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Mangrove ecosystem valuation can be used as a reference for decision making for management and conservation of mangrove ecosystems in a sustainable manner. The range of activities and interests conducted in coastal areas is not expected to negatively impact the ecology, economic and social. Carat Cape mangrove areas provide enormous benefits to the surrounding community, especially Sungsang IV village. From the results of the study illustrate the provosioning ecosystem service utilized community Sungsang IV village consists of materials construction (timber and nypa leaves), a source of livelihood or subsistance (nypa fruit, fish, shrimp, crab, and scallops). The total value of provosioning ecosystem services mangrove Carat Cape utilized by the Sungsang IV village Rp. Rp. 1.715.590.000, - per year dominated by income generated by marine species of fish which is the main livelihood of the fishermen Sungsang IV village reached Rp. 1.302.600.000,- per year.

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.

Purpose: For many children, needle procedures are fearful events that are often painful. The first step in symptom management is to assess the child's pain and fear, and the next step is to use coping strategies to provide symptom relief for children who experience or feel pain and fear during procedures. The Children's Action–Reaction Assessment Tool (CARAT) is built on action–reaction strategies. This study aimed to determine the inter-rater reliability of the CARAT when used during needle procedures with 3- to 7-year-old children. Design and Methods: We used a quantitative approach in which 21 children were observed by two independent observers during needle procedures to evaluate the inter-rater reliability of the CARAT. Data were analysed with descriptive statistics, and the observation scores were calculated with an intraclass correlation coefficient (ICC) test on SPSS for Windows, version 25. Results: The completed CARAT indicated the use of action–reaction strategies. Neither action nor reaction strategies were frequently used. The parents were seldom involved in the procedure. The inter-rater reliability showed a sufficient correlation between the observers. Practice Implications: This study showed promising results for the inter-rater reliability of the CARAT, which can be used to facilitate care for children. The observational tool can be used to assess the use of action–reaction strategies in conjunction with needle procedures in children aged 3–7 years.

Funding: MA reports personal fees from POCI-01-0145-FEDER-029130 mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalization and evaluation of gamification, peer support and advanced image processing technologies from ERDF (European Regional Development Fund) funded by the COMPETE2020 and by National Funds through FCT (Fundação para a Ciência e a Tecnologia)… Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed. publishersversion published

Asthma and allergic rhinitis (AR) are frequently associated. The objective of the treatment of asthma and AR should be the control of symptoms and disease progression. Therefore, the combined measurement of disease control is desirable. In this regard, a questionnaire able to together assess asthma and AR control has been validated: the CARAT (Control of Allergic Rhinitis and Asthma Test). A further pediatric version (CARATkids) has been generated. The current real-world study used different disease control measures in children and adolescents with asthma and rhinitis. A total of 138 children and adolescents were recruited at three allergy centers. CARAT, CARATkids, ACT (Asthma Control Test), cACT (children ACT), GINA (Global Initiative for Asthma) disease control classification, VAS (Visual Analog Scale) for asthma and nasal symptoms, and lung function were used in all subjects. There was a predominance of males (67.4%) and asthma was well-controlled (according to GINA classification) in about half the subjects. In children, the median CARAT and cACT values were 5 and 22 respectively. In adolescents, the median CARAT and ACT values were 23 for both tests. There were significant differences between CARAT and ACT (p = 0.035) as well as between CARATkids and cACT (p = 0.0001). However, the tests’ outcomes were different as assessed in different domains. CARAT and CARATkids are disease-control measurements that give additional information to other tests, therefore, these different questionnaires to measure disease control complement each other.

