and correlated target motion remain challenges for margin recipes in radiotherapy (RT). This study presents a statistical deformable motion model for multiple targets and applies it to margin evaluations for locally advanced prostate cancer i.e. RT of the prostate (CTV-p), seminal vesicles (CTV-sv) and pelvic lymph nodes (CTV-ln). Material and methods: The 19 patients included in this study, all had 7–10 repeat CT-scans available that were rigidly aligned with the planning CT-scan using intra-prostatic implanted markers, followed by deformable registrations. The displacement vectors from the deformable registrations were used to create patient-specific statistical motion models. The models were applied in treatment simulations to determine probabilities for adequate target coverage, e.g. by establishing distributions of the accumulated dose to 99% of the target volumes (D 99 ) for various CTV–PTV expansions in the planning-CTs. Results: The method allowed for estimation of the expected accumulated dose and its variance of different DVH parameters for each patient. Simulations of inter-fractional motion resulted in 7, 10, and 18 patients with an average D 99 >95% of the prescribed dose for CTV-p expansions of 3 mm, 4 mm and 5 mm, respectively. For CTV-sv and CTV-ln, expansions of 3 mm, 5 mm and 7 mm resulted in 1, 11 and 15 vs. 8, 18 and 18 patients respectively with an average D 99 >95% of the prescription. Conclusions: Treatment simulations of target motion revealed large individual differences in accumulated dose mainly for CTV-sv, demanding the largest margins whereas those required for CTV-p and CTV-ln were comparable

  2. Seismic Safety Margins Research Program (Phase I). Project I. Plant/site selection, plant/site selection assessment report

    International Nuclear Information System (INIS)

    Reed, R.L.

    1979-01-01

    Lawrence Livermore Laboratory (LLL) is conducting research on the seismic risk of nuclear power plants through the Seismic Safety Margins Research Program (SSMRP). Phase I of the SSMRP will include a study of an existing plant and site. Results are presented of a study of existing and planned nuclear power plants in the United States. Selection criteria were developed and a recommendation for a specific plant for the SSMRP Phase I effort is given. Power plant characteristics including types of nuclear steam supply steam, containment structure, electric power capacity, geographic location, site seismicity, and foundation soil properties were evaluated

  3. Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland: role of daily inter- and intrafraction motion.

    Science.gov (United States)

    Tanyi, James A; He, Tongming; Summers, Paige A; Mburu, Ruth G; Kato, Catherine M; Rhodes, Stephen M; Hung, Arthur Y; Fuss, Martin

    2010-12-01

    To determine planning target volume margins for prostate intensity-modulated radiotherapy based on inter- and intrafraction motion using four daily localization techniques: three-point skin mark alignment, volumetric imaging with bony landmark registration, volumetric imaging with implanted fiducial marker registration, and implanted electromagnetic transponders (beacons) detection. Fourteen patients who underwent definitive intensity-modulated radiotherapy for prostate cancer formed the basis of this study. Each patient was implanted with three electromagnetic transponders and underwent a course of 39 treatment fractions. Daily localization was based on three-point skin mark alignment followed by transponder detection and patient repositioning. Transponder positioning was verified by volumetric imaging with cone-beam computed tomography of the pelvis. Relative motion between the prostate gland and bony anatomy was quantified by offline analyses of daily cone-beam computed tomography. Intratreatment organ motion was monitored continuously by the Calypso® System for quantification of intrafraction setup error. As expected, setup error (that is, inter- plus intrafraction motion, unless otherwise stated) was largest with skin mark alignment, requiring margins of 7.5 mm, 11.4 mm, and 16.3 mm, in the lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. Margin requirements accounting for intrafraction motion were smallest for transponder detection localization techniques, requiring margins of 1.4 mm (LR), 2.6 mm (SI), and 2.3 mm (AP). Bony anatomy alignment required 2.1 mm (LR), 9.4 mm (SI), and 10.5 mm (AP), whereas image-guided marker alignment required 2.8 mm (LR), 3.7 mm (SI), and 3.2 mm (AP). No marker migration was observed in the cohort. Clinically feasible, rapid, and reliable tools such as the electromagnetic transponder detection system for pretreatment target localization and, subsequently, intratreatment target location monitoring

  4. Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net.

    Science.gov (United States)

    Fleming, Mark D; Shim, Janet K; Yen, Irene H; Thompson-Lastad, Ariana; Rubin, Sara; Van Natta, Meredith; Burke, Nancy J

    2017-06-01

    Increasing "patient engagement" has become a priority for health care organizations and policy-makers seeking to reduce cost and improve the quality of care. While concepts of patient engagement have proliferated rapidly across health care settings, little is known about how health care providers make use of these concepts in clinical practice. This paper uses 20 months of ethnographic and interview research carried out from 2015 to 2016 to explore how health care providers working at two public, urban, safety-net hospitals in the United States define, discuss, and assess patient engagement. We investigate how health care providers describe engagement for high cost patients-the "super-utilizers" of the health care system-who often face complex challenges related to socioeconomic marginalization including poverty, housing insecurity, exposure to violence and trauma, cognitive and mental health issues, and substance use. The health care providers in our study faced institutional pressure to assess patient engagement and to direct care towards engaged patients. However, providers considered such assessments to be highly challenging and oftentimes inaccurate, particularly because they understood low patient engagement to be the result of difficult socioeconomic conditions. Providers tried to navigate the demand to assess patient engagement in care by looking for explicit positive and negative indicators of engagement, while also being sensitive to more subtle and intuitive signs of engagement for marginalized patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. ASSESSMENT OF THE TSUNAMIGENIC POTENTIAL ALONG THE NORTHERN CARIBBEAN MARGIN Case Study: Earthquake and Tsunamis of 12 January 2010 in Haiti.

    Directory of Open Access Journals (Sweden)

    George Pararas-Carayannis

    2010-01-01

    Full Text Available The potential tsunami risk for Hispaniola, as well as for the other Greater Antilles Islands is assessed by reviewing the complex geotectonic processes and regimes along the Northern Caribbean margin, including the convergent, compressional and collisional tectonic activity of subduction, transition, shearing, lateral movements, accretion and crustal deformation caused by the eastward movement of the Caribbean plate in relation to the North American plate. These complex tectonic interactions have created a broad, diffuse tectonic boundary that has resulted in an extensive, internal deformational sliver slab - the Gonâve microplate – as well as further segmentation into two other microplates with similarly diffused boundary characteristics where tsunamigenic earthquakes have and will again occur. The Gonâve microplate is the most prominent along the Northern Caribbean margin and extends from the Cayman Spreading Center to Mona Pass, between Puerto Rico and the island of Hispaniola, where the 1918 destructive tsunami was generated. The northern boundary of this sliver microplate is defined by the Oriente strike-slip fault south of Cuba, which appears to be an extension of the fault system traversing the northern part of Hispaniola, while the southern boundary is defined by another major strike-slip fault zone where the Haiti earthquake of 12 January 2010 occurred. Potentially tsunamigenic regions along the Northern Caribbean margin are located not only along the boundaries of the Gonâve microplate’s dominant western transform zone but particularly within the eastern tectonic regimes of the margin where subduction is dominant - particularly along the Puerto Rico trench. The Haiti earthquake of 12 January 2010 and its focal mechanism are examined, as they provide additional clues of potential tsunami generation that can occur along transform zones and, more specifically, from interplate and intraplate seismic events and subsequently induced

  6. Rio+20, biodiversity marginalized

    OpenAIRE

    Carrière, Stéphanie M.; Rodary, Estienne; Méral, Philippe; Serpantié, Georges; Boisvert, Valérie; Kull, C.A.; Lestrelin, Guillaume; Lhoutellier, Louise; Moizo, Bernard; Smektala, G.; Vandevelde, Jean-Christophe

    2013-01-01

    At the Rio+20 Conference (June 2012), the biodiversity conservation agenda was subsumed into broader environmental issues like sustainable development, “green economy,” and climate change. This shoehorning of biodiversity issues is concomitant with a trend toward market-based instruments and toward standardized biodiversity assessment and monitoring. This article raises concern that these trends can marginalize important and specific aspects of biodiversity governance, including other policy ...

  7. Treatment of splenic marginal zone lymphoma of the CNS with high-dose therapy and allogeneic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Busemann Christoph

    2012-10-01

    Full Text Available Abstract Therapy of indolent lymphomas with involvement of the central nervous system (CNS has not been standardized so far. A 42-year old male patient presented with neurological signs because of leukemic splenic marginal zone lymphoma (SMZL manifested in bone marrow, lymph nodes and CNS. Due to the aggressiveness of the disease and the young age of the patient, an intensive immunochemotherapy followed by high-dose therapy with busulfan, thiotepa and fludarabine and subsequent unrelated allogeneic stem cell transplantation (alloSCT was performed. The haemopoietic stem cells engrafted in time and the patient is doing well (ECOG 0 without evidence for active lymphoma three years after transplantation. Highly sensitive tests by specific quantitative real-time polymerase chain reaction for presence of lymphoma cells in blood and bone marrow indicated also a molecular remission. The reported case shows the feasibility of high-dose therapy and allogeneic stem cell transplantation in high-risk patients with CNS-involvement of indolent non-Hodgkin’s lymphoma. In addition, the case supports the hypothesis that the graft-versus lymphoma effect after alloSCT is also active within the CNS.

  8. Effects of oral hygiene, residual caries and cervical Marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations

    Directory of Open Access Journals (Sweden)

    Arthur M Kemoli

    2011-01-01

    Full Text Available Background: Although Atraumatic restorative treatment (ART approach has been in existence for a while, the reasons for the poor performance of multisurface ART restorations are not very clear. Aim: The aim of this study is to investigate the effects of oral hygiene, residual caries and cervical marginal-gaps on survival of proximal ART restorations. Settings: Two rural divisions in Kenya were selected for the study. Design: A randomized clinical trial. Material and Methods: The 804 children in the study had their baseline- and 2-year dental plaque levels documented. Each child received one proximal restoration in a primary molar using ART approach, together with trained and pre-tested operators/assistants, three glass ionomer cements (GIC-brands and two tooth-isolation methods. The restorations were clinically evaluated soon after placement and after 2 years. Post-restorative bite-wing radiographs taken soon after restoration were also evaluated. Statistical analysis: Statistical Package for Social Sciences (SPSS version 14 computer programme was used and results tested using Pearson′s correlation, Cox Proportional Hazards regression analysis and Multiple Logistic regression models tests. Results: At baseline and after 2 years, the mean cumulative survival and plaque index changed from 94.4% to 30.8% and 2.34 (Standard Deviation, or SD of 0.46 to 1.92 (SD 2.1 respectively, with higher plaque indices associated with higher restoration failures. Of the 507 radiographs evaluated, 48 (9.5%, 63 (12.4% and 9 (1.8% restorations had residual caries (RC, cervical marginal-gaps (CMG and both RC/CMG respectively. Survival of the restorations with RC/CMG was significantly lower (p = 0.003 compared to those with RC or without RC. Conclusion: Low survival of proximal restorations in the study was associated with the presence of cervical marginal-gaps.

  9. End points and assessments in esthetic dental treatment.

    Science.gov (United States)

    Ishida, Yuichi; Fujimoto, Keiko; Higaki, Nobuaki; Goto, Takaharu; Ichikawa, Tetsuo

    2015-10-01

    There are two key considerations for successful esthetic dental treatments. This article systematically describes the two key considerations: the end points of esthetic dental treatments and assessments of esthetic outcomes, which are also important for acquiring clinical skill in esthetic dental treatments. The end point and assessment of esthetic dental treatment were discussed through literature reviews and clinical practices. Before designing a treatment plan, the end point of dental treatment should be established. The section entitled "End point of esthetic dental treatment" discusses treatments for maxillary anterior teeth and the restoration of facial profile with prostheses. The process of assessing treatment outcomes entitled "Assessments of esthetic dental treatment" discusses objective and subjective evaluation methods. Practitioners should reach an agreement regarding desired end points with patients through medical interviews, and continuing improvements and developments of esthetic assessments are required to raise the therapeutic level of esthetic dental treatments. Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  10. Robust Adaptation? Assessing the sensitivity of safety margins in flood defences to uncertainty in future simulations - a case study from Ireland.

    Science.gov (United States)

    Murphy, Conor; Bastola, Satish; Sweeney, John

    2013-04-01

    Climate change impact and adaptation assessments have traditionally adopted a 'top-down' scenario based approach, where information from different Global Climate Models (GCMs) and emission scenarios are employed to develop impacts led adaptation strategies. Due to the tradeoffs in the computational cost and need to include a wide range of GCMs for fuller characterization of uncertainties, scenarios are better used for sensitivity testing and adaptation options appraisal. One common approach to adaptation that has been defined as robust is the use of safety margins. In this work the sensitivity of safety margins that have been adopted by the agency responsible for flood risk management in Ireland, to the uncertainty in future projections are examined. The sensitivity of fluvial flood risk to climate change is assessed for four Irish catchments using a large number of GCMs (17) forced with three emissions scenarios (SRES A1B, A2, B1) as input to four hydrological models. Both uncertainty within and between hydrological models is assessed using the GLUE framework. Regionalisation is achieved using a change factor method to infer changes in the parameters of a weather generator using monthly output from the GCMs, while flood frequency analysis is conducted using the method of probability weighted moments to fit the Generalised Extreme Value distribution to ~20,000 annual maxima series. The sensitivity of design margins to the uncertainty space considered is visualised using risk response surfaces. The hydrological sensitivity is measured as the percentage change in flood peak for specified recurrence intervals. Results indicate that there is a considerable residual risk associated with allowances of +20% when uncertainties are accounted for and that the risk of exceedence of design allowances is greatest for more extreme, low frequency events with considerable implication for critical infrastructure, e.g., culverts, bridges, flood defences whose designs are normally

  11. Periodontal risk assessment, diagnosis and treatment planning.

    Science.gov (United States)

    Pihlstrom, B L

    2001-01-01

    The prevention and treatment of the periodontal diseases is based on accurate diagnosis, reduction or elimination of causative agents, risk management and correction of the harmful effects of disease. Prominent and confirmed risk factors or risk predictors for periodontitis in adults include smoking, diabetes, race, P. gingivalis, P. intermedia, low education, infrequent dental attendance and genetic influences. Several other specific periodontal bacteria, herpesviruses, increased age, male, sex, depression, race, traumatic occlusion and female osteoporosis in the presence of heavy dental calculus have been shown to be associated with loss of periodontal support and can be considered to be risk indicators of periodontitis. The presence of furcation involvement, tooth mobility, and a parafunctional habit without the use of a biteguard are associated with a poorer periodontal prognosis following periodontal therapy. An accurate diagnosis can only be made by a thorough evaluation of data that have been systematically collected by: 1) patient interview, 2) medical consultation as indicated, 3) clinical periodontal examination, 4) radiographic examination, and 5) laboratory tests as needed. Clinical signs of periodontal disease such as pocket depth, loss of clinical attachment and bone loss are cumulative measures of past disease. They do not provide the dentist with a current assessment of disease activity. In an attempt to improve the ability to predict future disease progression, several types of diagnostic tests have been studied, including host inflammatory products and mediators, enzymes, tissue breakdown products and subgingival temperature. In general, the usefulness of these tests for predicting future disease activity remains to be established in terms of sensitivity, specificity and predictive value. Although microbiological analysis of subgingival plaque is not necessary to diagnose and treat most patients with periodontitis, it is helpful when treating

  12. [Opinions and attitudes of clinical staff on systems for the assessment and treatment of children's pain].

    Science.gov (United States)

    Ullan, A M; Fernández, E; Badia, M; Lorente, F; Malmierca, F; Zapatero, I

    2013-08-01

    Many factors affect the assessment and treatment of pain, among them being the knowledge and attitudes of clinical staff. The goal of this work was to determine the opinions and attitudes of clinical staff from two hospitals on the different aspects of the assessment and treatment of children's pain. A cross-sectional, descriptive study was conducted using a self-administered questionnaire issued to clinical staff. The questionnaire was given to the professionals, doctors, and nursing staff of the paediatric services of two hospitals, and to an incidental sample of paediatric doctors. Of the 146 questionnaires sent out, 105 were completed. Participants indicated that standardised scales and physiological recordings were the least frequently used methods to assess children's pain. Participants considered that pharmacological techniques for the treatment of pain were used more frequently than non-pharmacological techniques, at all ages. Participants acknowledged being significantly more knowledgeable about pharmacological methods to relieve paediatric pain than about non-pharmacological methods. There is margin for improvement in systems for the assessment and treatment of children's pain as regards the more frequent and standardised use of techniques and standardised tools for the assessment of pain, and the greater administration of non-pharmacological strategies for its treatment. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  13. Comparison of marginal periosteal pedicle graft and bioactive glass with platelet-rich fibrin and bioactive glass in the treatment of intrabony defects – A clinicoradiographic study

    Directory of Open Access Journals (Sweden)

    M S Yasaswini

    2017-01-01

    Full Text Available Introduction and Objectives: The objective of the study was to compare clinically and radiographically the regenerative potential of marginal periosteal pedicle graft (MPPG or platelet-rich fibrin (PRF with a bioactive glass in the treatment of two- and three-wall intrabony defects. Methods: A total of 28 sites (bilateral or contralateral infrabony defects from 14 patient were treated with MPPG (Experimental site A and the other site was treated with PRF (Experimental site B. The clinical parameters, such as full-mouth plaque index (PI and site PI, were recorded at baseline, 3, 6, and 9 months' postsurgery while sulcus bleeding index (SBI, probing pocket depth (PD, clinical attachment level (CAL, and gingival recession were recorded at baseline, 6, and 9 months. Radiographic evaluation was carried out to evaluate the defect fill, change in alveolar crest height, and percent defect fill at 6 and 9 months. Results: Results showed that both the experimental groups showed clinically and statistically significant reduction in mean PI, SBI, PD, radiographic defect depth, and gain in CAL. The percentage of defect fill at 6 months (70.55 ± 15.99 vs. 55.30 ± 11.87 and 9 months (84.55 ± 11.74 vs. 72.2 ± 9.91 was significantly greater in Site A compared to Site B. Conclusions: Within the limitations of this study, it can be concluded that both the treatment modalities showed the potential of enhancing bone regeneration. However, the use of marginal periosteal pedicle flap showed better improvement in clinical and radiographic parameters.

  14. From the Margins to the Spotlight: Diverse Deaf and Hard of Hearing Student Populations and Standardized Assessment Accessibility.

    Science.gov (United States)

    Cawthon, Stephanie

    2015-01-01

    Designing assessments and tests is one of the more challenging aspects of creating an accessible learning environment for students who are deaf or hard of hearing (DHH), particularly for deaf students with a disability (DWD). Standardized assessments are a key mechanism by which the educational system in the United States measures student progress, teacher effectiveness, and the impact of school reform. The diversity of student characteristics within DHH and DWD populations is only now becoming visible in the research literature relating to standardized assessments and their use in large-scale accountability reforms. The purpose of this article is to explore the theoretical frameworks surrounding assessment policy and practice, current research related to standardized assessment and students who are DHH and DWD, and potential implications for practice within both the assessment and instruction contexts.

  15. Treatment Outcome of Mucosa Associated Lymphoid Tissue (MALT) Marginal Zone Non-Hodgkin's Lymphoma. Single Institutional Experience

    International Nuclear Information System (INIS)

    Hamada, E.; Omar, H.; Abd El-Kader, Y.; Makram, O.

    2003-01-01

    To evaluate the treatment outcome in patients with mucosa associated lymphoid tissue (MALT) lymphoma in terms of response to treatment, progression-free and overall survivals as well as prognostic factors. Patients and Methods: Between 1995 and 2002,40 patients with clinical stages (CS) I-IV MALT lymphoma were treated at NEMROCK. The progression free survival (PFS) and overall survival (OAS) were calculated using the Kaplan Meier technique. Thirty-one patients (77.5%) had CS I-II and 9 (22.5%) had CS III-IV disease. Twenty of the 31 CS I-II patients received radiation therapy alone, five patients received chemotherapy, while three patients were treated by triple therapy (Amoxicillin, Omeperazole, Clarithromycin). Among the 9 CS III-IV patients, treatment included chemotherapy alone (6 patients), chemo radiation (2 patients) and surgery (one patient). The median followup period was 40 months. 19 out of twenty patients with CS I-II treated by radiation therapy alone had a 95% response rate (CR 85% - PR 10%). Among the study population (40 patients), the 5 year OAS and PFS were 86% and 66%, respectively. The 5 year OAS was 86% and PFS was 72% among CS III patients; the corresponding estimates in CS III-IV patients were 70% and 28%, respectively. Using multivariate analysis, there was a significant correlation between the stage of the disease, site of presentation (non GIT) and the overall survival. Modest doses of radiation therapy provide better local control in patients with early stage MALT lymphoma. The poor PFS in advanced staged disease suggests the need for further clinical trials evaluating novel drug approaches taking into consideration the biological behavior and the indolent nature of such disease entity

  16. The choice of the noninferiority margin in clinical trials was driven by baseline risk, type of primary outcome, and benefits of new treatment.

    Science.gov (United States)

    Gayet-Ageron, Angèle; Agoritsas, Thomas; Rudaz, Sandrine; Courvoisier, Delphine; Perneger, Thomas

    2015-10-01

    To explore characteristics of clinical trials that influence the choice of the noninferiority margin (NIM) when planning the trial. We conducted an experimental survey among corresponding authors of randomized controlled trials indexed in MEDLINE. We described two hypothetical studies and asked the respondents' opinion on the largest loss of effectiveness that is clinically negligible (or the smallest lost of effectiveness that is clinically important in the superiority scenario). We randomly manipulated four study attributes in each vignette, using a factorial design. A total of 364 researchers participated. The values for NIMs were significantly lower than the differences to be detected in a superiority trial. The NIM was smaller when the primary outcome was mortality compared with treatment failure, when baseline risk in the control arm was lower, and when the advantage of the new treatment was a lower cost compared with having fewer side effects. In contrast, the population age group under study and the difficulty to recruit patients showed no effect on the choice of the NIM. In our experimental study, the factors associated with lower NIMs were mortality as a primary outcome, low baseline risk, and a less costly new treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Assessing the Consequences of Using Self-Report Data to Determine the Correlates of HIV Status: Conditional and Marginal Approaches

    Science.gov (United States)

    Rindskopf, David M.; Strauss, Shiela M.; Falkin, Gregory P.; Deren, Sherry

    2003-01-01

    This article examines whether relationships between individual characteristics and HIV status can be identified when self-report data are used as a proxy for HIV serotest results. The analyses use data obtained from HIV serotests and face-to-face interviews with 7,256 out-of-treatment drug users in ten sites from 1992 to 1998. Relationships…

  18. California Drug and Alcohol Treatment Assessment (CALDATA-1991-1993)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The California Drug and Alcohol Treatment Assessment (CALDATA) was designed to study the costs, benefits, and effectiveness of the state's alcohol and drug treatment...

  19. Assessing Outpatient Drug Abuse Treatment Programs.

    Science.gov (United States)

    Tims, Frank M.; And Others

    1992-01-01

    Data about outpatient treatment unit follow-up evaluations drawn from selected evaluation items in the recent National Drug Abuse Treatment Survey are reported. Directors and supervisors of 670 units completed surveys describing the follow-up studies. The majority of programs collecting follow-up data used the information for program change. (SLD)

  20. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute...... Achilles tendon rupture. METHODS: In study I, a cross-sectional survey was performed investigating the chosen treatment protocols across Scandinavia. In study II, the effect of immediate weight-bearing on patient reported and functional outcomes was investigated in a randomized controlled trial (RCT...

  1. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment ofacute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... to be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non-operative treatment of acute...... Achilles tendon rupture. METHODS: In study I, a cross-sectional survey was performed investigating the chosen treatment protocols across Scandinavia. In study II, the effect of immediate weight-bearing on patient reported and functional outcomes was investigated in a randomized controlled trial (RCT...

  2. Thermodynamic assessment of the Na-O and Na-U-O systems : Margin to the safe operation of SFRs

    NARCIS (Netherlands)

    Smith, A.L.; Guéneau, C; Flèche, J. L.; Chatain, S.; Beneš, O.; Konings, R.J.M.

    2017-01-01

    A thermodynamic model for the Na-O system was developed for the first time using the CALPHAD method after review of the structural, thermodynamic, and phase diagram data available on this system. Differential Scanning Calorimetry measurements were moreover performed to assess the phase equilibria

  3. Chemical analysis of estragole in fennel based teas and associated safety assessment using the Margin of Exposure (MOE) approach

    NARCIS (Netherlands)

    Berg, van den S.J.P.L.; Alhusainy, W.; Restani, P.; Rietjens, I.

    2014-01-01

    This study describes the analysis of estragole in dry fennel preparations and in infusions prepared from them and an associated safety assessment. A wide range of estragole levels of 0.15–13.3 mg/g dry fennel preparation was found. The estragole content in infusions was considerably lower ranging

  4. Seismic Safety Margins Research Programs. Assessment of potential increases in risk due to degradation of steam generator and reactor coolant pump supports. [PWR

    Energy Technology Data Exchange (ETDEWEB)

    Bohn, M. P.; Wells, J. E.; Shieh, L. C.; Cover, L. E.; Streit, R. L.

    1983-08-01

    During the NRC licensing review for the North Anna Units 1 and 2 pressurized-water reactors (PWRs), questions were raised regarding the potential for low-fracture toughness of steam-generator and reactor-coolant-pump supports. Because other PWRs may face similar problems, this issue was incorporated into the NRC Program for Resolution of Generic Issues. The work described in this report was performed to provide the NRC with a quantitative evaluation of the value/impact implications of the various options of resolving the fracture-toughness question. This report presents an assessment of the probabilistic risk associated with nil-ductility failures of steam-generator and reactor-coolant-pump structural-support systems during seismic events, performed using the Seismic Safety Margins Research Program codes and data bases.

  5. A Margin-of-Exposure Approach to Assessment of Noncancer Risks of Dioxins Based on Human Exposure and Response Data

    OpenAIRE

    Aylward, Lesa L.; Goodman, Julie E.; Charnley, Gail; Rhomberg, Lorenz R.

    2008-01-01

    Background Risk assessment of human environmental exposure to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/PCDFs) and other dioxin-like compounds is complicated by several factors, including limitations in measuring intakes because of the low concentrations of these compounds in foods and the environment and interspecies differences in pharmacokinetics and responses. Objectives We examined the feasibility of relying directly on human studies of exposure and potential responses to...

  6. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    Science.gov (United States)

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

  7. Development of margin assessment methodology of decay heat removal function against external hazards. (2) Tornado PRA methodology

    International Nuclear Information System (INIS)

    Nishino, Hiroyuki; Kurisaka, Kenichi; Yamano, Hidemasa

    2014-01-01

    Probabilistic Risk Assessment (PRA) for external events has been recognized as an important safety assessment method after the TEPCO's Fukushima Daiichi nuclear power station accident. The PRA should be performed not only for earthquake and tsunami which are especially key events in Japan, but also the PRA methodology should be developed for the other external hazards (e.g. tornado). In this study, the methodology was developed for Sodium-cooled Fast Reactors paying attention to that the ambient air is their final heat sink for removing decay heat under accident conditions. First, tornado hazard curve was estimated by using data recorded in Japan. Second, important structures and components for decay heat removal were identified and an event tree resulting in core damage was developed in terms of wind load and missiles (i.e. steel pipes, boards and cars) caused by a tornado. Main damage cause for important structures and components is the missiles and the tornado missiles that can reach those components and structures placed on high elevations were identified, and the failure probabilities of the components and structures against the tornado missiles were calculated as a product of two probabilities: i.e., a probability for the missiles to enter the intake or outtake in the decay heat removal system, and a probability of failure caused by the missile impacts. Finally, the event tree was quantified. As a result, the core damage frequency was enough lower than 10 -10 /ry. (author)

  8. Re-assessing community-directed treatment

    DEFF Research Database (Denmark)

    Halwindi, H.; Magnussen, Pascal; Siziya, S.

    2015-01-01

    Cross-sectional surveys with carers, health workers, community drug distributors (CDDs) and neighbourhood health committees were conducted to identify factors associated with utilization of community-directed treatment (ComDT) of soil-transmitted helminths in children aged 12-59 months in Mazabuka...... district, Zambia. The surveys took place in December 2006 and December 2007. In addition child treatment records were reviewed. The factors that were found to be significantly associated (pCDDs were: (1) the perception of soil-transmitted helminth infections...... as having significant health importance, (2) the community-based decision to launch and subsequently implement ComDT, (3) the use of the door-to-door method of drug distribution, (4) CDDs being visited by a supervisor, (5) CDDs receiving assistance in mobilizing community members for treatment, (6) CDDs...

  9. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    The treatment approach for enuresis is controversial due to a lack of consensus as to the exact causes of nocturnal enuresis. Aim: Aim was to assess the efficacy of desmopressin therapy in the treatment of Primary Monosymptomatic Nocturnal Enuresis (PMNE) in Egyptian children. Method: The study assessed 40 children ...

  10. Compilation, assessment and expansion of the strong earthquake ground motion data base. Seismic Safety Margins Research Program (SSMRP)

    International Nuclear Information System (INIS)

    Crouse, C.B.; Hileman, J.A.; Turner, B.E.; Martin, G.R.

    1980-09-01

    A catalog has been prepared which contains information for: (1) world-wide, ground-motion accelerograms (2) the accelerograph sites where these records were obtained, and (3) the seismological parameters of the causative earthquakes. The catalog is limited to data for those accelerograms which have been digitized and published. In addition, the quality and completeness of these data are assessed. This catalog is unique because it is the only publication which contains comprehensive information on the recording conditions of all known digitized accelerograms. However, information for many accelerograms is missing. Although some literature may have been overlooked, most of the missing data has not been published. Nevertheless, the catalog provides a convenient reference and useful tool for earthquake engineering research and applications. (author)

  11. Life Cycle Assessment of Horse Manure Treatment

    Directory of Open Access Journals (Sweden)

    Ola Eriksson

    2016-11-01

    Full Text Available Horse manure consists of feces, urine, and varying amounts of various bedding materials. The management of horse manure causes environmental problems when emissions occur during the decomposition of organic material, in addition to nutrients not being recycled. The interest in horse manure undergoing anaerobic digestion and thereby producing biogas has increased with an increasing interest in biogas as a renewable fuel. This study aims to highlight the environmental impact of different treatment options for horse manure from a system perspective. The treatment methods investigated are: (1 unmanaged composting; (2 managed composting; (3 large-scale incineration in a waste-fired combined heat and power (CHP plant; (4 drying and small-scale combustion; and (5 liquid anaerobic digestion with thermal pre-treatment. Following significant data uncertainty in the survey, the results are only indicative. No clear conclusions can be drawn regarding any preference in treatment methods, with the exception of their climate impact, for which anaerobic digestion is preferred. The overall conclusion is that more research is needed to ensure the quality of future surveys, thus an overall research effort from horse management to waste management.

  12. DWTF [decontamination and waste treatment facilities] assessment

    International Nuclear Information System (INIS)

    Maimoni, A.

    1986-01-01

    The purpose of this study has been to evaluate the adequacy of present and proposed decontamination and waste treatment facilities (DWTF) at LLNL, to determine the cost effectiveness for proposed improvements, and possible alternatives for accomplishing these improvements. To the extent possible, we have also looked at some of the proposed environmental compliance and cleanup (ECC) projects

  13. Assessment of antiretroviral treatment outcome in public hospitals ...

    African Journals Online (AJOL)

    Background: The outcome of antiretroviral treatment, survival patterns and associated determining factors in public hospitals are not well known. Thus a longitudinal study is vital to understand the pattern of survival and treatment outcome. Objective: To assess the outcome of antiretroviral treatment in rural public hospitals in ...

  14. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    Farida ElBaz

    2015-03-31

    Mar 31, 2015 ... Aim: Aim was to assess the efficacy of desmopressin therapy in the treatment of Primary ... to the modality of treatment they were receiving. 20 patients receiving desmopressin treatment plus behavioral therapy and 20 patients on behavioral therapy only were ... fast and before child leaves for school.

  15. Foundation-Level Dyslexia: Assessment and Treatment.

    Science.gov (United States)

    Evans, Henryka M.; Seymour, Philip H. K.

    1999-01-01

    An assessment of foundation processes was administered to 51 Scottish children with reading difficulties and to 56 reading-level-matched controls. Results suggested the foundation is in place by the reading age of 7 years and that foundation-level dyslexia is identifiable in children with reading difficulty whose reading ages fall below this…

  16. POLA KEBERAGAMAAN MASYARAKAT MARGINAL

    Directory of Open Access Journals (Sweden)

    Ahmad Muttaqin

    2016-11-01

    Full Text Available This is a research on sociology of religion, focusing on the issue of religious practices in a local community. Kampung Laut was chosen as the setting of this research for two reasons. First, the rituals of religion practices in the region are different from mainstream practices, which result in label and justification that their religiosity is not a part of or only a fragment of the mainstream religion and tend to be the target of correction. Second, this region raises conflicts among government institutions in relation to the rights of natural resources possession and utilization. The bad image built through this marginalization has formed Kampung Laut community as the one that is resistant and latent. This research used descriptive qualitative method with sociological approach. Rituals of religious practices that are different from the mainstream are explained on the basis of Weber’s theory of behavior categorized into value-oriented rationality. This kind of practices is considered to be more beneficial in the context of struggling for identity among the practices of marginalization experienced by Kampung Laut community. This condition gives a description to public that Kampung Laut community receives unfair treatments for their natural resources. Religious issues is made an entry for its massive, communal, and related to transcendental values.

  17. Spasticity after stroke: Physiology, assessment and treatment

    OpenAIRE

    Thibaut, Aurore; Chatelle, Camille; Ziegler, Erik; Bruno, Marie-Aurelie; Laureys, Steven; Gosseries, Olivia

    2013-01-01

    Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder. The lack of consensus is high...

  18. The Value of High-Resolution MRI Technique in Patients with Rectal Carcinoma: Pre-Operative Assessment of Mesorectal Fascia Involvement, Circumferential Resection Margin and Local Staging

    International Nuclear Information System (INIS)

    Algebally, Ahmed Mohamed; Mohey, Nesreen; Szmigielski, Wojciech; Yousef, Reda Ramadan Hussein; Kohla, Samah

    2015-01-01

    The purpose of the study was to identify the accuracy of high-resolution MRI in the pre-operative assessment of mesorectal fascia involvement, circumfrential resection margin (CRM) and local staging in patients with rectal carcinoma. The study included 56 patients: 32 male and 24 female. All patients underwent high-resolution MRI and had confirmed histopathological diagnosis of rectal cancer located within 15 cm from the anal verge, followed by surgery. MRI findings were compared with pathological and surgical results. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI-based T-staging were 92.8, 88.8%, 96.5%, 96%, and 90.3%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based assessment of CRM were 94.6%, 84.6%, 97.6%, 91.4, and 94.6%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of MRI-based N-staging were 82.1%, 75%, 67.3%, 60%, and 86.1%, respectively. Preoperative high-resolution rectal MRI is accurate in predicting tumor stage and CRM involvement. MRI is a precise diagnostic tool to select patients who may benefit from neo-adjuvant therapy and to avoid overtreatment in those patients who can proceed directly to surgery

  19. Female sexual disorders: assessment, diagnosis, and treatment.

    Science.gov (United States)

    Kingsberg, Sheryl A; Knudson, Gail

    2011-02-01

    Sexual health is important to overall health and quality of life. Sexual problems have been associated with relationship problems and may interfere with overall health and they may also be a marker for other undiagnosed comorbid medical conditions. In order for healthcare professionals to manage the sexual health concerns of their patients, it is important for them to understand what constitutes good sexual health. To that end, it is necessary to have a working knowledge of the evolving theoretical models offered to describe a healthy sexual response as well as an understanding of the neurobiology of sexual function. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised lists six primary female sexual disorders: hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, female orgasmic disorder,dyspareunia, and vaginismus. Despite a growing awareness of the high prevalence of sexual disorders they are not typically identified nor treated. There are a number of reasons why clinicians fail to identify and treat sexual problems including insufficient training in sexual medicine and communication skills, time-constraints, and embarrassment. Treatment for female sexual problems is usually individualized and may include a combination of office-based education and basic counseling, cognitive-behavioral psychotherapy, pharmacotherapy, and treatment of concomitant medical conditions.

  20. Spasticity: A review of Methods for Assessment and Treatment

    Directory of Open Access Journals (Sweden)

    Mohammad Amouzadeh Khalili

    2011-10-01

    Full Text Available Spasticity is the condition resulting of corticispinal damage as occurs in some neurological diseases. The aim of the article is to review the literature on assessment and treatment of spasticity and spastic limbs. The assessment and treatment methods are studied the study involves different method of mangement of spastic limbs in depth. Different method of evaluation of spasticity, including biomechanical and clinical assessment are reviewed and also some of the most common treatment methods of spasticity are studied. A number of methods for assessment and treatment of spasticity are reviewed, some of methods commonly used for assessment or management of spasticity, depend on the condition of the patient and the aim of the therapist a method may empoyed.

  1. Texas curve margin of safety.

    Science.gov (United States)

    2013-01-01

    This software can be used to assist with the assessment of margin of safety for a horizontal curve. It is intended for use by engineers and technicians responsible for safety analysis or management of rural highway pavement or traffic control devices...

  2. Impact of cone beam computed tomography on periapical assessment and treatment planning five to eleven years after surgical endodontic retreatment.

    Science.gov (United States)

    Kruse, C; Spin-Neto, R; Wenzel, A; Vaeth, M; Kirkevang, L-L

    2018-01-18

    To evaluate how additional information from Cone Beam CT (CBCT) impacts on periapical assessment and treatment planning based on clinical examination and periapical radiographs (PR) in cases followed up five to eleven years after surgical endodontic retreatment (SER). Patients receiving SER during 2004-2010 were reinvited for follow-up examination including clinical examination, PR, and CBCT. In total, 108 patients (119 teeth) were reinvited, 74 patients (83 teeth) accepted to participate. Three observers initially assessed PR according to the four-scaled, increasing disease severity criteria by Rud et al. (International Journal of Oral Surgery, 1, 1972 and 195) and Molven et al. (International Journal of Oral and Maxillofacial Surgery, 16, and 432): 'Radiographic assessment A'. By including clinical information 'Treatment plan A' was made as follows: 1) no treatment, 2) further observation, 3) SER reoperation (SER-R), or 4) extraction. Hereafter, the CBCT volume was assessed and the information incorporated for 'Radiographic assessment B' followed by 'Treatment plan B'. Agreement between radiographic assessments and between treatment plans was recorded and assessed statistically by Stuart-Maxwell test for marginal homogeneity. Nine teeth had been extracted; thus, the final analysis included 74 teeth (66 patients). The radiographic assessment was changed as a result of the CBCT evaluation in 38 cases (51.4%), of which 35 (47.3%) were to a higher Rud & Molven score, P Endodontic Journal. Published by John Wiley & Sons Ltd.

  3. A margin of exposure approach to assessment of non-cancerous risk of diethyl phthalate based on human exposure from bottled water consumption.

    Science.gov (United States)

    Zare Jeddi, Maryam; Rastkari, Noushin; Ahmadkhaniha, Reza; Yunesian, Masud; Nabizadeh, Ramin; Daryabeygi, Reza

    2015-12-01

    Phthalates may be present in food due to their widespread presence as environmental contaminants or due to migration from food contact materials. Exposure to phthalates is considered to be potentially harmful to human health as well. Therefore, determining the main source of exposure is an important issue. So, the purpose of this study was (1) to measure the release of diethyl phthalate (DEP) in bottled water consumed in common storage conditions specially low temperature and freezing conditions; (2) to evaluate the intake of DEP from polyethylene terephthalate (PET) bottled water and health risk assessment; and (3) to assess the contribution of the bottled water to the DEP intake against the tolerable daily intake (TDI) values. DEP migration was investigated in six brands of PET-bottled water under different storage conditions room temperature, refrigerator temperature, freezing conditions (40 °C ,0 °C and -18 °C) and outdoor] at various time intervals by magnetic solid extraction (MSPE) using gas chromatography-mass spectroscopy (GC-MS). Eventually, a health risk assessment was conducted and the margin of exposure (MOE) was calculated. The results indicate that contact time with packaging and storage temperatures caused DEP to be released into water from PET bottles. But, when comprising the DEP concentration with initial level, the results demonstrated that the release of phthalates were not substantial in all storage conditions especially at low temperatures (bottled water was much lower than the reference value. However, the lowest MOE was estimated for high water consumers (preschooler > children > lactating women > teenagers > adults > pregnant women), but in all target groups, the MOE was much higher than 1000, thus, low risk is implied. Consequently, PET-bottled water is not a major source of human exposure to DEP and from this perspective is safe for consumption.

