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Sample records for models compared outcome

  1. Creating a Common Data Model for Comparative Effectiveness with the Observational Medical Outcomes Partnership.

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    FitzHenry, F; Resnic, F S; Robbins, S L; Denton, J; Nookala, L; Meeker, D; Ohno-Machado, L; Matheny, M E

    2015-01-01

    Adoption of a common data model across health systems is a key infrastructure requirement to allow large scale distributed comparative effectiveness analyses. There are a growing number of common data models (CDM), such as Mini-Sentinel, and the Observational Medical Outcomes Partnership (OMOP) CDMs. In this case study, we describe the challenges and opportunities of a study specific use of the OMOP CDM by two health systems and describe three comparative effectiveness use cases developed from the CDM. The project transformed two health system databases (using crosswalks provided) into the OMOP CDM. Cohorts were developed from the transformed CDMs for three comparative effectiveness use case examples. Administrative/billing, demographic, order history, medication, and laboratory were included in the CDM transformation and cohort development rules. Record counts per person month are presented for the eligible cohorts, highlighting differences between the civilian and federal datasets, e.g. the federal data set had more outpatient visits per person month (6.44 vs. 2.05 per person month). The count of medications per person month reflected the fact that one system's medications were extracted from orders while the other system had pharmacy fills and medication administration records. The federal system also had a higher prevalence of the conditions in all three use cases. Both systems required manual coding of some types of data to convert to the CDM. The data transformation to the CDM was time consuming and resources required were substantial, beyond requirements for collecting native source data. The need to manually code subsets of data limited the conversion. However, once the native data was converted to the CDM, both systems were then able to use the same queries to identify cohorts. Thus, the CDM minimized the effort to develop cohorts and analyze the results across the sites.

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

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    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

  3. Generalized outcome-based strategy classification: comparing deterministic and probabilistic choice models.

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    Hilbig, Benjamin E; Moshagen, Morten

    2014-12-01

    Model comparisons are a vital tool for disentangling which of several strategies a decision maker may have used--that is, which cognitive processes may have governed observable choice behavior. However, previous methodological approaches have been limited to models (i.e., decision strategies) with deterministic choice rules. As such, psychologically plausible choice models--such as evidence-accumulation and connectionist models--that entail probabilistic choice predictions could not be considered appropriately. To overcome this limitation, we propose a generalization of Bröder and Schiffer's (Journal of Behavioral Decision Making, 19, 361-380, 2003) choice-based classification method, relying on (1) parametric order constraints in the multinomial processing tree framework to implement probabilistic models and (2) minimum description length for model comparison. The advantages of the generalized approach are demonstrated through recovery simulations and an experiment. In explaining previous methods and our generalization, we maintain a nontechnical focus--so as to provide a practical guide for comparing both deterministic and probabilistic choice models.

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

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    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…

  5. Model-based analyses to compare health and economic outcomes of cancer control: inclusion of disparities.

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    Goldie, Sue J; Daniels, Norman

    2011-09-21

    Disease simulation models of the health and economic consequences of different prevention and treatment strategies can guide policy decisions about cancer control. However, models that also consider health disparities can identify strategies that improve both population health and its equitable distribution. We devised a typology of cancer disparities that considers types of inequalities among black, white, and Hispanic populations across different cancers and characteristics important for near-term policy discussions. We illustrated the typology in the specific example of cervical cancer using an existing disease simulation model calibrated to clinical, epidemiological, and cost data for the United States. We calculated average reduction in cancer incidence overall and for black, white, and Hispanic women under five different prevention strategies (Strategies A1, A2, A3, B, and C) and estimated average costs and life expectancy per woman, and the cost-effectiveness ratio for each strategy. Strategies that may provide greater aggregate health benefit than existing options may also exacerbate disparities. Combining human papillomavirus vaccination (Strategy A2) with current cervical cancer screening patterns (Strategy A1) resulted in an average reduction of 69% in cancer incidence overall but a 71.6% reduction for white women, 68.3% for black women, and 63.9% for Hispanic women. Other strategies targeting risk-based screening to racial and ethnic minorities reduced disparities among racial subgroups and resulted in more equitable distribution of benefits among subgroups (reduction in cervical cancer incidence, white vs. Hispanic women, 69.7% vs. 70.1%). Strategies that employ targeted risk-based screening and new screening algorithms, with or without vaccination (Strategies B and C), provide excellent value. The most effective strategy (Strategy C) had a cost-effectiveness ratio of $28,200 per year of life saved when compared with the same strategy without

  6. A dismantling study of assertive outreach services: comparing activity and outcomes following replacement with the FACT model.

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    Firn, Mike; Hindhaugh, Keelyjo; Hubbeling, Dieneke; Davies, Gwyn; Jones, Ben; White, Sarah Jane

    2013-06-01

    Financial constraints and some disappointing research evaluations have seen English assertive outreach (AO) teams subject to remodelling, decommissioning and integration into standard care. We tested a specific alternative model of integrating the AO function from two AO teams into six standard community mental health teams (CMHT). The Flexible Assertive Community Treatment model (FACT) was adopted from the Netherlands (Van Veldhuizen, Commun Mental Health J 43(4):421-433, 2007; Bond and Drake, Commun Mental Health J 43(4):435-438, 2007). We aimed to demonstrate non-inferiority in clinical effectiveness and thereby show cost efficiencies associated with FACT. Outcomes were compared in a mirror-image study of the 12 months periods pre- and post-service change with eligible individuals from the AO teams' caseloads (n = 112) acting as their own controls. We also conducted a cost-consequence analysis of the changes. Outcome data regarding admissions, use of crisis and home treatment, frequency of contact and DNA rate were extracted from the electronic patient record. The results show AO patients (n = 112) transferred to standard CMHTs with FACT had significantly fewer admissions and a halving of bed use (21 fewer admission and 2,394 fewer occupied bed days) whilst being in receipt of a less intensive service (2,979 fewer contacts). This was offset by significantly poorer engagement but not by increased use of crisis and home treatment services. Enhancing multi-disciplinary CMHTs with FACT provides a clinically effective alternative to AO teams. FACT offers a cost-effective model compared to AO.

  7. Comparing pyloromyotomy outcomes across Canada.

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    Ednie, Alexander C; Amram, Ofer; Schuurman, Nadine; Yanchar, Natalie L

    2017-05-01

    Changing patterns of referral and management of hypertrophic pyloric stenosis (HPS) in North America have recently been described. Comfort with perioperative management, anesthesia, and corrective surgery have been cited as reasons for these changes. Our primary objective was to assess pyloromyotomy outcomes between different hospital types across Canada. The secondary objective was to geospatially map all pyloromyotomies to identify regions of higher HPS incidence across Canada. Data of all pyloromyotomies done between 2011 and 2013 were acquired from Canadian Institute for Health Information (CIHI). Complication rates and length of hospital stay (LOS) were analyzed. Postal codes for each patient were used to geospatially map regions of higher HPS incidence. A total of 1261 pyloromyotomies were assessed. There was no difference in LOS or complication rates between different hospital types or surgeon group. Open pyloromyotomies were done in 75% of the cases. Several regions of higher HPS incidence were identified across Canada. This study found no difference in complication rate or LOS stay between hospital type and surgeon type across Canada. This may reflect a previously identified referral trend in the United States towards pediatric centers. Several regions of higher HPS incidence were identified, and may aid in identifying genetic elements causing HPS. 2c. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  8. Resuscitation outcomes comparing year 2000 with year 2005 ALS guidelines in a pig model of cardiac arrest.

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    Xanthos, Theodoros; Tsirikos-Karapanos, Nikolas; Papadimitriou, Dimitrios; Vlachos, Ioannis S; Tsiftsi, Katerina; Ekmektzoglou, Konstantinos A; Papadimitriou, Lila

    2007-06-01

    Ventricular fibrillation remains the leading cause of death in western societies. International organizations publish guidelines to follow in case of cardiac arrest. The aim of the present study is to assess whether the newly published guidelines record similar resuscitation success with the 2000 Advanced Life Support Guidelines on Resuscitation in a swine model of cardiac arrest. Nineteen landrace/large white pigs were used. Ventricular fibrillation was induced with the use of a transvenous pacing wire inserted into the right ventricle. The animals were randomized into two groups. In Group A, 10 animals were resuscitated using the 2000 guidelines, whereas in Group B, 9 animals were resuscitated using the 2005 guidelines. Both algorithms recorded similar successful resuscitation rates, as 60% of the animals in Group A and 44.5% in Group B were successfully resuscitated. However, animals in Group A restored a rhythm, compatible with a pulse, quicker than those in Group B (p=0.002). Coronary perfusion pressure (CPP) was not adversely affected by three defibrillation attempts in Group A. Both algorithms' resulted in comparable resuscitation success, however, guidelines 2000 resulted in faster resuscitation times. These preliminary results merit further investigation.

  9. Comparative strain analysis of Anaplasma phagocytophilum infection and clinical outcomes in a canine model of granulocytic anaplasmosis.

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    Scorpio, Diana G; Dumler, J Stephen; Barat, Nicole C; Cook, Judith A; Barat, Christopher E; Stillman, Brett A; DeBisceglie, Kristen C; Beall, Melissa J; Chandrashekar, Ramaswamy

    2011-03-01

    A pilot study was conducted to determine whether existing human or canine strains of Anaplasma phagocytophilum would reproduce clinical disease in experimentally inoculated dogs similar to dogs with naturally acquired granulocytic anaplasmosis. Six hounds were inoculated intravenously with one human and two canine strains of A. phagocytophilum that were propagated in vitro in HL-60 cells or in infected autologous neutrophils. Infected dogs were monitored for lethargy, anorexia, petechiae, lymphadenopathy, and fever. Dogs were assessed for complete blood count (CBC), serum chemistry, and serology (IFA and SNAP® 4Dx®); for A. phagocytophilum blood load by quantitative polymerase chain reaction; and for cytokine production. Prominent clinical signs were generalized lymphadenopathy and scleral injection; only one dog developed fever lasting 4 days. Notable laboratory alterations included sustained leukopenia and thrombocytopenia in all dogs. A. phagocytophilum morulae were noted in blood between days 10 and 11, although all dogs retained A. phagocytophilum DNA in blood through day 60. All dogs seroconverted by days 10-15 by IFA, and by days 17-30 by SNAP 4Dx; cytokine analyses revealed 10-fold increases in interleukin-2 and interleukin-18 in the neutrophil-propagated 98E4 strain-infected dog. All A. phagocytophilum strains produced infection, although canine 98E4 strain reproduced clinical signs, hematologic changes, and inflammatory cytokine elevations most consistent with granulocytic anaplasmosis when recognized clinically. Therefore, this strain should be considered for use in future studies of A. phagocytophilum canine infection models.

  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.

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    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. 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

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    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.

  12. Comparative Outcomes of Two Instructional Models for Students with Learning Disabilities: Inclusion with Co-Teaching and Solo-Taught Special Education

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    Tremblay, Philippe

    2013-01-01

    We compared two instructional models (co-teaching inclusion and solo-taught special education) for students with learning disabilities (LD) with regard to their effect on academic achievement and class attendance. Twelve inclusive classes (experimental group) and 13 special education classes (control group) participated in the study. In grade 1,…

  13. 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.

  14. A randomized controlled study comparing community based with health facility based direct observation of treatment models on patients' satisfaction and TB treatment outcome in Nigeria.

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    Adewole, Olanisun O; Oladele, T; Osunkoya, Arinola H; Erhabor, Greg E; Adewole, Temitayo O; Adeola, Oluwaseun; Obembe, Olufemi; Ota, Martin O C

    2015-12-01

    Directly observed treatment short-course (DOTS) strategy is an effective mode of treating TB. We aimed to study the cost effectiveness and patients' satisfaction with home based direct observation of treatment (DOT), an innovative approach to community-based DOT (CBDOT) and hospital based DOT (HBDOT). A randomized controlled trial involving 150 newly diagnosed pulmonary TB patients in four TB clinics in Ile Ife , Nigeria, was done. They were randomly assigned to receive treatment with anti TB drugs for the intensive phase administered at home by a TB worker (CBDOT) or at the hospital (HBDOT). Outcome measures were treatment completion/default rates, cost effectiveness and patients' satisfaction with care using a 13 item patients satisfaction questionnaire (PS-13) at 2 months. This trial was registered with pactr.org: number PACTR 201503001058381. At the end of intensive phase, 15/75 (20%) and 2/75 (3%) of patients in the HBDOT and CBDOT, respectively had defaulted from treatment, p= 0.01. Of those with pretreatment positive sputum smear, 97% (68/70) on CBDOT and 54/67 (81%) on HBDOT were sputum negative for AFB at the end of 2 months of treatment, p=0.01. The CBDOT method was associated with a higher patient satisfaction score compared with HBDOT (OR 3.1; 95% CI 1.25-7.70), p=0.001.The total cost for patients was higher in HBDOT (US$159.38) compared with the CBDOT (US$89.52). The incremental cost effectiveness ratio was US$410 per patient who completed the intensive phase treatment with CBDOT. CBDOT is a cost effective approach associated with better compliance to treatment and better patient satisfaction compared to HBDOT. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

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    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

  16. Comparing linear probability model coefficients across groups

    DEFF Research Database (Denmark)

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

    2015-01-01

    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......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....

  17. Functional outcome of microsurgical clipping compared to endovascular coiling.

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    Premananda, R M; Ramesh, N; Hillol, K P

    2012-12-01

    Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. In a retrospective cohort review on the treatment methods of aneurysm rupture in Hospital Kuala Lumpur over the period of five years (2005-2009) a total of 268 patients were treated. These patients were broadly categorized into two groups based on their treatment mode for ruptured aneurysms. Statistical analysis was determined using Chi- Square tests to study these associations. In our study, 67.5% of patients presented with Good World Federation of Neurosurgical Societies (WFNS) grade (WFNS1-2) while 32.5% patients presented with Poor WFNS prior to intervention. In our outcome, it was noted that 60.4% had good functional outcome (mRS grade 0-2) as compared to 39.6% patients who had poor mRS(modified rankin scale) outcome (mRS 3-6). In the good WFNS group, 76% of patients in clipping group had a good mRS outcome while, 86.5% patients in coiling group had good mRS outcome (p=0.114). In poor WFNS presentation, it was noted that in 77.3% patients in clipping group, had poor mRS outcome. Similarly with poor WFNS presentation, 83.3% of patient in coiling group had poor outcome. (p=1.00). Hence when we control the WFNS group, there was no significant association between treatment group (clipping and coiling) and mRS outcome at 6 months. The outcome of patient is determined by initial clinical presentation (WFNS grade) and influenced by requirement of Extraventricular drain (EVD) in presence of hydrocephalus, CSF infection and pneumonia. Therefore the decision regarding treatment option needs to be individualized based on the presentation of the patient.

  18. Is it Worth Comparing Different Bankruptcy Models?

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    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.

  19. 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...

  20. Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial.

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    Wu, Shinyi; Ell, Kathleen; Jin, Haomiao; Vidyanti, Irene; Chou, Chih-Ping; Lee, Pey-Jiuan; Gross-Schulman, Sandra; Sklaroff, Laura Myerchin; Belson, David; Nezu, Arthur M; Hay, Joel; Wang, Chien-Ju; Scheib, Geoffrey; Di Capua, Paul; Hawkins, Caitlin; Liu, Pai; Ramirez, Magaly; Wu, Brian W; Richman, Mark; Myers, Caitlin; Agustines, Davin; Dasher, Robert; Kopelowicz, Alex; Allevato, Joseph; Roybal, Mike; Ipp, Eli; Haider, Uzma; Graham, Sharon; Mahabadi, Vahid; Guterman, Jeffrey

    2018-04-23

    Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5

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

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    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.

  2. Comparability of outcome frameworks in medical education: Implications for framework development.

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    Hautz, Stefanie C; Hautz, Wolf E; Feufel, Markus A; Spies, Claudia D

    2015-01-01

    Given the increasing mobility of medical students and practitioners, there is a growing need for harmonization of medical education and qualifications. Although several initiatives have sought to compare national outcome frameworks, this task has proven a challenge. Drawing on an analysis of existing outcome frameworks, we identify factors that hinder comparability and suggest ways of facilitating comparability during framework development and revisions. We searched MedLine, EmBase and the Internet for outcome frameworks in medical education published by national or governmental organizations. We analyzed these frameworks for differences and similarities that influence comparability. Of 1816 search results, 13 outcome frameworks met our inclusion criteria. These frameworks differ in five core features: history and origins, formal structure, medical education system, target audience and key terms. Many frameworks reference other frameworks without acknowledging these differences. Importantly, the level of detail of the outcomes specified differs both within and between frameworks. The differences identified explain some of the challenges involved in comparing outcome frameworks and medical qualifications. We propose a two-level model distinguishing between "core" competencies and culture-specific "secondary" competencies. This approach could strike a balance between local specifics and cross-national comparability of outcome frameworks and medical education.

  3. Sepsis progression and outcome: a dynamical model

    Directory of Open Access Journals (Sweden)

    Gessler Damian DG

    2006-02-01

    Full Text Available Abstract Background Sepsis (bloodstream infection is the leading cause of death in non-surgical intensive care units. It is diagnosed in 750,000 US patients per annum, and has high mortality. Current understanding of sepsis is predominately observational and correlational, with only a partial and incomplete understanding of the physiological dynamics underlying the syndrome. There exists a need for dynamical models of sepsis progression, based upon basic physiologic principles, which could eventually guide hourly treatment decisions. Results We present an initial mathematical model of sepsis, based on metabolic rate theory that links basic vascular and immunological dynamics. The model includes the rate of vascular circulation, a surrogate for the metabolic rate that is mechanistically associated with disease progression. We use the mass-specific rate of blood circulation (SRBC, a correlate of the body mass index, to build a differential equation model of circulation, infection, organ damage, and recovery. This introduces a vascular component into an infectious disease model that describes the interaction between a pathogen and the adaptive immune system. Conclusion The model predicts that deviations from normal SRBC correlate with disease progression and adverse outcome. We compare the predictions with population mortality data from cardiovascular disease and cancer and show that deviations from normal SRBC correlate with higher mortality rates.

  4. 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...... if the preferences are represented by a function that is an integral of a discounting function times a scale defined on outcomes at instants of time....

  5. Synergistic Man: Outcome Model for Counselors

    Science.gov (United States)

    Rousseve, Ronald J.

    1973-01-01

    Drawing on the insights of Ruth Benedict and Abraham Maslow in their search for an ethical gauge by which to rate personal-social health, this article proposes synergistic man'' as the desired outcome model for counselors. (Author)

  6. Comparing 2 Whiplash Grading Systems to Predict Clinical Outcomes.

    Science.gov (United States)

    Croft, Arthur C; Bagherian, Alireza; Mickelsen, Patrick K; Wagner, Stephen

    2016-06-01

    Two whiplash severity grading systems have been developed: Quebec Task Force on Whiplash-Associated Disorders (QTF-WAD) and the Croft grading system. The majority of clinical studies to date have used the modified grading system published by the QTF-WAD in 1995 and have demonstrated some ability to predict outcome. But most studies include only injuries of lower severity (grades 1 and 2), preventing a broader interpretation. The purpose of this study was assess the ability of these grading systems to predict clinical outcome within the context of a broader injury spectrum. This study evaluated both grading systems for their ability to predict the bivalent outcome, recovery, within a sample of 118 whiplash patients who were part of a previous case-control designed study. Of these, 36% (controls) had recovered, and 64% (cases) had not recovered. The discrete bivariate distribution between recovery status and whiplash grade was analyzed using the 2-tailed cross-tabulation statistics. Applying the criteria of the original 1993 Croft grading system, the subset comprised 1 grade 1 injury, 32 grade 2 injuries, 53 grade 3 injuries, and 32 grade 4 injuries. Applying the criteria of the modified (QTF-WAD) grading system, there were 1 grade 1 injury, 89 grade 2 injuries, and 28 grade 3 injuries. Both whiplash grading systems correlated negatively with recovery; that is, higher severity grades predicted a lower probability of recovery, and statistically significant correlations were observed in both, but the Croft grading system substantially outperformed the QTF-WAD system on this measure. The Croft grading system for whiplash injury severity showed a better predictive measure for recovery status from whiplash injuries as compared with the QTF-WAD grading system.

  7. Single-case synthesis tools II: Comparing quantitative outcome measures.

    Science.gov (United States)

    Zimmerman, Kathleen N; Pustejovsky, James E; Ledford, Jennifer R; Barton, Erin E; Severini, Katherine E; Lloyd, Blair P

    2018-03-07

    Varying methods for evaluating the outcomes of single case research designs (SCD) are currently used in reviews and meta-analyses of interventions. Quantitative effect size measures are often presented alongside visual analysis conclusions. Six measures across two classes-overlap measures (percentage non-overlapping data, improvement rate difference, and Tau) and parametric within-case effect sizes (standardized mean difference and log response ratio [increasing and decreasing])-were compared to determine if choice of synthesis method within and across classes impacts conclusions regarding effectiveness. The effectiveness of sensory-based interventions (SBI), a commonly used class of treatments for young children, was evaluated. Separately from evaluations of rigor and quality, authors evaluated behavior change between baseline and SBI conditions. SBI were unlikely to result in positive behavior change across all measures except IRD. However, subgroup analyses resulted in variable conclusions, indicating that the choice of measures for SCD meta-analyses can impact conclusions. Suggestions for using the log response ratio in SCD meta-analyses and considerations for understanding variability in SCD meta-analysis conclusions are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Comparative clinical outcomes between pediatric and young adult dialysis patients.

    Science.gov (United States)

    Atkinson, Meredith A; Lestz, Rachel M; Fivush, Barbara A; Silverstein, Douglas M

    2011-12-01

    Published data on the comparative achievement of The Kidney Disease Dialysis Outcome Quality Initiative (KDOQI) recommended clinical performance targets between children and young adults on dialysis are scarce. To characterize the achievement of KDOQI targets among children (young adults (18-24 years) with prevalent end stage renal disease (ESRD), we performed a cross-sectional analysis of data collected by the Mid-Atlantic Renal Coalition, in conjunction with the 2007 and 2008 ESRD Clinical Performance Measures Projects. Data on all enrolled pediatric dialysis patients, categorized into three age groups (0-8, 9-12, 13-17 years), and on a random sample of 5% of patients ≥ 18 years in ESRD Network 5 were examined for two study periods: hemodialysis (HD) data were collected from October to December 2006 and from October to December 2007 and peritoneal dialysis (PD) data were collected from October 2006 to March 2007 and from October 2007 to March 2008. In total, 114 unique patients were enrolled the study, of whom 41.2% (47/114) were on HD and 58.8% (67/114) on PD. Compared to the pediatric patients, young adults were less likely to achieve the KDOQI recommended serum phosphorus levels and serum calcium × phosphorus product values, with less than one-quarter demonstrating values at or below each goal. Multivariate analysis revealed that both young adults and 13- to 17-year-olds were less likely to achieve target values for phosphorus [young adults: odds ratio (OR) 0.04, 95% confidence interval (95% CI) 0.01-0.19, p young adults: OR 0.01, 95% CI 0.002-0.09, p young adult ESRD patients.

  9. Teachers' Continuing Professional Development: Framing a Model of Outcomes

    Science.gov (United States)

    Harland, John; Kinder, Kay

    2014-01-01

    In order to contribute towards the construction of an empirically-grounded theory of effective continuing professional development (CPD), this paper seeks to develop a model of the effects of teachers' CPD or in-service education and training (INSET). It builds on an earlier typology of INSET outcomes and compares it to two previous classification…

  10. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes.

    Science.gov (United States)

    Gibson, E J; Begum, N; Koblbauer, I; Dranitsaris, G; Liew, D; McEwan, P; Tahami Monfared, A A; Yuan, Y; Juarez-Garcia, A; Tyas, D; Lees, M

    2018-01-01

    Economic models in oncology are commonly based on the three-state partitioned survival model (PSM) distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O) suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs). The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%). Increased sophistication in the representation of disease dynamics in economic models is desirable when attempting to model treatment response in I-O. However, the assumptions underlying different model structures and the availability of data for health state mapping may be important limiting factors.

  11. Labour Outcomes After Successful External Cephalic Version Compared With Spontaneous Cephalic Version.

    Science.gov (United States)

    Krueger, Samantha; Simioni, Julia; Griffith, Lauren E; Hutton, Eileen K

    2018-01-01

    This study sought to compare obstetrical outcomes for women with a cephalic presentation at birth resulting from successful external cephalic version (ECV) compared to those resulting from spontaneous cephalic version (SCV). Secondary analysis was performed on Early External Cephalic Version Trial data. A total of 931 study participants had breech presentations between 34 and 36 weeks' gestation and cephalic presentations at birth. The incidence of intrapartum interventions was compared between patients with successful ECV (557) and those with SCV (374). A generalized linear mixed model was used to determine ORs for our primary outcomes. Parity, maternal BMI, previous CS, and enrolment centre were controlled for in the analysis. No differences were found after ECV compared with SCV in the incidence of CS (96 of 557 and 76 of 374, respectively; adjusted OR [aOR] 0.89; 95% CI 0.63-1.26), instrumental birth (68 of 557 and 29 of 373, respectively; aOR 1.55; 95% CI 0.96-2.50), or normal vaginal birth (393 of 557 and 268 of 373, respectively; aOR 0.92; 95% CI 0.68-1.24). Multiparous women with successful ECV were half as likely to require a CS compared with those with SCV and no ECV (28 of 313 and 42 of 258, respectively; aOR 0.45; 95% CI 0.26-0.80). This is the first study to compare birth outcomes of breech pregnancies that convert to cephalic presentation by means of SCV with birth outcomes of breech pregnancies that have ECV. Women with a cephalic-presenting fetus at birth as a result of successful ECV are not at greater risk of obstetrical interventions at birth when compared with women with fetuses who spontaneously turn to a cephalic presentation in the third trimester. Copyright © 2018. Published by Elsevier Inc.

  12. 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.)

  13. Improving treatment outcome assessment in a mouse tuberculosis model.

    Science.gov (United States)

    Mourik, Bas C; Svensson, Robin J; de Knegt, Gerjo J; Bax, Hannelore I; Verbon, Annelies; Simonsson, Ulrika S H; de Steenwinkel, Jurriaan E M

    2018-04-09

    Preclinical treatment outcome evaluation of tuberculosis (TB) occurs primarily in mice. Current designs compare relapse rates of different regimens at selected time points, but lack information about the correlation between treatment length and treatment outcome, which is required to efficiently estimate a regimens' treatment-shortening potential. Therefore we developed a new approach. BALB/c mice were infected with a Mycobacterium tuberculosis Beijing genotype strain and were treated with rifapentine-pyrazinamide-isoniazid-ethambutol (R p ZHE), rifampicin-pyrazinamide-moxifloxacin-ethambutol (RZME) or rifampicin-pyrazinamide-moxifloxacin-isoniazid (RZMH). Treatment outcome was assessed in n = 3 mice after 9 different treatment lengths between 2-6 months. Next, we created a mathematical model that best fitted the observational data and used this for inter-regimen comparison. The observed data were best described by a sigmoidal E max model in favor over linear or conventional E max models. Estimating regimen-specific parameters showed significantly higher curative potentials for RZME and R p ZHE compared to RZMH. In conclusion, we provide a new design for treatment outcome evaluation in a mouse TB model, which (i) provides accurate tools for assessment of the relationship between treatment length and predicted cure, (ii) allows for efficient comparison between regimens and (iii) adheres to the reduction and refinement principles of laboratory animal use.

  14. Bariatric Outcomes and Obesity Modeling: Study Meeting

    Science.gov (United States)

    2010-09-17

    Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA...developed a cost-effectiveness model and a payer-based budget and fiscal impact tool to compare bariatric surgical procedures to non- operative ...SURVIVAL MODELED FROM NHIS -NDI • Statistical analysis adapts the methods from Schauer 2010. • Logistic regression model is used to predict the 5-year

  15. 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.

  16. 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.

  17. Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

    Science.gov (United States)

    Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

    2015-08-01

    When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. COMPARATIVE ANALYSIS OF SOFTWARE DEVELOPMENT MODELS

    OpenAIRE

    Sandeep Kaur*

    2017-01-01

    No geek is unfamiliar with the concept of software development life cycle (SDLC). This research deals with the various SDLC models covering waterfall, spiral, and iterative, agile, V-shaped, prototype model. In the modern era, all the software systems are fallible as they can’t stand with certainty. So, it is tried to compare all aspects of the various models, their pros and cons so that it could be easy to choose a particular model at the time of need

  19. Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Ohno, Yoshiharu, E-mail: yosirad@kobe-u.ac.jp [Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe (Japan); Fujisawa, Yasuko [Toshiba Medical Systems Corporation, Otawara (Japan); Koyama, Hisanobu; Kishida, Yuji; Seki, Shinichiro [Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Sugihara, Naoki [Toshiba Medical Systems Corporation, Otawara (Japan); Yoshikawa, Takeshi [Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe (Japan)

    2017-01-15

    Purpose: To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy. Materials and methods: Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR + PR) and 2) stable or progressive disease (SD + PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV{sub max}, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared. Results: The step-wise regression test showed that therapeutic effect (r{sup 2} = 0.63, p = 0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV{sub max}. Mean overall survival showed a significant difference for total perfusion (p = 0.003) and systemic arterial perfusion (p = 0.04). Conclusion: Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.

  20. Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT

    International Nuclear Information System (INIS)

    Ohno, Yoshiharu; Fujisawa, Yasuko; Koyama, Hisanobu; Kishida, Yuji; Seki, Shinichiro; Sugihara, Naoki; Yoshikawa, Takeshi

    2017-01-01

    Purpose: To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy. Materials and methods: Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR + PR) and 2) stable or progressive disease (SD + PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV max , and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared. Results: The step-wise regression test showed that therapeutic effect (r 2 = 0.63, p = 0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV max . Mean overall survival showed a significant difference for total perfusion (p = 0.003) and systemic arterial perfusion (p = 0.04). Conclusion: Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.

  1. Dynamic contrast-enhanced perfusion area-detector CT assessed with various mathematical models: Its capability for therapeutic outcome prediction for non-small cell lung cancer patients with chemoradiotherapy as compared with that of FDG-PET/CT.

    Science.gov (United States)

    Ohno, Yoshiharu; Fujisawa, Yasuko; Koyama, Hisanobu; Kishida, Yuji; Seki, Shinichiro; Sugihara, Naoki; Yoshikawa, Takeshi

    2017-01-01

    To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy. Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV max , and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared. The step-wise regression test showed that therapeutic effect (r 2 =0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV max . Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04). Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Measuring outcomes in psychiatry: an inpatient model.

    Science.gov (United States)

    Davis, D E; Fong, M L

    1996-02-01

    This article describes a system for measuring outcomes recently implemented in the department of psychiatry of Baptist Memorial Hospital, a 78-bed inpatient and day treatment unit that represents one service line of a large, urban teaching hospital in Memphis. In June 1993 Baptist Hospital began a 15-month pilot test of PsychSentinel, a measurement tool developed by researchers in the Department of Community Medicine at the University of Connecticut. The hospital identified the following four primary goals for this pilot project: provide data for internal hospital program evaluation, provide data for external marketing in a managed care environment, satisfy requirements of the Joint Commission on Accreditation of Health Care Organizations, and generate studies that add to the literature in psychiatry and psychology. PsychSentinel is based on the standardized diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). The outcome measure assesses the change in the number of symptoms of psychopathology that occurs between admission and discharge from the hospital. Included in the nonproprietary system are risk adjustment factors, as well as access to a national reference database for comparative analysis purposes. Data collection can be done by trained ancillary staff members, with as much or as little direct physician involvement as desired. The system has proven to be both time effective and cost effective, and it provides important outcome information both at the program level and at the clinician level. After the pilot test, the staff at Baptist Memorial Hospital determined that the system met all initial objectives identified and recently adopted the system as an ongoing measure of quality patient care in the department of psychiatry.

  3. Modeling the economic outcomes of immuno-oncology drugs: alternative model frameworks to capture clinical outcomes

    Directory of Open Access Journals (Sweden)

    Gibson EJ

    2018-03-01

    Full Text Available EJ Gibson,1 N Begum,1 I Koblbauer,1 G Dranitsaris,2 D Liew,3 P McEwan,4 AA Tahami Monfared,5,6 Y Yuan,7 A Juarez-Garcia,7 D Tyas,8 M Lees9 1Wickenstones Ltd, Didcot, UK; 2Augmentium Pharma Consulting Inc, Toronto, ON, Canada; 3Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia; 4Health Economics and Outcomes Research Ltd, Cardiff, UK; 5Bristol-Myers Squibb Canada, Saint-Laurent, QC Canada; 6Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; 7Bristol-Myers Squibb, Princeton, NJ, USA; 8Bristol-Myers Squibb, Uxbridge, UK; 9Bristol-Myers Squibb, Rueil-Malmaison, France Background: Economic models in oncology are commonly based on the three-state partitioned survival model (PSM distinguishing between progression-free and progressive states. However, the heterogeneity of responses observed in immuno-oncology (I-O suggests that new approaches may be appropriate to reflect disease dynamics meaningfully. Materials and methods: This study explored the impact of incorporating immune-specific health states into economic models of I-O therapy. Two variants of the PSM and a Markov model were populated with data from one clinical trial in metastatic melanoma patients. Short-term modeled outcomes were benchmarked to the clinical trial data and a lifetime model horizon provided estimates of life years and quality adjusted life years (QALYs. Results: The PSM-based models produced short-term outcomes closely matching the trial outcomes. Adding health states generated increased QALYs while providing a more granular representation of outcomes for decision making. The Markov model gave the greatest level of detail on outcomes but gave short-term results which diverged from those of the trial (overstating year 1 progression-free survival by around 60%. Conclusion: Increased sophistication in the representation of disease dynamics in economic models

  4. Wellness Model of Supervision: A Comparative Analysis

    Science.gov (United States)

    Lenz, A. Stephen; Sangganjanavanich, Varunee Faii; Balkin, Richard S.; Oliver, Marvarene; Smith, Robert L.

    2012-01-01

    This quasi-experimental study compared the effectiveness of the Wellness Model of Supervision (WELMS; Lenz & Smith, 2010) with alternative supervision models for developing wellness constructs, total personal wellness, and helping skills among counselors-in-training. Participants were 32 master's-level counseling students completing their…

  5. Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes.

    Science.gov (United States)

    Street, Maryann; Berry, Debra; Considine, Julie

    2018-04-12

    To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. People aged ≥65 years attending the ED in financial year 2013/2014. The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.

  6. Comparing flood loss models of different complexity

    Science.gov (United States)

    Schröter, Kai; Kreibich, Heidi; Vogel, Kristin; Riggelsen, Carsten; Scherbaum, Frank; Merz, Bruno

    2013-04-01

    Any deliberation on flood risk requires the consideration of potential flood losses. In particular, reliable flood loss models are needed to evaluate cost-effectiveness of mitigation measures, to assess vulnerability, for comparative risk analysis and financial appraisal during and after floods. In recent years, considerable improvements have been made both concerning the data basis and the methodological approaches used for the development of flood loss models. Despite of that, flood loss models remain an important source of uncertainty. Likewise the temporal and spatial transferability of flood loss models is still limited. This contribution investigates the predictive capability of different flood loss models in a split sample cross regional validation approach. For this purpose, flood loss models of different complexity, i.e. based on different numbers of explaining variables, are learned from a set of damage records that was obtained from a survey after the Elbe flood in 2002. The validation of model predictions is carried out for different flood events in the Elbe and Danube river basins in 2002, 2005 and 2006 for which damage records are available from surveys after the flood events. The models investigated are a stage-damage model, the rule based model FLEMOps+r as well as novel model approaches which are derived using data mining techniques of regression trees and Bayesian networks. The Bayesian network approach to flood loss modelling provides attractive additional information concerning the probability distribution of both model predictions and explaining variables.

  7. 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 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.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.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.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 attendance, and may suggest encouraging employees to

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

    Science.gov (United States)

    Cocker, Fiona; Nicholson, Jan M; Graves, Nicholas; Oldenburg, Brian; Palmer, Andrew J; Martin, Angela; Scott, Jenn; Venn, Alison; Sanderson, Kristy

    2014-01-01

    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. 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). 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. 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 attendance, and may suggest encouraging employees to continue

  9. Comparable Short- and Long-term Outcomes in Living Donor and Deceased Donor Liver Transplantations for Patients With Model for End-stage Liver Disease Scores ≥35 in a Hepatitis-B Endemic Area.

    Science.gov (United States)

    Chok, Kenneth S H; Fung, James Y Y; Chan, Albert C Y; Dai, Wing Chiu; Sharr, William W; Cheung, Tan To; Chan, See Ching; Lo, Chung Mau

    2017-01-01

    To evaluate if living donor liver transplantation (LDLT) should be offered to patients with Model for End-stage Liver Disease (MELD) scores ≥35. No data was available to support LDLT of such patients. Data of 672 consecutive adult liver transplant recipients from 2005 to 2014 at our center were reviewed. Patients with MELD scores ≥35 were divided into the deceased donor liver transplantation (DDLT) group and the LDLT group and were compared. Univariate analysis was performed to identify risk factors affecting survival. The LDLT group (n = 54) had younger (33 yrs vs 50 yrs, P standard-liver-volume rates (51.28% vs 99.76%, P Hong Kong, where most waitlisted patients have acute-on-chronic liver failure from hepatitis B, LDLT is a wise alternative to DDLT.

  10. Comparative study of void fraction models

    International Nuclear Information System (INIS)

    Borges, R.C.; Freitas, R.L.

    1985-01-01

    Some models for the calculation of void fraction in water in sub-cooled boiling and saturated vertical upward flow with forced convection have been selected and compared with experimental results in the pressure range of 1 to 150 bar. In order to know the void fraction axial distribution it is necessary to determine the net generation of vapour and the fluid temperature distribution in the slightly sub-cooled boiling region. It was verified that the net generation of vapour was well represented by the Saha-Zuber model. The selected models for the void fraction calculation present adequate results but with a tendency to super-estimate the experimental results, in particular the homogeneous models. The drift flux model is recommended, followed by the Armand and Smith models. (F.E.) [pt

  11. Comparative Study of Bancruptcy Prediction Models

    Directory of Open Access Journals (Sweden)

    Isye Arieshanti

    2013-09-01

    Full Text Available Early indication of bancruptcy is important for a company. If companies aware of  potency of their bancruptcy, they can take a preventive action to anticipate the bancruptcy. In order to detect the potency of a bancruptcy, a company can utilize a a model of bancruptcy prediction. The prediction model can be built using a machine learning methods. However, the choice of machine learning methods should be performed carefully. Because the suitability of a model depends on the problem specifically. Therefore, in this paper we perform a comparative study of several machine leaning methods for bancruptcy prediction. According to the comparative study, the performance of several models that based on machine learning methods (k-NN, fuzzy k-NN, SVM, Bagging Nearest Neighbour SVM, Multilayer Perceptron(MLP, Hybrid of MLP + Multiple Linear Regression, it can be showed that fuzzy k-NN method achieve the best performance with accuracy 77.5%

  12. 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.

  13. 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

    2017-11-01

    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.

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    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...... and by the absence of 'agonizing' pain and of symptoms coinciding with pain (P model 15 of 18 predicted patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overall accuracy...... was 89%. CONCLUSION: From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies....

  15. Comparing Learning Outcomes of Blended Learning and Traditional Face-to-Face Learning of University Students in ESL Courses

    Science.gov (United States)

    Zhang, Wei; Zhu, Chang

    2018-01-01

    Combining elements of online and face-to-face education, blended learning is emerging as an important teaching and learning model in higher education. In order to examine the effectiveness of blended learning, as compared to the traditional face-to-face learning mode, this research investigated the learning outcomes of students following English…

  16. 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.

  17. 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.

  18. Redefining Outcome Measurement: A Model for Brief Psychotherapy.

    Science.gov (United States)

    McGuinty, Everett; Nelson, John; Carlson, Alain; Crowther, Eric; Bednar, Dina; Foroughe, Mirisse

    2016-05-01

    The zeitgeist for short-term psychotherapy efficacy has fundamentally shifted away from evidence-based practices to include evidence-informed practices, resulting in an equally important paradigm shift in outcome measurement designed to reflect change in this short-term modality. The present article delineates a short-term psychotherapy structure which defines four fundamental stages that all brief therapies may have in common, and are represented through Cognitive Behavioral Therapy, Solution-Focused Brief Therapy, Narrative Therapy, and Emotion-Focused Therapy. These four theoretical approaches were analyzed via a selected literature review through comparing and contrasting specific and common tasks as they relate to the process of psychotherapy and change. Once commonalities were identified within session, they were categorized or grouped into themes or general stages of change within the parameters of a four to six session model of short-term therapy. Commonalities in therapeutic stages of change may more accurately and uniformly measure outcome in short-term work, unlike the symptom-specific psychometric instruments of longer-term psychotherapy. A systematic framework for evaluating the client and clinician adherence to 20 specific tasks for these four short-term therapies is presented through the newly proposed, Brief Task Acquisition Scale (BTAS). It is further proposed that the client-clinicians' adherence to these tasks will track and ultimately increase treatment integrity. Thus, when the client-clinician relationship tracks and evaluates the three pillars of (1) stage/process change, (2) task acquisition, and (3) treatment integrity, the culmination of these efforts presents a new way of more sensitively measuring outcome in short-term psychotherapy. Data collection is suggested as a first step to empirically evaluate the testable hypotheses suggested within this current model. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The

  19. Comparing Realistic Subthalamic Nucleus Neuron Models

    Science.gov (United States)

    Njap, Felix; Claussen, Jens C.; Moser, Andreas; Hofmann, Ulrich G.

    2011-06-01

    The mechanism of action of clinically effective electrical high frequency stimulation is still under debate. However, recent evidence points at the specific activation of GABA-ergic ion channels. Using a computational approach, we analyze temporal properties of the spike trains emitted by biologically realistic neurons of the subthalamic nucleus (STN) as a function of GABA-ergic synaptic input conductances. Our contribution is based on a model proposed by Rubin and Terman and exhibits a wide variety of different firing patterns, silent, low spiking, moderate spiking and intense spiking activity. We observed that most of the cells in our network turn to silent mode when we increase the GABAA input conductance above the threshold of 3.75 mS/cm2. On the other hand, insignificant changes in firing activity are observed when the input conductance is low or close to zero. We thus reproduce Rubin's model with vanishing synaptic conductances. To quantitatively compare spike trains from the original model with the modified model at different conductance levels, we apply four different (dis)similarity measures between them. We observe that Mahalanobis distance, Victor-Purpura metric, and Interspike Interval distribution are sensitive to different firing regimes, whereas Mutual Information seems undiscriminative for these functional changes.

  20. 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

  1. The Social Responsibility Performance Outcomes Model: Building Socially Responsible Companies through Performance Improvement Outcomes.

    Science.gov (United States)

    Hatcher, Tim

    2000-01-01

    Considers the role of performance improvement professionals and human resources development professionals in helping organizations realize the ethical and financial power of corporate social responsibility. Explains the social responsibility performance outcomes model, which incorporates the concepts of societal needs and outcomes. (LRW)

  2. Touch DNA collection versus firearm fingerprinting: comparing evidence production and identification outcomes.

    Science.gov (United States)

    Nunn, Samuel

    2013-05-01

    A project by a metropolitan police agency in 2008-2009 had police use touch DNA kits to collect cell samples from seized firearms. To assess outcomes, results of touch DNA swabbing of firearms were compared to fingerprinting firearm evidence. The rationale was that fingerprinting, as the older technology, was the baseline against which to compare touch DNA. But little is known about ways to measure touch DNA productivity compared to fingerprinting. To examine differences between the two requires comparable measurements. Two measures were used: quantity of probative or investigative evidence produced and identification outcomes. When applied to firearms seized within an Indianapolis, IN police district, touch DNA produced a larger volume of evidence than fingerprinting, but identification outcomes for the two methods were equal. Because touch DNA was deployed by police patrol officers, there are implications for firearm forensics and the choice of forensic approaches used by police. © 2013 American Academy of Forensic Sciences.

