162 research outputs found

    Critical Ingredients of Consumer Run Services: Results of a National Survey

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    Fidelity criteria are increasingly used in program monitoring and evaluation, but are difficult to derive for emerging models (i.e., those not based on theory or a research demonstration project). We describe steps used to develop and operationalize fidelity criteria for consumer-run (CR) mental health services: articulating and operationalizing criteria based on published literature, then revising and validating the criteria through expert judgments using a modified Delphi method. Respondents rated highest those structural and process components emphasizing the value of consumerism: consumer control, consumer choices and opportunities for decision-making, voluntary participation (and the absence of coercion), and respect for members by staff.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44316/1/10597_2004_Article_480623.pd

    Forsøksbehandling med monokloramin mot lakseparasitten Gyrodactylus salaris ved flere doseringspunkter i Driva

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    Prosjektleder/Hovedforfatter Anders Gjørwad HagenDet er nå veletablert at klor tilsatt som monokloramin i svært lave konsentrasjoner kan fjerne Gyrodactylus salaris fra laksunger i løpet av få dager uten å ha synlige negative effekter på fisken. I denne rapporten presenteres et feltforsøk der målet har vært å få ytterligere kjennskap til dosering av kloramin i stor skala ved å inkludere en lengre elvestrekning enn i tidligere forsøk, samt å undersøke samspillet mellom flere doseringsanlegg i hovedelva. I tillegg ble det tilsatt kloramin fra mindre doseringsanlegg i fire sidebekker; Røta, Somrungen, Gryta og Vermøybekken. Undersøkelsene ble gjennomført i elva Driva, der kloraminløsningen ble tilsatt elvevannet ved tre lokasjoner. Målinger av klor ble gjort ved en rekke stasjoner i elva, ned til cirka 18 km fra øverste doseringspunkt ved fiskesperra ved Snøvasmelan. Klorkonsentrasjonen i elva ble som forventet gradvis redusert fra tilsettingspunktet til målepunktene nedover i elva, i tråd med det som tidligere er målt under forsøk i Driva. Dosering fra påfriskpunkter i elva sørget imidlertid for at ønsket klorkonsentrasjon ble opprettholdt 6,4-10 km nedover i vassdraget fra øverste doseringspunkt ved fiskesperra. Forsøket var vellykket, og resultatene viser at metoden er klar for å tas i bruk i en fullskala testdosering.publishedVersio

    Klorbehandling i Driva og Litldalselva 2023 – Andre behandlingsår

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    Prosjektleder: Anders Gjørwad HagenI august 2023 ble den andre av to kjemiske behandlinger gjennomført mot lakseparasitten Gyrodactylus salaris i Drivaregionen. I de to elvene Driva og Litldalselva ble kloramin brukt som hovedkjemikalium. Klorbehandlingene ble gjennomført av et samarbeid mellom NIVA og NINA i henhold til kontrakt med Veterinærinstituttet som overordnet oppdragsgiver. I denne rapporten oppsummeres metodikk og resultater fra klorbehandlingen. Det ble gjort jevnlige målinger for å følge opp effekten av alle små og store doseringspunkter. I hovedelva viste analyse av disse prøvene at det generelt ble oppnådd en samlet behandlingseffekt på mer enn 90 mikrogramdøgn for alle stasjoner. I sidebekkene var det én av 188 stasjoner som ikke nådde målet på 90 mikrogramdøgn. Sannsynligheten for at det skal ha overlevd G. salaris i dette området høyt oppe i Litldalselva er imidlertid ansett som svært liten. Basert på funn fra behandlingen i 2022 ble behandlingen i 2023 utvidet, og dedikert personell ble allokert til å gjennomføre kritiske undersøkelser. Ved 34 punkter ble det gjort ett eller flere tiltak for å bedre behandlingen, og hvor det også ble gjort flere undersøkelser i etterkant for å vurdere effekten av tiltaket. Behandlingen var totalt sett vellykket, særlig gitt de vannføringsmessige utfordringene i forbindelse med ekstremværet «Hans».Veterinærinstituttet i TrondheimpublishedVersio

    Klorbehandling i øvre Driva 2023 – Supplerende tiltak i hovedelv og utvalgte sidevassdrag oppstrøms fiskesperra i Driva

