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Sample records for two-stage cluster random

  1. Two-Stage Modelling Of Random Phenomena

    Science.gov (United States)

    Barańska, Anna

    2015-12-01

    The main objective of this publication was to present a two-stage algorithm of modelling random phenomena, based on multidimensional function modelling, on the example of modelling the real estate market for the purpose of real estate valuation and estimation of model parameters of foundations vertical displacements. The first stage of the presented algorithm includes a selection of a suitable form of the function model. In the classical algorithms, based on function modelling, prediction of the dependent variable is its value obtained directly from the model. The better the model reflects a relationship between the independent variables and their effect on the dependent variable, the more reliable is the model value. In this paper, an algorithm has been proposed which comprises adjustment of the value obtained from the model with a random correction determined from the residuals of the model for these cases which, in a separate analysis, were considered to be the most similar to the object for which we want to model the dependent variable. The effect of applying the developed quantitative procedures for calculating the corrections and qualitative methods to assess the similarity on the final outcome of the prediction and its accuracy, was examined by statistical methods, mainly using appropriate parametric tests of significance. The idea of the presented algorithm has been designed so as to approximate the value of the dependent variable of the studied phenomenon to its value in reality and, at the same time, to have it "smoothed out" by a well fitted modelling function.

  2. TWO-STAGE CHARACTER CLASSIFICATION : A COMBINED APPROACH OF CLUSTERING AND SUPPORT VECTOR CLASSIFIERS

    NARCIS (Netherlands)

    Vuurpijl, L.; Schomaker, L.

    2000-01-01

    This paper describes a two-stage classification method for (1) classification of isolated characters and (2) verification of the classification result. Character prototypes are generated using hierarchical clustering. For those prototypes known to sometimes produce wrong classification results, a

  3. A two-stage method for microcalcification cluster segmentation in mammography by deformable models

    Energy Technology Data Exchange (ETDEWEB)

    Arikidis, N.; Kazantzi, A.; Skiadopoulos, S.; Karahaliou, A.; Costaridou, L., E-mail: costarid@upatras.gr [Department of Medical Physics, School of Medicine, University of Patras, Patras 26504 (Greece); Vassiou, K. [Department of Anatomy, School of Medicine, University of Thessaly, Larissa 41500 (Greece)

    2015-10-15

    Purpose: Segmentation of microcalcification (MC) clusters in x-ray mammography is a difficult task for radiologists. Accurate segmentation is prerequisite for quantitative image analysis of MC clusters and subsequent feature extraction and classification in computer-aided diagnosis schemes. Methods: In this study, a two-stage semiautomated segmentation method of MC clusters is investigated. The first stage is targeted to accurate and time efficient segmentation of the majority of the particles of a MC cluster, by means of a level set method. The second stage is targeted to shape refinement of selected individual MCs, by means of an active contour model. Both methods are applied in the framework of a rich scale-space representation, provided by the wavelet transform at integer scales. Segmentation reliability of the proposed method in terms of inter and intraobserver agreements was evaluated in a case sample of 80 MC clusters originating from the digital database for screening mammography, corresponding to 4 morphology types (punctate: 22, fine linear branching: 16, pleomorphic: 18, and amorphous: 24) of MC clusters, assessing radiologists’ segmentations quantitatively by two distance metrics (Hausdorff distance—HDIST{sub cluster}, average of minimum distance—AMINDIST{sub cluster}) and the area overlap measure (AOM{sub cluster}). The effect of the proposed segmentation method on MC cluster characterization accuracy was evaluated in a case sample of 162 pleomorphic MC clusters (72 malignant and 90 benign). Ten MC cluster features, targeted to capture morphologic properties of individual MCs in a cluster (area, major length, perimeter, compactness, and spread), were extracted and a correlation-based feature selection method yielded a feature subset to feed in a support vector machine classifier. Classification performance of the MC cluster features was estimated by means of the area under receiver operating characteristic curve (Az ± Standard Error) utilizing

  4. Multiobjective Two-Stage Stochastic Programming Problems with Interval Discrete Random Variables

    Directory of Open Access Journals (Sweden)

    S. K. Barik

    2012-01-01

    Full Text Available Most of the real-life decision-making problems have more than one conflicting and incommensurable objective functions. In this paper, we present a multiobjective two-stage stochastic linear programming problem considering some parameters of the linear constraints as interval type discrete random variables with known probability distribution. Randomness of the discrete intervals are considered for the model parameters. Further, the concepts of best optimum and worst optimum solution are analyzed in two-stage stochastic programming. To solve the stated problem, first we remove the randomness of the problem and formulate an equivalent deterministic linear programming model with multiobjective interval coefficients. Then the deterministic multiobjective model is solved using weighting method, where we apply the solution procedure of interval linear programming technique. We obtain the upper and lower bound of the objective function as the best and the worst value, respectively. It highlights the possible risk involved in the decision-making tool. A numerical example is presented to demonstrate the proposed solution procedure.

  5. Two-stage scheduling algorithm based on priority table for clusters with inaccurate system parameters

    Institute of Scientific and Technical Information of China (English)

    LIU An-feng; CHEN Zhi-gang; XIONG Ce

    2006-01-01

    A new two-stage soft real-time scheduling algorithm based on priority table was proposed for task dispatch and selection in cluster systems with inaccurate parameters. The inaccurate characteristics of the system were modeled through probability analysis. By taking into account the multiple important system parameters, including task deadline, priority, session integrity and memory access locality, the algorithm is expected to achieve high quality of service. Lots of simulation results collected under different load conditions demonstrate that the algorithm can not only effectively overcome the inaccuracy of the system state, but also optimize the task rejected ratio, value realized ratio, differentiated service guaranteed ratio, and session integrity ensured ratio with the average improvement of 3.5%, 5.8%, 7.6% and 5.5%, respectively. Compared with many existing schemes that cannot deal with the inaccurate parameters of the system, the proposed scheme can achieve the best system performance by carefully adjusting scheduling probability. The algorithm is expected to be promising in systems with soft real-time scheduling requirement such as E-commerce applications.

  6. Modifications of some simple One-stage Randomized Response Models to Two-stage in complex surveys

    Directory of Open Access Journals (Sweden)

    Mohammad Rafiq

    2016-06-01

    Full Text Available Warner (1965 introduced a Randomized Response Technique (RRT to minimize bias due to non- response or false response. Thereafter, several researchers have made significant contribution in the development and modification of different Randomized Response Models. We have modified a few one-stage Simple Randomized Response Models to two-stage randomized response models in complex surveys and found that our developed models are more efficient.

  7. A covariate adjusted two-stage allocation design for binary responses in randomized clinical trials.

    Science.gov (United States)

    Bandyopadhyay, Uttam; Biswas, Atanu; Bhattacharya, Rahul

    2007-10-30

    In the present work, we develop a two-stage allocation rule for binary response using the log-odds ratio within the Bayesian framework allowing the current allocation to depend on the covariate value of the current subject. We study, both numerically and theoretically, several exact and limiting properties of this design. The applicability of the proposed methodology is illustrated by using some data set. We compare this rule with some of the existing rules by computing various performance measures.

  8. TSCC: Two-Stage Combinatorial Clustering for virtual screening using protein-ligand interactions and physicochemical features

    Science.gov (United States)

    2010-01-01

    Background The increasing numbers of 3D compounds and protein complexes stored in databases contribute greatly to current advances in biotechnology, being employed in several pharmaceutical and industrial applications. However, screening and retrieving appropriate candidates as well as handling false positives presents a challenge for all post-screening analysis methods employed in retrieving therapeutic and industrial targets. Results Using the TSCC method, virtually screened compounds were clustered based on their protein-ligand interactions, followed by structure clustering employing physicochemical features, to retrieve the final compounds. Based on the protein-ligand interaction profile (first stage), docked compounds can be clustered into groups with distinct binding interactions. Structure clustering (second stage) grouped similar compounds obtained from the first stage into clusters of similar structures; the lowest energy compound from each cluster being selected as a final candidate. Conclusion By representing interactions at the atomic-level and including measures of interaction strength, better descriptions of protein-ligand interactions and a more specific analysis of virtual screening was achieved. The two-stage clustering approach enhanced our post-screening analysis resulting in accurate performances in clustering, mining and visualizing compound candidates, thus, improving virtual screening enrichment. PMID:21143810

  9. Effekt of a two-stage nursing assesment and intervention - a randomized intervention study

    DEFF Research Database (Denmark)

    Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

    to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80...... % of geriatric patients have complex and often unresolved caring needs. The objective was to examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...

  10. The Mark Coventry, MD, Award: Oral Antibiotics Reduce Reinfection After Two-Stage Exchange: A Multicenter, Randomized Controlled Trial.

    Science.gov (United States)

    Frank, Jonathan M; Kayupov, Erdan; Moric, Mario; Segreti, John; Hansen, Erik; Hartman, Curtis; Okroj, Kamil; Belden, Katherine; Roslund, Brian; Silibovsky, Randi; Parvizi, Javad; Della Valle, Craig J

    2017-01-01

    Many patients develop recurrent periprosthetic joint infection after two-stage exchange arthroplasty of the hip or knee. One potential but insufficiently tested strategy to decrease the risk of persistent or recurrent infection is to administer additional antibiotics after the second-stage reimplantation. (1) Does a 3-month course of oral antibiotics decrease the risk of failure secondary to infection after a two-stage exchange? (2) Are there any complications related to the administration of oral antibiotics after a two-stage exchange? (3) In those patients who develop a reinfection, is the infecting organism different from the initial infection? Patients at seven centers randomized to receive 3 months of oral antibiotics or no further antibiotic treatment after operative cultures after the second-stage reimplantation were negative. Adult patients undergoing two-stage hip or knee revision arthroplasty for a periprosthetic infection who met Musculoskeletal Infection Society (MSIS) criteria for infection at the first stage were included. Oral antibiotic therapy was tailored to the original infecting organism(s) in consultation with an infectious disease specialist. MSIS criteria as used by the treating surgeon defined failure. Surveillance of patients for complications, including reinfection, occurred at 3 weeks, 6 weeks, 3 months, 12 months, and 24 months. If an organism demonstrated the same antibiotic sensitivities as the original organism, it was considered the same organism; no DNA subtyping was performed. Analysis was performed as intent to treat with all randomized patients included in the groups to which they were randomized. A log-rank survival curve was used to analyze the primary outcome of reinfection. At planned interim analysis (enrollment is ongoing), 59 patients were successfully randomized to the antibiotic group and 48 patients to the control group. Fifty-seven patients had an infection after TKA and 50 after a THA. There was no minimum followup

  11. FunSAV: predicting the functional effect of single amino acid variants using a two-stage random forest model.

    Directory of Open Access Journals (Sweden)

    Mingjun Wang

    Full Text Available Single amino acid variants (SAVs are the most abundant form of known genetic variations associated with human disease. Successful prediction of the functional impact of SAVs from sequences can thus lead to an improved understanding of the underlying mechanisms of why a SAV may be associated with certain disease. In this work, we constructed a high-quality structural dataset that contained 679 high-quality protein structures with 2,048 SAVs by collecting the human genetic variant data from multiple resources and dividing them into two categories, i.e., disease-associated and neutral variants. We built a two-stage random forest (RF model, termed as FunSAV, to predict the functional effect of SAVs by combining sequence, structure and residue-contact network features with other additional features that were not explored in previous studies. Importantly, a two-step feature selection procedure was proposed to select the most important and informative features that contribute to the prediction of disease association of SAVs. In cross-validation experiments on the benchmark dataset, FunSAV achieved a good prediction performance with the area under the curve (AUC of 0.882, which is competitive with and in some cases better than other existing tools including SIFT, SNAP, Polyphen2, PANTHER, nsSNPAnalyzer and PhD-SNP. The sourcecodes of FunSAV and the datasets can be downloaded at http://sunflower.kuicr.kyoto-u.ac.jp/sjn/FunSAV.

  12. Robust prediction of B-factor profile from sequence using two-stage SVR based on random forest feature selection.

    Science.gov (United States)

    Pan, Xiao-Yong; Shen, Hong-Bin

    2009-01-01

    B-factor is highly correlated with protein internal motion, which is used to measure the uncertainty in the position of an atom within a crystal structure. Although the rapid progress of structural biology in recent years makes more accurate protein structures available than ever, with the avalanche of new protein sequences emerging during the post-genomic Era, the gap between the known protein sequences and the known protein structures becomes wider and wider. It is urgent to develop automated methods to predict B-factor profile from the amino acid sequences directly, so as to be able to timely utilize them for basic research. In this article, we propose a novel approach, called PredBF, to predict the real value of B-factor. We firstly extract both global and local features from the protein sequences as well as their evolution information, then the random forests feature selection is applied to rank their importance and the most important features are inputted to a two-stage support vector regression (SVR) for prediction, where the initial predicted outputs from the 1(st) SVR are further inputted to the 2nd layer SVR for final refinement. Our results have revealed that a systematic analysis of the importance of different features makes us have deep insights into the different contributions of features and is very necessary for developing effective B-factor prediction tools. The two-layer SVR prediction model designed in this study further enhanced the robustness of predicting the B-factor profile. As a web server, PredBF is freely available at: http://www.csbio.sjtu.edu.cn/bioinf/PredBF for academic use.

  13. Mixed effect regression analysis for a cluster-based two-stage outcome-auxiliary-dependent sampling design with a continuous outcome.

    Science.gov (United States)

    Xu, Wangli; Zhou, Haibo

    2012-09-01

    Two-stage design is a well-known cost-effective way for conducting biomedical studies when the exposure variable is expensive or difficult to measure. Recent research development further allowed one or both stages of the two-stage design to be outcome dependent on a continuous outcome variable. This outcome-dependent sampling feature enables further efficiency gain in parameter estimation and overall cost reduction of the study (e.g. Wang, X. and Zhou, H., 2010. Design and inference for cancer biomarker study with an outcome and auxiliary-dependent subsampling. Biometrics 66, 502-511; Zhou, H., Song, R., Wu, Y. and Qin, J., 2011. Statistical inference for a two-stage outcome-dependent sampling design with a continuous outcome. Biometrics 67, 194-202). In this paper, we develop a semiparametric mixed effect regression model for data from a two-stage design where the second-stage data are sampled with an outcome-auxiliary-dependent sample (OADS) scheme. Our method allows the cluster- or center-effects of the study subjects to be accounted for. We propose an estimated likelihood function to estimate the regression parameters. Simulation study indicates that greater study efficiency gains can be achieved under the proposed two-stage OADS design with center-effects when compared with other alternative sampling schemes. We illustrate the proposed method by analyzing a dataset from the Collaborative Perinatal Project.

  14. Could the clinical interpretability of subgroups detected using clustering methods be improved by using a novel two-stage approach?

    DEFF Research Database (Denmark)

    Kent, Peter; Stochkendahl, Mette Jensen; Wulff Christensen, Henrik

    2015-01-01

    is to use statistical clustering techniques, such as Cluster Analysis or Latent Class Analysis, to detect latent relationships between patient characteristics. Influential patient characteristics can come from diverse domains of health, such as pain, activity limitation, physical impairment, social role...... participation, psychological factors, biomarkers and imaging. However, such ‘whole person’ research may result in data-driven subgroups that are complex, difficult to interpret and challenging to recognise clinically. This paper describes a novel approach to applying statistical clustering techniques that may...... improve the clinical interpretability of derived subgroups and reduce sample size requirements. Methods This approach involves clustering in two sequential stages. The first stage involves clustering within health domains and therefore requires creating as many clustering models as there are health...

  15. Cluster randomization and political philosophy.

    Science.gov (United States)

    Chwang, Eric

    2012-11-01

    In this paper, I will argue that, while the ethical issues raised by cluster randomization can be challenging, they are not new. My thesis divides neatly into two parts. In the first, easier part I argue that many of the ethical challenges posed by cluster randomized human subjects research are clearly present in other types of human subjects research, and so are not novel. In the second, more difficult part I discuss the thorniest ethical challenge for cluster randomized research--cases where consent is genuinely impractical to obtain. I argue that once again these cases require no new analytic insight; instead, we should look to political philosophy for guidance. In other words, the most serious ethical problem that arises in cluster randomized research also arises in political philosophy.

  16. Random matrix improved subspace clustering

    KAUST Repository

    Couillet, Romain

    2017-03-06

    This article introduces a spectral method for statistical subspace clustering. The method is built upon standard kernel spectral clustering techniques, however carefully tuned by theoretical understanding arising from random matrix findings. We show in particular that our method provides high clustering performance while standard kernel choices provably fail. An application to user grouping based on vector channel observations in the context of massive MIMO wireless communication networks is provided.

  17. A two-stage adaptive stochastic collocation method on nested sparse grids for multiphase flow in randomly heterogeneous porous media

    Science.gov (United States)

    Liao, Qinzhuo; Zhang, Dongxiao; Tchelepi, Hamdi

    2017-02-01

    A new computational method is proposed for efficient uncertainty quantification of multiphase flow in porous media with stochastic permeability. For pressure estimation, it combines the dimension-adaptive stochastic collocation method on Smolyak sparse grids and the Kronrod-Patterson-Hermite nested quadrature formulas. For saturation estimation, an additional stage is developed, in which the pressure and velocity samples are first generated by the sparse grid interpolation and then substituted into the transport equation to solve for the saturation samples, to address the low regularity problem of the saturation. Numerical examples are presented for multiphase flow with stochastic permeability fields to demonstrate accuracy and efficiency of the proposed two-stage adaptive stochastic collocation method on nested sparse grids.

  18. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

    Directory of Open Access Journals (Sweden)

    Logoluso Nicola

    2011-05-01

    Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

  19. Description of two-stage processes in reactions of nucleon and cluster knock out by medium-energy protons on the basis of the effective t-matrix

    Energy Technology Data Exchange (ETDEWEB)

    Vdovin, A.I.; Golovin, A.V.; Loshchakov, I.I.

    1986-06-01

    We propose to calculate the amplitude for the two-stage processes in reactions of nucleon and cluster knock out from light nuclei by medium-energy protons as a coherent sum of amplitudes of the probability of the quasielastic pp (or px) interaction and of inelastic proton scattering by the target nucleus with formation of excited states of the intermediate nucleus and with their subsequent decay with emission of a nucleon or a particle x. The reaction matrix element is calculated on the basis of the t-matrix distorted-wave approximation. All functions entering into the matrix element are given analytically, which allows the analytic calculation of multidimensional integrals entering into the matrix element. The calculations of the energy spectra of protons carried out with this model are in good agreement with experiment.

  20. Overlapping Community Detection Algorithm Based on Two-Stage Clustering%基于二阶段聚类的重叠社区发现算法

    Institute of Scientific and Technical Information of China (English)

    蒋盛益; 杨博泓; 李敏敏; 吴美玲; 王连喜

    2015-01-01

    Aiming at the complex network overlapping community detection, an overlapping community detection algorithm based on two-stage clustering is proposed. Eigen decomposition is applied to network adjacency matrix. The nodes are projected into k-dimensional Euclidean space, and then they are clustered by hard and soft clustering algorithm to detect the structure of overlapping community efficiently and adaptively. At the stage of hard clustering, a clustering algorithm based on the principle of minimum distance is introduced to divide nodes autonomously, and the number of communities and cluster centers for the soft clustering stage are determined. At the stage of soft clustering, fuzzy C-means algorithm is introduced and the fuzzy modularity is considered as objective function for the algorithm. Through iterative optimization of the fuzzy modularity, a soft partition is realized and overlapping community structures in network can be figured out. Experiments are carried out on a number of real network datasets, and the results indicate that the proposed algorithm can mine overlapping community structure in complex network with high efficiency and effectiveness.%针对当前复杂网络重叠社区发现的热点问题,提出基于二阶段聚类的重叠社区发现算法.对网络邻接矩阵进行特征分解时,节点投影到k维欧氏空间后,对节点先后进行硬聚类和软聚类,高效自适应地挖掘网络中的重叠社区结构.在硬聚类阶段中,引入基于距离最小原则的一趟聚类算法对节点进行自适应的硬划分,确定软聚类阶段中的聚类中心和网络的社区数量.在软聚类阶段中,引入以模糊模块度为目标函数的模糊C均值算法,通过迭代优化模糊模块度实现对节点的软划分,挖掘网络中的重叠社区结构.在多个真实网络数据集上的实验验证文中算法能高效挖掘复杂网络中的重叠社区结构.

  1. A two-stage cluster sampling method using gridded population data, a GIS, and Google EarthTM imagery in a population-based mortality survey in Iraq

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    Galway LP

    2012-04-01

    Full Text Available Abstract Background Mortality estimates can measure and monitor the impacts of conflict on a population, guide humanitarian efforts, and help to better understand the public health impacts of conflict. Vital statistics registration and surveillance systems are rarely functional in conflict settings, posing a challenge of estimating mortality using retrospective population-based surveys. Results We present a two-stage cluster sampling method for application in population-based mortality surveys. The sampling method utilizes gridded population data and a geographic information system (GIS to select clusters in the first sampling stage and Google Earth TM imagery and sampling grids to select households in the second sampling stage. The sampling method is implemented in a household mortality study in Iraq in 2011. Factors affecting feasibility and methodological quality are described. Conclusion Sampling is a challenge in retrospective population-based mortality studies and alternatives that improve on the conventional approaches are needed. The sampling strategy presented here was designed to generate a representative sample of the Iraqi population while reducing the potential for bias and considering the context specific challenges of the study setting. This sampling strategy, or variations on it, are adaptable and should be considered and tested in other conflict settings.

  2. 基于Hadoop二阶段并行模糊c-Means聚类算法%HADOOP-BASED TWO-STAGE PARALLEL FUZZY C-MEANS CLUSTERING ALGORITHM

    Institute of Scientific and Technical Information of China (English)

    胡吉朝; 黄红艳

    2016-01-01

    Aiming at the problem of too high occupancy of communication time and limited applying value of the algorithm under the mechanism of Mapreduce,we put forward a Hadoop-based two-stage parallel c-Means clustering algorithm to deal with the problem of extra-large data classification.First,we improved the MPI communication management method in Mapreduce mechanism,and used membership management protocol mode to realise the synchronisation of members management and Mapreduce reducing operation.Secondly, we implemented typical individuals group reducing operation instead of global individual reducing operation,and defined the two-stage buffer algorithm.Finally,through the buffer in first stage we further reduced the data amount of Mapreduce operation in second stage,and reduced the negative impact brought about by big data on the algorithm as much as possible.Based on this,we carried out the simulation by using artificial big data test set and KDD CUP 99 invasion test data.Experimental result showed that the algorithm could both guarantee the clustering precision requirement and speed up effectively the operation efficiency of algorithm.%针对Mapreduce机制下算法通信时间占用比过高,实际应用价值受限的情况,提出基于Hadoop二阶段并行c-Means聚类算法用来解决超大数据的分类问题。首先,改进Mapreduce机制下的MPI通信管理方法,采用成员管理协议方式实现成员管理与Mapreduce降低操作的同步化;其次,实行典型个体组降低操作代替全局个体降低操作,并定义二阶段缓冲算法;最后,通过第一阶段的缓冲进一步降低第二阶段Mapreduce操作的数据量,尽可能降低大数据带来的对算法负面影响。在此基础上,利用人造大数据测试集和KDD CUP 99入侵测试集进行仿真,实验结果表明,该算法既能保证聚类精度要求又可有效加快算法运行效率。

  3. An unsupervised two-stage clustering approach for forest structure classification based on X-band InSAR data - A case study in complex temperate forest stands

    Science.gov (United States)

    Abdullahi, Sahra; Schardt, Mathias; Pretzsch, Hans

    2017-05-01

    Forest structure at stand level plays a key role for sustainable forest management, since the biodiversity, productivity, growth and stability of the forest can be positively influenced by managing its structural diversity. In contrast to field-based measurements, remote sensing techniques offer a cost-efficient opportunity to collect area-wide information about forest stand structure with high spatial and temporal resolution. Especially Interferometric Synthetic Aperture Radar (InSAR), which facilitates worldwide acquisition of 3d information independent from weather conditions and illumination, is convenient to capture forest stand structure. This study purposes an unsupervised two-stage clustering approach for forest structure classification based on height information derived from interferometric X-band SAR data which was performed in complex temperate forest stands of Traunstein forest (South Germany). In particular, a four dimensional input data set composed of first-order height statistics was non-linearly projected on a two-dimensional Self-Organizing Map, spatially ordered according to similarity (based on the Euclidean distance) in the first stage and classified using the k-means algorithm in the second stage. The study demonstrated that X-band InSAR data exhibits considerable capabilities for forest structure classification. Moreover, the unsupervised classification approach achieved meaningful and reasonable results by means of comparison to aerial imagery and LiDAR data.

  4. Methods for analyzing cost effectiveness data from cluster randomized trials

    Directory of Open Access Journals (Sweden)

    Clark Allan

    2007-09-01

    Full Text Available Abstract Background Measurement of individuals' costs and outcomes in randomized trials allows uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomizing clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. Methods We used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1 joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2 joint modeling of costs and effects with Bayesian hierarchical models and 3 linear regression of net benefits at different willingness to pay levels using a least squares regression with Huber-White robust adjustment of errors, b a least squares hierarchical model and c a Bayesian hierarchical model. Results All five methods produced similar results, with greater uncertainty than if cluster randomization was not accounted for. Conclusion Cost effectiveness analyses alongside cluster randomized trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.

  5. The Design of Cluster Randomized Crossover Trials

    Science.gov (United States)

    Rietbergen, Charlotte; Moerbeek, Mirjam

    2011-01-01

    The inefficiency induced by between-cluster variation in cluster randomized (CR) trials can be reduced by implementing a crossover (CO) design. In a simple CO trial, each subject receives each treatment in random order. A powerful characteristic of this design is that each subject serves as its own control. In a CR CO trial, clusters of subjects…

  6. Optimal production lot size and reorder point of a two-stage supply chain while random demand is sensitive with sales teams' initiatives

    Science.gov (United States)

    Sankar Sana, Shib

    2016-01-01

    The paper develops a production-inventory model of a two-stage supply chain consisting of one manufacturer and one retailer to study production lot size/order quantity, reorder point sales teams' initiatives where demand of the end customers is dependent on random variable and sales teams' initiatives simultaneously. The manufacturer produces the order quantity of the retailer at one lot in which the procurement cost per unit quantity follows a realistic convex function of production lot size. In the chain, the cost of sales team's initiatives/promotion efforts and wholesale price of the manufacturer are negotiated at the points such that their optimum profits reached nearer to their target profits. This study suggests to the management of firms to determine the optimal order quantity/production quantity, reorder point and sales teams' initiatives/promotional effort in order to achieve their maximum profits. An analytical method is applied to determine the optimal values of the decision variables. Finally, numerical examples with its graphical presentation and sensitivity analysis of the key parameters are presented to illustrate more insights of the model.

  7. Empirical power and sample size calculations for cluster-randomized and cluster-randomized crossover studies.

    Science.gov (United States)

    Reich, Nicholas G; Myers, Jessica A; Obeng, Daniel; Milstone, Aaron M; Perl, Trish M

    2012-01-01

    In recent years, the number of studies using a cluster-randomized design has grown dramatically. In addition, the cluster-randomized crossover design has been touted as a methodological advance that can increase efficiency of cluster-randomized studies in certain situations. While the cluster-randomized crossover trial has become a popular tool, standards of design, analysis, reporting and implementation have not been established for this emergent design. We address one particular aspect of cluster-randomized and cluster-randomized crossover trial design: estimating statistical power. We present a general framework for estimating power via simulation in cluster-randomized studies with or without one or more crossover periods. We have implemented this framework in the clusterPower software package for R, freely available online from the Comprehensive R Archive Network. Our simulation framework is easy to implement and users may customize the methods used for data analysis. We give four examples of using the software in practice. The clusterPower package could play an important role in the design of future cluster-randomized and cluster-randomized crossover studies. This work is the first to establish a universal method for calculating power for both cluster-randomized and cluster-randomized clinical trials. More research is needed to develop standardized and recommended methodology for cluster-randomized crossover studies.

  8. Single-cluster dynamics for the random-cluster model

    NARCIS (Netherlands)

    Deng, Y.; Qian, X.; Blöte, H.W.J.

    2009-01-01

    We formulate a single-cluster Monte Carlo algorithm for the simulation of the random-cluster model. This algorithm is a generalization of the Wolff single-cluster method for the q-state Potts model to noninteger values q>1. Its results for static quantities are in a satisfactory agreement with those

  9. Single-cluster dynamics for the random-cluster model

    NARCIS (Netherlands)

    Deng, Y.; Qian, X.; Blöte, H.W.J.

    2009-01-01

    We formulate a single-cluster Monte Carlo algorithm for the simulation of the random-cluster model. This algorithm is a generalization of the Wolff single-cluster method for the q-state Potts model to noninteger values q>1. Its results for static quantities are in a satisfactory agreement with those

  10. The design of cluster randomized crossover trials

    NARCIS (Netherlands)

    Rietbergen, C.; Moerbeek, M.

    2011-01-01

    The inefficiency induced by between-cluster variation in cluster randomized (CR) trials can be reduced by implementing a crossover (CO) design. In a simple CO trial, each subject receives each treatment in random order. A powerful characteristic of this design is that each subject serves as its own

  11. Single-cluster dynamics for the random-cluster model

    Science.gov (United States)

    Deng, Youjin; Qian, Xiaofeng; Blöte, Henk W. J.

    2009-09-01

    We formulate a single-cluster Monte Carlo algorithm for the simulation of the random-cluster model. This algorithm is a generalization of the Wolff single-cluster method for the q -state Potts model to noninteger values q>1 . Its results for static quantities are in a satisfactory agreement with those of the existing Swendsen-Wang-Chayes-Machta (SWCM) algorithm, which involves a full-cluster decomposition of random-cluster configurations. We explore the critical dynamics of this algorithm for several two-dimensional Potts and random-cluster models. For integer q , the single-cluster algorithm can be reduced to the Wolff algorithm, for which case we find that the autocorrelation functions decay almost purely exponentially, with dynamic exponents zexp=0.07 (1), 0.521 (7), and 1.007 (9) for q=2 , 3, and 4, respectively. For noninteger q , the dynamical behavior of the single-cluster algorithm appears to be very dissimilar to that of the SWCM algorithm. For large critical systems, the autocorrelation function displays a range of power-law behavior as a function of time. The dynamic exponents are relatively large. We provide an explanation for this peculiar dynamic behavior.

  12. How Clustering Affects Epidemics in Random Networks

    CERN Document Server

    Coupechoux, Emilie

    2012-01-01

    Motivated by the analysis of social networks, we study a model of random networks that has both a given degree distribution and a tunable clustering coefficient. We consider two types of growth processes on these graphs: diffusion and symmetric threshold model. The diffusion process is inspired from epidemic models. It is characterized by an infection probability, each neighbor transmitting the epidemic independently. In the symmetric threshold process, the interactions are still local but the propagation rule is governed by a threshold (that might vary among the different nodes). An interesting example of symmetric threshold process is the contagion process, which is inspired by a simple coordination game played on the network. Both types of processes have been used to model spread of new ideas, technologies, viruses or worms and results have been obtained for random graphs with no clustering. In this paper, we are able to analyze the impact of clustering on the growth processes. While clustering inhibits th...

  13. Bridges in the random-cluster model

    Directory of Open Access Journals (Sweden)

    Eren Metin Elçi

    2016-02-01

    Full Text Available The random-cluster model, a correlated bond percolation model, unifies a range of important models of statistical mechanics in one description, including independent bond percolation, the Potts model and uniform spanning trees. By introducing a classification of edges based on their relevance to the connectivity we study the stability of clusters in this model. We prove several exact relations for general graphs that allow us to derive unambiguously the finite-size scaling behavior of the density of bridges and non-bridges. For percolation, we are also able to characterize the point for which clusters become maximally fragile and show that it is connected to the concept of the bridge load. Combining our exact treatment with further results from conformal field theory, we uncover a surprising behavior of the (normalized variance of the number of (non-bridges, showing that it diverges in two dimensions below the value 4cos2⁡(π/3=0.2315891⋯ of the cluster coupling q. Finally, we show that a partial or complete pruning of bridges from clusters enables estimates of the backbone fractal dimension that are much less encumbered by finite-size corrections than more conventional approaches.

  14. Random Projections for $k$-means Clustering

    CERN Document Server

    Boutsidis, Christos; Drineas, Petros

    2010-01-01

    This paper discusses the topic of dimensionality reduction for $k$-means clustering. We prove that any set of $n$ points in $d$ dimensions (rows in a matrix $A \\in \\RR^{n \\times d}$) can be projected into $t = \\Omega(k / \\eps^2)$ dimensions, for any $\\eps \\in (0,1/3)$, in $O(n d \\lceil \\eps^{-2} k/ \\log(d) \\rceil )$ time, such that with constant probability the optimal $k$-partition of the point set is preserved within a factor of $2+\\eps$. The projection is done by post-multiplying $A$ with a $d \\times t$ random matrix $R$ having entries $+1/\\sqrt{t}$ or $-1/\\sqrt{t}$ with equal probability. A numerical implementation of our technique and experiments on a large face images dataset verify the speed and the accuracy of our theoretical results.

  15. Two-stage replication of previous genome-wide association studies of AS3MT-CNNM2-NT5C2 gene cluster region in a large schizophrenia case-control sample from Han Chinese population.

    Science.gov (United States)

    Guan, Fanglin; Zhang, Tianxiao; Li, Lu; Fu, Dongke; Lin, Huali; Chen, Gang; Chen, Teng

    2016-10-01

    Schizophrenia is a devastating psychiatric condition with high heritability. Replicating the specific genetic variants that increase susceptibility to schizophrenia in different populations is critical to better understand schizophrenia. CNNM2 and NT5C2 are genes recently identified as susceptibility genes for schizophrenia in Europeans, but the exact mechanism by which these genes confer risk for schizophrenia remains unknown. In this study, we examined the potential for genetic susceptibility to schizophrenia of a three-gene cluster region, AS3MT-CNNM2-NT5C2. We implemented a two-stage strategy to conduct association analyses of the targeted regions with schizophrenia. A total of 8218 individuals were recruited, and 45 pre-selected single nucleotide polymorphisms (SNPs) were genotyped. Both single-marker and haplotype-based analyses were conducted in addition to imputation analysis to increase the coverage of our genetic markers. Two SNPs, rs11191419 (OR=1.24, P=7.28×10(-5)) and rs11191514 (OR=1.24, P=0.0003), with significant independent effects were identified. These results were supported by the data from both the discovery and validation stages. Further haplotype and imputation analyses also validated these results, and bioinformatics analyses indicated that CALHM1, which is located approximately 630kb away from CNNM2, might be a susceptible gene for schizophrenia. Our results provide further support that AS3MT, CNNM2 and CALHM1 are involved with the etiology and pathogenesis of schizophrenia, suggesting these genes are potential targets of interest for the improvement of disease management and the development of novel pharmacological strategies.

  16. Multilevel Analysis Methods for Partially Nested Cluster Randomized Trials

    Science.gov (United States)

    Sanders, Elizabeth A.

    2011-01-01

    This paper explores multilevel modeling approaches for 2-group randomized experiments in which a treatment condition involving clusters of individuals is compared to a control condition involving only ungrouped individuals, otherwise known as partially nested cluster randomized designs (PNCRTs). Strategies for comparing groups from a PNCRT in the…

  17. A Framework for Designing Cluster Randomized Trials with Binary Outcomes

    Science.gov (United States)

    Spybrook, Jessaca; Martinez, Andres

    2011-01-01

    The purpose of this paper is to provide a frame work for approaching a power analysis for a CRT (cluster randomized trial) with a binary outcome. The authors suggest a framework in the context of a simple CRT and then extend it to a blocked design, or a multi-site cluster randomized trial (MSCRT). The framework is based on proportions, an…

  18. Effects of regularly consuming dietary fibre rich soluble cocoa products on bowel habits in healthy subjects: a free-living, two-stage, randomized, crossover, single-blind intervention

    Directory of Open Access Journals (Sweden)

    Sarriá Beatriz

    2012-04-01

    Full Text Available Abstract Background Dietary fibre is both preventive and therapeutic for bowel functional diseases. Soluble cocoa products are good sources of dietary fibre that may be supplemented with this dietary component. This study assessed the effects of regularly consuming two soluble cocoa products (A and B with different non-starch polysaccharides levels (NSP, 15.1 and 22.0% w/w, respectively on bowel habits using subjective intestinal function and symptom questionnaires, a daily diary and a faecal marker in healthy individuals. Methods A free-living, two-stage, randomized, crossover, single-blind intervention was carried out in 44 healthy men and women, between 18-55 y old, who had not taken dietary supplements, laxatives, or antibiotics six months before the start of the study. In the four-week-long intervention stages, separated by a three-week-wash-out stage, two servings of A and B, that provided 2.26 vs. 6.60 g/day of NSP respectively, were taken. In each stage, volunteers' diet was recorded using a 72-h food intake report. Results Regularly consuming cocoa A and B increased fibre intake, although only cocoa B significantly increased fibre intake (p Conclusions Regular consumption of the cocoa products increases dietary fibre intake to recommended levels and product B improves bowel habits. The use of both objective and subjective assessments to evaluate the effects of food on bowel habits is recommended.

  19. Efficacy and safety of 5% lidocaine (lignocaine) medicated plaster in comparison with pregabalin in patients with postherpetic neuralgia and diabetic polyneuropathy: interim analysis from an open-label, two-stage adaptive, randomized, controlled trial.

    Science.gov (United States)

    Baron, Ralf; Mayoral, Victor; Leijon, Göran; Binder, Andreas; Steigerwald, Ilona; Serpell, Michael

    2009-01-01

    Postherpetic neuralgia (PHN) and diabetic polyneuropathy (DPN) are two common causes of peripheral neuropathic pain. Typical localized symptoms can include burning sensations or intermittent shooting or stabbing pains with or without allodynia. Evidence-based treatment guidelines recommend the 5% lidocaine (lignocaine) medicated plaster or pregabalin as first-line therapy for relief of peripheral neuropathic pain. This study aimed to compare 5% lidocaine medicated plaster treatment with pregabalin in patients with PHN and patients with DPN. The study was a two-stage, adaptive, randomized, controlled, open-label, multicentre trial that incorporated a drug wash-out phase of up to 2 weeks prior to the start of the comparative phase. At the end of the enrollment phase, patients who fulfilled the eligibility criteria were randomized to either 5% lidocaine medicated plaster or pregabalin treatment and entered the 4-week comparative phase. The interim analysis represents the first stage of the two-stage adaptive trial design and was planned to include data from the comparative phase for the first 150 randomized patients of the 300 total planned for the trial. Patients aged > or = 18 years with PHN or DPN were recruited from 53 investigational centres in 14 European countries. For this interim analysis, 55 patients with PHN and 91 with DPN (full-analysis set [FAS]), randomly assigned to the treatment groups, were available for analysis. Topical 5% lidocaine medicated plaster treatment was administered by patients to the area of most painful skin. A maximum of three or four plasters were applied for up to 12 hours within each 24-hour period in patients with PHN or DPN, respectively. Pregabalin capsules were administered orally, twice daily. The dose was titrated to effect: all patients received 150 mg/day in the first week and 300 mg/day in the second week of treatment. After 1 week at 300 mg/day, the dose of pregabalin was further increased to 600 mg/day in patients with

  20. Macroscopic flame structure in a premixed-spray burner. 1st Report. formation and disappearance processes of droplet clusters and two-stage flame structure; Yokongo funmu kaen no kyoshiteki nensho kyodo. 1. Yuteki cluster no keisei shoshitsu katei to niju kaen kozo

    Energy Technology Data Exchange (ETDEWEB)

    Tsushima, S.; Saito, H.; Akamatsu, F.; Katsuki, M. [Osaka University, Osaka (Japan)

    2000-08-25

    In an attempt to elucidate formation and disappearance processes of droplet clusters in spray flames, simultaneous measurements consisting of laser tomography and flame chemiluminescence detection are applied to a premixed-spay burner. The smart combination of measurements provides time-series data-set serving for better understanding of spray flames, which essentially contains inhomogeneity in space and time. It is revealed that referential flame propagation through a premixed-spray stream plays a significant role in creating droplet clusters and that droplet clusters formed in this manner evanesces from their outer boundaries. Those observation confirms that the premixed-spray flame comprises both premixed-mode flame in upstream region and diffusion-mode flame in downstream region, respectively, i.e, two-stage flame structure previously reported for spray flames stabilized in either counter or stagnation flows. (author)

  1. Phase transitions for information diffusion in random clustered networks

    Science.gov (United States)

    Lim, Sungsu; Shin, Joongbo; Kwak, Namju; Jung, Kyomin

    2016-09-01

    We study the conditions for the phase transitions of information diffusion in complex networks. Using the random clustered network model, a generalisation of the Chung-Lu random network model incorporating clustering, we examine the effect of clustering under the Susceptible-Infected-Recovered (SIR) epidemic diffusion model with heterogeneous contact rates. For this purpose, we exploit the branching process to analyse information diffusion in random unclustered networks with arbitrary contact rates, and provide novel iterative algorithms for estimating the conditions and sizes of global cascades, respectively. Showing that a random clustered network can be mapped into a factor graph, which is a locally tree-like structure, we successfully extend our analysis to random clustered networks with heterogeneous contact rates. We then identify the conditions for phase transitions of information diffusion using our method. Interestingly, for various contact rates, we prove that random clustered networks with higher clustering coefficients have strictly lower phase transition points for any given degree sequence. Finally, we confirm our analytical results with numerical simulations of both synthetically-generated and real-world networks.

  2. Imputation strategies for missing binary outcomes in cluster randomized trials

    Directory of Open Access Journals (Sweden)

    Akhtar-Danesh Noori

    2011-02-01

    Full Text Available Abstract Background Attrition, which leads to missing data, is a common problem in cluster randomized trials (CRTs, where groups of patients rather than individuals are randomized. Standard multiple imputation (MI strategies may not be appropriate to impute missing data from CRTs since they assume independent data. In this paper, under the assumption of missing completely at random and covariate dependent missing, we compared six MI strategies which account for the intra-cluster correlation for missing binary outcomes in CRTs with the standard imputation strategies and complete case analysis approach using a simulation study. Method We considered three within-cluster and three across-cluster MI strategies for missing binary outcomes in CRTs. The three within-cluster MI strategies are logistic regression method, propensity score method, and Markov chain Monte Carlo (MCMC method, which apply standard MI strategies within each cluster. The three across-cluster MI strategies are propensity score method, random-effects (RE logistic regression approach, and logistic regression with cluster as a fixed effect. Based on the community hypertension assessment trial (CHAT which has complete data, we designed a simulation study to investigate the performance of above MI strategies. Results The estimated treatment effect and its 95% confidence interval (CI from generalized estimating equations (GEE model based on the CHAT complete dataset are 1.14 (0.76 1.70. When 30% of binary outcome are missing completely at random, a simulation study shows that the estimated treatment effects and the corresponding 95% CIs from GEE model are 1.15 (0.76 1.75 if complete case analysis is used, 1.12 (0.72 1.73 if within-cluster MCMC method is used, 1.21 (0.80 1.81 if across-cluster RE logistic regression is used, and 1.16 (0.82 1.64 if standard logistic regression which does not account for clustering is used. Conclusion When the percentage of missing data is low or intra-cluster

  3. Incorporating Contact Network Structure in Cluster Randomized Trials

    CERN Document Server

    Staples, Patrick C; Onnela, Jukka-Pekka

    2015-01-01

    Whenever possible, the efficacy of a new treatment, such as a drug or behavioral intervention, is investigated by randomly assigning some individuals to a treatment condition and others to a control condition, and comparing the outcomes between the two groups. Often, when the treatment aims to slow an infectious disease, groups or clusters of individuals are assigned en masse to each treatment arm. The structure of interactions within and between clusters can reduce the power of the trial, i.e. the probability of correctly detecting a real treatment effect. We investigate the relationships among power, within-cluster structure, between-cluster mixing, and infectivity by simulating an infectious process on a collection of clusters. We demonstrate that current power calculations may be conservative for low levels of between-cluster mixing, but failing to account for moderate or high amounts can result in severely underpowered studies. Power also depends on within-cluster network structure for certain kinds of i...

  4. General Framework for Effect Sizes in Cluster Randomized Experiments

    Science.gov (United States)

    VanHoudnos, Nathan

    2016-01-01

    Cluster randomized experiments are ubiquitous in modern education research. Although a variety of modeling approaches are used to analyze these data, perhaps the most common methodology is a normal mixed effects model where some effects, such as the treatment effect, are regarded as fixed, and others, such as the effect of group random assignment…

  5. Power Calculations for Binary Moderator in Cluster Randomized Trials

    Science.gov (United States)

    Spybrook, Jessaca; Kelcey, Ben

    2014-01-01

    Cluster randomized trials (CRTs), or studies in which intact groups of individuals are randomly assigned to a condition, are becoming more common in the evaluation of educational programs, policies, and practices. The website for the National Center for Education Evaluation and Regional Assistance (NCEE) reveals they have launched over 30…

  6. The construction of two-stage tests

    NARCIS (Netherlands)

    Adema, Jos J.

    1988-01-01

    Although two-stage testing is not the most efficient form of adaptive testing, it has some advantages. In this paper, linear programming models are given for the construction of two-stage tests. In these models, practical constraints with respect to, among other things, test composition, administrat

  7. Limited Random Walk Algorithm for Big Graph Data Clustering

    CERN Document Server

    Zhang, Honglei; Kiranyaz, Serkan; Gabbouj, Moncef

    2016-01-01

    Graph clustering is an important technique to understand the relationships between the vertices in a big graph. In this paper, we propose a novel random-walk-based graph clustering method. The proposed method restricts the reach of the walking agent using an inflation function and a normalization function. We analyze the behavior of the limited random walk procedure and propose a novel algorithm for both global and local graph clustering problems. Previous random-walk-based algorithms depend on the chosen fitness function to find the clusters around a seed vertex. The proposed algorithm tackles the problem in an entirely different manner. We use the limited random walk procedure to find attracting vertices in a graph and use them as features to cluster the vertices. According to the experimental results on the simulated graph data and the real-world big graph data, the proposed method is superior to the state-of-the-art methods in solving graph clustering problems. Since the proposed method uses the embarrass...

  8. Measurement Error Correction Formula for Cluster-Level Group Differences in Cluster Randomized and Observational Studies

    Science.gov (United States)

    Cho, Sun-Joo; Preacher, Kristopher J.

    2016-01-01

    Multilevel modeling (MLM) is frequently used to detect cluster-level group differences in cluster randomized trial and observational studies. Group differences on the outcomes (posttest scores) are detected by controlling for the covariate (pretest scores) as a proxy variable for unobserved factors that predict future attributes. The pretest and…

  9. Fuzzy c-Means and Cluster Ensemble with Random Projection for Big Data Clustering

    Directory of Open Access Journals (Sweden)

    Mao Ye

    2016-01-01

    Full Text Available Because of its positive effects on dealing with the curse of dimensionality in big data, random projection for dimensionality reduction has become a popular method recently. In this paper, an academic analysis of influences of random projection on the variability of data set and the dependence of dimensions has been proposed. Together with the theoretical analysis, a new fuzzy c-means (FCM clustering algorithm with random projection has been presented. Empirical results verify that the new algorithm not only preserves the accuracy of original FCM clustering, but also is more efficient than original clustering and clustering with singular value decomposition. At the same time, a new cluster ensemble approach based on FCM clustering with random projection is also proposed. The new aggregation method can efficiently compute the spectral embedding of data with cluster centers based representation which scales linearly with data size. Experimental results reveal the efficiency, effectiveness, and robustness of our algorithm compared to the state-of-the-art methods.

  10. The effect of cluster size variability on statistical power in cluster-randomized trials.

    Directory of Open Access Journals (Sweden)

    Stephen A Lauer

    Full Text Available The frequency of cluster-randomized trials (CRTs in peer-reviewed literature has increased exponentially over the past two decades. CRTs are a valuable tool for studying interventions that cannot be effectively implemented or randomized at the individual level. However, some aspects of the design and analysis of data from CRTs are more complex than those for individually randomized controlled trials. One of the key components to designing a successful CRT is calculating the proper sample size (i.e. number of clusters needed to attain an acceptable level of statistical power. In order to do this, a researcher must make assumptions about the value of several variables, including a fixed mean cluster size. In practice, cluster size can often vary dramatically. Few studies account for the effect of cluster size variation when assessing the statistical power for a given trial. We conducted a simulation study to investigate how the statistical power of CRTs changes with variable cluster sizes. In general, we observed that increases in cluster size variability lead to a decrease in power.

  11. Sample size calculations for 3-level cluster randomized trials

    NARCIS (Netherlands)

    Teerenstra, S.; Moerbeek, M.; Achterberg, T. van; Pelzer, B.J.; Borm, G.F.

    2008-01-01

    BACKGROUND: The first applications of cluster randomized trials with three instead of two levels are beginning to appear in health research, for instance, in trials where different strategies to implement best-practice guidelines are compared. In such trials, the strategy is implemented in health

  12. Sample size calculations for 3-level cluster randomized trials

    NARCIS (Netherlands)

    Teerenstra, S.; Moerbeek, M.; Achterberg, T. van; Pelzer, B.J.; Borm, G.F.

    2008-01-01

    Background The first applications of cluster randomized trials with three instead of two levels are beginning to appear in health research, for instance, in trials where different strategies to implement best-practice guidelines are compared. In such trials, the strategy is implemented in health

  13. Sample size calculations for 3-level cluster randomized trials

    NARCIS (Netherlands)

    Teerenstra, S.; Moerbeek, M.; Achterberg, T. van; Pelzer, B.J.; Borm, G.F.

    2008-01-01

    BACKGROUND: The first applications of cluster randomized trials with three instead of two levels are beginning to appear in health research, for instance, in trials where different strategies to implement best-practice guidelines are compared. In such trials, the strategy is implemented in health ca

  14. Sample size calculations for 3-level cluster randomized trials

    NARCIS (Netherlands)

    Teerenstra, S.; Moerbeek, M.; Achterberg, T. van; Pelzer, B.J.; Borm, G.F.

    2008-01-01

    Background The first applications of cluster randomized trials with three instead of two levels are beginning to appear in health research, for instance, in trials where different strategies to implement best-practice guidelines are compared. In such trials, the strategy is implemented in health car

  15. Planning a cluster randomized trial with unequal cluster sizes: practical issues involving continuous outcomes

    Directory of Open Access Journals (Sweden)

    Ravaud Philippe

    2006-04-01

    Full Text Available Abstract Background Cluster randomization design is increasingly used for the evaluation of health-care, screeening or educational interventions. At the planning stage, sample size calculations usually consider an average cluster size without taking into account any potential imbalance in cluster size. However, there may exist high discrepancies in cluster sizes. Methods We performed simulations to study the impact of an imbalance in cluster size on power. We determined by simulations to which extent four methods proposed to adapt the sample size calculations to a pre-specified imbalance in cluster size could lead to adequately powered trials. Results We showed that an imbalance in cluster size can be of high influence on the power in the case of severe imbalance, particularly if the number of clusters is low and/or the intraclass correlation coefficient is high. In the case of a severe imbalance, our simulations confirmed that the minimum variance weights correction of the variation inflaction factor (VIF used in the sample size calculations has the best properties. Conclusion Publication of cluster sizes is important to assess the real power of the trial which was conducted and to help designing future trials. We derived an adaptation of the VIF from the minimum variance weights correction to be used in case the imbalance can be a priori formulated such as "a proportion (γ of clusters actually recruit a proportion (τ of subjects to be included (γ ≤ τ".

  16. Ethical issues posed by cluster randomized trials in health research

    Directory of Open Access Journals (Sweden)

    Donner Allan

    2011-04-01

    Full Text Available Abstract The cluster randomized trial (CRT is used increasingly in knowledge translation research, quality improvement research, community based intervention studies, public health research, and research in developing countries. However, cluster trials raise difficult ethical issues that challenge researchers, research ethics committees, regulators, and sponsors as they seek to fulfill responsibly their respective roles. Our project will provide a systematic analysis of the ethics of cluster trials. Here we have outlined a series of six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation: 1. Who is a research subject? 2. From whom, how, and when must informed consent be obtained? 3. Does clinical equipoise apply to CRTs? 4. How do we determine if the benefits outweigh the risks of CRTs? 5. How ought vulnerable groups be protected in CRTs? 6. Who are gatekeepers and what are their responsibilities? Subsequent papers in this series will address each of these areas, clarifying the ethical issues at stake and, where possible, arguing for a preferred solution. Our hope is that these papers will serve as the basis for the creation of international ethical guidelines for the design and conduct of cluster randomized trials.

  17. Power Calculations for Moderators in Multi-Site Cluster Randomized Trials

    Science.gov (United States)

    Spybrook, Jessaca; Kelcey, Ben; Dong, Nianbo

    2016-01-01

    Cluster randomized trials (CRTs), or studies in which intact groups of individuals are randomly assigned to a condition, are becoming more common in evaluation studies of educational programs. A specific type of CRT in which clusters are randomly assigned to treatment within blocks or sites, known as multisite cluster randomized trials (MSCRTs),…

  18. Randomness versus deterministic chaos: Effect on invasion percolation clusters

    Science.gov (United States)

    Peng, Chung-Kang; Prakash, Sona; Herrmann, Hans J.; Stanley, H. Eugene

    1990-10-01

    What is the difference between randomness and chaos \\? Although one can define randomness and one can define chaos, one cannot easily assess the difference in a practical situation. Here we compare the results of these two antipodal approaches on a specific example. Specifically, we study how well the logistic map in its chaotic regime can be used as quasirandom number generator by calculating pertinent properties of a well-known random process: invasion percolation. Only if λ>λ*1 (the first reverse bifurcation point) is a smooth extrapolation in system size possible, and percolation exponents are retrieved. If λ≠1, a sequential filling of the lattice with the random numbers generates a measurable anisotropy in the growth sequence of the clusters, due to short-range correlations.

  19. Evaluation of a Two-Stage Approach in Trans-Ethnic Meta-Analysis in Genome-Wide Association Studies.

    Science.gov (United States)

    Hong, Jaeyoung; Lunetta, Kathryn L; Cupples, L Adrienne; Dupuis, Josée; Liu, Ching-Ti

    2016-05-01

    Meta-analysis of genome-wide association studies (GWAS) has achieved great success in detecting loci underlying human diseases. Incorporating GWAS results from diverse ethnic populations for meta-analysis, however, remains challenging because of the possible heterogeneity across studies. Conventional fixed-effects (FE) or random-effects (RE) methods may not be most suitable to aggregate multiethnic GWAS results because of violation of the homogeneous effect assumption across studies (FE) or low power to detect signals (RE). Three recently proposed methods, modified RE (RE-HE) model, binary-effects (BE) model and a Bayesian approach (Meta-analysis of Transethnic Association [MANTRA]), show increased power over FE and RE methods while incorporating heterogeneity of effects when meta-analyzing trans-ethnic GWAS results. We propose a two-stage approach to account for heterogeneity in trans-ethnic meta-analysis in which we clustered studies with cohort-specific ancestry information prior to meta-analysis. We compare this to a no-prior-clustering (crude) approach, evaluating type I error and power of these two strategies, in an extensive simulation study to investigate whether the two-stage approach offers any improvements over the crude approach. We find that the two-stage approach and the crude approach for all five methods (FE, RE, RE-HE, BE, MANTRA) provide well-controlled type I error. However, the two-stage approach shows increased power for BE and RE-HE, and similar power for MANTRA and FE compared to their corresponding crude approach, especially when there is heterogeneity across the multiethnic GWAS results. These results suggest that prior clustering in the two-stage approach can be an effective and efficient intermediate step in meta-analysis to account for the multiethnic heterogeneity.

  20. Design and Analysis Considerations for Cluster Randomized Controlled Trials That Have a Small Number of Clusters.

    Science.gov (United States)

    Deke, John

    2016-10-25

    Cluster randomized controlled trials (CRCTs) often require a large number of clusters in order to detect small effects with high probability. However, there are contexts where it may be possible to design a CRCT with a much smaller number of clusters (10 or fewer) and still detect meaningful effects. The objective is to offer recommendations for best practices in design and analysis for small CRCTs. I use simulations to examine alternative design and analysis approaches. Specifically, I examine (1) which analytic approaches control Type I errors at the desired rate, (2) which design and analytic approaches yield the most power, (3) what is the design effect of spurious correlations, and (4) examples of specific scenarios under which impacts of different sizes can be detected with high probability. I find that (1) mixed effects modeling and using Ordinary Least Squares (OLS) on data aggregated to the cluster level both control the Type I error rate, (2) randomization within blocks is always recommended, but how best to account for blocking through covariate adjustment depends on whether the precision gains offset the degrees of freedom loss, (3) power calculations can be accurate when design effects from small sample, spurious correlations are taken into account, and (4) it is very difficult to detect small effects with just four clusters, but with six or more clusters, there are realistic circumstances under which small effects can be detected with high probability. © The Author(s) 2016.

  1. Two-stage sampling for acceptance testing

    Energy Technology Data Exchange (ETDEWEB)

    Atwood, C.L.; Bryan, M.F.

    1992-09-01

    Sometimes a regulatory requirement or a quality-assurance procedure sets an allowed maximum on a confidence limit for a mean. If the sample mean of the measurements is below the allowed maximum, but the confidence limit is above it, a very widespread practice is to increase the sample size and recalculate the confidence bound. The confidence level of this two-stage procedure is rarely found correctly, but instead is typically taken to be the nominal confidence level, found as if the final sample size had been specified in advance. In typical settings, the correct nominal [alpha] should be between the desired P(Type I error) and half that value. This note gives tables for the correct a to use, some plots of power curves, and an example of correct two-stage sampling.

  2. Two-stage sampling for acceptance testing

    Energy Technology Data Exchange (ETDEWEB)

    Atwood, C.L.; Bryan, M.F.

    1992-09-01

    Sometimes a regulatory requirement or a quality-assurance procedure sets an allowed maximum on a confidence limit for a mean. If the sample mean of the measurements is below the allowed maximum, but the confidence limit is above it, a very widespread practice is to increase the sample size and recalculate the confidence bound. The confidence level of this two-stage procedure is rarely found correctly, but instead is typically taken to be the nominal confidence level, found as if the final sample size had been specified in advance. In typical settings, the correct nominal {alpha} should be between the desired P(Type I error) and half that value. This note gives tables for the correct a to use, some plots of power curves, and an example of correct two-stage sampling.

  3. Two Stage Gear Tooth Dynamics Program

    Science.gov (United States)

    1989-08-01

    cordi - tions and associated iteration prooedure become more complex. This is due to both the increased number of components and to the time for a...solved for each stage in the two stage solution . There are (3 + ntrrber of planets) degrees of freedom fcr eacb stage plus two degrees of freedom...should be devised. It should be noted that this is not minor task. In general, each stage plus an input or output shaft will have 2 times (4 + number

  4. Condensate from a two-stage gasifier

    DEFF Research Database (Denmark)

    Bentzen, Jens Dall; Henriksen, Ulrik Birk; Hindsgaul, Claus

    2000-01-01

    that the organic compounds and the inhibition effect are very low even before treatment with activated carbon. The moderate inhibition effect relates to a high content of ammonia in the condensate. The nitrifiers become tolerant to the condensate after a few weeks of exposure. The level of organic compounds......Condensate, produced when gas from downdraft biomass gasifier is cooled, contains organic compounds that inhibit nitrifiers. Treatment with activated carbon removes most of the organics and makes the condensate far less inhibitory. The condensate from an optimised two-stage gasifier is so clean...

  5. Two Stage Sibling Cycle Compressor/Expander.

    Science.gov (United States)

    1994-02-01

    vol. 5, p. 424. 11. L. Bauwens and M.P. Mitchell, " Regenerator Analysis: Validation of the MS*2 Stirling Cycle Code," Proc. XVIIIth International...PL-TR--94-1051 PL-TR-- 94-1051 TWO STAGE SIBLING CYCLE COMPRESSOR/EXPANDER Matthew P. Mitchell . Mitchell/ Stirling Machines/Systems, Inc. No\\ 1995...ty. THIS PAGE IS UNCLASSIFIED PL-TR-94-1051 This final report was prepared byMitchell/ Stirling Machines/Systems, Inc., Berkeley, CA under Contract

  6. Sample size for cluster randomized trials: effect of coefficient of variation of cluster size and analysis method.

    Science.gov (United States)

    Eldridge, Sandra M; Ashby, Deborah; Kerry, Sally

    2006-10-01

    Cluster randomized trials are increasingly popular. In many of these trials, cluster sizes are unequal. This can affect trial power, but standard sample size formulae for these trials ignore this. Previous studies addressing this issue have mostly focused on continuous outcomes or methods that are sometimes difficult to use in practice. We show how a simple formula can be used to judge the possible effect of unequal cluster sizes for various types of analyses and both continuous and binary outcomes. We explore the practical estimation of the coefficient of variation of cluster size required in this formula and demonstrate the formula's performance for a hypothetical but typical trial randomizing UK general practices. The simple formula provides a good estimate of sample size requirements for trials analysed using cluster-level analyses weighting by cluster size and a conservative estimate for other types of analyses. For trials randomizing UK general practices the coefficient of variation of cluster size depends on variation in practice list size, variation in incidence or prevalence of the medical condition under examination, and practice and patient recruitment strategies, and for many trials is expected to be approximately 0.65. Individual-level analyses can be noticeably more efficient than some cluster-level analyses in this context. When the coefficient of variation is <0.23, the effect of adjustment for variable cluster size on sample size is negligible. Most trials randomizing UK general practices and many other cluster randomized trials should account for variable cluster size in their sample size calculations.

  7. Measuring the Learning from Two-Stage Collaborative Group Exams

    CERN Document Server

    Ives, Joss

    2014-01-01

    A two-stage collaborative exam is one in which students first complete the exam individually, and then complete the same or similar exam in collaborative groups immediately afterward. To quantify the learning effect from the group component of these two-stage exams in an introductory Physics course, a randomized crossover design was used where each student participated in both the treatment and control groups. For each of the two two-stage collaborative group midterm exams, questions were designed to form matched near-transfer pairs with questions on an end-of-term diagnostic which was used as a learning test. For learning test questions paired with questions from the first midterm, which took place six to seven weeks before the learning test, an analysis using a mixed-effects logistic regression found no significant differences in learning-test performance between the control and treatment group. For learning test questions paired with questions from the second midterm, which took place one to two weeks prio...