  3. Comparative study of the maternal and fetal outcome of women who ...

    African Journals Online (AJOL)

    Context: Antepartum haemorrhage is a grave and potentially life threatening condition and a major cause of both maternal and fetal mortality. Objective: To compare the fetal and maternal outcome of patients with abruption placenta and placental praevia. Design/Setting/Subjects: A retrospective comparative study ...

  4. Comparing Social Worker and Non-Social Worker Outcomes: A Research Review

    Science.gov (United States)

    Rubin, Allen; Parrish, Danielle E.

    2012-01-01

    This article reports on a review of the literature comparing the outcomes of social workers with those of non-social workers. The review was commissioned by NASW's Texas Chapter to examine empirical evidence regarding the comparative effectiveness of social work to possibly support efforts to educate employers and the public about the value of…

  5. 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...... 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......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...

  6. Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2013-01-01

    Full Text Available Introduction. Single-incision laparoscopic colectomy (SILC is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies ( and anterior resections (. There were no significant differences in operative time (127.9 versus 126.7 min, conversions (0 versus 1, complications (14% versus 8%, length of stay (4.5 versus 4.0 days, readmissions (2% versus 2%, and reoperations (2% versus 2%. Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

  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. Decision modeling for analyzing fire action outcomes

    Science.gov (United States)

    Donald MacGregor; Armando Gonzalez-Caban

    2008-01-01

    A methodology for incident decomposition and reconstruction is developed based on the concept of an "event-frame model." The event-frame model characterizes a fire incident in terms of (a) environmental events that pertain to the fire and the fire context (e.g., fire behavior, weather, fuels) and (b) management events that represent responses to the fire...

  9. Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes.

    Science.gov (United States)

    Sheng, Weizheng; Zhang, Bo; Chen, Weifeng; Gu, Dayong; Gao, Weidong

    2015-01-01

    This study evaluated the short- and long-term outcomes of laparoscopic colectomy compared with open colectomy for patients with transverse colon cancer by matched-pair analysis. This study enrolled 59 patients who underwent laparoscopic colectomy and compared them with 59 matched patients who underwent open colectomy for transverse colon cancer. The following parameters were matched: clinical stage and type of resection. Both short- and long-term outcomes of laparoscopic colectomy were compared with those of open colectomy. No difference was observed between the two groups in terms of age, gender, ASA score, comorbidity, clinical stage and operative procedures. Regarding short-term outcomes, blood loss, time to first flatus, time to liquid diet and postoperative stay were significantly shorter in the laparoscopy group than in the open group, while operation time was significantly longer in the laparoscopy group than in the open group. Postoperative complication was similar between the two groups. With respect to long-term outcomes, the two groups did not differ significantly in terms of 5-year overall and disease-free survival. In summary, laparoscopic colectomy is a safe and feasible option for selected patients with transverse colon cancer. The short- and long-term outcomes of laparoscopic colectomy are considered to be acceptable.

  10. Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy

    DEFF Research Database (Denmark)

    Shen, Li; Ramires, Felix; Martinez, Felipe

    2017-01-01

    BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies...

  11. Comparing Delivery Approaches to Teaching Abnormal Psychology: Investigating Student Perceptions and Learning Outcomes

    Science.gov (United States)

    Goette, William F.; Delello, Julie A.; Schmitt, Andrew L.; Sullivan, Jeremy R.; Rangel, Angelica

    2017-01-01

    This study compares the academic performance and perceptions of 114 undergraduate students enrolled in an abnormal psychology course. Specifically, this study focuses on whether face-to-face (F2F) or blended modalities are associated with student learning outcomes. In this study, data analysis was based upon the examination of end-of-course…

  12. 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…

  13. 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…

  14. Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: Observational study of mortality outcomes

    NARCIS (Netherlands)

    P. Sooriakumaran (Prasanna); T. Nyberg (Tommy); O. Akre (Olof); L. Haendler (Leif); I. Heus (Inge); M. Olsson (Marita); S. Carlsson (Sigrid); M.J. Roobol-Bouts (Monique); G. Steineck (Gunnar); P. Wiklund (Peter)

    2014-01-01

    textabstractObjective: To compare the survival outcomes of patients treated with surgery or radiotherapy for prostate cancer. Design: Observational study. Setting: Sweden, 1996-2010. Participants: 34 515 men primarily treated for prostate cancer with surgery (n=21 533) or radiotherapy (n=12 982).

  15. Blended versus Traditional Course Delivery: Comparing Students' Motivation, Learning Outcomes, and Preferences

    Science.gov (United States)

    Tseng, Hungwei; Walsh, Eamonn Joseph, Jr.

    2016-01-01

    This study sought to compare and assess students' experiences and perceptions in a blended and a traditional course, as well as their level of learning motivation, level of learning outcomes and skills, and learning achievement. Two instructors who were teaching 1 section of an undergraduate English literacy course using the face-to-face format…

  16. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death

    NARCIS (Netherlands)

    van Loo, Ellen S.; Krikke, Christina; Hofker, Hendrik S.; Berger, Stefan P.; Leuvenink, Henri G. D.; Pol, Robert A.

    Introduction: To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD). Materials and methods: A literature search was performed using Medline,

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

    OpenAIRE

    Mahtab ORDOOEI; Hadi MOTTAGHIPISHEH; Razieh FALLAH*; Azar RABIEE

    2014-01-01

    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 wit...

  18. Comparing holographic dark energy models with statefinder

    International Nuclear Information System (INIS)

    Cui, Jing-Lei; Zhang, Jing-Fei

    2014-01-01

    We apply the statefinder diagnostic to the holographic dark energy models, including the original holographic dark energy (HDE) model, the new holographic dark energy model, the new agegraphic dark energy (NADE) model, and the Ricci dark energy model. In the low-redshift region the holographic dark energy models are degenerate with each other and with the ΛCDM model in the H(z) and q(z) evolutions. In particular, the HDE model is highly degenerate with the ΛCDM model, and in the HDE model the cases with different parameter values are also in strong degeneracy. Since the observational data are mainly within the low-redshift region, it is very important to break this lowredshift degeneracy in the H(z) and q(z) diagnostics by using some quantities with higher order derivatives of the scale factor. It is shown that the statefinder diagnostic r(z) is very useful in breaking the low-redshift degeneracies. By employing the statefinder diagnostic the holographic dark energy models can be differentiated efficiently in the low-redshift region. The degeneracy between the holographic dark energy models and the ΛCDM model can also be broken by this method. Especially for the HDE model, all the previous strong degeneracies appearing in the H(z) and q(z) diagnostics are broken effectively. But for the NADE model, the degeneracy between the cases with different parameter values cannot be broken, even though the statefinder diagnostic is used. A direct comparison of the holographic dark energy models in the r-s plane is also made, in which the separations between the models (including the ΛCDM model) can be directly measured in the light of the current values {r 0 , s 0 } of the models. (orig.)

  19. Outcomes of cochlear implantation in deaf children of deaf parents: comparative study.

    Science.gov (United States)

    Hassanzadeh, S

    2012-10-01

    This retrospective study compared the cochlear implantation outcomes of first- and second-generation deaf children. The study group consisted of seven deaf, cochlear-implanted children with deaf parents. An equal number of deaf children with normal-hearing parents were selected by matched sampling as a reference group. Participants were matched based on onset and severity of deafness, duration of deafness, age at cochlear implantation, duration of cochlear implantation, gender, and cochlear implant model. We used the Persian Auditory Perception Test for the Hearing Impaired, the Speech Intelligibility Rating scale, and the Sentence Imitation Test, in order to measure participants' speech perception, speech production and language development, respectively. Both groups of children showed auditory and speech development. However, the second-generation deaf children (i.e. deaf children of deaf parents) exceeded the cochlear implantation performance of the deaf children with hearing parents. This study confirms that second-generation deaf children exceed deaf children of hearing parents in terms of cochlear implantation performance. Encouraging deaf children to communicate in sign language from a very early age, before cochlear implantation, appears to improve their ability to learn spoken language after cochlear implantation.

  20. 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.

  1. 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.

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

    International Nuclear Information System (INIS)

    Ruiz Santiago, Fernando; Perez Abela, Antonio; Guzman Alvarez, Luis; Alvarez Osuna, Rosa Maria; Mar Castellano Garcia, Maria del

    2010-01-01

    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.

  3. Atterberg Limits Prediction Comparing SVM with ANFIS Model

    Directory of Open Access Journals (Sweden)

    Mohammad Murtaza Sherzoy

    2017-03-01

    Full Text Available Support Vector Machine (SVM and Adaptive Neuro-Fuzzy inference Systems (ANFIS both analytical methods are used to predict the values of Atterberg limits, such as the liquid limit, plastic limit and plasticity index. The main objective of this study is to make a comparison between both forecasts (SVM & ANFIS methods. All data of 54 soil samples are used and taken from the area of Peninsular Malaysian and tested for different parameters containing liquid limit, plastic limit, plasticity index and grain size distribution and were. The input parameter used in for this case are the fraction of grain size distribution which are the percentage of silt, clay and sand. The actual and predicted values of Atterberg limit which obtained from the SVM and ANFIS models are compared by using the correlation coefficient R2 and root mean squared error (RMSE value.  The outcome of the study show that the ANFIS model shows higher accuracy than SVM model for the liquid limit (R2 = 0.987, plastic limit (R2 = 0.949 and plastic index (R2 = 0966. RMSE value that obtained for both methods have shown that the ANFIS model has represent the best performance than SVM model to predict the Atterberg Limits as a whole.

  4. 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

    The objective of the article was to: a) present results from a case cohort pilot study comparing stand-alone ALIF and TLIF and, b) review the literature on studies comparing the clinical outcome of stand-alone ALIF with posterior instrumentation including TLIF or PLIF, in patients with disabling...... 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...

  5. Comparative Analysis of Investment Decision Models

    Directory of Open Access Journals (Sweden)

    Ieva Kekytė

    2017-06-01

    Full Text Available Rapid development of financial markets resulted new challenges for both investors and investment issues. This increased demand for innovative, modern investment and portfolio management decisions adequate for market conditions. Financial market receives special attention, creating new models, includes financial risk management and investment decision support systems.Researchers recognize the need to deal with financial problems using models consistent with the reality and based on sophisticated quantitative analysis technique. Thus, role mathematical modeling in finance becomes important. This article deals with various investments decision-making models, which include forecasting, optimization, stochatic processes, artificial intelligence, etc., and become useful tools for investment decisions.

  6. Total hip arthroplasty outcomes assessment using functional and radiographic scores to compare canine systems.

    Science.gov (United States)

    Iwata, D; Broun, H C; Black, A P; Preston, C A; Anderson, G I

    2008-01-01

    A retrospective multi-centre study was carried out in order to compare outcomes between cemented and uncemented total hip arthoplasties (THA). A quantitative orthopaedic outcome assessment scoring system was devised in order to relate functional outcome to a numerical score, to allow comparison between treatments and amongst centres. The system combined a radiographic score and a clinical score. Lower scores reflect better outcomes than higher scores. Consecutive cases of THA were included from two specialist practices between July 2002 and December 2005. The study included 46 THA patients (22 uncemented THA followed for 8.3 +/- 4.7M and 24 cemented THA for 26.0 +/- 15.7M) with a mean age of 4.4 +/- 3.3 years at surgery. Multi-variable linear and logistical regression analyses were performed with adjustments for age at surgery, surgeon, follow-up time, uni- versus bilateral disease, gender and body weight. The differences between treatment groups in terms of functional scores or total scores were not significant (p > 0.05). Radiographic scores were different between treatment groups. However, these scores were usually assessed within two months of surgery and proved unreliable predictors of functional outcome (p > 0.05). The findings reflect relatively short-term follow-up, especially for the uncemented group, and do not include clinician-derived measures, such as goniometry and thigh circumference. Longer-term follow-up for the radiographic assessments is essential. A prospective study including the clinician-derived outcomes needs to be performed in order to validate the outcome instrument in its modified form.

  7. Clinical Prediction Models for Cardiovascular Disease: Tufts Predictive Analytics and Comparative Effectiveness Clinical Prediction Model Database.

    Science.gov (United States)

    Wessler, Benjamin S; Lai Yh, Lana; Kramer, Whitney; Cangelosi, Michael; Raman, Gowri; Lutz, Jennifer S; Kent, David M

    2015-07-01

    Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision making and individualize care. For patients with cardiovascular disease, there are numerous CPMs available although the extent of this literature is not well described. We conducted a systematic review for articles containing CPMs for cardiovascular disease published between January 1990 and May 2012. Cardiovascular disease includes coronary heart disease, heart failure, arrhythmias, stroke, venous thromboembolism, and peripheral vascular disease. We created a novel database and characterized CPMs based on the stage of development, population under study, performance, covariates, and predicted outcomes. There are 796 models included in this database. The number of CPMs published each year is increasing steadily over time. Seven hundred seventeen (90%) are de novo CPMs, 21 (3%) are CPM recalibrations, and 58 (7%) are CPM adaptations. This database contains CPMs for 31 index conditions, including 215 CPMs for patients with coronary artery disease, 168 CPMs for population samples, and 79 models for patients with heart failure. There are 77 distinct index/outcome pairings. Of the de novo models in this database, 450 (63%) report a c-statistic and 259 (36%) report some information on calibration. There is an abundance of CPMs available for a wide assortment of cardiovascular disease conditions, with substantial redundancy in the literature. The comparative performance of these models, the consistency of effects and risk estimates across models and the actual and potential clinical impact of this body of literature is poorly understood. © 2015 American Heart Association, Inc.

  8. 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.

  9. Comparing victim attributions and outcomes for workplace aggression and sexual harassment.

    Science.gov (United States)

    Hershcovis, M Sandy; Barling, Julian

    2010-09-01

    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 an experimental study. We hypothesized that victims of sexual harassment are more likely than victims of workplace aggression to depersonalize their mistreatment and attribute blame to the perpetrator or the perpetrator's attitudes toward their gender. In contrast, victims of workplace aggression are more likely than victims of sexual harassment to personalize the mistreatment and make internal attributions. Results supported our hypotheses. On the basis of differential attributions for these 2 types of mistreatment, we argue that victims of workplace aggression may experience stronger adverse outcomes than victims of sexual harassment. In Study 2, we compared meta-analytically the attitudinal, behavioral, and health outcomes of workplace aggression and sexual harassment. Negative outcomes of workplace aggression were stronger in magnitude than those of sexual harassment for 6 of the 8 outcome variables. Implications and future directions are discussed. Copyright 2010 APA, all rights reserved

  10. Outcome of Peroral Endoscopic Myotomy (POEM) for Treating Achalasia Compared With Laparoscopic Heller Myotomy (LHM).

    Science.gov (United States)

    Peng, Lijun; Tian, Shuni; Du, Chao; Yuan, Ziying; Guo, Mingxiao; Lu, Lin

    2017-02-01

    Peroral endoscopic myotomy (POEM) is an emerging endoscopic treatment for achalasia and the long-term efficacy of POEM remains to be evaluated. This study compared the outcomes of POEM with that of the standard laparoscopic Heller myotomy (LHM) for achalasia. Achalasia patients treated by POEM or LHM were retrospectively analyzed, with a minimum postoperative follow-up of 3 years. Perioperative outcomes and long-term outcomes including treatment success (Eckardt score ≤3), occurrence of gastroesophageal reflux disease (GERD) (GerdQ score ≥9) and quality of life (36-item short form) were compared. Thirteen patients who underwent POEM were compared with 18 patients who received LHM. These patients were similar in age, sex, symptoms duration, Eckardt score, and previous therapy (all P>0.05). Mean myotomy lengths were similar (P=0.73). Operation time was shorter in the POEM group (P=0.001). One patient (7.7%) developed pneumothorax after POEM and 1 patient (5.6%) experienced postoperative infection after LHM (P=1.00). Treatment success was achieved in 83.3% (9/12) of POEM patients and 80.0% (12/15) of LHM patients (P=1.00). Both POEM and LHM significantly reduced Eckardt score (both P=0.00). GERD rate was similar (8.3% vs. 6.7%, P=1.00). There was no difference in all aspects of quality of life between the 2 groups. Long-term outcomes indicate that POEM is an effective treatment that is comparable with LHM. More data of randomized trials comparing POEM with LHM will enrich the existing evidence.

  11. 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...

  12. Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer.

    Science.gov (United States)

    Kim, Woo Ram; Baek, Se Jin; Kim, Chang Woo; Jang, Hyun A; Cho, Min Soo; Bae, Sung Uk; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu; Sohn, Seung Kuk

    2014-01-01

    Laparoscopic resection for transverse colon cancer is a technically challenging procedure that has been excluded from various large randomized controlled trials of which the long-term outcomes still need to be verified. The purpose of this study was to evaluate long-term oncologic outcomes for transverse colon cancer patients undergoing laparoscopic colectomy (LAC) or open colectomy (OC). This retrospective review included patients with transverse colon cancer who received a colectomy between January 2006 and December 2010. Short-term and five-year oncologic outcomes were compared between these groups. A total of 131 patients were analyzed in the final study (LAC, 84 patients; OC, 47 patients). There were no significant differences in age, gender, body mass index, tumor location, operative procedure, or blood loss between groups, but the mean operative time in LAC was significantly longer (LAC, 246.8 minutes vs. OC, 213.8 minutes; P = 0.03). Hospital stay was much shorter for LAC than OC (9.1 days vs. 14.5 days, P transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.

  13. Prediction modelling for trauma using comorbidity and 'true' 30-day outcome.

    Science.gov (United States)

    Bouamra, Omar; Jacques, Richard; Edwards, Antoinette; Yates, David W; Lawrence, Thomas; Jenks, Tom; Woodford, Maralyn; Lecky, Fiona

    2015-12-01

    Prediction models for trauma outcome routinely control for age but there is uncertainty about the need to control for comorbidity and whether the two interact. This paper describes recent revisions to the Trauma Audit and Research Network (TARN) risk adjustment model designed to take account of age and comorbidities. In addition linkage between TARN and the Office of National Statistics (ONS) database allows patient's outcome to be accurately identified up to 30 days after injury. Outcome at discharge within 30 days was previously used. Prospectively collected data between 2010 and 2013 from the TARN database were analysed. The data for modelling consisted of 129 786 hospital trauma admissions. Three models were compared using the area under the receiver operating curve (AuROC) for assessing the ability of the models to predict outcome, the Akaike information criteria to measure the quality between models and test for goodness-of-fit and calibration. Model 1 is the current TARN model, Model 2 is Model 1 augmented by a modified Charlson comorbidity index and Model 3 is Model 2 with ONS data on 30 day outcome. The values of the AuROC curve for Model 1 were 0.896 (95% CI 0.893 to 0.899), for Model 2 were 0.904 (0.900 to 0.907) and for Model 3 0.897 (0.896 to 0.902). No significant interaction was found between age and comorbidity in Model 2 or in Model 3. The new model includes comorbidity and this has improved outcome prediction. There was no interaction between age and comorbidity, suggesting that both independently increase vulnerability to mortality after injury. 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/

  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. Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals.

    Science.gov (United States)

    Kobayashi, Taisei; Glorioso, Thomas J; Armstrong, Ehrin J; Maddox, Thomas M; Plomondon, Mary E; Grunwald, Gary K; Bradley, Steven M; Tsai, Thomas T; Waldo, Stephen W; Rao, Sunil V; Banerjee, Subhash; Nallamothu, Brahmajee K; Bhatt, Deepak L; Rene, A Garvey; Wilensky, Robert L; Groeneveld, Peter W; Giri, Jay

    2017-09-01

    Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. To compare outcomes between black and white patients undergoing PCI in the VA health system. This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Percutaneous coronary intervention at a VA hospital. The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white

  16. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2012-03-01

    Full Text Available Group Fallback only No Damballa, 2008 Crime Case studies Lone No No Owens et al, 2009 Warfare Literature Group Yes Yes Croom, 2010 Crime (APT) Case studies Group No No Dreijer, 2011 Warfare Previous models and case studies Group Yes No Van... be needed by a geographically or functionally distributed group of attackers. While some of the models describe the installation of a backdoor or an advanced persistent threat (APT), none of them describe the behaviour involved in returning to a...

  17. 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

    has 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

  18. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2015-10-01

    Full Text Available would be needed by a Cyber Security Operations Centre in order to perform offensive cyber operations?". The analysis was performed, using as a springboard seven models of cyber-attack, and resulted in the development of what is described as a canonical...

  19. 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.

  20. Women with coronary artery disease report worse health-related quality of life outcomes compared to men

    Directory of Open Access Journals (Sweden)

    Galbraith P Diane

    2004-05-01

    Full Text Available Abstract Background Although there have been substantial medical advances that improve the outcomes following cardiac ischemic events, gender differences in the treatment and course of recovery for patients with coronary artery disease (CAD continue to exist. There is a general paucity of data comparing the health related quality of life (HRQOL in men and women undergoing treatment for CAD. The purpose of this study was to compare HRQOL outcomes of men and women in Alberta, at one-year following initial catheterization, after adjustment for known demographic, co-morbid, and disease severity predictors of outcome. Method The HRQOL outcome data were collected by means of a self-reported questionnaire mailed to patients on or near the one-year anniversary of their initial cardiac catheterization. Using the Seattle Angina Questionnaire (SAQ, 5 dimensions of HRQOL were measured: exertional capacity, anginal stability, anginal frequency, quality of life and treatment satisfaction. Data from the APPROACH registry were used to risk-adjust the SAQ scale scores. Two analytical strategies were used including general least squares linear modeling, and proportional odds modeling sometimes referred to as the "ordinal logistic modeling". Results 3392 (78.1% patients responded to the follow-up survey. The adjusted proportional odds ratios for men relative to women (PORs > 1 = better indicated that men reported significantly better HRQOL on all 5 SAQ dimensions as compared to women. (PORs: Exertional Capacity 3.38 (2.75–4.15, Anginal Stability 1.23 (1.03–1.47, Anginal Frequency 1.70 (1.43–2.01, Treatment Satisfaction 1.27 (1.07–1.50, and QOL 1.74 (1.48–2.04. Conclusions Women with CAD consistently reported worse HRQOL at one year follow-up compared to men. These findings underline the fact that conclusions based on research performed on men with CAD may not be valid for women and that more gender-related research is needed. Future studies are needed to

  1. Implementation and outcome of child psychotherapy compared with other psychiatric treatments in a naturalistic clinical setting.

    Science.gov (United States)

    Ryynänen, Taimi; Alen, Markku; Koivumaa-Honkanen, Heli; Joskitt, Leena; Ebeling, Hanna

    2015-04-01

    Mental health problems of children are commonly treated by psychotherapy and other psychosocial treatments. Studies comparing different treatments in naturalistic clinical settings are few, however. We assessed the differences: 1) in symptoms and diagnoses; 2) in treatment outcome between psychotherapy and other psychosocial treatments; and 3) evaluated the effect of family background and life circumstances on the outcome. The data were collected from the psychiatric hospital records of Oulu University Hospital, Finland. All 118 children (aged psychotherapy from the Department of Child Psychiatry in 1996-2005 and 118 age- and sex-matched children undergoing other psychosocial treatments were included. A lack of later recorded psychiatric problems was used as an indicator of good treatment outcome. On referral, functional ability was severely impaired in almost half of the children (Children's Global Assessment Scale score psychotherapy group, while no difference was found in externalizing symptoms between the groups. In both groups, later psychiatric problems were associated with a child's low functional ability and poor parental coping with their responsibilities. Children with internalizing problems had impaired prognosis if they had psychosocial treatments other than psychotherapy. Individual psychotherapy should especially be considered for children with internalizing symptoms, but the outcome of psychiatric treatment depends not only on children's own functional abilities, but also on parental abilities.

  2. 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.

  3. 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

  4. A New Zealand based cohort study of anaesthetic trainees' career outcomes compared with previously expressed intentions.

    Science.gov (United States)

    Moran, E M L; French, R A; Kennedy, R R

    2011-09-01

    Predicting workforce requirements is a difficult but necessary part of health resource planning. A 'snapshot' workforce survey undertaken in 2002 examined issues that New Zealand anaesthesia trainees expected would influence their choice of future workplace. We have restudied the same cohort to see if that workforce survey was a good predictor of outcome. Seventy (51%) of 138 surveys were completed in 2009 compared with 100 (80%) of 138 in the 2002 survey. Eighty percent of the 2002 respondents planned consultant positions in New Zealand. We found 64% of respondents were working in New Zealand (P New Zealand based respondents but only 40% of those living outside New Zealand agreed or strongly agreed with this statement (P New Zealand but was important for only 2% of those resident in New Zealand (P New Zealand were predominantly between NZ$150,000 and $200,000 while those overseas received between NZ$300,000 and $400,000. Of those that are resident in New Zealand, 84% had studied in a New Zealand medical school compared with 52% of those currently working overseas (P < 0.01). Our study shows that stated career intentions in a group do not predict the actual group outcomes. We suggest that 'snapshot' studies examining workforce intentions are of little value for workforce planning. However we believe an ongoing program matching career aspirations against career outcomes would be a useful tool in workforce planning.

  5. 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

  6. Modele bicamerale comparate. Romania: Monocameralism versus bicameralism

    Directory of Open Access Journals (Sweden)

    Cynthia Carmen CURT

    2007-06-01

    Full Text Available The paper attempts to evaluate the Romanian bicameral model as well as to identify and critically asses which are the options our country has in choosing between unicameral and bicameral system. The analysis attempts to observe the characteristics of some Second Chambers that are related to Romanian bicameralism by influencing the configuration of the Romanian bicameral legislature, or which devised constitutional mechanisms can be used in order to preserve an efficient bicameral formula. Also the alternative of giving up the bicameral formula due to some arguments related to the simplification and the efficiency of the legislative procedure is explored.

  7. A Model for Comparing Free Cloud Platforms

    Directory of Open Access Journals (Sweden)

    Radu LIXANDROIU

    2014-01-01

    Full Text Available VMware, VirtualBox, Virtual PC and other popular desktop virtualization applications are used only by a few users of IT techniques. This article attempts to make a comparison model for choosing the best cloud platform. Many virtualization applications such as VMware (VMware Player, Oracle VirtualBox and Microsoft Virtual PC are free for home users. The main goal of the virtualization software is that it allows users to run multiple operating systems simultane-ously on one virtual environment, using one computer desktop.

  8. Preschool outcome of less than 801-gram preterm infants compared with full-term siblings.

    Science.gov (United States)

    Kilbride, Howard W; Thorstad, Karla; Daily, Donna K

    2004-04-01

    Extremely low birth weight (ELBW) infants are at greater risk for neurodevelopmental delay than full-term infants. Outcomes may be compromised secondary to abnormal brain development associated with complications of prematurity. Long-term cognitive outcome has also been reported to be significantly influenced by postnatal factors. The objective of this study was to clarify the effects of prematurity separate from environmental factors on growth and neurodevelopmental outcomes by comparing ELBW children with their full-term siblings. The study consisted of 25 ELBW children, a subset selected from a larger population of infants who were siblings. Twenty-three sets of siblings were evaluated at 5 years of age and 2 sets at 3 years of age with standardized medical, social, cognitive, motor, and language testing. Physical and neurodevelopmental outcomes were compared between groups, controlling for gender and socioeconomic status (SES). At follow-up, ELBW children were lighter, were shorter, and had smaller head circumference. The ELBW children had lower Stanford-Binet IQs (85 +/- 12 [mean +/- SD] and 95 +/- 11), with lower Stanford-Binet subtests except short-term memory and quantitative reasoning, lower spelling scores on the Wide Range Achievement Test, and lower Peabody motor quotients (79 +/- 11 and 92 +/- 17). Preschool Language Scale quotients were not different, but other receptive language measures were lower for ELBW children. High SES seemed to modify the impact of preterm status on cognitive and language but not motor scores. The mean IQ for high-SES ELBW children was equivalent to that of the low-SES term siblings. Preschool-age cognitive and language functioning in ELBW children seemed to be affected by both prenatal and birth influences (preterm status) and postnatal influences (SES variables). Motor scores were significantly related to preterm status but not to SES.

  9. Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome

    Directory of Open Access Journals (Sweden)

    Naess H

    2011-08-01

    Full Text Available Halvor Naess, Fredrik RomiDepartment of Neurology, Haukeland University Hospital, N-5021 Bergen, NorwayBackground: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction.Methods: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain, neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution as dependent variables.Results: Multivariate analysis showed that patients with spinal cord infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral infarction. Functional score (BI was lower among patients with spinal cord infarctions 1 week after onset of symptoms (P < 0.001. Odds ratio for being discharged home was 5.5 for patients with spinal cord infarction compared to cerebral infarction after adjusting for BI scored 1 week after onset (P = 0.019.Conclusion: Patients with spinal cord infarction have a risk factor profile that differs significantly from that of patients with cerebral infarction, although there are some parallels to cerebral infarction caused by atherosclerosis. Patients with spinal cord infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.Keywords: spinal cord infarction, cerebral infarction, risk factors, short-term outcome

  10. No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial.

    Science.gov (United States)

    Bayle, Xavier; Pham, Thuy-Trang; Faruch, Marie; Gobet, Aurelie; Mansat, Pierre; Bonnevialle, Nicolas

    2017-12-01

    Arthroscopic techniques tend to become the gold standard in rotator cuff repair. However, little data are reported in the literature regarding the improvement of postoperative outcomes and re-tear rate relative to conventional open surgery. The aim of this study was to compare clinical outcomes and cuff integrity after arthroscopic versus open cuff repair. We prospectively assessed clinical outcomes and cuff integrity after an arthroscopic or open rotator cuff repair with a minimum follow-up of 12 months. Clinical evaluation was based on Constant score, Simple Shoulder Value (SSV) and American Shoulder and Elbow Score (ASES). Rotator cuff healing was explored with ultrasound. 44 patients in arthroscopic group A (mean age 56-year-old) and 43 in open group O (mean age 61-year-old) fulfilled the inclusion criteria. Tendons were repaired with a single row technique associated with biceps tenodesis and subacromial decompression. All objective clinical scores significantly improved postoperatively in both groups. No statistical difference was identified between group A and O regarding, respectively, Constant score (72 vs 75 points; p = 0.3), ASES score (88 vs 91 points; p = 0.3), and SSV (81 vs 85%). The overall rate of re-tear (Sugaya type IV or V) reached 7 and 9%, respectively, in group A and O (p = 0.8). This study did not prove any difference of arthroscopic over open surgery in case of rotator cuff repair regarding clinical outcome and cuff integrity at 1-year follow-up. Prospective comparative study.

  11. The Child Anxiety Prevention Study: intervention model and primary outcomes.

    Science.gov (United States)

    Ginsburg, Golda S

    2009-06-01

    The article presents the intervention model and primary outcomes of a preventive intervention designed to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40 volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Copyright 2009 APA

  12. Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair.

    Science.gov (United States)

    Dangle, Pankaj P; Kearns, James; Anderson, Blake; Gundeti, Mohan S

    2013-12-01

    Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach. We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria. Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10). In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Safety Outcomes of Apixaban Compared With Warfarin in Patients With End-Stage Renal Disease.

    Science.gov (United States)

    Sarratt, Stefanie C; Nesbit, Ross; Moye, Robert

    2017-06-01

    Current guidelines make no specific recommendations on the selection of direct oral anticoagulants for the prevention and treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) receiving hemodialysis. Based on these guidelines, warfarin remains the anticoagulant of choice in these patients. To compare bleeding rates in patients receiving apixaban or warfarin with ESRD undergoing chronic hemodialysis. This was a single-center, retrospective, institutional review board-approved cohort analysis. Patients with ESRD undergoing chronic hemodialysis and receiving anticoagulation therapy with either apixaban or warfarin were included in this study. All data were collected from paper charts and electronic medical records and included documentation of bleeding events and related interventions. The primary outcome of this study was clinically relevant major bleeding events. Secondary outcomes included clinically relevant nonmajor bleeding events and minor bleeding events. A total of 160 patients were included in this study (warfarin group, n = 120; apixaban group, n = 40). There were 7 major bleeding events in the warfarin group compared with zero in the apixaban group ( P = 0.34). There were similar rates of clinically relevant nonmajor bleeding events (12.5% vs 5.8%, P = 0.17) and minor bleeding (2.5% vs 2.5%, P = 0.74) events in patients receiving apixaban and warfarin. There were no observed differences in bleeding rates in patients receiving apixaban compared with those receiving warfarin. Apixaban may be a cautious consideration in hemodialysis patients until there is further insight into the effect of subsequent, multiple doses on drug accumulation and clinical outcomes.

  14. Uncertainties in model-based outcome predictions for treatment planning

    International Nuclear Information System (INIS)

    Deasy, Joseph O.; Chao, K.S. Clifford; Markman, Jerry

    2001-01-01

    Purpose: Model-based treatment-plan-specific outcome predictions (such as normal tissue complication probability [NTCP] or the relative reduction in salivary function) are typically presented without reference to underlying uncertainties. We provide a method to assess the reliability of treatment-plan-specific dose-volume outcome model predictions. Methods and Materials: A practical method is proposed for evaluating model prediction based on the original input data together with bootstrap-based estimates of parameter uncertainties. The general framework is applicable to continuous variable predictions (e.g., prediction of long-term salivary function) and dichotomous variable predictions (e.g., tumor control probability [TCP] or NTCP). Using bootstrap resampling, a histogram of the likelihood of alternative parameter values is generated. For a given patient and treatment plan we generate a histogram of alternative model results by computing the model predicted outcome for each parameter set in the bootstrap list. Residual uncertainty ('noise') is accounted for by adding a random component to the computed outcome values. The residual noise distribution is estimated from the original fit between model predictions and patient data. Results: The method is demonstrated using a continuous-endpoint model to predict long-term salivary function for head-and-neck cancer patients. Histograms represent the probabilities for the level of posttreatment salivary function based on the input clinical data, the salivary function model, and the three-dimensional dose distribution. For some patients there is significant uncertainty in the prediction of xerostomia, whereas for other patients the predictions are expected to be more reliable. In contrast, TCP and NTCP endpoints are dichotomous, and parameter uncertainties should be folded directly into the estimated probabilities, thereby improving the accuracy of the estimates. Using bootstrap parameter estimates, competing treatment

  15. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.

    Science.gov (United States)

    Lai, Eric C H; Tang, Chung Ngai

    2015-09-01

    Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

  16. 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.

  17. 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...

  18. Poisson regression for modeling count and frequency outcomes in trauma research.

    Science.gov (United States)

    Gagnon, David R; Doron-LaMarca, Susan; Bell, Margret; O'Farrell, Timothy J; Taft, Casey T

    2008-10-01

    The authors describe how the Poisson regression method for analyzing count or frequency outcome variables can be applied in trauma studies. The outcome of interest in trauma research may represent a count of the number of incidents of behavior occurring in a given time interval, such as acts of physical aggression or substance abuse. Traditional linear regression approaches assume a normally distributed outcome variable with equal variances over the range of predictor variables, and may not be optimal for modeling count outcomes. An application of Poisson regression is presented using data from a study of intimate partner aggression among male patients in an alcohol treatment program and their female partners. Results of Poisson regression and linear regression models are compared.

  19. Comparing the responsiveness of functional outcome assessment measures for trauma registries.

    Science.gov (United States)

    Williamson, Owen D; Gabbe, Belinda J; Sutherland, Ann M; Wolfe, Rory; Forbes, Andrew B; Cameron, Peter A

    2011-07-01

    Measuring long-term disability and functional outcomes after major trauma is not standardized across trauma registries. An ideal measure would be responsive to change but not have significant ceiling effects. The aim of this study was to compare the responsiveness of the Glasgow Outcome Scale (GOS), GOS-Extended (GOSE), Functional Independence Measure (FIM), and modified FIM in major trauma patients, with and without significant head injuries. Patients admitted to two adult Level I trauma centers in Victoria, Australia, who survived to discharge from hospital, were aged 15 years to 80 years with a blunt mechanism of injury, and had an estimated Injury Severity Score >15 on admission, were recruited for this prospective study. The instruments were administered at baseline (hospital discharge) and by telephone interview 6 months after injury. Measures of responsiveness, including effect sizes, were calculated. Bootstrapping techniques, and floor and ceiling effects, were used to compare the measures. Two hundred forty-three patients participated, of which 234 patients (96%) completed the study. The GOSE and GOS were the most responsive instruments in this major trauma population with effect sizes of 5.3 and 4.4, respectively. The GOSE had the lowest ceiling effect (17%). The GOSE was the instrument with greatest responsiveness and the lowest ceiling effect in a major trauma population with and without significant head injuries and is recommended for use by trauma registries for monitoring functional outcomes and benchmarking care. The results of this study do not support the use of the modified FIM for this purpose.

  20. Outcome of acute nonvariceal gastrointestinal haemorrhage after nontherapeutic arteriography compared with embolization

    International Nuclear Information System (INIS)

    Defreyne, Luc; Vanlangenhove, Peter; Decruyenaere, Johan; Van Maele, Georges; De Vos, Martine; Troisi, Roberto; Pattyn, Piet

    2003-01-01

    In acute nonvariceal gastrointestinal (GI) bleeding, immediate arteriographic haemostasis is presently assumed to be a therapeutic advantage. This study assesses whether the risk of a delayed haemostasis, caused by arteriographic findings precluding embolization, might influence patient outcome. We performed a 5.5-year retrospective database search to find all patients referred for arteriography to arrest acute nonvariceal GI bleeding with embolization. The embolized and nonembolized patients were compared for differences in baseline characteristics and bleeding parameters. In both groups the outcome of all endoscopic or surgical interventions after catheterization was included in the follow-up. Clinical success (at 30 days, after all therapy) and in-hospital mortality in the embolized and nonembolized group were compared. We retrieved 63 nonembolized bleedings in 58 patients and 49 embolized bleedings in 49 patients. In the nonembolized group, transfusion need and haemodynamic instability were significantly less severe. Forty-two of 63 (66%) nonembolized bleedings persisted requiring haemostasis by surgery (n=23), endoscopy (n=13) or supportive transfusions. Thirteen of 49 (27%) embolized bleedings recurred and were managed by surgery (n=7), endoscopy (n=3) or transfusion. Overall clinical success rate was 88.9% (56 of 63) in the nonembolized and 87.8% (43 of 49) in the embolized group. Mortality rate was 17.2% (10 of 58) in the nonembolized vs 30.6% (15 of 49) in the embolized patients (P=0.115). Whether or not arteriographic findings afforded the opportunity to embolize, outcome of acute nonvariceal GI bleeding did not differ significantly; however, patients undergoing embolization were more critically bleeding and ill. (orig.)

  1. Comparative Effectiveness of Surgical Treatments for Prostate Cancer: A Population-Based Analysis of Postoperative Outcomes

    Science.gov (United States)

    Lowrance, William T.; Elkin, Elena B.; Jacks, Lindsay M.; Yee, David S.; Jang, Thomas L.; Laudone, Vincent P.; Guillonneau, Bertrand D.; Scardino, Peter T.; Eastham, James A.

    2010-01-01

    Background Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown, despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic (with or without robotic assistance) versus open radical prostatectomy in terms of postoperative outcomes and subsequent cancer-directed therapy. Materials and Methods Using a population-based cancer registry linked with Medicare claims, we identified men age 66 or older with localized prostate cancer who received a radical prostatectomy from 2003-2005. Outcome measures were general medical/surgical complications and mortality within 90 days following surgery; genitourinary/bowel complications within 365 days; receipt of radiation therapy, androgen deprivation therapy or both within 365 days; length of hospital stay. Results Of the 5,923 men,18% received a laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in rates of general medical/surgical complications (OR 0.93; 95% CI: 0.77-1.14) or genitourinary/bowel complications (OR 0.96; 95% CI: 0.76-1.22) or in the use of postoperative radiation, androgen deprivation or both (OR 0.80; 95% CI: 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p<0.0001) and a lower rate of bladder neck/urethral obstruction (OR 0.74; 95% CI 0.58-0.94). In laparoscopic patients, surgeon volume was inversely associated with length of hospital stay and the odds of any genitourinary/bowel complication. Conclusions Laparoscopic and open radical prostatectomy have similar rates of postoperative morbidity and use of additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision-making and to set realistic expectations. PMID:20188381

  2. Comparative effectiveness of prostate cancer surgical treatments: a population based analysis of postoperative outcomes.

    Science.gov (United States)

    Lowrance, William T; Elkin, Elena B; Jacks, Lindsay M; Yee, David S; Jang, Thomas L; Laudone, Vincent P; Guillonneau, Bertrand D; Scardino, Peter T; Eastham, James A

    2010-04-01

    Enthusiasm for laparoscopic surgical approaches to prostate cancer treatment has grown despite limited evidence of improved outcomes compared with open radical prostatectomy. We compared laparoscopic prostatectomy with or without robotic assistance vs open radical prostatectomy in terms of postoperative outcomes and subsequent cancer directed therapy. Using a population based cancer registry linked with Medicare claims we identified men 66 years old or older with localized prostate cancer who underwent radical prostatectomy from 2003 to 2005. Outcome measures were general medical/surgical complications and mortality within 90 days after surgery, genitourinary/bowel complications within 365 days, radiation therapy and/or androgen deprivation therapy within 365 days and length of hospital stay. Of the 5,923 men 18% underwent laparoscopic radical prostatectomy. Adjusting for patient and tumor characteristics, there were no differences in the rate of general medical/surgical complications (OR 0.93 95% CI 0.77-1.14) or genitourinary/bowel complications (OR 0.96 95% CI 0.76-1.22), or in postoperative radiation and/or androgen deprivation (OR 0.80 95% CI 0.60-1.08). Laparoscopic prostatectomy was associated with a 35% shorter hospital stay (p <0.0001) and a lower bladder neck/urethral obstruction rate (OR 0.74, 95% CI 0.58-0.94). In laparoscopic cases surgeon volume was inversely associated with hospital stay and the odds of any genitourinary/bowel complication. Laparoscopic prostatectomy and open radical prostatectomy have similar rates of postoperative morbidity and additional treatment. Men considering prostate cancer surgery should understand the expected benefits and risks of each technique to facilitate decision making and set realistic expectations. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Maternal and Neonatal Outcomes With Early Compared With Delayed Pushing Among Nulliparous Women.

    Science.gov (United States)

    Yee, Lynn M; Sandoval, Grecio; Bailit, Jennifer; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Caritis, Steve N; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E

    2016-11-01

    To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included. Women in whom pushing was delayed by 60 minutes or greater (delayed group) were compared with those who initiated pushing within 30 minutes (early group). Multivariable regression analyses were used to assess the independent association of delayed pushing with mode of delivery, length of the second stage, and other maternal and perinatal outcomes (significance defined as Ppushing was delayed in 18.4% (n=3,870). Women who were older, privately insured, or non-Hispanic white as well as those who had induction or augmentation of labor, diabetes, or epidural analgesia were more likely to have delayed pushing. Delayed pushing was more common when the second stage began during daytime hours or in hospitals with dedicated 24-hour obstetric anesthesia, although differences were small. After adjusting for differences in baseline and labor characteristics including center, women in the delayed group had longer mean durations of the second stage (191 compared with 84 minutes, Ppushing (86 compared with 76 minutes, Ppushing was associated with greater rates of cesarean delivery (11.2% compared with 5.1%; adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.63-2.12), operative vaginal delivery (adjusted OR 1.26, 95% CI 1.14-1.40), postpartum hemorrhage (adjusted OR 1.43, 95% CI 1.05-1.95), and blood transfusion (adjusted OR 1.51, 95% CI 1.04-2.17). Delayed pushing was not associated with increased odds of adverse neonatal outcomes

  4. Intensity-Modulated Radiotherapy for Sinonasal Cancer: Improved Outcome Compared to Conventional Radiotherapy

    International Nuclear Information System (INIS)

    Dirix, Piet; Vanstraelen, Bianca; Jorissen, Mark; Vander Poorten, Vincent; Nuyts, Sandra

    2010-01-01

    Purpose: To evaluate clinical outcome and toxicity of postoperative intensity-modulated radiotherapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between 2003 and 2008, 40 patients with cancer of the paranasal sinuses (n = 34) or nasal cavity (n = 6) received postoperative IMRT to a dose of 60 Gy (n = 21) or 66 Gy (n = 19). Treatment outcome and toxicity were retrospectively compared with that of a previous patient group (n = 41) who were also postoperatively treated to the same doses but with three-dimensional conformal radiotherapy without intensity modulation, from 1992 to 2002. Results: Median follow-up was 30 months (range, 4-74 months). Two-year local control, overall survival, and disease-free survival were 76%, 89%, and 72%, respectively. Compared to the three-dimensional conformal radiotherapy treatment, IMRT resulted in significantly improved disease-free survival (60% vs. 72%; p = 0.02). No grade 3 or 4 toxicity was reported in the IMRT group, either acute or chronic. The use of IMRT significantly reduced the incidence of acute as well as late side effects, especially regarding skin toxicity, mucositis, xerostomia, and dry-eye syndrome. Conclusions: Postoperative IMRT for sinonasal cancer significantly improves disease-free survival and reduces acute as well as late toxicity. Consequently, IMRT should be considered the standard treatment modality for malignancies of the nasal cavity and paranasal sinuses.

