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The article discusses the approaches for gluteal tendinopathy which includes education plus exercise and corticosteroid injection.

Thin layer chromatography (TLC) is a simple and inexpensive type of chromatography that is extensively used in forensic laboratories for drugs of abuse analysis. In this work, TLC is optimized to analyze cocaine and its adulterants (caffeine, benzocaine, lidocaine and phenacetin) in which the sensitivity (visual determination of LOD from 0.5 to 14mgmL(-1)) and the selectivity (from the study of three different eluents: CHCl3:CH3OH:HCOOHglacial (75:20:5v%), (C2H5)2O:CHCl3 (50:50v%) and CH3OH:NH4OH (100:1.5v%)) were evaluated. Aiming to improve these figures of merit, the TLC spots were identified and quantified (linearity with R(2)>0.98) by the paper spray ionization mass spectrometry (PS-MS), reaching now lower LOD values (>1.0μgmL(-1)). The method developed in this work open up perspective of enhancing the reliability of traditional and routine TLC analysis employed in the criminal expertise units. Higher sensitivity, selectivity and rapidity can be provided in forensic reports, besides the possibility of quantitative analysis. Due to the great simplicity, the PS(+)-MS technique can also be coupled directly to other separation techniques such as the paper chromatography and can still be used in analyses of LSD blotter, documents and synthetic drugs. [ABSTRACT FROM AUTHOR]

The Phadebas® Forensic Press Test is routinely used for the detection of saliva. However, assessment of the use of Phadebas® paper for this purpose has not been studied extensively. The suitability of Phadebas® paper as a presumptive screening tool for saliva on forensic exhibits, was investigated by analysing the following: (1) sensitivity, (2) specificity, (3) effects of temperature on sensitivity and specificity, (4) detection of saliva in mixed body fluid samples, and (5) influence of substrate porosity. The results of this study demonstrated that Phadebas® paper is more sensitive to α-amylase activity and less specific for saliva than previously reported. The use of an examination temperature of 37°C had no effect on sensitivity, but increased the incidence of cross-reactivity with other forensically relevant body fluid stains. Blood, urine and vaginal secretions can inhibit the detection of α-amylase activity with Phadebas® paper in mixed stains of saliva and body fluid. Substrate porosity is a weak predictor for the time taken for a saliva stain to achieve a strong positive result on Phadebas® paper. Overall, this study demonstrated that the Phadebas® Forensic Press Test has limitations as a presumptive test for the accurate identification of saliva. [ABSTRACT FROM AUTHOR]

Background: Electronic data collection is increasingly being used for discrete choice experiments (DCEs).Objectives: To study whether paper or electronic administration results in measurement effects.Methods: Respondents were drawn from the same sample frame (an Internet panel) and completed a nearly identical DCE survey either online or on paper during the same period. A DCE on preferences for basic health insurance served as a case study. We used panel mixed logit models for the analysis.Results: In total, 898 respondents completed the survey: 533 respondents completed the survey online, whereas 365 respondents returned the paper survey. There were no significant differences with respect to sociodemographic characteristics between the respondents in both samples. The median response time was shorter for the online sample than for the paper sample, and a smaller proportion of respondents from the online sample were satisfied with the number of choice sets. Although some willingness- to-pay estimates were higher for the online sample, the elicited preferences for basic health insurance characteristics were similar between both modes of administration.Conclusions: We find no indication that online surveys yield inferior results compared with paper-based surveys, whereas the price per respondent is lower for online surveys. Researchers might want to include fewer choice sets per respondent when collecting DCE data online. Because our findings are based on a nonrandomized DCE that covers one health domain only, research in other domains is needed to support our findings. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the measurement equivalence of individual response scale types by using a patient reported outcome measure (PROM) collected on paper and migrated into electronic format for use on the subject's own mobile device (BYOD) and on a provisioned device (site device).Methods: Subjects suffering from chronic health conditions causing daily pain or discomfort were invited to participate in this single-site, single visit, three-way crossover study. Association between individual item and instrument subscale scores was assessed by using the intraclass correlation coefficient (ICC) and its CI. Participant attitudes toward the use of BYOD in a clinical trial were assessed through use of a questionnaire.Results: In this study, 155 subjects (females 83 [54%]; males 72 [46%]) ages 19 to 69 years (mean ± SD: 48.6 ± 13.1) were recruited. High association between the modes of administration (paper, BYOD, site device) was shown with analysis of ICCs (0.79-0.98) for each response scale type, including visual analogue scale, numeric rating scale, verbal response scale, and Likert scale. Of the subjects, 94% (146 of 155) stated that they would definitely or probably be willing to download an app onto their own mobile device for a forthcoming clinical trial. Forty-five percent of subjects felt BYOD would be more convenient compared with 15% preferring a provisioned device (40% had no preference).Conclusions: This study provides strong evidence supporting the use of BYOD for PROM collection in terms of the conservation of instrument measurement equivalence across the most widely used response scale types, and high patient acceptance of the approach. [ABSTRACT FROM AUTHOR]

Context: Researchers administering surveys seek to balance data quality, sources of error, and practical concerns when selecting an administration mode. Rarely are decisions about survey administration based on the background of study participants, although socio-demographic characteristics like age, education, and race may contribute to participants' (non)responses.Objectives: In this study, we describe differences in paper- and web-based surveys administered in a national cancer survivor study of women with a history of cancer to compare the ability of each survey administrative mode to provide quality, generalizable data.Methods: We compared paper- and web-based survey data by socio-demographic characteristics of respondents, missing data rates, scores on primary outcome measure, and administrative costs and time using descriptive statistics, tests of mean group differences, and linear regression.Results: Our findings indicate that more potentially vulnerable patients preferred paper questionnaires and that data quality, responses, and costs significantly varied by mode and participants' demographic information. We provide targeted suggestions for researchers conducting survey research to reduce survey error and increase generalizability of study results to the patient population of interest.Conclusion: Researchers must carefully weigh the pros and cons of survey administration modes to ensure a representative sample and high-quality data. [ABSTRACT FROM AUTHOR]

