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Sample records for models compared outcome

  1. Human experts' and a fuzzy model's predictions of outcomes of scoliosis treatment: a comparative analysis.

    Science.gov (United States)

    Chalmers, Eric; Pedrycz, Witold; Lou, Edmond

    2015-03-01

    Brace treatment is the most commonly used nonsurgical treatment for adolescents with idiopathic scoliosis. However, brace treatment is not always successful and the factors influencing its success are not completely clear. This makes treatment outcome difficult to predict. A computer model which can accurately predict treatment outcomes could potentially provide valuable treatment recommendations. This paper describes a fuzzy system that includes a prediction model and a decision support engine. The model was constructed using conditional fuzzy c-means clustering to discover patterns in retrospective patient data. The model's ability to predict treatment outcome was compared to the ability of eight Scoliosis experts. The model and experts each predicted treatment outcome retrospectively for 28 braced patients, and these predictions were compared to the actual outcomes. The model outperformed all but one expert individually and performed similarly to the experts as a group. These results suggest that the fuzzy model is capable of providing meaningful treatment recommendations. This study offers the first model for this application whose performance has been shown to be at or above the human expert level.

  2. Factors Associated With Rehabilitation Outcomes After Traumatic Brain Injury: Comparing Functional Outcomes Between TBIMS Centers Using Hierarchical Linear Modeling.

    Science.gov (United States)

    Dahdah, Marie N; Hofmann, Melissa; Pretz, Christopher; An, Viktoriya; Barnes, Sunni A; Bennett, Monica; Dreer, Laura E; Bergquist, Thomas; Shafi, Shahid

    To examine differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and factors that influence these differences using hierarchical linear modeling (HLM). Sixteen TBIMS centers. A total of 2056 individuals 16 years or older with moderate to severe traumatic brain injury (TBI) who received inpatient rehabilitation. Multicenter observational cohort study using HLM to analyze prospectively collected data. Functional Independence Measure and Disability Rating Scale total scores at discharge and 1 year post-TBI. Duration of posttraumatic amnesia (PTA) demonstrated a significant inverse relationship with functional outcomes. However, the magnitude of this relationship (change in functional status for each additional day in PTA) varied among centers. Functional status at discharge from rehabilitation and at 1 year post-TBI could be predicted using the slope and intercept of each TBIMS center for the duration of PTA, by comparing it against the average slope and intercept. HLM demonstrated center effect due to variability in the relationship between PTA and functional outcomes of patients. This variability is not accounted for in traditional linear regression modeling. Future studies examining variations in patient outcomes between centers should utilize HLM to measure the impact of additional factors that influence patient rehabilitation functional outcomes.

  3. Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care.

    Science.gov (United States)

    Conesa Ferrer, Ma Belén; Canteras Jordana, Manuel; Ballesteros Meseguer, Carmen; Carrillo García, César; Martínez Roche, M Emilia

    2016-08-26

    To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). 2 university hospitals in south-eastern Spain from April to October 2013. A correlational descriptive study. A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0-4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care

    Science.gov (United States)

    Conesa Ferrer, Ma Belén; Canteras Jordana, Manuel; Ballesteros Meseguer, Carmen; Carrillo García, César; Martínez Roche, M Emilia

    2016-01-01

    Objectives To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). Setting 2 university hospitals in south-eastern Spain from April to October 2013. Design A correlational descriptive study. Participants A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. Results The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0–4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. Conclusions The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model. PMID:27566632

  5. Comparing different approach and avoidance models of learning and personality in the prediction of work, university, and leadership outcomes.

    Science.gov (United States)

    Jackson, Chris J; Hobman, Elizabeth V; Jimmieson, Nerina L; Martin, Robin

    2009-05-01

    Jackson (2005) developed a hybrid model of personality and learning, known as the learning styles profiler (LSP) which was designed to span biological, socio-cognitive, and experiential research foci of personality and learning research. The hybrid model argues that functional and dysfunctional learning outcomes can be best understood in terms of how cognitions and experiences control, discipline, and re-express the biologically based scale of sensation-seeking. In two studies with part-time workers undertaking tertiary education (N = 137 and 58), established models of approach and avoidance from each of the three different research foci were compared with Jackson's hybrid model in their predictiveness of leadership, work, and university outcomes using self-report and supervisor ratings. Results showed that the hybrid model was generally optimal and, as hypothesized, that goal orientation was a mediator of sensation-seeking on outcomes (work performance, university performance, leader behaviours, and counterproductive work behaviour). Our studies suggest that the hybrid model has considerable promise as a predictor of work and educational outcomes as well as dysfunctional outcomes.

  6. Online Finance and Economics Courses: A Comparative Study of Course Satisfaction and Outcomes across Learning Models

    Science.gov (United States)

    Wiechowski, Linda; Washburn, Terri L.

    2014-01-01

    Student learning outcomes and course satisfaction scores are two key considerations when assessing the success of any degree program. This empirical study was based upon more than 3,000 end-of-semester course evaluations collected from 171 courses in the 2010-2011 academic year. The study, conducted at a Midwestern business college, considered the…

  7. Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care

    OpenAIRE

    Conesa Ferrer, Ma Belén; Canteras Jordana, Manuel; Ballesteros Meseguer, Carmen; Carrillo García, César; Martínez Roche, M Emilia

    2016-01-01

    Objectives To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). Setting 2 university hospitals in south-eastern Spain from April to October 2013. Design A correlational descriptive study. Participants A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. Results The differences in obstetrical results were (biom...

  8. [Comparative evaluation of health services outcomes].

    Science.gov (United States)

    Agabiti, Nera; Davoli, Marina; Fusco, Danilo; Stafoggia, Massimo; Perucci, Carlo A

    2011-01-01

    This introductory guide represents an operative tool to conduct epidemiological studies in the area of comparative outcomes evaluation. It is based on the experience of epidemiological research in this field conducted in Italy within national (BPAC-Esiti del bypass aortocoronarico, Progetto mattoni outcome, Progetto Progressi) or regional (P.Re.Val.E. Programma Regionale di Valutazione degli Esiti, Lazio) health care outcomes projects and the National outcome programme. This guide is aimed to all those interested in conducting or interpreting health care outcomes studies within different levels of the Italian NHS. It gives an introductory description of the operative steps to build outcome indicators and to perform comparative analyses, with the general objective of measuring and promoting improvement in health care. A specific emphasis is given to the use of routinely collected health care databases that have found widespread use for epidemiological purposes. This guide has two parts: part A includes an introduction and comments on critical methodological points, part B shows three example of epidemiological studies (A. Complications after cholecystectomy: comparison between two surgical techniques, B. 30-day mortality after acute myocardial infarction: comparison among hospitals, C. 30-day mortality after acute myocardial infarction: comparison between time periods). The online version of this guide is organised as a hypertext as practical instrument of appraisal.

  9. A Comparative Assessment of Observational Medical Outcomes Partnership and Mini-Sentinel Common Data Models and Analytics: Implications for Active Drug Safety Surveillance.

    Science.gov (United States)

    Xu, Yihua; Zhou, Xiaofeng; Suehs, Brandon T; Hartzema, Abraham G; Kahn, Michael G; Moride, Yola; Sauer, Brian C; Liu, Qing; Moll, Keran; Pasquale, Margaret K; Nair, Vinit P; Bate, Andrew

    2015-08-01

    An often key component to coordinating surveillance activities across distributed networks is the design and implementation of a common data model (CDM). The purpose of this study was to evaluate two drug safety surveillance CDMs from an ecosystem perspective to better understand how differences in CDMs and analytic tools affect usability and interpretation of results. Humana claims data from 2007 to 2012 were mapped to Observational Medical Outcomes Partnership (OMOP) and Mini-Sentinel CDMs. Data were described and compared at the patient level by source code and mapped concepts. Study cohort construction and effect estimates were also compared using two different analytical methods--one based on a new user design implementing a high-dimensional propensity score (HDPS) algorithm and the other based on univariate self-controlled case series (SCCS) design--across six established positive drug-outcome pairs to learn how differences in CDMs and analytics influence steps in the database analytic process and results. Claims data for approximately 7.7 million Humana health plan members were transformed into the two CDMs. Three health outcome cohorts and two drug cohorts showed differences in cohort size and constituency between Mini-Sentinel and OMOP CDMs, which was a result of multiple factors. Overall, the implementation of the HDPS procedure on Mini-Sentinel CDM detected more known positive associations than that on OMOP CDM. The SCCS method results were comparable on both CDMs. Differences in the implementation of the HDPS procedure between the two CDMs were identified; analytic model and risk period specification had a significant impact on the performance of the HDPS procedure on OMOP CDM. Differences were observed between OMOP and Mini-Sentinel CDMs. The analysis of both CDMs at the data model level indicated that such conceptual differences had only a slight but not significant impact on identifying known safety associations. Our results show that differences at

  10. The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes: an econometric and comparative risk assessment evaluation.

    Science.gov (United States)

    Smed, S; Scarborough, P; Rayner, M; Jensen, J D

    2016-06-01

    The World Health Organisation recommends governments to consider the use of fiscal policies to promote healthy eating. However, there is very limited evidence of the effect of food taxation in a real-life setting, as most evidence is based on simulation studies. The objective of this study is to evaluate the effect of the Danish tax on saturated fat in terms of changes in nutritional quality of the diet, that is, changes in saturated fat consumption, as well as other non-targeted dietary measures, and to model the associated changes in mortality for different age groups and genders. On the basis of household scanner data, we estimate the impact of the tax on consumption of saturated fat, unsaturated fat, salt, fruit, vegetables and fibre. The resultant changes in dietary quality are then used as inputs into a comparative risk assessment model (PRIME (Preventable Risk Integrated ModEl)) to estimate the effect of these changes on non-communicable diseases (NCDs) and mortality. The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable consumption increased, and salt consumption increased for most individuals, except younger females. We find a modelled reduction in mortality with 123 lives saved annually, 76 of them below 75 years equal to 0.4% of all deaths from NCDs. Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive, but minor, contribution to public health in Denmark.

  11. Protein Models Comparator

    CERN Document Server

    Widera, Paweł

    2011-01-01

    The process of comparison of computer generated protein structural models is an important element of protein structure prediction. It has many uses including model quality evaluation, selection of the final models from a large set of candidates or optimisation of parameters of energy functions used in template free modelling and refinement. Although many protein comparison methods are available online on numerous web servers, their ability to handle a large scale model comparison is often very limited. Most of the servers offer only a single pairwise structural comparison, and they usually do not provide a model-specific comparison with a fixed alignment between the models. To bridge the gap between the protein and model structure comparison we have developed the Protein Models Comparator (pm-cmp). To be able to deliver the scalability on demand and handle large comparison experiments the pm-cmp was implemented "in the cloud". Protein Models Comparator is a scalable web application for a fast distributed comp...

  12. State-and-transition simulation modeling to compare outcomes of alternative management scenarios under two natural disturbance regimes in a forested landscape in northeastern Wisconsin, USA

    Directory of Open Access Journals (Sweden)

    Amanda Swearingen

    2015-07-01

    Full Text Available Comparisons of the potential outcomes of multiple land management strategies and an understanding of the influence of potential increases in climate-related disturbances on these outcomes are essential for long term land management and conservation planning. To provide these insights, we developed an approach that uses collaborative scenario development and state-and-transition simulation modeling to provide land managers and conservation practitioners with a comparison of potential landscapes resulting from alternative management scenarios and climate conditions, and we have applied this approach in the Wild Rivers Legacy Forest (WRLF area in northeastern Wisconsin. Three management scenarios were developed with input from local land managers, scientists, and conservation practitioners: 1 continuation of current management, 2 expanded working forest conservation easements, and 3 cooperative ecological forestry. Scenarios were modeled under current climate with contemporary probabilities of natural disturbance and under increased probability of windthrow and wildfire that may result from climate change in this region. All scenarios were modeled for 100 years using the VDDT/TELSA modeling suite. Results showed that landscape composition and configuration were relatively similar among scenarios, and that management had a stronger effect than increased probability of windthrow and wildfire. These findings suggest that the scale of the landscape analysis used here and the lack of differences in predominant management strategies between ownerships in this region play significant roles in scenario outcomes. The approach used here does not rely on complex mechanistic modeling of uncertain dynamics and can therefore be used as starting point for planning and further analysis.

  13. Modelling lymphoma therapy and outcome.

    Science.gov (United States)

    Roesch, Katja; Hasenclever, Dirk; Scholz, Markus

    2014-02-01

    Dose and time intensifications of chemotherapy improved the outcome of lymphoma therapy. However, recent study results show that too intense therapies can result in inferior tumour control. We hypothesise that the immune system plays a key role in controlling residual tumour cells after treatment. More intense therapies result in a stronger depletion of immune cells allowing an early re-growth of the tumour.We propose a differential equations model of the dynamics and interactions of tumour and immune cells under chemotherapy. Major model features are an exponential tumour growth, a modulation of the production of effector cells by the presence of the tumour (immunogenicity), and mutual destruction of tumour and immune cells. Chemotherapy causes damage to both, immune and tumour cells. Growth rate, chemosensitivity, immunogenicity, and initial size of the tumour are assumed to be patient-specific, resulting in heterogeneity regarding therapy outcome. Maximum-entropy distributions of these parameters were estimated on the basis of clinical survival data. The resulting model can explain the outcome of five different chemotherapeutic regimens and corresponding hazard-ratios.We conclude that our model explains observed paradox effects in lymphoma therapy by the simple assumption of a relevant anti-tumour effect of the immune system. Heterogeneity of therapy outcomes can be explained by distributions of model parameters, which can be estimated on the basis of clinical survival data. We demonstrate how the model can be used to make predictions regarding yet untested therapy options.

  14. The Best Prediction Model for Trauma Outcomes of the Current Korean Population: a Comparative Study of Three Injury Severity Scoring Systems

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    Kyoungwon Jung

    2016-08-01

    Full Text Available Background: Injury severity scoring systems that quantify and predict trauma outcomes have not been established in Korea. This study was designed to determine the best system for use in the Korean trauma population. Methods: We collected and analyzed the data from trauma patients admitted to our institution from January 2010 to December 2014. Injury Severity Score (ISS, Revised Trauma Score (RTS, and Trauma and Injury Severity Score (TRISS were calculated based on the data from the enrolled patients. Area under the receiver operating characteristic (ROC curve (AUC for the prediction ability of each scoring system was obtained, and a pairwise comparison of ROC curves was performed. Additionally, the cut-off values were estimated to predict mortality, and the corresponding accuracy, positive predictive value, and negative predictive value were obtained. Results: A total of 7,120 trauma patients (6,668 blunt and 452 penetrating injuries were enrolled in this study. The AUCs of ISS, RTS, and TRISS were 0.866, 0.894, and 0.942, respectively, and the prediction ability of the TRISS was significantly better than the others (p < 0.001, respectively. The cut-off value of the TRISS was 0.9082, with a sensitivity of 81.9% and specificity of 92.0%; mortality was predicted with an accuracy of 91.2%; its positive predictive value was the highest at 46.8%. Conclusions: The results of our study were based on the data from one institution and suggest that the TRISS is the best prediction model of trauma outcomes in the current Korean population. Further study is needed with more data from multiple centers in Korea.

  15. Comparing root architectural models

    Science.gov (United States)

    Schnepf, Andrea; Javaux, Mathieu; Vanderborght, Jan

    2017-04-01

    Plant roots play an important role in several soil processes (Gregory 2006). Root architecture development determines the sites in soil where roots provide input of carbon and energy and take up water and solutes. However, root architecture is difficult to determine experimentally when grown in opaque soil. Thus, root architectural models have been widely used and been further developed into functional-structural models that are able to simulate the fate of water and solutes in the soil-root system (Dunbabin et al. 2013). Still, a systematic comparison of the different root architectural models is missing. In this work, we focus on discrete root architecture models where roots are described by connected line segments. These models differ (a) in their model concepts, such as the description of distance between branches based on a prescribed distance (inter-nodal distance) or based on a prescribed time interval. Furthermore, these models differ (b) in the implementation of the same concept, such as the time step size, the spatial discretization along the root axes or the way stochasticity of parameters such as root growth direction, growth rate, branch spacing, branching angles are treated. Based on the example of two such different root models, the root growth module of R-SWMS and RootBox, we show the impact of these differences on simulated root architecture and aggregated information computed from this detailed simulation results, taking into account the stochastic nature of those models. References Dunbabin, V.M., Postma, J.A., Schnepf, A., Pagès, L., Javaux, M., Wu, L., Leitner, D., Chen, Y.L., Rengel, Z., Diggle, A.J. Modelling root-soil interactions using three-dimensional models of root growth, architecture and function (2013) Plant and Soil, 372 (1-2), pp. 93 - 124. Gregory (2006) Roots, rhizosphere and soil: the route to a better understanding of soil science? European Journal of Soil Science 57: 2-12.

  16. The comparative effects of group prenatal care on psychosocial outcomes.

    Science.gov (United States)

    Heberlein, Emily C; Picklesimer, Amy H; Billings, Deborah L; Covington-Kolb, Sarah; Farber, Naomi; Frongillo, Edward A

    2016-04-01

    To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group

  17. Comparing Predictions and Outcomes : Theory and Application to Income Changes

    NARCIS (Netherlands)

    Das, J.W.M.; Dominitz, J.; van Soest, A.H.O.

    1997-01-01

    Household surveys often elicit respondents' intentions or predictions of future outcomes. The survey questions may ask respondents to choose among a selection of (ordered) response categories. If panel data or repeated cross-sections are available, predictions may be compared with realized outcomes.

  18. Social outcome compared in psychotic and nonpsychotic bipolar I patients.

    Science.gov (United States)

    Rosen, L N; Rosenthal, N E; Dunner, D L; Fieve, R R

    1983-05-01

    Eighty-nine bipolar I patients were given a structured interview, the Schedule for Affective Disorders and Schizophrenia. Those who had experienced delusions or hallucinations at some time during the course of their illness were designated "psychotic," and those who had not were designated "nonpsychotic." The two groups were compared with regard to a number of outcome variables as well as age, age at first treatment, and duration of illness. The psychotic group had significantly poorer outcome in terms of social functioning. Although age, age at first treatment, and duration of illness distinguished between the two groups of patients, statistical analyses indicated that these variables did not account for differences in social outcome.

  19. A prospective study comparing the predictions of doctors versus models for treatment outcome of lung cancer patients: A step toward individualized care and shared decision making

    NARCIS (Netherlands)

    C. Oberije (Cary); G.I. Nalbantov (Georgi); A.T. den Dekker (Alexander); L. Boersma (Liesbeth); J.H. Borger (Jacques); B. Reymen (Bart); A. van Baardwijk (Angela); R. Wanders (Rinus); D.K.M. de Ruysscher (Dirk); E.W. Steyerberg (Ewout); A.M.C. Dingemans (Anne-Marie); P. Lambin (Philippe)

    2014-01-01

    textabstractBackground: Decision Support Systems, based on statistical prediction models, have the potential to change the way medicine is being practiced, but their application is currently hampered by the astonishing lack of impact studies. Showing the theoretical benefit of using these models cou

  20. Comparing linear probability model coefficients across groups

    DEFF Research Database (Denmark)

    Holm, Anders; Ejrnæs, Mette; Karlson, Kristian Bernt

    2015-01-01

    This article offers a formal identification analysis of the problem in comparing coefficients from linear probability models between groups. We show that differences in coefficients from these models can result not only from genuine differences in effects, but also from differences in one or more...... of the following three components: outcome truncation, scale parameters and distributional shape of the predictor variable. These results point to limitations in using linear probability model coefficients for group comparisons. We also provide Monte Carlo simulations and real examples to illustrate...... these limitations, and we suggest a restricted approach to using linear probability model coefficients in group comparisons....

  1. Comparing different dynamic stall models

    Energy Technology Data Exchange (ETDEWEB)

    Holierhoek, J.G. [Unit Wind Energy, Energy research Centre of the Netherlands, ZG, Petten (Netherlands); De Vaal, J.B.; Van Zuijlen, A.H.; Bijl, H. [Aerospace Engineering, Delft University of Technology, Delft (Netherlands)

    2012-07-16

    The dynamic stall phenomenon and its importance for load calculations and aeroelastic simulations is well known. Different models exist to model the effect of dynamic stall; however, a systematic comparison is still lacking. To investigate if one is performing better than another, three models are used to simulate the Ohio State University measurements and a set of data from the National Aeronautics and Space Administration Ames experimental study of dynamic stall and compare results. These measurements were at conditions and for aerofoils that are typical for wind turbines, and the results are publicly available. The three selected dynamic stall models are the ONERA model, the Beddoes-Leishman model and the Snel model. The simulations show that there are still significant differences between measurements and models and that none of the models is significantly better in all cases than the other models. Especially in the deep stall regime, the accuracy of each of the dynamic stall models is limited.

  2. Comparative Protein Structure Modeling Using MODELLER.

    Science.gov (United States)

    Webb, Benjamin; Sali, Andrej

    2016-06-20

    Comparative protein structure modeling predicts the three-dimensional structure of a given protein sequence (target) based primarily on its alignment to one or more proteins of known structure (templates). The prediction process consists of fold assignment, target-template alignment, model building, and model evaluation. This unit describes how to calculate comparative models using the program MODELLER and how to use the ModBase database of such models, and discusses all four steps of comparative modeling, frequently observed errors, and some applications. Modeling lactate dehydrogenase from Trichomonas vaginalis (TvLDH) is described as an example. The download and installation of the MODELLER software is also described. © 2016 by John Wiley & Sons, Inc.

  3. Is it Worth Comparing Different Bankruptcy Models?

    Directory of Open Access Journals (Sweden)

    Miroslava Dolejšová

    2015-01-01

    Full Text Available The aim of this paper is to compare the performance of small enterprises in the Zlín and Olomouc Regions. These enterprises were assessed using the Altman Z-Score model, the IN05 model, the Zmijewski model and the Springate model. The batch selected for this analysis included 16 enterprises from the Zlín Region and 16 enterprises from the Olomouc Region. Financial statements subjected to the analysis are from 2006 and 2010. The statistical data analysis was performed using the one-sample z-test for proportions and the paired t-test. The outcomes of the evaluation run using the Altman Z-Score model, the IN05 model and the Springate model revealed the enterprises to be financially sound, but the Zmijewski model identified them as being insolvent. The one-sample z-test for proportions confirmed that at least 80% of these enterprises show a sound financial condition. A comparison of all models has emphasized the substantial difference produced by the Zmijewski model. The paired t-test showed that the financial performance of small enterprises had remained the same during the years involved. It is recommended that small enterprises assess their financial performance using two different bankruptcy models. They may wish to combine the Zmijewski model with any bankruptcy model (the Altman Z-Score model, the IN05 model or the Springate model to ensure a proper method of analysis.

  4. Revisiting the comparative outcomes of workplace aggression and sexual harassment.

    Science.gov (United States)

    Dionisi, Angela M; Barling, Julian; Dupré, Kathryne E

    2012-10-01

    We focus on the differential outcomes associated with experiencing workplace aggression and sexual harassment by a supervisor. To do so, we identify and empirically address several issues within current workplace aggression and sexual harassment research, including the need to (a) conceptualize their multidimensional nature, (b) contrast comparable dimensions between the two, (c) recognize and control for covictimization, and (d) consider the role of target gender. Data were analyzed using multiple regression and dominance analyses on a sample of 467 employed women (M age = 40 years). Results showed that all forms of sexual harassment were more strongly associated with work withdrawal and psychological well-being than comparable forms of workplace aggression. Nonphysical workplace aggression accounted for more of the variance in attitudinal outcomes (job, coworker and supervisor satisfaction, intent to quit, commitment) than nonphysical sexual harassment. Sexual harassment accounted for more of the variance than workplace aggression in all outcomes when the harassment and aggression involved some form of threatened or actual physical contact. Conceptual and methodological issues are discussed.

  5. Comparing coefficients of nested nonlinear probability models

    DEFF Research Database (Denmark)

    Kohler, Ulrich; Karlson, Kristian Bernt; Holm, Anders

    2011-01-01

    In a series of recent articles, Karlson, Holm and Breen have developed a method for comparing the estimated coeffcients of two nested nonlinear probability models. This article describes this method and the user-written program khb that implements the method. The KHB-method is a general decomposi......In a series of recent articles, Karlson, Holm and Breen have developed a method for comparing the estimated coeffcients of two nested nonlinear probability models. This article describes this method and the user-written program khb that implements the method. The KHB-method is a general...... decomposition method that is unaffected by the rescaling or attenuation bias that arise in cross-model comparisons in nonlinear models. It recovers the degree to which a control variable, Z, mediates or explains the relationship between X and a latent outcome variable, Y*, underlying the nonlinear probability...

  6. Discounting Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Events that occur over a period of time can be described either as sequences of outcomes at discrete times or as functions of outcomes in an interval of time. This paper presents discounting models for events of the latter type. Conditions on preferences are shown to be satisfied if and only if t...

  7. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, Linda

    1999-01-01

    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients...... and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty...

  8. Driving lean and green project outcomes using BIM: A qualitative comparative analysis

    Directory of Open Access Journals (Sweden)

    Ritu Ahuja

    2017-06-01

    Full Text Available Driven by a plethora of external and internal influences, the construction industry has independently embraced lean principles and green initiatives. Prima facie significant synergies have been reported between these two paradigms. It is foreseen that when tapped and adopted in unison, these paradigms may yield additional benefits for the construction projects. This synergy is investigated in this research. Further this study identifies and proposes Building Information Modelling (BIM as an enabler for gaining lean and green project outcomes. The study uses crisp set qualitative comparative analysis (csQCA method for exploring the causal combinations of different BIM capabilities and asserts that causal combinations of four BIM capabilities: MEP system modelling, energy and environment analysis, constructability analysis and structural analysis, when implemented on construction projects can lead to lean and green outcomes. With the help of sixteen cases it is shown that adoption of BIM leads to improved project outcomes especially ones targeting lean and green aspects.

  9. Measuring, comparing and improving clinical outcomes in gastrointestinal cancer surgery

    NARCIS (Netherlands)

    Henneman, D.

    2016-01-01

    In this thesis, hospital variation concerning various surgical outcomes is illustrated, thereby exploring the usability of these outcomes for hospital comparisons, both from a clinical and methodological point of view. Moreover, the studies provide insight in risk factors for adverse events in color

  10. Measuring, comparing and improving clinical outcomes in gastrointestinal cancer surgery

    OpenAIRE

    Henneman, D.

    2016-01-01

    In this thesis, hospital variation concerning various surgical outcomes is illustrated, thereby exploring the usability of these outcomes for hospital comparisons, both from a clinical and methodological point of view. Moreover, the studies provide insight in risk factors for adverse events in colorectal and oesophageal cancer surgery, focusing on the mechanism behind postoperative complications leading to mortality or not.

  11. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis.

    Science.gov (United States)

    Koch, Michael; Kohnle, Matthias; Trapp, Rudolf; Haastert, Burkhard; Rump, Lars Christian; Aker, Sendogan

    2012-01-01

    The impact of dialysis modality on outcome, especially on infection early in the course of dialysis, in unplanned acute dialysis initiation has not been well evaluated. The aim of the study was to compare the rates and causes of mortality and morbidity in incident dialysis patients started unplanned acute peritoneal dialysis (PD) or haemodialysis (HD). In this observational cohort study, incident dialysis patients with initiation of unplanned and acute PD (n = 66) or HD (n = 57) at a single centre from March 2005 to June 2010 were included and followed up for 6 months (0-183 days, mean follow-up time 4.72 months). For PD, surgically placed Tenckhoff catheters were used. All HD patients were dialysed with a central venous catheter (non-tunnelled or tunnelled). There were no significant differences in terms of gender, age and prevalence of diabetes mellitus in either group. The prevalence of heart failure [New York Heart Association (NYHA) Stage III-IV] was significantly higher in the PD group (73 versus 46% in HD group, P dialysis, n = 44 (35.8%) died during the follow-up period of 0-183 days. There were no significant difference in half-year mortality in n = 20 PD patients (30.3%) versus n = 24 HD patients (42.1%) (P = 0.19). The cardiovascular mortality in PD and HD patients were 9.1 and 10.5%, respectively (P = 1.00). Overall mortality due to infection was higher in the HD (17.5%) versus in the PD group (9.1%), however, not significant (P = 0.19). HD patients had significantly higher probability of bacteraemia in the first 183 days compared to PD patients (21.1 versus 3.0%, P dialysis, male sex, heart failure (NYHA III-IV), diabetes, malignancy and peripheral arterial occlusive disease Stage IV. There were high proportions of hospitalization after the initiation of dialysis in both groups (PD 75.0% and HD 67.3%, P = 0.40). Univariate and multiple regression analyses revealed only age at initiation of dialysis to be significantly associated with overall mortality

  12. Α Markov model for longitudinal studies with incomplete dichotomous outcomes.

    Science.gov (United States)

    Efthimiou, Orestis; Welton, Nicky; Samara, Myrto; Leucht, Stefan; Salanti, Georgia

    2017-03-01

    Missing outcome data constitute a serious threat to the validity and precision of inferences from randomized controlled trials. In this paper, we propose the use of a multistate Markov model for the analysis of incomplete individual patient data for a dichotomous outcome reported over a period of time. The model accounts for patients dropping out of the study and also for patients relapsing. The time of each observation is accounted for, and the model allows the estimation of time-dependent relative treatment effects. We apply our methods to data from a study comparing the effectiveness of 2 pharmacological treatments for schizophrenia. The model jointly estimates the relative efficacy and the dropout rate and also allows for a wide range of clinically interesting inferences to be made. Assumptions about the missingness mechanism and the unobserved outcomes of patients dropping out can be incorporated into the analysis. The presented method constitutes a viable candidate for analyzing longitudinal, incomplete binary data.

  13. Worthing Physiological Score vs Revised Trauma Score in Outcome Prediction of Trauma patients; a Comparative Study

    Science.gov (United States)

    Nakhjavan-Shahraki, Babak; Yousefifard, Mahmoud; Hajighanbari, Mohammad Javad; Karimi, Parviz; Baikpour, Masoud; Mirzay Razaz, Jalaledin; Yaseri, Mehdi; Shahsavari, Kavous; Mahdizadeh, Fatemeh; Hosseini, Mostafa

    2017-01-01

    Introduction: Awareness about the outcome of trauma patients in the emergency department (ED) has become a topic of interest. Accordingly, the present study aimed to compare the rapid trauma score (RTS) and worthing physiological scoring system (WPSS) in predicting in-hospital mortality and poor outcome of trauma patients. Methods: In this comparative study trauma patients brought to five EDs in different cities of Iran during the year 2016 were included. After data collection, discriminatory power and calibration of the models were assessed and compared using STATA 11. Results: 2148 patients with the mean age of 39.50±17.27 years were included (75.56% males). The AUC of RTS and WPSS models for prediction of mortality were 0.86 (95% CI: 0.82-0.90) and 0.91 (95% CI: 0.87-0.94), respectively (p=0.006). RTS had a sensitivity of 71.54 (95% CI: 62.59-79.13) and a specificity of 97.38 (95% CI: 96.56-98.01) in prediction of mortality. These measures for the WPSS were 87.80 (95% CI: 80.38-92.78) and 83.45 (95% CI: 81.75-85.04), respectively. The AUC of RTS and WPSS in predicting poor outcome were 0.81 (95% CI: 0.77-0.85) and 0.89 (95% CI: 0.85-0.92), respectively (p<0.0001). Conclusion: The findings showed a higher prognostic value for the WPSS model in predicting mortality and severe disabilities in trauma patients compared to the RTS model. Both models had good overall performance in prediction of mortality and poor outcome. PMID:28286838

  14. Challenges conducting comparative effectiveness research: the Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE experience

    Directory of Open Access Journals (Sweden)

    Friedly JL

    2014-05-01

    Full Text Available Janna L Friedly,1,4 Zoya Bauer,2,4 Bryan A Comstock,3,4 Emily DiMango,5 Assiamira Ferrara,6 Susan S Huang,7 Elliot Israel,8 Jeffrey G Jarvik,2,4 Andrew A Nierenberg,9 Michael K Ong,10 David F Penson,11 Rebecca Smith-Bindman,12 Arthur E Stillman,13 William M Vollmer,6 Stephen M Warren,14 Chunliu Zhan,15 David Chu-Wen Hsia,15 Anne Trontell15 1Department of Rehabilitation Medicine, 2Department of Radiology, 3Department of Biostatistics, 4Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, 5Columbia University Medical Center, New York, NY, 6Kaiser Foundation Research Institute, Oakland, 7Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, 8Harvard Medical School, Pulmonary and Critical Care, Allergy and Immunology, Brigham and Women's Hospital, 9Massachusetts General Hospital, Boston, MA, 10Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 11Vanderbilt University and Tennessee Valley VAHCC, Nashville, TN, 12Departments of Radiology and Biomedical Imaging, Health Policy, Epidemiology and Biostatistics, University of California, San Francisco, SF, 13Emory University, Atlanta, GA, 14Department of Plastic Surgery, Division of Clinical and Translational Research, NYU Langone Medical Center, New York, NY, 15Agency for Healthcare Research and Quality, Rockville, MD, USA Abstract: The Clinical and Health Outcomes Initiative in Comparative Effectiveness (CHOICE program, which includes 12 ongoing comparative effectiveness research (CER trials funded by the Agency for Healthcare Research and Quality under the American Recovery and Reinvestment Act of 2009, has had firsthand experience in dealing with the unique challenges of conducting CER since the trials started in the fall of 2010. This paper will explore the collective experience

  15. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients.

    NARCIS (Netherlands)

    Westerveld, L.A.; van Bemmel, J.C.; Dhert, W.J.A.; Öner, F.C.; Verlaan, J.J.

    2014-01-01

    Background context The clinical outcome of patients with ankylosing spinal disorders (ASDs) sustaining a spinal fracture has been described to be worse compared with the general trauma population. Purpose To investigate clinical outcome (neurologic deficits, complications, and mortality) after spina

  16. Simulation modeling of outcomes and cost effectiveness.

    Science.gov (United States)

    Ramsey, S D; McIntosh, M; Etzioni, R; Urban, N

    2000-08-01

    Modeling will continue to be used to address important issues in clinical practice and health policy issues that have not been adequately studied with high-quality clinical trials. The apparent ad hoc nature of models belies the methodologic rigor that is applied to create the best models in cancer prevention and care. Models have progressed from simple decision trees to extremely complex microsimulation analyses, yet all are built using a logical process based on objective evaluation of the path between intervention and outcome. The best modelers take great care to justify both the structure and content of the model and then test their assumptions using a comprehensive process of sensitivity analysis and model validation. Like clinical trials, models sometimes produce results that are later found to be invalid as other data become available. When weighing the value of models in health care decision making, it is reasonable to consider the alternatives. In the absence of data, clinical policy decisions are often based on the recommendations of expert opinion panels or on poorly defined notions of the standard of care or medical necessity. Because such decision making rarely entails the rigorous process of data collection, synthesis, and testing that is the core of well-conducted modeling, it is usually not possible for external audiences to examine the assumptions and data that were used to derive the decisions. One of the modeler's most challenging tasks is to make the structure and content of the model transparent to the intended audience. The purpose of this article is to clarify the process of modeling, so that readers of models are more knowledgeable about their uses, strengths, and limitations.

  17. Overview of cost-consequence modeling in outcomes research.

    Science.gov (United States)

    Stergachis, A

    1995-01-01

    Outcomes research has developed in response to the need for information on costs, risks, and benefits of clinical treatments, including data regarding the effectiveness of prescription drugs. It attempts to consider more than the biologic effects of pharmaceuticals, that is, to encompass wider measures of the results of their use, issues that are not routinely addressed during clinical trials. Cost-effectiveness analysis compares the outcome of different treatment options in terms of monetary cost per unit of effectiveness. Examples of measures of effectiveness are years of life saved, number of days of hospitalization avoided, and number of treatment successes. Cost-consequence models, also referred to as cost-outcome models, deal with costs and a variety of outcomes ranging from clinical to humanistic. Direct medical costs are those for prevention, detection, treatment, and rehabilitation; they are amounts spent to treat an illness, including hospitalization, professional services, pharmaceuticals, and medical supplies. Indirect medical costs are associated with changes in productivity, such as earnings lost because of illness. Humanistic outcomes deal primarily with functional status, quality of life, and satisfaction, and may include pain, anxiety, self-esteem, ability to carry out normal activities, and overall impressions. Since it is not possible to study all effects of treatments with clinical trials, modeling techniques are useful in making therapeutic decisions.

  18. Comparing Distributions of Environmental Outcomes for Regulatory Environmental Justice Analysis

    Directory of Open Access Journals (Sweden)

    Glenn Sheriff

    2011-05-01

    Full Text Available Economists have long been interested in measuring distributional impacts of policy interventions. As environmental justice (EJ emerged as an ethical issue in the 1970s, the academic literature has provided statistical analyses of the incidence and causes of various environmental outcomes as they relate to race, income, and other demographic variables. In the context of regulatory impacts, however, there is a lack of consensus regarding what information is relevant for EJ analysis, and how best to present it. This paper helps frame the discussion by suggesting a set of questions fundamental to regulatory EJ analysis, reviewing past approaches to quantifying distributional equity, and discussing the potential for adapting existing tools to the regulatory context.

  19. 隐形矫治器和传统金属矫治器的疗效比较%Assessment of Invisalign Treatment Outcomes Compared with Braces by Using the ABO Model Grading System

    Institute of Scientific and Technical Information of China (English)

    林佳强; 周昱

    2014-01-01

    目的:应用美国ABO客观评分系统,对无托槽隐形矫治器和传统金属矫治器的矫治效果进行评价。方法选择120例成人轻中度错合畸形患者,分为无托槽隐形矫治器组和传统矫治器组各60例。用差异系数评价错合畸形严重程度, OGS评价治疗结果。结果无托槽隐形矫治器可以很好地矫治轻中度错合畸形,与传统金属托槽矫治器无统计学差异。结论无托槽隐形矫治器对轻中度错合畸形临床矫治效果可达到传统矫治器矫治的效果。%Objective The aim of this study is to assessment treatment -outcome of invisalign treatment compared with braces by ABO .Methods This retrospective study select 2 groups of 120 patients ( invisalign and braces groups including both 60 patients ) were evaluated by using methods from the American Board of Orthodontics .The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion . The objective grading system ( OGS ) was used to systematically grade posttreatment records .Statistical analyses evaluated treatment outcome of invisalign compared with braces .Results The invisalign group significant improve results and was no difference between both groups .Conclusions According to the OGS , invisalign treat malocclusions as well as braces in this sample .

  20. Employment Satisfaction and Health Outcomes among Professional Iraqi refugees as compared to Immigrants

    Science.gov (United States)

    Jamil, Hikmet; Aldhalimi, Abir; Arnetz, Bengt B.

    2012-01-01

    This study investigates employment and health outcomes in Iraqi refugees compared to Iraqi immigrants. We surveyed 148 Iraqi professional refugees and 111 Iraqi professional immigrants residing in the U.S. We hypothesized that Iraqi refugees would report lower employment and worse self-rated health as compared to Iraqi immigrants. Logistic Regression was used to test various models. Results showed that more immigrants were employed, as well as employed in their original profession as compared to refugees. Regardless of immigration status, participants' age and the way they rated their job played a larger role in health. The study is the first to demonstrate that, controlling for professional, ethnic and cultural background, there are unknown mechanisms resulting in lower employment and skilled employment in refugees as compared to matched immigrant controls. Furthermore, satisfaction with the new work appears more important than employment per se. PMID:24683383

  1. Variable selection for propensity score models when estimating treatment effects on multiple outcomes: a simulation study.

    Science.gov (United States)

    Wyss, Richard; Girman, Cynthia J; LoCasale, Robert J; Brookhart, Alan M; Stürmer, Til

    2013-01-01

    It is often preferable to simplify the estimation of treatment effects on multiple outcomes by using a single propensity score (PS) model. Variable selection in PS models impacts the efficiency and validity of treatment effects. However, the impact of different variable selection strategies on the estimated treatment effects in settings involving multiple outcomes is not well understood. The authors use simulations to evaluate the impact of different variable selection strategies on the bias and precision of effect estimates to provide insight into the performance of various PS models in settings with multiple outcomes. Simulated studies consisted of dichotomous treatment, two Poisson outcomes, and eight standard-normal covariates. Covariates were selected for the PS models based on their effects on treatment, a specific outcome, or both outcomes. The PSs were implemented using stratification, matching, and weighting (inverse probability treatment weighting). PS models including only covariates affecting a specific outcome (outcome-specific models) resulted in the most efficient effect estimates. The PS model that only included covariates affecting either outcome (generic-outcome model) performed best among the models that simultaneously controlled measured confounding for both outcomes. Similar patterns were observed over the range of parameter values assessed and all PS implementation methods. A single, generic-outcome model performed well compared with separate outcome-specific models in most scenarios considered. The results emphasize the benefit of using prior knowledge to identify covariates that affect the outcome when constructing PS models and support the potential to use a single, generic-outcome PS model when multiple outcomes are being examined. Copyright © 2012 John Wiley & Sons, Ltd.

  2. Outcome Modeling Using Clinical DVH Data

    CERN Document Server

    Gordon, JJ

    2015-01-01

    Purpose: To quantify the ability of correlation and regression analysis to extract the normal lung dose-response function from dose volume histogram (DVH) data. Methods: A local injury model is adopted, in which radiation-induced damage (functional loss) G is the integral of the DVH with function R(D). RP risk is H(G) where H() is the sigmoid cumulative distribution of functional reserve. RP incidence is a Bernoulli function of risk. A homogeneous patient cohort is assumed, allowing non-dose-related factors to be ignored. Clinically realistic DVHs are combined with the injury model to simulate RP data. Results: Correlation analysis is often used to identify predictor variables that are correlated with outcome, for inclusion in a predictive model. In the local injury model, all DVH metrics VD contribute to damage. Correlation analysis therefore has limited value. The subset of VD significantly correlated with incidence varies randomly from trial to trial due to random variations in the DVH set, and does not ne...

  3. Comparing the Discrete and Continuous Logistic Models

    Science.gov (United States)

    Gordon, Sheldon P.

    2008-01-01

    The solutions of the discrete logistic growth model based on a difference equation and the continuous logistic growth model based on a differential equation are compared and contrasted. The investigation is conducted using a dynamic interactive spreadsheet. (Contains 5 figures.)

  4. Comparing the Discrete and Continuous Logistic Models

    Science.gov (United States)

    Gordon, Sheldon P.

    2008-01-01

    The solutions of the discrete logistic growth model based on a difference equation and the continuous logistic growth model based on a differential equation are compared and contrasted. The investigation is conducted using a dynamic interactive spreadsheet. (Contains 5 figures.)

  5. Depression in working adults: comparing the costs and health outcomes of working when ill.

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    Full Text Available OBJECTIVE: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism" amongst employed Australians reporting lifetime major depression. METHODS: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs, captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar. RESULTS: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism. However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover, and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. CONCLUSIONS: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work

  6. Comparative dynamics in a health investment model.

    Science.gov (United States)

    Eisenring, C

    1999-10-01

    The method of comparative dynamics fully exploits the inter-temporal structure of optimal control models. I derive comparative dynamic results in a simplified demand for health model. The effect of a change in the depreciation rate on the optimal paths for health capital and investment in health is studied by use of a phase diagram.

  7. Composite scores in comparative effectiveness research: counterbalancing parsimony and dimensionality in patient-reported outcomes.

    Science.gov (United States)

    Schwartz, Carolyn E; Patrick, Donald L

    2014-07-01

    When planning a comparative effectiveness study comparing disease-modifying treatments, competing demands influence choice of outcomes. Current practice emphasizes parsimony, although understanding multidimensional treatment impact can help to personalize medical decision-making. We discuss both sides of this 'tug of war'. We discuss the assumptions, advantages and drawbacks of composite scores and multidimensional outcomes. We describe possible solutions to the multiple comparison problem, including conceptual hierarchy distinctions, statistical approaches, 'real-world' benchmarks of effectiveness and subgroup analysis. We conclude that comparative effectiveness research should consider multiple outcome dimensions and compare different approaches that fit the individual context of study objectives.

  8. Loss Given Default Modelling: Comparative Analysis

    OpenAIRE

    Yashkir, Olga; Yashkir, Yuriy

    2013-01-01

    In this study we investigated several most popular Loss Given Default (LGD) models (LSM, Tobit, Three-Tiered Tobit, Beta Regression, Inflated Beta Regression, Censored Gamma Regression) in order to compare their performance. We show that for a given input data set, the quality of the model calibration depends mainly on the proper choice (and availability) of explanatory variables (model factors), but not on the fitting model. Model factors were chosen based on the amplitude of their correlati...

  9. Comparative effectiveness studies to improve clinical outcomes in end stage renal disease: the DEcIDE patient outcomes in end stage renal disease study

    Directory of Open Access Journals (Sweden)

    Boulware Ebony L

    2012-12-01

    Full Text Available Abstract Background Evidence is lacking to inform providers’ and patients’ decisions about many common treatment strategies for patients with end stage renal disease (ESRD. Methods/design The DEcIDE Patient Outcomes in ESRD Study is funded by the United States (US Agency for Health Care Research and Quality to study the comparative effectiveness of: 1 antihypertensive therapies, 2 early versus later initiation of dialysis, and 3 intravenous iron therapies on clinical outcomes in patients with ESRD. Ongoing studies utilize four existing, nationally representative cohorts of patients with ESRD, including (1 the Choices for Healthy Outcomes in Caring for ESRD study (1041 incident dialysis patients recruited from October 1995 to June 1999 with complete outcome ascertainment through 2009, (2 the Dialysis Clinic Inc (45,124 incident dialysis patients initiating and receiving their care from 2003–2010 with complete outcome ascertainment through 2010, (3 the United States Renal Data System (333,308 incident dialysis patients from 2006–2009 with complete outcome ascertainment through 2010, and (4 the Cleveland Clinic Foundation Chronic Kidney Disease Registry (53,399 patients with chronic kidney disease with outcome ascertainment from 2005 through 2009. We ascertain patient reported outcomes (i.e., health-related quality of life, morbidity, and mortality using clinical and administrative data, and data obtained from national death indices. We use advanced statistical methods (e.g., propensity scoring and marginal structural modeling to account for potential biases of our study designs. All data are de-identified for analyses. The conduct of studies and dissemination of findings are guided by input from Stakeholders in the ESRD community. Discussion The DEcIDE Patient Outcomes in ESRD Study will provide needed evidence regarding the effectiveness of common treatments employed for dialysis patients. Carefully planned dissemination strategies to the

  10. Children's resilience and trauma-specific cognitive behavioral therapy: Comparing resilience as an outcome, a trait, and a process.

    Science.gov (United States)

    Happer, Kaitlin; Brown, Elissa J; Sharma-Patel, Komal

    2017-09-20

    Resilience, which is associated with relatively positive outcomes following negative life experiences, is an important research target in the field of child maltreatment (Luthar et al., 2000). The extant literature contains multiple conceptualizations of resilience, which hinders development in research and clinical utility. Three models emerge from the literature: resilience as an immediate outcome (i.e., behavioral or symptom response), resilience as a trait, and resilience as a dynamic process. The current study compared these models in youth undergoing trauma-specific cognitive behavioral therapy. Results provide the most support for resilience as a process, in which increase in resilience preceded associated decrease in posttraumatic stress and depressive symptoms. There was partial support for resilience conceptualized as an outcome, and minimal support for resilience as a trait. Results of the models are compared and discussed in the context of existing literature and in light of potential clinical implications for maltreated youth seeking treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. A Comparative of business process modelling techniques

    Science.gov (United States)

    Tangkawarow, I. R. H. T.; Waworuntu, J.

    2016-04-01

    In this era, there is a lot of business process modeling techniques. This article is the research about differences of business process modeling techniques. For each technique will explain about the definition and the structure. This paper presents a comparative analysis of some popular business process modelling techniques. The comparative framework is based on 2 criteria: notation and how it works when implemented in Somerleyton Animal Park. Each technique will end with the advantages and disadvantages. The final conclusion will give recommend of business process modeling techniques that easy to use and serve the basis for evaluating further modelling techniques.

  12. Comparing linear probability model coefficients across groups

    DEFF Research Database (Denmark)

    Holm, Anders; Ejrnæs, Mette; Karlson, Kristian Bernt

    2015-01-01

    This article offers a formal identification analysis of the problem in comparing coefficients from linear probability models between groups. We show that differences in coefficients from these models can result not only from genuine differences in effects, but also from differences in one or more...... these limitations, and we suggest a restricted approach to using linear probability model coefficients in group comparisons....

  13. Major models used in comparative management

    OpenAIRE

    Ioan Constantin Dima; Codruta Dura

    2001-01-01

    Comparative management literature emphasizes the following models: Farmer-Richman Model (based on the assumption that environment represents the main factor whom influence upon management is decisive); Rosalie Tung Model (using the following variables:environment,or extra-organisational variables, intra-organisational variables, personal and result variables); Child Model (including the three determinative domains-contingency, culture and economic system-threated as items objectively connecte...

  14. Outcomes in Cochrane systematic reviews addressing four common eye conditions: an evaluation of completeness and comparability.

    Directory of Open Access Journals (Sweden)

    Ian J Saldanha

    Full Text Available INTRODUCTION: Choice of outcomes is critical for clinical trialists and systematic reviewers. It is currently unclear how systematic reviewers choose and pre-specify outcomes for systematic reviews. Our objective was to assess the completeness of pre-specification and comparability of outcomes in all Cochrane reviews addressing four common eye conditions. METHODS: We examined protocols for all Cochrane reviews as of June 2013 that addressed glaucoma, cataract, age-related macular degeneration (AMD, and diabetic retinopathy (DR. We assessed completeness and comparability for each outcome that was named in ≥ 25% of protocols on those topics. We defined a completely-specified outcome as including information about five elements: domain, specific measurement, specific metric, method of aggregation, and time-points. For each domain, we assessed comparability in how individual elements were specified across protocols. RESULTS: We identified 57 protocols addressing glaucoma (22, cataract (16, AMD (15, and DR (4. We assessed completeness and comparability for five outcome domains: quality-of-life, visual acuity, intraocular pressure, disease progression, and contrast sensitivity. Overall, these five outcome domains appeared 145 times (instances. Only 15/145 instances (10.3% were completely specified (all five elements (median = three elements per outcome. Primary outcomes were more completely specified than non-primary (median = four versus two elements. Quality-of-life was least completely specified (median = one element. Due to largely incomplete outcome pre-specification, conclusive assessment of comparability in outcome usage across the various protocols per condition was not possible. DISCUSSION: Outcome pre-specification was largely incomplete; we encourage systematic reviewers to consider all five elements. This will indicate the importance of complete specification to clinical trialists, on whose work systematic reviewers depend, and will

  15. Comparing repetition-based melody segmentation models

    NARCIS (Netherlands)

    Rodríguez López, M.E.; de Haas, Bas; Volk, Anja

    2014-01-01

    This paper reports on a comparative study of computational melody segmentation models based on repetition detection. For the comparison we implemented five repetition-based segmentation models, and subsequently evaluated their capacity to automatically find melodic phrase boundaries in a corpus of 2

  16. Comparing models of Red Knot population dynamics

    Science.gov (United States)

    McGowan, Conor

    2015-01-01

    Predictive population modeling contributes to our basic scientific understanding of population dynamics, but can also inform management decisions by evaluating alternative actions in virtual environments. Quantitative models mathematically reflect scientific hypotheses about how a system functions. In Delaware Bay, mid-Atlantic Coast, USA, to more effectively manage horseshoe crab (Limulus polyphemus) harvests and protect Red Knot (Calidris canutus rufa) populations, models are used to compare harvest actions and predict the impacts on crab and knot populations. Management has been chiefly driven by the core hypothesis that horseshoe crab egg abundance governs the survival and reproduction of migrating Red Knots that stopover in the Bay during spring migration. However, recently, hypotheses proposing that knot dynamics are governed by cyclical lemming dynamics garnered some support in data analyses. In this paper, I present alternative models of Red Knot population dynamics to reflect alternative hypotheses. Using 2 models with different lemming population cycle lengths and 2 models with different horseshoe crab effects, I project the knot population into the future under environmental stochasticity and parametric uncertainty with each model. I then compare each model's predictions to 10 yr of population monitoring from Delaware Bay. Using Bayes' theorem and model weight updating, models can accrue weight or support for one or another hypothesis of population dynamics. With 4 models of Red Knot population dynamics and only 10 yr of data, no hypothesis clearly predicted population count data better than another. The collapsed lemming cycle model performed best, accruing ~35% of the model weight, followed closely by the horseshoe crab egg abundance model, which accrued ~30% of the weight. The models that predicted no decline or stable populations (i.e. the 4-yr lemming cycle model and the weak horseshoe crab effect model) were the most weakly supported.

  17. Genetic network models: a comparative study

    Science.gov (United States)

    van Someren, Eugene P.; Wessels, Lodewyk F. A.; Reinders, Marcel J. T.

    2001-06-01

    Currently, the need arises for tools capable of unraveling the functionality of genes based on the analysis of microarray measurements. Modeling genetic interactions by means of genetic network models provides a methodology to infer functional relationships between genes. Although a wide variety of different models have been introduced so far, it remains, in general, unclear what the strengths and weaknesses of each of these approaches are and where these models overlap and differ. This paper compares different genetic modeling approaches that attempt to extract the gene regulation matrix from expression data. A taxonomy of continuous genetic network models is proposed and the following important characteristics are suggested and employed to compare the models: inferential power; predictive power; robustness; consistency; stability and computational cost. Where possible, synthetic time series data are employed to investigate some of these properties. The comparison shows that although genetic network modeling might provide valuable information regarding genetic interactions, current models show disappointing results on simple artificial problems. For now, the simplest models are favored because they generalize better, but more complex models will probably prevail once their bias is more thoroughly understood and their variance is better controlled.

  18. Comparing Client Outcomes for Two Evidence-Based Treatment Consultation Strategies.

    Science.gov (United States)

    Funderburk, Beverly; Chaffin, Mark; Bard, Elizabeth; Shanley, Jenelle; Bard, David; Berliner, Lucy

    2015-01-01

    Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.

  19. Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US.

    Directory of Open Access Journals (Sweden)

    Taku Inohara

    Full Text Available Ethnicity has a significant impact on coronary artery disease (CAD. This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups.We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto and the Texas (US Heart Institute Research Database (THIRDBase registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6-4.3 and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8-6.5 who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35-1.79; Hispanics: HR, 1.53; 95% CI, 1.22-1.93; African-Americans: HR, 2.03; 95% CI, 1.62-2.56, except for Asian-Americans (HR, 0.84; 95% CI. 0.38-1.89 who had outcomes similar to Japanese patients.Our findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.

  20. Comparing and Using Occupation-Focused Models.

    Science.gov (United States)

    Wong, Su Ren; Fisher, Gail

    2015-01-01

    As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.

  1. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living

    Directory of Open Access Journals (Sweden)

    Hogan David B

    2012-09-01

    Full Text Available Abstract Background Few studies have directly compared the competing approaches to identifying frailty in more vulnerable older populations. We examined the ability of two versions of a frailty index (43 vs. 83 items, the Cardiovascular Health Study (CHS frailty criteria, and the CHESS scale to accurately predict the occurrence of three outcomes among Assisted Living (AL residents followed over one year. Methods The three frailty measures and the CHESS scale were derived from assessment items completed among 1,066 AL residents (aged 65+ participating in the Alberta Continuing Care Epidemiological Studies (ACCES. Adjusted risks of one-year mortality, hospitalization and long-term care placement were estimated for those categorized as frail or pre-frail compared with non-frail (or at high/intermediate vs. low risk on CHESS. The area under the ROC curve (AUC was calculated for select models to assess the predictive accuracy of the different frailty measures and CHESS scale in relation to the three outcomes examined. Results Frail subjects defined by the three approaches and those at high risk for decline on CHESS showed a statistically significant increased risk for death and long-term care placement compared with those categorized as either not frail or at low risk for decline. The risk estimates for hospitalization associated with the frailty measures and CHESS were generally weaker with one of the frailty indices (43 items showing no significant association. For death and long-term care placement, the addition of frailty (however derived or CHESS significantly improved on the AUC obtained with a model including only age, sex and co-morbidity, though the magnitude of improvement was sometimes small. The different frailty/risk models did not differ significantly from each other in predicting mortality or hospitalization; however, one of the frailty indices (83 items showed significantly better performance over the other measures in predicting long

  2. Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

    Science.gov (United States)

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

    This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were…

  3. Practice based evidence: incorporating clinical heterogeneity and patient-reported outcomes for comparative effectiveness research.

    Science.gov (United States)

    Horn, Susan D; Gassaway, Julie

    2010-06-01

    Comparative effectiveness research analyzes groups of patients and looks for associations between medical treatments and patient outcomes. To make meaningful comparisons of medical interventions, one must consider clinical heterogeneity of patient populations, intervention combinations, and outcomes. To explain how practice-based evidence (PBE) study methodology measures and controls for heterogeneity of patients, treatments, and outcomes seen in real-world clinical settings. Overview of PBE methodology. PBE study designs address comparative effectiveness by creating a comprehensive set of patient, treatment, and outcome variables, and analyzing them to identify treatments associated with better outcomes for specific types of patients. PBE studies are an alternative to randomized controlled trials, well suited to determine what works best for specific patient types, and provide clinicians with a rational basis for treatment recommendations for individual patients. They provide a holistic picture of patients, treatments, and outcomes, with no preset limits to the number of variables that can be included. Such an approach is needed for high quality comparative effectiveness research.

  4. Development of a caregiver empowerment model to promote positive outcomes.

    Science.gov (United States)

    Jones, Patricia S; Winslow, Betty W; Lee, Jerry W; Burns, Margaret; Zhang, Xinwei Esther

    2011-02-01

    Family members caring for aging parents experience both negative and positive outcomes from providing care. Theoretical explanations for negative outcomes have been developed. There is need for models that explain and predict positive outcomes. This article describes the evolution of the Caregiver Empowerment Model (CEM) to explain and predict positive outcomes of family caregiving. Although empirical findings support positive outcomes of family caregiving, less attention has been given to theoretical rationale for positive effects. The CEM predicts that, in the presence of filial values and certain background variables, caregiving demands are appraised as challenges instead of stressors. Appraising caregiving demands as a challenge, finding meaning, and using certain types of coping strategies are posited to be associated with growth and well-being. The CEM extends our understanding of the complexity of the caregiving experience, and can serve as a framework to guide in developing and testing theory-based interventions to promote positive outcomes.

  5. Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women.

    Science.gov (United States)

    Abenhaim, Haim A; Alrowaily, Nouf; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Klam, Stephanie L

    2016-11-01

    Pregnancies among morbidly obese women are associated with serious adverse maternal and neonatal outcomes. Our study objective is to evaluate the effect of bariatric surgery on obstetrical outcomes. We carried out a retrospective cohort study using the healthcare cost and utilization project - Nationwide Inpatient Sample from 2003 to 2011 comparing outcome of births among women who had undergone bariatric surgery with births among women with morbid obesity. Logistic regression was used to estimate the adjusted effect of bariatric surgery on maternal and newborn outcomes. There were 8 475 831 births during the study period (221 580 (2.6%) in morbidly obese women and 9587 (0.1%) in women with bariatric surgery). Women with bariatric surgery were more likely to be Caucasian and ≥35 years old as compared with morbidly obese women. As compared with women with morbid obesity, women with bariatric surgery had lower rates of hypertensive disorders, premature rupture of membrane, chorioamnionitis, cesarean delivery, instrumental delivery, postpartum hemorrhage, and postpartum infection. Induction of labor, postpartum blood transfusions, venous thromboembolisms, and intrauterine fetal growth restriction were more common in the bariatric surgery group. There were no differences observed in preterm births, fetal deaths, or reported congenital anomalies. In general, women who undergo bariatric surgery have improved pregnancy outcomes as compared with morbidly obese women. However, the bariatric surgery group was more likely to have venous thromboembolisms, to require a blood transfusion, to have their labor induced and to experience fetal growth restriction.

  6. Hip resurfacing versus total hip arthroplasty: a systematic review comparing standardized outcomes.

    Science.gov (United States)

    Marshall, Deborah A; Pykerman, Karen; Werle, Jason; Lorenzetti, Diane; Wasylak, Tracy; Noseworthy, Tom; Dick, Donald A; O'Connor, Greg; Sundaram, Aish; Heintzbergen, Sanne; Frank, Cy

    2014-07-01

    Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies. We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis. Secondarily, we compared the revision frequency identified in the systematic review with revisions reported in four major joint replacement registries. We conducted a systematic review of English language studies published after 1996. Adverse events of interest included rates of early failure, time to revision, revision, reoperation, dislocation, infection/sepsis, femoral neck fracture, mortality, and postoperative component alignment. Revision rates were compared with those from four national joint replacement registries. Results were reported as adverse event rates per 1000 person-years stratified by device market status (in use and discontinued). Comparisons between event rates of metal-on-metal hip resurfacing and THA are made using a quasilikelihood generalized linear model. We identified 7421 abstracts, screened and reviewed 384 full-text articles, and included 236. The most common study designs were prospective cohort studies (46.6%; n = 110) and retrospective studies (36%; n = 85). Few randomized controlled trials were included (7.2%; n = 17). The average time to revision was 3.0 years for metal-on-metal hip resurfacing (95% CI, 2.95-3.1) versus 7.8 for THA (95% CI, 7.2-8.3). For all devices, revisions and reoperations were more frequent with metal-on-metal hip resurfacing than THA based on point estimates and CIs: 10.7 (95% CI, 10.1-11.3) versus 7.1 (95% CI, 6.7-7.6; p = 0.068), and 7.9 (95% CI, 5.4-11.3) versus 1

  7. Discrete event simulation: Modeling simultaneous complications and outcomes

    NARCIS (Netherlands)

    Quik, E.H.; Feenstra, T.L.; Krabbe, P.F.M.