International audience; Background: Nasal irrigations (NI) are increasingly used as an over-the-counter adjunctive treatment for allergic rhinitis (AR), but clinical studies on their effectiveness are limited.Methods: An open-label, controlled, non-randomized, real-life study was conducted to evaluate the effectiveness of NI with a new hypertonic solution as add-on treatment for AR. Children and adolescents with AR were prescribed symptomatic treatment. The active group also received an additional sea-water NI solution supplemented with algae extracts. The primary endpoint was symptom control, assessed by the control of allergic rhinitis and asthma test (CARAT) questionnaires. Moreover, the MASK/Allergy Diary was used to track symptoms and daily medication use that were combined in a novel total symptom/medication score (TSMS).Results: We assessed 76 patients. Overall, there was a significant improvement of CARAT results (median Z-score change of 1.1 in the active/NI group vs. 0.4 in the control group; p = 0.035). Among patients > 12 years old (n = 51), there was a significant improvement in CARAT10 results among participants receiving NI (21.0 to 25.5; p < 0.001), but not in the regular treatment group (21.5 to 24.0; p = 0.100). For children < 12 years old (n = 25), the ΝΙ group had significantly improved symptom control (CARATKids results: 5.0 to 2.0; p = 0.002), in contrast to the control group (4.0 to 2.5; p = 0.057). MASK data on allergic symptoms were comparable between groups. However, the NI group had lower TSMS, more days with < 20% symptoms and fewer days using symptomatic treatment (26.9% vs. 43.5%; p = 0.005).Conclusion: Addition of NI with a sea-water solution to regular treatment improved AR symptom control. CARAT questionnaires and MASK application can be useful outcome tools in real-life studies.

La Grutta, Stefania/0000-0001-8026-0715; Briedis, Vitalis/0000-0002-5106-6638; Yusuf, M Osman/0000-0002-8067-1204; Regateiro, Frederico S/0000-0002-6332-3056; Regateiro, Frederico/0000-0002-6332-3056; Martins, Pedro/0000-0002-4129-133X; de Sousa, Jaime Correia/0000-0001-6459-7908; Cardona, Victoria/0000-0003-2197-9767; Niedoszytko, Marek/0000-0003-1089-1911; Panzner, Petr/0000-0002-1291-450X; van der Kleij, Rianne/0000-0002-8638-4978; Chu, Derek/0000-0001-8269-4496; Pugin, Benoit/0000-0001-7132-9477; O'Hehir, Robyn/0000-0002-3489-7595; Briggs, Andrew/0000-0002-0777-1997; Bedard, Annabelle/0000-0002-7842-8889; Psarros, Fotis/0000-0002-2928-150X; Zuberbier, Torsten/0000-0002-1466-8875 WOS:000581175300001 PubMed ID: 32512619 Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed. EUEuropean Union (EU); Region Occitanie (France); Mylan; GSKGlaxoSmithKline; Meda; NovartisNovartis; Sanofi; Stallergenes; Uriach; ALK MASK funding was obtained from EU grants (SPAL, POLLAR, Sunfrail, Rhinitis and Asthma TWINNING, DHE TWINNING on severe asthma), the Region Occitanie (France), unrestricted educational grants (Meda, Mylan, ALK, GSK, Novartis, Sanofi, Stallergenes and Uriach) and private donations. Euforea provided assistance for the ARIA website and the physician's questionnaire.

CARAT is a toolbox for computer-aided rhythm analysis from audio recordings that includes a set of ready-to-use tools in order to ease the adoption of computational tools by musicologists, while at the same time making readily available to MIR researchers some recently developed techniques for rhythm analysis, along with musical examples of their applicability. Pieces from three different corpora of music from the Afro-Atlantic tradition were taken as case studies for rhythmic pattern analysis.

Background: There are few studies regarding severe chronic upper-airway disease (SCUAD) that represents an important socioeconomic problem for the treatment of rhinitis and associated comorbidities, particularly asthma. Objectives: The aim of our study is to evaluate the prevalence of this pathology in patients with allergic rhinitis (AR) in real life, to phenotype allergic patients with SCUAD, and to identify which factors are related to the severity of the disease. Methods: We studied 113 patients with uncontrolled AR despite optimal adherence to therapy according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in a multicenter Italian study, analyzing comorbidity, use of additional drugs, not scheduled visits, and the number of emergency room admissions. Results: Our data suggest that polysensitization is the only statistically significant factor correlating with SCUAD. Asthma does not seem to represent a correlating factor. An important finding is the poor use (20%) of allergy immunotherapy (AIT), although patients were suffering from AR and the ARIA guidelines recommend the use of AIT in moderate/severe AR. Conclusions: The SCUAD population seems not to have a specific phenotype; there is a greater presence of SCUAD in polysensibilized patients, perhaps a sign of greater inflammation.