Objective: Most preventable adverse drug events and medication errors occur during medication ordering. Medication order entry and clinical decision support are available on paper or as computerized systems. In this post-hoc analysis we investigated frequency and clinical impact of blood glucose (BG) documentation- and user-related calculation errors as well as workflow deviations in diabetes management. We aimed to compare a paper-based protocol to a computerized medication management system combined with clinical workflow and decision support.Methods: Seventy-nine hospitalized patients with type 2 diabetes mellitus were treated with an algorithm driven basal-bolus insulin regimen. BG measurements, which were the basis for insulin dose calculations, were manually entered either into the paper-based workflow protocol (PaperG: 37 patients) or into GlucoTab(®)-a mobile tablet PC based system (CompG: 42 patients). We used BG values from the laboratory information system as a reference. A workflow simulator was used to determine user calculation errors as well as workflow deviations and to estimate the effect of errors on insulin doses. The clinical impact of insulin dosing errors and workflow deviations on hypo- and hyperglycemia was investigated.Results: The BG documentation error rate was similar for PaperG (4.9%) and CompG group (4.0%). In PaperG group, 11.1% of manual insulin dose calculations were erroneous and the odds ratio (OR) of a hypoglycemic event following an insulin dosing error was 3.1 (95% CI: 1.4-6.8). The number of BG values influenced by insulin dosing errors was eightfold higher than in the CompG group. In the CompG group, workflow deviations occurred in 5.0% of the tasks which led to an increased likelihood of hyperglycemia, OR 2.2 (95% CI: 1.1-4.6).Discussion: Manual insulin dose calculations were the major source of error and had a particularly strong influence on hypoglycemia. By using GlucoTab(®), user calculation errors were entirely excluded. The immediate availability and automated handling of BG values from medical devices directly at the point of care has a high potential to reduce errors. Computerized systems facilitate the safe use of more complex insulin dosing algorithms without compromising usability. In CompG group, missed or delayed tasks had a significant effect on hyperglycemia, while in PaperG group insufficient precision of documentation times limited analysis. The use of old BG measurements was clinically less relevant.Conclusion: Insulin dosing errors and workflow deviations led to measurable changes in clinical outcome. Diabetes management systems including decision support should address nurses as well as physicians in a computerized way. Our analysis shows that such systems reduce the frequency of errors and therefore decrease the probability of hypo- and hyperglycemia. [ABSTRACT FROM AUTHOR]

Background: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption.Objective: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows.Methods: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score.Results: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger.Conclusion: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. [ABSTRACT FROM AUTHOR]

Background: Fermentation is a widely used method of natural food preservation that has consequences on the nutritional value of the transformed food. Fermented dairy products are increasingly investigated in view of their ability to exert health benefits beyond their nutritional qualities.Objective: To explore the mechanisms underpinning the health benefits of fermented dairy intake, the present study followed the effects of milk fermentation, from changes in the product metabolome to consequences on the human serum metabolome after its ingestion.Methods: A randomized crossover study design was conducted in 14 healthy men [mean age: 24.6 y; mean body mass index (in kg/m2): 21.8]. At the beginning of each test phase, serum samples were taken 6 h postprandially after the ingestion of 800 g of a nonfermented milk or a probiotic yogurt. During the 2-wk test phases, subjects consumed 400 g of the assigned test product daily (200 g, 2 times/d). Serum samples were taken from fasting participants at the end of each test phase. The serum metabolome was assessed through the use of LC-MS-based untargeted metabolomics.Results: Postprandial serum metabolomes after milk or yogurt intake could be differentiated [orthogonal projections to latent structures discriminant analysis (OPLS-DA) Q2 = 0.74]. Yogurt intake was characterized by higher concentrations of 7 free amino acids (including proline, P = 0.03), reduced concentrations of 5 bile acids (including glycocholic acid, P = 0.04), and modulation of 4 indole derivative compounds (including indole lactic acid, P = 0.01). Fasting serum samples after 2 wk of daily intake of milk or yogurt could also be differentiated based on their metabolic profiles (OPLS-DA Q2 = 0.56) and were discussed in light of the postprandial results.Conclusion: Metabolic pathways related to amino acids, indole derivatives, and bile acids were modulated in healthy men by the intake of yogurt. Further investigation to explore novel health effects of fermented dairy products is warranted.This trial was registered at clinicaltrials.gov as NCT02230345. [ABSTRACT FROM AUTHOR]

Objectives: A new patient-reported outcome (PRO) instrument to measure fatigue symptoms and impacts in relapsing multiple sclerosis (RMS) was developed in a qualitative stage, followed by psychometric validation and migration from paper to an electronic format.Methods: Adult patients with relapsing-remitting multiple sclerosis (RRMS) were interviewed to elicit fatigue-related symptoms and impacts. A draft questionnaire was debriefed in cognitive interviews with further RRMS patients, and revised. Content confirmation interviews were conducted with patients with progressive-relapsing multiple sclerosis (PRMS) and relapsing secondary-progressive multiple sclerosis (RSPMS). Psychometric analyses used data from adult patients with different RMS subtypes and matched non-RMS controls in a multicenter, observational study. After item reduction, the final instrument was migrated to a smartphone (eDiary) and usability was confirmed in interviews with additional adult RMS patients.Results: The qualitative stage included 37 RRMS, 5 PRMS, and 5 RSPMS patients. Saturation of concepts was reached during concept elicitation. Cognitive interviews confirmed that participants understood the instructions, items, and response options of the instrument-named FSIQ-RMS-as intended. Psychometric validation included 164 RMS and 74 control patients. Internal consistency and test-retest reliability were demonstrated. The symptoms domain discriminated along the RMS symptom-severity continuum and between patients and controls. Patients were able to attribute fatigue-related symptoms to RMS. Usability and conceptual equivalence of the eDiary were confirmed (n = 10 participants).Conclusions: With 7 symptom items and 13 impact items (in 3 impacts subdomains: physical, cognitive and emotional, and coping) after item reduction, the FSIQ-RMS is a comprehensive, valid, and reliable measure of fatigue-related symptoms and impacts in RMS patients. [ABSTRACT FROM AUTHOR]

Iron deficiency is the most common micronutrient deficiency worldwide, and transferrin receptor (TfR) level has been identified as an important measure of iron status that is not confounded by inflammation. However, logistical constraints associated with sample collection and processing have limited efforts to measure TfR, particularly at the community level. Standardized filter paper provides a relatively convenient and minimally invasive means for collecting and transporting samples of whole blood from simple finger pricks, and we present results of our validation of an improved method for quantifying TfR in dried blood spots. The method is based on commercially available reagents and uses capillary blood that is applied directly from the finger to filter paper, eliminating the need for premeasurement at the collection site. The blood spot TfR assay is precise and reliable, agrees well with plasma TfR, and can be performed at any facility with a microplate reader and basic laboratory equipment. Concentrations of TfR remain stable for at least 4 wk when blood spots are stored at room temperature, but begin to deteriorate after 3 d of exposure to higher temperatures. The advantages and disadvantages of the blood spot TfR method are discussed, as well as its potential contribution to future field-based studies of iron deficiency. [ABSTRACT FROM AUTHOR]

