Educational intervention improves anticoagulation control in atrial fibrillation patients:the TREAT randomised trial

Background: Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its’ treatment may contribute to patient’s willingness to adhere to recommendations. Method: A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an ‘expert-patient’ focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. Main findings: Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. Conclusions: A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment.

Myopia control with orthokeratology contact lenses in Spain:a comparison of vision-related quality-of-life measures between orthokeratology contact lenses and single-vision spectacles

Purpose: To compare vision-related quality-of-life measures between children wearing orthokeratology (OK) contact lenses and distance single-vision (SV) spectacles. Methods: Subjects 6 to 12 years of age and with myopia of -0.75 to -4.00 diopters and astigmatism less than or equal to 1.00 diopters were prospectively assigned OK contact lens or SV spectacle correction. A pediatric refractive error profile questionnaire was administered at 12- and 24-month intervals to evaluate children's perceptions in terms of overall vision, near vision, far distance vision, symptoms, appearance, satisfaction, activities, academic performance, handling, and peer perceptions. The mean score of all items was calculated as the overall score. Additionally, parents/guardians were asked to rate their child's mode of visual correction and their intention to continue treatment after study completion. Results: Thirty-one children were fitted with OK contact lenses and 30 with SV spectacles. Children wearing OK contact lenses rated overall vision, far distance vision, symptoms, appearance, satisfaction, activities, academic performance, handling, peer perceptions, and the overall score significantly better than children wearing SV spectacles (all P<0.05). Near vision and handling were, respectively, rated better (P<0.001) and similar (P=0.44) for SV spectacles in comparison to OK contact lenses. No significant differences were found between 12 and 24 months for any of the subjective ratings assessed (all P>0.05). Parents/guardians of children wearing OK contact lenses rated visual correction method and intention to continue treatment higher than parents of children wearing SV spectacles (P=0.01). Conclusion: The results indicate that the significant improvement in vision-related quality of life and acceptability with OK contact lenses is an incentive to engage in its use for the control of myopia in children.

A probabilistic indirect adaptive control for systems with input-dependent noise

A probabilistic indirect adaptive controller is proposed for the general nonlinear multivariate class of discrete time system. The proposed probabilistic framework incorporates input–dependent noise prediction parameters in the derivation of the optimal control law. Moreover, because noise can be nonstationary in practice, the proposed adaptive control algorithm provides an elegant method for estimating and tracking the noise. For illustration purposes, the developed method is applied to the affine class of nonlinear multivariate discrete time systems and the desired result is obtained: the optimal control law is determined by solving a cubic equation and the distribution of the tracking error is shown to be Gaussian with zero mean. The efficiency of the proposed scheme is demonstrated numerically through the simulation of an affine nonlinear system.

A comparison of denoising methods for X-ray fluoroscopic images

Fluoroscopic images exhibit severe signal-dependent quantum noise, due to the reduced X-ray dose involved in image formation, that is generally modelled as Poisson-distributed. However, image gray-level transformations, commonly applied by fluoroscopic device to enhance contrast, modify the noise statistics and the relationship between image noise variance and expected pixel intensity. Image denoising is essential to improve quality of fluoroscopic images and their clinical information content. Simple average filters are commonly employed in real-time processing, but they tend to blur edges and details. An extensive comparison of advanced denoising algorithms specifically designed for both signal-dependent noise (AAS, BM3Dc, HHM, TLS) and independent additive noise (AV, BM3D, K-SVD) was presented. Simulated test images degraded by various levels of Poisson quantum noise and real clinical fluoroscopic images were considered. Typical gray-level transformations (e.g. white compression) were also applied in order to evaluate their effect on the denoising algorithms. Performances of the algorithms were evaluated in terms of peak-signal-to-noise ratio (PSNR), signal-to-noise ratio (SNR), mean square error (MSE), structural similarity index (SSIM) and computational time. On average, the filters designed for signal-dependent noise provided better image restorations than those assuming additive white Gaussian noise (AWGN). Collaborative denoising strategy was found to be the most effective in denoising of both simulated and real data, also in the presence of image gray-level transformations. White compression, by inherently reducing the greater noise variance of brighter pixels, appeared to support denoising algorithms in performing more effectively. © 2012 Elsevier Ltd. All rights reserved.