    2012-01-01

    OBJECTIVES: To present an effective and elegant model approach to deal with specific characteristics of complex modeling. METHODS: A discrete event simulation (DES) model with multiple complications and multiple outcomes that each can occur simultaneously was developed. In this DES model parameters,

  8. A COMPARATIVE STUDY TO ASSES THE OUTCOME OF GRAND MULTIPARA WITH THAT OF GREAT GRAND MULTIPARA

    Directory of Open Access Journals (Sweden)

    Nayana

    2015-01-01

    Full Text Available NEED FOR THE STUDY: In a developing country like India , where poverty , illiteracy , ignorance and lack of knowledge of family planning facilities available have greatly increased the incidence of grandmultipara 2. Grandmultipara has been associated with increased maternal morbidity and mortality rat es as well as poor outcome. The investigator is interested in finding out the outcome in grand multipara women and great grand multipara 1 women during the antenatal , internatal and postnatal period , and also to analyze demographic characteristics such as socioeconomic status and religion of the sample. STATEMENT OF THE PROBLEM: A comparative study to assess the outcome of grandmultipara (1 with that of grandmultipara women. OBJECTIVE OF THE STUDY: 1. To findout the outcome of grandmultipara women during th e antenatal , internatal and postnatal period. 2. To find the outcome of great grandmultipara women during the antenatal , internatal (2 and postnatal period. 3. To compare the outcomes of grandmultipara with that of non - grandmultipara women during the anten atal , internatal and postnatal (3 period. ( 4 To analyze the demographic characteristics 6 of the sample i.e. income and religion.

  9. Comparing numerically exact and modelled static friction

    Directory of Open Access Journals (Sweden)

    Krengel Dominik

    2017-01-01

    Full Text Available Currently there exists no mechanically consistent “numerically exact” implementation of static and dynamic Coulomb friction for general soft particle simulations with arbitrary contact situations in two or three dimension, but only along one dimension. We outline a differential-algebraic equation approach for a “numerically exact” computation of friction in two dimensions and compare its application to the Cundall-Strack model in some test cases.

  10. Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials.

    Science.gov (United States)

    Anglemyer, Andrew; Horvath, Hacsi T; Bero, Lisa

    2014-04-29

    Researchers and organizations often use evidence from randomized controlled trials (RCTs) to determine the efficacy of a treatment or intervention under ideal conditions. Studies of observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and modifications of existing designs, including both randomized and observational, are used for comparative effectiveness research in an attempt to give an unbiased estimate of whether one treatment is more effective or safer than another for a particular population.A systematic analysis of study design features, risk of bias, parameter interpretation, and effect size for all types of randomized and non-experimental observational studies is needed to identify specific differences in design types and potential biases. This review summarizes the results of methodological reviews that compare the outcomes of observational studies with randomized trials addressing the same question, as well as methodological reviews that compare the outcomes of different types of observational studies. To assess the impact of study design (including RCTs versus observational study designs) on the effect measures estimated.To explore methodological variables that might explain any differences identified.To identify gaps in the existing research comparing study designs. We searched seven electronic databases, from January 1990 to December 2013.Along with MeSH terms and relevant keywords, we used the sensitivity-specificity balanced version of a validated strategy to identify reviews in PubMed, augmented with one term ("review" in article titles) so that it better targeted narrative reviews. No language restrictions were applied. We examined systematic reviews that were designed as methodological reviews to compare quantitative effect size estimates measuring efficacy or effectiveness of interventions tested in trials with those tested in observational studies

  11. Comparative analysis of Goodwin's business cycle models

    Science.gov (United States)

    Antonova, A. O.; Reznik, S.; Todorov, M. D.

    2016-10-01

    We compare the behavior of solutions of Goodwin's business cycle equation in the form of neutral delay differential equation with fixed delay (NDDE model) and in the form of the differential equations of 3rd, 4th and 5th orders (ODE model's). Such ODE model's (Taylor series expansion of NDDE in powers of θ) are proposed in N. Dharmaraj and K. Vela Velupillai [6] for investigation of the short periodic sawthooth oscillations in NDDE. We show that the ODE's of 3rd, 4th and 5th order may approximate the asymptotic behavior of only main Goodwin's mode, but not the sawthooth modes. If the order of the Taylor series expansion exceeds 5, then the approximate ODE becomes unstable independently of time lag θ.

  12. Minimalist models for proteins: a comparative analysis.

    Science.gov (United States)

    Tozzini, Valentina

    2010-08-01

    The last decade has witnessed a renewed interest in the coarse-grained (CG) models for biopolymers, also stimulated by the needs of modern molecular biology, dealing with nano- to micro-sized bio-molecular systems and larger than microsecond timescale. This combination of size and timescale is, in fact, hard to access by atomic-based simulations. Coarse graining the system is a route to be followed to overcome these limits, but the ways of practically implementing it are many and different, making the landscape of CG models very vast and complex. In this paper, the CG models are reviewed and their features, applications and performances compared. This analysis, restricted to proteins, focuses on the minimalist models, namely those reducing at minimum the number of degrees of freedom without losing the possibility of explicitly describing the secondary structures. This class includes models using a single or a few interacting centers (beads) for each amino acid. From this analysis several issues emerge. The difficulty in building these models resides in the need for combining transferability/predictive power with the capability of accurately reproducing the structures. It is shown that these aspects could be optimized by accurately choosing the force field (FF) terms and functional forms, and combining different parameterization procedures. In addition, in spite of the variety of the minimalist models, regularities can be found in the parameters values and in FF terms. These are outlined and schematically presented with the aid of a generic phase diagram of the polypeptide in the parameter space and, hopefully, could serve as guidelines for the development of minimalist models incorporating the maximum possible level of predictive power and structural accuracy.

  13. Integral-Value Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions...... on preferences between real- or vector-valued outcomes over continuous time are satisfied if and only if the preferences are represented by a value function having an integral form...

  14. Comparing Virtual and Location-Based Augmented Reality Mobile Learning: Emotions and Learning Outcomes

    Science.gov (United States)

    Harley, Jason M.; Poitras, Eric G.; Jarrell, Amanda; Duffy, Melissa C.; Lajoie, Susanne P.

    2016-01-01

    Research on the effectiveness of augmented reality (AR) on learning exists, but there is a paucity of empirical work that explores the role that positive emotions play in supporting learning in such settings. To address this gap, this study compared undergraduate students' emotions and learning outcomes during a guided historical tour using mobile…

  15. A Qualitative Assessment of the Learning Outcomes of Teaching Introductory American Politics in Comparative Perspective

    Science.gov (United States)

    Gelbman, Shamira M.

    2011-01-01

    This article discusses the findings of an ethnographic content analysis of students' written reflections as a means for assessing the learning outcomes of teaching introductory American politics in comparative perspective. It focuses especially on determining whether and how this approach enhanced students' understanding and retention of knowledge…

  16. Comparing Three Preprocessing Strategies for Longitudinal Data: An Example in Functional Outcomes Research.

    Science.gov (United States)

    Yarnold, Paul R.; Feinglass, Joe; McCarthy, Walter J.; Martin, Gary J.

    1999-01-01

    Compared three methods for evaluating clinical outcomes for individual patients: (1) raw change score analysis, (2) normative statistical analysis, and (3) ipsative statistical analysis. Results with two samples of 39 and 20 patients show the ipsative method to be most consistent with a priori hypotheses evaluated for repeated-measures data. (SLD)

  17. Comparing Virtual and Location-Based Augmented Reality Mobile Learning: Emotions and Learning Outcomes

    Science.gov (United States)

    Harley, Jason M.; Poitras, Eric G.; Jarrell, Amanda; Duffy, Melissa C.; Lajoie, Susanne P.

    2016-01-01

    Research on the effectiveness of augmented reality (AR) on learning exists, but there is a paucity of empirical work that explores the role that positive emotions play in supporting learning in such settings. To address this gap, this study compared undergraduate students' emotions and learning outcomes during a guided historical tour using mobile…

  18. Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

    Directory of Open Access Journals (Sweden)

    Leila Pourali

    2016-05-01

    Full Text Available Introduction: Regarding to the recent advances in assisted reproductive techniques (ART, twin and multiple pregnancies have increased during past years. Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96 and ART group (n=31. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR, postpartum hemorrhage, neonatal outcomes (weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit (NICU admission, mortality, respiratory distress, and icterus were recorded using a questionnaire. Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus. Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.

  19. Bayesian Network Models for Local Dependence among Observable Outcome Variables

    Science.gov (United States)

    Almond, Russell G.; Mulder, Joris; Hemat, Lisa A.; Yan, Duanli

    2009-01-01

    Bayesian network models offer a large degree of flexibility for modeling dependence among observables (item outcome variables) from the same task, which may be dependent. This article explores four design patterns for modeling locally dependent observations: (a) no context--ignores dependence among observables; (b) compensatory context--introduces…

  20. Comparative study on the incidence and outcomes of pigmented versus non pigmented keratomycosis

    Directory of Open Access Journals (Sweden)

    Sabyasachi Sengupta

    2011-01-01

    Full Text Available Purpose: To determine the incidence, outcomes and establish factors determining visual prognosis of keratomycosis due to pigmented fungi in comparison with nonpigmented fungi. Materials and Methods: All culture-proven cases of fungal keratitis from January 2006 to August 2008 were drawn from a computerized database and cases with adequate documentation were analyzed for predisposing factors, clinical characteristics, microbiology and treatment methods. Outcomes of keratitis due to pigmented and nonpigmented fungi were compared using t-test and χ2 test. Results: Of 373 cases of keratomycosis during the study period, pigmented fungi were etiological agents in 117 eyes (31.3% and nonpigmented fungi in 256 eyes (68.7%. Eyes with nonpigmented keratitis had significantly larger ulcers (14.96 mm 2 and poorer vision (1.42 logMAR at presentation compared to those with keratomycosis due to pigmented fungi (P=0.01. The characteristic macroscopic pigmentation was seen in only 14.5% in the pigmented keratitis group. Both groups responded favorably to medical therapy (78.1% vs. 69.1% with scar formation (P=0.32 and showed a significant improvement in mean visual acuity compared with that at presentation (P<0.01. Visual improvement in terms of line gainers and losers in the subgroup of eyes that experienced healing was also similar. Location of the ulcer was the only factor that had significant predictive value for visual outcome (P=0.021. Conclusion: Incidence of keratomycosis due to pigmented fungi may be increasing as compared to previous data. These eyes have similar response to medical therapy and similar visual outcome compared to nonpigmented keratitis. Central ulcers have a poor visual outcome.

  1. Comparative outcomes for three-dimensional conformal versus intensity-modulated radiation therapy for esophageal cancer.

    Science.gov (United States)

    Freilich, J; Hoffe, S E; Almhanna, K; Dinwoodie, W; Yue, B; Fulp, W; Meredith, K L; Shridhar, R

    2015-01-01

    Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P 20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.

  2. Disparities in obstetrical outcomes in ART pregnancies compared with natural conceptions.

    Science.gov (United States)

    Plowden, Torie C; Novak, Christopher M; Spong, Catherine Y

    2013-09-01

    Health disparities are observed in all fields of medicine and reproductive health is not immune to this phenomenon. The incidence of women using infertility treatments to conceive is increasing. Women undergoing assisted reproduction appear to be at increased risk of adverse outcomes, and minority women tend to be at even greater risk. This article examines several adverse obstetrical outcomes including preterm birth, congenital malformations, and preeclampsia among women receiving infertility treatments compared with those who conceive spontaneously. It will further examine societal costs associated with these procedures.

  3. Pain and functional outcome after vertebroplasty and kyphoplasty. A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Santiago, Fernando, E-mail: ferusan@ono.co [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Perez Abela, Antonio [Department of Traumatology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Guzman Alvarez, Luis [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada Spain (Spain); Alvarez Osuna, Rosa Maria [Department of Traumatology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Mar Castellano Garcia, Maria del [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain)

    2010-08-15

    Purpose: The aim of this study was to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain from non-neoplastic vertebral fractures and improve functional outcomes. Materials and methods: We compared 30 patients treated by vertebroplasty for non-neoplastic vertebral fractures with 30 patients treated by kyphoplasty for the same condition. Pain was measured with a visual analogue scale (VAS) and functional outcome with the Oswestry disability index (ODI). Baseline data were compared with measurements on the day after the procedure (for pain alone) and at 1 month, 6 months, and 1 year. Results: The VAS pain score was reduced by 4-5 points on the day after either type of treatment, a statistically significant improvement. The global ODI was significantly improved (by 13-18 points) at 1 month after either procedure. These improvements persisted at 6 months and 1 year. No significant differences in functional outcome were observed between the techniques. Conclusion: Vertebroplasty and kyphoplasty obtain similar improvements in pain and functional outcomes in these patients. The choice of technique must therefore depend on other factors. An initial improvement with either technique is a good predictor of long-term improvement.

  4. Accuracy of stereolithographically printed digital models compared to plaster models.

    Science.gov (United States)

    Camardella, Leonardo Tavares; Vilella, Oswaldo V; van Hezel, Marleen M; Breuning, Karel H

    2017-03-30

    This study compared the accuracy of plaster models from alginate impressions and printed models from intraoral scanning. A total of 28 volunteers were selected and alginate impressions and intraoral scans were used to make plaster models and digital models of their dentition, respectively. The digital models were printed using a stereolithographic (SLA) 3D printer with a horseshoe-shaped design. Two calibrated examiners measured distances on the plaster and printed models with a digital caliper. The paired t test was used to determine intraobserver error and compare the measurements. The Pearson correlation coefficient was used to evaluate the reliability of measurements for each model type. The measurements on plaster models and printed models show some significant differences in tooth dimensions and interarch parameters, but these differences were not clinically relevant, except for the transversal measurements. The upper and lower intermolar distances on the printed models were statistically significant and clinically relevant smaller. Printed digital models with the SLA 3D printer studied, with a horseshoe-shaped base made from intraoral scans cannot replace conventional plaster models from alginate impressions in orthodontics for diagnosis and treatment planning because of their clinically relevant transversal contraction.

  5. Enhancing Learning Outcomes: The Internet Mirror Model

    Science.gov (United States)

    Stephenson, Robert S.

    2004-01-01

    The author redesigned an undergraduate physiology course using a novel Internet mirror model: parallel lecture and Internet-based sections conducted so that students can move freely from one to the other (or choose both) during the semester. Within the constraints of this paradigm, he used technology to enhance student learning: adding…

  6. Comparative evaluation of neonatal and obstetrics outcomes of labour between Iranian and Afghan ethnicities

    Directory of Open Access Journals (Sweden)

    Aboutaleb Beigi

    2015-05-01

    Full Text Available Introduction: There are major differences in neonatal and obstetrics outcomes of labour among different ethnicities. The present study compared the neonatal and obstetrics outcomes of labour between the Iranian and Afghan ethnicities. Methods: Neonatal and obstetrics problems were evaluated in Iranian and Afghan pregnant women, who had referred to Arash Educational/Treatment Center for labour during a year. Results: 3020 (93.7% Iranian and 202 (63% Afghan women were evaluated. There were no significant differences between the two ethnicities in relation to a need for Neonatal Intensive Care Unit (NICU, the rate of live births, infant birth weight, congenital anomalies and premature births (P>0.05. The rate of Caesarian section was higher in Iranian women (P=0.001. Conclusion: It seems that the differences in neonatal problems and outcomes of labour obstetrics between Iranians and Afghans can be attributed to different cultural, economic, and social conditions in comparison to different ethnicities.

  7. Bariatric Outcomes and Obesity Modeling: Study Meeting

    Science.gov (United States)

    2010-09-17

    from Picot et al ( HTA , 2009) BMI LOSS IS NON-LINEAR Source: Picot et al ( HTA , 2009) NATURAL HISTORY MODEL OVERVIEW Source: BOOM Research ANNUAL ESTIMATES...those above 30 BMI Source: BOOM Research ONE-WAY SENSITIVITY ANALYSIS Variables Reference values Minimum Maximum Early Mortality rate (%) 0.23 0 0.5... Early complication rate (%) 2.5 0 5 Sex F M F Age 45 18 70 BMI change at 5 years (%) 20% AGB or 30% GB -10% +10% Discount rate (%) 3 0 5 BMI at

  8. Index of Complexity, Outcome and Need scored on plaster and digital models.

    NARCIS (Netherlands)

    Veenema, A.C.; Katsaros, C.; Boxum, S.C.; Bronkhorst, E.M.; Kuijpers-Jagtman, A.M.

    2009-01-01

    The aim of this study was to compare standard plaster models with their digital counterparts for the applicability of the Index of Complexity, Outcome, and Need (ICON). Generated study models of 30 randomly selected patients: 30 pre- (T(0)) and 30 post- (T(1)) treatment. Two examiners, calibrated in

  9. Index of Complexity, Outcome and Need scored on plaster and digital models

    NARCIS (Netherlands)

    Veenema, A. C.; Katsaros, C.; Boxum, S. C.; Bronkhorst, E. M.; Kuijpers-Jagtman, A. M.

    2009-01-01

    The aim of this study was to compare standard plaster models with their digital counterparts for the applicability of the Index of Complexity, Outcome, and Need (ICON). Generated study models of 30 randomly selected patients: 30 pre- (T-0) and 30 post- (T-1) treatment. Two examiners, calibrated in t

  10. Fitting Multilevel Models with Ordinal Outcomes: Performance of Alternative Specifications and Methods of Estimation

    Science.gov (United States)

    Bauer, Daniel J.; Sterba, Sonya K.

    2011-01-01

    Previous research has compared methods of estimation for fitting multilevel models to binary data, but there are reasons to believe that the results will not always generalize to the ordinal case. This article thus evaluates (a) whether and when fitting multilevel linear models to ordinal outcome data is justified and (b) which estimator to employ…

  11. How comparing decision outcomes affects subsequent decisions: The carry-over of a comparative mind-set

    Directory of Open Access Journals (Sweden)

    Daniela Raeva

    2011-06-01

    Full Text Available In the current paper we investigate how feedback over decision outcomes may affect future decisions. In an experimental study we demonstrate that if people receive feedback over the outcomes they obtained (``factual outcomes'' and the outcomes they would have obtained had they decided differently (``counterfactual outcomes'', they become regret-averse in subsequent decisions. This effect is not only observed when this feedback evoked regret (with counterfactual outcomes being higher than factual outcomes, but even when the feedback evoked no regret (with factual outcomes being equal to counterfactual outcomes. The findings suggest that this effect on subsequent decisions is at least partly due to the transfer of a comparison mind-set triggered in the prior choice.

  12. Integral-Value Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions on prefere...

  13. Physiotherapy and low back pain - part iii: outcomes research utilising the biosychosocial model: psychosocial outcomes

    Directory of Open Access Journals (Sweden)

    L. D. Bardin

    2003-02-01

    Full Text Available A comprehensive understanding of low back pain (LBPhas evolved that necessitates the use of a biopsychosocial model, focusing on illness rather than disease and incorporating the biological, psychological and social aspects that are important to understand and to study LBP in its chronic form. Traditional outcome measures that measure elements within the biological component are limited to assess the spectrum of impacts caused by chronic low back pain (CLBP and the validity, reliability and sensitivity of some of these measures has been questioned.Few physiologic tests of spine function are clinically meaningful to patients, objective physical findings can be absent, and in CLBP disability and activity intolerance are often disproportional to the original injury. Biological outcomes should be complemented by outcomes of the psychosocial aspects of back pain that measure the considerable functional and emotional impact on the quality of life of patients experiencing low back dysfunction. Outcomes research is an analysis of clinical practice as it actually occurs and can  make a valuable contribution to understanding the multidimensional impact of LBP. Psychosocial aspects of the biopsychosocial model for outcomes research are discussed in part III: functional status/disability, psychological impairment, patient satisfaction, health related quality of life

  14. Attitudes Towards Immigrants, Immigration Policies and Labour Market Outcomes: Comparing Croatia with Hungary and Slovenia

    Directory of Open Access Journals (Sweden)

    Botrić Valerija

    2016-10-01

    Full Text Available The paper provides comparative evidence on attitudes towards immigrants, their labour market outcomes and policies in Croatia and two neighbouring countries – Slovenia and Hungary. Three different data sources have been used: the European Social Survey, an ad-hoc Labour Force Survey module for the year 2014, and the MIPEX index. Although immigrants have a disadvantaged position on the Croatian labour market, most analysed indicators do not imply that they are in a worse position than in other European economies. Migrant integration policies related to the labour market are assessed as being relatively favourable for Croatia. Judging by the comparable indicators for the native population in Croatia, immigrants’ adverse labour market outcomes seem to be more related to the unfavourable general economic situation, and particularly by the deep and long recession.

  15. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2015-10-01

    Full Text Available was performed, using as a springboard seven models of cyber- attack, and resulted in the development of what is described as a canonical model. Keywords: Offensive cyber operations; Process models; Rational reconstructions; Canonical models; Structured...

  16. Comparing Adolescent Only Children with Those Who Have Siblings on Academic Related Outcomes and Psychosocial Adjustment

    Directory of Open Access Journals (Sweden)

    Zeng-yin Chen

    2014-01-01

    Full Text Available This study uses a large and representative sample of adolescents to test the theoretically informed hypotheses comparing adolescent singletons with those who have siblings. The results found that, for academic related outcomes (educational expectations, time spent on homework, and self-reported grades, there are no differences between singletons and firstborns who have any number of younger siblings. Singletons are also not different from laterborns from two-child families. In contrast, singletons are more advantageous compared to laterborns who have two or more siblings on educational expectations and grades. Singletons also spend more time on homework than laterborns who have three or more siblings. For psychosocial outcomes (psychological distress, susceptibility to negative peer pressure, and problem behaviors, singletons are not different from both firstborns and laterborns with any number of siblings. The findings suggest that singletons are not at any disadvantage compared to their peers who have siblings and they enjoy some advantages over laterborns from medium to large families on academic related outcomes.

  17. Outcomes of shipped live donor kidney transplants compared with traditional living donor kidney transplants.

    Science.gov (United States)

    Treat, Eric G; Miller, Eric T; Kwan, Lorna; Connor, Sarah E; Maliski, Sally L; Hicks, Elisabeth M; Williams, Kristen C; Whitted, Lauren A; Gritsch, Hans A; McGuire, Suzanne M; Mone, Thomas D; Veale, Jeffrey L

    2014-11-01

    The disparity between kidney transplant candidates and donors necessitates innovations to increase organ availability. Transporting kidneys allows for living donors and recipients to undergo surgery with a familiar transplant team, city, friends, and family. The effect of shipping kidneys and prolonged cold ischemia time (CIT) with living donor transplantation outcomes is not clearly known. This retrospective matched (age, gender, race, and year of procedure) cohort study compared allograft outcomes for shipped live donor kidney transplants and nonshipped living donor kidney transplants. Fifty-seven shipped live donor kidneys were transplanted from 31 institutions in 26 cities. The mean shipping distance was 1634 miles (range 123-2811) with mean CIT of 12.1 ± 2.8 h. The incidence of delayed graft function in the shipped cohort was 1.8% (1/57) compared to 0% (0/57) in the nonshipped cohort. The 1-year allograft survival was 98% in both cohorts. There were no significant differences between the mean serum creatinine values or the rates of serum creatinine decline in the immediate postoperative period even after adjusted for gender and differences in recipient and donor BMI. Despite prolonged CITs, outcomes for shipped live donor kidney transplants were similar when compared to matched nonshipped living donor kidney transplants.

  18. Comparative Study on the Difference in Functional Outcomes at Discharge between Proximal and Total Gastrectomy

    Directory of Open Access Journals (Sweden)

    Kazuaki Kuwabara

    2012-06-01

    Full Text Available Several studies have regarded proximal gastrectomy (PG as optimal compared to total gastrectomy (TG for upper stomach cancer. In addition to the traditional outcomes of complication and mortality, change in functional status should be considered as another relevant outcome in aging generations. However, there has been no community-based appraisal of functional outcomes between PG and TG. Using an administrative database, we compared functional outcomes between PG and TG. Among 12,508 patients who survived for ≥15 years and underwent open gastrectomy between 2008 and 2010, we examined patient characteristics, comorbidities, functional status estimated by the Barthel index (BI at admission and discharge, complications, ICU care, ventilation administration, blood transfusion, operating room time, resumption of oral intake, length of stay and total charges. With reference to distal gastrectomy (DG, we performed multivariate analyses to assess the impacts of PG and TG on complications and BI deterioration. A total of 434 PGs and 4,941 TGs were observed in 148 and 295 hospitals, respectively. Patient characteristics, care process, resumption of oral intake, operating room time, length of stay and total charges were also significantly different among the three gastrectomy types. PG, TG and DG were not associated with complications or functional deterioration. Patient characteristics, preoperative blood transfusion and longer operating room time were significantly associated with more complications and BI deterioration. Since patient case mix and longer operating room time were associated with poor outcomes, physicians should recognize the role of PG and might optimally challenge and complete gastrectomies within the appropriate indications.

  19. Anatomic outcomes after pelvic-organ-prolapse surgery: comparing uterine preservation with hysterectomy.

    Science.gov (United States)

    Marschalek, Julian; Trofaier, Marie-Louise; Yerlikaya, Guelen; Hanzal, Engelbert; Koelbl, Heinz; Ott, Johannes; Umek, Wolfgang

    2014-12-01

    Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses. In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse. Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery. Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Membrane Sweeping for Vaginal Birth after Caesarean Section and its Outcome -A Comparative Study.

    Science.gov (United States)

    Ramya, V; Ghose, Seetesh; Pallavee, P

    2015-08-01

    Sweeping of membrane is a method of induction of labour. This is used to avoid prolonged labour. However, there is paucity of data about the use of this method for induction of labour and reducing prolonged labour in pregnancy with previous caesarean section. This study is an effort to find the effect of membrane sweeping in previous caesarean section. To initiate labour in previous LSCS patients by membrane sweeping and maternal outcome. This prospective randomised control study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry between January 2011 to June 2012. Seventy five women were randomly assigned to membrane sweeping and seventy five to control. In study group serial membrane sweeping was done once weekly from 39 weeks of gestation until the onset of labour up to 41weeks of gestation. In control group, no intervention up to 41 weeks of gestation. All the cases were monitored by biophysical profile. The primary outcomes measured were number of patients who had onset of labour. The secondary outcome included the successful vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval and amount of oxytocin required. The onset of labour in study group was 61.3% similar in control group 64% with p 0.736. The mean interval from sweeping to labour onset was 50.15±8 hours. The rate of VBAC was 17.3% in study group in compared to 18.7% in control group and LSCS was 82.7% in study group in compared to 81.3% in control group respectively. The mean gestation age at delivery 40±0.56 weeks for study group compared with 39.92±0.55 weeks for control group. Although membrane sweeping is an easy way of inducing labour, present study failed to demonstrate its beneficial effect on obstetrical outcome.

  1. Comparison of models for predicting outcomes in patients with coronary artery disease focusing on microsimulation

    Directory of Open Access Journals (Sweden)

    Masoud Amiri

    2012-01-01

    Full Text Available Background: Physicians have difficulty to subjectively estimate the cardiovascular risk of their patients. Using an estimate of global cardiovascular risk could be more relevant to guide decisions than using binary representation (presence or absence of risk factors data. The main aim of the paper is to compare different models of predicting the progress of a coronary artery diseases (CAD to help the decision making of physician. Methods: There are different standard models for predicting risk factors such as models based on logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. Each model has its own application which can or cannot use by physicians to make a decision on treatment of each patient. Results: There are five main common models for predicting of outcomes, including models based on logistic regression model (for short-term outcomes, Cox regression model (for intermediate-term outcomes, dynamic logistic regression model, and simulation models such as Markov and microsimulation models (for long-term outcomes. The advantages and disadvantages of these models have been discussed and summarized. Conclusion: Given the complex medical decisions that physicians face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, physicians may potentially benefit from a clinical decision support system that accounts for all these considerations. The microsimulation model could provide cardiologists, researchers, and medical students a user-friendly software, which can be used as an intelligent interventional simulator.

  2. The expected-outcome model of two-player games

    CERN Document Server

    Abramson, Bruce

    1990-01-01

    The Expected-Outcome Model of Two-Player Games deals with the expected-outcome model of two-player games, in which the relative merit of game-tree nodes, rather than board positions, is considered. The ambiguity of static evaluation and the problems it generates in the search system are examined and the development of a domain-independent static evaluator is described. Comprised of eight chapters, this book begins with an overview of the rationale for the mathematical study of games, followed by a discussion on some previous artificial intelligence (AI) research efforts on game-trees. The nex

  3. Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

    Directory of Open Access Journals (Sweden)

    Lynne N. Bettinger, MD

    2017-07-01

    Full Text Available Background:. Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique. Methods:. Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of 3 surgical techniques: (1 Prepectoral, (2 subpectoral with acellular dermal matrix (ADM sling (“Classic”, or (3 subpectoral/subserratus expander placement without ADM (“No ADM”. Demographics, comorbidities, radiation therapy, and chemotherapy were assessed for correlation with Clavien IIIb score outcomes. Follow-up was a minimum of 6 months. Results:. Surgical cohorts (n = 165 Prepectoral; n = 77 Classic; n = 52 No ADM had comparable demographics except Classic had more cardiac disease (P = 0.03, No ADM had higher body mass index (BMI (P = 0.01, and the Prepectoral group had more nipple-sparing mastectomies (P 40, stage 4 cancer, and contralateral prophylactic mastectomy were associated with adverse expander outcomes and a prior history of radiation therapy adversely impacted implant outcomes. Ninety-day follow-up for expander and implant complications may be a better National Surgical Quality Improvement Program measure.

  4. Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system.

    Science.gov (United States)

    du Toit, Nagib; Mustak, Hamza; Cook, Colin

    2015-01-01

    To determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS. A prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome. There were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P<0.005). Reliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

  5. An Approach to Assess Relative Degradation in Dissimilar Forests: Toward a Comparative Assessment of Institutional Outcomes

    Directory of Open Access Journals (Sweden)

    Catherine M. Tucker

    2008-06-01

    Full Text Available A significant challenge in the assessment of forest management outcomes is the limited ability to compare forest conditions quantitatively across ecological zones. We propose an approach for comparing different forest types through the use of reference forests. We tested our idea by drawing a sample of 42 forests from the Midwest USA, Mexico, Guatemala, Honduras, Brazil, Bolivia, Uganda, and Nepal. We grouped these forests by shared characteristics and selected a reference forest to serve as a baseline for each forest type. We developed an index of disturbances using ratios of several forest measurements to assess differences between each study forest and its reference forest. None of the study forests was known to have been impacted by major natural disturbances during the past 50 years. Therefore, the disturbances in these forests appear to be largely related to human activities. The forests most similar to their reference forests have had limited human interventions. Our results indicate the potential of this approach to compare different forest conditions across biomes. We argue that development of this approach could facilitate analyses of forest management institutions, promote reliable indicators to compare management outcomes, and contribute to improved policies for conservation.

  6. Comparative study of fetal and maternal outcomes of prelabour rupture of membranes at term

    Directory of Open Access Journals (Sweden)

    Janhavi Mukharya

    2016-12-01

    Full Text Available Background: Premature rupture of membranes (PROM refers to the loss of integrity of membranes before onset of labor, with resulting leakage of amniotic fluid and establishment of communication between the amniotic cavity and the endocervical canal and vagina. The aim of the study was to compare the fetal and maternal outcomes of actively managed and expectantly managed term PROM in a rural setup. Methods: In this prospective study we included 200 women with diagnosed prelabour rupture of membranes. All women had gestational age >37 weeks and <41 weeks with singleton pregnancy and vertex presentation. Study excluded all patients with previous uterine scar or with any medical or surgical disorder. They were randomly divided in two groups with 100 women each: Group A which was induced with PGE1 or oxytocin depending on their cervical score and Group E which was managed expectantly and late induction after 24 hours was done. Both the groups were given intravenous antibiotics. They were evaluated on the basis of fetal and maternal outcomes. Results: In this study we found that 70% women who were managed expectantly went in labour within 24 hours of PROM. But PROM to delivery interval was longer in expectantly managed as compared to actively managed or induced group. Rate of cesarean was more in induced group but was statistically insignificant when compared in both the groups. So was NICU admission more in expectant group but was statistically insignificant when compared in both the groups. Conclusions: Expectant managed can be done in patients with term PROM to reduce the cesarean rate in rural setup. There was no significant difference in maternal and fetal outcomes of the management.

  7. Autograft versus allograft reconstruction of acute tibial plateau fractures: a comparative study of complications and outcome.

    Science.gov (United States)

    Bagherifard, Abolfazl; Ghandhari, Hassan; Jabalameli, Mahmoud; Rahbar, Mohammad; Hadi, Hosseinali; Moayedfar, Mehdi; Sajadi, Mohammadreza Minatour; Karimpour, Alireza

    2017-07-01

    There is no consensus regarding the use of filling agent in the re-elevation of depressed tibial plateau fracture (TPF). Although autograft is considered as the gold standard approach of such reconstructions, its limitation has led to a recent attraction toward allograft substitution. In this study, we compare the complications and outcome of autograft and allograft in TPF reconstruction, in order to address the existing controversy. A total of 81 patients with acute TPF were included in this study. Allograft and autograft were applied in 58 and 23 cases, respectively. The mean age of the patients was 40.26 years, and the mean follow-up period of patients was 19.1 months. Clinical and radiological assessment of the outcome was conducted, employing the modified Rasmussen clinical criteria. A total of three infections were observed in our patients, from which two infections occurred in allograft received patients. Articular surface collapse was seen in two cases, including one allograft and one autograft receiving patient. The mean clinical score was 18.65 and 18.55 in autograft and allograft received patients, respectively (p = 0.09). The mean radiological score was 15.65 and 15.68 in autograft and allograft received patients (p = 0.3). With respect to the comparable complication rate, clinical and radiological outcome of allogenic versus autologous reconstruction of TPF, freeze-dried allograft could be recommended as an appropriate substitute of autograft in this treatment. Nevertheless, the longer follow-up period of the patients could further extend our understanding of the clinical outcome of each component.

  8. Improved Functional Outcomes with Robotic Compared with Manual Total Hip Arthroplasty.

    Science.gov (United States)

    Bukowski, Brandon R; Anderson, Paul; Khlopas, Anton; Chughtai, Morad; Mont, Michael A; Illgen, Richard L

    2016-10-26

    Functional outcome following total hip arthroplasty (THA) is affected by accurate component positioning and restoration of hip biomechanics. Robotic-assisted THA (rTHA) has been shown to improve accuracy of component positioning, but its impact on functional outcomes has not been demonstrated. The purpose of this study was to compare: 1) operative time; 2) estimated blood loss; 3) postoperative complications; and 4) patient-reported outcome measures (PROMs) between patients who either underwent rTHA or manual THA (mTHA). In this retrospective cohort study, a single-center database was used to identify all patients who underwent primary THA since introduction of rTHA at a large academic medical center. Surgical factors including operative time and estimated blood loss as well as postoperative complications were recorded. Validated PROMs following rTHA (n = 100) were compared with consecutive mTHA cases (n = 100) performed by the same fellowship-trained surgeon at a minimum one-year follow-up (24 ± 6 months). PROMs included the Short-Form 12 Health Survey (SF-12), UCLA activity score (UCLA), Western Ontario and McMaster (WOMAC) Osteoarthritis Index, and modified Harris Hip Score (mHHS). A categorical analysis was performed to determine differences in proportions of patients with mHHS scores of 90 to 100, 80 to 89, 70 to 79, and < 70 points between the two groups. Chi-square and two-tailed t-tests were used to compare categorical and continuous data between cohorts. Mean operative time was nine minutes longer for the rTHA group compared with the mTHA group (131 ± 23 min vs. 122 ± 29 min, respectively, p = 0.012). Estimated intraoperative blood loss was significantly reduced for the rTHA group when compared to the mTHA group (374 ± 133 mL vs. 423 ± 186 mL, p = 0.035), and there was no difference in overall complication rates between the two groups (p = 0.101). Robotic-assisted THA demonstrated significantly higher mean postoperative mHHS (92.1 ± 10.5 vs. 86.1

  9. Comparing outcomes in patients with persistent asthma: a registry of two therapeutic alternatives.

    Science.gov (United States)

    O'Connor, Richard D; Gilmore, Amanda S; Manjunath, Ranjani; Stanford, Richard H; Legorreta, Antonio P; Jhingran, Priti M

    2006-03-01

    Clinical trials have demonstrated improved efficacy of fluticasone propionate/salmeterol (100/50 mcg) in a single device (FSC) compared with montelukast (10 mg) (MON). This study was designed to assess asthma control, asthma-related quality of life, asthma-related emergency department (ED) visit/hospitalization, treatment-related satisfaction, and productivity losses in patients newly started on FSC or MON. Patients who were newly prescribed FSC or MON during a regularly scheduled office visit were enrolled in a prospective observational study by nearly 500 physicians from eight managed care plans. Patient survey data were collected at baseline and at months 1, 3, 6, and 12, to measure study outcomes. ED visits/inpatient stays were reported from commercial claims data. Multivariate analyses assessed 12-month outcomes, controlling for several baseline patient characteristics. A total of 1414 patients >or= 15 years old were enrolled in the registry (FSC, n = 1061; MON, n = 353), 90% of which completed a 12-month survey. FSC patients had significantly greater improvement in both asthma control and quality of life, and reported significantly higher satisfaction with their medication (p = 0.003) and fewer days at work/school with asthma symptoms (p = 0.04) than MON. Other parameters of productivity losses such as missed work/school days due to asthma were not significantly different between the two groups. FSC use was also significantly associated with a lower risk of an asthma-related ED visit/hospitalization compared with MON (odds ratio = 0.35, 95% confidence interval: 0.15-0.92). In a 12-month office-based observational study, patients age 15 and older with persistent asthma, newly started on FSC, improved in symptom, quality of life, treatment, and utilization-related outcomes compared with patients newly started on MON. These results should be interpreted in light of the inherent limitations of non-randomized, uncontrolled studies.

  10. Graphical models for inference under outcome-dependent sampling

    DEFF Research Database (Denmark)

    Didelez, V; Kreiner, S; Keiding, N

    2010-01-01

    a node for the sampling indicator, assumptions about sampling processes can be made explicit. We demonstrate how to read off such graphs whether consistent estimation of the association between exposure and outcome is possible. Moreover, we give sufficient graphical conditions for testing and estimating......We consider situations where data have been collected such that the sampling depends on the outcome of interest and possibly further covariates, as for instance in case-control studies. Graphical models represent assumptions about the conditional independencies among the variables. By including...

  11. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study.

    Science.gov (United States)

    Gagne, Joshua J; Choudhry, Niteesh K; Kesselheim, Aaron S; Polinski, Jennifer M; Hutchins, David; Matlin, Olga S; Brennan, Troyen A; Avorn, Jerry; Shrank, William H

    2014-09-16

    Statins are effective in preventing cardiovascular events, but patients do not fully adhere to them. To determine whether patients are more adherent to generic statins versus brand-name statins (lovastatin, pravastatin, or simvastatin) and whether greater adherence improves health outcomes. Observational, propensity score-matched, new-user cohort study. Linked electronic data from medical and pharmacy claims. Medicare beneficiaries aged 65 years or older with prescription drug coverage between 2006 and 2008. Initiation of a generic or brand-name statin. Adherence to statin therapy (measured as the proportion of days covered [PDC] up to 1 year) and a composite outcome comprising hospitalization for an acute coronary syndrome or stroke and all-cause mortality. Hazard ratios (HRs) and absolute rate differences were estimated. A total of 90,111 patients who initiated a statin during the study was identified; 83,731 (93%) initiated a generic drug, and 6380 (7%) initiated a brand-name drug. The mean age of patients was 75.6 years, and most (61%) were female. The average PDC was 77% for patients in the generic group and 71% for those in the brand-name group (P<0.001). An 8% reduction in the rate of the clinical outcome was observed among patients in the generic group versus those in the brand-name group (HR, 0.92 [95% CI, 0.86 to 0.99]). The absolute difference was -1.53 events per 100 person-years (CI, -2.69 to -0.19 events per 100 person-years). Results may not be generalizable to other populations with different incomes or drug benefit structures. Compared with those initiating brand-name statins, patients initiating generic statins were more likely to adhere and had a lower rate of a composite clinical outcome. Teva Pharmaceuticals.

  12. A comparative study of neonatal outcomes in placenta previa versus cesarean for other indication at term.

    Science.gov (United States)

    Schneiderman, Megan; Balayla, Jacques

    2013-07-01

    Currently, no ACOG guidelines address the issue of the optimal timing of delivery in placenta previa. Though there is an increased risk of neonatal morbidity and mortality when electively delivered preterm, it is unclear whether adverse neonatal outcomes exist when these pregnancies make it beyond term. By comparing neonatal outcomes amongst pregnancies with placenta previa versus those from cesarean for another indication at term, the objective of this study was to determine whether placenta previa is an independent risk factor for adverse neonatal outcomes at term. We conducted a population-based cohort-study using the CDC's Linked Birth-Infant Death data from the United States. The effect of placenta previa on the risk of adverse neonatal outcomes was estimated using unconditional logistic regression analysis, adjusting for relevant confounders. Our cohort consisted of 3,550,842 deliveries meeting inclusion criteria. The incidence of placenta previa at term was 1.3/1000 (n = 4,492), accounting for 40.6% of all previa cases. Relative to cesareans for other indications, pregnancies with placenta previa had an increased risk of IUGR 3.20 [2.50-4.10], SGA 2.70 [2.45-2.97], respiratory distress 3.82 [2.91-5.00], prolonged ventilation 3.41 [2.70-4.32] and neonatal anemia 6.87 [4.43-10.65]. Rates of meconium aspiration syndrome, seizures, birth injury and overall infant mortality do not appear to be affected by this condition. Relative to cesareans for other indications, placenta previa is associated with increased morbidity, but not mortality, at term. This information might be helpful in the development of future guidelines, which are currently needed to guide and standardize clinical practice regarding the optimal timing of delivery in placenta previa.

  13. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study.

    Science.gov (United States)

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina

    2015-07-01

    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  14. Outcome Prediction in Mathematical Models of Immune Response to Infection.

    Directory of Open Access Journals (Sweden)

    Manuel Mai

    Full Text Available Clinicians need to predict patient outcomes with high accuracy as early as possible after disease inception. In this manuscript, we show that patient-to-patient variability sets a fundamental limit on outcome prediction accuracy for a general class of mathematical models for the immune response to infection. However, accuracy can be increased at the expense of delayed prognosis. We investigate several systems of ordinary differential equations (ODEs that model the host immune response to a pathogen load. Advantages of systems of ODEs for investigating the immune response to infection include the ability to collect data on large numbers of 'virtual patients', each with a given set of model parameters, and obtain many time points during the course of the infection. We implement patient-to-patient variability v in the ODE models by randomly selecting the model parameters from distributions with coefficients of variation v that are centered on physiological values. We use logistic regression with one-versus-all classification to predict the discrete steady-state outcomes of the system. We find that the prediction algorithm achieves near 100% accuracy for v = 0, and the accuracy decreases with increasing v for all ODE models studied. The fact that multiple steady-state outcomes can be obtained for a given initial condition, i.e. the basins of attraction overlap in the space of initial conditions, limits the prediction accuracy for v > 0. Increasing the elapsed time of the variables used to train and test the classifier, increases the prediction accuracy, while adding explicit external noise to the ODE models decreases the prediction accuracy. Our results quantify the competition between early prognosis and high prediction accuracy that is frequently encountered by clinicians.

  15. A win ratio approach to comparing continuous non-normal outcomes in clinical trials.

    Science.gov (United States)

    Wang, Duolao; Pocock, Stuart

    2016-05-01

    Clinical trials are often designed to compare continuous non-normal outcomes. The conventional statistical method for such a comparison is a non-parametric Mann-Whitney test, which provides a P-value for testing the hypothesis that the distributions of both treatment groups are identical, but does not provide a simple and straightforward estimate of treatment effect. For that, Hodges and Lehmann proposed estimating the shift parameter between two populations and its confidence interval (CI). However, such a shift parameter does not have a straightforward interpretation, and its CI contains zero in some cases when Mann-Whitney test produces a significant result. To overcome the aforementioned problems, we introduce the use of the win ratio for analysing such data. Patients in the new and control treatment are formed into all possible pairs. For each pair, the new treatment patient is labelled a 'winner' or a 'loser' if it is known who had the more favourable outcome. The win ratio is the total number of winners divided by the total numbers of losers. A 95% CI for the win ratio can be obtained using the bootstrap method. Statistical properties of the win ratio statistic are investigated using two real trial data sets and six simulation studies. Results show that the win ratio method has about the same power as the Mann-Whitney method. We recommend the use of the win ratio method for estimating the treatment effect (and CI) and the Mann-Whitney method for calculating the P-value for comparing continuous non-Normal outcomes when the amount of tied pairs is small. Copyright © 2016 John Wiley & Sons, Ltd.

  16. The Trauma Outcome Process Assessment Model: A Structural Equation Model Examination of Adjustment

    Science.gov (United States)

    Borja, Susan E.; Callahan, Jennifer L.

    2009-01-01

    This investigation sought to operationalize a comprehensive theoretical model, the Trauma Outcome Process Assessment, and test it empirically with structural equation modeling. The Trauma Outcome Process Assessment reflects a robust body of research and incorporates known ecological factors (e.g., family dynamics, social support) to explain…

  17. Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery

    DEFF Research Database (Denmark)

    Bertelsen, C A; Neuenschwander, A U; Jansen, J E

    2016-01-01

    2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). RESULTS: Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing......BACKGROUND: Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity. METHODS: Data for patients after elective resection at the four centres in the Capital Region of Denmark (June...... group was 6·2 per cent versus 4·9 per cent in the 'conventional' group (P = 0·219), with a propensity score-adjusted logistic regression odds ratio (OR) of 1·22 (95 per cent c.i. 0·79 to 1·87). Laparoscopic surgery was associated with a lower risk of mortality at 90 days (OR 0·63, 0·42 to 0...

  18. Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

    Science.gov (United States)

    Jain, Shruti; Guleria, Kiran; Vaid, Neelam B; Suneja, Amita; Ahuja, Sharmila

    2016-01-01

    This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

  19. What can be learned from computer modeling? Comparing expository and modeling approaches to teaching dynamic systems behavior

    NARCIS (Netherlands)

    van Borkulo, S.P.|info:eu-repo/dai/nl/297554727; van Joolingen, W.R.; Savelsbergh, E.R.|info:eu-repo/dai/nl/17345853X; de Jong, T.

    2012-01-01

    Computer modeling has been widely promoted as a means to attain higher order learning outcomes. Substantiating these benefits, however, has been problematic due to a lack of proper assessment tools. In this study, we compared computer modeling with expository instruction, using a tailored assessment

  20. What can be learned from computer modeling? Comparing expository and modeling approaches to teaching dynamic systems behavior

    NARCIS (Netherlands)

    van Borkulo, S.P.; van Joolingen, W.R.; Savelsbergh, E.R.; de Jong, T.

    2012-01-01

    Computer modeling has been widely promoted as a means to attain higher order learning outcomes. Substantiating these benefits, however, has been problematic due to a lack of proper assessment tools. In this study, we compared computer modeling with expository instruction, using a tailored assessment

  1. COMPARATIVE STUDY OF MATERNAL AND PERINATAL OUTCOME IN EARLY ONSET AND LATE ONSET PREECLAMPSIA

    Directory of Open Access Journals (Sweden)

    Sreedevi Atluri

    2017-01-01

    Full Text Available BACKGROUND Preeclampsia is the leading cause of maternal and perinatal morbidity and mortality worldwide, the exact aetiology of which is still unknown. The concept of early and late pre-eclampsia depending on gestational age at onset is more modern and is widely accepted that these two entities have different aetiologies and should be considered as different forms of the disease. Even though the presenting features overlap, these two entities of preeclampsia differ by biochemical markers, maternal and foetal outcomes. Aim of the Study- This study compares early-onset preeclampsia and late-onset preeclampsia with respect to their clinical presentation, laboratory parameters, management options, maternal and foetal outcomes which gives us an idea that these two preeclampsia subtypes have different pathological processes and a need for varied clinical approach to prevent adverse outcomes. METHODS This is a prospective comparative study conducted in JSS Hospital, Mysore from November, 2014 to June, 2016. All Antenatal cases (both booked and unbooked with gestational age ≥20 weeks between 18 yrs. and 40 yrs. of age diagnosed as preeclampsia as per the inclusion and exclusion criteria attending the outpatient department or admitted were selected and divided in to two groups, early onset preeclampsia (EOP group if gestational age at onset of preeclampsia is before 34 weeks and late onset preeclampsia if gestational age at onset is at 34 weeks or later were observed until delivery and early postpartum period and babies till early neonatal period. RESULTS A total of 158 patients at >20 weeks of gestation with preeclampsia were enrolled for this study. Early-onset Preeclampsia (EOP and Late-onset Preeclampsia (LOP had 75 and 83 pre eclamptic women respectively. Early onset group had severe clinical picture with deranged laboratory findings (Thrombocytopenia, altered liver enzymes, lactic dehydrogenase (LDH levels, urea and creatinine levels compared to

  2. Atmosphere of Mars - Mariner IV models compared.

    Science.gov (United States)

    Eshleman, V. R.; Fjeldbo, G.; Fjeldbo, W. C.

    1966-01-01

    Mariner IV models of three Mars atmospheric layers analogous to terrestrial E, F-1 and F-2 layers, considering relative mass densities, temperatures, carbon dioxide photodissociation and ionization profile

  3. An Outcome-Weighted Network Model for Characterizing Collaboration

    Science.gov (United States)

    Scholtens, Denise M.; Frailey, Conor N.; Gravenor, Stephanie J.; Kricke, Gayle E.; Soulakis, Nicholas D.

    2016-01-01

    Shared patient encounters form the basis of collaborative relationships, which are crucial to the success of complex and interdisciplinary teamwork in healthcare. Quantifying the strength of these relationships using shared risk-adjusted patient outcomes provides insight into interactions that occur between healthcare providers. We developed the Shared Positive Outcome Ratio (SPOR), a novel parameter that quantifies the concentration of positive outcomes between a pair of healthcare providers over a set of shared patient encounters. We constructed a collaboration network using hospital emergency department patient data from electronic health records (EHRs) over a three-year period. Based on an outcome indicating patient satisfaction, we used this network to assess pairwise collaboration and evaluate the SPOR. By comparing this network of 574 providers and 5,615 relationships to a set of networks based on randomized outcomes, we identified 295 (5.2%) pairwise collaborations having significantly higher patient satisfaction rates. Our results show extreme high- and low-scoring relationships over a set of shared patient encounters and quantify high variability in collaboration between providers. We identified 29 top performers in terms of patient satisfaction. Providers in the high-scoring group had both a greater average number of associated encounters and a higher percentage of total encounters with positive outcomes than those in the low-scoring group, implying that more experienced individuals may be able to collaborate more successfully. Our study shows that a healthcare collaboration network can be structurally evaluated to characterize the collaborative interactions that occur between healthcare providers in a hospital setting. PMID:27706199

  4. Comparing disciplines: outcomes of non melanoma cutaneous malignant lesions in oral and maxillofacial surgery and dermatology.

    Science.gov (United States)

    Thavarajah, M; Szamocki, S; Komath, D; Cascarini, L; Heliotis, M

    2015-01-01

    300 cases of non-melanoma cutaneous lesion procedures carried out by the Oral and Maxillofacial Surgery and Dermatology departments in a North West London hospital over a 6 month period between September 2011 and February 2012 were included in a retrospective case control study. The results from each speciality were compared. The mean age of the OMFS group was 75.8 years compared to 69.9 years in the dermatology group. There was no statistically significant difference in gender between the 2 groups. The OMFS group treated a higher proportion of atypical (17%) and malignant (64.9%) cases compared to the dermatology group (11.3% and 50.5% respectively). This could also account for the fact that the OMFS group carried out a higher number of full excisions compared to dermatology. Both groups had a similar number of false positives (a benign lesion initially diagnosed as malignant) and a similar proportion of false negatives (a malignant lesion initially diagnosed as benign). Overall, the results show that both specialities had similar outcomes when managing non-melanoma cutaneous lesions. Both groups adhere to the guidelines set out by the British Association of Dermatologists and the National Institute of Clinical Excellence when managing such lesions.

  5. Localized therapy for male breast cancer: functional advantages with comparable outcomes using breast conservation.

    Science.gov (United States)

    Fogh, Shannon; Kachnic, Lisa A; Goldberg, Saveli I; Taghian, Alphonse G; Powell, Simon N; Hirsch, Ariel E

    2013-10-01

    Male breast cancer (MBC) accounts for approximately 1% of all breast cancers. Given the rarity of this disease, treatment of MBC generally follows the same principles as treatment of female breast cancer. However, the traditional surgical approach for MBC is modified radical mastectomy (MRM) or total simple mastectomy (TSM) instead of breast conservation surgery (BCS). The purpose of this study was to examine the feasibility of BCS as an alternative to mastectomy for MBC with respect to musculoskeletal functionality and treatment outcome. A retrospective analysis was undertaken of all male patients with breast cancer who presented to Massachusetts General Hospital or Boston Medical Center for localized therapy from 1990 to 2003. Musculoskeletal functionality (tissue fibrosis, arm edema, and range of motion) and treatment outcome (local-regional control, disease-free survival, and overall survival) were evaluated. Functional/cosmetic outcomes were assessed by multidisciplinary review of patient follow-up visits and were scored as either "good-excellent" or "fair-poor" to account for subjectivity between different clinicians. Forty-two patients in total were identified to undergo localized treatment. Thirty patients (71%) received MRM, 4 (10%) had TSM, and 8 (19%) underwent BCS. Actuarial overall 1-year fair-poor documented tissue fibrosis, arm edema, and decreased range of motion rates were 13%, 23%, and 27% for patients receiving MRM; 25%, 0%, and 50% for patients who underwent TSM; and 13%, 0%, and 0% for those undergoing BCS, respectively. Overall survival and disease-free survival were not statistically different between the groups. These data suggest that breast conservation therapy may be considered a reasonable local treatment option for male patients presenting with breast cancer because it may offer functional advantages over mastectomy with comparable rates of local control and disease-free survival and overall survival. Copyright © 2013 Elsevier Inc. All

  6. Comparative Distributions of Hazard Modeling Analysis

    Directory of Open Access Journals (Sweden)

    Rana Abdul Wajid

    2006-07-01

    Full Text Available In this paper we present the comparison among the distributions used in hazard analysis. Simulation technique has been used to study the behavior of hazard distribution modules. The fundamentals of Hazard issues are discussed using failure criteria. We present the flexibility of the hazard modeling distribution that approaches to different distributions.

  7. Comparing Diagnostic Outcomes of Autism Spectrum Disorder Using DSM-IV-TR and DSM-5 Criteria.

    Science.gov (United States)

    Harstad, Elizabeth B; Fogler, Jason; Sideridis, Georgios; Weas, Sarah; Mauras, Carrie; Barbaresi, William J

    2015-05-01

    Controversy exists regarding the DSM-5 criteria for ASD. This study tested the psychometric properties of the DSM-5 model and determined how well it performed across different gender, IQ, and DSM-IV-TR sub-type, using clinically collected data on 227 subjects (median age = 3.95 years, majority had IQ > 70). DSM-5 was psychometrically superior to the DSM-IV-TR model (Comparative Fit Index of 0.970 vs 0.879, respectively). Measurement invariance revealed good model fit across gender and IQ. Younger children tended to meet fewer diagnostic criteria. Those with autistic disorder were more likely to meet social communication and repetitive behaviors criteria (p < .001) than those with PDD-NOS. DSM-5 is a robust model but will identify a different, albeit overlapping population of individuals compared to DSM-IV-TR.

  8. Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies.

    Science.gov (United States)

    Siegel, Yoel; Kuker, Russ

    2016-08-01

    The incidence of superior vena cava (SVC) obstruction associated with non-malignant diseases is on the rise, and a large percentage of these patients are on hemodialysis (HD). The objective was to characterize the presentation, symptoms and outcomes of HD patients with SVC obstruction identified on computerized tomography (CT) compared to patients with other etiologies such as neoplasm. A search was performed through the PACS system using key words to identify patients with SVC obstruction. The CT scans and charts were reviewed for degree of obstruction, signs, symptoms and outcomes. Thirty-six patients were included in the study. Thirteen were on HD and of these, five had symptoms associated with SVC obstruction and one had concordant findings on physical exam. In comparison, thirteen patients with a chest neoplasm had symptoms and four had concordant findings on physical exam. On follow up, 31% of the HD patients died and of these 60% were symptomatic and died within 2 years. 29% of lung cancer patients died within 16 months. The majority of the HD patients had complete SVC obstruction (85%) as opposed to those with a chest neoplasm who mostly had partial SVC occlusion (67%). In conclusion, patients on HD with SVC obstruction are less often symptomatic than those with a neoplasm. However, these HD patients had a death rate similar to the patients with cancer. This risk seems to increase in those who are symptomatic. Diagnosis of SVC obstruction by CT in HD patients may help identify those with less favorable prognosis.

  9. [Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis].

    Science.gov (United States)

    Krimmer, H; Wiemer, P; Kalb, K

    2000-11-01

    Total wrist fusion still represents the main treatment for severe posttraumatic disorders of the wrist due to longstanding scaphoid nonunion (SNAC-wrist) or scapholunate dissociation (SLAC-wrist). During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The question, however, remained if the preserved motion is of real benefit from a patient point of view, as complete pain relief is rare following this type of limited wrist fusion. The purpose of this study was to compare the outcome of both treatments with the modified Cooney wrist score and the DASH questionnaire. Between 1993 and 1997, 138 patients with progressive carpal collapse were treated either by midcarpal fusion (97) or total wrist fusion (41). Overall satisfaction was high in both groups with 86% (midcarpal fusion) and 84% (total wrist fusion). The traditional wrist score (70 versus 52 points) and the DASH questionnaire (33 versus 45 points) revealed the superiority of midcarpal fusion. The correlation between the wrist score and the DASH was statistically high (p wrist fusion for treatment of progressive carpal collapse (SLAC- and SNAC-wrist). The DASH represents a sensitive tool to evaluate the outcome of salvage procedures for treatment of disorders of the wrist.

  10. Very-low-birthweight neonates: do outcomes differ in multiple compared with singleton gestations?

    Science.gov (United States)

    Hayes, Edward J; Paul, David; Ness, Amen; Mackley, Amy; Berghella, Vincenzo

    2007-06-01

    The purpose of this study is to determine if outcomes for very-low-birthweight (VLBW) neonates differ in multiple versus singleton gestations. This is a retrospective cohort study of neonates weighing less than 1500 g admitted to a neonatal intensive care unit from 1993 to 2004. Outcome variables were necrotizing enterocolitis, death, and/or severe intraventricular hemorrhage (IVH). Statistical analysis included univariate and multivariate analysis. During the study period, 1769 VLBW infants including 465 multiples and 1304 singletons were identified. Gestational age and birthweight were similar; conversely white race (68% multiples versus 43% singletons), maternal age (28.7 +/- 5.7 versus 26.1 +/- 6.5 years), born at facility (95% versus 86%), antenatal steroids (74% versus 58%), preeclampsia (14% versus 24%), and preterm labor (74% versus 62%) were significantly different. Correcting for these, VLBW multiples had a higher odds ratio (OR) of death and/or severe IVH, OR 1.4 (1.03-1.95). In our population, VLBW multiple gestations were at elevated odds for death and/or severe IVH compared with VLBW singletons.

  11. Bayesian Treatment Effects Models with Variable Selection for Panel Outcomes with an Application to Earnings Effects of Maternity Leave

    OpenAIRE

    Jacobi, Liana; Wagner, Helga; Frühwirth-Schnatter, Sylvia

    2014-01-01

    Child birth leads to a break in a woman's employment history and is considered one reason for the relatively poor labor market outcomes observed for women compared to men. However, the time spent at home after child birth varies significantly across mothers and is likely driven by observed and, more importantly, unobserved factors that also affect labor market outcomes directly. In this paper we propose two alternative Bayesian treatment modeling and inferential frameworks for panel outcomes ...

  12. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2012-03-01

    Full Text Available (CSIR), Pretoria, South Africa tj.grant@nlda.nl iburke@csir.co.za rvhheerden@csir.co.za Abstract: Cyber operations denote the response of governments and organisations to cyber crime, terrorism, and warfare. To date, cyber operations have been.... This could include responding to an (impending) attack by counter-attacking or by proactively neutralizing the source of an impending attack. A good starting point to improving understanding would be to model the offensive cyber operations process...

  13. Outcomes of Temporary Interruption of Rivaroxaban Compared With Warfarin in Patients With Nonvalvular Atrial Fibrillation

    Science.gov (United States)

    Sherwood, Matthew W.; Douketis, James D.; Patel, Manesh R.; Piccini, Jonathan P.; Hellkamp, Anne S.; Lokhnygina, Yuliya; Spyropoulos, Alex C.; Hankey, Graeme J.; Singer, Daniel E.; Nessel, Christopher C.; Mahaffey, Kenneth W.; Fox, Keith A. A.; Califf, Robert M.; Becker, Richard C.