The detection and identification of body fluids at a crime scene shed light on the events which might have occurred and the people involved in the crime; the techniques used being lengthy, makes the on-scene detection a tough process to carry out and handle. This study aims to develop an on-spot detection method for serological testing using silica gel encapsulation technique and a modified microfluidic paper-based analytical device (μPADs). Kastle-Meyer reagent was incorporated into the μPAD and Silica Gel plate and was subsequently validated for the detection of blood. This study revealed that the μPAD was a better option. The emerging technique of μPADs allows a cost-effective and simple method of detection for body fluids. The fibrous network of the paper is manipulated to fabricate a guided channel for the fluid flow. The guided channels in the modified μPADs were fabricated by patterning a hydrophobic barrier out of wax. The analyte of interest for this study is blood but the principle can be modified to include other biological fluids. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: The aims of this study were to label the versatile amino acid l-lysine with 99mTc using 2,3-dimercapto-succinic acid (DMSA) as a chelator, and to assess its tumor imaging feasibility under in vivo and in vitro conditions, and finally to determine the subcellular biodistribution of this radiopharmaceutical. Materials and Methods: DMSA-l-lysine was chemically synthesized and labeled with sodium pertechnetate. Nuclear magnetic resonance (NMR) and mass spectral analysis of DMSA-l-lysine were conducted. Radiochemical purity was determined by thin-layer chromatography (TLC) and paper chromatography. Cellular uptake, competition and subcellular localization studies were performed in rat breast cancer cells (13762). In vivo studies of planar imaging and biodistribution studies were performed on female Fischer 344 rats. Medical Internal Radiation Dose (MIRD) dosimetry estimates were calculated. Results: Radiochemical purity (determined by radio-TLC and high-performance liquid chromatography) of these compounds was >95%. 99mTc-DMSA-l-lysine showed good uptake in in vitro cell culture assays and uptake was reduced in competition studies. 99mTc-DMSA-l-lysine accumulates in the nucleus as much as in the cytoplasm and it was also shown that accumulation of the 99mTc-DMSA-l-lysine in the nucleus increases as a function of a time. There was an increase in tumor-to-blood and tumor-to-muscle count density ratios. Tumor/background ratios were 5.75 at 1 hour and 6.87 at 2 hours. In vivo tissue distribution studies revealed that radiation dosimetry of blood-forming organs were within radiation dose limits. Conclusion: DMSA-l-lysine kits can be labeled with 99mTc easily and efficiently, with high radiochemical purity and cost-effectiveness. In vitro cellular uptake and scintigraphic imaging studies demonstrated the pharmacokinetic distribution and feasibility of using 99mTc-DMSA-l-lysine for tumor imaging. [Copyright &y& Elsevier]

Functional foods can be considered to be those whole, fortified, enriched or enhanced foods that provide health benefits beyond the provision of essential nutrients (e.g., vitamins and minerals), when they are consumed at efficacious levels as part of a varied diet on a regular basis. Linking the consumption of functional foods or food ingredients with health claims should be based on sound scientific evidence, with the "gold standard" being replicated, randomized, placebo-controlled, intervention trials in human subjects. However, not all foods on the market today that are claimed to be functional foods are supported by enough solid data to merit such claims. This review categorizes a variety of functional foods according to the type of evidence supporting their functionality, the strength of that evidence and the recommended intakes. Functional foods represent one of the most intensively investigated and widely promoted areas in the food and nutrition sciences today. However, it must be emphasized that these foods and ingredients are not magic bullets or panaceas for poor health habits. Diet is only one aspect of a comprehensive approach to good health. [ABSTRACT FROM AUTHOR]

Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of holding external loads on postural sway during upright stance across age decades. Sixty-five healthy adults (females, n = 35), aged 18-80 years were assessed in four conditions; (1) standing without holding a load, holding a load corresponding to 5% body mass in the (2) left hand, (3) right hand and (4) both hands. The centre of pressure (COP) path length and anteroposterior and mediolateral COP displacement were used to indirectly assess postural sway. External loading elicited reductions in COP measures of postural sway in older age groups only (P < 0.05). No changes were observed in younger or intermediate aged adults (P > 0.05). Holding external loads during standing is relevant to many activities of daily living (i.e. holding groceries). The reduction in postural sway may suggest this type of loading has a stabilising effect during quiet standing among older adults. [ABSTRACT FROM AUTHOR]

Background: We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds.Methods: We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range).Results: Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement.Conclusions: A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU.Clinical Trial Registration: NCT03599856. [ABSTRACT FROM AUTHOR]

This paper describes the INSIDE system, a networked robot system designed to allow the use of mobile robots as active players in the therapy of children with autism spectrum disorders (ASD). While a significant volume of work has explored the impact of robots in ASD therapy, most such work comprises remotely operated robots and/or well-structured interaction dynamics. In contrast, the INSIDE system allows for complex, semi-unstructured interaction in ASD therapy while featuring a fully autonomous robot. In this paper we describe the hardware and software infrastructure that supports such rich form of interaction, as well as the design methodology that guided the development of the INSIDE system. We also present some results on the use of our system both in pilot and in a long-term study comprising multiple therapy sessions with children at Hospital Garcia de Orta, in Portugal, highlighting the robustness and autonomy of the system as a whole. [ABSTRACT FROM AUTHOR]

Introduction: Currently, there are few evidence-based guidelines to inform optimal clinical data-entry template design that maximizes usability while reducing unintended consequences. This study explored the impact of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction to identify the most beneficial data-entry methods for use in future documentation interface design.Methodology: A study using observational data collection and psychometric instruments (for perceived workload and user-satisfaction) was conducted at three hospitals using different methods of data-entry for perioperative documentation (auto-filling with unstructured data, computer-assisted data selection with semi-structured documentation, and paper-based documentation). Nurse anesthetists at each hospital (N = 30) were observed completing documentation on routine abdominal surgical cases.Results: Auto-filling (61.2%) had the lowest documentation accuracy scores compared to computer-assisted (81.3%) and paper-based documentation (76.2%). Computer-assisted data-entry had the best documentation efficiency scores and required the least percentage of the nurse anesthetists' time (9.65%) compared to auto-filling (11.43%) and paper-based documentation (15.23%). Paper-based documentation had the highest perceived workload scores (M = 288, SD = 88) compared to auto-filling (M = 160, SD = 93, U = 16.5, p < 0.01) and computer assisted data-entry (M = 93, SD = 50, U = 4.0, P < 0.001).Conclusions: Auto-filling with unstructured data needs to be used sparingly because of its low documentation accuracy. Computer-assisted data entry with semi-structured data needs to be further study because of its better documentation accuracy, documentation efficiency, and perceived workload. [ABSTRACT FROM AUTHOR]