  5. Comparing Hospital Processes and Outcomes in California Medicare Beneficiaries: Simulation Prompts Reconsideration.

    Science.gov (United States)

    Escobar, Gabriel J; Baker, Jennifer M; Turk, Benjamin J; Draper, David; Liu, Vincent; Kipnis, Patricia

    2017-01-01

    This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. Future hospital benchmarking should consider the impact of variation in admission thresholds.

  6. Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor.

    Science.gov (United States)

    Ezekian, Brian; Englum, Brian R; Gulack, Brian C; Rialon, Kristy L; Kim, Jina; Talbot, Lindsay J; Adibe, Obinna O; Routh, Jonathan C; Tracy, Elisabeth T; Rice, Henry E

    2018-01-01

    Minimally invasive surgery (MIS) has been widely adopted for common operations in pediatric surgery; however, its role in childhood tumors is limited by concerns about oncologic outcomes. We compared open and MIS approaches for pediatric neuroblastoma and Wilms tumor (WT) using a national database. The National Cancer Data Base from 2010 to 2012 was queried for cases of neuroblastoma and WT in children ≤21 years old. Children were classified as receiving open or MIS surgery for definitive resection, with clinical outcomes compared using a propensity matching methodology (two open:one MIS). For children with neuroblastoma, 17% (98 of 579) underwent MIS, while only 5% of children with WT (35 of 695) had an MIS approach for tumor resection. After propensity matching, there was no difference between open and MIS surgery for either tumor for 30-day mortality, readmissions, surgical margin status, and 1- and 3-year survival. However, in both tumors, open surgery more often evaluated lymph nodes and had larger lymph node harvest. Our retrospective review suggests that the use of MIS appears to be a safe method of oncologic resection for select children with neuroblastoma and WT. Further research should clarify which children are the optimal candidates for this approach. © 2017 Wiley Periodicals, Inc.

  7. A Mixed Methods Comparison of Teachers' Lunar Modeling Lesson Implementation and Student Learning Outcomes

    Science.gov (United States)

    Lamar, Mary F.; Wilhelm, Jennifer Anne; Cole, Merryn

    2018-01-01

    The authors compare three teachers' adaptations and implementation of a lunar modeling lesson to explain marked differences in student learning outcomes on a spatial-scientific lunar assessment. They used a modified version of the Practices of Science Observation Protocol (P-SOP; Forbes, Biggers, & Zangori, 2013) to identify ways in which…

  8. Healing models for organizations: description, measurement, and outcomes.

    Science.gov (United States)

    Malloch, K

    2000-01-01

    Healthcare leaders are continually searching for ways to improve their ability to provide optimal healthcare services, be financially viable, and retain quality caregivers, often feeling like such goals are impossible to achieve in today's intensely competitive environment. Many healthcare leaders intuitively recognize the need for more humanistic models and the probable connection with positive patient outcomes and financial success but are hesitant to make significant changes in their organizations because of the lack of model descriptions or documented recognition of the clinical and financial advantages of humanistic models. This article describes a study that was developed in response to the increasing work in humanistic or healing environment models and the need for validation of the advantages of such models. The healthy organization model, a framework for healthcare organizations that incorporates humanistic healing values within the traditional structure, is presented as a result of the study. This model addresses the importance of optimal clinical services, financial performance, and staff satisfaction. The five research-based organizational components that form the framework are described, and key indicators of organizational effectiveness over a five-year period are presented. The resulting empirical data are strongly supportive of the healing model and reflect positive outcomes for the organization.

  9. 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.

  10. 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. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  11. Mediation Analysis with Survival Outcomes: Accelerated Failure Time vs. Proportional Hazards Models.

    Science.gov (United States)

    Gelfand, Lois A; MacKinnon, David P; DeRubeis, Robert J; Baraldi, Amanda N

    2016-01-01

    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. 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. 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. 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.

  12. 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

  13. A behavioral economic reward index predicts drinking resolutions: moderation revisited and compared with other outcomes.

    Science.gov (United States)

    Tucker, Jalie A; Roth, David L; Vignolo, Mary J; Westfall, Andrew O

    2009-04-01

    Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1- to 2-year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes than abstinence or relapse and to be predicted by more balanced preresolution monetary allocations between short-term and longer term objectives (i.e., drinking and saving for the future). Standardized odds ratios (ORs) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this "Alcohol-Savings Discretionary Expenditure" index predicted higher rates of abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors. The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of preresolution spending patterns aids in predicting moderation.

  14. Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.

    Science.gov (United States)

    Reynolds, Shaun; Galiñanes, Edgar Luis; Dombrovskiy, Viktor Y; Vogel, Todd R

    2013-10-01

    There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy. Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A). A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.

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

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

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    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.

  17. Localized prostate cancer in elderly patients. Outcome after radiation therapy compared to matched younger patients

    International Nuclear Information System (INIS)

    Huguenin, P.U.; Bitterli, M.; Luetolf, U.M.; Glanzmann, C.; Bernhard, J.

    1999-01-01

    Purpose: To detect a difference in outcome (disease-specific survival, local tumor progression, late toxicity, quality of life) after curative radiotherapy for localized prostate cancer in elderly as compared to younger patients. Patients and methods: In a retrospective analysis 59 elderly patients (>74 years old) were matched 1:2 with younger patients from the data base according to tumor stage, grading, pre-treatment PSA values and year of radiotherapy. Surviving patients were contacted to fill in a validated questionnaire for quality of life measurement (EORTC QLQ-C30). Median follow-up for elderly and younger patients was 5.2 and 4.5 years, respectively. Results: Overall survival at 5 years was 66% for the elderly and 80% for younger patients. Intercurrent deaths were observed more frequently in the elderly population. There was no age-specific difference in disease-specific survival (78% vs 82%), late toxicity or quality of life. Clinically meaningful local tumor progression was observed in 15% and 14%, respectively, corresponding to data from the literature following hormonal ablation. Conclusions: There is no obvious difference in outcome including disease-specific survival, late toxicity and quality of life in elderly patients, compared to a matched younger population. A clinically meaningful local tumor progression following radiotherapy or hormonal ablation only is rare. Local radiotherapy or, alternatively, hormonal ablation is recommended to preserve local progression-free survival in elderly patients except for very early stage of disease (i.e. T1 G1-2 M0). (orig.) [de

  18. FUNCTIONAL OUTCOME OF INTERTROCHANTERIC FRACTURES AFTER FIXATION WITH PFN OR DHS IN ELDERLY- A COMPARATIVE STUDY

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    Sreekumar K

    2017-05-01

    Full Text Available BACKGROUND Ninety percent of the hip fractures in the elderly result from a simple fall. More than fifty percent of the hip fractures in the elderly are intertrochanteric fractures. The goal of treatment of any intertrochanteric fracture in elderly is to restore mobility at the earliest and minimise the complications of prolonged bed rest. The Dynamic Hip Screw (DHS has been shown to produce good results, but complications are frequent, particularly in unstable intertrochanteric fractures. Intramedullary fixation is considered to provide a more biomechanically stable construct by reducing the distance between the hip joint and implant. MATERIALS AND METHODS The goal of this study is to compare the functional outcome of intertrochanteric fractures in elderly patients treated with Proximal Femoral Nail (PFN and Dynamic Hip Screw (DHS by analysing the clinical and radiological results to evaluate the advantages and disadvantages and possible complications associated with fixation of intertrochanteric fractures with PFN and DHS. 1 In our study, we included 106 intertrochanteric fractures, out of which 46 were treated with PFN and 60 with DHS. Ordinary fracture table was used in all cases and were followed up at regular intervals of 4, 8 and 12 weeks, 6 months and one year. RESULTS Functional results were assessed with modified Harris hip score. We observed significantly higher excellent results and less poor results in PFN compared to DHS. CONCLUSION Unstable intertrochanteric fractures treated with PFN have significantly better outcome than DHS. In unstable fractures, reduction loss, union in varus and limb shortening are significantly higher in DHS. Hence, the advantages of PFN are less surgical trauma, less blood loss and the possibility of early weightbearing even after very complex fractures.

  19. Clinical Outcome of Sacral Chordoma With Carbon Ion Radiotherapy Compared With Surgery

    International Nuclear Information System (INIS)

    Nishida, Yoshihiro; Kamada, Tadashi; Imai, Reiko; Tsukushi, Satoshi; Yamada, Yoshihisa; Sugiura, Hideshi; Shido, Yoji; Wasa, Junji; Ishiguro, Naoki

    2011-01-01

    Purpose: To evaluate the efficacy, post-treatment function, toxicity, and complications of carbon ion radiotherapy (RT) for sacral chordoma compared with surgery. Methods and Materials: The records of 17 primary sacral chordoma patients treated since 1990 with surgery (n = 10) or carbon ion RT (n = 7) were retrospectively analyzed for disease-specific survival, local recurrence-free survival, complications, and functional outcome. The applied carbon ion dose ranged from 54.0 Gray equivalent (GyE) to 73.6 GyE (median 70.4). Results: The mean age at treatment was 55 years for the surgery group and 65 years for the carbon ion RT group. The median duration of follow-up was 76 months for the surgery group and 49 months for the carbon ion RT group. The local recurrence-free survival rate at 5 years was 62.5% for the surgery and 100% for the carbon ion RT group, and the disease-specific survival rate at 5 years was 85.7% and 53.3%, respectively. Urinary-anorectal function worsened in 6 patients (60%) in the surgery group, but it was unchanged in all the patients who had undergone carbon ion RT. Postoperative wound complications requiring reoperation occurred in 3 patients (30%) after surgery and in 1 patient (14%) after carbon ion RT. The functional outcome evaluated using the Musculoskeletal Tumor Society scoring system revealed 55% in the surgery group and 75% in the carbon ion RT group. Of the six factors in this scoring system, the carbon ion RT group had significantly greater scores in emotional acceptance than did the surgery group. Conclusion: Carbon ion RT results in a high local control rate and preservation of urinary-anorectal function compared with surgery.

  20. Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.

    Science.gov (United States)

    Smith, Evan J; Kuang, Xiangyu; Pandarinath, Rajeev

    2017-07-01

    Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. Data were extracted from the ACS-NSQIP database from 2005 to 2014. Cases were identified based on CPT codes for intramedullary fixation and categorized as closed vs open based on ICD9 code. In addition to demographic and case data, primary analysis examined correlation between open and closed fracture status with infection, complications, reoperation and hospital length of stay. Secondary analysis examined preoperative variables including gender, race, age, BMI, and diabetes effect on outcomes. There were 272 cases identified. There were no significant demographic differences between open and closed tibia fracture cases. Open fracture status did not increase the rate of infection, 30day complications, reoperation, or length of stay. The only preoperative factor that correlated with length of stay was age. There was no correlation between BMI, presence of insulin dependent and nondependent diabetes, and any outcome measure. When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to

  1. 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.…

  2. 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

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

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    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.

  4. 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.

  5. Dysphagia management: an analysis of patient outcomes using VitalStim therapy compared to traditional swallow therapy.

    Science.gov (United States)

    Kiger, Mary; Brown, Catherine S; Watkins, Lynn

    2006-10-01

    This study compares the outcomes using VitalStim therapy to outcomes using traditional swallowing therapy for deglutition disorders. Twenty-two patients had an initial and a followup videofluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing and were divided into an experimental group that received VitalStim treatments and a control group that received traditional swallowing therapy. Outcomes were analyzed for changes in oral and pharyngeal phase dysphagia severity, dietary consistency restrictions, and progression from nonoral to oral intake. Results of chi(2) analysis showed no statistically significant difference in outcomes between the experimental and control groups.

  6. 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

  7. 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.

  8. A comparative study of breastfeeding during pregnancy: impact on maternal and newborn outcomes.

    Science.gov (United States)

    Madarshahian, Farah; Hassanabadi, Mohsen

    2012-03-01

    Despite widespread cultural vilification, lactation-pregnancy overlap remains common. Its actual adverse effects remain uncertain. This study compared rates of success in reaching full-term delivery and newborn birth weights between two groups of multiparous pregnant women: those who breast-fed during pregnancy and those who did not. This was a comparative study conducted over 9 months, which examined two groups of women in the maternity units of two hospitals in Birjand, Iran. The first group comprised 80 women who breast-fed for 30 days or more during pregnancy; the second group comprised 240 women who did not. The two groups had similar distributions in terms of maternal age, parity, medical/midwifery problems, and nutritional changes during pregnancy. Two trained nurses used a self-developed questionnaire to collect data. Results found no significant difference in full-term or non-full-term births rates and mean newborn birth weight between the two groups. We further found no significant difference between full-term or non-full-term births and mean newborn birth weight for those who continued and discontinued breastfeeding during pregnancy in the overlap group. Results suggest that breastfeeding during normal pregnancy does not increase chance of untoward maternal and newborn outcomes. Nurses and midwives should give expectant mothers appropriate evidence-based guidance and focus attention on promoting proper nutritional intake based on lactation status during pregnancy.

  9. Management of Pediatric Perforated Appendicitis: Comparing Outcomes Using Early Appendectomy Versus Solely Medical Management.

    Science.gov (United States)

    Bonadio, William; Rebillot, Katie; Ukwuoma, Onyinyechi; Saracino, Christine; Iskhakov, Arthur

    2017-10-01

    There is controversy regarding whether children with perforated appendicitis should receive early appendectomy (EA) versus medical management (MM) with antibiotics and delayed interval appendectomy. The objective of this study was to compare outcomes of children with perforated appendicitis who receive EA versus MM. Case review of consecutive children appendicitis who received either EA or MM during an 8-year period. Criteria for hospital discharge included patient being afebrile for at least 24 hours, pain-free and able to tolerate oral intake. Of 203 patients diagnosed with perforated appendicitis, 122 received EA and 81 received MM. All received parenteral antibiotic therapy initiated in the emergency department and continued during hospitalization. There were no significant differences between groups in mean patient age, mean complete blood count total white blood cells count, gender distribution, rates of emergency department fever or rates of intra-abdominal infection (abscess or phlegmon) identified on admission. Compared with patients receiving MM, those receiving EA experienced significantly fewer (1) days of hospitalization, parenteral antibiotic therapy and in-hospital fever; (2) radiographic studies, percutaneous drainage procedures and placement of central venous catheters performed; (3) post admission intra-abdominal complications and (4) unscheduled repeat hospitalizations after hospital discharge. Only 1 EA-managed patient developed a postoperative wound infection. Children with perforated appendicitis who receive EA experience significantly less morbidity and complications versus those receiving MM. The theoretical concern for enhanced morbidity associated with EA management of perforated appendicitis is not supported by our analysis.

  10. A New Statistical Method to Determine the Degree of Validity of Health Economic Model Outcomes against Empirical Data.

    Science.gov (United States)

    Corro Ramos, Isaac; van Voorn, George A K; Vemer, Pepijn; Feenstra, Talitha L; Al, Maiwenn J

    2017-09-01

    The validation of health economic (HE) model outcomes against empirical data is of key importance. Although statistical testing seems applicable, guidelines for the validation of HE models lack guidance on statistical validation, and actual validation efforts often present subjective judgment of graphs and point estimates. To discuss the applicability of existing validation techniques and to present a new method for quantifying the degrees of validity statistically, which is useful for decision makers. A new Bayesian method is proposed to determine how well HE model outcomes compare with empirical data. Validity is based on a pre-established accuracy interval in which the model outcomes should fall. The method uses the outcomes of a probabilistic sensitivity analysis and results in a posterior distribution around the probability that HE model outcomes can be regarded as valid. We use a published diabetes model (Modelling Integrated Care for Diabetes based on Observational data) to validate the outcome "number of patients who are on dialysis or with end-stage renal disease." Results indicate that a high probability of a valid outcome is associated with relatively wide accuracy intervals. In particular, 25% deviation from the observed outcome implied approximately 60% expected validity. Current practice in HE model validation can be improved by using an alternative method based on assessing whether the model outcomes fit to empirical data at a predefined level of accuracy. This method has the advantage of assessing both model bias and parameter uncertainty and resulting in a quantitative measure of the degree of validity that penalizes models predicting the mean of an outcome correctly but with overly wide credible intervals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. COMPARING OF DEPOSIT MODEL AND LIFE INSURANCE MODEL IN MACEDONIA

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    TATJANA ATANASOVA-PACHEMSKA

    2016-02-01

    Full Text Available In conditions of the continuous decline of the interest rates for bank deposits, and at a time when uncertainty about the future is increasing, physical and legal persons have doubts how to secure their future or how and where to invest their funds and thus to “fertilize” and increase their savings. Individuals usually choose to put their savings in the bank for a certain period, and for that period to receive certain interest, or decide to invest their savings in different types of life insurance and thus to "take care" of their life, their future and the future of their families. In mathematics are developed many models that relate to the compounding and the insurance. This paper is a comparison of the deposit model and the model of life insurance

  12. Bayesian Mixed Hidden Markov Models: A Multi-Level Approach to Modeling Categorical Outcomes with Differential Misclassification

    Science.gov (United States)

    Zhang, Yue; Berhane, Kiros

    2014-01-01

    Questionnaire-based health status outcomes are often prone to misclassification. When studying the effect of risk factors on such outcomes, ignoring any potential misclassification may lead to biased effect estimates. Analytical challenges posed by these misclassified outcomes are further complicated when simultaneously exploring factors for both the misclassification and health processes in a multi-level setting. To address these challenges, we propose a fully Bayesian Mixed Hidden Markov Model (BMHMM) for handling differential misclassification in categorical outcomes in a multi-level setting. The BMHMM generalizes the traditional Hidden Markov Model (HMM) by introducing random effects into three sets of HMM parameters for joint estimation of the prevalence, transition and misclassification probabilities. This formulation not only allows joint estimation of all three sets of parameters, but also accounts for cluster level heterogeneity based on a multi-level model structure. Using this novel approach, both the true health status prevalence and the transition probabilities between the health states during follow-up are modeled as functions of covariates. The observed, possibly misclassified, health states are related to the true, but unobserved, health states and covariates. Results from simulation studies are presented to validate the estimation procedure, to show the computational efficiency due to the Bayesian approach and also to illustrate the gains from the proposed method compared to existing methods that ignore outcome misclassification and cluster level heterogeneity. We apply the proposed method to examine the risk factors for both asthma transition and misclassification in the Southern California Children's Health Study (CHS). PMID:24254432

  13. Comparative analysis of rationale used by dentists and patient for final esthetic outcome of dental treatment.

    Science.gov (United States)

    Reddy, S Varalakshmi; Madineni, Praveen Kumar; Sudheer, A; Gujjarlapudi, Manmohan Choudary; Sreedevi, B; Reddy, Patelu Sunil Kumar

    2013-05-01

    To compare and evaluate the perceptions of esthetics among dentists and patients regarding the final esthetic outcome of a dental treatment. Esthetics is a matter of perception and is associated with the way different people look at an object. What constitutes esthetic for a particular person may not be acceptable for another. Hence it is subjective in nature. This becomes more obvious during the post-treatment evaluation of esthetics by dentist and the concerned patient. Opinion seldom matches. Hence, the study is a necessary part of the process of understanding the mind of dentist and patient regarding what constitutes esthetics. A survey has been conducted by means of a questionnaire consisting of 10 questions, on two groups of people. First group consists of 100 dentists picked at random in Kanyakumari district of Tamil Nadu, India. Second group consisted of 100 patients who required complete denture prosthesis. The second group was divided into two subgroups A and B. Subgroup A consisting of 50 men and subgroup B consisting of 50 women. In each subgroup 25 patients were selected in age group of 40 to 50 and 25 patients were selected in the age group of 50 to 60. The questionnaire was given to both the groups and asked to fill up, which was then statistically analyzed to look for patterns of thought process among them. Results were subjected to statistical analysis by Student's t-test. Perceptions of esthetics differs from dentist who is educated regarding esthetic principles of treatment and a patient who is not subjected to such education. Since, the questions were formulated such that patients could better understand the underlying problem, the final outcome of survey is a proof that dentists need to take into account what the patient regards as esthetics in order to provide a satisfactory treatment. CLINICAL AND ACADEMIC SIGNIFICANCE: The current study helps the dentist to better educate the patient regarding esthetics so that patient appreciates the final

  14. Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome.

    Science.gov (United States)

    Lekkerkerker, Selma J; Besselink, Marc G; Busch, Olivier R; Verheij, Joanne; Engelbrecht, Marc R; Rauws, Erik A; Fockens, Paul; van Hooft, Jeanin E

    2017-05-01

    Currently, 3 guidelines are available for the management of pancreatic cysts. These guidelines vary in their indication for resection of high-risk cysts. We retrospectively compared the final pathologic outcome of surgically removed pancreatic cysts with the indications for resection according to 3 different guidelines. Patients who underwent pancreatic resection were extracted from our prospective pancreatic cyst database (2006-present). The final histopathologic diagnosis was compared with the initial indication for surgery stated by the guidelines of the International Association of Pancreatology (IAP), European Study Group on Cystic tumors of the Pancreas and American Gastroenterological Association (AGA). We considered surgery in retrospect justified for malignancy, high-grade dysplasia, solid pseudopapillary neoplasms, neuroendocrine tumors or symptom improvement. Furthermore, we evaluated the patients with suspected intraductal papillary mucinous neoplasm (IPMN) separately. Overall, 115 patients underwent pancreatic resection. The preoperative diagnosis was correct in 83 of 115 patients (72%) and differentiation between benign and premalignant in 99 of 115 patients (86%). In retrospect, surgery was justified according to the aforementioned criteria in 52 of 115 patients (45%). For patients with suspected IPMN (n = 75) resection was justified in 36 of 67 (54%), 36 of 68 (53%), and 32 of 54 (59%) of patients who would have had surgery based on the IAP, European, or AGA guidelines, respectively. The AGA guideline would have avoided resection in 21 of 75 (28%) patients, versus 8 of 75 (11%) and 7 of 75 (9%) when the IAP or European guideline would have been applied strictly. Nevertheless, 4 of 33 patients (12%) with high-grade dysplasia or malignancy would have been missed with the AGA guidelines, compared with none with the IAP or European guidelines. Although fewer patients undergo unnecessary surgery based on the AGA guidelines, the risk of missing

  15. A Comparative Study Of Stock Price Forecasting Using Nonlinear Models

    Directory of Open Access Journals (Sweden)

    Diteboho Xaba

    2017-03-01

    Full Text Available This study compared the in-sample forecasting accuracy of three forecasting nonlinear models namely: the Smooth Transition Regression (STR model, the Threshold Autoregressive (TAR model and the Markov-switching Autoregressive (MS-AR model. Nonlinearity tests were used to confirm the validity of the assumptions of the study. The study used model selection criteria, SBC to select the optimal lag order and for the selection of appropriate models. The Mean Square Error (MSE, Mean Absolute Error (MAE and Root Mean Square Error (RMSE served as the error measures in evaluating the forecasting ability of the models. The MS-AR models proved to perform well with lower error measures as compared to LSTR and TAR models in most cases.

  16. Pregnancy outcomes in type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls.

    Science.gov (United States)

    Knight, Kristin M; Thornburg, Loralei L; Pressman, Eva K

    2012-01-01

    To characterize the neonatal and maternal outcomes of type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls. We performed a retrospective cohort study reviewing perinatal outcomes of type 1 and type 2 diabetic patients and nondiabetic controls from July 2000 to August 2006. Analysis of variance, t testing and chi2 analysis were used to compare groups. Post hoc power analysis indicated 80% power was necessary to detect a 15% difference in composite poor neonatal outcomes. A total of 64 type 2 and 64 type 1 diabetic patients were compared with 256 controls. Type 1 diabetic patients had higher incidences of composite poor neonatal outcome and congenital anomalies than did type 2 diabetic and control patients. Both diabetic groups had similarly higher incidences of cesarean delivery, preeclampsia, preterm delivery, polyhydramnios and macrosomia than did controls. Type 2 diabetic patients have a decreased incidence of adverse neonatal outcomes when compared with that of type 1 diabetic patients. No difference was observed between the diabetic groups in the incidence of a majority of the adverse maternal outcomes examined, however both diabetic groups had overall worse outcomes that did nondiabetic controls.

  17. 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 < .001). Lawyer involvement and medical assessments were significantly associated with poorer perceived 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

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

    Directory of Open Access Journals (Sweden)

    Nieke A. Elbers

    2016-07-01

    Full Text Available Abstract Background 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. Methods 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. Results In Victoria, 84 % of the participants considered the claims process fair, compared to 46 % of NSW participants (χ2 = 28.54; p < .001. Lawyer involvement and medical assessments were significantly associated with poorer perceived 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. Conclusion 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

  19. 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

  20. Home healthcare nurse retention and patient outcome model: discussion and model development.

    Science.gov (United States)

    Ellenbecker, Carol Hall; Cushman, Margaret

    2012-08-01

    This paper discusses additions to an empirically tested model of home healthcare nurse retention. An argument is made that the variables of shared decision-making and organizational commitment be added to the model based on the authors' previous research and additional evidence from the literature. Previous research testing the home healthcare nurse retention model established empirical relationships between nurse, agency, and area characteristics to nurse job satisfaction, intent to stay, and retention. Unexplained model variance prompted a new literature search to augment understanding of nurse retention and patient and agency outcomes. Data come from the authors' previous research, and a literature search from 1990 to 2011 on the topics organizational commitment, shared decision-making, nurse retention, patient outcomes and agency performance. The literature provides a rationale for the additional variables of shared decision-making and affective and continuous organizational commitment, linking these variables to nurse job satisfaction, nurse intent to stay, nurse retention and patient outcomes and agency performance. Implications for nursing.  The new variables in the model suggest that all agencies, even those not struggling to retain nurses, should develop interventions to enhance nurse job satisfaction to assure quality patient outcomes. The new nurse retention and patient outcome model increases our understanding of nurse retention. An understanding of the relationship among these variables will guide future research and the development of interventions to create and maintain nursing work environments that contribute to nurse affective agency commitment, nurse retention and quality of patient outcomes. © 2011 Blackwell Publishing Ltd.

  1. The structure of observed learning outcome (SOLO) taxonomy: a model to promote dental students' learning.

    Science.gov (United States)

    Lucander, H; Bondemark, L; Brown, G; Knutsson, K

    2010-08-01

    Selective memorising of isolated facts or reproducing what is thought to be required - the surface approach to learning - is not the desired outcome for a dental student or a dentist in practice. The preferred outcome is a deep approach as defined by an intention to seek understanding, develop expertise and relate information and knowledge into a coherent whole. The aim of this study was to investigate whether the structure of observed learning outcome (SOLO) taxonomy could be used as a model to assist and promote the dental students to develop a deep approach to learning assessed as learning outcomes in a summative assessment. Thirty-two students, participating in course eight in 2007 at the Faculty of Odontology at Malmö University, were introduced to the SOLO taxonomy and constituted the test group. The control group consisted of 35 students participating in course eight in 2006. The effect of the introduction was measured by evaluating responses to a question in the summative assessment by using the SOLO taxonomy. The evaluators consisted of two teachers who performed the assessment of learning outcomes independently and separately on the coded material. The SOLO taxonomy as a model for learning was found to improve the quality of learning. Compared to the control group significantly more strings and structured relations between these strings were present in the test group after the SOLO taxonomy had been introduced (P SOLO taxonomy is recommended as a model for promoting and developing a deeper approach to learning in dentistry.

  2. Comparative pharmacogenetic analysis of risk polymorphisms in Caucasian and Vietnamese children with acute lymphoblastic leukemia: prediction of therapeutic outcome?

    Science.gov (United States)

    Hoang, Phuong Thu Vu; Ambroise, Jérôme; Dekairelle, Anne-France; Durant, Jean-François; Butoescu, Valentina; Chi, Vu Luan Dang; Huynh, Nghia; Nguyen, Tan Binh; Robert, Annie; Vermylen, Christiane; Gala, Jean-Luc

    2015-03-01

    Acute lymphoblastic leukemia (ALL) is the most common of all paediatric cancers. Aside from predisposing to ALL, polymorphisms could also be associated with poor outcome. Indeed, genetic variations involved in drug metabolism could, at least partially, be responsible for heterogeneous responses to standardized leukemia treatments, hence requiring more personalized therapy. The aims of this study were to (a) to determine the prevalence of seven common genetic polymorphisms including those that affect the folate and/or thiopurine metabolic pathways, i.e. cyclin D1 (CCND1-G870A), γ-glutamyl hydrolase (GGH-C452T), methylenetetrahydrofolate reductase (MTHFR-C677T and MTHFR-A1298C), thymidylate synthase promoter (TYMS-TSER), thiopurine methyltransferase (TPMT*3A and TPMT*3C) and inosine triphosphate pyrophosphatase (ITPA-C94A), in Caucasian (n = 94, age Vietnamese (n = 141, age Vietnamese (P < 0.001 and P = 0.02, respectively). Compared with children with a low MGRS (≤ 3), those with a high MGRS (≥ 4) were 2.06 (95% CI = 1.01, 4.22; P = 0.04) times more likely to relapse. Adding MGRS into a multivariate Cox regression model with race/ethnicity and four clinical variables improved the predictive accuracy of the model (AUC from 0.682 to 0.709 at 24 months). Including MGRS into a clinical model improved the predictive accuracy of short and medium term prognosis, hence confirming the association between well determined pharmacogenotypes and outcome of paediatric ALL. Whether variants on other genes associated with folate metabolism can substantially improve the predictive value of current MGRS is not known but deserves further evaluation. © 2014 The British Pharmacological Society.

  3. Improving outcomes of emergency bowel surgery using nela model

    International Nuclear Information System (INIS)

    Sultan, R.; Zafar, H.

    2018-01-01

    To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA). Study Design:An audit. Place and Duration of Study:Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014. Methodology:Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their first report. P-value for categorical variables was calculated using Chi-square tests. Results:Although the patients were younger with nearly same spectrum of disease, the mortality rate was significantly more than reported in NELA (24% versus 11%, p=0.004). Comparison showed that care at AKUH was significantly lacking in terms of proper preoperative risk assessment and documentation, case booking to operating room timing, intraoperative goal directed fluid therapy using cardiac output monitoring, postoperative intensive care for highest risk patients and review of elderly patients by MCOP specialist. Conclusion:This study helped in understanding the deficiencies in the care of patients undergoing emergency bowel surgery and alarmingly poor outcomes in a very systematic manner. In view of results of this study, it is planned to do interventions in the deficient areas to improve care given to these patients and their outcomes with the limited resources of a developing country. (author)

  4. A Behavioral Economic Reward Index Predicts Drinking Resolutions: Moderation Re-visited and Compared with Other Outcomes

    Science.gov (United States)

    Tucker, Jalie A.; Roth, David L.; Vignolo, Mary J.; Westfall, Andrew O.

    2014-01-01

    Data were pooled from three studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1-2 year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes compared to abstinence or relapse and to be predicted by more balanced pre-resolution monetary allocations between short- and longer-term objectives (i.e., drinking and saving for the future). Standardized odds ratios (OR) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this “Alcohol-Savings Discretionary Expenditure” index predicted higher rates of both abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors. The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of pre-resolution spending patterns aids in predicting moderation. PMID:19309182

  5. 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. Copyright © 2015 John Wiley & Sons, Ltd.

  6. A Comprehensive Method for Comparing Mental Models of Dynamic Systems

    OpenAIRE

    Schaffernicht, Martin; Grösser, Stefan N.

    2011-01-01

    Mental models are the basis on which managers make decisions even though external decision support systems may provide help. Research has demonstrated that more comprehensive and dynamic mental models seem to be at the foundation for improved policies and decisions. Eliciting and comparing such models can systematically explicate key variables and their main underlying structures. In addition, superior dynamic mental models can be identified. This paper reviews existing studies which measure ...

  7. 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.

  8. 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%]; pmethods (61 students [84.7%] versus 38 students [52.8%]; ptraditional 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.

  9. A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.

    Science.gov (United States)

    Concannon, Thomas W; Fuster, Melissa; Saunders, Tully; Patel, Kamal; Wong, John B; Leslie, Laurel K; Lau, Joseph

    2014-12-01

    We conducted a review of the peer-reviewed literature since 2003 to catalogue reported methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. We worked with stakeholders before, during and after the review was conducted to: define the primary and key research questions; conduct the literature search; screen titles, abstracts and articles; abstract data from the articles; and analyze the data. The literature search yielded 2,062 abstracts. The review was conducted on 70 articles that reported on stakeholder engagement in individual research projects or programs. Reports of stakeholder engagement are highly variable in content and quality. We found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with stakeholders in other key decision-making groups across the healthcare system. Stakeholder engagement was more common in earlier (prioritization) than in later (implementation and dissemination) stages of research. The roles and activities of stakeholders were highly variable across research and program reports. To improve on the quality and content of reporting, we developed a 7-Item Stakeholder Engagement Reporting Questionnaire. We recommend three directions for future research: 1) descriptive research on stakeholder-engagement in research; 2) evaluative research on the impact of stakeholder engagement on the relevance, transparency and adoption of research; and 3) development and validation of tools that can be used to support stakeholder engagement in future work.

  10. Comparative study of long-term outcomes of accelerated and conventional collagen crosslinking for progressive keratoconus.

    Science.gov (United States)

    Males, J J; Viswanathan, D

    2018-01-01

    PurposeTo compare the long-term outcomes of accelerated corneal collagen crosslinking (CXL) to conventional CXL for progressive keratoconus.Patients and methodsComparative clinical study of consecutive progressive keratoconic eyes that underwent either accelerated CXL (9 mW/cm 2 ultraviolet A (UVA) light irradiance for 10 min) or conventional CXL (3 mW/cm 2 UVA light irradiance for 30 min). Eyes with minimum 12 months' follow-up were included. Post-procedure changes in keratometry readings (Flat meridian: K1; steep meridian: K2), central corneal thickness (CCT), best spectacle-corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were analysed.ResultsA total of 42 eyes were included. In all, 21 eyes had accelerated CXL (20.5±5.5 months' follow-up) and 21 eyes had conventional CXL group (20.2±5.6 months' follow-up). In the accelerated CXL group, a significant reduction in K2 (P=0.02), however no significant change in K1 (P=0.35) and CCT (P=0.62) was noted. In the conventional CXL group, a significant reduction was seen in K1 (P=0.01) and K2 (P=0.04), but not in CCT (P=0.95). Although both groups exhibited significant reductions in K2 readings, no noteworthy differences were noted between them (P=0.36). Improvements in BSCVA (accelerated CXL; P=0.22 and conventional CXL; P=0.20) and MRSE (accelerated CXL; P=0.97 and conventional CXL; P=0.54) were noted, however were not significant in either group.ConclusionAccelerated and conventional CXL appear to be effective procedures for stabilising progressive keratoconus in the long-term.

  11. comparative analysis of some existing kinetic models with proposed

    African Journals Online (AJOL)

    IGNATIUS NWIDI

    two statistical parameters namely; linear regression coefficient of correlation (R2) and ... Keynotes: Heavy metals, Biosorption, Kinetics Models, Comparative analysis, Average Relative Error. 1. ... If the flow rate is low, a simple manual batch.

  12. Comparing the engineering program feeders from SiF and convention models

    Science.gov (United States)

    Roongruangsri, Warawaran; Moonpa, Niwat; Vuthijumnonk, Janyawat; Sangsuwan, Kampanart

    2018-01-01

    This research aims to compare the relationship between two types of engineering program feeder models within the technical education systems of Rajamangala University of Technology Lanna (RMUTL), Chiangmai, Thailand. To illustrate, the paper refers to two typologies of feeder models, which are the convention and the school in factory (SiF) models. The new SiF model is developed through a collaborative educational process between the sectors of industry, government and academia, using work-integrated learning. The research methodology were use to compared features of the the SiF model with conventional models in terms of learning outcome, funding budget for the study, the advantages and disadvantages from the point of view of students, professors, the university, government and industrial partners. The results of this research indicate that the developed SiF feeder model is the most pertinent ones as it meet the requirements of the university, the government and the industry. The SiF feeder model showed the ability to yield positive learning outcomes with low expenditures per student for both the family and the university. In parallel, the sharing of knowledge between university and industry became increasingly important in the process, which resulted in the improvement of industrial skills for professors and an increase in industrial based research for the university. The SiF feeder model meets its demand of public policy in supporting a skilled workforce for the industry, which could be an effective tool for the triple helix educational model of Thailand.

  13. Patterns of Use of an Agent-Based Model and a System Dynamics Model: The Application of Patterns of Use and the Impacts on Learning Outcomes

    Science.gov (United States)

    Thompson, Kate; Reimann, Peter

    2010-01-01

    A classification system that was developed for the use of agent-based models was applied to strategies used by school-aged students to interrogate an agent-based model and a system dynamics model. These were compared, and relationships between learning outcomes and the strategies used were also analysed. It was found that the classification system…

  14. 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.

  15. 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...

  16. Multi-criteria comparative evaluation of spallation reaction models

    Science.gov (United States)

    Andrianov, Andrey; Andrianova, Olga; Konobeev, Alexandr; Korovin, Yury; Kuptsov, Ilya

    2017-09-01

    This paper presents an approach to a comparative evaluation of the predictive ability of spallation reaction models based on widely used, well-proven multiple-criteria decision analysis methods (MAVT/MAUT, AHP, TOPSIS, PROMETHEE) and the results of such a comparison for 17 spallation reaction models in the presence of the interaction of high-energy protons with natPb.

  17. Comparative analysis of various methods for modelling permanent magnet machines

    NARCIS (Netherlands)

    Ramakrishnan, K.; Curti, M.; Zarko, D.; Mastinu, G.; Paulides, J.J.H.; Lomonova, E.A.

    2017-01-01

    In this paper, six different modelling methods for permanent magnet (PM) electric machines are compared in terms of their computational complexity and accuracy. The methods are based primarily on conformal mapping, mode matching, and harmonic modelling. In the case of conformal mapping, slotted air

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

    Science.gov (United States)

    Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles

    2013-11-21

    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. 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. 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 (phospitals 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). 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 compared to hospitals.

  19. Comparing resident cataract surgery outcomes under novice versus experienced attending supervision

    Directory of Open Access Journals (Sweden)

    Puri S

    2015-09-01

    Full Text Available Sidharth Puri,1 Amanda E Kiely,2 Jiangxia Wang,3 Alonzo S Woodfield,4 Saras Ramanathan,5 Shameema Sikder21Johns Hopkins School of Medicine, Baltimore, MD, 2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 4Kaiser Permanente South Sacramento Medical Center, Sacramento, 5San Francisco School of Medicine, University of California, San Francisco, CA, USAPurpose: To determine whether supervision by an attending new to surgical teaching or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents.Setting: Single tertiary hospital.Design: Retrospective cohort study. Methods: Resident-performed phacoemulsification cases supervised by one novice attending (N=189 and experienced attending (N=172 over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy, intraoperative risk factors (Trypan blue, iris hooks, and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet’s tear. Experienced attending data were compared against those of the novice attending.Results: Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005, Flomax (P<0.001, or glaucoma risk (P=0.001. For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001. Regarding complications, novice attending cases were associated with vitreous loss (P=0.002 and anterior capsule tears (P<0.001. When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice

  20. A Comparative Study of Glasgow Coma Scale and Full Outline of Unresponsiveness Scores for Predicting Long-Term Outcome After Brain Injury.

    Science.gov (United States)

    McNett, Molly M; Amato, Shelly; Philippbar, Sue Ann

    2016-01-01

    The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury. This is a prospective cohort study. Data were gathered on adult patients with traumatic brain injury admitted to urban level I trauma center. GCS and FOUR scores were assigned at 24 and 72 hours and at hospital discharge. Glasgow Outcome Scale scores were assigned at 6 and 12 months. The sample size was n = 107. Mean age was 53.5 (SD = ±21, range = 18-91) years. Spearman correlations were comparable and strongest among discharge GCS and FOUR scores and 12-month outcome (r = .73, p coma scores performed best for both tools, with GCS discharge scores predictive in multivariate models.

  1. 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.

  2. Methods and models used in comparative risk studies

    International Nuclear Information System (INIS)

    Devooght, J.

    1983-01-01

    Comparative risk studies make use of a large number of methods and models based upon a set of assumptions incompletely formulated or of value judgements. Owing to the multidimensionality of risks and benefits, the economic and social context may notably influence the final result. Five classes of models are briefly reviewed: accounting of fluxes of effluents, radiation and energy; transport models and health effects; systems reliability and bayesian analysis; economic analysis of reliability and cost-risk-benefit analysis; decision theory in presence of uncertainty and multiple objectives. Purpose and prospect of comparative studies are assessed in view of probable diminishing returns for large generic comparisons [fr

  3. 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.

  4. Restrictions of comparative analysis of investing in scientific research and scientific outcomes of the countries in nanotechnology

    OpenAIRE

    Milanović, Vesna; Bučalina-Matić, Andrea; Golubović, Marina

    2016-01-01

    The aim of this paper is to provide an insight into restrictions of comparative analysis of investing in scientific research and scientific outcomes of the countries in nanotechnology, having in mind that it is a developing technology which is expected to give significant contribution to science, economy and society in the future. Using the methods of content analysis, comparative methods and relevant literature, certain restrictions of this comparative analysis have been established. They ar...

  5. Comparing estimates of genetic variance across different relationship models.

    Science.gov (United States)

    Legarra, Andres

    2016-02-01

    Use of relationships between individuals to estimate genetic variances and heritabilities via mixed models is standard practice in human, plant and livestock genetics. Different models or information for relationships may give different estimates of genetic variances. However, comparing these estimates across different relationship models is not straightforward as the implied base populations differ between relationship models. In this work, I present a method to compare estimates of variance components across different relationship models. I suggest referring genetic variances obtained using different relationship models to the same reference population, usually a set of individuals in the population. Expected genetic variance of this population is the estimated variance component from the mixed model times a statistic, Dk, which is the average self-relationship minus the average (self- and across-) relationship. For most typical models of relationships, Dk is close to 1. However, this is not true for very deep pedigrees, for identity-by-state relationships, or for non-parametric kernels, which tend to overestimate the genetic variance and the heritability. Using mice data, I show that heritabilities from identity-by-state and kernel-based relationships are overestimated. Weighting these estimates by Dk scales them to a base comparable to genomic or pedigree relationships, avoiding wrong comparisons, for instance, "missing heritabilities". Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Comparing live and remote models in eating conformity research.

    Science.gov (United States)

    Feeney, Justin R; Polivy, Janet; Pliner, Patricia; Sullivan, Margot D

    2011-01-01

    Research demonstrates that people conform to how much other people eat. This conformity occurs in the presence of other people (live model) and when people view information about how much food prior participants ate (remote models). The assumption in the literature has been that remote models produce a similar effect to live models, but this has never been tested. To investigate this issue, we randomly paired participants with a live or remote model and compared their eating to those who ate alone. We found that participants exposed to both types of model differed significantly from those in the control group, but there was no significant difference between the two modeling procedures. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

  7. Comparative calculations and validation studies with atmospheric dispersion models

    International Nuclear Information System (INIS)

    Paesler-Sauer, J.

