Smith, P F
A few studies in humans suggest that changes in stimulation of the balance organs of the inner ear (the 'vestibular system') can disrupt numerical cognition, resulting in 'dyscalculia', the inability to manipulate numbers. Many studies have also demonstrated that patients with vestibular dysfunction exhibit deficits in spatial memory. It is suggested that there may be a connection between spatial memory deficits resulting from vestibular dysfunction and the occurrence of dyscalculia, given the evidence that numerosity is coupled to the processing of spatial information (e.g., the 'spatial numerical association of response codes ('SNARC') effect'). The evidence supporting this hypothesis is summarised and potential experiments to test it are proposed. Copyright © 2012 Elsevier Ltd. All rights reserved.
Castro-Cañizares, D; Estévez-Pérez, N; Reigosa-Crespo, V
To analyze the current theories describing the cognitive mechanisms underlying developmental dyscalculia. The four most researched hypotheses concerning the cognitive deficits related to developmental dyscalculia, as well as experimental evidences supporting or refusing them are presented. The first hypothesis states that developmental dyscalculia is consequence of domain general cognitive deficits. The second hypothesis suggests that it is due to a failure in the development of specialized brain systems dedicated to numerosity processing. The third hypothesis asserts the disorder is caused by a deficit in accessing quantity representation through numerical symbols. The last hypothesis states developmental dyscalculia appears as a consequence of impairments in a generalized magnitude system dedicated to the processing of continuous and discrete magnitudes. None of the hypotheses has been proven more plausible than the rest. Relevant issues rose by them need to be revisited and answered in the light of new experimental designs. In the last years the understanding of cognitive disorders involved in developmental dyscalculia has remarkably increased, but it is nonetheless insufficient. Additional research is required in order to achieve a comprehensive cognitive model of numerical processing development and its disorders. This will improve the diagnostic precision and the effectiveness of developmental dyscalculia intervention strategies.
Gavin R. Price
Full Text Available Developmental Dyscalculia (DD is a learning disorder affecting the ability to acquire school-level arithmetic skills, affecting approximately 3-6% of individuals. Progress in understanding the root causes of DD and how best to treat it have been impeded by lack of widespread research and variation in characterizations of the disorder across studies. However, recent years have witnessed significant growth in the field, and a growing body of behavioral and neuroimaging evidence now points to an underlying deficit in the representation and processing of numerical magnitude information as a potential core deficit in DD. An additional product of the recent progress in understanding DD is the resurgence of a distinction between ‘primary’ and ‘secondary’ developmental dyscalculia. The first appears related to impaired development of brain mechanisms for processing numerical magnitude information, while the latter refers to mathematical deficits stemming from external factors such as poor teaching, low socio-economic status, and behavioral attention problems or domain-general cognitive deficits. Increased awareness of this distinction going forward, in combination with longitudinal empirical research, offers great potential for deepening our understanding of the disorder and developing effective educational interventions.
Cappelletti, Marinella; Price, Cathy J
Developmental dyscalculia - a congenital learning disability in understanding numerical concepts - is typically associated with parietal lobe abnormality. However, people with dyscalculia often retain some residual numerical abilities, reported in studies that otherwise focused on abnormalities in the dyscalculic brain. Here we took a different perspective by focusing on brain regions that support residual number processing in dyscalculia. All participants accurately performed semantic and categorical colour-decision tasks with numerical and non-numerical stimuli, with adults with dyscalculia performing slower than controls in the number semantic tasks only. Structural imaging showed less grey-matter volume in the right parietal cortex in people with dyscalculia relative to controls. Functional MRI showed that accurate number semantic judgements were maintained by parietal and inferior frontal activations that were common to adults with dyscalculia and controls, with higher activation for participants with dyscalculia than controls in the right superior frontal cortex and the left inferior frontal sulcus. Enhanced activation in these frontal areas was driven by people with dyscalculia who made faster rather than slower numerical decisions; however, activation could not be accounted for by response times per se, because it was greater for fast relative to slow dyscalculics but not greater for fast controls relative to slow dyscalculics. In conclusion, our results reveal two frontal brain regions that support efficient number processing in dyscalculia.
Full Text Available Developmental dyscalculia – a congenital learning disability in understanding numerical concepts – is typically associated with parietal lobe abnormality. However, people with dyscalculia often retain some residual numerical abilities, reported in studies that otherwise focused on abnormalities in the dyscalculic brain. Here we took a different perspective by focusing on brain regions that support residual number processing in dyscalculia. All participants accurately performed semantic and categorical colour-decision tasks with numerical and non-numerical stimuli, with adults with dyscalculia performing slower than controls in the number semantic tasks only. Structural imaging showed less grey-matter volume in the right parietal cortex in people with dyscalculia relative to controls. Functional MRI showed that accurate number semantic judgements were maintained by parietal and inferior frontal activations that were common to adults with dyscalculia and controls, with higher activation for participants with dyscalculia than controls in the right superior frontal cortex and the left inferior frontal sulcus. Enhanced activation in these frontal areas was driven by people with dyscalculia who made faster rather than slower numerical decisions; however, activation could not be accounted for by response times per se, because it was greater for fast relative to slow dyscalculics but not greater for fast controls relative to slow dyscalculics. In conclusion, our results reveal two frontal brain regions that support efficient number processing in dyscalculia.
Wang, Enguo; Du, Chenguang; Ma, Yujun
This study reports the neurophysiological and behavioral correlates of digital memory retrieval features in Chinese individuals with and without dyscalculia. A total of 18 children with dyscalculia (ages 11.5-13.5) and 18 controls were tested, and their event-related potentials were digitally recorded simultaneously with behavior measurement.…
Monuteaux, Michael C.; Faraone, Stephen V.; Herzig, Kathleen; Navsaria, Neha; Biederman, Joseph
The familial relationship between dyscalculia and attention-deficit/hyperactivity disorder (ADHD) was assessed. We conducted a familial risk analysis using probands with and without ADHD of both genders and their first-degree relatives. Participants were assessed with structured diagnostic interviews and a cognitive test battery. We found elevated…
Jaekel, Julia; Wolke, Dieter
To evaluate whether the risk for dyscalculia in preterm children increases the lower the gestational age (GA) and whether small-for-gestational age birth is associated with dyscalculia. A total of 922 children ranging from 23 to 41 weeks' GA were studied as part of a prospective geographically defined longitudinal investigation of neonatal at-risk children in South Germany. At 8 years of age, children's cognitive and mathematic abilities were measured with the Kaufman Assessment Battery for Children and with a standardized mathematics test. Dyscalculia diagnoses were evaluated with discrepancy-based residuals of a linear regression predicting children's math scores by IQ and with fixed cut-off scores. We investigated each GA group's ORs for general cognitive impairment, general mathematic impairment, and dyscalculia by using binary logistic regressions. The risk for general cognitive and mathematic impairment increased with lower GA. In contrast, preterm children were not at increased risk of dyscalculia after statistically adjusting for child sex, family socioeconomic status, and small-for-gestational age birth. The risk of general cognitive and mathematic impairments increases with lower GA but preterm children are not at increased risk of dyscalculia. Copyright © 2014 Elsevier Inc. All rights reserved.
Moreau, David; Wilson, Anna J; McKay, Nicole S; Nihill, Kasey; Waldie, Karen E
Learning disabilities such as dyslexia, dyscalculia and their comorbid manifestation are prevalent, affecting as much as 15% of the population. Structural neuroimaging studies have indicated that these disorders can be related to differences in white matter integrity, although findings remain disparate. In this study, we used a unique design composed of individuals with dyslexia, dyscalculia, both disorders and controls, to systematically explore differences in fractional anisotropy across groups using diffusion tensor imaging. Specifically, we focused on the corona radiata and the arcuate fasciculus, two tracts associated with reading and mathematics in a number of previous studies. Using Bayesian hypothesis testing, we show that the present data favor the null model of no differences between groups for these particular tracts-a finding that seems to go against the current view but might be representative of the disparities within this field of research. Together, these findings suggest that structural differences associated with dyslexia and dyscalculia might not be as reliable as previously thought, with potential ramifications in terms of remediation.
Kaufmann, Liane; von Aster, Michael
BACKGROUND: Dyscalculia is defined as difficulty acquiring basic arithmetic skills that is not explained by low intelligence or inadequate schooling. About 5% of children in primary schools are affected. Dyscalculia does not improve without treatment. METHODS: In this article, we selectively review publications on dyscalculia from multiple disciplines (medicine, psychology, neuroscience, education/special education). RESULTS: Many children and adolescents with dyscalculia have associate...
Full Text Available Abstract Background Very little is known about attention deficits in developmental dyscalculia, hence, this study was designed to provide the missing information. We examined attention abilities of participants suffering from developmental dyscalculia using the attention networks test - interactions. This test was designed to examine three different attention networks--executive function, orienting and alerting--and the interactions between them. Methods Fourteen university students that were diagnosed as suffering from developmental dyscalculia--intelligence and reading abilities in the normal range and no indication of attention-deficit hyperactivity disorder--and 14 matched controls were tested using the attention networks test - interactions. All participants were given preliminary tests to measure mathematical abilities, reading, attention and intelligence. Results The results revealed deficits in the alerting network--a larger alerting effect--and in the executive function networks--a larger congruity effect in developmental dyscalculia participants. The interaction between the alerting and executive function networks was also modulated by group. In addition, developmental dyscalculia participants were slower to respond in the non-cued conditions. Conclusions These results imply specific attentional deficits in pure developmental dyscalculia. Namely, those with developmental dyscalculia seem to be deficient in the executive function and alertness networks. They suffer from difficulty in recruiting attention, in addition to the deficits in numerical processing.
Askenazi, Sarit; Henik, Avishai
Very little is known about attention deficits in developmental dyscalculia, hence, this study was designed to provide the missing information. We examined attention abilities of participants suffering from developmental dyscalculia using the attention networks test - interactions. This test was designed to examine three different attention networks--executive function, orienting and alerting--and the interactions between them. Fourteen university students that were diagnosed as suffering from developmental dyscalculia--intelligence and reading abilities in the normal range and no indication of attention-deficit hyperactivity disorder--and 14 matched controls were tested using the attention networks test-interactions. All participants were given preliminary tests to measure mathematical abilities, reading, attention and intelligence. The results revealed deficits in the alerting network--a larger alerting effect--and in the executive function networks--a larger congruity effect in developmental dyscalculia participants. The interaction between the alerting and executive function networks was also modulated by group. In addition, developmental dyscalculia participants were slower to respond in the non-cued conditions. These results imply specific attentional deficits in pure developmental dyscalculia. Namely, those with developmental dyscalculia seem to be deficient in the executive function and alertness networks. They suffer from difficulty in recruiting attention, in addition to the deficits in numerical processing.
Messenger, Chris; Emerson, Jane; Bird, Ronit
In this article, the authors offer three definitions of dyscalculia, then describe the background and initial progress of the Harrow Dyscalculia Project. Their project in Harrow is associated with ongoing research into numeracy and brain development led by Brian Butterworth, Professor of Cognitive Neuropsychology at UCL. Pupils from Harrow schools…
Cappelletti, Marinella; Price, Cathy J.
Developmental dyscalculia – a congenital learning disability in understanding numerical concepts – is typically associated with parietal lobe abnormality. However, people with dyscalculia often retain some residual numerical abilities, reported in studies that otherwise focused on abnormalities in the dyscalculic brain. Here we took a different perspective by focusing on brain regions that support residual number processing in dyscalculia. All participants accurately performed semantic and ca...
Kucian, Karin; Ashkenazi, Simone Schwizer; Hänggi, Jürgen; Rotzer, Stephanie; Jäncke, Lutz; Martin, Ernst; von Aster, Michael
Numerical understanding is important for everyday life. For children with developmental dyscalculia (DD), numbers and magnitudes present profound problems which are thought to be based upon neuronal impairments of key regions for numerical understanding. The aim of the present study was to investigate possible differences in white matter fibre integrity between children with DD and controls using diffusion tensor imaging. White matter integrity and behavioural measures were evaluated in 15 children with developmental dyscalculia aged around 10 years and 15 matched controls. The main finding, obtained by a whole brain group comparison, revealed reduced fractional anisotropy in the superior longitudinal fasciculus in children with developmental dyscalculia. In addition, a region of interest analysis exhibited prominent deficits in fibres of the superior longitudinal fasciculus adjacent to the intraparietal sulcus, which is thought to be the core region for number processing. To conclude, our results outline deficient fibre projection between parietal, temporal and frontal regions in children with developmental dyscalculia, and therefore raise the question of whether dyscalculia can be seen as a dysconnection syndrome. Since the superior longitudinal fasciculus is involved in the integration and control of distributed brain processes, the present results highlight the importance of considering broader domain-general mechanisms in the diagnosis and therapy of dyscalculia.
De Visscher, Alice; Szmalec, Arnaud; Van Der Linden, Lize; Noël, Marie-Pascale
In the context of heterogeneity, the different profiles of dyscalculia are still hypothetical. This study aims to link features of mathematical difficulties to certain potential etiologies. First, we wanted to test the hypothesis of a serial-order learning deficit in adults with dyscalculia. For this purpose we used a Hebb repetition learning task. Second, we wanted to explore a recent hypothesis according to which hypersensitivity-to-interference hampers the storage of arithmetic facts and leads to a particular profile of dyscalculia. We therefore used interfering and non-interfering repeated sequences in the Hebb paradigm. A final test was used to assess the memory trace of the non-interfering sequence and the capacity to manipulate it. In line with our predictions, we observed that people with dyscalculia who show good conceptual knowledge in mathematics but impaired arithmetic fluency suffer from increased sensitivity-to-interference compared to controls. Secondly, people with dyscalculia who show a deficit in a global mathematical test suffer from a serial-order learning deficit characterized by a slow learning and a quick degradation of the memory trace of the repeated sequence. A serial-order learning impairment could be one of the explanations for a basic numerical deficit, since it is necessary for the number-word sequence acquisition. Among the different profiles of dyscalculia, this study provides new evidence and refinement for two particular profiles. Copyright © 2015 Elsevier B.V. All rights reserved.
Ulfarsson, M O; Walters, G B; Gustafsson, O; Steinberg, S; Silva, A; Doyle, O M; Brammer, M; Gudbjartsson, D F; Arnarsdottir, S; Jonsdottir, G A; Gisladottir, R S; Bjornsdottir, G; Helgason, H; Ellingsen, L M; Halldorsson, J G; Saemundsen, E; Stefansdottir, B; Jonsson, L; Eiriksdottir, V K; Eiriksdottir, G R; Johannesdottir, G H; Unnsteinsdottir, U; Jonsdottir, B; Magnusdottir, B B; Sulem, P; Thorsteinsdottir, U; Sigurdsson, E; Brandeis, D; Meyer-Lindenberg, A; Stefansson, H; Stefansson, K
Several copy number variants have been associated with neuropsychiatric disorders and these variants have been shown to also influence cognitive abilities in carriers unaffected by psychiatric disorders. Previously, we associated the 15q11.2(BP1-BP2) deletion with specific learning disabilities and a larger corpus callosum. Here we investigate, in a much larger sample, the effect of the 15q11.2(BP1-BP2) deletion on cognitive, structural and functional correlates of dyslexia and dyscalculia. We report that the deletion confers greatest risk of the combined phenotype of dyslexia and dyscalculia. We also show that the deletion associates with a smaller left fusiform gyrus. Moreover, tailored functional magnetic resonance imaging experiments using phonological lexical decision and multiplication verification tasks demonstrate altered activation in the left fusiform and the left angular gyri in carriers. Thus, by using convergent evidence from neuropsychological testing, and structural and functional neuroimaging, we show that the 15q11.2(BP1-BP2) deletion affects cognitive, structural and functional correlates of both dyslexia and dyscalculia.
Kaufmann, Liane; von Aster, Michael
Dyscalculia is defined as difficulty acquiring basic arithmetic skills that is not explained by low intelligence or inadequate schooling. About 5% of children in primary schools are affected. Dyscalculia does not improve without treatment. In this article, we selectively review publications on dyscalculia from multiple disciplines (medicine, psychology, neuroscience, education/special education). Many children and adolescents with dyscalculia have associated cognitive dysfunction (e.g., impairment of working memory and visuospatial skills), and 20% to 60% of those affected have comorbid disorders such as dyslexia or attention deficit disorder. The few interventional studies that have been published to date document the efficacy of pedagogic-therapeutic interventions directed toward specific problem areas. The treatment is tailored to the individual patient's cognitive functional profile and severity of manifestations. Psychotherapy and/or medication are sometimes necessary as well. The early identification and treatment of dyscalculia are very important in view of its frequent association with mental disorders. Sufferers need a thorough, neuropsychologically oriented diagnostic evaluation that takes account of the complexity of dyscalculia and its multiple phenotypes and can thus provide a basis for the planning of effective treatment.
Shalev, Ruth S.; Manor, Orly; Kerem, Batsheva; Ayali, Mady; Badichi, Navah; Friedlander, Yechiel; Gross-Tsur, Varda
Siblings and parents of 39 children with dyscalculia were assessed for arithmetic, reading, and attention disorders. Findings indicated a familial prevalence of dyscalculia almost tenfold higher than expected for the general population and suggest that dyscalculia, like other learning disabilities, has a significant familial aggregation,…
Shalev, R. S.; Manor, O.; Gross-Tsur, V.
Classification of arithmetic disorders is predicated on neuropsychological features and associated learning disabilities. Assesses the compatibility of these classifications on a nonreferred, population-based cohort of children (N=139) with developmental dyscalculia. Concludes that children with dyscalculia and disabilities in reading and/or…
Full Text Available Poor mathematical abilities adversely affect academic and career opportunities. The neuroanatomical basis of developmental dyscalculia (DD, a specific learning deficit with prevalence rates exceeding 5%, is poorly understood. We used structural MRI and diffusion tensor imaging (DTI to examine macro- and micro-structural impairments in 7-9 year old children with DD, compared to a group of typically developing (TD children matched on age, gender, intelligence, reading abilities and working memory capacity. Voxel-based morphometry (VBM revealed reduced grey matter (GM bilaterally in superior parietal lobule, intra-parietal sulcus, fusiform gyrus, parahippocampal gyrus and right anterior temporal cortex in children with DD. VBM analysis also showed reduced white matter (WM volume in right temporal-parietal cortex. DTI revealed reduced fractional anisotropy (FA in this WM region, pointing to significant right hemisphere micro-structural impairments. Furthermore, FA in this region was correlated with numerical operations but not verbal mathematical reasoning or word reading. Atlas-based tract mapping identified the inferior longitudinal fasciculus, inferior fronto-occipital fasciculus and caudal forceps major as key pathways impaired in DD. DTI tractography suggests that long-range WM projection fibers linking the right fusiform gyrus with temporal-parietal WM are a specific source of vulnerability in DD. Network and classification analysis suggest that DD in children may be characterized by multiple dysfunctional circuits arising from a core WM deficit. Our findings link GM and WM abnormalities in children with DD and they point to macro- and micro-structural abnormalities in right hemisphere temporal-parietal WM, and pathways associated with it, as key neuroanatomical correlates of DD.
Moeller, K.; Neuburger, S.; Kaufmann, L.; Landerl, K.; Nuerk, H. C.
Recent research suggests that developmental dyscalculia is associated with a subitizing deficit (i.e., the inability to quickly enumerate small sets of up to 3 objects). However, the nature of this deficit has not previously been investigated. In the present study the eye-tracking methodology was employed to clarify whether (a) the subitizing…
Willburger, Edith; Fussenegger, Barbara; Moll, Kristina; Wood, Guilherme; Landerl, Karin
In four carefully selected samples of 8- to 10-year old children with dyslexia (but age adequate arithmetic skills), dyscalculia (but age adequate reading skills), dyslexia/dyscalculia and controls a domain-general deficit in rapid automatized naming (RAN) was found for both dyslexia groups. Dyscalculic children exhibited a domain-specific deficit…
Kirk, Kirsty; Payne, Bob
Dyscalculia is a learning need that requires assessment and provision of reasonable adjustments. Although there have been numerous discussions about how to identify, assess and support dyscalculic children, there is less information available covering further and higher education, and even less concerned with the education of health professionals. This article aims to address this deficit, to discuss the disparity often felt by educators, and to raise awareness of the impact of dyscalculia on student nurses.
Full Text Available This article analyzes the researches by a number of national and foreign scholars on the issue of dyscalculia. The review of the results obtained allows tracking the changes in the concept of dyscalculia, its diagnostic criteria and strategies for targeted intervention designed for children of pre-school and primary school age. The analyzed studies basically refer to the modern understanding of the basic properties of dyscalculia - heterogeneity and the background of its formation, neuroanatomical prerequisites and the risks of inadequate interpretation of empirical data. They also define the primary and secondary dyscalculia and give an idea of the range of educational technologies. The article outlines the features of foreign and national approach to this issue. It appears that the priority of the problem of dyscalculia remains underestimated in comparison to dyslexia and other systemic psycho-pedagogical problems of childhood.
Katherine E. Lewis
Full Text Available Students with dyscalculia are typically thought of by both researchers and educators as having deficits. The deficit language permeates studies of dyscalculia as well as assessments and documentation of students in schools. In this paper, we offer an alternative to the dominant narrative. We understand disabilities, and dyscalculia specifically, as resulting from cognitive differences—not deficits—which lead to issues of access. We provide a case study of Dylan (second author, an individual with dyscalculia who decided to major in statistics at University of California, Berkeley and become a statistician. Although she experienced significant issues of access—both in the standard tools used to do mathematics, and in navigating the structures at the university—she developed systems to enable her to compensate. She collaborated in this research enterprise in order to share with researchers, teachers, parents, and students her experiences with dyscalculia and how she was able to succeed in higher level mathematics. Informed by previous empirical work, we collected video recordings of Dylan’s deliberate efforts to share insights and strategies with another student with dyscalculia. In this work, Dylan challenges dominant and problematic myths about ability and mathematics.
Ermolova T.V.; Ponomareva V.V.; Florova N.B.
This article analyzes the researches by a number of national and foreign scholars on the issue of dyscalculia. The review of the results obtained allows tracking the changes in the concept of dyscalculia, its diagnostic criteria and strategies for targeted intervention designed for children of pre-school and primary school age. The analyzed studies basically refer to the modern understanding of the basic properties of dyscalculia - heterogeneity and the background of its formation, neuroanato...
Szucs, Denes; Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Gabriel, Florence
Developmental dyscalculia is thought to be a specific impairment of mathematics ability. Currently dominant cognitive neuroscience theories of developmental dyscalculia suggest that it originates from the impairment of the magnitude representation of the human brain, residing in the intraparietal sulcus, or from impaired connections between number symbols and the magnitude representation. However, behavioral research offers several alternative theories for developmental dyscalculia and neuro-imaging also suggests that impairments in developmental dyscalculia may be linked to disruptions of other functions of the intraparietal sulcus than the magnitude representation. Strikingly, the magnitude representation theory has never been explicitly contrasted with a range of alternatives in a systematic fashion. Here we have filled this gap by directly contrasting five alternative theories (magnitude representation, working memory, inhibition, attention and spatial processing) of developmental dyscalculia in 9–10-year-old primary school children. Participants were selected from a pool of 1004 children and took part in 16 tests and nine experiments. The dominant features of developmental dyscalculia are visuo-spatial working memory, visuo-spatial short-term memory and inhibitory function (interference suppression) impairment. We hypothesize that inhibition impairment is related to the disruption of central executive memory function. Potential problems of visuo-spatial processing and attentional function in developmental dyscalculia probably depend on short-term memory/working memory and inhibition impairments. The magnitude representation theory of developmental dyscalculia was not supported. PMID:23890692
Szucs, Denes; Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Gabriel, Florence
Developmental dyscalculia is thought to be a specific impairment of mathematics ability. Currently dominant cognitive neuroscience theories of developmental dyscalculia suggest that it originates from the impairment of the magnitude representation of the human brain, residing in the intraparietal sulcus, or from impaired connections between number symbols and the magnitude representation. However, behavioral research offers several alternative theories for developmental dyscalculia and neuro-imaging also suggests that impairments in developmental dyscalculia may be linked to disruptions of other functions of the intraparietal sulcus than the magnitude representation. Strikingly, the magnitude representation theory has never been explicitly contrasted with a range of alternatives in a systematic fashion. Here we have filled this gap by directly contrasting five alternative theories (magnitude representation, working memory, inhibition, attention and spatial processing) of developmental dyscalculia in 9-10-year-old primary school children. Participants were selected from a pool of 1004 children and took part in 16 tests and nine experiments. The dominant features of developmental dyscalculia are visuo-spatial working memory, visuo-spatial short-term memory and inhibitory function (interference suppression) impairment. We hypothesize that inhibition impairment is related to the disruption of central executive memory function. Potential problems of visuo-spatial processing and attentional function in developmental dyscalculia probably depend on short-term memory/working memory and inhibition impairments. The magnitude representation theory of developmental dyscalculia was not supported. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
Jovanović, Gordana; Jovanović, Zoran; Banković-Gajić, Jelena; Nikolić, Anđelka; Svetozarević, Srđana; Ignjatović-Ristić, Dragana
Formal education, daily living activities and jobs require knowledge and application skills of counting and simple mathematical operations. Problems with mathematics start in primary school and persist till adulthood. This is known as dyscalculia and its prevalence in the school population ranges from 3 to 6.5%. The study included 1424 third-grade students (aged 9-10) of all primary schools in the City of Kragujevac, Serbia. Tests in mathematics were given in order to determine their mathematical achievement. 1078 students (538 boys and 540 girls) completed all five tests. The frequency of dyscalculia in the sample was 9.9%. The difference between boys and girls according to the total score on the test was statistically significant (pstatistically significant for all tests (pmathematics and Serbian language. Frequency of dyscalculia of 9.9% in the sample is higher than in the other similar studies. Further research should identify possible causes of such frequency of dyscalculia in order to improve students` mathematical abilities.
Knudsen, Greger Siem; Babic, Ankica
This paper presents a study that has developed a mobile software application for assisting diagnosis of learning disabilities in mathematics, called dyscalculia, and measuring correlations between dyscalculia symptoms and magnocellular reasoning. Usually, software aids for dyscalculic individuals are focused on both assisting diagnosis and teaching the material. The software developed in this study however maintains a specific focus on the former, and in the process attempts to capture alleged correlations between dyscalculia symptoms and possible underlying causes of the condition. Classification of symptoms is performed by k-Nearest Neighbor algorithm classifying five parameters evaluating user's skills, returning calculated performance in each category as well as correlation strength between detected symptoms and magnocellular reasoning abilities. Expert evaluations has found the application to be appropriate and productive for its intended purpose, proving that mobile software is a suitable and valuable tool for assisting dyscalculia diagnosis and identifying root causes of developing the condition.
Sousa, Paula; Dias, Paulo C.; Cadime, Irene
Developmental dyscalculia is a specific learning disability that is described as a heterogeneous and persistent cognitive disorder. Given the need to detect and intervene as early as possible to minimise its effects, teachers' knowledge about symptoms, characteristics and effective intervention strategies in dyscalculia is essential. Given the…
Witzel, Bradley; Mize, Minnie
Understanding dyslexia and dyscalculia is not only important to helping students achieve, it has also been recently legislated in one southeastern state. The purpose of the North Carolina House Bill 149 is to ensure that students identified with learning disabilities, including dyslexia and dyscalculia, receive the appropriate assessment and…
Wang, Enguo; Du, Chenguang; Ma, Yujun
This study reports the neurophysiological and behavioral correlates of digital memory retrieval features in Chinese individuals with and without dyscalculia. A total of 18 children with dyscalculia (ages 11.5-13.5) and 18 controls were tested, and their event-related potentials were digitally recorded simultaneously with behavior measurement. Behavioral data showed that the dyscalculia group had lower hit rates and higher false rates than the control group. The electroencephalography results showed that both groups had a significant old/new effect and that this effect was greater in the control group. In the 300 to 400 ms processing stages, both groups showed significant differences in digital memory retrieval in the frontal regions. In the 400 to 500 and 500 to 600 ms epochs, the old/new effect in the control group was significantly greater than it was in the dyscalculia group at the frontal, central, and parietal regions. In the 600 to 700 ms processing stages, both groups showed significant differences in digital memory retrieval in the frontal, central, parietal, and occipital regions. These results suggest that individuals with dyscalculia exhibit impaired digital memory retrieval. Extraction failure may be an important cause of calculation difficulties.
Zhang, Huaiying; Wu, Hanrong
Inhibitory ability of children with developmental dyscalculia (DD) was investigated to explore the cognitive mechanism underlying DD. According to the definition of developmental dyscalculia, 19 children with DD-only and 10 children with DD&RD (DD combined with reading disability) were selected step by step, children in two control groups were matched with children in case groups by gender and age, and the match ratio was 1:1. Psychological testing software named DMDX was used to measure inhibitory ability of the subjects. The differences of reaction time in number Stroop tasks and differences of accuracy in incongruent condition of color-word Stroop tasks and object inhibition tasks between DD-only children and their controls reached significant levels (P<0.05), and the differences of reaction time in number Stroop tasks between dyscalculic and normal children did not disappear after controlling the non-executive components. The difference of accuracy in color-word incongruent tasks between children with DD&RD and normal children reached significant levels (P<0.05). Children with DD-only confronted with general inhibitory deficits, while children with DD&RD confronted with word inhibitory deficits only.
Szucs, Denes; Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Gabriel, Florence
Developmental dyscalculia is thought to be a specific impairment of mathematics ability. Currently dominant cognitive neuroscience theories of developmental dyscalculia suggest that it originates from the impairment of the magnitude representation of the human brain, residing in the intraparietal sulcus, or from impaired connections between number symbols and the magnitude representation. However, behavioral research offers several alternative theories for developmental dyscalculia and neuro-...
Rubinsten, Orly; Henik, Avishai
This work examines the association between symbols and their representation in adult developmental dyscalculia and dyslexia. Experiment 1 used comparative judgment of numerals, and it was found that in physical comparisons (e.g., 3-5 vs. 3-5) the dyscalculia group showed a significantly smaller congruity effect than did the dyslexia and the…
Sietske eVan Viersen
Full Text Available The present study compared eye movements and performance of a nine-year-old girl with Developmental Dyscalculia (DD on a series of number line tasks to those of a group of typically developing (TD children (n = 10, in order to answer the question whether eye-tracking data from number line estimation tasks can be a useful tool to discriminate between TD children and children with a number processing deficit. Quantitative results indicated that the child with dyscalculia performed worse on all symbolic number line tasks compared to the control group, indicated by a low linear fit (R2 and a low accuracy measured by mean percent absolute error. In contrast to the control group, her magnitude representations seemed to be better represented by a logarithmic than a linear fit. Furthermore, qualitative analyses on the data of the child with dyscalculia revealed more unidentifiable fixation patterns in the processing of multi-digit numbers and more dysfunctional estimation strategy use in one third of the estimation trials as opposed to approximately 10% in the control group. In line with her dyscalculia diagnosis, these results confirm the difficulties with spatially representing and manipulating numerosities on a number line, resulting in inflexible and inadequate estimation or processing strategies. It can be concluded from this case study that eye-tracking data can be used to discern different number processing and estimation strategies in TD children and children with a number processing deficit. Hence, eye-tracking data in combination with number line estimation tasks might be a valuable and promising addition to current diagnostic measures.
van Viersen, Sietske; Slot, Esther M; Kroesbergen, Evelyn H; Van't Noordende, Jaccoline E; Leseman, Paul P M
The present study compared eye movements and performance of a 9-year-old girl with Developmental Dyscalculia (DD) on a series of number line tasks to those of a group of typically developing (TD) children (n = 10), in order to answer the question whether eye-tracking data from number line estimation tasks can be a useful tool to discriminate between TD children and children with a number processing deficit. Quantitative results indicated that the child with dyscalculia performed worse on all symbolic number line tasks compared to the control group, indicated by a low linear fit (R (2)) and a low accuracy measured by mean percent absolute error. In contrast to the control group, her magnitude representations seemed to be better represented by a logarithmic than a linear fit. Furthermore, qualitative analyses on the data of the child with dyscalculia revealed more unidentifiable fixation patterns in the processing of multi-digit numbers and more dysfunctional estimation strategy use in one third of the estimation trials as opposed to ~10% in the control group. In line with her dyscalculia diagnosis, these results confirm the difficulties with spatially representing and manipulating numerosities on a number line, resulting in inflexible and inadequate estimation or processing strategies. It can be concluded from this case study that eye-tracking data can be used to discern different number processing and estimation strategies in TD children and children with a number processing deficit. Hence, eye-tracking data in combination with number line estimation tasks might be a valuable and promising addition to current diagnostic measures.
Background: Developmental dyscalculia is a heterogeneous disorder with largely dissociable performance profiles. Though our current understanding of the neurofunctional foundations of (adult) numerical cognition has increased considerably during the past two decades, there are still many unanswered questions regarding the developmental pathways of…
Wang, Enguo; Qin, Shutao; Chang, MengYan; Zhu, Xiangru
This study reports the neurophysiological and behavioral correlates of digital memory encoding features in Chinese individuals with and without dyscalculia. Eighteen children with dyscalculia (ages 11.5-13.5) and 18 matched controls were tested, and their event-related potentials (ERPs) were digitally recorded simultaneously with behavioral measures. The results showed that both groups had a significant Dm effect, and this effect was greater in the control group. In the 300-400-ms, 400-500-ms, and 600-700-ms processing stages, both groups showed significant differences of digital memory encoding in the frontal, central, and parietal regions. In the 500-600-ms period, the Dm effect in the control group was significantly greater than that in the dyscalculia group only in the parietal region. These results suggest that individuals with dyscalculia exhibit impaired digital memory encoding and deficits in psychological resource allocation. Copyright © 2014 Elsevier Ltd. All rights reserved.
One important cause of very low attainment in arithmetic (dyscalculia) seems to be a core deficit in an inherited foundational capacity for numbers. According to one set of hypotheses, arithmetic ability is built on an inherited system responsible for representing approximate numerosity. One account holds that this is supported by a system for representing exactly a small number (less than or equal to four4) of individual objects. In these approaches, the core deficit in dyscalculia lies in either of these systems. An alternative proposal holds that the deficit lies in an inherited system for sets of objects and operations on them (numerosity coding) on which arithmetic is built. I argue that a deficit in numerosity coding, not in the approximate number system or the small number system, is responsible for dyscalculia. Nevertheless, critical tests should involve both longitudinal studies and intervention, and these have yet to be carried out. Copyright © 2010 Elsevier Ltd. All rights reserved.
Vaidya, Sheila Rao
Dyscalculia, a poor understanding of the number concept and the number system, is a learning problem affecting many individuals. However, less is known about this disability than about the reading disability, dyslexia, because society accepts learning problems in mathematics as quite normal. This article provides a summary of the research on…
Landerl, Karin; Fussenegger, Barbara; Moll, Kristina; Willburger, Edith
This study tests the hypothesis that dyslexia and dyscalculia are associated with two largely independent cognitive deficits, namely a phonological deficit in the case of dyslexia and a deficit in the number module in the case of dyscalculia. In four groups of 8- to 10-year-olds (42 control, 21 dyslexic, 20 dyscalculic, and 26…
Mussolin, Christophe; Mejias, Sandrine; Noel, Marie-Pascale
Developmental dyscalculia (DD) is a pervasive difficulty affecting number processing and arithmetic. It is encountered in around 6% of school-aged children. While previous studies have mainly focused on general cognitive functions, the present paper aims to further investigate the hypothesis of a specific numerical deficit in dyscalculia. The…
Morsanyi, Kinga; Devine, Amy; Nobes, Alison; Szucs, Denes
This study examined performance on transitive inference problems in children with developmental dyscalculia (DD), typically developing controls matched on IQ, working memory and reading skills, and in children with outstanding mathematical abilities. Whereas mainstream approaches currently consider DD as a domain-specific deficit, we hypothesized…
Vicario, Carmelo Mario; Rappo, Gaetano; Pepi, Annamaria; Pavan, Andrea; Martino, Davide
Recent imaging studies have associated Developmental dyscalculia (DD) to structural and functional alterations corresponding Parietal and the Prefrontal cortex (PFC). Since these areas were shown also to be involved in timing abilities, we hypothesized that time processing is abnormal in DD. We compared time processing abilities between 10 children with pure DD (8 years old) and 11 age-matched healthy children. Results show that the DD group underestimated duration of a sub-second scale when asked to perform a time comparison task. The timing abnormality observed in our DD participants is consistent with evidence of a shared fronto-parietal neural network for representing time and quantity.
Lindenskov, Lena; Bent, Lindhardt,
Aims, requirements and context for the development of test materials for dyscalculia are analyzed. The test materials are to be used for Grade 4 pupils in Danish primary schools. Preliminary results are presented from focus group interview with adolescents and adults, who see themselves as being...
National Institute of Adult Continuing Education, 2009
Dyscalculia is considered to be a learning difficulty or difference. It is increasingly being recognised and "diagnosed" within adult learning. However, practitioners are often unclear about whether learners who are considered to have dyscalculia are entitled to access arrangements for examinations and assessments, and which access…
Dyscalculia, like dyslexia, affects some 5% of school-age children but has received much less investigative attention. In two thirds of affected children, dyscalculia is associated with another developmental disorder like dyslexia, attention-deficit disorder, anxiety disorder, visual and spatial disorder, or cultural deprivation. Infants, primates, some birds, and other animals are born with the innate ability, called subitizing, to tell at a glance whether small sets of scattered dots or other items differ by one or more item. This nonverbal approximate number system extends mostly to single digit sets as visual discrimination drops logarithmically to "many" with increasing numerosity (size effect) and crowding (distance effect). Preschoolers need several years and specific teaching to learn verbal names and visual symbols for numbers and school agers to understand their cardinality and ordinality and the invariance of their sequence (arithmetic number line) that enables calculation. This arithmetic linear line differs drastically from the nonlinear approximate number system mental number line that parallels the individual number-tuned neurons in the intraparietal sulcus in monkeys and overlying scalp distribution of discrete functional magnetic resonance imaging activations by number tasks in man. Calculation is a complex skill that activates both visual and spatial and visual and verbal networks. It is less strongly left lateralized than language, with approximate number system activation somewhat more right sided and exact number and arithmetic activation more left sided. Maturation and increasing number skill decrease associated widespread non-numerical brain activations that persist in some individuals with dyscalculia, which has no single, universal neurological cause or underlying mechanism in all affected individuals. Copyright © 2016 Elsevier Inc. All rights reserved.
Auerbach, Judith G.; Gross-Tsur, Varda; Manor, Orly; Shalev, Ruth S.
The authors examined behavior problems in a matched sample of 58 youths with persistent dyscalculia (PD) and nonpersistent dyscalculia (NPD). Participants were classified as having dyscalculia at age 10-11 years. Parents completed the Child Behavior Checklist for their children at ages 10-11, 13-14, and 16-17 years, while the youths did so at the…
Abd Halim Fiqa Azureen
Full Text Available Learning disabilities (LD are problem that influence the brain capacity to receive, process, analyse and store information. These processing issues can interfere with learning fundamental abilities, for example, reading (Dyslexia, writing (Dysgraphia and math (Dyscalculia. Fortunately, in today's world technology, we have numerous option techniques for educating and supporting fundamental skills in reading, writing and math such as mobile learning by using mobile app. However, the research in mobile app design model for Dyscalculia children is still scarce: very few studies have focus on how to design and develop appropriate mobile app for Dyscalculia children from the perspective of mobile app designers and developers. The purpose of this paper is to identify the appropriate components that should be included in the mobile app model. Interview sessions were conducted with Dyscalculia practitioners that involved a teacher, paediatric and an educational psychology. This has resulted in identifying 16 components that can be included in the mobile app design model.
Monei, Thato; Pedro, Athena
The acquisition of numerical competency is regarded as imperative for quality of life and economic well-being. Many children have significant mathematical learning difficulties known as dyscalculia. The aim of this research was to systematically review the available literature for interventions with children presenting with dyscalculia in primary…
Osisanya, Ayo; Lazarus, Kelechi; Adewunmi, Abiodun
This study examined the prevalence of dyslexia and dyscalculia among persons with academic deficits in English Language and Mathematics in public primary schools in Ibadan metropolis. A correlational survey study, sampling 477 pupils who were between the ages of eight and 12 years, and in 4th and 5th grades with the use of four research…
Van Hoof, Jo; Verschaffel, Lieven; Ghesquière, Pol; Van Dooren, Wim
Previous research indicated that in several cases learners' errors on rational number tasks can be attributed to learners' tendency to (wrongly) apply natural number properties. There exists a large body of literature both on learners' struggle with understanding the rational number system and on the role of the natural number bias in this struggle. However, little is known about this phenomenon in learners with dyscalculia. We investigated the rational number understanding of learners with dyscalculia and compared it with the rational number understanding of learners without dyscalculia. Three groups of learners were included: sixth graders with dyscalculia, a chronological age match group, and an ability match group. The results showed that the rational number understanding of learners with dyscalculia is significantly lower than that of typically developing peers, but not significantly different from younger learners, even after statistically controlling for mathematics achievement. Next to a delay in their mathematics achievement, learners with dyscalculia seem to have an extra delay in their rational number understanding, compared with peers. This is especially the case in those rational number tasks where one has to inhibit natural number knowledge to come to the right answer. Copyright © 2017 Elsevier Ltd. All rights reserved.
Lafay, Anne; St-Pierre, Marie-Catherine; Macoir, Joël
Numbers may be manipulated and represented mentally over a compressible number line oriented from left to right. According to numerous studies, one of the primary reasons for dyscalculia is related to improper understanding of the mental number line. Children with dyscalculia usually show difficulty when they have to place Arabic numbers on a…
Landerl, Karin; Bevan, Anna; Butterworth, Brian
Thirty-one 8- and 9-year-old children selected for dyscalculia, reading difficulties or both, were compared to controls on a range of basic number processing tasks. Children with dyscalculia only had impaired performance on the tasks despite high-average performance on tests of IQ, vocabulary and working memory tasks. Children with reading…
Ashkenazi, Sarit; Mark-Zigdon, Nitza; Henik, Avishai
Children in third and fourth grades suffering from developmental dyscalculia (DD) and typically developing children were asked to compare numbers to a standard. In two separate blocks, they were asked to compare a number between 1 and 9 to 5, or a two-digit number between 10 and 99 to 55. In the single-digit comparisons, DD children were…
Ramaa, S; Gowramma, I P
This paper describes the procedures adopted by two independent studies in India for identifying and classifying children with dyscalculia in primary schools. For determining the presence of dyscalculia both inclusionary and exclusionary criteria were used. When other possible causes of arithmetic failure had been excluded, figures for dyscalculia came out as 5.98% (15 cases out of 251) in one study and 5.54% (78 out of 1408) in the second. It was found in the latter study that 40 out of the 78 (51.27%) also had reading and writing problems. The findings are discussed in the light of previous studies.
Raja, B. William Dharma; Kumar, S. Praveen
Children with learning disabilities face problems in acquiring the basic skills needed for learning. Dyscalculia is one among those learning disorders which affects the ability to acquire arithmetic skills that are needed to perform mathematical calculations. However this is a learning difficulty which is often not recognized. The objectives of…
Dyscalculia has been described as a specific learning difficulty affecting the ability to acquire arithmetical skills. In recent years, it has become a topic for discussion in the popular media, yet there has been little research undertaken by educational psychologists. This paper provides a summary of neuroscientific research into the development…
Cangoz, Banu; Altun, Arif; Olkun, Sinan; Kacar, Funda
Mathematical skills are becoming increasingly critical for achieving academic and professional success. Developmental dyscalculia (DD) is a childhood-onset disorder characterized by the presence of abnormalities in the acquisition of arithmetic skills affecting approximately 5% of school age children. Diagnosing students with possible dyscalculia…
Chan, Winnie Wai Lan; Au, Terry K.; Tang, Joey
Children struggle with mathematics for different reasons. Developmental dyscalculia and low numeracy--two kinds of mathematical difficulties--may have their roots, respectively, in poor understanding of exact non-symbolic numerosities and of symbolic numerals. This study was the first to explore whether Chinese children, despite cultural and…
Träff, Ulf; Olsson, Linda; Östergren, Rickard; Skagerlund, Kenny
Developmental Dyscalculia (DD) has long been thought to be a monolithic learning disorder that can be attributed to a specific neurocognitive dysfunction. However, recent research has increasingly recognized the heterogeneity of DD, where DD can be differentiated into subtypes in which the underlying cognitive deficits and neural dysfunctions may differ. The aim was to further understand the heterogeneity of developmental dyscalculia (DD) from a cognitive psychological perspective. Utilizing four children (8-9 year-old) we administered a comprehensive cognitive test battery that shed light on the cognitive-behavioral profile of each child. The children were compared against norm groups of aged-matched peers. Performance was then contrasted against predominant hypotheses of DD, which would also give insight into candidate neurocognitive correlates. Despite showing similar mathematical deficits, these children showed remarkable interindividual variability regarding cognitive profile and deficits. Two cases were consistent with the approximate number system deficit account and also the general magnitude-processing deficit account. These cases showed indications of having domain-general deficits as well. One case had an access deficit in combination with a general cognitive deficit. One case suffered from general cognitive deficits only. The results showed that DD cannot be attributed to a single explanatory factor. These findings support a multiple deficits account of DD and suggest that some cases have multiple deficits, whereas other cases have a single deficit. We discuss a previously proposed distinction between primary DD and secondary DD, and suggest hypotheses of dysfunctional neurocognitive correlates responsible for the displayed deficits.
Cappelletti, Marinella; Freeman, Elliot D; Butterworth, Brian L
To test whether atypical number development may affect other types of quantity processing, we investigated temporal discrimination in adults with developmental dyscalculia (DD). This also allowed us to test whether number and time may be sub-served by a common quantity system or decision mechanisms: if they do, both should be impaired in dyscalculia, but if number and time are distinct they should dissociate. Participants judged which of two successively presented horizontal lines was longer in duration, the first line being preceded by either a small or a large number prime ("1" or "9") or by a neutral symbol ("#"), or in a third task participants decided which of two Arabic numbers (either "1," "5," "9") lasted longer. Results showed that (i) DD's temporal discriminability was normal as long as numbers were not part of the experimental design, even as task-irrelevant stimuli; however (ii) task-irrelevant numbers dramatically disrupted DD's temporal discriminability the more their salience increased, though the actual magnitude of the numbers had no effect; in contrast (iii) controls' time perception was robust to the presence of numbers but modulated by numerical quantity: therefore small number primes or numerical stimuli seemed to make durations appear shorter than veridical, but longer for larger numerical prime or numerical stimuli. This study is the first to show spared temporal discrimination - a dimension of continuous quantity - in a population with a congenital number impairment. Our data reinforce the idea of a partially shared quantity system across numerical and temporal dimensions, which supports both dissociations and interactions among dimensions; however, they suggest that impaired number in DD is unlikely to originate from systems initially dedicated to continuous quantity processing like time.
Iuculano, Teresa; Cohen Kadosh, Roi
Nearly 7% of the population exhibit difficulties in dealing with numbers and performing arithmetic, a condition named Developmental Dyscalculia (DD), which significantly affects the educational and professional outcomes of these individuals, as it often persists into adulthood. Research has mainly focused on behavioral rehabilitation, while little is known about performance changes and neuroplasticity induced by the concurrent application of brain-behavioral approaches. It has been shown that numerical proficiency can be enhanced by applying a small-yet constant-current through the brain, a non-invasive technique named transcranial electrical stimulation (tES). Here we combined a numerical learning paradigm with transcranial direct current stimulation (tDCS) in two adults with DD to assess the potential benefits of this methodology to remediate their numerical difficulties. Subjects learned to associate artificial symbols to numerical quantities within the context of a trial and error paradigm, while tDCS was applied to the posterior parietal cortex (PPC). The first subject (DD1) received anodal stimulation to the right PPC and cathodal stimulation to the left PPC, which has been associated with numerical performance's improvements in healthy subjects. The second subject (DD2) received anodal stimulation to the left PPC and cathodal stimulation to the right PPC, which has been shown to impair numerical performance in healthy subjects. We examined two indices of numerical proficiency: (i) automaticity of number processing; and (ii) mapping of numbers onto space. Our results are opposite to previous findings with non-dyscalculic subjects. Only anodal stimulation to the left PPC improved both indices of numerical proficiency. These initial results represent an important step to inform the rehabilitation of developmental learning disabilities, and have relevant applications for basic and applied research in cognitive neuroscience, rehabilitation, and education.
Full Text Available Nearly 7% of the population exhibit difficulties in dealing with numbers and performing arithmetic, a condition named Developmental Dyscalculia (DD, which significantly affects the educational and professional outcomes of these individuals, as it often persists into adulthood. Research has mainly focused on behavioral rehabilitation, while little is known about performance changes and neuroplasticity induced by the concurrent application of brain-behavioral approaches. It has been shown that numerical proficiency can be enhanced by applying a small – yet constant – current through the brain, a non-invasive technique named transcranial electrical stimulation (tES. Here we combined a numerical learning paradigm with transcranial direct current stimulation (tDCS in two adults with DD to assess the potential benefits of this methodology to remediate their numerical difficulties. Subjects learned to associate artificial symbols to numerical quantities within the context of a trial and error paradigm, while tDCS was applied to the posterior parietal cortex (PPC. The first subject (DD1 received anodal stimulation to the right PPC and cathodal stimulation to the left PPC, which has been associated with numerical performance’s improvements in healthy subjects. The second subject (DD2 received anodal stimulation to the left PPC and cathodal stimulation to the right PPC, which has been shown to impair numerical performance in healthy subjects. We examined two indices of numerical proficiency: (i automaticity of number processing; and (ii mapping of numbers onto space. Our results are opposite to previous findings with non-dyscalculic subjects. Only anodal stimulation to the left PPC improved both indices of numerical proficiency. These initial results represent an important step to inform the rehabilitation of developmental learning disabilities, and have relevant applications for basic and applied research in cognitive neuroscience, rehabilitation
Fatemeh Bazzaz Monsef
Full Text Available Background and Objectives: Cognitive functions are one of the most important effective factors in students with dyscalculia. The present research aims to investigate the effectiveness of neurocognitive rehabilitation program on math performance and working memory of students with dyscalculia. Methods: This study was a quasi-experimental study with pretest-posttest design. Thirty elementary students with dyscalculia were selected using convenience sampling, and then the experimental and control groups (each 15 individuals, were matched in terms of age, gender, intelligence, and school grade. The subjects of the experimental group received twenty 45-minute sessions of neurocognitive rehabilitation. To collect the data, Wechsler Intelligence Scale (WISC-R test, Iran Key Math Diagnostic test, Digit Span test, Counting Span task, and Corsi Blocks task, were used. Results: In this study, the results of covariance analysis showed that the scores of the experimental group in working memory (digit span, counting span posttest and in Key-Math posttest, were higher than the control group. Conclusion: The results of this study is indicative of the effectiveness of cognitive rehabilitation in working memory (phonological loop, central executive and math performance (operation and applications in students with dyscalculia.