  8. Complementary feeding: a Global Network cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Pasha Omrana

    2011-01-01

    Full Text Available Abstract Background Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. Animal source foods in particular are cited as essential to achieve micronutrient requirements. The efficacy of the recommendation for regular meat consumption, however, has not been systematically evaluated. Methods/Design A cluster randomized efficacy trial was designed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement. The study is being conducted in 4 sites of the Global Network for Women's and Children's Health Research located in Guatemala, Pakistan, Democratic Republic of the Congo (DRC and Zambia in communities with toddler stunting rates of at least 20%. Five clusters per country were randomized to each of the food arms, with 30 infants in each cluster. The daily meat or cereal supplement was delivered to the home by community coordinators, starting when the infants were 6 months of age and continuing through 18 months. All participating mothers received nutrition education messages to enhance complementary feeding practices delivered by study coordinators and through posters at the local health center. Outcome measures, obtained at 6, 9, 12, and 18 months by a separate assessment team, included anthropometry; dietary variety and diversity scores; biomarkers of iron, zinc and Vitamin B12 status (18 months; neurocognitive development (12 and 18 months; and incidence of infectious morbidity throughout the trial. The trial was supervised by a trial steering committee, and an independent data monitoring committee provided oversight for the safety and conduct of the trial. Discussion Findings from this trial will test the efficacy of daily intake of meat commencing at age 6 months and, if beneficial, will

  9. Classification in two-stage screening.

    Science.gov (United States)

    Longford, Nicholas T

    2015-11-10

    Decision theory is applied to the problem of setting thresholds in medical screening when it is organised in two stages. In the first stage that involves a less expensive procedure that can be applied on a mass scale, an individual is classified as a negative or a likely positive. In the second stage, the likely positives are subjected to another test that classifies them as (definite) positives or negatives. The second-stage test is more accurate, but also more expensive and more involved, and so there are incentives to restrict its application. Robustness of the method with respect to the parameters, some of which have to be set by elicitation, is assessed by sensitivity analysis.

  10. Two stage gear tooth dynamics program

    Science.gov (United States)

    Boyd, Linda S.

    1989-01-01

    The epicyclic gear dynamics program was expanded to add the option of evaluating the tooth pair dynamics for two epicyclic gear stages with peripheral components. This was a practical extension to the program as multiple gear stages are often used for speed reduction, space, weight, and/or auxiliary units. The option was developed for either stage to be a basic planetary, star, single external-external mesh, or single external-internal mesh. The two stage system allows for modeling of the peripherals with an input mass and shaft, an output mass and shaft, and a connecting shaft. Execution of the initial test case indicated an instability in the solution with the tooth paid loads growing to excessive magnitudes. A procedure to trace the instability is recommended as well as a method of reducing the program's computation time by reducing the number of boundary condition iterations.

  11. Calculating sample sizes for cluster randomized trials: we can keep it simple and efficient !

    NARCIS (Netherlands)

    van Breukelen, Gerard J.P.; Candel, Math J.J.M.

    2012-01-01

    Objective: Simple guidelines for efficient sample sizes in cluster randomized trials with unknown intraclass correlation and varying cluster sizes. Methods: A simple equation is given for the optimal number of clusters and sample size per cluster. Here, optimal means maximizing power for a given

  12. Cluster randomized clinical trials in orthodontics: design, analysis and reporting issues.

    Science.gov (United States)

    Pandis, Nikolaos; Walsh, Tanya; Polychronopoulou, Argy; Eliades, Theodore

    2013-10-01

    Cluster randomized trials (CRTs) use as the unit of randomization clusters, which are usually defined as a collection of individuals sharing some common characteristics. Common examples of clusters include entire dental practices, hospitals, schools, school classes, villages, and towns. Additionally, several measurements (repeated measurements) taken on the same individual at different time points are also considered to be clusters. In dentistry, CRTs are applicable as patients may be treated as clusters containing several individual teeth. CRTs require certain methodological procedures during sample calculation, randomization, data analysis, and reporting, which are often ignored in dental research publications. In general, due to similarity of the observations within clusters, each individual within a cluster provides less information compared with an individual in a non-clustered trial. Therefore, clustered designs require larger sample sizes compared with non-clustered randomized designs, and special statistical analyses that account for the fact that observations within clusters are correlated. It is the purpose of this article to highlight with relevant examples the important methodological characteristics of cluster randomized designs as they may be applied in orthodontics and to explain the problems that may arise if clustered observations are erroneously treated and analysed as independent (non-clustered).

  13. Design of a cluster-randomized minority recruitment trial: RECRUIT.

    Science.gov (United States)

    Tilley, Barbara C; Mainous, Arch G; Smith, Daniel W; McKee, M Diane; Amorrortu, Rossybelle P; Alvidrez, Jennifer; Diaz, Vanessa; Ford, Marvella E; Fernandez, Maria E; Hauser, Robert A; Singer, Carlos; Landa, Veronica; Trevino, Aron; DeSantis, Stacia M; Zhang, Yefei; Daniels, Elvan; Tabor, Derrick; Vernon, Sally W

    2017-06-01

    Racial/ethnic minority groups remain underrepresented in clinical trials. Many strategies to increase minority recruitment focus on minority communities and emphasize common diseases such as hypertension. Scant literature focuses on minority recruitment to trials of less common conditions, often conducted in specialty clinics and dependent on physician referrals. We identified trust/mistrust of specialist physician investigators and institutions conducting medical research and consequent participant reluctance to participate in clinical trials as key-shared barriers across racial/ethnic groups. We developed a trust-based continuous quality improvement intervention to build trust between specialist physician investigators and community minority-serving physicians and ultimately potential trial participants. To avoid the inherent biases of non-randomized studies, we evaluated the intervention in the national Randomized Recruitment Intervention Trial (RECRUIT). This report presents the design of RECRUIT. Specialty clinic follow-up continues through April 2017. We hypothesized that specialist physician investigators and coordinators trained in the trust-based continuous quality improvement intervention would enroll a greater proportion of minority participants in their specialty clinics than specialist physician investigators in control specialty clinics. Specialty clinic was the unit of randomization. Using continuous quality improvement, the specialist physician investigators and coordinators tailored recruitment approaches to their specialty clinic characteristics and populations. Primary analyses were adjusted for clustering by specialty clinic within parent trial and matching covariates. RECRUIT was implemented in four multi-site clinical trials (parent trials) supported by three National Institutes of Health institutes and included 50 associated specialty clinics from these parent trials. Using current data, we have 88% power or greater to detect a 0.15 or

  14. Making birthing safe for Pakistan women: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Khan Muhammad

    2012-07-01

    Full Text Available Abstract Background Two out of three neonatal deaths occur in just 10 countries and Pakistan stands third among them. Maternal mortality is also high with most deaths occurring during labor, birth, and first few hours after birth. Enhanced access and utilization of skilled delivery and emergency obstetric care is the demonstrated strategy in reducing maternal and neonatal mortality. This trial aims to compare reduction in neonate mortality and utilization of available safe birthing and Emergency Obstetric and Neonatal Care services among pregnant mothers receiving ‘structured birth planning’, and/or ‘transport facilitation’ compared to routine care. Methods A pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Jhang, Chiniot and Khanewal districts of Punjab, Pakistan, from February 2011 to May 2013. At least 29,295 pregnancies will be registered in the three arms, seven clusters per arm; 1 structured birth planning and travel facilitation, 2 structured birth planning, and 3 control arm. Trial will be conducted through the Lady Health Worker program. Main outcomes are difference in neonatal mortality and service utilization; maternal mortality being the secondary outcome. Cluster level analysis will be done according to intention-to-treat. Discussion A nationwide network of about 100,000 lady health workers is already involved in antenatal and postnatal care of pregnant women. They also act as “gatekeepers” for the child birthing services. This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required. The review of current arrangements and practices show that the care delivery process needs enhancement to include adequate information provision as well as informed “decision” making and planned “action” by the pregnant women. The proposed three-year research is to develop, through national

  15. Design, rationale, and baseline demographics of SEARCH I: a prospective cluster-randomized study

    Directory of Open Access Journals (Sweden)

    Albers F

    2012-07-01

    Full Text Available Frank Albers,1 Asif Shaikh,2 Ahmar Iqbal,31Medical Affairs Respiratory, 2Clinical Development and Medical Affairs, Field Based Medicine-Respiratory, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA; 3Respiratory Medical Affairs, Pfizer Inc, New York, NY, USAAbstract: Questionnaires are available to identify patients at risk for several chronic diseases, including COPD, but are infrequently utilized in primary care. COPD is often underdiagnosed, while at the same time the US Preventive Services Task Force recommends against spirometric screening for COPD in asymptomatic adults. Use of a symptom-based questionnaire and subsequent handheld spirometric device depending on the answers to the questionnaire is a promising approach to identify patients at risk for COPD. Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH I was a prospective cluster-randomized study in 168 US primary care practices evaluating the effect of the COPD-Population Screener (COPD-PS™ questionnaire. The effect of this questionnaire alone or sequentially with the handheld copd-6TM device was evaluated on new diagnoses of COPD and on respiratory diagnostic practice patterns (including referrals for pulmonary function testing, referrals to pulmonologists, new diagnoses of COPD, and new respiratory medication prescriptions. Participating practices entered a total of 9704 consecutive consenting subjects aged ≥ 40 years attending primary care clinics. Study arm results were compared for new COPD diagnosis rates between usual care and (1 COPD-PS plus copd-6 and (2 COPD-PS alone. A cluster-randomization design allowed comparison of the intervention effects at the practice level instead of individuals being the subjects of the intervention. Regional principal investigators controlled the flow of study information to sub-investigators at participating practices to reduce observation bias (Hawthorne effect. The

  16. Composite likelihood and two-stage estimation in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2002-01-01

    Composite likelihood; Two-stage estimation; Family studies; Copula; Optimal weights; All possible pairs......Composite likelihood; Two-stage estimation; Family studies; Copula; Optimal weights; All possible pairs...

  17. On the robustness of two-stage estimators

    KAUST Repository

    Zhelonkin, Mikhail

    2012-04-01

    The aim of this note is to provide a general framework for the analysis of the robustness properties of a broad class of two-stage models. We derive the influence function, the change-of-variance function, and the asymptotic variance of a general two-stage M-estimator, and provide their interpretations. We illustrate our results in the case of the two-stage maximum likelihood estimator and the two-stage least squares estimator. © 2011.

  18. Understanding Statistical Power in Cluster Randomized Trials: Challenges Posed by Differences in Notation and Terminology

    Science.gov (United States)

    Spybrook, Jessaca; Hedges, Larry; Borenstein, Michael

    2014-01-01

    Research designs in which clusters are the unit of randomization are quite common in the social sciences. Given the multilevel nature of these studies, the power analyses for these studies are more complex than in a simple individually randomized trial. Tools are now available to help researchers conduct power analyses for cluster randomized…

  19. Preventing diabetes in primary care: a feasibility cluster randomized trial.

    Science.gov (United States)

    Dawes, Diana; Ashe, Maureen; Campbell, Kristin; Cave, Douglas; Elley, C Raina; Kaczorowski, Janusz; Sohal, Parmjit; Ur, Ehud; Dawes, Martin

    2015-04-01

    To determine the feasibility of implementing a large-scale primary care-based diabetes prevention trial. A feasibility cluster randomized controlled trial was conducted in British Columbia, Canada, amongst adults with prediabetes using the Facilitated Lifestyle Intervention Prescription (FLIP) vs. usual care. FLIP included lifestyle advice, a pedometer, and telephone support from a lifestyle facilitator for 6 months. Indicators of feasibility included recruitment rates of family practices, participants and facilitators, as well as feasibility and retention rates in the FLIP program and study protocols. Six family practices participated; 59 patients were enrolled between October 2012 and March 2013. The trial protocol was acceptable to practices and participants and had a 95% participant retention rate over the 6 months (56/59). Adherence to the intervention was high (97%), with 34 of 35 patients continuing to receive telephone calls from the facilitator for 6 months. The mean cost of the intervention was C$144 per person. Compared with control, intervention participants significantly reduced weight by 3.2 kg (95% CI, 1.7 to 4.6); body mass index by 1.2 (95% CI, 0.7 to 1.7) and waist circumference by 3 cm (95% CI, 0.3 to 5.7). It is feasible to implement FLIP and to conduct a trial to assess effectiveness. A larger trial with longer follow up to assess progression to diabetes is warranted. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  20. Capacity Analysis of Two-Stage Production lines with Many Products

    NARCIS (Netherlands)

    M.B.M. de Koster (René)

    1987-01-01

    textabstractWe consider two-stage production lines with an intermediate buffer. A buffer is needed when fluctuations occur. For single-product production lines fluctuations in capacity availability may be caused by random processing times, failures and random repair times. For multi-product producti

  1. 考虑内部激励随机性的两级分流式人字齿轮传动动力学特性%Dynamic characteristics of two-stage split herringbone gear trains considering the randomness of internal excitations

    Institute of Scientific and Technical Information of China (English)

    廖映华; 秦大同; 刘长钊

    2015-01-01

    According to the configurational characteristics,a bearing-gear coupled non-linear dynamics model of two-stage split herringbone gear trains used in special equipment was presented.In the model,bearing stiffness,mesh stiffness,mesh errors and gear backlash were all included.Then the Runge-Kutta step-by-step integration method was used to solve the non-linear differential equations of motion,the time history curves and frequency spectrums of the dynamic meshing force and dynamic bearing force were obtained considering the random mesh stiffness and mesh error excitations, and further,their statistical characteristics were determined by Monte Carlo simulation to analyze the influences of the randomness of mesh stiffness and mesh errors on the dynamic mesh force and dynamic bearing force.The research results lay a foundation for the dynamic optimization and dynamic reliability optimization of two-stage split herringbone gear trains.%根据某特种装备用两级分流式人字齿轮传动系统的构型特点,考虑轴承变形、啮合刚度、啮合误差和齿侧间隙等因素,建立了两级分流式人字齿轮传动系统的轴承-齿轮耦合非线性动力学模型。采用 Runge-Kutta 逐步积分法求解系统的非线性动力学微分方程,从而获得随机啮合刚度和啮合误差激励作用下两级分流式人字齿轮传动系统的动态啮合力和动态支承力及其频谱,采用 Monte Carlo 仿真获得动态啮合力和动态支承力的统计特征,研究了啮合刚度和啮合误差随机性对动态啮合力和动态支承力的影响规律,为两级分流式人字齿轮传动系统动力学优化以及动态可靠性优化奠定基础。

  2. Systematic care for caregivers of patients with dementia: a multicenter, cluster-randomized, controlled trial

    NARCIS (Netherlands)

    Spijker, A.; Wollersheim, H.C.H.; Teerenstra, S.; Graff, M.J.L.; Adang, E.M.M.; Verhey, F.; Vernooij-Dassen, M.J.F.J.

    2011-01-01

    OBJECTIVE: To evaluate the effectiveness of the Systematic Care Program for Dementia (SCPD) on patient institutionalization and to determine the predictors of institutionalization. DESIGN: Single-blind, multicenter, cluster-randomized, controlled trial. SETTING: Six community mental health services

  3. School snacks decrease morbidity in Kenyan schoolchildren: a cluster randomized, controlled feeding intervention trial

    National Research Council Canada - National Science Library

    Neumann, Charlotte G; Bwibo, Nimrod O; Jiang, Luohua; Weiss, Robert E

    2013-01-01

    .... There were three schools per group in this cluster randomized trial. Children in feeding group schools received school snacks of a local plant-based dish, githeri, with meat, milk or extra oil added...

  4. Initialization of Markov Random Field Clustering of Large Remote Sensing Images

    NARCIS (Netherlands)

    Tran, T.N.; Wehrens, H.R.M.J.; Hoekman, D.H.; Buydens, L.M.C.

    2005-01-01

    Markov random field (MRF) clustering, utilizing both spectral and spatial interpixel dependency information, often improves classification accuracy for remote sensing images, such as multichannel polarimetric synthetic aperture radar (SAR) images. However, it is heavily sensitive to initial conditio

  5. Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects.

    Science.gov (United States)

    Dreyhaupt, Jens; Mayer, Benjamin; Keis, Oliver; Öchsner, Wolfgang; Muche, Rainer

    2017-01-01

    An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention) studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called "cluster randomization"). Compared with studies with individual randomization, studies with cluster randomization normally require (significantly) larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies. Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.

  6. Universal scaling functions for bond percolation on planar random and square lattices with multiple percolating clusters

    OpenAIRE

    Hsu, Hsiao-Ping; Lin, Simon C.; Hu, Chin-Kun

    2001-01-01

    Percolation models with multiple percolating clusters have attracted much attention in recent years. Here we use Monte Carlo simulations to study bond percolation on $L_{1}\\times L_{2}$ planar random lattices, duals of random lattices, and square lattices with free and periodic boundary conditions, in vertical and horizontal directions, respectively, and with various aspect ratio $L_{1}/L_{2}$. We calculate the probability for the appearance of $n$ percolating clusters, $W_{n},$ the percolati...

  7. Cluster-size dependent randomization traffic flow model

    Institute of Scientific and Technical Information of China (English)

    Gao Kun; Wang Bing-Hong; Fu Chuan-Ji; Lu Yu-Feng

    2007-01-01

    In order to exhibit the meta-stable states, several slow-to-start rules have been investigated as modification to Nagel-Schreckenberg (NS) model. These models can reproduce some realistic phenomena which are absent in the original NS model. But in these models, the size of cluster is still not considered as a useful parameter. In real traffic,the slow-to-start motion of a standing vehicle often depends on the degree of congestion which can be measured by the clusters'size. According to this idea, we propose a cluster-size dependent slow-to-start model based on the speeddependent slow-to-start rule (VDR) model. It gives expected results through simulations. Comparing with the VDR model, our new model has a better traffic efficiency and shows richer complex characters.

  8. Contextual Classification of Point Clouds Using a Two-Stage Crf

    Science.gov (United States)

    Niemeyer, J.; Rottensteiner, F.; Soergel, U.; Heipke, C.

    2015-03-01

    In this investigation, we address the task of airborne LiDAR point cloud labelling for urban areas by presenting a contextual classification methodology based on a Conditional Random Field (CRF). A two-stage CRF is set up: in a first step, a point-based CRF is applied. The resulting labellings are then used to generate a segmentation of the classified points using a Conditional Euclidean Clustering algorithm. This algorithm combines neighbouring points with the same object label into one segment. The second step comprises the classification of these segments, again with a CRF. As the number of the segments is much smaller than the number of points, it is computationally feasible to integrate long range interactions into this framework. Additionally, two different types of interactions are introduced: one for the local neighbourhood and another one operating on a coarser scale. This paper presents the entire processing chain. We show preliminary results achieved using the Vaihingen LiDAR dataset from the ISPRS Benchmark on Urban Classification and 3D Reconstruction, which consists of three test areas characterised by different and challenging conditions. The utilised classification features are described, and the advantages and remaining problems of our approach are discussed. We also compare our results to those generated by a point-based classification and show that a slight improvement is obtained with this first implementation.

  9. Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects

    Directory of Open Access Journals (Sweden)

    Dreyhaupt, Jens

    2017-05-01

    Full Text Available An increasing number of studies are being performed in educational research to evaluate new teaching methods and approaches. These studies could be performed more efficiently and deliver more convincing results if they more strictly applied and complied with recognized standards of scientific studies. Such an approach could substantially increase the quality in particular of prospective, two-arm (intervention studies that aim to compare two different teaching methods. A key standard in such studies is randomization, which can minimize systematic bias in study findings; such bias may result if the two study arms are not structurally equivalent. If possible, educational research studies should also achieve this standard, although this is not yet generally the case. Some difficulties and concerns exist, particularly regarding organizational and methodological aspects. An important point to consider in educational research studies is that usually individuals cannot be randomized, because of the teaching situation, and instead whole groups have to be randomized (so-called “cluster randomization”. Compared with studies with individual randomization, studies with cluster randomization normally require (significantly larger sample sizes and more complex methods for calculating sample size. Furthermore, cluster-randomized studies require more complex methods for statistical analysis. The consequence of the above is that a competent expert with respective special knowledge needs to be involved in all phases of cluster-randomized studies.Studies to evaluate new teaching methods need to make greater use of randomization in order to achieve scientifically convincing results. Therefore, in this article we describe the general principles of cluster randomization and how to implement these principles, and we also outline practical aspects of using cluster randomization in prospective, two-arm comparative educational research studies.

  10. A Coupled Hidden Markov Random Field Model for Simultaneous Face Clustering and Tracking in Videos

    KAUST Repository

    Wu, Baoyuan

    2016-10-25

    Face clustering and face tracking are two areas of active research in automatic facial video processing. They, however, have long been studied separately, despite the inherent link between them. In this paper, we propose to perform simultaneous face clustering and face tracking from real world videos. The motivation for the proposed research is that face clustering and face tracking can provide useful information and constraints to each other, thus can bootstrap and improve the performances of each other. To this end, we introduce a Coupled Hidden Markov Random Field (CHMRF) to simultaneously model face clustering, face tracking, and their interactions. We provide an effective algorithm based on constrained clustering and optimal tracking for the joint optimization of cluster labels and face tracking. We demonstrate significant improvements over state-of-the-art results in face clustering and tracking on several videos.

  11. Fall injuries in Baghdad from 2003 to 2014: results of a randomized household cluster survey

    Science.gov (United States)

    Stewart, Barclay T; Lafta, Riyadh; Shatari, Sahar A Esa Al; Cherewick, Megan; Flaxman, Abraham; Hagopian, Amy; Burnham, Gilbert; Kushner, Adam L

    2015-01-01

    Introduction Falls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship. Results Nine hundred households totaling 5,148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged injuries) and 77 were respondents aged 15 - 64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30 – 8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%). Conclusion Falls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life

  12. Hyperspectral image clustering method based on artificial bee colony algorithm and Markov random fields

    Science.gov (United States)

    Sun, Xu; Yang, Lina; Gao, Lianru; Zhang, Bing; Li, Shanshan; Li, Jun

    2015-01-01

    Center-oriented hyperspectral image clustering methods have been widely applied to hyperspectral remote sensing image processing; however, the drawbacks are obvious, including the over-simplicity of computing models and underutilized spatial information. In recent years, some studies have been conducted trying to improve this situation. We introduce the artificial bee colony (ABC) and Markov random field (MRF) algorithms to propose an ABC-MRF-cluster model to solve the problems mentioned above. In this model, a typical ABC algorithm framework is adopted in which cluster centers and iteration conditional model algorithm's results are considered as feasible solutions and objective functions separately, and MRF is modified to be capable of dealing with the clustering problem. Finally, four datasets and two indices are used to show that the application of ABC-cluster and ABC-MRF-cluster methods could help to obtain better image accuracy than conventional methods. Specifically, the ABC-cluster method is superior when used for a higher power of spectral discrimination, whereas the ABC-MRF-cluster method can provide better results when used for an adjusted random index. In experiments on simulated images with different signal-to-noise ratios, ABC-cluster and ABC-MRF-cluster showed good stability.

  13. Evaluation of cluster-randomized trials on maternal and child health research in developing countries

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Chakraborty, Hrishikesh; Sen, Pranab Kumar

    2009-01-01

    To summarize and evaluate all publications including cluster-randomized trials used for maternal and child health research in developing countries during the last 10 years. METHODS: All cluster-randomized trials published between 1998 and 2008 were reviewed, and those that met our criteria...... for inclusion were evaluated further. The criteria for inclusion were that the trial should have been conducted in maternal and child health care in a developing country and that the conclusions should have been made on an individual level. Methods of accounting for clustering in design and analysis were......, and the trials generally improved in quality. CONCLUSIONS: Shortcomings exist in the sample-size calculations and in the analysis of cluster-randomized trials conducted during maternal and child health research in developing countries. Even though there has been improvement over time, further progress in the way...

  14. Evaluation of cluster-randomized trials on maternal and child health research in developing countries

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Chakraborty, Hrishikesh; Sen, Pranab Kumar

    2009-01-01

    To summarize and evaluate all publications including cluster-randomized trials used for maternal and child health research in developing countries during the last 10 years. METHODS: All cluster-randomized trials published between 1998 and 2008 were reviewed, and those that met our criteria...... for inclusion were evaluated further. The criteria for inclusion were that the trial should have been conducted in maternal and child health care in a developing country and that the conclusions should have been made on an individual level. Methods of accounting for clustering in design and analysis were......, and the trials generally improved in quality. CONCLUSIONS: Shortcomings exist in the sample-size calculations and in the analysis of cluster-randomized trials conducted during maternal and child health research in developing countries. Even though there has been improvement over time, further progress in the way...

  15. Treatment of cadmium dust with two-stage leaching process

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The treatment of cadmium dust with a two-stage leaching process was investigated to replace the existing sulphation roast-leaching processes. The process parameters in the first stage leaching were basically similar to the neutralleaching in zinc hydrometallurgy. The effects of process parameters in the second stage leaching on the extraction of zincand cadmium were mainly studied. The experimental results indicated that zinc and cadmium could be efficiently recoveredfrom the cadmium dust by two-stage leaching process. The extraction percentages of zinc and cadmium in two stage leach-ing reached 95% and 88% respectively under the optimum conditions. The total extraction percentage of Zn and Cdreached 94%.

  16. Bayesian network meta-analysis for cluster randomized trials with binary outcomes.

    Science.gov (United States)

    Uhlmann, Lorenz; Jensen, Katrin; Kieser, Meinhard

    2017-06-01

    Network meta-analysis is becoming a common approach to combine direct and indirect comparisons of several treatment arms. In recent research, there have been various developments and extensions of the standard methodology. Simultaneously, cluster randomized trials are experiencing an increased popularity, especially in the field of health services research, where, for example, medical practices are the units of randomization but the outcome is measured at the patient level. Combination of the results of cluster randomized trials is challenging. In this tutorial, we examine and compare different approaches for the incorporation of cluster randomized trials in a (network) meta-analysis. Furthermore, we provide practical insight on the implementation of the models. In simulation studies, it is shown that some of the examined approaches lead to unsatisfying results. However, there are alternatives which are suitable to combine cluster randomized trials in a network meta-analysis as they are unbiased and reach accurate coverage rates. In conclusion, the methodology can be extended in such a way that an adequate inclusion of the results obtained in cluster randomized trials becomes feasible. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Are Earthquake Clusters/Supercycles Real or Random?

    Science.gov (United States)

    Salditch, L.; Brooks, E. M.; Stein, S.; Spencer, B. D.

    2016-12-01

    Long records of earthquakes at plate boundaries such as the San Andreas or Cascadia often show that large earthquakes occur in temporal clusters, also termed supercycles, separated by less active intervals. These are intriguing because the boundary is presumably being loaded by steady plate motion. If so, earthquakes resulting from seismic cycles - in which their probability is small shortly after the past one, and then increases with time - should occur quasi-periodically rather than be more frequent in some intervals than others. We are exploring this issue with two approaches. One is to assess whether the clusters result purely by chance from a time-independent process that has no "memory." Thus a future earthquake is equally likely immediately after the past one and much later, so earthquakes can cluster in time. We analyze the agreement between such a model and inter-event times for Parkfield, Pallet Creek, and other records. A useful tool is transformation by the inverse cumulative distribution function, so the inter-event times have a uniform distribution when the memorylessness property holds. The second is via a time-variable model in which earthquake probability increases with time between earthquakes and decreases after an earthquake. The probability of an event increases with time until one happens, after which it decreases, but not to zero. Hence after a long period of quiescence, the probability of an earthquake can remain higher than the long-term average for several cycles. Thus the probability of another earthquake is path dependent, i.e. depends on the prior earthquake history over multiple cycles. Time histories resulting from simulations give clusters with properties similar to those observed. The sequences of earthquakes result from both the model parameters and chance, so two runs with the same parameters look different. The model parameters control the average time between events and the variation of the actual times around this average, so

  18. Clustering, randomness, and regularity in cloud fields. 4: Stratocumulus cloud fields

    Science.gov (United States)

    Lee, J.; Chou, J.; Weger, R. C.; Welch, R. M.

    1994-01-01

    To complete the analysis of the spatial distribution of boundary layer cloudiness, the present study focuses on nine stratocumulus Landsat scenes. The results indicate many similarities between stratocumulus and cumulus spatial distributions. Most notably, at full spatial resolution all scenes exhibit a decidedly clustered distribution. The strength of the clustering signal decreases with increasing cloud size; the clusters themselves consist of a few clouds (less than 10), occupy a small percentage of the cloud field area (less than 5%), contain between 20% and 60% of the cloud field population, and are randomly located within the scene. In contrast, stratocumulus in almost every respect are more strongly clustered than are cumulus cloud fields. For instance, stratocumulus clusters contain more clouds per cluster, occupy a larger percentage of the total area, and have a larger percentage of clouds participating in clusters than the corresponding cumulus examples. To investigate clustering at intermediate spatial scales, the local dimensionality statistic is introduced. Results obtained from this statistic provide the first direct evidence for regularity among large (more than 900 m in diameter) clouds in stratocumulus and cumulus cloud fields, in support of the inhibition hypothesis of Ramirez and Bras (1990). Also, the size compensated point-to-cloud cumulative distribution function statistic is found to be necessary to obtain a consistent description of stratocumulus cloud distributions. A hypothesis regarding the underlying physical mechanisms responsible for cloud clustering is presented. It is suggested that cloud clusters often arise from 4 to 10 triggering events localized within regions less than 2 km in diameter and randomly distributed within the cloud field. As the size of the cloud surpasses the scale of the triggering region, the clustering signal weakens and the larger cloud locations become more random.

  19. LOGISTICS SCHEDULING: ANALYSIS OF TWO-STAGE PROBLEMS

    Institute of Scientific and Technical Information of China (English)

    Yung-Chia CHANG; Chung-Yee LEE

    2003-01-01

    This paper studies the coordination effects between stages for scheduling problems where decision-making is a two-stage process. Two stages are considered as one system. The system can be a supply chain that links two stages, one stage representing a manufacturer; and the other, a distributor.It also can represent a single manufacturer, while each stage represents a different department responsible for a part of operations. A problem that jointly considers both stages in order to achieve ideal overall system performance is defined as a system problem. In practice, at times, it might not be feasible for the two stages to make coordinated decisions due to (i) the lack of channels that allow decision makers at the two stages to cooperate, and/or (ii) the optimal solution to the system problem is too difficult (or costly) to achieve.Two practical approaches are applied to solve a variant of two-stage logistic scheduling problems. The Forward Approach is defined as a solution procedure by which the first stage of the system problem is solved first, followed by the second stage. Similarly, the Backward Approach is defined as a solution procedure by which the second stage of the system problem is solved prior to solving the first stage. In each approach, two stages are solved sequentially and the solution generated is treated as a heuristic solution with respect to the corresponding system problem. When decision makers at two stages make decisions locally without considering consequences to the entire system,ineffectiveness may result - even when each stage optimally solves its own problem. The trade-off between the time complexity and the solution quality is the main concern. This paper provides the worst-case performance analysis for each approach.

  20. Residential Two-Stage Gas Furnaces - Do They Save Energy?

    Energy Technology Data Exchange (ETDEWEB)

    Lekov, Alex; Franco, Victor; Lutz, James

    2006-05-12

    Residential two-stage gas furnaces account for almost a quarter of the total number of models listed in the March 2005 GAMA directory of equipment certified for sale in the United States. Two-stage furnaces are expanding their presence in the market mostly because they meet consumer expectations for improved comfort. Currently, the U.S. Department of Energy (DOE) test procedure serves as the method for reporting furnace total fuel and electricity consumption under laboratory conditions. In 2006, American Society of Heating Refrigeration and Air-conditioning Engineers (ASHRAE) proposed an update to its test procedure which corrects some of the discrepancies found in the DOE test procedure and provides an improved methodology for calculating the energy consumption of two-stage furnaces. The objectives of this paper are to explore the differences in the methods for calculating two-stage residential gas furnace energy consumption in the DOE test procedure and in the 2006 ASHRAE test procedure and to compare test results to research results from field tests. Overall, the DOE test procedure shows a reduction in the total site energy consumption of about 3 percent for two-stage compared to single-stage furnaces at the same efficiency level. In contrast, the 2006 ASHRAE test procedure shows almost no difference in the total site energy consumption. The 2006 ASHRAE test procedure appears to provide a better methodology for calculating the energy consumption of two-stage furnaces. The results indicate that, although two-stage technology by itself does not save site energy, the combination of two-stage furnaces with BPM motors provides electricity savings, which are confirmed by field studies.

  1. Survival analysis of the CEAwatch multicentre clustered randomized trial

    NARCIS (Netherlands)

    Verberne, C. J.; Zhan, Z.; van den Heuvel, E. R.; Oppers, F.; de Jong, A. M.; Grossmann, Irene; Klaase, J. M.; de Bock, G. H.; Wiggers, T.

    2017-01-01

    Background: The CEAwatch randomized trial showed that follow-up with intensive carcinoembryonic antigen (CEA) monitoring (CEAwatch protocol) was better than care as usual (CAU) for early postoperative detection of colorectal cancer recurrence. The aim of this study was to calculate overall survival

  2. Two-stage local M-estimation of additive models

    Institute of Scientific and Technical Information of China (English)

    JIANG JianCheng; LI JianTao

    2008-01-01

    This paper studies local M-estimation of the nonparametric components of additive models. A two-stage local M-estimation procedure is proposed for estimating the additive components and their derivatives. Under very mild conditions, the proposed estimators of each additive component and its derivative are jointly asymptotically normal and share the same asymptotic distributions as they would be if the other components were known. The established asymptotic results also hold for two particular local M-estimations: the local least squares and least absolute deviation estimations. However,for general two-stage local M-estimation with continuous and nonlinear ψ-functions, its implementation is time-consuming. To reduce the computational burden, one-step approximations to the two-stage local M-estimators are developed. The one-step estimators are shown to achieve the same efficiency as the fully iterative two-stage local M-estimators, which makes the two-stage local M-estimation more feasible in practice. The proposed estimators inherit the advantages and at the same time overcome the disadvantages of the local least-squares based smoothers. In addition, the practical implementation of the proposed estimation is considered in details. Simulations demonstrate the merits of the two-stage local M-estimation, and a real example illustrates the performance of the methodology.

  3. Two-stage local M-estimation of additive models

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    This paper studies local M-estimation of the nonparametric components of additive models.A two-stage local M-estimation procedure is proposed for estimating the additive components and their derivatives.Under very mild conditions,the proposed estimators of each additive component and its derivative are jointly asymptotically normal and share the same asymptotic distributions as they would be if the other components were known.The established asymptotic results also hold for two particular local M-estimations:the local least squares and least absolute deviation estimations.However,for general two-stage local M-estimation with continuous and nonlinear ψ-functions,its implementation is time-consuming.To reduce the computational burden,one-step approximations to the two-stage local M-estimators are developed.The one-step estimators are shown to achieve the same effciency as the fully iterative two-stage local M-estimators,which makes the two-stage local M-estimation more feasible in practice.The proposed estimators inherit the advantages and at the same time overcome the disadvantages of the local least-squares based smoothers.In addition,the practical implementation of the proposed estimation is considered in details.Simulations demonstrate the merits of the two-stage local M-estimation,and a real example illustrates the performance of the methodology.

  4. Functional Principal Component Analysis and Randomized Sparse Clustering Algorithm for Medical Image Analysis

    Science.gov (United States)

    Lin, Nan; Jiang, Junhai; Guo, Shicheng; Xiong, Momiao

    2015-01-01

    Due to the advancement in sensor technology, the growing large medical image data have the ability to visualize the anatomical changes in biological tissues. As a consequence, the medical images have the potential to enhance the diagnosis of disease, the prediction of clinical outcomes and the characterization of disease progression. But in the meantime, the growing data dimensions pose great methodological and computational challenges for the representation and selection of features in image cluster analysis. To address these challenges, we first extend the functional principal component analysis (FPCA) from one dimension to two dimensions to fully capture the space variation of image the signals. The image signals contain a large number of redundant features which provide no additional information for clustering analysis. The widely used methods for removing the irrelevant features are sparse clustering algorithms using a lasso-type penalty to select the features. However, the accuracy of clustering using a lasso-type penalty depends on the selection of the penalty parameters and the threshold value. In practice, they are difficult to determine. Recently, randomized algorithms have received a great deal of attentions in big data analysis. This paper presents a randomized algorithm for accurate feature selection in image clustering analysis. The proposed method is applied to both the liver and kidney cancer histology image data from the TCGA database. The results demonstrate that the randomized feature selection method coupled with functional principal component analysis substantially outperforms the current sparse clustering algorithms in image cluster analysis. PMID:26196383

  5. Functional Principal Component Analysis and Randomized Sparse Clustering Algorithm for Medical Image Analysis.

    Directory of Open Access Journals (Sweden)

    Nan Lin

    Full Text Available Due to the advancement in sensor technology, the growing large medical image data have the ability to visualize the anatomical changes in biological tissues. As a consequence, the medical images have the potential to enhance the diagnosis of disease, the prediction of clinical outcomes and the characterization of disease progression. But in the meantime, the growing data dimensions pose great methodological and computational challenges for the representation and selection of features in image cluster analysis. To address these challenges, we first extend the functional principal component analysis (FPCA from one dimension to two dimensions to fully capture the space variation of image the signals. The image signals contain a large number of redundant features which provide no additional information for clustering analysis. The widely used methods for removing the irrelevant features are sparse clustering algorithms using a lasso-type penalty to select the features. However, the accuracy of clustering using a lasso-type penalty depends on the selection of the penalty parameters and the threshold value. In practice, they are difficult to determine. Recently, randomized algorithms have received a great deal of attentions in big data analysis. This paper presents a randomized algorithm for accurate feature selection in image clustering analysis. The proposed method is applied to both the liver and kidney cancer histology image data from the TCGA database. The results demonstrate that the randomized feature selection method coupled with functional principal component analysis substantially outperforms the current sparse clustering algorithms in image cluster analysis.

  6. Comparing cluster-level dynamic treatment regimens using sequential, multiple assignment, randomized trials: Regression estimation and sample size considerations.

    Science.gov (United States)

    NeCamp, Timothy; Kilbourne, Amy; Almirall, Daniel

    2017-08-01

    Cluster-level dynamic treatment regimens can be used to guide sequential treatment decision-making at the cluster level in order to improve outcomes at the individual or patient-level. In a cluster-level dynamic treatment regimen, the treatment is potentially adapted and re-adapted over time based on changes in the cluster that could be impacted by prior intervention, including aggregate measures of the individuals or patients that compose it. Cluster-randomized sequential multiple assignment randomized trials can be used to answer multiple open questions preventing scientists from developing high-quality cluster-level dynamic treatment regimens. In a cluster-randomized sequential multiple assignment randomized trial, sequential randomizations occur at the cluster level and outcomes are observed at the individual level. This manuscript makes two contributions to the design and analysis of cluster-randomized sequential multiple assignment randomized trials. First, a weighted least squares regression approach is proposed for comparing the mean of a patient-level outcome between the cluster-level dynamic treatment regimens embedded in a sequential multiple assignment randomized trial. The regression approach facilitates the use of baseline covariates which is often critical in the analysis of cluster-level trials. Second, sample size calculators are derived for two common cluster-randomized sequential multiple assignment randomized trial designs for use when the primary aim is a between-dynamic treatment regimen comparison of the mean of a continuous patient-level outcome. The methods are motivated by the Adaptive Implementation of Effective Programs Trial which is, to our knowledge, the first-ever cluster-randomized sequential multiple assignment randomized trial in psychiatry.

  7. Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: a cluster randomized controlled trial.

    NARCIS (Netherlands)

    Pieper, M.J.C.; Francke, A.L.; Steen, J.T. van der; Scherder, E.J.A.; Twisk, J.W.R.; Kovach, C.R.; Achterberg, W.P.

    2016-01-01

    Objectives: To assess whether implementation of a stepwise multicomponent intervention (STA OP!) is effective in reducing challenging behavior and depression in nursing home residents with advanced dementia. Design: Cluster randomized controlled trial. Setting: Twenty-one clusters (single

  8. Effects of a Stepwise Multidisciplinary Intervention for Challenging Behavior in Advanced Dementia: A Cluster Randomized Controlled Trial

    NARCIS (Netherlands)

    Pieper, M.J.; Francke, A.L.; Steen, J.T. van der; Scherder, E.J.; Twisk, J.W.; Kovach, C.R.; Achterberg, W.P.

    2016-01-01

    OBJECTIVES: To assess whether implementation of a stepwise multicomponent intervention (STA OP!) is effective in reducing challenging behavior and depression in nursing home residents with advanced dementia. DESIGN: Cluster randomized controlled trial. SETTING: Twenty-one clusters (single

  9. AREA DETERMINATION OF DIABETIC FOOT ULCER IMAGES USING A CASCADED TWO-STAGE SVM BASED CLASSIFICATION.

    Science.gov (United States)

    Wang, Lei; Pedersen, Peder; Agu, Emmanuel; Strong, Diane; Tulu, Bengisu

    2016-11-23

    It is standard practice for clinicians and nurses to primarily assess patients' wounds via visual examination. This subjective method can be inaccurate in wound assessment and also represents a significant clinical workload. Hence, computer-based systems, especially implemented on mobile devices, can provide automatic, quantitative wound assessment and can thus be valuable for accurately monitoring wound healing status. Out of all wound assessment parameters, the measurement of the wound area is the most suitable for automated analysis. Most of the current wound boundary determination methods only process the image of the wound area along with a small amount of surrounding healthy skin. In this paper, we present a novel approach that uses Support Vector Machine (SVM) to determine the wound boundary on a foot ulcer image captured with an image capture box, which provides controlled lighting, angle and range conditions. The Simple Linear Iterative Clustering (SLIC) method is applied for effective super-pixel segmentation. A cascaded two-stage classifier is trained as follows: in the first stage a set of k binary SVM classifiers are trained and applied to different subsets of the entire training images dataset, and a set of incorrectly classified instances are collected. In the second stage, another binary SVM classifier is trained on the incorrectly classified set. We extracted various color and texture descriptors from super-pixels that are used as input for each stage in the classifier training. Specifically, we apply the color and Bag-of-Word (BoW) representation of local Dense SIFT features (DSIFT) as the descriptor for ruling out irrelevant regions (first stage), and apply color and wavelet based features as descriptors for distinguishing healthy tissue from wound regions (second stage). Finally, the detected wound boundary is refined by applying a Conditional Random Field (CRF) image processing technique. We have implemented the wound classification on a Nexus

  10. Improving antibiotic prescribing in primary care: a cluster-randomized controlled trial

    OpenAIRE

    Teixeira Rodrigues, António; Roque,Fátima; Soares, Sara; Figueiras, Adolfo; Herdeiro, Maria Teresa

    2016-01-01

    Aiming to improve antibiotic prescribing and to diminish the misuse of antibiotics, an educational intervention was performed targeting physicians’ attitudes, knowledge and perceptions about antibiotic prescribing and antimicrobial resistances. Methods The educational intervention was developed in the Centre Health Region of Portugal, with a sample size of 1168 primary care physicians. Clusters were randomly selected as control (4 clusters, 35 primary care facilities, n=862) and interv...

  11. Handling missing data in cluster randomized trials: A demonstration of multiple imputation with PAN through SAS

    Directory of Open Access Journals (Sweden)

    Jiangxiu Zhou

    2014-09-01

    Full Text Available The purpose of this study is to demonstrate a way of dealing with missing data in clustered randomized trials by doing multiple imputation (MI with the PAN package in R through SAS. The procedure for doing MI with PAN through SAS is demonstrated in detail in order for researchers to be able to use this procedure with their own data. An illustration of the technique with empirical data was also included. In this illustration thePAN results were compared with pairwise deletion and three types of MI: (1 Normal Model (NM-MI ignoring the cluster structure; (2 NM-MI with dummy-coded cluster variables (fixed cluster structure; and (3 a hybrid NM-MI which imputes half the time ignoring the cluster structure, and the other half including the dummy-coded cluster variables. The empirical analysis showed that using PAN and the other strategies produced comparable parameter estimates. However, the dummy-coded MI overestimated the intraclass correlation, whereas MI ignoring the cluster structure and the hybrid MI underestimated the intraclass correlation. When compared with PAN, the p-value and standard error for the treatment effect were higher with dummy-coded MI, and lower with MI ignoring the clusterstructure, the hybrid MI approach, and pairwise deletion. Previous studies have shown that NM-MI is not appropriate for handling missing data in clustered randomized trials. This approach, in addition to the pairwise deletion approach, leads to a biased intraclass correlation and faultystatistical conclusions. Imputation in clustered randomized trials should be performed with PAN. We have demonstrated an easy way for using PAN through SAS.

  12. Effect of Random Clustering on Surface Damage Density Estimates

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, M J; Feit, M D

    2007-10-29

    Identification and spatial registration of laser-induced damage relative to incident fluence profiles is often required to characterize the damage properties of laser optics near damage threshold. Of particular interest in inertial confinement laser systems are large aperture beam damage tests (>1cm{sup 2}) where the number of initiated damage sites for {phi}>14J/cm{sup 2} can approach 10{sup 5}-10{sup 6}, requiring automatic microscopy counting to locate and register individual damage sites. However, as was shown for the case of bacteria counting in biology decades ago, random overlapping or 'clumping' prevents accurate counting of Poisson-distributed objects at high densities, and must be accounted for if the underlying statistics are to be understood. In this work we analyze the effect of random clumping on damage initiation density estimates at fluences above damage threshold. The parameter {psi} = a{rho} = {rho}/{rho}{sub 0}, where a = 1/{rho}{sub 0} is the mean damage site area and {rho} is the mean number density, is used to characterize the onset of clumping, and approximations based on a simple model are used to derive an expression for clumped damage density vs. fluence and damage site size. The influence of the uncorrected {rho} vs. {phi} curve on damage initiation probability predictions is also discussed.

  13. When is informed consent required in cluster randomized trials in health research?

    Directory of Open Access Journals (Sweden)

    Boruch Robert

    2011-09-01

    Full Text Available Abstract This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the second of the questions posed, namely, from whom, when, and how must informed consent be obtained in CRTs in health research? The ethical principle of respect for persons implies that researchers are generally obligated to obtain the informed consent of research subjects. Aspects of CRT design, including cluster randomization, cluster level interventions, and cluster size, present challenges to obtaining informed consent. Here we address five questions related to consent and CRTs: How can a study proceed if informed consent is not possible? Is consent to randomization always required? What information must be disclosed to potential subjects if their cluster has already been randomized? Is passive consent a valid substitute for informed consent? Do health professionals have a moral obligation to participate as subjects in CRTs designed to improve professional practice? We set out a framework based on the moral foundations of informed consent and international regulatory provisions to address each of these questions. First, when informed consent is not possible, a study may proceed if a research ethics committee is satisfied that conditions for a waiver of consent are satisfied. Second, informed consent to randomization may not be required if it is not possible to approach subjects at the time of randomization. Third, when potential subjects are approached after cluster randomization, they must be provided with a detailed description of the interventions in the trial arm to which their cluster has been randomized; detailed information on interventions in other trial arms need not be provided. Fourth, while passive consent may serve a

  14. Clustering statistics, roughness feedbacks, and randomness in experimental step-pool morphodynamics

    Science.gov (United States)

    Johnson, Joel P. L.

    2017-04-01

    Step pools are a common bed morphology in boulder-rich gravel streams, but predicting how mountainous landscapes will respond to environmental perturbations such as climate-related hydrological changes requires a better understanding of channel morphodynamics and factors that influence bed stability. Flume experiments exploring bed stabilization demonstrate feedbacks among surface roughness, coarse grain clustering, and surface grain size. Clustering is quantified by using a novel normalization of Ripley's K statistic designed for use in power law functions. At 95% confidence, many but not all beds stabilized with coarse grains becoming more clustered than complete spatial randomness. The clustering statistic predicts hydraulic roughness better than D84 does (the diameter at which 84% of grains are smaller), suggesting that the spatial organization of the bed can be a stronger control than grain size on flow hydraulics. Initial conditions affect the degree of clustering at stability, indicating sensitivity to history.

  15. Single-cluster-update Monte Carlo method for the random anisotropy model

    Science.gov (United States)

    Rößler, U. K.

    1999-06-01

    A Wolff-type cluster Monte Carlo algorithm for random magnetic models is presented. The algorithm is demonstrated to reduce significantly the critical slowing down for planar random anisotropy models with weak anisotropy strength. Dynamic exponents zcluster algorithms are estimated for models with ratio of anisotropy to exchange constant D/J=1.0 on cubic lattices in three dimensions. For these models, critical exponents are derived from a finite-size scaling analysis.

  16. Improving efficiency in cluster-randomized study design and implementation: taking advantage of a crossover

    OpenAIRE

    Reich NG; Milstone AM

    2013-01-01

    Nicholas G Reich,1 Aaron M Milstone2,3 1Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, UMass-Amherst, Amherst, MA, USA; 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 3Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA Abstract: While individually randomized trials have long provided the gold standard of clinical evidence, the use of cluster-randomized tr...

  17. STARS A Two Stage High Gain Harmonic Generation FEL Demonstrator

    Energy Technology Data Exchange (ETDEWEB)

    M. Abo-Bakr; W. Anders; J. Bahrdt; P. Budz; K.B. Buerkmann-Gehrlein; O. Dressler; H.A. Duerr; V. Duerr; W. Eberhardt; S. Eisebitt; J. Feikes; R. Follath; A. Gaupp; R. Goergen; K. Goldammer; S.C. Hessler; K. Holldack; E. Jaeschke; Thorsten Kamps; S. Klauke; J. Knobloch; O. Kugeler; B.C. Kuske; P. Kuske; A. Meseck; R. Mitzner; R. Mueller; M. Neeb; A. Neumann; K. Ott; D. Pfluckhahn; T. Quast; M. Scheer; Th. Schroeter; M. Schuster; F. Senf; G. Wuestefeld; D. Kramer; Frank Marhauser

    2007-08-01

    BESSY is proposing a demonstration facility, called STARS, for a two-stage high-gain harmonic generation free electron laser (HGHG FEL). STARS is planned for lasing in the wavelength range 40 to 70 nm, requiring a beam energy of 325 MeV. The facility consists of a normal conducting gun, three superconducting TESLA-type acceleration modules modified for CW operation, a single stage bunch compressor and finally a two-stage HGHG cascaded FEL. This paper describes the faciliy layout and the rationale behind the operation parameters.

  18. Dynamic Modelling of the Two-stage Gasification Process

    DEFF Research Database (Denmark)

    Gøbel, Benny; Henriksen, Ulrik B.; Houbak, Niels

    1999-01-01

    A two-stage gasification pilot plant was designed and built as a co-operative project between the Technical University of Denmark and the company REKA.A dynamic, mathematical model of the two-stage pilot plant was developed to serve as a tool for optimising the process and the operating conditions...... of the gasification plant.The model consists of modules corresponding to the different elements in the plant. The modules are coupled together through mass and heat conservation.Results from the model are compared with experimental data obtained during steady and unsteady operation of the pilot plant. A good...

  19. RRW: repeated random walks on genome-scale protein networks for local cluster discovery

    Directory of Open Access Journals (Sweden)

    Can Tolga

    2009-09-01

    Full Text Available Abstract Background We propose an efficient and biologically sensitive algorithm based on repeated random walks (RRW for discovering functional modules, e.g., complexes and pathways, within large-scale protein networks. Compared to existing cluster identification techniques, RRW implicitly makes use of network topology, edge weights, and long range interactions between proteins. Results We apply the proposed technique on a functional network of yeast genes and accurately identify statistically significant clusters of proteins. We validate the biological significance of the results using known complexes in the MIPS complex catalogue database and well-characterized biological processes. We find that 90% of the created clusters have the majority of their catalogued proteins belonging to the same MIPS complex, and about 80% have the majority of their proteins involved in the same biological process. We compare our method to various other clustering techniques, such as the Markov Clustering Algorithm (MCL, and find a significant improvement in the RRW clusters' precision and accuracy values. Conclusion RRW, which is a technique that exploits the topology of the network, is more precise and robust in finding local clusters. In addition, it has the added flexibility of being able to find multi-functional proteins by allowing overlapping clusters.

  20. Toward Improving Electrocardiogram (ECG) Biometric Verification using Mobile Sensors: A Two-Stage Classifier Approach.

    Science.gov (United States)

    Tan, Robin; Perkowski, Marek

    2017-02-20

    Electrocardiogram (ECG) signals sensed from mobile devices pertain the potential for biometric identity recognition applicable in remote access control systems where enhanced data security is demanding. In this study, we propose a new algorithm that consists of a two-stage classifier combining random forest and wavelet distance measure through a probabilistic threshold schema, to improve the effectiveness and robustness of a biometric recognition system using ECG data acquired from a biosensor integrated into mobile devices. The proposed algorithm is evaluated using a mixed dataset from 184 subjects under different health conditions. The proposed two-stage classifier achieves a total of 99.52% subject verification accuracy, better than the 98.33% accuracy from random forest alone and 96.31% accuracy from wavelet distance measure algorithm alone. These results demonstrate the superiority of the proposed algorithm for biometric identification, hence supporting its practicality in areas such as cloud data security, cyber-security or remote healthcare systems.

  1. Effect of imbalance and intracluster correlation coefficient in cluster randomization trials with binary outcomes when the available number of clusters is fixed in advance.

    Science.gov (United States)

    Ahn, Chul; Hu, Fan; Skinner, Celette Sugg; Ahn, Daniel

    2009-07-01

    In some cluster randomization trials, the number of clusters cannot exceed a specified maximum value due to cost constraints or other practical reasons. Donner and Klar [Donner A, and Klar N. Design and analysis of cluster randomization trials in health research. Oxford University Press 2000] provided the sample size formula for the number of subjects required per cluster when the number of clusters cannot exceed a specified maximum value. The sample size formula of Donner and Klar assumes that the number of subjects is the same in each cluster. In practical situations, the number of subjects may be different among clusters. We conducted simulation studies to investigate the effect of the cluster size variability (kappa) and the intracluster correlation coefficient (rho) on the power of the study in which the number of available clusters is fixed in advance. For the balanced case (kappa=1.0), i.e., equal cluster size among clusters, the sample size formula yielded empirical powers close to the nominal level even when the number of available clusters per group (k*) is as small as 10. The sample size formula yielded empirical powers close to the nominal level when the number of available clusters per group (k*) is at least 20 and the imbalance parameter (kappa) is at least 0.8. Empirical powers were close to the nominal level when (rho or =0.8, and k*=10) or (rho< or =0.02, kappa=0.8, and k*=20).

  2. A pilot cluster randomized controlled trial of structured goal-setting following stroke.

    Science.gov (United States)

    Taylor, William J; Brown, Melanie; William, Levack; McPherson, Kathryn M; Reed, Kirk; Dean, Sarah G; Weatherall, Mark

    2012-04-01

    To determine the feasibility, the cluster design effect and the variance and minimal clinical importance difference in the primary outcome in a pilot study of a structured approach to goal-setting. A cluster randomized controlled trial. Inpatient rehabilitation facilities. People who were admitted to inpatient rehabilitation following stroke who had sufficient cognition to engage in structured goal-setting and complete the primary outcome measure. Structured goal elicitation using the Canadian Occupational Performance Measure. Quality of life at 12 weeks using the Schedule for Individualised Quality of Life (SEIQOL-DW), Functional Independence Measure, Short Form 36 and Patient Perception of Rehabilitation (measuring satisfaction with rehabilitation). Assessors were blinded to the intervention. Four rehabilitation services and 41 patients were randomized. We found high values of the intraclass correlation for the outcome measures (ranging from 0.03 to 0.40) and high variance of the SEIQOL-DW (SD 19.6) in relation to the minimally importance difference of 2.1, leading to impractically large sample size requirements for a cluster randomized design. A cluster randomized design is not a practical means of avoiding contamination effects in studies of inpatient rehabilitation goal-setting. Other techniques for coping with contamination effects are necessary.

  3. The Effectiveness of Healthy Start Home Visit Program: Cluster Randomized Controlled Trial

    Science.gov (United States)

    Leung, Cynthia; Tsang, Sandra; Heung, Kitty

    2015-01-01

    Purpose: The study reported the effectiveness of a home visit program for disadvantaged Chinese parents with preschool children, using cluster randomized controlled trial design. Method: Participants included 191 parents and their children from 24 preschools, with 84 dyads (12 preschools) in the intervention group and 107 dyads (12 preschools) in…

  4. Efficacy of a Universal Parent Training Program (HOPE-20): Cluster Randomized Controlled Trial

    Science.gov (United States)

    Leung, Cynthia; Tsang, Sandra; Kwan, H. W.

    2017-01-01

    Objective: This study examined the efficacy of Hands-On Parent Empowerment-20 (HOPE-20) program. Methods: Eligible participants were parents residing in Hong Kong with target children aged 2 years attending nursery schools. Cluster randomized control trial was adopted, with 10 schools (110 participants) assigned to intervention group and 8 schools…

  5. Standardized Effect Size Measures for Mediation Analysis in Cluster-Randomized Trials

    Science.gov (United States)

    Stapleton, Laura M.; Pituch, Keenan A.; Dion, Eric

    2015-01-01

    This article presents 3 standardized effect size measures to use when sharing results of an analysis of mediation of treatment effects for cluster-randomized trials. The authors discuss 3 examples of mediation analysis (upper-level mediation, cross-level mediation, and cross-level mediation with a contextual effect) with demonstration of the…

  6. Improving comfort in people with dementia and pneumonia: a cluster randomized trial

    NARCIS (Netherlands)

    Maaden, T. van der; Vet, H.C. de; Achterberg, W.P.; Boersma, F.; Schols, J.M.; Mehr, D.R.; Galindo-Garre, F.; Hertogh, C.M.; Koopmans, R.T.C.M.; Steen, J.T. van der

    2016-01-01

    BACKGROUND: Pneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. METHODS: A single-blind, multicenter, cluster randomized controll

  7. Improving comfort in people with dementia and pneumonia : a cluster randomized trial

    NARCIS (Netherlands)

    van der Maaden, Tessa; de Vet, Henrica C. W.; Achterberg, Wilco P.; Boersma, Froukje; Schols, Jos M. G. A.; Mehr, David R.; Galindo-Garre, Francisca; Hertogh, Cees M. P. M.; Koopmans, Raymond T. C. M.; van der Steen, Jenny T.

    2016-01-01

    Background: Pneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. Methods: A single-blind, multicenter, cluster randomized controll

  8. Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records

    NARCIS (Netherlands)

    Dregan, Alex; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Ashworth, Mark; Charlton, Judith; Wolfe, Charles D A; Rudd, Anthony; Yardley, Lucy; Gulliford, Martin C

    BACKGROUND AND PURPOSE: The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using

  9. Prescribing ANtiDepressants Appropriately (PANDA) : a cluster randomized controlled trial in primary care

    NARCIS (Netherlands)

    Muskens, Esther; Eveleigh, Rhona; Lucassen, Peter; van Weel, Chris; Spijker, Jan; Verhaak, Peter; Speckens, Anne; Voshaar, Richard Oude

    2013-01-01

    Background: Inappropriate use of antidepressants (AD), defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users. Methods/design: We have designed a cluster randomized control

  10. Potts Model with Invisible Colors : Random-Cluster Representation and Pirogov–Sinai Analysis

    NARCIS (Netherlands)

    Enter, Aernout C.D. van; Iacobelli, Giulio; Taati, Siamak

    We study a recently introduced variant of the ferromagnetic Potts model consisting of a ferromagnetic interaction among q “visible” colors along with the presence of r non-interacting “invisible” colors. We introduce a random-cluster representation for the model, for which we prove the existence of

  11. Two-Stage Fuzzy Portfolio Selection Problem with Transaction Costs

    Directory of Open Access Journals (Sweden)

    Yanju Chen

    2015-01-01

    Full Text Available This paper studies a two-period portfolio selection problem. The problem is formulated as a two-stage fuzzy portfolio selection model with transaction costs, in which the future returns of risky security are characterized by possibility distributions. The objective of the proposed model is to achieve the maximum utility in terms of the expected value and variance of the final wealth. Given the first-stage decision vector and a realization of fuzzy return, the optimal value expression of the second-stage programming problem is derived. As a result, the proposed two-stage model is equivalent to a single-stage model, and the analytical optimal solution of the two-stage model is obtained, which helps us to discuss the properties of the optimal solution. Finally, some numerical experiments are performed to demonstrate the new modeling idea and the effectiveness. The computational results provided by the proposed model show that the more risk-averse investor will invest more wealth in the risk-free security. They also show that the optimal invested amount in risky security increases as the risk-free return decreases and the optimal utility increases as the risk-free return increases, whereas the optimal utility increases as the transaction costs decrease. In most instances the utilities provided by the proposed two-stage model are larger than those provided by the single-stage model.

  12. Efficient Two-Stage Group Testing Algorithms for DNA Screening

    CERN Document Server

    Huber, Michael

    2011-01-01

    Group testing algorithms are very useful tools for DNA library screening. Building on recent work by Levenshtein (2003) and Tonchev (2008), we construct in this paper new infinite classes of combinatorial structures, the existence of which are essential for attaining the minimum number of individual tests at the second stage of a two-stage disjunctive testing algorithm.

  13. High Performance Gasification with the Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Gøbel, Benny; Hindsgaul, Claus; Henriksen, Ulrik Birk

    2002-01-01

    Based on more than 15 years of research and practical experience, the Technical University of Denmark (DTU) and COWI Consulting Engineers and Planners AS present the two-stage gasification process, a concept for high efficiency gasification of biomass producing negligible amounts of tars. In the ......Based on more than 15 years of research and practical experience, the Technical University of Denmark (DTU) and COWI Consulting Engineers and Planners AS present the two-stage gasification process, a concept for high efficiency gasification of biomass producing negligible amounts of tars....... In the two-stage gasification concept, the pyrolysis and the gasification processes are physical separated. The volatiles from the pyrolysis are partially oxidized, and the hot gases are used as gasification medium to gasify the char. Hot gases from the gasifier and a combustion unit can be used for drying...... a cold gas efficiency exceeding 90% is obtained. In the original design of the two-stage gasification process, the pyrolysis unit consists of a screw conveyor with external heating, and the char unit is a fixed bed gasifier. This design is well proven during more than 1000 hours of testing with various...

