Neural markers of individual and age differences in TVA attention capacity parameters

DEFF Research Database (Denmark)

Wiegand, Iris

2013-01-01

The ‘Theory of Visual Attention’ quantifies an interindividual’s capacity of attentional resources in parameters visual processing speed C and vSTM storage capacity K. Distinct neural markers of interindividual differences in these functions were identified by combining TVA-based assessment...

TVA reaps big savings by letting powerplant work to outside firms

International Nuclear Information System (INIS)

Anon.

1992-01-01

This abstract is the entire text of the article. In a report to Congress, the Tennessee Valley Authority says its shift to full reliance on outside contractors for powerplant construction and modification work saved a net $54M in the first half of 1992. TVA says that total savings from lower overhead and increased efficiency were $75M, but that was partially offset by $21M in one-time mobilization/de-mobilization charges. TVA has a budget of $1.7B this year for new plant and equipment. That will rise to over $2B in the next two years. About 70% of the work involves nuclear plant work. Several members of Congress from the area criticized TVA in mid-1991 when it cut more than 5,000 hourly construction jobs and several hundred salaried construction jobs. The agency said the cuts let it concentrate on power production and promised to make semi-annual reports to Congress detailing the results of contracting out. In the agency's first report, TVA Chairman John Waters says that it saved $19.2M in personnel costs and staff overhead over the six-month period ending June 30, 1992. At the same time, $21.8M was saved through increased construction efficiency and productivity. Waters also says that the switch caused minimal impact on the local work force. Contractors employed 6,166 craft workers on their TVA projects at mid-year, compared with the 5,200 dropped by the agency in mid-1991

O etici poslovanja i poduzetništva "business ethics"

OpenAIRE

Bozanić, Anton

1998-01-01

O etici poslovanja i poduzetništva ili gospodarstva i poduzetništva, opće poznatoj kao "business ethics", mnogo se danas raspravlja i piše, posebno u visoko razvijenijim zemljama, ali i svim ostalim koje žele uhvatiti korak sa svjetskim tržištem i vrlo dinamičnim izazovima konkurencije, ponude i potražnje. Sve više Jača svijest kako personalna etika - toliko važna u svakidašnjem ljudskom životu - nije sama po sebi dostatna kod donošenja etičkih odluka, Jer su u suvremenom gospodarskom...

TVA-based assessment of visual attentional functions in developmental dyslexia

Directory of Open Access Journals (Sweden)

Johanna eBogon

2014-10-01

Full Text Available There is an ongoing debate whether an impairment of visual attentional functions constitutes an additional or even an isolated deficit of developmental dyslexia (DD. Especially performance in tasks that require the processing of multiple visual elements in parallel has been reported to be impaired in DD. We review studies that used parameter-based assessment for identifying and quantifying impaired aspect(s of visual attention that underlie this multi-element-processing deficit in DD. These studies used the mathematical framework provided by the ‘theory of visual attention’ (TVA; Bundesen, 1990 to derive quantitative measures of general attentional resources and attentional weighting aspects on the basis of behavioral performance in whole- and partial-report tasks. Based on parameter estimates in children and adults with DD, the reviewed studies support a slowed perceptual processing speed as an underlying primary deficit in DD. Moreover, a reduction in visual short term memory storage capacity seems to present a modulating component, contributing to difficulties in written language processing. Furthermore, comparing the spatial distributions of attentional weights in children and adults suggest that having limited reading and writing skills might impair the development of a slight leftward bias, that is typical for unimpaired adult readers.

ULOGA I VAŽNOST INTELEKTUALNOG VLASNIŠTVA U PODUZETNIŠTVU

OpenAIRE

Milović, Tanja; Mustapić, Zrinka; Moslavac-Forjan, Davorka

2016-01-01

Poduzetnička aktivnost pokretač je ekonomskog rasta nacionalne ekonomije. Ona je u velikoj mjeri vezana uz razvoj inovativnih proizvoda i usluga, čiji je ključni aspekt zaštita intelektualnog vlasništva. U suvremenom poduzetničkom okruženju zaštita i primjena zaštite intelektualnog vlasništva ima značajnu ulogu u uspješnom razvoju inovacija i razvoju poslovanja općenito te time predstavlja poticaj poduzetničkoj aktivnosti. Najrazvijenije ekonomije imaju i najveći stupanj zaštite intelektualno...

Modelling auditory attention: Insights from the Theory of Visual Attention (TVA)

DEFF Research Database (Denmark)

Roberts, K. L.; Andersen, Tobias; Kyllingsbæk, Søren

modelled using a log-logistic function than an exponential function. A more challenging difference is that in the partial report task, there is more target-distractor confusion for auditory than visual stimuli. This failure of object-formation (prior to attentional object-selection) is not yet effectively......We report initial progress towards creating an auditory analogue of a mathematical model of visual attention: the ‘Theory of Visual Attention’ (TVA; Bundesen, 1990). TVA is one of the best established models of visual attention. It assumes that visual stimuli are initially processed in parallel......, and that there is a ‘race’ for selection and representation in visual short term memory (VSTM). In the basic TVA task, participants view a brief display of letters and are asked to report either all of the letters (whole report) or a subset of the letters (e.g., the red letters; partial report). Fitting the model...

18 CFR 1314.4 - Law governing the rights and obligations of TVA and Reserve Banks; law governing the rights of...

Science.gov (United States)

2010-04-01

... rights and obligations of TVA and Reserve Banks; law governing the rights of any Person against TVA and... FEDERAL RESERVE BANKS § 1314.4 Law governing the rights and obligations of TVA and Reserve Banks; law governing the rights of any Person against TVA and Reserve Banks; law governing other interests. (a) Except...

trans-11 18:1 Vaccenic Acid (TVA Has a Direct Anti-Carcinogenic Effect on MCF-7 Human Mammary Adenocarcinoma Cells

Directory of Open Access Journals (Sweden)

Ji-Na Lim

2014-02-01

Full Text Available Trans vaccenic acid (TVA; trans-11 18:1 is a positional and geometric isomer of oleic acid and it is the predominant trans isomer found in ruminant fats. TVA can be converted into cis-9, trans-11 conjugated linoleic acid (c9, t11-CLA, a CLA isomer that has many beneficial effects, by stearoyl CoA desaturase 1 (SCD1 in the mammary gland. The health benefits associated with CLA are well documented, but it is unclear whether trans fatty acids (TFAs from ruminant products have healthy effects. Therefore, the effects of TVA on the proliferation of MCF-7 human breast adenocarcinoma cells and MCF-10A human breast epithelial cells were investigated in the present study. Results showed that TVA inhibited the proliferation of MCF-7 cells but not MCF-10A cells by down-regulating the expression of Bcl-2 as well as procaspase-9. In addition, the suppressive effect of TVA was confirmed in SCD1-depleted MCF-7 cells. Our results suggested that TVA exerts a direct anti-carcinogenic effect on MCF-7 cells. These findings provided a better understanding of the research on the anti-carcinogenic effects of TVA and this may facilitate the manufacture of TVA/c9, t11-CLA fortified ruminant products.

Real-time meteorological data flow in support of TVA's radiological emergency plan

International Nuclear Information System (INIS)

Hunter, C.H.; Pittman, D.E.; Malo, J.E.

1985-01-01

The Tennessee Valley Authority (TVA) presently operates two nuclear power plants - Browns Ferry (3 units) and Sequoyah (2 units). Two additional plants are under construction. These are Watts Bar scheduled for commercial operation later this year, and Bellefonte (2 units), scheduled for operation near the end of the decade. Under regulations promulgated under 10 CFR Part 50, TVA has developed a Radiological Emergency Plan (REP) to facilitate assessment of the effects of a radiological accident at any of the operational plants. As part of the REP, TVA has developed a system for collecting, displaying, and reviewing, and disseminating real-time meteorological information collected at the nuclear plant sites. The flow of this information must be reliable and continuous so that prompt, informed decisions are possible. This system has been designed using guidance provided in applicable Nuclear Regulatory Commission (NRC) documents, most notably Supplement 1 to NUREG-0737 and Regularoty Guide (R.G.) 1.23. This paper presents a brief description of the REP meteorological support. Meteorological support for nuclear plant emergency preparedness at TVA nuclear plants has been provided for several years. The system has undergone numerous changes during this time, reflecting changes in regulatory guidance and experience gained in implementing the system through numerous drills and exercises. A brief discussion of some of this experience is also presented

TVA, Abnormal Return, and Investor Perception on Changing of Tick Size 2 May 2016

Directory of Open Access Journals (Sweden)

Tri Gunarsih

2017-07-01

Full Text Available The objective of this study was to analyze the market reaction to the changing of capital market’s tick size regulation in May 2, 2016. The main goal of the regulation was to increase the capital market liquidity, then it’s important to test whether there was a difference in market liquidity before and after the regulation released. The method of this study was studying with Trading Volume Activity (TVA and abnormal return based on secondary data and also investor perception based on primary data. The secondary data consist of 65 samples of listed companies in Indonesia Stock Exchange. The primary data consist of 67 investors in Yogyakarta that were selected using purposive sampling method.The result of this study was mix, there was no difference before and after the release of regulation in TVA, but there was a difference in abnormal return. The result of investor perception shows that there was a positive response to the changing of tick size regulation.

Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I

DEFF Research Database (Denmark)

Finke, Kathrin; Bublak, Peter; Krummenacher, Joseph

2005-01-01

four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance......The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen’s (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes...... of these parameters. The present study was designed to examine whether (a) a shortened procedure bears sufficient accuracy and reliability, (b) whether the procedures reveal attentional constructs with clinical relevance, and (c) whether the mathematically independent parameters are also empirically independent...

Campbell Creek TVA 2010 First Year Performance Report July 1, 2009 August 31, 2010

Energy Technology Data Exchange (ETDEWEB)

Christian, Jeffrey E [ORNL; Gehl, Anthony C [ORNL; Boudreaux, Philip R [ORNL; New, Joshua Ryan [ORNL

2010-10-01

This research project was initiated by TVA in March 2008 and encompasses three houses that are of similar size, design and located within the same community - Campbell Creek, Farragut TN with simulated occupancy. This report covers the performance period from July 1, 2009 to August 31, 2010. It is the intent of TVA that this Valley Data will inform electric utilities future residential retrofit incentive program.

Međuovisnost industrijalizacije i nekih oblika socijalne mobilnosti stanovništva u sisačkom i petrinjskom kraju

Directory of Open Access Journals (Sweden)

Zdenko Braičić

2012-01-01

Full Text Available U prvom dijelu rada analiziraju se odabrani oblici socijalne mobilnosti stanovništva sisačkog i petrinjskog kraja između 1961. i 2001. godine: industrijska zaposlenost, deagrarizacija i razina obrazovanosti stanovništva. Potom se istražuje međuovisnost zaposlenosti stanovništva u industriji i drugih dvaju oblika socijalne mobilnosti. U tu svrhu izračunati su statistički pokazatelji jakosti veza između navedenih pojava (koeficijent jednostavne linearne korelacije. Rezultati su uputili na postojanje slabe pozitivne korelacije između industrijske zaposlenosti i deagrarizacije u sisačkom kraju, odnosno na srednje jaku korelaciju u petrinjskom kraju. Nešto jača korelacija ustanovljena je između industrijske zaposlenosti i obrazovanosti stanovništva.

Varnostni vidiki spletnega bančništva : diplomsko delo univerzitetnega študija

OpenAIRE

Prodanović, Stanislav

2013-01-01

Banke imajo, kot osrednje finančne institucije, veliko zaslug za hiter razvoj informacijske tehnologije. Če je bila še pred približno 15 leti tehnologija bank skrita pred očmi javnosti, je danes preko elektronskega bančništva povezana s komitenti bank, saj se je v zadnjem desetletju elektronsko bančništvo izkazalo za eno najbolj dobičkonosnih spletnih storitev. Spletno bančništvo je del elektronskega bančništva in omogoča opravljanje bančnih poslov preko interneta ob vseh urah dneva, hkrat...

TVA experience in BWR reload design and licensing

International Nuclear Information System (INIS)

Robertson, J.D.

1986-01-01

TVA has developed and implemented the capability to perform BWR reload core design and licensing analyses. The advantages accruing from this capability include the tangible cost-savings from performing reload analyses in-house. Also, ''intangible'' benefits such as increased operating flexibility and the ability to accommodate multivendor fuel designs have been demonstrated. The major disadvantage with performing in-house analyses is the cost associated with development and maintenance of the analytical methods and staff expertise

The Properties of Binary and Ternary Ti Based Coatings Produced by Thermionic Vacuum Arc (TVA Technology

Directory of Open Access Journals (Sweden)

Aurelia Mandes

2018-03-01

Full Text Available A series of the multicomponent thin films (binary: Ti-C; Ti-Ag and ternary: Ti-C-Ag; Ti-C-Al were fabricated by Thermionic Vacuum Arc (TVA technology in order to study the wear resistance and the anticorrosion properties. The effects of Ti amount on the microstructure, tribological and morphological properties were subsequently investigated. TVA is an original deposition method using a combination of anodic arc and electron gun systems for the growth of films. The samples were characterized using scanning electron microscope (SEM and a transmission electron microscope (TEM accompanied by selected area electron diffraction (SAED. Tribological properties were studied by a ball-on-disc tribometer in the dry regime and the wettability was assessed by measuring the contact angle with the See System apparatus. Wear Rate results indicate an improved sliding wear behavior for Ti-C-Ag: 1.31 × 10−7 mm3/N m (F = 2 N compared to Ti-C-Al coating wear rate: 4.24 × 10−7 mm3/N m. On the other hand, by increasing the normal load to 3 N an increase to the wear rate was observed for Ti-C-Ag: 2.58 × 10−5 mm3 compared to 2.33 × 10−6 mm3 for Ti-C-Al coating.

Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I: evidence from normal subjects

DEFF Research Database (Denmark)

Finke, Kathrin; Bublak, Peter; Krummenacher, Joseph

2005-01-01

four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance......The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen's (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes...... of these parameters. The present study was designed to examine whether (a) a shortened procedure bears sufficient accuracy and reliability, (b) whether the procedures reveal attentional constructs with clinical relevance, and (c) whether the mathematically independent parameters are also empirically independent...

Physical model of a floating trash boom to control aquatic weeds at the TVA Widows Creek Fossil Plant

International Nuclear Information System (INIS)

Hopping, P.N.

1991-01-01

This paper reports that the Tennessee Valley Authority (TVA) Widows Creek Fossil plant seasonally encounters adverse accumulations of aquatic weeds at the intakes of the condenser cooling water pumps. To reduce the accumulations, a floating trash boom has been proposed for the intakes. To evaluate the hydraulic feasibility of a boom, a physical model of the intakes has been built at the TVA Engineering Laboratory. The model was used to determine the boom alignment and depth of skimming needed to successfully deflect weeds away from the intakes and provide self-cleaning

18 CFR 1304.407 - Development within flood control storage zones of TVA reservoirs.

Science.gov (United States)

2010-04-01

... flood control storage zones of TVA reservoirs. 1304.407 Section 1304.407 Conservation of Power and Water... documentation related to flood control storage, provided the loss of flood control storage caused by the project... control storage. If this determination can be made, the applicant must then demonstrate how the loss of...

Design process and philosophy of TVA's latest advance control room complex

International Nuclear Information System (INIS)

Owens, G.R.; Masters, D.W.

1979-01-01

TVA's latest nuclear power plant control room design includes a greater emphasis on human factors as compared to their earlier plant designs. This emphasis has resulted in changes in the overall design philosophy and design process. This paper discusses some of the prominent design features of both the control room and the surrounding control room complex. In addition, it also presents some of the important activities involved in the process of developing the advanced control room design

Fluid transient analysis and design considerations in TVA PWR feedwater systems and steam generators

International Nuclear Information System (INIS)

Kelley, B.T.

1979-01-01

TVA has evaluated a number of fluid transients in an effort to discover areas of potential problems and to improve overall unit operation. The transients recently or currently being evaluated fall into four major areas - accident analyses, fast valving, heater drain systems, and steam generators. A discussion of each area follows

VZROKI MLADOLETNIŠKEGA PRESTOPNIŠTVA IN UKREPI ZA NJEGOVO PREPREČEVANJE

OpenAIRE

Matija, Sabina

2013-01-01

Diplomska naloga obravnava mladoletniško prestopništvo. Osredotoča se na vzroke in ukrepe za preprečevanje oziroma zmanjševanje prestopništva mladih. Pozornost je posvečena še obravnavi tako mladoletnih storilcev kaznivih dejanj kot mladoletnih storilcev prekrškov. Mladoletniško prestopništvo obsega kazniva dejanja in druge oblike deviantnega, negativnega odklonskega vedenja otrok in mladoletnikov, vendar je pri nas sprejeto ožje pojmovanje omenjenega pojava. Po tem konceptu obravnava kaz...

Sudar vozila u vlasništvu istog leasing društva i problem treće osobe iz AO osiguranja

OpenAIRE

Radionov, Nikoleta; Padovan, Adriana Vincenca

2012-01-01

U radu se razmatraju pravni odnosi koji nastaju u slučaju sudara dvaju (ili više) vozila u vlasništvu istog leasing društva (slučaj leasing – leasing). Prema uvriježenoj praksi na domaćem tržištu osiguranja, u takvim slučajevima dolazi do isključenja iz osiguranja šteta na vozilu temeljem osiguranja automobilske odgovornosti (AO), s obzirom na to da su vozila u vlasništvu istog leasing društva koje je i jedini osiguranik po policama AO oba (ili više) vozila sudionika nezgode. Primatelj leasin...

Evaluating a biomass resource: The TVA region-wide biomass resource assessment model

International Nuclear Information System (INIS)

Downing, M.; Graham, R.L.

1993-01-01

Wood is an alterative fuel for electric power generation at coal-fired plants in the Tennessee Valley Authority (TVA) region. Short rotation wood energy crops (SRWC) could provide a source of this woody biomass. However, the economic and supply structures of SRWC markets have not been established. Establishing the likely price and supply of SRWC biomass in a region is a complex task because biomass is not an established commodity as are oil, natural gas and coal. In this study we project the cost and supply of short-rotation woody biomass for the TVA region -- a 276 county area that includes all of Tennessee and portions of 10 contiguous states in the southeastern United States. Projected prices and quantities of SRWC are assumed to be a function of the amount and quality of crop and pasture land available in a region. expected SRWC yields and production costs on differing soils and land types, and the profit that could be obtained from current conventional crop production on these same lands. Results include the supply curve of SRWC biomass that is projected to be available from the entire region, the amount and location of crop and pasture land that would be used, and the conventional agricultural crops that would be displaced as a function of SRWC production. Finally, we show the results of sensitivity analysis on the projected cost and supply of SRWC biomass. In particular, we examine the separate impacts of varying SRWC production yields

Premagovanje izzivov življenja z disleksijo od otroštva do odraslosti

OpenAIRE

Javornik, Pia

2017-01-01

V magistrskem delu smo raziskali izzive, s katerimi se srečujejo osebe z disleksijo skozi celoten razvojni potek od otroštva do odraslosti. V teoretičnem delu smo povzeli nekatere definicije ter teoretične razlage disleksije in njeno izražanje skozi različna razvojna obdobja, vezana na potek znotraj izobraževalnega sistema. Predstavili smo zakonodajne možnosti prilagajanja vzgojno izobraževalnega procesa osebam z disleksijo v slovenskem prostoru. V nadaljevanju smo se osredotočili na značilno...

Control of occupational radiation exposures in TVA nuclear power plants - design and operating philosophy

International Nuclear Information System (INIS)

Belvin, E.A.; Lyon, M.; Beasley, E.G. Jr.; Zobel, W.; Stone, G.F.

1976-01-01

TVA has some 21,000 MWe of nuclear generation in various phases of design, construction, or operation. When Browns Ferry was designed in the late 1960's, there were no guidelines available regarding implant radiation control features, so TVA relied on good engineering and health physics judgement in developing its design and operating criteria for radiation protection. After two years of operation at Browns Ferry, the authors experience shows that their design criteria were in most cases adequate or more than adequate. However, several areas present continuing problems relative to radiation and contamination control. In view of the recent NRC ALARA guidelines, they have instituted a program to ensure that the ALARA concept is made an integral part of their design and operating plans. Administrative documents were issued giving management support to the ALARA concept. A 4-member management audit team consisting of representatives from their design, operating, and radiation protection groups was established to review the effectiveness of radiation protection design features and operating activities on a plant-by-plant basis. Reports and recommendations from these audits are sent to top-level management staff. Their goal is to maintain an audit-appraisal system consisting of in-plant awareness of radiation and contamination conditions, assessment of trends in occupational radiation exposures, and feedback to their designers regarding problems encountered during operation and maintenance activities

Instrumentation and controls training in TVA: a story of large numbers

International Nuclear Information System (INIS)

Conner, D.L.

1981-01-01

The Tennessee Valley Authority currently has four nuclear units on line with seventeen units planned prior to the year 2000. Providing a permanent instrumentation and controls workforce, projected to be approximately 700 trades and labor craftsmen, is a formidable task requiring the cooperative efforts of many diverse groups: mangement and labor, engineers and craftsmen, students and instructors. In TVA, the primary source of skilled I and C craftsmen is through formal training programs conducted in cooperation with the craft bargaining unit, the International Brotherhood of Electrical Workers. The purpose of this paper is to describe and review the progress of two of these programs: the Instrument Mechanic Training Program and the Senior Instrument Mechanic Training Program

NRC regulation of TVA. Hearings before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, Ninety-Ninth Congress, Second Session, February 26, June 11, and October 1, 1986

International Nuclear Information System (INIS)

Anon.

1987-01-01

Nuclear Regulatory Commissioners, Tennessee Valley Authority (TVA) chairman Charles Dean, and members of both agencies, as well as representatives of review groups testified at a hearing on the performance of regulators in overseeing TVA's nuclear programs, all of which are inoperative. The witnesses reviewed certification, licensing, and inspection processes which reflect poor management on the part of NRC and indifference to TVA. Of major concern was the sacrifice of safety for expeditious construction. The hearing took place over three days in February, June, and October of 1986. Material submitted for the record follows the testimony of the 19 witnesses

MHD repowering of a 250 MWe unit of the TVA Allen Steam Plant

International Nuclear Information System (INIS)

Chapman, J.N.; Attig, R.C.

1992-01-01

In this paper coal fired MHD repowering is considered for the TVA Allen Steam Plant. The performance of the repowered plant is presented. Cost comparisons are made of the cost of repowering with MHD versus the cost of meeting similar standards by installing scrubbers and selective catalytic NO x reduction (SCNR). For repowering of a single 250 MW e unit, the costs favor scrubbing and SCNR. If one considers a single repowering of all three 250 MW e units by a single MHD topping cycle and boiler, MHD repowering is more economical. Environmental emissions from the repowered plant are estimated

Bioluminescent Bioreporter Pseudomonas putida TVA8 as a Detector of Water Pollution. Operational Conditions and Selectivity of Free Cells Sensor

Czech Academy of Sciences Publication Activity Database

Kuncová, Gabriela; Pazlarová, J.; Hlavatá, Alena; Ripp, S.; Sayler, G.S.

2011-01-01

Roč. 11, č. 3 (2011), s. 882-887 ISSN 1470-160X R&D Projects: GA MŠk ME 893 Institutional research plan: CEZ:AV0Z40720504 Keywords : whole-cell biosensor * bioluminiscence * pseudomonas putida TVA8 Subject RIV: EI - Biotechnology ; Bionics Impact factor: 2.695, year: 2011

Reconstructed image of human heart for total artificial heart implantation, based on MR image and cast silicone model of heart

International Nuclear Information System (INIS)

Komoda, Takashi; Maeta, Hajime; Uyama, Chikao.

1991-01-01

Based on transverse (TRN) and LV long axis (LAX) MR images of two cadaver hearts, three-dimensional (3-D) computer models of the connecting interface between remaining heart and total artificial heart, i.e., mitral and tricuspid valvular annuli (MVA and TVA), ascending aorta (Ao) and pulmonary artery (PA), were reconstructed to compare the shape and the size of MVA and those of TVA, the distance between the center of MVA and TVA (D G ), the angle between the plane of MVA and that of TVA (R T ), and the angles of Ao and PA, respectively, to the plane of MVA (R A , R P ), with those obtained in cast silicone models. It was found that based on LAX rather than TRN MR image, MVA and TVA might be more precisely reconstructed. The data obtained in 3-D images of MVA, TVA, Ao and PA based on silicone models of 32 hearts were as follows: D G (cm): 4.17±0.43, R T (degrees): 22.1±11.3, R A (degrees): 54.9±15.3, R P (degrees): 30.8±17.1. (author)

Analysis of plume rise data from five TVA steam plants

International Nuclear Information System (INIS)

Anfossi, D.

1985-01-01

A large data set containing the measurements of the rise of plumes emitted by five TVA steam plants was examined. Particular attention was paid to the problem of the merging of the plumes emitted by adjacent stacks and to the role played by the wind angle in this respect. It was demonstrated that there is a noticeable rise enhancement of merged plumes with respect to single emissions, both in neutral and in stable conditions, as far as transversal and parallel plumes are concerned. For plumes advected normal to the row of the stacks the enhancement is noticeable only in the final stage of rise. The existence of a critical angle for merging suggested enhancement is noticeable only in the final stage of rise. The existence of a critical angle for merging suggested by Briggs was examined. Finally, a formula to describe plume rise in the transitional and in the final phase, both in neutral and stable conditions, is proposed; it was obtained by interpolation of two familiar Brigg's equations

Visual attention capacity

DEFF Research Database (Denmark)

Habekost, Thomas; Starrfelt, Randi

2009-01-01

Psychophysical studies have identified two distinct limitations of visual attention capacity: processing speed and apprehension span. Using a simple test, these cognitive factors can be analyzed by Bundesen's Theory of Visual Attention (TVA). The method has strong specificity and sensitivity......, and measurements are highly reliable. As the method is theoretically founded, it also has high validity. TVA-based assessment has recently been used to investigate a broad range of neuropsychological and neurological conditions. We present the method, including the experimental paradigm and practical guidelines...... to patient testing, and review existing TVA-based patient studies organized by lesion anatomy. Lesions in three anatomical regions affect visual capacity: The parietal lobes, frontal cortex and basal ganglia, and extrastriate cortex. Visual capacity thus depends on large, bilaterally distributed anatomical...

Nitrogen doped silicon-carbon multilayer protective coatings on carbon obtained by TVA method

Science.gov (United States)

Ciupina, Victor; Vasile, Eugeniu; Porosnicu, Corneliu; Lungu, Cristian P.; Vladoiu, Rodica; Jepu, Ionut; Mandes, Aurelia; Dinca, Virginia; Caraiane, Aureliana; Nicolescu, Virginia; Cupsa, Ovidiu; Dinca, Paul; Zaharia, Agripina

2017-08-01

Protective nitrogen doped Si-C multilayer coatings on carbon, used to improve the oxidation resistance of carbon, were obtained by Thermionic Vacuum Arc (TVA) method. The initial carbon layer having a thickness of 100nm has been deposed on a silicon substrate in the absence of nitrogen, and then a 3nm Si thin film to cover carbon layer was deposed. Further, seven Si and C layers were alternatively deposed in the presence of nitrogen ions, each having a thickness of 40nm. In order to form silicon carbide at the interface between silicon and carbon layers, all carbon, silicon and nitrogen ions energy has increased up to 150eV . The characterization of microstructure and electrical properties of as-prepared N-Si-C multilayer structures were done using Transmission Electron Microscopy (TEM, STEM) techniques, Thermal Desorption Spectroscopy (TDS) and electrical measurements. Oxidation protection of carbon is based on the reaction between oxygen and silicon carbide, resulting in SiO2, SiO and CO2, and also by reaction involving N, O and Si, resulting in silicon oxynitride (SiNxOy) with a continuously variable composition, and on the other hand, since nitrogen acts as a trapping barrier for oxygen. To perform electrical measurements, 80% silver filled two-component epoxy-based glue ohmic contacts were attached on the N-Si-C samples. Electrical conductivity was measured in constant current mode. The experimental data show the increase of conductivity with the increase of the nitrogen content. To explain the temperature behavior of electrical conductivity we assumed a thermally activated electric transport mechanism.

Video game experience and its influence on visual attention parameters: an investigation using the framework of the Theory of Visual Attention (TVA).

Science.gov (United States)

Schubert, Torsten; Finke, Kathrin; Redel, Petra; Kluckow, Steffen; Müller, Hermann; Strobach, Tilo

2015-05-01

Experts with video game experience, in contrast to non-experienced persons, are superior in multiple domains of visual attention. However, it is an open question which basic aspects of attention underlie this superiority. We approached this question using the framework of Theory of Visual Attention (TVA) with tools that allowed us to assess various parameters that are related to different visual attention aspects (e.g., perception threshold, processing speed, visual short-term memory storage capacity, top-down control, spatial distribution of attention) and that are measurable on the same experimental basis. In Experiment 1, we found advantages of video game experts in perception threshold and visual processing speed; the latter being restricted to the lower positions of the used computer display. The observed advantages were not significantly moderated by general person-related characteristics such as personality traits, sensation seeking, intelligence, social anxiety, or health status. Experiment 2 tested a potential causal link between the expert advantages and video game practice with an intervention protocol. It found no effects of action video gaming on perception threshold, visual short-term memory storage capacity, iconic memory storage, top-down control, and spatial distribution of attention after 15 days of training. However, observations of a selected improvement of processing speed at the lower positions of the computer screen after video game training and of retest effects are suggestive for limited possibilities to improve basic aspects of visual attention (TVA) with practice. Copyright © 2015 Elsevier B.V. All rights reserved.

TVA–based assessment of attentional capacities – associations with age and indices of brain white matter microstructure

Directory of Open Access Journals (Sweden)

Thomas eEspeseth

2014-10-01

Full Text Available In this study the primary aims were to characterize the effects of age on basic components of visual attention derived from assessments based on a theory of visual attention (TVA in 325 healthy volunteers covering the adult lifespan (19-81 years. Furthermore, we aimed to investigate how age-related differences on TVA parameters are associated with white matter (WM microstructure as indexed by diffusion tensor imaging (DTI. Finally, we explored how TVA parameter estimates were associated with complex, or multicomponent indices of processing speed (Digit-symbol substitution, DSS and fluid intelligence (gF. The results indicated that the TVA parameters for visual short-term memory capacity, K, and for attentional selectivity, α, were most strongly associated with age before the age of 50. However, in this age range, it was the parameter for processing speed, C, that was most clearly associated with DTI indices, in this case fractional anisotropy (FA, particularly in the genu and body of the corpus callosum. Furthermore, differences in the C parameter partially mediated differences in DSS within this age range. After the age of 50, the TVA parameter for the perceptual threshold, t0, as well as K, were most strongly related to participant age. Both parameters, but t0 more strongly so than K, were associated WM diffusivity, particularly in projection fibers such as the internal capsule, the sagittal stratum, and the corona radiata. Within this age range, t0 partially mediated age-related differences in gF. The results are consistent with, and provide novel empirical support for the neuroanatomical localization of TVA computations as outlined in the neuronal interpretation of TVA (NTVA. Furthermore, the results indicate that to understand the biological sources of age-related changes in processing speed and fluid cognition, it may be useful to employ methods that allow for computational fractionation of these multicomponent measures.

Evaluating a biomass resource: The TVA region-wide biomass resource assessment model

Energy Technology Data Exchange (ETDEWEB)

Downing, M.; Graham, R.L. [Oak Ridge National Lab., TN (United States)

1993-12-31

The economic and supply structures of short rotation woody crop (SRWC) markets have not been established. Establishing the likely price and supply of SRWC biomass in a region is a complex task because biomass is not an established commodity as are oil, natural gas and coal. In this study we project the cost and supply of short-rotation woody biomass for the TVA region -- a 276 county area that includes all of Tennessee and portions of 10 contiguous states in the southeastern United States. Projected prices and quantities of SRWC are assumed to be a function of the amount and quality of crop and pasture land available in a region, expected SRWC yields and production costs on differing soils and land types, and the profit that could be obtained from current conventional crop production on these same lands. Results include the supply curve of SRWC biomass that is projected to be available from the entire region, the amount and location of crop and pasture land that would be used, and the conventional agricultural crops that would be displaced as a function of SRWC production. Finally, we show the results of sensitivity analysis on the projected cost and supply of SRWC biomass. In particular, we examine the separate impacts of varying SRWC production yields.

18 CFR 1301.24 - Specific exemptions.

Science.gov (United States)

2010-04-01

... individual an unfair competitive advantage in selection based on test performance. (d) The TVA system OIG... other individuals who perform services for TVA. TVA has received this information in the past under both... solely to determine individual qualifications for appointment or promotion in the Federal service would...

Genetically engineered rat gliomas: PDGF-driven tumor initiation and progression in tv-a transgenic rats recreate key features of human brain cancer.

Directory of Open Access Journals (Sweden)

Nina P Connolly

Full Text Available Previously rodent preclinical research in gliomas frequently involved implantation of cell lines such as C6 and 9L into the rat brain. More recently, mouse models have taken over, the genetic manipulability of the mouse allowing the creation of genetically accurate models outweighed the disadvantage of its smaller brain size that limited time allowed for tumor progression. Here we illustrate a method that allows glioma formation in the rat using the replication competent avian-like sarcoma (RCAS virus / tumor virus receptor-A (tv-a transgenic system of post-natal cell type-specific gene transfer. The RCAS/tv-a model has emerged as a particularly versatile and accurate modeling technology by enabling spatial, temporal, and cell type-specific control of individual gene transformations and providing de novo formed glial tumors with distinct molecular subtypes mirroring human GBM. Nestin promoter-driven tv-a (Ntv-a transgenic Sprague-Dawley rat founder lines were created and RCAS PDGFA and p53 shRNA constructs were used to initiate intracranial brain tumor formation. Tumor formation and progression were confirmed and visualized by magnetic resonance imaging (MRI and spectroscopy. The tumors were analyzed using histopathological and immunofluorescent techniques. All experimental animals developed large, heterogeneous brain tumors that closely resembled human GBM. Median survival was 92 days from tumor initiation and 62 days from the first point of tumor visualization on MRI. Each tumor-bearing animal showed time dependent evidence of malignant progression to high-grade glioma by MRI and neurological examination. Post-mortem tumor analysis demonstrated the presence of several key characteristics of human GBM, including high levels of tumor cell proliferation, pseudopalisading necrosis, microvascular proliferation, invasion of tumor cells into surrounding tissues, peri-tumoral reactive astrogliosis, lymphocyte infiltration, presence of numerous tumor

Nitrogen doped silicon-carbon multilayer protective coatings on carbon obtained by thermionic vacuum arc (TVA) method

Science.gov (United States)

Ciupinǎ, Victor; Vasile, Eugeniu; Porosnicu, Corneliu; Vladoiu, Rodica; Mandes, Aurelia; Dinca, Virginia; Nicolescu, Virginia; Manu, Radu; Dinca, Paul; Zaharia, Agripina

2018-02-01

To obtain protective nitrogen doped Si-C multilayer coatings on carbon, used to improve the oxidation resistance of carbon, was used TVA method. The initial carbon layer has been deposed on a silicon substrate in the absence of nitrogen, and then a 3nm Si thin film to cover carbon layer was deposed. Further, seven Si and C layers were alternatively deposed in the presence of nitrogen ions. In order to form silicon carbide at the interface between silicon and carbon layers, all carbon, silicon and nitrogen ions energy has increased up to 150eV. The characterization of microstructure and electrical properties of as-prepared N-Si-C multilayer structures were done using Transmission Electron Microscopy (TEM, STEM) techniques, Thermal Desorption Spectroscopy (TDS) and electrical measurements. The retention of oxygen in the protective layer of N-Si-C is due to the following phenomena: (a) The reaction between oxygen and silicon carbide resulting in silicon oxide and carbon dioxide; (b) The reaction involving oxygen, nitrogen and silicon resulting silicon oxinitride with a variable composition; (c) Nitrogen acts as a trapping barrier for oxygen. To perform electrical measurements, ohmic contacts were attached on the N-Si-C samples. Electrical conductivity was measured in constant current mode. To explain the temperature behavior of electrical conductivity we assumed a thermally activated electric transport mechanism.

Persisting asymmetries of vision after right side lesions

DEFF Research Database (Denmark)

Habekost, Thomas; Rostrup, Egill

2006-01-01

Visual neglect and extinction are well-known effects of lesions in the right hemisphere. This study shows that even with minor or no clinical signs of these deficits, and in the stable phase of recovery, asymmetric visual perception is common after right side lesions. Whole, partial and colour...... report experiments were used to estimate psychophysical parameters related to visual capacity and attentional weighting in 26 patients with stroke in the right side of the brain. The results were analyzed using Bundesen's Theory of Visual Attention (TVA [Bundesen, C. (1990). A theory of visual attention....... Psychological Review, 97, 523-547]) including bootstrap estimation of the measurement error related to each test result [Habekost, T., & Bundesen, C. (2003). Patient assessment based on a theory of visual attention (TVA): Subtle deficits after a right frontal-subcortical lesion. Neuropsychologia, 41, 1171...

TVA-based assessment of visual attentional functions in developmental dyslexia

Science.gov (United States)

Bogon, Johanna; Finke, Kathrin; Stenneken, Prisca

2014-01-01

There is an ongoing debate whether an impairment of visual attentional functions constitutes an additional or even an isolated deficit of developmental dyslexia (DD). Especially performance in tasks that require the processing of multiple visual elements in parallel has been reported to be impaired in DD. We review studies that used parameter-based assessment for identifying and quantifying impaired aspect(s) of visual attention that underlie this multi-element processing deficit in DD. These studies used the mathematical framework provided by the “theory of visual attention” (Bundesen, 1990) to derive quantitative measures of general attentional resources and attentional weighting aspects on the basis of behavioral performance in whole- and partial-report tasks. Based on parameter estimates in children and adults with DD, the reviewed studies support a slowed perceptual processing speed as an underlying primary deficit in DD. Moreover, a reduction in visual short term memory storage capacity seems to present a modulating component, contributing to difficulties in written language processing. Furthermore, comparing the spatial distributions of attentional weights in children and adults suggests that having limited reading and writing skills might impair the development of a slight leftward bias, that is typical for unimpaired adult readers. PMID:25360129

76 FR 17160 - Notice of Finding of No Significant Antitrust Changes and Time for Filing Requests for...

Science.gov (United States)

2011-03-28

... was determined that none of the changes resulted from abuse of TVA's market power. In its review of... activity associated with abuse of its market power. In relation to TVA's customers, TVA projected a... TVA is allowed to supply and sell power is still dictated by Section 15d(a) of the TVA Act. But, TVA...

76 FR 53994 - Final Environmental Impact Statement, Single Nuclear Unit at the Bellefonte Plant Site, Jackson...

Science.gov (United States)

2011-08-30

... limited to, wind, solar, natural and methane gas, hydroelectric, and lignite coal. TVA also purchases... even with substantial energy replacement through conservation measures, TVA must still add new base... plant species have been previously reported to verify if the rare species are still present in the...

18 CFR 1301.12 - Definitions.

Science.gov (United States)

2010-04-01

... Investigatory Files—TVA. Health Records—TVA. Payroll Records—TVA. Travel History Records—TVA. Employment... & Employee Relations (or incumbent of a successor position), or another TVA official designated by the Vice... time period, excludes Saturdays, Sundays, and legal public holidays. [40 FR 45313, Oct. 1, 1975...

Exploring deformation scenarios in Timanfaya volcanic area (Lanzarote, Canary Islands) from GNSS and ground based geodetic observations

Science.gov (United States)

Riccardi, U.; Arnoso, J.; Benavent, M.; Vélez, E.; Tammaro, U.; Montesinos, F. G.

2018-05-01

We report on a detailed geodetic continuous monitoring in Timanfaya volcanic area (TVA), where the most intense geothermal anomalies of Lanzarote Island are located. We analyze about three years of GNSS data collected on a small network of five permanent stations, one of which at TVA, deployed on the island, and nearly 20 years of tiltmeter and strainmeter records acquired at Los Camelleros site settled in the facilities of the Geodynamics Laboratory of Lanzarote within TVA. This study is intended to contribute to understanding the active tectonics on Lanzarote Island and its origin, mainly in TVA. After characterizing and filtering out the seasonal periodicities related to "non-tectonic" sources from the geodetic records, a tentative ground deformation field is reconstructed through the analysis of both tilt, strain records and the time evolution of the baselines ranging the GNSS stations. The joint interpretation of the collected geodetic data show that the area of the strongest geothermal anomaly in TVA is currently undergoing a SE trending relative displacement at a rate of about 3 mm/year. This area even experiences a significant subsidence with a maximum rate of about 6 mm/year. Moreover, we examine the possible relation between the observed deformations and atmospheric effects by modelling the response functions of temperature and rain recorded in the laboratory. Finally, from the retrieval of the deformation patterns and the joint analysis of geodetic and environmental observations, we propose a qualitative model of the interplaying role between the hydrological systems and the geothermal anomalies. Namely, we explain the detected time correlation between rainfall and ground deformation because of the enhancement of the thermal transfer from the underground heat source driven by the infiltration of meteoric water.

Third-generation dual-source CT of the neck using automated tube voltage adaptation in combination with advanced modeled iterative reconstruction: evaluation of image quality and radiation dose

International Nuclear Information System (INIS)

Scholtz, Jan-Erik; Wichmann, Julian L.; Huesers, Kristina; Albrecht, Moritz H.; Beeres, Martin; Bauer, Ralf W.; Vogl, Thomas J.; Bodelle, Boris

2016-01-01

To evaluate image quality and radiation dose in third-generation dual-source computed tomography (DSCT) of the neck using automated tube voltage adaptation (TVA) with advanced modelled iterative reconstruction (ADMIRE) algorithm. One hundred and sixteen patients were retrospectively evaluated. Group A (n = 59) was examined on second-generation DSCT with automated TVA and filtered back projection. Group B (n = 57) was examined on a third-generation DSCT with automated TVA and ADMIRE. Age, body diameter, attenuation of several anatomic structures, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), radiation dose (CTDI vol ) and size-specific dose estimates (SSDE) were assessed. Diagnostic acceptability was rated by three readers. Age (p = 0.87) and body diameter (p = 0.075) did not differ significantly. Tube voltage in Group A was set automatically to 100 kV for all patients (n = 59), and to 70 kV (n = 2), 80 kV (n = 5), and 90 kV (n = 50) in Group B. Noise was reduced and CNR was increased significantly (p < 0.001). Diagnostic acceptability was rated high in both groups, with better ratings in Group B (p < 0.001). SSDE was reduced by 34 % in Group B (20.38 ± 1.63 mGy vs. 13.04 ± 1.50 mGy, p < 0.001). Combination of automated TVA and ADMIRE in neck CT using third-generation DSCT results in a substantial radiation dose reduction with low noise and increased CNR. (orig.)

18 CFR 1304.200 - Scope and intent.

Science.gov (United States)

2010-04-01

... facilities, specifically the construction of docks, piers, boathouses (fixed and floating), retaining walls... along TVA-owned residential access shoreland. TVA manages the TVA-owned residential access shoreland to...

Motor-cognitive dual-task performance: effects of a concurrent motor task on distinct components of visual processing capacity

OpenAIRE

Künstler, E. C. S.; Finke, K.; Günther, A.; Klingner, C.; Witte, O.; Bublak, P.

2017-01-01

Dual tasking, or the simultaneous execution of two continuous tasks, is frequently associated with a performance decline that can be explained within a capacity sharing framework. In this study, we assessed the effects of a concurrent motor task on the efficiency of visual information uptake based on the ‘theory of visual attention’ (TVA). TVA provides parameter estimates reflecting distinct components of visual processing capacity: perceptual threshold, visual processing speed, and visual sh...

A tunable magneto-rheological fluid-filled beam-like vibration absorber

International Nuclear Information System (INIS)

Hirunyapruk, C; Brennan, M J; Mace, B R; Li, W H

2010-01-01

Tuned vibration absorbers (TVAs) are often used to suppress unwanted vibrations. If the excitation frequency is time harmonic but the frequency changes with time, it is desirable to retune the TVA so that the natural frequency of the TVA always coincides with the excitation frequency. One way of achieving this is to adjust the stiffness of the TVA. The key challenge is to change the stiffness quickly in real time. In this paper a magneto-rheological (MR) fluid in its pre-yield state is used as the core of a three-layer beam-like TVA. The shear stiffness of the MR fluid is adjusted by varying the magnetic field to which it is exposed by changing the current supplied to the electromagnets. Hence the stiffness of the TVA can be varied. The vibration characteristics of the TVA as a function of the magnetic field strength are predicted using a finite element model together with an empirical model for the shear modulus of the MR fluid and a model for the magnetic field applied to the fluid. An MR fluid-filled TVA was manufactured and tested to validate the predictions. This TVA design allows the natural frequency to be changed by about 40%

Secure Control Systems for the Energy Sector

Energy Technology Data Exchange (ETDEWEB)

Smith, Rhett [Schweitzer Engineering Lab., Inc., Alpharetta, GA (United States); Stewart, John [Tennessee Valley Authority, Knoxville, TN (United States); Chavez, Adrian [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2014-10-22

The Padlock Project is an alliance between Tennessee Valley Authority (TVA), Sandia National Laboratories (SNL), and Schweitzer Engineering Laboratories Inc. (SEL). SEL is the prime contractor on the Padlock project. Rhett Smith (SEL) is the project director and Adrian Chaves (SNL) and John Stewart (TVA) are principle investigators. SEL is the world’s leader in microprocessor-based electronic equipment for protecting electric power systems. The Tennessee Valley Authority, a corporation owned by the U.S. government, provides electricity for 9 million people in parts of seven southeastern states at prices below the national average. TVA, which receives no taxpayer money and makes no profits, also provides flood control, navigation and land management for the Tennessee River system and assists utilities, and state and local governments with economic development.

Ruminal microbe of biohydrogenation of trans-vaccenic acid to stearic acid in vitro

Directory of Open Access Journals (Sweden)

Li Dan

2012-02-01

Full Text Available Abstract Background Optimization of the unsaturated fatty acid composition of ruminant milk and meat is desirable. Alteration of the milk and fatty acid profile was previously attempted by the management of ruminal microbial biohydrogenation. The aim of this study was to identify the group of ruminal trans-vaccenic acid (trans-11 C18:1, t-VA hydrogenating bacteria by combining enrichment studies in vitro. Methods The enrichment culture growing on t-VA was obtained by successive transfers in medium containing t-VA. Fatty acids were detected by gas chromatograph and changes in the microbial composition during enrichment were analyzed by denaturing gradient gel electrophoresis (DGGE. Prominent DGGE bands of the enrichment cultures were identified by 16S rRNA gene sequencing. Results The growth of ruminal t-VA hydrogenating bacteria was monitored through the process of culture transfer according to the accumulation of stearic acid (C18:0, SA and ratio of the substrate (t-VA transformed to the product (SA. A significant part of the retrieved 16S rRNA gene sequences was most similar to those of uncultured bacteria. Bacteria corresponding to predominant DGGE bands in t-VA enrichment cultures clustered with t-VA biohydrogenated bacteria within Group B. Conclusions This study provides more insight into the pathway of biohydrogenation. It also may be important to control the production of t-VA, which has metabolic and physiological benefits, through management of ruminal biohydrogenation bacterium.

18 CFR 1304.412 - Definitions.

Science.gov (United States)

2010-04-01

... flood the land. Footprint means the total water surface area of either a square or rectangular shape... elevation typically five feet above the top of the gates of a TVA dam. It is sometimes the property boundary... elevation. Shoreline Management Zone (SMZ) means a 50-foot-deep vegetated zone designated by TVA on TVA...