Yusta, Nyudule; Karugu, Geoffrey; Muthee, Jessica; Tekle, Tesfu
Learners with dyscalculia in the integrated primary schools in Arusha have been performing poorly in the Primary School Leaving Examination (PSLE). Thus, the journal sought to investigate the impact of instructional resources on mathematics performance of learners with dyscalculia in integrated primary schools found in Arusha city, Tanzania. The…
Filippo, Gloria Di; Zoccolotti, Pierluigi
The study examined whether developmental deficits in reading and numerical skills could be expressed in terms of global factors by reference to the rate and amount (RAM) and difference engine (DEM) models. From a sample of 325 fifth grade children, we identified 5 children with dyslexia, 16 with dyscalculia, 7 with a "mixed pattern," and 49 control children. Children were asked to read aloud words presented individually that varied for frequency and length and to respond (either vocally or manually) to a series of simple number tasks (addition, subtraction, number reading, and number comparisons). Reaction times were measured. Results indicated that the deficit of children with dyscalculia and children with a mixed pattern on numerical tasks could be explained by a single global factor, similarly to the reading deficit shown by children with dyslexia. As predicted by the DEM, increases in task difficulty were accompanied by a corresponding increase in inter-individual variability for both the reading and numerical tasks. These relationships were constant across the four groups of children but differed in terms of slope and intercept on the x -axis, indicating that two different general rules underlie performance in reading and numerical skills. The study shows for the first time that, as previously shown for reading, also numerical performance can be explained with reference to a global factor. The advantage of this approach is that it takes into account the over-additivity effect, i.e., the presence of larger group differences in the case of more difficult conditions over and above the characteristics of the experimental conditions. It is concluded that reference to models such as the RAM and DEM can be useful in delineating the characteristics of the dyscalculic deficit as well as in the description of co-morbid disturbances, as in the case of dyslexia and dyscalculia.
Gloria Di Filippo
Full Text Available The study examined whether developmental deficits in reading and numerical skills could be expressed in terms of global factors by reference to the rate and amount (RAM and difference engine (DEM models. From a sample of 325 fifth grade children, we identified 5 children with dyslexia, 16 with dyscalculia, 7 with a “mixed pattern,” and 49 control children. Children were asked to read aloud words presented individually that varied for frequency and length and to respond (either vocally or manually to a series of simple number tasks (addition, subtraction, number reading, and number comparisons. Reaction times were measured. Results indicated that the deficit of children with dyscalculia and children with a mixed pattern on numerical tasks could be explained by a single global factor, similarly to the reading deficit shown by children with dyslexia. As predicted by the DEM, increases in task difficulty were accompanied by a corresponding increase in inter-individual variability for both the reading and numerical tasks. These relationships were constant across the four groups of children but differed in terms of slope and intercept on the x-axis, indicating that two different general rules underlie performance in reading and numerical skills. The study shows for the first time that, as previously shown for reading, also numerical performance can be explained with reference to a global factor. The advantage of this approach is that it takes into account the over-additivity effect, i.e., the presence of larger group differences in the case of more difficult conditions over and above the characteristics of the experimental conditions. It is concluded that reference to models such as the RAM and DEM can be useful in delineating the characteristics of the dyscalculic deficit as well as in the description of co-morbid disturbances, as in the case of dyslexia and dyscalculia.
Full Text Available Abstract Background Functional magnetic resonance imaging (fMRI studies investigating the neural mechanisms underlying developmental dyscalculia are scarce and results are thus far inconclusive. Main aim of the present study is to investigate the neural correlates of nonsymbolic number magnitude processing in children with and without dyscalculia. Methods 18 children (9 with dyscalculia were asked to solve a non-symbolic number magnitude comparison task (finger patterns during brain scanning. For the spatial control task identical stimuli were employed, instructions varying only (judgment of palm rotation. This design enabled us to present identical stimuli with identical visual processing requirements in the experimental and the control task. Moreover, because numerical and spatial processing relies on parietal brain regions, task-specific contrasts are expected to reveal true number-specific activations. Results Behavioral results during scanning reveal that despite comparable (almost at ceiling performance levels, task-specific activations were stronger in dyscalculic children in inferior parietal cortices bilaterally (intraparietal sulcus, supramarginal gyrus, extending to left angular gyrus. Interestingly, fMRI signal strengths reflected a group × task interaction: relative to baseline, controls produced significant deactivations in (intraparietal regions bilaterally in response to number but not spatial processing, while the opposite pattern emerged in dyscalculics. Moreover, beta weights in response to number processing differed significantly between groups in left – but not right – (intraparietal regions (becoming even positive in dyscalculic children. Conclusion Overall, findings are suggestive of (a less consistent neural activity in right (intraparietal regions upon processing nonsymbolic number magnitudes; and (b compensatory neural activity in left (intraparietal regions in developmental dyscalculia.
Kaufmann, Liane; Vogel, Stephan E; Starke, Marc; Kremser, Christian; Schocke, Michael; Wood, Guilherme
Functional magnetic resonance imaging (fMRI) studies investigating the neural mechanisms underlying developmental dyscalculia are scarce and results are thus far inconclusive. Main aim of the present study is to investigate the neural correlates of nonsymbolic number magnitude processing in children with and without dyscalculia. 18 children (9 with dyscalculia) were asked to solve a non-symbolic number magnitude comparison task (finger patterns) during brain scanning. For the spatial control task identical stimuli were employed, instructions varying only (judgment of palm rotation). This design enabled us to present identical stimuli with identical visual processing requirements in the experimental and the control task. Moreover, because numerical and spatial processing relies on parietal brain regions, task-specific contrasts are expected to reveal true number-specific activations. Behavioral results during scanning reveal that despite comparable (almost at ceiling) performance levels, task-specific activations were stronger in dyscalculic children in inferior parietal cortices bilaterally (intraparietal sulcus, supramarginal gyrus, extending to left angular gyrus). Interestingly, fMRI signal strengths reflected a group x task interaction: relative to baseline, controls produced significant deactivations in (intra)parietal regions bilaterally in response to number but not spatial processing, while the opposite pattern emerged in dyscalculics. Moreover, beta weights in response to number processing differed significantly between groups in left - but not right - (intra)parietal regions (becoming even positive in dyscalculic children). Overall, findings are suggestive of (a) less consistent neural activity in right (intra)parietal regions upon processing nonsymbolic number magnitudes; and (b) compensatory neural activity in left (intra)parietal regions in developmental dyscalculia.
Studies in children with AD(H)D without mathematical learning disability (MLD) as well as studies on the effects of methylphenidate on arithmetic have shown that most deficits in mathematics and most error types commonly described as specific to developmental dyscalculia (e. g., finger-counting, fact-retrieval deficit, complex counting, difficulties with carry/borrow procedures, self-corrections) cannot be classified as such and should thus not be used for the differential diagnosis of primary dyscalculia and secondary MLD. This article proposes using the overall score in the dyscalculia test Basis-Math 4-8 (Moser Opitz et al., 2010) as well as implausible subtraction errors as a marker for dyscalculia and the number of self-corrections made during the test as a cognitive marker for attention deficits. Hierarchical cluster analyses were calculated in a sample of 51 clinically referred children with normal IQ and suspicion of MLD, using IQ, years of schooling, overall score of the Basis-Math 4–8 and number of self-corrections in this test as variables. The results revealed a subgroup with primary dyscalculia as well as three subgroups with secondary MLD (two with attention deficit hyperactivity disorder, one with depression and one small subgroup with high IQ). In conclusion, the Basis-Math 4–8 (Moser Opitz et al., 2010) can offer substantial information for the differential diagnosis of dyscalculia and secondary deficits in mathematics due to attention problems and enable optimization of treatment decisions for the different groups.
LDA of Minnesota, 2005
The focus of this issue of "NetNews" is dyscalculia, or math disability. Most of the attention over the years has been on reading and writing difficulties, thus leading to the belief that math difficulties are not very common or serious. However, it has been estimated that about 6% of school-age children experience significant math difficulties.…
Devine, Amy; Soltesz, Fruzsina; Nobes, Alison; Goswami, Usha; Szucs, Denes
Developmental dyscalculia (DD) is a learning difficulty specific to mathematics learning. The prevalence of DD may be equivalent to that of dyslexia, posing an important challenge for effective educational provision. Nevertheless, there is no agreed definition of DD and there are controversies surrounding cutoff decisions, specificity and gender…
Nikolaos Christos Zygouris
Full Text Available Traditional definitions of Developmental Dyscalculia state that a child must substantially underachieve on mathematical abilities tests relative to the level expected given age, education and intelligence. However, cognitive developmental neuropsychological studies nowadays suggest that not only core numerical but also cognitive skills of children with developmental dyscalculia present deficits. The main aim of the research protocol was to construct a battery of six tests that can be delivered by computer in order to screen children’s arithmetic and cognitive skills. The hypothesis of the study was that children that are already diagnosed by paper and pencil tests as dyscalculic will present lower scores and larger time latencies not only in arithmetical but also in executive function tasks. A total of 134 right handed children (74 male and 60 female, age range 8 – 12 years participated in this study. The students with disorders in mathematics (N= 67, 37 male and 30 female age range 8 – 12 years M= 10.15 SD=1.10 had a statement of dyscalculia after assessment at a Centre of Diagnosis, Assessment and Support, as it is required by Greek Law. A comparison group without any learning disabilities was individually matched with the dyscalculic group according to age, sex and grade (N=67, 37 male and 30 female, age range 8 – 12 years old, M=10.24 SD=1.12. Statistical analysis revealed that children with dyscalculia had statistically significant lower mean scores of correct answers and larger time latencies in all tasks compared to their average peers that participated in the comparison group.`
Kucian, Karin; von Aster, Michael
Numerical skills are essential in our everyday life, and impairments in the development of number processing and calculation have a negative impact on schooling and professional careers. Approximately 3 to 6 % of children are affected from specific disorders of numerical understanding (developmental dyscalculia (DD)). Impaired development of number processing skills in these children is characterized by problems in various aspects of numeracy as well as alterations of brain activation and brain structure. Moreover, DD is assumed to be a very heterogeneous disorder putting special challenges to define homogeneous diagnostic criteria. Finally, interdisciplinary perspectives from psychology, neuroscience and education can contribute to the design for interventions, and although results are still sparse, they are promising and have shown positive effects on behaviour as well as brain function. In the current review, we are going to give an overview about typical and atypical development of numerical abilities at the behavioural and neuronal level. Furthermore, current status and obstacles in the definition and diagnostics of DD are discussed, and finally, relevant points that should be considered to make an intervention as successful as possible are summarized.
Five to seven percent of children experience severe difficulties in learning mathematics and/or reading. Current trials that are focused on identifying biological markers suggest that these learning disabilities, known as Developmental Dyscalculia (DD) and Dyslexia (for reading), are due to underlying brain dysfunctions. One ongoing controversy…
Fuertes, Elaine; Standl, Marie; Forns, Joan; Berdel, Dietrich; Garcia-Aymerich, Judith; Markevych, Iana; Schulte-Koerne, Gerd; Sugiri, Dorothea; Schikowski, Tamara; Tiesler, Carla M T; Heinrich, Joachim
Few studies have examined the link between air pollution exposure and behavioural problems and learning disorders during late childhood and adolescence. To determine whether traffic-related air pollution exposure is associated with hyperactivity/inattention, dyslexia and dyscalculia up to age 15years using the German GINIplus and LISAplus birth cohorts (recruitment 1995-1999). Hyperactivity/inattention was assessed using the German parent-completed (10years) and self-completed (15years) Strengths and Difficulties Questionnaire. Responses were categorized into normal versus borderline/abnormal. Parent-reported dyslexia and dyscalculia (yes/no) at age 10 and 15years were defined using parent-completed questionnaires. Individual-level annual average estimates of nitrogen dioxide (NO 2 ), particulate matter (PM) 10 mass, PM 2.5 mass and PM 2.5 absorbance concentrations were assigned to each participant's birth, 10year and 15year home address. Longitudinal associations between the air pollutants and the neurodevelopmental outcomes were assessed using generalized estimation equations, separately for both study areas, and combined in a random-effects meta-analysis. Odds ratios and 95% confidence intervals are given per interquartile range increase in pollutant concentration. The prevalence of abnormal/borderline hyperactivity/inattention scores and parental-reported dyslexia and dyscalculia at 15years of age was 12.9%, 10.5% and 3.4%, respectively, in the combined population (N=4745). In the meta- analysis, hyperactivity/inattention was associated with PM 2.5 mass estimated to the 10 and 15year addresses (1.12 [1.01, 1.23] and 1.11 [1.01, 1.22]) and PM 2.5 absorbance estimated to the 10 and 15year addresses (1.14 [1.05, 1.25] and 1.13 [1.04, 1.23], respectively). We report associations suggesting a potential link between air pollution exposure and hyperactivity/inattention scores, although these findings require replication. Copyright © 2016 Elsevier Ltd. All rights
Mussolin, Christophe; De Volder, Anne; Grandin, Cecile; Schlogel, Xavier; Nassogne, Marie-Cecile; Noel, Marie-Pascale
Developmental dyscalculia (DD) is a deficit in number processing and arithmetic that affects 3-6% of schoolchildren. The goal of the present study was to analyze cerebral bases of DD related to symbolic number processing. Children with DD aged 9-11 years and matched children with no learning disability history were investigated using fMRI. The two…
Mejias, Sandrine; Gregoire, Jacques; Noel, Marie-Pascale
It has been hypothesized that developmental dyscalculia (DD) is either due to a defect of the approximate number system (ANS) or to an impaired access between that system and symbolic numbers. Several studies have tested these two hypotheses in children with DD but none has dealt with adults who had experienced DD as children. This study aimed to…
Mohd Syah, Nor Elleeiana; Hamzaid, Nur Azah; Murphy, Belinda Pingguan; Lim, Einly
This study describes the development of a basic computer-based play pedagogy intervention using a dyscalculia-remedy-oriented approach such as repetition and number orientation manipulation, and the investigation of its effect on children displaying dyscalculia characteristics. This computer play was evaluated in a group of 50 seven-year-old…
Full Text Available The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.
Bhattacharyya, S; Cai, X; Klein, J P
The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.
Full Text Available The present article resulted of the research entitled "Students with dyscalculia: the ransom of the self-esteem and of the solemnity-image through the playfulness", developed as Dissertation of Master’s degree in Education for PUCRS. The investigation was accomplished in the Laboratory of Learning in a municipal public school of Porto Alegre/RS in the year of 2006 and it aimed to verify the influence of the playfulness in the selfesteem and solemnityimage of dyscalcúlicas children. After the psychopedagógical intervention the playfulness it was noticed an elevation in the selfesteem levels and solemnityimage and an increment in the participants’ mathematical capacities.
Rotzer, S.; Loenneker, T.; Kucian, K.; Martin, E.; Klaver, P.; von Aster, M.
The underlying neural mechanisms of developmental dyscalculia (DD) are still far from being clearly understood. Even the behavioral processes that generate or influence this heterogeneous disorder are a matter of controversy. To date, the few studies examining functional brain activation in children with DD mainly focus on number and counting…
Thomé, Ursula; Paixão Alves, Sandra Regina da; Guerreiro, Sabrina Mendonça; Machado da Costa, Célia Regina Carvalho; Souza Moreira, Fernanda de; Bandeira Lima, Andrea; Ferreira Tavares, Maria Rita; Souza Maia Filho, Heber
Epilepsy is one of the most prevalent chronic disorders of childhood which can threaten child development and mental health. Among cognitive disorders, dyscalculia is one of the most important. In this study, 39 children and adolescents with idiopathic epilepsy underwent clinical and neuropsychological assessment to determine the intellectual level, math skills, reading and writing performance and neuropsychological profile. It was observed that the mathematical ability was below schooling expectations in a higher frequency than expected. There were no significant differences in mathematical performance among groups divided by number of antiepileptic drugs used, duration of disease and types and frequency of seizures. There was a positive correlation with intelligence quotient and attentional and reading level. These results suggest the existence not only of dyscalculia, but the concurrence of attentional and reading problems for the poor mathematical performance in this population.
Full Text Available Epilepsy is one of the most prevalent chronic disorders of childhood which can threaten child development and mental health. Among cognitive disorders, dyscalculia is one of the most important. In this study, 39 children and adolescents with idiopathic epilepsy underwent clinical and neuropsychological assessment to determine the intellectual level, math skills, reading and writing performance and neuropsychological profile. It was observed that the mathematical ability was below schooling expectations in a higher frequency than expected. There were no significant differences in mathematical performance among groups divided by number of antiepileptic drugs used, duration of disease and types and frequency of seizures. There was a positive correlation with intelligence quotient and attentional and reading level. These results suggest the existence not only of dyscalculia, but the concurrence of attentional and reading problems for the poor mathematical performance in this population.
De Visscher, Alice; Noël, Marie-Pascale
While the heterogeneity of developmental dyscalculia is increasingly recognized, the different profiles have not yet been clearly established. Among the features underpinning types of developmental dyscalculia suggested in the literature, an impairment in arithmetic fact retrieval is particularly prominent. In this paper, we present a case study of an adult woman (DB) with very good cognitive capacities suffering from a specific and developmental arithmetic fact retrieval deficit. We test the main hypotheses about developmental dyscalculia derived from literature. We first explore the influential hypothesis of an approximate number system deficit, through estimation tasks, comparison tasks and a priming comparison task. Secondly, we evaluate whether DB's mathematical deficiencies are caused by a rote verbal memory deficit, using tasks involving completion of expressions, and reciting automatic series such as the alphabet and the months of the year. Alternatively, taking into account the extreme similarity of the arithmetic facts, we propose that a heightened sensitivity to interference could have prevented DB from memorizing the arithmetic facts. The pattern of DB's results on different tasks supports this hypothesis. Our findings identify a new etiology of a specific impairment of arithmetic facts storage, namely a hypersensitivity-to-interference. Copyright © 2012 Elsevier Ltd. All rights reserved.
Mazzocco, Michele M. M.; Feigenson, Lisa; Halberda, Justin
Many children have significant mathematical learning disabilities (MLD, or dyscalculia) despite adequate schooling. The current study hypothesizes that MLD partly results from a deficiency in the Approximate Number System (ANS) that supports nonverbal numerical representations across species and throughout development. In this study of 71 ninth…
Attout, Lucie; Salmon, Eric; Majerus, Steve
Recent studies suggest that order working memory (WM) may be specifically associated with numerical abilities. This study explored behavioral performance and neural networks associated with verbal WM in adults with a history of developmental dyscalculia (DD). The DD group performed significantly poorer but with the same precision than the control group in order WM tasks and showed a lower activation of the right middle frontal gyrus during the order WM and the alphabetical order judgment tasks. This study suggests a persistent impairment in order WM in adults with DD, characterized by more general difficulties in controlled activation of order information.
Piazza, Manuela; Facoetti, Andrea; Trussardi, Anna Noemi; Berteletti, Ilaria; Conte, Stefano; Lucangeli, Daniela; Dehaene, Stanisalas; Zorzi, Marco
Developmental dyscalculia is a learning disability that affects the acquisition of knowledge about numbers and arithmetic. It is widely assumed that numeracy is rooted on the "number sense", a core ability to grasp numerical quantities that humans share with other animals and deploy spontaneously at birth. To probe the links between number sense…
Full Text Available Abstract Background In a companion article 1, we described the development and evaluation of software designed to remediate dyscalculia. This software is based on the hypothesis that dyscalculia is due to a "core deficit" in number sense or in its access via symbolic information. Here we review the evidence for this hypothesis, and present results from an initial open-trial test of the software in a sample of nine 7–9 year old children with mathematical difficulties. Methods Children completed adaptive training on numerical comparison for half an hour a day, four days a week over a period of five-weeks. They were tested before and after intervention on their performance in core numerical tasks: counting, transcoding, base-10 comprehension, enumeration, addition, subtraction, and symbolic and non-symbolic numerical comparison. Results Children showed specific increases in performance on core number sense tasks. Speed of subitizing and numerical comparison increased by several hundred msec. Subtraction accuracy increased by an average of 23%. Performance on addition and base-10 comprehension tasks did not improve over the period of the study. Conclusion Initial open-trial testing showed promising results, and suggested that the software was successful in increasing number sense over the short period of the study. However these results need to be followed up with larger, controlled studies. The issues of transfer to higher-level tasks, and of the best developmental time window for intervention also need to be addressed.
Wilson, Anna J; Revkin, Susannah K; Cohen, David; Cohen, Laurent; Dehaene, Stanislas
Background In a companion article , we described the development and evaluation of software designed to remediate dyscalculia. This software is based on the hypothesis that dyscalculia is due to a "core deficit" in number sense or in its access via symbolic information. Here we review the evidence for this hypothesis, and present results from an initial open-trial test of the software in a sample of nine 7–9 year old children with mathematical difficulties. Methods Children completed adaptive training on numerical comparison for half an hour a day, four days a week over a period of five-weeks. They were tested before and after intervention on their performance in core numerical tasks: counting, transcoding, base-10 comprehension, enumeration, addition, subtraction, and symbolic and non-symbolic numerical comparison. Results Children showed specific increases in performance on core number sense tasks. Speed of subitizing and numerical comparison increased by several hundred msec. Subtraction accuracy increased by an average of 23%. Performance on addition and base-10 comprehension tasks did not improve over the period of the study. Conclusion Initial open-trial testing showed promising results, and suggested that the software was successful in increasing number sense over the short period of the study. However these results need to be followed up with larger, controlled studies. The issues of transfer to higher-level tasks, and of the best developmental time window for intervention also need to be addressed. PMID:16734906
Narimani, Mohammad; Abbasi, Moslem; Abolghasemi, Abbas; Ahadi, Batoul
Now a days the utilization of Acceptance / Commitment and Emotion Regulation Strategy as a comprehensive treatment plan has been discussed in both the prevention and the control of destructive and risky behaviors. Treatment based on Acceptance/Commitment and Emotion Regulation was effective in both the improvement and the control of high-risk behaviors of students with dyscalculia. The purpose of this study was to investigate the effectiveness of Acceptance and Commitment, and Emotional Regulation training in high-risk behaviors of students with dyscalculia. This research was experimental, with pre-test, post-test and a control group. The statistical universe of this study included all sixth-grade male students in Ardabil city in the academic year of 2012-2013 (A.H.). The subjects of this study involved 800 sixth-grade elementary students in Ardabil province, selected using a multi-stage cluster sampling. From among them, 60 students with dyscalculia were selected using random sampling method after the initial diagnosis by structured clinical interview and the Keymath Mathematic test. Twenty pupil were selected for either the experimental or the control group. To collect data, the questionnaires of "Keymath Mathematic test" and High-risk Behavior" were used. The results of Multivariate Analysis of Variance (MANOVA) showed that "Acceptance / Commitment and Emotion Regulation" treatment trainings were effective in reducing high-risk behaviors, in a manner that they led to a reduction in negative emotions, self-destructive and impulsive behaviors of students with math disorder (dyscalculia). It can be concluded that teaching these skills to the students has been influential in enhancing awareness level and change or positive attitude creation in the subjects. Therefore, it is essential to design and implement interventions based on "prevention caused by the peer group, in collaboration with the parents either at the school or at home among the family members".
Skagerlund, Kenny; Träff, Ulf
This study investigated if developmental dyscalculia (DD) in children with different profiles of mathematical deficits has the same or different cognitive origins. The defective approximate number system hypothesis and the access deficit hypothesis were tested using two different groups of children with DD (11-13 years old): a group with…
Full Text Available In this paper a didactical method that has been proven effective for evaluating the “resistance to the treatment” of the student is presented. This parameter is essential for distinguishing the learning difficulties in mathematics from the learning disorder of dyscalculia. The method is based on GimmeFive, an application that has been designed to develop skills in mental calculation of multi-digit additions and subtractions. In this paper we present the results of two experiments conducted with groups of students respectively with learning difficulties in mathematics and dyscalculia. These experiments allowed to show the effectiveness of the didactical method in the evaluation of the resistance to the treatment and to discuss the features that make it adequate for the evaluation of the learning disorder. An educational method for evaluating the resistance to the treatment in the diagnosis of dyscalculiaIn questo lavoro viene presentato un metodo didattico che si è dimostrato efficace per valutare la resistenza al trattamento dello studente che è uno dei parametri fondamentali per distinguere la difficoltà di apprendimento in matematica dal disturbo di apprendimento noto come discalculia. Il metodo si basa sull’uso dell’applicazione GimmeFive che è stata progettata per sviluppare competenze nel calcolo mentale di addizioni e sottrazioni a più cifre. In questo lavoro vengono presentati risultati di due sperimentazioni condotte con gruppi di studenti rispettivamente con difficoltà di apprendimento e con diagnosi di discalculia. Queste sperimentazioni hanno consentito di mostrare l’efficacia del metodo didattico nella valutazione della resistenza al trattamento e di discutere le caratteristiche che lo rendono adeguato per la valutazione del disturbo di apprendimento.
Abd Halim Fiqa Azureen; Mohd Ariffin Mazeyanti; K. Sugathan Savita
Learning disabilities (LD) are problem that influence the brain capacity to receive, process, analyse and store information. These processing issues can interfere with learning fundamental abilities, for example, reading (Dyslexia), writing (Dysgraphia) and math (Dyscalculia). Fortunately, in today's world technology, we have numerous option techniques for educating and supporting fundamental skills in reading, writing and math such as mobile learning by using mobile app. However, the researc...
Gergely, Katalin; Lakos, Renáta
Pediatricians play an important role in the diagnosis and therapy of children with dyslexia, dysgraphia or dyscalculia. These syndromes strongly affect children's school performance. Children with dyslexia, dysgraphia or dyscalculia show a significant underachievement in reading, writing or counting and their failure to meet the school requirements undermines their self confidence and positive self-concept. As a result, children with learning problems often become aggressive, frustrated or play the clown in the classroom. According to the Hungarian law children with any learning difficulties have the right to get special education by their specific symptoms. In the realisation of the law and equity the pediatrician's expertise is essential and has an important role in the therapeutical procedures. However, the pediatrician's role is more complex than writing an opinion. Pediatricians can help by giving a detailed description about these syndromes and explain them how they can help their child, what are the main difficulties during the child's studies, what kind of therapies can be efficient and how they can make their child's school years easier. During the assessment most of the parents ask the following questions: What does dyslexia, dyscalculia or dysgraphia exactly mean? Is it a handicap or a learning difficulty? Could the child live a normal life? With the proper answer and with an inclusive attitude pediatricians can help both the parents and the children to create a liveable lifestyle and make their children's schoolwork more successful. The authors' opinions are to close the medical and the pedagogical view, because without the cooperation of these two scientific fields, the theme affected parents, children and teachers cannot get proper help to find better solution and support for their problems. In the survey the authors intend to give a complex view about the symptoms of these syndromes and try to give useful advice for pediatricians how they can support
Henik, Avishai; Rubinsten, Orly; Ashkenazi, Sarit
Developmental dyscalculia (DD) is a congenital deficit that affects the ability to acquire arithmetical skills. Individuals with DD have problems learning standard number facts and procedures. Estimates of the prevalence rate of DD are similar to those of developmental dyslexia. Recent reports and discussions suggest that those with DD suffer from specific deficits (e.g., subitizing, comparative judgment). Accordingly, DD has been described as a domain-specific disorder that involves particular brain areas (e.g., intra-parietal sulcus). However, we and others have found that DD is characterized by additional deficiencies and may be affected by domain-general (e.g., attention) factors. Hence "pure DD" might be rather rare and not as pure as one would think. We suggest that the heterogeneity of symptoms that commonly characterize learning disabilities needs to be taken into account in future research and treatment.
Thomé,Ursula; Alves,Sandra Regina da Paixão; Guerreiro,Sabrina Mendonça; Costa,Célia Regina Carvalho Machado da; Moreira,Fernanda de Souza; Lima,Andrea Bandeira; Tavares,Maria Rita Ferreira; Maia Filho,Heber Souza
Epilepsy is one of the most prevalent chronic disorders of childhood which can threaten child development and mental health. Among cognitive disorders, dyscalculia is one of the most important. In this study, 39 children and adolescents with idiopathic epilepsy underwent clinical and neuropsychological assessment to determine the intellectual level, math skills, reading and writing performance and neuropsychological profile. It was observed that the mathematical ability was below schooling ex...
Rosenberg-Lee, Miriam; Ashkenazi, Sarit; Chen, Tianwen; Young, Christina B.; Geary, David C.; Menon, Vinod
Developmental dyscalculia (DD) is marked by specific deficits in processing numerical and mathematical information despite normal intelligence (IQ) and reading ability. We examined how brain circuits used by young children with DD to solve simple addition and subtraction problems differ from those used by typically developing (TD) children who…
Soltesz, Fruzsina; Szucs, Denes
Developmental dyscalculia (DD) still lacks a generally accepted definition. A major problem is that the cognitive component processes contributing to arithmetic performance are still poorly defined. By a reanalysis of our previous event-related brain potential (ERP) data (Soltesz et al., 2007) here our objective was to identify and compare…
Bugden, Stephanie; Ansari, Daniel
In the present study we examined whether children with Developmental Dyscalculia (DD) exhibit a deficit in the so-called "Approximate Number System" (ANS). To do so, we examined a group of elementary school children who demonstrated persistent low math achievement over 4 years and compared them to typically developing (TD), aged-matched…
Devine, A; Hill, F; Carey, E; Szucs, Denes
© 2017 APA, all rights reserved). A negative correlation between math anxiety and mathematics performance is frequently reported. Thus, some may assume that high levels of mathematics anxiety are associated with poor mathematical understanding. However, no previous research has clearly measured the association between mathematics anxiety and mathematical learning disability. To fill this gap, here we investigated the comorbidity of developmental dyscalculia (a selective, serious deficit in ma...
Layes, Smail; Lalonde, Robert; Bouakkaz, Yamina; Rebai, Mohamed
We examined whether the working memory (WM) capacity of developmentally dyscalculic children can be improved by a WM training program and whether outcomes relate to mathematical performance. The experimental design comprised two groups with developmental dyslexia with grade 4 schooling: an experimental group (n = 14; mean age = 129.74 months) and a control group (n = 14; mean age = 126.9 months). All participants were assessed on measures of WM, mathematic attainment, and nonverbal mental ability (Raven test) before and after training. The WM training program focused on manipulating and maintaining arithmetic information. The results show that both WM and mathematical performances improved significantly after intervention, indicating a strong relationship between these two constructs. The control group improved slightly in Raven's progressive matrices and a reading number task. These findings are discussed in terms of near and far transfer toward trained and untrained skills and stress the positive impact of WM training on learning mathematics in children with dyscalculia.
Numbers are one of the most pervasive stimulus categories in our environment and an integral foundation of modern society. Yet, up to 20% of individuals fail to understand, represent, and manipulate numbers and form the basis of arithmetic, a condition termed developmental dyscalculia (DD). Multiple cognitive and neural systems including those that serve numerical, mnemonic, visuospatial, and cognitive control functions have independently been implicated in the etiology of DD, yet most studies have not taken a comprehensive or dynamic view of the disorder. This chapter supports the view of DD as a multifaceted neurodevelopmental disorder that is the result of multiple aberrancies at one or multiple levels of the information processing hierarchy, which supports successful arithmetic learning, and suggests that interventions should target all these systems to achieve successful outcomes, at the behavioral and neural levels. © 2016 Elsevier B.V. All rights reserved.
Magda Solange Vanzo Pestun
Full Text Available Nonverbal learning disabilities (NVLD, a clinical condition still little reported in Brazil, are characterized by damages in the visual spatial domains, visual motor integration, fine motor skills, math skills and social and emotional difficulties. Developmental Dyscalculia (DD is a neurodevelopmental disorder that affects basic arithmetic skills acquisition, including storage and recovery of arithmetic facts, calculation fluency and precision and number sense domain. Although both are persistent Math learning disorder/disability, they cause different damages. The objective of this case report is to describe, compare and analyze the neuropsychological profile of two Brazilian children with similar complaints but distinct diagnosis.
Full Text Available The relationship between numbers and other magnitudes has been extensively investigated in the scientific literature. Here, the objectives were to examine whether two continuous magnitudes, area and perimeter, are automatically processed and whether adults with developmental dyscalculia (DD are deficient in their ability to automatically process one or both of these magnitudes. Fifty-seven students (30 with DD and 27 with typical development performed a novel Stroop-like task requiring estimation of one aspect (area or perimeter while ignoring the other. In order to track possible changes in automaticity due to practice, we measured performance after initial and continuous exposure to stimuli. Similar to previous findings, current results show a significant group × congruency interaction, evident beyond exposure level or magnitude type. That is, the DD group systematically showed larger Stroop effects. However, analysis of each exposure period showed that during initial exposure to stimuli the DD group showed larger Stroop effects in the perimeter and not in the area task. In contrast, during continuous exposure to stimuli no triple interaction was evident. It is concluded that both magnitudes are automatically processed. Nevertheless, individuals with DD are deficient in inhibiting irrelevant magnitude information in general and, specifically, struggle to inhibit salient area information after initial exposure to a perimeter comparison task. Accordingly, the findings support the assumption that DD involves a deficiency in multiple cognitive components, which include domain-specific and domain-general cognitive functions.
Eidlin-Levy, Hili; Rubinsten, Orly
The relationship between numbers and other magnitudes has been extensively investigated in the scientific literature. Here, the objectives were to examine whether two continuous magnitudes, area and perimeter, are automatically processed and whether adults with developmental dyscalculia (DD) are deficient in their ability to automatically process one or both of these magnitudes. Fifty-seven students (30 with DD and 27 with typical development) performed a novel Stroop-like task requiring estimation of one aspect (area or perimeter) while ignoring the other. In order to track possible changes in automaticity due to practice, we measured performance after initial and continuous exposure to stimuli. Similar to previous findings, current results show a significant group × congruency interaction, evident beyond exposure level or magnitude type. That is, the DD group systematically showed larger Stroop effects. However, analysis of each exposure period showed that during initial exposure to stimuli the DD group showed larger Stroop effects in the perimeter and not in the area task. In contrast, during continuous exposure to stimuli no triple interaction was evident. It is concluded that both magnitudes are automatically processed. Nevertheless, individuals with DD are deficient in inhibiting irrelevant magnitude information in general and, specifically, struggle to inhibit salient area information after initial exposure to a perimeter comparison task. Accordingly, the findings support the assumption that DD involves a deficiency in multiple cognitive components, which include domain-specific and domain-general cognitive functions.
Kuhn, Jörg-Tobias; Ise, Elena; Raddatz, Julia; Schwenk, Christin; Dobel, Christian
Deficits in basic numerical skills, calculation, and working memory have been found in children with developmental dyscalculia (DD) as well as children with attention-deficit/hyperactivity disorder (ADHD). This paper investigates cognitive profiles of children with DD and/or ADHD symptoms (AS) in a double dissociation design to obtain a better understanding of the comorbidity of DD and ADHD. Children with DD-only (N = 33), AS-only (N = 16), comorbid DD+AS (N = 20), and typically developing controls (TD, N = 40) were assessed on measures of basic numerical processing, calculation, working memory, processing speed, and neurocognitive measures of attention. Children with DD (DD, DD+AS) showed deficits in all basic numerical skills, calculation, working memory, and sustained attention. Children with AS (AS, DD+AS) displayed more selective difficulties in dot enumeration, subtraction, verbal working memory, and processing speed. Also, they generally performed more poorly in neurocognitive measures of attention, especially alertness. Children with DD+AS mostly showed an additive combination of the deficits associated with DD-only and A_Sonly, except for subtraction tasks, in which they were less impaired than expected. DD and AS appear to be related to largely distinct patterns of cognitive deficits, which are present in combination in children with DD+AS.
De Visscher, Alice; Noël, Marie-Pascale; Pesenti, Mauro; Dormal, Valérie
Numerous studies have tried to identify the core deficit of developmental dyscalculia (DD), mainly by assessing a possible deficit of the mental representation of numerical magnitude. Research in healthy adults has shown that numerosity, duration, and space share a partly common system of magnitude processing and representation. However, in DD, numerosity processing has until now received much more attention than the processing of other non-numerical magnitudes. To assess whether or not the processing of non-numerical magnitudes is impaired in DD, the performance of 15 adults with DD and 15 control participants was compared in four categorization tasks using numerosities, lengths, durations, and faces (as non-magnitude-based control stimuli). Results showed that adults with DD were impaired in processing numerosity and duration, while their performance in length and face categorization did not differ from controls' performance. Our findings support the idea of a nonsymbolic magnitude deficit in DD, affecting numerosity and duration processing but not length processing.
Mussolin, Christophe; Martin, Romain; Schiltz, Christine
A large body of evidence indicates clear relationships between number and space processing in healthy and brain-damaged adults, as well as in children. The present paper addressed this issue regarding atypical math development. Adults with a diagnosis of dyscalculia (DYS) during childhood were compared to adults with average or high abilities in mathematics across two bisection tasks. Participants were presented with Arabic number triplets and had to judge either the number magnitude or the spatial location of the middle number relative to the two outer numbers. For the numerical judgment, adults with DYS were slower than both groups of control peers. They were also more strongly affected by the factors related to number magnitude such as the range of the triplets or the distance between the middle number and the real arithmetical mean. By contrast, adults with DYS were as accurate and fast as adults who never experienced math disability when they had to make a spatial judgment. Moreover, number-space congruency affected performance similarly in the three experimental groups. These findings support the hypothesis of a deficit of number magnitude representation in DYS with a relative preservation of some spatial mechanisms in DYS. Results are discussed in terms of direct and indirect number-space interactions. Copyright © 2011 Elsevier B.V. All rights reserved.
Devine, Amy; Soltész, Fruzsina; Nobes, Alison; Goswami, Usha; Szűcs, Dénes
Developmental dyscalculia (DD) is a learning difficulty specific to mathematics learning. The prevalence of DD may be equivalent to that of dyslexia, posing an important challenge for effective educational provision. Nevertheless, there is no agreed definition of DD and there are controversies surrounding cutoff decisions, specificity and gender differences. In the current study, 1004 British primary school children completed mathematics and reading assessments. The prevalence of DD and gender ratio were estimated in this sample using different criteria. When using absolute thresholds, the prevalence of DD was the same for both genders regardless of the cutoff criteria applied, however gender differences emerged when using a mathematics-reading discrepancy definition. Correlations between mathematics performance and the control measures selected to identify a specific learning difficulty affect both prevalence estimates and whether a gender difference is in fact identified. Educational implications are discussed.
Mammarella, Irene C; Bomba, Monica; Caviola, Sara; Broggi, Fiorenza; Neri, Francesca; Lucangeli, Daniela; Nacinovich, Renata
The main goal of the present study was to shed further light on the weaknesses of children with different profiles of mathematical difficulties, testing children with nonverbal learning disability (NLD), co-morbid dyscalculia and dyslexia (D&D), or typical development (TD). Sixteen children with NLD, 15 with D&D, and 16 with TD completed tasks derived from Butterworth (2003 ) and divided into: a capacity subscale (i.e., a number-dots comparison task, a number comparison task, and a dots comparison task); and an achievement subscale (i.e., mental calculations and arithmetical fact retrieval). Children with NLD were impaired in the dots comparison task, children with D&D in the mental calculation and arithmetical facts.
Castro Cañizares, Danilka; Reigosa Crespo, Vivian; González Alemañy, Eduardo
The aim of this study was to evaluate if children with Developmental Dyscalculia (DD) exhibit a general deficit in magnitude representations or a specific deficit in the connection of symbolic representations with the corresponding analogous magnitudes. DD was diagnosed using a timed arithmetic task. The experimental magnitude comparison tasks were presented in non-symbolic and symbolic formats. DD and typically developing (TD) children showed similar numerical distance and size congruity effects. However, DD children performed significantly slower in the symbolic task. These results are consistent with the access deficit hypothesis, according to which DD children's deficits are caused by difficulties accessing magnitude information from numerical symbols rather than in processing numerosities per se.
Full Text Available To test whether atypical number development may affect other types of quantity processing, we investigated temporal discrimination in adults with developmental dyscalculia (DD. This also allowed us to test whether (1 number and time may be sub-served by a common quantity system or decision mechanisms –in which case they may both be impaired, or (2 whether number and time are distinct –and therefore they may dissociate. Participants judged which of two successively presented horizontal lines was longer in duration, the first line being preceded by either a small or a large number prime (‘1’ or ‘9’ or by a neutral symbol (‘#’, or in third task decide which of two Arabic numbers (either ‘1’, ‘5’, ’9’ lasted longer. Results showed that (i DD’s temporal discriminability was normal as long as numbers were not part of the experimental design even as task-irrelevant stimuli; however (ii task-irrelevant numbers dramatically disrupted DD’s temporal discriminability, the more their salience increased, though the actual magnitude of the numbers had no effect; and in contrast (iii controls’ time perception was robust to the presence of numbers but modulated by numerical quantity such that small number primes or numerical stimuli made durations appear shorter than veridical and the opposite for larger numerical prime or numerical stimuli. This study is the first to investigate continuous quantity as time in a population with a congenital number impairment and to show that atypical development of numerical competence leaves continuous quantity processing spared. Our data support the idea of a partially shared quantity system across numerical and temporal dimensions, which allows dissociations and interactions among dimensions; furthermore, they suggest that impaired number in DD is unlikely to originate from systems initially dedicated to continuous quantity processing like time.
Mammarella, Irene C; Caviola, Sara; Cornoldi, Cesare; Lucangeli, Daniela
This study examined the involvement of verbal and visuo-spatial domains in solving addition problems with carrying in a sample of children diagnosed with developmental dyscalculia (DD) divided into two groups: (i) those with DD alone and (ii) those with DD and dyslexia. Age and stage matched typically developing (TD) children were also studied. The addition problems were presented horizontally or vertically and associated with verbal or visuo-spatial information. Study results showed that DD children's performance on mental calculation tasks was more impaired when they tackled horizontally presented addition problems compared to vertically presented ones that are associated to verbal domain involvement. The performance pattern in the two DD groups was found to be similar. The theoretical, clinical and educational implications of these findings are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.
Bastos, José Alexandre; Cecato, Angela Maria Traldi; Martins, Marielza Regina Ismael; Grecca, Kelly Regina Risso; Pierini, Rafael
The goal of the study was to assess public school children at the end of the first stage of elementary school. We used a protocol applied concurrently with a writing test in the form of an unexpected activity in 28 public schools; 2,893 children assessed, 687 exhibited performance below 58 points, 184 were excluded due to change of address or lack of consent; 503 children subjected to a test of intellectual capacity and reading assessment and 71 considered intellectually disabled were excluded. 226 (7.8%) children, who could read, write, and had normal intellectual level, met the criteria of developmental dyscalculia (DD), 98 female and 128 male. The most influential factors in the prevalence were socioeconomic levels of the schools neighborhood, education level of parents, and being male, as demonstrated by the odds ratio and multiple logistic regression analysis. Further studies should be done so that educational policies are taken.
Simms, Victoria; Gilmore, Camilla; Cragg, Lucy; Clayton, Sarah; Marlow, Neil; Johnson, Samantha
Children born very preterm (mathematics learning difficulties that are out of proportion to other academic and cognitive deficits. However, the etiology of mathematics difficulties in very preterm children is unknown. We sought to identify the nature and origins of preterm children's mathematics difficulties. One hundred and fifteen very preterm children aged 8-10 y were assessed in school with a control group of 77 term-born classmates. Achievement in mathematics, working memory, visuospatial processing, inhibition, and processing speed were assessed using standardized tests. Numerical representations and specific mathematics skills were assessed using experimental tests. Very preterm children had significantly poorer mathematics achievement, working memory, and visuospatial skills than term-born controls. Although preterm children had poorer performance in specific mathematics skills, there was no evidence of imprecise numerical representations. Difficulties in mathematics were associated with deficits in visuospatial processing and working memory. Mathematics difficulties in very preterm children are associated with deficits in working memory and visuospatial processing not numerical representations. Thus, very preterm children's mathematics difficulties are different in nature from those of children with developmental dyscalculia. Interventions targeting general cognitive problems, rather than numerical representations, may improve very preterm children's mathematics achievement.
José Alexandre Bastos
Full Text Available ABSTRACT The goal of the study was to assess public school children at the end of the first stage of elementary school. We used a protocol applied concurrently with a writing test in the form of an unexpected activity in 28 public schools; 2,893 children assessed, 687 exhibited performance below 58 points, 184 were excluded due to change of address or lack of consent; 503 children subjected to a test of intellectual capacity and reading assessment and 71 considered intellectually disabled were excluded. 226 (7.8% children, who could read, write, and had normal intellectual level, met the criteria of developmental dyscalculia (DD, 98 female and 128 male. The most influential factors in the prevalence were socioeconomic levels of the schools neighborhood, education level of parents, and being male, as demonstrated by the odds ratio and multiple logistic regression analysis. Further studies should be done so that educational policies are taken.
Gifford, Sue; Rockliffe, Freda
This article reviews the nature of learning difficulties in mathematics and, in particular, the nature and prevalence of dyscalculia, a condition that affects the acquisition of arithmetical skills. The evidence reviewed suggests that younger children (under the age of 10) often display a combination of problems, including minor physical…
Rubinsten, Orly; Tannock, Rosemary
Math anxiety, defined as a negative affective response to mathematics, is known to have deleterious effects on math performance in the general population. However, the assumption that math anxiety is directly related to math performance, has not yet been validated. Thus, our primary objective was to investigate the effects of math anxiety on numerical processing in children with specific deficits in the acquisition of math skills (Developmental Dyscalculia; DD) by using a novel affective priming task as an indirect measure. Participants (12 children with DD and 11 typically-developing peers) completed a novel priming task in which an arithmetic equation was preceded by one of four types of priming words (positive, neutral, negative or related to mathematics). Children were required to indicate whether the equation (simple math facts based on addition, subtraction, multiplication or division) was true or false. Typically, people respond to target stimuli more quickly after presentation of an affectively-related prime than after one that is unrelated affectively. Participants with DD responded faster to targets that were preceded by both negative primes and math-related primes. A reversed pattern was present in the control group. These results reveal a direct link between emotions, arithmetic and low achievement in math. It is also suggested that arithmetic-affective priming might be used as an indirect measure of math anxiety.
Full Text Available Abstract Background Math anxiety, defined as a negative affective response to mathematics, is known to have deleterious effects on math performance in the general population. However, the assumption that math anxiety is directly related to math performance, has not yet been validated. Thus, our primary objective was to investigate the effects of math anxiety on numerical processing in children with specific deficits in the acquisition of math skills (Developmental Dyscalculia; DD by using a novel affective priming task as an indirect measure. Methods Participants (12 children with DD and 11 typically-developing peers completed a novel priming task in which an arithmetic equation was preceded by one of four types of priming words (positive, neutral, negative or related to mathematics. Children were required to indicate whether the equation (simple math facts based on addition, subtraction, multiplication or division was true or false. Typically, people respond to target stimuli more quickly after presentation of an affectively-related prime than after one that is unrelated affectively. Result Participants with DD responded faster to targets that were preceded by both negative primes and math-related primes. A reversed pattern was present in the control group. Conclusion These results reveal a direct link between emotions, arithmetic and low achievement in math. It is also suggested that arithmetic-affective priming might be used as an indirect measure of math anxiety.
Gliksman, Yarden; Henik, Avishai
People suffering from developmental dyscalculia (DD) are known to have impairment in numerical abilities and have been found to have weaker processing of countable magnitudes. However, not much research was done on their abilities to process noncountable magnitudes. An example of noncountable magnitude is conceptual size (e.g., mouse is small and elephant is big). Recently, we found that adults process conceptual size automatically. The current study examined automatic processing of conceptual size in students with DD and developmental dyslexia. Conceptual and physical sizes were manipulated orthogonally to create congruent (e.g., a physically small apple compared to a physically large violin) and incongruent (e.g., a physically large apple compared to a physically small violin) conditions. Participants were presented with 2 objects and had to choose the larger one. Each trial began with an instruction to respond to the physical or to the conceptual dimension. Control and the dyslexic groups presented automatic processing of both conceptual and physical sizes. The dyscalculic group presented automatic processing of physical size but not automaticity of processing conceptual size. Our results fit with previous findings of weaker magnitude representation in those with DD, specifically regarding noncountable magnitudes, and support theories of a shared neurocognitive substrate for different types of magnitudes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Background Math anxiety, defined as a negative affective response to mathematics, is known to have deleterious effects on math performance in the general population. However, the assumption that math anxiety is directly related to math performance, has not yet been validated. Thus, our primary objective was to investigate the effects of math anxiety on numerical processing in children with specific deficits in the acquisition of math skills (Developmental Dyscalculia; DD) by using a novel affective priming task as an indirect measure. Methods Participants (12 children with DD and 11 typically-developing peers) completed a novel priming task in which an arithmetic equation was preceded by one of four types of priming words (positive, neutral, negative or related to mathematics). Children were required to indicate whether the equation (simple math facts based on addition, subtraction, multiplication or division) was true or false. Typically, people respond to target stimuli more quickly after presentation of an affectively-related prime than after one that is unrelated affectively. Result Participants with DD responded faster to targets that were preceded by both negative primes and math-related primes. A reversed pattern was present in the control group. Conclusion These results reveal a direct link between emotions, arithmetic and low achievement in math. It is also suggested that arithmetic-affective priming might be used as an indirect measure of math anxiety. PMID:20633269
Full Text Available Abstract Background Adaptive game software has been successful in remediation of dyslexia. Here we describe the cognitive and algorithmic principles underlying the development of similar software for dyscalculia. Our software is based on current understanding of the cerebral representation of number and the hypotheses that dyscalculia is due to a "core deficit" in number sense or in the link between number sense and symbolic number representations. Methods "The Number Race" software trains children on an entertaining numerical comparison task, by presenting problems adapted to the performance level of the individual child. We report full mathematical specifications of the algorithm used, which relies on an internal model of the child's knowledge in a multidimensional "learning space" consisting of three difficulty dimensions: numerical distance, response deadline, and conceptual complexity (from non-symbolic numerosity processing to increasingly complex symbolic operations. Results The performance of the software was evaluated both by mathematical simulations and by five weeks of use by nine children with mathematical learning difficulties. The results indicate that the software adapts well to varying levels of initial knowledge and learning speeds. Feedback from children, parents and teachers was positive. A companion article 1 describes the evolution of number sense and arithmetic scores before and after training. Conclusion The software, open-source and freely available online, is designed for learning disabled children aged 5–8, and may also be useful for general instruction of normal preschool children. The learning algorithm reported is highly general, and may be applied in other domains.
Deng, Xinyang; Han, Deqiang; Dezert, Jean; Deng, Yong; Shyr, Yu
Dempster-Shafer evidence theory is a primary methodology for multisource information fusion because it is good at dealing with uncertain information. This theory provides a Dempster's rule of combination to synthesize multiple evidences from various information sources. However, in some cases, counter-intuitive results may be obtained based on that combination rule. Numerous new or improved methods have been proposed to suppress these counter-intuitive results based on perspectives, such as minimizing the information loss or deviation. Inspired by evolutionary game theory, this paper considers a biological and evolutionary perspective to study the combination of evidences. An evolutionary combination rule (ECR) is proposed to help find the most biologically supported proposition in a multievidence system. Within the proposed ECR, we develop a Jaccard matrix game to formalize the interaction between propositions in evidences, and utilize the replicator dynamics to mimick the evolution of propositions. Experimental results show that the proposed ECR can effectively suppress the counter-intuitive behaviors appeared in typical paradoxes of evidence theory, compared with many existing methods. Properties of the ECR, such as solution's stability and convergence, have been mathematically proved as well.
Ashkenazi, Sarit; Mark-Zigdon, Nitza; Henik, Avishai
The abilities of children diagnosed with developmental dyscalculia (DD) were examined in two types of object enumeration: subitizing, and small estimation (5-9 dots). Subitizing is usually defined as a fast and accurate assessment of a number of small dots (range 1 to 4 dots), and estimation is an imprecise process to assess a large number of items (range 5 dots or more). Based on reaction time (RT) and accuracy analysis, our results indicated a deficit in the subitizing and small estimation range among DD participants in relation to controls. There are indications that subitizing is based on pattern recognition, thus presenting dots in a canonical shape in the estimation range should result in a subitizing-like pattern. In line with this theory, our control group presented a subitizing-like pattern in the small estimation range for canonically arranged dots, whereas the DD participants presented a deficit in the estimation of canonically arranged dots. The present finding indicates that pattern recognition difficulties may play a significant role in both subitizing and subitizing deficits among those with DD. © 2012 Blackwell Publishing Ltd.