    2014-01-01

    Background During long-term anticoagulation in atrial fibrillation, temporary interruptions (TIs) of therapy are common, but the relationship between patient outcomes and TIs has not been well studied. We sought to determine reasons for TI, the characteristics of patients undergoing TI, and the relationship between anticoagulant and outcomes among patients with TI. Methods and Results In the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF), a randomized, double-blind, double-dummy study of rivaroxaban and warfarin in nonvalvular atrial fibrillation, baseline characteristics, management, and outcomes, including stroke, non–central nervous system systemic embolism, death, myocardial infarction, and bleeding, were reported in participants who experienced TI (3–30 days) for any reason. The at-risk period for outcomes associated with TI was from TI start to 30 days after resumption of study drug. In 14 236 participants who received at least 1 dose of study drug, 4692 (33%) experienced TI. Participants with TI were similar to the overall ROCKET AF population in regard to baseline clinical characteristics. Only 6% (n=483) of TI incidences involved bridging therapy. Stroke/systemic embolism rates during the at-risk period were similar in rivaroxaban-treated and warfarin-treated participants (0.30% versus 0.41% per 30 days; hazard ratio [confidence interval]=0.74 [0.36–1.50]; P=0.40). Risk of major bleeding during the at-risk period was also similar in rivaroxaban-treated and warfarin-treated participants (0.99% versus 0.79% per 30 days; hazard ratio [confidence interval]=1.26 [0.80–2.00]; P=0.32). Conclusions TI of oral anticoagulation is common and is associated with substantial stroke risks and bleeding risks that were similar among patients treated with rivaroxaban or warfarin. Further investigation is needed to determine the optimal

  14. Comparing Learning Outcomes of Video-Based E-Learning with Face-to-Face Lectures of Agricultural Engineering Courses in Korean Agricultural High Schools

    Science.gov (United States)

    Park, Sung Youl; Kim, Soo-Wook; Cha, Seung-Bong; Nam, Min-Woo

    2014-01-01

    This study investigated the effectiveness of e-learning by comparing the learning outcomes in conventional face-to-face lectures and e-learning methods. Two video-based e-learning contents were developed based on the rapid prototyping model and loaded onto the learning management system (LMS), which was available at http://www.greenehrd.com.…

  15. Student Teaching Abroad Inter-Group Outcomes: A Comparative, Country-Specific Analysis

    Directory of Open Access Journals (Sweden)

    Binbin Jiang

    2010-11-01

    Full Text Available As student diversity becomes the norm in U.S. schools, future teachers must be comprehensively prepared to work with the increasingly diverse student population through application of informed instruction that enhances general and individual student learning and outcomes. Teacher Education programs increasingly promote student teaching in international settings as a substantive step to develop teachers who embody these new competencies and instructional practices. The proposed paper presentation offers a framework and analysis highlighting similarities and differences between two groups of student teachers in Belize (2005 and 2008. Findings are comparative and relate to the type and degree of (1 cultural-, professional-, and character-development influences on student teachers, and (2 emergent common intergroup patterns.

  16. Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning.

    Science.gov (United States)

    Rommel, Niklas; Kesting, Marco Rainer; Rohleder, Nils Hagen; Bauer, Florian Martin Josef; Wolff, Klaus-Dietrich; Weitz, Jochen

    2017-08-01

    The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 € planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 € planning costs/patient). We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Correlation of Subjective Hospital Compare Metrics With Objective Outcomes of Cranial Neurosurgical Procedures in New York State.

    Science.gov (United States)

    Bekelis, Kimon; Missios, Symeon; Coy, Shannon; Rahmani, Redi; MacKenzie, Todd A; Asher, Anthony L

    2017-03-01

    Public reporting is at the forefront of health care reform. To investigate whether patient satisfaction as expressed in a public reporting platform correlates with objective outcomes for cranial neurosurgery patients. We performed a cohort study involving patients undergoing cranial neurosurgery from 2009 to 2013 who were registered in the Statewide Planning and Research Cooperative System database. This cohort was merged with the corresponding data from the Centers for Medicare and Medicaid Services Hospital Compare website. The association of patient satisfaction metrics with outcomes was examined with the use of a propensity-adjusted regression model. Overall, 19 591 patients underwent cranial neurosurgery during the study. Using a propensity-adjusted multivariable regression analysis, we demonstrated that hospitals with a greater percentage of patient-assigned "high" scores had decreased mortality (OR, 0.60; 95% CI, 0.53-0.67), rate of discharge to rehabilitation (OR, 0.93; 95% CI, 0.88-0.98), length of stay (adjusted difference, -1.29; 95% CI, -1.46 to -1.13), and hospitalization charges (adjusted difference, -23%; 95% CI, -36% to -9%) after cranial neurosurgery. Similar associations were identified for hospitals with a higher percentage of patients, who would recommend these institutions to others. In a Centers for Medicare and Medicaid Services Hospital Compare-Statewide Planning and Research Cooperative System merged dataset, we observed an association of higher performance in patient satisfaction measures with decreased mortality, rate of discharge to rehabilitation, hospitalization charges, and length of stay.

  18. Obstetric and perinatal outcome of elderly mothers aged 35 years and above: a comparative study

    Directory of Open Access Journals (Sweden)

    Nirmala Ramachandran

    2015-01-01

    Full Text Available Background: Across the world, there is a rising trend among women towards delaying pregnancy and child birth. The wide educational and career choices available currently encourage women to pursue their professional goals relentlessly and many opt to delay pregnancy. Easy access to the wide range of modern contraceptive methods has enabled them to achieve better control of fertility. Methods: The study conducted in Chennai Medical College and Research Centre, Trichy over a period of 18 months compared pregnancy related complications, maternal and perinatal outcomes in elderly women, with non-elderly women as controls. Forty two elderly gravidae were compared with 50 non-elderly gravidae. Results: The mean age of women in study group was 37.1 and 27.6 in the control group. 14.3% in the study group of patients had assisted conception whereas all of patients in the control group conceived spontaneously. There were 4 (9.5% miscarriages in the study group and none in the control group. The incidence of pre-gestational diabetes, gestational diabetes and preeclampsia was found to be higher in the study group and this was statistically significant (P Value <0.0001. Conclusion: This study analyzing the effect of advanced maternal age on pregnancy has shown favourable maternal and perinatal outcomes. The study showed a significant difference in the incidence of pre-gestational diabetes, gestational diabetes, preeclampsia, miscarriage, antepartum hemorrhage, induction of labour, instrumental deliveries and caesarean section rates in elderly gravidae. But the risk of aneuploidy, malpresentations, placenta previa and prolonged labour were not found to be high. The incidence of low APGAR score was high in the study group, but it was attributable to specific causes like placental abruption. There were no perinatal deaths in both groups. [Int J Res Med Sci 2015; 3(1.000: 214-219

  19. Comparing a tablet computer and paper forms for assessing patient-reported outcomes in edentulous patients

    Science.gov (United States)

    Caetano, Thais Angelina; Ribeiro, Adriana Barbosa; Della Vecchia, Maria Paula; Cunha, Tatiana Ramirez; Chaves, Carolina de Andrade Lima

    2016-01-01

    PURPOSE The aim of this study was to determine whether two methods of documentation, print and electronic forms, for the assessment of patient-reported outcomes (PRO) in complete denture wearers provide comparable results. The study also quantified the time needed for filling the forms by each method. MATERIALS AND METHODS Thirty participants enrolled in a university clinic answered two forms (a questionnaire for denture satisfaction and OHIP-EDENT). They provided answers with two application methods in a random order, with a one-month interval between them: (1) electronic forms on a tablet computer; and (2) print forms. The methods were compared in terms of mean results, correlation/agreement, internal consistency, and spent time. RESULTS Mean results for both methods were similar for each denture satisfaction item (100-mm VAS) and OHIP-EDENT summary score. Both questionnaires presented good internal consistency regardless of the application method (Cronbach's α=0.86 or higher). Correlation and agreement between the methods regarding specific items was at least moderate for the majority of cases. Mean time for the electronic and print forms were 9.2 and 8.5 minutes, respectively (paired t test, P=.06, non-significant). CONCLUSION The electronic method is comparable to print forms for the assessment of important PRO of prosthetic treatment for edentulism, considering the results and time needed. Findings suggest the viability of replacing print forms with a tablet for applying the tested inventories in clinical trials. PMID:28018563

  20. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome

    Directory of Open Access Journals (Sweden)

    Jitumoni Baishya

    2017-01-01

    Full Text Available Introduction: Minimally invasive (MI cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG surgery. Methods: This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group. Demographic, intra- and post-operative variables were collected. Results: In MI group, duration of the surgery was significantly longer (P = 0.029. Intraoperative blood loss lesser (P = 0.002, shorter duration of ventilation (P = 0.002, shorter Intensive Care Unit stay (P = 0.004, shorter hospital stay (P = 0.003, lesser postoperative analgesic requirements (P = 0.027, and lower visual analog scale scores on day of surgery (P = 0.032 and 1 st postoperative day (P = 0.025. No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality. Conclusion: MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.

  1. Economic evaluation of newborn hearing screening: modelling costs and outcomes

    Directory of Open Access Journals (Sweden)

    von Voß, Hubertus

    2003-12-01

    Full Text Available Objectives: The prevalence of newborn hearing disorders is 1-3 per 1,000. Crucial for later outcome are correct diagnosis and effective treatment as soon as possible. With BERA and TEOAE low-risk techniques for early detection are available. Universal screening is recommended but not realised in most European health care systems.Aim of the study was to examine the scientific evidence of newborn hearing screening and a comparison of medical outcome and costs of different programmes, differentiated by type of strategy (risk screening, universal screening, no systematical screening. Methods: In an interdisciplinary health technology assessment project all studies on newborn hearing screening detected in a standardized comprehensive literature search were identified and data on medical outcome, costs, and cost-effectiveness extracted. A Markov model was designed to calculate cost-effectiveness ratios. Results: Economic data were extracted from 20 relevant publications out of 39 publications found. In the model total costs for screening of 100,000 newborns with a time horizon of ten years were calculated: 2.0 Mio.€ for universal screening (U, 1.0 Mio.€ for risk screening (R, and 0.6 Mio.€ for no screening (N. The costs per child detected: 13,395€ (U respectively 6,715€ (R, and 4,125€ (N. At 6 months of life the following percentages of cases are detected: U 72%, R 43%, N 13%. Conclusions: A remarkable small number of economic publications mainly of low methodological quality was found. In our own model we found reasonable cost-effectiveness ratios also for universal screening. Considering the outcome advantages of higher numbers of detected cases a universal newborn hearing screening is recommended.

  2. A COMPARATIVE STUDY OF PERINATAL OUTCOME IN LOW RISK PREGNANCIES WITH CTG MONITORING AND INTERMITTENT AUSCULTATION

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    Velimala Ratna

    2015-12-01

    Full Text Available EFM was introduced into widespread clinical practice in the 1970s to 1980s on the premise that it would facilitate early detection of abnormal FHR patterns thought to be associated with hypoxia thus allowing earlier intervention to prevent foetal neurological damage and/or death. There is a lack of evidence of benefit supporting the use of the admission CTG in low-risk pregnancy. In this study we the aim to evaluate the effects of Cardiotocograph Foetal Monitoring on perinatal outcome in low risk Obstetric population and determine the cost effective and reliable method of fetal monitoring that is applicable to low-risk population. METHODOLOGY A prospective randomized study conducted on 200 low risk pregnant women in labour divided into 2 groups of 100 each. Group A includes those monitored with admission CTG and Group B includes those monitored with intermittent auscultation (IA. OBSERVATION AND RESULTS The demographic features, parity and gestational age in both the groups were comparable; 10 out of the 100 in CTG group had meconium stained liquor whereas 15 of them had meconium in IA group; 71% of the patients in CTG group had normal delivery, whereas it was 84% in IA group. Incidence of LSCS was 23% in CTG group as against 9% in IA group. A ‘P’ value of 0.02, RR of 2 5 for operative deliveries in CTG group was observed which was significant. Incidence of AVD was 6% in CTG group and 7% in IA group with a p value of <0.05, which is statistically significant. The incidence of MSL, APGAR scores at 1, 5 and 10 minutes and NICU admissions were comparable in both the groups. There was no significant difference in babies with low APGAR <7 at 5 min and NICU admissions in both the groups. In our study the sensitivity of CTG was 63.63%, specificity 80.35%, positive predictive value 33.3%, negative predictive value 94.93%. The low sensitivity and high false positives led to the intervention in delivery and increase in operative delivery with no

  3. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C

    2001-01-01

    -up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...... progression (new AIDS/death). Adjustment was made for differences in baseline parameters, in particular pVL, CD4 cell count, and region of Europe. RESULTS: A total of 2708 patients (median follow-up: 30 months) were included, of which 556 started ritonavir (21%), 1342 indinavir (50%), and 810 saquinavir hgc......OBJECTIVE: To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN: We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow...

  4. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C;

    2001-01-01

    OBJECTIVE: To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN: We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow.......62--1.11); P = 0.20. CONCLUSIONS: Saquinavir hgc was associated with an inferior long-term clinical response relative to indinavir, which was consistent with the observed differences in virological and immunological responses.......-up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...

  5. Comparative molecular modelling of biologically active sterols

    Science.gov (United States)

    Baran, Mariusz; Mazerski, Jan

    2015-04-01

    Membrane sterols are targets for a clinically important antifungal agent - amphotericin B. The relatively specific antifungal action of the drug is based on a stronger interaction of amphotericin B with fungal ergosterol than with mammalian cholesterol. Conformational space occupied by six sterols has been defined using the molecular dynamics method to establish if the conformational features correspond to the preferential interaction of amphotericin B with ergosterol as compared with cholesterol. The compounds studied were chosen on the basis of structural features characteristic for cholesterol and ergosterol and on available experimental data on the ability to form complexes with the antibiotic. Statistical analysis of the data obtained has been performed. The results show similarity of the conformational spaces occupied by all the sterols tested. This suggests that the conformational differences of sterol molecules are not the major feature responsible for the differential sterol - drug affinity.

  6. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

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    Macfarlane, Alan James Robert; Kearns, Rachel Joyce; Aitken, Emma; Kinsella, John; Clancy, Marc James

    2013-08-19

    An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infiltration of local anaesthetic alone. This, however, has not yet been shown in a large trial to influence long-term fistula patency, the ultimate clinical measure of success.The aim of this study is to compare whether a regional anaesthetic block, compared to local anaesthetic infiltration, can improve long-term fistula patency. This study is an observer-blinded, randomised controlled trial. Patients scheduled to undergo creation of either brachial or radial arteriovenous fistulae will receive a study information sheet, and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either: (i) an ultrasound guided brachial plexus block using lignocaine with adrenaline and levobupivicaine, or (ii) local anaesthetic infiltration with lignocaine and levobupivicaine.A total of 126 patients will be recruited. The primary outcome is fistula primary patency at three months. Secondary outcomes include primary patency at 1 and 12 months, secondary patency and fistula flow at 1, 3 and 12 months, flow on first haemodialysis, procedural pain, patient satisfaction, change in cephalic vein diameter pre- and post-anaesthetic, change in radial or brachial artery flow pre- and post-anaesthetic, alteration of the surgical plan after anaesthesia as guided by vascular mapping with ultrasound, and fistula infection requiring antibiotics. No large randomised controlled trial has examined the influence of brachial plexus block compared with local anaesthetic

  7. Gains in Learning Outcomes of College Students in Japan: Comparative Study between Academic Fields

    Science.gov (United States)

    Yamada, Reiko

    2014-01-01

    Ensuring gains in the learning outcomes of college students has become a major concern for Japanese higher education institutions. In recent decades, national and public as well as private universities have been forced to embed learning outcomes into their curriculum. A number of studies have shown that the learning outcomes of students are…

  8. Comparative Outcome Analysis of Penicillin-Based Versus Fluoroquinolone-Based Antibiotic Therapy for Community-Acquired Pneumonia

    Science.gov (United States)

    Wang, Chi-Chuan; Lin, Chia-Hui; Lin, Kuan-Yin; Chuang, Yu-Chung; Sheng, Wang-Huei

    2016-01-01

    Abstract Community-acquired pneumonia (CAP) is a common but potentially life-threatening condition, but limited information exists on the effectiveness of fluoroquinolones compared to β-lactams in outpatient settings. We aimed to compare the effectiveness and outcomes of penicillins versus respiratory fluoroquinolones for CAP at outpatient clinics. This was a claim-based retrospective cohort study. Patients aged 20 years or older with at least 1 new pneumonia treatment episode were included, and the index penicillin or respiratory fluoroquinolone therapies for a pneumonia episode were at least 5 days in duration. The 2 groups were matched by propensity scores. Cox proportional hazard models were used to compare the rates of hospitalizations/emergence service visits and 30-day mortality. A logistic model was used to compare the likelihood of treatment failure between the 2 groups. After propensity score matching, 2622 matched pairs were included in the final model. The likelihood of treatment failure of fluoroquinolone-based therapy was lower than that of penicillin-based therapy (adjusted odds ratio [AOR], 0.88; 95% confidence interval [95%CI], 0.77–0.99), but no differences were found in hospitalization/emergence service (ES) visits (adjusted hazard ratio [HR], 1.27; 95% CI, 0.92–1.74) and 30-day mortality (adjusted HR, 0.69; 95% CI, 0.30–1.62) between the 2 groups. The likelihood of treatment failure of fluoroquinolone-based therapy was lower than that of penicillin-based therapy for CAP on an outpatient clinic basis. However, this effect may be marginal. Further investigation into the comparative effectiveness of these 2 treatment options is warranted. PMID:26871827

  9. The Assessment of Patient Clinical Outcome: Advantages, Models, Features of an Ideal Model

    Directory of Open Access Journals (Sweden)

    Mou’ath Hourani

    2016-06-01

    Full Text Available Background: The assessment of patient clinical outcome focuses on measuring various aspects of the health status of a patient who is under healthcare intervention. Patient clinical outcome assessment is a very significant process in the clinical field as it allows health care professionals to better understand the effectiveness of their health care programs and thus for enhancing the health care quality in general. It is thus vital that a high quality, informative review of current issues regarding the assessment of patient clinical outcome should be conducted. Aims & Objectives: 1 Summarizes the advantages of the assessment of patient clinical outcome; 2 reviews some of the existing patient clinical outcome assessment models namely: Simulation, Markov, Bayesian belief networks, Bayesian statistics and Conventional statistics, and Kaplan-Meier analysis models; and 3 demonstrates the desired features that should be fulfilled by a well-established ideal patient clinical outcome assessment model. Material & Methods: An integrative review of the literature has been performed using the Google Scholar to explore the field of patient clinical outcome assessment. Conclusion: This paper will directly support researchers, clinicians and health care professionals in their understanding of developments in the domain of the assessment of patient clinical outcome, thus enabling them to propose ideal assessment models.

  10. Performance of models for estimating absolute risk difference in multicenter trials with binary outcome

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    Claudia Pedroza

    2016-08-01

    Full Text Available Abstract Background Reporting of absolute risk difference (RD is recommended for clinical and epidemiological prospective studies. In analyses of multicenter studies, adjustment for center is necessary when randomization is stratified by center or when there is large variation in patients outcomes across centers. While regression methods are used to estimate RD adjusted for baseline predictors and clustering, no formal evaluation of their performance has been previously conducted. Methods We performed a simulation study to evaluate 6 regression methods fitted under a generalized estimating equation framework: binomial identity, Poisson identity, Normal identity, log binomial, log Poisson, and logistic regression model. We compared the model estimates to unadjusted estimates. We varied the true response function (identity or log, number of subjects per center, true risk difference, control outcome rate, effect of baseline predictor, and intracenter correlation. We compared the models in terms of convergence, absolute bias and coverage of 95 % confidence intervals for RD. Results The 6 models performed very similar to each other for the majority of scenarios. However, the log binomial model did not converge for a large portion of the scenarios including a baseline predictor. In scenarios with outcome rate close to the parameter boundary, the binomial and Poisson identity models had the best performance, but differences from other models were negligible. The unadjusted method introduced little bias to the RD estimates, but its coverage was larger than the nominal value in some scenarios with an identity response. Under the log response, coverage from the unadjusted method was well below the nominal value (<80 % for some scenarios. Conclusions We recommend the use of a binomial or Poisson GEE model with identity link to estimate RD for correlated binary outcome data. If these models fail to run, then either a logistic regression, log Poisson

  11. Risk profiles and outcomes of total laparoscopic hysterectomy compared with laparoscopically assisted vaginal hysterectomy.

    Science.gov (United States)

    Hanwright, Philip J; Mioton, Lauren M; Thomassee, May S; Bilimoria, Karl Y; Van Arsdale, John; Brill, Elizabeth; Kim, John Y S

    2013-04-01

    With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes. A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; Plaparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07-1.42). Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity. II.

  12. Prediction of an outcome using trajectories estimated from a linear mixed model.

    Science.gov (United States)

    Maruyama, Nami; Takahashi, Fumiaki; Takeuchi, Masahiro

    2009-09-01

    In longitudinal data, interest is usually focused on the repeatedly measured variable itself. In some situations, however, the pattern of variation of the variable over time may contain information about a separate outcome variable. In such situations, longitudinal data provide an opportunity to develop predictive models for future observations of the separate outcome variable given the current data for an individual. In particular, longitudinally changing patterns of repeated measurements of a variable measured up to time t, or trajectories, can be used to predict an outcome measure or event that occurs after time t. In this article, we propose a method for predicting an outcome variable based on a generalized linear model, specifically, a logistic regression model, the covariates of which are variables that characterize the trajectory of an individual. Since the trajectory of an individual contains estimation error, the proposed logistic regression model constitutes a measurement error model. The model is fitted in two steps. First, a linear mixed model is fitted to the longitudinal data to estimate the random effect that characterizes the trajectory for each individual while adjusting for other covariates. In the second step, a conditional likelihood approach is applied to account for the estimation error in the trajectory. Prediction of an outcome variable is based on the logistic regression model in the second step. The receiver operating characteristic curve is used to compare the discrimination ability of a model with trajectories to one without trajectories as covariates. A simulation study is used to assess the performance of the proposed method, and the method is applied to clinical trial data.

  13. Comparative genomics of Helicobacter pylori strains of China associated with different clinical outcome.

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    Yuanhai You

    Full Text Available In this study, a whole-genome CombiMatrix Custom oligonucleotide tiling microarray with 90,000 probes covering six sequenced Helicobacter pylori (H. pylori genomes was designed. This microarray was used to compare the genomic profiles of eight unsequenced strains isolated from patients with different gastroduodenal diseases in Heilongjiang province of China. Since significant genomic variation was found among these strains, an additional 76 H. pylori strains associated with different clinical outcomes were isolated from various provinces of China. These strains were tested by polymerase chain reaction to demonstrate this distinction. We identified several highly variable regions in strains associated with gastritis, gastric ulceration, and gastric cancer. These regions are associated with genes involved in the bacterial type I, type II, and type III R-M systems. They were also associated with the virB gene, which lies on the well-studied cag pathogenic island. While previous studies have reported on the diverse genetic characterization of this pathogenic island, in this study, we find that it is conserved in all strains tested by microarray. Moreover, a number of genes involved in the type IV secretion system, which is related to horizontal DNA transfer between H. pylori strains, were identified in the comparative analysis of the strain-specific genes. These findings may provide insight into new biomarkers for the prediction of gastric diseases.

  14. Post-mastectomy reconstruction: a risk-stratified comparative analysis of outcomes.

    Science.gov (United States)

    Saha, Dujata; Davila, Armando A; Ver Halen, Jon P; Jain, Umang K; Hansen, Nora; Bethke, Kevin; Khan, Seema A; Jeruss, Jacqueline; Fine, Neil; Kim, john Y S

    2013-12-01

    Although breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive. Using the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared. Of 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p < 0.001). Immediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes. Level 3.

  15. Comparative analysis of carotid endarterectomy late outcomes related to intervention modality.

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Beloiartsev, D F; Timina, I E; Kolosov, R V

    2005-01-01

    The paper presents a comparative analysis of late outcomes after 105 carotid endarterectomies (CEA) performed in 89 patients from 1997 to 2003, including 95 patients (90.5%) operated for atherosclerotic stenosis of internal carotid artery (ICA) and 7 patients (6.6%)--for combined ICA stenosis and tortuosity. The severity distribution of cerebrovascular insufficiency (CVI) was the following: grade I--in 22.8%, grade II--in 12.4%, grade III--in 25.7% and grade IV--in 38.1% of patients. CEA methods included eversion endarterectomy in 50.4% cases and open (classic) surgical CEA with PTFE patch angioplasty in 49.6% cases. Mean follow-up period was 31.8 months for the eversion CEA group and 37 months--for the open CEA group (from 3 to 72 months). In 76.4% patients the duration of follow-up period exceeded 1 year. During the follow-up period all patients underwent clinical examination and color duplex scanning of reconstructed CA segment with assessment of diameter, vascular wall thickness and blood flow. TIA was registered in 1 patient from eversion CEA group and in 1 patient from open CEA group. Thus, in the long-term postoperative period 98% of patients were free from neurological complications. Hemodynamically significant restenoses developed in 8 cases (7.6%), including 4 patients from the eversion CEA group and 4 patients from the open CEA group. Myointimal hyperplasia (> 3 mm) accompanied by hemodynamical alterations occurred in 1 patient from the eversion CEA group and in 2 from the open CEA group. In the rest of cases restenoses were related to atherosclerotic plaque formation. In conclusion, the long-term outcomes indicate that CEA is effective in the prevention of cerebrovascular events regardless of carotid angioplasty strategy. The rate of late postoperative restenoses was similar for eversion and open CEAs. Both modalities can be promising for the surgical correction of CA stenoses.

  16. Antibiotic Resistances in Livestock: A Comparative Approach to Identify an Appropriate Regression Model for Count Data

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    Anke Hüls

    2017-05-01

    Full Text Available Antimicrobial resistance in livestock is a matter of general concern. To develop hygiene measures and methods for resistance prevention and control, epidemiological studies on a population level are needed to detect factors associated with antimicrobial resistance in livestock holdings. In general, regression models are used to describe these relationships between environmental factors and resistance outcome. Besides the study design, the correlation structures of the different outcomes of antibiotic resistance and structural zero measurements on the resistance outcome as well as on the exposure side are challenges for the epidemiological model building process. The use of appropriate regression models that acknowledge these complexities is essential to assure valid epidemiological interpretations. The aims of this paper are (i to explain the model building process comparing several competing models for count data (negative binomial model, quasi-Poisson model, zero-inflated model, and hurdle model and (ii to compare these models using data from a cross-sectional study on antibiotic resistance in animal husbandry. These goals are essential to evaluate which model is most suitable to identify potential prevention measures. The dataset used as an example in our analyses was generated initially to study the prevalence and associated factors for the appearance of cefotaxime-resistant Escherichia coli in 48 German fattening pig farms. For each farm, the outcome was the count of samples with resistant bacteria. There was almost no overdispersion and only moderate evidence of excess zeros in the data. Our analyses show that it is essential to evaluate regression models in studies analyzing the relationship between environmental factors and antibiotic resistances in livestock. After model comparison based on evaluation of model predictions, Akaike information criterion, and Pearson residuals, here the hurdle model was judged to be the most appropriate

  17. Cognitive Outcomes for Congenital Hypothyroid and Healthy Children: A Comparative Study

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    Mahtab ORDOOEI

    2014-12-01

    Full Text Available How to Cite This Article: Ordooei M, MottaghiPisheh H, Fallah R, Rabiee A. Cognitive Outcomes for Congenital Hypothyroid andHealthy Children: A Comparative Study. Iran J Child Neurol. 2014 Autumn;8(4: 28-32.AbstractObjectiveEarly diagnosis and treatment of congenital hypothyroidism (CH and the prevention of developmental retardation is the main goal of public health national screening programs. This study compares the cognitive ability of children with CH diagnosed by neonatal screening with a healthy control group (2007 in Yazd, Iran.Materials & MethodsIn a case-controlled study, the intelligent quotient (IQ of 40 five-year-old children with early treated CH and good compliance were evaluated by the Wechsler preschool and primary scale of intelligent test and compared to 40 healthy age and gender matched children as controls.Results22 boys (55% and 18 girls (45% in both groups were evaluated. In children with CH, 19 (47.5% and 21 (52.5% persons had transient and permanent hypothyroidism, respectively.Range of TSH and T4 level at the onset of diagnosis were 11.41–81 mu/l and 1.50–14.20 μg/dl, respectively.The intelligence levels of all children with CH were within the average or normal range and IQs ranged from 91–108.Children with CH had lower full-scale IQs (107.25 ± 2. 9 versus 110.50 ± 2.66, p=0.001, verbal IQ (106.95 ± 3.5 versus 109.90 ± 3.44, P-value=0.001 and performance IQ (106.3 ± 3.68 versus 108.87 ± 3.70 than the control group.However, no statistically significant differences were observed for mean IQ scores in permanent and transient CH.ConclusionChildren with CH who had early treatment and good compliance had normal cognitive abilities, but may have a decreased IQ relative to the healthy control group.ReferencesLeFranchi S. Hypothyroidism. Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE. Nelson Textbook of Pediatrics. Philadelphia, Saunders 2011; 19th edition, Pp: 1895-1900.Nouri-Shadkam M, Jafarizadeh M

  18. Outcomes in Adult Survivors of Childhood Burn Injuries as Compared with Matched Controls.

    Science.gov (United States)

    Stone, James; Gawaziuk, Justin P; Khan, Sazzadul; Chateau, Dan; Bolton, James M; Sareen, Jitender; Enns, Jessica; Doupe, Malcolm; Brownell, Marni; Logsetty, Sarvesh

    2016-01-01

    Limited research exists examining long-term mental and physical health outcomes in adult survivors of pediatric burns. The authors examine the postinjury lifetime prevalence of common mental and physical disorders in a large pediatric burn cohort and compare the results with matched controls. Seven hundred and forty five survivors of childhood burns identified in the Burn Registry (1% between April 1, 1988 and March 31, 2010) were matched 1:5 to the general population based on age at time of injury (index date), sex, and geographic residence. Postinjury rate ratio (RR) was used to compare burn cases and control cohorts for common mental and physical illnesses through physician billings, and hospital claims. RR was adjusted for sex, rural residence, and income. Compared with matched controls, postburn cases had significantly higher RR of all mental disorders, which remained significant (P < .05) after adjustment (major depression RR = 1.5 [confidence limit {CL}: 1.2-1.8], anxiety disorder RR = 1.5 [CL: 1.3-1.8), substance abuse RR = 2.3 [CL: 1.7-3.2], suicide attempt RR = 4.3 [CL: 1.6-12.1], or any mental disorder RR = 1.5 [CL: 1.3-1.8]). The relative rate of some physical illnesses was also significantly increased in burn survivors: arthritis RR = 1.2 (CL: 1.1-1.4), fractures RR = 1.4 (CL: 1.2-1.6), total respiratory morbidity RR = 1.1 (CL: 1.02-1.3), and any physical illness RR = 1.2 (CL: 1.1-1.3). Adult survivors of childhood burn injury have significantly increased rates of postburn mental and physical illnesses. Screening and appropriate management of these illnesses is essential when caring for this population.

  19. Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays.

    Science.gov (United States)

    Glance, Laurent G; Osler, Turner; Li, Yue; Lustik, Stewart J; Eaton, Michael P; Dutton, Richard P; Dick, Andrew W

    2016-06-01

    Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US patients undergoing moderate-to-high risk surgery on weekends are more likely to experience worse outcomes than patients undergoing surgery on weekdays. The aim of this study was to determine whether patients undergoing surgery on weekends are more likely to die or experience a major complication compared with patients undergoing surgery on a weekday. Using all-payer data, we conducted a retrospective cohort study of 305,853 patients undergoing isolated coronary artery bypass graft surgery, colorectal surgery, open repair of abdominal aortic aneurysm, endovascular repair of abdominal aortic aneurysm, and lower extremity revascularization. We compared in-hospital mortality and major complications for weekday versus weekend surgery using multivariable logistic regression analysis. After controlling for patient risk and surgery type, weekend elective surgery [adjusted odds ratio (AOR)=3.18; 95% confidence interval (CI), 2.26-4.49; Psurgery (AOR=2.11; 95% CI, 1.68-2.66; Psurgery. Weekend elective (AOR=1.58; 95% CI, 1.29-1.93; Psurgery (AOR=1.61; 95% CI, 1.42-1.82; Psurgery. Patients undergoing nonemergent major cardiac and noncardiac surgery on the weekends have a clinically significantly increased risk of death and major complications compared with patients undergoing surgery on weekdays. These findings should prompt decision makers to seek to better understand factors, such physician and nurse staffing, which may contribute to the weekend effect.

  20. Outcome modelling strategies in epidemiology: traditional methods and basic alternatives.

    Science.gov (United States)

    Greenland, Sander; Daniel, Rhian; Pearce, Neil

    2016-04-01

    Controlling for too many potential confounders can lead to or aggravate problems of data sparsity or multicollinearity, particularly when the number of covariates is large in relation to the study size. As a result, methods to reduce the number of modelled covariates are often deployed. We review several traditional modelling strategies, including stepwise regression and the 'change-in-estimate' (CIE) approach to deciding which potential confounders to include in an outcome-regression model for estimating effects of a targeted exposure. We discuss their shortcomings, and then provide some basic alternatives and refinements that do not require special macros or programming. Throughout, we assume the main goal is to derive the most accurate effect estimates obtainable from the data and commercial software. Allowing that most users must stay within standard software packages, this goal can be roughly approximated using basic methods to assess, and thereby minimize, mean squared error (MSE).

  1. Differences in perceived fairness and health outcomes in two injury compensation systems: a comparative study.

    Science.gov (United States)

    Elbers, Nieke A; Collie, Alex; Hogg-Johnson, Sheilah; Lippel, Katherine; Lockwood, Keri; Cameron, Ian D

    2016-07-29

    Involvement in a compensation process following a motor vehicle collision is consistently associated with worse health status but the reasons underlying this are unclear. Some compensation systems are hypothesised to be more stressful than others. In particular, fault-based compensation systems are considered to be more adversarial than no-fault systems and associated with poorer recovery. This study compares the perceived fairness and recovery of claimants in the fault-based compensation system in New South Wales (NSW) to the no-fault system in Victoria, Australia. One hundred eighty two participants were recruited via claims databases of the compensation system regulators in Victoria and NSW. Participants were > 18 years old and involved in a transport injury compensation process. The crash occurred 12 months (n = 95) or 24 months ago (n = 87). Perceived fairness about the compensation process was measured by items derived from a validated organisational justice questionnaire. Health outcome was measured by the initial question of the Short Form Health Survey. In Victoria, 84 % of the participants considered the claims process fair, compared to 46 % of NSW participants (χ(2) = 28.54; p fairness. Overall perceived fairness was positively associated with health outcome after adjusting for demographic and injury variables (Adjusted Odds Ratio = 2.8, 95 % CI = 1.4 - 5.7, p = .004). The study shows large differences in perceived fairness between two different compensation systems and an association between fairness and health. These findings are politically important because compensation processes are designed to improve recovery. Lower perceived fairness in NSW may have been caused by potential adversarial aspects of the scheme, such as liability assessment, medical assessments, dealing with a third party for-profit insurance agency, or financial insecurity due to lump sum payments at settlement. This study should encourage an

  2. Investigating follow-up outcome change using hierarchical linear modeling.

    Science.gov (United States)

    Ogrodniczuk, J S; Piper, W E; Joyce, A S

    2001-03-01

    Individual change in outcome during a one-year follow-up period for 98 patients who received either interpretive or supportive psychotherapy was examined using hierarchical linear modeling (HLM). This followed a previous study that had investigated average (treatment condition) change during follow-up using traditional methods of data analysis (repeated measures ANOVA, chi-square tests). We also investigated whether two patient personality characteristics-quality of object relations (QOR) and psychological mindedness (PM)-predicted individual change. HLM procedures yielded findings that were not detected using traditional methods of data analysis. New findings indicated that the rate of individual change in outcome during follow-up varied significantly among the patients. QOR was directly related to favorable individual change for supportive therapy patients, but not for patients who received interpretive therapy. The findings have implications for determining which patients will show long-term benefit following short-term supportive therapy and how to enhance it. The study also found significant associations between QOR and final outcome level.

  3. A Program Evaluation Model: Using Bloom's Taxonomy to Identify Outcome Indicators in Outcomes-Based Program Evaluations

    Science.gov (United States)

    McNeil, Rita C.

    2011-01-01

    Outcomes-based program evaluation is a systematic approach to identifying outcome indicators and measuring results against those indicators. One dimension of program evaluation is assessing the level of learner acquisition to determine if learning objectives were achieved as intended. The purpose of the proposed model is to use Bloom's Taxonomy to…

  4. Meta-analysis of studies with bivariate binary outcomes: a marginal beta-binomial model approach.

    Science.gov (United States)

    Chen, Yong; Hong, Chuan; Ning, Yang; Su, Xiao

    2016-01-15

    When conducting a meta-analysis of studies with bivariate binary outcomes, challenges arise when the within-study correlation and between-study heterogeneity should be taken into account. In this paper, we propose a marginal beta-binomial model for the meta-analysis of studies with binary outcomes. This model is based on the composite likelihood approach and has several attractive features compared with the existing models such as bivariate generalized linear mixed model (Chu and Cole, 2006) and Sarmanov beta-binomial model (Chen et al., 2012). The advantages of the proposed marginal model include modeling the probabilities in the original scale, not requiring any transformation of probabilities or any link function, having closed-form expression of likelihood function, and no constraints on the correlation parameter. More importantly, because the marginal beta-binomial model is only based on the marginal distributions, it does not suffer from potential misspecification of the joint distribution of bivariate study-specific probabilities. Such misspecification is difficult to detect and can lead to biased inference using currents methods. We compare the performance of the marginal beta-binomial model with the bivariate generalized linear mixed model and the Sarmanov beta-binomial model by simulation studies. Interestingly, the results show that the marginal beta-binomial model performs better than the Sarmanov beta-binomial model, whether or not the true model is Sarmanov beta-binomial, and the marginal beta-binomial model is more robust than the bivariate generalized linear mixed model under model misspecifications. Two meta-analyses of diagnostic accuracy studies and a meta-analysis of case-control studies are conducted for illustration.

  5. Outcome Prediction after Traumatic Brain Injury: Comparison of the Performance of Routinely Used Severity Scores and Multivariable Prognostic Models

    Science.gov (United States)

    Majdan, Marek; Brazinova, Alexandra; Rusnak, Martin; Leitgeb, Johannes

    2017-01-01

    Objectives: Prognosis of outcome after traumatic brain injury (TBI) is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E) multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS), GCS motor (GCSM) score, abbreviated injury scale for the head region, Marshall computed tomographic (CT) classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC) and Nagelkerke's R2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome) were used as end-points. Results: Comparing AUCs and R2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs 0.83 and R2 > 0.42 for all outcomes): AUCs were worse by 0.10–0.22 (P prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.

  6. Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study.

    Science.gov (United States)

    Bouvier, Sylvie; Cochery-Nouvellon, Eva; Lavigne-Lissalde, Géraldine; Mercier, Erick; Marchetti, Tess; Balducchi, Jean-Pierre; Marès, Pierre; Gris, Jean-Christophe

    2014-01-16

    The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome (APS) treated with prophylactic low-molecular-weight heparin (LMWH) plus low-dose aspirin (LDA) has not been documented. We observed women without a history of thrombosis who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal loss at or beyond the 10th week. We compared the frequencies of complications during new pregnancies between treated women with APS (n = 513; LMWH + LDA) and women negative for antiphospholipid antibodies as controls (n = 791; no treatment). Among APS women, prior fetal loss was a risk factor for fetal loss, preeclampsia (PE), premature birth, and the occurrence of any placenta-mediated complication. Being positive for anticardiolipin immunoglobulin M antibodies was a risk factor for any placenta-mediated complication. Among women with a history of recurrent abortion, APS women were at a higher risk than other women of PE, placenta-mediated complications, and neonatal mortality. Among women with prior fetal loss, LMWH + LDA-treated APS women had lower pregnancy loss rates but higher PE rates than other women. Improved therapies, in particular better prophylaxis of late pregnancy complications, are urgently needed for obstetric APS and should be evaluated according to the type of pregnancy loss.

  7. Everolimus-eluting stent platforms in percutaneous coronary intervention: comparative effectiveness and outcomes

    Directory of Open Access Journals (Sweden)

    Panoulas VF

    2015-07-01

    Full Text Available Vasileios F Panoulas,1 Ioannis Mastoris,2 Klio Konstantinou,1 Maurizio Tespili,3 Alfonso Ielasi3 1National Heart and Lung Institute, Imperial College London, London, UK; 2Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York NY, USA; 3Cardiology Department, Bolognini Hospital Seriate, Seriate (BG, Italy Abstract: Despite the remarkable benefits obtained following the introduction of the first-generation drug-eluting stent (DES, concerns were raised over its long-term safety, particularly with regard to very late (beyond 1 year stent thrombosis. Newer-generation DESs have been developed to overcome this limitation using novel stent platforms, new drugs, more biocompatible durable polymers, and bioabsorbable polymers or backbones. To date, new-generation DESs have virtually replaced the use of first-generation DESs worldwide. In this review article, we discuss in detail the design, pharmacology, and mechanism of action of the newer-generation permanent and bioresorbable everolimus-eluting platforms. Furthermore, we present and evaluate the current evidence on the performance and safety of these devices compared to those of other available stent platforms. Keywords: PCI, angioplasty, stent, outcome 

  8. Comparative analysis of postoperative outcomes of myasthenia gravis with and without thymoma

    Institute of Scientific and Technical Information of China (English)

    WANG Ru-wen; LIN Yi-dan; JIANG Yao-guang; XUE Zhi-qiang; ZHAO Yun-ping; MA Zheng

    2005-01-01

    Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis (MG) surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics, complication, remissions and survival rates were compared between MG with and without thymoma. Results: The patients of MG with thymoma were significantly older (P<0. 01), had shorter duration of symptom(P<0.01), and higher myasthenia crisis rates after operation(P<0.01) than those without thymoma. No difference of Osserman classification was found between the 2 groups. The complete remission rates and partial remission rates of MG with thymoma were significantly lower than those without thymoma at 1 and 3 years(P=0. 049, P=0. 000, P=0. 015, P=0. 010), but no differences at 5 years (P= 0. 457, P= 0. 699). The survival rates were lower in MG with thymoma than without thymoma (Log rank = 18.58,P = 0. 000). Conclusion: The clinical characteristics are different between MG with and without thymoma. The remission of symptom of MG- with thymoma is worse than that of MG without thymoma in the near future, but similar in the long future. In a long-term, the death rate of MG with thymoma is significantly higher than that of MG without thymoma.

  9. Active learning on the ward: outcomes from a comparative trial with traditional methods.

    Science.gov (United States)

    Melo Prado, Hegla; Hannois Falbo, Gilliatt; Rodrigues Falbo, Ana; Natal Figueirôa, José

    2011-03-01

    Academic activity during internship is essentially practical and ward rounds are traditionally considered the cornerstone of clinical education. However, the efficacy and effectiveness of ward rounds for learning purposes have been under-investigated and it is necessary to assess alternative educational paradigms for this activity. This study aimed to compare the educational effectiveness of ward rounds conducted with two different learning methodologies. Student subjects were first tested on 30 true/false questions to assess their initial degree of knowledge on pneumonia and diarrhoea. Afterwards, they attended ward rounds conducted using an active and a traditional learning methodology. The participants were submitted to a second test 48hours later in order to assess knowledge acquisition and were asked to answer two questions about self-directed learning and their opinions on the two learning methodologies used. Seventy-two medical students taking part in a paediatric clinic rotation were enrolled. The active methodology proved to be more effective than the traditional methodology for the three outcomes considered: knowledge acquisition (33 students [45.8%] versus 21 students [29.2%]; p=0.03); self-directed learning (38 students [52.8%] versus 11 students [15.3%]; pactive methodology produced better results than the traditional methodology in a ward-based context. This study seems to be valuable in terms of the new evidence it demonstrates on learning methodologies in the context of the ward round. © Blackwell Publishing Ltd 2011.

  10. Comparing Poisson Sigma Model with A-model

    Science.gov (United States)

    Bonechi, F.; Cattaneo, A. S.; Iraso, R.

    2016-10-01

    We discuss the A-model as a gauge fixing of the Poisson Sigma Model with target a symplectic structure. We complete the discussion in [4], where a gauge fixing defined by a compatible complex structure was introduced, by showing how to recover the A-model hierarchy of observables in terms of the AKSZ observables. Moreover, we discuss the off-shell supersymmetry of the A-model as a residual BV symmetry of the gauge fixed PSM action.

  11. Comparing model predictions for ecosystem-based management

    DEFF Research Database (Denmark)

    Jacobsen, Nis Sand; Essington, Timothy E.; Andersen, Ken Haste

    2016-01-01

    Ecosystem modeling is becoming an integral part of fisheries management, but there is a need to identify differences between predictions derived from models employed for scientific and management purposes. Here, we compared two models: a biomass-based food-web model (Ecopath with Ecosim (Ew......E)) and a size-structured fish community model. The models were compared with respect to predicted ecological consequences of fishing to identify commonalities and differences in model predictions for the California Current fish community. We compared the models regarding direct and indirect responses to fishing...... on one or more species. The size-based model predicted a higher fishing mortality needed to reach maximum sustainable yield than EwE for most species. The size-based model also predicted stronger top-down effects of predator removals than EwE. In contrast, EwE predicted stronger bottom-up effects...

  12. Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care.

    Science.gov (United States)

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure. Models were derived from hospital claims data and were then enhanced with admission laboratory predictive results. Case-level discrimination, goodness of fit, and calibration were used to compare administrative models (ADM) and laboratory predictive models (LAB). LAB models for the prediction of PD-90 were modestly enhanced over ADM, but negligible benefit was seen for RA-90. A consistent predictor of PD-90 and RA-90 was prolonged length of stay outliers from the index hospitalization.

  13. Comparing SVARs and SEMs : Two models of the UK economy

    NARCIS (Netherlands)

    Jacobs, J.P.A.M.; Wallis, K.F.

    2005-01-01

    The structural vector autoregression (SVAR) and simultaneous equation macroeconometric model (SEM) styles of empirical macroeconomic modelling are compared and contrasted, with reference to two models of the UK economy, namely the long-run structural VAR model of Garratt, Lee, Pesaran and Shin and t

  14. Evolution and physics in comparative protein structure modeling.

    Science.gov (United States)

    Fiser, András; Feig, Michael; Brooks, Charles L; Sali, Andrej

    2002-06-01

    From a physical perspective, the native structure of a protein is a consequence of physical forces acting on the protein and solvent atoms during the folding process. From a biological perspective, the native structure of proteins is a result of evolution over millions of years. Correspondingly, there are two types of protein structure prediction methods, de novo prediction and comparative modeling. We review comparative protein structure modeling and discuss the incorporation of physical considerations into the modeling process. A good starting point for achieving this aim is provided by comparative modeling by satisfaction of spatial restraints. Incorporation of physical considerations is illustrated by an inclusion of solvation effects into the modeling of loops.

  15. Mediation Analysis with Survival Outcomes: Accelerated Failure Time Versus Proportional Hazards Models

    Directory of Open Access Journals (Sweden)

    Lois A Gelfand

    2016-03-01

    Full Text Available Objective: Survival time is an important type of outcome variable in treatment research. Currently, limited guidance is available regarding performing mediation analyses with survival outcomes, which generally do not have normally distributed errors, and contain unobserved (censored events. We present considerations for choosing an approach, using a comparison of semi-parametric proportional hazards (PH and fully parametric accelerated failure time (AFT approaches for illustration.Method: We compare PH and AFT models and procedures in their integration into mediation models and review their ability to produce coefficients that estimate causal effects. Using simulation studies modeling Weibull-distributed survival times, we compare statistical properties of mediation analyses incorporating PH and AFT approaches (employing SAS procedures PHREG and LIFEREG, respectively under varied data conditions, some including censoring. A simulated data set illustrates the findings.Results: AFT models integrate more easily than PH models into mediation models. Furthermore, mediation analyses incorporating LIFEREG produce coefficients that can estimate causal effects, and demonstrate superior statistical properties. Censoring introduces bias in the coefficient estimate representing the treatment effect on outcome – underestimation in LIFEREG, and overestimation in PHREG. With LIFEREG, this bias can be addressed using an alternative estimate obtained from combining other coefficients, whereas this is not possible with PHREG.Conclusions: When Weibull assumptions are not violated, there are compelling advantages to using LIFEREG over PHREG for mediation analyses involving survival-time outcomes. Irrespective of the procedures used, the interpretation of coefficients, effects of censoring on coefficient estimates, and statistical properties should be taken into account when reporting results.

  16. Comparing Poisson Sigma Model with A-model

    CERN Document Server

    Bonechi, Francesco; Iraso, Riccardo

    2016-01-01

    We discuss the A-model as a gauge fixing of the Poisson Sigma Model with target a symplectic structure. We complete the discussion in [arXiv:0706.3164], where a gauge fixing defined by a compatible complex structure was introduced, by showing how to recover the A-model hierarchy of observables in terms of the AKSZ observables. Moreover, we discuss the off-shell supersymmetry of the A-model as a residual BV symmetry of the gauge-fixed PSM action.

  17. Comparative Effectiveness of Etanercept and Adalimumab in Patient Reported Outcomes and Injection-Related Tolerability.

    Directory of Open Access Journals (Sweden)

    Iris Navarro-Millán

    Full Text Available To describe patient preferences in selecting specific biologics and compare clinical response using patient reported outcomes (PROs among patients with rheumatoid arthritis (RA started on different anti-tumor necrosis factor (TNF therapies.Participants were enrollees in Kaiser Permanente Northern California. Patients with RA who had at least two provider visits and started a new anti-TNF therapy from 10/2010-8/2011, were eligible for participation in this longitudinal study. Using a telephone survey, patient preferences in biologic selection and RAPID3, MDHAQ, and SF-12 scores were collected at baseline and at 6 months. Patient scores rating injection/infusion-site burning and stinging (ISBS were collected at 6 months.In all, 267 patients with RA responded to the baseline survey, of whom 57% preferred an injectable biologic, 22% preferred an infused biologic, and 21% had no preference. Motivation for injectable biologics was convenience (92% and for infusion therapy was dislike or lack of self-efficacy for self-injection (16%. After 6 months of treatment with anti-TNF, 70% of the 177 patients who answered the ISBS question reported ISBS with the last dose; on a scale of 1 (none to 10 (worst, 41% of these reported a score of 2-5; and 29% reported a score of 6-10. Adalimumab users experienced 3.2 times (95% confidence interval 1.2-8.6 the level of ISBS that etanercept users experienced. There were no significant differences in RAPID3, MDHAQ, or SF-12 scores between etanercept or adalimumab initiators.Convenience and fear of self-injection were important considerations to patients selecting a biologic drug. Although more convenient, adalimumab associated with more ISBS than did etanercept, and this rate was higher than reported in clinical trials. At 6 months, PROs did not differ between etanercept and adalimumab users.

  18. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey.

    Science.gov (United States)

    Longhurst, H J; Zanichelli, A; Caballero, T; Bouillet, L; Aberer, W; Maurer, M; Fain, O; Fabien, V; Andresen, I

    2017-04-01

    Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P types I/II, respectively. © 2016 British Society for Immunology.

  19. A Semiparametric Bivariate Probit Model for Joint Modeling of Outcomes in STEMI Patients

    Directory of Open Access Journals (Sweden)

    Francesca Ieva

    2014-01-01

    parameter estimates. Secondly, covariate-outcomes relationships can exhibit nonlinear patterns. Provided that proper statistical methods for model fitting in such framework are available, it is possible to employ a simultaneous estimation approach to account for unobservable confounders. Such a framework can also provide flexible covariate structures and model the whole conditional distribution of the response.

  20. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

    Directory of Open Access Journals (Sweden)

    Niklaus Daniel Labhardt

    2013-11-01

    Full Text Available Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs to scale up the provision of antiretroviral therapy (ART. We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5% started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81 and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001. These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR: 0.89, 95% confidence interval (CI: 0.73–1.09 and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96. The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93. Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities

  1. A randomized controlled trial comparing two techniques for unilateral cleft lip and palate: Growth and speech outcomes during mixed dentition.

    Science.gov (United States)

    Ganesh, Praveen; Murthy, Jyotsna; Ulaghanathan, Navitha; Savitha, V H

    2015-07-01

    To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols. A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7-10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted. A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group. Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  2. Theory-based Practice: Comparing and Contrasting OT Models

    DEFF Research Database (Denmark)

    Nielsen, Kristina Tomra; Berg, Brett

    2012-01-01

    Theory- Based Practice: Comparing and Contrasting OT Models The workshop will present a critical analysis of the major models of occupational therapy, A Model of Human Occupation, Enabling Occupation II, and Occupational Therapy Intervention Process Model. Similarities and differences among...... the models will be discussed, including each model’s limitations and unique contributions to the profession. Workshop format will include short lectures and group discussions....

  3. Building v/s Exploring Models: Comparing Learning of Evolutionary Processes through Agent-based Modeling

    Science.gov (United States)

    Wagh, Aditi

    Two strands of work motivate the three studies in this dissertation. Evolutionary change can be viewed as a computational complex system in which a small set of rules operating at the individual level result in different population level outcomes under different conditions. Extensive research has documented students' difficulties with learning about evolutionary change (Rosengren et al., 2012), particularly in terms of levels slippage (Wilensky & Resnick, 1999). Second, though building and using computational models is becoming increasingly common in K-12 science education, we know little about how these two modalities compare. This dissertation adopts agent-based modeling as a representational system to compare these modalities in the conceptual context of micro-evolutionary processes. Drawing on interviews, Study 1 examines middle-school students' productive ways of reasoning about micro-evolutionary processes to find that the specific framing of traits plays a key role in whether slippage explanations are cued. Study 2, which was conducted in 2 schools with about 150 students, forms the crux of the dissertation. It compares learning processes and outcomes when students build their own models or explore a pre-built model. Analysis of Camtasia videos of student pairs reveals that builders' and explorers' ways of accessing rules, and sense-making of observed trends are of a different character. Builders notice rules through available blocks-based primitives, often bypassing their enactment while explorers attend to rules primarily through the enactment. Moreover, builders' sense-making of observed trends is more rule-driven while explorers' is more enactment-driven. Pre and posttests reveal that builders manifest a greater facility with accessing rules, providing explanations manifesting targeted assembly. Explorers use rules to construct explanations manifesting non-targeted assembly. Interviews reveal varying degrees of shifts away from slippage in both

  4. Care pathways models and clinical outcomes in Disorders of consciousness.

    Science.gov (United States)

    Sattin, Davide; Morganti, Laura; De Torres, Laura; Dolce, Giuliano; Arcuri, Francesco; Estraneo, Anna; Cardinale, Viviana; Piperno, Roberto; Zavatta, Elena; Formisano, Rita; D'Ippolito, Mariagrazia; Vassallo, Claudio; Dessi, Barbara; Lamberti, Gianfranco; Antoniono, Elena; Lanzillotti, Crocifissa; Navarro, Jorge; Bramanti, Placido; Corallo, Francesco; Zampolini, Mauro; Scarponi, Federico; Avesani, Renato; Salvi, Luca; Ferro, Salvatore; Mazza, Luigi; Fogar, Paolo; Feller, Sandro; De Nigris, Fulvio; Martinuzzi, Andrea; Buffoni, Mara; Pessina, Adriano; Corsico, Paolo; Leonardi, Matilde

    2017-08-01

    Patients with Disorders of consciousness, are persons with extremely low functioning levels and represent a challenge for health care systems due to their high needs of facilitating environmental factors. Despite a common Italian health care pathway for these patients, no studies have analyzed information on how each region have implemented it in its welfare system correlating data with patients' clinical outcomes. A multicenter observational pilot study was realized. Clinicians collected data on the care pathways of patients with Disorder of consciousness by asking 90 patients' caregivers to complete an ad hoc questionnaire through a structured phone interview. Questionnaire consisted of three sections: sociodemographic data, description of the care pathway done by the patient, and caregiver evaluation of health services and information received. Seventy-three patients were analyzed. Length of hospital stay was different across the health care models and it was associated with improvement in clinical diagnosis. In long-term care units, the diagnosis at admission and the number of caregivers available for each patient (median value = 3) showed an indirect relationship with worsening probability in clinical outcome. Caregivers reported that communication with professionals (42%) and the answer to the need of information were the most critical points in the acute phase, whereas presence of Non-Governmental Organizations (25%) and availability of psychologists for caregivers (21%) were often missing during long-term care. The 65% of caregivers reported they did not know the UN Convention on the Rights of Persons with Disabilities. This study highlights relevant differences in analyzed models, despite a recommended national pathway of care. Future public health considerations and actions are needed to guarantee equity and standardization of the care process in all European countries.

  5. National Initiatives to Improve Healthcare Outcomes: A Comparative Study of Health Delivery Systems in Slovakia and the United States.

    Science.gov (United States)

    Curtis, Robert; Caplanova, Anetta; Novak, Marcel

    2015-01-01

    While the United States and Slovakia offer different healthcare delivery systems, each country faces the same challenges of improving the health status of their populations. The authors explore the impact of their respective systems on the health of their populations and compare the health outcomes of both nations. They point out that socioeconomic factors play a far more important role in determining population health outcomes than do the structures of the systems surrounding the care delivery. The authors illustrate this finding through a comparison of the poverty and education levels of a selected minority group from each country in relation to the health outcomes for each population group. The comparison reveals that education is a more influential determinant in a population's health outcomes, than the improved access to care offered by a universal system.

  6. Comparative assessment of three-phase oil relative permeability models

    Science.gov (United States)

    Ranaee, Ehsan; Riva, Monica; Porta, Giovanni M.; Guadagnini, Alberto

    2016-07-01

    We assess the ability of 11 models to reproduce three-phase oil relative permeability (kro) laboratory data obtained in a water-wet sandstone sample. We do so by considering model performance when (i) solely two-phase data are employed to render predictions of kro and (ii) two and three-phase data are jointly used for model calibration. In the latter case, a Maximum Likelihood (ML) approach is used to estimate model parameters. The tested models are selected among (i) classical models routinely employed in practical applications and implemented in commercial reservoir software and (ii) relatively recent models which are considered to allow overcoming some drawbacks of the classical formulations. Among others, the latter set of models includes the formulation recently proposed by Ranaee et al., which has been shown to embed the critical effects of hysteresis, including the reproduction of oil remobilization induced by gas injection in water-wet media. We employ formal model discrimination criteria to rank models according to their skill to reproduce the observed data and use ML Bayesian model averaging to provide model-averaged estimates (and associated uncertainty bounds) of kro by taking advantage of the diverse interpretive abilities of all models analyzed. The occurrence of elliptic regions is also analyzed for selected models in the framework of the classical fractional flow theory of displacement. Our study confirms that model outcomes based on channel flow theory and classical saturation-weighted interpolation models do not generally yield accurate reproduction of kro data, especially in the regime associated with low oil saturations, where water alternating gas injection (WAG) techniques are usually employed for enhanced oil recovery. This negative feature is not observed in the model of Ranaee et al. (2015) due to its ability to embed key effects of pore-scale phase distributions, such as hysteresis effects and cycle dependency, for modeling kro observed

  7. Modeling classical swine fever outbreak-related outcomes

    Directory of Open Access Journals (Sweden)

    Shankar eYadav

    2016-02-01

    Full Text Available The study was carried out to estimate classical swine fever (CSF outbreak-related outcomes such as epidemic duration and number of infected, vaccinated, and depopulated premises, using defined most likely CSF outbreak scenarios. Risk metrics were established using empirical data to select the most likely CSF outbreak scenarios in Indiana. The scenarios were simulated using a stochastic between-premises disease spread model to estimate outbreak-related outcomes. A total of 19 single-site (i.e., with a single-index premises at the onset of an outbreak and 15 multiple-site (i.e., with more than one index premises at the onset of an outbreak outbreak scenarios of CSF were selected using the risk metrics. The number of index premises in the multiple-site outbreak scenarios ranged from 4 to 32. The multiple-site outbreak scenarios were further classified into clustered (N=6 and non-clustered (N=9 groups. The estimated median (5th, 95th percentiles epidemic duration (days was 224 (24, 343 in the single-site and was 190 (157, 251 and 210 (167, 302 in the clustered and non-clustered multiple-site outbreak scenarios, respectively. The median (5th, 95th percentiles number of infected premises was 323 (0, 488 in the single-site outbreak scenarios and was 529 (395, 662 and 465 (295, 640 in the clustered and non-clustered multiple-site outbreak scenarios, respectively. Both the number and spatial distribution of the index premises affected the outcome estimates. The results also showed the importance of implementing vaccinations to accommodate depopulation in the CSF outbreak controls. The use of routinely collected surveillance data in the risk metrics and disease spread model allows end users to generate timely outbreak-related information based on the initial outbreak’s characteristics. Swine producers can use this information to make an informed decision on management of swine operations and continuity of business so that potential losses could be

  8. Comparative effectiveness of angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers for major renal outcomes in patients with diabetes: A 15-year cohort study.