  4. Environmental integrated impact assessment for waste treatment activity: methodology and case-study application

    International Nuclear Information System (INIS)

    Lonati, G.; Panzeri, A.

    2008-01-01

    A literature method for the environmental integrated impact assessment, according to the IPPC Directive, has been critically analysed and adjusted in order to be used for the environmental performance assessment of waste treatment activities. The assessment parameters, sorted in eight treatment and combined pollution categories, have been partly redefined and re balanced. The adjusted methodology has been applied to a real case-study, a chemical- physical waste treatment plant, in order to calculate the current performance (Actual Integrated Index) and the ideal performance (Actual Integrated Index) achievable by technical and operational improvements. The adjusted methodology has also been used as a decision support system, in order to estimate the value of the expected environmental performances improvement after the execution achievable from the introduction of a single one or a set of improvement actions. The valuation of the Integrated Index percentage reduction, along with the action achievable, made the best actions able to be identified, both in comparative way and in the cost-effective one. The results, 50 as Effective Integrated Index and 42 as Ideal Integrated Index, in a 10-100 scale, show a medium impact level and point out an appreciable improvement margin on all the environmental performances, especially in air emission control and water consumption [it

  5. LIHNCS - Lugol's iodine in head and neck cancer surgery: a multicentre, randomised controlled trial assessing the effectiveness of Lugol's iodine to assist excision of moderate dysplasia, severe dysplasia and carcinoma in situ at mucosal resection margins of oral and oropharyngeal squamous cell carcinoma: study protocol for a randomised controlled trial.

    Science.gov (United States)

    McCaul, James A; Cymerman, James A; Hislop, Stuart; McConkey, Chris; McMahon, Jeremy; Mehanna, Hisham; Shaw, Richard; Sutton, David N; Dunn, Janet

    2013-09-24

    Oral cavity and oropharynx cancer are increasing in incidence worldwide but survival outcomes have not significantly improved over the last three decades. The presence of dysplasia or carcinoma in situ at surgical margins following resection of squamous carcinoma of the mucosal surfaces of the head and neck has been shown to be associated with a higher incidence of local recurrence and reduced survival. While invasive carcinoma in mucosal surfaces can usually be distinguished from adjacent normal mucous membrane, pre-malignant disease is much less readily distinguished at operation. We describe a protocol for a randomised, controlled trial in which we will assess the effectiveness of Lugol's iodine staining in allowing visualisation and excision of cancer margin dysplasia at time of primary surgery. We will recruit 300 patients diagnosed with oral cavity or oropharynx squamous cell carcinoma. All participants will be planned for primary surgery with curative intent. After completion of baseline assessment participants will be randomised into either a standard surgical treatment arm or surgical treatment including Lugol's iodine staining. This paper describes the rationale and design of a unique trial in head and neck surgical oncology. If margin dysplasia visualisation with Lugol's iodine allows complete excision of high-risk, pre-cancer mucosa at time of primary surgery, this may lead to a reduction in local recurrence and improved survival. Current Controlled Trials ISRCTN03712770.

  6. LIHNCS - Lugol’s iodine in head and neck cancer surgery: a multicentre, randomised controlled trial assessing the effectiveness of Lugol’s iodine to assist excision of moderate dysplasia, severe dysplasia and carcinoma in situ at mucosal resection margins of oral and oropharyngeal squamous cell carcinoma: study protocol for a randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Background Oral cavity and oropharynx cancer are increasing in incidence worldwide but survival outcomes have not significantly improved over the last three decades. The presence of dysplasia or carcinoma in situ at surgical margins following resection of squamous carcinoma of the mucosal surfaces of the head and neck has been shown to be associated with a higher incidence of local recurrence and reduced survival. While invasive carcinoma in mucosal surfaces can usually be distinguished from adjacent normal mucous membrane, pre-malignant disease is much less readily distinguished at operation. We describe a protocol for a randomised, controlled trial in which we will assess the effectiveness of Lugol’s iodine staining in allowing visualisation and excision of cancer margin dysplasia at time of primary surgery. Methods/Design We will recruit 300 patients diagnosed with oral cavity or oropharynx squamous cell carcinoma. All participants will be planned for primary surgery with curative intent. After completion of baseline assessment participants will be randomised into either a standard surgical treatment arm or surgical treatment including Lugol’s iodine staining. Discussion This paper describes the rationale and design of a unique trial in head and neck surgical oncology. If margin dysplasia visualisation with Lugol’s iodine allows complete excision of high-risk, pre-cancer mucosa at time of primary surgery, this may lead to a reduction in local recurrence and improved survival. Trial registration Current Controlled Trials ISRCTN03712770. PMID:24063578

  7. Comparison of elastography, contrast-enhanced ultrasonography, and computed tomography for assessment of lesion margin after radiofrequency ablation in livers of healthy dogs.

    Science.gov (United States)

    Moon, Sohyeon; Park, Seungjo; Lee, Sang-Kwon; Cheon, Byunggyu; Hong, Sunghwa; Cho, Hyun; Park, Jun-Gyu; Alfajaro, Mia Madel; Cho, Kyoung-Oh; Woo, Dong; Choi, Jihye

    2017-03-01

    OBJECTIVE To assess by use of various diagnostic imaging modalities acute changes in livers of healthy dogs after radiofrequency ablation (RFA) and determine the capability of each imaging modality to monitor ablation lesion changes. ANIMALS 6 healthy Beagles. PROCEDURES 12 ablation lesions were created in the liver of the dogs (2 lesions/dog). Ablation lesions were evaluated by use of conventional ultrasonography, strain elastography, and contrast-enhanced ultrasonography immediately after (time 0), 30 to 60 minutes after, and 3 days after RFA, and by use of CT 30 minutes and 3 days after RFA. Three dogs were euthanized shortly after RFA, and the other 3 dogs were euthanized on day 3. Lesion size measured by each imaging modality was compared with necropsy findings. RESULTS Immediately after RFA, clear margins were more visible with elastography and contrast-enhanced ultrasonography than with conventional ultrasonography, which had acoustic shadowing. On triphasic contrast CT, the ablation zone, which indicated necrosis and hemorrhage, was not enhanced and could be measured. Marked enhancement of the periablation rim was observed during the venous phase and was identified as granulation tissue. Size of the ablation area measured on enhanced CT images was strongly correlated with actual lesion size. CONCLUSIONS AND CLINICAL RELEVANCE For dogs of this study, CT was the most reliable method for lesion size determination. Although ultrasonographic imaging measurements underestimated lesion size, all modalities could be used to provide additional real-time guidance for RFA procedures of the liver as well as for other RFA procedures.

  8. Establishment of a new marginal plaque index with high sensitivity for changes in oral hygiene.

    Science.gov (United States)

    Deinzer, Renate; Jahns, Stephan; Harnacke, Daniela

    2014-12-01

    Although several plaque indices exist, they rarely assess in detail the plaque adjacent to the gingival margin, an area most important for periodontal health. This study aims to develop a new marginal plaque index (MPI) and to assess its validity and treatment sensitivity compared to the internationally accepted Turesky modification of the Quigley and Hein Index (TQHI). Data from two studies with n = 64 and n = 67 participants, respectively, are reported here. Convergence of MPI with TQHI and concurrent and predictive validity with papillary bleeding index were assessed, as was treatment sensitivity to a treatment of proximal hygiene (study 1) or toothbrushing (study 2), respectively. Convergent validity with TQHI is very good. Concurrent and predictive validity parameters of the MPI are similar to the TQHI. The treatment sensitivity of MPI exceeds TQHI by far. This results in a reduction by >70% of the sample size needed to discover significant treatment effects. As expected, the largest treatment sensitivity was observed for proximal MPI measures in study 1, whereas study 2 showed largest effects for cervical measures. MPI appears to be a valid plaque-scoring system that assesses plaque at the gingival margin. It responds with high sensitivity to treatments aimed at plaque reduction at the gingival margin. Its treatment sensitivity and capacity to differentiate between proximal and cervical plaque make it a promising tool for periodontal research.

  9. Optimizing stormwater treatment practices a handbook of assessment and maintenance

    CERN Document Server

    Erickson, Andrew J; Gulliver, John S

    2013-01-01

    Optimizing Stormwater Treatment Practices: A Handbook of Assessment and Maintenance provides the information necessary for developing and operating an effective maintenance program for stormwater treatment. The book offers instructions on how to measure the level of performance of stormwater treatment practices directly and bases proposed maintenance schedules on actual performance and historical maintenance efforts and costs. The inspection methods, which are proven in the field and have been implemented successfully, are necessary as regulatory agencies are demanding evaluations of the performance of stormwater treatment practices. The authors have developed a three-tiered approach that offers readers a standard protocol for how to determine the effectiveness of stormwater treatment practices currently in place. This book also: Provides a standard protocol for how to determine the effectiveness of stormwater treatment practices Assists readers with identifying which assessment techniques to use for stormwa...

  10. Assessment and Treatment of Co-occurring Eating Disorders in Privately Funded Addiction Treatment Programs

    Science.gov (United States)

    Killeen, Therese K.; Greenfield, Shelly F.; Bride, Brian E.; Cohen, Lisa; Gordon, Susan Merle; Roman, Paul M.

    2011-01-01

    Privately-funded addiction treatment programs were surveyed to increase understanding of assessment and current treatment options for patients with co-occurring substance use and eating disorders. Data were collected from face-to-face interviews with program administrators of a nationally representative sample of 345 private addiction treatment programs. Although the majority of programs reported screening for eating disorders, programs varied in screening instruments used. Sixty-seven percent reported admitting cases of low severity. Twenty-one percent of programs attempt to treat eating disorders. These results highlight the need for education of addiction treatment professionals in assessment, referral and treatment of eating disorders. PMID:21477048

  11. A laboratory assessment of various treatment conditions affecting ...

    African Journals Online (AJOL)

    A laboratory assessment of various treatment conditions affecting the ammoniation of wheat straw ... levels of 250 and 375 g/kg wheat straw and treatment periods of 0;. 1; 2; 4; 6 and 8 weeks. Dependent variables .... Individual samples were sealed airtightly in 2 000 ml plastic containers. Subsequently the urea included in ...

  12. Issues in the Assessment and Treatment of Obesity.

    Science.gov (United States)

    Foreyt, John P.

    1987-01-01

    Summarizes recent developments in assessment and treatment of obesity. Reviews studies on genetics and weight cycling, which demonstrate the heterogeneous etiology of obesity and help explain difficulty in losing weight or maintaining weight loss. Describes the newer treatment programs which emphasize the development of exercise behaviors,…

  13. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma

    DEFF Research Database (Denmark)

    Lawaetz, Mads; Homøe, Preben

    2014-01-01

    OBJECTIVE: The purpose of this study was to examine which factors are associated with inadequate surgical margins and to assess the postoperative consequences. STUDY DESIGN: A retrospective cohort of 110 patients with oral squamous cell carcinoma treated with surgery during a 2-year period...... was examined. Clinical, histopathologic, and operative variables were related to the surgical margin status. Furthermore postoperative treatment data were compared with margin status. RESULTS: Univariate statistically significant associations were found between the tumor site in the floor of mouth, more...

  14. The margin of internal exposure (MOIE) concept for dermal risk assessment based on oral toxicity data - A case study with caffeine.

    Science.gov (United States)

    Bessems, Jos G M; Paini, Alicia; Gajewska, Monika; Worth, Andrew

    2017-12-01

    Route-to-route extrapolation is a common part of human risk assessment. Data from oral animal toxicity studies are commonly used to assess the safety of various but specific human dermal exposure scenarios. Using theoretical examples of various user scenarios, it was concluded that delineation of a generally applicable human dermal limit value is not a practicable approach, due to the wide variety of possible human exposure scenarios, including its consequences for internal exposure. This paper uses physiologically based kinetic (PBK) modelling approaches to predict animal as well as human internal exposure dose metrics and for the first time, introduces the concept of Margin of Internal Exposure (MOIE) based on these internal dose metrics. Caffeine was chosen to illustrate this approach. It is a substance that is often found in cosmetics and for which oral repeated dose toxicity data were available. A rat PBK model was constructed in order to convert the oral NOAEL to rat internal exposure dose metrics, i.e. the area under the curve (AUC) and the maximum concentration (C max ), both in plasma. A human oral PBK model was constructed and calibrated using human volunteer data and adapted to accommodate dermal absorption following human dermal exposure. Use of the MOIE approach based on internal dose metrics predictions provides excellent opportunities to investigate the consequences of variations in human dermal exposure scenarios. It can accommodate within-day variation in plasma concentrations and is scientifically more robust than assuming just an exposure in mg/kg bw/day. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  15. Optimizing Surgical Margins in Breast Conservation

    Science.gov (United States)

    Ananthakrishnan, Preya; Balci, Fatih Levent; Crowe, Joseph P.

    2012-01-01

    Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future. PMID:23304479

  16. Optimizing Surgical Margins in Breast Conservation

    Directory of Open Access Journals (Sweden)

    Preya Ananthakrishnan

    2012-01-01

    Full Text Available Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy, include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.

  17. Marginalization of the Youth

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal

    2009-01-01

    The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization.......The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization....

  18. Conducting Systematic Outcome Assessment in Private Addictions Treatment Settings

    Directory of Open Access Journals (Sweden)

    Gerard J Connors

    2017-07-01

    Full Text Available Systematic outcome assessment is central to ascertaining the impact of treatment services and to informing future treatment initiatives. This project was designed to be conducted within the clinical operations of 4 private addictions treatment centers. A structured interview was used to assess patients’ alcohol and other drug use and related variables (on treatment entry and at 1, 3, and 6 months following treatment discharge. The primary outcomes were percentage of days abstinent (PDA from alcohol and drugs, PDA from alcohol, and PDA from other drugs. Collateral reports during follow-up also were gathered. A total of 280 patients (56% men across the 4 programs participated. Percentage of days abstinent for each outcome increased significantly from baseline to the 1-month follow-up assessment, and this change was maintained at the 3- and 6-month follow-up assessments. Collateral reports mirrored the patient follow-up reports. Secondary outcomes of patient ratings of urges/cravings, depression, anxiety, and general life functioning all indicated significant improvement from baseline over the course of the follow-up. The results suggest the feasibility of conducting systematic outcome assessment in freestanding private addictions treatment environments.

  19. Condom use assessment of persons in drug abuse treatment.

    Science.gov (United States)

    Ross, Dana; Schumacher, Joseph E

    2004-12-01

    The purpose of this study was to objectively and quantitatively assess individual skill level of male condom use. This study developed a reliable and face valid assessment of correct male condom use based on Centers for Disease Control and Prevention criteria. Participants (N= 163) were recruited from persons in treatment for cocaine addiction. Condom use was assessed on the basis of correct completion of eight discrete steps. An overall score of 40% correct condom use indicated the need for training in this sample. Assessment showed training needs especially related to steps involving reduction of ejaculate leakage and steps related to potential hazards of nonoxynol-9 use. Frequency of condom use was also assessed; there was no correlation between frequency of condom use and condom use skill. Drug addiction treatment programs are encouraged to incorporate HIV risk reduction programs that teach condom use skills and use the CUDOS as an empirical measure of condom skill acquisition.

  20. Respiratory gated beam delivery cannot facilitate margin reduction, unless combined with respiratory correlated image guidance

    DEFF Research Database (Denmark)

    Korreman, S.S.; Boyer, A.L.; Juhler-Nøttrup, Trine

    2008-01-01

    was not accounted for. CONCLUSIONS: Margins can only be reduced for respiratory gated radiotherapy, if respiratory baseline shifts and variations in external/internal motion correlation are accounted for. Gated beam delivery alone cannot facilitate margin reduction. In the worst case, margins must be increased...... measurements over 30 fraction treatment courses for 10 patients, and synchronous external/internal measurements in single sessions for seven patients. Variations in respiratory amplitude (simulated coaching) and external/internal phase shifts were simulated by perturbation with realistic values. Variations...... compared to those of ungated data, to assess potential margin reductions. RESULTS: External respiratory data collected over entire treatment courses showed SDs from 1.6 to 8.1mm, the major part arising from baseline variations. The gated data had SDs from 1.5 to 7.7mm, with a mean reduction of 0.3mm (6...

  1. Matthew and marginality

    Directory of Open Access Journals (Sweden)

    Denis C. Duling

    1995-12-01

    Full Text Available This article explores marginality theory as it was first proposed in  the social sciences, that is related to persons caught between two competing cultures (Park; Stonequist, and, then, as it was developed in sociology as related to the poor (Germani and in anthropology as it was related to involuntary marginality and voluntary marginality (Victor Turner. It then examines a (normative scheme' in antiquity that creates involuntary marginality at the macrosocial level, namely, Lenski's social stratification model in an agrarian society, and indicates how Matthean language might fit with a sample inventory  of socioreligious roles. Next, it examines some (normative schemes' in  antiquity for voluntary margi-nality at the microsocial level, namely, groups, and examines how the Matthean gospel would fit based on indications of factions and leaders. The article ,shows that the author of the Gospel of Matthew has an ideology of (voluntary marginality', but his gospel includes some hope for (involuntary  marginals' in  the  real world, though it is somewhat tempered. It also suggests that the writer of the Gospel is a (marginal man', especially in the sense defined by the early theorists (Park; Stone-quist.

  2. Comparative oesophageal cancer risk assessment of hot beverage consumption (coffee, mate and tea): the margin of exposure of PAH vs very hot temperatures.

    Science.gov (United States)

    Okaru, Alex O; Rullmann, Anke; Farah, Adriana; Gonzalez de Mejia, Elvira; Stern, Mariana C; Lachenmeier, Dirk W

    2018-03-01

    Consumption of very hot (> 65 °C) beverages is probably associated with increased risk of oesophageal cancer. First associations were reported for yerba mate and it was initially believed that high content of polycyclic aromatic hydrocarbons (PAH) might explain the risk. Later research on other beverage groups such as tea and coffee, which are also consumed very hot, found associations with increased risk of oesophageal cancer as well. The risk may therefore not be inherent in any compound contained in mate, but due to temperature. The aim of this study was to quantitatively assess the risk of PAH in comparison with the risk of the temperature effect using the margin of exposure (MOE) methodology. The human dietary benzo[a]pyrene (BaP) and PAH4 (sum of benzo[a]pyrene, benzo[a]anthracene, chrysene, and benzo[b]fluoranthene) exposure through consumption of coffee, mate, and tea was estimated. The oesophageal cancer risk assessment for both PAH and temperature was conducted using the MOE approach. Considering differences in the transfer of the PAH from the leaves of mate and tea or from the ground coffee to the infusion, and considering the different preparation methods, exposures may vary considerably. The average individual exposure in μg/kg bw/day arising from consumption of 1 cup (0.2 L) of infusion was highest for mate (2.85E-04 BaP and 7.22E-04 PAH4). The average per capita exposure in μg/kg bw/day was as follows: coffee (4.21E-04 BaP, 4.15E-03 PAH4), mate (4.26E-03 BaP, 2.45E-02 PAH4), and tea (8.03E-04 BaP, 4.98E-03 PAH4). For all individual and population-based exposure scenarios, the average MOE for BaP and PAH4 was > 100,000 independent of beverage type. MOE values in this magnitude are considered as a very low risk. On the contrary, the MOE for the temperature effect was estimated as < 1 for very hot drinking temperatures, corroborating epidemiological observations about a probable oesophageal cancer risk caused by this behaviour. The

  3. Improving treatment outcome assessment in a mouse tuberculosis model.

    Science.gov (United States)

    Mourik, Bas C; Svensson, Robin J; de Knegt, Gerjo J; Bax, Hannelore I; Verbon, Annelies; Simonsson, Ulrika S H; de Steenwinkel, Jurriaan E M

    2018-04-09

    Preclinical treatment outcome evaluation of tuberculosis (TB) occurs primarily in mice. Current designs compare relapse rates of different regimens at selected time points, but lack information about the correlation between treatment length and treatment outcome, which is required to efficiently estimate a regimens' treatment-shortening potential. Therefore we developed a new approach. BALB/c mice were infected with a Mycobacterium tuberculosis Beijing genotype strain and were treated with rifapentine-pyrazinamide-isoniazid-ethambutol (R p ZHE), rifampicin-pyrazinamide-moxifloxacin-ethambutol (RZME) or rifampicin-pyrazinamide-moxifloxacin-isoniazid (RZMH). Treatment outcome was assessed in n = 3 mice after 9 different treatment lengths between 2-6 months. Next, we created a mathematical model that best fitted the observational data and used this for inter-regimen comparison. The observed data were best described by a sigmoidal E max model in favor over linear or conventional E max models. Estimating regimen-specific parameters showed significantly higher curative potentials for RZME and R p ZHE compared to RZMH. In conclusion, we provide a new design for treatment outcome evaluation in a mouse TB model, which (i) provides accurate tools for assessment of the relationship between treatment length and predicted cure, (ii) allows for efficient comparison between regimens and (iii) adheres to the reduction and refinement principles of laboratory animal use.

  4. Reporting methods of blinding in randomized trials assessing nonpharmacological treatments.

    Directory of Open Access Journals (Sweden)

    Isabelle Boutron

    2007-02-01

    Full Text Available BACKGROUND: Blinding is a cornerstone of treatment evaluation. Blinding is more difficult to obtain in trials assessing nonpharmacological treatment and frequently relies on "creative" (nonstandard methods. The purpose of this study was to systematically describe the strategies used to obtain blinding in a sample of randomized controlled trials of nonpharmacological treatment. METHODS AND FINDINGS: We systematically searched in Medline and the Cochrane Methodology Register for randomized controlled trials (RCTs assessing nonpharmacological treatment with blinding, published during 2004 in high-impact-factor journals. Data were extracted using a standardized extraction form. We identified 145 articles, with the method of blinding described in 123 of the reports. Methods of blinding of participants and/or health care providers and/or other caregivers concerned mainly use of sham procedures such as simulation of surgical procedures, similar attention-control interventions, or a placebo with a different mode of administration for rehabilitation or psychotherapy. Trials assessing devices reported various placebo interventions such as use of sham prosthesis, identical apparatus (e.g., identical but inactivated machine or use of activated machine with a barrier to block the treatment, or simulation of using a device. Blinding participants to the study hypothesis was also an important method of blinding. The methods reported for blinding outcome assessors relied mainly on centralized assessment of paraclinical examinations, clinical examinations (i.e., use of video, audiotape, photography, or adjudications of clinical events. CONCLUSIONS: This study classifies blinding methods and provides a detailed description of methods that could overcome some barriers of blinding in clinical trials assessing nonpharmacological treatment, and provides information for readers assessing the quality of results of such trials.

  5. Microleakage of Four Dental Cements in Metal Ceramic Restorations With Open Margins

    Science.gov (United States)

    Eftekhar Ashtiani, Reza; Farzaneh, Babak; Azarsina, Mohadese; Aghdashi, Farzad; Dehghani, Nima; Afshari, Aisooda; Mahshid, Minu

    2015-01-01

    Background: Fixed prosthodontics is a routine dental treatment and microleakage is a major cause of its failure. Objectives: The aim of this study was to assess the marginal microleakage of four cements in metal ceramic restorations with adapted and open margins. Materials and Methods: Sixty sound human premolars were selected for this experimental study performed in Tehran, Iran and prepared for full-crown restorations. Wax patterns were formed leaving a 300 µm gap on one of the proximal margins. The crowns were cast and the samples were randomly divided into four groups based on the cement used. Copings were cemented using zinc phosphate cement (Fleck), Fuji Plus resin-modified glass ionomer, Panavia F2.0 resin cement, or G-Cem resin cement, according to the manufacturers’ instructions. Samples were immersed in 2% methylene blue solution. After 24 hours, dye penetration was assessed under a stereomicroscope and analyzed using the respective software. Data were analyzed using ANOVA, paired t-tests, and Kruskal-Wallis, Wilcoxon, and Mann-Whitney tests. Results: The least microleakage occurred in the Panavia F2.0 group (closed margin, 0.18 mm; open margin, 0.64 mm) and the maximum was observed in the Fleck group (closed margin, 1.92 mm; open margin, 3.32 mm). The Fleck group displayed significantly more microleakage compared to the Fuji Plus and Panavia F2.0 groups (P cement exhibited better sealing ability in closed and open margins compared to G-Cem and Fleck cements. When using G-Cem and Fleck cements for full metal ceramic restorations, clinicians should try to minimize marginal gaps in order to reduce restoration failure. In situations where there are doubts about perfect marginal adaptation, the use of Fuji Plus cement may be helpful. PMID:26730349

  6. DYSLEXIA – AN OVERVIEW OF ASSESSMENT AND TREATMENT METHODS

    Directory of Open Access Journals (Sweden)

    Evelin Witruk

    2016-06-01

    Full Text Available This article will give an overview of the different methods of assessment and treatment currently used in the field of dyslexia with a special focus on genetic research. Based on the modification and extension of the multilevel model of Valtin (1989, modified by Witruk, 1993b, assessment and treatment methods will be discussed due to their primary objectives. These methods will be described regarding primary causes (biological risk factors, secondary causes (partial performance deficits, primary symptoms (reading and writing problems and secondary symptoms (emotional and behavioural disorders. Keywords: Multilevel model of dyslexia, genetics, magnocellular deficit, partial performance

  7. Characterization of drinking water treatment for virus risk assessment.

    Science.gov (United States)

    Teunis, P F M; Rutjes, S A; Westrell, T; de Roda Husman, A M

    2009-02-01

    Removal or inactivation of viruses in drinking water treatment processes can be quantified by measuring the concentrations of viruses or virus indicators in water before and after treatment. Virus reduction is then calculated from the ratio of these concentrations. Most often only the average reduction is reported. That is not sufficient when treatment efficiency must be characterized in quantitative risk assessment. We present three simple models allowing statistical analysis of series of counts before and after treatment: distribution of the ratio of concentrations, and distribution of the probability of passage for unpaired and paired water samples. Performance of these models is demonstrated for several processes (long and short term storage, coagulation/filtration, coagulation/sedimentation, slow sand filtration, membrane filtration, and ozone disinfection) using microbial indicator data from full-scale treatment processes. All three models allow estimation of the variation in (log) reduction as well as its uncertainty; the results can be easily used in risk assessment. Although they have different characteristics and are present in vastly different concentrations, different viruses and/or bacteriophages appear to show similar reductions in a particular treatment process, allowing generalization of the reduction for each process type across virus groups. The processes characterized in this paper may be used as reference for waterborne virus risk assessment, to check against location specific data, and in case no such data are available, to use as defaults.

  8. Necessidade de tratamento periodontal avaliada pelo CPITN e sua relação com a qualidade de acabamento cervical das restaurações Need for periodontal treatment evaluated through CPITN and its relation to the quality of the cervical margin of restorations

    Directory of Open Access Journals (Sweden)

    Getúlio da Rocha NOGUEIRA-FILHO

    2001-03-01

    Full Text Available Irregularidades do acabamento cervical de restaurações constituem fatores de retenção de placa bacteriana, dificultando o controle de placa pelos procedimentos habituais de higiene bucal, favorecendo o desenvolvimento da doença periodontal. O objetivo deste estudo foi avaliar as condições periodontais e a necessidade de tratamento em função do acabamento cervical de restaurações dentais. Foram examinados 367 dentes restaurados com classes II e V de amálgama, classe III em resina, restauração metálica fundida e próteses unitárias. Utilizando-se sonda periodontal (OMS, verificou-se a posição do término da restauração (supragengival, subgengival ou ao nível da margem gengival; a qualidade das restaurações (falta ou excesso de material restaurador e a presença de grau 2 do CPITN. Após a análise dos dados, foi possível concluir que: 1 o término supragengival ofereceu a melhor adaptação marginal e a menor freqüência de grau 2 do CPITN; 2 a falta ou excesso de material restaurador favorecem o desenvolvimento de grau 2, independentemente do material utilizado e 3 nos términos subgengivais, foi maior a freqüência de adaptação marginal incorreta, principalmente casos de excesso de material restaurador, sendo estes casos de maior ocorrência de grau 2 do CPITN.Irregularities of the cervical margin of restorations facilitate the retention of bacterial plaque, hindering plaque control through the habitual procedures of oral hygiene and favoring the development of periodontal disease. The aim of this study was to evaluate the periodontal condition and treatment needs (applying CPITN in relation to the cervical margin of dental restorations. Three hundred and sixty-seven teeth with class II and V cavities restored with amalgam, class III cavities restored with composite resin, cast metal restorations and unitary prostheses were examined. With a WHO periodontal probe, the position of the cervical margins of restorations

  9. Defining and Assessing Parent Empowerment and Its Relationship to Academic Achievement Using the National Household Education Survey: A Focus on Marginalized Parents

    Science.gov (United States)

    Kim, Jungnam

    2012-01-01

    Marginalized parents experience multiple and complex challenges in terms of social isolation, exclusion, and powerlessness. This empirical study investigated the effects of parent empowerment on academic outcomes using a large national representative sample and should provide insights about the importance of parent empowerment in education and…

  10. Suicide assessment and treatment: Gaps between theory, research, and practice.

    Science.gov (United States)

    Kene, Prachi; Yee, Elena T; Gimmestad, Katherine D

    2018-02-23

    A considerable body of literature focuses on suicide risk assessment, treatment, and prevention. However, incorporation of these research and theoretical advances in routine care by practitioners has been largely unexamined. We examine the challenges - lack of training, fear, complexities of decision-making, practical barriers, lack of usage of assessment tools, and violations of psychometric principles by assessment tools - that confront practitioners when utilizing advances in the field. Identifying and addressing these barriers has implications to help bridge the gaps between theory, research, and practice to improve quality of care. Clinical, training, policy implications and future research directions are reviewed.

  11. Assessment of alternatives to correct inventory difference statistical treatment deficiencies

    International Nuclear Information System (INIS)

    Byers, K.R.; Johnston, J.W.; Bennett, C.A.; Brouns, R.J.; Mullen, M.F.; Roberts, F.P.

    1983-11-01

    This document presents an analysis of alternatives to correct deficiencies in the statistical treatment of inventory differences in the NRC guidance documents and licensee practice. Pacific Northwest Laboratory's objective for this study was to assess alternatives developed by the NRC and a panel of safeguards statistical experts. Criteria were developed for the evaluation and the assessment was made considering the criteria. The results of this assessment are PNL recommendations, which are intended to provide NRC decision makers with a logical and statistically sound basis for correcting the deficiencies

  12. [Stalking: diagnostics, risk assessment, principles of treatment and forensic psychiatric assessment].

    Science.gov (United States)

    Dressing, H

    2013-11-01

    Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behavior that leads to the victim's perception of being harassed, threatened and frightened. Physical assault and even homicide may sometimes occur in the context of stalking. For psychiatry the following tasks result: (1) diagnosis and classification of stalking cases, (2) risk assessment of stalking cases, (3) counselling and treatment of victims of stalking and, (4) treatment and assessment of stalkers. Empirical findings and instructions are presented for these four areas.

  13. Assessing the effect of marginal water use efficiency on water use of loblolly pine and sweetgum in ambient and elevated CO2 conditions

    Science.gov (United States)

    Kim, D.; Medvigy, D.; Xu, X.; Oren, R.; Ward, E. J.

    2017-12-01

    Stomata are the common pathways through which diffusion of CO2 and water vapor take place in a plant. Therefore, the responses of stomatal conductance to environmental conditions are important to quantify carbon assimilation and water use of plants. In stomatal optimality theory, plants may adjust the stomatal conductance to maximize carbon assimilation for a given water availability. The carbon cost for unit water loss, marginal water use efficiency (λ), depends on changes in atmospheric CO2 concentration and pre-dawn leaf water potential. The relationship can be described by λ with no water stress (λ0) and the sensitivity of λ to pre-dawn leaf water potential (β0), which may vary by plant functional type. Assessment of sensitivity of tree and canopy water use to those parameters and the estimation of the parameters for individual plant functional type or species are needed. We modeled tree water use of loblolly pine (Pinus taeda) and sweetgum (Liquidambar styraciflua) in ambient and elevated CO2 (+200 µmol mol-1) at the Duke Forest free-air CO2 enrichment (FACE) site with Ecosystem Demography model 2 (ED2), a demographic terrestrial biosphere model that scales up individual-level competition for light, water and nutrients to the ecosystem-level. Simulated sap flux density for different tree size classes and species was compared to observations. The sensitivity analysis with respect to the model's hydraulic parameters was performed. The initial results showed that the impacts of λ on tree water use were greater than other hydraulic traits in the model, such as vertical hydraulic conductivity and leaf and stem capacitance. With 10% increase in λ, modeled water flow from root to leaf decreased by 2.5 and 1.6% for P. taeda and by 7.9 and 5.1% for L. styraciflua in ambient and elevated CO2 conditions, respectively. Values of hydraulic traits (λ0 and β0) for P. taeda and L. styraciflua in ambient an elevated CO2 conditions were also suggested.

  14. Assessment of dairy wastewater treatment and its potential for ...

    African Journals Online (AJOL)

    The extent of pollution of dairy wastewater treated in a septic tank and its potential for biogas production was investigated. Performance of the existing treatment system was assessed through characterization of both raw and treated effluents. From the analysis parameters likeChemical Oxygen Demand (COD), Biochemical ...

  15. Cardiovascular genetic assessment and treatment in middle age to ...

    African Journals Online (AJOL)

    Assessment and treatment of cardiovascular disease (CVD) risk factors as a preventable cause of cognitive decline, morbidity and mortality is an important clinical goal. The apolipoprotein E (Apo E) gene provides a genetic link between CVD and the development of Alzheimer's disease (AD). The E4 allele increases the risk ...

  16. A Protocol for the Assessment and Treatment of School Phobia.

    Science.gov (United States)

    Doll, Beth

    This paper addresses the problem of school phobia, one of the most common childhood anxiety disorders. It presents four case studies of preadolescent school phobia involving two girls and two boys in grades four through seven. Several features of effective strategies for the assessment and treatment of school phobia which have emerged from the…

  17. Assessment and treatment of post patent ductus arteriosus ligation syndrome.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif F

    2014-07-01

    To compare differences in tissue Doppler imaging, global longitudinal strain (GLS), and cardiac troponin T (cTnT) between infants with low (<200 mL\\/kg\\/min) and high (>200 mL\\/kg\\/min) left ventricular (LV) output 1 hour after duct ligation and assess the impact of milrinone treatment on cardiac output and myocardial performance.

  18. Life Cycle Assessment to Municipal Wastewater Treatment Plant

    International Nuclear Information System (INIS)

    Garcia, J. s.; Herrera, I.; Rodriguez, A.

    2011-01-01

    The evaluation was done at a Municipal Wastewater Treatment Plant (MWTP), through the application of the methodology of Life Cycle Assessment (LCA) performed by using a commercial tool called SIMAPRO. The objective of this study was to apply Life Cycle Assessment (LCA) in two systems: municipal wastewater effluent without treatment and Wastewater Treatment Plant (WTP) that is operating in poor condition and has a direct discharge to a natural body, which is a threat to the environment. A LCA was done using SIMAPRO 7, in order to determine the environmental impact in each scenery was assessed, a comparison of the impacts and propose improvements to decrease, following the steps this methodology and according to the respective standardized normative (ISO 14040/ ISO 14044). In this study, most of used data have been reported by the plant from early 2010 and some data from literature. We identified the environmental impacts generated by the treatment, making emphasis on those related to the subsequent use of the water body receiving the discharge, such as eutrophication (near to 15% reduction). Likewise, a comparative analysis between the impacts in the two systems, with and without treatment by analyzing the variation in the impact categories studied. Finally within this work, alternatives of improvements, in order to reduce the identified and quantified impacts are proposed. (Author) 33 refs.

  19. Refining margins: recent trends

    International Nuclear Information System (INIS)

    Baudoin, C.; Favennec, J.P.

    1999-01-01

    Despite a business environment that was globally mediocre due primarily to the Asian crisis and to a mild winter in the northern hemisphere, the signs of improvement noted in the refining activity in 1996 were borne out in 1997. But the situation is not yet satisfactory in this sector: the low return on invested capital and the financing of environmental protection expenditure are giving cause for concern. In 1998, the drop in crude oil prices and the concomitant fall in petroleum product prices was ultimately rather favorable to margins. Two elements tended to put a damper on this relative optimism. First of all, margins continue to be extremely volatile and, secondly, the worsening of the economic and financial crisis observed during the summer made for a sharp decline in margins in all geographic regions, especially Asia. Since the beginning of 1999, refining margins are weak and utilization rates of refining capacities have decreased. (authors)

  20. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt

    2014-01-01

    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...... argue that researchers not only need to pay attention to how certain voices are marginalized in Environmental Education research and practice, but also to how learners as agents respond to, use and negotiate the marginalization of their perspectives.......In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency...

  1. Indian Ocean margins

    Digital Repository Service at National Institute of Oceanography (India)

    Naqvi, S.W.A.

    The most important biogeochemical transformations and boundary exchanges in the Indian Ocean seem to occur in the northern region, where the processes originating at the land-ocean boundary extend far beyond the continental margins. Exchanges across...

  2. Life cycle assessment of advanced waste water treatment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Hansen, Peter Augusto

    The EU FP6 NEPTUNE project is related to the EU Water Framework Directive and the main goal is to develop new and optimize existing waste water treatment technologies (WWTT) and sludge handling methods for municipal waste water. Besides nutrients, a special focus area is micropollutants (e...... of induced impacts as compared to avoided impacts is introduced in the life cycle impact assessment (LCIA) part. Furthermore, as novel approaches, potential ecotoxicity impact from a high number of micropollutants and the potential impact from pathogens (and whole effluent toxicity) are to be included....... In total more that 20 different waste water and sludge treatment technologies are to be assessed. This paper will present the preliminary LCA results from running the induced versus avoided impact approach (mainly based on existing LCIA methodology) on one of the advanced treatment technologies, i...

  3. Areaplanning in marginal areas

    OpenAIRE

    Janneau, Thibaut; Arborg, Pernille; Sandberg, Rina

    2007-01-01

    This project is also a comparative analysis between two cases: Lolland Kommune and Venise Verte, having both a marginal characteristic. The analyze of these two marginal areas makes us able to found out some dilemmas showing the crucial issues of planners between economic development, social equity, cultural evolution and finally environmental enhancer. We also tried to see the different views of nature between two paradigms: widleness of nature and cultural landscapes as well as graduate dif...

  4. Neuropathic Pain Following Spinal Cord Injury: Mechanism, Assessment and Treatment

    Directory of Open Access Journals (Sweden)

    Gul Mete Civelek

    2016-04-01

    Full Text Available Spinal cord injury (SCI is a devastating disease which may cause physical, psychological and social dysfunction. Neuropathic pain (NP after SCI is common, can be seen in varying degrees and is one of the most difficultly treated problems developing after SCI. With the addition of the NP to loss of function after SCI, sleep patterns, moods and daily activities of patients are adversely affected. In order to treat pain effectively, classification of pain after SCI must be done carefully and correctly. According to classification of International Pain Study Group, pain after SCI is divided into two main groups as nociceptive and neuropathic pain. Neuropathic pain is defined as %u201Cpain occuring as a direct result of a disease or lesion directly affecting somato-sensorial system%u201D. NP after SCI can be classified according to anatomical region (above the level of lesion, at the level of lesion, below the level of lesion. Treatment of NP after SCI is often challenging and receiving response to treatment may take long time. Therefore, treatment of NP after SCI should be multifactorial. Treatment options include pharmochologic treatment, application of transcutanous electrical nerve stimulation, psychiatric treatment approaches, and surgical approaches in selected cases. In pharmachologic treatment, first line agents are tricyclic antidepresants, pregabalin and gabapentin. In this review, mechanisms and assessment and treatment of NP after SCI is discussed with the guide of current literature.