    1986-11-01

    This report presents the results of an intercomparison of different mesoscale dispersion models and measured data of tracer experiments. The types of models taking part in the intercomparison are Gaussian-type, numerical Eulerian, and Lagrangian dispersion models. They are suited for the calculation of the atmospherical transport of radionuclides released from a nuclear installation. For the model intercomparison artificial meteorological situations were defined and corresponding arithmetical problems were formulated. For the purpose of model validation real dispersion situations of tracer experiments were used as input data for model calculations; in these cases calculated and measured time-integrated concentrations close to the ground are compared. Finally a valuation of the models concerning their efficiency in solving the problems is carried out by the aid of objective methods. (orig./HP) [de

  8. Effect Of Inquiry Learning Model And Motivation On Physics Outcomes Learning Students

    OpenAIRE

    Pardede, Dahlia Megawati; Manurung, Sondang Rina

    2016-01-01

    The purposes of the research are: (a) to determine differences in learning outcomes of students with Inquiry Training models and conventional models, (b) to determine differences in physics learning outcomes of students who have high motivation and low motivation, (c) to determine the interaction between learning models with the level of motivation in improving student Physics learning outcomes. The results were found: (a) there are differences in physical students learning outcomes are taugh...

  9. A comparative review of radiation-induced cancer risk models

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hee; Kim, Ju Youl [FNC Technology Co., Ltd., Yongin (Korea, Republic of); Han, Seok Jung [Risk and Environmental Safety Research Division, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2017-06-15

    With the need for a domestic level 3 probabilistic safety assessment (PSA), it is essential to develop a Korea-specific code. Health effect assessments study radiation-induced impacts; in particular, long-term health effects are evaluated in terms of cancer risk. The objective of this study was to analyze the latest cancer risk models developed by foreign organizations and to compare the methodology of how they were developed. This paper also provides suggestions regarding the development of Korean cancer risk models. A review of cancer risk models was carried out targeting the latest models: the NUREG model (1993), the BEIR VII model (2006), the UNSCEAR model (2006), the ICRP 103 model (2007), and the U.S. EPA model (2011). The methodology of how each model was developed is explained, and the cancer sites, dose and dose rate effectiveness factor (DDREF) and mathematical models are also described in the sections presenting differences among the models. The NUREG model was developed by assuming that the risk was proportional to the risk coefficient and dose, while the BEIR VII, UNSCEAR, ICRP, and U.S. EPA models were derived from epidemiological data, principally from Japanese atomic bomb survivors. The risk coefficient does not consider individual characteristics, as the values were calculated in terms of population-averaged cancer risk per unit dose. However, the models derived by epidemiological data are a function of sex, exposure age, and attained age of the exposed individual. Moreover, the methodologies can be used to apply the latest epidemiological data. Therefore, methodologies using epidemiological data should be considered first for developing a Korean cancer risk model, and the cancer sites and DDREF should also be determined based on Korea-specific studies. This review can be used as a basis for developing a Korean cancer risk model in the future.

  10. 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.

  11. Dispersion Modeling Using Ensemble Forecasts Compared to ETEX Measurements.

    Science.gov (United States)

    Straume, Anne Grete; N'dri Koffi, Ernest; Nodop, Katrin

    1998-11-01

    Numerous numerical models are developed to predict long-range transport of hazardous air pollution in connection with accidental releases. When evaluating and improving such a model, it is important to detect uncertainties connected to the meteorological input data. A Lagrangian dispersion model, the Severe Nuclear Accident Program, is used here to investigate the effect of errors in the meteorological input data due to analysis error. An ensemble forecast, produced at the European Centre for Medium-Range Weather Forecasts, is then used as model input. The ensemble forecast members are generated by perturbing the initial meteorological fields of the weather forecast. The perturbations are calculated from singular vectors meant to represent possible forecast developments generated by instabilities in the atmospheric flow during the early part of the forecast. The instabilities are generated by errors in the analyzed fields. Puff predictions from the dispersion model, using ensemble forecast input, are compared, and a large spread in the predicted puff evolutions is found. This shows that the quality of the meteorological input data is important for the success of the dispersion model. In order to evaluate the dispersion model, the calculations are compared with measurements from the European Tracer Experiment. The model manages to predict the measured puff evolution concerning shape and time of arrival to a fairly high extent, up to 60 h after the start of the release. The modeled puff is still too narrow in the advection direction.

  12. EFFECT OF INQUIRY LEARNING MODEL AND MOTIVATION ON PHYSICS OUTCOMES LEARNING STUDENTS

    Directory of Open Access Journals (Sweden)

    Dahlia Megawati Pardede

    2016-06-01

    Full Text Available The purposes of the research are: (a to determine differences in learning outcomes of students with Inquiry Training models and conventional models, (b to determine differences in physics learning outcomes of students who have high motivation and low motivation, (c to determine the interaction between learning models with the level of motivation in improving student Physics learning outcomes. The results were found: (a there are differences in physical students learning outcomes are taught by Inquiry Training models and conventional models. (b learning outcomes of students who are taught by Inquiry Learning Model Training better than student learning outcomes are taught with conventional model. (c there is a difference in student's learning outcomes that have high motivation and low motivation. (d Student learning outcomes that have a high motivation better than student learning outcomes than have a low motivation. (e there is interaction between learning and motivation to student learning outcomes. Learning outcomes of students who are taught by the model is influenced also by the motivation, while learning outcomes of students who are taught with conventional models are not affected by motivation.

  13. 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

  14. Joint modeling of correlated binary outcomes: The case of contraceptive use and HIV knowledge in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Di Fang

    Full Text Available Recent advances in statistical methods enable the study of correlation among outcomes through joint modeling, thereby addressing spillover effects. By joint modeling, we refer to simultaneously analyzing two or more different response variables emanating from the same individual. Using the 2011 Bangladesh Demographic and Health Survey, we jointly address spillover effects between contraceptive use (CUC and knowledge of HIV and other sexually transmitted diseases. Jointly modeling these two outcomes is appropriate because certain types of contraceptive use contribute to the prevention of HIV and STDs and the knowledge and awareness of HIV and STDs typically lead to protection during sexual intercourse. In particular, we compared the differences as they pertained to the interpretive advantage of modeling the spillover effects of joint modeling HIV and CUC as opposed to addressing them separately. We also identified risk factors that determine contraceptive use and knowledge of HIV and STDs among women in Bangladesh. We found that by jointly modeling the correlation between HIV knowledge and contraceptive use, the importance of education decreased. The HIV prevention program had a spillover effect on CUC: what seemed to be impacted by education can be partially contributed to one's exposure to HIV knowledge. The joint model revealed a less significant impact of covariates as opposed to both separate models and standard models. Additionally, we found a spillover effect that would have otherwise been undiscovered if we did not jointly model. These findings further suggested that the simultaneous impact of correlated outcomes can be adequately addressed for the commonality between different responses and deflate, which is otherwise overestimated when examined separately.

  15. Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures.

    Science.gov (United States)

    Jones, Laura L; Calvert, Melanie; Moiemen, Naiem; Deeks, Jonathan J; Bishop, Jonathan; Kinghorn, Philip; Mathers, Jonathan

    2017-12-01

    Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial

  16. Comparative study of outcome measures and analysis methods for traumatic brain injury trials.

    Science.gov (United States)

    Alali, Aziz S; Vavrek, Darcy; Barber, Jason; Dikmen, Sureyya; Nathens, Avery B; Temkin, Nancy R

    2015-04-15

    Batteries of functional and cognitive measures have been proposed as alternatives to the Extended Glasgow Outcome Scale (GOSE) as the primary outcome for traumatic brain injury (TBI) trials. We evaluated several approaches to analyzing GOSE and a battery of four functional and cognitive measures. Using data from a randomized trial, we created a "super" dataset of 16,550 subjects from patients with complete data (n=331) and then simulated multiple treatment effects across multiple outcome measures. Patients were sampled with replacement (bootstrapping) to generate 10,000 samples for each treatment effect (n=400 patients/group). The percentage of samples where the null hypothesis was rejected estimates the power. All analytic techniques had appropriate rates of type I error (≤5%). Accounting for baseline prognosis either by using sliding dichotomy for GOSE or using regression-based methods substantially increased the power over the corresponding analysis without accounting for prognosis. Analyzing GOSE using multivariate proportional odds regression or analyzing the four-outcome battery with regression-based adjustments had the highest power, assuming equal treatment effect across all components. Analyzing GOSE using a fixed dichotomy provided the lowest power for both unadjusted and regression-adjusted analyses. We assumed an equal treatment effect for all measures. This may not be true in an actual clinical trial. Accounting for baseline prognosis is critical to attaining high power in Phase III TBI trials. The choice of primary outcome for future trials should be guided by power, the domain of brain function that an intervention is likely to impact, and the feasibility of collecting outcome data.

  17. Meta-analysis of studies comparing oncologic outcomes of radical prostatectomy and brachytherapy for localized prostate cancer.

    Science.gov (United States)

    Cozzi, Gabriele; Musi, Gennaro; Bianchi, Roberto; Bottero, Danilo; Brescia, Antonio; Cioffi, Antonio; Cordima, Giovanni; Delor, Maurizio; Di Trapani, Ettore; Ferro, Matteo; Matei, Deliu Victor; Russo, Andrea; Mistretta, Francesco Alessandro; De Cobelli, Ottavio

    2017-11-01

    The aim of this study was to compare oncologic outcomes of radical prostatectomy (RP) with brachytherapy (BT). A literature review was conducted according to the 'Preferred reporting items for systematic reviews and meta-analyses' (PRISMA) statement. We included studies reporting comparative oncologic outcomes of RP versus BT for localized prostate cancer (PCa). From each comparative study, we extracted the study design, the number and features of the included patients, and the oncologic outcomes expressed as all-cause mortality (ACM), PCa-specific mortality (PCSM) or, when the former were unavailable, as biochemical recurrence (BCR). All of the data retrieved from the selected studies were recorded in an electronic database. Cumulative analysis was conducted using the Review Manager version 5.3 software, designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Statistical heterogeneity was tested using the Chi-square test. Our cumulative analysis did not show any significant difference in terms of BCR, ACM or PCSM rates between the RP and BT cohorts. Only three studies reported risk-stratified outcomes of intermediate- and high-risk patients, which are the most prone to treatment failure. our analysis suggested that RP and BT may have similar oncologic outcomes. However, the analysis included a limited number of studies, and most of them were retrospective, making it impossible to derive any definitive conclusion, especially for intermediate- and high-risk patients. In this scenario, appropriate urologic counseling remains of utmost importance.

  18. Comparing the line broadened quasilinear model to Vlasov code

    International Nuclear Information System (INIS)

    Ghantous, K.; Berk, H. L.; Gorelenkov, N. N.

    2014-01-01

    The Line Broadened Quasilinear (LBQ) model is revisited to study its predicted saturation level as compared with predictions of a Vlasov solver BOT [Lilley et al., Phys. Rev. Lett. 102, 195003 (2009) and M. Lilley, BOT Manual. The parametric dependencies of the model are modified to achieve more accuracy compared to the results of the Vlasov solver both in regards to a mode amplitude's time evolution to a saturated state and its final steady state amplitude in the parameter space of the model's applicability. However, the regions of stability as predicted by LBQ model and BOT are found to significantly differ from each other. The solutions of the BOT simulations are found to have a larger region of instability than the LBQ simulations

  19. Comparing the line broadened quasilinear model to Vlasov code

    Energy Technology Data Exchange (ETDEWEB)

    Ghantous, K. [Laboratoire de Physique des Plasmas, Ecole Polytechnique, 91128 Palaiseau Cedex (France); Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543-0451 (United States); Berk, H. L. [Institute for Fusion Studies, University of Texas, 2100 San Jacinto Blvd, Austin, Texas 78712-1047 (United States); Gorelenkov, N. N. [Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543-0451 (United States)

    2014-03-15

    The Line Broadened Quasilinear (LBQ) model is revisited to study its predicted saturation level as compared with predictions of a Vlasov solver BOT [Lilley et al., Phys. Rev. Lett. 102, 195003 (2009) and M. Lilley, BOT Manual. The parametric dependencies of the model are modified to achieve more accuracy compared to the results of the Vlasov solver both in regards to a mode amplitude's time evolution to a saturated state and its final steady state amplitude in the parameter space of the model's applicability. However, the regions of stability as predicted by LBQ model and BOT are found to significantly differ from each other. The solutions of the BOT simulations are found to have a larger region of instability than the LBQ simulations.

  20. Comparing the line broadened quasilinear model to Vlasov code

    Science.gov (United States)

    Ghantous, K.; Berk, H. L.; Gorelenkov, N. N.

    2014-03-01

    The Line Broadened Quasilinear (LBQ) model is revisited to study its predicted saturation level as compared with predictions of a Vlasov solver BOT [Lilley et al., Phys. Rev. Lett. 102, 195003 (2009) and M. Lilley, BOT Manual. The parametric dependencies of the model are modified to achieve more accuracy compared to the results of the Vlasov solver both in regards to a mode amplitude's time evolution to a saturated state and its final steady state amplitude in the parameter space of the model's applicability. However, the regions of stability as predicted by LBQ model and BOT are found to significantly differ from each other. The solutions of the BOT simulations are found to have a larger region of instability than the LBQ simulations.

  1. Comparing the staffing models of outsourcing in selected companies

    OpenAIRE

    Chaloupková, Věra

    2010-01-01

    This thesis deals with problems of takeover of employees in outsourcing. The capital purpose is to compare the staffing model of outsourcing in selected companies. To compare in selected companies I chose multi-criteria analysis. This thesis is dividend into six chapters. The first charter is devoted to the theoretical part. In this charter describes the basic concepts as outsourcing, personal aspects, phase of the outsourcing projects, communications and culture. The rest of thesis is devote...

  2. Modelling variable dropout in randomised controlled trials with longitudinal outcomes: application to the MAGNETIC study.

    Science.gov (United States)

    Kolamunnage-Dona, Ruwanthi; Powell, Colin; Williamson, Paula Ruth

    2016-04-28

    Clinical trials with longitudinally measured outcomes are often plagued by missing data due to patients withdrawing or dropping out from the trial before completing the measurement schedule. The reasons for dropout are sometimes clearly known and recorded during the trial, but in many instances these reasons are unknown or unclear. Often such reasons for dropout are non-ignorable. However, the standard methods for analysing longitudinal outcome data assume that missingness is non-informative and ignore the reasons for dropout, which could result in a biased comparison between the treatment groups. In this article, as a post hoc analysis, we explore the impact of informative dropout due to competing reasons on the evaluation of treatment effect in the MAGNETIC trial, the largest randomised placebo-controlled study to date comparing the addition of nebulised magnesium sulphate to standard treatment in acute severe asthma in children. We jointly model longitudinal outcome and informative dropout process to incorporate the information regarding the reasons for dropout by treatment group. The effect of nebulised magnesium sulphate compared with standard treatment is evaluated more accurately using a joint longitudinal-competing risk model by taking account of such complexities. The corresponding estimates indicate that the rate of dropout due to good prognosis is about twice as high in the magnesium group compared with standard treatment. We emphasise the importance of identifying reasons for dropout and undertaking an appropriate statistical analysis accounting for such dropout. The joint modelling approach accounting for competing reasons for dropout is proposed as a general approach for evaluating the sensitivity of conclusions to assumptions regarding missing data in clinical trials with longitudinal outcomes. EudraCT number 2007-006227-12 . Registration date 18 Mar 2008.

  3. Neurophysiological model of tinnitus: dependence of the minimal masking level on treatment outcome.

    Science.gov (United States)

    Jastreboff, P J; Hazell, J W; Graham, R L

    1994-11-01

    Validity of the neurophysiological model of tinnitus (Jastreboff, 1990), outlined in this paper, was tested on data from multicenter trial of tinnitus masking (Hazell et al., 1985). Minimal masking level, intensity match of tinnitus, and the threshold of hearing have been evaluated on a total of 382 patients before and after 6 months of treatment with maskers, hearing aids, or combination devices. The data has been divided into categories depending on treatment outcome and type of approach used. Results of analysis revealed that: i) the psychoacoustical description of tinnitus does not possess a predictive value for the outcome of the treatment; ii) minimal masking level changed significantly depending on the treatment outcome, decreasing on average by 5.3 dB in patients reporting improvement, and increasing by 4.9 dB in those whose tinnitus remained the same or worsened; iii) 73.9% of patients reporting improvement had their minimal masking level decreased as compared with 50.5% for patients not showing improvement, which is at the level of random change; iv) the type of device used has no significant impact on the treatment outcome and minimal masking level change; v) intensity match and threshold of hearing did not exhibit any significant changes which can be related to treatment outcome. These results are fully consistent with the neurophysiological interpretation of mechanisms involved in the phenomenon of tinnitus and its alleviation.

  4. Comparative Assessment of Nonlocal Continuum Solvent Models Exhibiting Overscreening

    Directory of Open Access Journals (Sweden)

    Ren Baihua

    2017-01-01

    Full Text Available Nonlocal continua have been proposed to offer a more realistic model for the electrostatic response of solutions such as the electrolyte solvents prominent in biology and electrochemistry. In this work, we review three nonlocal models based on the Landau-Ginzburg framework which have been proposed but not directly compared previously, due to different expressions of the nonlocal constitutive relationship. To understand the relationships between these models and the underlying physical insights from which they are derive, we situate these models into a single, unified Landau-Ginzburg framework. One of the models offers the capacity to interpret how temperature changes affect dielectric response, and we note that the variations with temperature are qualitatively reasonable even though predictions at ambient temperatures are not quantitatively in agreement with experiment. Two of these models correctly reproduce overscreening (oscillations between positive and negative polarization charge densities, and we observe small differences between them when we simulate the potential between parallel plates held at constant potential. These computations require reformulating the two models as coupled systems of local partial differential equations (PDEs, and we use spectral methods to discretize both problems. We propose further assessments to discriminate between the models, particularly in regards to establishing boundary conditions and comparing to explicit-solvent molecular dynamics simulations.

  5. New tips for structure prediction by comparative modeling

    Science.gov (United States)

    Rayan, Anwar

    2009-01-01

    Comparative modelling is utilized to predict the 3-dimensional conformation of a given protein (target) based on its sequence alignment to experimentally determined protein structure (template). The use of such technique is already rewarding and increasingly widespread in biological research and drug development. The accuracy of the predictions as commonly accepted depends on the score of sequence identity of the target protein to the template. To assess the relationship between sequence identity and model quality, we carried out an analysis of a set of 4753 sequence and structure alignments. Throughout this research, the model accuracy was measured by root mean square deviations of Cα atoms of the target-template structures. Surprisingly, the results show that sequence identity of the target protein to the template is not a good descriptor to predict the accuracy of the 3-D structure model. However, in a large number of cases, comparative modelling with lower sequence identity of target to template proteins led to more accurate 3-D structure model. As a consequence of this study, we suggest new tips for improving the quality of omparative models, particularly for models whose target-template sequence identity is below 50%. PMID:19255646

  6. 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

  7. A Behavioral Economic Reward Index Predicts Drinking Resolutions: Moderation Revisited and Compared with Other Outcomes

    Science.gov (United States)

    Tucker, Jalie A.; Roth, David L.; Vignolo, Mary J.; Westfall, Andrew O.

    2009-01-01

    Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes. Moderation over 1- to 2-year prospective follow-up…

  8. 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…

  9. 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…

  10. Bayesian models for comparative analysis integrating phylogenetic uncertainty

    Directory of Open Access Journals (Sweden)

    Villemereuil Pierre de

    2012-06-01

    Full Text Available Abstract Background Uncertainty in comparative analyses can come from at least two sources: a phylogenetic uncertainty in the tree topology or branch lengths, and b uncertainty due to intraspecific variation in trait values, either due to measurement error or natural individual variation. Most phylogenetic comparative methods do not account for such uncertainties. Not accounting for these sources of uncertainty leads to false perceptions of precision (confidence intervals will be too narrow and inflated significance in hypothesis testing (e.g. p-values will be too small. Although there is some application-specific software for fitting Bayesian models accounting for phylogenetic error, more general and flexible software is desirable. Methods We developed models to directly incorporate phylogenetic uncertainty into a range of analyses that biologists commonly perform, using a Bayesian framework and Markov Chain Monte Carlo analyses. Results We demonstrate applications in linear regression, quantification of phylogenetic signal, and measurement error models. Phylogenetic uncertainty was incorporated by applying a prior distribution for the phylogeny, where this distribution consisted of the posterior tree sets from Bayesian phylogenetic tree estimation programs. The models were analysed using simulated data sets, and applied to a real data set on plant traits, from rainforest plant species in Northern Australia. Analyses were performed using the free and open source software OpenBUGS and JAGS. Conclusions Incorporating phylogenetic uncertainty through an empirical prior distribution of trees leads to more precise estimation of regression model parameters than using a single consensus tree and enables a more realistic estimation of confidence intervals. In addition, models incorporating measurement errors and/or individual variation, in one or both variables, are easily formulated in the Bayesian framework. We show that BUGS is a useful, flexible

  11. Bayesian models for comparative analysis integrating phylogenetic uncertainty

    Science.gov (United States)

    2012-01-01

    Background Uncertainty in comparative analyses can come from at least two sources: a) phylogenetic uncertainty in the tree topology or branch lengths, and b) uncertainty due to intraspecific variation in trait values, either due to measurement error or natural individual variation. Most phylogenetic comparative methods do not account for such uncertainties. Not accounting for these sources of uncertainty leads to false perceptions of precision (confidence intervals will be too narrow) and inflated significance in hypothesis testing (e.g. p-values will be too small). Although there is some application-specific software for fitting Bayesian models accounting for phylogenetic error, more general and flexible software is desirable. Methods We developed models to directly incorporate phylogenetic uncertainty into a range of analyses that biologists commonly perform, using a Bayesian framework and Markov Chain Monte Carlo analyses. Results We demonstrate applications in linear regression, quantification of phylogenetic signal, and measurement error models. Phylogenetic uncertainty was incorporated by applying a prior distribution for the phylogeny, where this distribution consisted of the posterior tree sets from Bayesian phylogenetic tree estimation programs. The models were analysed using simulated data sets, and applied to a real data set on plant traits, from rainforest plant species in Northern Australia. Analyses were performed using the free and open source software OpenBUGS and JAGS. Conclusions Incorporating phylogenetic uncertainty through an empirical prior distribution of trees leads to more precise estimation of regression model parameters than using a single consensus tree and enables a more realistic estimation of confidence intervals. In addition, models incorporating measurement errors and/or individual variation, in one or both variables, are easily formulated in the Bayesian framework. We show that BUGS is a useful, flexible general purpose tool for

  12. Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients.

    Science.gov (United States)

    Detering, Karen Margaret; Carter, Rachel Zoe; Sellars, Marcus William; Lewis, Virginia; Sutton, Elizabeth Anne

    2017-12-01

    Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period. This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs). 30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client's files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion. While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Exploring the Contribution of Professional Staff to Student Outcomes: A Comparative Study of Australian and UK Case Studies

    Science.gov (United States)

    Graham, Carroll; Regan, Julie-Anne

    2016-01-01

    This paper reports on the second stage of a comparative study between two higher education institutions: one in Australia and the other in the United Kingdom, which explored the contributions of professional staff to student outcomes. The first stage acted as a scoping exercise to ascertain how the contributions of professional staff to student…

  14. A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine Hagedorn in type 1 diabetes

    DEFF Research Database (Denmark)

    Hod, Moshe; Mathiesen, Elisabeth R; Jovanovič, Lois

    2014-01-01

    OBJECTIVE: This randomized controlled trial aimed to compare the efficacy and safety of insulin detemir (IDet) with neutral protamine Hagedorn (NPH), both with insulin aspart, in pregnant women with type 1 diabetes. The perinatal and obstetric pregnancy outcomes are presented. METHODS: Subjects w...

  15. 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…

  16. Image based 3D city modeling : Comparative study

    Directory of Open Access Journals (Sweden)

    S. P. Singh

    2014-06-01

    Full Text Available 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

  17. Comparing several boson mappings with the shell model

    International Nuclear Information System (INIS)

    Menezes, D.P.; Yoshinaga, Naotaka; Bonatsos, D.

    1990-01-01

    Boson mappings are an essential step in establishing a connection between the successful phenomenological interacting boson model and the shell model. The boson mapping developed by Bonatsos, Klein and Li is applied to a single j-shell and the resulting energy levels and E2 transitions are shown for a pairing plus quadrupole-quadrupole Hamiltonian. The results are compared to the exact shell model calculation, as well as to these obtained through use of the Otsuka-Arima-Iachello mapping and the Zirnbauer-Brink mapping. In all cases good results are obtained for the spherical and near-vibrational cases

  18. Stakeholder Perceptions, Learning Opportunities, and Student Outcomes in Three Clinical Learning Models.

    Science.gov (United States)

    Hendricks, Susan; DeMeester, Deborah; Stephenson, Evelyn; Welch, Janet

    2016-05-01

    Understanding the strengths and challenges of various clinical models is important for nursing education. Three long-standing clinical models (preceptored, hybrid, and traditional) were compared on several outcome measures related to satisfaction, learning opportunities, and student outcomes. Students, faculty, and preceptors participated in this study. Although no differences were noted in satisfaction or standardized examination scores, students in the preceptored clinical model were able to practice more psychomotor skills. Although participants in the preceptored model reported spending more time communicating with staff nurses than did those in the other models, students in the traditional model spent more time with faculty. No differences were noted among groups in student clinical observation time. All clinical learning models were focused on how clinical time was structured, without an emphasis on how faculty and preceptors work with students to develop nursing clinical reasoning skills. Identifying methodology to impact thinking in the clinical environment is a key next step. [J Nurs Educ. 2016;55(5):271-277.]. Copyright 2016, SLACK Incorporated.

  19. Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer.

    Science.gov (United States)

    Fischer, C; Lingsma, H; Hardwick, R; Cromwell, D A; Steyerberg, E; Groene, O

    2016-01-01

    Outcomes for oesophagogastric cancer surgery are compared with the aim of benchmarking quality of care. Adjusting for patient characteristics is crucial to avoid biased comparisons between providers. The study objective was to develop a case-mix adjustment model for comparing 30- and 90-day mortality and anastomotic leakage rates after oesophagogastric cancer resections. The study reviewed existing models, considered expert opinion and examined audit data in order to select predictors that were consequently used to develop a case-mix adjustment model for the National Oesophago-Gastric Cancer Audit, covering England and Wales. Models were developed on patients undergoing surgical resection between April 2011 and March 2013 using logistic regression. Model calibration and discrimination was quantified using a bootstrap procedure. Most existing risk models for oesophagogastric resections were methodologically weak, outdated or based on detailed laboratory data that are not generally available. In 4882 patients with oesophagogastric cancer used for model development, 30- and 90-day mortality rates were 2·3 and 4·4 per cent respectively, and 6·2 per cent of patients developed an anastomotic leak. The internally validated models, based on predictors selected from the literature, showed moderate discrimination (area under the receiver operating characteristic (ROC) curve 0·646 for 30-day mortality, 0·664 for 90-day mortality and 0·587 for anastomotic leakage) and good calibration. Based on available data, three case-mix adjustment models for postoperative outcomes in patients undergoing curative surgery for oesophagogastric cancer were developed. These models should be used for risk adjustment when assessing hospital performance in the National Health Service, and tested in other large health systems. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. Towards consensus in comparative chemical characterization modeling for LCIA

    DEFF Research Database (Denmark)

    Hauschild, Michael Zwicky; Bachmann, Till; Huijbregts, Mark

    2006-01-01

    work within, for instance, the OECD, and guidance from a series of expert workshops held between 2002 and 2005, preliminary guidelines focusing on chemical fate, and human and ecotoxic effects were established. For further elaboration of the fate-, exposure- and effect-sides of the modeling, six models...... by the Task Force and the model providers. While the compared models and their differences are important tools to further advance LCA science, the consensus model is intended to provide a generally agreed and scientifically sound method to calculate consistent characterization factors for use in LCA practice...... and to be the basis of the “recommended practice” for calculation of characterization factors for chemicals under authority of the UNEP/SETAC Life Cycle Initiative....

  1. Mediation Analysis with Survival Outcomes: Accelerated Failure Time vs. Proportional Hazards Models

    Science.gov (United States)

    Gelfand, Lois A.; MacKinnon, David P.; DeRubeis, Robert J.; Baraldi, Amanda N.

    2016-01-01

    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. PMID:27065906

  2. Comparing survival outcomes of gross total resection and subtotal resection with radiotherapy for craniopharyngioma: a meta-analysis.

    Science.gov (United States)

    Wang, Guoqing; Zhang, Xiaoyang; Feng, Mengzhao; Guo, Fuyou

    2018-06-01

    Recent studies suggest that subtotal resection (STR) followed by radiation therapy (RT) is an appealing alternative to gross total resection (GTR) for craniopharyngioma, but it remains controversial. We conducted a meta-analysis to determine whether GTR is superior to STR with RT for craniopharyngioma. A systematic search was performed for articles published until October 2017 in the PubMed, Embase, and Cochrane Central databases. The endpoints of interest are overall survival and progression-free survival. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using a fixed or random-effects model. The data were analyzed using Review Manager 5.3 software. A total of 744 patients (seven cohort studies) were enrolled for analyses. There were no significant differences between the GTR and STR with RT groups when the authors compared the pooled HRs at the end of the follow-up period. Overall survival (pooled HR = 0.76, 95% CI: 0.46-1.25, P = 0.28) and progression-free survival (pooled HR = 1.52, 95% CI: 0.42-5.44, P = 0.52) were similar between the two groups. The current meta-analysis suggests that GTR and STR with RT have the similar survival outcomes for craniopharyngioma. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. 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 M....... 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.......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...

  4. A framework for testing and comparing binaural models.

    Science.gov (United States)

    Dietz, Mathias; Lestang, Jean-Hugues; Majdak, Piotr; Stern, Richard M; Marquardt, Torsten; Ewert, Stephan D; Hartmann, William M; Goodman, Dan F M

    2018-03-01

    Auditory research has a rich history of combining experimental evidence with computational simulations of auditory processing in order to deepen our theoretical understanding of how sound is processed in the ears and in the brain. Despite significant progress in the amount of detail and breadth covered by auditory models, for many components of the auditory pathway there are still different model approaches that are often not equivalent but rather in conflict with each other. Similarly, some experimental studies yield conflicting results which has led to controversies. This can be best resolved by a systematic comparison of multiple experimental data sets and model approaches. Binaural processing is a prominent example of how the development of quantitative theories can advance our understanding of the phenomena, but there remain several unresolved questions for which competing model approaches exist. This article discusses a number of current unresolved or disputed issues in binaural modelling, as well as some of the significant challenges in comparing binaural models with each other and with the experimental data. We introduce an auditory model framework, which we believe can become a useful infrastructure for resolving some of the current controversies. It operates models over the same paradigms that are used experimentally. The core of the proposed framework is an interface that connects three components irrespective of their underlying programming language: The experiment software, an auditory pathway model, and task-dependent decision stages called artificial observers that provide the same output format as the test subject. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. EFFECTS OF INQUIRY TRAINING LEARNING MODEL BASED MULTIMEDIA AND MOTIVATION OF PHYSICS STUDENT LEARNING OUTCOMES

    OpenAIRE

    Hayati .; Retno Dwi Suyanti

    2013-01-01

    The objective in this research: (1) Determine a better learning model to improve learning outcomes physics students among learning model Inquiry Training based multimedia and Inquiry Training learning model. (2) Determine the level of motivation to learn in affects physics student learning outcomes. (3) Knowing the interactions between the model of learning and motivation in influencing student learning outcomes. This research is a quasi experimental. The population in this research was all s...

  6. Outcome and safety analysis of 3D printed patient specific pedicle screw jigs for complex spinal deformities: A comparative study.

    Science.gov (United States)

    Garg, Bhavuk; Gupta, Manish; Singh, Menaka; Kalyanasundaram, Dinesh

    2018-05-03

    Spinal deformities are very challenging to treat and have a great risk of neurological complications due to hardware placement during corrective surgery. Various techniques have been introduced to ensure safe and accurate placement of pedicle screws. Patient-specific screw guides with pre-drawn and pre-validated trajectory seems to be an attractive option. We have focused on developing 3D printing technique for complex spinal deformities in India. This study also aimed to compare the placement of pedicle screw with 3D printing and free hand technique. This is a retrospective comparative clinical study at an academic institutional setting. A total of 20 patients were enrolled during the study, 10 were operated with the help of 3D printing (group 1) and 10 were operated with freehand technique (group 2). Group 1 included 6 congenital, 3 adolescent idiopathic scoliosis (AIS), one post tubercular kyphosis and Group 2 included 5 congenital, 4 AIS and one post tubercular kyphosis patient. Primary outcomes were measured in terms of screw violation and secondary outcome were measured in terms of Surgical time, Blood loss, Radiation exposure (no. of shoots required) and complications. MIMICS v18.0 Software was used for 3D reconstruction from CT scan images of all the patients. 3-Matic software was used to create drill guide. 3-D printer from Stratasys Mojo ABS P 430 model material cartilage (a thermoplastic material) was used for printing of vertebrae model and jigs. Two sample test of proportion was used to compare correctly and wrongly pedicle screw placement with 3D printing and freehand technique. T-test with equal variance was used for operating surgical time and blood loss. This work was carried out by collaboration of Orthopaedics Department, All India Institute of Medical Sciences (AIIMS), New Delhi and Biomedical Engineering Department, Indian Institute of Technology (IIT) Delhi. This project received the grant of USD 60000 from Department of Biotechnology (DBT

  7. Increasing uptake of comparative effectiveness and patient-centered outcomes research among stakeholders: insights from conference discussion.

    Science.gov (United States)

    Law, Ernest; Harrington, Rachel; Alexander, G Caleb; Saha, Soumi; Oehrlein, Elisabeth; Perfetto, Eleanor M

    2018-02-01

    The goal of comparative effectiveness research (CER) and patient-centered outcomes research (PCOR) is to improve health outcomes by providing stakeholders with evidence directly relevant to decision making. In January 2017, the Pharmaceutical Research and Manufacturers Association Foundation, alongside the Academy for Managed Care Pharmacy, organized a conference aimed at engaging experts and opinion leaders representing clinicians, patients and payers to identify and discuss barriers and strategies to enhancing uptake and use of CER/PCOR. This report summarizes the conference discussion in the following sections: preconference survey; summary of barriers and strategies to the uptake of CER/PCOR identified by conference attendees; and future perspectives on the field.

  8. 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.

  9. Comparative analysis of whole mount processing and systematic sampling of radical prostatectomy specimens: pathological outcomes and risk of biochemical recurrence.

    Science.gov (United States)

    Salem, Shady; Chang, Sam S; Clark, Peter E; Davis, Rodney; Herrell, S Duke; Kordan, Yakup; Wills, Marcia L; Shappell, Scott B; Baumgartner, Roxelyn; Phillips, Sharon; Smith, Joseph A; Cookson, Michael S; Barocas, Daniel A

    2010-10-01

    Whole mount processing is more resource intensive than routine systematic sampling of radical retropubic prostatectomy specimens. We compared whole mount and systematic sampling for detecting pathological outcomes, and compared the prognostic value of pathological findings across pathological methods. We included men (608 whole mount and 525 systematic sampling samples) with no prior treatment who underwent radical retropubic prostatectomy at Vanderbilt University Medical Center between January 2000 and June 2008. We used univariate and multivariate analysis to compare the pathological outcome detection rate between pathological methods. Kaplan-Meier curves and the log rank test were used to compare the prognostic value of pathological findings across pathological methods. There were no significant differences between the whole mount and the systematic sampling groups in detecting extraprostatic extension (25% vs 30%), positive surgical margins (31% vs 31%), pathological Gleason score less than 7 (49% vs 43%), 7 (39% vs 43%) or greater than 7 (12% vs 13%), seminal vesicle invasion (8% vs 10%) or lymph node involvement (3% vs 5%). Tumor volume was higher in the systematic sampling group and whole mount detected more multiple surgical margins (each p systematic sampling yield similar pathological information. Each method stratifies patients into comparable risk groups for biochemical recurrence. Thus, while whole mount is more resource intensive, it does not appear to result in improved detection of clinically important pathological outcomes or prognostication. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. 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. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  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. Comparative effectiveness studies examining patient-reported outcomes among children with cleft lip and/or palate: a systematic review.

    Science.gov (United States)

    Ranganathan, Kavitha; Vercler, Christian J; Warschausky, Seth A; MacEachern, Mark P; Buchman, Steven R; Waljee, Jennifer F

    2015-01-01

    Health care policy makers are increasingly encouraging comparative effectiveness research. Little is known regarding comparative studies among children with cleft lip and/or palate. Cleft lip and/or palate profoundly influences self-perception and social functioning, and patient-reported outcomes provide a unique perspective on the success of reconstruction. The purpose of this study was to systematically review the literature regarding patient-reported outcomes among patients with cleft lip and/or palate. The authors reviewed articles from MEDLINE, Embase, and PsycInfo that examined the use of patient-reported outcome instruments for cleft lip and/or palate. Studies of patients with cleft lip and/or palate across any age that described the use of patient-completed measures in patient and control populations were included. A research librarian confirmed the search, and two independent, blinded reviewers performed full-text review. The authors identified 1979 articles and selected 30 for inclusion. Forty-two different assessment tools were used to analyze factors such as self-esteem, behavior, and social support. The Strengths and Difficulties Questionnaire was most commonly used (n = 7), followed by the Childhood Experience Questionnaire (n = 5), and the Satisfaction with Appearance survey (n = 4). Barriers to analysis included lack of standardization of survey administration, effect of publication bias, and variations in patient populations between individual studies. Comparative studies of patient-reported outcomes among patients with cleft lip and/or palate are infrequent. Many instruments exist to measure patient-reported outcomes in this population, but no specific standard exists. Identifying efficient and targeted forms of instrument selection and administration will enhance comparative studies among children with cleft lip and/or palate. Diagnostic, III.

  13. The Effect of Group Investigation Learning Model with Brainstroming Technique on Students Learning Outcomes

    Directory of Open Access Journals (Sweden)

    Astiti Kade kAyu

    2018-01-01

    Full Text Available This study aims to determine the effect of group investigation (GI learning model with brainstorming technique on student physics learning outcomes (PLO compared to jigsaw learning model with brainstroming technique. The learning outcome in this research are the results of learning in the cognitive domain. The method used in this research is experiment with Randomised Postest Only Control Group Design. Population in this research is all students of class XI IPA SMA Negeri 9 Kupang year lesson 2015/2016. The selected sample are 40 students of class XI IPA 1 as the experimental class and 38 students of class XI IPA 2 as the control class using simple random sampling technique. The instrument used is 13 items description test. The first hypothesis was tested by using two tailed t-test. From that, it is obtained that H0 rejected which means there are differences of students physics learning outcome. The second hypothesis was tested using one tailed t-test. It is obtained that H0 rejected which means the students PLO in experiment class were higher than control class. Based on the results of this study, researchers recommend the use of GI learning models with brainstorming techniques to improve PLO, especially in the cognitive domain.

  14. Spatial Distribution of Hydrologic Ecosystem Service Estimates: Comparing Two Models

    Science.gov (United States)

    Dennedy-Frank, P. J.; Ghile, Y.; Gorelick, S.; Logsdon, R. A.; Chaubey, I.; Ziv, G.

    2014-12-01

    We compare estimates of the spatial distribution of water quantity provided (annual water yield) from two ecohydrologic models: the widely-used Soil and Water Assessment Tool (SWAT) and the much simpler water models from the Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) toolbox. These two models differ significantly in terms of complexity, timescale of operation, effort, and data required for calibration, and so are often used in different management contexts. We compare two study sites in the US: the Wildcat Creek Watershed (2083 km2) in Indiana, a largely agricultural watershed in a cold aseasonal climate, and the Upper Upatoi Creek Watershed (876 km2) in Georgia, a mostly forested watershed in a temperate aseasonal climate. We evaluate (1) quantitative estimates of water yield to explore how well each model represents this process, and (2) ranked estimates of water yield to indicate how useful the models are for management purposes where other social and financial factors may play significant roles. The SWAT and InVEST models provide very similar estimates of the water yield of individual subbasins in the Wildcat Creek Watershed (Pearson r = 0.92, slope = 0.89), and a similar ranking of the relative water yield of those subbasins (Spearman r = 0.86). However, the two models provide relatively different estimates of the water yield of individual subbasins in the Upper Upatoi Watershed (Pearson r = 0.25, slope = 0.14), and very different ranking of the relative water yield of those subbasins (Spearman r = -0.10). The Upper Upatoi watershed has a significant baseflow contribution due to its sandy, well-drained soils. InVEST's simple seasonality terms, which assume no change in storage over the time of the model run, may not accurately estimate water yield processes when baseflow provides such a strong contribution. Our results suggest that InVEST users take care in situations where storage changes are significant.

  15. 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.

  16. COMPARATIVE ANALYSIS OF TREATMENT OUTCOMES IN PATIENTS WITH TYPES B AND C PYLON FRACTURES

    Directory of Open Access Journals (Sweden)

    V. V. Khominets

    2017-01-01

    Full Text Available Objective — to develop and implement improved approaches to the diagnosis and tactics of surgical treatment in patients with fractures of the distal tibia metaepiphysis.Material and methods. The study included 126 patients with fractures of distal tibia metaepiphysis of «B» and «C» types who underwent internal fixation with plates in 2005–2012. The authors analyzed surgical treatment outcomes within the period from 2.5 to 9 years (average of 5.7–2.3 years of postoperative follow up. Average age of patients was 23.4±2.1 years. Patients were divided into the main group (64 patients and the comparison group (62 patients. In the comparison group, traditional approaches to diagnosis and surgical treatment were used, including standard clinical examination and X-rays of the affected ankle in two views and the median access to the distal tibia metaepiphysis. In the main group, a specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program. Clinical and functional data were assessed by Foot and Ankle Outcome Score (FAOS and SF-36 Health Survey. Roentgenological assessment was done by X-rays and CT scans. Statistical significance of the differences was evaluated by Wald-Wolfowitz and Fisher tests.Results. Improved approaches to the tactics of surgical treatment in patients with pylon fractures of «B» and «C» types allowed to reduce the incidence of unsatisfactory anatomical and functional outcomes from 43.5% to 28.1%. The number of satisfactory and good outcomes increased by 4.7% and 10.7% respectively after application of improved therapeutic and diagnostic approaches.Conclusion. Proposed improved approaches to verification of severe intraarticular fractures of the distal tibia metabiphysis allowed to increase the informative value of the diagnostic procedures and to avoid discrepancies between preand intraoperative assessment of fracture type by classifications of M

  17. Comparative modeling of InP solar cell structures

    Science.gov (United States)

    Jain, R. K.; Weinberg, I.; Flood, D. J.

    1991-01-01

    The comparative modeling of p(+)n and n(+)p indium phosphide solar cell structures is studied using a numerical program PC-1D. The optimal design study has predicted that the p(+)n structure offers improved cell efficiencies as compared to n(+)p structure, due to higher open-circuit voltage. The various cell material and process parameters to achieve the maximum cell efficiencies are reported. The effect of some of the cell parameters on InP cell I-V characteristics was studied. The available radiation resistance data on n(+)p and p(+)p InP solar cells are also critically discussed.

  18. Comparative effects of meditation and exercise on physical and psychosocial health outcomes: a review of randomized controlled trials.

    Science.gov (United States)

    Edwards, Meghan K; Loprinzi, Paul D

    2018-03-01

    No review papers have examined studies that have directly compared non-active forms of meditation with exercise to evaluate effects on physical or psychosocial outcomes, which was the purpose of this paper. Studies were included if they had a randomized controlled trial (RCT) design, included a non-active form of meditation and exercise as intervention arms, and evaluated physical or psychosocial outcomes. The quality of included RCTs was rated using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials. Five RCTs met the inclusion criteria. The total sample size across all studies was N = 325. Of the main outcomes assessed across the five studies, meditation was shown to be more effective than the exercise comparison arm when evaluating the psychosocial outcomes of anxiety, altruism, and life changes. Additionally, meditation was more effective at reducing chronic neck pain at rest and pain-related bothersomeness. Exercise, however, was more effective in improving physical health-related quality of life, HDL and LDL cholesterol, and fasting blood glucose levels. The interventions were found to be comparable when evaluating the outcomes of well-being, ethanol consumption, and perceived stress levels. Four of the evaluated studies were determined to have an overall 'unclear' risk of bias and one study was found to have a 'high' risk of bias. Exercise and non-active meditation may uniquely influence various health-related outcomes. A continued exploration of the effects of exercise and non-active meditation in controlled trials may yield a better understanding of their benefits.