Background: Asthma and Allergic Rhinitis (AR) are two chronic inflammatory diseases that are often concomitant. The Control of Allergic Rhinitis and Asthma Test (CARAT) was developed to evaluate the control of these diseases from the patients' perspective. Its performance in asthma patients without AR has not been previously studied. Aim: To test the hypothesis that CARAT can be used to assess asthma control in patients with asthma and without AR. Methods: A cross-sectional study was conducted in 3 primary healthcare centres in Northern Portugal. Adult patients identified in the Electronic Patient Record with a diagnosis of asthma were invited to participate. CARAT was used to assess asthma control and Asthma Control Test (ACT) as a comparator. The associations between asthma patients without AR (AsAR) and with AR (AwAR) were analyzed with Spearman correlation. Additionally, Receiver Operating Characteristic (ROC) curve analysis, summarized by Area Under the Curve (AUC), was used to assess performance of CARAT for screening asthma that was not well-controlled. Results: A total of 103 asthma patients completed the study, 64 (62%) had AwAR and in 87 (85%) asthma was not well-controlled. We observed a strong correlation between CARAT and ACT scores (r = 0.734) in all asthma patients and in both groups: AsAR (r = 0.737) and AwAR (r = 0.843). ROC curve demonstrated CARAT as having a good discriminative power for both AsAR and AwAR groups (AUC = 0.894 and 0.946, respectively). Conclusion: These initial results suggest that CARAT has a good discriminative performance, similar to other asthma control assessment tools, for asthma patients with and without AR. © 2015 Sociedade Portuguesa de Pneumologia., The study required no additional external funding. The statistical analysis was conducted with the support of the CARAT Project CINTESIS belonging to the Faculty of Medicine, University of Porto., info:eu-repo/semantics/publishedVersion

Background Allergic Rhinitis (AR) is a high-prevalence disease. In Europe about 25% of the general population is affected, and in Italy the prevalence is estimated to be 19.8%. The Allergic Rhinitis and its Impact on Asthma (ARIA) international document underlined that the prevalence of severe or refractory or overlapping rhinitis is increasing and represents a non-negligible socio-economic burden. In general, despite the social healthcare costs, allergic rhinitis remains underestimated, not sufficiently controlled and often undertreated. Aim of the study In this multi-center Italian observational and prospective study we assessed the control of AR in patients (> 16 years) without previous asthma diagnosis, referred to Allergy Centers. Methods Patients of both sexes and older than 16 with rhinitis symptoms and without asthma were studied. A Visual Analogue Scale (VAS) and the CARAT (Control of Allergic Rhinitis and Asthma Test) were used as patient reported outcome. The possible causes of poor control of AR, as per protocol, were assessed accordingly. Results We observed 250 patients in a real-life setting: more than 60% of them had an uncontrolled AR, only about 50% used multiple medications, and only a minority were receiving allergen immunotherapy. Conclusion This survey, conducted in a real-life setting, confirmed that AR is overall poorly controlled. The VAS assessment well correlates with the structured CARAT questionnaire and with the relevant symptoms of AR.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project), The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults., Unrestricted educational grant from Meda (Bad Homburg, Germany). Structural Development Funds from the European Union (Région Languedoc Roussillon). The App belongs to the Région Occitanie (formerly Languedoc - Roussillon, Midi-Pyrénées,France). MASK is a project of the B3 Action Plan of the European Innovation Partnership on Active and Healthy Ageing - EIP on AHA (European Commission DG Santé and DG CONNECT) and of the “Twinning” (Transfer of Innovation, 2016 Pilot Twinning Support Scheme of the EIP on AHA) of the App in 22 EIP on AHA Reference Sites., info:eu-repo/semantics/publishedVersion