Phasic alerting increases visual attention capacity in younger but not in older individuals

DEFF Research Database (Denmark)

Wiegand, Iris Michaela; Petersen, Anders; Bundesen, Claus

2017-01-01

In the present study, we investigated effects of phasic alerting on visual attention in younger and older adults. We modelled parameters of visual attention based on the computational Theory of Visual Attention (TVA) and measured event-related lateralizations (ERLs) in a partial report task, in w...... and attention, which governs the responsiveness to external cues and is critical for general cognitive functioning in aging.......In the present study, we investigated effects of phasic alerting on visual attention in younger and older adults. We modelled parameters of visual attention based on the computational Theory of Visual Attention (TVA) and measured event-related lateralizations (ERLs) in a partial report task...

VLOGA DIGITALNIH POTRDIL PRI ELEKTRONSKEM POSLOVANJU

OpenAIRE

Zorman, Tjaša

2010-01-01

Uporaba elektronskega poslovanja je danes v svetu in pri nas zelo razširjena. Število uporabnikov elektronskega bančništva kot elementa elektronskega poslovanja se je od leta 2000 do leta 2008 povečalo skoraj za 30-krat. Vedno večje število uporabnikov kaže na pomembnost in uporabnost elektronskega bančništva pri nas. Del uspešnosti elektronskega bančništva lahko pripišemo njegovi varnosti, ki s svojimi elementi sodi v sam vrh kakovosti. Uporabniki elektronskega bančništva se zavedajo, d...

Reporting on nuclear power: the Tennessee Valley case

International Nuclear Information System (INIS)

Shapley, D.

1977-01-01

The Tennessee Valley Authority (TVA), by deciding to have 90 percent of its new generating capacity nuclear, has made the valley a testing ground for civilian nuclear power, but valley newspapers have not provided consumers with enough information on either the pros or cons. A 1975 Browns Ferry plant fire, the most serious in the history of the civilian nuclear industry, prompted some nuclear critics to question TVA's competence to plan and manage the program. Newspapers carried wire-service stories of the fire, while their editorials gave strong support to TVA and the effort to reopen the plant. Valley newspapers have traditionally favored TVA as a powerful economic and political force which has brought many benefits. Local pride in the Oak Ridge Laboratory and plant facilities and the Federal fast-breeder reactor project headquarters also enhanced the positive attitude of the press, which tended to report details but not question nuclear safety or TVA ability. Newspapers have also failed to question TVA's claims that rates will decline as nuclear plants begin operating. A review of relevant news stories during the 1975--1976 period addresses the press coverage and notes its failure to question whether power demands justify TVA's plant construction program. Knowledgeable consultants are available to provide information on the issues, while editors are advised to give comprehensive, critical coverage and avoid promotion

The weight of the visual world is modified by recent experience

DEFF Research Database (Denmark)

Ásgeirsson, Árni Gunnar; Kyllingsbæk, Søren; Kristjánsson, Árni

. Recent proposals assume that repetition priming operates at multiple levels. Here we focus on two questions: (1) does repetition priming have a purely perceptual component? and (2) how does such a component fit into the TVA framework? (Bundesen, C. 1990. Psychological bulletin and Review, 97, 523...... not ruling out repetition benefits at other levels. Furthermore, color repetition was only beneficial when the task required attentional selection. The results were fitted to a TVA-based model from which we provided estimates of weights. The results from the modeling procedure indicate that the perceptual...

Nonlinear dynamic analysis of high energy line pipe whip

International Nuclear Information System (INIS)

Hsu, L.C.; Kuo, A.Y.; Tang, H.T.

1983-01-01

To facilitate potential cost savings in pipe whip protection design, TVA conducted a 1'' high pressure line break test to investigate the pipe whip behavior. The test results are available to EPRI as a data base for a generic study on nonlinear dynamic behavior of piping systems and pipe whip phenomena. This paper describes a nonlinear dynamic analysis of the TVA high energy line tests using ABAQUS-EPGEN code. The analysis considers the effects of large deformation and high strain rate on resisting moment and energy absorption capability of the analyzed piping system. The numerical results of impact forces, impact velocities, and reaction forces at pipe supports are compared to the TVA test data. The pipe whip impact time and forces have also been calculated per the current NRC guidelines and compared. The calculated pipe support reaction forces prior to impact have been found to be in good agreement with the TVA test data except for some peak values at the very beginning of the pipe break. These peaks are believed to be due to stress wave propagation which cannot be addressed by the ABAQUS code. Both the effects of elbow crushing and strain rate have been approximately simulated. The results are found to be important on pipe whip impact evaluation. (orig.)

Safety Evaluation Report on Tennessee Valley Authority: Revised Corporate Nuclear Performance Plan

International Nuclear Information System (INIS)

1987-07-01

The TVA Corporate Nuclear Performance Plan addresses those corporate concerns identified by the NRC staff. Because much of the TVA corporate plan is programmatic, its effectiveness depends on its implementation, and the NRC staff plans to closely monitor this implementation. The NRC staff will address site-specific concerns in subsequent SERs on each volume of the Nuclear Performance Plan. On the basis of its review, the NRC staff finds TVA's revised Corporate Nuclear Performance Plan (Revision 4) acceptable. The NRC staff concludes that the organization and staffing of TVA's Office of Nuclear Power and the programmatic improvements in place or under way are sufficient, if implemented properly, to resolve the problems at the corporate level that led to issuance of the 10 CFR 50.54(f) letter dated September 17, 1985, and to support continuing TVA nuclear activities, including plant operations. 19 refs., 3 figs

Measuring and modeling salience with the theory of visual attention.

Science.gov (United States)

Krüger, Alexander; Tünnermann, Jan; Scharlau, Ingrid

2017-08-01

For almost three decades, the theory of visual attention (TVA) has been successful in mathematically describing and explaining a wide variety of phenomena in visual selection and recognition with high quantitative precision. Interestingly, the influence of feature contrast on attention has been included in TVA only recently, although it has been extensively studied outside the TVA framework. The present approach further develops this extension of TVA's scope by measuring and modeling salience. An empirical measure of salience is achieved by linking different (orientation and luminance) contrasts to a TVA parameter. In the modeling part, the function relating feature contrasts to salience is described mathematically and tested against alternatives by Bayesian model comparison. This model comparison reveals that the power function is an appropriate model of salience growth in the dimensions of orientation and luminance contrast. Furthermore, if contrasts from the two dimensions are combined, salience adds up additively.

Single-Trial Inference on Visual Attention

DEFF Research Database (Denmark)

Dyrholm, Mads; Kyllingsbæk, Søren; Vangkilde, Signe Allerup

2011-01-01

In this paper we take a step towards single-trial behavioral modeling within a Theory of Visual Attention (TVA). In selective attention tasks, such as the Partial Report paradigm, the subject is asked to ignore distractors and only report stimuli that belong to the target class. Nothing about...... Report trial. This result retrodicts a latent attentional state of the subject using the observed response from that particular trial and thus differs from other predictions made with TVA which are based on expected values of observed variables. We show an example of the result in single-trial analysis...

Persisting asymmetries of vision after right side lesions

DEFF Research Database (Denmark)

Habekost, Thomas; Rostrup, Egill

2006-01-01

Visual neglect and extinction are well-known effects of lesions in the right hemisphere. This study shows that even with minor or no clinical signs of these deficits, and in the stable phase of recovery, asymmetric visual perception is common after right side lesions. Whole, partial and colour....... Psychological Review, 97, 523-547]) including bootstrap estimation of the measurement error related to each test result [Habekost, T., & Bundesen, C. (2003). Patient assessment based on a theory of visual attention (TVA): Subtle deficits after a right frontal-subcortical lesion. Neuropsychologia, 41, 1171...

Interagency Research Conference (15th) Held in Vicksburg, Mississippi on 3-5 November 1987

Science.gov (United States)

1987-11-05

Stepped Spillway USBR H-7b Labyrinth Spillways USBR H-7d Scour Downstream from Stilling Basins WES H-Ba Analyses of Hydroturbine Vibrations TVA H-Be... Hydroturbine Flow Measurement Using the Pressure- Time Method TVA The following technology transfer methods were given by the participants: a. Technical...7c Stilling Basin Damage Due to Erosion USBR H-7d Scour Downstream from Stilling Basins WES H-8a Analyses of Hydroturbine Vibrations TVA H-8b

Bacterial spoilage profiles to identify irradiated fish

International Nuclear Information System (INIS)

Alur, M.D.; Venugopal, V.; Nerkar, D.P.; Nair, P.M.

1991-01-01

Effects of low dose gamma-irradiation of fish product on spoilage potentials of bacteria (Aeromonas hydrophila, Salmonella typhimurium, Bacillus megaterium, and Pseudomonas marinoglutinosa) and mixed flora were examined for ability to proliferate in radurized fish and produce volatile acids (TVA) and bases (TVBN). Bacteria proliferated well in unirradiated and irradiated fish, but formation of VA and VB were lower in irradiated than unirradiated counterparts. This was found in Bombay duck, Indian mackerel, white pomfret, seer and shrimp gamma-irradiated at 0 to 5 kGy under ice. TVA and TVBN produced by the organisms or mixed flora from fish were only 30-50% those of controls. A method for identifying radiation-processed fish could evolve based on lower susceptibility of irradiated fish to bacterial spoilage

76 FR 32258 - Meeting of the Regional Resource Stewardship Council

Science.gov (United States)

2011-06-03

... developing an accompanying Environmental Impact Statement (EIS) in which TVA will evaluate the preferred... stakeholder group throughout the development of the NRP to advise TVA on the issues, tradeoffs, and focus of...

Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose.

Science.gov (United States)

May, Matthias S; Kramer, Manuel R; Eller, Achim; Wuest, Wolfgang; Scharf, Michael; Brand, Michael; Saake, Marc; Schmidt, Bernhard; Uder, Michael; Lell, Michael M

2014-09-01

Low tube voltage allows for computed tomography (CT) imaging with increased iodine contrast at reduced radiation dose. We sought to evaluate the image quality and potential dose reduction using a combination of attenuation based tube current modulation (TCM) and automated tube voltage adaptation (TVA) between 100 and 120 kV in CT of the head and neck. One hundred thirty consecutive patients with indication for head and neck CT were examined with a 128-slice system capable of TCM and TVA. Reference protocol was set at 120 kV. Tube voltage was reduced to 100 kV whenever proposed by automated analysis of the localizer. An additional small scan aligned to the jaw was performed at a fixed 120 kV setting. Image quality was assessed by two radiologists on a standardized Likert-scale and measurements of signal- (SNR) and contrast-to-noise ratio (CNR). Radiation dose was assessed as CTDIvol. Diagnostic image quality was excellent in both groups and did not differ significantly (p = 0.34). Image noise in the 100 kV data was increased and SNR decreased (17.8/9.6) in the jugular veins and the sternocleidomastoid muscle when compared to 120 kV (SNR 24.4/10.3), but not in fatty tissue and air. However, CNR did not differ statistically significant between 100 (23.5/14.4/9.4) and 120 kV data (24.2/15.3/8.6) while radiation dose was decreased by 7-8%. TVA between 100 and 120 kV in combination with TCM led to a radiation dose reduction compared to TCM alone, while keeping CNR constant though maintaining diagnostic image quality.

Automated tube voltage adaptation in head and neck computed tomography between 120 and 100 kV: effects on image quality and radiation dose

Energy Technology Data Exchange (ETDEWEB)

May, Matthias S.; Uder, Michael; Lell, Michael M. [University Hospital Erlangen, Department of Radiology, Erlangen (Germany); University Erlangen, Imaging Science Institute, Erlangen (Germany); Kramer, Manuel R.; Eller, Achim; Wuest, Wolfgang; Scharf, Michael; Brand, Michael; Saake, Marc [University Hospital Erlangen, Department of Radiology, Erlangen (Germany); Schmidt, Bernhard [Siemens Healthcare, Erlangen (Germany)

2014-09-15

Low tube voltage allows for computed tomography (CT) imaging with increased iodine contrast at reduced radiation dose. We sought to evaluate the image quality and potential dose reduction using a combination of attenuation based tube current modulation (TCM) and automated tube voltage adaptation (TVA) between 100 and 120 kV in CT of the head and neck. One hundred thirty consecutive patients with indication for head and neck CT were examined with a 128-slice system capable of TCM and TVA. Reference protocol was set at 120 kV. Tube voltage was reduced to 100 kV whenever proposed by automated analysis of the localizer. An additional small scan aligned to the jaw was performed at a fixed 120 kV setting. Image quality was assessed by two radiologists on a standardized Likert-scale and measurements of signal- (SNR) and contrast-to-noise ratio (CNR). Radiation dose was assessed as CTDI{sub vol}. Diagnostic image quality was excellent in both groups and did not differ significantly (p = 0.34). Image noise in the 100 kV data was increased and SNR decreased (17.8/9.6) in the jugular veins and the sternocleidomastoid muscle when compared to 120 kV (SNR 24.4/10.3), but not in fatty tissue and air. However, CNR did not differ statistically significant between 100 (23.5/14.4/9.4) and 120 kV data (24.2/15.3/8.6) while radiation dose was decreased by 7-8 %. TVA between 100 and 120 kV in combination with TCM led to a radiation dose reduction compared to TCM alone, while keeping CNR constant though maintaining diagnostic image quality. (orig.)

Assessment of the interface of beating heart with total artificial heart using magnetic resonance imaging

International Nuclear Information System (INIS)

Komoda, Tsuyoshi; Maeta, Hajime; Uyama, Chikao; Sanou, Kazuo.

1992-01-01

We have studied three-dimensionally (3-D) reconstructed images of atrioventricular (AV) annuli based on four-chamber magnetic resonance (MR) images for total artificial heart (TAH) implantation. To assess the interrelationship among the AV annuli and the thorax, we applied the frame of reference of the vertebral canal to these images. The Z-axis was along the vertebral canal, the Y-axis in the anteroposterior direction. The angle alpha was defined as the angle between the X-axis and the intersection between the plane of the annulus and the X-Y plane. The angle beta was defined as the angle between the Z-axis and the intersection between the plane of annulus and X-Z plane. The angle gamma was defined as the angle between the plane of the annulus and the anterior thoracic wall. We determined each angle for the mitral annulus (MVA) and tricuspid annulus (TVA) in four normal subjects to be as follows: alpha-MVA, 20.5-39.5 degrees; alpha-TVA, 26.1-43.5 degrees; beta-MVA, 4.7-49.4 degrees; beta-TVA, 4.4-40.9 degrees; and gamma-TVA, 35.2-44.1 degrees. It is suggested that reconstruction of the thoracic wall and AV annuli using the frame of reference of the diaphragmatic surface of the heart would facilitate evaluation of the spacial requirements for TAH implantation. Research to define this new frame of reference is in progress. (author)

Emission allowances stall in marketplace

International Nuclear Information System (INIS)

Malec, W.F.

1993-01-01

Misinformation and public misunderstanding have given emissions trading a bad reputation in the public marketplace, says William F. Malec, executive vice president of the Tennessee Valley Authority (TVA), in Knoxville, Tennessee. Media coverage of a May 1992 emissions-allowance trade between TVA and Wisconsin Power and Light open-quotes focused on the agreement's pollution-trading aspects, not its overall potential economic and environmental benefits,close quotes Malec says. Such negative portrayal of TVA's transaction sparked severe public criticism and charges that emissions trading gives utilities the right to pollute. open-quotes The fact is that TVA sought the emissions-trading agreement as a means to reduce overall emissions in the most cost-effective way,close quotes Malec explains. Emissions trading allows a company with emission levels lower than clean-air standards to earn open-quotes credits.close quotes These credits then may be purchased by a company with emission levels that exceed federal standards. Under this arrangement, the environment is protected and companies that buy credits save money because they do not have to purchase expensive emissions-control devices or reduce their production levels. Malec says TVA decided to enter into the emissions-allowance market, not only to cut costs, but also to publicize the existence and benefits of emissions trading. However, TVA's experience proves that open-quotes people will not accept what they do not understand,close quotes concludes Malec, open-quotes especially when complex environmental issues are involved.close quotes

Principles of visual attention

DEFF Research Database (Denmark)

Bundesen, Claus; Habekost, Thomas

research as a field that is fundamentally fragmented. This book takes a different perspective and presents a unified theory of visual attention: the TVA model. The TVA model explains the many aspects of visual attention by just two mechanisms for selection of information: filtering and pigeonholing......The nature of attention is one of the oldest and most central problems in psychology. A huge amount of research has been produced on this subject in the last half century, especially on attention in the visual modality, but a general explanation has remained elusive. Many still view attention....... These mechanisms are described in a set of simple equations, which allow TVA to mathematically model a large number of classical results in the attention literature. The theory explains psychological and neuroscientific findings by the same equations; TVA is a complete theory of visual attention, linking mind...

Value Creation and Value Claiming in Make-Or-Buy Decisions

NARCIS (Netherlands)

E. Verwaal (Ernst); W.J.M.I. Verbeke (Willem); H.R. Commandeur (Harry)

2002-01-01

textabstractTransaction value analysis (TVA) integrates the concepts of resource heterogeneity and transaction cost economics into a single framework, which emphasizes both value creation and value claiming in firms' vertical integration decisions. Using a TVA perspective, we develop hypotheses to

76 FR 13401 - Environmental Impact Statements; Notice of Availability

Science.gov (United States)

2011-03-11

... Mine Pits, Haul Roads, Water Management Structures, and Overburden Disposal Areas, Implementation..., Final EIS, TVA, KY, Tennessee Valley Authority (TVA) Integrated Resource Plan (IRP), To Address the... Activities, Proposal to Support and Conduct Current, Emerging, and Future Training Activities, Implementation...

Cochlear implant benefits in deafness rehabilitation: PET study of temporal voice Activations

Energy Technology Data Exchange (ETDEWEB)

Coez, A.; Zilbovicius, M. [CEA, Serv Hosp Frederic Joliot, INSERM, Res Unit Neuroimaging and Psychiat, U797, IFR49, F-91406 Orsay (France); Zilbovicius, M.; Syrota, A.; Samson, Y. [CEA, DSV, DRM, Serv Hosp Frederic Joliot, F-91406 Orsay (France); Bizaguet, E. [Lab Correct Audit, Paris (France); Coez, A. [Univ Paris Sud 11, Paris (France); Ferrary, E.; Bouccara, D.; Mosnier, I.; Sterkers, O. [INSERM, Unit M 867, Paris (France); Ambert-Dahan, E. [Hop Beaujon, Serv ORL Chirurg Cervicofaciale, AP-HP, Clichy (France); Ferrary, E.; Bouccara, D.; Mosnier, I.; Sterkers, O. [Inst Fed Rech Claude Bernard Physiol et Pathol, IFR02, Paris (France); Samson, Y. [Hop La Pitie Salpetriere, Serv Urgences Cerebro-vasc, AP-HP, Paris (France); Samson, Y. [Univ Paris 06, Paris (France); Sterkers, O. [Univ Denis Diderot Paris 7, Paris (France)

2008-07-01

Cochlear implants may improve the medical and social prognosis of profound deafness. Nevertheless, some patients have experienced poor results without any clear explanations. One correlate may be an alteration in cortical voice processing. To test this hypothesis, we studied the activation of human temporal voice areas (TVA) using a well-standardized PET paradigm adapted from previous functional MRI (fMRI) studies. Methods: A PET H{sub 2}{sup 15}O activation study was performed on 3 groups of adult volunteers: normal-hearing control subjects (n 6) and cochlear-implanted post-lingually deaf patients with {>=}2 y of cochlear implant experience, with intelligibility scores in the 'Lafon monosyllabic task' {>=}80% (Good group; n 6) or {<=}20% (Poor group; n 6). Relative cerebral blood flow was measured in 3 conditions: rest, passive listening to human voice, and non-voice stimuli. Results: Compared with silence, the activations induced by non-voice stimuli were bilaterally located in the superior temporal regions in all groups. However these activations were significantly and similarly reduced in both cochlear implant groups, whereas control subjects showed supplementary activations. Compared with non-voice, the voice stimuli induced bilateral activation of the TVA along the superior temporal sulcus (STS) in both the control and the Good groups. In contrast, these activations were not detected in the Poor group, which showed only left unilateral middle STS activation. Conclusion: These results suggest that PET is an adequate method to explore cochlear implant benefits and that this benefit could be linked to the activation of the TVA. (authors)

Cochlear implant benefits in deafness rehabilitation: PET study of temporal voice Activations

International Nuclear Information System (INIS)

Coez, A.; Zilbovicius, M.; Zilbovicius, M.; Syrota, A.; Samson, Y.; Bizaguet, E.; Coez, A.; Ferrary, E.; Bouccara, D.; Mosnier, I.; Sterkers, O.; Ambert-Dahan, E.; Ferrary, E.; Bouccara, D.; Mosnier, I.; Sterkers, O.; Samson, Y.; Samson, Y.; Sterkers, O.

2008-01-01

Cochlear implants may improve the medical and social prognosis of profound deafness. Nevertheless, some patients have experienced poor results without any clear explanations. One correlate may be an alteration in cortical voice processing. To test this hypothesis, we studied the activation of human temporal voice areas (TVA) using a well-standardized PET paradigm adapted from previous functional MRI (fMRI) studies. Methods: A PET H 2 15 O activation study was performed on 3 groups of adult volunteers: normal-hearing control subjects (n 6) and cochlear-implanted post-lingually deaf patients with ≥2 y of cochlear implant experience, with intelligibility scores in the 'Lafon monosyllabic task' ≥80% (Good group; n 6) or ≤20% (Poor group; n 6). Relative cerebral blood flow was measured in 3 conditions: rest, passive listening to human voice, and non-voice stimuli. Results: Compared with silence, the activations induced by non-voice stimuli were bilaterally located in the superior temporal regions in all groups. However these activations were significantly and similarly reduced in both cochlear implant groups, whereas control subjects showed supplementary activations. Compared with non-voice, the voice stimuli induced bilateral activation of the TVA along the superior temporal sulcus (STS) in both the control and the Good groups. In contrast, these activations were not detected in the Poor group, which showed only left unilateral middle STS activation. Conclusion: These results suggest that PET is an adequate method to explore cochlear implant benefits and that this benefit could be linked to the activation of the TVA. (authors)

Behavioral and Brain Measures of Phasic Alerting Effects on Visual Attention

DEFF Research Database (Denmark)

Wiegand, Iris Michaela; Petersen, Anders; Finke, Kathrin

2017-01-01

In the present study, we investigated effects of phasic alerting on visual attention in a partial report task, in which half of the displays were preceded by an auditory warning cue. Based on the computational Theory of Visual Attention (TVA), we estimated parameters of spatial and non......-spatial aspects of visual attention and measured event-related lateralizations (ERLs) over visual processing areas. We found that the TVA parameter sensory effectiveness a, which is thought to reflect visual processing capacity, significantly increased with phasic alerting. By contrast, the distribution of visual....... These results suggest that phasic alerting facilitates visual processing in a general, unselective manner and that this effect originates in early stages of visual information processing....

75 FR 6257 - Watts Bar Reservoir Land Management Plan, Loudon, Meigs, Rhea, and Roane Counties, TN

Science.gov (United States)

2010-02-08

... TENNESSEE VALLEY AUTHORITY Watts Bar Reservoir Land Management Plan, Loudon, Meigs, Rhea, and... Watts Bar Reservoir in Tennessee. On November 19, 2009, the TVA Board of Directors (TVA Board) decided... the final environmental impact statement (FEIS) for the Watts Bar Reservoir Land Management Plan...

78 FR 65416 - Supplemental Environmental Impact Statement-Integrated Resource Plan

Science.gov (United States)

2013-10-31

... utility industry trends since 2011. As part of the study, TVA intends to prepare a programmatic... EIS process to elicit and prioritize the values and concerns of stakeholders; identify issues, trends, events, and tradeoffs affecting TVA's policies; formulate, evaluate and compare alternative portfolios of...

Urban vegetation and thermal patterns following city growth in different socio-economic contexts

Science.gov (United States)

Dronova, I.; Clinton, N.; Yang, J.; Radke, J.; Marx, S. S.; Gong, P.

2015-12-01

highly vary depending on economy, population trends and historical legacies of planned green spaces. Remote sensing-based metrics such as TVA facilitate their comparisons and offer useful strategies to cost-effectively monitor urban transformation and inform more explicit environmental modeling of cities in the future.

Beyond time and space: The effect of a lateralized sustained attention task and brain stimulation on spatial and selective attention.

Science.gov (United States)

Shalev, Nir; De Wandel, Linde; Dockree, Paul; Demeyere, Nele; Chechlacz, Magdalena

2017-10-03

The Theory of Visual Attention (TVA) provides a mathematical formalisation of the "biased competition" account of visual attention. Applying this model to individual performance in a free recall task allows the estimation of 5 independent attentional parameters: visual short-term memory (VSTM) capacity, speed of information processing, perceptual threshold of visual detection; attentional weights representing spatial distribution of attention (spatial bias), and the top-down selectivity index. While the TVA focuses on selection in space, complementary accounts of attention describe how attention is maintained over time, and how temporal processes interact with selection. A growing body of evidence indicates that different facets of attention interact and share common neural substrates. The aim of the current study was to modulate a spatial attentional bias via transfer effects, based on a mechanistic understanding of the interplay between spatial, selective and temporal aspects of attention. Specifically, we examined here: (i) whether a single administration of a lateralized sustained attention task could prime spatial orienting and lead to transferable changes in attentional weights (assigned to the left vs right hemi-field) and/or other attentional parameters assessed within the framework of TVA (Experiment 1); (ii) whether the effects of such spatial-priming on TVA parameters could be further enhanced by bi-parietal high frequency transcranial random noise stimulation (tRNS) (Experiment 2). Our results demonstrate that spatial attentional bias, as assessed within the TVA framework, was primed by sustaining attention towards the right hemi-field, but this spatial-priming effect did not occur when sustaining attention towards the left. Furthermore, we show that bi-parietal high-frequency tRNS combined with the rightward spatial-priming resulted in an increased attentional selectivity. To conclude, we present a novel, theory-driven method for attentional modulation

75 FR 67454 - Notice of Sunshine Act Meeting; Meeting No. 10-05

Science.gov (United States)

2010-11-02

... Business Approval of minutes of August 20, 2010, Board Meeting. New Business 1. Welcome. 2. President's Report. 3. Chairman's Report. A. Board Governance matters, including the creation of the TVA Board... comments to: TVA Board of Directors, Board Agenda Comments, 400 West Summit Hill Drive, Knoxville...

Web-Based Patient Education in Orthopedics: Systematic Review.

Science.gov (United States)

Dekkers, Tessa; Melles, Marijke; Groeneveld, Bob Sander; de Ridder, Huib

2018-04-23

Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only. ©Tessa Dekkers, Marijke Melles, Bob Sander Groeneveld, Huib de Ridder. Originally published in the Journal of Medical Internet Research (http

Acid-base disturbance in patients with cirrhosis

DEFF Research Database (Denmark)

Henriksen, Jens H; Bendtsen, Flemming; Møller, Søren

2015-01-01

(r=-0.25, Psodium (r=-0.38, Preduced standard base excess in all patients (P...PURPOSE: Acid-base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation. METHODS: A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study......, and effects of unidentified ions (all P

18 CFR 1300.105 - National origin harassment.

Science.gov (United States)

2010-04-01

... harassment. 1300.105 Section 1300.105 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY STANDARDS OF CONDUCT FOR EMPLOYEES OF TENNESSEE VALLEY AUTHORITY § 1300.105 National origin harassment. It is TVA policy that all TVA employees are responsible for assuring that the workplace is free from...

18 CFR 1316.10 - Officials not to benefit.

Science.gov (United States)

2010-04-01

... breach of this contract, and TVA shall have the right to exercise all remedies provided in this contract... GENERAL CONDITIONS AND CERTIFICATIONS FOR INCORPORATION IN CONTRACT DOCUMENTS OR ACTIONS Text of Conditions and Certifications § 1316.10 Officials not to benefit. When so indicated in TVA contract documents...

Bridging Block and Bundesen

DEFF Research Database (Denmark)

Sørensen, Thomas Alrik

that some fields in cognitive science are already gaining ground on the hard problem. An interesting model is Claus Bundesen‘s (1990) Theory of Visual Attention (TVA) that seems to be compatible with Ned Block‘s (1995) distinction between access consciousness and phenomenal consciousness. TVA proposes a two...

An evaluation of the Browns Ferry Nuclear Plant preventive maintenance program based on reliability centered maintenance analysis

International Nuclear Information System (INIS)

McCullough, C.L.; McCullough, C.A.

1989-01-01

Reliability centered maintenance (RCM) techniques were used to support a preventative maintenance (PM) upgrade program (PMUP) performed at TVA Browns Ferry Nuclear Plant (BFNP). The purpose of the RCM analysis was to identify critical equipment based on risk and economic importance and to evaluate the PM activities applicable to that equipment. The analysis may be conveniently divided into three steps, which will be outlined in the Approach section of this paper. The net benefit of the RCM approach was a prioritization of the focus of the PM upgrade program so that plant components receive attention proportional to their importance, and assurance that PM activities properly address the most likely component failure causes

Web-Based Patient Education in Orthopedics: Systematic Review

Science.gov (United States)

Melles, Marijke; Groeneveld, Bob Sander; de Ridder, Huib

2018-01-01

Background Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. Objective The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. Methods CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. Results A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients’ knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Conclusions Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients’ knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only. PMID:29685869

Evaluation of an Immunochromatographic Strip (Xenostrip –Tv Test for Diagnosis of Vaginal Trichomoniasis Compared with Wet Mount and PCR Assay

Directory of Open Access Journals (Sweden)

MH Feiz-Haddad

2008-09-01

Full Text Available "nBackground: Trichomoniasis, caused by Trichomonas vaginalis, is one of the most common sexually transmitted infections in the world. Diagnosis of T. vaginalis is performed by different methods, including wet mount, culture, serological methods and PCR, which required laboratory equipments and expert laboratory personnel. The aim of this study was evaluation of immunochromatographic strip test (Xenostrip-Tv for diagnosis of vaginal trichomoniasis compared with wet mount and PCR assay."nMethods: In this prospective study vaginal swabs were obtained from 100 women with genital complaints demanding a speculum examination, referred to Imam Khomeini and Amir Kabir hospitals in Ahwaz, Khuzestan Province. Samples were first examined by wet mount and Xenostrip-Tv. PCR assay was performed in the next step using TVK3 and TVK7 primers initially. The positive samples were then confirmed by the second PCR assay using TVA5-1 and TVA6 primers."nResults: PCR with TVA5-1 and TVA6 primers was determined as gold standard. The wet mount as well as Xenostrip-Tv sensitivity and specificity were 73.3% and 100%, respectively in comparison with gold standard. The sensitivity and specificity of PCR with primers TVK3 and TVK7 were also determined as 100% and 96.6%, respectively. The infection rates were 14% for wet mount and Xenostrip-Tv, 21% for PCR with primers TVK3 plus TVK7 and 19% with the gold standard PCR using TVA5-1 and TVA6 primers."nConclusion: Xenostrip- Tv could be used for diagnosis of vaginal trichomoniasis in regions with no laboratory diagnostic facilities.

MORALNA PANIKA U HRVATSKOJ: ANALIZA IZVJEŠTAVANJA MEDIJA O UBOJSTVU FRANE DESPIĆA

OpenAIRE

Krznar, Nikolina

2014-01-01

Moralna panika pretjerana je reakcija medija, policije i javnosti na ponašanje određenih društvenih grupa, najčešće mladih. Smatra se karakteristikom suvremenog društva u kojem su moralne panike sve češće i uključuju velik broj ljudi. Za uvođenje koncepta moralne panike u sociologiju zaslužan je Stanley Cohen, koji je u djelu ‘’Folk Devils and Moral Panics’’ analizirao reakciju društva na pojavu i sukobe modsa i rockera. U analizi je naglasio važnost medija u onstrukciji reakcije društva. ...

Law proposition aiming to establish the double display of sale prices of petroleum products

International Nuclear Information System (INIS)

Vannson, F.

2006-03-01

Petroleum products are submitted to the internal tax (called TIPP in France) and the sales tax (called TVA in France). The TVA product is increasing proportionally to the petroleum products prices. On the other hand the TIPP product, which is five time as much high as the TVA, is proportional to the consumed volumes and decreases proportionally with the consumption decrease, resulting from the prices increase. In a framework of transparency for the consumers, and to reveal the importance of the taxes in the hydrocarbons prices, it should be desirable to display the sale prices without and with the taxes. Here are the objectives of this law proposition. (A.L.B.)

Event-related potential indices of inter-individual and age differences in visual attention capacity

DEFF Research Database (Denmark)

Wiegand, Iris; Töllner, Thomas; Dyrholm, Mads

The ‘Theory of Visual Attention’ quantifies an individual’s capacity of attentional resources in parameters visual processing speed C and vSTM storage capacity K. By combining TVA-based assessment with neurophysiology, we showed that distinct ERP components index inter-individual differences......-related changes in attentional capacities, these ERP markers of individual differences in processing speed and storage capacity were validated in an older group. Furthermore, additional components were related to performance exclusively in older inidividuals: Anterior N1 amplitudes were reduced for slower older...... that reorganization of attentional brain networks, including age-specific decline and compensation mechanisms, determines older individuals’ attention capacity. Furthermore, we show that the distinctiveness of the two functions, as defined in TVA, is preserved (or even increased) in older age....

Patient Posture Monitoring System Based on Flexible Sensors

Directory of Open Access Journals (Sweden)

Youngsu Cha

2017-03-01

Full Text Available Monitoring patients using vision cameras can cause privacy intrusion problems. In this paper, we propose a patient position monitoring system based on a patient cloth with unobtrusive sensors. We use flexible sensors based on polyvinylidene fluoride, which is a flexible piezoelectric material. Theflexiblesensorsareinsertedintopartsclosetothekneeandhipoftheloosepatientcloth. We measure electrical signals from the sensors caused by the piezoelectric effect when the knee and hip in the cloth are bent. The measured sensor outputs are transferred to a computer via Bluetooth. We use a custom-made program to detect the position of the patient through a rule-based algorithm and the sensor outputs. The detectable postures are based on six human motions in and around a bed. The proposed system can detect the patient positions with a success rate over 88 percent for three patients.

Exploring the word superiority effect using TVA

DEFF Research Database (Denmark)

Starrfelt, Randi

Words are made of letters, and yet sometimes it is easier to identify a word than a single letter. This word superiority effect (WSE) has been observed when written stimuli are presented very briefly or degraded by visual noise. It is unclear, however, if this is due to a lower threshold for perc...... simultaneously we find a different pattern: In a whole report experiment with six stimuli (letters or words), letters are perceived more easily than words, and this is reflected both in perceptual processing speed and short term memory capacity....... for perception of words, or a higher speed of processing for words than letters. We have investigated the WSE using methods based on a Theory of Visual Attention. In an experiment using single stimuli (words or letters) presented centrally, we show that the classical WSE is specifically reflected in perceptual...

78 FR 78466 - Meeting of the Regional Energy Resource Council

Science.gov (United States)

2013-12-26

.... The public comment session will be held at 10:00 a.m. EST, on January 23. Persons wishing to speak are... includes the following: 1. Welcome and Introductions 2. TVA updates regarding recent Board of Directors.... Public Comments 5. Council Discussion on the balancing of TVA's business objectives during Integrated...

18 CFR 1300.104 - Sexual harassment.

Science.gov (United States)

2010-04-01

... CONDUCT FOR EMPLOYEES OF TENNESSEE VALLEY AUTHORITY § 1300.104 Sexual harassment. It is TVA policy that all TVA employees are responsible for assuring that the workplace is free from sexual harassment... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Sexual harassment. 1300...

Components of Attention in Grapheme-Color Synesthesia

DEFF Research Database (Denmark)

Ásgeirsson, Árni Gunnar; Nordfang, Maria; Sørensen, Thomas Alrik

2015-01-01

as many letters (targets) as possible, while ignoring digit (distractors). Graphemes were either congruently or incongruently colored with the synesthetes’ reported grapheme-color association. A mathematical model, based on Bundesen’s (1990) Theory of Visual Attention (TVA), was fitted to each observer...

Atmospheric pollution in the Tula Industrial Corridor studied using a bio monitor and nuclear analytical techniques

Energy Technology Data Exchange (ETDEWEB)

Martinez C, M. A.; Solis, C.; Andrade, E. [UNAM, Instituto de Fisica, Apdo. Postal 20-364, 01000 Mexico D. F. (Mexico); Beltran H, R. I. [Universidad Autonoma del Estado de Hidalgo, Centro de Investigaciones Quimicas, Carretera Pachuca-Tulancingo Km. 4.5, 42184 Pachuca, Hidalgo (Mexico); Issac O, K. [Universidad Autonoma del Estado de Mexico, Facultad de Medicina, Paseo Tollocan s/n, esq. Jesus Carranza, 50120 Toluca, Estado de Mexico (Mexico); Lucho C, C. A. [Universidad Politecnica de Pachuca, Carretera Pachuca-Cd. Sahagun Km. 20, Hidalgo (Mexico); Lopez R, M. C.; Longoria, L. C. [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)

2011-02-15

This study deals with the application of nuclear analytical techniques to analyze trace elements in the biological monitor Tillandsia usneoides. Biological monitors provides an alternative advantageous way of particulate matter sampling in air pollution studies, since there is no need of special sampling devices, accumulation time can be as long as desired. T. usneoides, which occurs naturally throughout Mexico, was used to monitor air quality of Tula-Vito-Apasco (TVA) industrial corridor at central Mexico. This area is considered one of the critical zones of the country because of atmospheric contaminants high concentration. Particulate matter is regulated by Mexican norms, but its chemical composition is not. Plants were transplanted from a clean environment to four sites at the TVA corridor, and exposed for 12 weeks from February to April 2008. Trace element accumulation of plants was determined by particle induced X-ray emission and neutron activation analysis. Results reveal differences in trace elements distribution among sites in the TVA corridor. Furthermore, anthropogenic elements (S, V) and crustal elements (Ca) in T. usneoides exhibit high levels. Highly toxic elements such as Hg, As and Cr although present at trace levels, showed un enrichment relative to the initial values, when transplanted to the TVA corridor. Results show that monitoring with T. usneoides allows a first approximation of air sources to provide insights of the atmospheric pollution in the TVA corridor. (Author)

Atmospheric pollution in the Tula Industrial Corridor studied using a bio monitor and nuclear analytical techniques

International Nuclear Information System (INIS)

Martinez C, M. A.; Solis, C.; Andrade, E.; Beltran H, R. I.; Issac O, K.; Lucho C, C. A.; Lopez R, M. C.; Longoria, L. C.

2011-01-01

This study deals with the application of nuclear analytical techniques to analyze trace elements in the biological monitor Tillandsia usneoides. Biological monitors provides an alternative advantageous way of particulate matter sampling in air pollution studies, since there is no need of special sampling devices, accumulation time can be as long as desired. T. usneoides, which occurs naturally throughout Mexico, was used to monitor air quality of Tula-Vito-Apasco (TVA) industrial corridor at central Mexico. This area is considered one of the critical zones of the country because of atmospheric contaminants high concentration. Particulate matter is regulated by Mexican norms, but its chemical composition is not. Plants were transplanted from a clean environment to four sites at the TVA corridor, and exposed for 12 weeks from February to April 2008. Trace element accumulation of plants was determined by particle induced X-ray emission and neutron activation analysis. Results reveal differences in trace elements distribution among sites in the TVA corridor. Furthermore, anthropogenic elements (S, V) and crustal elements (Ca) in T. usneoides exhibit high levels. Highly toxic elements such as Hg, As and Cr although present at trace levels, showed un enrichment relative to the initial values, when transplanted to the TVA corridor. Results show that monitoring with T. usneoides allows a first approximation of air sources to provide insights of the atmospheric pollution in the TVA corridor. (Author)

Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

Science.gov (United States)

Considine, Julie; Currey, Judy

2015-01-01

To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy. © 2014 John Wiley & Sons Ltd.

Implementation of Technology-based Patient Engagement Strategies within Practice-based Research Networks.

Science.gov (United States)

Careyva, Beth; Shaak, Kyle; Mills, Geoffrey; Johnson, Melanie; Goodrich, Samantha; Stello, Brian; Wallace, Lorraine S

2016-01-01

Technology-based patient engagement strategies (such as patient portals) are increasingly available, yet little is known about current use and barriers within practice-based research networks (PBRNs). PBRN directors have unique opportunities to inform the implementation of patient-facing technology and to translate these findings into practice. PBRN directors were queried regarding technology-based patient engagement strategies as part of the 2015 CAFM Educational Research Alliance (CERA) survey of PBRN directors. A total of 102 PBRN directors were identified via the Agency for Healthcare Research and Quality's registry; 54 of 96 eligible PBRN directors completed the survey, for a response rate of 56%. Use of technology-based patient engagement strategies within PBRNs was limited, with less than half of respondents reporting experience with the most frequently named tools (risk assessments/decision aids). Information technology (IT) support was the top barrier, followed by low rates of portal enrollment. For engaging participant practices, workload and practice leadership were cited as most important, with fewer respondents noting concerns about patient privacy. Given limited use of patient-facing technologies, PBRNs have an opportunity to clarify the optimal use of these strategies. Providing IT support and addressing clinician concerns regarding workload may facilitate the inclusion of innovative technologies in PBRNs. © Copyright 2016 by the American Board of Family Medicine.

REAKSI PASAR TERHADAP DIVIDEND ANNOUNCEMENT PERUSAHAAN YANG SAHAMNYA MASUK DAFTAR EFEK SYARIAH

Directory of Open Access Journals (Sweden)

Moh. Khoiruddin

2014-09-01

Full Text Available Tujuan dilakukan penelitian ini adalah untuk menguji reaksi pasar yang diukur dengan variabel abnormal return dan trading volume activity (TVA di sekitar pengumuman dividen (dividend announcement. Populasi dalam penelitian ini adalah semua pengumuman dividen dari perusahaan yang sahamnya masuk pada daftar efek syariah (DES Indonesia pada tahun 2013, yang berjumlah 40. Sampel penelitian diambil dari semua jumlah populasi. Analisis data dilakukan dengan uji One Sample t-test untuk menguji reaksi pasar yang terjadi selama periode pengamatan (event window 21 hari yaitu t-10 (10 hari sebelum pengumuman dividen, t0 (saat pengumuman dividen, dan t+10 (10 hari sesudah pengumuman dividen. Hasil penelitian menunjukkan terdapat reaksi pasar di sekitar hari pengumuman dividen yang diukur menggunakan variabel abnormal return dan trading volume activity (TVA. The purpose of this study was to test the market reaction which was measured by abnormal return variable and trading volume activity (TVA around the dividend announcement. The population of this study was all companies’s dividendannouncement which their shares were listed on Indonesia Syariah Securities List published in 2013, they were 40 companies. The samples were taken from all population. The data were analyzed by one sample t-test to test the market reactions which occurred during event window for 21 days; they were t-10 (10 days before the dividend announcement, t0 (at the dividend announcement time, and t+10 (10 days after the dividend announcement. Based on the research results, it can be seen that there was a market reaction around the dividend announcement which was measured by abnormal returns variable and trading volume activity (TVA.

Agreement between touch-screen and paper-based patient-reported outcomes for patients with fibromyalgia

DEFF Research Database (Denmark)

Wæhrens, Eva Elisabet Ejlersen; Amris, Kirstine; Bartels, Else Marie

2015-01-01

OBJECTIVES: To compare data based on computerized and paper versions of health status questionnaires (HSQs) for sampling patient-reported outcomes (PROs) in patients with fibromyalgia (FM). In addition, to examine associations between patient characteristics (age, education, computer experience......) and differences between versions. Finally, to evaluate the acceptability of computer-based questionnaires among patients with FM. METHOD: The study population comprised female patients diagnosed with FM. All patients completed six HSQs: the Fibromyalgia Impact Questionnaire (FIQ), the Major Depression Inventory...

NRC Information Notice No. 92-01: Cable damage caused by inadequate cable installation procedures and controls

International Nuclear Information System (INIS)

Rossi, C.E.

1993-01-01

In June 1989, the Tennessee Valley Authority (TVA) removed the cables from a conduit in the reactor protection system of the Watts Bar Nuclear Plant, Unit 2, to inspect for damage. TVA selected this conduit in response to an employee's concern that a welding arc that struck the conduit in response to an employee's concern that a welding arc that struck the conduit during construction may have damaged cables in the conduit. When the cables were removed, TVA found significant damage in the insulation of some cables. This damage was not attributed to heat generated by the alleged welding arc. The damage was principally attributed to the pulling stresses exerted during the initial installation of the cables. Some of the cables had insulation removed down to the conductors. To assess the extent of cable damage and determine the scope of its investigation, TVA removed more cables from conduits that constituted the most difficult pulls (worst case) and found varying degrees of damage that it attributed to pulling stresses. To fill a conduit at Watts Bar, personnel used pull cords to pull more cables through the conduits over the top of existing cables. This practice is called ''pull-by.'' This practice can cause damage to the existing cables from the sawing action of the pull cords and the friction of cables as they are pulled over existing cables. TVA instituted programs to assess the adequacy of cable installation at all its nuclear facilities and take appropriate corrective actions. At Watts Bar, TVA replaced cables in conduits which exceeded a calculated threshold value of side wall bearing pressure (SWBP) and performed a high-potential (hi-pot) tests on a number of other cables in conduits with SWBP below the calculated threshold value

18 CFR 1306.6 - Expense of transfer of title and proration of taxes.

Science.gov (United States)

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Expense of transfer of title and proration of taxes. 1306.6 Section 1306.6 Conservation of Power and Water Resources TENNESSEE... property by TVA: (a) TVA will, to the extent it deems fair and reasonable, bear all expenses incidental to...

76 FR 12354 - Cumberland System of Projects

Science.gov (United States)

2011-03-07

... Third Scenario--Return to Original Marketing Policy Inside TVA Preference Customers Capacity and Base.... Discussion: The marketing policy for the Cumberland System of Projects provides peaking capacity, along with 1500 hours of energy annually with each kilowatt of capacity, to customers outside the Tennessee Valley...

Development and testing of hydrogen ignition devices

International Nuclear Information System (INIS)

Renfro, D.; Smith, L.; Thompson, L.; Clever, R.

1982-01-01

Controlled ignition systems for the mitigation of hydrogen produced during degraded core accidents have been installed recently in several light water reactor (LWR) containments. This paper relates the background of the thermal igniter approach and its application to LWR controlled ignition systems. The process used by the Tennessee Valley Authority (TVA) to select a hydrogen mitigation system in general and an igniter type in particular is described. Descriptions of both the Interim Distributed Ignition System and the Permanent Hydrogen Mitigation System installed by TVA are included as examples. Testing of igniter durability at TVA's Singleton Materials Engineering Laboratory and of igniter performance at Atomic Energy of Canada's Whiteshell Nuclear Research Establishment is presented

Mathematics in energy related research at the Tennessee Valley Authority, at Union Carbide's Oak Ridge Facilities, and at University of Tennessee College of Engineering. Final report

International Nuclear Information System (INIS)

Barett, L.K.