Background: Constrained optimization methods are already widely used in health care to solve problems that represent traditional applications of operations research methods, such as choosing the optimal location for new facilities or making the most efficient use of operating room capacity.Objectives: In this paper we illustrate the potential utility of these methods for finding optimal solutions to problems in health care delivery and policy. To do so, we selected three award-winning papers in health care delivery or policy development, reflecting a range of optimization algorithms. Two of the three papers are reviewed using the ISPOR Constrained Optimization Good Practice Checklist, adapted from the framework presented in the initial Optimization Task Force Report. The first case study illustrates application of linear programming to determine the optimal mix of screening and vaccination strategies for the prevention of cervical cancer. The second case illustrates application of the Markov Decision Process to find the optimal strategy for treating type 2 diabetes patients for hypercholesterolemia using statins. The third paper (described in Appendix 1) is used as an educational tool. The goal is to describe the characteristics of a radiation therapy optimization problem and then invite the reader to formulate the mathematical model for solving it. This example is particularly interesting because it lends itself to a range of possible models, including linear, nonlinear, and mixed-integer programming formulations. From the case studies presented, we hope the reader will develop an appreciation for the wide range of problem types that can be addressed with constrained optimization methods, as well as the variety of methods available.Conclusions: Constrained optimization methods are informative in providing insights to decision makers about optimal target solutions and the magnitude of the loss of benefit or increased costs associated with the ultimate clinical decision or policy choice. Failing to identify a mathematically superior or optimal solution represents a missed opportunity to improve economic efficiency in the delivery of care and clinical outcomes for patients. The ISPOR Optimization Methods Emerging Good Practices Task Force's first report provided an introduction to constrained optimization methods to solve important clinical and health policy problems. This report also outlined the relationship of constrained optimization methods relative to traditional health economic modeling, graphically illustrated a simple formulation, and identified some of the major variants of constrained optimization models, such as linear programming, dynamic programming, integer programming, and stochastic programming. The second report illustrates the application of constrained optimization methods in health care decision making using three case studies. The studies focus on determining optimal screening and vaccination strategies for cervical cancer, optimal statin start times for diabetes, and an educational case to invite the reader to formulate radiation therapy optimization problems. These illustrate a wide range of problem types that can be addressed with constrained optimization methods. [ABSTRACT FROM AUTHOR]

1,2-Indanedione has been extensively researched since the discovery of its fluorogenic reaction with amino acids in 1997 by Joullié et al. [1]. This current study compares the development of fingermarks on used train tickets by the three leading reagents for amino acids-ninhydrin, DFO and 1,2-indanedione. The train tickets are ideal for the task due to their high abundance and frequent use by a diverse population. However, their unique double-layer composition of a cellulose-based regular paper on one side and a thermally sensitive layer on the other requires an adjustment of the traditional development procedures. Heat, which is normally applied after dipping the specimens in the reagents solutions, had to be avoided due to darkening of the sensitive thermal layer. Instead, it has been replaced by air-drying in a fume-hood 24h prior to the recording of the results. Three groups, each containing 500 used train tickets had been treated by each of the three reagents. The results were expressed in terms of percentage of both comparable and partial fingermarks. In this study we controlled neither the quality of the fingerprint donors nor the conditions under which the latent fingermarks had been deposited or stored. However, the large number of similar exhibits which are randomly chosen allows tentative conclusions on the potential of each reagent, hence, a new criterion for the potential of fingermark development (PFD) is proposed. The PFD combines all the partial fingermarks and identifiable fingermarks (graded 1 and 2) thus, highlighting the sensitivity of the reagents. In this work, the superiority of 1,2-indanedione is demonstrated using both the traditional comparison tests as well as the suggested "PFD". [ABSTRACT FROM AUTHOR]

Introduction: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations.Objective: This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations.Methods: The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2).Results: Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces.Conclusions: If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions. [ABSTRACT FROM AUTHOR]

Objective: To determine if high alpha-fetoprotein (AFP) level in vaginal blood collected on a sanitary pad can assist with detecting an active miscarriage.Design: A prospective cohort study.Setting: Academic medical center.Patient(s): Five groups were evaluated: women with active miscarriage, pregnancy of unknown location, completed miscarriage or extrauterine pregnancy (EUP), ongoing pregnancy, and undergoing elective dilation and curettage (D&C).Intervention(s): None.Main Outcome Measure(s): For each patient, AFP level in the vaginal blood collected on a sanitary pad was quantified.Result(s): The vaginal blood AFP median levels (and their ranges) were 3.7 IU/mL (0.5-739.2) and 4,542 IU/mL (15.6-100,000) in the active miscarriage (n = 16) and the elective D&C (n = 24) groups, respectively. Alpha-fetoprotein was detected in all elective D&C and active miscarriage cases except in 1 case. In the ongoing pregnancy group (n = 35), only 2 of 35 specimens showed detectable AFP levels. In the pregnancy of unknown location (n = 12) and the completed miscarriage or EUP (n = 10) groups, no AFP was detected. Receiver operating characteristic analysis demonstrated 93.7% sensitivity and 97.8% specificity for the detection of an active miscarriage (cutoff 0.61 IU/mL; area under the curve 0.96).Conclusion(s): Alpha-fetoprotein can be extracted from vaginal blood collected on sanitary pads. A high level of vaginal AFP can assist with the same-day detection of an active miscarriage. This novel test is useful in differentiating active miscarriages from ongoing pregnancies, completed miscarriages, and EUPs and, therefore, it reduces uncertainty, anxiety level, and number of repeat office visits. [ABSTRACT FROM AUTHOR]

The horopter is defined by the criterion with which it is measured; these include the apparent frontoparallel plane, the region of binocular single vision, and identical visual direction. Another criterion is one that "the positions of the points are such that none provides a stimulus for fusional movement of the eyes". Measuring the horopter using this criterion is the aim of the current paper. Based on previous research investigating corresponding points, we predicted the vergence horopter should trace an arc similar to the empirical horizontal horopter. We further predicted based on the characteristics of vergence eye movements in the periphery, that the range of horizontal disparities that do not elicit a vergence movement would increase with eccentricity. In experiment 1 we conducted the first measurements of the vergence horopter along the horizontal plane of regard and sagittal planes. We found that the vergence horopter consists of a stable range of disparities that do not increase with eccentricity. In experiment 2, we measured Panum's fusional range for the same eccentricities and elevations to determine the placement of the vergence horopter within the fusional ranges. In the horizontal plane, the vergence horopter sits centrally within Panum's fusional range. In the vertical plane, the data are suggestive that the vergence horopter is less slanted than the corresponding fusional range. [ABSTRACT FROM AUTHOR]

Screening tests are used in forensic science for field testing and directing laboratory analysis of physical evidence. These tests are often binary in that the data produced is interpreted as yes/no or present/absent. The utility of screening assays can be improved by evaluating a relevant background population and incorporating prior knowledge to refine the decision boundary. This paper describes the results of using ion mobility spectrometry (IMS) and hand swab samples collected from 73 individuals to differentiate shooters from non-shooters by targeting organic constituents of firearms discharge residues. Each individual completed a questionnaire helpful in analyzing positive results when they did occur. Pattern matching was undertaken using neural networks, and decision thresholds were established using likelihood ratios derived from the population study. This approach significantly reduced the background positive rates compared to an arbitrary decision threshold technique. This methodology could be extended to other pattern-recognition algorithms used with instrumental data. This paper also reports the largest population study to date focused on the organic residues of firearms discharge. The proportion of positives found in the population sample were less than 5%; when a likelihood ratio of 10:1 (shooter/not shooter) was used, the frequency of positives fell below 2%. The results suggest that background levels of organic gunshot residue will not be a significant analytic concern for assay development. [ABSTRACT FROM AUTHOR]