  19. Comparative Outcomes of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use.

    Science.gov (United States)

    Dagher, Jehane H; Costa, Camille; Lamoureux, Julie; de Guise, Elaine; Feyz, Mitra

    2016-01-01

    To determine if health outcomes and demographics differ according to helmet status between persons with cycling-related traumatic brain injuries (TBI). This is a retrospective study of 128 patients admitted to the Montreal General Hospital following a TBI that occurred while cycling from 2007-2011. Information was collected from the Quebec trauma registry and the coroner's office in cases of death from cycling accidents. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated were length of stay (LOS), extended Glasgow outcome scale (GOS-E), injury severity scale (ISS), discharge destination and death. 25% of cyclists wore a helmet. The helmet group was older, more likely to be university educated, married and retired. Unemployment, longer intensive care unit (ICU) stay, severe intracranial bleeding and neurosurgical interventions were more common in the no helmet group. There was no significant association between the severity of the TBI, ISS scores, GOS-E or death and helmet wearing. The median age of the subjects who died was higher than those who survived. Cyclists without helmets were younger, less educated, single and unemployed. They had more severe TBIs on imaging, longer LOS in ICU and more neurosurgical interventions. Elderly cyclists admitted to the hospital appear to be at higher risk of dying in the event of a TBI.

  20. Euthyroid sick syndrome in head injury patients compared with Glasgow Coma and Outcome Scales

    International Nuclear Information System (INIS)

    Palugniok, R.; Kochanska-Dziurowicz, A.A.

    2000-01-01

    Background: Evaluation of the role of euthyroid sick syndrome and pituitary gland hormonal changes and the prognosis of patient mortality after severe brain injury. METHODS: The research was conducted on 65 patients with isolated severe brain injury. Blood samples were obtained as soon as possible after the injury and on the 1st, 2nd, 3rd, 5th and 7th day after the injury. Blood concentrations of T3, rT3, T4, FT4, TSH, and PRL were estimated. The patients' state of health was evaluated in the sixth hour after the injury, using Glasgow Coma Scale, and after 180 days, using the Glasgow Outcome Scale. Multidirectional correlation was sought between the concentrations of the estimated hormones and the score obtained in the Glasgow Coma Scale and Glasgow Outcome Scale. RESULTS: Cluster analysis showed that concentrations of the hormones in the patients who died are grouped in different clusters from those in the patients who survived. This proves that hormonal patterns are different in these groups. Statistically significant lower T3 concentrations were observed on the 3rd day in comparison with the 0 day. Cumulative proportion surviving was lower for the OP group in comparison with the NOP group and amounted to 0.57. CONCLUSIONS: In all patients covered by the research euthyroid sick syndrome was diagnosed. T3 concentration on the 3rd day after the injury together with the evaluation in Glasgow Coma Scale allows for more precise prognosis. (author)

  1. 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.)

  2. Elastic models: a comparative study applied to retinal images.

    Science.gov (United States)

    Karali, E; Lambropoulou, S; Koutsouris, D

    2011-01-01

    In this work various methods of parametric elastic models are compared, namely the classical snake, the gradient vector field snake (GVF snake) and the topology-adaptive snake (t-snake), as well as the method of self-affine mapping system as an alternative to elastic models. We also give a brief overview of the methods used. The self-affine mapping system is implemented using an adapting scheme and minimum distance as optimization criterion, which is more suitable for weak edges detection. All methods are applied to glaucomatic retinal images with the purpose of segmenting the optical disk. The methods are compared in terms of segmentation accuracy and speed, as these are derived from cross-correlation coefficients between real and algorithm extracted contours and segmentation time, respectively. As a result, the method of self-affine mapping system presents adequate segmentation time and segmentation accuracy, and significant independence from initialization.

  3. Long-term outcome of lobar ablation in differentiated thyroid cancer (DTC): a comparative study with patients of completion thyroidectomy

    International Nuclear Information System (INIS)

    Santra, Amburanjan; Maharjan, S.; Bal, C.

    2010-01-01

    Full text: Completion thyroidectomy (CT) is usually recommended after partial surgery in patients with differentiated thyroid cancer. Radioiodine lobar ablation (RAILA) is an easy alternative and avoids complications that might be associated with re-surgery. But its effectiveness in terms of long-term outcome and recurrence free survival is yet to be established. This study was aimed to compare long term outcome of RAILA with that of completion thyroidectomy. Materials and Methods: A retrospective analysis was done from the case records of patients treated in our thyroid clinic for last 25 years. Records of all patients of RAILA (364) and CT (372) were analyzed. Complete ablation rate, cumulative dose needed for complete ablation, Recurrence rate and recurrence free survival was estimated in each group. Comparison was made between two groups by statistical method. Results: There was 73% ablation rate at 1st dose of RAILA itself. Second dose in LA and first dose of remnant ablation after CT is comparable (92% and 93% respectively). Cumulative dose to achieve 100% ablation rate is more for RAILA group. Seven patients developed recurrence in RAILA group, compared to 14 in CT group. No statistically significant difference was noted between recurrence rate and recurrence free survival between two groups. Conclusion: Radioiodine Lobar ablation is a safe, effective and less costly alternative to completion thyroidectomy in patients with differentiated thyroid cancer with comparable long term outcome like recurrence rate and recurrence free survival

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

    DEFF Research Database (Denmark)

    Tina, Giuseppe; Ventura, Cristina; Sera, Dezso

    2017-01-01

    . 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...... the performance of the studied PV plants with others, the efficiency of the systems has been estimated by both conventional Performance Ratio and Corrected Performance Ratio...

  5. New tips for structure prediction by comparative modeling

    OpenAIRE

    Rayan, Anwar

    2009-01-01

    Comparative modelling is utilized to predict the 3-dimensional conformation of a given protein (target) based on its sequence alignment to experimentally determined protein structure (template). The use of such technique is already rewarding and increasingly widespread in biological research and drug development. The accuracy of the predictions as commonly accepted depends on the score of sequence identity of the target protein to the template. To assess the relationship between sequence iden...

  6. Comparing Neural Networks and ARMA Models in Artificial Stock Market

    Czech Academy of Sciences Publication Activity Database

    Krtek, Jiří; Vošvrda, Miloslav

    2011-01-01

    Roč. 18, č. 28 (2011), s. 53-65 ISSN 1212-074X R&D Projects: GA ČR GD402/09/H045 Institutional research plan: CEZ:AV0Z10750506 Keywords : neural networks * vector ARMA * artificial market Subject RIV: AH - Economics http://library.utia.cas.cz/separaty/2011/E/krtek-comparing neural networks and arma models in artificial stock market.pdf

  7. 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 (phand hygiene 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

  8. 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

    2017-09-06

    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 self-select 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 and -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% versus 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 with 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 the absence of other improved outcomes.

  9. 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.

  10. 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.

  11. 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

  12. Knowledge Modeling for the Outcome of Brain Stereotactic Radiosurgery

    Science.gov (United States)

    Hauck, Jillian E.

    Purpose: To build a model that will predict the survival time for patients that were treated with stereotactic radiosurgery for brain metastases using support vector machine (SVM) regression. Methods and Materials: This study utilized data from 481 patients, which were equally divided into training and validation datasets randomly. The SVM model used a Gaussian RBF function, along with various parameters, such as the size of the epsilon insensitive region and the cost parameter (C) that are used to control the amount of error tolerated by the model. The predictor variables for the SVM model consisted of the actual survival time of the patient, the number of brain metastases, the graded prognostic assessment (GPA) and Karnofsky Performance Scale (KPS) scores, prescription dose, and the largest planning target volume (PTV). The response of the model is the survival time of the patient. The resulting survival time predictions were analyzed against the actual survival times by single parameter classification and two-parameter classification. The predicted mean survival times within each classification were compared with the actual values to obtain the confidence interval associated with the model's predictions. In addition to visualizing the data on plots using the means and error bars, the correlation coefficients between the actual and predicted means of the survival times were calculated during each step of the classification. Results: The number of metastases and KPS scores, were consistently shown to be the strongest predictors in the single parameter classification, and were subsequently used as first classifiers in the two-parameter classification. When the survival times were analyzed with the number of metastases as the first classifier, the best correlation was obtained for patients with 3 metastases, while patients with 4 or 5 metastases had significantly worse results. When the KPS score was used as the first classifier, patients with a KPS score of 60 and

  13. A comparative study of the constitutive models for silicon carbide

    Science.gov (United States)

    Ding, Jow-Lian; Dwivedi, Sunil; Gupta, Yogendra

    2001-06-01

    Most of the constitutive models for polycrystalline silicon carbide were developed and evaluated using data from either normal plate impact or Hopkinson bar experiments. At ISP, extensive efforts have been made to gain detailed insight into the shocked state of the silicon carbide (SiC) using innovative experimental methods, viz., lateral stress measurements, in-material unloading measurements, and combined compression shear experiments. The data obtained from these experiments provide some unique information for both developing and evaluating material models. In this study, these data for SiC were first used to evaluate some of the existing models to identify their strength and possible deficiencies. Motivated by both the results of this comparative study and the experimental observations, an improved phenomenological model was developed. The model incorporates pressure dependence of strength, rate sensitivity, damage evolution under both tension and compression, pressure confinement effect on damage evolution, stiffness degradation due to damage, and pressure dependence of stiffness. The model developments are able to capture most of the material features observed experimentally, but more work is needed to better match the experimental data quantitatively.

  14. Outcomes of Single-Incision Laparoscopic Surgery for Colon Cancer: A Case-Matched Comparative Study

    Directory of Open Access Journals (Sweden)

    Atthaphorn Trakarnsanga

    2016-03-01

    Full Text Available Background: Single-incisionlaparoscopiccolectomy(SILC isanevolvingtechnique withpotentialadvantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purposeof thisstudy wastocomparetheshort-termoutcomesbetweenSILC,hand-assistedlaparoscopiccolectomy (HALC andstandard multi-port laparoscopic colectomy (MLC. Methods: Retrospectiveanalysesofatotalof90patientsbetweenMay2010and December2011, whounderwent SILC for coloncancer surgery, wereperformedin30patients. Clinicopathologicalparameters were matched1:1 withpatients whounderwent HALC (n=30andMLC (n=30.Short-term outcomes werecollectedandanalyzed. Results: Operativetime wassignificantlyshorter inSILC comparedto HALC andMLC (p<0.001,as wellasless estimatedbloodloss (p=0.02. There werenosignificantdifferences inconversionrateandnumberofharvested lymphnodes.SILChadtheadvantageofless24-hrpostoperativepainscorecomparedtoHALCandMLC(p<0.001, whereas length of stayandtime to full diet werenotdifferent. Conclusion: Inselectedpatients,SILC canbesuccessfullyandsafelyperformed withshorteroperativetime, less estimated blood loss andless postoperativepainscore.

  15. Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

    Science.gov (United States)

    Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

    Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems

  16. Choosing Important Health Outcomes for Comparative Effectiveness Research: An Updated Review and Identification of Gaps.

    Science.gov (United States)

    Gorst, Sarah L; Gargon, Elizabeth; Clarke, Mike; Smith, Valerie; Williamson, Paula R

    2016-01-01

    The COMET (Core Outcome Measures in Effectiveness Trials) Initiative promotes the development and application of core outcome sets (COS), including relevant studies in an online database. In order to keep the database current, an annual search of the literature is undertaken. This study aimed to update a previous systematic review, in order to identify any further studies where a COS has been developed. Furthermore, no prioritization for COS development has previously been undertaken, therefore this study also aimed to identify COS relevant to the world's most prevalent health conditions. The methods used in this updated review followed the same approach used in the original review and the previous update. A survey was also sent to the corresponding authors of COS identified for inclusion in this review, to ascertain what lessons they had learnt from developing their COS. Additionally, the COMET database was searched to identify COS that might be relevant to the conditions with the highest global prevalence. Twenty-five reports relating to 22 new studies were eligible for inclusion in the review. Further improvements were identified in relation to the description of the scope of the COS, use of the Delphi technique, and the inclusion of patient participants within the development process. Additionally, 33 published and ongoing COS were identified for 13 of the world's most prevalent conditions. The development of a reporting guideline and minimum standards should contribute towards future improvements in development and reporting of COS. This study has also described a first approach to identifying gaps in existing COS, and to priority setting in this area. Important gaps have been identified, on the basis of global burden of disease, and the development and application of COS in these areas should be considered a priority.

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

    International Nuclear Information System (INIS)

    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. (paper)

  18. Workplace Bullying and Employee Outcomes: A Moderated Mediated Model

    OpenAIRE

    Sheehan, M.; McCabe, T J.; Garavan, Thomas.

    2018-01-01

    This paper investigates the relationship between workplace bullying and employee outcomes in a healthcare setting. Drawing on HR process theory, we investigate the mediating role of the perceived effectiveness of implementation of anti-bullying practices on employee outcomes and whether targeted line manager training was a moderator of that relationship. Our multi-level analysis (utilising responses from 1,507 employees within forty-seven hospitals with matched HR Director interviews), finds ...

  19. 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.

  20. A Randomized Study Comparing Outcomes of Stapled and Hand-Sutured Anastomoses in Patients Undergoing Open Gastrointestinal Surgery

    OpenAIRE

    Chandramohan, S. M.; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L.; Waggoner, Jason R.; Tatla, Daljit

    2012-01-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospectiv...

  1. Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS

    OpenAIRE

    Wu, Ching-Feng; Gonzalez-Rivas, Diego; Wen, Chih-Tsung; Liu, Yun-Hen; Wu, Yi-Cheng; Chao, Yin-Kai; Hsieh, Ming-Ju; Wu, Ching-Yang; Chen, Wei-Hsun

    2015-01-01

    Abstract Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome. We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received st...

  2. Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies?

    Science.gov (United States)

    Abraham, George P; Das, Krishanu; Ramaswami, Krishnamohan; Siddaiah, Avinash T; George, Datson P; Abraham, Jisha J; Thampan, Oppukeril S

    2012-05-01

    To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2). The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared. Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42). The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Post-term surveillance and birth outcomes in South Asian-born compared with Australian-born women.

    Science.gov (United States)

    Yim, C; Wong, L; Cabalag, C; Wallace, E M; Davies-Tuck, M

    2017-02-01

    To determine if apparently healthy post-term South Asian-born (SA) women were more likely to have abnormal post-term fetal surveillance than Australian- and New Zealand-born (AUS/NZ) women, whether those abnormalities were associated with increased rates of obstetric intervention and adverse perinatal outcomes, and whether SA women and their babies were at higher risk of adverse outcomes in the post-term period irrespective of their post-term surveillance outcomes. Post-term surveillance and perinatal outcomes of 145 SA and 272 AUS/NZ nulliparous women with a singleton post-term pregnancy were compared in a retrospective multicentre cohort analysis. Post-term SA women were not significantly more likely to have a low amniotic fluid index (AFI) than AUS/NZ women. However, they were nearly four times more likely (odds ratio 3.75; 95% CI 1.49-9.44) to have an abnormal CTG (P=0.005). Irrespective of maternal region of birth having an abnormal cardiotocography (CTG) or AFI was not associated with adverse intrapartum or perinatal outcomes. However, post-term SA women were significantly more likely than AUS/NZ women to have intrapartum fetal compromise (P=0.03) and an intrapartum cesarean section (P=0.002). Babies of SA women were more also significantly likely to be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (P=0.02). Post-term SA women experience higher rates of fetal compromise (antenatal and intrapartum) and obstetric intervention than AUS/NZ women. Irrespective of maternal region of birth an abnormal CTG or AFI was not predictive of adverse outcomes.

  4. 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.

  5. Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

    Science.gov (United States)

    Lindley, Lisa C; Cozad, Melanie J

    2017-09-01

    Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  6. 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

  7. Dinucleotide controlled null models for comparative RNA gene prediction.

    Science.gov (United States)

    Gesell, Tanja; Washietl, Stefan

    2008-05-27

    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. 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. 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 randomization of multiple alignments can be considered. SISSIz

  8. Comparative Proteomic Analysis of Two Uveitis Models in Lewis Rats.

    Science.gov (United States)

    Pepple, Kathryn L; Rotkis, Lauren; Wilson, Leslie; Sandt, Angela; Van Gelder, Russell N

    2015-12-01

    Inflammation generates changes in the protein constituents of the aqueous humor. Proteins that change in multiple models of uveitis may be good biomarkers of disease or targets for therapeutic intervention. The present study was conducted to identify differentially-expressed proteins in the inflamed aqueous humor. Two models of uveitis were induced in Lewis rats: experimental autoimmune uveitis (EAU) and primed mycobacterial uveitis (PMU). Differential gel electrophoresis was used to compare naïve and inflamed aqueous humor. Differentially-expressed proteins were separated by using 2-D gel electrophoresis and excised for identification with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF). Expression of select proteins was verified by Western blot analysis in both the aqueous and vitreous. The inflamed aqueous from both models demonstrated an increase in total protein concentration when compared to naïve aqueous. Calprotectin, a heterodimer of S100A8 and S100A9, was increased in the aqueous in both PMU and EAU. In the vitreous, S100A8 and S100A9 were preferentially elevated in PMU. Apolipoprotein E was elevated in the aqueous of both uveitis models but was preferentially elevated in EAU. Beta-B2-crystallin levels decreased in the aqueous and vitreous of EAU but not PMU. The proinflammatory molecules S100A8 and S100A9 were elevated in both models of uveitis but may play a more significant role in PMU than EAU. The neuroprotective protein β-B2-crystallin was found to decline in EAU. Therapies to modulate these proteins in vivo may be good targets in the treatment of ocular inflammation.

  9. Comparing pharmacophore models derived from crystallography and NMR ensembles

    Science.gov (United States)

    Ghanakota, Phani; Carlson, Heather A.

    2017-11-01

    NMR and X-ray crystallography are the two most widely used methods for determining protein structures. Our previous study examining NMR versus X-Ray sources of protein conformations showed improved performance with NMR structures when used in our Multiple Protein Structures (MPS) method for receptor-based pharmacophores (Damm, Carlson, J Am Chem Soc 129:8225-8235, 2007). However, that work was based on a single test case, HIV-1 protease, because of the rich data available for that system. New data for more systems are available now, which calls for further examination of the effect of different sources of protein conformations. The MPS technique was applied to Growth factor receptor bound protein 2 (Grb2), Src SH2 homology domain (Src-SH2), FK506-binding protein 1A (FKBP12), and Peroxisome proliferator-activated receptor-γ (PPAR-γ). Pharmacophore models from both crystal and NMR ensembles were able to discriminate between high-affinity, low-affinity, and decoy molecules. As we found in our original study, NMR models showed optimal performance when all elements were used. The crystal models had more pharmacophore elements compared to their NMR counterparts. The crystal-based models exhibited optimum performance only when pharmacophore elements were dropped. This supports our assertion that the higher flexibility in NMR ensembles helps focus the models on the most essential interactions with the protein. Our studies suggest that the "extra" pharmacophore elements seen at the periphery in X-ray models arise as a result of decreased protein flexibility and make very little contribution to model performance.

  10. 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.

  11. Comparative assessment of condensation models for horizontal tubes

    International Nuclear Information System (INIS)

    Schaffrath, A.; Kruessenberg, A.K.; Lischke, W.; Gocht, U.; Fjodorow, A.

    1999-01-01

    The condensation in horizontal tubes plays an important role e.g. for the determination of the operation mode of horizontal steam generators of VVER reactors or passive safety systems for the next generation of nuclear power plants. Two different approaches (HOTKON and KONWAR) for modeling this process have been undertaken by Forschungszentrum Juelich (FZJ) and University for Applied Sciences Zittau/Goerlitz (HTWS) and implemented into the 1D-thermohydraulic code ATHLET, which is developed by the Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH for the analysis of anticipated and abnormal transients in light water reactors. Although the improvements of the condensation models are developed for different applications (VVER steam generators - emergency condenser of the SWR1000) with strongly different operation conditions (e.g. the temperature difference over the tube wall in HORUS is up to 30 K and in NOKO up to 250 K, the heat flux density in HORUS is up to 40 kW/m 2 and in NOKO up to 1 GW/m 2 ) both models are now compared and assessed by Forschungszentrum Rossendorf FZR e.V. Therefore, post test calculations of selected HORUS experiments were performed with ATHLET/KONWAR and compared to existing ATHLET and ATHLET/HOTKON calculations of HTWS. It can be seen that the calculations with the extension KONWAR as well as HOTKON improve significantly the agreement between computational and experimental data. (orig.) [de

  12. 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.

  13. Digital and traditional slides for teaching cellular morphology: a comparative analysis of learning outcomes.

    Science.gov (United States)

    Solberg, Brooke L

    2012-01-01

    Recent advances in technology have brought forth an intriguing new tool for teaching hematopoietic cellular identification skills: the digital slide. Although digitized slides offer a number of appealing options for educators, little research has been done to examine how their utilization would impact learning outcomes. To fill that void, this study was designed to examine student performance, skill retention and transferability, and self-efficacy beliefs amongst undergraduate MLS students learning cellular morphology with digital versus traditional slides. Results showed that students learning with digital slides performed better on assessments containing only traditional slide specimens than students learning with traditional slides, both immediately following the learning activity and after a considerable duration of time. Students learning with digital slides also reported slightly higher levels of self-efficacy related to cellular identification. The findings of this study suggest that students learning cellular identification skills with digital slides are able to transfer that skill directly to traditional slides, and that their ability to identify cells is not negatively affected in present or future settings.

  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. Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

    Science.gov (United States)

    Lindsay, William R.; Michie, Amanda M.; Steptoe, Lesley; Moore, Fhionna; Haut, Fabian

    2011-01-01

    Background: Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method:…

  16. Poles Apart? A Comparative Study of Housing Policies and Outcomes in Portugal and Denmark

    DEFF Research Database (Denmark)

    Alves, Sonia

    2017-01-01

    that the comparison between northern and southern European countries has been largely neglected in comparative housing literature, by using the Danish and Portuguese cases I test Kemeny’s typology of rental systems to explain the divergence between these two housing realities. The empirical evidence presented...

  17. Parental Report of the Diagnostic Process and Outcome: ASD Compared with Other Developmental Disabilities

    Science.gov (United States)

    Oswald, Donald P.; Haworth, Shannon M.; Mackenzie, Bernadette K.; Willis, Janet H.

    2017-01-01

    Parents report that the process of getting an autism spectrum disorder (ASD) diagnosis is arduous, lengthy, and fraught with difficulties. This analysis of the Pathways survey data set examined the experiences of parents who said, at the time of the survey, that their child currently had ASD compared with parents who said, at the time of the…

  18. Using Qualitative Comparative Analysis to Explore Outcome Patterns of Grant Support to Farmer Organisations in Bolivia

    NARCIS (Netherlands)

    Ton, G.

    2015-01-01

    We used Qualitative Comparative Analysis (QCA) to study the combinations of factors that are consistently related to success or failure of grants given to farmer groups. Using data from a sample of 26 grant beneficiaries, we explored whether baseline characteristics of the organisations related to

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

    NARCIS (Netherlands)

    Verger, A.; Novelli, M.; Verger, A.; Novelli, M.

    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

  20. 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…

  1. 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

  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. Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature.

    Science.gov (United States)

    Smith, Fraser G D; Brogan, Richard A; Alabas, Oras; Laut, Kristina G; Quinn, Tom; Bugiardini, Raffaele; Gale, Chris P

    2015-12-01

    The purpose of this review was to compare quality of care and outcomes following acute coronary syndrome (ACS) in Central and Eastern European Transitional (CEET) countries. This was a review of original ACS articles in CEET countries from PubMed, ISI Web of Science, Medline and Embase databases published in English from November 2003 to February 2014. Seventeen manuscripts fulfilled the search criteria. Of 19 CEET countries studied, there were no published ACS management or outcome data for four countries. In-hospital mortality for patients with acute myocardial infarction (AMI) ranged from 6.3% in the Czech Republic to 15.3% in Latvia. In-hospital mortality for ST-elevation myocardial infarction (STEMI) ranged from 3.0% in Poland to 20.7% in Romania. For STEMI, primary percutaneous coronary intervention (PCI) ranged from 1.0% to over 92.0%, fibrinolytic therapy from 0.0% to 49.6%, and no reperfusion therapy from 7.0% to 63.0%. Many CEET countries do not have published ACS care and outcomes data. Of those that do, there is evidence for substantial geographical variation in early mortality. Wide variation in emergency reperfusion strategies for STEMI suggests that acute cardiac care is likely to be modifiable and if addressed could reduce mortality from ACS in CEET countries. The collection of ACS care and outcomes data across Europe must be prioritised. © The European Society of Cardiology 2014.

  4. Unsatisfactory clinical outcomes of second-generation mobile bearing floating platform total knee arthroplasty: comparing outcomes with fixed bearing after five years minimum.

    Science.gov (United States)

    Yoon, Jung-Ro; Yang, Jae-Hyuk

    2018-03-20

    The purpose of this retrospective study was to analyze and compare the clinical and radiologic outcomes of fixed bearing ultracongruent (UC) insert total knee arthroplasty (TKA) and mobile bearing (MB) floating platform TKA using the navigation-assisted gap balancing technique with a minimum follow-up of five years. The study retrospectively enrolled 105 patients who received the UC type fixed bearing insert (group 1) and 95 patients who received the floating platform MB insert (group 2) during the period from August 2009 to June 2012. All surgery was performed using the navigation-assisted gap balancing technique. For strict assessment of gap measurements, the offset-type-force-controlled-spreader-system was used. Radiologic and clinical outcomes were assessed before operation and at the most recent follow-up using the Knee Society Score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. For statistical analysis, paired sample t tests were used. A p value less than 0.05 was considered significant. Although the radiologic alignments were satisfactory for both groups (99/105 [94%] cases were neutral for group 1 and 90/95 [94%] for group 2), the functional and total WOMAC scores were inferior in group 2 (p bearing exchange. The Kaplan-Meier survivorship rates for groups 1 and 2 at 77 months were 100.0 and 97.9%, respectively. Second-generation MB floating platform TKA cases did not have satisfactory outcomes. There were two cases of insert breakage, which required bearing exchange. Other patients who underwent surgery with second-generation MB floating platform were encouraged to avoid high knee flexion activities, resulting in lower clinical performance.

  5. Time to pediatric epilepsy surgery is longer and developmental outcomes lower for government compared with private insurance.

    Science.gov (United States)

    Hauptman, Jason S; Dadour, Andrew; Oh, Taemin; Baca, Christine B; Vickrey, Barbara G; Vassar, Stefanie; Sankar, Raman; Salamon, Noriko; Vinters, Harry V; Mathern, Gary W

    2013-07-01

    It is unclear if socioeconomic factors like type of insurance influence time to referral and developmental outcomes for pediatric patients undergoing epilepsy surgery. This study determined whether private compared with state government insurance was associated with shorter intervals of seizure onset to surgery and better developmental quotients for pediatric patients undergoing epilepsy surgery. A consecutive cohort (n = 420) of pediatric patients undergoing epilepsy surgery were retrospectively categorized into those with Medicaid (California Children's Services; n = 91) or private (Preferred Provider Organization, Health Maintenance Organization, Indemnity; n = 329) insurance. Intervals from seizure onset to referral and surgery and Vineland developmental assessments were compared by insurance type with the use of log-rank tests. Compared with private insurance, children with Medicaid had longer intervals from seizure onset to referral for evaluation (log-rank test, P = .034), and from seizure onset to surgery (P = .017). In a subset (25%) that had Vineland assessments, children with Medicaid compared with private insurance had lower Vineland scores presurgery (P = .042) and postsurgery (P = .003). Type of insurance was not associated with seizure severity, types of operations, etiology, postsurgical seizure-free outcomes, and complication rate. Compared with Medicaid, children with private insurance had shorter intervals from seizure onset to referral and to epilepsy surgery, and this was associated with lower Vineland scores before surgery. These findings may reflect delayed access for uninsured children who eventually obtained state insurance. Reasons for the delay and whether longer intervals before epilepsy surgery affect long-term cognitive and developmental outcomes warrant further prospective investigations.

  6. 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.

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

    International Nuclear Information System (INIS)

    Kim, Ja Young; Chang, Sei Kyung; Lee, Bo Mi; Shin, Hyun Soo; Park, Heily

    2012-01-01

    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 0.05). 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.

  8. Comparing soil moisture memory in satellite observations and models

    Science.gov (United States)

    Stacke, Tobias; Hagemann, Stefan; Loew, Alexander

    2013-04-01

    A major obstacle to a correct parametrization of soil processes in large scale global land surface models is the lack of long term soil moisture observations for large parts of the globe. Currently, a compilation of soil moisture data derived from a range of satellites is released by the ESA Climate Change Initiative (ECV_SM). Comprising the period from 1978 until 2010, it provides the opportunity to compute climatological relevant statistics on a quasi-global scale and to compare these to the output of climate models. Our study is focused on the investigation of soil moisture memory in satellite observations and models. As a proxy for memory we compute the autocorrelation length (ACL) of the available satellite data and the uppermost soil layer of the models. Additional to the ECV_SM data, AMSR-E soil moisture is used as observational estimate. Simulated soil moisture fields are taken from ERA-Interim reanalysis and generated with the land surface model JSBACH, which was driven with quasi-observational meteorological forcing data. The satellite data show ACLs between one week and one month for the greater part of the land surface while the models simulate a longer memory of up to two months. Some pattern are similar in models and observations, e.g. a longer memory in the Sahel Zone and the Arabian Peninsula, but the models are not able to reproduce regions with a very short ACL of just a few days. If the long term seasonality is subtracted from the data the memory is strongly shortened, indicating the importance of seasonal variations for the memory in most regions. Furthermore, we analyze the change of soil moisture memory in the different soil layers of the models to investigate to which extent the surface soil moisture includes information about the whole soil column. A first analysis reveals that the ACL is increasing for deeper layers. However, its increase is stronger in the soil moisture anomaly than in its absolute values and the first even exceeds the

  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. Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy.

    Science.gov (United States)

    Kerschberger, Bernhard; Boulle, Andrew M; Kranzer, Katharina; Hilderbrand, Katherine; Schomaker, Michael; Coetzee, David; Goemaere, Eric; Van Cutsem, Gilles

    2015-01-01

    Routine viral load (VL) monitoring is utilized to assess antiretroviral therapy (ART) adherence and virologic failure, and it is currently scaled-up in many resource-constrained settings. The first routine VL is recommended as late as six months after ART initiation for early detection of sub-optimal adherence. We aimed to assess the optimal timing of first VL measurement after initiation of ART. This was a retrospective, cohort analysis of routine monitoring data of adults enrolled at three primary care clinics in Khayelitsha, Cape Town, between January 2002 and March 2009. Primary outcomes were virologic failure and switch to second-line ART comparing patients in whom first VL done was at three months (VL3M) and six months (VL6M) after ART initiation. Adjusted hazard ratios (aHR) were estimated using Cox proportional hazard models. In total, 6264 patients were included for the time to virologic failure and 6269 for the time to switch to second-line ART analysis. Patients in the VL3M group had a 22% risk reduction of virologic failure (aHR 0.78, 95% CI 0.64-0.95; p=0.016) and a 27% risk reduction of switch to second-line ART (aHR 0.73, 95% CI 0.58-0.92; p=0.008) when compared to patients in the VL6M group. For each additional month of delay of the first VL measurement (up to nine months), the risk of virologic failure increased by 9% (aHR 1.09, 95% CI 1.02-1.15; p=0.008) and switch to second-line ART by 13% (aHR 1.13, 95% CI 1.05-1.21; p<0.001). A first VL at three months rather than six months with targeted adherence interventions for patients with high VL may improve long-term virologic suppression and reduce switches to costly second-line ART. ART programmes should consider the first VL measurement at three months after ART initiation.

  11. A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

    Science.gov (United States)

    Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

    2013-08-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

  12. A novel stent inflation protocol improves long-term outcomes compared with rapid inflation/deflation deployment method.

    Science.gov (United States)

    Vallurupalli, Srikanth; Kasula, Srikanth; Kumar Agarwal, Shiv; Pothineni, Naga Venkata K; Abualsuod, Amjad; Hakeem, Abdul; Ahmed, Zubair; Uretsky, Barry F

    2017-08-01

    High-pressure inflation for coronary stent deployment is universally performed. However, the duration of inflation is variable and does not take into account differences in lesion compliance. We developed a standardized "pressure optimization protocol" (POP) using inflation pressure stability rather than an arbitrary inflation time or angiographic balloon appearance for stent deployment. Whether this approach improves long-term outcomes is unknown. 792 patients who underwent PCI using either rapid inflation/deflation (n = 376) or POP (n = 416) between January 2009 and March 2014 were included. Exclusion criteria included PCI for acute myocardial infarction, in-stent restenosis, chronic total occlusion, left main, and saphenous vein graft lesions. Primary endpoint was target vessel failure [TVF = combined end point of target vessel revascularization (TVR), myocardial infarction, and cardiac death]. Outcomes were analyzed in the entire cohort and in a propensity analysis. Stent implantation using POP with a median follow-up of 1317 days was associated with lower TVF compared with rapid inflation/deflation (10.1 vs. 17.8%, P inflation/deflation (10 vs. 18%, P < 0.0001). Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  13. 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…

  14. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

    Science.gov (United States)

    Tsang, Victor T; Brown, Katherine L; Synnergren, Mats Johanssen; Kang, Nicholas; de Leval, Marc R; Gallivan, Steve; Utley, Martin

    2009-02-01

    Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time. We used a recently developed graphic technique to evaluate the performance of an existing risk model among those patients at a single center during 2000 to 2003 originally used in model development. We then compared the distribution of predicted risk among these patients with that among patients in 2004 to 2006. Finally, we constructed a VLAD chart of risk-adjusted outcomes for the latter period. Among 1083 patients between April 2000 and March 2003, the risk model performed well at predicted risks above 3%, underestimated mortality at 2% to 3% predicted risk, and overestimated mortality below 2% predicted risk. There was little difference in the distribution of predicted risk among these patients and among 903 patients between June 2004 and October 2006. Outcomes for the more recent period were appreciably better than those expected according to the risk model. This finding cannot be explained by any apparent bias in the risk model combined with changes in case-mix. Risk models can, and hopefully do, become out of date. There is scope for complacency in the risk-adjusted audit if the risk model used is not regularly recalibrated to reflect changing standards and expectations.

  15. 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

  16. 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…

  17. Post-Mastectomy Radiation Therapy for Invasive Lobular Carcinoma: A Comparative Utilization and Outcomes Study.

    Science.gov (United States)

    Stecklein, Shane R; Shen, Xinglei; Mitchell, Melissa P

    2016-08-01

    To date, there have been no analyses to assess factors that influence post-mastectomy radiation therapy (PMRT) utilization in invasive lobular carcinoma (ILC) or to quantify the benefit of PMRT in ILC as compared with invasive ductal carcinoma (IDC). We compared histology-specific utilization of PMRT by tumor and patient characteristics and estimated the effect of PMRT on overall and breast cancer-specific survival in ILC and IDC patients meeting American College of Radiology (ACR) criteria for PMRT. We used the Surveillance, Epidemiology, and End Results database to identify women diagnosed with ILC or IDC from 2004 to 2009 who underwent mastectomy. We assessed utilization of PMRT by T and N stage, analyzed factors associated with PMRT use, and quantified the histology-specific survival benefit of PMRT using log-rank tests and multivariate Cox regression analysis. We identified 86,098 IDC and 12,703 ILC patients. Within this cohort, 18.7% of IDC patients and 26.1% of ILC met ACR criteria for PMRT. Among patients with a definite indication, PMRT was more commonly employed in ILC than in IDC (59.6% vs. 56.3%; P = .0004). Among patients with a definite indication for PMRT, radiation improved 5-year breast cancer-specific survival from 71.4% to 77.0% for IDC (P cancer-specific survival for ILC patients to a degree comparable with that seen in IDC. Moreover, among ILC and IDC patients who meet ACR criteria, PMRT appears to be significantly underutilized. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Clinical outcomes for patients finished with the SureSmile™ method compared with conventional fixed orthodontic therapy

    Science.gov (United States)

    Alford, Timothy J.; Roberts, W. Eugene; Hartsfield, James K.; Eckert, George J.; Snyder, Ronald J.

    2016-01-01

    Objective Utilize American Board of Orthodontics (ABO) cast/radiographic evaluation (CRE) to compare a series of 63 consecutive patients, finished with manual wire bending (conventional) treatment, vs a subsequent series of 69 consecutive patients, finished by the same orthodontist using the SureSmile™ (SS) method. Materials and Methods Records of 132 nonextraction patients were scored by a calibrated examiner blinded to treatment mode. Age and discrepancy index (DI) between groups were compared by t-tests. A chi-square test was used to compare for differences in sex and whether the patient was treated using braces only (no orthopedic correction). Analysis of covariance tested for differences in CRE outcomes and treatment times, with sex and DI included as covariates. A logarithmic transformation of CRE outcomes and treatment times was used because their distributions were skewed. Significance was defined as P space closure; however, second-order root angulation (RA) was inferior. Conclusion SS patients were treated in less time to better CRE scores for first-order rotation (AR) and interproximal space closure (IC) but on the average, malocclusions were less complex and second order root alignment was inferior, compared with patients finished with manual wire bending. PMID:21261488

  19. Comparing Numerical Spall Simulations with a Nonlinear Spall Formation Model

    Science.gov (United States)

    Ong, L.; Melosh, H. J.

    2012-12-01

    Spallation accelerates lightly shocked ejecta fragments to speeds that can exceed the escape velocity of the parent body. We present high-resolution simulations of nonlinear shock interactions in the near surface. Initial results show the acceleration of near-surface material to velocities up to 1.8 times greater than the peak particle velocity in the detached shock, while experiencing little to no shock pressure. These simulations suggest a possible nonlinear spallation mechanism to produce the high-velocity, low show pressure meteorites from other planets. Here we pre-sent the numerical simulations that test the production of spall through nonlinear shock interactions in the near sur-face, and compare the results with a model proposed by Kamegai (1986 Lawrence Livermore National Laboratory Report). We simulate near-surface shock interactions using the SALES_2 hydrocode and the Murnaghan equation of state. We model the shock interactions in two geometries: rectangular and spherical. In the rectangular case, we model a planar shock approaching the surface at a constant angle phi. In the spherical case, the shock originates at a point below the surface of the domain and radiates spherically from that point. The angle of the shock front with the surface is dependent on the radial distance of the surface point from the shock origin. We model the target as a solid with a nonlinear Murnaghan equation of state. This idealized equation of state supports nonlinear shocks but is tem-perature independent. We track the maximum pressure and maximum velocity attained in every cell in our simula-tions and compare them to the Hugoniot equations that describe the material conditions in front of and behind the shock. Our simulations demonstrate that nonlinear shock interactions in the near surface produce lightly shocked high-velocity material for both planar and cylindrical shocks. The spall is the result of the free surface boundary condi-tion, which forces a pressure gradient

  20. Comparative study of computational model for pipe whip analysis

    International Nuclear Information System (INIS)

    Koh, Sugoong; Lee, Young-Shin

    1993-01-01

    Many types of pipe whip restraints are installed to protect the structural components from the anticipated pipe whip phenomena of high energy lines in nuclear power plants. It is necessary to investigate these phenomena accurately in order to evaluate the acceptability of the pipe whip restraint design. Various research programs have been conducted in many countries to develop analytical methods and to verify the validity of the methods. In this study, various calculational models in ANSYS code and in ADLPIPE code, the general purpose finite element computer programs, were used to simulate the postulated pipe whips to obtain impact loads and the calculated results were compared with the specific experimental results from the sample pipe whip test for the U-shaped pipe whip restraints. Some calculational models, having the spring element between the pipe whip restraint and the pipe line, give reasonably good transient responses of the restraint forces compared with the experimental results, and could be useful in evaluating the acceptability of the pipe whip restraint design. (author)

  1. 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.

  2. An assessment model in outcomes-based education and training ...

    African Journals Online (AJOL)

    The study addresses a concern in higher education and specifically in health sciences and technology regarding integrated and authentic assessment with an outcomes-based approach. Interviews were conducted with head-hunted academics in health sciences and technology. From the information generated, an ...

  3. Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies.

    Science.gov (United States)

    McNamara, David G; Asher, M Innes; Rubin, Bruce K; Stewart, Alistair; Byrnes, Catherine A

    2014-01-01

    The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known. We conducted a short-term 20-hour study and a long-term 10-week randomized crossover study comparing a heated humidifier (HH) to a heat and moisture exchanger (HME) in children with established tracheostomies. Subjects were assessed for clinical events, clinical examination findings, airway cytokine levels, and airway secretion viscoelasticity. For the short-term study, 15 children were recruited; for the long-term study, 14 children were recruited. Children using the HH had decreased respiratory examination score (P < .001) but no change in clinical events over the short term. There was a decrease in acute clinical events (P = .008) in the long-term study. No differences were found in airway secretion viscoelasticity results or cytokine levels in either study, but these sample numbers were limited. Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.

  4. Comparison of expected treatment outcomes, obtained using risk models and international guidelines, with observed treatment outcomes in a Dutch cohort of patients with non-muscle-invasive bladder cancer treated with intravesical chemotherapy.

    Science.gov (United States)

    Lammers, Rianne J M; Palou, Joan; Witjes, Wim P J; Janzing-Pastors, Maria H D; Caris, Christien T M; Witjes, J Alfred

    2014-08-01

    To compare the risks according to the American Urological Association (AUA), EAU, European Organization for Research and Treatment of Cancer (EORTC) and Club Urológico Español de Tratamiento Oncologico (CUETO) classifications with real outcomes in a cohort of patients in the Netherlands, and to confirm that patients who were undertreated according to these risk models have worse outcomes than adequately treated patients. Patients treated with complete transurethral resection of bladder tumour and intravesical chemotherapy were included. Not all patients would have received intravesical chemotherapy had they been treated to current standards, and thus comparison of the observed outcomes in our Dutch cohort vs expected outcomes based on the EORTC risk tables and CUETO scoring model was possible. The cohort was reclassified according to the definitions of five index patients (IPs), as defined by the AUA guidelines, and three risk groups, defined according to the EAU guidelines, to compare the outcomes of undertreated patients with those of adequately treated patients. A total of 1001 patients were available for comparison with the AUA definitions and 728 patients were available for comparison with the EORTC and CUETO models. There was a large overlap between the observed outcomes and expected recurrence and progression probabilities when comparison was made using the EORTC risk tables. The observed recurrence outcomes were in general higher than the expected probabilities according to the CUETO risk classification, especially in the long term. No differences in progression were found when comparing these two models to the Dutch cohort. Patients who were undertreated according to the guidelines showed, in general, a higher risk of developing recurrence and progression. Limitations are i.a. its retrospective nature and the differences in grading system. Comparisons between the observed outcomes in our Dutch cohort and the expected outcomes based on EAU and CUETO risk

  5. THE FLAT TAX - A COMPARATIVE STUDY OF THE EXISTING MODELS

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    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

  6. Influence of a modified preservation solution in kidney transplantation: A comparative experimental study in a porcine model

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    Mohammad Golriz

    2017-03-01

    Conclusion: Although the new preservation HTK solution is in several points a well-thought-out modification of the standard HTK solution, its preservation efficacy, at least for kidney preservation in a pig model for 30 hours, seems to be comparable to the current used solutions. A real advantage, however, could be confirmed in clinical settings, where marginal organs may influence the clinical outcome.

  7. Effects of Intensive Control of Glycemia on Clinical Kidney Outcomes in Type 2 Diabetes Patients Compared with Standard Control: A Meta-Analysis

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    Francisco Herrera-Gómez

    2017-11-01

    Full Text Available Background: Association between poor control of glycemia and the onset of microvascular complications in type 2 diabetes mellitus (T2DM patients is a hard issue. However, it seems that the impact of pharmacological treatment is important only in early stages of diabetic nephropathy. We sought to examine whether intensive glycemic control is associated with improvement of clinical Chronic Kidney Disease (CKD outcomes compared to standard glycemic control.Methods: Meta-analysis of published and unpublished randomized controlled trials (RCT and post-hoc analysis of RCTs comparing anti-diabetic drugs and/or insulin (intensive control vs. dietary measures (standard control for relevant outcomes related to progression of CKD clinically manifest was undertaken. Summary estimates obtained by random effects model and funnel plots for assessing reporting bias are presented.Results: Our analysis was based on four RCTs representing 27,391 adult T2DM patients with CKD from around the world. The pooled OR for the outcomes of doubling of serum creatinine and need of dialysis were, respectively, of 0.98 with 95% confidence interval (95% CI 0.81–1.19, and 0.84 with 95% CI 0.69–1.02. The pooled OR for the outcome of death from kidney failure was 0.62 with 95% CI 0.39–0.98. Clinical differences between studies were not translated in statistical heterogeneity. Reporting bias may be present.Conclusions: Intensive glycemic control has an effect on death from kidney failure compared to standard glycemic control. Better comprehension of glycemic control effects on both T2DM patients with and without CKD is important for individualization of these two treatment modalities.