The effect of the use of computer assisted instruction (CAI) on attitudes and computational scores of developmental mathematics students at two inner city schools with predominantly Black enrollment

This study examined the effects of computer assisted instruction (CAI) 1 hour per week for 18 weeks on changes in computational scores and attitudes of developmental mathematics students at schools with predominantly Black enrollment. Comparisons were made between students using CAI with differing software--PLATO, CSR or both together--and students using traditional instruction (TI) only.^ This study was conducted in the Dade County Public School System from February through June 1991, at two senior high schools. The dependent variables, the State Student Assessment Test (SSAT), and the School Subjects Attitude Scales (SSAS), measured students' computational scores and attitudes toward mathematics in 3 categories: interest, usefulness, and difficulty, respectively.^ Univariate analyses of variance were performed on the least squares mean differences from pretest to posttest for testing main effects and interactions. A t-test measured significant main effects and interactions. Results were interpreted at the.01 level of significance.^ Null hypotheses 1, 2, and 3 compared versions of CAI with the control group, for changes in mathematical computation scores measured with the SSAT. It could not be concluded that changes in standardized mathematics test scores of students using CAI with differing software 1 hour per week for 18 class hours combined with TI were significantly higher than changes in test scores for students receiving TI only.^ Null hypotheses 4, 5, and 6 tested the effects of CAI for attitudes toward mathematics for experimental groups against control groups measured with the SSAS. Changes in attitudes toward mathematics of students using CAI with differing software 1 hour per week for 18 class hours combined with TI were not significantly higher than attitude changes for students receiving TI only.^ Teacher effect on students' computational scores was a more influential variable than CAI. No interaction was found between gender and learning method on standardized mathematics test scores (null hypothesis 7). ^

Vegetation:environment relationships and water management in Shark Slough, Everglades National Park

The hydrologic regime of Shark Slough, the most extensive long hydroperiod marsh in Everglades National Park, is largely controlled by the location, volume, and timing of water delivered to it through several control structures from Water Conservation Areas north of the Park. Where natural or anthropogenic barriers to water flow are present, water management practices in this highly regulated system may result in an uneven distribution of water in the marsh, which may impact regional vegetation patterns. In this paper, we use data from 569 sampling locations along five cross-Slough transects to examine regional vegetation distribution, and to test and describe the association of marsh vegetation with several hydrologic and edaphic parameters. Analysis of vegetation:environment relationships yielded estimates of both mean and variance in soil depth, as well as annual hydroperiod, mean water depth, and 30-day maximum water depth within each cover type during the 1990’s. We found that rank abundances of the three major marsh cover types (Tall Sawgrass, Sparse Sawgrass, and Spikerush Marsh) were identical in all portions of Shark Slough, but regional trends in the relative abundance of individual communities were present. Analysis also indicated clear and consistent differences in the hydrologic regime of three marsh cover types, with hydroperiod and water depths increasing in the order Tall Sawgrass , Sparse Sawgrass , Spikerush Marsh. In contrast, soil depth decreased in the same order. Locally, these differences were quite subtle; within a management unit of Shark Slough, mean annual values for the two water depth parameters varied less than 15 cm among types, and hydroperiods varied by 65 days or less. More significantly, regional variation in hydrology equaled or exceeded the variation attributable to cover type within a small area. For instance, estimated hydroperiods for Tall Sawgrass in Northern Shark Slough were longer than for Spikerush Marsh in any of the other regions. Although some of this regional variation may reflect a natural gradient within the Slough, a large proportion is the result of compartmentalization due to current water management practices within the marsh.We conclude that hydroperiod or water depth are the most important influences on vegetation within management units, and attribute larger scale differences in vegetation pattern to the interactions among soil development, hydrology and fire regime in this pivotal portion of Everglades.

Quality Performance In our World: What Fast Service Should Really Mean

The service-producing industries have experienced problems in quality in the 1980s because of intense competition. The author discusses how these problems have been compounded in the fast food industry and how quality control can lead to success.