Craniofacial reconstruction recreates a facial outlook from the cranium based on the relationship between the face and the skull to assist identification. But craniofacial structures are very complex, and this relationship is not the same in different craniofacial regions. Several regional methods have recently been proposed, these methods segmented the face and skull into regions, and the relationship of each region is then learned independently, after that, facial regions for a given skull are estimated and finally glued together to generate a face. Most of these regional methods use vertex coordinates to represent the regions, and they define a uniform coordinate system for all of the regions. Consequently, the inconsistence in the positions of regions between different individuals is not eliminated before learning the relationships between the face and skull regions, and this reduces the accuracy of the craniofacial reconstruction. In order to solve this problem, an improved regional method is proposed in this paper involving two types of coordinate adjustments. One is the global coordinate adjustment performed on the skulls and faces with the purpose to eliminate the inconsistence of position and pose of the heads; the other is the local coordinate adjustment performed on the skull and face regions with the purpose to eliminate the inconsistence of position of these regions. After these two coordinate adjustments, partial least squares regression (PLSR) is used to estimate the relationship between the face region and the skull region. In order to obtain a more accurate reconstruction, a new fusion strategy is also proposed in the paper to maintain the reconstructed feature regions when gluing the facial regions together. This is based on the observation that the feature regions usually have less reconstruction errors compared to rest of the face. The results demonstrate that the coordinate adjustments and the new fusion strategy can significantly improve the craniofacial reconstructions. [ABSTRACT FROM AUTHOR]

Many people regard the concept of hypothesis testing as fundamental to inferential statistics. Various schools of thought, in particular frequentist and Bayesian, have promoted radically different solutions for taking a decision about the plausibility of competing hypotheses. Comprehensive philosophical comparisons about their advantages and drawbacks are widely available and continue to span over large debates in the literature. More recently, controversial discussion was initiated by an editorial decision of a scientific journal [1] to refuse any paper submitted for publication containing null hypothesis testing procedures. Since the large majority of papers published in forensic journals propose the evaluation of statistical evidence based on the so called p-values, it is of interest to expose the discussion of this journal's decision within the forensic science community. This paper aims to provide forensic science researchers with a primer on the main concepts and their implications for making informed methodological choices. [ABSTRACT FROM AUTHOR]

This paper highlights a preference evaluation methodology for text entry methods in a touch keyboard smartphone using analytic network process (ANP). Evaluation of text entry methods in literature mainly considers speed and accuracy. This study presents an alternative means for selecting text entry method that considers user preference. A case study was carried out with a group of experts who were asked to develop a selection decision model of five text entry methods. The decision problem is flexible enough to reflect interdependencies of decision elements that are necessary in describing real-life conditions. Results showed that QWERTY method is more preferred than other text entry methods while arrangement of keys is the most preferred criterion in characterizing a sound method. Sensitivity analysis using simulation of normally distributed random numbers under fairly large perturbation reported the foregoing results reliable enough to reflect robust judgment. The main contribution of this paper is the introduction of a multi-criteria decision approach in the preference evaluation of text entry methods. [ABSTRACT FROM AUTHOR]

Context: Few resources exist to support collaborative quality monitoring in palliative care. These tools, if proven efficient through technology-enabled methods, may begin to routinize data collection on quality during usual palliative care delivery. Usability testing is a common approach to assess how easily and effectively users can interact with a newly developed tool.Objectives: We performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC) a novel, point-of-care quality monitoring tool for palliative care.Methods: We used a mixed methods approach to assess community palliative care clinicians' evaluations of five domains of usability. These approaches included clinician surveys after recording mock patient data to assess satisfaction; review of entered data for accuracy and time to completion; and thematic review of "think aloud" protocols to determine issues, barriers, and advantages to the electronic system.Results: We enrolled 14 palliative care clinicians for the study. Testing the electronic system vs. paper-based methods demonstrated similar error rates and time to completion. Overall, 68% of the participants believed that the electronic interface would not pose a moderate or major burden during usual clinical activities, and 65% thought it would improve the care they provided. Thematic analysis revealed significant issues with paper-based methods alongside training needs for future participants on using novel technologies that support the QDACT-PC.Conclusion: The QDACT-PC is a usable electronic system for quality monitoring in palliative care. Testing reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability. [ABSTRACT FROM AUTHOR]

Purposes: This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medication administration processes followed by nurses in an Australian residential aged care home. It also aimed to identify the benefits and unintended adverse consequences of using the electronic medication administration records.Methods: Time-motion observation, taking of field notes, informal conversation and document review were used to collect data in two units of a residential aged care home. Each unit had one nurse administer medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medication administration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on various activities in a medication round, including documentation, verbal communication, medication administration, infection control and transit. Comparison of the medication administration processes between the electronic and paper-based medication administration records identified a procedural problem which violated the organization's documentation requirement. This problem was documenting before providing medication to a resident when using the paper-based records. It was not observed with the electronic medication administration records. Benefits of introducing the electronic medication administration records included improving nurses' compliance with documentation requirements, freedom from the error of signing twice, reducing the possibility of forgetting to medicate a resident, facilitating nurses to record the time of medication administration to a resident and increasing documentation space. Unintended adverse consequences of introducing the electronic medication administration records included inadequate information about residents, late addition of a new resident's medication profile in the records and nurses' forgetting to medicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent on various activities in a medication round or substantially alter the medication administration processes, but can generate both benefits and unintended adverse consequences. Future research may investigate whether and how the adverse consequences can be prevented. [ABSTRACT FROM AUTHOR]

Neuroscientists postulate 3D representations in the brain in a variety of different coordinate frames (e.g. 'head-centred', 'hand-centred' and 'world-based'). Recent advances in reinforcement learning demonstrate a quite different approach that may provide a more promising model for biological representations underlying spatial perception and navigation. In this paper, we focus on reinforcement learning methods that reward an agent for arriving at a target image without any attempt to build up a 3D 'map'. We test the ability of this type of representation to support geometrically consistent spatial tasks such as interpolating between learned locations using decoding of feature vectors. We introduce a hand-crafted representation that has, by design, a high degree of geometric consistency and demonstrate that, in this case, information about the persistence of features as the camera translates (e.g. distant features persist) can improve performance on the geometric tasks. These examples avoid Cartesian (in this case, 2D) representations of space. Non-Cartesian, learned representations provide an important stimulus in neuroscience to the search for alternatives to a 'cognitive map'. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing.Methods: A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold.Results: In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher.Conclusions: Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines. [ABSTRACT FROM AUTHOR]