  8. Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis.

    Science.gov (United States)

    Frank, Rachel M; Lee, Simon; Cotter, Eric J; Hannon, Charles P; Leroux, Timothy; Cole, Brian J

    2018-03-01

    Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Control study; Level of evidence, 3. Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and

  9. Adverse mental health outcomes in breast cancer survivors compared to women who did not have cancer: systematic review protocol.

    Science.gov (United States)

    Carreira, Helena; Williams, Rachael; Müller, Martin; Harewood, Rhea; Bhaskaran, Krishnan

    2017-08-14

    Recent increasing trends in breast cancer incidence and survival have resulted in unprecedented numbers of cancer survivors in the general population. A cancer diagnosis may have a profound psychological impact, and breast cancer treatments often cause long-term physical sequelae, potentially affecting women's mental health. The aim of this systematic review is to identify and summarise all studies that have compared mental health outcomes in breast cancer survivors, versus women who did not have cancer. This study will be a systematic review of the literature. Four databases, including MEDLINE and PsycINFO, will be searched to identify potentially relevant studies. The search expressions will use a Boolean logic, including terms for the target population (women who have had breast cancer), outcomes (psychiatric disorders) and comparators (e.g. risk, hazard). All mental disorders will be eligible, except those with onset normally occurring during childhood or strong genetic basis (e.g. Huntington disease). The eligibility of the studies will be assessed in two phases: (1) considering the information provided in the title and abstract; (2) evaluating the full text. Studies including women diagnosed with breast cancer 1 year or more ago and that provide original data on mental health outcomes will be eligible. Studies in which all women were undergoing surgery, chemotherapy or radiotherapy, or hospitalised or institutionalised, will be excluded, as well as studies that include patients selected on the basis of symptomatology. Two investigators will do the screening of the references and the data extraction independently, with results compared and discrepancies resolved by involving a third investigator when necessary. Study quality and risk of bias will be assessed across six broad domains. Results will be summarised by outcome, and summary measures of frequency and/or association will be computed if possible. This review will summarise the evidence on the mental

  10. 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.

  11. 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.

  12. 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

  13. Novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy: description and comparative outcomes.

    Science.gov (United States)

    Jeong, Chang Wook; Oh, Jong Jin; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Choe, Gheeyoung; Lee, Sang Eun

    2012-07-01

    The aim of the present study was to assess the impact of a novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy on continence recovery. A total of 116 consecutive patients who received the novel posterior reconstruction (case group) were retrospectively compared with a cohort of 126 patients who did not receive posterior reconstruction (control group). The primary end-point was the duration of continence recovery (no pad use) after robot-assisted laparoscopic prostatectomy. The posterior reconstruction was obtained by opposing the median dorsal fibrous raphe to the posterior counterpart of the detrusor apron, rather than the Denonvilliers' fascia. The case group showed higher continence rates at all points of evaluation, which were 2 weeks (30.1% vs 19.8%), 1 month (58.4% vs 45.7%), 3 months (82.7% vs 70.5%) and 6 months postoperatively (95.3% vs 86.4%) (P = 0.007). Application of the novel posterior reconstruction technique, age and length of membranous urethra were significant variables for the complete recovery of continence on multivariable analysis. This study shows that the application of this novel PR technique significantly improves the recovery of continence in patients undergoing robot-assisted laparoscopic prostatectomy. © 2012 The Japanese Urological Association.

  14. Connective tissue graft vs. emdogain: A new approach to compare the outcomes.

    Science.gov (United States)

    Sayar, Ferena; Akhundi, Nasrin; Gholami, Sanaz

    2013-01-01

    The aim of this clinical trial study was to clinically evaluate the use of enamel matrix protein derivative combined with the coronally positioned flap to treat gingival recession compared to the subepithelial connective tissue graft by a new method to obtain denuded root surface area. Thirteen patients, each with two or more similar bilateral Miller class I or II gingival recession (40 recessions) were randomly assigned to the test (enamel matrix protein derivative + coronally positioned flap) or control group (subepithelial connective tissue graft). Recession depth, width, probing depth, keratinized gingival, and plaque index were recorded at baseline and at one, three, and six months after treatment. A stent was used to measure the denuded root surface area at each examination session. Results were analyzed using Kolmogorov-Smirnov, Wilcoxon, Friedman, paired-sample t test. The average percentages of root coverage for control and test groups were 63.3% and 55%, respectively. Both groups showed significant keratinized gingival increase (P 0.05). The results of Friedman test were significant for clinical indices (P < 0.05), except for probing depth in control group (P = 0.166). Enamel matrix protein derivative showed the same results as subepithelial connective tissue graft with relatively easy procedure to perform and low patient morbidity.

  15. Percutaneous intervention for infrainguinal occlusive disease in women: equivalent outcomes despite increased severity of disease compared with men.

    Science.gov (United States)

    DeRubertis, Brian G; Vouyouka, Angela; Rhee, Soo J; Califano, Joseph; Karwowski, John; Angle, Niren; Faries, Peter L; Kent, K Craig

    2008-07-01

    Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention. Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis. A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% +/- 4%, 66% +/- 3%, and 80% +/- 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics. Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were

  16. 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. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Animal models for clinical and gestational diabetes: maternal and fetal outcomes.

    Science.gov (United States)

    Kiss, Ana Ci; Lima, Paula Ho; Sinzato, Yuri K; Takaku, Mariana; Takeno, Marisa A; Rudge, Marilza Vc; Damasceno, Débora C

    2009-10-19

    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. 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. 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. Experimental models of severe diabetes during pregnancy reproduced maternal and fetal outcomes of pregnant women

  18. Comparative benefit of malaria chemoprophylaxis modelled in United Kingdom travellers.

    Science.gov (United States)

    Toovey, Stephen; Nieforth, Keith; Smith, Patrick; Schlagenhauf, Patricia; Adamcova, Miriam; Tatt, Iain; Tomianovic, Danitza; Schnetzler, Gabriel

    2014-01-01

    .3% decrease in estimated infections. The number of travellers experiencing moderate adverse events (AE) or those requiring medical attention or drug withdrawal per case prevented is as follows: C ± P 170, Mq 146, Dx 114, AP 103. The model correctly predicted the number of malaria deaths, providing a robust and reliable estimate of the number of imported malaria cases in the UK, and giving a measure of benefit derived from chemoprophylaxis use against the likely adverse events generated. Overall numbers needed to prevent a malaria infection are comparable among the four options and are sensitive to changes in the background infection rates. Only a limited impact on the number of infections can be expected if Mq is substituted by AP.

  19. No Variation in Patient Care Outcomes After Implementation of Resident Shift Work Duty Hour Limitations and a Hospitalist Model System.

    Science.gov (United States)

    Hollier, John M; Wilson, Stephen D

    This study examines whether implementing a resident shift work schedule (RSWS) alone or combined with a hospitalist-led model system (HMS/RSWS) affects patient care outcomes or costs at a pediatric tertiary care teaching hospital. A retrospective sample compared pre- and postintervention groups for the most common primary discharge diagnoses, including asthma and cellulitis (RSWS intervention) and inflammatory bowel disease and diabetic ketoacidosis (HMS/RSWS intervention). Outcome variables included length of stay, number of subspecialty consultations, and hospitalization charges. For the RSWS intervention, the preintervention (n = 107) and postintervention (n = 92) groups showed no difference in any of the outcome variables. For the HMS/RSWS intervention, the preintervention (n = 98) and postintervention (n = 69) groups did not differ in demographics or length of stay. However, subspecialty consultations increased significantly during postintervention from 0.83 to 1.52 consults/hospitalization ( P care outcomes at a pediatric tertiary care teaching hospital.

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

    Directory of Open Access Journals (Sweden)

    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

  1. A comparative study of machine learning models for ethnicity classification

    Science.gov (United States)

    Trivedi, Advait; Bessie Amali, D. Geraldine

    2017-11-01

    This paper endeavours to adopt a machine learning approach to solve the problem of ethnicity recognition. Ethnicity identification is an important vision problem with its use cases being extended to various domains. Despite the multitude of complexity involved, ethnicity identification comes naturally to humans. This meta information can be leveraged to make several decisions, be it in target marketing or security. With the recent development of intelligent systems a sub module to efficiently capture ethnicity would be useful in several use cases. Several attempts to identify an ideal learning model to represent a multi-ethnic dataset have been recorded. A comparative study of classifiers such as support vector machines, logistic regression has been documented. Experimental results indicate that the logical classifier provides a much accurate classification than the support vector machine.

  2. Clinical outcomes of isolated renal failure compared to other forms of organ failure in patients with severe acute pancreatitis.

    Science.gov (United States)

    Gougol, Amir; Dugum, Mohannad; Dudekula, Anwar; Greer, Phil; Slivka, Adam; Whitcomb, David C; Yadav, Dhiraj; Papachristou, Georgios I

    2017-08-07

    To assess differences in clinical outcomes of isolated renal failure (RF) compared to other forms of organ failure (OF) in patients with severe acute pancreatitis (SAP). Using a prospectively maintained database of patients with acute pancreatitis admitted to a tertiary medical center between 2003 and 2016, those with evidence of persistent OF were classified to renal, respiratory, cardiovascular, or multi-organ (2 or more organs). Data regarding demographics, comorbidities, etiology of acute pancreatitis, and clinical outcomes were prospectively recorded. Differences in clinical outcomes after development of isolated RF in comparison to other forms of OF were determined using independent t and Mann-Whitney U tests for continues variables, and χ 2 test for discrete variables. Among 500 patients with acute pancreatitis, 111 patients developed persistent OF: mean age was 54 years, and 75 (67.6%) were male. Forty-three patients had isolated OF: 17 (15.3%) renal, 25 (21.6%) respiratory, and 1 (0.9%) patient with cardiovascular failure. No differences in demographics, etiology of acute pancreatitis, systemic inflammatory response syndrome scores, or development of pancreatic necrosis were seen between patients with isolated RF vs isolated respiratory failure. Patients with isolated RF were less likely to require nutritional support (76.5% vs 96%, P = 0.001), ICU admission (58.8% vs 100%, P = 0.001), and had shorter mean ICU stay (2.4 d vs 15.7 d, P pancreatitis.

  3. Limited Hiatal Dissection Without Fundoplication Results in Comparable Symptomatic Outcomes to Laparoscopic Heller Myotomy with Anterior Fundoplication.

    Science.gov (United States)

    DeHaan, Reece K; Frelich, Matthew J; Gould, Jon C

    2016-07-01

    Previous randomized controlled trials have demonstrated that partial fundoplication following Heller myotomy results in less pathologic acid exposure to the esophagus when compared to myotomy without fundoplication. Recent studies have questioned the necessity of a fundoplication, especially when a limited hiatal dissection (LHD) is performed and the angle of His is preserved. This is a retrospective review of prospectively maintained data. All patients underwent primary Heller myotomy for achalasia over a 30-month period. In select patients, an LHD was performed anteriorly. Symptomatic outcomes were assessed up to 2 years postoperation using the Achalasia Severity Questionnaire (ASQ), Gastrointestinal Quality of Life Index (GIQLI), and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL). A total of 31 patients underwent Heller myotomy during the study interval. The majority of patients underwent Heller myotomy with full hiatal dissection (FHD) (21, 68%). Intraoperative mucosal perforations occurred in 3 (14%) patients undergoing FHD. Patient demographics, surgery details, and baseline symptomatic outcomes did not differ significantly preoperatively. At greater than 1 year postoperation, there was no significant difference between the groups for ASQ, GERD-HRQL, and GIGLI (P = .76, .78, and .33, respectively). Heller myotomy with LHD and no fundoplication and Heller myotomy with FHD and partial fundoplication result in similar GERD-related quality of life outcomes. Further studies (including pH studies) are necessary to determine if fundoplication is a necessary step in selected patients in whom an LHD is possible.

  4. Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases.

    Science.gov (United States)

    Gerard, Justin; Luu, Minh B; Poirier, Jennifer; Deziel, Daniel J

    2018-03-09

    The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis. We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes. A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien-Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001). In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.

  5. Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes?

    Science.gov (United States)

    Haider, Adil H; Villegas, Cassandra V; Saleem, Taimur; Efron, David T; Stevens, Kent A; Oyetunji, Tolulope A; Cornwell, Edward E; Bowman, Stephen; Haack, Sara; Baker, Susan P; Schneider, Eric B

    2012-06-01

    Optimum quantification of injury severity remains an imprecise science with a need for improvement. The accuracy of the criterion standard Injury Severity Score (ISS) worsens as a patient's injury severity increases, especially among patients with penetrating trauma. The objective of this study was to comprehensively compare the mortality prediction ability of three anatomic injury severity indices: the ISS, the New ISS (NISS), and the DRG International Classification of Diseases-9th Rev.-Trauma Mortality Prediction Model (TMPM-ICD-9), a recently developed contemporary injury assessment model. Retrospective analysis of patients in the National Trauma Data Bank from 2007 to 2008. The TMPM-ICD-9 values were computed and compared with the ISS and NISS for each patient using in-hospital mortality after trauma as the outcome measure. Discrimination and calibration were compared using the area under the receiver operator characteristic curve. Subgroup analysis was performed to compare each score across varying ranges of injury severity and across different types of injury. A total of 533,898 patients were identified with a crude mortality rate of 4.7%. The ISS and NISS performed equally in the groups with minor (ISS, 1-8) and moderate (ISS, 9-15) injuries, regardless of the injury type. However, in the populations with severe (ISS, 16-24) and very severe (ISS, ≥ 25) injuries for all injury types, the NISS predicted mortality better than the ISS did. The TMPM-ICD-9 outperformed both the NISS and ISS almost consistently. The NISS and TMPM-ICD-9 are both superior predictors of mortality as compared with the ISS. The immediate adoption of NISS for evaluating trauma outcomes using trauma registry data is recommended. The TMPM-ICD-9 may be an even better measure of human injury, and its use in administrative or nonregistry data is suggested. Further research on its attributes is recommended because it has the potential to become the basis for benchmarking trauma outcomes

  6. Comparative metabolomics of drought acclimation in model and forage legumes.

    Science.gov (United States)

    Sanchez, Diego H; Schwabe, Franziska; Erban, Alexander; Udvardi, Michael K; Kopka, Joachim

    2012-01-01

    Water limitation has become a major concern for agriculture. Such constraints reinforce the urgent need to understand mechanisms by which plants cope with water deprivation. We used a non-targeted metabolomic approach to explore plastic systems responses to non-lethal drought in model and forage legume species of the Lotus genus. In the model legume Lotus. japonicus, increased water stress caused gradual increases of most of the soluble small molecules profiled, reflecting a global and progressive reprogramming of metabolic pathways. The comparative metabolomic approach between Lotus species revealed conserved and unique metabolic responses to drought stress. Importantly, only few drought-responsive metabolites were conserved among all species. Thus we highlight a potential impediment to translational approaches that aim to engineer traits linked to the accumulation of compatible solutes. Finally, a broad comparison of the metabolic changes elicited by drought and salt acclimation revealed partial conservation of these metabolic stress responses within each of the Lotus species, but only few salt- and drought-responsive metabolites were shared between all. The implications of these results are discussed with regard to the current insights into legume water stress physiology. © 2011 Blackwell Publishing Ltd.

  7. Static response of deformable microchannels: a comparative modelling study

    Science.gov (United States)

    Shidhore, Tanmay C.; Christov, Ivan C.

    2018-02-01

    We present a comparative modelling study of fluid-structure interactions in microchannels. Through a mathematical analysis based on plate theory and the lubrication approximation for low-Reynolds-number flow, we derive models for the flow rate-pressure drop relation for long shallow microchannels with both thin and thick deformable top walls. These relations are tested against full three-dimensional two-way-coupled fluid-structure interaction simulations. Three types of microchannels, representing different elasticity regimes and having been experimentally characterized previously, are chosen as benchmarks for our theory and simulations. Good agreement is found in most cases for the predicted, simulated and measured flow rate-pressure drop relationships. The numerical simulations performed allow us to also carefully examine the deformation profile of the top wall of the microchannel in any cross section, showing good agreement with the theory. Specifically, the prediction that span-wise displacement in a long shallow microchannel decouples from the flow-wise deformation is confirmed, and the predicted scaling of the maximum displacement with the hydrodynamic pressure and the various material and geometric parameters is validated.

  8. COMPAR

    International Nuclear Information System (INIS)

    Kuefner, K.

    1976-01-01

    COMPAR works on FORTRAN arrays with four indices: A = A(i,j,k,l) where, for each fixed k 0 ,l 0 , only the 'plane' [A(i,j,k 0 ,l 0 ), i = 1, isub(max), j = 1, jsub(max)] is held in fast memory. Given two arrays A, B of this type COMPAR has the capability to 1) re-norm A and B ind different ways; 2) calculate the deviations epsilon defined as epsilon(i,j,k,l): =[A(i,j,k,l) - B(i,j,k,l)] / GEW(i,j,k,l) where GEW (i,j,k,l) may be chosen in three different ways; 3) calculate mean, standard deviation and maximum in the array epsilon (by several intermediate stages); 4) determine traverses in the array epsilon; 5) plot these traverses by a printer; 6) simplify plots of these traverses by the PLOTEASY-system by creating input data blocks for this system. The main application of COMPAR is given (so far) by the comparison of two- and three-dimensional multigroup neutron flux-fields. (orig.) [de

  9. 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.

  10. 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.

  11. Numerical modeling of carrier gas flow in atomic layer deposition vacuum reactor: A comparative study of lattice Boltzmann models

    International Nuclear Information System (INIS)

    Pan, Dongqing; Chien Jen, Tien; Li, Tao; Yuan, Chris

    2014-01-01

    This paper characterizes the carrier gas flow in the atomic layer deposition (ALD) vacuum reactor by introducing Lattice Boltzmann Method (LBM) to the ALD simulation through a comparative study of two LBM models. Numerical models of gas flow are constructed and implemented in two-dimensional geometry based on lattice Bhatnagar–Gross–Krook (LBGK)-D2Q9 model and two-relaxation-time (TRT) model. Both incompressible and compressible scenarios are simulated and the two models are compared in the aspects of flow features, stability, and efficiency. Our simulation outcome reveals that, for our specific ALD vacuum reactor, TRT model generates better steady laminar flow features all over the domain with better stability and reliability than LBGK-D2Q9 model especially when considering the compressible effects of the gas flow. The LBM-TRT is verified indirectly by comparing the numerical result with conventional continuum-based computational fluid dynamics solvers, and it shows very good agreement with these conventional methods. The velocity field of carrier gas flow through ALD vacuum reactor was characterized by LBM-TRT model finally. The flow in ALD is in a laminar steady state with velocity concentrated at the corners and around the wafer. The effects of flow fields on precursor distributions, surface absorptions, and surface reactions are discussed in detail. Steady and evenly distributed velocity field contribute to higher precursor concentration near the wafer and relatively lower particle velocities help to achieve better surface adsorption and deposition. The ALD reactor geometry needs to be considered carefully if a steady and laminar flow field around the wafer and better surface deposition are desired

  12. Numerical modeling of carrier gas flow in atomic layer deposition vacuum reactor: A comparative study of lattice Boltzmann models

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Dongqing; Chien Jen, Tien [Department of Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53201 (United States); Li, Tao [School of Mechanical Engineering, Dalian University of Technology, Dalian 116024 (China); Yuan, Chris, E-mail: cyuan@uwm.edu [Department of Mechanical Engineering, University of Wisconsin-Milwaukee, 3200 North Cramer Street, Milwaukee, Wisconsin 53211 (United States)

    2014-01-15

    This paper characterizes the carrier gas flow in the atomic layer deposition (ALD) vacuum reactor by introducing Lattice Boltzmann Method (LBM) to the ALD simulation through a comparative study of two LBM models. Numerical models of gas flow are constructed and implemented in two-dimensional geometry based on lattice Bhatnagar–Gross–Krook (LBGK)-D2Q9 model and two-relaxation-time (TRT) model. Both incompressible and compressible scenarios are simulated and the two models are compared in the aspects of flow features, stability, and efficiency. Our simulation outcome reveals that, for our specific ALD vacuum reactor, TRT model generates better steady laminar flow features all over the domain with better stability and reliability than LBGK-D2Q9 model especially when considering the compressible effects of the gas flow. The LBM-TRT is verified indirectly by comparing the numerical result with conventional continuum-based computational fluid dynamics solvers, and it shows very good agreement with these conventional methods. The velocity field of carrier gas flow through ALD vacuum reactor was characterized by LBM-TRT model finally. The flow in ALD is in a laminar steady state with velocity concentrated at the corners and around the wafer. The effects of flow fields on precursor distributions, surface absorptions, and surface reactions are discussed in detail. Steady and evenly distributed velocity field contribute to higher precursor concentration near the wafer and relatively lower particle velocities help to achieve better surface adsorption and deposition. The ALD reactor geometry needs to be considered carefully if a steady and laminar flow field around the wafer and better surface deposition are desired.

  13. Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study.

    Science.gov (United States)

    Gilot, Gregory J; Alvarez-Pinzon, Andres M; Barcksdale, Leticia; Westerdahl, David; Krill, Michael; Peck, Evan

    2015-08-01

    To compare the results of arthroscopic repair of large to massive rotator cuff tears (RCTs) with or without augmentation using an extracellular matrix (ECM) graft and to present ECM graft augmentation as a valuable surgical alternative used for biomechanical reinforcement in any RCT repair. We performed a prospective, blinded, single-center, comparative study of patients who underwent arthroscopic repair of a large to massive RCT with or without augmentation with ECM graft. The primary outcome was assessed by the presence or absence of a retear of the previously repaired rotator cuff, as noted on ultrasound examination. The secondary outcomes were patient satisfaction evaluated preoperatively and postoperatively using the 12-item Short Form Health Survey, the American Shoulder and Elbow Surgeons shoulder outcome score, a visual analog scale score, the Western Ontario Rotator Cuff index, and a shoulder activity level survey. We enrolled 35 patients in the study: 20 in the ECM-augmented rotator cuff repair group and 15 in the control group. The follow-up period ranged from 22 to 26 months, with a mean of 24.9 months. There was a significant difference between the groups in terms of the incidence of retears: 26% (4 retears) in the control group and 10% (2 retears) in the ECM graft group (P = .0483). The mean pain level decreased from 6.9 to 4.1 in the control group and from 6.8 to 0.9 in the ECM graft group (P = .024). The American Shoulder and Elbow Surgeons score improved from 62.1 to 72.6 points in the control group and from 63.8 to 88.9 points (P = .02) in the treatment group. The mean Short Form 12 scores improved in the 2 groups, with a statistically significant difference favoring graft augmentation (P = .031), and correspondingly, the Western Ontario Rotator Cuff index scores improved in both arms, favoring the treatment group (P = .0412). The use of ECM for augmentation of arthroscopic repairs of large to massive RCTs reduces the incidence of retears

  14. [Analysis of clinical outcomes of different embryo stage biopsy in array comparative genomic hybridization based preimplantation genetic diagnosis and screening].

    Science.gov (United States)

    Shen, J D; Wu, W; Shu, L; Cai, L L; Xie, J Z; Ma, L; Sun, X P; Cui, Y G; Liu, J Y

    2017-12-25

    Objective: To evaluate the efficiency of the application of array comparative genomic hybridization (array-CGH) in preimplantation genetic diagnosis or screening (PGD/PGS), and compare the clinical outcomes of different stage embryo biopsy. Methods: The outcomes of 381 PGD/PGS cycles referred in the First Affiliated Hospital of Nanjing Medical University from July 2011 to August 2015 were retrospectively analyzed. There were 320 PGD cycles with 156 cleavage-stage-biopsy cycles and 164 trophectoderm-biopsy cycles, 61 PGS cycles with 23 cleavage-stage-biopsy cycles and 38 trophectoderm-biopsy cycles. Chromosomal analysis was performed by array-CGH technology combined with whole genome amplification. Single embryo transfer was performed in all transfer cycles. Live birth rate was calculated as the main clinical outcomes. Results: The embryo diagnosis rate of PGD/PGS by array-CGH were 96.9%-99.1%. In PGD biopsy cycles, the live birth rate per embryo transfer cycle and live birth rate per embryo biopsy cycle were 50.0%(58/116) and 37.2%(58/156) in cleavage-stage-biopsy group, 67.5%(85/126) and 51.8%(85/164) in trophectoderm-biopsy group (both P 0.05). Conclusions: High diagnosis rate and idea live birth rate are achieved in PGD/PGS cycles based on array-CGH technology. The live birth rate of trophectoderm-biopsy group is significantly higher than that of cleavage-stage-biopsy group in PGD cycles; the efficiency of trophectoderm-biopsy is better.

  15. 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…

  16. 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

    2012-01-01

    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 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. PMID:22622598

  17. Machine-Learning-Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index.

    Science.gov (United States)

    Levin, Scott; Toerper, Matthew; Hamrock, Eric; Hinson, Jeremiah S; Barnes, Sean; Gardner, Heather; Dugas, Andrea; Linton, Bob; Kirsch, Tom; Kelen, Gabor

    2018-05-01

    Standards for emergency department (ED) triage in the United States rely heavily on subjective assessment and are limited in their ability to risk-stratify patients. This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. A multisite, retrospective, cross-sectional study of 172,726 ED visits from urban and community EDs was conducted. E-triage is composed of a random forest model applied to triage data (vital signs, chief complaint, and active medical history) that predicts the need for critical care, an emergency procedure, and inpatient hospitalization in parallel and translates risk to triage level designations. Predicted outcomes and secondary outcomes of elevated troponin and lactate levels were evaluated and compared with the Emergency Severity Index (ESI). E-triage predictions had an area under the curve ranging from 0.73 to 0.92 and demonstrated equivalent or improved identification of clinical patient outcomes compared with ESI at both EDs. E-triage provided rationale for risk-based differentiation of the more than 65% of ED visits triaged to ESI level 3. Matching the ESI patient distribution for comparisons, e-triage identified more than 10% (14,326 patients) of ESI level 3 patients requiring up triage who had substantially increased risk of critical care or emergency procedure (1.7% ESI level 3 versus 6.2% up triaged) and hospitalization (18.9% versus 45.4%) across EDs. E-triage more accurately classifies ESI level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking. Further prospective validation is needed. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  18. 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.

  19. Diferentes modelos de gestão de serviços de saneamento produzem os mesmos resultados? Um estudo comparativo em Minas Gerais com base em indicadores Different management models for water supply and sanitation services produce the same outcomes? A comparative study in Minas Gerais, Brazil, based on indicators

    Directory of Open Access Journals (Sweden)

    Léo Heller

    2006-12-01

    Full Text Available O trabalho compara grupos de 600 municípios de Minas Gerais, segundo as diferentes categorias de gestores dos serviços de saneamento: (1 aqueles em que a sede tem os sistemas administrados por autarquia municipal, conveniada com a FUNASA; (2 em que a autarquia fora outrora conveniada com a FUNASA; (3 sistemas sob responsabilidade de autarquia municipal; (4 sistemas de abastecimento de água administrados pela COPASA e de esgotamento sanitário pelo município; (5 ambos os serviços administrados pela COPASA; (6 serviços administrados diretamente pela prefeitura e (7 novos municípios, criados após 1989. A pesquisa foi realizada para o ano base de 1998, empregando dados secundários. Foram construídos indicadores operacionais, epidemiológicos e sociais para cada um dos municípios. As comparações foram realizadas por meio de diversas técnicas estatísticas, incluindo multivariadas. Os resultados indicam diferenças entre os gestores e que, além do bom desempenho da COPASA em alguns aspectos, o conjunto de municípios com serviços administrados por autarquias destaca-se positivamente.The paper compares groups from 600 municipalities, according to different categories of management models: (1 water supply and sanitation (WSS managed by a municipal autarchy, through cooperation with FUNASA; (2 WSS managed by a municipal autarchy that had had a cooperation agreement with FUNASA; (3 WSS managed by a municipal autarchy; (4 water supply managed by COPASA and sanitation directly by the municipality; (5 both water supply and sanitation managed by COPASA; (6 WSS directly managed by the municipality; (7 new municipalities, created after 1989. The research used data of 1998 from secondary sources. Operational, epidemiological, and social indicators were created for each municipality. The comparisons were performed by several statistical techniques, including multivariate ones. The results indicate differences between the management models and

  20. Can community change be measured for an outcomes-based initiative? A comparative case study of the success by 6 initiative.

    Science.gov (United States)

    Minich, Lisa; Howe, Steven; Langmeyer, Daniel; Corcoran, Kevin

    2006-12-01

    One of the challenges facing nonprofit organizations today is the demand for measurable results. Increasingly, these organizations are focusing less on program outputs and program outcomes in favor of community outcomes or changes demonstrated in the larger community. Success by 6(R) is a popular United Way initiative that emphasizes defining and measuring community outcomes. In this paper, we describe our work with 24 Success by 6(R) initiatives around the country. It is clear that not all of these initiatives are measuring community outcomes. Of those initiatives that are experiencing some success measuring community outcomes, similar measurement strategies are reported. Additionally, our experience suggests several United Way employees express dissatisfaction with the logic model as a framework for defining and measuring community outcomes although no preferred alternative model is identified. Evaluators working with community-wide initiatives must find ways to communicate the differences between program and community outcomes to key stakeholders and funders.

  1. Comparative Evaluation of Some Crop Yield Prediction Models ...

    African Journals Online (AJOL)

    A computer program was adopted from the work of Hill et al. (1982) to calibrate and test three of the existing yield prediction models using tropical cowpea yieldÐweather data. The models tested were Hanks Model (first and second versions). Stewart Model (first and second versions) and HallÐButcher Model. Three sets of ...

  2. How Do People Think About Interdependence? A Multidimensional Model of Subjective Outcome Interdependence.

    Science.gov (United States)

    Gerpott, Fabiola H; Balliet, Daniel; Columbus, Simon; Molho, Catherine; de Vries, Reinout E

    2017-09-04

    Interdependence is a fundamental characteristic of social interactions. Interdependence Theory states that 6 dimensions describe differences between social situations. Here we examine if these 6 dimensions describe how people think about their interdependence with others in a situation. We find that people (in situ and ex situ) can reliably differentiate situations according to 5, but not 6, dimensions of interdependence: (a) mutual dependence, (b) power, (c) conflict, (d) future interdependence, and (e) information certainty. This model offers a unique framework for understanding how people think about social situations compared to another recent model of situation construal (DIAMONDS). Furthermore, we examine factors that are theorized to shape perceptions of interdependence, such as situational cues (e.g., nonverbal behavior) and personality (e.g., HEXACO and Social Value Orientation). We also study the implications of subjective interdependence for emotions and cooperative behavior during social interactions. This model of subjective interdependence explains substantial variation in the emotions people experience in situations (i.e., happiness, sadness, anger, and disgust), and explains 24% of the variance in cooperation, above and beyond the DIAMONDS model. Throughout these studies, we develop and validate a multidimensional measure of subjective outcome interdependence that can be used in diverse situations and relationships-the Situational Interdependence Scale (SIS). We discuss how this model of interdependence can be used to better understand how people think about social situations encountered in close relationships, organizations, and society. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Comparing the relative cost-effectiveness of diagnostic studies: a new model

    International Nuclear Information System (INIS)

    Patton, D.D.; Woolfenden, J.M.; Wellish, K.L.

    1986-01-01

    We have developed a model to compare the relative cost-effectiveness of two or more diagnostic tests. The model defines a cost-effectiveness ratio (CER) for a diagnostic test as the ratio of effective cost to base cost, only dollar costs considered. Effective cost includes base cost, cost of dealing with expected side effects, and wastage due to imperfect test performance. Test performance is measured by diagnostic utility (DU), a measure of test outcomes incorporating the decision-analytic variables sensitivity, specificity, equivocal fraction, disease probability, and outcome utility. Each of these factors affecting DU, and hence CER, is a local, not universal, value; these local values strongly affect CER, which in effect becomes a property of the local medical setting. When DU = +1 and there are no adverse effects, CER = 1 and the patient benefits from the test dollar for dollar. When there are adverse effects effective cost exceeds base cost, and for an imperfect test DU 1. As DU approaches 0 (worthless test), CER approaches infinity (no effectiveness at any cost). If DU is negative, indicating that doing the test at all would be detrimental, CER also becomes negative. We conclude that the CER model is a useful preliminary method for ranking the relative cost-effectiveness of diagnostic tests, and that the comparisons would best be done using local values; different groups might well arrive at different rankings. (Author)

  4. A Bayesian Approach to Functional Mixed Effect Modeling for Longitudinal Data with Binomial Outcomes

    Science.gov (United States)

    Kliethermes, Stephanie; Oleson, Jacob

    2014-01-01

    Longitudinal growth patterns are routinely seen in medical studies where individual and population growth is followed over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear, quadratic); however, these relationships may not accurately capture growth over time. Functional mixed effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well-developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible and thus estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. PMID:24723495

  5. A Bayesian approach to functional mixed-effects modeling for longitudinal data with binomial outcomes.

    Science.gov (United States)

    Kliethermes, Stephanie; Oleson, Jacob

    2014-08-15

    Longitudinal growth patterns are routinely seen in medical studies where individual growth and population growth are followed up over a period of time. Many current methods for modeling growth presuppose a parametric relationship between the outcome and time (e.g., linear and quadratic); however, these relationships may not accurately capture growth over time. Functional mixed-effects (FME) models provide flexibility in handling longitudinal data with nonparametric temporal trends. Although FME methods are well developed for continuous, normally distributed outcome measures, nonparametric methods for handling categorical outcomes are limited. We consider the situation with binomially distributed longitudinal outcomes. Although percent correct data can be modeled assuming normality, estimates outside the parameter space are possible, and thus, estimated curves can be unrealistic. We propose a binomial FME model using Bayesian methodology to account for growth curves with binomial (percentage) outcomes. The usefulness of our methods is demonstrated using a longitudinal study of speech perception outcomes from cochlear implant users where we successfully model both the population and individual growth trajectories. Simulation studies also advocate the usefulness of the binomial model particularly when outcomes occur near the boundary of the probability parameter space and in situations with a small number of trials. Copyright © 2014 John Wiley & Sons, Ltd.

  6. Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older.

    Science.gov (United States)

    Steadman, J Richard; Matheny, Lauren M; Singleton, Steven B; Johnson, Nicholas S; Rodkey, William G; Crespo, Bernardo; Briggs, Karen K

    2015-09-01

    Few studies have compared outcomes after meniscus suture repair in patients younger than 40 years versus patients 40 years and older. To document failure rates and long-term outcomes after meniscus suture repair by a single surgeon, using the inside-out technique, at a minimum 10-year follow-up in patients younger than 40 years versus those 40 years and older. Cohort study; Level of evidence, 3. This study included all patients 18 years or older who underwent meniscus suture repair with the inside-out technique by a single surgeon between January 1992 and December 2003. Patients were divided into 2 cohorts according to age: meniscus as repaired in the index surgery. Patients completed a subjective questionnaire at minimum of 10 years after arthroscopy. Outcomes measures included Lysholm, Tegner, and patient satisfaction with outcome. All data were collected prospectively. The surgeon performed 339 meniscus repairs between 1992 and 2003. The study included 181 knees in 178 patients, who had a mean age of 33 years (range, 18-70 years). Cohort 1 contained 136 knees; 16 patients (12%) were lost to follow-up and 47 (35%) underwent a subsequent knee arthroscopy. Cohort 2 contained 45 knees; 2 patients (4.4%) were lost to follow-up, 3 patients had a total knee arthroplasty, and 12 patients (28%) underwent a subsequent knee arthroscopy. In cohort 1, the meniscus repair failure rate was 5.5% (6/110), and in cohort 2 it was 5.3% (2/38) (P = .927). There was no significant difference in failure rate based on which meniscus was repaired (P = .257), concomitant anterior cruciate ligament (ACL) reconstruction (P = .092), or microfracture (P = .674). Average follow-up time for cohort 1 was 16.1 years (range, 10.0-21.9 years), with 82% follow-up (n = 73/89); average follow-up time for cohort 2 was 16.2 years (range, 10.1-21.0 years), with 93% follow-up (n = 28/30). There were no significant differences in outcomes scores after meniscus suture repair based on age cohort or meniscus

  7. 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

  8. Jump Model / Comparability Ratio Model — Joinpoint Help System 4.4.0.0

    Science.gov (United States)

    The Jump Model / Comparability Ratio Model in the Joinpoint software provides a direct estimation of trend data (e.g. cancer rates) where there is a systematic scale change, which causes a “jump” in the rates, but is assumed not to affect the underlying trend.

  9. Traumatic brain injury and alcohol/substance abuse: A Bayesian meta-analysis comparing the outcomes of people with and without a history of abuse.

    Science.gov (United States)

    Unsworth, David J; Mathias, Jane L

    2017-08-01

    Alcohol and substance (drugs and/or alcohol) abuse are major risk factors for traumatic brain injury (TBI); however, it remains unclear whether outcomes differ for those with and without a history of preinjury abuse. A meta-analysis was performed to examine this issue. The PubMed, Embase, and PsycINFO databases were searched for research that compared the neuroradiological, cognitive, or psychological outcomes of adults with and without a documented history of alcohol and/or substance abuse who sustained nonpenetrating TBIs. Data from 22 studies were analyzed using a random-effects model: Hedges's g effect sizes measured the mean difference in outcomes of individuals with/without a history of preinjury abuse, and Bayes factors assessed the probability that the outcomes differed. Patients with a history of alcohol and/or substance abuse had poorer neuroradiological outcomes, including reduced hippocampal (g = -0.82) and gray matter volumes (g = -0.46 to -0.82), and enlarged cerebral ventricles (g = -0.73 to -0.80). There were limited differences in cognitive outcomes: Executive functioning (g = -0.51) and memory (g = -0.39 to -0.43) were moderately affected, but attention and reasoning were not. The findings for fine motor ability, construction, perception, general cognition, and language were inconclusive. Postinjury substance and alcohol use (g = -0.97 to -1.07) and emotional functioning (g = -0.29 to -0.44) were worse in those with a history of alcohol and/or substance abuse (psychological outcomes). This study highlighted the type and extent of post-TBI differences between persons with and without a history of alcohol or substance abuse, many of which may hamper recovery. However, variation in the criteria for premorbid abuse, limited information regarding the history of abuse, and an absence of preinjury baseline data prevented an assessment of whether the differences predated the TBI, occurred as a result of ongoing alcohol/substance abuse, or

  10. Clinical outcomes of CO2-less single-port video-assisted thoracoscopic thymectomy versus open thymectomy: comparative study.

    Science.gov (United States)

    Aragón, Javier; Pérez Méndez, Itzell; Gutiérrez Pérez, Alexia

    2016-01-01

    Although video-assisted thoracoscopic surgery (VATS) for thymic disorders has been introduced, its oncological outcome and benefits over others open approaches remains unclear. Single-port VATS thymectomy using a flexible port and CO 2 has been described. However, VATS thymectomy is possible by a single incision of 3 cm without CO 2 insufflation or special port device avoiding objections related to CO 2 insufflation and allowing instruments to move more freely making procedure easier and cheaper. Our institutional experience in open and CO 2 -less VATS single-port thymectomy was retrospectively reviewed to evaluate compared to sternotomy, the clinical and oncological outcomes with this novel approach. A retrospective review consisting of 84 patients who underwent thymectomy because different thymic disorders especially thymoma was performed. Eighteen patients underwent CO 2 -less VATS single port thymectomy, while 66 underwent thymectomy through open sternotomy. Many clinical factors associated with the surgical and clinical outcomes, including tumor recurrence and clinical remission, were recorded. Non major postoperative complications were observed in any group. The median operative time and postoperative hospital stay of CO 2 -less VATS single port thymectomy were 95 min and 1 day, respectively and 120 min and 7 days for open sternotomy. The thymoma was the most common thymic disorder with 7 patients (38%) in VATS group and 28 patients (42.4%) for the open approach. The median lesion size was 2.6 cm in the VATS group and 3.2 cm in the open approach. No thymoma recurrence in patients undergoing VATS was observed during the follow-up time, while in the open surgery group 14.28% recurrence was observed, distributed as follows: loco-regional 75% and 25% at distance; free disease period of these patients was 8.3 months. Thymectomy associated with myasthenia gravis (MG) was observed in 6 (33%) patients in the VATS group and 32 (48%) patients for sternotomy; our

  11. Grafton and local bone have comparable outcomes to iliac crest bone in instrumented single-level lumbar fusions.

    Science.gov (United States)

    Kang, James; An, Howard; Hilibrand, Alan; Yoon, S Tim; Kavanagh, Eoin; Boden, Scott

    2012-05-20

    Prospective multicenter randomized clinical trail. The goal of our 2-year prospective study was to perform a randomized clinical trial comparing the outcomes of Grafton demineralized bone matrix (DBM) Matrix with local bone with that of iliac crest bone graft (ICBG) in a single-level instrumented posterior lumbar fusion. There has been extensive research and development in identifying a suitable substitute to replace autologous ICBG that is associated with known morbidities. DBMs are a class of commercially available grafting agents that are prepared from allograft bone. Many such products have been commercially available for clinical use; however, their efficacy for spine fusion has been mostly based on anecdotal evidence rather than randomized controlled clinical trials. Forty-six patients were randomly assigned (2:1) to receive Grafton DBM Matrix with local bone (30 patients) or autologous ICBG (16 patients). The mean age was 64 (females [F] = 21, males [M] = 9) in the DBM group and 65 (F = 9, M = 5) in the ICBG group. An independent radiologist evaluated plain radiographs and computed tomographic scans at 6-month, 1-year, and 2-year time points. Clinical outcomes were measured using Oswestry Disability Index (ODI) and Medical Outcomes Study 36-Item Short Form Health Survey. Forty-one patients (DBM = 28 and ICBG = 13) completed the 2-year follow-up. Final fusion rates were 86% (Grafton Matrix) versus 92% (ICBG) (P = 1.0 not significant). The Grafton group showed slightly better improvement in ODI score than the ICBG group at the final 2-year follow-up (Grafton [16.2] and ICBG [22.7]); however, the difference was not statistically significant (P = 0.2346 at 24 mo). Grafton showed consistently higher physical function scores at 24 months; however, differences were not statistically significant (P = 0.0823). Similar improvements in the physical component summary scores were seen in both the Grafton and ICBG groups. There was a statistically significant greater mean

  12. 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

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

    Science.gov (United States)

    Haidvogl, Max; Riley, David S; Heger, Marianne; Brien, Sara; Jong, Miek; Fischer, Michael; Lewith, George T; Jansen, Gerard; Thurneysen, André E

    2007-01-01

    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 treatment both

  14. Family Socialization and Children's School Outcomes: An Investigation of a Parenting Model.

    Science.gov (United States)

    Marjoribanks, Kevin

    1996-01-01

    Investigates the relationships between the characteristics of a parenting model and children's school outcomes. Utilizes interviews to identify and define parenting styles. Discovers that parenting styles affect academic achievement and school attitudes but do little to influence the relationship between intellectual ability and school outcomes.…

  15. A Statistical Model for Misreported Binary Outcomes in Clustered RCTs of Education Interventions

    Science.gov (United States)

    Schochet, Peter Z.

    2013-01-01

    In education randomized control trials (RCTs), the misreporting of student outcome data could lead to biased estimates of average treatment effects (ATEs) and their standard errors. This article discusses a statistical model that adjusts for misreported binary outcomes for two-level, school-based RCTs, where it is assumed that misreporting could…

  16. Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia

    NARCIS (Netherlands)

    Siregar, A.Y.M.; Komarudin, D.; Wisaksana, R.; Crevel, R. van; Baltussen, R.M.P.M.