Much has been written on the learning needs of dyslexic and dyscalculic students in primary and early secondary education. However, it is not clear that the necessary disability support staff and specialist literature are available to ensure that these needs are being adequately met within the context of learning statistics and general quantitative skills in the self-directed learning environments encountered in higher education. This commentary draws attention to dyslexia and dyscalculia as two potentially unrecognized conditions among undergraduate medical students and in turn, highlights key developments from recent literature in the diagnosis of these conditions. With a view to assisting medical educators meet the needs of dyscalculic learners and the more varied needs of dyslexic learners, a comprehensive list of suggestions is provided as to how learning resources can be designed from the outset to be more inclusive. A hitherto neglected area for future research is also identified through a call for a thorough investigation of the meaning of statistical literacy within the context of the undergraduate medical curriculum.
Mammarella, Irene C; Hill, Francesca; Devine, Amy; Caviola, Sara; Szűcs, Dénes
Although many children encounter difficulties in arithmetic, the underlying cognitive and emotive factors are still not fully understood. This study examined verbal and visuospatial short-term memory (STM) and working memory (WM) performance in children with developmental dyscalculia (DD) and high mathematics anxiety (MA) compared with typically developing (TD) children. Groups were matched on reading comprehension performance and IQ as well as on general anxiety. We aimed to test whether children with DD and MA were differently impaired in verbal and visuospatial STM and WM. Children were individually tested with four computerized tasks: two STM tasks (forward verbal and visuospatial recall) and two WM tasks (backward verbal and visuospatial recall). Relative to children with TD, those with DD did not show impairments on the forward or backward verbal tasks, but showed specific impairments in the visuospatial WM task. In contrast, children with MA were particularly impaired in the verbal WM task. Knowing the underlying cognitive processes that differentiate why children with DD and MA fail in math could have both educational and clinical implications.
Much has been written on the learning needs of dyslexic and dyscalculic students in primary and early secondary education. However, it is not clear that the necessary disability support staff and specialist literature are available to ensure that these needs are being adequately met within the context of learning statistics and general quantitative skills in the self-directed learning environments encountered in higher education. This commentary draws attention to dyslexia and dyscalculia as two potentially unrecognized conditions among undergraduate medical students and in turn, highlights key developments from recent literature in the diagnosis of these conditions. With a view to assisting medical educators meet the needs of dyscalculic learners and the more varied needs of dyslexic learners, a comprehensive list of suggestions is provided as to how learning resources can be designed from the outset to be more inclusive. A hitherto neglected area for future research is also identified through a call for a thorough investigation of the meaning of statistical literacy within the context of the undergraduate medical curriculum. PMID:20165516
Kucian, Karin; Loenneker, Thomas; Martin, Ernst; von Aster, Michael
This study investigated areas of brain activation related to non-symbolic distance effects in children with and without developmental dyscalculia (DD). We examined 15 children with DD (11.3 years) and 15 controls (10.6 years) by means of functional magnetic resonance imaging (fMRI). Both groups displayed similar behavioral performance, but differences in brain activation were observed, particularly in the supplementary motor area and the right fusiform gyrus, where children with DD demonstrated stronger activation. These results suggest that dyscalculic children engage areas attributed to higher difficulty in response selection more than control children, possibly due to a deficient development of a spatial number representation in DD.
Philipp Johannes Dinkel
Full Text Available FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number
Dinkel, Philipp Johannes; Willmes, Klaus; Krinzinger, Helga; Konrad, Kerstin; Koten, Jan Willem
FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number representation in
Full Text Available In contrast to quantity processing, up to date, the nature of ordinality has received little attention from researchers despite the fact that both quantity and ordinality are embodied in numerical information. Here we ask if there are two separate core systems that lie at the foundations of numerical cognition: (1 the traditionally and well accepted numerical magnitude system but also (2 core system for representing ordinal information. We report two novel experiments of ordinal processing that explored the relation between ordinal and numerical information processing in typically developing adults and adults with developmental dyscalculia (DD. Participants made "ordered" or "non-ordered" judgments about 3 groups of dots (non-symbolic numerical stimuli; in Experiment 1 and 3 numbers (symbolic task: Experiment 2. In contrast to previous findings and arguments about quantity deficit in DD participants, when quantity and ordinality are dissociated (as in the current tasks, DD participants exhibited a normal ratio effect in the non-symbolic ordinal task. They did not show, however, the ordinality effect. Ordinality effect in DD appeared only when area and density were randomized, but only in the descending direction. In the symbolic task, the ordinality effect was modulated by ratio and direction in both groups. These findings suggest that there might be two separate cognitive representations of ordinal and quantity information and that linguistic knowledge may facilitate estimation of ordinal information.
Rubinsten, Orly; Sury, Dana
In contrast to quantity processing, up to date, the nature of ordinality has received little attention from researchers despite the fact that both quantity and ordinality are embodied in numerical information. Here we ask if there are two separate core systems that lie at the foundations of numerical cognition: (1) the traditionally and well accepted numerical magnitude system but also (2) core system for representing ordinal information. We report two novel experiments of ordinal processing that explored the relation between ordinal and numerical information processing in typically developing adults and adults with developmental dyscalculia (DD). Participants made "ordered" or "non-ordered" judgments about 3 groups of dots (non-symbolic numerical stimuli; in Experiment 1) and 3 numbers (symbolic task: Experiment 2). In contrast to previous findings and arguments about quantity deficit in DD participants, when quantity and ordinality are dissociated (as in the current tasks), DD participants exhibited a normal ratio effect in the non-symbolic ordinal task. They did not show, however, the ordinality effect. Ordinality effect in DD appeared only when area and density were randomized, but only in the descending direction. In the symbolic task, the ordinality effect was modulated by ratio and direction in both groups. These findings suggest that there might be two separate cognitive representations of ordinal and quantity information and that linguistic knowledge may facilitate estimation of ordinal information.
Huber, S; Sury, D; Moeller, K; Rubinsten, O; Nuerk, H-C
Previous research on developmental dyscalculia (DD) suggested that deficits in the number line estimation task are related to a failure to represent number magnitude linearly. This conclusion was derived from the observation of logarithmically shaped estimation patterns. However, recent research questioned this idea of an isomorphic relationship between estimation patterns and number magnitude representation. In the present study, we evaluated an alternative hypothesis: impairments in the number line estimation task are due to a general deficit in mapping numbers onto space. Adults with DD and a matched control group had to learn linear and non-linear layouts of the number line via feedback. Afterwards, we assessed their performance how well they learnt the new number-space mappings. We found irrespective of the layouts worse performance of adults with DD. Additionally, in case of the linear layout, we observed that their performance did not differ from controls near reference points, but that differences between groups increased as the distance to reference point increased. We conclude that worse performance of adults with DD in the number line task might be due a deficit in mapping numbers onto space which can be partly overcome relying on reference points. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Dempster–Shafer evidence theory is widely applied in various fields related to information fusion. However, how to avoid the counter-intuitive results is an open issue when combining highly conflicting pieces of evidence. In order to handle such a problem, a weighted combination method for conflicting pieces of evidence in multi-sensor data fusion is proposed by considering both the interplay between the pieces of evidence and the impacts of the pieces of evidence themselves. First, the degree of credibility of the evidence is determined on the basis of the modified cosine similarity measure of basic probability assignment. Then, the degree of credibility of the evidence is adjusted by leveraging the belief entropy function to measure the information volume of the evidence. Finally, the final weight of each piece of evidence generated from the above steps is obtained and adopted to modify the bodies of evidence before using Dempster’s combination rule. A numerical example is provided to illustrate that the proposed method is reasonable and efficient in handling the conflicting pieces of evidence. In addition, applications in data classification and motor rotor fault diagnosis validate the practicability of the proposed method with better accuracy.
Lewis, Nicholas; Grünwald, Peter
Combining instrumental period evidence regarding equilibrium climate sensitivity with largely independent paleoclimate proxy evidence should enable a more constrained sensitivity estimate to be obtained. Previous, subjective Bayesian approaches involved selection of a prior probability distribution reflecting the investigators' beliefs about climate sensitivity. Here a recently developed approach employing two different statistical methods—objective Bayesian and frequentist likelihood-ratio—is used to combine instrumental period and paleoclimate evidence based on data presented and assessments made in the IPCC Fifth Assessment Report. Probabilistic estimates from each source of evidence are represented by posterior probability density functions (PDFs) of physically-appropriate form that can be uniquely factored into a likelihood function and a noninformative prior distribution. The three-parameter form is shown accurately to fit a wide range of estimated climate sensitivity PDFs. The likelihood functions relating to the probabilistic estimates from the two sources are multiplicatively combined and a prior is derived that is noninformative for inference from the combined evidence. A posterior PDF that incorporates the evidence from both sources is produced using a single-step approach, which avoids the order-dependency that would arise if Bayesian updating were used. Results are compared with an alternative approach using the frequentist signed root likelihood ratio method. Results from these two methods are effectively identical, and provide a 5-95% range for climate sensitivity of 1.1-4.05 K (median 1.87 K).
Attout, Lucie; Majerus, Steve
Although a number of studies suggests a link between working memory (WM) storage capacity of short-term memory and calculation abilities, the nature of verbal WM deficits in children with developmental dyscalculia (DD) remains poorly understood. We explored verbal WM capacity in DD by focusing on the distinction between memory for item information (the items to be retained) and memory for order information (the order of the items within a list). We hypothesized that WM for order could be specifically related to impaired numerical abilities given that recent studies suggest close interactions between the representation of order information in WM and ordinal numerical processing. We investigated item and order WM abilities as well as basic numerical processing abilities in 16 children with DD (age: 8-11 years) and 16 typically developing children matched on age, IQ, and reading abilities. The DD group performed significantly poorer than controls in the order WM condition but not in the item WM condition. In addition, the DD group performed significantly slower than the control group on a numerical order judgment task. The present results show significantly reduced serial order WM abilities in DD coupled with less efficient numerical ordinal processing abilities, reflecting more general difficulties in explicit processing of ordinal information.
Ashkenazi, Sarit; Henik, Avishai
Recently, a deficit in attention was found in those with pure developmental dyscalculia (DD). Accordingly, the present study aimed to examine the influence of attentional training on attention abilities, basic numerical abilities, and arithmetic in participants who were diagnosed as having DD. Nine university students diagnosed as having DD (IQ and reading abilities in the normal range and no indication of attention-deficit hyperactivity disorder) and nine matched controls participated in attentional training (i.e., video game training). First, training modulated the orienting system; after training, the size of the validity effect (i.e., effect of valid vs. invalid) decreased. This effect was comparable in the two groups. Training modulated abnormalities in the attention systems of those with DD, that is, it reduced their enlarged congruity effect (i.e., faster responding when flanking arrows pointed to the same location as a center arrow). Second, in relation to the enumeration task, training reduced the reaction time of the DD group in the subitizing range but did not change their smaller-than-normal subitizing range. Finally, training improved performance in addition problems in both the DD and control groups. These results imply that attentional training does improve most of the attentional deficits of those with DD. In contrast, training did not improve the abnormalities of the DD group in arithmetic or basic numerical processing. Thus, in contrast to the domain-general hypothesis, the deficits in attention among those with DD and the deficits in numerical processing appear to originate from different sources.
Michels, Lars; O'Gorman, Ruth; Kucian, Karin
Developmental dyscalculia (DD) is a developmental learning disability associated with deficits in processing numerical and mathematical information. Although behavioural training can reduce these deficits, it is unclear which neuronal resources show a functional reorganization due to training. We examined typically developing (TD) children (N=16, mean age: 9.5 years) and age-, gender-, and handedness-matched children with DD (N=15, mean age: 9.5 years) during the performance of a numerical order task with fMRI and functional connectivity before and after 5-weeks of number line training. Using the intraparietal sulcus (IPS) as seed region, DD showed hyperconnectivity in parietal, frontal, visual, and temporal regions before the training controlling for age and IQ. Hyperconnectivity disappeared after training, whereas math abilities improved. Multivariate classification analysis of task-related fMRI data corroborated the connectivity results as the same group of TD could be discriminated from DD before but not after number line training (86.4 vs. 38.9%, respectively). Our results indicate that abnormally high functional connectivity in DD can be normalized on the neuronal level by intensive number line training. As functional connectivity in DD was indistinguishable to TD's connectivity after training, we conclude that training lead to a re-organization of inter-regional task engagement. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
McCaskey, Ursina; von Aster, Michael; O'Gorman Tuura, Ruth; Kucian, Karin
The link between number and space has been discussed in the literature for some time, resulting in the theory that number, space and time might be part of a generalized magnitude system. To date, several behavioral and neuroimaging findings support the notion of a generalized magnitude system, although contradictory results showing a partial overlap or separate magnitude systems are also found. The possible existence of a generalized magnitude processing area leads to the question how individuals with developmental dyscalculia (DD), known for deficits in numerical-arithmetical abilities, process magnitudes. By means of neuropsychological tests and functional magnetic resonance imaging (fMRI) we aimed to examine the relationship between number and space in typical and atypical development. Participants were 16 adolescents with DD (14.1 years) and 14 typically developing (TD) peers (13.8 years). In the fMRI paradigm participants had to perform discrete (arrays of dots) and continuous magnitude (angles) comparisons as well as a mental rotation task. In the neuropsychological tests, adolescents with dyscalculia performed significantly worse in numerical and complex visuo-spatial tasks. However, they showed similar results to TD peers when making discrete and continuous magnitude decisions during the neuropsychological tests and the fMRI paradigm. A conjunction analysis of the fMRI data revealed commonly activated higher order visual (inferior and middle occipital gyrus) and parietal (inferior and superior parietal lobe) magnitude areas for the discrete and continuous magnitude tasks. Moreover, no differences were found when contrasting both magnitude processing conditions, favoring the possibility of a generalized magnitude system. Group comparisons further revealed that dyscalculic subjects showed increased activation in domain general regions, whilst TD peers activate domain specific areas to a greater extent. In conclusion, our results point to the existence of a
Noël, Marie-Pascale; Rousselle, Laurence
Studies on developmental dyscalculia (DD) have tried to identify a basic numerical deficit that could account for this specific learning disability. The first proposition was that the number magnitude representation of these children was impaired. However, Rousselle and Noël (2007) brought data showing that this was not the case but rather that these children were impaired when processing the magnitude of symbolic numbers only. Since then, incongruent results have been published. In this paper, we will propose a developmental perspective on this issue. We will argue that the first deficit shown in DD regards the building of an exact representation of numerical value, thanks to the learning of symbolic numbers, and that the reduced acuity of the approximate number magnitude system appears only later and is secondary to the first deficit.
McCaskey, Ursina; von Aster, Michael; O’Gorman Tuura, Ruth; Kucian, Karin
The link between number and space has been discussed in the literature for some time, resulting in the theory that number, space and time might be part of a generalized magnitude system. To date, several behavioral and neuroimaging findings support the notion of a generalized magnitude system, although contradictory results showing a partial overlap or separate magnitude systems are also found. The possible existence of a generalized magnitude processing area leads to the question how individuals with developmental dyscalculia (DD), known for deficits in numerical-arithmetical abilities, process magnitudes. By means of neuropsychological tests and functional magnetic resonance imaging (fMRI) we aimed to examine the relationship between number and space in typical and atypical development. Participants were 16 adolescents with DD (14.1 years) and 14 typically developing (TD) peers (13.8 years). In the fMRI paradigm participants had to perform discrete (arrays of dots) and continuous magnitude (angles) comparisons as well as a mental rotation task. In the neuropsychological tests, adolescents with dyscalculia performed significantly worse in numerical and complex visuo-spatial tasks. However, they showed similar results to TD peers when making discrete and continuous magnitude decisions during the neuropsychological tests and the fMRI paradigm. A conjunction analysis of the fMRI data revealed commonly activated higher order visual (inferior and middle occipital gyrus) and parietal (inferior and superior parietal lobe) magnitude areas for the discrete and continuous magnitude tasks. Moreover, no differences were found when contrasting both magnitude processing conditions, favoring the possibility of a generalized magnitude system. Group comparisons further revealed that dyscalculic subjects showed increased activation in domain general regions, whilst TD peers activate domain specific areas to a greater extent. In conclusion, our results point to the existence of a
Full Text Available Conflict management in Dempster-Shafer theory (D-S theory is a hot topic in information fusion. In this paper, a novel weighted evidence combination rule based on evidence distance and uncertainty measure is proposed. The proposed approach consists of two steps. First, the weight is determined based on the evidence distance. Then, the weight value obtained in first step is modified by taking advantage of uncertainty. Our proposed method can efficiently handle high conflicting evidences with better performance of convergence. A numerical example and an application based on sensor fusion in fault diagnosis are given to demonstrate the efficiency of our proposed method.
Full Text Available Developmental dyscalculia (DD is a learning disorder associated with impairments in a preverbal non-symbolic approximate number system (ANS pertaining to areas in and around the intraparietal sulcus (IPS. The current study sought to enhance our understanding of the developmental trajectory of the ANS and symbolic number processing skills, thereby getting insight into whether a deficit in the ANS precedes or is preceded by impaired symbolic and exact number processing. Recent work has also suggested that humans are endowed with a shared magnitude system (beyond the number domain in the brain. We therefore investigated whether children with DD demonstrated a general magnitude deficit, stemming from the proposed magnitude system, rather than a specific one limited to numerical quantity. Fourth graders with DD were compared to age-matched controls and a group of ability-matched second graders, on a range of magnitude processing tasks pertaining to space, time, and number. Children with DD displayed difficulties across all magnitude dimensions compared to age-matched peers and showed impaired ANS acuity compared to the younger, ability-matched control group, while exhibiting intact symbolic number processing. We conclude that (1 children with DD suffer from a general magnitude-processing deficit, (2 a shared magnitude system likely exists, and (3 a symbolic number-processing deficit in DD tends to be preceded by an ANS deficit.
Skagerlund, Kenny; Träff, Ulf
Developmental dyscalculia (DD) is a learning disorder associated with impairments in a preverbal non-symbolic approximate number system (ANS) pertaining to areas in and around the intraparietal sulcus (IPS). The current study sought to enhance our understanding of the developmental trajectory of the ANS and symbolic number processing skills, thereby getting insight into whether a deficit in the ANS precedes or is preceded by impaired symbolic and exact number processing. Recent work has also suggested that humans are endowed with a shared magnitude system (beyond the number domain) in the brain. We therefore investigated whether children with DD demonstrated a general magnitude deficit, stemming from the proposed magnitude system, rather than a specific one limited to numerical quantity. Fourth graders with DD were compared to age-matched controls and a group of ability-matched second graders, on a range of magnitude processing tasks pertaining to space, time, and number. Children with DD displayed difficulties across all magnitude dimensions compared to age-matched peers and showed impaired ANS acuity compared to the younger, ability-matched control group, while exhibiting intact symbolic number processing. We conclude that (1) children with DD suffer from a general magnitude-processing deficit, (2) a shared magnitude system likely exists, and (3) a symbolic number-processing deficit in DD tends to be preceded by an ANS deficit.
Rocha, L. M. (Luis Mateus)
Recommendation systems for different Document Networks (DN) such as the World Wide Web (WWW), Digitnl Libarries, or Scientific Databases, often make use of distance functions extracted from relationships among documents and between documents and semantic tags. For instance, documents In the WWW are related via a hyperlink network, while documents in bibliographic databases are related by citation and collaboration networks.Furthermore, documents can be related to semantic tags such as keywords used to describe their content, The distance functions computed from these relations establish associative networks among items of the DN, and allow recommendation systems to identify relevant associations for iudividoal users. The process of recommendation can be improved by integrating associative data from different sources. Thus we are presented with a problem of combining evidence (about assochaons between items) from different sonrces characterized by distance functions. In this paper we summarize our work on (1) inferring associations from semi-metric distance functions and (2) combining evidence from different (distance) associative DN.
Mathematicians and scientists have struggled to adequately describe the ultimate foundations of mathematics. Nobel laureates Albert Einstein and Eugene Wigner were perplexed by this issue, with Wigner concluding that the workability of mathematics in the real world is a mystery we cannot explain. In response to this classic enigma, the major purpose of this article is to provide a theoretical model of the ultimate origin of mathematics and "number sense" (as defined by S. Dehaene) that is proposed to involve the learning of inverse dynamics models through the collaboration of the cerebellum and the cerebral cortex (but prominently cerebellum-driven). This model is based upon (1) the modern definition of mathematics as the "science of patterns," (2) cerebellar sequence (pattern) detection, and (3) findings that the manipulation of numbers is automated in the cerebellum. This cerebro-cerebellar approach does not necessarily conflict with mathematics or number sense models that focus on brain functions associated with especially the intraparietal sulcus region of the cerebral cortex. A direct corollary purpose of this article is to offer a cerebellar inner speech explanation for difficulty in developing "number sense" in developmental dyscalculia. It is argued that during infancy the cerebellum learns (1) a first tier of internal models for a primitive physics that constitutes the foundations of visual-spatial working memory, and (2) a second (and more abstract) tier of internal models based on (1) that learns "number" and relationships among dimensions across the primitive physics of the first tier. Within this context it is further argued that difficulty in the early development of the second tier of abstraction (and "number sense") is based on the more demanding attentional requirements imposed on cerebellar inner speech executive control during the learning of cerebellar inverse dynamics models. Finally, it is argued that finger counting improves (does not
Full Text Available Transposable elements (TEs are mobile, repetitive sequences that make up significant fractions of metazoan genomes. Despite their near ubiquity and importance in genome and chromosome biology, most efforts to annotate TEs in genome sequences rely on the results of a single computational program, RepeatMasker. In contrast, recent advances in gene annotation indicate that high-quality gene models can be produced from combining multiple independent sources of computational evidence. To elevate the quality of TE annotations to a level comparable to that of gene models, we have developed a combined evidence-model TE annotation pipeline, analogous to systems used for gene annotation, by integrating results from multiple homology-based and de novo TE identification methods. As proof of principle, we have annotated "TE models" in Drosophila melanogaster Release 4 genomic sequences using the combined computational evidence derived from RepeatMasker, BLASTER, TBLASTX, all-by-all BLASTN, RECON, TE-HMM and the previous Release 3.1 annotation. Our system is designed for use with the Apollo genome annotation tool, allowing automatic results to be curated manually to produce reliable annotations. The euchromatic TE fraction of D. melanogaster is now estimated at 5.3% (cf. 3.86% in Release 3.1, and we found a substantially higher number of TEs (n = 6,013 than previously identified (n = 1,572. Most of the new TEs derive from small fragments of a few hundred nucleotides long and highly abundant families not previously annotated (e.g., INE-1. We also estimated that 518 TE copies (8.6% are inserted into at least one other TE, forming a nest of elements. The pipeline allows rapid and thorough annotation of even the most complex TE models, including highly deleted and/or nested elements such as those often found in heterochromatic sequences. Our pipeline can be easily adapted to other genome sequences, such as those of the D. melanogaster heterochromatin or other
Full Text Available Developmental dyscalculia (DD is a learning disability affecting the acquisition of numerical-arithmetical skills. Studies report persistent deficits in number processing and aberrant functional activation of the fronto-parietal numerical network in DD. However, the neural development of numerical abilities has been scarcely investigated. The present paper provides a first attempt to investigate behavioral and neural trajectories of numerical abilities longitudinally in typically developing (TD and DD children. During a study period of 4 years, 28 children (8–11 years were evaluated twice by means of neuropsychological tests and a numerical order fMRI paradigm. Over time, TD children improved in numerical abilities and showed a consistent and well-developed fronto-parietal network. In contrast, DD children revealed persistent deficits in number processing and arithmetic. Brain imaging results of the DD group showed an age-related activation increase in parietal regions (intraparietal sulcus, pointing to a delayed development of number processing areas. Besides, an activation increase in frontal areas was observed over time, indicating the use of compensatory mechanisms. In conclusion, results suggest a continuation in neural development of number representation in DD, whereas the neural network for simple ordinal number estimation seems to be stable or show only subtle changes in TD children over time.
McCaskey, Ursina; von Aster, Michael; Maurer, Urs; Martin, Ernst; O'Gorman Tuura, Ruth; Kucian, Karin
Developmental dyscalculia (DD) is a learning disability affecting the acquisition of numerical-arithmetical skills. Studies report persistent deficits in number processing and aberrant functional activation of the fronto-parietal numerical network in DD. However, the neural development of numerical abilities has been scarcely investigated. The present paper provides a first attempt to investigate behavioral and neural trajectories of numerical abilities longitudinally in typically developing (TD) and DD children. During a study period of 4 years, 28 children (8-11 years) were evaluated twice by means of neuropsychological tests and a numerical order fMRI paradigm. Over time, TD children improved in numerical abilities and showed a consistent and well-developed fronto-parietal network. In contrast, DD children revealed persistent deficits in number processing and arithmetic. Brain imaging results of the DD group showed an age-related activation increase in parietal regions (intraparietal sulcus), pointing to a delayed development of number processing areas. Besides, an activation increase in frontal areas was observed over time, indicating the use of compensatory mechanisms. In conclusion, results suggest a continuation in neural development of number representation in DD, whereas the neural network for simple ordinal number estimation seems to be stable or show only subtle changes in TD children over time.
Ashkenazi, Sarit; Rosenberg-Lee, Miriam; Tenison, Caitlin; Menon, Vinod
Developmental dyscalculia (DD) is a disability that impacts math learning and skill acquisition in school-age children. Here we investigate arithmetic problem solving deficits in young children with DD using univariate and multivariate analysis of fMRI data. During fMRI scanning, 17 children with DD (ages 7-9, grades 2 and 3) and 17 IQ- and reading ability-matched typically developing (TD) children performed complex and simple addition problems which differed only in arithmetic complexity. While the TD group showed strong modulation of brain responses with increasing arithmetic complexity, children with DD failed to show such modulation. Children with DD showed significantly reduced activation compared to TD children in the intraparietal sulcus, superior parietal lobule, supramarginal gyrus and bilateral dorsolateral prefrontal cortex in relation to arithmetic complexity. Critically, multivariate representational similarity revealed that brain response patterns to complex and simple problems were less differentiated in the DD group in bilateral anterior IPS, independent of overall differences in signal level. Taken together, these results show that children with DD not only under-activate key brain regions implicated in mathematical cognition, but they also fail to generate distinct neural responses and representations for different arithmetic problems. Our findings provide novel insights into the neural basis of DD. Copyright © 2011 Elsevier Ltd. All rights reserved.
Wadlington, Elizabeth; Wadlington, Patrick L.
Teachers and parents are often perplexed when an intelligent student performs poorly in mathematics. Research tells us that this is often due to math disability, otherwise known as "dyscalculia". The authors define dyscalculia and describe its major subtypes. Also, the authors describe characteristics of dyscalculia and explain why dyscalculia is…
Full Text Available Abstract Background The question whether Developmental Dyscalculia (DD; a deficit in the ability to process numerical information is the result of deficiencies in the non symbolic numerical representation system (e.g., a group of dots or in the symbolic numerical representation system (e.g., Arabic numerals has been debated in scientific literature. It is accepted that the non symbolic system is divided into two different ranges, the subitizing range (i.e., quantities from 1-4 which is processed automatically and quickly, and the counting range (i.e., quantities larger than 4 which is an attention demanding procedure and is therefore processed serially and slowly. However, so far no study has tested the automaticity of symbolic and non symbolic representation in DD participants separately for the subitizing and the counting ranges. Methods DD and control participants undergo a novel version of the Stroop task, i.e., the Enumeration Stroop. They were presented with a random series of between one and nine written digits, and were asked to name either the relevant written digit (in the symbolic task or the relevant quantity of digits (in the non symbolic task while ignoring the irrelevant aspect. Result DD participants, unlike the control group, didn't show any congruency effect in the subitizing range of the non symbolic task. Conclusion These findings suggest that DD may be impaired in the ability to process symbolic numerical information or in the ability to automatically associate the two systems (i.e., the symbolic vs. the non symbolic. Additionally DD have deficiencies in the non symbolic counting range.
Furman, Tamar; Rubinsten, Orly
The question whether Developmental Dyscalculia (DD; a deficit in the ability to process numerical information) is the result of deficiencies in the non symbolic numerical representation system (e.g., a group of dots) or in the symbolic numerical representation system (e.g., Arabic numerals) has been debated in scientific literature. It is accepted that the non symbolic system is divided into two different ranges, the subitizing range (i.e., quantities from 1-4) which is processed automatically and quickly, and the counting range (i.e., quantities larger than 4) which is an attention demanding procedure and is therefore processed serially and slowly. However, so far no study has tested the automaticity of symbolic and non symbolic representation in DD participants separately for the subitizing and the counting ranges. DD and control participants undergo a novel version of the Stroop task, i.e., the Enumeration Stroop. They were presented with a random series of between one and nine written digits, and were asked to name either the relevant written digit (in the symbolic task) or the relevant quantity of digits (in the non symbolic task) while ignoring the irrelevant aspect. DD participants, unlike the control group, didn't show any congruency effect in the subitizing range of the non symbolic task. These findings suggest that DD may be impaired in the ability to process symbolic numerical information or in the ability to automatically associate the two systems (i.e., the symbolic vs. the non symbolic). Additionally DD have deficiencies in the non symbolic counting range.
Cappelletti, Marinella; Price, Cathy J.
Developmental dyscalculia – a congenital learning disability in understanding numerical concepts – is typically associated with parietal lobe abnormality. However, people with dyscalculia often retain some residual numerical abilities, reported in studies that otherwise focused on abnormalities in the dyscalculic brain. Here we took a different perspective by focusing on brain regions that support residual number processing in dyscalculia. All participants accurately performed semantic and categorical colour-decision tasks with numerical and non-numerical stimuli, with adults with dyscalculia performing slower than controls in the number semantic tasks only. Structural imaging showed less grey-matter volume in the right parietal cortex in people with dyscalculia relative to controls. Functional MRI showed that accurate number semantic judgements were maintained by parietal and inferior frontal activations that were common to adults with dyscalculia and controls, with higher activation for participants with dyscalculia than controls in the right superior frontal cortex and the left inferior frontal sulcus. Enhanced activation in these frontal areas was driven by people with dyscalculia who made faster rather than slower numerical decisions; however, activation could not be accounted for by response times per se, because it was greater for fast relative to slow dyscalculics but not greater for fast controls relative to slow dyscalculics. In conclusion, our results reveal two frontal brain regions that support efficient number processing in dyscalculia. PMID:24266008
Full Text Available To solve the invalidation problem of Dempster-Shafer theory of evidence (DS with high conflict in multisensor data fusion, this paper presents a novel combination approach of conflict evidence with different weighting factors using a new probabilistic dissimilarity measure. Firstly, an improved probabilistic transformation function is proposed to map basic belief assignments (BBAs to probabilities. Then, a new dissimilarity measure integrating fuzzy nearness and introduced correlation coefficient is proposed to characterize not only the difference between basic belief functions (BBAs but also the divergence degree of the hypothesis that two BBAs support. Finally, the weighting factors used to reassign conflicts on BBAs are developed and Dempster’s rule is chosen to combine the discounted sources. Simple numerical examples are employed to demonstrate the merit of the proposed method. Through analysis and comparison of the results, the new combination approach can effectively solve the problem of conflict management with better convergence performance and robustness.
Friso-van den Bos, I.; van Luit, J.E.H.; Kroesbergen, E.H.; Xenidou-Dervou, I.; van der Schoot, M.; van Lieshout, E.C.D.M.; Jonkman, L.M.
Dyscalculia, or mathematics learning disability, has received growing attention in recent years. Working memory and number sense are hypothesized to form important determinants of dyscalculia, but longitudinal assessments of number sense in children with or at-risk for dyscalculia are scarce. The
Bugden, Stephanie; Ansari, Daniel
In the present study we examined whether children with Developmental Dyscalculia (DD) exhibit a deficit in the so-called 'Approximate Number System' (ANS). To do so, we examined a group of elementary school children who demonstrated persistent low math achievement over 4 years and compared them to typically developing (TD), aged-matched controls. The integrity of the ANS was measured using the Panamath (www.panamath.org) non-symbolic numerical discrimination test. Children with DD demonstrated imprecise ANS acuity indexed by larger Weber fraction (w) compared to TD controls. Given recent findings showing that non-symbolic numerical discrimination is affected by visual parameters, we went further and investigated whether children performed differently on trials on which number of dots and their overall area were either congruent or incongruent with each other. This analysis revealed that differences in w were only found between DD and TD children on the incongruent trials. In addition, visuo-spatial working memory strongly predicts individual differences in ANS acuity (w) during the incongruent trials. Thus the purported ANS deficit in DD can be explained by a difficulty in extracting number from an array of dots when area is anti-correlated with number. These data highlight the role of visuo-spatial working memory during the extraction process, and demonstrate that close attention needs to be paid to perceptual processes invoked by tasks thought to represent measures of the ANS. © 2015 John Wiley & Sons Ltd.
Yan, Ying; Suo, Bin
Due to the complexity of system and lack of expertise, epistemic uncertainties may present in the experts’ judgment on the importance of certain indices during group decision-making. A novel combination weighting method is proposed to solve the index weighting problem when various uncertainties are present in expert comments. Based on the idea of evidence theory, various types of uncertain evaluation information are uniformly expressed through interval evidence structures. Similarity matrix b...
Lee, M. K.
Full Text Available An absence of measurement bias against distinct groups is a prerequisite for the use of a given psychological instrument in scientific research or high-stakes assessment. Factor analysis is the framework explicitly adopted for the identification of such bias when the instrument consists of a multi-test battery, whereas item response theory is employed when the focus narrows to a single test composed of discrete items. Item response theory can be treated as a mild nonlinearization of the standard factor model, and thus the essential unity of bias detection at the two levels merits greater recognition. Here we illustrate the benefits of a unified approach with a real-data example, which comes from a statewide test of mathematics achievement where examinees diagnosed with dyscalculia were accommodated with calculators. We found that items that can be solved by explicit arithmetical computation became easier for the accommodated examinees, but the quantitative magnitude of this differential item functioning (measurement bias was small.
Rishishwar, Lavanya; Conley, Andrew B; Vidakovic, Brani; Jordan, I King
Uniparental genetic markers, mitochondrial DNA (mtDNA) and Y chromosomal DNA, are widely used for the inference of human ancestry. However, the resolution of ancestral origins based on mtDNA haplotypes is limited by the fact that such haplotypes are often found to be distributed across wide geographical regions. We have addressed this issue here by combining two sources of ancestry information that have typically been considered separately: historical records regarding population origins and genetic information on mtDNA haplotypes. To combine these distinct data sources, we applied a Bayesian approach that considers historical records, in the form of prior probabilities, together with data on the geographical distribution of mtDNA haplotypes, formulated as likelihoods, to yield ancestry assignments from posterior probabilities. This combined evidence Bayesian approach to ancestry assignment was evaluated for its ability to accurately assign sub-continental African ancestral origins to Afro-Colombians based on their mtDNA haplotypes. We demonstrate that the incorporation of historical prior probabilities via this analytical framework can provide for substantially increased resolution in sub-continental African ancestry assignment for members of this population. In addition, a personalized approach to ancestry assignment that involves the tuning of priors to individual mtDNA haplotypes yields even greater resolution for individual ancestry assignment. Despite the fact that Colombia has a large population of Afro-descendants, the ancestry of this community has been understudied relative to populations with primarily European and Native American ancestry. Thus, the application of the kind of combined evidence approach developed here to the study of ancestry in the Afro-Colombian population has the potential to be impactful. The formal Bayesian analytical framework we propose for combining historical and genetic information also has the potential to be widely applied
HAI-NA JIANG; XIAO-BIN XU; CHENG-LIN WEN
This paper provides a method based on Dezert-Smarandache Theory (DSmT) for simultaneous faults diagnosis when evidence is dependent. Firstly, according to the characteristics of simultaneous faults, a frame of discernment is given for both single fault and simultaneous faults diagnosis, the DSmT combination rule applicable to simultaneous faults diagnosis is introduced.
Kaufmann, L.; Vogel, S. E.; Starke, M.; Kremser, C.; Schocke, M.
Ordinality is--beyond numerical magnitude (i.e., quantity)--an important characteristic of the number system. There is converging empirical evidence that (intra)parietal brain regions mediate number magnitude processing. Furthermore, recent findings suggest that the human intraparietal sulcus (IPS) supports magnitude and ordinality in a…
Full Text Available In this research we investigate how the evidences provided by both static and mobile nodes that are part of a heterogenous sensor network can be combined to have trustworthy results. A solution relying on a network agreement-based approach was implemented and tested.
Mórocz, István Akos; Janoos, Firdaus; van Gelderen, Peter; Manor, David; Karni, Avi; Breznitz, Zvia; von Aster, Michael; Kushnir, Tammar; Shalev, Ruth
The aim of this article is to report on the importance and challenges of a time-resolved and spatio-temporal analysis of fMRI data from complex cognitive processes and associated disorders using a study on developmental dyscalculia (DD). Participants underwent fMRI while judging the incorrectness of multiplication results, and the data were analyzed using a sequence of methods, each of which progressively provided more a detailed picture of the spatio-temporal aspect of this disease. Healthy subjects and subjects with DD performed alike behaviorally though they exhibited parietal disparities using traditional voxel-based group analyses. Further and more detailed differences, however, surfaced with a time-resolved examination of the neural responses during the experiment. While performing inter-group comparisons, a third group of subjects with dyslexia (DL) but with no arithmetic difficulties was included to test the specificity of the analysis and strengthen the statistical base with overall fifty-eight subjects. Surprisingly, the analysis showed a functional dissimilarity during an initial reading phase for the group of dyslexic but otherwise normal subjects, with respect to controls, even though only numerical digits and no alphabetic characters were presented. Thus our results suggest that time-resolved multi-variate analysis of complex experimental paradigms has the ability to yield powerful new clinical insights about abnormal brain function. Similarly, a detailed compilation of aberrations in the functional cascade may have much greater potential to delineate the core processing problems in mental disorders. PMID:22368322
Rajagopalan, Vidya; Wyatt, Christopher
In tensor-based morphometry (TBM) group-wise differences in brain structure are measured using high degreeof- freedom registration and some form of statistical test. However, it is known that TBM results are sensitive to both the registration method and statistical test used. Given the lack of an objective model of group variation is it difficult to determine a best registration method for TBM. The use of statistical tests is also problematic given the corrections required for multiple testing and the notorius difficulty selecting and intepreting signigance values. This paper presents an approach to address both of these issues by combining multiple registration methods using Dempster-Shafer Evidence theory to produce belief maps of categorical changes between groups. This approach is applied to the comparison brain morphometry in aging, a typical application of TBM, using the determinant of the Jacobian as a measure of volume change. We show that the Dempster-Shafer combination produces a unique and easy to interpret belief map of regional changes between and within groups without the complications associated with hypothesis testing.
Cohen, Paul; Shafer, Glenn; Shenoy, Prakash P.
Modifiable combining functions are a synthesis of two common approaches to combining evidence. They offer many of the advantages of these approaches and avoid some disadvantages. Because they facilitate the acquisition, representation, explanation, and modification of knowledge about combinations of evidence, they are proposed as a tool for knowledge engineers who build systems that reason under uncertainty, not as a normative theory of evidence.
Kucian, Karin; Zuber, Isabelle; Kohn, Juliane; Poltz, Nadine; Wyschkon, Anne; Esser, Günter; von Aster, Michael
Many children show negative emotions related to mathematics and some even develop mathematics anxiety. The present study focused on the relation between negative emotions and arithmetical performance in children with and without developmental dyscalculia (DD) using an affective priming task. Previous findings suggested that arithmetic performance is influenced if an affective prime precedes the presentation of an arithmetic problem. In children with DD specifically, responses to arithmetic operations are supposed to be facilitated by both negative and mathematics-related primes (= negative math priming effect ).We investigated mathematical performance, math anxiety, and the domain-general abilities of 172 primary school children (76 with DD and 96 controls). All participants also underwent an affective priming task which consisted of the decision whether a simple arithmetic operation (addition or subtraction) that was preceded by a prime (positive/negative/neutral or mathematics-related) was true or false. Our findings did not reveal a negative math priming effect in children with DD. Furthermore, when considering accuracy levels, gender, or math anxiety, the negative math priming effect could not be replicated. However, children with DD showed more math anxiety when explicitly assessed by a specific math anxiety interview and showed lower mathematical performance compared to controls. Moreover, math anxiety was equally present in boys and girls, even in the earliest stages of schooling, and interfered negatively with performance. In conclusion, mathematics is often associated with negative emotions that can be manifested in specific math anxiety, particularly in children with DD. Importantly, present findings suggest that in the assessed age group, it is more reliable to judge math anxiety and investigate its effects on mathematical performance explicitly by adequate questionnaires than by an affective math priming task.
Full Text Available Many children show negative emotions related to mathematics and some even develop mathematics anxiety. The present study focused on the relation between negative emotions and arithmetical performance in children with and without developmental dyscalculia (DD using an affective priming task. Previous findings suggested that arithmetic performance is influenced if an affective prime precedes the presentation of an arithmetic problem. In children with DD specifically, responses to arithmetic operations are supposed to be facilitated by both negative and mathematics-related primes (=negative math priming effect.We investigated mathematical performance, math anxiety, and the domain-general abilities of 172 primary school children (76 with DD and 96 controls. All participants also underwent an affective priming task which consisted of the decision whether a simple arithmetic operation (addition or subtraction that was preceded by a prime (positive/negative/neutral or mathematics-related was true or false. Our findings did not reveal a negative math priming effect in children with DD. Furthermore, when considering accuracy levels, gender, or math anxiety, the negative math priming effect could not be replicated. However, children with DD showed more math anxiety when explicitly assessed by a specific math anxiety interview and showed lower mathematical performance compared to controls. Moreover, math anxiety was equally present in boys and girls, even in the earliest stages of schooling, and interfered negatively with performance. In conclusion, mathematics is often associated with negative emotions that can be manifested in specific math anxiety, particularly in children with DD. Importantly, present findings suggest that in the assessed age group, it is more reliable to judge math anxiety and investigate its effects on mathematical performance explicitly by adequate questionnaires than by an affective math priming task.
Kucian, Karin; Zuber, Isabelle; Kohn, Juliane; Poltz, Nadine; Wyschkon, Anne; Esser, Günter; von Aster, Michael
Many children show negative emotions related to mathematics and some even develop mathematics anxiety. The present study focused on the relation between negative emotions and arithmetical performance in children with and without developmental dyscalculia (DD) using an affective priming task. Previous findings suggested that arithmetic performance is influenced if an affective prime precedes the presentation of an arithmetic problem. In children with DD specifically, responses to arithmetic operations are supposed to be facilitated by both negative and mathematics-related primes (=negative math priming effect).We investigated mathematical performance, math anxiety, and the domain-general abilities of 172 primary school children (76 with DD and 96 controls). All participants also underwent an affective priming task which consisted of the decision whether a simple arithmetic operation (addition or subtraction) that was preceded by a prime (positive/negative/neutral or mathematics-related) was true or false. Our findings did not reveal a negative math priming effect in children with DD. Furthermore, when considering accuracy levels, gender, or math anxiety, the negative math priming effect could not be replicated. However, children with DD showed more math anxiety when explicitly assessed by a specific math anxiety interview and showed lower mathematical performance compared to controls. Moreover, math anxiety was equally present in boys and girls, even in the earliest stages of schooling, and interfered negatively with performance. In conclusion, mathematics is often associated with negative emotions that can be manifested in specific math anxiety, particularly in children with DD. Importantly, present findings suggest that in the assessed age group, it is more reliable to judge math anxiety and investigate its effects on mathematical performance explicitly by adequate questionnaires than by an affective math priming task.
The thesis deals with the topic of dyscalculia, which is officially recognized as a learning disability. The theoretical part of the thesis is focused on the current status of knowledge about development of mathematical skills and their disorders in the context of dyscalculia. The empiric part of this thesis describes a research which compares the performances of individuals with dyscalculia and control participants on a range number and numerosity processing tasks. The main goal was to descr...
Bekker, Linda-Gail; Johnson, Leigh; Cowan, Frances; Overs, Cheryl; Besada, Donela; Hillier, Sharon; Cates, Willard
Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide. Copyright © 2015 Elsevier Ltd. All rights reserved.
Full Text Available Staphylococcal bacteremia and enterococcal bacteremia are prevalent in hospitalized or recently instrumented patients, and are associated with significant morbidity and mortality. They are often difficult to treat due to the pathogenicity of the organisms, poor response to antibiotics, and increasing development of multidrug resistance. Therefore, there has been increasing interest in combination therapy for the treatment of these infections. The aim of this review was to summarize and assess the evidence supporting combination beta-lactam therapy for both Staphylococcus aureus and Enterococcus species blood stream infections. Currently, there is promising in vitro data but little clinical evidence supporting combination beta-lactam therapy for this indication. Further clinical investigations are needed to elucidate the potential benefits of beta-lactam combination therapy over monotherapy for Gram-positive bacteremia, although combination therapy may be useful in refractory cases of bacteremia that do not respond to standard antibiotic therapy.
Lawton, Clare Louise
This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area. PMID:29425182
Boyle Neil Bernard
Full Text Available This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and glucoregulatory control. There is modest evidence to suggest modulating glycemic response may impact cognitive function. The evidence presented in this review identifies dose ranges of glucose and caffeine which improve cognition, but fails to find convincing consistent synergistic effects of combining caffeine and glucose. Whilst combining glucose and caffeine has been shown to facilitate cognitive performance and mood compared to placebo or glucose alone, the relative contribution of caffeine and glucose to the observed effects is difficult to ascertain, due to the paucity of studies that have appropriately compared the effects of these ingredients combined and in isolation. This review identifies a number of methodological challenges which need to be considered in the design of future hypothesis driven research in this area.
Andrea Carolina Rojas Suarez
Full Text Available This study was aimed to encourage the learning of mathematics in children with developmental dyscalculia through education and teaching strategies. The research methodology is framed within the qualitative paradigm, with an exploratory ethnographic method, as its object of study needs to be addressed from the observational record of the development of students with learning difficulties in mathematics through the development of evidence in this area. The categories addressed relate to factors that affect learning, alternative teaching, learning mathematics in children with dyscalculia and mathematics activities according to numerical thinking, which marked the path of execution to address the subject of investigation. Finally, we conclude that the strategies used allowed the student not only know the subject from the process developed but at the same time, enhance and maintain constant motivation and participation in learning in this key area in the school curriculum.
Schuchardt, Kirsten; Maehler, Claudia; Hasselhorn, Marcus
This article examines working memory functioning in children with specific developmental disorders of scholastic skills as defined by ICD-10. Ninety-seven second to fourth graders with a minimum IQ of 80 are compared using a 2 x 2 factorial (dyscalculia vs. no dyscalculia; dyslexia vs. no dyslexia) design. An extensive test battery assesses the three subcomponents of working memory described by Baddeley (1986): phonological loop, visual-spatial sketchpad, and central executive. Children with dyscalculia show deficits in visual-spatial memory; children with dyslexia show deficits in phonological and central executive functioning. When controlling for the influence of the phonological loop on the performance of the central executive, however, the effect is no longer significant. Although children with both reading and arithmetic disorders are consistently outperformed by all other groups, there is no significant interaction between the factors dyscalculia and dyslexia.
Svensson, Elin M; Yngman, Gunnar; Denti, Paolo; McIlleron, Helen; Kjellsson, Maria C; Karlsson, Mats O
Fixed-dose combination formulations where several drugs are included in one tablet are important for the implementation of many long-term multidrug therapies. The selection of optimal dose ratios and tablet content of a fixed-dose combination and the design of individualized dosing regimens is a complex task, requiring multiple simultaneous considerations. In this work, a methodology for the rational design of a fixed-dose combination was developed and applied to the case of a three-drug pediatric anti-tuberculosis formulation individualized on body weight. The optimization methodology synthesizes information about the intended use population, the pharmacokinetic properties of the drugs, therapeutic targets, and practical constraints. A utility function is included to penalize deviations from the targets; a sequential estimation procedure was developed for stable estimation of break-points for individualized dosing. The suggested optimized pediatric anti-tuberculosis fixed-dose combination was compared with the recently launched World Health Organization-endorsed formulation. The optimized fixed-dose combination included 15, 36, and 16% higher amounts of rifampicin, isoniazid, and pyrazinamide, respectively. The optimized fixed-dose combination is expected to result in overall less deviation from the therapeutic targets based on adult exposure and substantially fewer children with underexposure (below half the target). The development of this design tool can aid the implementation of evidence-based formulations, integrating available knowledge and practical considerations, to optimize drug exposures and thereby treatment outcomes.
De Visscher, Alice; Noël, Marie-Pascale
Dyscalculia, or mathematics learning disorders, is currently known to be heterogeneous (Wilson & Dehaene, 2007). While various profiles of dyscalculia coexist, a general and persistent hallmark of this math learning disability is the difficulty in memorizing arithmetic facts (Geary, Hoard & Hamson, 1999; Jordan & Montani, 1997; Slade…
Anca, Maria; Hategan, Carolina
In the given study dyscalculia is approached in the context of learning difficulties, but also in relation with damaged psychic processes and functions. The practical part of the study describes intervention models from the perspective of dyscalculia prevention and therapymaterialized in personalized intervention programs.
Full Text Available Due to the complexity of system and lack of expertise, epistemic uncertainties may present in the experts’ judgment on the importance of certain indices during group decision-making. A novel combination weighting method is proposed to solve the index weighting problem when various uncertainties are present in expert comments. Based on the idea of evidence theory, various types of uncertain evaluation information are uniformly expressed through interval evidence structures. Similarity matrix between interval evidences is constructed, and expert’s information is fused. Comment grades are quantified using the interval number, and cumulative probability function for evaluating the importance of indices is constructed based on the fused information. Finally, index weights are obtained by Monte Carlo random sampling. The method can process expert’s information with varying degrees of uncertainties, which possesses good compatibility. Difficulty in effectively fusing high-conflict group decision-making information and large information loss after fusion is avertible. Original expert judgments are retained rather objectively throughout the processing procedure. Cumulative probability function constructing and random sampling processes do not require any human intervention or judgment. It can be implemented by computer programs easily, thus having an apparent advantage in evaluation practices of fairly huge index systems.
Kumar, S. Praveen; Raja, B. William Dharma
This article focusses on the specific learning disabilities found in schools such as Dyslexia and Dyscalculia, the influence of dyslexia on dyscalculia and the need to adopt certain strategies that help cope with this problem. Learners with multifarious language-related or arithmetic-related disabilities are found in most schools. These children…
This presentation, Assessing the Combined Effects of Environmental and Social Stress: A Review of the Evidence and Implications for Research, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome held on May 11, 2016.
Schuchardt, Kirsten; Maehler, Claudia; Hasselhorn, Marcus
This article examines working memory functioning in children with specific developmental disorders of scholastic skills as defined by ICD-10. Ninety-seven second to fourth graders with a minimum IQ of 80 are compared using a 2 x 2 factorial (dyscalculia vs. no dyscalculia; dyslexia vs. no dyslexia) design. An extensive test battery assesses the…
Ise, Elena; Schulte-Körne, Gerd
Children with dyscalculia show deficits in basic numerical processing which cause difficulties in the acquisition of mathematical skills. This article provides an overview of current research findings regarding the symptoms, cause, and prognosis of dyscalculia, and it summarizes recent developments in the diagnosis, early intervention, and treatment thereof. Diagnosis has improved recently because newly developed tests focus not only on the math curriculum, but also on basic skills found to be impaired in dyscalculia. A controversial debate continues with regard to IQ achievement discrepancy. International studies have demonstrated the effectiveness of specialized interventions. This article summarizes the research findings from intervention studies, describes different treatment approaches, and discusses implications for clinical practice.