  14. FREE GRAFT TWO-STAGE URETHROPLASTY FOR HYPOSPADIAS REPAIR

    Institute of Scientific and Technical Information of China (English)

    Zhong-jin Yue; Ling-jun Zuo; Jia-ji Wang; Gan-ping Zhong; Jian-ming Duan; Zhi-ping Wang; Da-shan Qin

    2005-01-01

    Objective To evaluate the effectiveness of free graft transplantation two-stage urethroplasty for hypospadias repair.Methods Fifty-eight cases with different types of hypospadias including 10 subcoronal, 36 penile shaft, 9 scrotal, and 3 perineal were treated with free full-thickness skin graft or (and) buccal mucosal graft transplantation two-stage urethroplasty. Of 58 cases, 45 were new cases, 13 had history of previous failed surgeries. Operative procedure included two stages: the first stage is to correct penile curvature (chordee), prepare transplanting bed, harvest and prepare full-thickness skin graft, buccal mucosal graft, and perform graft transplantation. The second stage is to complete urethroplasty and glanuloplasty.Results After the first stage operation, 56 of 58 cases (96.6%) were successful with grafts healing well, another 2foreskin grafts got gangrened. After the second stage operation on 56 cases, 5 cases failed with newly formed urethras opened due to infection, 8 cases had fistulas, 43 (76.8%) cases healed well.Conclusions Free graft transplantation two-stage urethroplasty for hypospadias repair is a kind of effective treatment with broad indication, comparatively high success rate, less complicationsand good cosmatic results, indicative of various types of hypospadias repair.

  15. Composite likelihood and two-stage estimation in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2004-01-01

    In this paper register based family studies provide the motivation for linking a two-stage estimation procedure in copula models for multivariate failure time data with a composite likelihood approach. The asymptotic properties of the estimators in both parametric and semi-parametric models are d...

  16. A two-stage rank test using density estimation

    NARCIS (Netherlands)

    Albers, Willem/Wim

    1995-01-01

    For the one-sample problem, a two-stage rank test is derived which realizes a required power against a given local alternative, for all sufficiently smooth underlying distributions. This is achieved using asymptotic expansions resulting in a precision of orderm −1, wherem is the size of the first

  17. The construction of customized two-stage tests

    NARCIS (Netherlands)

    Adema, Jos J.

    1990-01-01

    In this paper mixed integer linear programming models for customizing two-stage tests are given. Model constraints are imposed with respect to test composition, administration time, inter-item dependencies, and other practical considerations. It is not difficult to modify the models to make them use

  18. Clustering, randomness and regularity in cloud fields. I - Theoretical considerations. II - Cumulus cloud fields

    Science.gov (United States)

    Weger, R. C.; Lee, J.; Zhu, Tianri; Welch, R. M.

    1992-01-01

    The current controversy existing in reference to the regularity vs. clustering in cloud fields is examined by means of analysis and simulation studies based upon nearest-neighbor cumulative distribution statistics. It is shown that the Poisson representation of random point processes is superior to pseudorandom-number-generated models and that pseudorandom-number-generated models bias the observed nearest-neighbor statistics towards regularity. Interpretation of this nearest-neighbor statistics is discussed for many cases of superpositions of clustering, randomness, and regularity. A detailed analysis is carried out of cumulus cloud field spatial distributions based upon Landsat, AVHRR, and Skylab data, showing that, when both large and small clouds are included in the cloud field distributions, the cloud field always has a strong clustering signal.

  19. A Cluster-Based Random Key Revocation Protocol for Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    Yi Jiang; Hao-Shan Shi

    2008-01-01

    In recent years, several random key pre distribution schemes have been proposed to bootstrap keys for encryption, but the problem of key and node revocation has received relatively little attention. In this paper, based on a random key pre-distribution scheme using clustering, we present a novel random key revocation protocol, which is suitable for large scale networks greatly and removes compromised information efficiently. The revocation protocol can guarantee network security by using less memory consumption and communication load, and combined by centralized and distributed revocation, having virtues of timeliness and veracity for revocation at the same time.

  20. A randomized algorithm for two-cluster partition of a set of vectors

    Science.gov (United States)

    Kel'manov, A. V.; Khandeev, V. I.

    2015-02-01

    A randomized algorithm is substantiated for the strongly NP-hard problem of partitioning a finite set of vectors of Euclidean space into two clusters of given sizes according to the minimum-of-the sum-of-squared-distances criterion. It is assumed that the centroid of one of the clusters is to be optimized and is determined as the mean value over all vectors in this cluster. The centroid of the other cluster is fixed at the origin. For an established parameter value, the algorithm finds an approximate solution of the problem in time that is linear in the space dimension and the input size of the problem for given values of the relative error and failure probability. The conditions are established under which the algorithm is asymptotically exact and runs in time that is linear in the space dimension and quadratic in the input size of the problem.

  1. Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Vlemmix, F.; Rosman, A.N.; Rijnders, M.E.; Beuckens, A.; Opmeer, B.C.; Mol, B.W.J.; Kok, M.; Fleuren, M.A.H.

    2015-01-01

    Onjective: To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Design: Cluster randomized controlled trial.Setting: Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the Netherland

  2. A review of R-packages for random-intercept probit regression in small clusters

    Directory of Open Access Journals (Sweden)

    Haeike Josephy

    2016-10-01

    Full Text Available Generalized Linear Mixed Models (GLMMs are widely used to model clustered categorical outcomes. To tackle the intractable integration over the random effects distributions, several approximation approaches have been developed for likelihood-based inference. As these seldom yield satisfactory results when analyzing binary outcomes from small clusters, estimation within the Structural Equation Modeling (SEM framework is proposed as an alternative. We compare the performance of R-packages for random-intercept probit regression relying on: the Laplace approximation, adaptive Gaussian quadrature (AGQ, penalized quasi-likelihood, an MCMC-implementation, and integrated nested Laplace approximation within the GLMM-framework, and a robust diagonally weighted least squares estimation within the SEM-framework. In terms of bias for the fixed and random effect estimators, SEM usually performs best for cluster size two, while AGQ prevails in terms of precision (mainly because of SEM's robust standard errors. As the cluster size increases, however, AGQ becomes the best choice for both bias and precision.

  3. Square Kilometre Array station configuration using two-stage beamforming

    CERN Document Server

    Jiwani, Aziz; Razavi-Ghods, Nima; Hall, Peter J; Padhi, Shantanu; de Vaate, Jan Geralt bij

    2012-01-01

    The lowest frequency band (70 - 450 MHz) of the Square Kilometre Array will consist of sparse aperture arrays grouped into geographically-localised patches, or stations. Signals from thousands of antennas in each station will be beamformed to produce station beams which form the inputs for the central correlator. Two-stage beamforming within stations can reduce SKA-low signal processing load and costs, but has not been previously explored for the irregular station layouts now favoured in radio astronomy arrays. This paper illustrates the effects of two-stage beamforming on sidelobes and effective area, for two representative station layouts (regular and irregular gridded tile on an irregular station). The performance is compared with a single-stage, irregular station. The inner sidelobe levels do not change significantly between layouts, but the more distant sidelobes are affected by the tile layouts; regular tile creates diffuse, but regular, grating lobes. With very sparse arrays, the station effective area...

  4. Two stage sorption type cryogenic refrigerator including heat regeneration system

    Science.gov (United States)

    Jones, Jack A.; Wen, Liang-Chi; Bard, Steven

    1989-01-01

    A lower stage chemisorption refrigeration system physically and functionally coupled to an upper stage physical adsorption refrigeration system is disclosed. Waste heat generated by the lower stage cycle is regenerated to fuel the upper stage cycle thereby greatly improving the energy efficiency of a two-stage sorption refrigerator. The two stages are joined by disposing a first pressurization chamber providing a high pressure flow of a first refrigerant for the lower stage refrigeration cycle within a second pressurization chamber providing a high pressure flow of a second refrigerant for the upper stage refrigeration cycle. The first pressurization chamber is separated from the second pressurization chamber by a gas-gap thermal switch which at times is filled with a thermoconductive fluid to allow conduction of heat from the first pressurization chamber to the second pressurization chamber.

  5. Recursive algorithm for the two-stage EFOP estimation method

    Institute of Scientific and Technical Information of China (English)

    LUO GuiMing; HUANG Jian

    2008-01-01

    A recursive algorithm for the two-stage empirical frequency-domain optimal param-eter (EFOP) estimation method Was proposed. The EFOP method was a novel sys-tem identificallon method for Black-box models that combines time-domain esti-mation and frequency-domain estimation. It has improved anti-disturbance perfor-mance, and could precisely identify models with fewer sample numbers. The two-stage EFOP method based on the boot-strap technique was generally suitable for Black-box models, but it was an iterative method and takes too much computation work so that it did not work well online. A recursive algorithm was proposed for dis-turbed stochastic systems. Some simulation examples are included to demonstrate the validity of the new method.

  6. Two-stage approach to full Chinese parsing

    Institute of Scientific and Technical Information of China (English)

    Cao Hailong; Zhao Tiejun; Yang Muyun; Li Sheng

    2005-01-01

    Natural language parsing is a task of great importance and extreme difficulty. In this paper, we present a full Chinese parsing system based on a two-stage approach. Rather than identifying all phrases by a uniform model, we utilize a divide and conquer strategy. We propose an effective and fast method based on Markov model to identify the base phrases. Then we make the first attempt to extend one of the best English parsing models i.e. the head-driven model to recognize Chinese complex phrases. Our two-stage approach is superior to the uniform approach in two aspects. First, it creates synergy between the Markov model and the head-driven model. Second, it reduces the complexity of full Chinese parsing and makes the parsing system space and time efficient. We evaluate our approach in PARSEVAL measures on the open test set, the parsing system performances at 87.53% precision, 87.95% recall.

  7. Income and Poverty across SMSAs: A Two-Stage Analysis

    OpenAIRE

    1993-01-01

    Two popular explanations of urban poverty are the "welfare-disincentive" and "urban-deindustrialization" theories. Using cross-sectional Census data, we develop a two-stage model to predict an SMSAs median family income and poverty rate. The model allows the city's welfare level and industrial structure to affect its median family income and poverty rate directly. It also allows welfare and industrial structure to affect income and poverty indirectly, through their effects on family structure...

  8. A Two-stage Polynomial Method for Spectrum Emissivity Modeling

    OpenAIRE

    Qiu, Qirong; Liu, Shi; Teng, Jing; Yan, Yong

    2015-01-01

    Spectral emissivity is a key in the temperature measurement by radiation methods, but not easy to determine in a combustion environment, due to the interrelated influence of temperature and wave length of the radiation. In multi-wavelength radiation thermometry, knowing the spectral emissivity of the material is a prerequisite. However in many circumstances such a property is a complex function of temperature and wavelength and reliable models are yet to be sought. In this study, a two stages...

  9. Ab initio random structure search for 13-atom clusters of fcc elements.

    Science.gov (United States)

    Chou, J P; Hsing, C R; Wei, C M; Cheng, C; Chang, C M

    2013-03-27

    The 13-atom metal clusters of fcc elements (Al, Rh, Ir, Ni, Pd, Pt, Cu, Ag, Au) were studied by density functional theory calculations. The global minima were searched for by the ab initio random structure searching method. In addition to some new lowest-energy structures for Pd13 and Au13, we found that the effective coordination numbers of the lowest-energy clusters would increase with the ratio of the dimer-to-bulk bond length. This correlation, together with the electronic structures of the lowest-energy clusters, divides the 13-atom clusters of these fcc elements into two groups (except for Au13, which prefers a two-dimensional structure due to the relativistic effect). Compact-like clusters that are composed exclusively of triangular motifs are preferred for elements without d-electrons (Al) or with (nearly) filled d-band electrons (Ni, Pd, Cu, Ag). Non-compact clusters composed mainly of square motifs connected by some triangular motifs (Rh, Ir, Pt) are favored for elements with unfilled d-band electrons.

  10. Forty-five-degree two-stage venous cannula: advantages over standard two-stage venous cannulation.

    Science.gov (United States)

    Lawrence, D R; Desai, J B

    1997-01-01

    We present a 45-degree two-stage venous cannula that confers advantage to the surgeon using cardiopulmonary bypass. This cannula exits the mediastinum under the transverse bar of the sternal retractor, leaving the rostral end of the sternal incision free of apparatus. It allows for lifting of the heart with minimal effect on venous return and does not interfere with the radially laid out sutures of an aortic valve replacement using an interrupted suture technique.

  11. Analysis of cost data in a cluster-randomized, controlled trial: comparison of methods

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Ørnbøl, Eva; Rosendal, Marianne

    studies have used non-valid analysis of skewed data. We propose two different methods to compare mean cost in two groups. Firstly, we use a non-parametric bootstrap method where the re-sampling takes place on two levels in order to take into account the cluster effect. Secondly, we proceed with a log......  We consider health care data from a cluster-randomized intervention study in primary care to test whether the average health care costs among study patients differ between the two groups. The problems of analysing cost data are that most data are severely skewed. Median instead of mean...... is commonly used for skewed distributions. For health care data, however, we need to recover the total cost in a given patient population. Thus, we focus, on making inferences on population means. Furthermore, a problem of clustered data is added as data related to patients in primary care are organized...

  12. A Denoising Scheme for Randomly Clustered Noise Removal in ICCD Sensing Image

    Directory of Open Access Journals (Sweden)

    Fei Wang

    2017-01-01

    Full Text Available An Intensified Charge-Coupled Device (ICCD image is captured by the ICCD image sensor in extremely low-light conditions. Its noise has two distinctive characteristics. (a Different from the independent identically distributed (i.i.d. noise in natural image, the noise in the ICCD sensing image is spatially clustered, which induces unexpected structure information; (b The pattern of the clustered noise is formed randomly. In this paper, we propose a denoising scheme to remove the randomly clustered noise in the ICCD sensing image. First, we decompose the image into non-overlapped patches and classify them into flat patches and structure patches according to if real structure information is included. Then, two denoising algorithms are designed for them, respectively. For each flat patch, we simulate multiple similar patches for it in pseudo-time domain and remove its noise by averaging all the simulated patches, considering that the structure information induced by the noise varies randomly over time. For each structure patch, we design a structure-preserved sparse coding algorithm to reconstruct the real structure information. It reconstructs each patch by describing it as a weighted summation of its neighboring patches and incorporating the weights into the sparse representation of the current patch. Based on all the reconstructed patches, we generate a reconstructed image. After that, we repeat the whole process by changing relevant parameters, considering that blocking artifacts exist in a single reconstructed image. Finally, we obtain the reconstructed image by merging all the generated images into one. Experiments are conducted on an ICCD sensing image dataset, which verifies its subjective performance in removing the randomly clustered noise and preserving the real structure information in the ICCD sensing image.

  13. A Denoising Scheme for Randomly Clustered Noise Removal in ICCD Sensing Image.

    Science.gov (United States)

    Wang, Fei; Wang, Yibin; Yang, Meng; Zhang, Xuetao; Zheng, Nanning

    2017-01-26

    An Intensified Charge-Coupled Device (ICCD) image is captured by the ICCD image sensor in extremely low-light conditions. Its noise has two distinctive characteristics. (a) Different from the independent identically distributed (i.i.d.) noise in natural image, the noise in the ICCD sensing image is spatially clustered, which induces unexpected structure information; (b) The pattern of the clustered noise is formed randomly. In this paper, we propose a denoising scheme to remove the randomly clustered noise in the ICCD sensing image. First, we decompose the image into non-overlapped patches and classify them into flat patches and structure patches according to if real structure information is included. Then, two denoising algorithms are designed for them, respectively. For each flat patch, we simulate multiple similar patches for it in pseudo-time domain and remove its noise by averaging all the simulated patches, considering that the structure information induced by the noise varies randomly over time. For each structure patch, we design a structure-preserved sparse coding algorithm to reconstruct the real structure information. It reconstructs each patch by describing it as a weighted summation of its neighboring patches and incorporating the weights into the sparse representation of the current patch. Based on all the reconstructed patches, we generate a reconstructed image. After that, we repeat the whole process by changing relevant parameters, considering that blocking artifacts exist in a single reconstructed image. Finally, we obtain the reconstructed image by merging all the generated images into one. Experiments are conducted on an ICCD sensing image dataset, which verifies its subjective performance in removing the randomly clustered noise and preserving the real structure information in the ICCD sensing image.

  14. Random walks on finite lattices with multiple traps: Application to particle-cluster aggregation

    Energy Technology Data Exchange (ETDEWEB)

    Evans, J.W.; Nord, R.S.

    1985-11-01

    For random walks on finite lattices with multiple (completely adsorbing) traps, one is interested in the mean walk length until trapping and in the probability of capture for the various traps (either for a walk with a specific starting site, or for an average over all nontrap sites). We develop the formulation of Montroll to enable determination of the large-lattice-size asymptotic behavior of these quantities. (Only the case of a single trap has been analyzed in detail previously.) Explicit results are given for the case of symmetric nearest-neighbor random walks on two-dimensional (2D) square and triangular lattices. Procedures for exact calculation of walk lengths on a finite lattice with a single trap are extended to the multiple-trap case to determine all the above quantities. We examine convergence to asymptotic behavior as the lattice size increases. Connection with Witten-Sander irreversible particle-cluster aggregation is made by noting that this process corresponds to designating all sites adjacent to the cluster as traps. Thus capture probabilities for different traps determine the proportions of the various shaped clusters formed. (Reciprocals of) associated average walk lengths relate to rates for various irreversible aggregation processes involving a gas of walkers and clusters. Results are also presented for some of these quantities.

  15. On Two-stage Seamless Adaptive Design in Clinical Trials

    Directory of Open Access Journals (Sweden)

    Shein-Chung Chow

    2008-12-01

    Full Text Available In recent years, the use of adaptive design methods in clinical research and development based on accrued data has become very popular because of its efficiency and flexibility in modifying trial and/or statistical procedures of ongoing clinical trials. One of the most commonly considered adaptive designs is probably a two-stage seamless adaptive trial design that combines two separate studies into one single study. In many cases, study endpoints considered in a two-stage seamless adaptive design may be similar but different (e.g. a biomarker versus a regular clinical endpoint or the same study endpoint with different treatment durations. In this case, it is important to determine how the data collected from both stages should be combined for the final analysis. It is also of interest to know how the sample size calculation/allocation should be done for achieving the study objectives originally set for the two stages (separate studies. In this article, formulas for sample size calculation/allocation are derived for cases in which the study endpoints are continuous, discrete (e.g. binary responses, and contain time-to-event data assuming that there is a well-established relationship between the study endpoints at different stages, and that the study objectives at different stages are the same. In cases in which the study objectives at different stages are different (e.g. dose finding at the first stage and efficacy confirmation at the second stage and when there is a shift in patient population caused by protocol amendments, the derived test statistics and formulas for sample size calculation and allocation are necessarily modified for controlling the overall type I error at the prespecified level.

  16. Two stage treatment of dairy effluent using immobilized Chlorella pyrenoidosa.

    Science.gov (United States)

    Yadavalli, Rajasri; Heggers, Goutham Rao Venkata Naga

    2013-12-19

    Dairy effluents contains high organic load and unscrupulous discharge of these effluents into aquatic bodies is a matter of serious concern besides deteriorating their water quality. Whilst physico-chemical treatment is the common mode of treatment, immobilized microalgae can be potentially employed to treat high organic content which offer numerous benefits along with waste water treatment. A novel low cost two stage treatment was employed for the complete treatment of dairy effluent. The first stage consists of treating the diary effluent in a photobioreactor (1 L) using immobilized Chlorella pyrenoidosa while the second stage involves a two column sand bed filtration technique. Whilst NH4+-N was completely removed, a 98% removal of PO43--P was achieved within 96 h of two stage purification processes. The filtrate was tested for toxicity and no mortality was observed in the zebra fish which was used as a model at the end of 96 h bioassay. Moreover, a significant decrease in biological oxygen demand and chemical oxygen demand was achieved by this novel method. Also the biomass separated was tested as a biofertilizer to the rice seeds and a 30% increase in terms of length of root and shoot was observed after the addition of biomass to the rice plants. We conclude that the two stage treatment of dairy effluent is highly effective in removal of BOD and COD besides nutrients like nitrates and phosphates. The treatment also helps in discharging treated waste water safely into the receiving water bodies since it is non toxic for aquatic life. Further, the algal biomass separated after first stage of treatment was highly capable of increasing the growth of rice plants because of nitrogen fixation ability of the green alga and offers a great potential as a biofertilizer.

  17. Two-stage series array SQUID amplifier for space applications

    Science.gov (United States)

    Tuttle, J. G.; DiPirro, M. J.; Shirron, P. J.; Welty, R. P.; Radparvar, M.

    We present test results for a two-stage integrated SQUID amplifier which uses a series array of d.c. SQUIDS to amplify the signal from a single input SQUID. The device was developed by Welty and Martinis at NIST and recent versions have been manufactured by HYPRES, Inc. Shielding and filtering techniques were employed during the testing to minimize the external noise. Energy resolution of 300 h was demonstrated using a d.c. excitation at frequencies above 1 kHz, and better than 500 h resolution was typical down to 300 Hz.

  18. A Two Stage Classification Approach for Handwritten Devanagari Characters

    CERN Document Server

    Arora, Sandhya; Nasipuri, Mita; Malik, Latesh

    2010-01-01

    The paper presents a two stage classification approach for handwritten devanagari characters The first stage is using structural properties like shirorekha, spine in character and second stage exploits some intersection features of characters which are fed to a feedforward neural network. Simple histogram based method does not work for finding shirorekha, vertical bar (Spine) in handwritten devnagari characters. So we designed a differential distance based technique to find a near straight line for shirorekha and spine. This approach has been tested for 50000 samples and we got 89.12% success

  19. Two-Stage Aggregate Formation via Streams in Myxobacteria

    Science.gov (United States)

    Alber, Mark; Kiskowski, Maria; Jiang, Yi

    2005-03-01

    In response to adverse conditions, myxobacteria form aggregates which develop into fruiting bodies. We model myxobacteria aggregation with a lattice cell model based entirely on short range (non-chemotactic) cell-cell interactions. Local rules result in a two-stage process of aggregation mediated by transient streams. Aggregates resemble those observed in experiment and are stable against even very large perturbations. Noise in individual cell behavior increases the effects of streams and result in larger, more stable aggregates. Phys. Rev. Lett. 93: 068301 (2004).

  20. Straw Gasification in a Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Bentzen, Jens Dall; Hindsgaul, Claus; Henriksen, Ulrik Birk

    2002-01-01

    Additive-prepared straw pellets were gasified in the 100 kW two-stage gasifier at The Department of Mechanical Engineering of the Technical University of Denmark (DTU). The fixed bed temperature range was 800-1000°C. In order to avoid bed sintering, as observed earlier with straw gasification...... residues were examined after the test. No agglomeration or sintering was observed in the ash residues. The tar content was measured both by solid phase amino adsorption (SPA) method and cold trapping (Petersen method). Both showed low tar contents (~42 mg/Nm3 without gas cleaning). The particle content...

  1. Two-Stage Fan I: Aerodynamic and Mechanical Design

    Science.gov (United States)

    Messenger, H. E.; Kennedy, E. E.

    1972-01-01

    A two-stage, highly-loaded fan was designed to deliver an overall pressure ratio of 2.8 with an adiabatic efficiency of 83.9 percent. At the first rotor inlet, design flow per unit annulus area is 42 lbm/sec/sq ft (205 kg/sec/sq m), hub/tip ratio is 0.4 with a tip diameter of 31 inches (0.787 m), and design tip speed is 1450 ft/sec (441.96 m/sec). Other features include use of multiple-circular-arc airfoils, resettable stators, and split casings over the rotor tip sections for casing treatment tests.

  2. Two-Stage Eagle Strategy with Differential Evolution

    CERN Document Server

    Yang, Xin-She

    2012-01-01

    Efficiency of an optimization process is largely determined by the search algorithm and its fundamental characteristics. In a given optimization, a single type of algorithm is used in most applications. In this paper, we will investigate the Eagle Strategy recently developed for global optimization, which uses a two-stage strategy by combing two different algorithms to improve the overall search efficiency. We will discuss this strategy with differential evolution and then evaluate their performance by solving real-world optimization problems such as pressure vessel and speed reducer design. Results suggest that we can reduce the computing effort by a factor of up to 10 in many applications.

  3. Sample size calculation in cost-effectiveness cluster randomized trials: optimal and maximin approaches.

    Science.gov (United States)

    Manju, Md Abu; Candel, Math J J M; Berger, Martijn P F

    2014-07-10

    In this paper, the optimal sample sizes at the cluster and person levels for each of two treatment arms are obtained for cluster randomized trials where the cost-effectiveness of treatments on a continuous scale is studied. The optimal sample sizes maximize the efficiency or power for a given budget or minimize the budget for a given efficiency or power. Optimal sample sizes require information on the intra-cluster correlations (ICCs) for effects and costs, the correlations between costs and effects at individual and cluster levels, the ratio of the variance of effects translated into costs to the variance of the costs (the variance ratio), sampling and measuring costs, and the budget. When planning, a study information on the model parameters usually is not available. To overcome this local optimality problem, the current paper also presents maximin sample sizes. The maximin sample sizes turn out to be rather robust against misspecifying the correlation between costs and effects at the cluster and individual levels but may lose much efficiency when misspecifying the variance ratio. The robustness of the maximin sample sizes against misspecifying the ICCs depends on the variance ratio. The maximin sample sizes are robust under misspecification of the ICC for costs for realistic values of the variance ratio greater than one but not robust under misspecification of the ICC for effects. Finally, we show how to calculate optimal or maximin sample sizes that yield sufficient power for a test on the cost-effectiveness of an intervention.

  4. Geometry controlled anomalous diffusion in random fractal geometries: looking beyond the infinite cluster.

    Science.gov (United States)

    Mardoukhi, Yousof; Jeon, Jae-Hyung; Metzler, Ralf

    2015-11-28

    We investigate the ergodic properties of a random walker performing (anomalous) diffusion on a random fractal geometry. Extensive Monte Carlo simulations of the motion of tracer particles on an ensemble of realisations of percolation clusters are performed for a wide range of percolation densities. Single trajectories of the tracer motion are analysed to quantify the time averaged mean squared displacement (MSD) and to compare this with the ensemble averaged MSD of the particle motion. Other complementary physical observables associated with ergodicity are studied, as well. It turns out that the time averaged MSD of individual realisations exhibits non-vanishing fluctuations even in the limit of very long observation times as the percolation density approaches the critical value. This apparent non-ergodic behaviour concurs with the ergodic behaviour on the ensemble averaged level. We demonstrate how the non-vanishing fluctuations in single particle trajectories are analytically expressed in terms of the fractal dimension and the cluster size distribution of the random geometry, thus being of purely geometrical origin. Moreover, we reveal that the convergence scaling law to ergodicity, which is known to be inversely proportional to the observation time T for ergodic diffusion processes, follows a power-law ∼T(-h) with h fractal structure of the accessible space. These results provide useful measures for differentiating the subdiffusion on random fractals from an otherwise closely related process, namely, fractional Brownian motion. Implications of our results on the analysis of single particle tracking experiments are provided.

  5. Two-stage perceptual learning to break visual crowding.

    Science.gov (United States)

    Zhu, Ziyun; Fan, Zhenzhi; Fang, Fang

    2016-01-01

    When a target is presented with nearby flankers in the peripheral visual field, it becomes harder to identify, which is referred to as crowding. Crowding sets a fundamental limit of object recognition in peripheral vision, preventing us from fully appreciating cluttered visual scenes. We trained adult human subjects on a crowded orientation discrimination task and investigated whether crowding could be completely eliminated by training. We discovered a two-stage learning process with this training task. In the early stage, when the target and flankers were separated beyond a certain distance, subjects acquired a relatively general ability to break crowding, as evidenced by the fact that the breaking of crowding could transfer to another crowded orientation, even a crowded motion stimulus, although the transfer to the opposite visual hemi-field was weak. In the late stage, like many classical perceptual learning effects, subjects' performance gradually improved and showed specificity to the trained orientation. We also found that, when the target and flankers were spaced too finely, training could only reduce, rather than completely eliminate, the crowding effect. This two-stage learning process illustrates a learning strategy for our brain to deal with the notoriously difficult problem of identifying peripheral objects in clutter. The brain first learned to solve the "easy and general" part of the problem (i.e., improving the processing resolution and segmenting the target and flankers) and then tackle the "difficult and specific" part (i.e., refining the representation of the target).

  6. Runway Operations Planning: A Two-Stage Heuristic Algorithm

    Science.gov (United States)

    Anagnostakis, Ioannis; Clarke, John-Paul

    2003-01-01

    The airport runway is a scarce resource that must be shared by different runway operations (arrivals, departures and runway crossings). Given the possible sequences of runway events, careful Runway Operations Planning (ROP) is required if runway utilization is to be maximized. From the perspective of departures, ROP solutions are aircraft departure schedules developed by optimally allocating runway time for departures given the time required for arrivals and crossings. In addition to the obvious objective of maximizing throughput, other objectives, such as guaranteeing fairness and minimizing environmental impact, can also be incorporated into the ROP solution subject to constraints introduced by Air Traffic Control (ATC) procedures. This paper introduces a two stage heuristic algorithm for solving the Runway Operations Planning (ROP) problem. In the first stage, sequences of departure class slots and runway crossings slots are generated and ranked based on departure runway throughput under stochastic conditions. In the second stage, the departure class slots are populated with specific flights from the pool of available aircraft, by solving an integer program with a Branch & Bound algorithm implementation. Preliminary results from this implementation of the two-stage algorithm on real-world traffic data are presented.

  7. Two-Stage Heuristic Algorithm for Aircraft Recovery Problem

    Directory of Open Access Journals (Sweden)

    Cheng Zhang

    2017-01-01

    Full Text Available This study focuses on the aircraft recovery problem (ARP. In real-life operations, disruptions always cause schedule failures and make airlines suffer from great loss. Therefore, the main objective of the aircraft recovery problem is to minimize the total recovery cost and solve the problem within reasonable runtimes. An aircraft recovery model (ARM is proposed herein to formulate the ARP and use feasible line of flights as the basic variables in the model. We define the feasible line of flights (LOFs as a sequence of flights flown by an aircraft within one day. The number of LOFs exponentially grows with the number of flights. Hence, a two-stage heuristic is proposed to reduce the problem scale. The algorithm integrates a heuristic scoring procedure with an aggregated aircraft recovery model (AARM to preselect LOFs. The approach is tested on five real-life test scenarios. The computational results show that the proposed model provides a good formulation of the problem and can be solved within reasonable runtimes with the proposed methodology. The two-stage heuristic significantly reduces the number of LOFs after each stage and finally reduces the number of variables and constraints in the aircraft recovery model.

  8. A systematic review of factors affecting children's right to health in cluster randomized trials in Kenya.

    Science.gov (United States)

    Oduwo, Elizabeth; Edwards, Sarah J L

    2014-07-16

    Following the South African case, Treatment Action Campaign and Others v Minister of Health and Others, the use of 'pilot' studies to investigate interventions already proven efficacious, offered free of charge to government, but confined by the government to a small part of the population, may violate children's right to health, and the negative duty on governments not to prevent access to treatment. The applicants challenged a government decision to offer Nevirapine in a few pilot sites when evidence showed Nevirapine significantly reduced HIV transmission rates and despite donor offers of a free supply. The government refused to expand access, arguing they needed to collect more information, and citing concerns about long-term hazards, side effects, resistance and inadequate infrastructure. The court ruled this violated children's right to health and asked the government to immediately expand access. Cluster randomized trials involving children are increasingly popular, and are often used to reduce 'contamination': the possibility that members of a cluster adopt behavior of other clusters. However, they raise unique issues insufficiently addressed in literature and ethical guidelines. This case provides additional crucial guidance, based on a common human rights framework, for the Kenyan government and other involved stakeholders. Children possess special rights, often represent a 'captive' group, and so motivate extra consideration. In a systematic review, we therefore investigated whether cluster trial designs are used to prevent or delay children's access to treatment in Kenya or otherwise inconsistently with children's right to health as outlined in the above case. Although we did not find state sponsored cluster trials, most had significant public sector involvement. Core obligations under children's right to health were inadequately addressed across trials. Few cluster trials reported rationale for cluster randomization, offered post- trial access or

  9. A Novel Two-Stage Illumination Estimation Framework for Expression Recognition

    Directory of Open Access Journals (Sweden)

    Zheng Zhang

    2014-01-01

    Full Text Available One of the critical issues for facial expression recognition is to eliminate the negative effect caused by variant poses and illuminations. In this paper a two-stage illumination estimation framework is proposed based on three-dimensional representative face and clustering, which can estimate illumination directions under a series of poses. First, 256 training 3D face models are adaptively categorized into a certain amount of facial structure types by k-means clustering to group people with similar facial appearance into clusters. Then the representative face of each cluster is generated to represent the facial appearance type of that cluster. Our training set is obtained by rotating all representative faces to a certain pose, illuminating them with a series of different illumination conditions, and then projecting them into two-dimensional images. Finally the saltire-over-cross feature is selected to train a group of SVM classifiers and satisfactory performance is achieved when estimating a number of test sets including images generated from 64 3D face models kept for testing, CAS-PEAL face database, CMU PIE database, and a small test set created by ourselves. Compared with other related works, our method is subject independent and has less computational complexity O(C×N without 3D facial reconstruction.

  10. A cluster randomized trial evaluating electronic prescribing in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Quan Sherman

    2007-10-01

    Full Text Available Abstract Background Medication errors, adverse drug events and potential adverse drug events are common and serious in terms of the harms and costs that they impose on the health system and those who use it. Errors resulting in preventable adverse drug events have been shown to occur most often at the stages of ordering and administration. This paper describes the protocol for a pragmatic trial of electronic prescribing to reduce prescription error. The trial was designed to overcome the limitations associated with traditional study design. Design This study was designed as a 65-week, cluster randomized, parallel study. Methods The trial was conducted within ambulatory outpatient clinics in an academic tertiary care centre in Ontario, Canada. The electronic prescribing software for the study is a Canadian electronic prescribing software package which provides physician prescription entry with decision support at the point of care. Using a handheld computer (PDA the physician selects medications using an error minimising menu-based pick list from a comprehensive drug database, create specific prescription instructions and then transmit the prescription directly and electronically to a participating pharmacy via facsimile or to the physician's printer using local area wireless technology. The unit of allocation and randomization is by 'week', i.e. the system is "on" or "off" according to the randomization scheme and the unit of analysis is the prescription, with adjustment for clustering of patients within practitioners. Discussion This paper describes the protocol for a pragmatic cluster randomized trial of point-of-care electronic prescribing, which was specifically designed to overcome the limitations associated with traditional study design. Trial Registration This trial has been registered with clinicaltrials.gov (ID: NCT00252395

  11. Noncausal two-stage image filtration at presence of observations with anomalous errors

    Directory of Open Access Journals (Sweden)

    S. V. Vishnevyy

    2013-04-01

    Full Text Available Introduction. It is necessary to develop adaptive algorithms, which allow to detect such regions and to apply filter with respective parameters for suppression of anomalous noises for the purposes of image filtration, which consist of regions with anomalous errors. Development of adaptive algorithm for non-causal two-stage images filtration at pres-ence of observations with anomalous errors. The adaptive algorithm for noncausal two-stage filtration is developed. On the first stage the adaptive one-dimensional algorithm for causal filtration is used for independent processing along rows and columns of image. On the second stage the obtained data are united and a posteriori estimations are calculated. Results of experimental investigations. The developed adaptive algorithm for noncausal images filtration at presence of observations with anomalous errors is investigated on the model sample by means of statistical modeling on PC. The image is modeled as a realization of Gaussian-Markov random field. The modeled image is corrupted with uncorrelated Gaussian noise. Regions of image with anomalous errors are corrupted with uncorrelated Gaussian noise which has higher power than normal noise on the rest part of the image. Conclusions. The analysis of adaptive algorithm for noncausal two-stage filtration is done. The characteristics of accuracy of computed estimations are shown. The comparisons of first stage and second stage of the developed adaptive algorithm are done. Adaptive algorithm is compared with known uniform two-stage algorithm of image filtration. According to the obtained results the uniform algorithm does not suppress anomalous noise meanwhile the adaptive algorithm shows good results.

  12. On the estimation of intracluster correlation for time-to-event outcomes in cluster randomized trials.

    Science.gov (United States)

    Kalia, Sumeet; Klar, Neil; Donner, Allan

    2016-12-30

    Cluster randomized trials (CRTs) involve the random assignment of intact social units rather than independent subjects to intervention groups. Time-to-event outcomes often are endpoints in CRTs. Analyses of such data need to account for the correlation among cluster members. The intracluster correlation coefficient (ICC) is used to assess the similarity among binary and continuous outcomes that belong to the same cluster. However, estimating the ICC in CRTs with time-to-event outcomes is a challenge because of the presence of censored observations. The literature suggests that the ICC may be estimated using either censoring indicators or observed event times. A simulation study explores the effect of administrative censoring on estimating the ICC. Results show that ICC estimators derived from censoring indicators or observed event times are negatively biased. Analytic work further supports these results. Observed event times are preferred to estimate the ICC under minimum frequency of administrative censoring. To our knowledge, the existing literature provides no practical guidance on the estimation of ICC when substantial amount of administrative censoring is present. The results from this study corroborate the need for further methodological research on estimating the ICC for correlated time-to-event outcomes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  13. A Two-Stage Assembly-Type Flowshop Scheduling Problem for Minimizing Total Tardiness

    Directory of Open Access Journals (Sweden)

    Ju-Yong Lee

    2016-01-01

    Full Text Available This research considers a two-stage assembly-type flowshop scheduling problem with the objective of minimizing the total tardiness. The first stage consists of two independent machines, and the second stage consists of a single machine. Two types of components are fabricated in the first stage, and then they are assembled in the second stage. Dominance properties and lower bounds are developed, and a branch and bound algorithm is presented that uses these properties and lower bounds as well as an upper bound obtained from a heuristic algorithm. The algorithm performance is evaluated using a series of computational experiments on randomly generated instances and the results are reported.

  14. Two-Stage Part-Based Pedestrian Detection

    DEFF Research Database (Denmark)

    Møgelmose, Andreas; Prioletti, Antonio; Trivedi, Mohan M.

    2012-01-01

    Detecting pedestrians is still a challenging task for automotive vision system due the extreme variability of targets, lighting conditions, occlusions, and high speed vehicle motion. A lot of research has been focused on this problem in the last 10 years and detectors based on classifiers has...... gained a special place among the different approaches presented. This work presents a state-of-the-art pedestrian detection system based on a two stages classifier. Candidates are extracted with a Haar cascade classifier trained with the DaimlerDB dataset and then validated through part-based HOG...... of several metrics, such as detection rate, false positives per hour, and frame rate. The novelty of this system rely in the combination of HOG part-based approach, tracking based on specific optimized feature and porting on a real prototype....

  15. A two-stage method for inverse medium scattering

    KAUST Repository

    Ito, Kazufumi

    2013-03-01

    We present a novel numerical method to the time-harmonic inverse medium scattering problem of recovering the refractive index from noisy near-field scattered data. The approach consists of two stages, one pruning step of detecting the scatterer support, and one resolution enhancing step with nonsmooth mixed regularization. The first step is strictly direct and of sampling type, and it faithfully detects the scatterer support. The second step is an innovative application of nonsmooth mixed regularization, and it accurately resolves the scatterer size as well as intensities. The nonsmooth model can be efficiently solved by a semi-smooth Newton-type method. Numerical results for two- and three-dimensional examples indicate that the new approach is accurate, computationally efficient, and robust with respect to data noise. © 2012 Elsevier Inc.

  16. Laparoscopic management of a two staged gall bladdertorsion

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Gall bladder torsion (GBT) is a relatively uncommonentity and rarely diagnosed preoperatively. A constantfactor in all occurrences of GBT is a freely mobilegall bladder due to congenital or acquired anomalies.GBT is commonly observed in elderly white females.We report a 77-year-old, Caucasian lady who wasoriginally diagnosed as gall bladder perforation butwas eventually found with a two staged torsion of thegall bladder with twisting of the Riedel's lobe (partof tongue like projection of liver segment 4A). Thistogether, has not been reported in literature, to thebest of our knowledge. We performed laparoscopiccholecystectomy and she had an uneventful postoperativeperiod. GBT may create a diagnostic dilemmain the context of acute cholecystitis. Timely diagnosisand intervention is necessary, with extra care whileoperating as the anatomy is generally distorted. Thefundus first approach can be useful due to alteredanatomy in the region of Calot's triangle. Laparoscopiccholecystectomy has the benefit of early recovery.

  17. Lightweight Concrete Produced Using a Two-Stage Casting Process

    Directory of Open Access Journals (Sweden)

    Jin Young Yoon

    2015-03-01

    Full Text Available The type of lightweight aggregate and its volume fraction in a mix determine the density of lightweight concrete. Minimizing the density obviously requires a higher volume fraction, but this usually causes aggregates segregation in a conventional mixing process. This paper proposes a two-stage casting process to produce a lightweight concrete. This process involves placing lightweight aggregates in a frame and then filling in the remaining interstitial voids with cementitious grout. The casting process results in the lowest density of lightweight concrete, which consequently has low compressive strength. The irregularly shaped aggregates compensate for the weak point in terms of strength while the round-shape aggregates provide a strength of 20 MPa. Therefore, the proposed casting process can be applied for manufacturing non-structural elements and structural composites requiring a very low density and a strength of at most 20 MPa.

  18. TWO-STAGE OCCLUDED OBJECT RECOGNITION METHOD FOR MICROASSEMBLY

    Institute of Scientific and Technical Information of China (English)

    WANG Huaming; ZHU Jianying

    2007-01-01

    A two-stage object recognition algorithm with the presence of occlusion is presented for microassembly. Coarse localization determines whether template is in image or not and approximately where it is, and fine localization gives its accurate position. In coarse localization, local feature, which is invariant to translation, rotation and occlusion, is used to form signatures. By comparing signature of template with that of image, approximate transformation parameter from template to image is obtained, which is used as initial parameter value for fine localization. An objective function, which is a function of transformation parameter, is constructed in fine localization and minimized to realize sub-pixel localization accuracy. The occluded pixels are not taken into account in objective function, so the localization accuracy will not be influenced by the occlusion.

  19. Two-stage designs for cross-over bioequivalence trials.

    Science.gov (United States)

    Kieser, Meinhard; Rauch, Geraldine

    2015-07-20

    The topic of applying two-stage designs in the field of bioequivalence studies has recently gained attention in the literature and in regulatory guidelines. While there exists some methodological research on the application of group sequential designs in bioequivalence studies, implementation of adaptive approaches has focused up to now on superiority and non-inferiority trials. Especially, no comparison of the features and performance characteristics of these designs has been performed, and therefore, the question of which design to employ in this setting remains open. In this paper, we discuss and compare 'classical' group sequential designs and three types of adaptive designs that offer the option of mid-course sample size recalculation. A comprehensive simulation study demonstrates that group sequential designs can be identified, which show power characteristics that are similar to those of the adaptive designs but require a lower average sample size. The methods are illustrated with a real bioequivalence study example.

  20. The hybrid two stage anticlockwise cycle for ecological energy conversion

    Directory of Open Access Journals (Sweden)

    Cyklis Piotr

    2016-01-01

    Full Text Available The anticlockwise cycle is commonly used for refrigeration, air conditioning and heat pumps applications. The application of refrigerant in the compression cycle is within the temperature limits of the triple point and the critical point. New refrigerants such as 1234yf or 1234ze have many disadvantages, therefore natural refrigerants application is favourable. The carbon dioxide and water can be applied only in the hybrid two stages cycle. The possibilities of this solutions are shown for refrigerating applications, as well some experimental results of the adsorption-compression double stages cycle, powered with solar collectors are shown. As a high temperature cycle the adsorption system is applied. The low temperature cycle is the compression stage with carbon dioxide as a working fluid. This allows to achieve relatively high COP for low temperature cycle and for the whole system.

  1. Two Stage Assessment of Thermal Hazard in An Underground Mine

    Science.gov (United States)

    Drenda, Jan; Sułkowski, Józef; Pach, Grzegorz; Różański, Zenon; Wrona, Paweł

    2016-06-01

    The results of research into the application of selected thermal indices of men's work and climate indices in a two stage assessment of climatic work conditions in underground mines have been presented in this article. The difference between these two kinds of indices was pointed out during the project entitled "The recruiting requirements for miners working in hot underground mine environments". The project was coordinated by The Institute of Mining Technologies at Silesian University of Technology. It was a part of a Polish strategic project: "Improvement of safety in mines" being financed by the National Centre of Research and Development. Climate indices are based only on physical parameters of air and their measurements. Thermal indices include additional factors which are strictly connected with work, e.g. thermal resistance of clothing, kind of work etc. Special emphasis has been put on the following indices - substitute Silesian temperature (TS) which is considered as the climatic index, and the thermal discomfort index (δ) which belongs to the thermal indices group. The possibility of the two stage application of these indices has been taken into consideration (preliminary and detailed estimation). Based on the examples it was proved that by the application of thermal hazard (detailed estimation) it is possible to avoid the use of additional technical solutions which would be necessary to reduce thermal hazard in particular work places according to the climate index. The threshold limit value for TS has been set, based on these results. It was shown that below TS = 24°C it is not necessary to perform detailed estimation.

  2. Efficacy and effectiveness as aspects of cluster randomized trials with nursing home residents: Methodological insights from a pneumonia prevention trial

    OpenAIRE

    Van Ness, Peter H.; Peduzzi, Peter N.; Quagliarello, Vincent J.

    2012-01-01

    This report discusses how methodological aspects of study efficacy and effectiveness combine in cluster randomized trials in nursing homes. Discussion focuses on the relationships between these study aspects in the Pneumonia Reduction in Institutionalized Disabled Elders (PRIDE) trial, an ongoing cluster randomized clinical trial of pneumonia prevention among nursing home residents launched in October 2009 in Greater New Haven, Connecticut. This clinical trial has enrolled long-term care nurs...

  3. Efficient treatment allocation in 2 × 2 cluster randomized trials, when costs and variances are heterogeneous

    NARCIS (Netherlands)

    Lemme, Francesca; van Breukelen, Gerard J P; Berger, Martijn P F

    2016-01-01

    Typically, clusters and individuals in cluster randomized trials are allocated across treatment conditions in a balanced fashion. This is optimal under homogeneous costs and outcome variances. However, both the costs and the variances may be heterogeneous. Then, an unbalanced allocation is more effi

  4. Potts q-color field theory and scaling random cluster model

    CERN Document Server

    Delfino, Gesualdo

    2011-01-01

    We study structural properties of the q-color Potts field theory which, for real values of q, describes the scaling limit of the random cluster model. We show that the number of independent n-point Potts spin correlators coincides with that of independent n-point cluster connectivities and is given by generalized Bell numbers. Only a subset of these spin correlators enters the determination of the Potts magnetic properties for q integer. The structure of the operator product expansion of the spin fields for generic q is also identified. For the two-dimensional case, we analyze the duality relation between spin and kink field correlators, both for the bulk and boundary cases, obtaining in particular a sum rule for the kink-kink elastic scattering amplitudes.

  5. Comparison of population-averaged and cluster-specific models for the analysis of cluster randomized trials with missing binary outcomes: a simulation study.

    Science.gov (United States)

    Ma, Jinhui; Raina, Parminder; Beyene, Joseph; Thabane, Lehana

    2013-01-23

    The objective of this simulation study is to compare the accuracy and efficiency of population-averaged (i.e. generalized estimating equations (GEE)) and cluster-specific (i.e. random-effects logistic regression (RELR)) models for analyzing data from cluster randomized trials (CRTs) with missing binary responses. In this simulation study, clustered responses were generated from a beta-binomial distribution. The number of clusters per trial arm, the number of subjects per cluster, intra-cluster correlation coefficient, and the percentage of missing data were allowed to vary. Under the assumption of covariate dependent missingness, missing outcomes were handled by complete case analysis, standard multiple imputation (MI) and within-cluster MI strategies. Data were analyzed using GEE and RELR. Performance of the methods was assessed using standardized bias, empirical standard error, root mean squared error (RMSE), and coverage probability. GEE performs well on all four measures--provided the downward bias of the standard error (when the number of clusters per arm is small) is adjusted appropriately--under the following scenarios: complete case analysis for CRTs with a small amount of missing data; standard MI for CRTs with variance inflation factor (VIF) cluster MI for CRTs with VIF≥3 and cluster size>50. RELR performs well only when a small amount of data was missing, and complete case analysis was applied. GEE performs well as long as appropriate missing data strategies are adopted based on the design of CRTs and the percentage of missing data. In contrast, RELR does not perform well when either standard or within-cluster MI strategy is applied prior to the analysis.

  6. Antibiotic selection pressure and macrolide resistance in nasopharyngeal Streptococcus pneumoniae: a cluster-randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Alison H Skalet

    Full Text Available BACKGROUND: It is widely thought that widespread antibiotic use selects for community antibiotic resistance, though this has been difficult to prove in the setting of a community-randomized clinical trial. In this study, we used a randomized clinical trial design to assess whether macrolide resistance was higher in communities treated with mass azithromycin for trachoma, compared to untreated control communities. METHODS AND FINDINGS: In a cluster-randomized trial for trachoma control in Ethiopia, 12 communities were randomized to receive mass azithromycin treatment of children aged 1-10 years at months 0, 3, 6, and 9. Twelve control communities were randomized to receive no antibiotic treatments until the conclusion of the study. Nasopharyngeal swabs were collected from randomly selected children in the treated group at baseline and month 12, and in the control group at month 12. Antibiotic susceptibility testing was performed on Streptococcus pneumoniae isolated from the swabs using Etest strips. In the treated group, the mean prevalence of azithromycin resistance among all monitored children increased from 3.6% (95% confidence interval [CI] 0.8%-8.9% at baseline, to 46.9% (37.5%-57.5% at month 12 (p = 0.003. In control communities, azithromycin resistance was 9.2% (95% CI 6.7%-13.3% at month 12, significantly lower than the treated group (p < 0.0001. Penicillin resistance was identified in 0.8% (95% CI 0%-4.2% of isolates in the control group at 1 year, and in no isolates in the children-treated group at baseline or 1 year. CONCLUSIONS: This cluster-randomized clinical trial demonstrated that compared to untreated control communities, nasopharyngeal pneumococcal resistance to macrolides was significantly higher in communities randomized to intensive azithromycin treatment. Mass azithromycin distributions were given more frequently than currently recommended by the World Health Organization's trachoma program. Azithromycin use in this setting

  7. A nationwide cluster randomized controlled trial of unanounced versus announced periodic hospital surveys

    DEFF Research Database (Denmark)

    Simonsen, Katherina Beltoft

    2016-01-01

    based on DDKM version 2. Construction of the DDKM:  3-year cycle  One announced on-site accreditation survey  One announced periodic midterm survey  82 accreditation standards divided in three themes: organizational standards, continuity of care standards, and disease-specific standards  473......:  Nationwide block and cluster RCT  23 public hospitals (3 university hospitals, 15 general hospitals, and 5 psychiatric hospitals  11 hospitals received announced surveys (control group)  12 hospitals received unannounced surveys (intervention group)  9 surveyors randomly allocated in surveyor teams...

  8. Inertial particles distribute in turbulence as Poissonian points with random intensity inducing clustering and supervoiding

    CERN Document Server

    Schmidt, Lukas; Holzner, Markus

    2016-01-01

    This work considers the distribution of inertial particles in turbulence using the point-particle approximation. We demonstrate that the random point process formed by the positions of particles in space is a Poisson point process with log-normal random intensity ("log Gaussian Cox process" or LGCP). The probability of having a finite number of particles in a small volume is given in terms of the characteristic function of a log-normal distribution. Corrections due to discreteness of the number of particles to the previously derived statistics of particle concentration in the continuum limit are provided. These are relevant for dealing with experimental or numerical data. The probability of having regions without particles, i.e. voids, is larger for inertial particles than for tracer particles where voids are distributed according to Poisson processes. Further, the probability of having large voids decays only log-normally with size. This shows that particles cluster, leaving voids behind. At scales where the...

  9. Exercise program for prevention of groin pain in football players: a cluster-randomized trial

    DEFF Research Database (Denmark)

    Hölmich, P; Larsen, K; Krogsgaard, Kim

    2010-01-01

    Groin injuries cause major problems in sports and particularly in football. Exercise is effective in treating adductor-related groin pain, but no trials have been published regarding the specific prevention of groin pain or prevention specifically targeting overuse injuries in sport using exercise...... programs. We performed a cluster-randomized trial including 55 football clubs representing 1211 players. The clubs were randomized to an exercise program aimed at preventing groin injuries (n=27) or to a control group training as usual (n=28). The intervention program consisted of six exercises including...... strengthening (concentric and eccentric), coordination, and core stability exercises for the muscles related to the pelvis. Physiotherapists assigned to each club registered all groin injuries. Twenty-two clubs in each group completed the study, represented by 977 players. There was no significant effect...

  10. Partition-associated incompatibility caused by random assortment of pure plasmid clusters

    DEFF Research Database (Denmark)

    Ebersbach, Gitte; Sherratt, David J; Gerdes, Kenn;

    2005-01-01

    Summary Bacterial plasmids and chromosomes encode centromere-like partition loci that actively segregate DNA before cell division. The molecular mechanism behind DNA segregation in bacteria is largely unknown. Here we analyse the mechanism of partition-associated incompatibility for plasmid pB171......-lived pairing of plasmids. Instead, pure R1 and F foci were positioned along the length of the cell, and in a random order. Thus, our results raise the possibility that partition-mediated plasmid incompatibility is not caused by pairing of heterologous plasmids but instead by random positioning of pure plasmid...... clusters along the long axis of the cell. The strength of the incompatibility was correlated with the capability of the plasmids to compete for the mid-cell position....

  11. Effect of Silica Fume on two-stage Concrete Strength

    Science.gov (United States)

    Abdelgader, H. S.; El-Baden, A. S.

    2015-11-01

    Two-stage concrete (TSC) is an innovative concrete that does not require vibration for placing and compaction. TSC is a simple concept; it is made using the same basic constituents as traditional concrete: cement, coarse aggregate, sand and water as well as mineral and chemical admixtures. As its name suggests, it is produced through a two-stage process. Firstly washed coarse aggregate is placed into the formwork in-situ. Later a specifically designed self compacting grout is introduced into the form from the lowest point under gravity pressure to fill the voids, cementing the aggregate into a monolith. The hardened concrete is dense, homogeneous and has in general improved engineering properties and durability. This paper presents the results from a research work attempt to study the effect of silica fume (SF) and superplasticizers admixtures (SP) on compressive and tensile strength of TSC using various combinations of water to cement ratio (w/c) and cement to sand ratio (c/s). Thirty six concrete mixes with different grout constituents were tested. From each mix twenty four standard cylinder samples of size (150mm×300mm) of concrete containing crushed aggregate were produced. The tested samples were made from combinations of w/c equal to: 0.45, 0.55 and 0.85, and three c/s of values: 0.5, 1 and 1.5. Silica fume was added at a dosage of 6% of weight of cement, while superplasticizer was added at a dosage of 2% of cement weight. Results indicated that both tensile and compressive strength of TSC can be statistically derived as a function of w/c and c/s with good correlation coefficients. The basic principle of traditional concrete, which says that an increase in water/cement ratio will lead to a reduction in compressive strength, was shown to hold true for TSC specimens tested. Using a combination of both silica fume and superplasticisers caused a significant increase in strength relative to control mixes.

  12. Risk moderation of a parent and student preventive alcohol intervention by adolescent and family factors : A cluster randomized trial

    NARCIS (Netherlands)

    Verdurmen, Jacqueline E E; Koning, Ina M.; Vollebergh, Wilma A M; van den Eijnden, Regina J J M; Engels, Rutger C M E

    2014-01-01

    Objective: To examine risk moderation of an alcohol intervention targeting parents and adolescents. Design: A cluster randomized trial including 2937 Dutch early adolescents (m=12.68. years, SD=0.51) and their parents randomized over four conditions: parent intervention, student intervention, combin

  13. A cluster randomized controlled trial testing the effectiveness of Houvast: A strengths-based intervention for homeless young adults

    NARCIS (Netherlands)

    Krabbenborg, M.A.M.; Boersma, S.N.; Veld, W.M. van der; Hulst, B. van; Vollebergh, W.A.M.; Wolf, J.R.L.M.

    2017-01-01

    Objective: To test the effectiveness of Houvast: a strengths-based intervention for homeless young adults. Method: A cluster randomized controlled trial was conducted with 10 Dutch shelter facilities randomly allocated to an intervention and a control group. Homeless young adults were interviewed

  14. Characterization of component interactions in two-stage axial turbine

    Directory of Open Access Journals (Sweden)

    Adel Ghenaiet

    2016-08-01

    Full Text Available This study concerns the characterization of both the steady and unsteady flows and the analysis of stator/rotor interactions of a two-stage axial turbine. The predicted aerodynamic performances show noticeable differences when simulating the turbine stages simultaneously or separately. By considering the multi-blade per row and the scaling technique, the Computational fluid dynamics (CFD produced better results concerning the effect of pitchwise positions between vanes and blades. The recorded pressure fluctuations exhibit a high unsteadiness characterized by a space–time periodicity described by a double Fourier decomposition. The Fast Fourier Transform FFT analysis of the static pressure fluctuations recorded at different interfaces reveals the existence of principal harmonics and their multiples, and each lobed structure of pressure wave corresponds to the number of vane/blade count. The potential effect is seen to propagate both upstream and downstream of each blade row and becomes accentuated at low mass flow rates. Between vanes and blades, the potential effect is seen to dominate the quasi totality of blade span, while downstream the blades this effect seems to dominate from hub to mid span. Near the shroud the prevailing effect is rather linked to the blade tip flow structure.

  15. A continuous two stage solar coal gasification system

    Science.gov (United States)

    Mathur, V. K.; Breault, R. W.; Lakshmanan, S.; Manasse, F. K.; Venkataramanan, V.

    The characteristics of a two-stage fluidized-bed hybrid coal gasification system to produce syngas from coal, lignite, and peat are described. Devolatilization heat of 823 K is supplied by recirculating gas heated by a solar receiver/coal heater. A second-stage gasifier maintained at 1227 K serves to crack remaining tar and light oil to yield a product free from tar and other condensables, and sulfur can be removed by hot clean-up processes. CO is minimized because the coal is not burned with oxygen, and the product gas contains 50% H2. Bench scale reactors consist of a stage I unit 0.1 m in diam which is fed coal 200 microns in size. A stage II reactor has an inner diam of 0.36 m and serves to gasify the char from stage I. A solar power source of 10 kWt is required for the bench model, and will be obtained from a central receiver with quartz or heat pipe configurations for heat transfer.

  16. Characterization of component interactions in two-stage axial turbine

    Institute of Scientific and Technical Information of China (English)

    Adel Ghenaiet; Kaddour Touil

    2016-01-01

    This study concerns the characterization of both the steady and unsteady flows and the analysis of stator/rotor interactions of a two-stage axial turbine. The predicted aerodynamic perfor-mances show noticeable differences when simulating the turbine stages simultaneously or sepa-rately. By considering the multi-blade per row and the scaling technique, the Computational fluid dynamics (CFD) produced better results concerning the effect of pitchwise positions between vanes and blades. The recorded pressure fluctuations exhibit a high unsteadiness characterized by a space–time periodicity described by a double Fourier decomposition. The Fast Fourier Transform FFT analysis of the static pressure fluctuations recorded at different interfaces reveals the existence of principal harmonics and their multiples, and each lobed structure of pressure wave corresponds to the number of vane/blade count. The potential effect is seen to propagate both upstream and downstream of each blade row and becomes accentuated at low mass flow rates. Between vanes and blades, the potential effect is seen to dominate the quasi totality of blade span, while down-stream the blades this effect seems to dominate from hub to mid span. Near the shroud the prevail-ing effect is rather linked to the blade tip flow structure.

  17. Two stages kinetics of municipal solid waste inoculation composting processes

    Institute of Scientific and Technical Information of China (English)

    XI Bei-dou1; HUANG Guo-he; QIN Xiao-sheng; LIU Hong-liang

    2004-01-01

    In order to understand the key mechanisms of the composting processes, the municipal solid waste(MSW) composting processes were divided into two stages, and the characteristics of typical experimental scenarios from the viewpoint of microbial kinetics was analyzed. Through experimentation with advanced composting reactor under controlled composting conditions, several equations were worked out to simulate the degradation rate of the substrate. The equations showed that the degradation rate was controlled by concentration of microbes in the first stage. The degradation rates of substrates of inoculation Run A, B, C and Control composting systems were 13.61 g/(kg·h), 13.08 g/(kg·h), 15.671 g/(kg·h), and 10.5 g/(kg·h), respectively. The value of Run C is around 1.5 times higher than that of Control system. The decomposition rate of the second stage is controlled by concentration of substrate. Although the organic matter decomposition rates were similar to all Runs, inoculation could reduce the values of the half velocity coefficient and could be more efficient to make the composting stable. Particularly. For Run C, the decomposition rate is high in the first stage, and is low in the second stage. The results indicated that the inoculation was efficient for the composting processes.

  18. Gas loading system for LANL two-stage gas guns

    Science.gov (United States)

    Gibson, Lee; Bartram, Brian; Dattelbaum, Dana; Lang, John; Morris, John

    2015-06-01

    A novel gas loading system was designed for the specific application of remotely loading high purity gases into targets for gas-gun driven plate impact experiments. The high purity gases are loaded into well-defined target configurations to obtain Hugoniot states in the gas phase at greater than ambient pressures. The small volume of the gas samples is challenging, as slight changing in the ambient temperature result in measurable pressure changes. Therefore, the ability to load a gas gun target and continually monitor the sample pressure prior to firing provides the most stable and reliable target fielding approach. We present the design and evaluation of a gas loading system built for the LANL 50 mm bore two-stage light gas gun. Targets for the gun are made of 6061 Al or OFHC Cu, and assembled to form a gas containment cell with a volume of approximately 1.38 cc. The compatibility of materials was a major consideration in the design of the system, particularly for its use with corrosive gases. Piping and valves are stainless steel with wetted seals made from Kalrez and Teflon. Preliminary testing was completed to ensure proper flow rate and that the proper safety controls were in place. The system has been used to successfully load Ar, Kr, Xe, and anhydrous ammonia with purities of up to 99.999 percent. The design of the system, and example data from the plate impact experiments will be shown. LA-UR-15-20521

  19. Context by treatment interactions as the primary object of study in cluster randomized controlled trials of population health interventions.

