463,869 research outputs found

    Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.

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    OBJECTIVE: To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN: Multicenter pragmatic parallel randomized controlled trial. SETTING: Six emergency departments in the United States. PARTICIPANTS: 898 adults (aged \u3e17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. INTERVENTIONS: Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. RESULTS: Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P CONCLUSIONS: Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240

    The study pace among college students before and after a student aid reform: some Swedish results

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    In 2001, the Swedish system of student aid for college students was substantially re-formed; the grant-share of the total aid was increased, students were allowed to earn more without a reduction in student aid, and the repayment schedule of the loans was significantly tightened. In this paper, we examine the effects of the reform on individual study efficiency, measured as the number of credit points achieved each semester. We use all program students with a first registration at a Swedish college between 1995 and 2001(before the reform) and estimate a linear regression model including individual fixed effects. There is a slightly positive and significant effect of the reform on the ag-gregate level. However, dividing the sample conditionally on the parental educational level reveals that the individual study efficiency has increased only for students from a strong academic background. In other words, the relative study efficiency has decreased for students from a weak academic background. The different results between students from different parental backgrounds appear to be related to the reallocation of time be-tween work and studies.study efficiency; time-to-graduation; university education; student aid

    JointZone: users' view of an adaptive online learning resource for rheumatology

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    This paper describes an online learning resource for rheumatology that was designed for a wide constituency of users including primarily undergraduate medical students and health professionals. Although the online resources afford an informal learning environment, the site was pedagogically designed to comply with the general recommendations of the Standing Committee on Training and Education of EULAR (European League Against Rheumatism) for a rheumatology core curriculum. Any Internet user may freely browse the site content with optional registration providing access to adaptive features that personalize the user’s view, for example, providing a reading history and targeted support based on scores from completed case studies. The site has now been available since early 2003, and an online survey of site registrants indicates that well structured pedagogical materials that reflect a learners’ dominant ‘community of practice’ appear to be a successful aid to informal learning

    Intensity Based Non-rigid Registration of 3D Whole Mouse Optical and MR Image Volumes

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    Novel magnetic resonance (MR) imaging techniques can be validated using accurate co-registration with histology. Whole-animal histological sections allow for simultaneous analysis of multiple tissues, and may also aid in registration by providing contextual information and structural support to tissues which if isolated from the body would be difficult to register. This thesis explores the feasibility of co-registration between whole mouse histology with 3D MR images using an intermediate optical image volume acquired during tissue sectioning. Of the two transformations required for this approach, 3D co-registration of MR and optical images is more challenging to perform due to changes in contrast, slice orientation, and resolution between these modalities. Here, an automated non-rigid registration technique utilizing mutual information is proposed to accurately register 3D whole mouse optical and MR images as a first step towards automated registration of histology. Validation of this technique was accomplished through calculation of post-registration target registration error

    Dawson, Ella Mai (Randolph), 1892-1991 (MSS 397)

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    Finding aid only for Manuscripts Collection 397. Family correspondence, church materials, greeting cards and other personal papers of Ella Mai (Randolph) Dawson, a native of Logan County, Kentucky and resident of Clarksville, Tennessee. Includes voter registration and urban renewal materials relating to African Americans

    SP mountain data analysis

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    An analysis of synthetic aperture radar data of SP Mountain was undertaken to demonstrate the use of digital image processing techniques to aid in geologic interpretation of SAR data. These data were collected with the ERIM X- and L-band airborne SAR using like- and cross-polarizations. The resulting signal films were used to produce computer compatible tapes, from which four-channel imagery was generated. Slant range-to-ground range and range-azimuth-scale corrections were made in order to facilitate image registration; intensity corrections were also made. Manual interpretation of the imagery showed that L-band represented the geology of the area better than X-band. Several differences between the various images were also noted. Further digital analysis of the corrected data was done for enhancement purposes. This analysis included application of an MSS differencing routine and development of a routine for removal of relief displacement. It was found that accurate registration of the SAR channels is critical to the effectiveness of the differencing routine. Use of the relief displacement algorithm on the SP Mountain data demonstrated the feasibility of the technique

    Apparatus for histological validation of in vivo and ex vivo magnetic resonance imaging of the human prostate

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    This article describes apparatus to aid histological validation of magnetic resonance imaging studies of the human prostate. The apparatus includes a 3D-printed patientspecific mold that facilitates aligned in vivo and ex vivo imaging, in situ tissue fixation, and tissue sectioning with minimal organ deformation. The mold and a dedicated container include MRI-visible landmarks to enable consistent tissue positioning and minimize image registration complexity. The inclusion of high spatial resolution ex vivo imaging aids in registration of in vivo MRI and histopathology data
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