Full Text Available Jasmina Varagic,1–3 Henry Punzi,4,5 Carlos M Ferrario2,3,61Hypertension and Vascular Research Center, 2Division of Surgical Sciences, 3Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA; 4Trinity Hypertension and Diagnostic Research Center, Carrollton, TX, USA; 5Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; 6Department of Internal Medicine and Nephrology, Wake Forest University, Winston-Salem, NC, USAAbstract: Despite significant advances in pharmacologic approaches to treat hypertension during the last decades, hypertension- and hypertension-related organ damage are still a high health and economic burden because a large proportion of patients with hypertension do not achieve optimal blood pressure control. There is now general agreement that combination therapy with two or more antihypertensive drugs is required for targeted blood pressure accomplishment and reduction of global cardiovascular risk. The goals of combination therapies are to reduce long-term cardiovascular events by targeting different mechanism underlying hypertension and target organ disease, to block the counterregulatory pathways activated by monotherapies, to improve tolerability and decrease the adverse effects of up-titrated single agents, and to increase persistence and adherence with antihypertensive therapy. Multiple clinical trials provide evidence that fixed-dose combinations in a single pill offer several advantages when compared with loose-dose combinations. This review discusses the advances in hypertension control and associated cardiovascular disease as they relate to the prospect of combination therapy targeting a third-generation beta (β 1-adrenergic receptor (nebivolol and an angiotensin II receptor blocker (valsartan in fixed-dose single-pill formulations.Keywords: blood pressure control, hypertension, β1-adrenergic receptor, renin angiotensin system
H. T. Chu
Full Text Available The integration of different kinds of remotely sensed data, in particular Synthetic Aperture Radar (SAR and optical satellite imagery, is considered a promising approach for land cover classification because of the complimentary properties of each data source. However, the challenges are: how to fully exploit the capabilities of these multiple data sources, which combined datasets should be used and which data processing and classification techniques are most appropriate in order to achieve the best results. In this paper an approach, in which synergistic use of a feature selection (FS methods with Genetic Algorithm (GA and multiple classifiers combination based on Dempster-Shafer Theory of Evidence, is proposed and evaluated for classifying land cover features in New South Wales, Australia. Multi-date SAR data, including ALOS/PALSAR, ENVISAT/ASAR and optical (Landsat 5 TM+ images, were used for this study. Textural information were also derived and integrated with the original images. Various combined datasets were generated for classification. Three classifiers, namely Artificial Neural Network (ANN, Support Vector Machines (SVMs and Self-Organizing Map (SOM were employed. Firstly, feature selection using GA was applied for each classifier and dataset to determine the optimal input features and parameters. Then the results of three classifiers on particular datasets were combined using the Dempster-Shafer theory of Evidence. Results of this study demonstrate the advantages of the proposed method for land cover mapping using complex datasets. It is revealed that the use of GA in conjunction with the Dempster-Shafer Theory of Evidence can significantly improve the classification accuracy. Furthermore, integration of SAR and optical data often outperform single-type datasets.
The information society has raised the value of numeracy. This is a challenge to schools and societies, because individual differences are large already in basic number sense and calculation skills. Approximately 5-7 % of school children have extensive difficulties to keep with the speed of curricular demands, i.e. one child in every classroom. These children often have difficulties in other areas of learning too, but disorders in learning can also manifest only in mathematics. Undiagnosed and untreated mathematical disorders become a lifelong handicap creating a barrier to vocational education. They also hinder independent management of mathematical activities of daily living. Low numeracy is a measurable social problem. Intensive and early special education or neuropsychological rehabilitation can diminish the negative effects of the disorders.
Clark, Rachel; Waters, Elizabeth; Armstrong, Rebecca; Conning, Rebecca; Allender, Steven; Swinburn, Boyd
Public health practitioners make decisions based on research evidence in combination with a variety of other influences. Evidence summaries are one of a range of knowledge translation options used to support evidence-informed decision making. The literature relevant to obesity prevention requires synthesis for it to be accessible and relevant to…
Youngstrom, Eric A
Assessment has been a historical strength of psychology, with sophisticated traditions of measurement, psychometrics, and theoretical underpinnings. However, training, reimbursement, and utilization of psychological assessment have been eroded in many settings. Evidence-based medicine (EBM) offers a different perspective on evaluation that complements traditional strengths of psychological assessment. EBM ties assessment directly to clinical decision making about the individual, uses simplified Bayesian methods explicitly to integrate assessment data, and solicits patient preferences as part of the decision-making process. Combining the EBM perspective with psychological assessment creates a hybrid approach that is more client centered, and it defines a set of applied research topics that are highly clinically relevant. This article offers a sequence of a dozen facets of the revised assessment process, along with examples of corollary research studies. An eclectic integration of EBM and evidence-based assessment generates a powerful hybrid that is likely to have broad applicability within clinical psychology and enhance the utility of psychological assessments.
Gaspelin, Nicholas; Luck, Steven J
Researchers have long debated how salient-but-irrelevant features guide visual attention. Pure stimulus-driven theories claim that salient stimuli automatically capture attention irrespective of goals, whereas pure goal-driven theories propose that an individual's attentional control settings determine whether salient stimuli capture attention. However, recent studies have suggested a hybrid model in which salient stimuli attract visual attention but can be actively suppressed by top-down attentional mechanisms. Support for this hybrid model has primarily come from ERP studies demonstrating that salient stimuli, which fail to capture attention, also elicit a distractor positivity (P D ) component, a putative neural index of suppression. Other support comes from a handful of behavioral studies showing that processing at the salient locations is inhibited compared with other locations. The current study was designed to link the behavioral and neural evidence by combining ERP recordings with an experimental paradigm that provides a behavioral measure of suppression. We found that, when a salient distractor item elicited the P D component, processing at the location of this distractor was suppressed below baseline levels. Furthermore, the magnitude of behavioral suppression and the magnitude of the P D component covaried across participants. These findings provide a crucial connection between the behavioral and neural measures of suppression, which opens the door to using the P D component to assess the timing and neural substrates of the behaviorally observed suppression.
针对D-S证据理论在高冲突下失效的问题,在比较修正原始证据源和重新分配冲突两种方法的基础上,提出一种新的合成规则,新方法用可信度修正证据的同时,把全局冲突分为两部分,并依据“全局冲突在全局分配、局部冲突在局部分配”的原则对冲突进行细化分配.通过仿真分析,并与其他方法比较,新的合成方法能更好地融合冲突证据,收敛速度快,具有较强的抗干扰能力.%To solve the invalidation problem of Dempster-Shafer evidence combination rule with high conflict,a new method is proposed by comparing correcting original evidence sources and redistributing conflicts.With correcting original evidence sources by reliability,the new method separated the overall conflict into two parts and distributed conflicts based on the rules which distributes overall conflicts on the whole and part conflicts on the part.The simulation analysis shows that,compared with other methods,the new combination rules have good performances in fusing evidence conflicts and can accelerate convergence and enhance the anti-interference ability.
Szardenings, Carsten; Kuhn, Jörg-Tobias; Ranger, Jochen; Holling, Heinz
The respective roles of the approximate number system (ANS) and an access deficit (AD) in developmental dyscalculia (DD) are not well-known. Most studies rely on response times (RTs) or accuracy (error rates) separately. We analyzed the results of two samples of elementary school children in symbolic magnitude comparison (MC) and non-symbolic MC using a diffusion model. This approach uses the joint distribution of both RTs and accuracy in order to synthesize measures closer to ability and response caution or response conservatism. The latter can be understood in the context of the speed-accuracy tradeoff: It expresses how much a subject trades in speed for improved accuracy. We found significant effects of DD on both ability (negative) and response caution (positive) in MC tasks and a negative interaction of DD with symbolic task material on ability. These results support that DD subjects suffer from both an impaired ANS and an AD and in particular support that slower RTs of children with DD are indeed related to impaired processing of numerical information. An interaction effect of symbolic task material and DD (low mathematical ability) on response caution could not be refuted. However, in a sample more representative of the general population we found a negative association of mathematical ability and response caution in symbolic but not in non-symbolic task material. The observed differences in response behavior highlight the importance of accounting for response caution in the analysis of MC tasks. The results as a whole present a good example of the benefits of a diffusion model analysis.
Full Text Available The respective roles of the approximate number system (ANS and an access deficit (AD in developmental dyscalculia (DD are not well-known. Most studies rely on response times (RTs or accuracy (error rates separately. We analyzed the results of two samples of elementary school children in symbolic magnitude comparison (MC and non-symbolic MC using a diffusion model. This approach uses the joint distribution of both RTs and accuracy in order to synthesize measures closer to ability and response caution or response conservatism. The latter can be understood in the context of the speed-accuracy tradeoff: It expresses how much a subject trades in speed for improved accuracy. We found significant effects of DD on both ability (negative and response caution (positive in MC tasks and a negative interaction of DD with symbolic task material on ability. These results support that DD subjects suffer from both an impaired ANS and an AD and in particular support that slower RTs of children with DD are indeed related to impaired processing of numerical information. An interaction effect of symbolic task material and DD (low mathematical ability on response caution could not be refuted. However, in a sample more representative of the general population we found a negative association of mathematical ability and response caution in symbolic but not in non-symbolic task material. The observed differences in response behavior highlight the importance of accounting for response caution in the analysis of MC tasks. The results as a whole present a good example of the benefits of a diffusion model analysis.
Evans, Valerie; Roderick, Peter; Pollock, Allyson M
There is growing national and international concern about the drug regulatory system in India. Parliamentary reports have highlighted the presence of high numbers of unapproved medicines and irrational combinations of both approved and unapproved drugs in the Indian market-place. Fixed-dose combinations (FDCs) are a peculiar feature of the Indian pharmaceutical landscape. Although metformin is a first-line treatment, FDCs for diabetes in India account for two-thirds of all diabetes medicine sales, and some have not been approved by the Central Drugs Standard Control Organization (CDSCO). This study examines the basis of efficacy and safety of top-selling metformin FDCs in India against four WHO criteria from clinical trials guidelines for the approval of FDCs. Data from a commercial drug sales database (PharmaTrac) were combined with searches through published literature, clinical trial registries, and published and unpublished trial websites of metformin FDCs in adults with type 2 diabetes mellitus. Five metformin FDCs in India from November 2011 to October 2012 accounted for 80% of all metformin FDC sales by value and volume. Although all five had obtained CDSCO approval, three had been sold and marketed prior to receiving this approval. Evaluation of published and unpublished clinical trials of these five FDCs found none provided robust evidence of safety and efficacy for the treatment of type 2 diabetes. Recommendations are made for publishing evidence that underpins drug approvals, marketing bans, greater transparency through updated clinical trials databases and legislative reform in order to prevent irrational FDCs from entering the market.
黎湘; 刘永祥; 付耀文; 庄钊文
A modified evidence combination rule with a combination parameter λ is proposed to solve some problems in D-S theory by considering the correlation and complement among the evidences as well as the size and intersection of subsets in evidence. It can get reasonable results even the evidences are conflicting. Applying this rule to the real infrared/millimetre wave fusion system, a satisfactory result has been obtained.
Full Text Available Most cellular functions involve proteins’ features based on their physical interactions with other partner proteins. Sketching a map of protein–protein interactions (PPIs is therefore an important inception step towards understanding the basics of cell functions. Several experimental techniques operating in vivo or in vitro have made significant contributions to screening a large number of protein interaction partners, especially high-throughput experimental methods. However, computational approaches for PPI predication supported by rapid accumulation of data generated from experimental techniques, 3D structure definitions, and genome sequencing have boosted the map sketching of PPIs. In this review, we shed light on in silico PPI prediction methods that integrate evidence from multiple sources, including evolutionary relationship, function annotation, sequence/structure features, network topology and text mining. These methods are developed for integration of multi-dimensional evidence, for designing the strategies to predict novel interactions, and for making the results consistent with the increase of prediction coverage and accuracy.
Boyle Neil Bernard; Lawton Clare Louise; Dye Louise
This review examines the effects of carbohydrates, delivered individually and in combination with caffeine, on a range of cognitive domains and subjective mood. There is evidence for beneficial effects of glucose at a dose of 25 g on episodic memory, but exploration of dose effects has not been systematic and the effects on other cognitive domains is not known. Factors contributing to the differential sensitivity to glucose facilitation include age, task difficulty/demand, task domain, and gl...
A nearly endless number of procedures has been tried and in particular sold for the treatment of tinnitus, unfortunately they have not been evaluated appropriately in an evidence-based way. A causal therapy, omitting the tinnitus still does not exist, actually it cannot exist because of the various mechanisms of its origin. However or perhaps because of that, medical interventions appear and reappear like fashion trends that can never be proven by stable and reliable treatment success. This contribution will discuss and acknowledge all current therapeutic procedures and the existing or non-existing evidence will be assessed. Beside external evidence, the term of evidence also encompasses the internal evidence, i.e. the experience of the treating physician and the patient’s needs shall be included. While there is no evidence for nearly all direct procedures that intend modulating or stimulating either the cochlea or specific cervical regions such as the auditory cortex, there are therapeutic procedures that are acknowledged in clinical practice and have achieved at least a certain degree of evidence and generate measurable effect sizes. Those are in particular habituation therapy and psychotherapeutic measures, especially if they are combined with concrete measures for improved audio perception (hearing aids, CI, hearing therapies). PMID:28025604
Cairney, Paul; Oliver, Kathryn
There is extensive health and public health literature on the 'evidence-policy gap', exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda - should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise 'evidence-based' policymaking above other factors? The latter includes governance principles such the 'co-production' of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.We conclude that successful engagement in 'evidence-based policymaking' requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions
Broholm, Mette Martina; Janniche, Gry Sander; Mosthaf, Klaus
Characterization of dense non-aqueous phase liquid (DNAPL) source zones in limestone aquifers/bedrock is essential to develop accurate site-specific conceptual models and perform risk assessment. Here innovative field methods were combined to improve determination of source zone architecture......, hydrogeology and contaminant distribution. The FACT™ is a new technology and it was applied and tested at a contaminated site with a limestone aquifer, together with a number of existing methods including wire-line coring with core subsampling, FLUTe® transmissivity profiling and multilevel water sampling...... groundwater sampling (under two flow conditions) and FACT™ sampling and analysis combined with FLUTe® transmissivity profiling and modeling were used to provide a line of evidence for the presence of DNAPL, dissolved and sorbed phase contamination in the limestone fractures and matrix. The combined methods...
Full Text Available Dave Singh,1 Massimo Corradi,2 Monica Spinola,3 Alberto Papi,4 Omar S Usmani,5 Mario Scuri,3 Stefano Petruzzelli,3 Jørgen Vestbo1 1Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; 2Department of Medicine and Surgery, University of Parma, Parma, Italy; 3Chiesi Farmaceutici SpA, Parma, Italy; 4Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy; 5National Heart and Lung Institute, Imperial College London, London, UK Abstract: The goals of COPD therapy are to prevent and control symptoms, reduce the frequency and severity of exacerbations, and improve exercise tolerance. The triple combination therapy of inhaled corticosteroids (ICSs, long-acting beta2 agonists (LABAs, and long-acting muscarinic antagonists (LAMAs has become an option for maintenance treatment of COPD and as a “step-up” therapy from single or double combination treatments. There is evidence that triple combination ICS/LABA/LAMA with different inhalers improves lung function, symptoms, and health status and reduces exacerbations. A new triple fixed-dose combination of extrafine beclomethasone dipropionate (100 µg/puff/formoterol fumarate (6 µg/puff/glycopyrronium bromide (12.5 µg/puff has been developed as a hydrofluoroalkane pressurized metered dose inhaler. Two large pivotal studies showed that this extrafine fixed ICS/LABA/LAMA triple combination is superior to fixed ICS/LABA combined therapy and also superior to the LAMA tiotropium in terms of lung function and exacerbation prevention in COPD patients at risk of exacerbation. This review considers the new information provided by these clinical trials of extrafine triple therapy and the implications for the clinical management of COPD patients. Keywords: COPD, inhaled triple therapy, beclomethasone dipropionate, formoterol fumarate and glycopyrronium bromide
Oplevelser, forskning, uddannelsespolitik: Fem slags oplevet usikkerhed ved vanskeligheder ved at meningsgøre tal og størrelser. Fem tilgange til dyskalkuli i forskning. Fire usikkerheder i uddannelsessystemet....
Bieber, Frederick R; Buckleton, John S; Budowle, Bruce; Butler, John M; Coble, Michael D
The evaluation and interpretation of forensic DNA mixture evidence faces greater interpretational challenges due to increasingly complex mixture evidence. Such challenges include: casework involving low quantity or degraded evidence leading to allele and locus dropout; allele sharing of contributors leading to allele stacking; and differentiation of PCR stutter artifacts from true alleles. There is variation in statistical approaches used to evaluate the strength of the evidence when inclusion of a specific known individual(s) is determined, and the approaches used must be supportable. There are concerns that methods utilized for interpretation of complex forensic DNA mixtures may not be implemented properly in some casework. Similar questions are being raised in a number of U.S. jurisdictions, leading to some confusion about mixture interpretation for current and previous casework. Key elements necessary for the interpretation and statistical evaluation of forensic DNA mixtures are described. Given the most common method for statistical evaluation of DNA mixtures in many parts of the world, including the USA, is the Combined Probability of Inclusion/Exclusion (CPI/CPE). Exposition and elucidation of this method and a protocol for use is the focus of this article. Formulae and other supporting materials are provided. Guidance and details of a DNA mixture interpretation protocol is provided for application of the CPI/CPE method in the analysis of more complex forensic DNA mixtures. This description, in turn, should help reduce the variability of interpretation with application of this methodology and thereby improve the quality of DNA mixture interpretation throughout the forensic community.
Buonocore, M; Bosia, M; Riccaboni, R; Bechi, M; Spangaro, M; Piantanida, M; Cocchi, F; Guglielmino, C; Bianchi, L; Smeraldi, E; Cavallaro, R
A Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement. Fifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE. After MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures. This study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Mammarella, Irene C; Caviola, Sara; Giofrè, David; Borella, Erika
Deficits in executive functions have been hypothesized and documented for children with severe mathematics anxiety (MA) or developmental dyscalculia, but the role of inhibition-related processes has not been specifically explored. The main aim of the present study was to shed further light on the specificity of these profiles in children in terms of working memory (WM) and the inhibitory functions involved. Four groups of children between 8 and 10 years old were selected: one group with developmental dyscalculia (DD) and no MA, one with severe MA and developmental dyscalculia (MA-DD), one with severe MA and no DD (MA), and one with typical development (TD). All children were presented with tasks measuring two inhibition-related functions, that is, proactive interference and prepotent response, and a WM task. The results showed that children with severe MA (but no DD) were specifically impaired in the proactive interference task, while children with DD (with or without MA) failed in the WM task. Our findings point to the importance of distinguishing the cognitive processes underlying these profiles.
Hafslund, Bjorg; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica
Evidence-based practice (EBP) offers the integration of the best research evidence with clinical knowledge and expertise and patient values. EBP is a well known term in health care. This paper discusses the implementation of EBP into radiography and introduces the term evidence-based radiography. Evidence-based radiography is radiography informed and based on the combination of clinical expertise and the best available research-based evidence, patient preferences and resources available. In Norway, EBP in radiography is being debated and radiographers are discussing the challenges of implementing EBP in both academic and clinical practice. This discussion paper explains why EBP needs to be a basis for a radiography curriculum and a part of radiographers' practice. We argue that Norwegian radiographers must increase participation in research and developing practice within their specific radiographic domain
Gallo, Maria F; Lopez, Laureen M; Grimes, David A; Carayon, Florence; Schulz, Kenneth F; Helmerhorst, Frans M
evidence supporting a causal association between combination oral contraceptives or a combination skin patch and weight change. Most comparisons of different combination contraceptives showed no substantial difference in weight. In addition, discontinuation of combination contraceptives because of weight change did not differ between groups where this was studied. Available evidence was insufficient to determine the effect of combination contraceptives on weight, but no large effect was evident. Trials to evaluate the link between combination contraceptives and weight change require a placebo or non-hormonal group to control for other factors, including changes in weight over time.
Wen, Wanxin; Gao, Hongxia; Kang, Nini; Lu, Aili; Qian, Caiwen; Zhao, Yuanqi
Fluoroacetamide poisoning is the acute and severe disease of human, which leads to nervous, digestive, and cardiovascular system damage or even death in a short period of time. We report a case of a 65-year-old woman with loss of consciousness, nausea, and vomiting who was sent to the hospital by passers-by. She was diagnosed with severe fluoroacetamide poisoning with combined multiple organ dysfunction syndrome. When the diagnosis was unclear, we gave gastric lavage, support and symptomatic treatment, and closely with the vital sign. When the diagnosis was clear, based on the evidence of retrieved, muscle injection of acetamide, calcium gluconate, and vitamin C. Traditional Chinese medicine aspect, oral administration of mung bean soup of glycyrrhizae and Da-Cheng-Qi decoction enema. By setting reasonable treatment for patients, she had no special discomfort and complications after treatment. Besides, through 1-month follow-up, it was confirmed that the treatments were effective. Evidence-based integrated Chinese and Western medicines can effectively improve the therapeutic effects in severe fluoroacetamide-poisoned patients with combined MODS.
Cooke, Matt; Cribb, Paul J.
Few supplement combinations that are marketed to athletes are supported by scientific evidence of their effectiveness. Quite often, under the rigor of scientific investigation, the patented combination fails to provide any greater benefit than a group given the active (generic) ingredient. The focus of this chapter is supplement combinations and dosing strategies that are effective at promoting an acute physiological response that may improve/enhance exercise performance or influence chronic adaptations desired from training. In recent years, there has been a particular focus on two nutritional ergogenic aids—creatine monohydrate and protein/amino acids—in combination with specific nutrients in an effort to augment or add to their already established independent ergogenic effects. These combinations and others are discussed in this chapter.
, and single clinics. Accordingly, there is an urgent need to improve this situation. Guidelines for Good Clinical (Research) Practice, conduct of more trials as multicentre trials, The Consort Statement, and The Cochrane Collaboration may all help in the application of the best research evidence in clinical......Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....
Corbí, Josep E.
In this paper, I challlenge David Finkelstein's claim that evidence does not contribute to first-person authority. To this end, I first argue that the phenomenon of first-person authority involves a certain combination of two kinds of authority, namely: an epistemic (insofar as evidence is at issue here) and a practical (insofar as the capacity to shape one's own psychological and dispositions is the central concern) kind of authority. Secondly, I defend the view that gathering evidence plays...
This monograph considers the evaluation and expression of measurement uncertainty within the mathematical framework of the Theory of Evidence. With a new perspective on the metrology science, the text paves the way for innovative applications in a wide range of areas. Building on Simona Salicone’s Measurement Uncertainty: An Approach via the Mathematical Theory of Evidence, the material covers further developments of the Random Fuzzy Variable (RFV) approach to uncertainty and provides a more robust mathematical and metrological background to the combination of measurement results that leads to a more effective RFV combination method. While the first part of the book introduces measurement uncertainty, the Theory of Evidence, and fuzzy sets, the following parts bring together these concepts and derive an effective methodology for the evaluation and expression of measurement uncertainty. A supplementary downloadable program allows the readers to interact with the proposed approach by generating and combining ...
Full Text Available With the introduction of Mutual funds in India in 1963, the Indian investor has shown positive response to mutual fund investments which is evidenced through increasing AUM (Assets Under Management every quarter. So far as management style is concerned the industry offers two options to the common investor- on one hand the passively managed funds with the sole objective of replicating their benchmark index and on the other the actively managed funds where the fund manager continuously puts his efforts to enhance the returns, by making frequent changes in the composition of the portfolio. The common investor with limited savings cannot be expected to hold too many funds in his portfolio. Further with limited exposure to financial concepts and complexities he is left guessing on the right combination of funds that should constitute his small portfolio. This paper is a sincere attempt to address the above mentioned situation. We have empirically tested and shown that given the restricted savings which combination, either only two passively managed funds, two actively managed funds or a portfolio comprising of one of each type will win the race for the investor. This paper will be of interest, particularly to the small investors, academicians as well as the financial advisors.
Marios A. Pappas
Full Text Available Specific Learning Disorder with impairment in Mathematics (Developmental Dyscalculia is a complex learning disorder which affects arithmetic skills, symbolic magnitude processing, alertness, flexibility in problem solving and maintained attention. Neuro-cognitive studies revealed that such difficulties in children with DD could be related to poor Working Memory and attention deficits. Furthermore, neuroimaging studies indicate that brain structure differences in children with DD compared to typically developing children could affect mathematical performance. In this study we present the cognitive profile of Dyscalculia, as well as the neuropsychological aspects of the deficit, with special reference to the utilization of enhanced assessment technology such as computerized neuropsychological tools and neuroimaging techniques.
Full Text Available The power transformer is one of the most critical and expensive components for the stable operation of the power system. Hence, how to obtain the health condition of transformer is of great importance for power utilities. Multi-attribute decision-making (MADM, due to its ability of solving multi-source information problems, has become a quite effective tool to evaluate the health condition of transformers. Currently, the analytic hierarchy process (AHP and Dempster–Shafer theory are two popular methods to solve MADM problems; however, these techniques rarely consider one-sidedness of the single weighting method and the exclusiveness hypothesis of the Dempster–Shafer theory. To overcome these limitations, this paper introduces a novel decision-making model, which integrates the merits of fuzzy set theory, game theory and modified evidence combination extended by D numbers, to evaluate the health condition of transformers. A four-level framework, which includes three factors and seventeen sub-factors, is put forward to facilitate the evaluation model. The model points out the following: First, the fuzzy set theory is employed to obtain the original basic probability assignments for all indices. Second, the subjective and objective weights of indices, which are calculated by fuzzy AHP and entropy weight, respectively, are integrated to generate the comprehensive weights based on game theory. Finally, based on the above two steps, the modified evidence combination extended by D numbers, which avoids the limitation of the exclusiveness hypothesis in the application of Dempster–Shafer theory, is proposed to obtain the final assessment results of transformers. Case studies are given to demonstrate the proposed modeling process. The results show the effectiveness and engineering practicability of the model in transformer condition assessment.
Garattini, Silvio; Jakobsen, Janus C; Wetterslev, Jørn
was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading...
Jensen, Peter; Skov, Lone; Zachariae, Claus
Psoriasis is a chronic inflammatory skin disease, which affects approximately 2.6% of the population in Northern Europe and Scandinavia. In order to achieve disease control, combinations of systemic treatments are sometimes needed for variable time periods. However, no evidence-based guidelines...... exist for the use of systemic combination therapy. Therefore, our aim was to review the current literature on systemic anti-psoriatic combination regimens. We searched PubMed and identified 98 papers describing 116 studies (23 randomized) reporting on the effect of various systemic combination...
Dusseldorp, E.; Buuren, S. van; Genugten, L. van; Verheijden, M.W.; Empelen, P. van
Objective: Many health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available meta-analyses have not been able to identify specific combinations of techniques that provide synergistic
Full Text Available Sayf A Yassin,1 Vanita R Aroda2 1MedStar Union Memorial Hospital, Baltimore, 2MedStar Health Research Institute, Hyattsville, MD, USA Abstract: Type 2 diabetes mellitus (T2DM is a progressive and multifactorial cardiometabolic disorder. Almost half of adults with diabetes fail to achieve their recommended glucose control target. This has prompted some clinicians to advocate the use of more intensive initial therapy, including the use of combination therapy to target multiple physiologic defects in diabetes with the goal of achieving and sustaining glucose control. Numerous options exist for combining the various classes of glucose-lowering agents in the treatment of T2DM. This report reviews the mechanism, rationale, and evidence from clinical trials for combining two of the newer drug classes, namely, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter 2 inhibitors, and considers the possible role of such dual therapy in the management of T2DM. Keywords: sodium-glucose cotransporter 2 inhibitors, dipeptidyl peptidase-4 inhibitors, type 2 diabetes mellitus, combination therapy
Full Text Available Anja Schweizer,1 James E Foley,2 Wolfgang Kothny,2 Bo Ahrén31Novartis Pharma AG, Basel, Switzerland; 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Department of Clinical Sciences, Lund University, Lund, SwedenAbstract: Due to the progressive nature of type 2 diabetes, many patients need insulin as add-on to oral antidiabetic drugs (OADs in order to maintain adequate glycemic control. Insulin therapy primarily targets elevated fasting glycemia but is less effective to reduce postprandial hyperglycemia. In addition, the risk of hypoglycemia limits its effectiveness and there is a concern of weight gain. These drawbacks may be overcome by combining insulin with incretin-based therapies as these increase glucose sensitivity of both the α- and β-cells, resulting in improved postprandial glycemia without the hypoglycemia and weight gain associated with increasing the dose of insulin. The dipeptidyl peptidase-IV (DPP-4 inhibitor vildagliptin has also been shown to protect from hypoglycemia by enhancing glucagon counterregulation. The effectiveness of combining vildagliptin with insulin was demonstrated in three different studies in which vildagliptin decreased A1C levels when added to insulin therapy without increasing hypoglycemia. This was established with and without concomitant metformin therapy. Furthermore, the effectiveness of vildagliptin appears to be greater when insulin is used as a basal regimen as opposed to being used to reduce postprandial hyperglycemia, since improvement in insulin secretion likely plays a minor role when relatively high doses of insulin are administered before meals. This article reviews the clinical experience with the combination of vildagliptin and insulin and discusses the mechanistic basis for the beneficial effects of the combination. The data support the use of vildagliptin in combination with insulin in general and, in line with emerging clinical practice, suggest that treating patients with
Aronoff, Stephen C; Evans, Barry; Fleece, David; Lyons, Paul; Kaplan, Lawrence; Rojas, Roberto
Incorporation of evidence based medicine into the undergraduate curriculum varies from school to school. The purpose of this study was to determine if an online course in evidence based medicine run concurrently with the clinical clerkships in the 3rd year of undergraduate medical education provided effective instruction in evidence based medicine (EBM). During the first 18 weeks of the 3rd year, students completed 6 online, didactic modules. Over the next 24 weeks, students developed questions independently from patients seen during clerkships and then retrieved and appraised relevant evidence. Online, faculty mentors reviewed student assignments submitted throughout the course to monitor progress. Mastery of the skills of EBM was assessed prior to and at the conclusion of the course using the Fresno test of competency. Paired data were available from 139 students. Postcourse test scores (M= 77.7; 95% CI = 59-96.4) were significantly higher than precourse scores (M= 66.6; 95% CI = 46.5-86.7), ponline, faculty mentored instruction. This method of instruction provided uniform instruction across geographic sites and medical specialties and permitted efficient use of faculty time.
Wendy A. Abbott
Full Text Available Objective - To demonstrate how evidence based practice has contributed to informaing decisions and resolving issues if concern in service delivery at Bond University Librray. Methods - This paper critically analyses three evidence based research projects conducted at Bond University Library. Each project combined a range of research methods including surveys, literature reviews and the analysis of internal performance data to find solutions to problems in library service delivery. The first research project investigated library opening hours and the feasability of twenty-four hour opening. Another project reseached questions about the management of a collection of feature films on DVD and video. The thrd project investigated issues surrounding the teaching of EndNote to undergarduate students. Results - Despite some deficiencies in the methodologies used, each evidence based research project had positive outcomes. One of the highlights asn an essential feature of the process at Bond University Library was the involvement of stakeholders. The ability to build consensus and agree action plans with stakeholders was an important outcome of that process. Conclusion - Drawing on the experience of these research projects, the paper illustrates the benefits of evidence based information practice to stimulate innovation and improve library services. Librarians, like most professionals, need to continue to develop the skills and a culture to effectively carry out evidence based practice.
Full Text Available Abstract Background Given limited research evidence for community-based alcohol interventions, this study examines the intervention preferences of rural communities and alcohol professionals, and factors that influence their choices. Method Community preferences were identified by a survey of randomly selected individuals across 20 regional Australian communities. The preferences of alcohol professionals were identified by a survey of randomly selected members of the Australasian Professional Society on Alcohol and Other Drugs. To identify preferred interventions and the extent of support for them, a budget allocation exercise was embedded in both surveys, asking respondents to allocate a given budget to different interventions. Tobit regression models were estimated to identify the characteristics that explain differences in intervention preferences. Results Community respondents selected school programs most often (88.0% and allocated it the largest proportion of funds, followed by promotion of safer drinking (71.3%, community programs (61.4% and police enforcement of alcohol laws (60.4%. Professionals selected GP training most often (61.0% and allocated it the largest proportion of funds, followed by school programs (36.6%, community programs (33.8% and promotion of safer drinking (31.7%. Community views were susceptible to response bias. There were no significant predictors of professionals' preferences. Conclusions In the absence of sufficient research evidence for effective community-based alcohol interventions, rural communities and professionals both strongly support school programs, promotion of safer drinking and community programs. Rural communities also supported police enforcement of alcohol laws and professionals supported GP training. The impact of a combination of these strategies needs to be rigorously evaluated.
Micheyl, Christophe; Oxenham, Andrew J
The "combined-stimulation advantage" refers to an improvement in speech recognition when cochlear-implant or vocoded stimulation is supplemented by low-frequency acoustic information. Previous studies have been interpreted as evidence for "super-additive" or "synergistic" effects in the combination of low-frequency and electric or vocoded speech information by human listeners. However, this conclusion was based on predictions of performance obtained using a suboptimal high-threshold model of information combination. The present study shows that a different model, based on Gaussian signal detection theory, can predict surprisingly large combined-stimulation advantages, even when performance with either information source alone is close to chance, without involving any synergistic interaction. A reanalysis of published data using this model reveals that previous results, which have been interpreted as evidence for super-additive effects in perception of combined speech stimuli, are actually consistent with a more parsimonious explanation, according to which the combined-stimulation advantage reflects an optimal combination of two independent sources of information. The present results do not rule out the possible existence of synergistic effects in combined stimulation; however, they emphasize the possibility that the combined-stimulation advantages observed in some studies can be explained simply by non-interactive combination of two information sources.
Schweizer, Anja; Foley, James E; Kothny, Wolfgang; Ahrén, Bo
Due to the progressive nature of type 2 diabetes, many patients need insulin as add-on to oral antidiabetic drugs (OADs) in order to maintain adequate glycemic control. Insulin therapy primarily targets elevated fasting glycemia but is less effective to reduce postprandial hyperglycemia. In addition, the risk of hypoglycemia limits its effectiveness and there is a concern of weight gain. These drawbacks may be overcome by combining insulin with incretin-based therapies as these increase glucose sensitivity of both the α- and β-cells, resulting in improved postprandial glycemia without the hypoglycemia and weight gain associated with increasing the dose of insulin. The dipeptidyl peptidase-IV (DPP-4) inhibitor vildagliptin has also been shown to protect from hypoglycemia by enhancing glucagon counterregulation. The effectiveness of combining vildagliptin with insulin was demonstrated in three different studies in which vildagliptin decreased A1C levels when added to insulin therapy without increasing hypoglycemia. This was established with and without concomitant metformin therapy. Furthermore, the effectiveness of vildagliptin appears to be greater when insulin is used as a basal regimen as opposed to being used to reduce postprandial hyperglycemia, since improvement in insulin secretion likely plays a minor role when relatively high doses of insulin are administered before meals. This article reviews the clinical experience with the combination of vildagliptin and insulin and discusses the mechanistic basis for the beneficial effects of the combination. The data support the use of vildagliptin in combination with insulin in general and, in line with emerging clinical practice, suggest that treating patients with vildagliptin, metformin, and basal insulin could be an attractive therapeutic option. PMID:23431062
Olaratumab in Combination with Doxorubicin for the Treatment of Advanced Soft Tissue Sarcoma: An Evidence Review Group Perspective of a National Institute for Health and Care Excellence Single Technology Appraisal.
Tikhonova, Irina A; Jones-Hughes, Tracey; Dunham, James; Warren, Fiona C; Robinson, Sophie; Stephens, Peter; Hoyle, Martin
The manufacturer of olaratumab (Lartruvo ® ), Eli Lilly & Company Limited, submitted evidence for the clinical and cost effectiveness of this drug, in combination with doxorubicin, for untreated advanced soft tissue sarcoma (STS) not amenable to surgery or radiotherapy, as part of the National Institute for Health and Care Excellence (NICE) Single Technology Appraisal process. The Peninsula Technology Assessment Group, commissioned to act as the Evidence Review Group (ERG), critically reviewed the company's submission. Clinical effectiveness evidence for the company's analysis was derived from an open-label, randomised controlled trial, JGDG. The analysis was based on a partitioned survival model with a time horizon of 25 years, and the perspective was of the UK National Health Service (NHS) and Personal Social Services. Costs and benefits were discounted at 3.5% per year. Given the available evidence, olaratumab is likely to meet NICE's end-of-life criteria. To improve the cost effectiveness of olaratumab, the company offered a discount through a Commercial Access Agreement (CAA) with the NHS England. When the discount was applied, the mean base-case and probabilistic incremental cost-effectiveness ratios (ICERs) for olaratumab plus doxorubicin versus the standard-of-care doxorubicin were £46,076 and £47,127 per quality-adjusted life-year (QALY) gained, respectively; the probability of this treatment being cost effective at the willingness-to-pay threshold of £50,000 per QALY gained, applicable to end-of-life treatments, was 0.54. The respective ICERs from the ERG's analysis were approximately £60,000/QALY gained, and the probability of the treatment being cost effective was 0.21. In August 2017, the NICE Appraisal Committee recommended olaratumab in combination with doxorubicin for this indication for use via the UK Cancer Drugs Fund under the agreed CAA until further evidence being collected in the ongoing phase III trial-ANNOUNCE-becomes available in
Dreier, G; Löhler, J
medical education of students.One problem is the wealth of information, so that in clinical practice there may be gaps in knowledge of actual evidence. Usually it still takes several years until new knowledge is fully implemented in daily practice. The German Society of Otolaryngology, Head and Neck Surgery (DGHNOKHC) and the German professional association of otolaryngologists (BVHNO) have a vested interest in supporting their members in the generation, processing and dissemination of evidence, and to foster the transfer of knowledge into practice. This includes the areas of diagnosis, treatment, prognosis and prevention as well as drug therapies or the application of medical devices or surgical procedures. Crucial is the regular determination of existing evidence gaps, including in the area of already established procedures, which must be followed by a prioritization of research questions and subsequent conduct of clinical research. Only with combined efforts even large trials can be performed, to test therapies and diagnostics for example, also after approval under everyday conditions. Methods, Results and Vision: The executive committees of DGHNOKHC and BVHNO have together founded the German Clinical Trials Unit for Ear, Nose and Throat medicine, Head and Neck Surgery (DSZ-HNO) to assist their members in the identification of evidence gaps and the planning and conduct of systematic reviews and clinical trials. The first projects have been started, including a BMBF(German Ministry for education and research)-funded clinical trial for the treatment of sudden hearing loss and a survey to detect evidence gaps in Otolaryngology. It seems both reasonable and feasible to provide a structure such as a jointly-run study center for doctors in hospitals and medical practices to assist in clinical research and to anchor the principles of evidence-based medicine in daily life. © Georg Thieme Verlag KG Stuttgart · New York.
The use of small chance probabilities as evidence for sources of cosmic rays is examined, with particular emphasis upon issues involved when combining results from two experiments, two analyses, or two independent tests of the same data. Examples are given in which different methods of combining results should be used
Baart, Martijn; Lindborg, Alma Cornelia; Andersen, Tobias S
Incongruent audiovisual speech stimuli can lead to perceptual illusions such as fusions or combinations. Here, we investigated the underlying audiovisual integration process by measuring ERPs. We observed that visual speech-induced suppression of P2 amplitude (which is generally taken as a measure...... of audiovisual integration) for fusions was comparable to suppression obtained with fully congruent stimuli, whereas P2 suppression for combinations was larger. We argue that these effects arise because the phonetic incongruency is solved differently for both types of stimuli. This article is protected...
Krause, Michelle W; Fonseca, Vivian A; Shah, Sudhir V
Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers are considered the standard of care for treatment of cardiovascular disease and chronic kidney disease. Combination therapy with both angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers effectively inhibits the renin-angiotensin system as well as potentiates the vasodilatory effects of bradykinin. It has been advocated that this dual blockade approach theoretically should result in improved clinical outcomes in both cardiovascular disease and chronic kidney disease. Clinical trial evidence for the use of combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in cardiovascular disease has provided conflicting results in hypertension, congestive heart failure, and ischemic heart disease. Clinical trial evidence to support combination therapy with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in chronic kidney disease has largely been based on proteinuria reduction as a surrogate marker for clinically meaningful outcomes. Recent large-scale randomized clinical trials have not been able to validate protection in halting progression in chronic kidney disease with a dual blockade approach. This review serves as an appraisal on the clinical evidence of combination angiotensin-converting enzyme inhibition and angiotensin II receptor blockade in both cardiovascular disease and chronic kidney disease.
Thorndycraft, V. R.; Benito, G.; Barriendos, M.; Rico, M.; Sánchez-Moya, Y.; Sopeña, A.; Casas, A.
Palaeoflood hydrology is the reconstruction of flood magnitude and frequency using geomorphological flood evidence and is particularly valuable for extending the record of extreme floods prior to the availability of instrumental data series. This paper will provide a review of recent developments in palaeoflood hydrology and will be presented in three parts: 1) an overview of the key methodological approaches used in palaeoflood hydrology and the use of historical documentary evidence for reconstructing extreme events; 2) a summary of the Llobregat River palaeoflood case study (Catalonia, NE Spain); and 3) analysis of the AD 1617 flood and its impacts across Catalonia (including the rivers Llobregat, Ter and Segre). The key findings of the Llobregat case study were that at least eight floods occurred with discharges significantly larger than events recorded in the instrumental record, for example at the Pont de Vilomara study reach the palaeodischarges of these events were 3700-4300 m3/s compared to the 1971 flood, the largest on record, of 2300 m3/s. Five of these floods were dated to the last 3000 years and the three events directly dated by radiocarbon all occurred during cold phases of global climate. Comparison of the palaeoflood record with documentary evidence indicated that one flood, radiocarbon dated to cal. AD 1540-1670, was likely to be the AD 1617 event, the largest flood of the last 700 years. Historical records indicate that this event was caused by rainfall occurring from the 2nd to 6th November and the resultant flooding caused widespread socio-economic impacts including the destruction of at least 389 houses, 22 bridges and 17 water mills. Discharges estimated from palaeoflood records and historical flood marks indicate that the Llobregat (4680 m3/s) and Ter (2700-4500 m3/s) rivers witnessed extreme discharges in comparison to observed floods in the instrumental record (2300 and 2350 m3/s, respectively); whilst further east in the Segre River
Thorpe, Joelle; Shum, Bonnie; Moore, R Andrew; Wiffen, Philip J; Gilron, Ian
Fibromyalgia is a chronic widespread pain condition affecting millions of people worldwide. Current pharmacotherapies are often ineffective and poorly tolerated. Combining different agents could provide superior pain relief and possibly also fewer side effects. To assess the efficacy, safety, and tolerability of combination pharmacotherapy compared to monotherapy or placebo, or both, for the treatment of fibromyalgia pain in adults. We searched CENTRAL, MEDLINE, and Embase to September 2017. We also searched reference lists of other reviews and trials registries. Double-blind, randomised controlled trials comparing combinations of two or more drugs to placebo or other comparators, or both, for the treatment of fibromyalgia pain. From all studies, we extracted data on: participant-reported pain relief of 30% or 50% or greater; patient global impression of clinical change (PGIC) much or very much improved or very much improved; any other pain-related outcome of improvement; withdrawals (lack of efficacy, adverse events), participants experiencing any adverse event, serious adverse events, and specific adverse events (e.g. somnolence and dizziness). The primary comparison was between combination and one or all single-agent comparators. We also assessed the evidence using GRADE and created a 'Summary of findings' table. We identified 16 studies with 1474 participants. Three studies combined a non-steroidal anti-inflammatory drug (NSAID) with a benzodiazepine (306 participants); two combined amitriptyline with fluoxetine (89 participants); two combined amitriptyline with a different agent (92 participants); two combined melatonin with an antidepressant (164 participants); one combined carisoprodol, paracetamol (acetaminophen), and caffeine (58 participants); one combined tramadol and paracetamol (acetaminophen) (315 participants); one combined malic acid and magnesium (24 participants); one combined a monoamine oxidase inhibitor with 5-hydroxytryptophan (200
Baart, Martijn; Lindborg, Alma; Andersen, Tobias S
Incongruent audiovisual speech stimuli can lead to perceptual illusions such as fusions or combinations. Here, we investigated the underlying audiovisual integration process by measuring ERPs. We observed that visual speech-induced suppression of P2 amplitude (which is generally taken as a measure of audiovisual integration) for fusions was similar to suppression obtained with fully congruent stimuli, whereas P2 suppression for combinations was larger. We argue that these effects arise because the phonetic incongruency is solved differently for both types of stimuli. © 2017 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.
Sol, Marleen Elisabeth; Verschuren, Olaf; de Groot, Laura; de Groot, Janke Frederike
Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents. Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the 'COnsensus-based Standards for the selection of health Measurement Instruments' (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing. Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were
Dreier, Gabriele; Löhler, Jan
, databases, information portals with processed evidence as well as specific journals and finally teaching are appropriate vehicles. One problem is the multitude of information so that knowledge gaps may affect the clinical routine despite actually existing evidence. Generally, it still takes several years until new knowledge is implemented in daily routine. Tasks: The German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsche Gesellschaft für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., DGHNOKHC) and the Professional Association of Otolaryngologists (Deutscher Berufsverband der HNO-Ärzte e.V., BVHNO) have fundamental interest in supporting their members in generating, processing, and providing evidence as well as accompanying knowledge transfer. It encompasses the fields of diagnostics, therapy, and prognosis in the same way as prevention and applies to medicinal products as well as to medical devices or surgical procedures. The base for this is the regular assessment of evidence gaps, also in the area of established procedures, that has to be followed by a prioritization of research questions and the subsequent initiation of clinical research. In addition, large trials verifying therapies and diagnostics, for example in the context of daily conditions after approval, can only be conducted combining all resources in the ENT community. Method, results, and outlook: Together, the executive committees of the DGHNOKHC and the BVHNO founded the German Study Center of Oto-Rhino-Laryngology, Head and Neck Surgery (Deutsches Studienzentrum für Hals-, Nasen- und Ohren-Heilkunde, Kopf- und Hals-Chirurgie, DSZ-HNO). First projects have been initiated, among those a clinical trial on the therapy of sudden hearing loss supported by the BMBF and a survey on evidence gaps in oto-rhino-laryngology. It seems to be both reasonable and feasible to make available methodological expertise via such an infrastructure of a study center for physicians in
Full Text Available In the present review, we deliver an overview of the involvement of metabotropic glutamate receptor 5 (mGluR5 activity and density in pathological anxiety, mood disorders and addiction. Specifically, we will describe mGluR5 studies in humans that employed Positron Emission Tomography (PET and combined the findings with preclinical animal research. This combined view of different methodological approaches — from basic neurobiological approaches to human studies — might give a more comprehensive and clinically relevant view of mGluR5 function in mental health than the view on preclinical data alone. We will also review the current research data on mGluR5 along the Research Domain Criteria (RDoC. Firstly, we found evidence of abnormal glutamate activity related to the positive and negative valence systems, which would suggest that antagonistic mGluR5 intervention has prominent anti-addictive, anti-depressive and anxiolytic effects. Secondly, there is evidence that mGluR5 plays in important role in systems for social functioning and the response to social stress. Finally, mGluR5’s important role in sleep homeostasis suggests that this glutamate receptor may play an important role in RDoC’s arousal and modulatory systems domain. Glutamate was previously mostly investigate in non-human studies, however initial human clinical PET research now also supports the hypothesis that, by mediating brain excitability, neuroplasticity and social cognition, abnormal metabotropic glutamate activity might predispose individuals to a broad range of psychiatric problems.
Full Text Available Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods.
Crittenden, Marka; Kohrt, Holbrook; Levy, Ronald; Jones, Jennifer; Camphausen, Kevin; Dicker, Adam; Demaria, Sandra; Formenti, Silvia
Preclinical evidence of successful combinations of ionizing radiation with immunotherapy has inspired testing the translation of these results to the clinic. Interestingly, the preclinical work has consistently predicted the responses encountered in clinical trials. The first example came from a proof-of-principle trial started in 2001 that tested the concept that growth factors acting on antigen-presenting cells improve presentation of tumor antigens released by radiation and induce an abscopal effect. Granulocyte-macrophage colony-stimulating factor was administered during radiotherapy to a metastatic site in patients with metastatic solid tumors to translate evidence obtained in a murine model of syngeneic mammary carcinoma treated with cytokine FLT-3L and radiation. Subsequent clinical availability of vaccines and immune checkpoint inhibitors has triggered a wave of enthusiasm for testing them in combination with radiotherapy. Examples of ongoing clinical trials are described in this report. Importantly, most of these trials include careful immune monitoring of the patients enrolled and will generate important data about the proimmunogenic effects of radiation in combination with a variety of immune modulators, in different disease settings. Results of these studies are building a platform of evidence for radiotherapy as an adjuvant to immunotherapy and encourage the growth of this novel field of radiation oncology. Copyright © 2015 Elsevier Inc. All rights reserved.
Ferla Matteo P
Full Text Available Abstract Background The phylogeny of Eumalacostraca (Crustacea remains elusive, despite over a century of interest. Recent morphological and molecular phylogenies appear highly incongruent, but this has not been assessed quantitatively. Moreover, 18S rRNA trees show striking branch length differences between species, accompanied by a conspicuous clustering of taxa with similar branch lengths. Surprisingly, previous research found no rate heterogeneity. Hitherto, no phylogenetic analysis of all major eumalacostracan taxa (orders has either combined evidence from multiple loci, or combined molecular and morphological evidence. Results We combined evidence from four nuclear ribosomal and mitochondrial loci (18S rRNA, 28S rRNA, 16S rRNA, and cytochrome c oxidase subunit I with a newly synthesized morphological dataset. We tested the homogeneity of data partitions, both in terms of character congruence and the topological congruence of inferred trees. We also performed Bayesian and parsimony analyses on separate and combined partitions, and tested the contribution of each partition. We tested for potential long-branch attraction (LBA using taxon deletion experiments, and with relative rate tests. Additionally we searched for molecular polytomies (spurious clades. Lastly, we investigated the phylogenetic stability of taxa, and assessed their impact on inferred relationships over the whole tree. We detected significant conflict between data partitions, especially between morphology and molecules. We found significant rate heterogeneity between species for both the 18S rRNA and combined datasets, introducing the possibility of LBA. As a test case, we showed that LBA probably affected the position of Spelaeogriphacea in the combined molecular evidence analysis. We also demonstrated that several clades, including the previously reported and surprising clade of Amphipoda plus Spelaeogriphacea, are 'supported' by zero length branches. Furthermore we showed
Sharma, Tarang; Choudhury, Moni; Kaur, Bindweep
from the literature and a combined best practice checklist has been proposed. CONCLUSIONS: As decisions often need to be made in areas where there is a lack of published scientific evidence, CE is employed. Therefore to ensure its appropriateness the development of a validated CE data quality check......-list to assist decision makers is essential and further research in this area is a priority....