  5. Multi-Criteria Sustainability Assessment of Urban Sludge Treatment Technologies

    DEFF Research Database (Denmark)

    An, Da; Xi, Beidou; Ren, Jingzheng

    2017-01-01

    to determine the weights of the criteria for sustainability assessment, and extension theory was used to prioritize the alternative technologies for the treatment of urban sewage sludge and grade their sustainability performances. An illustrative case including three technologies (compositing, incineration......This study aims at developing a sustainability assessment framework for assessing the technologies for the treatment of urban sewage sludge based on the logarithmic fuzzy preference programming based fuzzy analytic hierarchy process (LFPPFAHP) and extension theory. LFPPFAHP was employed......, and resource utilization) was studied by the proposed method, and compositing, incineration, and resource utilization are recognized as "Moderately Sustainable", "Not Sustainable", and "Highly Sustainable", respectively. The sustainability sequence in the descending order is resource utilization, compositing...

  6. Pickering seismic safety margin

    International Nuclear Information System (INIS)

    Ghobarah, A.; Heidebrecht, A.C.; Tso, W.K.

    1992-06-01

    A study was conducted to recommend a methodology for the seismic safety margin review of existing Canadian CANDU nuclear generating stations such as Pickering A. The purpose of the seismic safety margin review is to determine whether the nuclear plant has sufficient seismic safety margin over its design basis to assure plant safety. In this review process, it is possible to identify the weak links which might limit the seismic performance of critical structures, systems and components. The proposed methodology is a modification the EPRI (Electric Power Research Institute) approach. The methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path, and the determination of the seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of using historical records and the regional seismo-tectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection, analysis or testing. An implementation plan for the application of the methodology to the Pickering A NGS is prepared

  7. SOCIAL MARGINALIZATION AND HEALTH

    Directory of Open Access Journals (Sweden)

    Marjana Bogdanović

    2007-04-01

    Full Text Available The 20th century was characterized by special improvement in health. The aim of WHO’s policy EQUITY IN HEALTH is to enable equal accessibility and equal high quality of health care for all citizens. More or less some social groups have stayed out of many social systems even out of health care system in the condition of social marginalization. Phenomenon of social marginalization is characterized by dynamics. Marginalized persons have lack of control over their life and available resources. Social marginalization stands for a stroke on health and makes the health status worse. Low socio-economic level dramatically influences people’s health status, therefore, poverty and illness work together. Characteristic marginalized groups are: Roma people, people with AIDS, prisoners, persons with development disorders, persons with mental health disorders, refugees, homosexual people, delinquents, prostitutes, drug consumers, homeless…There is a mutual responsibility of community and marginalized individuals in trying to resolve the problem. Health and other problems could be solved only by multisector approach to well-designed programs.

  8. Treatments for somnambulism in adults: assessing the evidence.

    Science.gov (United States)

    Harris, Melanie; Grunstein, Ronald R

    2009-08-01

    Somnambulism, or sleepwalking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleepwalking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. MEDLINE, EMBASE, PsycINFO and the Ovid Evidence-Based Medicine Reviews (EBM) multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well-designed clinical trials are now needed, and multi-centre collaborations may be required to obtain the sample sizes required.

  9. Prevalence, assessment, and treatment of pathological gambling: a review.

    Science.gov (United States)

    Petry, N M; Armentano, C

    1999-08-01

    Although pathological gambling is an increasing problem, many mental health providers are unfamiliar with its diagnosis and treatment. To improve recognition and treatment of pathological gambling, the authors reviewed the literature on its prevalence, assessment, and treatment. Entries in PsycLIT and MEDLINE were examined for the years 1984 to 1998. The prevalence of pathological gambling seems to be increasing with the spread of legalized gambling; casinos are now operating in 27 states. Point and lifetime prevalence rates of pathological gambling are reported to be as high as 1.4 percent and 5.1 percent, respectively. The most commonly used assessment instrument is the DSM-based, 20-item South Oaks Gambling Screen. There is no standard treatment for pathological gambling. Gamblers Anonymous (GA) is the most popular intervention, and about 1,000 chapters exist in the U.S. Studies suggest that only 8 percent of GA attendees achieve a year of abstinence. Combining professional therapy and GA participation may improve retention and abstinence. Marital and family treatments, including participation in Gam-Anon, the spousal component of GA, have not been sufficiently evaluated. The few studies of cognitive-behavioral treatments suggest that this approach, which may include cognitive restructuring, problem solving, social skills training, and relapse prevention, is promising. Carbamazepine, naltrexone, clomipramine, fluvoxamine, and lithium have been used with some effect. Therapists' manuals and self-help manuals are available. Although research evaluating their efficacy is necessary, manuals can provide a start for therapists who encounter patients with gambling problems. Brief motivational interviewing may be a useful strategy for decreasing gambling among heavy gamblers who are ambivalent about entering treatment or who do not desire abstinence.

  10. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement

    DEFF Research Database (Denmark)

    Harris-Hayes, Marcie; McDonough, Christine M; Leunig, Michael

    2013-01-01

    Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels...... developed recently and have not been established in the literature. Although currently used generic and activity-level measures have limitations, as well, they should be considered, depending on the specific goals of the study. Additional research is needed to assess the properties of these measures fully...

  11. Three-dimensional volumetric assessment of response to treatment

    International Nuclear Information System (INIS)

    Willett, C.G.; Stracher, M.A.; Linggood, R.M.; Leong, J.C.; Skates, S.J.; Miketic, L.M.; Kushner, D.C.; Jacobson, J.O.

    1988-01-01

    From 1981 to 1986, 12 patients with Stage I and II diffuse large cell lymphoma of the mediastinum were treated with 4 or more cycles of multiagent chemotherapy and for nine patients this was followed by mediastinal irradiation. The response to treatment was assessed by three-dimensional volumetric analysis utilizing thoracic CT scans. The initial mean tumor volume of the five patients relapsing was 540 ml in contrast to an initial mean tumor volume of 360 ml for the seven patients remaining in remission. Of the eight patients in whom mediastinal lymphoma volumes could be assessed 1-2 months after chemotherapy prior to mediastinal irradiation, the three patients who have relapsed had volumes of 292, 92 and 50 ml (mean volume 145 ml) in contrast to five patients who have remained in remission with residual volume abnormalities of 4-87 ml (mean volume 32 ml). Four patients in prolonged remission with CT scans taken one year after treatment have been noted to have mediastinal tumor volumes of 0-28 ml with a mean value of 10 ml. This volumetric technique to assess the extent of mediastinal large cell lymphoma from thoracic CT scans appears to be a useful method to quantitate the amount of disease at presentation as well as objectively monitor response to treatment. 13 refs.; 2 figs.; 1 table

  12. Evaluation of marginal circumference and marginal thickness changes in precrimped stainless steel crowns, after recrimping

    Directory of Open Access Journals (Sweden)

    Afshar H

    2006-07-01

    Full Text Available Background and Aim: The need for recrimping precrimped stainless steel crowns by the dentist in clinic is controversial. This study aimed to evaluate the rate of marginal circumference and marginal thickness change of precrimped stainless steel crowns after recrimping. Materials and Methods: In this experimental study, 30 primary photos were taken from margins of 30 S.S.Cs (3M, Ni-Cr related to tooth 85 with a digital camera fixed at a determined distance. Margins of crowns were crimped by 114 and 137 pliers with a controlled force (0.2 N and then 30 secondary photos were taken in the same conditions. The circumference of crown margins in primary (group A and secondary (group B photos were assessed by a digitizer system. Comparing the circumferences of crown margins in primary and secondary photos showed a significant decrease after crimping. Thickness of 30 random points on the crown margins of a crown similar to mentioned cases was measured by SEM (×150. Then similar procedures including taking a primary photo, crimping and taking a secondary photo was done for the sample crown. After significant reduction in margin circumference, thickness of 30 other random points on the crown margin were measured by SEM. Data were analyzed by paired sample t-test with p<0.05 as the limit of significance. Results: The mean marginal circumference of precrimped stainless steel crowns was reduced by 7.3% which was significant (P<0.001. On the other hand the mean marginal thickness of sample stainless steel crown showed 18µ increase. Conclusion: According to the results of this study, marginal circumference of precrimped stainless steel crowns (3M, Ni-Cr showed a significant decrease after crimping. It is concluded that crimping the stainless steel crowns even for precrimped ones seems necessary.

  13. Residential Treatment for Sexually Abusive Youth: An Assessment of Treatment Outcomes

    Science.gov (United States)

    Jones, Christopher D.; Chancey, Roy; Lowe, Laura A.; Risler, Edwin A.

    2010-01-01

    Objective: This research study assesses the effectiveness of participation in a multimodal/holistic residential treatment program on changing deviant sexual interests and functional impairment among sexually abusive youth. Method: A one-group pretest posttest design was utilized to examine pretest (intake) and posttest (discharge) scores for 58…

  14. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

    Science.gov (United States)

    Herschtal, A.; te Marvelde, L.; Mengersen, K.; Hosseinifard, Z.; Foroudi, F.; Devereux, T.; Pham, D.; Ball, D.; Greer, P. B.; Pichler, P.; Eade, T.; Kneebone, A.; Bell, L.; Caine, H.; Hindson, B.; Kron, T.

    2015-02-01

    Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement (‘random error’) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.

  15. From Borders to Margins

    DEFF Research Database (Denmark)

    Parker, Noel

    2009-01-01

    upon Deleuze's philosophy to set out an ontology in which the continual reformulation of entities in play in ‘post-international' society can be grasped.  This entails a strategic shift from speaking about the ‘borders' between sovereign states to referring instead to the ‘margins' between a plethora...

  16. Deep continental margin reflectors

    Science.gov (United States)

    Ewing, J.; Heirtzler, J.; Purdy, M.; Klitgord, Kim D.

    1985-01-01

    In contrast to the rarity of such observations a decade ago, seismic reflecting and refracting horizons are now being observed to Moho depths under continental shelves in a number of places. These observations provide knowledge of the entire crustal thickness from the shoreline to the oceanic crust on passive margins and supplement Consortium for Continental Reflection Profiling (COCORP)-type measurements on land.

  17. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup

    2010-01-01

    This article analyses how young marginalized ethnic minority men in Denmark react to the othering they are subject to in the media as well as in the social arenas of every day life. The article is based on theoretically informed ethnographic fieldwork among such young men as well as interviews an...

  18. Maintaining plant safety margins

    International Nuclear Information System (INIS)

    Bergeron, P.A.

    1989-01-01

    The Final Safety Analysis Report Forms the basis of demonstrating that the plant can operate safely and meet all applicable acceptance criteria. In order to assure that this continues through each operating cycle, the safety analysis is reexamined for each reload core. Operating limits are set for each reload core to assure that safety limits and applicable acceptance criteria are not exceeded for postulated events within the design basis. These operating limits form the basis for plant operation, providing barriers on various measurable parameters. The barriers are refereed to as limiting conditions for operation (LCO). The operating limits, being influenced by many factors, can change significantly from cycle to cycle. In order to be successful in demonstrating safe operation for each reload core (with adequate operating margin), it is necessary to continue to focus on ways to maintain/improve existing safety margins. Existing safety margins are a function of the plant type [boiling water reactor/pressurized water reactor (BWR/PWR)], nuclear system supply (NSSS) vendor, operating license date, core design features, plant design features, licensing history, and analytical methods used in the safety analysis. This paper summarizes the experience at Yankee Atomic Electric Company (YAEC) in its efforts to provide adequate operating margin for the plants that it supports

  19. Oceanography of marginal seas

    Digital Repository Service at National Institute of Oceanography (India)

    DileepKumar, M.

    The North Indian Ocean consists of three marginal seas; The Persian Gulf and the Red Sea in the west and the Andaman Sea in the east. Oceanographic features of these semi-enclosed basins have been discussed in this article. While circulation...

  20. Marginally Deformed Starobinsky Gravity

    DEFF Research Database (Denmark)

    Codello, A.; Joergensen, J.; Sannino, Francesco

    2015-01-01

    We show that quantum-induced marginal deformations of the Starobinsky gravitational action of the form $R^{2(1 -\\alpha)}$, with $R$ the Ricci scalar and $\\alpha$ a positive parameter, smaller than one half, can account for the recent experimental observations by BICEP2 of primordial tensor modes....

  1. Assessment and treatment of eating disorders in children and adolescents.

    Science.gov (United States)

    Mairs, Rebecca; Nicholls, Dasha

    2016-12-01

    Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder. 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/.

  2. Technology assessment of thermal treatment technologies using ORWARE

    International Nuclear Information System (INIS)

    Assefa, G.; Eriksson, O.; Frostell, B.

    2005-01-01

    A technology assessment of thermal treatment technologies for wastes was performed in the form of scenarios of chains of technologies. The Swedish assessment tool, ORWARE, was used for the assessment. The scenarios of chains of thermal technologies assessed were gasification with catalytic combustion, gasification with flame combustion, incineration and landfilling. The landfilling scenario was used as a reference for comparison. The technologies were assessed from ecological and economic points of view. The results are presented in terms of global warming potential, acidification potential, eutrophication potential, consumption of primary energy carriers and welfare costs. From the simulations, gasification followed by catalytic combustion with energy recovery in a combined cycle appeared to be the most competitive technology from an ecological point of view. On the other hand, this alternative was more expensive than incineration. A sensitivity analysis was done regarding electricity prices to show which technology wins at what value of the unit price of electricity (SEK/kW h). Within this study, it was possible to make a comparison both between a combined cycle and a Rankine cycle (a system pair) and at the same time between flame combustion and catalytic combustion (a technology pair). To use gasification just as a treatment technology is not more appealing than incineration, but the possibility of combining gasification with a combined cycle is attractive in terms of electricity production. This research was done in connection with an empirical R and D work on both gasification of waste and catalytic combustion of the gasified waste at the Division of Chemical Technology, Royal Institute of Technology (KTH), Sweden

  3. NRC Seismic Design Margins Program Plan

    International Nuclear Information System (INIS)

    Cummings, G.E.; Johnson, J.J.; Budnitz, R.J.

    1985-08-01

    Recent studies estimate that seismically induced core melt comes mainly from earthquakes in the peak ground acceleration range from 2 to 4 times the safe shutdown earthquake (SSE) acceleration used in plant design. However, from the licensing perspective of the US Nuclear Regulatory Commission, there is a continuing need for consideration of the inherent quantitative seismic margins because of, among other things, the changing perceptions of the seismic hazard. This paper discusses a Seismic Design Margins Program Plan, developed under the auspices of the US NRC, that provides the technical basis for assessing the significance of design margins in terms of overall plant safety. The Plan will also identify potential weaknesses that might have to be addressed, and will recommend technical methods for assessing margins at existing plants. For the purposes of this program, a general definition of seismic design margin is expressed in terms of how much larger that the design basis earthquake an earthquake must be to compromise plant safety. In this context, margin needs to be determined at the plant, system/function, structure, and component levels. 14 refs., 1 fig

  4. Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration

    Directory of Open Access Journals (Sweden)

    Natalie R. Danna

    2015-01-01

    Full Text Available This study assessed the osseointegrative effects of atmospheric pressure plasma (APP surface treatment for implants in a canine model. Control surfaces were untreated textured titanium (Ti and calcium phosphate (CaP. Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical characterization was performed to assess topography, surface energy, and chemical composition. One implant from each control and experimental group (four in total was placed in one radius of each of the seven male beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks. After sacrifice, bone-to-implant contact (BIC and bone area fraction occupancy (BAFO were assessed. X-ray photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (P<0.001 increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces. There were no significant (P=0.57 differences for BAFO between treated and untreated surfaces for either material at either time point. This suggests that air-based APP surface treatment may improve osseointegration of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted.

  5. Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration.

    Science.gov (United States)

    Danna, Natalie R; Beutel, Bryan G; Tovar, Nick; Witek, Lukasz; Marin, Charles; Bonfante, Estevam A; Granato, Rodrigo; Suzuki, Marcelo; Coelho, Paulo G

    2015-01-01

    This study assessed the osseointegrative effects of atmospheric pressure plasma (APP) surface treatment for implants in a canine model. Control surfaces were untreated textured titanium (Ti) and calcium phosphate (CaP). Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical characterization was performed to assess topography, surface energy, and chemical composition. One implant from each control and experimental group (four in total) was placed in one radius of each of the seven male beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks. After sacrifice, bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed. X-ray photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (P < 0.001) increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces. There were no significant (P = 0.57) differences for BAFO between treated and untreated surfaces for either material at either time point. This suggests that air-based APP surface treatment may improve osseointegration of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted.

  6. Antipsychotic treatment in schizophrenia: the role of computerized neuropsychological assessment.

    Science.gov (United States)

    Kertzman, Semion; Reznik, Ilya; Grinspan, Haim; Weizman, Abraham; Kotler, Moshe

    2008-01-01

    The present study analyzes the role of neurocognitive assessment instruments in the detection of the contribution of antipsychotic treatment to cognitive functioning. Recently, a panel of experts suggested six main domains (working memory; attention/vigilance; verbal/visual learning and memory; reasoning and problem solving; speed of processing) implicated in schizophrenia-related cognitive deficits, which serve as a theoretical base for creation of real-time computerized neurocognitive batteries. The high sensitivity of computerized neuropsychological testing is based on their ability to adopt the reaction time (RT) paradigm for the assessment of brain function in a real-time regime. This testing is highly relevant for the monitoring of the cognitive effects of antipsychotics. Computerized assessment assists in the identification of state- and trait-related cognitive impairments. The optimal real-time computerized neurocognitive battery should composite balance between broad and narrow coverage of cognitive domains relevant to the beneficial effects of antipsychotics and will enable better planning of treatment and rehabilitation programs.

  7. Cultural Aspects in Symptomatology, Assessment, and Treatment of Personality Disorders.

    Science.gov (United States)

    Ronningstam, Elsa F; Keng, Shian-Ling; Ridolfi, Maria Elena; Arbabi, Mohammad; Grenyer, Brin F S

    2018-03-26

    This review discusses cultural trends, challenges, and approaches to assessment and treatment of personality traits and disorders. Specific focus include current developments in the Asian, Italian, Iranian, and Australian societies, as well as the process of acculturation, following moves between cultures with the impact on healthy and disordered personality function. Each culture with its specific history, dimensions, values, and practices influences and gears the individual and family or group in unique ways that affect personality functioning. Similarly, each culture provides means of protection and assimilation as well as norms for acceptance and denunciations of specific behaviors and personality traits. The diagnosis of personality disorders and their treatment need to take into consideration the individual in the context of the culture and society in which they live. Core personality problems, especially emotion dysregulation and interpersonal functioning are specifically influenced by cultural norms and context.

  8. Environmental performance assessment of a company of aluminum surface treatment

    Directory of Open Access Journals (Sweden)

    Susan Catieri Ramalho

    2013-08-01

    Full Text Available The purpose of this article was to evaluate the environmental performance of a medium-sized company that provides services for surface treatment of aluminum. The treatment is known as anodizing. The research method was qualitative numerical modeling. The environmental performance of the company was organized into five constructs: atmosphere, wastewater, energy and natural resources, solid waste, and legislation and management. Nineteen indicators were chosen to explain the five constructs. Ten employees of the company prioritized the constructs and evaluated the situation of the indicators by means of a scale of assessment. By means of a mathematical model, the general performance of the environmental operation was calculated at 74.5% of the maximum possible. The indicators that most contributed to the performance not to reach 100% were consumption of electricity and water consumption. The construct of worse performance was natural and energy resources. These are the priorities for future environmental improvement actions that the company may promote.

  9. Assessing the population representativeness of colorectal cancer treatment clinical trials.

    Science.gov (United States)

    Zhe He; Zhiwei Chen; George, Thomas J; Lipori, Gloria; Bian

    2016-08-01

    The generalizability (external validity) of clinical trials has long been a concern for both clinical research community as well as the general public. Results of trials that do not represent the target population may not be applicable to the broader patient population. In this study, we used a previously published metric Generalizability Index for Study Traits (GIST) to assess the population representativeness of colorectal cancer (CRC) treatment trials. Our analysis showed that the quantitative eligibility criteria of CRC trials are in general not restrictive. However, the qualitative eligibility criteria in these trials are with moderate or strict restrictions, which may impact their population representativeness of the real-world patient population.

  10. Assessment, Diagnosis, and Treatment of Binge Eating Disorder.

    Science.gov (United States)

    Ambrogne, Janet A

    2017-08-01

    Binge eating disorder (BED) is the most prevalent eating disorder in the United States, believed to affect an estimated 2.8 million adults. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BED was recognized as a separate diagnosis. The purpose of the current article is to provide an overview of BED including assessment, diagnosis, and current pharmacological and nonpharmacological treatment options. Implications for nursing are also addressed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 32-38.]. Copyright 2017, SLACK Incorporated.

  11. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches.

    Science.gov (United States)

    Melrose, Sherri

    2015-01-01

    Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as "winter blues." Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ). Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.

  12. Radioiodine (I-131) treatment for uncomplicated hyperthyroidism: An assessment of optimal dose and cost-effectiveness

    International Nuclear Information System (INIS)

    Paul, A.K.; Rahman, H.A.; Jahan, N.

    2002-01-01

    Aim: Radioiodine (I-131) is increasingly being considered for the treatment of hyperthyroidism but there is no general agreement for the initial dose. To determine the cost-effectiveness and optimal dose of I-131 to cure disease, we prospectively studied the outcome of radioiodine therapy of 423 patients. Material and Methods: Any of the fixed doses of 6, 8, 10, 12 or 15 mCi of I-131 was administered to the patients relating to thyroid gland size. The individual was excluded from this study who had multinodular goitre and autonomous toxic nodule. Patients were classified as cured if the clinical and biochemical status was either euthyroid or hypothyroid at one year without further treatment by antithyroid drugs or radioiodine. The costs were assessed by analyzing the total cost of care including office visit, laboratory testing, radioiodine treatment, average conveyance and income loss of patient and attendant and thyroxine replacement for a period of 2 years from the day of I-131 administration. Results: The results showed a progressive increase of cure rate from the doses of 6, 8 and 10 mCi by 67%, 76.5% and 85.7% respectively but the cure rate for the doses of 12 and 15 mCi was 87.9% and 88.8% respectively. Cure was directly related to the dose between 6 and 10 mCi but at higher doses the cure rate was increased marginally at the expense of increased total body radiation. There was little variation in total costs, but was higher for low dose-therapy and the cost proportion between the 6 mCi regimen and 10 mCi regimen was 1.04:1. Conclusion: We could conclude that an initial 10 mCi of I-131 may be the optimal dose for curing hyperthyroidism and will also limit the total costs

  13. Assessment of provider adherence to obesity treatment guidelines.

    Science.gov (United States)

    Farran, Nicole; Ellis, Peggy; Lee Barron, Mary

    2013-03-01

    Despite the presence of obesity treatment guidelines, healthcare providers often provide suboptimal weight management. The purpose of the quality improvement project was to systematically assess adherence with adult overweight/obesity guidelines in primary care to reduce patient risk. Retrospective analysis of 420 encounter notes from overweight and obese adult patients in three primary care clinics. Data were collected before and after a continuing education session for providers on guidelines for optimal management of obesity. Measures of completeness of quality indicators were abstracted from records. Significant improvement in the completeness score and documentation of body mass index, height, diagnosis of overweight/obesity, and counseling for diet and physical activity were achieved. The proposed measures for systematically assessing the integration of obesity guidelines in primary care are feasible quality indicators and useful for evidence-based decision making. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

  14. Comprehensive assessment of cytochromes P450 and transporter genetics with endoxifen concentration during tamoxifen treatment.

    Science.gov (United States)

    Marcath, Lauren A; Deal, Allison M; Van Wieren, Emily; Danko, William; Walko, Christine M; Ibrahim, Joseph G; Weck, Karen E; Jones, David R; Desta, Zeruesenay; McLeod, Howard L; Carey, Lisa A; Irvin, William J; Hertz, Daniel L

    2017-11-01

    Tamoxifen bioactivation to endoxifen is mediated primarily by CYP2D6; however, considerable variability remains unexplained. Our aim was to perform a comprehensive assessment of the effect of genetic variation in tamoxifen-relevant enzymes and transporters on steady-state endoxifen concentrations. Comprehensive genotyping of CYP enzymes and transporters was performed using the iPLEX ADME PGx Pro Panel in 302 tamoxifen-treated breast cancer patients. Predicted activity phenotype for 19 enzymes and transporters were analyzed for univariate association with endoxifen concentration, and then adjusted for CYP2D6 and clinical covariates. In univariate analysis, higher activity of CYP2C8 (regression β=0.22, P=0.020) and CYP2C9 (β=0.20, P=0.04), lower body weight (β=-0.014, P<0.0001), and endoxifen measurement during winter (each β<-0.39, P=0.002) were associated with higher endoxifen concentrations. After adjustment for the CYP2D6 diplotype, weight, and season, CYP2C9 remained significantly associated with higher concentrations (P=0.02), but only increased the overall model R by 1.3%. Our results further support a minor contribution of CYP2C9 genetic variability toward steady-state endoxifen concentrations. Integration of clinician and genetic variables into individualized tamoxifen dosing algorithms would marginally improve their accuracy and potentially enhance tamoxifen treatment outcomes.

  15. Marginalized Youth. An Introduction.

    OpenAIRE

    Kessl, Fabian; Otto, Hans-Uwe

    2009-01-01

    The life conduct of marginalized groups has become subject to increasing levels of risk in advanced capitalist societies. In particular, children and young people are confronted with the harsh consequences of a “new poverty” in the contemporary era. The demographic complexion of today’s poverty is youthful, as a number of government reports have once again documented in recent years in Australia, Germany, France, Great Britain, the US or Scandinavian countries. Key youth studies have shown a ...

  16. Containment safety margins

    International Nuclear Information System (INIS)

    Von Riesemann, W.A.

    1980-01-01

    Objective of the Containment Safety Margins program is the development and verification of methodologies which are capable of reliably predicting the ultimate load-carrying capability of light water reactor containment structures under accident and severe environments. The program was initiated in June 1980 at Sandia and this paper addresses the first phase of the program which is essentially a planning effort. Brief comments are made about the second phase, which will involve testing of containment models

  17. Traumatic brain injury: future assessment tools and treatment prospects

    Directory of Open Access Journals (Sweden)

    Steven R Flanagan

    2008-10-01

    Full Text Available Steven R Flanagan1, Joshua B Cantor2, Teresa A Ashman21New York University School of Medicine, The Rusk Institute of Rehabilitation, New York, NY, USA; 2Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USAAbstract: Traumatic brain injury (TBI is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.Keywords: traumatic brain injury, assessments, treatments

  18. Dysphonia in preterm children: assessing incidence and response to treatment.

    Science.gov (United States)

    Reynolds, Victoria; Meldrum, Suzanne; Simmer, Karen; Vijayasekaran, Shyan; French, Noel P

    2014-03-01

    Mild dysphonia in childhood is surprisingly common, yet moderate to severe dysphonia is rare. The latter has been associated with complex medical conditions and congenital abnormalities. Intubation injury has also been documented as a cause of childhood dysphonia. Children born very preterm may be intubated as part of the intensive care administered in the perinatal and neonatal periods, yet there are few studies investigating dysphonia in this population. This study will be the first to: use an objective acoustic voice assessment in a paediatric study, document the incidence of dysphonia in very preterm children at school age, and conduct a controlled trial of behavioural voice therapy in this population. This study will consist of three phases: assessment of voice quality and its impact on quality of life in up to 200 children born at less than 32 weeks' gestation: assessment of the nature and extent of laryngeal pathology in children with moderate to severe dysphonia; and a non-blinded, randomised controlled trial of behavioural voice therapy in children with moderate to severe dysphonia. This study will be the first to use clinical assessment to examine the voice quality of very preterm children, and to use fibre optic endoscopic evaluation of laryngeal function to determine the nature and extent of any laryngeal pathology in such children. Those participants with significant voice difficulties will be randomised to receive treatment immediately or after the eight week assessment. This study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12613001015730/ACTRN12613001012763). Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  19. Patient factors influencing dermal filler complications: prevention, assessment, and treatment

    Directory of Open Access Journals (Sweden)

    De Boulle K

    2015-04-01

    Full Text Available Koenraad De Boulle,1 Izolda Heydenrych2 On behalf of the Consensus Group 1Aalst Dermatology Group, Aalst, Belgium; 2Cape Town Cosmetic Dermatology Centre, Century City, South Africa Abstract: While rare, complications do occur with the esthetic use of dermal fillers. Careful attention to patient factors and technique can do much to avoid these complications, and a well-informed practitioner can mitigate problems when they do occur. Since cosmetic surgery is usually an elective process, requested by the patient, clinical trials are complex to organize and run. For this reason, an international group of practicing physicians in the field of esthetics came together to share knowledge and to try and produce some informed guidance for their colleagues, considering the literature and also pooling their own extensive clinical experience. This manuscript aims to summarize the crucial aspects of patient selection, including absolute contraindications as well as situations that warrant caution, and also covers important considerations for the pre- and posttreatment periods as well as during the procedure itself. Guidance is given on both immediate and long-term management of adverse reactions. The majority of complications are related to accepting patients inappropriate for treatment or issues of sterility, placement, volume, and injection technique. It is clear that esthetic practitioners need an in-depth knowledge of all aspects of treatment with dermal fillers to achieve optimal outcomes for their patients. Keywords: dermal fillers, complications, prevention, assessment, treatment, patient factors

  20. Environmental risk assessment of Polish wastewater treatment plant activity.

    Science.gov (United States)

    Kudłak, Błażej; Wieczerzak, Monika; Yotova, Galina; Tsakovski, Stefan; Simeonov, Vasil; Namieśnik, Jacek

    2016-10-01

    Wastewater treatment plants (WWTPs) play an extremely important role in shaping modern society's environmental well-being and awareness, however only well operated and supervised systems can be considered as environmentally sustainable. For this reason, an attempt was undertaken to assess the environmental burden posed by WWTPs in major Polish cities by collecting water samples prior to and just after wastewater release points. Both classical and biological methods (Microtox(®), Ostracodtoxkit F™ and comet assay) were utilized to assess environmental impact of given WWTP. Interestingly, in some cases, water quality improvement indicated as a toxicity decrement toward one of the bio-indicating organisms makes water worse for others in the systems. This fact is particularly noticeable in case of Silesian cities where heavy industry and high population density is present. It proves that WWTP should undergo individual evaluation of pollutant removal efficiency and tuned to selectively remove pollutants of highest risk to surrounding regional ecosystems. Biotests again proved to be an extremely important tool to fully assess the impact of environmental stressors on water bodies receiving effluents from WWTPs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Estimation of dynamic treatment strategies for maintenance therapy of children with acute lymphoblastic leukaemia: an application of history-adjusted marginal structural models

    DEFF Research Database (Denmark)

    Rosthøj, Susanne; Keiding, Niels; Schmiegelow, Kjeld

    2012-01-01

    is therefore highly dynamic. In 1992-1996, the Nordic Society of Paediatric Haematology and Oncology (NOPHO) conducted a randomised study (NOPHO-ALL-92) to investigate the effect of a new and more sophisticated dynamic treatment strategy. Unexpectedly, the new strategy worsened the outcome for the girls...

  2. Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches

    Directory of Open Access Journals (Sweden)

    Sherri Melrose

    2015-01-01

    Full Text Available Seasonal affective disorder or SAD is a recurrent major depressive disorder with a seasonal pattern usually beginning in fall and continuing into winter months. A subsyndromal type of SAD, or S-SAD, is commonly known as “winter blues.” Less often, SAD causes depression in the spring or early summer. Symptoms center on sad mood and low energy. Those most at risk are female, are younger, live far from the equator, and have family histories of depression, bipolar disorder, or SAD. Screening instruments include the Seasonal Pattern Assessment Questionnaire (SPAQ. Typical treatment includes antidepressant medications, light therapy, Vitamin D, and counselling. This paper provides an overview of SAD.

  3. Amphetamine margin in sports

    Energy Technology Data Exchange (ETDEWEB)

    Laties, V.G.; Weiss, B.

    1981-10-01

    The amphetamines can enhance athletic performance. That much seem clear from the literature, some of which is reviewed here. Increases in endurance have been demonstrated in both humans and rats. Smith and Beecher, 20 years ago, showed improvement of running, swimming, and weight throwing in highly trained athletes. Laboratory analogs of such performances have also been used and similar enhancement demonstrated. The amount of change induced by the amphetamines is usually small, of the order of a few percent. Nevertheless, since a fraction of a percent improvement can make the difference between fame and oblivion, the margin conferred by these drugs can be quite important.

  4. Assessment and treatment of torture victims: a critical review.

    Science.gov (United States)

    Allodi, F A

    1991-01-01

    This paper presents the main issues in the diagnosis and treatment of psychiatric sequelae in torture victims. The concept of post traumatic stress disorder is used to organize literature on psychiatric casualties resulting from massive psychic trauma, e.g., the Nazi Holocaust, the Vietnam and Israeli wars, and the current world epidemic of torture. Torture is a unique human made stressor resulting in category-specific diagnostic symptoms. Medical assessment can be complemented with photographs, x-rays, electroencephalograms, and sleep studies. Individual psychotherapy and group techniques focus on the issues of denial and trust, loss, survivor guilt, and reparation. Programs of psychological and social rehabilitation and treatment with benzodiazepines, tricyclic antidepressants, and other compounds are reviewed. Future research needs include the conceptualization of the trauma of torture and its sequelae in broader terms, the application of standardized measurements to facilitate international comparisons, and the testing of various approaches to intervention in an experimental design. An ethical physician must resist the pressures of totalitarian governments to assume neutrality in the presence of human rights violations affecting his/her patients.

  5. Toxicological assessment of hospital wastewater in different treatment processes.

    Science.gov (United States)

    Hamjinda, Nutta Sangnarin; Chiemchaisri, Wilai; Watanabe, Toru; Honda, Ryo; Chiemchaisri, Chart

    2018-03-01

    This study surveyed the hospital wastewater characters focusing on antibiotic contamination in seven hospitals in Bangkok. It detected 19 antibiotics of which the high-frequent detection were quinolones such as ofloxacin + levofloxacin, norfloxacin, ciprofloxacin including sulfamethoxazole. Norfloxacin and ciprofloxacin appeared the highest concentrations of 12.11 and 9.60 μg/L, respectively. Most antibiotic concentrations in the wastewaters of the studied hospitals gave a good correlation (r 2  = 0.77-0.99) to the amount of usage. In this study, batch acute toxicity tests were performed to assess the toxicity of hospital wastewater on mixed liquor, freshwater algae (Chlorella vulgaris and Scenedesmus quadricauda), and microcrustacean (Moina macrocopa). The hospital wastewaters could inhibit the mixed liquor growth and gave similar toxic levels among test species: algae and microcrustacean (9.81-13.63 and 2.62-3.09 TU, respectively). The conventional activated sludge (CAS) and rotating biological contactor (RBC) could remove fluoroquinolones and tetracycline via biomass adsorption. After treatment, most of treatment could reduce the toxicity. Nevertheless, the effluent gave slight toxicity on some test species which might be caused from chlorination and a common toxicant (NH 3 -N).

  6. Assessments for High Dose Radionuclide Therapy Treatment Planning

    International Nuclear Information System (INIS)

    Fisher, Darrell R.

    2003-10-01

    Advances in the biotechnology of cell-specific targeting of cancer, and the increased number of clinical trials involving treatment of cancer patients with radiolabeled antibodies, peptides, and similar delivery vehicles have led to an increase in the number of high-dose radionuclide therapy procedures. Optimized radionuclide therapy for cancer treatment is based on the concept of absorbed dose to the dose-limiting normal organ or tissue. The limiting normal tissue is often the red marrow, but it may sometimes be lungs, liver, intestinal tract, or kidneys. Appropriate treatment planning requires assessment of radiation dose to several internal organs and tissues, and usually involves biodistribution studies in the patient using a tracer amount of radionuclide bound to the targeting agent and imaged at sequential time points using a planar gamma camera. Time-activity curves are developed from the imaging data for the major organs tissues of concern, for the whole body, and sometimes for selected tumors. Patient-specific factors often require that dose estimates be customized for each patient. The Food and Drug Administration regulates the experimental use of investigational new drugs and requires reasonable calculation of radiation absorbed dose to the whole body and to critical organs using methods prescribed by the Medical Internal Radiation Dose (MIRD) Committee of the Society of Nuclear Medicine. Review of high-dose studies in the U.S. and elsewhere shows that (1) some studies are conducted with minimal dosimetry, (2) the marrow dose is difficult to establish and is subject to large uncertainties, and (3) despite the general availability of MIRD software, internal dosimetry methods are often inconsistent from one clinical center to another

  7. Assessing fly ash treatment: Remediation and stabilization of heavy metals

    DEFF Research Database (Denmark)

    Lima, A.T.; Ottosen, Lisbeth M.; Ribeiro, Alexandra B.

    2012-01-01

    Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through the electrodialy......Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through...... the electrodialytic process (EDR) has been tried out before. The goal of removing heavy metals has always been the reuse of fly ash, for instance in agricultural fields (BEK). The best removal rates are here summarized and some new results have been added. MSW fly ashes are still too hazardous after treatment to even...... consider application to the soil. ST ash is the only residue that gets concentrations low enough to be reused, but its fertilizing value might be questioned. An alternative reuse for the three ashes is here preliminary tested, the combination of fly ash with mortar. Fly ashes have been substituted...

  8. [Alcohol consumption in patients with psychiatric disorders: assessment and treatment].

    Science.gov (United States)

    Lang, J-P; Bonnewitz, M-L; Kusterer, M; Lalanne-Tongio, L

    2014-09-01

    Alcohol consumption in France exceeds the European average (12.7L of pure alcohol/habitant/year in 2009 for an average of 12.5 L). This consumption has a major professional, social and health impact on the individuals and their families. The cost of such, estimated in Europe to be of 155.8 billion Euros in 2010, is the highest among the central nervous system diseases in Europe, far higher than that of depression or dementia. Patients suffering from psychiatric disorders are more frequently affected by problems related to alcohol use than the general population. They are also more vulnerable to the immediate and subsequent consequences of their consumption. The alcohol related disorders that are often accompanied by risk taking and other addictive behaviour require a global assessment of the addiction, with and without substance, and of the complications. These have a strong impact on risk taking, compliance with care, and the morbidity of somatic and psychiatric disorders, as well as access to optimal care and the life span of patients suffering from psychiatric disorders. The development of addictology care, with integrative treatment programs, is recommended in response to these public health issues. Nevertheless, specific addictology practices and partners with addictology care structures are still scarcely developed in psychiatry. Firstly, it would be necessary to set up such integrated treatments through the systematisation of an "addictology" checkup on admission, a global assessment of addictive behaviour and cognitive disorders, using pragmatic tools that are user-friendly for the care teams, maintain the reduction in risk taking, and apply prescriptions for addiction to psychotropic treatments, in liaison with the referring general practitioner. As early as possible, accompanied by specific training in addictology for the psychiatrists and the mental health nursing teams, such care could be enhanced by the development of liaison and advanced psychiatric

  9. Thermal sludge treatment. Pilot project on the possibilities and marginal conditions; Thermische slibontsluiting. Pilot-onderzoek naar de mogelijkheden en randvoorwaarden

    Energy Technology Data Exchange (ETDEWEB)

    Berkhof, D.; Koornneef, E.; Janus, H. [Royal Haskoning DHV, Amersfoort (Netherlands)

    2012-09-15

    As part of the agreements within the framework of the Dutch Green Deal between Water Boards and the Ministry of Economic Affairs, Agriculture and Innovation (ELI) a research program has been set up which addresses the implementation of new developments that can improve energy efficiency in the treatment of waste water. Attention is paid to supercritical gasification, supercritical oxidation and conventional gasification. The study on conventional gasification is split into two phases: research into the economic feasibility in combination with TDH (thermal pressure hydrolysis) and drying, and next to that a pilot plant. This report concerns phase 2: pilot projects on thermal sewage treatment [Dutch] Als onderdeel van de afspraken in het kader van de Green Deal tussen Waterschappen en het ministerie van ELI is een onderzoeksprogramma opgesteld gericht op het implementeren van nieuwe ontwikkelingen die de energie efficientie bij de verwerking van afvalwater kunnen verbeteren. Daarbij wordt gekeken naar superkritische vergassing en oxidatie en naar conventionele vergassing. De studie naar conventionele vergassing is gesplitst in 2 fasen: onderzoek naar de economische haalbaarheid in combinatie met TDH (thermische druk hydrolyse), en drogen en daarnaast een onderzoek op pilot plant/praktijkschaal. In de onderhavige rapportage wordt fase 2, het onderzoek op pilot plant/praktijkschaal naar thermische slibontsluiting (TSO) beschreven.