Background: Despite the greater prevalence of familial hypercholesterolemia (FH) in subjects with ischemic heart disease (IHD), premature IHD, and severe hypercholesterolemia (low-density lipoprotein ≥190 mg/dl), overall prevalence estimates are not available.Objectives: The aim of this study was to provide worldwide estimates of FH prevalence in subjects with IHD, premature IHD, and severe hypercholesterolemia compared with those in the general population.Methods: In this systematic review and meta-analyses, Embase, PubMed, and the Web of Science were searched until June 3, 2019, for peer-reviewed papers and conference abstracts reporting heterozygous FH prevalence in nonfounder populations, revealing 104 studies eligible for inclusion.Results: Estimates of FH prevalence were pooled using random-effects meta-analyses and were 0.32% (95% confidence interval [CI]: 0.26% to 0.39% [corresponding to 1:313]) among 10,921,310 unique subjects in the general population (33,036 patients with FH) on the basis of 44 studies, 3.2% (95% CI: 2.2% to 4.3% [1:31]) among 84,479 unique subjects with IHD (2,103 patients with FH) on the basis of 28 studies, 6.7% (95% CI: 4.9% to 8.7% [1:15]) among 31,316 unique subjects with premature IHD (1,471 patients with FH) on the basis of 32 studies, and 7.2% (95% CI: 4.6% to 10.8% [1:14]) among 17,728 unique subjects with severe hypercholesterolemia (920 patients with FH) on the basis of 7 studies. FH prevalence in the general population was similar using genetic versus clinical diagnoses. Seventeen of 195 countries (9%) in the world have reported FH prevalence for the general population, leaving 178 (91%) countries in the world with unknown prevalence.Conclusions: Compared with 1:313 among subjects in the general population, FH prevalence is 10-fold higher among those with IHD, 20-fold higher among those with premature IHD, and 23-fold higher among those with severe hypercholesterolemia. The prevalence of FH is unknown in 90% of countries in the world. [ABSTRACT FROM AUTHOR]

Background: In dentistry, the use of electronic patient records for research is underexplored. The aim of this paper is to describe a case study process of obtaining research data (sociodemographic, clinical and workforce) from electronic primary care dental records, and outlining data cleaning and validation strategies. This study was undertaken at the University of Portsmouth Dental Academy (UPDA), which is a centre of education, training and provision of state funded services (National Health Services). UPDA's electronic patient management system is R4/Clinical +. This is a widely used system in general dental practices in the UK.Method: A two-phase process, involving first Pilot and second Main data extraction were undertaken. Using System Query Language (SQL), data extracts containing variables related to patients' demography, socio-economic status and dental care received were generated. A data cleaning and validation exercise followed, using a combination of techniques including Maletic and Marcus's (2000) general framework for data cleaning and Rahm and Haido's (2010) principles of data cleaning.Results: The findings of the case study support the use of a two-phase data extraction process. The data validation processes highlighted the need for both manual and analytical strategies when cleaning these data. Finally, the process demonstrated that electronic dental records can be validated and used for epidemiological and heath service research. The potential to generalise findings is great due to the large number of records. There are, however, limitations to the data which need to be considered, relating to quality (data input), database structure and interpretation of data codes.Conclusion: Electronic dental records are useful in health service research, epidemiological studies and skill mix research. Researchers should work closely with clinicians, managers and software developers to ensure that the data generated are accurate, valid and generalisable. Following data extraction the researchers need to adapt stringent validation and data cleaning strategies to guarantee that the extracted electronic data are accurate. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of the clinical decision support systems (CDSSs) is hampered by frequent workflow interruptions and alert fatigue because of alerts with little or no clinical relevance. In this paper, we reported a methodology through which we applied knowledge from the clinical context and the international recommendations to develop a potential drug-drug interaction (pDDI) CDSS in the field of kidney transplantation.Methods: Prescriptions of five nephrologists were prospectively recorded through non-participatory observations for two months. The Medscape multi-drug interaction checker tool was used to detect pDDIs. Alongside the Stockley's drug interactions reference, our clinicians were consulted with respect to the clinical relevance of detected pDDIs. We performed semi-structured interviews with five nephrologists and one informant nurse. Our clinically relevant pDDIs were checked with the Dutch "G-Standard". A multidisciplinary team decided the design characteristics of pDDI-alerts in a CDSS considering the international recommendations and the inputs from our clinical context. Finally, the performance of the CDSS in detecting DDIs was evaluated iteratively by a multidisciplinary research team.Results: Medication data of 595 patients with 788 visits were collected and analyzed. Fifty-two types of interactions were most common, comprising 90% of all pDDIs. Among them 33 interactions (comprising 77% of all pDDIs) were rated as clinically relevant and were included in the CDSS's knowledge-base. Of these pDDIs, 73% were recognized as either pseudoduplication of drugs or not a pDDI when checked with the Dutch G-standard. Thirty-three alerts were developed and physicians were allowed to customize the appearance of pDDI-alerts based on a proposed algorithm.Conclusion: Clinical practice contexts should be studied to understand the complexities of clinical work and to learn the type, severity and frequency of pDDIs. In order to make the alerts more effective, clinicians' points of view concerning the clinical relevance of pDDIs are critical. Moreover, flexibility should be built into a pDDI-CDSS to allow clinicians to customize the appearance of pDDI-alerts based on their clinical context. [ABSTRACT FROM AUTHOR]

Background and Objective: The condition of vessel of the human eye is an important factor for the diagnosis of ophthalmological diseases. Vessel segmentation in fundus images is a challenging task due to complex vessel structure, the presence of similar structures such as microaneurysms and hemorrhages, micro-vessel with only one to several pixels wide, and requirements for finer results.Methods: In this paper, we present a multi-scale deeply supervised network with short connections (BTS-DSN) for vessel segmentation. We used short connections to transfer semantic information between side-output layers. Bottom-top short connections pass low level semantic information to high level for refining results in high-level side-outputs, and top-bottom short connection passes much structural information to low level for reducing noises in low-level side-outputs. In addition, we employ cross-training to show that our model is suitable for real world fundus images.Results: The proposed BTS-DSN has been verified on DRIVE, STARE and CHASE_DB1 datasets, and showed competitive performance over other state-of-the-art methods. Specially, with patch level input, the network achieved 0.7891/0.8212 sensitivity, 0.9804/0.9843 specificity, 0.9806/0.9859 AUC, and 0.8249/0.8421 F1-score on DRIVE and STARE, respectively. Moreover, our model behaves better than other methods in cross-training experiments.Conclusions: BTS-DSN achieves competitive performance in vessel segmentation task on three public datasets. It is suitable for vessel segmentation. The source code of our method is available at: https://github.com/guomugong/BTS-DSN. [ABSTRACT FROM AUTHOR]

This paper proposes a stochastic shortest path approach to find an optimal sequence of tests to confirm or discard a disease, for any prescribed optimality criterion. The idea is to select the best sequence in which to apply a series of available tests, with a view at reaching a diagnosis with minimum expenditure of resources. The proposed approach derives an optimal policy whereby the decision maker is provided with a test strategy for each a priori probability of disease, aiming to reach posterior probabilities that warrant either immediate treatment or a not-ill diagnosis. [ABSTRACT FROM AUTHOR]