To review and discuss the evidence and arguments to combine enteral nutrition and parenteral nutrition in the ICU, in particular with reference to the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The EPaNIC study shows an advantage in terms of discharges alive from the ICU when parenteral nutrition is delayed to day 8 as compared with combining enteral nutrition and parenteral nutrition from day 3 of ICU stay. The difference between the guidelines from the European Society of Enteral and Parenteral Nutrition in Europe and American Society for Parenteral and Enteral Nutrition/Society of Critical Care Medicine in North America concerning the combination of enteral nutrition and parenteral nutrition during the initial week of ICU stay was reviewed. The EPaNIC study clearly demonstrates that early parenteral nutrition in the ICU is not in the best interests of most patients. Exactly at what time point the combination of enteral nutrition and parenteral nutrition should be considered is still an open question.
Full Text Available In this paper some difficulties associated with dyscalculia and dyslexia are examined. Several of these difficulties depend either on mnemo-nic problems or on lateralization defects. Here some suggestions in order to weaken them are proposed
An accelerated aging method which can be used to simulate aging in combined stress environment situations is described. It is shown how the assumptions of the method can be tested experimentally. Aging data for a chloroprene cable jacketing material in single and combined radiation and temperature environments are analyzed and it is shown that these data offer evidence for the validity of the method
Aerts, D; Sozzo, S; Veloz, T
We recently performed cognitive experiments on conjunctions and negations of two concepts with the aim of investigating the combination problem of concepts. Our experiments confirmed the deviations (conceptual vagueness, underextension, overextension etc.) from the rules of classical (fuzzy) logic and probability theory observed by several scholars in concept theory, while our data were successfully modelled in a quantum-theoretic framework developed by ourselves. In this paper, we isolate a new, very stable and systematic pattern of violation of classicality that occurs in concept combinations. In addition, the strength and regularity of this non-classical effect leads us to believe that it occurs at a more fundamental level than the deviations observed up to now. It is our opinion that we have identified a deep non-classical mechanism determining not only how concepts are combined but, rather, how they are formed. We show that this effect can be faithfully modelled in a two-sector Fock space structure, and that it can be exactly explained by assuming that human thought is the superposition of two processes, a 'logical reasoning', guided by 'logic', and a 'conceptual reasoning', guided by 'emergence', and that the latter generally prevails over the former. All these findings provide new fundamental support to our quantum-theoretic approach to human cognition. © 2015 The Author(s).
Schmidt, Maria Christina Secher
The presentation is based on a substudy conducted in connection with a Danish PhD study of inclusive teaching of beginner mathematics in the Danish municipal primary school and focuses on the research question: What conflicting positions can be identified in relation to low-performing pupils in t...
This article is the first attempt to study the empirical link between income aspirations and cooperation in a one shot public good game. By combining experimental with survey data, we find evidence that the more frustrated people are with their income, the lower is their propensity to cooperate with
Wang, Dongming; Wang, Zhichao; Zhou, Min; Li, Wenzhen; He, Meian; Zhang, Xiaomin; Guo, Huan; Yuan, Jing; Zhan, Yue; Zhang, Kun; Zhou, Tao; Kong, Weijia; Chen, Weihong
Combined effect of cigarette smoking and occupational noise exposure on hearing loss has rarely been evaluated among Chinese population, especially among females. This cross-sectional study was conducted in 11196 participants of Dongfeng-Tongji cohort study. Smoking status was self-reported through questionnaire and occupational noise exposure was evaluated through workplace noise level and/or the job titles. Hearing loss was defined as a pure-tone mean of 25 dB or higher at 0.5, 1, 2, and 4 kHz in both ears. Compared with participants without occupational noise exposure, the risk of hearing loss was significantly higher for noise exposure duration ≥20 (OR = 1.45, 95%CI = 1.28-1.65). The association was particularly evident among individuals who were males (OR = 1.74, 95%CI = 1.45-2.08) and aged ≥ 70 (OR = 1.74, 95%CI = 1.30-2.33). Similarly, the risks increased with the increasing of pack-years in males and all age groups except for those aged hearing loss risk was highest for noise exposure duration ≥20 and pack-years ≥25 (OR = 2.41, 95%CI = 1.78-3.28), especially among males (OR = 2.42, 95%CI = 1.74-3.37) and those aged ≥70 (OR = 2.76, 95%CI = 1.36-5.60). Smoking may be an independent risk factor for hearing loss. And it may synergistically affect hearing when combined with occupational noise exposure, especially among males and older participants.
Full Text Available In the first article in this series, I touched on the enormous challenge to make access to information equal for those who need it at the time and place when they need it. Only if this is achieved can we successfully promote an evidence-based approach to health care. The move towards open access publishing is taking us some way to achieving this. However, there are further gaps to be bridged if we are to turn eye care workers into evidence-based practitioners. We can define an evidence-based practitioner as one who combines their individual knowledge and expertise with the best available external clinical evidence from systematic research.
The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence. Strange enough, scientific discussion focuses on external evidence from systematic research, but neglects its counterpart, i.e., individual clinical expertise. Apart from a lack of appropriate intellectual tools for approaching the latter, this might be due to the mutual concealment of thought and action, of sensor and motor activity (Viktor von Weizsaecker's principle of the revolving door). Behind this, and incommensurably different from each other, lie the world of physics and the world of biology with an ego animal, that is, the dilemma of the self-conscious subject in a world of objects. When practicing medicine, this dilemma of self-reference is being resolved but only through a holistic approach combining rational and external evidence with biographical, spiritual, emotional and pre-rational elements represented in the physician's individual clinical expertise. Copyright © 2010. Published by Elsevier GmbH.
van 't Noordende, Jaccoline E|info:eu-repo/dai/nl/369862422; van Hoogmoed, Anne H|info:eu-repo/dai/nl/314839496; Schot, Willemijn D; Kroesbergen, Evelyn H|info:eu-repo/dai/nl/241607949
INTRODUCTION: Number line estimation is one of the skills related to mathematical performance. Previous research has shown that eye tracking can be used to identify differences in the estimation strategies children with dyscalculia and children with typical mathematical development use on number
van’t Noordende, Jaccoline E.; van Hoogmoed, Anne H.; Schot, Willemijn D.; Kroesbergen, Evelyn H.
Introduction: Number line estimation is one of the skills related to mathematical performance. Previous research has shown that eye tracking can be used to identify differences in the estimation strategies children with dyscalculia and children with typical mathematical development use on number
Cowan, Richard; Powell, Daisy
Explanations of the marked individual differences in elementary school mathematical achievement and mathematical learning disability (MLD or dyscalculia) have involved domain-general factors (working memory, reasoning, processing speed, and oral language) and numerical factors that include single-digit processing efficiency and multidigit skills…
Makundi, Emmanuel; Kapiriri, Lydia; Norheim, Ole Frithjof
Procedures for priority setting need to incorporate both scientific evidence and public values. The aim of this study was to test out a model for priority setting which incorporates both scientific evidence and public values, and to explore use of evidence by a selection of stakeholders and to study reasons for the relative ranking of health care interventions in a setting of extreme resource scarcity. Systematic search for and assessment of relevant evidence for priority setting in a low-income country. Development of a balance sheet according to Eddy's explicit method. Eight group interviews (n-85), using a modified nominal group technique for eliciting individual and group rankings of a given set of health interventions. The study procedure made it possible to compare the groups' ranking before and after all the evidence was provided to participants. A rank deviation is significant if the rank order of the same intervention differed by two or more points on the ordinal scale. A comparison between the initial rank and the final rank (before deliberation) showed a rank deviation of 67%. The difference between the initial rank and the final rank after discussion and voting gave a rank deviation of 78%. Evidence-based and deliberative decision-making does change priorities significantly in an experimental setting. Our use of the balance sheet method was meant as a demonstration project, but could if properly developed be feasible for health planners, experts and health workers, although more work is needed before it can be used for laypersons.
Demaria, Sandra; Bhardwaj, Nina; McBride, William H.; Formenti, Silvia C.
Ionizing radiation therapy (RT) is an important local modality for the treatment of cancer. The current rationale for its use is based largely on the ability of RT to kill the cancer cells by a direct cytotoxic effect. Nevertheless, considerable evidence indicates that RT effects extend beyond the mere elimination of the more radiosensitive fraction of cancer cells present within a tumor at the time of radiation exposure. For instance, a large body of evidence is accumulating on the ability of RT to modify the tumor microenvironment and generate inflammation. This might have far-reaching consequences regarding the response of a patient to treatment, especially if radiation-induced tumor cell kill were to translate into the generation of effective antitumor immunity. Although much remains to be learned about how radiation can impact tumor immunogenicity, data from preclinical studies provide the proof of principle that different immunotherapeutic strategies can be combined with RT to enhance antitumor effects. Conversely, RT could be a useful tool to combine with immunotherapy. This article will briefly summarize what is known about the impact of RT on tumor immunity, including tumor-associated antigens, antigen-presenting cells, and effector mechanisms. In addition, the experimental evidence supporting the contention that RT can be used as a tool to induce antitumor immunity is discussed, and a new approach to radioimmunotherapy of cancer is proposed
Tannock, I.F.; Toronto Univ., ON
The present paper discusses some of the methodological issues which can confound the interpretation of clinical trials of combined modality treatment. It reviews some of the larger randomized trials which have evaluated combined modality treatment in cancers of the head and neck, lung, gastrointestinal tract and bladder. It concludes that adequate trials have yet to be performed in many of thses sites, but that at present, evidence for long-term benefit from adjunctivechemotherapy is meagre. Finally, it suggests some possible mechanisms which might heve limited the benefit of chemotherapy when added to radiation treatment. (Author). 87 refs.; 4 figs.; 4 tabs
Monitoring corruption typically relies on top-down interventions aimed at increasing the probability of external controls and the severity of punishment. An alternative approach to fighting corruption is to induce bottom-up pressure for reform. Recent studies have shown that both top-down and bottom-up mechanisms are rarely able to keep service providers accountable. This paper investigates the effectiveness of an accountability system that combines bottom-up monitoring and top-down auditing ...
Østergaard, Kasper Rud
Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature. To test whether there is evidence on treatment based on CBT, medication or a combination of these. Systematic and critical review of the literature on CBT and/or pharmacological treatments of SM. Literature was sought on PubMed, Embase and Psycinfo in March 2017. Of the included studies, six examined CBT, seven pharmacologic treatment and two a combination of these. Using CBT 53/60 children improved symptomatically whilst respectively 55/67 and 6/7 improved using pharmacologic- and combination-treatment. Pharmacologic treatment and especially CBT showed promising results supported by some degree of evidence, which combination treatment lacks. Yet small numbers, few RCTs, heterogeneous study designs, lack of consistent measures, short treatment and follow-up periods, generally limits the evidence. This needs focus in future research.
Brankaer, Carmen; Ghesquière, Pol; De Wel, Anke; Swillen, Ann; De Smedt, Bert
Cross-syndrome comparisons offer an important window onto understanding heterogeneity in mathematical learning disabilities or dyscalculia. The present study therefore investigated symbolic numerical magnitude processing in two genetic syndromes that are both characterized by mathematical learning disabilities: Turner syndrome and 22q11.2 deletion…
Buentgen, U.; Brázdil, Rudolf; Heussner, K. U.; Hofmann, J.; Kontic, R.; Kyncl, T.; Pfister, Ch.; Chromá, K.; Tegel, W.
Roč. 30, 27-28 (2011), s. 3947-3959 ISSN 0277-3791 Institutional research plan: CEZ:AV0Z60870520 Keywords : Climate change * Dendroarchaeology * Dendroclimatology * Documentary evidence * Drought spells * Forest growth * Historical climatology * Palaeoclimatic reconstruction Subject RIV: DG - Athmosphere Sciences, Meteorology Impact factor: 3.973, year: 2011
Sep 24, 2014 ... patients undergoing transurethral surgery could reduce block duration and ... There was no evidence of higher risk of analgesic failure in the combination group. ... tumor (TURBT) are elderly people who have coexisting.
de Lange, F.P.; van Gaal, S.; Lamme, V.A.F.; Dehaene, S.
Human decisions are based on accumulating evidence over time for different options. Here we ask a simple question: How is the accumulation of evidence affected by the level of awareness of the information? We examined the influence of awareness on decision-making using combined behavioral methods
Giles, Thomas D; Cockcroft, John R; Pitt, Bertram; Jakate, Abhijeet; Wright, Harold M
: To treat hypertension, combining two or more antihypertensive drugs from different classes is often necessary. β-Blockers and renin-angiotensin-aldosterone system inhibitors, when combined, have been deemed 'less effective' based on partially overlapping mechanisms of action and limited evidence. Recently, the single-pill combination (SPC) of nebivolol (Neb) 5 mg - a vasodilatory β1-selective antagonist/β3 agonist - and valsartan 80 mg, an angiotensin II receptor blocker, was US Food and Drug Administration-approved for hypertension. Pharmacological profiles of Neb and valsartan, alone and combined, are well characterized. In addition, a large 8-week randomized trial in stages I-II hypertensive patients (N = 4161) demonstrated greater blood pressure-reducing efficacy for Neb/valsartan SPCs than component monotherapies with comparable tolerability. In a biomarkers substudy (N = 805), Neb/valsartan SPCs prevented valsartan-induced increases in plasma renin, and a greater reduction in plasma aldosterone was observed with the highest SPC dose vs. valsartan 320 mg/day. This review summarizes preclinical and clinical evidence supporting Neb/valsartan as an efficacious and well tolerated combination treatment for hypertension.
Käser, Tanja; Busetto, Alberto Giovanni; Solenthaler, Barbara; Baschera, Gian-Marco; Kohn, Juliane; Kucian, Karin; von Aster, Michael; Gross, Markus
This study introduces a student model and control algorithm, optimizing mathematics learning in children. The adaptive system is integrated into a computer-based training system for enhancing numerical cognition aimed at children with developmental dyscalculia or difficulties in learning mathematics. The student model consists of a dynamic…
This book clearly explains what Specific Learning Difficulties (SpLD) are, and describes the symptoms of conditions most commonly encountered in the mainstream classroom: dyslexia, dyspraxia, dyscalculia, dysgraphia, Autism Spectrum Disorder, ADHD, and OCD. The author provides an overview of the strengths and weaknesses commonly associated with…
Kaufmann, Liane; Handl, Pia; Thony, Brigitte
In this study, six elementary grade children with developmental dyscalculia were trained individually and in small group settings with a one-semester program stressing basic numerical knowledge and conceptual knowledge. All the children showed considerable and partly significant performance increases on all calculation components. Results suggest…
Anobile, Giovanni; Cicchini, Guido Marco; Burr, David C.
Mapping of number onto space is fundamental to mathematics and measurement. Previous research suggests that while typical adults with mathematical schooling map numbers veridically onto a linear scale, pre-school children and adults without formal mathematics training, as well as individuals with dyscalculia, show strong compressive,…
Imdad, Aamer; Sadiq, Kamran; Bhutta, Zulfiqar A
Childhood malnutrition is prevalent in developing countries and contributes to one-third of all deaths in these countries. There have been advances in prevention of childhood malnutrition and the purpose of this article was to review the current evidence in the field. Multiple micronutrient (MMN) supplements during pregnancy reduce the incidence of maternal anemia and small for gestational-age babies. Recent evidence suggest that combined supplementation of MMNs with protein energy supplement is more effective than MMN supplementation alone. It is now recommended that HIV-infected mothers can exclusively breast-feed their infants for 6 months when the mother or infant is on effective antiretroviral therapy. Home fortification of complementary foods reduces the prevalence of anemia in infancy and combined supplementation of MMNs with lipid-based supplements improves growth in young children. Ready-to-use therapeutic foods have been successfully used to manage severe acute malnutrition in the community. Zinc supplementation is associated with a reduction in diarrhea and respiratory disease morbidity and improves linear growth. Vitamin A supplementation decreases the incidence of diarrhea and measles. Water supply, sanitation, and hygiene are important for the prevention of malnutrition because of their direct impact on infectious disease. There is clear evidence on the causes and consequences of malnutrition as well as effective interventions to prevent undernutrition. The next step is to implement these packages of interventions at large scale. A global effort is required that should entail unified and compelling advocacy among governments, lead organizations, and institutions.
Millard, Julie T
The cornerstone of forensic chemistry is that a perpetrator inevitably leaves trace evidence at a crime scene. One important type of evidence is DNA, which has been instrumental in both the implication and exoneration of thousands of suspects in a wide range of crimes. The Combined DNA Index System (CODIS), a network of DNA databases, provides…
Han, Zhaoying; Fuchs, Lynn; Davis, Nikki; Cannistraci, Christopher J.; Anderson, Adam W.; Gore, John C.; Dawant, Benoit M.
Mathematical difficulty affects approximately 5-9% of the population. Studies on individuals with dyscalculia, a neurologically based math disorder, provide important insight into the neural correlates of mathematical ability. For example, cognitive theories, neuropsychological studies, and functional neuroimaging studies in individuals with dyscalculia suggest that the bilateral parietal lobes and intraparietal sulcus are central to mathematical performance. The purpose of the present study was to investigate morphological differences in a group of third grade children with poor math skills. We compare population averages of children with low math skill (MD) to gender and age matched controls with average math ability. Anatomical data were gathered with high resolution MRI and four different population averaging methods were used to study the effect of the normalization technique on the results. Statistical results based on the deformation fields between the two groups show anatomical differences in the bilateral parietal lobes, right frontal lobe, and left occipital/parietal lobe.
Tatik Imadatus Sa'adati
Full Text Available Psychological interventions can be used to assist in the education. One of the problems in is the achievement of learners are less than the maximum in field of education, even if they have a level of intelligence (IQ in average/ normal. Learning difficulties which is divided into difficulties/complicacy learning to read (dyslexia, difficulties learning process of writing (dysgraphia and difficulty learning of math (dyscalculia became one of the causes of the lack of student interest in learning and academic achievement of students is low. Learning methods for children with learning difficulties should suit/appropriate with students’ characteristics and the environment. In the domain of psychology, therapy or intervention for mentoring in the learning process also provides an important role for students. This review will discuss the psychological interventions for teachers and parents.Besides, the alternative intervention applicative psychomotor presented is Brain Gym that aims to improve children's intelligence. Keywords: Psychological interventions, dyslexia, dysgraphia, dyscalculia
Saleem, Shahzad; Popov, Oliver
RFC 3227 provides general guidelines for digital evidence collection and archiving, while the International Organization on Computer Evidence offers guidelines for best practice in the digital forensic examination. In the light of these guidelines we will analyze integrity protection mechanism provided by EnCase and FTK which is mainly based on Message Digest Codes (MDCs). MDCs for integrity protection are not tamper proof, hence they can be forged. With the proposed model for protecting digital evidence integrity by using smart cards (PIDESC) that establishes a secure platform for digitally signing the MDC (in general for a whole range of cryptographic services) in combination with Public Key Cryptography (PKC), one can show that this weakness might be overcome.
Learning Disabilities in Mathematics (LDM) or dyscalculia are a frequent and disruptive problem within schools. Nevertheless, this problem has received little attention from researchers and practitioners, if compared with the number of studies published on disabilities in reading. Therefore, teachers do not have enough guidance to help children…
Boets, Bart; De Smedt, Bert; Ghesquiere, Pol
Recent findings suggest deficits in coherent motion sensitivity, an index of visual dorsal stream functioning, in children with poor mathematical skills or dyscalculia, a specific learning disability in mathematics. We extended these data using a longitudinal design to unravel whether visual dorsal stream functioning is able to "predict"…
Tutaj, Lindsey; Hoare, Derek J; Sereda, Magdalena
In most cases, tinnitus is accompanied by some degree of hearing loss. Current tinnitus management guidelines recognize the importance of addressing hearing difficulties, with hearing aids being a common option. Sound therapy is the preferred mode of audiological tinnitus management in many countries, including in the United Kingdom. Combination instruments provide a further option for those with an aidable hearing loss, as they combine amplification with a sound generation option. The aims of this scoping review were to catalog the existing body of evidence on combined amplification and sound generation for tinnitus and consider opportunities for further research or evidence synthesis. A scoping review is a rigorous way to identify and review an established body of knowledge in the field for suggestive but not definitive findings and gaps in current knowledge. A wide variety of databases were used to ensure that all relevant records within the scope of this review were captured, including gray literature, conference proceedings, dissertations and theses, and peer-reviewed articles. Data were gathered using scoping review methodology and consisted of the following steps: (1) identifying potentially relevant records; (2) selecting relevant records; (3) extracting data; and (4) collating, summarizing, and reporting results. Searches using 20 different databases covered peer-reviewed and gray literature and returned 5959 records. After exclusion of duplicates and works that were out of scope, 89 records remained for further analysis. A large number of records identified varied considerably in methodology, applied management programs, and type of devices. There were significant differences in practice between different countries and clinics regarding candidature and fitting of combination aids, partly driven by the application of different management programs. Further studies on the use and effects of combined amplification and sound generation for tinnitus are
Full Text Available Forecast combination has been proven to be a very important technique to obtain accurate predictions for various applications in economics, finance, marketing and many other areas. In many applications, forecast errors exhibit heavy-tailed behaviors for various reasons. Unfortunately, to our knowledge, little has been done to obtain reliable forecast combinations for such situations. The familiar forecast combination methods, such as simple average, least squares regression or those based on the variance-covariance of the forecasts, may perform very poorly due to the fact that outliers tend to occur, and they make these methods have unstable weights, leading to un-robust forecasts. To address this problem, in this paper, we propose two nonparametric forecast combination methods. One is specially proposed for the situations in which the forecast errors are strongly believed to have heavy tails that can be modeled by a scaled Student’s t-distribution; the other is designed for relatively more general situations when there is a lack of strong or consistent evidence on the tail behaviors of the forecast errors due to a shortage of data and/or an evolving data-generating process. Adaptive risk bounds of both methods are developed. They show that the resulting combined forecasts yield near optimal mean forecast errors relative to the candidate forecasts. Simulations and a real example demonstrate their superior performance in that they indeed tend to have significantly smaller prediction errors than the previous combination methods in the presence of forecast outliers.
Jbilou, Jalila; Landry, Réjean; Amara, Nabil; El Adlouni, Salaheddine
Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal's Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as
Silverman, C.L.; Marks, J.E.
Though the planned combined use of surgery and radiation has been shown to be beneficial for other tumors, the authors feel that the present evidence is far from persuasive in demonstrating a definite superiority of combined therapy over surgery or radiation alone for advanced laryngeal tumors. The actuarial or disease-free survival rates for patients treated with combined therapy have not been significantly increased over those obtained with a single modality in any randomized, well-controlled study, although the trend is toward improved local regional control. Many of the retrospective studies are probably flawed by selection bias; the patients selected for combined treatment generally have more advanced cancers and represent a worse prognostic group. It is clear from this review that the positive value of irradiation for advanced transglottic and supraglottic tumors needs to be documented by a controlled study that compares surgery alone with salvage radiation at time of recurrence to surgery plus adjuvant radiation. The authors feel that such a study is needed to put to rest the present controversy before they can advocate a course of treatment that is expensive, time-consuming, and difficult for the patients to tolerate owing to severe acute side effects and potentially morbid late effects (xerostomia, necrosis) that can greatly lessen the quality of life for these patients
Background and purpose: Maintaining balance is a necessary requirement for most human actions. Most cerebral palsy children, who constitute a large portion in our country, continue to evidence deficits in balance, co-ordination, and gait throughout childhood. So, the purpose of this study was to determine the combined ...
Lonappan, Anto. I.; Kumar, Sumit; Ruchika; Dinda, Bikash R.; Sen, Anjan A.
We do a comprehensive study of the Bayesian evidences for a large number of dark energy models using a combination of latest cosmological data from SNIa, CMB, BAO, strong lensing time delay, growth measurements, measurements of Hubble parameter at different redshifts and measurements of angular diameter distance by Megamaser Cosmology Project. We consider a variety of scalar field models with different potentials as well as different parametrizations for the dark energy equation of state. Among 21 models that we consider in our study, we do not find strong evidences in favor of any evolving dark energy model compared to Λ CDM . For the evolving dark energy models, we show that purely nonphantom models have much better evidences compared to those models that allow both phantom and nonphantom behaviors. Canonical scalar field with exponential and tachyon field with square potential have highest evidences among all the models considered in this work. We also show that a combination of low redshift measurements decisively favors an accelerating Λ CDM model compared to a nonaccelerating power law model.
Tobia, Valentina; Rinaldi, Luca; Marzocchi, Gian Marco
The occurrence of time processing problems in individuals with Development Dyscalculia (DD) has favored the view of a general magnitude system devoted to both numerical and temporal information. Yet, this scenario has been partially challenged by studies indicating that time difficulties can be attributed to poor calculation or counting skills,…
Wong, Terry T.-Y.; Ho, Connie S.-H.; Tang, Joey
Developmental dyscalculia (DD) is a specific learning disability in mathematics that affects around 6% of the population. Currently, the core deficit of DD remains unknown. While the number sense deficit hypothesis suggests that the core deficit of DD lies in the inability to represent nonsymbolic numerosity, the access deficit hypothesis suggests…
Koumoula, Anastasia; Tsironi, Vanda; Stamouli, Victoria; Bardani, Irini; Stavroula, Siapati; Graham, Annik; Kafantaris, Ignatios; Charalambidou, Irini; Dellatolas, Georges; von Aster, Michael
The aim of this study was to validate and standardize an instrument for the diagnosis of developmental dyscalculia (mathematics disorder) in a Greek population and to obtain relevant epidemiological data. We used the "Neuropsychological Test Battery for Number Processing and Calculation in Children" (NUCALC) in a community sample of 240 students…
Landerl, Karin; Kolle, Christina
Deficits in basic numerical processing have been identified as a central and potentially causal problem in developmental dyscalculia; however, so far not much is known about the typical and atypical development of such skills. This study assessed basic number skills cross-sectionally in 262 typically developing and 51 dyscalculic children in…
The paper proposes a new interdisciplinary approach to helping low attaining learners in basic mathematics. It reports on the research-informed design and user testing of an adaptive digital game based on constructionist tasks with intrinsic feedback. The approach uses findings from the neuroscience of dyscalculia, cognitive science research on…
Full Text Available Dempster-Shafer evidence theory has been extensively used in many information fusion systems since it was proposed by Dempster and extended by Shafer. Many scholars have been conducted on conflict management of Dempster-Shafer evidence theory in past decades. However, how to determine a potent parameter to measure evidence conflict, when the given environment is in an open world, namely the frame of discernment is incomplete, is still an open issue. In this paper, a new method which combines generalized conflict coefficient, generalized evidence distance, and generalized interval correlation coefficient based on ordered weighted averaging (OWA operator, to measure the conflict of evidence is presented. Through ordered weighted average of these three parameters, the combinatorial coefficient can still measure the conflict effectively when one or two parameters are not valid. Several numerical examples demonstrate the effectiveness of the proposed method.
Savović, Jelena; Harris, Ross J; Wood, Lesley
or review. Unique identifiers were assigned to each reference and used to identify duplicate trials. Sets of meta-analyses with overlapping trials were identified and duplicates removed. Overlapping trials were used to examine agreement between assessments of trial characteristics. The combined database...... database will be used to examine the combined evidence on sources of bias in randomized controlled trials. The strategy used to remove overlap between meta-analyses may be of use for future empirical research. Copyright © 2010 John Wiley & Sons, Ltd.......Collections of meta-analyses assembled in meta-epidemiological studies are used to study associations of trial characteristics with intervention effect estimates. However, methods and findings are not consistent across studies. To combine data from 10 meta-epidemiological studies into a single...
Bloch, G.; Vernier, P.; Le Bihan, D.; Comtat, C.; Van Wassenhove, V.; Texier, I.; Planat-Chretien, A.; Poher, V.; Dinten, J.M.; Pannetier-lecoeur, M.; Trebossen, R.; Lethimonnier, F.; Eger, E.; Thirion, B.; Dehaene-Lambertz, G.; Piazza, M.; Mangin, J.F.; Dehaene, S.; Pallier, C.; Marti, S.; Klein, E.; Martinot, J.L.; Paillere, M.L.; Artiges, E.; Lemaitre, H.; Karila, L.; Houenou, J.; Sarrazin, S.; Hantraye, P.; Aron Badin, R.; Mergui, S.; Palfi, S.; Bemelmans, A.; Berger, F.; Frouin, V.; Pinel, J.F.; Crivello, F.; Mazoyer, B.; Flury-Herard, A.
CEA (French Alternative Energies and Atomic Energy Commission) has been involved in brain research for over 50 years and this 62. issue of 'Clefs CEA' is the best occasion to come back on the latest advances in this wide field. The purpose is to show how neuroimaging combined with neuro sciences and computational sciences has shed light on various aspects of the brain life and experience such as for instance learning (with highlights on dyslexia and dyscalculia), vision, the feeling of time, consciousness, addictions, ageing, and neuro-degenerative diseases. This document is divided into 6 parts: 1) non-invasive exploration of the brain, 2) development, learning and plasticity of the brain, 3) cognitive architecture and the brain, 4) mental health and vulnerability, 5) neuro-degenerative diseases, and 6) identifying bio-markers for cerebral disorders. (A.C.)
The IAEA has recently explored techniques to augment and improve its existing safeguards information systems as part of Program 93 + 2 in order to address the detection of undeclared activities. Effective utilization of information on undeclared activities requires a formulation of the relationship between the information being gathered and the resulting safeguards assurance. The process of safeguards is represented as the gathering of evidence to provide assurance that no undeclared activities take place. It is shown that the analysis of this process can be represented by a theory grounded in the Dempster-Shafer theory of evidence and the concept of possibility. This paper presents the underlying evidence theory required to support a new information system tool for the analysis of information with respect to undeclared activities. The Dempster-Shafer theory serves as the calculus for the combination of diverse sources of evidence, and when applied to safeguards information, provides a basis for interpreting the result of safeguards indicators and measurements -- safeguards assurance
Gonzalez, Juan E. Jimenez; Espinel, Ana Isabel Garcia
A study was designed to test whether there are differences between Spanish children (ages 7-9) with arithmetic learning disabilities (n=60), garden-variety (G-V) poor performance (n=44), and typical children (n=44) in strategy choice when solving arithmetic word problems. No significant differences were found between children with dyscalculia and…
Reston James T
Full Text Available Abstract Background Methods for describing one's confidence in the available evidence are useful for end-users of evidence reviews. Analysts inevitably make judgments about the quality, quantity consistency, robustness, and magnitude of effects observed in the studies identified. The subjectivity of these judgments in several areas underscores the need for transparency in judgments. Discussion This paper introduces a new system for rating medical evidence. The system requires explicit judgments and provides explicit rules for balancing these judgments. Unlike other systems for rating the strength of evidence, our system draws a distinction between two types of conclusions: quantitative and qualitative. A quantitative conclusion addresses the question, "How well does it work?", whereas a qualitative conclusion addresses the question, "Does it work?" In our system, quantitative conclusions are tied to stability ratings, and qualitative conclusions are tied to strength ratings. Our system emphasizes extensive a priori criteria for judgments to reduce the potential for bias. Further, the system makes explicit the impact of heterogeneity testing, meta-analysis, and sensitivity analyses on evidence ratings. This article provides details of our system, including graphical depictions of how the numerous judgments that an analyst makes can be combined. We also describe two worked examples of how the system can be applied to both interventional and diagnostic technologies. Summary Although explicit judgments and formal combination rules are two important steps on the path to a comprehensive system for rating medical evidence, many additional steps must also be taken. Foremost among these are the distinction between quantitative and qualitative conclusions, an extensive set of a priori criteria for making judgments, and the direct impact of analytic results on evidence ratings. These attributes form the basis for a logically consistent system that can
Cepeda, Jose; Schwendtner, Barbara; Quan, Byron; Nadim, Farrokh; Diaz, Manuel; Molina, Giovanni
As a contribution to the Global Assessment Report 2013 - GAR2013, coordinated by the United Nations International Strategy for Disaster Reduction - UNISDR, a drill-down exercise for landslide hazard assessment was carried out by entering the results of both heuristic and statistical techniques into a new but simple combination rule. The data available for this evaluation included landslide inventories, both historical and event-based. In addition to the application of a heuristic method used in the previous editions of GAR, the availability of inventories motivated the use of statistical methods. The heuristic technique is largely based on the Mora & Vahrson method, which estimates hazard as the product of susceptibility and triggering factors, where classes are weighted based on expert judgment and experience. Two statistical methods were also applied: the landslide index method, which estimates weights of the classes for the susceptibility and triggering factors based on the evidence provided by the density of landslides in each class of the factors; and the weights of evidence method, which extends the previous technique to include both positive and negative evidence of landslide occurrence in the estimation of weights for the classes. One key aspect during the hazard evaluation was the decision on the methodology to be chosen for the final assessment. Instead of opting for a single methodology, it was decided to combine the results of the three implemented techniques using a combination rule based on a normalization of the results of each method. The hazard evaluation was performed for both earthquake- and rainfall-induced landslides. The country chosen for the drill-down exercise was El Salvador. The results indicate that highest hazard levels are concentrated along the central volcanic chain and at the centre of the northern mountains.
Mühlhofer, Heinrich M L; Pohlig, Florian; Kanz, Karl-Georg; Lenze, Ulrich; Lenze, Florian; Toepfer, Andreas; Kelch, Sarah; Harrasser, Norbert; von Eisenhart-Rothe, Rüdiger; Schauwecker, Johannes
Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps. We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms. From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807. The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.
Shepherd, Emily; Gomersall, Judith C; Tieu, Joanna; Han, Shanshan; Crowther, Caroline A; Middleton, Philippa
Gestational diabetes mellitus (GDM) is associated with a wide range of adverse health consequences for women and their infants in the short and long term. With an increasing prevalence of GDM worldwide, there is an urgent need to assess strategies for GDM prevention, such as combined diet and exercise interventions. This is an update of a Cochrane review that was first published in 2015. To assess the effects of diet interventions in combination with exercise interventions for pregnant women for preventing GDM, and associated adverse health consequences for the mother and her infant/child. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 November 2016) and reference lists of retrieved studies. We included randomised controlled trials (RCTs) and cluster-RCTs, comparing combined diet and exercise interventions with no intervention (i.e. standard care), that reported on GDM diagnosis as an outcome. Quasi-RCTs were excluded. Cross-over trials were not eligible for inclusion. We planned to include RCTs comparing two or more different diet/exercise interventions, however none were identified. Two review authors independently assessed study eligibility, extracted data, assessed the risk of bias of the included trials and assessed quality of evidence for selected maternal and infant/child outcomes using the GRADE approach. We checked data for accuracy. In this update, we included 23 RCTs (involving 8918 women and 8709 infants) that compared combined diet and exercise interventions with no intervention (standard care). The studies varied in the diet and exercise programs evaluated and health outcomes reported. None reported receiving funding from a drug manufacturer or agency with interests in the results. Overall risk of bias was judged to be unclear due to the lack of methodological detail reported. Most studies were undertaken in high-income countries.For our primary review outcomes, there was a possible reduced risk of GDM in the diet and
Njau, Joseph D; Goodman, Catherine A; Kachur, S Patrick; Mulligan, Jo; Munkondya, John S; McHomvu, Naiman; Abdulla, Salim; Bloland, Peter; Mills, Anne
The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. The costs of implementing ACT are substantial. Although drug purchases
Rebollo, M A; Rodríguez, A L
To discuss our concern for some aspects of mathematics learning disorders related to the nomenclature employed and their diagnosis; these aspects refer to the term 'dyscalculia' and to its diagnosis (especially syndromatic diagnosis). We also intend to propose a classification that could help to define the terminology. Lastly we are going to consider the different aspects of diagnosis and to determine which of them are indispensable in the diagnosis of primary and secondary disorders. As far as the nomenclature is concerned, we refer to the term 'dyscalculia'. The origins of the term are analysed along with the reasons why it should not be used in children with difficulties in learning mathematics. We propose a classification and denominations for the different types that should undoubtedly be discussed. With respect to the diagnosis, several problems related to the syndromatic diagnosis are considered, since in our country there are no standardised tests with which to study performance in arithmetic and geometry. This means that criterion reference tests are conducted to try to establish current and potential performance. At this stage of the diagnosis pedagogical and psychological studies must be conducted. The important factors with regard to the topographical and aetiological diagnoses are prior knowledge, results from the studies that have been carried out and findings from imaging studies. The importance of a genetic study must be defined in the aetiological diagnosis. We propose a nomenclature to replace the term 'dyscalculia'. Standardised tests are needed for the diagnosis. The need to establish current and potential performance is hierarchized. With regard to the topographical diagnosis, we highlight the need for more information about geometry, and in aetiological studies the analyses must be conducted with greater numbers of children.
Full Text Available Intuitionistic fuzzy (IF evidence theory, as an extension of Dempster-Shafer theory of evidence to the intuitionistic fuzzy environment, is exploited to process imprecise and vague information. Since its inception, much interest has been concentrated on IF evidence theory. Many works on the belief functions in IF information systems have appeared. Although belief functions on the IF sets can deal with uncertainty and vagueness well, it is not convenient for decision making. This paper addresses the issue of probability estimation in the framework of IF evidence theory with the hope of making rational decision. Background knowledge about evidence theory, fuzzy set, and IF set is firstly reviewed, followed by introduction of IF evidence theory. Axiomatic properties of probability distribution are then proposed to assist our interpretation. Finally, probability estimations based on fuzzy and IF belief functions together with their proofs are presented. It is verified that the probability estimation method based on IF belief functions is also potentially applicable to classical evidence theory and fuzzy evidence theory. Moreover, IF belief functions can be combined in a convenient way once they are transformed to interval-valued possibilities.
Pogue, Jason M; Kaye, Keith S
Despite many theoretical and in vitro advantages, clinical data comparing combination therapy with colistin + rifampicin to colistin alone for infection due to extremely-drug resistant (XDR) Acinetobacter baumanni are scarce and limited by small numbers and/or low quality evidence. This article represents the first large, randomized, controlled, prospective study comparing colistin monotherapy and combination therapy. The reviewed article found no difference in all cause or infection related mortality, though there was an improved rate of microbiological clearance in the combination therapy arm. This study adds important new data to the literature and sets the stage for future studies that can be designed to overcome the limitations of this study, which are discussed in detail below. Based on this study, we cannot say definitively that combination therapy is not warranted for treatment of invasive infection due to A. baumannii, but the results do suggest that rifampicin is not an ideal agent to be combined with colistin.
Patel, Nupur U; Felix, Kayla; Reimer, Danielle; Feldman, Steven R
While topical medications remain the cornerstone of the psoriasis treatment paradigm, they also come with the risk of multiple side effects. An alternative topical treatment option, calcipotriene or calcipotriol, is a vitamin D derivative that is thought to work by inhibiting keratinocyte proliferation and enhancing keratinocyte differentiation. Multiple studies have demonstrated its efficacy and safety in improving psoriasis when used in combination with topical corticosteroids. Given the effectiveness and side effect profile seen with this combination of topical steroid and calcipotriene, the US Food and Drug Administration approved a calcipotriene/betamethasone dipropionate product for use in psoriasis patients over the age of 12 in 2006. Our paper seeks to review clinical trial evidence of this combination medication and its use in the treatment of psoriasis vulgaris. While assessment of available evidence indicates that the topical medication is both safe and effective for the treatment of psoriasis vulgaris, addressing limitations of what is known, such as tolerability, adherence, and patient preference, of this combination drug in future high-impact studies is needed. PMID:29033598
Koizumi, Yoshiki [School of Medicine, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan; Nakajim, Syo [Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan; Department of Applied Biological Sciences, Faculty of Science and Technology, Tokyo University of Sciences, Chiba, J; Ohash, Hirofumi [Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan: Department of Applied Biological Sciences, Faculty of Science and Technology, Tokyo University of Sciences, Chiba, J; Tanaka, Yasuhito [Department of Virology and Liver Unit, Nagoya City University Graduate School of Medicinal Sciences, Nagoya, Japan; Wakita, Takaji [Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan; Perelson, Alan S. [Los Alamos National Laboratory; Iwami, Shingo [Department of Biology, Faculty of Sciences, Kyushu University, Fukuoka, Japan: PRESTO, JST, Saitama, Japan: CREST, JST, Saitama, Japan; Watashi, Koichi [Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan: Department of Applied Biological Sciences, Faculty of Science and Technology, Tokyo University of Sciences, Chiba, J
Cell culture study combing a mathematical model and computer simulation quantifies the anti-hepatitis C virus drug efficacy at any concentrations and any combinations in preclinical settings, and can obtain rich basic evidences for selecting optimal treatments prior to costly clinical trials.
Full Text Available We conduct a systematic comparison of the performance of four commonly used value combination methods applied to panel unit root tests: the original Fisher test, the modified inverse normal method, Simes test, and the modified truncated product method (TPM. Our simulation results show that under cross-section dependence the original Fisher test is severely oversized, but the other three tests exhibit good size properties. Simes test is powerful when the total evidence against the joint null hypothesis is concentrated in one or very few of the tests being combined, but the modified inverse normal method and the modified TPM have good performance when evidence against the joint null is spread among more than a small fraction of the panel units. These differences are further illustrated through one empirical example on testing purchasing power parity using a panel of OECD quarterly real exchange rates.
Warholm, Lina; Petersen, Kresten R; Ravn, Pernille
Combined oral contraceptives (COCs) are increasingly used by adolescents. The aim of this review is to investigate the evidence regarding COCs' influence on weight, height and bone mineral density (BMD) in girls younger than 18 years.......Combined oral contraceptives (COCs) are increasingly used by adolescents. The aim of this review is to investigate the evidence regarding COCs' influence on weight, height and bone mineral density (BMD) in girls younger than 18 years....
Gallardo, Carmen R; Rigau Comas, David; Valderrama Rodríguez, Angélica; Roqué i Figuls, Marta; Parker, Lucy Anne; Caylà, Joan; Bonfill Cosp, Xavier
meta-analysis. We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Main results We included 13 randomized controlled trials (RCTs) in the review, which enrolled 5824 participants. Trials were published between 1987 and 2015 and included participants in treatment with newly diagnosed pulmonary TB in countries with high TB prevalence. Only two trials reported the HIV status of included participants. Overall there is little or no difference detected between FDCs and single-drug formulations for most outcomes reported. We did not detect a difference in treatment failure between FDCs compared with single-drug formulations (RR 1.28, 95% CI 0.82 to 2.00; 3606 participants, seven trials, moderate quality evidence). Relapse may be more frequent in people treated with FDCs compared to single-drug formulations, although the confidence interval (CI) includes no difference (RR 1.28, 95% CI 1.00 to 1.64; 3621 participants, 10 trials, low quality evidence). We did not detect any difference in death between fixed-dose and single-drug formulation groups (RR 0.96, 95% CI 0.67 to 1.39; 4800 participants, 11 trials, moderate quality evidence). When we compared FDCs with single-drug formulations we found little or no difference for sputum smear or culture conversion at the end of treatment (RR 0.99, 95% CI 0.96 to 1.02; 2319 participants, seven trials, high quality evidence), for serious adverse events (RR 1.45, 95% CI 0.90 to 2.33; 3388 participants, six trials, moderate quality evidence), and for adverse events that led to discontinuation of therapy (RR 0.96, 95% CI 0.56 to 1.66; 5530 participants, 13 trials, low quality evidence). We conducted a sensitivity analysis excluding studies at high risk of bias and this did not alter the review findings. Authors' conclusions Fixed-dose combinations and single-drug formulations probably have similar effects for treating people with newly diagnosed pulmonary TB. PLAIN
Julian H Elliott; Tari Turner; Ornella Clavisi; James Thomas; Julian P T Higgins; Chris Mavergames; Russell L Gruen
The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are ...
Beard, S. P.; Swindle, T. D.
We use cosmic-ray exposure (CRE) ages of ureilites, combined with magnesium numbers of olivine, and oxygen isotopes, to search for evidence of specific source events initiating exposure for groups of ureilites. This technique can also be used to investigate the heterogeneity of the body from which the samples were derived. There are a total of 39 ureilites included in our work, which represents the largest collection of ureilite CRE age data used to date. Although we find some evidence of possible clusters, it is clear that most ureilites did not originate in one or two events on a homogeneous parent body.
Kumar, S. Praveen; Raja, B. William Dharma
Not all children are made the same. Learning disabilities like dyslexia, dysgraphia or dyscalculia are either not understood or ignored in schools. As a result, the schoolchildren suffer for no fault of theirs and they lag behind in their course of learning. They may find it difficult to achieve the basic skills of learning such as reading,…
Dahl, Jørgen Berg; Nielsen, Rasmus; Wetterslev, Jørn
, and no well-documented 'gold standards' exist. The aim of the present topical, narrative review is to provide an update of the evidence for post-operative analgesic efficacy with the most commonly used, systemic non-opioid drugs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs)/COX-2 antagonists......, glucocorticoids, gabapentinoids, and combinations of these. The review is based on data from previous systematic reviews with meta-analyses, investigating effects of non-opioid analgesics on pain, opioid-requirements, and opioid-related adverse effects. Paracetamol, NSAIDs, COX-2 antagonists, and gabapentin....... Trials of pregabalin > 300 mg/day indicated a morphine-sparing effect of 13.4 (4, 22.8) mg morphine/24 h. Notably, though, the available evidence for additive or synergistic effects of most combination regimens was sparse or lacking. Paracetamol, NSAIDs, selective COX-2 antagonists, and gabapentin all...
Fernandez, L. I.; Gambis, D.; Arias, E. F.
In this analysis a one-day combined time series of LOD(length-of-day) estimates is presented. We use individual data series derived by 7 GPS and 3 SLR analysis centers, which routinely contribute to the IERS database over a recent 27-month period (Jul 1996 - Oct 1998). The result is compared to the multi-technique combined series C04 produced by the Central Bureau of the IERS that is commonly used as a reference for the study of the phenomena of Earth rotation variations. The Frequency Windows Combined Series procedure brings out a time series, which is close to C04 but shows an amplitude difference that might explain the evident periodic behavior present in the differences of these two combined series. This method could be useful to generate a new time series to be used as a reference in the high frequency variations of the Earth rotation studies.
Hong, Quan Nha; Pluye, Pierre; Bujold, Mathieu; Wassef, Maggy
Systematic reviews of qualitative and quantitative evidence can provide a rich understanding of complex phenomena. This type of review is increasingly popular, has been used to provide a landscape of existing knowledge, and addresses the types of questions not usually covered in reviews relying solely on either quantitative or qualitative evidence. Although several typologies of synthesis designs have been developed, none have been tested on a large sample of reviews. The aim of this review of reviews was to identify and develop a typology of synthesis designs and methods that have been used and to propose strategies for synthesizing qualitative and quantitative evidence. A review of systematic reviews combining qualitative and quantitative evidence was performed. Six databases were searched from inception to December 2014. Reviews were included if they were systematic reviews combining qualitative and quantitative evidence. The included reviews were analyzed according to three concepts of synthesis processes: (a) synthesis methods, (b) sequence of data synthesis, and (c) integration of data and synthesis results. A total of 459 reviews were included. The analysis of this literature highlighted a lack of transparency in reporting how evidence was synthesized and a lack of consistency in the terminology used. Two main types of synthesis designs were identified: convergent and sequential synthesis designs. Within the convergent synthesis design, three subtypes were found: (a) data-based convergent synthesis design, where qualitative and quantitative evidence is analyzed together using the same synthesis method, (b) results-based convergent synthesis design, where qualitative and quantitative evidence is analyzed separately using different synthesis methods and results of both syntheses are integrated during a final synthesis, and (c) parallel-results convergent synthesis design consisting of independent syntheses of qualitative and quantitative evidence and an
J. W. Van Sambeek; George Rink
Research literature was reviewed for evidence supporting the management of black walnut plantations for combined timber and nut production. The silviculture of the species is discussed in relation to dual cropping. Stimulation and phenology of flowering and fruiting are reviewed.
Anatomical evidence for direct fiber projections from the cerebellar nucleus interpositus to rubrospinal neurons. A quantitative EM study in the rat combining anterograde and retrograde intra-axonal tracing methods
A quantitative electron microscopic (EM) study combining the anterograde intra-axonal transport of radioactive amino acids and the retrograde intra-axonal transport of the enzyme horseradish peroxidase (HRP) was performed in the magnocellular red nucleus of the rat to obtain anatomical evidence as to whether there is a direct projection from the cerebellar nucleus interpositus to the cells in the red nucleus that give rise to the rubrospinal tract. Large asymmetrical synaptic terminals were radioactively labeled in the magnocellular red nucleus following injections of [ 3 H]leucine into the cerebellar nucleus interpositus. In these same animals, the postsynaptic target neurons were labeled with HRP granules after injection of this substance in the rubrospinal tract. A quantitative analysis showed that more than 85% of the large and giant neurons in the magnocellular red nucleus were labeled with HRP granules and also received synaptic contacts from radioactively-labeled terminals. Thus, it can be concluded that in the rat, afferents from the cerebellar nucleus interpositus establish asymmetrical synaptic contacts with large and giant rubrospinal neurons, thus confirming and extending the previous physiological evidence of such direct monosynaptic connections. (Auth.)
Venasse, Myriam; Edwards, Thomas; Pilutti, Lara A
There has been recent interest in the role of lifestyle and wellness-based approaches in the treatment and management of multiple sclerosis (MS). These approaches may be particularly relevant for patients with progressive MS, considering limited therapeutic options currently available. The purpose of this review is to examine the role of wellness-based interventions including exercise training, emotional well-being therapies, and dietary modification in patients with progressive MS. We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention. There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.
Marchevsky, Alberto M; Walts, Ann E; Wick, Mark R
Evidence-based pathology advocates using a combination of best available data ("evidence") from the literature and personal experience for the diagnosis, estimation of prognosis, and assessment of other variables that impact individual patient care. Evidence-based pathology relies on systematic reviews of the literature, evaluation of the quality of evidence as categorized by evidence levels and statistical tools such as meta-analyses, estimates of probabilities and odds, and others. However, it is well known that previously "statistically significant" information usually does not accurately forecast the future for individual patients. There is great interest in "cognitive computing" in which "data mining" is combined with "predictive analytics" designed to forecast future events and estimate the strength of those predictions. This study demonstrates the use of IBM Watson Analytics software to evaluate and predict the prognosis of 101 patients with typical and atypical pulmonary carcinoid tumors in which Ki-67 indices have been determined. The results obtained with this system are compared with those previously reported using "routine" statistical software and the help of a professional statistician. IBM Watson Analytics interactively provides statistical results that are comparable to those obtained with routine statistical tools but much more rapidly, with considerably less effort and with interactive graphics that are intuitively easy to apply. It also enables analysis of natural language variables and yields detailed survival predictions for patient subgroups selected by the user. Potential applications of this tool and basic concepts of cognitive computing are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.