  10. Assessment of the efficacy of desmopressin in treatment of Primary ...

    African Journals Online (AJOL)

    Farida ElBaz

    2015-03-31

    , detrusor muscle overactivity at night and lack of arousal from sleep, led to the proposal of various lines of treatment such as behavioral treatment, medical treatment like imipramine, oxybutynin, alarm therapy, hypnosis and.

  11. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system.

    Science.gov (United States)

    Djeu, Garret; Shelton, Clarence; Maganzini, Anthony

    2005-09-01

    This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. The objective grading system (OGS) was used to systematically grade posttreatment records. Statistical analyses evaluated treatment outcome, duration, and strengths and weaknesses of Invisalign compared with braces. The Invisalign group lost 13 OGS points more than the braces group on average, and the OGS passing rate for Invisalign was 27% lower than that for braces. Invisalign scores were consistently lower than braces scores for buccolingual inclination, occlusal contacts, occlusal relationships, and overjet. Invisalign's OGS scores were negatively correlated to initial overjet, occlusion, and buccal posterior crossibite. Invisalign patients finished 4 months sooner than those with fixed appliances on average. P Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights. This study might help clinicians to determine which patients are best suited for Invisalign treatment.

  12. Marginally Stable Nuclear Burning

    Science.gov (United States)

    Strohmayer, Tod E.; Altamirano, D.

    2012-01-01

    Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high- inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi- periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.

  13. Margins for geometric uncertainty around organs at risk in radiotherapy

    NARCIS (Netherlands)

    McKenzie, Alan; van Herk, Marcel; Mijnheer, Ben

    2002-01-01

    BACKGROUND AND PURPOSE: ICRU Report 62 suggests drawing margins around organs at risk (ORs) to produce planning organ at risk volumes (PRVs) to account for geometric uncertainty in the radiotherapy treatment process. This paper proposes an algorithm for drawing such margins, and compares the

  14. Cold plasma treatment in wound care: efficacy and risk assessment

    Science.gov (United States)

    Stoffels, Eva

    2007-10-01

    Cold atmospheric plasma is an ideal medium for non-destructive modification of vulnerable surfaces. One of the most promising medical applications of cold plasma treatment is wound healing. Potential advantages in wound healing have been demonstrated in vitro: the plasma does not necrotize the cells and does not affect the extracellular matrix [1], has clear bactericidal or bacteriostatic effects [2], and stimulates fibroblast cells towards faster attachment and proliferation [3]. However, safety issues, such as the potential cytotoxicity of the plasma must be clarified prior to clinical implementation. This work comprises the recent facts on sub-lethal plasma effects on mammalian cells, as well as studies on apoptosis induction and quantitative assessment of DNA damage. Fibroblast, smooth muscle and endothelial cells were treated using the standard cold plasma needle [1,2]; intra- and extracellular oxidant levels as well as the influence of the plasma on intracellular antioxidant balance were monitored using appropriate fluorescent markers [1]. We have studied long-term cellular damage was monitored using flow cytometry to determine the DNA profiles in treated cells. Dose-response curves were obtained: increased proliferation as well as apoptosis were visualized under different treatment conditions. The results from the in vitro studies are satisfying. [1] I.E. Kieft, ``Plasma needle: exploring biomedical applications of non-thermal plasmas'', PhD Thesis, Eindhoven University of Technology (2005). [2] R.E.J. Sladek, ``Plasma needle: non-thermal atmospheric plasmas in dentistry'' PhD Thesis, Eindhoven University of Technology (2006). [3] I.E. Kieft, D. Darios, A.J.M. Roks, E. Stoffels, IEEE Trans. Plasma Sci. 34(4), 2006, pp. 1331-1336.

  15. Methodological issues in randomized trials assessing probiotics for periodontal treatment.

    Science.gov (United States)

    Dhingra, K

    2012-02-01

    Probiotics traditionally used in medicine field are now being used in an attempt to control and treat periodontal disease. However, the trials used to analyze the effects of probiotics have been subject to methodological criticism. The aim of this review was to assess the methodological deficiencies in randomized controlled trials evaluating the efficacy and safety of oral administration of probiotics for the treatment of periodontal disease. A manual and electronic literature search (of MEDLINE and The Cochrane Library) was made, to March 2011, for randomized controlled trials presenting clinical, microbiological, immunological and patient-centered data for the efficacy of probiotics compared with a placebo/standard periodontal therapy for the treatment of periodontal disease. The literature search yielded only four randomized double-blind, placebo-controlled studies that evaluated the efficacy of probiotics (using Lactobacillus reuteri and Lactobacillus salivarius probiotic strains) in patients with gingivitis. The studies were too methodologically flawed (of mediocre quality) with a high risk of bias for any meaningful conclusions to be reached. These studies lacked adequate descriptions of appropriate randomization, allocation concealment, blinding, formulation and dosage of probiotic and placebo, extent and severity of periodontal disease in patient populations, patient-centered outcomes, results data and potential confounding factors. The existing randomized controlled trials have important methodological limitations; consequently, there is insufficient evidence to support the efficacy of probiotics in treating periodontal disease. More rigorous scientific research, in accordance with existing guidelines and research recommendations of the present review, is required to examine the safety and efficacy of probiotics before they are embraced in periodontal therapy. © 2011 John Wiley & Sons A/S.

  16. Analysis of indirect treatment comparisons in national health technology assessment assessments and requirements for industry submissions.

    Science.gov (United States)

    Es-Skali, Ischa J; Spoors, John

    2018-03-28

    To determine the preferred methodologies of health technology assessment (HTA) agencies across Europe, Canada and Australia to ascertain acceptance of indirect treatment comparisons (ITC) as a source of comparative evidence. A review of official submission guidelines and analysis of comments in HTA submissions that have used different ITC methodologies. ITC is generally accepted as a technique that allows demonstration of noninferiority to a comparator provided the chosen methodology and underlying assumptions are clear and justified. However, HTA agencies are more likely to closely scrutinize submitted data and evaluate statistical significance of results when superiority is claimed. In addition, the HTA agencies in scope tended to be cautious and only accept ITC data as support for similarity of treatments.

  17. Assessment and treatment relevance in elderly glioblastoma patients.

    Science.gov (United States)

    Bauchet, Luc; Zouaoui, Sonia; Darlix, Amélie; Menjot de Champfleur, Nicolas; Ferreira, Ernestine; Fabbro, Michel; Kerr, Christine; Taillandier, Luc

    2014-11-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and "standards of care" do not exist for GBM patients aged >70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy. © The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Toxicological assessment of polyhexamethylene biguanide for water treatment

    Directory of Open Access Journals (Sweden)

    Asiedu-Gyekye Isaac J.

    2015-12-01

    Full Text Available Polyhexamethylene biguanide (PHMB is an antiseptic with antiviral and antibacterial properties used in a variety of products including wound care dressings, contact lens cleaning solutions, perioperative cleansing products, and swimming pool cleaners. There are regulatory concerns with regard to its safety in humans for water treatment. We decided to assess the safety of this chemical in Sprague-Dawley rats. PHMB was administered in a single dose by gavage via a stomach tube as per the manufacturer’s instruction within a dose range of 2 mg/kg to 40 mg/kg. Subchronic toxicity studies were also conducted at doses of 2 mg/kg, 8 mg/kg and 32 mg/kg body weight and hematological, biochemical and histopathological findings of the major organs were assessed. Administration of a dose of 25.6 mg/kg, i.e. 1.6 mL of 0.4% PHMB solution (equivalent to 6.4×103 mg/L of 0.1% solution resulted in 50% mortality. Histopathological analysis in the acute toxicity studies showed that no histopathological lesions were observed in the heart and kidney samples but 30% of the animals had mild hydropic changes in zone 1 of their liver samples, while at a dosage of 32 mg/kg in the subchronic toxicity studies, 50% of the animals showed either mild hepatocyte cytolysis with or without lymphocyte infiltration and feathery degeneration. Lymphocyte infiltration was, for the first time, observed in one heart sample, whereas one kidney sample showed mild tubular damage. The acute studies showed that the median lethal dose (LD50 is 25.6 mg/kg (LC50 of 1.6 mL of 0.4% PHMB. Subchronic toxicological studies also revealed few deleterious effects on the internal organs examined, as seen from the results of the biochemical parameters evaluated. These results have implications for the use of PHMB to make water potable.

  19. Radiological Risk Assessment for King County Wastewater Treatment Division

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Daniel J.

    2005-08-05

    Staff of the King County Wastewater Treatment Division (WTD) have concern about the aftermath of a radiological dispersion event (RDE) leading to the introduction of significant quantities of radioactive material into the combined sanitary and storm sewer system in King County, Washington. Radioactive material could come from the use of a radiological dispersion device (RDD). RDDs include "dirty bombs" that are not nuclear detonations but are explosives designed to spread radioactive material (National Council on Radiation Protection and Measurements (NCRP) 2001). Radioactive material also could come from deliberate introduction or dispersion of radioactive material into the environment, including waterways and water supply systems. This document develops plausible and/or likely scenarios, including the identification of likely radioactive materials and quantities of those radioactive materials to be involved. These include 60Co, 90Sr, 137Cs, 192Ir, 226Ra, plutonium, and 241Am. Two broad categories of scenarios are considered. The first category includes events that may be suspected from the outset, such as an explosion of a "dirty bomb" in downtown Seattle. The explosion would most likely be heard, but the type of explosion (e.g., sewer methane gas or RDD) may not be immediately known. Emergency first responders must be able to quickly detect the radioisotopes previously listed, assess the situation, and deploy a response to contain and mitigate (if possible) detrimental effects resulting from the incident. In such scenarios, advance notice of about an hour or two might be available before any contaminated wastewater reaches a treatment plant. The second category includes events that could go initially undetected by emergency personnel. Examples of such a scenario would be the inadvertent or surreptitious introduction of radioactive material into the sewer system. Intact rogue radioactive sources from industrial radiography devices, well-logging apparatus, or

  20. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Directory of Open Access Journals (Sweden)

    Vargaonkar Gauresh

    2014-07-01

    Full Text Available 【Abstract】Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist, increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner. The purpose of our study was to evaluate the difference in patients function among those treated by 1 closed reduction and Plaster of Paris cast, 2 distractor application, or 3 open reduction and internal fixation with a volar plate, and to assess the treatment choice for each particular fracture type. Methods: A prospective study was carried out on 60 patients with fractures of the distal end radius. Fractures were classified according to the AO classification into type A (extra-articular, type B (partial articular and type C (complete articular. After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years. Results: Anatomical results were evaluated according to the Sarmiento’s modification of Lindstrom Criteria, which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique. Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification, which was revealed to relate with the type of treatment techniques. Conclusion: There is no customized solution for all the fractures of the distal radius. The choice of treatment should be based on the fracture type, the patient’s characteristics, the patient’s demands and the treating surgeon’s experience and preference. Key words: Distal end radius fractures; Volar plate; Radial orthofix

  1. Assessing fly ash treatment: Remediation and stabilization of heavy metals

    KAUST Repository

    Lima, A.T.

    2010-12-17

    Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through the electrodialytic process (EDR) has been tried out before. The goal of removing heavy metals has always been the reuse of fly ash, for instance in agricultural fields (BEK). The best removal rates are here summarized and some new results have been added. MSW fly ashes are still too hazardous after treatment to even consider application to the soil. ST ash is the only residue that gets concentrations low enough to be reused, but its fertilizing value might be questioned. An alternative reuse for the three ashes is here preliminary tested, the combination of fly ash with mortar. Fly ashes have been substituted by cement fraction or aggregate fraction. Surprisingly, better compressive strengths were obtained by replacing the aggregate fraction. CW ashes presented promising results for the substitution of aggregate in mortar and possibly in concrete. © 2010 Elsevier Ltd.

  2. Assessing fly ash treatment: remediation and stabilization of heavy metals.

    Science.gov (United States)

    Lima, A T; Ottosen, Lisbeth M; Ribeiro, Alexandra B

    2012-03-01

    Fly ashes from Municipal Solid Waste (MSW), straw (ST) and co-combustion of wood (CW) are here analyzed with the intent of reusing them. Two techniques are assessed, a remediation technique and a solidification/stabilization one. The removal of heavy metals from fly ashes through the electrodialytic process (EDR) has been tried out before. The goal of removing heavy metals has always been the reuse of fly ash, for instance in agricultural fields (BEK). The best removal rates are here summarized and some new results have been added. MSW fly ashes are still too hazardous after treatment to even consider application to the soil. ST ash is the only residue that gets concentrations low enough to be reused, but its fertilizing value might be questioned. An alternative reuse for the three ashes is here preliminary tested, the combination of fly ash with mortar. Fly ashes have been substituted by cement fraction or aggregate fraction. Surprisingly, better compressive strengths were obtained by replacing the aggregate fraction. CW ashes presented promising results for the substitution of aggregate in mortar and possibly in concrete. Copyright © 2010 Elsevier Ltd. All rights reserved.

  3. The Need for Consensus and Transparency in Assessing Population-Based Rates of Positive Circumferential Radial Margins in Rectal Cancer: Data from Consecutive Cases in a Large Region of Ontario, Canada.

    Science.gov (United States)

    Keng, Christine; Coates, Angela; Grubac, Vanja; Lovrics, Peter; DeNardi, Franco; Thabane, Lehana; Simunovic, Marko

    2016-02-01

    A positive circumferential radial margin (CRM) after rectal cancer surgery is an important predictor of local recurrence. The definition of a positive CRM differs internationally, and reported rates vary greatly in the literature. This study used time-series population-based data to assess positive CRM rates in a region over time and to inform future methods of CRM analysis in a defined geographic area. Chart reviews provided relevant data from consecutive patients undergoing rectal cancer surgery between 2006 and 2012 in all hospitals of the authors' region. Outcomes included rates for pathologic examination of CRM, CRM distance reporting, and positive CRM. The rate of positive CRM was calculated using various definitions. The variations included positive margin cutoffs of CRM at 1 mm or less versus 2 mm or less and inclusion or exclusion of cases without CRM assessment. In this study, 1222 consecutive rectal cancer cases were analyzed. The rate for pathology reporting of CRM distance increased from 54.7 to 93.2 % during the study. Depending on how the rate of positive CRM was defined, its value varied 8.5 to 19.4 % in 2006 and 6.0 to 12.5 % in 2012. Using a pre-specified definition, the rate of positive CRM decreased over time from 14.0 to 6.3 %. A marked increase in CRM distance reporting was observed, whereas the rates of positive CRM dropped, suggesting improved pathologist and surgeon performance over time. Changing definitions greatly influenced the rates of positive CRM, indicating the need for more transparency when such population-based rates are reported in the literature.

  4. On probabilistically defined margins in radiation therapy

    International Nuclear Information System (INIS)

    Papiez, Lech; Langer, Mark

    2006-01-01

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  5. On probabilistically defined margins in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Papiez, Lech; Langer, Mark [Department of Radiation Oncology, Indiana University, Indianapolis, IN (United States)

    2006-08-21

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  6. Assessment of Marginal Peri-implant Bone-Level Short-Length Implants Compared with Standard Implants Supporting Single Crowns in a Controlled Clinical Trial: 12-Month Follow-up.

    Science.gov (United States)

    Mendoza-Azpur, Gerardo; Lau, Miguel; Valdivia, Erick; Rojas, Jorge; Muñoz, Henry; Nevins, Myron

    In oral rehabilitation, crown-to-root ratio is accepted as an indicator of bone loss, and this concept was transferred to implants. Recent studies have indicated that there is no significant difference between short and standard implants. The aim of this study was to compare marginal bone-level alteration through radiographic evaluation and clinical parameters between short and standard implants supporting single crowns. This prospective clinical trial study included 82 systemically healthy, nonsmoking subjects. Patients were divided into two groups: one group for short dental implants measuring 5.5 or 7 mm, and one group for standard dental implants measuring 10 or 12 mm, in accordance with the individual needs of the patient. A clinical dental history was taken for each subject, including model casts, dental radiography, and cone beam computed tomography. A periapical analysis was also performed using ImageJ computer software to establish the initial bone measurement and periapical bone loss. A statistically significant difference was found in favor of the standard-length implants after 12 months, with greater gingival recession around the implant; however, bone loss in the short implants did not exceed 0.53 mm. The treatment with 5.5- to 7-mm-length implants is as reliable as treatment with 10- or 12-mm implants. Peri-implant bone loss is minimal, and therefore use of short implants can be recommended as treatment for the restoration of partially edentulous patients without the need for splinted crowns.

  7. Prospective environmental risk assessment of mixtures in wastewater treatment plant effluents - Theoretical considerations and experimental verification.

    Science.gov (United States)

    Coors, Anja; Vollmar, Pia; Sacher, Frank; Polleichtner, Christian; Hassold, Enken; Gildemeister, Daniela; Kühnen, Ute

    2018-04-14

    The aquatic environment is continually exposed to a complex mixture of chemicals, whereby effluents of wastewater treatment plants (WWTPs) are one key source. The aim of the present study was to investigate whether environmental risk assessments (ERAs) addressing individual substances are sufficiently protective for such coincidental mixtures. Based on a literature review of chemicals reported to occur in municipal WWTP effluents and mode-of-action considerations, four different types of mixtures were composed containing human pharmaceuticals, pesticides, and chemicals regulated under REACH. The experimentally determined chronic aquatic toxicity of these mixtures towards primary producers and the invertebrate Daphnia magna could be adequately predicted by the concept of concentration addition, with up to 5-fold overestimation and less than 3-fold underestimation of mixture toxicity. Effluents of a municipal WWTP had no impact on the predictability of mixture toxicity and showed no adverse effects on the test organisms. Predictive ERAs for the individual mixture components based on here derived predicted no effect concentrations (PNECs) and median measured concentrations in WWTP effluents (MC eff ) indicated no unacceptable risk for any of the individual chemicals, while MC eff /PNEC summation indicated a possible risk for multi-component mixtures. However, a refined mixture assessment based on the sum of toxic units at species level indicated no unacceptable risks, and allowed for a safety margin of more than factor 10, not taking into account any dilution of WWTP effluents by surface waters. Individual substances, namely climbazole, fenofibric acid and fluoxetine, were dominating the risks of the investigated mixtures, while added risk due to the mixture was found to be low with the risk quotient being increased by less than factor 2. Yet, uncertainty remains regarding chronic mixture toxicity in fish, which was not included in the present study. The number and

  8. Assessment and Treatment of Personality Disorders: A Behavioral Perspective

    Science.gov (United States)

    Nelson-Gray, Rosemery O.; Lootens, Christopher M.; Mitchell, John T.; Robertson, Christopher D.; Hundt, Natalie E.; Kimbrel, Nathan A.

    2009-01-01

    Personality disorders are complex and highly challenging to treatment providers; yet, for clients with these problems, there exist very few treatment options that have been supported by research. Given the lack of empirically-supported therapies for personality disorders, it can be difficult to make treatment decisions for this population. The…

  9. In vitro evaluation of marginal microleakage in class V restorations with composite resin in bovine teeth. Laser irradiation influences and the adhesive system in the dentin pre-treatment; Avaliacao in vitro da microinfiltracao marginal em restauracoes de classe V com resina composta em dentes bovinos. Influencia da irradiacao laser e sistema adesivo no pre-tratamento dentinario

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho, Wendell Lima de

    2003-07-01

    Microleakage is one of the most important reasons to restorations failure, it is the responsible for marginal colors changing, new caries, hipersensibility and pulpar diseases. Several techniques and materials have been studied to eliminate or, at least, to decrease microleakage. The cavities preparation with Er:YAG laser and autoconditioning adhesive are some of these techniques and materials. This research has the objective to compare, in vitro, microleakage in class V cavities, prepared with high rotation (conventional treatment), Er:YAG laser (Enamel-400 mj/2 Hz/128,38 J/Cm{sup 2}, Dentin 250 mJ/ 2 Hz/ 80,24 J/Cm{sup 2}) and the treatment made at dentin with autoconditioning adhesive (Clerafil SE Bond) using Er:YAG laser (with water or not water) or not using Er:YAG laser. It was used 48 bovines teeth with cavities prepared in vestibular face and gingival wall on cement enamel junction and oclusal wall on enamel. The materials used were autoconditioning adhesive (Clerafil SE Bond) and composite resin Z250. Teeth were divided into four groups of twelve samples each one, according to dentin treatment. Group 1 - Conventional cavity and autoconditioning adhesive. Group 2- Cavity prepared with Er: YAG laser and autoconditioning adhesive. Group 3 - Cavity prepared with Er:YAG laser and dentin conditioning with Er:YAG laser associated to water and autoconditioning adhesive. Group 4 - Cavity prepared with Er:YAG laser and dentin conditioning with Er: YAG laser without water and associated to autoconditioning adhesive. Teeth were restored and stocked at 37 deg C, thermocycled and placed into a 50% silver nitrate solution. Right after, teeth were sliced and evaluated on a stereo microscopic magnifying glass in order to see microleakage degree trying to follow a score from 0 to 3. The findings were submitted to Fisher, Anderson-Darling tests and to the not parametric Sen and Puri test. The results indicated that in gingival edge, the Group 2 showed less microleakage than

  10. Feasibility assessment of electrocoagulation towards a new sustainable wastewater treatment.

    Science.gov (United States)

    Rodriguez, Jackson; Stopić, Srećko; Krause, Gregor; Friedrich, Bernd

    2007-11-01

    Electrocoagulation (EC) may be a potential answer to environmental problems dealing with water reuse and rational waste management. The aim of this research was to assess the feasibility of EC-process for industrial contaminated effluents from copper production, taking into consideration technical and economical factors. EC-technology claims to offer efficient removal rates for most types of wastewater impurities at low power consumption and without adding any precipitating agents. Real wastewater from Saraka stream with high concentrations of heavy metals was provided by RTB-BOR, a Serbian copper mining and smelting complex. Runs were performed on a 10 l EC-reactor using aluminum plates as sacrificial electrodes and powered by a 40 A supply unit. Results concerning key factors like pH, conductivity and power consumption were measured in real time. Analysis of dissolved metal concentrations before and after treatment were carried out via ICP-OES and confirmed by an independent test via AAS. Several aspects were taken into account, including current density, conductivity, interfacial resistivity and reactor settings throughout the runs, in order to analyze all possible factors playing a role in neutralization and metal removal in real industrial wastewater. Electrode configurations and their effects on energy demand were discussed and exemplified based on fundamentals of colloidal and physical chemistry. Based on experimental data and since no precipitating agents were applied, the EC-process proved to be not only feasible and environmentally-friendly, but also a cost-effective technology The EC-technology provides strategic guidelines for further research and development of sustainable water management processes. However, additional test series concerning continuous operation must be still performed in order to get this concept ready for future large-scale applications.

  11. Evaluation of errors set-up and setting margins calculation in treatments 3-D conformal radiotherapy; Evaluacion de errores de set-up y calculo de margenes de configuracion en tratamientos de radioterapia CONFORMADA 3-D

    Energy Technology Data Exchange (ETDEWEB)

    Donis, S.; Robayna, B.; Gonzalez, A.; Hernandez Armas, J.

    2011-07-01

    The use of IGRT techniques provide knowledge of the mistakes made in the positioning of a patient, to population studies and estimate the margins for each population.In this paper we evaluate the errors of set-up in 3 different locations and from these margins are calculated configuration (SM).

  12. A gene signature in histologically normal surgical margins is predictive of oral carcinoma recurrence

    International Nuclear Information System (INIS)

    Reis, Patricia P; Simpson, Colleen; Goldstein, David; Brown, Dale; Gilbert, Ralph; Gullane, Patrick; Irish, Jonathan; Jurisica, Igor; Kamel-Reid, Suzanne; Waldron, Levi; Perez-Ordonez, Bayardo; Pintilie, Melania; Galloni, Natalie Naranjo; Xuan, Yali; Cervigne, Nilva K; Warner, Giles C; Makitie, Antti A

    2011-01-01

    Oral Squamous Cell Carcinoma (OSCC) is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence. We used a meta-analysis of 199 samples (OSCCs and normal oral tissues) from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients. We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01) in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Over-expression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test) and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test). Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence

  13. Pulmonary marginal zone B-cell lymphoma of MALT type--what is a prognostic factor and which is the optimal treatment, operation, or chemotherapy?: Consortium for Improving Survival of Lymphoma (CISL) study.

    Science.gov (United States)

    Oh, Sung Yong; Kim, Won Seog; Kim, Jin Seok; Kim, Seok Jin; Kwon, Hyuk-Chan; Lee, Dae Ho; Won, Jong Ho; Hwang, In Gyu; Kim, Min Kyoung; Lee, Soon Il; Chae, Yee Soo; Yang, Deok-Hwan; Lee, Gyeong-Won; Choi, Chul Won; Park, Jinny; Suh, Cheolwon; Kim, Hyo-Jin

    2010-06-01

    Pulmonary marginal zone B-cell lymphoma of the MALT type (P-MZL) is a relatively rare form of lymphoma. We conducted a retrospective analysis of the clinical features and treatment outcomes of P-MZL for the evaluation of prognostic factors, and to collect information about the optimal treatment modality for this condition. From 1991 to 2008, a total of 61 patients with biopsy-confirmed P-MZL were retrospectively analyzed. The median age of our subjects was 60 (range, 34-79) years. Twenty-five of the patients (41%) were initially diagnosed without any symptoms. Video-assisted thoracic surgery was utilized for diagnosis in 19 patients (31%). Thirty-eight patients' conditions (62%) involved a single lobe. Lung lesions were bilateral in 15 patients (25%). Eleven patients evidenced synchronous involvement of extra-pulmonary site MZL. Overall, 56 of 61 patients were treated with surgery (n = 22), chemotherapy (n = 28), or radiotherapy (n = 6). Among them, 46 patients achieved complete or partial remission. The median time to progression (TTP) was 5.6 (95% CI, 2.6-8.6) years. Five patients died during follow-up. Extra-pulmonary MZL and LN involvement were shown to be poor prognostic factors for TTP. We noted no differences between the operation group and chemotherapy group in terms of TTP. P-MZL tends to be an indolent disease-characterized by prolonged survival with frequent relapses. This is similar to what is observed with other cases of MALT-type site MZL. In order to conserve lung function and reduce the risks of operation, chemotherapy should be considered as a first-line option for the treatment of P-MZL.

  14. Seismic Safety Margins Research Program, Phase I. Project II: seismic input. Compilation, assessment and expansion of the strong earthquake ground motion data base

    Energy Technology Data Exchange (ETDEWEB)

    Crouse, C B; Hileman, J A; Turner, B E; Martin, G R

    1980-04-01

    A catalog has been prepared which contains information for: (1) world-wide, ground-motion accelerograms, (2) the accelerograph sites where these records were obtained, and (3) the seismological parameters of the causative earthquakes. The catalog is limited to data for those accelerograms which have been digitized and published. In addition, the quality and completeness of these data are assessed. This catalog is unique because it is the only publication which contains comprehensive information on the recording conditions of all known digitized accelerograms. However, information for many accelerograms is missing. Although some literature may have been overlooked, most of the missing data has not been published. Nevertheless, the catalog provides a convenient reference and useful tool for earthquake engineering research and applications.

  15. Cooperation and Competition: The Comparative Assessment of Tribal Dynamics in the Marginal Landscapes of the Wadi el-Hasa, in west-central Jordan in the Early Bronze and Iron ages

    Directory of Open Access Journals (Sweden)

    Bulent Arikan

    2011-12-01

    Full Text Available The issue of emergent social complexity has long been debated in the anthropological literature. In the eastern Mediterranean context, the archaeological discussions of social complexity focused largely on societies that showed centralized administration, hierarchic social formations, and large urban centers in temperate parts of the region. For the marginal landscapes in the eastern Mediterranean, such as semi-desert regions, scholars have long denied social complexity on the basis of lack of attributes listed in traditional frameworks of complexity. Recently however, alternate models of complexity have been developed for tribal societies following heterarchy and corporate mode of complexity. In these models, the concepts of group fusion (i.e., cooperation and fission (i.e., competition have significant roles and they need to be examined in more detail, especially about how we can identify these group dynamics in the archaeological record, specifically in the settlement systems. This article focuses on the Early Bronze I-III (ca. 3,500-2,400 BC and the Iron Age (ca. 1,200-500 BC of the Wadi el-Hasa, in west-central Jordan, for the evolution of settlement systems as a result of tribal cooperation/competition strategies and the emergence of long-distance trade, which allowed tribes not only to thrive economically but also gain political significance in a marginal landscape in the southern Levant. The use of relatively new analytical methods in archaeology, such as the geographical information systems, for assessing temporal changes in spatial distribution of sites, identifying trade routes, determining the impacts of long-distance trade and other socio-political events in the region on the settlement systems of the Hasa has been discussed.

  16. Workers' marginal costs of commuting

    DEFF Research Database (Denmark)

    van Ommeren, Jos; Fosgerau, Mogens

    2009-01-01

    This paper applies a dynamic search model to estimate workers' marginal costs of commuting, including monetary and time costs. Using data on workers' job search activity as well as moving behaviour, for the Netherlands, we provide evidence that, on average, workers' marginal costs of one hour...

  17. Assessement of Modalities for Treatment of Otorrhoea in Active ...

    African Journals Online (AJOL)

    Objective: To compare the efficacy of various modalities of treatment of Otorrhoea in simple chronic suppurative otitis media (CSOM) at the ENT unit of Jos University Teaching Hospital. Method: Patients with uncomplicated CSOM were randomly assigned to 4 groups for treatment. A: Aural toilet alone. B: Aural toilet and mild ...

  18. Outcome of wide local excision in dermatofibrosarcoma protuberans and use of radiotherapy for margin-positive disease

    Directory of Open Access Journals (Sweden)

    Raashid Hamid

    2013-01-01

    Full Text Available Purpose: Wide local excision (WLE is the preferred treatment of dermatofibrosarcoma protuberans (DFSP. The aim is to achieve negtive margins. We followed the impact of radiotherapy used postoperatively for both margin-negative and margin-positive DFSP tumors. Materials and Methods: Outcome of treatment of 36 patients of DFSP treated at our hospital was assessed. Thirty patients received radiotherapy postoperatively and six patients received radiotherapy alone. The maximum dimension of the lesion was 15 cm 2 . Patients were followed up for varying periods of time for any recurrence. Results: 10-year actuarial local control rate was determined. Local control was realized in six patients who were treated with radiotherapy alone. 30 patients were treated by radiotherapy and surgery. Out of these 30 patients, there were 6 local failures (failure rate 10%. Actuarial control rate was 82%. The failures were among patients who had positive margins. Conclusion: Radiotherapy is effective, and it decreases the recurrence rate in the treatment of DFSP. It is especially helpful in margin-positive disease. This appears true for patients treated with radiotherapy alone or radiotherapy used postoperatively.

  19. Systematic approach to the treatment of crude oil produced by small concessionaires in marginal areas of the Reconcavo Basin; Abordagem sistematizada para o tratamento do oleo produzido em campos marginais da Bacia do Reconcavo por pequenos concessionarios

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Edson Jorge Alves [Universidade Federal da Bahia (UFBA), Salvador, BA (Brazil). Dept. de Engenharia Quimica; Araujo, Marcia Queiroz de [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Faculdade de Engenharia Quimica; Ferreira, Doneivan Fernandes [Universidade Federal da Bahia (UFBA), Salvador, BA (Brazil). Dept. de Geologia e Geofisica Aplicada

    2008-07-01

    The establishment of the 'Petroleum Law' (Law No. 9.478/97) abolished the Exploration and Production State Monopoly in Brazil. Attaining concessions through the bidding rounds promoted by the Brazilian Petroleum Agency (ANP) became the only legal means for exploring and/or producing oil and natural gas in Brazil. In order to attract small and medium companies to this niche, inactive areas with marginal accumulations were offered by the Agency. These areas were returned to ANP by PETROBRAS. Currently, six small companies operate in the Reconcavo Oil Province, extracting and processing different types of oil. The available infrastructure is mostly deteriorated and obsolete. Additionally, there are serious limitations in the separation and storage capacity. This scenario resulted in the fragmentation of the old PETROBRAS production infrastructure. A possible solution to this problem could involve the establishment of a collective treatment unit which would work as a condominium. However, the operation of this plant must take into account the diversity of oils being produced in the Reconcavo Basin (physical-chemicals characteristics). This paper is aimed at (1) establishing a preliminary characterization of the different types of oil which will be delivered by local producers; (2) the critical variables for the oil model (it includes all oils received from different areas of the Reconcavo); (3) the identification of the main stake holders within this process; and (4) suggestions for operating models for the treatment unit taking into account the potential innovations and opportunities for R and D and spin-offs. (author)

  20. Sustainable biomass production on Marginal Lands (SEEMLA)

    Science.gov (United States)

    Barbera, Federica; Baumgarten, Wibke; Pelikan, Vincent

    2017-04-01

    Sustainable biomass production on Marginal Lands (SEEMLA) The main objective of the H2020 funded EU project SEEMLA (acronym for Sustainable Exploitation of Biomass for Bioenergy from Marginal Lands in Europe) is the establishment of suitable innovative land-use strategies for a sustainable production of plant-based energy on marginal lands while improving general ecosystem services. The use of marginal lands (MagL) could contribute to the mitigation of the fast growing competition between traditional food production and production of renewable bio-resources on arable lands. SEEMLA focuses on the promotion of re-conversion of MagLs for the production of bioenergy through the direct involvement of farmers and forester, the strengthening of local small-scale supply chains, and the promotion of plantations of bioenergy plants on MagLs. Life cycle assessment is performed in order to analyse possible impacts on the environment. A soil quality rating tool is applied to define and classify MagL. Suitable perennial and woody bioenergy crops are selected to be grown in pilot areas in the partner countries Ukraine, Greece and Germany. SEEMLA is expected to contribute to an increasing demand of biomass for bioenergy production in order to meet the 2020 targets and beyond.

  1. Water footprint assessment for wastewater treatment: method, indicator, and application.

    Science.gov (United States)

    Shao, Ling; Chen, G Q

    2013-07-16

    The water footprint in terms of the sum of both direct and indirect water cost of wastewater treatment is for the first time accounted in this work. On the basis of the hybrid method as a combination of process analysis and input-output analysis, a detailed water footprint accounting procedure is provided to cover the supply chain of a wastewater treatment plant. A set of indices intending to reveal the efficiency as well as renewability of wastewater treatment systems are devised as parallels of corresponding indicators in net energy analysis for energy supply systems. A case study is carried out for the Beijing Space City wastewater treatment plant as a landmark project. The high WROI (water return on investment) and low WIWP (water investment in water purified) indicate a high efficiency and renewability of the case system, illustrating the fundamental function of wastewater treatment for water reuse. The increasing of the wastewater and sludge treatment rates are revealed in an urgent need to reduce the water footprint of China and to improve the performance of wastewater treatment.

  2. Current concepts in the assessment and treatment of hepatic encephalopathy.

    LENUS (Irish Health Repository)

    Cash, W J

    2012-02-01

    Hepatic encephalopathy (HE) is defined as a metabolically induced, potentially reversible, functional disturbance of the brain that may occur in acute or chronic liver disease. Standardized nomenclature has been proposed but a standardized approach to the treatment, particularly of persistent, episodic and recurrent encephalopathy associated with liver cirrhosis has not been proposed. This review focuses on the pathogenesis and treatment of HE in patients with cirrhosis. The pathogenesis and treatment of hepatic encephalopathy in fulminant hepatic failure is quite different and is reviewed elsewhere.

  3. Reliability of assessment of adherence to an antimicrobial treatment guideline

    NARCIS (Netherlands)

    Mol, PGM; Gans, ROB; Panday, PVN; Degener, JE; Laseur, M; Haaijer-Ruskamp, FM

    Assessment procedures for adherence to a guideline must be reliable and credible. The aim of this study was to explore the reliability of assessment of adherence, taking account of the professional backgrounds of the observers. A secondary analysis explored the impact of case characteristics on

  4. Realistic respiratory motion margins for external beam partial breast irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Conroy, Leigh; Quirk, Sarah [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Smith, Wendy L., E-mail: wendy.smith@albertahealthservices.ca [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta T2N 4N2 (Canada); Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada); Department of Oncology, University of Calgary, Calgary, Alberta T2N 1N4 (Canada)

    2015-09-15

    Purpose: Respiratory margins for partial breast irradiation (PBI) have been largely based on geometric observations, which may overestimate the margin required for dosimetric coverage. In this study, dosimetric population-based respiratory margins and margin formulas for external beam partial breast irradiation are determined. Methods: Volunteer respiratory data and anterior–posterior (AP) dose profiles from clinical treatment plans of 28 3D conformal radiotherapy (3DCRT) PBI patient plans were used to determine population-based respiratory margins. The peak-to-peak amplitudes (A) of realistic respiratory motion data from healthy volunteers were scaled from A = 1 to 10 mm to create respiratory motion probability density functions. Dose profiles were convolved with the respiratory probability density functions to produce blurred dose profiles accounting for respiratory motion. The required margins were found by measuring the distance between the simulated treatment and original dose profiles at the 95% isodose level. Results: The symmetric dosimetric respiratory margins to cover 90%, 95%, and 100% of the simulated treatment population were 1.5, 2, and 4 mm, respectively. With patient set up at end exhale, the required margins were larger in the anterior direction than the posterior. For respiratory amplitudes less than 5 mm, the population-based margins can be expressed as a fraction of the extent of respiratory motion. The derived formulas in the anterior/posterior directions for 90%, 95%, and 100% simulated population coverage were 0.45A/0.25A, 0.50A/0.30A, and 0.70A/0.40A. The differences in formulas for different population coverage criteria demonstrate that respiratory trace shape and baseline drift characteristics affect individual respiratory margins even for the same average peak-to-peak amplitude. Conclusions: A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was

  5. Continental transform margins : state of art and future milestones

    Science.gov (United States)

    Basile, Christophe

    2010-05-01

    to be emphasized. There is not only one type of transform margins, but as for divergent margins huge changes from one margin to another in both structure and evolution. Multiple types have to be evidenced together with the various parameters that should control the variability. As for divergent margins, special attention should be paid to conjugated transform margins as a tool to assess symmetrical / asymmetrical processes in the oceanic opening. Attention should also be focused on the three-dimensional structure of the intersections between transform and divergent margins, such as the one where the giant oil field Jubilee was recently discovered. There is almost no 3D data available in these area, and their structures still have to be described. An other key point to develop is the mechanical behavior of the lithosphere in and in the vicinity of transform margins. The classical behaviors (isostasy, elastic flexure) have be tested extensively. The localization of the deformation by the transform fault, and the coupling of continental and oceanic lithosphere across the transform fault have to be adressed to understand the evolution of these margins. Again as for divergent margins, new concepts are needed to explain the variations in the post-rift and post-transform subsidence, that can not always be explained by classical subsidence models. But the most remarkable advance in our understanding of transform margins may be related to the study of interactions between the lithosphere and adjacent envelops : deep interactions with the mantle, as underplating, tectonic erosion, or possible lateral crustal flow ; surficial interactions between structural evolution, erosion and sedimentation processes in transform margins may affect the topography and bathymetry, thus the oceanic circulation with possible effects on regional and global climate.