1979-05-01

This report contains a description of the work performed under the Department of Energy Contract No. ER078-S-05-5944 to the University of Tennessee. The major objective of this contract was to survey and to classify a selection of the mathematics used in energy-related activities at the Tennessee Valley Authority (TVA), at Union Carbide's Oak Ridge Facilities (UCORF), and at the University of Tennessee College of Engineering (UTCE). Eighty-seven projects were identified at these organizations in which mathematics plays a significant modeling or problem-solving role. Uniform abstracts of these projects are included in this report, as well as abstracts of twenty-seven presentations by TVA and UCORF personnel on the topic of mathematics in energy research, at the 1978 Fall SIAM meeting. Classifications of these one hundred and fourteen abstracts are given in terms of the energy area or function involved and in terms of the mathematical disciplines used in the activity. Only a selection of the mathematical activity at the TVA, UCORF, and UTCE involved in energy research was obtained due to time and budget constraints. However, it was possible to make some important observations and recommendations based upon these sample data, and these are included in the summary of this report

Value redefined for inflammatory bowel disease patients: a choice-based conjoint analysis of patients' preferences.

Science.gov (United States)

van Deen, Welmoed K; Nguyen, Dominic; Duran, Natalie E; Kane, Ellen; van Oijen, Martijn G H; Hommes, Daniel W

2017-02-01

Value-based healthcare is an upcoming field. The core idea is to evaluate care based on achieved outcomes divided by the costs. Unfortunately, the optimal way to evaluate outcomes is ill-defined. In this study, we aim to develop a single, preference based, outcome metric, which can be used to quantify overall health value in inflammatory bowel disease (IBD). IBD patients filled out a choice-based conjoint (CBC) questionnaire in which patients chose preferable outcome scenarios with different levels of disease control (DC), quality of life (QoL), and productivity (Pr). A CBC analysis was performed to estimate the relative value of DC, QoL, and Pr. A patient-centered composite score was developed which was weighted based on the stated preferences. We included 210 IBD patients. Large differences in stated preferences were observed. Increases from low to intermediate outcome levels were valued more than increases from intermediate to high outcome levels. Overall, QoL was more important to patients than DC or Pr. Individual outcome scores were calculated based on the stated preferences. This score was significantly different from a score not weighted based on patient preferences in patients with active disease. We showed the feasibility of creating a single outcome metric in IBD which incorporates patients' values using a CBC. Because this metric changes significantly when weighted according to patients' values, we propose that success in healthcare should be measured accordingly.

Are web-based questionnaires accepted in patients attending rehabilitation?

Science.gov (United States)

Engan, Harald K; Hilmarsen, Christina; Sittlinger, Sverre; Sandmæl, Jon Arne; Skanke, Frode; Oldervoll, Line M

2016-12-01

The aim of the present paper was to study preferences for web based self-administered questionnaires (web SAQs) vs. paper-based self-administered questionnaires (paper SAQs) and to evaluate the feasibility of using web SAQs in patients referred to cardiac, lung, occupational and cancer rehabilitation programs. The patients were approached by mail and given the choice to answer the compulsory SAQs either on paper or on a web-based platform. Hundred and twenty seven out of 183 eligible patients (69.3%) were willing to participate and 126 completed the study. Web SAQs were preferred by 77.7%, and these patients were significantly younger, more often cohabiting and tended to have higher level of education than paper SAQ users. Mean number of data missing per patient was less among the web SAQ users than the paper SAQ users (0.55 vs. 2.15, p questionnaires on internet platforms when internet access is common and available. Implications for Rehabilitation The high acceptability of web-based self-administered questionnaires among rehabilitation patients suggests that internet platforms are suitable tools to collect patient information for rehabilitation units. Web-based modes of patient data collection demonstrate low number of missing data and can therefore improve the quality of data collection from rehabilitation patients. Use of web-based questionnaires considerably reduces administrative costs of data collection in rehabilitation settings compared to traditional pen and paper methods.

Testing of mobile surveillance robot at a nuclear power plant

International Nuclear Information System (INIS)

White, J.R.; Harvey, H.W.; Farnstrom, K.A.

1987-01-01

In-plant testing of a mobile surveillance robot (SURBOT) was performed at the Browns Ferry Nuclear Plant by TVA personnel. The results verified that SURBOT can be used for remote surveillance in 54 separate controlled radiation rooms at the plant. High-quality color video, audio, and other data are collected, digitized by an on-board computer, and transmitted through a cable to the control console for real-time display and videotaping. TVA projects that the use of SURBOT for surveillance during plant operation will produce annual savings of about 100 person-rem radiation exposure and $200,000 in operating costs. Based on the successful results of this program, REMOTEC is now commercializing the SURBOT technology on both wheeled and tracked mobile robots for use in nuclear power plants and other hazardous environments

75 FR 54961 - Final Supplemental Environmental Impact Statement, Single Nuclear Unit at the Bellefonte Plant...

Science.gov (United States)

2010-09-09

... facility, a wind farm, a methane- gas cofiring facility, and several small solar photovoltaic facilities... including wind, solar, biomass, and hydropower. All of these energy resources have a place in TVA's plans... still add new base load generation to balance resources with the projected load requirements. Neither...

Improving Patient Satisfaction Through Computer-Based Questionnaires.

Science.gov (United States)

Smith, Matthew J; Reiter, Michael J; Crist, Brett D; Schultz, Loren G; Choma, Theodore J

2016-01-01

Patient-reported outcome measures are helping clinicians to use evidence-based medicine in decision making. The use of computer-based questionnaires to gather such data may offer advantages over traditional paper-based methods. These advantages include consistent presentation, prompts for missed questions, reliable scoring, and simple and accurate transfer of information into databases without manual data entry. The authors enrolled 308 patients over a 16-month period from 3 orthopedic clinics: spine, upper extremity, and trauma. Patients were randomized to complete either electronic or paper validated outcome forms during their first visit, and they completed the opposite modality at their second visit, which was approximately 7 weeks later. For patients with upper-extremity injuries, the Penn Shoulder Score (PSS) was used. For patients with lower-extremity injuries, the Foot Function Index (FFI) was used. For patients with lumbar spine symptoms, the Oswestry Disability Index (ODI) was used. All patients also were asked to complete the 36-Item Short Form Health Survey (SF-36) Health Status Survey, version 1. The authors assessed patient satisfaction with each survey modality and determined potential advantages and disadvantages for each. No statistically significant differences were found between the paper and electronic versions for patient-reported outcome data. However, patients strongly preferred the electronic surveys. Additionally, the paper forms had significantly more missed questions for the FFI (P<.0001), ODI (P<.0001), and PSS (P=.008), and patents were significantly less likely to complete these forms (P<.0001). Future research should focus on limiting the burden on responders, individualizing forms and questions as much as possible, and offering alternative environments for completion (home or mobile platforms). Copyright 2016, SLACK Incorporated.

Vseživljenjsko učenje, pogoj za preživetje in kakovost

Directory of Open Access Journals (Sweden)

Vida A. Mohorčič-Špolar

1996-12-01

Full Text Available Posvet s tem naslovom je (v organizaciji Andragoškega društva Slovenije potekal od 30. maja do l. junija 1996. Sodelovalo je več kot 100 udeležencev iz različnih dejavnosti, ki se ukvarjajo z izobraževanjem odraslih. Posvet je bil po eni strani odgovor Andragoškega društva Slovenije na izzive, ki jih izobraževalcem odraslih narekuje čas, v katerem živimo, po drugi strani pa priprava na posvet, ki ga bo v Hamburgu, julija 1997, organiziral Unesco, z geslom: Učenje odraslih, ključ za 21. stoletje. Hkrati pa je tudi čas za premislek o nadaljnjem delu društva.

HIGHLY ENRICHED URANIUM BLEND DOWN PROGRAM AT THE SAVANNAH RIVER SITE PRESENT AND FUTURE

International Nuclear Information System (INIS)

Magoulas, V; Charles Goergen, C; Ronald Oprea, R

2008-01-01

The Department of Energy (DOE) and Tennessee Valley Authority (TVA) entered into an Interagency Agreement to transfer approximately 40 metric tons of highly enriched uranium (HEU) to TVA for conversion to fuel for the Browns Ferry Nuclear Power Plant. Savannah River Site (SRS) inventories included a significant amount of this material, which resulted from processing spent fuel and surplus materials. The HEU is blended with natural uranium (NU) to low enriched uranium (LEU) with a 4.95% 235U isotopic content and shipped as solution to the TVA vendor. The HEU Blend Down Project provided the upgrades needed to achieve the product throughput and purity required and provided loading facilities. The first blending to low enriched uranium (LEU) took place in March 2003 with the initial shipment to the TVA vendor in July 2003. The SRS Shipments have continued on a regular schedule without any major issues for the past 5 years and are due to complete in September 2008. The HEU Blend program is now looking to continue its success by dispositioning an additional approximately 21 MTU of HEU material as part of the SRS Enriched Uranium Disposition Project

Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

Science.gov (United States)

Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

2012-01-01

There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

Attentional weights in vision as products of spatial and nonspatial components

DEFF Research Database (Denmark)

Nordfang, Maria; Staugaard, Camilla; Bundesen, Claus

2018-01-01

The relationship between visual attentional selection of items in particular spatial locations and selection by nonspatial criteria was investigated in a partial report experiment with report of letters (as many as possible) from brief postmasked exposures of circular arrays of letters and digits....... The data were fitted by mathematical models based on Bundesen's (Psychological Review, 97, 523-547, 1990) theory of visual attention (TVA). Both attentional weights of targets (letters) and attentional weights of distractors (digits) showed strong variations across the eight possible target locations......, but for each of the ten participants, the ratio of the weight of a distractor at a given location to the weight of a target at the same location was approximately constant. The results were accommodated by revising the weight equation of TVA such that the attentional weight of an object equals a product...

Developing an Android-Based Patient Decision Aid Based on Ottawa Standards for Patients After Kidney Transplant and Its Usability Evaluation.

Science.gov (United States)

Zare Moayedi, Mahboobeh; Aslani, Azam; Fakhrahmad, Mostafa; Ezzatzadegan J, Shahrokh

2018-01-01

This study was conducted to develop an android based patient decision aid (PDA) as a self-care instrument for patients after kidney transplant and its usability evaluation. In this study, the systematic development process of Android-based self-care application for patients after kidney transplant based on Ottawa standard was included: scoping, assemble steering group, analysis of requirements, designing, develop of a prototype and system evaluation. The PDA is a self-triage system that will help early identification of risk symptoms in patients, and help manage them. System recommendations for risk signs are: Refer to the nearest hospital or healthcare center without delay, refer to the doctor and tell your doctor in the next visit. To identify patient care needs, a semi-structured interview with members of steering group, including patients and clinical experts, was conducted by the researchers. A prototype of the decision aid was made according to identified needs in the previous step. Finally, in order to evaluate its usability rate by using the System Usability Scale (SUS) questionnaire, it was used by exerts and patients. This study identified information needs, risk signs and steps that patients need to make appropriate decisions about them. The main capabilities of the decision aid are features such as reminders for appointment/test, time of taking medication, registration of symptoms, weight, blood pressure, body temperature, advising to patient in case of signs of risk, weight, blood pressure, body temperature and test results which were reported in the diagram. The mean score of system's usability evaluated by medical informatics specialists, clinicians, and patients were 88.33, 95, and 91. PDAs was usable and desirable from the point of view of medical informatics specialists, clinicians and patients.

Hospital based patient coordination for ethnic minority patients - a health technology assessment

DEFF Research Database (Denmark)

Sodemann, Morten

A cross diciplinary, cross specialty, cross sectoral hospital based approach to cultural management of ethnic minority patients is effective in creating more approprite patient flows, better quality of care and increases functional level of patients. Surprisingly the aggregated effect saves...... especially on public medicine expenses and social services. Ethnic minority patients can achieve increased empowerment & Equity in type and quality of hospital care through cross dicplinary cross specialty cultural case management & support between hospital departments and primary sectors...

Cue-it? We say: Block-it!

DEFF Research Database (Denmark)

Cooreman, Bart; Wiegand, Iris Michaela; Petersen, Anders

2015-01-01

A bilateral change detection paradigm is often used to measure lateralized ERP-components, such as the Contralateral Delay Activity (CDA), believed to be associated with visual short-term memory (e.g. Vogel and Machizawa, 2004; Alvarez and Cavanagh, 2004; McCollough et al., 2007 ). Recently......, Wiegand et al. (2014) developed a similar whole report paradigm in which participants reported the identity of four letters, presented in a pre-cued hemifield, showing a correlation between CDA amplitude and visual short-term memory capacity when modeled using Bundesen' s Theory of Visual Attention (TVA...... modelled by TVA, providing an estimate of perceptual threshold, processing speed, and visual short-term memory capacity for each participant. Our results show that the blocked design compared with the intermixed pre-cued design provided an equally good estimate of participants' TVA...

[Shared decision-making based on equal information. Patient guidelines as a tool for patient counseling].

Science.gov (United States)

Sänger, Sylvia; Kopp, Ina; Englert, Gerhard; Brunsmann, Frank; Quadder, Bernd; Ollenschläger, Günter

2007-06-15

In discussions on the quality of cross-sectorial health-care services high importance is attributed to patient education and patient counseling, with guideline-based patient information being considered a crucial tool. Guideline-based patient information is supposed to serve patients as a decision-making basis and, in addition, to also support the implementation of the guidelines themselves. The article highlights how patient guidelines for National Disease Management Guidelines in Germany--within the scope of patient education and patient counseling--may provide a uniform information platform for physicians and patients aiming to promote shared decision-making. The authors will also address the issue which contents should be included in patient guidelines in order to meet these requirements and which measures are required to review their quality. The present paper continues the series of articles on the Program for German National Disease Management Guidelines.

DIGITAL ONCOLOGY PATIENT RECORD - HETEROGENEOUS FILE BASED APPROACH

Directory of Open Access Journals (Sweden)

Nikolay Sapundzhiev

2010-12-01

Full Text Available Introduction: Oncology patients need extensive follow-up and meticulous documentation. The aim of this study was to introduce a simple, platform independent file based system for documentation of diagnostic and therapeutic procedures in oncology patients and test its function.Material and methods: A file-name based system of the type M1M2M3.F2 was introduced, where M1 is a unique identifier for the patient, M2 is the date of the clinical intervention/event, M3 is an identifier for the author of the medical record and F2 is the specific software generated file-name extension.Results: This system is in use at 5 institutions, where a total of 11 persons on 14 different workstations inputted 16591 entries (files for 2370. The merge process was tested on 2 operating systems - when copied together all files sort up as expected by patient, and for each patient in a chronological order, providing a digital cumulative patient record, which contains heterogeneous file formats.Conclusion: The file based approach for storing heterogeneous digital patient related information is an reliable system, which can handle open-source, proprietary, general and custom file formats and seems to be easily scalable. Further development of software for automatic checks of the integrity and searching and indexing of the files is expected to produce a more user-friendly environment

Anemia and Iron Deficiency in Children With Potential Celiac Disease.

Science.gov (United States)

Repo, Marleena; Lindfors, Katri; Mäki, Markku; Huhtala, Heini; Laurila, Kaija; Lähdeaho, Marja-Leena; Saavalainen, Päivi; Kaukinen, Katri; Kurppa, Kalle

2017-01-01

Active screening for celiac disease frequently detects seropositive children with normal villous morphology (potential celiac disease). It remains unclear whether these subjects should be treated. We here investigated the prevalence of anemia and iron deficiency in children with potential and mucosal atrophy celiac disease. The prospective study involved 19 children with potential disease, 67 with partial or subtotal villous atrophy (P/SVA), and 16 with total villous atrophy (TVA). Twenty-three healthy children comprised the control group. The groups were compared for various clinical, histological, and laboratory parameters and hepcidin. The prevalence of abnormal parameters was as follows (controls, potential celiac disease, P/SVA, and TVA, respectively): anemia 0%, 15%, 22%, and 63%; low iron 5%, 0%, 14%, and 50%; increased transferrin receptor 1 5%, 16%, 20%, and 47%; low ferritin 0%, 21%, 35%, and 87%; and low transferrin saturation 10%, 11%, 41%, and 71%. One subject had low folate and none had low vitamin B12. The median values for hemoglobin, total iron, ferritin, and transferrin saturation were significantly lower and transferrin receptor 1 values higher in TVA group compared with other groups. After a median of 7 months on a gluten-free diet hemoglobin, total iron, ferritin, and albumin in children with P/SVA exceeded the baseline values in the potential celiac disease group. The development of anemia and iron deficiency in celiac disease is a continuum and may already be present in children with normal villous morphology, advocating an early diagnosis and possible dietary treatment of these patients.

Safety evaluation report on Tennessee Valley Authority: Browns Ferry Nuclear Performance Plan

International Nuclear Information System (INIS)

1991-01-01

This safety evaluation report (SER) was prepared by the US Nuclear Regulatory Commission (NRC) staff and represents the second and last supplement (SSER 2) to the staff's original SER published as Volume 3 of NUREG-1232 in April 1989. Supplement 1 of Volume 3 of NUREG-1232 (SSER 1) was published in October 1989. Like its predecessors, SSER 2 is composed of numerous safety evaluations by the staff regarding specific elements contained in the Browns Ferry Nuclear Performance Plan (BFNPP), Volume 3 (up to and including Revision 2), submitted by the Tennessee Valley Authority (TVA) for the Browns Ferry Nuclear Plant (BFN). The Browns Ferry Nuclear Plant consists of three boiling-water reactors (BWRs) at a site in Limestone County, Alabama. The BFNPP describes the corrective action plans and commitments made by TVA to resolve deficiencies with its nuclear programs before the startup of Unit 2. The staff has inspected and will continue to inspect TVA's implementation of these BFNPP corrective action plans that address staff concerns about TVA's nuclear program. SSER 2 documents the NRC staff's safety evaluations and conclusions for those elements of the BFNPP that were not previously addressed by the staff or that remained open as a result of unresolved issues identified by the staff in previous SERs and inspections

[QR-Code based patient tracking: a cost-effective option to improve patient safety].

Science.gov (United States)

Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

2013-03-01

Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

Internet based patient pathway as an educational tool for breast cancer patients.

Science.gov (United States)

Ryhänen, Anne M; Rankinen, Sirkku; Tulus, Kirsi; Korvenranta, Heikki; Leino-Kilpi, Helena

2012-04-01

The aim of this paper was to describe the process of developing an Internet-based empowering patient education program for breast cancer patients and to evaluate the quality of the program from the perspective of patients. In this program, the patient pathway was used as an educational tool. The Breast Cancer Patient Pathway (BCPP) was developed and tested at one Finnish university hospital in 2005-2007. Thirty-eight newly diagnosed breast cancer patients used the program during their treatment process until the end of all treatments (average 9 months) in 2008-2010. After the treatments the patients evaluated the content, language and structure, instructiveness, external appearance and technical characteristics of the web site as subcategories with the Evaluating Internet Pages of Patient Education instrument, which is a 37-item Likert scale (1-4) questionnaire. Comparison between the subcategories was done with Friedman's test. Dependencies between demographic variables and evaluation values were tested with Pearson correlation coefficients. The mean value of all evaluation criteria was 3.40. However, patients' evaluations between different subcategories varied, being the highest in language and structure (mean 3.48) and lowest in content (mean 3.13). Language and structure, external appearance and technical characteristics were significantly better than content, and language and structure better than instructiveness. Significant correlations were not found between demographic variables and evaluation values. Patients evaluated the quality of the BCPP to be best in language and structure and weakest in content. In terms of future development of the BCPP, the most improvement is needed in content and instructiveness. There is also a need for further development and study of Internet-based patient education. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A patient-centred approach to treatment with incretin-based agents in patients with type 2 diabetes.

Science.gov (United States)

Cornell, Susan A

2013-06-01

The 2012 position statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommends a haemoglobin A1c level of <7% for most patients with type 2 diabetes (T2D). Initial therapy consists of lifestyle changes plus metformin, with an emphasis on a patient-centred approach to management. Addition of incretin-based therapy is recommended as an add-on after metformin failure, and later on in combination with basal insulin. Basal insulin is recommended from the onset in patients with A1c ≥10%. The possibility of incorporating incretin-based therapy in the patient-centred approach will be investigated both in the literature and clinical experience. Incretin-based therapy targets multiple dysfunctional organ systems in T2D and provides sustained glycaemic control, with extraglycaemic benefits and low risk of hypoglycaemia. To initiate an incretin-based therapy that best fits an individual patient's needs, the patient's A1c level, preference and comorbid conditions should be considered along with any drug safety and adherence-related issues. There is good evidence to support the patient-centred approach to T2D management. This approach allows patient treatment goals and personal preferences to be matched with the clinical profile(s) of one or more agents to formulate a treatment plan that can best achieve the goals. Incretin-based therapies are an important class of agents to consider after metformin monotherapy failure and later in combination with basal insulin. By matching patient needs with the clinical profiles of the various treatment options, pharmacists can actively engage in the practice of patient-centred care and management. © 2013 Blackwell Publishing Ltd.

A Web-based patient information system--identification of patients' information needs.

Science.gov (United States)

Hassling, Linda; Babic, Ankica; Lönn, Urban; Casimir-Ahn, Henrik

2003-06-01

Research described here was carried out to explore possibilities of creating a web-based patient information system within the areas of thoracic surgery. Data were collected to distinguish and assess the actual information needs of patients (1) prior to surgical treatment, (2) before discharge, and (3) 8 months after the hospitalization using a follow-up questionnaire. Interviews were performed with patients undergoing heart surgery. The study included material of 19 consecutive patients undergoing coronary artery bypass surgery (12) and valve replacement (7), age 35-74, 13 males and 6 females with nonacademic background. Patient satisfaction with given information was high. Analysis of the interviews held at the hospital resulted in seven different categories describing and giving a picture of the patients' information needs and apprehension of received care. The results found in this study can be used as guidance for developers in their design and development process of a health information system.

Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training

OpenAIRE

Ballangrud, Randi

2013-01-01

Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven I...

Community pharmacy-based asthma services--what do patients prefer?

Science.gov (United States)

Naik Panvelkar, Pradnya; Armour, Carol; Saini, Bandana

2010-12-01

Patient preferences can influence the outcomes of treatment and so understanding and organizing health-care services around these preferences is vital. To explore patient preferences for types of community pharmacy-based asthma services, to investigate the influence of "experience" in molding preferences for such services, and to identify aspects of the services that patients prefer over others. Semistructured face-to-face interviews were conducted with a convenience sample of two types of asthma patients: (1) those naïve to a specialized asthma service and (2) those who had experienced a specialized asthma service. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Eighteen interviews were conducted (8 experienced patients, 10 naïve patients). The majority of the patients wanted the pharmacist to play a greater role in their asthma management. Patients experiencing increased levels of service had increased levels of expectations as well as more specific preferences for various aspects of the service. The key aspects of an asthma service that all patients wanted their pharmacists to provide were the provision of information about asthma and its medications, lung function testing and monitoring of their asthma, and checking/correcting their inhaler technique. Patients also expressed a desire for skilled communication and behavioral aspects from the pharmacist such as friendliness, empathy, attentiveness, and dedicated time. Patients highlighted the importance of privacy in the pharmacy. There was a high level of satisfaction toward the currently delivered asthma service among both naïve and experienced patients. The provision of the specialized service was associated with increased patient loyalty to the particular pharmacy. All patients indicated a willingness to participate in future pharmacy-delivered specialized asthma services. Elements of the specialized pharmacy-based asthma services important from a patient's perspective were

[Acid-base status in patients treated with peritoneal dialysis].

Science.gov (United States)

Katalinić, Lea; Blaslov, Kristina; Pasini, Eva; Kes, Petar; Bašić-Jukić, Nikolina

2014-04-01

When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.

Motor-cognitive dual-task performance: effects of a concurrent motor task on distinct components of visual processing capacity.

Science.gov (United States)

Künstler, E C S; Finke, K; Günther, A; Klingner, C; Witte, O; Bublak, P

2018-01-01

Dual tasking, or the simultaneous execution of two continuous tasks, is frequently associated with a performance decline that can be explained within a capacity sharing framework. In this study, we assessed the effects of a concurrent motor task on the efficiency of visual information uptake based on the 'theory of visual attention' (TVA). TVA provides parameter estimates reflecting distinct components of visual processing capacity: perceptual threshold, visual processing speed, and visual short-term memory (VSTM) storage capacity. Moreover, goodness-of-fit values and bootstrapping estimates were derived to test whether the TVA-model is validly applicable also under dual task conditions, and whether the robustness of parameter estimates is comparable in single- and dual-task conditions. 24 subjects of middle to higher age performed a continuous tapping task, and a visual processing task (whole report of briefly presented letter arrays) under both single- and dual-task conditions. Results suggest a decline of both visual processing capacity and VSTM storage capacity under dual-task conditions, while the perceptual threshold remained unaffected by a concurrent motor task. In addition, goodness-of-fit values and bootstrapping estimates support the notion that participants processed the visual task in a qualitatively comparable, although quantitatively less efficient way under dual-task conditions. The results support a capacity sharing account of motor-cognitive dual tasking and suggest that even performing a relatively simple motor task relies on central attentional capacity that is necessary for efficient visual information uptake.

Empower the patients with a dialogue-based web application

DEFF Research Database (Denmark)

Bjørnes, Charlotte D.; Cummings, Elizabeth; Nøhr, Christian

2012-01-01

-based web application was designed and implemented to accommodate patients' information and communication needs in short stay hospital settings. To ensure the system meet the patients' needs, both patients and healthcare professionals were involved in the design process by applying various participatory...

Web-Based Distress Management for Implantable Cardioverter Defibrillator Patients

DEFF Research Database (Denmark)

Habibović, Mirela; Denollet, Johan; Cuijpers, Pim

2017-01-01

distress post-ICD implantation. The WEB-based distress management program for ICD patients (WEBCARE) was developed to mitigate anxiety and depression and enhance health-related quality of life in ICD patients. This study investigates the 6- and 12-months outcomes. METHOD: A total of 289 consecutive ICD...... care as usual. RESULTS: Current findings show no significant difference on anxiety, depression or quality of life between the WEBCARE and Usual Care group at 6- and 12-months postimplantation. CONCLUSIONS: In this clinical trial of a Web-based behavioral intervention for ICD patients, the Web...

Dynamical Behavior of a Pseudoelastic Vibration Absorber Using Shape Memory Alloys

Directory of Open Access Journals (Sweden)

Hugo De S. Oliveira

2017-01-01

Full Text Available The tuned vibration absorber (TVA provides vibration reduction of a primary system subjected to external excitation. The idea is to increase the number of system degrees of freedom connecting a secondary system to the primary system. This procedure promotes vibration reduction at its design forcing frequency but two new resonance peaks appear introducing critical behaviors that must be avoided. The use of shape memory alloys (SMAs can improve the performance of the classical TVA establishing an adaptive TVA (ATVA. This paper deals with the nonlinear dynamics of a passive pseudoelastic tuned vibration absorber with an SMA element. In this regard, a single degree of freedom elastic oscillator is used to represent the primary system, while an extra oscillator with an SMA element represents the secondary system. Temperature dependent behavior of the system allows one to change the system response avoiding undesirable responses. Nevertheless, hysteretic behavior introduces complex characteristics to the system dynamics. The influence of the hysteretic behavior due to stress-induced phase transformation is investigated. The ATVA performance is evaluated by analyzing primary system maximum vibration amplitudes for different forcing amplitudes and frequencies. Numerical simulations establish comparisons of the ATVA results with those obtained from the classical TVA. A parametric study is developed showing the best performance conditions and this information can be useful for design purposes.

Behavioral and Brain Measures of Phasic Alerting Effects on Visual Attention.

Science.gov (United States)

Wiegand, Iris; Petersen, Anders; Finke, Kathrin; Bundesen, Claus; Lansner, Jon; Habekost, Thomas

2017-01-01

In the present study, we investigated effects of phasic alerting on visual attention in a partial report task, in which half of the displays were preceded by an auditory warning cue. Based on the computational Theory of Visual Attention (TVA), we estimated parameters of spatial and non-spatial aspects of visual attention and measured event-related lateralizations (ERLs) over visual processing areas. We found that the TVA parameter sensory effectiveness a , which is thought to reflect visual processing capacity, significantly increased with phasic alerting. By contrast, the distribution of visual processing resources according to task relevance and spatial position, as quantified in parameters top-down control α and spatial bias w index , was not modulated by phasic alerting. On the electrophysiological level, the latencies of ERLs in response to the task displays were reduced following the warning cue. These results suggest that phasic alerting facilitates visual processing in a general, unselective manner and that this effect originates in early stages of visual information processing.

A Componential Analysis of Visual Attention in Children With ADHD.

Science.gov (United States)

McAvinue, Laura P; Vangkilde, Signe; Johnson, Katherine A; Habekost, Thomas; Kyllingsbæk, Søren; Bundesen, Claus; Robertson, Ian H

2015-10-01

Inattentive behaviour is a defining characteristic of ADHD. Researchers have wondered about the nature of the attentional deficit underlying these symptoms. The primary purpose of the current study was to examine this attentional deficit using a novel paradigm based upon the Theory of Visual Attention (TVA). The TVA paradigm enabled a componential analysis of visual attention through the use of a mathematical model to estimate parameters relating to attentional selectivity and capacity. Children's ability to sustain attention was also assessed using the Sustained Attention to Response Task. The sample included a comparison between 25 children with ADHD and 25 control children aged 9-13. Children with ADHD had significantly impaired sustained attention and visual processing speed but intact attentional selectivity, perceptual threshold and visual short-term memory capacity. The results of this study lend support to the notion of differential impairment of attentional functions in children with ADHD. © 2012 SAGE Publications.

Are patients satisfied with a web-based followup after total joint arthroplasty?

Science.gov (United States)

Marsh, Jacquelyn; Bryant, Dianne; MacDonald, Steven J; Naudie, Douglas; Remtulla, Alliya; McCalden, Richard; Howard, James; Bourne, Robert; McAuley, James

2014-06-01

A web-based followup assessment may be a feasible, cost-saving alternative of tracking patient outcomes after total joint arthroplasty. However, before implementing a web-based program, it is important to determine patient satisfaction levels with the new followup method. Satisfaction with the care received is becoming an increasingly important metric, and we do not know to what degree patients are satisfied with an approach to followup that does not involve an in-person visit with their surgeons. We determined (1) patient satisfaction and (2) patients' preferences for followup method (web-based or in-person) after total joint arthroplasty. We randomized patients who were at least 12 months after primary THA or TKA to complete a web-based followup or to have their appointment at the clinic. There were 410 eligible patients contacted for the study during the recruitment period. Of these, 256 agreed to participate, and a total of 229 patients completed the study (89% of those enrolled, 56% of those potentially eligible; 111 in the usual-care group, 118 in the web-based group). Their mean age was 69 years (range, 38-86 years). There was no crossover between groups. All 229 patients completed a satisfaction questionnaire at the time of their followup appointments. Patients in the web-based group also completed a satisfaction and preference questionnaire 1 year later. Only patients from the web-based group were asked to indicate preference as they had experienced the web-based and in-person followup methods. We used descriptive statistics to summarize the satisfaction questionnaires and compared results using Pearson's chi-square test. Ninety-one patients (82.0%) in the usual-care group indicated that they were either extremely or very satisfied with the followup process compared with 90 patients (75.6%) who were in the web-based group (p person followup assessment reported greater satisfaction; however, the difference was small and may not outweigh the additional cost

[Does simulator-based team training improve patient safety?].

Science.gov (United States)

Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

2013-10-01

Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

A Rapid Method for Deposition of Sn-Doped GaN Thin Films on Glass and Polyethylene Terephthalate Substrates

Science.gov (United States)

Pat, Suat; Özen, Soner; Korkmaz, Şadan

2018-01-01

We report the influence of Sn doping on microstructure, surface, and optical properties of GaN thin films deposited on glass and polyethylene terephthalate (PET) substrate. Sn-doped GaN thin films have been deposited by thermionic vacuum arc (TVA) at low temperature. TVA is a rapid deposition technology for thin film growth. Surface and optical properties of the thin films were presented. Grain size, height distribution, roughness values were determined. Grain sizes were calculated as 20 nm and 13 nm for glass and PET substrates, respectively. Nano crystalline forms were shown by field emission scanning electron microscopy. Optical band gap values were determined by optical methods and photoluminescence measurement. The optical band gap values of Sn doped GaN on glass and PET were determined to be approximately ˜3.40 eV and ˜3.47 eV, respectively. As a result, TVA is a rapid and low temperature deposition technology for the Sn doped GaN deposited on glass and PET substrate.

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology

OpenAIRE

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M. B.

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has ...

Patient-Centered Goal Setting in a Hospital-Based Outpatient Stroke Rehabilitation Center.

Science.gov (United States)

Rice, Danielle B; McIntyre, Amanda; Mirkowski, Magdalena; Janzen, Shannon; Viana, Ricardo; Britt, Eileen; Teasell, Robert

2017-09-01

Goal-setting can have a positive impact on stroke recovery during rehabilitation. Patient participation in goal formulation can ensure that personally relevant goals are set, and can result in greater satisfaction with the rehabilitation experience, along with improved recovery of stroke deficits. This, however, not yet been studied in a stroke outpatient rehabilitation setting. To assess patient satisfaction of meeting self-selected goals during outpatient rehabilitation following a stroke. Retrospective chart review. Stroke patients enrolled in a multidisciplinary outpatient rehabilitation program, who set at least 1 goal during rehabilitation. Patients recovering from a stroke received therapy through the outpatient rehabilitation program between January 2010 and December 2013. Upon admission and discharge from rehabilitation, patients rated their satisfaction with their ability to perform goals that they wanted to achieve. Researchers independently sorted and labeled recurrent themes of goals. Goals were further sorted into International Classification of Functioning, Disability and Health (ICF) categories. To compare the perception of patients' goal satisfaction, repeated-measures analysis of variance was conducted across the 3 ICF goal categorizations. Goal satisfaction scores. A total of 286 patients were included in the analysis. Patient goals concentrated on themes of improving hand function, mobility, and cognition. Goals were also sorted into ICF categories in which impairment-based and activity limitation-based goals were predominant. Compared to activity-based and participation-based goals, patients with impairment-based goals perceived greater satisfaction with meeting their goals at admission and discharge (P rehabilitation program (P stroke rehabilitation setting, patients set heterogeneous goals that were predominantly impairment based. Satisfaction in achieving goals significantly improved after receiving therapy. The type of goals that patients

Information technology-based standardized patient education in psychiatric inpatient care.

Science.gov (United States)

Anttila, Minna; Koivunen, Marita; Välimäki, Maritta

2008-10-01

This paper is a report of a study to describe nurses' experiences of information technology-based standardized patient education in inpatient psychiatric care. Serious mental health problems are an increasing global concern. Emerging evidence supports the implementation of practices that are conducive to patient self-management and improved patient outcomes among chronically ill patients with mental health problems. In contrast, the attitude of staff towards information technology has been reported to be contradictory in mental health care. After 1 year of using an Internet-based portal (Mieli.Net) developed for patients with schizophrenia spectrum psychosis, all 89 participating nurses were asked to complete questionnaires about their experiences. The data were collected in 2006. Fifty-six participants (63%) returned completed questionnaires and the data were analysed using content analysis. Nurses' experiences of the information technology-based standardized patient education were categorized into two major categories describing the advantages and obstacles in using information technology. Nurses thought that it brought the patients and nurses closer to each other and helped nurses to provide individual support for their patients. However, the education was time-consuming. Systematic patient education using information technology is a promising method of patient-centred care which supports nurses in their daily work. However, it must fit in with clinical activities, and nurses need some guidance in understanding its benefits. The study data can be used in policy-making when developing methods to improve the transparency of information provision in psychiatric nursing.

Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review.

Science.gov (United States)

Voruganti, Teja; Grunfeld, Eva; Makuwaza, Tutsirai; Bender, Jacqueline L

2017-10-27

Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14

Cranial base pathology in pediatric osteogenesis imperfecta patients treated with bisphosphonates.

Science.gov (United States)

Arponen, Heidi; Vuorimies, Ilkka; Haukka, Jari; Valta, Helena; Waltimo-Sirén, Janna; Mäkitie, Outi

2015-03-01

Cranial base pathology is a serious complication of osteogenesis imperfecta (OI). Our aim was to analyze whether bisphosphonate treatment, used to improve bone strength, could also prevent the development of craniocervical junction pathology (basilar impression, basilar invagination, or platybasia) in children with OI. In this single-center retrospective study the authors analyzed the skull base morphology from lateral skull radiographs and midsagittal MR images (total of 94 images), obtained between the ages of 0 and 25 years in 39 bisphosphonate-treated OI patients. The results were compared with age-matched normative values and with findings in 70 OI patients who were not treated with bisphosphonates. In addition to cross-sectional data, longitudinal data were available from 22 patients with an average follow-up period of 7.6 years. The patients, who had OI types I, III, IV, VI, and VII, had been treated with zoledronic acid, pamidronate, or risedronate for 3.2 years on average. Altogether 33% of the 39 bisphosphonate-treated patients had at least 1 cranial base anomaly, platybasia being the most prevalent diagnosis (28%). Logistic regression analysis suggested a higher risk of basilar impression or invagination in patients with severe OI (OR 22.04) and/or older age at initiation of bisphosphonate treatment (OR 1.45), whereas a decreased risk was associated with longer duration of treatment (OR 0.28). No significant associations between age, height, or cumulative bisphosphonate dose and the risk for cranial base anomaly were detected. In longitudinal evaluation, Kaplan-Meier curves suggested delayed development of cranial base pathology in patients treated with bisphosphonates but the differences from the untreated group were not statistically significant. These findings indicate that cranial base pathology may develop despite bisphosphonate treatment. Early initiation of bisphosphonate treatment may delay development of craniocervical junction pathology

Patient Similarity in Prediction Models Based on Health Data: A Scoping Review

Science.gov (United States)

Sharafoddini, Anis; Dubin, Joel A

2017-01-01

Background Physicians and health policy makers are required to make predictions during their decision making in various medical problems. Many advances have been made in predictive modeling toward outcome prediction, but these innovations target an average patient and are insufficiently adjustable for individual patients. One developing idea in this field is individualized predictive analytics based on patient similarity. The goal of this approach is to identify patients who are similar to an index patient and derive insights from the records of similar patients to provide personalized predictions.. Objective The aim is to summarize and review published studies describing computer-based approaches for predicting patients’ future health status based on health data and patient similarity, identify gaps, and provide a starting point for related future research. Methods The method involved (1) conducting the review by performing automated searches in Scopus, PubMed, and ISI Web of Science, selecting relevant studies by first screening titles and abstracts then analyzing full-texts, and (2) documenting by extracting publication details and information on context, predictors, missing data, modeling algorithm, outcome, and evaluation methods into a matrix table, synthesizing data, and reporting results. Results After duplicate removal, 1339 articles were screened in abstracts and titles and 67 were selected for full-text review. In total, 22 articles met the inclusion criteria. Within included articles, hospitals were the main source of data (n=10). Cardiovascular disease (n=7) and diabetes (n=4) were the dominant patient diseases. Most studies (n=18) used neighborhood-based approaches in devising prediction models. Two studies showed that patient similarity-based modeling outperformed population-based predictive methods. Conclusions Interest in patient similarity-based predictive modeling for diagnosis and prognosis has been growing. In addition to raw/coded health

Empower the patients with a dialogue-based web application.

Science.gov (United States)

Bjørnes, Charlotte D; Cummings, Elizabeth; Nøhr, Christian

2012-01-01

Based on a clinical intervention study this paper adds to the significance of users involvement in design processes and substantiate the potential of online, flexible health informatics tools as useful components to accommodate organizational changes that short stay treatment demands. A dialogue-based web application was designed and implemented to accommodate patients' information and communication needs in short stay hospital settings. To ensure the system meet the patients' needs, both patients and healthcare professionals were involved in the design process by applying various participatory methods. Contextualization of the new application was also central in all phases to ensure a focus not only on the technology itself, but also the way it is used and in which relations and contexts. In evaluation of the tool, the patients' descriptions as user substantiate that the use of Internet applications can expand the time for dialogue between the individual patient and healthcare professionals. The patients experience being partners in an on going dialogue, and thereby are empowered, e.g. in managing their care even at home, as these dialogues generate individualized information.

77 FR 42317 - Establish a Patient-Based Registry To Evaluate the Association of Gadolinium Based Contrast...

Science.gov (United States)

2012-07-18

... Quality Assurance (QA) registry of patients with renal failure who received GBCAs as the basis for a... of the development of a patient-based registry to evaluate the association of gadolinium based..., and a copy to Ira Krefting, Center for Drug Evaluation and Research, Division of Medical Imaging...

Improving patient knowledge about sacral nerve stimulation using a patient based educational video.

Science.gov (United States)

Jeppson, Peter Clegg; Clark, Melissa A; Hampton, Brittany Star; Raker, Christina A; Sung, Vivian W

2013-10-01

We developed a patient based educational video to address the information needs of women considering sacral nerve stimulation for overactive bladder. Five semistructured focus groups were used to identify patient knowledge gaps, information needs, patient acceptable terminology and video content preferences for a patient based sacral nerve stimulation educational video. Each session was transcribed, independently coded by 2 coders and examined using an iterative method. A 16-minute educational video was created to address previously identified knowledge gaps and information needs using patient footage, 3-dimensional animation and peer reviewed literature. We developed a questionnaire to evaluate participant sacral nerve stimulation knowledge and therapy attitudes. We then performed a randomized trial to assess the effect of the educational video vs the manufacturer video on patient knowledge and attitudes using our questionnaire. We identified 10 patient important domains, including 1) anatomy, 2) expectations, 3) sacral nerve stimulation device efficacy, 4) surgical procedure, 5) surgical/device complications, 6) post-procedure recovery, 7) sacral nerve stimulation side effects, 8) postoperative restrictions, 9) device maintenance and 10) general sacral nerve stimulation information. A total of 40 women with overactive bladder were randomized to watch the educational (20) or manufacturer (20) video. Knowledge scores improved in each group but the educational video group had a greater score improvement (76.6 vs 24.2 points, p <0.0001). Women who watched the educational video reported more favorable attitudes and expectations about sacral nerve stimulation therapy. Women with overactive bladder considering sacral nerve stimulation therapy have specific information needs. The video that we developed to address these needs was associated with improved short-term patient knowledge. Copyright © 2013 American Urological Association Education and Research, Inc

Mindfulness-Based Cognitive Therapy for Cancer Patients Delivered via Internet: Qualitative Study of Patient and Therapist Barriers and Facilitators.

Science.gov (United States)

Compen, Félix R; Bisseling, Else M; Schellekens, Melanie Pj; Jansen, Ellen Tm; van der Lee, Marije L; Speckens, Anne Em

2017-12-18

The number of patients living with cancer is growing, and a substantial number of patients suffer from psychological distress. Mindfulness-based interventions (MBIs) seem effective in alleviating psychological distress. Unfortunately, several cancer patients find it difficult, if not impossible, to attend a group-based course. Internet-based MBIs (eMBIs) such as Internet-based mindfulness-based cognitive therapy (eMBCT) may offer solutions. However, it is yet to be studied what facilitators and barriers cancer patients experience during eMBCT. This study aimed to explore facilitators and barriers of individual asynchronous therapist-assisted eMBCT as experienced by both patients and therapists. Patients with heterogeneous cancer diagnoses suffering from psychological distress were offered eMBCT. This 9-week intervention mirrored the group-based MBCT protocol and included weekly asynchronous written therapist feedback. Patients were granted access to a website that contained the eMBCT protocol and a secured inbox, and they were asked to practice and fill out diaries on which the therapist provided feedback. In total, 31 patients participated in an individual posttreatment interview on experienced facilitators and barriers during eMBCT. Moreover, eight therapists were interviewed. The data were analyzed with qualitative content analysis to identify barriers and facilitators in eMBCT. Both patients and therapists mentioned four overarching themes as facilitators and barriers: treatment setting (the individual and Internet-based nature of the treatment), treatment format (how the treatment and its guidance were organized and delivered), role of the therapist, and individual patient characteristics. The eMBCT provided flexibility in when, where, and how patients and therapists engage in MBCT. Future studies should assess how different eMBCT designs could further improve barriers that were found. ©Félix R Compen, Else M Bisseling, Melanie PJ Schellekens, Ellen TM

Interleukin-2 based immunotherapy in patients with metastatic renal cell carcinoma

DEFF Research Database (Denmark)

Donskov, Frede

2007-01-01

The present thesis consists of 8 published articles focusing on interleukin-2 based immunotherapy in metastatic renal cell carcinoma (mRCC). This disease represents a significant challenge, as the tumor is resistant to current chemotherapy, hormonal therapy and radiation therapy. However, IL-2...... based immunotherapy may induce dramatic durable tumor regression by manipulating the immune system, however, only in a minority of patients. Two critical questions have driven the present thesis. First, which properties of the immune system are responsible for the dramatic tumor regression seen in some...... patients with mRCC following IL-2 administration? And second, can histamine increase the efficacy of IL-2 based immunotherapy by ending the immune suppression induced by phagocyte-generation of reactive oxygen species? 120 Danish patients, 41 UK patients and 20 Swedish patients were treated with low...

Patient preferences for types of community-based cardiac rehabilitation programme.

Science.gov (United States)

Chia, Shermain; Wong, Xin Yi; Toon, Min Li; Seah, Yi; Yap, Angela Frances; Lim, Cindy; Tay, Hung Yong; Fong, Warren; Low, Lian Leng; Kwan, Yu Heng

2018-01-01

Cardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours constraints. Community-based CR is a possible solution. To understand the type of community-based CR preferred and identify patient characteristics associated with certain programme combinations. A cross-sectional survey was administered to a randomised list of patients at risk for or with cardiovascular diseases at two community-based CR centres. Participants were presented with nine hypothetical choice sets and asked to choose only one of the two alternative programme combinations in each choice set. Attributes include support group presence, cash incentives, upfront deposit and out-of-pocket cost. The counts for each combination were tallied and corrected for repeats. Chi-square test and logistic regression were performed to understand the characteristics associated with the preferred CR combination. After correcting for repeats, patients most (85.2%) prefer CR programmes with new group activities, support group, cash rewards, deposit and out-of-pocket cost, and few exercise equipment with physiotherapist presence without the need for monitoring equipment. Patients with more than three bedrooms in their house are less likely (OR 0.367; CI 0.17 to 0.80; P=0.011) to choose the choice with no physiotherapist and few equipment available. This is the first study to explore patients' preferences for different types of community CR. Higher income patients prefer physiotherapist presence and are willing to settle for less equipment. Our study serves as a guide for designing future community-based CR programmes.

Structural Variability within Frontoparietal Networks and Individual Differences in Attentional Functions: An Approach Using the Theory of Visual Attention.

Science.gov (United States)

Chechlacz, Magdalena; Gillebert, Celine R; Vangkilde, Signe A; Petersen, Anders; Humphreys, Glyn W

2015-07-29

Visuospatial attention allows us to select and act upon a subset of behaviorally relevant visual stimuli while ignoring distraction. Bundesen's theory of visual attention (TVA) (Bundesen, 1990) offers a quantitative analysis of the different facets of attention within a unitary model and provides a powerful analytic framework for understanding individual differences in attentional functions. Visuospatial attention is contingent upon large networks, distributed across both hemispheres, consisting of several cortical areas interconnected by long-association frontoparietal pathways, including three branches of the superior longitudinal fasciculus (SLF I-III) and the inferior fronto-occipital fasciculus (IFOF). Here we examine whether structural variability within human frontoparietal networks mediates differences in attention abilities as assessed by the TVA. Structural measures were based on spherical deconvolution and tractography-derived indices of tract volume and hindrance-modulated orientational anisotropy (HMOA). Individual differences in visual short-term memory (VSTM) were linked to variability in the microstructure (HMOA) of SLF II, SLF III, and IFOF within the right hemisphere. Moreover, VSTM and speed of information processing were linked to hemispheric lateralization within the IFOF. Differences in spatial bias were mediated by both variability in microstructure and volume of the right SLF II. Our data indicate that the microstructural and macrostrucutral organization of white matter pathways differentially contributes to both the anatomical lateralization of frontoparietal attentional networks and to individual differences in attentional functions. We conclude that individual differences in VSTM capacity, processing speed, and spatial bias, as assessed by TVA, link to variability in structural organization within frontoparietal pathways. Copyright © 2015 Chechlacz et al.

