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Sample records for models compared outcome

  1. Comparing Dynamic Treatment Regimes Using Repeated-Measures Outcomes: Modeling Considerations in SMART Studies

    Science.gov (United States)

    Lu, Xi; Nahum-Shani, Inbal; Kasari, Connie; Lynch, Kevin G.; Oslin, David W.; Pelham, William E.; Fabiano, Gregory; Almirall, Daniel

    2016-01-01

    A dynamic treatment regime (DTR) is a sequence of decision rules, each of which recommends a treatment based on a patient’s past and current health status. Sequential, multiple assignment, randomized trials (SMARTs) are multi-stage trial designs that yield data specifically for building effective DTRs. Modeling the marginal mean trajectories of a repeated-measures outcome arising from a SMART presents challenges, because traditional longitudinal models used for randomized clinical trials do not take into account the unique design features of SMART. We discuss modeling considerations for various forms of SMART designs, emphasizing the importance of considering the timing of repeated measures in relation to the treatment stages in a SMART. For illustration, we use data from three SMART case studies with increasing level of complexity, in autism, child attention deficit hyperactivity disorder (ADHD), and adult alcoholism. In all three SMARTs we illustrate how to accommodate the design features along with the timing of the repeated measures when comparing DTRs based on mean trajectories of the repeated-measures outcome. PMID:26638988

  2. A comparative study of four intensive care outcome prediction models in cardiac surgery patients

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    Lehmann Thomas

    2011-03-01

    Full Text Available Abstract Background Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS] in patients after open heart surgery. Methods We prospectively included all consecutive adult patients who underwent open heart surgery and were admitted to the intensive care unit (ICU between January 1st 2007 and December 31st 2008. Scores were calculated daily from ICU admission until discharge. The outcome measure was ICU mortality. The performance of the four scores was assessed by calibration and discrimination statistics. Derived variables (Mean- and Max- scores were also evaluated. Results During the study period, 2801 patients (29.6% female were included. Mean age was 66.9 ± 10.7 years and the ICU mortality rate was 5.2%. Calibration tests for SOFA and CASUS were reliable throughout (p-value not Conclusions CASUS and SOFA are reliable ICU mortality risk stratification models for cardiac surgery patients. SAPS II and APACHE II did not perform well in terms of calibration and discrimination statistics.

  3. A comparative study of four intensive care outcome prediction models in cardiac surgery patients.

    Science.gov (United States)

    Doerr, Fabian; Badreldin, Akmal Ma; Heldwein, Matthias B; Bossert, Torsten; Richter, Markus; Lehmann, Thomas; Bayer, Ole; Hekmat, Khosro

    2011-03-01

    Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS]) in patients after open heart surgery. We prospectively included all consecutive adult patients who underwent open heart surgery and were admitted to the intensive care unit (ICU) between January 1st 2007 and December 31st 2008. Scores were calculated daily from ICU admission until discharge. The outcome measure was ICU mortality. The performance of the four scores was assessed by calibration and discrimination statistics. Derived variables (Mean- and Max- scores) were also evaluated. During the study period, 2801 patients (29.6% female) were included. Mean age was 66.9 ± 10.7 years and the ICU mortality rate was 5.2%. Calibration tests for SOFA and CASUS were reliable throughout (p-value not predicted and observed outcome for SAPS II (days 1, 2, 3 and 5) and APACHE II (days 2 and 3). CASUS, and its mean- and maximum-derivatives, discriminated better between survivors and non-survivors than the other scores throughout the study (area under curve ≥ 0.90). In order of best discrimination, CASUS was followed by SOFA, then SAPS II, and finally APACHE II. SAPS II and APACHE II derivatives had discrimination results that were superior to those of the SOFA derivatives. CASUS and SOFA are reliable ICU mortality risk stratification models for cardiac surgery patients. SAPS II and APACHE II did not perform well in terms of calibration and discrimination statistics.

  4. 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

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

    Science.gov (United States)

    Wiechowski, Linda; Washburn, Terri L.

    2014-01-01

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

  6. A comparative 2D modeling of debris-flow propagation and outcomes for end-users

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    Bettella, F.; Bertoldi, G.; Pozza, E.; McArdell, B. W.; D'Agostino, V.

    2012-04-01

    In Alpine regions gravity-driven natural hazards, in particular debris flows, endanger settlements and human life. Mitigation strategies based on hazard maps are necessary tools for land planning. These maps can be made more precise by using numerical models to forecasting the inundated areas after a careful setting of those 'key parameters' (K-P) which directly affect the flow motion and its interaction with the ground surface. Several physically based 2D models are available for practitioners and governmental agencies, but the selection criteria of model type and of the related K-P remain flexible and partly subjective. This remark has driven us to investigate how different models simulate different types of debris flows (from granular to muddy debris flows, going through intermediate types), in particular when the flow is influenced by the presence of deposition basins. Two commercial 2D physical models (RAMMS and FLO-2D) have been tested for five well-documented debris flows events from five Italian catchments were different geology and flow dynamics are observed: 1) a viscous debris flow occurred in 2009 in a catchment with a metamorphic geology (Gadria torrent, Bolzano Province); 2) the 2009 granular debris flow in an granitic geological setting (Rio Dosson, Trento Province); 3-4) two events occurred in the 'rio Val del Lago' and 'rio Molinara' (Trento Province) in 2010 where porphyritic lithology prevails (intermediate granular debris flow); 5) the Rotolon torrent (Vicenza Province) 2009 debris flow containing sedimentary rocks enclosed in an abundant clay-rich matrix (intermediate viscous case). Event volumes range from 5.000 to 50.000 cubic meters. The Gadria, Rotolon and Val del Lago events are also influenced by artificial retention basins. Case study simulations allowed delineation of some practical end-user suggestions and good practices in order to guide the model choice and the K-P setting, particularly related to different flow dynamics. The

  7. The Vermont model for rural HIV care delivery: eleven years of outcome data comparing urban and rural clinics.

    Science.gov (United States)

    Grace, Christopher; Kutzko, Deborah; Alston, W Kemper; Ramundo, Mary; Polish, Louis; Osler, Turner

    2010-01-01

    Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers. To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic. This was a retrospective cohort study. Over an 11-year period 363 new patients received care, including 223 in the urban clinic and 140 in the rural clinics. Patients in the 2 cohorts were demographically similar and had similar initial CD4 counts and viral loads. There was no difference between the urban and rural clinic patients receiving Pneumocystis carinii prophylaxis (83.5% vs 86%, P= .38) or antiretroviral therapy (96.8% vs 97.5%, P= .79). Both rural and urban cohorts had similar decreases in median viral load from 1996 to 2006 (3,876 copies/mL to vs 8,331 copies/mL to vs 16%-71.4%, P= .11). Rural and urban cohorts had similar increases in median CD4 counts (275/mm(3)-350/mm(3) vs 182 cells/mm(3)-379/mm(3)). A repeated measures regression analysis showed that neither fall in viral load (P= .91) nor rise in CD4 count (P= .64) were associated with urban versus rural site of care. Survival times, using a Cox proportional hazards model, were similar for urban and rural patients (hazard ratio for urban = 0.80 [95% CI, 0.39-1.61; P= .53]). This urban outreach model provides similar quality of care to persons receiving care in rural areas of Vermont as compared to those receiving care in the urban center.

  8. Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials.

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    Meza, Rafael; ten Haaf, Kevin; Kong, Chung Yin; Erdogan, Ayca; Black, William C; Tammemagi, Martin C; Choi, Sung Eun; Jeon, Jihyoun; Han, Summer S; Munshi, Vidit; van Rosmalen, Joost; Pinsky, Paul; McMahon, Pamela M; de Koning, Harry J; Feuer, Eric J; Hazelton, William D; Plevritis, Sylvia K

    2014-06-01

    The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography screening is an effective way of reducing lung cancer (LC) mortality. However, optimal screening strategies have not been determined to date and it is uncertain whether lighter smokers than those examined in the NLST may also benefit from screening. To address these questions, it is necessary to first develop LC natural history models that can reproduce NLST outcomes and simulate screening programs at the population level. Five independent LC screening models were developed using common inputs and calibration targets derived from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). Imputation of missing information regarding smoking, histology, and stage of disease for a small percentage of individuals and diagnosed LCs in both trials was performed. Models were calibrated to LC incidence, mortality, or both outcomes simultaneously. Initially, all models were calibrated to the NLST and validated against PLCO. Models were found to validate well against individuals in PLCO who would have been eligible for the NLST. However, all models required further calibration to PLCO to adequately capture LC outcomes in PLCO never-smokers and light smokers. Final versions of all models produced incidence and mortality outcomes in the presence and absence of screening that were consistent with both trials. The authors developed 5 distinct LC screening simulation models based on the evidence in the NLST and PLCO. The results of their analyses demonstrated that the NLST and PLCO have produced consistent results. The resulting models can be important tools to generate additional evidence to determine the effectiveness of lung cancer screening strategies using low-dose computed tomography. © 2014 American Cancer Society.

  9. 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.

  10. Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques

    DEFF Research Database (Denmark)

    Bekkering, G.E.; Hendriks, H.J.M.; van Tulder, M.

    2005-01-01

    Study Design. Data were derived from a randomized controlled trial on the (cost-) effectiveness of the implementation of the clinical guidelines on physiotherapy for low back pain in primary care. Objectives. To describe the course of low back pain in patients who are referred to physiotherapy...... focused on different outcome measures and used various statistical techniques. Methods. Primary outcomes were perceived recovery, improvement in pain, improvement in functioning, and presence of disabling low back pain at 3 and 12 months follow-up. Multivariate logistic regression analyses were performed...

  11. A Comparative Study on Student Perceptions of Their Learning Outcomes in Undergraduate Science Degree Programmes with Differing Curriculum Models

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    Matthews, Kelly E.; Firn, Jennifer; Schmidt, Susanne; Whelan, Karen

    2017-01-01

    This study investigated students' perceptions of their graduate learning outcomes including content knowledge, communication, writing, teamwork, quantitative skills, and ethical thinking in two Australian universities. One university has a traditional discipline-orientated curriculum and the other, an interdisciplinary curriculum in the entry…

  12. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model.

    Directory of Open Access Journals (Sweden)

    Rachael Maree Hunter

    Full Text Available BACKGROUND: In July 2010 a new multiple hub-and-spoke model for acute stroke care was implemented across the whole of London, UK, with continuous specialist care during the first 72 hours provided at 8 hyper-acute stroke units (HASUs compared to the previous model of 30 local hospitals receiving acute stroke patients. We investigated differences in clinical outcomes and costs between the new and old models. METHODS: We compared outcomes and costs 'before' (July 2007-July 2008 vs. 'after' (July 2010-June 2011 the introduction of the new model, adjusted for patient characteristics and national time trends in mortality and length of stay. We constructed 90-day and 10-year decision analytic models using data from population based stroke registers, audits and published sources. Mortality and length of stay were modelled using survival analysis. FINDINGS: In a pooled sample of 307 patients 'before' and 3156 patients 'after', survival improved in the 'after' period (age adjusted hazard ratio 0.54; 95% CI 0.41-0.72. The predicted survival rates at 90 days in the deterministic model adjusted for national trends were 87.2% 'before' % (95% CI 86.7%-87.7% and 88.7% 'after' (95% CI 88.6%-88.8%; a relative reduction in deaths of 12% (95% CI 8%-16%. Based on a cohort of 6,438 stroke patients, the model produces a total cost saving of £5.2 million per year at 90 days (95% CI £4.9-£5.5 million; £811 per patient. CONCLUSION: A centralized model for acute stroke care across an entire metropolitan city appears to have reduced mortality for a reduced cost per patient, predominately as a result of reduced hospital length of stay.

  13. Comparing Active Vision Models

    NARCIS (Netherlands)

    Croon, G.C.H.E. de; Sprinkhuizen-Kuyper, I.G.; Postma, E.O.

    2009-01-01

    Active vision models can simplify visual tasks, provided that they can select sensible actions given incoming sensory inputs. Many active vision models have been proposed, but a comparative evaluation of these models is lacking. We present a comparison of active vision models from two different

  14. Comparing active vision models

    NARCIS (Netherlands)

    Croon, G.C.H.E. de; Sprinkhuizen-Kuyper, I.G.; Postma, E.O.

    2009-01-01

    Active vision models can simplify visual tasks, provided that they can select sensible actions given incoming sensory inputs. Many active vision models have been proposed, but a comparative evaluation of these models is lacking. We present a comparison of active vision models from two different

  15. 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.

  16. The Comparative Effects of Spinal and Peripheral Thrust Manipulation and Exercise on Pain Sensitivity and the Relation to Clinical Outcome: A Mechanistic Trial Using a Shoulder Pain Model

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    Coronado, Rogelio A.; Bialosky, Joel E.; Bishop, Mark D.; Riley, Joseph L.; Robinson, Michael E.; Michener, Lori A.; George, Steven Z.

    2016-01-01

    STUDY DESIGN Single-blind randomized trial. OBJECTIVES To compare the effects of cervical and shoulder thrust manipulation (TM) and exercise on pain sensitivity, and to explore associations with clinical outcomes in patients with shoulder pain. BACKGROUND Experimental studies indicate that spinal TM has an influence on central pain processes, supporting its application for treatment of extremity conditions. Direct comparison of spinal and peripheral TM on pain sensitivity has not been widely examined. METHODS Seventy-eight participants with shoulder pain (36 female; mean ± SD age, 39.0 ± 14.5 years) were randomized to receive 3 treatments of cervical TM (n = 26), shoulder TM (n = 27), or shoulder exercise (n = 25) over 2 weeks. Twenty-five healthy participants (13 female; mean ± SD age, 35.2 ± 11.1 years) were assessed to compare pain sensitivity with that in clinical participants at baseline. Primary outcomes were changes in local (eg, shoulder) and remote (eg, tibialis anterior) pressure pain threshold and heat pain threshold occurring over 2 weeks. Secondary outcomes were shoulder pain intensity and patient-rated function at 4, 8, and 12 weeks. Analysis-of-variance models and partial-correlation analyses were conducted to examine comparative effects and the relationship between measures. RESULTS At baseline, clinical participants demonstrated lower local (mean difference, −1.63 kg; 95% confidence interval [CI]: −2.40, −0.86) and remote pressure pain threshold (mean difference, −1.96 kg; 95% CI: −3.09, −0.82) and heat pain threshold (mean difference, −1.15°C; 95% CI: −2.06, −0.24) compared to controls, suggesting enhanced pain sensitivity. Following intervention, there were no between-group differences in pain sensitivity or clinical outcome (P>.05). However, improvements were noted, regardless of intervention, for pressure pain threshold (range of mean differences, 0.22–0.32 kg; 95% CI: 0.03, 0.43), heat pain threshold (range of mean

  17. Comparing denominator degrees of freedom approximations for the generalized linear mixed model in analyzing binary outcome in small sample cluster-randomized trials.

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    Li, Peng; Redden, David T

    2015-04-23

    Small number of clusters and large variation of cluster sizes commonly exist in cluster-randomized trials (CRTs) and are often the critical factors affecting the validity and efficiency of statistical analyses. F tests are commonly used in the generalized linear mixed model (GLMM) to test intervention effects in CRTs. The most challenging issue for the approximate Wald F test is the estimation of the denominator degrees of freedom (DDF). Some DDF approximation methods have been proposed, but their small sample performances in analysing binary outcomes in CRTs with few heterogeneous clusters are not well studied. The small sample performances of five DDF approximations for the F test are compared and contrasted under CRT frameworks with simulations. Specifically, we illustrate how the intraclass correlation (ICC), sample size, and the variation of cluster sizes affect the type I error and statistical power when different DDF approximation methods in GLMM are used to test intervention effect in CRTs with binary outcomes. The results are also illustrated using a real CRT dataset. Our simulation results suggest that the Between-Within method maintains the nominal type I error rates even when the total number of clusters is as low as 10 and is robust to the variation of the cluster sizes. The Residual and Containment methods have inflated type I error rates when the cluster number is small (<30) and the inflation becomes more severe with increased variation in cluster sizes. In contrast, the Satterthwaite and Kenward-Roger methods can provide tests with very conservative type I error rates when the total cluster number is small (<30) and the conservativeness becomes more severe as variation in cluster sizes increases. Our simulations also suggest that the Between-Within method is statistically more powerful than the Satterthwaite or Kenward-Roger method in analysing CRTs with heterogeneous cluster sizes, especially when the cluster number is small. We conclude that the

  18. 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.

  19. Comparing root architectural models

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    Schnepf, Andrea; Javaux, Mathieu; Vanderborght, Jan

    2017-04-01

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

  20. 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,…

  1. 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.

  2. 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

  3. Comparing language outcomes in monolingual and bilingual stroke patients

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    Parker Jones, ‘Ōiwi; Grogan, Alice; Crinion, Jenny; Rae, Johanna; Ruffle, Louise; Leff, Alex P.; Seghier, Mohamed L.; Price, Cathy J.; Green, David W.

    2015-01-01

    Post-stroke prognoses are usually inductive, generalizing trends learned from one group of patients, whose outcomes are known, to make predictions for new patients. Research into the recovery of language function is almost exclusively focused on monolingual stroke patients, but bilingualism is the norm in many parts of the world. If bilingual language recruits qualitatively different networks in the brain, prognostic models developed for monolinguals might not generalize well to bilingual stroke patients. Here, we sought to establish how applicable post-stroke prognostic models, trained with monolingual patient data, are to bilingual stroke patients who had been ordinarily resident in the UK for many years. We used an algorithm to extract binary lesion images for each stroke patient, and assessed their language with a standard tool. We used feature selection and cross-validation to find ‘good’ prognostic models for each of 22 different language skills, using monolingual data only (174 patients; 112 males and 62 females; age at stroke: mean = 53.0 years, standard deviation = 12.2 years, range = 17.2–80.1 years; time post-stroke: mean = 55.6 months, standard deviation = 62.6 months, range = 3.1–431.9 months), then made predictions for both monolinguals and bilinguals (33 patients; 18 males and 15 females; age at stroke: mean = 49.0 years, standard deviation = 13.2 years, range = 23.1–77.0 years; time post-stroke: mean = 49.2 months, standard deviation = 55.8 months, range = 3.9–219.9 months) separately, after training with monolingual data only. We measured group differences by comparing prediction error distributions, and used a Bayesian test to search for group differences in terms of lesion-deficit associations in the brain. Our models distinguish better outcomes from worse outcomes equally well within each group, but tended to be over-optimistic when predicting bilingual language outcomes: our bilingual patients tended to have poorer language skills

  4. Comparative analysis of one year outcomes of selective laser ...

    African Journals Online (AJOL)

    Comparative analysis of one year outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in Primary Open Angle Glaucoma patients in Nigeria. ... The main outcome measure was intraocular pressure (IOP) at one month, three months, six months and one year. Success was defined as IOP reduction ...

  5. Protein synthesis inhibiting clindamycin improves outcome in a mouse model of Staphylococcus aureus sepsis compared with the cell wall active ceftriaxone.

    Science.gov (United States)

    Azeh, Ivo; Gerber, Joachim; Wellmer, Andreas; Wellhausen, Malte; Koenig, Brigitte; Eiffert, Helmut; Nau, Roland

    2002-07-01

    The release of proinflammatory components from bacteria depends on the mode of action of the antibacterial therapy used. We studied whether this influences mortality in experimental sepsis. In a lethal murine model of Staphylococcus aureus sepsis, animals were randomly assigned to receive the protein synthesis inhibitor clindamycin (CLI) or the beta-lactam ceftriaxone (CRO). Therapy was introduced subcutaneously 5 hrs after intraperitoneal injection of 10 colony forming units of S. aureus American Type Culture Collection 29213 and was continued every 8 hrs for 3 days. Survival was higher in mice receiving CLI (29/50 animals [58%]) than in mice receiving CRO (16/50 animals [32%]; p =.015). Mice treated with CRO died earlier than mice receiving CLI (p =.002). Eight hours after the first antibiotic dose, the motor performance of mice receiving CRO had deteriorated more than it did for mice receiving CLI (p =.009). Higher levels of tumor necrosis factor-alpha were measured in serum (p =.027) and peritoneal fluid (p =.001) of CRO-treated mice. In vitro, CLI released smaller amounts of staphylococcal enterotoxin A than CRO. Antibiotic treatment of Gram-positive sepsis with a protein synthesis inhibitor decreases morbidity and mortality compared with a bacteriolytic compound. This may be caused by a reduction of the concentrations of proinflammatory/toxic bacterial components and cytokines.

  6. Comparing linear probability model coefficients across groups

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  7. Is it Worth Comparing Different Bankruptcy Models?

    Directory of Open Access Journals (Sweden)

    Miroslava Dolejšová

    2015-01-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

  9. 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....

  10. Rapid Acute Physiology Score versus Rapid Emergency Medicine Score in Trauma Outcome Prediction; a Comparative Study

    Directory of Open Access Journals (Sweden)

    Babak Nakhjavan-Shahraki

    2017-01-01

    Full Text Available Introduction: Rapid acute physiology score (RAPS and rapid emergency medicine score (REMS are two physiologic models for measuring injury severity in emergency settings. The present study was designed to compare the two models in outcome prediction of trauma patients presenting to emergency department (ED.Methods: In this prospective cross-sectional study, the two models of RAPS and REMS were compared regarding prediction of mortality and poor outcome (severe disability based on Glasgow outcome scale of trauma patients presenting to the EDs of 5 educational hospitals in Iran (Tehran, Tabriz, Urmia, Jahrom and Ilam from May to October 2016. The discriminatory power and calibration of the models were calculated and compared using STATA 11.Results: 2148 patients with the mean age of 39.50±17.27 years were studied (75.56% males. The area under the curve of REMS and RAPS in predicting in-hospital mortality were calculated to be 0.93 (95% CI: 0.92-0.95 and 0.899 (95% CI: 0.86-0.93, respectively (p=0.02. These measures were 0.92 (95% CI: 0.90-0.94 and 0.86 (95% CI: 0.83-0.90, respectively, regarding poor outcome (p=0.001. The optimum cut-off point in predicting outcome was found to be 3 for REMS model and 2 for RAPS model. The sensitivity and specificity of REMS and RAPS in the mentioned cut offs were 95.93 vs. 85.37 and 77.63 vs. 83.51, respectively, in predicting mortality. Calibration and overall performance of the two models were acceptable.Conclusion: The present study showed that adding age and level of arterial oxygen saturation to the variables included in RAPS model can increase its predictive value. Therefore, it seems that REMS could be used for predicting mortality and poor outcome of trauma patients in emergency settings

  11. Tibial plateau fractures: compared outcomes between ARIF and ORIF.

    Science.gov (United States)

    Dall'oca, C; Maluta, T; Lavini, F; Bondi, M; Micheloni, G M; Bartolozzi, P

    2012-11-01

    The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 ± 2.60 (range, 19-30), while in group B is 26.81 ± 2.65 (range, 21-30). HSS score in group A was 76.36 ± 14.19 (range, 38-91) as the average clinical result, while in group B was 73.12 ± 14.55 (range, 45-91). According to Rasmussen radiological results, the average score for group A was 16.56 ± 2.66 (range, 8-18), while in group B was 15.88 ± 2.71 (range, 10-18). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II-III-IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections.

  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. Multilevel moderated mediation model with ordinal outcome.

    Science.gov (United States)

    Rusá, Šárka; Komárek, Arnošt; Lesaffre, Emmanuel; Bruyneel, Luk

    2018-05-10

    Although increasingly complex models have been proposed in mediation literature, there is no model nor software that incorporates the multiple possible generalizations of the simple mediation model jointly. We propose a flexible moderated mediation model allowing for (1) a hierarchical structure of clustered data, (2) more and possibly correlated mediators, and (3) an ordinal outcome. The motivating data set is obtained from a European study in nursing research. Patients' willingness to recommend their treating hospital was recorded in an ordinal way. The research question is whether such recommendation directly depends on system-level features in the organization of nursing care, or whether these associations are mediated by 2 measurements of nursing care left undone and possibly moderated by nurse education. We have developed a Bayesian approach and accompanying program that takes all the above generalizations into account. Copyright © 2018 John Wiley & Sons, Ltd.

  14. Effect of dietary intakes on pregnancy outcomes: a comparative ...

    African Journals Online (AJOL)

    The effect of maternal dietary intakes on pregnancy outcomes was assessed in a descriptive, cross-sectional survey among women attending the Prevention of Mother-to-Child Transmission (PMTCT) of HIV program at Nyanza Provincial General Hospital (NPGH), Kenya. A Purposive sampling procedure was employed to ...

  15. A comparative evaluation of outcome of cataract surgery at Ago ...

    African Journals Online (AJOL)

    Poor outcome was associated with pre-existing ocular disease in 10.8% of the eyes operated and were due to pre-existing glaucoma, macular degeneration, optic atrophy and diabetic retinopathy. Conclusion: Best functional visual results are obtained by modern techniques of ECCE with IOL, which ensures that the patient ...

  16. 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.

  17. Functional and clinical outcomes of total ankle arthroplasty in elderly compared to younger patients.

    Science.gov (United States)

    Tenenbaum, Shay; Bariteau, Jason; Coleman, Scott; Brodsky, James

    2017-06-01

    Total ankle arthroplasty (TAA) is becoming an increasingly utilized procedure for the management of end-stage ankle arthritis. Elderly patients are the fastest growing segment of the population in the western world, creating a unique challenge to the health economics of our era. Determining if elderly patients with end-stage ankle arthritis demonstrate the same improvements in clinical outcomes and functional measures of gait following TAA would be valuable. This can aid to evaluate the utilization of TAA in this enlarging cohort of our population. Consecutive series of twenty-one patients over the age of 70, who underwent TAA for end-stage ankle arthritis, was prospectively compared to a series of twenty-one patients aged 50-60, who underwent the same procedure by single surgeon during same time period. Clinical outcomes were measured with outcome scores including VAS pain score, AOFAS Ankle and Hindfoot Score, and the SF-36. Three-dimensional gait analysis was performed preoperatively and at a minimum of one year postoperatively, to measure temporal-spatial, kinematic, and kinetic parameters of gait. Mixed model multivariate statistical analysis was used to evaluate and compare the independent contributions to outcomes of the surgical intervention over time; of patient age; and of time-plus-age interaction, as these influenced both the clinical outcomes and the functional gait outcomes. Statistically significant improvements in VAS pain scores, AOFAS ankle/hindfoot scores, and SF-36 scores were demonstrated in both age groups. Following surgery, there were improvements in all parameters of gait, including temporal-spatial parameters as step length and walking velocity; kinematic parameters, including, increase in total range of motion to a total of 17-19°; and kinetic parameters, including increase in ankle power and moment. The improvements both in clinical and gait outcomes were equivalent in the two age groups. In this comparative study, it is shown that both

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

    Directory of Open Access Journals (Sweden)

    Glenn Sheriff

    2011-05-01

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

  19. 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…

  20. Comparing models of Red Knot population dynamics

    Science.gov (United States)

    McGowan, Conor P.

    2015-01-01

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

  1. 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

  2. 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.

  3. 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.

  4. Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable.

    Science.gov (United States)

    Bhamidipati, Castigliano M; LaPar, Damien J; Stukenborg, George J; Lutz, Charles J; Tracci, Margaret C; Cherry, Kenneth J; Upchurch, Gilbert R; Kern, John A

    2012-07-01

    Outcomes following transcatheter interventions at vascular and general surgery teaching hospitals (STH) are unknown. We examine whether surgery training programs influence clinically relevant outcomes after commonly performed endovascular procedures. Using an all-payer inpatient care database from 2008, we selected adults who underwent either endovascular carotid stenting, endografting of descending thoracic aortic aneurysm, endovascular abdominal aortic aneurysm repair, or peripheral arterial revascularization. Patients were stratified by procedures completed at Surgery Teaching (Participate in Accreditation Council for Graduate Medical Education [ACGME]-accredited vascular and general surgery programs), STH, or nonteaching hospitals (NTH). Hierarchical regression models assessed adverse outcomes and in-hospital mortality among groups. Of the 175,698 records, 44% of the patients were treated at STH, while 56% underwent procedures at NTH. The adjusted odds ratio of any complication or mortality at STH and NTH were similar. Transfers, weekend admissions, and nonelective cases were higher at STH (P STH treated fewer patients with more than three comorbidities compared with NTH (STH: 47% vs NTH: 53%; P STH. Following commonly performed transcatheter vascular procedures, and despite more transfers, weekend admissions, and nonelective procedures completed at STH, complications, and mortality were comparable across centers. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  5. 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

  6. 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%

  7. 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...

  8. Commentary: Monotremes and marsupials: Comparative models to ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Biosciences; Volume 37; Issue 4. Commentary: Monotremes and marsupials: Comparative models to better understand the function of milk. Sanjana Kuruppath Swathi Bisana Julie A Sharp Christophe Lefevre Satish Kumar Kevin R Nicholas. Volume 37 Issue 4 September 2012 pp 581-588 ...

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

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

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

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

    Science.gov (United States)

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

    2017-11-01

    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.

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

    DEFF Research Database (Denmark)

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

    1999-01-01

    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....

  12. 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.

  13. Yoga Therapy Research: A Whole-Systems Perspective on Comparative Effectiveness and Patient-Centered Outcomes.

    Science.gov (United States)

    Rioux, Jennifer G

    2015-01-01

    For the yoga research community to capitalize on its current momentum, it is critical to consider certain developments in research theory and innovative methodologies. The concept of model validity must be incorporated in yoga therapy research so that explanatory constructs employed and outcome measures chosen reflect the principles of traditional yogic science. Focusing on effectiveness research will ensure maximum generalizability of study results and reflect real-world therapy delivery settings, thereby increasing the relevance of outcomes. Whole systems of healing require research methodologies that address complex relationships between multi-target therapies with multiple potential treatment results. Complex, dynamic systems theory provides the theoretical and methodological innovations necessary to design studies, choose outcomes, and analyze data in a way that can account for charting complex, cyclical, therapeutic trajectories across time. Emphasizing patient-centered outcomes is aligned with the patent-oriented and tailored natured of yoga therapy delivery. Increasing the quality and quantity of comparative effectiveness research to analyze the harms and benefits of contrasting therapies can provide an infrastructure for designing studies that can have significant practical impact. The creation of practice-based research networks within the yoga research community will incentivize links between mainstream clinical researchers and yoga therapy delivery settings, ultimately developing collaborative networks. Yoga therapy centers can facilitate patient recruitment for studies and inform standards for yoga researchers. Collaborative efforts between the yoga and ayurvedic research communities will streamline efforts, solidify expertise, cross-pollinate theoretical and methodological innovation, and consolidate efforts to secure research funding and increase publication and dissemination of study findings.

  14. 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.

  15. A Comparative Analysis of Task Modeling Notations

    Directory of Open Access Journals (Sweden)

    Jean Vanderdonckt

    2012-03-01

    paper a comparative analysis of selected models involving multiple users in an interaction is provided in order to identify concepts which are underexplored in today's multi-user interaction task modeling. This comparative analysis is based on three families of criteria: information criteria, conceptual coverage, and expressiveness. Merging the meta-models of the selected models enables to come up with a broader meta-model that could be instantiated in most situations involving multi-user interaction, like workflow information systems, CSCW.

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

    Directory of Open Access Journals (Sweden)

    Ian J Saldanha

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

  17. 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

  18. Comparing Methods to Denote Treatment Outcome in Clinical Research and Benchmarking Mental Health Care.

    Science.gov (United States)

    de Beurs, Edwin; Barendregt, Marko; de Heer, Arco; van Duijn, Erik; Goeree, Bob; Kloos, Margot; Kooiman, Kees; Lionarons, Helen; Merks, Andre

    2016-07-01

    Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size or ΔT) and on categorical indicators (Percentage Improvement and the Jacobson-Truax approach to Clinical Significance) are evaluated to determine which has the best methodological and statistical characteristics, and optimal performance, in comparing outcomes of treatment providers. Performance is compared in two datasets from providers using the Brief Symptom Inventory or the Outcome Questionnaire. Concordance of methods and their suitability to rank providers is assessed. Outcome indicators tend to converge and lead to a similar ranking of institutes within each dataset. Statistically and conceptually, continuous outcome indicators are superior to categorical outcomes as change scores have more statistical power and allow for a ranking of providers at first glance. However, the Jacobson-Truax approach can complement the change score approach as it presents outcome information in a clinically meaningful manner. Copyright © 2015 John Wiley & Sons, Ltd. When comparing various indicators or treatment outcome, statistical considerations designate continuous outcomes, such as the effect size of the pre-post change (effect size or ΔT) as the optimal choice. Expressing outcome in proportions of recovered, changed, unchanged or deteriorated patients has supplementary value, as it is more easily interpreted and appreciated by clinicians, managerial staff and, last but not the least, by patients. If categorical outcomes are used with small datasets, true differences in institutional performance may get obscured due to diminished power to detect differences. With sufficient data, outcome according to continuous and categorical indicators converge and lead to similar rankings of institutes' performance. Copyright © 2015 John Wiley & Sons, Ltd.