Clustering white matter (WM) tracts from diffusion tensor imaging (DTI) is primarily important for quantitative analysis on pediatric brain development. A recently developed algorithm, density peaks (DP) clustering, demonstrates great robustness to the complex structural variations of WM tracts without any prior templates. Nevertheless, the calculation of densities, the core step of DP, is time consuming especially when the number of WM fibers is huge. In this paper, we propose a fast algorithm that accelerates the density computation about 50 times over the original one. We convert the global calculation for the density as well as critical parameter in the process into local computations, and develop a binary tree structure to orderly store the neighbors for these local computations. Hence, the density computation turns out to be a direct access of the structure, rendering significantly computational saving. Performing experiments on synthetic point data and the JHU-DTI data set and comparing results of our fast DP algorithm and existing clustering methods, we can validate the efficiency and effectiveness of our fast DP algorithm. Finally, we demonstrate the application of the proposed algorithm on the analysis of pediatric WM tract development. [ABSTRACT FROM AUTHOR]

This paper focuses on the comparative assessment of comfort and discomfort (hereafter, (dis-)comfort) for aircraft seating. Subjective and objective data of seating (dis-)comfort were collected during an experiment involving 20 volunteers who tested 3 aircraft double-seats in upright and reclined position. In order to minimize experimental uncertainty due to well-known noise factors (i.e. patterns of discomfort during the work week and during the work day, order of evaluation, inter-individual differences), experimental trials were performed according to a crossover design. Statistical data analysis aimed mainly at investigating (dis-)comfort differences across seat conditions; gender-based differences in perceived discomfort on different body parts; effect of sitting duration on perceived discomfort on different body parts. The experimental results show that differences across seat conditions impacted differently on perceived discomfort depending on gender, body parts and sitting duration. No significant differences in perceived discomfort across gender were evident for the lightweight seat in both upright and reclined positions. On the contrary, for both baseline configurations, perceived discomfort at head and neck areas was higher for males than for females. For all seat conditions, participants experienced a significant worsening of perceived comfort over time at shoulders, back, sacrum and thighs and, in addition, at upper body area (i.e. neck, arm and forearm) and knees only for seats in reclined position. [ABSTRACT FROM AUTHOR]

Background: Conflicting findings on the effects of garlic supplementation on inflammatory biomarkers have been observed in randomized clinical trials (RCTs).Objectives: The aim of this study was to summarize study results regarding the effects of garlic supplementation on serum inflammatory biomarkers in adults.Methods: We searched Scopus, PubMed, Google Scholar and Cochrane library databases for relevant papers published until April 2018, using keywords such as "garlic" and "inflammatory biomarker." We included RCTs that 1) were conducted in adults, 2) examined the effects of garlic supplementation on inflammatory biomarkers compared to a control group, and 3) reported sufficient data on inflammatory biomarkers. Results were reported as weighted mean differences (WMD) with 95% CI using random effects models. Cochrane's Q and I-squared (I2) tests were used to determine heterogeneity among studies. Funnel plots and Egger's regression test were used to assess publication bias.Results: Sixteen RCTs were included. Garlic doses ranged from 12 to 3600 mg/d, and intervention duration ranged from 2 to 52 wk. Garlic administration significantly reduced serum C-reactive protein (CRP) (n = 13) (WMD: -0.61 mg/L, 95% CI: -1.12, -0.11, P = 0.018, I2 = 76.9%), IL-6 (n = 5) (WMD: -0.73 ng/L, 95% CI: -1.06, -0.40, P < 0.001, I2 = 0%), and TNF (n = 7) (WMD: -0.26 ng/L, 95% CI: -0.41, -0.12, P < 0.001, I2 = 0.0%), compared to controls. However, the effect of garlic supplementation on serum adiponectin (n = 3) (WMD: 0.18 µg/L, 95% CI: -0.21, 0.57, P = 0.35, I2 = 60.7%) and leptin (n = 2) (WMD: -1.25 µg/L, 95% CI: -2.64, 0.14, P = 0.07, I2 = 0.0%) concentrations were not significant.Conclusion: In this meta-analysis of RCTs, we found that garlic supplementation reduced serum concentrations of CRP, TNF, IL-6, but did not affect serum adiponectin and leptin in adults. More RCTs are needed to test the effects of garlic supplementation on inflammation. [ABSTRACT FROM AUTHOR]

Background: The Weight-Specific Adolescent Instrument for Economic Evaluation (WAItE) is a new condition-specific patient reported outcome measure that incorporates the views of adolescents in assessing the impact of above healthy weight status on key aspects of their lives. Presently it is not possible to use the WAItE to calculate quality adjusted life years (QALYs) for cost-utility analysis (CUA), given that utility scores are not available for health states described by the WAItE.Objective: This paper examines different regression models for estimating Child Health Utility 9 Dimension (CHU-9D) utility scores from the WAItE for the purpose of calculating QALYs to inform CUA.Methods: The WAItE and CHU-9D were completed by a sample of 975 adolescents. Nine regression models were estimated: ordinary least squares, Tobit, censored least absolute deviations, two-part, generalized linear model, robust MM-estimator, beta-binomial, finite mixture models, and ordered logistic regression. The mean absolute error (MAE) and mean squared error (MSE) were used to assess the predictive ability of the models.Results: The robust MM-estimator with stepwise-selected WAItE item scores as explanatory variables had the best predictive accuracy.Conclusions: Condition-specific tools have been shown to be more sensitive to changes that are important to the population for which they have been developed for. The mapping algorithm developed in this study facilitates the estimation of health-state utilities necessary for undertaking CUA within clinical studies that have only collected the WAItE. [ABSTRACT FROM AUTHOR]

Background: This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD).Methods: This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded.Results: Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost.Conclusions: Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities. [ABSTRACT FROM AUTHOR]

Convolutional Neural Networks have been proposed as suitable frameworks to model biological vision. Some of these artificial networks showed representational properties that rival primate performances in object recognition. In this paper we explore how color is encoded in a trained artificial network. It is performed by estimating a color selectivity index for each neuron, which allows us to describe the neuron activity to a color input stimuli. The index allows us to classify whether they are color selective or not and if they are of a single or double color. We have determined that all five convolutional layers of the network have a large number of color selective neurons. Color opponency clearly emerges in the first layer, presenting 4 main axes (Black-White, Red-Cyan, Blue-Yellow and Magenta-Green), but this is reduced and rotated as we go deeper into the network. In layer 2 we find a denser hue sampling of color neurons and opponency is reduced almost to one new main axis, the Bluish-Orangish coinciding with the dataset bias. In layers 3, 4 and 5 color neurons are similar amongst themselves, presenting different type of neurons that detect specific colored objects (e.g., orangish faces), specific surrounds (e.g., blue sky) or specific colored or contrasted object-surround configurations (e.g. blue blob in a green surround). Overall, our work concludes that color and shape representation are successively entangled through all the layers of the studied network, revealing certain parallelisms with the reported evidences in primate brains that can provide useful insight into intermediate hierarchical spatio-chromatic representations. [ABSTRACT FROM AUTHOR]