  6. Assessment of didecyldimethylammonium chloride as a ballast water treatment method

    NARCIS (Netherlands)

    van Slooten, Cees; Buma, Anita; Peperzak, Louis

    Ballast water-mediated transfer of aquatic invasive species is considered a major threat to marine biodiversity, marine industry and human health. A ballast water treatment is needed to comply with International Maritime Organization (IMO) ballast water discharge regulations. Didecyldimethylammonium

  7. Assessment of didecyldimethylammonium chloride as a ballast water treatment method

    NARCIS (Netherlands)

    van Slooten, C.; Peperzak, L.; Buma, A.G.J.

    2015-01-01

    Ballast water-mediated transfer of aquatic invasive species is considered a major threat to marine biodiversity, marine industry and human health. A ballast water treatment is needed to comply with International Maritime Organization (IMO) ballast water discharge regulations. Didecyldimethylammonium

  8. Assessment of wastewater treatment plant effluent effects on fish reproduction

    Science.gov (United States)

    Wastewater treatment plant (WWTP) effluents are known contributors of chemical mixtures into the environment. Of particular concern are endocrine-disrupting compounds that can affect hypothalamic-pituitary-gonadal axis function in exposed organisms. The present study examined t...

  9. Assessment and treatment of binge eating in obese patients

    OpenAIRE

    Walmir Ferreira Coutinho

    2006-01-01

    Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED) is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating,...

  10. Margin to CTV in simultaneous irradiation of treatment volumes attache to various anatomical frameworks: The paradigm of the CA. Of prostate in high risk with indication of lymph node irradiation

    International Nuclear Information System (INIS)

    Sanz Freire, C. J.; Perez Echaguen, S.; Collado chamorro, P.; Diaz Pascual, V.; Vazquez Galinanes, A.; Ossola Lentati, G. A.

    2013-01-01

    The triple objective of this work is: 1 check the effect on the positioning of the GGPP of corrections on the position of the prostate in simultaneous irradiation guided through daily image and its relationship with the filling of rectum and bladder 2. check if employees standard margins for CTV GGPP are valid for this technique 3 calculate the necessary extension of the margin to 2. is not verified. (Author)

  11. Life cycle assessment comparing the treatment of surplus activated sludge in a sludge treatment reed bed system with mechanical treatment on centrifuge

    DEFF Research Database (Denmark)

    Larsen, Julie Dam; Hoeve, Marieke ten; Nielsen, Steen

    2018-01-01

    In Denmark, the conventional method for treating sewage sludge is mechanical dewatering and subsequent storage. However, sludge treatment reed bed systems, which are holistic sludge treatment facilities combining the dewatering, mineralisation and storage of sludge, have been more common during...... the last three decades. Treatment of sludge in a sludge treatment reed bed system can be combined with post-treatment (further dewatering and mineralisation) on a stockpile area. This study aimed to compare the environmental performances of a mechanical sludge treatment method with the sludge treatment...... reed bed system strategy, using the life cycle assessment approach and a life cycle inventory based on newly generated data obtained from Danish reference facilities. The scenarios based on the different treatment methods were initiated by sludge entering the sludge treatment reed bed system...

  12. Assessment of the Evolution of Cancer Treatment Therapies

    International Nuclear Information System (INIS)

    Arruebo, Manuel; Vilaboa, Nuria; Sáez-Gutierrez, Berta; Lambea, Julio; Tres, Alejandro; Valladares, Mónica; González-Fernández, África

    2011-01-01

    Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present

  13. Assessment of the Evolution of Cancer Treatment Therapies

    Energy Technology Data Exchange (ETDEWEB)

    Arruebo, Manuel [Instituto de Nanociencia de Aragón (INA), Mariano Esquillor, Edif. I+D, University of Zaragoza, Zaragoza 50018 (Spain); CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza 50018 (Spain); Vilaboa, Nuria [CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza 50018 (Spain); Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 (Spain); Sáez-Gutierrez, Berta; Lambea, Julio; Tres, Alejandro [Instituto de Nanociencia de Aragón (INA), Mariano Esquillor, Edif. I+D, University of Zaragoza, Zaragoza 50018 (Spain); Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco 50009, Zaragoza (Spain); Instituto Aragonés de Ciencias de la Salud (I-CS), Avda. Gómez Laguna, 25, Zaragoza 50009 (Spain); Valladares, Mónica [Lonza Biologics Porriño, A relva s/n, Porriño (Pontevedra) 36410 (Spain); González-Fernández, África, E-mail: africa@uvigo.es [Immunology Department, Biomedical Research Center (CINBIO), University of Vigo, Campus Lagoas Marcosende, Vigo (Pontevedra) 36310 (Spain)

    2011-08-12

    Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present.

  14. Sex-Positive Assessment and Treatment Among Female Trauma Survivors.

    Science.gov (United States)

    Baggett, Linda R; Eisen, Ethan; Gonzalez-Rivas, Sara; Olson, Lacy A; Cameron, Rebecca P; Mona, Linda R

    2017-08-01

    Sexuality and intimacy difficulties are often a part of the aftermath of sexual trauma. We argue that combining techniques from evidence-based, trauma-focused treatment with sex-positive techniques used in sex therapy can best help survivors reduce trauma-related symptoms and develop or regain comfort with their sexuality. In this article, we illustrate this approach by describing the case of a survivor of sexual assault, who completed 20 sessions of treatment that combined modules of trauma-focused therapies, Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) with sensate focus therapy, a technique often used in sex therapy. The outcome of this case suggests that clinicians who work with sexual trauma survivors may want to consider a sex-positive approach to conceptualizing and planning the course of treatment, to achieve optimal results. © 2017 Wiley Periodicals, Inc.

  15. I Heard About It From a Friend: Assessing Interest in Buprenorphine Treatment

    Science.gov (United States)

    Fox, Aaron D.; Shah, Pooja A.; Sohler, Nancy L.; Lopez, Carolina M.; Starrels, Joanna L.; Cunningham, Chinazo O.

    2013-01-01

    Background In the United States, opioid abuse and dependence continue to be a growing problem, while treatment for opioid abuse and dependence remains fairly static. Buprenorphine treatment for opioid dependence is safe and effective but underutilized. Prior research has demonstrated low awareness and use of buprenorphine among marginalized groups. This study investigates syringe exchange participants’ awareness of, exposure to, and interest in buprenorphine treatment. Methods Syringe exchange participants were recruited from a mobile unit performing outreach to nine street-side sites in New York City. Computer-based interviews were conducted to determine: (1) opioid users’ awareness of, exposure to, and interest in buprenorphine treatment; and (2) the association between awareness or exposure and interest in buprenorphine treatment. Logistic regression models were used to examine the associations between awareness, direct exposure (i.e. having taken buprenorphine), or indirect exposure (i.e. knowing someone who had taken buprenorphine) and interest in buprenorphine treatment. Results Of 158 opioid users, 70% were aware of, 32% had direct exposure to, and 31% had indirect exposure to buprenorphine; 12% had been prescribed buprenorphine. Of 138 opioid users who had never been prescribed buprenorphine, 57% were interested in buprenorphine treatment. In multivariate models, indirect exposure was associated with interest in buprenorphine treatment (AOR = 2.65, 95% CI: 1.22 – 5.77), but awareness and direct exposure were not. Conclusions Syringe exchange participants were mostly aware of buprenorphine and interested in treatment, but few had actually been prescribed buprenorphine. Because indirect exposure to buprenorphine was associated with interest in treatment, future interventions could capitalize on indirect exposure, such as through peer mentorship, to address underutilization of buprenorphine treatment. PMID:24588297

  16. In vitro evaluation of marginal microleakage in class V restorations with composite resin in bovine teeth. Laser irradiation influences and the adhesive system in the dentin pre-treatment

    International Nuclear Information System (INIS)

    Carvalho, Wendell Lima de

    2003-01-01

    Microleakage is one of the most important reasons to restorations failure, it is the responsible for marginal colors changing, new caries, hipersensibility and pulpar diseases. Several techniques and materials have been studied to eliminate or, at least, to decrease microleakage. The cavities preparation with Er:YAG laser and autoconditioning adhesive are some of these techniques and materials. This research has the objective to compare, in vitro, microleakage in class V cavities, prepared with high rotation (conventional treatment), Er:YAG laser (Enamel-400 mj/2 Hz/128,38 J/Cm 2 , Dentin 250 mJ/ 2 Hz/ 80,24 J/Cm 2 ) and the treatment made at dentin with autoconditioning adhesive (Clerafil SE Bond) using Er:YAG laser (with water or not water) or not using Er:YAG laser. It was used 48 bovines teeth with cavities prepared in vestibular face and gingival wall on cement enamel junction and oclusal wall on enamel. The materials used were autoconditioning adhesive (Clerafil SE Bond) and composite resin Z250. Teeth were divided into four groups of twelve samples each one, according to dentin treatment. Group 1 - Conventional cavity and autoconditioning adhesive. Group 2- Cavity prepared with Er: YAG laser and autoconditioning adhesive. Group 3 - Cavity prepared with Er:YAG laser and dentin conditioning with Er:YAG laser associated to water and autoconditioning adhesive. Group 4 - Cavity prepared with Er:YAG laser and dentin conditioning with Er: YAG laser without water and associated to autoconditioning adhesive. Teeth were restored and stocked at 37 deg C, thermocycled and placed into a 50% silver nitrate solution. Right after, teeth were sliced and evaluated on a stereo microscopic magnifying glass in order to see microleakage degree trying to follow a score from 0 to 3. The findings were submitted to Fisher, Anderson-Darling tests and to the not parametric Sen and Puri test. The results indicated that in gingival edge, the Group 2 showed less microleakage than others

  17. Training Needs of Rehabilitation Counselors concerning Alcohol and Other Drugs Abuse Assessment and Treatment

    Science.gov (United States)

    Ong, Lee Za; Cardoso, Elizabeth; Chan, Fong; Chronister, Julie; Chou, Chih Chin

    2007-01-01

    Forty-two rehabilitation counselors participated in a study regarding perceived training needs concerning alcohol and other drug abuse (AODA) treatment and assessment. Participants reported that 85% of consumers with whom they worked had AODA issues, yet over half rated their graduate training in AODA treatment and assessment as poor, and their…

  18. Can Assessment Reactivity Predict Treatment Outcome among Adolescents with Alcohol and Other Substance Use Disorders?

    Science.gov (United States)

    Kaminer, Yifrah; Burleson, Joseph A.; Burke, Rebecca H.

    2008-01-01

    The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome.…

  19. Pushing the Margins of Responsibility

    DEFF Research Database (Denmark)

    Santoni de Sio, Filippo; Di Nucci, Ezio

    2018-01-01

    marginal responsibility in three steps: we first deny that Parks acts involuntarily as traditionally claimed in the legal literature; we then propose to extend Shoemaker’s analysis of marginal responsibility based on quality of will so as to include two other dimensions: the moral status of the agent......David Shoemaker has claimed that a binary approach to moral responsibility leaves out something important, namely instances of marginal agency, cases where agents seem to be eligible for some responsibility responses but not others. In this paper we endorse and extend Shoemaker’s approach...... by presenting and discussing one more case of marginal agency not yet covered by Shoemaker or in the other literature on moral responsibility. Our case is that of Kenneth Parks, a Canadian man who drove a long way to his mother-in-law’s and killed her in a state of somnambulism. We support our claim about Parks...

  20. Seismic and tsunami safety margin assessment

    International Nuclear Information System (INIS)

    2013-01-01

    Nuclear Regulation Authority is going to establish new seismic and tsunami safety guidelines to increase the safety of NPPs. The main purpose of this research is testing structures/components important to safety and tsunami resistant structures/components, and evaluating the capacity of them against earthquake and tsunami. Those capacity data will be utilized for the seismic and tsunami back-fit review based on the new seismic and tsunami safety guidelines. The summary of the program in 2012 is as follows. 1. Component seismic capacity test and quantitative seismic capacity evaluation. PWR emergency diesel generator partial-model seismic capacity tests have been conducted and quantitative seismic capacities have been evaluated. 2. Seismic capacity evaluation of switching-station electric equipment. Existing seismic test data investigation, specification survey and seismic response analyses have been conducted. 3. Tsunami capacity evaluation of anti-inundation measure facilities. Tsunami pressure test have been conducted utilizing a small breakwater model and evaluated basic characteristics of tsunami pressure against seawall structure. (author)

  1. Assessment and treatment of anxiety disorders in children and adolescents.

    Science.gov (United States)

    Wehry, Anna M; Beesdo-Baum, Katja; Hennelly, Meghann M; Connolly, Sucheta D; Strawn, Jeffrey R

    2015-07-01

    Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.

  2. Eating disorders in day treatment aspects of assessment and outcome

    NARCIS (Netherlands)

    Exterkate, C.C.

    2007-01-01

    Part I gives a general introduction and overview of the research with a naturalistic design that has been done in Amarum. Amarus is a specialized public health centre for the treatment of people with eating disorders where the development of Evidence Based Mental Health (EBMH) and the use of

  3. Medical tourism: assessing the evidence on treatment abroad.

    Science.gov (United States)

    Lunt, Neil; Carrera, Percivil

    2010-05-01

    The review focuses on one growing dimension of health care globalisation - medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The review sought to identify the medical tourist literature for out-of-pocket payments, focusing wherever possible on evidence and experience pertaining to patients in mid-life and beyond. Despite increasing media interest and coverage hard empirical findings pertaining to out-of-pocket medical tourism are rare. Despite a number of countries offering relatively low cost treatments we know very little about many of the numbers and key indicators on medical tourism. The narrative review traverses discussion on medical tourist markets, consumer choice, clinical outcomes, quality and safety, and ethical and legal dimensions. The narrative review draws attention to gaps in research evidence and strengthens the call for more empirical research on the role, process and outcomes of medical tourism. In concluding it makes suggestion for the content of such a strategy. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  4. Assessment and Treatment of Anxiety Disorders in Children and Adolescents

    Science.gov (United States)

    Wehry, Anna M.; Beesdo-Baum, Katja; Hennelly, Meghann M.; Connolly, Sucheta D.; Strawn, Jeffrey R.

    2015-01-01

    Recent advances in the developmental epidemiology, neurobiology and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive-behavioral therapy (CBT) are efficacious in the treatment of these conditions in youth and that combination of CBT + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy. PMID:25980507

  5. Clinical assessment of mineral trioxide aggregate in the treatment of ...

    African Journals Online (AJOL)

    Four teeth capped with Ca(OH)2 (two each at the end of 6 and 12 months) and one tooth capped with MTA (at the end of 12 months) received endodontic emergency treatment because of symptoms of irreversible pulpitis that were clinically and/or radiographically established. There was no significant difference between the ...

  6. Assessment of the Concentration of Metals in a Sewage Treatment ...

    African Journals Online (AJOL)

    Metal concentration of the water in the sewage treatment pond of the Ahmadu Bello University Zaria, Nigeria, was studied between April and September 2007 using Energy Dispersive X-Ray Fluorescence (ED-XRF) Analysis. The mean concentrations of ten (10) heavy metals observed during the study were as follows: ...

  7. Assessment of antiretroviral treatment outcome in public hospitals ...

    African Journals Online (AJOL)

    Bernt Lindtjørn

    2009-01-31

    Jan 31, 2009 ... Background: The outcome of antiretroviral treatment, survival patterns and associated determining factors in public hospitals are ... Method: A historical retrospective cohort study design was used for patients visiting hospitals from January 1, 2005 to. January .... SPSS version 15 was used for data analysis.

  8. Assessing Instructional Modalities: Individualized Treatment Effects for Personalized Learning

    Science.gov (United States)

    Beemer, Joshua; Spoon, Kelly; Fan, Juanjuan; Stronach, Jeanne; Frazee, James P.; Bohonak, Andrew J.; Levine, Richard A.

    2018-01-01

    Estimating the efficacy of different instructional modalities, techniques, and interventions is challenging because teaching style covaries with instructor, and the typical student only takes a course once. We introduce the individualized treatment effect (ITE) from analyses of personalized medicine as a means to quantify individual student…

  9. Environmental life cycle assessments for water treatment processes ...

    African Journals Online (AJOL)

    The objective of this study was to generate information on the environmental profile of the life cycle of water, including treatment, distribution and collection and disposal (including recycling), in an urban context. As a case study the eThekwini Municipality (with its main city Durban) in South Africa was used. Another aim of ...

  10. Behavior Observations for Linking Assessment to Treatment for Selective Mutism

    Science.gov (United States)

    Shriver, Mark D.; Segool, Natasha; Gortmaker, Valerie

    2011-01-01

    Selective mutism is a childhood disorder that most school psychologists and educational providers will come across at least once in their careers. Selective mutism is associated with significant impairment in educational settings where speaking is necessary for academic and social skill development. Effective treatments for selective mutism…

  11. Assessment and Treatment of Selective Mutism with English Language Learners

    Science.gov (United States)

    Mayworm, Ashley M.; Dowdy, Erin; Knights, Kezia; Rebelez, Jennica

    2015-01-01

    Selective mutism (SM) is a type of anxiety disorder that involves the persistent failure to speak in contexts where speech is typically expected (e.g., school), despite speaking in other contexts (e.g., home). Research on the etiology and treatment of SM is limited, as it is a rare disorder and few clinical trials evaluating SM interventions have…

  12. Assessment of didecyldimethylammonium chloride as a ballast water treatment method.

    Science.gov (United States)

    van Slooten, Cees; Peperzak, Louis; Buma, Anita G J

    2015-01-01

    Ballast water-mediated transfer of aquatic invasive species is considered a major threat to marine biodiversity, marine industry and human health. A ballast water treatment is needed to comply with International Maritime Organization (IMO) ballast water discharge regulations. Didecyldimethylammonium chloride (DDAC) was tested for its applicability as a ballast water treatment method. The treatment of the marine phytoplankton species Tetraselmis suecica, Isochrysis galbana and Chaetoceros calcitrans showed that at 2.5 µL L(-1) DDAC was able to inactivate photosystem II (PSII) efficiency and disintegrate the cells after 5 days of dark incubation. The treatment of natural marine plankton communities with 2.5 µL L(-1) DDAC did not sufficiently decrease zooplankton abundance to comply with the IMO D-2 standard. Bivalve larvae showed the highest resistance to DDAC. PSII efficiency was inactivated within 5 days but phytoplankton cells remained intact. Regrowth occurred within 2 days of incubation in the light. However, untreated phytoplankton exposed to residual DDAC showed delayed cell growth and reduced PSII efficiency, indicating residual DDAC toxicity. Natural marine plankton communities treated with 5 µL L(-1) DDAC showed sufficient disinfection of zooplankton and inactivation of PSII efficiency. Phytoplankton regrowth was not detected after 9 days of light incubation. Bacteria were initially reduced due to the DDAC treatment but regrowth was observed within 5 days of dark incubation. Residual DDAC remained too high after 5 days to be safely discharged. Two neutralization cycles of 50 mg L(-1) bentonite were needed to inactivate residual DDAC upon discharge. The inactivation of residual DDAC may seriously hamper the practical use of DDAC as a ballast water disinfectant.

  13. Treatment of uncertainty in low-level waste performance assessment

    International Nuclear Information System (INIS)

    Kozak, M.W.; Olague, N.E.; Gallegos, D.P.; Rao, R.R.

    1991-01-01

    Uncertainties arise from a number of different sources in low-level waste performance assessment. In this paper the types of uncertainty are reviewed, and existing methods for quantifying and reducing each type of uncertainty are discussed. These approaches are examined in the context of the current low-level radioactive waste regulatory performance objectives, which are deterministic. The types of uncertainty discussed in this paper are model uncertainty, uncertainty about future conditions, and parameter uncertainty. The advantages and disadvantages of available methods for addressing uncertainty in low-level waste performance assessment are presented. 25 refs

  14. Environmental impact assessment of decommissioning treatment about radioactive model plant waste ore storage site

    International Nuclear Information System (INIS)

    Bei Xinyu

    2012-01-01

    Aiming at decommissioning treatment project of radioactive model plant waste ore storage site, based on the detailed investigations of source terms and project description, systematic environmental impacts have been identified. The environmental impacts both during decommissioning treatment, radioactive waste transportation and after treatment are assessed. Some specific environmental protection measures are proposed so as to minimize the adverse environmental impacts. (author)

  15. Crowdsourced assessment of common genetic contribution to predicting anti-TNF treatment response in rheumatoid arthritis

    NARCIS (Netherlands)

    Sieberts, Solveig K.; Zhu, Fan; García-García, Javier; Stahl, Eli; Pratap, Abhishek; Pandey, Gaurav; Pappas, Dimitrios; Aguilar, Daniel; Anton, Bernat; Bonet, Jaume; Eksi, Ridvan; Fornés, Oriol; Guney, Emre; Li, Hongdong; Marín, Manuel Alejandro; Panwar, Bharat; Planas-Iglesias, Joan; Poglayen, Daniel; Cui, Jing; Falcao, Andre O.; Suver, Christine; Hoff, Bruce; Balagurusamy, Venkat S. K.; Dillenberger, Donna; Neto, Elias Chaibub; Norman, Thea; Aittokallio, Tero; Ammad-Ud-Din, Muhammad; Azencott, Chloe-Agathe; Bellón, Víctor; Boeva, Valentina; Bunte, Kerstin; Chheda, Himanshu; Cheng, Lu; Corander, Jukka; Dumontier, Michel; Goldenberg, Anna; Gopalacharyulu, Peddinti; Hajiloo, Mohsen; Hidru, Daniel; Jaiswal, Alok; Kaski, Samuel; Khalfaoui, Beyrem; Khan, Suleiman Ali; Kramer, Eric R.; Marttinen, Pekka; Mezlini, Aziz M.; Molparia, Bhuvan; Pirinen, Matti; Saarela, Janna; Samwald, Matthias; Stoven, Véronique; Tang, Hao; Tang, Jing; Torkamani, Ali; Vert, Jean-Phillipe; Wang, Bo; Wang, Tao; Wennerberg, Krister; Wineinger, Nathan E.; Xiao, Guanghua; Xie, Yang; Yeung, Rae; Zhan, Xiaowei; Zhao, Cheng; Greenberg, Jeff; Kremer, Joel; Michaud, Kaleb; Barton, Anne; Coenen, Marieke; Mariette, Xavier; Miceli, Corinne; Shadick, Nancy; Weinblatt, Michael; de Vries, Niek; Tak, Paul P.; Gerlag, Danielle; Huizinga, Tom W. J.; Kurreeman, Fina; Allaart, Cornelia F.; Louis Bridges, S.; Criswell, Lindsey; Moreland, Larry; Klareskog, Lars; Saevarsdottir, Saedis; Padyukov, Leonid; Gregersen, Peter K.; Friend, Stephen; Plenge, Robert; Stolovitzky, Gustavo; Oliva, Baldo; Guan, Yuanfang; Mangravite, Lara M.; Bridges, S. Louis; Calaza, Manuel; Elmarakeby, Haitham; Heath, Lenwood S.; Long, Quan; Moore, Jonathan D.; Opiyo, Stephen Obol; Savage, Richard S.; Zhu, Jun

    2016-01-01

    Rheumatoid arthritis (RA) affects millions world-wide. While anti-TNF treatment is widely used to reduce disease progression, treatment fails in Bone-third of patients. No biomarker currently exists that identifies non-responders before treatment. A rigorous community-based assessment of the utility

  16. Respiratory gated beam delivery cannot facilitate margin reduction, unless combined with respiratory correlated image guidance

    International Nuclear Information System (INIS)

    Korreman, Stine S.; Juhler-Nottrup, Trine; Boyer, Arthur L.

    2008-01-01

    Purpose/objective: In radiotherapy of targets moving with respiration, beam gating is offered as a means of reducing the target motion. The purpose of this study is to evaluate the safe magnitude of margin reduction for respiratory gated beam delivery. Materials/methods: The study is based on data for 17 lung cancer patients in separate protocols at Rigshospitalet and Stanford Cancer Center. Respiratory curves for external optical markers and implanted fiducials were collected using equipment based on the RPM system (Varian Medical Systems). A total of 861 respiratory curves represented external measurements over 30 fraction treatment courses for 10 patients, and synchronous external/internal measurements in single sessions for seven patients. Variations in respiratory amplitude (simulated coaching) and external/internal phase shifts were simulated by perturbation with realistic values. Variations were described by medians and standard deviations (SDs) of position distributions of the markers. Gating windows (35% duty cycle) were retrospectively applied to the respiratory data for each session, mimicking the use of commercially available gating systems. Medians and SDs of gated data were compared to those of ungated data, to assess potential margin reductions. Results: External respiratory data collected over entire treatment courses showed SDs from 1.6 to 8.1 mm, the major part arising from baseline variations. The gated data had SDs from 1.5 to 7.7 mm, with a mean reduction of 0.3 mm (6%). Gated distributions were more skewed than ungated, and in a few cases a marginal miss of gated respiration would be found even if no margin reduction was applied. Regularization of breathing amplitude to simulate coaching did not alter these results significantly. Simulation of varying phase shifts between internal and external respiratory signals showed that the SDs of gated distributions were the same as for the ungated or smaller, but the median values were markedly shifted

  17. Assessment and treatment of planning skills in adolescents with ADHD

    NARCIS (Netherlands)

    Boyer, B.E.

    2016-01-01

    Planning problems are described to be prominent in the daily lives of adolescents with ADHD (Barkley, 2004) and may cause comorbid conditions and impairments (Safren, 2006). Therefore the central aim of this thesis was to assess planning skills of adolescents with ADHD and to investigate whether

  18. Games for the assessment and treatment of mental health

    NARCIS (Netherlands)

    Mandryk, R.L.; Birk, M.V.; Lobel, A.M.; Rooij, M.M.J.W. van; Granic, I.; Abeele, V. vanden

    2017-01-01

    The community for research on video games for assessment and intervention for mental health spans multiple disciplines, from cognitive sciences, computer science, and interaction design, to psychology, neurobiology, and medicine. The goal of this workshop is to bring together an international group

  19. A comparative life cycle assessment of process water treatment ...

    African Journals Online (AJOL)

    Two different raw water desalination technologies, an existing ion exchange plant and a proposed reverse osmosis intervention, are compared by life cycle assessment for the production of 1 M. of boiler feed water, in the context of the Secunda industrial complex situated in Mpumalanga, South Africa. The proposed reverse ...

  20. Distributions with given marginals and statistical modelling

    CERN Document Server

    Fortiana, Josep; Rodriguez-Lallena, José

    2002-01-01

    This book contains a selection of the papers presented at the meeting `Distributions with given marginals and statistical modelling', held in Barcelona (Spain), July 17-20, 2000. In 24 chapters, this book covers topics such as the theory of copulas and quasi-copulas, the theory and compatibility of distributions, models for survival distributions and other well-known distributions, time series, categorical models, definition and estimation of measures of dependence, monotonicity and stochastic ordering, shape and separability of distributions, hidden truncation models, diagonal families, orthogonal expansions, tests of independence, and goodness of fit assessment. These topics share the use and properties of distributions with given marginals, this being the fourth specialised text on this theme. The innovative aspect of the book is the inclusion of statistical aspects such as modelling, Bayesian statistics, estimation, and tests.

  1. Post-closure performance assessment treatment of the biosphere

    International Nuclear Information System (INIS)

    Broderick, M.A.; Egan, M.J.; Thorne, M.C.; Williams, J.A.

    1996-01-01

    The Nirex strategy for radioactive waste disposal is based on a system of engineered and natural barriers, providing long-term isolation of the waste from those parts of the environment that are in contact with or readily available for use by humans (i.e. the biosphere). Even so, there remains the possibility that, on a timescale of thousands to tens of thousands of years, small quantities of poorly-sorbed, long-lived radionuclides may be released from the engineered disposal system, ultimately to emerge into the biosphere. Biosphere models are used in post-closure performance assessments to quantify the competing effects of dilution and accumulation processes on radionuclide concentrations in the accessible environment. Understanding biosphere processes and their time dependence is necessary not only to determine the radiological impact of possible future releases, but also to characterise the dynamics of transport in groundwater and the location, duration and extent of any such releases. Nirex is developing a new biosphere model for use in post-closure radiological assessments for the proposed Sellafield repository. A compartment modelling approach has been adopted, as in studies performed previously, but the system will be dynamic, allowing changes with time in both the properties of compartments and the transfers between compartments. The transport model considers both mass transport within the biosphere and the migration of radionuclides, thereby ensuring that a self-consistent description of the biosphere, in a spatially-extensive domain is maintained. The above approach is designed to link the assessment models used by the Nirex assessment team more closely into the Nirex biosphere research programme than has hitherto been possible with time-invariant assessment models. (author)

  2. Diagnosis, treatment, and response assessment in solitary plasmacytoma

    DEFF Research Database (Denmark)

    Caers, J; Paiva, B; Zamagni, E

    2018-01-01

    Solitary plasmacytoma is an infrequent form of plasma cell dyscrasia that presents as a single mass of monoclonal plasma cells, located either extramedullary or intraosseous. In some patients, a bone marrow aspiration can detect a low monoclonal plasma cell infiltration which indicates a high ris......, but studies exploring the potential benefit of systemic therapies for high-risk patients are urgently needed. In this review, a panel of expert European hematologists updates the recommendations on the diagnosis and management of patients with solitary plasmacytoma....... of early progression to an overt myeloma disease. Before treatment initiation, whole body positron emission tomography-computed tomography or magnetic resonance imaging should be performed to exclude the presence of additional malignant lesions. For decades, treatment has been based on high-dose radiation...

  3. Nevus of the Eyelid Margin Mimicking a Malignant Melanoma

    Directory of Open Access Journals (Sweden)

    A. Echchaoui

    2016-06-01

    Full Text Available Nevi are a benign skin lesions commonly found on the eyelid margin, these tumors are usually pigmented and have thickness. Nevi are not typically visible at birth; they appear during childhood and often exhibit a more rapid increase in pigmentation about the time of puberty. Most eyelid nevi can be diagnosed by clinical examination; suspicious lesions should be biopsied when rapid growth, loss of eyelashes or discoloration of the nevus is noted. Eyelid nevi require treatment if malignant transformation and/or cosmetically bothersome to the patient. We report a case of a 37-year-old female patient exhibited a single cutaneous tumor at the free margin of the lower left eyelid, she noticed a dark spot on their eyelid since childhood. It was a brown, fleshy, thickened, and nodular well-circumscribed exophytic mass, measuring 6 mm in diameter; its clinical appearance argued for a possible nodular melanoma. Excisional-biopsy was performed using a full-thickness pentagonal wedge excision technique. Histopathology showed that the lesion was a benign melanocytic nevocellular nevus. The post-operative courses were uneventful with excellent cosmetic and functional result. Preventive measures (cap, sunglasses... and regular monitoring of the lesion by assessing ABCDE criteria (asymmetry, irregular borders, multiple colors, diameter ≥ 6 mm, and enlargement remain necessary to detect and rule out a possible risk of malignant melanoma.

  4. HOW ASSESS DRUGS IN THE TREATMENT OF ACUTE BIPOLAR MANIA ?

    Directory of Open Access Journals (Sweden)

    Michel eBourin

    2013-01-01

    Full Text Available Bipolar affective disorder is a serious mental disease associated with significant morbidity and mortality. Good-quality research available to guide treatment strategies remains insufficient, particularly with regard to manic or hypomanic episodes. A critical review of the various stages of mania might be helpful for pharmamaceutical companies and investigators as a prerequisite for the clinical evaluation of potential antimanic properties of medications. The main difficulty remains the comparison between antipsychotics and mood stabilizers such as lithium (with equal efficacy in the acute phase and the prevention of recurrent manic episodesNo consensus has been reached with regard to the treatment of bouts of acute mania in various parts of the world. Controlled clinical trials have, at last, provided irrefutable evidence of the activity of lithium, which has long been used alone, as well asthat of divalproate or its derivatives and, to a lesser extent, carbamazepine. The new antipsychotic agents have more recently established their efficacy, especially aripiprazole, asenapine, quetiapine; olanzapine, risperidone and ziprazidone. It is paradoxical to note that, in Europe, haloperidol is still the reference substance used in clinical trials despite the fact that it is not officially indicated in the treatment of mania. In the USA, lithium, divalproate or antipsychotics can be prescribed as first-line treatment. In Europe, lithium remains the first-line medication, whereas divalproate and atypical antipsychotic agents are used only as second-line therapy.Although both types of medication (antipsychotics, normothymic agents and/or anticonvulsants have proved to be clinically effective in the management of mania by reducing the mania scores overall, the same does not apply, however, to all symptoms of mania. Factorial approaches to mania have all shown that since there are several clinical forms of mania, several lines of manic symptoms can be

  5. A laboratory assessment of various treatment conditions affecting ...

    African Journals Online (AJOL)

    former author reported a NH3-N content of 0,48% in barley straw ammoniated by a 10% urea solution at a moisture level of 400 g/kg for a period of 90 days. In the present investigation the NH3-N content of ground and long wheat straw, treated for a comparable treatment period (12 weeks) at a comparable moisture level ...

  6. Liquid Effluent Retention Facility/Effluent Treatment Facility Hazards Assessment

    International Nuclear Information System (INIS)

    Simiele, G.A.

    1994-01-01

    This document establishes the technical basis in support of Emergency Planning activities for the Liquid Effluent Retention Facility and Effluent Treatment Facility the Hanford Site. The document represents an acceptable interpretation of the implementing guidance document for DOE ORDER 5500.3A. Through this document, the technical basis for the development of facility specific Emergency Action Levels and the Emergency Planning Zone is demonstrated

  7. Eating disorders in day treatment aspects of assessment and outcome

    OpenAIRE

    Exterkate, C.C.

    2007-01-01

    Part I gives a general introduction and overview of the research with a naturalistic design that has been done in Amarum. Amarus is a specialized public health centre for the treatment of people with eating disorders where the development of Evidence Based Mental Health (EBMH) and the use of guidelines is of importance. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Guidelines...

  8. Passive margins through earth history

    Science.gov (United States)

    Bradley, Dwight C.

    2008-12-01

    Passive margins have existed somewhere on Earth almost continually since 2740 Ma. They were abundant at 1900-1890, 610-520, and 150-0 Ma, scarce at ca. 2445-2300, 1600-1000, and 300-275 Ma, and absent before ca. 3000 Ma and at 1740-1600. The fluctuations in abundance of passive margins track the first-order fluctuations of the independently derived seawater 87Sr/ 86Sr secular curve, and the compilation thus appears to be robust. The 76 ancient passive margins for which lifespans could be measured have a mean lifespan of 181 m.y. The world-record holder, with a lifespan of 590 m.y., is the Mesoproterozoic eastern margin of the Siberian craton. Subdivided into natural age groups, mean lifespans are 186 m.y. for the Archean to Paleoproterozoic, 394 m.y. for the Mesoproterozoic, 180 m.y. for the Neoproterozoic, 137 m.y. for the Cambrian to Carboniferous, and 130 m.y. for the Permian to Neogene. The present-day passive margins, which are not yet finished with their lifespans, have a mean age of 104 m.y. and a maximum age of 180 m.y. On average, Precambrian margins thus had longer, not shorter, lifespans than Phanerozoic ones—and this remains the case even discounting all post-300 Ma margins, most of which have time left. Longer lifespans deeper in the past is at odds with the widely held notion that the tempo of plate tectonics was faster in the Precambrian than at present. It is entirely consistent, however, with recent modeling by Korenaga [Korenaga, J., 2004. Archean geodynamics and thermal evolution of Earth. Archean Geodynamics and Environments, AGU Geophysical Monograph Series 164, 7-32], which showed that plate tectonics was more sluggish in the Precambrian. The abundance of passive margins clearly tracks the assembly, tenure, and breakup of Pangea. Earlier parts of the hypothesized supercontinent cycle, however, are only partly consistent with the documented abundance of passive margins. The passive-margin record is not obviously consistent with the proposed

  9. Durability assessment of limestone subjected to surface treatments

    Science.gov (United States)

    Theodoridou, Magdalini; Charalambous, Cleopatra; Ioannou, Ioannis

    2017-04-01

    Weathering is inevitable in existing limestone structures due to their exposure to fluctuating and aggressive environmental conditions, such as wetting/drying, and the presence of salts. Therefore, conservation treatments are often deemed necessary in order to prevent or at least delay the progress of deterioration and to strengthen weathered stones. This paper focuses on the effect of an ethanol-based laboratory produced water repellent and three water-based commercial products (water repellent, pure acrylic emulsion mixed with a water repellent with thermal insulation properties and consolidant) on the durability and other properties of three different types of limestone (massive chalk, calcarenite and bioclastic limestone). All test specimens were subjected to micro-destructive cutting tests before/after the application of the aforementioned surface treatments to investigate changes in resistance to cutting on the area close to the treated surface. They were also subjected to two cycles of salt contamination with 20% w/w Na2SO4•10H2O solution by capillary absorption through their bottom face, until 2 mm of pore space was theoretically filled with salt crystals. Drying after salt contamination took place at 70 °C. The results of the micro-destructive cutting tests showed increases in cutting resistance at the topmost area (1-2 mm below the treated surface) of the massive chalk and the calcarenite, but no significant changes in the case of the rather non-homogeneous bioclastic limestone. At the same time, the performance of each surface treatment varied from lithotype to lithotype. The laboratory produced water repellent showed a generally better performance; no signs of damage were detected due to the formation of salt crystals within the pores of the materials, i.e. subflorescence, when applied on the calcarenite and the bioclastic limestone. Very poor performance was observed for all treatments when applied on the massive chalk. This accounted for (i

  10. [Sinaloa: the geography of marginalization].

    Science.gov (United States)

    Aguayo Hernandez, J R

    1993-01-01

    Sinaloa's State Population Program for 1993-98 contains the objective of promoting integration of demographic criteria into the planning process. The action program calls for establishing indicators of economic and social inequality so that conditions of poverty and margination can be identified. To further these goals, the State Population Council used data from the National Population Council project on regional inequality and municipal margination in Mexico to analyze margination at the state level. Nine indicators of educational status, housing conditions, spatial distribution, and income provide information that allows the definition of municipios and regions that should receive priority in economic and social development programs. The index of municipal margination (IMM) is a statistical summary of the nine indicators, which are based on information in the 1990 census. As of March 1990, 9.9% of Sinaloa's population over age 15 was illiterate and 37.4% had incomplete primary education. 91.0% had electricity, but 18.7% lacked indoor toilet facilities and 19.4% had no piped water. 23.7% of houses had dirt floors. 60% of households were crowded, defined as having more than two persons per bedroom. 43.5% of the state population lived in localities with fewer than 5000 inhabitants, where service delivery is difficult and costly. 55.6% of the economically active population was judged to earn less than the amount needed to satisfy essential needs. All except one municipio bordering the Pacific ocean had low or very low indicators of margination, while all those in the sierra had a medium or high degree of margination. Sinaloa's statewide IMM was eighteenth among Mexico's 32 federal entities, with Chiapas showing the highest degree of margination and the Federal District the lowest.

  11. The significance of motivation in periodontal treatment: validity and reliability of the motivation assessment scale among patients undergoing periodontal treatment.

    Science.gov (United States)

    Pac, A; Oruba, Z; Olszewska-Czyż, I; Chomyszyn-Gajewska, M

    2014-03-01

    The individual evaluation of patients' motivation should be introduced to the protocol of periodontal treatment, as it could impact positively on effective treatment planning and treatment outcomes. However, a standardised tool measuring the extent of periodontal patients' motivation has not yet been proposed in the literature. Thus, the objective of the present study was to determine the validity and reliability of the Zychlińscy motivation scale adjusted to the needs of periodontology. Cross sectional study. Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. 199 adult periodontal patients, aged 20-78. 14-item questionnaire. The items were adopted from the original Zychlińscy motivation assessment scale. Validity and reliability of the proposed motivation assessment instrument. The assessed Cronbach's alpha of 0.79 indicates the scale is a reliable tool. Principal component analysis revealed a model with three factors, which explained half of the total variance. Those factors represented: the patient's attitude towards treatment and oral hygiene practice; previous experiences during treatment; and the influence of external conditions on the patient's attitude towards treatment. The proposed scale proved to be a reliable and accurate tool for the evaluation of periodontal patients' motivation.