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    Prosjekleder: Anders Gjørwad HagenI august 2023 mottok gruppen «Gyroklor» en bestilling på klorbehandling i øvre deler av Driva som skulle gjennomføres i løpet av september 2023. I henhold til bestillingen var formålet med denne behandlingen «(…) å redusere smittetrykket i Driva etter påvising av laks (Salmo salar) og Gyrodactylus salaris på oversiden av fiskesperra, så langt det er praktisk mulig». Den reelle behandlingsstrekningen ble ut fra dette definert med nederste doseringsstasjon ved Vikabrua og øvre doseringspunkt ovenfor Mågålaupet. I tillegg ble det dosert kloramin i sideelvene Vinstra og Ålma for å håndtere fortynningseffekten fra disse. Behandlingsperioden var på seks dager. I løpet av denne perioden var målsettingen å oppnå minimum 90 mikrogramdøgn aktivt klor i alle behandlede vannveier. Det ble gjort jevnlige målinger for å følge opp effekten av alle doseringspunkter. Det ble også gjort undersøkelser for å påvise hvor langt behandlingseffekten strakk seg fra nederste doseringspunkt. Analysene viste at det ble oppnådd en samlet behandlingseffekt på mer enn 90 mikrogramdøgn ved alle prøvepunkter. Sannsynligheten for at det skal ha overlevd G. salaris i behandlingsområdet er ansett som svært liten, og behandlingen var vellykket.Veterinærinstituttet i TrondheimpublishedVersio

    Drug adherence and multidisciplinary care in patients with multiple sclerosis: Protocol of a prospective, web-based, patient-centred, nation-wide, Dutch cohort study in glatiramer acetate treated patients (CAIR study)

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    Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, for which no definitive treatment is available. Most patients start with a relapsing-remitting course (RRMS). Disease-modifying drugs (DMDs) reduce relapses and disability progression. First line DMDs include glatiramer acetate (GA), interferon-beta (INFb)-1a and INFb-1b, which are all administered via injections. Effectiveness of DMD treatment depends on adequate adherence, meaning year-long continuation of injections with a minimum of missed doses. In real-life practice DMD-treated patients miss 30% of doses. The 6-month discontinuation rate is up to 27% and most patients who discontinue do so in the first 12 months.Treatment adherence is influenced by the socio-economic situation, health care and caregivers, disease, treatment and patient characteristics. Only a few studies have dealt with adherence-related factors in DMD-treated patients. Self-efficacy expectations were found to be related to GA adherence. Patient education and optimal support improve adherence in general. Knowledge of the aspects of care that significantly relate to adherence could lead to adherence-improving measures. Moreover, identification of patients at risk of inadequate adherence could lead to more efficient care.In the near future new drugs will become available for RRMS. Detailed knowledge on factors prognostic of adherence and on care aspects that are associated with adequate adherence will improve the chances of these drugs becoming effective treatments. We investigate in RRMS patients the relationship between drug adherence and multidisciplinary care, as well as factors associated with adherence. Given the differences in the frequency of administration and in the side effects between the DMDs we decided to study patients treated with the same DMD, GA.Methods/design: The Correlative analyses of Adherence In Relapsing remitting MS (CAIR) study is an investigator-initiated, prospective, web-based, patient-centred, nation-wide cohort study in the Netherlands.The primary objective is to investigate whether GA adherence is associated with specific disciplines of care or quantities of specific care. The secondary objective is to investigate whether GA adherence is associated with specific aspects of the socio-economic situation, health care and caregivers, disease, treatment or patient characteristics.All data are acquired on-line via a study website. All RRMS patients in the Netherlands starting GA treatment are eligible. Patients are informed by neurologists, nurses, and websites from national MS patient organisations. All data, except on disability, are obtained by patient self-reports on pre-defined and random time points. The number of missed doses and the number of patients having discontinued GA treatment at 6 and 12 months are measures of adherence. Per care discipline the number of sessions and the total duration of care are measures of received care. The full spectrum of non-experimental care that is available in the Netherlands is assessed. Care includes 'physical' contacts, contacts by telephone or internet, health-promoting activities and community care activities. Care received over the preceding 14 days is assessed by patients at baseline and every other week thereafter up to month 12. Every 3 months neurologists and nurses record care disciplines to which patients have been referred.The Dutch Adherence Questionnaire-90 (DAQ-90) is a 90-item questionnaire based on the World Health Organisation (WHO) 2003 report on adherence and comprehensively assesses five domains of evidence-based determinants of adherence: socio-economic, health care and caregivers, disease, treatment, and patient-related factors. In addition, self-efficacy is assessed by the MS Self-Efficacy Scale (MSSES), and mood and health-related quality of life (HRQoL) by the Multiple Sclerosis Quality of Life-54 questionnaire (MSQoL-54). Relapses and adverse events probably or definitively related to GA are also reported.Discussion: In this study data is mainly acquired by patients' self-reporting via the internet. On-line data acquisition by patients does not require study visits to the hospital and can easily be integrated into daily life. The web-based nature of the study is believed to prevent missing data and study drop-outs. Moreover, the automated process of filling in questionnaires ensures completeness and consistency, thus improving data quality. The combination of patient-reported outcomes, fully web-based data capture and nation-wide information to all eligible patients are distinguishing features of the study and contribute to its scientific potential.Trial registration: Netherlands Trial Register (NTR): NTR2432