    Science.gov (United States)

    Wu, Hon-Yen; Peng, Chiao-Ling; Chen, Pei-Chun; Chiang, Chih-Kang; Chang, Chee-Jen; Huang, Jenq-Wen; Peng, Yu-Sen; Tu, Yu-Kang; Chu, Tzong-Shinn; Hung, Kuan-Yu; Chien, Kuo-Liong

    2017-01-01

    Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are considered to have similar renoprotective effects; so far there has been no consensus about their priorities. This study aimed to compare ACEIs and ARBs for major renal outcomes and survival in a 15-year cohort of adults with diabetes. This study utilized Taiwan's medical and pharmacy claims data in the Longitudinal Cohort of Diabetes Patients. The primary outcome was long-term dialysis, and secondary outcomes were hospitalization for acute kidney injury, hospitalization for hyperkalemia, all-cause death, cardiovascular death, and non-cardiovascular death. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes comparing ACEIs with ARBs. We conducted subgroup analyses and interaction tests among patients with different age and comorbid diseases. A total of 34,043 patients received ACEIs and 23,772 patients received ARBs. No differences were found for primary or secondary outcomes in the main analyses. ACEIs showed significantly lower hazard than ARBs for long-term dialysis among patients with cardiovascular disease (HR 0.80, 95% CI 0.66-0.97, interaction P = 0.003) or chronic kidney disease (0.81, 0.71-0.93, interaction P = 0.001). Our analyses show similar effects of ACEIs and ARBs in patients with diabetes. However, ACEIs might provide additional renoprotective effects among patients who have cardiovascular disease or chronic kidney disease.

  9. Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis (PRISMA Compliant).

    Science.gov (United States)

    Jayadevappa, Ravishankar; Chhatre, Sumedha; Wong, Yu-Ning; Wittink, Marsha N; Cook, Ratna; Morales, Knashawn H; Vapiwala, Neha; Newman, Diane K; Guzzo, Thomas; Wein, Alan J; Malkowicz, Stanley B; Lee, David I; Schwartz, Jerome S; Gallo, Joseph J

    2017-05-01

    In the context of prostate cancer (PCa) characterized by the multiple alternative treatment strategies, comparative effectiveness analysis is essential for informed decision-making. We analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly diagnosed localized PCa patients. We performed a systematic review of literature published in English from 1995 to October 2016. A search strategy was employed using terms "prostate cancer," "localized," "outcomes," "mortality," "health related quality of life," and "complications" to identify relevant randomized controlled trials (RCTs), prospective, and retrospective studies. For observational studies, only those adjusting for selection bias using propensity-score or instrumental-variables approaches were included. Multivariable adjusted hazard ratio was used to assess all-cause and disease-specific mortality. Funnel plots were used to assess the level of bias. Our search strategy yielded 58 articles, of which 29 were RCTs, 6 were prospective studies, and 23 were retrospective studies. The studies provided moderate data for the patient-centered outcome of mortality. Radical prostatectomy demonstrated mortality benefit compared to watchful waiting (all-cause HR = 0.63 CI = 0.45, 0.87; disease-specific HR = 0.48 CI = 0.40, 0.58), and radiation therapy (all-cause HR = 0.65 CI = 0.57, 0.74; disease-specific HR = 0.51 CI = 0.40, 0.65). However, we had minimal comparative information about tradeoffs between and within treatment for other patient-centered outcomes in the short and long-term. Lack of patient-centered outcomes in comparative effectiveness research in localized PCa is a major hurdle to informed and shared decision-making. More rigorous studies that can integrate patient-centered and intermediate outcomes in addition to mortality are needed.

  10. Parmodel: a web server for automated comparative modeling of proteins.

    Science.gov (United States)

    Uchôa, Hugo Brandão; Jorge, Guilherme Eberhart; Freitas Da Silveira, Nelson José; Camera, João Carlos; Canduri, Fernanda; De Azevedo, Walter Filgueira

    2004-12-24

    Parmodel is a web server for automated comparative modeling and evaluation of protein structures. The aim of this tool is to help inexperienced users to perform modeling, assessment, visualization, and optimization of protein models as well as crystallographers to evaluate structures solved experimentally. It is subdivided in four modules: Parmodel Modeling, Parmodel Assessment, Parmodel Visualization, and Parmodel Optimization. The main module is the Parmodel Modeling that allows the building of several models for a same protein in a reduced time, through the distribution of modeling processes on a Beowulf cluster. Parmodel automates and integrates the main softwares used in comparative modeling as MODELLER, Whatcheck, Procheck, Raster3D, Molscript, and Gromacs. This web server is freely accessible at .

  11. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

    Directory of Open Access Journals (Sweden)

    Liu JL

    2014-05-01

    Full Text Available Jun Le Liu,1,* Xiao Lin Wang,1,* Mao Wei Gong,1,* Hai Xing Mai,2 Shu Jun Pei,1 Wei Xiu Yuan,1 Hong Zhang11Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital and Medical School of Chinese People’s Liberation Army, Beijing, People’s Republic of China; 2Department of Urology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People’s Republic of China*These authors contributed equally to this workBackground: Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.Objectives: We compared general anesthesia (GA and peripheral nerve blocks (PNBs on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF undergoing hemiarthroplasty.Materials and methods: This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.Results: Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely

  12. Comparing Structural Brain Connectivity by the Infinite Relational Model

    DEFF Research Database (Denmark)

    Ambrosen, Karen Marie Sandø; Herlau, Tue; Dyrby, Tim;

    2013-01-01

    The growing focus in neuroimaging on analyzing brain connectivity calls for powerful and reliable statistical modeling tools. We examine the Infinite Relational Model (IRM) as a tool to identify and compare structure in brain connectivity graphs by contrasting its performance on graphs from...... modeling tool for the identification of structure and quantification of similarity in graphs of brain connectivity in general....

  13. Improving the Rank Precision of Population Health Measures for Small Areas with Longitudinal and Joint Outcome Models.

    Directory of Open Access Journals (Sweden)

    Jessica K Athens

    Full Text Available The University of Wisconsin Population Health Institute has published the County Health Rankings since 2010. These rankings use population-based data to highlight health outcomes and the multiple determinants of these outcomes and to encourage in-depth health assessment for all United States counties. A significant methodological limitation, however, is the uncertainty of rank estimates, particularly for small counties. To address this challenge, we explore the use of longitudinal and pooled outcome data in hierarchical Bayesian models to generate county ranks with greater precision.In our models we used pooled outcome data for three measure groups: (1 Poor physical and poor mental health days; (2 percent of births with low birth weight and fair or poor health prevalence; and (3 age-specific mortality rates for nine age groups. We used the fixed and random effects components of these models to generate posterior samples of rates for each measure. We also used time-series data in longitudinal random effects models for age-specific mortality. Based on the posterior samples from these models, we estimate ranks and rank quartiles for each measure, as well as the probability of a county ranking in its assigned quartile. Rank quartile probabilities for univariate, joint outcome, and/or longitudinal models were compared to assess improvements in rank precision.The joint outcome model for poor physical and poor mental health days resulted in improved rank precision, as did the longitudinal model for age-specific mortality rates. Rank precision for low birth weight births and fair/poor health prevalence based on the univariate and joint outcome models were equivalent.Incorporating longitudinal or pooled outcome data may improve rank certainty, depending on characteristics of the measures selected. For measures with different determinants, joint modeling neither improved nor degraded rank precision. This approach suggests a simple way to use existing

  14. Comparing Treatment Outcome of Guided Imagery and Music and Psychodynamic Imaginative Trauma Therapy for Women with Complex PTSD

    DEFF Research Database (Denmark)

    Maack, Carola

    2013-01-01

    To investigate whether the use of recorded music enhances therapy outcome in psychodynamic trauma therapy for women with Complex PTSD, outcome measures of three groups of patients were compared. One group received 50 hours of outpatient trauma therapy with the Bonny Method of Guided Imagery...... of Complex PTSD, structural and somatoform dissociation, interpersonal problems, and factors promoting health before treatment and after 50 therapy hours or before and after waiting. Results showed significant differences in all scores when either of the treatment conditions was compared to the control group....... Participants treated with GIM showed significantly better outcome in all measurements than participants treated with PITT. This indicates that the use of music is beneficial for women with Complex PTSD treated with psychodynamic trauma therapy....

  15. Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and non-resistant hypertension

    Science.gov (United States)

    Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; Reynolds, Kristi; Calhoun, David A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

    2015-01-01

    We sought to compare the risk of end stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was sub-categorized into 2 groups; 23,104 patients with cRH (controlled on 4 or more medicines) and 37,223 patients with uRH (uncontrolled on 3 or more medicines) in a 5 year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and co-morbidities. Resistant hypertension (cRH and uRH) compared to non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27–1.37), 1.24 (1.20–1.28), 1.46 (1.40–1.52), 1.14 (1.10–1.19), and 1.06 (1.03–1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH to cRH had hazard ratios of 1.25 (1.18–1.33), 1.04 (0.99–1.10), 0.94 (0.89–1.01), 1.23 (1.14–1.31), and 1.01 (0.97–1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Males and Hispanics had greater risk for ESRD within all 3 cohorts. Resistant hypertension had greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA and were 25% and 23% greater, respectively, in uRH compared to cRH supporting the linkage between blood pressure and both outcomes. PMID:25945406

  16. [Maternal and perinatal outcomes in nulliparous gestations with late onset preeclampsia: Comparative study with gestations without preeclampsia].

    Science.gov (United States)

    Salazar-Pousada, Danny; Chedraui, Peter; Villao, Alejandro; Pérez-Roncero, Gonzalo R; Hidalgo, Luis

    2014-01-01

    To assess obstetrical outcomes in a sample of nulliparous gestations with preeclampsia, as compared to gestations without preeclampsia, attended in the Enrique C. Sotomayor Hospital of Guayaquil, Ecuador. This was a comparative study of maternal and perinatal outcome data of gestations with late onset preeclampsia (n=150; gestational age=36.7±3.3 weeks) with that of normal gestations (n=150; gestational age 38.7±1.7 weeks). Almost three-quarters (73.3%) of preeclampsia cases were defined as severe. Compared to normal gestations, preeclampsia cases had higher anthropometric indices (neck and mid-arm circumference) and had more oligohydramnios, cesarean sections, transfusions, distressed fetuses, and adverse perinatal outcomes such as, lower Apgar scores at birth, and more preterm births, lower birth weight and small for gestational age infants. Gestations with preeclampsia had a negative impact on maternal and perinatal outcomes compared to gestations without preeclampsia. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Comparing Online with Brick and Mortar Course Learning Outcomes: An Analysis of Quantitative Methods Curriculum in Public Administration

    Science.gov (United States)

    Harris, Ronald A.; Nikitenko, Gleb O.

    2014-01-01

    Teaching graduate students in an intensive adult-learning format presents a special challenge for quantitative analytical competencies. Students often lack necessary background, skills and motivation to deal with quantitative-skill-based course work. This study compares learning outcomes for graduate students enrolled in three course sections…

  18. Comparing Victim Attributions and Outcomes for Workplace Aggression and Sexual Harassment

    Science.gov (United States)

    Hershcovis, M. Sandy; Barling, Julian

    2010-01-01

    In 2 studies, we investigated victim attributions (Study 1) and outcomes (Study 2) for workplace aggression and sexual harassment. Drawing on social categorization theory, we argue that victims of workplace aggression and sexual harassment may make different attributions about their mistreatment. In Study 1, we investigated victim attributions in…

  19. A comparative analytical study of clinical outcome of oligohydramnios at or beyond 34 weeks of gestation

    Directory of Open Access Journals (Sweden)

    Sunita TH

    2016-06-01

    Conclusions: Determination of AFI is a valuable parameter, which can be used as an adjunct to other fetal surveillance methods. It helps to identify neonates at risk of poor perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1801-1808

  20. Comparing Child Outcomes of Physical Punishment and Alternative Disciplinary Tactics: A Meta-Analysis

    Science.gov (United States)

    Larzelere, Robert E.; Kuhn, Brett R.

    2005-01-01

    This meta-analysis investigates differences between the effect sizes of physical punishment and alternative disciplinary tactics for child outcomes in 26 qualifying studies. Analyzing differences in effect sizes reduces systematic biases and emphasizes direct comparisons between the disciplinary tactics that parents have to select among. The…

  1. A Comparative Study of the Perceptions of Professional Staff on Their Contribution to Student Outcomes

    Science.gov (United States)

    Regan, Julie-Anne; Dollard, Emma; Banks, Nicci

    2014-01-01

    This study examined the perceptions of professional staff on their contribution to student outcomes. An online Delphi survey method was used to collect data from two expert panels: professional staff based in faculties and professional staff based in central university departments. The aim of this method is for the panels to reach consensus. The…

  2. A comparative study of adoloscents’ perceived stress and health outcomes among adolescent mothers and their infants in Lesotho

    Directory of Open Access Journals (Sweden)

    E.M. Yako

    2007-09-01

    Full Text Available The purpose of this study was to compare perceived stress in general, stress due to pregnancy, and post partum complications between a group of unmarried adolescent first-time mothers and a group of married adolescent first-time mothers. Never-pregnant adolescents served as a comparison group on perceived stress. Health outcomes of infants of the two groups of adolescent mothers were also compared on birth weight, nutritional status (weight gain and immunization status.

  3. Comparative Study of Various SDLC Models on Different Parameters

    Directory of Open Access Journals (Sweden)

    Prateek Sharma

    2015-04-01

    Full Text Available The success of a software development project greatly depends upon which process model is used. This paper emphasizes on the need of using appropriate model as per the application to be developed. In this paper we have done the comparative study of the following software models namely Waterfall, Prototype, RAD (Rapid Application Development Incremental, Spiral, Build and Fix and V-shaped. Our aim is to create reliable and cost effective software and these models provide us a way to develop them. The main objective of this research is to represent different models of software development and make a comparison between them to show the features of each model.

  4. The Integrated Medical Model: Outcomes from Independent Review

    Science.gov (United States)

    Myers, J.; Garcia, Y.; Griffin, D.; Arellano, J.; Boley, L.; Goodenow, D. A.; Kerstman, E.; Reyes, D.; Saile, L.; Walton, M.; hide

    2017-01-01

    In 2016, the Integrated Medical Model (IMM) v4.0 underwent an extensive external review in preparation for transition to an operational status. In order to insure impartiality of the review process, the Exploration Medical Capabilities Element of NASA's Human Research Program convened the review through the Systems Review Office at NASA Goddard Space Flight Center (GSFC). The review board convened by GSFC consisted of persons from both NASA and academia with expertise in the fields of statistics, epidemiology, modeling, software development, aerospace medicine, and project management (see Figure 1). The board reviewed software and code standards, as well as evidence pedigree associated with both the input and outcomes information. The board also assesses the models verification, validation, sensitivity to parameters and ability to answer operational questions. This talk will discuss the processes for designing the review, how the review progressed and the findings from the board, as well as summarize the IMM project responses to those findings. Overall, the board found that the IMM is scientifically sound, represents a necessary, comprehensive approach to identifying medical and environmental risks facing astronauts in long duration missions and is an excellent tool for communication between engineers and physicians. The board also found IMM and its customer(s) should convene an additional review of the IMM data sources and to develop a sustainable approach to augment, peer review, and maintain the information utilized in the IMM. The board found this is critically important because medical knowledge continues to evolve. Delivery of IMM v4.0 to the Crew Health and Safety (CHS) Program will occur in the 2017. Once delivered for operational decision support, IMM v4.0 will provide CHS with additional quantitative capability in to assess astronaut medical risks and required medical capabilities to help drive down overall mission risks.

  5. Comparing Outcomes from Field and Classroom Based Settings for Undergraduate Geoscience Courses

    Science.gov (United States)

    Skinner, M. R.; Harris, R. A.; Flores, J.

    2011-12-01

    Field based learning can be found in nearly every course offered in Geology at Brigham Young University. For example, in our Structural Geology course field studies substitute for labs. Students collect data their own data from several different structural settings of the Wasatch Range. Our curriculum also includes a two-week, sophomore-level field course that introduces students to interpreting field relations themselves and sets the stage for much of what they learn in their upper-division courses. Our senior-level six-week field geology course includes classical field mapping with exercises in petroleum and mineral exploration, environmental geology and geological hazards. Experiments with substituting field-based general education courses for those in traditional classroom settings indicate that student cognition, course enjoyment and recruiting of majors significantly increase in a field-based course. We offer a field-based introductory geology course (Geo 102) that is taught in seven, six-hour field trips during which students travel to localities of geologic interest to investigate a variety of fundamental geological problems. We compare the outcomes of Geo 102 with a traditional classroom-based geology course (Geo 101). For the comparison both courses are taught by the same instructor, use the same text and supplementary materials and take the same exams. The results of 7 years of reporting indicate that test scores and final grades are one-half grade point higher for Geo 102 students versus those in traditional introductory courses. Student evaluations of the course are also 0.8-1.4 points higher on a scale of 1-8, and are consistently the highest in the Department and College. Other observations include increased attendance, attention and curiosity. The later two are measured by the number of students asking questions of other students as well as the instructors, and the total number of questions asked during class time in the field versus the classroom

  6. A comparative study of treatment outcomes between begg and edgewise orthodontic systems in class I cases

    Directory of Open Access Journals (Sweden)

    Abas Ali Sahafian

    2014-01-01

    Full Text Available Background: The purpose of this study was to compare the occlusal peer assessment rating (PAR index in Class I patients treated by means of Begg and Edgewise methods. Materials and Methods: The pre- and post-treatment study models of Class I patients, referred to two private clinics, treated with Begg method (n = 30 and standard Edgewise method (n = 30, were reviewed retrospectively using PAR index including dental displacements, buccal occlusion (anteroposterior, vertical and transverse, overjet, overbite and midline parameters. The changes in PAR indices were analyzed using paired t-test. A P < 0.05 was considered as statistically significant. Results: There was no significant difference in sex and age distribution between the two groups. The improvement of buccal occlusion in patients treated by Begg method (1.51 ± 0.39 was significantly higher than that of patients treated by Edgewise method (0.28 ± 0.39. The duration of treatment in Begg method (17.8 ± 1.3 months was significantly shorter than that of Edgewise method (23.7 ± 1.3 months. However, there were no significant differences between the two methods in terms of total PAR index, dental displacements, overjet, overbite and midline. Conclusion: In conclusion, findings of the present study indicated that Begg method might be associated with better improvement of buccal occlusion and shorter duration of treatment

  7. Comparing predictive models of glioblastoma multiforme built using multi-institutional and local data sources.

    Science.gov (United States)

    Singleton, Kyle W; Hsu, William; Bui, Alex A T

    2012-01-01

    The growing amount of electronic data collected from patient care and clinical trials is motivating the creation of national repositories where multiple institutions share data about their patient cohorts. Such efforts aim to provide sufficient sample sizes for data mining and predictive modeling, ultimately improving treatment recommendations and patient outcome prediction. While these repositories offer the potential to improve our understanding of a disease, potential issues need to be addressed to ensure that multi-site data and resultant predictive models are useful to non-contributing institutions. In this paper we examine the challenges of utilizing National Cancer Institute datasets for modeling glioblastoma multiforme. We created several types of prognostic models and compared their results against models generated using data solely from our institution. While overall model performance between the data sources was similar, different variables were selected during model generation, suggesting that mapping data resources between models is not a straightforward issue.

  8. Comparative Performance of Volatility Models for Oil Price

    Directory of Open Access Journals (Sweden)

    Afees A. Salisu

    2012-07-01

    Full Text Available In this paper, we compare the performance of volatility models for oil price using daily returns of WTI. The innovations of this paper are in two folds: (i we analyse the oil price across three sub samples namely period before, during and after the global financial crisis, (ii we also analyse the comparative performance of both symmetric and asymmetric volatility models for the oil price. We find that oil price was most volatile during the global financial crises compared to other sub samples. Based on the appropriate model selection criteria, the asymmetric GARCH models appear superior to the symmetric ones in dealing with oil price volatility. This finding indicates evidence of leverage effects in the oil market and ignoring these effects in oil price modelling will lead to serious biases and misleading results.

  9. Comparing various multi-component global heliosphere models

    CERN Document Server

    Müller, H -R; Heerikhuisen, J; Izmodenov, V V; Scherer, K; Alexashov, D; Fahr, H -J

    2008-01-01

    Modeling of the global heliosphere seeks to investigate the interaction of the solar wind with the partially ionized local interstellar medium. Models that treat neutral hydrogen self-consistently and in great detail, together with the plasma, but that neglect magnetic fields, constitute a sub-category within global heliospheric models. There are several different modeling strategies used for this sub-category in the literature. Differences and commonalities in the modeling results from different strategies are pointed out. Plasma-only models and fully self-consistent models from four research groups, for which the neutral species is modeled with either one, three, or four fluids, or else kinetically, are run with the same boundary parameters and equations. They are compared to each other with respect to the locations of key heliospheric boundary locations and with respect to the neutral hydrogen content throughout the heliosphere. In many respects, the models' predictions are similar. In particular, the loca...

  10. Outcome Inelasticity and Outcome Variability in Behaviour-Incidence Models: An Example from an SEIR Infection on a Dynamic Network

    Directory of Open Access Journals (Sweden)

    Bryce Morsky

    2012-01-01

    Full Text Available Behavior-incidence models have been used to model phenomena such as free-riding vaccinating behavior, where nonvaccinators free ride on herd immunity generated by vaccinators. Here, we develop and analyze a simulation model of voluntary ring vaccination on an evolving social contact network. Individuals make vaccination decisions by examining their expected payoffs, which are influenced by the infection status of their neighbors. We find that stochasticity can make outcomes extremely variable (near critical thresholds and thus unpredictable: some stochastic realizations result in rapid control through ring vaccination while others result in widespread transmission. We also explore the phenomenon of outcome inelasticity, wherein behavioral responses result in certain outcome measures remaining relatively unchanged. Finally, we explore examples where ineffective or risky vaccines are more widely adopted than safe, effective vaccines. This occurs when such a vaccine is unattractive to a sufficient number of contacts of an index case to cause failure of ring vaccination. As a result, the infection percolates through the entire network, causing the final epidemic size and vaccine coverage to be higher than would otherwise occur. Effects such as extreme outcome variability and outcome inelasticity have implications for vaccination policies that depend on individual choice for their success and predictability.

  11. Differential cytokine gene expression according to outcome in a hamster model of leptospirosis.

    Directory of Open Access Journals (Sweden)

    Frédérique Vernel-Pauillac

    Full Text Available BACKGROUND: Parameters predicting the evolution of leptospirosis would be useful for clinicians, as well as to better understand severe leptospirosis, but are scarce and rarely validated. Because severe leptospirosis includes septic shock, similarities with predictors evidenced for sepsis and septic shock were studied in a hamster model. METHODOLOGY/PRINCIPAL FINDINGS: Using an LD50 model of leptospirosis in hamsters, we first determined that 3 days post-infection was a time-point that allowed studying the regulation of immune gene expression and represented the onset of the clinical signs of the disease. In the absence of tools to assess serum concentrations of immune effectors in hamsters, we determined mRNA levels of various immune genes, especially cytokines, together with leptospiraemia at this particular time-point. We found differential expression of both pro- and anti-inflammatory mediators, with significantly higher expression levels of tumor necrosis factor alpha, interleukin 1alpha, cyclo-oxygenase 2 and interleukin 10 genes in nonsurvivors compared to survivors. Higher leptospiraemia was also observed in nonsurvivors. Lastly, we demonstrated the relevance of these results by comparing their respective expression levels using a LD100 model or an isogenic high-passage nonvirulent variant. CONCLUSIONS/SIGNIFICANCE: Up-regulated gene expression of both pro- and anti-inflammatory immune effectors in hamsters with fatal outcome in an LD50 model of leptospirosis, together with a higher Leptospira burden, suggest that these gene expression levels could be predictors of adverse outcome in leptospirosis.

  12. Short-term outcome in patients treated with cytoreduction and HIPEC compared to conventional colon cancer surgery

    DEFF Research Database (Denmark)

    Simkens, Geert A; Verwaal, Victor Jilbert; Lemmens, Valery E;

    2016-01-01

    peritoneally metastasized (PM) colon cancer patients treated with CRS + HIPEC and patients undergoing conventional colon surgery. Furthermore, the impact of CRS + HIPEC on the risk of postoperative complications will be assessed, probably leading to better insight into how to report on postoperative outcomes...... in this distinct group of patients undergoing extensive colon surgery.All patients with primary colon cancer who underwent segmental colon resection in a tertiary referral hospital between 2011 and 2014 were included in this prospective cohort study. Outcome after surgery was compared between patients who......-related mortality.Although patients with colonic PM undergoing CRS + HIPEC treatment were younger and healthier, the postoperative outcome was worse. This is most probably due to less favorable tumor characteristics and more extensive surgery. Nevertheless, CRS + HIPEC treatment was not associated with severe...

  13. Comparing Treatment Outcome of Guided Imagery and Music and Psychodynamic Imaginative Trauma Therapy for Women with Complex PTSD

    DEFF Research Database (Denmark)

    Maack, Carola

    2013-01-01

    To investigate whether the use of recorded music enhances therapy outcome in psychodynamic trauma therapy for women with Complex PTSD, outcome measures of three groups of patients were compared. One group received 50 hours of outpatient trauma therapy with the Bonny Method of Guided Imagery...... and Music (GIM), another group received 50 hours of outpatient trauma therapy with Psychodynamic Imaginative Trauma Therapy (PITT). The third group was a waiting-list control group of women who had to wait at least nine months for therapy. The participants filled out questionnaires measuring symptoms....... Participants treated with GIM showed significantly better outcome in all measurements than participants treated with PITT. This indicates that the use of music is beneficial for women with Complex PTSD treated with psychodynamic trauma therapy....

  14. Streptozotocin-Induced Diabetes Models: Pathophysiological Mechanisms and Fetal Outcomes

    Directory of Open Access Journals (Sweden)

    D. C. Damasceno

    2014-01-01

    Full Text Available Glucose homeostasis is controlled by endocrine pancreatic cells, and any pancreatic disturbance can result in diabetes. Because 8% to 12% of diabetic pregnant women present with malformed fetuses, there is great interest in understanding the etiology, pathophysiological mechanisms, and treatment of gestational diabetes. Hyperglycemia enhances the production of reactive oxygen species, leading to oxidative stress, which is involved in diabetic teratogenesis. It has also been suggested that maternal diabetes alters embryonic gene expression, which might cause malformations. Due to ethical issues involving human studies that sometimes have invasive aspects and the multiplicity of uncontrolled variables that can alter the uterine environment during clinical studies, it is necessary to use animal models to better understand diabetic pathophysiology. This review aimed to gather information about pathophysiological mechanisms and fetal outcomes in streptozotocin-induced diabetic rats. To understand the pathophysiological mechanisms and factors involved in diabetes, the use of pancreatic regeneration studies is increasing in an attempt to understand the behavior of pancreatic beta cells. In addition, these studies suggest a new preventive concept as a treatment basis for diabetes, introducing therapeutic efforts to minimize or prevent diabetes-induced oxidative stress, DNA damage, and teratogenesis.

  15. Reciprocal Ontological Models Show Indeterminism Comparable to Quantum Theory

    Science.gov (United States)

    Bandyopadhyay, Somshubhro; Banik, Manik; Bhattacharya, Some Sankar; Ghosh, Sibasish; Kar, Guruprasad; Mukherjee, Amit; Roy, Arup

    2016-12-01

    We show that within the class of ontological models due to Harrigan and Spekkens, those satisfying preparation-measurement reciprocity must allow indeterminism comparable to that in quantum theory. Our result implies that one can design quantum random number generator, for which it is impossible, even in principle, to construct a reciprocal deterministic model.

  16. Reciprocal Ontological Models Show Indeterminism Comparable to Quantum Theory

    Science.gov (United States)

    Bandyopadhyay, Somshubhro; Banik, Manik; Bhattacharya, Some Sankar; Ghosh, Sibasish; Kar, Guruprasad; Mukherjee, Amit; Roy, Arup

    2017-02-01

    We show that within the class of ontological models due to Harrigan and Spekkens, those satisfying preparation-measurement reciprocity must allow indeterminism comparable to that in quantum theory. Our result implies that one can design quantum random number generator, for which it is impossible, even in principle, to construct a reciprocal deterministic model.

  17. A Mathematical Model for Comparing Holland's Personality and Environmental Codes.

    Science.gov (United States)

    Kwak, Junkyu Christopher; Pulvino, Charles J.

    1982-01-01

    Presents a mathematical model utilizing three-letter codes of personality patterns determined from the Self Directed Search. This model compares personality types over time or determines relationships between personality types and person-environment interactions. This approach is consistent with Holland's theory yet more comprehensive than one- or…

  18. Comparative Analysis of Uncertainties in Urban Surface Runoff Modelling

    DEFF Research Database (Denmark)

    Thorndahl, Søren; Schaarup-Jensen, Kjeld

    2007-01-01

    In the present paper a comparison between three different surface runoff models, in the numerical urban drainage tool MOUSE, is conducted. Analysing parameter uncertainty, it is shown that the models are very sensitive with regards to the choice of hydrological parameters, when combined overflow...... analysis, further research in improved parameter assessment for surface runoff models is needed....... volumes are compared - especially when the models are uncalibrated. The occurrences of flooding and surcharge are highly dependent on both hydrological and hydrodynamic parameters. Thus, the conclusion of the paper is that if the use of model simulations is to be a reliable tool for drainage system...

  19. Comparative analysis of model assessment in community detection

    CERN Document Server

    Kawamoto, Tatsuro

    2016-01-01

    Bayesian cluster inference with a flexible generative model allows us to detect various types of structures. However, it has problems stemming from computational complexity and difficulties in model assessment. We consider the stochastic block model with restricted hyperparameter space, which is known to correspond to modularity maximization. We show that it not only reduces computational complexity, but is also beneficial for model assessment. Using various criteria, we conduct a comparative analysis of the model assessments, and analyze whether each criterion tends to overfit or underfit. We also show that the learning of hyperparameters leads to qualitative differences in Bethe free energy and cross-validation errors.

  20. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals

    Science.gov (United States)

    Mumford, Virginia; Greenfield, David; Hogden, Anne; Debono, Deborah; Gospodarevskaya, Elena; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-01-01

    Objectives The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. Design A retrospective, longitudinal, multisite comparative survey. Setting Acute public hospitals in New South Wales, Australia. Participants 96 acute hospitals with accreditation survey results from two surveys during 2009–2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Outcomes Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010–2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Results Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010–2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (phygiene rates, accreditation outcomes and infection control scores is less clear. Conclusions Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control

  1. k-Nearest neighbor models for microarray gene expression analysis and clinical outcome prediction.

    Science.gov (United States)

    Parry, R M; Jones, W; Stokes, T H; Phan, J H; Moffitt, R A; Fang, H; Shi, L; Oberthuer, A; Fischer, M; Tong, W; Wang, M D

    2010-08-01

    In the clinical application of genomic data analysis and modeling, a number of factors contribute to the performance of disease classification and clinical outcome prediction. This study focuses on the k-nearest neighbor (KNN) modeling strategy and its clinical use. Although KNN is simple and clinically appealing, large performance variations were found among experienced data analysis teams in the MicroArray Quality Control Phase II (MAQC-II) project. For clinical end points and controls from breast cancer, neuroblastoma and multiple myeloma, we systematically generated 463,320 KNN models by varying feature ranking method, number of features, distance metric, number of neighbors, vote weighting and decision threshold. We identified factors that contribute to the MAQC-II project performance variation, and validated a KNN data analysis protocol using a newly generated clinical data set with 478 neuroblastoma patients. We interpreted the biological and practical significance of the derived KNN models, and compared their performance with existing clinical factors.

  2. Comparing clinical outcomes of repeat discectomy versus fusion for recurrent disc herniation utilizing the N(2)QOD.

    Science.gov (United States)

    Guan, Jian; Ravindra, Vijay M; Schmidt, Meic H; Dailey, Andrew T; Hood, Robert S; Bisson, Erica F

    2017-01-01

    OBJECTIVE Recurrent lumbar disc herniation (RLDH) is a significant cause of morbidity in patients undergoing lumbar discectomy and has been reported to occur in up to 18% of cases. While repeat discectomy is often successful in treating these patients, concern over repeat RLDH may lead surgeons to advocate instrumented fusion even in the absence of instability. The authors' goal was to compare clinical outcomes for patients undergoing repeat discectomy versus instrumented fusion for RLDH. METHODS The authors used the National Neurosurgery Quality and Outcomes Database (N(2)QOD) to assess outcomes of patients who underwent repeat discectomy versus instrumented fusion at a single institution from 2012 to 2015. Primary outcomes included Oswestry Disability Index (ODI) score, visual analog scale (VAS) score, and quality-adjusted life year (QALY) measures. Secondary outcomes included hospital length of stay, discharge status, and hospital charges. RESULTS The authors identified 25 repeat discectomy and 12 instrumented fusion patients with 3- and 12-month follow-up records. The groups had similar ODI and VAS scores and QALY measurements at 3 and 12 months. Patients in the instrumented fusion group had significantly longer hospitalizations (3.7 days vs 1.0 days, p fusion group were also significantly higher ($54,458.29 vs $11,567.05, p fusion result in similar clinical outcomes at short-term follow-up. Patients undergoing repeat discectomy had significantly shorter operative times and length of stay, and they incurred dramatically lower hospital charges. They were also less likely to require acute rehabilitation postoperatively. Further research is needed to compare these two management strategies.

  3. Pregnancy outcomes in women with childhood-onset and adult-onset systemic lupus erythematosus: a comparative study.

    Science.gov (United States)

    Saavedra, Miguel Ángel; Miranda-Hernández, Dafhne; Sánchez, Antonio; Morales, Sara; Cruz-Domínguez, Pilar; Medina, Gabriela; Jara, Luis Javier

    2016-10-01

    To compare the maternal and fetal outcomes between childhood-onset and adult-onset systemic lupus erythematosus (SLE), we reviewed the medical records of SLE pregnant women treated from January 2005 to August 2013. For comparison, patients were allocated to one of the two groups, those pregnant patients with SLE onset before 18 years of age (childhood-onset) and ≥18 years (adult-onset). The patients were evaluated at least once in each trimester and postpartum. Relevant maternal and fetal outcomes were extracted, such as lupus flare, preeclampsia/eclampsia, rate of liveborns, fetal loss (spontaneous abortion and stillbirth), term delivery, preterm birth, neonatal death, low birth weight, low birth weight at term, and congenital malformations. We studied 186 pregnancies (in 180 women), 58 of them had childhood-onset SLE, and the remaining 128 had adult-onset SLE. The rate of maternal and fetal complications was similar in both groups. Multivariate analysis showed that active SLE before pregnancy, primigravida, renal flare, preeclampsia, lupus flare, anticardiolipin antibodies, and low serum complement were associated with an increased risk of poor maternal and fetal outcomes. The diagnosis of childhood-onset had no impact on maternal-fetal outcome. The maternal and fetal outcome in women with childhood-onset SLE is similar to that reported in women with adult-onset SLE. Pregnancy in women with childhood-onset SLE should not be contraindicated if the disease is well controlled.

  4. Added value of CT perfusion compared to CT angiography in predicting clinical outcomes of stroke patients treated with mechanical thrombectomy

    Energy Technology Data Exchange (ETDEWEB)

    Tsogkas, Ioannis; Knauth, Michael; Schregel, Katharina; Behme, Daniel; Psychogios, Marios Nikos [University Medicine Goettingen, Department of Neuroradiology, Goettingen (Germany); Wasser, Katrin; Maier, Ilko; Liman, Jan [University Medicine Goettingen, Department of Neurology, Goettingen (Germany)

    2016-11-15

    CTP images analyzed with the Alberta stroke program early CT scale (ASPECTS) have been shown to be optimal predictors of clinical outcome. In this study we compared two biomarkers, the cerebral blood volume (CBV)-ASPECTS and the CTA-ASPECTS as predictors of clinical outcome after thrombectomy. Stroke patients with thrombosis of the M1 segment of the middle cerebral artery were included in our study. All patients underwent initial multimodal CT with CTP and CTA on a modern CT scanner. Treatment consisted of full dose intravenous tissue plasminogen activator, when applicable, and mechanical thrombectomy. Three neuroradiologists separately scored CTP and CTA images with the ASPECTS score. Sixty-five patients were included. Median baseline CBV-ASPECTS and CTA-ASPECTS for patients with favourable clinical outcome at follow-up were 8 [interquartile range (IQR) 8-9 and 7-9 respectively]. Patients with poor clinical outcome showed a median baseline CBV-ASPECTS of 6 (IQR 5-8, P < 0.0001) and a median baseline CTA-ASPECTS of 7 (IQR 7-8, P = 0.18). Using CBV-ASPECTS and CTA-ASPECTS raters predicted futile reperfusions in 96 % and 56 % of the cases, respectively. CBV-ASPECTS is a significant predictor of clinical outcome in patients with acute ischemic stroke treated with mechanical thrombectomy. (orig.)

  5. Comparative Study of Path Loss Models in Different Environments

    Directory of Open Access Journals (Sweden)

    Tilotma Yadav,

    2011-04-01

    Full Text Available By using propagation path models to estimate the received signal level as a function of distance, it becomes possible to predict the SNR for a mobile communication system. Both theoretical andmeasurement-based propagation models indicate that average received signal power decreases logarithmically with distance. For comparative analysis we use Okumura’s model, Hata model, COST231 Extension to Hata model,ECEC-33 model,SUI model along with the practical data. Most of these models are based on a systematic interpretation of theoretical data service area like urban(Built-up city or largetown crowded with large buildings, suburban (having some obstacles near the mobile radio car, but still not very congested and rural (No obstacles like tall trees or buildings like farm-land, rice field, open fields in INDIA at 900MHz & 1800MHz frequency .

  6. Comparing predictive validity of four ballistic swing phase models of human walking.

    Science.gov (United States)

    Selles, R W; Bussmann, J B; Wagenaar, R C; Stam, H J

    2001-09-01

    It is unclear to what extent ballistic walking models can be used to qualitatively predict the swing phase at comfortable walking speed. Different study findings regarding the accuracy of the predictions of the swing phase kinematics may have been caused by differences in (1) kinematic input, (2) model characteristics (e.g. the number of segments), and (3) evaluation criteria. In the present study, the predictive validity of four ballistic swing phase models was evaluated and compared, that is, (1) the ballistic walking model as originally introduced by Mochon and McMahon, (2) an extended version of this model in which heel-off of the stance leg is added, (3) a double pendulum model, consisting of a two-segment swing leg with a prescribed hip trajectory, and (4) a shank pendulum model consisting of a shank and rigidly attached foot with a prescribed knee trajectory. The predictive validity was evaluated by comparing the outcome of the model simulations with experimentally derived swing phase kinematics of six healthy subjects. In all models, statistically significant differences were found between model output and experimental data. All models underestimated swing time and step length. In addition, statistically significant differences were found between the output of the different models. The present study shows that although qualitative similarities exist between the ballistic models and normal gait at comfortable walking speed, these models cannot adequately predict swing phase kinematics.

  7. Using virtual humans to alleviate social anxiety: preliminary report from a comparative outcome study.

    Science.gov (United States)

    Robillard, Genevève; Bouchard, Stéphane; Dumoulin, Stéphane; Guitard, Tanya; Klinger, Evelyne

    2010-01-01

    Empirical studies have consistently shown the effectiveness of a multicomponent CBT treatment of social anxiety disorder (SAD). Previous outcome studies on virtual reality and SAD have focused on people suffering from fear of public speaking and not full blown SAD. In this study, 45 adults receiving a DSM-IV-TR diagnostic of social anxiety were randomly assigned to traditional CBT treatment (with in vivo exposure), CBT-VR combined treatment, or a waiting list. Results show significant reduction of anxiety on all questionnaires as well as statistically significant interactions between both treatment groups and the waiting list.

  8. Comparing measured and modeled firn compaction rates in Greenland

    Science.gov (United States)

    Stevens, C.; MacFerrin, M. J.; Waddington, E. D.; Vo, H.; Yoon, M.

    2015-12-01

    Quantifying the mass balance of the Greenland and Antarctic ice sheets using satellite and/or airborne altimetry requires a firn-densification model to correct for firn-air content and transient firn-thickness changes. We have developed the Community Firn Model (CFM) that allows users to run firn-densification physics from a suite of published models. Here, we use the CFM to compare model-predicted firn depth-density profiles and compaction rates with observed profiles and compaction rates collected from a network of in situ strain gauges at eight different sites in Greenland. Additionally, we use regional-climate-model output to force the CFM and compare the depth-density profiles and compaction rates predicted by the different models. Many of the models were developed using a steady-state assumption and were tuned for the dry-snow zone. Our results demonstrate the challenges of using these models to simulate firn density in Greenland's expanding wet firn and percolation zones, and they help quantify the uncertainty in firn-density model predictions. Next-generation firn models are incorporating more physics (e.g. meltwater percolation and grain growth), and field measurements are essential to inform continuing development of these new models.

  9. Superior outcomes in HIV-positive kidney transplant patients compared with HCV-infected or HIV/HCV-coinfected recipients.

    Science.gov (United States)

    Sawinski, Deirdre; Forde, Kimberly A; Eddinger, Kevin; Troxel, Andrea B; Blumberg, Emily; Tebas, Pablo; Abt, Peter L; Bloom, Roy D

    2015-08-01

    The prerequisite for an 'undetectable' HIV viral load has restricted access to transplantation for HIV-infected kidney recipients. However, HCV-infected recipients, owing to the historic limitations of HCV therapy in patients with renal disease, are commonly viremic at transplant and have universal access. To compare the effect of HIV, HCV, and HIV/HCV coinfection on kidney transplant patient and allograft outcomes, we performed a retrospective study of kidney recipients transplanted from January 1996 through December 2013. In multivariable analysis, patient (hazard ratio 0.90, 95% confidence interval 0.66-1.24) and allograft survival (0.60, 40-0.88) in 492 HIV patients did not differ significantly from the 117,791 patient-uninfected reference group. This was superior to outcomes in both the 5605 patient HCV group for death (1.44, 1.33-1.56) and graft loss (1.43, 1.31-1.56), as well as the 147 patient HIV/HCV coinfected group for death (2.26, 1.45-3.52) and graft loss (2.59, 1.60-4.19). HIV infection did not adversely affect recipient or allograft survival and was associated with superior outcomes compared with both HCV infection and HIV/HCV coinfection in this population. Thus, pretransplant viral eradication and/or immediate posttransplant eradication should be studied as potential strategies to improve posttransplant outcomes in HCV-infected kidney recipients.

  10. Neonatal outcomes in women with gestational diabetes mellitus treated with metformin in compare with insulin: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Safura Ruholamin

    2014-01-01

    Full Text Available Background: The objective of this study was to compare neonatal outcomes in women with gestational diabetes mellitus (GDM treated with either metformin or insulin. Materials and Methods: A randomized clinical trial carried out on year 2011 on 109 women with GDM who did not adequately control by dietary measures. They received metformin 500 mg once or twice daily or insulin 0.2 IU/kg/day initially. The dose was titrated to achieve target blood glucose values. Neonatal outcomes such as hypoglycemia, birth weight, Apgar score, umbilical artery pH, and hyperbilirubinemia in the 50 women who remained exclusively on metformin were compared with 50 women who treated with insulin. Results: Two groups were similar in mean fasting blood sugar (P = 0.7 and postprandial measurements (P = 0.8 throughout GDM treatment. Pregnancy complications or preterm labor were not different significantly between two groups. Considering neonatal outcomes between insulin and metformin groups, such as hypoglycemia (2 [4%] and 0 [0%], respectively, birth weight (3342 ± 506 mg and 3176 ± 438 mg, respectively, 5 th min Apgar score <7 (no one in either group, umbilical artery pH <7.05 (no one in either group and hyperbilirubinemia (1 [2%] and 0 [0%], respectively, no significant statistical differences were seen. Conclusion: Based on these preliminary data, considering neonatal outcomes, metformin appears to be a safe as insulin in the treatment of GDM.

  11. A retrospective study comparing outcomes in a midwestern US population after introduction of IADPSG guidelines for gestational diabetes.

    Science.gov (United States)

    Lee, Gene T; Satyan, Megha Teeka; Grothusen, Jill D; Drummond, Kelsi M; Hagen, Grace; Brown, Crystal; Satterwhite, Catherine L

    2017-08-24

    More evidence is required to endorse the 1-step approach for gestational diabetes mellitus (GDM) for clinical practice. Since 2010, our department has pragmatically allowed faculty to selfselect the guidelines they use to screen and diagnose GDM. We sought to compare the maternal and neonatal outcomes from these two simultaneous cohorts. We performed a retrospective cohort study of all singleton pregnancies delivered between October 2011-November 2013 at our hospital. Patients were excluded if they had preexisting diabetes, were not screened or screened inappropriately, or their fetus had congenital anomalies. Patients were grouped by their screening strategy, and maternal and neonatal outcomes were analyzed. The 1-step group had a higher incidence of GDM (21.6 vs. 5.0%). Initial results suggested higher rates of neonatal hypoglycemia, phototherapy for hyperbilirubinemia, and a lower rate of gestational HTN. After adjustment, these differences disappeared, but a lower rate of large for gestational age (LGA) infants was discovered (adjusted odds ratios (aOR) 0.78). The picture remains unclear as to whether the 1-step approach is associated with significantly improved outcomes compared to the 2-step approach. We did find a lower risk for a LGA infant in our 1-step cohort, but it is unlikely that the 1-step approach would be cost-effective due to absence of other improved outcomes.

  12. Modelling droplet collision outcomes for different substances and viscosities

    Science.gov (United States)

    Sommerfeld, Martin; Kuschel, Matthias

    2016-12-01

    The main objective of the present study is the derivation of models describing the outcome of binary droplet collisions for a wide range of dynamic viscosities in the well-known collision maps (i.e. normalised lateral droplet displacement at collision, called impact parameter, versus collision Weber number). Previous studies by Kuschel and Sommerfeld (Exp Fluids 54:1440, 2013) for different solution droplets having a range of solids contents and hence dynamic viscosities (here between 1 and 60 mPa s) revealed that the locations of the triple point (i.e. coincidence of bouncing, stretching separation and coalescence) and the critical Weber number (i.e. condition for the transition from coalescence to separation for head-on collisions) show a clear dependence on dynamic viscosity. In order to extend these findings also to pure liquids and to provide a broader data basis for modelling the viscosity effect, additional binary collision experiments were conducted for different alcohols (viscosity range 1.2-15.9 mPa s) and the FVA1 reference oil at different temperatures (viscosity range 3.0-28.2 mPa s). The droplet size for the series of alcohols was around 365 and 385 µm for the FVA1 reference oil, in each case with fixed diameter ratio at Δ= 1. The relative velocity between the droplets was varied in the range 0.5-3.5 m/s, yielding maximum Weber numbers of around 180. Individual binary droplet collisions with defined conditions were generated by two droplet chains each produced by vibrating orifice droplet generators. For recording droplet motion and the binary collision process with good spatial and temporal resolution high-speed shadow imaging was employed. The results for varied relative velocity and impact angle were assembled in impact parameter-Weber number maps. With increasing dynamic viscosity a characteristic displacement of the regimes for the different collision scenarios was also observed for pure liquids similar to that observed for solutions. This

  13. Comparative flood damage model assessment: towards a European approach

    Directory of Open Access Journals (Sweden)

    B. Jongman

    2012-12-01

    Full Text Available There is a wide variety of flood damage models in use internationally, differing substantially in their approaches and economic estimates. Since these models are being used more and more as a basis for investment and planning decisions on an increasingly large scale, there is a need to reduce the uncertainties involved and develop a harmonised European approach, in particular with respect to the EU Flood Risks Directive. In this paper we present a qualitative and quantitative assessment of seven flood damage models, using two case studies of past flood events in Germany and the United Kingdom. The qualitative analysis shows that modelling approaches vary strongly, and that current methodologies for estimating infrastructural damage are not as well developed as methodologies for the estimation of damage to buildings. The quantitative results show that the model outcomes are very sensitive to uncertainty in both vulnerability (i.e. depth–damage functions and exposure (i.e. asset values, whereby the first has a larger effect than the latter. We conclude that care needs to be taken when using aggregated land use data for flood risk assessment, and that it is essential to adjust asset values to the regional economic situation and property characteristics. We call for the development of a flexible but consistent European framework that applies best practice from existing models while providing room for including necessary regional adjustments.

  14. Early neural disruption and auditory processing outcomes in rodent models: Implications for developmental language disability

    Directory of Open Access Journals (Sweden)

    Roslyn Holly Fitch

    2013-10-01

    Full Text Available Most researchers in the field of neural plasticity are familiar with the Kennard Principle," which purports a positive relationship between age at brain injury and severity of subsequent deficits (plateauing in adulthood. As an example, a child with left hemispherectomy can recover seemingly normal language, while an adult with focal injury to sub-regions of left temporal and/or frontal cortex can suffer dramatic and permanent language loss. Here we present data regarding the impact of early brain injury in rat models as a function of type and timing, measuring long-term behavioral outcomes via auditory discrimination tasks varying in temporal demand. These tasks were created to model (in rodents aspects of human sensory processing that may correlate – both developmentally and functionally – with typical and atypical language. We found that bilateral focal lesions to the cortical plate in rats during active neuronal migration led to worse auditory outcomes than comparable lesions induced after cortical migration was complete. Conversely, unilateral hypoxic-ischemic injuries (similar to those seen in premature infants and term infants with birth complications led to permanent auditory processing deficits when induced at a neurodevelopmental point comparable to human "term," but only transient deficits (undetectable in adulthood when induced in a "preterm" window. Convergent evidence suggests that regardless of when or how disruption of early neural development occurs, the consequences may be particularly deleterious to rapid auditory processing outcomes when they trigger developmental alterations that extend into subcortical structures (i.e., lower sensory processing stations. Collective findings hold implications for the study of behavioral outcomes following early brain injury as well as genetic/environmental disruption, and are relevant to our understanding of the neurologic risk factors underlying developmental language disability in

  15. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions.

    Science.gov (United States)

    Fridrich, Annemarie; Jenny, Gregor J; Bauer, Georg F

    2015-01-01

    To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results.

  16. The Context, Process, and Outcome Evaluation Model for Organisational Health Interventions

    Science.gov (United States)

    Fridrich, Annemarie; Jenny, Gregor J.; Bauer, Georg F.

    2015-01-01

    To facilitate evaluation of complex, organisational health interventions (OHIs), this paper aims at developing a context, process, and outcome (CPO) evaluation model. It builds on previous model developments in the field and advances them by clearly defining and relating generic evaluation categories for OHIs. Context is defined as the underlying frame that influences and is influenced by an OHI. It is further differentiated into the omnibus and discrete contexts. Process is differentiated into the implementation process, as the time-limited enactment of the original intervention plan, and the change process of individual and collective dynamics triggered by the implementation process. These processes lead to proximate, intermediate, and distal outcomes, as all results of the change process that are meaningful for various stakeholders. Research questions that might guide the evaluation of an OHI according to the CPO categories and a list of concrete themes/indicators and methods/sources applied within the evaluation of an OHI project at a hospital in Switzerland illustrate the model's applicability in structuring evaluations of complex OHIs. In conclusion, the model supplies a common language and a shared mental model for improving communication between researchers and company members and will improve the comparability and aggregation of evaluation study results. PMID:26557665

  17. Estimation of a partially linear additive model for data from an outcome-dependent sampling design with a continuous outcome.

    Science.gov (United States)

    Tan, Ziwen; Qin, Guoyou; Zhou, Haibo

    2016-10-01

    Outcome-dependent sampling (ODS) designs have been well recognized as a cost-effective way to enhance study efficiency in both statistical literature and biomedical and epidemiologic studies. A partially linear additive model (PLAM) is widely applied in real problems because it allows for a flexible specification of the dependence of the response on some covariates in a linear fashion and other covariates in a nonlinear non-parametric fashion. Motivated by an epidemiological study investigating the effect of prenatal polychlorinated biphenyls exposure on children's intelligence quotient (IQ) at age 7 years, we propose a PLAM in this article to investigate a more flexible non-parametric inference on the relationships among the response and covariates under the ODS scheme. We propose the estimation method and establish the asymptotic properties of the proposed estimator. Simulation studies are conducted to show the improved efficiency of the proposed ODS estimator for PLAM compared with that from a traditional simple random sampling design with the same sample size. The data of the above-mentioned study is analyzed to illustrate the proposed method. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Exploring Social Quality and Community Health Outcomes: An Ecological Model.

    Science.gov (United States)

    Jung, Minsoo

    2015-01-01

    Quality of life is widely used as a measure of individual well-being in developed countries. Social quality (SQ), however, describes how favorable the socioenvironmental components are that impact the life chance of an individual. Despite the associations between SQ, including institutional capacity and citizen capacity, and other community indicators, the impact of SQ on community health status has not been fully examined. This study investigated the interrelationships among institutional capacity, citizen capacity, and their associations with community-level health indicators such as mortality and suicide among 230 local governments in South Korea. Under the principles of conceptual suitability, clarity, reliability, consistency, changeability, and comparability, a total of 81 SQ indicators were collected, and 19 indicators of the 81 indicators were selected. The 19 indicators were transformed by the imputation of missing values, standardization, and geographic information system transformation. It was found that the health outcome of local government was superior as social welfare, political participation, and education were higher. According to the result of the regression analysis based on the regional type, social welfare had the most influence on the health level of local government in both metropolises and small-/medium-sized cities. In addition, education and political participation had a positive effect on the health indicator of local metropolis government. However, SQ indicators did not have any meaningful influence at the county level. Therefore, small- and medium-sized cities need to promote the collective health of the local government through improving social welfare, and metropolises need to consider the complex relationship among other indicators while increasing the level of social welfare and education. Meanwhile, counties need to develop health indicators that reflect aged population characteristics and social environment of rural areas

  19. Ways of Knowing, Outcomes and "Comparative Education": Be Careful What You Pray For

    Science.gov (United States)

    Cowen, Robert

    2014-01-01

    Comparative education as a field of study in universities (and "comparative education" as practised by nineteenth-century administrators of education in Canada, England, France and the USA) has always addressed the theme of "transfer": that is, the movement of educational ideas, principles and practices, and institutions and…

  20. Outcome prediction after traumatic brain injury: Comparison of the performance of routinely used severity scores and multivariable prognostic models

    Directory of Open Access Journals (Sweden)

    Marek Majdan

    2017-01-01

    Full Text Available Objectives: Prognosis of outcome after traumatic brain injury (TBI is important in the assessment of quality of care and can help improve treatment and outcome. The aim of this study was to compare the prognostic value of relatively simple injury severity scores between each other and against a gold standard model – the IMPACT-extended (IMP-E multivariable prognostic model. Materials and Methods: For this study, 866 patients with moderate/severe TBI from Austria were analyzed. The prognostic performances of the Glasgow coma scale (GCS, GCS motor (GCSM score, abbreviated injury scale for the head region, Marshall computed tomographic (CT classification, and Rotterdam CT score were compared side-by-side and against the IMP-E score. The area under the receiver operating characteristics curve (AUC and Nagelkerke's R2 were used to assess the prognostic performance. Outcomes at the Intensive Care Unit, at hospital discharge, and at 6 months (mortality and unfavorable outcome were used as end-points. Results: Comparing AUCs and R2s of the same model across four outcomes, only little variation was apparent. A similar pattern is observed when comparing the models between each other: Variation of AUCs 0.83 and R2 > 0.42 for all outcomes: AUCs were worse by 0.10–0.22 (P < 0.05 and R2s were worse by 0.22–0.39 points. Conclusions: All tested simple scores can provide reasonably valid prognosis. However, it is confirmed that well-developed multivariable prognostic models outperform these scores significantly and should be used for prognosis in patients after TBI wherever possible.

  1. Improved outcomes for laparoscopic appendectomy compared with open appendectomy in the pediatric population.

    Science.gov (United States)

    Schmelzer, Thomas M; Rana, Ankur R; Walters, K Christian; Norton, H James; Bambini, Daniel A; Heniford, B Todd

    2007-10-01

    The appendectomy is a common emergent surgical procedure in the pediatric population. The aim of this study was to examine our institution's experience and outcomes in the appendectomy in the pediatric population early in our transition from open surgery to a predominantly laparoscopic approach. We retrospectively studied all pediatric patients (age 20 years) that underwent an appendectomy at a tertiary care center over 2 years. The data collected included patient demographics, comorbidities, operative details, outcomes, and complications. Two hundred twenty-three consecutive patients, with a mean age of 9.5 (3.9) years, were included in the study. Forty-four laparoscopic and 179 open appendectomies were performed. Two of the laparoscopic cases were converted to open appendectomies. Significant differences were seen between the two groups, with longer operative times (P < 0.0001) and lower estimated blood loss (P = 0.007) in the laparoscopic group. Operative times improved significantly for the laparoscopic group as the surgeons became more experienced (P = 0.03). The laparoscopic group used intravenous pain medication for a shorter time (0.8 vs. 1.9 days; P = 0.0003) and had a shorter postoperative hospital length of stay (2.2 vs. 3.4 days; P = 0.004). The laparoscopic group had fewer wound infections (2.3% vs. 6.2%; P = 0.3), intra-abdominal abscesses (4.5% vs. 5.6%; P = 0.8), and postoperative ileus (0% vs. 2.2%; P = 0.3), although these differences did not reach statistical significance. The laparoscopic appendectomy procedure is a safe alternative to open appendectomy in pediatric patients and results in shorter hospital stays with less postoperative pain.

  2. Disaggregation of Rainy Hours: Compared Performance of Various Models.

    Science.gov (United States)

    Ben Haha, M.; Hingray, B.; Musy, A.

    In the urban environment, the response times of catchments are usually short. To de- sign or to diagnose waterworks in that context, it is necessary to describe rainfall events with a good time resolution: a 10mn time step is often necessary. Such in- formation is not always available. Rainfall disaggregation models have thus to be applied to produce from rough rainfall data that short time resolution information. The communication will present the performance obtained with several rainfall dis- aggregation models that allow for the disaggregation of rainy hours into six 10mn rainfall amounts. The ability of the models to reproduce some statistical character- istics of rainfall (mean, variance, overall distribution of 10mn-rainfall amounts; ex- treme values of maximal rainfall amounts over different durations) is evaluated thanks to different graphical and numerical criteria. The performance of simple models pre- sented in some scientific papers or developed in the Hydram laboratory as well as the performance of more sophisticated ones is compared with the performance of the basic constant disaggregation model. The compared models are either deterministic or stochastic; for some of them the disaggregation is based on scaling properties of rainfall. The compared models are in increasing complexity order: constant model, linear model (Ben Haha, 2001), Ormsbee Deterministic model (Ormsbee, 1989), Ar- tificial Neuronal Network based model (Burian et al. 2000), Hydram Stochastic 1 and Hydram Stochastic 2 (Ben Haha, 2001), Multiplicative Cascade based model (Olsson and Berndtsson, 1998), Ormsbee Stochastic model (Ormsbee, 1989). The 625 rainy hours used for that evaluation (with a hourly rainfall amount greater than 5mm) were extracted from the 21 years chronological rainfall series (10mn time step) observed at the Pully meteorological station, Switzerland. The models were also evaluated when applied to different rainfall classes depending on the season first and on the

  3. Comparative Analysis of Vehicle Make and Model Recognition Techniques

    Directory of Open Access Journals (Sweden)

    Faiza Ayub Syed

    2014-03-01

    Full Text Available Vehicle Make and Model Recognition (VMMR has emerged as a significant element of vision based systems because of its application in access control systems, traffic control and monitoring systems, security systems and surveillance systems, etc. So far a number of techniques have been developed for vehicle recognition. Each technique follows different methodology and classification approaches. The evaluation results highlight the recognition technique with highest accuracy level. In this paper we have pointed out the working of various vehicle make and model recognition techniques and compare these techniques on the basis of methodology, principles, classification approach, classifier and level of recognition After comparing these factors we concluded that Locally Normalized Harris Corner Strengths (LHNS performs best as compared to other techniques. LHNS uses Bayes and K-NN classification approaches for vehicle classification. It extracts information from frontal view of vehicles for vehicle make and model recognition.

  4. Sex, ADHD symptoms, and smoking outcomes: an integrative model.

    Science.gov (United States)

    Van Voorhees, Elizabeth E; Mitchell, John T; McClernon, F Joseph; Beckham, Jean C; Kollins, Scott H

    2012-05-01

    Both females and individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have been found to be at increased risk for a range of smoking outcomes, and recent empirical findings have suggested that women with ADHD may be particularly vulnerable to nicotine dependence. On a neurobiological level, the dopamine reward processing system may be implicated in the potentially unique interaction of nicotine with sex and with ADHD status. Specifically, nicotine appears to mitigate core ADHD symptoms through interaction with the dopamine reward processing system, and ovarian hormones have been found to interact with nicotine within the dopamine reward processing system to affect neurotransmitter release and functioning. This article synthesizes data from research examining smoking in women and in individuals with ADHD to build an integrative model through which unique risk for cigarette smoking in women with ADHD can be systematically explored. Based upon this model, the following hypotheses are proposed at the intersection of each of the three variables of sex, ADHD, and smoking: (1) individuals with ADHD have altered functioning of the dopamine reward system, which diminishes their ability to efficiently form conditioned associations based on environmental contingencies; these deficits are partially ameliorated by nicotine; (2) nicotine interacts with estrogen and the dopamine reward system to increase the positive and negative reinforcement value of smoking in female smokers; (3) in adult females with ADHD, ovarian hormones interact with the dopamine reward system to exacerbate ADHD-related deficits in the capacity to form conditioned associations; and (4) during different phases of the menstrual cycle, nicotine and ovarian hormones may interact differentially with the dopamine reward processing system to affect the type and value of reinforcement smoking provides for women with ADHD. Understanding the bio-behavioral mechanisms underlying cigarette addiction in

  5. Comparative Analysis of Dayside Reconnection Models in Global Magnetosphere Simulations

    CERN Document Server

    Komar, C M; Cassak, P A

    2015-01-01

    We test and compare a number of existing models predicting the location of magnetic reconnection at Earth's dayside magnetopause for various solar wind conditions. We employ robust image processing techniques to determine the locations where each model predicts reconnection to occur. The predictions are then compared to the magnetic separators, the magnetic field lines separating different magnetic topologies. The predictions are tested in distinct high-resolution simulations with interplanetary magnetic field (IMF) clock angles ranging from 30 to 165 degrees in global magnetohydrodynamic simulations using the three-dimensional Block-Adaptive Tree Solarwind Roe-type Upwind Scheme (BATS-R-US) code with a uniform resistivity, although the described techniques can be generally applied to any self-consistent magnetosphere code. Additional simulations are carried out to test location model dependence on IMF strength and dipole tilt. We find that most of the models match large portions of the magnetic separators wh...