    Science.gov (United States)

    Fuller, Daniel; Potvin, Louise

    2012-06-01

    Cluster randomized controlled trials are increasingly used in population health intervention research. Through randomization, researchers attempt to isolate the treatment effect and remove all other effects, including any effects of social context. In many cases, the constant effect assumption cannot be satisfied in cluster randomized controlled trials. We argue that when studying population health interventions, the effective mechanism of intervention lies in the interaction between the treatment and social context. Researchers should be cognizant that attempts to remove the effect of social context using CRTC may fail. The interaction between the treatment and social context should be the primary object of study in population health intervention research.

  20. A Coupled Hidden Conditional Random Field Model for Simultaneous Face Clustering and Naming in Videos

    KAUST Repository

    Zhang, Yifan

    2016-08-18

    For face naming in TV series or movies, a typical way is using subtitles/script alignment to get the time stamps of the names, and tagging them to the faces. We study the problem of face naming in videos when subtitles are not available. To this end, we divide the problem into two tasks: face clustering which groups the faces depicting a certain person into a cluster, and name assignment which associates a name to each face. Each task is formulated as a structured prediction problem and modeled by a hidden conditional random field (HCRF) model. We argue that the two tasks are correlated problems whose outputs can provide prior knowledge of the target prediction for each other. The two HCRFs are coupled in a unified graphical model called coupled HCRF where the joint dependence of the cluster labels and face name association is naturally embedded in the correlation between the two HCRFs. We provide an effective algorithm to optimize the two HCRFs iteratively and the performance of the two tasks on real-world data set can be both improved.

  1. Ethical challenges in cluster randomized controlled trials: experiences from public health interventions in Africa and Asia.

    Science.gov (United States)

    Osrin, David; Azad, Kishwar; Fernandez, Armida; Manandhar, Dharma S; Mwansambo, Charles W; Tripathy, Prasanta; Costello, Anthony M

    2009-10-01

    Public health interventions usually operate at the level of groups rather than individuals, and cluster randomized controlled trials (RCTs) are one means of evaluating their effectiveness. Using examples from six such trials in Bangladesh, India, Malawi and Nepal, we discuss our experience of the ethical issues that arise in their conduct. We set cluster RCTs in the broader context of public health research, highlighting debates about the need to reconcile individual autonomy with the common good and about the ethics of public health research in low-income settings in general. After a brief introduction to cluster RCTs, we discuss particular challenges we have faced. These include the nature of - and responsibility for - group consent, and the need for consent by individuals within groups to intervention and data collection. We discuss the timing of consent in relation to the implementation of public health strategies, and the problem of securing ethical review and approval in a complex domain. Finally, we consider the debate about benefits to control groups and the standard of care that they should receive, and the issue of post-trial adoption of the intervention under test.

  2. Particle-particle and quasiparticle random phase approximations: connections to coupled cluster theory.

    Science.gov (United States)

    Scuseria, Gustavo E; Henderson, Thomas M; Bulik, Ireneusz W

    2013-09-14

    We establish a formal connection between the particle-particle (pp) random phase approximation (RPA) and the ladder channel of the coupled cluster doubles (CCD) equations. The relationship between RPA and CCD is best understood within a Bogoliubov quasiparticle (qp) RPA formalism. This work is a follow-up to our previous formal proof on the connection between particle-hole (ph) RPA and ring-CCD. Whereas RPA is a quasibosonic approximation, CC theory is a "correct bosonization" in the sense that the wavefunction and Hilbert space are exactly fermionic, yet the amplitude equations can be interpreted as adding different quasibosonic RPA channels together. Coupled cluster theory achieves this goal by interacting the ph (ring) and pp (ladder) diagrams via a third channel that we here call "crossed-ring" whose presence allows for full fermionic antisymmetry. Additionally, coupled cluster incorporates what we call "mosaic" terms which can be absorbed into defining a new effective one-body Hamiltonian. The inclusion of these mosaic terms seems to be quite important. The pp-RPA and qp-RPA equations are textbook material in nuclear structure physics but are largely unknown in quantum chemistry, where particle number fluctuations and Bogoliubov determinants are rarely used. We believe that the ideas and connections discussed in this paper may help design improved ways of incorporating RPA correlation into density functionals based on a CC perspective.

  3. Particle-particle and quasiparticle random phase approximations: Connections to coupled cluster theory

    CERN Document Server

    Scuseria, Gustavo E; Bulik, Ireneusz W

    2013-01-01

    We establish a formal connection between the particle-particle (pp) random phase approximation (RPA) and the ladder channel of the coupled cluster doubles (CCD) equations. The relationship between RPA and CCD is best understood within a Bogoliubov quasiparticle (qp) RPA formalism. This work is a follow-up to our previous formal proof on the connection between particle-hole (ph) RPA and ring-CCD. Whereas RPA is a quasibosonic approximation, CC theory is a correct bosonization in the sense that the wavefunction and Hilbert space are exactly fermionic. Coupled cluster theory achieves this goal by interacting the ph (ring) and pp (ladder) diagrams via a third channel that we here call "crossed-ring" whose presence allows for full fermionic antisymmetry. Additionally, coupled cluster incorporates what we call "mosaic" terms which can be absorbed into defining a new effective one-body Hamiltonian. The inclusion of these mosaic terms seems to be quite important. The pp-RPA an d qp-RPA equations are textbook material...

  4. An Intervention to Enhance Obstetric and Newborn Care in India: A cluster randomized-trial

    Science.gov (United States)

    Goudar, Shivaprasad S.; Derman, Richard J.; Honnungar, Narayan V.; Patil, Kamal P.; Swamy, Mallaiah K.; Moore, Janet; Wallace, Dennis D.; McClure, Elizabeth M.; Kodkany, Bhalchandra S.; Pasha, Omrana; Sloan, Nancy L.; Wright, Linda L.; Goldenberg, Robert L.

    2016-01-01

    Objectives This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care (EmONC) reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India. Methods The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities. Results 17,754 intervention births and 15,954 control births weighing ≥1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention vs. control clusters (OR=0.60, 95% CI 0.34–1.06, p=.076) as was the PMR (OR = 0.74, 95% CI 0.46–1.19, p=.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures. Conclusions The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery. PMID:26205277

  5. The effects of motivation feedback in patients with severe mental illness: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jochems EC

    2015-12-01

    Full Text Available Eline C Jochems,1,2 Christina M van der Feltz-Cornelis,1–3 Arno van Dam,3,4 Hugo J Duivenvoorden,5 Cornelis L Mulder1,6 1Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands; 2GGz Breburg, Top Clinical Center for Body, Mind and Health, Tilburg, the Netherlands; 3Tilburg University, Faculty of Social Sciences, Tranzo Department, Tilburg, the Netherlands; 4GGZ Westelijk Noord Brabant, Bergen op Zoom, the Netherlands; 5Erasmus MC University Medical Center, Rotterdam, the Netherlands; 6BavoEuropoort, Parnassia Psychiatric Institute, Rotterdam, the Netherlands Objective: To evaluate the effectiveness of providing clinicians with regular feedback on the patient’s motivation for treatment in increasing treatment engagement in patients with severe mental illness.Methods: Design: cluster randomized controlled trial (Dutch Trials Registry NTR2968. Participants: adult outpatients with a primary diagnosis of a psychotic disorder or a personality disorder and their clinicians, treated in 12 community mental health teams (the clusters of two mental health institutions in the Netherlands. Interventions: monthly motivation feedback (MF generated by clinicians additional to treatment as usual (TAU and TAU by the community mental health teams. Primary outcome: treatment engagement at patient level, assessed at 12 months by clinicians. Randomization: teams were allocated to MF or TAU by a computerized randomization program that randomized each team to a single treatment by blocks of varying size. All participants within these teams received similar treatment. Clinicians and patients were not blind to treatment allocation at the 12-month assessment.Results: The 294 randomized patients (148 MF, 146 TAU and 57 clinicians (29 MF, 28 TAU of 12 teams (6 MF, 6 TAU were analyzed according to the intention-to-treat principle. No statistically significant differences

  6. Headache cessation by an educational intervention in grammar schools: a cluster randomized trial.

    Science.gov (United States)

    Albers, L; Heinen, F; Landgraf, M; Straube, A; Blum, B; Filippopulos, F; Lehmann, S; Mansmann, U; Berger, U; Akboga, Y; von Kries, R

    2015-02-01

    Headache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors. In all, 1674 students in 8th-10th grade at 12 grammar schools in greater Munich, Germany, were cluster randomized into intervention and control groups. A standardized 60-min prevention lesson focusing on preventable risk factors for headache (physical inactivity, coffee consumption, alcohol consumption and smoking) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting. Seven months later, students were reassessed. The main outcome parameter was headache cessation. Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated. Nine hundred students (intervention group N = 450, control group N = 450) with headache at baseline and complete data for headache and confounders were included in the analysis. Headache cessation was observed in 9.78% of the control group compared with 16.22% in the intervention group (number needed to treat = 16). Accounting for cluster effects and confounders, the probability of headache cessation in the intervention group was 1.77 (95% confidence interval = [1.08; 2.90]) higher than in the control group. The effect was most pronounced in adolescents with tension-type headache: odds ratio = 2.11 (95% confidence interval = [1.15; 3.80]). Our study demonstrates the effectiveness of a one-time, classroom-based headache prevention programme. © 2014 EAN.

  7. A Cluster Randomized Controlled Trial of the MyFamilyPlan Online Preconception Health Education Tool.

    Science.gov (United States)

    Batra, Priya; Mangione, Carol M; Cheng, Eric; Steers, W Neil; Nguyen, Tina A; Bell, Douglas; Kuo, Alice A; Gregory, Kimberly D

    2017-01-01

    To evaluate whether exposure to MyFamilyPlan-a web-based preconception health education module-changes the proportion of women discussing reproductive health with providers at well-woman visits. Cluster randomized controlled trial. One hundred thirty participants per arm distributed among 34 clusters (physicians) required to detect a 20% change in the primary outcome. Urban academic medical center (California). Eligible women were 18 to 45 years old, were English speaking, were nonpregnant, were able to access the Internet, and had an upcoming well-woman visit. E-mail and phone recruitment between September 2015 and May 2016; 292 enrollees randomized. Intervention participants completed the MyFamilyPlan module online 7 to 10 days before a scheduled well-woman visit; control participants reviewed standard online preconception health education materials. The primary outcome was self-reported discussion of reproductive health with the physician at the well-woman visit. Self-reported secondary outcomes were folic acid use, contraceptive method initiation/change, and self-efficacy score. Multilevel multivariate logistic regression. After adjusting for covariates and cluster, exposure to MyFamilyPlan was the only variable significantly associated with an increase in the proportion of women discussing reproductive health with providers (odds ratio: 1.97, 95% confidence interval: 1.22-3.19). Prespecified secondary outcomes were unaffected. MyFamilyPlan exposure was associated with a significant increase in the proportion of women who reported discussing reproductive health with providers and may promote preconception health awareness; more work is needed to affect associated behaviors.

  8. Structuring communication relationships for interprofessional teamwork (SCRIPT: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kenaszchuk Chris

    2007-09-01

    Full Text Available Abstract Background Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care. Objectives The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care. Methods The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs in general internal medicine (GIM divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices. Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication. The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS; adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design. Discussion Pre-intervention qualitative analysis revealed that a

  9. Comparison of population-averaged and cluster-specific models for the analysis of cluster randomized trials with missing binary outcomes: a simulation study

    Directory of Open Access Journals (Sweden)

    Ma Jinhui

    2013-01-01

    Full Text Available Abstracts Background The objective of this simulation study is to compare the accuracy and efficiency of population-averaged (i.e. generalized estimating equations (GEE and cluster-specific (i.e. random-effects logistic regression (RELR models for analyzing data from cluster randomized trials (CRTs with missing binary responses. Methods In this simulation study, clustered responses were generated from a beta-binomial distribution. The number of clusters per trial arm, the number of subjects per cluster, intra-cluster correlation coefficient, and the percentage of missing data were allowed to vary. Under the assumption of covariate dependent missingness, missing outcomes were handled by complete case analysis, standard multiple imputation (MI and within-cluster MI strategies. Data were analyzed using GEE and RELR. Performance of the methods was assessed using standardized bias, empirical standard error, root mean squared error (RMSE, and coverage probability. Results GEE performs well on all four measures — provided the downward bias of the standard error (when the number of clusters per arm is small is adjusted appropriately — under the following scenarios: complete case analysis for CRTs with a small amount of missing data; standard MI for CRTs with variance inflation factor (VIF 50. RELR performs well only when a small amount of data was missing, and complete case analysis was applied. Conclusion GEE performs well as long as appropriate missing data strategies are adopted based on the design of CRTs and the percentage of missing data. In contrast, RELR does not perform well when either standard or within-cluster MI strategy is applied prior to the analysis.

  10. PERFORMANCE STUDY OF A TWO STAGE SOLAR ADSORPTION REFRIGERATION SYSTEM

    Directory of Open Access Journals (Sweden)

    BAIJU. V

    2011-07-01

    Full Text Available The present study deals with the performance of a two stage solar adsorption refrigeration system with activated carbon-methanol pair investigated experimentally. Such a system was fabricated and tested under the conditions of National Institute of Technology Calicut, Kerala, India. The system consists of a parabolic solar concentrator,two water tanks, two adsorbent beds, condenser, expansion device, evaporator and accumulator. In this particular system the second water tank is act as a sensible heat storage device so that the system can be used during night time also. The system has been designed for heating 50 litres of water from 25oC to 90oC as well ascooling 10 litres of water from 30oC to 10oC within one hour. The performance parameters such as specific cooling power (SCP, coefficient of performance, solar COP and exergetic efficiency are studied. The dependency between the exergetic efficiency and cycle COP with the driving heat source temperature is also studied. The optimum heat source temperature for this system is determined as 72.4oC. The results show that the system has better performance during night time as compared to the day time. The system has a mean cycle COP of 0.196 during day time and 0.335 for night time. The mean SCP values during day time and night time are 47.83 and 68.2, respectively. The experimental results also demonstrate that the refrigerator has cooling capacity of 47 to 78 W during day time and 57.6 W to 104.4W during night time.

  11. Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial.

    Science.gov (United States)

    Taveras, Elsie M; Marshall, Richard; Kleinman, Ken P; Gillman, Matthew W; Hacker, Karen; Horan, Christine M; Smith, Renata L; Price, Sarah; Sharifi, Mona; Rifas-Shiman, Sheryl L; Simon, Steven R

    2015-06-01

    Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and quality of care. We conducted a cluster-randomized, 3-arm clinical trial. We enrolled 549 children aged 6 to 12 years with a BMI at the 95% percentile or higher from 14 primary care practices in Massachusetts from October 1, 2011, through June 30, 2012. Patients were followed up for 1 year (last follow-up, August 30, 2013). In intent-to-treat analyses, we used linear mixed-effects models to account for clustering by practice and within each person. In 5 practices randomized to CDS, pediatric clinicians received decision support on obesity management, and patients and their families received an intervention for self-guided behavior change. In 5 practices randomized to CDS + coaching, decision support was augmented by individualized family coaching. The remaining 4 practices were randomized to usual care. Smaller age-associated change in BMI and the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity during the 1-year follow-up. At baseline, mean (SD) patient age and BMI were 9.8 (1.9) years and 25.8 (4.3), respectively. At 1 year, we obtained BMI from 518 children (94.4%) and HEDIS measures from 491 visits (89.4%). The 3 randomization arms had different effects on BMI over time (P = .04). Compared with the usual care arm, BMI increased less in children in the CDS arm during 1 year (-0.51 [95% CI, -0.91 to -0.11]). The CDS + coaching arm had a smaller magnitude of effect (-0.34 [95% CI, -0.75 to 0.07]). We found substantially greater achievement of childhood obesity HEDIS measures in the CDS arm (adjusted odds ratio, 2.28 [95% CI, 1

  12. Metamodeling and Optimization of a Blister Copper Two-Stage Production Process

    Science.gov (United States)

    Jarosz, Piotr; Kusiak, Jan; Małecki, Stanisław; Morkisz, Paweł; Oprocha, Piotr; Pietrucha, Wojciech; Sztangret, Łukasz

    2016-06-01

    It is often difficult to estimate parameters for a two-stage production process of blister copper (containing 99.4 wt.% of Cu metal) as well as those for most industrial processes with high accuracy, which leads to problems related to process modeling and control. The first objective of this study was to model flash smelting and converting of Cu matte stages using three different techniques: artificial neural networks, support vector machines, and random forests, which utilized noisy technological data. Subsequently, more advanced models were applied to optimize the entire process (which was the second goal of this research). The obtained optimal solution was a Pareto-optimal one because the process consisted of two stages, making the optimization problem a multi-criteria one. A sequential optimization strategy was employed, which aimed for optimal control parameters consecutively for both stages. The obtained optimal output parameters for the first smelting stage were used as input parameters for the second converting stage. Finally, a search for another optimal set of control parameters for the second stage of a Kennecott-Outokumpu process was performed. The optimization process was modeled using a Monte-Carlo method, and both modeling parameters and computed optimal solutions are discussed.

  13. Continuity of the Phase Transition for Planar Random-Cluster and Potts Models with {1 ≤ q ≤ 4}

    Science.gov (United States)

    Duminil-Copin, Hugo; Sidoravicius, Vladas; Tassion, Vincent

    2017-01-01

    This article studies the planar Potts model and its random-cluster representation. We show that the phase transition of the nearest-neighbor ferromagnetic q-state Potts model on Z^2 is continuous for {q in {2,3,4}}, in the sense that there exists a unique Gibbs state, or equivalently that there is no ordering for the critical Gibbs states with monochromatic boundary conditions. The proof uses the random-cluster model with cluster-weight {q ≥ 1} (note that q is not necessarily an integer) and is based on two ingredients: The fact that the two-point function for the free state decays sub-exponentially fast for cluster-weights {1≤ q≤ 4}, which is derived studying parafermionic observables on a discrete Riemann surface.

  14. Cardiorespiratory fitness, cardiovascular workload and risk factors among cleaners; a cluster randomized worksite intervention

    DEFF Research Database (Denmark)

    Korshøj, Mette; Krustrup, Peter; Jørgensen, Marie Birk;

    2012-01-01

    Prevalence of cardiovascular risk factors is unevenly distributed among occupational groups. The working environment, as well as lifestyle and socioeconomic status contribute to the disparity and variation in prevalence of these risk factors. High physical work demands have been shown to increase...... the risk for cardiovascular disease and mortality, contrary to leisure time physical activity. High physical work demands in combination with a low cardiorespiratory fitness infer a high relative workload and an excessive risk for cardiovascular mortality. Therefore, the aim of this study is to examine...... and cardiovascular risk factors among cleaners. Cleaners are eligible if they are employed ≥ 20 hours/week, at one of the enrolled companies. In the randomization, strata are formed according to the manager the participant reports to. The clusters will be balanced on the following criteria: Geographical work...

  15. Nonlinear random resistor diode networks and fractal dimensions of directed percolation clusters.

    Science.gov (United States)

    Stenull, O; Janssen, H K

    2001-07-01

    We study nonlinear random resistor diode networks at the transition from the nonpercolating to the directed percolating phase. The resistor-like bonds and the diode-like bonds under forward bias voltage obey a generalized Ohm's law V approximately I(r). Based on general grounds such as symmetries and relevance we develop a field theoretic model. We focus on the average two-port resistance, which is governed at the transition by the resistance exponent straight phi(r). By employing renormalization group methods we calculate straight phi(r) for arbitrary r to one-loop order. Then we address the fractal dimensions characterizing directed percolation clusters. Via considering distinct values of the nonlinearity r, we determine the dimension of the red bonds, the chemical path, and the backbone to two-loop order.

  16. Sanitation subsidies. Encouraging sanitation investment in the developing world: a cluster-randomized trial.

    Science.gov (United States)

    Guiteras, Raymond; Levinsohn, James; Mobarak, Ahmed Mushfiq

    2015-05-22

    Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments-community motivation and information; subsidies; a supply-side market access intervention; and a control-in a cluster-randomized trial. Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, P = 0.43), nor did the supply-side intervention (+0.3 percentage points, P = 0.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, P < 0.001) and their unsubsidized neighbors (+8.5 percentage points, P = 0.001), which suggests that investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (P < 0.001).

  17. Right Axillary Sweating After Left Thoracoscopic Sypathectomy in Two-Stage Surgery

    Directory of Open Access Journals (Sweden)

    Berkant Ozpolat

    2013-06-01

    Full Text Available One stage bilateral or two stage unilateral video assisted thoracoscopic sympathectomy could be performed in the treatment of primary focal hyperhidrosis. Here we present a case with compensatory sweating of contralateral side after a two stage operation.

  18. The Two-stage Constrained Equal Awards and Losses Rules for Multi-Issue Allocation Situation

    NARCIS (Netherlands)

    Lorenzo-Freire, S.; Casas-Mendez, B.; Hendrickx, R.L.P.

    2005-01-01

    This paper considers two-stage solutions for multi-issue allocation situations.Characterisations are provided for the two-stage constrained equal awards and constrained equal losses rules, based on the properties of composition and path independence.

  19. Effectiveness of a school-based physical activity injury prevention program: a cluster randomized controlled trial.

    Science.gov (United States)

    Collard, Dorine C M; Verhagen, Evert A L M; Chinapaw, Mai J M; Knol, Dirk L; van Mechelen, Willem

    2010-02-01

    To study the effects of a school-based injury prevention program on physical activity injury incidence and severity. Cluster randomized controlled trial performed from January 1, 2006, through July 31, 2007. Forty Dutch primary schools. A total of 2210 children (aged 10-12 years). Schools were randomized to receive either the regular curriculum or an intervention program that targeted physical activity injuries. Incidence and severity of physical activity injuries per 1000 hours of physical activity participation. A total of 100 injuries in the intervention group and 104 injuries in the control group were registered. Nonresponse at baseline or follow-up was minimal (8.7%). The Cox regression analyses adjusted for clustering showed a small nonsignificant intervention effect on total (HR, 0.81; 95% confidence interval [CI], 0.41-1.59), sports club (0.69; 0.28-1.68), and leisure time injuries (0.75; 0.36-1.55). However, physical activity appeared to be an effect modifier. In those who were less physically active, the intervention had a larger effect. The intervention reduced the total and leisure time injury incidence (HR, 0.47; 95% CI, 0.21-1.06; and 0.43; 0.16-1.14; respectively). Sports club injury incidence was significantly reduced (HR, 0.23; 95% CI, 0.07-0.75). We found a substantial and relevant reduction in physical activity injuries, especially in children in the low active group, because of the intervention. This school-based injury prevention program is promising, but future large-scale research is needed.

  20. Cluster-randomized xylitol toothpaste trial for early childhood caries prevention.

    Science.gov (United States)

    Chi, Donald L; Tut, Ohnmar; Milgrom, Peter

    2014-01-01

    The purpose of this study was to assess the efficacy of supervised tooth-brushing with xylitol toothpaste to prevent early childhood caries (ECC) and reduce mutans streptococci. In this cluster-randomized efficacy trial, 196 four- to five-year-old children in four Head Start classrooms in the Marshall Islands were randomly assigned to supervised toothbrushing with 1,400 ppm/31 percent fluoride xylitol or 1,450 ppm fluoride sorbitol toothpaste. We hypothesized that there would be no difference in efficacy between the two types of toothpaste. The primary outcome was the surface-level primary molar caries increment (d(2-3)mfs) after six months. A single examiner was blinded to classroom assignments. Two classrooms were assigned to the fluoride-xylitol group (85 children), and two classrooms were assigned to the fluoride-sorbitol group (83 children). The child-level analyses accounted for clustering. There was no difference between the two groups in baseline or end-of-trial mean d(2-3)mfs. The mean d(2-3)mfs increment was greater in the fluoride-xylitol group compared to the fluoride-sorbitol group (2.5 and 1.4 d(2-3)mfs, respectively), but the difference was not significant (95% confidence interval: -0.17, 2.37; P=.07). No adverse effects were reported. After six months, brushing with a low-strength xylitol/fluoride tooth-paste is no more efficacious in reducing ECC than a fluoride-only toothpaste in a high caries-risk child population.

  1. Two-Stage Exams Improve Student Learning in an Introductory Geology Course: Logistics, Attendance, and Grades

    Science.gov (United States)

    Knierim, Katherine; Turner, Henry; Davis, Ralph K.

    2015-01-01

    Two-stage exams--where students complete part one of an exam closed book and independently and part two is completed open book and independently (two-stage independent, or TS-I) or collaboratively (two-stage collaborative, or TS-C)--provide a means to include collaborative learning in summative assessments. Collaborative learning has been shown to…

  2. Prescribing ANtiDepressants Appropriately (PANDA: a cluster randomized controlled trial in primary care

    Directory of Open Access Journals (Sweden)

    Muskens Esther

    2013-01-01

    Full Text Available Abstract Background Inappropriate use of antidepressants (AD, defined as either continuation in the absence of a proper indication or continuation despite the lack of therapeutic efficacy, applies to approximately half of all long term AD users. Methods/design We have designed a cluster randomized controlled clinical trial to assess the (cost- effectiveness of an antidepressant cessation advice in the absence of a proper indication for maintenance treatment with antidepressants in primary care. We will select all patients using antidepressants for over 9 months from 45 general practices. Patients will be diagnosed using the Composite International Diagnostic Interview (CIDI version 3.0, extended with questions about the psychiatric history and previous treatment strategies. General practices will be randomized to either the intervention or the control group. In case of overtreatment, defined as the absence of a proper indication according to current guidelines, a cessation advice is given to the general practitioner. In the control groups no specific information is given. The primary outcome measure will be the proportion of patients that successfully discontinue their antidepressants at one-year follow-up. Secondary outcomes are dimensional measures of psychopathology and costs. Discussion This study protocol provides a detailed overview of the design of the trial. Study results will be of importance for refining current guidelines. If the intervention is effective it can be used in managed care programs. Trial registration NTR2032

  3. Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam.

    Science.gov (United States)

    Wagstaff, Adam; Nguyen, Ha Thi Hong; Dao, Huyen; Bales, Sarah

    2016-06-01

    Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12 months prior to the baseline survey the subsidy-only intervention raised enrollment by 3.5 ppts (p = 0.08) while the combined intervention raised enrollment by 4.5 ppts (p = 0.02); however, the differences in the effect sizes between the sick and non-sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.

  4. The Chronic CARe for diAbeTes study (CARAT: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Birnbaum Beatrice

    2010-06-01

    Full Text Available Abstract Background Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices. Methods/Design CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538. The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome. Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure ( Discussion This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.

  5. Improving language comprehension in preschool children with language difficulties: a cluster randomized trial.

    Science.gov (United States)

    Hagen, Åste M; Melby-Lervåg, Monica; Lervåg, Arne

    2017-10-01

    Children with language comprehension difficulties are at risk of educational and social problems, which in turn impede employment prospects in adulthood. However, few randomized trials have examined how such problems can be ameliorated during the preschool years. We conducted a cluster randomized trial in 148 preschool classrooms. Our intervention targeted language comprehension skills and lasted 1 year and 1 month, with five blocks of 6 weeks and intervention three times per week (about 75 min per week). Effects were assessed on a range of measures of language performance. Immediately after the intervention, there were moderate effects on both near, intermediate and distal measures of language performance. At delayed follow-up (7 months after the intervention), these reliable effects remained for the distal measures. It is possible to intervene in classroom settings to improve the language comprehension skills of children with language difficulties. However, it appears that such interventions need to be intensive and prolonged. © 2017 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

  6. Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Gulpers Math JM

    2006-10-01

    Full Text Available Abstract Background Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents. Methods A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia. The wards were assigned at random to either educational intervention (3 wards or control status (2 wards. The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS at baseline and 1 month after intervention. Results Restraint use did not change significantly over time in the experimental group (55%–56%, compared to a significant increased use (P Conclusion An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention.

  7. Inertial particles distribute in turbulence as Poissonian points with random intensity inducing clustering and supervoiding

    Science.gov (United States)

    Schmidt, Lukas; Fouxon, Itzhak; Holzner, Markus

    2017-07-01

    inertia, described by the Poisson distribution, the typical void size is of the order of the mean interparticle distance. However, at small but finite inertia, the void size is larger than the mean interparticle distance by a factor that diverges in the continuum limit of infinite number of particles, manifesting strong deviations from the Poisson distribution. Thus, voids are very sensitive to inertia and limits of zero inertia and continuum may not commute. Further, the tail of the probability distribution of the void size is log normal, in contrast with faster than exponential decay of the Poisson distribution. Remarkably, at scales where there is no clustering (so pair-correlation function of concentration splits in the product of averages), there can still be an increase of the void probability so that turbulent voiding is stronger than clustering. These results can find applications in the long-time survival probability of reacting particles where the particle survives in the void of predators. The demonstrated double stochasticity (Poisson with random intensity) of the distribution originates in the two-step formation of fluctuations of the number of particles inside the volume under observation. First, turbulence randomly brings uncorrelated particles below the viscous scale with Poisson-type probability. Then, turbulence compresses the particles inside the observation volume. We confirm the predictions by numerical observations of inertial particle motion in a chaotic Arnold-Beltrami-Childress flow. Our work implies that the particle distribution in arbitrary weakly compressible flow with finite time correlations is a LGCP.

  8. Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY: a pilot cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Pai Menaka

    2013-01-01

    Full Text Available Abstract Background Venous thromboembolism (VTE is a common preventable cause of mortality in hospitalized medical patients. Despite rigorous randomized trials generating strong recommendations for anticoagulant use to prevent VTE, nearly 40% of medical patients receive inappropriate thromboprophylaxis. Knowledge-translation strategies are needed to bridge this gap. Methods We conducted a 16-week pilot cluster randomized controlled trial (RCT to determine the proportion of medical patients that were appropriately managed for thromboprophylaxis (according to the American College of Chest Physician guidelines within 24 hours of admission, through the use of a multicomponent knowledge-translation intervention. Our primary goal was to determine the feasibility of conducting this study on a larger scale. The intervention comprised clinician education, a paper-based VTE risk assessment algorithm, printed physicians’ orders, and audit and feedback sessions. Medical wards at six hospitals (representing clusters in Ontario, Canada were included; three were randomized to the multicomponent intervention and three to usual care (i.e., no active strategies for thromboprophylaxis in place. Blinding was not used. Results A total of 2,611 patients (1,154 in the intervention and 1,457 in the control group were eligible and included in the analysis. This multicomponent intervention did not lead to a significant difference in appropriate VTE prophylaxis rates between intervention and control hospitals (appropriate management rate odds ratio = 0.80; 95% confidence interval: 0.50, 1.28; p = 0.36; intra-class correlation coefficient: 0.022, and thus was not considered feasible. Major barriers to effective knowledge translation were poor attendance by clinical staff at education and feedback sessions, difficulty locating preprinted orders, and lack of involvement by clinical and administrative leaders. We identified several factors that may increase uptake of a VTE

  9. Cardiorespiratory fitness, cardiovascular workload and risk factors among cleaners; a cluster randomized worksite intervention

    Directory of Open Access Journals (Sweden)

    Korshøj Mette

    2012-08-01

    Full Text Available Abstract Background Prevalence of cardiovascular risk factors is unevenly distributed among occupational groups. The working environment, as well as lifestyle and socioeconomic status contribute to the disparity and variation in prevalence of these risk factors. High physical work demands have been shown to increase the risk for cardiovascular disease and mortality, contrary to leisure time physical activity. High physical work demands in combination with a low cardiorespiratory fitness infer a high relative workload and an excessive risk for cardiovascular mortality. Therefore, the aim of this study is to examine whether a worksite aerobic exercise intervention will reduce the relative workload and cardiovascular risk factors by an increased cardiorespiratory fitness. Methods/design A cluster-randomized controlled trial is performed to evaluate the effect of the worksite aerobic exercise intervention on cardiorespiratory fitness and cardiovascular risk factors among cleaners. Cleaners are eligible if they are employed ≥ 20 hours/week, at one of the enrolled companies. In the randomization, strata are formed according to the manager the participant reports to. The clusters will be balanced on the following criteria: Geographical work location, gender, age and seniority. Cleaners are randomized to either I a reference group, receiving lectures concerning healthy living, or II an intervention group, performing worksite aerobic exercise “60 min per week”. Data collection will be conducted at baseline, four months and 12 months after baseline, at the worksite during working hours. The data collection will consist of a questionnaire-based interview, physiological testing of health and capacity-related measures, and objective diurnal measures of heart rate, physical activity and blood pressure. Primary outcome is cardiorespiratory fitness. Discussion Information is lacking about whether an improved cardiorespiratory fitness will affect

  10. Engineering practice variation through provider agreement: a cluster-randomized feasibility trial

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    McCarren M

    2014-10-01

    Full Text Available Madeline McCarren,1 Elaine L Twedt,1 Faizmohamed M Mansuri,2 Philip R Nelson,3 Brian T Peek3 1Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL, 2Wilkes-Barre VA Medical Center, Wilkes-Barre, PA, 3Charles George VA Medical Center, Asheville, NC, USA Purpose: Minimal-risk randomized trials that can be embedded in practice could facilitate learning health-care systems. A cluster-randomized design was proposed to compare treatment strategies by assigning clusters (eg, providers to “favor” a particular drug, with providers retaining autonomy for specific patients. Patient informed consent might be waived, broadening inclusion. However, it is not known if providers will adhere to the assignment or whether institutional review boards will waive consent. We evaluated the feasibility of this trial design.Subjects and methods: Agreeable providers were randomized to “favor” either hydrochlorothiazide or chlorthalidone when starting patients on thiazide-type therapy for hypertension. The assignment applied when the provider had already decided to start a thiazide, and providers could deviate from the strategy as needed. Prescriptions were aggregated to produce a provider strategy-adherence rate.Results: All four institutional review boards waived documentation of patient consent. Providers (n=18 followed their assigned strategy for most of their new thiazide prescriptions (n=138 patients. In the “favor hydrochlorothiazide” group, there was 99% adherence to that strategy. In the “favor chlorthalidone” group, chlorthalidone comprised 77% of new thiazide starts, up from 1% in the pre-study period. When the assigned strategy was followed, dosing in the recommended range was 48% for hydrochlorothiazide (25–50 mg/day and 100% for chlorthalidone (12.5–25.0 mg/day. Providers were motivated to participate by a desire to contribute to a comparative effectiveness study. A study promotional mug, provider information

  11. Study protocol: optimization of complex palliative care at home via telemedicine. A cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Hasselaar Jeroen

    2011-08-01

    Full Text Available Abstract Background Due to the growing number of elderly with advanced chronic conditions, healthcare services will come under increasing pressure. Teleconsultation is an innovative approach to deliver quality of care for palliative patients at home. Quantitative studies assessing the effect of teleconsultation on clinical outcomes are scarce. The aim of this present study is to investigate the effectiveness of teleconsultation in complex palliative homecare. Methods/Design During a 2-year recruitment period, GPs are invited to participate in this cluster randomized controlled trial. When a GP refers an eligible patient for the study, the GP is randomized to the intervention group or the control group. Patients in the intervention group have a weekly teleconsultation with a nurse practitioner and/or a physician of the palliative consultation team. The nurse practitioner, in cooperation with the palliative care specialist of the palliative consultation team, advises the GP on treatment policy of the patient. The primary outcome of patient symptom burden is assessed at baseline and weekly using the Edmonton Symptom Assessment Scale (ESAS and at baseline and every four weeks using the Hospital Anxiety and Depression Scale (HADS. Secondary outcomes are self-perceived burden from informal care (EDIZ, patient experienced continuity of medical care (NCQ, patient and caregiver satisfaction with the teleconsultation (PSQ, the experienced problems and needs in palliative care (PNPC-sv and the number of hospital admissions. Discussion This is one of the first randomized controlled trials in palliative telecare. Our data will verify whether telemedicine positively affects palliative homecare. Trial registration The Netherlands National Trial Register NTR2817

  12. Testing a workplace physical activity intervention: a cluster randomized controlled trial

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    Jackson Cath

    2011-04-01

    Full Text Available Abstract Background Increased physical activity levels benefit both an individuals' health and productivity at work. The purpose of the current study was to explore the impact and cost-effectiveness of a workplace physical activity intervention designed to increase physical activity levels. Methods A total of 1260 participants from 44 UK worksites (based within 5 organizations were recruited to a cluster randomized controlled trial with worksites randomly allocated to an intervention or control condition. Measurement of physical activity and other variables occurred at baseline, and at 0 months, 3 months and 9 months post-intervention. Health outcomes were measured during a 30 minute health check conducted in worksites at baseline and 9 months post intervention. The intervention consisted of a 3 month tool-kit of activities targeting components of the Theory of Planned Behavior, delivered in-house by nominated facilitators. Self-reported physical activity (measured using the IPAQ short-form and health outcomes were assessed. Results and discussion Multilevel modelling found no significant effect of the intervention on MET minutes of activity (from the IPAQ at any of the follow-up time points controlling for baseline activity. However, the intervention did significantly reduce systolic blood pressure (B = -1.79 mm/Hg and resting heart rate (B = -2.08 beats and significantly increased body mass index (B = .18 units compared to control. The intervention was found not to be cost-effective, however the substantial variability round this estimate suggested that further research is warranted. Conclusions The current study found mixed support for this worksite physical activity intervention. The paper discusses some of the tensions involved in conducting rigorous evaluations of large-scale randomized controlled trials in real-world settings. Trial registration Current controlled trials ISRCTN08807396

  13. Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial.

    Science.gov (United States)

    Tong, Elisa K; Nguyen, Tung T; Lo, Penny; Stewart, Susan L; Gildengorin, Ginny L; Tsoh, Janice Y; Jo, Angela M; Kagawa-Singer, Marjorie L; Sy, Angela U; Cuaresma, Charlene; Lam, Hy T; Wong, Ching; Tran, Mi T; Chen, Moon S

    2017-01-01

    Asian Americans have lower colorectal cancer (CRC) screening rates than non-Hispanic white individuals. Hmong Americans have limited socioeconomic resources and literacy. The current randomized controlled trial was conducted to determine whether bilingual/bicultural lay health educator (LHE) education could increase CRC screening among Hmong Americans. A cluster randomized controlled trial was conducted among Hmong Americans in Sacramento, California. LHEs and recruited participants were randomized to intervention or control groups. The intervention group received CRC education over 3 months delivered by an LHE. The control group received education regarding nutrition and physical activity delivered by a health educator. The outcomes were changes in self-reported ever-screening and up-to-date CRC screening after 6 months. All 329 participants were foreign-born with mostly no formal education, limited English proficiency, and no employment. The majority of the participants were insured and had a regular source of health care. The intervention group experienced greater changes after the intervention than the control group for ever-screening (P = .068) and being up-to-date with screening (Pscreening (adjusted odds ratio, 1.73; 95% confidence interval, 1.07-2.79) and being up-to-date with screening (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32). Individuals who had health insurance were found to have >4 times the odds of receiving screening, both ever-screening and up-to-date screening. A higher CRC knowledge score mediated the intervention effect for both screening outcomes. A culturally and linguistically appropriate educational intervention delivered by trained LHEs was found to increase CRC screening in an immigrant population with low levels of education, employment, English proficiency, and literacy. Cancer 2017;98-106. © 2016 American Cancer Society. © 2016 American Cancer Society.

  14. Ethical and policy issues in cluster randomized trials: rationale and design of a mixed methods research study

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    Chaudhry Shazia H

    2009-07-01

    Full Text Available Abstract Background Cluster randomized trials are an increasingly important methodological tool in health research. In cluster randomized trials, intact social units or groups of individuals, such as medical practices, schools, or entire communities – rather than individual themselves – are randomly allocated to intervention or control conditions, while outcomes are then observed on individual cluster members. The substantial methodological differences between cluster randomized trials and conventional randomized trials pose serious challenges to the current conceptual framework for research ethics. The ethical implications of randomizing groups rather than individuals are not addressed in current research ethics guidelines, nor have they even been thoroughly explored. The main objectives of this research are to: (1 identify ethical issues arising in cluster trials and learn how they are currently being addressed; (2 understand how ethics reviews of cluster trials are carried out in different countries (Canada, the USA and the UK; (3 elicit the views and experiences of trial participants and cluster representatives; (4 develop well-grounded guidelines for the ethical conduct and review of cluster trials by conducting an extensive ethical analysis and organizing a consensus process; (5 disseminate the guidelines to researchers, research ethics boards (REBs, journal editors, and research funders. Methods We will use a mixed-methods (qualitative and quantitative approach incorporating both empirical and conceptual work. Empirical work will include a systematic review of a random sample of published trials, a survey and in-depth interviews with trialists, a survey of REBs, and in-depth interviews and focus group discussions with trial participants and gatekeepers. The empirical work will inform the concurrent ethical analysis which will lead to a guidance document laying out principles, policy options, and rationale for proposed guidelines. An

  15. Two Stage Secure Dynamic Load Balancing Architecture for SIP Server Clusters

    Directory of Open Access Journals (Sweden)

    G. Vennila

    2014-08-01

    Full Text Available Session Initiation Protocol (SIP is a signaling protocol emerged with an aim to enhance the IP network capabilities in terms of complex service provision. SIP server scalability with load balancing has a greater concern due to the dramatic increase in SIP service demand. Load balancing of session method (request/response and security measures optimizes the SIP server to regulate of network traffic in Voice over Internet Protocol (VoIP. Establishing a honeywall prior to the load balancer significantly reduces SIP traffic and drops inbound malicious load. In this paper, we propose Active Least Call in SIP Server (ALC_Server algorithm fulfills objectives like congestion avoidance, improved response times, throughput, resource utilization, reducing server faults, scalability and protection of SIP call from DoS attacks. From the test bed, the proposed two-tier architecture demonstrates that the ALC_Server method dynamically controls the overload and provides robust security, uniform load distribution for SIP servers.

  16. An inexact mixed risk-aversion two-stage stochastic programming model for water resources management under uncertainty.

    Science.gov (United States)

    Li, W; Wang, B; Xie, Y L; Huang, G H; Liu, L

    2015-02-01

    Uncertainties exist in the water resources system, while traditional two-stage stochastic programming is risk-neutral and compares the random variables (e.g., total benefit) to identify the best decisions. To deal with the risk issues, a risk-aversion inexact two-stage stochastic programming model is developed for water resources management under uncertainty. The model was a hybrid methodology of interval-parameter programming, conditional value-at-risk measure, and a general two-stage stochastic programming framework. The method extends on the traditional two-stage stochastic programming method by enabling uncertainties presented as probability density functions and discrete intervals to be effectively incorporated within the optimization framework. It could not only provide information on the benefits of the allocation plan to the decision makers but also measure the extreme expected loss on the second-stage penalty cost. The developed model was applied to a hypothetical case of water resources management. Results showed that that could help managers generate feasible and balanced risk-aversion allocation plans, and analyze the trade-offs between system stability and economy.

  17. The use of permutation tests for the analysis of parallel and stepped-wedge cluster-randomized trials.

    Science.gov (United States)

    Wang, Rui; De Gruttola, Victor

    2017-08-15

    We investigate the use of permutation tests for the analysis of parallel and stepped-wedge cluster-randomized trials. Permutation tests for parallel designs with exponential family endpoints have been extensively studied. The optimal permutation tests developed for exponential family alternatives require information on intraclass correlation, a quantity not yet defined for time-to-event endpoints. Therefore, it is unclear how efficient permutation tests can be constructed for cluster-randomized trials with such endpoints. We consider a class of test statistics formed by a weighted average of pair-specific treatment effect estimates and offer practical guidance on the choice of weights to improve efficiency. We apply the permutation tests to a cluster-randomized trial evaluating the effect of an intervention to reduce the incidence of hospital-acquired infection. In some settings, outcomes from different clusters may be correlated, and we evaluate the validity and efficiency of permutation test in such settings. Lastly, we propose a permutation test for stepped-wedge designs and compare its performance with mixed-effect modeling and illustrate its superiority when sample sizes are small, the underlying distribution is skewed, or there is correlation across clusters. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Comparison of methods for estimating the intraclass correlation coefficient for binary responses in cancer prevention cluster randomized trials.

    Science.gov (United States)

    Wu, Sheng; Crespi, Catherine M; Wong, Weng Kee

    2012-09-01

    The intraclass correlation coefficient (ICC) is a fundamental parameter of interest in cluster randomized trials as it can greatly affect statistical power. We compare common methods of estimating the ICC in cluster randomized trials with binary outcomes, with a specific focus on their application to community-based cancer prevention trials with primary outcome of self-reported cancer screening. Using three real data sets from cancer screening intervention trials with different numbers and types of clusters and cluster sizes, we obtained point estimates and 95% confidence intervals for the ICC using five methods: the analysis of variance estimator, the Fleiss-Cuzick estimator, the Pearson estimator, an estimator based on generalized estimating equations and an estimator from a random intercept logistic regression model. We compared estimates of the ICC for the overall sample and by study condition. Our results show that ICC estimates from different methods can be quite different, although confidence intervals generally overlap. The ICC varied substantially by study condition in two studies, suggesting that the common practice of assuming a common ICC across all clusters in the trial is questionable. A simulation study confirmed pitfalls of erroneously assuming a common ICC. Investigators should consider using sample size and analysis methods that allow the ICC to vary by study condition.

  19. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, M.; Kleinjan, M.; Overbeek, G.; Vermulst, A.; Monshouwer, K.; Lammers, J.; Vollebergh, W.A.M.; Engels, R.C.M.E.

    2014-01-01

    Aim: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting: General population of 11-15-year-old adolesce

  20. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use : A randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, Monique; Kleinjan, Marloes; Overbeek, Geertjan; Vermulst, Ad; Monshouwer, Karin; Lammers, Jeroen; Vollebergh, Wilma A M; Engels, Rutger C M E

    2014-01-01

    Aim: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting: General population of 11-15-year-old adolesce

  1. Cluster Randomized-Controlled Trial of Interventions to Improve Health for Adults with Intellectual Disability Who Live in Private Dwellings

    Science.gov (United States)

    Lennox, Nicholas; Bain, Chris; Rey-Conde, Therese; Taylor, Miriam; Boyle, Frances M.; Purdie, David M.; Ware, Robert S.

    2010-01-01

    Background: People with intellectual disability who live in the community often have poor health and healthcare, partly as a consequence of poor communication, recall difficulties and incomplete patient health information. Materials and Methods: A cluster randomized-controlled trial with 2 x 2 factorial design was conducted with adults with…

  2. A General Framework for Power Analysis to Detect the Moderator Effects in Two- and Three-Level Cluster Randomized Trials

    Science.gov (United States)

    Dong, Nianbo; Spybrook, Jessaca; Kelcey, Ben

    2016-01-01

    The purpose of this study is to propose a general framework for power analyses to detect the moderator effects in two- and three-level cluster randomized trials (CRTs). The study specifically aims to: (1) develop the statistical formulations for calculating statistical power, minimum detectable effect size (MDES) and its confidence interval to…

  3. Intraclass Correlations and Covariate Outcome Correlations for Planning Two-and Three-Level Cluster-Randomized Experiments in Education

    Science.gov (United States)

    Hedges, Larry V.; Hedberg, E. C.

    2013-01-01

    Background: Cluster-randomized experiments that assign intact groups such as schools or school districts to treatment conditions are increasingly common in educational research. Such experiments are inherently multilevel designs whose sensitivity (statistical power and precision of estimates) depends on the variance decomposition across levels.…

  4. Effects of a lifestyle program in subjects with Impaired Fasting Glucose, a pragmatic cluster-randomized controlled trial

    NARCIS (Netherlands)

    Hesselink, Arlette E.; Rutten, Guy E. H.; Slootmaker, Sander M.; de Weerdt, Inge; Raaijmakers, Lieke G. M.; Jonkers, Ruud; Martens, Marloes K.; Bilo, Henk J. G.

    2015-01-01

    Background: The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention strategies. In this study the feasibility and effectiveness of a nurse led lifestyle program for subjects with impaired fasting glucose (IFG) is assessed. Methods: A cluster randomized clinical t

  5. Effects of a lifestyle program in subjects with Impaired Fasting Glucose, a pragmatic cluster-randomized controlled trial

    NARCIS (Netherlands)

    Hesselink, Arlette E.; Rutten, Guy E. H.; Slootmaker, Sander M.; de Weerdt, Inge; Raaijmakers, Lieke G. M.; Jonkers, Ruud; Martens, Marloes K.; Bilo, Henk J. G.

    2015-01-01

    Background: The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention strategies. In this study the feasibility and effectiveness of a nurse led lifestyle program for subjects with impaired fasting glucose (IFG) is assessed. Methods: A cluster randomized clinical

  6. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, M.; Kleinjan, M.; Overbeek, G.J.; Vermulst, A.A.; Monshouwer, K.; Lammers, J.; Vollebergh, W.A.M.; Engels, R.C.M.E.

    2014-01-01

    Aim To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting General population of 11-15-year-old adolescents

  7. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, M.; Kleinjan, M.; Overbeek, G.; Vermulst, A.; Monshouwer, K.; Lammers, J.; Vollebergh, W.A.M.; Engels, R.C.M.E.

    2014-01-01

    Aim: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting: General population of 11-15-year-old adolesce

  8. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use : A randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, Monique; Kleinjan, Marloes; Overbeek, Geertjan|info:eu-repo/dai/nl/25233602X; Vermulst, Ad; Monshouwer, Karin|info:eu-repo/dai/nl/202651967; Lammers, Jeroen; Vollebergh, Wilma A M|info:eu-repo/dai/nl/090632893; Engels, Rutger C M E

    2014-01-01

    Aim: To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design: Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting: General population of 11-15-year-old adolesce

  9. Effectiveness of the 'Healthy School and Drugs' prevention programme on adolescents' substance use: a randomized clustered trial

    NARCIS (Netherlands)

    Malmberg, M.; Kleinjan, M.; Overbeek, G.J.; Vermulst, A.A.; Monshouwer, K.; Lammers, J.; Vollebergh, W.A.M.; Engels, R.C.M.E.

    2014-01-01

    Aim To evaluate the effectiveness of the Healthy School and Drugs programme on alcohol, tobacco and marijuana use among Dutch early adolescents. Design Randomized clustered trial with two intervention conditions (i.e. e-learning and integral). Setting General population of 11-15-year-old adolescents

  10. Diabetes Care Protocol : effects on patient-important outcomes. A cluster randomized, non-inferiority trial in primary care

    NARCIS (Netherlands)

    Cleveringa, F. G. W.; Minkman, M. H.; Gorter, K. J.; van den Donk, M.; Rutten, G. E. H. M.

    2010-01-01

    P>Aims The Diabetes Care Protocol (DCP) combines task delegation, intensification of diabetes treatment and feedback. It reduces cardiovascular risk in Type 2 diabetes (T2DM) patients. This study determines the effects of DCP on patient-important outcomes. Methods A cluster randomized, non-inferiori

  11. Intraclass Correlations and Covariate Outcome Correlations for Planning 2 and 3 Level Cluster Randomized Experiments in Education

    Science.gov (United States)

    Hedges, Larry V.; Hedberg, Eric C.

    2013-01-01

    Background: Cluster randomized experiments that assign intact groups such as schools or school districts to treatment conditions are increasingly common in educational research. Such experiments are inherently multilevel designs whose sensitivity (statistical power and precision of estimates) depends on the variance decomposition across levels.…

  12. The HOPE Social Media Intervention for Global HIV Prevention: A Cluster Randomized Controlled Trial in Peru

    Science.gov (United States)

    Young, Sean D.; Cumberland, William G.; Nianogo, Roch; Menacho, Luis A.; Galea, Jerome T.; Coates, Thomas

    2015-01-01

    Background Social media technologies are newly emerging tools that can be used for HIV prevention and testing in low- and middle-income countries, such as Peru. This study examined the efficacy of using the Harnessing Online Peer Education (HOPE) social media intervention to increase HIV testing among men who have sex with men (MSM) in Peru. Methods In a cluster randomized controlled trial with concealed allocation, Peruvian MSM from Greater Lima/Callao (N = 556) were randomly assigned to join private intervention or control groups on Facebook for 12 weeks. In the intervention condition, forty-nine Peruvian MSM were trained and randomly assigned to be HIV prevention mentors to participants via Facebook groups over 12 weeks. Control participants received an enhanced standard of care, including standard offline HIV prevention available in Peru as well as participation in Facebook groups (without peer leaders) that provided study updates and HIV testing information. After accepting a request to join the groups, continued participation was voluntary. Participants could request a free HIV test at a local community clinic, and completed questionnaires on HIV risk behaviors and social media use at baseline and 12-week follow-up. Findings Between March 19, 2012, and June 11, 2012, and Sept 26, 2012, and Dec 19, 2012, 556 participants were randomly assigned to intervention groups (N=278) or control groups (N=278); we analyse data for 252 and 246. 43 participants (17%) in the intervention group and 16 (7%) in the control groups got tested for HIV (adjusted odds ratio 2.61, 95% CI 1.55–4.38). No adverse events were reported. Retention at 12-week follow-up was 90%. Across conditions, 7 (87.5%) of the 8 participants who tested positive were linked to care at a local clinic. Interpretation Development of peer-mentored social media communities seemed to be an effective method to increase HIV testing among high-risk populations in Peru.: Results suggest that the HOPE social

  13. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial.

    Science.gov (United States)

    Dupont, Corinne; Winer, Norbert; Rabilloud, Muriel; Touzet, Sandrine; Branger, Bernard; Lansac, Jacques; Gaucher, Laurent; Duclos, Antoine; Huissoud, Cyril; Boutitie, Florent; Rudigoz, René-Charles; Colin, Cyrille

    2017-08-01

    Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and

  14. Does clinical equipoise apply to cluster randomized trials in health research?

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2011-05-01

    Full Text Available Abstract This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs in health research. In the introductory paper in this series, Weijer and colleagues set out six areas of inquiry that must be addressed if the cluster trial is to be set on a firm ethical foundation. This paper addresses the third of the questions posed, namely, does clinical equipoise apply to CRTs in health research? The ethical principle of beneficence is the moral obligation not to harm needlessly and, when possible, to promote the welfare of research subjects. Two related ethical problems have been discussed in the CRT literature. First, are control groups that receive only usual care unduly disadvantaged? Second, when accumulating data suggests the superiority of one intervention in a trial, is there an ethical obligation to act? In individually randomized trials involving patients, similar questions are addressed by the concept of clinical equipoise, that is, the ethical requirement that, at the start of a trial, there be a state of honest, professional disagreement in the community of expert practitioners as to the preferred treatment. Since CRTs may not involve physician-researchers and patient-subjects, the applicability of clinical equipoise to CRTs is uncertain. Here we argue that clinical equipoise may be usefully grounded in a trust relationship between the state and research subjects, and, as a result, clinical equipoise is applicable to CRTs. Clinical equipoise is used to argue that control groups receiving only usual care are not disadvantaged so long as the evidence supporting the experimental and control interventions is such that experts would disagree as to which is preferred. Further, while data accumulating during the course of a CRT may favor one intervention over another, clinical equipoise supports continuing the trial until the results are likely to be broadly convincing, often coinciding with the planned

  15. Efficacy and effectiveness as aspects of cluster randomized trials with nursing home residents: methodological insights from a pneumonia prevention trial.

    Science.gov (United States)

    Van Ness, Peter H; Peduzzi, Peter N; Quagliarello, Vincent J

    2012-11-01

    This report discusses how methodological aspects of study efficacy and effectiveness combine in cluster randomized trials in nursing homes. Discussion focuses on the relationships between these study aspects in the Pneumonia Reduction in Institutionalized Disabled Elders (PRIDE) trial, an ongoing cluster randomized clinical trial of pneumonia prevention among nursing home residents launched in October 2009 in Greater New Haven, Connecticut. This clinical trial has enrolled long-term care nursing home residents, over 65years in age, who have either inadequate oral care or swallowing difficulty, previously identified risk factors for pneumonia. It has used a multicomponent intervention consisting of manual tooth/gum brushing, 0.12% chlorhexidine oral rinse administered twice daily by nurses, and upright feeding positioning at meals to reduce rates of radiographically documented pneumonia. Cluster randomization is attractive for nursing home intervention studies because physical proximity and administrative arrangements make it difficult to deliver different interventions to residents of the same nursing home. Implementing an intervention in an entire home requires integration into the daily life of residents and into the administrative procedures of the nursing home. This characteristic of nursing home cluster randomized trials makes them approximate "real-world" research contexts, but implementation can be challenging. The PRIDE trial of pneumonia prevention utilized specific methodological choices that include both efficacy and effectiveness elements. Cluster randomized trials in nursing homes having elements of both efficacy and effectiveness (i.e., hybrid designs) can address some of the methodological challenges of conducting clinical research in nursing homes; they have distinctive advantages and some limitations.

  16. Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Jiong Lu; Yao Cheng; Xian-Ze Xiong; Yi-Xin Lin; Si-Jia Wu; Nan-Sheng Cheng

    2012-01-01

    AIM:To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.METHODS:Four databases,including PubMed,Embase,the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011,were searched to identify all randomized controlled trials (RCTs).Data were extracted from the studies by two independent reviewers.The primary outcomes were stone clearance from the common bile duct,postoperative morbidity and mortality.The secondary outcomes were conversion to other procedures,number of procedures per patient,length of hospital stay,total operative time,hospitalization charges,patient acceptance and quality of life scores.RESULTS:Seven eligible RCTs [five trials (n =621)comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC +laparoscopic common bile duct exploration (LCBDE);two trials (n =166) comparing postoperative ERCP/EST + LC with LC + LCBDE],composed of 787 patients in total,were included in the final analysis.The metaanalysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) =-0.10,95% confidence intervals (CI):-0.24 to 0.04,P =0.17],postoperative morbidity (RR =0.79,95% CI:0.58 to 1.10,P =0.16),mortality (RR =2.19,95% CI:0.33 to 14.67,P =0.42),conversion to other procedures (RR =1.21,95% CI:0.54 to 2.70,P =0.39),length of hospital stay (MD =0.99,95% CI:-1.59 to 3.57,P =0.45),total operative time (MD =12.14,95% CI:-1.83 to 26.10,P =0.09).Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.CONCLUSION:Single-stage management is equivalent to two-stage management but requires fewer procedures.However,patient's condition,operator's expertise and local resources should be taken into account in

  17. Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial

    Science.gov (United States)

    Huizing, Anna R; Hamers, Jan PH; Gulpers, Math JM; Berger, Martijn PF

    2006-01-01

    Background Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents. Methods A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia). The wards were assigned at random to either educational intervention (3 wards) or control status (2 wards). The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS) at baseline and 1 month after intervention. Results Restraint use did not change significantly over time in the experimental group (55%–56%), compared to a significant increased use (P < 0.05) in the control group (56%–70%). The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group. Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group. Conclusion An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention. PMID:17067376

  18. Surgical mask to prevent influenza transmission in households: a cluster randomized trial.

    Directory of Open Access Journals (Sweden)

    Laetitia Canini

    Full Text Available BACKGROUND: Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households. METHODOLOGY AND PRINCIPAL FINDINGS: A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2% of the contacts in the intervention arm and in 25/158 (15.8% of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00. We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks. CONCLUSION: This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic. TRIAL REGISTRATION: clinicaltrials.gov NCT00774774.

  19. Who is the research subject in cluster randomized trials in health research?

    Directory of Open Access Journals (Sweden)

    Brehaut Jamie C

    2011-07-01

    Full Text Available Abstract This article is part of a series of papers examining ethical issues in cluster randomized trials (CRTs in health research. In the introductory paper in this series, we set out six areas of inquiry that must be addressed if the CRT is to be set on a firm ethical foundation. This paper addresses the first of the questions posed, namely, who is the research subject in a CRT in health research? The identification of human research subjects is logically prior to the application of protections as set out in research ethics and regulation. Aspects of CRT design, including the fact that in a single study the units of randomization, experimentation, and observation may differ, complicate the identification of human research subjects. But the proper identification of human research subjects is important if they are to be protected from harm and exploitation, and if research ethics committees are to review CRTs efficiently. We examine the research ethics literature and international regulations to identify the core features of human research subjects, and then unify these features under a single, comprehensive definition of human research subject. We define a human research subject as any person whose interests may be compromised as a result of interventions in a research study. Individuals are only human research subjects in CRTs if: (1 they are directly intervened upon by investigators; (2 they interact with investigators; (3 they are deliberately intervened upon via a manipulation of their environment that may compromise their interests; or (4 their identifiable private information is used to generate data. Individuals who are indirectly affected by CRT study interventions, including patients of healthcare providers participating in knowledge translation CRTs, are not human research subjects unless at least one of these conditions is met.