Evaluation of Web-Based Ostomy Patient Support Resources.

Science.gov (United States)

Pittman, Joyce; Nichols, Thom; Rawl, Susan M

To evaluate currently available, no-cost, Web-based patient support resources designed for those who have recently undergone ostomy surgery. Descriptive, correlational study using telephone survey. The sample comprised 202 adults who had ostomy surgery within the previous 24 months in 1 of 5 hospitals within a large healthcare organization in the Midwestern United States. Two of the hospitals were academic teaching hospitals, and 3 were community hospitals. The study was divided into 2 phases: (1) gap analysis of 4 Web sites (labeled A-D) based on specific criteria; and (2) telephone survey of individuals with an ostomy. In phase 1, a comprehensive checklist based on best practice standards was developed to conduct the gap analysis. In phase 2, data were collected from 202 participants by trained interviewers via 1-time structured telephone interviews that required approximately 30 minutes to complete. Descriptive analyses were performed, along with correlational analysis of relationships among Web site usage, acceptability and satisfaction, demographic characteristics, and medical history. Gap analysis revealed that Web site D, managed by a patient advocacy group, received the highest total content score of 155/176 (88%) and the highest usability score of 31.7/35 (91%). Two hundred two participants completed the telephone interview, with 96 (48%) reporting that they used the Internet as a source of information. Sixty participants (30%) reported that friends or family member had searched the Internet for ostomy information on their behalf, and 148 (75%) indicated they were confident they could get information about ostomies on the Internet. Of the 90 participants (45%) who reported using the Internet to locate ostomy information, 73 (82%) found the information on the Web easy to understand, 28 (31%) reported being frustrated during their search for information, 24 (27%) indicated it took a lot of effort to get the information they needed, and 39 (43%) were

Položaj nacionalnih i vjerskih manjina u Bosni i Hercegovini

OpenAIRE

Kukić, Slavo

2002-01-01

Autor analizira rezultate empirijskog istraživanja “Položaj nacionalnih i vjerskih manjina u Bosni i Hercegovini”. Istraživanje je pokazalo da se u svoje predratne domove najsporije vraćaju građani srpske nacionalnosti. Spremnost na povratak iskazuje preko sedamdeset posto građana BiH. Što se tiče ljudskih prava, preko polovice stanovništva smatra da su u BiH ugrožena temeljna ljudska prava. Autor smatra da je rat doveo do velikih demografskih pokreta stanovništva te je utjecao na radikalno p...

The Palatability of Cereal Based Nutritional Supplements in Cancer Patients

Science.gov (United States)

Baik, Hyun Wook; Lee, Yu Sun; Song, Min-Kyung

2014-01-01

Recently, it is reported that intervention of oral nutritional supplement improves the nutritional status of cancer patients, and the effectiveness is affected by the sensory preference of cancer patients on the oral nutritional supplement. However, the variety of oral nutritional supplement is extremely limited and the number of patient's benefits from using the products are restricted mostly due to sensory dislikes. The objective of this study was to provide sensory preference score of trial manufactured products with different accessory ingredients to maximize the use of oral nutritional supplements. Cancer patients (n = 30) and age, sex-matched healthy volunteers (n = 30) participated in the sensory assessments (taste, flavor, viscosity, color and overall preference) of three types of oral supplements (cereal base, cereal base+herb and cereal base+fruit) and a control supplement product with scorched cereal flavor, a top seller in current Korean market. Results indicate that the cancer patients' overall preference was significantly higher for the control supplement, and fruit added supplement was preferred over plain cereal and herb added products, although the difference was insignificant. However, there was no significant preference difference for the supplements among the control group for all sensory factors. These results suggest that cancer patients are more sensitive to sensory preferences compared to the control group, and the patients prefer the flavor of cooked cereal which is a staple food in Korea. PMID:24527420

Home-based specialized palliative care in patients with advanced cancer

DEFF Research Database (Denmark)

Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per

2016-01-01

OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care...... for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required....

Value Based Care and Patient-Centered Care: Divergent or Complementary?

Science.gov (United States)

Tseng, Eric K; Hicks, Lisa K

2016-08-01

Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

Characterization of Cardiac Patients Based on the Synergy Model

Directory of Open Access Journals (Sweden)

Tavangar

2014-10-01

Full Text Available Background Cardiac patients need comprehensive support due to the adverse effects of this disease on different aspects of their lives. Synergy intervention is a model that focuses on patients' requirements. Objectives This study aimed to determine the eightfold characteristic of cardiac patients based on the synergy model that represent their clinical requirements. Materials and Methods In this descriptive cross-sectional study, 40 cardiac patients hospitalized at the cardiac care unit (CCU of Yazd Afshar Hospital were randomly selected. The data were collected by using a two-part check-list including demographic characteristics and also by studying eight characteristics of patients through interviewing and reviewing their records. The results were analyzed using descriptive statistics such as frequency (percentage and analytical statistics such as Spearman and Mann-Whitney test with the SPSS software, version 18. Results The results showed that among patients' internal characteristics, reversibility (70.6%, vulnerability (68.6%, and predictability (80.4% at level 1 (the minimum score had the highest frequency and stability (49% and complexity (54.9% were at level 3 (average score. Among external characteristics participation in decision-making (80.4% at level 1 had the highest frequency while care (62.7% and recourses (98% were at level 3. Conclusions Ignoring any of the eightfold characteristics based on the synergy model interferes with comprehensive support of cardiac patients. Therefore, it is necessary for professional health practitioners, especially nurses, to consider patients' eightfold characteristics in order to provide quality care.

Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients

Directory of Open Access Journals (Sweden)

Jaydip Ramani

Full Text Available Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients, long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients, standard St Thomas IB (short-acting blood-based cardioplegia solution was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43 and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23 in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65 in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB, Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

Base stock system for patient vs impatient customers with varying demand distribution

Science.gov (United States)

Fathima, Dowlath; Uduman, P. Sheik

2013-09-01

An optimal Base-Stock inventory policy for Patient and Impatient Customers using finite-horizon models is examined. The Base stock system for Patient and Impatient customers is a different type of inventory policy. In case of the model I, Base stock for Patient customer case is evaluated using the Truncated Exponential Distribution. The model II involves the study of Base-stock inventory policies for Impatient customer. A study on these systems reveals that the Customers wait until the arrival of the next order or the customers leaves the system which leads to lost sale. In both the models demand during the period [0, t] is taken to be a random variable. In this paper, Truncated Exponential Distribution satisfies the Base stock policy for the patient customer as a continuous model. So far the Base stock for Impatient Customers leaded to a discrete case but, in this paper we have modeled this condition into a continuous case. We justify this approach mathematically and also numerically.

Comparison of the outcome of burn patients using acute-phase plasma base deficit.

Science.gov (United States)

Salehi, S H; As'adi, K; Mousavi, J

2011-12-31

Background. In recent years, plasma base deficit has been used as a marker to determine the status of tissue perfusion in trauma patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma base deficit in predicting burn patient outcome. Methods. This prospective cohort study was performed from October 2009 to October 2010 in the acute phase of burn patients who were admitted within 6 h post-injury to Motahari Burn Hospital in Iran. The patients were divided into two groups based on the plasma base deficit in the first 24 h post-injury: group A, in which the mean plasma base deficit was less than or equal to -6 (more negative), and group B, in which the mean plasma base deficit greater than -6. Statistical analysis was performed using SPSS v.16 software. Results. Thirty-eight patients were enrolled in each group. The mean plasma base deficit in group A (-7.76 ± 2.18 mmol) was significantly less than that in group B (-1.19 ± 2.82) mmol (p 0.05) and despite removal of interfering factors, there were significant differences between the systemic inflammatory response syndrome and the multiple organ dysfunction syndrome score and the percentage of sepsis between the two groups (p 0.05). Conclusion. The plasma base deficit can be used as a valuable marker in the resuscitation of burn patients, along with clinical criteria. Physiological indicators (burn percentage, age, and mucosal burns) are not sufficient to predict mortality and morbidity in burn patients, and it is necessary to investigate the role of biochemical markers such as base deficit in determining the final outcome of burn patients.

Micronized Coal Reburning Demonstration for NOx Control: A DOE Assessment

Energy Technology Data Exchange (ETDEWEB)

National Energy Technology Laboratory

2001-08-15

The goal of the U.S. Department of Energy's (DOE) Clean Coal Technology (CCT) program is to furnish the energy marketplace with a number of advanced, more efficient, and environmentally responsible coal utilization technologies through demonstration projects. These projects seek to establish the commercial feasibility of the most promising advanced coal technologies that have developed beyond the proof-of-concept stage. This document serves as a DOE post-project assessment of a project selected in CCT Round IV, the Micronized Coal Reburning (MCR) Demonstration for NO{sub x} Control, as described in a report to Congress (U.S. Department of Energy 1999). The need to meet strict emissions requirements at a minimum cost prompted the Tennessee Valley Authority (TVA), in conjunction with Fuller Company, Energy and Environmental Research Corporation (EER), and Fluor Daniel, to submit the proposal for this project to be sited at TVA's Shawnee Fossil Plant. In July 1992, TVA entered into a cooperative agreement with DOE to conduct the study. However, because of operational and environmental compliance strategy changes, the Shawnee site became unavailable.

Browns Ferry

International Nuclear Information System (INIS)

Wood, J.

1996-01-01

In 1986, the US Nuclear Regulatory Commission (NRC) established a ''watch list'' of power reactors requiring special attention which included the three BWR units at Brown's Ferry owned by the Tennessee Valley Authority (TVA). The reactors has been closed down voluntarily by the TVA in 1985 in order to deal with a backlog of maintenance and regulatory issues. Intended as short-term, the shutdown was indefinitely extended when the nature and extent of the design changes, accompanying documentation and retrofitting required to satisfy the NRC became apparent. The recovery programme for Unit 2 was completed by 1991 and the reactor returned to service under a dedicated operating staff. Meanwhile, a separate, dedicated, recovery team was set up to manage Unit 3 which was returned to service in December 1995. Browns Ferry 2 was removed from the NRC watch list in June 1992 and Units 1 and 3 in June 1996. Units 2 and 3 have both operated successfully since restart but Unit 1 is currently mothballed and TVA has no plans to bring it back into service. (UK)

Micronized Coal Reburning Demonstration for NOx Control: A DOE Assessment; FINAL

International Nuclear Information System (INIS)

National Energy Technology Laboratory

2001-01-01

The goal of the U.S. Department of Energy's (DOE) Clean Coal Technology (CCT) program is to furnish the energy marketplace with a number of advanced, more efficient, and environmentally responsible coal utilization technologies through demonstration projects. These projects seek to establish the commercial feasibility of the most promising advanced coal technologies that have developed beyond the proof-of-concept stage. This document serves as a DOE post-project assessment of a project selected in CCT Round IV, the Micronized Coal Reburning (MCR) Demonstration for NO(sub x) Control, as described in a report to Congress (U.S. Department of Energy 1999). The need to meet strict emissions requirements at a minimum cost prompted the Tennessee Valley Authority (TVA), in conjunction with Fuller Company, Energy and Environmental Research Corporation (EER), and Fluor Daniel, to submit the proposal for this project to be sited at TVA's Shawnee Fossil Plant. In July 1992, TVA entered into a cooperative agreement with DOE to conduct the study. However, because of operational and environmental compliance strategy changes, the Shawnee site became unavailable

Evidence-Based Treatment of Delirium in Patients With Cancer

Science.gov (United States)

Breitbart, William; Alici, Yesne

2012-01-01

Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123

Community Based Organizations in HIV/AIDS Prevention, Patient ...

African Journals Online (AJOL)

Community Based Organizations in HIV/AIDS Prevention, Patient. ... behavioral change communication methods that may contribute significantly to overcoming ... Towards that objective, CBOs need both internal strengthening of programs and ...

Training smarter: Refocus through reduction

International Nuclear Information System (INIS)

Durham, L.B.

1991-01-01

In this era of ever increasing operations and maintenance (O and M) costs, the Tennessee Valley Authority (TVA) like most other nuclear utilities, has been faced with the problem of reducing its overhead costs while at the same time maintaining its commitment to providing effective training. Due in part to the extended shutdown of its operating nuclear plants (Sequoyah and Browns Ferry Nuclear Plants) and faced with continued delays in its construction programs at the Watts Bar and Bellefonte Nuclear Plants, TVA had relied on an expanded complement of personnel in all facets of its nuclear program to get back on track and operating once again. Nuclear Training was no exception. At one point in the recovery process (1988), Nuclear Training had an authorized manpower level of 573. Faced with spiraling O and M costs, potential loss of long-term customers to neighboring utilities, and enormous outstanding debt, TVA management responded by setting goals that included becoming the best electric utility in North America and the most productive and effective agency in the Federal government. Operating TVA like a business became second only to safety as a managerial objective. Accountability for planning ahead, achieving goals, and operating within authorized budgets became a way of life. Work forces were reduced significantly including reduction of Nuclear Training's complement to 203. In spite of the importance of training to a nuclear utility, Nuclear Training was not immune to such sweeping changes. Program scope was refocused on accredited and regulatory training. The purpose of this paper is to explain the major elements of this revitalization program

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

Science.gov (United States)

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2013-01-16

Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a

Image-based electronic patient records for secured collaborative medical applications.

Science.gov (United States)

Zhang, Jianguo; Sun, Jianyong; Yang, Yuanyuan; Liang, Chenwen; Yao, Yihong; Cai, Weihua; Jin, Jin; Zhang, Guozhen; Sun, Kun

2005-01-01

We developed a Web-based system to interactively display image-based electronic patient records (EPR) for secured intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). In the EPR-GW and EPR-Viewer, the security modules of Digital Signature and Authentication are integrated to perform the security processing on the EPR data with integrity and authenticity. The privacy of EPR in data communication and exchanging is provided by SSL/TLS-based secure communication. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.

Health-related quality of life in patients with skull base tumours.

LENUS (Irish Health Repository)

Kelleher, M O

2012-02-03

The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.

Bellefonte primary containment structure

International Nuclear Information System (INIS)

Olyniec, J.H.

1981-01-01

Construction of the reactor building primary containment structure at the Bellefonte Nuclear Plant involved several specialized construction techniques. This two unit plant is one of the nine nuclear units at six different sites now under construction by the Tennessee Valley Authority (TVA). The post-Tensioned, cast-in-place interior steel lined containment structure is unique within TVA. Problems during construction were identified at weekly planning meetings, and options were discussed. Close coordination between craft supervisors and on-site engineering personnel drew together ''hands-on''experience and technical background. Details of the construction techniques, problems, and solutions are presented

A neural theory of visual attention

DEFF Research Database (Denmark)

Bundesen, Claus; Habekost, Thomas; Kyllingsbæk, Søren

2005-01-01

A neural theory of visual attention (NTVA) is presented. NTVA is a neural interpretation of C. Bundesen's (1990) theory of visual attention (TVA). In NTVA, visual processing capacity is distributed across stimuli by dynamic remapping of receptive fields of cortical cells such that more processing...... resources (cells) are devoted to behaviorally important objects than to less important ones. By use of the same basic equations used in TVA, NTVA accounts for a wide range of known attentional effects in human performance (reaction times and error rates) and a wide range of effects observed in firing rates...

What Do Stroke Patients Look for in Game-Based Rehabilitation

Science.gov (United States)

Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

2016-01-01

Abstract Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients’ places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey – interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey – a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing

Stanovení vagového prahu a možnosti jeho využití Determination of the vagal threshold and changes of it's using

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Aleš Gába

2008-01-01

critical exercise intensity, at which, if exceeded, the cardiovascular system starts to be influenced dominantly by rising sympathetic activity including catecholamine and a significant withdrawal in cardiac vagal activity (vagal threshold – TVA occurs. The testing group consisted of 10 volunteers (men. Their mean age was 27.24 ± 3.23 years and the mean value of their maximal oxygen uptake (VO2max was 50.24 ± 4.63 ml·kg–1·min–1. ANS activity was monitored by the microprocessor diagnostics system VarCor PF 7 and assessed by a non invasive spectral analysis (SA of heart rate variability (HRV method. The power of the high frequency component (PHF was calculated by integrating the area under the power spectral density curve in the frequency range from 0.15 to 0.5 Hz. Changes in autonomic cardiac regulation were assessed during walking in the steady state with exercise intensities ranging from 20 to 70% of maximal heart rate reserve (MHRR on the treadmill. Each exercise intensity increases of about the 10% MHRR in a range from 20 to 70% MHRR led to a significant decrease in vagal activity. A designed mathematic algorithm for detecting the deflection point of the vagal activity during incremental exercise intensity revealed TVA at 43.63 ± 4.66% MHRR. We can state that the designed algorithm for detection of TVA enables an estimation of such a "safe" intensity, when the vagal activity is still preserved and sympathetic activity does not markedly rise up during exercise. The estimation of TVA could be recommended especially for the exercise prescription for patients with both reduction HRV, and at risk for sudden cardiac death.

Toward a patient-based paradigm for blood transfusion.

Science.gov (United States)

Farrugia, Albert; Vamvakas, Eleftherios

2014-01-01

The current "manufacturing paradigm" of transfusion practice has detached transfusion from the clinical environment. As an example, fresh whole blood in large-volume hemorrhage may be superior to whole blood reconstituted from multiple components. Multicomponent apheresis can overcome logistical difficulties in matching patient needs with fresh component availability and can deliver the benefits of fresh whole blood. Because of the different transfusion needs of patients in emerging economies and the vulnerability of these blood systems to emerging infections, fresh whole blood and multicomponent apheresis can better meet patient needs when compared with transplants of the "manufacturing paradigm". We propose that patient blood management, along with panels of repeat, paid, accredited apheresis and fresh whole-blood donors can be used in emerging economies to support decentralized blood services. This alternative transfusion-medicine paradigm could eventually also be adopted by established economies to focus transfusion medicine on local patient needs and to alleviate the problem of the aging volunteer donor base.

Practical Application of Modern Forecasting and Decision Tools at an Operational River Management Agency

Science.gov (United States)

Jawdy, C. M.; Carney, S.; Barber, N. M.; Balk, B. C.; Miller, G. A.

2017-12-01

The Tennessee Valley Authority (TVA) recently completed a complete overhaul of our River Forecast System (RFS). This modernization effort encompassed: uplift or addition of 89 data feeds calibration of a 140 subbasin rainfall-runoff model calibration of over 650 miles of hydraulic routings implementation of a decision optimization routine for 29 reservoirs implementation of hydrothermal forecast models for five river-cooled thermal plants creation of decision-friendly displays creation of a user-friendly wiki creation of a robust reporting system This talk will walk attendees through how a 24x7 river and grid management agency made decisions around how to operationalize the latest technologies in hydrology, hydraulics, decision science and information technology. The tradeoffs inherent in such an endeavor will be discussed so that research-oriented attendees can understand how best to align their research if they desire adoption within industry. More industry-oriented attendees can learn about the mechanics of how to succeed at such a large and complex project. Following the description of the modernization project, I can discuss TVA's plans for future growth of the system. We plan to add the following capabilities in the coming years: forecast verification tools to communicate floodplain risk tools to choose the best possible model forcings ensemble inflow modelling a river policy that allows for more reasonable tradeoff of benefits river decisions based on ensembles The iterative staging of such improvements is highly fraught with technical, political and operational risks. I will discuss how TVA's is using what we learned in the RFS modernization effort to grow further into delivering on the promise of these additional technologies.

Dicty_cDB: AFH787 [Dicty_cDB

Lifescience Database Archive (English)

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Parameter-Based Evaluation of Attentional Impairments in Schizophrenia and Their Modulation by Prefrontal Transcranial Direct Current Stimulation

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Nadine Gögler

2017-11-01

Full Text Available BackgroundAttentional dysfunctions constitute core cognitive symptoms in schizophrenia, but the precise underlying neurocognitive mechanisms remain to be elucidated.MethodsIn this randomized, double-blind, sham-controlled study, we applied, for the first time, a theoretically grounded modeling approach based on Bundesen’s Theory of Visual Attention (TVA to (i identify specific visual attentional parameters affected in schizophrenia and (ii assess, as a proof of concept, the potential of single-dose anodal transcranial direct current stimulation (tDCS; 20 min, 2 mA to the left dorsolateral prefrontal cortex to modulate these attentional parameters. To that end, attentional parameters were measured before (baseline, immediately after, and 24 h after the tDCS intervention in 20 schizophrenia patients and 20 healthy controls.ResultsAt baseline, analyses revealed significantly reduced visual processing speed and visual short-term memory storage capacity in schizophrenia. A significant stimulation condition × time point interaction in the schizophrenia patient group indicated improved processing speed at the follow-up session only in the sham condition (a practice effect, whereas performance remained stable across the three time points in patients receiving verum stimulation. In healthy controls, anodal tDCS did not result in a significant change in attentional performance.ConclusionWith regard to question (i above, these findings are indicative of a processing speed and short-term memory deficit as primary sources of attentional deficits in schizophrenia. With regard to question (ii, the efficacy of single-dose anodal tDCS for improving (speed aspects of visual cognition, it appears that prefrontal tDCS (at the settings used in the present study, rather than ameliorating the processing speed deficit in schizophrenia, actually may interfere with practice-dependent improvements in the rate of visual information uptake. Such potentially

Celiac Disease and Drug-Based Therapies: Inquiry into Patients Demands.

Science.gov (United States)

Branchi, Federica; Tomba, Carolina; Ferretti, Francesca; Norsa, Lorenzo; Roncoroni, Leda; Bardella, Maria Teresa; Conte, Dario; Elli, Luca

2016-01-01

Medical research is looking for alternative drug-based options to the gluten-free diet (GFD) for celiac disease. We aimed at evaluating the need for alternative therapies perceived by celiac patients. During the 2013 meeting of the Lombardy section of the Italian Celiac Patients Association, adult subjects were invited to fill in a questionnaire investigating their clinical profile in relation to compliance to the diet, quality of life (QOL) as well as their opinion on alternative therapies. Three hundred and seventy two patients (76 m, mean age 41.7 ± 13.9 years) completed the questionnaire. Patients reported a significant improvement in health status (HS) and QOL after the diet was started (p < 0.001). The GFD was accepted by 88% patients, but the need for alternative therapies was reported by 65%. Subjects expressing the need for a drug-based therapy showed a lower increase in QOL (p = 0.003) and HS (p = 0.005) on GFD. The preferred option for an alternative therapy was the use of enzymes (145 subjects), followed by a vaccine (111 subjects). The GFD is favorably accepted by most celiac patients. Nevertheless, a proportion of patients pronounce themselves in favor of the development of alternative drugs. © 2016 S. Karger AG, Basel.

Levetiracetam (Keppra: Evidence-Based Polypharmacy in Two Patients With Epilepsy

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Tolou-Ghamari

2016-04-01

Full Text Available Introduction Epilepsy is a prolonged disorder characterized by repeated violent epileptic seizures. Its managements depend on proper classification of the seizure category and the epileptic pattern. Levetiracetam (Keppra® has been approved as monotherapy or for adjunctive management of partial onset seizures, juvenile myoclonic epilepsy, and idiopathic generalized epilepsy. Case reporting of levetiracetam polypharmacy shows adverse effects linked to evidence-based clinical and laboratory data in two patients with epilepsy. Case reporting of levetiracetam polypharmacy, based on evidence-based clinical and laboratory data was of interest that investigated. Case Presentation Two cases were studied, one patient was a 32-year-old male and the other was a 14-year-old female. The key words relevant to search topics were surveyed using PubMed (United States national library of medicine. Articles related to the levetiracetam prescription in epileptic patients were selected and considered separately. Pharmacotherapy based on levetiracetam, primidone, phenytoin, and topiramate in a 32-year-old epileptic male showed a decrease in white blood cell count (3400 cells/mcL, red blood cell count (4.4 mil/mm3 hemoglobin (11.8 g/dL and hematocrit (36.7%. The drug regimen for the 14-year-old epileptic female was a levetiracetam polypharmacy in combination with primidone and sodium-valproate simultaneously. In this patient, there was a decrease in hemoglobin (10.4 g/dL and hematocrit (34%. An increase in lymphocyte (84% was also observed. Conclusions Administration of AEDs in general and levetiracetam in particular should be based on attention to pharmacokinetic behavior in terms of monotherapy or polypharmacy.

Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation.

Science.gov (United States)

Jiang, Shaohai; Hong, Y Alicia

2018-03-01

Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based patient-provider communication (MBPPC). The relationship between MBPPC and patients' health outcomes, however, remains unclear; how health literacy and patient activation interact with such relationship is unexplored. Data were drawn from National Cancer Institute's Health Information National Trends Survey 4 Cycle 3. A sample of 459 cancer survivors were included in the analysis. Based on the 3-stage model of health promotion using interactive media, this study empirically tested a moderated mediation model. MBPPC (eg, patient use of email, text message, mobile app, and social media to communicate with providers) had no direct effect on cancer survivors' emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health and further increased the indirect effect of MBPPC on emotional health. MBPPC alone does not directly result in better emotional health outcomes; health literacy is the key to realize its health benefits; patient activation significantly strengthens the effects of MBPPC. As we embrace the mHealth movement, innovative programs are needed to promote MBPPC, and improve health literacy and activation of cancer survivors, particularly in underserved communities, to reduce health disparities. Copyright © 2017 John Wiley & Sons, Ltd.

Web app based patient education in psoriasis - a randomized controlled trial.

Science.gov (United States)

Hawkins, Spencer D; Barilla, Steven; Feldman, Steven R

2017-04-15

Patients report wanting more information about psoriasis and clear expectations from the onset of therapy. Dermatologists do not think patients receive or internalize adequate information. There isa need for further explanation of treatment regimens to increase knowledge, compliance, and patient satisfaction. Recent advancements in web technology have the potential to improve these psoriasis outcomes. A web based application was created to educate psoriasis patients using video, graphics, and textual information. An investigator blinded, randomized, controlled study evaluated the website's efficacy in 50 psoriasis patients at Wake Forest Baptist Health Dermatology. Patients were randomized into two groups: Group 1 received a link to the educational web app and a survey following their visit; Group 2 received a link to the survey with no educational web app. The survey assessed patient knowledge, self reported adherence to medication, and adequacy of addressing concerns. Twenty two patients completed the study. Patients in the web app group scored an average of 11/14 on the psoriasis knowledge quiz, whereas patients in the control group scored an average of 9/14 for an improvement of roughly 18% (p=0.008, n=22). Web app based education via DermPatientEd.Com is an efficient way to improve knowledge, but we did not demonstrate improvements in self-reported medication adherence or the ability to address concerns of psoriasis patients.

Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients.

Science.gov (United States)

Mateti, Uday Venkat; Nagappa, Anantha Naik; Attur, Ravindra Prabhu; Bairy, Manohar; Nagaraju, Shankar Prasad; Mallayasamy, Surulivelrajan; Vilakkathala, Rajesh; Guddattu, Vasudev; Balkrishnan, Rajesh

2015-11-01

Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value information leaflets can be considered an effective educational tool for HD patients.

A deformation-based morphometry study of patients with early-stage Parkinson's disease

DEFF Research Database (Denmark)

Borghammer, P; Østergaard, Karen; Cumming, P

2010-01-01

BACKGROUND AND PURPOSE: Previous volumetric magnetic resonance imaging (MRI) studies of Parkinson's disease (PD) utilized primarily voxel-based morphometry (VBM), and investigated mostly patients with moderate- to late-stage disease. We now use deformation-based morphometry (DBM), a method...... purported to be more sensitive than VBM, to test for atrophy in patients with early-stage PD. METHODS: T1-weighted MRI images from 24 early-stage PD patients and 26 age-matched normal control subjects were compared using DBM. Two separate studies were conducted, where two minimally-biased nonlinear...... intensity-average were created; one for all subjects and another for just the PD patients. The DBM technique creates an average population-based MRI-average in an iterative hierarchical fashion. The nonlinear transformations estimated to match each subject to the MRI-average were then analysed. RESULTS...

Two-year outcome of team-based intensive case management for patients with schizophrenia.

Science.gov (United States)

Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

1995-12-01

Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

Lisfranc injuries: patient- and physician-based functional outcomes.

LENUS (Irish Health Repository)

O'Connor, P A

2012-02-03

The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

Science.gov (United States)

2013-01-01

Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly

Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

Directory of Open Access Journals (Sweden)

Chang Ching-Sheng

2013-01-01

Full Text Available Abstract Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A interpersonal-based medical

Ramipril-based versus diuretic-based antihypertensive primary treatment in patients with pre-diabetes (ADaPT study

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Zidek Walter

2012-01-01

Full Text Available Abstract Background Previous randomized controlled trials demonstrated a protective effect of renin angiotensin system blocking agents for the development of type-2 diabetes in patients with pre-diabetes. However, there are no real-world data available to illustrate the relevance for clinical practice. Methods Open, prospective, parallel group study comparing patients with an ACE inhibitor versus a diuretic based treatment. The principal aim was to document the first manifestation of type-2 diabetes in either group. Results A total of 2,011 patients were enrolled (mean age 69.1 ± 10.3 years; 51.6% female. 1,507 patients were available for the per-protocol analysis (1,029 ramipril, 478 diuretic group. New-onset diabetes was less frequent in the ramipril than in the diuretic group over 4 years. Differences were statistically different at a median duration of 3 years (24.4% vs 29.5%; p Conclusions Ramipril treatment is preferable over diuretic based treatment regimens for the treatment of hypertension in pre-diabetic patients, because new-onset diabetes is delayed.

Cultural Resources Investigations at Redstone Arsenal, Madison County, Alabama. Volume I.

Science.gov (United States)

1980-01-01

units pro- hably based upon changes in projectile point themes. Although Walthall is probably right in predicting that the Lauder - dale phase is...investigations. According to him, During the WPA-TVA salvage program, time and money allowed investigation of only shell mounds, burial mounds, and other large...1813, becoming the first school in Alabama to be subsidized with public money . Alabama’s first bank, the Planters and 3 Mechanics Bank of Huntsville

Moving from gamma passing rates to patient DVH-based QA metrics in pretreatment dose QA

Energy Technology Data Exchange (ETDEWEB)

Zhen, Heming; Nelms, Benjamin E.; Tome, Wolfgang A. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Department of Human Oncology, University of Wisconsin, Madison, Wisconsin 53792 and Canis Lupus LLC, Merrimac, Wisconsin 53561 (United States); Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 and Department of Human Oncology, University of Wisconsin, Madison, Wisconsin 53792 (United States)

2011-10-15

Purpose: The purpose of this work is to explore the usefulness of the gamma passing rate metric for per-patient, pretreatment dose QA and to validate a novel patient-dose/DVH-based method and its accuracy and correlation. Specifically, correlations between: (1) gamma passing rates for three 3D dosimeter detector geometries vs clinically relevant patient DVH-based metrics; (2) Gamma passing rates of whole patient dose grids vs DVH-based metrics, (3) gamma passing rates filtered by region of interest (ROI) vs DVH-based metrics, and (4) the capability of a novel software algorithm that estimates corrected patient Dose-DVH based on conventional phan-tom QA data are analyzed. Methods: Ninety six unique ''imperfect'' step-and-shoot IMRT plans were generated by applying four different types of errors on 24 clinical Head/Neck patients. The 3D patient doses as well as the dose to a cylindrical QA phantom were then recalculated using an error-free beam model to serve as a simulated measurement for comparison. Resulting deviations to the planned vs simulated measured DVH-based metrics were generated, as were gamma passing rates for a variety of difference/distance criteria covering: dose-in-phantom comparisons and dose-in-patient comparisons, with the in-patient results calculated both over the whole grid and per-ROI volume. Finally, patient dose and DVH were predicted using the conventional per-beam planar data as input into a commercial ''planned dose perturbation'' (PDP) algorithm, and the results of these predicted DVH-based metrics were compared to the known values. Results: A range of weak to moderate correlations were found between clinically relevant patient DVH metrics (CTV-D95, parotid D{sub mean}, spinal cord D1cc, and larynx D{sub mean}) and both 3D detector and 3D patient gamma passing rate (3%/3 mm, 2%/2 mm) for dose-in-phantom along with dose-in-patient for both whole patient volume and filtered per-ROI. There was

Patient Safety Based Knowledge Management SECI to Improve Nusrsing Students Competency

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Joanggi Wiriatarina Harianto

2015-10-01

Full Text Available Introduction: Patient safety is an important component of health services quality,and  basic principles of patient care. Nursing students also have a great potential to make an action that could endanger the patient, because hospital is one of student practice area. The purpose of this study was to improve the nursing students competency in patient safety by using knowledge management SECI approached. Method: The study used exploratory survey, and quasy experiment. The samples were some of nursing students of STIKes Muhammadiyah Samarinda who were on internship programme that selected using simple random sampling technique, in total of 54 students. This research’s variables were the knowledge management SECI based-patient safety and nursing student’s competency. The data were collected by using questionnaires and observation. The data were analyze by using Partial Least Square (PLS. Result: The result showed that there were significant influence the implementation of a model patient safety based knowledge management seci on increased competence nursing students. Discussion: Improved student competency in patient safety using SECI knowledge management was carried out in four phases, that is Socialization, Externalization, Combination, and Internalization. The result was a new knowledge related to patient safety that able to improve the student’s competency.. Keywords: Patient safety, Knowledge management, SECI, competency

Usefulness of antiemetic therapy with aprepitant, palonosetron, and dexamethasone for lung cancer patients on cisplatin-based or carboplatin-based chemotherapy.

Science.gov (United States)

Kitazaki, Takeshi; Fukuda, Yuichi; Fukahori, Susumu; Oyanagi, Kazuhiko; Soda, Hiroshi; Nakamura, Yoichi; Kohno, Shigeru

2015-01-01

The purpose of the study is to investigate the usefulness of the triplet regimen comprising aprepitant, palonosetron, and dexamethasone in patients treated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Patients with lung cancer (aged 65.8 ± 8.4 years) who received carboplatin-based MEC and those treated with cisplatin-based HEC were enrolled. The antiemetic regimen for both types of chemotherapy consisted of aprepitant, palonosetron, and dexamethasone based on the May 2010 guidelines prepared by the Japan Society of Clinical Oncology. The incidence of chemotherapy-induced nausea and vomiting (CINV) and the use of salvage treatment were assessed. The primary endpoints were the percentage of patients with a complete response (CR: no nausea and no salvage treatment) during the entire study period (5 days) after chemotherapy, during the acute phase (day 1), and during the delayed phase (days 2-5). CR rates for the entire period were 86 and 71% in patients receiving carboplatin-based and cisplatin-based chemotherapy, respectively. CR rates were respectively 98 and 100% in the acute phase versus 87 and 71% in the delayed phase. Most of the patients could ingest food throughout the entire period after chemotherapy. Assessment of various risk factors for acute and delayed CINV (gender, age, prior vomiting due to antineoplastic therapy, prior experience of motion sickness, and history of drinking) revealed no significant influence of these factors on the CR rate for the entire period in patients receiving either carboplatin-based or cisplatin-based chemotherapy. The present triple therapy can be recommended for supporting both carboplatin-based and cisplatin-based chemotherapy regimens.

KERMA-based radiation dose management system for real-time patient dose measurement

Science.gov (United States)

Kim, Kyo-Tae; Heo, Ye-Ji; Oh, Kyung-Min; Nam, Sang-Hee; Kang, Sang-Sik; Park, Ji-Koon; Song, Yong-Keun; Park, Sung-Kwang

2016-07-01

Because systems that reduce radiation exposure during diagnostic procedures must be developed, significant time and financial resources have been invested in constructing radiation dose management systems. In the present study, the characteristics of an existing ionization-based system were compared to those of a system based on the kinetic energy released per unit mass (KERMA). Furthermore, the feasibility of using the KERMA-based system for patient radiation dose management was verified. The ionization-based system corrected the effects resulting from radiation parameter perturbations in general radiography whereas the KERMA-based system did not. Because of this difference, the KERMA-based radiation dose management system might overestimate the patient's radiation dose due to changes in the radiation conditions. Therefore, if a correction factor describing the correlation between the systems is applied to resolve this issue, then a radiation dose management system can be developed that will enable real-time measurement of the patient's radiation exposure and acquisition of diagnostic images.

Identification of a New Antimicrobial Resistance Gene Provides Fresh Insights Into Pleuromutilin Resistance in Brachyspira hyodysenteriae, Aetiological Agent of Swine Dysentery

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Roderick M. Card

2018-06-01

Full Text Available Brachyspira hyodysenteriae is the aetiological agent of swine dysentery, a globally distributed disease that causes profound economic loss, impedes the free trade and movement of animals, and has significant impact on pig health. Infection is generally treated with antibiotics of which pleuromutilins, such as tiamulin, are widely used for this purpose, but reports of resistance worldwide threaten continued effective control. In Brachyspira hyodysenteriae pleuromutilin resistance has been associated with mutations in chromosomal genes encoding ribosome-associated functions, however the dynamics of resistance acquisition are poorly understood, compromising stewardship efforts to preserve pleuromutilin effectiveness. In this study we undertook whole genome sequencing (WGS and phenotypic susceptibility testing of 34 UK field isolates and 3 control strains to investigate pleuromutilin resistance in Brachyspira hyodysenteriae. Genome-wide association studies identified a new pleuromutilin resistance gene, tva(A (tiamulin valnemulin antibiotic resistance, encoding a predicted ABC-F transporter. In vitro culture of isolates in the presence of inhibitory or sub-inhibitory concentrations of tiamulin showed that tva(A confers reduced pleuromutilin susceptibility that does not lead to clinical resistance but facilitates the development of higher-level resistance via mutations in genes encoding ribosome-associated functions. Genome sequencing of antibiotic-exposed isolates identified both new and previously described mutations in chromosomal genes associated with reduced pleuromutilin susceptibility, including the 23S rRNA gene and rplC, which encodes the L3 ribosomal protein. Interesting three antibiotic-exposed isolates harboured mutations in fusA, encoding Elongation Factor G, a gene not previously associated with pleuromutilin resistance. A longitudinal molecular epidemiological examination of two episodes of swine dysentery at the same farm indicated

Alternative prosthodontic-based treatment of a patient with hypocalcified type Amelogenesis Imperfecta.

Science.gov (United States)

Jivanescu, Anca; Miglionico, Antonio; Barua, Souman; Hategan, Simona Ioana

2017-07-01

The Amelogenesis Imperfecta is associated with malocclusion and usually requires an interdisciplinary treatment. Due to the patient's refusal of orthodontic treatment, prosthodontics-based treatments alternative was considered and planned. The patient was treated with zirconia-based fixed partial dentures, which resulted in improved occlusion, better oral health, and improved esthetic appearance.

Nomogram-based Prediction of Overall Survival in Patients with Metastatic Urothelial Carcinoma Receiving First-line Platinum-based Chemotherapy

DEFF Research Database (Denmark)

Necchi, Andrea; Sonpavde, Guru; Lo Vullo, Salvatore

2017-01-01

BACKGROUND: The available prognostic models for overall survival (OS) in patients with metastatic urothelial carcinoma (UC) have been derived from clinical trial populations of cisplatin-treated patients. OBJECTIVE: To develop a new model based on real-world patients. DESIGN, SETTING, AND PARTICI...

Marquez Uranium Project, McKinley County, New Mexico: draft environmental impact statement

International Nuclear Information System (INIS)

Anon.

1983-01-01

Development and operation of an underground mine to remove uranium deposits from the Canon de Marquez in McKinley County, New Mexico is proposed by the Tennessee Valley Authority (TVA). Uranium mined from the area would be used by TVA to supply fuel for its nuclear plants, ensuring a continued supply of inexpensive electricity and a source of employment for the population of the TVA's region. In addition, the mine would employ 55 to 120 persons and generate $21.1 million in state and local taxes during its lifetime. Construction and operation of mine facilities would alter land uses on 120 acres of wildlife habitat, alter the topography of the area in the vicinity of the proposed pond and rock pile sites, depress groundwater levels in the Westwater Canyon Member of the Morrison Formation in the vicinity of the mine, degrade groundwater and air quality in the vicinity of the mine, decrease plant and animal species at the site, degrade water quality in creeks downstream of the mine, and increase ambient noise levels. All negative impacts would be confined to the life of the mine, since reclamation activities would return the mine area to premining conditions

A Cloud Computing Based Patient Centric Medical Information System

Science.gov (United States)

Agarwal, Ankur; Henehan, Nathan; Somashekarappa, Vivek; Pandya, A. S.; Kalva, Hari; Furht, Borko

This chapter discusses an emerging concept of a cloud computing based Patient Centric Medical Information System framework that will allow various authorized users to securely access patient records from various Care Delivery Organizations (CDOs) such as hospitals, urgent care centers, doctors, laboratories, imaging centers among others, from any location. Such a system must seamlessly integrate all patient records including images such as CT-SCANS and MRI'S which can easily be accessed from any location and reviewed by any authorized user. In such a scenario the storage and transmission of medical records will have be conducted in a totally secure and safe environment with a very high standard of data integrity, protecting patient privacy and complying with all Health Insurance Portability and Accountability Act (HIPAA) regulations.

ŽENSKO PODJETNIŠTVO V SLOVENIJI

OpenAIRE

Zver, Doroteja

2015-01-01

Namen diplomskega seminarja je bil preučiti, kakšne so značilnosti podjetništva v Sloveniji, ter ugotoviti, s kakšnimi ovirami se srečujejo ženske pri vključevanju v podjetništvo. Prav tako nas je zanimala vloga žensk na vodilnih položajih. V teoretičnem delu smo se najprej seznanili s tem, kaj sploh je podjetništvo in navedli nekaj definicij različnih avtorjev, prav tako smo opredelili tudi pojem žensko podjetništvo in raziskali, kakšne so značilnosti ženskega podjetništva v Sloveniji, pr...

Clinical responses in patients with advanced colorectal cancer to a dendritic cell based vaccine

DEFF Research Database (Denmark)

Burgdorf, Stefan K; Fischer, Anders; Myschetzky, Peter S

2008-01-01

Patients with disseminated colorectal cancer have a poor prognosis. Preliminary studies have shown encouraging results from vaccines based on dendritic cells. The aim of this phase II study was to evaluate the effect of treating patients with advanced colorectal cancer with a cancer vaccine based...... with this DC-based cancer vaccine was safe and non-toxic. Stable disease was found in 24% (4/17) of the patients. The quality of life remained for most categories high and stable throughout the study period.......Patients with disseminated colorectal cancer have a poor prognosis. Preliminary studies have shown encouraging results from vaccines based on dendritic cells. The aim of this phase II study was to evaluate the effect of treating patients with advanced colorectal cancer with a cancer vaccine based......-testis antigens. Vaccines were biweekly administered intradermally with a total of 10 vaccines per patient. CT scans were performed and responses were graded according to the RECIST criteria. Quality of life was monitored with the SF-36 questionnaire. Toxicity and adverse events were graded according...

Classifying Normal and Abnormal Status Based on Video Recordings of Epileptic Patients

Directory of Open Access Journals (Sweden)

Jing Li

2014-01-01

Full Text Available Based on video recordings of the movement of the patients with epilepsy, this paper proposed a human action recognition scheme to detect distinct motion patterns and to distinguish the normal status from the abnormal status of epileptic patients. The scheme first extracts local features and holistic features, which are complementary to each other. Afterwards, a support vector machine is applied to classification. Based on the experimental results, this scheme obtains a satisfactory classification result and provides a fundamental analysis towards the human-robot interaction with socially assistive robots in caring the patients with epilepsy (or other patients with brain disorders in order to protect them from injury.

Purine Bases in Blood Plasma of Patients with Chronic Pulmonary Diseases

Directory of Open Access Journals (Sweden)

Larissa E. Muravluyova

2012-09-01

Full Text Available The article is focused on the study of purine bases and intermediates of purine catabolism in plasma of patients with chronic obstructive bronchitis and idiopathic interstitial pneumonia. Decrease of adenine and hypoxantine in plasma of patients with idiopathic interstitial pneumonia was registered. Increase of guanine in plasma of patients with chronic obstructive pulmonary disease was established.

Single-centre experience with Renal PatientView, a web-based system that provides patients with access to their laboratory results.

Science.gov (United States)

Woywodt, Alexander; Vythelingum, Kervina; Rayner, Scott; Anderton, John; Ahmed, Aimun

2014-10-01

Renal PatientView (RPV) is a novel, web-based system in the UK that provides patients with access to their laboratory results, in conjunction with patient information. To study how renal patients within our centre access and use RPV. We sent out questionnaires in December 2011 to all 651 RPV users under our care. We collected information on aspects such as the frequency and timing of RPV usage, the parameters viewed by users, and the impact of RPV on their care. A total of 295 (45 %) questionnaires were returned. The predominant users of RPV were transplant patients (42 %) followed by pre-dialysis chronic kidney disease patients (37 %). Forty-two percent of RPV users accessed their results after their clinic appointments, 38 % prior to visiting the clinic. The majority of patients (76 %) had used the system to discuss treatment with their renal physician, while 20 % of patients gave permission to other members of their family to use RPV to monitor results on their behalf. Most users (78 %) reported accessing RPV on average 1-5 times/month. Most patients used RPV to monitor their kidney function, 81 % to check creatinine levels, 57 % to check potassium results. Ninety-two percent of patients found RPV easy to use and 93 % felt that overall the system helps them in taking care of their condition; 53 % of patients reported high satisfaction with RPV. Our results provide interesting insight into use of a system that gives patients web-based access to laboratory results. The fact that 20 % of patients delegate access to relatives also warrants further study. We propose that online access to laboratory results should be offered to all renal patients, although clinicians need to be mindful of the 'digital divide', i.e. part of the population that is not amenable to IT-based strategies for patient empowerment.

Patient outcomes in simulation-based medical education: a systematic review.

Science.gov (United States)

Zendejas, Benjamin; Brydges, Ryan; Wang, Amy T; Cook, David A

2013-08-01

Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction. Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78). Focused field in education; high inconsistency (I(2) > 50 % in most analyses). Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical

Efficacy of peg-interferon based treatment in patients with hepatitis C refractory to previous conventional interferon-based treatment

International Nuclear Information System (INIS)

Shaikh, S.; Devrajani, B.R.; Kalhoro, M.