  6. Comparing Sediment Yield Predictions from Different Hydrologic Modeling Schemes

    Science.gov (United States)

    Dahl, T. A.; Kendall, A. D.; Hyndman, D. W.

    2015-12-01

    Sediment yield, or the delivery of sediment from the landscape to a river, is a difficult process to accurately model. It is primarily a function of hydrology and climate, but influenced by landcover and the underlying soils. These additional factors make it much more difficult to accurately model than water flow alone. It is not intuitive what impact different hydrologic modeling schemes may have on the prediction of sediment yield. Here, two implementations of the Modified Universal Soil Loss Equation (MUSLE) are compared to examine the effects of hydrologic model choice. Both the Soil and Water Assessment Tool (SWAT) and the Landscape Hydrology Model (LHM) utilize the MUSLE for calculating sediment yield. SWAT is a lumped parameter hydrologic model developed by the USDA, which is commonly used for predicting sediment yield. LHM is a fully distributed hydrologic model developed primarily for integrated surface and groundwater studies at the watershed to regional scale. SWAT and LHM models were developed and tested for two large, adjacent watersheds in the Great Lakes region; the Maumee River and the St. Joseph River. The models were run using a variety of single model and ensemble downscaled climate change scenarios from the Coupled Model Intercomparison Project 5 (CMIP5). The initial results of this comparison are discussed here.

  7. MHD models compared with Artemis observations at -60 Re

    Science.gov (United States)

    Gencturk Akay, Iklim; Sibeck, David; Angelopoulos, Vassilis; Kaymaz, Zerefsan; Kuznetsova, Maria

    2016-07-01

    The distant magnetotail has been one of the least studied magnetic regions of the Earth's magnetosphere compared to the other near Earth both dayside and nightside magnetospheric regions owing to the limited number of spacecraft observations. Since 2011, ARTEMIS spacecraft give an excellent opportunity to study the magnetotail at lunar distances in terms of data quality and parameter space. This also gives opportunities to improve the magnetotail models at -60 Re and encourages the modelling studies of the distant magnetotail. Using ARTEMIS data in distant magnetotail, we create magnetic field and plasma flow vector maps in different planes and separated with IMF orientation to understand the magnetotail dynamics at this distance. For this study, we use CCMC's Run-on-Request resources of the MHD models; specifically SWMF-BATS-R-US, OpenGGCM, and LFM and perform the similar analysis with the models. Our main purpose in this study is to measure the performance of the MHD models at -60 Re distant magnetotail by comparing the model results with Artemis observations. In the literature, such a comprehensive comparative study is lacking in the distant tail. Preliminary results show that in general all three models underestimate the magnetic field structure while overestimating the flow speed. In the cross-sectional view, LFM seems to produce the better agreement with the observations. A clear dipolar magnetic field structure is seen with dawn-dusk asymmetry in all models owing to slight positive IMF By but the effect was found to be exaggerated. All models show tailward flows at this distance of the magnetotail, most possibly owing to the magnetic reconnection at the near Earth tail distances. A detailed comparison of several tail characteristics from the models will be presented and discussions will be given with respect to the observations from Artemis at this distance.

  8. A comparative analysis of multi-output frontier models

    Institute of Scientific and Technical Information of China (English)

    Tao ZHANG; Eoghan GARVEY

    2008-01-01

    Recently, there have been more debates on the methods of measuring efficiency. The main objective of this paper is to make a sensitivity analysis for different frontier models and compare the results obtained from the different methods of estimating multi-output frontier for a specific application. The methods include stochastic distance function frontier, stochastic ray frontier,and data envelopment analysis. The stochastic frontier regressions with and without the inefficiency effects model are also com-pared and tested. The results indicate that there are significant correlations between the results obtained from the alternative estimation methods.

  9. Engaging stakeholders in review and recommendations for models of outcome monitoring for substance abuse treatment.

    Science.gov (United States)

    Rush, Brian; Martin, Garth; Corea, Larry; Rotondi, Nooshin Khobzi

    2012-10-01

    We present an example of a collaborative process designed to review models of outcome monitoring for substance abuse services, with a view to assessing the feasibility of different approaches in Ontario, Canada. A conceptual framework that describes the parameters of an outcome monitoring system and four models of outcome monitoring were identified. Consultations were held with stakeholders (managers, directors, researchers, clinicians, and governmental representatives) about the types of information they would like to obtain from an outcome monitoring system. Our process is useful as a model for collaborative research with respect to performance measurement. The study's implications and limitations are noted.

  10. Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals.

    Science.gov (United States)

    Mumford, Virginia; Greenfield, David; Hogden, Anne; Debono, Deborah; Gospodarevskaya, Elena; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

    2014-09-23

    The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. A retrospective, longitudinal, multisite comparative survey. Acute public hospitals in New South Wales, Australia. 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target compliance rates of 70% in audit 1, versus 92.3% in audit 8. Average hand hygiene rates at small hospitals were 7.8 percentage points (pp) higher than those at the largest hospitals (phygiene rates, accreditation outcomes and infection control scores is less clear. Our results indicate that accreditation outcomes and hand hygiene audit data are measuring different parts of the quality and safety spectrum. Understanding what is being measured when selecting indicators to assess the impact of accreditation is critical as focusing on accreditation results would discount successful hand hygiene implementation by smaller hospitals. Conversely, relying on hand hygiene results would discount the infection control related research and leadership investment by larger hospitals. Our hypothesis appears to be confounded by an accreditation programme that makes it more difficult for smaller hospitals to achieve high infection control scores. Published by the BMJ Publishing Group Limited. For permission to

  11. Meta-Analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-Wilderness Treatment Programs

    Science.gov (United States)

    Gillis, Harold L.; Speelman, Elizabeth; Linville, Noelle; Bailey, Emily; Kalle, Ashley; Oglesbee, Nathan; Sandlin, James; Thompson, Lauren; Jensen, Jennifer

    2016-01-01

    Background: Monitoring youth treatments requires outcome instruments sensitive to change. The Y-OQ and the Y-OQ-SR measure behavioral change during psychological treatment. Objective: The focus of this study was to compare treatment progress of youth in studies using the Youth Outcome Questionnaire (YOQ) or the Youth Outcome Questionnaire Self…

  12. The Prime Diabetes Model: Novel Methods for Estimating Long-Term Clinical and Cost Outcomes in Type 1 Diabetes Mellitus.

    Science.gov (United States)

    Valentine, William J; Pollock, Richard F; Saunders, Rhodri; Bae, Jay; Norrbacka, Kirsi; Boye, Kristina

    Recent publications describing long-term follow-up from landmark trials and diabetes registries represent an opportunity to revisit modeling options in type 1 diabetes mellitus (T1DM). To develop a new product-independent model capable of predicting long-term clinical and cost outcomes. After a systematic literature review to identify clinical trial and registry data, a model was developed (the PRIME Diabetes Model) to simulate T1DM progression and complication onset. The model runs as a patient-level simulation, making use of covariance matrices for cohort generation and risk factor progression, and simulating myocardial infarction, stroke, angina, heart failure, nephropathy, retinopathy, macular edema, neuropathy, amputation, hypoglycemia, ketoacidosis, mortality, and risk factor evolution. Several approaches novel to T1DM modeling were used, including patient characteristics and risk factor covariance, a glycated hemoglobin progression model derived from patient-level data, and model averaging approaches to evaluate complication risk. Validation analyses comparing modeled outcomes with published studies demonstrated that the PRIME Diabetes Model projects long-term patient outcomes consistent with those reported for a number of long-term studies. Macrovascular end points were reliably reproduced across five different populations and microvascular complication risk was accurately predicted on the basis of comparisons with landmark studies and published registry data. The PRIME Diabetes Model is product-independent, available online, and has been developed in line with good practice guidelines. Validation has indicated that outcomes from long-term studies can be reliably reproduced. The model offers new approaches to long-standing challenges in diabetes modeling and may become a valuable tool for informing health care policy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. Weight Loss After Laparoscopic Band-to-Bypass Revision Compared With Primary Gastric Bypass: Long-term Outcomes.

    Science.gov (United States)

    Sadot, Eran; Spivak, Hadar

    2015-06-01

    Laparoscopic Roux-en-Y gastric bypass (RYGB) is frequently performed as a salvage operation after failed laparoscopic adjustable gastric banding (LAGB). Reports about long-term outcomes are lacking. We assessed the long-term outcomes of RYGB revision surgery after failed LAGB (study group, n = 44) and compared these outcomes with a demographically matched group who underwent primary RYGB (control group, n = 82). There were no between-group differences in sex distribution, age, or initial weight characteristics. At 2 years after RYGB, the mean ΔBMI was 11.8 ± 5.7 kg/m2 in the study group and 15.6 ± 4.2 kg/m2 in the control group (P = 0.01); the corresponding %EWL values were 57% and 78% (P = 0.005). At 6 years after RYGB, the mean ΔBMI was 10 ± 4.5 kg/m2 in the study group and 13.6 ± 5.7 kg/m2 in the control group (P = 0.006); the corresponding %EWL values were 53% and 66% (P = 0.04). In conclusion, this study supports the safety and favorable weight-loss outcome of LAGB revision to RYGB. However, the results are inferior to those of primary RYGB.

  14. Application of a source-to-outcome model for the assessment of health impacts from dietary exposures to insecticide residues.

    Science.gov (United States)

    Price, Paul S; Schnelle, Karl D; Cleveland, Cheryl B; Bartels, Michael J; Hinderliter, Paul M; Timchalk, Charles; Poet, Torka S

    2011-10-01

    The paper presents a case study of the application of a "source-to-outcome" model for the evaluation of the health outcomes from dietary exposures to an insecticide, chlorpyrifos, in populations of adults (age 30) and children (age 3). The model is based on publically-available software programs that characterize the longitudinal dietary exposure and anthropometry of exposed individuals. These predictions are applied to a validated PBPK/PD model to estimate interindividual and longitudinal variation in brain and RBC AChE inhibition (key events) and chlorpyrifos concentrations in blood and TCPy in urine (biomarkers of exposure). The predicted levels of chlorpyrifos and TCPy are compared to published measurements of the biomarkers. Predictions of RBC AChE are compared to levels of inhibition associated with reported exposure-related effects in humans to determine the potential for the occurrence of adverse cholinergic effects. The predicted distributions of chlorpyrifos in blood and TCPy in urine were found to be reasonably consistent with published values, supporting the predictive value of the exposure and PBPK portions of the source-to-outcome model. Key sources of uncertainty in predictions of dietary exposures were investigated and found to have a modest impact on the model predictions. Future versions of this source-to-outcome model can be developed that consider advances in our understanding of metabolism, to extend the approach to other age groups (infants), and address intakes from other routes of exposure.

  15. Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty.

    Science.gov (United States)

    Cook, Laurence E; Klika, Alison K; Szubski, Caleb R; Rosneck, James; Molloy, Robert; Barsoum, Wael K

    2012-07-01

    A recent development to better recreate joint kinematics has been a change from a multiradius (MR) design to a single radius (SR) design. We analyzed 559 primary total knee arthroplasty (TKA) procedures which used either a SR (n = 426 Triathlon; Stryker Orthopaedics, Mahwah, NJ) or MR of curvature knee system (n = 133 Duracon; Stryker Orthopaedics, Mahwah, NJ) (79.3% follow-up; 705 total TKA procedures identified). Patients were administered a modification of the Knee Society score (KSS) (3.9 years average follow-up). The SR design showed improvements over the MR design in pain (p = 0.021), stability (p = 0.002), flexion (p = 0.006), ability to completely straighten the knee (p = 0.025), stair climbing (p = 0.0001), walking (p = 0.0001), use of assistive devices (p = 0.0005), postoperative knee score (p = 0.0005), and postoperative function (p < 0.0001). Analysis of the change in KSS knee (p = 0.002) and function scores (p = 0.002) from preoperative visit to postoperative follow-up favored the SR design as well. These data support the use of SR implants and provide evidence of improved outcomes in terms of function, stability, and pain.

  16. Do vertebral derotation techniques offer better outcomes compared to traditional methods in the surgical treatment of adolescent idiopathic scoliosis?

    Science.gov (United States)

    Rushton, Paul R P; Grevitt, Michael P

    2014-06-01

    In recent years, authors have described novel derotation techniques for surgery in adolescent idiopathic scoliosis. These methods include direct vertebral body derotation (DVD) and vertebral coplanar alignment (VCA). By improved derotation it is hoped that there is further reduction in rib hump prominence and corresponding improvement in patients' quality of life. This paper aims to evaluate studies reporting outcomes from DVD and VCA techniques to assess if these methods lead to superior radiographic vertebral derotation, rib hump correction on surface measurements or patient-reported outcomes compared to traditional derotation manoeuvres using similar instrumentation. Literature review. Fifteen reports were identified. Most comparative studies represent class three or four data. DVD and VCA techniques have been shown to reduce apical vertebral rotation by 37-63 %. Few studies compare DVD/VCA techniques with traditional methods. Most DVD/VCA reports with pedicle screw instrumentation have reported superior radiographic derotation on CT compared with conventional techniques. Despite this the majority of studies have found similar corrections of rib hump measurements between DVD/VCA techniques and cantilever or global derotation methods. There is no evidence that DVD/VCA techniques allow greater correction of significant rib hump deformity without an adjuvant thoracoplasty. No studies to date have used patient-reported outcomes prospectively or demonstrated clinically meaningful differences retrospectively between DVD/VCA and conventional techniques. There is little evidence to recommend the widespread adoption of DVD/VCA techniques. Whilst there is some weak evidence to suggest that novel techniques may improve radiographic measures, there is little to suggest that they offer patients improved correction of clinical rib hump or quality of life compared to established techniques. Further well-designed prospective studies are needed in this area.

  17. Motivation Monitoring and Assessment Extension for Input-Process-Outcome Game Model

    Science.gov (United States)

    Ghergulescu, Ioana; Muntean, Cristina Hava

    2014-01-01

    This article proposes a Motivation Assessment-oriented Input-Process-Outcome Game Model (MotIPO), which extends the Input-Process-Outcome game model with game-centred and player-centred motivation assessments performed right from the beginning of the game-play. A feasibility case-study involving 67 participants playing an educational game and…

  18. Positive Outcomes Increase over Time with the Implementation of a Semiflipped Teaching Model

    Science.gov (United States)

    Gorres-Martens, Brittany K.; Segovia, Angela R.; Pfefer, Mark T.

    2016-01-01

    The flipped teaching model can engage students in the learning process and improve learning outcomes. The purpose of the present study was to assess the outcomes of a semiflipped teaching model over time. Neurophysiology students spent the majority of class time listening to traditional didactic lectures, but they also listened to 5 online…

  19. An evolution of trauma care evaluation: A thesis on trauma registry and outcome prediction models

    NARCIS (Netherlands)

    Joosse, P.

    2013-01-01

    Outcome prediction models play an invaluable role in the evaluation and improvement of modern trauma care. Trauma registries underlying these outcome prediction models need to be accurate, complete and consistent. This thesis focused on the opportunities and limitations of trauma registries and

  20. Motivation Monitoring and Assessment Extension for Input-Process-Outcome Game Model

    Science.gov (United States)

    Ghergulescu, Ioana; Muntean, Cristina Hava

    2014-01-01

    This article proposes a Motivation Assessment-oriented Input-Process-Outcome Game Model (MotIPO), which extends the Input-Process-Outcome game model with game-centred and player-centred motivation assessments performed right from the beginning of the game-play. A feasibility case-study involving 67 participants playing an educational game and…

  1. An evolution of trauma care evaluation: A thesis on trauma registry and outcome prediction models

    NARCIS (Netherlands)

    Joosse, P.

    2013-01-01

    Outcome prediction models play an invaluable role in the evaluation and improvement of modern trauma care. Trauma registries underlying these outcome prediction models need to be accurate, complete and consistent. This thesis focused on the opportunities and limitations of trauma registries and outc

  2. An evolution of trauma care evaluation: A thesis on trauma registry and outcome prediction models

    NARCIS (Netherlands)

    Joosse, P.

    2013-01-01

    Outcome prediction models play an invaluable role in the evaluation and improvement of modern trauma care. Trauma registries underlying these outcome prediction models need to be accurate, complete and consistent. This thesis focused on the opportunities and limitations of trauma registries and outc

  3. Image based 3D city modeling : Comparative study

    Science.gov (United States)

    Singh, S. P.; Jain, K.; Mandla, V. R.

    2014-06-01

    3D city model is a digital representation of the Earth's surface and it's related objects such as building, tree, vegetation, and some manmade feature belonging to urban area. The demand of 3D city modeling is increasing rapidly for various engineering and non-engineering applications. Generally four main image based approaches were used for virtual 3D city models generation. In first approach, researchers were used Sketch based modeling, second method is Procedural grammar based modeling, third approach is Close range photogrammetry based modeling and fourth approach is mainly based on Computer Vision techniques. SketchUp, CityEngine, Photomodeler and Agisoft Photoscan are the main softwares to represent these approaches respectively. These softwares have different approaches & methods suitable for image based 3D city modeling. Literature study shows that till date, there is no complete such type of comparative study available to create complete 3D city model by using images. This paper gives a comparative assessment of these four image based 3D modeling approaches. This comparative study is mainly based on data acquisition methods, data processing techniques and output 3D model products. For this research work, study area is the campus of civil engineering department, Indian Institute of Technology, Roorkee (India). This 3D campus acts as a prototype for city. This study also explains various governing parameters, factors and work experiences. This research work also gives a brief introduction, strengths and weakness of these four image based techniques. Some personal comment is also given as what can do or what can't do from these softwares. At the last, this study shows; it concluded that, each and every software has some advantages and limitations. Choice of software depends on user requirements of 3D project. For normal visualization project, SketchUp software is a good option. For 3D documentation record, Photomodeler gives good result. For Large city

  4. Immediate Postpartum Intrauterine Contraceptive Device Insertions in Caesarean and Vaginal Deliveries: A Comparative Study of Follow-Up Outcomes

    Science.gov (United States)

    Nanda, Smiti; Gupta, Anjali; More, Hemant

    2016-01-01

    Background. Immediate postpartum intrauterine contraceptive device (IPPIUCD) is a lucrative postpartum family planning method which provides effective reversible contraception to women in the delivery setting. Our aim was to study the clinical outcomes of IPPIUCD insertions and compare them as a factor of route of insertion (vaginal versus caesarean). Methods. This is a retrospective analytical study done in a tertiary care teaching institute. A Cohort of 593 vaginal and caesarean deliveries with IPPIUCD insertions, over a two-year period, was studied and compared for follow-up results. Outcome measures were safety (perforation, irregular bleeding, unusual vaginal discharge, and infection), efficacy (pregnancy, expulsions, and discontinuations), and incidence of undescended IUCD strings. Descriptives were calculated for various outcomes and chi square tests were used for comparison in between categorical variables. Results. Overall complication rates were low. No case of perforation or pregnancy was reported. Spontaneous expulsions were present in 5.3% cases and were significantly higher in vaginal insertions (p = 0.042). The incidence of undescended strings was high (38%), with highly significant difference between both groups (p = 0.000). Conclusion. IPPIUCD is a strong weapon in the family planning armoury and should be encouraged in both vaginal and caesarean deliveries. Early follow-up should be encouraged to detect expulsions and tackle common problems. PMID:27631023

  5. Prediction for Major Adverse Outcomes in Cardiac Surgery: Comparison of Three Prediction Models

    Directory of Open Access Journals (Sweden)

    Cheng-Hung Hsieh

    2007-09-01

    Conclusion: The Parsonnet score performed as well as the logistic regression models in predicting major adverse outcomes. The Parsonnet score appears to be a very suitable model for clinicians to use in risk stratification of cardiac surgery.

  6. Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State

    Science.gov (United States)

    Oman, Roy F.; Merritt, Breanca T.; Fluhr, Janene; Williams, Jean M.

    2015-01-01

    Background: The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. Methods: Pre- and…

  7. Clinical outcome of stand-alone ALIF compared to posterior instrumentation for degenerative disc disease

    DEFF Research Database (Denmark)

    Udby, Peter M.; Bech-Azeddine, Rachid

    2015-01-01

    low back pain resulting from degenerative disc disease. ALIF surgery has previously been linked with certain high risk complications and unfavorable long term fusion results. Newer studies suggest that stand-alone ALIF can possibly be advantageous compared to other types of posterior instrumented...

  8. OBSTETRICAL CONDITION AND NEONATAL NEUROLOGICAL OUTCOME IN DOMINICA, THE CARIBBEAN - A COMPARATIVE-STUDY

    NARCIS (Netherlands)

    VANDERVEERE, CN; LUTEYN, AJ; SORHAINDO, BA; FERREIRA, CJ; BOERSMA, ER; HUISJES, HJ; TOUWEN, BCL; HADDERSALGRA, M

    1992-01-01

    Risk factors during pregnancy and delivery and neurological morbidity of newborns were assessed in a birth cohort in Dominica, the Caribbean. The data were compared with two reference groups, one from Grenada, the Caribbean, and the other from Groningen, the Netherlands. Despite variations in cultur

  9. Outcomes and milestone achievement differences for very low-birth-weight multiples compared with singleton infants.

    Science.gov (United States)

    Kirkby, Sharon; Genen, Linda; Turenne, Wendy; Dysart, Kevin

    2010-06-01

    We examined if very low-birth-weight (VLBW) infants of multiple gestation pregnancies experience more complications and take longer to achieve clinical milestones compared with similar singletons. We performed a retrospective analysis of all infants less than 1500 g at birth in a large neonatal database. Singletons were compared with twins and higher-order multiples for demographic, morbidities, and process milestones including feeding, respiratory, thermoregulation, and length of stay. Multivariable regression analyses were performed to control for potential confounding variables. A total of 5507 infants were included: 3792 singletons, 1391 twins, and 324 higher-order multiples. There were no differences in Apgar scores, small for gestational age status, and incidence of necrotizing enterocolitis, severe retinopathy of prematurity, severe intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, or the need for surgery. Multiples had higher rates of apnea and patent ductus arteriosus than singletons. VLBW multiples achieved milestones at similar rates in most areas compared with singletons except for the achievement of full oral feedings. Length of stay, after controlling for confounding variables, did not differ between the groups. Compared with singletons, VLBW multiples had similar morbidity and achieved most feeding and thermoregulation milestones at similar rates.

  10. Work-Focused Treatment of Common Mental Disorders and Return to Work: A Comparative Outcome Study

    NARCIS (Netherlands)

    Lagerveld, S.E.; Blonk, R.W.B.; Brenninkmeijer, V.; Wijngaards-de Meij, L.; Schaufeli, W.B.

    2012-01-01

    The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive– behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried

  11. Understanding the outcomes of advocacy coalitions in education: a comparative perspective

    NARCIS (Netherlands)

    A. Verger; M. Novelli

    2012-01-01

    In this chapter, we use comparative analysis lenses to better understand the nature of civil society coalitions and their impact in the educational field. The arguments provide a synthesis of core issues that have emerged from the case studies presented in earlier chapters. In particular, this chapt

  12. Comparing the Transition Planning, Postsecondary Education, and Employment Outcomes of Students with Intellectual and Other Disabilities

    Science.gov (United States)

    Grigal, Meg; Hart, Debra; Migliore, Alberto

    2011-01-01

    This article describes a secondary analysis of variables from the National Longitudinal Transition Survey 2 (NLTS-2) database. Specifically, students with intellectual disability (ID) were compared to students with other disabilities regarding post-school transition goals listed on their IEPs/Transition Plans, contacts/referrals made to outside…

  13. Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State

    Science.gov (United States)

    Oman, Roy F.; Merritt, Breanca T.; Fluhr, Janene; Williams, Jean M.

    2015-01-01

    Background: The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. Methods: Pre- and…

  14. Work-Focused Treatment of Common Mental Disorders and Return to Work: A Comparative Outcome Study

    NARCIS (Netherlands)

    Lagerveld, S.E.; Blonk, R.W.B.; Brenninkmeijer, V.; Wijngaards-de Meij, L.; Schaufeli, W.B.

    2012-01-01

    The aim of this study was to compare the effectiveness of two individual-level psychotherapy interventions: (a) treatment as usual consisting of cognitive– behavioral therapy (CBT) and (b) work-focused CBT (W-CBT) that integrated work aspects early into the treatment. Both interventions were carried

  15. Conceptualizations of Creativity: Comparing Theories and Models of Giftedness

    Science.gov (United States)

    Miller, Angie L.

    2012-01-01

    This article reviews seven different theories of giftedness that include creativity as a component, comparing and contrasting how each one conceptualizes creativity as a part of giftedness. The functions of creativity vary across the models, suggesting that while the field of gifted education often cites the importance of creativity, the…

  16. Conceptualizations of Creativity: Comparing Theories and Models of Giftedness

    Science.gov (United States)

    Miller, Angie L.

    2012-01-01

    This article reviews seven different theories of giftedness that include creativity as a component, comparing and contrasting how each one conceptualizes creativity as a part of giftedness. The functions of creativity vary across the models, suggesting that while the field of gifted education often cites the importance of creativity, the…

  17. Theoretical biology: Comparing models of species abundance - Brief Communications Arising

    NARCIS (Netherlands)

    Chave, J.; Alonso, D.; Etienne, R.S.

    2006-01-01

    Ecologists are struggling to explain how so many tropical tree species can coexist in tropical forests, and several empirical studies have demonstrated that negative density dependence is an important mechanism of tree-species coexistence1, 2. Volkov et al.3 compare a model incorporating negative de

  18. Comparing satellite SAR and wind farm wake models

    DEFF Research Database (Denmark)

    Hasager, Charlotte Bay; Vincent, P.; Husson, R.

    2015-01-01

    The aim of the paper is to present offshore wind farm wake observed from satellite Synthetic Aperture Radar (SAR) wind fields from RADARSAT-1/-2 and Envisat and to compare these wakes qualitatively to wind farm wake model results. From some satellite SAR wind maps very long wakes are observed. Th...

  19. Gene panel model predictive of outcome in patients with prostate cancer.

    Science.gov (United States)

    Rabiau, Nadège; Dantal, Yann; Guy, Laurent; Ngollo, Marjolaine; Dagdemir, Aslihan; Kemeny, Jean-Louis; Terris, Benoît; Vieillefond, Annick; Boiteux, Jean-Paul; Bignon, Yves-Jean; Bernard-Gallon, Dominique

    2013-08-01

    In men at high risk for prostate cancer, established clinical and pathological parameters provide only limited prognostic information. Here we analyzed a French cohort of 103 prostate cancer patients and developed a gene panel model predictive of outcome in this group of patients. The model comprised of a 15-gene TaqMan Low-Density Array (TLDA) card, with gene expressions compared to a standardized reference. The RQ value for each gene was calculated, and a scoring system was developed. Summing all the binary scores (0 or 1) corresponding to the 15 genes, a global score is obtained between 0 and 15. This global score can be compared to Gleason score (0 to 10) by recalculating it into a 0-10 scaled score. A scaled score ≥2 suggested that the patient is suffering from a prostate cancer, and a scaled score ≥7 flagged aggressive cancer. Statistical analyses demonstrated a strongly significant linear correlation (p=3.50E-08) between scaled score and Gleason score for this prostate cancer cohort (N=103). These results support the capacity of this designed 15 target gene TLDA card approach to predict outcome in prostate cancer, opening up a new avenue for personalized medicine through future independent replication and applications for rapid identification of aggressive prostate cancer phenotypes for early intervention.

  20. Comparing contents of outcome measures in cerebral palsy using the International Classification of Functioning (ICF-CY): a systematic review.

    Science.gov (United States)

    Schiariti, Veronica; Klassen, Anne F; Cieza, Alarcos; Sauve, Karen; O'Donnell, Maureen; Armstrong, Robert; Mâsse, Louise C

    2014-01-01

    The International Classification of Functioning children and youth version (ICF-CY) provides a universal framework for defining and classifying functioning and disability in children worldwide. To facilitate the application of the ICF in practice, ICF based-tools like the "ICF Core Sets" are being developed. In the context of the development of the ICF-CY Core Sets for children with Cerebral Palsy (CP), the aims of this study were as follows: to identify and compare the content of outcome measures used in studies of children with CP using the ICF-CY coding system; and to describe the most frequently addressed areas of functioning in those studies. We searched multiple databases likely to capture studies involving children with CP from January 1998 to March 2012. We included all English language articles that studied children aged 2-18 years and described an interventional or observational study. Constructs of the outcome measures identified in studies were linked to the ICF-CY by two trained professionals. We found 231 articles that described 238 outcome measures. The outcome measures contained 2193 concepts that were linked to the ICF-CY and covered 161 independent ICF-CY categories. Out of the 161 categories, 53 (33.5%) were related to body functions, 75 (46%) were related to activities/participation, 26 (16.1%) were related to environmental factors, and 7 (4.3%) were related to body structures. This systematic review provides information about content of measures that may guide researchers and clinicians in their selection of an outcome measure for use in a study and/or clinical practice with children with CP. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  1. Comparing Diagnostic Outcomes of Autism Spectrum Disorder Using "DSM-IV-TR" and "DSM-5" Criteria

    Science.gov (United States)

    Harstad, Elizabeth B.; Fogler, Jason; Sideridis, Georgios; Weas, Sarah; Mauras, Carrie; Barbaresi, William J.

    2015-01-01

    Controversy exists regarding the "DSM-5" criteria for ASD. This study tested the psychometric properties of the "DSM-5" model and determined how well it performed across different gender, IQ, and "DSM-IV-TR" sub-type, using clinically collected data on 227 subjects (median age = 3.95 years, majority had IQ > 70).…

  2. Comparing Diagnostic Outcomes of Autism Spectrum Disorder Using "DSM-IV-TR" and "DSM-5" Criteria

    Science.gov (United States)

    Harstad, Elizabeth B.; Fogler, Jason; Sideridis, Georgios; Weas, Sarah; Mauras, Carrie; Barbaresi, William J.

    2015-01-01

    Controversy exists regarding the "DSM-5" criteria for ASD. This study tested the psychometric properties of the "DSM-5" model and determined how well it performed across different gender, IQ, and "DSM-IV-TR" sub-type, using clinically collected data on 227 subjects (median age = 3.95 years, majority had IQ > 70).…

  3. Computational EEG modelling of decision making under ambiguity reveals spatio-temporal dynamics of outcome evaluation.

    Science.gov (United States)

    Jollans, Lee; Whelan, Robert; Venables, Louise; Turnbull, Oliver H; Cella, Matteo; Dymond, Simon

    2017-03-15

    Complex human cognition, such as decision-making under ambiguity, is reflected in dynamic spatio-temporal activity in the brain. Here, we combined event-related potentials with computational modelling of the time course of decision-making and outcome evaluation during the Iowa Gambling Task. Measures of choice probability generated using the Prospect Valence Learning Delta (PVL-Delta) model, in addition to objective trial outcomes (outcome magnitude and valence), were applied as regressors in a general linear model of the EEG signal. The resulting three-dimensional spatio-temporal characterization of task-related neural dynamics demonstrated that outcome valence, outcome magnitude, and PVL-Delta choice probability were expressed in distinctly separate event related potentials. Our findings showed that the P3 component was associated with an experience-based measure of outcome expectancy. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Training models in laparoscopy: a systematic review comparing their effectiveness in learning surgical skills.

    Science.gov (United States)

    Willaert, W; Van De Putte, D; Van Renterghem, K; Van Nieuwenhove, Y; Ceelen, W; Pattyn, P

    2013-01-01

    Surgery has traditionally been learned on patients in the operating room, which is time-consuming, can have an impact on the patient outcomes, and is of variable effectiveness. As a result, surgical training models have been developed, which are compared in this systematic review. We searched Pubmed, CENTRAL, and Science Citation index expanded for randomised clinical trials and randomised cross-over studies comparing laparoscopic training models. Studies comparing one model with no training were also included. The reference list of identified trials was searched for further relevant studies. Fifty-eight trials evaluating several training forms and involving 1591 participants were included (four studies with a low risk of bias). Training (virtual reality (VR) or video trainer (VT)) versus no training improves surgical skills in the majority of trials. Both VR and VT are as effective in most studies. VR training is superior to traditional laparoscopic training in the operating room. Outcome results for VR robotic simulations versus robot training show no clear difference in effectiveness for either model. Only one trial included human cadavers and observed better results versus VR for one out of four scores. Contrasting results are observed when robotic technology is compared with manual laparoscopy. VR training and VT training are valid teaching models. Practicing on these models similarly improves surgical skills. A combination of both methods is recommended in a surgical curriculum. VR training is superior to unstructured traditional training in the operating room. The reciprocal effectiveness of the other models to learn surgical skills has not yet been established.

  5. Comparing modelling techniques for analysing urban pluvial flooding.

    Science.gov (United States)

    van Dijk, E; van der Meulen, J; Kluck, J; Straatman, J H M

    2014-01-01

    Short peak rainfall intensities cause sewer systems to overflow leading to flooding of streets and houses. Due to climate change and densification of urban areas, this is expected to occur more often in the future. Hence, next to their minor (i.e. sewer) system, municipalities have to analyse their major (i.e. surface) system in order to anticipate urban flooding during extreme rainfall. Urban flood modelling techniques are powerful tools in both public and internal communications and transparently support design processes. To provide more insight into the (im)possibilities of different urban flood modelling techniques, simulation results have been compared for an extreme rainfall event. The results show that, although modelling software is tending to evolve towards coupled one-dimensional (1D)-two-dimensional (2D) simulation models, surface flow models, using an accurate digital elevation model, prove to be an easy and fast alternative to identify vulnerable locations in hilly and flat areas. In areas at the transition between hilly and flat, however, coupled 1D-2D simulation models give better results since catchments of major and minor systems can differ strongly in these areas. During the decision making process, surface flow models can provide a first insight that can be complemented with complex simulation models for critical locations.

  6. SURGICAL AND VISUAL OUTCOME OF PHACOEMULSIFICATION SURGERY (ROUTINE AND MICRO - PHACO (BIMANUAL PHACO: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Sudha

    2015-03-01

    Full Text Available Cataract surgery has evolved over the past few decades with progressive decrease in the size of the incision. Originally from 12 mm intracapsular incision to bimanual phacoemulsification (Micro - Phaco that has incision size of just 700 microns. In the pres ent comparative PROSPECTIVE study best corrected visual acuity postoperatively and surgically induced astigmatism were compared in routine Phacoemulsification technique and bimanual phaco (Micro - Phaco 60 eyes were studied. There was no statistically signi ficant difference in postoperative best corrected visual acuity (BCVA of patients operated with Micro - Phaco or routine Phacoemulsification. There was difference in surgically induced astigmatism (SIA ; average SIA in microphaco was 0.5972 as against 0.832 8 in routine Phacoemulsification.

  7. Obstetrical and perinatal outcomes following blastocyst transfer compared to cleavage transfer: a systematic review and meta-analysis.

    Science.gov (United States)

    Martins, W P; Nastri, C O; Rienzi, L; van der Poel, S Z; Gracia, C R; Racowsky, C

    2016-11-01

    Is blastocyst transfer safe when compared to cleavage stage embryo transfer regarding obstetric and perinatal outcomes? The clinical equipoise between blastocyst and cleavage stage embryo transfer remains as the evidence associating blastocyst transfer with some adverse perinatal outcomes is of low/very low quality. Extended embryo culture to the blastocyst stage provides some theoretical advantages and disadvantages. While it permits embryo self-selection, it also exposes those embryos to possible harm due to the in vitro environment. Both effectiveness and safety should be weighed to permit evidence-based decisions in clinical practice. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies reporting perinatal outcomes for singletons comparing the deliveries resulting from blastocyst and cleavage stage embryo transfer. Observational studies were included because the primary outcomes, perinatal mortality and birth defects, are rare and require a large number of participants (>50 000) to be properly assessed. The last electronic searches were last run on 11 March 2016. There were 12 observational studies encompassing 195 325 singleton pregnancies included in the study. No RCT reported the studied outcomes. The quality of the included studies was evaluated according to the Newcastle-Ottawa Scale and the quality of the evidence was evaluated according to GRADE criteria. Blastocyst stage transfer was associated with increased risks of preterm birth (best practice, and in light of the challenges in lower resource settings to offer extended culture to blastocyst stage, it is critical to take into consideration these obstetric and neonatal outcomes in order to ensure any recommendation will not result in the overburdening of existing maternal and child health care systems and services. No external funding was either sought or obtained for this study. The authors have no competing interests to declare. CRD

  8. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

    OpenAIRE

    Macfarlane, Alan James Robert; Kearns, Rachel; Aitken, Emma; Kinsella, John; Clancy, Marc

    2013-01-01

    Background An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infi...

  9. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    Science.gov (United States)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  10. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair: Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes.

    Science.gov (United States)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    2015-07-01

    Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure. This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic. RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46). The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.

  11. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, Linda

    1999-01-01

    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients w...

  12. A stratified model for health outcomes in ankylosing spondylitis

    NARCIS (Netherlands)

    P. Machado; R. Landewé; J. Braun; K.G.A. Hermann; X. Baraliakos; D. Baker; B. Hsu; D. van der Heijde

    2011-01-01

    To investigate the relationships between several health outcomes in ankylosing spondylitis (AS). Baseline pretreatment data from 214 patients with AS participating in the AS Study for the Evaluation of Recombinant Infliximab Therapy were analysed. Measures of health-related quality of life (HRQoL) a

  13. Comparative 3-D Modeling of tmRNA

    Directory of Open Access Journals (Sweden)

    Wower Iwona

    2005-06-01

    Full Text Available Abstract Background Trans-translation releases stalled ribosomes from truncated mRNAs and tags defective proteins for proteolytic degradation using transfer-messenger RNA (tmRNA. This small stable RNA represents a hybrid of tRNA- and mRNA-like domains connected by a variable number of pseudoknots. Comparative sequence analysis of tmRNAs found in bacteria, plastids, and mitochondria provides considerable insights into their secondary structures. Progress toward understanding the molecular mechanism of template switching, which constitutes an essential step in trans-translation, is hampered by our limited knowledge about the three-dimensional folding of tmRNA. Results To facilitate experimental testing of the molecular intricacies of trans-translation, which often require appropriately modified tmRNA derivatives, we developed a procedure for building three-dimensional models of tmRNA. Using comparative sequence analysis, phylogenetically-supported 2-D structures were obtained to serve as input for the program ERNA-3D. Motifs containing loops and turns were extracted from the known structures of other RNAs and used to improve the tmRNA models. Biologically feasible 3-D models for the entire tmRNA molecule could be obtained. The models were characterized by a functionally significant close proximity between the tRNA-like domain and the resume codon. Potential conformational changes which might lead to a more open structure of tmRNA upon binding to the ribosome are discussed. The method, described in detail for the tmRNAs of Escherichia coli, Bacillus anthracis, and Caulobacter crescentus, is applicable to every tmRNA. Conclusion Improved molecular models of biological significance were obtained. These models will guide in the design of experiments and provide a better understanding of trans-translation. The comparative procedure described here for tmRNA is easily adopted for the modeling the members of other RNA families.

  14. Comparative analysis of used car price evaluation models

    Science.gov (United States)

    Chen, Chuancan; Hao, Lulu; Xu, Cong

    2017-05-01

    An accurate used car price evaluation is a catalyst for the healthy development of used car market. Data mining has been applied to predict used car price in several articles. However, little is studied on the comparison of using different algorithms in used car price estimation. This paper collects more than 100,000 used car dealing records throughout China to do empirical analysis on a thorough comparison of two algorithms: linear regression and random forest. These two algorithms are used to predict used car price in three different models: model for a certain car make, model for a certain car series and universal model. Results show that random forest has a stable but not ideal effect in price evaluation model for a certain car make, but it shows great advantage in the universal model compared with linear regression. This indicates that random forest is an optimal algorithm when handling complex models with a large number of variables and samples, yet it shows no obvious advantage when coping with simple models with less variables.

  15. A microbial model of economic trading and comparative advantage.

    Science.gov (United States)

    Enyeart, Peter J; Simpson, Zachary B; Ellington, Andrew D

    2015-01-07

    The economic theory of comparative advantage postulates that beneficial trading relationships can be arrived at by two self-interested entities producing the same goods as long as they have opposing relative efficiencies in producing those goods. The theory predicts that upon entering trade, in order to maximize consumption both entities will specialize in producing the good they can produce at higher efficiency, that the weaker entity will specialize more completely than the stronger entity, and that both will be able to consume more goods as a result of trade than either would be able to alone. We extend this theory to the realm of unicellular organisms by developing mathematical models of genetic circuits that allow trading of a common good (specifically, signaling molecules) required for growth in bacteria in order to demonstrate comparative advantage interactions. In Conception 1, the experimenter controls production rates via exogenous inducers, allowing exploration of the parameter space of specialization. In Conception 2, the circuits self-regulate via feedback mechanisms. Our models indicate that these genetic circuits can demonstrate comparative advantage, and that cooperation in such a manner is particularly favored under stringent external conditions and when the cost of production is not overly high. Further work could involve implementing the models in living bacteria and searching for naturally occurring cooperative relationships between bacteria that conform to the principles of comparative advantage.

  16. Concurrently examining unrealistic absolute and comparative optimism: Temporal shifts, individual-difference and event-specific correlates, and behavioural outcomes.

    Science.gov (United States)

    Ruthig, Joelle C; Gamblin, Bradlee W; Jones, Kelly; Vanderzanden, Karen; Kehn, Andre

    2017-02-01

    Researchers have spent considerable effort examining unrealistic absolute optimism and unrealistic comparative optimism, yet there is a lack of research exploring them concurrently. This longitudinal study repeatedly assessed unrealistic absolute and comparative optimism within a performance context over several months to identify the degree to which they shift as a function of proximity to performance and performance feedback, their associations with global individual difference and event-specific factors, and their link to subsequent behavioural outcomes. Results showed similar shifts in unrealistic absolute and comparative optimism based on proximity to performance and performance feedback. Moreover, increases in both types of unrealistic optimism were associated with better subsequent performance beyond the effect of prior performance. However, several differences were found between the two forms of unrealistic optimism in their associations with global individual difference factors and event-specific factors, highlighting the distinctiveness of the two constructs. © 2016 The British Psychological Society.

  17. Treatment outcome in patients with triple negative early stage breast cancers compared with other molecular subtypes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young; Chang, Sei Kyung; Lee, Bo Mi; Shin, Hyun Soo [Dept. of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of); Park, Heily [Dept. of Radiation Oncology, Presbyterian Hospital, Jeonju (Korea, Republic of)

    2012-09-15

    To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p < 0.0001), and nuclear (p < 0.0001). The median follow-up period was 78 months (range, 4 to 130 months). There were 9 local relapses (2.0%), 15 nodal (3.4%), 40 distant metastases (9.0%), and 33 deaths (7.4%) for all patients. The rates of 5-year OS, DFS, LFS, and DMFS for all patients were 95.5%, 89.9%, 95.4%, and 91.7%, respectively. There were no significant differences in OS, DFS, LFS, and DMFS between triple negative and other subtypes (p > 0.05). We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.

  18. Comparative Analysis of Visco-elastic Models with Variable Parameters

    Directory of Open Access Journals (Sweden)

    Silviu Nastac

    2010-01-01

    Full Text Available The paper presents a theoretical comparative study for computational behaviour analysis of vibration isolation elements based on viscous and elastic models with variable parameters. The changing of elastic and viscous parameters can be produced by natural timed evolution demo-tion or by heating developed into the elements during their working cycle. It was supposed both linear and non-linear numerical viscous and elastic models, and their combinations. The results show the impor-tance of numerical model tuning with the real behaviour, as such the characteristics linearity, and the essential parameters for damping and rigidity. Multiple comparisons between linear and non-linear simulation cases dignify the basis of numerical model optimization regarding mathematical complexity vs. results reliability.

  19. Comparison of robustness to outliers between robust poisson models and log-binomial models when estimating relative risks for common binary outcomes: a simulation study.

    Science.gov (United States)

    Chen, Wansu; Shi, Jiaxiao; Qian, Lei; Azen, Stanley P

    2014-06-26

    To estimate relative risks or risk ratios for common binary outcomes, the most popular model-based methods are the robust (also known as modified) Poisson and the log-binomial regression. Of the two methods, it is believed that the log-binomial regression yields more efficient estimators because it is maximum likelihood based, while the robust Poisson model may be less affected by outliers. Evidence to support the robustness of robust Poisson models in comparison with log-binomial models is very limited. In this study a simulation was conducted to evaluate the performance of the two methods in several scenarios where outliers existed. The findings indicate that for data coming from a population where the relationship between the outcome and the covariate was in a simple form (e.g. log-linear), the two models yielded comparable biases and mean square errors. However, if the true relationship contained a higher order term, the robust Poisson models consistently outperformed the log-binomial models even when the level of contamination is low. The robust Poisson models are more robust (or less sensitive) to outliers compared to the log-binomial models when estimating relative risks or risk ratios for common binary outcomes. Users should be aware of the limitations when choosing appropriate models to estimate relative risks or risk ratios.

  20. Cleft characteristics and treatment outcomes in hemifacial microsomia compared to non-syndromic cleft lip/palate.

    Science.gov (United States)

    Dentino, K M; Valstar, A; Padwa, B L

    2016-06-01

    The goal of this study was to describe the clinical characteristics and treatment outcomes of patients with hemifacial microsomia (HFM) and cleft lip/palate (CL/P), and to compare them to a historic cohort of patients with non-syndromic CL/P treated at the same centre. A retrospective review of patients with HFM and CL/P was performed; the main outcome measures assessed were cleft type/side, surgical outcome, midfacial retrusion, and speech. Twenty-six patients (13 male, 13 female; mean age 22.7±14.9, range 1-52 years) with cleft lip with/without cleft palate (CL±P) were identified: three with cleft lip (12%), two with cleft lip and alveolus and an intact secondary palate (8%), and 21 with cleft lip and palate (CLP) (81%; 15 unilateral and six bilateral). Four patients (19%) had a palatal fistula after palatoplasty. Twelve of 22 patients aged >5 years (55%) had midfacial retrusion and two (9%) required a pharyngeal flap for velopharyngeal insufficiency (VPI). Fisher's exact test demonstrated a higher frequency of complete labial clefting (P=0.004), CLP (P=0.009), midfacial retrusion (P=0.0009), and postoperative palatal fistula (P=0.03) in HFM compared to non-syndromic CL±P. There was no difference in VPI prevalence. This study revealed that patients with HFM and CL±P have more severe forms of orofacial clefting than patients with non-syndromic CL±P. Patients with HFM and CL±P have more severe midfacial retrusion and a higher palatal fistula rate compared to patients with non-syndromic CL±P.

  1. PREGNANCY OUTCOME FOLLOWING INDUCTION OF LABOUR IN OLIGOHYDRAMNIOS AND BO R DERLINE LIQUOR AT TERM: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Akshaya Kumar

    2013-12-01

    Full Text Available The purpose of this study was to compare the feto - maternal outcome after induction of labor in oligohydramnios and bo r derline liquorat term. STUDY DESIGN : This retrospective study was conducted in a medical college and general hospital with wome n of 37 – 42 weeks’ gestation. The amniotic fluid index (AFI was determined in all cases using the four - quadrant technique. The cases were divided into two groups based on their AFI. Oligohydramnios group (n=102 with AFI ≤ 5 cm and borderline liquor group (n=99 with AFI of 5.1 to 8 cm. Induction of labor was done by misoprostol in all cases. Different maternal outcomes like mode of delivery , indication for operative or instrumental delivery , meconium stained liquor and perinatal outcomes were compared in b etween the two groups. RESULTS : The two groups were similar with regard to maternal age , parity , and gestational age. Meconium staining of the amniotic fluid was significantly higher in the group with AFI < 5 cm (p = 0.05. The number of cesarean deliveries and incidence non - reassuring fetal heart (fetal distress were similar in both the groups. There was no significant difference between the two groups with regard to Apgar scores or admission to neonatal intensive care unit (NICU. CONCLUSION : Induction of labor at term in women with oligohydramnios is associated with an increased incidence of meconium staining of the amniotic fluid but the risk of cesarean delivery or fetal distress it is not increased as compared with bo r derline liquor. KEYWO RDS: Amniotic fluid index; Bo r derline liquor; Induction of labor; Fetal distress Oligohydramnios at Term

  2. Naltrexone implants compared to methadone: outcomes six months after prison release.

    Science.gov (United States)

    Lobmaier, Philipp P; Kunøe, Nikolaj; Gossop, Michael; Katevoll, Tormod; Waal, Helge

    2010-01-01

    After prison release, offenders with heroin use problems are at high risk of relapse and overdose death. There is a particular need for treatments that can be initiated in prison and continued after release into the community. Methadone maintenance treatment has been shown to reduce heroin use, criminality and mortality. Naltrexone implant treatment has not previously been evaluated in prison settings. This study compares the effects of naltrexone implants and methadone treatment on heroin and other illicit drug use, and criminality among heroin-dependent inmates after release from prison. Forty-six volunteers were randomly allocated to naltrexone implants or methadone before release. Intention-to-treat analyses showed reductions in both groups in frequency of use of heroin and benzodiazepines, as well as criminality, 6 months after prison release. Naltrexone implants may be a valuable treatment option in prison settings. 2010 S. Karger AG, Basel.

  3. TEMPORALIS FASCIA VERSUS TRAGAL PERICHONDRIUM : A COMPARATIVE STUDY OF OUTCOMES AS GRAFT MATERIAL IN TYMPANOPLASTY

    Directory of Open Access Journals (Sweden)

    Adip K

    2013-12-01

    Full Text Available Chronic suppurative otitis media is a major cause of morbidity with a large proportion ofpatients presenting with a tubo - tympanic type o f disease. Type 1 tympanoplasty has been established as the standardized treatment of choice for such patients.Right since the early years of this century a number of grafts have been used for tympanoplasty.Still , there exists a controversy about which is the best graft material.A good graft material is one which is locally available , is easily harvested , is viable, easy to place and gives a good healing result. Both temporalis fascia and tragal perichondrium satisfy all these criteria. Our study was aimed out to find which amongst these two is a better graft material by comparing the efficacy of tragal perichondrium as graft material to that of temporalis fascia. KEY WORDS : Chronic suppurative otitis media , tympanoplasty , temporalis fascia , tragal perichondrium

  4. Modeling Verdict Outcomes Using Social Network Measures: The Watergate and Caviar Network Cases.

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    Víctor Hugo Masías

    Full Text Available Modelling criminal trial verdict outcomes using social network measures is an emerging research area in quantitative criminology. Few studies have yet analyzed which of these measures are the most important for verdict modelling or which data classification techniques perform best for this application. To compare the performance of different techniques in classifying members of a criminal network, this article applies three different machine learning classifiers-Logistic Regression, Naïve Bayes and Random Forest-with a range of social network measures and the necessary databases to model the verdicts in two real-world cases: the U.S. Watergate Conspiracy of the 1970's and the now-defunct Canada-based international drug trafficking ring known as the Caviar Network. In both cases it was found that the Random Forest classifier did better than either Logistic Regression or Naïve Bayes, and its superior performance was statistically significant. This being so, Random Forest was used not only for classification but also to assess the importance of the measures. For the Watergate case, the most important one proved to be betweenness centrality while for the Caviar Network, it was the effective size of the network. These results are significant because they show that an approach combining machine learning with social network analysis not only can generate accurate classification models but also helps quantify the importance social network variables in modelling verdict outcomes. We conclude our analysis with a discussion and some suggestions for future work in verdict modelling using social network measures.

  5. Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes

    Directory of Open Access Journals (Sweden)

    Breaux-Shropshire TL

    2015-07-01

    Full Text Available Tonya L Breaux-Shropshire,1,2 Eric Judd,1 Lee A Vucovich,3 Toneyell S Shropshire,4 Sonal Singh5 1Vascular Biology and Hypertension Program, Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 2Veterans Administration, Birmingham, AL, USA; 3Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA; 5Department of Medicine, John Hopkins School of Medicine, Baltimore, MD, USA Objective: Our objective was to compare the clinical effectiveness of home blood pressure monitoring (HBPM and 24-hour ambulatory blood pressure monitoring (ABPM on blood pressure (BP control and patient outcomes. Design: A systematic review was conducted. We also appraised the methodological quality of studies. Data sources: PubMed, Scopus, CINAHL, and the Cochrane Central Register of Control Trials (CENTRAL. Inclusion criteria: Randomized control trials, prospective and retrospective cohort studies, observational studies, and case-control studies published in English from any year to present that describe HBPM and 24-hour ABPM and report on systolic and/or diastolic BP and/or heart attack, stroke, kidney failure and/or all-cause mortality for adult patients. Due to the nature of the question, studies with only untreated patients were not considered. Results: Of 1,742 titles and abstractions independently reviewed by two reviewers, 137 studies met predetermined criteria for evaluation. Nineteen studies were identified as relevant and included in the paper. The common themes were that HBPM and ABPM correlated with cardiovascular events and mortality, and targeting HBPM or ABPM resulted in similar outcomes. Associations between BP measurement type and mortality differed by study population. Both the low sensitivity of office blood pressure monitoring (OBPM to detect optimal BP control by ABPM and the

  6. Mid-term outcome comparing temporary K-wire fixation versus PDS augmentation of Rockwood grade III acromioclavicular joint separations

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    Pilotto Susann

    2009-05-01

    Full Text Available Abstract Backround The treatment of acute acromioclavicular (AC joint injuries depends mainly on the type of the dislocation and patient demands. This study compares the mid term outcome of two frequently performed surgical concepts of Rockwood grade III AC joint separations: The temporary articular fixation with K-wires (TKW and the refixation with an absorbable polydioxansulfate (PDS sling. Findings Retrospective observational study of 86 patients with a mean age of 37 years underwent either TKW (n = 70 or PDS treatment (n = 16 of Rockwood grade III AC joint injuries. Mid term outcome with a mean follow up of 3 years was measured using a standardized functional patient questionnaire including Constant score, ASES rating scale, SPADI, XSMFA-D and a pain score. K-wire therapy resulted in significantly better functional results expressed by Constant score (88 ± 10 vs. 73 ± 18, ASES rating scale (29 ± 3 vs. 25 ± 5, SPADI (3 ± 9 vs. 9 ± 13, XSMFA-D function (13 ± 2 vs. 14 ± 3, XSMFA-D impairment (4 ± 1 vs. 6 ± 2 and pain score (1 ± 1 vs. 2 ± 2. Conclusion Either temporary K-wire fixation and PDS sling enable good or satisfying functional results in the treatment of Rockwood grade III AC separations. However functional outcome parameters indicate a significant advantage for the K-wire technique.

  7. Assay conditions can influence the outcome of cytotoxicity tests of nanomaterials: better assay characterization is needed to compare studies.

    Science.gov (United States)

    Geys, Jorina; Nemery, Benoit; Hoet, Peter H M

    2010-03-01

    Reliable in vitro studies that generate consistent toxicity data on nanomaterials on a high-throughput scale will be of invaluable significance in the next few years. In this study, we checked the influence of several steps of the experimental design on the outcome: we investigated the role of cell density, viability assay and particle dispersion method, including the influence of serum and effect of a surfactant (Tween 80). The dose-response curve was assessed for ground multiwalled carbon nanotubes (CNT) and the silica benchmark Min-U-Sil, on lung epithelial cells (A549 cells) and macrophages (stimulated THP-1 cells). The cell density used in the cytotoxicity study has an impact on the outcome: for the same concentration of Min-U-Sil, the viability of A549 cells varied from 10% to 55% with increasing cell density. Whereas foetal calf serum attenuated the cytotoxicity of Min-U-Sil, this effect was not seen for CNT. The results show how cell culture conditions can modify the outcome of a toxicological experiment, as shown in this study for Tween 80 to disperse the test agent. These experiments illustrates that results reported in literature can only be compared when, in addition to the use of a benchmark particle, a detailed method description is available. Therefore, more emphasis is needed on a standardized design for cytotoxicity studies. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  8. Salvage Liver Transplantation Leads to Poorer Outcome in Hepatocellular Carcinoma Compared with Primary Liver Transplantation

    Science.gov (United States)

    Shan, Yuhua; Huang, Lifeng; Xia, Qiang

    2017-01-01

    Hepatocellular carcinoma is the most common liver malignancy. Salvage liver transplantation (SLT) is viewed as a feasible cure for recurrence of HCC after resectomy, but the effect is under dispute. A retrospective study examined data at Renji Hospital for 239 transplants from January 2006 to December 2015, including 211 who received primary liver transplantation (PLT) and 28 who underwent SLT. A multivariable cox regression model was employed to pick out relative factors to overall survival (OS) and recurrence free survival (RFS). Propensity score matching (PSM) was used to balance the bias. Both OS and RFS were worse in SLT group than in PLT group, especially for those patients within Milan criteria. Our study demonstrates that SLT bears higher risk of recurrence and death than PLT, indicating that SLT should be given a more careful thought at performance. PMID:28294176

  9. Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies

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    Wenzlaff Paul

    2008-01-01

    Full Text Available Abstract Background Recently, attention has been focused on subsequent pregnancies among teenage mothers. Previous studies that compared the reproductive outcomes of teenage nulliparae and multiparae often did not consider the adolescents' reproductive histories. Thus, the authors compared the risks for adverse reproductive outcomes of adolescent nulliparae to teenagers who either have had an induced abortion or a previous birth. Methods In this retrospective cohort study we used perinatal data prospectively collected by obstetricians and midwives from 1990–1999 (participation rate 87–98% of all hospitals in Lower Saxony, Germany. From the 9742 eligible births among adolescents, women with multiple births, >1 previous pregnancies, or a previous spontaneous miscarriage were deleted and 8857 women Results In bivariate logistic regression analyses, compared to nulliparous teenagers, adolescents with a previous birth had higher risks for perinatal [OR = 2.08, CI = 1.11,3.89] and neonatal [OR = 4.31, CI = 1.77,10.52] mortality and adolescents with a previous abortion had higher risks for stillbirths [OR = 3.31, CI = 1.01,10.88] and preterm births [OR = 2.21, CI = 1.07,4.58]. After adjusting for maternal nationality, partner status, smoking, prenatal care and pre-pregnancy BMI, adolescents with a previous birth were at higher risk for perinatal [OR = 2.35, CI = 1.14,4.86] and neonatal mortality [OR = 4.70, CI = 1.60,13.81] and adolescents with a previous abortion had a higher risk for very low birthweight infants [OR = 2.74, CI = 1.06,7.09] than nulliparous teenagers. Conclusion The results suggest that teenagers who give birth twice as adolescents have worse outcomes in their second pregnancy compared to those teenagers who are giving birth for the first time. The prevention of the second pregnancy during adolescence is an important public health objective and should be addressed by health care providers who attend the first birth or the abortion

  10. Modeling Error in Quantitative Macro-Comparative Research

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    Salvatore J. Babones

    2015-08-01

    Full Text Available Much quantitative macro-comparative research (QMCR relies on a common set of published data sources to answer similar research questions using a limited number of statistical tools. Since all researchers have access to much the same data, one might expect quick convergence of opinion on most topics. In reality, of course, differences of opinion abound and persist. Many of these differences can be traced, implicitly or explicitly, to the different ways researchers choose to model error in their analyses. Much careful attention has been paid in the political science literature to the error structures characteristic of time series cross-sectional (TSCE data, but much less attention has been paid to the modeling of error in broadly cross-national research involving large panels of countries observed at limited numbers of time points. Here, and especially in the sociology literature, multilevel modeling has become a hegemonic – but often poorly understood – research tool. I argue that widely-used types of multilevel models, commonly known as fixed effects models (FEMs and random effects models (REMs, can produce wildly spurious results when applied to trended data due to mis-specification of error. I suggest that in most commonly-encountered scenarios, difference models are more appropriate for use in QMC.