  20. Study protocol: The Adherence and Intensification of Medications (AIM study - a cluster randomized controlled effectiveness study

    Directory of Open Access Journals (Sweden)

    Selby Joe

    2010-10-01

    Full Text Available Abstract Background Many patients with diabetes have poor blood pressure (BP control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an effective partnership between providers who initiate and increase doses of effective medications and patients who adhere to the regimen. Methods In this cluster-randomized controlled effectiveness study, primary care teams within sites were randomized to a program led by a clinical pharmacist trained in motivational interviewing-based behavioral counseling approaches and authorized to make BP medication changes or to usual care. This study involved the collection of data during a 14-month intervention period in three Department of Veterans Affairs facilities and two Kaiser Permanente Northern California facilities. The clinical pharmacist was supported by clinical information systems that enabled proactive identification of, and outreach to, eligible patients identified on the basis of poor BP control and either medication refill gaps or lack of recent medication intensification. The primary outcome is the relative change in systolic blood pressure (SBP measurements over time. Secondary outcomes are changes in Hemoglobin A1c, low-density lipoprotein cholesterol (LDL, medication adherence determined from pharmacy refill data, and medication intensification rates. Discussion Integration of the three intervention elements - proactive identification, adherence counseling and medication intensification - is essential to achieve optimal levels of control for high-risk patients. Testing the effectiveness of this intervention at the team level allows us to study the program as it would typically be implemented within a clinic setting, including how it integrates with other elements of care. Trial Registration The ClinicalTrials.gov registration number is NCT

  1. A cluster-randomized evaluation of a responsive stimulation and feeding intervention in bangladesh.

    Science.gov (United States)

    Aboud, Frances E; Akhter, Sadika

    2011-05-01

    The goal of this study was to determine if a responsive stimulation and feeding intervention improved developmental and nutritional outcomes compared with a regular information-based parenting program. The hypothesis was that mothers in the intervention would exhibit better parenting skills and children would exhibit better developmental and nutritional outcomes than controls. A cluster-randomized field trial was conducted with 302 children aged 8 to 20 months and their mothers in rural Bangladesh who were randomly assigned according to village to 1 of 3 groups. The control mothers received 12 informational sessions on health and nutrition. The intervention groups received an additional 6 sessions delivered by peer educators who included modeling and coached practice in self-feeding and verbal responsiveness with the child during play. A second intervention group received, along with the sessions, 6 months of a food powder fortified with minerals and vitamins. Developmental outcomes included the Home Observation for Measurement of the Environment (HOME) Inventory, mother-child responsive talk, and language development. Nutritional outcomes included weight, height, self-feeding, and mouthfuls eaten. We used analysis of covariance to compare the 3 groups at the posttest and at follow-up, covarying the pretest levels and confounders. At follow-up, responsive stimulation-feeding groups had better HOME inventory scores, responsive talking, language, mouthfuls eaten, and hand-washing. Micronutrient fortification resulted in more weight gain. A brief behavior-change program that focused on modeling and practice in stimulation and feeding was found to benefit children's nutrition and language development. Micronutrients benefited children's weight but not length.

  2. A cluster-based randomized controlled trial promoting community participation in arsenic mitigation efforts in Bangladesh

    Directory of Open Access Journals (Sweden)

    George Christine

    2012-06-01

    Full Text Available Abstract Objective To reduce arsenic (As exposure, we evaluated the effectiveness of training community members to perform water arsenic (WAs testing and provide As education compared to sending representatives from outside communities to conduct these tasks. Methods We conducted a cluster based randomized controlled trial of 20 villages in Singair, Bangladesh. Fifty eligible respondents were randomly selected in each village. In 10 villages, a community member provided As education and WAs testing. In a second set of 10 villages an outside representative performed these tasks. Results Overall, 53% of respondents using As contaminated wells, relative to the Bangladesh As standard of 50 μg/L, at baseline switched after receiving the intervention. Further, when there was less than 60% arsenic contaminated wells in a village, the classification used by the Bangladeshi and UNICEF, 74% of study households in the community tester villages, and 72% of households in the outside tester villages reported switching to an As safe drinking water source . Switching was more common in the outside-tester (63% versus community-tester villages (44%. However, after adjusting for the availability of arsenic safe drinking water sources, well switching did not differ significantly by type of As tester (Odds ratio =0.86[95% confidence interval 0.42-1.77. At follow-up, among those using As contaminated wells who switched to safe wells, average urinary As concentrations significantly decreased. Conclusion The overall intervention was effective in reducing As exposure provided there were As-safe drinking water sources available. However, there was not a significant difference observed in the ability of the community and outside testers to encourage study households to use As-safe water sources. The findings of this study suggest that As education and WAs testing programs provided by As testers, irrespective of their residence, could be used as an effective, low cost

  3. Micronutrient-Fortified Rice Can Increase Hookworm Infection Risk: A Cluster Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Brechje de Gier

    Full Text Available Fortification of staple foods is considered an effective and safe strategy to combat micronutrient deficiencies, thereby improving health. While improving micronutrient status might be expected to have positive effects on immunity, some studies have reported increases in infections or inflammation after iron supplementation.To study effects of micronutrient-fortified rice on hookworm infection in Cambodian schoolchildren.A double-blinded, cluster-randomized trial was conducted in 16 Cambodian primary schools partaking in the World Food Program school meal program. Three types of multi-micronutrient fortified rice were tested against placebo rice within the school meal program: UltraRice_original, UltraRice_improved and NutriRice. Four schools were randomly assigned to each study group (placebo n = 492, UltraRice_original n = 479, UltraRice_improved n = 500, NutriRice n = 506. Intestinal parasite infection was measured in fecal samples by Kato-Katz method at baseline and after three and seven months. In a subgroup (N = 330, fecal calprotectin was measured by ELISA as a marker for intestinal inflammation.Baseline prevalence of hookworm infection was 18.6%, but differed considerably among schools (range 0%- 48.1%.Micronutrient-fortified rice significantly increased risk of new hookworm infection. This effect was modified by baseline hookworm prevalence at the school; hookworm infection risk was increased by all three types of fortified rice in schools where baseline prevalence was high (>15%, and only by UltraRice_original in schools with low baseline prevalence. Neither hookworm infection nor fortified rice was related to fecal calprotectin.Consumption of rice fortified with micronutrients can increase hookworm prevalence, especially in environments with high infection pressure. When considering fortification of staple foods, a careful risk-benefit analysis is warranted, taking into account severity of micronutrient deficiencies and local

  4. Web-based consultation between general practitioners and nephrologists: a cluster randomized controlled trial.

    Science.gov (United States)

    van Gelder, Vincent A; Scherpbier-de Haan, Nynke D; van Berkel, Saskia; Akkermans, Reinier P; de Grauw, Inge S; Adang, Eddy M; Assendelft, Pim J; de Grauw, Wim J C; Biermans, Marion C J; Wetzels, Jack F M

    2017-08-01

    Consultation of a nephrologist is important in aligning care for patients with chronic kidney disease (CKD) at the primary-secondary care interface. However, current consultation methods come with practical difficulties that can lead to postponed consultation or patient referral instead. This study aimed to investigate whether a web-based consultation platform, telenephrology, led to a lower referral rate of indicated patients. Furthermore, we assessed consultation rate, quality of care, costs and general practitioner (GPs') experiences with telenephrology. Cluster randomized controlled trial with 47 general practices in the Netherlands was randomized to access to telenephrology or to enhanced usual care. A total of 3004 CKD patients aged 18 years or older who were under primary care were included (intervention group n = 1277, control group n = 1727) and 2693 completed the trial. All practices participated in a CKD management course and were given an overview of their CKD patients. The referral rates amounted to 2.3% (n = 29) in the intervention group and 3.0% (n = 52) in the control group, which was a non-significant difference, OR 0.61; 95% CI 0.31 to 1.23. The intervention group's consultation rate was 6.3% (n = 81) against 5.0% (n = 87) (OR 2.00; 95% CI 0.75-5.33). We found no difference in quality of care or costs. The majority of GPs had a positive opinion about telenephrology. The data in our study do not allow for conclusions on the effect of telenephrology on the rate of patient referrals and provider-to-provider consultations, compared to conventional methods. It was positively evaluated by GPs and was non-inferior in terms of quality of care and costs.

  5. Meta-analysis using individual participant data: one-stage and two-stage approaches, and why they may differ.

    Science.gov (United States)

    Burke, Danielle L; Ensor, Joie; Riley, Richard D

    2017-02-28

    Meta-analysis using individual participant data (IPD) obtains and synthesises the raw, participant-level data from a set of relevant studies. The IPD approach is becoming an increasingly popular tool as an alternative to traditional aggregate data meta-analysis, especially as it avoids reliance on published results and provides an opportunity to investigate individual-level interactions, such as treatment-effect modifiers. There are two statistical approaches for conducting an IPD meta-analysis: one-stage and two-stage. The one-stage approach analyses the IPD from all studies simultaneously, for example, in a hierarchical regression model with random effects. The two-stage approach derives aggregate data (such as effect estimates) in each study separately and then combines these in a traditional meta-analysis model. There have been numerous comparisons of the one-stage and two-stage approaches via theoretical consideration, simulation and empirical examples, yet there remains confusion regarding when each approach should be adopted, and indeed why they may differ. In this tutorial paper, we outline the key statistical methods for one-stage and two-stage IPD meta-analyses, and provide 10 key reasons why they may produce different summary results. We explain that most differences arise because of different modelling assumptions, rather than the choice of one-stage or two-stage itself. We illustrate the concepts with recently published IPD meta-analyses, summarise key statistical software and provide recommendations for future IPD meta-analyses. © 2016 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

  6. Loss Function Based Ranking in Two-Stage, Hierarchical Models

    Science.gov (United States)

    Lin, Rongheng; Louis, Thomas A.; Paddock, Susan M.; Ridgeway, Greg

    2009-01-01

    Performance evaluations of health services providers burgeons. Similarly, analyzing spatially related health information, ranking teachers and schools, and identification of differentially expressed genes are increasing in prevalence and importance. Goals include valid and efficient ranking of units for profiling and league tables, identification of excellent and poor performers, the most differentially expressed genes, and determining “exceedances” (how many and which unit-specific true parameters exceed a threshold). These data and inferential goals require a hierarchical, Bayesian model that accounts for nesting relations and identifies both population values and random effects for unit-specific parameters. Furthermore, the Bayesian approach coupled with optimizing a loss function provides a framework for computing non-standard inferences such as ranks and histograms. Estimated ranks that minimize Squared Error Loss (SEL) between the true and estimated ranks have been investigated. The posterior mean ranks minimize SEL and are “general purpose,” relevant to a broad spectrum of ranking goals. However, other loss functions and optimizing ranks that are tuned to application-specific goals require identification and evaluation. For example, when the goal is to identify the relatively good (e.g., in the upper 10%) or relatively poor performers, a loss function that penalizes classification errors produces estimates that minimize the error rate. We construct loss functions that address this and other goals, developing a unified framework that facilitates generating candidate estimates, comparing approaches and producing data analytic performance summaries. We compare performance for a fully parametric, hierarchical model with Gaussian sampling distribution under Gaussian and a mixture of Gaussians prior distributions. We illustrate approaches via analysis of standardized mortality ratio data from the United States Renal Data System. Results show that SEL

  7. Progress in the Past Decade: An Examination of the Precision of Cluster Randomized Trials Funded by the U.S. Institute of Education Sciences

    Science.gov (United States)

    Spybrook, Jessaca; Shi, Ran; Kelcey, Benjamin

    2016-01-01

    This article examines the statistical precision of cluster randomized trials (CRTs) funded by the Institute of Education Sciences (IES). Specifically, it compares the total number of clusters randomized and the minimum detectable effect size (MDES) of two sets of studies, those funded in the early years of IES (2002-2004) and those funded in the…

  8. Bayesian and frequentist two-stage treatment strategies based on sequential failure times subject to interval censoring.

    Science.gov (United States)

    Thall, Peter F; Wooten, Leiko H; Logothetis, Christopher J; Millikan, Randall E; Tannir, Nizar M

    2007-11-20

    For many diseases, therapy involves multiple stages, with the treatment in each stage chosen adaptively based on the patient's current disease status and history of previous treatments and clinical outcomes. Physicians routinely use such multi-stage treatment strategies, also called dynamic treatment regimes or treatment policies. We present a Bayesian framework for a clinical trial comparing two-stage strategies based on the time to overall failure, defined as either second disease worsening or discontinuation of therapy. Each patient is randomized among a set of treatments at enrollment, and if disease worsening occurs the patient is then re-randomized among a set of treatments excluding the treatment received initially. The goal is to select the two-stage strategy having the largest average overall failure time. A parametric model is formulated to account for non-constant failure time hazards, regression of the second failure time on the patient's first worsening time, and the complications that the failure time in either stage may be interval censored and there may be a delay between first worsening and the start of the second stage of therapy. Four different criteria, two Bayesian and two frequentist, for selecting a best strategy are considered. The methods are applied to a trial comparing two-stage strategies for treating metastatic renal cancer, and a simulation study in the context of this trial is presented. Advantages and disadvantages of this design compared to standard methods are discussed.

  9. Allowing for imprecision of the intracluster correlation coefficient in the design of cluster randomized trials.

    Science.gov (United States)

    Turner, Rebecca M; Prevost, A Toby; Thompson, Simon G

    2004-04-30

    The sample size required for a cluster randomized trial depends on the magnitude of the intracluster correlation coefficient (ICC). The usual sample size calculation makes no allowance for the fact that the ICC is not known precisely in advance. We develop methods which allow for the uncertainty in a previously observed ICC, using a variety of distributional assumptions. Distributions for the power are derived, reflecting this uncertainty. Further, the observed ICC in a future study will not equal its true value, and we consider the impact of this on power. We implement calculations within a Bayesian simulation approach, and provide one simplification that can be performed using simple simulation within spreadsheet software. In our examples, recognizing the uncertainty in a previous ICC estimate decreases expected power, especially when the power calculated naively from the ICC estimate is high. To protect against the possibility of low power, sample sizes may need to be very substantially increased. Recognizing the variability in the future observed ICC has little effect if prior uncertainty has already been taken into account. We show how our method can be extended to the case in which multiple prior ICC estimates are available. The methods presented in this paper can be used by applied researchers to protect against loss of power, or to choose a design which reduces the impact of uncertainty in the ICC. Copyright 2004 John Wiley & Sons, Ltd.

  10. Ant Colony Clustering Algorithm and Improved Markov Random Fusion Algorithm in Image Segmentation of Brain Images

    Directory of Open Access Journals (Sweden)

    Guohua Zou

    2016-12-01

    Full Text Available New medical imaging technology, such as Computed Tomography and Magnetic Resonance Imaging (MRI, has been widely used in all aspects of medical diagnosis. The purpose of these imaging techniques is to obtain various qualitative and quantitative data of the patient comprehensively and accurately, and provide correct digital information for diagnosis, treatment planning and evaluation after surgery. MR has a good imaging diagnostic advantage for brain diseases. However, as the requirements of the brain image definition and quantitative analysis are always increasing, it is necessary to have better segmentation of MR brain images. The FCM (Fuzzy C-means algorithm is widely applied in image segmentation, but it has some shortcomings, such as long computation time and poor anti-noise capability. In this paper, firstly, the Ant Colony algorithm is used to determine the cluster centers and the number of FCM algorithm so as to improve its running speed. Then an improved Markov random field model is used to improve the algorithm, so that its antinoise ability can be improved. Experimental results show that the algorithm put forward in this paper has obvious advantages in image segmentation speed and segmentation effect.

  11. Prevention of Anxiety and Depression in Swedish School Children: a Cluster-Randomized Effectiveness Study.

    Science.gov (United States)

    Ahlen, Johan; Hursti, Timo; Tanner, Lindsey; Tokay, Zelal; Ghaderi, Ata

    2017-07-20

    Our study aimed at evaluating FRIENDS for Life, an intervention to prevent anxiety and depression in Swedish school children. A total of 695 children between the ages of 8 and 11 were recruited from 17 schools in Stockholm, Sweden, and cluster-randomized to either the intervention or control group. Teachers in the intervention group received a full day of training and administered FRIENDS for Life in their classrooms. We assessed the children's anxiety and depressive symptoms, general mental health, and academic performance at pre- and post-intervention as well as at the 12-month follow-up. A multi-informant approach was used with data collected from children, parents, and teachers. Assessment was done with the Spence Children's Anxiety Scale, Children's Depression Inventory, and the Strengths and Difficulties Questionnaire. Children's baseline symptoms, gender, and age as well as their teacher's use of supervision were examined as moderators of effect. Our study found no short- or long-term effects of the intervention for any outcome with regard to the entire sample. We found an enhanced effect of the intervention regarding children with elevated depressive symptoms at baseline. We found a decrease in anxiety symptoms among children whose teachers attended a larger number of supervision sessions, compared to children whose teachers attended fewer supervised sessions or the control group. Mediation analyses showed that this effect was driven by change in the last phase of the intervention, suggesting that supervision might play an important role in enhancing teachers' ability to administer the intervention effectively.

  12. Cluster-randomized trial demonstrating impact on academic achievement of elementary social-emotional learning.

    Science.gov (United States)

    Schonfeld, David J; Adams, Ryan E; Fredstrom, Bridget K; Weissberg, Roger P; Gilman, Richard; Voyce, Charlene; Tomlin, Ricarda; Speese-Linehan, Dee

    2015-09-01

    This study evaluated the results of a social and emotional learning (SEL) program on academic achievement among students attending a large, urban, high-risk school district. Using a cluster-randomized design, 24 elementary schools were assigned to receive either the intervention curriculum (Promoting Alternative Thinking Strategies, or PATHS) or a curriculum that delivered few if any SEL topics (i.e., the control group). In addition to state mastery test scores, demographic data, school attendance, and dosage information were obtained from 705 students who remained in the same group from the 3rd to the 6th grade. Analyses of odds ratios revealed that students enrolled in the intervention schools demonstrated higher levels of basic proficiency in reading, writing, and math at some grade levels. Although these between-groups differences held for race/ethnicity, gender, and socioeconomic status, significant within-group differences also were noted across these variables. Collectively, these findings indicated that social development instruction may be a promising approach to promote acquisition of academic proficiency, especially among youth attending high-risk school settings. Implications of these findings with respect to SEL programs conclude the article.

  13. Complex Contagions and hybrid phase transitions in unclustered and clustered random networks

    CERN Document Server

    Miller, Joel C

    2015-01-01

    A complex contagion is an infectious process in which an individual may require multiple transmissions. We typically think of individuals beginning inactive and becoming active once they are contacted by sufficient numbers of active partners. These have been studied in a number of contexts, but the analytic models for dynamic spread of complex contagions are typically complex. Here we study the dynamics of a generalized Watts Threshold Model (gWTM). We first show that a wide range of other processes can be thought of as a special case of this gWTM. Then we adapt an "edge-based compartmental modeling" approach used for infectious diseases in networks to develop and analyze analytic models for the dynamics the gWTM in configuration model and a class of random clustered (triangle-based) networks. The resulting model is relatively simple and compact, and we use this model to gain insights into the dynamics. Under some conditions a cascade can happen with an arbitrarily small initial proportion active, and we deri...

  14. Researchers’ perceptions of ethical challenges in cluster randomized trials: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    McRae Andrew D

    2013-01-01

    Full Text Available Abstract Background Cluster randomized trials (CRTs pose ethical challenges for investigators and ethics committees. This study describes the views and experiences of CRT researchers with respect to: (1 ethical challenges in CRTs; (2 the ethics review process for CRTs; and (3 the need for comprehensive ethics guidelines for CRTs. Methods Descriptive qualitative analysis of interviews conducted with a purposive sample of 20 experienced CRT researchers. Results Informants expressed concern over the potential for bias that may result from requirements to obtain informed consent from research participants in CRTs. Informants suggested that the need for informed consent ought to be related to the type of intervention under study in a CRT. Informants rarely expressed concern regarding risks to research participants in CRTs, other than risks to privacy. Important issues identified in the research ethics literature, including fair subject selection and other justice issues, were not mentioned by informants. The ethics review process has had positive and negative impacts on CRT conduct. Informants stated that variability in ethics review between jurisdictions, and increasingly stringent ethics review in recent years, have hampered their ability to conduct CRTs. Many informants said that comprehensive ethics guidelines for CRTs would be helpful to researchers and research ethics committees. Conclusions Informants identified key ethical challenges in the conduct of CRTs, specifically relating to identifying subjects, seeking informed consent, and the use of gatekeepers. These data have since been used to identify topics for in-depth ethical analysis and to guide the development of comprehensive ethics guidelines for CRTs.

  15. Group Music Therapy as a Preventive Intervention for Young People at Risk: Cluster-Randomized Trial.

    Science.gov (United States)

    Gold, Christian; Saarikallio, Suvi; Crooke, Alexander Hew Dale; McFerran, Katrina Skewes

    2017-07-01

    Music forms an important part of the lives and identities of adolescents and may have positive or negative mental health implications. Music therapy can be effective for mental disorders such as depression, but its preventive potential is unknown. The aim of this study was to examine whether group music therapy (GMT) is an effective intervention for young people who may be at risk of developing mental health problems, as indicated via unhealthy music use. The main question was whether GMT can reduce unhealthy uses of music and increase potentials for healthy uses of music, compared to self-directed music listening (SDML). We were also interested in effects of GMT on depressive symptoms, psychosocial well-being, rumination, and reflection. In an exploratory cluster-randomized trial in Australian schools, 100 students with self-reported unhealthy music use were invited to GMT (weekly sessions over 8 weeks) or SDML. Changes in the Healthy-Unhealthy Music Scale (HUMS) and mental health outcomes were measured over 3 months. Both interventions were well accepted. No effects were found between GMT and SDML (all p > 0.05); both groups tended to show small improvements over time. Younger participants benefited more from GMT, and older ones more from SDML (p = 0.018). GMT was associated with similar changes as SDML. Further research is needed to improve the processes of selecting participants for targeted interventions; to determine optimal dosage; and to provide more reliable evidence of effects of music-based interventions for adolescents.

  16. An Empirical Investigation of Variance Design Parameters for Planning Cluster-Randomized Trials of Science Achievement.

    Science.gov (United States)

    Westine, Carl D; Spybrook, Jessaca; Taylor, Joseph A

    2013-12-01

    Prior research has focused primarily on empirically estimating design parameters for cluster-randomized trials (CRTs) of mathematics and reading achievement. Little is known about how design parameters compare across other educational outcomes. This article presents empirical estimates of design parameters that can be used to appropriately power CRTs in science education and compares them to estimates using mathematics and reading. Estimates of intraclass correlations (ICCs) are computed for unconditional two-level (students in schools) and three-level (students in schools in districts) hierarchical linear models of science achievement. Relevant student- and school-level pretest and demographic covariates are then considered, and estimates of variance explained are computed. Subjects: Five consecutive years of Texas student-level data for Grades 5, 8, 10, and 11. Science, mathematics, and reading achievement raw scores as measured by the Texas Assessment of Knowledge and Skills. Results: Findings show that ICCs in science range from .172 to .196 across grades and are generally higher than comparable statistics in mathematics, .163-.172, and reading, .099-.156. When available, a 1-year lagged student-level science pretest explains the most variability in the outcome. The 1-year lagged school-level science pretest is the best alternative in the absence of a 1-year lagged student-level science pretest. Science educational researchers should utilize design parameters derived from science achievement outcomes. © The Author(s) 2014.

  17. Improving blood pressure control through provider education, provider alerts, and patient education: a cluster randomized trial.

    Science.gov (United States)

    Roumie, Christianne L; Elasy, Tom A; Greevy, Robert; Griffin, Marie R; Liu, Xulei; Stone, William J; Wallston, Kenneth A; Dittus, Robert S; Alvarez, Vincent; Cobb, Janice; Speroff, Theodore

    2006-08-01

    Inadequate blood pressure control is a persistent gap in quality care. To evaluate provider and patient interventions to improve blood pressure control. Cluster randomized, controlled trial. 2 hospital-based and 8 community-based clinics in the Veterans Affairs Tennessee Valley Healthcare System. 1341 veterans with essential hypertension cared for by 182 providers. Eligible patients had 2 or more blood pressure measurements greater than 140/90 mm Hg in a 6-month period and were taking a single antihypertensive agent. Providers who cared for eligible patients were randomly assigned to receive an e-mail with a Web-based link to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines (provider education); provider education and a patient-specific hypertension computerized alert (provider education and alert); or provider education, hypertension alert, and patient education, in which patients were sent a letter advocating drug adherence, lifestyle modification, and conversations with providers (patient education). Proportion of patients with a systolic blood pressure less than 140 mm Hg at 6 months; intensification of antihypertensive medication. Mean baseline blood pressure was 157/83 mm Hg with no differences between groups (P = 0.105). Six-month follow-up data were available for 975 patients (73%). Patients of providers who were randomly assigned to the patient education group had better blood pressure control (138/75 mm Hg) than those in the provider education and alert or provider education alone groups (146/76 mm Hg and 145/78 mm Hg, respectively). More patients in the patient education group had a systolic blood pressure of 140 mm Hg or less compared with those in the provider education or provider education and alert groups (adjusted relative risk for the patient education group compared with the provider education alone group, 1.31 [95% CI, 1.06 to 1.62]; P = 0

  18. Effect partitioning under interference in two-stage randomized vaccine trials.

    Science.gov (United States)

    Vanderweele, Tyler J; Tchetgen Tchetgen, Eric J

    2011-07-01

    In the presence of interference, the exposure of one individual may affect the outcomes of others. We provide new effect partitioning results under interferences that express the overall effect as a sum of (i) the indirect (or spillover) effect and (ii) a contrast between two direct effects.

  19. Relationship between clustering and algorithmic phase transitions in the random k-XORSAT model and its NP-complete extensions

    CERN Document Server

    Altarelli, Fabrizio; Zamponi, Francesco

    2007-01-01

    We study the performances of stochastic heuristic search algorithms on Uniquely Extendible Constraint Satisfaction Problems with random inputs. We show that, for any heuristic preserving the Poissonian nature of the underlying instance, the (heuristic-dependent) largest ratio $\\alpha_a$ of constraints per variables for which a search algorithm is likely to find solutions is smaller than the critical ratio $\\alpha_d$ above which solutions are clustered and highly correlated. In addition we show that the clustering ratio can be reached when the number k of variables per constraints goes to infinity by the so-called Generalized Unit Clause heuristic.

  20. A Cluster-Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use for Acute Bronchitis

    Science.gov (United States)

    Gonzales, Ralph; Anderer, Tammy; McCulloch, Charles E.; Maselli, Judith H.; Bloom, Frederick J; Graf, Thomas R; Stahl, Melissa; Yefko, Michelle; Molecavage, Julie; Metlay, Joshua P

    2013-01-01

    Background National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the impact of two decision support strategies on antibiotic treatment of uncomplicated acute bronchitis. Methods We conducted a three-arm, cluster-randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed intervention arm (n=11 practices) received decision support for acute cough illness through a print-based strategy, the computerized intervention group (n=11) received decision support through an electronic medical record-based strategy, and third group of practices (n=11) served as the control arm. Both intervention groups also received provider education and feedback on prescribing practices, and patient education brochures at check-in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 2009 – March 2010) following introduction of the intervention were compared with the previous three winter periods in an intent-to-treat analysis. Results Compared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed (from 80.0% to 68.3%) and computerized intervention sites (from 74.0% to 60.7%), but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and provider characteristics, and clustering of observations by provider and practice site, the differences for the intervention groups were statistically significant from control (control vs. printed P=0.003; control vs. computerized P=0.014) but no among themselves (printed vs. computerized P=0.67). Changes in total visits, proportion diagnosed as uncomplicated acute bronchitis and thirty-day return visit rates were similar between study groups. Conclusions Implementation of a decision support strategy for acute bronchitis can help reduce overuse

  1. A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis.

    Science.gov (United States)

    Gonzales, Ralph; Anderer, Tammy; McCulloch, Charles E; Maselli, Judith H; Bloom, Frederick J; Graf, Thomas R; Stahl, Melissa; Yefko, Michelle; Molecavage, Julie; Metlay, Joshua P

    2013-02-25

    National quality indicators show little change in the overuse of antibiotics for uncomplicated acute bronchitis. We compared the effect of 2 decision support strategies on antibiotic treatment of uncomplicated acute bronchitis. We conducted a 3-arm cluster randomized trial among 33 primary care practices belonging to an integrated health care system in central Pennsylvania. The printed decision support intervention sites (11 practices) received decision support for acute cough illness through a print-based strategy, the computer-assisted decision support intervention sites (11 practices) received decision support through an electronic medical record-based strategy, and the control sites (11 practices) served as a control arm. Both intervention sites also received clinician education and feedback on prescribing practices, as well as patient education brochures at check-in. Antibiotic prescription rates for uncomplicated acute bronchitis in the winter period (October 1, 2009, through March 31, 2010) following introduction of the intervention were compared with the previous 3 winter periods in an intent-to-treat analysis. Compared with the baseline period, the percentage of adolescents and adults prescribed antibiotics during the intervention period decreased at the printed decision support intervention sites (from 80.0% to 68.3%) and at the computer-assisted decision support intervention sites (from 74.0% to 60.7%) but increased slightly at the control sites (from 72.5% to 74.3%). After controlling for patient and clinician characteristics, as well as clustering of observations by clinician and practice site, the differences for the intervention sites were statistically significant from the control sites (P = .003 for control sites vs printed decision support intervention sites and P = .01 for control sites vs computer-assisted decision support intervention sites) but not between themselves (P = .67 for printed decision support intervention sites vs computer

  2. Enhancing a sustainable healthy working life: design of a clustered randomized controlled trial.

    Science.gov (United States)

    Koolhaas, Wendy; Brouwer, Sandra; Groothoff, Johan W; van der Klink, Jac Jl

    2010-08-06

    To improve a sustainable healthy working life, we have developed the intervention 'Staying healthy at work', which endeavours to enhance work participation of employees aged 45 years and older by increasing their problem-solving capacity and stimulating their awareness of their role and responsibility towards a healthy working life. This research study aims to evaluate the process and the effectiveness of the intervention compared with care as usual. The study is a cluster-randomized controlled trial design (randomized at the supervisor level), with a 1-year follow-up. Workers aged 45 years and older have been enrolled in the study. Workers in the intervention group are receiving the intervention 'Staying healthy at work'. The main focus of the intervention is to promote a healthy working life of ageing workers by: (1) changing workers awareness and behaviour, by emphasizing their own decisive role in attaining goals; (2) improving the supervisors' ability to support workers in taking the necessary action, by means of enhancing knowledge and competence; and (3) enhancing the use of the human resource professionals and the occupational health tools available within the organization. The supervisors in the intervention group have been trained how to present themselves as a source of support for the worker. Workers in the control group are receiving care as usual; supervisors in the control group have not participated in the training. Measurements have been taken at baseline and will be followed up at 3, 6 and 12 months. The primary outcome measures are vitality, work ability and productivity. The secondary outcomes measures include fatigue, job strain, work attitude, self-efficacy and work engagement. A process evaluation will be conducted at both the supervisor and the worker levels, and satisfaction with the content of the intervention will be assessed. The intervention 'Staying healthy at work' has the potential to provide evidence-based knowledge of an innovative

  3. Enhancing a sustainable healthy working life: design of a clustered randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Koolhaas Wendy

    2010-08-01

    Full Text Available Abstract Background To improve a sustainable healthy working life, we have developed the intervention 'Staying healthy at work', which endeavours to enhance work participation of employees aged 45 years and older by increasing their problem-solving capacity and stimulating their awareness of their role and responsibility towards a healthy working life. This research study aims to evaluate the process and the effectiveness of the intervention compared with care as usual. Methods/design The study is a cluster-randomized controlled trial design (randomized at the supervisor level, with a 1-year follow-up. Workers aged 45 years and older have been enrolled in the study. Workers in the intervention group are receiving the intervention 'Staying healthy at work'. The main focus of the intervention is to promote a healthy working life of ageing workers by: (1 changing workers awareness and behaviour, by emphasizing their own decisive role in attaining goals; (2 improving the supervisors' ability to support workers in taking the necessary action, by means of enhancing knowledge and competence; and (3 enhancing the use of the human resource professionals and the occupational health tools available within the organization. The supervisors in the intervention group have been trained how to present themselves as a source of support for the worker. Workers in the control group are receiving care as usual; supervisors in the control group have not participated in the training. Measurements have been taken at baseline and will be followed up at 3, 6 and 12 months. The primary outcome measures are vitality, work ability and productivity. The secondary outcomes measures include fatigue, job strain, work attitude, self-efficacy and work engagement. A process evaluation will be conducted at both the supervisor and the worker levels, and satisfaction with the content of the intervention will be assessed. Discussion The intervention 'Staying healthy at work' has the

  4. Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial

    Directory of Open Access Journals (Sweden)

    López-García-Franco Alberto

    2012-05-01

    Full Text Available Abstract Background Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services. Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. Methods/design This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain. The number of patients required is 242 (121 in each arm, all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. Discussion This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity

  5. Cost-consequence analysis of "washing without water" for nursing home residents: a cluster randomized trial.

    Science.gov (United States)

    Schoonhoven, Lisette; van Gaal, Betsie G I; Teerenstra, Steven; Adang, Eddy; van der Vleuten, Carine; van Achterberg, Theo

    2015-01-01

    No-rinse disposable wash gloves are increasingly implemented in health care to replace traditional soap and water bed baths without proper evaluation of (cost) effectiveness. To compare bed baths for effects on skin integrity and resistance against bathing and costs. Cluster randomized trial. Fifty six nursing home wards in the Netherlands. Participants: Five hundred adult care-dependent residents and 275 nurses from nursing home wards. The experimental condition 'washing without water' consists of a bed bath with disposable wash gloves made of non-woven waffled fibers, saturated with a no-rinse, quickly vaporizing skin cleaning and caring lotion. The control condition is a traditional bed bath using soap, water, washcloths and towels. Both conditions were continued for 6 weeks. Outcome measures were prevalence of skin damage distinguished in two levels of severity: any skin abnormality/lesion and significant skin lesions. Additional outcomes: resistance during bed baths, costs. Any skin abnormalities/lesions over time decreased slightly in the experimental group, and increased slightly in the control group, resulting in 72.7% vs 77.6% of residents having any skin abnormalities/lesions after 6 weeks, respectively (p=0.04). There were no differences in significant skin lesions or resistance after 6 weeks. Mean costs for bed baths during 6 weeks per resident were estimated at €218.30 (95%CI 150.52-286.08) in the experimental group and €232.20 (95%CI: 203.80-260.60) in the control group (difference €13.90 (95%CI: -25.61-53.42). Washing without water mildly protects from skin abnormalities/lesions, costs for preparing and performing bed baths do not differ from costs for traditional bed bathing. Thus, washing without water can be considered the more efficient alternative. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Universal School-Based Depression Prevention 'Op Volle Kracht': a Longitudinal Cluster Randomized Controlled Trial.

    Science.gov (United States)

    Tak, Yuli R; Lichtwarck-Aschoff, Anna; Gillham, Jane E; Van Zundert, Rinka M P; Engels, Rutger C M E

    2016-07-01

    The longitudinal effectiveness of a universal, adolescent school-based depression prevention program Op Volle Kracht (OVK) was evaluated by means of a cluster randomized controlled trial with intervention and control condition (school as usual). OVK was based on the Penn Resiliency Program (PRP) (Gillham et al. Psychological Science, 6, 343-351, 1995). Depressive symptoms were assessed with the Child Depression Inventory (Kovacs 2001). In total, 1341 adolescents participated, Mage = 13.91, SD = 0.55, 47.3 % girls, 83.1 % Dutch ethnicity; intervention group n = 655, four schools; control group n = 735, five schools. Intent-to-treat analyses revealed that OVK did not prevent depressive symptoms, β = -0.01, SE = 0.05, p = .829, Cohen's d = 0.02, and the prevalence of an elevated level of depressive symptoms was not different between groups at 1 year follow-up, OR = 1.00, 95 % CI = 0.60-1.65, p = .992, NNT = 188. Latent Growth Curve Modeling over the 2 year follow-up period showed that OVK did not predict differences in depressive symptoms immediately following intervention, intercept: β = 0.02, p = .642, or changes in depressive symptoms, slope: β = -0.01, p = .919. No moderation by gender or baseline depressive symptoms was found. To conclude, OVK was not effective in preventing depressive symptoms across the 2 year follow-up. The implications of these findings are discussed.

  7. Updated teaching techniques improve CPR performance measures: a cluster randomized, controlled trial.

    Science.gov (United States)

    Ettl, Florian; Testori, Christoph; Weiser, Christoph; Fleischhackl, Sabine; Mayer-Stickler, Monika; Herkner, Harald; Schreiber, Wolfgang; Fleischhackl, Roman

    2011-06-01

    The first-aid training necessary for obtaining a drivers license in Austria has a regulated and predefined curriculum but has been targeted for the implementation of a new course structure with less theoretical input, repetitive training in cardiopulmonary resuscitation (CPR) and structured presentations using innovative media. The standard and a new course design were compared with a prospective, participant- and observer-blinded, cluster-randomized controlled study. Six months after the initial training, we evaluated the confidence of the 66 participants in their skills, CPR effectiveness parameters and correctness of their actions. The median self-confidence was significantly higher in the interventional group [IG, visual analogue scale (VAS:"0" not-confident at all,"100" highly confident):57] than in the control group (CG, VAS:41). The mean chest compression rate in the IG (98/min) was closer to the recommended 100 bpm than in the CG (110/min). The time to the first chest compression (IG:25s, CG:36s) and time to first defibrillator shock (IG:86s, CG:92s) were significantly shorter in the IG. Furthermore, the IG participants were safer in their handling of the defibrillator and started with countermeasures against developing shock more often. The management of an unconscious person and of heavy bleeding did not show a difference between the two groups even after shortening the lecture time. Motivation and self-confidence as well as skill retention after six months were shown to be dependent on the teaching methods and the time for practical training. Courses may be reorganized and content rescheduled, even within predefined curricula, to improve course outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. Mental health first aid training for high school teachers: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Jorm Anthony F

    2010-06-01

    Full Text Available Abstract Background Mental disorders often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster randomized trial. Methods The trial was carried out with teachers in South Australian high schools. Teachers at 7 schools received training and those at another 7 were wait-listed for future training. The effects of the training on teachers were evaluated using questionnaires pre- and post-training and at 6 months follow-up. The questionnaires assessed mental health knowledge, stigmatizing attitudes, confidence in providing help to others, help actually provided, school policy and procedures, and teacher mental health. The indirect effects on students were evaluated using questionnaires at pre-training and at follow-up which assessed any mental health help and information received from school staff, and also the mental health of the student. Results The training increased teachers' knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training. However, no effects were found on teachers' individual support towards students with mental health problems or on student mental health. Conclusions Mental Health First Aid training has positive effects on teachers' mental health knowledge, attitudes, confidence and some aspects of their behaviour. Trial registration ACTRN12608000561381

  9. A cluster randomized trial to evaluate a health education programme "Living with Sun at School".

    Science.gov (United States)

    Sancho-Garnier, Hélène; Pereira, Bruno; Césarini, Pierre

    2012-07-01

    Over-exposure to sunlight increases the risk of skin cancers, particularly when exposure occurs during childhood. School teachers can play an active role in providing an education programme that can help prevent this. "Living with the Sun," (LWS) is a sun safety education program for school children based on a handy guide for classroom activities designed to improve children's knowledge, but moreover to positively modify their sun safety attitudes and behaviours. The goal of our study was to determine the effectiveness of this programme by examining children's knowledge, attitude and sun exposure behaviours prior to and after the completion of the programme. We carried out a cluster randomised trial in which the classes were randomly assigned to one of two groups; one using the LWS programme and another that didn't, serving as the control. Data was collected before completion of the programme and an additional three times in the year after completion. The 70 participating classes (1,365 schoolchildren) were distributed throughout France. Statistical analysis confirmed that knowledge of sun risk increased significantly in the LWS classes (p < 0.001). Both groups positively changed their attitudes when considering the best sun protection, but the LWS group proved to consistently be more convinced (p = 0.04). After the summer holidays, differences between the two groups decreased throughout the year but stayed globally significant. We also observed some significant behaviour modification during the holidays. For instance, the LWS group applied sunscreen more frequently than the control group, and were more likely to wear a hat (72% versus 59%) and use a sun umbrella on the beach (75% versus 64%).

  10. Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial.

    Directory of Open Access Journals (Sweden)

    Elvira Nouwens

    Full Text Available BACKGROUND: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM. METHOD: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22 were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23 could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project. RESULTS: No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale. CONCLUSIONS: The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.

  11. Effects of the X:IT smoking intervention: a school-based cluster randomized trial.

    Science.gov (United States)

    Andersen, Anette; Krølner, Rikker; Bast, Lotus Sofie; Thygesen, Lau Caspar; Due, Pernille

    2015-12-01

    Uptake of smoking in adolescence is still of major public health concern. Evaluations of school-based programmes for smoking prevention show mixed results. The aim of this study was to examine the effect of X:IT, a multi-component school-based programme to prevent adolescent smoking. Data from a Danish cluster randomized trial included 4041 year-7 students (mean age: 12.5) from 51 intervention and 43 control schools. Outcome measure 'current smoking' was dichotomized into smoking daily, weekly, monthly or more seldom vs do not smoke. Analyses were adjusted for baseline covariates: sex, family socioeconomic position (SEP), best friend's smoking and parental smoking. We performed multilevel, logistic regression analyses of available cases and intention-to-treat (ITT) analyses, replacing missing outcome values by multiple imputation. At baseline, 4.7% and 6.8% of the students at the intervention and the control schools smoked, respectively. After 1 year of the intervention, the prevalence was 7.9% and 10.7%, respectively. At follow-up, 553 students (13.7%) did not answer the question on smoking. Available case analyses: crude odds ratios (OR) for smoking at intervention schools compared with control schools: 0.65 (0.48-0.88) and adjusted: 0.70 (0.47-1.04). ITT analyses: crude OR for smoking at intervention schools compared with control schools: 0.67 (0.50-0.89) and adjusted: 0.61 (0.45-0.82). Students at intervention schools had a lower risk of smoking after a year of intervention in year 7. This multi-component intervention involving educational, parental and context-related intervention components seems to be efficient in lowering or postponing smoking uptake in Danish adolescents. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  12. Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records.

    Science.gov (United States)

    Dregan, Alex; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Ashworth, Mark; Charlton, Judith; Wolfe, Charles D A; Rudd, Anthony; Yardley, Lucy; Gulliford, Martin C; Trial Steering Committee

    2014-07-01

    The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records. Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models. There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875) participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47,887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was -0.56 mm Hg (95% confidence interval, -1.38 to 0.26; P=0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated. Large pragmatic intervention studies may be implemented at low cost by using electronic health records. The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies. http://www.controlled-trials.com. Current Controlled Trials identifier: ISRCTN35701810. © 2014 American Heart Association, Inc.

  13. Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial.

    Science.gov (United States)

    Vellinga, Akke; Galvin, Sandra; Duane, Sinead; Callan, Aoife; Bennett, Kathleen; Cormican, Martin; Domegan, Christine; Murphy, Andrew W

    2016-02-02

    Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections. We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing. The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention. A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. ClinicalTrials.gov, no. NCT01913860. © 2016 Canadian Medical Association or its licensors.

  14. Supportive supervision for volunteers to deliver reproductive health education: a cluster randomized trial.

    Science.gov (United States)

    Singh, Debra; Negin, Joel; Orach, Christopher Garimoi; Cumming, Robert

    2016-10-03

    Community Health Volunteers (CHVs) can be effective in improving pregnancy and newborn outcomes through community education. Inadequate supervision of CHVs, whether due to poor planning, irregular visits, or ineffective supervisory methods, is, however, recognized as a weakness in many programs. There has been little research on best practice supervisory or accompaniment models. From March 2014 to February 2015 a proof of concept study was conducted to compare training alone versus training and supportive supervision by paid CHWs (n = 4) on the effectiveness of CHVs (n = 82) to deliver education about pregnancy, newborn care, family planning and hygiene. The pair-matched cluster randomized trial was conducted in eight villages (four intervention and four control) in Budondo sub-county in Jinja, Uganda. Increases in desired behaviors were seen in both the intervention and control arms over the study period. Both arms showed high retention rates of CHVs (95 %). At 1 year follow-up there was a significantly higher prevalence of installed and functioning tippy taps for hand washing (p reproductive health care by addressing cultural norms and scientific misconceptions. Having a team of 2 CHWs to 40 CHVs enables close to community access to information, conversation and services. Supportive supervision involves creating a non-threatening, empowering environment in which both the CHV and the supervising CHW learn together and overcome obstacles that might otherwise demotivate the CHV. While the results seem promising for added value with supportive supervision for CHVs undertaking reproductive health activities, further research on a larger scale will be needed to substantiate the effect.

  15. Physical exercise at the workplace reduces perceived physical exertion during healthcare work: cluster randomized controlled trial.

    Science.gov (United States)

    Jakobsen, Markus Due; Sundstrup, Emil; Brandt, Mikkel; Jay, Kenneth; Aagaard, Per; Andersen, Lars L

    2015-11-01

    High physical exertion during work is a risk factor for musculoskeletal pain and long-term sickness absence. Physical exertion (RPE) reflects the balance between physical work demands and physical capacity of the individual. Thus, increasing the physical capacity through physical exercise may decrease physical exertion during work. This study investigates the effect of workplace-based versus home-based physical exercise on physical exertion during work (WRPE) among healthcare workers. 200 female healthcare workers (age: 42.0, body mass index: 24.1, average pain intensity: 3.1 on a scale of 0 to 10, average WRPE: 3.6 on a scale of 0 to 10) from 18 departments at three participating hospitals. Participants were randomly allocated at the cluster level to 10 weeks of: (1) workplace physical exercise (WORK) performed in groups during working hours for 5×10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (2) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Physical exertion was assessed at baseline and at 10-week follow-up. 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. Physical exertion was reduced more in WORK than HOME (pworkplace appears more effective than home-based exercise in reducing physical exertion during daily work tasks in healthcare workers. © 2015 the Nordic Societies of Public Health.

  16. School-based strategies for oral health education of adolescents- a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Haleem Abdul

    2012-12-01

    Full Text Available Abstract Background Oral health education (OHE in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education. Methods A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations. Results All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK, oral health behavior (OHB, oral hygiene status (OHS and combined knowledge, behavior and oral hygiene status (KBS scores than the self-learning and control groups (p Conclusions The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior. Trail registration SRCTN39391017

  17. Alcohol consumption and metabolic syndrome among Shanghai adults: A randomized multistage stratified cluster sampling investigation

    Institute of Scientific and Technical Information of China (English)

    Jian-Gao Fan; Xiao-Bu Cai; Lui Li; Xing-Jian Li; Fei Dai; Jun Zhu

    2008-01-01

    AIM: To examine the relations of alcohol consumption to the prevalence of metabolic syndrome in Shanghai adults.METHODS: We performed a cross-sectional analysis of data from the randomized multistage stratified cluster sampling of Shanghai adults, who were evaluated for alcohol consumption and each component of metabolic syndrome, using the adapted U.S. National Cholesterol Education Program criteria. Current alcohol consumption was defined as more than once of alcohol drinking per month.RESULTS: The study population consisted of 3953participants (1524 men) with a mean age of 54.3 ± 12.1years. Among them, 448 subjects (11.3%) were current alcohol drinkers, including 405 males and 43 females.After adjustment for age and sex, the prevalence of current alcohol drinking and metabolic syndrome in the general population of Shanghai was 13.0% and 15.3%,respectively. Compared with nondrinkers, the prevalence of hypertriglyceridemia and hypertension was higher while the prevalence of abdominal obesity, low serum high-density-lipoprotein cholesterol (HDL-C) and diabetes mellitus was lower in subjects who consumed alcohol twice or more per month, with a trend toward reducing the prevalence of metabolic syndrome. Among the current alcohol drinkers, systolic blood pressure, HDL-C, fasting plasma glucose, and prevalence of hypertriglyceridemia tended to increase with increased alcohol consumption.However, Iow-density-lipoprotein cholesterol concentration,prevalence of abdominal obesity, low serum HDL-C andmetabolic syndrome showed the tendency to decrease.Moreover, these statistically significant differences were independent of gender and age.CONCLUSION: Current alcohol consumption is associatedwith a lower prevalence of metabolic syndrome irrespe-ctive of alcohol intake (g/d), and has a favorable influence on HDL-C, waist circumference, and possible diabetes mellitus. However, alcohol intake increases the likelihoodof hypertension, hypertriglyceridemia and hyperglycemia

  18. Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial

    OpenAIRE

    Sugama Junko; Sanada Hiromi; Shigeta Yoshie; Nakagami Gojiro; Konya Chizuko

    2012-01-01

    Abstract Background Most older adults with urinary incontinence use absorbent pads. Because of exposure to moisture and chemical irritating substances in urine, the perineal skin region is always at risk for development of incontinence-associated dermatitis (IAD). The aim of this study was to examine the efficacy of an improved absorbent pad against IAD. Methods A cluster randomized controlled design was used to compare the efficacy of two absorbent pads. Female inpatients aged ≥65 years who ...

  19. Preemptive scheduling in a two-stage supply chain to minimize the makespan

    NARCIS (Netherlands)

    Pei, Jun; Fan, Wenjuan; Pardalos, Panos M.; Liu, Xinbao; Goldengorin, Boris; Yang, Shanlin

    2015-01-01

    This paper deals with the problem of preemptive scheduling in a two-stage supply chain framework. The supply chain environment contains two stages: production and transportation. In the production stage jobs are processed on a manufacturer's bounded serial batching machine, preemptions are allowed,

  20. The effectiveness of job rotation to prevent work-related musculoskeletal disorders: protocol of a cluster randomized clinical trial.

    Science.gov (United States)

    Comper, Maria Luiza Caires; Padula, Rosimeire Simprini

    2014-05-22

    Job rotation has often been used in situations where the level of exposure cannot be reduced due to the characteristics of the job or through physical measures. However, the effectiveness of the job rotation strategy at preventing musculoskeletal complaints lacks adequate scientific data. A cluster randomized controlled trial will be used to investigate the effectiveness of job rotation to prevent musculoskeletal disorders in industrial workers. The randomized cluster was based in characteristics of production sectors. A total cluster will be 4 sectors, and 957 workers will be recruited from a textile industry and randomly allocated into intervention or control groups. Both groups will receive training on ergonomics guidelines. In addition, the intervention group will perform job rotation, switching between tasks with low, moderate, and high risk for musculoskeletal complaints. The primary outcome will be the number of working hours lost due to sick leave by musculoskeletal injuries recorded in employee administrative data bases. Secondary outcomes measured via survey include: body parts with musculoskeletal pain, the intensity of this pain, physical workload, fatigue, general health status, physical activity level, and work productivity. Secondary outcome measures will be assessed at baseline and after 3, 6, 9, and 12 months. The cost-effectiveness analysis will be performed from the societal and company perspective. Prevention of work-related musculoskeletal disorders is beneficial for workers, employers, and society. The results of this study will provide new information about the effectiveness of job rotation as a strategy to reduce work-related musculoskeletal disorders. NCT01979731, November 3, 2013.

  1. A Two-Stage Queue Model to Optimize Layout of Urban Drainage System considering Extreme Rainstorms

    Directory of Open Access Journals (Sweden)

    Xinhua He

    2017-01-01

    Full Text Available Extreme rainstorm is a main factor to cause urban floods when urban drainage system cannot discharge stormwater successfully. This paper investigates distribution feature of rainstorms and draining process of urban drainage systems and uses a two-stage single-counter queue method M/M/1→M/D/1 to model urban drainage system. The model emphasizes randomness of extreme rainstorms, fuzziness of draining process, and construction and operation cost of drainage system. Its two objectives are total cost of construction and operation and overall sojourn time of stormwater. An improved genetic algorithm is redesigned to solve this complex nondeterministic problem, which incorporates with stochastic and fuzzy characteristics in whole drainage process. A numerical example in Shanghai illustrates how to implement the model, and comparisons with alternative algorithms show its performance in computational flexibility and efficiency. Discussions on sensitivity of four main parameters, that is, quantity of pump stations, drainage pipe diameter, rainstorm precipitation intensity, and confidence levels, are also presented to provide guidance for designing urban drainage system.

  2. A New Two-Stage Approach to Short Term Electrical Load Forecasting

    Directory of Open Access Journals (Sweden)

    Dragan Tasić

    2013-04-01

    Full Text Available In the deregulated energy market, the accuracy of load forecasting has a significant effect on the planning and operational decision making of utility companies. Electric load is a random non-stationary process influenced by a number of factors which make it difficult to model. To achieve better forecasting accuracy, a wide variety of models have been proposed. These models are based on different mathematical methods and offer different features. This paper presents a new two-stage approach for short-term electrical load forecasting based on least-squares support vector machines. With the aim of improving forecasting accuracy, one more feature was added to the model feature set, the next day average load demand. As this feature is unknown for one day ahead, in the first stage, forecasting of the next day average load demand is done and then used in the model in the second stage for next day hourly load forecasting. The effectiveness of the presented model is shown on the real data of the ISO New England electricity market. The obtained results confirm the validity advantage of the proposed approach.

  3. A Two-Stage Framework for 3D Face Reconstruction from RGBD Images.

    Science.gov (United States)

    Wang, Kangkan; Wang, Xianwang; Pan, Zhigeng; Liu, Kai

    2014-08-01

    This paper proposes a new approach for 3D face reconstruction with RGBD images from an inexpensive commodity sensor. The challenges we face are: 1) substantial random noise and corruption are present in low-resolution depth maps; and 2) there is high degree of variability in pose and face expression. We develop a novel two-stage algorithm that effectively maps low-quality depth maps to realistic face models. Each stage is targeted toward a certain type of noise. The first stage extracts sparse errors from depth patches through the data-driven local sparse coding, while the second stage smooths noise on the boundaries between patches and reconstructs the global shape by combining local shapes using our template-based surface refinement. Our approach does not require any markers or user interaction. We perform quantitative and qualitative evaluations on both synthetic and real test sets. Experimental results show that the proposed approach is able to produce high-resolution 3D face models with high accuracy, even if inputs are of low quality, and have large variations in viewpoint and face expression.

  4. Precision and cost considerations for two-stage sampling in a panelized forest inventory design.

    Science.gov (United States)

    Westfall, James A; Lister, Andrew J; Scott, Charles T

    2016-01-01

    Due to the relatively high cost of measuring sample plots in forest inventories, considerable attention is given to sampling and plot designs during the forest inventory planning phase. A two-stage design can be efficient from a field work perspective as spatially proximate plots are grouped into work zones. A comparison between subsampling with units of unequal size (SUUS) and a simple random sample (SRS) design in a panelized framework assessed the statistical and economic implications of using the SUUS design for a case study in the Northeastern USA. The sampling errors for estimates of forest land area and biomass were approximately 1.5-2.2 times larger with SUUS prior to completion of the inventory cycle. Considerable sampling error reductions were realized by using the zones within a post-stratified sampling paradigm; however, post-stratification of plots in the SRS design always provided smaller sampling errors in comparison. Cost differences between the two designs indicated the SUUS design could reduce the field work expense by 2-7 %. The results also suggest the SUUS design may provide substantial economic advantage for tropical forest inventories, where remote areas, poor access, and lower wages are typically encountered.

  5. A Two-Stage Compression Method for the Fault Detection of Roller Bearings

    Directory of Open Access Journals (Sweden)

    Huaqing Wang

    2016-01-01

    Full Text Available Data measurement of roller bearings condition monitoring is carried out based on the Shannon sampling theorem, resulting in massive amounts of redundant information, which will lead to a big-data problem increasing the difficulty of roller bearing fault diagnosis. To overcome the aforementioned shortcoming, a two-stage compressed fault detection strategy is proposed in this study. First, a sliding window is utilized to divide the original signals into several segments and a selected symptom parameter is employed to represent each segment, through which a symptom parameter wave can be obtained and the raw vibration signals are compressed to a certain level with the faulty information remaining. Second, a fault detection scheme based on the compressed sensing is applied to extract the fault features, which can compress the symptom parameter wave thoroughly with a random matrix called the measurement matrix. The experimental results validate the effectiveness of the proposed method and the comparison of the three selected symptom parameters is also presented in this paper.

  6. Randomized cluster crossover trials for reliable, efficient, comparative effectiveness testing: design of the Prevention of Arrhythmia Device Infection Trial (PADIT).

    Science.gov (United States)

    Connolly, Stuart J; Philippon, Francois; Longtin, Yves; Casanova, Amparo; Birnie, David H; Exner, Derek V; Dorian, Paul; Prakash, Ratika; Alings, Marco; Krahn, Andrew D

    2013-06-01

    Randomized clinical trials are a major advance in clinical research methodology. However, there are myriad important questions about the effectiveness of treatments used in daily practice that are not informed by the results of randomized trials. This is in part because of important limitations inherent in the methodology of randomized efficacy trials which are performed with tight control of inclusion, exclusion, treatment, and follow-up. This approach enhances evaluation of clinical efficacy (performance in controlled situations) but increases complexity and is not well suited to test clinical effectiveness (performance under conditions of actual use). The cluster crossover trial is a new concept for efficient comparative effectiveness testing. Deep tissue infection occurs in 2% of patients after arrhythmia device implantation, usually requires system extraction, and increases mortality. There is variation in antibiotic prophylaxis used to reduce implanted device infections. To efficiently evaluate the comparative effectiveness of antibiotic strategies now in use, we designed a cluster crossover clinical trial, which randomized implanting centres to 1 of 2 prophylactic antibiotic strategies, which became the standard care at the centre for 6 months, followed by crossover to the other strategy, rerandomization, and second crossover. This method greatly reduces trial complexity because it aligns study procedures with usual clinical care and increases generalizability. Pilot studies have tested the feasibility and an 10,800-patient trial, funded by the Canadian Institutes of Health Research, is now under way. The cluster crossover randomized trial design is well suited to efficiently test comparative effectiveness of existing treatments where there is variability of practice, clinical equipoise, and minimal risk.

  7. Minimizing makespan in a two-stage hybrid flow shop scheduling problem with open shop in one stage

    Institute of Scientific and Technical Information of China (English)

    DONG Jian-ming; HU Jue-liang; CHEN Yong

    2013-01-01

    This paper considers a scheduling problem in two-stage hybrid flow shop, where the first stage consists of two machines formed an open shop and the other stage has only one machine. The objective is to minimize the makespan, i.e., the maximum completion time of all jobs. We first show the problem is NP-hard in the strong sense, then we present two heuristics to solve the problem. Computational experiments show that the combined algorithm of the two heuristics performs well on randomly generated problem instances.

  8. Two-Stage Multi-Objective Collaborative Scheduling for Wind Farm and Battery Switch Station

    Directory of Open Access Journals (Sweden)

    Zhe Jiang

    2016-10-01

    Full Text Available In order to deal with the uncertainties of wind power, wind farm and electric vehicle (EV battery switch station (BSS were proposed to work together as an integrated system. In this paper, the collaborative scheduling problems of such a system were studied. Considering the features of the integrated system, three indices, which include battery swapping demand curtailment of BSS, wind curtailment of wind farm, and generation schedule tracking of the integrated system are proposed. In addition, a two-stage multi-objective collaborative scheduling model was designed. In the first stage, a day-ahead model was built based on the theory of dependent chance programming. With the aim of maximizing the realization probabilities of these three operating indices, random fluctuations of wind power and battery switch demand were taken into account simultaneously. In order to explore the capability of BSS as reserve, the readjustment process of the BSS within each hour was considered in this stage. In addition, the stored energy rather than the charging/discharging power of BSS during each period was optimized, which will provide basis for hour-ahead further correction of BSS. In the second stage, an hour-ahead model was established. In order to cope with the randomness of wind power and battery swapping demand, the proposed hour-ahead model utilized ultra-short term prediction of the wind power and the battery switch demand to schedule the charging/discharging power of BSS in a rolling manner. Finally, the effectiveness of the proposed models was validated by case studies. The simulation results indicated that the proposed model could realize complement between wind farm and BSS, reduce the dependence on power grid, and facilitate the accommodation of wind power.

  9. The Statistical Power of the Cluster Randomized Block Design with Matched Pairs--A Simulation Study

    Science.gov (United States)

    Dong, Nianbo; Lipsey, Mark

    2010-01-01

    This study uses simulation techniques to examine the statistical power of the group- randomized design and the matched-pair (MP) randomized block design under various parameter combinations. Both nearest neighbor matching and random matching are used for the MP design. The power of each design for any parameter combination was calculated from…

  10. Patient, Provider, and Combined Interventions for Managing Osteoarthritis in Primary Care: A Cluster Randomized Trial.

    Science.gov (United States)

    Allen, Kelli D; Oddone, Eugene Z; Coffman, Cynthia J; Jeffreys, Amy S; Bosworth, Hayden B; Chatterjee, Ranee; McDuffie, Jennifer; Strauss, Jennifer L; Yancy, William S; Datta, Santanu K; Corsino, Leonor; Dolor, Rowena J

    2017-03-21

    A single-site study showed that a combined patient and provider intervention improved outcomes for patients with knee osteoarthritis, but it did not assess separate effects of the interventions. To examine whether patient-based, provider-based, and patient-provider interventions improve osteoarthritis outcomes. Cluster randomized trial with assignment to patient, provider, and patient-provider interventions or usual care. (ClinicalTrials.gov: NCT01435109). 10 Duke University Health System community-based primary care clinics. 537 outpatients with symptomatic hip or knee osteoarthritis. The telephone-based patient intervention focused on weight management, physical activity, and cognitive behavioral pain management. The provider intervention involved electronic delivery of patient-specific osteoarthritis treatment recommendations to providers. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score at 12 months. Secondary outcomes were objective physical function (Short Physical Performance Battery) and depressive symptoms (Patient Health Questionnaire). Linear mixed models assessed the difference in improvement among groups. No difference was observed in WOMAC score changes from baseline to 12 months in the patient (-1.5 [95% CI, -5.1 to 2.0]; P = 0.40), provider (2.5 [CI, -0.9 to 5.9]; P = 0.152), or patient-provider (-0.7 [CI, -4.2 to 2.8]; P = 0.69) intervention groups compared with usual care. All groups had improvements in WOMAC scores at 12 months (range, -3.7 to -7.7). In addition, no differences were seen in objective physical function or depressive symptoms at 12 months in any of the intervention groups compared with usual care. The study involved 1 health care network. Data on provider referrals were not collected. Contrary to a previous study of a combined patient and provider intervention for osteoarthritis in a Department of Veterans Affairs medical center, this study found no statistically

  11. Intervention effects on adolescent physical activity in the multicomponent SPACE study: a cluster randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Mette Toftager

    Full Text Available BACKGROUND: Multicomponent school-based interventions have the potential to reduce the age-related decline in adolescents' physical activity (PA, yet there is not consistent evidence to guide non-curricular and school environment interventions. The aim of this study was to assess the effectiveness of a multicomponent environmental school-based intervention, designed to reduce the age-related decline in PA among adolescents. METHODS: A cluster randomized controlled trial was conducted with 7 intervention and 7 control schools. Baseline measurements were carried out in spring 2010 with 2 years of follow-up. A total of 1,348 students (11-13 years, in grade 5 and 6 enrolled in the study at baseline. The 14 schools included in the study were located in the Region of Southern Denmark. The intervention consisted of organizational and physical changes in the school environment with a total of 11 intervention components. The primary outcome measure was overall PA (cpm, counts per minute and was supported by analyses of time spent in MVPA, and time spent sedentary. Furthermore, a secondary outcome measure was PA in school time and during recess. PA was measured using accelerometer (Actigraph GT3X. RESULTS: A total of 797 students completed the trial and had valid accelerometer data. No significant difference was found for overall PA with an adjusted difference of -19.1 cpm (95% CI: -93, 53 or for school time activity with an adjusted difference of 6 cpm (95% CI: -73, 85. A sensitivity analysis revealed a positive significant intervention effect of PA in recess with an adjusted difference of 95 cpm. CONCLUSIONS: No evidence was found of the overall effect of a non-curricular multicomponent school-based intervention on PA among Danish adolescents. The intervention was positively associated with PA during school time and recess, however, with small estimates. Lack of effect on overall PA could be due to both program theory and different degrees of

  12. Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol.