2012-01-01

Objective: To determine the efficacy of peg-interferon-based therapy in patients refractory to previous conventional interferon-based treatment and factors predicting sustained viral response (SVR). Study Design: Analytical study. Place and Duration of Study: Medical Unit IV, Liaquat University Hospital, Jamshoro, from July 2009 to June 2011. Methodology: This study included consecutive patients of hepatitis C who were previously treated with conventional interferon-based treatment for 6 months but were either non-responders, relapsed or had virologic breakthrough and stage = 2 with fibrosis on liver biopsy. All eligible patients were provided peg-interferon at the dosage of 180 mu g weekly with ribavirin thrice a day for 6 months. Sustained Viral Response (SVR) was defined as absence of HCV RNA at twenty four week after treatment. All data was processed on SPSS version 16. Results: Out of 450 patients enrolled in the study, 192 were excluded from the study on the basis of minimal fibrosis (stage 0 and 1). Two hundred and fifty eight patients fulfilled the inclusion criteria and 247 completed the course of peg-interferon treatment. One hundred and sixty one (62.4%) were males and 97 (37.6%) were females. The mean age was 39.9 +- 6.1 years, haemoglobin was 11.49 +- 2.45 g/dl, platelet count was 127.2 +- 50.6 10/sup 3/ /mm/sup 3/, ALT was 99 +- 65 IU/L. SVR was achieved in 84 (32.6%). The strong association was found between SVR and the pattern of response (p = 0. 001), degree of fibrosis and early viral response (p = 0.001). Conclusion: Peg-interferon based treatment is an effective and safe treatment option for patients refractory to conventional interferon-based treatment. (author)

Development of Evidence-Based Disease Education Literature for Pakistani Rheumatoid Arthritis Patients

Directory of Open Access Journals (Sweden)

Atta Abbas Naqvi

2017-11-01

Full Text Available Rheumatoid arthritis affects 0.5% to 1% of the population globally and is one of the most common causes of disability. Patient education plays a key role in improving treatment outcomes. The purpose of this study was to discuss the process involved in designing an evidence-based disease education literature for rheumatoid arthritis patients of Pakistan in Urdu language with culturally relevant illustrations. A study was conducted to develop disease education literature using Delphi consensus, content validity, and patient feedback. A panel of experts comprised of university professors and health care experts, including health practitioners and pharmacists as well as a social scientist, was set up to assess the need. Eight patients were randomly selected and were asked to give their feedback. Their feedback was incorporated in the development process. The entire process was carried out in eight steps. A disease education literature for patients of rheumatoid arthritis was developed and edited in the form of a booklet. The booklet contained evidence-based information that must be provided to patients in both Urdu and English languages with culturally relevant illustrations. The availability of such literature is significant, as it enables the patients to seek knowledge at home at their convenience. This home-based knowledge support is as helpful as any other means of medical care. The developed literature is planned to be used in further studies which will evaluate its impact in improving knowledge of RA patients.

The digital divide in Internet-based patient education materials.

Science.gov (United States)

Sun, Gordon H

2012-11-01

The ubiquity of the Internet has led to the widespread availability of health-related information to the public, and the subsequent empowerment of patients has fundamentally altered the patient-physician relationship. Among several concerns of physicians is the possibility that patients may be misinformed by information obtained from the Internet. One opportunity for health care providers to address this problem exists within Internet-based patient education materials (IPEMs). According to recent research in Otolaryngology-Head and Neck Surgery, IPEMs found within professional otolaryngology websites are written at the 8th- to 18th-grade reading comprehension level, essentially unchanged over the past 3 years. This greatly exceeds the fourth- to sixth-grade reading level recommended by the National Institutes of Health. Benefits, strategies, and challenges to improving the readability of IPEMs are discussed.

A Secure ECC-based RFID Mutual Authentication Protocol to Enhance Patient Medication Safety.

Science.gov (United States)

Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Li, Fagen

2016-01-01

Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems.

Addressing Dual Patient and Staff Safety Through A Team-Based Standardized Patient Simulation for Agitation Management in the Emergency Department.

Science.gov (United States)

Wong, Ambrose H; Auerbach, Marc A; Ruppel, Halley; Crispino, Lauren J; Rosenberg, Alana; Iennaco, Joanne D; Vaca, Federico E

2018-06-01

Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management. We used a mixed-methods approach with emergency medicine resident and attending physicians, Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs), ED nurses, technicians, and security officers at two hospital sites. After a simulated agitated patient encounter, we conducted uniprofessional and interprofessional focus groups. We undertook structured thematic analysis using a grounded theory approach. Quantitative data consisted of responses to the KidSIM Questionnaire addressing teamwork and simulation-based learning attitudes before and after each session. We reached data saturation with 57 participants. KidSIM scores revealed significant improvements in attitudes toward relevance of simulation, opportunities for interprofessional education, and situation awareness, as well as four of six questions for roles/responsibilities. Two broad themes emerged from the focus groups: (1) a team-based agitated patient simulation addressed dual safety of staff and patients simultaneously and (2) the experience fostered interprofessional discovery and cooperation in agitation management. A team-based simulated agitated patient encounter highlighted the need to consider the dual safety of staff and patients while facilitating interprofessional dialog and learning. Our findings suggest that simulation may be effective to enhance teamwork in

Design and development of an impedimetric-based system for the remote monitoring of home-based dialysis patients.

Science.gov (United States)

Montalibet, Amalric; Arkouche, Walid; Bogónez Franco, Paco; Bonnet, Stéphane; Clarion, Antoine; Delhomme, Georges; Géhin, Claudine; Gharbi, Sadok; Guillemaud, Régis; Jallon, Pierre; Massot, Bertrand; Pham, Pascale; Ribbe-Cornet, Eva; McAdams, Eric

2016-01-01

A key clinical challenge is to determine the desired 'dry weight' of a patient in order to terminate the dialysis procedure at the optimal moment and thus avoid the effects of over- and under-hydration. It has been found that the effects of haemodialysis on patients can be conveniently monitored using whole-body bioimpedance measurements. The identified need of assessing the hydrational status of patients undergoing haemodialysis at home gave rise to the present Dialydom (DIALYse à DOMicile) project. The aim of the project is to develop a convenient miniaturised impedance monitoring device for localised measurements (on the calf) in order to estimate an impedimetric hydrational index of the home-based patient, and to transmit this and other parameters to a remote clinical site. Many challenges must be overcome to develop a robust and valid home-based device. Some of these are presented in the paper.

What constitutes evidence-based patient information? Overview of discussed criteria.

Science.gov (United States)

Bunge, Martina; Mühlhauser, Ingrid; Steckelberg, Anke

2010-03-01

To survey quality criteria for evidence-based patient information (EBPI) and to compile the evidence for the identified criteria. Databases PubMed, Cochrane Library, PsycINFO, PSYNDEX and Education Research Information Center (ERIC) were searched to update the pool of criteria for EBPI. A subsequent search aimed to identify evidence for each criterion. Only studies on health issues with cognitive outcome measures were included. Evidence for each criterion is presented using descriptive methods. 3 systematic reviews, 24 randomized-controlled studies and 1 non-systematic review were included. Presentation of numerical data, verbal presentation of risks and diagrams, graphics and charts are based on good evidence. Content of information and meta-information, loss- and gain-framing and patient-oriented outcome measures are based on ethical guidelines. There is a lack of studies on quality of evidence, pictures and drawings, patient narratives, cultural aspects, layout, language and development process. The results of this review allow specification of EBPI and may help to advance the discourse among related disciplines. Research gaps are highlighted. Findings outline the type and extent of content of EBPI, guide the presentation of information and describe the development process. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

THE CONCEPTUAL DESIGN ASSESSMENT FOR THE CO-FIRING OF BIO-REFINERY SUPPLIED LIGNIN PROJECT

International Nuclear Information System (INIS)

Ted Berglund; Jeffrey T. Ranney; Carol L. Babb; Jacqueline G. Broder

2001-01-01

The major aspects of this project are proceeding toward completion. Prior to this quarter, design criteria, tentative site selection, facility layout, and preliminary facility cost estimates were completed and issued. Processing of bio-solids was completed, providing material for the pilot operations. Pilot facility design, equipment selection, and modification were completed during the fourth quarter of 2000. Initial pilot facility shakedown was completed during the fourth quarter. After some unavoidable delays, a suitable representative supply of MSW feed material was procured. During this first quarter of 2001, shredding of the feed material and final feed conditioning were completed. Pilot facility hydrolysis production was completed to produce lignin for co-fire testing. During this quarter, TVA completed the washing and dewatering of the lignin material produced from the MSW hydrolysis. Seven drums of lignin material were washed to recover the acid and sugar from the lignin and provide an improved fuel for steam generation. Samples of both the lignin and bio-solids fuel materials for co-fire testing were sent to the co-fire facility (EERC) for evaluation. After sample evaluation, EERC approved sending the material and all of the necessary fuel for testing was shipped to EERC. EERC has requested and will receive coal typical of the fuel to the TVA-Colbert boilers. This material will be used at EERC as baseline material and for mixing with the bio-fuel for combustion testing. EERC combustion testing of the bio based fuels is scheduled to begin in August of 2001. The TVA-Colbert facility has neared completion of the task to evaluate the co-location of the Masada facility on the operation of the power generation facility. The TVA-Colbert fossil plant is fully capable of providing a reliable steam supply. The preferred steam supply connection points and steam pipeline routing have been identified. The environmental review of the pipeline routing has been completed

Toward a patient-based paradigm for blood transfusion

Directory of Open Access Journals (Sweden)

Farrugia A

2014-01-01

Full Text Available Albert Farrugia,1,2 Eleftherios Vamvakas31College of Medicine, Biology and Environment, Australian National University, Acton, ACT, Australia; 2Centre for Orthopaedic Research, Department of Surgery, Faculty of Medicine and Surgery, University of Western Australia, Perth, WA, Australia; 3Cedars-Sinai Medical Center, Los Angeles, CA, USAAbstract: The current "manufacturing paradigm" of transfusion practice has detached transfusion from the clinical environment. As an example, fresh whole blood in large-volume hemorrhage may be superior to whole blood reconstituted from multiple components. Multicomponent apheresis can overcome logistical difficulties in matching patient needs with fresh component availability and can deliver the benefits of fresh whole blood. Because of the different transfusion needs of patients in emerging economies and the vulnerability of these blood systems to emerging infections, fresh whole blood and multicomponent apheresis can better meet patient needs when compared with transplants of the "manufacturing paradigm". We propose that patient blood management, along with panels of repeat, paid, accredited apheresis and fresh whole-blood donors can be used in emerging economies to support decentralized blood services. This alternative transfusion–medicine paradigm could eventually also be adopted by established economies to focus transfusion medicine on local patient needs and to alleviate the problem of the aging volunteer donor base.Keywords: indications, emerging countries, patient blood management

Operation of a P300-based brain-computer interface by patients with spinocerebellar ataxia

Directory of Open Access Journals (Sweden)

Yoji Okahara

Full Text Available Objective: We investigated the efficacy of a P300-based brain-computer interface (BCI for patients with spinocerebellar ataxia (SCA, which is often accompanied by cerebellar impairment. Methods: Eight patients with SCA and eight age- and gender-matched healthy controls were instructed to input Japanese hiragana characters using the P300-based BCI with green/blue flicker. All patients depended on some assistance in their daily lives (modified Rankin scale: mean 3.5. The chief symptom was cerebellar ataxia; no cognitive deterioration was present. A region-based, two-step P300-based BCI was used. During the P300 task, eight-channel EEG data were recorded, and a linear discriminant analysis distinguished the target from other nontarget regions of the matrix. Results: The mean online accuracy in BCI operation was 82.9% for patients with SCA and 83.2% for controls; no significant difference was detected. Conclusion: The P300-based BCI was operated successfully not only by healthy controls but also by individuals with SCA. Significance: These results suggest that the P300-based BCI may be applicable for patients with SCA. Keywords: BCI, BMI, P300, Visual stimuli, Spinocerebellar ataxia

Using a knowledge-based planning solution to select patients for proton therapy.

Science.gov (United States)

Delaney, Alexander R; Dahele, Max; Tol, Jim P; Kuijper, Ingrid T; Slotman, Ben J; Verbakel, Wilko F A R

2017-08-01

Patient selection for proton therapy by comparing proton/photon treatment plans is time-consuming and prone to bias. RapidPlan™, a knowledge-based-planning solution, uses plan-libraries to model and predict organ-at-risk (OAR) dose-volume-histograms (DVHs). We investigated whether RapidPlan, utilizing an algorithm based only on photon beam characteristics, could generate proton DVH-predictions and whether these could correctly identify patients for proton therapy. Model PROT and Model PHOT comprised 30 head-and-neck cancer proton and photon plans, respectively. Proton and photon knowledge-based-plans (KBPs) were made for ten evaluation-patients. DVH-prediction accuracy was analyzed by comparing predicted-vs-achieved mean OAR doses. KBPs and manual plans were compared using salivary gland and swallowing muscle mean doses. For illustration, patients were selected for protons if predicted Model PHOT mean dose minus predicted Model PROT mean dose (ΔPrediction) for combined OARs was ≥6Gy, and benchmarked using achieved KBP doses. Achieved and predicted Model PROT /Model PHOT mean dose R 2 was 0.95/0.98. Generally, achieved mean dose for Model PHOT /Model PROT KBPs was respectively lower/higher than predicted. Comparing Model PROT /Model PHOT KBPs with manual plans, salivary and swallowing mean doses increased/decreased by <2Gy, on average. ΔPrediction≥6Gy correctly selected 4 of 5 patients for protons. Knowledge-based DVH-predictions can provide efficient, patient-specific selection for protons. A proton-specific RapidPlan-solution could improve results. Copyright © 2017 Elsevier B.V. All rights reserved.

Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials

Science.gov (United States)

Wen, Jin; Schulman, Kevin A.

2014-01-01

Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed. PMID:25014674

Distinctive Correspondence Between Separable Visual Attention Functions and Intrinsic Brain Networks.

Science.gov (United States)

Ruiz-Rizzo, Adriana L; Neitzel, Julia; Müller, Hermann J; Sorg, Christian; Finke, Kathrin

2018-01-01

Separable visual attention functions are assumed to rely on distinct but interacting neural mechanisms. Bundesen's "theory of visual attention" (TVA) allows the mathematical estimation of independent parameters that characterize individuals' visual attentional capacity (i.e., visual processing speed and visual short-term memory storage capacity) and selectivity functions (i.e., top-down control and spatial laterality). However, it is unclear whether these parameters distinctively map onto different brain networks obtained from intrinsic functional connectivity, which organizes slowly fluctuating ongoing brain activity. In our study, 31 demographically homogeneous healthy young participants performed whole- and partial-report tasks and underwent resting-state functional magnetic resonance imaging (rs-fMRI). Report accuracy was modeled using TVA to estimate, individually, the four TVA parameters. Networks encompassing cortical areas relevant for visual attention were derived from independent component analysis of rs-fMRI data: visual, executive control, right and left frontoparietal, and ventral and dorsal attention networks. Two TVA parameters were mapped on particular functional networks. First, participants with higher (vs. lower) visual processing speed showed lower functional connectivity within the ventral attention network. Second, participants with more (vs. less) efficient top-down control showed higher functional connectivity within the dorsal attention network and lower functional connectivity within the visual network. Additionally, higher performance was associated with higher functional connectivity between networks: specifically, between the ventral attention and right frontoparietal networks for visual processing speed, and between the visual and executive control networks for top-down control. The higher inter-network functional connectivity was related to lower intra-network connectivity. These results demonstrate that separable visual attention

Final environmental impact statement. Marquez uranium mine

International Nuclear Information System (INIS)

1984-01-01

As one of many activities TVA has undertaken to ensure an adequate supply of uranium for these plants, TVA has proposed to underground mine, through its operator, the uranium deposits located in the Canon de Marquez in McKinley County, New Mexico. Construction and operation of the underground mine would be expected to have the following environmental effects: (a) a temporary change in land use for 48.5 hectares from wildlife habitat and recreation to mineral extraction; (b) a minor alteration in topography near the proposed pond sites due to reclamation of waste rock piles; (c) minimal impacts on land due to limited vehicular traffic and road construction; (d) temporary depression of ground water levels in the Westwater Canyon Member of the Morrison Formation in the mine vicinity during mine life; (e) short-term project-induced impacts to surface water and shallow ground water quality; (f) a temporary decrease in air quality in the vicinity of the mining operations due to fugitive dust and exhaust emissions from combustion-driven mining and support vehicles and releases of radon and short-lived radon progeny from ventilation shafts and ore piles; (g) a temporary decrease of plant and animal species at the mine site; (h) a minor and temporary effect on aquatic systems downstream from the mine and settling ponds due to sedimentation; and (i) a minor increase of noise levels in the immediate vicinity of mine shafts and vents. The no action alternative and alternatives for securing uranium ore by other methods were considered but were found insufficient to meet TVA objectives. None of the alternatives explored were environmentally preferable. TVA also evaluated site specific alternatives including the following: different shaft and support building siting, mining techniques, and reclamation options. 25 figures, 20 tables

Distinctive Correspondence Between Separable Visual Attention Functions and Intrinsic Brain Networks

Science.gov (United States)

Ruiz-Rizzo, Adriana L.; Neitzel, Julia; Müller, Hermann J.; Sorg, Christian; Finke, Kathrin

2018-01-01

Separable visual attention functions are assumed to rely on distinct but interacting neural mechanisms. Bundesen's “theory of visual attention” (TVA) allows the mathematical estimation of independent parameters that characterize individuals' visual attentional capacity (i.e., visual processing speed and visual short-term memory storage capacity) and selectivity functions (i.e., top-down control and spatial laterality). However, it is unclear whether these parameters distinctively map onto different brain networks obtained from intrinsic functional connectivity, which organizes slowly fluctuating ongoing brain activity. In our study, 31 demographically homogeneous healthy young participants performed whole- and partial-report tasks and underwent resting-state functional magnetic resonance imaging (rs-fMRI). Report accuracy was modeled using TVA to estimate, individually, the four TVA parameters. Networks encompassing cortical areas relevant for visual attention were derived from independent component analysis of rs-fMRI data: visual, executive control, right and left frontoparietal, and ventral and dorsal attention networks. Two TVA parameters were mapped on particular functional networks. First, participants with higher (vs. lower) visual processing speed showed lower functional connectivity within the ventral attention network. Second, participants with more (vs. less) efficient top-down control showed higher functional connectivity within the dorsal attention network and lower functional connectivity within the visual network. Additionally, higher performance was associated with higher functional connectivity between networks: specifically, between the ventral attention and right frontoparietal networks for visual processing speed, and between the visual and executive control networks for top-down control. The higher inter-network functional connectivity was related to lower intra-network connectivity. These results demonstrate that separable visual attention

Distinctive Correspondence Between Separable Visual Attention Functions and Intrinsic Brain Networks

Directory of Open Access Journals (Sweden)

Adriana L. Ruiz-Rizzo

2018-03-01

Full Text Available Separable visual attention functions are assumed to rely on distinct but interacting neural mechanisms. Bundesen's “theory of visual attention” (TVA allows the mathematical estimation of independent parameters that characterize individuals' visual attentional capacity (i.e., visual processing speed and visual short-term memory storage capacity and selectivity functions (i.e., top-down control and spatial laterality. However, it is unclear whether these parameters distinctively map onto different brain networks obtained from intrinsic functional connectivity, which organizes slowly fluctuating ongoing brain activity. In our study, 31 demographically homogeneous healthy young participants performed whole- and partial-report tasks and underwent resting-state functional magnetic resonance imaging (rs-fMRI. Report accuracy was modeled using TVA to estimate, individually, the four TVA parameters. Networks encompassing cortical areas relevant for visual attention were derived from independent component analysis of rs-fMRI data: visual, executive control, right and left frontoparietal, and ventral and dorsal attention networks. Two TVA parameters were mapped on particular functional networks. First, participants with higher (vs. lower visual processing speed showed lower functional connectivity within the ventral attention network. Second, participants with more (vs. less efficient top-down control showed higher functional connectivity within the dorsal attention network and lower functional connectivity within the visual network. Additionally, higher performance was associated with higher functional connectivity between networks: specifically, between the ventral attention and right frontoparietal networks for visual processing speed, and between the visual and executive control networks for top-down control. The higher inter-network functional connectivity was related to lower intra-network connectivity. These results demonstrate that separable

Deficits of spatial and task-related attentional selection in mild cognitive impairment and Alzheimer's disease.

Science.gov (United States)

Redel, P; Bublak, P; Sorg, C; Kurz, A; Förstl, H; Müller, H J; Schneider, W X; Perneczky, R; Finke, K

2012-01-01

Visual selective attention was assessed with a partial-report task in patients with probable Alzheimer's disease (AD), amnestic mild cognitive impairment (MCI), and healthy elderly controls. Based on Bundesen's "theory of visual attention" (TVA), two parameters were derived: top-down control of attentional selection, representing task-related attentional weighting for prioritizing relevant visual objects, and spatial distribution of attentional weights across the left and the right hemifield. Compared with controls, MCI patients showed significantly reduced top-down controlled selection, which was further deteriorated in AD subjects. Moreover, attentional weighting was significantly unbalanced across hemifields in MCI and tended to be more lateralized in AD. Across MCI and AD patients, carriers of the apolipoprotein E ε4 allele (ApoE4) displayed a leftward spatial bias, which was the more pronounced the younger the ApoE4-positive patients and the earlier disease onset. These results indicate that impaired top-down control may be linked to early dysfunction of fronto-parietal networks. An early temporo-parietal interhemispheric asymmetry might cause a pathological spatial bias which is associated with ApoE4 genotype and may therefore function as early cognitive marker of upcoming AD. Copyright © 2012 Elsevier Inc. All rights reserved.

Power Service Shops

Data.gov (United States)

Federal Laboratory Consortium — TVA's Power Service Shops provides expert repair and maintenance of power system components and large industrial equipment. With world-class maintenance facilities...

Central Laboratories Services

Data.gov (United States)

Federal Laboratory Consortium — The TVA Central Laboratories Services is a comprehensive technical support center, offering you a complete range of scientific, engineering, and technical services....

iPad-based patient briefing for radiological examinations-a clinical trial.

Science.gov (United States)

Schlechtweg, Philipp M; Hammon, Matthias; Giese, David; Heberlein, Christian; Uder, Michael; Schwab, Siegfried A

2014-08-01

To analyze if an iPad-based patient briefing can serve as a digital alternative to conventional documentations prior to radiological examinations. One hundred one patients referred for routine MRI were randomized into two groups, who underwent iPad-based and classic written briefing in opposite order. For each briefing completion time, completeness and correctness were noted. Patient's knowledge about the content of either briefing modality was subsequently tested. The influence of patient-related factors on the performance of the electronic briefing (EB) was analyzed. Finally, the patient's subjective impression of the EB was assessed. The mean durations were 4.4 ± 2.2 min for EB and 1.7 ± 1.3 min for the classic briefing (p iPad briefings were returned entirely filled out, whereas 11 % of the classic forms were returned with missing data. No significant differences in memorization of the briefing's information were objectified. There was a positive correlation between the duration of EB and age (r = 0.53; p iPads transfers the information for the patients equally well compared to the classic written approach. Although iPad briefing took patients longer to perform, the majority would prefer it to written consent briefings in the future. Nevertheless, measures have to be undertaken to improve the overall acceptance and performance.

An evidence-based patient-centered method makes the biopsychosocial model scientific.

Science.gov (United States)

Smith, Robert C; Fortin, Auguste H; Dwamena, Francesca; Frankel, Richard M

2013-06-01

To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. Engel's BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Poslanje Crkve u pluralizmu - »preobražavajuće prihvaćanje«

OpenAIRE

RAGUŽ, Ivica

2003-01-01

Članak namjerava predočiti osnovni teološki pristup pluralizmu i pluralističkome društvu. U prvome će se dijelu pružiti osnovna obilježja pluralizma i pluralističke misli u novovjekovlju. Pri tomu će doći do izražaja da je pluralizam postao osnovni pojam kojim teologija tumači današnju situaciju društva i čovjeka. U drugome dijelu autor će prikazati promijenjeno stanje odnosa između Crkve i društva u pluralizmu. Navest će se ujedno osobine te nove situacije za Crkvu i kršćane. U trećemu odlom...

Safety evaluation report on Tennessee Valley Authority: Browns Ferry nuclear performance plan

International Nuclear Information System (INIS)

1989-10-01

This safety evaluation report (SER) on the information submitted by the Tennessee Valley Authority (TVA) in its Nuclear Performance Plan, through Revision 2, for the Browns Ferry Nuclear Plant and in supporting documents has been prepared by the US Nuclear Regulatory commission staff. The Browns Ferry Nuclear Plant consists of three boiling-water reactors at a site in Limestone County, Alabama. The plan addresses the plant-specific concerns requiring resolution before the startup of Unit 2. The staff will inspect implementation of those TVA programs that address these concerns. Where systems are common to Units 1 and 2 or to Units 2 and 3, the staff safety evaluations of those systems are included herein. 85 refs

Assessing the Costs and Benefits of Resilience Investments: Tennessee Valley Authority Case Study

Energy Technology Data Exchange (ETDEWEB)

Allen, Melissa R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wilbanks, Thomas J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Preston, Benjamin L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kao, Shih-Chieh [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Bradbury, James [U.S. Department of Energy (DOE), Office of Energy Policy and Systems Analysis (EPSA), Washington, DC (United States)

2017-01-01

This report describes a general approach for assessing climate change vulnerabilities of an electricity system and evaluating the costs and benefits of certain investments that would increase system resilience. It uses Tennessee Valley Authority (TVA) as a case study, concentrating on the Cumberland River basin area on the northern side of the TVA region. The study focuses in particular on evaluating risks associated with extreme heat wave and drought conditions that could be expected to affect the region by mid-century. Extreme climate event scenarios were developed using a combination of dynamically downscaled output from the Community Earth System Model and historical heat wave and drought conditions in 1993 and 2007, respectively.

Study of community leaders in a nuclear host community: local issues, expectations and support and opposition

International Nuclear Information System (INIS)

Bronfman, B.H.

1977-08-01

A study of community leaders was undertaken in Hartsville, Tennessee, site of the TVA Hartsville Nuclear Power Plant currently under construction. Leaders were found to be extremely supportive of the plant and of TVA's efforts to mitigate impacts expected to result from construction. Like their citizen counterparts, leaders expect economic benefits and some growth-related disruption to occur as a result of the plant, while environmental impacts are seen as extremely unlikely to occur. Plant-related issues, such as housing availability and traffic congestion, dominate leaders' thinking about current issues. These issues are expected to continue to be important in the future, and new issues dealing with growth and planning, employment and taxation are expected to arise

Developing an Anti-Xa-Based Anticoagulation Protocol for Patients with Percutaneous Ventricular Assist Devices.

Science.gov (United States)

Sieg, Adam; Mardis, B Andrew; Mardis, Caitlin R; Huber, Michelle R; New, James P; Meadows, Holly B; Cook, Jennifer L; Toole, J Matthew; Uber, Walter E

2015-01-01

Because of the complexities associated with anticoagulation in temporary percutaneous ventricular assist device (pVAD) recipients, a lack of standardization exists in their management. This retrospective analysis evaluates current anticoagulation practices at a single center with the aim of identifying an optimal anticoagulation strategy and protocol. Patients were divided into two cohorts based on pVAD implanted (CentriMag (Thoratec; Pleasanton, CA) / TandemHeart (CardiacAssist; Pittsburgh, PA) or Impella (Abiomed, Danvers, MA)), with each group individually analyzed for bleeding and thrombotic complications. Patients in the CentriMag/TandemHeart cohort were subdivided based on the anticoagulation monitoring strategy (activated partial thromboplastin time (aPTT) or antifactor Xa unfractionated heparin (anti-Xa) values). In the CentriMag/TandemHeart cohort, there were five patients with anticoagulation titrated based on anti-Xa values; one patient developed a device thrombosis and a major bleed, whereas another patient experienced major bleeding. Eight patients received an Impella pVAD. Seven total major bleeds in three patients and no thrombotic events were detected. Based on distinct differences between the devices, anti-Xa values, and outcomes, two protocols were created to guide anticoagulation adjustments. However, anticoagulation in patients who require pVAD support is complex with constantly evolving anticoagulation goals. The ideal level of anticoagulation should be individually determined using several coagulation laboratory parameters in concert with hemodynamic changes in the patient's clinical status, the device, and the device cannulation.

Exploring change in a group-based psychological intervention for multiple sclerosis patients.

Science.gov (United States)

Borghi, Martina; Bonino, Silvia; Graziano, Federica; Calandri, Emanuela

2018-07-01

The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients' adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness

Meta-analysis of cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data

DEFF Research Database (Denmark)

Gyöngyösi, Mariann; Wojakowski, Wojciech; Lemarchand, Patricia

2015-01-01

RATIONALE: The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. OBJECTIVE: We analyzed the safety and efficacy of intracoronary cell...... therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). METHODS AND RESULTS: The primary end point was freedom from combined major adverse.......1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. CONCLUSIONS: This meta-analysis of individual patient data from...

Problem based review: The patient taking methadone.

Science.gov (United States)

Arora, Alok; Williams, Karen

2013-01-01

Methadone maintenance treatment (MMT) is an effective therapy for opioid-dependence; its use is based on a harm reduction philosophy and represents one of a range of treatment approaches for opioid-dependent individuals. The medical literature supports MMT as a well established and cost-effective treatment for opioid-dependence that allows a return-to-normal physiological, psychological and societal functioning. The effectiveness of MMT is enhanced by psycho-social interventions such as contingency management and addressing other co-existing health and social needs. MMT saves lives and reduces violent and non-violent crime, drug use and the transmission of HIV, hepatitis C and other communicable diseases. For some people, MMT may continue for life, while others may eventually be able to discontinue and remain abstinent. Methadone interacts with numerous drugs and prolongs the corrected QT interval (QTc) with risk of sudden cardiac death. It has a prolonged half-life and premature discharge of patients after methadone overdose may be fatal. Each patient must be assessed, treated and monitored on an individual basis. Successful outcomes through MMT require knowledge, experience, vigilance, and diligence on the part of the physician, the patient and all of those involved in treatment.

Increased migraine risk in osteoporosis patients: a nationwide population-based study

OpenAIRE

Wu, Chieh-Hsin; Zhang, Zi-Hao; Wu, Ming-Kung; Wang, Chiu-Huan; Lu, Ying-Yi; Lin, Chih-Lung

2016-01-01

Background Osteoporosis and migraine are both important public health problems and may have overlapping pathophysiological mechanisms. The aim of this study was to use a Taiwanese population-based dataset to assess migraine risk in osteoporosis patients. Methods The Taiwan National Health Insurance Research Database was used to analyse data for 40,672 patients aged ?20?years who had been diagnosed with osteoporosis during 1996?2010. An additional 40,672 age-matched patients without osteoporos...

The Role of Patient-Reported Outcome Measures in Value-Based Payment Reform.

Science.gov (United States)

Squitieri, Lee; Bozic, Kevin J; Pusic, Andrea L

2017-06-01

The U.S. health care system is currently experiencing profound change. Pressure to improve the quality of patient care and control costs have caused a rapid shift from traditional volume-driven fee-for-service reimbursement to value-based payment models. Under the 2015 Medicare Access and Children's Health Insurance Program Reauthorization Act, providers will be evaluated on the basis of quality and cost efficiency and ultimately receive adjusted reimbursement as per their performance. Although current performance metrics do not incorporate patient-reported outcome measures (PROMs), many wonder whether and how PROMs will eventually fit into value-based payment reform. On November 17, 2016, the second annual Patient-Reported Outcomes in Healthcare Conference brought together international stakeholders across all health care disciplines to discuss the potential role of PROs in value-based health care reform. The purpose of this article was to summarize the findings from this conference in the context of recent literature and guidelines to inform implementation of PROs in value-based payment models. Recommendations for evaluating key perspectives and measurement goals are made to facilitate appropriate use of PROMs to best benefit and amplify the voice of our patients. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Availability of cosmetic treatment using novel cosmetics-based material on patients with craniofacial concavity.

Science.gov (United States)

Koyama, Shigeto; Kanetaka, Hiroyasu; Sagehashi, Yoshinori; Sasaki, Keiichi; Sato, Naoko

2018-03-08

Patients treated with maxillofacial prosthetics often experience emotional problems because of the remaining facial skin concavity such as a surgical scar. In such cases, cosmetic treatment can potentially correct their skin tone imperfections and deformities. This study aimed to evaluate the clinical availability of novel cosmetics-based material for craniofacial small concavity by initiating a cosmetic treatment in a preliminary case. Eighteen patients with aesthetic problems such as craniofacial deformities, small defects, and concavities on their faces underwent cosmetic treatment that was performed by makeup practitioners. Data were collected from the patient's charts and a survey questionnaire. A visual analog scale was used to conduct a survey regarding the satisfaction levels of the patients following cosmetic treatment with a novel cosmetics-based material. The cosmetic treatment was performed for a concavity on the left midface of a 67-year-old woman with partial maxillectomy. The novel cosmetics-based material was manufactured from a semi-translucent oil base. The satisfaction level of the patient increased after undergoing the cosmetic treatment. Regarding clinical applications, the novel cosmetics-based material can help reduce their cosmetic disturbance and restore the small deformity. These results suggest that the cosmetic treatment with the novel cosmetics-based material can be used as a subsidiary method for facial prostheses or an independent new method for correcting patients' small craniofacial concavity and for reducing visible deformity. Copyright © 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Web-based symptom screening in cystic fibrosis patients: A feasibility study.

Science.gov (United States)

Balzano, Julie; Fresenius, Ashley; Walker, Patricia; Berdella, Maria; Portenoy, Russell K; Bookbinder, Marilyn; Glajchen, Myra; Plachta, Amy; Langfelder-Schwind, Elinor; Chen, Jack; Dhingra, Lara

2016-01-01

Cystic fibrosis (CF) causes high illness burden. Screening may identify patients who could potentially benefit from interventions for symptoms or other sources of distress. We evaluated the feasibility of a web-based system for routine monitoring. Adult CF patients enrolled in a study of palliative care service delivery completed web-based assessments every 30 days on global distress, physical and psychological symptom distress, and the perceived benefits of discussing advance care planning (ACP) with CF clinicians. Feasibility was assessed by the rate of survey completion, survey reminders, and missed surveys during a 9-month rolling enrollment period. Of 74 participants (47.3% women, 94.4% white), 36.7% had comorbid diabetes, and 56.9% had an FEV1% predicted score of 40-69. In total, patients completed 456 (80.6%) of 566 surveys every 30 days over the assessment period. Sixty-five (87.8%) completed 405 (79.7%) of 508 surveys online and 9 (12.2%) completed 51 (88.0%) of 58 surveys using a combination of online, telephone, and mail-based methods. Many surveys were completed without reminders (online: 261 [64.4%] of 405; combined methods: 29 [56.9%] of 51), with 166 (36.4%) surveys requiring 1 or more reminders. Further, 23.0% (17) of patients noted elevated global distress; 20.3% (15) endorsed physical symptom distress, 12.2% (9) had psychological distress, and 58.1% (43) reported that discussing ACP would be beneficial. Repeated web-based screening for symptom distress and ACP preferences is feasible in adult CF patients. Future studies should assess the system's generalizability and staff resources when implementing reminders and non-web methods of completion. Copyright © 2015 European Cystic Fibrosis Society. All rights reserved.

Web-based versus face-to-face interprofessional team encounters with standardized patients.

Science.gov (United States)

Lempicki, Kelly A; Holland, Christine S

2018-03-01

Challenges exist in developing interprofessional education (IPE) activities including coordinating schedules and obtaining appropriate space for teams to work. Virtual worlds have been explored as a means to overcome some of these challenges. We sought to develop a web-based interprofessional team interaction with a standardized patient (SP), as compared to a face-to-face SP interaction, focusing on the competency area of interprofessional communication. Interprofessional teams of students were randomized to complete a web-based or face-to-face SP encounter. The web-based encounter was conducted via video conference that students accessed using their own electronic device. Interprofessional communication was evaluated by faculty observers and the SPs. Participants of the web-based encounter also completed a perceptions questionnaire. Interprofessional communication was rated as average/above average by the authors and SPs. Perceptions of the web-based encounter were mixed with not all students willing to complete such an encounter again despite finding it enjoyable and a positive learning experience. The need for adequate preparation was identified, including the opportunity to review the patient case before the encounter. The web-based SP encounter afforded students the opportunity to utilize communication technology to provide patient-centered care while collaborating as an interprofessional team. Video conferencing presents an opportunity to bypass some logistical challenges in scheduling IPE experiences and can be implemented as a co-curricular activity, avoiding course revisions. Additional studies are needed to further explore student and patient perspectives and clarify when, and with what level of trainees, the experiences are most valuable. Copyright © 2017 Elsevier Inc. All rights reserved.

A patient group based business planning model for a surgical specialty

NARCIS (Netherlands)

Adan, I.J.B.F.; Vissers, J.M.H.; van den Heuvel, M.N.; Wiersema, K.; Vissers, J.M.H.; Beech, R.

2005-01-01

In this contribution we present an approach for a business planning model for a surgical specialty, based on modelling of all patient processes as well as of the dynamics involved in planning and managing resources. An important basis of the model is the description of the processes of all patient

An evidence-based recommendation on bed head elevation for mechanically ventilated patients

OpenAIRE

Ni?l-Weise, Barbara S; Gastmeier, Petra; Kola, Axel; Vonberg, Ralf P; Wille, Jan C; van den Broek, Peterhans J

2011-01-01

Introduction A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based ...

Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

LENUS (Irish Health Repository)

Tan, T

2012-02-01

BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

Overview of autoventing turbine technology development project

International Nuclear Information System (INIS)

Waldrop, W.R.

1991-01-01

This paper reports on low concentrations of dissolved oxygen (DO) in the discharge of hydro plants which represents one of the most significant environmental concerns confronting the hydropower industry. This is especially of concern to utilities attempting to relicense older plants and to build new facilities. One method which shows promise is the autoventing turbine (AVT). The concept of an AVT involves air to be aspirated into the water as it passes through the turbine whenever concentrations of DO are less than desired. Because of this simple and natural process of aeration, the AVT promises to be more cost efficient and reliable than any of the other techniques. This has been demonstrated through experimentation at TVA's Norris Dam. An applied research project is being conducted to develop experimental and numerical methods to allow for reliable design and deployment of this new environmentally improved hydroturbine. TVA is providing overall coordination for this research which is being performed cooperatively with the U.S. Army Corps of Engineers, the U.S. Bureau of Reclamation, and the Iowa Institute of Hydraulic Research. This applied research project is fully integrated with a scale model test program jointly supported and conducted by TVA and Voith Hydro to test alternative locations for venting air into replacement turbine runners for Norris Dam

Investigation of the structural, surface, optical and electrical properties of the Indium doped CuxO thin films deposited by a thermionic vacuum arc

Science.gov (United States)

Musaoğlu, Caner; Pat, Suat; Özen, Soner; Korkmaz, Şadan; Mohammadigharehbagh, Reza

2018-03-01

In this study, investigation of some physical properties of In-doped CuxO thin films onto amorphous glass substrates were done. The thin films were depsoied by thermionic vacuum arc technique (TVA). TVA technique gives a thin film with lower precursor impurity according to the other chemical and physical depsoition methods. The microstructural properties of the produced thin films was determined by x-ray diffraction device (XRD). The thickness values were measured as to be 30 nm and 60 nm, respectively. The miller indices of the thin films’ crystalline planes were determined as to be Cu (111), CuO (\\bar{1} 12), CuInO2 (107) and Cu2O (200), Cu (111), CuO (\\bar{1} 12), CuO (\\bar{2} 02), CuInO2 (015) for sample C1 and C2, respectively. The produced In-doped CuO thin films are in polycrystalline structure. The surface properties of produced In doped CuO thin films were determined by using an atomic force microscope (AFM) and field emission scanning electron microscope (FESEM) tools. The optical properties of the In doped CuO thin films were determined by UV–vis spectrophotometer, interferometer, and photoluminescence devices. p-type semiconductor thin film was obtained by TVA depsoition.

Web-based audiovisual patient information system--a study of preoperative patient information in a neurosurgical department.

Science.gov (United States)

Gautschi, Oliver P; Stienen, Martin N; Hermann, Christel; Cadosch, Dieter; Fournier, Jean-Yves; Hildebrandt, Gerhard

2010-08-01

In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation. To optimise information delivery, different auxiliary materials are used. In a prospective study, 52 consecutive stationary patients, scheduled for an elective lumbar disc operation were asked to use a web-based audiovisual patient information system. A combination of pictures, text, tone and video about the planned surgical intervention is installed on a tablet personal computer presented the day before surgery. All patients were asked to complete a questionnaire. Eighty-four percent of all participants found that the audiovisual patient information system lead to a better understanding of the forthcoming operation. Eighty-two percent found that the information system was a very helpful preparation before the pre-surgical interview with the surgeon. Ninety percent of all participants considered it meaningful to provide this kind of preoperative education also to patients planned to undergo other surgical interventions. Eighty-four percent were altogether "very content" with the audiovisual patient information system and 86% would recommend the system to others. This new approach of patient information had a positive impact on patient education as is evident from high satisfaction scores. Because patient satisfaction with the informed consent process and understanding of the presented information improved substantially, the audiovisual patient information system clearly benefits both surgeons and patients.

Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

Science.gov (United States)

Kato, Koki; Fukuda, Haruhisa

2017-11-01

To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

78 FR 35989 - Tennessee Valley Authority; Watts Bar Nuclear Plant, Unit 2

Science.gov (United States)

2013-06-14

..., Maryland 20852. FOR FURTHER INFORMATION CONTACT: Elaine N. Keegan, Office of Nuclear Reactor Regulation, U....Keegan@nrc.gov . SUPPLEMENTARY INFORMATION: The Tennessee Valley Authority (TVA or the applicant...

What Do Stroke Patients Look for in Game-Based Rehabilitation: A Survey Study.

Science.gov (United States)

Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

2016-03-01

Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients' places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey - interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey - a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing, appropriately

Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer

OpenAIRE

Zhang, Mei-Fen; Wen, Yong-Shan; Liu, Wei-Yan; Peng, Li-Fen; Wu, Xiao-Dan; Liu, Qian-Wen

2015-01-01

Abstract Anxiety and depression are common among patients with cancer, and are often treated with psychological interventions including mindfulness-based therapy. The aim of the study was to perform a meta-analysis of the effectiveness of mindfulness-based interventions for improving anxiety and depression in patients with cancer. Medline, the Cochrane Library, EMBASE, and Google Scholar were searched. The randomized controlled trials designed for patients diagnosed with cancer were included....

Insurance problems among inflammatory bowel disease patients: results of a Dutch population based study.

Science.gov (United States)

Russel, M G V M; Ryan, B M; Dagnelie, P C; de Rooij, M; Sijbrandij, J; Feleus, A; Hesselink, M; Muris, J W; Stockbrugger, R

2003-03-01

The majority of patients with inflammatory bowel disease (IBD) have a normal life expectancy and therefore should not be weighted when applying for life assurance. There is scant literature on this topic. In this study our aim was to document and compare the incidence of difficulties in application for life and medical insurance in a population based cohort of IBD patients and matched population controls. A population based case control study of 1126 IBD patients and 1723 controls. Based on a detailed questionnaire, the frequency and type of difficulties encountered when applying for life and medical insurance in matched IBD and control populations were appraised. In comparison with controls, IBD patients had an 87-fold increased risk of encountering difficulties when applying for life assurance (odds ratio (OR) 87 (95% confidence interval (CI) 31-246)), with a heavily weighted premium being the most common problem. Patients of high educational status, with continuous disease activity, and who smoked had the highest odds of encountering such problems. Medical insurance difficulties were fivefold more common in IBD patients compared with controls (OR 5.4 (95% CI 2.3-13)) although no specific disease or patient characteristics were identified as associated with such difficulties. This is the first detailed case control study that has investigated insurance difficulties among IBD patients. Acquiring life and medical insurance constituted a major problem for IBD patients in this study. These results are likely to be more widely representative given that most insurance companies use international guidelines for risk assessment. In view of the recent advances in therapy and promising survival data on IBD patients, evidence based guidelines for risk assessment of IBD patients by insurance companies should be drawn up to prevent possible discriminatory practices.

Comparison of antiemetic effects of granisetron and palonosetron in patients receiving bendamustine-based chemotherapy.

Science.gov (United States)

Uchida, M; Nakamura, T; Makihara, Y; Suetsugu, K; Ikesue, H; Mori, Y; Kato, K; Shiratsuchi, M; Hosohata, K; Miyamoto, T; Akashi, K

2018-05-01

The antiemetic effects and safety of granisetron and palonosetron against chemotherapy-induced nausea and vomiting (CINV) were retrospectively evaluated in patients with non-Hodgkin lymphoma receiving bendamustine-based chemotherapy. A total of 61 patients were eligible for this study. Before starting the bendamustine-based chemotherapy, granisetron or palonosetron were intravenously administered with or without aprepitant and/or dexamethasone. The proportions of patients with complete control (CC) during the overall (during the 6 days after the start of the chemotherapy), acute (up to 2 days), and delayed (3 to 6 days) phases were assessed. CC was defined as complete response with only grade 0-1 nausea, no vomiting, and no use of antiemetic rescue medication. Granisetron or palonosetron alone were administered to 9 and 19 patients, respectively. Aprepitant and/or dexamethasone were combined with granisetron and palonosetron in 28 and 5 patients, respectively. Acute CINV was completely controlled in all patients. Both granisetron monotherapy and palonosetron combination therapy could provide good control of delayed CINV, although the CC rates during the delayed and overall phases were not significantly different among mono- and combination therapy of the antiemetics. There was no significant difference in the frequencies of adverse drug events between the granisetron and palonosetron treatment groups. The present study showed that the antiemetic efficacy and safety of granisetron-based therapy were non-inferior to those of palonosetron-based therapy. Taken together with treatment costs, granisetron monotherapy would be adequate to prevent CINV in patients with non-Hodgkin lymphoma receiving bendamustine-based chemotherapy.

Understanding Patient Experience Using Internet-based Email Surveys: A Feasibility Study at Mount Sinai Hospital.

Science.gov (United States)

Morgan, Matthew; Lau, Davina; Jivraj, Tanaz; Principi, Tania; Dietrich, Sandra; Bell, Chaim M

2015-01-01

Email is becoming a widely accepted communication tool in healthcare settings. This study sought to test the feasibility of Internet-based email surveys of patient experience in the ambulatory setting. We conducted a study of email Internet-based surveys sent to patients in selected ambulatory clinics at Mount Sinai Hospital in Toronto, Canada. Our findings suggest that email links to Internet surveys are a feasible, timely and efficient method to solicit patient feedback about their experience. Further research is required to optimally leverage Internet-based email surveys as a tool to better understand the patient experience.

Evidence-based medicine and patient choice: the case of heart failure care.

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Sanders, Tom; Harrison, Stephen; Checkland, Kath

2008-04-01

The implementation of evidence-based medicine and policies aimed at increasing user involvement in health care decisions are central planks of contemporary English health policy. Yet they are potentially in conflict. Our aim was to explore how clinicians working in the field of heart failure resolve this conflict. Qualitative semi-structured interviews were carried out with health professionals who were currently caring for patients with heart failure, and observations were conducted at one dedicated heart failure clinic in northern England. While clinicians acknowledged that patients' ideas and preferences should be an important part of treatment decisions, the widespread acceptance of an evidence-based clinical protocol for heart failure among the clinic doctors significantly influenced the content and style of the consultation. Evidence-based medicine was used to buttress professional authority and seemed to provide an additional barrier to the adoption of patient-centred clinical practice.

Selecting the patients for morning report sessions: case-based vs. conventional method.

Science.gov (United States)

Rabiei, Mehdi; Saeidi, Masumeh; Kiani, Mohammad Ali; Amin, Sakineh Mohebi; Ahanchian, Hamid; Jafari, Seyed Ali; Kianifar, Hamidreza

2015-08-01

One of the most important issues in morning report sessions is the number of patients. The aim of this study was to investigate and compare the number of cases reported in the morning report sessions in terms of case-based and conventional methods from the perspective of pediatric residents of Mashhad University of Medical Sciences. The present study was conducted on 24 pediatric residents of Mashhad University of Medical Sciences in the academic year 2014-2015. In this survey, the residents replied to a 20-question researcher-made questionnaire that had been designed to measure the views of residents regarding the number of patients in the morning report sessions using case-based and conventional methods. The validity of the questionnaire was confirmed by experts' views and its reliability by calculating Cronbach's alpha coefficients. Data were analyzed by t-test analysis. The mean age of the residents was 30.852 ± 2.506, and 66.6% of them were female. The results showed that there was no significant relationship among the variables of academic year, gender, and residents' perspective to choosing the number of patients in the morning report sessions (P > 0.05). T-test analysis showed a significant relationship among the average scores of residents in the selection of the case-based method in comparison to the conventional method (P case-based morning report was preferred compared to the conventional method. This method makes residents pay more attention to the details of patients' issues and therefore helps them to better plan how to address patient problems and improve their differential diagnosis skills.