Rationale: prevalence of pollen-related allergic respiratory diseases has increased in past decades in Europe. Aim: to evaluate the clinical impact of pollen allergy in an European general population sample. Methods: in 2016, 643 subjects suffering from pollen allergy were enrolled in Italy (Pisa, PI), France (Paris, PA), Austria (Vienna, VI). Each subject filled in the Health, CARAT (modified) and Rhinasthma questionnaires about health status, disease control and quality of life (QoL) associated with allergic diseases in the previous 12 months. Statistical analyses included chi-square test and analysis of variance. Results: the highest reported allergies were those to Betulaceae (73%) in VI, Graminaceae (61%) in PI and Platanaceae (28%) in PA. Allergic rhinitis was higher in VI (95%), allergic conjunctivitis and asthma in PA (69 and 54%, respectively) than in the other countries. Respiratory symptoms were significantly higher in PA (97%) than in VI (73%) and PI (65%); oculo-rhinitic symptoms were higher in VI (96%) than in PA (91%) and PI (80%); nasal symptoms did not differ among the countries. Health services and anti-allergic medicines were significantly more used in VI (67 and 94%) than in PI (26 and 78%) and PA (39 and 47%). VI and PA showed worse QoL and diseases control than PI according to Rhinasthma and CARAT scores. Overall, only 27.2% had a good/optimal QoL, 25.3% reported daily limitations at work, school or in other activities and 12.6% had a controlled allergic rhinitis and asthma. Conclusions: there is a relevant clinical impact of pollen allergy in 3 European countries which should prompt measures to reduce such environmental exposure. Supported by EU LIFE program, project no. LIFE13 ENV/IT/001107.

Introduction: We aimed (1) to measure asthma control using a structure-questionnaire and patient self-perception of asthma-control in the Portuguese National Asthma Survey (INAsma) and (2) to study the relationship between asthma control and asthma-related quality of life. Methods: We analyze data of asthma patients from a cross-sectional, nationwide telephone interview study â INAsma. Controlled asthma was defined as CARAT global score >24 or CARAT lower airways score â¥16. Mini-AQLQ was used to measure quality of life. Results: Two hundred and seven (56.9% [95%CI: 51.8â62.0]) of the 364 patients had controlled asthma. Most patients with non-controlled asthma (88%) perceived their disease as controlled. Patients with controlled asthma presented higher mini-AQLQ scores (median, P25âP75; 6.6, 6.0â6.9) than those with non-controlled asthma (4.9, 3.7â5.7) (pÂ

In genome-wide association studies (GWAS), regression analysis has been most commonly used to establish an association between a phenotype and genetic variants, such as single nucleotide polymorphism (SNP). However, most applications of regression analysis have been restricted to the investigation of single marker because of the large computational burden. Thus, there have been limited applications of regression analysis to multiple SNPs, including gene–gene interaction (GGI) in large-scale GWAS data. In order to overcome this limitation, we propose CARAT-GxG, a GPU computing system-oriented toolkit, for performing regression analysis with GGI using CUDA (compute unified device architecture). Compared to other methods, CARAT-GxG achieved almost 700-fold execution speed and delivered highly reliable results through our GPU-specific optimization techniques. In addition, it was possible to achieve almost-linear speed acceleration with the application of a GPU computing system, which is implemented by the TORQUE Resource Manager. We expect that CARAT-GxG will enable large-scale regression analysis with GGI for GWAS data.