  11. Apnea after awake-regional and general anesthesia in infants: The General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnea and neurodevelopmental outcomes, a randomized controlled trial

    Science.gov (United States)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; de Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen

    2015-01-01

    Background Post-operative apnea is a complication in young infants. Awake-regional anesthesia (RA) may reduce the risk; however the evidence is weak. The General Anesthesia compared to Spinal anesthesia (GAS) study is a randomized, controlled, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods Infants ≤ 60 weeks postmenstrual age scheduled for inguinal herniorraphy were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born < 26 weeks’ gestation. The primary outcome of this analysis was any observed apnea up to 12 hours post-operatively. Apnea assessment was unblinded. Results 363 patients were assigned to RA and 359 to GA. Overall the incidence of apnea (0 to 12 hours) was similar between arms (3% in RA and 4% in GA arms, Odds Ratio (OR) 0.63, 95% Confidence Intervals (CI): 0.31 to 1.30, P=0.2133), however the incidence of early apnea (0 to 30 minutes) was lower in the RA arm (1% versus 3%, OR 0.20, 95%CI: 0.05 to 0.91, P=0.0367). The incidence of late apnea (30 minutes to 12 hours) was 2% in both RA and GA arms (OR 1.17, 95%CI: 0.41 to 3.33, P=0.7688). The strongest predictor of apnea was prematurity (OR 21.87, 95% CI 4.38 to 109.24) and 96% of infants with apnea were premature. Conclusions RA in infants undergoing inguinal herniorraphy reduces apnea in the early post-operative period. Cardio-respiratory monitoring should be used for all ex-premature infants. PMID:26001033

  12. Comparing measures of racial/ethnic discrimination, coping, and associations with health-related outcomes in a diverse sample.

    Science.gov (United States)

    Benjamins, Maureen R

    2013-10-01

    Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination.

  13. Comparative assessment of PV plant performance models considering climate effects

    DEFF Research Database (Denmark)

    Tina, Giuseppe; Ventura, Cristina; Sera, Dezso

    2017-01-01

    The paper investigates the effect of climate conditions on the accuracy of PV system performance models (physical and interpolation methods) which are used within a monitoring system as a reference for the power produced by a PV system to detect inefficient or faulty operating conditions....... The methodological approach is based on comparative tests of the analyzed models applied to two PV plants installed respectively in north of Denmark (Aalborg) and in the south of Italy (Agrigento). The different ambient, operating and installation conditions allow to understand how these factors impact the precision...... and effectiveness of such approaches, among these factors it is worth mentioning the different percentage of diffuse component of the yearly solar radiation on the global one. The experimental results show the effectiveness of the proposed approach. In order to have the possibility to analyze and compare...

  14. Children, computer exposure and musculoskeletal outcomes: the development of pathway models for school and home computer-related musculoskeletal outcomes.

    Science.gov (United States)

    Harris, Courtenay; Straker, Leon; Pollock, Clare; Smith, Anne

    2015-01-01

    Children's computer use is rapidly growing, together with reports of related musculoskeletal outcomes. Models and theories of adult-related risk factors demonstrate multivariate risk factors associated with computer use. Children's use of computers is different from adult's computer use at work. This study developed and tested a child-specific model demonstrating multivariate relationships between musculoskeletal outcomes, computer exposure and child factors. Using pathway modelling, factors such as gender, age, television exposure, computer anxiety, sustained attention (flow), socio-economic status and somatic complaints (headache and stomach pain) were found to have effects on children's reports of musculoskeletal symptoms. The potential for children's computer exposure to follow a dose-response relationship was also evident. Developing a child-related model can assist in understanding risk factors for children's computer use and support the development of recommendations to encourage children to use this valuable resource in educational, recreational and communication environments in a safe and productive manner. Computer use is an important part of children's school and home life. Application of this developed model, that encapsulates related risk factors, enables practitioners, researchers, teachers and parents to develop strategies that assist young people to use information technology for school, home and leisure in a safe and productive manner.

  15. A Statistical Word-Level Translation Model for Comparable Corpora

    Science.gov (United States)

    2000-06-01

    readily available resources such as corpora, thesauri, bilingual and multilingual lexicons and dictionaries. The acquisition of such resources has...could aid in Monolingual Information Retrieval (MIR) by methods of query expansion, and thesauri construction. To date, most of the existing...testing the limits of its performance. Future directions include testing the model with a monolingual comparable corpus, e.g. WSJ [42M] and either IACA/B

  16. Logistic random effects regression models: a comparison of statistical packages for binary and ordinal outcomes

    Directory of Open Access Journals (Sweden)

    Steyerberg Ewout W

    2011-05-01

    Full Text Available Abstract Background Logistic random effects models are a popular tool to analyze multilevel also called hierarchical data with a binary or ordinal outcome. Here, we aim to compare different statistical software implementations of these models. Methods We used individual patient data from 8509 patients in 231 centers with moderate and severe Traumatic Brain Injury (TBI enrolled in eight Randomized Controlled Trials (RCTs and three observational studies. We fitted logistic random effects regression models with the 5-point Glasgow Outcome Scale (GOS as outcome, both dichotomized as well as ordinal, with center and/or trial as random effects, and as covariates age, motor score, pupil reactivity or trial. We then compared the implementations of frequentist and Bayesian methods to estimate the fixed and random effects. Frequentist approaches included R (lme4, Stata (GLLAMM, SAS (GLIMMIX and NLMIXED, MLwiN ([R]IGLS and MIXOR, Bayesian approaches included WinBUGS, MLwiN (MCMC, R package MCMCglmm and SAS experimental procedure MCMC. Three data sets (the full data set and two sub-datasets were analysed using basically two logistic random effects models with either one random effect for the center or two random effects for center and trial. For the ordinal outcome in the full data set also a proportional odds model with a random center effect was fitted. Results The packages gave similar parameter estimates for both the fixed and random effects and for the binary (and ordinal models for the main study and when based on a relatively large number of level-1 (patient level data compared to the number of level-2 (hospital level data. However, when based on relatively sparse data set, i.e. when the numbers of level-1 and level-2 data units were about the same, the frequentist and Bayesian approaches showed somewhat different results. The software implementations differ considerably in flexibility, computation time, and usability. There are also differences in

  17. PROSPECTIVE AND COMPARATIVE STUDY ON FUNCTIONAL OUTCOMES AFTER OPEN AND ARTHROSCOPIC REPAIR OF ROTATOR CUFF TEARS

    Science.gov (United States)

    de Castro Veado, Marco Antônio; Castilho, Rodrigo Simões; Maia, Philipe Eduardo Carvalho; Rodrigues, Alessandro Ulhôa

    2015-01-01

    Objective: To prospectively assess the surgical results from patients undergoing repairs to rotator cuff injuries via open and arthroscopic procedures, with regard to functional and clinical features, and by means of ultrasound examinations, and to compare occurrences of renewed tearing. Methods: Sixty patients underwent operations performed by the same surgeon (29 via open surgery and 31 via arthroscopy), to repair complete rotator cuff tears. The procedures were performed at Hospital Governor Israel Pinheiro (HGIP) and Mater Dei Hospital in Belo Horizonte, Minas Gerais, between August 2007 and February 2009. The patients were assessed functionally by means of the UCLA score before and after the operation, and magnetic resonance imaging was done before the operation. All the patients were reassessed at least 12 months after the operation, and an ultrasound examination was also performed at this time. Results: Out of the 29 patients who underwent open surgery, 27 (93.1%) presented good or excellent results, with a mean UCLA score of 32 after the operation. Their mean follow-up was 14 months. Three patients presented renewed tearing on ultrasound, of whom one remained asymptomatic. Out of the 31 patients who underwent arthroscopic procedures, 29 (93.5%) presented good or excellent results, with a mean UCLA score of 33 after the operation. Their mean follow-up was 19 months. Two patients presented renewed tearing, of whom one remained asymptomatic and one evolved with loosening of an anchor, with an unsatisfactory result. Conclusion: The repairs on rotator cuff injuries presented good results by means of both open surgery and arthroscopy, with similar functional results in the two groups and similar rates of renewed tearing. PMID:27027052

  18. Outcome of Management of Otosclerosis by Stapedotomy Compared to Stapedectomy in a Jordanian Population

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    Hassan Al-Husban

    2013-01-01

    Full Text Available Objective: To study the success results rates and complications of stapedotomy compared to stapedectomy in the operative management of otosclerosis.Methods: This is a retrospective study of 50 patients who were treated surgically for otosclerosis. The medical records of these patients were reviewed for the type of operation performed, complications and the serial pure tune audiometries pre- and postoperatively for at least one year. Patients with conductive hearing loss not due to otosclerosis were excluded from this study. The medical records of equal number of patients (25 patients with stapedotomy and 25 patients with stapedectomy were analyzed for hearing improvement or loss, postoperative nausea, vomiting, vertigo, nystagmus, perilymph fistula, reparative granuloma, labyrinthitis, tinnitus and perforation of the tympanic membrane. All operations were performed by the senior consultant-otologists of our department. Stapes superstructures were removed by crural scissors and stapes footplate was perforated by microdrill.Results: Out of 25 patients with stapedotomy, 22 (88% developed complete closure (≤10 dB of the air-bone gap on pure tune audiometry; in two patients (8%, the air-bone gap improved to less 20 dB, and recurrent conductive hearing loss (due piston slipping in one patient (4%. On the other hand, in patients with stapedectomy, only 16 patients (64% developed complete closure of the air-bone gap (≤10 dB on pure tune audiometry, and in four patients (16% the air-bone gap improved to less 20 dB, while recurrent conductive hearing loss occured in three patients (12%, one patient developed complete sensorineural hearing loss (4%, there was one case of fluctuating hearing loss due to reparative granuloma (4%, perilymph fistula was reported in one case (4% and no cases of facial palsy or perforation of the tympanic membrane were recorded.Conclusion: The results of this study clearly show that stapedotomy gives better hearing results

  19. Functional outcomes after open versus arthroscopic Latarjet procedure: A prospective comparative study.

    Science.gov (United States)

    Nourissat, G; Neyton, L; Metais, P; Clavert, P; Villain, B; Haeni, D; Walch, G; Lafosse, L

    2016-12-01

    The Latarjet procedure provides effective stabilization of chronically unstable shoulders. Since this procedure is mainly performed in a young athletic population, the functional impact is significant. Published data does not shed light on the time needed to recover work-related or sports-related function. Performing this procedure arthroscopically may improve functional recovery. This led us to carry out a prospective, multicenter study to compare the functional recovery after arthroscopic versus open Latarjet procedure. Between June and November 2014, 184 patients were included in a prospective multicenter study: 85 in the open group and 99 in the arthroscopy group. The patients were evaluated preoperatively with the WOSI score. The early postoperative pain was evaluated on D3, D7 and D30. The WOSI score was determined postoperatively at 1, 3, 6 and 12 months of follow-up. The functional scores of the shoulder in both cohorts were identical overall preoperatively. In the immediate postoperative period, the arthroscopy group had statistically lower pain levels on D3 and D7. The postoperative WOSI was improved in both groups at 3 months, then continued to improve until it reached a plateau at 1 year. The WOSI score was better in the arthroscopy group at 3 months, but better in the open group at 6 months. This study found that a Latarjet procedure performed arthroscopically generates less immediately postoperative pain than when it is performed as an open procedure. The Latarjet procedure (whether open or arthroscopic) improves shoulder function, with normal function returning after 1 year. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Comparative evaluation of kinetic, equilibrium and semi-equilibrium models for biomass gasification

    Energy Technology Data Exchange (ETDEWEB)

    Buragohain, Buljit [Center for Energy, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India); Chakma, Sankar; Kumar, Peeush [Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India); Mahanta, Pinakeswar [Center for Energy, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India); Department of Mechanical Engineering, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India); Moholkar, Vijayanand S. [Center for Energy, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India); Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati – 781 039, Assam (India)

    2013-07-01

    Modeling of biomass gasification has been an active area of research for past two decades. In the published literature, three approaches have been adopted for the modeling of this process, viz. thermodynamic equilibrium, semi-equilibrium and kinetic. In this paper, we have attempted to present a comparative assessment of these three types of models for predicting outcome of the gasification process in a circulating fluidized bed gasifier. Two model biomass, viz. rice husk and wood particles, have been chosen for analysis, with gasification medium being air. Although the trends in molar composition, net yield and LHV of the producer gas predicted by three models are in concurrence, significant quantitative difference is seen in the results. Due to rather slow kinetics of char gasification and tar oxidation, carbon conversion achieved in single pass of biomass through the gasifier, calculated using kinetic model, is quite low, which adversely affects the yield and LHV of the producer gas. Although equilibrium and semi-equilibrium models reveal relative insensitivity of producer gas characteristics towards temperature, the kinetic model shows significant effect of temperature on LHV of the gas at low air ratios. Kinetic models also reveal volume of the gasifier to be an insignificant parameter, as the net yield and LHV of the gas resulting from 6 m and 10 m riser is same. On a whole, the analysis presented in this paper indicates that thermodynamic models are useful tools for quantitative assessment of the gasification process, while kinetic models provide physically more realistic picture.

  1. Comparative evaluation of kinetic, equilibrium and semi-equilibrium models for biomass gasification

    Directory of Open Access Journals (Sweden)

    Buljit Buragohain, Sankar Chakma, Peeush Kumar, Pinakeswar Mahanta, Vijayanand S. Moholkar

    2013-01-01

    Full Text Available Modeling of biomass gasification has been an active area of research for past two decades. In the published literature, three approaches have been adopted for the modeling of this process, viz. thermodynamic equilibrium, semi-equilibrium and kinetic. In this paper, we have attempted to present a comparative assessment of these three types of models for predicting outcome of the gasification process in a circulating fluidized bed gasifier. Two model biomass, viz. rice husk and wood particles, have been chosen for analysis, with gasification medium being air. Although the trends in molar composition, net yield and LHV of the producer gas predicted by three models are in concurrence, significant quantitative difference is seen in the results. Due to rather slow kinetics of char gasification and tar oxidation, carbon conversion achieved in single pass of biomass through the gasifier, calculated using kinetic model, is quite low, which adversely affects the yield and LHV of the producer gas. Although equilibrium and semi-equilibrium models reveal relative insensitivity of producer gas characteristics towards temperature, the kinetic model shows significant effect of temperature on LHV of the gas at low air ratios. Kinetic models also reveal volume of the gasifier to be an insignificant parameter, as the net yield and LHV of the gas resulting from 6 m and 10 m riser is same. On a whole, the analysis presented in this paper indicates that thermodynamic models are useful tools for quantitative assessment of the gasification process, while kinetic models provide physically more realistic picture.

  2. Do Magnet®-accredited hospitals show improvements in nurse and patient outcomes compared to non-Magnet hospitals: a systematic review.

    Science.gov (United States)

    Petit Dit Dariel, Odessa; Regnaux, Jean-Phillipe

    2015-07-17

    The Magnet model proposes an accreditation for hospitals having demonstrated a healthy work environment and, as a result, positive staff and patient outcomes. Yet there are conflicting findings surrounding the actual impact of Magnet's organizational model on these outcomes, as well as a wide range of designs influencing the quality of these results. To conduct a systematic review that explores the effect of Magnet accreditation on objective nurse and patient outcomes. Magnet and non-Magnet accredited hospitals matched according to their similarity (e.g. size, type [urban or rural], level of acuity, location, etc.). Hospitals could be either university based or non-teaching hospitals and in any geographical location. As the focus of the study was outcomes specific to Magnet accreditation, studies reporting on "reputational Magnets" (the original hospitals), Magnet-aspiring and non-Magnet hospitals alone were excluded from the review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: Exposure to Magnet accreditation. A Magnet hospital is defined as a hospital with American Nursing Credentialing Center -designated Magnet status at the time of study and having received this accreditation in the last four years, as this is the length of time for which the accreditation is valid, after which the hospital must reapply for another four-year accreditation. TYPES OF STUDIES: This review considered any quantitative study comparing nurse and patient outcomes in Magnet accredited hospitals with those in non-Magnet hospitals. Controlled clinical trials, controlled before and after and interrupted time series were considered first. When these were not available, case-controlled, descriptive comparative and descriptive correlational designs were considered. All studies presenting a "case study" with no comparison and other studies reporting on interviews and other qualitative data were excluded. TYPES OF OUTCOMES: The outcomes of interest were nurse outcomes related to turnover and

  3. A new thermal comfort approach comparing adaptive and PMV models

    Energy Technology Data Exchange (ETDEWEB)

    Orosa, Jose A. [Universidade da Coruna, Departamento de Energia y P. M. Paseo de Ronda, n :51, 15011. A Coruna (Spain); Oliveira, Armando C. [Universidade do Porto, Faculdade de Engenharia, New Energy Tec. Unit. Rua Dr Roberto Frias, 4200-465 Porto (Portugal)

    2011-03-15

    In buildings with heating, ventilation, and air-conditioning (HVAC), the Predicted Mean Vote index (PMV) was successful at predicting comfort conditions, whereas in naturally ventilated buildings, only adaptive models provide accurate predictions. On the other hand, permeable coverings can be considered as a passive control method of indoor conditions and, consequently, have implications in the perception of indoor air quality, local thermal comfort, and energy savings. These energy savings were measured in terms of the set point temperature established in accordance with adaptive methods. Problems appear when the adaptive model suggests the same neutral temperature for ambiences with the same indoor temperature but different relative humidities. In this paper, a new design of the PMV model is described to compare the neutral temperature to real indoor conditions. Results showed that this new PMV model tends to overestimate thermal neutralities but with a lower value than Fanger's PMV index. On the other hand, this new PMV model considers indoor relative humidity, showing a clear differentiation of indoor ambiences in terms of it, unlike adaptive models. Finally, spaces with permeable coverings present indoor conditions closer to thermal neutrality, with corresponding energy savings. (author)

  4. Comparing the ecological relevance of four wave exposure models

    Science.gov (United States)

    Sundblad, G.; Bekkby, T.; Isæus, M.; Nikolopoulos, A.; Norderhaug, K. M.; Rinde, E.

    2014-03-01

    Wave exposure is one of the main structuring forces in the marine environment. Methods that enable large scale quantification of environmental variables have become increasingly important for predicting marine communities in the context of spatial planning and coastal zone management. Existing methods range from cartographic solutions to numerical hydrodynamic simulations, and differ in the scale and spatial coverage of their outputs. Using a biological exposure index we compared the performance of four wave exposure models ranging from simple to more advanced techniques. All models were found to be related to the biological exposure index and their performance, measured as bootstrapped R2 distributions, overlapped. Qualitatively, there were differences in the spatial patterns indicating higher complexity with more advanced techniques. In order to create complex spatial patterns wave exposure models should include diffraction, especially in coastal areas rich in islands. The inclusion of wind strength and frequency, in addition to wind direction and bathymetry, further tended to increase the amount of explained variation. The large potential of high-resolution numerical models to explain the observed patterns of species distribution in complex coastal areas provide exciting opportunities for future research. Easy access to relevant wave exposure models will aid large scale habitat classification systems and the continuously growing field of marine species distribution modelling, ultimately serving marine spatial management and planning.

  5. Comparing Two Strategies to Model Uncertainties in Structural Dynamics

    Directory of Open Access Journals (Sweden)

    Rubens Sampaio

    2010-01-01

    Full Text Available In the modeling of dynamical systems, uncertainties are present and they must be taken into account to improve the prediction of the models. Some strategies have been used to model uncertainties and the aim of this work is to discuss two of those strategies and to compare them. This will be done using the simplest model possible: a two d.o.f. (degrees of freedom dynamical system. A simple system is used because it is very helpful to assure a better understanding and, consequently, comparison of the strategies. The first strategy (called parametric strategy consists in taking each spring stiffness as uncertain and a random variable is associated to each one of them. The second strategy (called nonparametric strategy is more general and considers the whole stiffness matrix as uncertain, and associates a random matrix to it. In both cases, the probability density functions either of the random parameters or of the random matrix are deduced from the Maximum Entropy Principle using only the available information. With this example, some important results can be discussed, which cannot be assessed when complex structures are used, as it has been done so far in the literature. One important element for the comparison of the two strategies is the analysis of the samples spaces and the how to compare them.

  6. Comparative analysis of existing models for power-grid synchronization

    CERN Document Server

    Nishikawa, Takashi

    2015-01-01

    The dynamics of power-grid networks is becoming an increasingly active area of research within the physics and network science communities. The results from such studies are typically insightful and illustrative, but are often based on simplifying assumptions that can be either difficult to assess or not fully justified for realistic applications. Here we perform a comprehensive comparative analysis of three leading models recently used to study synchronization dynamics in power-grid networks -- a fundamental problem of practical significance given that frequency synchronization of all power generators in the same interconnection is a necessary condition for a power grid to operate. We show that each of these models can be derived from first principles within a common framework based on the classical model of a generator, thereby clarifying all assumptions involved. This framework allows us to view power grids as complex networks of coupled second-order phase oscillators with both forcing and damping terms. U...

  7. Treatment tolerance and patient-reported outcomes favor online hemodiafiltration compared to high-flux hemodialysis in the elderly.

    Science.gov (United States)

    Morena, Marion; Jaussent, Audrey; Chalabi, Lotfi; Leray-Moragues, Hélène; Chenine, Leila; Debure, Alain; Thibaudin, Damien; Azzouz, Lynda; Patrier, Laure; Maurice, Francois; Nicoud, Philippe; Durand, Claude; Seigneuric, Bruno; Dupuy, Anne-Marie; Picot, Marie-Christine; Cristol, Jean-Paul; Canaud, Bernard

    2017-03-15

    Large cohort studies suggest that high convective volumes associated with online hemodiafiltration may reduce the risk of mortality/morbidity compared to optimal high-flux hemodialysis. By contrast, intradialytic tolerance is not well studied. The aim of the FRENCHIE (French Convective versus Hemodialysis in Elderly) study was to compare high-flux hemodialysis and online hemodiafiltration in terms of intradialytic tolerance. In this prospective, open-label randomized controlled trial, 381 elderly chronic hemodialysis patients (over age 65) were randomly assigned in a one-to-one ratio to either high-flux hemodialysis or online hemodiafiltration. The primary outcome was intradialytic tolerance (day 30-day 120). Secondary outcomes included health-related quality of life, cardiovascular risk biomarkers, morbidity, and mortality. During the observational period for intradialytic tolerance, 85% and 84% of patients in high-flux hemodialysis and online hemodiafiltration arms, respectively, experienced at least one adverse event without significant difference between groups. As exploratory analysis, intradialytic tolerance was also studied, considering the sessions as a statistical unit according to treatment actually received. Over a total of 11,981 sessions, 2,935 were complicated by the occurrence of at least one adverse event, with a significantly lower occurrence in online hemodiafiltration with fewer episodes of intradialytic symptomatic hypotension and muscle cramps. By contrast, health-related quality of life, morbidity, and mortality were not different in both groups. An improvement in the control of metabolic bone disease biomarkers and β2-microglobulin level without change in serum albumin concentration was observed with online hemodiafiltration. Thus, overall outcomes favor online hemodiafiltration over high-flux hemodialysis in the elderly.

  8. The effects of an intensive behavior and nutrition intervention compared to standard of care on weight outcomes in CF.

    Science.gov (United States)

    Stark, Lori J; Opipari-Arrigan, Lisa; Quittner, Alexandra L; Bean, Judy; Powers, Scott W

    2011-01-01

    Inadequate intake and suboptimal growth are common problems for patients with CF and a critical target for intervention. The purpose of this study was to compare the growth outcomes of children with CF who participated in a randomized clinical trial to improve energy intake and weight to children with CF receiving standard of care during the same time period. Our primary outcome was change in body mass index z-score (BMI z-score) over 2 years. An exploratory outcome was forced expiratory volume at 1-sec (FEV(1) ) over 2 years. Participants were children ages 4-12 with CF, who participated in a randomized clinical trial of behavior plus nutrition intervention versus nutrition education alone, and a matched Comparison Sample receiving standard of care drawn from the Cystic Fibrosis Foundation (CFF) Registry. Children in the Clinical Trial Group (N=67) participated in a 9-week, nutrition intervention and were followed at regular intervals (3, 6, 12, 18, and 24 months) for 2 years post-treatment to obtain anthropometric and pulmonary function data. For each child in the Comparison Sample (N=346), these measures were obtained from the CFF Registry at matching intervals for the 27-month period corresponding to the clinical trial. Over 27 months, children in the Clinical Trial Group (the combined sample of the behavior plus nutrition and the nutrition alone) demonstrated significantly less decline in BMI z-score, -0.05 (SD=0.68, CI= -0.23 to 0.13), as compared to children in the Comparison Sample, -0.21 (SD=0.67, CI= -0.31 to -0.11). No statistically significant differences were found for decline in FEV(1) between children in the Clinical Trial Group and the Comparison Sample. The key implication of these findings is that intensive behavioral and nutritional intervention is effective and needs to be adapted so that it can be broadly disseminated into clinical practice.

  9. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    Science.gov (United States)

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

  10. Comparative analysis of existing models for power-grid synchronization

    Science.gov (United States)

    Nishikawa, Takashi; Motter, Adilson E.

    2015-01-01

    The dynamics of power-grid networks is becoming an increasingly active area of research within the physics and network science communities. The results from such studies are typically insightful and illustrative, but are often based on simplifying assumptions that can be either difficult to assess or not fully justified for realistic applications. Here we perform a comprehensive comparative analysis of three leading models recently used to study synchronization dynamics in power-grid networks—a fundamental problem of practical significance given that frequency synchronization of all power generators in the same interconnection is a necessary condition for a power grid to operate. We show that each of these models can be derived from first principles within a common framework based on the classical model of a generator, thereby clarifying all assumptions involved. This framework allows us to view power grids as complex networks of coupled second-order phase oscillators with both forcing and damping terms. Using simple illustrative examples, test systems, and real power-grid datasets, we study the inherent frequencies of the oscillators as well as their coupling structure, comparing across the different models. We demonstrate, in particular, that if the network structure is not homogeneous, generators with identical parameters need to be modeled as non-identical oscillators in general. We also discuss an approach to estimate the required (dynamical) system parameters that are unavailable in typical power-grid datasets, their use for computing the constants of each of the three models, and an open-source MATLAB toolbox that we provide for these computations.

  11. Tumor characteristics and the clinical outcome of invasive lobular carcinoma compared to infiltrating ductal carcinoma in a Chinese population

    Directory of Open Access Journals (Sweden)

    Cao A-Yong

    2012-07-01

    Full Text Available Abstract Background We sought to compare the baseline demographics, standard pathologic factors and long-term clinical outcomes between ILC and infiltrating ductal carcinoma (IDC using a large database. Methods Clinicopathologic features, overall survival (OS, and recurrence/metastasis-free survival (RFS were compared between 2,202 patients with IDC and 215 patients with ILC. Results ILC was significantly more likely to be associated with a favorable phenotype, but the incidence of contralateral breast cancer was higher for ILC patients than for IDC patients (8.4% vs. 3.9%; P =0.001. The frequencies of recurrence/metastasis (P = 0.980 and death (P = 0.064 were similar among patients with IDC and patients with ILC after adjustment for tumor size and nodal status. The median follow-up was 42.8 months. Conclusions Chinese women with ILCs do not have better clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics, and not on lobular histology.

  12. Prediction of Fetal Hypertrophic Cardiomyopathy in Diabetic Pregnancies Compared with Postnatal Outcome

    Science.gov (United States)

    Elmekkawi, Sherif F.; Mansour, Ghada M.; Elsafty, Mohammed S.E.; Hassanin, Alaa S.; Laban, Mohamed; Elsayed, Heba M.

    2015-01-01

    OBJECTIVE The aim of this study was to estimate the accuracy of prenatal assessment of interventricular septum (IVS) thickness, right myocardial wall thickness (RMWT), and left myocardial wall thickness (LMWT) by two-dimensional (2D) ultrasound for the prediction of perinatal mortality and postnatal diagnosis of hypertrophic cardiomyopathy (HCM) among diabetic pregnant women. SUBJECTS AND METHODS A total of 120 diabetic pregnant women at 35 weeks or more were enrolled in this study from January 1, 2012, to June 30, 2014, at Ain Shams Maternity Hospital, Cairo, Egypt. The 2D ultrasound was done once for all the participants at the time of recruitment; IVS thickness, RMWT, and LMWT were measured. The glycosylated hemoglobin (HbA1c) levels of the participants were recorded. Neonatal assessment including postnatal echocardiography was done after 48 hours. Postnatal results were compared with the prenatal predictive results. RESULTS Higher thickness values for IVS, RMW, and LMW were obtained in the uncontrolled diabetic cases (HbA1c > 6.5%) than in the controlled diabetic cases (HbA1c < 6.5%; P < 0.01). Of the included 120 neonates, 10 (8.3%) were stillborn, 99 (82.5%) had a five-minute Apgar score ≥7, and 4 (3.3%) had a five-minute Apgar score ≤3. The four neonates with severe neonatal distress died after admission to neonatal intensive care unit within one week after delivery. Out of 110 live-born neonates, 4 (3.6%) neonates had a low ejection fraction (EF) (<50%) due to HCM; of them 2 (1.8%) died within one week after delivery, while 2 (1.8%) survived. Another two (1.8%) neonates died from severe respiratory distress syndrome. A cutoff value of ≥4.5 mm for prenatal IVS thickness was predictive of neonatal distress due to HCM with a sensitivity of 82%, specificity of 68%, and diagnostic accuracy of 72%. A cutoff value of <1.18 for the ratio of IVS thickness to LMWT had a sensitivity of 82%, specificity of 72%, and diagnostic accuracy of 74% for the prediction of

  13. The Chicago Parent Program: comparing 1-year outcomes for African American and Latino parents of young children.

    Science.gov (United States)

    Breitenstein, Susan M; Gross, Deborah; Fogg, Louis; Ridge, Alison; Garvey, Christine; Julion, Wrenetha; Tucker, Sharon

    2012-10-01

    Data were merged from two prevention randomized trials testing 1-year outcomes of a parenting skills program, the Chicago Parent Program (CPP) and comparing its effects for African-American (n = 291) versus Latino (n = 213) parents and their preschool children. Compared to controls, intervention parents had improved self-efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent-report, teacher-report, and observation. Although improvements from the CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their children's behavior and in parenting self-efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low-income urban communities.

  14. Saccharomyces cerevisiae as a model organism: a comparative study.

    Directory of Open Access Journals (Sweden)

    Hiren Karathia

    Full Text Available BACKGROUND: Model organisms are used for research because they provide a framework on which to develop and optimize methods that facilitate and standardize analysis. Such organisms should be representative of the living beings for which they are to serve as proxy. However, in practice, a model organism is often selected ad hoc, and without considering its representativeness, because a systematic and rational method to include this consideration in the selection process is still lacking. METHODOLOGY/PRINCIPAL FINDINGS: In this work we propose such a method and apply it in a pilot study of strengths and limitations of Saccharomyces cerevisiae as a model organism. The method relies on the functional classification of proteins into different biological pathways and processes and on full proteome comparisons between the putative model organism and other organisms for which we would like to extrapolate results. Here we compare S. cerevisiae to 704 other organisms from various phyla. For each organism, our results identify the pathways and processes for which S. cerevisiae is predicted to be a good model to extrapolate from. We find that animals in general and Homo sapiens in particular are some of the non-fungal organisms for which S. cerevisiae is likely to be a good model in which to study a significant fraction of common biological processes. We validate our approach by correctly predicting which organisms are phenotypically more distant from S. cerevisiae with respect to several different biological processes. CONCLUSIONS/SIGNIFICANCE: The method we propose could be used to choose appropriate substitute model organisms for the study of biological processes in other species that are harder to study. For example, one could identify appropriate models to study either pathologies in humans or specific biological processes in species with a long development time, such as plants.

  15. Determinants of Students' Outcome: A Full-Fledged Structural Equation Modelling Approach

    Science.gov (United States)

    Musah, Mohammed Borhandden; Ali, Hairuddin Bin Mohd; Al-Hudawi, Shafeeq Hussain Vazhathodi; Tahir, Lokman Mohd; Daud, Khadijah Binti; Hamdan, Abdul Rahim

    2015-01-01

    The vibrant demand for academic excellence in the twenty-first century has brought diverse determinants of students' outcome into play. However, few studies have validated the instruments and examined the mediating effect between exogenous and endogenous variables of the student outcome model. This study, therefore, investigates the psychometric…

  16. Determinants of Students' Outcome: A Full-Fledged Structural Equation Modelling Approach

    Science.gov (United States)

    Musah, Mohammed Borhandden; Ali, Hairuddin Bin Mohd; Al-Hudawi, Shafeeq Hussain Vazhathodi; Tahir, Lokman Mohd; Daud, Khadijah Binti; Hamdan, Abdul Rahim

    2015-01-01

    The vibrant demand for academic excellence in the twenty-first century has brought diverse determinants of students' outcome into play. However, few studies have validated the instruments and examined the mediating effect between exogenous and endogenous variables of the student outcome model. This study, therefore, investigates the psychometric…

  17. COMPARATIVE STUDY ON MAIN SOLVENCY ASSESSMENT MODELS FOR INSURANCE FIELD

    Directory of Open Access Journals (Sweden)

    Daniela Nicoleta SAHLIAN

    2015-07-01

    Full Text Available During the recent financial crisis of insurance domain, there were imposed new aspects that have to be taken into account concerning the risks management and surveillance activity. The insurance societies could develop internal models in order to determine the minimum capital requirement imposed by the new regulations that are to be adopted on 1 January 2016. In this respect, the purpose of this research paper is to offer a real presentation and comparing with the main solvency regulation systems used worldwide, the accent being on their common characteristics and current tendencies. Thereby, we would like to offer a better understanding of the similarities and differences between the existent solvency regimes in order to develop the best regime of solvency for Romania within the Solvency II project. The study will show that there are clear differences between the existent Solvency I regime and the new approaches based on risk and will also point out the fact that even the key principles supporting the new solvency regimes are convergent, there are a lot of approaches for the application of these principles. In this context, the question we would try to find the answer is "how could the global solvency models be useful for the financial surveillance authority of Romania for the implementation of general model and for the development of internal solvency models according to the requirements of Solvency II" and "which would be the requirements for the implementation of this type of approach?". This thing makes the analysis of solvency models an interesting exercise.

  18. Comparative Study of MHD Modeling of the Background Solar Wind

    CERN Document Server

    Gressl, C; Temmer, M; Odstrcil, D; Linker, J A; Mikic, Z; Riley, P

    2013-01-01

    Knowledge about the background solar wind plays a crucial role in the framework of space weather forecasting. In-situ measurements of the background solar wind are only available for a few points in the heliosphere where spacecraft are located, therefore we have to rely on heliospheric models to derive the distribution of solar wind parameters in interplanetary space. We test the performance of different solar wind models, namely Magnetohydrodynamic Algorithm outside a Sphere/ENLIL (MAS/ENLIL), Wang-Sheeley-Arge/ENLIL (WSA/ENLIL), and MAS/MAS, by comparing model results with in-situ measurements from spacecraft located at 1 AU distance to the Sun (ACE, Wind). To exclude the influence of interplanetary coronal mass ejections (ICMEs), we chose the year 2007 as a time period with low solar activity for our comparison. We found that the general structure of the background solar wind is well reproduced by all models. The best model results were obtained for the parameter solar wind speed. However, the predicted ar...

  19. Decision Analysis Modelling of Costs and Outcomes following Cefepime Monotherapy in Canada

    Directory of Open Access Journals (Sweden)

    Michael T Halpern

    1997-01-01

    Full Text Available OBJECTIVE: To evaluate the comparative cost of treatment and intermediate outcomes (percentage resistant organisms, days in hospital, etc among cefepime and alternative parenteral antibiotics used for empiric monotherapy.

  20. Dinucleotide controlled null models for comparative RNA gene prediction

    Directory of Open Access Journals (Sweden)

    Gesell Tanja

    2008-05-01

    Full Text Available Abstract Background Comparative prediction of RNA structures can be used to identify functional noncoding RNAs in genomic screens. It was shown recently by Babak et al. [BMC Bioinformatics. 8:33] that RNA gene prediction programs can be biased by the genomic dinucleotide content, in particular those programs using a thermodynamic folding model including stacking energies. As a consequence, there is need for dinucleotide-preserving control strategies to assess the significance of such predictions. While there have been randomization algorithms for single sequences for many years, the problem has remained challenging for multiple alignments and there is currently no algorithm available. Results We present a program called SISSIz that simulates multiple alignments of a given average dinucleotide content. Meeting additional requirements of an accurate null model, the randomized alignments are on average of the same sequence diversity and preserve local conservation and gap patterns. We make use of a phylogenetic substitution model that includes overlapping dependencies and site-specific rates. Using fast heuristics and a distance based approach, a tree is estimated under this model which is used to guide the simulations. The new algorithm is tested on vertebrate genomic alignments and the effect on RNA structure predictions is studied. In addition, we directly combined the new null model with the RNAalifold consensus folding algorithm giving a new variant of a thermodynamic structure based RNA gene finding program that is not biased by the dinucleotide content. Conclusion SISSIz implements an efficient algorithm to randomize multiple alignments preserving dinucleotide content. It can be used to get more accurate estimates of false positive rates of existing programs, to produce negative controls for the training of machine learning based programs, or as standalone RNA gene finding program. Other applications in comparative genomics that require

  1. The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study.

    Science.gov (United States)

    Levic, K; Bulut, O; Hesselfeldt, P; Bülow, S

    2013-08-01

    Transanal endoscopic microsurgery (TEM) allows locally complete resection of early rectal cancer as an alternative to conventional radical surgery. In case of unfavourable histology after TEM, or positive resection margins, salvage surgery can be performed. However, it is unclear if the results are equivalent to primary treatment with total mesorectal excision (TME). The aim of this retrospective study was to determine whether there is a difference in outcome between patients who underwent early salvage resection with TME after TEM, and those who underwent primary TME for rectal cancer. From 1997 to 2011, early salvage surgery with TME after TEM was performed in 25 patients in our institution. These patients were compared with 25 patients who underwent primary TME, matched according to gender, age (±2 years), cancer stage and operative procedure. Data were obtained from the patients' charts and reviewed retrospectively. No patients received preoperative chemotherapy. Perioperative data and oncological outcome were analysed. The Mann-Whitney U-test and Fisher's exact test were used to compare the results between the two groups. There was no significant difference between the two groups in median operating time (P = 0.39), median blood loss (P = 0.19) or intraoperative complications (P = 1.00). The 30-day mortality was 8 % (n = 2) among patients who underwent salvage TME after TEM, and no patients died in the primary TME group (P = 0.49). There was no significant difference between two groups of patients in the median number of harvested lymph nodes (P = 0.34), median circumferential resection margin (CRM) (P = 0.99) or the completeness of the mesorectal fascia plane. No local recurrences occurred among the patients with salvage TME, and there were 2 patients (8 %) with local recurrences among the patients with primary TME (P = 0.49). Distant metastasis occurred in one patient (4 %) after salvage TME and in 3 patients (12 %) with primary TME (P = 0.61). The median

  2. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

    Directory of Open Access Journals (Sweden)

    Fischer Michael

    2007-03-01

    Full Text Available Abstract Background The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting. Methods The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8, Germany (8, the Netherlands (7, Russia (6, Spain (6, Ukraine (4, United Kingdom (10 and the USA (8 and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy. Results Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H and 720 conventional (C treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing. In the per-protocol set (H: 576 and C: 540 patients similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019. Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5% and adults (H: 85.6%; C: 86.6%. The unadjusted odds ratio (OR of the primary outcome criterion was 1.40 (0.89–2.22 in children and 0.92 (0.63–1.34 in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic

  3. Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy.

    Science.gov (United States)

    Shamali, Awad; De'Ath, Henry D; Jaber, Bashar; Abuawad, Mahmoud; Barbaro, Salvatore; Hamaday, Zaed; Abu Hilal, Mohammad

    2017-09-01

    Outcomes following pancreaticoduodenectomy (PD) in elderly patients in the United Kingdom (UK) remain uncertain. This study aimed to analyse peri-operative outcomes in the elderly, and investigate the impact of age on five-year survival following PD in a UK tertiary centre. All patients who underwent PD in a single Hepatobiliary and Pancreatic unit in the UK between January 2007 to December 2015 were analysed from a prospectively collected database. Individuals were divided into two groups (Group A years and Group B ≥ 75 years "elderly") and outcomes compared. Five hundred and twenty-four patients were included (Group A n = 422, Group B n = 102). Post-operative cardiac events and peri-operative mortality were higher in the elderly (10.8 vs 3.6%, p = 0.008 and 5.9 vs 1.9%, 0.037, respectively). Multivariate analysis revealed only ASA score (OR 0.279, 95% CI 0.063-1.130), post-pancreatectomy haemorrhage (OR 0.055, 95% CI 0.006-0.518) and pulmonary embolism (OR 0.03, 95% CI 0.00-0.148) as independent risk factors for peri-operative mortality. Age was not (OR 0.978, 95% CI 0.911-1.049). Median survival was 22 months in Group A and 19 months in Group B (p = 0.165). Predictors of five-year survival included vascular resection (OR 0.171, 95% CI 0.053-0.549), positive margin (OR 0.256, 95% CI 0.102-0.641), lympho-vascular invasion (OR 0.392, 95% CI 0.160-0.958) and lymph node ratio (OR 67.381, 95% CI 3.301-1375.586), but not age (OR 1.012, 95% CI 0.972-1.054). Older patients have similar peri-operative outcomes and five-year survival compared to younger counterparts after PD in a UK tertiary centre, and should be considered for surgical resection of pancreatic and periampullary cancers. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Comparative Modelling of the Spectra of Cool Giants

    Science.gov (United States)

    Lebzelter, T.; Heiter, U.; Abia, C.; Eriksson, K.; Ireland, M.; Neilson, H.; Nowotny, W; Maldonado, J; Merle, T.; Peterson, R.; hide

    2012-01-01

    Our ability to extract information from the spectra of stars depends on reliable models of stellar atmospheres and appropriate techniques for spectral synthesis. Various model codes and strategies for the analysis of stellar spectra are available today. Aims. We aim to compare the results of deriving stellar parameters using different atmosphere models and different analysis strategies. The focus is set on high-resolution spectroscopy of cool giant stars. Methods. Spectra representing four cool giant stars were made available to various groups and individuals working in the area of spectral synthesis, asking them to derive stellar parameters from the data provided. The results were discussed at a workshop in Vienna in 2010. Most of the major codes currently used in the astronomical community for analyses of stellar spectra were included in this experiment. Results. We present the results from the different groups, as well as an additional experiment comparing the synthetic spectra produced by various codes for a given set of stellar parameters. Similarities and differences of the results are discussed. Conclusions. Several valid approaches to analyze a given spectrum of a star result in quite a wide range of solutions. The main causes for the differences in parameters derived by different groups seem to lie in the physical input data and in the details of the analysis method. This clearly shows how far from a definitive abundance analysis we still are.

  5. A New Method of Comparing Forcing Agents in Climate Models

    Energy Technology Data Exchange (ETDEWEB)

    Kravitz, Benjamin S.; MacMartin, Douglas; Rasch, Philip J.; Jarvis, Andrew

    2015-10-14

    We describe a new method of comparing different climate forcing agents (e.g., CO2, CH4, and solar irradiance) that avoids many of the ambiguities introduced by temperature-related climate feedbacks. This is achieved by introducing an explicit feedback loop external to the climate model that adjusts one forcing agent to balance another while keeping global mean surface temperature constant. Compared to current approaches, this method has two main advantages: (i) the need to define radiative forcing is bypassed and (ii) by maintaining roughly constant global mean temperature, the effects of state dependence on internal feedback strengths are minimized. We demonstrate this approach for several different forcing agents and derive the relationships between these forcing agents in two climate models; comparisons between forcing agents are highly linear in concordance with predicted functional forms. Transitivity of the relationships between the forcing agents appears to hold within a wide range of forcing. The relationships between the forcing agents obtained from this method are consistent across both models but differ from relationships that would be obtained from calculations of radiative forcing, highlighting the importance of controlling for surface temperature feedback effects when separating radiative forcing and climate response.

  6. Ionospheric topside models compared with experimental electron density profiles

    Directory of Open Access Journals (Sweden)

    S. M. Radicella

    2005-06-01

    Full Text Available Recently an increasing number of topside electron density profiles has been made available to the scientific community on the Internet. These data are important for ionospheric modeling purposes, since the experimental information on the electron density above the ionosphere maximum of ionization is very scarce. The present work compares NeQuick and IRI models with the topside electron density profiles available in the databases of the ISIS2, IK19 and Cosmos 1809 satellites. Experimental electron content from the F2 peak up to satellite height and electron densities at fixed heights above the peak have been compared under a wide range of different conditions. The analysis performed points out the behavior of the models and the improvements needed to be assessed to have a better reproduction of the experimental results. NeQuick topside is a modified Epstein layer, with thickness parameter determined by an empirical relation. It appears that its performance is strongly affected by this parameter, indicating the need for improvements of its formulation. IRI topside is based on Booker's approach to consider two parts with constant height gradients. It appears that this formulation leads to an overestimation of the electron density in the upper part of the profiles, and overestimation of TEC.

  7. Comparing Productivity Simulated with Inventory Data Using Different Modelling Technologies

    Science.gov (United States)

    Klopf, M.; Pietsch, S. A.; Hasenauer, H.

    2009-04-01

    The Lime Stone National Park in Austria was established in 1997 to protect sensible lime stone soils from degradation due to heavy forest management. Since 1997 the management activities were successively reduced and standing volume and coarse woody debris (CWD) increased and degraded soils began to recover. One option to study the rehabilitation process towards natural virgin forest state is the use of modelling technology. In this study we will test two different modelling approaches for their applicability to Lime Stone National Park. We will compare standing tree volume simulated resulting from (i) the individual tree growth model MOSES, and (ii) the species and management sensitive adaptation of the biogeochemical-mechanistic model Biome-BGC. The results from the two models are compared with filed observations form repeated permanent forest inventory plots of the Lime Stone National Park in Austria. The simulated CWD predictions of the BGC-model were compared with dead wood measurements (standing and lying dead wood) recorded at the permanent inventory plots. The inventory was established between 1994 and 1996 and remeasured from 2004 to 2005. For this analysis 40 plots of this inventory were selected which comprise the required dead wood components and are dominated by a single tree species. First we used the distance dependant individual tree growth model MOSES to derive the standing timber and the amount of mortality per hectare. MOSES is initialized with the inventory data at plot establishment and each sampling plot is treated as forest stand. The Biome-BGC is a process based biogeochemical model with extensions for Austrian tree species, a self initialization and a forest management tool. The initialization for the actual simulations with the BGC model was done as follows: We first used spin up runs to derive a balanced forest vegetation, similar to an undisturbed forest. Next we considered the management history of the past centuries (heavy clear cuts

  8. Do Medicare Advantage enrollees tend to be admitted to hospitals with better or worse outcomes compared with fee-for-service enrollees?

    Science.gov (United States)

    Friedman, Bernard; Jiang, H Joanna

    2010-06-01

    The hospitals selected by or for Medicare beneficiaries might depend on whether the patient is enrolled in a Medicare Advantage (MA) plan. A theoretical model of profit maximization by MA plans takes into account the tradeoffs of consumer preferences for annual premium versus outcomes of care in the hospital and other attributes of the plan. Hospital discharge databases for 13 states in 2006, maintained by the Agency for Healthcare Research and Quality, are the main source of data. Risk-adjusted mortality rates are available for all non-maternity adult patients in each of 15 clinical categories in about 1,500 hospitals. All-adult postoperative safety event rates covering 9 categories of events are calculated for surgical cases in about 900 hospitals. Instrumental variables are used to address potential endogeneity of the choice of a MA plan. The key findings are these: enrollees in MA plans tend to be treated in hospitals with lower resource cost and higher risk-adjusted mortality compared to Fee-for-Service (FFS) enrollees. The risk-adjusted mortality measure is about 1.5 percentage points higher for MA plan enrollees than the overall mean of 4%. However, the rate of safety events in surgical patients favors MA plan enrollees--the rate is 1 percentage point below the average of 3.5%. These discrepant results are noteworthy and are plausibly due to greater discretion by the health plan in approving patients for elective surgery and as well as selecting hospitals for surgical patients. Emergency patients are generally excluded for the safety outcome measures. In addition, the current mortality measures may not adequately represent all surgical patients. Such caveats should be prominently highlighted when presenting comparative data. With that proviso, the study justifies informing Medicare beneficiaries about the mortality and safety outcome measures for hospitals being used by a MA plan compared to hospitals used by FFS enrollees.

  9. Mental and Physical Health Outcomes in Parents of Children with Burn Injuries as Compared with Matched Controls.

    Science.gov (United States)

    Enns, Jessica; Gawaziuk, Justin P; Khan, Sazzadul; Chateau, Dan; Bolton, James M; Sareen, Jitender; Stone, James; Doupe, Malcolm; Logsetty, Sarvesh

    2016-01-01

    Pediatric burn injuries are common, and the stress of caring for them can affect caregivers' health. This study's objective was to examine the rates of common mental and physical disorders of parents of burn-injured children (cases) compared with matched controls (controls). This is a population-based study linking the Regional Pediatric burn registry with administrative health information. Pediatric burn cases were matched 1:5 with control children from the general population based on age, sex, and geographical location then parents identified. One thousand and twenty-six parental cases and 4858 controls were identified. International Classification of Disease codes were used to identify diagnoses of common mental and physical disorders. Using rates of disease 2 years before and 2 years after the date of burn, the changes in the relative rates of health outcomes were compared between the cases and the controls. The cases had higher rates of postinjury mental and physical illness compared with the matches. However, it was found that controls also had increased rates postindex date and additionally cases had increased rates of preinjury illnesses. There was no difference in the relative rates of illnesses between the groups from pre- to post-index date. The higher rate of illness in cases postinjury could be explained by preinjury illness, and similar rate increases in the control cohort. Evaluation of the effect of a child's burn injury on parents should take into context the preexisting health of the parent. Socioeconomic factors associated with increased risk of burns may also be associated with adverse health outcomes.

  10. Comparative dynamic analysis of the full Grossman model.

    Science.gov (United States)

    Ried, W

    1998-08-01

    The paper applies the method of comparative dynamic analysis to the full Grossman model. For a particular class of solutions, it derives the equations implicitly defining the complete trajectories of the endogenous variables. Relying on the concept of Frisch decision functions, the impact of any parametric change on an endogenous variable can be decomposed into a direct and an indirect effect. The focus of the paper is on marginal changes in the rate of health capital depreciation. It also analyses the impact of either initial financial wealth or the initial stock of health capital. While the direction of most effects remains ambiguous in the full model, the assumption of a zero consumption benefit of health is sufficient to obtain a definite for any direct or indirect effect.

  11. A model of global citizenship: antecedents and outcomes.

    Science.gov (United States)

    Reysen, Stephen; Katzarska-Miller, Iva

    2013-01-01

    As the world becomes increasingly interconnected, exposure to global cultures affords individuals opportunities to develop global identities. In two studies, we examine the antecedents and outcomes of identifying with a superordinate identity--global citizen. Global citizenship is defined as awareness, caring, and embracing cultural diversity while promoting social justice and sustainability, coupled with a sense of responsibility to act. Prior theory and research suggest that being aware of one's connection with others in the world (global awareness) and embedded in settings that value global citizenship (normative environment) lead to greater identification with global citizens. Furthermore, theory and research suggest that when global citizen identity is salient, greater identification is related to adherence to the group's content (i.e., prosocial values and behaviors). Results of the present set of studies showed that global awareness (knowledge and interconnectedness with others) and one's normative environment (friends and family support global citizenship) predicted identification with global citizens, and global citizenship predicted prosocial values of intergroup empathy, valuing diversity, social justice, environmental sustainability, intergroup helping, and a felt responsibility to act for the betterment of the world. The relationship between antecedents (normative environment and global awareness) and outcomes (prosocial values) was mediated by identification with global citizens. We discuss the relationship between the present results and other research findings in psychology, the implications of global citizenship for other academic domains, and future avenues of research. Global citizenship highlights the unique effect of taking a global perspective on a multitude of topics relevant to the psychology of everyday actions, environments, and identity.

  12. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland

    Science.gov (United States)

    Sahanne, Sari; Tuuminen, Raimo; Haukka, Jari; Loukovaara, Sirpa

    2017-01-01

    Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV). Methods This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively. Results Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures. Conclusion PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD. PMID:28331284

  13. Comparing theoretical models of our galaxy with observations

    Directory of Open Access Journals (Sweden)

    Johnston K.V.

    2012-02-01

    Full Text Available With the advent of large scale observational surveys to map out the stars in our galaxy, there is a need for an efficient tool to compare theoretical models of our galaxy with observations. To this end, we describe here the code Galaxia, which uses efficient and fast algorithms for creating a synthetic survey of the Milky Way, and discuss its uses. Given one or more observational constraints like the color-magnitude bounds, a survey size and geometry, Galaxia returns a catalog of stars in accordance with a given theoretical model of the Milky Way. Both analytic and N-body models can be sampled by Galaxia. For N-body models, we present a scheme that disperses the stars spawned by an N-body particle, in such a way that the phase space density of the spawned stars is consistent with that of the N-body particles. The code is ideally suited to generating synthetic data sets that mimic near future wide area surveys such as GAIA, LSST and HERMES. In future, we plan to release the code publicly at http://galaxia.sourceforge.net. As an application of the code, we study the prospect of identifying structures in the stellar halo with future surveys that will have velocity information about the stars.

  14. Excision Versus Fixation of the Radial Head: A Comparative Study of the Functional Outcomes of the Two Techniques

    Science.gov (United States)

    Shetty, Sanath Kumar; Shetty, Ashwin; Balan, Bijith; Rai, H.Ravindranath; Hegde, Anoop

    2017-01-01

    Introduction The management of displaced and comminuted radial head fractures has been a matter of debate amongst surgeons for many years. Radial head excision formed the mainstay of surgical management of these injuries. Over the years, there have been improvements in the surgical techniques and availability of better implants and instrumentation techniques, hence, open reduction and internal fixation of these fractures is gaining popularity. Aim To compare the outcome of elbow function between radial head excision and open reduction and internal fixation of the radial head with mini screws of Mason Type II and Type III radial head fractures and to assess the complications that occur in both techniques. Materials and Methods A prospective study was conducted in the Department of Orthopaedic Surgery of Justice K.S.Hegde Charitable hospital. A total of 40 patients between the age group of 30-50 years with Mason Type II and Type III fresh closed radial head fractures were included in the study. Group I consisted of 20 patients who underwent radial head excision and Group II consisted of 20 patients who underwent open reduction and internal fixation with mini screws. Patients were reviewed at postoperative week 3, 6 and 24. Radiographs were taken and functional outcome assessment of the elbow was done during all the follow ups. Elbow physiotherapy was started on postoperative week three. Scoring of elbow function was done as per the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. Results were tabulated, compared and analysed statistically using the ‘chi-square test’. Results At the end of six months, the patients of the open reduction and internal fixation group had lower DASH scores (4.82±2.73 points) than the radial head excision group (14.23±5.60 points). This inferred that patients who underwent open reduction and internal fixation had better functional outcomes than the excision group. Complications of proximal radial migration was noted

  15. Semiparametric Bayesian joint modeling of a binary and continuous outcome with applications in toxicological risk assessment.

    Science.gov (United States)

    Hwang, Beom Seuk; Pennell, Michael L

    2014-03-30

    Many dose-response studies collect data on correlated outcomes. For example, in developmental toxicity studies, uterine weight and presence of malformed pups are measured on the same dam. Joint modeling can result in more efficient inferences than independent models for each outcome. Most methods for joint modeling assume standard parametric response distributions. However, in toxicity studies, it is possible that response distributions vary in location and shape with dose, which may not be easily captured by standard models. To address this issue, we propose a semiparametric Bayesian joint model for a binary and continuous response. In our model, a kernel stick-breaking process prior is assigned to the distribution of a random effect shared across outcomes, which allows flexible changes in distribution shape with dose shared across outcomes. The model also includes outcome-specific fixed effects to allow different location effects. In simulation studies, we found that the proposed model provides accurate estimates of toxicological risk when the data do not satisfy assumptions of standard parametric models. We apply our method to data from a developmental toxicity study of ethylene glycol diethyl ether.

  16. Modeling and comparative study of fluid velocities in heterogeneous rocks

    Science.gov (United States)

    Hingerl, Ferdinand F.; Romanenko, Konstantin; Pini, Ronny; Balcom, Bruce; Benson, Sally

    2013-04-01

    Detailed knowledge of the distribution of effective porosity and fluid velocities in heterogeneous rock samples is crucial for understanding and predicting spatially resolved fluid residence times and kinetic reaction rates of fluid-rock interactions. The applicability of conventional MRI techniques to sedimentary rocks is limited by internal magnetic field gradients and short spin relaxation times. The approach developed at the UNB MRI Centre combines the 13-interval Alternating-Pulsed-Gradient Stimulated-Echo (APGSTE) scheme and three-dimensional Single Point Ramped Imaging with T1 Enhancement (SPRITE). These methods were designed to reduce the errors due to effects of background gradients and fast transverse relaxation. SPRITE is largely immune to time-evolution effects resulting from background gradients, paramagnetic impurities and chemical shift. Using these techniques quantitative 3D porosity maps as well as single-phase fluid velocity fields in sandstone core samples were measured. Using a new Magnetic Resonance Imaging technique developed at the MRI Centre at UNB, we created 3D maps of porosity distributions as well as single-phase fluid velocity distributions of sandstone rock samples. Then, we evaluated the applicability of the Kozeny-Carman relationship for modeling measured fluid velocity distributions in sandstones samples showing meso-scale heterogeneities using two different modeling approaches. The MRI maps were used as reference points for the modeling approaches. For the first modeling approach, we applied the Kozeny-Carman relationship to the porosity distributions and computed respective permeability maps, which in turn provided input for a CFD simulation - using the Stanford CFD code GPRS - to compute averaged velocity maps. The latter were then compared to the measured velocity maps. For the second approach, the measured velocity distributions were used as input for inversely computing permeabilities using the GPRS CFD code. The computed

  17. Rodent models of cardiopulmonary bypass: utility in improving perioperative outcomes

    NARCIS (Netherlands)

    de Lange, F.

    2008-01-01

    Despite advances in surgical and anesthesia techniques, subtle neurologic injury still remains an important complication after cardiac surgery. Because the causes are multifactorial and complex, research in an appropriate small animal model for cardiopulmonary bypass (CPB) is warranted. This thesis

  18. Greater expectations: using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response.

    Science.gov (United States)

    Price, Matthew; Anderson, Page; Henrich, Christopher C; Rothbaum, Barbara Olasov

    2008-12-01

    A client's expectation that therapy will be beneficial has long been considered an important factor contributing to therapeutic outcomes, but recent empirical work examining this hypothesis has primarily yielded null findings. The present study examined the contribution of expectancies for treatment outcome to actual treatment outcome from the start of therapy through 12-month follow-up in a clinical sample of individuals (n=72) treated for fear of flying with either in vivo exposure or virtual reality exposure therapy. Using a piecewise hierarchical linear model, outcome expectancy predicted treatment gains made during therapy but not during follow-up. Compared to lower levels, higher expectations for treatment outcome yielded stronger rates of symptom reduction from the beginning to the end of treatment on 2 standardized self-report questionnaires on fear of flying. The analytic approach of the current study is one potential reason that findings contrast with prior literature. The advantages of using hierarchical linear modeling to assess interindividual differences in longitudinal data are discussed.

  19. Matched unrelated donor allogeneic transplantation provides comparable long-term outcome to HLA-identical sibling transplantation in relapsed diffuse large B-cell lymphoma

    NARCIS (Netherlands)

    Avivi, I.; Canals, C.; Vernant, J.P.; Wulf, G.; Nagler, A.; Hermine, O.; Petersen, E.; Yakoub-Agha, I.; Craddock, C.; Schattenberg, A.V.; Niederwieser, D.; Thomson, K.; Blaise, D.; Attal, M.; Pfreundschuh, M.; Passweg, J.; Russell, N.; Dreger, P.; Sureda, A.

    2014-01-01

    The objective of this retrospective analysis was to compare outcomes of patients with diffuse large B-cell lymphoma (DLBCL) who received either a matched sibling (sib) or an unrelated donor (URD) allogeneic hematopoietic cell transplantation (allo-HCT). Long-term outcome of 172 DLBCL patients receiv

  20. Mental health and developmental outcomes for children born after ART: a comparative prospective study on child gender and treatment type.

    Science.gov (United States)

    Punamäki, Raija-Leena; Tiitinen, Aila; Lindblom, Jallu; Unkila-Kallio, Leila; Flykt, Marjo; Vänskä, Mervi; Poikkeus, Piia; Tulppala, Maija

    2016-01-01

    Do children born after assisted reproductive techniques (ART; IVF/ICSI) display more mental health issues or social and cognitive developmental problems at 7-8 years than naturally conceived (NC) controls, and does child gender play a role? ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls, but some gender-specific differences do exist. Systematic reviews have not found any evidence of delays in neurocognitive or sensorimotor development in ART children. However findings on the effect of the type of ART treatment (IVF versus ICSI) on the offspring's physical and mental development have not been uniform. Knowledge of the role of child gender in ART research is scarce. This prospective follow-up study compares mental health and social and cognitive developmental problems between 7-8-year-old ART and NC children, controlling for the father's age, length of the parents' partnership, mother's parity, child's gestational age, and the need of neonatal intensive care unit (NICU). Further, within the ART group, we analysed whether the treatment type (IVF versus ICSI) and the child's gender are associated with the mental health and developmental outcomes. In this study, 255 singleton ART children (IVF and ICSI) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms, and social (social skills and peer relations) and cognitive development (executive functioning, perception, memory, and language). Within the ART group, 164 IVF and 76 ICSI children were compared on the same outcomes. Statistics included analyses of covariates (ANCOVA) with group main effects, group and gender interaction effects, and Bonferroni post hoc tests. ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems (Group main effects, P > 0.05), but gender-specific group differences

  1. Addressing Missing Data in Patient-Reported Outcome Measures (PROMS): Implications for the Use of PROMS for Comparing Provider Performance.