  12. Social marginalization of overweight children.

    Science.gov (United States)

    Strauss, Richard S; Pollack, Harold A

    2003-08-01

    Overweight is the most common health problem that faces children and adolescents. Although the correlation among overweight, low self-esteem, and depression is well known, social isolation among overweight children and adolescents has not been studied. To investigate social networks of overweight and normal-weight adolescents in a large, nationally representative sample. Cross-sectional, nationally representative cohort study. Population A total of 90 118 adolescents aged 13 to 18 years who were enrolled in the National Longitudinal Study of Adolescent Health, of which a 1:5 subsample was selected for detailed in-home assessment, including height and weight measurements (n = 17 557). Overweight was defined according to body mass index (>95th percentile for age and sex). This analysis focuses on the number of friendship nominations each adolescent received from other adolescents. The number of friendship nominations and other social network measures were calculated using statistical software. Overweight adolescents were more likely to be socially isolated and to be peripheral to social networks than were normal-weight adolescents. Although overweight adolescents listed similar numbers of friends as normal-weight adolescents, overweight adolescents received significantly fewer friendship nominations from others than were received by normal-weight adolescents (mean [SE] number of friendship nominations, 3.39 [0.08] vs 4.79 [0.04]; POverweight adolescents were also more likely to receive no friendship nominations than were normal-weight adolescents (odds ratio, 1.71; 95% confidence interval, 1.39-2.20). Decreased television viewing (Poverweight and normal-weight adolescents. Many overweight adolescents are socially marginalized. Such isolation may aggravate the social and emotional consequences of overweight in this age group.

  13. Monte Carlo conformal treatment planning as an independent assessment

    International Nuclear Information System (INIS)

    Rincon, M.; Leal, A.; Perucha, M.; Carrasco, E.; Sanchez-Doblado, F.; Hospital Univ. Virgen Macarena, Sevilla; Arrans, R.; Sanchez-Calzado, J.A.; Errazquin, L.; Medrano, J.C.

    2001-01-01

    The wide range of possibilities available in Radiotherapy with conformal fields cannot be covered experimentally. For this reason, dosimetrical and planning procedures are based on approximate algorithms or systematic measurements. Dose distribution calculations based on Monte Carlo (MC) simulations can be used to check results. In this work, two examples of conformal field treatments are shown: A prostate carcinoma and an ocular lymphoma. The dose distributions obtained with a conventional Planning System and with MC have been compared. Some significant differences have been found. (orig.)

  14. Circadian rhythm disorders among adolescents: assessment and treatment options.

    Science.gov (United States)

    Bartlett, Delwyn J; Biggs, Sarah N; Armstrong, Stuart M

    2013-10-21

    Delayed sleep phase disorder (DSPD) - a circadian rhythm sleep disorder - is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include bright light therapy, chronotherapeutic regimens, and administration of melatonin as a chronobiotic (as distinct from a soporific). Attention to non-photic and extrinsic factors including healthy sleep parameters is also important to enable better sleep and mood outcomes in adolescents.

  15. Assessment and treatment of binge eating in obese patients

    Directory of Open Access Journals (Sweden)

    Walmir Ferreira Coutinho

    2006-03-01

    Full Text Available Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating, as part of a multidimensional therapeutic approach,associated to psychotherapy and eating behavior modification.Although the investigation of pharmacological agents for thetreatment of BED is still in its preliminary stages, somemedications have shown promising results in randomized clinicaltrials. Currently, three main classes of drugs have been evaluatedin randomized controlled trials: antidepressants, anti-obesityagents and anticonvulsants. The most studied drugs were theserotonina selective reuptake inhibitors (SSRIs. Fluoxetine,fluvoxamine, sertralina and citalopram have been shown to causemodest, but significant reduction in the frequency of bingeepisodes and body weight over the short term of the trials. Morerecently, sibutramina and topiramate have been shown tosignificantly reduce the binge eating behavior and the body weightin patients with obesity and binge eating.

  16. Probabilistic Assessment of Hypobaric Decompression Sickness Treatment Success

    Science.gov (United States)

    Conkin, Johnny; Abercromby, Andrew F. J.; Dervay, Joseph P.; Feiveson, Alan H.; Gernhardt, Michael L.; Norcross, Jason R.; Ploutz-Snyder, Robert; Wessel, James H., III

    2014-01-01

    The Hypobaric Decompression Sickness (DCS) Treatment Model links a decrease in computed bubble volume from increased pressure (DeltaP), increased oxygen (O2) partial pressure, and passage of time during treatment to the probability of symptom resolution [P(symptom resolution)]. The decrease in offending volume is realized in 2 stages: a) during compression via Boyle's Law and b) during subsequent dissolution of the gas phase via the O2 window. We established an empirical model for the P(symptom resolution) while accounting for multiple symptoms within subjects. The data consisted of 154 cases of hypobaric DCS symptoms along with ancillary information from tests on 56 men and 18 women. Our best estimated model is P(symptom resolution) = 1 / (1+exp(-(ln(Delta P) - 1.510 + 0.795×AMB - 0.00308×Ts) / 0.478)), where (DeltaP) is pressure difference (psid), AMB = 1 if ambulation took place during part of the altitude exposure, otherwise AMB = 0; and where Ts is the elapsed time in mins from start of the altitude exposure to recognition of a DCS symptom. To apply this model in future scenarios, values of DeltaP as inputs to the model would be calculated from the Tissue Bubble Dynamics Model based on the effective treatment pressure: (DeltaP) = P2 - P1 | = P1×V1/V2 - P1, where V1 is the computed volume of a spherical bubble in a unit volume of tissue at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. If 100% ground level O2 (GLO) was breathed in place of air, then V2 continues to decrease through time at P2 at a faster rate. This calculated value of (DeltaP then represents the effective treatment pressure at any point in time. Simulation of a "pain-only" symptom at 203 min into an ambulatory extravehicular activity (EVA) at 4.3 psia on Mars resulted in a P(symptom resolution) of 0.49 (0.36 to 0.62 95% confidence intervals) on immediate return to 8.2 psia in the Multi-Mission Space Exploration Vehicle. The P(symptom resolution) increased

  17. The assessment and treatment of wound pain at dressing change.

    LENUS (Irish Health Repository)

    Bell, Cassandra

    2010-01-01

    Pain is a common reason for patients with acute or chronic wounds seeking hospital admission, but it appears to be under-treated by health professionals. A quantitative descriptive study was conducted to investigate nurses\\' knowledge with regard to dressing change and wound pain. Data were collected from registered nurses (n=94). Analysis indicated a low level of knowledge with regard to pain assessment and strategies to overcome pain at dressing change, but a good knowledge of factors that contribute to pain at dressing change.

  18. Functional assessment of endoprosthesis in the treatment of bone tumors

    Directory of Open Access Journals (Sweden)

    Denis Kiyoshi Fukumothi

    Full Text Available ABSTRACT OBJECTIVES: Evaluate the functional grade of these patients and to identify the types of complications found that influenced the average life span of endoprostheses the functions of the operated limb. METHODS: We analyzed 14 post-operative cases of endoprosthesis, patients with malignant bone tumors and aggressive benign bone tumors submitted to surgery between 2004 and 2014. The evaluation system used was proposed by Enneking, recommended by the Musculoskeletal Tumor Society (MSTS, in addition to the radiologic evaluation. RESULTS: Endoprosthesis are excellent choices for the treatment of bone tumors with limb preservation in relation to pain, strength, and patient's emotional acceptance. Another factor for good results is the immediate weight-bearing capacity, generating a greater independence. CONCLUSION: The authors conclude that all patients classified the therapy as excellent/good, regardless of the type of prosthesis used, extent of injury, and/or type of tumor resection performed.

  19. Faster assessment of patients receiving unnecessary thyroid treatment: concise communication

    Energy Technology Data Exchange (ETDEWEB)

    Stoffer, S.S.; Szpunar, W.E.; Meier, D.A.

    1983-02-01

    Forty-five consecutive patients on thyroid hormone treatment without obvious indication were evaluated. Twenty-five of these cases were found to have no evidence of thyroid disease. Biochemical testing was not helpful in making the diagnosis of hypothyroidism in the majority of thyroid-treated hypothyroid patients. Normal technetium images were obtained in 25 patients, 22 of which had no thyroid disease. In contrast, abnormal technetium images were obtained in 20 patients, 16 of whom were thought to be hypothyroid, and one of whom developed a goiter within 2 mo after discontinuing levothyroxine. The use of technetium imaging seems useful for the rapid (20 min) evaluation of those patients likely to benefit from discontinuing thyroid medication.

  20. Using simulated wetlands to assess acid mine drainage treatment efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Karathanasis, A.D. (Kentucky University, Lexington, KY (USA). Dept. of Agronomy)

    1992-01-01

    The elevated acidity and increased solubility of toxic metals such as Al, Fe, Mn, Cu, and Zn associated with acid mine drainage (AMD) is causing increasing concern about possible toxic effects to plants, aquatic life, animals, and even humans in the coal regions of the Appalachian states. During the last few years, a new technology for treatment of acid mine discharges has emerged. The technology involves the construction of artificial wetlands with dominant vegetation [ital Typha] (cattails), [ital Sphagnum] (moss), certain algae, and other plant species which have the potential to treat small flows of acid mine water moving through them. Greenhouse experiments at the University of Kentucky involving AMD treatment by surface and subsurface flow simulated wetlands with [ital Typha] plants (cattails) grown in six different substrates showed significant differences among substrates in their ability to buffer mine drainage acidity and in metal removal efficiency. Of the six substrates tested, the pine-needle-and-hay mixtures were the most efficient over the peat, sphagnum moss and mine spoil mixtures in reducing acidity and Al, Cu and Zn concentrations in surface effluents. The majority of the substrates (except the mine spoil surface soil) showed similar efficiencies for Fe removal, but all substrates were a source rather than a sink for Mn in surface and subsurface flows. The results of this study suggest that short-term screenings of various substrate materials under greenhouse conditions such as those used in this investigation may provide useful information on the selection of the most efficient substrate for the metal(s) of interest and thus, help improve the performance of the wetland under construction. 2 figs.

  1. 78 FR 66621 - Protection of Collateral of Counterparties to Uncleared Swaps; Treatment of Securities in a...

    Science.gov (United States)

    2013-11-06

    ... involved in the assessment of risk and/or collateral management to receive this notification. However... Collateral of Counterparties to Uncleared Swaps; Treatment of Securities in a Portfolio Margining Account in... collateral posted by their counterparties to margin, guarantee, or secure uncleared swaps. Additionally, the...

  2. Systems considerations in seismic margin evaluations

    International Nuclear Information System (INIS)

    Buttermer, D.R.

    1987-01-01

    Increasing knowledge in the geoscience field has led to the understanding that, although highly unlikely, it is possible for a nuclear power plant to be subjected to earthquake ground motion greater than that for which the plant was designed. While it is recognized that there are conservatisms inherent in current design practices, interest has developed in evaluating the seismic risk of operating plants. Several plant-specific seismic probabilistic risk assessments (SPRA) have been completed to address questions related to the seismic risk of a plant. The results from such SPRAs are quite informative, but such studies may entail a considerable amount of expensive analysis of large portions of the plant. As an alternative to an SPRA, it may be more practical to select an earthquake level above the design basis for which plant survivability is to be demonstrated. The principal question to be addressed in a seismic margin evaluation is: At what ground motion levels does one have a high confidence that the probability of seismically induced core damage is sufficiently low? In a seismic margin evaluation, an earthquake level is selected (based on site-specific geoscience considerations) for which a stable, long-term safe shutdown condition is to be demonstrated. This prespecified earthquake level is commonly referred to as the seismic margin earthquake (SME). The Electric Power Research Institute is currently supporting a research project to develop procedures for use by the utilities to allow them to perform nuclear plant seismic margin evaluations. This paper describes the systems-related aspects of these procedures

  3. Assessing Treatment Outcomes in Attention-Deficit/Hyperactivity Disorder: A Narrative Review

    Science.gov (United States)

    Weiss, Margaret D.

    2012-01-01

    Objective: To review measures used to assess treatment response in patients with attention-deficit/hyperactivity disorder (ADHD) across the life span. Data Sources: Keyword searches of English-language articles in the PubMed database up to and including the May 4, 2011, index date were performed with the search strings (1) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (outcome assessment [MeSH] OR adaptation of life skills OR executive function [MeSH]) and (2) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (function OR functioning OR quality of life [MeSH]). Study Selection: Articles found through this search were then selected based on relevance to the topic area; no specific quality criteria were applied. Data Extraction: Narrative review. Results: The vast majority of studies assessing ADHD treatments have measured treatment response using ADHD symptom measures. Additional domains relevant for assessing treatment response among children and adults with ADHD include functional impairment, quality of life, adaptive life skills, and executive function. Validated rating scales exist for assessing these additional domains, but there has been minimal research evaluating the sensitivity of these instruments for detecting treatment response in pediatric and adult samples. Conclusions: Assessment of treatment outcomes in ADHD should move beyond symptom assessment to incorporate measures of functioning, quality of life, adaptive skills, and executive function, especially when assessing long-term treatment response. The authors recommend a potential battery and schedule of measures that could be used to more comprehensively assess treatment response in patients with ADHD. PMID:23585986

  4. Assessment of heat treatment of various types of milk.

    Science.gov (United States)

    Sakkas, Lambros; Moutafi, Alexandra; Moschopoulou, Ekaterini; Moatsou, Golfo

    2014-09-15

    Raw milk (RM), reconstituted condensed milk (CM) and three types of reconstituted milk powders (SMPs) were heated indirectly at 80-140°C for 4 s. Native β-lactoglobulin after 90°C treatment of RM was 1132±167 mg/L but no reliable quantities were estimated at temperatures >100°C, whereas 218±43 mg/L residual α-lactalbumin were found at 130°C. Average lactulose contents from 51 to 1549 mg/L were detected at ⩾100°C; average furosine was 1.9 and 126.5 mg/L in raw and 140°C treated milks respectively. The behaviour of heated CM was similar to that of heated RM except for higher furosine concentration. Reconstituted SMPs contained high quantities of lactulose and furosine, the ratio of which was lower than in similarly treated RM. Among the market milks analysed, the group of high-pasteurised milks was highly variable; i.e. native β-lactoglobulin was 69-2831 mg/L, lactulose 0-824 mg/L and furosine 3.3-68.8 mg/L. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Comparative assessment of the treatment of type 2 Diabetes Mellitus

    International Nuclear Information System (INIS)

    Kokic, S.; Radman, M.; Capkum, V.; Dovzak-Kokic, D.; Tesanovic, S.

    2002-01-01

    The objective of the study was to estimate the most successful way of treating patients with type 2 diabetes mellitus. A total of 87 patients with type 2 diabetes mellitus were selected for a three-month study. The patients were divided into three groups comprising 29 patients in each group, based upon the treatment regimen. Group 1 (BMI 32.3+-3.6 kg/m2) was treated with glimepiride and metformin; group 2 (BMI 27.9+-3.9) was treated with daily doses of insulin mixture 30/70 and bed-time NPH insulin; and group 3 (BMI 30.02+-4.8) was treated with a combination of three daily doses of lispo and metformin.The groups did not differ significantly in terms of sex and age. Initially, there were significant statistical differences in HbA1c (P=0.035) between the three groups (9, 21%+-1.72%; 9.21%+-1.54%; and 10, 0%+-1.73% respectively). After three months there were no statistically differences in HbA1c (P=0.66) between the groups (8.52+-1.7%; 8.03%+-1.05%; and 8.0%+-0.63%, respectively. Decreases in HbA1c were significant in all groups, but most pronounced in patients treated with lispro and metaformin (17% on average). The study results suggest the need for establishing guidelines on how to treat type 2 diabetics. (author)

  6. Consent and assessment of capacity to decide or refuse treatment.

    Science.gov (United States)

    Simpson, Owena

    Consent protects the right of patients to decide what happens to them. Before any medical intervention, adults must give valid consent, which must be voluntary, informed and given free of undue influence. When consent is being obtained, patients must be informed about the intervention, why it is being done and its risks; information they are given must be recorded. Every effort should be made to explain the issues in terms that the patient can understand and by providing support and aids to communicate. Consent can be expressed, where patients say they consent or put it in writing, or implied, where a healthcare professional infers from their behaviour that they consent. While different types of consent are valid, some are evidence of stronger proof in court that valid consent has been given. Competent adults have the right to refuse treatment, regardless of the reasons they give for refusal and even if the refusal will result in death; clinicians must respect their decision. In some circumstances-such as when an unconscious person is admitted as an emergency-healthcare professionals can make decisions on behalf of patients, and must do so in patients' best interests.

  7. Treatment of Primary Pulmonary Aspergillosis: An Assessment of the Evidence

    Directory of Open Access Journals (Sweden)

    Ethan R. Stewart

    2016-09-01

    Full Text Available Aspergillus spp. are a group of filamentous molds that were first described due to a perceived similarity to an aspergillum, or liturgical device used to sprinkle holy water, when viewed under a microscope. Although commonly inhaled due to their ubiquitous nature within the environment, an invasive fungal infection (IFI is a rare outcome that is often reserved for those patients who are immunocompromised. Given the potential for significant morbidity and mortality within this patient population from IFI due to Aspergillus spp., along with the rise in the use of therapies that confer immunosuppression, there is an increasing need for appropriate initial clinical suspicion leading to accurate diagnosis and effective treatment. Voriconazole remains the first line agent for therapy; however, the use of polyenes, novel triazole agents, or voriconazole in combination with an echinocandin may also be utilized. Consideration as to which particular agent and for what duration should be made in the individual context for each patient based upon underlying immunosuppression, comorbidities, and overall tolerance of therapy.

  8. Task Group on Safety Margins Action Plan (SMAP). Safety Margins Action Plan - Final Report

    International Nuclear Information System (INIS)

    Hrehor, Miroslav; Gavrilas, Mirela; Belac, Josef; Sairanen, Risto; Bruna, Giovanni; Reocreux, Michel; Touboul, Francoise; Krzykacz-Hausmann, B.; Park, Jong Seuk; Prosek, Andrej; Hortal, Javier; Sandervaag, Odbjoern; Zimmerman, Martin

    2007-01-01

    The international nuclear community has expressed concern that some changes in existing plants could challenge safety margins while fulfilling all the regulatory requirements. In 1998, NEA published a report by the Committee on Nuclear Regulatory Activities on Future Nuclear Regulatory Challenges. The report recognized 'Safety margins during more exacting operating modes' as a technical issue with potential regulatory impact. Examples of plant changes that can cause such exacting operating modes include power up-rates, life extension or increased fuel burnup. In addition, the community recognized that the cumulative effects of simultaneous changes in a plant could be larger than the accumulation of the individual effects of each change. In response to these concerns, CSNI constituted the safety margins action plan (SMAP) task group with the following objectives: 'To agree on a framework for integrated assessments of the changes to the overall safety of the plant as a result of simultaneous changes in plant operation / condition; To develop a CSNI document which can be used by member countries to assess the effect of plant change on the overall safety of the plant; To share information and experience.' The two approaches to safety analysis, deterministic and probabilistic, use different methods and have been developed mostly independently of each other. This makes it difficult to assure consistency between them. As the trend to use information on risk (where the term risk means results of the PSA/PRA analysis) to support regulatory decisions is growing in many countries, it is necessary to develop a method of evaluating safety margin sufficiency that is applicable to both approaches and, whenever possible, integrated in a consistent way. Chapter 2 elaborates on the traditional view of safety margins and the means by which they are currently treated in deterministic analyses. This chapter also discusses the technical basis for safety limits as they are used today

  9. Aggressive ameloblastic fibro-odontoma assessment with CBCT and treatment.

    Science.gov (United States)

    Lúcio, P S C; Cavalcante, R B; Maia, R N; Santos, E S; Godoy, G P

    2013-06-01

    Ameloblastic fibro-odontomas (AFO) are rare lesions and defined by the World Health Organisation as a tumour composed of a proliferation of odontogenic epithelium immersed in ectomesenchyme reminiscent of the interdental papilla. It also presents inductive processes leading to formation of enamel and dentine, confusing, histopathologically, with odontoma. Despite numerous efforts, there is still considerable confusion over its controversial aetiopathogenesis and treatment. A brief review of the literature on the clinical, pathological and therapeutic features of this lesion is reported. A case of aggressive AFO in a 3-year-old boy was referred to the Oral Diagnostics Service of Hospital General de Fortaleza for evaluation following a 3-months painless swelling in the right mandibular and facial regions. During anamnesis, the patient's carers reported no systemic problem and his medical history was non-contributory. Intra-orally there was a swelling of the right lateral portion of the mandible, adjacent teeth were not mobile and the oral mucosa appeared normal and showed no signs of ulceration. Radiographic examination, with panoramic radiography and cone beam computed tomography with three-dimensional (3D) reconstruction, was better able to identify the extent of bone involvement and showed an expansive hypodense image in the right mandibular region. 3D reconstruction showed expansion of buccal and lingual cortical bone and the preservation of basal bone. Enucleation and curettage of the lesion were carried out and care was taken not to fracture the basal bone during the surgical procedure. Tissue specimens were sent for histopathologic analysis. Aspiration performed during surgery was negative for blood and other exudates. No recurrence has occurred during a follow-up period of 11 months. A comprehensive diagnosis including all clinical, radiographic and histopathologic features is necessary for the success of therapy, which varies from case to case, thus

  10. Exposure assessment of residents living near a wood treatment plant

    International Nuclear Information System (INIS)

    Dahlgren, James; Warshaw, Raphael; Horsak, Randy D.; Parker, Frank M. III; Takhar, Harpreet

    2003-01-01

    We report the results of environmental sampling and modeling in a neighborhood adjacent to a wood processing plant. This plant used creosote and pentachlorophenol (PCP) to treat wood for over 70 years. Between 1999 and 2001, environmental samples were obtained to quantify the level of environmental contamination from the wood processing plant. Blood from 10 residents was measured for chlorinated dioxins and dibenzofurans. Soil sediment samples from drainage ditches and attic/dust samples from nearby residents' homes were tested for polychlorinated dioxins, furans, and polycyclic aromatic hydrocarbons (PAH). The dioxin congeners analysis of the 10 residents revealed elevated valued for octachlorodibenzo-p-dioxin and heptachlorodibenzo-p-dioxin compatible with PCP as the source. The levels of carcinogenic PAHs were higher than background levels and were similar to soil contamination on wood preserving sites. Wipe sampling in the kitchens of 11 homes revealed that 20 of the 33 samples were positive for octachlorinated dioxins with a mean value of 10.27 ng/m 2 . The soil, ditch samples, and positive wipe samples from the homes indicate a possible ongoing route of exposure to the contaminants in the homes of these residents. Modeled air exposure estimated for the wood processing waste chemicals indicate some air exposure to combustion products. The estimated air levels for benzo(a)pyrene and tetrachlorodibenzodiozin in this neighborhood exceeded the recommended levels for these compounds in some states. The quantitative data presented suggest a significant contamination of a neighborhood by wood processing waste chemicals. These findings suggest the need for more stringent regulations on waste discharges from wood treatment plants

  11. 12 CFR 220.4 - Margin account.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Margin account. 220.4 Section 220.4 Banks and... BROKERS AND DEALERS (REGULATION T) § 220.4 Margin account. (a) Margin transactions. (1) All transactions not specifically authorized for inclusion in another account shall be recorded in the margin account...

  12. 17 CFR 41.45 - Required margin.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Required margin. 41.45 Section... PRODUCTS Customer Accounts and Margin Requirements § 41.45 Required margin. (a) Applicability. Each security futures intermediary shall determine the required margin for the security futures and related...

  13. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study

    NARCIS (Netherlands)

    van Asselt, D.Z.; van Bokhorst-de van der Schueren, M.A.E.; van der Cammen, T.J.; Disselhorst, L.G.; Janse, A.; Lonterman-Monasch, S.; Maas, H.A.; Popescu, M.E.; Scholzel-Dorenbos, C.J.; Sipers, W.M.; Veldhoven, C.M.; Wijnen, H.H.; Rikkert, M. G.

    2012-01-01

    Objective: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and

  14. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study.

    NARCIS (Netherlands)

    Asselt, D.Z.B. van; Bokhorst-de van der Schueren, M.A. van; Cammen, T.J.M. van der; Disselhorst, L.G.; Janse, A.; Lonterman-Monasch, S.; Maas, H.A.; Popescu, M.E.; Scholzel-Dorenbos, C.J.M.; Sipers, W.M.; Veldhoven, C.M.M. van; Wijnen, H.H.M; Olde Rikkert, M.

    2012-01-01

    OBJECTIVE: scientific evidence regarding the optimal management of malnutrition in geriatric patients is scarce. Our aim was to develop a consensus statement for geriatric hospital practice concerning six elements: (i) definition of malnutrition, (ii) screening and assessment, (iii) treatment and

  15. The assessment of port wine stains in children following multiple pulsed-dye laser treatments.

    Science.gov (United States)

    Naran, Sanjay; Gilmore, John; Deleyiannis, Frederic W-B

    2008-04-01

    The purpose of this study was to compare 3 methods of assessment of pediatric port wine stains (PWSs) following multiple pulsed-dye laser (PDL) treatments; (i) parental evaluation, (ii) objective evaluation utilizing L*a*b* color measurement, and (iii) the visual inspection of serial photographs by blinded observers. Twenty-one children who had received at least 4 prior PDL treatments were prospectively enrolled. Following additional PDL treatment, 72.5% of the parental responses indicated a lighter PWS; 85% said that they would continue with further treatment. According to the assessments by 3 observers, only 33.3% to 61.9% (correlation coefficients: 0.41 and 0.54; P L*a*b* measurements were not significantly correlated with the observers' perceptions. L*a*b* assessment is not a clinically useful method to evaluate PDL response in the PWS previously treated. Relying solely on parental assessment may lead to overtreatment without a demonstrable benefit.

  16. Variable planning margin approach to account for locoregional variations in setup uncertainties.

    Science.gov (United States)

    Yang, Jinzhong; Garden, Adam S; Zhang, Yongbin; Zhang, Lifei; Dong, Lei

    2012-08-01

    To develop a method for creating variable planning margins around a clinical treatment volume (CTV) and to evaluate its application in head and neck cancer radiotherapy in accounting for locoregional variations of nonrigid setup uncertainties. Ten computed tomography (CT) images (with a resolution of 0.68 × 0.68 × 2.5 mm(3)) of a head and neck cancer patient were acquired from the first two weeks of treatment for this study. Five rigid structures (the C2, C5, and caudal C7 vertebrae, mandible, and jugular notch) were used as the landmarks for creating variable local margins. At different CTV locations, local margins were calculated as the weighted average of margins determined at different landmark points from previous studies. The weight was determined by a Gaussian falloff function of the distance between the current location and each landmark point. The CTV delineated on the planning CT image, spanning from the upper portion of the mouth to the lower part of the neck, was expanded to form the planning treatment volume (PTV) with either variable or the conventional constant margins. To evaluate the target coverage, the original planning CTV was deformably mapped to each daily treatment CT using a deformable image registration method. We examined the overlap of the deformed CTV and the rigidly aligned PTV for each margin design strategy and compared the efficacy of the variable margin with the constant margin approach. For the variable margin approach with a baseline C2 margin of 2.5 mm in the left-right, anterior-posterior, and superior-inferior directions, an average of 99.2% of the CTV was within the PTV, and for the approach with a constant 2.5 mm margin, an average of 97.9% of the CTV was within the PTV. With a baseline margin of 2.0 mm, the variable margin approach had an average coverage of 97.8%, similar to that of the constant 2.5 mm margin approach. However, its average nonoverlapped PTV proportion was 32.4%, smaller than that of the constant 2.5 mm

  17. Brief hierarchical assessment of potential treatment components with children in an outpatient clinic.

    OpenAIRE

    Harding, J; Wacker, D P; Cooper, L J; Millard, T; Jensen-Kovalan, P

    1994-01-01

    Seven patients conducted assessments in an outpatient clinic using a prescribed hierarchy of antecedent and consequence treatment components for their children's problem behavior. Brief assessment of potential treatment components was conducted to identify variables that controlled the children's appropriate behavior. Experimental control via a brief reversal was achieved for 6 of the 7 children, (1 child continued to behave appropriately following initial improvement in behavior). For these ...

  18. Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population

    International Nuclear Information System (INIS)

    Warren, Graham W.; Arnold, Susanne M.; Valentino, Joseph P.; Gal, Thomas J.; Hyland, Andrew J.; Singh, Anurag K.; Rangnekar, Vivek M.; Cummings, K. Michael; Marshall, James R.; Kudrimoti, Mahesh R.

    2012-01-01

    Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.

  19. Intra-fractional bladder motion and margins in adaptive radiotherapy for urinary bladder cancer

    DEFF Research Database (Denmark)

    Grønborg, Caroline; Vestergaard, Anne; Høyer, Morten

    2015-01-01

    and to estimate population-based and patient-specific intra-fractional margins, also relevant for a future re-optimisation strategy. MATERIAL AND METHODS: Nine patients treated in a clinical phase II ART trial of daily plan selection for bladder cancer were included. In the library plans, 5 mm isotropic margins......BACKGROUND: The bladder is a tumour site well suited for adaptive radiotherapy (ART) due to large inter-fractional changes, but it also displays considerable intra-fractional motion. The aim of this study was to assess target coverage with a clinically applied method for plan selection ART...... were added to account for intra-fractional changes. Pre-treatment and weekly repeat magnetic resonance imaging (MRI) series were acquired in which a full three-dimensional (3D) volume was scanned every second min for 10 min (a total of 366 scans in 61 series). Initially, the bladder clinical target...

  20. Assessment of options for the treatment of Sizewell PWR liquid effluent

    International Nuclear Information System (INIS)

    Hornby, J.; Allam, J.; Knibbs, R.H.

    1992-01-01

    This report describes the origins of PWR liquid waste streams, their composition and rates of arising. Data has been collected from operational PWRs and estimates obtained for Sizewell B PWR liquid waste streams. Current liquid waste treatment practices are reviewed and assessments made of established and novel treatment techniques which could be applicable to Sizewell B. A short list of treatment options is given and recommendations are made relating to established treatment technologies suitable for Sizewell B and also to development work on more novel treatments which could lead to a reduction in waste disposal volumes. (author)

  1. Ethnographies of marginality [Review article

    NARCIS (Netherlands)

    Beuving, J.J.

    2016-01-01

    Africanist discourse today displays a strong, widespread and growing sense of optimism about Africa's economic future. After decades of decline and stagnation in which Africa found itself reduced to the margins of the global economic stage, upbeat Afro-optimism seems fully justified. One only needs

  2. Marginality and Variability in Esperanto.

    Science.gov (United States)

    Brent, Edmund

    This paper discusses Esperanto as a planned language and refutes three myths connected to it, namely, that Esperanto is achronical, atopical, and apragmatic. The focus here is on a synchronic analysis. Synchronic variability is studied with reference to the structuralist determination of "marginality" and the dynamic linguistic…

  3. Profit margins in Japanese retailing

    NARCIS (Netherlands)

    J.C.A. Potjes; A.R. Thurik (Roy)

    1993-01-01

    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service

  4. Selection and utilization of assessment instruments in substance abuse treatment trials: the National Drug Abuse Treatment Clinical Trials Network experience

    Directory of Open Access Journals (Sweden)

    Rosa C

    2012-07-01

    Full Text Available Carmen Rosa, Udi Ghitza, Betty TaiCenter for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USAAbstract: Based on recommendations from a US Institute of Medicine report, the National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN in 1999, to accelerate the translation of science-based addiction treatment research into community-based practice, and to improve the quality of addiction treatment, using science as the vehicle. One of the CTN's primary tasks is to serve as a platform to forge bi-directional communications and collaborations between providers and scientists, to enhance the relevance of research, which generates empirical results that impact practice. Among many obstacles in moving research into real-world settings, this commentary mainly describes challenges and iterative experiences in regard to how the CTN develops its research protocols, with focus on how the CTN study teams select and utilize assessment instruments, which can reasonably balance the interests of both research scientists and practicing providers when applied in CTN trials. This commentary also discusses the process by which the CTN further selects a core set of common assessment instruments that may be applied across all trials, to allow easier cross-study analyses of comparable data.Keywords: addiction, assessment, drug abuse treatment, drug dependence, NIDA Clinical Trials Network, substance use disorder

  5. Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains.

    Science.gov (United States)

    Naeem, Muhammad; Rahimnajjad, Muhammad Kazim; Rahimnajjad, Nasir Ali; Idrees, Zaki; Shah, Ghazanfar Ali; Abbas, Ghulam

    2015-03-01

    Despite the common occurrence of ankle sprains, no treatment is considered to be the gold standard for the management of such sprains. We assessed functional treatment versus plaster of Paris (POP) for the treatment of lateral ankle sprains, with pain and function employed as the outcome measures. 126 Patients were eligible for inclusion. They were assigned to either the functional treatment Tubigrip (TG) group or the POP group after applying block randomization. Characteristics such as age, dominant ankle, and gender were assessed at baseline. Pain and functional assessments were done using the visual analog scale (VAS) and the Karlsson score (KS) at baseline (at the start of the study) and during the 2nd and 6th weeks, respectively. Data on other subjective parameters, such as the number of painkillers used, the number of days taken off work, and the number of sleepless nights, were requested from the patients at the end of the study. SPSS version 16 was used for analysis, and p knee POP cast. Level I.

  6. (89)Zr-mAb3481 PET for HER3 tumor status assessment during lapatinib treatment

    NARCIS (Netherlands)

    Pool, Martin; Kol, Arjan; de Jong, Steven; de Vries, Elisabeth G. E.; Lub-de Hooge, Marjolijn N; Terwisscha van Scheltinga, Anton G T

    2017-01-01

    Treatment of human epidermal growth factor receptor 2 (HER2)-driven breast cancer with tyrosine kinase inhibitor lapatinib can induce a compensatory HER3 increase, which may attenuate antitumor efficacy. Therefore, we explored in vivo HER3 tumor status assessment after lapatinib treatment with

  7. Randomized controlled trial assessing a traditional Chinese medicine remedy in the treatment of primary dysmenorrhea

    NARCIS (Netherlands)

    Kennedy, S.; Jin, X.; Yu, H.; Zhong, S.; Magill, P.; Vliet, T. van; Kistemaker, C.; Voors, C.; Pasman, W.

    2006-01-01

    A proof-of-concept study to assess the safety and efficacy of a traditional Chinese medicine formula as treatment for primary dysmenorrhea showed no statistically significant benefit over placebo. However, some efficacy parameters suggested possible superiority of the active treatment and so a

  8. Tools to aid post-wildfire assessment and erosion-mitigation treatment decisions

    Science.gov (United States)

    Peter R. Robichaud; Louise E. Ashmun

    2013-01-01

    A considerable investment in post-fire research over the past decade has improved our understanding of wildfire effects on soil, hydrology, erosion and erosion-mitigation treatment effectiveness. Using this new knowledge, we have developed several tools to assist land managers with post-wildfire assessment and treatment decisions, such as prediction models, research...

  9. Adults with Attention-Deficit/ Hyperactivity Disorder: Assessment and Treatment Strategies

    Science.gov (United States)

    Wadsworth, John S.; Harper, Dennis C.

    2007-01-01

    Attention-deficit/hyperactivity disorder (ADHD) among adults is characterized by inattentiveness and impulsivity. This article provides counselors with information about the etiology, assessment, and treatment of adult ADHD. The identification of the genetic and neurological features of ADHD has led to improvements in evaluation and treatment.…

  10. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder

    Science.gov (United States)

    Journal of the American Academy of Child & Adolescent Psychiatry, 2012

    2012-01-01

    Research in etiology, neurobiology, genetics, clinical correlates, and evidence-based treatments in children and adolescents with obsessive-compulsive disorder indicate a need for the revision of the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Obsessive-Compulsive Disorder first published a decade ago. The…

  11. Development and Use of an Eating Disorder Assessment and Treatment Protocol

    Science.gov (United States)

    Huebner, Lois A.; Weitzman, Lauren M.; Mountain, Lisa M.; Nelson, Kris L.; Oakley, Danielle R.; Smith, Michael L.

    2006-01-01

    Counseling centers have been challenged to effectively treat the growing number of college students who struggle with disordered eating. In response to this critical issue, an Eating Disorder Assessment and Treatment Protocol (EDATP) was developed to assist clinical disposition in the counseling center setting and identify treatment guidelines…

  12. Caries Risk Assessment/Treatment Programs in U.S. Dental Schools.

    Science.gov (United States)

    Yorty, Jack S.; Brown, K. Birgitta

    1999-01-01

    A survey of 42 U.S. dental schools was conducted to identify the number and characteristics of caries risk- assessment/treatment programs. Findings address lectures about caries risk, use of variable recall programs, categorization of risk level, early detection and treatment of lesions, and restoration of radiographically visible lesions. (DB)

  13. Life Cycle Assessment of Thermal Treatment Technologies. An environmental and financial systems analysis of gasification, incineration and landfilling of waste

    Energy Technology Data Exchange (ETDEWEB)

    Assefa, Getachew; Eriksson, Ola [Royal Inst. of Tech., Stockholm (Sweden). Industrial Ecology; Jaeraas, Sven; Kusar, Henrik [Royal Inst. of Tech., Stockholm (Sweden). Chemical Technology

    2003-05-01

    A technology which is currently developed by researchers at KTH is catalytic combustion. which is one component of a gasification system. Instead of performing the combustion in the gas turbine by a flame, a catalyst is used. When the development of a new technology (as catalytic combustion) reaches a certain step where it is possible to quantify material-, energy- and capital flows, the prerequisites for performing a systems analysis is at hand. The systems analysis can be used to expand the know-how about the potential advantages of the catalytic combustion technology by highlighting its function as a component of a larger system. In this way it may be possible to point out weak points which have to be investigated more, but also strong points to emphasise the importance of further development. The aim of this project was to assess the energy turnover as well as the potential environmental impacts and economic costs of thermal treatment technologies in general and catalytic combustion in particular. By using a holistic assessment of the advantages and disadvantages of catalytic combustion of waste it was possible to identify the strengths and weaknesses of the technology under different conditions. Following different treatment scenarios have been studied: (1) Gasification with catalytic combustion, (2) Gasification with flame combustion, (3) Incineration with energy recovery and (4) Landfilling with gas collection. In the study compensatory district heating is produced by combustion. of biofuel. The power used for running the processes in the scenarios is supplied by the waste-to-energy technologies themselves while compensatory power is assumed to be produced. from natural gas. The emissions from the system studied were classified and characterised using methodology from Life Cycle Assessment into the following environmental impact categories: Global Warming Potential, Acidification Potential, Eutrophication Potential and finally Formation of Photochemical

  14. Evaluation of motion management strategies based on required margins

    International Nuclear Information System (INIS)

    Sawkey, D; Svatos, M; Zankowski, C

    2012-01-01

    Strategies for delivering radiation to a moving lesion each require a margin to compensate for uncertainties in treatment. These motion margins have been determined here by separating the total uncertainty into components. Probability density functions for the individual sources of uncertainty were calculated for ten motion traces obtained from the literature. Motion margins required to compensate for the center of mass motion of the clinical treatment volume were found by convolving the individual sources of uncertainty. For measurements of position at a frequency of 33 Hz, system latency was the dominant source of positional uncertainty. Averaged over the ten motion traces, the motion margin for tracking with a latency of 200 ms was 4.6 mm. Gating with a duty cycle of 33% required a mean motion margin of 3.2–3.4 mm, and tracking with a latency of 100 ms required a motion margin of 3.1 mm. Feasible reductions in the effects of the sources of uncertainty, for example by using a simple prediction algorithm to anticipate the lesion position at the end of the latency period, resulted in a mean motion margin of 1.7 mm for tracking with a latency of 100 ms, 2.4 mm for tracking with a latency of 200 ms, and 2.1–2.2 mm for the gating strategies with duty cycles of 33%. A crossover tracking latency of 150 ms was found, below which tracking strategies could take advantage of narrower motion margins than gating strategies. The methods described here provide a means to guide selection of a motion management strategy for a given patient. (paper)

  15. Epidemiology of Malocclusion and Assessment of Orthodontic Treatment Need for Nepalese Children

    OpenAIRE

    Singh, Varun Pratap; Sharma, Amita

    2014-01-01

    Objective. To evaluate the prevalence of malocclusion and orthodontic treatment needs among 12- to 15-year-old schoolchildren in eastern Nepal and compare the findings with those of other populations. Methods. Two thousand seventy-four children (1149 males and 925 females) aged between 12 and 15 years were evaluated. Their orthodontic treatment need was assessed using the Index of Orthodontic Treatment Needs (IOTN) (dental health component (DHC)). Angle’s classes of malocclusion were also eva...