    Multivariate curve resolution of time course microarray data

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    BACKGROUND: Modeling of gene expression data from time course experiments often involves the use of linear models such as those obtained from principal component analysis (PCA), independent component analysis (ICA), or other methods. Such methods do not generally yield factors with a clear biological interpretation. Moreover, implicit assumptions about the measurement errors often limit the application of these methods to log-transformed data, destroying linear structure in the untransformed expression data. RESULTS: In this work, a method for the linear decomposition of gene expression data by multivariate curve resolution (MCR) is introduced. The MCR method is based on an alternating least-squares (ALS) algorithm implemented with a weighted least squares approach. The new method, MCR-WALS, extracts a small number of basis functions from untransformed microarray data using only non-negativity constraints. Measurement error information can be incorporated into the modeling process and missing data can be imputed. The utility of the method is demonstrated through its application to yeast cell cycle data. CONCLUSION: Profiles extracted by MCR-WALS exhibit a strong correlation with cell cycle-associated genes, but also suggest new insights into the regulation of those genes. The unique features of the MCR-WALS algorithm are its freedom from assumptions about the underlying linear model other than the non-negativity of gene expression, its ability to analyze non-log-transformed data, and its use of measurement error information to obtain a weighted model and accommodate missing measurements

    Redirecting T Cells to Ewing's Sarcoma Family of Tumors by a Chimeric NKG2D Receptor Expressed by Lentiviral Transduction or mRNA Transfection

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    We explored the possibility to target Ewing's sarcoma family of tumors (ESFT) by redirecting T cells. To this aim, we considered NKG2D-ligands (NKG2D-Ls) as possible target antigens. Detailed analysis of the expression of MICA, MICB, ULBP-1, -2, and -3 in fourteen ESFT cell lines revealed consistent expression of at least one NKG2D-L. Thus, for redirecting T cells, we fused a CD3ζ/CD28-derived signaling domain to the ectodomain of NKG2D, however, opposite transmembrane orientation of this signaling domain and NKG2D required inverse orientation fusion of either of them. We hypothesized that the particularly located C-terminus of the NKG2D ectodomain should allow reengineering of the membrane anchoring from a native N-terminal to an artificial C-terminal linkage. Indeed, the resulting chimeric NKG2D receptor (chNKG2D) was functional and efficiently mediated ESFT cell death triggered by activated T cells. Notably, ESFT cells with even low NKG2D-L expression were killed by CD8pos and also CD4pos cells. Both, mRNA transfection and lentiviral transduction resulted in high level surface expression of chNKG2D. However, upon target-cell recognition receptor surface levels were maintained by tranfected RNA only during the first couple of hours after transfection. Later, target-cell contact resulted in strong and irreversible receptor down-modulation, whereas lentivirally mediated expression of chNKG2D remained constant under these conditions. Together, our study defines NKG2D-Ls as targets for a CAR-mediated T cell based immunotherapy of ESFT. A comparison of two different methods of gene transfer reveals strong differences in the susceptibility to ligand-induced receptor down-modulation with possible implications for the applicability of RNA transfection
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