    2011-01-01

    OBJECTIVE: To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. METHODS: We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually

  17. Brazilian experience in electricity auctions: Comparing outcomes from new and old energy auctions as well as the application of the hybrid Anglo-Dutch design

    International Nuclear Information System (INIS)

    Rego, Erik Eduardo; Parente, Virginia

    2013-01-01

    Since 2004, the Government of Brazil (GoB) has acted as an intermediary between distribution and generator companies in the energy procurement sector. The GoB procures energy from generator companies through auctions of long-term energy contracts. After an auction, the winning generator companies sign contracts directly with distribution companies. In particular, the GoB runs two different auctions: one for energy from existing power plants (i.e., old energy) and another for energy from power plants that have not yet been built (i.e., new energy). This paper describes these auctions and compares the outcomes from the old and new energy auctions from 2004 to 2010 using final auction prices. The Brazilian case is particularly interesting, not only because energy is predominantly supplied by hydropower plants but also because new energy auctions reach prices below those for old energy. Therefore, it is likely that it is not necessary to run the two different energy auctions. As a secondary objective, this article analyze whether the Anglo-Dutch hybrid auction model is a better design for electricity procurement in Brazil. - Highlights: ► We analyze the outcomes from the Brazilian old and new energy auctions. ► We evaluate the Anglo-Dutch auction design. ► Outcomes from both kind of auctions reveal that the prices are statistically similar. ► One kind of auction increase competition and minimize Eletrobras' market power

  18. A Comparative Study on the Relationship Between Learning Motivations and Outcomes of College Students in Taiwan and Shenzhen Region of Mainland China: Learning Modes as Mediators

    Directory of Open Access Journals (Sweden)

    Sophia Shi-Huei Ho

    2016-06-01

    Full Text Available Previous studies in the relationship of learning motivation and outcome were mostly conducted on research samples in Asia from the perspective of oriental culture; however, under the same cultural background, different social systems might lead to different teaching and learning outcomes. Therefore, this study examines the learning motivation patterns of Taiwan and Mainland China college students from the perspectives on psychological motivation, and investigates the relationship between learning modes and learning outcomes. Adopting judgmental sampling, a total of 651 valid questionnaires were collected from cross-strait business college sophomore, junior, and senior students. The measurement scales were developed by Li et al. (2007, Nasir et al. (2009, Philip et al. (2008, Pike et al. (2011, White et al. (2008, and all measures were 5-point Likert-type scales. The path relationship of the two groups was examined through structural equation modeling (SEM using AMOS. The results showed that exploitative learning was perceived as more effective by the college students in Taiwan as compared to those in Mainland China. In terms of academic identity, the contrary is the case. However, in path analysis, Taiwanese students were superior to Chinese students in regard to the positive influence of role identity on exploitative and explorative learning and the positive influence of exploitative learning on cognitive and non-cognitive gains.

  19. 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.

  20. Characterizing Cavities in Model Inclusion Fullerenes: A Comparative Study

    Directory of Open Access Journals (Sweden)

    Francisco Torrens

    2001-06-01

    Full Text Available Abstract: The fullerene-82 cavity is selected as a model system in order to test several methods for characterizing inclusion molecules. The methods are based on different technical foundations such as a square and triangular tessellation of the molecular surface, spherical tessellation of the molecular surface, numerical integration of the atomic volumes and surfaces, triangular tessellation of the molecular surface, and cubic lattice approach to the molecular volume. Accurate measures of the molecular volume and surface area have been performed with the pseudorandom Monte Carlo (MCVS and uniform Monte Carlo (UMCVS methods. These calculations serve as a reference for the rest of the methods. The SURMO2 method does not recognize the cavity and may not be convenient for intercalation compounds. The programs that detect the cavities never exceed 1% deviation relative to the reference value for molecular volume and 5% for surface area. The GEPOL algorithm, alone or combined with TOPO, shows results in good agreement with those of the UMCVS reference. The uniform random number generator provides the fastest convergence for UMCVS and a correct estimate of the standard deviations. The effect of the internal cavity on the solvent-accessible surfaces has been calculated. Fullerene-82 is compared with fullerene-60 and -70.

  1. 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.

  2. Modeling Conformal Growth in Photonic Crystals and Comparing to Experiment

    Science.gov (United States)

    Brzezinski, Andrew; Chen, Ying-Chieh; Wiltzius, Pierre; Braun, Paul

    2008-03-01

    Conformal growth, e.g. atomic layer deposition (ALD), of materials such as silicon and TiO2 on three dimensional (3D) templates is important for making photonic crystals. However, reliable calculations of optical properties as a function of the conformal growth, such as the optical band structure, are hampered by difficultly in accurately assessing a deposited material's spatial distribution. A widely used approximation ignores ``pinch off'' of precursor gas and assumes complete template infilling. Another approximation results in non-uniform growth velocity by employing iso-intensity surfaces of the 3D interference pattern used to create the template. We have developed an accurate model of conformal growth in arbitrary 3D periodic structures, allowing for arbitrary surface orientation. Results are compared with the above approximations and with experimentally fabricated photonic crystals. We use an SU8 polymer template created by 4-beam interference lithography, onto which various amounts of TiO2 are grown by ALD. Characterization is performed by analysis of cross-sectional scanning electron micrographs and by solid angle resolved optical spectroscopy.

  3. 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.

  4. 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

    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). 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. 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. 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.

  5. Bilateral Cavernous Nerve Crush Injury in the Rat Model: A Comparative Review of Pharmacologic Interventions.

    Science.gov (United States)

    Haney, Nora M; Nguyen, Hoang M T; Honda, Matthew; Abdel-Mageed, Asim B; Hellstrom, Wayne J G

    2018-04-01

    It is common for men to develop erectile dysfunction after radical prostatectomy. The anatomy of the rat allows the cavernous nerve (CN) to be identified, dissected, and injured in a controlled fashion. Therefore, bilateral CN injury (BCNI) in the rat model is routinely used to study post-prostatectomy erectile dysfunction. To compare and contrast the available literature on pharmacologic intervention after BCNI in the rat. A literature search was performed on PubMed for cavernous nerve and injury and erectile dysfunction and rat. Only articles with BCNI and pharmacologic intervention that could be grouped into categories of immune modulation, growth factor therapy, receptor kinase inhibition, phosphodiesterase type 5 inhibition, and anti-inflammatory and antifibrotic interventions were included. To assess outcomes of pharmaceutical intervention on erectile function recovery after BCNI in the rat model. The ratio of maximum intracavernous pressure to mean arterial pressure was the main outcome measure chosen for this analysis. All interventions improved erectile function recovery after BCNI based on the ratio of maximum intracavernous pressure to mean arterial pressure results. Additional end-point analysis examined the corpus cavernosa and/or the major pelvic ganglion and CN. There was extreme heterogeneity within the literature, making accurate comparisons between crush injury and therapeutic interventions difficult. BCNI in the rat is the accepted animal model used to study nerve-sparing post-prostatectomy erectile dysfunction. However, an important limitation is extreme variability. Efforts should be made to decrease this variability and increase the translational utility toward clinical trials in humans. Haney NM, Nguyen HMT, Honda M, et al. Bilateral Cavernous Nerve Crush Injury in the Rat Model: A Comparative Review of Pharmacologic Interventions. Sex Med Rev 2018;6:234-241. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier

  6. Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation: The Maugeri Model.

    Science.gov (United States)

    Scrutinio, Domenico; Lanzillo, Bernardo; Guida, Pietro; Mastropasqua, Filippo; Monitillo, Vincenzo; Pusineri, Monica; Formica, Roberto; Russo, Giovanna; Guarnaschelli, Caterina; Ferretti, Chiara; Calabrese, Gianluigi

    2017-12-01

    Prediction of outcome after stroke rehabilitation may help clinicians in decision-making and planning rehabilitation care. We developed and validated a predictive tool to estimate the probability of achieving improvement in physical functioning (model 1) and a level of independence requiring no more than supervision (model 2) after stroke rehabilitation. The models were derived from 717 patients admitted for stroke rehabilitation. We used multivariable logistic regression analysis to build each model. Then, each model was prospectively validated in 875 patients. Model 1 included age, time from stroke occurrence to rehabilitation admission, admission motor and cognitive Functional Independence Measure scores, and neglect. Model 2 included age, male gender, time since stroke onset, and admission motor and cognitive Functional Independence Measure score. Both models demonstrated excellent discrimination. In the derivation cohort, the area under the curve was 0.883 (95% confidence intervals, 0.858-0.910) for model 1 and 0.913 (95% confidence intervals, 0.884-0.942) for model 2. The Hosmer-Lemeshow χ 2 was 4.12 ( P =0.249) and 1.20 ( P =0.754), respectively. In the validation cohort, the area under the curve was 0.866 (95% confidence intervals, 0.840-0.892) for model 1 and 0.850 (95% confidence intervals, 0.815-0.885) for model 2. The Hosmer-Lemeshow χ 2 was 8.86 ( P =0.115) and 34.50 ( P =0.001), respectively. Both improvement in physical functioning (hazard ratios, 0.43; 0.25-0.71; P =0.001) and a level of independence requiring no more than supervision (hazard ratios, 0.32; 0.14-0.68; P =0.004) were independently associated with improved 4-year survival. A calculator is freely available for download at https://goo.gl/fEAp81. This study provides researchers and clinicians with an easy-to-use, accurate, and validated predictive tool for potential application in rehabilitation research and stroke management. © 2017 American Heart Association, Inc.

  7. Outcome evaluation of a new model of critical care orientation.

    Science.gov (United States)

    Morris, Linda L; Pfeifer, Pamela; Catalano, Rene; Fortney, Robert; Nelson, Greta; Rabito, Robb; Harap, Rebecca

    2009-05-01

    The shortage of critical care nurses and the service expansion of 2 intensive care units provided a unique opportunity to create a new model of critical care orientation. The goal was to design a program that assessed critical thinking, validated competence, and provided learning pathways that accommodated diverse experience. To determine the effect of a new model of critical care orientation on satisfaction, retention, turnover, vacancy, preparedness to manage patient care assignment, length of orientation, and cost of orientation. A prospective, quasi-experimental design with both quantitative and qualitative methods. The new model improved satisfaction scores, retention rates, and recruitment of critical care nurses. Length of orientation was unchanged. Cost was increased, primarily because a full-time education consultant was added. A new model for nurse orientation that was focused on critical thinking and competence validation improved retention and satisfaction and serves as a template for orientation of nurses throughout the medical center.

  8. 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.

  9. Comparing Outcomes of Coronary Artery Bypass Grafting Among Large Teaching and Urban Hospitals in China and the United States.

    Science.gov (United States)

    Zheng, Zhe; Zhang, Heng; Yuan, Xin; Rao, Chenfei; Zhao, Yan; Wang, Yun; Normand, Sharon-Lise; Krumholz, Harlan M; Hu, Shengshou

    2017-06-01

    Coronary artery disease is prevalent in China, with concomitant increases in the volume of coronary artery bypass grafting (CABG). The present study aims to compare CABG-related outcomes between China and the United States among large teaching and urban hospitals. Observational analysis of patients aged ≥18 years, discharged from acute-care, large teaching and urban hospitals in China and the United States after hospitalization for an isolated CABG surgery. Data were obtained from the Chinese Cardiac Surgery Registry in China and the National Inpatient Sample in the United States. Analysis was stratified by 2 periods: 2007, 2008, and 2010; and 2011 to 2013 periods. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. The sample included 51 408 patients: 32 040 from 77 hospitals in the China-CABG group and 19 368 from 303 hospitals in the US-CABG group. In the 2007 to 2008, 2010 period and for all-age and aged ≥65 years, the China-CABG group had higher mortality than the US-CABG group (1.91% versus 1.58%, P =0.059; and 3.12% versus 2.20%, P =0.004) and significantly higher age-, sex-, and comorbidity-adjusted odds of death (odds ratio, 1.58; 95% confidential interval, 1.22-2.04; and odds ratio, 1.73; 95% confidential interval, 1.24-2.40). There were no significant mortality differences in the 2011 to 2013 period. For preoperative, postoperative, and total hospital stay, respectively, the median (interquartile range) length of stay across the entire study period between China-CABG and US-CABG groups were 9 (8) versus 1 (3), 9 (6) versus 6 (3), and 20 (12) versus 7 (5) days (all P China and the United States. The longer length of stay in China may represent an opportunity for improvement. © 2017 The Authors.

  10. Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

    Science.gov (United States)

    Duchesne, Juan C; Simmons, Jon D; Schmieg, Robert E; McSwain, Norman E; Bellows, Charles F

    2008-12-01

    Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy. A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years. The cohorts were defined by two separate 30 month periods and included 78 patients seen before (group I) and 76 patients seen after (group II) the introduction of an institutional SAE protocol. Demographics, splenic injury grade, and outcomes of the two groups were compared using Student's t test, or chi2 test. Analysis was by intention-to-treat. Six hundred eighty-two patients with blunt splenic injury were identified; 154 patients (29%) were HDS with CT evidence of active contrast extravasation. Group I (n = 78) was treated with splenectomy and group II (n = 76) was treated with proximal SAE. There was no difference in age (33 +/- 14 vs. 37 +/- 17 years), Injury Severity Score (31 +/- 13 vs. 29 +/- 11), or mortality (18% vs. 15%) between the two groups. However, the incidence of Adult Respiratory Distress Syndrome (ARDS) was 4-fold higher in those patients that underwent proximal SAE compared with those that underwent splenectomy (22% vs. 5%, p = 0.002). Twenty two patients failed nonoperative management (NOM) after SAE. This failure appeared to be directly related to the grade of splenic organ injury (grade I and II: 0%; grade III: 24%; grade IV: 53%; and grade V: 100%). Introduction of proximal SAE in NOM of HDS splenic trauma patients with active extravasation did not alter mortality rates at a Level 1 Trauma Center. Increased incidence of ARDS and association of

  11. Using competing risks model and competing events in outcome of pulmonary tuberculosis patients

    Directory of Open Access Journals (Sweden)

    Mehdi Kazempour Dizaji

    2016-01-01

    Conclusions: Use of competing risks model with competing events can provide a better way to understand the associated risk factors co-related with outcome of the pulmonary TB process, especially among DR-TB patients.

  12. Comparing the outcomes of two strategies for colorectal tumor detection: policy-promoted screening program versus health promotion service.

    Science.gov (United States)

    Wu, Ping-Hsiu; Lin, Yu-Min; Liao, Chao-Sheng; Chang, Hung-Chuen; Chen, Yu-Hung; Yang, Kuo-Ching; Shih, Chia-Hui

    2013-06-01

    The Taiwanese government has proposed a population-based colorectal tumor detection program for the average-risk population. This study's objectives were to understand the outcomes of these screening policies and to evaluate the effectiveness of the program. We compared two databases compiled in one medical center. The "policy-promoted cancer screening" (PPS) database was built on the basis of the policy of the Taiwan Bureau of National Health Insurance for cancer screening. The "health promotion service" (HPS) database was built to provide health check-ups for self-paid volunteers. Both the PPS and HPS databases employ the immunochemical fecal occult blood test (iFOBT) and colonoscopy for colorectal tumor screening using different strategies. A comparison of outcomes between the PPS and HPS included: (1) quality indicators-compliance rate, cecum reaching rate, and tumor detection rate; and (2) validity indicators-sensitivity, specificity, positive, and negative predictive values for detecting colorectal neoplasms. A total of 10,563 and 1481 individuals were enrolled in PPS and HPS, respectively. Among quality indicators, there was no statistically significant difference in the cecum reaching rate between PPS and HPS. The compliance rates were 56.1% for PPS and 91.8% for HPS (p performance. Copyright © 2013. Published by Elsevier B.V.

  13. GEOQUIMICO : an interactive tool for comparing sorption conceptual models (surface complexation modeling versus K[D])

    International Nuclear Information System (INIS)

    Hammond, Glenn E.; Cygan, Randall Timothy

    2007-01-01

    Within reactive geochemical transport, several conceptual models exist for simulating sorption processes in the subsurface. Historically, the K D approach has been the method of choice due to ease of implementation within a reactive transport model and straightforward comparison with experimental data. However, for modeling complex sorption phenomenon (e.g. sorption of radionuclides onto mineral surfaces), this approach does not systematically account for variations in location, time, or chemical conditions, and more sophisticated methods such as a surface complexation model (SCM) must be utilized. It is critical to determine which conceptual model to use; that is, when the material variation becomes important to regulatory decisions. The geochemical transport tool GEOQUIMICO has been developed to assist in this decision-making process. GEOQUIMICO provides a user-friendly framework for comparing the accuracy and performance of sorption conceptual models. The model currently supports the K D and SCM conceptual models. The code is written in the object-oriented Java programming language to facilitate model development and improve code portability. The basic theory underlying geochemical transport and the sorption conceptual models noted above is presented in this report. Explanations are provided of how these physicochemical processes are instrumented in GEOQUIMICO and a brief verification study comparing GEOQUIMICO results to data found in the literature is given

  14. EFFECTS OF INQUIRY TRAINING LEARNING MODEL BASED MULTIMEDIA AND MOTIVATION OF PHYSICS STUDENT LEARNING OUTCOMES

    Directory of Open Access Journals (Sweden)

    Hayati .

    2013-06-01

    Full Text Available The objective in this research: (1 Determine a better learning model to improve learning outcomes physics students among learning model Inquiry Training based multimedia and Inquiry Training learning model. (2 Determine the level of motivation to learn in affects physics student learning outcomes. (3 Knowing the interactions between the model of learning and motivation in influencing student learning outcomes. This research is a quasi experimental. The population in this research was all students in class XI SMA Negeri 1 T.P Sunggal Semester I 2012/2013. The sample of this research was consisted of two classes with a sample of 70 peoples who are determined by purposive sampling, the IPA XI-2 as a class experiment using a model-based multimedia learning Training Inquiry as many as 35 peoples and XI IPA-3 as a control class using learning model Inquiry Training 35 peoples. Hypotheses were analyzed using the GLM at significant level of 0.05 using SPSS 17.0 for Windows. Based on data analysis and hypothesis testing conducted found that: (1 Training Inquiry-based multimedia learning model in improving student learning outcomes rather than learning model physics Inquiry Training. (2 The results of studying physics students who have high motivation to learn better than students who have a low learning motivation. (3 From this research there was an interaction between learning model inquiry-based multimedia training and motivation to study on learning outcomes of students.

  15. A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies.

    Science.gov (United States)

    van den Heuvel, Meta; Hopkins, Jessica; Biscaro, Anne; Srikanthan, Cinntha; Feller, Andrea; Bremberg, Sven; Verkuijl, Nienke; Flapper, Boudien; Ford-Jones, Elizabeth Lee; Williams, Robin

    2013-11-06

    The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Four social determinants of early child development were selected to provide a cross-section of key time periods in a child's life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization

  16. Comparing Outcomes and Cost of 3 Surgical Treatments for Sagittal Synostosis: A Retrospective Study Including Procedure-Related Cost Analysis.

    Science.gov (United States)

    Garber, Sarah T; Karsy, Michael; Kestle, John R W; Siddiqi, Faizi; Spanos, Stephen P; Riva-Cambrin, Jay

    2017-10-01

    Neurosurgical techniques for repair of sagittal synostosis include total cranial vault (TCV) reconstruction, open sagittal strip (OSS) craniectomy, and endoscopic strip (ES) craniectomy. To evaluate outcomes and cost associated with these 3 techniques. Via retrospective chart review with waiver of informed consent, the last consecutive 100 patients with sagittal synostosis who underwent each of the 3 surgical correction techniques before June 30, 2013, were identified. Clinical, operative, and process of care variables and their associated specific charges were analyzed along with overall charge. The study included 300 total patients. ES patients had fewer transfusion requirements (13% vs 83%, P cost savings compared with the TCV reconstruction. The charges were similar to those incurred with OSS craniectomy, but patients had a shorter length of stay and fewer revisions. Copyright © 2017 by the Congress of Neurological Surgeons

  17. 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

  18. Hodgkin lymphoma in children, adolescents and young adults - a comparative study of clinical presentation and treatment outcome.

    Science.gov (United States)

    Englund, Annika; Glimelius, Ingrid; Rostgaard, Klaus; Smedby, Karin E; Eloranta, Sandra; Molin, Daniel; Kuusk, Thomas; Brown, Peter de Nully; Kamper, Peter; Hjalgrim, Henrik; Ljungman, Gustaf; Hjalgrim, Lisa Lyngsie

    2018-02-01

    Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990-2010) and Sweden (1992-2009) in pediatric (n = 315, Denmark clinical characteristics was assessed with Pearson's chi 2 -test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression. Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies for the relapsing patients.

  19. Outcomes of Transhiatal and Intercostal Pleural Drain After Ivor Lewis Esophagectomy: Comparative Analysis of Two Consecutive Patient Cohorts.

    Science.gov (United States)

    Asti, Emanuele; Bernardi, Daniele; Bonitta, Gianluca; Bonavina, Luigi

    2018-05-01

    In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of this study was to compare the short-term outcomes of transhiatal and intercostal pleural drainage. This is an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to a historical cohort of patients treated with the conventional intercostal drain connected to underwater seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on demand were recorded. Between January 2014 and December 2016, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinicopathological variables were similar in the two groups. There was no statistically significant difference in the rate of postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P pleural drainage connected to a portable vacuum system could safely replace the intercostal drain after hybrid Ivor Lewis esophagectomy. It has the potential to reduce postoperative pain and use of nonsteroidal anti-inflammatory drugs, and to enhance recovery from surgery.

  20. Comparing satellite SAR and wind farm wake models

    DEFF Research Database (Denmark)

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

    2015-01-01

    . These extend several tens of kilometres downwind e.g. 70 km. Other SAR wind maps show near-field fine scale details of wake behind rows of turbines. The satellite SAR wind farm wake cases are modelled by different wind farm wake models including the PARK microscale model, the Weather Research and Forecasting...... (WRF) model in high resolution and WRF with coupled microscale parametrization....

  1. 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."…

  2. Outcomes from the implementation of a counselling model ...

    African Journals Online (AJOL)

    2015-07-02

    Jul 2, 2015 ... One-third of antiretroviral treatment (ART)-eligible patients are estimated to be lost to care .... Information and Counselling Centre (ATICC) according .... patients whose last visit to the clinic or documented transfer .... recent systematic review reporting a range of 22–108 days,18 .... transition-state model.

  3. Computational models as predictors of HIV treatment outcomes for ...

    African Journals Online (AJOL)

    Background: Selecting the optimal combination of HIV drugs for an individual in resourcelimited settings is challenging because of the limited availability of drugs and genotyping. Objective: The evaluation as a potential treatment support tool of computational models that predict response to therapy without a genotype, ...

  4. Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty.

    Science.gov (United States)

    Cheung, Jason Pui Yin; Cheung, Prudence Wing Hang; Cheung, Amy Yim Ling; Lui, Darren; Cheung, Kenneth M C

    2018-06-01

    To compare the clinical and radiological outcomes between skipped-level and all-level plating for cervical laminoplasty. Patients with cervical spondylotic myelopathy (CSM) treated by open-door laminoplasty with minimum 2-year postoperative follow-up were included. All patients had opening from C3-6 or C3-7 and were divided into skipped-level or all-level plating groups. Japanese Orthopaedic Association (JOA) scores and canal measurements were obtained preoperatively, immediate (within 1 week) postoperatively, and at 2, 6 weeks, 3, 6 and 12 months postoperatively. Paired t test was used for comparative analysis. Receiver operating characteristic analysis was used to determine the canal expansion cutoff for spring-back closure. A total of 74 subjects were included with mean age of 66.1 ± 11.3 years at surgery. Of these, 32 underwent skipped-level plating and 42 underwent all-level plating. No significant differences were noted between the two groups at baseline and follow-up. Spring-back closure was observed in up to 50% of the non-plated levels within 3 months postoperatively. The cutoff for developing spring-back closure was 7 mm canal expansion for C3-6. No differences were observed in JOA scores and recovery rates between the two groups. None of the patients with spring-back required reoperation. There were no significant differences between skipped-level and all-level plating in terms of JOA or recovery rate, and canal diameter differences. This has tremendous impact on saving costs in CSM management as up to two plates per patient undergoing a standard C3-6 laminoplasty may be omitted instead of four plates to every level to achieve similar clinical and radiological outcomes. III. These slides can be retrieved under Electronic Supplementary Material.

  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. 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…

  7. Models of Purposive Human Organization: A Comparative Study

    Science.gov (United States)

    1984-02-01

    develop techniques for organizational diagnosis with the D-M model, to be followed by intervention by S-T methodology. 2. Introduction 2.1. Background In...relational and object data for Dinnat-Murphree model construction. 2. Develop techniques for organizational diagnosis with the Dinnat-Murphree model

  8. A Prospective Study to Compare the Functional and Aesthetic Outcomes with and without Primary Bone Grafting in Facial Fractures

    Directory of Open Access Journals (Sweden)

    Narayanamurthy Sundaramurthy

    2017-10-01

    Full Text Available Introduction: Open Reduction and Internal Fixation (ORIF has been the gold standard in treatment of facial fractures. Bone grafts have been used to correct bone defects in face. Many studies assessing outcomes of ORIF and primary bone grafting separately have been published in literature. Aim: A prospective study to compare the functional and aesthetic outcomes with and without primary bone grafting in facial fractures. Materials and Methods: Thirty patients, admitted between January 2012 and December 2013, were divided into two groups. Group 1 patients underwent ORIF with primary bone grafting and in group 2, only ORIF was done. Clinical and functional, photographic and radiological assessments were done after one month and three months. Results: Mean value of vertical dystopia in groups 1 and 2 after three months postoperatively were 1.25mm and 0.67mm. Mean value of enophthalmos in groups 1 and 2 after three months postoperatively were 0.5mm and 1mm. Thus, vertical dystopia was corrected better without bone grafts and enophthalmos corrected better with bone grafts. Photographic assessment revealed no statistical difference between the two groups. Postoperatively, in upper face fractures, both groups had similar number of patients in grades 1 and 2. Only one patient from group 2 of midface fractures ended up with grade 3 asymmetry. Radiologically, in upper face fractures, group 2 had more mean projection, height and breadth deficits (1.28mm, 2.57mm and 2.42mm when compared to group 1 (0.67mm, 1.50mm and 0.50mm. The mean projection and height deficits were statistically better in group 1. In midface fractures, mean zygomatic complex projection and height deficits were more in group 2 (1.88mm and 0.63mm than group 1 (0.78mm and 0.44mm. The mean zygomatic complex projection was statistically better in group1. Postoperative complications were lesser with the bone graft group. Conclusion: Judicious use of bone grafts in comminuted facial and orbital

  9. Counting the costs of overweight and obesity: modeling clinical and cost outcomes.

    Science.gov (United States)

    Tucker, Daniel M D; Palmer, Andrew J; Valentine, William J; Roze, Stéphane; Ray, Joshua A

    2006-03-01

    To quantify changes in clinical and cost outcomes associated with increasing levels of body mass index (BMI) in a US setting. A semi-Markov model was developed to project and compare life expectancy (LE), quality-adjusted life expectancy (QALE) and direct medical costs associated with distinct levels of BMI in simulated adult cohorts over a lifetime horizon. Cohort definitions included age (20-65 years), gender, race, and BMI (24-45 kg m(-2)). Cohorts were exclusively male or female and either Caucasian or African-American. Mortality rates were adjusted according to these factors using published data. BMI progression over time was modeled. BMI-dependent US direct medical costs were derived from published sources and inflated to year 2004 values. A third party reimbursement perspective was taken. QALE and costs were discounted at 3% per annum. In young Caucasian cohorts LE decreased as BMI increased. However, in older Caucasian cohorts the BMI associated with greatest longevity was higher than 25 kg m(-2). A similar pattern was observed in young adult African-American cohorts. A survival paradox was projected in older African-American cohorts, with some BMI levels in the obese category associated with greatest longevity. QALE in all four race/gender cohorts followed similar patterns to LE. Sensitivity analyses demonstrated that simulating BMI progression over time had an important impact on results. Direct costs in all four cohorts increased with BMI, with a few exceptions. Optimal BMI, in terms of longevity, varied between race/gender cohorts and within these cohorts, according to age, contributing to the debate over what BMI level or distribution should be considered ideal in terms of mortality risk. Simulating BMI progression over time had a substantial impact on health outcomes and should be modeled in future health economic analyses of overweight and obesity.

  10. 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

  11. 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.

  12. Comparing Intrinsic Connectivity Models for the Primary Auditory Cortices

    Science.gov (United States)

    Hamid, Khairiah Abdul; Yusoff, Ahmad Nazlim; Mohamad, Mazlyfarina; Hamid, Aini Ismafairus Abd; Manan, Hanani Abd

    2010-07-01

    This fMRI study is about modeling the intrinsic connectivity between Heschl' gyrus (HG) and superior temporal gyrus (STG) in human primary auditory cortices. Ten healthy male subjects participated and required to listen to white noise stimulus during the fMRI scans. Two intrinsic connectivity models comprising bilateral HG and STG were constructed using statistical parametric mapping (SPM) and dynamic causal modeling (DCM). Group Bayes factor (GBF), positive evidence ratio (PER) and Bayesian model selection (BMS) for group studies were used in model comparison. Group results indicated significant bilateral asymmetrical activation (puncorr < 0.001) in HG and STG. Comparison results showed strong evidence of Model 2 as the preferred model (STG as the input center) with GBF value of 5.77 × 1073 The model is preferred by 6 out of 10 subjects. The results were supported by BMS results for group studies. One-sample t-test on connection values obtained from Model 2 indicates unidirectional parallel connections from STG to bilateral HG (p<0.05). Model 2 was determined to be the most probable intrinsic connectivity model between bilateral HG and STG when listening to white noise.

  13. Tutorial on Using Regression Models with Count Outcomes Using R

    Directory of Open Access Journals (Sweden)

    A. Alexander Beaujean

    2016-02-01

    Full Text Available Education researchers often study count variables, such as times a student reached a goal, discipline referrals, and absences. Most researchers that study these variables use typical regression methods (i.e., ordinary least-squares either with or without transforming the count variables. In either case, using typical regression for count data can produce parameter estimates that are biased, thus diminishing any inferences made from such data. As count-variable regression models are seldom taught in training programs, we present a tutorial to help educational researchers use such methods in their own research. We demonstrate analyzing and interpreting count data using Poisson, negative binomial, zero-inflated Poisson, and zero-inflated negative binomial regression models. The count regression methods are introduced through an example using the number of times students skipped class. The data for this example are freely available and the R syntax used run the example analyses are included in the Appendix.

  14. Phototherapy of the newborn: a predictive model for the outcome.

    Science.gov (United States)

    Ossamu Osaku, Nelson; Silverio Lopes, Heitor

    2005-01-01

    Jaundice in one of the most common problems of the newborn. In most cases, jaundice is considered a physiological transient situation, but sometimes it can lead to death or serious injuries for the survivors. For decades, phototherapy has been used as the main method for prevention and treatment of hyperbilirubinaemia of the newborn. This work aims at finding a predictive model for the decrement of blood bilirubin followed conventional phototherapy. Data from 90 patients were collected and used in the multiple regression method. A rigorous statistical analysis was done in order to guarantee a correct and valid model. The obtained model was able to explain 78% of the variation of the dependent variable We found that it is possible to predict the total sugar bilirubin of the patient under phototherapy by knowing its birth weight, bilirubin level at the beginning of treatment, duration of exposition, and irradiance. Besides, it is possible to infer the time necessary for a given decrement of bilirubin, under approximately constant irradiance.

  15. A statin a day keeps the doctor away: comparative proverb assessment modelling study

    Science.gov (United States)

    Mizdrak, Anja; Scarborough, Peter

    2013-01-01

    Objective To model the effect on UK vascular mortality of all adults over 50 years old being prescribed either a statin or an apple a day. Design Comparative proverb assessment modelling study. Setting United Kingdom. Population Adults aged over 50 years. Intervention Either a statin a day for people not already taking a statin or an apple a day for everyone, assuming 70% compliance and no change in calorie consumption. The modelling used routinely available UK population datasets; parameters describing the relations between statins, apples, and health were derived from meta-analyses. Main outcome measure Mortality due to vascular disease. Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800). Conclusions Both nutritional and pharmaceutical approaches to the prevention of vascular disease may have the potential to reduce UK mortality significantly. With similar reductions in mortality, a 150 year old health promotion message is able to match modern medicine and is likely to have fewer side effects.

  16. Endeavour zotarolimus-eluting stent reduces stent thrombosis and improves clinical outcomes compared with cypher sirolimus-eluting stent : 4-year results of the PROTECT randomized trial

    NARCIS (Netherlands)

    Wijns, William; Steg, Ph. Gabriel; Mauri, Laura; Kurowski, Volkhard; Parikh, Keyur; Gao, Runlin; Bode, Christoph; Greenwood, John P.; Lipsic, Erik; Alamgir, Farqad; Rademaker-Havinga, Tessa; Boersma, Eric; Radke, Peter; van Leeuwen, Frank; Camenzind, Edoardo

    2014-01-01

    Aims To compare the long-term clinical safety between two drug-eluting stents with different healing characteristics in the Patient Related Outcomes with Endeavour (E-ZES) vs. Cypher (C-SES) Stenting Trial (PROTECT). At 3 years, there was no difference in the primary outcome of definite or probable

  17. 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.

  18. Using empirical Bayes predictors from generalized linear mixed models to test and visualize associations among longitudinal outcomes.

    Science.gov (United States)

    Mikulich-Gilbertson, Susan K; Wagner, Brandie D; Grunwald, Gary K; Riggs, Paula D; Zerbe, Gary O

    2018-01-01

    Medical research is often designed to investigate changes in a collection of response variables that are measured repeatedly on the same subjects. The multivariate generalized linear mixed model (MGLMM) can be used to evaluate random coefficient associations (e.g. simple correlations, partial regression coefficients) among outcomes that may be non-normal and differently distributed by specifying a multivariate normal distribution for their random effects and then evaluating the latent relationship between them. Empirical Bayes predictors are readily available for each subject from any mixed model and are observable and hence, plotable. Here, we evaluate whether second-stage association analyses of empirical Bayes predictors from a MGLMM, provide a good approximation and visual representation of these latent association analyses using medical examples and simulations. Additionally, we compare these results with association analyses of empirical Bayes predictors generated from separate mixed models for each outcome, a procedure that could circumvent computational problems that arise when the dimension of the joint covariance matrix of random effects is large and prohibits estimation of latent associations. As has been shown in other analytic contexts, the p-values for all second-stage coefficients that were determined by naively assuming normality of empirical Bayes predictors provide a good approximation to p-values determined via permutation analysis. Analyzing outcomes that are interrelated with separate models in the first stage and then associating the resulting empirical Bayes predictors in a second stage results in different mean and covariance parameter estimates from the maximum likelihood estimates generated by a MGLMM. The potential for erroneous inference from using results from these separate models increases as the magnitude of the association among the outcomes increases. Thus if computable, scatterplots of the conditionally independent empirical Bayes

  19. 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.

  20. Comparative study between a QCD inspired model and a multiple diffraction model

    International Nuclear Information System (INIS)

    Luna, E.G.S.; Martini, A.F.; Menon, M.J.

    2003-01-01

    A comparative study between a QCD Inspired Model (QCDIM) and a Multiple Diffraction Model (MDM) is presented, with focus on the results for pp differential cross section at √s = 52.8 GeV. It is shown that the MDM predictions are in agreement with experimental data, except for the dip region and that the QCDIM describes only the diffraction peak region. Interpretations in terms of the corresponding eikonals are also discussed. (author)

  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. Mathematical model comparing of the multi-level economics systems

    Science.gov (United States)

    Brykalov, S. M.; Kryanev, A. V.

    2017-12-01

    The mathematical model (scheme) of a multi-level comparison of the economic system, characterized by the system of indices, is worked out. In the mathematical model of the multi-level comparison of the economic systems, the indicators of peer review and forecasting of the economic system under consideration can be used. The model can take into account the uncertainty in the estimated values of the parameters or expert estimations. The model uses the multi-criteria approach based on the Pareto solutions.

  3. Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU

    Directory of Open Access Journals (Sweden)

    Chong MS

    2014-04-01

    Full Text Available Mei Sian Chong, Mark Chan, Laura Tay, Yew Yoong Ding Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore Objective: Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients. Method: A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI], and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects were collected. Results: There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively (P<0.05. The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively and control (1.3% and 7.7%, respectively subjects compared with the pre-GMU (9.1% and 23.4%, respectively subjects (P<0.05. No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient

  4. Is Shared Decision Making for End-of-Life Decisions Associated With Better Outcomes as Compared to Other Forms of Decision Making? A Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Negin Hajizadeh MD, MPH

    2016-07-01

    Full Text Available Background: Whether shared decision making (SDM has been evaluated for end-of-life (EOL decisions as compared to other forms of decision making has not been studied. Purpose: To summarize the evidence on SDM being associated with better outcomes for EOL decision making, as compared to other forms of decision making. Data Sources: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, and CINAHL databases were searched through April 2014. Study Selection: Studies were selected that evaluated SDM, compared to any other decision making style, for an EOL decision. Data Extraction: Components of SDM tested, comparators to SDM, EOL decision being assessed, and outcomes measured. Data Synthesis: Seven studies met the inclusion criteria (three experimental and four observational studies. Results were analyzed using narrative synthesis. All three experimental studies compared SDM interventions to usual care. The four observational studies compared SDM to doctor-controlled decision making, or reported the correlation between level of SDM and outcomes. Components of SDM specified in each study differed widely, but the component most frequently included was presenting information on the risks/benefits of treatment choices (five of seven studies. The outcome most frequently measured was communication, although with different measurement tools. Other outcomes included decisional conflict, trust, satisfaction, and “quality of dying.” Limitations: We could not analyze the strength of evidence for a given outcome due to heterogeneity in the outcomes reported and measurement tools. Conclusions: There is insufficient evidence supporting SDM being associated with improved outcomes for EOL decisions as opposed to other forms of decision making. Future studies should describe which components of SDM are being tested, outline the comparator decision making style, and use validated tools to measure outcomes.

  5. Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals.

    Science.gov (United States)

    Gilmartin, Heather M; Sousa, Karen H

    2016-01-01

    To test the Quality Health Outcomes Model to investigate the relationship between health care-associated infection (HAI) prevention interventions, organizational context, and HAI outcomes using structural equation modeling. Variables for adherence to the central line bundle, organizational context, and central line-associated bloodstream infections (CLABSIs) were selected for this secondary data analysis from 614 US hospitals that participated in the Prevention of Nosocomial Infection and Cost-effectiveness-Refined study. One half of the dataset was used for exploration of the concepts, the second half for confirmation of the measurement models and testing of the structural model. The final model resulted in a good fit to the data (χ (1215) = 1906.86, P preventing HAIs, ongoing research is needed to reveal the exact aspects of context that influence interventions and outcomes.

  6. 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

  7. 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.

  8. Obstetric and perinatal outcome in induction of labor compared with expectant management for prelabor rupture of the membranes at term

    International Nuclear Information System (INIS)

    Yaqoob, U.; Mushtaq, R.; Mushtaq, M.

    2015-01-01

    To compare the management outcome of induction of labor with expectant management in patients with term pre labor rupture of membranes (PROM). Study Design: Randomized controlled trial. Place and Duration of Study: This study was conducted in the department of Obstetrics and Gynaecology; Combined Military Hospital Rawalpindi from 25th July 2010 to 25th January 2011. Methods: A total of 384 patients were selected for this study, which were divided into two groups by lottery method. Patients in group A were induced with tablet prostaglandin E2 and group B patients were managed expectantly for 24 hours. The outcome of mothers and neonates was recorded on a pre-designed proforma. Results: The mean duration between PROM to onset of active labor in group A was significantly less (8.4 ± 2.3 hours) as compared to group B in which it was (9.6±2.1 hours) (p = 0.000). The mean duration between PROM to delivery in group A was significantly less in group A (17.4 ± 2.0) versus group B (22.2 ± 2.0 hours) (p = 0.000). The spontaneous vaginal delivery (SVD) rate was considerably higher (p=0.056) in group A in which 161 (83.8%) patients delivered by SVD and 31 (16.1%) patients by LSCS. In group B, 146 (76.0%) patients delivered by SVD and 46 (23.9%) patients by LSCS. In group A, 8 (4.1%) patients developed chorioamnionitis and 13 (6.7%) patients in group B (p = 0.262). In group A there were 178 (92.7%) neonates with APGAR score of > 5 at 1 minute in contrast to 173 (90.1%) in group B with (p = 0.363). Similarly in group A at 5 minutes, there were 178 (92.7%) neonates with APGAR score of > 7 and 173 (90.1%) in group B (p = 0.460). There were 9 (4.6%) cases of neonatal sepsis in group A, in comparison with 12 (6.2%) patients in group B (p = 0.501). Conclusion: The mean duration of labor in induced patients was less as compared to patients with expectant management. (author)

  9. Comparative Treatment Outcomes of Pre and Post-exercise TENS Application on Knee Osteoarthritis: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Ajediran I. Bello

    2014-03-01

    Full Text Available Objective The effects of TENS before exercise (TBE and TENS after exercise (TAE in the management of knee osteoarthritis (OA were compared. Methods Fifteen participants with knee OA were alternatively assigned to either TBE or TAE groups. Participants' pain, active knee flexibility, thigh girth, disability, and activity levels were assessed at baseline and at the end of eight-week study. Mixed design two-way analysis of variance (ANOVA at P < 0.05 was used to compare the two groups. Results The mean age of the participants was 58.1 ± 10.9 years. Post-intervention comparison showed that TAE had significantly lower scores (1.9 ± 0.9 than TBE (4.3 ± 1.5 on Disability Index Questionnaire (DIQ ( F -ratio = 10.5; P = 0.006, and significantly lower scores (0.8 ± 0.3 than TBE (1.4 ± 0.6 on Patient Assessment Scale (PAS ( F -ratio = 8.3; P = 0.013. However, both groups did not significantly differ on the selected impairment measures. Conclusion TAE was found to be more effective on the primary outcome measures in patients with knee OA.

  10. International comparative studies in mathematics education: are we obsessed with the international rankings of measured educational outcomes?

    Science.gov (United States)

    Tsai, Tsung-Lung; Li, Hui-Chuan

    2017-11-01

    Over the past few decades, researchers, policy makers, educators and the general public, who have an interest in mathematics education in different countries, pay a great deal of attention to the results from international comparative studies. Of great interest to the international studies is the results of Eastern students consistently achieving higher marks among the participating countries. In recent years, we have seen a climate of intense global economic competition and a growing belief in the key role of education, which have persuaded governments to become increasingly obsessed with the international rankings of measured educational outcomes. Accordingly, educational policy is increasingly driven by national attempts to "copy" the perceived advantage associated with the educational strategies and techniques of other countries. In this note, we present a discussion of the benefits and criticisms of one of these international comparative studies: Trends in International Mathematics and Science Study (TIMSS) studies. In so doing, we attempt to call attention to a continuously growing culture of "teaching to the test" in mathematics education.

  11. Comparative study of Moore and Mealy machine models adaptation ...

    African Journals Online (AJOL)

    Information and Communications Technology has influenced the need for automated machines that can carry out important production procedures and, automata models are among the computational models used in design and construction of industrial processes. The production process of the popular African Black Soap ...