  16. Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients

    OpenAIRE

    Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

    2013-01-01

    This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 pat...

  17. Modelling passive margin sequence stratigraphy

    Science.gov (United States)

    Steckler, M.S.; Reynolds, D.; Coakley, B.; Swift, B.A.; Jarrard, R.D.

    1993-01-01

    We have modelled stratigraphic sequences to aid in deciphering the sedimentary response to sea-level change. Sequence geometry is found to be most sensitive to sea level, but other factors, including subsidence rate and sediment supply, can produce similar changes. Sediment loading and compaction also play a major role in generating accommodation, a factor often neglected in sequence-stratigraphic models. All of these parameters can control whether a type 1 or type 2 sequence boundary is produced. The models indicate that variations in margin characteristics produce systematic shifts in sequence boundary timing and systems tract distribution. The timing of the sequence boundary formation and systems tracts may differ by up to one-half of a sea-level cycle. Thus correlative sequence boundaries will not be synchronous. While rates of sea-level change may exceed the rate of thermal subsidence, isostasy and compaction may amplify the rate of total subsidence to several times greater than the thermal subsidence. Thus, total subsidence does not vary uniformly across the margin since it is modified by the sediment load. The amplitude of sea-level changes cannot be determined accurately without accounting for the major processes that affect sediment accumulation. Backstripping of a seismic line on the New Jersey margin is used to reconstruct continental margin geometry. The reconstructions show that the pre-existing ramp-margin geometry, rather than sea level, controls clinoform heights and slopes and sedimentary bypass. Backstripping also reveals progressive deformation of sequences due to compaction. Further work is still needed to understand quantitatively the role of sea level and the tectonic and sedimentary processes controlling sequence formation and influencing sequence architecture.

  18. Marginal grafts increase early mortality in liver transplantation

    Directory of Open Access Journals (Sweden)

    Telesforo Bacchella

    Full Text Available CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD, as low MELD ( 20. The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.

  19. Energy system analysis of marginal electricity supply in consequential LCA

    DEFF Research Database (Denmark)

    Lund, Henrik; Mathiesen, Brian Vad; Christensen, Per

    2010-01-01

    in capacity but can be characterised as a complex set of affected electricity and heat supply technologies. A long-term YAM technology is identified for the Danish BAU2030 system in the case of three different long-term marginal changes in capacity, namely coal, natural gas or wind power. Discussion Four...... of four different situations are provided. We suggest that the technology mix with the installation of natural gas or coal power plant is applied as the marginal capacity. Conclusions The environmental consequences of marginal changes in electricity supply cannot always be represented solely by long......Background, aim and scope This paper discusses the identification of the environmental consequences of marginal electricity supplies in consequential life cycle assessments (LCA). According to the methodology, environmental characteristics can be examined by identifying affected activities, i...

  20. Safety assessments for centralized waste treatment and disposal facility in Puspokszilagy Hungary

    International Nuclear Information System (INIS)

    Berci, K.; Hauszmann, Z.; Ormai, P.

    2002-01-01

    The centralized waste treatment and disposal facility Puspokszilagy is a shallow land, near surface engineered type disposal unit. The site, together with its geographic, geological and hydrogeological characteristics, is described. Data are given on the radioactive inventory. The operational safety assessment and the post-closure safety assessment is outlined. (author)

  1. Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

    Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine

  2. Pain Management in Intellectually Disabled Children: Assessment, Treatment, and Translational Research

    Science.gov (United States)

    Valkenburg, Abraham J.; van Dijk, Monique; de Klein, Annelies; van den Anker, Johannes N.; Tibboel, Dick

    2010-01-01

    The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of…

  3. The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies

    NARCIS (Netherlands)

    Souza, A.L. de; Bronkhorst, E.M.; Creugers, N.H.; Leal, S.C.; Frencken, J.E.

    2014-01-01

    A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to

  4. Pre-treatment predictors of response for assessing outcomes to standard treatment in infection with HCV genotype 3.

    Science.gov (United States)

    Qureshi, Saleem; Batool, Uzma; Iqbal, Mussarat; Burki, Umar Farooq; Khan, Naqeeb Ullah

    2011-02-01

    To determine the role of pre-treatment predictors of response in assessing outcomes to standard treatment in HCV genotype 3. Observational study. Department of Medicine, KRL General Hospital, Islamabad, from December 2004 to December 2006. All patients with positive anti-HCV and PCR genotype 3a were recruited and written and informed consent was taken. Patients were treated with standard Interferon plus Ribavirin therapy (IFN alpha-2a, 3MU t.i.w 24 weeks plus Ribavirin 1000-1200 mg/day) for 6 months. The effect of pre-treatment factors influencing outcome i.e. age, gender, weight, baseline ALT, necroinflammatory grade, fibrosis and steatosis on the final outcome were further analyzed by univariate logistic regression analysis. Response rates to standard Interferon plus Ribazole therapy were studied in 190 patients. The end-of-treatment complete response (EOTCR) was seen in 81% (n=155) of the patients, whereas 17% (n=33) were non-responders (NR). Sustained viral response (SVR) was seen in 58% (n=112) patients and 24% (n=45) were relapsers. SVR was higher in patients without steatosis (OR=2.52, 95% CI=1.356- 4.71, p=0.04). Higher SVR was seen in patients weighing less than 65 kg, as compared with weight>65 kg (OR=2.277, 95% CI=1.246-4.161, p=0.007). The other variables were not found to be significantly associated with improved SVRs. Out of the studied predictors, body weight and presence of steatosis, were statistically related to treatment outcome. Pre-treatment host factors can predict response to treatment that can help in individualizing treatment and patient selection and optimize treatment outcomes.

  5. Contributions to knowledge of the continental margin of Uruguay. Uruguayan continental margin: Physiographic and seismic analysis

    International Nuclear Information System (INIS)

    Preciozzi, F

    2014-01-01

    This work is about the kind of continental margins such as a )Atlantic type passive margins which can be hard or soft b) An active or Pacific margins that because of the very frequent earthquakes develop a morphology dominated by tectonic processes. The Uruguayan continental margin belongs to a soft Atlantic margin

  6. Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment.

    Science.gov (United States)

    Tsui, Patricia; Deptula, Andrew; Yuan, Derek Y

    2017-06-01

    This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.

  7. Assessing Tumor Response to Treatment in Patients with Lung Cancer Using Dynamic Contrast-Enhanced CT

    DEFF Research Database (Denmark)

    Strauch, Louise S; Eriksen, Rie Ø; Sandgaard, Michael

    2016-01-01

    yielded 651 publications, and 16 articles were included in this study. The articles were divided into groups of treatment. In studies where patients were treated with systemic chemotherapy with or without anti-angiogenic drugs, four out of the seven studies found a significant decrease in permeability...... after treatment. Four out of five studies that measured blood flow post anti-angiogenic treatments found that blood flow was significantly decreased. DCE-CT may be a useful tool in assessing treatment response in patients with lung cancer. It seems that particularly permeability and blood flow...

  8. [Prospective assessment of children with pervasive developmental disorder after 2 years of day-hospital treatment].

    Science.gov (United States)

    Poinso, F; Dubois, B; Chatel, C; Viellard, M; Bastard-Rosset, D; Girardot, A-M; Grandgeorge, P; De Martino, S; Sokolowsky, M; Salle-Collemiche, X; Da Fonseca, D

    2013-01-01

    The treatment of children with pervasive developmental disorders (PDD) has not been systematically assessed in French day-care units. In this prospective study, 11 children with a diagnosis of PDD were followed up for 2years in a day-care unit in the Marseille university hospital. The treatment they received is based on an initial assessment by the "Centre Ressources Autisme" (CRA PACA) and further included a continued observation of the child and an assessment of the child's abilities and needs. This treatment used various therapeutic approaches 10h weekly and also included parental counseling and coordinated work with schools. Treatment in our day-care unit can be categorized as eclectic, non-intensive therapy. It is based on methods such as TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), Floor Time Play, speech and language therapy, developmental therapy, and psychotherapy. International studies on intensive behavioral therapies suggest that this treatment is superior to non-behavioral and/or non-intensive treatment. They suggest its efficiency is due both to the nature of the treatment (behavioral) and to its intensity (more than 25h a week). In this study, the CRA diagnosed children using the ADI and ADOS. The 11 children (mean age, 3years 5months) were tested twice, with the Vineland and CARS scales. The first assessment was on admission to the day hospital and the second was 2years later. The results showed developmental progress with a mean increase of 13.5 months at the Vineland Scale, and a decrease of the autism severity score on the CARS. The treatment presented here proves to be efficient; if compared to similar results in international studies, we obtained better results than their eclectic intensive or non-intensive treatment comparison group. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. The Margins of Medieval Manuscripts

    Directory of Open Access Journals (Sweden)

    Nataša Kavčič

    2011-12-01

    Full Text Available Shortly after the mid-thirteenth century, various images began to fill the margins in both religious and secular texts. Many factors influenced the emergence of this type of manuscript decoration, but it has generally been attributed to the revived interest in nature and the Gothic inclination for humorous and anecdotic detail. After highlighting other possible reasons for the occurrence of marginal illumination, this paper introduces two manuscripts from the Archiepiscopal Archives in Ljubljana. The manuscripts show numerous facial drawings affixed to some of the letters. This article addresses how to interpret such drawings and stresses that they do not necessarily function as symbolic images or images with any specific didactic value. Quite the opposite, these drawings seem not to have any meaning and are oft en merely indications of an illuminator’s sense of humor. Because of their exaggerated facial expressions, these drawings could be perceived as the true predecessors of modern caricature.

  10. Margins related to equipment design

    International Nuclear Information System (INIS)

    Devos, J.

    1994-01-01

    Safety margins related to design of reactor equipment are defined according to safety regulations. Advanced best estimate methods are proposed including some examples which were computed and compared to experimental results. Best estimate methods require greater computation effort and more material data but give better variable accuracy and need careful experimental validation. Simplified methods compared to the previous are less sensitive to material data, sometimes are more accurate but very long to elaborate

  11. A methodology to determine margins by EPID measurements of patient setup variation and motion as applied to immobilization devices

    International Nuclear Information System (INIS)

    Prisciandaro, Joann I.; Frechette, Christina M.; Herman, Michael G.; Brown, Paul D.; Garces, Yolanda I.; Foote, Robert L.

    2004-01-01

    Assessment of clinic and site specific margins are essential for the effective use of three-dimensional and intensity modulated radiation therapy. An electronic portal imaging device (EPID) based methodology is introduced which allows individual and population based CTV-to-PTV margins to be determined and compared with traditional margins prescribed during treatment. This method was applied to a patient cohort receiving external beam head and neck radiotherapy under an IRB approved protocol. Although the full study involved the use of an EPID-based method to assess the impact of (1) simulation technique (2) immobilization, and (3) surgical intervention on inter- and intrafraction variations of individual and population-based CTV-to-PTV margins, the focus of the paper is on the technique. As an illustration, the methodology is utilized to examine the influence of two immobilization devices, the UON TM thermoplastic mask and the Type-S TM head/neck shoulder immobilization system on margins. Daily through port images were acquired for selected fields for each patient with an EPID. To analyze these images, simulation films or digitally reconstructed radiographs (DRR's) were imported into the EPID software. Up to five anatomical landmarks were identified and outlined by the clinician and up to three of these structures were matched for each reference image. Once the individual based errors were quantified, the patient results were grouped into populations by matched anatomical structures and immobilization device. The variation within the subgroup was quantified by calculating the systematic and random errors (Σ sub and σ sub ). Individual patient margins were approximated as 1.65 times the individual-based random error and ranged from 1.1 to 6.3 mm (A-P) and 1.1 to 12.3 mm (S-I) for fields matched on skull and cervical structures, and 1.7 to 10.2 mm (L-R) and 2.0 to 13.8 mm (S-I) for supraclavicular fields. Population-based margins ranging from 5.1 to 6.6 mm (A

  12. THE EFFECTIVNESS OF CHRONIC GINGIVITES TREATMENT IN PATIENTS WITH NON-REMOVABLE ORTHODONTIC APPARATUS ACCORDING TO THE RESULTS OF PERIODONTAL TISSUES INDEX ASSESSMENT

    Directory of Open Access Journals (Sweden)

    Ye. Ya. Kostenko

    2017-07-01

    Full Text Available Background. The risk of chronic gingivitis is increased in patients who undergo orthodontic treatment. It is known that the gingivitis is closely correlated with the level of hygiene. Objective. The study involved 123 orthodontic patients with chronic catarrhal and hypertrophic gingivitis that developed during the first two months of active orthodontic treatment. We chose VITIS ORTНODONTIС (DENTAID INTERNATIONAL, Spain that contains active ingredients we need to support healthy state of oral cavity. All studied patients were 12-15 years old. Methods. For dental examination we used health indices OHI-S according to Greene-Vermillion (1964. Gums bleeding was determined according to a modified SBI index by Muhlemann (1971, inflammation of the gingival margin was assessed by PMA index Parma (1960. Results. Therapeutic treatment consisted of the following: all patients underwent correction of oral hygiene, removal of dental plaque. Vitis ORTHODONTIC was prescribed due to the manufacturer's recommendations: rinse 15 ml for 30 seconds after normal procedures of oral hygiene. Eating or drinking is not recommended during the next 30 minutes after using this product. The results proved a high anti-inflammatory efficacy of the treatment schemes. Conclusions. The complex therapy of early manifestations of inflammation in periodontal had a positive effect on the subjective feelings of patients and health performance rate, gum inflammation and bleeding.

  13. Quantifying motion for pancreatic radiotherapy margin calculation

    International Nuclear Information System (INIS)

    Whitfield, Gillian; Jain, Pooja; Green, Melanie; Watkins, Gillian; Henry, Ann; Stratford, Julie; Amer, Ali; Marchant, Thomas; Moore, Christopher; Price, Patricia

    2012-01-01

    Background and purpose: Pancreatic radiotherapy (RT) is limited by uncertain target motion. We quantified 3D patient/organ motion during pancreatic RT and calculated required treatment margins. Materials and methods: Cone-beam computed tomography (CBCT) and orthogonal fluoroscopy images were acquired post-RT delivery from 13 patients with locally advanced pancreatic cancer. Bony setup errors were calculated from CBCT. Inter- and intra-fraction fiducial (clip/seed/stent) motion was determined from CBCT projections and orthogonal fluoroscopy. Results: Using an off-line CBCT correction protocol, systematic (random) setup errors were 2.4 (3.2), 2.0 (1.7) and 3.2 (3.6) mm laterally (left–right), vertically (anterior–posterior) and longitudinally (cranio-caudal), respectively. Fiducial motion varied substantially. Random inter-fractional changes in mean fiducial position were 2.0, 1.6 and 2.6 mm; 95% of intra-fractional peak-to-peak fiducial motion was up to 6.7, 10.1 and 20.6 mm, respectively. Calculated clinical to planning target volume (CTV–PTV) margins were 1.4 cm laterally, 1.4 cm vertically and 3.0 cm longitudinally for 3D conformal RT, reduced to 0.9, 1.0 and 1.8 cm, respectively, if using 4D planning and online setup correction. Conclusions: Commonly used CTV–PTV margins may inadequately account for target motion during pancreatic RT. Our results indicate better immobilisation, individualised allowance for respiratory motion, online setup error correction and 4D planning would improve targeting.

  14. A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status.

    Science.gov (United States)

    Wittekind, Christian; Compton, Carolyn; Quirke, Phil; Nagtegaal, Iris; Merkel, Susanne; Hermanek, Paul; Sobin, Leslie H

    2009-08-01

    Since the introduction of the TNM residual tumor (R) classification, the involvement of resection margins has been defined either as a microscopic (R1) or a macroscopic (R2) demonstration of tumor directly at the resection margin ("tumor transected"). The recognition of the importance of the circumferential resection margin (CRM) in patients with rectal cancer patients raises the need for an alternative definition of resection margin involvement, namely, the importance of delineating tumor with a minimal distance from the CRM of CRM-positive) from tumor directly at the resection margin. The different use of both definitions of resection margin involvement prevents valid comparisons between reports on treatment results. To avoid confusion by different definitions, the authors proposed including the minimal distance between tumor and resection margin into the current R classification. By using the proposed expanded classification, comparisons of new data with previous publications will be possible. Copyright (c) 2009 American Cancer Society.

  15. Assessment and treatment of PTSD after a motor vehicle collision: Empirical findings and clinical observations

    Science.gov (United States)

    Beck, J. Gayle; Coffey, Scott F.

    2007-01-01

    Individuals who experience a serious motor vehicle accident (MVA) are at increased risk for psychological problems, particularly Posttraumatic Stress Disorder (PTSD). In this article, we review the literature on PTSD among MVA survivors, with particular attention to available instruments to screen for and assess symptomatology of the disorder. Approaches to the treatment of PTSD in this population are reviewed, separated into interventions designed to prevent PTSD in unselected samples, treatment targeting individuals with Acute Stress Disorder that are designed to prevent subsequent development of PTSD, and therapy for individuals with chronic PTSD. Treatment process issues are discussed, in an effort to integrate empirical findings with clinical observations. The empirical literature suggests several approaches to treatment that have good potential outcomes, although continued work is needed to identify factors that predict treatment response, as well as augment individual-based treatment formats. PMID:18509507

  16. Margins for geometric uncertainty around organs at risk in radiotherapy

    International Nuclear Information System (INIS)

    McKenzie, Alan; Herk, Marcel van; Mijnheer, Ben

    2002-01-01

    Background and purpose: ICRU Report 62 suggests drawing margins around organs at risk (ORs) to produce planning organ at risk volumes (PRVs) to account for geometric uncertainty in the radiotherapy treatment process. This paper proposes an algorithm for drawing such margins, and compares the recommended margin widths with examples from clinical practice and discusses the limitations of the approach. Method: The use of the PRV defined in this way is that, despite the geometric uncertainties, the dose calculated within the PRV by the treatment planning system can be used to represent the dose in the OR with a certain confidence level. A suitable level is where, in the majority of cases (90%), the dose-volume histogram of the PRV will not under-represent the high-dose components in the OR. In order to provide guidelines on how to do this in clinical practice, this paper distinguishes types of OR in terms of the tolerance doses relative to the prescription dose and suggests appropriate margins for serial-structure and parallel-structure ORs. Results: In some instances of large and parallel ORs, the clinician may judge that the complication risk in omitting a margin is acceptable. Otherwise, for all types of OR, systematic, treatment preparation uncertainties may be accommodated by an OR→PRV margin width of 1.3Σ. Here, Σ is the standard deviation of the combined systematic (treatment preparation) uncertainties. In the case of serial ORs or small, parallel ORs, the effects of blurring caused by daily treatment execution errors (set-up and organ motion) should be taken into account. Near a region of high dose, blurring tends to shift the isodoses away from the unblurred edge as shown on the treatment planning system by an amount that may be represented by 0.5σ. This margin may be used either to increase or to decrease the margin already calculated for systematic uncertainties, depending upon the size of the tolerance dose relative to the detailed planned dose

  17. Assessment and monitoring of treatment response in adult ADHD patients: current perspectives.

    Science.gov (United States)

    Ramsay, J Russell

    2017-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental syndrome that emerges in childhood or early adolescence and persists into adulthood for a majority of individuals. There are many other adults with ADHD who may not seek out evaluation and treatment until adulthood, having been able to "get by" before struggling with inattention, hyperactivity, and/or impulsivity in adulthood, in addition to facing the associated features of disorganization, poor time management, and procrastination among many others. A lifetime diagnosis of ADHD is associated with a wide range of life impairments, which makes a comprehensive and accurate diagnostic assessment essential in order to obtain appropriate treatment. Moreover, while there are effective medical and psychosocial treatments for ADHD, it is important to be able to track treatment response in order to evaluate whether adjustments in specific interventions are needed or referrals for adjunctive treatments and supports are indicated to facilitate optimal therapeutic outcomes. The goal of this article is to provide a clinically useful review of the various measures that practicing clinicians can use to aid in the diagnostic assessment and monitoring of psychosocial and medical treatment of ADHD in adult patients. This review includes various structured interviews, screening scales, adult ADHD symptom inventories, measures of associated features of ADHD, as well as ratings of impairment and functioning which can be adapted to clinicians' practice needs in order to track treatment progress and optimize treatments for adults with ADHD.

  18. Environmental Assessment of Sewage Sludge Management – Focusing on Sludge Treatment Reed Bed Systems

    DEFF Research Database (Denmark)

    Larsen, Julie Dam

    ; however, in the late 1980s, sludge treatment reed bed (STRB) systems were intro-duced in Denmark and in 2016, more than 100 STRB systems were operating in the country. Sludge treatment in STRB systems is often considered more environmentally friendly compared to mechanical sludge treatment technologies......, albeit only a few life cycle assess-ments (LCAs) comparing the environmental performances of sludge treatment technologies include STRB systems. Furthermore, as data on the STRB system technology suitable for LCA are scarce, the results of these LCAs are unreliable. The project aimed at generating data...... in treated sludge when applied to the land. The overall goal of the project was to perform an LCA comparing the environmental performance of the STRB system technology with a conventional technology based on mechanical dewatering of sludge on a decanter centrifuge and subsequent storage. Geographically...

  19. Wastewater Treatment Energy Recovery Potential For Adaptation To Global Change: An Integrated Assessment.

    Science.gov (United States)

    Breach, Patrick A; Simonovic, Slobodan P

    2018-04-01

    Approximately 20% of wastewaters globally do not receive treatment, whereas wastewater discharges are projected to increase, thereby leading to excessive water quality degradation of surface waters on a global scale. Increased treatment could help alleviate water quality issues by constructing more treatment plants; however, in many areas there exist economic constraints. Energy recovery methods including the utilization of biogas and incineration of biosolids generated during the treatment process may help to alleviate treatment costs. This study explores the potential for investments in energy recovery from wastewater to increase treatment levels and thus improve surface water quality. This was done by examining the relationships between nutrient over-enrichment, wastewater treatment, and energy recovery at a global scale using system dynamics simulation as part of the ANEMI integrated assessment model. The results show that a significant amount of energy can be recovered from wastewater, which helps to alleviate some of the costs of treatment. It was found that wastewater treatment levels could be increased by 34%, helping to offset the higher nutrient loading from a growing population with access to improved sanitation. The production of renewable natural gas from biogas was found to have the potential to prolong the depletion of natural gas resources used to produce electricity and heat. It is recommended that agricultural nutrient discharges be better managed to help reduce nutrient over-enrichment on global scale. To increase the utility of the simulation, a finer spatial scale should be used to consider regional treatment, economic, and water quality characteristics.

  20. Wastewater Treatment Energy Recovery Potential For Adaptation To Global Change: An Integrated Assessment

    Science.gov (United States)

    Breach, Patrick A.; Simonovic, Slobodan P.

    2018-04-01

    Approximately 20% of wastewaters globally do not receive treatment, whereas wastewater discharges are projected to increase, thereby leading to excessive water quality degradation of surface waters on a global scale. Increased treatment could help alleviate water quality issues by constructing more treatment plants; however, in many areas there exist economic constraints. Energy recovery methods including the utilization of biogas and incineration of biosolids generated during the treatment process may help to alleviate treatment costs. This study explores the potential for investments in energy recovery from wastewater to increase treatment levels and thus improve surface water quality. This was done by examining the relationships between nutrient over-enrichment, wastewater treatment, and energy recovery at a global scale using system dynamics simulation as part of the ANEMI integrated assessment model. The results show that a significant amount of energy can be recovered from wastewater, which helps to alleviate some of the costs of treatment. It was found that wastewater treatment levels could be increased by 34%, helping to offset the higher nutrient loading from a growing population with access to improved sanitation. The production of renewable natural gas from biogas was found to have the potential to prolong the depletion of natural gas resources used to produce electricity and heat. It is recommended that agricultural nutrient discharges be better managed to help reduce nutrient over-enrichment on global scale. To increase the utility of the simulation, a finer spatial scale should be used to consider regional treatment, economic, and water quality characteristics.

  1. Treatment planning capability assessment of a beam shaping assembly for accelerator-based BNCT.

    Science.gov (United States)

    Herrera, M S; González, S J; Burlon, A A; Minsky, D M; Kreiner, A J

    2011-12-01

    Within the frame of an ongoing project to develop a folded Tandem-Electrostatic-Quadrupole accelerator facility for Accelerator-Based Boron Neutron Capture Therapy (AB-BNCT) a theoretical study was performed to assess the treatment planning capability of different configurations of an optimized beam shaping assembly for such a facility. In particular this study aims at evaluating treatment plans for a clinical case of Glioblastoma. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. ECOLOGICAL LIFE CYCLE ASSESSMENT OF MODIFIED NOVOLAKS WASTE USED IN INDUSTRIAL WASTEWATER TREATMENT

    Directory of Open Access Journals (Sweden)

    Wioletta M. BAJDUR

    2017-06-01

    Full Text Available Ecological Life Cycle Assessment (LCA applied in the assessment of the impact of products on the environment is a technique that allows for the evaluation of the environmental impact of polymeric flocculants used in industrial wastewater treatment. The possibility of conducting a full life cycle and thus manufacturing process analysis allows for reliable and accurate identification of the sources of environmental hazards and the impact of new products on the environment. Newly synthesized waste-based polymers are water soluble and possess the properties of flocculants, while reducing the parameters in industrial wastewater. In the paper, there are presented the results of the analysis conducted using LCA technique for the assessment of the impact of modified waste phenol formaldehyde resin (Novolak on the environment. LCA technique was used to assess the impact of the new flocculant applied in the process of metallurgical wastewater treatment taking into account the environmental impact of the flocculant manufacturing process.

  3. Life Cycle Assessment of urban wastewater reuse with ozonation as tertiary treatment

    International Nuclear Information System (INIS)

    Munoz, Ivan; Rodriguez, Antonio; Rosal, Roberto; Fernandez-Alba, Amadeo R.

    2009-01-01

    Life Cycle Assessment has been used to compare different scenarios involving wastewater reuse, with special focus on toxicity-related impact categories. The study is based on bench-scale experiments applying ozone and ozone in combination with hydrogen peroxide to a wastewater effluent from a Spanish sewage treatment plant. Two alternative characterisation models have been used to account for toxicity of chemical substances, namely USES-LCA and EDIP97. Four alternative scenarios have been assessed: wastewater discharge plus desalination supply, wastewater reuse without tertiary treatment, wastewater reuse after applying a tertiary treatment consisting on ozonation, and wastewater reuse after applying ozonation in combination with hydrogen peroxide. The results highlight the importance of including wastewater pollutants in LCA of wastewater systems assessing toxicity, since the contribution of wastewater pollutants to the overall toxicity scores in this case study can be above 90%. Key pollutants here are not only heavy metals and other priority pollutants, but also non-regulated pollutants such as pharmaceuticals and personal care products. Wastewater reuse after applying any of the tertiary treatments considered appears as the best choice from an ecotoxicity perspective. As for human toxicity, differences between scenarios are smaller, and taking into account the experimental and modelling uncertainty, the benefits of tertiary treatment are not so clear. From a global warming potential perspective, tertiary treatments involve a potential 85% reduction of greenhouse gas emissions when compared with desalination

  4. Patterns of failure for glioblastoma multiforme following limited-margin radiation and concurrent temozolomide

    International Nuclear Information System (INIS)

    Gebhardt, Brian J; Dobelbower, Michael C; Ennis, William H; Bag, Asim K; Markert, James M; Fiveash, John B

    2014-01-01

    To analyze patterns of failure in patients with glioblastoma multiforme (GBM) treated with limited-margin radiation therapy and concurrent temozolomide. We hypothesize that patients treated with margins in accordance with Adult Brain Tumor Consortium guidelines (ABTC) will demonstrate patterns of failure consistent with previous series of patients treated with 2–3 cm margins. A retrospective review was performed of patients treated at the University of Alabama at Birmingham for GBM between 2000 and 2011. Ninety-five patients with biopsy-proven disease and documented disease progression after treatment were analyzed. The initial planning target volume includes the T1-enhancing tumor and surrounding edema plus a 1 cm margin. The boost planning target volume includes the T1-enhancing tumor plus a 1 cm margin. The tumors were classified as in-field, marginal, or distant if greater than 80%, 20-80%, or less than 20% of the recurrent volume fell within the 95% isodose line, respectively. The median progression-free survival from the time of diagnosis to documented failure was 8 months (range 3–46). Of the 95 documented recurrences, 77 patients (81%) had an in-field component of treatment failure, 6 (6%) had a marginal component, and 27 (28%) had a distant component. Sixty-three patients (66%) demonstrated in-field only recurrence. The low rate of marginal recurrence suggests that wider margins would have little impact on the pattern of failure, validating the use of limited margins in accordance ABTC guidelines

  5. Silenced, Silence, Silent: Motherhood in the Margins

    Science.gov (United States)

    Carpenter, Lorelei; Austin, Helena

    2007-01-01

    This project explores the experiences of women who mother children with ADHD. The authors use the metaphor of the text and the margin. The text is the "motherhood myth" that describes a particular sort of "good" mothering. The margin is the space beyond that text. This marginal space is inhabited by some or all of the mothers they spoke with, some…

  6. 17 CFR 31.18 - Margin calls.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Margin calls. 31.18 Section 31....18 Margin calls. (a) No leverage transaction merchant shall liquidate a leverage contract because of a margin deficiency without effecting personal contact with the leverage customer. If a leverage...

  7. Research priorities for zoonoses and marginalized infections.

    Science.gov (United States)

    2012-01-01

    This report provides a review and analysis of the research landscape for zoonoses and marginalized infections which affect poor populations, and a list of research priorities to support disease control. The work is the output of the Disease Reference Group on Zoonoses and Marginalized Infectious Diseases of Poverty (DRG6), which is part of an independent think tank of international experts, established and funded by the Special Programme for Research and Training in Tropical Diseases (TDR), to identify key research priorities through review of research evidence and input from stakeholder consultations. The report covers a diverse range of diseases, including zoonotic helminth, protozoan, viral and bacterial infections considered to be neglected and associated with poverty. Disease-specific research issues are elaborated under individual disease sections and many common priorities are identified among the diseases such as the need for new and/or improved drugs and regimens, diagnostics and, where appropriate, vaccines. The disease-specific priorities are described as micro priorities compared with the macro level priorities which will drive policy-making for: improved surveillance; interaction between the health, livestock, agriculture, natural resources and wildlife sectors in tackling zoonotic diseases; and true assessment of the burden of zoonoses. This is one often disease and thematic reference group reports that have come out of the TDR Think Tank, all of which have contributed to the development of the Global Report search on Infectious Diseases of Poverty, available at: w.who.int/tdr/stewardship/global_report/en/index.html.

  8. Treatment of biodiversity issues in impact assessment of electricity power transmission lines: A Finnish case review

    International Nuclear Information System (INIS)

    Soederman, Tarja

    2006-01-01

    The Environmental Impact Assessment (EIA) process concerning the route of a 400 kV power transmission line between Loviisa and Hikiae in southern Finland was reviewed in order to assess how biodiversity issues are treated and to provide suggestions on how to improve the effectiveness of treatment of biodiversity issues in impact assessment of linear development projects. The review covered the whole assessment process, including interviews of stakeholders, participation in the interest group meetings and review of all documents from the project. The baseline studies and assessment of direct impacts in the case study were detailed but the documentation, both the assessment programme and the assessment report, only gave a partial picture of the assessment process. All existing information, baseline survey and assessment methods should be addressed in the scoping phase in order to promote interaction between all stakeholders. In contrast to the assessment of the direct effects, which first emphasized impacts on the nationally important and protected flying squirrel but later expanded to deal with the assessment of impacts on ecologically important sites, the indirect and cumulative impacts of the power line were poorly addressed. The public was given the opportunity to become involved in the EIA process. However, they were more concerned with impacts on their properties and less so on biodiversity and species protection issues. This suggests that the public needs to become more informed about locally important features of biodiversity

  9. Nursing professionals’ knowledge and attitude related to assessment and treatment of neonatal pain

    OpenAIRE

    Iana Mundim de Oliveira; Thaíla Corrêa Castral; Marcela Maria Faria Peres Cavalcante; Julyana Calatayud Carvalho; Mariana Firmino Daré; Ana Karina Marques Salge

    2016-01-01

    The objective of the study was to verify the knowledge and attitude of nursing professionals from a neonatal unit regarding assessment and treatment of acute procedural pain in newborns. We conducted an exploratory descriptive study with 26 nursing professionals from a neonatal unit at the Center-Western region of Brazil. Most professionals identified at least one assessment scale for neonatal pain (76.9%). Strategies to relieve pain chosen by professionals were decrease of noise and light (8...

  10. Assessing Treatment Options Based on Expected Long-Term Results: Case Report Demonstrates 6-Year Outcomes.

    Science.gov (United States)

    McMaster, Douglas E

    2015-05-01

    A patient whose chief concern was the esthetics of her anterior teeth presented for a second opinion after it had been recommended that crowns be placed throughout her mouth. Examination revealed numerous defective and some fractured restorations with recurring caries. With treatment goals including creating and maintaining a healthy periodontal environment, leveling the occlusal plane, and decreasing biomechanical risk, the treatment plan incorporated an interdisciplinary approach that utilized orthodontics, a Kois deprogrammer, and implant therapy. Demonstrating 6-year outcomes, this report discusses use of a method to assess treatment options based on expected long-term results.

  11. Managing margins through physician engagement.

    Science.gov (United States)

    Sears, Nicholas J

    2012-07-01

    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication.

  12. Lithosphere structure and subsidence evolution of the conjugate S-African and Argentine margins

    Science.gov (United States)

    Dressel, Ingo; Scheck-Wenderoth, Magdalena; Cacace, Mauro; Götze, Hans-Jürgen; Franke, Dieter

    2016-04-01

    The bathymetric evolution of the South Atlantic passive continental margins is a matter of debate. Though it is commonly accepted that passive margins experience thermal subsidence as a result of lithospheric cooling as well as load induced subsidence in response to sediment deposition it is disputed if the South Atlantic passive margins were affected by additional processes affecting the subsidence history after continental breakup. We present a subsidence analysis along the SW African margin and offshore Argentina and restore paleobathymetries to assess the subsidence evolution of the margin. These results are discussed with respect to mechanisms behind margin evolution. Therefore, we use available information about the lithosphere-scale present-day structural configuration of these margins as a starting point for the subsidence analysis. A multi 1D backward modelling method is applied to separate individual subsidence components such as the thermal- as well as the load induced subsidence and to restore paleobathymetries for the conjugate margins. The comparison of the restored paleobathymetries shows that the conjugate margins evolve differently: Continuous subsidence is obtained offshore Argentina whereas the subsidence history of the SW African margin is interrupted by phases of uplift. This differing results for both margins correlate also with different structural configurations of the subcrustal mantle. In the light of these results we discuss possible implications for uplift mechanisms.

  13. Enhancing the management of secondary encopresis by assessing acceptability of treatment: a case study.

    Science.gov (United States)

    Steege, M W; Harper, D C

    1989-12-01

    This clinical case study utilized a behavioral treatment sequence to assist an 11-year-old encopretic male who had been refractory to prior treatments. The sequence included: (1) positive reinforcement of bowel movements and the non-occurrence of soiling accidents; (2) self-evaluation; (3) positive practice; (4) milk of magnesia; (5) diet modifications; and (6) a numbered underwear strategy. The treatment was initiated on a pediatric inpatient unit and then generalized to the child's home environment. Parental acceptability of treatment was assessed during a three-day home visit while the procedure was implemented by the parents. The combination of behavioral treatment with milk of magnesia eliminated soiling accidents and increased the frequency of appropriate bowel movements. Results were maintained throughout a one-year follow-up.

  14. Seismic margin review of the Maine Yankee Atomic Power Station: Fragility analysis

    International Nuclear Information System (INIS)

    Ravindra, M.K.; Hardy, G.S.; Hashimoto, P.S.; Griffin, M.J.

    1987-03-01

    This Fragility Analysis is the third of three volumes for the Seismic Margin Review of the Maine Yankee Atomic Power Station. Volume 1 is the Summary Report of the first trial seismic margin review. Volume 2, Systems Analysis, documents the results of the systems screening for the review. The three volumes are part of the Seismic Margins Program initiated in 1984 by the Nuclear Regulatory Commission (NRC) to quantify seismic margins at nuclear power plants. The overall objectives of the trial review are to assess the seismic margins of a particular pressurized water reactor, and to test the adequacy of this review approach, quantification techniques, and guidelines for performing the review. Results from the trial review will be used to revise the seismic margin methodology and guidelines so that the NRC and industry can readily apply them to assess the inherent quantitative seismic capacity of nuclear power plants

  15. Seismic margin review of the Maine Yankee Atomic Power Station: Fragility analysis

    Energy Technology Data Exchange (ETDEWEB)

    Ravindra, M. K.; Hardy, G. S.; Hashimoto, P. S.; Griffin, M. J.

    1987-03-01

    This Fragility Analysis is the third of three volumes for the Seismic Margin Review of the Maine Yankee Atomic Power Station. Volume 1 is the Summary Report of the first trial seismic margin review. Volume 2, Systems Analysis, documents the results of the systems screening for the review. The three volumes are part of the Seismic Margins Program initiated in 1984 by the Nuclear Regulatory Commission (NRC) to quantify seismic margins at nuclear power plants. The overall objectives of the trial review are to assess the seismic margins of a particular pressurized water reactor, and to test the adequacy of this review approach, quantification techniques, and guidelines for performing the review. Results from the trial review will be used to revise the seismic margin methodology and guidelines so that the NRC and industry can readily apply them to assess the inherent quantitative seismic capacity of nuclear power plants.

  16. Treatment response assessment of radiofrequency ablation for hepatocellular carcinoma: Usefulness of virtual CT sonography with magnetic navigation

    International Nuclear Information System (INIS)

    Minami, Yasunori; Kitai, Satoshi; Kudo, Masatoshi

    2012-01-01

    Purpose: Virtual CT sonography using magnetic navigation provides cross sectional images of CT volume data corresponding to the angle of the transducer in the magnetic field in real-time. The purpose of this study was to clarify the value of this virtual CT sonography for treatment response of radiofrequency ablation for hepatocellular carcinoma. Patients and methods: Sixty-one patients with 88 HCCs measuring 0.5–1.3 cm (mean ± SD, 1.0 ± 0.3 cm) were treated by radiofrequency ablation. For early treatment response, dynamic CT was performed 1–5 days (median, 2 days). We compared early treatment response between axial CT images and multi-angle CT images using virtual CT sonography. Results: Residual tumor stains on axial CT images and multi-angle CT images were detected in 11.4% (10/88) and 13.6% (12/88) after the first session of RFA, respectively (P = 0.65). Two patients were diagnosed as showing hyperemia enhancement after the initial radiofrequency ablation on axial CT images and showed local tumor progression shortly because of unnoticed residual tumors. Only virtual CT sonography with magnetic navigation retrospectively showed the residual tumor as circular enhancement. In safety margin analysis, 10 patients were excluded because of residual tumors. The safety margin more than 5 mm by virtual CT sonographic images and transverse CT images were determined in 71.8% (56/78) and 82.1% (64/78), respectively (P = 0.13). The safety margin should be overestimated on axial CT images in 8 nodules. Conclusion: Virtual CT sonography with magnetic navigation was useful in evaluating the treatment response of radiofrequency ablation therapy for hepatocellular carcinoma.