Contains fulltext : 177252.pdf (Publisher’s version ) (Open Access) Background Community pharmacists play an important role in supporting patients for optimal drug use. Objective To assess the effectiveness of monitoring in asthma patients with inhaled corticosteroids (ICS) on disease control. Setting Asthma patients using ICS were invited from two intervention (IG) and two control pharmacies (CG). Method Participating patients completed questionnaires at the study start and at 6-month follow-up, including the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaire. IG patients completed the CARAT questionnaire every 2 weeks and received counselling on disease management, ICS adherence, and inhalation technique when scores were suboptimal, deteriorating, or absent. For Turbuhaler users, additional electronic monitoring (EMI) was available, with daily alerts for ICS intake. Main outcome measure As the primary outcome, CARAT scores at follow-up were compared between IG and CG using linear regression. As secondary outcome, refill adherence was compared using logistic regression. Results From March to July 2015, we enrolled 39 IG and 41 CG patients. At follow-up, CARAT scores did not differ between IG and CG (-0.19; 95% confidence interval [CI], -2.57 to 2.20), neither did patient numbers with ICS adherence >80% (0.82; 95% CI, 0.28-2.37). Among EMI users, CARAT scores did not differ, but ICS adherence >80% showed a 4.52-fold increase (95% CI, 1.56-13.1) compared with EMI nonusers. Conclusion Among community-dwelling asthma patients, pharmacist monitoring did not affect CARAT scores, but EMI use showed improved ICS refill adherence.

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives while ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study is to transfer innovation from an App developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will: (i) assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) study phenotypic characteristics and treatment over a period of one year of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults. This article is protected by copyright. All rights reserved.

Background: High-density lipoprotein (HDL) is believed to have atheroprotective properties, but an effective HDL-based therapy remains elusive. Early studies have suggested that infusion of reconstituted HDL promotes reverse cholesterol transport and vascular reactivity. The CER-001 Atherosclerosis Regression Acute Coronary Syndrome Trial (CARAT) is investigating the impact of infusing an engineered pre-beta HDL mimetic containing sphingomyelin (SM) and dipalmitoyl phosphatidlyglycerol (CER-001) on coronary atheroma volume in patients with a recent acute coronary syndrome (ACS). Methods: The CARAT is a phase 2, multicenter trial in which 292 patients with an ACS undergoing intracoronary ultrasonography and showing percent atheroma volume (PAV) greater than 30% are randomly assigned to treatment with ten infusions of CER-001 3 mg/kg or matching placebo, administered at weekly intervals. Intracoronary ultrasonography is repeated at the end of the treatment period. Results: The primary endpoint is the nominal change in PAV. Safety and tolerability will also be evaluated. Conclusions: CARAT will establish whether serial 3 mg/kg infusions of an engineered pre-beta HDL mimetic containing SM and dipalmitoyl phosphatidlyglycerol (CER-001) will regress atherosclerotic plaque in patients with a recent ACS.

Control of allergic rhinitis and asthma test (CARAT) was designed and validated to measure control of both asthma and allergic rhinitis (AR). The CARAT meets all COSMIN criteria for patient reported outcomes. Cutpoint analysis for (un)control are preliminary.The aim is to identify cutpoints of CARAT to differentiate between controlled and uncontrolled asthma and AR using gold standards.As part of a yearly asthma assessment, patients completed the CARAT together with the Asthma Control Questionnaire (ACQ), Visual Analog Scale (VAS), Global Initiative for Asthma (GINA) assessment and the Allergic Rhinitis And Its Impact On Asthma (ARIA) assessment. Potential cutpoints were related to existing gold standard cutpoints: ACQ and GINA for the CARAT asthma scale, VAS-upper airways and ARIA for the CARAT AR scale. Decisions were based on Area Under the Curve (AUC), sensitivity (SS), specificity (SP), percentage correctly classified patients (PCCP), positive and negative predicted value (PPV and NPV).Data from 382 asthma patients (37% men, mean 55 yrs) suggests potential cutpoints of 14.5 or 15.5 for CARAT asthma scale (based on ACQ (SS82%, SP79%, AUC.88, PCCP81%, PPV.87, NPV.72) and GINA (SS78%, SP61%, AUC.74, PCCP64%, PPV.33, NPV.92)) and 6.5 or 8.5 for CARAT AR scale (based on VAS (SS65%, SP93%, AUC.84, PCCP69%, PPV.98, NPV.33)) and ARIA (SS70%, SP69%, AUC.75, PCCP70%, PPV.79 NPV.58)).We found a suggested cutpoint of 14.5 or 15.5 for the CARAT asthma scale and 6.5 or 8.5 for the CARAT AR scale. This corresponds largely with the preliminary cutpoints of 16 and 8. Further analysis will investigate a single cutpoint per subscale and a cutpoint for the whole CARAT.