  12. 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

  13. Lifetime Costs and Outcomes of Repair of Tetralogy of Fallot Compared to Natural Progression of the Disease: Great Ormond Street Hospital Cohort

    Science.gov (United States)

    Hunter, Rachael Maree; Isaac, Mark; Frigiola, Alessandra; Blundell, David; Brown, Kate; Bull, Kate

    2013-01-01

    Background Tetralogy of Fallot is a congenital heart disease that requires surgical repair without which survival through childhood is extremely rare. The aim of this paper is to use data from the mandatory follow-up of patients with Tetralogy of Fallot to model the health-related costs and outcomes over the first 55-years of life. Method A decision analytical model was developed to establish costs and outcomes for patients up to 55 years after diagnosis and first repair of Tetralogy of Fallot compared to natural progression. Data from Adult Congenital Heart Disease (ACHD) centres that follow up Tetralogy of Fallot patients and Great Ormond Street Hospital (GOSH), London, United Kingdom (UK) medical records was used to establish the cost and effectiveness of current interventions. Data from a Czech cohort was used for the natural, no intervention condition. Results The average cost per patient of a repair for Tetralogy of Fallot was £26,938 (SE = £4,140). The full life time cost per patient, with no discount rate, was £65,310 (95% CI £64,981–£65,729); £56,559 discounted (95% CI £56,159–£56,960). Patients with a repair had an average of 35 Quality Adjusted Life Years (QALYs) per patient over 55 years undiscounted and 20.16 QALYs discounted. If the disorder was left to take its natural course, patients on average had a total of 3 QALYs per patient with no discount rate and 2.30 QALYs discounted. Conclusion A model has been developed that provides an estimate of the value for money of an expensive repair of a congenital heart disease. The model could be used to test the cost-effectiveness of making amendments to the care pathway. PMID:23533645

  14. Environmental standards as strategic outcomes: A simple model

    International Nuclear Information System (INIS)

    Bhattacharya, Rabindra N.; Pal, Rupayan

    2010-01-01

    This paper analyses the strategic nature of choice of environmental standards considering both local and global pollution under alternative regimes of international trade. It also compares and contrasts the strategic equilibrium environmental standards and levels of pollution, local and global, with the world optimum levels. It shows that, in case of open economies, environmental standards can be either strategic substitutes or strategic complements. On the contrary, in case of closed economies, environmental standards are always strategic substitutes. It also shows that the strategic equilibrium environmental standards in case of open economies are higher than the world optimum in certain situations. Whereas, in absence of international trade, countries set, in equilibrium, lower environmental standards than the world optimum. (author)

  15. 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

  16. Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy

    International Nuclear Information System (INIS)

    Liu Wengui; Wu Xiaotao; Guo Jinhe; Zhuang Suyang; Teng Gaojun

    2010-01-01

    We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 ± 0.67 years and 6.42 ± 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications

  17. Preoperative Cognitive Impairment As a Predictor of Postoperative Outcomes in a Collaborative Care Model.

    Science.gov (United States)

    Zietlow, Kahli; McDonald, Shelley R; Sloane, Richard; Browndyke, Jeffrey; Lagoo-Deenadayalan, Sandhya; Heflin, Mitchell T

    2018-03-01

    To compare postoperative outcomes of individuals with and without cognitive impairment enrolled in the Perioperative Optimization of Senior Health (POSH) program at Duke University, a comanagement model involving surgery, anesthesia, and geriatrics. Retrospective analysis of individuals enrolled in a quality improvement program. Tertiary academic center. Older adults undergoing surgery and referred to POSH (N = 157). Cognitive impairment was defined as a score less than 25 out of 30 (adjusted for education) on the St. Louis University Mental Status (SLUMS) Examination. Median length of stay (LOS), mean number of postoperative complications, rates of postoperative delirium (POD, %), 30-day readmissions (%), and discharge to home (%) were compared using bivariate analysis. Seventy percent of participants met criteria for cognitive impairment (mean SLUMS score 20.3 for those with cognitive impairment and 27.7 for those without). Participants with and without cognitive impairment did not significantly differ in demographic characteristics, number of medications (including anticholinergics and benzodiazepines), or burden of comorbidities. Participants with and without cognitive impairment had similar LOS (P = .99), cumulative number of complications (P = .70), and 30-day readmission (P = .20). POD was more common in those with cognitive impairment (31% vs 24%), but the difference was not significant (P = .34). Participants without cognitive impairment had higher rates of discharge to home (80.4% vs 65.1%, P = .05). Older adults with and without cognitive impairment referred to the POSH program fared similarly on most postoperative outcomes. Individuals with cognitive impairment may benefit from perioperative geriatric comanagement. Questions remain regarding the validity of available measures of cognition in the preoperative period. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  18. Towards single embryo transfer? Modelling clinical outcomes of potential treatment choices using multiple data sources: predictive models and patient perspectives.

    Science.gov (United States)

    Roberts, Sa; McGowan, L; Hirst, Wm; Brison, Dr; Vail, A; Lieberman, Ba

    2010-07-01

    In vitro fertilisation (IVF) treatments involve an egg retrieval process, fertilisation and culture of the resultant embryos in the laboratory, and the transfer of embryos back to the mother over one or more transfer cycles. The first transfer is usually of fresh embryos and the remainder may be cryopreserved for future frozen cycles. Most commonly in UK practice two embryos are transferred (double embryo transfer, DET). IVF techniques have led to an increase in the number of multiple births, carrying an increased risk of maternal and infant morbidity. The UK Human Fertilisation and Embryology Authority (HFEA) has adopted a multiple birth minimisation strategy. One way of achieving this would be by increased use of single embryo transfer (SET). To collate cohort data from treatment centres and the HFEA; to develop predictive models for live birth and twinning probabilities from fresh and frozen embryo transfers and predict outcomes from treatment scenarios; to understand patients' perspectives and use the modelling results to investigate the acceptability of twin reduction policies. A multidisciplinary approach was adopted, combining statistical modelling with qualitative exploration of patients' perspectives: interviews were conducted with 27 couples at various stages of IVF treatment at both UK NHS and private clinics; datasets were collated of over 90,000 patients from the HFEA registry and nearly 9000 patients from five clinics, both over the period 2000-5; models were developed to determine live birth and twin outcomes and predict the outcomes of policies for selecting patients for SET or DET in the fresh cycle following egg retrieval and fertilisation, and the predictions were used in simulations of treatments; two focus groups were convened, one NHS and one web based on a patient organisation's website, to present the results of the statistical analyses and explore potential treatment policies. The statistical analysis revealed no characteristics that

  19. 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.

  20. Clinical features and outcome of cryptogenic hepatocellular carcinoma compared to those of viral and alcoholic hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Lee, Sang Soo; Park, Guan Jung; Lee, Yoon Jin; Lee, Kyoung Ho; Ahn, Soyeon; Jeong, Sook-Hyang; Byoun, Young-Sang; Chung, Seong Min; Seong, Mun Hyuk; Sohn, Hyung Rae; Min, Bo-young; Jang, Eun Sun; Kim, Jin-Wook

    2013-01-01

    Cryptogenic hepatocellular carcinoma (HCC) is thought to arise due to non-alcoholic fatty liver disease (NAFLD). This study investigated the prevalence, clinical features, and outcomes of cryptogenic HCC and compared them with those of HCC related to hepatitis B virus infection (HBV-HCC), hepatitis C virus infection (HCV-HCC), and alcohol (ALC-HCC) in Korea. The clinical features, treatment modalities, and survival data for 480 patients with HCC consecutively enrolled from January 2003 to June 2012 were analyzed. Computed tomography images were used to measure the visceral fat area (VFA) and liver-spleen density ratio. Cryptogenic HCC accounted for 6.8% of all HCC cases, whereas HBV-HCC, HCV-HCC, and ALC-HCC accounted for 62.7%, 13.5%, and 10.7% of HCC cases, respectively. The cryptogenic HCC group was characterized by older age, a low proportion of male patients, a high proportion of patients with metabolic syndrome or single nodular presentation, and a low proportion of patients with portal vein invasion compared to the viral-HCC and ALC-HCC groups. However, Child Pugh classes, tumor stages, and overall survival rates of cryptogenic HCC patients were similar to those of patients with HCC of other etiologies. VFA in cryptogenic HCC patients was significantly higher than that in viral-HCC patients, but similar to that in ALC-HCC patients. The liver-spleen density ratio did not vary according to HCC etiology. Cryptogenic HCC accounts for approximately 7% of HCC cases in Korea, associated with an older age at diagnosis, more frequent occurrence of metabolic syndrome, and less aggressive tumor characteristics, but similar survival compared to viral-HCC or ALC-HCC. Based on VFA and the liver-to-spleen density ratio, cryptogenic HCC may be burnt-out NAFLD in which visceral fat remains but liver fat is depleted

  1. comparative study of moore and mealy machine models adaptation

    African Journals Online (AJOL)

    user

    automata model was developed for ABS manufacturing process using Moore and Mealy Finite State Machines. Simulation ... The simulation results showed that the Mealy Machine is faster than the Moore ..... random numbers from MATLAB.

  2. Cost Valuation: A Model for Comparing Dissimilar Aircraft Platforms

    National Research Council Canada - National Science Library

    Long, Eric J

    2006-01-01

    .... A demonstration of the model's validity using aircraft and cost data from the Predator UAV and the F-16 was then performed to illustrate how it can be used to aid comparisons of dissimilar aircraft...

  3. A Comparative Study of Three Methodologies for Modeling Dynamic Stall

    Science.gov (United States)

    Sankar, L.; Rhee, M.; Tung, C.; ZibiBailly, J.; LeBalleur, J. C.; Blaise, D.; Rouzaud, O.

    2002-01-01

    During the past two decades, there has been an increased reliance on the use of computational fluid dynamics methods for modeling rotors in high speed forward flight. Computational methods are being developed for modeling the shock induced loads on the advancing side, first-principles based modeling of the trailing wake evolution, and for retreating blade stall. The retreating blade dynamic stall problem has received particular attention, because the large variations in lift and pitching moments encountered in dynamic stall can lead to blade vibrations and pitch link fatigue. Restricting to aerodynamics, the numerical prediction of dynamic stall is still a complex and challenging CFD problem, that, even in two dimensions at low speed, gathers the major difficulties of aerodynamics, such as the grid resolution requirements for the viscous phenomena at leading-edge bubbles or in mixing-layers, the bias of the numerical viscosity, and the major difficulties of the physical modeling, such as the turbulence models, the transition models, whose both determinant influences, already present in static maximal-lift or stall computations, are emphasized by the dynamic aspect of the phenomena.

  4. Comparing single- and dual-process models of memory development.

    Science.gov (United States)

    Hayes, Brett K; Dunn, John C; Joubert, Amy; Taylor, Robert

    2017-11-01

    This experiment examined single-process and dual-process accounts of the development of visual recognition memory. The participants, 6-7-year-olds, 9-10-year-olds and adults, were presented with a list of pictures which they encoded under shallow or deep conditions. They then made recognition and confidence judgments about a list containing old and new items. We replicated the main trends reported by Ghetti and Angelini () in that recognition hit rates increased from 6 to 9 years of age, with larger age changes following deep than shallow encoding. Formal versions of the dual-process high threshold signal detection model and several single-process models (equal variance signal detection, unequal variance signal detection, mixture signal detection) were fit to the developmental data. The unequal variance and mixture signal detection models gave a better account of the data than either of the other models. A state-trace analysis found evidence for only one underlying memory process across the age range tested. These results suggest that single-process memory models based on memory strength are a viable alternative to dual-process models for explaining memory development. © 2016 John Wiley & Sons Ltd.

  5. Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

    Science.gov (United States)

    Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

    2018-01-01

    Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

  6. Treatment outcomes of the simple bone cyst: A comparative study of 2 surgical techniques using artificial bone substitutes.

    Science.gov (United States)

    Higuchi, Takashi; Yamamoto, Norio; Shirai, Toshiharu; Hayashi, Katsuhiro; Takeuchi, Akihiko; Kimura, Hiroaki; Miwa, Shinji; Abe, Kensaku; Taniguchi, Yuta; Tsuchiya, Hiroyuki

    2018-05-01

    Simple bone cysts (SBCs) are benign lesions of unknown etiology. Because of its high relapse rate, they occasionally need a long period of treatment and restriction of activities in children and adolescent. Although various treatment modalities with variable differing outcomes have been described in the literature, no consensus has been reached regarding the standard treatment. The purpose of this study was to evaluate the outcome of a minimally invasive technique that uses a ceramic hydroxyapatite cannulated pin (HA pin) for the treatment of SBCs.Between 1998 and 2015, we have treated 75 patients with SBCs either with continuous decompression by inserting HA pins after curettage and multiple drilling (group 1, n = 39 patients) or with calcium phosphate cement (CPC) filling after curettage (group 2, n = 36 patients). These patients were retrospectively analyzed for recurrence-free survival (RFS) and factors implicated in SBC recurrence.Seventy-five patients (50 man and 25 females) with a mean age of 17.5 ± 11.6 years and a histopathologically confirmed diagnosis of SBCs were included. The mean follow-up period was 33 ± 25.3 months. RFS were 88% at 1 year and 81% at 5 years. Residual or progressing cysts were observed in 12 patients after the surgery and 10 of them underwent additional surgery. Recurrence rate was significantly higher in patients under the age of 10 years (P = .01), in long bone cysts (P = .01), and in active phase cysts (P = .003) (log-rank test). Multivariate analysis results revealed that age less than 10 years was an independent risk factor of recurrence (P = .04). No significant difference in recurrence rate was observed between groups 1 and 2. However, the mean operating time was significantly shorter in group 1. (62.4 ± 25.6 vs 110.5 ± 48.4 minutes in group 2).Continuous decompression using HA pin is a less invasive surgical technique for the treatment of SBCs compared with CPC filling and has a

  7. Towards a Model and Methodology for Assessing Student Learning Outcomes and Satisfaction

    Science.gov (United States)

    Duque, Lola C.; Weeks, John R.

    2010-01-01

    Purpose: The purpose of this paper is threefold: first, to introduce a conceptual model for assessing undergraduate student learning outcomes and satisfaction that involves concepts drawn from the services marketing and assessment literatures; second, to illustrate the utility of the model as implemented in an academic department (geography)…

  8. 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…

  9. Assessing the Quality of the Learning Outcome in Vocational Education: The Expero Model

    Science.gov (United States)

    Cervai, Sara; Cian, Luca; Berlanga, Alicia; Borelli, Massimo; Kekale, Tauno

    2013-01-01

    Purpose: This paper aims to present an innovative model to evaluate the quality of the learning outcome in vocational education and training (VET) considering a wide approach that includes, in particular, stakeholders' expectations and perceptions. Design/methodology/approach: The Expero model was implemented in various kinds of vocational schools…

  10. 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

  11. The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation.

    Science.gov (United States)

    Burnett, E; Curran, E; Loveday, H P; Kiernan, M A; Tannahill, M

    2014-01-01

    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.

  12. Developing a risk prediction model for the functional outcome after hip arthroscopy.

    Science.gov (United States)

    Stephan, Patrick; Röling, Maarten A; Mathijssen, Nina M C; Hannink, Gerjon; Bloem, Rolf M

    2018-04-19

    Hip arthroscopic treatment is not equally beneficial for every patient undergoing this procedure. Therefore, the purpose of this study was to develop a clinical prediction model for functional outcome after surgery based on preoperative factors. Prospective data was collected on a cohort of 205 patients having undergone hip arthroscopy between 2011 and 2015. Demographic and clinical variables and patient reported outcome (PRO) scores were collected, and considered as potential predictors. Successful outcome was defined as either a Hip Outcome Score (HOS)-ADL score of over 80% or improvement of 23%, defined by the minimal clinical important difference, 1 year after surgery. The prediction model was developed using backward logistic regression. Regression coefficients were converted into an easy to use prediction rule. The analysis included 203 patients, of which 74% had a successful outcome. Female gender (OR: 0.37 (95% CI 0.17-0.83); p = 0.02), pincer impingement (OR: 0.47 (95% CI 0.21-1.09); p = 0.08), labral tear (OR: 0.46 (95% CI 0.20-1.06); p = 0.07), HOS-ADL score (IQR OR: 2.01 (95% CI 0.99-4.08); p = 0.05), WHOQOL physical (IQR OR: 0.43 (95% CI 0.22-0.87); p = 0.02) and WHOQOL psychological (IQR OR: 2.40 (95% CI 1.38-4.18); p = prediction model of successful functional outcome 1 year after hip arthroscopy. The model's discriminating accuracy turned out to be fair, as 71% (95% CI: 64-80%) of the patients were classified correctly. The developed prediction model can predict the functional outcome of patients that are considered for a hip arthroscopic intervention, containing six easy accessible preoperative risk factors. The model can be further improved trough external validation and/or adding additional potential predictors.

  13. Comparative Analysis Of Three Largest World Models Of Business Excellence

    Directory of Open Access Journals (Sweden)

    Jasminka Samardžija

    2009-07-01

    Full Text Available Business excellence has become the strongest means of achieving competitive advantage of companies while total management of quality has become the road that ensures support of excellent results recognized by many world companies. Despite many differences, we can conclude that models have many common elements. By the audit in 2005, the DP and MBNQA moved the focus from excellence of product, i.e service, onto the excellence of quality of the entire organization process. Thus, the quality got strategic dimension instead of technical one and the accent passed from the technical quality on the total excellence of all organization processes. The joint movement goes to the direction of good management and appreciation of systems thinking. The very structure of EFOM model criteria itself is adjusted to strategic dimension of quality and that is why the model underwent only short audits within the criteria themselves. Essentially, the model remained unchanged. In all models, the accent is on the satisfaction of buyers, employees and community. National rewards for quality have an important role in promotion and giving a prize to excellence in organization performances. Moreover, they raise quality standards of companies and the country profile as a whole. Considering the GDP per capita and the percentage of certification level of companies, Croatia has all the predispositions for introduction the EFQM model of business excellence with the basic aim of deficit decrease in foreign trade balance and strengthening of competitiveness as the necessary preliminary work for the entrance in the competitive market of the EU. Quality management was introduced in many organizations. The methods used at that time developed in the course of years, and what are to predict is the continuation of the evolution road model as well as the method of business excellence.

  14. HEMS in Slovenia: one country, four models, different quality outcomes.

    Science.gov (United States)

    Klemenc-Ketis, Zalika; Tomazin, Iztok; Kersnik, Janko

    2012-01-01

    The objective of this study was to determine the quality of patient care using quality indicators in 4 different Slovenian helicopter emergency medical service (HEMS) models. This was a cross-sectional study of all 4 HEMS in Slovenia. We collected data on quality for the period from July 2003 to August 2008, in a sample of all eligible patients that were managed by HEMS during the study period (N = 833). We obtained the following data on emergency operations: the time and organizational features of the operation; the description of the patients' condition; and the on-site diagnostic and treatment procedures. We used the following as quality indicators: the number of resuscitated patients that were intubated; the number of patients with a Glasgow Coma Scale (GCS) score of # 8 that were intubated; the number of patients with acute coronary syndrome that received treatment with morphine, oxygen, nitroglycerine, and aspirin (MONA); the number of patients with a National Advisory Committee on Aeronautics (NACA) scale score of $ 4 with an intravenous line; the number of patients with a NACA score of $ 5 that were given oxygen; and the number of patients with a NACA score of $ 4 that were given appropriate analgesic treatment. Across all HEMS bases, 36 (87.8%) resuscitated patients were intubated; 122 (81.9%) patients with GCS # 8 were intubated; 149 (89.2%) patients with ACS were given MONA treatment; 52 (92.9%) patients with a NACA score of $ 4 were given an intravenous line; 254 (92.7%) patients with a NACA score of $ 5 were given oxygen; and 18 (32.7%) trauma patients with a NACA score of $ 4 were given intravenous analgesics. The quality of patient management in HEMS in Slovenia is affected by the callout procedure, the presence or absence of a fixed rope, the type of helicopter operator, and the provider of the doctor in the helicopter team. The data from our study indicates that the quality of patient management in HEMS in Slovenia is high. It also seems that

  15. Comparing hierarchical models via the marginalized deviance information criterion.

    Science.gov (United States)

    Quintero, Adrian; Lesaffre, Emmanuel

    2018-07-20

    Hierarchical models are extensively used in pharmacokinetics and longitudinal studies. When the estimation is performed from a Bayesian approach, model comparison is often based on the deviance information criterion (DIC). In hierarchical models with latent variables, there are several versions of this statistic: the conditional DIC (cDIC) that incorporates the latent variables in the focus of the analysis and the marginalized DIC (mDIC) that integrates them out. Regardless of the asymptotic and coherency difficulties of cDIC, this alternative is usually used in Markov chain Monte Carlo (MCMC) methods for hierarchical models because of practical convenience. The mDIC criterion is more appropriate in most cases but requires integration of the likelihood, which is computationally demanding and not implemented in Bayesian software. Therefore, we consider a method to compute mDIC by generating replicate samples of the latent variables that need to be integrated out. This alternative can be easily conducted from the MCMC output of Bayesian packages and is widely applicable to hierarchical models in general. Additionally, we propose some approximations in order to reduce the computational complexity for large-sample situations. The method is illustrated with simulated data sets and 2 medical studies, evidencing that cDIC may be misleading whilst mDIC appears pertinent. Copyright © 2018 John Wiley & Sons, Ltd.

  16. Re-construction of action awareness depends on an internal model of action-outcome timing.

    Science.gov (United States)

    Stenner, Max-Philipp; Bauer, Markus; Machts, Judith; Heinze, Hans-Jochen; Haggard, Patrick; Dolan, Raymond J

    2014-04-01

    The subjective time of an instrumental action is shifted towards its outcome. This temporal binding effect is partially retrospective, i.e., occurs upon outcome perception. Retrospective binding is thought to reflect post-hoc inference on agency based on sensory evidence of the action - outcome association. However, many previous binding paradigms cannot exclude the possibility that retrospective binding results from bottom-up interference of sensory outcome processing with action awareness and is functionally unrelated to the processing of the action - outcome association. Here, we keep bottom-up interference constant and use a contextual manipulation instead. We demonstrate a shift of subjective action time by its outcome in a context of variable outcome timing. Crucially, this shift is absent when there is no such variability. Thus, retrospective action binding reflects a context-dependent, model-based phenomenon. Such top-down re-construction of action awareness seems to bias agency attribution when outcome predictability is low. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  17. Functional outcome measures in a surgical model of hip osteoarthritis in dogs

    OpenAIRE

    Little, Dianne; Johnson, Stephen; Hash, Jonathan; Olson, Steven A.; Estes, Bradley T.; Moutos, Franklin T.; Lascelles, B. Duncan X.; Guilak, Farshid

    2016-01-01

    Background The hip is one of the most common sites of osteoarthritis in the body, second only to the knee in prevalence. However, current animal models of hip osteoarthritis have not been assessed using many of the functional outcome measures used in orthopaedics, a characteristic that could increase their utility in the evaluation of therapeutic interventions. The canine hip shares similarities with the human hip, and functional outcome measures are well documented in veterinary medicine, pr...

  18. COMPARING FINANCIAL DISTRESS PREDICTION MODELS BEFORE AND DURING RECESSION

    Directory of Open Access Journals (Sweden)

    Nataša Šarlija

    2011-02-01

    Full Text Available The purpose of this paper is to design three separate financial distress prediction models that will track the changes in a relative importance of financial ratios throughout three consecutive years. The models were based on the financial data from 2000 privately-owned small and medium-sized enterprises in Croatia from 2006 to 2009, and developed by means of logistic regression. Macroeconomic conditions as well as market dynamic have been changed over the mentioned period. Financial ratios that were less important in one period become more important in the next period. Composition of model starting in 2006 has been changed in the next years. It tells us what financial ratios are more important during the time of economic downturn. Besides, it helps us to understand behavior of small and medium-sized enterprises in the period of prerecession and in the period of recession.

  19. Discrete factor approximations in simultaneous equation models: estimating the impact of a dummy endogenous variable on a continuous outcome.

    Science.gov (United States)

    Mroz, T A

    1999-10-01

    This paper contains a Monte Carlo evaluation of estimators used to control for endogeneity of dummy explanatory variables in continuous outcome regression models. When the true model has bivariate normal disturbances, estimators using discrete factor approximations compare favorably to efficient estimators in terms of precision and bias; these approximation estimators dominate all the other estimators examined when the disturbances are non-normal. The experiments also indicate that one should liberally add points of support to the discrete factor distribution. The paper concludes with an application of the discrete factor approximation to the estimation of the impact of marriage on wages.

  20. Energy modeling and comparative assessment beyond the market

    International Nuclear Information System (INIS)

    Rogner, H.-H.; Langlois, L.; McDonald, A.; Jalal, I.

    2004-01-01

    Market participants engage in constant comparative assessment of prices, available supplies, consumer options. Such implicit comparative assessment is a sine qua non for decision making in, and the smooth function of, competitive markets, but it is not always sufficient for policy makers who make decisions based on priorities other than or in addition to market prices. Supplementary mechanisms are needed to make explicit, to expose for consideration and to incorporate into their decision making processes, broader factors that are not necessarily reflected directly in the market price of a good or service. These would include, for example, employment, environment, national security or trade considerations. They would include long-term considerations, e.g., global warming or greatly diminished future supplies of oil and gas. This paper explores different applications of comparative assessment beyond the market, reviews different approaches for accomplishing such evaluations, and presents some tools available for conducting various types of extra-market comparative assessment, including those currently in use by Member States of the IAEA.(author)

  1. Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

    Science.gov (United States)

    Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

    2017-11-01

    Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can

  2. Shock outcome prediction before and after CPR: a comparative study of manual and automated active compression-decompression CPR.

    Science.gov (United States)

    Box, M S; Watson, J N; Addison, P S; Clegg, G R; Robertson, C E

    2008-09-01

    We report on a study designed to compare the relative efficacy of manual CPR (M-CPR) and automated mechanical CPR (ACD-CPR) provided by an active compression-decompression (ACD) device. The ECG signals of out-of-hospital cardiac arrest patients of cardiac aetiology were analysed just prior to, and immediately after, cardiopulmonary resuscitation (CPR) to assess the likelihood of successful defibrillation at these time points. The cardioversion outcome prediction (COP) measure previously developed by our group was used to quantify the probability of return of spontaneous circulation (ROSC) after counter-shock and was used as a measure of the efficacy of CPR. An initial validation study using COP to predict shock outcome from the patient data set resulted in a performance of 60% specificity achieved at 100% sensitivity on a blind test of the data. This is comparable with previous studies and provided confidence in the robustness of the technique across hardware platforms. Significantly, the COP marker also displayed an ability to stratify according to outcomes: asystole, ventricular fibrillation (VF), pulseless electrical activity (PEA), normal sinus rhythm (NSR). We then used the validated COP marker to analyse the ECG data record just prior to and immediately after the chest compression segments. This was initially performed for 87 CPR segments where VF was both the pre- and post-CPR waveform. An increase in the mean COP values was found for both CPR types. A signed rank sum test found the increase due to manual CPR not to be significant (p>0.05) whereas the automated CPR was found to be significant (pCPR (1.26, p=0.024) than for the manual CPR (0.99, p=0.124). These results indicate that the application of CPR does indeed provide beneficial preparation of the heart prior to defibrillation therapy whether manual or automated CPR is applied. The COP marker shows promise as a definitive, quantitative determinant of the immediate positive effect of both types of CPR

  3. Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model.

    Science.gov (United States)

    Wisniowski, Brendan; Barnes, Mary; Jenkins, Jason; Boyne, Nicholas; Kruger, Allan; Walker, Philip J

    2011-09-01

    Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model. All elective EVAR procedures at the RBWH before July 1, 2009, were reviewed. Descriptive analyses were performed to determine the outcomes. Univariate and multivariate analyses were performed to identify preoperative and operative variables predictive of outcomes after EVAR. Binomial logistic regression analyses were used to externally validate the ERA model. Before July 1, 2009, 197 patients (172 men), who were a mean age of 72.8 years, underwent elective EVAR at the RBWH. Operative mortality was 1.0%. Survival was 81.1% at 3 years and 63.2% at 5 years. Multivariate analysis showed predictors of survival were age (P = .0126), American Society of Anesthesiologists (ASA) score (P = .0180), and chronic obstructive pulmonary disease (P = .0348) at 3 years and age (P = .0103), ASA score (P = .0006), renal failure (P = .0048), and serum creatinine (P = .0022) at 5 years. Aortic branch vessel score was predictive of initial (30-day) type II endoleak (P = .0015). AAA tortuosity was predictive of midterm type I endoleak (P = .0251). Female sex was associated with lower rates of initial clinical success (P = .0406). The ERA model fitted RBWH data well for early death (C statistic = .906), 3-year survival (C statistic = .735), 5-year

  4. A comparative study of independent particle model based ...

    Indian Academy of Sciences (India)

    We find that among these three independent particle model based methods, the ss-VSCF method provides most accurate results in the thermal averages followed by t-SCF and the v-VSCF is the least accurate. However, the ss-VSCF is found to be computationally very expensive for the large molecules. The t-SCF gives ...

  5. Nature of Science and Models: Comparing Portuguese Prospective Teachers' Views

    Science.gov (United States)

    Torres, Joana; Vasconcelos, Clara

    2015-01-01

    Despite the relevance of nature of science and scientific models in science education, studies reveal that students do not possess adequate views regarding these topics. Bearing in mind that both teachers' views and knowledge strongly influence students' educational experiences, the main scope of this study was to evaluate Portuguese prospective…

  6. Classifying and comparing spatial models of fire dynamics

    Science.gov (United States)

    Geoffrey J. Cary; Robert E. Keane; Mike D. Flannigan

    2007-01-01

    Wildland fire is a significant disturbance in many ecosystems worldwide and the interaction of fire with climate and vegetation over long time spans has major effects on vegetation dynamics, ecosystem carbon budgets, and patterns of biodiversity. Landscape-Fire-Succession Models (LFSMs) that simulate the linked processes of fire and vegetation development in a spatial...

  7. Target normal sheath acceleration analytical modeling, comparative study and developments

    International Nuclear Information System (INIS)

    Perego, C.; Batani, D.; Zani, A.; Passoni, M.

    2012-01-01

    Ultra-intense laser interaction with solid targets appears to be an extremely promising technique to accelerate ions up to several MeV, producing beams that exhibit interesting properties for many foreseen applications. Nowadays, most of all the published experimental results can be theoretically explained in the framework of the target normal sheath acceleration (TNSA) mechanism proposed by Wilks et al. [Phys. Plasmas 8(2), 542 (2001)]. As an alternative to numerical simulation various analytical or semi-analytical TNSA models have been published in the latest years, each of them trying to provide predictions for some of the ion beam features, given the initial laser and target parameters. However, the problem of developing a reliable model for the TNSA process is still open, which is why the purpose of this work is to enlighten the present situation of TNSA modeling and experimental results, by means of a quantitative comparison between measurements and theoretical predictions of the maximum ion energy. Moreover, in the light of such an analysis, some indications for the future development of the model proposed by Passoni and Lontano [Phys. Plasmas 13(4), 042102 (2006)] are then presented.

  8. Social participation and psychosocial outcomes of young adults with chronic physical conditions: Comparing recipients and non-recipients of disability benefits.

    Science.gov (United States)

    Bal, Marjolijn I; Sattoe, Jane N T; Miedema, Harald S; van Staa, AnneLoes

    2018-03-01

    Little is known about any differences between young people with chronic physical conditions who do and do not apply for disability benefits in young adulthood for providing insights for future policy and rehabilitation care. We aimed to identify predictors during adolescence of receiving disability benefits in young adulthood and to compare recipients and non-recipients of benefits in social participation and psychosocial outcomes in young adulthood. Follow-up study of 18 to 25 year olds with various chronic conditions who at adolescent age completed a web-based survey (n=518; T0). The outcome was receiving disability benefits (yes or no). Associations with background characteristics, social participation, and impact of the chronic condition were explored with stepwise multivariate modelling, using T0 variables. Differences between recipients and non-recipients were explored using chi-square tests and t-tests. Receiving disability benefits in young adulthood was associated with greater extent of physical disability, receiving less special education, absenteeism at school/work, and low health-related quality of life during adolescence. In young adulthood, recipients of benefits reported higher perceived impact of the chronic condition on their school/work career and lower quality of life than non-recipients. Social participation varied across domains. This study provides important insights into the characteristics of a vulnerable subgroup of young people with chronic physical conditions. Disability benefit recipients experienced more impact of their chronic condition and reported a lower health-related quality of life over time than non-recipients. Rehabilitation professionals are encouraged to use patient-reported outcomes to address the lived experiences and screen the need for psychosocial support of this vulnerable subgroup of young people with chronic physical conditions. Copyright © 2018. Published by Elsevier Masson SAS.

  9. Clinical outcomes of three different types of hardware for the treatment of mandibular angle fractures: a comparative retrospective study.

    Science.gov (United States)

    Elsayed, S A; Mohamed, F I; Khalifa, G A

    2015-10-01

    A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B patient. The lag screw was associated with the fewest complications and exhibited all of the advantages of plating systems in the treatment of angle fracture. The lag screw involved the least hardware and a short operating time, however the differences were not significant. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. 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.

  11. Randomized Controlled Trial Comparing Open Versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The CAPD I Trial.

    Science.gov (United States)

    van Laanen, Jorinde H H; Cornelis, Tom; Mees, Barend M; Litjens, Elisabeth J; van Loon, Magda M; Tordoir, Jan H M; Peppelenbosch, Arnoud G

    2018-01-01

    had a paramedian wound infection. In the laparoscopic group, 1 patient had a transient cardiac event, 1 patient had intraabdominal bleeding requiring reoperation, and 1 patient had fluid leakage that could be managed conservatively. The survival curve demonstrated a good long-term function of PD. This randomized controlled trial (RCT) comparing open vs laparoscopic placement of PD catheters demonstrates equal clinical success rates between the 2 techniques. Advanced laparoscopic techniques such as catheter fixation techniques and omentopexy might further improve clinical outcome. Copyright © 2018 International Society for Peritoneal Dialysis.

  12. The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

    Science.gov (United States)

    Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

    2009-03-01

    To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly

  13. Quantifying relative importance: Computing standardized effects in models with binary outcomes

    Science.gov (United States)

    Grace, James B.; Johnson, Darren; Lefcheck, Jonathan S.; Byrnes, Jarrett E.K.

    2018-01-01

    Scientists commonly ask questions about the relative importances of processes, and then turn to statistical models for answers. Standardized coefficients are typically used in such situations, with the goal being to compare effects on a common scale. Traditional approaches to obtaining standardized coefficients were developed with idealized Gaussian variables in mind. When responses are binary, complications arise that impact standardization methods. In this paper, we review, evaluate, and propose new methods for standardizing coefficients from models that contain binary outcomes. We first consider the interpretability of unstandardized coefficients and then examine two main approaches to standardization. One approach, which we refer to as the Latent-Theoretical or LT method, assumes that underlying binary observations there exists a latent, continuous propensity linearly related to the coefficients. A second approach, which we refer to as the Observed-Empirical or OE method, assumes responses are purely discrete and estimates error variance empirically via reference to a classical R2 estimator. We also evaluate the standard formula for calculating standardized coefficients based on standard deviations. Criticisms of this practice have been persistent, leading us to propose an alternative formula that is based on user-defined “relevant ranges”. Finally, we implement all of the above in an open-source package for the statistical software R.

  14. Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches.

    Science.gov (United States)

    Lee, Boeun; Tam, Idy; Weigel, Bernard; Breeze, Janis L; Paulus, Jessica K; Nelson, Jason; Allison, Genève M

    2015-08-01

    β-Lactam antibiotics are commonly used in outpatient parenteral antimicrobial therapy (OPAT), but data regarding outcomes of long-term therapy are limited. The purpose of this study was to compare treatment success, readmission and antibiotic switch rates in patients treated with β-lactam antibiotics as OPAT. We carried out a retrospective review of all patients, discharged from Tufts Medical Center with cefazolin, ceftriaxone, ertapenem or oxacillin, between January 2009 and June 2013. A competing risks analysis was used to compare the cumulative incidence of first occurrence of treatment success, antibiotic switch and 30 day readmission for each drug. Four hundred patients were identified (cefazolin n = 38, ceftriaxone n = 104, ertapenem n = 128 and oxacillin n = 130). Baseline demographics were similar. Treatment success rates were higher for ceftriaxone and ertapenem (cefazolin 61%, ceftriaxone 81%, ertapenem 73% and oxacillin 58%; P antibiotic switches were accomplished without readmission. Adverse drug events (ADEs) were the most common reason for outpatient antibiotic switches (31/37, 84%). The ADE rate was higher for the oxacillin group (cefazolin 2.0 versus ceftriaxone 1.5 versus ertapenem 2.9 versus oxacillin 8.4 per 1000 OPAT days; P antibiotics is effective, but antibiotic switches for adverse events were more frequent with oxacillin use. Clinicians should be cognizant of the risk of readmissions and ADEs in OPAT patients, as the value of OPAT lies in reducing patient morbidity and readmissions by managing ADEs and preventing clinical failures. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study.

    Directory of Open Access Journals (Sweden)

    Stefan Salminger

    Full Text Available Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands.Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT, Southampton Hand Assessment Procedure (SHAP and the Disabilities of the Arm, Shoulder and Hand measure (DASH. Quality-of-life was compared with the Short-Form 36 (SF-36.Transplanted patients (n = 5 achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7 achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in "role-physical" (p = 0.006, "vitality" (p = 0.008, "role-emotional" (p = 0.035 and "mental-health" (p = 0.003.The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient's best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.

  16. Interpreting the improved outcome of patients with central nervous system metastases managed in clinical trials compared with standard hospital practice

    International Nuclear Information System (INIS)

    Tang, J.I; Back, M.; Shakespeare, T.; Lu, J.J.; Mukherjee, R.; Wynne, C.

    2005-01-01

    The aims were to determine the median survival and prognostic factors of patients with central nervous system (CNS) metastases managed with whole-brain radiation therapy (WBRT), and to explore selection criteria in recently published clinical trials using aggressive interventions in CNS metastases. A retrospective audit was performed on patients managed with WBRT for CNS metastases. Potential prognostic factors were recorded and analysed for their association with survival duration. The proportion of patients with these factors was also compared with those of patients managed under three recently reported studies investigating aggressive interventions, such as radiosurgery and chemotherapy for CNS metastases. Seventy-three patients were treated with WBRT for cerebral metastases over a 12-month period. The median survival of the population was 3.4 months (95% confidence interval: 2.7-4.1), with 6- and 12-month survival rates of 30 and 18%, respectively. Significant prognostic factors for prolonged median survival were Eastern Cooperative Oncology Group status 0-2 (P = 0.015), Medical Research Council neurological functional status 0-1 (P = 0.006), and Recursive Partitioning Analysis Class 2 versus Class 3 (P = 0.020). On multivariate analysis, younger patient age (P = 0.02) and better performance status (P<0.01) were associated with improved outcome. When comparing these characteristics with selected published studies, our study cohort demonstrated a higher proportion of patients with poor performance status, a greater number of metastases per patient and a higher incidence of extracranial disease. This reflects the selected nature of patients in these published studies. Central nervous system metastases confer a poor prognosis and, for the majority of patients, aggressive interventions are unlikely to improve survival. The use of potentially toxic and expensive treatments should be reserved for those few in whom these studies have shown a potential benefit

  17. 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.

  18. Clinical Outcomes of the Marginal Ulcer Bleeding after Gastrectomy: As Compared to the Peptic Ulcer Bleeding with Nonoperated Stomach

    Science.gov (United States)

    Chung, Woo Chul; Jeon, Eun Jung; Lee, Kang-Moon; Paik, Chang Nyol; Oh, You Suk; Lee, Yang Woon; Kim, Sang Bae; Jun, Kyong-Hwa; Chin, Hyung Min

    2012-01-01

    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. PMID:23304127

  19. Comparative Study of Injury Models for Studying Muscle Regeneration in Mice.

    Directory of Open Access Journals (Sweden)

    David Hardy

    Full Text Available A longstanding goal in regenerative medicine is to reconstitute functional tissues or organs after injury or disease. Attention has focused on the identification and relative contribution of tissue specific stem cells to the regeneration process. Relatively little is known about how the physiological process is regulated by other tissue constituents. Numerous injury models are used to investigate tissue regeneration, however, these models are often poorly understood. Specifically, for skeletal muscle regeneration several models are reported in the literature, yet the relative impact on muscle physiology and the distinct cells types have not been extensively characterised.We have used transgenic Tg:Pax7nGFP and Flk1GFP/+ mouse models to respectively count the number of muscle stem (satellite cells (SC and number/shape of vessels by confocal microscopy. We performed histological and immunostainings to assess the differences in the key regeneration steps. Infiltration of immune cells, chemokines and cytokines production was assessed in vivo by Luminex®.We compared the 4 most commonly used injury models i.e. freeze injury (FI, barium chloride (BaCl2, notexin (NTX and cardiotoxin (CTX. The FI was the most damaging. In this model, up to 96% of the SCs are destroyed with their surrounding environment (basal lamina and vasculature leaving a "dead zone" devoid of viable cells. The regeneration process itself is fulfilled in all 4 models with virtually no fibrosis 28 days post-injury, except in the FI model. Inflammatory cells return to basal levels in the CTX, BaCl2 but still significantly high 1-month post-injury in the FI and NTX models. Interestingly the number of SC returned to normal only in the FI, 1-month post-injury, with SCs that are still cycling up to 3-months after the induction of the injury in the other models.Our studies show that the nature of the injury model should be chosen carefully depending on the experimental design and desired

  20. Use of models in large-area forest surveys: comparing model-assisted, model-based and hybrid estimation

    Science.gov (United States)

    Goran Stahl; Svetlana Saarela; Sebastian Schnell; Soren Holm; Johannes Breidenbach; Sean P. Healey; Paul L. Patterson; Steen Magnussen; Erik Naesset; Ronald E. McRoberts; Timothy G. Gregoire

    2016-01-01

    This paper focuses on the use of models for increasing the precision of estimators in large-area forest surveys. It is motivated by the increasing availability of remotely sensed data, which facilitates the development of models predicting the variables of interest in forest surveys. We present, review and compare three different estimation frameworks where...

  1. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts.

    Science.gov (United States)

    Failla, Mathew J; Logerstedt, David S; Grindem, Hege; Axe, Michael J; Risberg, May Arna; Engebretsen, Lars; Huston, Laura J; Spindler, Kurt P; Snyder-Mackler, Lynn

    2016-10-01

    Rehabilitation before anterior cruciate ligament (ACL) reconstruction (ACLR) is effective at improving postoperative outcomes at least in the short term. Less is known about the effects of preoperative rehabilitation on functional outcomes and return-to-sport (RTS) rates 2 years after reconstruction. The purpose of this study was to compare functional outcomes 2 years after ACLR in a cohort that underwent additional preoperative rehabilitation, including progressive strengthening and neuromuscular training after impairments were resolved, compared with a nonexperimental cohort. We hypothesized that the cohort treated with extended preoperative rehabilitation would have superior functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. This study compared outcomes after an ACL rupture in an international cohort (Delaware-Oslo ACL Cohort [DOC]) treated with extended preoperative rehabilitation, including neuromuscular training, to data from the Multicenter Orthopaedic Outcomes Network (MOON) cohort, which did not undergo extended preoperative rehabilitation. Inclusion and exclusion criteria from the DOC were applied to the MOON database to extract a homogeneous sample for comparison. Patients achieved knee impairment resolution before ACLR, and postoperative rehabilitation followed each cohort's respective criterion-based protocol. Patients completed the International Knee Documentation Committee (IKDC) subjective knee form and Knee injury and Osteoarthritis Outcome Score (KOOS) at enrollment and again 2 years after ACLR. RTS rates were calculated for each cohort at 2 years. After adjusting for baseline IKDC and KOOS scores, the DOC patients showed significant and clinically meaningful differences in IKDC and KOOS scores 2 years after ACLR. There was a significantly higher (P < .001) percentage of DOC patients returning to preinjury sports (72%) compared with those in the MOON cohort (63%). The cohort treated with additional preoperative

  2. Activity Modelling and Comparative Evaluation of WSN MAC Security Attacks

    DEFF Research Database (Denmark)

    Pawar, Pranav M.; Nielsen, Rasmus Hjorth; Prasad, Neeli R.

    2012-01-01

    and initiate security attacks that disturb the normal functioning of the network in a severe manner. Such attacks affect the performance of the network by increasing the energy consumption, by reducing throughput and by inducing long delays. Of all existing WSN attacks, MAC layer attacks are considered...... the most harmful as they directly affect the available resources and thus the nodes’ energy consumption. The first endeavour of this paper is to model the activities of MAC layer security attacks to understand the flow of activities taking place when mounting the attack and when actually executing it....... The second aim of the paper is to simulate these attacks on hybrid MAC mechanisms, which shows the performance degradation of aWSN under the considered attacks. The modelling and implementation of the security attacks give an actual view of the network which can be useful in further investigating secure...

  3. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

    Science.gov (United States)

    Koffmann, Andrew

    2017-03-02

    Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

  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 i