    Science.gov (United States)

    Gomes, Manuel; Gutacker, Nils; Bojke, Chris; Street, Andrew

    2016-05-01

    Patient-reported outcome measures (PROMs) are now routinely collected in the English National Health Service and used to compare and reward hospital performance within a high-powered pay-for-performance scheme. However, PROMs are prone to missing data. For example, hospitals often fail to administer the pre-operative questionnaire at hospital admission, or patients may refuse to participate or fail to return their post-operative questionnaire. A key concern with missing PROMs is that the individuals with complete information tend to be an unrepresentative sample of patients within each provider and inferences based on the complete cases will be misleading. This study proposes a strategy for addressing missing data in the English PROM survey using multiple imputation techniques and investigates its impact on assessing provider performance. We find that inferences about relative provider performance are sensitive to the assumptions made about the reasons for the missing data.

  2. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

    DEFF Research Database (Denmark)

    McCloy, R.; Randall, D.; Schug, S.A.;

    2008-01-01

    cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p ... using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other...... patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. RESULTS: Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared...

  3. Comparing models of star formation simulating observed interacting galaxies

    Science.gov (United States)

    Quiroga, L. F.; Muñoz-Cuartas, J. C.; Rodrigues, I.

    2017-07-01

    In this work, we make a comparison between different models of star formation to reproduce observed interacting galaxies. We use observational data to model the evolution of a pair of galaxies undergoing a minor merger. Minor mergers represent situations weakly deviated from the equilibrium configuration but significant changes in star fomation (SF) efficiency can take place, then, minor mergers provide an unique scene to study SF in galaxies in a realistic but yet simple way. Reproducing observed systems also give us the opportunity to compare the results of the simulations with observations, which at the end can be used as probes to characterize the models of SF implemented in the comparison. In this work we compare two different star formation recipes implemented in Gadget3 and GIZMO codes. Both codes share the same numerical background, and differences arise mainly in the star formation recipe they use. We use observations from Pico dos Días and GEMINI telescopes and show how we use observational data of the interacting pair in AM2229-735 to characterize the interacting pair. Later we use this information to simulate the evolution of the system to finally reproduce the observations: Mass distribution, morphology and main features of the merger-induced star formation burst. We show that both methods manage to reproduce roughly the star formation activity. We show, through a careful study, that resolution plays a major role in the reproducibility of the system. In that sense, star formation recipe implemented in GIZMO code has shown a more robust performance. Acknowledgements: This work is supported by Colciencias, Doctorado Nacional - 617 program.

  4. The comparative study of the outcomes of early and late oral feeding in intestinal anastomosis surgeries in children

    Directory of Open Access Journals (Sweden)

    Omid Amanollahi

    2013-01-01

    Full Text Available Background: A leakage of intestinal anastomosis is typically regarded as a devastating post-operative complication. Traditionally its believed that long fasting after intestinal surgery protect anastomosis site and most surgeons applied this method. Post-operative long fasting has many physical and mental adverse effects, especially in children, but its benefit has not proven yet. This study aimed to compare the outcomes of early and late oral feeding in intestinal resection and anastomosis surgery in children. Patients and Methods: This randomized, double-blind controlled trial evaluated the outcome of early-feeding following in children aged 1 month to 12 years who underwent intestinal resection and anastomosis and compared the results with those who had late-feeding. The results were anlysed for fever, nausea and vomiting, abdominal distension, first passage of gas and stool were also evaluated hospital stay time, major post-operative complications such as anastomosis leakage, wound infection or dehiscence, intra-abdominal abscess between the two groups. Results: The mean time of first oral feeding in the early feeding group (study group was 2.5 ± 0.7 days but it was 5.3 ± 0.6 days in the late feeding group (control group. There was no mortality in both groups. There was no difference in major complications in both groups (anastomosis leakage. In the study group, first defecation time was shorter than the control group (3.7 days v. 4.4 days and they had less hospital stay also (5.2 days vs. 8.3 days and lower cost of hospitalization. Conclusion: Early oral feeding after intestinal resection and anastomosis in children is a safe method, it has many benefits and does not increase the major or minor post-operative complications (anastomosis leakage long time fasting is not necessary and has not any beneficial effect and early feeding increases satisfaction of the parents and children, and reduce hospital stay and costs.

  5. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes.

    Science.gov (United States)

    Kelsall, Jennett E; McCulley, Stephen J; Brock, Lisa; Akerlund, Malin T E; Macmillan, R Douglas

    2017-10-01

    Oncoplastic breast conserving surgery (OBCS) allows women who may otherwise have mastectomy and immediate reconstruction (MxIR) the choice to conserve their breast yet avoid deformity. We compared the outcome of these options. Two cohorts meeting study criteria were identified from prospectively audited series of women undergoing OBCS or MxIR. After case matching for age, tumour size and date of surgery, stratification by breast size and controlling for radiotherapy; body image scale (BIS) scores of psychosocial function and patient reported outcome measures (PROMs) for breast appearance and return to function were analysed. A total of 567 women (286 treated by OBCS and 281 by MxIR) fulfilled inclusion criteria. Demographics were similar between the two unmatched cohorts, except for radiotherapy, age and tumour size (all p < 0.001). Overall, BIS score (p = 0.002), self-rated breast appearance, return to work and function (all p < 0.001) significantly favoured OBCS. Case-matched women with larger breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p < 0.001) than MxIR, whereas no significant difference was observed for smaller breasts. BIS and appearance favoured OBCS, regardless of whether radiotherapy would have been avoided if treated by MxIR. OBCS offers suitable women the option to avoid MxIR while providing faster recovery. Better psychosocial and self-rated satisfaction with breast appearance is achieved for OBCS in all groups, regardless of the need for radiotherapy, apart from those women with smaller breasts for whom the results are comparable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Comparative outcome of stapled trans-anal rectal resection and macrogol in the treatment of defecation disorders

    Institute of Scientific and Technical Information of China (English)

    Ivano Biviano; Danilo Badiali; Laura Candeloro; Fortunee Irene Habib; Massimo Mongardini; Angelo Caviglia; Fiorella Anzini; Enrico S Corazziari

    2011-01-01

    AIM: To prospectively assess the efficacy and safety of stapled trans-anal rectal resection (STARR) compared to standard conservative treatment, and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR. METHODS: Thirty patients (Female, 28; age: 51 ± 9 years) with rectocele or rectal intussusception, a defecation disorder, and functional constipation were submitted for STARR. Thirty comparable patients (Female, 30; age 53 ± 13 years), who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol, were assessed. Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment. A responder was defined as an absence of the Rome El diagnostic criteria for functional constipation. Defecography and recto-anal manometry were performed before and after the STARR procedure in 16 and 12 patients, respectively. RESULTS: After STARR, 53% of patients were re-sponders; during conservative treatment, 75% were responders. After STARR, 30% of the patients reported the use of laxatives, 17% had intermittent anal pain, 13% had anal leakage, 13% required digital facilitation, 6% experienced defecatory urgency, 6% experienced fecal incontinence, and 6% required re-intervention. During macrogol therapy, 23% of the patients complained of abdominal bloating and 13% of borborygmi, and 3% required digital facilitation.No preoperative symptom, defecographic, or manometric finding predicted the outcome of STARR. Post-operative defecography showed a statistically significant reduction (P < 0.05) of the rectal diameter and rectocele. The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified, and that rectal compliance was reduced (P = 0.01). CONCLUSION: STARR is not better and is less safe than macrogol in the treatment of defecation disorders. It

  7. THE FLAT TAX - A COMPARATIVE STUDY OF THE EXISTING MODELS

    Directory of Open Access Journals (Sweden)

    Schiau (Macavei Laura - Liana

    2011-07-01

    Full Text Available In the two last decades the flat tax systems have spread all around the globe from East and Central Europe to Asia and Central America. Many specialists consider this phenomenon a real fiscal revolution, but others see it as a mistake as long as the new systems are just a feint of the true flat tax designed by the famous Stanford University professors Robert Hall and Alvin Rabushka. In this context this paper tries to determine which of the existing flat tax systems resemble the true flat tax model by comparing and contrasting their main characteristics with the features of the model proposed by Hall and Rabushka. The research also underlines the common features and the differences between the existing models. The idea of this kind of study is not really new, others have done it but the comparison was limited to one country. For example Emil Kalchev from New Bulgarian University has asses the Bulgarian income system, by comparing it with the flat tax and concluding that taxation in Bulgaria is not simple, neutral and non-distortive. Our research is based on several case studies and on compare and contrast qualitative and quantitative methods. The study starts form the fiscal design drawn by the two American professors in the book The Flat Tax. Four main characteristics of the flat tax system were chosen in order to build the comparison: fiscal design, simplicity, avoidance of double taxation and uniformity of the tax rates. The jurisdictions chosen for the case study are countries all around the globe with fiscal systems which are considered flat tax systems. The results obtained show that the fiscal design of Hong Kong is the only flat tax model which is built following an economic logic and not a legal sense, being in the same time a simple and transparent system. Others countries as Slovakia, Albania, Macedonia in Central and Eastern Europe fulfill the requirement regarding the uniformity of taxation. Other jurisdictions avoid the double

  8. Comparing spatial and temporal transferability of hydrological model parameters

    Science.gov (United States)

    Patil, Sopan D.; Stieglitz, Marc

    2015-06-01

    Operational use of hydrological models requires the transfer of calibrated parameters either in time (for streamflow forecasting) or space (for prediction at ungauged catchments) or both. Although the effects of spatial and temporal parameter transfer on catchment streamflow predictions have been well studied individually, a direct comparison of these approaches is much less documented. Here, we compare three different schemes of parameter transfer, viz., temporal, spatial, and spatiotemporal, using a spatially lumped hydrological model called EXP-HYDRO at 294 catchments across the continental United States. Results show that the temporal parameter transfer scheme performs best, with lowest decline in prediction performance (median decline of 4.2%) as measured using the Kling-Gupta efficiency metric. More interestingly, negligible difference in prediction performance is observed between the spatial and spatiotemporal parameter transfer schemes (median decline of 12.4% and 13.9% respectively). We further demonstrate that the superiority of temporal parameter transfer scheme is preserved even when: (1) spatial distance between donor and receiver catchments is reduced, or (2) temporal lag between calibration and validation periods is increased. Nonetheless, increase in the temporal lag between calibration and validation periods reduces the overall performance gap between the three parameter transfer schemes. Results suggest that spatiotemporal transfer of hydrological model parameters has the potential to be a viable option for climate change related hydrological studies, as envisioned in the "trading space for time" framework. However, further research is still needed to explore the relationship between spatial and temporal aspects of catchment hydrological variability.

  9. Curriculum inventory: Modeling, sharing and comparing medical education programs.

    Science.gov (United States)

    Ellaway, Rachel H; Albright, Susan; Smothers, Valerie; Cameron, Terri; Willett, Timothy

    2014-03-01

    Abstract descriptions of how curricula are structured and run. The American National Standards Institute (ANSI) MedBiquitous Curriculum Inventory Standard provides a technical syntax through which a wide range of different curricula can be expressed and subsequently compared and analyzed. This standard has the potential to shift curriculum mapping and reporting from a somewhat disjointed and institution-specific undertaking to something that is shared among multiple medical schools and across whole medical education systems. Given the current explosion of different models of curricula (time-free, competency-based, socially accountable, distributed, accelerated, etc.), the ability to consider this diversity using a common model has particular value in medical education management and scholarship. This article describes the development and structure of the Curriculum Inventory Standard as a way of standardizing the modeling of different curricula for audit, evaluation and research purposes. It also considers the strengths and limitations of the current standard and the implications for a medical education world in which this level of commonality, precision, and accountability for curricular practice is the norm rather than the exception.

  10. An overview of comparative modelling and resources dedicated to large-scale modelling of genome sequences.

    Science.gov (United States)

    Lam, Su Datt; Das, Sayoni; Sillitoe, Ian; Orengo, Christine

    2017-08-01

    Computational modelling of proteins has been a major catalyst in structural biology. Bioinformatics groups have exploited the repositories of known structures to predict high-quality structural models with high efficiency at low cost. This article provides an overview of comparative modelling, reviews recent developments and describes resources dedicated to large-scale comparative modelling of genome sequences. The value of subclustering protein domain superfamilies to guide the template-selection process is investigated. Some recent cases in which structural modelling has aided experimental work to determine very large macromolecular complexes are also cited.

  11. Lack of blinding of outcome assessors in animal model experiments implies risk of observer bias

    DEFF Research Database (Denmark)

    Bello, Segun; Krogsbøll, Lasse T; Gruber, Jan

    2014-01-01

    and caused by three pesticides experiments with very large observer bias, pooled ROR was 0.20 (95% CI, 0.07, 0.59) in contrast to the pooled ROR in the other seven experiments, 0.82 (95% CI, 0.57, 1.17). CONCLUSION: Lack of blinding of outcome assessors in animal model experiments with subjective outcomes......OBJECTIVES: To examine the impact of not blinding outcome assessors on estimates of intervention effects in animal experiments modeling human clinical conditions. STUDY DESIGN AND SETTING: We searched PubMed, Biosis, Google Scholar, and HighWire Press and included animal model experiments with both...... blinded and nonblinded outcome assessors. For each experiment, we calculated the ratio of odds ratios (ROR), that is, the odds ratio (OR) from nonblinded assessments relative to the corresponding OR from blinded assessments. We standardized the ORs according to the experimental hypothesis...

  12. Modeling Employee Social Responsibility as an Antecedent to Competitiveness Outcomes

    Directory of Open Access Journals (Sweden)

    Thomas Kimeli Cheruiyot

    2015-02-01

    Full Text Available The study explained a model of employee social responsibility (ESR as an antecedent to corporate competitiveness. It hypothesizes that ESR has significant effect on employee competitiveness (EC. Questionnaires were administered to a sample of 700 employees selected from a population of 5,595 from 20 classified hotels in the coastal region of Kenya using proportionate and systematic random sampling methods. Structural equation model was used for model specification and hypotheses testing. Confirmatory factor analysis was performed on six and four constructs representing ESR and EC, respectively. Overall, a negative effect of ESR on EC was found with un-standardized β estimates = −.516; SE = .071, p = .000. Accordingly, increase in employee corporate social responsibility (CSR is associated with decline in EC. This was potentially paradoxical because employees demonstrated job and organization commitment and retention intention despite poor ESR practices.

  13. Comparative clinicopathological and outcome analysis of differentiated thyroid cancer in Saudi patients aged below 60 years and above 60 years

    Directory of Open Access Journals (Sweden)

    AL-Qahtani KH

    2016-08-01

    Full Text Available Khalid Hussain AL-Qahtani,1 Mutahir A Tunio,2 Mushabbab Al Asiri,2 Yasser Bayoumi,3 Ali Balbaid,2 Naji J Aljohani,4 Hanadi Fatani5 1Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 3Department of Radiation Oncology, NCI, Cairo University, Cairo, Egypt; 4Department of Endocrinology and Thyroid Oncology, 5Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia Introduction: The aim of this study was to evaluate the treatment outcomes of differentiated thyroid cancer in Saudi patients aged above 60 years. Materials and methods: Comparative analysis was performed in 252 patients aged 46–60 years (Group A and 118 patients aged above 60 years (Group B, who had thyroidectomy, radioactive iodine-131, and thyroid-stimulating hormone suppression therapy between July 2000 and December 2012. Different clinicopathological features, treatment, complications, disease-free survival, and overall survival rates were compared. Results: Mean age of patients in Group A was 51.9 years (range: 46–60, and mean age of those in Group B was 68.6 years (range: 62–97. Group B patients had higher positive lymph nodes (43.2%, P=0.011. The frequency of extrathyroidal extension, multifocality, and lymphovascular space invasion was seen more in Group B than in Group A. Postsurgical complications (permanent hypoparathyroidism, bleeding, and wound infections were also seen more in Group B (P=0.043, P=0.011, and P=0.021, respectively. Group B patients experienced more locoregional recurrences (11.0%, P=0.025; similarly, more distant metastases were observed in Group B (15.3%, P=0.003. The 10-year disease-free survival rates were 87.6% in Group A and 70.8% in Group B (P<0.0001. Conclusion: Differentiated thyroid cancer in patients aged above 60 years are more

  14. Management outcome of acute urinary retention: model of prediction.

    LENUS (Irish Health Repository)

    Daly, Padraig

    2012-01-31

    OBJECTIVES: To assess for predictors of outcome in patients presenting with acute urinary retention (AUR). METHODS: A study was performed in our unit to evaluate trial without catheter (TWOC) and successive management. We assessed for predictors of surgical or medical management, which included: age, volume drained at time of catheterisation, cause of retention, serum creatinine, success of trial of voiding, co-morbidities, prostate-specific antigen (PSA) and prostate size on digital rectal examination (DRE). RESULTS: 72 men were entered into the study over an 18-month period: 27 had a successful first TWOC, 20 patients had a second TWOC, and 6 were successful. In total, 31 of the 33 patients with a successful TWOC remained on alpha-blockers without a further episode of AUR within a minimum of 6 months\\' follow-up. Patients failing TWOC were managed by transurethral resection of the prostate (n = 22), long-term catheterisation (n = 15) or prostatic stents (n = 3), and 1 patient died prior to intervention. Three predictors were significant on multivariate analysis: PSA (>2.9 ng\\/ml), prostate size on DRE (large) and volume drained at time of catheterisation (>or=1,000 ml). CONCLUSION: Patients with elevated PSA (>2.9 ng\\/ml), a large prostate size on DRE and a volume drained at time of catheterisation >1,000 ml are best managed by surgical intervention, while those with volumes drained at time of catheterisation of <1,000 ml, a PSA

  15. Investigating the outcomes of SPH models of catastrophic destruction

    Science.gov (United States)

    Dell'Oro, A.; Cellino, A.; Paolicchi, P.; Tanga, P.

    Smooth particle hydro-dynamics (SPH) codes have proved able to simulate satisfactorily the shattering processes in high-energy collisions among asteroids, reproducing the major observational evidences. In particular, SPH models reproduce fairly well the size distributions of the members of some asteroid families. A considerable difference between SPH models and Semi-Empirical Models (SEM) is that in the former the asteroids are ground up into very small fragments, the size of which is limited by the resolution of the code. Moreover, the subsequent ballistic dynamical evolution, driven by their mutual gravitational attraction, would result in a significant re-accumulation into many bodies. On the contrary, ejection velocity fields predicted by SEM allow the reaccumulation into very few bodies, sometimes only the largest remnant. This difference is a critical issue for the interpretation of the observational data in order to understand the physics of the catastrophic destruction process, and the physical characteristics of the asteroids themselves. We present a new analysis of some SPH velocity fields aiming to shed light on the intrinsic differences between SPH models and SEMs.

  16. Reformulating the Depression Model of Learned Hopelessness for Academic Outcomes

    Science.gov (United States)

    Au, Raymond C. P.; Watkins, David; Hattie, John; Alexander, Patricia

    2009-01-01

    This review explores developments in the construct of learned hopelessness, which originated in the clinical literature dealing with depression. In that context, the model developed by Abramson, Metalsky, and Alloy [Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). "Hopelessness depression: A theory-based subtype of depression."…

  17. Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Hansen, Peter Riis; Iversen, Allan; Abdulla, Jawdat

    2010-01-01

    Intracoronary (IC) administration of abciximab may increase local drug levels by several orders of magnitude compared to intravenous (IV) treatment and may improve clinical outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI). In the absence...

  18. The impact of role models on health outcomes for lesbian, gay, bisexual, and transgender youth.

    Science.gov (United States)

    Bird, Jason D P; Kuhns, Lisa; Garofalo, Robert

    2012-04-01

    There is little research on the impact of role models on health outcomes for lesbian, gay, bisexual, and transgender (LGBT) youth. This exploratory study describes the presence and availability of LGBT-affirming role models, and examines the relationship between the accessibility of role models and health outcomes among a community-based sample of LGBT youth. A convenience sample of 496 ethnically diverse, 16-24-year-old LGBT youth was recruited to complete a computer-assisted interview, using standardized instruments validated with adolescents. The prevalence and characteristics of role models were described. Differences in subgroup distribution were assessed using Pearson χ(2) test (p youth from negative outcomes, and formal mechanisms for connecting LGBT youth with caring adults who can serve as role models, such as mentoring programs, are critical. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  19. Comparative Outcome Analysis of Penicillin-Based Versus Fluoroquinolone-Based Antibiotic Therapy for Community-Acquired Pneumonia: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Wang, Chi-Chuan; Lin, Chia-Hui; Lin, Kuan-Yin; Chuang, Yu-Chung; Sheng, Wang-Huei

    2016-02-01

    Community-acquired pneumonia (CAP) is a common but potentially life-threatening condition, but limited information exists on the effectiveness of fluoroquinolones compared to β-lactams in outpatient settings. We aimed to compare the effectiveness and outcomes of penicillins versus respiratory fluoroquinolones for CAP at outpatient clinics.This was a claim-based retrospective cohort study. Patients aged 20 years or older with at least 1 new pneumonia treatment episode were included, and the index penicillin or respiratory fluoroquinolone therapies for a pneumonia episode were at least 5 days in duration. The 2 groups were matched by propensity scores. Cox proportional hazard models were used to compare the rates of hospitalizations/emergence service visits and 30-day mortality. A logistic model was used to compare the likelihood of treatment failure between the 2 groups.After propensity score matching, 2622 matched pairs were included in the final model. The likelihood of treatment failure of fluoroquinolone-based therapy was lower than that of penicillin-based therapy (adjusted odds ratio [AOR], 0.88; 95% confidence interval [95%CI], 0.77-0.99), but no differences were found in hospitalization/emergence service (ES) visits (adjusted hazard ratio [HR], 1.27; 95% CI, 0.92-1.74) and 30-day mortality (adjusted HR, 0.69; 95% CI, 0.30-1.62) between the 2 groups.The likelihood of treatment failure of fluoroquinolone-based therapy was lower than that of penicillin-based therapy for CAP on an outpatient clinic basis. However, this effect may be marginal. Further investigation into the comparative effectiveness of these 2 treatment options is warranted.

  20. Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

    DEFF Research Database (Denmark)

    Secher, Niels; Malte, Christian Lind; Tønnesen, Else

    2016-01-01

    CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. METHODS: Male Sprague Dawley rats were randomized to anesthesia with isoflurane (n=11) or fentanyl...... samples for Endothelin-1 and cathecolamines were drawn before and after CA. KEY FINDINGS: Compared with fentanyl/fluanisone/midazolam anesthesia, isoflurane resulted in a shorter time to return of spontaneous circulation (ROSC), less use of epinephrine, increased coronary perfusion pressure during CPR......, higher mean arterial pressure post ROSC, increased plasma levels of Endothelin-1 and decreased levels of epinephrine. The choice of anesthesia did not affect ROSC rate or systemic O2 consumption. CONCLUSION: Isoflurane reduces time to ROSC, increases coronary perfusion pressure, and improves hemodynamic...

  1. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland

    Directory of Open Access Journals (Sweden)

    Sahanne S

    2017-03-01

    Full Text Available Sari Sahanne,1 Raimo Tuuminen,2 Jari Haukka,3 Sirpa Loukovaara4 1Department of Anesthesiology, Helsinki University Central Hospital, Helsinki, 2Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, 3Hjelt Institute, Faculty of Medicine, University of Helsinki, 4Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland Background: Rhegmatogenous retinal detachment (RRD is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV. Methods: This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50 and PPV (n=269. Changes in intraocular pressure (IOP and best-corrected visual acuity (BCVA were recorded at 30 days and reoperation rates within 180 days postoperatively. Results: Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test; however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006. Changes in BCVA did not differ between the surgical procedures. Conclusion: PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD. Keywords: rhegmatogenous retinal detachment, vitrectomy, scleral buckling

  2. A Markov Model for Analyzing Polytomous Outcome Data

    Directory of Open Access Journals (Sweden)

    M Ataharul Islam

    2012-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} This paper highlights the estimation and test procedures for multi-state Markov models with covariate dependences in higher orders. Logistic link functions are used to analyze the transition probabilities of three or more states of a Markov model emerging from a longitudinal study. For illustration purpose the models are used for analysis of panel data on Health and Retirement Study conducted in USA during 1992-2002. The applications use self reported data on perceived emotional health at each round of the nationwide survey conducted among the elderly people. Useful and detailed results on the change in the perceived emotional health status among the elderly people are obtained.

  3. Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.

    Science.gov (United States)

    Saurav, Alok; Alla, Venkata Mahesh; Kaushik, Manu; Hunter, Claire C; Mooss, Aryan V

    2015-09-01

    Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively

  4. A comparative assessment of efficient uncertainty analysis techniques for environmental fate and transport models: application to the FACT model

    Science.gov (United States)

    Balakrishnan, Suhrid; Roy, Amit; Ierapetritou, Marianthi G.; Flach, Gregory P.; Georgopoulos, Panos G.

    2005-06-01

    This work presents a comparative assessment of efficient uncertainty modeling techniques, including Stochastic Response Surface Method (SRSM) and High Dimensional Model Representation (HDMR). This assessment considers improvement achieved with respect to conventional techniques of modeling uncertainty (Monte Carlo). Given that traditional methods for characterizing uncertainty are very computationally demanding, when they are applied in conjunction with complex environmental fate and transport models, this study aims to assess how accurately these efficient (and hence viable) techniques for uncertainty propagation can capture complex model output uncertainty. As a part of this effort, the efficacy of HDMR, which has primarily been used in the past as a model reduction tool, is also demonstrated for uncertainty analysis. The application chosen to highlight the accuracy of these new techniques is the steady state analysis of the groundwater flow in the Savannah River Site General Separations Area (GSA) using the subsurface Flow And Contaminant Transport (FACT) code. Uncertain inputs included three-dimensional hydraulic conductivity fields, and a two-dimensional recharge rate field. The output variables under consideration were the simulated stream baseflows and hydraulic head values. Results show that the uncertainty analysis outcomes obtained using SRSM and HDMR are practically indistinguishable from those obtained using the conventional Monte Carlo method, while requiring orders of magnitude fewer model simulations.

  5. Collaborative Care for patients with severe borderline and NOS personality disorders: A comparative multiple case study on processes and outcomes

    Directory of Open Access Journals (Sweden)

    Koekkoek Bauke

    2011-06-01

    Full Text Available Abstract Background Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer access to psychotherapy a Collaborative Care Program (CCP is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen

  6. Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions.

    Science.gov (United States)

    Salinas, Pablo; Mejía-Rentería, Hernán; Herrera-Nogueira, Raúl; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Núñez-Gil, Iván Javier; Gonzalo, Nieves; Del Trigo, María; Pérez-Vizcayno, María José; Quirós, Alicia; Escaned, Javier; Macaya, Carlos; Fernández-Ortiz, Antonio

    2017-08-09

    We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL. Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years. Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43). Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Single-center comparative outcomes of the Edwards SAPIEN and Medtronic Melody transcatheter heart valves in the pulmonary position.

    Science.gov (United States)

    Faza, Nadeen; Kenny, Damien; Kavinsky, Clifford; Amin, Zahid; Heitschmidt, Mary; Hijazi, Ziyad M

    2013-10-01

    Two transcatheter pulmonary valve replacement (tPVR) systems (Edwards SAPIEN and Medtronic Melody) are available; however, comparative studies evaluating outcome data are lacking. The aim of this study was to compare short- with medium-term outcome data of these valves in the pulmonary position from a single institution. Retrospective data analysis of all patients undergoing tPVR from April 2008 until April 2012. Pre-procedural investigations, patient demographics, procedural hemodynamics, and clinical and echocardiographic follow-up data were included. Data are presented as mean ± standard deviation. Thirty-three patients underwent successful tPVR (SAPIEN (S) n = 20, Melody (M) n = 13). Patient age and weight were similar between the two groups. Primary indication included regurgitation (S (n = 2), M (n = 3)), stenosis (S (n = 13), M (n = 7)), or mixed (S (n = 5), M (n = 3)). There was no difference in pre-procedural peak Doppler gradients across the pulmonary outflow (S = 47.73 ± 21.14 mm Hg, M = 42.62 ± 15.59 mm Hg, P = 0.46). All but one patient underwent pre-stenting prior to valve implantation. Immediately following valve deployment, the transvalvar gradient was not statistically different between the two groups (S = 11.5 ± 8.07 mm Hg, M = 8.15 ± 4.56 mm Hg, P = 0.18). There were no procedural deaths. Follow-up mean pulmonary Doppler gradients were higher with the SAPIEN cohort (18.43 ± 9.06 mm Hg (S) and 11.17 ± 5.24 mm Hg (M), P = 0.016); however, no differences were seen when similar procedural epochs were assessed. All but one patient remained with PR grade = 2. In a single-center series, the SAPIEN and Melody valves demonstrated comparable medium-term valve function. Greater residual gradients with the SAPIEN valve may represent a more conservative early pre-stenting approach with this valve. Copyright © 2012 Wiley Periodicals, Inc.

  8. Comparative and pharmacophore model for deacetylase SIRT1

    Science.gov (United States)

    Huhtiniemi, Tero; Wittekindt, Carsten; Laitinen, Tuomo; Leppänen, Jukka; Salminen, Antero; Poso, Antti; Lahtela-Kakkonen, Maija

    2006-09-01

    Sirtuins are NAD-dependent histone deacetylases, which cleave the acetyl-group from acetylated proteins, such as histones but also the acetyl groups from several transcription factors, and in this way can change their activities. Of all seven mammalian SirTs, the human sirtuin SirT1 has been the most extensively studied. However, there is no crystal structure or comparative model reported for SirT1. We have therefore built up a three-dimensional comparison model of the SirT1 protein catalytic core (domain area from residues 244 to 498 of the full length SirT1) in order to assist in the investigation of active site-ligand interactions and in the design of novel SirT1 inhibitors. In this study we also propose the binding-mode of recently reported set of indole-based inhibitors in SirT1. The site of interaction and the ligand conformation were predicted by the use of molecular docking techniques. To distinguish between active and inactive compounds, a post-docking filter based on H-bond network was constructed. Docking results were used to investigate the pharmacophore and to identify a filter for database mining.

  9. Animal models for clinical and gestational diabetes: maternal and fetal outcomes

    Directory of Open Access Journals (Sweden)

    Kiss Ana CI

    2009-10-01

    Full Text Available Abstract Background Diabetes in pregnant women is associated with an increased risk of maternal and neonatal morbidity and remains a significant medical challenge. Diabetes during pregnancy may be divided into clinical diabetes and gestational diabetes. Experimental models are developed with the purpose of enhancing understanding of the pathophysiological mechanisms of diseases that affect humans. With regard to diabetes in pregnancy, experimental findings from models will lead to the development of treatment strategies to maintain a normal metabolic intrauterine milieu, improving perinatal development by preventing fetal growth restriction or macrosomia. Based on animal models of diabetes during pregnancy previously reported in the medical literature, the present study aimed to compare the impact of streptozotocin-induced severe (glycemia >300 mg/dl and mild diabetes (glycemia between 120 and 300 mg/dl on glycemia and maternal reproductive and fetal outcomes of Wistar rats to evaluate whether the animal model reproduces the maternal and perinatal results of clinical and gestational diabetes in humans. Methods On day 5 of life, 96 female Wistar rats were assigned to three experimental groups: control (n = 16, severe (n = 50 and mild diabetes (n = 30. At day 90 of life, rats were mated. On day 21 of pregnancy, rats were killed and their uterine horns were exposed to count implantation and fetus numbers to determine pre- and post-implantation loss rates. The fetuses were classified according to their birth weight. Results Severe and mild diabetic dams showed different glycemic responses during pregnancy, impairing fetal glycemia and weight, confirming that maternal glycemia is directly associated with fetal development. Newborns from severe diabetic mothers presented growth restriction, but mild diabetic mothers were not associated with an increased rate of macrosomic fetuses. Conclusion Experimental models of severe diabetes during pregnancy

  10. Comparative study of final visual outcome between open- and closed-globe injuries following surgical treatment of traumatic cataract.

    Science.gov (United States)

    Shah, Mehul Ashvin; Shah, Shreya Mehul; Shah, Shashank B; Patel, Chintan G; Patel, Utsav A; Appleware, Adway; Gupta, Ashish

    2011-12-01

    The objective of this work is to compare final visual outcomes in cases of surgically treated traumatic cataract between open-globe and closed-globe groups, as classified by the Birmingham Eye Trauma Terminology system. Observational cohort study. Tertiary eye-care center at the trijunction of Gujarat, Madhya Pradesh, and Rajasthan states in central western India. We enrolled patients meeting specific inclusion criteria, examined their eyes to review any co-morbidities due to trauma, performed surgery for traumatic cataracts, and implanted lenses. The patients were re-examined 6 weeks postoperatively. We classified the cases of traumatic cataract as either open-globe (group 1) or closed-globe (group 2), according to the Birmingham Eye Trauma Terminology (BETT) system, and compared visual acuity. Visual Acuity. Our cohort of 687 eyes with traumatic cataracts included 496 eyes in group 1 and 191 in group 2. Six weeks postoperatively, the visual acuity was >20/60 in 298 (58%) and 75 (39.1%) operated eyes in groups 1 and 2, respectively (p 20/60 vision was significantly higher in group 1 than in group 2 (OR = 1.61; 95% CI, 0.85-3.02). Overall, 373 eyes (54.3%) regained final visual acuity >20/60. Open-globe injury has a more favorable prognosis for satisfactory (>20/60) visual recovery after management of traumatic cataracts.

  11. Milan Criteria and UCSF Criteria: A Preliminary Comparative Study of Liver Transplantation Outcomes in the United States

    Directory of Open Access Journals (Sweden)

    Supriya S. Patel

    2012-01-01

    Full Text Available The application of orthotopic liver transplantation (OLT for patients with hepatocellular cancer (HCC necessitates highly selective criteria to maximize survival and to optimize allocation of a scarce resource. The objective of this study was to compare the outcomes of OLT for HCC in patients transplanted under Milan and UCSF criteria. The United Network of Organ Sharing (UNOS database was queried for patients who had undergone OLT for HCC from 2002 to 2007, and 1,972 patients (Milan criteria, n=1,913; UCSF criteria, n=59 were identified. Patients were stratified by pretransplant criteria (Milan versus UCSF, and clinical and pathologic factors and overall survival were compared. There were no differences in age, gender, diabetes mellitus, body mass index, and hepatitis B, or C status between the two groups. Overall survival was similar between the Milan and UCSF cohorts (1-, 2-, 3-, and 4-year survival rates: 88%, 81%, 76%, and 72% versus 91%, 80%, 68% and 51%, respectively, P=0.21. Although the number of patients within UCSF criteria was small, our results nevertheless suggest that patients with HCC may have equivalent survival when transplanted under Milan and UCSF criteria. Long-term followup may better determine whether UCSF criteria should be widely adopted.

  12. Comparing Transformation Possibilities of Topological Functioning Model and BPMN in the Context of Model Driven Architecture

    Directory of Open Access Journals (Sweden)

    Solomencevs Artūrs

    2016-05-01

    Full Text Available The approach called “Topological Functioning Model for Software Engineering” (TFM4SE applies the Topological Functioning Model (TFM for modelling the business system in the context of Model Driven Architecture. TFM is a mathematically formal computation independent model (CIM. TFM4SE is compared to an approach that uses BPMN as a CIM. The comparison focuses on CIM modelling and on transformation to UML Sequence diagram on the platform independent (PIM level. The results show the advantages and drawbacks the formalism of TFM brings into the development.

  13. Comparing spatial and temporal transferability of hydrological model parameters

    Science.gov (United States)

    Patil, Sopan; Stieglitz, Marc

    2015-04-01

    Operational use of hydrological models requires the transfer of calibrated parameters either in time (for streamflow forecasting) or space (for prediction at ungauged catchments) or both. Although the effects of spatial and temporal parameter transfer on catchment streamflow predictions have been well studied individually, a direct comparison of these approaches is much less documented. In our view, such comparison is especially pertinent in the context of increasing appeal and popularity of the "trading space for time" approaches that are proposed for assessing the hydrological implications of anthropogenic climate change. Here, we compare three different schemes of parameter transfer, viz., temporal, spatial, and spatiotemporal, using a spatially lumped hydrological model called EXP-HYDRO at 294 catchments across the continental United States. Results show that the temporal parameter transfer scheme performs best, with lowest decline in prediction performance (median decline of 4.2%) as measured using the Kling-Gupta efficiency metric. More interestingly, negligible difference in prediction performance is observed between the spatial and spatiotemporal parameter transfer schemes (median decline of 12.4% and 13.9% respectively). We further demonstrate that the superiority of temporal parameter transfer scheme is preserved even when: (1) spatial distance between donor and receiver catchments is reduced, or (2) temporal lag between calibration and validation periods is increased. Nonetheless, increase in the temporal lag between calibration and validation periods reduces the overall performance gap between the three parameter transfer schemes. Results suggest that spatiotemporal transfer of hydrological model parameters has the potential to be a viable option for climate change related hydrological studies, as envisioned in the "trading space for time" framework. However, further research is still needed to explore the relationship between spatial and temporal

  14. Forward Surgical Teams provide comparable outcomes to combat support hospitals during support and stabilization operations on the battlefield.

    Science.gov (United States)

    Eastridge, Brian J; Stansbury, Lynn G; Stinger, Harry; Blackbourne, Lorne; Holcomb, John B

    2009-04-01

    Forward Surgical Teams (FST) provide forward deployed surgical care within the battle space. The next level of care in theater, the Combat Support Hospitals (CSH), are distinguished from the FST by advanced resource capabilities including more complex diagnostic imaging, laboratory support with blood banking, and intensive care units. This study was intended to assess the effect of FST capability on the outcome of seriously injured casualties in comparison to the CSH. We reviewed all casualty records in the Joint Theater Trauma Registry database from April 2004 to April 2006. The study cohort included all US military battle casualties who were admitted to either a FST or a CSH and were not returned to duty within 72 hours. Data were tabulated and assessed for basic demographics, mechanism of injury, injury severity score, ventilator and critical care days, and mortality. Statistical inferences were made using Chi square and Student's t tests. As of April 2006, the above information was available in the Joint Theater Trauma Registry on 2,617 US military battle casualties who survived to reach care at a FST and/or CSH. Of this population, 77 subsequently died of wounds and 2,540 survived. We found no significant difference in died of wounds rates between the sample populations or rates of ventilator or critical care days between the two groups, nor did controlling for injury severity score alter this picture. The most significant predictor of mortality in both these groups was head injury. The disparity between the availability of the highest level of injury care and the ability to care for injury as soon as possible is an issue of central importance to both the civilian and military trauma care communities. Our analysis demonstrates that despite the operational and logistic challenges that burden the FST, this level of surgical care confers equivalent battlefield injury outcome results compared with the CSH.

  15. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  16. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  17. When Lanchester met Richardson, the outcome was stalemate: A parable for mathematical models of insurgency

    OpenAIRE

    Niall J MacKay

    2015-01-01

    Many authors have used dynamical systems to model asymmetric war. We explore this approach more broadly, first returning to the prototypical models such as Richardson’s arms race, Lanchester’s attrition models and Deitchman’s guerrilla model. We investigate combinations of these and their generalizations, understanding how they relate to assumptions about asymmetric conflict. Our main result is that the typical long-term outcome is neither annihilation nor escalation but a stable fixed point,...

  18. The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation

    Science.gov (United States)

    Curran, E; Loveday, HP; Kiernan, MA; Tannahill, M

    2013-01-01

    Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences.

  19. The Balanced Scorecard: A Systemic Model for Evaluation and Assessment of Learning Outcomes?

    Directory of Open Access Journals (Sweden)

    Tom Bielavitz

    2010-06-01

    Full Text Available Objective – The goal of this paper is to explore using Kaplan and Norton’s balanced scorecard methodology as a systemic model for outcomes assessment. The expectations of academic accrediting agencies have shifted from measurement of inputs and outputs to that of the library’s impact on learning and demonstrating accountability. Recent literature has presented methods for performing specific aspects of outcomes assessment. However, the scorecard methodology may provide a systemic advantage beneficial to library administrators and managers.Methods – This paper provides a selective review of outcomes assessment in academic libraries and a description of the balanced scorecard methodology, focusing on its relevance to assessment and demonstration of accountability.Results – A theoretical scenario is outlined, including examples of a scorecard used for outcomes assessment. For each example, the benefits of using a systemic approach are examined.Conclusions – Using a systems‐thinking approach to outcomes assessment may provide significant advantages to library administrators and managers. As the model includes traditional methods of outcomes assessment, the scorecard approach adds elements of process improvement, identification of the inputs and outputs that create outcomes, and a tool for communicating accountability for resources.

  20. Clinical outcomes of HIV care delivery models in the US: a systematic review.

    Science.gov (United States)

    Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H

    2016-10-01

    With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially

  1. Overview of data-synthesis in systematic reviews of studies on outcome prediction models

    NARCIS (Netherlands)

    T. van den Berg (Tobias); M.W. Heymans (Martijn); O. Leone; D. Vergouw (David); J. Hayden (Jill); A.P. Verhagen (Arianne); H.C. de Vet (Henrica C)

    2013-01-01

    textabstractBackground: Many prognostic models have been developed. Different types of models, i.e. prognostic factor and outcome prediction studies, serve different purposes, which should be reflected in how the results are summarized in reviews. Therefore we set out to investigate how authors of

  2. Overview of data-synthesis in systematic reviews of studies on outcome prediction models.

    NARCIS (Netherlands)

    Berg, T. van den; Heymans, M.W.; Leone, S.S.; Vergouw, D.; Hayden, J.A.; Verhagen, A.P.; Vet, H.C.W. de

    2013-01-01

    Background: Many prognostic models have been developed. Different types of models, i.e. prognostic factor and outcome prediction studies, serve different purposes, which should be reflected in how the results are summarized in reviews. Therefore we set out to investigate how authors of reviews

  3. Student Identification with Business Education Models: Measurement and Relationship to Educational Outcomes

    Science.gov (United States)

    Halbesleben, Jonathon R. B.; Wheeler, Anthony R.

    2009-01-01

    Although management scholars have provided a variety of metaphors to describe the role of students in management courses, researchers have yet to explore students' identification with the models and how they are linked to educational outcomes. This article develops a measurement tool for students' identification with business education models and…

  4. The Effect of Integrated Learning Model and Critical Thinking Skill of Science Learning Outcomes

    Science.gov (United States)

    Fazriyah, N.; Supriyati, Y.; Rahayu, W.

    2017-02-01

    This study aimed to determine the effect of integrated learning model and critical thinking skill toward science learning outcomes. The study was conducted in SDN Kemiri Muka 1 Depok in fifth grade school year 2014/2015 using cluster random sampling was done to 80 students. Retrieval of data obtained through tests and analysis by Variance (ANOVA) and two lines with the design treatment by level 2x2. The results showed that: (1) science learning outcomes students that given thematic integrated learning model is higher than in the group of students given fragmented learning model, (2) there is an interaction effect between critical thinking skills with integrated learning model, (3) for students who have high critical thinking skills, science learning outcomes students who given by thematic integrated learning model higher than fragmented learning model and (4) for students who have the ability to think critically low yield higher learning science fragmented model. The results of this study indicate that thematic learning model with critical thinking skills can improve science learning outcomes of students.

  5. Evidencing Learning Outcomes: A Multi-Level, Multi-Dimensional Course Alignment Model

    Science.gov (United States)

    Sridharan, Bhavani; Leitch, Shona; Watty, Kim

    2015-01-01

    This conceptual framework proposes a multi-level, multi-dimensional course alignment model to implement a contextualised constructive alignment of rubric design that authentically evidences and assesses learning outcomes. By embedding quality control mechanisms at each level for each dimension, this model facilitates the development of an aligned…

  6. Comparing the Outcomes of Patients With Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia.

    Science.gov (United States)

    Tamma, Pranita D; Goodman, Katherine E; Harris, Anthony D; Tekle, Tsigereda; Roberts, Ava; Taiwo, Abimbola; Simner, Patricia J

    2017-02-01

    Carbapenem-resistant Enterobacteriaceae (CRE) are associated with considerable mortality. As mechanisms of carbapenem resistance are heterogeneous, it is unclear if mortality differs based on resistance mechanisms. We sought to determine whether CRE resistance mechanism determination is prognostically informative. We conducted an observational study comparing 14-day mortality between patients with carbapenemase-producing (CP)-CRE compared with non-CP-CRE bacteremia. Clinical data were collected on all patients. A comprehensive DNA microarray-based assay was performed on all isolates to identify β-lactamase-encoding genes. There were 83 unique episodes of monomicrobial CRE bacteremia during the study period: 37 (45%) CP-CRE and 46 (55%) non-CP-CRE. The majority of CP-CRE isolates were bla KPC (92%), followed by bla NDM (5%) and bla OXA-48-type (3%). CP-CRE isolates were more likely to have meropenem minimum inhibitory concentrations (MICs) ≥16 µg/mL, while non-CP-CRE isolates were more likely to have meropenem MICs ≤1 µg/mL (P value < .001). A total of 18 (22%) patients died within 14 days, including 12 (32%) in the CP-CRE group and 6 (13%) in the non-CP-CRE group. Adjusting for severity of illness on day 1 of bacteremia, underlying medical conditions, and differences in antibiotic treatment administered, the odds of dying within 14 days were more than 4 times greater for CP-CRE compared with non-CP-CRE bacteremic patients (adjusted odds ratio, 4.92; 95% confidence interval, 1.01-24.81). Our findings suggest that CP-CRE may be more virulent than non-CP-CRE and are associated with poorer outcomes. This underscores the added importance of delineating underlying resistance mechanisms of CRE to direct antibiotic treatment decisions. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  7. Early outcomes of twin-peg mobile-bearing unicompartmental knee arthroplasty compared with primary total knee arthroplasty

    Science.gov (United States)

    Lum, Z. C.; Lombardi, A. V.; Hurst, J. M.; Morris, M. J.; Adams, J. B.; Berend, K. R.

    2016-01-01

    Aims Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts. Patients and Methods A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed. Results The mean follow-up for UKA and TKA groups was 5.4 and 5.5 years, respectively. Six TKA (3.2%) versus three UKAs (1.5%) were revised which was not significant (p = 0.269). Manipulation was more frequent after TKA (16; 8.5%) versus none in the UKA group (p < 0.001). UKA patients had higher post-operative KS function scores versus TKA patients (78 versus 66, p < 0.001) with a trend toward greater improvement, but there was no difference in ROM and KS clinical improvement (p = 0.382 and 0.420, respectively). Conclusion We found fewer manipulations, and higher functional outcomes for patients treated with medial mobile-bearing UKA compared with TKA. TKA had twice the revision rate as UKA although this did not reach statistical significance with the numbers available. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):28–33. PMID:27694513

  8. Comparative study of serum uric acid levels in preeclamptic and normal pregnant women and its related outcomes

    Directory of Open Access Journals (Sweden)

    M. Fakhri

    2005-01-01

    Full Text Available Background and purpose: Preeclampsia is a hypertensive disorder in pregnancy and is known as a specific syndrom of pregnancy. Several studies have been done to asses the indicators of preeclampsia for early detection of the disease. Uric acid is considered by some investigators as one of the most sensetive indicators in preeclampsia. In contrast some researchers have found it not useful in prediction of preeclampsia. Hence, more studies are needed about the role of uric acid levels in diagnosis of preeclampsia. The aim of this research is to compare the serum uric acid levels in preeclamptic and normal pregnant women and its sensivity as an indicator of preeclampsia.Materials and methods : In this case-control study 304 pregnant women were enrolled in the study at Fatmeh Zahrah Hospital of Sari. Among them, 151 preeclamptic women were allocated in case group and 153 healthy pregnant women in control group. SPSS were used for analysis of data and variables were compared by Chi square, ANOVA, Pearson correlation index, and sensivity and specifity were calculated.Results : Difference in the number of term delivery and primi gravidity between the three groups (normal, mild and severe preeclampsia were significant (P<0.05. Considering maternal and fetal outcomes, only Decolman (two cases had no significant difference between 3 groups.Mean of uric acid levels differed between three groups (P<0.0001. Severe preeclampsia had the most significant difference with normal group. Elevated uric acid (defined as up of 5.5 mg/dl was observed in 34/2% in hyperuricemia group, 71.2 % in preeclamtic and 28.8% in control group (P<0.0001 The sensivity of uric acid levels for determining the preeclampsia and its severity elevated with increasing in concentration of uric acid but the specifity decreased.Conclusion : Results showed that the sensivity of uric acid levels in diagnosis of preeclampsia is moderate and measuring uric acid can be used in determining the

  9. Post-Transplant Outcomes in High-Risk Compared with Non-High-Risk Multiple Myeloma: A CIBMTR Analysis.

    Science.gov (United States)

    Scott, Emma C; Hari, Parameswaran; Sharma, Manish; Le-Rademacher, Jennifer; Huang, Jiaxing; Vogl, Dan; Abidi, Muneer; Beitinjaneh, Amer; Fung, Henry; Ganguly, Siddhartha; Hildebrandt, Gerhard; Holmberg, Leona; Kalaycio, Matt; Kumar, Shaji; Kyle, Robert; Lazarus, Hillard; Lee, Cindy; Maziarz, Richard T; Meehan, Kenneth; Mikhael, Joseph; Nishihori, Taiga; Ramanathan, Muthalagu; Usmani, Saad; Tay, Jason; Vesole, David; Wirk, Baldeep; Yared, Jean; Savani, Bipin N; Gasparetto, Cristina; Krishnan, Amrita; Mark, Tomer; Nieto, Yago; D'Souza, Anita

    2016-10-01

    Conventional cytogenetics and interphase fluorescence in situ hybridization (FISH) identify high-risk multiple myeloma (HRM) populations characterized by poor outcomes. We analyzed these differences among HRM versus non-HRM populations after upfront autologous hematopoietic cell transplantation (autoHCT). Between 2008 and 2012, 715 patients with multiple myeloma identified by FISH and/or cytogenetic data with upfront autoHCT were identified in the Center for International Blood and Marrow Transplant Research database. HRM was defined as del17p, t(4;14), t(14;16), hypodiploidy (day 100 post-transplant, at least a very good partial response was 59% in HRM and 61% in non-HRM (P = .6). More HRM patients received post-transplant therapy with bortezomib and imids (26% versus 12%, P = .004). Three-year post-transplant progression-free (PFS) and overall survival (OS) rates in HRM versus non-HRM were 37% versus 49% (P post-transplant therapy was 46% (95% confidence interval [CI], 33 to 59) versus 14% (95% CI, 4 to 29) and in non-HRM patients with and without post-transplant therapy 55% (95% CI, 49 to 62) versus 39% (95% CI, 32 to 47); rates of OS for HRM patients with and without post-transplant therapy were 81% (95% CI, 70 to 90) versus 48% (95% CI, 30 to 65) compared with 88% (95% CI, 84 to 92) and 79% (95% CI, 73 to 85) in non-HRM patients with and without post-transplant therapy, respectively. Among patients receiving post-transplant therapy, there was no difference in OS between HRM and non-HRM (P = .08). In addition to HRM, higher stage, less than a CR pretransplant, lack of post-transplant therapy, and African American race were associated with worse OS. In conclusion, we show HRM patients achieve similar day 100 post-transplant responses compared with non-HRM patients, but these responses are not sustained. Post-transplant therapy appeared to improve the poor outcomes of HRM.

  10. Outcomes analysis of hospital management model in restricted budget conditions

    Directory of Open Access Journals (Sweden)

    Virsavia Vaseva

    2016-03-01

    Full Text Available Facing conditions of market economy and financial crisis, the head of any healthcare facility has to take adequate decisions about the cost-effective functioning of the hospital. Along with cost reduction, the main problem is how to maintain a high level of health services. The aim of our study was to analyse the quality of healthcare services after the implementation of control over expenses due to a reduction in the budgetary resources in Military Medical Academy (MMA, Sofia, Bulgaria. Data from the hospital information system and the Financial Department about the incomes and expenditures for patient treatment were used. We conducted a retrospective study on the main components of clinical indicators in 2013 to reveal the main problems in the hospital management. In 2014, control was imposed on the use of the most expensive medicines and consumables. Comparative analysis was made of the results of the medical services in MMA for 2013 and 2014. Our results showed that despite the limited budget in MMA over the last year, the policy of control over operational costs succeeded in maintaining the quality of healthcare services. While reducing the expenses for medicines, consumables and laboratory investigations by ∼26%, some quality criteria for healthcare services were observed to be improved by ∼9%. Financial crisis and budget reduction urge healthcare economists to create adequate economical instruments to assist the normal functioning of hospital facilities. Our analysis showed that when a right policy is chosen, better results may be achieved with fewer resources.

  11. Comparing interval estimates for small sample ordinal CFA models.

    Science.gov (United States)

    Natesan, Prathiba

    2015-01-01

    Robust maximum likelihood (RML) and asymptotically generalized least squares (AGLS) methods have been recommended for fitting ordinal structural equation models. Studies show that some of these methods underestimate standard errors. However, these studies have not investigated the coverage and bias of interval estimates. An estimate with a reasonable standard error could still be severely biased. This can only be known by systematically investigating the interval estimates. The present study compares Bayesian, RML, and AGLS interval estimates of factor correlations in ordinal confirmatory factor analysis models (CFA) for small sample data. Six sample sizes, 3 factor correlations, and 2 factor score distributions (multivariate normal and multivariate mildly skewed) were studied. Two Bayesian prior specifications, informative and relatively less informative were studied. Undercoverage of confidence intervals and underestimation of standard errors was common in non-Bayesian methods. Underestimated standard errors may lead to inflated Type-I error rates. Non-Bayesian intervals were more positive biased than negatively biased, that is, most intervals that did not contain the true value were greater than the true value. Some non-Bayesian methods had non-converging and inadmissible solutions for small samples and non-normal data. Bayesian empirical standard error estimates for informative and relatively less informative priors were closer to the average standard errors of the estimates. The coverage of Bayesian credibility intervals was closer to what was expected with overcoverage in a few cases. Although some Bayesian credibility intervals were wider, they reflected the nature of statistical uncertainty that comes with the data (e.g., small sample). Bayesian point estimates were also more accurate than non-Bayesian estimates. The results illustrate the importance of analyzing coverage and bias of interval estimates, and how ignoring interval estimates can be misleading

  12. Predictive Modeling for End-of-Life Pain Outcome using Electronic Health Records

    Science.gov (United States)

    Lodhi, Muhammad K.; Stifter, Janet; Yao, Yingwei; Ansari, Rashid; Kee-nan, Gail M.; Wilkie, Diana J.; Khokhar, Ashfaq A.

    2016-01-01

    Electronic health record (EHR) systems are being widely used in the healthcare industry nowadays, mostly for monitoring the progress of the patients. EHR data analysis has become a big data problem as data is growing rapidly. Using a nursing EHR system, we built predictive models for determining what factors influence pain in end-of-life (EOL) patients. Utilizing different modeling techniques, we developed coarse-grained and fine-grained models to predict patient pain outcomes. The coarse-grained models help predict the outcome at the end of each hospitalization, whereas fine-grained models help predict the outcome at the end of each shift, thus providing a trajectory of predicted outcomes over the entire hospitalization. These models can help in determining effective treatments for individuals and groups of patients and support standardization of care where appropriate. Using these models may also lower the cost and increase the quality of end-of-life care. Results from these techniques show significantly accurate predictions. PMID:27500287

  13. Comparing rainfall variability, model complexity and hydrological response at the intra-event scale

    Science.gov (United States)

    Cristiano, Elena; ten Veldhuis, Marie-claire; Ochoa-Rodriguez, Susana; van de Giesen, Nick

    2017-04-01

    represents the surface with a dense 2D mesh, based on a high resolution Digital Elevation Map. Nine storm events measured by a dual polarimetric X-Band weather radar, located in Cabauw (CAESAR weather station, NL) were used, with original resolution of 100mx100m in space and 1min in time. Results show that the FD model presents a slightly higher sensitivity to spatial rainfall variability than the SD1 and SD2 model. Model resolution, however, seems to have a small impact on the sensitivity of model outcomes compared to rainfall variability: intensity and intermittency, as well as spatial range and velocity, have a higher influence than model configuration.

  14. Comparing Entrepreneurship Intention: A Multigroup Structural Equation Modeling Approach

    Directory of Open Access Journals (Sweden)

    Sabrina O. Sihombing

    2012-04-01

    Full Text Available Unemployment is one of the main social and economic problems that many countries face nowadays. One strategic way to overcome this problem is by fostering entrepreneurship spirit especially for unem-ployment graduates. Entrepreneurship is becoming an alternative Job for students after they graduate. This is because entrepreneurship of fers major benefits, such as setting up one’s own business and the pos sibility of having significant financial rewards than working for others. Entrepreneurship is then offered by many universities. This research applies the theory of planned behavior (TPB by incorporating attitude toward success as an antecedent variable of the attitude to examine students’ intention to become an entrepreneur. The objective of this research is to compare entrepreneurship intention between business students and non-business students. A self-administered questionnaire was used to collect data for this study. Questionnaires were distributed to respondents by applying the drop-off/pick-up method. A number of 294 by questionnaires were used in the analysis. Data were analyzed by using structural equation modeling. Two out of four hypotheses were confirmed. These hypotheses are the relationship between the attitude toward becoming an entrepreneur and the intention to try becoming an entrepreneur, and the relationship perceived behavioral control and intention to try becoming an entrepreneur. This paper also provides a discussion and offers directions for future research.

  15. Comparing Entrepreneurship Intention: A Multigroup Structural Equation Modeling Approach

    Directory of Open Access Journals (Sweden)

    Sabrina O. Sihombing

    2012-04-01

    Full Text Available Unemployment is one of the main social and economic problems that many countries face nowadays. One strategic way to overcome this problem is by fostering entrepreneurship spirit especially for unem ployment graduates. Entrepreneurship is becoming an alternative Job for students after they graduate. This is because entrepreneurship of-fers major benefits, such as setting up one’s own business and the pos-sibility of having significant financial rewards than working for others. Entrepreneurship is then offered by many universities. This research applies the theory of planned behavior (TPB by incorporating attitude toward success as an antecedent variable of the attitude to examine students’ intention to become an entrepreneur. The objective of this research is to compare entrepreneurship intention between business students and non-business students. A self-administered questionnaire was used to collect data for this study. Questionnaires were distributed to respondents by applying the drop-off/pick-up method. A number of 294 by questionnaires were used in the analysis. Data were analyzed by using structural equation modeling. Two out of four hypotheses were confirmed. These hypotheses are the relationship between the attitude toward becoming an entrepreneur and the intention to try becoming an entrepreneur, and the relationship perceived behavioral control and intention to try becoming an entrepreneur. This paper also provides a discussion and offers directions for future research.

  16. Comparative analysis of marine ecosystems: international production modelling workshop.

    Science.gov (United States)

    Link, Jason S; Megrey, Bernard A; Miller, Thomas J; Essington, Tim; Boldt, Jennifer; Bundy, Alida; Moksness, Erlend; Drinkwater, Ken F; Perry, R Ian

    2010-12-23

    Understanding the drivers that dictate the productivity of marine ecosystems continues to be a globally important issue. A vast literature identifies three main processes that regulate the production dynamics of such ecosystems: biophysical, exploitative and trophodynamic. Exploring the prominence among this 'triad' of drivers, through a synthetic analysis, is critical for understanding how marine ecosystems function and subsequently produce fisheries resources of interest to humans. To explore this topic further, an international workshop was held on 10-14 May 2010, at the National Academy of Science's Jonsson Center in Woods Hole, MA, USA. The workshop compiled the data required to develop production models at different hierarchical levels (e.g. species, guild, ecosystem) for many of the major Northern Hemisphere marine ecosystems that have supported notable fisheries. Analyses focused on comparable total system biomass production, functionally equivalent species production, or simulation studies for 11 different marine fishery ecosystems. Workshop activities also led to new analytical tools. Preliminary results suggested common patterns driving overall fisheries production in these ecosystems, but also highlighted variation in the relative importance of each among ecosystems.

  17. Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study.

    Science.gov (United States)

    Sun, Jian-Jun; Wang, Zhen-Yu; Teo, Mario; Li, Zhen-Dong; Wu, Hai-Bo; Yen, Ru-Yu; Zheng, Mei; Chang, Qing; Yisha Liu, Isabelle

    2013-01-01

    This prospective study compares different clinical characteristics and outcomes of patients with two types of sacral extradural spinal meningeal cysts (SESMC) undergoing different means of surgical excision. Using the relationship between the cysts and spinal nerve roots fibers (SNRF) as seen under microscope, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. The surgical methods were tailored to the different types of SESMCs. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function of the patients. Preoperative IJOA scores were 18.5 ± 1.73, and postoperative IJOA scores were 19.6 ± 0.78. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -4.52, p = 0.0001), with a significant improvement in neurological function after surgery. Among the improvements in neurological functions, the most significant was sensation (z=-2.74, p=0.006), followed by bowel/bladder function (z=-2.50, p=0.01). There was a statistically significant association between the types of SESMC and the number (F=12.57, p=0.001) and maximum diameter (F=8.08, p=0.006) of the cysts. SESMC with SNRF are often multiple and small, while cysts without SNRF tend to be solitary and large. We advocate early surgical intervention for symptomatic SESMCs in view of significant clinical improvement postoperatively.

  18. Feline cutaneous mast cell tumours: a UK-based study comparing signalment and histological features with long-term outcomes.