  19. Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability.

    Science.gov (United States)

    Bliven, Kellie C Huxel; Parr, Gail P

    2018-02-01

    Reference/Citation:  An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg. 2016;25(5):853-863.   Are clinical and patient-reported outcomes different between the Latarjet and Bankart repair stabilization procedures when performed for recurrent traumatic anterior shoulder instability?   Ovid MEDLINE, PubMed, Cochrane databases, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness were searched up to June 2015. The search terms used were Bankart AND Latarjet OR Bristow.   Criteria used to include studies that (1) were written in English; (2) compared the outcomes of any Latarjet procedure (Bristow-Latarjet, coracoid transfer, or modified Bristow) with Bankart repair (anatomic); (3) reported a minimum of 1 outcome of recurrence, redislocation, revision, or patient-reported outcome measure; and (4) reported original data.   Data presented in any format (text, table, figure) were extracted from all included studies. The quality of each study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Summary statistics were reported as relative risks and weighted mean differences. Fixed-effects (the assumed treatment effect was the same across studies) and random-effects (variations in treatment effect were assumed among studies) models were tested. Heterogeneity between trials was assessed using the χ 2 statistic, and the amount (percentage) of variation across studies due to heterogeneity was calculated using the I 2 statistic. Forest plots were used to present pooled results.   After the initial search, 245 articles were identified. After we applied the inclusion criteria, a total of 8 studies reporting on 795 patients (Latarjet = 379, Bankart

  20. 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)

  1. 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...

  2. Comparative analysis of arteriovenous malformation grading scales in predicting outcomes after stereotactic radiosurgery.

    Science.gov (United States)

    Pollock, Bruce E; Storlie, Curtis B; Link, Michael J; Stafford, Scott L; Garces, Yolanda I; Foote, Robert L

    2017-03-01

    OBJECTIVE Successful stereotactic radiosurgery (SRS) for the treatment of arteriovenous malformations (AVMs) results in nidus obliteration without new neurological deficits related to either intracranial hemorrhage (ICH) or radiation-induced complications (RICs). In this study the authors compared 5 AVM grading scales (Spetzler-Martin grading scale, radiosurgery-based AVM score [RBAS], Heidelberg score, Virginia Radiosurgery AVM Scale [VRAS], and proton radiosurgery AVM scale [PRAS]) at predicting outcomes after SRS. METHODS The study group consisted of 381 patients with sporadic AVMs who underwent Gamma Knife SRS between January 1990 and December 2009; none of the patients underwent prior radiation therapy. The primary end point was AVM obliteration without a decline in modified Rankin Scale (mRS) score (excellent outcome). Comparison of the area under the receiver operating characteristic curve (AUC) and accuracy was performed between the AVM grading scales and the best linear regression model (generalized linear model, elastic net [GLMnet]). RESULTS The median radiological follow-up after initial SRS was 77 months; the median clinical follow-up was 93 months. AVM obliteration was documented in 297 patients (78.0%). Obliteration was 59% at 4 years and 85% at 8 years. Fifty-five patients (14.4%) had a decline in mRS score secondary to RICs (n = 29, 7.6%) or ICH (n = 26, 6.8%). The mRS score declined by 10% at 4 years and 15% at 8 years. Overall, 274 patients (71.9%) had excellent outcomes. There was no difference between the AUC for the GLMnet (0.69 [95% CI 0.64-0.75]), RBAS (0.68 [95% CI 0.62-0.74]), or PRAS (0.69 [95% CI 0.62-0.74]). Pairwise comparison for accuracy showed no difference between the GLMnet and the RBAS (p = 0.08) or PRAS (p = 0.16), but it did show a significant difference between the GLMnet and the Spetzler-Martin grading system (p compared with the Spetzler-Martin grading scale (p = 0.03 and p = 0.01), Heidelberg score (p = 0.02 and p = 0

  3. 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

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

    Science.gov (United States)

    Hogan, David B; Freiheit, Elizabeth A; Strain, Laurel A; Patten, Scott B; Schmaltz, Heidi N; Rolfson, Darryl; Maxwell, Colleen J

    2012-09-14

    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. 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. 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-term care placement. Using different

  5. Evaluating alternate discrete outcome frameworks for modeling crash injury severity.

    Science.gov (United States)

    Yasmin, Shamsunnahar; Eluru, Naveen

    2013-10-01

    This paper focuses on the relevance of alternate discrete outcome frameworks for modeling driver injury severity. The study empirically compares the ordered response and unordered response models in the context of driver injury severity in traffic crashes. The alternative modeling approaches considered for the comparison exercise include: for the ordered response framework-ordered logit (OL), generalized ordered logit (GOL), mixed generalized ordered logit (MGOL) and for the unordered response framework-multinomial logit (MNL), nested logit (NL), ordered generalized extreme value logit (OGEV) and mixed multinomial logit (MMNL) model. A host of comparison metrics are computed to evaluate the performance of these alternative models. The study provides a comprehensive comparison exercise of the performance of ordered and unordered response models for examining the impact of exogenous factors on driver injury severity. The research also explores the effect of potential underreporting on alternative frameworks by artificially creating an underreported data sample from the driver injury severity sample. The empirical analysis is based on the 2010 General Estimates System (GES) data base-a nationally representative sample of road crashes collected and compiled from about 60 jurisdictions across the United States. The performance of the alternative frameworks are examined in the context of model estimation and validation (at the aggregate and disaggregate level). Further, the performance of the model frameworks in the presence of underreporting is explored, with and without corrections to the estimates. The results from these extensive analyses point toward the emergence of the GOL framework (MGOL) as a strong competitor to the MMNL model in modeling driver injury severity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Surgical Patient Safety Outcomes in Critical Access Hospitals: How Do They Compare?

    Science.gov (United States)

    Natafgi, Nabil; Baloh, Jure; Weigel, Paula; Ullrich, Fred; Ward, Marcia M

    2017-04-01

    The aim of the study was to examine whether Critical Access Hospitals (CAHs), the predominant type of hospital in small and isolated rural areas, perform better than, the same as, or worse than Prospective Payment System (PPS) hospitals on measures of quality. The Healthcare Cost and Utilization Project State Inpatient Databases and American Hospital Association annual survey data were used for analyses. A total of 35,674 discharges from 136 nonfederal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included 6 bivariate indicators of adverse events (including complications) of surgical care developed from the Agency for Healthcare Research and Quality's Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. Compared with PPS hospitals, CAHs are significantly less likely to have any observed (unadjusted) adverse event on 4 of the 6 indicators. After adjusting for patient mix and hospital characteristics, CAHs perform better on 3 of the 6 indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one. The study suggests there are no differences in surgical patient safety outcomes between CAHs and PPS hospitals of comparable size. This reinforces the central role of CAHs in providing quality surgical care to populations in rural and isolated areas, and underscores the importance of strategies to sustain rural surgery infrastructure. © 2016 National Rural Health Association.

  7. 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.

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

    Science.gov (United States)

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

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

  9. 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 ...

  10. 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...

  11. 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.

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

    Science.gov (United States)

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

    2016-11-01

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

  13. 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.)

  14. Stochastic models for some meteorological outcomes in Niger Delta ...

    African Journals Online (AJOL)

    In this paper, stochastic models based on autoregressive integrated moving average models of various orders and its seasonalized versions are presented, with a view to identifying the optimal model for some meteorological outcomes in some cities in Niger Delta region of Nigeria, using Normalized Bayesian Information ...

  15. Challenges in the Analysis of Outcomes for Surgical Compared to Radiotherapy Treatment of Prostate Cancer.

    Science.gov (United States)

    Glaser, Scott M; Kalash, Ronny; Bongiorni, Dante R; Roberts, Mark S; Balasubramani, Goundappa K; Jacobs, Bruce L; Beriwal, Sushil; Heron, Dwight E; Greenberger, Joel S

    2018-01-01

    Prostate cancer can be treated with radical prostatectomy (RP), external-beam radiotherapy (EBRT), or brachytherapy (BT). These modalities have similar cancer-related outcomes. We used an innovative method to analyze the cost of such treatment. We queried our Institution's Insurance Division [University of Pittsburgh Medical Center (UPMC) Health Plan] beneficiaries from 2003-2008, who were diagnosed with prostate cancer and also queried the UPMC tumor registry for all patients with prostate cancer treated at our Institution. In a de-identified manner, data from the Health Plan and Tumor Registry were merged. A total of 354 patients with non-metastatic disease with treatment initiated within 9 months of diagnosis were included (RP=236, EBRT=55, and BT=63). Radiotherapy-treated patients tended to be older, higher-risk, and have more comorbidities. Unadjusted median total health care expenditures during the first year after diagnosis were: RP: $16,743, EBRT: $47,256, and BT: $23,237 (p<0.0005). A propensity score-matched model comparing RP and EBRT demonstrated median total health care expenditures during year one: RP: $8,189, EBRT: $10,081; p=0.48. In a propensity-matched model comparing RP and BT, the median total health care expenditures during year one were: RP: $18,143, BT: $26,531; p=0.015 and per year during years 2 through 5 from diagnosis were: RP: $5,913, BT: $6,110; p=0.68. This pilot study demonstrates the feasibility of combining healthcare costs from the payer's perspective with clinical data from a Tumor Registry within an IDFS and represents a novel approach to investigating the economic impact of cancer treatment. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  16. 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.

  17. Modeling Count Outcomes from HIV Risk Reduction Interventions: A Comparison of Competing Statistical Models for Count Responses

    Directory of Open Access Journals (Sweden)

    Yinglin Xia

    2012-01-01

    Full Text Available Modeling count data from sexual behavioral outcomes involves many challenges, especially when the data exhibit a preponderance of zeros and overdispersion. In particular, the popular Poisson log-linear model is not appropriate for modeling such outcomes. Although alternatives exist for addressing both issues, they are not widely and effectively used in sex health research, especially in HIV prevention intervention and related studies. In this paper, we discuss how to analyze count outcomes distributed with excess of zeros and overdispersion and introduce appropriate model-fit indices for comparing the performance of competing models, using data from a real study on HIV prevention intervention. The in-depth look at these common issues arising from studies involving behavioral outcomes will promote sound statistical analyses and facilitate research in this and other related areas.

  18. 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.

  19. Laparoscopy-assisted and open living donor right hepatectomy: a comparative study of outcomes.

    Science.gov (United States)

    Baker, Talia B; Jay, Colleen L; Ladner, Daniela P; Preczewski, Luke B; Clark, Lori; Holl, Jane; Abecassis, Michael M

    2009-10-01

    Minimally invasive liver surgery is a rapidly advancing field with demonstrated applicability to living donation. In this paper, we compare the safety and efficacy of laparoscopy-assisted donor right hepatectomy (LADRH) to open donor right hepatectomy (ODRH). We performed a retrospective, comparative analysis of 33 LADRH to the most recent 33 ODRH performed at our institution, evaluating donor complications, costs, and recipient outcomes. Donor demographics including age, gender, body mass index (BMI), and vascular and biliary anomalies were comparable. Donor complication rates were equivalent for LADRH and ODRH. Donor operative times were shorter for LADRH (LADRH 265 minutes, ODRH 316; P size, recipient patient or graft survival, or recipient vascular or biliary complications. Our experience suggests that LADRH compares favorably with ODRH with equivalent safety, resource utilization, and effectiveness. We believe that LADRH provides potential physical and psychological benefits without an adverse effect on outcomes.

  20. 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…

  1. 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…

  2. The Outcome Of The Six Major Forms Of Marriage Counseling Compared: A Pilot Study

    Science.gov (United States)

    Cookerly, J. Richard

    1973-01-01

    This paper presents a follow-up records' study of 773 former marriage counseling clients of 21 marriage counselors. The clients' primary treatment form was compared with six categories of counseling outcome. A rank ordering of the six forms for effectiveness suggested conjoint interviews and conjoint groups to be the most effective forms.…

  3. 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…

  4. 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…

  5. COMPARATIVE STUDY OF MATERNAL OUTCOME IN EMERGENCY VERSUS ELECTIVE CAESAREAN SECTION

    OpenAIRE

    Indira Priyadarshini; Saraswathi; Ratna Kumari

    2015-01-01

    : OBJECTIVE: The aim of this study was to find out the maternal outcome in emergency and elective caesarean sections and to compare the intraoperative and postoperative maternal complications in emergency and elective caesarean sections. METHOD: In this hospital based descriptive study 100 cases of emergency caesarean section (EMCS) were compared with 100 cases of elective caesarean section (ELCS) over a period of 2 years in the department of obstetrics and gynaecology in Niloufer...

  6. 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.

  7. Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery.

    Science.gov (United States)

    Tangthongkum, Manupol; Kirtsreesakul, Virat; Supanimitjaroenporn, Pasawat; Leelasawatsuk, Peesit

    2017-06-01

    Concurrent chemoradiotherapy (CCRT) has been reported as effective and has become an acceptable treatment in advanced oral cancer. However, to date there is insufficient data to conclude that CCRT provides a good survival outcome. The purpose of this study was to compare survival rates and complications in patients with resectable advanced oral cavity squamous cell carcinoma treated with either CCRT or surgery with adjuvant radiotherapy (RT)/chemoradiotherapy (CRT). Stage III or IVa oral cavity carcinoma patients treated with curative intent by either CCRT or surgery with adjuvant RT were identified over a 7-year period (2009-2015). Survival rates and treatment complications were analyzed and compared between the two groups. 61 patients underwent CCRT and 128 patients underwent surgical excision and received postoperative RT. There was no statistically significant difference in survival outcome between the two treatment groups. 5-year overall survival rates (OS) were 33 versus 24% (P = 0.191) and the disease-specific survival rates (DSS) were 27 versus 25% (P = 0.857) when comparing the CCRT group and surgery with adjuvant RT/CRT group, respectively. Long-term complications were comparable between the two groups. CCRT has comparable survival outcome and complications for the treatment of advanced oral cavity squamous cell carcinoma, compared to surgery with adjuvant RT/CRT.

  8. Obstetric Outcomes in Adolescents Related to Body Mass Index and Compared with Low-Risk Adult Women.

    Science.gov (United States)

    Ramö Isgren, Anna; Kjølhede, Preben; Blomberg, Marie

    2017-05-01

    To evaluate in adolescents the association between body mass index (BMI) and obstetric outcomes and to determine whether the outcomes in the BMI groups of adolescents differ from those of a low-risk population of adult women. This is a nationwide population-based register study. Obstetric outcomes of 31,386 singleton primiparous adolescents were evaluated in relation to BMI classes. Furthermore, the outcomes of the adolescents and 178,844 normal weight, nonsmoking, singleton primiparous women, 25-29 years old with no known comorbidity, defined as standard women, were compared. Multiple logistic regression models were used. Results are presented as crude odds ratios (ORs) or adjusted ORs and with a 95% confidence interval. Compared with normal weight adolescents, obese adolescents had a lower chance of a normal vaginal delivery (VD)-76% versus 85% [adjusted OR 0.61 (0.55-0.68)], a higher risk for acute cesarean section (CS)-8.9% versus 4.5% [adjusted OR 2.45 (2.08-2.88)], and stillbirth-0.7% versus 0.2% [adjusted OR 3.17 (1.74-5.77)]. Compared with standard women, overweight adolescents had a higher chance of a normal VD-82% versus 75% [crude OR 1.53 (1.44-1.64)] and a lower risk for acute CS-6.3% versus 7.1% [crude OR 0.85 (0.76-0.95)]. Obese adolescents had a lower risk for instrumental VD-8% versus 13% [crude OR 0.61 (0.53-0.71)] and obstetric anal sphincter injury-1% versus 3% [crude OR 0.38 (0.26-0.57)]. Several adverse obstetric outcomes were obesity related among adolescents. Overweight adolescents seemed to have better obstetric outcomes than standard women, something to consider when optimizing resources for women during pregnancy and delivery.

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

    Directory of Open Access Journals (Sweden)

    Sabyasachi Sengupta

    2011-01-01

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

  10. Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Prentice, Julia C; Conlin, Paul R; Gellad, Walid F; Edelman, David; Lee, Todd A; Pizer, Steven D

    2015-03-01

    Long-acting insulin analogues (eg, insulin glargine and insulin detemir) are an alternative to neutral protamine Hagedorn (NPH) insulin for maintaining glycemic control in patients with diabetes. Clinical trials comparing analogue insulin and NPH have neither been adequately powered nor had sufficient follow-up to examine long-term health outcomes. To compare the effects of NPH and long-acting insulin analogues on long-term outcomes. This retrospective observational study relied on administrative data from the Veterans Health Administration and Medicare from 2000 to 2010. Local variations in analogue insulin prescribing rates were used in instrumental variable models to control for confounding. Outcomes were assessed using survival models. The study population included US veterans dually enrolled in Medicare who received at least 1 prescription for oral diabetes medication and then initiated long-acting insulin between 2001 and 2009. Outcomes included ambulatory care-sensitive condition (ACSC) hospitalizations and mortality. There was no significant relationship between type of insulin and ACSC hospitalization or mortality. The hazard ratio for mortality of individuals starting a long-acting analogue insulin was 0.97 (95% CI, 0.85-1.11), and was 1.05 (95% CI, 0.95-1.16) for ACSC hospitalization. Differences in risk remained insignificant when predicting diabetes-specific ACSC hospitalizations, but starting on long-acting analogue insulin significantly increased the risk of a cardiovascular-specific ACSC hospitalization. We found no consistent difference in long-term health outcomes when comparing use of long-acting insulin analogues and NPH insulin. The higher cost of analogue insulin without demonstrable clinical benefit raises questions of its cost-effectiveness in the treatment of patients with diabetes.

  11. Population health outcome models in suicide prevention policy.

    Science.gov (United States)

    Lynch, Frances L

    2014-09-01

    Suicide is a leading cause of death in the U.S. and results in immense suffering and significant cost. Effective suicide prevention interventions could reduce this burden, but policy makers need estimates of health outcomes achieved by alternative interventions to focus implementation efforts. To illustrate the utility of health outcome models to help in achieving goals defined by the National Action Alliance for Suicide Prevention's Research Prioritization Task Force. The approach is illustrated specifically with psychotherapeutic interventions to prevent suicide reattempt in emergency department settings. A health outcome model using decision analysis with secondary data was applied to estimate suicide attempts and deaths averted from evidence-based interventions. Under optimal conditions, the model estimated that over 1 year, implementing evidence-based psychotherapeutic interventions in emergency departments could decrease the number of suicide attempts by 18,737, and if offered over 5 years, it could avert 109,306 attempts. Over 1 year, the model estimated 2,498 fewer deaths from suicide, and over 5 years, about 13,928 fewer suicide deaths. Health outcome models could aid in suicide prevention policy by helping focus implementation efforts. Further research developing more sophisticated models of the impact of suicide prevention interventions that include a more complex understanding of suicidal behavior, longer time frames, and inclusion of additional outcomes that capture the full benefits and costs of interventions would be helpful next steps. Copyright © 2014 American Journal of Preventive Medicine. All rights reserved.

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

    NARCIS (Netherlands)

    B. Li (Bayoue); B. Roozenbeek (Bob); E.W. Steyerberg (Ewout); E.M.E.H. Lesaffre (Emmanuel)

    2011-01-01

    textabstractBackground: Logistic random effects models are a popular tool to analyze multilevel also called hierarchical data with a binary or ordinal outcome. Here, we aim to compare different statistical software implementations of these models. Methods. We used individual patient data from 8509

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

    Science.gov (United States)

    Bauer, Daniel J.; Sterba, Sonya K.

    2011-01-01

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

  14. Functional Outcomes of Surgery in Cervical Spondylotic Radiculopathy versus Myelopathy: A Comparative Study

    Directory of Open Access Journals (Sweden)

    F. Omidi-Kashani

    2013-01-01

    Full Text Available Background. Cervical spondylosis can cause three different categories of symptoms and signs with possible overlap in the affected patients. Aim. We aim to compare functional outcome of surgery in the patients with cervical spondylotic radiculopathy and myelopathy, regardless of their surgical type and approach. Materials and Methods. We retrospectively reviewed 140 patients with cervical spondylotic radiculopathy and myelopathy who had been operated from August 2006 to January 2011, as Group A (68 cases and Group B (72 cases, respectively. The mean age was 48.2 and 55.7 years, while the mean followup was 38.9 and 37.3 months, respectively. Functional outcome of the patients was assessed by neck disability index (NDI and patient satisfaction with surgery. Results. Only in Group A, the longer delay caused a worse surgical outcome (NDI. In addition, in Group B, there was no significant relationship between imaging signal change of the spinal cord and our surgical outcomes. Improvement in NDI and final satisfaction rate in both groups are comparable. Conclusions. Surgery was associated with an improvement in NDI in both groups (P<0.001. The functional results in both groups were similar and comparable, regarding this index and patient's satisfaction score.

  15. 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.

  16. Handicraft or interactional groups: a comparative outcome study of neurotic inpatients.

    Science.gov (United States)

    Sexton, H; Fornes, G; Kruger, M B; Grendahl, G; Kolset, M

    1990-11-01

    A comparative outcome study of 2 contrasting activity-based groups with 80 hospitalized nonpsychotic patients is described. One group focused on activities designed to evoke emotional or interpersonal reactions followed by a subsequent reflection. The other focused on handicrafts and non-emotionally challenging activities. Ego strength was also measured with an instrument developed in conjunction with the study. The 2 groups were demonstrated to be consistent with the preconditions and significantly different by independent scoring of videotaped sessions. There was a greater rated therapeutic gain in the interactional group at discharge, but patient ratings did not differ between groups. There were no differences at follow-up between the groups. Measured ego strength strongly predicted outcome after correcting for the initial symptom levels. Ego strength did not interact with activity type. Clinical diagnosis did not predict differential outcome. The groups had no differential effects on specific symptom clusters or social functioning.

  17. Defining Our Clinical Practice: The Identification of Genetic Counseling Outcomes Utilizing the Reciprocal Engagement Model.

    Science.gov (United States)

    Redlinger-Grosse, Krista; Veach, Patricia McCarthy; Cohen, Stephanie; LeRoy, Bonnie S; MacFarlane, Ian M; Zierhut, Heather

    2016-04-01

    The need for evidence-based medicine, including comparative effectiveness studies and patient-centered outcomes research, has become a major healthcare focus. To date, a comprehensive list of genetic counseling outcomes, as espoused by genetic counselors, has not been established and thus, identification of outcomes unique to genetic counseling services has become a priority for the National Society of Genetic Counselors (NSGC). The purpose of this study was to take a critical first step at identifying a more comprehensive list of genetic counseling outcomes. This paper describes the results of a focus group study using the Reciprocal-Engagement Model (REM) as a framework to characterize patient-centered outcomes of genetic counseling clinical practice. Five focus groups were conducted with 27 peer nominated participants who were clinical genetic counselors, genetic counseling program directors, and/or outcomes researchers in genetic counseling. Members of each focus group were asked to identify genetic counseling outcomes for four to five of the 17 goals of the REM. A theory-driven, thematic analysis of focus group data yielded 194 genetic counseling outcomes across the 17 goals. Participants noted some concerns about how genetic counseling outcomes will be measured and evaluated given varying stakeholders and the long-term nature of genetic concerns. The present results provide a list of outcomes for use in future genetic counseling outcomes research and for empirically-supported clinical interventions.

  18. 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.

  19. 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

  20. Aspiration Abortion With Immediate Intrauterine Device Insertion: Comparing Outcomes of Advanced Practice Clinicians and Physicians.

    Science.gov (United States)

    Patil, Eva; Darney, Blair; Orme-Evans, Kaebah; Beckley, Ethan H; Bergander, Linn; Nichols, Mark; Bednarek, Paula H

    2016-05-01

    Immediate postabortion intrauterine device (IUD) insertion is a safe, effective strategy to prevent subsequent unplanned pregnancy. Oregon is one of 5 US states where advanced practice clinicians perform aspiration abortions. This study compares outcomes of first-trimester aspiration abortion with immediate IUD insertion between advanced practice clinicians and physicians. We conducted a historical cohort study of first-trimester aspiration abortions with immediate IUD insertion performed at our center from 2009 to 2011. We extracted demographic and clinical data from patient charts. Immediate complications including excessive blood loss, perforation, and reaspirations were recorded at the time of procedure. We used descriptive statistics and multivariable logistic regression to test for differences in outcomes by clinician type. Data were available on 669 of the 1134 combined procedures. Advanced practice clinicians performed 224 of these. There were no significant differences in immediate outcomes. The only immediate complications were reaspirations; 1.8% (4/224) in the advanced practice clinician group, and 2.0% (9/445) in the physician group (P = .83). We found no differences in outcomes between provider type for immediate IUD insertion after first-trimester aspiration abortion. This study helps reinforce that advanced practice clinicians can provide immediate postaspiration abortion IUD insertions with similar outcomes to those of physicians. Many countries do not allow advanced practice clinicians to perform this service, but a change in policy could help address family planning provider shortages. © 2016 by the American College of Nurse-Midwives.

  1. 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...

  2. 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.

  3. Comparative study of vocal outcomes with silicone versus Gore-Tex thyroplasty.

    Science.gov (United States)

    Suehiro, Atsushi; Hirano, Shigeru; Kishimoto, Yo; Tanaka, Shinzo; Ford, Charles N

    2009-06-01

    We examined vocal outcomes of patients who underwent type I thyroplasty for unilateral vocal fold paralysis. Specifically, the vocal outcomes were compared between 15 patients whose thyroplasties were performed with silicone and 15 patients whose thyroplasties were performed with Gore-Tex. The examined clinical characteristics did not differ significantly between the groups. The vocal outcomes were evaluated by aerodynamic and acoustic measurements. Aerodynamic examination indicated significant postoperative improvements in the maximum phonation time and mean flow rate in both groups. Shimmer was significantly improved only in the Gore-Tex group. A direct comparison between groups showed no significant difference in the degree of improvement of the vocal parameters, except for a significant improvement in the noise-to-harmonics ratio in the Gore-Tex group. The duration of surgery was significantly less in the Gore-Tex group than in the silicone group. Gore-Tex thyroplasty is considered to be comparable to silicone thyroplasty in terms of postoperative vocal outcomes. Gore-Tex thyroplasty enables a less invasive procedure with a shorter surgical duration and easier adjustment of medialization due to its flexibility.

  4. 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 cancer stage also revealed no differences. LAC for transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.

  5. 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.

  6. 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

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

    Directory of Open Access Journals (Sweden)

    L. D. Bardin

    2003-02-01

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

  8. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2012-03-01

    Full Text Available system, few represent target selection, attack planning, and Denial of Service attacks, and none specifically represent attack coordination within distributed groups. Finally, a canonical model has been constructed by rational reconstruction (Habermas... logical form? (Habermas, 1976). RR has been applied in computing research to redesign a seminal expert system (Cendrowski & Bramer, 1984) and to formalise Boyd?s (1996) Observe-Orient-Decide-Act (OODA) loop (Grant & Kooter, 2005). In the research...

  9. 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.

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

    NARCIS (Netherlands)

    van Borkulo, S.P.|info:eu-repo/dai/nl/297554727; van Joolingen, W.R.|info:eu-repo/dai/nl/073458872; Savelsbergh, E.R.|info:eu-repo/dai/nl/17345853X; de Jong, T.

    2012-01-01

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

  11. How do the outcomes of the DEKA Arm compare to conventional prostheses?

    Science.gov (United States)

    Resnik, Linda J; Borgia, Matthew L; Acluche, Frantzy; Cancio, Jill M; Latlief, Gail; Sasson, Nicole

    2018-01-01

    Objectives were to 1) compare self-reported function, dexterity, activity performance, quality of life and community integration of the DEKA Arm to conventional prostheses; and 2) examine differences in outcomes by conventional prosthesis type, terminal device type and by DEKA Arm configuration level. This was a two-part study; Part A consisted of in-laboratory training. Part B consisted of home use. Study participants were 23 prosthesis users (mean age = 45 ± 16; 87% male) who completed Part A, and 15 (mean age = 45 ± 18; 87% male) who completed Parts A and B. Outcomes including self-report and performance measures, were collected at Baseline using participants' personal prostheses and at the End of Parts A and B. Scores were compared using paired t-tests. Wilcoxon signed-rank tests were used to compare outcomes for the full sample, and for the sample stratified by device and terminal device type. Analysis of outcomes by configuration level was performed graphically. At the End of Part A activity performance using the DEKA Arm and conventional prosthesis was equivalent, but slower with the DEKA Arm. After Part B, performance using the DEKA Arm surpassed conventional prosthesis scores, and speed of activity completion was equivalent. Participants reported using the DEKA Arm to perform more activities, had less perceived disability, and less difficulty in activities at the End of A and B as compared to Baseline. No differences were observed in dexterity, prosthetic skill, spontaneity, pain, community integration or quality of life. Comparisons stratified by device type revealed similar patterns. Graphic comparisons revealed variations by configuration level. Participants using the DEKA Arm had less perceived disability and more engagement of the prosthesis in everyday tasks, although activity performance was slower. After home use experience, activity performance was improved and activity speed equivalent to using conventional prostheses.

  12. How do the outcomes of the DEKA Arm compare to conventional prostheses?

    Directory of Open Access Journals (Sweden)

    Linda J Resnik

    Full Text Available Objectives were to 1 compare self-reported function, dexterity, activity performance, quality of life and community integration of the DEKA Arm to conventional prostheses; and 2 examine differences in outcomes by conventional prosthesis type, terminal device type and by DEKA Arm configuration level.This was a two-part study; Part A consisted of in-laboratory training. Part B consisted of home use. Study participants were 23 prosthesis users (mean age = 45 ± 16; 87% male who completed Part A, and 15 (mean age = 45 ± 18; 87% male who completed Parts A and B. Outcomes including self-report and performance measures, were collected at Baseline using participants' personal prostheses and at the End of Parts A and B. Scores were compared using paired t-tests. Wilcoxon signed-rank tests were used to compare outcomes for the full sample, and for the sample stratified by device and terminal device type. Analysis of outcomes by configuration level was performed graphically.At the End of Part A activity performance using the DEKA Arm and conventional prosthesis was equivalent, but slower with the DEKA Arm. After Part B, performance using the DEKA Arm surpassed conventional prosthesis scores, and speed of activity completion was equivalent. Participants reported using the DEKA Arm to perform more activities, had less perceived disability, and less difficulty in activities at the End of A and B as compared to Baseline. No differences were observed in dexterity, prosthetic skill, spontaneity, pain, community integration or quality of life. Comparisons stratified by device type revealed similar patterns. Graphic comparisons revealed variations by configuration level.Participants using the DEKA Arm had less perceived disability and more engagement of the prosthesis in everyday tasks, although activity performance was slower. After home use experience, activity performance was improved and activity speed equivalent to using conventional prostheses.

  13. 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

  14. 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

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

    Directory of Open Access Journals (Sweden)

    Zeng-yin Chen

    2014-01-01

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

  16. Comparing National Water Model Inundation Predictions with Hydrodynamic Modeling

    Science.gov (United States)

    Egbert, R. J.; Shastry, A.; Aristizabal, F.; Luo, C.

    2017-12-01

    The National Water Model (NWM) simulates the hydrologic cycle and produces streamflow forecasts, runoff, and other variables for 2.7 million reaches along the National Hydrography Dataset for the continental United States. NWM applies Muskingum-Cunge channel routing which is based on the continuity equation. However, the momentum equation also needs to be considered to obtain better estimates of streamflow and stage in rivers especially for applications such as flood inundation mapping. Simulation Program for River NeTworks (SPRNT) is a fully dynamic model for large scale river networks that solves the full nonlinear Saint-Venant equations for 1D flow and stage height in river channel networks with non-uniform bathymetry. For the current work, the steady-state version of the SPRNT model was leveraged. An evaluation on SPRNT's and NWM's abilities to predict inundation was conducted for the record flood of Hurricane Matthew in October 2016 along the Neuse River in North Carolina. This event was known to have been influenced by backwater effects from the Hurricane's storm surge. Retrospective NWM discharge predictions were converted to stage using synthetic rating curves. The stages from both models were utilized to produce flood inundation maps using the Height Above Nearest Drainage (HAND) method which uses the local relative heights to provide a spatial representation of inundation depths. In order to validate the inundation produced by the models, Sentinel-1A synthetic aperture radar data in the VV and VH polarizations along with auxiliary data was used to produce a reference inundation map. A preliminary, binary comparison of the inundation maps to the reference, limited to the five HUC-12 areas of Goldsboro, NC, yielded that the flood inundation accuracies for NWM and SPRNT were 74.68% and 78.37%, respectively. The differences for all the relevant test statistics including accuracy, true positive rate, true negative rate, and positive predictive value were found

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Complete mesocolic excision (CME) seems to be associated with improved oncological outcomes compared with 'conventional' surgery, but there is a potential for higher morbidity. METHODS: Data for patients after elective resection at the four centres in the Capital Region of Denmark (Ju...... for colonic cancer....... 2008 to December 2013) were retrieved from the Danish Colorectal Cancer Group database and medical charts. Approval from a Danish ethics committee was not required (retrospective study). RESULTS: Some 529 patients who underwent CME surgery at one centre were compared with 1701 patients undergoing...