The effects of content-based ESOL instruction on the overall English proficiency of foreign -born college students

This study investigates the effects of content-based ESOL instruction on the overall English proficiency of foreign-born college students. Based on various psychological and social factors which affect second language acquisition, it is suggested that the techniques of content-based instruction, while focusing on subject matter, allow the learners to overcome the language barrier by neutralizing their subconscious defense mechanism, thus attaining greater proficiency.^ Two groups of Miami-Dade Community College ESOL students were chosen as subjects for this study: a control group composed of students from the North and Wolfson campuses, where the ESOL program is based predominantly on structural or structural-functional approach, and an experimental group of Medical Center campus students, where content-based instruction is incorporated into curriculum. Ethnicity, gender, age, and other differences in the population are discussed in the study.^ The students' English Placement Test (EPT) scores were used as covariate, and the scores on Multiple Assessment Programs and Services (MAPS) test as dependent variables. Multivariate analysis of variance (MANOVA) was applied to test significant difference between the means. The results of the analysis of data indicate that there is a consistent difference in the mean performance of the Medical Center campus ESOL students demonstrated by their scores on MAPS. Although neither ethnicity, nor gender of the subjects has affected the outcome, age had a contributing effect. The implications of these findings suggest that content-based instruction facilitates greater overall English proficiency in foreign-born college students. ^

The effects of trained teachers' integration of dialogic reading discourse on Hispanic English Language Learners' literacy skills in kindergarten

This quasi-experimental Analysis of Covariance (ANCOVA) study explored whether the vocabulary and reading comprehension mean scores of Hispanic Kindergarten ELs whose teachers were trained to utilize Dialogic Reading (DR) discourse were higher than the mean scores of Hispanic ELs in kindergarten whose teachers were not trained to utilize DR discourse strategies. Sixty-three self-identified Hispanic, English Language Kindergarten students and four teachers participated in the study. The teachers were randomly assigned to either the experimental group (DR trained) or control group by drawing names from a hat. Student assignment to experimental versus comparison group was based on the teacher's assignment to either the experimental or comparison group. Thirty-one were assigned to the control group and 32 to the experimental group. The teachers were instructed to read the story to a group of six students (maximum) at a time, utilizing the DR discourse strategies they had been trained to implement. Subjects were read a story each week during the 8-week duration of the study. Teachers in the experimental group collaboratively selected 10 words each week from the Read Together Talk Together (RTTT) instructional stories that were utilized for vocabulary instruction. A test of homogeneity was conducted to evaluate whether the variance among the dependent variables was the same across the groups. An Analyses of Covariance (ANCOVA) was applied to analyze students' vocabulary and comprehension mean scores in the experimental group and the comparison group. The results of the study demonstrated a significant increase in the vocabulary and reading comprehension mean scores for the students whose teachers had been trained in DR discourse strategies. When comparing the two groups, the results revealed a statistically significant difference (p < 0.05). In conclusion, this study was conducted to explore how DR discourse may be an effective technique to teach literacy skills. The findings of this study showed that vocabulary knowledge and reading comprehension of Hispanic ELs were positively affected by the teachers' inclusion of dialogue during storybook reading. Its outcomes accentuated the need for teachers to provide assistance to ELs as they develop vocabulary knowledge and reading comprehension skills.

Self-tuning algorithm for dsp-based motion control in cnc applications

This thesis describes the development of an adaptive control algorithm for Computerized Numerical Control (CNC) machines implemented in a multi-axis motion control board based on the TMS320C31 DSP chip. The adaptive process involves two stages: Plant Modeling and Inverse Control Application. The first stage builds a non-recursive model of the CNC system (plant) using the Least-Mean-Square (LMS) algorithm. The second stage consists of the definition of a recursive structure (the controller) that implements an inverse model of the plant by using the coefficients of the model in an algorithm called Forward-Time Calculation (FTC). In this way, when the inverse controller is implemented in series with the plant, it will pre-compensate for the modification that the original plant introduces in the input signal. The performance of this solution was verified at three different levels: Software simulation, implementation in a set of isolated motor-encoder pairs and implementation in a real CNC machine. The use of the adaptive inverse controller effectively improved the step response of the system in all three levels. In the simulation, an ideal response was obtained. In the motor-encoder test, the rise time was reduced by as much as 80%, without overshoot, in some cases. Even with the larger mass of the actual CNC machine, decrease of the rise time and elimination of the overshoot were obtained in most cases. These results lead to the conclusion that the adaptive inverse controller is a viable approach to position control in CNC machinery.