  17. Assessment and monitoring of treatment response in adult ADHD patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Ramsay JR

    2017-01-01

    Full Text Available J Russell Ramsay Adult ADHD Treatment & Research Program, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA Abstract: Attention-deficit/hyperactivity disorder (ADHD is a neurodevelopmental syndrome that emerges in childhood or early adolescence and persists into adulthood for a majority of individuals. There are many other adults with ADHD who may not seek out evaluation and treatment until adulthood, having been able to “get by” before struggling with inattention, hyperactivity, and/or impulsivity in adulthood, in addition to facing the associated features of disorganization, poor time management, and procrastination among many others. A lifetime diagnosis of ADHD is associated with a wide range of life impairments, which makes a comprehensive and accurate diagnostic assessment essential in order to obtain appropriate treatment. Moreover, while there are effective medical and psychosocial treatments for ADHD, it is important to be able to track treatment response in order to evaluate whether adjustments in specific interventions are needed or referrals for adjunctive treatments and supports are indicated to facilitate optimal therapeutic outcomes. The goal of this article is to provide a clinically useful review of the various measures that practicing clinicians can use to aid in the diagnostic assessment and monitoring of psychosocial and medical treatment of ADHD in adult patients. This review includes various structured interviews, screening scales, adult ADHD symptom inventories, measures of associated features of ADHD, as well as ratings of impairment and functioning which can be adapted to clinicians’ practice needs in order to track treatment progress and optimize treatments for adults with ADHD. Keywords: adult attention-deficit/hyperactivity disorder, adult ADHD, pharmacotherapy, psychosocial treatment, symptoms, functional impairments, executive functions

  18. Issues and challenges in the assessment, diagnosis and treatment of cardiovascular risk factors: Assessing the needs of cardiologists

    Directory of Open Access Journals (Sweden)

    Dupuis Martin

    2008-05-01

    Full Text Available Abstract Background This needs assessment, initiated by the Academy for Healthcare Education Inc. in cooperation with AXDEV Group Inc., explored the knowledge, attitudes, behavior, and skills of community-based and academic-affiliated U.S. cardiologists in the area of CV risk assessment, treatment, and management from July 2006 to December 2006. Methods The needs assessment used a multistage, mixed-method approach to collect, analyze, and verify data from two independent sources. The exploratory phase collected data from a representative sampling of U.S. cardiologists by means of qualitative panel meetings, one-on-one interviews, and quantitative questionnaires. In the validation phase, 150 cardiologists from across the United States completed a quantitative online questionnaire. Data were analyzed with standardized statistical methods. Results The needs assessment found that cardiologists have areas of weakness pertaining to their interpersonal skills, which may influence patient-physician communication and patient adherence. Cardiologists appeared to have little familiarity with or lend little credence to the concept of relative CV risk. In daily clinical practice, they faced challenges with regard to optimal patient outcome in areas of patient referral from primary-care providers, CV risk assessment and treatment, and patient monitoring. Community-based and academic-affiliated cardiologists appeared to be only moderately interested in educational interventions that pertain to CV risk-reduction strategies. Conclusion Educational interventions that target cardiologists' interpersonal skills to enhance their efficacy may benefit community-based and academic-affiliated specialists. Other desirable educational initiatives should address gaps in the patient referral process, improve patient knowledge and understanding of their disease, and provide supportive educational tools and materials to enhance patient-physician communication.

  19. Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners

    DEFF Research Database (Denmark)

    Hansen, Malene Plejdrup; Bjerrum, Lars; Gahrn-Hansen, Bente

    2013-01-01

    Background: In 2008, a set of 41 quality indicators for antibiotic treatment of respiratory tract infections (RTIs) in general practice were developed in an international setting as part of the European project HAPPY AUDIT. Objectives: To investigate Danish general practitioners' (GPs') assessment...... of a set of internationally developed quality indicators and to explore if there is an association between the GPs' assessment of the indicators and their practice characteristics as well as their antibiotic prescription pattern. Methods: A total of 102 Danish GPs were invited to assess the 41 quality...

  20. Assessment and treatment of insomnia in adult patients with alcohol use disorders.

    Science.gov (United States)

    Brower, Kirk J

    2015-06-01

    Insomnia in patients with alcohol dependence has increasingly become a target of treatment due to its prevalence, persistence, and associations with relapse and suicidal thoughts, as well as randomized controlled studies demonstrating efficacy with behavior therapies and non-addictive medications. This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Selecting among the various options for treatment follows a comprehensive assessment of insomnia and its multifactorial causes. In addition to chronic, heavy alcohol consumption and its effects on sleep regulatory systems, contributing factors include premorbid insomnia; co-occurring medical, psychiatric, and other sleep disorders; use of other substances and medications; stress; environmental factors; and inadequate sleep hygiene. The assessment makes use of history, rating scales, and sleep diaries as well as physical, mental status, and laboratory examinations to rule out these factors. Polysomnography is indicated when another sleep disorder is suspected, such as sleep apnea or periodic limb movement disorder, or when insomnia is resistant to treatment. Sobriety remains a necessary, first-line treatment for insomnia, and most patients will have some improvement. If insomnia-specific treatment is needed, then brief behavioral therapies are the treatment of choice, because they have shown long-lasting benefit without worsening of drinking outcomes. Medications work faster, but they generally work only as long as they are taken. Melatonin agonists; sedating antidepressants, anticonvulsants, and antipsychotics; and benzodiazepine receptor agonists each have their benefits and risks, which must be weighed and monitored to optimize outcomes. Some relapse prevention medications may also have sleep-promoting activity. Although it is assumed that treatment for insomnia will help prevent relapse, this has not been firmly established. Therefore

  1. Skin cancer margin analysis within minutes with full-field OCT (Conference Presentation)

    Science.gov (United States)

    Dalimier, Eugénie; Ogrich, Lauren; Morales, Diego; Cusack, Carrie Ann; Abdelmalek, Mark; Boccara, Claude; Durkin, John

    2017-02-01

    Non-melanoma skin cancer (NMSC) is the most common cancer. Treatment consists of surgical removal of the skin cancer. Traditional excision involves the removal of the visible skin cancer with a significant margin of normal skin. On cosmetically sensitive areas, Mohs micrographic tissue is the standard of care. Mohs uses intraoperative microscopic margin assessment which minimizes the surgical defect and can help reduce the recurrence rate by a factor of 3. The current Mohs technique relies on frozen section tissue slide preparation which significantly lengthens operative time and requires on-site trained histotechnicians. Full-Field Optical Coherence Tomography (FFOCT) is a novel optical imaging technique which provides a quick and efficient method to visualize cancerous areas in minutes, without any preparation or destruction of the tissue. This study aimed to evaluate the potential of FFOCT for the analysis of skin cancer margins during Mohs surgery. Over 150 images of Mohs specimens were acquired intraoperatively with FFOCT before frozen section analysis. The imaging procedure took less than 5 minutes for each specimen. No artifacts on histological preparation were found arising from FFOCT manipulation; however frozen section artifact was readily seen on FFOCT. An atlas was established with FFOCT images and corresponding histological slides to reveal FFOCT reading criteria of normal and cancerous structures. Blind analysis showed high concordance between FFOCT and histology. FFOCT can potentially reduce recurrence rates while maintaining short surgery times, optimize clinical workflow, and decrease healthcare costs. For the patient, this translates into smaller infection risk, decreased stress, and better comfort.

  2. Surgical Margin Status after Breast Conservation Surgery at Aga ...

    African Journals Online (AJOL)

    The conservation of the breast in a woman after diagnosis of breast cancer plays a vital role in the overall management of the patient. While the cosmetic outcome enhances the patients' self-image, assurance of clear margins is essential in prognostication. An analysis was carried out to assess the adequacy of surgical ...

  3. Seismic margin analysis technique for nuclear power plant structures

    International Nuclear Information System (INIS)

    Seo, Jeong Moon; Choi, In Kil

    2001-04-01

    In general, the Seismic Probabilistic Risk Assessment (SPRA) and the Seismic Margin Assessment(SAM) are used for the evaluation of realistic seismic capacity of nuclear power plant structures. Seismic PRA is a systematic process to evaluate the seismic safety of nuclear power plant. In our country, SPRA has been used to perform the probabilistic safety assessment for the earthquake event. SMA is a simple and cost effective manner to quantify the seismic margin of individual structural elements. This study was performed to improve the reliability of SMA results and to confirm the assessment procedure. To achieve this goal, review for the current status of the techniques and procedures was performed. Two methodologies, CDFM (Conservative Deterministic Failure Margin) sponsored by NRC and FA (Fragility Analysis) sponsored by EPRI, were developed for the seismic margin review of NPP structures. FA method was originally developed for Seismic PRA. CDFM approach is more amenable to use by experienced design engineers including utility staff design engineers. In this study, detailed review on the procedures of CDFM and FA methodology was performed

  4. Comparison of central adjudication of outcomes and onsite outcome assessment on treatment effect estimates.

    Science.gov (United States)

    Ndounga Diakou, Lee Aymar; Trinquart, Ludovic; Hróbjartsson, Asbjørn; Barnes, Caroline; Yavchitz, Amelie; Ravaud, Philippe; Boutron, Isabelle

    2016-03-10

    Assessment of events by adjudication committees (ACs) is recommended in multicentre randomised controlled trials (RCTs). However, its usefulness has been questioned. The aim of this systematic review was to compare 1) treatment effect estimates of subjective clinical events assessed by onsite assessors versus by AC, and 2) treatment effect estimates according to the blinding status of the onsite assessor as well as the process used to select events to adjudicate. We searched Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, PsycINFO, CINAHL and Google Scholar (25 August 2015 as the last updated search date), using a combination of terms to retrieve RCTs with commonly used terms to describe ACs. We included all reports of RCTs and the published RCTs included in reviews and meta-analyses that reported the same subjective outcome event assessed by both an onsite assessor and an AC. We extracted the odds ratio (OR) from onsite assessment and the corresponding OR from AC assessment and calculated the ratio of the odds ratios (ROR). A ratio of odds ratios effect estimates in favour of the experimental treatment than ACs. Data from 47 RCTs (275,078 patients) were used in the meta-analysis. We excluded 11 RCTs because of incomplete outcome data to calculate the OR for onsite and AC assessments. On average, there was no difference in treatment effect estimates from onsite assessors and AC (combined ROR: 1.00, 95% confidence interval (CI) 0.97 to 1.04; I(2) = 0%, 47 RCTs). The combined ROR was 1.00 (95% CI 0.96 to 1.04; I(2) = 0%, 35 RCTs) when onsite assessors were blinded; 0.76 (95% CI 0.48 to 1.12, I(2) = 0%, two RCTs) when AC assessed events identified independently from unblinded onsite assessors; and 1.11 (95% CI 0.96 to 1.27, I(2) = 0%, 10 RCTs) when AC assessed events identified by unblinded onsite assessors. However, there was a statistically significant interaction between these subgroups (P = 0.03) AUTHORS' CONCLUSIONS: On average

  5. Vertical distraction of the severely resorbed edentulous mandible : An assessment of treatment outcome

    NARCIS (Netherlands)

    Raghoebar, Gerry M.; Stellingsma, Kees; Meijer, Henny J. A.; Vissink, Arjan

    2008-01-01

    Purpose: To assess the treatment outcome (implant survival, surgical complications, patient satisfaction) of vertical distraction of the severely resorbed edentulous mandible. Materials and Methods: Forty-six patients with severe resorption of the edentulous mandible (bone height 5 to 8 mm, median 6

  6. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

    NARCIS (Netherlands)

    Bier, Jasper D; Scholten-Peeters, Wendy G M; Staal, J Bart; Pool, Jan; van Tulder, Maurits W; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P

    2017-01-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  7. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain

    NARCIS (Netherlands)

    Bier, Jasper D.; Scholten-Peeters, Wendy G. M.; Staal, J. Bart; Pool, Jan; van Tulder, Maurits W.; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P.

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  8. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain

    NARCIS (Netherlands)

    Bier, Jasper D.; Scholten-Peeters, Wendy G.M.; Staal, J. Bart; Pool, Jan; van Tulder, Maurits W.; Beekman, Emmylou; Knoop, Jesper; Meerhoff, Guus; Verhagen, Arianne P.

    2018-01-01

    The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of

  9. Texas Christian University (TCU) Short Forms for Assessing Client Needs and Functioning in Addiction Treatment

    Science.gov (United States)

    Simpson, D. Dwayne; Joe, George W.; Knight, Kevin; Rowan-Szal, Grace A.; Gray, Julie S.

    2012-01-01

    The TCU Short Forms contain a revised and expanded set of assessments for planning and managing addiction treatment services. They are formatted as brief (one-page) forms to measure client needs and functioning, including drug use severity and history (TCUDS II), criminal thinking and cognitive orientation (CTSForm), motivation and readiness for…

  10. The world is a scary place? INvestigating Treatments and Assessment for Children after Trauma

    NARCIS (Netherlands)

    Diehle, J.

    2014-01-01

    This dissertation provides new insights about treatments and assessment for children who experienced traumatic events. We investigated the comparative effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) by means of a

  11. Religion and End-of-Life Treatment Preferences: Assessing the Effects of Religious Denomination and Beliefs

    Science.gov (United States)

    Sharp, Shane; Carr, Deborah; Macdonald, Cameron

    2012-01-01

    We use Wisconsin Longitudinal Study data (n = 2,678) to assess the effects of religious denomination and ideology on end-of-life treatment preferences in two hypothetical terminal illness scenarios: physical pain and severe cognitive impairment. We found no statistically significant differences when comparing traditionally defined religious…

  12. A simple method for assessing quinine pre-treatment in acute malaria

    NARCIS (Netherlands)

    Silamut, K.; Hough, R.; Eggelte, T.; Pukrittayakamee, S.; Angus, B.; White, N. J.

    1995-01-01

    Administration of a loading dose of quinine in severe malaria may be dangerous if therapeutic blood concentrations are already present because of previous treatment. To assess the reliability of the history of pretreatment we conducted a prospective study of 379 adult patients with acute falciparum

  13. ArcFuels: an ArcMap toolbar for fuel treatment planning and wildfire risk assessment

    Science.gov (United States)

    Nicole M. Vaillant; Alan A. Ager

    2014-01-01

    Fire behavior modeling and geospatial analysis can provide tremendous insight to land managers in defining both the benefits and potential impacts of fuel treatments in the context of land management goals and public expectations. ArcFuels is a streamlined fuel management planning and wildfire risk assessment system that creates a trans-scale (stand to large landscape...

  14. Using Pretreatment and Posttreatment Assessments To Enhance and Evaluate Existing Treatment Packages.

    Science.gov (United States)

    Richman, David M.; Berg, Wendy K.; Wacker, David P.; Stephens, Tracy; Rankin, Barbara; Kilroy, Jennette

    1997-01-01

    Pretreatment assessment data were used to enhance an existing treatment package to reduce aggression and to increase the positive social interactions of a 9-year-old boy with moderate mental retardation and Hunter's syndrome. Additional reinforcements and punishment components were added and resulted in positive social interactions and suppressed…

  15. Relationships between Rapid Eye Movement Sleep Behavior Disorder and Neurodegenerative Diseases: Clinical Assessments, Biomarkers, and Treatment

    Directory of Open Access Journals (Sweden)

    Min Li

    2018-01-01

    Conclusions: More longitudinal studies should be conducted to evaluate the predictive value of biomarkers of RBD. Moreover, because the glucose and dopamine metabolisms are not specific for assessing cognitive cognition, the molecular metabolism directly related to cognition should be investigated. There is a need for more treatment trials to determine the effectiveness of interventions of RBD on preventing the conversion to neurodegenerative diseases.

  16. Utility of Doppler ultrasonography for diagnosing and assessing treatment effects in liver compartment syndrome.

    Science.gov (United States)

    Ando, Yusuke; Ishigami, Masatoshi; Ishizu, Yoji; Kuzuya, Teiji; Honda, Takashi; Hayashi, Kazuhiko; Ishikawa, Tetsuya; Goto, Hidemi; Hirooka, Yoshiki

    2017-06-01

    Liver compartment syndrome is a life-threatening complication of hepatic subcapsular hematoma; diagnosis and assessment of treatment effects are therefore important. We report a rare case of liver compartment syndrome due to spontaneous hepatic subcapsular hematoma without any underlying conditions, in which Doppler ultrasonography (US) proved useful in both diagnosis and assessment of treatment effects. A 32-year-old woman experienced sudden epigastralgia and was diagnosed with hepatic subcapsular hematoma in the right lobe, based on contrast-enhanced computed tomography. Hepatic arteriography showed active hemorrhage and Doppler US showed retrograde flow in the right portal vein. From these findings, we diagnosed hepatic subcapsular hematoma complicated with liver compartment syndrome, and performed embolization of the bleeding point and percutaneous hematoma drainage. After these medical procedures, normalized antegrade flow in the right portal vein was observed on Doppler US. No underlying conditions contributing to hematoma were identified. In this case, Doppler US was useful for both diagnosis and assessment of treatment effects in liver compartment syndrome. When we examine patients with hepatic subcapsular hematoma, Doppler US should be used to diagnose the presence of liver compartment syndrome and assess treatment effects.

  17. Anxiety disorders in young children: Parent and child contributions to the maintenance, assessment and treatment

    NARCIS (Netherlands)

    van der Sluis, C.M.

    2016-01-01

    It was not until recently that research started to focus on the maintenance, assessment and treatment of anxiety disorders in young children aged 4-7 years. It was assumed that, especially for children of this age, parents play an important role. However, this was rarely empirically tested, nor were

  18. Attention Deficit Hyperactivity Disorder among Asian American Families: Challenges in Assessment and Treatment

    Science.gov (United States)

    Pham, Andy V.

    2013-01-01

    Studies addressing assessment and treatment of attention deficit hyperactivity disorder (ADHD) have primarily been focused on Caucasian populations, although a growing number of studies have included ethnic minority populations, particularly Hispanic and African American children. Findings regarding the relationship between ADHD diagnosis and race…

  19. Selective Mutism: A Team Approach to Assessment and Treatment in the School Setting

    Science.gov (United States)

    Ponzurick, Joan M.

    2012-01-01

    The school nurse plays a pivotal role in the assessment and treatment of selective mutism (SM), a rare disorder found in elementary school children. Due to anxiety, children with SM do not speak in uncomfortable situations, primarily the school setting. Diagnosis of SM is often missed in the formative years because the child does speak at home.…

  20. Assessment and Treatment of Selective Mutism: Recommendations and a Case Study.

    Science.gov (United States)

    Sheridan, Susan M.; And Others

    1995-01-01

    Presents results of stimulus fading procedure used to treat a six-year-old girl with elective mutism. Presents assessment protocol that features procedures that can be used to render a diagnosis and assist in treatment planning. Results suggest stimulus fading of new persons into the school setting was effective in producing speech. (JBJ)

  1. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder

    Science.gov (United States)

    Cohen, Judith A.; Bukstein, Oscar; Walter, Heather; Benson, R. Scott; Chrisman, Allan; Farchione, Tiffany R.; Hamilton, John; Keable, Helene; Kinlan, Joan; Schoettle, Ulrich; Siegel, Matthew; Stock, Saundra; Medicus, Jennifer

    2010-01-01

    This Practice Parameter reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder since the previous Parameter was published in 1998. It highlights the importance of early identification of posttraumatic stress disorder, the importance of…

  2. Omitting cytogenetic assessment from routine treatment response monitoring in chronic myeloid leukemia is safe.

    Science.gov (United States)

    Geelen, Inge G P; Thielen, Noortje; Janssen, Jeroen J W M; Hoogendoorn, Mels; Roosma, Tanja J A; Valk, Peter J M; Visser, Otto; Cornelissen, Jan J; Westerweel, Peter E

    2018-04-01

    The monitoring of response in chronic myeloid leukemia (CML) is of great importance to identify patients failing their treatment in order to adjust TKI choice and thereby prevent progression to advanced stage disease. Cytogenetic monitoring has a lower sensitivity, is expensive, and requires invasive bone marrow sampling. Nevertheless, chronic myeloid leukemia guidelines continue to recommend performing routine cytogenetic response assessments, even when adequate molecular diagnostics are available. In a population-based registry of newly diagnosed CML patients in the Netherlands, all simultaneous cytogenetic and molecular assessments performed at 3, 6, and 12 months were identified and response of these matched assessments was classified according to European Leukemia Net (ELN) recommendations. The impact of discrepant cytogenetic and molecular response classifications and course of patients with additional chromosomal abnormalities were evaluated. The overall agreement of 200 matched assessments was 78%. In case of discordant responses, response at 24 months was consistently better predicted by the molecular outcome. Cytogenetic response assessments provided relevant additional clinical information only in some cases of molecular "warning." The development of additional cytogenetic abnormalities was always accompanied with molecular failure. We conclude that it is safe to omit routine cytogenetics for response assessment during treatment and to only use molecular monitoring, in order to prevent ambiguous classifications, reduce costs, and reduce the need for invasive bone marrow sampling. Cytogenetic re-assessment should still be performed when molecular response is suboptimal. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Selection of odour removal technologies in wastewater treatment plants: a guideline based on Life Cycle Assessment.

    Science.gov (United States)

    Alfonsín, Carolina; Lebrero, Raquel; Estrada, José M; Muñoz, Raúl; Kraakman, N J R Bart; Feijoo, Gumersindo; Moreira, M Teresa

    2015-02-01

    This paper aims at analysing the environmental benefits and impacts associated with the treatment of malodorous emissions from wastewater treatment plants (WWTPs). The life cycle assessment (LCA) methodology was applied to two biological treatments, namely biofilter (BF) and biotrickling filter (BTF), two physical/chemical alternatives, namely activated carbon tower (AC) and chemical scrubber (CS), and a hybrid combination of BTF + AC. The assessment provided consistent guidelines for technology selection, not only based on removal efficiencies, but also on the environmental impact associated with the treatment of emissions. The results showed that biological alternatives entailed the lowest impacts. On the contrary, the use of chemicals led to the highest impacts for CS. Energy use was the main contributor to the impact related to BF and BTF, whereas the production of glass fibre used as infrastructure material played an important role in BTF impact. Production of NaClO entailed the highest burdens among the chemicals used in CS, representing ∼ 90% of the impact associated to chemicals. The frequent replacement of packing material in AC was responsible for the highest environmental impacts, granular activated carbon (GAC) production and its final disposal representing more than 50% of the impact in most categories. Finally, the assessment of BTF + AC showed that the hybrid technology is less recommendable than BF and BTF, but friendlier to the environment than physical/chemical treatments. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Comparative assessment of the environmental sustainability of existing and emerging perchlorate treatment technologies for drinking water.

    Science.gov (United States)

    Choe, Jong Kwon; Mehnert, Michelle H; Guest, Jeremy S; Strathmann, Timothy J; Werth, Charles J

    2013-05-07

    Environmental impacts of conventional and emerging perchlorate drinking water treatment technologies were assessed using life cycle assessment (LCA). Comparison of two ion exchange (IX) technologies (i.e., nonselective IX with periodic regeneration using brines and perchlorate-selective IX without regeneration) at an existing plant shows that brine is the dominant contributor for nonselective IX, which shows higher impact than perchlorate-selective IX. Resource consumption during the operational phase comprises >80% of the total impacts. Having identified consumables as the driving force behind environmental impacts, the relative environmental sustainability of IX, biological treatment, and catalytic reduction technologies are compared more generally using consumable inputs. The analysis indicates that the environmental impacts of heterotrophic biological treatment are 2-5 times more sensitive to influent conditions (i.e., nitrate/oxygen concentration) and are 3-14 times higher compared to IX. However, autotrophic biological treatment is most environmentally beneficial among all. Catalytic treatment using carbon-supported Re-Pd has a higher (ca. 4600 times) impact than others, but is within 0.9-30 times the impact of IX with a newly developed ligand-complexed Re-Pd catalyst formulation. This suggests catalytic reduction can be competitive with increased activity. Our assessment shows that while IX is an environmentally competitive, emerging technologies also show great promise from an environmental sustainability perspective.

  5. Social science to improve fuels management: a synthesis of research on assessing social acceptability of fuels treatments

    Science.gov (United States)

    Terry C. Daniel; Michael Valdiserri; Carrie R. Daniel; Pamela Jakes; Pamela Jakes; Susan Barro

    2005-01-01

    A series of syntheses were commissioned by the USDA Forest Service to aid in fuels mitigation project planning. This synthesis focuses on research for assessing the social acceptability of fuels treatments. The synthesis is structured around six important considerations for any social acceptability assessment: defining the fuels treatments being assessed; representing...

  6. Considerations about an administrative ''margin of prognosis''

    International Nuclear Information System (INIS)

    Tettinger, P.J.

    1982-01-01

    The investigation is concerned with the limitations of certain judicial concepts, and the descretion of the appropriate administrative authorities to interpret them, especially in the area of necessary precautionary measures with regard to nuclear power plants safety. Thereby the question arises, whether by interpreting undefined judicial concepts (such as ''the status of science and technology'', e.g. section 1 sub-section 2, number 3 of the Atomic Energy Law), administrative authorities should be given a flexible margin of judgement which could not be examined, by the administrative courts, especially in view of risk analysis and risk assessments. Diverging opinions in legal literature and the administration of justice will be presented and critically analyzed. The author argues for an integral administrative procedure. Controlling the licensing of nuclear power plants, which - if need be - should only be limited by a ''plausibility control'' in cases where several security-safety related technical solutions appear acceptable. (WBI) [de

  7. Comorbid diabetes and eating disorders in adult patients: assessment and considerations for treatment.

    Science.gov (United States)

    Gagnon, Cynthia; Aimé, Annie; Bélanger, Claude; Markowitz, Jessica Tuttman

    2012-01-01

    The lack of research concerning treatment for individuals with diabetes mellitus (DM) and comorbid eating disorders (ED) contributes to the gulf between the psychosocial needs of individuals with the two conditions and the treatment they receive. Empirical evidence has established that the prognosis of patients with this comorbid diagnosis (ED-DM) is poor in the absence of a specialized DM treatment specifically adapted to ED. In individuals with DM, comorbid ED is associated with numerous complications. Despite these interactions, current knowledge about the comorbid diagnosis is limited, and eating disorders in patients with diabetes often remain undiagnosed. This article presents standard procedures for assessment and optimal therapeutic interventions for patients with ED and DM. In patients with diabetes, problematic eating behaviors and symptoms should be assessed routinely. When an eating disorder is detected, diabetes management needs to be adapted, binge eating or medication misuse needs to be addressed, and eating disorder specialists should be included in the multidisciplinary team.

  8. New methodology in life cycle impact assessment (LCIA) of waste water treatment

    DEFF Research Database (Denmark)

    Larsen, Henrik Fred; Wenzel, Henrik; Hauschild, Michael Zwicky

    Reducing environmental problems related to wastewater effluents containing micro-pollutants requires resources in terms of energy, chemicals, infrastructure, installations for wastewater treatment, thus, involves advantages as well as disadvantages to the environment and society. But how does one...... chose among different waste water treatments? Which ones are most beneficial in a holistic perspective? Here, the life cycle assessment (LCA) approach as a decision supporting tool may help because its goal is to allow quantification and direct comparison of characteristics as diverse as energy...... EU research project "NEPTUNE" focusing on nutrient recycling, micro-pollutants and ecotoxicity removal, energy production, and reuse of sludge and of its resources, this paper will present the first results of the development of a new methodology for assessing advances in wastewater treatment...

  9. Improved statistical confirmation of margins for setpoints and transients

    International Nuclear Information System (INIS)

    Nutt, W.T.

    2001-01-01

    Framatome ANP Richland, Inc. has developed an integrated, automated, statistical methodology for Pressurized Water Reactors (PWRs). Margins for transients and calculated trips are confirmed using several new applications of probability theory. The methods used for combining statistics reduces the conservatisms inherent in conventional methods and avoids the numerical limitations and time constraints imposed by Monte Carlo techniques. The new methodology represents the state of the art in the treatment of uncertainties for reactor protection systems. It all but eliminates concerns with the calculated trips for PWRs and by improving the margin for all transients will allow for far more aggressive peaking limits and fuel management schemes. The automated nature of the bulk of this process saves Framatome ANP time and effort, minimizes the potential for errors and makes the analysis for all cycles and plants consistent. The enhanced margins remove analytical limitations from the customer and allow for more economical operation of the plant. (authors)

  10. Characterization of oil and gas waste disposal practices and assessment of treatment costs. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Bedient, P.B.

    1995-01-16

    This study examines wastes associated with the onshore exploration and production of crude oil and natural gas in the US. The objective of this study was to update and enhance the current state of knowledge with regard to oil and gas waste quantities, the potential environmental impact of these wastes, potential methods of treatment, and the costs associated with meeting various degrees of treatment. To meet this objective, the study consisted of three tasks: (1) the development of a production Environmental Database (PED) for the purpose of assessing current oil and gas waste volumes by state and for investigating the potential environmental impacts associated with current waste disposal practices on a local scale; (2) the evaluation of available and developing technologies for treating produced water waste streams and the identification of unit process configurations; and (3) the evaluation of the costs associated with various degrees of treatment achievable by different treatment configurations. The evaluation of feasible technologies for the treatment of produced water waste streams was handled in the context of comparing the level of treatment achievable with the associated cost of treatment. Treatment processes were evaluated for the removal of four categories of produced water contaminants: particulate material, volatile organic compounds, adsorbable organic compounds, and dissolved inorganic species. Results showed dissolved inorganic species to be the most costly to remove. The potential cost of treating all 18.3 billion barrels of produced water generated in a year amounts to some 15 billion dollars annually.

  11. [Algorithms and urinary incontinence in the elderly. Assessment, treatment, recommendations and levels of evidence. Review].

    Science.gov (United States)

    Meyer, P

    2017-03-01

    Search processing algorithms in a primary care setting, analyzing the specifics of care management for seniors suffering from urinary incontinence (UI), described the recommendations and levels of evidence of treatment. A literature review carried out via PubMed ® and websites of scientific societies with search keywords classified according to an algorithm. One hundred algorithms have been discovered in the field of evaluation and treatment of UI. Screening for UI risk factors began early on in the treatment of reversible or chronic comorbidities, avoiding iatrogenic. Specific clinical features (red flags) required specialized advice. Non-pharmacological conservative treatment should be offered first in line for seniors: behavioral therapy, changes in lifestyle, walk, treatment of constipation. For women, pelvic floor muscle training combined biofeedback and functional electrical stimulation. After failure and persistence of UI with urgency, the information of the risk of a possible urinary retention or cognitive impairments preceded the prescription of an anticholinergic and the measurement of post-voiding residue done by ultrasounds. Older age is not a cons-indication for surgery UI least invasive. The cough test and Bonney maneuver can confirm a masked stress urinary incontinence and/or an associated prolapse. Cases of failure of UI, doubtful diagnosis or programmed surgery required urodynamic assessment. Algorithms and recommendations of UI should remain a valuable aid to the clinical assessment, diagnosis and treatment of UI in the elderly. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

    Directory of Open Access Journals (Sweden)

    Katarzyna Kapuścińska

    2015-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

  13. Reliability assessment and correlation analysis of evaluating orthodontic treatment outcome in Chinese patients.

    Science.gov (United States)

    Song, Guang-Ying; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Baumrind, Sheldon; Geng, Zhi; Xu, Tian-Min

    2014-03-01

    This study aimed to assess the reliability of experienced Chinese orthodontists in evaluating treatment outcome and to determine the correlations between three diagnostic information sources. Sixty-nine experienced Chinese orthodontic specialists each evaluated the outcome of orthodontic treatment of 108 Chinese patients. Three different information sources: study casts (SC), lateral cephalometric X-ray images (LX) and facial photographs (PH) were generated at the end of treatment for 108 patients selected randomly from six orthodontic treatment centers throughout China. Six different assessments of treatment outcome were made by each orthodontist using data from the three information sources separately and in combination. Each assessment included both ranking and grading for each patient. The rankings of each of the 69 judges for the 108 patients were correlated with the rankings of each of the other judges yielding 13 873 Spearman rs values, ranging from -0.08 to +0.85. Of these, 90% were greater than 0.4, showing moderate-to-high consistency among the 69 orthodontists. In the combined evaluations, study casts were the most significant predictive component (R(2)=0.86, P<0.000 1), while the inclusion of lateral cephalometric films and facial photographs also contributed to a more comprehensive assessment (R(2)=0.96, P<0.000 1). Grading scores for SC+LX and SC+PH were highly significantly correlated with those for SC+LX+PH (r(SC+LX)vs.(SC+LX+PH)=0.96, r(SC+PH)vs.(SC+LX+PH)=0.97), showing that either SC+LX or SC+PH is an excellent substitute for all three combined assessment.

  14. Technique for histological control of surgical margins in lip cancer.

    Science.gov (United States)

    Aoyagi, Satoru; Hata, Hiroo; Homma, Erina; Shimizu, Hiroshi

    2014-04-01

    To preserve oral function and achieve acceptable cosmetic results, intraoperative control of surgical margins with frozen section evaluation may help to determine surgical technique in lip cancer. However, frozen section analysis is usually limited to suspicious areas and has not been systematically performed among surgeons. The accuracy of such analysis for detecting histological surgical margins is highly dependent on the methods used to obtain and analyze the margins. Improving the pathodiagnostic reliability of conventional intraoperative frozen section evaluation is the most important goal of surgical management in our method. We describe the successful use of the "double-blade method" in lip cancer treatment. The technique we describe has the advantage of histologically confirming clear margins in lip cancer. This method appears to be time-saving and easy to apply with existing surgical systems. In addition, this method may be used as an alternative to complete evaluation of lateral surgical margins that is important in planning a suitable surgical reconstruction procedure in lip cancer at many institutions where Mohs micrographic surgery is difficult to perform. © 2014 Japanese Dermatological Association.

  15. Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome

    DEFF Research Database (Denmark)

    Amit, Moran; Na'ara, Shorook; Trejo-Leider, Leonor

    2017-01-01

    Background: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. Methods: We conducted univariate ...

  16. Bias in retrospective assessment of perceived dental treatment effects when using the Oral Health Impact Profile.

    Science.gov (United States)

    Reissmann, Daniel R; Erler, Antje; Hirsch, Christian; Sierwald, Ira; Machuca, Carolina; Schierz, Oliver

    2017-10-23

    Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance. In this prospective clinical study, a sample of 126 adult patients (age 17-83 years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients' ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments. Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment. Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

  17. Recent Trends In The Methods Of Safety Assessment Of Rad Waste Treatment And Disposal

    International Nuclear Information System (INIS)

    Mahmoud, N.S.

    2012-01-01

    Radioactive waste management system involves a huge variety of processes and activities. This includes; collection and segregation, pretreatment, treatment, conditioning, storage and finally disposal. To assure the safety of the different facility of each step in the waste management system, the operator should prepare a safety analysis report to be assessed by the national regulatory body. The content of the safety analysis report must include all data about the site, facility design, operational phase, waste materials, and safety assessment methodologies. Safety assessment methodologies are iterative processes involving site-specific, prospective modeling evaluations of the pre-operational, operational, and post-closure time in case of disposal facilities. The safety assessment focuses primarily on a decision about compliance with performance objectives, rather than the much more difficult problem of predicting actual radiological impacts on the public at far future times. The recent organization processes of the safety assessment are improved by the ISAM working group from IAEA for waste disposal site. These safety assessment methodologies have been modified within SADRWMS IAEA project for the establishment of safety methodologies for the pre-disposal facilities (treatment and storage facilities) and the disposal site.

  18. Assessing the population health impact of market interventions to improve access to antiretroviral treatment.

    Science.gov (United States)

    Bärnighausen, Till; Kyle, Margaret; Salomon, Joshua A; Waning, Brenda

    2012-09-01

    Despite extraordinary global progress in increasing coverage of antiretroviral treatment (ART), the majority of people needing ART currently are not receiving treatment. Both the number of people needing ART and the average ART price per patient-year are expected to increase in coming years, which will dramatically raise funding needs for ART. Several international organizations are using interventions in ART markets to decrease ART price or to improve ART quality, delivery and innovation, with the ultimate goal of improving population health. These organizations need to select those market interventions that are most likely to substantially affect population health outcomes (ex ante assessment) and to evaluate whether implemented interventions have improved health outcomes (ex post assessment). We develop a framework to structure ex ante and ex post assessment of the population health impact of market interventions, which is transmitted through effects in markets and health systems. Ex ante assessment should include evaluation of the safety and efficacy of the ART products whose markets will be affected by the intervention; theoretical consideration of the mechanisms through which the intervention will affect population health; and predictive modelling to estimate the potential population health impact of the intervention. For ex post assessment, analysts need to consider which outcomes to estimate empirically and which to model based on empirical findings and understanding of the economic and biological mechanisms along the causal pathway from market intervention to population health. We discuss methods for ex post assessment and analyse assessment issues (unintended intervention effects, interaction effects between different interventions, and assessment impartiality and cost). We offer seven recommendations for ex ante and ex post assessment of population health impact of market interventions.

  19. Rat cardiovascular telemetry: Marginal distribution applied to positive control drugs.

    Science.gov (United States)

    Accardi, M V; Troncy, E; Abtout, S; Ascah, A; Maghezzi, S; Authier, S

    2016-01-01

    Cardiovascular effects are considered frequent during drug safety testing. This investigation aimed to characterize the pharmacological response of the conscious telemetered rat in vivo model to known cardiovascular active agents. These effects were analyzed using statistical analysis and cloud representation with marginal distribution curves for the contractility index and heart rate as to assess the effect relationship between cardiac variables. Arterial blood pressure, left ventricular pressure, electrocardiogram and body temperature were monitored. The application of data cloud with marginal distribution curves to heart rate and contractility index provided an interesting tactic during the interpretation of drug-induced changes particularly during selective time resolution (i.e. marginal distribution curves restricted to Tmax). Taken together, the present data suggests that marginal distribution curves can be a valuable interpretation strategy when using the rat cardiovascular telemetry model to detect drug-induced cardiovascular effects. Marginal distribution curves could also be considered during the interpretation of other inter-dependent parameters in safety pharmacology studies. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Assessment of canyon wall failure process from multibeam bathymetry and Remotely Operated Vehicle (ROV) observations, U.S. Atlantic continental margin: Chapter 10 in Submarine mass movements and their consequences: 7th international symposium part II

    Science.gov (United States)

    Chaytor, Jason D.; Demopoulos, Amanda W. J.; ten Brink, Uri S.; Baxter, Christopher D. P.; Quattrini, Andrea M.; Brothers, Daniel S.; Lamarche, Geoffroy; Mountjoy, Joshu; Bull, Suzanne; Hubble, Tom; Krastel, Sebastian; Lane, Emily; Micallef, Aaron; Moscardelli, Lorena; Mueller, Christof; Pecher, Ingo; Woelz, Susanne

    2016-01-01

    Over the last few years, canyons along the northern U.S. Atlantic continental margin have been the focus of intensive research examining canyon evolution, submarine geohazards, benthic ecology and deep-sea coral habitat. New high-resolution multibeam bathymetry and Remotely Operated Vehicle (ROV) dives in the major shelf-breaching and minor slope canyons, provided the opportunity to investigate the size of, and processes responsible for, canyon wall failures. The canyons cut through thick Late Cretaceous to Recent mixed siliciclastic and carbonate-rich lithologies which impart a primary control on the style of failures observed. Broad-scale canyon morphology across much of the margin can be correlated to the exposed lithology. Near vertical walls, sedimented benches, talus slopes, and canyon floor debris aprons were present in most canyons. The extent of these features depends on canyon wall cohesion and level of internal fracturing, and resistance to biological and chemical erosion. Evidence of brittle failure over different spatial and temporal scales, physical abrasion by downslope moving flows, and bioerosion, in the form of burrows and surficial scrape marks provide insight into the modification processes active in these canyons. The presence of sessile fauna, including long-lived, slow growing corals and sponges, on canyon walls, especially those affected by failure provide a critical, but as yet, poorly understood chronological record of geologic processes within these systems.