Oxidatively-induced DNA damage and base excision repair in euthymic patients with bipolar disorder.

Science.gov (United States)

Ceylan, Deniz; Tuna, Gamze; Kirkali, Güldal; Tunca, Zeliha; Can, Güneş; Arat, Hidayet Ece; Kant, Melis; Dizdaroglu, Miral; Özerdem, Ayşegül

2018-05-01

Oxidatively-induced DNA damage has previously been associated with bipolar disorder. More recently, impairments in DNA repair mechanisms have also been reported. We aimed to investigate oxidatively-induced DNA lesions and expression of DNA glycosylases involved in base excision repair in euthymic patients with bipolar disorder compared to healthy individuals. DNA base lesions including both base and nucleoside modifications were measured using gas chromatography-tandem mass spectrometry and liquid chromatography-tandem mass spectrometry with isotope-dilution in DNA samples isolated from leukocytes of euthymic patients with bipolar disorder (n = 32) and healthy individuals (n = 51). The expression of DNA repair enzymes OGG1 and NEIL1 were measured using quantitative real-time polymerase chain reaction. The levels of malondialdehyde were measured using high performance liquid chromatography. Seven DNA base lesions in DNA of leukocytes of patients and healthy individuals were identified and quantified. Three of them had significantly elevated levels in bipolar patients when compared to healthy individuals. No elevation of lipid peroxidation marker malondialdehyde was observed. The level of OGG1 expression was significantly reduced in bipolar patients compared to healthy individuals, whereas the two groups exhibited similar levels of NEIL1 expression. Our results suggest that oxidatively-induced DNA damage occurs and base excision repair capacity may be decreased in bipolar patients when compared to healthy individuals. Measurement of oxidatively-induced DNA base lesions and the expression of DNA repair enzymes may be of great importance for large scale basic research and clinical studies of bipolar disorder. Copyright © 2018 Elsevier B.V. All rights reserved.

Feasibility of web-based decision aids in neurological patients

NARCIS (Netherlands)

van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

2010-01-01

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

Couch height–based patient setup for abdominal radiation therapy

Energy Technology Data Exchange (ETDEWEB)

Ohira, Shingo [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita (Japan); Ueda, Yoshihiro [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita (Japan); Nishiyama, Kinji [Department of Radiation Oncology, Yao Municipal Hospital, Yao (Japan); Miyazaki, Masayoshi; Isono, Masaru; Tsujii, Katsutomo [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Takashina, Masaaki; Koizumi, Masahiko [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita (Japan); Kawanabe, Kiyoto [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Teshima, Teruki, E-mail: teshima-te@mc.pref.osaka.jp [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan)

2016-04-01

There are 2 methods commonly used for patient positioning in the anterior-posterior (A-P) direction: one is the skin mark patient setup method (SMPS) and the other is the couch height–based patient setup method (CHPS). This study compared the setup accuracy of these 2 methods for abdominal radiation therapy. The enrollment for this study comprised 23 patients with pancreatic cancer. For treatments (539 sessions), patients were set up by using isocenter skin marks and thereafter treatment couch was shifted so that the distance between the isocenter and the upper side of the treatment couch was equal to that indicated on the computed tomographic (CT) image. Setup deviation in the A-P direction for CHPS was measured by matching the spine of the digitally reconstructed radiograph (DRR) of a lateral beam at simulation with that of the corresponding time-integrated electronic portal image. For SMPS with no correction (SMPS/NC), setup deviation was calculated based on the couch-level difference between SMPS and CHPS. SMPS/NC was corrected using 2 off-line correction protocols: no action level (SMPS/NAL) and extended NAL (SMPS/eNAL) protocols. Margins to compensate for deviations were calculated using the Stroom formula. A-P deviation > 5 mm was observed in 17% of SMPS/NC, 4% of SMPS/NAL, and 4% of SMPS/eNAL sessions but only in one CHPS session. For SMPS/NC, 7 patients (30%) showed deviations at an increasing rate of > 0.1 mm/fraction, but for CHPS, no such trend was observed. The standard deviations (SDs) of systematic error (Σ) were 2.6, 1.4, 0.6, and 0.8 mm and the root mean squares of random error (σ) were 2.1, 2.6, 2.7, and 0.9 mm for SMPS/NC, SMPS/NAL, SMPS/eNAL, and CHPS, respectively. Margins to compensate for the deviations were wide for SMPS/NC (6.7 mm), smaller for SMPS/NAL (4.6 mm) and SMPS/eNAL (3.1 mm), and smallest for CHPS (2.2 mm). Achieving better setup with smaller margins, CHPS appears to be a reproducible method for abdominal patient setup.

Brainstem dysfunction in patients with late-onset Lennox-Gastaut syndrome: Voxel-based morphometry and tract-based spatial statistics study

Directory of Open Access Journals (Sweden)

Kang Min Park

2016-01-01

Full Text Available Background: There have been a few reports of patients who developed Lennox-Gastaut syndrome (LGS in the second decades of their life. Objectives: The aim of this study was to investigate electroclinical presentation in patients with late-onset LGS. In addition, we evaluated structural abnormalities of the brain, which may give some clue about the common pathogenic pathway in LGS. Materials and Methods: We enrolled the patients with late-onset LGS. We collected electroclinical characteristics of the patients and evaluated structural abnormalities using voxel-based morphometry (VBM and tract-based spatial statistics (TBSS analysis. Results: The three subjects were diagnosed with late-onset LGS. The patients have no mental retardation and normal background activities on electroencephalography (EEG, and they had generalized paroxysmal fast activities on EEG, especially during sleep. The TBSS analysis revealed that fractional anisotropy values in the patients were significantly reduced in the white matter of brainstem compared with normal controls. However, VBM analysis did not show any significant difference between the patients and normal controls. Conclusions: Patients with late-onset LGS have different clinical and EEG characteristics from those with early-onset LGS. In addition, we demonstrated that brainstem dysfunction might contribute to the pathogenesis of late-onset LGS.

A Kinect-Based Physiotherapy and Assessment Platform for Parkinson's Disease Patients

OpenAIRE

Pachoulakis, Ioannis; Xilourgos, Nikolaos; Papadopoulos, Nikolaos; Analyti, Anastasia

2016-01-01

We report on a Kinect-based, augmented reality, real-time physiotherapy platform tailored to Parkinson’s disease (PD) patients. The platform employs a Kinect sensor to extract real-time 3D skeletal data (joint information) from a patient facing the sensor (at 30 frames per second). In addition, a small collection of exercises practiced in traditional physiotherapy for PD patients has been implemented in the Unity 3D game engine. Each exercise employs linear or circular movement patterns and p...

Development of a Performance-Based Measure of Executive Functions in Patients with Schizophrenia.

Directory of Open Access Journals (Sweden)

En-Chi Chiu

Full Text Available A performance-based measure for assessing executive functions (EF is useful to understand patients' real life performance of EF. This study aimed to develop a performance-based measure of executive functions (PEF based on the Lezak model and to examine psychometric properties (i.e., unidimensionality and reliability of the PEF using Rasch analysis in patients with schizophrenia. We developed the PEF in three phases: (1 designing the preliminary version of PEF; (2 consultation with experts, cognitive interviews with patients, and pilot tests on patients to revise the preliminary PEF; (3 establishment of the final version of the PEF and examination of unidimensionality and Rasch reliability. Two hundred patients were assessed using the revised PEF. After deleting items which did not satisfy the Rasch model's expectations, the final version of the PEF contained 1 practice item and 13 test items for assessing the four domains of EF (i.e., volition, planning, purposive action, and effective performance. For unidimensional and multidimensional Rasch analyses, the 4 domains showed good reliability (i.e., 0.77-0.85 and 0.87-0.90, respectively. Our results showed that the PEF had satisfactory unidimensionality and Rasch reliability. Therefore, clinicians and researchers could use the PEF to assess the four domains of EF in patients with schizophrenia.

Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review.

Science.gov (United States)

Salonen, Anne; Ryhänen, Anne M; Leino-Kilpi, Helena

2014-01-01

This study aims to review systematically the available literature on Internet and computer-based patient education programmes, assess the quality of these studies and analyze the benefit of these programmes for prostate cancer patients. Complete databases were searched. Studies were included if they concerned patient education of prostate cancer patients, were qualitative or quantitative and examined Internet or interactive CD-ROM use. Eighteen studies met the inclusion criteria. The majority of the studies reported a significant increase in the knowledge of the disease, satisfaction with treatment options and support for men. The benefit of the programmes was that the patients felt more empowered and obtained a heightened sense of control over their disease. The Internet or computer-based programmes had a positive impact on prostate cancer patient education. Most papers reported that the programmes were beneficial, but few presented data from studies with rigorous research methodologies to support these claims. Internet and computer-based programmes can be useful tools in prostate cancer patient education. In order to improve the benefits of the programmes, more Internet and computer-based programmes need to be developed and studied. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Stability of parameters in repeated TVA measures

DEFF Research Database (Denmark)

Sørensen, Thomas Alrik

Several recent studies have explored the limitations of human visual short-term memory or VSTM (e.g. Luck & Vogel, 1997; Wheeler & Treisman, 2002; Alvarez & Cavanagh, 2004). Usually researchers agree that VSTM is limited to a capacity of about 3 to 4 objects at any given moment (Cowan, 2001......). Capacity of short-term memory is measured in a range of studies often using the change detection paradigm (CD). However, the whole report paradigm (WR) may be a more reliable paradigm (Cusack, Lehmann, Veldsman, & Mitchell, 2009). Moreover, each individual WR trial yield more information compared to a CD...

76 FR 34273 - Environmental Assessment and Finding of No Significant Impact for Special Nuclear Material...

Science.gov (United States)

2011-06-13

... Nuclear Material, TVA applied for an SNM license by application dated November 12, 2009 (ML100120487). The..., including site geography, demographics, meteorology, hydrology, and geology. The proposed activity is...

Quality of life of community-based chronic schizophrenia patients in Penang, Malaysia.

Science.gov (United States)

Mubarak, A R; Baba, Ismail; Chin, Low Heng; Hoe, Quah Soon

2003-10-01

This is a study of the quality of life (QOL) of 174 community-based chronic schizophrenia patients in Penang, Malaysia. The study samples were selected from the Out Patient Department, Department of Psychiatry, Penang General Hospital, Malaysia. The data was collected through personal interviews with the respondents. A questionnaire prepared by the research team was used to collect data on background characteristics. Lehman's (1988) Quality of Life Interview was used to collect data on patients' QOL. Equal number of males and females participated in the study. The interviews on QOL indicated problems in the areas of life in general, place of living, daily activities, social relations, finance, work and general health. The results also revealed that community-based schizophrenia patients had acute poverty and experienced social isolation, discrimination and exploitation in the workplace. Implications of these results on the implementation process of National Mental Health Policy in Malaysia are discussed. The research paper also discusses the negative impacts of limited rehabilitation facilities available in the community and its implications on the QOL of severely mentally ill patients. The need for immediate research attention on QOL of such patients in the South-east Asian region has been highlighted.

Increasing patient engagement in rehabilitation exercises using computer-based citizen science.

Science.gov (United States)

Laut, Jeffrey; Cappa, Francesco; Nov, Oded; Porfiri, Maurizio

2015-01-01

Patient motivation is an important factor to consider when developing rehabilitation programs. Here, we explore the effectiveness of active participation in web-based citizen science activities as a means of increasing participant engagement in rehabilitation exercises, through the use of a low-cost haptic joystick interfaced with a laptop computer. Using the joystick, patients navigate a virtual environment representing the site of a citizen science project situated in a polluted canal. Participants are tasked with following a path on a laptop screen representing the canal. The experiment consists of two conditions: in one condition, a citizen science component where participants classify images from the canal is included; and in the other, the citizen science component is absent. Both conditions are tested on a group of young patients undergoing rehabilitation treatments and a group of healthy subjects. A survey administered at the end of both tasks reveals that participants prefer performing the scientific task, and are more likely to choose to repeat it, even at the cost of increasing the time of their rehabilitation exercise. Furthermore, performance indices based on data collected from the joystick indicate significant differences in the trajectories created by patients and healthy subjects, suggesting that the low-cost device can be used in a rehabilitation setting for gauging patient recovery.

Risk of Clostridium difficile Infection in Patients With Celiac Disease: A Population-Based Study.

Science.gov (United States)

Lebwohl, Benjamin; Nobel, Yael R; Green, Peter H R; Blaser, Martin J; Ludvigsson, Jonas F

2017-12-01

Patients with celiac disease are at increased risk for infections such as tuberculosis, influenza, and pneumococcal pneumonia. However, little is known about the incidence of Clostridium difficile infection (CDI) in patients with celiac disease. We identified patients with celiac disease based on intestinal biopsies submitted to all pathology departments in Sweden over a 39-year period (from July 1969 through February 2008). We compared risk of CDI (based on stratified Cox proportional hazards models) among patients with celiac disease vs. without celiac disease (controls) matched by age, sex, and calendar period. We identified 28,339 patients with celiac disease and 141,588 controls; neither group had a history of CDI. The incidence of CDI was 56/100,000 person-years among patients with celiac disease and 26/100,000 person-years among controls, yielding an overall hazard ratio (HR) of 2.01 (95% confidence interval (CI), 1.64-2.47; Pceliac disease (HR, 5.20; 95% CI, 2.81-9.62; Pceliac disease and controls. In a large population-based cohort study, patients with celiac disease had significantly higher incidence of CDI than controls. This finding is consistent with prior findings of higher rates of other infections in patients with celiac disease, and suggests the possibility of altered gut immunity and/or microbial composition in patients with celiac disease.

Impact of Gender on Patient Preferences for Technology-Based Behavioral Interventions

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David J. Kim

2014-08-01

Full Text Available Introduction: Technology-based interventions offer an opportunity to address high-risk behaviors in the emergency department (ED. Prior studies suggest behavioral health strategies are more effective when gender differences are considered. However, the role of gender in ED patient preferences for technology-based interventions has not been examined. The objective was to assess whether patient preferences for technology-based interventions varies by gender. Methods: This was a secondary analysis of data from a systematic survey of adult (18 years of age, English-speaking patients in a large urban academic ED. Subjects were randomly selected during a purposive sample of shifts. The iPad survey included questions on access to technology, preferences for receiving health information, and demographics. We defined ‘‘technology-based’’ as web, text message, e-mail, social networking, or DVD; ‘‘non-technology-based’’ was defined as in-person, written materials, or landline. We calculated descriptive statistics and used univariate tests to compare men and women. Gender-stratified multivariable logistic regression models were used to examine associations between other demographic factors (age, race, ethnicity, income and technology-based preferences for information on specific risky behaviors. Results: Of 417 participants, 45.1% were male. There were no significant demographic differences between men and women. Women were more likely to use computers (90.8% versus 81.9%; p¼0.03, Internet (66.8% versus 59.0%; p¼0.03, and social networks (53.3% versus 42.6%; p¼0.01. 89% of men and 90% of women preferred technology-based formats for at least type of health information; interest in technology-based for individual health topics did not vary by gender. Concern about confidentiality was the most common barrier to technology-based use for both genders. Multivariate analysis showed that for smoking, depression, drug/alcohol use, and injury

Development and Analysis of Patient-Based Complete Conducting Airways Models.

Directory of Open Access Journals (Sweden)

Rafel Bordas

Full Text Available The analysis of high-resolution computed tomography (CT images of the lung is dependent on inter-subject differences in airway geometry. The application of computational models in understanding the significance of these differences has previously been shown to be a useful tool in biomedical research. Studies using image-based geometries alone are limited to the analysis of the central airways, down to generation 6-10, as other airways are not visible on high-resolution CT. However, airways distal to this, often termed the small airways, are known to play a crucial role in common airway diseases such as asthma and chronic obstructive pulmonary disease (COPD. Other studies have incorporated an algorithmic approach to extrapolate CT segmented airways in order to obtain a complete conducting airway tree down to the level of the acinus. These models have typically been used for mechanistic studies, but also have the potential to be used in a patient-specific setting. In the current study, an image analysis and modelling pipeline was developed and applied to a number of healthy (n = 11 and asthmatic (n = 24 CT patient scans to produce complete patient-based airway models to the acinar level (mean terminal generation 15.8 ± 0.47. The resulting models are analysed in terms of morphometric properties and seen to be consistent with previous work. A number of global clinical lung function measures are compared to resistance predictions in the models to assess their suitability for use in a patient-specific setting. We show a significant difference (p < 0.01 in airways resistance at all tested flow rates in complete airway trees built using CT data from severe asthmatics (GINA 3-5 versus healthy subjects. Further, model predictions of airways resistance at all flow rates are shown to correlate with patient forced expiratory volume in one second (FEV1 (Spearman ρ = -0.65, p < 0.001 and, at low flow rates (0.00017 L/s, FEV1 over forced vital capacity (FEV1

Teamwork in skull base surgery: An avenue for improvement in patient care.

Science.gov (United States)

McLaughlin, Nancy; Carrau, Ricardo L; Kelly, Daniel F; Prevedello, Daniel M; Kassam, Amin B

2013-01-01

During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: "teamwork", "multidisciplinary", "interdisciplinary", "surgery", "skull base", "neurosurgery", "tumor", and "outcome". Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support. Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise.

Predicting Patient-specific Dosimetric Benefits of Proton Therapy for Skull-base Tumors Using a Geometric Knowledge-based Method

Energy Technology Data Exchange (ETDEWEB)

Hall, David C.; Trofimov, Alexei V.; Winey, Brian A.; Liebsch, Norbert J.; Paganetti, Harald, E-mail: hpaganetti@mgh.harvard.edu

2017-04-01

Purpose: To predict the organ at risk (OAR) dose levels achievable with proton beam therapy (PBT), solely based on the geometric arrangement of the target volume in relation to the OARs. A comparison with an alternative therapy yields a prediction of the patient-specific benefits offered by PBT. This could enable physicians at hospitals without proton capabilities to make a better-informed referral decision or aid patient selection in model-based clinical trials. Methods and Materials: Skull-base tumors were chosen to test the method, owing to their geometric complexity and multitude of nearby OARs. By exploiting the correlations between the dose and distance-to-target in existing PBT plans, the models were independently trained for 6 types of OARs: brainstem, cochlea, optic chiasm, optic nerve, parotid gland, and spinal cord. Once trained, the models could estimate the feasible dose–volume histogram and generalized equivalent uniform dose (gEUD) for OAR structures of new patients. The models were trained using 20 patients and validated using an additional 21 patients. Validation was achieved by comparing the predicted gEUD to that of the actual PBT plan. Results: The predicted and planned gEUD were in good agreement. Considering all OARs, the prediction error was +1.4 ± 5.1 Gy (mean ± standard deviation), and Pearson's correlation coefficient was 93%. By comparing with an intensity modulated photon treatment plan, the model could classify whether an OAR structure would experience a gain, with a sensitivity of 93% (95% confidence interval: 87%-97%) and specificity of 63% (95% confidence interval: 38%-84%). Conclusions: We trained and validated models that could quickly and accurately predict the patient-specific benefits of PBT for skull-base tumors. Similar models could be developed for other tumor sites. Such models will be useful when an estimation of the feasible benefits of PBT is desired but the experience and/or resources required for treatment

Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

Science.gov (United States)

Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

2015-01-01

This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

A qualitative analysis of coronary heart disease patient views of dietary adherence and web-based and mobile-based nutrition tools.

Science.gov (United States)

Yehle, Karen S; Chen, Aleda M H; Plake, Kimberly S; Yi, Ji Soo; Mobley, Amy R

2012-01-01

Dietary adherence can be challenging for patients with coronary heart disease (CHD), as they may require multiple dietary changes. Choosing appropriate food items may be difficult or take extensive amounts of time without the aid of technology. The objective of this project was to (1) examine the dietary challenges faced by patients with CHD, (2) examine methods of coping with dietary challenges, (3) explore the feasibility of a Web-based food decision support system, and (4) explore the feasibility of a mobile-based food decision support system. Food for the Heart (FFH), a Web site-based food decision support system, and Mobile Magic Lens (MML), a mobile-based system, were developed to aid in daily dietary choices. Three CHD patient focus groups were conducted and focused on CHD-associated dietary changes as well as the FFH and MML prototypes. A total of 20 CHD patients and 7 informal caregivers participated. Qualitative, content analysis was performed to find themes grounded in the responses. Five predominant themes emerged: (1) decreasing carbohydrate intake and portion control are common dietary challenges, (2) clinician and social support makes dietary adherence easier, (3) FFH could make meal-planning and dietary adherence less complicated, (4) MML could save time and assist with healthy choices, and (5) additional features need to be added to make both tools more comprehensive. Food for the Heart and MML may be tools that CHD patients would value in making food choices and adhering to dietary recommendations, especially if additional features are added to assist patients with changes.

Patients at the centre: methodological considerations for evaluating evidence from health interventions involving patients use of web-based information systems.

Science.gov (United States)

Cummings, Elizabeth; Turner, Paul

2010-09-15

Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions.Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences.Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the 'patient at the centre' by engaging them in their own care and/or 'empowering' them through the use of information systems.This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients' interests and outcomes are measured, defined and evaluated within health interventions that involve them using web-based information systems

3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

International Nuclear Information System (INIS)

Dhou, S; Hurwitz, M; Cai, W; Rottmann, J; Williams, C; Wagar, M; Berbeco, R; Lewis, J H; Mishra, P; Li, R; Ionascu, D

2015-01-01

3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we developed and performed initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and used these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparison to ground truth digital and physical phantom images. The performance of 4DCBCT-based and 4DCT-based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. (paper)

Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

DEFF Research Database (Denmark)

Villumsen, Brigitta R; Jørgensen, Martin Grønbech; Frystyk, Jan

2015-01-01

The most optimal exercise plan for men with prostate cancer (PC) receiving androgen deprivation therapy needs to be identified. We plan to investigate a 12-week home-based health programme (exergaming) on physical function, fatigue and metabolic parameters in this group. In addition, our study...... will explore the satisfaction and experience with the health game programme. To the best of our knowledge this is the first RCT study to investigate the effect of a home based health game programme on PC patients. No statistical analysis have been made thus far because inclusion is ongoing, however baseline...

Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients.

Science.gov (United States)

Camerini, Luca; Camerini, Anne-Linda; Schulz, Peter J

2013-08-01

To evaluate the effectiveness of an Internet-based patient education intervention, which was designed upon principles of personalization and participatory design. Fifteen months after the first release of the website, 209 fibromyalgia patients recruited through health professionals completed an online questionnaire to assess patients' use of the website, health knowledge, self-management behavior, and health outcomes. These constructs were combined into an a-priory model that was tested using a structural equation modeling approach. Results show that the usage of certain tools of the website - designed and personalized involving the end users - impacts patients' health knowledge, which in turn impacts self-management. Improvements in self-management ultimately lower the impact of Fibromyalgia Syndrome leading to better health outcomes. This study empirically confirmed that the adoption of a participatory approach to the design of eHealth interventions and the use of personalized contents enhance the overall effectiveness of systems. More time and effort should be invested in involving patients in the preliminary phases of the development of Internet-based patient education interventions and in the definition of models that can guide the systems' evaluation beyond technology-related variables such as usability, accessibility or adoption. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Preparation, validation and user-testing of pictogram-based patient information leaflets for tuberculosis.

Science.gov (United States)

Shrestha, Anmol; Rajesh, V; Dessai, Sneha Shamrao; Stanly, Sharon Mary; Mateti, Uday Venkat

2018-05-25

Patient education is of paramount importance with regard to the condition of the disease and the treatment given besides lifestyle remodelling in order to get the desired therapeutic outcome. When verbal information is provided to the patients, they often tend to forget it. Pictorial aids or pictograms, as they are commonly known, are tools that are widely used for imparting knowledge to the patients. The aim of the study is to prepare and validate a Pictogram-based Patient Information Leaflet (P-PILs) on Tuberculosis (TB). P-PILs have been prepared from tertiary, secondary and primary sources. The knowledge-based questions are prepared with respect to the P-PILs. The baseline knowledge of the volunteers and patients have been analyzed before administering the P-PILs by using the validated questionnaire. The post-knowledge of the volunteers and patients has been analyzed after administering the P-PILs (20 min) by using the same questionnaire and the user-opinion has also been obtained at the end. The study results show that the mean scores of the overall user-testing knowledge assessment are found to have improved significantly from the pre-P-PILs administration score of 62.67 to the post-P-PILs administration score of 91. The overall user-opinion about the P-PILs has been found to be good (75%) followed by average (25%). The present study shows that there is significant improvement in the knowledge levels of the patients and volunteers after reading the validated leaflets. The Pictogram-based Patient Information Leaflets are found to be an effective educational tool for TB patients. Copyright © 2018. Published by Elsevier Ltd.

Lean body mass-based levothyroxine replacement in young athyrotic patients with differentiated carcinoma of thyroid

Directory of Open Access Journals (Sweden)

Fatima Begum

2013-01-01

Full Text Available Objective: The objective of this study was to optimize dose of levothyroxine (LT4 based on lean body mass (LBM in young athyrotic patients with differentiated carcinoma of thyroid (DCT which has not been properly addressed in Bangladesh before. Materials and Methods: Sixty patients with DCT (age, range: 20-39 years having total thyroidectomy followed by radioiodine ablative therapy (RIT and 23 euthyroid volunteers were recruited. Clinical, biochemical parameters were obtained from all patients after 2 months of RIT and on LT4 replacement at a dose of 200 μg/day as first follow up visit and also from control subjects. Then 60 patients were divided into two groups consisting of 30 patients each. Patients of Group-I received LT4 replacement based on LBM measured by dual energy X-ray absorptiometry (DXA and Group-II continued LT4 replacement in conventional dose. Patients of both groups were assessed again for same parameters at 6 to 12 months at the second visit. Results: Optimized dose of LT4 based on LBM by DXA (131 ±23 μg/day significantly reduced thyroid hormones and kept thyroid stimulating hormone (TSH in expected levels in patients of Group-I at the second visit compared to patients of Group-II who continued conventional LT4 dose (200 μg/day. Hyperthyroid symptom scale (HSS was significantly reduced to 2 ± 1 in patients of Group-I but not in patients of Group-II, HSS, 8 ±1 ( P < 0.001. Conclusion: Optimization of LT4 dose based on LBM can avoid chronic exposure of mild excess of thyroid hormone in young patients with low risk DCT.

Patient-Controlled Attribute-Based Encryption for Secure Electronic Health Records System.

Science.gov (United States)

Eom, Jieun; Lee, Dong Hoon; Lee, Kwangsu

2016-12-01

In recent years, many countries have been trying to integrate electronic health data managed by each hospital to offer more efficient healthcare services. Since health data contain sensitive information of patients, there have been much research that present privacy preserving mechanisms. However, existing studies either require a patient to perform various steps to secure the data or restrict the patient to exerting control over the data. In this paper, we propose patient-controlled attribute-based encryption, which enables a patient (a data owner) to control access to the health data and reduces the operational burden for the patient, simultaneously. With our method, the patient has powerful control capability of his/her own health data in that he/she has the final say on the access with time limitation. In addition, our scheme provides emergency medical services which allow the emergency staffs to access the health data without the patient's permission only in the case of emergencies. We prove that our scheme is secure under cryptographic assumptions and analyze its efficiency from the patient's perspective.

18 CFR 1301.10 - Fees.

Science.gov (United States)

2010-04-01

... example, magnetic tape or disk), among others. TVA shall honor a requester's specified preference of form... education, or an institution of professional education, or an institution of vocational education, that...

Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up.

Science.gov (United States)

Pozza, Edoardo Dalla; D'Souza, Gehaan F; DeLeonibus, Anthony; Fabiani, Brianna; Gharb, Bahar Bassiri; Zins, James E

2017-12-13

While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Web-based information and support for patients with a newly diagnosed neuroendocrine tumor: a feasibility study.

Science.gov (United States)

Bouma, Grietje; de Hosson, Lotte D; van Woerkom, Claudia E; van Essen, Hennie; de Bock, Geertruida H; Admiraal, Jolien M; Reyners, Anna K L; Walenkamp, Annemiek M E

2017-07-01

Patients with a neuroendocrine tumor (NET) frequently experience physical and psychosocial complaints. Novel strategies to provide information to optimize supportive care in these patients are of interest. The aim of this study was to examine whether the use of a web-based system consisting of self-screening of problems and care needs, patient education, and self-referral to professional health care is feasible in NET patients and to evaluate their opinion on this. Newly diagnosed NET patients were randomized between standard care (n = 10) or intervention with additional access to the web-based system (n = 10) during 12 weeks. Patients completed questionnaires regarding received information, distress, quality of life (QoL), and empowerment. The intervention group completed a semi-structured interview to assess patients' opinion on the web-based system. The participation rate was 77% (20/26 invited patients) with no dropouts. The use of the web-based system had a negative effect on patients' perception and satisfaction of received information (range Cohen's d -0.88 to 0.13). Positive effects were found for distress (Cohen's d 0.75), global QoL (subscale European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, Cohen's d 0.46), resolving problems with social functioning and finding information (subscales EORTC QLQ-GINET 21, Cohen's d 0.69, respectively, 1.04), and feeling informed (subscale empowerment questionnaire, Cohen's d 0.51). The interview indicated that the web-based system was of additional value to standard care. Use of this web-based system is feasible. Contradictory effects on informing and supporting NET patients were found and should be subject of further research. NCT01849523.

[Development and evaluation of a dance-based exercise therapy for patients with haemophilia].

Science.gov (United States)

Czepa, D; van Ravenstein, S; Stäuber, F; Hilberg, T

2013-01-01

So far, the use of methods derived from creative arts has not been considered in the haemophilia treatment. The AIM was to investigate the expectations for a dance-based exercise therapy for patients with haemophilia and the extent of its acceptance. The one-hour dance-based exercise therapy was offered to 30 haemophilia patients (HI30) (49 ± 11, 30-67 years). For the evaluation of expectations, questionnaires were created and filled out by participants before and after the intervention. Additionally, 19 haemophilia patients (HF) and 20 controls without haemophilia (KF) who did not participate in the intervention were also questioned. The RESULTS show that haemophilia patients have more experience in dance than controls (HI30:62%, HF:74%, KF:45%). In contrast, the proportion of those who are currently dancing is higher in controls without haemophilia (HI30: 17%, HF: 10%, KF:26%). The termination of dance activity in patients with haemophilia who were part of the intervention was mainly due to pain (HI30: 40%, HF: 29%, KF: 0%), whereby controls without intervention terminated the dance activity mainly due to lack of time (HI30: 30%, HF: 57%, KF: 56%). Ultimately, 24 out of 30 patients with haemophilia (HI24) completed the intervention. All HI24 met their expectations. 38% felt limited by haemophilia while carrying out the exercises. The majority of the participants were able to follow the exercises well (96%) and were did not overstrain physically (92%) nor mentally (87%), also 79% did not have pain. 23 of HI24 (96%) can envision a continuation of the dance-based exercise therapy. The experience with the dance-based exercise therapy was predominantly positive. It represents an alternative sports therapy programme for patients with haemophilia. Further studies are needed in order to make statements concerning the long-term use of such training.

Watts Bar Unit 2 Startup Results with VERA

Energy Technology Data Exchange (ETDEWEB)

Godfrey, Andrew T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Collins, Benjamin S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Gentry, Cole A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Stimpson, Shane G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Ritchie, John A. [Tennessee Valley Authority (TVA), Knoxville, TN (United States)

2017-03-01

CASL members TVA, Westinghouse, and Oak Ridge National Laboratory have successfully completed a detailed simulation of the initial startup of Watts Bar Nuclear Unit 2 (WBN2) using the advanced reactor simulation tools known as VERA. WBN2 is the first commercial power reactor to join the nation’s electrical grid in over two decades, and the modern core design and availability of data make it an excellent benchmark for CASL. Calculations were performed three months prior to the startup, and in the first blind application of VERA to a new reactor, predicted criticality and physics parameters very close to those later measured by TVA. Subsequent calculations with the latest version of VERA and using exact measurement conditions improved the results even further.

ANALISA DAMPAK KONVERGENSI IFRS KE DALAM PSAK 13, 16, DAN 30 TERHADAP AKTIVITAS PERDAGANGAN SAHAM PERUSAHAAN YANG TERDAFTAR DI BURSA EFEK INDONESIA

Directory of Open Access Journals (Sweden)

Arya Maulana

2014-03-01

Full Text Available The application of PSAK has been revised in reference with the IAS in the convergence of IFRS perspective. The objective of the research is to elaborate influence of this application on Trading Volume Activity (TVA companies that implement it. This research uses quantitative method that focus to a single incident within a certain period of publication an annual financial statements of 56 companies who implemented PSAK 13, 16, and 30 revised in 2007. This study indicates that the publication of financial statements has not give a significant influence on the TVA despite there is an increase in trading activity at the time after publication.JEL Classification : M 41, L51Keywords : IAS, PSAK, Financial Statement Publication, Trading Volume Activity

Identifying medication-related needs of HIV patients: foundation for community pharmacist-based services

Directory of Open Access Journals (Sweden)

Yardlee Kauffman

2014-01-01

Full Text Available Background: Patients living with HIV/AIDS have complex medication regimens. Pharmacists within community pharmacy settings can have a role managing patients living with HIV/AIDS. Patients' perspectives surrounding implementation about community pharmacist-based services is needed as limited information is available. Objective: To identify medication-related needs of HIV-infected patients who receive prescriptions from a community pharmacy. To determine patient perspectives and knowledge of community pharmacist-based services. Methods: A qualitative research study involving in-depth, semi-structured interviews with patients was conducted. Inclusion criteria included: HIV positive men and women at least 18 years of age who receive care at a HIV clinic, currently take medication(s and use a community pharmacy for all prescription fills. Patients were recruited from one urban and one rural health center. Patients answered questions about their perceptions and knowledge about the role and value of pharmacy services and completed a demographic survey. The recordings of the interviews were transcribed verbatim and were analyzed using principles of Grounded Theory. Results: Twenty-nine interviews were conducted: 15 participants from the urban site and 14 from the rural site. Five main themes emerged including: patients experience ongoing and varying medication-related needs; patients desire a pharmacist who is caring, knowledgeable and integrated with health care providers; patients expect ready access to drug therapy; patients value an individualized patient encounter, and patients need to be informed that a pharmacist-service exists. Conclusion: Patients with HIV value individualized and personal encounters with pharmacists at time intervals that are convenient for the patient. Patients felt that a one-on-one encounter with a pharmacist would be most valuable when initiating or modifying medication therapy. These patient perspectives can be useful for

Feasibility of Cisplatin-Based Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer Patients With Diminished Renal Function.

Science.gov (United States)

Koshkin, Vadim S; Barata, Pedro C; Rybicki, Lisa A; Zahoor, Haris; Almassi, Nima; Redden, Alicia M; Fergany, Amr F; Kaouk, Jihad; Haber, Georges-Pascal; Stephenson, Andrew J; Ornstein, Moshe C; Gilligan, Timothy; Garcia, Jorge A; Rini, Brian I; Grivas, Petros

2018-02-22

Cisplatin-based neoadjuvant chemotherapy (NAC) before radical cystectomy is the standard of care in muscle-invasive bladder cancer. There are limited data regarding chemotherapy tolerability and outcomes for patients with low glomerular filtration rate (GFR) who receive cisplatin-based NAC. A retrospective analysis of patients who received cisplatin-based NAC at Cleveland Clinic (2005-2016) was undertaken. Patients with pre-NAC GFR < 60 mL/min by either Cockcroft-Gault (CG) or Modification of Diet in Renal Disease (MDRD) formula were compared to patients with GFR ≥ 60 mL/min for NAC tolerability, pathologic complete and partial response (pPR), and the ability to undergo radical cystectomy. Thirty patients with low GFR (34-59 mL/min) and 94 patients with normal GFR (≥ 60 mL/min) were identified. Low GFR patients were older (median, 71 vs. 65 years), but other demographic and transurethral resection of bladder tumor characteristics were comparable. Low GFR patients more frequently had early NAC discontinuation (30% vs. 13%), NAC modifications (delays, dose reduction, or discontinuation, 66% vs. 40%), and cisplatin-based NAC administered in split doses (37% vs. 16%). No differences in NAC tolerability or outcomes were noted among low GFR patients receiving split-dose versus standard regimens. No differences were noted between low and normal GFR patients in NAC cycles (median, 3 for each), cystectomy rates (93% for each), time to cystectomy, and GFR change from baseline to after NAC. Pathologic complete response was higher among normal GFR patients (24% vs. 14%). Patients with low GFR had more NAC discontinuations and modifications, but most completed planned NAC cycles. For carefully selected patients with GFR < 60 mL/min, cisplatin-based NAC remains a treatment option. Copyright © 2018 Elsevier Inc. All rights reserved.

An information-motivation-behavioral skills (IMB) model-based intervention for CABG patients.

Science.gov (United States)

Zarani, Fariba; Besharat, Mohammad Ali; Sarami, Gholamreza; Sadeghian, Saeed

2012-12-01

In order to benefit from a coronary artery bypass graft (CABG) surgery, patients must adhere to medical recommendations and health advices. Despite the importance of adherence in CABG patients, adherence rates are disappointingly low. Despite the low adherence rates, very few articles regarding adherence-enhancing intervention among heart patients have been published. The goal of this study was to assess the effects of the Information-Motivation-Behavioral Skills (IMB) model-based intervention on the IMB model constructs among patients undergoing CABG and to evaluate the relationship of information, motivation, and behavioral skills with adherence. A total of 152 CABG patients were randomly assigned to either an intervention group or to a standard care control group. Participants completed pretest measures and were reassessed 1 month later. Findings showed mixed support for the effectiveness of the intervention. There was a significant effect of IMB intervention on information and motivation of patients, but no significant effect on behavioral skills. Furthermore, the results revealed that intervention constructs (information, motivation, and behavioral skills) were significantly related to patients' adherence. Findings provided initial evidence for the effectiveness of IMB-based interventions on the IMB constructs and supported the importance of these constructs to improve adherence; however, there are additional factors that need to be identified in order to improve behavioral skills more effectively.

Uptake of tenofovir-based antiretroviral therapy among HIV-HBV-coinfected patients in the EuroSIDA study

DEFF Research Database (Denmark)

Peters, Lars; Mocroft, Amanda; Grint, Daniel

2018-01-01

BACKGROUND: According to guidelines all HIV/HBV co-infected patients should receive tenofovir-based combination antiretroviral therapy (cART). We aimed to investigate uptake and outcomes of tenofovir-based cART among HIV/HBV patients in the EuroSIDA study. METHODS: All HBsAg+ patients followed up...

Race-based differences in length of stay among patients undergoing pancreatoduodenectomy.

Science.gov (United States)

Schneider, Eric B; Calkins, Keri L; Weiss, Matthew J; Herman, Joseph M; Wolfgang, Christopher L; Makary, Martin A; Ahuja, Nita; Haider, Adil H; Pawlik, Timothy M

2014-09-01

Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined. Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS. Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P < .001) and by medium- to high-volume surgeons (OR 1.62, P < .001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P = .250). After adjustment, black (OR 1.36, P = .010) and Hispanic (OR 1.68, P < .001) patients were more likely to have a greater LOS after PD. Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients. Copyright © 2014 Mosby, Inc. All rights reserved.

External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy

International Nuclear Information System (INIS)

Beetz, Ivo; Schilstra, Cornelis; Luijk, Peter van; Christianen, Miranda E.M.C.; Doornaert, Patricia; Bijl, Henk P.; Chouvalova, Olga; Heuvel, Edwin R. van den; Steenbakkers, Roel J.H.M.; Langendijk, Johannes A.

2012-01-01

Purpose: The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER 6M ) and sticky saliva (STIC 6M ) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER 6M consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC 6M consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R 2 Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer–Lemeshow “goodness-of-fit” test. Results: Overall model performance of the 3D-CRT based predictive models for XER 6M and STIC 6M was significantly worse in terms of the Brier score and R 2 Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer–Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. Conclusion: 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or

Mobile patient feedback through continued monitoring and guideline-based decision support

OpenAIRE

Hernando Pérez, María Elena; Martínez Sarriegui, Iñaki; García Sáez, Gema; Quaglini, Silvana; Rigla Cros, Mercedes; Napolitano, Carlo

2015-01-01

This paper demonstrates the MobiGuide mobile application that provides patients with guideline-based feedback personalized to their health state, preferences, social context and technological context. Patients? state and compliance are observed through the continued monitorization of physiological and lifestyle parameters: blood glucose, physical activity, ECG, heart rate and blood pressure. The Smartphone application is generic and has a modular structure to allow reusing system components i...

The effect of weight-based chemotherapy dosing in a cohort of gynecologic oncology patients.

Science.gov (United States)

Hansen, Jean; Stephan, Jean-Marie; Freesmeier, Michele; Bender, David; Button, Anna; Goodheart, Michael J

2015-07-01

Many clinicians limit chemotherapy doses based on a maximum body surface area (BSA) of 2m(2). We sought to determine how chemotherapy-related toxicities compared between groups of patients that varied with respect to BSA. We hypothesized that obese patients receiving weight-based (WB) dosing would not have significantly higher chemotherapy-related toxicities than control groups. We performed a retrospective review of patients with BSA≥2m(2) who received WB chemotherapy for a gynecologic cancer between January and August 2013. Subjects were matched with two controls: patients with BSAGynecologic cancer patients with BSA≥2m(2) treated with WB chemotherapy had no increase in hematologic or non-hematologic toxicities when compared to controls. Consideration should be given to using WB dosing in obese patients with gynecologic malignancies. Further investigation is required to determine the effect of WB dosing on progression-free and overall survival in obese gynecologic cancer patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Platinum-based chemotherapy with or without thoracic radiation therapy in patients with unresectable thymic carcinoma

International Nuclear Information System (INIS)

Nakamura, Yoichi; Kunitoh, Hideo; Kubota, Kaoru

2000-01-01

Thymic carcinoma is a rare mediastinal neoplasm with poor prognosis. Although the clinical benefit of chemotherapy for thymic carcinoma is controversial, cisplatin-based chemotherapy with or without radiation therapy is ordinarily adopted in advanced cases. We evaluated the clinical outcome of platinum-based chemotherapy with or without radiation therapy in unresectable thymic carcinoma patients. Ten patients with unresectable thymic carcinoma were treated with platinum-based chemotherapy with or without radiation therapy in the National Cancer Center Hospital between 1989 and 1998. We reviewed the histological type, treatment, response and survival of these patients. Four of the 10 patients responded to chemotherapy and both the median progression-free survival period and the median response duration were 6.0 months. The median survival time was 11.0 months. There was no relationship between histological classification and prognosis. Platinum-based chemotherapy with or without thoracic radiation is, regardless of tumor histology, marginally effective in advanced thymic carcinoma patients, giving only a modest tumor response rate and short response duration and survival. (author)

land- and water-based exercises in rheumatoid arthritis patients: a ...

African Journals Online (AJOL)

Apart from the direct consequences of the disease on the function ... stiffness of the joints, muscle weakness and cardiorespiratory de- ... Methods. Patients with RA Functional Class I and II (N=10) were randomly assigned to a land-based ...

[On the "folkloric" psychotherapy to schizophrenic patients--based on phenomenological study].

Science.gov (United States)

Yamada, T; Yamada, Y

1998-01-01

Psychotherapeutic treatment of schizophrenia is generally considered difficult. One reason for this is that the doctor and patient can easily fall into a relationship of conflict with each other concerning the propriety of "judgments which are morbidly and mistakenly made (K. Jaspers)", referred to as delusions. We carried out close phenomenological structure-analyses of the delusions and of patients' fundamental experiences, based on the premise that a patient with delusions probably has some actual grounding for these in the patient's own concepts, considering the fact that the patient firmly believes these delusions. As a result, we have clarified the following matters from the primary experience of delusions. 1) We found that patients are in a conflicted mental condition which can be considered a collapse of adaptability to "Seken". 2) In this condition of conflict, patients feel guilt relative to "Seken" or feel that they are indebted and should be punished. When patients complained of their primary experience, we were able to persuade them to reserve their judgment of their primary experience, by 3) having each patient listen to the folktale "Torikuyou" in which the "logic of stealing" and the "logic of being stolen", appear in a reciprocal relationship relative to the constitution of crime and punishment, by 4) explaining to each patient about the ambiguity and reciprocity of reality experienced, 5) instead of disputing the propriety of patient's judgment about primary experience, doctor and patient worked together to enable the patient to form a positive understanding of the primary experience. 6) We reduced the patient's psychological conflict relative to primary experience, and were able to defuse and distance the patient's delusions caused by erroneous judgment of primary experience. 7) Regarding the area in which this type of psychotherapeutic approach shows efficacy, we analyzed the concept of "Seken" as a world which can cause conflicts relative to

Recruiting former melanoma patients via hospitals in comparison to office-based dermatologists in a register-based cohort study that required indirect contact

Directory of Open Access Journals (Sweden)

S. R. Zeissig

2017-11-01

Full Text Available Abstract Background There are detailed reviews about different recruitment strategies, but not with regard to differences between recruitment of hospital-based versus office-based physicians. Within this study, the two different recruitment schemes are compared. Advantages and disadvantages of different ways of recruitment in registry-based studies are discussed. Methods In a cross-sectional cancer-registry-based study, long-term melanoma patients were contacted by dermatologists rather than directly by the registry on the basis of the legal situation. Logistic regression models and generalized estimating equations were used to assess effects of various patient and physician characteristics on participation and data quality. Especially differences between hospital-based versus office-based dermatologists are evaluated. Results Seventy two out of 112 contacted dermatologists took part in the study (64.3%. The cooperation proportion was 52.2% (689 participants/1320 contacted patients. Participants and non-participants differed regarding age and sex, but not regarding other social demographic factors and cancer stage. We did not observe a difference in patient participation between hospital-based versus office-based dermatologists (OR 1.08 [CI 0.84–1.39]; p = 0.57. However, medical data provided by the cancer registry were better for participants registered and recruited by hospitals. Conclusions In cohort studies with epidemiological cancer registries, recruitment via physicians has potential disadvantages and is more complex. If this indirect way of contact is mandatory, we recommend recruitment procedures including hospital-based rather than office-based physicians. However, physician characteristics were not associated with outcome.

Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.

Science.gov (United States)

Mishuris, Rebecca G; Stewart, Max; Fix, Gemmae M; Marcello, Thomas; McInnes, D Keith; Hogan, Timothy P; Boardman, Judith B; Simon, Steven R

2015-12-01

Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them. To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services. Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory. Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members. We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV. Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use. © 2014 John Wiley & Sons Ltd.

Understanding the allocation of attention when faced with varying perceptual load in partial report: a computational approach.