Summary: Good cooperation between health care (HC) professionals, patient, and family is indispensable during homecare as mentioned in reports and analyses from different countries. In a French National project named coordination for the quality of care (COQUAS), we aimed to address the problem of improving such cooperation with current tools and techniques. We hypothesized that, as in some other domains, a better integration of use and users in informatics systems could improve the usefulness of the cooperative tool. The first part of this paper is devoted to the cognitive analysis of the homecare process and highlights the requirements which should be met according to this analysis. We describe some specific features of asynchronous cooperation and some communication issues in the cooperation of HC workers. We then detail the analysis of the homecare process: methodology, description of the processes, cognitive activity analyses, and of the requirements which flow from this analysis. The second part of this paper proposes a framework and then describes a modular system prototype, designed to take into account these requirements, including aspects of both cooperation and interoperability. It uses a meta-description of actions and information derived from a cognitive study to build dynamically the interface settings; it respects the current trend in distributed architecture and uses XML communication of messages, manages complex coordination with a workflow and allows mobile work. The last part of the paper presents the evaluation which has been done with the implemented prototype, with actual homecare users. [Copyright &y& Elsevier]

This paper discusses the potential of fuzzy logic methods within medical imaging. Technical advances have produced imaging techniques that can visualize structures and their functions in the living human body. The interpretation of these images plays a prominent role in diagnostic and therapeutic decisions, so physicians must deal with a variety of image processing methods and their applications. This paper describes three different sources of medical imagery that allow the visualization of nerve fibers in the human brain: (1) an algorithm for automatic segmentation of some parts of the thalamus in magnetic resonance images based on the differences in myelin content in various thalamic subnuclei; (2) polarized light for classifying the 3D orientation of the nerve fibers at each point; and (3) confocal laser scanning microscopy (CLSM) for calculating semiquantitative variables for myelin content. Fuzzy logic methods were applied to analyze these pictures from low- to high-level image processing. The solutions presented here are motivated by problems of routine neuroanatomic research demonstrating fuzzy-based methods to be valuable tools in medical image processing. [Copyright &y& Elsevier]

This paper examines the paper of Haux et al. in this issue of this journal. It gives some background on specifics of the German health care system, which underlie the theses and prognoses proposed by Haux et al. In analogy to a forecast of the future of health informatics, which is now 10 years old, I then suggest that these attempts meet two types of challenges:•that of overestimating the positive effects of recent advances, which later are found not to scale up; and•that of blind spots with respect to unforeseen significant advances.The attempt to find indications of such in the projections of Haux et al. leads, among other, to the conclusion that the projections of direct linkages between patients and care providers may be overoptimistic. As to wheather the deviating opinions matter in the end, it is concluded that the technology advances may require less attention that the restructuring of the health care system required to take advantage of the advances of technology. [Copyright &y& Elsevier]

During the last 10 years, the English Speaking Working Group (ESWG) of the International Society for Forensic Genetics (ISFG) has once a year arranged a Paternity Testing Workshop in which blood samples as well as a questionnaire concerning laboratory strategies were distributed to the participating laboratories. In 2000 and 2001, paper challenges were included in the workshops. Here, we present the results of the 2000 and 2001 Paternity Testing Workshops. The numbers of participating laboratories were 33 (2000) and 36 (2001). A total of 36% (2000) and 31% (2001) of the laboratories submitted typing results of variable number of tandem repeats (VNTRs) investigated with restriction fragment length polymorphism (RFLP) and single locus probes (SLPs). A total of 91% (2000) and 86% (2001) submitted typing results of polymerase chain reaction (PCR) based systems. Typing errors occurred in 0.3% of the submitted PCR-based results in 2000 and in 0.1% in 2001. The results of the paper challenges showed a high degree of variation in the formulas used for calculation of the weight of evidence of rare events such as inconsistencies or possible silent alleles. The majority of the laboratories used the same formulas for calculations of frequently occurring events. [Copyright &y& Elsevier]

Iron deficiency anemia (IDA) depresses human productivity, but policymakers do not generally view this effect as an impediment to sustained economic growth. Economic logic should be enfolded in public advocacy for increased investment in the prevention and control of IDA. This paper argues that integrated strategies are required, with each intervention clearly related to particular groups at risk, and benefits carefully calibrated with costs. Protecting women's lives through supplementation has the first call on public resources, but the most productive investments reduce population prevalence at least cost, and these lie with food-based approaches within the competence of the processed food and seed industries. The public and private sectors must embark on modernization of the food industry in developing countries and reorientation of the international agricultural research complex so that iron-enriched essential foods will be affordable and accessible to the poor, especially children. The costs of IDA, the availability of cost-effective strategies and the benefits of sustained iron nutrition improvement to individuals, families and nations are reviewed. The roles of iron supplementation, food fortification, plant breeding and biotechnology, both actual and imminent, are described. The paper concludes that a recast Green Revolution directed toward dietary quality may be the key to enhancing the learning and earning capacity of young people in the developing world. [ABSTRACT FROM AUTHOR]

We describe an improved method for the measurement of retinol in dried blood spots (DBS) on filter paper. Retinol in human DBS on filter paper was analyzed by normal phase HPLC after a simple extraction method. Retinol associated with its binding protein was eluted from the paper into aqueous solution facilitated by ultrasonic agitation. Retinol associated with retinol binding protein was denatured with acetonitrile, and then retinol was isolated in a single hexane extract and analyzed directly by HPLC. When analyzing DBS, the individual plasma volume of the spots was calculated by measuring the sodium content or by weighing the blood spots. The described method yielded low intra- and interassay variability (<6%), with sufficient sensitivity (detection limit, 0.1 micromol/L) and good recovery (97% spike). Compared with matching plasma samples, DBS retinol consistently decreased 18-23% during the 1st wk of storage. After 1 wk, retinol remained stable in the blood spots at 23 degrees C for >3 mo. In conclusion, the analysis of retinol in DBS by HPLC is comparable to retinol analysis in serum. The variability of the method was reduced by using sodium concentration to estimate sample volume. Collection of DBS for retinol analysis is appropriate under field conditions, where it is difficult to centrifuge or freeze blood samples. [ABSTRACT FROM AUTHOR]

Appropriate visual display terminal (VDT) location is a subject of ongoing debate. Generally, visual strain is associated with higher placement, and musculoskeletal strain is associated with lower placement. Seeking resolution of the debate, this paper provides a comparison of results from previous lab-based monitor placement studies to recommendations and outcomes from viewing preference and neutral posture studies. The paper then presents results from a field study that addressed two outstanding issues: Does monitor placement in a workplace elicit postures and discomfort responses similar to those seen in laboratory settings? Results showed placements in the workplace elicited postures similar to those in lab studies. Additionally, preferred VDT location generally corresponded to the location in which less neck discomfort was reported, though that trend requires further investigation. Overall, there seems to be consistent evidence to support mid-level or somewhat higher placement, as a rule-of-thumb, considering preferred gaze angle and musculoskeletal concerns. However, optimal placement may be lower for some individuals or tasks. [ABSTRACT FROM AUTHOR]