  18. Pregnancy outcomes among Syrian refugee and Jordanian women: a comparative study.

    Science.gov (United States)

    Alnuaimi, K; Kassab, M; Ali, R; Mohammad, K; Shattnawi, K

    2017-12-01

    To compare pregnancy outcomes of Syrian refugee women and Jordanian women. In the past few years, thousands of Syrians fled Syria to neighbouring countries such as Jordan as a result of the continuing conflict in their country. Pregnant refugee women are facing many difficulties that increase the prevalence of antenatal complications. However, there is limited awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental hospital in northern Jordan, between 1 January 2014 and 31 December 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birthweight (Syrian refugees and Jordan women is a healthcare priority. The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. Action is required by policy makers, specifically targeting public and primary healthcare services, to address the problem of adequately meeting the needs for antenatal care of this vulnerable population. © 2017 International Council of Nurses.

  19. 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

  20. Graphical models for inference under outcome-dependent sampling

    DEFF Research Database (Denmark)

    Didelez, V; Kreiner, S; Keiding, N

    2010-01-01

    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...

  1. A comparative study of self-efficacy, outcome expectancy, and retention of beginning urban science teachers

    Science.gov (United States)

    Klein, Nina

    The purpose of the multi-tiered study presented is to compare the effect of credentialing route on the self-efficacy, outcome expectancy, and retention of beginning urban science teachers serving students in a large urban school district in Southern California. Candidates from one traditional, university-based teacher education program and from two alternative programs, the Teach for America and District Intern Programs, were surveyed and interviewed during the second semester of their first year of teaching. To determine the potential of a difference in self-efficacy and outcome expectancy, the study gave teachers a modified version of the Science Teachers' Efficacy Belief Instrument (STEBI), developed and validated by Riggs and Enochs (1989). Two representative candidates from each program were then interviewed in order to probe for deeper understanding of possible sources of their efficacy and outcome expectancy. The final part of the study is an evaluation of retention data from the three programs, each to triangulate this information with data collected from the surveys, and comparing these retention rates with published data. The study provides data on unresearched questions about traditionally and alternatively credentialed science teachers in urban settings in California.

  2. Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty Outcomes and Healing Patterns Compared to Manual Technique

    Directory of Open Access Journals (Sweden)

    Jorge L. Alio

    2015-01-01

    Full Text Available The purpose of the study is to report the visual, refractive, and wound healing pattern outcomes of femtosecond assisted deep anterior lamellar keratoplasty (DALK compared to the conventional manual technique. DALK was performed on 50 eyes of 47 advanced keratoconus patients. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond assisted or manual DALK technique was performed for the side cut of the procedure only. Patients were followed up at 1 month, 6 months, and 1 year for visual acuity, clinical refraction, corneal cylinder, date of suture removal, and side cut corneal healing pattern according to new grading classification of the side cut scar (Grade 0 = transparent scar, 1 = faint healing opacity, 2 = evident healing opacity, 3 = significant opacity with some cosmetic imbalance, and 4 = highly significant opacity with very significant cosmetic imbalance. Outcomes are reported at one year. In conclusion, femtosecond assisted and manual DALK show comparable visual and refractive outcomes but femtosecond assisted DALK shows more evident corneal wound healing patterns at the side cut. This observation may indicate that an activated cornea wound healing might allow earlier suture removal when femtosecond technology is used to perform the side cut for DALK.

  3. 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

  4. A meta-analysis of voice outcome comparing calcium hydroxylapatite injection laryngoplasty to silicone thyroplasty.

    Science.gov (United States)

    Shen, Tianjie; Damrose, Edward J; Morzaria, Sanjay

    2013-02-01

    To compare the voice outcome of calcium hydroxylapatite (CaHA) injection laryngoplasty (IL) vs silicone medialization thyroplasty (MT) in the treatment of unilateral vocal fold paralysis (UVFP). Systematic review of English literature from MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane library from January 1, 1980, to December 31, 2010. Included studies reporting voice-related quality of life (Voice Handicap Inventory [VHI]) following IL with CaHA or MT with silicone. The primary outcome measure was the improvement in VHI. The secondary outcome was improvement in maximum phonatory time (MPT). Of the 742 abstracts screened for relevancy, 24 studies qualified for analysis. The mean (SD) VHI scores were 72.22 (11.06) before MT and 34.02 (6.48) after MT. The mean (SD) VHI scores were 68.36 (6.88) before IL and 32.24 (7.33) after IL. The paired difference mean of VHI improvement was 38.20 (95% confidence interval [CI], 17.05-59.32; P = .007) for MT and 36.11 (95% CI, 29.65-42.57; P = .001) for IL. The mean (SD) MPT scores were 7.40 (3.14) before IL and 13.00 (1.75) after IL. The mean (SD) MPT scores were 6.16 (1.90) before MT and 12.40 (2.72) after MT. The paired difference mean of MPT improvement was 6.23 (95% CI, 4.74-7.73; P < .001) for MT and 5.60 (95% CI, 2.95-8.25; P = .006) for IL. Injection laryngoplasty with CaHA and MT with silicone appear to achieve comparable voice improvement within 1 year, but a definitive conclusion is limited by a lack of standardized outcome measures.

  5. Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty.

    Science.gov (United States)

    Postler, Anne E; Beyer, Franziska; Wegner, Tim; Lützner, Jörg; Hartmann, Albrecht; Ojodu, Ishaq; Günther, Klaus-Peter

    2017-03-31

    Patients who undergo either primary or revision total hip arthroplasty (THA) mainly expect improvement in pain, function/activity and quality of life. The purpose of the study was to measure the degree of short-term and medium-term improvement and the differences in patient-reported outcome that can be expected in patients undergoing revision THA, compared to patients undergoing primary THA. In this study, the results of patient-reported outcome measurements were compared in 124 matched patients, who underwent revision surgery and primary THA between 01/2007 and 12/2009. Assessment was performed at short-term and medium-term follow-up and included the WOMAC score, the UCLA activity score and EuroQol scores. 6 months after revision THA, the mean total WOMAC score improved by 22.1 points, the UCLA activity score by 0.6 points and the EuroQol-Index by 0.2 points. After primary THA, the improvement was 41.4 points on the WOMAC, 1.1 points on the UCLA and 0.3 points on the EuroQol-Index. At medium-term follow-up, 3.6 years after revision surgery and 2.3 years after primary THA, patients undergoing revision THA showed significantly less overall improvement, as well as lower final outcome scores, than patients undergoing primary THA. Patients undergoing revision arthroplasty, as well as patients undergoing primary THA, can expect major improvement in function, activity and quality of life postoperatively. However, overall level of improvement, as well as peak attainable outcome levels, are lower after revision surgery than after primary THA. Appropriate information for patients who undergo hip revision surgery is necessary in order to avoid unrealistic expectations and postoperative dissatisfaction.

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

    Science.gov (United States)

    Borja, Susan E.; Callahan, Jennifer L.

    2009-01-01

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

  7. Primary dermal melanoma: distinct immunohistochemical findings and clinical outcome compared with nodular and metastatic melanoma.

    Science.gov (United States)

    Cassarino, David S; Cabral, Erik S; Kartha, Reena V; Swetter, Susan M

    2008-01-01

    To provide an updated and expanded analysis of clinical outcome and immunohistochemical (IHC) findings unique to primary dermal melanoma (PDM) that may be used to differentiate this entity from primary nodular melanoma (PNM) and cutaneous metastatic melanoma (MM). Cohort analysis and extensive IHC panel comparing PDM with PNM and cutaneous MM. Melanoma clinics and pathology departments of academic and VA medical centers. Thirteen patients with a solitary dermal or subcutaneous nodule of histologically proven melanoma, prospectively followed through April 30, 2007. Clinical, pathologic, and IHC assessment of patients diagnosed as having PDM. Long-term clinical outcome and determination of unique clinical and IHC features in the study cohort compared with other melanoma subtypes. Histologically, there was no evidence of an overlying in situ component, ulceration, or regression, and there was no associated nevus in any cases. Clinical history and findings from workup, including imaging studies, skin examination, and sentinel lymph node biopsy, were negative for evidence of melanoma elsewhere. The mean Breslow depth was 9.6 mm. Two patients developed satellite or in-transit recurrences, 1 developed pulmonary metastasis, and another died of liver metastases. Overall, the cohort showed a 92% melanoma-specific survival rate at a mean duration of follow-up of 44 months. The IHC findings showed that PDM exhibited lower levels of staining for the antigens p53 (P = .02), Ki-67 (Mib-1) (P = .002), cyclin D1 (P = .001), and podoplanin (recognized by D2-40 antibody) lymphovascular staining (P <.001) compared with MM and PNM. All other markers were comparable. Patients with PDM have remarkably prolonged survival compared with patients with MM or PNM of similar thickness. Preliminary results suggest that PDM may be characterized by lower levels of p53, Ki-67, cyclin D1, and D2-40 compared with histologically similar MM and PNM.

  8. 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.

  9. Clinical outcome measurement: Models, theory, psychometrics and practice.

    Science.gov (United States)

    McClimans, Leah; Browne, John; Cano, Stefan

    In the last decade much has been made of the role that models play in the epistemology of measurement. Specifically, philosophers have been interested in the role of models in producing measurement outcomes. This discussion has proceeded largely within the context of the physical sciences, with notable exceptions considering measurement in economics. However, models also play a central role in the methods used to develop instruments that purport to quantify psychological phenomena. These methods fall under the umbrella term 'psychometrics'. In this paper, we focus on Clinical Outcome Assessments (COAs) and discuss two measurement theories and their associated models: Classical Test Theory (CTT) and Rasch Measurement Theory. We argue that models have an important role to play in coordinating theoretical terms with empirical content, but to do so they must serve: 1) as a representation of the measurement interaction; and 2) in conjunction with a theory of the attribute in which we are interested. We conclude that Rasch Measurement Theory is a more promising approach than CTT in these regards despite the latter's popularity with health outcomes researchers. Copyright © 2017. Published by Elsevier Ltd.

  10. Comparing Traditional Service Delivery and Telepractice for Speech Sound Production Using a Functional Outcome Measure.

    Science.gov (United States)

    Coufal, Kathy; Parham, Douglas; Jakubowitz, Melissa; Howell, Cassandra; Reyes, Jared

    2018-02-06

    Using American Speech-Language-Hearing Association's (ASHA's) National Outcomes Measurement System (NOMS) Functional Communication Measure (FCM) as a common metric, this investigation compared traditional service delivery and telepractice service delivery for children receiving therapy for the NOMS diagnostic category of "speech sound production." De-identified cases were secured from ASHA's NOMS database and a proprietary database from a private e-learning provider. Cases were included if they met 3 criteria: (a) children received treatment exclusively for speech sound production, (b) they were between 6.0 and 9.5 years old, and (c) they received therapy lasting between 4 and 9 months. A total of 1,331 ASHA NOMS cases and 428 telepractice cases were included. The 2 groups were matched by initial FCM scores. Mann-Whitney U tests were completed to compare differences in the median change scores (the difference between the initial and final FCM scores) between the 2 groups. There were no significant differences in the median change scores between the traditional group and the telepractice group. These results suggest comparable treatment outcomes between traditional service delivery and telepractice for treatment of children exhibiting speech sound disorders. The findings provide support for the use of telepractice for school-age children.

  11. Long-nerve grafts and nerve transfers demonstrate comparable outcomes for axillary nerve injuries.

    Science.gov (United States)

    Wolfe, Scott W; Johnsen, Parker H; Lee, Steve K; Feinberg, Joseph H

    2014-07-01

    To compare the functional and EMG outcomes of long-nerve grafts to nerve transfers for complete axillary nerve palsy. Over a 10-year period at a single institution, 14 patients with axillary nerve palsy were treated with long-nerve grafts and 24 patients were treated with triceps-to-axillary nerve transfers by the same surgeon (S.W.W.). Data were collected prospectively at regular intervals, beginning before surgery and continuing up to 11 years after surgery. Prior to intervention, all patients demonstrated EMG evidence of complete denervation of the deltoid. Deltoid recovery (Medical Research Council [MRC] grade), shoulder abduction (°), improvement in shoulder abduction (°), and EMG evidence of deltoid reinnervation were compared between cohorts. There were no significant differences between the long-nerve graft cohort and the nerve transfer cohort with respect to postoperative range of motion, deltoid recovery, improvement in shoulder abduction, or EMG evidence of deltoid reinnervation. These data demonstrate that outcomes of long-nerve grafts for axillary nerve palsy are comparable with those of modern nerve transfers and question a widely held belief that long-nerve grafts do poorly. When healthy donor roots or trunks are available, long-nerve grafts should not be overlooked as an effective intervention for the treatment of axillary nerve injuries in adults with brachial plexus injuries. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Robotic versus laparoscopic surgery for rectal cancer: a comparative study of clinical outcomes and costs.

    Science.gov (United States)

    Ielpo, Benedetto; Duran, H; Diaz, E; Fabra, I; Caruso, R; Malavé, L; Ferri, V; Nuñez, J; Ruiz-Ocaña, A; Jorge, E; Lazzaro, S; Kalivaci, D; Quijano, Y; Vicente, E

    2017-10-01

    The costs involved in performing robotic surgery present a critical issue which has not been well addressed yet. The aims of this study are to compare the clinical outcomes and cost differences of robotic versus laparoscopic surgery in the treatment of rectal cancer and to conduct a literature review of the cost analysis. This is an observational, comparative study whereby data were abstracted from a retrospective database of patients who underwent laparoscopic and robotic rectal resection from October 2010 to March 2017, at Sanchinarro University Hospital, Madrid. An independent company performed the financial analysis, and fixed costs were excluded. A total of 86 robotic and 112 laparoscopic rectal resections were included. The mean operative time was significantly lower in the laparoscopic approach (336 versus 283 min; p = 0.001). The main pre-operative data, overall morbidity, hospital stay and oncological outcomes were similar in both groups, except for the readmission rate (robotic: 5.8%, laparoscopic: 11.6%; p = 0.001). The mean operative costs were higher for robotic surgery (4285.16 versus 3506.11€; p = 0.04); however, the mean overall costs were similar (7279.31€ for robotic and 6879.8€ for the laparoscopic approach; p = 0.44). We found four studies reporting costs, three comparing robotic versus laparoscopy costs, with all of them reporting a higher overall cost for the robotic rectal resection. Robotic rectal resection has similar clinical outcomes to that of the conventional laparoscopic approach. Despite the higher operative costs of robotic rectal resection, overall mean costs were similar in our series.

  13. Outcomes of Infants with Home Tube Feeding: Comparing Nasogastric Versus Gastrostomy Tubes

    Science.gov (United States)

    Khalil, Syed Tariq; Uhing, Michael R.; Duesing, Lori; Visotcky, Alexis; Tarima, Sergey; Nghiem-Rao, T. Hang

    2017-01-01

    Background Determine the tube-related complications and feeding outcomes of infants discharged home from the NICU with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. Material & Methods We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 – December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months post-discharge. Univariate and multivariate analyses were conducted. Results There were 322 infants discharged with home enteral tube feeding, 84 NG tube and 238 G-tube, with available out-patient data for the 6 month post-discharge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared to the NG tube group (33.6% vs 9.5%, p tube related complication. By 6 months post-discharge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared to 19.3% in the G-tube group (p tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months post-discharge. Conclusion Home NG tube feeding is associated with fewer ED visits for tube-related complications compared to home G-tube feeding. There may be some infants who could benefit from a trial home NG tube feeding. PMID:27647478

  14. Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes.

    Science.gov (United States)

    Khalil, Syed Tariq; Uhing, Michael R; Duesing, Lori; Visotcky, Alexis; Tarima, Sergey; Nghiem-Rao, T Hang

    2017-11-01

    The aim of this study was to determine the tube-related complications and feeding outcomes of infants discharged home from the neonatal intensive care unit (NICU) with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 and December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months postdischarge. Univariate and multivariate analyses were conducted. There were 322 infants discharged with home enteral tube feeding (NG tube, n = 84; G-tube, n = 238), with available outpatient data for the 6-month postdischarge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared with the NG tube group (33.6% vs 9.5%, P tube-related complication. By 6 months postdischarge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared with 19.3% in the G-tube group ( P tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months postdischarge. Home NG tube feeding is associated with fewer ED visits for tube-related complications compared with home G-tube feeding. Some infants could benefit from a trial home NG tube feeding.

  15. Pregnancy outcome of patients following bariatric surgery as compared with obese women: a population-based study.

    Science.gov (United States)

    Shai, Daniel; Shoham-Vardi, Ilana; Amsalem, Doron; Silverberg, Daniel; Levi, Isaac; Sheiner, Eyal

    2014-02-01

    To evaluate pregnancy outcome and rates of anemia in patients following bariatric operation in comparison with obese pregnant women. A retrospective population-based study comparing pregnancy outcome of patients following bariatric with the obese population was conducted. Multivariate logistic regression models were constructed to control for confounders. To evaluate the change in hemoglobin levels, we included women who had one pregnancy before the bariatric surgery and one following the surgery or two pregnancies for women with obesity. This study included 326 women who had one pregnancy before and after a bariatric surgery and 1612 obese women who had at least two consecutive deliveries. Using a multivariable logistic regression model, controlling for confounders such as maternal age, patients following bariatric surgery had lower rates of gestational diabetes mellitus (OR 0.7; 95% CI 0.5-0.9; p = 0.49) and macrosomia (OR 0.3; 95% CI 0.2-0.5; p bariatric surgery were more likely to be anemic (hemoglobin bariatric surgery (a decline of 0.33 g/dL versus 0.18 g/dL between two consecutive pregnancies of obese women). Using another multivariable model with anemia as the outcome variable, bariatric was noted as a risk factor for anemia (adjusted OR = 1.45, 95%CI 1.13-1.86, p = 0.004). Women following bariatric surgery have lower risk for gestational diabetes mellitus and fetal macrosomia as compared with obese parturients. Nevertheless, bariatric surgery is a risk factor for anemia.

  16. 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.

  17. Comparing learning outcomes of international and local community partnerships for undergraduate nursing students.

    Science.gov (United States)

    Wros, Peggy; Archer, Sherry

    2010-10-01

    International health care experiences offer undergraduate nursing students the opportunity for significant personal and professional growth. During a month-long travel course to Cameroon, West Africa, students improved their skills in clinical assessment, data management, intercultural communication, and collaboration based on an empowerment model of international partnership. Although it is not possible for all students to participate in providing health care in another country, it is possible to design a local course in which students are able to meet similar outcomes in a community health experience in partnership with an immigrant and refugee center.

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

    Science.gov (United States)

    Schneiderman, Megan; Balayla, Jacques

    2013-07-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

  20. Minimally invasive abdominal cerclage compared to laparotomy: a comparison of surgical and obstetric outcomes.

    Science.gov (United States)

    Kim, Soorin; Hill, Amanda; Menderes, Gulden; Cross, Sarah; Azodi, Masoud; Bahtiyar, Mert Ozan

    2017-07-18

    The objective of this study is to report surgical and obstetric outcomes of patients following abdominal cerclage placement through either minimally invasive or open techniques. Subjects of this retrospective cohort study were patients at two referral centers specializing in high-risk pregnancy and minimally invasive gynecologic surgery. Electronic medical records of all patients who underwent abdominal cerclage placement between December 2011 and December 2015 at Yale New Haven Hospital and Bridgeport Hospital were reviewed. The patients included were women who underwent abdominal cerclage placement either during pregnancy or prior to conception. One cohort of women had their abdominal cerclage placed using traditional laparoscopy or robotic-assisted laparoscopy. The other cohort consisted of women whose abdominal cerclage was placed through laparotomy. Electronic medical charts were reviewed to collect baseline demographic and pre-procedure obstetric information, as well as surgical and subsequent obstetric outcomes. Eleven minimally invasive and nine open abdominal cerclages were performed during the study period. Seven of the minimally invasive and two open cerclages were done outside of pregnancy. Average operative time was longer in the minimally invasive cohort. Estimated blood loss was typically lower in the minimally invasive group. Length of hospital stay was shorter in the minimally invasive group. Obstetric outcomes were similar between the two cohorts, with a total of nine live births in the minimally invasive group and seven live births in the open group. Minimally invasive abdominal cerclage is a safe alternative when performed by a surgeon with appropriate training and technical skills, and obstetric outcomes are comparable to those after open abdominal cerclage.

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

    Directory of Open Access Journals (Sweden)

    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

  2. Valid Outcome Measures in Care for Older People: Comparing the ASCOT and the ICECAP-O.

    Science.gov (United States)

    Hackert, Mariska Q N; Exel, Job van; Brouwer, Werner B F

    Limited health care budgets and population aging result in a need to compare care services on their benefits and costs. Because services for older people often aim to improve multiple life aspects, valid measures are needed to examine their benefits on individuals' health and well-being simultaneously. Two measures may meet this end: the Adult Social Care Outcomes Toolkit (ASCOT) and the ICEpop CAPability measure for Older people (ICECAP-O). To compare the validity of both measures, the ASCOT and the ICECAP-O. A sampling agency gathered cross-sectional data in May 2015. Using exploratory factor analysis, the underlying factor structure of the ASCOT and the ICECAP-O was examined for the first time. Convergent and discriminant validity in relation to health measures (five-level EuroQol five-dimensional questionnaire, EuroQol Visual Analogue Scale, Barthel Index, and Geriatric Depression Scale-15) and well-being measures (Older People's Quality of Life Questionnaire-13, Satisfaction with Life Scale, and Cantril's Ladder) were tested using Spearman rank correlations and variance analysis. The ASCOT and the ICECAP-O tapped into a shared factor, whereas both measures also loaded on two separate factors. The ASCOT and the ICECAP-O correlated highly with the health and well-being measures, but the correlation with the physical health measure Barthel Index was moderate. Both measures discriminated between subgroups of respondents. The ASCOT and the ICECAP-O seem promising measures to evaluate well-being among older people, whereby the ASCOT seems more specific to social care-related outcomes. The performance of both measures in other respondent groups and countries, and their relation to physical health, need to be further examined before their use in economic evaluations can be recommended. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. 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.)

  4. Characteristics and outcome of spontaneous bacterial meningitis in patients with cancer compared to patients without cancer.

    Science.gov (United States)

    Pomar, Virginia; Benito, Natividad; López-Contreras, Joaquin; Coll, Pere; Gurguí, Mercedes; Domingo, Pere

    2017-05-01

    In cancer patients, who are frequently immunocompromised, bacterial meningitis (BM) can be a severe complication, with a different presentation, etiology, and course, compared to patients without cancer. Our objective is to compare the characteristics and outcomes of BM in patients with and without cancer. A single-center, prospective observational cohort study, conducted between 1982 and 2012, in a tertiary university hospital in Barcelona (Spain). The main outcome measure is in-hospital mortality. We evaluated 659 episodes of BM; 97 (15%) had active cancer. Patients with malignancies were older (median 63 (interquartile range [IQR] 24) vs 52 [IQR 42] years, P < .001) and more often had a Charlson comorbidity score of ≥3 (51% vs 11%, P < .001). The classic meningitis triad (35% vs 50%, P = .05), fever (91% vs 96%, P = .03), neck stiffness (58% vs 78%, P < .001), headache (63% vs 77%) P = .003), and rash (7% vs 30%, P < .001) were less frequent. There was a longer interval between admission and antibiotic therapy (median 5 [IQR 14] vs 3 [IQR 6] hours, P < .001). Listeria meningitis was the commonest cause of BM (29%) and was more frequent in cancer than noncancer (8%, P < .001) patients, whereas meningococcal meningitis was much less frequent (4% vs 36%, P < .001). Overall mortality was higher in patients with cancer (31% vs 16%, P < .001), although cancer was not associated with an unfavorable outcome in the multivariate analysis (odds ratio 1.825, P = .07). Patients with meningitis and cancer are older and have more subtle clinical manifestations than patients without cancer. Listeria monocytogenes is the predominant pathogen and mortality is higher in cancer patients.

  5. Meta-analysis of studies comparing adjuvant dexamethasone to glycerol to improve clinical outcome of bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Siavash Vaziri

    2016-01-01

    Full Text Available Background: Neurological complications are a problematic factor in acute bacterial meningitis; hence, its prevention is the key to ensure the success of meningitis treatment. Glycerol and dexamethasone are both applied in this regard. Oral glycerol is an appropriate alternative instead of intravenous dexamethasone because it does not have problems related to intravenous injection, the high cost, and drug complications. The main objective of this study was to compare the efficacy of adjuvant dexamethasone versus glycerol in order to improve the clinical outcome of bacterial meningitis. Materials and Methods: We conducted a search on the available resources including PubMed, Ovid, Elsevier, Cochrane, and another search engines such as Google till 2014. All clinical trials that were performed in the field of comparing the effectiveness of the two drugs and met the inclusion criteria were gathered and after extraction the relative risk (RR values, the pooled RR was calculated. The main outcome was neurological complications. Meta-analysis of the data was performed in Stata version 11.2 using both fixed and random effect models, weighting each study by inverse of variance. Results: In 5 comparative studies (1,340 patients, the rate of neurological complications of glycerol compared to that of dexamethasone was 1.02 [95% confidence interval (CI, 0.98 compared to 1.12]. The rate of neurological complications of dexamethasone compared to dexamethasone + glycerol was 1 (95% CI, 0.97 compared to 1.03, dexamethasone compared to placebo was 0.99 (95% CI, 0.97 compared to 1.03, glycerol compared to glycerol + dexamethasone was 0.98 (95% CI, 0.94 compared to 1.02, and glycerol compared to placebo was 0.97 (95% CI, 0.94 compared to 1.01. In these studies, no difference was reported between dexamethasone and glycerol in terms of reducing neurological complications. Conclusion: Although there were some weak evidences for the nonstatistical significant effect of

  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. [Comparative oncologic and functional outcomes of prostate cancer surgery with other curative treatments].

    Science.gov (United States)

    Soulié, M; Salomon, L

    2015-11-01

    Review of the comparative results of different treatment strategies (surgery, radiotherapy, ultrasound, surveillance) of prostate cancer, in which the main goal is the local control and the second target is the tolerance of the side effects of those treatments. Review of literature using Medline databases selected based on scientific relevance. Clinical keys centered on the oncological and functional outcomes of comparative series between different curative treatments. The numerous comparative series between surgery and other therapeutic modalities are essentially retrospective with significant methodological bias that is difficult to overcome in order to formulate the optimal thesis. However, there is a clear tendency toward surgery usually with young patients who have intermediate risk tumors without important comorbidity. In the absence of randomized comparative series with significant power, the oncological and functional results of the radical prostatectomy with or without adjuvant treatment seem at least the same, in a selected population of patients, compared with the combination of radiotherapy-hormonotherapy in terms of survival, without biochemical recurrence, disease-specific survival and overall survival, for the aggressive tumors necessitating curative local treatments. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Sreedevi Atluri

    2017-01-01

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

  9. Sample size and power calculations based on generalized linear mixed models with correlated binary outcomes.

    Science.gov (United States)

    Dang, Qianyu; Mazumdar, Sati; Houck, Patricia R

    2008-08-01

    The generalized linear mixed model (GLIMMIX) provides a powerful technique to model correlated outcomes with different types of distributions. The model can now be easily implemented with SAS PROC GLIMMIX in version 9.1. For binary outcomes, linearization methods of penalized quasi-likelihood (PQL) or marginal quasi-likelihood (MQL) provide relatively accurate variance estimates for fixed effects. Using GLIMMIX based on these linearization methods, we derived formulas for power and sample size calculations for longitudinal designs with attrition over time. We found that the power and sample size estimates depend on the within-subject correlation and the size of random effects. In this article, we present tables of minimum sample sizes commonly used to test hypotheses for longitudinal studies. A simulation study was used to compare the results. We also provide a Web link to the SAS macro that we developed to compute power and sample sizes for correlated binary outcomes.

  10. Comparative Studies of Population Synthesis Models in the ...

    Indian Academy of Sciences (India)

    Comparative Studies of Population Synthesis Models in the Framework of Modified Strömgren Filters ... The study conveys a good agreement of GALEV models with modified Strömgren colours but with poor UV model predictions and observed globular cluster data, while the spectroscopic models perform badly because of ...

  11. Comparative analysis of design models for concrete corbels

    OpenAIRE

    Araújo, D. L.; Silva Neto, A. P.; Lobo, F. A.; Debs, M. K. El

    2016-01-01

    ABSTRACT The main objective of this paper is performing a comparative analysis of some design models for precast concrete corbels. For this, it was analyzed design models from Brazilian (NBR 9062) and European (EUROCODE 2) Codes and a US design handbook (PCI). Moreover, three analytical models showed in the literature are analyzed. The objective of this comparative is identifying the best design models to represent the failure load of concrete corbels by the tie yields or by the concrete crus...

  12. Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation

    Directory of Open Access Journals (Sweden)

    Arya Satyavrat

    2008-11-01

    Full Text Available Abstract Background Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM score in cases of ileal perforations. Methods Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I was done in 38 patients, primary repair (Group II in 42 patients and 45 patients had an ileostomy (Group III. The disease severity was assessed in all patients using POSSUM score. The odds of death without and with risk adjustment using POSSUM mortality score were calculated for all groups Results Seventeen patients (14% patients died and 99 (79% developed postoperative complications. Using crude mortality rates Group I appeared to be the best treatment option with only 2 (5% deaths followed by Group II with 5 (12% deaths where as Group III had the worst outcome with 10 deaths (22%. However, Group III (ileostomy patients had higher mean POSSUM mortality and morbidity score (55.55%, 91.33% than Group I (28%, 75.26% and Group II (27%, 73.59%. Taking Group I as the reference (odds ratio, OR1 odds of death were greatest in Group III (OR 5.14, p = 0.043 followed by Group II (OR 2.43, p = 0.306. With risk adjustment using POSSUM mortality score the odds of death decreased in Group III (OR 1.16 p = 0.875. For the whole group, there was a significant association between the POSSUM score and postoperative complications and deaths. Mean POSSUM mortality and morbidity score of those who died (63.40 vs.33.68, p = 0.001 and developed complications (66.32 vs.84.20, p = 0.001 was significantly higher. For every percent increase in severity score the risk of postoperative complications and death increased by 1.10 (p = 0.001 and1.06 (p = 0.001 respectively. Conclusion Despite ileostomy patients having highest

  13. Towards consensus in comparative chemical characterization modeling for LCIA

    DEFF Research Database (Denmark)

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

    2006-01-01

    The Task Force on Toxic Impacts under the UNEP/SETAC Life Cycle Initiative is developing recommendations on characterization models and characterization factors for human toxicity and ecotoxicity impacts in Life Cycle Impact Assessment (LCIA). Building on experience from earlier model development...... unnecessary differences. Based on the adapted set of models and their outcomes, and on the earlier guidelines for fate modeling, overall guidelines for toxicity modeling in LCIA were developed. In line with these overall guidelines, a simple consensus model was developed. This model is collectively owned...... 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....

  14. 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.

  15. Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs.

    Science.gov (United States)

    Majumder, Arnab; Winder, Joshua S; Wen, Yuxiang; Pauli, Eric M; Belyansky, Igor; Novitsky, Yuri W

    2016-10-01

    Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields. We conducted a multicenter, retrospective review of patients undergoing open ventral hernia repair in clean-contaminated/contaminated fields using biologic or synthetic mesh. Patient and hernia details were characterized. Primary outcomes included 90-day surgical site event, surgical site infection, and hernia recurrence. A total of 126 patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields (69 biologic and 57 synthetic meshes) were analyzed. Groups were similar in both patient and hernia characteristics. There were 13 (22.8%) surgical site events in the synthetic cohort compared to 29 (42.0%) in the biologic cohort, P = .024. Similarly, surgical site infections were less frequent in the synthetic group, with 7 (12.3%) vs 22 (31.9%), P = .01. With a mean follow-up of 20 months, there were more recurrences in the biologic group: 15 (26.3%) vs 4 (8.9%) in the synthetic group, P = .039. The choice of mesh for clean-contaminated/contaminated ventral hernia repair remains debatable. We demonstrated that using synthetic sublay mesh resulted in a significantly lower wound morbidity and more durable outcomes versus a similar cohort of biologic repairs. This is likely secondary to improved bacterial clearance and faster integration of macroporous synthetics. Overall, our findings not only support suitability of synthetic mesh in contaminated settings but also challenge the purported advantage of biologics in clean-contaminated/contaminated ventral hernia repairs. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  17. 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.

  18. Evaluation of a nasal surgical questionnaire designed for monitoring surgical outcomes and comparing different techniques.

    Science.gov (United States)

    Haye, R; Døsen, L K; Shiryaeva, O; Amlie, E

    2015-07-01

    This study evaluated a nasal surgical questionnaire designed for monitoring surgical outcomes and comparing different techniques. Eighty-three healthy volunteers answered the same questionnaire twice with a minimum interval of five weeks. Three visual analogue scale items were used to assess nasal obstruction during the day, at night and during exercise. Respondents rated nasal obstruction severity by marking on a 10 cm line, with scores ranging from 0 to 100 (measured in millimetres). Other nasal symptoms, considered secondary outcomes, were graded using four-point Likert scales. Mean visual analogue scale scores for nasal obstruction severity experienced during the day, at night and during exercise at initial assessment were 9.99, 12.95 and 11.67, respectively. Thirty-eight per cent of scores indicated no obstruction (scores of 0), 47 per cent indicated mild obstruction (scores 1-30), 13 per cent indicated moderate obstruction (scores 31-70) and 2 per cent indicated severe obstruction (scores 71-100). Males had higher scores than females. The scores for the first and second assessment did not differ, except at night for obstruction in allergic individuals which was considered clinically unimportant. The questionnaire reliably assesses nasal symptoms and may be useful for prospective studies of nasal surgery.

  19. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research.

    Science.gov (United States)

    Wu, Albert W; Kharrazi, Hadi; Boulware, L Ebony; Snyder, Claire F

    2013-08-01

    This article presents the current state of patient-reported outcome measures and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient centeredness and digitization. We pose the question, "What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?" We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; and the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other electronic health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. 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

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

    Directory of Open Access Journals (Sweden)

    Binbin Jiang

    2010-11-01

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

  3. 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

  4. Meta-analysis of Randomized Controlled Trials Comparing Clinical Outcomes Between Short Implants and Long Implants with Bone Augmentation Procedure.

    Science.gov (United States)

    Tong, Qingchun; Zhang, Xingwen; Yu, Liming

    The purpose of this meta-analysis was to assess and compare clinical outcomes of short implants versus long implants placed in conjunction with a bone augmentation procedure. The eligible studies were searched from PubMed, Embase, Springer link, and the Cochrane library databases up to 23 January 2015. Prosthesis failures, implant failures, complications, and marginal bone loss were the clinical outcomes measured. The pooled weighted mean difference (WMD) or risk ratios (RRs) and their 95% confidence intervals (CIs) were used to measure the effect size of continuous variables and dichotomous variables, respectively. A random-effects model was performed to assess the effect size. Nine eligible studies including 480 short implants (≤ 8 mm) and 503 long implants (≥ 9.3 mm) were selected for this meta-analysis. Compared with the long-implant group, a notable decrease in the short-implant group was found for complications at the 5-year follow-up (RR = 0.34, 95% CI: 0.15 to 0.79, P short-implant and long-implant groups for other variables (P > .05). Moreover, the results were not obviously changed when stratified by implants placed in the mandible and maxilla. Implants ≤ 8 mm in length are considered to be a suitable alternative treatment when bone height is not adequate for standard implants.

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

    Directory of Open Access Journals (Sweden)

    Jitumoni Baishya

    2017-01-01

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

  6. Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy.

    Science.gov (United States)

    Bernardini, Marcus Q; Gien, Lilian T; Tipping, Helen; Murphy, Joan; Rosen, Barry P

    2012-01-01

    Before the introduction of robotic surgery at our institution, most obese women of class 2 or greater (body mass index [BMI] >35) underwent a laparotomy for the management of endometrial cancer. Since November 2008, we have performed most of these cases in a robotic fashion. This manuscript presents the outcome of these women in comparison with a historical cohort of women treated with laparotomy. Women with clinical stage I or II endometrial cancer and a BMI greater than 35 kg/m treated with robotic surgery at our institution between November 2008 and November 2010 were compared with a historical cohort of similar patients who underwent laparotomy. Patients' characteristics, operating room time, type of surgery, length of hospital stay, and incidence of perioperative complications were compared between the 2 groups. A total of 86 women were analyzed in this study (robotic surgery, 45; laparotomy, 41). The overall intraoperative complication rate is 5.8%. There is no statistical difference in age, number of comorbidities, BMI, prior abdominal surgery, and operative complications between the women who underwent robotic surgery versus laparotomy. Postoperative complication rates are higher in the laparotomy group (44% vs 17.7%; P = 0.007), and hospital length of stay is also higher in the laparotomy group (4 vs 2 days; P surgery group. Robotic surgery for the surgical management of the morbidly obese patient is shown to be safe and have less perioperative complications compared with open surgery.

  7. 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.

  8. 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.

  9. 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

  10. Acute type A aortic dissection: characteristics and outcomes comparing patients with bicuspid versus tricuspid aortic valve.

    Science.gov (United States)

    Etz, Christian D; von Aspern, Konstantin; Hoyer, Alexandro; Girrbach, Felix F; Leontyev, Sergey; Bakhtiary, Farhad; Misfeld, Martin; Mohr, Friedrich W

    2015-07-01

    The aim of this study is to investigate the clinical characteristics and postoperative outcome of patients with a bicuspid aortic valve (BAV) suffering acute dissection in comparison with their tricuspid peers. Between 1995 and 2011, 460 consecutive patients underwent emergency repair for acute type A aortic dissection. In 379 patients without connective tissue disease, the aortic valve morphology could clearly be specified (91.6% tricuspid and 8.4% bicuspid). At the time of dissection, patients with a bicuspid valve were younger (46.7 ± 13 vs 61.6 ± 12 years, P tricuspid valve (bicuspid: 31.3% vs tricuspid: 6.3%, P tricuspid valve patients (P tricuspid patients (P = 0.166). Hospital mortality was 20.3% and not significantly different between the two valve morphologies, even despite the younger age of bicuspid patients: 28.1% among bicuspids vs 19.6% among tricuspids (P = 0.255). Survival after discharge was 63.3% at 10 years for all patients. BAV patients had a significantly better survival with 100% at 10 years compared with 60.2% in tricuspid valve patients (P = 0.011). Mean follow-up among survivors was comparable for bicuspid and tricuspid patients (3.7 and 4.1 years, respectively). Patients with BAV have a distinctive dissection pattern with the entry tear frequently located in the aortic root and-despite their younger age-are subject to substantial hospital mortality. For bicuspid patients suffering from dissection, composite root replacement yields an excellent outcome equal to an age- and gender-matched normal population. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

    Science.gov (United States)

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

    2004-12-24

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

  12. 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

  13. Ceftaroline fosamil monotherapy for methicillin-resistant Staphylococcus aureus bacteremia: a comparative clinical outcomes study.

    Science.gov (United States)

    Arshad, Samia; Huang, Vanthida; Hartman, Pamela; Perri, Mary B; Moreno, Daniela; Zervos, Marcus J

    2017-04-01

    Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia; however, its use has been subject to scrutiny due to failure in severe infections. Ceftaroline fosamil (CPT-F) is approved for MRSA acute bacterial skin and skin structure infections, but not for bloodstream infections. The clinical outcomes of treatment with CPT-F in patients with MRSA bacteremia were evaluated. Patients diagnosed with MRSA bacteremia at Henry Ford Hospital in Detroit, Michigan, USA, involving isolates with a vancomycin minimum inhibitory concentration ≥1.0mg/l and susceptible in vitro to CPT-F, were systematically reviewed retrospectively. Ceftaroline fosamil-treated patients were matched with at least two vancomycin- and/or one daptomycin-treated control patient based on age-patients age 65 years or greater or less than 65 years of age. Outcomes evaluated included the duration of hospitalization, duration of therapy, adverse events, relapse, hospital readmission, and death. Thirty consecutive cases of MRSA bacteremia treated with CPT-F during the period May 2011 to June 2013 were identified; these patients were matched to 56 MRSA bacteremia patients treated with vancomycin and 46 MRSA bacteremia patients treated with daptomycin. The primary source of MRSA bacteremia in the cohort treated with CPT-F was endocarditis (n=7, 23%), skin/wound (n=9, 30%), and bone/joint (n=8, 27%). The MRSA bacteremia in those treated with CPT-F was community-acquired in 43% of cases, healthcare-associated in 43%, and hospital-acquired in 13%. The mean length of hospital stay for these patients was 22 days. The overall 30-day mortality rate was 13% (n=4) in CPT-F patients versus 24% (n=11) in daptomycin patients and 11% (n=6) in vancomycin patients (p=0.188). CPT-F demonstrated comparable clinical outcomes in MRSA bacteremia patients compared with the other agents, especially as salvage therapy. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All

  14. 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 failure. None of the patients with isolated RF or isolated respiratory failure died. Among patients with SAP per the Revised Atlanta Classification, approximately 15% develop isolated RF. This subgroup seems to have a less protracted clinical course compared to other forms of OF. Isolated RF might be weighed less than isolated respiratory failure in risk predictive modeling of acute pancreatitis.

  15. 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

  16. Funnel plots for comparing provider performance based on patient-reported outcome measures.

    Science.gov (United States)

    Neuburger, Jenny; Cromwell, David A; Hutchings, Andrew; Black, Nick; van der Meulen, Jan H

    2011-12-01

    Patient-reported outcome measures (PROMs) often produce skewed distributions of individual scores after a healthcare intervention. For health performance indicators derived from skewed distributions, funnel plots designed with symmetric control limits may increase the risk of false alarms about poor performance. To investigate the accuracy of funnel plots with symmetric control limits when comparing provider performance based on PROMs. The authors used a database containing condition-specific PROMs for 17,453 hip replacements and 7656 varicose vein procedures performed by providers in the English NHS. The mean postoperative PROM score, adjusted for patient characteristics, was used as the measure of performance. To compare performance, symmetric 99.8% control limits were calculated on funnel plots, 3 SDs away from the overall mean on either side. These were compared to control limits derived directly from percentiles of simulated (bootstrap) distributions of mean scores. The simulated control limits on funnel plots for both procedures were asymmetric. The empirical probability of falling outside the symmetric 99.8% 'poor performance' control limit was inflated from the stipulated rate of 0.1% to 0.2-0.3% for provider sample sizes of up to 150 procedures. The authors observed that, out of 237 providers of hip replacement, eight had adjusted mean scores that exceeded the symmetric 'poor performance' limit compared with only five that exceeded the corresponding simulated limit. In other words, three (1.3%) were differently classified. For varicose vein surgery, five out of 160 providers exceeded the symmetric limit and four exceeded the simulated limit, that is, 1 (0.6%) was differently classified. When designing funnel plots for comparisons of provider performance based on highly skewed data, the use of simulated control limits should be considered.

  17. Design, recruitment outcomes, and sample characteristics of the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial.

    Science.gov (United States)

    Krebs, Erin E; Jensen, Agnes C; Nugent, Sean; DeRonne, Beth; Rutks, Indulis; Leverty, David; Gravely, Amy; Noorbaloochi, Siamak; Bair, Matthew J; Kroenke, Kurt

    2017-11-01

    This manuscript describes the study protocol, recruitment outcomes, and baseline participant characteristics for the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial. SPACE is a pragmatic randomized comparative effectiveness trial conducted in multiple VA primary care clinics within one VA health care system. The objective was to compare benefits and harms of opioid therapy versus non-opioid medication therapy over 12months among patients with moderate-to-severe chronic back pain or hip/knee osteoarthritis pain despite analgesic therapy; patients already receiving regular opioid therapy were excluded. Key design features include comparing two clinically-relevant medication interventions, pragmatic eligibility criteria, and flexible treat-to-target interventions. Screening, recruitment and study enrollment were conducted over 31months. A total of 4491 patients were contacted for eligibility screening; 53.1% were ineligible, 41.0% refused, and 5.9% enrolled. The most common reasons for ineligibility were not meeting pain location and severity criteria. The most common study-specific reasons for refusal were preference for no opioid use and preference for no pain medications. Of 265 enrolled patients, 25 withdrew before randomization. Of 240 randomized patients, 87.9% were male, 84.1% were white, and age range was 21-80years. Past-year mental health diagnoses were 28.3% depression, 17% anxiety, 9.4% PTSD, 7.9% alcohol use disorder, and 2.6% drug use disorder. In conclusion, although recruitment for this trial was challenging, characteristics of enrolled participants suggest we were successful in recruiting patients similar to those prescribed opioid therapy in usual care. Published by Elsevier Inc.

  18. Comparative Study of Smeared Cracking Models for Concrete Structures

    Directory of Open Access Journals (Sweden)

    Samuel Silva Penna

    2014-02-01

    Full Text Available The article shows how the constitutive modeling of concrete has evolved since the initial attempts to characterize the medium cracked as continuous, moving from smeared cracking, damage and microplane models, until the current tendency to design different models according to a single theoretical framework. A generic formulation for smeared cracking models, including fixed and rotational models, as well as degradation in tension and in compression, is provided. Using this formulation, three models are generated by specifying the laws of degradation. A comparative study of models, based on computer simulations of a beam subjected to shear at four points, is presented. The results are compared, between themselves and with experimental results, providing a critical analysis of the models.

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

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C

    2001-01-01

    -up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...... progression (new AIDS/death). Adjustment was made for differences in baseline parameters, in particular pVL, CD4 cell count, and region of Europe. RESULTS: A total of 2708 patients (median follow-up: 30 months) were included, of which 556 started ritonavir (21%), 1342 indinavir (50%), and 810 saquinavir hgc...... (30%). The three groups were fairly evenly balanced at baseline regarding CD4 count, previous diagnosis of AIDS and pVL, After 12 months, the median changes in CD4 cell count were 90, 96 and 74 x 10(6) cells/l, respectively;P

  20. 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.

  1. 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.

  2. Glaucoma drainage device surgery in children and adults: a comparative study of outcomes and complications.

    Science.gov (United States)

    Mandalos, Achilleas; Sung, Velota

    2017-05-01

    To compare the postoperative outcomes and complications of glaucoma drainage device (GDD) surgery in pediatric (adult patients. Retrospective, comparative study including all patients who underwent Baervedlt or Molteno device surgery by the same surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 21 mmHg and a 20% reduction from baseline. Fifty-two children (69 eyes) and 130 adults (145 eyes) were included. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall failure rate was similar in children and adults. However, GDD failed earlier in adults than in children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later on, bleb encapsulation was more frequent in children, while corneal decompensation tended to be more frequent and occurred earlier in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults. GDD surgery presents different postoperative challenges in children and adults, and the surgeon should remain vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in pediatric patients. On the other hand, adults may be more prone to early corneal decompensation.

  3. Evaluating the impact of the laborist model of obstetric care on maternal and neonatal outcomes.

    Science.gov (United States)

    Srinivas, Sindhu K; Small, Dylan S; Macheras, Michelle; Hsu, Jesse Y; Caldwell, Donna; Lorch, Scott

    2016-12-01

    The laborist model of obstetric care represents a change in care delivery with the potential of improving maternal and neonatal outcomes. We evaluated the effectiveness of the laborist model of care compared to the traditional model of obstetric care using specific maternal and neonatal outcome measures. This is a population cohort study with laborist and nonlaborist hospitals matched 1:2 on delivery volume, geography, teaching status, and neonatal intensive care unit level using data from the National Perinatal Information Center/Quality Analytic Services database. A before-and-after study design with an untreated comparison group analyzed with the method of difference-in-differences was used to examine the impact of laborists on maternal and neonatal outcome measures within the 3 years after implementing the laborist system, after adjusting for secular trends, sociodemographic factors, and maternal medical conditions. The final outcome measures evaluated included cesarean delivery, chorioamnionitis, induction of labor, preterm birth, prolonged length of stay, Apgar at 5 minutes of outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Surgical outcome of extraperitoneal paraaortic lymph node dissections compared with transperitoneal approach in gynecologic cancer patients.

    Science.gov (United States)

    Morales, Sara; Zapardiel, Ignacio; Grabowski, Jacek P; Hernandez, Alicia; Diestro, Maria D; Gonzalez-Benitez, Cristina; De Santiago, Javier

    2013-01-01

    To evaluate the surgical outcome of extraperitoneal paraaortic lymph node dissection compared with the traditional transperitoneal approach. Retrospective review (Canadian Task Force classification III). University hospital. Women with gynecologic malignancies admitted to our hospital between 2007 and 2011 who underwent laparoscopic paraaortic lymphadenectomy. Indication, diagnosis, and outcome according to type of surgery were evaluated. Of 47 patients who underwent laparoscopic paraaortic lymphadenectomy because of gynecologic indications, 28 patients underwent extraperitoneal paraaortic lymph node dissection and 19 underwent the same procedure via the classic transperitoneal technique. The most frequent indication for extraperitoneal lymph node dissection was cervical cancer (71.4%), and for the transperitoneal technique was endometrial cancer (47.4%). The mean (SD) duration of surgery was 211 (38) minutes in the transperitoneal approach group, and 173 (51) minutes in the extraperitoneal lymphadenectomy group (p = .009). No significant differences between groups were found in the number of lymph nodes removed (15 [5.9] nodes in the extraperitoneal group vs 17.4 [8.6] in the transperitoneal group; p = .25). However, a higher rate of positive nodes was observed in the extraperitoneal group than in the transperitoneal group (42.8% vs 36.2%, respectively [p = .001]), and a significantly shorter stay in the intensive care unit in the extraperitoneal group (0.59 [0.5] vs 1.1 [0.5] days, respectively; p = .02). No significant differences in complication rate were found between groups. Extraperitoneal paraaortic lymph node dissection is a minimally invasive procedure that is an excellent and safe approach to the paraaortic area, with a low complication rate, sufficient number of lymph nodes, and short hospital stay. It seems to be a good alternative to the classic transperitoneal approach. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  5. A COMPARATIVE STUDY OF POSTOPERATIVE OUTCOME AFTER PTERYGIUM EXCISION USING AUTOLOGOUS BLOOD AND SUTURES

    Directory of Open Access Journals (Sweden)

    Harpal Singh

    2017-12-01

    Full Text Available BACKGROUND Pterygium is a degenerative and hyperplastic condition of conjunctiva. In this, subconjunctival tissue proliferates as vascularised granulation tissue, thus invading the cornea and destroying the superficial stroma and Bowman’s membrane. It varies from small asymptomatic lesion to large, rapidly growing lesion, thus leading to impairment of vision. Pterygium occurs more frequently between 30 degrees latitude north and south of the equator called as “pterygium belt.” The most challenging situation after pterygium excision is the recurrence of the pterygium. Many techniques had been used, but none of them is universally accepted due to variable recurrence rate. The aim of the study is to compare the two modalities of treatment in pterygium excision with postoperative outcomes. MATERIALS AND METHODS A comparative study was conducted from July 2016 to August 2017 in the Department of Ophthalmology, People’s College of Medical Sciences and Research Centre, Bhopal (M.P.. Total 50 patients with primary nasal pterygium of grade 2 or more were enrolled from eye outpatient department. The patients were randomly divided into two groups for pterygium excision with conjunctival autografting using either autologous blood (group A or sutures (group B. Two groups were compared for postoperative discomfort, recurrence and graft displacement. RESULTS Out of 50 patients, 28 were in group A and 22 were in group B. Maximum numbers of patients were involved in outdoor activities. In comparison to autologous blood technique, postoperative discomfort was more in suture group after pterygium excision. In group A, the graft displacement was found in 2 (7.1% patients, whereas in group B, there was no graft displacement seen. While in group B2 (9.1% patients had granuloma formation. The recurrence of pterygium was high (22.7% in group B as compared to group A (3.6%. There was a significant correlation between rate of recurrence and type of surgery (P

  6. 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

  7. Family models: comparing and contrasting the Olson Circumplex Model with the Beavers Systems Model.

    Science.gov (United States)

    Beavers, W R; Voeller, M N

    1983-03-01

    There is an increasing interest in and need for family models. One such model is the Olson Circumplex Model, previously reported in this journal (18). This model is compared and contrasted with the Beavers Systems Model, which was also developed from empirical data and has had extensive use in family assessment. Though both are cross-sectional, process-oriented, and capable of providing structure for family research, we believe there are certain short-comings in the Olson model that make it less clinically useful than the Beavers Systems Model. These include definitional problems and a total reliance on curvilinear dimensions with a grid approach to family typology that does not acknowledge a separation/individuation continuum. Our model avoids these deficiencies and includes a continuum of functional competence that reflects the development and differentiation of many living systems, including the family.

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

    Science.gov (United States)

    McNeil, Rita C.

    2011-01-01

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

  9. 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.

  10. 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…

  11. Comparative analysis of design models for concrete corbels

    Directory of Open Access Journals (Sweden)

    D. L. Araújo

    Full Text Available ABSTRACT The main objective of this paper is performing a comparative analysis of some design models for precast concrete corbels. For this, it was analyzed design models from Brazilian (NBR 9062 and European (EUROCODE 2 Codes and a US design handbook (PCI. Moreover, three analytical models showed in the literature are analyzed. The objective of this comparative is identifying the best design models to represent the failure load of concrete corbels by the tie yields or by the concrete crushing. Moreover, it is intended to evaluate the contribution of horizontal stirrups to resistance of concrete corbels. For this, a database was assembled from test results of concrete corbels carried out by several researchers and they are showed in the literature. The design models were applied to this database and from statistical tools, adjustments coefficients are recommended to be applied on these design models to take into account the results dispersion found in the analysis.

  12. 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.

  13. 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.

  14. Conservative models: parametric entropy vs. temporal entropy in outcomes.

    Science.gov (United States)

    Huang, Lumeng; Ritzi, Robert W; Ramanathan, Ramya

    2012-01-01

    The geologic architecture in aquifer systems affects the behavior of fluid flow and the dispersion of mass. The spatial distribution and connectivity of higher-permeability facies play an important role. Models that represent this geologic structure have reduced entropy in the spatial distribution of permeability relative to models without structure. The literature shows that the stochastic model with the greatest variance in the distribution of predictions (i.e., the most conservative model) will not simply be the model representing maximum disorder in the permeability field. This principle is further explored using the Shannon entropy as a single metric to quantify and compare model parametric spatial disorder to the temporal distribution of mass residence times in model predictions. The principle is most pronounced when geologic structure manifests as preferential-flow pathways through the system via connected high-permeability sediments. As per percolation theory, at certain volume fractions the full connectivity of the high-permeability sediments will not be represented unless the model is three-dimensional. At these volume fractions, two-dimensional models can profoundly underrepresent the entropy in the real, three-dimensional, aquifer system. Thus to be conservative, stochastic models must be three-dimensional and include geologic structure. © 2011, The Author(s). Ground Water © 2011, National Ground Water Association.

  15. Comparing Clinical Outcomes in Upper versus Lower Lobe Endobronchial Valve Treatment in Severe Emphysema.

    Science.gov (United States)

    Eberhardt, Ralf; Herth, Felix J F; Radhakrishnan, Sri; Gompelmann, Daniela

    2015-01-01

    Lung volume reduction surgery has been recommended for patients with upper lobe predominant emphysema and was associated with less favorable outcomes in patients with non-upper lobe predominant emphysema. The value of endobronchial valve (EBV) treatment in lower lobe predominant emphysema has not been studied. To confirm the equivalence of upper and lower lobe valve treatments in patients with heterogeneous emphysema. A retrospective analysis from the Endobronchial Valve for Emphysema Palliation Trial (VENT), where patients with heterogeneous emphysema received Zephyr® EBV (Pulmonx Corp., Redwood City, Calif., USA) or medical treatment, was performed. Patients with low interlobar collateral ventilation and accurate placement of valves in the target lobes were identified. Safety and efficacy were compared between patients who underwent upper versus lower lobe treatment. Of the 331 patients, 60 had low interlobar collateral ventilation and successful lobar exclusion (45 patients with upper lobe treatment and 15 patients with lower lobe treatment). There was no difference in baseline characteristics between the groups except for a higher destruction score (70.3 vs. 60.7%; p = 0.0010) and a higher heterogeneity index (24 vs. 13%; p = 0.0005) for the upper lobe cohort. At 180 days, both groups had improved clinically. There were no significant differences in mean changes or responder rates of forced expiratory volume in 1 s (+23.8 vs. +22.9%), the St. Georges Respiratory Questionnaire (-6.50 vs. -7.53 points), the 6-min walk test (+24.1 vs. +44.0 m), target lobe volume reduction (-1,199 vs. -1,042 ml), or in the adverse event rate between both cohorts. Patients with lower and upper lobe predominant emphysema benefit equally from EBV therapy when interlobar collateral ventilation is low and lobar exclusion is achieved. Patients with lower lobe disease did not have increased adverse events compared to patients with upper lobe emphysema. © 2015 S. Karger AG, Basel.

  16. 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

  17. Predictive Models of Cognitive Outcomes of Developmental Insults

    Science.gov (United States)

    Chan, Yupo; Bouaynaya, Nidhal; Chowdhury, Parimal; Leszczynska, Danuta; Patterson, Tucker A.; Tarasenko, Olga

    2010-04-01

    Representatives of Arkansas medical, research and educational institutions have gathered over the past four years to discuss the relationship between functional developmental perturbations and their neurological consequences. We wish to track the effect on the nervous system by developmental perturbations over time and across species. Except for perturbations, the sequence of events that occur during neural development was found to be remarkably conserved across mammalian species. The tracking includes consequences on anatomical regions and behavioral changes. The ultimate goal is to develop a predictive model of long-term genotypic and phenotypic outcomes that includes developmental insults. Such a model can subsequently be fostered into an educated intervention for therapeutic purposes. Several datasets were identified to test plausible hypotheses, ranging from evoked potential datasets to sleep-disorder datasets. An initial model may be mathematical and conceptual. However, we expect to see rapid progress as large-scale gene expression studies in the mammalian brain permit genome-wide searches to discover genes that are uniquely expressed in brain circuits and regions. These genes ultimately control behavior. By using a validated model we endeavor to make useful predictions.

  18. 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.

  19. 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.

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

    Science.gov (United States)

    Jongman, B.; Kreibich, H.; Apel, H.; Barredo, J. I.; Bates, P. D.; Feyen, L.; Gericke, A.; Neal, J.; Aerts, J. C. J. H.; Ward, P. J.

    2012-12-01

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

  1. 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.

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

    Science.gov (United States)

    Liu, Jun Le; Wang, Xiao Lin; Gong, Mao Wei; Mai, Hai Xing; Pei, Shu Jun; Yuan, Wei Xiu; Zhang, Hong

    2014-01-01

    Background Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive. Objectives We compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty. Materials and methods This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality. Results Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ2=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ2=0.68, P=0.410; χ2=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular

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

    Directory of Open Access Journals (Sweden)

    Iris Navarro-Millán

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

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

    Science.gov (United States)

    Greenland, Sander; Daniel, Rhian; Pearce, Neil

    2016-04-01

    Controlling for too many potential confounders can lead to or aggravate problems of data sparsity or multicollinearity, particularly when the number of covariates is large in relation to the study size. As a result, methods to reduce the number of modelled covariates are often deployed. We review several traditional modelling strategies, including stepwise regression and the 'change-in-estimate' (CIE) approach to deciding which potential confounders to include in an outcome-regression model for estimating effects of a targeted exposure. We discuss their shortcomings, and then provide some basic alternatives and refinements that do not require special macros or programming. Throughout, we assume the main goal is to derive the most accurate effect estimates obtainable from the data and commercial software. Allowing that most users must stay within standard software packages, this goal can be roughly approximated using basic methods to assess, and thereby minimize, mean squared error (MSE). © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.

  5. 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

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

    Science.gov (United States)

    Fang, Di; Sun, Renyuan

    2018-01-01

    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. PMID:29351328

  7. Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions: A Systematic Review and Meta-analysis of Comparative Studies.

    Science.gov (United States)

    Ajiboye, Remi M; Alas, Haddy; Mosich, Gina M; Sharma, Akshay; Pourtaheri, Sina

    2017-06-15

    Systematic review and meta-analysis. Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF). ALIF and TLIF are 2 methods of achieving spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody technique to achieve successful radiographic and clinical outcomes. The goal of this systematic review and meta-analysis was to compare the radiographic and clinical outcomes of ALIF to TLIF. A systematic search of multiple medical reference databases was conducted for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain. The search yielded 7 studies totaling 811 patients (ALIF=448, TLIF=363). ALIF was superior to TLIF in restoring segmental lumbar lordosis at L4-L5 and L5-S1 (L4-L5; P=0.013, L5-S1; P<0.001). ALIF was also superior to TLIF in restoring overall lumbar lordosis (P<0.001). However, no significant differences in fusion rates were noted between both techniques [odds ratio=0.905; 95% confidence interval, 0.458-1.789; P=0.775]. In addition, ALIF and TLIF were comparable with regards to ODI and VAS scores (ODI; P=0.184, VAS; P=0.983). For the restoration of lumbar lordosis, ALIF is superior to TLIF. However, TLIF is comparable to ALIF with regards to fusion rate and clinical outcomes.

  8. Joint generalized models for multidimensional outcomes: a case study of neuroscience data from multimodalities.

    Science.gov (United States)

    Wang, Xiao-Feng

    2012-03-01

    This paper is motivated from the analysis of neuroscience data in a study of neural and muscular mechanisms of muscle fatigue. Multidimensional outcomes of different natures were obtained simultaneously from multiple modalities, including handgrip force, electromyography (EMG), and functional magnetic resonance imaging (fMRI). We first study individual modeling of the univariate response depending on its nature. A mixed-effects beta model and a mixed-effects simplex model are compared for modeling the force/EMG percentages. A mixed-effects negative-binomial model is proposed for modeling the fMRI counts. Then, I present a joint modeling approach to model the multidimensional outcomes together, which allows us to not only estimate the covariate effects but also to evaluate the strength of association among the multiple responses from different modalities. A simulation study is conducted to quantify the possible benefits by the new approaches in finite sample situations. Finally, the analysis of the fatigue data is illustrated with the use of the proposed methods. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. 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.

  10. A comparative study of seven human cochlear filter models.

    Science.gov (United States)

    Saremi, Amin; Beutelmann, Rainer; Dietz, Mathias; Ashida, Go; Kretzberg, Jutta; Verhulst, Sarah

    2016-09-01

    Auditory models have been developed for decades to simulate characteristics of the human auditory system, but it is often unknown how well auditory models compare to each other or perform in tasks they were not primarily designed for. This study systematically analyzes predictions of seven publicly-available cochlear filter models in response to a fixed set of stimuli to assess their capabilities of reproducing key aspects of human cochlear mechanics. The following features were assessed at frequencies of 0.5, 1, 2, 4, and 8 kHz: cochlear excitation patterns, nonlinear response growth, frequency selectivity, group delays, signal-in-noise processing, and amplitude modulation representation. For each task, the simulations were compared to available physiological data recorded in guinea pigs and gerbils as well as to human psychoacoustics data. The presented results provide application-oriented users with comprehensive information on the advantages, limitations and computation costs of these seven mainstream cochlear filter models.

  11. 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...

  12. 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...

  13. 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

  14. Comparing Health Related Quality of Life Outcomes in Patients Undergoing Either Primary or Revision Anterior Cervical Discectomy and Fusion.

    Science.gov (United States)

    Schroeder, Gregory D; Boody, Barrett S; Kepler, Christopher K; Kurd, Mark F; Silva, Stephen; Nicholson, Kristen; Wilson, Jefferson R; Woods, Barret I; Radcliff, Kris E; Anderson, D Greg; Hilibrand, Alan S; Vaccaro, Alexander R; Rihn, Jeffery A

    2017-12-05

    A retrospective review of prospectively collected data. Compare HRQOL outcome metrics in patients undergoing primary and revision ACDF. Anterior cervical discectomy and fusion (ACDF) is associated with significant improvements in health related quality of life (HRQOL) outcome metrics. However, 2.9% of patients per year will develop symptomatic adjacent segment disease and there is a paucity of literature on HRQOL outcomes following revision ACDF. Patients were identified who underwent either a primary or revision ACDF, and who had both preoperative and a minimum of one-year post-operative HRQOL outcome data. Pre- and postoperative Short Form 12 Physical Component Score (SF12 PCS), Short Form 12 Mental Component Score (SF12 MCS) VAS neck, VAS arm and Neck Disability Index (NDI) scores were compared. 360 patients (299 primary, 61 revision) were identified. Significant improvement in SF12 PCS, NDI, VAS neck and VAS arm was seen in both groups, however only a significant improvement in SF12 MCS was seen in the primary group. When comparing the results of a primary versus a revision surgery, the SF12 PCS score was the only outcome with a significantly different net improvement in the primary group (7.23 +/- 9.72) compared to the revision group (2.9 +/- 11.07; p = 0.006) despite similar baseline SF12 PCS scores. The improvement in each of the other reported HRQOL outcomes did not significantly vary between surgical groups. A revision ACDF for cervical radiculopathy or myelopathy leads to a significant improvement in the HRQOL outcome, and with the exception of the SF12 PCS, these results are similar to those of patients undergoing a primary ACDF. 2.

  15. 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

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

    Directory of Open Access Journals (Sweden)

    Liu JL

    2014-05-01

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

  17. 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 < 0·001). Median total attack duration was 5·0 h and 9·0 h for patients with C1-INH-AAE versus C1-INH-HAE types I/II, respectively. © 2016 British Society for Immunology.

  18. 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.

  19. 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...

  20. a comparative study of models for correlated binary data with ...

    African Journals Online (AJOL)

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    significance. Next, several subsets of predictors are compared through the AIC criterion, whenever applicable. Key words/phrases: Beta-binomial, bootstrap, correlated binary data, model selection, overdispersion. *. Current address: University of Hannover, Bioinformatic Unit, Herrenhauser Strasse 2, D-30419 Hannover, ...

  1. A comparative study of models for correlated binary data with ...

    African Journals Online (AJOL)

    Various methods of modeling correlated binary data are compared as applied to data from health services research. The methods include the standard logistic regression, a simple adjustment of the standard errors of logistic regression by a single inflator, the weighted logistic regression, the generalized estimating equation ...

  2. Design of thermolabile bacteriophage repressor mutants by comparative molecular modeling

    NARCIS (Netherlands)

    Nauta, A; vandenBurg, B; Karsens, H; Venema, G; Kok, J; Burg, Bertus van den

    1997-01-01

    Comparative molecular modeling was performed with repressor protein Rro of the temperate Lactococcus lactis bacteriophage r1t using the known 3D-structures of related repressors in order to obtain thermolabile derivatives of Rro. Rro residues presumed to stabilize a nonhomologous but structurally

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

    Science.gov (United States)

    Miller, Angie L.

    2012-01-01

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

  4. Comparative analysis of Vening-Meinesz Moritz isostatic models ...

    Indian Academy of Sciences (India)

    We compare three different numerical schemes of treating the Moho density contrast in gravimetric inverse problems for finding the Moho depths. The results are validated using the global crustal model. CRUST2.0, which is determined based purely on seismic data. Firstly, the gravimetric recovery of the. Moho depths is ...

  5. 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.

  6. The Integrated Medical Model: Outcomes from Independent Review

    Science.gov (United States)

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

    2017-01-01

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

  7. 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

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Hon-Yen Wu

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

  10. Twelve Year Outcomes of Oxinium Total Knee Arthroplasty Compared to the Same Cobalt Chrome Prosthesis

    Science.gov (United States)

    Vertullo, Christopher; Lewis, Peter; Graves, Stephen; Kelly, Lan; Myers, Peter

    2016-01-01

    Introduction: Alternative bearings surfaces to Cobalt Chrome (Co-Cr), such as Oxidised have been introduced in an attempt to reduce polyethylene wear and hence decrease TKA loosening and lysis. While non-comparative reports have been described as promising, no short or long term clinical studies exists showing the superiority of Oxinium on a polyethylene bearing surfaces. In this study, we investigate the long-term outcomes of Oxinium and Co-Cr TKR in a “like for like” or matched cohort analysis of the Genesis II design (Smith & Nephew, Memphis, TN, USA). Using data from a large national joint replacement registry we selected cohorts that used only the cruciate retaining design, with the same method of fixation and polyethylene type, differing only in the femoral component bearing surfaces. Our primary hypothesis was that Oxinium TKA would have a lower cumulative percent revision than the same Co-Cr prosthesis at 12 years for all causes of revision. Our secondary hypothesis was that Oxinium TKA would have a lower loosening/ lysis rate and lower rate of non-infective revision than the same Co-Cr prosthesis at 12 years. Methods: Cumulative percent revision and revision diagnosis data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1 September 1999, until 31 December 2013. Results: At 12 years the cumulative percent revision of the Co-Cr Genesis II of 4.8 % (95%: CI 4.2, 5.4) for all causes was not statistically different to the Oxinium Genesis II CPR of 7.7 % (95%: CI 6.2, 9.5) (For the entire period, Hazard Ratio = 1.09 (95%: CI 0.92, 1.29), p = 0.329). The CPR for all causes was not different in the under 55 years old age group (Figure 3) (HR= 1.06 (0.68, 1.66) p=0.798).). Subgroup analysis of the CPR for loosening /lysis in both groups overall was not different (HR= 0.87 (95%: CI 0.61, 1.26), p = 0.461) Subgroup analysis of all causes of revisions excluding infection in both groups overall was not

  11. 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

  12. Mathematical modelling of human growth: A comparative study.

    Science.gov (United States)

    Guo, Shumei; Siervogel, Roger M; Roche, Alex F; Chumlea, Wm Cameron

    1992-01-01

    Kernel regression is a nonparametric procedure that provides good approximations to individual serial data. The method is useful and flexible when a parametric method is inappropriate due to restricted assumptions on the shape of the curve. In the present study, we compared kernel regression in fitting human stature growth with two models, one of which incorporates the possible existence of the midgrowth spurt while the other does not. Two families of mathematical functions and a nonparametric kernel regression were fitted to serial measures of stature on 227 participants enrolled in the Fels Longitudinal Study. The growth parameters that describe the timing, magnitude, and duration of the growth spurt, such as midgrowth spurt and pubertal spurts, were derived from the fitted models and kernel regression for each participant. The two parametric models and kernel regression were compared in regard to their overall goodness of fit and their capabilities to quantify the timing, rate of increase, and duration of the growth events. The Preece-Baines model does not describe the midgrowth spurt. The dervied growth parameters from the Preece-Baines model show an earlier onset and a longer duration of the pubertal spurt, and a slower increase in velocity. The kernel regression with bandwidth 2 years and a second-order polynomial kernel function yields relatively good fits compared with the triple logistic model. The derived biological parameters for the pubertal spurt are similar between the kernel regression and the triple logistic model. Kernel regression estimates an earlier onset and a more rapid increase of velocity for the midgrowth spurt. Copyright © 1992 Wiley-Liss, Inc., A Wiley Company.

  13. 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…

  14. 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

    prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic...

  15. 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…

  16. Criteria and indicators for the assessment of community forestry outcomes: a comparative analysis from Canada.

    Science.gov (United States)

    Teitelbaum, Sara

    2014-01-01

    In Canada, there are few structured evaluations of community forestry despite more than twenty years of practice. This article presents a criteria and indicator framework, designed to elicit descriptive information about the types of socio-economic results being achieved by community forests in the Canadian context. The criteria and indicators framework draws on themes proposed by other researchers both in the field of community forestry and related areas. The framework is oriented around three concepts described as amongst the underlying objectives of community forestry, namely participatory governance, local economic benefits and multiple forest use. This article also presents the results of a field-based application of the criteria and indicators framework, comparing four case studies in three Canadian provinces. All four are community forests with direct tenure rights to manage and benefit from forestry activities. Results reveal that in terms of governance, the case studies adhere to two different models, which we name 'interest group' vs. 'local government'. Stronger participatory dimensions are evident in two case studies. In the area of local economic benefits, the four case studies perform similarly, with some of the strongest benefits being in employment creation, especially for those case studies that offer non-timber activities such as recreation and education. Two of four cases have clearly adopted a multiple-use approach to management. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Abas Ali Sahafian

    2014-01-01

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

  18. The Qualification of Outcome after Cervical Spine Surgery by Patients Compared to the Neck Disability Index.

    Directory of Open Access Journals (Sweden)

    Roland Donk

    Full Text Available The Neck Disability Index (NDI is a patient self-assessed outcome measurement tool to assess disability, and that is frequently used to evaluate the effects of the treatment of neck-related problems. In individualized medicine it is mandatory that patients can interpret data in order to choose a treatment. A change of NDI or an absolute NDI is generally meaningless to a patient. Therefore, a correlation between the qualification of the clinical situation rated by the patient and the NDI score was evaluated.Patients who completed an NDI after anterior surgery because of symptomatic single level degenerative cervical disc disease were asked one month after completion of the NDI to qualify their clinical situation of a 5-item Likert scale varying from excellent to bad. Since a clear distinction between the categories was not possible based on the total NDI score, a ROC-curve was built, and the AUC computed in order to estimate best dichotomization in qualification of the clinical situation. The best corresponding cut-off point for the NDI total score was found by studying sensitivity and specificity for all possible cut-off points.102 patients were included. The highest AUC was obtained by dichotomizing the qualification into a group with good outcome and less-good outcome. The highest sensitivity and specificity for the dichotomized qualification as good outcome corresponded to a NDI ≤ 7. Sensitivity was 81.08% and specificity was 78.57%.This is the first study that correlated the qualification of the situation by the patients themselves and NDI. An NDI ≤ 7 corresponded to a good outcome according to the patients. This is valuable information to inform patients in their decision for any treatment.

  19. 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…

  20. Program Outcomes Assessment in Higher Education Hospitality Management Programs: A Qualitative Comparative Case Study of Learning Cultures

    Science.gov (United States)

    Hughes, John George

    2010-01-01

    The purpose of this qualitative, comparative case study was to determine the extent to which learning and improvement cultures were perceived to be linked to the traditional and non-traditional accreditation and Program Outcomes Assessment paradigms in use in two university hospitality programs. The findings of this study revealed that the…

  1. Incidence and long-term outcome of severe asthma-COPD overlap compared to asthma and COPD alone

    DEFF Research Database (Denmark)

    Baarnes, Camilla Boslev; Andersen, Zorana Jovanovic; Tjønneland, Anne

    2017-01-01

    BACKGROUND: Incidence and prognosis for severe asthma-COPD overlap is poorly characterized. We investigated incidence and long-term outcome for patients with asthma-COPD overlap compared to asthma and COPD alone. MATERIALS AND METHODS: A total of 57,053 adults (aged 50-64 years) enrolled in the D...

  2. Comparing the Outcomes of Online Listening versus Online Text-Based Tasks in University Level Italian L2 Study

    Science.gov (United States)

    Absalom, Matthew; Rizzi, Andrea

    2008-01-01

    In this paper, we describe an initial exploratory study designed to compare the outcomes of online listening and online text-based tasks in the context of the study of Italian at The University of Melbourne. Our findings allow us to characterise online listening and online reading as a qualitative difference between deep and surface approaches to…

  3. 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…

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    D. C. Damasceno

    2014-01-01

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

  6. 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.

  7. Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis

    OpenAIRE

    Kalsi, Navkiran; Altavilla, Daniela; Tambelli, Renata; Aceto, Paola; Trentini, Cristina; Di Giorgio, Chiara; Lai, Carlo

    2017-01-01

    The most prevalent mental disorders, anxiety and depression, are commonly associated with structural and functional changes in the fronto-limbic brain areas. The clinical trials investigating patients with affective disorders showed different outcome to different treatments such as psychotherapy or pharmacotherapy. It is, however, still unexplored how these interventions approach affect the functional brain. This meta-analysis aims to compare the effects of psychotherapy compared to antidepre...

  8. THE EFFECTS OF INQUIRY LEARNING MODEL TRAINING AND CRITICAL THINKING TOWARDS SMA STUDENT LEARNING OUTCOMES

    Directory of Open Access Journals (Sweden)

    Ella Lady Saura

    2014-12-01

    Full Text Available The purposes of the research are: (1 To determine differences in learning outcomes of students with Inquiry Training models and Direct Instruction teaching models, (2 to determine differences in physics learning outcomes of students who have high critical thinking and low critical thinking, (3 to determine the interaction between learning models with the level of critical thinking in improving student Physics learning outcomes. The sample in this study conducted in a cluster random sampling of two classes, where the first class as a class experiment applied Inquiry Training models as a class and the second class of controls implemented Direct Instruction models. The instrument is used in this study is physics learning outcomes tests in narrative form as many as 7 questions and critical thinking test in narrative form as 7 questions that have been declared valid and reliable. The results were found: (1 there are differences in physical students learning outcomes are taught by Inquiry Training models and Direct Instruction teaching models. Learning outcomes of students who are taught by Inquiry Learning Model Training better than student learning outcomes are taught with Direct Instruction Model Learning. (2 There is a difference in student's learning outcomes that have high critical thinking and low critical thinking. Student learning outcomes that have a high critical thinking better than student learning outcomes that have a low critical thinking. (3 There is interaction between learning and mastery of material Model Physics prerequisite to student learning outcomes. Learning outcomes of students who are taught by the model is influenced also by the Inquiry Training critical thinking, while learning outcomes of students who are taught with Direct Instruction models are not affected by the students' critical thinking.

  9. 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.

  10. Linear mixed model approach to network meta-analysis for continuous outcomes in periodontal research.

    Science.gov (United States)

    Tu, Yu-Kang

    2015-02-01

    Analysing continuous outcomes for network meta-analysis by means of linear mixed models is a great challenge, as it requires statistical software packages to specify special patterns of model error variance and covariance structure. This article demonstrates a non-Bayesian approach to network meta-analysis for continuous outcomes in periodontal research with a special focus on the adjustment of data dependency. Seventeen studies on guided tissue regeneration were used to illustrate how the proposed linear mixed models for network meta-analysis of continuous outcomes. Arm-based network meta-analysis use treatment arms from each study as the unit of analysis; when patients are randomly assigned to each arm, data are deemed independent and therefore no adjustment is required for multi-arm trials. Trial-based network meta-analysis use treatment contrasts as the unit of analysis, and therefore treatment contrasts within a multi-arm trial are not independent. This data dependency occurs also in split-mouth studies, and adjustments for data dependency are therefore required. Arm-based analysis is the preferred approach to network meta-analysis, when all included studies use the parallel group design and some compare more than two treatment arms. When included studies used designs that yield dependent data, the trial-based analysis is the preferred approach. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Rates of obstetric intervention during birth and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas.

    Science.gov (United States)

    Dahlen, Hannah G; Schmied, Virginia; Dennis, Cindy-Lee; Thornton, Charlene

    2013-05-01

    There are mixed reports in the literature about obstetric intervention and maternal and neonatal outcomes for migrant women born in resource rich countries. The aim of this study was to compare the risk profile, rates of obstetric intervention and selected maternal and perinatal outcomes for low risk women born in Australia compared to those born overseas. A population-based descriptive study was undertaken in NSW of all singleton births recorded in the NSW Midwives Data Collection between 2000-2008 (n=691,738). Risk profile, obstetric intervention rates and selected maternal and perinatal outcomes were examined. Women born in Australia were slightly younger (30 vs 31 years), less likely to be primiparous (41% vs 43%), three times more likely to smoke (18% vs 6%) and more likely to give birth in a private hospital (26% vs 18%) compared to women not born in Australia. Among the seven most common migrant groups to Australia, women born in Lebanon were the youngest, least likely to be primiparous and least likely to give birth in a private hospital. Hypertension was lowest amongst Vietnamese women (3%) and gestational diabetes highest amongst women born in China (14%). The highest caesarean section (31%), instrumental birth rates (16%) and episiotomy rates (32%) were seen in Indian women, along with the highest rates of babies obstetric intervention rates and maternal and neonatal outcomes between Australian-born and women born overseas and these differences are seen overall and in low risk populations. The finding that Indian women (the leading migrant group to Australia) have the lowest normal birth rate and high rates of low birth weight babies is concerning, and attention needs to be focused on why there are disparities in outcomes and on effective models of care that might improve outcomes for this population.

  12. Bootstrap model selection had similar performance for selecting authentic and noise variables compared to backward variable elimination: a simulation study.

    Science.gov (United States)

    Austin, Peter C

    2008-10-01

    Researchers have proposed using bootstrap resampling in conjunction with automated variable selection methods to identify predictors of an outcome and to develop parsimonious regression models. Using this method, multiple bootstrap samples are drawn from the original data set. Traditional backward variable elimination is used in each bootstrap sample, and the proportion of bootstrap samples in which each candidate variable is identified as an independent predictor of the outcome is determined. The performance of this method for identifying predictor variables has not been examined. Monte Carlo simulation methods were used to determine the ability of bootstrap model selection methods to correctly identify predictors of an outcome when those variables that are selected for inclusion in at least 50% of the bootstrap samples are included in the final regression model. We compared the performance of the bootstrap model selection method to that of conventional backward variable elimination. Bootstrap model selection tended to result in an approximately equal proportion of selected models being equal to the true regression model compared with the use of conventional backward variable elimination. Bootstrap model selection performed comparatively to backward variable elimination for identifying the true predictors of a binary outcome.

  13. Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches.

    Science.gov (United States)

    Lanier, Paul; Maguire-Jack, Kathryn; Lombardi, Brianna; Frey, Joseph; Rose, Roderick A

    2018-03-01

    Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

  14. 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

  15. Prognostic Model to Predict Post-Autologous Stem-Cell Transplantation Outcomes in Classical Hodgkin Lymphoma.

    Science.gov (United States)

    Chan, Fong Chun; Mottok, Anja; Gerrie, Alina S; Power, Maryse; Nijland, Marcel; Diepstra, Arjan; van den Berg, Anke; Kamper, Peter; d'Amore, Francesco; d'Amore, Alexander Lindholm; Hamilton-Dutoit, Stephen; Savage, Kerry J; Shah, Sohrab P; Connors, Joseph M; Gascoyne, Randy D; Scott, David W; Steidl, Christian

    2017-11-10

    Purpose Our aim was to capture the biology of classical Hodgkin lymphoma (cHL) at the time of relapse and discover novel and robust biomarkers that predict outcomes after autologous stem-cell transplantation (ASCT). Materials and Methods We performed digital gene expression profiling on a cohort of 245 formalin-fixed, paraffin-embedded tumor specimens from 174 patients with cHL, including 71 with biopsies taken at both primary diagnosis and relapse, to investigate temporal gene expression differences and associations with post-ASCT outcomes. Relapse biopsies from a training cohort of 65 patients were used to build a gene expression-based prognostic model of post-ASCT outcomes (RHL30), and two independent cohorts were used for validation. Results Gene expression profiling revealed that 24% of patients exhibited poorly correlated expression patterns between their biopsies taken at initial diagnosis and relapse, indicating biologic divergence. Comparative analysis of the prognostic power of gene expression measurements in primary versus relapse specimens demonstrated that the biology captured at the time of relapse contained superior properties for post-ASCT outcome prediction. We developed RHL30, using relapse specimens, which identified a subset of high-risk patients with inferior post-ASCT outcomes in two independent external validation cohorts. The prognostic power of RHL30 was independent of reported clinical prognostic markers (both at initial diagnosis and at relapse) and microenvironmental components as assessed by immunohistochemistry. Conclusion We have developed and validated a novel clinically applicable prognostic assay that at the time of first relapse identifies patients with unfavorable post-ASCT outcomes. Moving forward, it will be critical to evaluate the clinical use of RHL30 in the context of positron emission tomography-guided response assessment and the evolving cHL treatment landscape.

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

    Directory of Open Access Journals (Sweden)

    Bryce Morsky

    2012-01-01

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

  17. Oral anticancer drugs: how limited dosing options and dose reductions may affect outcomes in comparative trials and efficacy in patients.

    Science.gov (United States)

    Prasad, Vinay; Massey, Paul R; Fojo, Tito

    2014-05-20

    Historically, cancer medicine has avoided the problem of unequal dosing by comparing maximum-tolerated doses of intravenous regimens with proportionate dose reductions for toxicity. However, in recent years, with the development of numerous oral anticancer agents, dosing options are arbitrarily and increasingly limited by the size of pills. We contend that an underappreciated consequence of pill size is unequal dosing in comparative clinical trials and that this can have an impact on outcomes. We discuss how comparative effectiveness trials can be unbalanced and how the use of doses that are not sustainable might affect outcomes, especially marginal ones. We further argue that because of their poor tolerability and their limited dosing options, which often result in large dose adjustments in response to toxicity, the real-world clinical effectiveness of oral anticancer agents may be diminished and may not emulate results achieved in registration trials. © 2014 by American Society of Clinical Oncology.

  18. Demographic and Obstetric Outcomes of Pregnancies conceived by Assisted Reproductive Technology (ART) compared to Non-ART Pregnancies.

    Science.gov (United States)

    Johnston, Robert; Fong, Alex; Lovell, Sarah; Sobolewski, Paul S; Rad, Steve; Turner, Aaron

    2015-02-01

    Use of assisted reproductive technology has increased steadily, yet multiple socioeconomic and demographic disparities remain between the general population and those with infertility. Additionally, both mothers and infants experience higher rates of adverse outcomes compared to their non-ART counterparts. Using International Classification of Diseases, Ninth Revision (ICD-9) coding, we performed a retrospective review of all ART-conceived deliveries in California in 2009. A total of 551 ART pregnancies were compared to Non-ART pregnancies (n=406,885). The majority of ART deliveries belonged to women of advanced maternal age (AMA) and Caucasian or Asian race. Nearly half of all ART deliveries were multiple gestations. Compared to non-ART deliveries, ART pregnancies were associated with placenta previa, placental abruption, mild preeclampsia, and fetal growth restriction. While not powered to detect all outcomes, our study highlights significant racial and ethnic disparities between ART and Non-ART pregnancies.

  19. 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

  20. 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

  1. Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals.

    Science.gov (United States)

    Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Spong, Catherine Y; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Leveno, Kenneth J; Caritis, Steve N; Shubert, Phillip J; Tita, Alan T; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E; Van Dorsten, J Peter

    2013-11-01

    Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes. We studied a cohort of 115,502 women and their neonates born in 25 hospitals in the United States from March 2008 through February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Venous thromboembolism occurred too infrequently (0.03%; 95% confidence interval [CI], 0.02-0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage, 2.29%; 95% CI, 2.20-2.38, peripartum infection, 5.06%; 95% CI, 4.93-5.19, severe perineal laceration at spontaneous vaginal delivery, 2.16%; 95% CI, 2.06-2.27, neonatal composite, 2.73%; 95% CI, 2.63-2.84). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital-adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. Copyright © 2013 Mosby, Inc. All rights reserved.

  2. Estimating, Testing, and Comparing Specific Effects in Structural Equation Models: The Phantom Model Approach

    Science.gov (United States)

    Macho, Siegfried; Ledermann, Thomas

    2011-01-01

    The phantom model approach for estimating, testing, and comparing specific effects within structural equation models (SEMs) is presented. The rationale underlying this novel method consists in representing the specific effect to be assessed as a total effect within a separate latent variable model, the phantom model that is added to the main…

  3. 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.

  4. The outcome of rectal cancer after early salvage TME following TEM compared with primary TME

    DEFF Research Database (Denmark)

    Levic, K; Bulut, O; Hesselfeldt, P

    2012-01-01

    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......-73) for patients after primary TME. CONCLUSIONS: No difference was found in outcome between patients with rectal cancer undergoing salvage TME after TEM, those undergoing primary TME. In selected patients, TEM can therefore be chosen as a primary treatment, since failure of treatment and subsequent conventional...

  5. The outcome of rectal cancer after early salvage TME following TEM compared with primary TME

    DEFF Research Database (Denmark)

    Bulut, O; Levic, K; Hesselfeldt, P

    2014-01-01

    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......-73) for patients after primary TME. CONCLUSIONS: No difference was found in outcome between patients with rectal cancer undergoing salvage TME after TEM, those undergoing primary TME. In selected patients, TEM can therefore be chosen as a primary treatment, since failure of treatment and subsequent conventional...

  6. 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.

  7. Ceftaroline fosamil treatment outcomes compared with standard of care among hospitalized patients with complicated skin and soft tissue infections.

    Science.gov (United States)

    Karve, Sudeep; Hackett, Judith; Levinson, Jeremy; Gibson, Edward; Battersby, Alysia

    2016-07-01

    Compare clinical and cost outcomes associated with ceftaroline fosamil with other commonly used antibiotics in complicated skin and soft tissue infections. Retrospective analysis of hospital records from 2010 to 2013 in Premier's Perspective comparative database for adults with complicated skin and soft tissue infection treated with intravenous ceftaroline fosamil, vancomycin, daptomycin, linezolid or tigecycline. Length of stay, inpatient costs and mortality were compared between propensity score-matched treatment groups. Compared with the other commonly used antibiotics, matched patients in the ceftaroline fosamil treatment group had an equivalent (1%) or lower (compared with linezolid, 2%) in-hospital mortality rate, and significantly lower (p < 0.001) average unadjusted and regression-adjusted length of stay and inpatient costs (savings of $3398.80 compared with daptomycin).

  8. 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

    2017-11-27

    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.

  9. 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.

  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. 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)

  12. Perinatal Outcome in Assisted Reproductive Pregnancies: Comparative Analysis of Reduced versus Unreduced Gestation

    Directory of Open Access Journals (Sweden)

    Shilpa Bhandari

    2016-01-01

    Full Text Available Objectives. This study aims to evaluate perinatal outcomes such as gestational age at delivery and live birth rate in singleton and twin gestation with or without fetal reduction. Method. A retrospective analysis was done on patients which were divided into reduced and unreduced groups on the basis of order of reduction of one or more fetuses between 6 and 13 weeks of gestation. Patients records were studied to note gestational age at delivery/abortion, birth weight, and neonatal outcome. Result. The cohort included a total of 292 patients: 102 singletons and 190 twins. 52 pregnancies were reduced in singleton cohort and 68 were reduced in twin cohort. No statistical difference was observed in live birth rate, gestational age at delivery, and birth weight and significant higher incidence of IUGR was observed in reduced and unreduced twin gestation. In singleton pregnancies however preterm delivery rate increased with fetal reduction. Conclusion. Although reduction does not reduce the live birth rate, it does reduce gestation age of delivery and birth weight of newborn. This effect is more apparent when multiple gestation is reduced to singleton.

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

    Science.gov (United States)

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

    2016-10-01

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

  14. 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.)

  15. 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.

  16. A repeated measures model for analysis of continuous outcomes in sequential parallel comparison design studies.

    Science.gov (United States)

    Doros, Gheorghe; Pencina, Michael; Rybin, Denis; Meisner, Allison; Fava, Maurizio

    2013-07-20

    Previous authors have proposed the sequential parallel comparison design (SPCD) to address the issue of high placebo response rate in clinical trials. The original use of SPCD focused on binary outcomes, but recent use has since been extended to continuous outcomes that arise more naturally in many fields, including psychiatry. Analytic methods proposed to date for analysis of SPCD trial continuous data included methods based on seemingly unrelated regression and ordinary least squares. Here, we propose a repeated measures linear model that uses all outcome data collected in the trial and accounts for data that are missing at random. An appropriate contrast formulated after the model has been fit can be used to test the primary hypothesis of no difference in treatment effects between study arms. Our extensive simulations show that when compared with the other methods, our approach preserves the type I error even for small sample sizes and offers adequate power and the smallest mean squared error under a wide variety of assumptions. We recommend consideration of our approach for analysis of data coming from SPCD trials. Copyright © 2013 John Wiley & Sons, Ltd.

  17. Ionospheric topside models compared with experimental electron density profiles

    Directory of Open Access Journals (Sweden)

    S. M. Radicella

    2005-06-01

    Full Text Available Recently an increasing number of topside electron density profiles has been made available to the scientific community on the Internet. These data are important for ionospheric modeling purposes, since the experimental information on the electron density above the ionosphere maximum of ionization is very scarce. The present work compares NeQuick and IRI models with the topside electron density profiles available in the databases of the ISIS2, IK19 and Cosmos 1809 satellites. Experimental electron content from the F2 peak up to satellite height and electron densities at fixed heights above the peak have been compared under a wide range of different conditions. The analysis performed points out the behavior of the models and the improvements needed to be assessed to have a better reproduction of the experimental results. NeQuick topside is a modified Epstein layer, with thickness parameter determined by an empirical relation. It appears that its performance is strongly affected by this parameter, indicating the need for improvements of its formulation. IRI topside is based on Booker's approach to consider two parts with constant height gradients. It appears that this formulation leads to an overestimation of the electron density in the upper part of the profiles, and overestimation of TEC.

  18. 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

  19. 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.

  20. Comparative study on surgical outcomes between laparoscopic and open cornuotomy in urban tertiary center of Malaysia

    Directory of Open Access Journals (Sweden)

    Wan Ahmad Hazim Wan Ghazali

    2018-01-01

    Conclusion: Laparoscopic cornual resection (cornuotomy is a safe and less invasive procedure with a comparable complication rate. It has shown that it is feasibility and should be considered as initial treatment in managing those cases in trained hand surgeons.

  1. Domain analysis and modeling to improve comparability of health statistics.

    Science.gov (United States)

    Okada, M; Hashimoto, H; Ohida, T

    2001-01-01

    Health statistics is an essential element to improve the ability of managers of health institutions, healthcare researchers, policy makers, and health professionals to formulate appropriate course of reactions and to make decisions based on evidence. To ensure adequate health statistics, standards are of critical importance. A study on healthcare statistics domain analysis is underway in an effort to improve usability and comparability of health statistics. The ongoing study focuses on structuring the domain knowledge and making the knowledge explicit with a data element dictionary being the core. Supplemental to the dictionary are a domain term list, a terminology dictionary, and a data model to help organize the concepts constituting the health statistics domain.

  2. 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

  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

    of Complex PTSD, structural and somatoform dissociation, interpersonal problems, and factors promoting health before treatment and after 50 therapy hours or before and after waiting. Results showed significant differences in all scores when either of the treatment conditions was compared to the control group......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. SURGICAL AND VISUAL OUTCOME OF PHACOEMULSIFICATION SURGERY (ROUTINE) AND MICRO - PHACO (BIMANUAL PHACO): A COMPARATIVE STUDY

    OpenAIRE

    Sudha; Nitin; Vikas; Chitra; Nikhilesh; Rajesh; Pawar

    2015-01-01

    Cataract surgery has evolved over the past few decades with progressive decrease in the size of the incision. Originally from 12 mm intracapsular incision to bimanual phacoemulsification (Micro - Phaco) that has incision size of just 700 microns. In the pres ent comparative PROSPECTIVE study best corrected visual acuity postoperatively and surgically induced astigmatism were compared in routine Phacoemulsification technique and bimanual phaco (Micro - Phaco) 60 e...

  5. Comparing Numerical and Analog Models of Oblique Convergence With Nature

    Science.gov (United States)

    Koster, K.; Haq, S. S.; Flesch, L. M.

    2011-12-01

    Relative plate motion at convergent plate boundaries is rarely perfectly margin-normal, instead it typically exhibits some obliquity to the overlying plate. The resulting margin-parallel component of plate motion can have a considerable influence in determining the distribution and style of large-scale deformation at the margin. In accretionary prisms and fold and thrust belts oblique plate motion and the resulting deformation frequently results in spatially segregated dip-slip and strike-slip faulting in the deforming wedge. Analog modeling has demonstrated that the type of shearing structures that occur in response to this motion is strongly correlated with the vertical variation in rheology, where ductile layers at depth will localize strike-slip deformation. Additionally, we have performed numerical simulations where we solve force-balance equations for Stokes flow for oblique wedges with similar geometries and rheologies using the finite element software COMSOL. Using frictional and layered, frictional over viscous, rheologies we further constrain the role that rheological complexity plays in determining the style and distribution of deformation and of stress. In our numerical models, we have simulated a range of obliquities as well as layered rheologies to determine internal stresses in actively deforming wedges. Results from our numerical experiments are in agreement with available kinematic data from comparable analog experiments, suggesting our numerical method is also viable and suitable for modeling natural settings. Numerical models that simulated frictional wedges were characterized by diffusely distributed shear throughout the pro-wedge at low obliquities, and weakly partitioned strain, similar to analog results. However, the localization of shear in rheologically complex numerical models occurred across a narrower zone at comparable obliquities in both numerical and analog results, corresponding to the location where there the transition in basal

  6. 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.

  7. Maternal and neonatal outcomes of attempted vaginal compared with planned cesarean delivery in triplet gestations.

    Science.gov (United States)

    Lappen, Justin R; Hackney, David N; Bailit, Jennifer L

    2016-10-01

    The prevailing obstetric practice of planned cesarean delivery for triplet gestations is largely empiric and data on the optimal route of delivery are limited. The primary objectives of this study are to determine the likelihood of success in an attempted vaginal delivery and assess maternal and neonatal outcomes of attempted vaginal vs planned cesarean delivery of triplets using a multiinstitution obstetric cohort. We performed a retrospective cohort study using data from the Consortium on Safe Labor, identifying triplet pregnancies with delivery at a gestational age ≥28 weeks. Women with a history of cesarean delivery and pregnancies complicated by chromosomal or congenital anomalies, twin-twin transfusion syndrome, or a fetal demise were excluded. The attempted vaginal group included all women with spontaneous or induced labor and excluded all women delivering by prelabor cesarean delivery, including those coded as elective or for fetal malpresentation. Primary maternal outcomes included infection (composite of chorioamnionitis, endometritis, wound separation, and wound infection), blood transfusion, or transfer to the intensive care unit. Primary neonatal outcomes included neonatal asphyxia, mechanical ventilation, and composite neonatal morbidity, consisting of ≥1 of the following: birth injury, 5-minute Apgar delivery group was restricted to include only women with evidence of induction or augmentation or labor. 188 triplet sets were identified of which 80 sets (240 neonates) met inclusion criteria and 24 sets (30%) had an attempted vaginal delivery. The rate of successful attempted vaginal delivery was 16.7% (4 triplet sets; 12 neonates). No women had a combined mode of delivery. Women attempting vaginal delivery were more likely to have preterm labor (45.8 vs 12.5%, P delivery did not differ by mode of delivery. Attempted vaginal delivery was associated with a higher risk of maternal transfusion (20.8% vs 3.6%, P = .01) and neonatal mechanical

  8. Comparing treatment outcomes of stage IIIB cervical cancer patients between those with and without lower third of vaginal invasion.

    Science.gov (United States)

    Katanyoo, Kanyarat

    2017-11-01

    To evaluate treatment outcomes between stage IIIB cervical cancer with and without lower third of vaginal invasion (LTI) in terms of response to treatment and overall survival (OS). Matching one patient with LTI for 2 patients without LTI who had completed treatment between 1995 and 2012 were conducted by using treatment modalities (radiation therapy [RT] alone vs. concurrent chemoradiation therapy [CCRT]) and tumor histology (squamous cell carcinoma [SCC] vs. adenocarcinoma [ADC]). Treatment outcomes including complete response (CR) rate of RT/CCRT, patterns of treatment failure and survival outcomes were analyzed. Of 216 stage IIIB cervical cancer patients, 114 of them had no LTI and 72 had LTI. Most of the patients (83.8%) had tumor histology as SCC. The CR rates between stage IIIB without LTI and with LTI were 93.8% and 81.9% (p=0.009), and corresponding with disease progression at pelvis accounted for 18.2% and 34.4% (p=0.017), respectively. Distant metastasis was comparable between 2 groups of patients, 28.9% in patients without LTI and 29.5% in patients with LTI (p=0.988). The 2-year and 5-year OS of stage IIIB without LTI were 66.5% and 46.8% compared to stage IIIB with LTI which were 43.1% and 28.9% (p=0.004), respectively. For multivariable analysis, stage IIIB with LTI was only the influential factor on OS with hazard ratio (HR) of 1.63 (p=0.012). Stage IIIB cervical cancer patients with LTI have poorer treatment outcomes including response to treatment and survival outcomes than patients in the same stage without LTI. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

  9. Comparing Functional Outcomes After Injury-Specific Fixation of Posterior Malleolar Fractures and Equivalent Ligamentous Injuries in Rotational Ankle Fractures.

    Science.gov (United States)

    Levack, Ashley E; Warner, Stephen J; Gausden, Elizabeth B; Helfet, David L; Lorich, Dean G

    2018-04-01

    To evaluate the effect of posterior bony versus ligamentous injury pattern on functional outcomes in operatively treated rotational ankle fractures. Retrospective cohort analysis of prospective registry. Academic Level I trauma center. Operatively treated supination external rotation IV and pronation external rotation IV ankle fractures. Lateral malleolus plate fixation with either posterior malleolus (PM) plate fixation or posterior inferior tibiofibular ligament (PITFL) repair. Foot and ankle outcome scores at minimum 12 months postoperatively. One hundred seventy-eight fractures were treated with injury-specific anatomic fixation of a PM fracture (n = 122) or torn PITFL (n = 56). The PM group was significantly older, contained more women, and had lower mean body mass index versus the PITFL group. There was a higher rate of medial malleolar fracture in the PM group; other fracture and baseline characteristics were similar between groups. Univariate and multivariable analysis revealed no difference in foot and ankle outcome scores for any of the 5 summary domains (symptoms, pain, activities of daily living, sports, or quality of life) at the time of most recent follow-up. The median length of follow-up was 16.3 and 12.8 months in the PM and PITFL groups, respectively. In our cohort of ankle fractures, we have demonstrated comparable outcomes in stage IV rotational ankle fractures with and without PM fractures, indicating that the presence of a PM fracture may not result in inferior outcomes compared with ligamentous equivalent injuries if these fractures are addressed in an injury-specific manner. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    Cheng-Hung Hsieh

    2007-09-01

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

  12. 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

  13. 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…

  14. A COMPARATIVE STUDY OF OUTCOMES AFTER MODIFIED RADICAL MASTECTOMY DONE UNDER THORACIC EPIDURAL vs. GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Jakkula Kishore

    2017-03-01

    Full Text Available BACKGROUND In earlier days General Anaesthesia (GA was the choice for MRM, but recently Thoracic Epidural (TE analgesia is being increasingly used for MRM. TE technique has a lot of advantages over the conventional GA technique. MATERIALS AND METHODS 100 patients with carcinoma breast are divided into two groups- Thoracic Epidural (TE and General Anaesthesia (GA of 50 patients each. Four patients in TE group were converted to GA in view of patient’s anxiety during surgery. All the intraoperative parameters heart rate, blood pressure, bleeding and postoperative outcomes, seroma formation, drains, wound infection rates, flap necrosis and hospital stay are recorded. RESULTS The demographic data showed no differences between both groups. During the intraoperative period, hypertension and tachycardia were more frequent in GA group while hypotension and bradycardia more in TE group, which was statistically significant (p value <0.05. In the immediate postoperative period, nausea and vomiting were more in GA group (31% than in TE group (8.6%, which was statistically significant (p value 0.01. Also, pain scores were more in GA group than in TE group. Wound infection rates, seroma incidence, flap necrosis, length of hospital stay and hospital costs were less in TE group than GA group. CONCLUSION Use of thoracic epidural technique as a sole anaesthetic technique for MRM surgeries provides adequate operating conditions, better side effect profile, better pain management, less postoperative complications, early ambulation, early drain removal and early discharge from the hospital.

  15. Genetics and outcome of atypical hemolytic uremic syndrome: a nationwide French series comparing children and adults.

    Science.gov (United States)

    Fremeaux-Bacchi, Véronique; Fakhouri, Fadi; Garnier, Arnaud; Bienaimé, Frank; Dragon-Durey, Marie-Agnès; Ngo, Stéphanie; Moulin, Bruno; Servais, Aude; Provot, François; Rostaing, Lionel; Burtey, Stéphane; Niaudet, Patrick; Deschênes, Georges; Lebranchu, Yvon; Zuber, Julien; Loirat, Chantal

    2013-04-01

    Atypical hemolytic uremic syndrome (aHUS) is a rare complement-mediated kidney disease that was first recognized in children but also affects adults. This study assessed the disease presentation and outcome in a nationwide cohort of patients with aHUS according to the age at onset and the underlying complement abnormalities. A total of 214 patients with aHUS were enrolled between 2000 and 2008 and screened for mutations in the six susceptibility factors for aHUS and for anti-factor H antibodies. Onset of aHUS occurred as frequently during adulthood (58.4%) as during childhood (41.6%). The percentages of patients who developed the disease were 23%, 40%, 70%, and 98% by age 2, 18, 40, and 60 years, respectively. Mortality was higher in children than in adults (6.7% versus 0.8% at 1 year) (P=0.02), but progression to ESRD after the first aHUS episode was more frequent in adults (46% versus 16%; Pgenetic background. Only membrane cofactor protein (MCP) and undetermined aHUS were less severe in children than adults. The frequency of relapse after 1 year was 92% in children with MCP-associated HUS and approximately 30% in all other subgroups. Mortality rate was higher in children than adults with aHUS, but renal prognosis was worse in adults than children. In children, the prognosis strongly depends on the genetic background.

  16. Comparing ALS and Image-Based Point Cloud Metrics and Modelled Forest Inventory Attributes in a Complex Coastal Forest Environment

    Directory of Open Access Journals (Sweden)

    Joanne C. White

    2015-10-01

    Full Text Available Digital aerial photogrammetry (DAP is emerging as an alternate data source to airborne laser scanning (ALS data for three-dimensional characterization of forest structure. In this study we compare point cloud metrics and plot-level model estimates derived from ALS data and an image-based point cloud generated using semi-global matching (SGM for a complex, coastal forest in western Canada. Plot-level estimates of Lorey’s mean height (H, basal area (G, and gross volume (V were modelled using an area-based approach. Metrics and model outcomes were evaluated across a series of strata defined by slope and canopy cover, as well as by image acquisition date. We found statistically significant differences between ALS and SGM metrics for all strata for five of the eight metrics we used for model development. We also found that the similarity between metrics from the two data sources generally increased with increasing canopy cover, particularly for upper canopy metrics, whereas trends across slope classes were less consistent. Model outcomes from ALS and SGM were comparable. We found the greatest difference in model outcomes was for H (ΔRMSE% = 5.04%. By comparison, ΔRMSE% was 2.33% for G and 3.63% for V. We did not discern any corresponding trends in model outcomes across slope and canopy cover strata, or associated with different image acquisition dates.

  17. 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…

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

    Science.gov (United States)

    Grigal, Meg; Hart, Debra; Migliore, Alberto

    2011-01-01

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

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

    DEFF Research Database (Denmark)

    Udby, Peter M.; Bech-Azeddine, Rachid

    2015-01-01

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

  20. 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

  1. 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

  2. A comparative study of colorectal surgical outcome in a national audit separated by 15 years.

    Science.gov (United States)

    Evans, M D; Thomas, R; Williams, G L; Beynon, J; Smith, J J; Stamatakis, J D; Stephenson, B M

    2013-05-01

    The Wales-Trent Bowel Cancer Audit (WTBA) was carried out in 1993, and since 2001 Welsh Bowel Cancer Audits (WBCA) have taken place annually. Screening for bowel cancer in Wales was introduced in 2008. This study compared patient variables, the role of surgery and operative mortality rates over the 15-year interval between the WTBA and the last WBCA before the introduction of population screening. Data from the WTBA in 1993 were compared with those of the WBCA including patients diagnosed between April 2007 and March 2008. In 1993, 1536 patients were diagnosed with colorectal cancer (CRC) compared with 1793 in 2007-2008. Patient demographics and American Society of Anesthesiology (ASA) score did not change during these periods. Surgical treatment for CRC decreased (93% in 1993 vs 80% in 2007-2008; P Advanced disease at operation was more prevalent in the WTBA (25% of all operated patients were Stage IV in 1993 vs 13% in 2007-2008; P < 0.001). The use of surgery in patients with metastatic disease also declined over this period. Surgery is used less frequently in the management of CRC compared with 15 years previously, and is a factor in the reduction of the interpreted 30-day operative mortality. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

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

    Directory of Open Access Journals (Sweden)

    Schiau (Macavei Laura - Liana

    2011-07-01

    Full Text Available In the two last decades the flat tax systems have spread all around the globe from East and Central Europe to Asia and Central America. Many specialists consider this phenomenon a real fiscal revolution, but others see it as a mistake as long as the new systems are just a feint of the true flat tax designed by the famous Stanford University professors Robert Hall and Alvin Rabushka. In this context this paper tries to determine which of the existing flat tax systems resemble the true flat tax model by comparing and contrasting their main characteristics with the features of the model proposed by Hall and Rabushka. The research also underlines the common features and the differences between the existing models. The idea of this kind of study is not really new, others have done it but the comparison was limited to one country. For example Emil Kalchev from New Bulgarian University has asses the Bulgarian income system, by comparing it with the flat tax and concluding that taxation in Bulgaria is not simple, neutral and non-distortive. Our research is based on several case studies and on compare and contrast qualitative and quantitative methods. The study starts form the fiscal design drawn by the two American professors in the book The Flat Tax. Four main characteristics of the flat tax system were chosen in order to build the comparison: fiscal design, simplicity, avoidance of double taxation and uniformity of the tax rates. The jurisdictions chosen for the case study are countries all around the globe with fiscal systems which are considered flat tax systems. The results obtained show that the fiscal design of Hong Kong is the only flat tax model which is built following an economic logic and not a legal sense, being in the same time a simple and transparent system. Others countries as Slovakia, Albania, Macedonia in Central and Eastern Europe fulfill the requirement regarding the uniformity of taxation. Other jurisdictions avoid the double

  4. Comparative examination of two methods for modeling autoimmune uveitis

    Directory of Open Access Journals (Sweden)

    Svetlana V. Aksenova

    2017-09-01

    Full Text Available Introduction: Uveitis is a disease of the uveal tract, characterized by a variety of causes and clinical manifestations. The internal antigens prevail often in the pathogenesis of the disease and develop the so-called autoimmune reactions. The uveitis treatment has an important medico-social significance because of the high prevalence of uveitis, the significant rate of the disease in young people, and high disability. The article compares the efficiency of two methods for modeling autoimmune uveitis. Materials and Methods: The research was conducted on 6 rabbits of the Chinchilla breed (12 eyes. Two models of experimental uveitis were reproduced on rabbits using normal horse serum during the research. A clinical examination of the inflammatory process course in the eyes was carried out by biomicroscopy using a slit lamp, and a direct ophthalmoscope. Histological and immunological examinations were conducted by the authors of the article. Results: The faster-reproducing and vivid clinical picture of the disease was observed in the second group. The obvious changes in the immunological status of the animals were noted also: an increase in the number of leukocytes, neutrophils, HCT-active neutrophils, and activation of phagocytosis. Discussion and Conclusions: The research has showed that the second model of uveitis is the most convenient working variant, which is characterized by high activity and duration of the inflammatory process in the eye.

  5. Curriculum inventory: Modeling, sharing and comparing medical education programs.

    Science.gov (United States)

    Ellaway, Rachel H; Albright, Susan; Smothers, Valerie; Cameron, Terri; Willett, Timothy

    2014-03-01

    Abstract descriptions of how curricula are structured and run. The American National Standards Institute (ANSI) MedBiquitous Curriculum Inventory Standard provides a technical syntax through which a wide range of different curricula can be expressed and subsequently compared and analyzed. This standard has the potential to shift curriculum mapping and reporting from a somewhat disjointed and institution-specific undertaking to something that is shared among multiple medical schools and across whole medical education systems. Given the current explosion of different models of curricula (time-free, competency-based, socially accountable, distributed, accelerated, etc.), the ability to consider this diversity using a common model has particular value in medical education management and scholarship. This article describes the development and structure of the Curriculum Inventory Standard as a way of standardizing the modeling of different curricula for audit, evaluation and research purposes. It also considers the strengths and limitations of the current standard and the implications for a medical education world in which this level of commonality, precision, and accountability for curricular practice is the norm rather than the exception.

  6. 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).…

  7. 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 ...

  8. Alternative and traditional assessments: Their comparative impact on students' attitudes and science learning outcomes. An exploratory study

    Science.gov (United States)

    Century, Daisy Nelson

    This probing study focused on alternative and traditional assessments, their comparative impacts on students' attitudes and science learning outcomes. Four basic questions were asked: What type of science learning stemming from the instruction can best be assessed by the use of traditional paper-and pencil test? What type of science learning stemming from the instruction can best be assessed by the use of alternative assessment? What are the differences in the types of learning outcomes that can be assessed by the use of paper-pencil test and alternative assessment test? Is there a difference in students' attitude towards learning science when assessment of outcomes is by alternative assessment means compared to traditional means compared to traditional means? A mixed methodology involving quantitative and qualitative techniques was utilized. However, the study was essentially a case study. Quantitative data analysis included content achievement and attitude results, to which non-parametric statistics were applied. Analysis of qualitative data was done as a case study utilizing pre-set protocols resulting in a narrative summary style of report. These outcomes were combined in order to produce conclusions. This study revealed that the traditional method yielded more concrete cognitive content learning than did the alternative assessment. The alternative assessment yielded more psychomotor, cooperative learning and critical thinking skills. In both the alternative and the traditional methods the student's attitudes toward science were positive. There was no significant differences favoring either group. The quantitative findings of no statistically significant differences suggest that at a minimum there is no loss in the use of alternative assessment methods, in this instance, performance testing. Adding the results from the qualitative analysis to this suggests (1) that class groups were more satisfied when alternative methods were employed, and (2) that the two

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia.

    Science.gov (United States)

    Bhayani, Neil H; Kurian, Ashwin A; Dunst, Christy M; Sharata, Ahmed M; Rieder, Erwin; Swanstrom, Lee L

    2014-06-01

    To compare symptomatic and objective outcomes between HM and POEM. The surgical gold standard for achalasia is laparoscopic Heller myotomy (HM) and partial fundoplication. Per-oral endoscopic myotomy (POEM) is a less invasive flexible endoscopic alternative. We compare their safety and efficacy. Data on consecutive HMs and POEMs for achalasia from 2007 to 2012 were collected. swallowing function-1 and 6 months after surgery. operative time, complications, postoperative gastro-esophageal reflux disease (GERD). There were 101 patients: 64 HMs (42% Toupet and 58% Dor fundoplications) and 37 POEMs. Presenting symptoms were comparable. Median operative time (149 vs 120 min, P endoscopic therapy for achalasia with a shorter hospitalization than HM. Patient symptoms and esophageal physiology are improved equally with both procedures. Postoperative esophageal acid exposure is the same for both. The POEM is comparable with laparoscopic HM for safe and effective treatment of achalasia.

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

    Science.gov (United States)

    Rushton, Paul R P; Grevitt, Michael P

    2014-06-01

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

  13. 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.

  14. Patient-reported goal attainment and comprehensive functioning outcomes after surgery compared to pessary for pelvic organ prolapse

    Science.gov (United States)

    SUNG, Vivian W.; WOHLRAB, Kyle J.; MADSEN, Annetta; RAKER, Christina

    2016-01-01

    Background Pelvic organ prolapse can negatively impact a woman’s overall functioning. When choosing between surgery or pessary, many women have information needs about long-term expectations. While it has been shown that both surgery and pessary can improve prolapse symptoms, there is less information comparing comprehensive functioning outcomes and goal attainment between the two treatments. Objectives Our primary objective was to compare patient-reported goal attainment and comprehensive physical, social, and emotional functioning outcomes after surgery versus pessary for symptomatic prolapse. Study Design We conducted a prospective observational cohort study including women choosing surgery or pessary for symptomatic stage 2 or greater prolapse. Women undergoing any modality of prolapse surgery or those anticipating using a pessary long-term to avoid surgery were eligible. Women completed questionnaires at baseline (pre-treatment) and up to 12 months post-treatment including: 2) Pre-treatment goals and actual post-treatment goals achieved; 2) five functioning outcomes encompassing physical, social and emotional function using the Patient-Reported Outcomes Measurement Information System surveys; 3) validated symptom and quality of life questionnaires. Treatment goals were categorized into “Symptom Goals” (prolapse, urinary, bowel, pain) and “Function Goals” (physical, social, emotional, sexual). Goals achieved were compared using chi-square. Multiple logistic regression was used to identify variables associated with not achieving all pretreatment goals. Mean improvements in functioning scores were compared within groups and between groups using paired and independent t-tests. Assuming 80% of women would achieve complete goal attainment in the surgery group 64 women per group would be needed to detect a 20% difference at an alpha = 0.05. We recruited 80 women per group to account for drop out. Results A total of 160 women were enrolled and 72 (90

  15. 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.

  16. Comparative outcomes of surgical treatment of patients with Impression fractures of the calcaneus

    Directory of Open Access Journals (Sweden)

    G. S. Golubev

    2013-01-01

    Full Text Available Current prospective investigation with historical control was performed to compare functional results of less invasive surgical treatment of calcaneal comminuted fractures with ordinary surgical methods. Data of 40 patients is being analyzed. One patient was lost for follow up. Patients have been divided to four subgroups according to used surgical technologies. Groups differ by trauma on reposition and method of fracture’s fixation: open reduction and plating (ORIF, cannulated screws with triple thread (FusiFix, external fixation, other (diafixation, ordinary cortical or metaphyseal screws. Foot function was estimated by FAOS scale between 1 and six and more years after surgery. Combination of modified principles of reposition after Essex - Lopresti, using of original instrument set and C-arc with FusiFix stable fixation enables minimal complications add ratio. This method also creates good possibilities for foot functional recovery (average normalized FAOS index is 92 after 1 year comparatively to 60 (ORIF and 57(ExFix.

  17. Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function.

    Science.gov (United States)

    Hebert, Jeffrey J; Fritz, Julie M; Thackeray, Anne; Koppenhaver, Shane L; Teyhen, Deydre

    2015-01-01

    The optimal components of postoperative exercise programmes following single-level lumbar discectomy have not been identified. Facilitating lumbar multifidus (LM) function after discectomy may improve postoperative recovery. The aim of this study was to compare the clinical and muscle function outcomes of patients randomised to receive early multimodal rehabilitation following lumbar discectomy consisting of exercises targeting specific trunk muscles including the LM or general trunk exercises. We included participants aged 18 to 60 years who were scheduled to undergo single-level lumbar discectomy. After two postoperative weeks, participants were randomly assigned to receive an 8-week multimodal exercise programme including either general or specific trunk exercises. The primary outcome was pain-related disability (Oswestry Index). Secondary outcomes included low back and leg pain intensity (0-10 numeric pain rating scale), global change, sciatica frequency, sciatica bothersomeness and LM function measured with real-time ultrasound imaging. Treatment effects 10 weeks and 6 months after surgery were estimated with linear mixed models. 61 participants were randomised to receive a general trunk (n=32) or specific (n=29) exercise programme. There were no between-group differences in clinical or muscle function outcomes. Participants in both groups experienced improvements in most outcome measures. Following lumbar discectomy, multimodal rehabilitation programmes comprising specific or general trunk exercises have similar effects on clinical and muscle function outcomes. Local factors such as the individual patient characteristics identified by specific assessment findings, clinician expertise and patient preferences should direct therapy selection when considering the types of exercises tested in this trial for inclusion in rehabilitation programmes following lumbar disc surgery. Published by the BMJ Publishing Group Limited. For permission to use (where not

  18. Comparative outcomes of surgical treatment of patients with Impression fractures of the calcaneus

    OpenAIRE

    G. S. Golubev; A. V. Dubinskiy

    2013-01-01

    Current prospective investigation with historical control was performed to compare functional results of less invasive surgical treatment of calcaneal comminuted fractures with ordinary surgical methods. Data of 40 patients is being analyzed. One patient was lost for follow up. Patients have been divided to four subgroups according to used surgical technologies. Groups differ by trauma on reposition and method of fracture’s fixation: open reduction and plating (ORIF), cannulated screws with t...

  19. 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.

  20. An overview of animal models of pain: disease models and outcome measures

    Science.gov (United States)

    Gregory, N; Harris, AL; Robinson, CR; Dougherty, PM; Fuchs, PN; Sluka, KA

    2013-01-01

    Pain is ultimately a perceptual phenomenon. It is built from information gathered by specialized pain receptors in tissue, modified by spinal and supraspinal mechanisms, and integrated into a discrete sensory experience with an emotional valence in the brain. Because of this, studying intact animals allows the multidimensional nature of pain to be examined. A number of animal models have been developed, reflecting observations that pain phenotypes are mediated by distinct mechanisms. Animal models of pain are designed to mimic distinct clinical diseases to better evaluate underlying mechanisms and potential treatments. Outcome measures are designed to measure multiple parts of the pain experience including reflexive hyperalgesia measures, sensory and affective dimensions of pain and impact of pain on function and quality of life. In this review we discuss the common methods used for inducing each of the pain phenotypes related to clinical pain syndromes, as well as the main behavioral tests for assessing pain in each model. PMID:24035349

  1. 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

  2. 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 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.

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

    Directory of Open Access Journals (Sweden)

    Víctor Hugo Masías

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

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

    Science.gov (United States)

    Masías, Víctor Hugo; Valle, Mauricio; Morselli, Carlo; Crespo, Fernando; Vargas, Augusto; Laengle, Sigifredo

    2016-01-01

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

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

    Science.gov (United States)

    2016-01-01

    Modelling criminal trial verdict outcomes using social network measures is an emerging research area in quantitative criminology. Few studies have yet analyzed which of these measures are the most important for verdict modelling or which data classification techniques perform best for this application. To compare the performance of different techniques in classifying members of a criminal network, this article applies three different machine learning classifiers–Logistic Regression, Naïve Bayes and Random Forest–with a range of social network measures and the necessary databases to model the verdicts in two real–world cases: the U.S. Watergate Conspiracy of the 1970’s and the now–defunct Canada–based international drug trafficking ring known as the Caviar Network. In both cases it was found that the Random Forest classifier did better than either Logistic Regression or Naïve Bayes, and its superior performance was statistically significant. This being so, Random Forest was used not only for classification but also to assess the importance of the measures. For the Watergate case, the most important one proved to be betweenness centrality while for the Caviar Network, it was the effective size of the network. These results are significant because they show that an approach combining machine learning with social network analysis not only can generate accurate classification models but also helps quantify the importance social network variables in modelling verdict outcomes. We conclude our analysis with a discussion and some suggestions for future work in verdict modelling using social network measures. PMID:26824351

  6. 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.

  7. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial.

    Science.gov (United States)

    Song, Taejong; Cho, Juhee; Kim, Tae-Joong; Kim, Im-Ryung; Hahm, Tae Soo; Kim, Byoung-Gie; Bae, Duk-Soo

    2013-01-01

    To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery. Randomized controlled trial (Canadian Task Force classification I). University hospital. Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery. Laparoendoscopic single-site surgery or multi-port surgery. Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  8. 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

  9. 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.

  10. Data Collection Outcomes Comparing Paper Forms With PDA Forms in an Office-Based Patient Survey

    Science.gov (United States)

    Galliher, James M.; Stewart, Thomas V.; Pathak, Paramod K.; Werner, James J.; Dickinson, L. Miriam; Hickner, John M.

    2008-01-01

    PURPOSE We compared the completeness of data collection using paper forms and using electronic forms loaded on handheld computers in an office-based patient interview survey conducted within the American Academy of Family Physicians National Research Network. METHODS We asked 19 medical assistants and nurses in family practices to administer a survey about pneumococcal immunizations to 60 older adults each, 30 using paper forms and 30 using electronic forms on handheld computers. By random assignment, the interviewers used either the paper or electronic form first. Using multilevel analyses adjusted for patient characteristics and clustering of forms by practice, we analyzed the completeness of the data. RESULTS A total of 1,003 of the expected 1,140 forms were returned to the data center. The overall return rate was better for paper forms (537 of 570, 94%) than for electronic forms (466 of 570, 82%) because of technical difficulties experienced with electronic data collection and stolen or lost handheld computers. Errors of omission on the returned forms, however, were more common using paper forms. Of the returned forms, only 3% of those gathered electronically had errors of omission, compared with 35% of those gathered on paper. Similarly, only 0.04% of total survey items were missing on the electronic forms, compared with 3.5% of the survey items using paper forms. CONCLUSIONS Although handheld computers produced more complete data than the paper method for the returned forms, they were not superior because of the large amount of missing data due to technical difficulties with the hand-held computers or loss or theft. Other hardware solutions, such as tablet computers or cell phones linked via a wireless network directly to a Web site, may be better electronic solutions for the future. PMID:18332408

  11. 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.

  12. 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.

  13. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study.

    Science.gov (United States)

    Hayashi, Makoto; Iwasaki, Takuya; Yamazaki, Yohei; Takayasu, Hiromi; Tateno, Hidetsugu; Tazawa, Sakiko; Kato, Eisuke; Wakabayashi, Aya; Yamaguchi, Fumihiro; Tsuchiya, Yutaka; Yamashita, Jun; Takeda, Norikazu; Matsukura, Satoshi; Kokubu, Fumio

    2014-07-01

    Pneumonia is a leading cause of death among elderly patients. Although aspiration pneumonia (AP) commonly occurs with aging, its clinical features and outcomes are still uncertain. The aims of this study were to describe the clinical features and outcomes of AP and to assess whether presence of AP affects clinical outcomes in patients with community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). We retrospectively analyzed patients with CAP and HCAP hospitalized in our institution in Japan from October 2010 to March 2012. We compared clinical features and outcomes between AP and non-AP, and investigated risk factors for recurrence of pneumonia and death. Of 214 consecutive patients, 100 (46.7%) were diagnosed as having aspiration pneumonia. These patients were older and had lower body mass index, more comorbidities, and poorer Eastern Cooperative Oncology Group performance status (ECOG PS) than the patients with non-AP. Patients with AP had more severe disease, required longer hospital stays, and had a frequent recurrence rate of pneumonia and higher mortality. In multivariate analyses, AP, age, and ECOG PS were related to recurrence of pneumonia, and the prognostic factors were CURB-65 score and ECOG PS. AP was not a significant indicator for prognosis but was the strongest risk factor for recurrence of pneumonia. Clinical background and outcomes including recurrence and mortality of AP were obviously different from those of non-AP; therefore AP should be considered as a distinct subtype of pneumonia, and it is important to prevent the recurrence of pneumonia in the patients with AP. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  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...... tolerated as NPH as regards perinatal outcomes in pregnant women with type 1 diabetes and no safety issues were identified....... from the IDet arm than the NPH arm (treatment difference: 0.49 weeks [95% CI 0.11;0.88], p = 0.012, linear regression). Sixteen children had a malformation (IDet: n = 8/142, 5.6%; NPH: n = 8/145, 5.5%). The incidence of adverse events was similar between treatments. CONCLUSION: IDet is as well...

  15. 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.

  16. Comparison of intensive care outcome prediction models based on admission scores with those based on 24-hour data.

    Science.gov (United States)

    Duke, G J; Piercy, M; DiGiantomasso, D; Green, J V

    2008-11-01

    We compared the performance of six outcome prediction models--three based on 24-hour data and three based on admission-only data--in a metropolitan university-affiliated teaching hospital with a 10-bed intensive care unit. The Acute Physiology and Chronic Health Evaluation models, version II (APACHE II) and version III-J, and the Simplified Acute Physiology Score version II (SAPS II) are based on 24-hour data and were compared with the Mortality Prediction Model version II and the SAPS version III using international and Australian coefficients (SAPS IIIA). Data were collected prospectively according to the standard methodologies for each model. Calibration and discrimination for each model were assessed by the standardised mortality ratio, area under the receiver operating characteristic plot and Hosmer-Lemeshow contingency tables and chi-squared statistics (C10 and H10). Predetermined criteria were area under the receiver operating characteristic plot > 0.8, standardised mortality ratio 95% confidence interval includes 1.0, and C10 and H10 P values >0.05. Between October 1, 2005 and December 31, 2007, 1843 consecutive admissions were screened and after the standard exclusions, 1741 were included in the analysis. The SAPS II and SAPS IIIA models fulfilled and the APACHE II model failed all criteria. The other models satisfied the discrimination criterion but significantly over-predicted mortality risk and require recalibration. Outcome prediction models based on admission-only data compared favourably to those based on 24-hour data.

  17. Minimal access surgery compared to laparotomy for secondary surgical cytoreduction in patients with recurrent ovarian carcinoma: Perioperative and oncologic outcomes.

    Science.gov (United States)

    Eriksson, Ane Gerda Z; Graul, Ashley; Yu, Miao C; Halko, Anthony; Chi, Dennis S; Zivanovic, Oliver; Gardner, Ginger J; Sonoda, Yukio; Barakat, Richard R; Abu-Rustum, Nadeem R; Leitao, Mario M

    2017-08-01

    To assess the perioperative outcomes of minimal access surgery (MAS) in secondary surgical cytoreduction (SSCR) for recurrent epithelial ovarian cancer (ROC); to compare oncologic outcomes with laparotomy (LAP). Using an institutional database, we identified all patients with ROC undergoing SSCR from 1/5/09-6/14/14. Selection for MAS or LAP was based on surgeon preference. To minimize selection bias, preoperative imaging was reviewed for all LAP cases. In this manner, we identified potential MAS candidates, who were used in the comparison. Intent-to-treat analyses were undertaken using statistical testing. 170 cases were identified (131 LAP, 8 LSC, 31 RBT). 68/131 (52%) LAP cases were deemed potential candidates for MAS. Feasibility analyses included 68 LAP and 39 MAS cases. Six (15%) MAS cases were converted to LAP. Median age, BMI, operative time did not differ significantly between the groups. Complete gross resection was achieved in 37/39 (95%) MAS, 63/68 (93%) LAP (P=1.0). Median estimated blood loss was 50cm 3 (range, 5-500) MAS, 150cm 3 (range, 0-1500) LAP (P=0.001). Median length of stay was 1day (range, 0-23) MAS, 5days (range, 1-21) LAP (P<0.001). Complications occurred in 3/39 (8%) MAS, 15/68 (22%) LAP (P=0.06). The 2-year progression-free survival was 56.1% (SE 9%) MAS, 63.5% (SE 6%) LAP (P=1.0). The 2-year overall survival was 92.2% (SE 5.4%) MAS, 81.4% (SE 5.5%) LAP (P=0.7). MAS for SSCR is feasible in properly selected cases. MAS is associated with favorable perioperative outcomes and similar oncologic outcomes, compared to LAP. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Medaka: a promising model animal for comparative population genomics

    Directory of Open Access Journals (Sweden)

    Watanabe Koji

    2009-05-01

    Full Text Available Abstract Background Within-species genome diversity has been best studied in humans. The international HapMap project has revealed a tremendous amount of single-nucleotide polymorphisms (SNPs among humans, many of which show signals of positive selection during human evolution. In most of the cases, however, functional differences between the alleles remain experimentally unverified due to the inherent difficulty of human genetic studies. It would therefore be highly useful to have a vertebrate model with the following characteristics: (1 high within-species genetic diversity, (2 a variety of gene-manipulation protocols already developed, and (3 a completely sequenced genome. Medaka (Oryzias latipes and its congeneric species, tiny fresh-water teleosts distributed broadly in East and Southeast Asia, meet these criteria. Findings Using Oryzias species from 27 local populations, we conducted a simple screening of nonsynonymous SNPs for 11 genes with apparent orthology between medaka and humans. We found medaka SNPs for which the same sites in human orthologs are known to be highly differentiated among the HapMap populations. Importantly, some of these SNPs show signals of positive selection. Conclusion These results indicate that medaka is a promising model system for comparative population genomics exploring the functional and adaptive significance of allelic differentiations.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Cognitive outcomes for congenital hypothyroid and healthy children: a comparative study.

    Science.gov (United States)

    Ordooei, Mahtab; Mottaghipisheh, Hadi; Fallah, Razieh; Rabiee, Azar

    2014-01-01

    Early diagnosis and treatment of congenital hypothyroidism (CH) and the prevention of developmental retardation is the main goal of public health national screening programs. This study compares the cognitive ability of children with CH diagnosed by neonatal screening with a healthy control group (2007) in Yazd, Iran. In a case-controlled study, the intelligent quotient (IQ) of 40 five-year-old children with early treated CH and good compliance were evaluated by the Wechsler preschool and primary scale of intelligent test and compared to 40 healthy age and gender matched children as controls. 22 boys (55%) and 18 girls (45%) in both groups were evaluated. In children with CH, 19 (47.5%) and 21 (52.5%) persons had transient and permanent hypothyroidism, respectively. Range of TSH and T4 level at the onset of diagnosis were 11.41-81 mu/l and 1.50-14.20 μg/dl, respectively. The intelligence levels of all children with CH were within the average or normal range and IQs ranged from 91-108. Children with CH had lower full-scale IQs (107.25 ± 2. 9 versus 110.50 ± 2.66, p=0.001), verbal IQ (106.95 ± 3.5 versus 109.90 ± 3.44, P-value=0.001) and performance IQ (106.3 ± 3.68 versus 108.87 ± 3.70) than the control group. However, no statistically significant differences were observed for mean IQ scores in permanent and transient CH. Children with CH who had early treatment and good compliance had normal cognitive abilities, but may have a decreased IQ relative to the healthy control group.

  2. 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.

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

    Science.gov (United States)

    Li, Baoyue; Lingsma, Hester F; Steyerberg, Ewout W; Lesaffre, Emmanuel

    2011-05-23

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

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

    Directory of Open Access Journals (Sweden)

    Steyerberg Ewout W

    2011-05-01

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

  5. 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

  6. Apnea after Awake Regional and General Anesthesia in Infants: The General Anesthesia Compared to Spinal Anesthesia 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

    2015-07-01

    Postoperative 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 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. Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) 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. RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.

  7. Comparing Pregnancy Outcomes of Immigrants from Ethiopia and the Former Soviet Union to Israel, to those of Native-Born Israelis.

    Science.gov (United States)

    Lubotzky-Gete, Shakked; Shoham-Vardi, Ilana; Sheiner, Eyal

    2017-12-01

    To compare pregnancy outcomes of immigrants from Former-Soviet-Union (FSUI) and Ethiopia (EI) to those of Jewish-native-born Israelis (JNB), in context of universal health insurance. Birth outcomes of all singletons born in Soroka-University Medical-Center (1998-2011) of EI (n = 1,667) and FSUI (n = 12,920) were compared with those of JNB (n = 63,405). Low birthweight rate was significantly higher among EI (11.0 %) and slightly lower (7.0 %) among FSUI, compared to JNB (7.5 %). Preterm-delivery rates were similar to those of JNB. Both immigrant groups had significantly (p < 0.001) higher rates of perinatal mortality (PM) than JNB (21/1000 in EI, and 11/1000 in FSUI, compared to 9/1000). Using multivariable GEE models both immigrant groups had significantly increased risk for PM; however, EI had twice as much FSUI origin (OR 2.3, 95 % CI 1.6-3.4, and OR 1.3, 95 % CI 1.1-1.6, respectively). Universal health care insurance does not eliminate excess PM in immigrants, nor the gaps between immigrant groups.

  8. Predicting outcome of Morris water maze test in vascular dementia mouse model with deep learning.

    Science.gov (United States)

    Higaki, Akinori; Mogi, Masaki; Iwanami, Jun; Min, Li-Juan; Bai, Hui-Yu; Shan, Bao-Shuai; Kukida, Masayoshi; Kan-No, Harumi; Ikeda, Shuntaro; Higaki, Jitsuo; Horiuchi, Masatsugu

    2018-01-01

    The Morris water maze test (MWM) is one of the most popular and established behavioral tests to evaluate rodents' spatial learning ability. The conventional training period is around 5 days, but there is no clear evidence or guidelines about the appropriate duration. In many cases, the final outcome of the MWM seems predicable from previous data and their trend. So, we assumed that if we can predict the final result with high accuracy, the experimental period could be shortened and the burden on testers reduced. An artificial neural network (ANN) is a useful modeling method for datasets that enables us to obtain an accurate mathematical model. Therefore, we constructed an ANN system to estimate the final outcome in MWM from the previously obtained 4 days of data in both normal mice and vascular dementia model mice. Ten-week-old male C57B1/6 mice (wild type, WT) were subjected to bilateral common carotid artery stenosis (WT-BCAS) or sham-operation (WT-sham). At 6 weeks after surgery, we evaluated their cognitive function with MWM. Mean escape latency was significantly longer in WT-BCAS than in WT-sham. All data were collected and used as training data and test data for the ANN system. We defined a multiple layer perceptron (MLP) as a prediction model using an open source framework for deep learning, Chainer. After a certain number of updates, we compared the predicted values and actual measured values with test data. A significant correlation coefficient was derived form the updated ANN model in both WT-sham and WT-BCAS. Next, we analyzed the predictive capability of human testers with the same datasets. There was no significant difference in the prediction accuracy between human testers and ANN models in both WT-sham and WT-BCAS. In conclusion, deep learning method with ANN could predict the final outcome in MWM from 4 days of data with high predictive accuracy in a vascular dementia model.

  9. Predicting outcome of Morris water maze test in vascular dementia mouse model with deep learning.

    Directory of Open Access Journals (Sweden)

    Akinori Higaki

    Full Text Available The Morris water maze test (MWM is one of the most popular and established behavioral tests to evaluate rodents' spatial learning ability. The conventional training period is around 5 days, but there is no clear evidence or guidelines about the appropriate duration. In many cases, the final outcome of the MWM seems predicable from previous data and their trend. So, we assumed that if we can predict the final result with high accuracy, the experimental period could be shortened and the burden on testers reduced. An artificial neural network (ANN is a useful modeling method for datasets that enables us to obtain an accurate mathematical model. Therefore, we constructed an ANN system to estimate the final outcome in MWM from the previously obtained 4 days of data in both normal mice and vascular dementia model mice. Ten-week-old male C57B1/6 mice (wild type, WT were subjected to bilateral common carotid artery stenosis (WT-BCAS or sham-operation (WT-sham. At 6 weeks after surgery, we evaluated their cognitive function with MWM. Mean escape latency was significantly longer in WT-BCAS than in WT-sham. All data were collected and used as training data and test data for the ANN system. We defined a multiple layer perceptron (MLP as a prediction model using an open source framework for deep learning, Chainer. After a certain number of updates, we compared the predicted values and actual measured values with test data. A significant correlation coefficient was derived form the updated ANN model in both WT-sham and WT-BCAS. Next, we analyzed the predictive capability of human testers with the same datasets. There was no significant difference in the prediction accuracy between human testers and ANN models in both WT-sham and WT-BCAS. In conclusion, deep learning method with ANN could predict the final outcome in MWM from 4 days of data with high predictive accuracy in a vascular dementia model.

  10. Interpreting Hierarchical Linear and Hierarchical Generalized Linear Models with Slopes as Outcomes

    Science.gov (United States)

    Tate, Richard

    2004-01-01

    Current descriptions of results from hierarchical linear models (HLM) and hierarchical generalized linear models (HGLM), usually based only on interpretations of individual model parameters, are incomplete in the presence of statistically significant and practically important "slopes as outcomes" terms in the models. For complete description of…

  11. 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…

  12. Physical Training Outcome Predictions With Biomechanics, Part I: Army Physical Fitness Test Modeling.

    Science.gov (United States)

    Sih, Bryant L; Negus, Charles H

    2016-05-01

    The U.S. Army Basic Combat Training (BCT) is the first step in preparing soldier trainees for the physical demands of the military. Unfortunately, a substantial number of trainees fail BCT due to failure on the final Army Physical Fitness Test (also known as the "end of cycle" APFT). Current epidemiological studies have used statistics to identify several risk factors for poor APFT performance, but these studies have had limited utility for guiding regimen design to maximize APFT outcome. This is because such studies focus on intrinsic risks to APFT failure and do not utilize detailed BCT activity data to build models which offer guidance for optimizing the training regimen to improve graduation rates. In this study, a phenomenological run performance model that accounts for physiological changes in fitness and fatigue due to training was applied to recruits undergoing U.S. Army BCT using high resolution (minute-by-minute) activity data. The phenomenological model was better at predicting both the final as well as intermediate APFTs (R(2) range = 0.55-0.59) compared to linear regression models (LRMs) that used the same intrinsic input variables (R(2) range = 0.36-0.50). Unlike a statistical approach, a phenomenological model accounts for physiological changes and, therefore, has the potential to not only identify trainees at risk of failing BCT on novel training regimens, but offer guidance to regimen planners on how to change the regimen for maximizing physical performance. This paper is Part I of a 2-part series on physical training outcome predictions. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  13. A comparison of adult outcomes for males compared to females following pediatric traumatic brain injury.

    Science.gov (United States)

    Scott, Charis; McKinlay, Audrey; McLellan, Tracey; Britt, Eileen; Grace, Randolph; MacFarlane, Martin

    2015-07-01

    To identify the association between traumatic brain injury (TBI) and internalizing and externalizing problem behaviors and determine if these apply equally to males and females. The association between adult psychosocial functioning and childhood TBI for males and females was examined using groups with a history of childhood TBI (mild or moderate/severe) or orthopedic injury (injury age, 1-17, assessed 18-31 at >5 years postinjury), including rates of depression and anxiety disorders, substance abuse/dependence and offending behavior. Repeated-measures logistic regression was used to determine if the rates of internalizing and externalizing problem behaviors varied by group and sex. Overall rates of problem behaviors were significantly greater for both moderate/severe TBI (OR = 4.00) and mild TBI (OR = 3.60) groups compared with orthopedic controls. Females were significantly more likely than males to report a history of internalizing problems (OR = 2.22), whereas males were more likely than females to report externalizing problems (OR = 2.10). The sex difference in internalizing/externalizing problems was found consistently across TBI groups and controls. Childhood TBI is associated with psychosocial problems in adulthood, regardless of injury severity. How deficits are expressed differs between the sexes, with important implications for interventions strategies. (c) 2015 APA, all rights reserved).

  14. 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.

  15. 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.

  16. A comparative study of complications and outcomes associated with radical retropubic prostatectomy and robot assisted radical prostatectomy

    Science.gov (United States)

    Gettman, Matthew T.

    2008-02-01

    Purpose: To evaluate outcomes among a matched cohort of prostate cancer patients treated with radical retropubic prostatectomy (RRP) and robot assisted radical prostatectomy (RARP). Materials and methods: Between 2002 and 2005, 294 patients underwent RARP at our institution. Comparison RRP patients were matched 2:1 for surgical year, age, PSA, clinical stage, and biopsy grade (n=588). Outcomes among groups were compared. From an oncologic standpoint, pathologic features among groups were assessed and Kaplan-Meier estimates of PSA recurrence free survival were compared. Results: Overall margin positivity was not significantly different between groups (RARP, 15.6%, RRP, 17%), yet risk of apical margin was significantly less with RARP. RARP was associated with significantly shorter hospitalization (ptransfusion (p group (16% vs 10%, pgroup (6.6% pgroups was equivalent (p=0.15). Potency at 1 year was better among RARP patients (p=0.02). At a median followup of 1.3 years, PSA recurrence free estimates were not significantly different (92% vs 92%, p=0.69). Conclusions: Early complications were higher in this RARP group, but this experience includes cases performed in the learning curve. Oncologic, quality of life, and functional data in this study revealed encouraging results for RARP when compared to RRP.

  17. 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.

  18. 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.

  19. 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

  20. Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: A parallel comparative trial.

    Science.gov (United States)

    Tan, Hung-Jui; Xiong, Siwei; Laviana, Aaron A; Chuang, Ryan J; Treat, Eric; Walsh, Patrick C; Hu, Jim C

    2016-12-01

    Postprostatectomy incontinence significantly impairs quality of life. Although bladder neck intussusception has been reported to accelerate urinary recovery after open radical retropubic prostatectomy, its adaption to robotic surgery has not been assessed. Accordingly, we describe our technique and compare outcomes between men treated with and without bladder neck intussusception during robot-assisted laparoscopic prostatectomy. We performed a comparative trial of 48 men undergoing robot-assisted laparoscopic prostatectomy alternating between bladder neck intussusception (n = 24) and nonintussusception (n = 24). Intussusception was completed using 3-0 polyglycolic acid horizontal mattress sutures anterior and posterior to the bladder neck. We assessed baseline characteristics and clinicopathologic outcomes. Adjusting for age, body mass index, race, and D׳Amico risk classification, we prospectively compared urinary function at 2 days, 2 weeks, 2 months, and last follow-up using the urinary domain of the Expanded Prostate Cancer Index-Short Form. Baseline patient characteristics and clinicopathologic outcomes were similar between treatment groups (P>0.05). Median catheter duration (8 vs. 8d, P = 0.125) and rates of major postoperative complications (4.2% vs. 4.2%, P = 1.000) did not differ. In adjusted analyses, Expanded Prostate Cancer Index-Short Form urinary scores were significantly higher for the intussusception arm at 2 weeks (65.4 vs. 46.6, P = 0.019) before converging at 2 months (69.1 vs. 68.3, P = 0.929) after catheter removal and at last follow-up (median = 7mo, 80.5 vs. 77.0; P = 0.665). Bladder neck intussusception during robot-assisted laparoscopic prostatectomy is feasible and safe. Although the long-term effects appear limited, intussusception may improve urinary function during the early recovery period. Copyright © 2016. Published by Elsevier Inc.

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

    African Journals Online (AJOL)

    (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 cowpea yield-water use and weather data were collected.

  3. In vivo outcome study of BPD-mediated PDT using a macroscopic singlet oxygen model

    Science.gov (United States)

    Kim, Michele M.; Penjweini, Rozhin; Zhu, Timothy C.

    2015-03-01

    Macroscopic modeling of the apparent reacted singlet oxygen concentration ([1O2]rx) for use with photodynamic therapy (PDT) has been developed and studied for benzoporphryin derivative monoacid ring A (BPD), a common photosensitizer. The four photophysical parameters (ξ, σ, β, δ) and threshold singlet oxygen dose ([1O2]rx, sh) have been investigated and determined using the RIF model of murine fibrosarcomas and interstitial treatment delivery. These parameters are examined and verified further by monitoring tumor growth post-PDT. BPD was administered at 1 mg/kg, and mice were treated 3 hours later with fluence rates ranging between 75 - 150 mW/cm2 and total fluences of 100 - 350 J/cm2. Treatment was delivered superficially using a collimated beam. Changes in tumor volume were tracked following treatment. The tumor growth rate was fitted for each treatment condition group and compared using dose metrics including total light dose, PDT dose, and reacted singlet oxygen. Initial data showing the correlation between outcomes and various dose metrics indicate that reacted singlet oxygen serves as a good dosimetric quantity for predicting PDT outcome.

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Hassan Al-Husban

    2013-01-01

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

  6. 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

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

    Directory of Open Access Journals (Sweden)

    Pilotto Susann

    2009-05-01

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

  8. An interface finite element model can be used to predict healing outcome of bone fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; García-Aznar, J M

    2014-01-01

    After fractures, bone can experience different potential outcomes: successful bone consolidation, non-union and bone failure. Although, there are a lot of factors that influence fracture healing, experimental studies have shown that the interfragmentary movement (IFM) is one of the main regulators for the course of bone healing. In this sense, computational models may help to improve the development of mechanical-based treatments for bone fracture healing. Hence, based on this fact, we propose a combined repair-failure mechanistic computational model to describe bone fracture healing. Despite being a simple model, it is able to correctly estimate the time course evolution of the IFM compared to in vivo measurements under different mechanical conditions. Therefore, this mathematical approach is especially suitable for modeling the healing response of bone to fractures treated with different mechanical fixators, simulating realistic clinical conditions. This model will be a useful tool to identify factors and define targets for patient specific therapeutics interventions. © 2013 Published by Elsevier Ltd.

  9. Is after-hours orthopaedic surgery associated with adverse outcomes? A prospective comparative study.

    Science.gov (United States)

    Ricci, William M; Gallagher, Bethany; Brandt, Angel; Schwappach, John; Tucker, Michael; Leighton, Ross

    2009-09-01

    Treatment of fractures is sometimes performed after normal daytime operating hours and in such instances may be performed under less than ideal conditions. The consequence of performing operations under such conditions is largely unknown and was therefore studied in the context of intramedullary nail fixation of tibial and femoral shaft fractures. Two hundred and three consecutive patients with either a femoral or tibial shaft fracture (Orthopaedic Trauma Association classification 32 or 42) treated with intramedullary nail fixation were included in a prospective, multicenter, nonrandomized study. Patients were divided into an after-hours group defined as an operation beginning from 4:00 P.M. to 6:00 A.M. or a daytime group defined as an operation beginning from 6:00 A.M. to 4:00 P.M. These groups were further divided on the basis of the injured bone into the following subgroups: after-hours femoral fracture (fifty-five patients), daytime femoral fracture (forty-four patients), after-hours tibial fracture (forty-eight patients), and daytime tibial fracture (fifty-six patients). The demographic and fracture characteristics were similar among the subgroups. All patients were treated with the same type of femoral antegrade, femoral retrograde, or tibial nail fixation with reaming. Data for fracture-healing, complications, operative time, and fluoroscopy time were collected prospectively. The healing rates were similar between daytime and after-hours surgery groups for both the tibial and femoral nailing. On the basis of univariate analysis, operative times were shorter in the after-hours group compared with the daytime group for both the tibial and femoral nail fixation groups (p tibial and femoral nail fixation (p > 0.05). The after-hours group had more unplanned reoperations than the daytime group (p fracture group (27%) than in the daytime femoral fracture group (3%) (p fracture hardware (p intramedullary nail fixation of both femoral and tibial fractures. After

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

    Science.gov (United States)

    Benjamins, Maureen R

    2013-10-01

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

  11. Comparing interval estimates for small sample ordinal CFA models.

    Science.gov (United States)

    Natesan, Prathiba

    2015-01-01

    Robust maximum likelihood (RML) and asymptotically generalized least squares (AGLS) methods have been recommended for fitting ordinal structural equation models. Studies show that some of these methods underestimate standard errors. However, these studies have not investigated the coverage and bias of interval estimates. An estimate with a reasonable standard error could still be severely biased. This can only be known by systematically investigating the interval estimates. The present study compares Bayesian, RML, and AGLS interval estimates of factor correlations in ordinal confirmatory factor analysis models (CFA) for small sample data. Six sample sizes, 3 factor correlations, and 2 factor score distributions (multivariate normal and multivariate mildly skewed) were studied. Two Bayesian prior specifications, informative and relatively less informative were studied. Undercoverage of confidence intervals and underestimation of standard errors was common in non-Bayesian methods. Underestimated standard errors may lead to inflated Type-I error rates. Non-Bayesian intervals were more positive biased than negatively biased, that is, most intervals that did not contain the true value were greater than the true value. Some non-Bayesian methods had non-converging and inadmissible solutions for small samples and non-normal data. Bayesian empirical standard error estimates for informative and relatively less informative priors were closer to the average standard errors of the estimates. The coverage of Bayesian credibility intervals was closer to what was expected with overcoverage in a few cases. Although some Bayesian credibility intervals were wider, they reflected the nature of statistical uncertainty that comes with the data (e.g., small sample). Bayesian point estimates were also more accurate than non-Bayesian estimates. The results illustrate the importance of analyzing coverage and bias of interval estimates, and how ignoring interval estimates can be misleading

  12. 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

  13. 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

  14. [Model for the systematic classification of outcomes in health promotion and prevention].

    Science.gov (United States)

    Cloetta, Bernhard; Spencer, Brenda; Spörri, Adrian; Ruckstuhl, Brigitte; Broesskamp-Stone, Ursel; Ackermann, Günter

    2005-01-01

    Successful demonstration of the effects of health promotion calls for systematic documentation and comparison of the outcome of different measures and projects. A model has been developed in the form of an outcome categorisation system for this purpose and is presented here. The model includes four categories covering the intermediate outcomes of health promotion measures, and three categories for outcomes at the level of health determinants (conditions necessary for health). Each category includes three to four sub-categories, for which examples of possible indicators are presented. The model can be applied both in the planning and in the evaluation stage of a project. This makes it possible for health promotion agencies and institutions responsible for funding and promotion to obtain a general overview of the outcome of their work.

  15. Bayesian semiparametric regression models for evaluating pathway effects on continuous and binary clinical outcomes

    Science.gov (United States)

    Kim, Inyoung; Pang, Herbert; Zhao, Hongyu

    2013-01-01

    Many statistical methods for microarray data analysis consider one gene at a time, and they may miss subtle changes at the single gene level. This limitation may be overcome by considering a set of genes simultaneously where the gene sets are derived from prior biological knowledge. Limited work has been carried out in the regression setting to study the effects of clinical covariates and expression levels of genes in a pathway either on a continuous or on a binary clinical outcome. Hence, we propose a Bayesian approach for identifying pathways related to both types of outcomes. We compare our Bayesian approaches with a likelihood-based approach that was developed by relating a least squares kernel machine for nonparametric pathway effect with a restricted maximum likelihood for variance components. Unlike the likelihood-based approach, the Bayesian approach allows us to directly estimate all parameters and pathway effects. It can incorporate prior knowledge into Bayesian hierarchical model formulation and makes inference by using the posterior samples without asymptotic theory. We consider several kernels (Gaussian, polynomial, and neural network kernels) to characterize gene expression effects in a pathway on clinical outcomes. Our simulation results suggest that the Bayesian approach has more accurate coverage probability than the likelihood-based approach, and this is especially so when the sample size is small compared with the number of genes being studied in a pathway. We demonstrate the usefulness of our approaches through its applications to a type II diabetes mellitus data set. Our approaches can also be applied to other settings where a large number of strongly correlated predictors are present. PMID:22438129

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

    Directory of Open Access Journals (Sweden)

    Sherif F. Elmekkawi

    2015-01-01

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

  17. 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

  18. 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.

  19. `Dem DEMs: Comparing Methods of Digital Elevation Model Creation

    Science.gov (United States)

    Rezza, C.; Phillips, C. B.; Cable, M. L.

    2017-12-01

    Topographic details of Europa's surface yield implications for large-scale processes that occur on the moon, including surface strength, modification, composition, and formation mechanisms for geologic features. In addition, small scale details presented from this data are imperative for future exploration of Europa's surface, such as by a potential Europa Lander mission. A comparison of different methods of Digital Elevation Model (DEM) creation and variations between them can help us quantify the relative accuracy of each model and improve our understanding of Europa's surface. In this work, we used data provided by Phillips et al. (2013, AGU Fall meeting, abs. P34A-1846) and Schenk and Nimmo (2017, in prep.) to compare DEMs that were created using Ames Stereo Pipeline (ASP), SOCET SET, and Paul Schenk's own method. We began by locating areas of the surface with multiple overlapping DEMs, and our initial comparisons were performed near the craters Manannan, Pwyll, and Cilix. For each region, we used ArcGIS to draw profile lines across matching features to determine elevation. Some of the DEMs had vertical or skewed offsets, and thus had to be corrected. The vertical corrections were applied by adding or subtracting the global minimum of the data set to create a common zero-point. The skewed data sets were corrected by rotating the plot so that it had a global slope of zero and then subtracting for a zero-point vertical offset. Once corrections were made, we plotted the three methods on one graph for each profile of each region. Upon analysis, we found relatively good feature correlation between the three methods. The smoothness of a DEM depends on both the input set of images and the stereo processing methods used. In our comparison, the DEMs produced by SOCET SET were less smoothed than those from ASP or Schenk. Height comparisons show that ASP and Schenk's model appear similar, alternating in maximum height. SOCET SET has more topographic variability due to its

  20. 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.

  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. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

  4. 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.

  5. Inter-Facility Transport on Extracorporeal Life Support: Clinical Outcomes and Comparative Analysis with In-house Patients.

    Science.gov (United States)

    Hong, Tae Hee; Lee, Heemoon; Jung, Jae Jun; Cho, Yang Hyun; Sung, Kiick; Yang, Ji-Hyuk; Lee, Young-Tak; Cho, Su Hyun

    2017-10-01

    Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients. We also analyzed the risk factors for hospital mortality in the entire ECLS population using univariate and multivariate analyses to investigate the effects of transport. All 44 patients were safely transported without adverse events. The average travel distance was 178.7 km, with an average travel time of 74.0 minutes. Early survival of the transported group seemed to be better than that of the in-house group, but the difference was not statistically significant (70.5% vs. 56.6%, p=0.096). The incidence of complications was similar between the 2 groups, except for critical limb ischemia, which was significantly more common in the transported group than in the in-house group (25.0% vs. 8.1%, p=0.017). After adjusting for confounders, being part of the transported group was not a predictor of early death (adjusted odds ratio, 0.689; p=0.397). Transportation of patients on ECLS is relatively safe, and the clinical outcomes of transported patients are comparable to those of in-house ECLS patients. Although matched studies are required, our study demonstrates that transporting patients on ECLS did not increase their risk of hospital mortality after adjustment for other factors.

  6. Correlation between DNA ploidy, metaphase high-resolution comparative genomic hybridization results and clinical outcome of synovial sarcoma

    Directory of Open Access Journals (Sweden)

    Papp Gergő

    2011-11-01

    Full Text Available Abstract Background Although synovial sarcoma is the 3rd most commonly occurring mesenchymal tumor in young adults, usually with a highly aggressive clinical course; remarkable differences can be seen regarding the clinical outcome. According to comparative genomic hybridization (CGH data published in the literature, the simple and complex karyotypes show a correlation between the prognosis and clinical outcome. In addition, the connection between DNA ploidy and clinical course is controversial. The aim of this study was using a fine-tuning interpretation of our DNA ploidy results and to compare these with metaphase high-resolution CGH (HR-CGH results. Methods DNA ploidy was determined on Feulgen-stained smears in 56 synovial sarcoma cases by image cytometry; follow up was available in 46 cases (average: 78 months. In 9 cases HR-CGH analysis was also available. Results 10 cases were found DNA-aneuploid, 46 were DNA-diploid by image cytometry. With fine-tuning of the diploid cases according to the 5c exceeding events (single cell aneuploidy, 33 cases were so called "simple-diploid" (without 5c exceeding events and 13 cases were "complex-diploid"; containing 5c exceeding events (any number. Aneuploid tumors contained large numbers of genetic alterations with the sum gain of at least 2 chromosomes (A-, B- or C-group detected by HR-CGH. In the "simple-diploid" cases no or few genetic alterations could be detected, whereas the "complex-diploid" samples numerous aberrations (equal or more than 3 could be found. Conclusions Our results show a correlation between the DNA-ploidy, a fine-tuned DNA-ploidy and the HR-CGH results. Furthermore, we found significant correlation between the different ploidy groups and the clinical outcome (p

  7. Neural Correlates of Outcome of the Psychotherapy Compared to Antidepressant Therapy in Anxiety and Depression Disorders: A Meta-Analysis.

    Science.gov (United States)

    Kalsi, Navkiran; Altavilla, Daniela; Tambelli, Renata; Aceto, Paola; Trentini, Cristina; Di Giorgio, Chiara; Lai, Carlo

    2017-01-01

    The most prevalent mental disorders, anxiety and depression, are commonly associated with structural and functional changes in the fronto-limbic brain areas. The clinical trials investigating patients with affective disorders showed different outcome to different treatments such as psychotherapy or pharmacotherapy. It is, however, still unexplored how these interventions approach affect the functional brain. This meta-analysis aims to compare the effects of psychotherapy compared to antidepressant therapy on functional brain activity in anxiety and depression disorders. Twenty-one samples with psychotherapy and seventeen samples with antidepressant therapy were included. The main finding showed an inverse effect of the two treatments on the right paracingulate activity. The patients undergoing psychotherapy showed an increase in the right paracingulate activity while pharmacological treatment led to a decrease of activation of this area. This finding seems to support the recent studies that hypothesize how psychotherapy, through the self-knowledge and the meaning processing, involves a top-down emotional regulation.

  8. Improving pregnancy outcome during imprisonment: a model residential care program.

    Science.gov (United States)

    Siefert, K; Pimlott, S

    2001-04-01

    The female prison population has increased dramatically in recent years. Most women prisoners are involved with drugs, and as many as 25 percent are pregnant or have delivered within the past year. Reproductive health and drug treatment services for women in prison are inadequate, if they are available at all, and although illicit drugs are readily available in prison, drug-involved pregnant women often are incarcerated to protect fetal health. Studies of pregnancy outcome among women prisoners have demonstrated high rates of perinatal mortality and morbidity. This article examines issues related to pregnancy among women prisoners and describes an innovative residential program designed for pregnant, drug-dependent women in a state adult corrections system. Social workers can play an important role in promoting policy reform and improved services for this underserved population.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system.

    Science.gov (United States)

    Djeu, Garret; Shelton, Clarence; Maganzini, Anthony

    2005-09-01

    This treatment-outcome assessment objectively compares Invisalign (Align Technology, Santa Clara, Calif) treatment with braces. This study, a retrospective cohort analysis, was conducted in New York, NY, in 2004. Records from 2 groups of 48 patients (Invisalign and braces groups) were evaluated by using methods from the American Board of Orthodontics Phase III examination. The discrepancy index was used to analyze pretreatment records to control for initial severity of malocclusion. The objective grading system (OGS) was used to systematically grade posttreatment records. Statistical analyses evaluated treatment outcome, duration, and strengths and weaknesses of Invisalign compared with braces. The Invisalign group lost 13 OGS points more than the braces group on average, and the OGS passing rate for Invisalign was 27% lower than that for braces. Invisalign scores were consistently lower than braces scores for buccolingual inclination, occlusal contacts, occlusal relationships, and overjet. Invisalign's OGS scores were negatively correlated to initial overjet, occlusion, and buccal posterior crossibite. Invisalign patients finished 4 months sooner than those with fixed appliances on average. P Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights. This study might help clinicians to determine which patients are best suited for Invisalign treatment.

  14. Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology.

    Science.gov (United States)

    Zaheer, Salman; Pimentel, Samuel D; Simmons, Kristina D; Kuo, Lindsay E; Datta, Jashodeep; Williams, Noel; Fraker, Douglas L; Kelz, Rachel R

    2017-05-01

    The aim of this study is to compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). IMGs represent 15% of practicing surgeons in the United States (US), and their training pathways often differ substantially from USMGs. To date, differences in the clinical outcomes between the 2 cohorts have not been examined. Using a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and New York (2008-2011), patients who underwent 1 of 32 general surgical operations were stratified by IMG and USMG surgeon status. Mortality, complications, and prolonged length of stay were compared between IMG and USMG surgeon status using optimal sparse network matching with balance. We identified 972,718 operations performed by 4581 surgeons (72% USMG, 28% IMG). IMG and USMG surgeons differed significantly in demographic (age, gender) and baseline training (years of training, university affiliation of training hospital) characteristics. USMG surgeons performed complex procedures (13.7% vs 11.1%, P educational background, surgical training characteristics, and practice patterns, IMG and USMG-surgeons deliver equivalent surgical care to the patients whom they treat.

  15. 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.

  16. 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

  17. 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

  18. Predicting the fate of biodiversity using species' distribution models: enhancing model comparability and repeatability.

    Directory of Open Access Journals (Sweden)

    Genoveva Rodríguez-Castañeda

    Full Text Available Species distribution modeling (SDM is an increasingly important tool to predict the geographic distribution of species. Even though many problems associated with this method have been highlighted and solutions have been proposed, little has been done to increase comparability among studies. We reviewed recent publications applying SDMs and found that seventy nine percent failed to report methods that ensure comparability among studies, such as disclosing the maximum probability range produced by the models and reporting on the number of species occurrences used. We modeled six species of Falco from northern Europe and demonstrate that model results are altered by (1 spatial bias in species' occurrence data, (2 differences in the geographic extent of the environmental data, and (3 the effects of transformation of model output to presence/absence data when applying thresholds. Depending on the modeling decisions, forecasts of the future geographic distribution of Falco ranged from range contraction in 80% of the species to no net loss in any species, with the best model predicting no net loss of habitat in Northern Europe. The fact that predictions of range changes in response to climate change in published studies may be influenced by decisions in the modeling process seriously hampers the possibility of making sound management recommendations. Thus, each of the decisions made in generating SDMs should be reported and evaluated to ensure conclusions and policies are based on the biology and ecology of the species being modeled.

  19. A Comparative Metroscope Model for Urban Information Flows

    Science.gov (United States)

    Fink, J. H.; Shandas, V.; Beaudoin, F.

    2011-12-01

    One of the most promising ways to achieve global sustainability goals of climate stabilization, poverty reduction, and biodiversity preservation is to make the world's cities more efficient, equitable, and healthful. While each city must follow a unique and somewhat idiosyncratic path toward these linked goals based on its history, geography, demography, and politics, movement in this direction can accelerate if cities can learn from each other more effectively. Such learning requires the identification of common characteristics and methodologies. We have created a framework for organizing and applying urban information flows, which we refer to as "Metroscopes." Metroscopes, which are analogous to the large instruments that have advanced the physical and life sciences, integrate six elements: data collection and input; classification through the use of metrics; data storage and retrieval; analytics and modeling; decision support including visualization and scenario generation; and assessment of the effectiveness of policy choices. Standards for each of these elements can be agreed upon by relevant urban science and policy sub-communities, and then can evolve as technologies and practices advance. We are implementing and calibrating this approach using data and relationships from Portland (OR), Phoenix (AZ) and London (UK). Elements that are being integrated include the Global City Indicators Facility at University of Toronto, the J-Earth database system and Decision Theater from Arizona State University, urban mobility analyses performed by the SENSEable City Lab at MIT, and Portland's Ecodistrict approach for urban management. Individual Metroscopes can be compared directly from one city to another, or with larger assemblages of cities like those being classified by ICLEI's STAR program, the Clinton Climate Initiative's C40, and Siemens Green Cities Index. This large-scale integration of urban data sets and approaches and its systematic comparison are key steps

  20. [External quality assurance in inpatient medical rehabilitation and prevention centers for mothers, fathers and children: comparative outcome quality analyses across rehabilitation/prevention centers].

    Science.gov (United States)

    Lukasczik, M; Gerlich, C; Musekamp, G; Saupe-Heide, M; Löbmann, R; Vogel, H; Neuderth, S

    2014-01-01

    To date, there are no programs for external quality assurance for inpatient prevention and rehabilitation programs for mothers, fathers and children. Instruments for outcome quality assessment were evaluated with the goal of determining their ability to document differences between prevention/rehabilitation centers in quality-relevant outcome parameters. Referring to the ICF, relevant outcome variables were specified and operationalized using established questionnaires. Data from 45 inpatient prevention and rehabilitation centers for mothers, fathers and children were analyzed using multilevel modeling with risk adjustment. Intra-class correlations were computed to determine in which parameters differences between institutions could be found. The percentage of variability accounted for by patient vs. institution characteristics was computed while statistically controlling for relevant confounders. For prevention centers, substantial variation on the institutional level was found in 9 out of 15 parameters. Almost all institutions did not deviate significantly from the grand mean of the respective parameter. For rehabilitation centers, significant variability was found in 2 out of 10 parameters. The differences between most institutions remained within a range of expectable variability. The results imply that comparative analyses across hospitals are better suited to identify institutions with low quality rather than establish quality-based rankings of institutions. © Georg Thieme Verlag KG Stuttgart · New York.

  1. 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.

  2. 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

  3. 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.

  4. Continuity of Care and Outcomes in Residential Care: A Comparison of Two Care Giving Models

    Science.gov (United States)

    Jones, Loring

    2006-01-01

    This study examined differences in two residential care giving models (houseparent vs. child care worker) in providing continuity of care for youth in residential placement, and the effect that a care giving model had on selected program outcomes. Data for this research were collected in a residential facility that used both models. Youth with…

  5. 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

  6. 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

  7. [Application of statistical models for prognostication of outcomes in injured persons with severe trauma].

    Science.gov (United States)

    Boĭko, V V; Zamiatin, P N; Dubrovina, N A; Zamiatin, D P

    2014-02-01

    Basing on data, concerning the injured persons state, the investigations results for elaboration and application of statistic models, prognosticating the trauma outcome, were analyzed. Selected information about 373 injured persons, who were treated in Traumatic Shock Department, is presented. There was established, that the statistical models elaborated is expedient to use together with other qualitative and quantitative methods of prognostic determination of outcome in severely injured persons.

  8. 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....

  9. Maternal depressive symptoms, maternal behavior, and toddler internalizing outcomes: a moderated mediation model.

    Science.gov (United States)

    Hummel, Alexandra C; Kiel, Elizabeth J

    2015-02-01

    Maternal depression relates to child internalizing outcomes, but one missing aspect of this association is how variation in depressive symptoms, including mild and moderate symptoms, relates to young children's outcomes. The current study examined a moderated mediation model to investigate how maternal behaviors may mediate this association in the context of child temperament and gender. Mothers and toddlers completed a free-play/clean-up task in the laboratory. Mothers rated their depressive symptoms and their toddlers' temperament and internalizing behaviors. Results indicated a significant indirect effect of maternal warmth on the relation between maternal depressive symptoms and toddler internalizing outcomes for boys with low negative emotionality. Toddler gender and temperament moderated the relation between maternal intrusiveness and toddler internalizing outcomes, but mediation was not supported. Results highlight the important interaction between child and maternal variables in predicting child outcomes, and suggest mechanisms by and conditions under which mild maternal depressive symptomatology can be a risk factor for toddler internalizing outcomes.

  10. A comparative analysis of pricing models for enterprise cloud platforms

    CSIR Research Space (South Africa)

    Mvelase, P

    2013-09-01

    Full Text Available virtual enterprise (VE)-enabled cloud enterprise architecture for small medium and micro enterprises (SMMEs) against EC2 pricing model to prove that our pricing model is more suitable for small medium and micro enterprises (SMMEs). This model is based...

  11. Assessment of Bactericidal Drug Activity and Treatment Outcome in a Mouse Tuberculosis Model Using a Clinical Beijing Strain.

    Science.gov (United States)

    Mourik, Bas C; de Knegt, Gerjo J; Verbon, Annelies; Mouton, Johan W; Bax, Hannelore I; de Steenwinkel, Jurriaan E M

    2017-10-01

    Mycobacterium tuberculosis Beijing strains are associated with lower treatment success rates in tuberculosis (TB) patients. In contrast, laboratory strains such as H37Rv are often used in preclinical tuberculosis models. Therefore, we explored the impact of using a clinical Beijing strain on treatment outcome in our mouse tuberculosis model. Additionally, the predictive value of bactericidal activity on treatment outcome was assessed. BALB/c mice were infected with a Beijing strain and treated with one of 10 different combinations of conventional anti-TB drugs. Bactericidal activity was assessed by determining reductions in mycobacterial load after 7, 14, and 28 days and after 2, 3, and 6 months of treatment. Treatment outcome was evaluated after a 6-month treatment course and was based on lung culture status 3 months posttreatment. None of the anti-TB drug regimens tested could achieve 100% treatment success. Treatment outcome depended critically on rifampin. Four non-rifampin-containing regimens showed 0% treatment success compared to success rates between 81 and 95% for six rifampin-containing regimens. Bactericidal activity was predictive only for treatment outcome after 3 months of treatment. Our data advocate the use of multiple mycobacterial strains, including a Beijing strain, to increase the translational value of mouse TB models evaluating treatment outcome. Additionally, our findings support the notion that bactericidal activity in the first 2 months of treatment, as measured in clinical phase IIa/b trials, has limited predictive value for tuberculosis treatment outcome, thus emphasizing the need for better parameters to guide future phase IIII trials. Copyright © 2017 American Society for Microbiology.

  12. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland.

    Science.gov (United States)

    Sahanne, Sari; Tuuminen, Raimo; Haukka, Jari; Loukovaara, Sirpa

    2017-01-01

    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.

  13. 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, ...

  14. 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.

  15. Comparative performance of high-fidelity training models for flexible ureteroscopy: Are all models effective?

    Directory of Open Access Journals (Sweden)

    Shashikant Mishra

    2011-01-01

    Full Text Available Objective: We performed a comparative study of high-fidelity training models for flexible ureteroscopy (URS. Our objective was to determine whether high-fidelity non-virtual reality (VR models are as effective as the VR model in teaching flexible URS skills. Materials and Methods: Twenty-one trained urologists without clinical experience of flexible URS underwent dry lab simulation practice. After a warm-up period of 2 h, tasks were performed on a high-fidelity non-VR (Uro-scopic Trainer TM ; Endo-Urologie-Modell TM and a high-fidelity VR model (URO Mentor TM . The participants were divided equally into three batches with rotation on each of the three stations for 30 min. Performance of the trainees was evaluated by an expert ureteroscopist using pass rating and global rating score (GRS. The participants rated a face validity questionnaire at the end of each session. Results: The GRS improved statistically at evaluation performed after second rotation (P<0.001 for batches 1, 2 and 3. Pass ratings also improved significantly for all training models when the third and first rotations were compared (P<0.05. The batch that was trained on the VR-based model had more improvement on pass ratings on second rotation but could not achieve statistical significance. Most of the realistic domains were higher for a VR model as compared with the non-VR model, except the realism of the flexible endoscope. Conclusions: All the models used for training flexible URS were effective in increasing the GRS and pass ratings irrespective of the VR status.

  16. Comparing Outcomes 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.

  17. Phacoemulsification outcomes in Boston terriers as compared to non-Boston terriers: a retrospective study (2002-2015).

    Science.gov (United States)

    Newbold, Georgina M; Kelch, William J; Chen, Thomas; Ward, Daniel A; Hendrix, Diane V H

    2018-01-30

    To compare visual outcome and cause of blindness between two groups of dogs undergoing phacoemulsification. Study population consisted of 35 Boston terriers (BT; 70 eyes) and 77 non-Boston terriers (NBT; 154 eyes) that underwent bilateral phacoemulsification surgery. Medical records were reviewed to determine visual outcome, complications leading to blindness and follow-up. A Kaplan-Meier survival curve was used to estimate surgical success at 1 and 2 years postoperatively. Eleven of 35 BT developed known vision loss, with 12 of 70 (17.1%) eyes becoming blind within one year of surgery, and 17 of 77 NBT developed known vision loss, with 19 of 154 (12.3%) eyes becoming blind within 1 year of surgery. No further vision loss was reported among those BT with a 2-year follow-up. In the NBT group, seven additional dogs, a total of 24 of 77 NBT developed vision loss, with a known total of 31 of 154 (20.1%) eyes becoming blind within two years of surgery. These results were not significantly different. The overall surgical success in both groups based on individual eyes was estimated to be between 80 and 90% at 1 year postsurgery and between 65 and 80% at 2 years postsurgery. Glaucoma was the leading cause of vision loss in both groups. There was no significant difference in visual outcomes between a group of BT and a group of NBT undergoing bilateral phacoemulsification at the University of Tennessee between 2002 and 2015. Glaucoma was the leading cause of vision loss in both groups. © 2018 American College of Veterinary Ophthalmologists.

  18. 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

  19. 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.

  20. 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

  1. A Markov Model for Analyzing Polytomous Outcome Data

    Directory of Open Access Journals (Sweden)

    M Ataharul Islam

    2012-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} This paper highlights the estimation and test procedures for multi-state Markov models with covariate dependences in higher orders. Logistic link functions are used to analyze the transition probabilities of three or more states of a Markov model emerging from a longitudinal study. For illustration purpose the models are used for analysis of panel data on Health and Retirement Study conducted in USA during 1992-2002. The applications use self reported data on perceived emotional health at each round of the nationwide survey conducted among the elderly people. Useful and detailed results on the change in the perceived emotional health status among the elderly people are obtained.

  2. Integrating coalescent and ecological niche modeling in comparative phylogeography.

    Science.gov (United States)

    Carstens, Bryan C; Richards, Corinne L

    2007-06-01

    Understanding the factors that contribute to the formation of population genetic structure is a central goal of phylogeographic research, but achieving this goal can be complicated by the stochastic variance inherent to genetic processes. Statistical approaches to testing phylogeographic hypotheses accommodate this stochasticity by evaluating competing models of putative historical population structure, often by simulating null distributions of the expected variance. The effectiveness of these tests depends on the biological realism of the models. Information from the fossil record can aid in reconstructing the historical distributions of some taxa. However, for the majority of taxa, which lack sufficient fossils, paleodistributional modeling can provide valuable spatial-geographic data concerning ancestral distributions. Paleodistributional models are generated by projecting ecological niche models, which predict the current distribution of each species, onto a model of past climatic conditions. Here, we generate paleodistributional models describing the suitable habitat during the last glacial maximum for lineages from the mesic forests of the Pacific Northwest of North America, and use these models to generate alternative phylogeographic hypotheses. Coalescent simulations are then used to test these hypotheses to improve our understanding of the historical events that promoted the formation of population genetic structure in this ecosystem. Results from Pacific Northwest mesic forest organisms demonstrate the utility of these combined approaches. Paleodistribution models and population genetic structure are congruent across three amphibian lineages, suggesting that they have responded in a concerted manner to environmental change. Two other species, a willow and a water vole, despite being currently codistributed and having similar population genetic structure, were predicted by the paleodistributional model to have had markedly different distributions during

  3. A comparative outcomes analysis evaluating clinical effectiveness in two different human placental membrane products for wound management.

    Science.gov (United States)

    Johnson, Eric L; Marshall, James T; Michael, Georgina M

    2017-01-01

    Advances in tissue preservation have led to the commercialization of human placental membranes for the purposes of wound management with each product being characterized by different compositions and properties. The a priori specification of the research question in this investigator-initiated study focused on the clinical outcomes in two nonrandomized, however statistically equal and homogenous patient cohorts receiving either a viable intact cryopreserved human placental membrane (vCPM) or a dehydrated human amnion/chorion membrane (dHACM), for the management of wounds at a single center. A total of 79 patients with 101 wounds were analyzed: 40 patients with 46 wounds received vCPM and 39 patients with 55 wounds received dHACM. The proportion of wounds achieving complete wound closure was 63.0% (29/46) for vCPM and 18.2% (10/55) for dHACM (p < 0.0001) for all treated wounds combined. This is the first comparative effectiveness study to report on the clinical outcomes associated with the use of different placental wound care products once broadly implemented in the clinical setting. © 2016 The Authors. Wound Repair and Regeneration published by Wiley Periodicals, Inc. on behalf of The Wound Healing Society.

  4. 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.

  5. 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.

  6. Queue-based modelling and detection of parameters involved in stroke outcome

    DEFF Research Database (Denmark)

    Vilic, Adnan; Petersen, John Asger; Wienecke, Troels

    2017-01-01

    We designed a queue-based model, and investigated which parameters are of importance when predicting stroke outcome. Medical record forms have been collected for 57 ischemic stroke patients, including medical history and vital sign measurement along with neurological scores for the first twenty-f......, where outcome for patients were 36.75 ± 10.99. The queue-based model integrating multiple linear regression shows promising results for automatic selection of significant medically relevant parameters.......-four hours of admission. The importance of each parameter is identified using multiple regression combined with a circular queue to iteratively fit outcome. Out of 39 parameters, the model isolated 14 which combined could estimate outcome with a root mean square error of 1.69 on the Scandinavian Stroke Scale...

  7. A Random Pattern Mixture Model for Ordinal Outcomes with Informative Dropouts

    Science.gov (United States)

    Liu, Chengcheng; Ratcliffe, Sarah J.; Guo, Wensheng

    2016-01-01

    We extend a random pattern mixture joint model for longitudinal ordinal outcomes and informative dropouts. The patients are generalized to ”pattern” groups based on known covariates that are potential surrogated for the severity of the underlying condition. The random pattern effects are defined as the latent effects linking the dropout process and the ordinal longitudinal outcome. Conditional on the random pattern effects, the longitudinal outcome and the dropout times are assumed independent. Estimates are obtained via the EM algorithm. We applied the model to the end-stage renal disease (ESRD) data. Anemia was found to be significantly affected by baseline iron treatment when the dropout information was adjusted via the study model; as opposed to an independent or shared parameter model. Simulations were performed to evaluate the performance of the random pattern mixture model under various assumptions. PMID:25894456

  8. 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

  9. 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

  10. comparative analysis of two mathematical models for prediction

    African Journals Online (AJOL)

    Abstract. A mathematical modeling for prediction of compressive strength of sandcrete blocks was performed using statistical analysis for the sandcrete block data ob- tained from experimental work done in this study. The models used are Scheffes and Osadebes optimization theories to predict the compressive strength of ...

  11. Comparative homology modeling of human rhodopsin with several ...

    African Journals Online (AJOL)

    The molecular structure of rhodopsin has been studied by cryo-electron microscopic, Nuclear Magnetic Resonance (NMR) and X-ray crystallographic techniques in bovine. A humble effort has been ... Key words: Homology modeling, human rhodopsin, bovine templates, sequence alignment, model building, energy profiles.

  12. Comparative analysis of Vening-Meinesz Moritz isostatic models ...

    Indian Academy of Sciences (India)

    global gravity model and the DTM2006.0 global topographic/bathymetric model are used to generate the isostatic gravity anomalies. The comparison of numerical results reveals that the optimal isostatic inverse scheme should take into consideration both the variable depth and density of compensation. This is achieved by ...

  13. Mental Models about Seismic Effects: Students' Profile Based Comparative Analysis

    Science.gov (United States)

    Moutinho, Sara; Moura, Rui; Vasconcelos, Clara

    2016-01-01

    Nowadays, meaningful learning takes a central role in science education and is based in mental models that allow the representation of the real world by individuals. Thus, it is essential to analyse the student's mental models by promoting an easier reconstruction of scientific knowledge, by allowing them to become consistent with the curricular…

  14. A comparative study of click models for web search

    NARCIS (Netherlands)

    Grotov, A.; Chuklin, A.; Markov, I.; Stout, L.; Xumara, F.; de Rijke, M.; Mothe, J.; Savoy, J.; Kamps, J.; Pinel-Sauvagnat, K.; Jones, G.J.F.; SanJuan, E.; Cappellato, L.; Ferro, N.

    2015-01-01

    Click models have become an essential tool for understanding user behavior on a search engine result page, running simulated experiments and predicting relevance. Dozens of click models have been proposed, all aiming to tackle problems stemming from the complexity of user behavior or of contemporary

  15. 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

  16. A comparative study of explicit and implicit modelling of ...

    Indian Academy of Sciences (India)

    Further, for both speaker identification and verification tasks the explicit modelling provides relatively more complimentary information to the state-of-the-art vocal tract features. The contribution of the explicit features is relatively more robust against noise. We suggest that the explicit approach can be used to model the ...

  17. Comparative Studies of Population Synthesis Models in the ...

    Indian Academy of Sciences (India)

    2014-01-08

    Jan 8, 2014 ... Strömgren photometry to measure reliable parameter-sensitive colours and estimate precise model ages and metallicities. The assessment of. Rakos/Schulz ... Overall, the assessment finds modified Strömgren photometry ... The history of stellar population modelling dates back to the attempts by Crampin.

  18. 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 ...

  19. comparative study of moore and mealy machine models adaptation

    African Journals Online (AJOL)

    user

    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 ...

  20. Comparative Analysis of Two Mathematical Models for Prediction of ...

    African Journals Online (AJOL)

    A mathematical modeling for prediction of compressive strength of sandcrete blocks was performed using statistical analysis for the sandcrete block data obtained from experimental work done in this study. The models used are Scheffe's and Osadebe's optimization theories to predict the compressive strength of sandcrete ...

  1. 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 breast appearance, return to work and function (all p breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p 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.

  2. 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

    2018-02-28

    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.

  3. 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

  4. 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

  5. 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)

  6. Comparative study of stability in different TCP/RED models

    International Nuclear Information System (INIS)

    Nga, J.H.C.; Iu, H.H.C.; Ling, S.H.; Lam, H.K.

    2008-01-01

    This paper studies the stability issue of the average queue length of a Transmission Control Protocol (TCP) model when interacting with Random Early Detection (RED). The model used for the study has shown period doubling bifurcation (PDB) and border collision bifurcation (BCB) in the average queue size at certain values of parameters when original RED is deployed. In this paper, we adopt a gentle version of RED and a newly derived RED algorithm into the model to study the improvement in stability of average queue size of the system

  7. Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

    Directory of Open Access Journals (Sweden)

    Avinash Chaurasia

    2014-01-01

    Full Text Available Optimizing perioperative care to provide maximum benefit at minimum cost may be best achieved using a perioperative clinical pathway (PCP. Using our joint replacement surgical home (JSH model PCP, we examined length of stay (LOS following total joint arthroplasty (TJA to evaluate patient care optimization. We reviewed a spectrum of clinical measurements in 190 consecutive patients who underwent TJA. Patients who had surgery earlier in the week and who were earlier cases of the day had a significantly lower LOS than patients whose cases started both later in the week and later in the day. Patients discharged home had significantly lower LOS than those discharged to a secondary care facility. Patients who received regional versus general anesthesia had a significantly lower LOS. Scheduling patients discharged to home and who will likely receive regional anesthesia for the earliest morning slot and earlier in the week may help decrease overall LOS.

  8. 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.

  9. 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

    2018-01-13

    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.

  10. Outcomes analysis of hospital management model in restricted budget conditions

    Directory of Open Access Journals (Sweden)

    Virsavia Vaseva

    2016-03-01

    Full Text Available Facing conditions of market economy and financial crisis, the head of any healthcare facility has to take adequate decisions about the cost-effective functioning of the hospital. Along with cost reduction, the main problem is how to maintain a high level of health services. The aim of our study was to analyse the quality of healthcare services after the implementation of control over expenses due to a reduction in the budgetary resources in Military Medical Academy (MMA, Sofia, Bulgaria. Data from the hospital information system and the Financial Department about the incomes and expenditures for patient treatment were used. We conducted a retrospective study on the main components of clinical indicators in 2013 to reveal the main problems in the hospital management. In 2014, control was imposed on the use of the most expensive medicines and consumables. Comparative analysis was made of the results of the medical services in MMA for 2013 and 2014. Our results showed that despite the limited budget in MMA over the last year, the policy of control over operational costs succeeded in maintaining the quality of healthcare services. While reducing the expenses for medicines, consumables and laboratory investigations by ∼26%, some quality criteria for healthcare services were observed to be improved by ∼9%. Financial crisis and budget reduction urge healthcare economists to create adequate economical instruments to assist the normal functioning of hospital facilities. Our analysis showed that when a right policy is chosen, better results may be achieved with fewer resources.

  11. 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

  12. Comparing the health status of VA and non-VA ambulatory patients: the veterans' health and medical outcomes studies.

    Science.gov (United States)

    Rogers, William H; Kazis, Lewis E; Miller, Donald R; Skinner, Katherine M; Clark, Jack A; Spiro, Avron; Fincke, R Graeme

    2004-01-01

    The purpose of this study was to compare health status and disease profiles of ambulatory patients in specific Veterans Administration (VA) and civilian healthcare settings. A random sample of 2425 male veterans seeking care at 4 Boston-area VA outpatient clinics, who took part in the Veterans Health Study (VHS) in 1993-1995, were compared to 1318 male patients seeking civilian outpatient care in 3 major metropolitan areas covered in the Medical Outcomes Study (MOS) in 1986. The MOS sampled patients who had 1 of 5 conditions--hypertension, noninsulin-dependent diabetes, recent myocardial infarction, congestive heart failure, or depression. These 2 samples were age adjusted and compared in terms of the SF-36 Health Status/Quality of Life measures, and a list of 100 clinical variables (diagnostic, symptom, and medical event reports) collected with comparable instruments by a trained clinical observer. Individual odds ratios (VHS to MOS) were calculated for each measure and clinical variables. SF-36 measures of patient health in the VHS were lower than those in the MOS by more than one half of a standard deviation (SD) on 4 of 8 scales, by more than one quarter of a SD on the other 4, by 58% of a SD on the physical health summary scale, and by 37% of a SD on the mental health summary scale (P illness burden than did patients in the MOS. Current economic condition and service-connected disability explain most, if not all, of the differences. The differences were clinically and socially meaningful and would be consistent with substantially higher expected healthcare use.

  13. 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

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    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.

  14. 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

  15. Development and Implementation of ExPLORE Clinical Practice, a Web-accessible Comparative Outcomes Tool for California Hospitals and Physicians.

    Science.gov (United States)

    McNair, Peter D; Fang, Jade; Schwarzwaelder, Stephan; Jackson, Terri

    2015-01-01

    Hospital-based clinicians have little information about the outcomes of their care, much less how those outcomes compare with those of their peers. A variety of care quality indicators have been developed, but comparisons tend to be hospitalwide, and often irrelevant to the practice and patient group of many hospital clinicians. Moreover, information is not enough to transform clinical practice, as the human response to such comparisons is, "I'm doing the best I know how." What is needed is granular, clinically specific feedback with peer-mediated advice about how "positive deviants" achieve better results. This case study reports on the development and implementation of a web-accessible comparative outcomes tool, ExPLORE Clinical Practice, for hospitals and clinicians in California. We use iterative development and refinement of web tools to report comparative outcomes; incremental development of suites of procedure-patient outcome pairs specific to particular medical specialty groups; testing and refinement of response time metrics to reduce delays in report generation; and introduction of a comments section for each measure that assists with interpretation and ties results to strategies found to lead to better clinical outcomes. To date, 76 reports, each with 115 to 251 statistically evaluated outcomes, are available electronically to compare individual hospitals in California to statewide outcomes. ExPLORE Clinical Practice is one of a number of emerging systems that attempt to lever available data to improve patient outcomes. The ExPLORE Clinical Practice system combines a clinical focus on highly specific outcome measures with attention to technical issues such as crafting an intuitive user interface and graphic presentation. This case study illustrates the important advances made in using data to support clinicians to improve care for patients. We see this information as a way to start local conversations about quality improvement, and as a means of

  16. Comparing stochastic differential equations and agent-based modelling and simulation for early-stage cancer.

    Science.gov (United States)

    Figueredo, Grazziela P; Siebers, Peer-Olaf; Owen, Markus R; Reps, Jenna; Aickelin, Uwe

    2014-01-01

    There is great potential to be explored regarding the use of agent-based modelling and simulation as an alternative paradigm to investigate early-stage cancer interactions with the immune system. It does not suffer from some limitations of ordinary differential equation models, such as the lack of stochasticity, representation of individual behaviours rather than aggregates and individual memory. In this paper we investigate the potential contribution of agent-based modelling and simulation when contrasted with stochastic versions of ODE models using early-stage cancer examples. We seek answers to the following questions: (1) Does this new stochastic formulation produce similar results to the agent-based version? (2) Can these methods be used interchangeably? (3) Do agent-based models outcomes reveal any benefit when compared to the Gillespie results? To answer these research questions we investigate three well-established mathematical models describing interactions between tumour cells and immune elements. These case studies were re-conceptualised under an agent-based perspective and also converted to the Gillespie algorithm formulation. Our interest in this work, therefore, is to establish a methodological discussion regarding the usability of different simulation approaches, rather than provide further biological insights into the investigated case studies. Our results show that it is possible to obtain equivalent models that implement the same mechanisms; however, the incapacity of the Gillespie algorithm to retain individual memory of past events affects the similarity of some results. Furthermore, the emergent behaviour of ABMS produces extra patters of behaviour in the system, which was not obtained by the Gillespie algorithm.

  17. 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.

  18. River suspended sediment modelling using the CART model: A comparative study of machine learning techniques.

    Science.gov (United States)

    Choubin, Bahram; Darabi, Hamid; Rahmati, Omid; Sajedi-Hosseini, Farzaneh; Kløve, Bjørn

    2018-02-15

    Suspended sediment load (SSL) modelling is an important issue in integrated environmental and water resources management, as sediment affects water quality and aquatic habitats. Although classification and regression tree (CART) algorithms have been applied successfully to ecological and geomorphological modelling, their applicability to SSL estimation in rivers has not yet been investigated. In this study, we evaluated use of a CART model to estimate SSL based on hydro-meteorological data. We also compared the accuracy of the CART model with that of the four most commonly used models for time series modelling of SSL, i.e. adaptive neuro-fuzzy inference system (ANFIS), multi-layer perceptron (MLP) neural network and two kernels of support vector machines (RBF-SVM and P-SVM). The models were calibrated using river discharge, stage, rainfall and monthly SSL data for the Kareh-Sang River gauging station in the Haraz watershed in northern Iran, where sediment transport is a considerable issue. In addition, different combinations of input data with various time lags were explored to estimate SSL. The best input combination was identified through trial and error, percent bias (PBIAS), Taylor diagrams and violin plots for each model. For evaluating the capability of the models, different statistics such as Nash-Sutcliffe efficiency (NSE), Kling-Gupta efficiency (KGE) and percent bias (PBIAS) were used. The results showed that the CART model performed best in predicting SSL (NSE=0.77, KGE=0.8, PBIAS<±15), followed by RBF-SVM (NSE=0.68, KGE=0.72, PBIAS<±15). Thus the CART model can be a helpful tool in basins where hydro-meteorological data are readily available. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Cotrainers as Models of Relationships: Effects of the Outcome of Couples Therapy.

    Science.gov (United States)

    Epstein, Norman; And Others

    1979-01-01

    Investigated the generally neglected effects of the cotrainer relationship in studies of the outcome of couples communication training. Male-female cotrainer pairs modeled verbal dominance patterns similar or dissimilar to those of client couples. Changes in couples' speaking patterns after a two-hour workshop mirrored their trainers' models.…

  20. An outcome-based learning model to identify emerging threats : experimental and simulation results.

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Moyano, I. J.; Conrad, S. H.; Andersen, D. F.; Decision and Information Sciences; SNL; Univ. at Albany

    2007-01-01

    The authors present experimental and simulation results of an outcome-based learning model as it applies to the identification of emerging threats. This model integrates judgment, decision making, and learning theories to provide an integrated framework for the behavioral study of emerging threats.

  1. Overview of data-synthesis in systematic reviews of studies on outcome prediction models

    NARCIS (Netherlands)

    T. van den Berg (Tobias); M.W. Heymans (Martijn); O. Leone; D. Vergouw (David); J. Hayden (Jill); A.P. Verhagen (Arianne); H.C. de Vet (Henrica C)

    2013-01-01

    textabstractBackground: Many prognostic models have been developed. Different types of models, i.e. prognostic factor and outcome prediction studies, serve different purposes, which should be reflected in how the results are summarized in reviews. Therefore we set out to investigate how authors of

  2. 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)…

  3. 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…

  4. Improved Characters and Student Learning Outcomes through Development of Character Education Based General Physics Learning Model

    Science.gov (United States)

    Derlina; Sabani; Mihardi, Satria

    2015-01-01

    Education Research in Indonesia has begun to lead to the development of character education and is no longer fixated on the outcomes of cognitive learning. This study purposed to produce character education based general physics learning model (CEBGP Learning Model) and with valid, effective and practical peripheral devices to improve character…

  5. The Constructionism and Neurocognitive-Based Teaching Model for Promoting Science Learning Outcomes and Creative Thinking

    Science.gov (United States)

    Sripongwiwat, Supathida; Bunterm, Tassanee; Srisawat, Niwat; Tang, Keow Ngang

    2016-01-01

    The aim of this study was to examine the effect, after intervention on both experimental and control groups, of constructionism and neurocognitive-based teaching model, and conventional teaching model, on the science learning outcomes and creative thinking of Grade 11 students. The researchers developed a constructionism and neurocognitive-based…

  6. The Effect of Integrated Learning Model and Critical Thinking Skill of Science Learning Outcomes

    Science.gov (United States)

    Fazriyah, N.; Supriyati, Y.; Rahayu, W.

    2017-02-01

    This study aimed to determine the effect of integrated learning model and critical thinking skill toward science learning outcomes. The study was conducted in SDN Kemiri Muka 1 Depok in fifth grade school year 2014/2015 using cluster random sampling was done to 80 students. Retrieval of data obtained through tests and analysis by Variance (ANOVA) and two lines with the design treatment by level 2x2. The results showed that: (1) science learning outcomes students that given thematic integrated learning model is higher than in the group of students given fragmented learning model, (2) there is an interaction effect between critical thinking skills with integrated learning model, (3) for students who have high critical thinking skills, science learning outcomes students who given by thematic integrated learning model higher than fragmented learning model and (4) for students who have the ability to think critically low yield higher learning science fragmented model. The results of this study indicate that thematic learning model with critical thinking skills can improve science learning outcomes of students.

  7. Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction? A comparative analysis.

    NARCIS (Netherlands)

    Kamal, A.; Fahmy, I.; Mansour, R.; Serour, G.; Aboulghar, M.; Ramos, L.; Kremer, J.A.M.

    2010-01-01

    OBJECTIVE: To compare the outcomes of intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia and normal spermatogenesis, according to the use of epididymal or testicular spermatozoa and the cause of obstruction. DESIGN: Retrospective study. SETTING: Private infertility center.

  8. 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<