    Science.gov (United States)

    Willging, Cathleen E; Green, Amy E; Ramos, Mary M

    2016-10-22

    Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain

  13. Two-stage crystallization of charged colloids under low supersaturation conditions.

    Science.gov (United States)

    Kratzer, Kai; Arnold, Axel

    2015-03-21

    We report simulations on the homogeneous liquid-fcc nucleation of charged colloids for both low and high contact energy values. As a precursor for crystal formation, we observe increased local order at the position where the crystal will form, but no correlations with the local density. Thus, the nucleation is driven by order fluctuations rather than density fluctuations. Our results also show that the transition involves two stages in both cases, first a transition of liquid → bcc, followed by a bcc → hcp/fcc transition. Both transitions have to overcome free energy barriers, so that a spherical bcc-like cluster is formed first, in which the final fcc structure is nucleated mainly at the surface of the crystallite. This means that the second stage bcc-fcc phase transition is a heterogeneous nucleation in the partially grown solid phase, even though we start from a homogeneous bulk liquid. The height of the bcc → hcp/fcc free energy barrier strongly depends on the contact energies of the colloids. For low contact energy this barrier is low, so that the bcc → hcp/fcc transition occurs spontaneously. For the higher contact energy, the second barrier is too high to be crossed spontaneously by the colloidal system. However, it was possible to ratchet the system over the second barrier and to transform the bcc nuclei into the stable hcp/fcc phase. The transitions are dominated by the first liquid-bcc transition and can be described by classical nucleation theory using an effective surface tension.

  14. DEVELOPMENT OF COLD CLIMATE HEAT PUMP USING TWO-STAGE COMPRESSION

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Bo [ORNL; Rice, C Keith [ORNL; Abdelaziz, Omar [ORNL; Shrestha, Som S [ORNL

    2015-01-01

    This paper uses a well-regarded, hardware based heat pump system model to investigate a two-stage economizing cycle for cold climate heat pump applications. The two-stage compression cycle has two variable-speed compressors. The high stage compressor was modelled using a compressor map, and the low stage compressor was experimentally studied using calorimeter testing. A single-stage heat pump system was modelled as the baseline. The system performance predictions are compared between the two-stage and single-stage systems. Special considerations for designing a cold climate heat pump are addressed at both the system and component levels.

  15. DEVELOPMENT OF COLD CLIMATE HEAT PUMP USING TWO-STAGE COMPRESSION

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Bo [ORNL; Rice, C Keith [ORNL; Abdelaziz, Omar [ORNL; Shrestha, Som S [ORNL

    2015-01-01

    This paper uses a well-regarded, hardware based heat pump system model to investigate a two-stage economizing cycle for cold climate heat pump applications. The two-stage compression cycle has two variable-speed compressors. The high stage compressor was modelled using a compressor map, and the low stage compressor was experimentally studied using calorimeter testing. A single-stage heat pump system was modelled as the baseline. The system performance predictions are compared between the two-stage and single-stage systems. Special considerations for designing a cold climate heat pump are addressed at both the system and component levels.

  16. Cluster Forests

    CERN Document Server

    Yan, Donghui; Jordan, Michael I

    2011-01-01

    Inspired by Random Forests (RF) in the context of classification, we propose a new clustering ensemble method---Cluster Forests (CF). Geometrically, CF randomly probes a high-dimensional data cloud to obtain "good local clusterings" and then aggregates via spectral clustering to obtain cluster assignments for the whole dataset. The search for good local clusterings is guided by a cluster quality measure $\\kappa$. CF progressively improves each local clustering in a fashion that resembles the tree growth in RF. Empirical studies on several real-world datasets under two different performance metrics show that CF compares favorably to its competitors. Theoretical analysis shows that the $\\kappa$ criterion is shown to grow each local clustering in a desirable way---it is "noise-resistant." A closed-form expression is obtained for the mis-clustering rate of spectral clustering under a perturbation model, which yields new insights into some aspects of spectral clustering.

  17. The Effect of Improved Water Supply on Diarrhea Prevalence of Children under Five in the Volta Region of Ghana: A Cluster-Randomized Controlled Trial

    National Research Council Canada - National Science Library

    Cha, Seungman; Kang, Douk; Tuffuor, Benedict; Lee, Gyuhong; Cho, Jungmyung; Chung, Jihye; Kim, Myongjin; Lee, Hoonsang; Lee, Jaeeun; Oh, Chunghyeon

    2015-01-01

    .... We report the results of a matched cluster randomized trial investigating the effect of improved water supply on diarrheal prevalence of children under five living in rural areas of the Volta Region in Ghana...

  18. Multistage Random Growing Small-World Networks with Power-Law Degree Distribution

    Institute of Scientific and Technical Information of China (English)

    LIU Jian-Guo; DANG Yan-Zhong; WANG Zhong-Tuo

    2006-01-01

    @@ We present a simple rule which could generate scale-free networks with very large clustering coefficient and very small average distance. These networks, called the multistage random growing networks (MRGNs), are constructed by a two-stage adding process for each new node. The analytic results of the power-law exponentγ = 3 and the clustering coefficient C = 0.81 are obtained, which agree with the simulation results approximately.

  19. A Bayesian Alternative to Mutual Information for the Hierarchical Clustering of Dependent Random Variables.

    Directory of Open Access Journals (Sweden)

    Guillaume Marrelec

    Full Text Available The use of mutual information as a similarity measure in agglomerative hierarchical clustering (AHC raises an important issue: some correction needs to be applied for the dimensionality of variables. In this work, we formulate the decision of merging dependent multivariate normal variables in an AHC procedure as a Bayesian model comparison. We found that the Bayesian formulation naturally shrinks the empirical covariance matrix towards a matrix set a priori (e.g., the identity, provides an automated stopping rule, and corrects for dimensionality using a term that scales up the measure as a function of the dimensionality of the variables. Also, the resulting log Bayes factor is asymptotically proportional to the plug-in estimate of mutual information, with an additive correction for dimensionality in agreement with the Bayesian information criterion. We investigated the behavior of these Bayesian alternatives (in exact and asymptotic forms to mutual information on simulated and real data. An encouraging result was first derived on simulations: the hierarchical clustering based on the log Bayes factor outperformed off-the-shelf clustering techniques as well as raw and normalized mutual information in terms of classification accuracy. On a toy example, we found that the Bayesian approaches led to results that were similar to those of mutual information clustering techniques, with the advantage of an automated thresholding. On real functional magnetic resonance imaging (fMRI datasets measuring brain activity, it identified clusters consistent with the established outcome of standard procedures. On this application, normalized mutual information had a highly atypical behavior, in the sense that it systematically favored very large clusters. These initial experiments suggest that the proposed Bayesian alternatives to mutual information are a useful new tool for hierarchical clustering.

  20. A Bayesian Alternative to Mutual Information for the Hierarchical Clustering of Dependent Random Variables.

    Science.gov (United States)

    Marrelec, Guillaume; Messé, Arnaud; Bellec, Pierre

    2015-01-01

    The use of mutual information as a similarity measure in agglomerative hierarchical clustering (AHC) raises an important issue: some correction needs to be applied for the dimensionality of variables. In this work, we formulate the decision of merging dependent multivariate normal variables in an AHC procedure as a Bayesian model comparison. We found that the Bayesian formulation naturally shrinks the empirical covariance matrix towards a matrix set a priori (e.g., the identity), provides an automated stopping rule, and corrects for dimensionality using a term that scales up the measure as a function of the dimensionality of the variables. Also, the resulting log Bayes factor is asymptotically proportional to the plug-in estimate of mutual information, with an additive correction for dimensionality in agreement with the Bayesian information criterion. We investigated the behavior of these Bayesian alternatives (in exact and asymptotic forms) to mutual information on simulated and real data. An encouraging result was first derived on simulations: the hierarchical clustering based on the log Bayes factor outperformed off-the-shelf clustering techniques as well as raw and normalized mutual information in terms of classification accuracy. On a toy example, we found that the Bayesian approaches led to results that were similar to those of mutual information clustering techniques, with the advantage of an automated thresholding. On real functional magnetic resonance imaging (fMRI) datasets measuring brain activity, it identified clusters consistent with the established outcome of standard procedures. On this application, normalized mutual information had a highly atypical behavior, in the sense that it systematically favored very large clusters. These initial experiments suggest that the proposed Bayesian alternatives to mutual information are a useful new tool for hierarchical clustering.

  1. Numerical simulation of a step-piston type series two-stage pulse tube refrigerator

    Science.gov (United States)

    Zhu, Shaowei; Nogawa, Masafumi; Inoue, Tatsuo

    2007-09-01

    A two-stage pulse tube refrigerator has a great advantage in that there are no moving parts at low temperatures. The problem is low theoretical efficiency. In an ordinary two-stage pulse tube refrigerator, the expansion work of the first stage pulse tube is rather large, but is changed to heat. The theoretical efficiency is lower than that of a Stirling refrigerator. A series two-stage pulse tube refrigerator was introduced for solving this problem. The hot end of the regenerator of the second stage is connected to the hot end of the first stage pulse tube. The expansion work in the first stage pulse tube is part of the input work of the second stage, therefore the efficiency is increased. In a simulation result for a step-piston type two-stage series pulse tube refrigerator, the efficiency is increased by 13.8%.

  2. Theory and calculation of two-stage voltage stabilizer on zener diodes

    Directory of Open Access Journals (Sweden)

    G. S. Veksler

    1966-12-01

    Full Text Available Two-stage stabilizer is compared with one-stage. There have been got formulas, which give the possibility to make an engineering calculation. There is an example of the calculation.

  3. Two-stage fungal pre-treatment for improved biogas production from sisal leaf decortication residues

    National Research Council Canada - National Science Library

    Muthangya, Mutemi; Mshandete, Anthony Manoni; Kivaisi, Amelia Kajumulo

    2009-01-01

    .... Pre-treatment of the residue prior to its anaerobic digestion (AD) was investigated using a two-stage pre-treatment approach with two fungal strains, CCHT-1 and Trichoderma reesei in succession in anaerobic batch bioreactors...

  4. Experiment research on two-stage dry-fed entrained flow coal gasifier

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The process flow and the main devices of a new two-stage dry-fed coal gasification pilot plant with a throughout of 36 t/d are introduced in this paper. For comparison with the traditional one-stage gasifiers, the influences of the coal feed ratio between two stages on the performance of the gasifier are detailedly studied by a series of experiments. The results reveal that the two-stage gasification decreases the temperature of the syngas at the outlet of the gasifier, simplifies the gasification process, and reduces the size of the syngas cooler. Moreover, the cold gas efficiency of the gasifier can be improved by using the two-stage gasification. In our experiments, the efficiency is about 3%-6% higher than the existing one-stage gasifiers.

  5. A Two-Stage Waste Gasification Reactor for Mars In-Situ Resource Utilization Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose to design, build, and test a two-stage waste processing reactor for space applications. Our proposed technology converts waste from space missions into...

  6. Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Dopp, C.M.E.; Graff, M.J.L.; Teerenstra, S.; Sanden, M.W.; Olde Rikkert, M.G.M.; Vernooij-Dassen, M.J.F.J.

    2013-01-01

    BACKGROUND: To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS: A cluster randomized controlled trial with 28 experimental and 17 control clusters was

  7. Analyzing indirect effects in cluster randomized trials : The effect of estimation method, number of groups and group sizes on accuracy and power

    NARCIS (Netherlands)

    Hox, Joop J.; Moerbeek, Mirjam; Kluytmans, Anouck; van de Schoot, Rens

    2014-01-01

    Cluster randomized trials assess the effect of an intervention that is carried out at the group or cluster level. Ajzen's theory of planned behavior is often used to model the effect of the intervention as an indirect effect mediated in turn by attitude, norms and behavioral intention. Structural

  8. Impact of a cancer clinical trials web site on discussions about trial participation: a cluster randomized trial.

    Science.gov (United States)

    Dear, R F; Barratt, A L; Askie, L M; Butow, P N; McGeechan, K; Crossing, S; Currow, D C; Tattersall, M H N

    2012-07-01

    Cancer patients want access to reliable information about currently recruiting clinical trials. Oncologists and their patients were randomly assigned to access a consumer-friendly cancer clinical trials web site [Australian Cancer Trials (ACT), www.australiancancertrials.gov.au] or to usual care in a cluster randomized controlled trial. The primary outcome, measured from audio recordings of oncologist-patient consultations, was the proportion of patients with whom participation in any clinical trial was discussed. Analysis was by intention-to-treat accounting for clustering and stratification. Thirty medical oncologists and 493 patients were recruited. Overall, 46% of consultations in the intervention group compared with 34% in the control group contained a discussion about clinical trials (P=0.08). The mean consultation length in both groups was 29 min (P=0.69). The proportion consenting to a trial was 10% in both groups (P=0.65). Patients' knowledge about randomized trials was lower in the intervention than the control group (mean score 3.0 versus 3.3, P=0.03) but decisional conflict scores were similar (mean score 42 versus 43, P=0.83). Good communication between patients and physicians is essential. Within this context, a web site such as Australian Cancer Trials may be an important tool to encourage discussion about clinical trial participation.

  9. A new multi-motor drive system based on two-stage direct power converter

    OpenAIRE

    Kumar, Dinesh

    2011-01-01

    The two-stage AC to AC direct power converter is an alternative matrix converter topology, which offers the benefits of sinusoidal input currents and output voltages, bidirectional power flow and controllable input power factor. The absence of any energy storage devices, such as electrolytic capacitors, has increased the potential lifetime of the converter. In this research work, a new multi-motor drive system based on a two-stage direct power converter has been proposed, with two motors c...

  10. Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

    Directory of Open Access Journals (Sweden)

    Chia-Chang Chien

    2009-01-01

    Full Text Available Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST and the Wechsler Adult Intelligence Scale-Revised (WAIS-R assessments.Results: Logistic regression analysis showed the conceptual level responses (CLR index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84. We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.Keywords: intellectual disability, intelligence screening, two-stage positive screening, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Revised

  11. Two-Stage Conversion of Land and Marine Biomass for Biogas and Biohydrogen Production

    OpenAIRE

    Nkemka, Valentine

    2012-01-01

    The replacement of fossil fuels by renewable fuels such as biogas and biohydrogen will require efficient and economically competitive process technologies together with new kinds of biomass. A two-stage system for biogas production has several advantages over the widely used one-stage continuous stirred tank reactor (CSTR). However, it has not yet been widely implemented on a large scale. Biohydrogen can be produced in the anaerobic two-stage system. It is considered to be a useful fuel for t...

  12. Leveraging microfinance to impact HIV and financial behaviors among adolescents and their mothers in West Bengal: a cluster randomized trial.

    Science.gov (United States)

    Spielberg, Freya; Crookston, Benjamin T; Chanani, Sheila; Kim, Jaewhan; Kline, Sean; Gray, Bobbi L

    2013-01-01

    Microfinance can be used to reach women and adolescent girls with HIV prevention education. We report findings from a cluster-randomized control trial among 55 villages in West Bengal to determine the impact of non-formal education on knowledge, attitudes and behaviors for HIV prevention and savings. Multilevel regression models were used to evaluate differences between groups for key outcomes while adjusting for cluster correlation and differences in baseline characteristics. Women and girls who received HIV education showed significant gains in HIV knowledge, awareness that condoms can prevent HIV, self-efficacy for HIV prevention, and confirmed use of clean needles, as compared to the control group. Condom use was rare and did not improve for women. While HIV testing was uncommon, knowledge of HIV-testing resources significantly increased among girls, and trended in the positive direction among women in intervention groups. Conversely, the savings education showed no impact on financial knowledge or behavior change.

  13. Estimating the Standard Error of the Impact Estimator in Individually Randomized Trials with Clustering

    Science.gov (United States)

    Weiss, Michael J.; Lockwood, J. R.; McCaffrey, Daniel F.

    2016-01-01

    In the "individually randomized group treatment" (IRGT) experimental design, individuals are first randomly assigned to a treatment arm or a control arm, but then within each arm, are grouped together (e.g., within classrooms/schools, through shared case managers, in group therapy sessions, through shared doctors, etc.) to receive…

  14. A voxelation-corrected non-stationary 3D cluster-size test based on random field theory.

    Science.gov (United States)

    Li, Huanjie; Nickerson, Lisa D; Zhao, Xuna; Nichols, Thomas E; Gao, Jia-Hong

    2015-09-01

    Cluster-size tests (CSTs) based on random field theory (RFT) are commonly adopted to identify significant differences in brain images. However, the use of RFT in CSTs rests on the assumption of uniform smoothness (stationarity). When images are non-stationary, CSTs based on RFT will likely lead to increased false positives in smooth regions and reduced power in rough regions. An adjustment to the cluster size according to the local smoothness at each voxel has been proposed for the standard test based on RFT to address non-stationarity, however, this technique requires images with a large degree of spatial smoothing, large degrees of freedom and high intensity thresholding. Recently, we proposed a voxelation-corrected 3D CST based on Gaussian random field theory that does not place constraints on the degree of spatial smoothness. However, this approach is only applicable to stationary images, requiring further modification to enable use for non-stationary images. In this study, we present modifications of this method to develop a voxelation-corrected non-stationary 3D CST based on RFT. Both simulated and real data were used to compare the voxelation-corrected non-stationary CST to the standard cluster-size adjusted non-stationary CST based on RFT and the voxelation-corrected stationary CST. We found that voxelation-corrected stationary CST is liberal for non-stationary images and the voxelation-corrected non-stationary CST performs better than cluster-size adjusted non-stationary CST based on RFT under low smoothness, low intensity threshold and low degrees of freedom. Published by Elsevier Inc.

  15. A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Adang Eddy

    2011-03-01

    Full Text Available Abstract Background Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED strategy. Methods In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service, have been allocated randomly to either the intervention group (CI strategy or the control group (ED strategy. The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Discussion Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. Clinical trials registration NCT01117285

  16. The non-random clustering of non-synonymous substitutions and its relationship to evolutionary rate

    Directory of Open Access Journals (Sweden)

    Stone Eric A

    2011-08-01

    Full Text Available Abstract Background Protein sequences are subject to a mosaic of constraint. Changes to functional domains and buried residues, for example, are more apt to disrupt protein structure and function than are changes to residues participating in loops or exposed to solvent. Regions of constraint on the tertiary structure of a protein often result in loose segmentation of its primary structure into stretches of slowly- and rapidly-evolving amino acids. This clustering can be exploited, and existing methods have done so by relying on local sequence conservation as a signature of selection to help identify functionally important regions within proteins. We invert this paradigm by leveraging the regional nature of protein structure and function to both illuminate and make use of genome-wide patterns of local sequence conservation. Results Our hypothesis is that the regional nature of structural and functional constraints will assert a positive autocorrelation on the evolutionary rates of neighboring sites, which, in a pairwise comparison of orthologous proteins, will manifest itself as the clustering of non-synonymous changes across the amino acid sequence. We introduce a dispersion ratio statistic to test this and related hypotheses. Using genome-wide interspecific comparisons of orthologous protein pairs, we reveal a strong log-linear relationship between the degree of clustering and the intensity of constraint. We further demonstrate how this relationship varies with the evolutionary distance between the species being compared. We provide some evidence that proteins with a history of positive selection deviate from genome-wide trends. Conclusions We find a significant association between the evolutionary rate of a protein and the degree to which non-synonymous changes cluster along its primary sequence. We show that clustering is a non-redundant predictor of evolutionary rate, and we speculate that conflicting signals of clustering and constraint may

  17. Avalanches, branching ratios, and clustering of attractors in random Boolean networks and in the segment polarity network of Drosophila

    Energy Technology Data Exchange (ETDEWEB)

    Berdahl, Andrew; Shreim, Amer; Sood, Vishal; Davidsen, Joern; Paczuski, Maya [Complexity Science Group, Department of Physics and Astronomy, University of Calgary, Calgary, Alberta T2N 1N4 (Canada)], E-mail: aberdahl@phas.ucalgary.ca

    2008-06-15

    We discuss basic features of emergent complexity in dynamical systems far from equilibrium by focusing on the network structure of their state space. We start by measuring the distributions of avalanche and transient times in random Boolean networks (RBNs) and in the Drosophila polarity network by exact enumeration. A transient time is the duration of the transient from a starting state to an attractor. An avalanche is a special transient which starts as a single Boolean element perturbation of an attractor state. Significant differences at short times between the avalanche and the transient times for RBNs with small connectivity K-compared to the number of elements N-indicate that attractors tend to cluster in configuration space. In addition, one bit flip has a non-negligible chance to put an attractor state directly onto another attractor. This clustering is also present in the segment polarity gene network of Drosophila melanogaster, suggesting that this may be a robust feature of biological regulatory networks. We also define and measure a branching ratio for the state space networks and find evidence for a new timescale that diverges roughly linearly with N for 2{<=}K<random map nor can the random map exhibit clustering of attractors. We further show that for K=2 the branching ratio exhibits the largest variation with distance from the attractor compared to other values of K and that the avalanche durations exhibit no characteristic scale within our statistical resolution. Hence, we propose that the branching ratio and the avalanche duration are new indicators for scale-free behavior that may or may not be found simultaneously with other indicators of emergent complexity in extended, deterministic dynamical systems.

  18. Cluster randomized trials utilizing primary care electronic health records: methodological issues in design, conduct, and analysis (eCRT Study).

    Science.gov (United States)

    Gulliford, Martin C; van Staa, Tjeerd P; McDermott, Lisa; McCann, Gerard; Charlton, Judith; Dregan, Alex

    2014-06-11

    There is growing interest in conducting clinical and cluster randomized trials through electronic health records. This paper reports on the methodological issues identified during the implementation of two cluster randomized trials using the electronic health records of the Clinical Practice Research Datalink (CPRD). Two trials were completed in primary care: one aimed to reduce inappropriate antibiotic prescribing for acute respiratory infection; the other aimed to increase physician adherence with secondary prevention interventions after first stroke. The paper draws on documentary records and trial datasets to report on the methodological experience with respect to research ethics and research governance approval, general practice recruitment and allocation, sample size calculation and power, intervention implementation, and trial analysis. We obtained research governance approvals from more than 150 primary care organizations in England, Wales, and Scotland. There were 104 CPRD general practices recruited to the antibiotic trial and 106 to the stroke trial, with the target number of practices being recruited within six months. Interventions were installed into practice information systems remotely over the internet. The mean number of participants per practice was 5,588 in the antibiotic trial and 110 in the stroke trial, with the coefficient of variation of practice sizes being 0.53 and 0.56 respectively. Outcome measures showed substantial correlations between the 12 months before, and after intervention, with coefficients ranging from 0.42 for diastolic blood pressure to 0.91 for proportion of consultations with antibiotics prescribed, defining practice and participant eligibility for analysis requires careful consideration. Cluster randomized trials may be performed efficiently in large samples from UK general practices using the electronic health records of a primary care database. The geographical dispersal of trial sites presents a difficulty for

  19. Promoting Alternative Thinking Strategies (PATHS) and elementary school aged children's aggression: results from a cluster randomized trial.

    Science.gov (United States)

    Crean, Hugh F; Johnson, Deborah B

    2013-09-01

    This study reports on aggressive outcomes from a cluster randomized trial of the Promoting Alternative Thinking Strategies (PATHS) curriculum. Fourteen elementary schools were randomly assigned to intervention or control condition and third grade students were followed through the fifth grade. Teacher and self-reports of student aggression, conduct problems, delinquency, acting out problems, and social information processing (SIP) variables were collected. Linear change for each of the SIP variables was noted with control students demonstrating increased normative beliefs about aggression, increased aggressive social problem solving, increased hostile attribution bias, and increased aggressive interpersonal negotiation strategies over time while PATHS students remained relatively stable. Teachers reported significant curvilinear change in student aggression, conduct problems, and acting out behavior problems; all favoring PATHS students.

  20. The asymptotic distribution of a cluster-index for i.i.d. normal random variables

    OpenAIRE

    Yatracos, Yannis G.

    2009-01-01

    In a sample variance decomposition, with components functions of the sample's spacings, the largest component $\\tilde{I}_n$ is used in cluster detection. It is shown for normal samples that the asymptotic distribution of $\\tilde{I}_n$ is the Gumbel distribution.

  1. Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial.

    Science.gov (United States)

    Andersson, Neil; Nava-Aguilera, Elizabeth; Arosteguí, Jorge; Morales-Perez, Arcadio; Suazo-Laguna, Harold; Legorreta-Soberanis, José; Hernandez-Alvarez, Carlos; Fernandez-Salas, Ildefonso; Paredes-Solís, Sergio; Balmaseda, Angel; Cortés-Guzmán, Antonio Juan; Serrano de Los Santos, René; Coloma, Josefina; Ledogar, Robert J; Harris, Eva

    2015-07-08

    To test whether community mobilization adds effectiveness to conventional dengue control. Pragmatic open label parallel group cluster randomized controlled trial. Those assessing the outcomes and analyzing the data were blinded to group assignment. Centralized computerized randomization after the baseline study allocated half the sites to intervention, stratified by country, evidence of recent dengue virus infection in children aged 3-9, and vector indices. Random sample of communities in Managua, capital of Nicaragua, and three coastal regions in Guerrero State in the south of Mexico. Residents in a random sample of census enumeration areas across both countries: 75 intervention and 75 control clusters (about 140 households each) were randomized and analyzed (60 clusters in Nicaragua and 90 in Mexico), including 85,182 residents in 18,838 households. A community mobilization protocol began with community discussion of baseline results. Each intervention cluster adapted the basic intervention-chemical-free prevention of mosquito reproduction-to its own circumstances. All clusters continued the government run dengue control program. Primary outcomes per protocol were self reported cases of dengue, serological evidence of recent dengue virus infection, and conventional entomological indices (house index: households with larvae or pupae/households examined; container index: containers with larvae or pupae/containers examined; Breteau index: containers with larvae or pupae/households examined; and pupae per person: pupae found/number of residents). Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use. With cluster as the unit of analysis, serological evidence from intervention sites showed a lower risk of infection with dengue virus in children (relative risk reduction 29.5%, 95% confidence interval 3.8% to 55.3%), fewer reports of dengue illness (24.7%, 1.8% to 51.2%), fewer houses with larvae or pupae among houses visited

  2. Evidence based community mobilization for dengue prevention in Nicaragua and Mexico (Camino Verde, the Green Way): cluster randomized controlled trial

    Science.gov (United States)

    Nava-Aguilera, Elizabeth; Arosteguí, Jorge; Morales-Perez, Arcadio; Suazo-Laguna, Harold; Legorreta-Soberanis, José; Hernandez-Alvarez, Carlos; Fernandez-Salas, Ildefonso; Paredes-Solís, Sergio; Balmaseda, Angel; Cortés-Guzmán, Antonio Juan; Serrano de los Santos, René; Coloma, Josefina; Ledogar, Robert J; Harris, Eva

    2015-01-01

    Objective To test whether community mobilization adds effectiveness to conventional dengue control. Design Pragmatic open label parallel group cluster randomized controlled trial. Those assessing the outcomes and analyzing the data were blinded to group assignment. Centralized computerized randomization after the baseline study allocated half the sites to intervention, stratified by country, evidence of recent dengue virus infection in children aged 3-9, and vector indices. Setting Random sample of communities in Managua, capital of Nicaragua, and three coastal regions in Guerrero State in the south of Mexico. Participants Residents in a random sample of census enumeration areas across both countries: 75 intervention and 75 control clusters (about 140 households each) were randomized and analyzed (60 clusters in Nicaragua and 90 in Mexico), including 85 182 residents in 18 838 households. Interventions A community mobilization protocol began with community discussion of baseline results. Each intervention cluster adapted the basic intervention—chemical-free prevention of mosquito reproduction—to its own circumstances. All clusters continued the government run dengue control program. Main outcome measures Primary outcomes per protocol were self reported cases of dengue, serological evidence of recent dengue virus infection, and conventional entomological indices (house index: households with larvae or pupae/households examined; container index: containers with larvae or pupae/containers examined; Breteau index: containers with larvae or pupae/households examined; and pupae per person: pupae found/number of residents). Per protocol secondary analysis examined the effect of Camino Verde in the context of temephos use. Results With cluster as the unit of analysis, serological evidence from intervention sites showed a lower risk of infection with dengue virus in children (relative risk reduction 29.5%, 95% confidence interval 3.8% to 55.3%), fewer reports of

  3. A cluster randomized trial of routine HIV-1 viral load monitoring in Zambia: study design, implementation, and baseline cohort characteristics.

    Directory of Open Access Journals (Sweden)

    John R Koethe

    Full Text Available BACKGROUND: The benefit of routine HIV-1 viral load (VL monitoring of patients on antiretroviral therapy (ART in resource-constrained settings is uncertain because of the high costs associated with the test and the limited treatment options. We designed a cluster randomized controlled trial to compare the use of routine VL testing at ART-initiation and at 3, 6, 12, and 18 months, versus our local standard of care (which uses immunological and clinical criteria to diagnose treatment failure, with discretionary VL testing when the two do not agree. METHODOLOGY: Dedicated study personnel were integrated into public-sector ART clinics. We collected participant information in a dedicated research database. Twelve ART clinics in Lusaka, Zambia constituted the units of randomization. Study clinics were stratified into pairs according to matching criteria (historical mortality rate, size, and duration of operation to limit the effect of clustering, and independently randomized to the intervention and control arms. The study was powered to detect a 36% reduction in mortality at 18 months. PRINCIPAL FINDINGS: From December 2006 to May 2008, we completed enrollment of 1973 participants. Measured baseline characteristics did not differ significantly between the study arms. Enrollment was staggered by clinic pair and truncated at two matched sites. CONCLUSIONS: A large clinical trial of routing VL monitoring was successfully implemented in a dynamic and rapidly growing national ART program. Close collaboration with local health authorities and adequate reserve staff were critical to success. Randomized controlled trials such as this will likely prove valuable in determining long-term outcomes in resource-constrained settings. TRIAL REGISTRATION: Clinicaltrials.gov NCT00929604.

  4. Protocol for work place adjusted intelligent physical exercise reducing musculoskeletal pain in shoulder and neck (VIMS): a cluster randomized controlled trial

    DEFF Research Database (Denmark)

    Andersen, Lars L.; Zebis, Mette K.; Pedersen, Mogens Theisen;

    2010-01-01

    of training supervision for safe and effective training. METHODS/DESIGN: A cluster randomized controlled trial of 20 weeks duration where employed office workers are randomized to 1 x 60 min, 3 x 20 min, 9 x 7 min per week of specific strength training with training supervision, to 3 x 20 min per week...

  5. Start improving the quality of care for people with type 2 diabetes through a general practice support program: a cluster randomized trial.

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Grol, R.P.T.M.; Broeke, C. Van Den; Boland, B.; Verbeke, G.; Carbonez, A.; Mathieu, C.; Heyrman, J.

    2010-01-01

    AIMS: To evaluate the effectiveness of a two-arm quality improvement program (QIP) to support general practice with limited tradition in chronic care on type 2 diabetes patient outcomes. METHODS: During 18 months, we performed a cluster randomized trial with randomization of General Practices. The

  6. Interaction of Fanaroff-Riley class II radio jets with a randomly magnetised intra-cluster medium

    CERN Document Server

    Huarte-Espinosa, Martín; Alexander, Paul

    2011-01-01

    A combination of three-dimensional (3D) magnetohydrodynamics (MHD) and synthetic numerical simulations are presented to follow the evolution of a randomly magnetised plasma that models the intra-cluster medium (ICM), under the isolated effects of powerful, light, hypersonic and bipolar Fanaroff-Riley class II (FR II) jets. We prescribe the cluster magnetic field (CMF) as a Gaussian random field with a Kolmogorov-like energy spectrum. Both the power of the jets and the viewing angle that is used for the synthetic Rotation Measure (RM) observations are investigated. We find the model radio sources introduce and amplify fluctuations on the RM statistical properties which we analyse as a function of time as well as the viewing angle. The average RM and the RM standard deviation are increased by the action of the jets. Energetics, RM statistics and magnetic power spectral analysis consistently show that the effects also correlate with the jets' power, and that the lightest, fastest jets produce the strongest chang...

  7. Interrupted time-series analysis yielded an effect estimate concordant with the cluster-randomized controlled trial result.

    Science.gov (United States)

    Fretheim, Atle; Soumerai, Stephen B; Zhang, Fang; Oxman, Andrew D; Ross-Degnan, Dennis

    2013-08-01

    We reanalyzed the data from a cluster-randomized controlled trial (C-RCT) of a quality improvement intervention for prescribing antihypertensive medication. Our objective was to estimate the effectiveness of the intervention using both interrupted time-series (ITS) and RCT methods, and to compare the findings. We first conducted an ITS analysis using data only from the intervention arm of the trial because our main objective was to compare the findings from an ITS analysis with the findings from the C-RCT. We used segmented regression methods to estimate changes in level or slope coincident with the intervention, controlling for baseline trend. We analyzed the C-RCT data using generalized estimating equations. Last, we estimated the intervention effect by including data from both study groups and by conducting a controlled ITS analysis of the difference between the slope and level changes in the intervention and control groups. The estimates of absolute change resulting from the intervention were ITS analysis, 11.5% (95% confidence interval [CI]: 9.5, 13.5); C-RCT, 9.0% (95% CI: 4.9, 13.1); and the controlled ITS analysis, 14.0% (95% CI: 8.6, 19.4). ITS analysis can provide an effect estimate that is concordant with the results of a cluster-randomized trial. A broader range of comparisons from other RCTs would help to determine whether these are generalizable results. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Method of oxygen-enriched two-stage underground coal gasification

    Institute of Scientific and Technical Information of China (English)

    Liu Hongtao; Chen Feng; Pan Xia; Yao Kai; Liu Shuqin

    2011-01-01

    Two-stage underground coal gasification was studied to improve the caloric value of the syngas and to extend gas production times. A model test using the oxygen-enriched two-stage coal gasification method was carried out. The composition of the gas produced, the time ratio of the two stages, and the role of the temperature field were analysed. The results show that oxygen-enriched two-stage gasification shortens the time of the first stage and prolongs the time of the second stage. Feed oxygen concentrations of 30%,35%, 40%, 45%, 60%, or 80% gave time ratios (first stage to second stage) of 1:0.12, 1:0.21, 1:0.51, 1:0.64,1:0.90, and 1:4.0 respectively. Cooling rates of the temperature field after steam injection decreased with time from about 19.1-27.4 ℃/min to 2.3-6.8 ℃/min. But this rate increased with increasing oxygen concentrations in the first stage. The caloric value of the syngas improves with increased oxygen concentration in the first stage. Injection of 80% oxygen-enriched air gave gas with the highest caloric value and also gave the longest production time. The caloric value of the gas obtained from the oxygenenriched two-stage gasification method lies in the range from 5.31 MJ/Nm3 to 10.54 MJ/Nm3.

  9. High magnetostriction parameters for low-temperature sintered cobalt ferrite obtained by two-stage sintering

    Energy Technology Data Exchange (ETDEWEB)

    Khaja Mohaideen, K.; Joy, P.A., E-mail: pa.joy@ncl.res.in

    2014-12-15

    From the studies on the magnetostriction characteristics of two-stage sintered polycrystalline CoFe{sub 2}O{sub 4} made from nanocrystalline powders, it is found that two-stage sintering at low temperatures is very effective for enhancing the density and for attaining higher magnetostriction coefficient. Magnetostriction coefficient and strain derivative are further enhanced by magnetic field annealing and relatively larger enhancement in the magnetostriction parameters is obtained for the samples sintered at lower temperatures, after magnetic annealing, despite the fact that samples sintered at higher temperatures show larger magnetostriction coefficients before annealing. A high magnetostriction coefficient of ∼380 ppm is obtained after field annealing for the sample sintered at 1100 °C, below a magnetic field of 400 kA/m, which is the highest value so far reported at low magnetic fields for sintered polycrystalline cobalt ferrite. - Highlights: • Effect of two-stage sintering on the magnetostriction characteristics of CoFe{sub 2}O{sub 4} is studied. • Two-stage sintering is very effective for enhancing the density and the magnetostriction parameters. • Higher magnetostriction for samples sintered at low temperatures and after magnetic field annealing. • Highest reported magnetostriction of 380 ppm at low fields after two-stage, low-temperature sintering.

  10. 13 K thermally coupled two-stage Stirling-type pulse tube refrigerator

    Institute of Scientific and Technical Information of China (English)

    TANG Ke; CHEN Guobang; THUMMES Günter

    2005-01-01

    Stirling-type pulse tube refrigerators have attracted academic and commercial interest in recent years due to their more compact configuration and higher efficiency than those of G-M type pulse tube refrigerators. In order to achieve a no-load cooling temperature below 20 K, a thermally coupled two-stage Stirling-type pulse tube refrigerator has been built. The thermally coupled arrangement was expected to minimize the interference between the two stages and to simplify the adjustment and optimization of the phase shifters. A no-load cooling temperature of 14.97 K has been realized with the two-stage cooler driven by one linear compressor of 200 W electric input. When the two stages are driven by two compressors respectively, with total electric input of 400 W, the prototype has attained a no-load cooling temperature of 12.96 K, which is the lowest temperature ever reported with two-stage Stirling-type pulse tube refrigerators.

  11. Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Ladan Jamshidy

    2016-01-01

    Full Text Available Introduction. One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods. A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with two-stage technique using an appropriate tray. To measure the marginal gap, the distance between the restoration margin and preparation finish line of plaster dies was vertically determined in mid mesial, distal, buccal, and lingual (MDBL regions by a stereomicroscope using a standard method. Results. The results of independent test showed that the mean value of the marginal gap obtained by one-stage impression technique was higher than that of two-stage impression technique. Further, there was no significant difference between one- and two-stage impression techniques in mid buccal region, but a significant difference was reported between the two impression techniques in MDL regions and in general. Conclusion. The findings of the present study indicated higher accuracy for two-stage impression technique than for the one-stage impression technique.

  12. Carbon nanotubes randomly decorated with gold clusters: from nano{sup 2}hybrid atomic structures to gas sensing prototypes

    Energy Technology Data Exchange (ETDEWEB)

    Charlier, J-C; Zanolli, Z [Unite de Physico-Chimie et de Physique des Materiaux (PCPM), European Theoretical Spectroscopy Facility (ETSF), Universite Catholique de Louvain, Place Croix du Sud 1, B-1348 Louvain-la-Neuve (Belgium); Arnaud, L; Avilov, I V; Felten, A; Pireaux, J-J [Centre de Recherche en Physique de la Matiere et du Rayonnement (PMR-LISE), Facultes Universitaires Notre-Dame de la Paix, 61 Rue de Bruxelles, B-5000 Namur (Belgium); Delgado, M [Sensotran, s.l., Avenida Remolar 31, E-08820 El Prat de Llobregat, Barcelona (Spain); Demoisson, F; Reniers, F [Service de Chimie Analytique et Chimie des Interfaces (CHANI), Universite Libre de Bruxelles, Faculte des Sciences, CP255, Boulevard du Triomphe 2, B-1050 Bruxelles (Belgium); Espinosa, E H; Ionescu, R; Leghrib, R; Llobet, E [Department of Electronic Engineering, Universitat Rovira i Virgili, Avenida Paisos Catalans 26, E-43007 Tarragona (Spain); Ewels, C P; Suarez-Martinez, I [Institut des Materiaux Jean Rouxel (IMN), Universite de Nantes, 2 rue de la Houssiniere-BP 32229, F-44322 Nantes Cedex 3 (France); Guillot, J; Mansour, A; Migeon, H-N [Departement Science et Analyse des Materiaux, Centre de Recherche Public-Gabriel Lippmann, rue du Brill 41, L-4422 Belvaux (Luxembourg); Watson, G E, E-mail: jean-jacques.pireaux@fundp.ac.b [Vega Science Trust, Unit 118, Science Park SQ, Brighton, BN1 9SB (United Kingdom)

    2009-09-16

    Carbon nanotube surfaces, activated and randomly decorated with metal nanoclusters, have been studied in uniquely combined theoretical and experimental approaches as prototypes for molecular recognition. The key concept is to shape metallic clusters that donate or accept a fractional charge upon adsorption of a target molecule, and modify the electron transport in the nanotube. The present work focuses on a simple system, carbon nanotubes with gold clusters. The nature of the gold-nanotube interaction is studied using first-principles techniques. The numerical simulations predict the binding and diffusion energies of gold atoms at the tube surface, including realistic atomic models for defects potentially present at the nanotube surface. The atomic structure of the gold nanoclusters and their effect on the intrinsic electronic quantum transport properties of the nanotube are also predicted. Experimentally, multi-wall CNTs are decorated with gold clusters using (1) vacuum evaporation, after activation with an RF oxygen plasma and (2) colloid solution injected into an RF atmospheric plasma; the hybrid systems are accurately characterized using XPS and TEM techniques. The response of gas sensors based on these nano{sup 2}hybrids is quantified for the detection of toxic species like NO{sub 2}, CO, C{sub 2}H{sub 5}OH and C{sub 2}H{sub 4}.

  13. Does mass azithromycin distribution impact child growth and nutrition in Niger? A cluster-randomized trial.

    Directory of Open Access Journals (Sweden)

    Abdou Amza

    2014-09-01

    Full Text Available Antibiotic use on animals demonstrates improved growth regardless of whether or not there is clinical evidence of infectious disease. Antibiotics used for trachoma control may play an unintended benefit of improving child growth.In this sub-study of a larger randomized controlled trial, we assess anthropometry of pre-school children in a community-randomized trial of mass oral azithromycin distributions for trachoma in Niger. We measured height, weight, and mid-upper arm circumference (MUAC in 12 communities randomized to receive annual mass azithromycin treatment of everyone versus 12 communities randomized to receive biannual mass azithromycin treatments for children, 3 years after the initial mass treatment. We collected measurements in 1,034 children aged 6-60 months of age.We found no difference in the prevalence of wasting among children in the 12 annually treated communities that received three mass azithromycin distributions compared to the 12 biannually treated communities that received six mass azithromycin distributions (odds ratio = 0.88, 95% confidence interval = 0.53 to 1.49.We were unable to demonstrate a statistically significant difference in stunting, underweight, and low MUAC of pre-school children in communities randomized to annual mass azithromycin treatment or biannual mass azithromycin treatment. The role of antibiotics on child growth and nutrition remains unclear, but larger studies and longitudinal trials may help determine any association.

  14. Local and cluster critical dynamics of the 3d random-site Ising model

    Science.gov (United States)

    Ivaneyko, D.; Ilnytskyi, J.; Berche, B.; Holovatch, Yu.

    2006-10-01

    We present the results of Monte Carlo simulations for the critical dynamics of the three-dimensional site-diluted quenched Ising model. Three different dynamics are considered, these correspond to the local update Metropolis scheme as well as to the Swendsen-Wang and Wolff cluster algorithms. The lattice sizes of L=10-96 are analysed by a finite-size-scaling technique. The site dilution concentration p=0.85 was chosen to minimize the correction-to-scaling effects. We calculate numerical values of the dynamical critical exponents for the integrated and exponential autocorrelation times for energy and magnetization. As expected, cluster algorithms are characterized by lower values of dynamical critical exponent than the local one: also in the case of dilution critical slowing down is more pronounced for the Metropolis algorithm. However, the striking feature of our estimates is that they suggest that dilution leads to decrease of the dynamical critical exponent for the cluster algorithms. This phenomenon is quite opposite to the local dynamics, where dilution enhances critical slowing down.

  15. The rheumatoid arthritis treat-to-target trial: a cluster randomized trial within the Corrona rheumatology network.

    Science.gov (United States)

    Harrold, Leslie R; Reed, George W; Harrington, J Timothy; Barr, Christine J; Saunders, Katherine C; Gibofsky, Allan; Greenberg, Jeffrey D; John, Ani; Devenport, Jenny; Kremer, Joel M

    2014-11-21

    The treat-to-target (T2T) approach to the care of patients with rheumatoid arthritis involves using validated metrics to measure disease activity, frequent follow-up visits for patients with moderate to high disease activity, and escalation of therapy when patients have inadequate therapeutic response as assessed by standard disease activity scores. The study described is a newly launched cluster-randomized behavioral intervention to assess the feasibility and effectiveness of the T2T approach in US rheumatology practices. It is designed to identify patient and provider barriers to implementing T2T management. This initial paper focuses on the novel study design and methods created to provide these insights. This trial cluster-randomizes rheumatology practices from the existing Corrona network of private and academic sites rather than patients within sites or individual investigators to provide either T2T or usual care (UC) for qualified patients who meet the 2010 revised American College of Rheumatology criteria for the diagnosis of rheumatoid arthritis and have moderate to high disease activity. Specific medication choices are left to the investigator and patient, rather than being specified in the protocol. Enrollment is expected to be completed by the end of 2013, with 30 practices randomized and enrolling a minimum of 530 patients. During the 12-month follow-up, visits are mandated as frequently as monthly in patients with active disease in the T2T group and every 3 months for the UC group. Safety data are collected at each visit. The coprimary endpoints include a comparison of the proportion of patients achieving low disease activity in the T2T and UC groups and assessment of the feasibility of implementing T2T in rheumatology practices, specifically assessment of the rates of treatment acceleration, frequency of visits, time to next visit conditional on disease activity, and probability of acceleration conditional on disease activity in the 2 groups. This

  16. Design and construction of the X-2 two-stage free piston driven expansion tube

    Science.gov (United States)

    Doolan, Con

    1995-01-01

    This report outlines the design and construction of the X-2 two-stage free piston driven expansion tube. The project has completed its construction phase and the facility has been installed in the new impulsive research laboratory where commissioning is about to take place. The X-2 uses a unique, two-stage driver design which allows a more compact and lower overall cost free piston compressor. The new facility has been constructed in order to examine the performance envelope of the two-stage driver and how well it couple to sub-orbital and super-orbital expansion tubes. Data obtained from these experiments will be used for the design of a much larger facility, X-3, utilizing the same free piston driver concept.

  17. Analysis of performance and optimum configuration of two-stage semiconductor thermoelectric module

    Institute of Scientific and Technical Information of China (English)

    Li Kai-Zhen; Liang Rui-Sheng; Wei Zheng-Jun

    2008-01-01

    In this paper, the theoretical analysis and simulating calculation were conducted for a basic two-stage semiconductor thermoelectric module, which contains one thermocouple in the second stage and several thermocouples in the first stage. The study focused on the configuration of the two-stage semiconductor thermoelectric cooler, especially investigating the influences of some parameters, such as the current I1 of the first stage, the area A1 of every thermocouple and the number n of thermocouples in the first stage, on the cooling performance of the module. The obtained results of analysis indicate that changing the current I1 of the first stage, the area A1 of thcrmocouples and the number n of thermocouples in the first stage can improve the cooling performance of the module. These results can be used to optimize the configuration of the two-stage semiconductor thermoelectric module and provide guides for the design and application of thermoelectric cooler.

  18. Effects of earthworm casts and zeolite on the two-stage composting of green waste.

    Science.gov (United States)

    Zhang, Lu; Sun, Xiangyang

    2015-05-01

    Because it helps protect the environment and encourages economic development, composting has become a viable method for organic waste disposal. The objective of this study was to investigate the effects of earthworm casts (EWCs) (at 0.0%, 0.30%, and 0.60%) and zeolite (clinoptilolite, CL) (at 0%, 15%, and 25%) on the two-stage composting of green waste. The combination of EWCs and CL improved the conditions of the composting process and the quality of the compost products in terms of the thermophilic phase, humification, nitrification, microbial numbers and enzyme activities, the degradation of cellulose and hemicellulose, and physico-chemical characteristics and nutrient contents of final composts. The compost matured in only 21days with the optimized two-stage composting method rather than in the 90-270days required for traditional composting. The optimal two-stage composting and the best quality compost were obtained with 0.30% EWCs and 25% CL.

  19. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Cram, Tyler R; Civitarese, David; O'Brien, Luke; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    Outcomes of primary anterior cruciate ligament (ACL) reconstruction have been reported to be far superior to those of revision reconstruction. However, as the incidence of ACL reconstruction is rapidly increasing, so is the number of failures. The subsequent need for revision ACL reconstruction is estimated to occur in up to 13,000 patients each year in the United States. Revision ACL reconstruction can be performed in one or two stages. A two-stage approach is recommended in cases of improper placement of the original tunnels or in cases of unacceptable tunnel enlargement. The aim of this study was to describe the technique for allograft ACL tunnel bone grafting in patients requiring a two-stage revision ACL reconstruction.

  20. The CSS and The Two-Staged Methods for Parameter Estimation in SARFIMA Models

    Directory of Open Access Journals (Sweden)

    Erol Egrioglu

    2011-01-01

    Full Text Available Seasonal Autoregressive Fractionally Integrated Moving Average (SARFIMA models are used in the analysis of seasonal long memory-dependent time series. Two methods, which are conditional sum of squares (CSS and two-staged methods introduced by Hosking (1984, are proposed to estimate the parameters of SARFIMA models. However, no simulation study has been conducted in the literature. Therefore, it is not known how these methods behave under different parameter settings and sample sizes in SARFIMA models. The aim of this study is to show the behavior of these methods by a simulation study. According to results of the simulation, advantages and disadvantages of both methods under different parameter settings and sample sizes are discussed by comparing the root mean square error (RMSE obtained by the CSS and two-staged methods. As a result of the comparison, it is seen that CSS method produces better results than those obtained from the two-staged method.

  1. Effectiveness of a community-based nutrition programme to improve child growth in rural Ethiopia: a cluster randomized trial.

    Science.gov (United States)

    Kang, Yunhee; Kim, Sungtae; Sinamo, Sisay; Christian, Parul

    2017-01-01

    Few trials have shown that promoting complementary feeding among young children is effective in improving child linear growth in resource-challenged settings. We designed a community-based participatory nutrition promotion (CPNP) programme adapting a Positive Deviance/Hearth approach that engaged mothers in 2-week nutrition sessions using the principles of 'learning by doing' around child feeding. We aimed to test the effectiveness of the CPNP for improving child growth in rural Ethiopia. A cluster randomized trial was implemented by adding the CPNP to the existing government nutrition programmes (six clusters) vs. government programmes only (six clusters). A total of 1790 children aged 6 to 12 months (876 in the intervention and 914 in the control areas) were enrolled and assessed on anthropometry every 3 months for a year. Multi-level mixed-effect regression analysis of longitudinal outcome data (n = 1475) examined the programme impact on growth, adjusting for clustering and enrollment characteristics. Compared with children 6 to 24 months of age in the control area, those in the intervention area had a greater increase in z scores for length-for-age [difference (diff): 0.021 z score/month, 95% CI: 0.008, 0.034] and weight-for-length (diff: 0.042 z score/month, 95% CI: 0.024, 0.059). At the end of the 12-month follow-up, children in the intervention area showed an 8.1% (P = 0.02) and 6.3% (P = 0.046) lower prevalence of stunting and underweight, respectively, after controlling for differences in the prevalence at enrollment, compared with the control group. A novel CPNP programme was effective in improving child growth and reducing undernutrition in this setting. © 2016 John Wiley & Sons Ltd.

  2. A two-stage subsurface vertical flow constructed wetland for high-rate nitrogen removal.

    Science.gov (United States)

    Langergraber, Guenter; Leroch, Klaus; Pressl, Alexander; Rohrhofer, Roland; Haberl, Raimund

    2008-01-01

    By using a two-stage constructed wetland (CW) system operated with an organic load of 40 gCOD.m(-2).d(-1) (2 m2 per person equivalent) average nitrogen removal efficiencies of about 50% and average nitrogen elimination rates of 980 g N.m(-2).yr(-1) could be achieved. Two vertical flow beds with intermittent loading have been operated in series. The first stage uses sand with a grain size of 2-3.2 mm for the main layer and has a drainage layer that is impounded; the second stage sand with a grain size of 0.06-4 mm and a drainage layer with free drainage. The high nitrogen removal can be achieved without recirculation thus it is possible to operate the two-stage CW system without energy input. The paper shows performance data for the two-stage CW system regarding removal of organic matter and nitrogen for the two year operating period of the system. Additionally, its efficiency is compared with the efficiency of a single-stage vertical flow CW system designed and operated according to the Austrian design standards with 4 m2 per person equivalent. The comparison shows that a higher effluent quality could be reached with the two-stage system although the two-stage CW system is operated with the double organic load or half the specific surface area requirement, respectively. Another advantage is that the specific investment costs of the two-stage CW system amount to 1,200 EUR per person (without mechanical pre-treatment) and are only about 60% of the specific investment costs of the singe-stage CW system. IWA Publishing 2008.

  3. Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial.

    Science.gov (United States)

    Dalal, Anuj K; Roy, Christopher L; Poon, Eric G; Williams, Deborah H; Nolido, Nyryan; Yoon, Cathy; Budris, Jonas; Gandhi, Tejal; Bates, David W; Schnipper, Jeffrey L

    2014-01-01

    Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results. We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction. We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), pemail notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern. ClinicalTrials.gov (NCT01153451).

  4. Irritable bowel syndrome and upper dyspepsia among the elderly: a study of symptom clusters in a random 70 year old population

    DEFF Research Database (Denmark)

    Kay, L; Jørgensen, Torben; Schultz-Larsen, K;

    1996-01-01

    later. The following clusters of symptoms were constantly associated. One group constituted abdominal distension, borborygmi, altering stool consistency and number of bowel movements. Pain relieved by bowel movement was associated with this cluster. Nausea and vomiting comprised another cluster......With the aim to assess the clustering of abdominal symptoms in a random population, data from a cohort study of a 70 year old Danish population were analysed. The cohort comprised 1,119 subjects of which 72% participated in a primary study and 91% of the survivors in a similar study five years....... Heartburn/acid regurgitation did not show a consistent association to any other symptoms and may be considered as a cluster of it own. Pain characteristics traditionally related to upper dyspepsia did not specifically relate to any cluster. It is concluded that, in this 70-year-old population abdominal...

  5. Effectiveness of "Primary Bereavement Care" for Widows: A Cluster Randomized Controlled Trial Involving Family Physicians

    Science.gov (United States)

    García, Jesus A.; Landa, Victor; Grandes, Gonzalo; Pombo, Haizea; Mauriz, Amaia

    2013-01-01

    Thirty-one family physicians, from 19 primary care teams in Biscay (Spain), were randomly assigned to intervention or control group. The 15 intervention family physicians, after training in primary bereavement care, saw 43 widows for 7 sessions, from the 4th to 13th month after their loss. The 16 control family physicians, without primary…

  6. Methane production from sweet sorghum residues via a two-stage process

    Energy Technology Data Exchange (ETDEWEB)

    Stamatelatou, K.; Dravillas, K.; Lyberatos, G. [University of Patras (Greece). Department of Chemical Engineering, Laboratory of Biochemical Engineering and Environmental Technology

    2003-07-01

    The start-up of a two-stage reactor configuration for the anaerobic digestion of sweet sorghum residues was evaluated. The sweet sorghum residues were a waste stream originating from the alcoholic fermentation of sweet sorghum and the subsequent distillation step. This waste stream contained high concentration of solid matter (9% TS) and thus could be characterized as a semi-solid, not easily biodegradable wastewater with high COD (115 g/l). The application of the proposed two-stage configuration (consisting of one thermophilic hydrolyser and one mesophilic methaniser) achieved a methane production of 16 l/l wastewater under a hydraulic retention time of 19 d. (author)

  7. Two Stage Fully Differential Sample and Hold Circuit Using .18µm Technology

    Directory of Open Access Journals (Sweden)

    Dharmendra Dongardiye

    2014-05-01

    Full Text Available This paper presents a well-established Fully Differential sample & hold circuitry, implemented in 180-nm CMOS technology. In this two stage method the first stage give us very high gain and second stage gives large voltage swing. The proposed opamp provides 149MHz unity-gain bandwidth , 78 degree phase margin and a differential peak to peak output swing more than 2.4v. using the improved fully differential two stage operational amplifier of 76.7dB gain. Although the sample and hold circuit meets the requirements of SNR specifications.

  8. One-stage and two-stage penile buccal mucosa urethroplasty

    Directory of Open Access Journals (Sweden)

    G. Barbagli

    2016-03-01

    Full Text Available The paper provides the reader with the detailed description of current techniques of one-stage and two-stage penile buccal mucosa urethroplasty. The paper provides the reader with the preoperative patient evaluation paying attention to the use of diagnostic tools. The one-stage penile urethroplasty using buccal mucosa graft with the application of glue is preliminary showed and discussed. Two-stage penile urethroplasty is then reported. A detailed description of first-stage urethroplasty according Johanson technique is reported. A second-stage urethroplasty using buccal mucosa graft and glue is presented. Finally postoperative course and follow-up are addressed.

  9. Development of a linear compressor for two-stage pulse tube cryocoolers

    Institute of Scientific and Technical Information of China (English)

    Peng-da YAN; Wei-li GAO; Guo-bang CHEN

    2009-01-01

    A valveless linear compressor was built up to drive a self-made two-stage pulse tube cryocooler. With a designed maximum swept volume of 60 cm~3, the compressor can provide the cryocooler with a pressure volume (PV) power of 400 W.Preliminary measurements of the compressor indicated that both an efficiency of 35%~55% and a pressure ratio of 1.3~1.4 could be obtained. The two-stage pulse tube cryocooler driven by this compressor achieved the lowest temperature of 14.2 K.

  10. Terephthalic acid wastewater treatment by using two-stage aerobic process

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Based on the tests between anoxic and aerobic process, the two-stage aerobic process with a biological selector was chosen to treat terephthalic acid wastewater (PTA). By adopting the two- stage aerobic process, the CODCr in PTA wastewater could be reduced from 4000-6000 mg/L to below 100 mg/L; the COD loading in the first aerobic tank could reach 7.0-8.0 kgCODCr/(m3.d) and that of the second stage was from 0.2 to 0.4 kgCODCr/(m3.d). Further researches on the kinetics of substrate degradation were carried out.

  11. First Law Analysis of a Two-stage Ejector-vapor Compression Refrigeration Cycle working with R404A

    National Research Council Canada - National Science Library

    Feiza Memet; Daniela-Elena Mitu

    2011-01-01

    The traditional two-stage vapor compression refrigeration cycle might be replaced by a two-stage ejector-vapor compression refrigeration cycle if it is aimed the decrease of irreversibility during expansion...

  12. When Things Are Not as They Appear: Assessing the Adequacy of Cluster Randomization When Outcome Events Are Rare at Baseline

    Directory of Open Access Journals (Sweden)

    Veronica Dinaj-Koci

    2012-01-01

    Full Text Available The present study randomly assigned 15 Bahamian elementary schools to one of three intervention conditions. To assess the adequacy of cluster randomization, we examined two concerns identified by the local research team: inequality of gender distribution and environmental risk among groups. Baseline significant differences in risk and protective behaviors were minimal. There were significantly more males in the intervention group. Males had higher rates of risk behavior at all assessments. Poor school performance was also higher among the intervention condition and was significantly associated with increased rates of many but not all risk behaviors. Prior to adjusting for gender and school performance, several risk behaviors appeared to be higher after intervention among intervention youth. Adjusting for gender and school performance eradicated the group differences in risk behavior rates. Results demonstrate the importance of adequate randomization where outcomes of interest are rare events at baseline or differ by gender and there is an unequal gender distribution and the importance of the local research team’s knowledge of potential inequalities in environmental risk (i.e., school performance. Not considering such individual differences could impact the integrity of trial outcomes.

  13. Effect of Behavior Modification on Outcome in Early- to Moderate-Stage Chronic Kidney Disease: A Cluster-Randomized Trial.

    Directory of Open Access Journals (Sweden)

    Kunihiro Yamagata

    Full Text Available Owing to recent changes in our understanding of the underlying cause of chronic kidney disease (CKD, the importance of lifestyle modification for preventing the progression of kidney dysfunction and complications has become obvious. In addition, effective cooperation between general physicians (GPs and nephrologists is essential to ensure a better care system for CKD treatment. In this cluster-randomized study, we studied the effect of behavior modification on the outcome of early- to moderate-stage CKD.Stratified open cluster-randomized trial.A total of 489 GPs belonging to 49 local medical associations (clusters in Japan.A total of 2,379 patients (1,195 in group A (standard intervention and 1,184 in group B (advanced intervention aged between 40 and 74 years, who had CKD and were under consultation with GPs.All patients were managed in accordance with the current CKD guidelines. The group B clusters received three additional interventions: patients received both educational intervention for lifestyle modification and a CKD status letter, attempting to prevent their withdrawal from treatment, and the group B GPs received data sheets to facilitate reducing the gap between target and practice.The primary outcome measures were 1 the non-adherence rate of accepting continuous medical follow-up of the patients, 2 the collaboration rate between GPs and nephrologists, and 3 the progression of CKD.The rate of discontinuous clinical visits was significantly lower in group B (16.2% in group A vs. 11.5% in group B, p = 0.01. Significantly higher referral and co-treatment rates were observed in group B (p<0.01. The average eGFR deterioration rate tended to be lower in group B (group A: 2.6±5.8 ml/min/1.73 m2/year, group B: 2.4±5.1 ml/min/1.73 m2/year, p = 0.07. A significant difference in eGFR deterioration rate was observed in subjects with Stage 3 CKD (group A: 2.4±5.9 ml/min/1.73 m2/year, group B: 1.9±4.4 ml/min/1.73 m2/year, p = 0.03.Our care

  14. Preventing knee injuries in adolescent female football players – design of a cluster randomized controlled trial [NCT00894595

    Directory of Open Access Journals (Sweden)

    Waldén Markus

    2009-06-01

    Full Text Available Abstract Background Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football. Methods In this cluster randomized trial 516 teams (309 clusters in eight regional football districts in Sweden with female players aged 13–17 years were randomized into an intervention group (260 teams or a control group (256 teams. The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players' acute knee injuries during the study period. Three different forms are used in the trial: (1 baseline player data form collected at the start of the trial, (2 computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3 injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks. Outcome measures are assessed after the end of the 2009 season. Discussion Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to

  15. Analyzing indirect effects in cluster randomized trials. The effect of estimation method, number of groups and group sizes on accuracy and power.