Vujcich, Daniel; Rayner, Mike; Allender, Steven; Fitzpatrick, Ray
The Indigenous Tobacco Control Initiative and Tackling Indigenous Smoking Measure were both announced by the Australian Government at a time when its rhetoric around the importance of evidence-based policy making was strong. This article will (1) examine how the Rudd Government used evidence in Indigenous tobacco control policy making and (2) explore the facilitators of and barriers to the use of evidence. Data were collected through (1) a review of primary documents largely obtained under the Freedom of Information Act 1982 (Commonwealth of Australia) and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates, and academics. Through the Freedom of Information Act process, 24 previously undisclosed government documents relevant to the making of Indigenous tobacco control policies were identified. Interviewees ( n = 31, response rate 62%) were identified through both purposive and snowball recruitment strategies. The Framework Analysis method was used to analyze documentary and interview data. Government policy design was heavily influenced by the recommendations presented in government authored/commissioned literature reviews. Resulting policies were led by equivocal evidence for improved tobacco control outcomes among Indigenous Australians. Many of the cited studies had methodological limitations. In the absence of high-quality evidence, some policy makers supported policy recommendations that were perceived to be popular among the Indigenous community. Other policy makers recognized that there were barriers to accumulating rigorous, generalizable evidence; in the absence of such evidence, the policy makers considered that the "need for action" could be combined with the "need for research" by introducing innovative strategies and evaluating them. Despite the absence of high-quality evidence, the formulation and adoption of Indigenous tobacco policy was neither irrational nor reckless. The decision to
Wang Jiangfeng; Dai Yiping; Zhang Taiyong; Ma Shaolin
A new combined power and ejector-absorption refrigeration cycle is proposed, which combines the Rankine cycle and the ejector-absorption refrigeration cycle, and could produce both power output and refrigeration output simultaneously. This combined cycle, which originates from the cycle proposed by authors previously, introduces an ejector between the rectifier and the condenser, and provides a performance improvement without greatly increasing the complexity of the system. A parametric analysis is conducted to evaluate the effects of the key thermodynamic parameters on the cycle performance. It is shown that heat source temperature, condenser temperature, evaporator temperature, turbine inlet pressure, turbine inlet temperature, and basic solution ammonia concentration have significant effects on the net power output, refrigeration output and exergy efficiency of the combined cycle. It is evident that the ejector can improve the performance of the combined cycle proposed by authors previously.
Zhu, Zhanda; Jiang, Menghua; Cheng, Siqi; Hui, Yongling; Lei, Hong; Li, Qiang
Our experiment is expected to provide an approach for realizing ultranarrow linewidth for a spectral beam combined diode laser bar. The beams of a diode laser bar are combined in a fast axis after a beam transformation system. With the help of relay optics and a transform lens with a long focal length of 1.5 m, the whole wavelength of a spectral combined laser bar can be narrowed down to 0.48 nm from more than 10 nm. We have achieved 56.7 W cw from a 19-element single bar with an M2 of 1.4 (in horizontal direction)×11.6 (in vertical direction). These parameters are good evidence that all the beams from the diode laser bar are combined together to increase the brightness.
Kavey, Rae-Ellen W
Combined dyslipidemia (CD) is now the predominant dyslipidemic pattern in childhood, characterized by moderate-to-severe elevation in triglycerides and non-high-density lipoprotein cholesterol (non-HDL-C), minimal elevation in low-density lipoprotein cholesterol (LDL-C), and reduced HDL-C. Nuclear magnetic resonance spectroscopy shows that the CD pattern is represented at the lipid subpopulation level as an increase in small, dense LDL and in overall LDL particle number plus a reduction in total HDL-C and large HDL particles, a highly atherogenic pattern. In youth, CD occurs almost exclusively with obesity and is highly prevalent, seen in more than 40% of obese adolescents. CD in childhood predicts pathologic evidence of atherosclerosis and vascular dysfunction in adolescence and young adulthood, and early clinical cardiovascular events in adult life. There is a tight connection between CD, visceral adiposity, insulin resistance, nonalcoholic fatty liver disease, and the metabolic syndrome, suggesting an integrated pathophysiological response to excessive weight gain. Weight loss, changes in dietary composition, and increases in physical activity have all been shown to improve CD significantly in children and adolescents in short-term studies. Most importantly, even small amounts of weight loss are associated with significant decreases in triglyceride levels and increases in HDL-C levels with improvement in lipid subpopulations. Diet change focused on limitation of simple carbohydrate intake with specific elimination of all sugar-sweetened beverages is very effective. Evidence-based recommendations for initiating diet and activity change are provided. Rarely, drug therapy is needed, and the evidence for drug treatment of CD in childhood is reviewed. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Gralton, Jan; McLaws, Mary-Louise
To use evidence-based principles to develop infection control algorithms to ensure the protection of healthcare workers and the continuity of health service provision during a pandemic. : Evidence-based algorithms were developed from published research as well as "needs and values" assessments. Research evidence was obtained from 97 studies reporting the protectiveness of antiviral prophylaxis, seasonal vaccination, and mask use. Needs and values assessments were undertaken by international experts in pandemic infection control and local healthcare workers. Opportunity and resources costs were not determined. The Australian government commissioned the development of an evidence-based algorithm for inclusion in the 2008 revision of the Australian Health and Management Plan for Pandemic Influenza. Two international infection control teams responsible for healthcare worker safety during the Severe Acute Respiratory Syndrome outbreak reviewed the evidence-based algorithms. The algorithms were then reviewed for needs and values by eight local clinicians who were considered key frontline clinicians during the contain and sustain phases. The international teams reviewed for practicability of implementation, whereas local clinicians reviewed for clinician compliance. Despite strong evidence for vaccination and antiviral prophylaxis providing significant protection, clinicians believed they required the additional combinations of both masks and face shields. Despite the equivocal evidence for the efficacy of surgical and N95 masks and the provision of algorithms appropriate for the level of risk according to clinical care during a pandemic, clinicians still demanded N95 masks plus face shields in combination with prophylaxis and novel vaccination. Conventional evidence-based principles could not be applied to formulate recommendations due to the lack of pandemic-specific efficacy data of protection tools and the inherent unpredictability of pandemics. As an alternative
The literature on combined treatment with radiation and cytotoxic drugs in experimental tumours and normal tissues of laboratory animals is reviewed in the context of the four previously proposed mechanisms whereby a therapeutic advantage might be gained. There is evidence for strong time-dependent processes occurring in some normal tissues. In tumours, the evidence is much weaker and there is considerable disparity among experimental tumours in optimum timing. This review leads to the conclusion that the clinical use of drug-radiation combinations should not be based on an anticipated beneficial interaction; gain will most probably come from the best radiotherapy and the best chemotherapy given as far as possible independently. Deleterious interactions can be reduced by allowing a gap of some weeks between chemotherapy and radiotherapy and by avoiding drugs that are known to enhance radiation damage to the normal tissues that are irradiated. 131 refs.; 4 figs.; 5 tabs
Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...
Elliott, Julian H; Turner, Tari; Clavisi, Ornella; Thomas, James; Higgins, Julian P T; Mavergames, Chris; Gruen, Russell L
The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.
Büntgen, Ulf; Brázdil, Rudolf; Heussner, Karl-Uwe; Hofmann, Jutta; Kontic, Raymond; Kyncl, Tomáš; Pfister, Christian; Chromá, Kateřina; Tegel, Willy
A predicted rise in anthropogenic greenhouse gas emissions and associated effects on the Earth's climate system likely imply more frequent and severe weather extremes with alternations in hydroclimatic parameters expected to be most critical for ecosystem functioning, agricultural yield, and human health. Evaluating the return period and amplitude of modern climatic extremes in light of pre-industrial natural changes is, however, limited by generally too short instrumental meteorological observations. Here we introduce and analyze 11,873 annually resolved and absolutely dated ring width measurement series from living and historical fir ( Abies alba Mill.) trees sampled across France, Switzerland, Germany, and the Czech Republic, which continuously span the AD 962-2007 period. Even though a dominant climatic driver of European fir growth was not found, ring width extremes were evidently triggered by anomalous variations in Central European April-June precipitation. Wet conditions were associated with dynamic low-pressure cells, whereas continental-scale droughts coincided with persistent high-pressure between 35 and 55°N. Documentary evidence independently confirms many of the dendro signals over the past millennium, and further provides insight on causes and consequences of ambient weather conditions related to the reconstructed extremes. A fairly uniform distribution of hydroclimatic extremes throughout the Medieval Climate Anomaly, Little Ice Age and Recent Global Warming may question the common believe that frequency and severity of such events closely relates to climate mean stages. This joint dendro-documentary approach not only allows extreme climate conditions of the industrial era to be placed against the backdrop of natural variations, but also probably helps to constrain climate model simulations over exceptional long timescales.
Full Text Available Abstract Background The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT. However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Methods Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. Results The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita, which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD. In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. Conclusion The costs of
Anders, R; Riès, S; van Maanen, L; Alario, F X
We propose and demonstrate evidence accumulation as a plausible theoretical and/or empirical model for the lexical selection process of lexical retrieval. A number of current psycholinguistic theories consider lexical selection as a process related to selecting a lexical target from a number of alternatives, which each have varying activations (or signal supports), that are largely resultant of an initial stimulus recognition. We thoroughly present a case for how such a process may be theoretically explained by the evidence accumulation paradigm, and we demonstrate how this paradigm can be directly related or combined with conventional psycholinguistic theory and their simulatory instantiations (generally, neural network models). Then with a demonstrative application on a large new real data set, we establish how the empirical evidence accumulation approach is able to provide parameter results that are informative to leading psycholinguistic theory, and that motivate future theoretical development. Copyright © 2015 Elsevier Inc. All rights reserved.
Júlia Beatriz Lopes-Silva
Full Text Available Although verbal and numerical abilities have a well-established interaction, the impact of phonological processing on numeric abilities remains elusive. The aim of this study is to investigate the role of phonemic awareness in number processing and to explore its association with other functions such as working memory and magnitude processing. One hundred seventy-two children in 2nd grade to 4th grade were evaluated in terms of their intelligence, number transcoding, phonemic awareness, verbal and visuospatial working memory and number sense (nonsymbolic magnitude comparison performance. All of the children had normal intelligence. Among these measurements of magnitude processing, working memory and phonemic awareness, only the last was retained in regression and path models predicting transcoding ability. Phonemic awareness mediated the influence of verbal working memory on number transcoding. The evidence suggests that phonemic awareness significantly affects number transcoding. Such an association is robust and should be considered in cognitive models of both dyslexia and dyscalculia.
Li, Qiu; Wu, Lixin
Land resource development and utilization brings many problems. The numbers, the scale and volume of illegal land use cases are on the increasing. Since the territory is vast, and the land violations are concealment, it is difficulty for an effective land supervision and management. In this paper, the concepts of evidence, and preservation of evidence were described first. The concepts of image evidence (IE), natural evidence (NE), natural preservation of evidence (NPE), general preservation of evidence (GPE) were proposed based on the characteristics of remote sensing image (RSI) which has a characteristic of objectiveness, truthfulness, high spatial resolution, more information included. Using MapObjects and Visual Basic 6.0, under the Access management to implement the conjunction of spatial vector database and attribute data table; taking RSI as the data sources and background layer; combining the powerful management of geographic information system (GIS) for spatial data, and visual analysis, a land supervision and GIS management system was design and implemented based on NPE. The practical use in Beijing shows that the system is running well, and solved some problems in land supervision and management.
Full Text Available Piotr Milecki1,2, Piotr Martenka1, Andrzej Antczak3, Zbigniew Kwias31Department of Radiotherapy, Greater Poland Cancer Center, Poznan, Poland; 2Department of Electroradiology, Medical University, Poznan, Poland; 3Chair of Urology, Medical University, Poznan, PolandAbstract: Androgen-deprivation therapy (ADT is used routinely in combination with definitive external beam radiation therapy (EBRT in patients with high-risk clinically localized or locally advanced disease. The combined treatment (ADT–EBRT also seems to play a significant role in improving treatment results in the intermediate-risk group of prostate cancer patients. On the other hand, there is a growing body of evidence that treatment with ADT can be associated with serious and lifelong adverse events including osteoporosis, cardiovascular disease, diabetes, and many others. Almost all ADT adverse events are time dependant and tend to increase in severity with prolongation of hormonal manipulation. Therefore, it is crucial to clearly state the optimal schedule for ADT in combination with EBRT, that maintaining the positive effect on treatment efficacy would keep the adverse events risk at reasonable level. To achieve this goal, treatment schedule may have to be highly individualized on the basis of the patient-specific potential vulnerability to adverse events. In this study, the concise and evidence-based review of current literature concerning the general rationales for combining radiotherapy and hormonal therapy, its mechanism, treatment results, and toxicity profile is presented.Keywords: prostate cancer, radiotherapy, androgen deprivation, combined treatment
Isgut, Monica; Rao, Mukkavilli; Yang, Chunhua; Subrahmanyam, Vangala; Rida, Padmashree C G; Aneja, Ritu
Modern drug discovery efforts have had mediocre success rates with increasing developmental costs, and this has encouraged pharmaceutical scientists to seek innovative approaches. Recently with the rise of the fields of systems biology and metabolomics, network pharmacology (NP) has begun to emerge as a new paradigm in drug discovery, with a focus on multiple targets and drug combinations for treating disease. Studies on the benefits of drug combinations lay the groundwork for a renewed focus on natural products in drug discovery. Natural products consist of a multitude of constituents that can act on a variety of targets in the body to induce pharmacodynamic responses that may together culminate in an additive or synergistic therapeutic effect. Although natural products cannot be patented, they can be used as starting points in the discovery of potent combination therapeutics. The optimal mix of bioactive ingredients in natural products can be determined via phenotypic screening. The targets and molecular mechanisms of action of these active ingredients can then be determined using chemical proteomics, and by implementing a reverse pharmacokinetics approach. This review article provides evidence supporting the potential benefits of natural product-based combination drugs, and summarizes drug discovery methods that can be applied to this class of drugs. © 2017 Wiley Periodicals, Inc.
Das, E.; Kerkhof, P.; Kuiper, J.
This experimental study assessed the effectiveness of fundraising messages. Based on recent findings regarding the effects of message framing and evidence, effective fundraising messages should combine abstract, statistical information with a negative message frame and anecdotal evidence with a
Paul eDel Prato
Full Text Available The left anterior temporal lobe (LATL has risen as a leading candidate for a brain locus of composition in language; yet the computational details of its function are unknown. Although most literature discusses it as a combinatory region in very general terms, it has also been proposed to reflect the more specific function of conceptual combination, which in the classic use of this term mainly pertains to the combination of open class words with obvious conceptual contributions. We aimed to distinguish between these two possibilities by contrasting plural nouns in contexts where they were either preceded by a color modifier (red cups, eliciting conceptual combination, or by a number word (two cups, eliciting numeral quantification but no conceptual combination. This contrast was chosen because within a production task, it allows the manipulation of composition type while keeping the physical stimulus constant: a display of two red cups can be named as two cups or red cups depending on the task instruction. These utterances were compared to productions of two-word number and color lists, intended as noncombinatory control conditions. MEG activity was recorded during the planning for production, prior to motion artifacts. As expected on the basis of comprehension studies, color modification elicited increased LATL activity as compared to color lists, demonstrating that this basic combinatory effect is strongly crossmodal. However, numeral quantification did not elicit a parallel effect, suggesting that the function of the LATL is (i semantic and not syntactic (given that both color modification and numeral quantification involve syntactic composition and (ii corresponds more closely to the classical psychological notion of conceptual combination as opposed to a more general semantic combinatory function.
Carneiro, A V
Modern medical practice is an ever-changing process, and the doctor's need for information has been partially met by continuous medical education (CME) activities. It has been shown that CME activities have not prevented clinical knowledge, as well as medical practice, from deteriorating with time. When faced with the need to get the most recent and relevant information possible, the busy clinician has two major problems: most of the published medical literature is either irrelevant or not useful; and there is little time to read it. Evidence-based medicine constitutes a new paradigm for medical practice in the sense that it tries to transform clinical problems into well formulated clinical questions, selecting and critically appraising scientific evidence with predefined and rigorous rules. It combines the expertise of the individual clinician with the best external evidence from clinical research for rational, ethical and efficacious practice. Evidence-based medicine can be taught and practiced by physicians with different degrees of autonomy, with several subspecialties, working in the hospital or in outpatient clinics, alone or in groups.
van de Ven, Wynand P M M; van Vliet, René C J A; van Kleef, Richard C
If consumers have a choice of health plan, risk selection is often a serious problem (e.g., as in Germany, Israel, the Netherlands, the United States of America, and Switzerland). Risk selection may threaten the quality of care for chronically ill people, and may reduce the affordability and efficiency of healthcare. Therefore, an important question is: how can the regulator show evidence of (no) risk selection? Although this seems easy, showing such evidence is not straightforward. The novelty of this paper is two-fold. First, we provide a conceptual framework for showing evidence of risk selection in competitive health insurance markets. It is not easy to disentangle risk selection and the insurers' efficiency. We suggest two methods to measure risk selection that are not biased by the insurers' efficiency. Because these measures underestimate the true risk selection, we also provide a list of signals of selection that can be measured and that, in particular in combination, can show evidence of risk selection. It is impossible to show the absence of risk selection. Second, we empirically measure risk selection among the switchers, taking into account the insurers' efficiency. Based on 2-year administrative data on healthcare expenses and risk characteristics of nearly all individuals with basic health insurance in the Netherlands (N > 16 million) we find significant risk selection for most health insurers. This is the first publication of hard empirical evidence of risk selection in the Dutch health insurance market.
López-López, José A; Humphriss, Rachel L; Beswick, Andrew D; Thom, Howard H Z; Hunt, Linda P; Burston, Amanda; Fawsitt, Christopher G; Hollingworth, William; Higgins, Julian P T; Welton, Nicky J; Blom, Ashley W; Marques, Elsa M R
Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register. Review methods Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination. Conclusions Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies. Systematic review registration PROSPERO CRD42015019435. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence
Bos, Marijke; Vannoorenberghe, Gonzague
We examine how access to imported intermediate inputs affects firm-level product innovation in five developing counties. We combine trade data with survey data on innovation and develop a method to determine whether new inputs were essential for the product innovation. We find evidence that the
Julian H Elliott
Full Text Available The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.
Harlaar, Jaap; Brehm, Merel; Becher, Jules G; Bregman, Daan J J; Buurke, Jaap; Holtkamp, Fred; De Groot, Vincent; Nollet, Frans
Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.
Full Text Available BACKGROUND: The Indigenous Tobacco Control Initiative and Tackling Indigenous Smoking Measure were both announced by the Australian Government at a time when its rhetoric around the importance of evidence-based policy making was strong. This article will (1 examine how the Rudd Government used evidence in Indigenous tobacco control policy making and (2 explore the facilitators of and barriers to the use of evidence. METHODS: Data were collected through: (1 a review of primary documents largely obtained under the Freedom of Information Act 1982 (Commonwealth of Australia and (2 interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. Through the Freedom of Information Act process, 24 previously undisclosed government documents relevant to the making of Indigenous tobacco control policies were identified. Interviewees (n=31, response rate 62% were identified through both purposive and snowball recruitment strategies. The Framework Analysis method was used to analyse documentary and interview data.RESULTS: Government policy design was heavily influenced by recommendations presented in government authored/commissioned literature reviews. Resulting policies were led by equivocal evidence for improved tobacco control outcomes among Indigenous Australians. Many of the cited studies had methodological limitations. In the absence of high quality evidence, some policy makers supported policy recommendations that were perceived to be popular among the Indigenous community. Other policy makers recognised that there were barriers to accumulating rigorous, generalizable evidence; in the absence of such evidence, the policy makers considered that the ‘need for action’ could be combined with the ‘need for research’ by introducing innovative strategies and evaluating them.DISCUSSION: Despite the absence of high quality evidence, the formulation and adoption of Indigenous Tobacco policy was
Stubenrauch, Christa; Krinzinger, Helga; Konrad, Kerstin
Psychiatric disorders in childhood and adolescence, in particular attention deficit disorder or specific learning disorders like developmental dyslexia and developmental dyscalculia, affect academic performance and learning at school. Recent advances in neuroscientific research have incited an intensive debate both in the general public and in the field of educational and instructional science as well as to whether and to what extent these new findings in the field of neuroscience might be of importance for school-related learning and instruction. In this review, we first summarize neuroscientific findings related to the development of attention, working memory and executive functions in typically developing children and then evaluate their relevance for school-related learning. We present an overview of neuroimaging studies of specific learning disabilities such as developmental dyslexia and developmental dyscalculia, and critically discuss their practical implications for educational and teaching practice, teacher training, early diagnosis as well as prevention and disorder-specific therapy. We conclude that the new interdisciplinary field of neuroeducation cannot be expected to provide direct innovative educational applications (e.g., teaching methods). Rather, the future potential of neuroscience lies in creating a deeper understanding of the underlying cognitive mechanisms and pathomechanisms of learning processes and learning disorders.
Full Text Available Objectives: Dyscalculia is specific learning disabilities affecting the acquisition of mathematic skills in an otherwise normal child. The aim of this study was investigation of occupational therapy interventions effect on mathematical problems in students with special learning disorders. Methods: 40 students with dyscalculia (2-5 grades were selected and divided through randomized permuted blocks method into two groups 20 persons as intervention group and the others as the control group. Initially both of groups were administered by the "Iran Key math Test". Then intervention group received occupational therapy interventions for 20 sessions individually and two groups were administered by the Test again. Data was analyzed by using Paired and Independent t-tests. Results: By the paired sample t-test the mean of total marks of Iran Key math Test demonstrated statistically significant difference in both of groups (P<0.05, but the measure of difference in intervention group was more than control group. The mean of marks of Basic Concepts, Operations and Applications demonstrated statistically significant difference at intervention group. Discussion: Occupational therapy interventions had clinical effect on mathematical problems in students with special learning disorders.
Joliot, Marc; Leroux, Gaëlle; Dubal, Stéphanie; Tzourio-Mazoyer, Nathalie; Houdé, Olivier; Mazoyer, Bernard; Petit, Laurent
We combined event-related potential (ERP) and magnetoencephalography (MEG) acquisition and analysis to investigate the electrophysiological markers of the inhibitory processes involved in the number/length interference in a Piaget-like numerical task. Eleven healthy subjects performed four gradually interfering conditions with the heuristic "length equals number" to be inhibited. Low resolution tomography reconstruction was performed on the combined grand averaged electromagnetic data at the early (N1, P1) and late (P2, N2, P3(early) and P3(late)) latencies. Every condition was analyzed at both scalp and regional brain levels. The inhibitory processes were visible on the late components of the electromagnetic brain activity. A right P2-related frontal orbital activation reflected the change of strategy in the inhibitory processes. N2-related SMA/cingulate activation revealed the first occurrence of the stimuli processing to be inhibited. Both P3 components revealed the working memory processes operating in a medial temporal complex and the mental imagery processes subtended by the precuneus. Simultaneous ERP and MEG signal acquisition and analysis allowed to describe the spatiotemporal patterns of neural networks involved in the inhibition of the "length equals number" interference. Combining ERP and MEG ensured a sensitivity which could be reached previously only through invasive intracortical recordings.
Wesel, F. van; Boeije, H.R.; Alisic, E.
Combining the findings obtained by different research methods in mixed-research synthesis could potentially contribute to a broader, more diverse evidence base for interventions. In this article we focus on the methodological challenges involved in synthesizing various types of research findings.We
de Saxe Zerden, Lisa; O'Quinn, Erin; Davis, Corey
Evidence-based practice (EBP) combines proven interventions with clinical experience, ethics, and client preferences to inform treatment and services. Although EBP is integrated into most aspects of social work and public health, at times EBP is at odds with social policy. In this article the authors explore the paradox of evidence-based policy using syringe access programs (SAP) as a case example, and review methods of bridging the gap between the emphasis on EBP and lack of evidence informing SAP policy. Analysis includes the overuse of morality policy and examines historical and current theories why this paradox exists. Action steps are highlighted for creating effective policy and opportunities for public health change. Strategies on reframing the problem and shifting target population focus to garner support for evidence-based policy change are included. This interdisciplinary understanding of the way in which these factors converge is a critical first step in moving beyond morality-based policy toward evidence-based policy.
Full Text Available As the Internet becomes larger in scale, more complex in structure and more diversified in traffic, the number of crimes that utilize computer technologies is also increasing at a phenomenal rate. To react to the increasing number of computer crimes, the field of computer and network forensics has emerged. The general purpose of network forensics is to find malicious users or activities by gathering and dissecting firm evidences about computer crimes, e.g., hacking. However, due to the large volume of Internet traffic, not all the traffic captured and analyzed is valuable for investigation or confirmation. After analyzing some existing network forensics methods to identify common shortcomings, we propose in this paper a new network forensics method that uses a combination of network vulnerability and network evidence graph. In our proposed method, we use vulnerability evidence and reasoning algorithm to reconstruct attack scenarios and then backtrack the network packets to find the original evidences. Our proposed method can reconstruct attack scenarios effectively and then identify multi-staged attacks through evidential reasoning. Results of experiments show that the evidence graph constructed using our method is more complete and credible while possessing the reasoning capability.
Aryeetey, Richmond; Holdsworth, Michelle; Taljaard, Christine; Hounkpatin, Waliou Amoussa; Colecraft, Esi; Lachat, Carl; Nago, Eunice; Hailu, Tesfaye; Kolsteren, Patrick; Verstraeten, Roos
Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.
Kähkönen, S; Kesäniemi, M; Nikouline, V V; Karhu, J; Ollikainen, M; Holi, M; Ilmoniemi, R J
The motor cortex of 10 healthy subjects was stimulated by transcranial magnetic stimulation (TMS) before and after ethanol challenge (0.8 g/kg resulting in blood concentration of 0.77 +/- 0.14 ml/liter). The electrical brain activity resulting from the brief electromagnetic pulse was recorded with high-resolution electroencephalography (EEG) and located using inversion algorithms. Focal magnetic pulses to the left motor cortex were delivered with a figure-of-eight coil at the random interstimulus interval of 1.5-2.5 s. The stimulation intensity was adjusted to the motor threshold of abductor digiti minimi. Two conditions before and after ethanol ingestion (30 min) were applied: (1) real TMS, with the coil pressed against the scalp; and (2) control condition, with the coil separated from the scalp by a 2-cm-thick piece of plastic. A separate EMG control recording of one subject during TMS was made with two bipolar platinum needle electrodes inserted to the left temporal muscle. In each condition, 120 pulses were delivered. The EEG was recorded from 60 scalp electrodes. A peak in the EEG signals was observed at 43 ms after the TMS pulse in the real-TMS condition but not in the control condition or in the control scalp EMG. Potential maps before and after ethanol ingestion were significantly different from each other (P = 0.01), but no differences were found in the control condition. Ethanol changed the TMS-evoked potentials over right frontal and left parietal areas, the underlying effect appearing to be largest in the right prefrontal area. Our findings suggest that ethanol may have changed the functional connectivity between prefrontal and motor cortices. This new noninvasive method provides direct evidence about the modulation of cortical connectivity after ethanol challenge. Copyright 2001 Academic Press.
Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.
Full Text Available This mixed-methods study incorporated elements of survey, case study and action research approaches in investigating an at-risk child. Using an in-take interview, a diagnostic test, an error analysis, and a think-aloud clinical interview, the study identified the child’s major presenting difficulties. These included: inability to use the four arithmetic operations (addition, subtraction, multiplication, division efficiently; not understanding the relationship between units, tens and hundreds; using any two of the four arithmetic processes (+, - , x, ÷ in combination within one operation; treating each column as a separate problem; place value problems / wrong alignment of numbers; poor eye-hand coordination leading to dysgraphia; and memory lapses. The other problems that became apparent through this investigation and implied in the findings include possible causal factors such as dyscalculia, dyslexia, low self-esteem, low self-efficacy, and math anxiety. Further assessment, intervention and research are recommended to address problems of this vulnerable child.
Major, Lesa Hatley; Coleman, Renita
Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source--physician or minister--that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.
Das, Enny; Kerkhof, Peter; Kuiper, Joyce
This experimental study assessed the effectiveness of fundraising messages. Based on recent findings regarding the effects of message framing and evidence, effective fundraising messages should combine abstract, statistical information with a negative message frame and anecdotal evidence with a positive message frame. In addition, building on…
Klimas, J.; McNeil, R.; Ahamad, K.; Mead, A.; Rieb, L.; Cullen, W.; Wood, E.; Small, W.
Background Despite a large evidence-base upon which to base clinical practice, most health systems have not combined the training of healthcare providers in addiction medicine and research. As such, addiction care is often lacking, or not based on evidence or best practices. We undertook a qualitative study to assess the experiences of physicians who completed a clinician-scientist training programme in addiction medicine within a hospital setting. Methods We interviewed physicians from the S...
Baltag, Alexandru; Occhipinti, Andrés
We introduce a family of logics for reasoning about relational evidence: evidence that involves an ordering of states in terms of their relative plausibility. We provide sound and complete axiomatizations for the logics. We also present several evidential actions and prove soundness...
Krieger, James; Jacobs, David E; Ashley, Peter J; Baeder, Andrea; Chew, Ginger L; Dearborn, Dorr; Hynes, H Patricia; Miller, J David; Morley, Rebecca; Rabito, Felicia; Zeldin, Darryl C
Subject matter experts systematically reviewed evidence on the effectiveness of housing interventions that affect health outcomes, primarily asthma, associated with exposure to moisture, mold, and allergens. Three of the 11 interventions reviewed had sufficient evidence for implementation: multifaceted, in-home, tailored interventions for reducing asthma morbidity; integrated pest management to reduce cockroach allergen; and combined elimination of moisture intrusion and leaks and removal of moldy items to reduce mold and respiratory symptoms. Four interventions needed more field evaluation, 1 needed formative research, and 3 either had no evidence of effectiveness or were ineffective. The 3 interventions with sufficient evidence all applied multiple, integrated strategies. This evidence review shows that selected interventions that improve housing conditions will reduce morbidity from asthma and respiratory allergies.
Kraft, Kraig H.; Brown, Cecil H.; Nabhan, Gary P.; Luedeling, Eike; Luna Ruiz, José de Jesús; Coppens d’Eeckenbrugge, Geo; Hijmans, Robert J.; Gepts, Paul
The study of crop origins has traditionally involved identifying geographic areas of high morphological diversity, sampling populations of wild progenitor species, and the archaeological retrieval of macroremains. Recent investigations have added identification of plant microremains (phytoliths, pollen, and starch grains), biochemical and molecular genetic approaches, and dating through 14C accelerator mass spectrometry. We investigate the origin of domesticated chili pepper, Capsicum annuum, by combining two approaches, species distribution modeling and paleobiolinguistics, with microsatellite genetic data and archaeobotanical data. The combination of these four lines of evidence yields consensus models indicating that domestication of C. annuum could have occurred in one or both of two areas of Mexico: northeastern Mexico and central-east Mexico. Genetic evidence shows more support for the more northern location, but jointly all four lines of evidence support central-east Mexico, where preceramic macroremains of chili pepper have been recovered in the Valley of Tehuacán. Located just to the east of this valley is the center of phylogenetic diversity of Proto-Otomanguean, a language spoken in mid-Holocene times and the oldest protolanguage for which a word for chili pepper reconstructs based on historical linguistics. For many crops, especially those that do not have a strong archaeobotanical record or phylogeographic pattern, it is difficult to precisely identify the time and place of their origin. Our results for chili pepper show that expressing all data in similar distance terms allows for combining contrasting lines of evidence and locating the region(s) where cultivation and domestication of a crop began. PMID:24753581
Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina
Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.
Caster, Ola; Juhlin, Kristina; Watson, Sarah; Norén, G Niklas
Detection of unknown risks with marketed medicines is key to securing the optimal care of individual patients and to reducing the societal burden from adverse drug reactions. Large collections of individual case reports remain the primary source of information and require effective analytics to guide clinical assessors towards likely drug safety signals. Disproportionality analysis is based solely on aggregate numbers of reports and naively disregards report quality and content. However, these latter features are the very fundament of the ensuing clinical assessment. Our objective was to develop and evaluate a data-driven screening algorithm for emerging drug safety signals that accounts for report quality and content. vigiRank is a predictive model for emerging safety signals, here implemented with shrinkage logistic regression to identify predictive variables and estimate their respective contributions. The variables considered for inclusion capture different aspects of strength of evidence, including quality and clinical content of individual reports, as well as trends in time and geographic spread. A reference set of 264 positive controls (historical safety signals from 2003 to 2007) and 5,280 negative controls (pairs of drugs and adverse events not listed in the Summary of Product Characteristics of that drug in 2012) was used for model fitting and evaluation; the latter used fivefold cross-validation to protect against over-fitting. All analyses were performed on a reconstructed version of VigiBase(®) as of 31 December 2004, at around which time most safety signals in our reference set were emerging. The following aspects of strength of evidence were selected for inclusion into vigiRank: the numbers of informative and recent reports, respectively; disproportional reporting; the number of reports with free-text descriptions of the case; and the geographic spread of reporting. vigiRank offered a statistically significant improvement in area under the receiver
Zanotti, J-M; Bellissent-Funel, M C; Chen, S-H; Kolesnikov, A I
In a previous paper we combined calorimetric, diffraction and high-resolution quasi-elastic neutron scattering data to show that after exhibiting a glass transition at 165 K, interfacial water experiences a first order liquid-liquid transition at 240 K from a low-density to a high-density liquid. Here we present further evidence of these transitions obtained by high-energy inelastic neutron scattering
Lorenc, Z; Gökçe, Ö
The combination of tribenoside+lidocaine (Procto-Glyvenol®) is a medical preparation for the local treatment of hemorrhoids, delivered as a suppository or rectal cream. This product has been used for decades in the therapy of hemorrhoids. This review discusses available evidence on the use of tribenoside/lidocaine in clinical practice. Papers were retrieved by a PubMed search, using different combinations of pertinent keywords (e.g. tribenoside AND hemorrhoids), without any limitations in terms of publication date and language. Documents from Authors' personal collection of literature could also be considered. Papers were selected for inclusion according to their relevance for the topic, as judged by the Authors. The efficacy of the combination of tribenoside+lidocaine in relieving symptoms caused by hemorrhoids and its safety have been assessed in several clinical studies on patients of either gender, either versus its two individual components (tribenoside and lidocaine) or versus steroids in the same setting. Five studies compared the combination treatment with each of its single components, and of these, three studies compared tribenoside+ lidocaine with a tribenoside-free semi-placebo preparation containing only lidocaine, and two studies compared this combination with lidocaine-free preparations containing only tribenoside. Tribenoside+lidocaine was compared with steroid-containing preparations in six studies. Last, two studies evaluated the efficacy and tolerability of the tribenoside+lidocaine combination in women with hemorrhoids as a consequence of pregnancy or delivery. All the above-mentioned studies were well-conducted and can provide a comprehensive evaluation of tribenoside+lidocaine in the treatment of hemorrhoids. Enough evidence exists to recommend the use of this combination therapy as a fast, effective and safe option for the local treatment of low-grade hemorrhoids.
Yang, Ming-gen; Zheng, Gou-da; Xu, Zhen-qiang; Lin, Hai-li; Zhuang, Zhi-ming; Zhang, Chao-xian
To observe the therapeutic effect of Qilin Pills combined with clomiphene on idiopathic oligoasthenospermia. We randomly assigned 300 patients with idiopathic oligoasthenospermia to a trial (n = 156) and a control group (n = 144) to be treated with Qilin Pills (6 g, tid) combined with clomiphene (50 mg, qd) and clomiphene alone (50 mg, qd), respectively, both for a course of 12 weeks. Before and after 4, 8, and 12 weeks of medication, we determined sperm concentration, the percentages of grade a and grade a + b sperm, sperm motility, and the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T), followed by evaluation of the clinical efficacy of Qilin Pills with the pregnancy rate in the patients' spouses as the secondaty therapeutic indexes. Compared with the baseline, both groups of patients showed remarkably improved semen parameters and hormone levels after treatment (all P 0.05). No obvious adverse reactions were observed. Qilin Pills combined with clomiphene can evidently improve the seminal quality and hormone level of oligoasthenospermia patients with no obvious adverse events. However, its long-term efficacy and tolerance deserve further clinical investigation.
Lekaviciute, J.; Kluizenaar, Y. de; Laszlo, H.E.; Hansell, A.; Floud, S.; Lercher, P.; Babisch, W.; Kephalopoulos, S.
The combination of noise with other environmental stressors, particularly traffic-related air pollution, has been of growing interest in recent years. Cardiovascular effects are among the most evidence-based physical health outcomes. Moreover, the European Network on Noise and Health (ENNAH), which
Yang Zandong; Chen Meng; Carter, Jeffrey D.; Nunemaker, Craig S.; Garmey, James C.; Kimble, Sarah D.; Nadler, Jerry L.
Type 1 diabetes mellitus (T1DM) is an autoimmune disease leading to near complete pancreatic β-cell destruction. New evidence suggests that β-cell regeneration is possible, but ongoing autoimmune damage prevents restoration of β-cell mass. We tested the hypothesis that simultaneously blocking autoimmune cytokine damage and supplying a growth-promoting stimulus for β-cells would provide a novel approach to reverse T1DM. Therefore, in this study we combined lisofylline to suppress autoimmunity and exendin-4 to enhance β-cell proliferation for treating autoimmune-mediated diabetes in the non-obese diabetic (NOD) mouse model. We found that this combined therapy effectively reversed new-onset diabetes within a week of therapy, and even maintained euglycemia up to 145 days after treatment withdrawal. The therapeutic effect of this regimen was associated with improved β-cell metabolism and insulin secretion, while reducing β-cell apoptosis. It is possible that such combined therapy could become a new strategy to defeat T1DM in humans
Imlig, Flavian; Ruoss, Thomas
This article investigates the use of evidence in educational policy and politics, and how this use has changed over time. Using an analytical framework that combines research approaches from both political and educational science, evidence-related arguments in two major school reforms in the canton of Zurich, Switzerland are described. In…
Rozen, R.; Mascisch, A.; Scriver, C.R. (McGill Univ., Montreal (Canada)); Lambert, M. (Hopital Ste-Justine, Montreal (Canada)); Laframboise, R. (Centre Hospitalier Universite Laval, Quebec (Canada))
Independent phenylketonuria (PKU) chromosomes (n=109) representing 80% of a proband cohort in Quebec province carry 18 different identified mutations in 20 different mutation/haplotype combinations. The study reported here, the third in a series on Quebec populations, was done in the Montreal region and predominantly on French Canadians. It has identified three novel mutations (A309D, D338Y, and 1054/1055delG [352fs]) and one unusual mutation/RFLP haplotype combination (E280K on Hp 2). The relative frequencies and distribution of PKU mutations were then compared in three regions and population subsets (eastern Quebec, French Canadian; western Quebec, French Canadian; and Montreal, non-French Canadian). The distributions of the prevalent and rare mutations are nonrandom and provide evidence for genetic stratification. The latter and the presence of eight unusual mutation/haplotype combinations in Quebec families with European ancestries (the aforementioned four and M1V, 165T, S349P, and R408W on Hp 1) corroborate demographic and anthropologic evidence, from elsewhere, for different origins of French Canadians in eastern and western Quebec. 29 refs., 1 fig., 1 tab.
Johnson, Paula I; Sutton, Patrice; Atchley, Dylan S; Koustas, Erica; Lam, Juleen; Sen, Saunak; Robinson, Karen A; Axelrad, Daniel A; Woodruff, Tracey J
The Navigation Guide methodology was developed to meet the need for a robust method of systematic and transparent research synthesis in environmental health science. We conducted a case study systematic review to support proof of concept of the method. We applied the Navigation Guide systematic review methodology to determine whether developmental exposure to perfluorooctanoic acid (PFOA) affects fetal growth in humans. We applied the first 3 steps of the Navigation Guide methodology to human epidemiological data: 1) specify the study question, 2) select the evidence, and 3) rate the quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using prespecified criteria. We evaluated each study for risk of bias and conducted meta-analyses on a subset of studies. We rated quality and strength of the entire body of human evidence. We identified 18 human studies that met our inclusion criteria, and 9 of these were combined through meta-analysis. Through meta-analysis, we estimated that a 1-ng/mL increase in serum or plasma PFOA was associated with a -18.9 g (95% CI: -29.8, -7.9) difference in birth weight. We concluded that the risk of bias across studies was low, and we assigned a "moderate" quality rating to the overall body of human evidence. On the basis of this first application of the Navigation Guide systematic review methodology, we concluded that there is "sufficient" human evidence that developmental exposure to PFOA reduces fetal growth.
Kurz, C.S.; Rotte, K.
In clinical routine it was proved, how far an industrial X-ray-film in combination with the low-dose-system gives the same evidence as an foil-less industrial X-ray-film. Patients which had got in the past a mammography at both sides with a foil-less industrial X-ray-film received a mammography at both sides with the low-dose-system. Both X-rays were compared in the following criteria: artefacts, micro-calcifications, structure-differentiation, difinition, contrast, exposure, time of diagnosis and overal impression. Considering an evident dose reduction by the low-dose-system the result is, that a film-foil-combination with a vacuum-adapter is available without impairment of diagnostic evidence in clinical routine. (orig.) [de
This paper adds new empirical evidence to the political economy literature of economic reform. One of the main contributions of this paper is the development of a novel methodology to identify privatisations. The methodology is a combination of the Bai & Perron structural break filter, and validation of the breaks identified by this filter using de jure evidence of reforms. 21 de facto healthcare financing privatisations are identified in a sample of 23 OECD countries. It is analysed which fa...
Massenburg, Benjamin B; Sanati-Mehrizy, Paymon; Ingargiola, Michael J; Rosa, Jonatan Hernandez; Taub, Peter J
Abdominoplasty (ABP) at the time of hysterectomy (HYS) has been described in the literature since 1986 and is being increasingly requested by patients. However, outcomes of the combined procedure have not been thoroughly explored. The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program database and identified each ABP, HYS, and combined ABP-HYS performed between 2005 and 2012. The incidence of complications in each of the three procedures was calculated, and a multiplicative-risk model was used to calculate the probability of a complication for a patient undergoing distinct HYS and ABP on different dates. One-sample binomial hypothesis tests were performed to determine statistical significance. There were 1325 ABP cases, 12,173 HYS cases, and 143 ABP-HYS cases identified. Surgical complications occurred in 7.7 % of patients undergoing an ABP-HYS, while the calculated risk of a surgical complication was 12.5 % (p = 0.0407) for patients undergoing separate ABP and HYS procedures. The mean operative time was significantly lower for an ABP-HYS at 238 vs. 270 min for separate ABP and HYS procedures (p ABP-HYS has a lower incidence of surgical complications than separate ABP and HYS procedures performed on different dates. These data should not encourage all patients to elect a combined ABP-HYS, if only undergoing a HYS, as the combined procedure is associated with increased risks when compared to either isolated individual procedure. However, in patients who are planning on undergoing both procedures on separate dates, a combined ABP-HYS is a safe option that will result in fewer surgical complications, less operative time, less time under anesthesia, and a trend towards fewer days in the hospital. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www
Nana Rachmana Syambas
Full Text Available In digital forensic investigations, the investigators take digital evidence from computers, laptops or other electronic goods. There are many complications when a suspect or related person does not want to cooperate or has removed digital evidence. A lot of research has been done with the goal of retrieving data from flash memory or other digital storage media from which the content has been deleted. Unfortunately, such methods cannot guarantee that all data will be recovered. Most data can only be recovered partially and sometimes not perfectly, so that some or all files cannot be opened. This paper proposes the development of a new method for the retrieval of digital evidence called the Two-Step Injection method (TSI. It focuses on the prevention of the loss of digital evidence through the deletion of data by suspects or other parties. The advantage of this method is that the system works in secret and can be combined with other digital evidence applications that already exist, so that the accuracy and completeness of the resulting digital evidence can be improved. An experiment to test the effectiveness of the method was set up. The developed TSI system worked properly and had a 100% success rate.
Full Text Available Julian Segura, Luis M RuilopeHypertension Unit, Hospital 12 de Octubre, Madrid, SpainAbstract: The majority of hypertensive patients, especially those with target organ damage, are likely to require multiple-drug therapy in order to reach blood pressure (BP targets and reduce their risk of adverse vascular outcomes. The rationale for combination therapy with agents that block the renin–angiotensin system (RAS and a calcium channel blocker (CCB or diuretic is well founded in growing evidence. Recent published trials have shown that the combination of an RAS suppressor and a dihydropiridinic CCB would offer additional benefits independently of BP reduction. A telmisartan–amlodipine combination has demonstrated significantly greater BP reductions compared with each monotherapy component in the overall population, and in particular in patients with moderate to severe hypertension and high-risk patients. This combination is well tolerated with a safety profile similar to placebo and is consistent with the known safety profile of its monotherapy components.Keywords: hypertensive patients, monotherapy, stroke, antihypertensive
Cattaneo, A; Marchi, A N; Farrar, C R; Mascareñas, D D L; Bossert, J A; Gupta, G; Mohite, A; Dumont, J H; Purdy, G M; Guzman, C; Haaker, A; Miller, K A
This paper presents a prototype of a remotely readable graphite oxide (GO) paper-based tamper evident seal. The proposed device combines the tunable electrical properties offered by reduced graphite oxide (RGO) with a compressive sampling scheme. The benefit of using RGO as a tamper evident seal material is the sensitivity of its electrical properties to the common mechanisms adopted to defeat tamper-evident seals. RGO’s electrical properties vary upon local stress or cracks induced by mechanical action (e.g., produced by shimming or lifting attacks). Further, modification of the seal’s electrical properties can result from the incidence of other defeat mechanisms, such as temperature changes, solvent treatment and steam application. The electrical tunability of RGO enables the engraving of a circuit on the area of the tamper evident seal intended to be exposed to malicious attacks. The operation of the tamper evident seal, as well as its remote communication functionality, is supervised by a microcontroller unit (MCU). The MCU uses the RGO-engraved circuitry to physically implement a compressive sampling acquisition procedure. The compressive sampling scheme provides the seal with self-authentication and self-state-of-health awareness capabilities. The prototype shows potential for use in low-power, embedded, remote-operation non-proliferation security related applications. (paper)
B. D. Schrire
Full Text Available As a result of cladistic studies in the tribe Indigofereae in Africa and Madagascar (Schrire 1991 evidence was accumulated to justify resurrecting the genera Microcharis Benth. and Indigastrum Jaub. & Spach, which were previously considered part of Indigofera L. All described species in each genus are listed alphabetically. Forty-seven new combinations, six changes ain rank and four resurrected names are published.
We have audited the accompanying combined balance sheets of the Southwestern Federal Power System (SWFPS), as of September 30, 2009, 2008, 2007, and 2006, and the related combined statements of revenues and expenses, changes in capitalization, and cash flows for the years then ended. As described in note 1(a), the combined financial statement presentation includes the hydroelectric generation functions of another Federal agency (hereinafter referred to as the generating agency), for which Southwestern Power Administration (Southwestern) markets and transmits power. These combined financial statements are the responsibility of the management of Southwestern and the generating agency. Our responsibility is to express an opinion on these combined financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audits to obtain reasonable assurance about whether the combined financial statements are free of material misstatement. An audit includes consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of Southwestern and the generating agency’s internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the combined financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall combined financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the combined financial statements referred to above present fairly, in all material respects, the respective financial position of the Southwestern Federal Power
Fiebich Bernd L
Full Text Available Abstract Background Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix" are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. Discussion In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect. As an example the fixesd-dose combination of acetylsalicylic acid (ASA, paracetamol (acetaminophen and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Summary Multitarget therapeutics like combined analgesics broaden
Background Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. Discussion In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect. As an example the fixesd-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Summary Multitarget therapeutics like combined analgesics broaden the array of therapeutic
Straube, Andreas; Aicher, Bernhard; Fiebich, Bernd L; Haag, Gunther
Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect.As an example the fixed-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness
Rangwala, Reshma; Chang, Yunyoung C; Hu, Janice; Algazy, Kenneth M; Evans, Tracey L; Fecher, Leslie A; Schuchter, Lynn M; Torigian, Drew A; Panosian, Jeffrey T; Troxel, Andrea B; Tan, Kay-See; Heitjan, Daniel F; DeMichele, Angela M; Vaughn, David J; Redlinger, Maryann; Alavi, Abass; Kaiser, Jonathon; Pontiggia, Laura; Davis, Lisa E; O'Dwyer, Peter J; Amaravadi, Ravi K
The combination of temsirolimus (TEM), an MTOR inhibitor, and hydroxychloroquine (HCQ), an autophagy inhibitor, augments cell death in preclinical models. This phase 1 dose-escalation study evaluated the maximum tolerated dose (MTD), safety, preliminary activity, pharmacokinetics, and pharmacodynamics of HCQ in combination with TEM in cancer patients. In the dose escalation portion, 27 patients with advanced solid malignancies were enrolled, followed by a cohort expansion at the top dose level in 12 patients with metastatic melanoma. The combination of HCQ and TEM was well tolerated, and grade 3 or 4 toxicity was limited to anorexia (7%), fatigue (7%), and nausea (7%). An MTD was not reached for HCQ, and the recommended phase II dose was HCQ 600 mg twice daily in combination with TEM 25 mg weekly. Other common grade 1 or 2 toxicities included fatigue, anorexia, nausea, stomatitis, rash, and weight loss. No responses were observed; however, 14/21 (67%) patients in the dose escalation and 14/19 (74%) patients with melanoma achieved stable disease. The median progression-free survival in 13 melanoma patients treated with HCQ 1200mg/d in combination with TEM was 3.5 mo. Novel 18-fluorodeoxyglucose positron emission tomography (FDG-PET) measurements predicted clinical outcome and provided further evidence that the addition of HCQ to TEM produced metabolic stress on tumors in patients that experienced clinical benefit. Pharmacodynamic evidence of autophagy inhibition was evident in serial PBMC and tumor biopsies only in patients treated with 1200 mg daily HCQ. This study indicates that TEM and HCQ is safe and tolerable, modulates autophagy in patients, and has significant antitumor activity. Further studies combining MTOR and autophagy inhibitors in cancer patients are warranted.
Haas, B J; Salzberg, S L; Zhu, W; Pertea, M; Allen, J E; Orvis, J; White, O; Buell, C R; Wortman, J R
EVidenceModeler (EVM) is presented as an automated eukaryotic gene structure annotation tool that reports eukaryotic gene structures as a weighted consensus of all available evidence. EVM, when combined with the Program to Assemble Spliced Alignments (PASA), yields a comprehensive, configurable annotation system that predicts protein-coding genes and alternatively spliced isoforms. Our experiments on both rice and human genome sequences demonstrate that EVM produces automated gene structure annotation approaching the quality of manual curation.
Examines market and bureaucratic control of education in terms of "institutions" typically analyzed by economists. Focuses on hybrid educational institutions combining bureaucratic and market control (called "quasi-markets") in Belgium, the Netherlands, Great Britain, and New Zealand. Finds little evidence of improved efficiency of quasi-markets…
Sutton, Patrice; Atchley, Dylan S.; Koustas, Erica; Lam, Juleen; Sen, Saunak; Robinson, Karen A.; Axelrad, Daniel A.; Woodruff, Tracey J.
Background: The Navigation Guide methodology was developed to meet the need for a robust method of systematic and transparent research synthesis in environmental health science. We conducted a case study systematic review to support proof of concept of the method. Objective: We applied the Navigation Guide systematic review methodology to determine whether developmental exposure to perfluorooctanoic acid (PFOA) affects fetal growth in humans. Methods: We applied the first 3 steps of the Navigation Guide methodology to human epidemiological data: 1) specify the study question, 2) select the evidence, and 3) rate the quality and strength of the evidence. We developed a protocol, conducted a comprehensive search of the literature, and identified relevant studies using prespecified criteria. We evaluated each study for risk of bias and conducted meta-analyses on a subset of studies. We rated quality and strength of the entire body of human evidence. Results: We identified 18 human studies that met our inclusion criteria, and 9 of these were combined through meta-analysis. Through meta-analysis, we estimated that a 1-ng/mL increase in serum or plasma PFOA was associated with a –18.9 g (95% CI: –29.8, –7.9) difference in birth weight. We concluded that the risk of bias across studies was low, and we assigned a “moderate” quality rating to the overall body of human evidence. Conclusion: On the basis of this first application of the Navigation Guide systematic review methodology, we concluded that there is “sufficient” human evidence that developmental exposure to PFOA reduces fetal growth. Citation: Johnson PI, Sutton P, Atchley DS, Koustas E, Lam J, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. 2014. The Navigation Guide—evidence-based medicine meets environmental health: systematic review of human evidence for PFOA effects on fetal growth. Environ Health Perspect 122:1028–1039; http://dx.doi.org/10.1289/ehp.1307893 PMID:24968388
Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela
In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.