The Control of allergic rhinitis and asthma test (CARAT) has been designed to assess control of both asthma and allergic rhinitis (AR), covering a 4 week period, using paper-and-pencil (4wCARAT). It met al COSMIN criteria for patient reported outcomes. The aim is validation of the 1-week digital version and paper version (1wCARATapp and 1wCARAT. Asthma patients completed the 1wCARAT and 1wCARATapp each week for 1 month. At baseline the Asthma Control Questionnaire (ACQ), Visual Analog Scale (VAS), Global Initiative for Asthma (GINA) and the Allergic Rhinitis And Its Impact On Asthma (ARIA) were completed . At final visit the 4wCARAT was completed. Internal consistency was analysed with Cronbach's alfa, test-retest reliability with Spearman's correlation, relation between 4wCARAT and 1wCARAT and 1wCARAT and 1wCARATapp via Wilcoxon-Signed-Rank. The construct validity (using VAS general complaints for CARAT total score; ACQ and GINA for CARAT asthma subscale; VAS nasal complaints and ARIA for CARAT AR subscale) was calculated with Spearman correlation and Students T-test. Data from 109 asthma patients (39% men, mean 53 yrs) showed no significant differences between 1wCARAT and 4wCARAT. 1wCARAT featured Cronbach's alpha >.79 for all (sub)scales. Correlations between 1wCARAT and ACQ/VAS/GINA were significant (p>.001; .57≥r≤.71), as was the difference in CARAT AR score between ARIA mild vs medium/severe AR (p=0.01). Test-retest reliability between measuring moments was significant (p

Purpose: The antibiotic restriction policy has been validated nationwide since February 2003 by the Ministry of Health because the excessive consumption of antimicrobials causes a high cost. The aim of this study was to evaluate the therapeutic use of antibiotics in Aegean Region hospitals and to assess the impact of this nationwide antibiotic restriction policy. This new policy is based on justification that the infectious disease (ID) physicians should be primarily responsible for the prescription of antimicrobials. Materials and Methods: Eight university and government hospitals were included in the study. The criteria of the Council for Appropriate and Rational Antibiotic Therapy (CARAT) were considered. Both patient-based and antibiotic-based analyses were performed. For the analysis of inappropriate use, logistic regression was modeled. Results: Therapeutic use was determined in 540 patients by a total of 29 ID physicians.In the study, 30.2% of the patients were given antimicrobials and empirically started antibiotics accounted for 79% cases of therapeutic antibiotic use, and 60% of those were inappropriate (P = 0.001). The appropriate use of ID level antibiotics (P = 0.000) were very compatible with other antimicrobial groups. Conclusion: The study shows that the Turkish government's new intervention policy on antimicrobial prescribing has been effective.

Objectives: The aims of this study were to determine the usage patterns and the cost of antibiotics, along with the evaluation of the effects of infectious diseases (ID) specialists on appropriate antimicrobial use in hospitalized patients. Materials and methods: A one-day, cross-sectional study was conducted in a major tertiary hospital and data on the use of antibiotics were collected by using a standard form. The appropriateness of the antibiotic usage was evaluated using the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria; and the consumption and daily cost of antibiotics were determined. Results: On the study day, antibiotics were prescribed in 199 (35.6%) of 553 hospitalized patients, in 109 (32.9%) on the surgical and 90 patients (40.5%) on the medical wards. The total empirical antibiotic use was more frequent (49.7%) than prophylactic (29.1%) and culture-based therapy (21.2%). In 44 patients (22.1%) the antibiotics were used inappropriately; any of these antibiotics needed the approval of ID specialist. The inappropriate usage was more common in prophylactic therapy (46.5%) than empirical (16.1%) and specific antibiotic administration (2.3%). ID consultation rates were significantly higher in the appropriate antibiotic administrations (69.6%) than in the inappropriate group [(6.8%, p