Science.gov (United States)

Kyllingsbæk, Søren; Sy, Jocelyn L; Giesbrecht, Barry

2011-05-01

The allocation of visual processing capacity is a key topic in studies and theories of visual attention. The load theory of Lavie (1995) proposes that allocation happens in two steps where processing resources are first allocated to task-relevant stimuli and secondly remaining capacity 'spills over' to task-irrelevant distractors. In contrast, the Theory of Visual Attention (TVA) proposed by Bundesen (1990) assumes that allocation happens in a single step where processing capacity is allocated to all stimuli, both task-relevant and task-irrelevant, in proportion to their relative attentional weight. Here we present data from two partial report experiments where we varied the number and discriminability of the task-irrelevant stimuli (Experiment 1) and perceptual load (Experiment 2). The TVA fitted the data of the two experiments well thus favoring the simple explanation with a single step of capacity allocation. We also show that the effects of varying perceptual load can only be explained by a combined effect of allocation of processing capacity as well as limits in visual working memory. Finally, we link the results to processing capacity understood at the neural level based on the neural theory of visual attention by Bundesen et al. (2005). Copyright © 2010 Elsevier Ltd. All rights reserved.

Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine.

Science.gov (United States)

Bensing, J

2000-01-01

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and

Feasibility of the evidence-based cognitive telerehabilitation program Remind for patients with primary brain tumors.

Science.gov (United States)

van der Linden, Sophie D; Sitskoorn, Margriet M; Rutten, Geert-Jan M; Gehring, Karin

2018-05-01

Many patients with primary brain tumors experience cognitive deficits. Cognitive rehabilitation programs focus on alleviating these deficits, but availability of such programs is limited. Our large randomized controlled trial (RCT) demonstrated positive effects of the cognitive rehabilitation program developed by our group. We converted the program into the iPad-based cognitive rehabilitation program ReMind, to increase its accessibility. The app incorporates psychoeducation, strategy training and retraining. This pilot study in patients with primary brain tumors evaluates the feasibility of the use of the ReMind-app in a clinical (research) setting in terms of accrual, attrition, adherence and patient satisfaction. The intervention commenced 3 months after resective surgery and patients were advised to spend 3 h per week on the program for 10 weeks. Of 28 eligible patients, 15 patients with presumed low-grade glioma or meningioma provided informed consent. Most important reason for decline was that patients (7) experienced no cognitive complaints. Participants completed on average 71% of the strategy training and 76% of the retraining. Some patients evaluated the retraining as too easy. Overall, 85% of the patients evaluated the intervention as "good" or "excellent". All patients indicated that they would recommend the program to other patients with brain tumors. The ReMind-app is the first evidence-based cognitive telerehabilitation program for adult patients with brain tumors and this pilot study suggests that postoperative cognitive rehabilitation via this app is feasible. Based on patients' feedback, we have expanded the retraining with more difficult exercises. We will evaluate the efficacy of ReMind in an RCT.

Third annual Walker Branch Watershed research symposium. Program and abstracts

Energy Technology Data Exchange (ETDEWEB)

1992-03-01

The methods and concepts of watershed research, originally applied in an experimental or monitoring mode to relatively small catchments, are increasingly being used at larger scales and for specific applied problems. Research at Oak Ridge National Laboratory, the Tennessee Valley Authority, the US Forest Service, and other agencies and institutions participating in this symposium reflects research over a broad range of spatial scales that is being integrated through large-scale experiments along with computer modeling and graphical interfaces. These research projects address the basic atmospheric, geophysical, biogeochemical, and biological processes that regulate the responses of forested ecosystems to natural environmental variation and anthropogenic stresses. Regional and global issues addressed by presentations include emissions of carbon dioxide, methane, and other hydrocarbons; deposition of sulfate, nitrate, and mercury; land-use changes; biological diversity; droughts; and water quality. The reports presented in this symposium illustrate a wide range of methods and approaches and focus more on concepts and techniques than on a specific physical site. Sites and projects that have contributed research results to this symposium include Walker Branch Watershed (DOE), the Coweeta Hydrologic Laboratory and LTER site (USFS and NSF), Great Smoky Mountains National Park (research funded by NPS, TVA, and EPRI), Imnavait Creek, Alaska (DOE), the TVA-Norris Whole-tree Facility (TVA and EPRI), and DOE`s Biomass Program.

Barge loading facilities in conjunction with wood chipping and sawlog mill, Tennessee River Mile 145. 9R: Environmental assessment

Energy Technology Data Exchange (ETDEWEB)

1990-08-01

The purpose of this Environmental Assessment (EA) is to evaluate the environmental consequences of approving, denying, or adopting reasonable alternatives to a request for barge loading facilities. These facilities would serve a proposed wood chipping and sawlog products operation at Tennessee River Mile (TRM) 145.9, right descending bank, (Kentucky Lake), in Perry County, Tennessee. The site is located between Short Creek and Peters Landing. The applicant is Southeastern Forest Products, L.P. (SFP), Box 73, Linden, Tennessee and the proposed facilities would be constructed on or adjacent to company owned land. Portions of the barge terminal would be constructed on land over which flood easement rights are held by the United States of America and administered by the Tennessee Valley Authority (TVA). The US Army Corps of Engineers (CE) and TVA have regulatory control over the proposed barge terminal facilities since the action would involve construction in the Tennessee River which is a navigable water of the United States. The wood chipping and sawlog products facilities proposed on the upland property are not regulated by the CE or TVA. On the basis of the analysis which follows, it has been determined that a modified proposal (as described herein) would not significantly affect the quality of the human environment, and does not require the preparation of an environmental impact statement. 8 refs.

Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

Science.gov (United States)

Langenau, Erik; Kachur, Elizabeth; Horber, Dot

2014-07-01

Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Enhancing requirements engineering for patient registry software systems with evidence-based components.

Science.gov (United States)

Lindoerfer, Doris; Mansmann, Ulrich

2017-07-01

Patient registries are instrumental for medical research. Often their structures are complex and their implementations use composite software systems to meet the wide spectrum of challenges. Commercial and open-source systems are available for registry implementation, but many research groups develop their own systems. Methodological approaches in the selection of software as well as the construction of proprietary systems are needed. We propose an evidence-based checklist, summarizing essential items for patient registry software systems (CIPROS), to accelerate the requirements engineering process. Requirements engineering activities for software systems follow traditional software requirements elicitation methods, general software requirements specification (SRS) templates, and standards. We performed a multistep procedure to develop a specific evidence-based CIPROS checklist: (1) A systematic literature review to build a comprehensive collection of technical concepts, (2) a qualitative content analysis to define a catalogue of relevant criteria, and (3) a checklist to construct a minimal appraisal standard. CIPROS is based on 64 publications and covers twelve sections with a total of 72 items. CIPROS also defines software requirements. Comparing CIPROS with traditional software requirements elicitation methods, SRS templates and standards show a broad consensus but differences in issues regarding registry-specific aspects. Using an evidence-based approach to requirements engineering for registry software adds aspects to the traditional methods and accelerates the software engineering process for registry software. The method we used to construct CIPROS serves as a potential template for creating evidence-based checklists in other fields. The CIPROS list supports developers in assessing requirements for existing systems and formulating requirements for their own systems, while strengthening the reporting of patient registry software system descriptions. It may be

Patient's experience with blended video- and internet based cognitive behavioural therapy service in routine care

Directory of Open Access Journals (Sweden)

Anne Etzelmueller

2018-06-01

Full Text Available Introduction: Internet-based guided self-help and face-to-face CBT have shown to be effective in the treatment of depression, but both approaches might not be an available treatment option for all patients. A treatment which blends internet-based guided self-help with video-based psychotherapy might reduce potential disadvantages of both approaches, while maintaining major advantages such as being location-independent. Additionally, it could provide a stronger focus on patient empowerment and lower resource use compared to traditional face-to-face treatment. Aim: The aim of this study is to evaluate patient's experiences with blended internet- and video-based CBT (blended iCBT treatment and to derive suggestions for the improvement of such services. Methods: Semi-structured interviews were conducted with 15 participants of the blended iCBT treatment as part of the European MasterMind trial. Participants included adults suffering from Major Depressive Disorder. The interview guide assessed patient's experiences regarding the four treatment components program, 1. face-to-face diagnostic interviews, 2. video-based synchronous therapy sessions (VTS, 3. online self-help treatment modules (OTM as well as 4. behaviour diaries and symptom monitoring. Interviews were analyzed using the framework method and outcomes regarding connections within and between participants and categories were generated by counting the statements within relevant themes. Results: Overall, patients indicated to have been satisfied with all components of the treatment, highlighting the option to independently work from home in their own pace. While the OTMs allowed for a deeper reflection of the content, the VTS with the therapist were mentioned to provide the personal character of the service. The working alliance with the therapist was experienced as fostering the individual fit of the treatment. Patients reported a high self-perceived treatment effectiveness. Negative effects

A Systematic Approach to Find a Professional Audiology Clinic: Patient-Based Information

Science.gov (United States)

Kim, Gungu; Kim, Gibbeum; Na, Wondo

2016-01-01

This brief communication introduced a systematic way to find a professional audiology clinic developed for patients and professionals by the American Academy of Audiology, American Speech-Language-Hearing Association, and Healthy Hearing. Patients can access each organization's website to find professionals and/or clinics based on criteria such as location, hours, special areas, types of service, reviews and rating by previous patients, and kinds of insurance accepted. Such a system may protect the patients from information overload, guarantee accurate information, and help them find themselves professional audiologists who can assist them. We expect professional organizations to adopt this system as soon as possible and link hearing-impaired patients with professional audiologists in Korea. PMID:27626086

An investigation of a video-based patient repositioning technique

International Nuclear Information System (INIS)

Yan Yulong; Song Yulin; Boyer, Arthur L.

2002-01-01

Purpose: We have investigated a video-based patient repositioning technique designed to use skin features for radiotherapy repositioning. We investigated the feasibility of the clinical application of this system by quantitative evaluation of performance characteristics of the methodology. Methods and Materials: Multiple regions of interest (ROI) were specified in the field of view of video cameras. We used a normalized correlation pattern-matching algorithm to compute the translations of each ROI pattern in a target image. These translations were compared against trial translations using a quadratic cost function for an optimization process in which the patient rotation and translational parameters were calculated. Results: A hierarchical search technique achieved high-speed (compute correlation for 128x128 ROI in 512x512 target image within 0.005 s) and subpixel spatial accuracy (as high as 0.2 pixel). By treating the observed translations as movements of points on the surfaces of a hypothetical cube, we were able to estimate accurately the actual translations and rotations of the test phantoms used in our experiments to less than 1 mm and 0.2 deg. with a standard deviation of 0.3 mm and 0.5 deg. respectively. For human volunteer cases, we estimated the translations and rotations to have an accuracy of 2 mm and 1.2 deg. Conclusion: A personal computer-based video system is suitable for routine patient setup of fractionated conformal radiotherapy. It is expected to achieve high-precision repositioning of the skin surface with high efficiency

Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer

Science.gov (United States)

Zhang, Mei-Fen; Wen, Yong-Shan; Liu, Wei-Yan; Peng, Li-Fen; Wu, Xiao-Dan; Liu, Qian-Wen

2015-01-01

Abstract Anxiety and depression are common among patients with cancer, and are often treated with psychological interventions including mindfulness-based therapy. The aim of the study was to perform a meta-analysis of the effectiveness of mindfulness-based interventions for improving anxiety and depression in patients with cancer. Medline, the Cochrane Library, EMBASE, and Google Scholar were searched. The randomized controlled trials designed for patients diagnosed with cancer were included. Mindfulness-based interventions were provided. The outcomes assessed were the changes in anxiety and depression scores from before to after the intervention. The treatment response was determined by calculating the standardized mean difference (SMD) for individual studies and for pooled study results. Subgroup analyses by cancer type, type of therapy, and length of follow-up were performed. Seven studies, involving 469 participants who received mindfulness-based interventions and 419 participants in a control group, were included in the meta-analysis. Mindfulness-based stress reduction and art therapy were the most common interventions (5/7 studies). All studies reported anxiety and depression scores. The pooled SMD of the change in anxiety significantly favored mindfulness-based therapy over control treatment (−0.75, 95% confidence interval −1.28, −0.22, P = 0.005). Likewise, the pooled SMD of the change in depression also significantly favored mindfulness-based therapy over control (−0.90, 95% confidence interval −1.53, −0.26, P = 0.006). During the length of follow-ups less than 12 weeks, mindfulness-based therapy significantly improved anxiety for follow-up ≤12 weeks after the start of therapy, but not >12 weeks after the start of therapy. There was a lack of consistency between the studies in the type of mindfulness-based/control intervention implemented. Patients had different forms of cancer. Subgroup analyses included a relatively small number of

Technology-based assessment in patients with disorders of consciousness

Directory of Open Access Journals (Sweden)

Carol Di Perri

2014-09-01

Full Text Available Introduction. A number of studies highlight the difficulty in forming a diagnosis for patients with disorders of consciousness when this is established merely on behavioral assessments. Background. Positron emission tomography (PET, functional magnetic resonance imaging (fMRI, diffusion tensor imaging (DTI, and electroencephalography combined with transcranial magnetic stimulation (TMS-EEG techniques are promoting the clinical characterization of this challenging population. With such technology-based "objective" tools, patients are also differentially able to follow simple commands and in some cases even communicate through modified brain activity. Consequently, the vegetative state and minimally conscious state have been revised and new nosologies have been proposed, namely the unresponsive wakefulness syndrome, the minimally conscious state plus and minus, and the functional locked-in syndrome. Aim. To our mind, an integration of different technical modalities is important to gain a holistic vision of the underlying pathophysiology of disorders of consciousness in general and to promote single-patient medical management in particular.

Patients at the Centre: Methodological Considerations for Evaluating Evidence from Health Interventions Involving Patients Use of Web-Based Information Systems

Science.gov (United States)

Cummings, Elizabeth; Turner, Paul

2010-01-01

Building an evidence base for healthcare interventions has long been advocated as both professionally and ethically desirable. By supporting meaningful comparison amongst different approaches, a good evidence base has been viewed as an important element in optimising clinical decision-making and the safety and quality of care. Unsurprisingly, medical research has put considerable effort into supporting the development of this evidence base, and the randomised controlled trial has become the dominant methodology. Recently however, a body of research has begun to question, not just this methodology per se, but also the extent to which the evidence it produces may marginalise individual patient experiences, priorities and perceptions. Simultaneously, the widespread adoption and utilisation of information systems (IS) in health care has also prompted initiatives to develop a stronger base of evidence about their impacts. These calls have been stimulated both by numerous system failures and research expressing concerns about the limitations of information systems methodologies in health care environments. Alongside the potential of information systems to produce positive, negative and unintended consequences, many measures of success, impact or benefit appear to have little to do with improvements in care, health outcomes or individual patient experiences. Combined these methodological concerns suggest the need for more detailed examination. This is particularly the case, given the prevalence within contemporary clinical and IS discourses on health interventions advocating the need to put the ‘patient at the centre’ by engaging them in their own care and/or ‘empowering’ them through the use of information systems. This paper aims to contribute to these on-going debates by focusing on the socio-technical processes by which patients’ interests and outcomes are measured, defined and evaluated within health interventions that involve them using web-based

Localized intraoperative virtual endoscopy (LIVE) for surgical guidance in 16 skull base patients.

Science.gov (United States)

Haerle, Stephan K; Daly, Michael J; Chan, Harley; Vescan, Allan; Witterick, Ian; Gentili, Fred; Zadeh, Gelareh; Kucharczyk, Walter; Irish, Jonathan C

2015-01-01

Previous preclinical studies of localized intraoperative virtual endoscopy-image-guided surgery (LIVE-IGS) for skull base surgery suggest a potential clinical benefit. The first aim was to evaluate the registration accuracy of virtual endoscopy based on high-resolution magnetic resonance imaging under clinical conditions. The second aim was to implement and assess real-time proximity alerts for critical structures during skull base drilling. Patients consecutively referred for sinus and skull base surgery were enrolled in this prospective case series. Five patients were used to check registration accuracy and feasibility with the subsequent 11 patients being treated under LIVE-IGS conditions with presentation to the operating surgeon (phase 2). Sixteen skull base patients were endoscopically operated on by using image-based navigation while LIVE-IGS was tested in a clinical setting. Workload was quantitatively assessed using the validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire. Real-time localization of the surgical drill was accurate to ~1 to 2 mm in all cases. The use of 3-mm proximity alert zones around the carotid arteries and optic nerve found regular clinical use, as the median minimum distance between the tracked drill and these structures was 1 mm (0.2-3.1 mm) and 0.6 mm (0.2-2.5 mm), respectively. No statistical differences were found in the NASA-TLX indicators for this experienced surgical cohort. Real-time proximity alerts with virtual endoscopic guidance was sufficiently accurate under clinical conditions. Further clinical evaluation is required to evaluate the potential surgical benefits, particularly for less experienced surgeons or for teaching purposes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Acute gastroenteritis: evidence-based management of pediatric patients [digest].

Science.gov (United States)

Brady, KeriAnne; Pade, Kathryn H

2018-02-01

Although most cases of acute gastroenteritis require minimal medical intervention, severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This issue reviews the common etiologies of acute gastroenteritis, discusses more-severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in patients with mild-to-moderate dehydration, severe dehydration, and hypoglycemia. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

Patient-directed Internet-based Medical Image Exchange: Experience from an Initial Multicenter Implementation.

Science.gov (United States)

Greco, Giampaolo; Patel, Anand S; Lewis, Sara C; Shi, Wei; Rasul, Rehana; Torosyan, Mary; Erickson, Bradley J; Hiremath, Atheeth; Moskowitz, Alan J; Tellis, Wyatt M; Siegel, Eliot L; Arenson, Ronald L; Mendelson, David S

2016-02-01

Inefficient transfer of personal health records among providers negatively impacts quality of health care and increases cost. This multicenter study evaluates the implementation of the first Internet-based image-sharing system that gives patients ownership and control of their imaging exams, including assessment of patient satisfaction. Patients receiving any medical imaging exams in four academic centers were eligible to have images uploaded into an online, Internet-based personal health record. Satisfaction surveys were provided during recruitment with questions on ease of use, privacy and security, and timeliness of access to images. Responses were rated on a five-point scale and compared using logistic regression and McNemar's test. A total of 2562 patients enrolled from July 2012 to August 2013. The median number of imaging exams uploaded per patient was 5. Most commonly, exams were plain X-rays (34.7%), computed tomography (25.7%), and magnetic resonance imaging (16.1%). Of 502 (19.6%) patient surveys returned, 448 indicated the method of image sharing (Internet, compact discs [CDs], both, other). Nearly all patients (96.5%) responded favorably to having direct access to images, and 78% reported viewing their medical images independently. There was no difference between Internet and CD users in satisfaction with privacy and security and timeliness of access to medical images. A greater percentage of Internet users compared to CD users reported access without difficulty (88.3% vs. 77.5%, P Internet-based image-sharing system is feasible and surpasses the use of CDs with respect to accessibility of imaging exams while generating similar satisfaction with respect to privacy. Copyright © 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring.

Science.gov (United States)

Seto, Emily; Leonard, Kevin J; Masino, Caterina; Cafazzo, Joseph A; Barnsley, Jan; Ross, Heather J

2010-11-29

Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology. The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring. A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology. The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (Pmobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications. Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal

Development of a Nursing Handoff Tool: A Web-Based Application to Enhance Patient Safety

Science.gov (United States)

Goldsmith, Denise; Boomhower, Marc; Lancaster, Diane R.; Antonelli, Mary; Kenyon, Mary Anne Murphy; Benoit, Angela; Chang, Frank; Dykes, Patricia C.

2010-01-01

Dynamic and complex clinical environments present many challenges for effective communication among health care providers. The omission of accurate, timely, easily accessible vital information by health care providers significantly increases risk of patient harm and can have devastating consequences for patient care. An effective nursing handoff supports the standardized transfer of accurate, timely, critical patient information, as well as continuity of care and treatment, resulting in enhanced patient safety. The Brigham and Women’s/Faulkner Hospital Healthcare Information Technology Innovation Program (HIP) is supporting the development of a web based nursing handoff tool (NHT). The goal of this project is to develop a “proof of concept” handoff application to be evaluated by nurses on the inpatient intermediate care units. The handoff tool would enable nurses to use existing knowledge of evidence-based handoff methodology in their everyday practice to improve patient care and safety. In this paper, we discuss the results of nursing focus groups designed to identify the current state of handoff practice as well as the functional and data element requirements of a web based Nursing Handoff Tool (NHT). PMID:21346980

18 CFR 1304.205 - Other water-use facilities.

Science.gov (United States)

2010-04-01

... concrete is allowable; asphalt is not permitted. (b) Tables or benches for cleaning fish are permitted on... TVA. (3) Buoys must conform to the Uniform State Waterway Marking system. (f) Structures shall not be...

Patients' Data Management System Protected by Identity-Based Authentication and Key Exchange.

Science.gov (United States)

Rivero-García, Alexandra; Santos-González, Iván; Hernández-Goya, Candelaria; Caballero-Gil, Pino; Yung, Moti

2017-03-31

A secure and distributed framework for the management of patients' information in emergency and hospitalization services is proposed here in order to seek improvements in efficiency and security in this important area. In particular, confidentiality protection, mutual authentication, and automatic identification of patients are provided. The proposed system is based on two types of devices: Near Field Communication (NFC) wristbands assigned to patients, and mobile devices assigned to medical staff. Two other main elements of the system are an intermediate server to manage the involved data, and a second server with a private key generator to define the information required to protect communications. An identity-based authentication and key exchange scheme is essential to provide confidential communication and mutual authentication between the medical staff and the private key generator through an intermediate server. The identification of patients is carried out through a keyed-hash message authentication code. Thanks to the combination of the aforementioned tools, a secure alternative mobile health (mHealth) scheme for managing patients' data is defined for emergency and hospitalization services. Different parts of the proposed system have been implemented, including mobile application, intermediate server, private key generator and communication channels. Apart from that, several simulations have been performed, and, compared with the current system, significant improvements in efficiency have been observed.

A New Size-based Platform for Circulating Tumor Cell Detection in Colorectal Cancer Patients.

Science.gov (United States)

Oh, Bo Young; Kim, Jhingook; Lee, Woo Yong; Kim, Hee Cheol

2017-09-01

Circulating tumor cells (CTCs) might play a significant role in cancer progression and metastasis. However, the ability to detect CTCs is limited, especially in cells undergoing epithelial-mesenchymal transition. In this study, we evaluated a new size-based CTC detection platform and its clinical efficacy in colorectal cancer. Blood samples were obtained from 76 patients with colorectal cancer and 20 healthy control subjects for CTC analysis. CTCs were enriched using a high-density microporous chip filter and were detected using a 4-color staining protocol including 4',6-diamidino-2-phenylindole (DAPI) for nucleated cells, CD45 monoclonal antibody (mAb) as a leukocyte marker, and epithelial cell adhesion molecule (EpCAM) mAb or cytokeratin (CK) mAb as an epithelial cell marker. CTC positivity was defined as DAPI-positive (DAPI + )/CD45 - /EpCAM + or CK + cells and clinical outcomes of patients were analyzed according to CTC counts. CTCs were detected in 50 patients using this size-based filtration platform. CTC + patients were more frequently identified with a high level of carcinoembryonic antigen and advanced stage cancer (P = .038 and P = .017, respectively). CTC counts for patients with stage IV cancer (12.47 ± 24.00) were significantly higher than those for patients with cancers that were stage I to III (2.84 ± 5.29; P = .005) and healthy control subjects (0.25 ± 0.55; P colorectal cancer patients. Our results suggest that this new size-based platform has potential for determining prognosis and therapeutic response in colorectal cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

Directory of Open Access Journals (Sweden)

Titis Kurniawan

2011-01-01

Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

Depression among patients with diabetes: A community-based study in South India

Directory of Open Access Journals (Sweden)

Abdullahi S Aminu

2017-01-01

Full Text Available Background: Depression is one of the more common mental health conditions found among people suffering from chronic diseases. Its presence in patients with type 2 diabetes could hinder the adherence to and effectiveness of treatment. Most studies on depression among patients with diabetes are hospital-based suggesting the need for a community-based study to assess the correlates of depression among patients with diabetes. Aim: This study aimed to estimate the prevalence and to identify the factors influencing depression among patients with type 2 diabetes in Udupi taluk situated in southern India. Subjects and Methods: This study recruited 200 patients with type 2 diabetes from both rural and urban areas. Demographic, clinical, and diabetes-related information were collected using a semi-structured questionnaire. Depression was assessed using Patient Health Questionnaire-9; a standardized questionnaire developed in the United States of America and validated in the Indian population. Results: The prevalence of depression among patients with diabetes in the community was found to be 37.5%. Most frequently, depression was mild (42, 21% in nature with severe depression (9, 4.5% seen the least. Several factors were found to be positively associated with depression including female gender, rural residence, unemployment, and the status of being unmarried. The presence of diabetic complications and other chronic diseases such as hypertension and obesity also were found to be associated with depression. Conclusion: Depression was found to be particularly high among the study population. Since depression could significantly hinder patient's adherence to treatment, there is an urgent need for early diagnosis and treatment. This calls for the integration of mental health care into the management of diabetes.

Dietary Interventions in Multiple Sclerosis: Development and Pilot-Testing of an Evidence Based Patient Education Program.

Science.gov (United States)

Riemann-Lorenz, Karin; Eilers, Marlene; von Geldern, Gloria; Schulz, Karl-Heinz; Köpke, Sascha; Heesen, Christoph

2016-01-01

Dietary factors have been discussed to influence risk or disease course of multiple sclerosis (MS). Specific diets are widely used among patients with MS. To design and pilot-test an evidence based patient education program on dietary factors in MS. We performed a systematic literature search on the effectiveness of dietary interventions in MS. A web-based survey among 337 patients with MS and 136 healthy controls assessed knowledge, dietary habits and information needs. An interactive group education program was developed and pilot-tested. Fifteen randomised-controlled trials (RCTs) were included in the systematic review. Quality of evidence was low and no clear benefit could be seen. Patients with MS significantly more often adhered to a `Mediterranean Diet`(29.7% versus 14.0%, ppilot test of our newly developed patient education program with 13 participants showed excellent comprehensibility and the MS-specific content was judged as very important. However, the poor evidence base for dietary approaches in MS was perceived disappointing. Development and pilot-testing of an evidence-based patient education program on nutrition and MS is feasible. Patient satisfaction with the program suffers from the lack of evidence. Further research should focus on generating evidence for the potential influence of lifestyle habits (diet, physical activity) on MS disease course thus meeting the needs of patients with MS.

Master plan: Guntersville Reservoir Aquatic Plant Management. Executive summary

Energy Technology Data Exchange (ETDEWEB)

1992-12-31

In 1989, Congress provided funding to start a five-year comprehensive project to manage aquatic plants in Guntersville Reservoir, to be jointly implemented by the US Army Corps of Engineers (Corps) and Tennessee Valley Authority (TVA). TVA serves as the overall project coordinator and is the lead agency for this project. Known as the Joint Agency Guntersville Project (JAGP), the project will test and demonstrate innovative management technologies, and incorporate the most effective technologies into a comprehensive aquatic plant management plan for Guntersville Reservoir. The JAGP is intended to serve as a National Demonstration Project for aquatic plant management. As part of this JAGP, the Master Plan for Aquatic Plant Management for the Guntersville Reservoir Project, Alabama-Tennessee is authorized by Corps Contract Number DACW62-90-C-0067.

The Clean Coal Technology Program 100 MWe demonstration of gas suspension absorption for flue gas desulfurization

Energy Technology Data Exchange (ETDEWEB)

Hsu, F.E.; Hedenhag, J.G. [AirPol Inc., Teterboro, NJ (United States); Marchant, S.K.; Pukanic, G.W. [Dept. of Energy, Pittsburgh, PA (United States). Pittsburgh Energy Technology Center; Norwood, V.M.; Burnett, T.A. [Tennessee Valley Authority, Chattanooga, TN (United States)

1997-12-31

AirPol Inc., with the cooperation of the Tennessee Valley Authority (TVA) under a Cooperative Agreement with the United States Department of Energy, installed and tested a 10 MWe Gas Suspension Absorption (GSA) Demonstration system at TVA`s Shawnee Fossil Plant near Paducah, Kentucky. This low-cost retrofit project demonstrated that the GSA system can remove more than 90% of the sulfur dioxide from high-sulfur coal-fired flue gas, while achieving a relatively high utilization of reagent lime. This paper presents a detailed technical description of the Clean Coal Technology demonstration project. Test results and data analysis from the preliminary testing, factorial tests, air toxics texts, 28-day continuous demonstration run of GSA/electrostatic precipitator (ESP), and 14-day continuous demonstration run of GSA/pulse jet baghouse (PJBH) are also discussed within this paper.

Words Do Come Easy (Sometimes)

DEFF Research Database (Denmark)

Starrfelt, Randi; Petersen, Anders; Vangkilde, Signe Allerup

multiple stimuli are presented simultaneously: Are words treated as units or wholes in visual short term memory? Using methods based on a Theory of Visual Attention (TVA), we measured perceptual threshold, visual processing speed and visual short term memory capacity for words and letters, in two simple...... a different pattern: Letters are perceived more easily than words, and this is reflected both in perceptual processing speed and short term memory capacity. So even if single words do come easy, they seem to enjoy no advantage in visual short term memory....

Efficacy of tegafur-uracil in advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy.

Science.gov (United States)

Maolake, Aerken; Izumi, Kouji; Takahashi, Rie; Itai, Shingo; Machioka, Kazuaki; Yaegashi, Hiroshi; Nohara, Takahiro; Kitagawa, Yasuhide; Kadono, Yoshifumi; Konaka, Hiroyuki; Mizokami, Atsushi; Namiki, Mikio

2015-03-01

Platinum-based chemotherapy is the first-line treatment for advanced urinary tract urothelial cancers. However, the optimal second-line treatment is unclear. Although tegafur-uracil is sometimes used for advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy, there is little evidence regarding its use as a second-line treatment. Advanced urothelial cancer patients previously treated with platinum-based chemotherapy were retrospectively analyzed. Overall survival (OS) was compared between patients with and without tegafur-uracil treatment. Thirty-one patients (27 and 4 patients with and without tegafur-uracil treatment, respectively) were analyzed. OS from the last day of the final chemotherapy course was better in patients with tegafur-uracil treatment than in those without (p<0.001, 358 and 66.5 days of the median survival time, respectively). Tegafur-uracil may be a candidate for the secondary treatment of advanced urothelial cancer patients after the treatment failure of platinum-based chemotherapy. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Effects of virtual reality-based bilateral upper-extremity training on brain activity in post-stroke patients.

Science.gov (United States)

Lee, Su-Hyun; Kim, Yu-Mi; Lee, Byoung-Hee

2015-07-01

[Purpose] This study investigated the therapeutic effects of virtual reality-based bilateral upper-extremity training on brain activity in patients with stroke. [Subjects and Methods] Eighteen chronic stroke patients were divided into two groups: the virtual reality-based bilateral upper-extremity training group (n = 10) and the bilateral upper-limb training group (n = 8). The virtual reality-based bilateral upper-extremity training group performed bilateral upper-extremity exercises in a virtual reality environment, while the bilateral upper-limb training group performed only bilateral upper-extremity exercise. All training was conducted 30 minutes per day, three times per week for six weeks, followed by brain activity evaluation. [Results] Electroencephalography showed significant increases in concentration in the frontopolar 2 and frontal 4 areas, and significant increases in brain activity in the frontopolar 1 and frontal 3 areas in the virtual reality-based bilateral upper-extremity training group. [Conclusion] Virtual reality-based bilateral upper-extremity training can improve the brain activity of stroke patients. Thus, virtual reality-based bilateral upper-extremity training is feasible and beneficial for improving brain activation in stroke patients.

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

Science.gov (United States)

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

2017-01-01

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

Validation of an algorithm-based definition of treatment resistance in patients with schizophrenia.

Science.gov (United States)

Ajnakina, Olesya; Horsdal, Henriette Thisted; Lally, John; MacCabe, James H; Murray, Robin M; Gasse, Christiane; Wimberley, Theresa

2018-02-19

Large-scale pharmacoepidemiological research on treatment resistance relies on accurate identification of people with treatment-resistant schizophrenia (TRS) based on data that are retrievable from administrative registers. This is usually approached by operationalising clinical treatment guidelines by using prescription and hospital admission information. We examined the accuracy of an algorithm-based definition of TRS based on clozapine prescription and/or meeting algorithm-based eligibility criteria for clozapine against a gold standard definition using case notes. We additionally validated a definition entirely based on clozapine prescription. 139 schizophrenia patients aged 18-65years were followed for a mean of 5years after first presentation to psychiatric services in South-London, UK. The diagnostic accuracy of the algorithm-based measure against the gold standard was measured with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). A total of 45 (32.4%) schizophrenia patients met the criteria for the gold standard definition of TRS; applying the algorithm-based definition to the same cohort led to 44 (31.7%) patients fulfilling criteria for TRS with sensitivity, specificity, PPV and NPV of 62.2%, 83.0%, 63.6% and 82.1%, respectively. The definition based on lifetime clozapine prescription had sensitivity, specificity, PPV and NPV of 40.0%, 94.7%, 78.3% and 76.7%, respectively. Although a perfect definition of TRS cannot be derived from available prescription and hospital registers, these results indicate that researchers can confidently use registries to identify individuals with TRS for research and clinical practices. Copyright © 2018 Elsevier B.V. All rights reserved.

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Directory of Open Access Journals (Sweden)

Sipe Eilynn K

2004-01-01

Full Text Available Abstract Background We sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate, and impaired pulmonary physiology (decreased spirometric volume and PaO2/FiO2. Methods Level I trauma center prospective pilot and post-pilot study (2000–2001 of stable patients. Increased base deficit was 2.5 mmol/L in ethanol-negative and ≥ 3.0 mmol/L in ethanol-positive patients. Decreased PaO2/FiO2 was Results Of 215 patients, 66 (30.7% had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43. Glasgow Coma Scale score was 14.8 ± 0.5 (13–15. Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO2/FiO2, and spirometric volume – 0.0% & 0.0%; normal base deficit and normal spirometric volume – 4.2% & 4.5%; chest/abdominal soft tissue injury – 37.8% & 47.0%; increased lactate – 39.7% & 47.0%; increased base deficit – 41.3% & 75.8%; increased base deficit and/or decreased spirometric volume – 43.8% & 95.5%; decreased PaO2/FiO2 – 48.9% & 33.3%; positive abdominal ultrasound – 62.5% & 7.6%; decreased spirometric volume – 73.4% & 71.2%; increased base deficit and decreased spirometric volume – 82.9% & 51.5%. Conclusions Trauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2/FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.

Do Physicians Respond to Web-Based Patient Ratings? An Analysis of Physicians' Responses to More Than One Million Web-Based Ratings Over a Six-Year Period.

Science.gov (United States)

Emmert, Martin; Sauter, Lisa; Jablonski, Lisa; Sander, Uwe; Taheri-Zadeh, Fatemeh

2017-07-26

Physician-rating websites (PRWs) may lead to quality improvements in case they enable and establish a peer-to-peer communication between patients and physicians. Yet, we know little about whether and how physicians respond on the Web to patient ratings. The objective of this study was to describe trends in physicians' Web-based responses to patient ratings over time, to identify what physician characteristics influence Web-based responses, and to examine the topics physicians are likely to respond to. We analyzed physician responses to more than 1 million patient ratings displayed on the German PRW, jameda, from 2010 to 2015. Quantitative analysis contained chi-square analyses and the Mann-Whitney U test. Quantitative content techniques were applied to determine the topics physicians respond to based on a randomly selected sample of 600 Web-based ratings and corresponding physician responses. Overall, physicians responded to 1.58% (16,640/1,052,347) of all Web-based ratings, with an increasing trend over time from 0.70% (157/22,355) in 2010 to 1.88% (6377/339,919) in 2015. Web-based ratings that were responded to had significantly worse rating results than ratings that were not responded to (2.15 vs 1.74, PWeb to patient ratings differ significantly from nonresponders regarding several characteristics such as gender and patient recommendation results (PWeb to patient ratings. This is likely because of (1) the low awareness of PRWs among physicians, (2) the fact that only a few PRWs enable physicians to respond on the Web to patient ratings, and (3) the lack of an active moderator to establish peer-to-peer communication. PRW providers should foster more frequent communication between the patient and the physician and encourage physicians to respond on the Web to patient ratings. Further research is needed to learn more about the motivation of physicians to respond or not respond to Web-based patient ratings. ©Martin Emmert, Lisa Sauter, Lisa Jablonski, Uwe Sander

Biological-based and physical-based optimization for biological evaluation of prostate patient's plans

Science.gov (United States)

Sukhikh, E.; Sheino, I.; Vertinsky, A.

2017-09-01

Modern modalities of radiation treatment therapy allow irradiation of the tumor to high dose values and irradiation of organs at risk (OARs) to low dose values at the same time. In this paper we study optimal radiation treatment plans made in Monaco system. The first aim of this study was to evaluate dosimetric features of Monaco treatment planning system using biological versus dose-based cost functions for the OARs and irradiation targets (namely tumors) when the full potential of built-in biological cost functions is utilized. The second aim was to develop criteria for the evaluation of radiation dosimetry plans for patients based on the macroscopic radiobiological criteria - TCP/NTCP. In the framework of the study four dosimetric plans were created utilizing the full extent of biological and physical cost functions using dose calculation-based treatment planning for IMRT Step-and-Shoot delivery of stereotactic body radiation therapy (SBRT) in prostate case (5 fractions per 7 Gy).

Team-Based Care for Managing Noncardiac Conditions in Patients with Heart Failure.

Science.gov (United States)

Vader, Justin M; Rich, Michael W

2015-07-01

HF is a condition in which the prognosis and treatment are often defined by comorbidities, many of which are noncardiac. Knowledge of the interactions between HF and specific comorbidities is essential, yet to date the clinical trial evidence base for managing comorbidity in patients with HF is limited; further investigations are clearly needed. Perhaps the most pressing need is a focus on the overall multimorbidity state and its relationship to HF-a need that should be addressed in forthcoming trials. Successful navigation between HF and common interacting comorbidities requires coordination of care and team-based approaches that continually evolve to meet patient needs. Copyright © 2015 Elsevier Inc. All rights reserved.

Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

Directory of Open Access Journals (Sweden)

Marie Dorow

2018-05-01

Full Text Available Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1 investigate treatment preferences for depression including internet-based interventions and (2 examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences.Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences.Results: Patients had a mean age of 43.9 years (SD = 13.8 and more than two thirds (68.6% were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy.Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.

Beyond the computer-based patient record: re-engineering with a vision.

Science.gov (United States)

Genn, B; Geukers, L

1995-01-01

In order to achieve real benefit from the potential offered by a Computer-Based Patient Record, the capabilities of the technology must be applied along with true re-engineering of healthcare delivery processes. University Hospital recognizes this and is using systems implementation projects, such as the catalyst, for transforming the way we care for our patients. Integration is fundamental to the success of these initiatives and this must be explicitly planned against an organized systems architecture whose standards are market-driven. University Hospital also recognizes that Community Health Information Networks will offer improved quality of patient care at a reduced overall cost to the system. All of these implementation factors are considered up front as the hospital makes its initial decisions on to how to computerize its patient records. This improves our chances for success and will provide a consistent vision to guide the hospital's development of new and better patient care.

A phantom based method for deriving typical patient doses from measurements of dose-area product on populations of patients

International Nuclear Information System (INIS)

Chapple, C.-L.; Broadhead, D.A.

1995-01-01

One of the chief sources of uncertainty in the comparison of patient dosimetry data is the influence of patient size on dose. Dose has been shown to relate closely to the equivalent diameter of the patient. This concept has been used to derive a prospective, phantom based method for determining size correction factors for measurements of dose-area product. The derivation of the size correction factor has been demonstrated mathematically, and the appropriate factor determined for a number of different X-ray sets. The use of phantom measurements enables the effect of patient size to be isolated from other factors influencing patient dose. The derived factors agree well with those determined retrospectively from patient dose survey data. Size correction factors have been applied to the results of a large scale patient dose survey, and this approach has been compared with the method of selecting patients according to their weight. For large samples of data, mean dose-area product values are independent of the analysis method used. The chief advantage of using size correction factors is that it allows all patient data to be included in a survey, whereas patient selection has been shown to exclude approximately half of all patients. (author)

[Efficacy of health education on patients with hip replacement based on the Internet].

Science.gov (United States)

Zhou, Yang; Yang, Tubao; Li, Yinglan; Yu, Jie; Zeng, Biyun

2015-03-01

To evaluate the efficacy of health education on patients with hip replacement based on the Internet, and to establish a new health education model through modern technology. A total of 300 patients with hip replacement from March to August, 2015 were enrolled in this study. The participants were divided into a control group and an experimental group according to months surgeries performed. Traditional education was applied in the control group while the multimedia source material plus the Internet platform of Joint Registration System were applied in the experimental group. Levels of anxiety, degree of satisfaction, and postoperative complications were analyzed. The levels of knowledge, attitude and behavior compliance in the patients of the experimental group were significantly improved, while the levels of postoperative anxiety were decreased compared with those in the control group (PEducation based on the Internet platform of Joint Registration System and the computer video could improve patients' knowledge, attitude, and behavior, which is worthy of clinical spread.

Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients.

Science.gov (United States)

Sheeran, Thomas; Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L; Bruce, Martha L

2011-10-01

The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

Readability evaluation of Internet-based patient education materials related to the anesthesiology field.

Science.gov (United States)

De Oliveira, Gildasio S; Jung, Michael; Mccaffery, Kirsten J; McCarthy, Robert J; Wolf, Michael S

2015-08-01

The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade level. Online patient education materials describing procedures, risks, and management of anesthesia-related topics were identified using the search engine Google (available at www.google.com) using the terms anesthesia, anesthesiology, anesthesia risks, and anesthesia care. Cross-sectional evaluation. None. Assessments of content readability were performed using validated instruments (Flesch-Kincaid Grade Formulae, the Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Fry graph, and the Flesch Reading Ease score). Ninety-six Web sites containing Internet patient education materials (IPEMs) were evaluated. The median (interquartile range) readability grade level for all evaluated IPEMs was 13.5 (12.0-14.6). All the evaluated documents were classified at a greater readability level than the current recommended readability grade, P Internet-based patient education materials related to the field of anesthesiology are currently written far above the recommended readability grade level. High complexity of written education materials likely limits access of information to millions of American patients. Redesign of online content of Web sites that provide patient education material regarding anesthesia could be an important step in improving access to information for patients with poor health literacy. Copyright © 2015 Elsevier Inc. All rights reserved.

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

Directory of Open Access Journals (Sweden)

Grosbois JM

2015-09-01

Full Text Available Jean Marie Grosbois,1,2 Alice Gicquello,3 Carole Langlois,4 Olivier Le Rouzic,3 Frédéric Bart,2 Benoit Wallaert,2,3 Cécile Chenivesse5 1FormAction Santé, rue Pietralunga, Pérenchies, 2Service de Pneumologie, CH Béthune, 3Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille, 4Unité de Biostatistiques, CHRU Lille, 5AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Boulevard de l’Hôpital, Paris, France Introduction: Personalized, global pulmonary rehabilitation (PR management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.Methods: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%. Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28.Results: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the

[Percutaneous catheter-based implantation of artificial pulmonary valves in patients with congenital heart defects].

Science.gov (United States)

Wyller, Vegard Bruun; Aaberge, Lars; Thaulow, Erik; Døhlen, Gaute

2011-07-01

Percutaneous catheter-based implantation of artificial heart valves is a new technique that may supplement surgery and which may be used more in the future. We here report our first experience with implantation of artificial pulmonary valves in children with congenital heart defects. Eligible patients were those with symptoms of heart failure combined with stenosis and/or insufficiency in an established artificial right ventricular outflow tract. The valve was inserted through a catheter from a vein in the groin or neck. Symptoms, echocardiography, invasive measurements and angiography were assessed for evaluation of treatment effect. Our treatment results are reported for the period April 2007-September 2009. Ten patients (seven men and three women, median age 17 years) were assessed. The procedure reduced pressure in the right ventricle (p = 0.008) and resolved the pulmonary insufficiency in all patients. The median time in hospital was two days. No patients had complications that were directly associated with the implantation procedure. One patient developed a pseudoaneurysm in the femoral artery, another had a short-lasting fever two days after the procedure and one patient experienced a stent fracture that required surgery 9 months after the implantation. After 6 months all patients had a reduced pressure gradient in the right ventricular outflow tract (p = 0.008), the pulmonary insufficiency had improved (p = 0.006) and they all reported improval of symptoms. These results persisted for at least 24 months for the four patients who were monitored until then. Percutaneous catheter-based implantation of artificial pulmonary valves improves hemodynamics in the right ventricle of selected patients with congenital heart defects. A randomized controlled study should be undertaken to provide a stronger evidence-base for usefulness of this procedure.

Education for arthritis patients: a community pharmacy based pilot project.

Science.gov (United States)

Petkova, Valentina B

2009-04-01

There are different kinds of arthritis, widely spread among the population, that make them a clinical problem with social, psychological and economic burden. Different education programs have been developed in order to improve patients' disease management, medication compliance and from there patients' quality of life. To develop and implement a community pharmacy-based educational program for patients with arthritis. Improvements in pain, medication compliance, decrease in general practitioner's visits and hospitalizations are expected. Prospective, randomized, controlled trial. The sample consisted of 43 individuals, with different stages of arthritis (aged 15 - 71), attending pharmacies - intervention group; and 43 individuals - control group. A 4-month education was conducted on the following topics: what causes arthritis and what are the factors that can intensify it; pain management and physical activities; self-management and prevention; pharmacotherapy and possible adverse drug reactions. Patient's health-related quality of life was assessed in the beginning and at the end of the survey. PARAMETERS ASSESSED DURING THE FOUR STAGES OF THE PROGRAM WERE: frequency of severe pain, frequency of general practitioner's visits, frequency of urgent medical aid calls, compliance with therapy, satisfaction with pharmacy services. Improvement in patients' health-related quality of life was observed and also: decrease in the severity of patients' pain, decrease in the physician's visits, and increase in satisfaction overall care. Positive results from the educational approach in pharmacy conditions were demonstrated. These consequences have a potential to increase arthritis patient's quality of life.

Patient-completed or symptom-based screening tools for endometriosis: a scoping review.

Science.gov (United States)

Surrey, Eric; Carter, Cathryn M; Soliman, Ahmed M; Khan, Shahnaz; DiBenedetti, Dana B; Snabes, Michael C

2017-08-01

The objective of this review was to evaluate existing patient-completed screening questionnaires and/or symptom-based predictive models with respect to their potential for use as screening tools for endometriosis in adult women. Validated instruments were of particular interest. We conducted structured searches of PubMed and targeted searches of the gray literature to identify studies reporting on screening instruments used in endometriosis. Studies were screened according to inclusion and exclusion criteria that followed the PICOS (population, intervention, comparison, outcomes, study design) framework. A total of 16 studies were identified, of which 10 described measures for endometriosis in general, 2 described measures for endometriosis at specific sites, and 4 described measures for deep-infiltrating endometriosis. Only 1 study evaluated a questionnaire that was solely patient-completed. Most measures required physician, imaging, or laboratory assessments in addition to patient-completed questionnaires, and several measures relied on complex scoring. Validation for use as a screening tool in adult women with potential endometriosis was lacking in all studies, as most studies focused on diagnosis versus screening. This literature review did not identify any fully validated, symptom-based, patient-reported questionnaires for endometriosis screening in adult women.

Patient preparation for intravenous urography: are we practising evidence-based medicine?

International Nuclear Information System (INIS)

Singh, S.; Reddicliffe, N.; Parker, D.A.