Efeitos do treino de marcha em esteira com adição de carga ao membro inferior não parético de indivíduos com acidente vascular cerebral: ensaio clínico controlado e randomizado

Introduction: Gait after stroke is characterized by a significant asymmetry between the lower limbs, with predominant use of the non-paretic lower limb (NPLL) over using the paretic lower limb. Accordingly, it has been suggested that adding load/weight to the NPLL as a form of restricting the movement of this limb may favor the use of the paretic limb, reducing interlimb asymmetry. However, few studies have been conducted up to this moment, which only investigated the immediate effects of this practice. Objectives: 1) Investigating whether there is an influence of adding load to the NPLL during treadmill training on cardiovascular parameters and on gait performance of individuals with stroke, compared to treadmill training without load addition; 2) Analyzing the effects of treadmill training with and without load added to the NPLL on kinematic parameters of each lower limb during gait; 3) Analyzing the effects of treadmill training with and without load added to the NPLL on measurements of functional mobility and postural balance of these patients. Materials and Methods: This is a randomized single blinded clinical trial involving 38 subjects, with a mean age of 56.5 years, at the subacute post-stroke phase (with mean time since stroke of 4.5 months). Participants were randomly assigned into an experimental group (EG) or control group (CG). EG (n= 19) was submitted to gait training on a treadmill with the addition of load to the NPLL by ankle weights equivalent to 5% of body weight. CG (n= 19) was only submitted to gait training on a treadmill. Behavioral strategies which included home exercises were also applied to both groups. The interventions occurred daily for two consecutive weeks (Day 1 to Day 9), being of 30 minutes duration each. Outcome measures: postural balance (Berg Functional Balance Scale – BBS), functional mobility (Timed Up and Go – TUG; kinematic variables of 180° turning) and kinematic gait variables were assessed at baseline (Day 0), after four training sessions (Day 4), after nine training sessions (Day 9), and 40 days after completion of training (Follow-up). Cardiovascular parameters (mean arterial pressure and heart rate) were evaluated at four moments within each training session. Analysis of variance (ANOVA) was used to compare outcomes between EG and CG in the course of the study (Day 0, Day 4, Day 9 and Follow-up). Unpaired t-tests allowed for intergroup comparison at each training session. 5% significance was used for all tests. Results: 1) Cardiovascular parameters (systemic arterial pressure, heart rate and derivated variables) did not change after the interventions and there were no differences between groups within each training session. There was an improvement in gait performance, with increased speed and distance covered, with no statistically significant difference between groups. 2) After the interventions, patients had increased paretic and non-paretic step lengths, in addition to exhibiting greater hip and knee joint excursion on both lower limbs. The gains were observed in the EG and CG, with no statistical difference between the groups and (mostly) maintained at follow-up. 3) After the interventions, patients showed better postural balance (higher scores on BBS) and functional mobility (reduced time spent on the TUG test and better performance on the 180° turning). All gains were observed in the EG and CG, with no statistically significant difference between groups and were maintained at follow-up. Conclusions: The addition of load to the NPLL did not affect cardiovascular parameters in patients with subacute stroke, similar to treadmill training without load, thus seemingly a safe training to be applied to these patients. However, the use of the load did not bring any additional benefits to gait training. The gait training program (nine training sessions on a treadmill + strategies and exercises for paretic limb stimulation) was useful for improving gait performance and kinematics, functional mobility and postural balance, and its use is suggested to promote the optimization of these outcomes in the subacute phase after stroke.

LPJ-LMfire simulations for Europe for the Last Glacial Maximum and preindustrial control, link to netCDF files

This data sets contains LPJ-LMfire dynamic global vegetation model output covering Europe and the Mediterranean for the Last Glacial Maximum (LGM; 21 ka) and for a preindustrial control simulation (20th century detrended climate). The netCDF data files are time averages of the final 30 years of the model simulation. Each netCDF file contains four or five variables: fractional cover of 9 plant functional types (PFTs; cover), total fractional coverage of trees (treecover), population density of hunter-gatherers (foragerPD; only for the "people" simulations), fraction of the gridcell burned on 30-year average (burnedf), and vegetation net primary productivity (NPP). The model spatial resolution is 0.5-degrees For the LGM simulations, LPJ-LMfire was driven by the PMIP3 suite of eight GCMs for which LGM climate simulations were available. Also provided in this archive is the result of an LPJ-LMfire run that was forced by the average climate of all GCMs (the "GCM-mean" files), and the average of each of the individual LPJ-LMfire runs over the eight LGM scenarios individually (the "LPJ-mean" files). The model simulations are provided that include the influence of human presence on the landscape (the "people" files), and in a "world without humans" scenario (the "natural" files). Finally this archive contains the preindustrial reference simulation with and without human influence ("PI_reference_people" and "PI_reference_nat", respectively). There are therefore 22 netCDF files in this archive: 8 each of LGM simulations with and without people (total 16) and the "GCM mean" simulation (2 files) and the "LPJ mean" aggregate (2 files), and finally the two preindustrial "control" simulations ("PI"), with and without humans (2 files). In addition to the LPJ-LMfire model output (netCDF files), this archive also contains a table of arboreal pollen percent calculated from pollen samples dated to the LGM at sites throughout (lgmAP.txt), and a table containing the location of archaeological sites dated to the LGM (LGM_archaeological_site_locations.txt).

Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women?

Objectives: To assess whether stress or mixed urinary incontinence (UI) is associated with deficits in executive functioning among community-dwelling women. Design: An observational study comparing the performance, using multivariate analyses of variance (MANOVAs) and Bonferroni post hoc test, of continent women and women with stress or mixed UI during executive control tasks. Setting: The research center of the Institut universitaire de gériatrie de Montréal. Participants: One hundred and fifty-five community-dwelling women aged 60 and older participated in the study. Measurements: Based on the Urogenital Distress Inventory (UDI), participants were split into three groups: 35 continent women, 43 women with stress UI, and 78 women with mixed UI. Participants completed a battery of neuropsychological tests and a computerized dual-task test. Results: Women with mixed UI showed poorer performances than continent and stress UI women in executive control functions. Deficits were specific to tests involving switching and sharing/dividing attention between two tasks. Conclusion: Results of this study suggest that mixed UI can be associated with executive control deficits in community-dwelling older women. Future intervention studies in the treatment of UI should take the higher risk of an executive control deficit in women with UI under consideration.

Variability of the IFN-γ ELISpot assay in the context of proficiency testing and bridging studies.

Assays that assess cellular mediated immune responses performed under Good Clinical Laboratory Practice (GCLP) guidelines are required to provide specific and reproducible results. Defined validation procedures are required to establish the Standard Operating Procedure (SOP), include pass and fail criteria, as well as implement positivity criteria. However, little to no guidance is provided on how to perform longitudinal assessment of the key reagents utilized in the assay. Through the External Quality Assurance Program Oversight Laboratory (EQAPOL), an Interferon-gamma (IFN-γ) Enzyme-linked immunosorbent spot (ELISpot) assay proficiency testing program is administered. A limit of acceptable within site variability was estimated after six rounds of proficiency testing (PT). Previously, a PT send-out specific within site variability limit was calculated based on the dispersion (variance/mean) of the nine replicate wells of data. Now an overall 'dispersion limit' for the ELISpot PT program within site variability has been calculated as a dispersion of 3.3. The utility of this metric was assessed using a control sample to calculate the within (precision) and between (accuracy) experiment variability to determine if the dispersion limit could be applied to bridging studies (studies that assess lot-to-lot variations of key reagents) for comparing the accuracy of results with new lots to results with old lots. Finally, simulations were conducted to explore how this dispersion limit could provide guidance in the number of replicate wells needed for within and between experiment variability and the appropriate donor reactivity (number of antigen-specific cells) to be used for the evaluation of new reagents. Our bridging study simulations indicate using a minimum of six replicate wells of a control donor sample with reactivity of at least 150 spot forming cells per well is optimal. To determine significant lot-to-lot variations use the 3.3 dispersion limit for between and within experiment variability.

Performance of a single liquid column damper for the control of dynamic responses of a tension leg platform

Tuned liquid column dampers have been proved to be successful in mitigating the dynamic responses of civil infrastructure. There have been some recent applications of this concept on wind turbines and this passive control system can help to mitigate responses of offshore floating platforms and wave devices. The control of dynamic responses of these devices is important for reducing loads on structural elements and facilitating operations and maintenance (O&M) activities. This paper outlines the use of a tuned single liquid column damper for the control of a tension leg platform supported wind turbine. Theoretical studies were carried out and a scaled model was tested in a wave basin to assess the performance of the damper. The tests on the model presented in this paper correspond to a platform with a very low natural frequency for surge, sway and yaw motions. For practical purposes, it was not possible to tune the liquid damper exactly to this frequency. The consequent approach taken and the efficiency of such approach are presented in this paper. Responses to waves of a single frequency are investigated along with responses obtained from wave spectra characterising typical sea states. The extent of control is quantified using peak and root mean squared dynamic responses respectively. The tests present some guidelines and challenges for testing scaled devices in relation to including response control mechanisms. Additionally, the results provide a basis for dictating future research on tuned liquid column damper based control on floating platforms.