    Science.gov (United States)

    Melville, Kirsty; Smith, Ken C; Dobromylskyj, Melanie J

    2015-06-01

    Feline cutaneous mast cell tumours (MCTs) are the second most common skin tumour in cats; but, unlike in dogs, there is currently no histological grading system for this type of tumour. This study recorded the signalment and anatomical location from a total of 287 records from MCTs submitted to a UK commercial diagnostic laboratory. Questionnaires to submitting practices were used to obtain follow-up data, and the histological features of 86 tumours were evaluated from 69 cats with a known outcome. Twelve of the 69 cats (17.4%) died of MCTs, with significantly lower survival times. The median age of cats presenting with MCTs was 11 years (range 5 months-19 years), with no sex or neutered status predilection. Some pedigree breeds were more susceptible to MCTs, particularly the Siamese, Burmese, Russian Blue and Ragdoll. The head was the most common site in younger cats, compared with the trunk in older cats. The number of tumours had no effect on survival. A new subcategory of well-differentiated MCTs with prominent multinucleated cells is described, and three of the five cats with this novel form died from MCT-related disease. There was an association between mitotic index and survival time. However, there was no significant association between histological type and survival.

  19. Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

    Science.gov (United States)

    Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

    2013-03-01

    Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

  20. Does Percutaneous Kyphoplasty Have Better Functional Outcome Than Vertebroplasty in Single Level Osteoporotic Compression Fractures? A Comparative Prospective Study

    Directory of Open Access Journals (Sweden)

    F. Omidi-Kashani

    2013-01-01

    Full Text Available Purpose. To evaluate the relative differences in surgical outcome of kyphoplasty (KP versus vertebroplasty (VP in the patients with single level refractory osteoporotic compression fractures (OCFs. Method. From August 2008 to May 2012, we intermittently treated 57 patients with single level OCF by PV and KP (Groups A and B, resp.. We used visual analogue scale (VAS and short form 36 (SF36 questionnaire to measure functional recovery and followed them for six months. Independent samples t- and Kendall’s tau-b tests were for statistics. Results. In terms of age, number, and bone mineral density of the patients, there were no significant differences between the two groups. In both groups, VAS and SF-36 scores improved significantly and remained relatively stable throughout the follow-up period. We had 9 and 6 asymptomatic cement extravasations and 5 and 8 new vertebral fractures in Group A and B, respectively. In comparing the two groups, the results indicated that KP almost failed to show any significant higher effect relative to VP during this period. Conclusions. In considering the high cost of KP relative to VP in the developing countries like Iran, there is no logical reason to use KP in a single level refractory OCF in these regions.

  1. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years.

    Science.gov (United States)

    Pailhé, Régis; Reina, Nicolas; Cavaignac, Etienne; Sharma, Akash; Lafontan, Valérie; Laffosse, Jean-Michel; Chiron, Philippe

    2013-01-01

    There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS) and Postel-Merle d'Aubigné (MDA) score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1) [100 Durom(®) (Zimmer Inc., Warsaw, IN, USA) and 42 Birmingham Hip Resurfacing(®) (Smith & Nephew, Memphis, TN, USA)] and 278 patients with total hip arthroplasty (group 2). The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001). In group 1 we observed 6 complications only concerned males with Durom(®) implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  2. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years

    Directory of Open Access Journals (Sweden)

    Régis Pailhé

    2013-07-01

    Full Text Available There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS and Postel-Merle d’Aubigné (MDA score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1 [100 Durom® (Zimmer Inc., Warsaw, IN, USA and 42 Birmingham Hip Resurfacing® (Smith & Nephew, Memphis, TN, USA] and 278 patients with total hip arthroplasty (group 2. The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001. In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  3. A theoretical model of health-related outcomes of resilience in middle adolescents.

    Science.gov (United States)

    Scoloveno, Robert

    2015-03-01

    There is a dearth of knowledge about the health outcomes of resilience during adolescence, making the study of health-related outcomes of resilience important. The purpose of this study was to develop a theory-based just-identified model and to test the direct and indirect effects of resilience on hope, well-being, and health-promoting lifestyle in middle adolescents. The study used a correlational design. The final sample consisted of 311 middle adolescents, aged 15 to 17, who were recruited from a public high school. Participants responded to instrument packets in classroom settings. The structural equation model was tested with the LISREL 8.80 software program. All seven hypotheses were supported at a statistically significant level (p resilience. Alternate models of outcomes of resilience need to be tested on adolescents.

  4. Insight, psychopathology, explanatory models and outcome of schizophrenia in India: a prospective 5-year cohort study

    Directory of Open Access Journals (Sweden)

    Johnson Shanthi

    2012-09-01

    Full Text Available Abstract Background The sole focus of models of insight on bio-medical perspectives to the complete exclusion of local, non-medical and cultural constructs mandates review. This study attempted to investigate the impact of insight, psychopathology, explanatory models of illness on outcome of first episode schizophrenia. Method Patients diagnosed to have DSM IV schizophrenia (n = 131 were assessed prospectively for insight, psychopathology, explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Multiple linear and logistic regression and generalized estimating equations (GEE were employed to assess predictors of outcome. Results We could follow up 95 (72.5% patients. Sixty-five of these patients (68.4% achieved remission. There was a negative relationship between psychosis rating and insight scores. Urban residence, fluctuating course of the initial illness, and improvement in global functioning at 6 months and lower psychosis rating at 12 months were significantly related to remission at 5 years. Insight scores, number of non-medical explanatory models and individual explanatory models held during the later course of the illness were significantly associated with outcome. Analysis of longitudinal data using GEE showed that women, rural residence, insight scores and number of non-medical explanatory models of illness held were significantly associated with BPRS scores during the study period. Conclusions Insight, the disease model and the number of non-medical model positively correlated with improvement in psychosis arguing for a complex interaction between the culture, context and illness variables. These finding argue that insight and explanatory models are secondary to psychopathology, course and outcome of the illness. The awareness of mental illness is a narrative act in which people make personal sense of the many challenges they face. The course and outcome of the illness, cultural context

  5. Clinical Outcomes of the Marginal Ulcer Bleeding after Gastrectomy: As Compared to the Peptic Ulcer Bleeding with Nonoperated Stomach

    Directory of Open Access Journals (Sweden)

    Woo Chul Chung

    2012-01-01

    Full Text Available Background. Marginal ulcer is a well-known complication after gastrectomy. Its bleeding can be severe, but the severity has rarely been reported. We aim to evaluate the clinical outcomes of marginal ulcer bleeding (MUB as compared to peptic ulcer bleeding (PUB with nonoperated stomach. Methods. A consecutive series of patients who had nonvariceal upper gastrointestinal bleeding and admitted to the hospital between 2005 and 2011 were retrospectively analyzed. A total of 530 patients were enrolled in this study, and we compared the clinical characteristics between 70 patients with MUB and 460 patients with PUB. Results. Patients with MUB were older (mean age: 62.86±10.59 years versus 53.33±16.68 years, P=0.01. The initial hemoglobin was lower (8.16±3.05 g/dL versus 9.38±2.49 g/dL, P=0.01, and the duration of admission was longer in MUB (7.14±4.10 days versus 5.90±2.97 days, P=0.03. After initial hemostasis, the rebleeding rate during admission was higher (16.2% versus 6.5%, P=0.01 in MUB. However, the mortality rate did not differ statistically between MUB and PUB groups. Helicobacter pylori-positive rate with MUB was lower than that of PUB (19.4% versus 54.4%, P=0.01. Conclusions. Clinically, MUB after gastrectomy is more severe than PUB with nonoperated stomach. Infection with H. pylori might not appear to play an important role in MUB after gastrectomy.

  6. The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala.

    Science.gov (United States)

    Usha, M; Ravindran, V; Soumithran, C S; Ravindran Nair, K S

    2014-06-01

    Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala. Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period. The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period. Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

  7. Comparative analysis of business rules and business process modeling languages

    Directory of Open Access Journals (Sweden)

    Audrius Rima

    2013-03-01

    Full Text Available During developing an information system is important to create clear models and choose suitable modeling languages. The article analyzes the SRML, SBVR, PRR, SWRL, OCL rules specifying language and UML, DFD, CPN, EPC and IDEF3 BPMN business process modeling language. The article presents business rules and business process modeling languages theoretical comparison. The article according to selected modeling aspects of the comparison between different business process modeling languages ​​and business rules representation languages sets. Also, it is selected the best fit of language set for three layer framework for business rule based software modeling.

  8. Modelling constructed wetlands: scopes and aims - a comparative review

    OpenAIRE

    Meyer, D; Chazarenc, Florent; Claveau Mallet, D.; Dittmer, D; Forquet, N.; Molle, P.; Morvannou, A.; Palfy, T.; Petitjean, A; Rizzo, A.; Samso Campa, R.; Scholz, M.; Soric, Audrey; Langergraber, G.

    2015-01-01

    International audience; During the last two decades a couple of models were developed for constructed wetlands with differing purposes. Meanwhile the usage of this kind of tool is generally accepted, but the misuse of the models still confirms the skepticism. Generally three some groups of models can be distinguished: On one hand mechanistic models try to display the complex and diffuse interaction of occurring processes, on the other hand the same kind of models is are used to investigate si...

  9. A model to advance nursing science in trauma practice and injury outcomes research.

    Science.gov (United States)

    Richmond, Therese S; Aitken, Leanne M

    2011-12-01

    This discussion paper reports development of a model to advance nursing science and practice in trauma care based on an analysis of the literature and expert opinion. The continuum of clinical care provided to trauma patients extends from the time of injury through to long-term recovery and final outcomes. Nurses bring a unique expertise to meet the complex physical and psychosocial needs of trauma patients and their families to influence outcomes across this entire continuum. Literature was obtained by searching CINAHL, PubMed and OvidMedline databases for 1990-2010. Search terms included trauma, nursing, scope of practice and role, with results restricted to those published in English. Manual searches of relevant journals and websites were undertaken. Core concepts in this trauma outcomes model include environment, person/family, structured care settings, long-term outcomes and nursing interventions. The relationships between each of these concepts extend across all phases of care. Intermediate outcomes are achieved in each phase of care and influence and have congruence with long-term outcomes. Implications for policy and practice.  This model is intended to provide a framework to assist trauma nurses and researchers to consider the injured person in the context of the social, economic, cultural and physical environment from which they come and the long-term goals that each person has during recovery. The entire model requires testing in research and assessment of its practical contribution to practice. Planning and integrating care across the trauma continuum and recognition of the role of the injured person's background, family and resources will lead to improved long-term outcomes. © 2011 Blackwell Publishing Ltd.

  10. An evidence synthesis of care models to improve general medical outcomes for individuals with serious mental illness: a systematic review.

    Science.gov (United States)

    Bradford, Daniel W; Cunningham, Natasha T; Slubicki, Monica N; McDuffie, Jennifer R; Kilbourne, Amy M; Nagi, Avishek; Williams, John W

    2013-08-01

    To conduct a systematic review of studies of interventions that integrated medical and mental health care to improve general medical outcomes in individuals with serious mental illness. English-language publications in MEDLINE (via PubMed), EMBASE, PsycINFO, and the Cochrane Library, from database inception through January 18, 2013, were searched using terms for our diagnoses of interest, a broad set of terms for care models, and a set of terms for randomized controlled trials (RCTs) or quasi-experimental design. Bibliographies of included articles were examined for additional sources. ClinicalTrials.gov was searched using the terms for our diagnoses of interest (serious mental illness,SMI,bipolar disorder,schizophrenia,orschizoaffective disorder) to assess for evidence of publication bias and ongoing studies. 4 RCTs were included from 1,729 articles reviewed. Inclusion criteria were RCT or quasi-experimental design; adult outpatient population with 25% or greater carrying a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder; intervention with a stated goal to improve medical outcomes through integration of care, using a comparator of usual care or other quality improvement strategy; and outcomes assessing process of care, clinical outcomes, or physical functioning. A trained researcher abstracted the following data from the included articles: study design, funding source, setting, population characteristics, eligibility and exclusion criteria, number of subjects and providers, intervention(s), comparison(s), length of follow-up, and outcome(s). These abstracted data were then overread by a second reviewer. Of the 4 studies reviewed, 2 good-quality studies (according to the guidelines of the Agency for Healthcare Research and Quality) that evaluated processes of preventive and chronic disease care demonstrated positive effects of integrated care. Specifically, integrated care interventions were associated with increased rates of immunization

  11. Comparative study on mode split discrete choice models

    Institute of Scientific and Technical Information of China (English)

    Xianlong Chen; Xiaoqian Liu; Fazhi Li

    2013-01-01

    Discrete choice model acts as one of the most important tools for studies involving mode split in the context of transport demand forecast. As different types of discrete choice models display their merits and restrictions diversely, how to properly select the specific type among discrete choice models for realistic application still remains to be a tough problem. In this article, five typical discrete choice models for transport mode split are, respectively, discussed, which includes multinomial logit model, nested logit model (NL), heteroscedastic extreme value model, multinominal probit model and mixed multinomial logit model (MMNL). The theoretical basis and application attributes of these five models are especially analysed with great attention, and they are also applied to a realistic intercity case of mode split forecast, which results indi-cating that NL model does well in accommodating simi-larity and heterogeneity across alternatives, while MMNL model serves as the most effective method for mode choice prediction since it shows the highest reliability with the least significant prediction errors and even outperforms the other four models in solving the heterogeneity and similarity problems. This study indicates that conclusions derived from a single discrete choice model are not reli-able, and it is better to choose the proper model based on its characteristics.

  12. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae

    2015-04-23

    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  13. Characteristics and outcome of patients with primary CNS lymphoma in a "real-life" setting compared to a clinical trial.

    Science.gov (United States)

    Zeremski, Vanja; Koehler, Michael; Fischer, Thomas; Schalk, Enrico

    2016-04-01

    We aimed to compare the characteristics and outcome of patients treated within the multi-centre German Primary CNS Lymphoma Study Group 1 trial (G-PCNSL-SG-1; TRIAL group) and patients treated outside this clinical trial ("real-life" setting, R-LIFE group). Therefore, we conducted a retrospective single-centre study in order to analyse all patients with newly diagnosed primary CNS lymphoma (PCNSL) treated consecutively in our institution between November 2000 and June 2015. Altogether, 86 patients were analysed (median 68 years). Twenty patients were treated within (TRIAL) and 66 patients outside the clinical trial (R-LIFE), respectively. The majority (n = 75; 87 %) received high-dose methotrexate as the first-line treatment. Thirty-eight of 66 patients (57.6 %) responded to the first-line therapy. The R-LIFE patients were older (median age 70 vs. 62 years; p = 0.005) and had more frequently a worse performance status (ECOG score 2-4: 59.1 vs. 20.0 %; p = 0.004; median Karnofsky index 70 vs. 80 %; p = 0.003) and less frequently a low prognostic score (IELSG score 0-1: 19.7 vs. 45.0 %; p = 0.038), than the TRIAL patients. Median overall survial (OS) was shorter for the R-LIFE patients (9.3 months [95 % CI 1.9-16.7] vs. 33.4 months [95 % CI 17.6-49.2]; p = 0.065). Median progression-free survival (PFS) was significantly inferior for the R-LIFE patients (3.4 months [95 % CI 2.4-4.4] vs. 24.8 months [95 % CI 4.6-45.0]; p = 0.037). Our data indicate that the outcome of PCNSL patients treated outside, but about analogous to the G-PCNSL-SG-1 trial, was poor. This is likely explained by more unfavourable prognostic factors in patients being treated off trial.

  14. Orthodontic measurements on digital study models compared with plaster models: a systematic review.

    Science.gov (United States)

    Fleming, P S; Marinho, V; Johal, A

    2011-02-01

    The aim of this study is to evaluate the validity of the use of digital models to assess tooth size, arch length, irregularity index, arch width and crowding versus measurements generated on hand-held plaster models with digital callipers in patients with and without malocclusion. Studies comparing linear and angular measurements obtained on digital and standard plaster models were identified by searching multiple databases including MEDLINE, LILACS, BBO, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis database, without restrictions relating to publication status or language of publication. Two authors were involved in study selection, quality assessment and the extraction of data. Items from the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews checklist were used to assess the methodological quality of included studies. No meta-analysis was conducted. Comparisons between measurements of digital and plaster models made directly within studies were reported, and the difference between the (repeated) measurement means for digital and plaster models were considered as estimates. Seventeen relevant studies were included. Where reported, overall, the absolute mean differences between direct and indirect measurements on plaster and digital models were minor and clinically insignificant. Orthodontic measurements with digital models were comparable to those derived from plaster models. The use of digital models as an alternative to conventional measurement on plaster models may be recommended, although the evidence identified in this review is of variable quality. © 2010 John Wiley & Sons A/S.

  15. A Comparative Metroscope Model for Urban Information Flows

    Science.gov (United States)

    Fink, J. H.; Shandas, V.; Beaudoin, F.

    2011-12-01

    One of the most promising ways to achieve global sustainability goals of climate stabilization, poverty reduction, and biodiversity preservation is to make the world's cities more efficient, equitable, and healthful. While each city must follow a unique and somewhat idiosyncratic path toward these linked goals based on its history, geography, demography, and politics, movement in this direction can accelerate if cities can learn from each other more effectively. Such learning requires the identification of common characteristics and methodologies. We have created a framework for organizing and applying urban information flows, which we refer to as "Metroscopes." Metroscopes, which are analogous to the large instruments that have advanced the physical and life sciences, integrate six elements: data collection and input; classification through the use of metrics; data storage and retrieval; analytics and modeling; decision support including visualization and scenario generation; and assessment of the effectiveness of policy choices. Standards for each of these elements can be agreed upon by relevant urban science and policy sub-communities, and then can evolve as technologies and practices advance. We are implementing and calibrating this approach using data and relationships from Portland (OR), Phoenix (AZ) and London (UK). Elements that are being integrated include the Global City Indicators Facility at University of Toronto, the J-Earth database system and Decision Theater from Arizona State University, urban mobility analyses performed by the SENSEable City Lab at MIT, and Portland's Ecodistrict approach for urban management. Individual Metroscopes can be compared directly from one city to another, or with larger assemblages of cities like those being classified by ICLEI's STAR program, the Clinton Climate Initiative's C40, and Siemens Green Cities Index. This large-scale integration of urban data sets and approaches and its systematic comparison are key steps

  16. A randomized controlled trial comparing the effects of counseling and alarm device on HAART adherence and virologic outcomes.

    Directory of Open Access Journals (Sweden)

    Michael H Chung

    2011-03-01

    Full Text Available BACKGROUND: Behavioral interventions that promote adherence to antiretroviral medications may decrease HIV treatment failure. Antiretroviral treatment programs in sub-Saharan Africa confront increasing financial constraints to provide comprehensive HIV care, which include adherence interventions. This study compared the impact of counseling and use of an alarm device on adherence and biological outcomes in a resource-limited setting. METHODS AND FINDINGS: A randomized controlled, factorial designed trial was conducted in Nairobi, Kenya. Antiretroviral-naïve individuals initiating free highly active antiretroviral therapy (HAART in the form of fixed-dose combination pills (d4T, 3TC, and nevirapine were randomized to one of four arms: counseling (three counseling sessions around HAART initiation, alarm (pocket electronic pill reminder carried for 6 months, counseling plus alarm, and neither counseling nor alarm. Participants were followed for 18 months after HAART initiation. Primary study endpoints included plasma HIV-1 RNA and CD4 count every 6 months, mortality, and adherence measured by monthly pill count. Between May 2006 and September 2008, 400 individuals were enrolled, 362 initiated HAART, and 310 completed follow-up. Participants who received counseling were 29% less likely to have monthly adherence <80% (hazard ratio [HR] = 0.71; 95% confidence interval [CI] 0.49-1.01; p = 0.055 and 59% less likely to experience viral failure (HIV-1 RNA ≥5,000 copies/ml (HR 0.41; 95% CI 0.21-0.81; p = 0.01 compared to those who received no counseling. There was no significant impact of using an alarm on poor adherence (HR 0.93; 95% CI 0.65-1.32; p = 0.7 or viral failure (HR 0.99; 95% CI 0.53-1.84; p = 1.0 compared to those who did not use an alarm. Neither counseling nor alarm was significantly associated with mortality or rate of immune reconstitution. CONCLUSIONS: Intensive early adherence counseling at HAART initiation resulted

  17. Comparing three models to estimate transpiration of desert shrubs

    Science.gov (United States)

    Xu, Shiqin; Yu, Zhongbo; Ji, Xibin; Sudicky, Edward A.

    2017-07-01

    The role of environmental variables in controlling transpiration (Ec) is an important, but not well-understood, aspect of transpiration modeling in arid desert regions. Taking three dominant desert shrubs, Haloxylon ammodendron, Nitraria tangutorum, and Calligonum mongolicum, as examples, we aim to evaluate the applicability of three transpiration models, i.e. the modified Jarvis-Stewart model (MJS), the simplified process-based model (BTA), and the artificial neural network model (ANN) at different temporal scales. The stem sap flow of each species was monitored using the stem heat balance approach over both the 2014 and 2015 main growing seasons. Concurrent environmental variables were also measured with an automatic weather station. The ANN model generally produced better simulations of Ec than the MJS and BTA models at both hourly and daily scales, indicating its advantage in solving complicated, nonlinear problems between transpiration rate and environmental driving forces. The solar radiation and vapor pressure deficit were crucial variables in modeling Ec for all three species. The performance of the MJS and ANN models was significantly improved by incorporating root-zone soil moisture. We also found that the difference between hourly and daily fitted parameter values was considerable for the MJS and BTA models. Therefore, these models need to be recalibrated when applied at different temporal scales. This study provides insights regarding the application and performance of current transpiration models in arid desert regions, and thus provides a deeper understanding of eco-hydrological processes and sustainable ecosystem management at the study site.

  18. A Model of Comparative Ethics Education for Social Workers

    Science.gov (United States)

    Pugh, Greg L.

    2017-01-01

    Social work ethics education models have not effectively engaged social workers in practice in formal ethical reasoning processes, potentially allowing personal bias to affect ethical decisions. Using two of the primary ethical models from medicine, a new social work ethics model for education and practical application is proposed. The strengths…

  19. A comparative analysis of pricing models for enterprise cloud platforms

    CSIR Research Space (South Africa)

    Mvelase, P

    2013-09-01

    Full Text Available virtual enterprise (VE)-enabled cloud enterprise architecture for small medium and micro enterprises (SMMEs) against EC2 pricing model to prove that our pricing model is more suitable for small medium and micro enterprises (SMMEs). This model is based...

  20. Predicting the fate of biodiversity using species' distribution models: enhancing model comparability and repeatability.

    Directory of Open Access Journals (Sweden)

    Genoveva Rodríguez-Castañeda

    Full Text Available Species distribution modeling (SDM is an increasingly important tool to predict the geographic distribution of species. Even though many problems associated with this method have been highlighted and solutions have been proposed, little has been done to increase comparability among studies. We reviewed recent publications applying SDMs and found that seventy nine percent failed to report methods that ensure comparability among studies, such as disclosing the maximum probability range produced by the models and reporting on the number of species occurrences used. We modeled six species of Falco from northern Europe and demonstrate that model results are altered by (1 spatial bias in species' occurrence data, (2 differences in the geographic extent of the environmental data, and (3 the effects of transformation of model output to presence/absence data when applying thresholds. Depending on the modeling decisions, forecasts of the future geographic distribution of Falco ranged from range contraction in 80% of the species to no net loss in any species, with the best model predicting no net loss of habitat in Northern Europe. The fact that predictions of range changes in response to climate change in published studies may be influenced by decisions in the modeling process seriously hampers the possibility of making sound management recommendations. Thus, each of the decisions made in generating SDMs should be reported and evaluated to ensure conclusions and policies are based on the biology and ecology of the species being modeled.

  1. Predicting the fate of biodiversity using species' distribution models: enhancing model comparability and repeatability.

    Science.gov (United States)

    Rodríguez-Castañeda, Genoveva; Hof, Anouschka R; Jansson, Roland; Harding, Larisa E

    2012-01-01

    Species distribution modeling (SDM) is an increasingly important tool to predict the geographic distribution of species. Even though many problems associated with this method have been highlighted and solutions have been proposed, little has been done to increase comparability among studies. We reviewed recent publications applying SDMs and found that seventy nine percent failed to report methods that ensure comparability among studies, such as disclosing the maximum probability range produced by the models and reporting on the number of species occurrences used. We modeled six species of Falco from northern Europe and demonstrate that model results are altered by (1) spatial bias in species' occurrence data, (2) differences in the geographic extent of the environmental data, and (3) the effects of transformation of model output to presence/absence data when applying thresholds. Depending on the modeling decisions, forecasts of the future geographic distribution of Falco ranged from range contraction in 80% of the species to no net loss in any species, with the best model predicting no net loss of habitat in Northern Europe. The fact that predictions of range changes in response to climate change in published studies may be influenced by decisions in the modeling process seriously hampers the possibility of making sound management recommendations. Thus, each of the decisions made in generating SDMs should be reported and evaluated to ensure conclusions and policies are based on the biology and ecology of the species being modeled.

  2. A comparative study of aerosol deposition in different lung models.

    Science.gov (United States)

    Yu, C P; Diu, C K

    1982-01-01

    Theoretical calculations are made on total and regional deposition of inhaled particles in the human respiratory system based upon various current lung models. It is found that although total deposition does not vary appreciably from model to model, considerably large differences are present in regional deposition. Deposition profiles along the airways from different models also show very different patterns. These differences can be explained in terms of airway dimensions and the number of structures in different models. Extension to explain intersubject variability is also made.

  3. Lithium-ion battery models: a comparative study and a model-based powerline communication

    Science.gov (United States)

    Saidani, Fida; Hutter, Franz X.; Scurtu, Rares-George; Braunwarth, Wolfgang; Burghartz, Joachim N.

    2017-09-01

    In this work, various Lithium-ion (Li-ion) battery models are evaluated according to their accuracy, complexity and physical interpretability. An initial classification into physical, empirical and abstract models is introduced. Also known as white, black and grey boxes, respectively, the nature and characteristics of these model types are compared. Since the Li-ion battery cell is a thermo-electro-chemical system, the models are either in the thermal or in the electrochemical state-space. Physical models attempt to capture key features of the physical process inside the cell. Empirical models describe the system with empirical parameters offering poor analytical, whereas abstract models provide an alternative representation. In addition, a model selection guideline is proposed based on applications and design requirements. A complex model with a detailed analytical insight is of use for battery designers but impractical for real-time applications and in situ diagnosis. In automotive applications, an abstract model reproducing the battery behavior in an equivalent but more practical form, mainly as an equivalent circuit diagram, is recommended for the purpose of battery management. As a general rule, a trade-off should be reached between the high fidelity and the computational feasibility. Especially if the model is embedded in a real-time monitoring unit such as a microprocessor or a FPGA, the calculation time and memory requirements rise dramatically with a higher number of parameters. Moreover, examples of equivalent circuit models of Lithium-ion batteries are covered. Equivalent circuit topologies are introduced and compared according to the previously introduced criteria. An experimental sequence to model a 20 Ah cell is presented and the results are used for the purposes of powerline communication.

  4. Lithium-ion battery models: a comparative study and a model-based powerline communication

    Directory of Open Access Journals (Sweden)

    F. Saidani

    2017-09-01

    Full Text Available In this work, various Lithium-ion (Li-ion battery models are evaluated according to their accuracy, complexity and physical interpretability. An initial classification into physical, empirical and abstract models is introduced. Also known as white, black and grey boxes, respectively, the nature and characteristics of these model types are compared. Since the Li-ion battery cell is a thermo-electro-chemical system, the models are either in the thermal or in the electrochemical state-space. Physical models attempt to capture key features of the physical process inside the cell. Empirical models describe the system with empirical parameters offering poor analytical, whereas abstract models provide an alternative representation. In addition, a model selection guideline is proposed based on applications and design requirements. A complex model with a detailed analytical insight is of use for battery designers but impractical for real-time applications and in situ diagnosis. In automotive applications, an abstract model reproducing the battery behavior in an equivalent but more practical form, mainly as an equivalent circuit diagram, is recommended for the purpose of battery management. As a general rule, a trade-off should be reached between the high fidelity and the computational feasibility. Especially if the model is embedded in a real-time monitoring unit such as a microprocessor or a FPGA, the calculation time and memory requirements rise dramatically with a higher number of parameters. Moreover, examples of equivalent circuit models of Lithium-ion batteries are covered. Equivalent circuit topologies are introduced and compared according to the previously introduced criteria. An experimental sequence to model a 20 Ah cell is presented and the results are used for the purposes of powerline communication.

  5. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  6. Combining the Performance Strengths of the Logistic Regression and Neural Network Models: A Medical Outcomes Approach

    Directory of Open Access Journals (Sweden)

    Wun Wong

    2003-01-01

    Full Text Available The assessment of medical outcomes is important in the effort to contain costs, streamline patient management, and codify medical practices. As such, it is necessary to develop predictive models that will make accurate predictions of these outcomes. The neural network methodology has often been shown to perform as well, if not better, than the logistic regression methodology in terms of sample predictive performance. However, the logistic regression method is capable of providing an explanation regarding the relationship(s between variables. This explanation is often crucial to understanding the clinical underpinnings of the disease process. Given the respective strengths of the methodologies in question, the combined use of a statistical (i.e., logistic regression and machine learning (i.e., neural network technology in the classification of medical outcomes is warranted under appropriate conditions. The study discusses these conditions and describes an approach for combining the strengths of the models.

  7. Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil

    Science.gov (United States)

    Pires, Carla Andréa Avelar; Jucá Neto, Fernando Octávio Machado; de Albuquerque, Nahima Castelo; Macedo, Geraldo Mariano Moraes; Batista, Keila de Nazaré Madureira; Xavier, Marília Brasil

    2015-01-01

    Background Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. Methodology/Principal Findings Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. Conclusions/Significance This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses. PMID:26029928

  8. The comparative, long-term effect of the Salter osteotomy and Pemberton acetabuloplasty on pelvic height, scoliosis and functional outcome.

    Science.gov (United States)

    Wang, C-W; Wang, T-M; Wu, K-W; Huang, S-C; Kuo, K N

    2016-08-01

    This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145-50. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Perinatal outcome of illicit substance use in pregnancy--comparative and contemporary socio-clinical profile in the UK.

    Science.gov (United States)

    Goel, Nitin; Beasley, Dana; Rajkumar, Veena; Banerjee, Sujoy

    2011-02-01

    The aim of the study was to determine the contemporary socio-clinical profile and perinatal outcome of illicit substance use in pregnancy in a large UK city and compare with published literature. Cases were identified retrospectively from the 'cause for concern' referrals over 5 years (2003-2007). Data was collected on mother-infant pair from medical notes and laboratory records. Chi-square and Mann-Whitney U tests were used where appropriate for statistical analysis. One hundred sixty-eight women were identified as using illicit substance in pregnancy. Smoking (97.4%), unemployment (85.4%) and single status (42.3%) were frequent. Besides controlled use of methadone, heroin, cannabis and benzodiazepines were the most commonly used drugs. Hepatitis C prevalence was high (29.9%) despite low antenatal screening rates (57.7%). Neonatal morbidity was related to prematurity (22.9%), small for dates (28.6%) and neonatal abstinence syndrome (NAS; 58.9%). By day 5 of life, 95.1% of the babies developing NAS and 96.1% of those requiring pharmacological treatment were symptomatic. Of the infants developing NAS, 31.7% required pharmacological treatment. A total of 82.5% babies went home with their mother, and 21.2% were placed on the Child Protection Register. Only 14.3% were breast feeding at discharge. Illicit substance use in pregnancy continues to be associated with significant maternal and neonatal morbidity, and the socio-clinical profile in this decade appears unchanged in the UK. Hepatitis C prevalence is high, and detection should be improved through targeted antenatal screening. Where facility in the community is unavailable, 5 days of hospital stay is sufficient to safely identify babies at risk of developing NAS. Most babies were discharged home with their mother.

  10. Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

    Directory of Open Access Journals (Sweden)

    Xiao-Fang Tang

    2015-01-01

    Full Text Available Background: Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy. This study was to compare two tests, light transmittance aggregometry (LTA and modified thrombelastography (mTEG, for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI. Methods: Prospective, observational, single-center study of 789 Chinese patients undergoing PCI was enrolled. This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC analysis for major adverse cardiovascular events (MACEs at 1-year follow-up. Results: MACEs occurred in 32 patients (4.1%. Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r = 0.733, P < 0.001. ROC-curve analysis demonstrated that LTA (area under the curve [AUC]: 0.677; 95% confidence interval [CI]: 0.643-0.710; P = 0.0009, and mTEG (AUC: 0.684; 95% CI: 0.650-0.716; P = 0.0001 had moderate ability to discriminate between patients with and without MACE. MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR when assessed by LTA (7.4% vs. 2.7%; P < 0.001, and by TEG (6.7% vs. 2.6%; P < 0.001. Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up. Conclusions: The correlation between LTA and mTEG is relatively high in Chinese patients. HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

  11. Comparing of Light Transmittance Aggregometry and Modified Thrombelastograph in Predicting Clinical Outcomes in Chinese Patients Undergoing Coronary Stenting with Clopidogrel

    Institute of Scientific and Technical Information of China (English)

    Xiao-Fang Tang; Ya-Ling Han; Jia-Hui Zhang; Jing Wang; Yin Zhang; Bo Xu; Zhan Gao

    2015-01-01

    Background:Several platelet function tests are currently used to measure responsiveness to antiplatelet therapy.This study was to compare two tests,light transmittance aggregometry (LTA) and modified thrombelastography (mTEG),for predicting clinical outcomes in Chinese patients after percutaneous coronary intervention (PCI).Methods:Prospective,observational,single-center study of 789 Chinese patients undergoing PCI was enrolled.This study was investigated the correlations between the two tests and performed receiver operating characteristic curve (ROC) analysis for major adverse cardiovascular events (MACEs) at 1-year follow-up.Results:MACEs occurred in 32 patients (4.1%).Correlations were well between the two tests in the adenosine diphosphate induced platelet reactivity (Spearman r =0.733,P < 0.001).ROC-curve analysis demonstrated that LTA (area under the curve [AUC]:0.677; 95% confidence interval [CI]:0.643-0.710; P =0.0009),and mTEG (AUC:0.684; 95% CI:0.650-0.716; P =0.0001) had moderate ability to discriminate between patients with and without MACE.MACE occurred more frequently in patients with high on-treatment platelet reactivity (HPR) when assessed by LTA (7.4% vs.2.7%; P < 0.001),and by TEG (6.7% vs.2.6%; P < 0.001).Kaplan-Meier analysis demonstrated that HPR based on the LTA and mTEG was associated with almost 3-fold increased risk of MACE at 1-year follow-up.Conclusions:The correlation between LTA and mTEG is relatively high in Chinese patients.HPR measured by LTA and mTEG were significantly associated with MACE in Chinese patients undergoing PCI.

  12. The procedure outcome of laparoscopic resection for ‘small’ hepatocellular carcinoma is comparable to vlaparoscopic radiofrequency ablation

    Science.gov (United States)

    Casaccia, Marco; Santori, Gregorio; Bottino, Giuliano; Diviacco, Pietro; Negri, Antonella De; Moraglia, Eva; Adorno, Enzo

    2015-01-01

    BACKGROUND: The aim of this study was to compare the effectiveness of laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) in the treatment of small nodular hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We enrolled 50 cirrhotic patients with similar baseline characteristics that underwent LLR (n = 26) or LRFA (n = 24), in both cases with intraoperative ultrasonography. Operative and peri-operative data were retrospectively evaluated. RESULTS: LLR included anatomic resection in eight cases and non-anatomic resection in 18. In LRFA patients, a thermoablation of 62 nodules was achieved. Between LLR and LRFA groups, a significant difference was found both for median diameters of treated HCC nodules (30 vs. 17.1 mm; P < 0.001) and the number of treated nodules/patient (1.29 ± 0.62 vs. 2.65 ± 1.55; P < 0.001). A conversion to laparotomy occurred in two LLR patient (7.7%) for bleeding. No deaths occurred in both groups. Morbidity rates were 26.9% in the LLR group versus 16.6% in the LRFA group (P = 0.501). Hospital stay in the LLR and LRFA group was 8.30 ± 6.52 and 6.52 ± 2.69 days, respectively (P = 0.022). The surgical margin was free of tumour cells in all LLR patients, with a margin <5 mm in only one case. In the LRFA group, a complete response was achieved in 90.3% of thermoablated HCC nodules at the 1-month post-treatment computed tomography evaluation. CONCLUSIONS: LLR for small peripheral HCC in patients with chronic liver disease represents a valid alternative to LRFA in terms of patient toleration, surgical outcome of the procedure, and short-term morbidity. PMID:26622111

  13. Clinical Models to Compare the Safety and Efficacy of Inhaled Corticosteroids in Patients with Asthma

    Directory of Open Access Journals (Sweden)

    Krishnan Parameswaran

    2003-01-01

    Full Text Available There is no consensus on the methods to compare the clinical efficacy of different inhaled corticosteroids. A comparison needs to be made in terms of relative potency, and studies should include two-, or preferably, three-dose comparisons. A number of clinical models and outcomes are available; they have their relative advantages and disadvantages. While measurements of symptoms and spirometry are easy and readily available, they show a flat dose-response relationship. Measurements of bronchial hyper-responsiveness to exercise and adenosine monophosphate, allergen-induced airway responses, and measurements of inflammation in sputum and exhaled air show steep dose-response relationships, particularly to low doses of inhaled steroids. An uncontrolled asthma model followed by stabilization with a short course of additional steroid, with measurements of airway responsiveness and airway inflammation, in a crossover study seems more promising than the other models. Drug deposition studies and mathematical modelling of drug pharmacokinetics in the airway may provide complementary information to clinical drug relative potency studies. Fine particle dose and emitted doses, rather than the nominal dose, should be considered in the estimation of clinical and systemic effects, respectively. When a second entry (generic drug is being evaluated in comparison with the innovator drug (same compound and same device, it may be appropriate to consider accepting a generic as bioequivalent if it satisfies pharmaceutical equivalence.

  14. Accuracy of laser-scanned models compared to plaster models and cone-beam computed tomography.

    Science.gov (United States)

    Kim, Jooseong; Heo, Giseon; Lagravère, Manuel O

    2014-05-01

    To compare the accuracy of measurements obtained from the three-dimensional (3D) laser scans to those taken from the cone-beam computed tomography (CBCT) scans and those obtained from plaster models. Eighteen different measurements, encompassing mesiodistal width of teeth and both maxillary and mandibular arch length and width, were selected using various landmarks. CBCT scans and plaster models were prepared from 60 patients. Plaster models were scanned using the Ortho Insight 3D laser scanner, and the selected landmarks were measured using its software. CBCT scans were imported and analyzed using the Avizo software, and the 26 landmarks corresponding to the selected measurements were located and recorded. The plaster models were also measured using a digital caliper. Descriptive statistics and intraclass correlation coefficient (ICC) were used to analyze the data. The ICC result showed that the values obtained by the three different methods were highly correlated in all measurements, all having correlations>0.808. When checking the differences between values and methods, the largest mean difference found was 0.59 mm±0.38 mm. In conclusion, plaster models, CBCT models, and laser-scanned models are three different diagnostic records, each with its own advantages and disadvantages. The present results showed that the laser-scanned models are highly accurate to plaster models and CBCT scans. This gives general clinicians an alternative to take into consideration the advantages of laser-scanned models over plaster models and CBCT reconstructions.

  15. Comparative performance of high-fidelity training models for flexible ureteroscopy: Are all models effective?

    Directory of Open Access Journals (Sweden)

    Shashikant Mishra

    2011-01-01

    Full Text Available Objective: We performed a comparative study of high-fidelity training models for flexible ureteroscopy (URS. Our objective was to determine whether high-fidelity non-virtual reality (VR models are as effective as the VR model in teaching flexible URS skills. Materials and Methods: Twenty-one trained urologists without clinical experience of flexible URS underwent dry lab simulation practice. After a warm-up period of 2 h, tasks were performed on a high-fidelity non-VR (Uro-scopic Trainer TM ; Endo-Urologie-Modell TM and a high-fidelity VR model (URO Mentor TM . The participants were divided equally into three batches with rotation on each of the three stations for 30 min. Performance of the trainees was evaluated by an expert ureteroscopist using pass rating and global rating score (GRS. The participants rated a face validity questionnaire at the end of each session. Results: The GRS improved statistically at evaluation performed after second rotation (P<0.001 for batches 1, 2 and 3. Pass ratings also improved significantly for all training models when the third and first rotations were compared (P<0.05. The batch that was trained on the VR-based model had more improvement on pass ratings on second rotation but could not achieve statistical significance. Most of the realistic domains were higher for a VR model as compared with the non-VR model, except the realism of the flexible endoscope. Conclusions: All the models used for training flexible URS were effective in increasing the GRS and pass ratings irrespective of the VR status.

  16. Comparing outcomes in poorly-differentiated versus anaplastic thyroid cancers treated with radiation: A surveillance, epidemiology, and end results analysis

    Directory of Open Access Journals (Sweden)

    Shruthi Arora

    2014-01-01

    Conclusion: This is the first large population-based study evaluating PDTC and ATC outcomes in patients who received radiation treatment. Radioisotope use and timing of radiotherapy (postoperative vs. preoperative were associated with improved CSS in both histologies.

  17. Comparing physically-based and statistical landslide susceptibility model outputs - a case study from Lower Austria

    Science.gov (United States)

    Canli, Ekrem; Thiebes, Benni; Petschko, Helene; Glade, Thomas

    2015-04-01

    By now there is a broad consensus that due to human-induced global change the frequency and magnitude of heavy precipitation events is expected to increase in certain parts of the world. Given the fact, that rainfall serves as the most common triggering agent for landslide initiation, also an increased landside activity can be expected there. Landslide occurrence is a globally spread phenomenon that clearly needs to be handled. The present and well known problems in modelling landslide susceptibility and hazard give uncertain results in the prediction. This includes the lack of a universal applicable modelling solution for adequately assessing landslide susceptibility (which can be seen as the relative indication of the spatial probability of landslide initiation). Generally speaking, there are three major approaches for performing landslide susceptibility analysis: heuristic, statistical and deterministic models, all with different assumptions, its distinctive data requirements and differently interpretable outcomes. Still, detailed comparison of resulting landslide susceptibility maps are rare. In this presentation, the susceptibility modelling outputs of a deterministic model (Stability INdex MAPping - SINMAP) and a statistical modelling approach (generalized additive model - GAM) are compared. SINMAP is an infinite slope stability model which requires parameterization of soil mechanical parameters. Modelling with the generalized additive model, which represents a non-linear extension of a generalized linear model, requires a high quality landslide inventory that serves as the dependent variable in the statistical approach. Both methods rely on topographical data derived from the DTM. The comparison has been carried out in a study area located in the district of Waidhofen/Ybbs in Lower Austria. For the whole district (ca. 132 km²), 1063 landslides have been mapped and partially used within the analysis and the validation of the model outputs. The respective

  18. Comparative Election Forecasting: Further Insights from Synthetic Models

    OpenAIRE

    Michael S. Lewis-Beck; Dassonneville, Ruth

    2015-01-01

    As an enterprise, election forecasting has spread and grown. Initial work began in the 1980s in the United States, eventually travelling to Western Europe, where it finds a current outlet in the most of the region’s democracies. However, that work has been confined to traditional approaches – statistical modeling or poll-watching. We import a new approach, which we call synthetic modeling. These forecasts come from hybrid models blending structural knowledge with contemporary p...

  19. Comparative study of positive versus negative autologous serum skin test in chronic spontaneous urticaria and its treatment outcome

    Directory of Open Access Journals (Sweden)

    Yadalla Hari Kishan Kumar

    2016-01-01

    Full Text Available Background: Chronic urticaria (CU is defined as urticaria persisting daily or almost daily for more than 6 weeks and affecting 0.1% of the population. Mast cell degranulation and histamine release are of central importance in the pathogenesis of CU. About 40-50% of the patients with chronic idiopathic urticaria (CIU or chronic spontaneous urticaria (CSU demonstrates an immediate wheal and flare response to intradermal injected autologous serum. This led to the concept of autoimmune urticaria (AIU. Aims: To determine the occurrence, clinical features, associated clinical conditions, comorbidities of AIU, and to compare this with CSU. This study aimed to find the frequency of autologous serum skin test (ASST-positive patients among patients with CSU and to identify the clinical and laboratory parameters associated with positive ASST and to compare the treatment outcome. Materials and Methods: A prospective correlation study in 110 patients with CSU was conducted, after screening 200 CU patients attending the outpatient Department of Dermatology during from January 2012 to May 2013. Patients were subjected to ASST, complete blood counts, urine routine examination, liver function tests, renal function tests, thyroid function tests (T3, T4, and TSH, and urine analysis. Results: Out of 200 CU patients screened, 90 patients had excludable causes based on detailed history and skin prick test, and the remaining 110 patients were considered to have CSU. These 110 patients were further subjected to ASST, serum immunoglobulin E (IgE, and peripheral blood eosinophilia. ASST was positive in 48 patients and negative in 62 patients. Frequency of urticarial attacks and associated diseases such as abnormal thyroid function tests in both ASST-positive and ASST-negative patients did not show any statistical significance. Only attacks of angioedema in ASST-positive individuals were higher and were statistically significant. In the ASST-positive group, 31 (81

  20. A Comparative Evaluation of Structure, Process, and Outcomes Pre- and Post-Implementation of Primary Care Teams

    Science.gov (United States)

    2000-08-01

    back pain among patients seen by primary care practitioners, chiropractors , and orthopedic surgeons. Clinical outcomes did not differ significantly among...low back pain among patients seen by primary care practitioners, chiropractors , and orthopedic surgeons. The New England Journal of Medicine, 333(14...Garrett, J., Jackman, A., McLaughlin, C., Fryer, J., Smucker, D., & The North Carolina Back Pain Project (1995). The outcomes and costs of care for acute

  1. Joint modeling of longitudinal data and discrete-time survival outcome.

    Science.gov (United States)

    Qiu, Feiyou; Stein, Catherine M; Elston, Robert C

    2016-08-01

    A predictive joint shared parameter model is proposed for discrete time-to-event and longitudinal data. A discrete survival model with frailty and a generalized linear mixed model for the longitudinal data are joined to predict the probability of events. This joint model focuses on predicting discrete time-to-event outcome, taking advantage of repeated measurements. We show that the probability of an event in a time window can be more precisely predicted by incorporating the longitudinal measurements. The model was investigated by comparison with a two-step model and a discrete-time survival model. Results from both a study on the occurrence of tuberculosis and simulated data show that the joint model is superior to the other models in discrimination ability, especially as the latent variables related to both survival times and the longitudinal measurements depart from 0.

  2. High Performance Education. Porsche Shares Outcomes-Based Model with Teachers.

    Science.gov (United States)

    Luft, Vernon

    1994-01-01

    The Porsche model of outcome-based education in its auto technician training program was adapted by vocational instructors in Nevada. Its effectiveness derives from pretesting, teaching with demonstrations, student practice with peer coaching, performance measurement, and reteaching and retesting. (SK)

  3. Predicting major outcomes in type 1 diabetes: a model development and validation study

    NARCIS (Netherlands)

    Soedamah-Muthu, S.S.; Vergouwe, Y.; Costacou, T.; Miller, R.G.; Zgibor, J.; Chaturvedi, N.; Snell-Bergeon, J.K.; Maahs, D.M.; Rewers, M.; Forsblom, C.; Harjutsalo, V.; Groop, P.H.; Fuller, J.H.; Moons, K.G.M.; Orchard, T.J.

    2014-01-01

    Aims/hypothesis Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicted these outcomes early in the disease process would help in risk classification. We therefore developed such a prognostic model and quantified its performance in

  4. The assessment of learning outcomes of computer modeling in secondary science education

    NARCIS (Netherlands)

    Borkulo, van Sylvia Patricia

    2009-01-01

    The computer modeling of dynamic systems is a topic that aligns well with the current trend in secondary science education to actively involve students in their knowledge construction, give room for inquiry, and offer realistic tasks. In this dissertation the specific learning outcomes that can be e

  5. Linking HR strategy, e-HR goals, architectures, and outcomes: a model and case study evidence.

    NARCIS (Netherlands)

    Reddington, Martin; Martin, Graeme; Bondarouk, T.V.; Bondarouk, Tatiana; Ruel, H.; Ruel, Hubertus Johannes Maria; Looise, J.C.; Looise, Jan C.

    2011-01-01

    Building on our earlier model of the links between HR strategy, e-HR goals, architectures, and outcomes, we illustrate the relationship between some of these elements with data from three global organizations. In doing so, we aim to help academics and practitioners understand this increasingly

  6. Developing Reflective Thinking Instructional Model for Enhancing Students' Desirable Learning Outcomes

    Science.gov (United States)

    Porntaweekul, Satjatam; Raksasataya, Sarintip; Nethanomsak, Teerachai

    2016-01-01

    This work aims to investigate the reflective thinking instructional model for enhancing empowerment of pre-service and in-service educational students in Roi-Et Rajabhat University, Thailand. In this research, qualitative methods, observation, interview, short note, and group discussion were used to indicate students' desirable learning outcomes,…

  7. School Factors Explaining Achievement on Cognitive and Affective Outcomes : Establishing a Dynamic Model of Educational Effectiveness

    NARCIS (Netherlands)

    Creemers, Bert; Kyriakides, Leonidas

    2010-01-01

    The dynamic model of educational effectiveness defines school level factors associated with student outcomes. Emphasis is given to the two main aspects of policy, evaluation, and improvement in schools which affect quality of teaching and learning at both the level of teachers and students: a) teach

  8. School Factors Explaining Achievement on Cognitive and Affective Outcomes: Establishing a Dynamic Model of Educational Effectiveness

    Science.gov (United States)

    Creemers, Bert; Kyriakides, Leonidas

    2010-01-01

    The dynamic model of educational effectiveness defines school level factors associated with student outcomes. Emphasis is given to the two main aspects of policy, evaluation, and improvement in schools which affect quality of teaching and learning at both the level of teachers and students: a) teaching and b) school learning environment. Five…

  9. Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome

    NARCIS (Netherlands)

    Hulst, van der Marije; Vollenbroek-Hutten, Miriam M.R.; Groothuis-Oudshoorn, Karin G.M.; Hermens, Hermie J.

    2008-01-01

    Objectives: (1) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and (2) to explore the value of potentially prognostic factors further. Methods: Data were derived from a rand

  10. A Model of Stress and Coping and Their Influence on Individual and Organizational Outcomes

    Science.gov (United States)

    Boyd, Nancy G.; Lewin, Jeffrey E.; Sager, Jeffrey K.

    2009-01-01

    A model of coping with stress is proposed in which coping mediates the relationship among organizational stressors and personal characteristics, and job-related strains and organizational outcomes. Study results, based on a sample of professional salespeople, provide overall support for most of the hypothesized relationships among work-related…

  11. Assessing the potential for racial bias in hair analysis for cocaine: examining the relative risk of positive outcomes when comparing urine samples to hair samples.

    Science.gov (United States)

    Mieczkowski, Tom

    2011-03-20

    This article examines the conjecture that hair analysis, performed to detect cocaine use or exposure, is biased against African Americans. It does so by comparing the outcomes of 33,928 hair and 105,792 urine samples collected from both African American and white subjects. In making this comparison the analysis seeks to determine if there is a departure in rates of positive and negative outcomes when comparing the results of hair analysis for cocaine to the results from urinalysis for cocaine by racial group. It treats urine as an unbiased test. It compares both the relative ratios of positive outcomes when comparing the two groups and it calculates the relative risk of outcomes for each group for having positive or negative outcomes. The findings show that the ratios of each racial group are effectively same for hair and urine assays, and they also show that the relative risk and risk estimates for positive and negative outcomes are the same for both racial groups. Considering all samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.28 and for urinalysis the risk estimate is 3.10 (Breslow-Day χ(2) .250, 1 df, p = 0.617) a non-significant difference in risk. For pre-employment samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.10 and for urinalysis the risk estimate is 2.90 (Breslow-Day χ(2) .281, df = 1, p = 0.595), also a non-significant difference in risk.

  12. Disease Progression/Clinical Outcome Model for Castration-Resistant Prostate Cancer in Patients Treated with Eribulin

    NARCIS (Netherlands)

    Van Hasselt, J. G C; Gupta, A.; Hussein, Z.; Beijnen, J. H.; Schellens, J. H M; Huitema, A. D R

    2015-01-01

    Frameworks that associate cancer dynamic disease progression models with parametric survival models for clinical outcome have recently been proposed to support decision making in early clinical development. Here we developed such a disease progression clinical outcome model for castration-resistant

  13. Disease Progression/Clinical Outcome Model for Castration-Resistant Prostate Cancer in Patients Treated with Eribulin

    NARCIS (Netherlands)

    Van Hasselt, J. G C; Gupta, A.; Hussein, Z.; Beijnen, J. H.; Schellens, J. H M; Huitema, A. D R

    2015-01-01

    Frameworks that associate cancer dynamic disease progression models with parametric survival models for clinical outcome have recently been proposed to support decision making in early clinical development. Here we developed such a disease progression clinical outcome model for castration-resistant

  14. Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials

    Directory of Open Access Journals (Sweden)

    Van Arendonk Kyle J

    2011-06-01

    Full Text Available Abstract Background The emergence of multi-drug resistant Gram-negatives (MDRGNs coupled with an alarming scarcity of new antibiotics has forced the optimization of the therapeutic potential of available antibiotics. To exploit the time above the minimum inhibitory concentration mechanism of β-lactams, prolonging their infusion may improve outcomes. The primary objective of this meta-analysis was to determine if prolonged β-lactam infusion resulted in decreased mortality and improved clinical cure compared to intermittent β-lactam infusion. Methods Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL. Heterogeneity was assessed qualitatively, in addition to I2 and Chi-square statistics. Pooled relative risks (RR and 95% confidence intervals (CI were calculated using Mantel-Haenszel random-effects models. Results Fourteen randomized controlled trials (RCTs were included. Prolonged infusion β-lactams were not associated with decreased mortality (n= 982; RR 0.92; 95% CI:0.61-1.37 or clinical cure (n = 1380; RR 1.00 95% CI:0.94-1.06 compared to intermittent infusions. Subgroup analysis for β-lactam subclasses and equivalent total daily β-lactam doses yielded similar results. Most studies had notable methodological flaws. Conclusions No clinical advantage was observed for prolonged infusion β-lactams. The limited number of studies with MDRGNs precluded evaluation of prolonged infusion of β-lactams for this subgroup. A large, multicenter RCT with critically ill patients infected with MDRGNs is needed.

  15. Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling.

    Science.gov (United States)

    Factor, Roni; Kang, Minah

    2015-09-01

    The current study aims to develop a theoretical framework for understanding the antecedents of corruption and the effects of corruption on various health indicators. Using structural equation models, we analyzed a multinational dataset of 133 countries that included three main groups of variables--antecedents of corruption, corruption measures, and health indicators. Controlling for various factors, our results suggest that corruption rises as GDP per capita falls and as the regime becomes more autocratic. Higher corruption is associated with lower levels of health expenditure as a percentage of GDP per capita, and with poorer health outcomes. Countries with higher GDP per capita and better education for women have better health outcomes regardless of health expenditures and regime type. Our results suggest that there is no direct relationship between health expenditures and health outcomes after controlling for the other factors in the model. Our study enhances our understanding of the conceptual and theoretical links between corruption and health outcomes in a population, including factors that may mediate how corruption can affect health outcomes.

  16. Semiparametric analysis of incomplete current status outcome data under transformation models.

    Science.gov (United States)

    Wen, Chi-Chung; Chen, Yi-Hau

    2014-06-01

    This work, motivated by an osteoporosis survey study, considers regression analysis with incompletely observed current status data. Here the current status data, including an examination time and an indicator for whether or not the event of interest has occurred by the examination time, is not observed for all subjects. Instead, a surrogate outcome subject to misclassification of the current status is available for all subjects. We focus on semiparametric regression under transformation models, including the proportional hazards and proportional odds models as special cases. Under the missing at random mechanism where the missingness of the current status outcome can depend only on the observed surrogate outcome and covariates, we propose an approach of validation likelihood based on the likelihood from the validation subsample where the data are fully observed, with adjustments of the probability of observing the current status outcome, as well as the distribution of the surrogate outcome in the validation subsample. We propose an efficient computation algorithm for implementation, and derive consistency and asymptotic normality for inference with the proposed estimator. The application to the osteoporosis survey data and simulations reveal that the validation likelihood performs well; it removes the bias from the "complete case" analysis discarding subjects with missing data, and achieves higher efficiency than the inverse probability weighting analysis.

  17. Comparing stochastic differential equations and agent-based modelling and simulation for early-stage cancer.

    Science.gov (United States)

    Figueredo, Grazziela P; Siebers, Peer-Olaf; Owen, Markus R; Reps, Jenna; Aickelin, Uwe

    2014-01-01

    There is great potential to be explored regarding the use of agent-based modelling and simulation as an alternative paradigm to investigate early-stage cancer interactions with the immune system. It does not suffer from some limitations of ordinary differential equation models, such as the lack of stochasticity, representation of individual behaviours rather than aggregates and individual memory. In this paper we investigate the potential contribution of agent-based modelling and simulation when contrasted with stochastic versions of ODE models using early-stage cancer examples. We seek answers to the following questions: (1) Does this new stochastic formulation produce similar results to the agent-based version? (2) Can these methods be used interchangeably? (3) Do agent-based models outcomes reveal any benefit when compared to the Gillespie results? To answer these research questions we investigate three well-established mathematical models describing interactions between tumour cells and immune elements. These case studies were re-conceptualised under an agent-based perspective and also converted to the Gillespie algorithm formulation. Our interest in this work, therefore, is to establish a methodological discussion regarding the usability of different simulation approaches, rather than provide further biological insights into the investigated case studies. Our results show that it is possible to obtain equivalent models that implement the same mechanisms; however, the incapacity of the Gillespie algorithm to retain individual memory of past events affects the similarity of some results. Furthermore, the emergent behaviour of ABMS produces extra patters of behaviour in the system, which was not obtained by the Gillespie algorithm.

  18. Comparing stochastic differential equations and agent-based modelling and simulation for early-stage cancer.

    Directory of Open Access Journals (Sweden)

    Grazziela P Figueredo

    Full Text Available There is great potential to be explored regarding the use of agent-based modelling and simulation as an alternative paradigm to investigate early-stage cancer interactions with the immune system. It does not suffer from some limitations of ordinary differential equation models, such as the lack of stochasticity, representation of individual behaviours rather than aggregates and individual memory. In this paper we investigate the potential contribution of agent-based modelling and simulation when contrasted with stochastic versions of ODE models using early-stage cancer examples. We seek answers to the following questions: (1 Does this new stochastic formulation produce similar results to the agent-based version? (2 Can these methods be used interchangeably? (3 Do agent-based models outcomes reveal any benefit when compared to the Gillespie results? To answer these research questions we investigate three well-established mathematical models describing interactions between tumour cells and immune elements. These case studies were re-conceptualised under an agent-based perspective and also converted to the Gillespie algorithm formulation. Our interest in this work, therefore, is to establish a methodological discussion regarding the usability of different simulation approaches, rather than provide further biological insights into the investigated case studies. Our results show that it is possible to obtain equivalent models that implement the same mechanisms; however, the incapacity of the Gillespie algorithm to retain individual memory of past events affects the similarity of some results. Furthermore, the emergent behaviour of ABMS produces extra patters of behaviour in the system, which was not obtained by the Gillespie algorithm.

  19. Mental Models about Seismic Effects: Students' Profile Based Comparative Analysis

    Science.gov (United States)

    Moutinho, Sara; Moura, Rui; Vasconcelos, Clara

    2016-01-01

    Nowadays, meaningful learning takes a central role in science education and is based in mental models that allow the representation of the real world by individuals. Thus, it is essential to analyse the student's mental models by promoting an easier reconstruction of scientific knowledge, by allowing them to become consistent with the curricular…

  20. Criteria for comparing economic impact models of tourism

    NARCIS (Netherlands)

    Klijs, J.; Heijman, W.J.M.; Korteweg Maris, D.; Bryon, J.

    2012-01-01

    There are substantial differences between models of the economic impacts of tourism. Not only do the nature and precision of results vary, but data demands, complexity and underlying assumptions also differ. Often, it is not clear whether the models chosen are appropriate for the specific situation

  1. Criteria for comparing economic impact models of tourism

    NARCIS (Netherlands)

    Klijs, J.; Heijman, W.J.M.; Korteweg Maris, D.; Bryon, J.

    2012-01-01

    There are substantial differences between models of the economic impacts of tourism. Not only do the nature and precision of results vary, but data demands, complexity and underlying assumptions also differ. Often, it is not clear whether the models chosen are appropriate for the specific situation

  2. Sustained, low-dose intraperitoneal cisplatin improves treatment outcome in ovarian cancer mouse models.

    Science.gov (United States)

    Ye, Hongye; Tanenbaum, Laura M; Na, Young Jeong; Mantzavinou, Aikaterini; Fulci, Giulia; del Carmen, Marcela G; Birrer, Michael J; Cima, Michael J

    2015-12-28

    Intraperitoneal (IP) chemotherapy for ovarian cancer treatment prolongs overall survival by 16 months compared to intravenous chemotherapy but is not widely practiced due to catheter-related complications and complexity of administration. An implantable, nonresorbable IP microdevice was used to release chemotherapeutic agent at a constant rate of approximately 1.3 μg/h in vitro and 1.0 μg/h in vivo. Studies conducted in two orthotopic murine models bearing human xenografts (SKOV3 and UCI101) demo