    Directory of Open Access Journals (Sweden)

    Joop eHox

    2014-02-01

    Full Text Available Cluster randomized trials assess the effect of an intervention that is carried out at the group or cluster level. Ajzen’s theory of planned behaviour is often used to model the effect of the intervention as an indirect effect mediated in turn by attitude, norms and behavioural intention. Structural equation modelling (SEM is the technique of choice to estimate indirect effects and their significance. However, this is a large sample technique, and its application in a cluster randomized trial assumes a relatively large number of clusters. In practice, the number of clusters in these studies tends to be relatively small, e.g. much less than fifty. This study uses simulation methods to find the lowest number of clusters needed when multilevel SEM is used to estimate the indirect effect. Maximum likelihood estimation is compared to Bayesian analysis, with the central quality criteria being accuracy of the point estimate and the confidence interval. We also investigate the power of the test for the indirect effect. We conclude that Bayes estimation works well with much smaller cluster level sample sizes such as 20 cases than maximum likelihood estimation; although the bias is larger the coverage is much better. When only 5 to 10 clusters are available per treatment condition even with Bayesian estimation problems occur.

  16. Overcoming the bottlenecks of anaerobic digestion of olive mill solid waste by two-stage fermentation.

    Science.gov (United States)

    Stoyanova, Elitza; Lundaa, Tserennyam; Bochmann, Günther; Fuchs, Werner

    2017-02-01

    Two-stage anaerobic digestion (AD) of two-phase olive mill solid waste (OMSW) was applied for reducing the inhibiting factors by optimizing the acidification stage. Single-stage AD and co-fermentation with chicken manure were conducted coinstantaneous for direct comparison. Degradation of the polyphenols up to 61% was observed during the methanogenic stage. Nevertheless the concentration of phenolic substances was still high; the two-stage fermentation remained stable at OLR 1.5 kgVS/m³day. The buffer capacity of the system was twice as high, compared to the one-stage fermentation, without additives. The two-stage AD was a combined process - thermophilic first stage and mesophilic second stage, which pointed out to be the most profitable for AD of OMSW for the reduced hydraulic retention time (HRT) from 230 to 150 days, and three times faster than the single-stage and the co-fermentation start-up of the fermentation. The optimal HRT and incubation temperature for the first stage were determined to four days and 55°C. The performance of the two-stage AD concerning the stability of the process was followed by the co-digestion of OMSW with chicken manure as a nitrogen-rich co-substrate, which makes them viable options for waste disposal with concomitant energy recovery.

  17. The Design, Construction and Operation of a 75 kW Two-Stage Gasifier

    DEFF Research Database (Denmark)

    Henriksen, Ulrik Birk; Ahrenfeldt, Jesper; Jensen, Torben Kvist

    2003-01-01

    The Two-Stage Gasifier was operated for several weeks (465 hours) and of these 190 hours continuously. The gasifier is operated automatically unattended day and night, and only small adjustments of the feeding rate were necessary once or twice a day. The operation was successful, and the output a...... of the reactor had to be constructed in some other material....

  18. Treatment of corn ethanol distillery wastewater using two-stage anaerobic digestion.

    Science.gov (United States)

    Ráduly, B; Gyenge, L; Szilveszter, Sz; Kedves, A; Crognale, S

    In this study the mesophilic two-stage anaerobic digestion (AD) of corn bioethanol distillery wastewater is investigated in laboratory-scale reactors. Two-stage AD technology separates the different sub-processes of the AD in two distinct reactors, enabling the use of optimal conditions for the different microbial consortia involved in the different process phases, and thus allowing for higher applicable organic loading rates (OLRs), shorter hydraulic retention times (HRTs) and better conversion rates of the organic matter, as well as higher methane content of the produced biogas. In our experiments the reactors have been operated in semi-continuous phase-separated mode. A specific methane production of 1,092 mL/(L·d) has been reached at an OLR of 6.5 g TCOD/(L·d) (TCOD: total chemical oxygen demand) and a total HRT of 21 days (5.7 days in the first-stage, and 15.3 days in the second-stage reactor). Nonetheless the methane concentration in the second-stage reactor was very high (78.9%); the two-stage AD outperformed the reference single-stage AD (conducted at the same reactor loading rate and retention time) by only a small margin in terms of volumetric methane production rate. This makes questionable whether the higher methane content of the biogas counterbalances the added complexity of the two-stage digestion.

  19. A two-stage ethanol-based biodiesel production in a packed bed reactor

    DEFF Research Database (Denmark)

    Xu, Yuan; Nordblad, Mathias; Woodley, John

    2012-01-01

    A two-stage enzymatic process for producing fatty acid ethyl ester (FAEE) in a packed bed reactor is reported. The process uses an experimental immobilized lipase (NS 88001) and Novozym 435 to catalyze transesterification (first stage) and esterification (second stage), respectively. Both stages...

  20. Two-Stage MAS Technique for Analysis of DRA Elements and Arrays on Finite Ground Planes

    DEFF Research Database (Denmark)

    Larsen, Niels Vesterdal; Breinbjerg, Olav

    2007-01-01

    A two-stage Method of Auxiliary Sources (MAS) technique is proposed for analysis of dielectric resonator antenna (DRA) elements and arrays on finite ground planes (FGPs). The problem is solved by first analysing the DRA on an infinite ground plane (IGP) and then using this solution to model the FGP...... problem....

  1. Use a Log Splitter to Demonstrate Two-Stage Hydraulic Pump

    Science.gov (United States)

    Dell, Timothy W.

    2012-01-01

    The two-stage hydraulic pump is commonly used in many high school and college courses to demonstrate hydraulic systems. Unfortunately, many textbooks do not provide a good explanation of how the technology works. Another challenge that instructors run into with teaching hydraulic systems is the cost of procuring an expensive real-world machine…

  2. Two-Stage Sampling Procedures for Comparing Means When Population Distributions Are Non-Normal.

    Science.gov (United States)

    Luh, Wei-Ming; Olejnik, Stephen

    Two-stage sampling procedures for comparing two population means when variances are heterogeneous have been developed by D. G. Chapman (1950) and B. K. Ghosh (1975). Both procedures assume sampling from populations that are normally distributed. The present study reports on the effect that sampling from non-normal distributions has on Type I error…

  3. Some design aspects of a two-stage rail-to-rail CMOS op amp

    NARCIS (Netherlands)

    Gierkink, S.L.J.; Holzmann, Peter J.; Wiegerink, R.J.; Wassenaar, R.F.

    1999-01-01

    A two-stage low-voltage CMOS op amp with rail-to-rail input and output voltage ranges is presented. The circuit uses complementary differential input pairs to achieve the rail-to-rail common-mode input voltage range. The differential pairs operate in strong inversion, and the constant transconductan

  4. Kinetics analysis of two-stage austenitization in supermartensitic stainless steel

    DEFF Research Database (Denmark)

    Nießen, Frank; Villa, Matteo; Hald, John

    2017-01-01

    The martensite-to-austenite transformation in X4CrNiMo16-5-1 supermartensitic stainless steel was followed in-situ during isochronal heating at 2, 6 and 18 K min−1 applying energy-dispersive synchrotron X-ray diffraction at the BESSY II facility. Austenitization occurred in two stages, separated...

  5. An intracooling system for a novel two-stage sliding-vane air compressor

    Science.gov (United States)

    Murgia, Stefano; Valenti, Gianluca; Costanzo, Ida; Colletta, Daniele; Contaldi, Giulio

    2017-08-01

    Lube-oil injection is used in positive-displacement compressors and, among them, in sliding-vane machines to guarantee the correct lubrication of the moving parts and as sealing to prevent air leakage. Furthermore, lube-oil injection allows to exploit lubricant also as thermal ballast with a great thermal capacity to minimize the temperature increase during the compression. This study presents the design of a two-stage sliding-vane rotary compressor in which the air cooling is operated by high-pressure cold oil injection into a connection duct between the two stages. The heat exchange between the atomized oil jet and the air results in a decrease of the air temperature before the second stage, improving the overall system efficiency. This cooling system is named here intracooling, as opposed to intercooling. The oil injection is realized via pressure-swirl nozzles, both within the compressors and inside the intracooling duct. The design of the two-stage sliding-vane compressor is accomplished by way of a lumped parameter model. The model predicts an input power reduction as large as 10% for intercooled and intracooled two-stage compressors, the latter being slightly better, with respect to a conventional single-stage compressor for compressed air applications. An experimental campaign is conducted on a first prototype that comprises the low-pressure compressor and the intracooling duct, indicating that a significant temperature reduction is achieved in the duct.

  6. Development of a heavy-duty diesel engine with two-stage turbocharging

    NARCIS (Netherlands)

    Sturm, L.; Kruithof, J.

    2001-01-01

    A mean value model was developed by using Matrixx/ Systembuild simulation tool for designing real-time control algorithms for the two-stage engine. All desired characteristics are achieved, apart from lower A/F ratio at lower engine speeds and Turbocharger matches calculations. The CANbus is used to

  7. Two-stage, dilute sulfuric acid hydrolysis of wood : an investigation of fundamentals

    Science.gov (United States)

    John F. Harris; Andrew J. Baker; Anthony H. Conner; Thomas W. Jeffries; James L. Minor; Roger C. Pettersen; Ralph W. Scott; Edward L Springer; Theodore H. Wegner; John I. Zerbe

    1985-01-01

    This paper presents a fundamental analysis of the processing steps in the production of methanol from southern red oak (Quercus falcata Michx.) by two-stage dilute sulfuric acid hydrolysis. Data for hemicellulose and cellulose hydrolysis are correlated using models. This information is used to develop and evaluate a process design.

  8. Two-stage data envelopment analysis technique for evaluating internal supply chain efficiency

    Directory of Open Access Journals (Sweden)

    Nisakorn Somsuk

    2014-12-01

    Full Text Available A two-stage data envelopment analysis (DEA which uses mathematical linear programming techniques is applied to evaluate the efficiency of a system composed of two relational sub-processes, by which the outputs from the first sub-process (as the intermediate outputs of the system are the inputs for the second sub-process. The relative efficiencies of the system and its sub-processes can be measured by applying the two-stage DEA. According to the literature review on the supply chain management, this technique can be used as a tool for evaluating the efficiency of the supply chain composed of two relational sub-processes. The technique can help to determine the inefficient sub-processes. Once the inefficient sub-process was improved its efficiency, it would result in better aggregate efficiency of the supply chain. This paper aims to present a procedure for evaluating the efficiency of the supply chain by using the two-stage DEA, under the assumption of constant returns to scale, with an example of internal supply chain efficiency measurement of insurance companies by applying the two-stage DEA for illustration. Moreover, in this paper the authors also present some observations on the application of this technique.

  9. Two-stage estimation in copula models used in family studies

    DEFF Research Database (Denmark)

    Andersen, Elisabeth Anne Wreford

    2005-01-01

    In this paper register based family studies provide the motivation for studying a two-stage estimation procedure in copula models for multivariate failure time data. The asymptotic properties of the estimators in both parametric and semi-parametric models are derived, generalising the approach by...

  10. Innovative two-stage anaerobic process for effective codigestion of cheese whey and cattle manure.

    Science.gov (United States)

    Bertin, Lorenzo; Grilli, Selene; Spagni, Alessandro; Fava, Fabio

    2013-01-01

    The valorisation of agroindustrial waste through anaerobic digestion represents a significant opportunity for refuse treatment and renewable energy production. This study aimed to improve the codigestion of cheese whey (CW) and cattle manure (CM) by an innovative two-stage process, based on concentric acidogenic and methanogenic phases, designed for enhancing performance and reducing footprint. The optimum CW to CM ratio was evaluated under batch conditions. Thereafter, codigestion was implemented under continuous-flow conditions comparing one- and two-stage processes. The results demonstrated that the addition of CM in codigestion with CW greatly improved the anaerobic process. The highest methane yield was obtained co-treating the two substrates at equal ratio by using the innovative two-stage process. The proposed system reached the maximum value of 258 mL(CH4) g(gv(-1), which was more than twice the value obtained by the one-stage process and 10% higher than the value obtained by the two-stage one.

  11. Extraoral implants for orbit rehabilitation: a comparison between one-stage and two-stage surgeries.

    Science.gov (United States)

    de Mello, M C L M P; Guedes, R; de Oliveira, J A P; Pecorari, V A; Abrahão, M; Dib, L L

    2014-03-01

    The aim of the study was to compare the osseointegration success rate and time for delivery of the prosthesis among cases treated by two-stage or one-stage surgery for orbit rehabilitation between 2003 and 2011. Forty-five patients were included, 31 males and 14 females; 22 patients had two-stage surgery and 23 patients had one-stage surgery. A total 138 implants were installed, 42 (30.4%) on previously irradiated bone. The implant survival rate was 96.4%, with a success rate of 99.0% among non-irradiated patients and 90.5% among irradiated patients. Two-stage patients received 74 implants with a survival rate of 94.6% (four implants lost); one-stage surgery patients received 64 implants with a survival rate of 98.4% (one implant lost). The median time interval between implant fixation and delivery of the prosthesis for the two-stage group was 9.6 months and for the one-stage group was 4.0 months (P < 0.001). The one-stage technique proved to be reliable and was associated with few risks and complications; the rate of successful osseointegration was similar to those reported in the literature. The one-stage technique should be considered a viable procedure that shortens the time to final rehabilitation and facilitates appropriate patient follow-up treatment.

  12. Validation of Continuous CHP Operation of a Two-Stage Biomass Gasifier

    DEFF Research Database (Denmark)

    Ahrenfeldt, Jesper; Henriksen, Ulrik Birk; Jensen, Torben Kvist

    2006-01-01

    The Viking gasification plant at the Technical University of Denmark was built to demonstrate a continuous combined heat and power operation of a two-stage gasifier fueled with wood chips. The nominal input of the gasifier is 75 kW thermal. To validate the continuous operation of the plant, a 9-d...

  13. High rate treatment of terephthalic acid production wastewater in a two-stage anaerobic bioreactor

    NARCIS (Netherlands)

    Kleerebezem, R.; Beckers, J.; Pol, L.W.H.; Lettinga, G.

    2005-01-01

    The feasibility was studied of anaerobic treatment of wastewater generated during purified terephthalic acid (PTA) production in two-stage upflow anaerobic sludge blanket (UASB) reactor system. The artificial influent of the system contained the main organic substrates of PTA-wastewater: acetate, be

  14. Thermal design of two-stage evaporative cooler based on thermal comfort criterion

    Science.gov (United States)

    Gilani, Neda; Poshtiri, Amin Haghighi

    2017-04-01

    Performance of two-stage evaporative coolers at various outdoor air conditions was numerically studied, and its geometric and physical characteristics were obtained based on thermal comfort criteria. For this purpose, a mathematical model was developed based on conservation equations of mass, momentum and energy to determine heat and mass transfer characteristics of the system. The results showed that two-stage indirect/direct cooler can provide the thermal comfort condition when outdoor air temperature and relative humidity are located in the range of 34-54 °C and 10-60 %, respectively. Moreover, as relative humidity of the ambient air rises, two-stage evaporative cooler with the smaller direct and larger indirect cooler will be needed. In building with high cooling demand, thermal comfort may be achieved at a greater air change per hour number, and thus an expensive two-stage evaporative cooler with a higher electricity consumption would be required. Finally, a design guideline was proposed to determine the size of required plate heat exchangers at various operating conditions.

  15. ADM1-based modeling of methane production from acidified sweet sorghum extractin a two stage process

    DEFF Research Database (Denmark)

    Antonopoulou, Georgia; Gavala, Hariklia N.; Skiadas, Ioannis

    2012-01-01

    The present study focused on the application of the Anaerobic Digestion Model 1 οn the methane production from acidified sorghum extract generated from a hydrogen producing bioreactor in a two-stage anaerobic process. The kinetic parameters for hydrogen and volatile fatty acids consumption were...

  16. Thermal design of two-stage evaporative cooler based on thermal comfort criterion

    Science.gov (United States)

    Gilani, Neda; Poshtiri, Amin Haghighi

    2016-09-01

    Performance of two-stage evaporative coolers at various outdoor air conditions was numerically studied, and its geometric and physical characteristics were obtained based on thermal comfort criteria. For this purpose, a mathematical model was developed based on conservation equations of mass, momentum and energy to determine heat and mass transfer characteristics of the system. The results showed that two-stage indirect/direct cooler can provide the thermal comfort condition when outdoor air temperature and relative humidity are located in the range of 34-54 °C and 10-60 %, respectively. Moreover, as relative humidity of the ambient air rises, two-stage evaporative cooler with the smaller direct and larger indirect cooler will be needed. In building with high cooling demand, thermal comfort may be achieved at a greater air change per hour number, and thus an expensive two-stage evaporative cooler with a higher electricity consumption would be required. Finally, a design guideline was proposed to determine the size of required plate heat exchangers at various operating conditions.

  17. A Two-Stage Exercise on the Binomial Distribution Using Minitab.

    Science.gov (United States)

    Shibli, M. Abdullah

    1990-01-01

    Describes a two-stage experiment that was designed to explain binomial distribution to undergraduate statistics students. A manual coin flipping exercise is explained as the first stage; a computerized simulation using MINITAB software is presented as stage two; and output from the MINITAB exercises is included. (two references) (LRW)

  18. The rearrangement process in a two-stage broadcast switching network

    DEFF Research Database (Denmark)

    Jacobsen, Søren B.

    1988-01-01

    The rearrangement process in the two-stage broadcast switching network presented by F.K. Hwang and G.W. Richards (ibid., vol.COM-33, no.10, p.1025-1035, Oct. 1985) is considered. By defining a certain function it is possible to calculate an upper bound on the number of connections to be moved...

  19. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

    Directory of Open Access Journals (Sweden)

    Yukio Iwashita

    2012-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both post-operative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  20. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

    Directory of Open Access Journals (Sweden)

    Iwashita Yukio

    2005-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both postoperative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  1. Two-stage bargaining with coverage extension in a dual labour market

    DEFF Research Database (Denmark)

    Roberts, Mark A.; Stæhr, Karsten; Tranæs, Torben

    2000-01-01

    This paper studies coverage extension in a simple general equilibrium model with a dual labour market. The union sector is characterized by two-stage bargaining whereas the firms set wages in the non-union sector. In this model firms and unions of the union sector have a commonality of interest...

  2. Genetic modifiers of Hb E/β0 thalassemia identified by a two-stage genome-wide association study

    Directory of Open Access Journals (Sweden)

    Winichagoon Pranee

    2010-03-01

    Full Text Available Abstract Background Patients with Hb E/β0 thalassemia display remarkable variability in disease severity. To identify genetic modifiers influencing disease severity, we conducted a two-stage genome scan in groups of 207 mild and 305 severe unrelated patients from Thailand with Hb E/β0 thalassemia and normal α-globin genes. Methods First, we estimated and compared the allele frequencies of approximately 110,000 gene-based single nucleotide polymorphisms (SNPs in pooled DNAs from different severity groups. The 756 SNPs that showed reproducible allelic differences at P Results After adjustment for age, gender and geographic region, logistic regression models showed 50 SNPs significantly associated with disease severity (P P = 2.6 × 10-13. Seven SNPs in two distinct LD blocks within a region centromeric to the β-globin gene cluster that contains many olfactory receptor genes were also associated with disease severity; rs3886223 had the strongest association (OR = 3.03, P = 3.7 × 10-11. Several previously unreported SNPs were also significantly associated with disease severity. Conclusions These results suggest that there may be an additional regulatory region centromeric to the β-globin gene cluster that affects disease severity by modulating fetal hemoglobin expression.

  3. A two-stage short-term traffic flow prediction method based on AVL and AKNN techniques

    Institute of Scientific and Technical Information of China (English)

    孟梦; 王博彬; 邵春福; 李慧轩; 黃育兆

    2015-01-01

    Short-term traffic flow prediction is one of the essential issues in intelligent transportation systems (ITS). A new two-stage traffic flow prediction method named AKNN-AVL method is presented, which combines an advancedk-nearest neighbor (AKNN) method and balanced binary tree (AVL) data structure to improve the prediction accuracy. The AKNN method uses pattern recognition two times in the searching process, which considers the previous sequences of traffic flow to forecast the future traffic state. Clustering method and balanced binary tree technique are introduced to build case database to reduce the searching time. To illustrate the effects of these developments, the accuracies performance of AKNN-AVL method,k-nearest neighbor (KNN) method and the auto-regressive and moving average (ARMA) method are compared. These methods are calibrated and evaluated by the real-time data from a freeway traffic detector near North 3rd Ring Road in Beijing under both normal and incident traffic conditions. The comparisons show that the AKNN-AVL method with the optimal neighbor and pattern size outperforms both KNN method and ARMA method under both normal and incident traffic conditions. In addition, the combinations of clustering method and balanced binary tree technique to the prediction method can increase the searching speed and respond rapidly to case database fluctuations.

  4. The Bracka two-stage repair for severe proximal hypospadias: A single center experience

    Directory of Open Access Journals (Sweden)

    Rakesh S Joshi

    2015-01-01

    Full Text Available Background: Surgical correction of severe proximal hypospadias represents a significant surgical challenge and single-stage corrections are often associated with complications and reoperations. Bracka two-stage repair is an attractive alternative surgical procedure with superior, reliable, and reproducible results. Purpose: To study the feasibility and applicability of Bracka two-stage repair for the severe proximal hypospadias and to analyze the outcomes and complications of this surgical technique. Materials and Methods: This prospective study was conducted from January 2011 to December 2013. Bracka two-stage repair was performed using inner preputial skin as a free graft in subjects with proximal hypospadias in whom severe degree of chordee and/or poor urethral plate was present. Only primary cases were included in this study. All subjects received three doses of intra-muscular testosterone 3 weeks apart before first stage. Second stage was performed 6 months after the first stage. Follow-up ranged from 6 months to 24 months. Results: A total of 43 patients operated for Bracka repair, out of which 30 patients completed two-stage repair. Mean age of the patients was 4 years and 8 months. We achieved 100% graft uptake and no revision was required. Three patients developed fistula, while two had metal stenosis. Glans dehiscence, urethral stricture and the residual chordee were not found during follow-up and satisfactory cosmetic results with good urinary stream were achieved in all cases. Conclusion: The Bracka two-stage repair is a safe and reliable approach in select patients in whom it is impractical to maintain the axial integrity of the urethral plate, and, therefore, a full circumference urethral reconstruction become necessary. This gives good results both in terms of restoration of normal function with minimal complication.

  5. Optimisation of two-stage screw expanders for waste heat recovery applications

    Science.gov (United States)

    Read, M. G.; Smith, I. K.; Stosic, N.

    2015-08-01

    It has previously been shown that the use of two-phase screw expanders in power generation cycles can achieve an increase in the utilisation of available energy from a low temperature heat source when compared with more conventional single-phase turbines. However, screw expander efficiencies are more sensitive to expansion volume ratio than turbines, and this increases as the expander inlet vapour dryness fraction decreases. For singlestage screw machines with low inlet dryness, this can lead to under expansion of the working fluid and low isentropic efficiency for the expansion process. The performance of the cycle can potentially be improved by using a two-stage expander, consisting of a low pressure machine and a smaller high pressure machine connected in series. By expanding the working fluid over two stages, the built-in volume ratios of the two machines can be selected to provide a better match with the overall expansion process, thereby increasing efficiency for particular inlet and discharge conditions. The mass flow rate though both stages must however be matched, and the compromise between increasing efficiency and maximising power output must also be considered. This research uses a rigorous thermodynamic screw machine model to compare the performance of single and two-stage expanders over a range of operating conditions. The model allows optimisation of the required intermediate pressure in the two- stage expander, along with the rotational speed and built-in volume ratio of both screw machine stages. The results allow the two-stage machine to be fully specified in order to achieve maximum efficiency for a required power output.

  6. Impact of a care pathway for COPD on adherence to guidelines and hospital readmission: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Vanhaecht K

    2016-11-01

    Full Text Available Kris Vanhaecht,1,2 Cathy Lodewijckx,1 Walter Sermeus,1 Marc Decramer,3,4 Svin Deneckere,1,5 Fabrizio Leigheb,6 Paulo Boto,7 Seval Kul,8 Deborah Seys,1 Massimiliano Panella1,6 1Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven – University of Leuven, 2Department of Quality Management, University Hospitals Leuven, 3Department of Clinical and Experimental Medicine, KU Leuven – University of Leuven, 4University Hospitals Leuven, Leuven, 5Medical Department, Delta Hospitals Roeselare, Roeselare, Belgium; 6Department of Translational Medicine, University of Eastern Piedmont, Vercelli, Italy; 7Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal; 8Department of Biostatistics, School of Medicine, University of Gaziantep, Gaziantep, Turkey Purpose: Current in-hospital management of exacerbations of COPD is suboptimal, and patient outcomes are poor. The primary aim of this study was to evaluate whether implementation of a care pathway (CP for COPD improves the 6 months readmission rate. Secondary outcomes were the 30 days readmission rate, mortality, length of stay and adherence to guidelines. Patients and methods: An international cluster randomized controlled trial was performed in Belgium, Italy and Portugal. General hospitals were randomly assigned to an intervention group where a CP was implemented or a control group where usual care was provided. The targeted population included patients with COPD exacerbation. Results: Twenty-two hospitals were included, whereof 11 hospitals (n=174 patients were randomized to the intervention group and 11 hospitals (n=168 patients to the control group. The CP had no impact on the 6 months readmission rate. However, the 30 days readmission rate was significantly lower in the intervention group (9.7%; 15/155 compared to the control group

  7. A cluster randomized control field trial of the ABRACADABRA web-based literacy intervention: Replication and extension of basic findings.

    Directory of Open Access Journals (Sweden)

    Noella Angele Piquette

    2014-12-01

    Full Text Available The present paper reports a cluster randomized control trial evaluation of teaching using ABRACADABRA (ABRA, an evidence-based and web-based literacy intervention (http://abralite.concordia.ca with 107 kindergarten and 96 grade 1 children in 24 classes (12 intervention 12 control classes from all 12 elementary schools in one school district in Canada. Children in the intervention condition received 10-12 hours of whole class instruction using ABRA between pre- and post-test. Hierarchical linear modeling of post-test results showed significant gains in letter-sound knowledge for intervention classrooms over control classrooms. In addition, medium effect sizes were evident for three of five outcome measures favoring the intervention: letter-sound knowledge (d = +.66, phonological blending (d = +.52, and word reading (d = +.52, over effect sizes for regular teaching. It is concluded that regular teaching with ABRA technology adds significantly to literacy in the early elementary years.

  8. Cluster Randomized Controlled Trial of Group Prenatal Care: Perinatal Outcomes Among Adolescents in New York City Health Centers

    Science.gov (United States)

    Earnshaw, Valerie; Lewis, Jessica B.; Kershaw, Trace S.; Magriples, Urania; Stasko, Emily; Rising, Sharon Schindler; Cassells, Andrea; Cunningham, Shayna; Bernstein, Peter; Tobin, Jonathan N.

    2016-01-01

    Objectives. We compared an evidence-based model of group prenatal care to traditional individual prenatal care on birth, neonatal, and reproductive health outcomes. Methods. We performed a multisite cluster randomized controlled trial in 14 health centers in New York City (2008–2012). We analyzed 1148 pregnant women aged 14 to 21 years, at less than 24 weeks of gestation, and not at high obstetrical risk. We assessed outcomes via medical records and surveys. Results. In intention-to-treat analyses, women at intervention sites were significantly less likely to have infants small for gestational age (prenatal care resulted in more favorable birth, neonatal, and reproductive outcomes. Successful translation of clinical innovations to enhance care, improve outcomes, and reduce cost requires strategies that facilitate patient adherence and support organizational change. PMID:26691105

  9. An assessment of health behavior peer effects in Peking University dormitories: a randomized cluster-assignment design for interference.

    Science.gov (United States)

    Yuan, Changzheng; Lv, Jun; VanderWeele, Tyler J

    2013-01-01

    Relatively little is known about the peer influence in health behaviors within university dormitory rooms. Moreover, in China, the problem of unhealthy behaviors among university students has not yet been sufficiently recognized. We thus investigated health behavior peer influence in Peking University dormitories utilizing a randomized cluster-assignment design. Cross-sectional in-dormitory survey. Current students from Peking University Health Science Center from April to June, 2009. Self-reported questionnaire on health behaviors: physical activity (including bicycling), dietary intake and tobacco use. Use of bicycle, moderate-intensity exercise, frequency of sweet food and soybean milk intake, frequency of roasted/baked/toasted food intake were behaviors significantly or marginally significantly affected by peer influence. Health behavior peer effects exist within dormitory rooms among university students. This could provide guidance on room assignment, or inform intervention programs. Examining these may demand attention from university administrators and policy makers.

  10. Data Randomization and Cluster-Based Partitioning for Botnet Intrusion Detection.

    Science.gov (United States)

    Al-Jarrah, Omar Y; Alhussein, Omar; Yoo, Paul D; Muhaidat, Sami; Taha, Kamal; Kim, Kwangjo

    2016-08-01

    Botnets, which consist of remotely controlled compromised machines called bots, provide a distributed platform for several threats against cyber world entities and enterprises. Intrusion detection system (IDS) provides an efficient countermeasure against botnets. It continually monitors and analyzes network traffic for potential vulnerabilities and possible existence of active attacks. A payload-inspection-based IDS (PI-IDS) identifies active intrusion attempts by inspecting transmission control protocol and user datagram protocol packet's payload and comparing it with previously seen attacks signatures. However, the PI-IDS abilities to detect intrusions might be incapacitated by packet encryption. Traffic-based IDS (T-IDS) alleviates the shortcomings of PI-IDS, as it does not inspect packet payload; however, it analyzes packet header to identify intrusions. As the network's traffic grows rapidly, not only the detection-rate is critical, but also the efficiency and the scalability of IDS become more significant. In this paper, we propose a state-of-the-art T-IDS built on a novel randomized data partitioned learning model (RDPLM), relying on a compact network feature set and feature selection techniques, simplified subspacing and a multiple randomized meta-learning technique. The proposed model has achieved 99.984% accuracy and 21.38 s training time on a well-known benchmark botnet dataset. Experiment results demonstrate that the proposed methodology outperforms other well-known machine-learning models used in the same detection task, namely, sequential minimal optimization, deep neural network, C4.5, reduced error pruning tree, and randomTree.

  11. Impact of a school-based intervention to promote fruit intake: a cluster randomized controlled trial

    OpenAIRE

    Rosário, R.; ARAÚJO, A.; Padrão, P.; Lopes, O; Moreira, A.; Abreu, S; Vale, S; Pereira, B.; Moreira, P.

    2016-01-01

    OBJECTIVE: There is evidence that fruit consumption among school children is below the recommended levels. This study aims to examine the effects of a dietary education intervention program me, held by teachers previously trained in nutrition, on the consumption of fruit as a dessert at lunch and dinner, among children 6-12 years old. STUDY DESIGN: This is a randomized trial with the schools as the unit of randomisation. METHODS: A total of 464 children (239 female, 6-12years) from seve...

  12. People-centered tuberculosis care versus standard directly observed therapy: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Khachadourian, Vahe; Truzyan, Nune; Harutyunyan, Arusyak; Thompson, Michael E; Harutyunyan, Tsovinar; Petrosyan, Varduhi

    2015-06-22

    Tuberculosis is a major public health concern resulting in high rates of morbidity and mortality worldwide, particularly in low- and middle-income countries. Tuberculosis requires a long and intensive course of treatment. Thus, various approaches, including patient empowerment, education and counselling sessions, and involvement of family members and community workers, have been suggested for improving treatment adherence and outcome. The current randomized controlled trial aims to evaluate the effectiveness over usual care of an innovative multicomponent people-centered tuberculosis-care strategy in Armenia. Innovative Approach to Tuberculosis care in Armenia is an open-label, stratified cluster randomized controlled trial with two parallel arms. Tuberculosis outpatient centers are the clusters assigned to intervention and control arms. Drug-sensitive tuberculosis patients in the continuation phase of treatment in the intervention arm and their family members participate in a short educational and counselling session to raise their knowledge, decrease tuberculosis-related stigma, and enhance treatment adherence. Patients receive the required medications for one week during the weekly visits to the tuberculosis outpatient centers. Additionally, patients receive daily Short Message Service (SMS) reminders to take their medications and daily phone calls to assure adherence and monitoring of treatment potential side effects. Control-arm patients follow the World Health Organization--recommended directly observed treatment strategy, including daily visits to tuberculosis outpatient centers for drug-intake. The primary outcome is physician-reported treatment outcome. Patients' knowledge, depression, quality of life, within-family tuberculosis-related stigma, family social support, and self-reported adherence to tuberculosis treatment are secondary outcomes. Improved adherence and tuberculosis treatment outcomes can strengthen tuberculosis control and thereby forestall

  13. In a rural area of Bangladesh, traditional birth attendant training improved early infant feeding practices: a pragmatic cluster randomized trial.

    Science.gov (United States)

    Talukder, Shamim; Farhana, Dina; Vitta, Bineti; Greiner, Ted

    2017-01-01

    In rural Bangladesh, most births take place at home. There is little evidence regarding the influence of traditional birth attendants (TBAs) or community volunteers (CVs) on early infant feeding practices. We conducted a pragmatic cluster randomized controlled trial in Panchagarh District to examine the effects of training and post-training supervision of TBAs/CVs on early breastfeeding practices. Nine unions were randomized into three groups of three unions. We compared outcomes between mothers in a control group (CG), those living in unions where TBAs/CVs had received a 5-day training in early feeding practices (TG) and those living in unions where TBAs/CVs were both trained and supervised (SG). A total of 1182 mothers of infants aged 0-6 months were interviewed at baseline. After 6 months of intervention, an endline survey was conducted on a different sample of 1148 mothers of infants aged 0-6 months in the same areas. In both intervention areas, TBAs/CVs made regular home visits and attended births whenever possible. Rates of early initiation of breastfeeding, avoidance of prelacteal feeds and exclusive breastfeeding were compared between groups using cluster-controlled mixed model logistic regression. At endline, both intervention groups had significantly higher proportions of mothers who reported early initiation of breastfeeding (CG: 88%, TG: 96%, SG: 96%) and avoidance of prelacteal feeds (CG: 48%, TG: 80%, SG: 88%) compared with the control group; there were no significant differences between the two intervention groups. The endline rates of reported exclusive breastfeeding were not significantly different among groups (CG: 67%, TG: 76%, SG: 83%). © 2016 John Wiley & Sons Ltd.

  14. A stratified two-stage sampling design for digital soil mapping in a Mediterranean basin

    Science.gov (United States)

    Blaschek, Michael; Duttmann, Rainer

    2015-04-01

    The quality of environmental modelling results often depends on reliable soil information. In order to obtain soil data in an efficient manner, several sampling strategies are at hand depending on the level of prior knowledge and the overall objective of the planned survey. This study focuses on the collection of soil samples considering available continuous secondary information in an undulating, 16 km²-sized river catchment near Ussana in southern Sardinia (Italy). A design-based, stratified, two-stage sampling design has been applied aiming at the spatial prediction of soil property values at individual locations. The stratification based on quantiles from density functions of two land-surface parameters - topographic wetness index and potential incoming solar radiation - derived from a digital elevation model. Combined with four main geological units, the applied procedure led to 30 different classes in the given test site. Up to six polygons of each available class were selected randomly excluding those areas smaller than 1ha to avoid incorrect location of the points in the field. Further exclusion rules were applied before polygon selection masking out roads and buildings using a 20m buffer. The selection procedure was repeated ten times and the set of polygons with the best geographical spread were chosen. Finally, exact point locations were selected randomly from inside the chosen polygon features. A second selection based on the same stratification and following the same methodology (selecting one polygon instead of six) was made in order to create an appropriate validation set. Supplementary samples were obtained during a second survey focusing on polygons that have either not been considered during the first phase at all or were not adequately represented with respect to feature size. In total, both field campaigns produced an interpolation set of 156 samples and a validation set of 41 points. The selection of sample point locations has been done using

  15. Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Costello Anthony

    2011-06-01

    Full Text Available Abstract Background Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen. Methods/Design The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers. MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis. The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design. MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs are supported in convening monthly women's groups. Nine groups per cluster (270 in total work through two action research cycles in which they (i identify local issues around maternity, newborn health and nutrition, (ii prioritise key problems, (iii develop strategies to address them, (iv implement the strategies, and (v evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i identify local births, (ii identify low birth weight infants, (iii identify possible newborn infection, (iv manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v follow up infants and support families. Primary outcome: neonatal mortality rates. Secondary outcomes: MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal

  16. Effectiveness of brief suicide management training programme for medical residents in Japan: a cluster randomized controlled trial.

    Science.gov (United States)

    Suzuki, Y; Kato, T A; Sato, R; Fujisawa, D; Aoyama-Uehara, K; Hashimoto, N; Yonemoto, N; Fukasawa, M; Otsuka, K

    2014-06-01

    Aims. To evaluate the effectiveness of a brief suicide management training programme for Japanese medical residents compared with the usual lecture on suicidality. Methods. In this multi-center, clustered randomized controlled trial, the intervention group attended a structured suicide management programme and the control group, the usual lecture on depression and suicidality. The primary outcome was the difference in residents' cumulative competency score to manage suicidal persons from baseline (T0) to 1 month after the intervention (T2), determined using the Suicide Intervention Response Inventory (SIRI-1) score, at individual level. Results. Analysis of 114 residents (intervention group n = 65, control group n = 49) assigned to two clusters in each group revealed no change in SIRI-1 score from T0 to T2 or immediately after the intervention (T1) between the two groups. As a secondary analysis, discrepancy in judgement between the participants and Japanese suicidologists was examined immediately after the intervention in the adjusted model, with a mean difference in score of 9.98 (95% confidence interval: 4.39-15.56; p = 0.001). Conclusions. The structured programme was not proven to improve competency in suicide management when measured by the SIRI-1 score. Further elaboration of the programme and valid measurement of its outcome would be needed to show the program's effectiveness.

  17. A cross-sectional, randomized cluster sample survey of household vulnerability to extreme heat among slum dwellers in ahmedabad, india.

    Science.gov (United States)

    Tran, Kathy V; Azhar, Gulrez S; Nair, Rajesh; Knowlton, Kim; Jaiswal, Anjali; Sheffield, Perry; Mavalankar, Dileep; Hess, Jeremy

    2013-06-18

    Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile.

  18. Correlation of electron transport and photocatalysis of nanocrystalline clusters studied by Monte-Carlo continuity random walking.

    Science.gov (United States)

    Liu, Baoshun; Li, Ziqiang; Zhao, Xiujian

    2015-02-21

    In this research, Monte-Carlo Continuity Random Walking (MC-RW) model was used to study the relation between electron transport and photocatalysis of nano-crystalline (nc) clusters. The effects of defect energy disorder, spatial disorder of material structure, electron density, and interfacial transfer/recombination on the electron transport and the photocatalysis were studied. Photocatalytic activity is defined as 1/τ from a statistical viewpoint with τ being the electron average lifetime. Based on the MC-RW simulation, a clear physical and chemical "picture" was given for the photocatalytic kinetic analysis of nc-clusters. It is shown that the increase of defect energy disorder and material spatial structural disorder, such as the decrease of defect trap number, the increase of crystallinity, the increase of particle size, and the increase of inter-particle connection, can enhance photocatalytic activity through increasing electron transport ability. The increase of electron density increases the electron Fermi level, which decreases the activation energy for electron de-trapping from traps to extending states, and correspondingly increases electron transport ability and photocatalytic activity. Reducing recombination of electrons and holes can increase electron transport through the increase of electron density and then increases the photocatalytic activity. In addition to the electron transport, the increase of probability for electrons to undergo photocatalysis can increase photocatalytic activity through the increase of the electron interfacial transfer speed.

  19. Randomized assignment of jobs to servers in heterogeneous clusters of shared servers for low delay

    Directory of Open Access Journals (Sweden)

    Arpan Mukhopadhyay

    2016-11-01

    Full Text Available We consider the problem of assignning jobs to servers in a multi-server system consisting of N parallel processor sharing servers, categorized into M (≪N different types according to their processing capacities or speeds. Jobs of random sizes arrive at the system according to a Poisson process with rate Nλ. Upon each arrival, some servers of each type are sampled uniformly at random. The job is then assigned to one of the sampled servers based on their states. We propose two schemes, which differ in the metric for choosing the destination server for each arriving job. Our aim is to reduce the mean sojourn time of the jobs in the system. It is shown that the proposed schemes achieve the maximal stability region, without requiring the knowledge of the system parameters. The performance of the system operating under the proposed schemes is analyzed in the limit as N→∞. This gives rise to a mean field limit. The mean field is shown to have a unique, globally asymptotically stable equilibrium point which approximates the stationary distribution of load at each server. Asymptotic independence among the servers is established using a notion of intra-type exchangeability which generalizes the usual notion of exchangeability. It is further shown that the tail distribution of server occupancies decays doubly exponentially for each server type. Numerical evidence shows that at high load the proposed schemes perform at least as well as other schemes that require more knowledge of the system parameters.

  20. The Quality Initiative in Rectal Cancer (QIRC trial: study protocol of a cluster randomized controlled trial in surgery

    Directory of Open Access Journals (Sweden)

    Thabane Lehana

    2008-02-01

    Full Text Available Abstract Background Two unfortunate outcomes for patients treated surgically for rectal cancer are placement of a permanent colostomy and local tumor recurrence. Total mesorectal excision is a new technique for rectal cancer surgery that can lead to improved patient outcomes. We describe a cluster randomized controlled trial that is testing if the above patient outcomes can be improved through a knowledge translation strategy called the Quality Initiative in Rectal Cancer (QIRC strategy. The strategy is designed to optimize the use of total mesorectal excision techniques. Methods and Design Hospitals were randomized to the QIRC strategy (experimental group versus normal practice environment (control group. Participating hospitals, and the respective surgeon group operating in them, are from Ontario, Canada and have an annual procedure volume for major rectal cancer resections of 15 or greater. Patients were eligible if they underwent major rectal surgery for a diagnosis of primary rectal cancer. The surgeon-directed QIRC interventions included a workshop, use of opinion leaders, operative demonstrations, a post-operative questionnaire, and, audit and feedback. For an operative demonstration participating surgeons invited a study team surgeon to assist them with a case of rectal cancer surgery. The intent was to demonstrate total mesorectal excision techniques. Control arm surgeons received no intervention. Sample size calculations were two-sided, considered the clustering of data at the hospital level, and were driven by requirements for the outcome local recurrence. To detect an improvement in local recurrence from 20% to 8% with confidence we required 16 hospitals and 672 patients – 8 hospitals and 336 patients in each arm. Outcomes data are collected via chart review for at least 30 months after surgery. Analyses will use an intention-to-treat principle and will consider the clustering of data. Data collection will be complete by the end of

  1. Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations: a cluster randomized trial.

    Science.gov (United States)

    Taddio, Anna; Parikh, Chaitya; Yoon, Eugene W; Sgro, Michael; Singh, Harvinder; Habtom, Erita; Ilersich, Andrew F; Pillai Riddell, Rebecca; Shah, Vibhuti

    2015-01-01

    Educating parents about ways to minimize pain during routine infant vaccine injections at the point of care may positively impact on pain management practices. The objective of this cluster randomized trial was to determine the impact of educating parents about pain in outpatient pediatric clinics on their use of pain treatments during routine infant vaccinations. Four hospital-based pediatric clinics were randomized to intervention or control groups. Parents of 2- to 4-month-old infants attending the intervention clinics reviewed a pamphlet and a video about vaccination pain management on the day of vaccination, whereas those in the control clinics did not. Parent use of specific pain treatments (breastfeeding, sugar water, topical anesthetics, and/or holding of infants) on the education day and at subsequent routine vaccinations 2 months later was the primary outcome. Altogether, 160 parent-infant dyads (80 per group) participated between November 2012 and February 2014; follow-up data were available for 126 (79%). Demographics did not differ between groups (P > 0.05). On the education day and at follow-up vaccinations, use of pain interventions during vaccinations was higher in the intervention group (80% vs 26% and 68% vs 32%, respectively; P vaccinations.

  2. Effects of an Interactive School-Based Program for Preventing Adolescent Sexual Harassment: A Cluster-Randomized Controlled Evaluation Study.

    Science.gov (United States)

    de Lijster, Gaby P A; Felten, Hanneke; Kok, Gerjo; Kocken, Paul L

    2016-05-01

    Many adolescents experience sexual harassment and victims of sexual harassment have higher risks regarding well-being and health behaviors such as higher risks of suicidal thoughts, suicidal ideation and feeling unsafe at school. A peer-performed play and school lessons on preventing sexual harassment behavior were presented to secondary school students. We evaluated its effectiveness, using a cluster-randomized controlled design to assign schools to an experimental condition [n = 14 schools; 431 students (51 % female)] and a control condition [n = 11 schools; 384 students (51 % female)]. To measure the effects of the intervention at first post-test and 6-month follow-up, our multilevel analyses used a two-level random intercept model. Outcome measures were sexual harassment behaviors, behavioral determinants and distal factors influencing these behaviors. At post-test, students in the experimental group reported a reduced intention to commit sexual harassment behavior and higher self-efficacy in rejecting it. At post-test and follow-up there was a significant positive effect on social norms for rejecting sexual harassment behavior. At follow-up, sexual self-esteem was higher in students in the experimental group than in the control group. Effects on these determinants will benefit adolescents' future sexual behaviors. In combination, the play and lessons, possibly together with continued sexual health education and skills programs on social-emotional learning in subsequent school years, have potential for preventing sexual harassment behavior.

  3. Impact of a Text-Messaging Program on Adolescent Reproductive Health: A Cluster-Randomized Trial in Ghana.

    Science.gov (United States)

    Rokicki, Slawa; Cohen, Jessica; Salomon, Joshua A; Fink, Günther

    2017-02-01

    To evaluate whether text-messaging programs can improve reproductive health among adolescent girls in low- and middle-income countries. We conducted a cluster-randomized controlled trial among 756 female students aged 14 to 24 years in Accra, Ghana, in 2014. We randomized 38 schools to unidirectional intervention (n = 12), interactive intervention (n = 12), and control (n = 14). The unidirectional intervention sent participants text messages with reproductive health information. The interactive intervention engaged adolescents in text-messaging reproductive health quizzes. The primary study outcome was reproductive health knowledge at 3 and 15 months. Additional outcomes included self-reported pregnancy and sexual behavior. Analysis was by intent-to-treat. From baseline to 3 months, the unidirectional intervention increased knowledge by 11 percentage points (95% confidence interval [CI] = 7, 15) and the interactive intervention by 24 percentage points (95% CI = 19, 28), from a control baseline of 26%. Although we found no changes in reproductive health outcomes overall, both unidirectional (odds ratio [OR] = 0.14; 95% CI = 0.03, 0.71) and interactive interventions (OR = 0.15; 95% CI = 0.03, 0.86) lowered odds of self-reported pregnancy for sexually active participants. Text-messaging programs can lead to large improvements in reproductive health knowledge and have the potential to lower pregnancy risk for sexually active adolescent girls.

  4. Effect of workplace- versus home-based physical exercise on musculoskeletal pain among healthcare workers: a cluster randomized controlled trial.

    Science.gov (United States)

    Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Jay, Kenneth; Aagaard, Per; Andersen, Lars L

    2015-03-01

    Numerous studies has shown that regular physical exercise can reduce musculoskeletal pain, but the optimal setting to achieve high adherence and effectiveness remains unknown. This study investigated the effect of workplace versus home-based physical exercise on musculoskeletal pain among healthcare workers. The randomized controlled trial (RCT) comprised 200 female healthcare workers from 18 departments at 3 hospitals. Participants were randomly allocated at the cluster level to ten weeks of: (i) workplace physical exercise (WORK) performed during working hours for 5×10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed during leisure time for 5×10 minutes per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. Average pain intensity (0-10 scale) in the low back and neck/shoulder was the primary outcome. Per week, 2.2 (SD 1.1) and 1.0 (SD 1.2) training sessions were performed in WORK and HOME groups, respectively. Pain intensity, back muscle strength and use of analgesics improved more following WORK than HOME (PWorkplace physical exercise is more effective than home-based exercise in reducing musculoskeletal pain, increasing muscle strength and reducing the use of analgesics among healthcare workers.

  5. The Effects of a Community-Based Sodium Reduction Program in Rural China – A Cluster-Randomized Trial

    Science.gov (United States)

    Yan, Lijing L.; Niu, Wenyi; Yao, Chen; Feng, Xiangxian; Zhang, Jianxin; Shi, Jingpu; Zhang, Yuhong; Zhang, Ruijuan; Hao, Zhixin; Chu, Hongling; Zhang, Jing; Li, Xian; Pan, Jianhong; Li, Zhifang; Sun, Jixin; Zhou, Bo; Zhao, Yi; Yu, Yan; Engelgau, Michael; Labarthe, Darwin; Ma, Jixiang; MacMahon, Stephen; Elliott, Paul; Wu, Yangfeng; Neal, Bruce

    2016-01-01

    Background Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. Objective We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. Design This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. Results Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; psalt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved. Trial Registration Clinicaltrials.gov identifier: NCT01259700. PMID:27935977

  6. Shared decision making PLUS - a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS).

    Science.gov (United States)

    Hamann, Johannes; Holzhüter, Fabian; Stecher, Lynne; Heres, Stephan

    2017-02-23

    Shared decision making (SDM) is a model of how doctors and patients interact with each other. It aims at changing the traditional power asymmetry between doctors and patients by strengthening the exchange of information and the decisional position of the patient. Although SDM is generally welcomed by mental health patients as well as by mental health professionals its implementation in routine care, especially in the more acute settings, is still lacking. SDM-PLUS has been developed as an approach that addresses both patients and mental health professionals and aims at implementing SDM even for the very acutely ill patients. The SDM-PLUS study will be performed as a matched-pair cluster-randomized trial in acute psychiatric wards. On wards allocated to the intervention group personnel will receive communication training (addressing how to implement SDM for various scenarios) and patients will receive a group intervention addressing patient skills for SDM. Wards allocated to the control condition will continue treatment as usual. A total sample size of 276 patients suffering from schizophrenia or schizoaffective disorder on 12 wards is planned. The main outcome parameter will be patients' perceived involvement in decision making during the inpatient stay measured with the SDM-Q-9 questionnaire. Secondary objectives include the therapeutic relationship and long term outcomes such as medication adherence and rehospitalization rates. In addition, process measures and qualitative data will be obtained to allow for the analysis of potential barriers and facilitators of SDM-PLUS. The primary analysis will be a comparison of SDM-Q-9 sum scores 3 weeks after study inclusion (or discharge, if earlier) between the intervention and control groups. To assess the effect of the intervention on this continuous primary outcome, a random effects linear regression model will be fitted with ward (cluster) as a random effect term and intervention group as a fixed effect. This will be

  7. Effects of lifestyle education program for type 2 diabetes patients in clinics: study design of a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Kobayashi Itsuro

    2010-11-01

    Full Text Available Abstract Background The number of patients with type 2 diabetes is drastically increasing worldwide. It is a serious health problem in Japan as well. Lifestyle interventions can reduce progression from impaired glucose tolerance to type 2 diabetes, and glycemic control has been shown to improve postprandial plasma glucose levels. Moreover, several studies have suggested that continuous interventions (combined diet and exercise can improve the plasma glucose level and reduce dosage of hypoglycemic agents. Although many interventional studies of lifestyle education for persons with diabetes in hospitals have been reported, only a few have been clinic-based studies employing an evidence-based lifestyle education program. This article describes the design of a cluster randomized controlled trial of the effectiveness of lifestyle education for patients with type 2 diabetes in clinics by registered dietitians. Methods/Design In Japan, general practitioners generally have their own medical clinics to provide medical care for outpatients in the community, including those with type 2 diabetes. With the collaboration of such general practitioners, the study patients were enrolled in the present study. Twenty general practitioners were randomly allocated to each provide patients for entry into either an intervention group (10 or a control group (10. In total, 200 participants will be included in the study. The intervention group will receive intensive education on lifestyle improvement related to type 2 diabetes by registered dietitians in clinics. Lifestyle education will be conducted several times during the study period. The control group will receive information on dietary intake and standard advice on glycemic control by registered dietitians. The primary endpoint is the change from the baseline value of HbA1c at 6 months. Data on health behavior and related issues will be gathered continuously over a 6-month period. Discussion This is the first study

  8. A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Armstrong Natalie

    2012-09-01

    Full Text Available Abstract Background World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs rather than hospital specialists. Intermediate care clinics for diabetes (ICCD potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1 compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2 assess the cost-effectiveness of the intervention; and (3 explore the views and experiences of patients, health professionals and other stakeholders. Methods/Design This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention or to hospital care (control. Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice. or Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD. Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%; blood pressure ( Discussion Forty-nine practices have been randomized, 1,997 patients have been recruited to the trial, and 20 patients have been recruited to the qualitative study. Results will be available late 2012

  9. Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

    Science.gov (United States)

    Jairath, Vipul; Kahan, Brennan C.; Gray, Alasdair; Doré, Caroline J.; Mora, Ana; Dyer, Claire; Stokes, Elizabeth A.; Llewelyn, Charlotte; Bailey, Adam A.; Dallal, Helen; Everett, Simon M.; James, Martin W.; Stanley, Adrian J.; Church, Nicholas; Darwent, Melanie; Greenaway, John; Le Jeune, Ivan; Reckless, Ian; Campbell, Helen E.; Meredith, Sarah; Palmer, Kelvin R.; Logan, Richard F.A.; Travis, Simon P.L.; Walsh, Timothy S.; Murphy, Michael F.

    2013-01-01

    Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is bleeding, mortality, thromboembolic events, and infections. Quality of life will be measured using the EuroQol EQ-5D at day 28, and the costs associated with hospitalization for AUGIB in the UK will be estimated. Consent will be sought from participants or their representatives according to patient capacity for use of routine hospital data and day 28 follow up. The study has ethical approval for conduct in England and Scotland. Results will be analysed according to a pre-defined statistical analysis plan and disseminated in peer reviewed publications to relevant stakeholders. The results of this study will inform the feasibility and design of a phase III randomized trial. PMID:23706959

  10. Increasing students' physical activity during school physical education: rationale and protocol for the SELF-FIT cluster randomized controlled trial.

    Science.gov (United States)

    Ha, Amy S; Lonsdale, Chris; Lubans, David R; Ng, Johan Y Y

    2017-07-11

    The Self-determined Exercise and Learning For FITness (SELF-FIT) is a multi-component school-based intervention based on tenets of self-determination theory. SELF-FIT aims to increase students' moderate-to-vigorous physical activity (MVPA) during physical education lessons, and enhance their autonomous motivation towards fitness activities. Using a cluster randomized controlled trial, we aim to examine the effects of the intervention on students' MVPA during school physical education. Secondary 2 students (approximately aged 14 years) from 26 classes in 26 different schools will be recruited. After baseline assessments, students will be randomized into either the experimental group or wait-list control group using a matched-pair randomization. Teachers allocated to the experimental group will attend two half-day workshops and deliver the SELF-FIT intervention for 8 weeks. The main intervention components include training teachers to teach in more need supportive ways, and conducting fitness exercises using a fitness dice with interchangeable faces. Other motivational components, such as playing music during classes, are also included. The primary outcome of the trial is students' MVPA during PE lessons. Secondary outcomes include students' leisure-time MVPA, perceived need support from teachers, need satisfaction, autonomous motivation towards physical education, intention to engage in physical activity, psychological well-being, and health-related fitness (cardiorespiratory and muscular fitness). Quantitative data will be analyzed using multilevel modeling approaches. Focus group interviews will also be conducted to assess students' perceptions of the intervention. The SELF-FIT intervention has been designed to improve students' health and well-being by using high-intensity activities in classes delivered by teachers who have been trained to be autonomy needs supportive. If successful, scalable interventions based on SELF-FIT could be applied in physical

  11. Effect of cooking classes for housewives on salt reduction in family members: a cluster randomized controlled trial.

    Science.gov (United States)

    Takada, T; Imamoto, M; Fukuma, S; Yamamoto, Y; Sasaki, S; Uchida, M; Miura, Y; Shimizu, S; Nihata, K; Fukuhara, S

    2016-11-01

    Sodium reduction is very important in preventing cardiovascular diseases, especially in regions with high salt intake such as Japan. One strategy for salt reduction is to raise consumer awareness of the need to reduce daily salt intake. We investigated whether cooking classes given to housewives focussing on salt reduction would influence not only their own consumption behaviour but also that of their family members. Single-blinded, cluster randomized trial. We randomly assigned housewives to participate in cooking classes focussing on salt reduction (intervention group) or lectures about a healthy lifestyle (control group). The main outcome measure was the difference in estimated daily salt intake by spot urine sampling of housewives and their family members 2 months after intervention between the groups. A total of 35 housewives and 33 family members were randomized. The mean daily salt intake was 10.00 (standard deviation [SD] 1.75) g/day in the control group (17 housewives and 15 family members) and 9.57 (SD 2.45) g/day in the intervention group (18 housewives and 18 family members) at baseline. Two months after the intervention, the mean salt intake was 10.30 (SD 1.78) g/day in the control group and 8.95 (SD 2.45) g/day in the intervention group. The mean difference was -1.19 g/day (95% confidence interval -2.29, -0.09; P = 0.034). A similar tendency was observed in the subgroups of housewives and family members. Our trial suggested that the effects of cooking classes focussing on salt reduction for housewives could be transferred to family members (UMIN-CTR: 000018870). Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  12. A Stepped Wedge, Cluster-Randomized Trial of a Household UV-Disinfection and Safe Storage Drinking Water Intervention in Rural Baja California Sur, Mexico

    OpenAIRE

    Gruber, J. S; Reygadas, F; Arnold, B. F; Ray, I.; Nelson, K; Colford, J.M.

    2013-01-01

    In collaboration with a local non-profit organization, this study evaluated the expansion of a program that promoted and installed Mesita Azul, an ultraviolet-disinfection system designed to treat household drinking water in rural Mexico. We conducted a 15-month, cluster-randomized stepped wedge trial by randomizing the order in which 24 communities (444 households) received the intervention. We measured primary outcomes (water contamination and diarrhea) during seven household visits. The in...

  13. The Effect of Improved Water Supply on Diarrhea Prevalence of Children under Five in the Volta Region of Ghana: A Cluster-Randomized Controlled Trial

    OpenAIRE

    Seungman Cha; Douk Kang; Benedict Tuffuor; Gyuhong Lee; Jungmyung Cho; Jihye Chung; Myongjin Kim; Hoonsang Lee; Jaeeun Lee; Chunghyeon Oh

    2015-01-01

    Although a number of studies have been conducted to explore the effect of water quality improvement, the majority of them have focused mainly on point-of-use water treatment, and the studies investigating the effect of improved water supply have been based on observational or inadequately randomized trials. We report the results of a matched cluster randomized trial investigating the effect of improved water supply on diarrheal prevalence of children under five living in rural areas of the Vo...

  14. A Stepped Wedge, Cluster-Randomized Trial of a Household UV-Disinfection and Safe Storage Drinking Water Intervention in Rural Baja California Sur, Mexico

    OpenAIRE

    Gruber, J. S; Reygadas, F.; Arnold, B. F; Ray, I.; Nelson, K; Colford, J.M.

    2013-01-01

    In collaboration with a local non-profit organization, this study evaluated the expansion of a program that promoted and installed Mesita Azul, an ultraviolet-disinfection system designed to treat household drinking water in rural Mexico. We conducted a 15-month, cluster-randomized stepped wedge trial by randomizing the order in which 24 communities (444 households) received the intervention. We measured primary outcomes (water contamination and diarrhea) during seven household visits. The in...

  15. Matching tutor to student: rules and mechanisms for efficient two-stage learning in neural circuits

    CERN Document Server

    Tesileanu, Tiberiu; Balasubramanian, Vijay

    2016-01-01

    Existing models of birdsong learning assume that brain area LMAN introduces variability into song for trial-and-error learning. Recent data suggest that LMAN also encodes a corrective bias driving short-term improvements in song. These later consolidate in area RA, a motor cortex analogue downstream of LMAN. We develop a new model of such two-stage learning. Using a stochastic gradient descent approach, we derive how 'tutor' circuits should match plasticity mechanisms in 'student' circuits for efficient learning. We further describe a reinforcement learning framework with which the tutor can build its teaching signal. We show that mismatching the tutor signal and plasticity mechanism can impair or abolish learning. Applied to birdsong, our results predict the temporal structure of the corrective bias from LMAN given a plasticity rule in RA. Our framework can be applied predictively to other paired brain areas showing two-stage learning.

  16. HRI catalytic two-stage liquefaction (CTSL) process materials: chemical analysis and biological testing

    Energy Technology Data Exchange (ETDEWEB)

    Wright, C.W.; Later, D.W.

    1985-12-01

    This report presents data from the chemical analysis and biological testing of coal liquefaction materials obtained from the Hydrocarbon Research, Incorporated (HRI) catalytic two-stage liquefaction (CTSL) process. Materials from both an experimental run and a 25-day demonstration run were analyzed. Chemical methods of analysis included adsorption column chromatography, high-resolution gas chromatography, gas chromatography/mass spectrometry, low-voltage probe-inlet mass spectrometry, and proton nuclear magnetic resonance spectroscopy. The biological activity was evaluated using the standard microbial mutagenicity assay and an initiation/promotion assay for mouse-skin tumorigenicity. Where applicable, the results obtained from the analyses of the CTSL materials have been compared to those obtained from the integrated and nonintegrated two-stage coal liquefaction processes. 18 refs., 26 figs., 22 tabs.