邢晓辰; 蔡远文; 李岩; 姚静波
为解决证据融合时证据间冲突衡量不准确问题，提出了一种新的证据冲突衡量方法。对当前冲突衡量方法国内外研究现状进行总结，结合典型算例分析，指出了当前方法存在的主要问题。基于前人研究成果，提出了一种改进冲突因子用于衡量证据间冲突，主要基于修正证据距离与合取冲突，对两者采用加性组合。通过一般类型算例与特殊类型算例对所提方法进行验证，结果表明改进的冲突衡量因子能够准确衡量证据间冲突，并具有普适性。%The evidence conflict measure in Dempster-Shafer( D-S) evidence theory sometimes may be not accurate. In order to solve this problem,a new evidence conflict measure method is proposed. Research on evidence conflict measure methods at home and abroad is summarized and analyzed,and the problems of those methods are analyzed. Based on the foregoing research on evidence conflict measure, an improved conflict factor of evidence conflict is put forward,which is mainly built up by modified evidence distance and combination conflict factor. The improved conflict factor combines modified evidence distance and combination conflict factor based on the sum way. General types and special types of cases are used to ver-ify the correctness of the proposed method,and the result shows that the improved conflict factor can meas-ure the evidence conflict correctly and has universal applicability.
Maurício S de Lima
Full Text Available Em psiquiatria, observa-se grande variabilidade de práticas clínicas, muitas vezes desnecessária. Essas variações podem estar relacionadas à ausência de evidência científica confiável ou ao desconhecimento das evidências de boa qualidade disponíveis. A medicina baseada em evidências (MBE é uma combinação de estratégias que busca assegurar que o cuidado individual do paciente seja baseado na melhor informação disponível, a qual deve ser incorporada à prática clínica. Neste artigo, conceitos de MBE são discutidos com relação a aspectos e desafios no tratamento de pacientes com distimia, bulimia nervosa e esquizofrenia. A partir de resultados de três revisões sistemáticas recentemente publicadas, conclui-se que a prática de psiquiatria baseada em evidências acrescenta qualidade à prática psiquiátrica tradicional.The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.
Roeters, Steven J.; Iyer, Aditya; Pletikapić, Galja; Kogan, Vladimir; Subramaniam, Vinod; Woutersen, Sander
The aggregation of the intrinsically disordered protein alpha-synuclein (αS) into amyloid fibrils is thought to play a central role in the pathology of Parkinson’s disease. Using a combination of techniques (AFM, UV-CD, XRD, and amide-I 1D- and 2D-IR spectroscopy) we show that the structure of αS fibrils varies as a function of ionic strength: fibrils aggregated in low ionic-strength buffers ([NaCl] ≤ 25 mM) have a significantly different structure than fibrils grown in higher ionic-strength buffers. The observations for fibrils aggregated in low-salt buffers are consistent with an extended conformation of αS molecules, forming hydrogen-bonded intermolecular β-sheets that are loosely packed in a parallel fashion. For fibrils aggregated in high-salt buffers (including those prepared in buffers with a physiological salt concentration) the measurements are consistent with αS molecules in a more tightly-packed, antiparallel intramolecular conformation, and suggest a structure characterized by two twisting stacks of approximately five hydrogen-bonded intermolecular β-sheets each. We find evidence that the high-frequency peak in the amide-I spectrum of αS fibrils involves a normal mode that differs fundamentally from the canonical high-frequency antiparallel β-sheet mode. The high sensitivity of the fibril structure to the ionic strength might form the basis of differences in αS-related pathologies.
Eldredge, J D
This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).
Timmermann, Allan G
Forecast combinations have frequently been found in empirical studies to produce better forecasts on average than methods based on the ex-ante best individual forecasting model. Moreover, simple combinations that ignore correlations between forecast errors often dominate more refined combination schemes aimed at estimating the theoretically optimal combination weights. In this paper we analyse theoretically the factors that determine the advantages from combining forecasts (for example, the d...
Leichsenring, Falk; Steinert, Christiane; Hoyer, Jürgen
Depression may be treated by psychotherapy or pharmacotherapy or their combination. There is an ongoing debate whether one of these approaches is possibly superior. A recent meta-analysis reported results in favour of pharmacotherapy. Individual studies and meta-analyses on the comparative efficacy of psychotherapy vs. pharmacotherapy were reviewed. Evidence suggests that psychotherapy and pharmacotherapy are equally efficacious in the short-term, but psychotherapy is superior in the long-term. For the recently stated hypothesis that pharmacotherapy is superior to psychotherapy in studies without a pill placebo condition, which implies equally including a positive expectancy effect for both pharmacotherapy and psychotherapy no evidence was found. Depression may be treated by psychotherapy or pharmacotherapy with equivalent results in the short-term and advantages for psychotherapy in the long-term. As the rates of response and remission are still limited in both treatments, further improvement of treatments is required.
Smit, Nadine M; Morgan, Ruth M; Lagnado, David A
Evidence has the potential to be misleading if its value when expressing beliefs in hypotheses is not fully understood or presented. Although the knowledge base to understand uncertainties is growing, a challenge remains to prioritise research and to continuously assess the magnitude and consequences of misleading evidence in criminal cases. This study used a systematic content analysis to identify misleading evidence, drawing information from case transcripts of rulings argued unsafe by the Court of Appeal of England and Wales. In the 7-year study period, 218 applications were successful on appeal, containing 235 cases of misleading evidence. The majority (76%) of successful appeals were based upon the same materials available in the original trial, rather than the presentation of new relevant information. Witness (39%), forensic (32%), and character evidence (19%) were the most commonly observed evidence types, with the validity of witnesses (26%), probative value of forensic evidence (12%), and relevance of character evidence (10%) being the most prevalent combinations of identified issues. Additionally, the majority (66%) of misleading evidence types relate to their interpretation at activity level. The findings suggest that many of these misleading aspects could have been prevented by providing more transparency in the relationship between evidence and hypotheses. Generally, the results contribute to gaining a more complete picture of the role of misleading evidence in the criminal justice system. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Hypothyroidism is currently a condition that can be treated, but not cured. Although levothyroxine reverses stigmata of hypothyroidism in most individuals, some patients feel dissatisfied with 'monotherapy', and this has stimulated interest in 'combination therapy' with both levothyroxine and liothyronine. A search of PubMed was conducted using terms including hypothyroidism, treatment, benefits, risks, and safety. Based on the articles identified, the body of evidence regarding the efficacy of traditional levothyroxine is reviewed. Concerns with levothyroxine therapy including impaired quality of life in treated patients, thyroxine-predominant hormone ratios, and inadvertent iatrogenic thyroid disease are discussed. The trials of combination therapy performed since 1999 were reviewed. The heterogeneity of these trials, both in terms of design and results, is discussed. The potential for new trials to determine whether combination therapy can reverse the dissatisfaction associated with monotherapy, while avoiding non-physiologic hormone ratios, inadvertent thyrotoxicosis, and unacceptable side effects is discussed. Expert commentary: Research regarding which therapy fully reverses hypothyroidism at a tissue and cellular level is ongoing. The field would be advanced by the development of an extended release preparation of liothyronine. In the future regeneration of functional thyroid follicles from stem cells may offer hope for curing hypothyroidism.
This paper provides empirical evidence on the determinants of foreign ownership in manufacturing industries. Foreign ownership, according to the theory of international production, is the result of the combination of comparative and competitive advantage. An adequate examination of the ownership structure of an industry requires the ability to establish empirically the extent to which international competitiveness of firms rests on comparative and competitive advantage. Analysis is based on a...
Oh, Eui Geum
As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.
Eui Geum Oh, PhD, RN
Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.
Määttä, Sylvia; Wallmyr, Gudrun
The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.
George, Steven Z; Parr, Jeffrey J; Wallace, Margaret R; Wu, Samuel S; Borsa, Paul A; Dai, Yunfeng; Fillingim, Roger B
Chronic pain is influenced by biological, psychological, social, and cultural factors. The current study investigated potential roles for combinations of genetic and psychological factors in the development and/or maintenance of chronic musculoskeletal pain. An exercise-induced shoulder injury model was used, and a priori selected genetic (ADRB2, COMT, OPRM1, AVPR1 A, GCH1, and KCNS1) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as predictors. Pain phenotypes were shoulder pain intensity (5-day average and peak reported on numerical rating scale), upper extremity disability (5-day average and peak reported on the QuickDASH), and shoulder pain duration (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered as main effects and interaction terms in separate regression models for the different pain phenotypes. Results from the recruited cohort (N = 190) indicated strong statistical evidence for interactions between the COMT diplotype and 1) pain catastrophizing for 5-day average upper extremity disability and 2) depressive symptoms for pain duration. There was moderate statistical evidence for interactions for other shoulder pain phenotypes between additional genes (ADRB2, AVPR1 A, and KCNS1) and depressive symptoms, pain catastrophizing, or kinesiophobia. These findings confirm the importance of the combined predictive ability of COMT with psychological distress and reveal other novel combinations of genetic and psychological factors that may merit additional investigation in other pain cohorts. Interactions between genetic and psychological factors were investigated as predictors of different exercise-induced shoulder pain phenotypes. The strongest statistical evidence was for interactions between the COMT diplotype and pain catastrophizing (for upper extremity disability) or depressive symptoms (for pain duration). Other novel
Rohwer, Anke; Motaze, Nkengafac Villyen; Rehfuess, Eva; Young, Taryn
E-learning is a useful strategy to increase Evidence-based health care (EBHC) knowledge and skills, and when combined with face-to-face learning, to increase EBHC attitude and behaviour. EBHC is decision-making for health care, informed by the best research evidence. Doctors, nurses and allied health professionals need to have the necessary…
Olivier, Pascale; Montastruc, Jean-Louis
Because of design, objectives and number of included subjects, clinical studies are insufficient to assess the safety of new drugs. Sometimes, serious adverse drug reactions (ADRs) led to withdrawal of the drug from the market after their approval. The objective of our study was to determine the scientific evidences leading to drug withdrawal for pharmacovigilance reasons in France. Data coming from French Health Products Safety Agency, literature and Toulouse Pharmacovigilance Center allowed to identify all drugs withdrawn from the French market for pharmacovigilance reasons from 1998 to 2004. We classified data according to their study design (Randomized Clinical Trial [RCT], case serie or case report, case-control study, cohort study, observational study, animal study), the organ/system affected and the type of ADR. A total of 21 drugs were withdrawn for safety reasons between 1998 and 2004 in France. The most frequent ADRs were hepatic (n = 7), cardiovascular (n = 4) or neurological (n = 3) ones. Eleven withdrawals were due to type-B ('unexpected') reactions (52%). For 19 out of 21 drugs, scientific evidence leading to drug withdrawal came from spontaneous case reports (or case series). Among these, case reports were the sole evidence in 12 cases. Withdrawals were based on evidence from case reports in combination with case-control or cohort study in four cases, in combination with observational study in two cases or in combination with animal study in two other cases. In only one case, a RCT supported the decision. This study underlines the importance of spontaneous case reports in detecting signals and supporting withdrawal of drug for pharmacovigilance reasons in France. Health authorities suffer from lack of comparative data resource. In this perspective, a pharmaco-epidemiological population-based database could represent a helpful tool to both generate and test safety hypotheses.
Ellsberg, Mary; Arango, Diana J; Morton, Matthew; Gennari, Floriza; Kiplesund, Sveinung; Contreras, Manuel; Watts, Charlotte
In this Series paper, we review evidence for interventions to reduce the prevalence and incidence of violence against women and girls. Our reviewed studies cover a broad range of intervention models, and many forms of violence--ie, intimate partner violence, non-partner sexual assault, female genital mutilation, and child marriage. Evidence is highly skewed towards that from studies from high-income countries, with these evaluations mainly focusing on responses to violence. This evidence suggests that women-centred, advocacy, and home-visitation programmes can reduce a woman's risk of further victimisation, with less conclusive evidence for the preventive effect of programmes for perpetrators. In low-income and middle-income countries, there is a greater research focus on violence prevention, with promising evidence on the effect of group training for women and men, community mobilisation interventions, and combined livelihood and training interventions for women. Despite shortcomings in the evidence base, several studies show large effects in programmatic timeframes. Across different forms of violence, effective programmes are commonly participatory, engage multiple stakeholders, support critical discussion about gender relationships and the acceptability of violence, and support greater communication and shared decision making among family members, as well as non-violent behaviour. Further investment in intervention design and assessment is needed to address evidence gaps. Copyright © 2015 Elsevier Ltd. All rights reserved.
Benecke, M; Seifert, B
The combined analysis of both ant and blow fly evidence recovered from a corpse, and from the boot of a suspect, suggested that an assumed scenario in a high profile murder case was likely to be true. The ants (Lasius fuliginous) were used as classical crime scene stains that linked the suspect to the scene. Blow fly maggots (Calliphora spec.) helped to determine the post mortem interval (PMI) with the calculated PMI overlapping with the assumed time of the killing. In the trial, the results of the medico-legal analysis of the insects was understood to be crucial scientific evidence, and the suspect was sentenced to 8 years in prison.
Rosas, Samuel; Krill, Michael K; Amoo-Achampong, Kelms; Kwon, KiHyun; Nwachukwu, Benedict U; McCormick, Frank
Clinical examination of the shoulder joint has gained attention as clinicians aim to use an evidence-based examination of the biceps tendon, with the desire for a proper diagnosis while minimizing costly imaging procedures. The purpose of this study is to create a decision tree analysis that enables the development of a clinical algorithm for diagnosing long head of biceps (LHB) pathology. A literature review of Level I and II diagnostic studies was conducted to extract characteristics of clinical tests for LHB pathology through a systematic review of PubMed, Medline, Ovid, and Cochrane Review databases. Tests were combined in series and parallel to determine sensitivities and specificities, and positive and negative likelihood ratios were determined for each combination using a subjective pretest probability. The "gold standard" for diagnosis in all included studies was arthroscopy or arthrotomy. The optimal testing modality was use of the uppercut test combined with the tenderness to palpation of the biceps tendon test. This combination achieved a sensitivity of 88.4% when performed in parallel and a specificity of 93.8% when performed in series. These tests used in combination optimize post-test probability accuracy greater than any single individual test. Performing the uppercut test and biceps groove tenderness to palpation test together has the highest sensitivity and specificity of known physical examinations maneuvers to aid in the diagnosis of LHB pathology compared with diagnostic arthroscopy (practical, evidence-based, comprehensive examination). A decision tree analysis aides in the practical, evidence-based, comprehensive examination diagnostic accuracy post-testing based on the ordinal scale pretest probability. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
This paper adds new empirical evidence to the political economy literature of economic reform. One of the main contributions of this paper is the development of a novel methodology to identify privatisations. The methodology is a combination of the Bai & Perron structural break filter, and
Tobia, Valentina; Rinaldi, Luca; Marzocchi, Gian Marco
The occurrence of time processing problems in individuals with Development Dyscalculia (DD) has favored the view of a general magnitude system devoted to both numerical and temporal information. Yet, this scenario has been partially challenged by studies indicating that time difficulties can be attributed to poor calculation or counting skills, which can support reasoning on time in school-aged children and adults. Here, we tackle this debate by exploring the performance of young children before they fully develop the symbolic number system. Preschoolers at risk of developing DD were compared with typically developing children in a series of tasks investigating time processing and in their 'sense of time', evaluated by parents and teachers. Results yielded a poorer performance in time reproduction of 5-second intervals and in time discrimination, as well as a weaker 'sense of time', in children at risk of DD. These findings provide evidence of a common magnitude system that would be responsible for deficits in both numerical and temporal domains, already at early stages of life. © 2016 John Wiley & Sons Ltd.
为了解决证据理论中冲突证据合成问题,提出了一种局部冲突部分分配策略.该策略假设证据具有一致可信度,设定一个阈值,将大于该阈值的局部冲突按比例分配给产生该冲突的焦元,并用标准合成规则对证据进行融合,使合成的结果更加可靠.仿真结果表明该策略能有效解决冲突证据合成问题.%In order to solve the problem of conflict evidence combination in standard evidence theory, this paper proposed a kind of partial distribution strategy of local conflict. Assuming that the evidences had consistent reliability, the method proportionally distributed the local conflicts which was greater than threshold to those focus elements which contributed to the conflict. Then, it used the standard combination rule to achieve evidence fusion and obtained more reliable results. The simulation results demonstrate that the proposed method can effectively solve the problem to conflict evidence combination.
Full Text Available The core of adaptive system is user model containing personal information such as knowledge, learning styles, goals… which is requisite for learning personalized process. There are many modeling approaches, for example: stereotype, overlay, plan recognition… but they don’t bring out the solid method for reasoning from user model. This paper introduces the statistical method that combines Bayesian network and overlay modeling so that it is able to infer user’s knowledge from evidences collected during user’s learning process.
An increasing number of students leave the Swedish compulsory school without having a satisfactory grade in mathematics. Causes why students risk ending up with difficulties in the subject of mathematics are debated but one explanation might be that more and more students are diagnosed with dyscalculia. The purpose of this study is to investigate how educationalists identify and organize their teaching in order to help students with difficulties in mathematics to reach the schools requirement...
Pooja Manghirmalani; Darshana More; Kavita Jain
The endeavor of this work is to support the special education community in their quest to be with the mainstream. The initial segment of the paper gives an exhaustive study of the different mechanisms of diagnosing learning disability. After diagnosis of learning disability the further classification of learning disability that is dyslexia, dysgraphia or dyscalculia are fuzzy. Hence the paper proposes a model based on Fuzzy Expert System which enables the classification of learning disability...
This paper provides an overview of five key bodies of evidence identifying: 1) Characteristics of depression among older adults - its prevalence, risk factors and illness course, and impact on functional status, mortality, use of health services, and health care costs; 2) Effective Interventions, including pharmacologic, psychotherapies, care management, and combined intervention models; 3) Known Barriers to depression care including patient, provider and service system barriers; 4) Effective...
Lugtenberg, Marjolein; Burgers, Jako S.; Clancy, Carolyn; Westert, Gert P.; Schneider, Eric C.
Background Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity. Methodology/Principal Findings We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines. Conclusions/Significance Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more
Cools, Ann M; Borms, Dorien; Castelein, Birgit; Vanderstukken, Fran; Johansson, Fredrik R
To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.
Mansion-de Vries, E M; Hoedemaker, M; Krömker, V
Mastitis is one of the most common and expensive diseases in dairy cattle. The decision to treat clinical mastitis is usually made without any knowledge of the etiology, and can therefore only be evidence-based to a limited extent. Evidence-based medicine relies essentially on a combination of one's own clinical competence and scientific findings. In mastitis therapy, those insights depend mostly on pathogen-specific factors. Therefore, in evidence-based therapeutic decision making the pathogen identification should serve as a basis for the consideration of scientifically validated therapeutic concepts. The present paper considers evidence-based treatment of clinical mastitis based on a literature review. The authors conclude that an anti-inflammatory treatment using an NSAID should be conducted regardless of the pathogen. However, the choice of an antibiotic therapy depends on the mastitis causative pathogen, clinical symptoms and the animal itself. In principle, a local antibiotic treatment should be chosen for mild and moderate mastitis. It should be noted, that the benefit of an antibiotic therapy for coliform infections is questionable. With knowledge concerning the pathogen, it appears entirely reasonable to refrain from an antibiotic therapy. For severe (i. e. feverish) mastitis, a parenteral antibiotic therapy should be selected. An extension of the antibiotic therapy beyond the manufacturer's information is only reasonable for streptococcal infections. It is important to make the decision on a prolonged antibiotic therapy only with the knowledge of the mastitis-causative pathogen. In terms of the therapy of a staphylococcus or streptococcus infection, a narrow-spectrum antibiotic from the penicillin family should be adopted when selecting the active agents.
Perez, Lidia Lopez; van Eck, Ernst R. H.; Melian-Cabrera, Ignacio
MCM-41's limited hydrothermal stability has been often related to the hydrolysis of Si-O-Si bonds due to the low degree of condensation, its thin walls or a combination of them. In this work, evidence for an additional factor is provided; a physical effect that occurs during the drying of the
Full Text Available Mudit Chowdhary,1,2 Kirtesh R Patel,1 Hasan H Danish,1 David H Lawson,3 Mohammad K Khan1 1Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 2Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, 3Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA Abstract: Melanoma is an aggressive malignancy that frequently spreads to the brain, resulting in rapid deterioration in both quality and quantity of life. Historically, treatment options for melanoma brain metastases (MBM have predominantly consisted of surgery and radiotherapy. While these options can help provide local control, the majority of patients still develop intracranial progression. Indeed, novel therapeutic options, including molecularly targeted agents and immunotherapy, have improved outcomes and are now changing the role of radiotherapy. Up to 50% of melanomas contain an activating BRAF mutation, resulting in hyperactive cellular proliferation and survival. Drugs that target BRAF have been introduced for the treatment of metastatic melanoma and offer hope in improving disease outcomes; however, many of these trials either excluded or had a limited amount of patients with MBM. Recent studies have revealed that melanoma cell lines become more radiosensitive following BRAF inhibition, thus providing a potential synergistic mechanism when combining BRAF inhibitor (BRAFi and radiotherapy. However, neurotoxicity concerns also exist with this combination. This article reviews the efficacy and limitations of BRAFi therapy for MBM, describes current evidence for combining BRAFis with radiation, discusses the rationale and evidence for combination modalities, and highlights emerging clinical trials specifically investigating this combination in MBM. Keywords: brain metastases, melanoma, radiation, BRAF inhibitors, vemurafenib, dabrafenib
Sackett, D L; Straus, S E
Physicians need easy access to evidence for clinical decisions while they care for patients but, to our knowledge, no investigators have assessed use of evidence during rounds with house staff. To determine if it was feasible to find and apply evidence during clinical rounds, using an "evidence cart" that contains multiple sources of evidence and the means for projecting and printing them. Descriptive feasibility study of use of evidence during 1 month (April 1997) and anonymous questionnaire (May 1997). General medicine inpatient service. Medical students, house staff, fellows, and attending consultant. Evidence cart that included 2 secondary sources developed by the department (critically appraised topics [CATs] and Redbook), Best Evidence, JAMA Rational Clinical Examination series, the Cochrane Library, MEDLINE, a physical examination textbook, a radiology anatomy textbook, and a Simulscope, which allows several people to listen simultaneously to the same signs on physical examination. Number of times sources were used, type of sources searched and success of searches, time needed to search, and whether the search affected patient care. The evidence cart was used 98 times, but could not be taken on bedside rounds because of its bulk; hard copies of several sources were taken instead. When the evidence cart was used during team rounds and student rounds, some sources could be accessed quickly enough (10.2-25.4 seconds) to be practical on our service. Of 98 searches, 79 (81%) sought evidence that could affect diagnostic and/or treatment decisions. Seventy-one (90%) of 79 searches regarding patient management were successful, and when assessed from the perspective of the most junior team members responsible for each patient's evaluation and management, 37 (52%) of the 71 successful searches confirmed their current or tentative diagnostic or treatment plans, 18 (25%) led to a new diagnostic skill, an additional test, or a new management decision, and 16 (23
Full Text Available A model of syntactic development proposes that children’s very first word-combinations are already generated via productive rules that express in syntactic form the relation between a predicate word and its semantic argument. An alternative hypothesis is that they learn frozen chunks. In Study 1 we analyzed a large sample of young children’s early two-word sentences comprising of verbs with direct objects. A majority of objects were generated by pronouns but a third of children’s sentences used bare common nouns as objects. We checked parents’ twoword long sentences of verbs with objects and found almost no bare common nouns. Children cannot have copied sentences with bare noun objects from parents’ two-word long sentences as frozen chunks. In Study 2 we raised the possibility that children’s early sentences with bare nouns are rote-learned ‘telegraphic speech’, acquired as unanalyzed frozen chunks from longer input sentences due to perceptual problem to hear the unstressed determiners. To test this explanation, we tested the children’s speech corpus for evidence that they avoid determiners in their word-combinations. The results showed that they do not; in fact they generate very many determiner-common noun combinations as two-word utterances. The findings suggest that children produce their early word-combinations of the core-grammar type by a productive rule that maps the predicate-argument relations of verbs and their semantic arguments to headdependent syntax, and not as frozen word-combinations. Children mostly learn to use indexical expressions such as pronouns to express the variable semantic arguments of verbs as context dependent; they also employ bare common nouns to express specific values of the arguments. The earliest word-combinations demonstrate that children understand that syntax is built on the predicate-argument relations of words and use this insight to produce their early sentences.
Full Text Available Perceptual interferences in the estimation of quantities (time, space and numbers have been interpreted as evidence for a common magnitude system. However, if duration estimation has appears sensitive to spatial and numerical interferences, space and number estimation tend to be resilient to temporal manipulations. These observations question the relative contribution of each quantity in the elaboration of a representation in a common mental metric. Here, we elaborated a task in which perceptual evidence accumulated over time for all tested quantities (space, time and number in order to match the natural requirement for building a duration percept. For this, we used a bisection task. Experimental trials consisted of dynamic dots of different sizes appearing progressively on the screen. Participants were asked to judge the duration, the cumulative surface or the number of dots in the display while the two non-target dimensions varied independently. In a prospective experiment, participants were informed before the trial which dimension was the target; in a retrospective experiment, participants had to attend to all dimensions and were informed only after a given trial which dimension was the target. Surprisingly, we found that duration was resilient to spatial and numerical interferences whereas space and number estimation were affected by time. Specifically, and counter-intuitively, results revealed that longer durations lead to smaller number and space estimates whether participants knew before (prospectively or after (retrospectively a given trial which quantity they had to estimate. Altogether, our results support a magnitude system in which perceptual evidence for time, space and numbers integrate following Bayesian cue-combination rules.
Kittelson, J M; Kieser, J A; Buckingham, D M; Herbison, G P
Quantitative measures of the importance of evidence such as the "likelihood ratio" have become increasingly popular in the courtroom. These measures have been used by expert witnesses formally to describe their certainty about a piece of evidence. These measures are commonly interpreted as the amount by which the evidence should revise the opinion of guilt, and thereby summarize the importance of a particular piece of evidence. Unlike DNA evidence, quantitative measures have not been widely used by forensic dentists to describe their certainty when testifying about bitemark evidence. There is, however, no inherent reason why they should not be used to evaluate bitemarks. The purpose of this paper is to describe the likelihood ratio as it might be applied to bitemark evidence. We use a simple bitemark example to define the likelihood ratio, its application, and interpretation. In particular we describe how the jury interprets the likelihood ratio from a Bayesian perspective when evaluating the impact of the evidence on the odds that the accused is guilty. We describe how the dentist would calculate the likelihood ratio based on frequentist interpretations. We also illustrate some of the limitations of the likelihood ratio, and show how those limitations apply to bitemark evidence. We conclude that the quality of bitemark evidence cannot be adequately summarized by the likelihood ratio, and argue that its application in this setting may be more misleading than helpful.
Metzger, Miriam J; Flanagin, Andrew J
This article invokes research on information seeking and evaluation to address how providers of evidence-based medical information can use Web 2.0 technologies to increase access to, enliven users' experiences with, and enrich the quality of the information available. In an ideal scenario, evidence-based medical information can take appropriate advantage of community intelligence spawned by Web 2.0 technologies, resulting in the ideal combination of scientifically sound, high-quality information that is imbued with experiential insights from a multitude of individuals. To achieve this goal, the authors argue that people will engage with information that they can access easily, and that they perceive as (a) relevant to their information-seeking goals and (b) credible. The authors suggest the utility of Web 2.0 technologies for engaging stakeholders with evidence-based medical information through these mechanisms, and the degree to which the information provided can and should be trusted. Last, the authors discuss potential problems with Web 2.0 information in relation to decision making in health contexts, and they conclude with specific and practical recommendations for the dissemination of evidence-based health information via Web 2.0 technologies.
de Lange, Floris P; van Gaal, Simon; Lamme, Victor A F; Dehaene, Stanislas
Human decisions are based on accumulating evidence over time for different options. Here we ask a simple question: How is the accumulation of evidence affected by the level of awareness of the information? We examined the influence of awareness on decision-making using combined behavioral methods and magneto-encephalography (MEG). Participants were required to make decisions by accumulating evidence over a series of visually presented arrow stimuli whose visibility was modulated by masking. Behavioral results showed that participants could accumulate evidence under both high and low visibility. However, a top-down strategic modulation of the flow of incoming evidence was only present for stimuli with high visibility: once enough evidence had been accrued, participants strategically reduced the impact of new incoming stimuli. Also, decision-making speed and confidence were strongly modulated by the strength of the evidence for high-visible but not low-visible evidence, even though direct priming effects were identical for both types of stimuli. Neural recordings revealed that, while initial perceptual processing was independent of visibility, there was stronger top-down amplification for stimuli with high visibility than low visibility. Furthermore, neural markers of evidence accumulation over occipito-parietal cortex showed a strategic bias only for highly visible sensory information, speeding up processing and reducing neural computations related to the decision process. Our results indicate that the level of awareness of information changes decision-making: while accumulation of evidence already exists under low visibility conditions, high visibility allows evidence to be accumulated up to a higher level, leading to important strategical top-down changes in decision-making. Our results therefore suggest a potential role of awareness in deploying flexible strategies for biasing information acquisition in line with one's expectations and goals.
Floris P de Lange
Full Text Available Human decisions are based on accumulating evidence over time for different options. Here we ask a simple question: How is the accumulation of evidence affected by the level of awareness of the information? We examined the influence of awareness on decision-making using combined behavioral methods and magneto-encephalography (MEG. Participants were required to make decisions by accumulating evidence over a series of visually presented arrow stimuli whose visibility was modulated by masking. Behavioral results showed that participants could accumulate evidence under both high and low visibility. However, a top-down strategic modulation of the flow of incoming evidence was only present for stimuli with high visibility: once enough evidence had been accrued, participants strategically reduced the impact of new incoming stimuli. Also, decision-making speed and confidence were strongly modulated by the strength of the evidence for high-visible but not low-visible evidence, even though direct priming effects were identical for both types of stimuli. Neural recordings revealed that, while initial perceptual processing was independent of visibility, there was stronger top-down amplification for stimuli with high visibility than low visibility. Furthermore, neural markers of evidence accumulation over occipito-parietal cortex showed a strategic bias only for highly visible sensory information, speeding up processing and reducing neural computations related to the decision process. Our results indicate that the level of awareness of information changes decision-making: while accumulation of evidence already exists under low visibility conditions, high visibility allows evidence to be accumulated up to a higher level, leading to important strategical top-down changes in decision-making. Our results therefore suggest a potential role of awareness in deploying flexible strategies for biasing information acquisition in line with one's expectations and goals.
Emmet O'Brien, M; Restrepo, Marcos I; Martin-Loeches, Ignacio
Community-acquired pneumonia (CAP) is a leading cause of death from an infectious cause worldwide. Guideline-concordant antibiotic therapy initiated in a timely manner is associated with improved treatment responses and patient outcomes. In the post-antibiotic era, much of the morbidity and mortality of CAP is as a result of the interaction between bacterial virulence factors and host immune responses. In patients with severe CAP, or who are critically ill, there is a lot of emerging observational evidence demonstrating improved survival rates when treatment using combination therapy with a β-lactam and a macrolide is initiated, as compared to other antibiotic regimes without a macrolide. Macrolides in combination with a β-lactam antibiotic provide broader coverage for the atypical organisms implicated in CAP, and may contribute to antibacterial synergism. However, it has been postulated that the documented immunomodulatory effects of macrolides are the primary mechanism for improved patient outcomes through attenuation of bacterial virulence factors and host systemic inflammatory responses. Despite concerns regarding the limitations of observational evidence and the lack of confirmatory randomized controlled trials, the potential magnitude of mortality benefits estimated at 20-50% cannot be overlooked. In light of recent data from a number of trials showing that combination treatment with a macrolide and a suitable second agent is justified in all patients with severe CAP, such treatment should be obligatory for those admitted to an intensive care setting. Copyright © 2015 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
Pereira, C. I.; San Romao, M. V.; Lolkema, J. S.; Barreto Crespo, M. T.; Baretto Crespo, M.
Aims: To demonstrate that the meat food strain Weissella halotolerans combines an ornithine decarboxylation pathway and an arginine deiminase (ADI) pathway and is able to produce putrescine, a biogenic amine. Evidence is shown that these two pathways produce a proton motive force (PMF). Methods and
Mathews, G.J.; Wozniak, G.J.; Schmitt, R.P.; Moretto, L.G.
The connection between the characteristic features of reactions involving very heavy target-projectile combinations (e.g. 86 Kr + 197 Au) and lighter systems (e.g. 40 Ar + sup(nat)Ag) is discussed. Evidence for an impirical scaling law based upon the ratio E/B (center-of-mass kinetic energy to Coulomb barrier) is presented. This scaling is justified in terms of semiquantitative arguments whereby the different charge and angular distribution patterns from light and heavy target-projectile combinations are correlated with different lifetime regimes for the 'intermediate complex' as it diffuses along the mass-asymmetry coordinate. (orig.) [de
Full Text Available Mario Cazzola,1 Andrea Segreti,1 Maria Gabriella Matera2 1Department of System Medicine, University of Rome 'Tor Vergata', Rome, Italy; 2Department of Experimental Medicine, Second University, Naples, Italy Abstract: An increasing body of evidence suggests that the long-acting muscarinic antagonist (LAMA/long-acting β2-agonist (LABA combination appears to play an important role in maximizing bronchodilation, with studies to date indicating that combining different classes of bronchodilators may result in significantly greater improvements in lung function compared to the use of a single drug, and that these combinations are well tolerated in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD. An inhaled, fixed-dose combination of two 24-hour bronchodilators, the LAMA umeclidinium and the LABA vilanterol, is under development as a once-daily treatment for COPD. The efficacy of both mono-components has already been demonstrated. The information currently available suggests that umeclidinium/vilanterol is an effective once-daily dual bronchodilator fixed-dose combination in the treatment of COPD. However, it remains to be seen if it compares favorably with current therapies. Moreover, the question remains whether umeclidinium/vilanterol fixed-dose combination, which significantly improves FEV1, is also associated with improvements in other outcome measures that are important to COPD patients. Keywords: muscarinic antagonist, dual bronchodilation, COPD
Collins, Patrick S; Moyer, Kurtis E
The goal of this study is to examine the existing peer reviewed literature comparing modern adjunctive techniques in liposuction including laser-assisted liposuction (LAL) and ultrasound-assisted liposuction (UAL) to standard suction-assisted liposuction (SAL). We intend to interpret these findings into a literature-based clinical application to influence practice patterns. A literature review was conducted using a keyword search in PubMed. Keyword search items included liposuction, lipoplasty, suction assisted liposuction, ultrasound assisted liposuction, laser assisted liposuction, tumescent, liposuction comparison, liposuction review, and combinations therein. Exclusion criteria included articles with a primary focus on histologic effects of energy devices, primary animal models, primary opinion papers with no reference to available data, and industry-sponsored publications. Inclusion criteria included articles with direct comparison of liposuction modalities, randomized or blinded studies, and studies with objective outcomes. Twenty-five articles that met the inclusion criteria comparing SAL to UAL or LAL out of 9972 articles identified were obtained. The selected literature was assigned into 3 categories: evidence demonstrating an advantage of 1 modality (SAL, UAL, or LAL) over another, evidence that showed no benefit of 1 modality over another, and evidence that demonstrated risks of complications of 1 modality over another. The benefits of UAL and LAL over SAL include the following: (1) UAL over SAL in the treatment of gynecomastia, (2) LAL and UAL over SAL with decreased hemoglobin/hematocrit in high-volume lipoaspirates, and (3) LAL over SAL with skin tightening in select areas specifically the submental area. Otherwise, the literature demonstrates equivocal results among the described techniques with no clear benefit to set one apart from the other. There appears to be no demonstrable added benefit to the addition of either UAL or LAL that would urge a
Sojcher, Renee; Gould Fogerite, Susan; Perlman, Adam
Obesity is a growing epidemic. Chronic stress produces endocrine and immune factors that are contributors to obesity's etiology. These biochemicals also can affect appetite and eating behaviors that can lead to binge-eating disorder. The inadequacies of standard care and the problem of patient noncompliance have inspired a search for alternative treatments. Proposals in the literature have called for combination therapies involving behavioral or new biological therapies. This manuscript suggests that mind-body interventions would be ideal for such combinations. Two mind-body modalities, energy psychology and mindfulness meditation, are reviewed for their potential in treating weight loss, stress, and behavior modification related to binge-eating disorder. Whereas mindfulness meditation and practices show more compelling evidence, energy psychology, in the infancy stages of elucidation, exhibits initially promising outcomes but requires further evidence-based trials. Copyright © 2012 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the
Full Text Available Satoshi Morimoto, Nobuyuki Takahashi, Tatsuyori Morita, Kazunori Someya, Nagaoki Toyoda, Toshiji IwasakaSecond Department of Internal Medicine, Kansai Medical University 2-3-1, Shinmachi, Hirakata, Osaka 573-1191, JapanAbstract: Rigid control of blood pressure (BP is essential to prevent cardiovascular disease. However, only about 40% of hypertensive patients undergoing pharmacological intervention with a single agent achieve their BP goals in contemporary clinical practice. Combined therapy using currently available agents is effective in maximizing treatment outcome, although it raises medical costs and decreases the drug compliance rate. To overcome such negative consequences, a combination tablet containing an angiotensin II receptor blocker (ARB with a small dose of hydrochlorothiazide (HCTZ is now available on the international market, including Japan. This article briefly describes the unique properties of telmisartan, a highly selective ARB for the angiotensin II type 1 receptor, including its long-acting characteristics and recent prospective multicenter randomized clinical trials, followed by a description of a newly-introduced combination tablet in Japan, which contains telmisartan and HCTZ. This article also reviews its safety and efficacy based on currently available evidence. Finally, evidence comparing telmisartan/HCTZ with other combination therapies is presented.Keywords: angiotensin II receptor blocker, ARB, blood pressure, hypertension, diuretics, PPAR-γ
The Clinical and Cost Effectiveness of Aflibercept in Combination with Irinotecan and Fluorouracil-Based Therapy (FOLFIRI) for the Treatment of Metastatic Colorectal Cancer Which has Progressed Following Prior Oxaliplatin-Based Chemotherapy: a Critique of the Evidence.
Wade, Ros; Duarte, Ana; Simmonds, Mark; Rodriguez-Lopez, Rocio; Duffy, Steven; Woolacott, Nerys; Spackman, Eldon
The National Institute for Health and Care Excellence (NICE) invited the manufacturer of aflibercept (Sanofi) to submit clinical and cost-effectiveness evidence for aflibercept in combination with irinotecan and fluorouracil-based therapy [irinotecan/5-fluorouracil/folinic acid (FOLFIRI)] for the treatment of metastatic colorectal cancer which has progressed following prior oxaliplatin-based chemotherapy, as part of the Institute's Single Technology Appraisal process. The Centre for Reviews and Dissemination and Centre for Health Economics at the University of York were commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and the resulting NICE guidance TA307 issued in March 2014. The ERG critically reviewed the evidence presented in the manufacturer's submission and identified areas requiring clarification, for which the manufacturer provided additional evidence. The clinical effectiveness data were derived from one good-quality double-blind randomised controlled trial (RCT), the VELOUR trial, which compared aflibercept plus FOLFIRI with placebo plus FOLFIRI. This RCT found a small but statistically significant increase in overall survival (OS); the difference in median OS was 1.44 months (13.5 months in the aflibercept group and 12.06 months in the placebo group). There was also a statistically significant increase in progression-free survival (PFS) with aflibercept; the difference in median PFS was 2.23 months (6.9 months in the aflibercept group and 4.67 months in the placebo group). However, grade 3-4 adverse events were more frequent in the aflibercept group than the placebo group: 83.5% compared with 62.5%. Treatment-emergent adverse events led to permanent discontinuation of treatment in 26.8% of patients in the aflibercept group and 12.1% of patients in the placebo group. The manufacturer's submission included an estimation of mean OS benefit based on extrapolation
Thoma, Nathan; Pilecki, Brian; McKay, Dean
Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed.
Morgan, C; Reininghaus, U; Fearon, P; Hutchinson, G; Morgan, K; Dazzan, P; Boydell, J; Kirkbride, J B; Doody, G A; Jones, P B; Murray, R M; Craig, T
There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects. All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls. There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample. Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.
Sarris, Jerome; Lake, James; Hoenders, Rogier
Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. PubMed, CINAHL,(®) Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice
Sander, Gary E; Giles, Thomas D
The fixed-dose combination of nebivolol and valsartan drug has been clinically evaluated and demonstrated to represent a unique combination of nebivolol, a selective β1-adrenoceptor antagonist and a β3-adrenoceptor agonist; β3 receptor activation increases endothelial nitric oxide and produces vasodilation. Valsartan is highly selective angiotensin AT1 receptor blocker and exerts its major pharmacological effect by decreasing angiotensin II-induced vasoconstriction and production of aldosterone. The addition of nebivolol counteracts the effects of increased angiotensin II concentrations resulting from potent AT1 blockade. This review describes a recently completed trial establishing the efficacy of the nebivolol/valsartan combination. This review provides a literature search of pertinent pharmacological and clinical data that describes the mechanisms of both drugs individually and the results of a clinical trial comparing fixed-dose combinations of nebivolol with valsartan as compared with each drug as monotherapy. Fixed-dose combination drugs are intended to improve patient compliance and reduce drug costs, as well as to reduce long-term cardiovascular event rates and block counter-regulatory effects due to monotherapy. The vast majority of hypertensive patients will require at least two medications. We believe that the clinical evidence suggests that the combination of nebivolol with valsartan offers a definite clinical benefit, combining β1-adrenoceptor and angiotensin AT1 receptor blockade with β3 receptor activation and resultant increase in nitric oxide and vasodilation.
Lee, Jung Su; Mishra, Gita; Hayashi, Kunihiko; Watanabe, Etsuko; Mori, Katsumi; Kawakubo, Kiyoshi
Various eating behaviors have been linked with body weight management. However, combined effects of major eating behaviors are not fully understood. This study aimed to clarify the association of the combination of eating quickly (EQ), late evening meals (LEM), and skipping breakfast (SB) with being overweight. A cross-sectional study with standardized questions for EQ, LEM, and SB was conducted. Stratified random sampling of 5% of residents aged 20 to 80years was surveyed in a city in northeast Japan in 2011, and 4249 (84.9%) residents were analyzed. Association of combinations of eating behaviors on being overweight (BMI (kg/m(2)≥25.0)) was estimated by using logistic analysis, and odds ratio (OR) and 95% confidential interval were calculated after adjustment for potential covariates. LEM, SB, or a combination of LEM and SB was not significantly associated with being overweight. However, the combination of EQ or only EQ was significantly associated with being overweight. As the number of eating behavior practices increased, there was a linear increase in OR for being overweight. The OR of all three combined eating behaviors was higher than that of any combined two behaviors or of each behavior. This study result supports the evidence that EQ increases the risk of being overweight whether by itself or in combinations with LEM and/or SB. However, only LEM or only SB did not increase the risk of being overweight. Copyright © 2016 Elsevier Ltd. All rights reserved.
Nijhuis, F.A.; Heek, J. van; Bloem, B.R.; Post, B.; Faber, M.J.
BACKGROUND: In advanced Parkinson's disease (PD), neurologists and patients face a complex decision for an advanced therapy. When choosing a treatment, the best available evidence should be combined with the professional's expertise and the patient's preferences. OBJECTIVE: The objective of this
We perform a global fit of the most relevant neutrinoless double beta decay experiments within the standard model with massive Majorana neutrinos. Using Bayesian inference makes it possible to take into account the theoretical uncertainties on the nuclear matrix elements in a fully consistent way. First, we analyze the data used to claim the observation of neutrinoless double beta decay in 76Ge, and find strong evidence (according to Jeffrey's scale) for a peak in the spectrum and moderate evidence for that the peak is actually close to the energy expected for the neutrinoless decay. We also find a significantly larger statistical error than the original analysis, which we include in the comparison with other data. Then, we statistically test the consistency between this claim with that of recent measurements using 136Xe. We find that the two data sets are about 40 to 80 times more probable under the assumption that they are inconsistent, depending on the nuclear matrix element uncertainties and the prior on the smallest neutrino mass. Hence, there is moderate to strong evidence of incompatibility, and for equal prior probabilities the posterior probability of compatibility is between 1.3% and 2.5%. If one, despite such evidence for incompatibility, combines the two data sets, we find that the total evidence of neutrinoless double beta decay is negligible. If one ignores the claim, there is weak evidence against the existence of the decay. We also perform approximate frequentist tests of compatibility for fixed ratios of the nuclear matrix elements, as well as of the no signal hypothesis. Generalization to other sets of experiments as well as other mechanisms mediating the decay is possible.
The objectives of this article are to investigate and analyze the problem of combining symbol streams from many Deep Space Network stations to enhance bit signal-to-noise ratio and to compare the performance of this combining technique with baseband combining. Symbol stream combining (SSC) has some advantages and some disadvantages over baseband combining (BBC). The SSC suffers almost no loss in combining the digital data and no loss due to the transmission of the digital data by microwave links between the stations. The BBC suffers 0.2 dB loss due to alignment and combining the IF signals and 0.2 dB loss due to transmission of signals by microwave links. On the other hand, the losses in the subcarrier demodulation assembly (SDA) and in the symbol synchronization assembly (SSA) for SSC are more than the losses in the SDA and SSA for BBC. It is shown that SSC outperforms BBC by about 0.35 dB (in terms of the required bit energy-to-noise spectral density for a bit error rate of 1,000) for an array of three DSN antennas, namely 64 m, 34m(T/R) and 34m(R).
Barker, Christopher A.; Postow, Michael A.
Radiation therapy has long played a role in the management of melanoma. Recent advances have also demonstrated the efficacy of immunotherapy in the treatment of melanoma. Preclinical data suggest a biologic interaction between radiation therapy and immunotherapy. Several clinical studies corroborate these findings. This review will summarize the outcomes of studies reporting on patients with melanoma treated with a combination of radiation therapy and immunotherapy. Vaccine therapies often use irradiated melanoma cells, and may be enhanced by radiation therapy. The cytokines interferon-α and interleukin-2 have been combined with radiation therapy in several small studies, with some evidence suggesting increased toxicity and/or efficacy. Ipilimumab, a monoclonal antibody which blocks cytotoxic T-lymphocyte antigen-4, has been combined with radiation therapy in several notable case studies and series. Finally, pilot studies of adoptive cell transfer have suggested that radiation therapy may improve the efficacy of treatment. The review will demonstrate that the combination of radiation therapy and immunotherapy has been reported in several notable case studies, series and clinical trials. These clinical results suggest interaction and the need for further study
Barker, Christopher A., E-mail: firstname.lastname@example.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Postow, Michael A. [Department of Medicine, Melanoma and Sarcoma Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
Radiation therapy has long played a role in the management of melanoma. Recent advances have also demonstrated the efficacy of immunotherapy in the treatment of melanoma. Preclinical data suggest a biologic interaction between radiation therapy and immunotherapy. Several clinical studies corroborate these findings. This review will summarize the outcomes of studies reporting on patients with melanoma treated with a combination of radiation therapy and immunotherapy. Vaccine therapies often use irradiated melanoma cells, and may be enhanced by radiation therapy. The cytokines interferon-α and interleukin-2 have been combined with radiation therapy in several small studies, with some evidence suggesting increased toxicity and/or efficacy. Ipilimumab, a monoclonal antibody which blocks cytotoxic T-lymphocyte antigen-4, has been combined with radiation therapy in several notable case studies and series. Finally, pilot studies of adoptive cell transfer have suggested that radiation therapy may improve the efficacy of treatment. The review will demonstrate that the combination of radiation therapy and immunotherapy has been reported in several notable case studies, series and clinical trials. These clinical results suggest interaction and the need for further study.
Full Text Available Although computer makes human activities faster and easier, innovating and creating new forms of work and other kinds of activities, it also influenced the criminal activity. The development of information technology directly affects the development of computer forensics without which, it can not even imagine the discovering and proving the computer offences and apprehending the perpetrator. Information technology and computer forensic allows us to detect and prove the crimes committed by computer and capture the perpetrators. Computer forensics is a type of forensics which can be defined as a process of collecting, preserving, analyzing and presenting digital evidence in court proceedings. Bearing in mind, that combat against crime, in which computers appear as an asset or object of the offense, requires knowledge of digital evidence as well as specific rules and procedures, the author in this article specifically addresses the issues of digital evidence, forensic (computer investigation, specific rules and procedures for detecting, fixing and collecting digital evidence and use of this type of evidence in criminal proceedings. The author also delas with international standards regarding digital evidence and cyber-space investigation.
Full Text Available Objective: To highlight the issue of freely available fixed-dose combinations (FDCs of antimicrobials. Methods: A critique of two such antimicrobial FDCs was undertaken wherein the following aspects were assessed - rational and regulatory issues and justification for clinical use. Available in vitro, in vivo (animals and humans evidence from published literature was analysed. Conclusions: There are several inadequately addressed aspects of the considered FDCs which are available in Indian market. In view of the growing problem of antimicrobial resistance, this issue must get the required attention.
Spoelstra, Sandra L; Schueller, Monica; Hilton, Melissa; Ridenour, Kimberly
This article presents an integrative review of the evidence for combined motivational interviewing and cognitive behavioural interventions that promote medication adherence. We undertook this review to establish a scientific foundation for development of interventions to promote medication adherence and to guide clinical practice. The World Health Organization has designated medication adherence as a global problem. Motivational interviewing and cognitive behaviour interventions have been found to individually promote medication adherence. However, there is a gap in the literature on the effect of combined motivational interviewing and cognitive behavioural approaches to promote medication adherence. Integrative review. COCHRANE, PubMed and CINAHL were searched to access relevant studies between 2004-2014. Inclusion criteria were interventions combining motivational interviewing and cognitive behavioural therapy with medication adherence as the outcome. Articles were assessed for measures of adherence and methodological rigour. Analysis was performed using an integrative review process. Six articles met the inclusion criteria. A randomised controlled trial reported pretreatment missed doses of 5·58 and post-treatment of 0·92 and trended towards significance. Four cohort studies had effect sizes of 0·19-0·35 (p motivational interviewing and cognitive behavioural interventions, five out of six were effective at improving medication adherence. Future studies with large rigorous randomised trials are needed. This review provides clinicians with the state of the science in relation to combined motivational interviewing and cognitive behavioural therapy interventions that promote medication adherence. A summary of intervention components and talking points are provided to aid nurses in informing decision-making and translating evidence into practice. © 2014 John Wiley & Sons Ltd.
Hendriks, A.G.M.; Keijsers, R.R.M.C.; Jong, E.M.G.J. de; Seyger, M.M.B.; Kerkhof, P.C.M. van de
Background Most psoriasis patients suffering from mild to moderate disease are treated with first-line topical treatments, including corticosteroids, vitamin D analogues, topical retinoids and calcineurin inhibitors. Although evidence-based guidelines on combinations are lacking, the majority of
The main contribution of this paper is the development of a novel and versatile methodology to identify economic reforms. The methodology is a combination of the Bai & Perron structural break filter, and validation of the structural breaks identified using de jure evidence of reforms. The procedure
Fabiano, Gregory A.; Pelham, William E., Jr.; Gnagy, Elizabeth M.; Burrows-MacLean, Lisa; Coles, Erika K.; Chacko, Anil; Wymbs, Brian T.; Walker, Kathryn S.; Arnold, Fran; Garefino, Allison; Keenan, Jenna K.; Onyango, Adia N.; Hoffman, Martin T.; Massetti, Greta M.; Robb, Jessica A.