Electronic data capture of case report forms (CRFs), demographic, neuropsychiatric, or clinical assessments, can vary from scanning hand-written forms into databases to fully electronic systems. Web-based forms can be extremely useful for self-assessment; however, in the case of neuropsychiatric assessments, self-assessment is often not an option. The clinician often must be the person either summarizing or making their best judgment about the subject’s response in order to complete an assessment, and having the clinician turn away to type into a web browser may be disruptive to the flow of the interview. The Mind Research Network (MRN) has developed a prototype for a software tool for the real-time acquisition and validation of clinical assessments in remote environments. We have developed the Clinical Assessment and Remote Administration Tablet (CARAT) on a Microsoft Windows PC tablet system, which has been adapted to interact with various data models already in use in several large-scale databases of neuroimaging studies in clinical populations. The tablet has been used successfully to collect and administer clinical assessments in several large-scale studies, so that the correct clinical measures are integrated with the correct imaging and other data. It has proven to be incredibly valuable in confirming that data collection across multiple research groups is performed similarly, quickly, and with accountability for incomplete datasets. We present the overall architecture and an evaluation of its use.

The present study is based on the experimental reconstruction of samples of different carat gold foil, obtained by hand hammering, and subsequently subjected to different physical-chemical treatments with the aim of reproducing ancient patinas. The treated samples were then analysed by SEM-EDS in order to provide a valid comparison with the ancient goldsmiths’ techniques. Ce travail se base sur la recréation expérimentale d’échantillons de feuilles d’or réalisées par martelage à la main et dont la composition en carats est variée. Ces feuilles sont ensuite soumises à divers traitements physico-chimiques pour reproduire des patines anciennes. Les échantillons subissant ces traitements ont été analysés par MEB-EDS de façon à obtenir une comparaison valide avec les techniques orfèvres anciennes.

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.

Recent research has noted the resistance of humanities and social sciences experts to computer-assisted reading and analysis of texts (CARAT). One reason offered to explain this attitude is the lack of understanding of this type of technology. As a compute- related technology, its explanation requires the distinction of three different levels or layers: the cognitive, the functional and the physical. Such a distinction allows better design and use of the technology for expert reading and analysis of text

Solid frameworks and toolkits for design and analysis of embedded systems are of high importance, since they enable early reasoning about critical properties of a system. This paper presents a software toolkit that supports the design and performance analysis of real-time component-based software architectures deployed on heterogeneous multiprocessor platforms. The tooling environment contains a set of integrated tools for (a) component storage and retrieval, (b) graphics-based design of software and hardware architectures, (c) performance analysis of the designed architectures and, (d) automated code generation. The cornerstone of the toolkit is a performance analysis framework that automates composition of the individual component models into a system executable model, allows simulation of the system model and gives design-time predictions of key performance properties like response time, data throughput, and usage of hardware resources. The efficiency of this toolkit was illustrated on a car radio navigation benchmark system.

We present the results of our computations concerning the space groups of dimension 5 and 6. We find 222 018 and 28 927 922 isomorphism types of these groups, respectively. Some overall statistics on the number of $\funnyQ$-classes and $\funnyZ$-classes in dimensions up to six are provided. The computations were done with the package CARAT, which can parametrize, construct and identify all crystallographic groups up to dimension 6.

The development is traced of a press and sinter, powder metallurgical process for the production of carat gold wedding rings. The paper includes experimental data on powder production, powder pressing and sintering as well as details of the production process now fully adopted for the mass production of rings. Properties of the new rings compare favourably with those produced by traditional methods as well as offering significant cost savings.