  17. Two-stage precipitation process of iron and arsenic from acid leaching solutions

    Institute of Scientific and Technical Information of China (English)

    N.J.BOLIN; J.E.SUNDKVIST

    2008-01-01

    A leaching process for base metals recovery often generates considerable amounts of impurities such as iron and arsenic into the solution.It is a challenge to separate the non-valuable metals into manageable and stable waste products for final disposal,without loosing the valuable constituents.Boliden Mineral AB has patented a two-stage precipitation process that gives a very clean iron-arsenic precipitate by a minimum of coprecipitation of base metals.The obtained product shows to have good sedimentation and filtration properties,which makes it easy to recover the iron-arsenic depleted solution by filtration and washing of the precipitate.Continuos bench scale tests have been done,showing the excellent results achieved by the two-stage precipitation process.

  18. S-band gain-flattened EDFA with two-stage double-pass configuration

    Science.gov (United States)

    Fu, Hai-Wei; Xu, Shi-Chao; Qiao, Xue-Guang; Jia, Zhen-An; Liu, Ying-Gang; Zhou, Hong

    2011-11-01

    A gain-flattened S-band erbium-doped fiber amplifier (EDFA) using standard erbium-doped fiber (EDF) is proposed and experimentally demonstrated. The proposed amplifier with two-stage double-pass configuration employs two C-band suppressing filters to obtain the optical gain in S-band. The amplifier provides a maximum signal gain of 41.6 dB at 1524 nm with the corresponding noise figure of 3.8 dB. Furthermore, with a well-designed short-pass filter as a gain flattening filter (GFF), we are able to develop the S-band EDFA with a flattened gain of more than 20 dB in 1504-1524 nm. In the experiment, the two-stage double-pass amplifier configuration improves performance of gain and noise figure compared with the configuration of single-stage double-pass S-band EDFA.

  19. Power Frequency Oscillation Suppression Using Two-Stage Optimized Fuzzy Logic Controller for Multigeneration System

    Directory of Open Access Journals (Sweden)

    Y. K. Bhateshvar

    2016-01-01

    Full Text Available This paper attempts to develop a linearized model of automatic generation control (AGC for an interconnected two-area reheat type thermal power system in deregulated environment. A comparison between genetic algorithm optimized PID controller (GA-PID, particle swarm optimized PID controller (PSO-PID, and proposed two-stage based PSO optimized fuzzy logic controller (TSO-FLC is presented. The proposed fuzzy based controller is optimized at two stages: one is rule base optimization and other is scaling factor and gain factor optimization. This shows the best dynamic response following a step load change with different cases of bilateral contracts in deregulated environment. In addition, performance of proposed TSO-FLC is also examined for ±30% changes in system parameters with different type of contractual demands between control areas and compared with GA-PID and PSO-PID. MATLAB/Simulink® is used for all simulations.

  20. A two-stage scheme for multi-view human pose estimation

    Science.gov (United States)

    Yan, Junchi; Sun, Bing; Liu, Yuncai

    2010-08-01

    We present a two-stage scheme integrating voxel reconstruction and human motion tacking. By combining voxel reconstruction with human motion tracking interactively, our method can work in a cluttered background where perfect foreground silhouettes are hardly available. For each frame, a silhouette-based 3D volume reconstruction method and hierarchical tracking algorithm are applied in two stages. In the first stage, coarse reconstruction and tracking results are obtained, and then the refinement for reconstruction is applied in the second stage. The experimental results demonstrate our approach is promising. Although our method focuses on the problem of human body voxel reconstruction and motion tracking in this paper, our scheme can be used to reconstruct voxel data and infer the pose of many specified rigid and articulated objects.

  1. Effect of two-stage aging on superplasticity of Al-Li alloy

    Institute of Scientific and Technical Information of China (English)

    LUO Zhi-hui; ZHANG Xin-ming; DU Yu-xuan; YE Ling-ying

    2006-01-01

    The effect of two-stage aging on the microstructures and superplasticity of 01420 Al-Li alloy was investigated by means of OM, TEM analysis and stretching experiment. The results demonstrate that the second phase particles distributed more uniformly with a larger volume fraction can be observed after the two-stage aging (120 ℃, 12 h+300 ℃, 36 h) compared with the single-aging(300 ℃, 48 h). After rolling and recrystallization annealing, fine grains with size of 8-10 μm are obtained, and the superplastic elongation of the specimens reaches 560% at strain rate of 8×10-4 s-1 and 480 ℃. Uniformly distributed fine particles precipitate both on grain boundaries and in grains at lower temperature. When the sheet is aged at high temperature, the particles become coarser with a large volume fraction.

  2. Two stage bioethanol refining with multi litre stacked microbial fuel cell and microbial electrolysis cell.

    Science.gov (United States)

    Sugnaux, Marc; Happe, Manuel; Cachelin, Christian Pierre; Gloriod, Olivier; Huguenin, Gérald; Blatter, Maxime; Fischer, Fabian

    2016-12-01

    Ethanol, electricity, hydrogen and methane were produced in a two stage bioethanol refinery setup based on a 10L microbial fuel cell (MFC) and a 33L microbial electrolysis cell (MEC). The MFC was a triple stack for ethanol and electricity co-generation. The stack configuration produced more ethanol with faster glucose consumption the higher the stack potential. Under electrolytic conditions ethanol productivity outperformed standard conditions and reached 96.3% of the theoretically best case. At lower external loads currents and working potentials oscillated in a self-synchronized manner over all three MFC units in the stack. In the second refining stage, fermentation waste was converted into methane, using the scale up MEC stack. The bioelectric methanisation reached 91% efficiency at room temperature with an applied voltage of 1.5V using nickel cathodes. The two stage bioethanol refining process employing bioelectrochemical reactors produces more energy vectors than is possible with today's ethanol distilleries.

  3. HRI catalytic two-stage liquefaction (CTSL) process materials: chemical analysis and biological testing

    Energy Technology Data Exchange (ETDEWEB)

    Wright, C.W.; Later, D.W.

    1985-12-01

    This report presents data from the chemical analysis and biological testing of coal liquefaction materials obtained from the Hydrocarbon Research, Incorporated (HRI) catalytic two-stage liquefaction (CTSL) process. Materials from both an experimental run and a 25-day demonstration run were analyzed. Chemical methods of analysis included adsorption column chromatography, high-resolution gas chromatography, gas chromatography/mass spectrometry, low-voltage probe-inlet mass spectrometry, and proton nuclear magnetic resonance spectroscopy. The biological activity was evaluated using the standard microbial mutagenicity assay and an initiation/promotion assay for mouse-skin tumorigenicity. Where applicable, the results obtained from the analyses of the CTSL materials have been compared to those obtained from the integrated and nonintegrated two-stage coal liquefaction processes. 18 refs., 26 figs., 22 tabs.

  4. Performance measurement of insurance firms using a two-stage DEA method

    Directory of Open Access Journals (Sweden)

    Raha Jalili Sabet

    2013-01-01

    Full Text Available Measuring the relative performance of insurance firms plays an important role in this industry. In this paper, we present a two-stage data envelopment analysis to measure the performance of insurance firms, which were active over the period of 2006-2010. The proposed study of this paper performs DEA method in two stages where the first stage considers five inputs and three outputs while the second stage considers the outputs of the first stage as the inputs of the second stage and uses three different outputs for this stage. The results of our survey have indicated that while there were 4 efficient insurance firms most other insurances were noticeably inefficient. This means market was monopolized mostly by a limited number of insurance firms and competition was not fare enough to let other firms participate in economy, more efficiently.

  5. Direct Torque Control of Sensorless Induction Machine Drives: A Two-Stage Kalman Filter Approach

    Directory of Open Access Journals (Sweden)

    Jinliang Zhang

    2015-01-01

    Full Text Available Extended Kalman filter (EKF has been widely applied for sensorless direct torque control (DTC in induction machines (IMs. One key problem associated with EKF is that the estimator suffers from computational burden and numerical problems resulting from high order mathematical models. To reduce the computational cost, a two-stage extended Kalman filter (TEKF based solution is presented for closed-loop stator flux, speed, and torque estimation of IM to achieve sensorless DTC-SVM operations in this paper. The novel observer can be similarly derived as the optimal two-stage Kalman filter (TKF which has been proposed by several researchers. Compared to a straightforward implementation of a conventional EKF, the TEKF estimator can reduce the number of arithmetic operations. Simulation and experimental results verify the performance of the proposed TEKF estimator for DTC of IMs.

  6. Syme's two-stage amputation in insulin-requiring diabetics with gangrene of the forefoot.

    Science.gov (United States)

    Pinzur, M S; Morrison, C; Sage, R; Stuck, R; Osterman, H; Vrbos, L

    1991-06-01

    Thirty-five insulin-requiring adult diabetic patients underwent 38 Syme's Two-Stage amputations for gangrene of the forefoot with nonreconstructible peripheral vascular insufficiency. All had a minimum Doppler ischemic index of 0.5, serum albumin of 3.0 gm/dl, and total lymphocyte count of 1500. Thirty-one (81.6%) eventually healed and were uneventfully fit with a prosthesis. Regional anesthesia was used in all of the patients, with 22 spinal and 16 ankle block anesthetics. Twenty-seven (71%) returned to their preamputation level of ambulatory function. Six (16%) had major, and fifteen (39%) minor complications following the first stage surgery. The results of this study support the use of the Syme's Two-Stage amputation in adult diabetic patients with gangrene of the forefoot requiring amputation.

  7. Low-noise SQUIDs with large transfer: two-stage SQUIDs based on DROSs

    Science.gov (United States)

    Podt, M.; Flokstra, J.; Rogalla, H.

    2002-08-01

    We have realized a two-stage integrated superconducting quantum interference device (SQUID) system with a closed loop bandwidth of 2.5 MHz, operated in a direct voltage readout mode. The corresponding flux slew rate was 1.3×10 5Φ0/s and the measured white flux noise was 1.3 μ Φ0/√Hz at 4.2 K. The system is based on a conventional dc SQUID with a double relaxation oscillation SQUID (DROS) as the second stage. Because of the large flux-to-voltage transfer, the sensitivity of the system is completely determined by the sensor SQUID and not by the DROS or the room-temperature preamplifier. Decreasing the Josephson junction area enables a further improvement of the sensitivity of the two-stage SQUID systems.

  8. Interval estimation of binomial proportion in clinical trials with a two-stage design.

    Science.gov (United States)

    Tsai, Wei-Yann; Chi, Yunchan; Chen, Chia-Min

    2008-01-15

    Generally, a two-stage design is employed in Phase II clinical trials to avoid giving patients an ineffective drug. If the number of patients with significant improvement, which is a binomial response, is greater than a pre-specified value at the first stage, then another binomial response at the second stage is also observed. This paper considers interval estimation of the response probability when the second stage is allowed to continue. Two asymptotic interval estimators, Wald and score, as well as two exact interval estimators, Clopper-Pearson and Sterne, are constructed according to the two binomial responses from this two-stage design, where the binomial response at the first stage follows a truncated binomial distribution. The mean actual coverage probability and expected interval width are employed to evaluate the performance of these interval estimators. According to the comparison results, the score interval is recommended for both Simon's optimal and minimax designs.

  9. Experiment and surge analysis of centrifugal two-stage turbocharging system

    Institute of Scientific and Technical Information of China (English)

    Yituan HE; Chaochen MA

    2008-01-01

    To study a centrifugal two-stage turbocharging system's surge and influencing factors, a special test bench was set up and the system surge test was performed. The test results indicate that the measured parameters such as air mass flow and rotation speed of a high pressure (HP) stage compressor can be converted into corrected para-meters under a standard condition according to the Mach number similarity criterion, because the air flow in a HP stage compressor has entered the Reynolds number (Re) auto-modeling range. Accordingly, the reasons leading to a two-stage turbocharging system's surge can be analyzed according to the corrected mass flow characteristic maps and actual operating conditions of HP and low pressure (LP) stage compressors.

  10. A cluster randomized controlled trial of the Promoting Alternative Thinking Strategies (PATHS) curriculum.

    Science.gov (United States)

    Humphrey, Neil; Barlow, Alexandra; Wigelsworth, Michael; Lendrum, Ann; Pert, Kirsty; Joyce, Craig; Stephens, Emma; Wo, Lawrence; Squires, Garry; Woods, Kevin; Calam, Rachel; Turner, Alex

    2016-10-01

    This randomized controlled trial (RCT) evaluated the efficacy of the Promoting Alternative Thinking Strategies curriculum (PATHS; Kusche & Greenberg, 1994) as a means to improve children's social-emotional competence (assessed via the Social Skills Improvement System (SSIS); Gresham & Elliot, 2008) and mental health outcomes (assessed via the Strengths and Difficulties Questionnaire (SDQ); Goodman, 1997). Forty-five schools in Greater Manchester, England, were randomly assigned to treatment and control groups. Allocation was balanced by proportions of children eligible for free school meals and speaking English as an additional language via minimization. Children (N=4516) aged 7-9years at baseline in the participating schools were the target cohort. During the two-year trial period, teachers of this cohort in schools allocated to the intervention group delivered the PATHS curriculum, while their counterparts in the control group continued their usual provision. Teachers in PATHS schools received initial training and on-going support and assistance from trained coaches. Hierarchical linear modeling of outcome data was undertaken to identify both primary (e.g., for all children) and secondary (e.g., for children classified as "at-risk") intervention effects. A primary effect of the PATHS curriculum was found, demonstrating increases in teacher ratings of changes in children's social-emotional competence. Additionally, secondary effects of PATHS were identified, showing reductions in teacher ratings of emotional symptoms and increases in pro-social behavior and child ratings of engagement among children identified as at-risk at baseline. However, our analyses also identified primary effects favoring the usual provision group, showing reductions in teacher ratings of peer problems and emotional symptoms, and secondary effects demonstrating reductions in teacher ratings of conduct problems and child ratings of co-operation among at-risk children. Effect sizes were small

  11. Probiotic Compared with Standard Milk for High-caries Children: A Cluster Randomized Trial.

    Science.gov (United States)

    Rodríguez, G; Ruiz, B; Faleiros, S; Vistoso, A; Marró, M L; Sánchez, J; Urzúa, I; Cabello, R

    2016-04-01

    The aim of this study was to compare milk supplemented with probiotic lactobacilli with standard milk for the increment of caries in preschool children after 10 mo of intervention. The study was a triple-blind, placebo-controlled randomized trial. Participants were children aged 2 and 3 y (n = 261) attending 16 nursery schools in a metropolitan region in Chile. Nursery schools were randomly assigned to 2 parallel groups: children in the intervention group were given 150 mL of milk supplemented with Lactobacillus rhamnosus SP1 (10(7) CFU/mL), while children in the control group were given standard milk. Interventions took place on weekdays for 10 mo. Data were collected through a clinical examination of participants. The primary outcome measure was the increment of caries in preschool children. This was assessed using the International Caries Detection and Assessment System (ICDAS). The dropout rate was 21%. No differences in caries prevalence were detected between the groups at baseline (P = 0.68). After 10 mo of probiotic intake, the caries prevalence was 54.4% in the probiotic group and 65.8% in the control group. The percentage of new individuals who developed cavitated lesions (ICDAS 5-6) in the control group (24.3%) was significantly higher than that in the probiotic group (9.7%). The increment of dental caries showed an odds ratio of 0.35 (P < 0.05) in favor of the probiotic group. At the cavitated lesion level, the increment of new caries lesions within the groups showed 1.13 new lesions per child in the probiotic group compared with 1.75 lesions in the control group (P < 0.05). The probiotic group showed an increment of 0.58 ± 1.17 new lesions compared with 1.08 ± 1.70 new lesions observed in the control group. The difference in caries increment was significant at the cavitated lesion level (P < 0.01). In conclusion, the regular long-term intake of probiotic-supplemented milk may reduce caries development in high-caries preschool children (Clinical

  12. Two-staged management for all types of congenital pouch colon

    Directory of Open Access Journals (Sweden)

    Rajendra K Ghritlaharey

    2013-01-01

    Full Text Available Background: The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC. Patients and Methods: This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December 2011. Results: CPC comprised of 13.71% (97 of 707 of all anorectal malformations (ARM and 28.19% (97 of 344 of high ARM. Eleven CPC cases (all males were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.′s classification into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6, colostomy proximal to pouch (n = 4, and ligation of colovesical fistula and end colostomy (n = 1. As definitive procedures, pouch excision with abdomino-perineal pull through (APPT of colon in eight, and pouch excision with APPT of ileum in three were performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months and the mean weight was 7.5 kg (ranges from 4 to 11 kg. Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following definitive procedures amongst above 11 cases. Conclusions: Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the definitive procedure is being done without protective stoma and therefore, it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay.

  13. Hybrid staging of a Lysholm positive displacement engine with two Westinghouse two stage impulse Curtis turbines

    Energy Technology Data Exchange (ETDEWEB)

    Parker, D.A.

    1982-06-01

    The University of California at Berkeley has tested and modeled satisfactorly a hybrid staged Lysholm engine (positive displacement) with a two stage Curtis wheel turbine. The system operates in a stable manner over its operating range (0/1-3/1 water ratio, 120 psia input). Proposals are made for controlling interstage pressure with a partial admission turbine and volume expansion to control mass flow and pressure ratio for the Lysholm engine.

  14. Full noise characterization of a low-noise two-stage SQUID amplifier

    Energy Technology Data Exchange (ETDEWEB)

    Falferi, P [Istituto di Fotonica e Nanotecnologie, CNR-Fondazione Bruno Kessler, 38100 Povo, Trento (Italy); Mezzena, R [INFN, Gruppo Collegato di Trento, Sezione di Padova, 38100 Povo, Trento (Italy); Vinante, A [INFN, Sezione di Padova, 35131 Padova (Italy)], E-mail: falferi@science.unitn.it

    2009-07-15

    From measurements performed on a low-noise two-stage SQUID amplifier coupled to a high- Q electrical resonator we give a complete noise characterization of the SQUID amplifier around the resonator frequency of 11 kHz in terms of additive, back action and cross-correlation noise spectral densities. The minimum noise temperature evaluated at 135 mK is 10 {mu}K and corresponds to an energy resolution of 18{Dirac_h}.

  15. Development of a Novel Type Catalyst SY-2 for Two-Stage Hydrogenation of Pyrolysis Gasoline

    Institute of Scientific and Technical Information of China (English)

    Wu Linmei; Zhang Xuejun; Zhang Zhihua; Wang Fucun

    2004-01-01

    By using the group ⅢB or groupⅦB metals and modulating the characteristics of electric charges on carrier surface, improving the catalyst preparation process and techniques for loading the active metal components, a novel type SY-2 catalyst earmarked for two-stage hydrogenation of pyrolysis gasoline has been developed. The catalyst evaluation results have indicated that the novel catalyst is characterized by a better hydrogenation reaction activity to give higher aromatic yield.

  16. Investigation on a two-stage solvay refrigerator with magnetic material regenerator

    Science.gov (United States)

    Chen, Guobang; Zheng, Jianyao; Zhang, Fagao; Yu, Jianping; Tao, Zhenshi; Ding, Cenyu; Zhang, Liang; Wu, Peiyi; Long, Yi

    This paper describes experimental results that the no-load temperature of a two-stage Solvay refrigerator has been reached in liquid helium temperature region from the original 11.5 K by using magnetic regenerative material instead of lead. The structure and technological characteristics of the prototype machine are presented. The effects of operating frequency and pressure on the refrigerating temperature have been discussed in this paper.

  17. Biological hydrogen production from olive mill wastewater with two-stage processes

    Energy Technology Data Exchange (ETDEWEB)

    Eroglu, Ela; Eroglu, Inci [Department of Chemical Engineering, Middle East Technical University, 06531, Ankara (Turkey); Guenduez, Ufuk; Yuecel, Meral [Department of Biology, Middle East Technical University, 06531, Ankara (Turkey); Tuerker, Lemi [Department of Chemistry, Middle East Technical University, 06531, Ankara (Turkey)

    2006-09-15

    In the present work two novel two-stage hydrogen production processes from olive mill wastewater (OMW) have been introduced. The first two-stage process involved dark-fermentation followed by a photofermentation process. Dark-fermentation by activated sludge cultures and photofermentation by Rhodobacter sphaeroides O.U.001 were both performed in 55ml glass vessels, under anaerobic conditions. In some cases of dark-fermentation, activated sludge was initially acclimatized to the OMW to provide the adaptation of microorganisms to the extreme conditions of OMW. The highest hydrogen production potential obtained was 29l{sub H{sub 2}}/l{sub OMW} after photofermentation with 50% (v/v) effluent of dark fermentation with activated sludge. Photofermentation with 50% (v/v) effluent of dark fermentation with acclimated activated sludge had the highest hydrogen production rate (0.008ll{sup -1}h{sup -1}). The second two-stage process involved a clay treatment step followed by photofermentation by R. sphaeroides O.U.001. Photofermentation with the effluent of the clay pretreatment process (4% (v/v)) gives the highest hydrogen production potential (35l{sub H{sub 2}}/l{sub OMW}), light conversion efficiency (0.42%) and COD conversion efficiency (52%). It was concluded that both pretreatment processes enhanced the photofermentative hydrogen production process. Moreover, hydrogen could be produced with highly concentrated OMW. Two-stage processes developed in the present investigation have a high potential for solving the environmental problems caused by OMW. (author)

  18. The two-stage aegean extension, from localized to distributed, a result of slab rollback acceleration

    OpenAIRE

    Brun, Jean-Pierre; Faccenna, Claudio; Gueydan, Frédéric; Sokoutis, Dimitrios; Philippon, Mélody; Kydonakis, Konstantinos; Gorini, Christian

    2016-01-01

    International audience; Back-arc extension in the Aegean, which was driven by slab rollback since 45 Ma, is described here for the first time in two stages. From Middle Eocene to Middle Miocene, deformation was localized leading to i) the exhumation of high-pressure metamorphic rocks to crustal depths, ii) the exhumation of high-temperature metamorphic rocks in core complexes and iii) the deposition of sedimentary basins. Since Middle Miocene, extension distributed over the whole Aegean domai...

  19. A Two-stage Discriminating Framework for Making Supply Chain Operation Decisions under Uncertainties

    OpenAIRE

    Gu, H; Rong, G

    2010-01-01

    This paper addresses the problem of making supply chain operation decisions for refineries under two types of uncertainties: demand uncertainty and incomplete information shared with suppliers and transport companies. Most of the literature only focus on one uncertainty or treat more uncertainties identically. However, we note that refineries have more power to control uncertainties in procurement and transportation than in demand in the real world. Thus, a two-stage framework for dealing wit...

  20. Low-noise SQUIDs with large transfer: two-stage SQUIDs based on DROSs

    NARCIS (Netherlands)

    Podt, M.; Flokstra, Jakob; Rogalla, Horst

    2002-01-01

    We have realized a two-stage integrated superconducting quantum interference device (SQUID) system with a closed loop bandwidth of 2.5 MHz, operated in a direct voltage readout mode. The corresponding flux slew rate was 1.3×105 Φ0/s and the measured white flux noise was 1.3 μΦ0/√Hz at 4.2 K. The

  1. Latent Inhibition as a Function of US Intensity in a Two-Stage CER Procedure

    Science.gov (United States)

    Rodriguez, Gabriel; Alonso, Gumersinda

    2004-01-01

    An experiment is reported in which the effect of unconditioned stimulus (US) intensity on latent inhibition (LI) was examined, using a two-stage conditioned emotional response (CER) procedure in rats. A tone was used as the pre-exposed and conditioned stimulus (CS), and a foot-shock of either a low (0.3 mA) or high (0.7 mA) intensity was used as…

  2. Two stage dual gate MESFET monolithic gain control amplifier for Ka-band

    Science.gov (United States)

    Sokolov, V.; Geddes, J.; Contolatis, A.

    A monolithic two stage gain control amplifier has been developed using submicron gate length dual gate MESFETs fabricated on ion implanted material. The amplifier has a gain of 12 dB at 30 GHz with a gain control range of over 30 dB. This ion implanted monolithic IC is readily integrable with other phased array receiver functions such as low noise amplifiers and phase shifters.

  3. Exergy analysis of vapor compression refrigeration cycle with two-stage and intercooler

    Science.gov (United States)

    Kılıç, Bayram

    2012-07-01

    In this study, exergy analyses of vapor compression refrigeration cycle with two-stage and intercooler using refrigerants R507, R407c, R404a were carried out. The necessary thermodynamic values for analyses were calculated by Solkane program. The coefficient of performance, exergetic efficiency and total irreversibility rate of the system in the different operating conditions for these refrigerants were investigated. The coefficient of performance, exergetic efficiency and total irreversibility rate for alternative refrigerants were compared.

  4. Exergy analysis of vapor compression refrigeration cycle with two-stage and intercooler

    Energy Technology Data Exchange (ETDEWEB)

    Kilic, Bayram [Mehmet Akif Ersoy University, Bucak Emin Guelmez Vocational School, Bucak, Burdur (Turkey)

    2012-07-15

    In this study, exergy analyses of vapor compression refrigeration cycle with two-stage and intercooler using refrigerants R507, R407c, R404a were carried out. The necessary thermodynamic values for analyses were calculated by Solkane program. The coefficient of performance, exergetic efficiency and total irreversibility rate of the system in the different operating conditions for these refrigerants were investigated. The coefficient of performance, exergetic efficiency and total irreversibility rate for alternative refrigerants were compared. (orig.)

  5. Performance of Combined Water Turbine Darrieus-Savonius with Two Stage Savonius Buckets and Single Deflector

    OpenAIRE

    Sahim, Kaprawi; Santoso, Dyos; Sipahutar, Riman

    2016-01-01

    The objective of this study is to show the effect of single deflector plate on the performance of combined Darrieus-Savonius water turbine. In order to overcome the disadvantages of low torque of solo Darrieus turbine, a plate deflector mounted in front of returning Savonius bucket of combined water turbine composing of Darrieus and Savonius rotor has been proposed in this study. Some configurations of combined turbines with two stage Savonius rotors were experimentally tested in a river of c...

  6. Perceived Health Benefits and Soy Consumption Behavior: Two-Stage Decision Model Approach

    OpenAIRE

    Moon, Wanki; Balasubramanian, Siva K.; Rimal, Arbindra

    2005-01-01

    A two-stage decision model is developed to assess the effect of perceived soy health benefits on consumers' decisions with respect to soy food. The first stage captures whether or not to consume soy food, while the second stage reflects how often to consume. A conceptual/analytical framework is also employed, combining Lancaster's characteristics model and Fishbein's multi-attribute model. Results show that perceived soy health benefits significantly influence both decision stages. Further, c...

  7. Adherence to blood pressure telemonitoring in a cluster-randomized clinical trial

    Science.gov (United States)

    Kerby, Tessa J; Asche, Stephen E; Maciosek, Michael V; O’Connor, Patrick J; Sperl-Hillen, JoAnn M; Margolis, Karen L

    2012-01-01

    Background Hypertension is a leading cause of cardiovascular disease and death worldwide. Advances in technology have added telemedicine as a tool for managing hypertension. The effectiveness of telemedicine depends upon patients’ ability to adhere to schedules of home monitoring and case management. Methods Participants with uncontrolled hypertension in the intervention arm of a randomized trial who had completed 6 months of follow-up were included in this analysis. They were asked to measure their BP a minimum of 6 times per week using a telemonitor that transmitted the readings to their pharmacist case manager. Results Hypertensive patients in this study had high adherence to telemonitoring (73% took at least 6 BP readings per week) and phone visits (88% of expected visits were attended). In a multivariate analysis, older age, male gender, and some college education predicted better telemonitoring adherence. White non-hispanic race/ethnicity predicted better adherence to phone visits with pharmacist case managers. Telemonitoring adherence and phone adherence were highly correlated; participants who did not send readings on schedule were more likely to skip at least one phone visit with their pharmacist case manager. Conclusion The findings from this analysis indicate that hypertensive patients in this study were able to achieve and maintain high adherence to both the telemonitoring and the phone case management visits. PMID:23031143

  8. Adherence to blood pressure telemonitoring in a cluster-randomized clinical trial.

    Science.gov (United States)

    Kerby, Tessa J; Asche, Stephen E; Maciosek, Michael V; O'Connor, Patrick J; Sperl-Hillen, Joann M; Margolis, Karen L

    2012-10-01

    Hypertension is a leading cause of cardiovascular disease and death worldwide. Advances in technology have added telemedicine as a tool for managing hypertension. The effectiveness of telemedicine depends on patients' ability to adhere to schedules of home monitoring and case management. Participants with uncontrolled hypertension in the intervention arm of a randomized trial who completed 6 months of follow-up were included in this analysis. They were asked to measure their blood pressure (BP) a minimum of 6 times per week using a telemonitor that transmitted the readings to their pharmacist case manager. Hypertensive patients in this study had high adherence to telemonitoring (73% took at least 6 BP readings per week) and phone visits (88% of expected visits were attended). In a multivariate analysis, older age, male sex, and some college education predicted better telemonitoring adherence. White non-Hispanic race/ethnicity predicted better adherence to phone visits with pharmacist case managers. Telemonitoring adherence and phone adherence were highly correlated; participants who did not send readings on schedule were more likely to skip at least one phone visit with their pharmacist case manager. The findings from this analysis indicate that hypertensive patients in this study were able to achieve and maintain high adherence to both the telemonitoring and the phone case management visits. © 2012 Wiley Periodicals, Inc.

  9. Credit with Health Education in Benin: A Cluster Randomized Trial Examining Impacts on Knowledge and Behavior.

    Science.gov (United States)

    Karlan, Dean; Thuysbaert, Bram; Gray, Bobbi

    2017-02-08

    We evaluate whether health education integrated into microcredit lending groups reduces health risks by improving health knowledge and self-reported behaviors among urban and rural borrowers in eastern Benin. In 2007, we randomly assigned 138 villages in the Plateau region of Benin to one of four variations of a group liability credit product, varying lending groups' gender composition and/or inclusion of health education using a 2 × 2 design. Women in villages receiving health education, regardless of gender composition of the groups, showed improved knowledge of malaria and of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), but not of childhood illness danger signs. No significant changes in health behavior were observed except an increase in HIV/AIDS prevention behavior, a result predominantly driven by an increase in respondents' self-reported ability to procure a condom, likely an indicator of increased perceived access rather than improved preventative behavior. Women in villages assigned to mixed-gender groups had significantly lower levels of social capital, compared with villages assigned to female-only groups. This suggests there may be an important trade-off to consider for interventions seeking improved health outcomes and social capital through provision of services to mixed-gender groups. Although bundling health education with microcredit can expand health education coverage and lower service-delivery costs, the approach may not be sufficient to improve health behaviors. © The American Society of Tropical Medicine and Hygiene.

  10. Oral language supports early literacy: a pilot cluster randomized trial in disadvantaged schools.

    Science.gov (United States)

    Snow, Pamela C; Eadie, Patricia A; Connell, Judy; Dalheim, Brenda; McCusker, Hugh J; Munro, John K

    2014-10-01

    This study examined the impact of teacher professional development aimed at improving the capacity of primary teachers in disadvantaged schools to strengthen children's expressive and receptive oral language skills and early literacy success in the first 2 years of school. Fourteen low-SES schools in Victoria, Australia were randomly allocated to a research (n = 8) or control arm (n = 6), resulting in an initial sample of 1254 students, (n = 602 in research arm and n = 652 in control arm). The intervention comprised 6 days of teacher and principal professional development (delivered by language and literacy experts), school-based continuing contact with the research team and completion by one staff member of each research school of a postgraduate unit on early language and literacy. Schools in the control arm received standard teaching according to state auspiced curriculum guidelines. Full data were available on 979 students at follow-up (time 2). Students in the research arm performed significantly better on Test of Language Development: Primary (Fourth Edition) sub-tests (p ≤ .002) and the Reading Progress Test (F = 10.4(1); p = .001) than students in the control arm at time 2. Narrative scores were not significantly different at time 2, although students in research schools showed greater gains. Findings provide "proof of concept" for this approach, and are discussed with respect to implications for teacher professional development and pre-service education concerning the psycholinguistic competencies that underpin the transition to literacy.

  11. High quantum efficiency mid-wavelength interband cascade infrared photodetectors with one and two stages

    Science.gov (United States)

    Zhou, Yi; Chen, Jianxin; Xu, Zhicheng; He, Li

    2016-08-01

    In this paper, we report on mid-wavelength infrared interband cascade photodetectors grown on InAs substrates. We studied the transport properties of the photon-generated carriers in the interband cascade structures by comparing two different detectors, a single stage detector and a two-stage cascade detector. The two-stage device showed quantum efficiency around 19.8% at room temperature, and clear optical response was measured even at a temperature of 323 K. The two detectors showed similar Johnson-noise limited detectivity. The peak detectivity of the one- and two-stage devices was measured to be 2.15 × 1014 cm·Hz1/02/W and 2.19 × 1014 cm·Hz1/02/W at 80 K, 1.21 × 109 cm·Hz1/02/W and 1.23 × 109 cm·Hz1/02/W at 300 K, respectively. The 300 K background limited infrared performance (BLIP) operation temperature is estimated to be over 140 K.

  12. Development of Two-Stage Stirling Cooler for ASTRO-F

    Science.gov (United States)

    Narasaki, K.; Tsunematsu, S.; Ootsuka, K.; Kyoya, M.; Matsumoto, T.; Murakami, H.; Nakagawa, T.

    2004-06-01

    A two-stage small Stirling cooler has been developed and tested for the infrared astronomical satellite ASTRO-F that is planned to be launched by Japanese M-V rocket in 2005. ASTRO-F has a hybrid cryogenic system that is a combination of superfluid liquid helium (HeII) and two-stage Stirling coolers. The mechanical cooler has a two-stage displacer driven by a linear motor in a cold head and a new linear-ball-bearing system for the piston-supporting structure in a compressor. The linear-ball-bearing supporting system achieves the piston clearance seal, the long piston-stroke operation and the low frequency operation. The typical cooling power is 200 mW at 20 K and the total input power to the compressor and the cold head is below 90 W without driver electronics. The engineering, the prototype and the flight models of the cooler have been fabricated and evaluated to verify the capability for ASTRO-F. This paper describes the design of the cooler and the results from verification tests including cooler performance test, thermal vacuum test, vibration test and lifetime test.

  13. Performance analysis of RDF gasification in a two stage fluidized bed-plasma process.

    Science.gov (United States)

    Materazzi, M; Lettieri, P; Taylor, R; Chapman, C

    2016-01-01

    The major technical problems faced by stand-alone fluidized bed gasifiers (FBG) for waste-to gas applications are intrinsically related to the composition and physical properties of waste materials, such as RDF. The high quantity of ash and volatile material in RDF can provide a decrease in thermal output, create high ash clinkering, and increase emission of tars and CO2, thus affecting the operability for clean syngas generation at industrial scale. By contrast, a two-stage process which separates primary gasification and selective tar and ash conversion would be inherently more forgiving and stable. This can be achieved with the use of a separate plasma converter, which has been successfully used in conjunction with conventional thermal treatment units, for the ability to 'polish' the producer gas by organic contaminants and collect the inorganic fraction in a molten (and inert) state. This research focused on the performance analysis of a two-stage fluid bed gasification-plasma process to transform solid waste into clean syngas. Thermodynamic assessment using the two-stage equilibrium method was carried out to determine optimum conditions for the gasification of RDF and to understand the limitations and influence of the second stage on the process performance (gas heating value, cold gas efficiency, carbon conversion efficiency), along with other parameters. Comparison with a different thermal refining stage, i.e. thermal cracking (via partial oxidation) was also performed. The analysis is supported by experimental data from a pilot plant.

  14. Continuous removal of endocrine disruptors by versatile peroxidase using a two-stage system.

    Science.gov (United States)

    Taboada-Puig, Roberto; Lu-Chau, Thelmo A; Eibes, Gemma; Feijoo, Gumersindo; Moreira, Maria T; Lema, Juan M

    2015-01-01

    The oxidant Mn(3+) -malonate, generated by the ligninolytic enzyme versatile peroxidase in a two-stage system, was used for the continuous removal of endocrine disrupting compounds (EDCs) from synthetic and real wastewaters. One plasticizer (bisphenol-A), one bactericide (triclosan) and three estrogenic compounds (estrone, 17β-estradiol, and 17α-ethinylestradiol) were removed from wastewater at degradation rates in the range of 28-58 µg/L·min, with low enzyme inactivation. First, the optimization of three main parameters affecting the generation of Mn(3+) -malonate (hydraulic retention time as well as Na-malonate and H2 O2 feeding rates) was conducted following a response surface methodology (RSM). Under optimal conditions, the degradation of the EDCs was proven at high (1.3-8.8 mg/L) and environmental (1.2-6.1 µg/L) concentrations. Finally, when the two-stage system was compared with a conventional enzymatic membrane reactor (EMR) using the same enzyme, a 14-fold increase of the removal efficiency was observed. At the same time, operational problems found during EDCs removal in the EMR system (e.g., clogging of the membrane and enzyme inactivation) were avoided by physically separating the stages of complex formation and pollutant oxidation, allowing the system to be operated for a longer period (∼8 h). This study demonstrates the feasibility of the two-stage enzymatic system for removing EDCs both at high and environmental concentrations.

  15. A two-stage Stirling-type pulse tube cryocooler with a cold inertance tube

    Science.gov (United States)

    Gan, Z. H.; Fan, B. Y.; Wu, Y. Z.; Qiu, L. M.; Zhang, X. J.; Chen, G. B.

    2010-06-01

    A thermally coupled two-stage Stirling-type pulse tube cryocooler (PTC) with inertance tubes as phase shifters has been designed, manufactured and tested. In order to obtain a larger phase shift at the low acoustic power of about 2.0 W, a cold inertance tube as well as a cold reservoir for the second stage, precooled by the cold end of the first stage, was introduced into the system. The transmission line model was used to calculate the phase shift produced by the cold inertance tube. Effect of regenerator material, geometry and charging pressure on the performance of the second stage of the two-stage PTC was investigated based on the well known regenerator model REGEN. Experimental results of the two-stage PTC were carried out with an emphasis on the performance of the second stage. A lowest cooling temperature of 23.7 K and 0.50 W at 33.9 K were obtained with an input electric power of 150.0 W and an operating frequency of 40 Hz.

  16. Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries.

    Science.gov (United States)

    Sade, Ilgin; İnanir, Murat; Şen, Suzan; Çakmak, Esra; Kablanoğlu, Serkan; Selçuk, Barin; Dursun, Nigar

    2016-08-01

    [Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group. [Conclusion] Early and two-stage reconstruction of patients with flexor tendon injuries can be performed with similarly favorable responses and effective rehabilitation programs.

  17. A Comparison of Direct and Two-Stage Transportation of Patients to Hospital in Poland

    Directory of Open Access Journals (Sweden)

    Anna Rosiek

    2015-04-01

    Full Text Available Background: The rapid international expansion of telemedicine reflects the growth of technological innovations. This technological advancement is transforming the way in which patients can receive health care. Materials and Methods: The study was conducted in Poland, at the Department of Cardiology of the Regional Hospital of Louis Rydygier in Torun. The researchers analyzed the delay in the treatment of patients with acute coronary syndrome. The study was conducted as a survey and examined 67 consecutively admitted patients treated invasively in a two-stage transport system. Data were analyzed statistically. Results: Two-stage transportation does not meet the timeframe guidelines for the treatment of patients with acute myocardial infarction. Intervals for the analyzed group of patients were statistically significant (p < 0.0001. Conclusions: Direct transportation of the patient to a reference center with interventional cardiology laboratory has a significant impact on reducing in-hospital delay in case of patients with acute coronary syndrome. Perspectives: This article presents the results of two-stage transportation of the patient with acute coronary syndrome. This measure could help clinicians who seek to assess time needed for intervention. It also shows how time from the beginning of pain in chest is important and may contribute to patient disability, death or well-being.

  18. Two-Stage Liver Transplantation with Temporary Porto-Middle Hepatic Vein Shunt

    Directory of Open Access Journals (Sweden)

    Giovanni Varotti

    2010-01-01

    Full Text Available Two-stage liver transplantation (LT has been reported for cases of fulminant liver failure that can lead to toxic hepatic syndrome, or massive hemorrhages resulting in uncontrollable bleeding. Technically, the first stage of the procedure consists of a total hepatectomy with preservation of the recipient's inferior vena cava (IVC, followed by the creation of a temporary end-to-side porto-caval shunt (TPCS. The second stage consists of removing the TPCS and implanting a liver graft when one becomes available. We report a case of a two-stage total hepatectomy and LT in which a temporary end-to-end anastomosis between the portal vein and the middle hepatic vein (TPMHV was performed as an alternative to the classic end-to-end TPCS. The creation of a TPMHV proved technically feasible and showed some advantages compared to the standard TPCS. In cases in which a two-stage LT with side-to-side caval reconstruction is utilized, TPMHV can be considered as a safe and effective alternative to standard TPCS.

  19. Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling.

    Science.gov (United States)

    Terza, Joseph V; Basu, Anirban; Rathouz, Paul J

    2008-05-01

    The paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research-two-stage predictor substitution (2SPS) and two-stage residual inclusion (2SRI). 2SPS is the rote extension (to nonlinear models) of the popular linear two-stage least squares estimator. The 2SRI estimator is similar except that in the second-stage regression, the endogenous variables are not replaced by first-stage predictors. Instead, first-stage residuals are included as additional regressors. In a generic parametric framework, we show that 2SRI is consistent and 2SPS is not. Results from a simulation study and an illustrative example also recommend against 2SPS and favor 2SRI. Our findings are important given that there are many prominent examples of the application of inconsistent 2SPS in the recent literature. This study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work.

  20. Two-stage solar concentrators based on parabolic troughs: asymmetric versus symmetric designs.

    Science.gov (United States)

    Schmitz, Max; Cooper, Thomas; Ambrosetti, Gianluca; Steinfeld, Aldo

    2015-11-20

    While nonimaging concentrators can approach the thermodynamic limit of concentration, they generally suffer from poor compactness when designed for small acceptance angles, e.g., to capture direct solar irradiation. Symmetric two-stage systems utilizing an image-forming primary parabolic concentrator in tandem with a nonimaging secondary concentrator partially overcome this compactness problem, but their achievable concentration ratio is ultimately limited by the central obstruction caused by the secondary. Significant improvements can be realized by two-stage systems having asymmetric cross-sections, particularly for 2D line-focus trough designs. We therefore present a detailed analysis of two-stage line-focus asymmetric concentrators for flat receiver geometries and compare them to their symmetric counterparts. Exemplary designs are examined in terms of the key optical performance metrics, namely, geometric concentration ratio, acceptance angle, concentration-acceptance product, aspect ratio, active area fraction, and average number of reflections. Notably, we show that asymmetric designs can achieve significantly higher overall concentrations and are always more compact than symmetric systems designed for the same concentration ratio. Using this analysis as a basis, we develop novel asymmetric designs, including two-wing and nested configurations, which surpass the optical performance of two-mirror aplanats and are comparable with the best reported 2D simultaneous multiple surface designs for both hollow and dielectric-filled secondaries.

  1. Industrial demonstration plant for the gasification of herb residue by fluidized bed two-stage process.

    Science.gov (United States)

    Zeng, Xi; Shao, Ruyi; Wang, Fang; Dong, Pengwei; Yu, Jian; Xu, Guangwen

    2016-04-01

    A fluidized bed two-stage gasification process, consisting of a fluidized-bed (FB) pyrolyzer and a transport fluidized bed (TFB) gasifier, has been proposed to gasify biomass for fuel gas production with low tar content. On the basis of our previous fundamental study, an autothermal two-stage gasifier has been designed and built for gasify a kind of Chinese herb residue with a treating capacity of 600 kg/h. The testing data in the operational stable stage of the industrial demonstration plant showed that when keeping the reaction temperatures of pyrolyzer and gasifier respectively at about 700 °C and 850 °C, the heating value of fuel gas can reach 1200 kcal/Nm(3), and the tar content in the produced fuel gas was about 0.4 g/Nm(3). The results from this pilot industrial demonstration plant fully verified the feasibility and technical features of the proposed FB two-stage gasification process.

  2. Study on two stage activated carbon/HFC-134a based adsorption chiller

    Science.gov (United States)

    >K Habib,

    2013-06-01

    In this paper, a theoretical analysis on the performance of a thermally driven two-stage four-bed adsorption chiller utilizing low-grade waste heat of temperatures between 50°C and 70°C in combination with a heat sink (cooling water) of 30°C for air-conditioning applications has been described. Activated carbon (AC) of type Maxsorb III/HFC-134a pair has been examined as an adsorbent/refrigerant pair. FORTRAN simulation program is developed to analyze the influence of operating conditions (hot and cooling water temperatures and adsorption/desorption cycle times) on the cycle performance in terms of cooling capacity and COP. The main advantage of this two-stage chiller is that it can be operational with smaller regenerating temperature lifts than other heat-driven single-stage chillers. Simulation results shows that the two-stage chiller can be operated effectively with heat sources of 50°C and 70°C in combination with a coolant at 30°C.

  3. Effects of earthworm casts and zeolite on the two-stage composting of green waste

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Lu, E-mail: zhanglu1211@gmail.com; Sun, Xiangyang, E-mail: xysunbjfu@gmail.com

    2015-05-15

    Highlights: • Earthworm casts (EWCs) and clinoptilolite (CL) were used in green waste composting. • Addition of EWCs + CL improved physico-chemical and microbiological properties. • Addition of EWCs + CL extended the duration of thermophilic periods during composting. • Addition of EWCs + CL enhanced humification, cellulose degradation, and nutrients. • Combined addition of 0.30% EWCs + 25% CL reduced composting time to 21 days. - Abstract: Because it helps protect the environment and encourages economic development, composting has become a viable method for organic waste disposal. The objective of this study was to investigate the effects of earthworm casts (EWCs) (at 0.0%, 0.30%, and 0.60%) and zeolite (clinoptilolite, CL) (at 0%, 15%, and 25%) on the two-stage composting of green waste. The combination of EWCs and CL improved the conditions of the composting process and the quality of the compost products in terms of the thermophilic phase, humification, nitrification, microbial numbers and enzyme activities, the degradation of cellulose and hemicellulose, and physico-chemical characteristics and nutrient contents of final composts. The compost matured in only 21 days with the optimized two-stage composting method rather than in the 90–270 days required for traditional composting. The optimal two-stage composting and the best quality compost were obtained with 0.30% EWCs and 25% CL.

  4. A Two-stage injection-locked magnetron for accelerators with superconducting cavities

    CERN Document Server

    Kazakevich, Grigory; Flanagan, Gene; Marhauser, Frank; Neubauer, Mike; Yakovlev, Vyacheslav; Chase, Brian; Nagaitsev, Sergey; Pasquinelli, Ralph; Solyak, Nikolay; Tupikov, Vitali; Wolff, Daniel

    2013-01-01

    A concept for a two-stage injection-locked CW magnetron intended to drive Superconducting Cavities (SC) for intensity-frontier accelerators has been proposed. The concept considers two magnetrons in which the output power differs by 15-20 dB and the lower power magnetron being frequency-locked from an external source locks the higher power magnetron. The injection-locked two-stage CW magnetron can be used as an RF power source for Fermilab's Project-X to feed separately each of the 1.3 GHz SC of the 8 GeV pulsed linac. We expect output/locking power ratio of about 30-40 dB assuming operation in a pulsed mode with pulse duration of ~ 8 ms and repetition rate of 10 Hz. The experimental setup of a two-stage magnetron utilising CW, S-band, 1 kW tubes operating at pulse duration of 1-10 ms, and the obtained results are presented and discussed in this paper.

  5. Study on the Control Algorithm of Two-Stage DC-DC Converter for Electric Vehicles

    Directory of Open Access Journals (Sweden)

    Changhao Piao

    2014-01-01

    Full Text Available The fast response, high efficiency, and good reliability are very important characteristics to electric vehicles (EVs dc/dc converters. Two-stage dc-dc converter is a kind of dc-dc topologies that can offer those characteristics to EVs. Presently, nonlinear control is an active area of research in the field of the control algorithm of dc-dc converters. However, very few papers research on two-stage converter for EVs. In this paper, a fixed switching frequency sliding mode (FSFSM controller and double-integral sliding mode (DISM controller for two-stage dc-dc converter are proposed. And a conventional linear control (lag is chosen as the comparison. The performances of the proposed FSFSM controller are compared with those obtained by the lag controller. In consequence, the satisfactory simulation and experiment results show that the FSFSM controller is capable of offering good large-signal operations with fast dynamical responses to the converter. At last, some other simulation results are presented to prove that the DISM controller is a promising method for the converter to eliminate the steady-state error.

  6. PSP_MCSVM: brainstorming consensus prediction of protein secondary structures using two-stage multiclass support vector machines.

    Science.gov (United States)

    Chatterjee, Piyali; Basu, Subhadip; Kundu, Mahantapas; Nasipuri, Mita; Plewczynski, Dariusz

    2011-09-01

    Secondary structure prediction is a crucial task for understanding the variety of protein structures and performed biological functions. Prediction of secondary structures for new proteins using their amino acid sequences is of fundamental importance in bioinformatics. We propose a novel technique to predict protein secondary structures based on position-specific scoring matrices (PSSMs) and physico-chemical properties of amino acids. It is a two stage approach involving multiclass support vector machines (SVMs) as classifiers for three different structural conformations, viz., helix, sheet and coil. In the first stage, PSSMs obtained from PSI-BLAST and five specially selected physicochemical properties of amino acids are fed into SVMs as features for sequence-to-structure prediction. Confidence values for forming helix, sheet and coil that are obtained from the first stage SVM are then used in the second stage SVM for performing structure-to-structure prediction. The two-stage cascaded classifiers (PSP_MCSVM) are trained with proteins from RS126 dataset. The classifiers are finally tested on target proteins of critical assessment of protein structure prediction experiment-9 (CASP9). PSP_MCSVM with brainstorming consensus procedure performs better than the prediction servers like Predator, DSC, SIMPA96, for randomly selected proteins from CASP9 targets. The overall performance is found to be comparable with the current state-of-the art. PSP_MCSVM source code, train-test datasets and supplementary files are available freely in public domain at: http://sysbio.icm.edu.pl/secstruct and http://code.google.com/p/cmater-bioinfo/

  7. "The educating nursing staff effectively (TENSE) study": design of a cluster randomized controlled trial.

    Science.gov (United States)

    Hazelhof, Theo J G M; Gerritsen, Debby L; Schoonhoven, Lisette; Koopmans, Raymond T C M

    2014-01-01

    Challenging behavior exhibited by people with dementia can have adverse outcomes, like stress, low morale, low work satisfaction and absenteeism for nursing staff in long-term care settings. Training nursing staff to manage challenging behavior may reduce its impact. Although much of the research into training nursing staff shows methodological limitations, several studies find some effect of training programs on knowledge about and on management of challenging behavior. Effects on stress or burnout are almost not found. The TENSE-study is a randomized controlled study on 18 nursing home units (9 control, 9 intervention) investigating the effects of a continuous educational program for nursing staff about managing challenging behavior. Nursing staff of intervention units receive the program, nursing staff of control units do not and continue usual care. The primary outcome is stress experienced by nursing staff (N = 135). Secondary outcomes are: emotional workload, work satisfaction, stress reactions at work and knowledge about challenging behaviour of nursing staff; and frequency of challenging behavior, quality of life and social engagement of residents (N = 135). Because there are many unknown factors influencing the effect of the training, a process evaluation to evaluate sampling-, implementation- and intervention quality as well as barriers and facilitators to implementation will also be included in the analysis. Nursing staff could not be blinded to the intervention, but were blinded for the outcomes. Strengths of this study are the (good) description of the intervention complemented by a process evaluation and the tailoring of the intervention to the wishes and needs of the nursing homes at any moment during the study. Sustaining the effects of the intervention by using follow up sessions is another strength. Possible drawbacks may be dropout because of the frailty of the elderly population and because nursing staff might move to another job during

  8. The Effects of Therapist Competence in Assigning Homework in Cognitive Therapy with Cluster C Personality Disorders: Results from a Randomized Controlled Trial

    Science.gov (United States)

    Ryum, Truls; Stiles, Tore C.; Svartberg, Martin; McCullough, Leigh

    2010-01-01

    Therapist competence in assigning homework was used to predict mid- and posttreatment outcome for patients with Cluster C personality disorders in cognitive therapy (CT). Twenty-five patients that underwent 40 sessions of CT were taken from a randomized controlled trial (Svartberg, Stiles, & Seltzer, 2004). Therapist competence in assigning…

  9. Cost-effectiveness of a long-term Internet-delivered worksite health promotion programme on physical activity and nutrition: A cluster randomized controlled trial

    NARCIS (Netherlands)

    S.J.W. Robroek (Suzan); S. Polinder (Suzanne); F.J. Bredt (Folef); A. Burdorf (Alex)

    2012-01-01

    textabstractThis study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the u

  10. The Effects of Therapist Competence in Assigning Homework in Cognitive Therapy with Cluster C Personality Disorders: Results from a Randomized Controlled Trial

    Science.gov (United States)

    Ryum, Truls; Stiles, Tore C.; Svartberg, Martin; McCullough, Leigh

    2010-01-01

    Therapist competence in assigning homework was used to predict mid- and posttreatment outcome for patients with Cluster C personality disorders in cognitive therapy (CT). Twenty-five patients that underwent 40 sessions of CT were taken from a randomized controlled trial (Svartberg, Stiles, & Seltzer, 2004). Therapist competence in assigning…

  11. Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia : results from a cluster randomized cross-over trial

    NARCIS (Netherlands)

    van Werkhoven, Cornelis H; Postma, Douwe F; Mangen, Marie-Josee J; Oosterheert, Jan Jelrik; Bonten, Marc J M

    2017-01-01

    BACKGROUND: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy. METHODS: Costs and effects were estimated using data from a cluster-randomized cross-over trial

  12. Effects of a Physical Education-Based Programme on Health-Related Physical Fitness and Its Maintenance in High School Students: A Cluster-Randomized Controlled Trial

    Science.gov (United States)

    Mayorga-Vega, Daniel; Montoro-Escaño, Jorge; Merino-Marban, Rafael; Viciana, Jesús

    2016-01-01

    The purpose of this study was to examine the effects of a physical education-based development and maintenance programme on objective and perceived health-related physical fitness in high school students. A sample of 111 students aged 12-14 years old from six classes were cluster-randomly assigned to an experimental group (n = 54) or a control…

  13. The effectiveness of a construction worksite prevention program on work ability, health, and sick leave: Results from a cluster randomized controlled trial

    NARCIS (Netherlands)

    Oude Hengel, K.M.; Blatter, B.M.; Molen, H.F. van der; Bongers, P.M.; Beek, A.J. van der

    2013-01-01

    Objective This study aimed to investigate the effectiveness of a prevention program on work ability, health, and sick leave targeted at construction worksites. Methods A total of 15 departments (N=297 workers) from 6 construction companies participated in this cluster randomized controlled trial and

  14. Cost-effectiveness of antibiotic treatment strategies for community-acquired pneumonia : results from a cluster randomized cross-over trial

    NARCIS (Netherlands)

    van Werkhoven, Cornelis H; Postma, Douwe F; Mangen, Marie-Josee J; Oosterheert, Jan Jelrik; Bonten, Marc J M

    2017-01-01

    BACKGROUND: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy. METHODS: Costs and effects were estimated using data from a cluster-randomized cross-over trial o

  15. Evaluating a community-based early childhood education and development program in Indonesia: study protocol for a pragmatic cluster randomized controlled trial with supplementary matched control group

    NARCIS (Netherlands)

    M. Pradhan; S.A. Brinkman; A. Beatty; A. Maika; E. Satriawan; J. de Ree; A. Hasan

    2013-01-01

    Background This paper presents the study protocol for a pragmatic cluster randomized controlled trial (RCT) with a supplementary matched control group. The aim of the trial is to evaluate a community-based early education and development program launched by the Government of Indonesia. The program w

  16. Effects of a Physical Education-Based Programme on Health-Related Physical Fitness and Its Maintenance in High School Students: A Cluster-Randomized Controlled Trial

    Science.gov (United States)

    Mayorga-Vega, Daniel; Montoro-Escaño, Jorge; Merino-Marban, Rafael; Viciana, Jesús

    2016-01-01

    The purpose of this study was to examine the effects of a physical education-based development and maintenance programme on objective and perceived health-related physical fitness in high school students. A sample of 111 students aged 12-14 years old from six classes were cluster-randomly assigned to an experimental group (n = 54) or a control…

  17. Reasoning Exercises in Assisted Living: a cluster randomized trial to improve reasoning and everyday problem solving

    Directory of Open Access Journals (Sweden)

    Williams K

    2014-06-01

    Full Text Available Kristine Williams,1 Ruth Herman,2 Daniel Bontempo3 1College of Nursing, University of Iowa, Iowa City, IA, USA; 2School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA; 3The Schiefelbusch Institute for Life Span Studies, University of Kansas, Dole Human Development Center, Lawrence, KS, USA Purpose of the study: Assisted living (AL residents are at risk for cognitive and functional declines that eventually reduce their ability to care for themselves, thereby triggering nursing home placement. In developing a method to slow this decline, the efficacy of Reasoning Exercises in Assisted Living (REAL, a cognitive training intervention that teaches everyday reasoning and problem-solving skills to AL residents, was tested. Design and methods: At thirteen randomized Midwestern facilities, AL residents whose Mini Mental State Examination scores ranged from 19–29 either were trained in REAL or a vitamin education attention control program or received no treatment at all. For 3 weeks, treated groups received personal training in their respective programs. Results: Scores on the Every Day Problems Test for Cognitively Challenged Elders (EPCCE and on the Direct Assessment of Functional Status (DAFS showed significant increases only for the REAL group. For EPCCE, change from baseline immediately postintervention was +3.10 (P<0.01, and there was significant retention at the 3-month follow-up (d=2.71; P<0.01. For DAFS, change from baseline immediately postintervention was +3.52 (P<0.001, although retention was not as strong. Neither the attention nor the no-treatment control groups had significant gains immediately postintervention or at follow-up assessments. Post hoc across-group comparison of baseline change also highlights the benefits of REAL training. For EPCCE, the magnitude of gain was significantly larger in the REAL group versus the no-treatment control group immediately postintervention (d=3.82; P<0.01 and at the 3-month

  18. Lifestyle intervention for gestational diabetes mellitus prevention: A cluster-randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    Shuang Wang; Jing-Mei Ma; Hui-Xia Yang

    2015-01-01

    Objective: The study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.Methods: From September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation.According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group.Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6-8 gestational weeks, and at 12-13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered.Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24-28 gestational weeks.The weight gain after intervention and the prevalence of GDM were used to evaluate the effect.Results: (1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16% (23/134), lower than the control group which was 23.91% (33/138), P =0.168.(2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P =0.905, P =0.567).(3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55%) for the intervention group that was lower than 17/37 (45.95%) for the control group, but the statistical difference was not significant (P =0.076).Conclusion: The positive rate of GDM could be reduced by a certain amount lifestyle

  19. A participatory parent-focused intervention promoting physical activity in preschools: design of a cluster-randomized trial

    Directory of Open Access Journals (Sweden)

    Hoffmann Kristina

    2010-01-01

    Full Text Available Abstract Background With rates of childhood obesity increasing, physical activity (PA promotion especially in young children has assumed greater importance. Given the limited effectiveness of most interventions to date, new approaches are needed. The General Systems theory suggests that involving parents as intervention targets may be effective in fostering healthier life styles in children. We describe the development of a parent-focused participatory intervention and the procedures used to evaluate its effectiveness in increasing daily PA in preschoolers. Methods/Design Thirty-seven South German preschools were identified for this study and agreed to participate. Using a two-armed, controlled cluster-randomized trial design we test a participatory intervention with parents as the primary target group and potential agents of behavioural change. Specifically, the intervention is designed to engage parents in the development, refinement and selection of project ideas to promote PA and in incorporating these ideas into daily routines within the preschool community, consisting of children, teachers and parents. Our study is embedded within an existing state-sponsored programme providing structured gym lessons to preschool children. Thus, child-based PA outcomes from the study arm with the parent-focused intervention and the state-sponsored programme are compared with those from the study arm with the state-sponsored programme alone. The evaluation entails baseline measurements of study outcomes as well as follow-up measurements at 6 and 12 months. Accelerometry measures PA intensity over a period of six days, with the mean over six days used as the primary outcome measure. Secondary outcomes include childrens' BMI, a sum of averaged skin fold thickness measurements across multiple sites, and PA behaviour. Longitudinal multilevel models are used to assess within-subject change and between-group differences in study outcomes, adjusted for covariates

  20. Effects of a Stretching Development and Maintenance Program on Hamstring Extensibility in Schoolchildren: A Cluster-Randomized Controlled Trial.

    Science.gov (United States)

    Mayorga-Vega, Daniel; Merino-Marban, Rafael; Manzano-Lagunas, Jorge; Blanco, Humberto; Viciana, Jesús

    2016-03-01

    The main purpose of the present study was to examine the effects of a physical education-based stretching development and maintenance program on hamstring extensibility in schoolchildren. A sample of 150 schoolchildren aged 7-10 years old from a primary school participated in the present study (140 participants were finally included). The six classes balanced by grade were cluster randomly assigned to the experimental group 1 (n = 51), experimental group 2 (n = 51) or control group (n = 49) (i.e., a cluster randomized controlled trial design was used). During the physical education classes, the students from the experimental groups 1 and 2 performed a four-minute stretching program twice a week for nine weeks (first semester). Then, after a five-week period of detraining coinciding with the Christmas holidays, the students from the experimental groups 1 and 2 completed another stretching program twice a week for eleven weeks (second semester). The students from the experimental group 1 continued performing the stretching program for four minutes while those from the experimental group 2 completed a flexibility maintenance program for only one minute. The results of the two-way analysis of variance showed that the physical education-based stretching development program significantly improved the students' hamstring extensibility (p stretching maintenance program (p 0.05). After a short-term stretching development program, a physical education-based stretching maintenance program of only one-minute sessions twice a week is effective in maintaining hamstring extensibility among schoolchildren. This knowledge could help and guide teachers to design programs that allow a feasible and effective development and maintenance of students' flexibility in the physical education setting. Key pointsA physical education-based stretching maintenance program of only one-minute sessions twice a week is effective in maintaining hamstring extensibility among schoolchildren.A four