Currently behavior modification, stimulant medication, and combined treatments are supported as evidence-based interventions for attention deficit hyperactivity disorder in classroom settings. However, there has been little study of the relative effects of these two modalities and their combination in classrooms. Using a within-subject design, the…
Harrison, R F; Devitt, M
In a bid to minimise dosage and possible side-effects when relieving post episiotomy pain, the NSAID Indomethacin was studied in combination with a systemic haemostat Ethamsylate which has been shown to selectively inhibit some prostaglandins. Comparative groups also took Indomethacin alone and placebo in a double blind non-crossover comparison. Efficacy was judged in terms of side-effects and assessments of pain intensity, pain relief and global assessment of pain. There was some evidence of a beneficial interaction between Indomethacin and Ethamsylate when adjustments were made for the patient's age and initial pain score. Side-effects were most common in the combination therapy group.
Xiao, Y; Brunet, F; Kanskar, M; Faucher, M; Wetter, A; Holehouse, N
We have demonstrated a monolithic cladding-pumped ytterbium-doped single all-fiber laser oscillator generating 1 kW of CW signal power at 1080 nm with 71% slope efficiency and near diffraction-limited beam quality. Fiber components were highly integrated on "spliceless" passive fibers to promote laser efficiency and alleviate non-linear effects. The laser was pumped through a 7:1 pump combiner with seven 200-W 91x nm fiber-pigtailed wavelength-beam-combined diode-stack modules. The signal power of such a single all-fiber laser oscillator showed no evidence of roll-over, and the highest output was limited only by available pump power.
Filip, Pavel; Lungu, Ovidiu V; Manto, Mario-Ubaldo; Bareš, Martin
Essential tremor (ET), clinically characterized by postural and kinetic tremors, predominantly in the upper extremities, originates from pathological activity in the dynamic oscillatory network comprising the majority of nodes in the central motor network. Evidence indicates dysfunction in the thalamus, the olivocerebellar loops, and intermittent cortical engagement. Pathology of the cerebellum, a structure with architecture intrinsically predisposed to oscillatory activity, has also been implicated in ET as shown by clinical, neuroimaging, and pathological studies. Despite electrophysiological studies assessing cerebellar impairment in ET being scarce, their impact is tangible, as summarized in this review. The electromyography-magnetoencephalography combination provided the first direct evidence of pathological alteration in cortico-subcortical communication, with a significant emphasis on the cerebellum. Furthermore, complex electromyography studies showed disruptions in the timing of agonist and antagonist muscle activation, a process generally attributed to the cerebellum. Evidence pointing to cerebellar engagement in ET has also been found in electrooculography measurements, cerebellar repetitive transcranial magnetic stimulation studies, and, indirectly, in complex analyses of the activity of the ventral intermediate thalamic nucleus (an area primarily receiving inputs from the cerebellum), which is also used in the advanced treatment of ET. In summary, further progress in therapy will require comprehensive electrophysiological and physiological analyses to elucidate the precise mechanisms leading to disease symptoms. The cerebellum, as a major node of this dynamic oscillatory network, requires further study to aid this endeavor.
Singh, Michael N; Lacro, Ronald V
Marfan syndrome is a genetic disorder of connective tissue with principal manifestations in the cardiovascular, ocular, and skeletal systems. Cardiovascular disease, mainly progressive aortic root dilation and aortic dissection, is the leading cause of morbidity and mortality. The primary aims of this report were to examine the evidence related to medical therapy for Marfan syndrome, including recently completed randomized clinical trials on the efficacy of β-blockers and angiotensin II receptor blockers for the prophylactic treatment of aortic enlargement in Marfan syndrome, and to provide recommendations for medical therapy on the basis of available evidence. Medical therapy for Marfan syndrome should be individualized according to patient tolerance and risk factors such as age, aortic size, and family history of aortic dissection. The Pediatric Heart Network trial showed that atenolol and losartan each reduced the rate of aortic dilation. All patients with known or suspected Marfan syndrome and aortic root dilation should receive medical therapy with adequate doses of either β-blocker or angiotensin receptor blocker. The Pediatric Heart Network trial also showed that atenolol and losartan are more effective at reduction of aortic root z score in younger subjects, which suggests that medical therapy should be prescribed even in the youngest children with aortic dilation. For patients with Marfan syndrome without aortic dilation, the available evidence is less clear. If aortic dilation is severe and/or progressive, therapy with a combination of β-blocker and angiotensin receptor blocker should be considered, although trial results are mixed with respect to the efficacy of combination therapy vs monotherapy. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
Spratt, Daniel E; Soni, Payal D; McLaughlin, Patrick W; Merrick, Gregory S; Stock, Richard G; Blasko, John C; Zelefsky, Michael J
To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All
Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris
Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services
Reiskind, M H; Zarrabi, A A; Lounibos, L P
Resource diversity is critical to fitness in many insect species, and may determine the coexistence of competitive species and the function of ecosystems. Plant material provides the nutritional base for numerous aquatic systems, yet the consequences of diversity of plant material have not been studied in aquatic container systems important for the production of mosquitoes. To address how diversity in leaf detritus affects container-inhabiting mosquitoes, we examined how leaf species affect competition between two container inhabiting mosquito larvae, Aedes aegypti and Aedes albopictus, that co-occur in many parts of the world. We tested the hypotheses that leaf species changes the outcome of intra- and interspecific competition between these mosquito species, and that combinations of leaf species affect competition in a manner not predictable based upon the response to each leaf species alone (i.e. the response to leaf combinations is non-additive). We find support for our first hypothesis that leaf species can affect competition, evidence that, in general, leaf combination alters competitive interactions, and no support that leaf combination impacts interspecific competition differently than intraspecific competition. We conclude that combinations of leaves increase mosquito production non-additively such that combinations of leaves act synergistically, in general, and result in higher total yield of adult mosquitoes in most cases, although certain leaf combinations for A. albopictus are antagonistic. We also conclude that leaf diversity does not have a different effect on interspecific competition between A. aegypti and A. albopictus, relative to intraspecific competition for each mosquito.
Kragh, Mette; Roj Larsen, Erik; Martiny, Klaus
There is growing evidence for combined chronotherapeutic interventions as adjunctive treatments for major depression. However, as the treatments can be demanding, we need to identify predictors of response. This study aimed to describe predictors of response, remission and deterioration in the sh......There is growing evidence for combined chronotherapeutic interventions as adjunctive treatments for major depression. However, as the treatments can be demanding, we need to identify predictors of response. This study aimed to describe predictors of response, remission and deterioration...... in the short-term phase, as well as predictors of long-term response. The predictors investigated were gender, type of depression, severity of depression, treatment resistance, quetiapine use, general self-efficacy, educational level and positive diurnal variation. Follow-up data from 27 inpatients...... with moderate-to-severe depression participating in a chronotherapeutic intervention were analysed. As a supplement to standard treatment, they completed 3 wake therapy sessions in the first week, 30 min daily light treatment and sleep-time stabilisation in the entire 9-week study period. Patients had...
van Berkel, Sheila R; Tucker, Corinna Jenkins; Finkelhor, David
This study examined how the combination of sibling victimization and parental child maltreatment is related to mental health problems and delinquency in childhood and adolescence. Co-occurrence, additive associations, and interactive associations of sibling victimization and parental child maltreatment were investigated using a sample of 2,053 children aged 5-17 years from the National Survey of Children's Exposure to Violence. The results provide primarily evidence for additive associations and only suggest some co-occurrence and interactive associations of sibling victimization and child maltreatment. Evidence for co-occurrence was weak and, when controlling for the other type of maltreatment, only found for neglect. Sibling victimization was related to more mental health problems and delinquency over and above the effect of child abuse and neglect. Moderation by sibling victimization depended on child age and was only found for the relation between both types of child maltreatment by parents and delinquency. For mental health, no interactive associations were found. These results highlight the unique and combined associations between sibling victimization on child development.
Goffinet, D.R.; Kaplan, H.S.; Donaldson, S.S.; Bagshaw, M.A.; Wilbur, J.R.
Three children with osteogenic sarcomas which were either unresectable or whose parents refused permission to amputate were treated with combined intra-arterial 5'bromodeoxyuridine (BUdR) infusion and high-dose-per-fraction megavoltage irradiation to the primary site. Pulsed, 48-hour BUdR infusions were performed prior to each 600-rad radiation therapy fraction, with a total radiation dose to the primary site of 4,200 to 4,800 rads in five weeks. Local control was obtained in all 3 children. One child is alive two years after treatment, another died with metastatic disease, and the third patient who received radiotherapy to the lungs for pulmonary metastases is without evidence of disease one year later. (auth)
Mohr, Sharif B.; Gorham, Edward D.; Alcaraz, John E.; Kane, Christopher I.; Macera, Caroline A.; Parsons, J. Kellogg; Wingard, Deborah L.; Garland, Cedric F.
A wide range of epidemiologic and laboratory studies combined provide compelling evidence of a protective role of vitamin D on risk of breast cancer. This review evaluates the scientific evidence for such a role in the context of the A.B. Hill criteria for causality, in order to assess the presence of a causal, inverse relationship, between vitamin D status and breast cancer risk. After evaluation of this evidence in the context of Hill’s criteria, it was found that the criteria for a causal ...
Finlay A McAlister
Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.
Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H
Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.
Ren, Shijie; Bermejo, Iñigo; Simpson, Emma; Wong, Ruth; Scott, David L; Young, Adam; Stevenson, Matt
As part of its single technology appraisal process, the National Institute for Health and Care Excellence invited the manufacturer (Eli Lilly) of baricitinib (BARI; Olumiant ® ; a Janus kinase inhibitor that is taken orally) to submit evidence of its clinical and cost effectiveness for the treatment of moderate to severe rheumatoid arthritis (RA) after the failure of disease-modifying antirheumatic drugs (DMARDs). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a detailed review of the evidence for the clinical and cost effectiveness of the technology, based on the company's submission (CS) to NICE. The clinical-effectiveness evidence in the CS for BARI was based predominantly on three randomised controlled trials comparing the efficacy of BARI against adalimumab or placebo, as well as one long-term extension study. The clinical-effectiveness review identified no head-to-head evidence on the efficacy of BARI against all the comparators within the scope. Therefore, the company performed network meta-analyses (NMAs) in two different populations: one in patients who had experienced an inadequate response to conventional DMARDs (cDMARD-IR), and the other in patients who had experienced an inadequate response to tumour necrosis factor inhibitors (TNFi-IR). The company's NMAs concluded BARI had comparable efficacy as the majority of its comparators in both populations. The company submitted a de novo discrete event simulation model that analysed the incremental cost-effectiveness of BARI versus its comparators for the treatment of RA from the perspective of the National Health Service (NHS) in four different populations: (1) cDMARD-IR patients with moderate RA, defined as a 28-Joint Disease Activity Score (DAS28) > 3.2 and no more than 5.1; (2) cDMARD-IR patients with severe RA (defined as a DAS28 > 5.1); (3) TNFi-IR patients
Mogasale, Vijayalaxmi V; Patil, Vishwanath D; Patil, Nanasaheb M; Mogasale, Vittal
To measure the prevalence of specific learning disabilities (SpLDs) such as dyslexia, dysgraphia and dyscalculia among primary school children in a South Indian city. A cross-sectional multi-staged stratified randomized cluster sampling study was conducted among children aged 8-11 years from third and fourth standard. A six level screening approach that commenced with identification of scholastic backwardness followed by stepwise exclusion of impaired vision and hearing, chronic medical conditions and subnormal intelligence was carried out among these children. In the final step, the remaining children were subjected to specific tests for reading, comprehension, writing and mathematical calculation. The prevalence of specific learning disabilities was 15.17% in sampled children, whereas 12.5%, 11.2% and 10.5% had dysgraphia, dyslexia and dyscalculia respectively. This study suggests that the prevalence of SpLDs is at the higher side of previous estimations in India. The study is unique due to its large geographically representative design and identification of the problem using simplified screening approach and tools, which minimizes the number and time of specialist requirement and spares the expensive investigation. This approach and tools are suitable for field situations and resource scarce settings. Based on the authors' experience, they express the need for more prevalence studies, remedial education and policy interventions to manage SpLDs at main stream educational system to improve the school performance in Indian children.
Full Text Available Background: Onychomycosis is a fungal infection of the nails, which manifested as nail discoloration, thickening, and detachment from the nail bed. It is not life-threatening, however inappropriate treatment of onychomycosis might lead to complications and affect the patient’s quality of life; making the management of the disease a challenge for clinicians. Objective: Investigate the efficacy of pulse-dosed oral terbinafine combined with topical 8% ciclopirox olamine to treat onychomycosis. Methods: Literature search was performed in Pubmed and Cochrane databases using the keywords 'combination' AND 'oral terbinafine' AND 'ciclopirox' AND ‘onychomycosis treatment’ along with their synonyms and related terms. Results and Discussion: After critical appraisal, studies by Avner et al. and Jaiswal et al. found to be valid, important, and applicable to the patient. The first study found that oral terbinafine combined with topical 8% ciclopirox olamine is more effective and safe compared to terbinafine as a monotherapy (p0.05. Conclusions: Oral terbinafine combined with topical 8% ciclopirox olamine is more effective than monotherapy, despite statistical irrelevance in one of the studies appraised. Further studies are needed to support the implementation of combination therapy.
Stead, Lindsay F; Koilpillai, Priya; Fanshawe, Thomas R; Lancaster, Tim
healthcare settings or with specific health needs. Most studies provided NRT. Behavioural support was typically provided by specialists in cessation counselling, who offered between four and eight contact sessions. The planned maximum duration of contact was typically more than 30 minutes but less than 300 minutes. Overall, studies were at low or unclear risk of bias, and findings were not sensitive to the exclusion of any of the six studies rated at high risk of bias in one domain. One large study (the Lung Health Study) contributed heterogeneity due to a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. Based on the remaining 52 studies (19,488 participants) there was high quality evidence (using GRADE) for a benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98) with moderate statistical heterogeneity (I² = 36%).The pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for eight trials with community-based recruitment (RR 1.53, 95% CI 1.33 to 1.76). Compared to the first version of the review, previous weak evidence of differences in other subgroup analyses has disappeared. We did not detect differences between subgroups defined by motivation to quit, treatment provider, number or duration of support sessions, or take-up of treatment. Interventions that combine pharmacotherapy and behavioural support increase smoking cessation success compared to a minimal intervention or usual care. Updating this review with an additional 12
Grimpe, Christoph; Belderbos, Rene
learning and export learning – an issue that has been ignored in prior studies. Learning from foreign customers is more prevalent than learning from foreign competitors. Firms’ underlying innovation strategy appears as an important moderator of the propensity to learn and of the relationship between......We examine first direct evidence on the occurrence of learning by exporting, using unique survey data for German innovating firms on the role of (foreign) customers and competitors as sources of ideas and impetus for innovation. Export intensive firms frequently benefit simultaneously from domestic...... learning and innovativeness. Firms adopting a strategy of technology leadership more often exhibit effective learning from diverse foreign customers and this learning is strongly associated with innovative sales – but mostly so if combined with domestic customer learning. In contrast, firms that have...
Jiang, Zhi-quan; Hu, Ke-liang
In the field of forensic science, conventional infrared spectral analysis technique is usually unable to meet the detection requirements, because only very a few trace material evidence with diverse shapes and complex compositions, can be extracted from the crime scene. Infrared microscopic technique is developed based on a combination of Fourier-transform infrared spectroscopic technique and microscopic technique. Infrared microscopic technique has a lot of advantages over conventional infrared spectroscopic technique, such as high detection sensitivity, micro-area analysisand nondestructive examination. It has effectively solved the problem of authentication of trace material evidence in the field of forensic science. Additionally, almost no external interference is introduced during measurements by infrared microscopic technique. It can satisfy the special need that the trace material evidence must be reserved for witness in court. It is illustrated in detail through real case analysis in this experimental center that, infrared microscopic technique has advantages in authentication of trace material evidence in forensic science field. In this paper, the vibration features in infrared spectra of material evidences, including paints, plastics, rubbers, fibers, drugs and toxicants, can be comparatively analyzed by means of infrared microscopic technique, in an attempt to provide powerful spectroscopic evidence for qualitative diagnosis of various criminal and traffic accident cases. The experimental results clearly suggest that infrared microscopic technique has an incomparable advantage and it has become an effective method for authentication of trace material evidence in the field of forensic science.
Wada, Satoshi; Harris, Timothy J.; Tryggestad, Erik; Yoshimura, Kiyoshi; Zeng, Jing; Yen, Hung-Rong; Getnet, Derese; Grosso, Joseph F.; Bruno, Tullia C.; De Marzo, Angelo M.
Purpose: To optimize the combination of ionizing radiation and cellular immunotherapy using a preclinical autochthonous model of prostate cancer. Methods and Materials: Transgenic mice expressing a model antigen under a prostate-specific promoter were treated using a platform that integrates cone-beam CT imaging with 3-dimensional conformal therapy. Using this technology we investigated the immunologic and therapeutic effects of combining ionizing radiation with granulocyte/macrophage colony-stimulating factor-secreting cellular immunotherapy for prostate cancer in mice bearing autochthonous prostate tumors. Results: The combination of ionizing radiation and immunotherapy resulted in a significant decrease in pathologic tumor grade and gross tumor bulk that was not evident with either single-modality therapy. Furthermore, combinatorial therapy resulted in improved overall survival in a preventive metastasis model and in the setting of established micrometastases. Mechanistically, combined therapy resulted in an increase of the ratio of effector-to-regulatory T cells for both CD4 and CD8 tumor-infiltrating lymphocytes. Conclusions: Our preclinical model establishes a potential role for the use of combined radiation-immunotherapy in locally advanced prostate cancer, which warrants further exploration in a clinical setting
Wada, Satoshi [Department of Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Harris, Timothy J.; Tryggestad, Erik [Department of Radiation Oncology and Molecular Radiation Sciences, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Yoshimura, Kiyoshi [Department of Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Zeng, Jing [Department of Radiation Oncology and Molecular Radiation Sciences, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Yen, Hung-Rong; Getnet, Derese; Grosso, Joseph F.; Bruno, Tullia C. [Department of Oncology, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); De Marzo, Angelo M. [Department of Pathology, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); and others
Purpose: To optimize the combination of ionizing radiation and cellular immunotherapy using a preclinical autochthonous model of prostate cancer. Methods and Materials: Transgenic mice expressing a model antigen under a prostate-specific promoter were treated using a platform that integrates cone-beam CT imaging with 3-dimensional conformal therapy. Using this technology we investigated the immunologic and therapeutic effects of combining ionizing radiation with granulocyte/macrophage colony-stimulating factor-secreting cellular immunotherapy for prostate cancer in mice bearing autochthonous prostate tumors. Results: The combination of ionizing radiation and immunotherapy resulted in a significant decrease in pathologic tumor grade and gross tumor bulk that was not evident with either single-modality therapy. Furthermore, combinatorial therapy resulted in improved overall survival in a preventive metastasis model and in the setting of established micrometastases. Mechanistically, combined therapy resulted in an increase of the ratio of effector-to-regulatory T cells for both CD4 and CD8 tumor-infiltrating lymphocytes. Conclusions: Our preclinical model establishes a potential role for the use of combined radiation-immunotherapy in locally advanced prostate cancer, which warrants further exploration in a clinical setting.
Raditic, Donna M; Bartges, Joseph W
Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. Published by Elsevier Inc.
Kurita, G P; Benthien, K S; Nordly, M
related to cancer, pain, neuraxial route, analgesic and side effects. The search was performed in PubMed, EMBASE, and Cochrane for the period until February 2014. Studies were analysed according to methods, results, quality of evidence, and strength of recommendation. RESULTS: The number of abstracts...... retrieved was 2147, and 84 articles were selected for full reading. The final selection comprised nine articles regarding randomised controlled trials (RCTs) divided in four groups: neuraxial combinations of opioid and adjuvant analgesic compared with neuraxial administration of opioid alone (n = 4); single...... neuraxial drug in bolus compared with continuous administration (n = 2); single neuraxial drug compared with neuraxial placebo (n = 1); and neuraxial opioid combined with or without adjuvant analgesic compared with other comprehensive medical management than neuraxial analgesics (n = 2). The RCTs presented...
Sigurbjörnsson, Omar F; Signorell, Ruth
Recent evidence for ethane clouds and condensation in Titan's atmosphere raise the question whether liquid ethane condensation nuclei and supercooled liquid ethane droplets exist under the prevalent conditions. We present laboratory studies on the phase behaviour of pure ethane aerosols and ethane aerosols formed in the presence of other ice nuclei under conditions relevant to Titan's atmosphere. Combining bath gas cooling with infrared spectroscopy, we find evidence for the existence of supercooled liquid ethane aerosol droplets. The observed homogeneous freezing rates imply that supercooled ethane could be a long-lived species in ethane-rich regions of Titan's atmosphere similar to supercooled water in the Earth's atmosphere.
Boekema, C.; Lichti, R.L.; Chan, K.C.B.; Brabers, V.A.M.; Denison, A.B.; Cooke, D.W.; Heffner, R.H.; Hutson, R.L.; Schillaci, M.E.
New muon-spin-relaxation (μSR) results on magnetite are reported and discussed in light of earlier Moessbauer, neutron, and μSR results. Modification of the μSR anomaly (observed at 247 K in zero field), when an external magnetic field is applied, provides evidence that the anomaly results from cross relaxation between the muon Larmor precession and the electron-correlation process in the B sublattice. The combined results strongly indicate that phonon-assisted electron hopping is the principal conduction mechanism above the Verwey transition temperature (T/sub V/). Together with theoretical evidence, these data support Mott's suggestion that above T/sub V/ magnetite is in the Wigner-glass state
Iepsen, Ulrik Winning; Jørgensen, Karsten Juhl; Ringbæk, Thomas
Resistance training (RT) is thought to be effective in preventing muscle depletion, whereas endurance training (ET) is known to improve exercise capacity and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). Our objectives were to assess the efficiency...... improvements in HRQoL, walking distance and exercise capacity. However, we found moderate quality evidence of a significant increase in leg muscle strength favouring a combination of RT and ET (standardized mean difference of 0.69 (95% confidence interval: 0.39-0.98). In conclusion, we found significantly...... increased leg muscle strength favouring a combination of RT with ET compared with ET alone. Therefore, we recommend that RT should be incorporated in rehabilitation of COPD together with ET....
Jeengar, Manish Kumar; Shrivastava, Shweta; Nair, Kala; Singareddy, Sreenivasa Reddy; Putcha, Uday Kumar; Talluri, M V N Kumar; Naidu, V G M; Sistla, Ramakrishna
The purpose of the present study is to evaluate the effect of emu oil on bioavailability of curcumin when co-administered and to evaluate the property that enhances the anti-inflammatory potential of curcumin. Oral bioavailability of curcumin in combination with emu oil was determined by measuring the plasma concentration of curcumin by HPLC. The anti-inflammatory potential was evaluated in carrageenan-induced paw edema model (acute model) and in Freund's complete adjuvant (FCA)-induced arthritis model (chronic model) in male SD rats. The anti-inflammatory potential of curcumin in combination with emu oil has been significantly increased in both acute and chronic inflammatory models as evident from inhibition of increase in paw volume, arthritic score, and expression of pro-inflammatory cytokines. The increased anti-inflammatory activity in combination therapy is due to enhanced bioavailability (5.2-fold compared to aqueous suspension) of curcumin by emu oil. Finally, it is concluded that the combination of emu oil with curcumin will be a promising approach for the treatment of arthritis.
Full Text Available A combined intervention of strength and endurance training is common practice in elite swimming training, but the scientific evidence is scarce. The influences between strength and endurance training have been investigated in other sports but the findings are scattered. Some state the interventions are negative to each other, some state there is no negative relationship and some find bisected and supplementary benefits from the combination when training is applied appropriately. The aim of this study was to investigate the impact of a combined intervention among competitive swimmers. 20 subjects assigned to a training intervention group (n = 11 or a control group (n = 9 from two different teams completed the study. Anthropometrical data, tethered swimming force, land strength, performance in 50m, 100m and 400m, work economy, peak oxygen uptake, stroke length and stroke rate were investigated in all subjects at pre- and post-test. A combined intervention of maximal strength and high aerobic intensity interval endurance training 2 sessions per week over 11 weeks in addition to regular training were used, while the control group continued regular practice with their respective teams. The intervention group improved land strength, tethered swimming force and 400m freestyle performance more than the control group. The improvement of the 400m was correlated with the improvement of tethered swimming force in the female part of the intervention group. No change occurred in stroke length, stroke rate, performance in 50m or 100m, swimming economy or peak oxygen uptake during swimming. Two weekly dry-land strength training sessions for 11 weeks increase tethered swimming force in competitive swimmers. This increment further improves middle distance swimming performance. 2 weekly sessions of high- intensity interval training does not improve peak oxygen uptake compared with other competitive swimmers
Conclusion: This is the first report demonstrating the efficacy of antimicrobial agents in the G. mellonella larvae model of infections caused by E. cloacae. Our study suggested that imipenem-colistin combination was highly active against E. cloacae both in vitro and in the simple invertebrate model, and provided preliminary in vivo evidence that such combination might be useful therapeutically.
Lewis, Sharon R; Schofield-Robinson, Oliver J; Alderson, Phil; Smith, Andrew F
Critically ill people are at increased risk of malnutrition. Acute and chronic illness, trauma and inflammation induce stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting. In addition, patient management in the intensive care unit (ICU) may also interrupt feeding routines. Methods to deliver nutritional requirements include provision of enteral nutrition (EN), or parenteral nutrition (PN), or a combination of both (EN and PN). However, each method is problematic. This review aimed to determine the route of delivery that optimizes uptake of nutrition. To compare the effects of enteral versus parenteral methods of nutrition, and the effects of enteral versus a combination of enteral and parenteral methods of nutrition, among critically ill adults, in terms of mortality, number of ICU-free days up to day 28, and adverse events. We searched CENTRAL, MEDLINE, and Embase on 3 October 2017. We searched clinical trials registries and grey literature, and handsearched reference lists of included studies and related reviews. We included randomized controlled studies (RCTs) and quasi-randomized studies comparing EN given to adults in the ICU versus PN or versus EN and PN. We included participants that were trauma, emergency, and postsurgical patients in the ICU. Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence with GRADE. We included 25 studies with 8816 participants; 23 studies were RCTs and two were quasi-randomized studies. All included participants were critically ill in the ICU with a wide range of diagnoses; mechanical ventilation status between study participants varied. We identified 11 studies awaiting classification for which we were unable to assess eligibility, and two ongoing studies.Seventeen studies compared EN versus PN, six compared EN versus EN and PN, two were multi-arm studies comparing EN versus PN
Hu, Qing; Huang, Zisheng; ten Teije, Annette; van Harmelen, Frank; Riaño, David; Lenz, Richard; Reichert, Manfred
Evidence-based medical guidelines are systematically developed recommendations with the aim to assist practitioner and patients decisions regarding appropriate health care for specific clinical circumstances, and are based on evidence described in medical research papers. Evidence-based medical
Full Text Available Christina Antza,1 Stella Stabouli,2 Vasilios Kotsis1 1Hypertension Center, Third Department of Medicine, Papageorgiou Hospital, 2First Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece Abstract: Hypertension is an important risk factor for premature death as it increases the probability of stroke, myocardial infarction, and heart failure. Antihypertensive drugs can decrease cardiovascular (CV morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain blood pressure (BP targets. Monotherapy can effectively reduce BP only in 20%–40% of patients. Multiple mechanisms including increased peripheral vascular resistance, increased cardiac work, and hypervolemia are involved in the pathogenesis of hypertension. Targeting multiple pathways may more potently reduce BP. Increasing the dose of a single agent in many cases does not provide the expected BP-lowering effect because the underlying mechanism of the BP increase is either different or already corrected with the lower dose. Moreover, drugs acting on different pathways may have synergistic effects and thus better control hypertension. It is well known that diuretics enhance the actions of renin–angiotensin aldosterone system and activate it as a feedback to the reduced circulated blood volume. The addition of a renin–angiotensin aldosterone system blocker to a diuretic may more effectively reduce BP because the system is upregulated. Reducing the maximal dose of an agent may also reduce possible side effects if they are dose dependent. The increased prevalence of peripheral edema with higher doses of calcium channel blockers (CCBs is reduced when renin–angiotensin aldosterone system blockers are added to CCBs through vein dilation. The effectiveness of the combination of enalapril with lercanidipine in reducing BP, the safety profile, and the use of the combination of angiotensin
Full Text Available Abstract Ataxia-telangiectasia (A-T is a complex multisystem disorder characterized by progressive neurological impairment, variable immunodeficiency and oculo-cutaneous telangiectasia. A-T is a member of chromosomal breakage syndromes and it is caused by a mutation in the ataxia-telangiectasia mutated (ATM gene. Because of a wide clinical heterogeneity, A-T is often difficult to diagnose in children. We report an unusual case of a 3-year-old boy affected by A-T who presented exclusively with extensive cutaneous granulomatosis and severe combined immunodeficiency, without neurological abnormalities, at the time of diagnosis. This case clearly emphasizes the variable presentation of A-T syndrome and highlights the difficulties in the early diagnosis of A-T. A-T should be considered in children with evidence of combined humoral and cellular immunodeficiency associated with unexplained skin granulomatous lesions, even in the absence of the classic features of this syndrome.
Full Text Available The multi-sensor data fusion technique plays a significant role in fault diagnosis and in a variety of such applications, and the Dempster–Shafer evidence theory is employed to improve the system performance; whereas, it may generate a counter-intuitive result when the pieces of evidence highly conflict with each other. To handle this problem, a novel multi-sensor data fusion approach on the basis of the distance of evidence, belief entropy and fuzzy preference relation analysis is proposed. A function of evidence distance is first leveraged to measure the conflict degree among the pieces of evidence; thus, the support degree can be obtained to represent the reliability of the evidence. Next, the uncertainty of each piece of evidence is measured by means of the belief entropy. Based on the quantitative uncertainty measured above, the fuzzy preference relations are applied to represent the relative credibility preference of the evidence. Afterwards, the support degree of each piece of evidence is adjusted by taking advantage of the relative credibility preference of the evidence that can be utilized to generate an appropriate weight with respect to each piece of evidence. Finally, the modified weights of the evidence are adopted to adjust the bodies of the evidence in the advance of utilizing Dempster’s combination rule. A numerical example and a practical application in fault diagnosis are used as illustrations to demonstrate that the proposal is reasonable and efficient in the management of conflict and fault diagnosis.
Osisanya, Ayo; Adewunmi, Abiodun T
The need to develop a measure of managing children with a single profile of auditory processing disorders (APDs), and differentiate between true and artefactual improvements necessitated the study. The study also sought to determine the efficacy of interventions - both single and combined on APD, against no-treatment. A randomised controlled trial of interventions (RCT) was adopted. Participants were randomly allocated to each of the intervention groups or the no intervention group. The 10 weeks intervention included 45 minutes three times a week therapeutic intervention on listening with noise and sound localisation ability in the home and school environments. 80 pupils (7-11 years) with a single profile of APD participated in the study. Treatments were effective on the cocktail party and sound localisation. The best result was realised with the combined therapy (CT), and there was no significant difference in performance in the remaining treatment groups. The intervention groups were beneficial to pupils with APD and should be adopted by clinicians.
Batura, Neha; Hill, Zelee; Haghparast-Bidgoli, Hassan; Lingam, Raghu; Colbourn, Timothy; Kim, Sungwook; Sikander, Siham; Pulkki-Brannstrom, Anni-Maria; Rahman, Atif; Kirkwood, Betty; Skordis-Worrall, Jolene
There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering the relative cost and cost-effectiveness of these interventions. An evidence gap in this area may deter large-scale implementation, particularly in low- and middle-income countries. We conduct a literature review to establish what is known about the cost-effectiveness of early childhood nutrition and development interventions. A set of predefined search terms and exclusion criteria standardized the search across five databases. The search identified 15 relevant articles. Of these, nine were from studies set in high-income countries and six in low- and middle-income countries. The articles either calculated the cost-effectiveness of nutrition-specific interventions (n = 8) aimed at improving child growth, or parenting interventions (stimulation) to improve early childhood development (n = 7). No articles estimated the cost-effectiveness of combined interventions. Comparing results within nutrition or stimulation interventions, or between nutrition and stimulation interventions was largely prevented by the variety of outcome measures used in these analyses. This article highlights the need for further evidence relevant to low- and middle-income countries. To facilitate comparison of cost-effectiveness between studies, and between contexts where appropriate, a move towards a common outcome measure such as the cost per disability-adjusted life years averted is advocated. Finally, given the increasing number of combined nutrition and stimulation interventions being tested, there is a significant need for evidence of cost
Silvestris, N; Maiello, E; De Vita, F; Cinieri, S; Santini, D; Russo, A; Tommasi, S; Azzariti, A; Numico, G; Pisconti, S; Petriella, D; Lorusso, V; Millaku, A; Colucci, G
Capecitabine is an orally administered fluoropyrimidine carbamate which has been developed as a prodrug of 5-FU with the goal to improve its tolerability and intratumoral drug concentration. The review aims to provide an evidence-based update of clinical trials investigating the clinical efficacy, adverse-event profile, dosage and administration of this drug, alone or in combination with conventional chemotherapeutics and/or new target-oriented drugs, in the management of colorectal cancer patients. Copyright © 2010 Elsevier Ltd. All rights reserved.
Criscuolo, Paola; Laursen, Keld; Reichstein, Toke
examine the effectiveness of different combinations of knowledge sources for achieving innovative performance. We suggest that combinations involving integrative search strategies – combining internal and external knowledge – are the most likely to generate product and process innovation. In this context......, we present the idea that cognitively distant knowledge sources are helpful for innovation only when used in conjunction with knowledge sources that are closer to the focal firm. We also find important differences between product and process innovation, with the former associated with broader searches......Searching for the most rewarding sources of innovative ideas remains a key challenge in management of technological innovation. Yet, little is known about which combinations of internal and external knowledge sources are triggers for innovation. Extending theories about searching for innovation, we...
Full Text Available Abstract Background Soil-transmitted helminth (STH infections are responsible for a huge public health burden, however treatment options are limited. The discovery and development of novel efficacious drugs or drug combinations for the treatment of STH infections therefore has a high research priority. Methods We studied drug combination effects using the main standard anthelmintics, albendazole, mebendazole, levamisole, pyrantel pamoate and ivermectin in the Trichuris muris model. Drug combinations were first tested in vitro and additive and synergistic combinations investigated further in vivo in female mice using ratios based on the ED50 of the respective drugs. Results In vitro all 10 combinations of the standard anthelmintics tested against T. muris revealed synergistic behavior. We identified three drug combinations in vivo as strongly synergistic, namely mebendazole-ivermectin (Combination index (CI=0.16, mebendazole-levamisole (CI=0.17 and albendazole-mebendazole (CI=0.23. For albendazole-ivermectin, moderate synergism was observed (CI=0.81 and for albendazole-levamisole a nearly additive effect was documented (CI=0.93 in vivo. Five combinations (albendazole-pyrantel pamoate, mebendazole-pyrantel pamoate, levamisole-pyrantel pamoate, levamisole-ivermectin and pyrantel pamoate-ivermectin were antagonistic in vivo. Conclusion Our results strengthen the evidence that combination chemotherapy might play a role in the treatment of Trichuris infections. Albendazole-mebendazole should be studied in greater detail in preclinical studies.
Cerasa, Antonio; Quattrone, Aldo
Essential tremor (ET) is the most common pathological tremor disorder in the world, and post-mortem evidence has shown that the cerebellum is the most consistent area of pathology in ET. In the last few years, advanced neuroimaging has tried to confirm this evidence. The aim of the present review is to discuss to what extent the evidence provided by this field of study may be generalised. We performed a systematic literature search combining the terms ET with the following keywords: MRI, VBM, MRS, DTI, fMRI, PET and SPECT. We summarised and discussed each study and placed the results in the context of existing knowledge regarding the cerebellar involvement in ET. A total of 51 neuroimaging studies met our search criteria, roughly divided into 19 structural and 32 functional studies. Despite clinical and methodological differences, both functional and structural imaging studies showed similar findings but without defining a clear topography of neurodegeneration. Indeed, the vast majority of studies found functional and structural abnormalities in several parts of the anterior and posterior cerebellar lobules, but it remains to be established to what degree these neural changes contribute to clinical symptoms of ET. Currently, advanced neuroimaging has confirmed the involvement of the cerebellum in pathophysiological processes of ET, although a high variability in results persists. For this reason, the translation of this knowledge into daily clinical practice is again partially limited, although new advanced multivariate neuroimaging approaches (machine-learning) are proving interesting changes of perspective.
Opiyo, Newton; Yamey, Gavin; Garner, Paul
-randomised trials, controlled before-after studies and interrupted-time-series studies that compared the effects of ACT price subsidies for private retailers to no subsidies or alternative ACT financing mechanisms were eligible for inclusion. Two authors independently screened and selected studies for inclusion. Data collection and analysis Two review authors independently extracted data, assessed study risk of bias and confidence in effect estimates (certainty of evidence) using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Main results We included four trials (two cluster-randomised trials reported in three articles and two non-randomised cluster trials). Three trials assessed retail sector ACT subsidies combined with supportive interventions (retail outlet provider training, community awareness and mass media campaigns). One trial assessed vouchers provided to households to purchase subsidised ACTs. Price subsidies ranged from 80% to 95%. One trial enrolled children under five years of age; the other three trials studied people of all age groups. The studies were done in rural districts in East Africa (Kenya, Uganda and Tanzania). In this East Africa setting, these ACT subsidy programmes increased the percentage of children under five years of age receiving ACTs on the day, or following day, of fever onset by 25 percentage points (95% confidence interval (CI) 14.1 to 35.9 percentage points; 1 study, high certainty evidence). This suggests that in practice, among febrile children under five years of age with an ACT usage rate of 5% without a subsidy, subsidy programmes would increase usage by between 19% and 41% over a one year period. The ACT subsidy programmes increased the percentage of retail outlets stocking ACTs for children under five years of age by 31.9 percentage points (95% CI 26.3 to 37.5 percentage points; 1 study, high certainty evidence). Effects on ACT stocking for patients of any age is unknown because the certainty of evidence was
Full Text Available Introduction: Evidence-based medicine (EBM is the ability and skill in using and integration of the best up-to-date evidences. The aim of this study was a systematic review of barriers, facilities, knowledge and attitude of EBM in Iran. Methods: In this study, database and manual search was used with keywords such as, "evidence-based, EBM, evidence-based nursing, evidence-based practice, evidence-based care, evidence-based activities, evidence-based education" and their combination with the keywords of the barrier, facilitator, attitude, awareness, prospective, knowledge, practice and Iran. The databases of SID (Scientific information database, Magiran, MEDLIB, PubMed, Google scholar, IranMedex and CINAHL (Cumulative index to nursing and allied health literature were used for data collection. Results: Finally, 28 papers were included in this study. The lack of facilities, time and skill in research methodology were the most important barriers to EBM. The most and least important factors were orderly creating ample opportunity and detecting needs and problems. The degree of familiarity with the terminology of evidence-based performance was low (44.2%. The textbooks have been considered as the most significant source of obtaining information. The level of awareness, knowledge, and evidence-based performance was less than 50.0%. Conclusion: There are many various barriers in use of EBM and healthcare providers despite the positive attitude toward EBM had a low level knowledge in EBM setting. Consideration of the importance of EBM proper planning and effective intervention are necessary to removing the barriers and increase the knowledge of healthcare providers.
Full Text Available Until quite recently, telephone surveys have typically relied on landline telephone numbers. However, with the increasing popularity and affordability of mobile phones, there has been a surge in households that do not have landline connections. Additionally, there has been a decline in the response rates and population coverage of landline telephone surveys, creating a challenge to collecting representative social data. Dual-frame telephone surveys that use both landline and mobile phone sampling frames can overcome the incompleteness of landline-only telephone sampling. However, surveying mobile phone users introduces new complexities in sampling, nonresponse measurement and statistical weighting. This article examines these issues and illustrates the consequences of failing to include mobile-phone-only users in telephone surveys using data from Australia. Results show that there are significant differences in estimates of populations’ characteristics when using information solely from the landline or mobile telephone sample. These biases in the population estimates are significantly reduced when data from the mobile and landline samples are combined and appropriate dual-frame survey estimators are used. The optimal choice of a dual-frame estimation strategy depends on the availability of good-quality information that can account for the differential patterns of nonresponse by frame.
Nie, Qi-Yang; Maurer, Mara; Müller, Hermann J; Conci, Markus
Illusory Kanizsa figures demonstrate that a perceptually completed whole is more than the sum of its composite parts. In the current study, we explored part/whole relationships in object completion using the configural superiority effect (CSE) with illusory figures (Pomerantz & Portillo, 2011). In particular, we investigated to which extent the CSE is modulated by closure in target and distractor configurations. Our results demonstrated a typical CSE, with detection of a configural whole being more efficient than the detection of a corresponding part-level target. Moreover, the CSE was more pronounced when grouped objects were presented in distractors rather than in the target. A follow-up experiment systematically manipulated closure in whole target or, respectively, distractor configurations. The results revealed the effect of closure to be again stronger in distractor, rather than in target configurations, suggesting that closure primarily affects the inhibition of distractors, and to a lesser extent the selection of the target. In addition, a drift-diffusion model analysis of our data revealed that efficient distractor inhibition expedites the rate of evidence accumulation, with closure in distractors particularly speeding the drift toward the decision boundary. In sum, our findings demonstrate that the CSE in Kanizsa figures derives primarily from the inhibition of closed distractor objects, rather than being driven by a conspicuous target configuration. Altogether, these results support a fundamental role of inhibition in driving configural superiority effects in visual search. Copyright © 2016 Elsevier B.V. All rights reserved.
Full Text Available Background: Kligman′s triple combination formula has been one of the most popular treatment options in melasma over the last three decades. The original Kligman′s formula has been modified in many ways over the years and the most recent modification that has been introduced is a triple combination of 2% hydroquinone, 0.025% tretinoin, and 1% mometasone. The use of this triple combination in patients with melasma has seen a sharp rise over the last few years and with this rampant use the side-effect profile of this triple combination has also come to the fore. Aim : The aim of the present study was to assess the overall safety of the mometasone-based triple combination treatment in the management of melasma. Materials and Methods: This retrospective study was performed on 60 patients of melasma who had used a mometasone-based triple combination treatment for at least 3 weeks anytime in the previous 1 year. The patients were given a preformed questionnaire wherein they assessed the overall effect of the triple combination treatment on their melasma during its use as well as after its withdrawal. The patients were specifically asked about the status of their disease as well as the sun sensitivity of their skin before and after the use of triple combination treatment. In addition, the patients were assessed by a single trained dermatologist for the presence of any adverse effects arising out of the triple combination treatment in the form of telangiectasia, hypertrichosis, acne, skin atrophy, etc. Results: Majority of patients (51.7% had used the combination treatment well beyond the recommended duration. About one-third (36.7% of the patients rated their melasma as worse at the time of filling the questionnaire as compared with their disease before the use of triple combination treatment. On clinical examination, the evidence of steroid side effects was seen in 26 patients (43.3%. Steroid-induced telangiectasia was the commonest finding, seen
Worldwide, children can be found who reported that they have memories of a previous life. More than 2,500 cases have been studied and their specifications have been published and preserved in the archives of the Division of Perceptual Studies at the University of Virginia (United States). Many of those children come from countries where the majority of the inhabitants believe in reincarnation, but others come from countries with different cultures and religions that reject it. In many cases, the revelations of the children have been verified and have corresponded to a particular individual, already dead. A good number of these children have marks and birth defects corresponding to wounds on the body of his previous personality. Many have behaviors related to their claims to their former life: phobias, philias, and attachments. Others seem to recognize people and places of his supposed previous life, and some of their assertions have been made under controlled conditions. The hypothesis of reincarnation is controversial. We can never say that it does not occur, or will obtain conclusive evidence that it happens. The cases that have been described so far, isolated or combined, do not provide irrefutable proof of reincarnation, but they supply evidence that suggest its reality.
Berrada, Ghita; van Keulen, Maurice; de Keijzer, Ander
The establishment of a medical diagnosis is an incremental process highly fraught with uncertainty. At each step of this painstaking process, it may be beneficial to be able to quantify the uncertainty linked to the diagnosis and steadily update the uncertainty estimation using available sources of
Kochli, Daniel E; Campbell, Tiffany L; Hollingsworth, Ethan W; Lab, Rain S; Postle, Abagail F; Perry, Megan M; Mordzinski, Victoria M; Quinn, Jennifer J
Mixed evidence exists regarding the role of N-methyl-D-aspartate (NMDA) receptors in memory reconsolidation. We provide no evidence that NMDA receptors are involved with memory reconsolidation, but instead demonstrate that prereactivation systemic MK-801 injection, combined with postreactivation intrabasolateral amygdala (BLA) cycloheximide infusion, produces a delayed potentiation of extinction learning. These data suggest that an interaction between NMDA antagonism and protein synthesis inhibition may enhance extinction by exerting effects outside of the intended reconsolidation manipulation window. The present work demonstrates a novel pharmacological enhancement of extinction, and underscores the importance of employing proper control procedures in reconsolidation research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Full Text Available Saliency detection is one of the most valuable research topics in computer vision. It focuses on the detection of the most significant objects/regions in images and reduces the computational time cost of getting the desired information from salient regions. Local saliency detection or common pattern discovery schemes were actively used by the researchers to overcome the saliency detection problems. In this paper, we propose a bottom-up saliency fusion method by taking into consideration the importance of the DS-Evidence (Dempster–Shafer (DS theory. Firstly, we calculate saliency maps from different algorithms based on the pixels-level, patches-level and region-level methods. Secondly, we fuse the pixels based on the foreground and background information under the framework of DS-Evidence theory (evidence theory allows one to combine evidence from different sources and arrive at a degree of belief that takes into account all the available evidence. The development inclination of image saliency detection through DS-Evidence theory gives us better results for saliency prediction. Experiments are conducted on the publicly available four different datasets (MSRA, ECSSD, DUT-OMRON and PASCAL-S. Our saliency detection method performs well and shows prominent results as compared to the state-of-the-art algorithms.
Gascon, Mireia; Vrijheid, Martine; Nieuwenhuijsen, Mark J
Urbanization and the shaping of the built environment have provided a number of socioeconomic benefits, but they have also brought unwanted side effects on health. We aimed to review the current epidemiological evidence of the associations between the built environment, closely related exposures, and child health. We focused on growth and obesity, neuropsychological development, and respiratory and immune health. We used existing review articles and supplemented these with relevant work published and not included in existing reviews. The present review shows that there is good evidence for an association between air pollution and fetal growth restriction and respiratory health, whereas for other exposure and outcome combinations, further evidence is needed. Future studies should make efforts to integrate the different built environment features and to include the evaluation of environments other than home, as well as accessibility, qualitative and perception assessment of the built environment, and, if possible, with improved and standardized tools to facilitate comparability between studies. Efforts are also needed to conduct longitudinal and intervention studies and to understand potential mechanisms behind the associations observed. Finally, studies in low- and middle-income countries are needed.
Jenkins, Melissa M.; Youngstrom, Eric A.; Youngstrom, Jennifer Kogos; Feeny, Norah C.; Findling, Robert L.
Bipolar disorder is frequently clinically diagnosed in youths who do not actually satisfy DSM-IV criteria, yet cases that would satisfy full DSM-IV criteria are often undetected clinically. Evidence-based assessment methods that incorporate Bayesian reasoning have demonstrated improved diagnostic accuracy, and consistency; however, their clinical utility is largely unexplored. The present study examines the effectiveness of promising evidence-based decision-making compared to the clinical gold standard. Participants were 562 youth, ages 5-17 and predominantly African American, drawn from a community mental health clinic. Research diagnoses combined semi-structured interview with youths’ psychiatric, developmental, and family mental health histories. Independent Bayesian estimates relied on published risk estimates from other samples discriminated bipolar diagnoses, Area Under Curve=.75, pbipolar illness, were significant. Bayesian risk estimates were highly correlated with logistic regression estimates using optimal sample weights, r=.81, p<.0005. Clinical and Bayesian approaches agree in terms of overall concordance and deciding next clinical action, even when Bayesian predictions are based on published estimates from clinically and demographically different samples. Evidence-based assessment methods may be useful in settings that cannot routinely employ gold standard assessments, and they may help decrease rates of overdiagnosis while promoting earlier identification of true cases. PMID:22004538
Armstrong, M. E. G.; Cairns, B. J.; Key, T. J.; Travis, R. C.
Background Shift work, including night work, has been hypothesized to increase the risk of chronic diseases, including cancer, cardiovascular disease (CVD), metabolic syndrome and diabetes. Recent reviews of evidence relating to these hypotheses have focussed on specific diseases or potential mechanisms, but no general summary of the current data on shift work and chronic disease has been published. Methods Systematic and critical reviews and recent original studies indexed in PubMed prior to 31 December 2009 were retrieved, aided by manual searches of reference lists. The main conclusions from reviews and principle results from recent studies are presented in text and tables. Results Published evidence is suggestive but not conclusive for an adverse association between night work and breast cancer but limited and inconsistent for cancers at other sites and all cancers combined. Findings on shift work, in relation to risks of CVD, metabolic syndrome and diabetes are also suggestive but not conclusive for an adverse relationship. Conclusions Heterogeneity of study exposures and outcomes and emphasis on positive but non-significant results make it difficult to draw general conclusions. Further data are needed for additional disease endpoints and study populations. PMID:21355031
Woldegebriel, Michael; Zomer, Paul; Mol, Hans G J; Vivó-Truyols, Gabriel
In this work, we introduce an automated, efficient, and elegant model to combine all pieces of evidence (e.g., expected retention times, peak shapes, isotope distributions, fragment-to-parent ratio) obtained from liquid chromatography-tandem mass spectrometry (LC-MS/MS/MS) data for screening purposes. Combining all these pieces of evidence requires a careful assessment of the uncertainties in the analytical system as well as all possible outcomes. To-date, the majority of the existing algorithms are highly dependent on user input parameters. Additionally, the screening process is tackled as a deterministic problem. In this work we present a Bayesian framework to deal with the combination of all these pieces of evidence. Contrary to conventional algorithms, the information is treated in a probabilistic way, and a final probability assessment of the presence/absence of a compound feature is computed. Additionally, all the necessary parameters except the chromatographic band broadening for the method are learned from the data in training and learning phase of the algorithm, avoiding the introduction of a large number of user-defined parameters. The proposed method was validated with a large data set and has shown improved sensitivity and specificity in comparison to a threshold-based commercial software package.
Duncombe, Daphne C
To examine perceived barriers and facilitators to implementing evidence-based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas. It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence-based practice in nursing. Descriptive, comparative study. Data were collected using self-administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5-point Likert-like scales were used to examine nurses' perceptions of barriers and facilitators of evidence-based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses. Participants were predominantly female (98.4%), in the 25 to implement evidence-based practice previously. The greatest barriers identified were as follows: "Inadequate resources for implementing research findings" (85.2%; n = 52) and "Inadequate training in research methods" (83.6%; n = 51). The top facilitators identified were as follows: "Training in research methods" (88.5%; n = 54) and "Organisational policies and protocols that are evidence-based" (86.9%; n = 53). Nurses generally expressed that they required additional training in research and evidence-based practice concepts. Although some nurses had a desire to implement evidence-based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence-based practice both at institutional and governmental levels. Successful adoption of evidence-based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence-based practice into nursing