2008-01-01

Aim: To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Methods: Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results: Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. Conclusion: A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned

Rehabilitation of patients with motor disabilities using computer vision based techniques

Directory of Open Access Journals (Sweden)

Alejandro Reyes-Amaro

2012-05-01

Full Text Available In this paper we present details about the implementation of computer vision based applications for the rehabilitation of patients with motor disabilities. The applications are conceived as serious games, where the computer-patient interaction during playing contributes to the development of different motor skills. The use of computer vision methods allows the automatic guidance of the patient’s movements making constant specialized supervision unnecessary. The hardware requirements are limited to low-cost devices like usual webcams and Netbooks.

For the Love of the Game: Game- Versus Lecture-Based Learning With Generation Z Patients.

Science.gov (United States)

Adamson, Mary A; Chen, Hengyi; Kackley, Russell; Micheal, Alicia

2018-02-01

The current study evaluated adolescent patients' enjoyment of and knowledge gained from game-based learning compared with an interactive lecture format on the topic of mood disorders. It was hypothesized that game-based learning would be statistically more effective than a lecture in knowledge acquisition and satisfaction scores. A pre-post design was implemented in which a convenience sample of 160 adolescent patients were randomized to either a lecture (n = 80) or game-based (n = 80) group. Both groups completed a pretest/posttest and satisfaction survey. Results showed that both groups had significant improvement in knowledge from pretest compared to posttest. Game-based learning was statistically more effective than the interactive lecture in knowledge achievement and satisfaction scores. This finding supports the contention that game-based learning is an active technique that may be used with patient education. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 29-36.]. Copyright 2018, SLACK Incorporated.

Mass Spectrometry-Based Quantitative Metabolomics Revealed a Distinct Lipid Profile in Breast Cancer Patients

Directory of Open Access Journals (Sweden)

Yun Yen

2013-04-01

Full Text Available Breast cancer accounts for the largest number of newly diagnosed cases in female cancer patients. Although mammography is a powerful screening tool, about 20% of breast cancer cases cannot be detected by this method. New diagnostic biomarkers for breast cancer are necessary. Here, we used a mass spectrometry-based quantitative metabolomics method to analyze plasma samples from 55 breast cancer patients and 25 healthy controls. A number of 30 patients and 20 age-matched healthy controls were used as a training dataset to establish a diagnostic model and to identify potential biomarkers. The remaining samples were used as a validation dataset to evaluate the predictive accuracy for the established model. Distinct separation was obtained from an orthogonal partial least squares-discriminant analysis (OPLS-DA model with good prediction accuracy. Based on this analysis, 39 differentiating metabolites were identified, including significantly lower levels of lysophosphatidylcholines and higher levels of sphingomyelins in the plasma samples obtained from breast cancer patients compared with healthy controls. Using logical regression, a diagnostic equation based on three metabolites (lysoPC a C16:0, PC ae C42:5 and PC aa C34:2 successfully differentiated breast cancer patients from healthy controls, with a sensitivity of 98.1% and a specificity of 96.0%.

Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?

DEFF Research Database (Denmark)

Meyhoff, Christian S; Lund, Jørgen; Jenstrup, Morten T

2009-01-01

BACKGROUND: Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal...... intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections. METHODS: Fifty-one obese patients, with a median (range) body mass index of 44 (34-72) kg/m2, scheduled for laparoscopic gastric banding or gastric bypass under...... propofol-remifentanil anesthesia were randomized into three groups. The patients received rocuronium (0.6 mg/kg) based on IBW (IBW group, n = 17), IBW plus 20% of excess weight (corrected body weight [CBW]20% group, n = 17), or IBW plus 40% of excess weight (CBW40% group, n = 17). Propofol was administered...

Patient cloth with motion recognition sensors based on flexible piezoelectric materials.

Science.gov (United States)

Youngsu Cha; Kihyuk Nam; Doik Kim

2017-07-01

In this paper, we introduce a patient cloth for position monitoring using motion recognition sensors based on flexible piezoelectric materials. The motion recognition sensors are embedded in three parts, which are the knee, hip and back, in the patient cloth. We use polyvinylidene fluoride (PVDF) as the flexible piezoelectric material for the sensors. By using the piezoelectric effect of the PVDF, we detect electrical signals when the cloth is bent or extended. We analyze the sensing values for our human motions by processing the sensor outputs in a custom-made program. Specifically, we focus on the transitions between standing and sitting, and sitting knee extension and supine position, which are important motions for patient monitoring.

Changes in Resting-State Connectivity following Melody-Based Therapy in a Patient with Aphasia

OpenAIRE

Bitan, Tali; Simic, Tijana; Saverino, Cristina; Jones, Cheryl; Glazer, Joanna; Collela, Brenda; Wiseman-Hakes, Catherine; Green, Robin; Rochon, Elizabeth

2018-01-01

Melody-based treatments for patients with aphasia rely on the notion of preserved musical abilities in the RH, following left hemisphere damage. However, despite evidence for their effectiveness, the role of the RH is still an open question. We measured changes in resting-state functional connectivity following melody-based intervention, to identify lateralization of treatment-related changes. A patient with aphasia due to left frontal and temporal hemorrhages following traumatic brain injuri...

Comparing a medical records-based and a claims-based index for measuring comorbidity in patients with lung or colon cancer.

Science.gov (United States)

Kehl, Kenneth L; Lamont, Elizabeth B; McNeil, Barbara J; Bozeman, Samuel R; Kelley, Michael J; Keating, Nancy L

2015-05-01

Ascertaining comorbid conditions in cancer patients is important for research and clinical quality measurement, and is particularly important for understanding care and outcomes for older patients and those with multi-morbidity. We compared the medical records-based ACE-27 index and the claims-based Charlson index in predicting receipt of therapy and survival for lung and colon cancer patients. We calculated the Charlson index using administrative data and the ACE-27 score using medical records for Veterans Affairs patients diagnosed with stage I/II non-small cell lung or stage III colon cancer from January 2003 to December 2004. We compared the proportion of patients identified by each index as having any comorbidity. We used multivariable logistic regression to ascertain the predictive power of each index regarding delivery of guideline-recommended therapies and two-year survival, comparing the c-statistic and the Akaike information criterion (AIC). Overall, 97.2% of lung and 90.9% of colon cancer patients had any comorbidity according to the ACE-27 index, versus 59.5% and 49.7%, respectively, according to the Charlson. Multivariable models including the ACE-27 index outperformed Charlson-based models when assessing receipt of guideline-recommended therapies, with higher c-statistics and lower AICs. Neither index was clearly superior in prediction of two-year survival. The ACE-27 index measured using medical records captured more comorbidity and outperformed the Charlson index measured using administrative data for predicting receipt of guideline-recommended therapies, demonstrating the potential value of more detailed comorbidity data. However, the two indices had relatively similar performance when predicting survival. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis

DEFF Research Database (Denmark)

Lund, H.; Weile, U.; Christensen, R.

2008-01-01

patients reported adverse events (i.e. discomfort) in land-based exercise, while only 3 reported adverse events in the aquatic exercise. Conclusion: Only land-based exercise showed some improvement in pain and muscle strength compared with the control group, while no clinical benefits were detectable after......Objective: To compare the efficacy of aquatic exercise and a land-based exercise programme vs control in patients with knee osteoarthritis. Methods: Primary outcome was change in pain, and in addition Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS). Standing balance and strength...... was also measured after and at 3-month follow-up. Seventy-nine patients (62 women), with a mean age of 68 years (age range 40-89 years) were randomized to aquatic exercise (n = 27), land-based exercise (n = 25) or control (n = 27). Results: No effect was observed immediately after exercise cessation (8...

Development of an Online, Evidence-Based Patient Information Portal for Congenital Heart Disease: A Pilot Study

Directory of Open Access Journals (Sweden)

Jonathan R. G. Etnel

2017-05-01

Full Text Available ObjectivesIn response to an increased need for patient information on congenital heart disease in the Netherlands, we initiated a nationwide initiative to develop an online, evidence-based patient information portal, starting with a pilot project aimed at the subgroup of patients with congenital aortic and pulmonary valve disease.Methods and resultsWe developed an information portal that aims to (1 improve patient knowledge and involvement and to subsequently reduce anxiety and decisional conflict and improve mental quality of life and (2 to support physicians in informing and communicating with their patients. The information portal was developed according to the systematic International Patient Decision Aid Standards development process employing Delphi techniques by a multidisciplinary workgroup of pediatric and adult congenital cardiologists, a congenital cardiothoracic surgeon, a psychologist, an epidemiologist, a patient representative, and web and industrial design experts. First, patients and physicians were surveyed and interviewed to assess the current state of patient information and explore their preferences and needs to determine the focus for the development of the information portal. We found that patient knowledge and numeracy are limited, reliable information is scarce, physicians inform patients selectively and patient involvement is suboptimal, and there is a need for more reliable, tailored, and multi-faceted information. Based on the findings of these surveys and interviews, a patient-tailored information portal was designed that presents evidence-based disease- and age-specific medical and psychosocial information about diagnosis, treatment, prognosis, and impact on daily life in a manner that is comprehensible and digestible for patients and that meets the needs expressed by both patients and physicians. The effect of the website on patient outcome is currently being assessed in a multicenter stepped-wedge implementation

[Electronic versus paper-based patient records: a cost-benefit analysis].

Science.gov (United States)

Neubauer, A S; Priglinger, S; Ehrt, O

2001-11-01

The aim of this study is to compare the costs and benefits of electronic, paperless patient records with the conventional paper-based charts. Costs and benefits of planned electronic patient records are calculated for a University eye hospital with 140 beds. Benefit is determined by direct costs saved by electronic records. In the example shown, the additional benefits of electronic patient records, as far as they can be quantified total 192,000 DM per year. The costs of the necessary investments are 234,000 DM per year when using a linear depreciation over 4 years. In total, there are additional annual costs for electronic patient records of 42,000 DM. Different scenarios were analyzed. By increasing the time of depreciation to 6 years, the cost deficit reduces to only approximately 9,000 DM. Increased wages reduce the deficit further while the deficit increases with a loss of functions of the electronic patient record. However, several benefits of electronic records regarding research, teaching, quality control and better data access cannot be easily quantified and would greatly increase the benefit to cost ratio. Only part of the advantages of electronic patient records can easily be quantified in terms of directly saved costs. The small cost deficit calculated in this example is overcompensated by several benefits, which can only be enumerated qualitatively due to problems in quantification.

Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

Science.gov (United States)

Buckler, David L.

2012-01-01

The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

Patient perceptions and expectations of an anticoagulation service: a quantitative comparison study of clinic-based testers and patient self-testers.

Science.gov (United States)

Money, Arthur G; Barnett, Julie; Kuljis, Jasna; Duffin, Debbie

2015-12-01

Government initiatives see the provision of technology-assisted self-care as one of the key areas in which there is capacity for improving quality of care whilst reducing costs. However, levels of patient engagement in self-testing and management (STM) remain low. Little emphasis has been placed on understanding the patients' perspectives of the reasons for this limited engagement. Typically, patient engagement in STM is achieved via the provision of patient education programmes, which aim to enable patients to make the changes necessary to become competent self-carers. However, placing the onus to change on the individual patient is unrealistic. If levels of patient engagement are to be improved, patient needs and expectations of clinical services must be better understood and service provision must be adapted accordingly. Explore patient perceptions and expectations of clinical service provision and their views of having and making choices about care. Participants [N = 191, 103 patient self-tester managers (PSTMs) and 87 clinic-based testers (CBTs)] completed the SERVQUAL and ChQ instruments to capture perspectives on service quality and choice, respectively. A comparative statistical analysis explored the similarities and differences between PSTMs' and CBTs' responses. Clinic-based testers' perceptions of service quality were significantly more positive than PSTMs', as were their expectations of the 'tangible' aspects of service delivery. PSTMs' expectations of service quality were significantly higher than their perceptions. PSTMs attributed significantly more value to making choices compared with CBTs. To close the gap between PSTMs expectations and perceptions of service quality and better cater for their choice preferences, service providers may benefit from taking into account the following practice considerations: maintain frequent, timely, personalised and direct interactions with PSTMs; prioritise investment in resources to facilitate patient

An evidence-based recommendation on bed head elevation for mechanically ventilated patients.

Science.gov (United States)

Niël-Weise, Barbara S; Gastmeier, Petra; Kola, Axel; Vonberg, Ralf P; Wille, Jan C; van den Broek, Peterhans J

2011-01-01

A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45° bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45° elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45° position and preferably to a ≥ 30° position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes. Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions.

Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study.

Science.gov (United States)

van Eck, Carola F; Toor, Aneet; Banffy, Michael B; Gambardella, Ralph A

2018-01-01

A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. Randomized controlled trial; Level of evidence, 1. All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty.

Science.gov (United States)

Bolink, S A A N; Grimm, B; Heyligers, I C

2015-12-01

Outcome assessment of total knee arthroplasty (TKA) by subjective patient reported outcome measures (PROMs) may not fully capture the functional (dis-)abilities of relevance. Objective performance-based outcome measures could provide distinct information. An ambulant inertial measurement unit (IMU) allows kinematic assessment of physical performance and could potentially be used for routine follow-up. To investigate the responsiveness of IMU measures in patients following TKA and compare outcomes with conventional PROMs. Patients with end stage knee OA (n=20, m/f=7/13; age=67.4 standard deviation 7.7 years) were measured preoperatively and one year postoperatively. IMU measures were derived during gait, sit-stand transfers and block step-up transfers. PROMs were assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS). Responsiveness was calculated by the effect size, correlations were calculated with Spearman's rho correlation coefficient. One year after TKA, patients performed significantly better at gait, sit-to-stand transfers and block step-up transfers. Measures of time and kinematic IMU measures demonstrated significant improvements postoperatively for each performance-based test. The largest improvement was found in block step-up transfers (effect size=0.56-1.20). WOMAC function score and KSS function score demonstrated moderate correlations (Spearman's rho=0.45-0.74) with some of the physical performance-based measures pre- and postoperatively. To characterize the changes in physical function after TKA, PROMs could be supplemented by performance-based measures, assessing function during different activities and allowing kinematic characterization with an ambulant IMU. Copyright © 2015 Elsevier B.V. All rights reserved.

Mindfulness-based stress reduction for breast cancer patients: a mixed method study on what patients experience as a suitable stage to participate

NARCIS (Netherlands)

Bisseling, Else M.; Schellekens, Melanie P. J.; Jansen, Ellen T. M.; van Laarhoven, Hanneke W. M.; Prins, Judith B.; Speckens, Anne E. M.

2017-01-01

Breast cancer is associated with high levels of psychological distress. Mindfulness-based stress reduction (MBSR) has proven to be effective in reducing distress in cancer patients. In several studies, patients who are currently undergoing somatic anticancer treatment are excluded from participating

Autoimmune and immunogenetic profile of patients with optic neuritis in a population-based cohort

DEFF Research Database (Denmark)

Soelberg, K.; Nilsson, A. C.; Nielsen, C.

2018-01-01

Background: Optic neuritis (ON) is an inflammatory optic neuropathy, where the genetic and autoimmune dependency remains poorly characterized. Objective: To investigate autoimmune and immunogenetic aspects of ON. Method: In a prospective population-based cohort 51 patients with ON were included...... antibodies. Coexisting neural autoantibodies were detected in two patients and in 12 patients other systemic autoantibodies were found. Four (8%) had other autoimmune disorders. A family history of autoimmunity was observed in 12 (24%) and of demyelinating disease in six patients (12%). In MS-ON patients...

Erectile dysfunction among diabetic patients in Saudi Arabia: A hospital-based primary care study

Directory of Open Access Journals (Sweden)

Yousef A Al-Turki

2007-01-01

Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.

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

Science.gov (United States)

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

2017-10-01

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

Patient-Centered Radiology Reporting: Using Online Crowdsourcing to Assess the Effectiveness of a Web-Based Interactive Radiology Report.

Science.gov (United States)

Short, Ryan G; Middleton, Dana; Befera, Nicholas T; Gondalia, Raj; Tailor, Tina D

2017-11-01

The aim of this study was to evaluate the effectiveness of a patient-centered web-based interactive mammography report. A survey was distributed on Amazon Mechanical Turk, an online crowdsourcing platform. One hundred ninety-three US women ≥18 years of age were surveyed and then randomized to one of three simulated BI-RADS ® 0 report formats: standard report, Mammography Quality Standards Act-modeled patient letter, or web-based interactive report. Survey questions assessed participants' report comprehension, satisfaction with and perception of the interpreting radiologist, and experience with the presented report. Two-tailed t tests and χ 2 tests were used to evaluate differences among groups. Participants in the interactive web-based group spent more than double the time viewing the report than the standard report group (160.0 versus 64.2 seconds, P < .001). Report comprehension scores were significantly higher for the interactive web-based and patient letter groups than the standard report group (P < .05). Scores of satisfaction with the interpreting radiologist were significantly higher for the web-based interactive report and patient letter groups than the standard report group (P < .01). There were no significant differences between the patient letter and web-based interactive report groups. Radiology report format likely influences communication effectiveness. For result communication to a non-medical patient audience, patient-centric report formats, such as a Mammography Quality Standards Act-modeled patient letter or web-based interactive report, may offer advantages over the standard radiology report. Future work is needed to determine if these findings are reproducible in patient care settings and to determine how best to optimize radiology result communication to patients. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients.

Science.gov (United States)

Lee, Hyung Young; Kim, You Lim; Lee, Suk Min

2015-06-01

[Purpose] This study aimed to investigate the clinical effects of virtual reality-based training and task-oriented training on balance performance in stroke patients. [Subjects and Methods] The subjects were randomly allocated to 2 groups: virtual reality-based training group (n = 12) and task-oriented training group (n = 12). The patients in the virtual reality-based training group used the Nintendo Wii Fit Plus, which provided visual and auditory feedback as well as the movements that enabled shifting of weight to the right and left sides, for 30 min/day, 3 times/week for 6 weeks. The patients in the task-oriented training group practiced additional task-oriented programs for 30 min/day, 3 times/week for 6 weeks. Patients in both groups also underwent conventional physical therapy for 60 min/day, 5 times/week for 6 weeks. [Results] Balance and functional reach test outcomes were examined in both groups. The results showed that the static balance and functional reach test outcomes were significantly higher in the virtual reality-based training group than in the task-oriented training group. [Conclusion] This study suggested that virtual reality-based training might be a more feasible and suitable therapeutic intervention for dynamic balance in stroke patients compared to task-oriented training.

Engineered for the energy future. I. Moisture separator-reheaters: extreme reliability an imperative

International Nuclear Information System (INIS)

Anon.

1976-01-01

A description is given of the design and development activities performed by Foster-Wheeler to insure operational reliability of sixteen moisture separator-reheaters being manufactured for eight twin-unit BWR power plants to be operated by TVA

A target based approach identifies genomic predictors of breast cancer patient response to chemotherapy

Directory of Open Access Journals (Sweden)

Hallett Robin M

2012-05-01

Full Text Available Abstract Background The efficacy of chemotherapy regimens in breast cancer patients is variable and unpredictable. Whether individual patients either achieve long-term remission or suffer recurrence after therapy may be dictated by intrinsic properties of their breast tumors including genetic lesions and consequent aberrant transcriptional programs. Global gene expression profiling provides a powerful tool to identify such tumor-intrinsic transcriptional programs, whose analyses provide insight into the underlying biology of individual patient tumors. For example, multi-gene expression signatures have been identified that can predict the likelihood of disease reccurrence, and thus guide patient prognosis. Whereas such prognostic signatures are being introduced in the clinical setting, similar signatures that predict sensitivity or resistance to chemotherapy are not currently clinically available. Methods We used gene expression profiling to identify genes that were co-expressed with genes whose transcripts encode the protein targets of commonly used chemotherapeutic agents. Results Here, we present target based expression indices that predict breast tumor response to anthracycline and taxane based chemotherapy. Indeed, these signatures were independently predictive of chemotherapy response after adjusting for standard clinic-pathological variables such as age, grade, and estrogen receptor status in a cohort of 488 breast cancer patients treated with adriamycin and taxotere/taxol. Conclusions Importantly, our findings suggest the practicality of developing target based indices that predict response to therapeutics, as well as highlight the possibility of using gene signatures to guide the use of chemotherapy during treatment of breast cancer patients.

Development and implementation of a hospital-based patient safety program

International Nuclear Information System (INIS)

Frush, Karen S.; Alton, Michael; Frush, Donald P.

2006-01-01

Evidence from numerous studies indicates that large numbers of patients are harmed by medical errors while receiving health-care services in the United States today. The 1999 Institute of Medicine report on medical errors recommended that hospitals and health-care agencies ''establish safety programs to act as a catalyst for the development of a culture of safety'' [1]. In this article, we describe one approach to successful implementation of a hospital-based patient safety program. Although our experience at Duke University Health System will be used as an example, the needs, principles, and solutions can apply to a variety of other health-care practices. Key components include the development of safety teams, provision of tools that teams can use to support an environment of safety, and ongoing program modification to meet patient and staff needs and respond to changing priorities. By moving patient safety to the forefront of all that we do as health-care providers, we can continue to improve our delivery of health care to children and adults alike. This improvement is fostered when we enhance the culture of safety, develop a constant awareness of the possibility of human and system errors in the delivery of care, and establish additional safeguards to intercept medical errors in order to prevent harm to patients. (orig.)

SU-F-J-06: Optimized Patient Inclusion for NaF PET Response-Based Biopsies

Energy Technology Data Exchange (ETDEWEB)

Roth, A; Harmon, S; Perk, T; Jeraj, R [University of Wisconsin, Madison, WI (United States)

2016-06-15

Purpose: A method to guide mid-treatment biopsies using quantitative [F-18]NaF PET/CT response is being investigated in a clinical trial. This study aims to develop methodology to identify patients amenable to mid-treatment biopsy based on pre-treatment imaging characteristics. Methods: 35 metastatic prostate cancer patients had NaF PET/CT scans taken prior to the start of treatment and 9–12 weeks into treatment. For mid-treatment biopsy targeting, lesions must be at least 1.5 cm{sup 3} and located in a clinically feasible region (lumbar/sacral spine, pelvis, humerus, or femur). Three methods were developed based on number of lesions present prior to treatment: a feasibility-restricted method, a location-restricted method, and an unrestricted method. The feasibility restricted method only utilizes information from lesions meeting biopsy requirements in the pre-treatment scan. The unrestricted method accounts for all lesions present in the pre-treatment scan. For each method, optimized classification cutoffs for candidate patients were determined. Results: 13 of the 35 patients had enough lesions at the mid-treatment for biopsy candidacy. Of 1749 lesions identified in all 35 patients at mid-treatment, only 9.8% were amenable to biopsy. Optimizing the feasibility-restricted method required 4 lesions at pre-treatment meeting volume and region requirements for biopsy, resulting patient identification sensitivity of 0.8 and specificity of 0.7. Of 6 false positive patients, only one patient lacked lesions for biopsy. Restricting for location alone showed poor results (sensitivity 0.2 and specificity 0.3). The optimized unrestricted method required patients have at least 37 lesions in pretreatment scan, resulting in a sensitivity of 0.8 and specificity of 0.8. There were 5 false positives, only one lacked lesions for biopsy. Conclusion: Incorporating the overall pre-treatment number of NaF PET/CT identified lesions provided best prediction for identifying candidate

SU-F-J-06: Optimized Patient Inclusion for NaF PET Response-Based Biopsies

International Nuclear Information System (INIS)

Roth, A; Harmon, S; Perk, T; Jeraj, R

2016-01-01

Purpose: A method to guide mid-treatment biopsies using quantitative [F-18]NaF PET/CT response is being investigated in a clinical trial. This study aims to develop methodology to identify patients amenable to mid-treatment biopsy based on pre-treatment imaging characteristics. Methods: 35 metastatic prostate cancer patients had NaF PET/CT scans taken prior to the start of treatment and 9–12 weeks into treatment. For mid-treatment biopsy targeting, lesions must be at least 1.5 cm 3 and located in a clinically feasible region (lumbar/sacral spine, pelvis, humerus, or femur). Three methods were developed based on number of lesions present prior to treatment: a feasibility-restricted method, a location-restricted method, and an unrestricted method. The feasibility restricted method only utilizes information from lesions meeting biopsy requirements in the pre-treatment scan. The unrestricted method accounts for all lesions present in the pre-treatment scan. For each method, optimized classification cutoffs for candidate patients were determined. Results: 13 of the 35 patients had enough lesions at the mid-treatment for biopsy candidacy. Of 1749 lesions identified in all 35 patients at mid-treatment, only 9.8% were amenable to biopsy. Optimizing the feasibility-restricted method required 4 lesions at pre-treatment meeting volume and region requirements for biopsy, resulting patient identification sensitivity of 0.8 and specificity of 0.7. Of 6 false positive patients, only one patient lacked lesions for biopsy. Restricting for location alone showed poor results (sensitivity 0.2 and specificity 0.3). The optimized unrestricted method required patients have at least 37 lesions in pretreatment scan, resulting in a sensitivity of 0.8 and specificity of 0.8. There were 5 false positives, only one lacked lesions for biopsy. Conclusion: Incorporating the overall pre-treatment number of NaF PET/CT identified lesions provided best prediction for identifying candidate patients

Hydroxychloroquine use in a community-based cohort of patients with systemic lupus erythematosus

Science.gov (United States)

Schmajuk, Gabriela; Yazdany, Jinoos; Trupin, Laura; Yelin, Edward

2010-01-01

Background In recent years hydroxychloroquine (HCQ) has emerged as a key therapy in systemic lupus erythematosus (SLE). We determined the rates of HCQ use in a diverse, community-based cohort of patients with SLE and identified predictors of current HCQ use. Methods Patients were participants in the University of California San Francisco (UCSF) Lupus Outcomes Study (LOS), an ongoing longitudinal study of patients with confirmed SLE. We examined the prevalence of HCQ use per person-year and compared baseline characteristics of users and non-users, including demographic, socioeconomic, clinical, and health-system use variables. Multiple logistic regression with generalized estimating equations was used to evaluate predictors of HCQ use. Results Eight hundred and eighty one patients contributed 3095person-years of data over 4 interview cycles. The prevalence of HCQ use was 55 per 100 person-years and was constant throughout the observation period. In multivariate models, the odds of HCQ use were nearly doubled among patients receiving their SLE care from a rheumatologist compared to those identifying generalists or nephrologists as their primary sources of SLE care. In addition, patients with shorter disease duration were more likely to use HCQ, even after adjusting for age and other covariates. Conclusions In this community-based cohort of patients, HCQ use was suboptimal. Physician specialty and disease duration were the strongest predictors of HCQ use. Patients who are not using HCQ, those with longer disease duration, and those who see non-rheumatologists for their SLE care should be targeted for quality improvement. PMID:20391485

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

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Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F.; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L.; Bruce, Martha L.

2011-01-01

Abstract Objective The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Materials and Methods Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results An ethnically diverse sample of 48 English- and Spanish-only–speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the “markedly severe” range at baseline and in the “mild” range at follow-up. Conclusions Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed. PMID:21780942

Scrub Typhus among Pediatric Patients in Dambadeniya:A Base Hospital in Sri Lanka

OpenAIRE

De Silva, Nalika; Wijesundara, Sarojini; Liyanapathirana, Veranja; Thevanesam, Vasanthi; Stenos, John

2012-01-01

Data on pediatric scrub typhus is uncommon in Sri Lanka and other countries. The objective of this study was to identify the clinical features of patients with scrub typhus at a Base Hospital in Sri Lanka. Sixty patients presenting with suspected scrub typhus were included in the study. Their blood samples were tested for the presence of antibodies against rickettsioses using the reference method. Twenty patients had confirmed scrub typhus and 24 had possible scrub typhus. Their clinical feat...

Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

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Kelly, Sinead; O'Rourke, Malachy

2012-04-01

This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

Systematic Review of Data Mining Applications in Patient-Centered Mobile-Based Information Systems.

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Fallah, Mina; Niakan Kalhori, Sharareh R

2017-10-01

Smartphones represent a promising technology for patient-centered healthcare. It is claimed that data mining techniques have improved mobile apps to address patients' needs at subgroup and individual levels. This study reviewed the current literature regarding data mining applications in patient-centered mobile-based information systems. We systematically searched PubMed, Scopus, and Web of Science for original studies reported from 2014 to 2016. After screening 226 records at the title/abstract level, the full texts of 92 relevant papers were retrieved and checked against inclusion criteria. Finally, 30 papers were included in this study and reviewed. Data mining techniques have been reported in development of mobile health apps for three main purposes: data analysis for follow-up and monitoring, early diagnosis and detection for screening purpose, classification/prediction of outcomes, and risk calculation (n = 27); data collection (n = 3); and provision of recommendations (n = 2). The most accurate and frequently applied data mining method was support vector machine; however, decision tree has shown superior performance to enhance mobile apps applied for patients' self-management. Embedded data-mining-based feature in mobile apps, such as case detection, prediction/classification, risk estimation, or collection of patient data, particularly during self-management, would save, apply, and analyze patient data during and after care. More intelligent methods, such as artificial neural networks, fuzzy logic, and genetic algorithms, and even the hybrid methods may result in more patients-centered recommendations, providing education, guidance, alerts, and awareness of personalized output.

Dose optimization in radiotherapy patients for IMRT based on 4D-CBCT

International Nuclear Information System (INIS)

Alfonso, R.; Castillo, D.; Ascensión, Y.; Linares, H.; García, F.; Argota, R.

2015-01-01

The use of tomographic systems based on conical photon beams kVp (kV-CBCT) to verify the accuracy of the positioning of patients in external radiotherapy treatments has expanded in recent years, with increasing availability of linear accelerators systems for image guided radiation therapy (IGRT) based kV-CBCT systems, incorporated into the gantry of the equipment. Several studies have evaluated the collateral doses received by patients using these positioning systems for radiotherapy (RT). Recently, the firm Elekta has developed a solution to manage the effects of respiratory movements and reduce internal margins that affect the planning target volume (Symmetry TM ), which is based on the acquisition of dynamic tomographic studies (4D- CBCT), making it possible to estimate the average white temporal position in each treatment, without using methods triggered or ‘tracking’. These 4D studies however require a greater number of images per gantry angle, potentially involves a higher dose administered to patients, besides the actual dose treatment beam. The present study investigated a methodology to assess dose rates 4DCBCT (4D-CBDI) using dosimetric instrumentation and phantoms as those typically available in radiotherapy departments. The doses received by different techniques are compared using as criteria of merit image quality and overall geometric accuracy achieved in positioning and internal margins. The results show that it is possible to reduce the administered to patients in studies of CBCT static and dynamic, without significantly affecting the objectives of the same in terms of geometric accuracy dose. [es

Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

International Nuclear Information System (INIS)

Mir, A.W.; Chaudry, A.A.; Mir, S.; Ahmed, N.; Khan, A.A.; Shahzadi, M.

2017-01-01

To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings. Study Design: Descriptive Study. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011. Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma. Results: The overall frequency of gastric varices was 11 percent, whereas 89 percent had no gastric varices. Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension. (author)

An emergency call system for patients in locked-in state using an SSVEP-based brain switch.

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Lim, Jeong-Hwan; Kim, Yong-Wook; Lee, Jun-Hak; An, Kwang-Ok; Hwang, Han-Jeong; Cha, Ho-Seung; Han, Chang-Hee; Im, Chang-Hwan

2017-11-01

Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios. © 2017 Society for Psychophysiological Research.

Patient perceptions regarding the use of smart devices for medical photography: results of a patient-based survey.

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Nair, Akshay Gopinathan; Potdar, Nayana A; Dadia, Suchit; Aulakh, Simranjeet; Ali, Mohammad Javed; Shinde, Chhaya A

2018-03-06

To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography. A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed. Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient's consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic. Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.

Biosensor-based diagnostics of contaminated groundwater: assessment and remediation strategy

International Nuclear Information System (INIS)

Bhattacharyya, Jessica; Read, David; Amos, Sean; Dooley, Stephen; Killham, Kenneth; Paton, Graeme I.

2005-01-01

Shallow groundwater beneath a former airfield site in southern England has been heavily contaminated with a wide range of chlorinated solvents. The feasibility of using bacterial biosensors to complement chemical analysis and enable cost-effective, and focussed sampling has been assessed as part of a site evaluation programme. Five different biosensors, three metabolic (Vibrio fischeri, Pseudomonas fluorescens 10568 and Escherichia coli HB101) and two catabolic (Pseudomonas putida TVA8 and E. coli DH5α), were employed to identify areas where the availability and toxicity of pollutants is of most immediate environmental concern. The biosensors used showed different sensitivities to each other and to the groundwater samples tested. There was generally a good agreement with chemical analyses. The potential efficacy of remediation strategies was explored by coupling sample manipulation to biosensor tests. Manipulation involved sparging and charcoal treatment procedures to simulate remediative engineering solutions. Sparging was sufficient at most locations. - Luminescent bacteria complement chemical analysis and support remediation technology

User-experiences with a web-based self-help intervention for partners of cancer patients based on acceptance and commitment therapy and self-compassion: a qualitative study

Directory of Open Access Journals (Sweden)

Nadine Köhle

2017-02-01

Full Text Available Abstract Background Partners of cancer patients are the cornerstone of supportive cancer care. They assume different roles and responsibilities that optimally support the patient. Such support is highly demanding, and many partners report (mental health problems. However, many of them do not use professional supportive care themselves. Offering a Web-based self-help intervention based on Acceptance and Commitment Therapy (ACT and self-compassion could be an important resource to support this group. This qualitative study aimed to examine user-experiences with a Web-based self-help intervention based on ACT and self-compassion among partners of cancer patients. Methods Individual in-depth interviews, about partners’ appreciation of the intervention and lessons learned, were conducted with 14 partners of cancer patients who used the Web-based self-help intervention. Interviews were audio-recorded, transcribed verbatim and analyzed by three independent coders both deductively and inductively. Results In general, partners appreciated the intervention, however, they also expressed ambivalent feelings towards peer support, the content of the feedback of their counselor, and the ‘tunneled’ structure of the intervention. The majority of the partners reported being more self-compassionate accepting that they experienced negative thoughts and feelings, they reported that they learned to increase the distance between their thoughts and themselves, they indicated being more aware of their personal values, and they thought that they were better able to commit to those values. They also reported other (non-specific helpful processes such as insight and acknowledgement, positivity, the possibility to tell their story, time for themselves, and feeling closer and more connected with their partner (the patient. Conclusions Partners of cancer patients indicated to appreciate the Web-based self-help intervention based on ACT and self-compassion. They felt

What cancer patients find in the internet: the visibility of evidence-based patient information - analysis of information on German websites.

Science.gov (United States)

Liebl, Patrick; Seilacher, Eckart; Koester, Marie-Jolin; Stellamanns, Jan; Zell, Joerg; Hübner, Jutta

2015-01-01

The internet is an easy and always accessible source of information for cancer patients. The aim of our study was to evaluate the information provided on German websites. We developed an instrument based on criteria for patient information from the German Network for Evidence-based Medicine, the Agency for Quality in Medicine, HONcode, DISCERN, and the afgis. We simulated a patient's search and derived the websites for evaluation. We analyzed the visibility of each website and evaluated the websites using the developed instrument. We analyzed 77 websites. The highest visibility index was shown by 4 profit websites. Websites from professional societies and self-help groups have low rankings. Concerning quality, websites from non-profit providers and self-help groups are on top. Websites with a profit interest have the lowest average score. A discrepancy exists between the visibility and the quality of the analyzed websites. With the internet becoming an important source of information on cancer treatments for patients, this may lead to false information and wrong decisions. We provide a list of suggestions as to how this risk may be reduced by complementary information from the physician and from trustworthy websites. © 2015 S. Karger GmbH, Freiburg.

REAKSI PASAR MODAL INDONESIA TERHADAP PERGANTIAN MENTERI KEUANGAN (EVENT STUDY SAHAM YANG TERDAFTAR DI BEI

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Lia Nur Islami

2012-02-01

Full Text Available Information is the main needs of investors in capital markets. Sri Mulyani setback Event of the positions for the finance minister who has information content relevant to investors will cause the market reaction reflected through changes in stock prices and trading activity. This reaction can be measured by indicators of Abnormal Return (AR, Trading Volume Activity (TVA and Security Return variability (SRV. This research is a study of events that aims to find empirical evidence for the existence of the Indonesian capital market reaction to the events of Sri Mulyani setback from the office of finance minister. The population in this study is that all stocks listed on the BEI. While the sample taken through purposive sampling technique of shares - shares that are included in LQ45 corporate action and do not perform during the event period. One sample t-test (one sample t-test was used to analyze whether the AR, TVA, and SRV significant value on the day - the day around the occurrence of events that prove the existence of market reaction. TVA and AR significant at the time of announcement of events shows that the market reacted to the setback Sri Mulyani finance minister from office. However, the SRV is not significant at the time of announcement of events shows that the market reaction that occurs there is an uneven distribution of information and influence the distribution of stock return

Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review.

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Kuijer, P P F M; Gouttebarge, V; Brouwer, S; Reneman, M F; Frings-Dresen, M H W

2012-02-01

Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs? A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed. Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies. Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion.

Science.gov (United States)

van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

2008-02-27

As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

Directory of Open Access Journals (Sweden)

Heerdink Rob

2008-02-01

Full Text Available Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Methods The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Results Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. Conclusion For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

Diversity of respiratory impedance based on quantitative computed tomography in patients with COPD.

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Wada, Yosuke; Kitaguchi, Yoshiaki; Yasuo, Masanori; Ueno, Fumika; Kawakami, Satoshi; Fukushima, Kiyoyasu; Fujimoto, Keisaku; Hanaoka, Masayuki

2018-01-01

This study was conducted in order to investigate the diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative computed tomography (CT) in patients with COPD. Medical records of 174 stable COPD patients were retrospectively reviewed to obtain the patients' clinical data, including the pulmonary function and imaging data. According to the software-based quantification of the degree of emphysema and airway wall thickness, the patients were classified into the "normal by CT" phenotype, the airway-dominant phenotype, the emphysema-dominant phenotype, and the mixed phenotype. The pulmonary function, including the respiratory impedance evaluated by using the forced oscillation technique (FOT) and the reversibility of airway obstruction in response to inhaled short-acting β 2 -agonists, was then compared among the four phenotypes. The respiratory system resistance at 5 and 20 Hz (R5 and R20) was significantly higher, and the respiratory system reactance at 5 Hz (X5) was significantly more negative in the airway-dominant and mixed phenotypes than in the other phenotypes. The within-breath changes of X5 (ΔX5) were significantly greater in the mixed phenotype than in the "normal by CT" and emphysema-dominant phenotypes. The FOT parameters (R5, R20, and X5) were significantly correlated with indices of the degree of airway wall thickness and significantly but weakly correlated with the reversibility of airway obstruction. There was no significant correlation between the FOT parameters (R5, R20, and X5) and the degree of emphysema. There is a diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative CT in patients with COPD. The FOT measurements may reflect the degree of airway disease and aid in detecting airway remodeling in patients with COPD.

Re-Evaluation of Acid-Base Prediction Rules in Patients with Chronic Respiratory Acidosis

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Tereza Martinu

2003-01-01

Full Text Available RATIONALE: The prediction rules for the evaluation of the acid-base status in patients with chronic respiratory acidosis, derived primarily from an experimental canine model, suggest that complete compensation should not occur. This appears to contradict frequent observations of normal or near-normal pH levels in patients with chronic hypercapnia.

Initial test of a T9-like P300-based speller by an ALS patient

Science.gov (United States)

Ron-Angevin, R.; Varona-Moya, S.; da Silva-Sauer, L.

2015-08-01

Objective. Visual P300-based brain-computer interface spellers offer a useful communication channel for locked-in patients, who are completely dependent in their daily lives. One of the research goals for these systems is to achieve greater communication rates by means of modifying some features of their interfaces, e.g., reducing the matrix size. However, such modifications may not work well with disabled end-users, such as patients of amyotrophic lateral sclerosis (ALS), due to a supposed reduction of their cognitive resources. The purpose of the present study was to provide a proof of concept that ALS patients could efficiently use a P300-based speller with a 4 × 3 symbol matrix based on the T9 interface developed for mobile phones. Approach. We conducted an experiment with a sample of 11 able-bodied participants and one locked-in patient with ALS. All participants tested our T9-like visual P300-based speller and also two different 7 × 6 matrix spellers based on Farwell and Donchin’s classic proposal—one of them included a word predictor system like the T9-like speller did. Main results. The performance analyses indicated that the locked-in patient benefited from using a reduced matrix size as much as healthy users did, spelling words almost 1.6 times faster and equally accurately when using the T9-like speller than when using the alternative spellers. Significance. Due to counting on only one locked-in patient, the current work constitutes a feasibility study. The actual usability of systems such as the one proposed in this paper should be determined by means of studies with a greater number of end-users in real-life conditions.

Design and development of a web-based application for diabetes patient data management

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SS Deo

2005-03-01

Full Text Available A web-based database management system developed for collecting, managing and analysing information of diabetes patients is described here. It is a searchable, client-server, relational database application, developed on the WindowsTM platform using Oracle, Active Server Pages (ASP, Visual Basic Script (VB Script and Java Script. The software is menu-driven and allows authorised healthcare providers to access, enter, update and analyse patient information. Graphical representation of data can be generated by the system using bar charts and pie charts. An interactive web interface allows users to query the database and generate reports. Alpha- and beta-testing of the system was carried out and the system at present holds records of 500 diabetes patients and is found useful in diagnosis and treatment. In addition to providing patient data on a continuous basis in a simple format, the system is used in population and comparative analysis. It has proved to be of significant advantage to the healthcare provider as compared to the paper-based system.

Surface electromyography based muscle fatigue analysis for stroke patients at different Brunnstrom stages.

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Yinjun Tu; Zhe Zhang; Xudong Gu; Qiang Fang

2016-08-01

Muscle fatigue analysis has been an important topic in sport and rehabilitation medicine due to its role in muscle performance evaluation and pathology investigation. This paper proposes a surface electromyography (sEMG) based muscle fatigue analysis approach which was specifically designed for stroke rehabilitation applications. 14 stroke patients from 5 different Brunnstrom recovery stage groups were involved in the experiment and features including median frequency and mean power frequency were extracted from the collected sEMG samples for investigation. After signal decomposition, the decline of motor unit firing rate of patients from different groups had also been studied. Statistically significant presence of fatigue had been observed in deltoideus medius and extensor digitorum communis of patients at early recovery stages (P0.01). It had also been discovered that the motor unit firing frequency declines with a range positively correlated to the recovery stage during repetitive movements. Based on the experiment result, it can be verified that as the recovery stage increases, the central nervous system's control ability strengthens and the patient motion becomes more stable and resistive to fatigue.

Paclitaxel-Based Chemoradiotherapy in the Treatment of Patients With Operable Esophageal Cancer

International Nuclear Information System (INIS)

Kelsey, Chris R.; Chino, Junzo P.; Willett, Christopher G.; Clough, Robert W.; Hurwitz, Herbert I.; Morse, Michael A.; Bendell, Johanna C.; D'Amico, Thomas A.; Czito, Brian G.

2007-01-01

Purpose: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. Methods and Materials: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. Results: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. Conclusions: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens

Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial.

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Giesler, Jürgen M; Keller, Bettina; Repke, Tim; Leonhart, Rainer; Weis, Joachim; Muckelbauer, Rebecca; Rieckmann, Nina; Müller-Nordhorn, Jacqueline; Lucius-Hoene, Gabriele; Holmberg, Christine

2017-10-13

Patients often seek other patients' experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people's health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients' Experiences) aims to provide scientifically based online information on people's experiences with health and illness to fulfill patients' needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks. The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on

Wastes and by-products - alternatives for agricultural use

International Nuclear Information System (INIS)

Boles, J.L.; Craft, D.J.; Parker, B.R.

1994-01-01

Top address a growing national problem with generation of wastes and by-products, TVA has been involved for several years with developing and commercializing environmentally responsible practices for eliminating, minimizing, or utilizing various wastes/by-products. In many cases, reducing waste generation is impractical, but the wastes/by-products can be converted into other environmentally sound products. In some instances, conversion of safe, value-added agricultural products in the best or only practical alternative. TVA is currently involved with a diversity of projects converting wastes/by-products into safe, economical, and agriculturally beneficial products. Environmental improvement projects have involved poultry litter, cellulosic wastes, used battery acid, ammonium sulfate fines, lead smelting effluents, deep-welled sulfuric acid/ammonium bisulfate solutions, wood ash, waste magnesium ammonium sulfate slurry from recording tape production, and ammunition plant waste sodium nitrate/ammonium nitrate streams

Aquatic Plant Management Program current status and seasonal workplan

Energy Technology Data Exchange (ETDEWEB)

Burns, E.R.; Bates, A.L.; Webb, D.H.

1993-07-01

The objective of the TVA Aquatic Plant Management Program is to support in an environmentally and economically responsible manner, the balanced multiple uses of the water resource of the Tennessee Valley. This is accomplished by following an integrated approach to prevent introduction and spread of noxious species, documenting occurrence and spread of existing species, and suppressing or eliminating problems in designated high use areas. It is not the TVA objective, nor is it biologically feasible and prudent to eliminate all aquatic vegetation. Aerial photography, helicopter reconnaissance, and field surveys are used to assess distributions and abundance of various aquatic macrophytes. Water level fluctuations are supplemented by herbicide applications to control undesirable vegetation. Investigations are conducted to evaluate water level fluctuation schemes, as well as biological, mechanical, and alternative chemical control techniques which offer potential for more environmentally compatible and cost-effective management operations.

Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis

NARCIS (Netherlands)

Samoocha, David; Bruinvels, David J.; Elbers, Nieke A.; Anema, Johannes R.; van der Beek, Allard J.

2010-01-01

Patient empowerment is growing in popularity and application. Due to the increasing possibilities of the Internet and eHealth, many initiatives that are aimed at empowering patients are delivered online. Our objective was to evaluate whether Web-based interventions are effective in increasing

Atrial Fibrillation in Patients with Transient Ischemic Attack in Accordance with the Tissue-Based Definition.

Science.gov (United States)

Scheef, Björn; Al-Khaled, Mohamed

2016-06-01

Transient ischemic attack (TIA) management requires a cardiac evaluation with a Holter electrocardiogram (ECG), preferably a long-term (24 h) electrocardiogram (LT-ECG), to detect atrial fibrillation (AF), which places patients at higher risk of cerebrovascular events. The aim of this study was to determine the frequency of AF using ECG and LT-ECG in patients with tissue-based TIA. During a three-year period (starting in 2011), all consecutive patients with tissue-based TIA (no evidence of infarction by brain imaging) were included and prospectively evaluated. Of 861 patients (mean age, 70 ± 13 years; 49.7% women), 854 patients (99.2%) had an ECG at admission, and 338 patients (39.3%) underwent 24-h LT-ECG monitoring during hospitalization. Patients who underwent LT-ECG monitoring were significantly younger (68 vs. 71 years; P=0.001) and experienced longer symptom duration (143 vs. 79 minutes; P=0.024) compared with those who did not. Furthermore, they had lower rates of unilateral weakness (32% vs. 39%; P=0.034) and previous strokes (18% vs. 26%; P=0.007). The LT-ECG investigation was also associated with longer hospitalization (7.9 vs. 5.7 days; Phypertension (OR, 3.1; 95% CI: 1-8.9; P=0.041) and increased glucose level >6.05 mmol/L) on admission (OR, 1.9; 95% CI: 1-3.5; P=0.036). Cardiac evaluation with LT-ECG appears to increase the rate of detected AF and may lead to a change in secondary prophylaxis in patients with tissue-based TIA.

Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients.