Variable reporting of functional outcomes and return to play in superior labrum anterior and posterior tear.

Science.gov (United States)

Steinhaus, Michael E; Makhni, Eric C; Lieber, Adam C; Kahlenberg, Cynthia A; Gulotta, Lawrence V; Romeo, Anthony A; Verma, Nikhil N

2016-11-01

Outcomes assessments after superior labrum anterior and posterior (SLAP) tear/repair are highly varied, making it difficult to draw comparisons across the literature. This study examined the inconsistency in outcomes reporting in the SLAP tear literature. We hypothesize that there is significant variability in outcomes reporting and that although most studies may report return to play, time to return reporting will be highly variable. The PubMed, Medline, Scopus, and Embase databases were systematically reviewed for studies from January 2000 to December 2014 reporting outcomes after SLAP tear/repair. Two reviewers assessed each study, and those meeting inclusion criteria were examined for pertinent data. Outcomes included objective (range of motion, strength, clinical examinations, and imaging) and subjective (patient-reported outcomes, satisfaction, activities of daily living, and return to play) measures. Of the 56 included studies, 43% documented range of motion, 14% reported strength, and 16% noted postoperative imaging. There was significant variation in use of patient-reported outcomes measures, with the 3 most commonly noted measures reported in 20% to 55% of studies. Return to play was noted in 75% of studies, and 23% reported time to return, with greater rates in elite athletes. Eleven studies (20%) did not report follow-up or noted data with <12 months of follow-up. The SLAP literature is characterized by substantial variability in outcomes reporting, with time to return to play noted in few studies. Efforts to standardize outcomes reporting would facilitate comparisons across the literature and improve our understanding of the prognosis of this injury. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Visit-to-Visit Variability in Blood Pressure and Kidney and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Nephropathy

DEFF Research Database (Denmark)

McMullan, Ciaran J; Lambers Heerspink, Hiddo J; Parving, Hans-Henrik

2014-01-01

-to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization. OUTCOMES: The kidney disease outcome was defined as time to confirmed doubling of serum creatinine level, end-stage renal disease, or death; the cardiovascular outcome was defined......BACKGROUND: Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney...... disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy. STUDY DESIGN: Observational analysis of IDNT (Irbesartan Diabetic Nephropathy Trial) and the RENAAL...

Education and Health Matters: School Nurse Interventions, Student Outcomes, and School Variables

Science.gov (United States)

Wolfe, Linda C.

2013-01-01

This paper presents findings from a quantitative, correlational study that examined selected school nursing services, student academic outcomes, and school demographics. Ex post facto data from the 2011-2012 school year of Delaware public schools were used in the research. The selected variables were school nurse interventions provided to students…

Assessing the Impact of Socioeconomic Variables on Small Area Variations in Suicide Outcomes in England

Directory of Open Access Journals (Sweden)

Peter Congdon

2012-12-01

Full Text Available Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.

Inferior outcomes for black children with high risk acute lymphoblastic leukemia and the impact of socioeconomic variables.

Science.gov (United States)

Walsh, Alexandra; Chewning, Joseph; Li, Xuelin; Dai, Chen; Whelan, Kimberly; Madan-Swain, Avi; Waterbor, John; Baskin, Monica L; Goldman, Frederick D

2017-02-01

While significant improvements have been made for children with acute lymphoblastic leukemia (ALL) in the United States over the past 20 years, black patients continue to have inferior outcomes. The full impact of socioeconomic variables on outcomes in this minority population is not entirely understood. Disease characteristics, demographic, and socioeconomic status (SES) variables were collected on black (n = 44) and white (n = 178) patients diagnosed at the University of Alabama at Birmingham. Cox proportional hazard regression was used to evaluate the influence of SES and insurance status on survival. As a cohort, 5-year overall survival (OS) was 87% (82-91%), with a median follow-up of 99 months. In univariable analysis, black race was not significantly associated with a higher risk of death or relapse and death. White and black patients with standard-risk leukemia had excellent outcomes, with 97% (91-99%) and 96% (75-99%) 5-year OS, respectively. In contrast, for high-risk disease, white patients had a statistically significant improved 5-year OS rates compared with black patients (79% [68-87%] vs. 52% [28-72%]). Black children were more likely to have public insurance, and, in multivariable analysis, this was associated with a trend toward an improved outcome. Black patients also had poorer census tract-level SES parameters, but these variables were not associated with survival. Our study demonstrates significantly inferior outcomes for black children with high-risk leukemia. These outcome disparities were not related to SES variables, including poverty or private insurance coverage, suggesting the involvement of other factors and highlighting the need for a prospective investigative analysis. © 2016 Wiley Periodicals, Inc.

Effects of variable transformations on errors in FORM results

International Nuclear Information System (INIS)

Qin Quan; Lin Daojin; Mei Gang; Chen Hao

2006-01-01

On the basis of studies on second partial derivatives of the variable transformation functions for nine different non-normal variables the paper comprehensively discusses the effects of the transformation on FORM results and shows that senses and values of the errors in FORM results depend on distributions of the basic variables, whether resistances or actions basic variables represent, and the design point locations in the standard normal space. The transformations of the exponential or Gamma resistance variables can generate +24% errors in the FORM failure probability, and the transformation of Frechet action variables could generate -31% errors

LB01.06: VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOMES IN FELODIPINE EVENT REDUCTION STUDY.

Science.gov (United States)

Zhang, Y; Zhang, X; Liu, L; Zanchetti, A

2015-06-01

Many antihypertensive outcome trials have shown that visit-to-visit blood pressure variability is correlated closely with clinical outcomes in hypertensive patients. The objective of the study was to investigate the relationship between visit-to-visit blood pressure variability (BPV) and the major cardiovascular outcomes in the Chinese hypertensive patients. Felodipine Event Reduction (FEVER) study was a double-blind, randomized trial on 9711 Chinese hypertensive patients, in whom cardiovascular outcomes were significantly reduced by more intense therapy achieving a mean of 138 mmHg SBP compared with less-intense therapy achieving a mean of 142 mmHg. Visit-to-visit BPV during the follow-up period [defined as standard deviation (SD), coefficient of variation (CV), and average real variability(ARV)] was derived from casual cuff BP measures after six months follow-up until the end of the study. Hazard ratios (HRs), for the incidence of CVD associated with SD, CV, and ARV of SBP and DBP were calculated using Cox proportional hazard models. Overall predictive power [area under receiver operating characteristic (AUC ROC) curve] of the level of blood pressure, blood pressure variability and other baseline characteristics was calculated. In FEVER study, visit-to-visit variability in SBP were significant predictors of subsequent stroke [eg, hazard ratios [HR] for ARV, SD and CV was 1.071 (95% CI: 1.025-1.118), 1.373 (95% CI: 1.159-1.626) and 0.572 (95% CI: 0.451-0,726)]. Visit-to-visit variability in DBP were also showed similar trend [eg, HR for ARV, SD and CV was 1.066 (95% CI: 0.992-1.145), 1.931 (95% CI: 1.435-2.598) and 0.558 (95% CI: 0.438-0,710)]. However, using the analysis of AUC ROC analysis, the risk importance sequence of the stroke events in this cohort was level of SBP, age, level of DBP ARV, SD, sex, CV and treatment. Visit-to-visit blood pressure variability has some effects on the cardiovascular outcomes in the Chinese hypertensive patents in the cohort in

Sensitivity of adaptive enrichment trial designs to accrual rates, time to outcome measurement, and prognostic variables

Directory of Open Access Journals (Sweden)

Tianchen Qian

2017-12-01

Full Text Available Adaptive enrichment designs involve rules for restricting enrollment to a subset of the population during the course of an ongoing trial. This can be used to target those who benefit from the experimental treatment. Trial characteristics such as the accrual rate and the prognostic value of baseline variables are typically unknown when a trial is being planned; these values are typically assumed based on information available before the trial starts. Because of the added complexity in adaptive enrichment designs compared to standard designs, it may be of special concern how sensitive the trial performance is to deviations from assumptions. Through simulation studies, we evaluate the sensitivity of Type I error, power, expected sample size, and trial duration to different design characteristics. Our simulation distributions mimic features of data from the Alzheimer's Disease Neuroimaging Initiative cohort study, and involve two subpopulations based on a genetic marker. We investigate the impact of the following design characteristics: the accrual rate, the time from enrollment to measurement of a short-term outcome and the primary outcome, and the prognostic value of baseline variables and short-term outcomes. To leverage prognostic information in baseline variables and short-term outcomes, we use a semiparametric, locally efficient estimator, and investigate its strengths and limitations compared to standard estimators. We apply information-based monitoring, and evaluate how accurately information can be estimated in an ongoing trial.

FUNCTIONAL ABILITIES AS PREDICTORS OF PREADOSLESCENT STUDENTS’ ATHLETIC RESULTS OUTCOME

Directory of Open Access Journals (Sweden)

Miroljub Ivanović

2011-09-01

Full Text Available Aim of this research has been directed to the functional abilities relation testing (as predictors and athletic results (as criterion of students, who are VII and VIII grade of primary school (Χ= 13, 9 years; SD = 1, 17. The research has been conducted in Valjevo during November 2010. on the sample of 108 examinees. Variables’ sample has been assembled from 3 tests for functional abilities (maximal oxygen consumption, pulse frequency and vital lungs capacity evaluation and 4 athletic disciplines (high jump, long jump, shot put and 60 meters low start sprint from current physical education curriculum. Crombah-alfa coefficient values indicate to satisfactory reliability of applied instruments. In data processing canonical correlation analysis and multiple regression analysis have been used. Achieved canonical correlation analysis results showed that functional abilities set is statistically and significantly related to criterion variables set (R=.67, manifesting one canonical factor on the level p<.03. Achieved determination coefficient (R² = .43 indicates to functional abilities prognostic significance of explained variance 46% criterion. Using hierarchy regression model following statistically significant beta coefficient of functional abilities as partial predictors of athletics outcome have been determined: I for vital lungs capacity- high jump (β = .67, p < .01, II for vital lungs capacity- long jump (β = .55, p < .01, III for vital lungs capacity and pulse frequency- shot put (β =.-.34, p < .01; β =.42, p < .02 and IV for vital lungs capacity- 60 meters sprint (β = .-.39. Regression equation calculation of other applied functional abilities preadolescents’ predictor variables has not statistically and significantly contributed to univariance prediction of criterion variable variance

Association between Serum Uric Acid Levels and Sleep Variables: Results from the National Health and Nutrition Survey 2005–2008

Directory of Open Access Journals (Sweden)

R. Constance Wiener

2012-01-01

Full Text Available Sleep disordered breathing as well as high serum uric acid levels are independent risk factors for cardiovascular disease. However, studies evaluating the relationship between sleep-disordered breathing and hyperuricemia are limited. We examined the 2005–2008 National Health and Nutrition Examination survey's sleep variables and high serum uric acid among 6491 participants aged ≥20 years. The sleep variables included sleep duration, snoring, snorting, and daytime sleepiness. The main outcome was high serum uric acid level, defined as levels of serum uric acid >6.8 mg/dL in males and >6.0 mg/dL in females. We found that snoring more than 5 nights per week, daytime sleepiness, and an additive composite score of sleep variables were associated with high serum uric acid in the age- , sex-adjusted model and in a multivariable model adjusting for demographic and lifestyle/behavioral risk factors. The association was attenuated with the addition of variables related to clinical outcomes such as depression, diabetes, hypertension, and high-cholesterol levels. Our results indicate a positive relationship between sleep variables, including the presence of snoring, snorting, and daytime sleepiness, and high serum uric acid levels.

Dynamics of melanoma tumor therapy with vesicular stomatitis virus: explaining the variability in outcomes using mathematical modeling.

Science.gov (United States)

Rommelfanger, D M; Offord, C P; Dev, J; Bajzer, Z; Vile, R G; Dingli, D

2012-05-01

Tumor selective, replication competent viruses are being tested for cancer gene therapy. This approach introduces a new therapeutic paradigm due to potential replication of the therapeutic agent and induction of a tumor-specific immune response. However, the experimental outcomes are quite variable, even when studies utilize highly inbred strains of mice and the same cell line and virus. Recognizing that virotherapy is an exercise in population dynamics, we utilize mathematical modeling to understand the variable outcomes observed when B16ova malignant melanoma tumors are treated with vesicular stomatitis virus in syngeneic, fully immunocompetent mice. We show how variability in the initial tumor size and the actual amount of virus delivered to the tumor have critical roles on the outcome of therapy. Virotherapy works best when tumors are small, and a robust innate immune response can lead to superior tumor control. Strategies that reduce tumor burden without suppressing the immune response and methods that maximize the amount of virus delivered to the tumor should optimize tumor control in this model system.

The Effects of Job Autonomy on Work Outcomes: Self Efficacy as an Intervening Variable

OpenAIRE

Susanti Saragih

2011-01-01

The purpose of this research was to examine the relationship between job autonomy and work outcomes (job performance, job satisfaction and job stress), self efficacy as a mediating variable. This research also investigated the impact of job satisfaction on job performance and job stress on job performance. Va-riables in this research were measured via a survey of 190 banking salespersons in D.I. Yogyakarta and Solo. Structural Equation Modeling (SEM) were used to examine the effects of job au...

Age at disease onset and peak ammonium level rather than interventional variables predict the neurological outcome in urea cycle disorders.

Science.gov (United States)

Posset, Roland; Garcia-Cazorla, Angeles; Valayannopoulos, Vassili; Teles, Elisa Leão; Dionisi-Vici, Carlo; Brassier, Anaïs; Burlina, Alberto B; Burgard, Peter; Cortès-Saladelafont, Elisenda; Dobbelaere, Dries; Couce, Maria L; Sykut-Cegielska, Jolanta; Häberle, Johannes; Lund, Allan M; Chakrapani, Anupam; Schiff, Manuel; Walter, John H; Zeman, Jiri; Vara, Roshni; Kölker, Stefan

2016-09-01

Patients with urea cycle disorders (UCDs) have an increased risk of neurological disease manifestation. Determining the effect of diagnostic and therapeutic interventions on the neurological outcome. Evaluation of baseline, regular follow-up and emergency visits of 456 UCD patients prospectively followed between 2011 and 2015 by the E-IMD patient registry. About two-thirds of UCD patients remained asymptomatic until age 12 days [i.e. the median age at diagnosis of patients identified by newborn screening (NBS)] suggesting a potential benefit of NBS. In fact, NBS lowered the age at diagnosis in patients with late onset of symptoms (>28 days), and a trend towards improved long-term neurological outcome was found for patients with argininosuccinate synthetase and lyase deficiency as well as argininemia identified by NBS. Three to 17 different drug combinations were used for maintenance therapy, but superiority of any single drug or specific drug combination above other combinations was not demonstrated. Importantly, non-interventional variables of disease severity, such as age at disease onset and peak ammonium level of the initial hyperammonemic crisis (cut-off level: 500 μmol/L) best predicted the neurological outcome. Promising results of NBS for late onset UCD patients are reported and should be re-evaluated in a larger and more advanced age group. However, non-interventional variables affect the neurological outcome of UCD patients. Available evidence-based guideline recommendations are currently heterogeneously implemented into practice, leading to a high variability of drug combinations that hamper our understanding of optimised long-term and emergency treatment.

Scrub typhus in South India: clinical and laboratory manifestations, genetic variability, and outcome.

Science.gov (United States)

Varghese, George M; Janardhanan, Jeshina; Trowbridge, Paul; Peter, John V; Prakash, John A J; Sathyendra, Sowmya; Thomas, Kurien; David, Thambu S; Kavitha, M L; Abraham, Ooriapadickal C; Mathai, Dilip

2013-11-01

This study sought to document the clinical and laboratory manifestations, genetic variability, and outcomes of scrub typhus, an often severe infection caused by Orientia tsutsugamushi, in South India. Patients admitted to a large teaching hospital with IgM ELISA-confirmed scrub typhus were evaluated. Clinical examination with a thorough search for an eschar, laboratory testing, chest X-ray, and outcome were documented and analyzed. Additionally, a 410-bp region of the 56-kDa type-specific antigen gene of O. tsutsugamushi was sequenced and compared with isolates from other regions of Asia. Most of the 154 patients evaluated presented with fever and non-specific symptoms. An eschar was found in 86 (55%) patients. Mild hepatic involvement was seen in most, with other organ involvement including respiratory, cardiovascular, and renal. Multi-organ dysfunction was noted in 59 (38.3%), and the fatality rate was 7.8%. Hypotension requiring vasoactive agents was found to be an independent predictor of mortality (p<0.001). The phylogeny of 26 samples showed 17 (65%) clustering with the Kato-like group and eight (31%) with the Karp-like group. The presentation of scrub typhus can be variable, often non-specific, but with potentially severe multi-organ dysfunction. Prompt recognition is key to specific treatment and good outcomes. Further study of the circulating strains is essential for the development of a successful vaccine and sensitive point-of-care testing. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Social variables affecting mate preferences, copulation and reproductive outcome in a pack of free-ranging dogs.

Directory of Open Access Journals (Sweden)

Simona Cafazzo

Full Text Available Mating and reproductive outcome is often determined by the simultaneous operation of different mechanisms like intra-sexual competition, mating preferences and sexual coercion. The present study investigated how social variables affected mating outcome in a pack of free-ranging dogs, a species supposed to have lost most features of the social system of wolves during domestication. We found that, although the pack comprised multiple breeding individuals, both male copulation success and female reproductive success were positively influenced by a linear combination of dominance rank, age and leadership. Our results also suggest that mate preferences affect mating outcome by reinforcing the success of most dominant individuals. In particular, during their oestrous period bitches clearly searched for the proximity of high-ranking males who displayed affiliative behaviour towards them, while they were more likely to reject the males who intimidated them. At the same time, male courting effort and male-male competition for receptive females appeared to be stronger in the presence of higher-ranking females, suggesting a male preference for dominant females. To our knowledge, these results provide the first clear evidence of social regulation of reproductive activities in domestic dogs, and suggest that some common organizing mechanisms may contribute to shape the social organization of both dogs and wolves.

Reinforcing Saccadic Amplitude Variability

Science.gov (United States)

Paeye, Celine; Madelain, Laurent

2011-01-01

Saccadic endpoint variability is often viewed as the outcome of neural noise occurring during sensorimotor processing. However, part of this variability might result from operant learning. We tested this hypothesis by reinforcing dispersions of saccadic amplitude distributions, while maintaining constant their medians. In a first experiment we…

Narrative Processes in Psychotherapy: differences between Good and Poor Outcome Clients

Directory of Open Access Journals (Sweden)

Luis Botella

2015-12-01

Full Text Available This paper compares 30 patients with good therapeutic outcome to 30 with poor therapeutic outcome in terms of the differential distribution of (1 Intake Variables (2 Outcome and Process Variables, and (3 Narrative Variables. Results indicated that psychosocial functioning, motivation, pre-therapy symptoms, Working Alliance, total number of therapy sessions, total pre-post symptom reduction, and mean scoring for total working alliance in sessions 3, 4, and 8 discriminated between both groups. Results also showed that almost all narrative variables except some of them discriminated good outcome clients from poor outcome ones from the beginning, midpoint and final stage of their therapeutic process. These results are discussed according to their relevance for clinical practice.

Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis.

Science.gov (United States)

Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A

2017-07-01

Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICH SITS (OR, 1.14; 95% CI, 1.06-1.23), and SICH ECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all P interaction accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association, Inc.

Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

Science.gov (United States)

Novy, Diane M; Engle, Mitchell P; Lai, Emily A; Cook, Christina; Martin, Emily C; Trahan, Lisa; Yu, Jun; Koyyalagunta, Dhanalakshmi

2016-07-01

The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain.

Long-term outcome of major depressive disorder in psychiatric patients is variable.

Science.gov (United States)

Holma, K Mikael; Holma, Irina A K; Melartin, Tarja K; Rytsälä, Heikki J; Isometsä, Erkki T

2008-02-01

The prevailing view of outcome of major depressive disorder (MDD), based on mostly inpatient cohorts sampled from tertiary centers, emphasizes chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.5% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6 months, 18 months, and 5 years with a life chart between February 1, 1997, and April 30, 2004. The effects of comorbid disorders and other predictors on outcome were comprehensively investigated. Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria, and 88.4% reached full remission, with the median time to full remission being 11.0 months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced 1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences. Preceding dysthymic disorder (p = .028), cluster C personality disorder (p = .041), and longer MDE duration prior to entry (p = .011) were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one tenth of patients having poor, one third having intermediate, and one half having favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.

Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality

Directory of Open Access Journals (Sweden)

Harris PR

2014-08-01

Full Text Available Patricia R E Harris,1 Phyllis K Stein,2 Gordon L Fung,3 Barbara J Drew4 1Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San Francisco, CA, USA; 2Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA; 3Cardiology Services, Mount Zion, Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA; 4School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San Francisco, CA, USA Objective: This study sought to examine the prognostic value of heart rate variability (HRV measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS. Background: Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Methods: Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193. Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. Results: During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms2 predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4–3.8, P=0.001. Variables significantly associated with death included natural logs of total power and ultra low frequency

Analysis of biopsy outcome after three-dimensional conformal radiation therapy of prostate cancer using dose-distribution variables and tumor control probability models

International Nuclear Information System (INIS)

Levegruen, Sabine; Jackson, Andrew; Zelefsky, Michael J.; Venkatraman, Ennapadam S.; Skwarchuk, Mark W.; Schlegel, Wolfgang; Fuks, Zvi; Leibel, Steven A.; Ling, C. Clifton

2000-01-01

Purpose: To investigate tumor control following three-dimensional conformal radiation therapy (3D-CRT) of prostate cancer and to identify dose-distribution variables that correlate with local control assessed through posttreatment prostate biopsies. Methods and Material: Data from 132 patients, treated at Memorial Sloan-Kettering Cancer Center (MSKCC), who had a prostate biopsy 2.5 years or more after 3D-CRT for T1c-T3 prostate cancer with prescription doses of 64.8-81 Gy were analyzed. Variables derived from the dose distribution in the PTV included: minimum dose (Dmin), maximum dose (Dmax), mean dose (Dmean), dose to n% of the PTV (Dn), where n = 1%, ..., 99%. The concept of the equivalent uniform dose (EUD) was evaluated for different values of the surviving fraction at 2 Gy (SF 2 ). Four tumor control probability (TCP) models (one phenomenologic model using a logistic function and three Poisson cell kill models) were investigated using two sets of input parameters, one for low and one for high T-stage tumors. Application of both sets to all patients was also investigated. In addition, several tumor-related prognostic variables were examined (including T-stage, Gleason score). Univariate and multivariate logistic regression analyses were performed. The ability of the logistic regression models (univariate and multivariate) to predict the biopsy result correctly was tested by performing cross-validation analyses and evaluating the results in terms of receiver operating characteristic (ROC) curves. Results: In univariate analysis, prescription dose (Dprescr), Dmax, Dmean, dose to n% of the PTV with n of 70% or less correlate with outcome (p 2 : EUD correlates significantly with outcome for SF 2 of 0.4 or more, but not for lower SF 2 values. Using either of the two input parameters sets, all TCP models correlate with outcome (p 2 , is limited because the low dose region may not coincide with the tumor location. Instead, for MSKCC prostate cancer patients with their

Monitoring the quality of cardiac surgery based on three or more surgical outcomes using a new variable life-adjusted display.

Science.gov (United States)

Gan, Fah Fatt; Tang, Xu; Zhu, Yexin; Lim, Puay Weng

2017-06-01

The traditional variable life-adjusted display (VLAD) is a graphical display of the difference between expected and actual cumulative deaths. The VLAD assumes binary outcomes: death within 30 days of an operation or survival beyond 30 days. Full recovery and bedridden for life, for example, are considered the same outcome. This binary classification results in a great loss of information. Although there are many grades of survival, the binary outcomes are commonly used to classify surgical outcomes. Consequently, quality monitoring procedures are developed based on binary outcomes. With a more refined set of outcomes, the sensitivities of these procedures can be expected to improve. A likelihood ratio method is used to define a penalty-reward scoring system based on three or more surgical outcomes for the new VLAD. The likelihood ratio statistic W is based on testing the odds ratio of cumulative probabilities of recovery R. Two methods of implementing the new VLAD are proposed. We accumulate the statistic W-W¯R to estimate the performance of a surgeon where W¯R is the average of the W's of a historical data set. The accumulated sum will be zero based on the historical data set. This ensures that if a new VLAD is plotted for a future surgeon of performance similar to this average performance, the plot will exhibit a horizontal trend. For illustration of the new VLAD, we consider 3-outcome surgical results: death within 30 days, partial and full recoveries. In our first illustration, we show the effect of partial recoveries on surgical results of a surgeon. In our second and third illustrations, the surgical results of two surgeons are compared using both the traditional VLAD based on binary-outcome data and the new VLAD based on 3-outcome data. A reversal in relative performance of surgeons is observed when the new VLAD is used. In our final illustration, we display the surgical results of four surgeons using the new VLAD based completely on 3-outcome data. Full

Chaos resulting from nonlinear relations between different variables

International Nuclear Information System (INIS)

Dohtani, Akitaka

2011-01-01

Research highlights: → We prove a general result on the existence of chaos. → We focus on the cyclic composites of interdependent relations between different variables. → By considering several examples, we conclude that the cyclic composites play an important role in detecting chaotic dynamics. - Abstract: In this study, we further develop the perturbation method of Marotto and investigate the general mechanisms responsible for nonlinear dynamics, which are typical of multidimensional systems. We focus on the composites of interdependent relations between different variables. First, we prove a general result on chaos, which shows that the cyclic composites of nonlinear interdependent relations are sources of chaotic dynamics in multidimensional systems. By considering several examples, we conclude that the cyclic composites play an important role in detecting chaotic dynamics.

Astronaut Preflight Cardiovascular Variables Associated with Vascular Compliance are Highly Correlated with Post-Flight Eye Outcome Measures in the Visual Impairment Intracranial Pressure (VIIP) Syndrome Following Long Duration Spaceflight

Science.gov (United States)

Otto, Christian; Ploutz-Snyder, R.

2015-01-01

The detection of the first VIIP case occurred in 2005, and adequate eye outcome measures were available for 31 (67.4%) of the 46 long duration US crewmembers who had flown on the ISS since its first crewed mission in 2000. Therefore, this analysis is limited to a subgroup (22 males and 9 females). A "cardiovascular profile" for each astronaut was compiled by examining twelve individual parameters; eleven of these were preflight variables: systolic blood pressure, pulse pressure, body mass index, percentage body fat, LDL, HDL, triglycerides, use of anti-lipid medication, fasting serum glucose, and maximal oxygen uptake in ml/kg. Each of these variables was averaged across three preflight annual physical exams. Astronaut age prior to the long duration mission, and inflight salt intake was also included in the analysis. The group of cardiovascular variables for each crew member was compared with seven VIIP eye outcome variables collected during the immediate post-flight period: anterior-posterior axial length of the globe measured by ultrasound and optical biometry; optic nerve sheath diameter, optic nerve diameter, and optic nerve to sheath ratio- each measured by ultrasound and magnetic resonance imaging (MRI), intraocular pressure (IOP), change in manifest refraction, mean retinal nerve fiber layer (RNFL) on optical coherence tomography (OCT), and RNFL of the inferior and superior retinal quadrants. Since most of the VIIP eye outcome measures were added sequentially beginning in 2005, as knowledge of the syndrome improved, data were unavailable for 22.0% of the outcome measurements. To address the missing data, we employed multivariate multiple imputation techniques with predictive mean matching methods to accumulate 200 separate imputed datasets for analysis. We were able to impute data for the 22.0% of missing VIIP eye outcomes. We then applied Rubin's rules for collapsing the statistical results across our 200 multiply imputed data sets to assess the canonical

Identifying the independent effect of HbA1c variability on adverse health outcomes in patients with Type 2 diabetes.

Science.gov (United States)

Prentice, J C; Pizer, S D; Conlin, P R

2016-12-01

To characterize the relationship between HbA 1c variability and adverse health outcomes among US military veterans with Type 2 diabetes. This retrospective cohort study used Veterans Affairs and Medicare claims for veterans with Type 2 diabetes taking metformin who initiated a second diabetes medication (n = 50 861). The main exposure of interest was HbA 1c variability during a 3-year baseline period. HbA 1c variability, categorized into quartiles, was defined as standard deviation, coefficient of variation and adjusted standard deviation, which accounted for the number and mean number of days between HbA 1c tests. Cox proportional hazard models predicted mortality, hospitalization for ambulatory care-sensitive conditions, and myocardial infarction or stroke and were controlled for mean HbA 1c levels and the direction of change in HbA 1c levels during the baseline period. Over a mean 3.3 years of follow-up, all HbA 1c variability measures significantly predicted each outcome. Using the adjusted standard deviation measure for HbA 1c variability, the hazard ratios for the third and fourth quartile predicting mortality were 1.14 (95% CI 1.04, 1.25) and 1.42 (95% CI 1.28, 1.58), for myocardial infarction and stroke they were 1.25 (95% CI 1.10, 1.41) and 1.23 (95% CI 1.07, 1.42) and for ambulatory-care sensitive condition hospitalization they were 1.10 (95% CI 1.03, 1.18) and 1.11 (95% CI 1.03, 1.20). Higher baseline HbA 1c levels independently predicted the likelihood of each outcome. In veterans with Type 2 diabetes, greater HbA 1c variability was associated with an increased risk of adverse long-term outcomes, independently of HbA 1c levels and direction of change. Limiting HbA 1c fluctuations over time may reduce complications. © 2016 Diabetes UK.

Blood Pressure Variability and Outcome in Patients with Acute Nonlobar Intracerebral Hemorrhage following Intensive Antihypertensive Treatment

Directory of Open Access Journals (Sweden)

Jin Pyeong Jeon

2018-01-01

Conclusions: The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH. Therefore, sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.

Meta-modeling of occupancy variables and analysis of their impact on energy outcomes of office buildings

International Nuclear Information System (INIS)

Wang, Qinpeng; Augenbroe, Godfried; Kim, Ji-Hyun; Gu, Li

2016-01-01

Highlights: • A meta-analysis framework for a stochastic characterization of occupancy variables. • Sensitivity ranking of occupancy variability against all other sources of uncertainty. • Sensitivity of occupant presence for building energy consumption is low. • Accurate mean knowledge is sufficient for predicting building energy consumption. • Prediction of peak demand behavior requires stochastic occupancy modeling. - Abstract: Occupants interact with buildings in various ways via their presence (passive effects) and control actions (active effects). Therefore, understanding the influence of occupants is essential if we are to evaluate the performance of a building. In this paper, we model the mean profiles and variability of occupancy variables (presence and actions) separately. We will use a multi-variate Gaussian distribution to generate mean profiles of occupancy variables, while the variability will be represented by a multi-dimensional time series model, within a framework for a meta-analysis that synthesizes occupancy data gathered from a pool of buildings. We then discuss variants of occupancy models with respect to various outcomes of interest such as HVAC energy consumption and peak demand behavior via a sensitivity analysis. Results show that our approach is able to generate stochastic occupancy profiles, requiring minimum additional input from the energy modeler other than standard diversity profiles. Along with the meta-analysis, we enable the generalization of previous research results and statistical inferences to choose occupancy variables for future buildings. The sensitivity analysis shows that for aggregated building energy consumption, occupant presence has a smaller impact compared to lighting and appliance usage. Specifically, being accumulatively 55% wrong with regard to presence, only translates to 2% error in aggregated cooling energy in July and 3.6% error in heating energy in January. Such a finding redirects focus to the

Influence of Flow Sequencing Attributed to Climate Change and Climate Variability on the Assessment of Water-dependent Ecosystem Outcomes

Science.gov (United States)

Wang, J.; Nathan, R.; Horne, A.

2017-12-01

Traditional approaches to characterize water-dependent ecosystem outcomes in response to flow have been based on time-averaged hydrological indicators, however there is increasing recognition for the need to characterize ecological processes that are highly dependent on the sequencing of flow conditions (i.e. floods and droughts). This study considers the representation of flow regimes when considering assessment of ecological outcomes, and in particular, the need to account for sequencing and variability of flow. We conducted two case studies - one in the largely unregulated Ovens River catchment and one in the highly regulated Murray River catchment (both located in south-eastern Australia) - to explore the importance of flow sequencing to the condition of a typical long-lived ecological asset in Australia, the River Red Gum forests. In the first, the Ovens River case study, the implications of representing climate change using different downscaling methods (annual scaling, monthly scaling, quantile mapping, and weather generator method) on the sequencing of flows and resulting ecological outcomes were considered. In the second, the Murray River catchment, sequencing within a historic drought period was considered by systematically making modest adjustments on an annual basis to the hydrological records. In both cases, the condition of River Red Gum forests was assessed using an ecological model that incorporates transitions between ecological conditions in response to sequences of required flow components. The results of both studies show the importance of considering how hydrological alterations are represented when assessing ecological outcomes. The Ovens case study showed that there is significant variation in the predicted ecological outcomes when different downscaling techniques are applied. Similarly, the analysis in the Murray case study showed that the drought as it historically occurred provided one of the best possible outcomes for River Red Gum

Language and speech outcomes of children with hearing loss and additional disabilities: Identifying the variables that influence performance at 5 years of age

Science.gov (United States)

Cupples, Linda; Ching, Teresa Y.C.; Button, Laura; Leigh, Greg; Marnane, Vivienne; Whitfield, Jessica; Gunnourie, Miriam; Martin, Louise

2016-01-01

Objective This study examined language and speech outcomes in young children with hearing loss and additional disabilities. Design Receptive and expressive language skills and speech output accuracy were evaluated using direct assessment and caregiver report. Results were analysed first for the entire participant cohort, and then to compare results for children with hearing aids (HAs) versus cochlear implants (CIs). Study sample A population-based cohort of 146 5-year-old children with hearing loss and additional disabilities took part. Results Across all participants, multiple regressions showed that better language outcomes were associated with milder hearing loss, use of oral communication, higher levels of cognitive ability and maternal education, and earlier device fitting. Speech output accuracy was associated with use of oral communication only. Average outcomes were similar for children with HAs versus CIs, but their associations with demographic variables differed. For HA users, results resembled those for the whole cohort. For CI users, only use of oral communication and higher cognitive ability levels were significantly associated with better language outcomes. Conclusions The results underscore the importance of early device fitting for children with additional disabilities. Strong conclusions cannot be drawn for CI users given the small number of participants with complete data. PMID:27630013

THE TIME DOMAIN SPECTROSCOPIC SURVEY: VARIABLE SELECTION AND ANTICIPATED RESULTS

Energy Technology Data Exchange (ETDEWEB)

Morganson, Eric; Green, Paul J. [Harvard Smithsonian Center for Astrophysics, 60 Garden St, Cambridge, MA 02138 (United States); Anderson, Scott F.; Ruan, John J. [Department of Astronomy, University of Washington, Box 351580, Seattle, WA 98195 (United States); Myers, Adam D. [Department of Physics and Astronomy, University of Wyoming, Laramie, WY 82071 (United States); Eracleous, Michael; Brandt, William Nielsen [Department of Astronomy and Astrophysics, 525 Davey Laboratory, The Pennsylvania State University, University Park, PA 16802 (United States); Kelly, Brandon [Department of Physics, Broida Hall, University of California, Santa Barbara, CA 93106-9530 (United States); Badenes, Carlos [Department of Physics and Astronomy and Pittsburgh Particle Physics, Astrophysics and Cosmology Center (PITT PACC), University of Pittsburgh, 3941 O’Hara St, Pittsburgh, PA 15260 (United States); Bañados, Eduardo [Max-Planck-Institut für Astronomie, Königstuhl 17, D-69117 Heidelberg (Germany); Blanton, Michael R. [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Bershady, Matthew A. [Department of Astronomy, University of Wisconsin, 475 N. Charter St., Madison, WI 53706 (United States); Borissova, Jura [Instituto de Física y Astronomía, Universidad de Valparaíso, Av. Gran Bretaña 1111, Playa Ancha, Casilla 5030, and Millennium Institute of Astrophysics (MAS), Santiago (Chile); Burgett, William S. [GMTO Corp, Suite 300, 251 S. Lake Ave, Pasadena, CA 91101 (United States); Chambers, Kenneth, E-mail: emorganson@cfa.harvard.edu [Institute for Astronomy, University of Hawaii at Manoa, Honolulu, HI 96822 (United States); and others

2015-06-20

We present the selection algorithm and anticipated results for the Time Domain Spectroscopic Survey (TDSS). TDSS is an Sloan Digital Sky Survey (SDSS)-IV Extended Baryon Oscillation Spectroscopic Survey (eBOSS) subproject that will provide initial identification spectra of approximately 220,000 luminosity-variable objects (variable stars and active galactic nuclei across 7500 deg{sup 2} selected from a combination of SDSS and multi-epoch Pan-STARRS1 photometry. TDSS will be the largest spectroscopic survey to explicitly target variable objects, avoiding pre-selection on the basis of colors or detailed modeling of specific variability characteristics. Kernel Density Estimate analysis of our target population performed on SDSS Stripe 82 data suggests our target sample will be 95% pure (meaning 95% of objects we select have genuine luminosity variability of a few magnitudes or more). Our final spectroscopic sample will contain roughly 135,000 quasars and 85,000 stellar variables, approximately 4000 of which will be RR Lyrae stars which may be used as outer Milky Way probes. The variability-selected quasar population has a smoother redshift distribution than a color-selected sample, and variability measurements similar to those we develop here may be used to make more uniform quasar samples in large surveys. The stellar variable targets are distributed fairly uniformly across color space, indicating that TDSS will obtain spectra for a wide variety of stellar variables including pulsating variables, stars with significant chromospheric activity, cataclysmic variables, and eclipsing binaries. TDSS will serve as a pathfinder mission to identify and characterize the multitude of variable objects that will be detected photometrically in even larger variability surveys such as Large Synoptic Survey Telescope.

Diastolic blood pressure variability in 24 hour-ABPM and outcomes of chronic kidney disease
.

Science.gov (United States)

Sahutoglu, Tuncay; Sakaci, Tamer

2018-04-10

Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce. Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD. Coefficient of variation (CV) in diastolic blood pressure (DBP) was used as an index of BPV. Data of 191 patients (mean age 59.7 ± 12.4 years, 54.9% males, 42.1% diabetic, mean eGFR-EPI (Chronic Kidney Disease Epidemiology Collaboration) 51.7 ± 22.0 mL/min/1.73m2, mean follow-up 26.2 ± 10.4 months) were available for the analysis. On multivariate linear regression analysis, greater DBP-CV was associated with slower decline in eGFR-EPI per year (B -0.648, p = 0.000). Likewise, the hazard ratio (HR) for dialysis inception (occurred in 9.4%) was found significantly lower with increasing DBP-CV in unadjusted and fully adjusted Cox models (HR 0.730, 95% CI 0.618 - 0.861, p = 0.000, and HR 0.678, 95% CI 0.526 - 0.874, p = 0.003, respectively). These findings suggest that DBP variability in 24-hour ABPM may be a good prognostic factor for the outcomes of CKD. Further studies are needed to determine the impact of 24-hour ABPM BPV on CKD progression and its differences from VVV.
.

The Effect of Latent Binary Variables on the Uncertainty of the Prediction of a Dichotomous Outcome Using Logistic Regression Based Propensity Score Matching.

Science.gov (United States)

Szekér, Szabolcs; Vathy-Fogarassy, Ágnes

2018-01-01

Logistic regression based propensity score matching is a widely used method in case-control studies to select the individuals of the control group. This method creates a suitable control group if all factors affecting the output variable are known. However, if relevant latent variables exist as well, which are not taken into account during the calculations, the quality of the control group is uncertain. In this paper, we present a statistics-based research in which we try to determine the relationship between the accuracy of the logistic regression model and the uncertainty of the dependent variable of the control group defined by propensity score matching. Our analyses show that there is a linear correlation between the fit of the logistic regression model and the uncertainty of the output variable. In certain cases, a latent binary explanatory variable can result in a relative error of up to 70% in the prediction of the outcome variable. The observed phenomenon calls the attention of analysts to an important point, which must be taken into account when deducting conclusions.

High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

Directory of Open Access Journals (Sweden)

Dawn L. Goodall, MSc

2017-08-01

Conclusions. This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes.

Ensemble survival tree models to reveal pairwise interactions of variables with time-to-events outcomes in low-dimensional setting

Science.gov (United States)

Dazard, Jean-Eudes; Ishwaran, Hemant; Mehlotra, Rajeev; Weinberg, Aaron; Zimmerman, Peter

2018-01-01

Unraveling interactions among variables such as genetic, clinical, demographic and environmental factors is essential to understand the development of common and complex diseases. To increase the power to detect such variables interactions associated with clinical time-to-events outcomes, we borrowed established concepts from random survival forest (RSF) models. We introduce a novel RSF-based pairwise interaction estimator and derive a randomization method with bootstrap confidence intervals for inferring interaction significance. Using various linear and nonlinear time-to-events survival models in simulation studies, we first show the efficiency of our approach: true pairwise interaction-effects between variables are uncovered, while they may not be accompanied with their corresponding main-effects, and may not be detected by standard semi-parametric regression modeling and test statistics used in survival analysis. Moreover, using a RSF-based cross-validation scheme for generating prediction estimators, we show that informative predictors may be inferred. We applied our approach to an HIV cohort study recording key host gene polymorphisms and their association with HIV change of tropism or AIDS progression. Altogether, this shows how linear or nonlinear pairwise statistical interactions of variables may be efficiently detected with a predictive value in observational studies with time-to-event outcomes. PMID:29453930

Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.

Science.gov (United States)

Söderström-Anttila, Viveca; Wennerholm, Ulla-Britt; Loft, Anne; Pinborg, Anja; Aittomäki, Kristiina; Romundstad, Liv Bente; Bergh, Christina

2016-01-01

placenta praevia/placental abruption in 4.9%. Cases with hysterectomies have also been reported. Most surrogate mothers scored within the normal range on personality tests. Most psychosocial variables were satisfactory, although difficulties related to handing over the child did occur. The psychological well-being of children whose mother had been a surrogate mother between 5 and 15 years earlier was found to be good. No major differences in psychological state were found between intended mothers, mothers who conceived after other types of ART and mothers whose pregnancies were the result of natural conception. Most studies reporting on surrogacy have serious methodological limitations. According to these studies, most surrogacy arrangements are successfully implemented and most surrogate mothers are well-motivated and have little difficulty separating from the children born as a result of the arrangement. The perinatal outcome of the children is comparable to standard IVF and oocyte donation and there is no evidence of harm to the children born as a result of surrogacy. However, these conclusions should be interpreted with caution. To date, there are no studies on children born after cross-border surrogacy or growing up with gay fathers. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Provider volume and outcomes for oncological procedures.

LENUS (Irish Health Repository)

Killeen, S D

2012-02-03

BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable.

Science.gov (United States)

Sandberg, Evelien M; Driessen, Sara R C; Bak, Evelien A T; van Geloven, Nan; Berger, Judith P; Smeets, Mathilde J G H; Rhemrev, Johann P T; Jansen, Frank Willem

2018-01-01

Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable. A total of 2655 LH's were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I ( n  = 106) and II ( n  = 103) endometriosis compared to LH without endometriosis. LH with stages III ( n  = 93) and IV ( n  = 95) endometriosis were associated with more intra-operative blood loss ( p  = case-mix variables in future quality measurement tools.

Epidemiologic research using probabilistic outcome definitions.

Science.gov (United States)

Cai, Bing; Hennessy, Sean; Lo Re, Vincent; Small, Dylan S

2015-01-01

Epidemiologic studies using electronic healthcare data often define the presence or absence of binary clinical outcomes by using algorithms with imperfect specificity, sensitivity, and positive predictive value. This results in misclassification and bias in study results. We describe and evaluate a new method called probabilistic outcome definition (POD) that uses logistic regression to estimate the probability of a clinical outcome using multiple potential algorithms and then uses multiple imputation to make valid inferences about the risk ratio or other epidemiologic parameters of interest. We conducted a simulation to evaluate the performance of the POD method with two variables that can predict the true outcome and compared the POD method with the conventional method. The simulation results showed that when the true risk ratio is equal to 1.0 (null), the conventional method based on a binary outcome provides unbiased estimates. However, when the risk ratio is not equal to 1.0, the traditional method, either using one predictive variable or both predictive variables to define the outcome, is biased when the positive predictive value is value is poor (less than 0.75 in our simulation). In contrast, the POD method provides unbiased estimates of the risk ratio both when this measure of effect is equal to 1.0 and not equal to 1.0. Even when the sensitivity and positive predictive value are low, the POD method continues to provide unbiased estimates of the risk ratio. The POD method provides an improved way to define outcomes in database research. This method has a major advantage over the conventional method in that it provided unbiased estimates of risk ratios and it is easy to use. Copyright © 2014 John Wiley & Sons, Ltd.

Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population.

Science.gov (United States)

Sumithran, P; Purcell, K; Kuyruk, S; Proietto, J; Prendergast, L A

2018-02-01

Consistent, strong predictors of obesity treatment outcomes have not been identified. It has been suggested that broadening the range of predictor variables examined may be valuable. We explored methods to predict outcomes of a very-low-energy diet (VLED)-based programme in a clinically comparable setting, using a wide array of pre-intervention biological and psychosocial participant data. A total of 61 women and 39 men (mean ± standard deviation [SD] body mass index: 39.8 ± 7.3 kg/m 2 ) underwent an 8-week VLED and 12-month follow-up. At baseline, participants underwent a blood test and assessment of psychological, social and behavioural factors previously associated with treatment outcomes. Logistic regression, linear discriminant analysis, decision trees and random forests were used to model outcomes from baseline variables. Of the 100 participants, 88 completed the VLED and 42 attended the Week 60 visit. Overall prediction rates for weight loss of ≥10% at weeks 8 and 60, and attrition at Week 60, using combined data were between 77.8 and 87.6% for logistic regression, and lower for other methods. When logistic regression analyses included only baseline demographic and anthropometric variables, prediction rates were 76.2-86.1%. In this population, considering a wide range of biological and psychosocial data did not improve outcome prediction compared to simply-obtained baseline characteristics. © 2017 World Obesity Federation.

Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality.

Science.gov (United States)

Harris, Patricia R E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

2014-01-01

This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms(2) predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4-3.8, P=0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power 0.3 ng/mL (HR =4.0; 95% CI =1.3-12.1; P=0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes. HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study.

Exact statistical results for binary mixing and reaction in variable density turbulence

Science.gov (United States)

Ristorcelli, J. R.

2017-02-01

We report a number of rigorous statistical results on binary active scalar mixing in variable density turbulence. The study is motivated by mixing between pure fluids with very different densities and whose density intensity is of order unity. Our primary focus is the derivation of exact mathematical results for mixing in variable density turbulence and we do point out the potential fields of application of the results. A binary one step reaction is invoked to derive a metric to asses the state of mixing. The mean reaction rate in variable density turbulent mixing can be expressed, in closed form, using the first order Favre mean variables and the Reynolds averaged density variance, ⟨ρ2⟩ . We show that the normalized density variance, ⟨ρ2⟩ , reflects the reduction of the reaction due to mixing and is a mix metric. The result is mathematically rigorous. The result is the variable density analog, the normalized mass fraction variance ⟨c2⟩ used in constant density turbulent mixing. As a consequence, we demonstrate that use of the analogous normalized Favre variance of the mass fraction, c″ ⁣2˜ , as a mix metric is not theoretically justified in variable density turbulence. We additionally derive expressions relating various second order moments of the mass fraction, specific volume, and density fields. The central role of the density specific volume covariance ⟨ρ v ⟩ is highlighted; it is a key quantity with considerable dynamical significance linking various second order statistics. For laboratory experiments, we have developed exact relations between the Reynolds scalar variance ⟨c2⟩ its Favre analog c″ ⁣2˜ , and various second moments including ⟨ρ v ⟩ . For moment closure models that evolve ⟨ρ v ⟩ and not ⟨ρ2⟩ , we provide a novel expression for ⟨ρ2⟩ in terms of a rational function of ⟨ρ v ⟩ that avoids recourse to Taylor series methods (which do not converge for large density differences). We have derived

Moderation of effects of AAC based on setting and types of aided AAC on outcome variables: an aggregate study of single-case research with individuals with ASD.

Science.gov (United States)

Ganz, Jennifer B; Rispoli, Mandy J; Mason, Rose Ann; Hong, Ee Rea

2014-06-01

The purpose of this meta-analysis was to evaluate the potential moderating effects of intervention setting and type of aided augmentative and alternative communication (AAC) on outcome variables for students with autism spectrum disorders. Improvement rate difference, an effect size measure, was used to calculate aggregate effects across 35 single-case research studies. Results indicated that the largest effects for aided AAC were observed in general education settings. With respect to communication outcomes, both speech generating devices (SGDs) and the Picture Exchange Communication System (PECS) were associated with larger effects than other picture-based systems. With respect to challenging behaviour outcomes, SGDs produced larger effects than PECS. This aggregate study highlights the importance of considering intervention setting, choice of AAC system and target outcomes when designing and planning an aided AAC intervention.

Shareholders proposals, vote outcome, and board composition

Directory of Open Access Journals (Sweden)

Amani Khaled Bouresli

2008-07-01

Full Text Available This paper examines the variables that affect vote outcome in shareholder proposals. We found that sponsor identity, proposal type, and board composition play a significant role in determining vote outcome. Furthermore, we found that the interaction between the prior performance with board composition is significant and has a negative coefficient. We conducted nonparametric tests to investigate changes in board’s major characteristics before and after targeting. The results indicate that some changes in management and boards occur after shareholder proposals. These changes, however, are unrelated to variables that impact vote outcome. We conclude that shareholders proposals are not effective at changing company behavior or corporate governance

Variability analysis of AGN: a review of results using new statistical criteria

Science.gov (United States)

Zibecchi, L.; Andruchow, I.; Cellone, S. A.; Romero, G. E.; Combi, J. A.

We present here a re-analysis of the variability results of a sample of active galactic nuclei (AGN), which have been observed on several sessions with the 2.15 m "Jorge Sahade" telescope (CASLEO), San Juan, Argentina, and whose results are published (Romero et al. 1999, 2000, 2002; Cellone et al. 2000). The motivation for this new analysis is the implementation, dur- ing the last years, of improvements in the statistical criteria applied, taking quantitatively into account the incidence of the photometric errors (Cellone et al. 2007). This work is framed as a first step in an integral study on the statistical estimators of AGN variability. This study is motivated by the great diversity of statistical tests that have been proposed to analyze the variability of these objects. Since we note that, in some cases, the results of the object variability depend on the test used, we attempt to make a com- parative study of the various tests and analyze, under the given conditions, which of them is the most efficient and reliable.

Comparison of ASSESS neutralization module results with actual small force engagement outcomes

International Nuclear Information System (INIS)

Gardner, B.H.; Snell, M.K.; Paulus, W.K.

1991-01-01

The ASSESS Neutralization module (Neutralization) is part of the Analytic System and Software for Evaluation of Safeguards and Security (ASSESS), a vulnerability assessment tool. Neutralization models a fire fight between security inspectors (SIs) and adversaries. This paper reports that a comparison has been made between actual outcomes of police and small military engagements and the results predicted by the Neutralization module for similar scenarios. The results of this comparison show a surprising correlation between predicted outcomes (based on numbers of combatants, weapon types, and exposures, etc.) and the actual outcomes of the engagements analyzed. The importance of this analysis is that given the defenders have intelligence on actual adversary characteristics or are protecting against a design basis threat, defense capabilities can be evaluated before an engagement. Results could then be used to develop a favorable probability of a desired outcome. For example, law enforcement agencies are frequently able to compile the number of criminals, types of weaponry, willingness to use force, etc., from analysis of crime scenes

Predictors of outcomes in outpatients with anorexia nervosa - Results from the ANTOP study.

Science.gov (United States)

Wild, Beate; Friederich, Hans-Christoph; Zipfel, Stephan; Resmark, Gaby; Giel, Katrin; Teufel, Martin; Schellberg, Dieter; Löwe, Bernd; de Zwaan, Martina; Zeeck, Almut; Herpertz, Stephan; Burgmer, Markus; von Wietersheim, Jörn; Tagay, Sefik; Dinkel, Andreas; Herzog, Wolfgang

2016-10-30

This study aimed to determine predictors of BMI and recovery for outpatients with anorexia nervosa (AN). Patients were participants of the ANTOP (Anorexia Nervosa Treatment of Out-Patients) trial and randomized to focal psychodynamic therapy (FPT), enhanced cognitive behavior therapy (CBT-E), or optimized treatment as usual (TAU-O). N=169 patients participated in the one-year follow-up (T4). Outcomes were the BMI and global outcome (recovery/partial syndrome/full syndrome) at T4. We examined the following baseline variables as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, quality of life, self-esteem, and psychological characteristics relevant to AN. Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome. The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients. Negative predictors for BMI and recovery were a duration of illness >6 years and a lifetime depression diagnosis at baseline. Additionally, higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4. A higher baseline BMI and shorter illness duration led to a better outcome. Further research is necessary to investigate whether or not AN patients with lifetime depression, higher bodily pain, and lower self-esteem may benefit from specific treatment approaches. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Clinical outcomes resulting from telemedicine interventions: a systematic review

Directory of Open Access Journals (Sweden)

Kraemer Dale

2001-11-01

Full Text Available Abstract Background The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Methods Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis. All included articles were abstracted and graded for quality and direction of the evidence. Results A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Conclusions Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

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.

Perfiles de organizaciones positivas. Análisis de características percibidas según variables individuales, organizacionales y de resultado (Positive organization profiles. Analysis of perceived characteristics according to individual, organizational, and outcome variables

Directory of Open Access Journals (Sweden)

María Laura Lupano Perugini

2016-08-01

Full Text Available This study analysed the profiles of organizations based on employee perceptions of their workplace. The sample consisted of 459 Argentinian employees (232 men; average age, 36.3 years (SD = 11.7. The participants worked for public companies (17.2%, n = 79 or private companies (82.6%, n = 379. Most of them lived in Buenos Aires and surrounding areas (96.5%, n = 443. A protocol was used for data collection, in which the participants were asked to report positive and negative characteristics associated with their organization. A content analysis of the answers given by the participants was performed, from which different categories of characteristics were derived (e.g., work climate, commitment, values. Several multiple correspondence analyses were conducted to generate profiles according to individual variables (i.e., gender, age, and position, organizational variables (i.e., size, typology, and type, and outcome variables (i.e., performance and job satisfaction. One of the most significant profiles showed associations between the perception of positive characteristics, such as values and outcomes, and high levels of satisfaction and individual/organizational performance.

New Results On the Sum of Two Generalized Gaussian Random Variables

KAUST Repository

Soury, Hamza

2015-01-01

We propose in this paper a new method to compute the characteristic function (CF) of generalized Gaussian (GG) random variable in terms of the Fox H function. The CF of the sum of two independent GG random variables is then deduced. Based on this results, the probability density function (PDF) and the cumulative distribution function (CDF) of the sum distribution are obtained. These functions are expressed in terms of the bivariate Fox H function. Next, the statistics of the distribution of the sum, such as the moments, the cumulant, and the kurtosis, are analyzed and computed. Due to the complexity of bivariate Fox H function, a solution to reduce such complexity is to approximate the sum of two independent GG random variables by one GG random variable with suitable shape factor. The approximation method depends on the utility of the system so three methods of estimate the shape factor are studied and presented.

New Results on the Sum of Two Generalized Gaussian Random Variables

KAUST Repository

Soury, Hamza

2016-01-06

We propose in this paper a new method to compute the characteristic function (CF) of generalized Gaussian (GG) random variable in terms of the Fox H function. The CF of the sum of two independent GG random variables is then deduced. Based on this results, the probability density function (PDF) and the cumulative distribution function (CDF) of the sum distribution are obtained. These functions are expressed in terms of the bivariate Fox H function. Next, the statistics of the distribution of the sum, such as the moments, the cumulant, and the kurtosis, are analyzed and computed. Due to the complexity of bivariate Fox H function, a solution to reduce such complexity is to approximate the sum of two independent GG random variables by one GG random variable with suitable shape factor. The approximation method depends on the utility of the system so three methods of estimate the shape factor are studied and presented [1].

New Results on the Sum of Two Generalized Gaussian Random Variables

KAUST Repository

Soury, Hamza; Alouini, Mohamed-Slim

2016-01-01

We propose in this paper a new method to compute the characteristic function (CF) of generalized Gaussian (GG) random variable in terms of the Fox H function. The CF of the sum of two independent GG random variables is then deduced. Based on this results, the probability density function (PDF) and the cumulative distribution function (CDF) of the sum distribution are obtained. These functions are expressed in terms of the bivariate Fox H function. Next, the statistics of the distribution of the sum, such as the moments, the cumulant, and the kurtosis, are analyzed and computed. Due to the complexity of bivariate Fox H function, a solution to reduce such complexity is to approximate the sum of two independent GG random variables by one GG random variable with suitable shape factor. The approximation method depends on the utility of the system so three methods of estimate the shape factor are studied and presented [1].

Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

Science.gov (United States)

Cleophas, Ton J

2016-01-01

Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method.

Outcome of Minnesota's gambling treatment programs.

Science.gov (United States)

Stinchfield, R; Winters, K C

2001-01-01

This study measured the outcome of four state-supported outpatient gambling treatment programs in Minnesota. The programs were developed specifically for the treatment of pathological gamblers and offered multiple modalities of treatment including individual, group, education, twelve-step work, family groups, and financial counseling. The therapeutic orientation was eclectic with an emphasis on the twelve steps of Gamblers Anonymous (GA) and a treatment goal of abstinence. The sample included 348 men and 220 women treated between January 1992 and January 1995. A pretest-posttest design was utilized with multidimensional assessments obtained at intake, discharge, six-months, and twelve-months post-discharge. Variables assessed included a range of clinical and outcome variables. At six month follow-up, 28% reported that they had abstained from gambling during the six months following discharge and an additional 20% had gambled less than once per month. Almost half of the sample (48%) showed clinically significant improvement in gambling frequency at six month follow-up. Outcome variables of gambling frequency, SOGS scores, amount of money gambled, number of friends who gamble, psychosocial problems, and number of financial problems, all showed statistically significant improvements from pretreatment to follow-up. The treatment programs yielded outcome results similar to those reported for alcohol and drug abuse treatment programs.

The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables.

Science.gov (United States)

Flay, B R; Miller, T Q; Hedeker, D; Siddiqui, O; Britton, C F; Brannon, B R; Johnson, C A; Hansen, W B; Sussman, S; Dent, C

1995-01-01

This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California. The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7. We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior. Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior.

Variable importance and prediction methods for longitudinal problems with missing variables.

Directory of Open Access Journals (Sweden)

Iván Díaz

Full Text Available We present prediction and variable importance (VIM methods for longitudinal data sets containing continuous and binary exposures subject to missingness. We demonstrate the use of these methods for prognosis of medical outcomes of severe trauma patients, a field in which current medical practice involves rules of thumb and scoring methods that only use a few variables and ignore the dynamic and high-dimensional nature of trauma recovery. Well-principled prediction and VIM methods can provide a tool to make care decisions informed by the high-dimensional patient's physiological and clinical history. Our VIM parameters are analogous to slope coefficients in adjusted regressions, but are not dependent on a specific statistical model, nor require a certain functional form of the prediction regression to be estimated. In addition, they can be causally interpreted under causal and statistical assumptions as the expected outcome under time-specific clinical interventions, related to changes in the mean of the outcome if each individual experiences a specified change in the variable (keeping other variables in the model fixed. Better yet, the targeted MLE used is doubly robust and locally efficient. Because the proposed VIM does not constrain the prediction model fit, we use a very flexible ensemble learner (the SuperLearner, which returns a linear combination of a list of user-given algorithms. Not only is such a prediction algorithm intuitive appealing, it has theoretical justification as being asymptotically equivalent to the oracle selector. The results of the analysis show effects whose size and significance would have been not been found using a parametric approach (such as stepwise regression or LASSO. In addition, the procedure is even more compelling as the predictor on which it is based showed significant improvements in cross-validated fit, for instance area under the curve (AUC for a receiver-operator curve (ROC. Thus, given that 1 our VIM

Sleep quality, the neglected outcome variable in clinical studies focusing on locomotor system; a construct validation study

Directory of Open Access Journals (Sweden)

Röder Christoph

2010-09-01

Full Text Available Abstract Background In addition to general health and pain, sleep is highly relevant to judging the well-being of an individual. Of these three important outcome variables, however, sleep is neglected in most outcome studies. Sleep is a very important resource for recovery from daily stresses and strains, and any alteration of sleep will likely affect mental and physical health, especially during disease. Sleep assessment therefore should be standard in all population-based or clinical studies focusing on the locomotor system. Yet current sleep assessment tools are either too long or too specific for general use. Methods Based on a literature review and subsequent patient-based rating of items, an expert panel designed a four-item questionnaire about sleep. Construct validation of the questionnaire in a random sample of the German-speaking Swiss population was performed in 2003. Reliability, correlation, and tests for internal consistency and validity were analyzed. Results Overall, 16,634 (70% out of 23,763 eligible individuals participated in the study. Test-retest reliability coefficients ranged from 0.72 to 0.87, and a Cronbach's alpha of 0.83 indicates good internal consistency. Results show a moderate to good correlation between sleep disturbances and health perception, and between sleep disturbances and overall pain. Conclusions The Sleep Standard Evaluation Questionnaire (SEQ-Sleep is a reliable and short tool with confirmed construct validity for sleep assessment in population-based observational studies. It is easy to administer and therefore suitable for postal surveys of the general population. Criterion validity remains to be determined.

Metacognition as a Mediating Variable Between Neurocognition and Functional Outcome in First Episode Psychosis.

Science.gov (United States)

Davies, Geoff; Fowler, David; Greenwood, Kathryn

2017-07-01

Neurocognitive and functional outcome deficits have long been acknowledged in schizophrenia and neurocognition has been found to account for functional disability to a greater extent than psychopathology. Much of the variance in functional outcome however still remains unexplained and metacognition may mediate the relationship between neurocognition, functional capacity, and self-reported social and occupational function. Eighty first episode psychosis participants were recruited and completed measures of neurocognition (memory, executive function, and intelligence quotient), metacognition (Beck Cognitive Insight Scale, Metacognitive Awareness Interview), psychopathology (PANSS), and both functional capacity (UPSA) and real-life social and occupational function (The Time Use Survey). Path analyses investigated the relationships between variables through structural equation modeling. A series of path models demonstrated that metacognition partially mediates the relationship between neurocognition and functional capacity, and fully mediates the relationship between functional capacity and social and occupational function. The present study findings identify that metacognition may be critical to translating cognitive and functional skills into real-world contexts, and this relationship is found at early stages of illness. Understanding how individuals translate cognitive and functional skills into the real-world (the competence-performance gap) may offer valuable guidance to intervention programs. This finding is important to models of recovery as it suggests that intervention programs that focus on enhancing metacognition abilities may have a greater impact than traditional rehabilitation programs focusing on cognitive abilities, on social and occupational outcomes. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com

Do psychological variables affect early surgical recovery?

Directory of Open Access Journals (Sweden)

Michael N Mavros

Full Text Available BACKGROUND: Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. METHODS: We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. RESULTS: We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. CONCLUSION: Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.

Semiparametric methods for estimation of a nonlinear exposure‐outcome relationship using instrumental variables with application to Mendelian randomization

Science.gov (United States)

Staley, James R.

2017-01-01

ABSTRACT Mendelian randomization, the use of genetic variants as instrumental variables (IV), can test for and estimate the causal effect of an exposure on an outcome. Most IV methods assume that the function relating the exposure to the expected value of the outcome (the exposure‐outcome relationship) is linear. However, in practice, this assumption may not hold. Indeed, often the primary question of interest is to assess the shape of this relationship. We present two novel IV methods for investigating the shape of the exposure‐outcome relationship: a fractional polynomial method and a piecewise linear method. We divide the population into strata using the exposure distribution, and estimate a causal effect, referred to as a localized average causal effect (LACE), in each stratum of population. The fractional polynomial method performs metaregression on these LACE estimates. The piecewise linear method estimates a continuous piecewise linear function, the gradient of which is the LACE estimate in each stratum. Both methods were demonstrated in a simulation study to estimate the true exposure‐outcome relationship well, particularly when the relationship was a fractional polynomial (for the fractional polynomial method) or was piecewise linear (for the piecewise linear method). The methods were used to investigate the shape of relationship of body mass index with systolic blood pressure and diastolic blood pressure. PMID:28317167

A Two Year Longitudinal Outcome Study of Addicted Health Care Professionals: An Investigation of the Role of Personality Variables

Directory of Open Access Journals (Sweden)

Daniel Angres

2013-01-01

Full Text Available The co-morbidity of personality disorders (PDs and other dysregulatory personality patterns with addiction have been well-established, although few studies have examined this interplay on long-term sobriety outcome. In addition, health care professionals suffering from addiction have both a significant public health impact and a unique set of treatment and recovery challenges. The aim of this study was to investigate if personality variables differentiated sobriety outcome in this population over a two year interval. A clinical sample of health care professionals participated in a substance abuse hospital treatment program individually tailored with respect to personality. Participants took the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory at intake, and were tracked two years post-discharge to determine sobriety status. Univariate analyses showed antisocial personality, female gender, and alcohol dependence were independent predictors of relapse, however a significant relationship between personality and substance use did not exist in multivariate analysis when controlling for demographic variables The lack of multivariate relationships demonstrates the heterogeneity in self-report measures of personality, which suggests the interplay of personality and addiction is complex and individualized.

What Variables Are Associated With the Outcome of Arthroscopic Lysis and Lavage Surgery for Internal Derangement of the Temporomandibular Joint?

Science.gov (United States)

Haeffs, Tyler H; D'Amato, Lindsay N; Khawaja, Shehryar N; Keith, David A; Scrivani, Steven J

2018-04-26

Arthroscopic lysis and lavage surgery (AS) is an effective modality that can decrease pain and increase maximum interincisal opening (MIO) in patients with internal derangement (ID) of the temporomandibular joint (TMJ). However, some patients remain in pain or have limited mandibular range of motion despite AS. The purpose of this study was to determine the effectiveness, prevalence of adverse effects, and predictors of response to TMJ AS in patients with TMJ arthralgia and ID. A retrospective cohort study was conducted using data of patients who had undergone AS by a single surgeon (D.A.K.) from September 2010 to April 2015 in the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital (Boston, MA). Variables, including demographic data, medical history, and clinical presentation, were extracted and analyzed. Criteria for surgical success were defined as a postoperative MIO of at least 35 mm and a postoperative pain level no higher than 3 on an 11-point Likert-type numeric verbal pain rating scale. Appropriate descriptive and analytic statistics were computed and significance was set at a P value less than .05. Of the 247 participants, 226 (91.5%) were women. The mean age of the sample was 38 ± 15.4 years. Successful surgical outcome was achieved in 62.3% of patients. Based on logistic regression analysis, higher initial mean pain score and concurrent use of benzodiazepines were the only variables that predicted an unsuccessful surgical outcome (P < .001; P = .005). Adverse effects were reported by 13.4% of patients, the most common being postoperative increase in pain (13.4%), temporary malocclusion (1.2%), and temporary paresthesia in the preauricular region (0.4%). The results from this study indicate that in patients with ID of the TMJ unresponsive to noninvasive treatments, high initial pain scores and concurrent use of benzodiazepines are correlated with an unsuccessful outcome after AS. Copyright © 2018. Published by

The mediation proportion: a structural equation approach for estimating the proportion of exposure effect on outcome explained by an intermediate variable

DEFF Research Database (Denmark)

Ditlevsen, Susanne; Christensen, Ulla; Lynch, John

2005-01-01

It is often of interest to assess how much of the effect of an exposure on a response is mediated through an intermediate variable. However, systematic approaches are lacking, other than assessment of a surrogate marker for the endpoint of a clinical trial. We review a measure of "proportion...... of several intermediate variables. Binary or categorical variables can be included directly through threshold models. We call this measure the mediation proportion, that is, the part of an exposure effect on outcome explained by a third, intermediate variable. Two examples illustrate the approach. The first...... example is a randomized clinical trial of the effects of interferon-alpha on visual acuity in patients with age-related macular degeneration. In this example, the exposure, mediator and response are all binary. The second example is a common problem in social epidemiology-to find the proportion...

Differential Responding by Rhesus Monkeys (Macaca mulatta and Humans (Homo sapiens to Variable Outcomes in the Assurance Game

Directory of Open Access Journals (Sweden)

Audrey E. Parrish

2014-08-01

Full Text Available Behavioral flexibility in how one responds to variable partner play can be examined using economic coordination games in which subjects play against a variety of partners and therefore may need to alter their behavior to produce the highest payoff. But how do we study this behavioral flexibility once players have settled on a response? Here, we investigated how responding by rhesus monkeys (Macaca mulatta and humans (Homo sapiens playing a computerized single-player version of a coordination game, the Assurance game, changed as a function of the variable responses (Stag/Hare generated by multiple simulations (SIMs. We were interested in whether individuals could track and differentially respond to changing frequencies of Stag and Hare play by the SIMs, especially with regard to the payoff dominant (Stag-Stag outcome, something that could not be done with real partners as they quickly settled on the Stag response. For both monkeys and humans, there was a linear relationship between proportion of Stag play by the subject and the likelihood of the Stag choice by the SIM such that both species increased their use of Stag as the SIM increased its use of the Stag response. However, humans more closely matched their proportion of Stag responses to that of the SIM, whereas monkeys adopted a different, but equally effective, strategy of exploiting the higher-paying Stag alternative. These results suggest that monkeys and humans demonstrate sensitivity to a dynamic game environment in which they encounter variable contingencies for the same response options, although they may employ different strategies to maximize reward.

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection : A cohort analysis to define a case-mix variable

NARCIS (Netherlands)

Sandberg, Evelien M.; Driessen, Sara R C; Bak, Evelien A.T.; van Geloven, Nan; Berger, Judith P.; Smeets, Mathilde J.G.H.; Rhemrev, Johann P T; Jansen, F.W.

2018-01-01

Background: Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis

Psychosocial determinants of outcomes in knee replacement.

Science.gov (United States)

Lopez-Olivo, Maria A; Landon, Glenn C; Siff, Sherwin J; Edelstein, David; Pak, Chong; Kallen, Michael A; Stanley, Melinda; Zhang, Hong; Robinson, Kausha C; Suarez-Almazor, Maria E

2011-10-01

To identify potential psychosocial and educational barriers to clinical success following knee replacement. The authors evaluated 241 patients undergoing total knee replacement, preoperatively and 6 months after surgery. Outcomes included the Western Ontario McMaster (WOMAC) scale and the Knee Society rating system (KSRS). Independent variables included: the medical outcome study-social support scale; depression, anxiety and stress scale; brief COPE inventory; health locus of control; arthritis self-efficacy scale and the life orientation test-revised. Multiple regression models evaluated associations of baseline demographic and psychosocial variables with outcomes at 6 months, controlling for body mass index, comorbidities and baseline outcome scores. Patients' mean age was 65 ± 9 years; 65% were women. Most patients improved outcomes after surgery. Several psychosocial variables were associated with outcomes. Regression analyses indicated lower education, less tangible support, depression, less problem-solving coping, more dysfunctional coping, lower internal locus of control were associated with worse WOMAC scores (R(2) contribution of psychosocial variables for pain 0.07; for function, 0.14). Older age, lower education, depression and less problem-solving coping were associated with poorer total KSRS scores (R(2) contribution of psychosocial variables to total KSRS model 0.09). Psychosocial variables as a set contributed from 25% to 74% of total explained variance across the models tested. Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.

A review of instrumental variable estimators for Mendelian randomization.

Science.gov (United States)

Burgess, Stephen; Small, Dylan S; Thompson, Simon G

2017-10-01

Instrumental variable analysis is an approach for obtaining causal inferences on the effect of an exposure (risk factor) on an outcome from observational data. It has gained in popularity over the past decade with the use of genetic variants as instrumental variables, known as Mendelian randomization. An instrumental variable is associated with the exposure, but not associated with any confounder of the exposure-outcome association, nor is there any causal pathway from the instrumental variable to the outcome other than via the exposure. Under the assumption that a single instrumental variable or a set of instrumental variables for the exposure is available, the causal effect of the exposure on the outcome can be estimated. There are several methods available for instrumental variable estimation; we consider the ratio method, two-stage methods, likelihood-based methods, and semi-parametric methods. Techniques for obtaining statistical inferences and confidence intervals are presented. The statistical properties of estimates from these methods are compared, and practical advice is given about choosing a suitable analysis method. In particular, bias and coverage properties of estimators are considered, especially with weak instruments. Settings particularly relevant to Mendelian randomization are prioritized in the paper, notably the scenario of a continuous exposure and a continuous or binary outcome.

Maternal and fetal outcome of gestational diabetes mellitus in ...

African Journals Online (AJOL)

Blood sugar was measured using a one touch glucometer. Outcome variables: Socio demographic characteristics, maternal complications, mode of delivery and the foetal outcomes. Results: The mean age of mothers in both groups was similar: 28.6 years vs 27.5 years. Both groups had similar body mass index more than ...

Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)

DEFF Research Database (Denmark)

Poulter, Neil R; Wedel, Hans; Dahlöf, Björn

2005-01-01

Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen (HR...... 0.86 and 0.77, respectively). Our aim was to assess to what extent these differences were due to significant differences in blood pressures and in other variables noted after randomisation....

Food away from home and body mass outcomes: taking heterogeneity into account enhances quality of results.

Science.gov (United States)

Kim, Tae Hyun; Lee, Eui-Kyung; Han, Euna

2014-09-01

The aim of this study was to explore the heterogeneous association of consumption of food away from home (FAFH) with individual body mass outcomes including body mass index and waist circumference over the entire conditional distribution of each outcome. Information on 16,403 adults obtained from nationally representative data on nutrition and behavior in Korea was used. A quantile regression model captured the variability of the association of FAFH with body mass outcomes across the entire conditional distribution of each outcome measure. Heavy FAFH consumption was defined as obtaining ≥1400 kcal from FAFH on a single day. Heavy FAFH consumption, specifically at full-service restaurants, was significantly associated with higher body mass index (+0.46 kg/m2 at the 50th quantile, 0.55 at the 75th, 0.66 at the 90th, and 0.44 at the 95th) and waist circumference (+0.96 cm at the 25th quantile, 1.06 cm at the 50th, 1.35 cm at the 75th, and 0.96 cm at the 90th quantiles) with overall larger associations at higher quantiles. Findings of the study indicate that conventional regression methods may mask important heterogeneity in the association between heavy FAFH consumption and body mass outcomes. Further public health efforts are needed to improve the nutritional quality of affordable FAFH choices and nutrition education and to establish a healthy food consumption environment. Copyright © 2014 Elsevier Inc. All rights reserved.

The impact of employee assistance services on workplace outcomes: Results of a prospective, quasi-experimental study.

Science.gov (United States)

Richmond, Melissa K; Pampel, Fred C; Wood, Randi C; Nunes, Ana P

2017-04-01

Employee Assistance Programs (EAPs) are widely used to help employees experiencing personal or work-related difficulties that impact work productivity. However, rigorous research on the effectiveness of programs to improve work-related outcomes is lacking. The current study represents a major advance in EAP research by using a prospective, quasi-experimental design with a large and diverse employee base. Using propensity scores calculated from demographic, social, work-related, and psychological variables collected on baseline surveys, we matched 156 employees receiving EAP to 188 non-EAP employees. Follow-up surveys were collected from 2 to 12 months post-baseline (M = 6.0). At follow-up, EAP employees had significantly greater reductions in absenteeism (b = -.596, p = .001) and presenteeism (b = -.217, p = .038), but not workplace distress (b = -.079, p = .448), than did non-EAP employees. Tests of moderation of baseline alcohol use, depression, anxiety, and productivity indicate that for the most part, the program works equally well for all groups. However, EAP did more to reduce absenteeism for those who began with lower severity of depression and anxiety at baseline. Results provide the scientific rigor needed to demonstrate EAP impact on improved work outcomes. In the first study of its kind, findings confirm the value of EAPs to help employees address personal and work-related concerns that are affecting job performance. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study.

Science.gov (United States)

Hennigs, André; Biehl, Hannah; Rauch, Geraldine; Golatta, Michael; Tabatabai, Patrik; Domschke, Christoph; Schott, Sarah; Wallwiener, Markus; Schütz, Florian; Sohn, Christof; Heil, Jörg

2016-05-01

We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS). This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis. The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p procedures.

Long-term outcome of sports injuries : results after inpatient treatment

NARCIS (Netherlands)

Dekker, R; van der Sluis, CK; Groothoff, JW; Eisma, WH; ten Duis, HJ

Objective: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences. Materials and methods: All patients older than 17 years of age and admitted to the University

Cataclysmic Variables from SDSS I. The First Results

OpenAIRE

Szkody, P.; Anderson, S. F.; Agueros, M.; Covarrubias, R.; Bentz, M.; Hawley, S.; Margon, B.; Voges, W.; Henden, A.; Knapp, G. R.; Berk, D. E. Vanden; Rest, A.; Miknaitis, G.; Magnier, E.; Brinkmann, J.

2001-01-01

The commissioning year of the Sloan Digital Sky Survey has demonstrated that many cataclysmic variables have been missed in previous surveys with brighter limits. We report the identification of 22 cataclysmic variables, of which 19 are new discoveries and 3 are known systems (SW UMa, BH Lyn and Vir4). A compendium of positions, colors and characteristics of these systems obtained from the SDSS photometry and spectroscopy is presented along with data obtained during follow-up studies with the...

Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial.

Science.gov (United States)

Hoyer, Juergen; Wiltink, Joerg; Hiller, Wolfgang; Miller, Robert; Salzer, Simone; Sarnowsky, Stephan; Stangier, Ulrich; Strauss, Bernhard; Willutzki, Ulrike; Leibing, Eric

2016-01-01

We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed. Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety Scale (LSAS). Multiple linear regression analyses and logistic regression analyses were applied. Up to 37% of the post-treatment variance (LSAS) could be explained by all pre-treatment variables combined. Symptom severity (baseline LSAS) was consistently negatively associated with end-state functioning and remission, but not with response. Number of comorbid diagnoses was negatively associated with end-state functioning and response, but not with remission. Self-esteem was positively associated with higher end-state functioning and more shame with better response. Attrition could not be significantly predicted. The results indicate that the initial probability for treatment success mainly depends on severity of disorder and comorbid conditions while other psychological variables are of minor importance, at least on a nomothetic level. This stands in contrast with efforts to arrive at an empirical-based foundation for differential indication and argues to search for more potent moderators of therapeutic change rather on the process level. Personality, self-esteem, shame, attachment style and interpersonal problems do not or only marginally moderate the effects of interventions in CT of social phobia. Symptom severity and comorbid diagnoses might affect treatment outcome negatively

The GRB variability/peak luminosity correlation: new results

International Nuclear Information System (INIS)

Guidorzi, C.; Rossi, F.; Hurley, K.; Mundell, C.G.

2005-01-01

We test the correlation between time variability and isotropic-equivalent peak luminosity found by Reichart et al. (ApJ, 552 (2001) 57) using a set of 26 Gamma-Ray Bursts (GRBs) with known redshift. We confirm the correlation, thought with a larger spread around the best-fit power-law obtained by Reichart et al. which in turn does not provide an acceptable description any longer. In addiction, we find no evidence for correlation between variability and beaming-corrected peak luminosity for a subset of 14 GRBs whose beaming angles have been taken from Ghirlanda et al. (ApJ, 616 (2004) 331). Finally, we investigate the possible connection for some GRBs between the location in the variability/peak luminosity space and some afterglow properties, such as the detectability in the optical band, by adding some GRBs whose redshifts, unknown from direct measurements, have been derived assuming the Amati at al. (AeA, 390 (2002) 81) relationship

Hierarchy of treatment variables affecting outcome of 131I therapy in thyroid cancer patients with lung metastases.

Science.gov (United States)

Kozak, Oksana V; Sukach, Georgiy G; Korchinskaya, Oksana I; Trembach, Alexander M; Turicina, Viktoria L; Voit, Natalia U

2005-06-01

To assess the correlations between the first 131I activity value, time interval between the courses of radioiodine treatment and the overall number of courses required for total destruction of lung metastases in patients with differentiated thyroid cancer with metastatic lesions in lungs. 27 patients with differentiated thyroid cancer with metastases in lungs have been treated with radioiodine after surgical intervention. Activities administered amounted from 1600 to 7980 MBq. The number of radioiodine courses before total ablation of all metastatic lesions amounted from 1 to 10. Time interval between the 1st and the 2nd courses amounted from 3.5 to 11.5 months (6 months in average). The regression analysis of the data has been made. The exponential model fits the actual number of courses as a function of the first-second activity value and time interval between the courses. The first activity has a decisive influence on the number of courses required for total metastases ablation. The greater was the first activity value, the lesser was the overall number of courses. Increasing time interval between 1st and 2nd courses to 10 months seems to result in reducing the number of courses. Nevertheless even in the case of high activities the probability to undergone less then 3 courses is low. According to the proposed model in thyroid cancer patients with metastases in lungs the first activity should be not lesser than 6000 MBq, time interval between treatments--approximately 10 months. The results of our study suggest that individual factors such as histology, the number and the size of metastases in lymph nodes could not contribute more to the final outcome than the treatment variables, namely the first-second activity and time interval, nor could they affect the hierarchy of the effects revealed for the treatment variables.

Genetical variability of Gladioli as the result of gamma-radiation

International Nuclear Information System (INIS)

Jakota, L.I.; Murin, A.V.

1994-01-01

In the starting material of Gladioli, got in the result of Y-radiation, the forms with white spots on the petals were observed. The Gladioli form 165-81 is distinguished by low growth and middle early flowering. The flower form is triangular. Basic pigmentation is red. White spots of different size on the petals were observed. The investigation was made in 1992 in the field of genetical variability of Gladioli. The Gladioli form 165-81 was irradiated with gamma-radiation dose 30 Gr. As a result the depression of biometric indicators was observed. Consequently, 30 Gr is a mutant dose for Gladioli

A preliminary investigation of daily variability of stuttering in adults.

Science.gov (United States)

Constantino, Christopher D; Leslie, Paula; Quesal, Robert W; Yaruss, J Scott

2016-01-01

Variability in frequency of stuttering has made the results of treatment outcome studies difficult to interpret. Many factors that affect variability have been investigated; yet the typical range of variability experienced by speakers remains unknown. This study examined the day-to-day variability in the percentage of syllables containing stuttered and nonstuttered disfluencies in the speech of six adult speakers in three spontaneous speaking situations and two reading tasks. The frequency of moments stuttering during the tasks were compared within and between speakers and days to document the degree of variability in stuttering frequency and explore whether there were any consistent patterns. The Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering for Adults (OASES-A) were also tested for day-to-day variability. Correlations between frequency, severity, and life impact were made. The primary result of this study was the large range over which frequency of stuttering varied from day to day for the same individual. This variability did not correlate with any measures of stuttering severity but did correlate with life impact as measured by the OASES-A. No global pattern was detected in variability from day to day within or between participants. However, there were significantly more nonstuttered disfluencies present during the spontaneous speaking tasks than during the reading tasks. The day-to-day variability in the life impact of the disorder (OASES-A) was less than the day-to-day variability in observable stuttering behavior (percentage of syllables stuttered and SSI-4). Frequency of stuttering varies significantly from situation to situation and day to day, with observed variability exceeding the degree of change often reported in treatment outcomes studies from before to after treatment. This variability must be accounted for in future clinical and scientific work. Copyright © 2016 Elsevier Inc

Infertility trial outcomes: healthy moms and babies.

Science.gov (United States)

Silver, Robert

2014-05-01

Traditionally, the primary outcome of infertility trials has been a positive pregnancy test or a clinically recognized pregnancy. However, parents desire a healthy baby that grows up to be a healthy adult, rather than a positive pregnancy test. Too often results of infertility trials are lacking in crucial obstetric details. This is problematic because treatments for infertility have the capacity to increase the risk for a variety of adverse obstetric outcomes. This review will outline important obstetric variables that should be included when reporting infertility research. The rationale for including these data, precise definitions of the variables, and cost-effective strategies for obtaining these obstetric details will be highlighted. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Disaggregating measurement uncertainty from population variability and Bayesian treatment of uncensored results

International Nuclear Information System (INIS)

Strom, Daniel J.; Joyce, Kevin E.; Maclellan, Jay A.; Watson, David J.; Lynch, Timothy P.; Antonio, Cheryl L.; Birchall, Alan; Anderson, Kevin K.; Zharov, Peter

2012-01-01

In making low-level radioactivity measurements of populations, it is commonly observed that a substantial portion of net results are negative. Furthermore, the observed variance of the measurement results arises from a combination of measurement uncertainty and population variability. This paper presents a method for disaggregating measurement uncertainty from population variability to produce a probability density function (PDF) of possibly true results. To do this, simple, justifiable, and reasonable assumptions are made about the relationship of the measurements to the measurands (the 'true values'). The measurements are assumed to be unbiased, that is, that their average value is the average of the measurands. Using traditional estimates of each measurement's uncertainty to disaggregate population variability from measurement uncertainty, a PDF of measurands for the population is produced. Then, using Bayes's theorem, the same assumptions, and all the data from the population of individuals, a prior PDF is computed for each individual's measurand. These PDFs are non-negative, and their average is equal to the average of the measurement results for the population. The uncertainty in these Bayesian posterior PDFs is all Berkson with no remaining classical component. The methods are applied to baseline bioassay data from the Hanford site. The data include 90Sr urinalysis measurements on 128 people, 137Cs in vivo measurements on 5,337 people, and 239Pu urinalysis measurements on 3,270 people. The method produces excellent results for the 90Sr and 137Cs measurements, since there are nonzero concentrations of these global fallout radionuclides in people who have not been occupationally exposed. The method does not work for the 239Pu measurements in non-occupationally exposed people because the population average is essentially zero.

A points-based algorithm for prognosticating clinical outcome of Chiari malformation Type I with syringomyelia: results from a predictive model analysis of 82 surgically managed adult patients.

Science.gov (United States)

Thakar, Sumit; Sivaraju, Laxminadh; Jacob, Kuruthukulangara S; Arun, Aditya Atal; Aryan, Saritha; Mohan, Dilip; Sai Kiran, Narayanam Anantha; Hegde, Alangar S

2018-01-01

OBJECTIVE Although various predictors of postoperative outcome have been previously identified in patients with Chiari malformation Type I (CMI) with syringomyelia, there is no known algorithm for predicting a multifactorial outcome measure in this widely studied disorder. Using one of the largest preoperative variable arrays used so far in CMI research, the authors attempted to generate a formula for predicting postoperative outcome. METHODS Data from the clinical records of 82 symptomatic adult patients with CMI and altered hindbrain CSF flow who were managed with foramen magnum decompression, C-1 laminectomy, and duraplasty over an 8-year period were collected and analyzed. Various preoperative clinical and radiological variables in the 57 patients who formed the study cohort were assessed in a bivariate analysis to determine their ability to predict clinical outcome (as measured on the Chicago Chiari Outcome Scale [CCOS]) and the resolution of syrinx at the last follow-up. The variables that were significant in the bivariate analysis were further analyzed in a multiple linear regression analysis. Different regression models were tested, and the model with the best prediction of CCOS was identified and internally validated in a subcohort of 25 patients. RESULTS There was no correlation between CCOS score and syrinx resolution (p = 0.24) at a mean ± SD follow-up of 40.29 ± 10.36 months. Multiple linear regression analysis revealed that the presence of gait instability, obex position, and the M-line-fourth ventricle vertex (FVV) distance correlated with CCOS score, while the presence of motor deficits was associated with poor syrinx resolution (p ≤ 0.05). The algorithm generated from the regression model demonstrated good diagnostic accuracy (area under curve 0.81), with a score of more than 128 points demonstrating 100% specificity for clinical improvement (CCOS score of 11 or greater). The model had excellent reliability (κ = 0.85) and was validated with

Monosomy 3 by FISH in uveal melanoma: variability in techniques and results.

Science.gov (United States)

Aronow, Mary; Sun, Yang; Saunthararajah, Yogen; Biscotti, Charles; Tubbs, Raymond; Triozzi, Pierre; Singh, Arun D

2012-09-01

Tumor monosomy 3 confers a poor prognosis in patients with uveal melanoma. We critically review the techniques used for fluorescence in situ hybridization (FISH) detection of monosomy 3 in order to assess variability in practice patterns and to explain differences in results. Significant variability that has likely affected reported results was found in tissue sampling methods, selection of FISH probes, number of cells counted, and the cut-off point used to determine monosomy 3 status. Clinical parameters and specific techniques employed to report FISH results should be specified so as to allow meta-analysis of published studies. FISH-based detection of monosomy 3 in uveal melanoma has not been performed in a standardized manner, which limits conclusions regarding its clinical utility. FISH is a widely available, versatile technology, and when performed optimally has the potential to be a valuable tool for determining the prognosis of uveal melanoma. Copyright © 2012 Elsevier Inc. All rights reserved.

The delay effect on outcome evaluation: results from an Event-related Potential study

Directory of Open Access Journals (Sweden)

Chen eQu

2013-11-01

Full Text Available Behavioral studies demonstrate that the timing of receiving gains or losses affects decision-making, a phenomenon known as temporal discounting, as participants are inclined to prefer immediate rewards over delayed ones and vice versa for losses. The present study used the event-related potential (ERP technique with a simple gambling task to investigate how delayed rewards and losses affected the brain activity in outcome evaluations made by 20 young adults. Statistical analysis revealed a larger feedback related negativity (FRN effect between loss and gain following immediate outcomes than following future outcomes. In addition, delay impacted FRN only in gain conditions, with delayed winning eliciting a more negative FRN than immediatewinning. These results suggest that temporal discounting and sign effect could be encoded in the FRN in the early stage of outcome evaluation.

Psychological contract breach and outcomes: Combining meta-analysis and structural equation models.

Science.gov (United States)

Topa Cantisano, Gabriela; Morales Domínguez, J Francisco; Depolo, Marco

2008-08-01

In this study, meta-analytic procedures were used to examine the relationships between psychological contract perceived breach and certain outcome variables, such as organizational commitment, job satisfaction and organizational citizenship behaviours (OCB). Our review of the literature generated 41 independent samples in which perceived breach was used as a predictor of these personal and organizational outcomes. A medium effect size (ES) for desirable outcomes (job satisfaction, organizational commitment, organizational trust, OCB and performance) was obtained (r=-.35). For undesirable outcomes (neglect in role duties and intention to leave), ES were also medium (r=.31). When comparing attitudinal (job satisfaction, organizational commitment, organizational trust) and behavioural outcomes (OCB, neglect in role duties and performance), a stronger ES was found for attitudinal (r=-.24) than for behavioural outcomes (r=-.11). Potential moderator variables were examined, and it was found that they explained only a percentage of variability of primary studies. Structural equation analysis of the pooled meta-analytical correlation matrix indicated that the relationships of perceived breach with satisfaction, OCB, intention to leave and performance are fully mediated by organizational trust and commitment. Results are discussed in order to suggest theoretical and empirical implications.

Impact of hospital atmosphere on perceived health care outcome.

Science.gov (United States)

Narang, Ritu; Polsa, Pia; Soneye, Alabi; Fuxiang, Wei

2015-01-01

Healthcare service quality studies primarily examine the relationships between patients' perceived quality and satisfaction with healthcare services, clinical effectiveness, service use, recommendations and value for money. These studies suggest that patient-independent quality dimensions (structure, process and outcome) are antecedents to quality. The purpose of this paper is to propose an alternative by looking at the relationship between hospital atmosphere and healthcare quality with perceived outcome. Data were collected from Finland, India, Nigeria and the People's Republic of China. Regression analysis used perceived outcome as the dependent variable and atmosphere and healthcare service quality as independent variables. Findings - Results showed that atmosphere and healthcare service quality have a statistically significant relationship with patient perceived outcomes. The sample size was small and the sampling units were selected on convenience; thus, caution must be exercised in generalizing the findings. The study determined that service quality and atmosphere are considered significant for developing and developed nations. This result could have significant implications for policy makers and service providers developing healthcare quality and hospital atmosphere. Studies concentrate on healthcare outcome primarily regarding population health status, mortality, morbidity, customer satisfaction, loyalty, quality of life, customer behavior and consumption. However, the study exposes how patients perceive their health after treatment. Furthermore, the authors develop the healthcare service literature by considering atmosphere and perceived outcome.

Randomized trials, generalizability, and meta-analysis: Graphical insights for binary outcomes

Directory of Open Access Journals (Sweden)

Kramer Barnett S

2003-06-01

Full Text Available Abstract Background Randomized trials stochastically answer the question. "What would be the effect of treatment on outcome if one turned back the clock and switched treatments in the given population?" Generalizations to other subjects are reliable only if the particular trial is performed on a random sample of the target population. By considering an unobserved binary variable, we graphically investigate how randomized trials can also stochastically answer the question, "What would be the effect of treatment on outcome in a population with a possibly different distribution of an unobserved binary baseline variable that does not interact with treatment in its effect on outcome?" Method For three different outcome measures, absolute difference (DIF, relative risk (RR, and odds ratio (OR, we constructed a modified BK-Plot under the assumption that treatment has the same effect on outcome if either all or no subjects had a given level of the unobserved binary variable. (A BK-Plot shows the effect of an unobserved binary covariate on a binary outcome in two treatment groups; it was originally developed to explain Simpsons's paradox. Results For DIF and RR, but not OR, the BK-Plot shows that the estimated treatment effect is invariant to the fraction of subjects with an unobserved binary variable at a given level. Conclusion The BK-Plot provides a simple method to understand generalizability in randomized trials. Meta-analyses of randomized trials with a binary outcome that are based on DIF or RR, but not OR, will avoid bias from an unobserved covariate that does not interact with treatment in its effect on outcome.

Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes.

Science.gov (United States)

Ghidini, Filippo; Sekulovic, Sasa; Castagnetti, Marco

2016-03-01

Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients. Copyright © 2016 American Urological Association Education and Research, Inc

Masculine role adherence and outcomes among men with traumatic brain injury.

Science.gov (United States)

Schopp, Laura H; Good, Glenn E; Barker, Katharine B; Mazurek, Micah O; Hathaway, Stefani L

2006-10-01

Traumatic brain injury (TBI) is a significant health problem disproportionately affecting men and is often associated with changes in masculine role functioning in life domains such as vocational functioning, sexual and inter-personal functioning and personal independence. These changes could have serious implications for men's adjustment following injury. The aim of this study was to examine the relations among traditional masculine role adherence, psychosocial adjustment and rehabilitation outcomes in men with TBI. A correlational design was chosen to examine the relations among variables. Spearman correlations and Wilcoxon Rank Sum tests were used to examine relationships between masculine role variables and outcome variables. The study included 33 men with TBI who had been discharged from inpatient rehabilitation within 5 years. Participants completed surveys on traditional masculine gender role adherence and gender role conflict and additional data, including measures of functional outcome, life satisfaction, psychosocial outcomes and earnings, were obtained through the TBI Model System longitudinal data collection system. The results revealed significant associations between masculine role adherence and satisfaction with life, follow-up earnings and FIM change from admission to discharge. In the current study, particular masculine role variables corresponded to different functional and psychological outcomes. Understanding these differences provides new directions for treatment and offers important information about aspects of traditional masculine roles that may enhance or hinder adjustment to injury.

Variable mechanical ventilation.

Science.gov (United States)

Fontela, Paula Caitano; Prestes, Renata Bernardy; Forgiarini, Luiz Alberto; Friedman, Gilberto

2017-01-01

To review the literature on the use of variable mechanical ventilation and the main outcomes of this technique. Search, selection, and analysis of all original articles on variable ventilation, without restriction on the period of publication and language, available in the electronic databases LILACS, MEDLINE®, and PubMed, by searching the terms "variable ventilation" OR "noisy ventilation" OR "biologically variable ventilation". A total of 36 studies were selected. Of these, 24 were original studies, including 21 experimental studies and three clinical studies. Several experimental studies reported the beneficial effects of distinct variable ventilation strategies on lung function using different models of lung injury and healthy lungs. Variable ventilation seems to be a viable strategy for improving gas exchange and respiratory mechanics and preventing lung injury associated with mechanical ventilation. However, further clinical studies are necessary to assess the potential of variable ventilation strategies for the clinical improvement of patients undergoing mechanical ventilation.

An impossibility theorem for parameter independent hidden variable theories

Science.gov (United States)

Leegwater, Gijs

2016-05-01

Recently, Roger Colbeck and Renato Renner (C&R) have claimed that '[n]o extension of quantum theory can have improved predictive power' (Colbeck & Renner, 2011, 2012b). If correct, this is a spectacular impossibility theorem for hidden variable theories, which is more general than the theorems of Bell (1964) and Leggett (2003). Also, C&R have used their claim in attempt to prove that a system's quantum-mechanical wave function is in a one-to-one correspondence with its 'ontic' state (Colbeck & Renner, 2012a). C&R's claim essentially means that in any hidden variable theory that is compatible with quantum-mechanical predictions, probabilities of measurement outcomes are independent of these hidden variables. This makes such variables otiose. On closer inspection, however, the generality and validity of the claim can be contested. First, it is based on an assumption called 'Freedom of Choice'. As the name suggests, this assumption involves the independence of an experimenter's choice of measurement settings. But in the way C&R define this assumption, a no-signalling condition is surreptitiously presupposed, making the assumption less innocent than it sounds. When using this definition, any hidden variable theory violating parameter independence, such as Bohmian Mechanics, is immediately shown to be incompatible with quantum-mechanical predictions. Also, the argument of C&R is hard to follow and their mathematical derivation contains several gaps, some of which cannot be closed in the way they suggest. We shall show that these gaps can be filled. The issue with the 'Freedom of Choice' assumption can be circumvented by explicitly assuming parameter independence. This makes the result less general, but better founded. We then obtain an impossibility theorem for hidden variable theories satisfying parameter independence only. As stated above, such hidden variable theories are impossible in the sense that any supplemental variables have no bearing on outcome probabilities

Clinical outcomes of pars plicata anterior vitrectomy: 2-year results

Directory of Open Access Journals (Sweden)

Priya Narang

2015-01-01

Full Text Available Purpose: To demonstrate the safety and outcome of a surgical approach that uses pars plicata site for anterior vitrectomy during phacoemulsification procedure complicated by posterior capsule rupture and residual cortical matter. Design: Single center, retrospective, interventional, noncomparative study. Materials and Methods: Medical records of a consecutive series of 35 eyes of 35 patients who underwent pars plicata anterior vitrectomy (PPAV were reviewed. The main outcome measures were corrected and uncorrected distance visual acuity (CDVA, UDVA, early and late postoperative complications and intraocular pressure (IOP. Ultrasound biomicroscopic (UBM evaluation of sclerotomy site and spectral domain optical coherence tomography analysis for central macular thickness (CMT was performed. The final visual outcome at 2 years was evaluated. Results: At 2 years follow-up, the mean postoperative UDVA (logarithm of the minimum angle of resolution [logMAR] and CDVA (logMAR was 0.49 ± 0.26 and 0.19 ± 0.14, respectively. There was no significant change in the IOP (P = 0.061 and the mean CMT at 2 years was 192.5 ± 5.54 mm. The postoperative UBM image of the sclerotomy site at 8 weeks demonstrated a clear wound without any vitreous adhesion or incarceration. Intraoperative hyphema was seen in 1 (2.8% case and postoperative uveitis was seen in 2 (5.7% cases, which resolved with medications. No case of an iatrogenic retinal break or retinal detachment was reported. Conclusions: PPAV enables a closed chamber approach, allows thorough cleanup of vitreous in the pupillary plane and anterior chamber and affords better access to the subincisional and retropupillary cortical remnant with a significant visual outcome and an acceptable complication rate.

One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

Science.gov (United States)

Kejriwal, Ritwik; Buelow, Jens

2017-01-01

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

What predictors matter: Risk factors for late adolescent outcomes.

Science.gov (United States)

Wall-Wieler, Elizabeth; Roos, Leslie L; Chateau, Dan G; Rosella, Laura C

2016-06-27

A life course approach and linked Manitoba data from birth to age 18 were used to facilitate comparisons of two important outcomes: high school graduation and Attention-Deficit/Hyperactivity Disorder (ADHD). With a common set of variables, we sought to answer the following questions: Do the measures predicting high school graduation differ from those that predict ADHD? Which factors are most important? How well do the models fit each outcome? Administrative data from the Population Health Research Data Repository at the Manitoba Centre for Health Policy were used to conduct one of the strongest observational designs: multilevel modelling of large population (n = 62,739) and sibling (n = 29,444) samples. Variables included are neighbourhood characteristics, measures of family stability, and mental and physical health conditions in childhood and adolescence. The adverse childhood experiences important for each outcome differ. While family instability and economic adversity more strongly affect failing to graduate from high school, adverse health events in childhood and early adolescence have a greater effect on late adolescent ADHD. The variables included in the model provided excellent accuracy and discrimination. These results offer insights on the role of several family and social variables and can serve as the basis for reliable, valid prediction tools that can identify high-risk individuals. Applying such a tool at the population level would provide insight into the future burden of these outcomes in an entire region or nation and further quantify the burden of risk in the population.

Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

Directory of Open Access Journals (Sweden)

Tumul Chowdhury

2013-01-01

Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

Measuring Networking as an Outcome Variable in Undergraduate Research Experiences.

Science.gov (United States)

Hanauer, David I; Hatfull, Graham

2015-01-01

The aim of this paper is to propose, present, and validate a simple survey instrument to measure student conversational networking. The tool consists of five items that cover personal and professional social networks, and its basic principle is the self-reporting of degrees of conversation, with a range of specific discussion partners. The networking instrument was validated in three studies. The basic psychometric characteristics of the scales were established by conducting a factor analysis and evaluating internal consistency using Cronbach's alpha. The second study used a known-groups comparison and involved comparing outcomes for networking scales between two different undergraduate laboratory courses (one involving a specific effort to enhance networking). The final study looked at potential relationships between specific networking items and the established psychosocial variable of project ownership through a series of binary logistic regressions. Overall, the data from the three studies indicate that the networking scales have high internal consistency (α = 0.88), consist of a unitary dimension, can significantly differentiate between research experiences with low and high networking designs, and are related to project ownership scales. The ramifications of the networking instrument for student retention, the enhancement of public scientific literacy, and the differentiation of laboratory courses are discussed. © 2015 D. I. Hanauer and G. Hatfull. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Patient-Therapist Identification in Relation to Both Patient and Therapist Variables and Therapy Outcome

Science.gov (United States)

Melnick, Barry

1972-01-01

The results of the study confirmed the hypothesis that greater patient identification with the therapist, as defined by increased similarity between the patient's and therapist's semantic differential ratings, moderately correlated with more successful therapy outcome. (Author)

Outcome measurements in major trauma--results of a consensus meeting.

Science.gov (United States)

Ardolino, A; Sleat, G; Willett, K

2012-10-01

The NHS Outcomes Framework for England has identified recovery from major injury as an important clinical area. At present, there are no established outcome indicators. As more patients survive major trauma, outcomes will need to be measured in terms of morbidity and not mortality alone. To make recommendations for a selection of outcome measures that could be integrated into National Clinical Audit data collection and form part of clinical governance requirements for Regional Trauma Networks (RTNs) and measures by which RTNs are held to account by government. Specific focus was given to acute care and rehabilitation for both adults and children. A Multiprofessional, multidisciplinary expert group reviewed the current evidence on outcome measures for major trauma in the adult and children's populations, informed by a systematic review carried out jointly by the Trauma Audit and Research Network (TARN) and the Cochrane Injuries Group. A structured discussion covered functional and quality of life outcome measures as well as patient experience and indicators such as return to work, education and social dependency. For the adult population the group agreed with the in-hospital performance and hospital discharge measures recommended in the TARN and Cochrane systematic review. Concerning longer-term outcome indicators, the group suggested the use of the Glasgow Outcome Scale - Extended (GOS-E) and European Quality of Life 5D (EQ-5D) with consideration to be given to the World Health Organisation Quality of Life survey (WHO-QoL). For patients who had ongoing inpatient rehabilitation needs the group thought the measurement of the Rehabilitation Complexity Scale (RCS) and Functional Independence Measure (FIM) were important in total brain injury and, the American Spinal Injury Association Impairment Scale (ASIA) and Spinal Cord Independence Measure (SCIM) in spinal cord injury. For children the group recommended the use of the King's Outcome Scale for Childhood Head Injury

Client Predictors of Short-term Psychotherapy Outcomes among Asian and White American Outpatients

Science.gov (United States)

Kim, Jin E.; Zane, Nolan W.; Blozis, Shelley A.

2015-01-01

Purpose To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients. Method Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pre-treatment, and outcomes were measured post-fourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators. Results Higher levels of somatic symptoms predicted lower psychosocial functioning at post-treatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style. Conclusions Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes. PMID:22836681

Clinical Operations Variables are Associated With Blood Pressure Outcomes.

Science.gov (United States)

Kressin, Nancy R; Lasser, Karen E; Paasche-Orlow, Michael; Allison, Jeroan; Ash, Arlene S; Adams, William G; Shanahan, Christopher W; Legler, Aaron; Pizer, Steven D

2015-06-01

Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. To assess clinical operations factors' effects on normalization of uncontrolled BP. Observational cohort study. Patients diagnosed with hypertension from a large urban clinical practice (2005-2009). We obtained clinical data on BP, organized by person-month, and administrative data on primary care provider (PCP) staffing. We assessed the resolution of an episode of uncontrolled BP as a function of time-varying covariates including practice-level appointment volume, individual clinicians' appointment volume, overall practice-level PCP staffing, and number of unique PCPs. Among the 7409 unique patients representing 50,403 person-months, normalization was less likely for the patients in whom the episode starts during months when the number of unique PCPs were high [the top quintile of unique PCPs was associated with a 9 percentage point lower probability of normalization (Ppercentage point reduction in the probability of normalization (P=0.01)]. Neither clinician appointment volume nor practice clinician staffing levels were significantly associated with the probability of normalization. Findings suggest that clinical operations factors can affect clinical outcomes like BP normalization, and point to the importance of considering outcome effects when organizing clinical care.

Predictors of outcome for cognitive behaviour therapy in binge eating disorder.

Science.gov (United States)

Lammers, Mirjam W; Vroling, Maartje S; Ouwens, Machteld A; Engels, Rutger C M E; van Strien, Tatjana

2015-05-01

The aim of this naturalistic study was to identify pretreatment predictors of response to cognitive behaviour therapy in treatment-seeking patients with binge eating disorder (BED; N = 304). Furthermore, we examined end-of-treatment factors that predict treatment outcome 6 months later (N = 190). We assessed eating disorder psychopathology, general psychopathology, personality characteristics and demographic variables using self-report questionnaires. Treatment outcome was measured using the bulimia subscale of the Eating Disorder Inventory 1. Predictors were determined using hierarchical linear regression analyses. Several variables significantly predicted outcome, four of which were found to be both baseline predictors of treatment outcome and end-of-treatment predictors of follow-up: Higher levels of drive for thinness, higher levels of interoceptive awareness, lower levels of binge eating pathology and, in women, lower levels of body dissatisfaction predicted better outcome in the short and longer term. Based on these results, several suggestions are made to improve treatment outcome for BED patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

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

Science.gov (United States)

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

2014-04-01

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

Potential fitting biases resulting from grouping data into variable width bins

International Nuclear Information System (INIS)

Towers, S.

2014-01-01

When reading peer-reviewed scientific literature describing any analysis of empirical data, it is natural and correct to proceed with the underlying assumption that experiments have made good faith efforts to ensure that their analyses yield unbiased results. However, particle physics experiments are expensive and time consuming to carry out, thus if an analysis has inherent bias (even if unintentional), much money and effort can be wasted trying to replicate or understand the results, particularly if the analysis is fundamental to our understanding of the universe. In this note we discuss the significant biases that can result from data binning schemes. As we will show, if data are binned such that they provide the best comparison to a particular (but incorrect) model, the resulting model parameter estimates when fitting to the binned data can be significantly biased, leading us to too often accept the model hypothesis when it is not in fact true. When using binned likelihood or least squares methods there is of course no a priori requirement that data bin sizes need to be constant, but we show that fitting to data grouped into variable width bins is particularly prone to produce biased results if the bin boundaries are chosen to optimize the comparison of the binned data to a wrong model. The degree of bias that can be achieved simply with variable binning can be surprisingly large. Fitting the data with an unbinned likelihood method, when possible to do so, is the best way for researchers to show that their analyses are not biased by binning effects. Failing that, equal bin widths should be employed as a cross-check of the fitting analysis whenever possible

Potential fitting biases resulting from grouping data into variable width bins

Energy Technology Data Exchange (ETDEWEB)

Towers, S., E-mail: smtowers@asu.edu

2014-07-30

When reading peer-reviewed scientific literature describing any analysis of empirical data, it is natural and correct to proceed with the underlying assumption that experiments have made good faith efforts to ensure that their analyses yield unbiased results. However, particle physics experiments are expensive and time consuming to carry out, thus if an analysis has inherent bias (even if unintentional), much money and effort can be wasted trying to replicate or understand the results, particularly if the analysis is fundamental to our understanding of the universe. In this note we discuss the significant biases that can result from data binning schemes. As we will show, if data are binned such that they provide the best comparison to a particular (but incorrect) model, the resulting model parameter estimates when fitting to the binned data can be significantly biased, leading us to too often accept the model hypothesis when it is not in fact true. When using binned likelihood or least squares methods there is of course no a priori requirement that data bin sizes need to be constant, but we show that fitting to data grouped into variable width bins is particularly prone to produce biased results if the bin boundaries are chosen to optimize the comparison of the binned data to a wrong model. The degree of bias that can be achieved simply with variable binning can be surprisingly large. Fitting the data with an unbinned likelihood method, when possible to do so, is the best way for researchers to show that their analyses are not biased by binning effects. Failing that, equal bin widths should be employed as a cross-check of the fitting analysis whenever possible.

Phase Synchronization in Electroencephalographic Recordings Prognosticates Outcome in Paediatric Coma

Science.gov (United States)

Nenadovic, Vera; Perez Velazquez, Jose Luis; Hutchison, James Saunders

2014-01-01

Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG) phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000–2010) analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8) admitted to the paediatric critical care unit (PCCU) following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC) based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index), a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome. PMID:24752289

Shifting management of a community volunteer system for improved child health outcomes: results from an operations research study in Burundi.

Science.gov (United States)

Weiss, Jennifer; Makonnen, Raphael; Sula, Delphin

2015-01-01

Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson's chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.

Science.gov (United States)

Baugh, Nancy; Harris, David E; Aboueissa, AbouEl-Makarim; Sarton, Cheryl; Lichter, Erika

2016-01-01

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

Directory of Open Access Journals (Sweden)

Nancy Baugh

2016-01-01

Full Text Available The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU, and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

Evaluation of functional outcome of the floating knee injury using multivariate analysis.

Science.gov (United States)

Yokoyama, Kazuhiko; Tsukamoto, Tatsuro; Aoki, Shinichi; Wakita, Ryuji; Uchino, Masataka; Noumi, Takashi; Fukushima, Nobuaki; Itoman, Moritoshi

2002-11-01

The objective of this study is to evaluate significant contributing factors affecting the functional prognosis of floating knee injuries using multivariate analysis. A total of 68 floating knee injuries (67 patients) were treated at Kitasato University Hospital from 1986 to 1999. Both the femoral fractures and the tibial fractures were managed surgically by various methods. The functional results of these injuries were evaluated using the grading system of Karlström and Olerud. Follow-up periods ranged from 2 to 19 years (mean 50.2 months) after the original injury. We defined satisfactory (S) outcomes as those cases with excellent or good results and unsatisfactory (US) outcomes as those cases with acceptable or poor results. Logistic regression analysis was used as a multivariate analysis, and the dependent variables were defined as a satisfactory outcome or as an unsatisfactory outcome. The explanatory variables were predicting factors influencing the functional outcome such as age at trauma, gender, severity of soft-tissue injury in the femur and the tibia, AO fracture grade in the femur and the tibia, Fraser type (type I or type II), Injury Severity Score (ISS), and fixation time after injury (less than 1 week or more than 1 week) in the femur and the tibia. The final functional results were as follows: 25 cases had excellent results, 15 cases good results, 16 cases acceptable results, and 12 cases poor results. The predictive logistic regression equation was as follows: Log 1-p/p = 3.12-1.52 x Fraser type - 1.65 x severity of soft-tissue injury in the tibia - 1.31 x fixation time after injury in the tibia - 0.821 x AO fracture grade in the tibia + 1.025 x fixation time after injury in the femur - 0.687 x AO fracture grade in the femur ( p=0.01). Among the variables, Fraser type and the severity of soft-tissue injury in the tibia were significantly related to the final result. The multivariate analysis showed that both the involvement of the knee joint and

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

Science.gov (United States)

Mroz, T A

1999-10-01

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

Results of a Pilot Study to Ameliorate Psychological and Behavioral Outcomes of Minority Stress Among Young Gay and Bisexual Men.

Science.gov (United States)

Smith, Nathan Grant; Hart, Trevor A; Kidwai, Ammaar; Vernon, Julia R G; Blais, Martin; Adam, Barry

2017-09-01

Project PRIDE (Promoting Resilience In Discriminatory Environments) is an 8-session small group intervention aimed at reducing negative mental and behavioral health outcomes resulting from minority stress. This study reports the results of a one-armed pilot test of Project PRIDE, which aimed to examine the feasibility and potential for efficacy of the intervention in a sample of 33 gay and bisexual men aged 18 to 25. The intervention appeared feasible to administer in two different sites and all participants who completed posttreatment (n = 22) or follow-up (n = 19) assessments reported high satisfaction with the intervention. Small to large effect sizes were observed for increases in self-esteem; small effect sizes were found for decreases in loneliness and decreases in minority stress variables; and small and medium effect sizes were found for reductions in alcohol use and number of sex partners, respectively. Overall, Project PRIDE appears to be a feasible intervention with promise of efficacy. Copyright © 2017. Published by Elsevier Ltd.

Student Self-Reported Learning Outcomes of Field Trips: The pedagogical impact

Science.gov (United States)

Lavie Alon, Nirit; Tal, Tali

2015-05-01

In this study, we used the classification and regression trees (CART) method to draw relationships between student self-reported learning outcomes in 26 field trips to natural environments and various characteristics of the field trip that include variables associated with preparation and pedagogy. We wished to examine the extent to which the preparation for the field trip, its connection to the school curriculum, and the pedagogies used, affect students' self-reported outcomes in three domains: cognitive, affective, and behavioral; and the extent the students' socioeconomic group and the guide's affiliation affect students' reported learning outcomes. Given that most of the field trips were guide-centered, the most important variable that affected the three domains of outcomes was the guide's storytelling. Other variables that showed relationships with self-reported outcomes were physical activity and making connections to everyday life-all of which we defined as pedagogical variables. We found no significant differences in student self-reported outcomes with respect to their socioeconomic group and the guide's organizational affiliation.

Variable sleep schedules and outcomes in children with psychopathological problems: preliminary observations

Directory of Open Access Journals (Sweden)

Spruyt K

2012-02-01

Full Text Available Karen Spruyt1, Danielle L Raubuck2, Katie Grogan2, David Gozal1, Mark A Stein21Department of Pediatrics and Comer Children’s Hospital, Pritzker School of Medicine, University of Chicago, Chicago, IL; 2Institute for Juvenile Research, Hyperactivity and Learning Problems Clinic, University of Illinois at Chicago, Chicago, ILBackground: Night-to-night variability in sleep of children with attention deficit hyperactivity disorder (ADHD may be a mediator of behavioral phenotype. We examined the potential association between alertness, sleep, and eating behaviors in children with ADHD and comorbid problems.Methods: Sleep was monitored by actigraphy for 7 days. Questionnaires were used to assess sleep complaints, habits and food patterns by parental report, and sleep complaints and sleepiness by child report.Results: The group comprised 18 children, including 15 boys, aged 9.4 ± 1.7 years, 88.9% Caucasian, who took one or multiple medications. Children slept on average for 6 hours and 58 minutes with a variability of 1 hour 3 minutes relative to the mean, and their sleepiness scores were highly variable from day to day. Most children had a normal body mass index (BMI. Sleepiness and BMI were associated with sleep schedules and food patterns, such that they accounted for 76% of variance, predominantly by the association of BMI with mean wake after sleep onset and by bedtime sleepiness, with wake after sleep onset variability. Similarly, 97% of variance was shared with eating behaviors, such as desserts and snacks, and fast food meals were associated with morning sleepiness.Conclusion: Disrupted sleep and sleepiness appears to favor unhealthy food patterns and may place children with ADHD at increased risk for obesity.Keywords: sleep, child, attention deficit hyperactivity disorder, actigraphy

NOx emissions from large point sources: variability in ozone production, resulting health damages and economic costs

International Nuclear Information System (INIS)

Mauzerall, D.L.; Namsoug Kim

2005-01-01

We present a proof-of-concept analysis of the measurement of the health damage of ozone (O 3 ) produced from nitrogen oxides (NO x =NO+NO 2 ) emitted by individual large point sources in the eastern United States. We use a regional atmospheric model of the eastern United States, the Comprehensive Air quality Model with Extensions (CAMx), to quantify the variable impact that a fixed quantity of NO x emitted from individual sources can have on the downwind concentration of surface O 3 , depending on temperature and local biogenic hydrocarbon emissions. We also examine the dependence of resulting O 3 -related health damages on the size of the exposed population. The investigation is relevant to the increasingly widely used 'cap and trade' approach to NO x regulation, which presumes that shifts of emission over time and space, holding the total fixed over the course of the summer O 3 season, will have minimal effect on the environmental outcome. By contrast, we show that a shift of a unit of NO x emissions from one place or time to another could result in large changes in resulting health effects due to O 3 formation and exposure. We indicate how the type of modeling carried out here might be used to attach externality-correcting prices to emissions. Charging emitters fees that are commensurate with the damage caused by their NO x emissions would create an incentive for emitters to reduce emissions at times and in locations where they cause the largest damage. (author)

Outcomes of splenectomy in patients with common variable immunodeficiency (CVID): a survey of 45 patients

Science.gov (United States)

Wong, G K; Goldacker, S; Winterhalter, C; Grimbacher, B; Chapel, H; Lucas, M; Alecsandru, D; McEwen, D; Quinti, I; Martini, H; Schmidt, R E; Ernst, D; Espanol, T; Vidaller, A; Carbone, J; Fernandez-Cruz, E; Lougaris, V; Plebani, A; Kutukculer, N; Gonzalez-Granado, L I; Contreras, R; Kiani-Alikhan, S; Ibrahim, M A A; Litzman, J; Jones, A; Gaspar, H B; Hammarstrom, L; Baumann, U; Warnatz, K; Huissoon, A P

2013-01-01

Splenectomy has been used in patients with common variable immunodeficiency disorders (CVID), mainly in the context of refractory autoimmune cytopenia and suspected lymphoma, but there are understandable concerns about the potential of compounding an existing immunodeficiency. With increasing use of rituximab as an alternative treatment for refractory autoimmune cytopenia, the role of splenectomy in CVID needs to be re-examined. This retrospective study provides the largest cohesive data set to date describing the outcome of splenectomy in 45 CVID patients in the past 40 years. Splenectomy proved to be an effective long-term treatment in 75% of CVID patients with autoimmune cytopenia, even in some cases when rituximab had failed. Splenectomy does not worsen mortality in CVID and adequate immunoglobulin replacement therapy appears to play a protective role in overwhelming post-splenectomy infections. Future trials comparing the effectiveness and safety of rituximab and splenectomy are needed to provide clearer guidance on the second-line management of autoimmune cytopenia in CVID. PMID:23480186

Clinical results and functional outcomes after direct intralaminar screw repair of spondylolysis.

Science.gov (United States)

Menga, Emmanuel N; Kebaish, Khaled M; Jain, Amit; Carrino, John A; Sponseller, Paul D

2014-01-01

Prospective analysis. Our objective was to analyze clinical and functional results of patients with spondylolysis treated via direct intralaminar screw fixation and autograft, a minimally invasive and motion-preserving surgery. Spondylolysis is usually treated nonoperatively; multiple surgical techniques are available when nonoperative measures fail. No studies evaluate the clinical and functional outcomes and their correlation with pars defect size and disc morphology on magnetic resonance imaging. We reviewed patients with spondylolysis treated with intralaminar screw fixation and bone grafting from 2000 through 2010. Of the 31 patients (mean age, 16 yr; range, 10-37 yr), 25 (81%) were competitive athletes. Preoperative computed tomographic scans were used to measure the pars defect size, and preoperative magnetic resonance images were graded using Pfirrmann classification for correlation with postoperative outcomes. Student t test was used for analysis (significance, P spondylolysis repair for persistent pain starting 18 months after intralaminar screw fixation, 2 patients sustained unilateral intralaminar screw fractures at L5, and 1 patient required irrigation and debridement for a superficial postoperative infection. There was no correlation among preoperative magnetic resonance imaging disc morphology, defect size on computed tomography, patient age, and clinical outcomes. Direct repair of spondylolysis with intralaminar screws offers a low profile, reliable treatment with good functional outcome and a low complication rate in active patients. 4.

Bias formulas for sensitivity analysis of unmeasured confounding for general outcomes, treatments, and confounders.

Science.gov (United States)

Vanderweele, Tyler J; Arah, Onyebuchi A

2011-01-01

Uncontrolled confounding in observational studies gives rise to biased effect estimates. Sensitivity analysis techniques can be useful in assessing the magnitude of these biases. In this paper, we use the potential outcomes framework to derive a general class of sensitivity-analysis formulas for outcomes, treatments, and measured and unmeasured confounding variables that may be categorical or continuous. We give results for additive, risk-ratio and odds-ratio scales. We show that these results encompass a number of more specific sensitivity-analysis methods in the statistics and epidemiology literature. The applicability, usefulness, and limits of the bias-adjustment formulas are discussed. We illustrate the sensitivity-analysis techniques that follow from our results by applying them to 3 different studies. The bias formulas are particularly simple and easy to use in settings in which the unmeasured confounding variable is binary with constant effect on the outcome across treatment levels.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature.

Science.gov (United States)

MacAllister, Lorissa; Zimring, Craig; Ryherd, Erica

2016-10-01

Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research. © The Author(s) 2016.

Trochleoplasty as a Solitary Treatment for Recurrent Patellar Dislocation Results in Good Clinical Outcome in Adolescents.

Science.gov (United States)

Camathias, Carlo; Studer, Katrin; Kiapour, Ata; Rutz, Erich; Vavken, Patrick

2016-11-01

The essential static patellar stabilizer is a normal-shaped trochlear groove. A dysplastic groove destabilizes the patella. Trochleoplasty approaches this underlying condition and reshapes the trochlea. However, studies have reported on trochleoplasty for revision cases or as accompanied by other interventions. The effect of trochleoplasty alone remains unexplained. To introduce trochleoplasty as a stand-alone treatment for recurrent patellar dislocation and to compare its pre- to postoperative functional and clinical variables. Case series; Level of evidence, 4. A trochleoplasty was performed in 50 knees (27 right) in 44 patients (30 females; mean ± SD age, 15.6 ± 2.0 years). The indication for surgery was recurrent patellar dislocation not responding to nonoperative treatment (>6 months), with types B through D dysplasia and closed or closing physes in adolescents aged 10 to 20 years. Assessment included J-sign and apprehension test, Kujala and Lysholm scores, patients' subjective assessment and activity level according to the International Knee Documentation Committee questionnaire, and patients' overall satisfaction. The Caton-Deschamps ratio and the lateral condyle index were measured. Pre- versus postoperative values were compared with a paired Wilcoxon signed-rank test. The minimum follow-up was 24 months (33 ± 10.6 months). The Kujala score improved from 71 preoperatively to 92 postoperatively (P debridement. In this study, trochleoplasty as a solitary treatment for recurrent patellofemoral dislocations in patients with trochlear dysplasia resulted in good clinical outcomes if severe torsional and axial malalignment was excluded. Kujala and Lysholm scores increased postoperatively, as well as subjective International Knee Documentation Committee assessment of outcomes, activity level, and overall satisfaction. © 2016 The Author(s).

Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years

International Nuclear Information System (INIS)

Marlovits, Stefan; Singer, Philipp; Zeller, Philip; Mandl, Irena; Haller, Joerg; Trattnig, Siegfried

2006-01-01

In an observational study, the validity and reliability of magnetic resonance imaging (MRI) for the assessment of autologous chondrocyte transplantation (ACT) in the knee joint was determined. Two years after implantation, high-resolution MRI was used to analyze the repair tissue with nine pertinent variables. A complete filling of the defect was found in 61.5%, and a complete integration of the border zone to the adjacent cartilage in 76.9%. An intact subchondral lamina was present in 84.6% and an intact subchondral bone was present in 61.5%. Isointense signal intensities of the repair tissue compared to the adjacent native cartilage were seen in 92.3%. To evaluate interobserver variability, a reliability analysis with the determination of the intraclass correlation coefficient (ICC) was calculated. An 'almost perfect' agreement, with an ICC value >0.81, was calculated in 8 of 9 variables. The clinical outcome after 2 years showed the visual analog score (VAS) at 2.62 (S.D. ±0.65). The values for the knee injury and osteoarthritis outcome score (KOOS) subgroups were 68.29 (±23.90) for pain, 62.09 (±14.62) for symptoms, 75.45 (±21.91) for ADL function, 52.69 (±28.77) for sport and 70.19 (±22.41) for knee-related quality of life. The clinical scores were correlated with the MRI variables. A statistically significant correlation was found for the variables 'filling of the defect,' 'structure of the repair tissue,' 'changes in the subchondral bone,' and 'signal intensities of the repair issue'. High resolution MRI and well-defined MRI variables are a reliable, reproducible and accurate tool for assessing cartilage repair tissue

Spontaneous Intracerebral Hemorrhage: Computed Tomographic Characteristics and Outcome

Directory of Open Access Journals (Sweden)

Aimara de la Caridad Vergara Santos

2015-12-01

Full Text Available Background: strokes are the third leading cause of death among adults and 10-15 % of them are due to spontaneous intracerebral hemorrhage. Objective: to characterize spontaneous intracerebral hemorrhage through computed tomography scan and its outcome. Methods: a case series study was conducted comprising patients diagnosed with spontaneous intracerebral hemorrhage admitted to the Arnaldo Milián Castro Provincial University Hospital in Villa Clara from January 2009 to January 2010. Tomographic variables of interest were derived from evaluation of spontaneous intracerebral hematomas. Results: fifty-nine cases of spontaneous intracerebral hemorrhage were studied, 23 were located in lobar regions, 4 had severe midline shift, and 2 showed volume greater than 80 ml. Eight out of eleven with extension into the ventricular system had an unfavorable outcome. Among those with thalamic hemorrhage, patients with diameter larger than 4cm and extension into the ventricular system died. Patients with putaminal hemorrhage larger than 4 cm and posterior fossa hematoma with hydrocephalus had a poor outcome, as well as most individuals (55 with other mass effects. Most lobar hematomas (14 out of 23 had a satisfactory outcome, unlike cerebellar and brainstem hematomas. Conclusions: tomographic variables that had a negative impact on the outcome were: volume greater than 80 ml, severe midline shift, diameter larger than 4 cm, extension into the ventricular system, hydrocephalus, other signs of mass effect and brainstem location.

Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage

NARCIS (Netherlands)

Hijdra, A.; van Gijn, J.; Nagelkerke, N. J.; Vermeulen, M.; van Crevel, H.

1988-01-01

Using logistic regression, we analyzed the predictive value of a number of entry variables with respect to the outcome variables delayed cerebral ischemia, rebleeding, and poor outcome (death or severe disability) in patients with aneurysmal subarachnoid hemorrhage. The entry variables were clinical

Accelerated partial breast irradiation: An analysis of variables associated with late toxicity and long-term cosmetic outcome after high-dose-rate interstitial brachytherapy

International Nuclear Information System (INIS)

Wazer, David E.; Kaufman, Seth; Cuttino, Laurie; Di Petrillo, Thomas; Arthur, Douglas W.

2006-01-01

Purpose: To perform a detailed analysis of variables associated with late tissue effects of high-dose-rate (HDR) interstitial brachytherapy accelerated partial breast irradiation (APBI) in a large cohort of patients with prolonged follow-up. Methods and Materials: Beginning in 1995, 75 women with Stage I/II breast cancer were enrolled in identical institutional trials evaluating APBI as monotherapy after lumpectomy. Patients eligible included those with T1-2, N0-1 (≤3 nodes positive), M0 tumors of nonlobular histology with negative surgical margins, no extracapsular nodal extension, and negative results on postexcision mammogram. All patients underwent surgical excision and postoperative irradiation with HDR interstitial brachytherapy. The planning target volume was defined as the excision cavity plus a 2-cm margin. Treatment was delivered with a high-activity Ir-192 source at 3.4 Gy per fraction twice daily for 5 days to a total dose of 34 Gy. Dosimetric analyses were performed with three-dimensional postimplant dose and volume reconstructions. All patients were evaluated at 3-6-month intervals and assessed with a standardized cosmetic rating scale and according to Radiation Therapy Oncology Group late normal tissue toxicity scoring criteria. Clinical and therapy-related features were analyzed for their relationship to cosmetic outcome and toxicity rating. Clinical features analyzed included age, volume of resection, history of diabetes or hypertension, extent of axillary surgery, and systemic therapies. Therapy-related features analyzed included volume of tissue encompassed by the 100%, 150%, and 200% isodose lines (V100, V150, and V200, respectively), the dose homogeneity index (DHI), number of source dwell positions, and planar separation. Results: The median follow-up of all patients was 73 months (range, 43-118 months). The cosmetic outcome at last follow-up was rated as excellent, good, and fair/poor in 67%, 24%, and 9% of patients, respectively

Cataract Surgery Outcomes in Glaucomatous Eyes: Results From the Veterans Affairs Ophthalmic Surgery Outcomes Data Project.

Science.gov (United States)

Turalba, Angela; Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Cakiner-Egilmez, Tulay; Chomsky, Amy S; Vollman, David E; Baze, Elizabeth F; Lawrence, Mary; Daly, Mary K

2015-10-01

To compare visual acuity outcomes, vision-related quality of life, and complications related to cataract surgery in eyes with and without glaucoma. Retrospective cohort study. Cataract surgery outcomes in cases with and without glaucoma from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project were compared. We identified 608 glaucoma cases and 4306 controls undergoing planned cataract surgery alone. After adjusting for age, pseudoexfoliation, small pupil, prior ocular surgery, and anterior chamber depth, we found that glaucoma cases were more likely to have posterior capsular tear with vitrectomy (odds ratio [OR] 1.8, P = .03) and sulcus intraocular lens placement (OR 1.65, P = .03) during cataract surgery. Glaucoma cases were more likely to have postoperative inflammation (OR 1.73, P < .0001), prolonged elevated intraocular pressure (OR 2.96, P = .0003), and additional surgery within 30 days (OR 1.92, P = .03). Mean best-corrected visual acuity (BCVA) and Visual Function Questionnaire (VFQ) scores significantly improved after cataract surgery in both groups (P < .0001), but there were larger improvements in BCVA (P = .01) and VFQ composite scores (P < .0001) in the nonglaucoma vs the glaucoma group. A total of 3621 nonglaucoma cases (94.1%) had postoperative BCVA 20/40 or better, compared to 466 glaucoma cases (89.6%) (P = .0003). Eyes with glaucoma are at increased risk for complications and have more modest visual outcomes after cataract surgery compared to eyes without glaucoma. Despite this, glaucoma patients still experience significant improvement in vision-related outcomes after cataract extraction. Further study is needed to explore potential factors that influence cataract surgery outcomes in glaucomatous eyes. Published by Elsevier Inc.

Use of social adaptability index to explain self-care and diabetes outcomes.

Science.gov (United States)

Campbell, Jennifer A; Walker, Rebekah J; Smalls, Brittany L; Egede, Leonard E

2017-06-20

To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes. Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes. Separate models were run for each self-care behavior and outcome. Two models were run for each dependent variable to compare associations with the SAI and components of the index. The SAI has a significant association with the mental component of quality of life (0.23, p < 0.01). In adjusted analyses, the SAI score did not have a significant association with any of the self-care behaviors. Individual components from the index had significant associations between self-care and multiple SAI indicator variables. Significant associations also exist between outcomes and the individual SAI indicators for education and employment. In this population, the SAI has low explanatory power and few significant associations with diabetes self-care/outcomes. While the use of a composite index to predict outcomes within a diabetes population would have high utility, particularly for clinical settings, this SAI lacks statistical and clinical significance in a representative diabetes population. Based on these results, the index does not provide a good model fit and masks the relationship of individual components to diabetes self-care and outcomes. These findings suggest that five items alone are not adequate to explain or predict outcomes for patients with type 2 diabetes.

Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.

Science.gov (United States)

Wolf, Brian R; Ramme, Austin J; Wright, Rick W; Brophy, Robert H; McCarty, Eric C; Vidal, Armando R; Parker, Richard D; Andrish, Jack T; Amendola, Annunziato

2013-06-01

Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/ The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. Cross-sectional study; Level of evidence, 3. Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth

Maintained intentional weight loss reduces cardiovascular outcomes: results from the Sibutramine Cardiovascular OUTcomes (SCOUT) trial.

Science.gov (United States)

Caterson, I D; Finer, N; Coutinho, W; Van Gaal, L F; Maggioni, A P; Torp-Pedersen, C; Sharma, A M; Legler, U F; Shepherd, G M; Rode, R A; Perdok, R J; Renz, C L; James, W P T

2012-06-01

The Sibutramine Cardiovascular OUTcomes trial showed that sibutramine produced greater mean weight loss than placebo but increased cardiovascular morbidity but not mortality. The relationship between 12-month weight loss and subsequent cardiovascular outcomes is explored. Overweight/obese subjects (N = 10 744), ≥55 years with cardiovascular disease and/or type 2 diabetes mellitus, received sibutramine plus weight management during a 6-week Lead-in Period before randomization to continue sibutramine (N = 4906) or to receive placebo (N = 4898). The primary endpoint was the time from randomization to first occurrence of a primary outcome event (non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death). For the total population, mean weight change during Lead-in Period (sibutramine) was -2.54 kg. Post-randomization, mean total weight change to Month 12 was -4.18 kg (sibutramine) or -1.87 kg (placebo). Degree of weight loss during Lead-in Period or through Month 12 was associated with a progressive reduction in risk for the total population in primary outcome events and cardiovascular mortality over the 5-year assessment. Although more events occurred in the randomized sibutramine group, on an average, a modest weight loss of approximately 3 kg achieved in the Lead-in Period appeared to offset this increased event rate. Moderate weight loss (3-10 kg) reduced cardiovascular deaths in those with severe, moderate or mild cardiovascular disease. Modest weight loss over short-term (6 weeks) and longer-term (6-12 months) periods is associated with reduction in subsequent cardiovascular mortality for the following 4-5 years even in those with pre-existing cardiovascular disease. While the sibutramine group experienced more primary outcome events than the placebo group, greater weight loss reduced overall risk of these occurring in both groups. © 2011 Blackwell Publishing Ltd.

Planned versus actual outcomes as a result of animal feeding operation decisions for managing phosphorus.

Science.gov (United States)

Cabot, Perry E; Nowak, Pete

2005-01-01

The paper explores how decisions made on animal feeding operations (AFOs) influence the management of manure and phosphorus. Variability among these decisions from operation to operation and from field to field can influence the validity of nutrient loss risk assessments. These assessments are based on assumptions that the decision outcomes regarding manure distribution will occur as they are planned. The discrepancy between planned versus actual outcomes in phosphorus management was explored on nine AFOs managing a contiguous set of 210 fields in south-central Wisconsin. A total of 2611 soil samples were collected and multiple interviews conducted to assign phosphorus index (PI) ratings to the fields. Spearman's rank correlation coefficients (r(S)) indicated that PI ratings were less sensitive to soil test phosphorus (STP) levels (r(S) = 0.378), universal soil loss equation (USLE) (r(S) = 0.261), ratings for chemical fertilizer application (r(S) = 0.185), and runoff class (r(S) = -0.089), and more sensitive to ratings for manure application (r(S) = 0.854). One-way ANOVA indicated that mean field STP levels were more homogenous than field PI ratings between AFOs. Kolmogorov-Smirnov (K-S) tests displayed several nonsignificant comparisons for cumulative distribution functions, S(x), of mean STP levels on AFO fields. On the other hand, the K-S tests of S(x) for PI ratings indicated that the majority of these S(x) functions were significantly different between AFOs at or greater than the 0.05 significance level. Interviews suggested multiple reasons for divergence between planned and actual outcomes in managing phosphorus, and that this divergence arises at the strategic, tactical, and operational levels of decision-making.

Variability of creatinine measurements in clinical laboratories: results from the CRIC study.

Science.gov (United States)

Joffe, Marshall; Hsu, Chi-yuan; Feldman, Harold I; Weir, Matthew; Landis, J R; Hamm, L Lee

2010-01-01

Estimating equations using serum creatinine (SCr) are often used to assess glomerular filtration rate (GFR). Such creatinine (Cr)-based formulae may produce biased estimates of GFR when using Cr measurements that have not been calibrated to reference laboratories. In this paper, we sought to examine the degree of this variation in Cr assays in several laboratories associated with academic medical centers affiliated with the Chronic Renal Insufficiency Cohort (CRIC) Study; to consider how best to correct for this variation, and to quantify the impact of such corrections on eligibility for participation in CRIC. Variability of Cr is of particular concern in the conduct of CRIC, a large multicenter study of subjects with chronic renal disease, because eligibility for the study depends on Cr-based assessment of GFR. A library of 5 large volume plasma specimens from apheresis patients was assembled, representing levels of plasma Cr from 0.8 to 2.4 mg/dl. Samples from this library were used for measurement of Cr at each of the 14 CRIC laboratories repetitively over time. We used graphical displays and linear regression methods to examine the variability in Cr, and used linear regression to develop calibration equations. We also examined the impact of the various calibration equations on the proportion of subjects screened as potential participants who were actually eligible for the study. There was substantial variability in Cr assays across laboratories and over time. We developed calibration equations for each laboratory; these equations varied substantially among laboratories and somewhat over time in some laboratories. The laboratory site contributed the most to variability (51% of the variance unexplained by the specimen) and variation with time accounted for another 15%. In some laboratories, calibration equations resulted in differences in eligibility for CRIC of as much as 20%. The substantial variability in SCr assays across laboratories necessitates calibration

Effect of flow rate on environmental variables and phytoplankton dynamics: results from field enclosures

Science.gov (United States)

Zhang, Haiping; Chen, Ruihong; Li, Feipeng; Chen, Ling

2015-03-01

To investigate the effects of flow rate on phytoplankton dynamics and related environment variables, a set of enclosure experiments with different flow rates were conducted in an artificial lake. We monitored nutrients, temperature, dissolved oxygen, pH, conductivity, turbidity, chlorophyll- a and phytoplankton levels. The lower biomass in all flowing enclosures showed that flow rate significantly inhibited the growth of phytoplankton. A critical flow rate occurred near 0.06 m/s, which was the lowest relative inhibitory rate. Changes in flow conditions affected algal competition for light, resulting in a dramatic shift in phytoplankton composition, from blue-green algae in still waters to green algae in flowing conditions. These findings indicate that critical flow rate can be useful in developing methods to reduce algal bloom occurrence. However, flow rate significantly enhanced the inter-relationships among environmental variables, in particular by inducing higher water turbidity and vegetative reproduction of periphyton ( Spirogyra). These changes were accompanied by a decrease in underwater light intensity, which consequently inhibited the photosynthetic intensity of phytoplankton. These results warn that a universal critical flow rate might not exist, because the effect of flow rate on phytoplankton is interlinked with many other environmental variables.

Surgery of petroclival meningiomas. Recent surgical results and outcomes

Directory of Open Access Journals (Sweden)

Radoi Mugurel

2015-03-01

Full Text Available Petroclival meningiomas represent only 10% of all meningiomas located in the posterior fossa, but are some of the most formidable challenges in skull base surgery. We described our recent experience (2005-September2014 regarding the surgery of these tumors. We retrospectively analyzed surgical results and outcome in 11 cases of petroclival meningiomas. Most common symptoms in our series were headache and gait disturbance, while cranial nerves palsies represented the most common presenting signs. There were 8 females and 3 males, and the mean age was 52 years. Surgical approaches chosen for petroclival meningiomas in our series were retrosigmoid (9 patients and subtemporal transtentorial (2 patients. We achieved total tumor resection in 5 cases (45% and subtotal resection in 6 cases (55%. Overall outcome (total/subtotal resection was good in 6 cases, fair in 3 cases and poor in one case. One postoperative death occurred due to hemorrhagic midbrain infarction (9%. Complications were usually related to cranial nerve deficits: loss of hearing (2 patients, paresis of trochlear nerve (1 patient, trigeminal nerve (3 patients and facial nerve (1 patient. In 4 patients these cranial nerves deficits were transient. In one case, a patient developed postoperative hydrocephalus and needed shunt placement. Despite the fact that complications can be disastrous, we considered that an appropriate approach, combined with microsurgical techniques and a better understanding of the anatomy, greatly decrease the incidence and severity of complications and make feasible a total tumor resection.

Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy

OpenAIRE

Biary, Nora; Wrotniak, Brian; Islam, Shamim

2017-01-01

Abstract Background To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital. Methods Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12...

Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

Directory of Open Access Journals (Sweden)

Leonardo Lamas

Full Text Available We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs and defensive (i.e. space protection dynamics--SPDs actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover in Spanish professional basketball games.Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations.The pick action (e.g. pick and roll, pop and pop was the most prevalent SCD (33%. However, this SCD did not produce the highest probability of a free shot (0.235. The highest probability of a free shot followed the SCD without ball (0.409. The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403. Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome. In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

Modeling the Offensive-Defensive Interaction and Resulting Outcomes in Basketball.

Science.gov (United States)

Lamas, Leonardo; Santana, Felipe; Heiner, Matthew; Ugrinowitsch, Carlos; Fellingham, Gilbert

2015-01-01

We analyzed the interaction between offensive (i.e. space creation dynamics--SCDs) and defensive (i.e. space protection dynamics--SPDs) actions in six play outcomes (free shot, contested shot, new SCD, reset, foul, and turnover) in Spanish professional basketball games. Data consisted of 1548 SCD-SPD-outcome triples obtained from six play-off games. We used Bayesian methods to compute marginal probabilities of six outcomes following five different SCDs. We also computed probabilities of the six outcomes following the 16 most frequent SCD-SPD combinations. The pick action (e.g. pick and roll, pop and pop) was the most prevalent SCD (33%). However, this SCD did not produce the highest probability of a free shot (0.235). The highest probability of a free shot followed the SCD without ball (0.409). The pick was performed not only to attempt scoring but also to initiate offenses, as it produced the highest probability leading to a new SCD (0.403). Additionally, the SPD performed influenced the outcome of the SCD. This reinforces the notion that the opposition (offensive-defensive interaction) should be considered. To the best of our knowledge, in team sports, this is the first study to successfully model the tactical features involved in offense-defense interactions. Our analyses revealed that the high frequency of occurrence of some SCDs may be justified not only by an associated high probability of free shots but also by the possibility of progressively create more space in the defense (i.e. a new SCD as outcome). In the second case, it evidences offensive strategic features of progressive disruption of the defensive system through the concatenation of subsequent offensive actions.

Effect of an office worksite-based yoga program on heart rate variability: outcomes of a randomized controlled trial

Science.gov (United States)

2013-01-01

Background Chronic work-related stress is an independent risk factor for cardiometabolic diseases and associated mortality, particularly when compounded by a sedentary work environment. The purpose of this study was to determine if an office worksite-based hatha yoga program could improve physiological stress, evaluated via heart rate variability (HRV), and associated health-related outcomes in a cohort of office workers. Methods Thirty-seven adults employed in university-based office positions were randomized upon the completion of baseline testing to an experimental or control group. The experimental group completed a 10-week yoga program prescribed three sessions per week during lunch hour (50 min per session). An experienced instructor led the sessions, which emphasized asanas (postures) and vinyasa (exercises). The primary outcome was the high frequency (HF) power component of HRV. Secondary outcomes included additional HRV parameters, musculoskeletal fitness (i.e. push-up, side-bridge, and sit & reach tests) and psychological indices (i.e. state and trait anxiety, quality of life and job satisfaction). Results All measures of HRV failed to change in the experimental group versus the control group, except that the experimental group significantly increased LF:HF (p = 0.04) and reduced pNN50 (p = 0.04) versus control, contrary to our hypotheses. Flexibility, evaluated via sit & reach test increased in the experimental group versus the control group (p yoga sessions (n = 11) to control (n = 19) yielded the same findings, except that the high adherers also reduced state anxiety (p = 0.02) and RMSSD (p = 0.05), and tended to improve the push-up test (p = 0.07) versus control. Conclusions A 10-week hatha yoga intervention delivered at the office worksite during lunch hour did not improve HF power or other HRV parameters. However, improvements in flexibility, state anxiety and musculoskeletal fitness were noted with high adherence

A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy

Directory of Open Access Journals (Sweden)

Elliot M. Hirsch, MD

2014-01-01

Conclusions: Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.

Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years

Energy Technology Data Exchange (ETDEWEB)

Marlovits, Stefan [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)]. E-mail: stefan.marlovits@meduniwien.ac.at; Singer, Philipp [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Zeller, Philip [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Mandl, Irena [Department of Traumatology, Center for Joint and Cartilage, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich-Collin-Strasse, A-1140 Vienna (Austria); Trattnig, Siegfried [Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

2006-01-15

In an observational study, the validity and reliability of magnetic resonance imaging (MRI) for the assessment of autologous chondrocyte transplantation (ACT) in the knee joint was determined. Two years after implantation, high-resolution MRI was used to analyze the repair tissue with nine pertinent variables. A complete filling of the defect was found in 61.5%, and a complete integration of the border zone to the adjacent cartilage in 76.9%. An intact subchondral lamina was present in 84.6% and an intact subchondral bone was present in 61.5%. Isointense signal intensities of the repair tissue compared to the adjacent native cartilage were seen in 92.3%. To evaluate interobserver variability, a reliability analysis with the determination of the intraclass correlation coefficient (ICC) was calculated. An 'almost perfect' agreement, with an ICC value >0.81, was calculated in 8 of 9 variables. The clinical outcome after 2 years showed the visual analog score (VAS) at 2.62 (S.D. {+-}0.65). The values for the knee injury and osteoarthritis outcome score (KOOS) subgroups were 68.29 ({+-}23.90) for pain, 62.09 ({+-}14.62) for symptoms, 75.45 ({+-}21.91) for ADL function, 52.69 ({+-}28.77) for sport and 70.19 ({+-}22.41) for knee-related quality of life. The clinical scores were correlated with the MRI variables. A statistically significant correlation was found for the variables 'filling of the defect,' 'structure of the repair tissue,' 'changes in the subchondral bone,' and 'signal intensities of the repair issue'. High resolution MRI and well-defined MRI variables are a reliable, reproducible and accurate tool for assessing cartilage repair tissue.

Initial CGE Model Results Summary Exogenous and Endogenous Variables Tests

Energy Technology Data Exchange (ETDEWEB)

Edwards, Brian Keith [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Boero, Riccardo [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Rivera, Michael Kelly [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-08-07

The following discussion presents initial results of tests of the most recent version of the National Infrastructure Simulation and Analysis Center Dynamic Computable General Equilibrium (CGE) model developed by Los Alamos National Laboratory (LANL). The intent of this is to test and assess the model’s behavioral properties. The test evaluated whether the predicted impacts are reasonable from a qualitative perspective. This issue is whether the predicted change, be it an increase or decrease in other model variables, is consistent with prior economic intuition and expectations about the predicted change. One of the purposes of this effort is to determine whether model changes are needed in order to improve its behavior qualitatively and quantitatively.

Longitudinal assessment of maternal parenting capacity variables and child adjustment outcomes in pediatric cancer.

Science.gov (United States)

Fedele, David A; Mullins, Larry L; Wolfe-Christensen, Cortney; Carpentier, Melissa Y

2011-04-01

This preliminary investigation aimed to longitudinally examine parenting capacity variables, namely parental overprotection, perceived child vulnerability, and parenting stress and their relation to child adjustment in mothers of children on treatment for cancer. As part of a larger study, biological mothers (N=22) completed measures of parental overprotection, perceived child vulnerability, parenting stress, and child adjustment at Time 1 and a follow-up time point. Analyses were conducted to determine whether (1) levels of parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up and (2) if Time 1 parenting capacity variables were associated with child adjustment at follow-up. Results revealed that parental overprotection, perceived child vulnerability, and parenting stress declined from Time 1 to follow-up, and levels of parental overprotection, perceived child vulnerability, and parenting stress at Time 1 were significantly related to child adjustment at follow-up. Collectively, the preliminary findings of this study indicate that mothers of children with cancer evidence improved parenting capacity over time. Furthermore, it seems that Time 1 parenting capacity variables are significantly related to later child adjustment.

Nurse working conditions and patient safety outcomes.

Science.gov (United States)

Stone, Patricia W; Mooney-Kane, Cathy; Larson, Elaine L; Horan, Teresa; Glance, Laurent G; Zwanziger, Jack; Dick, Andrew W

2007-06-01

System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown. To examine effects of a comprehensive set of working conditions on elderly patient safety outcomes in intensive care units. Observational study, with patient outcome data collected using the National Nosocomial Infection Surveillance system protocols and Medicare files. Several measures of health status and fixed setting characteristics were used to capture distinct dimensions of patient severity of illness and risk for disease. Working condition variables included organizational climate measured by nurse survey; objective measures of staffing, overtime, and wages (derived from payroll data); and hospital profitability and magnet accreditation. The sample comprised 15,846 patients in 51 adult intensive care units in 31 hospitals depending on the outcome analyzed; 1095 nurses were surveyed. Central line associated bloodstream infections (CLBSI), ventilator-associated pneumonia, catheter-associated urinary tract infections, 30-day mortality, and decubiti. Units with higher staffing had lower incidence of CLBSI, ventilator-associated pneumonia, 30-day mortality, and decubiti (P working conditions were associated with all outcomes measured. Improving working conditions will most likely promote patient safety. Future researchers and policymakers should consider a broad set of working condition variables.

Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

Directory of Open Access Journals (Sweden)

HUGO KARLING MORESCHI

2015-02-01

Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

Directory of Open Access Journals (Sweden)

Volker Kast

Full Text Available Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers and untrained individuals (novices in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

Science.gov (United States)

Kast, Volker; Leukel, Christian

2016-01-01

Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers) and untrained individuals (novices) in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

Variable features on Mars - Preliminary Mariner 9 television results.

Science.gov (United States)

Sagan, C.; Veverka, J.; Fox, P.; Dubisch, R.; Lederberg, J.; Levinthal, E.; Quam, L.; Tucker, R.; Pollack, J. B.; Smith, B. A.

1972-01-01

Systematic Mariner 9 photography of a range of Martian surface features, observed with all three photometric angles approximately invariant, reveals three general categories of albedo variations: (1) an essentially uniform contrast enhancement due to the dissipation of the dust storm; (2) the appearance of splotches, irregular dark markings at least partially related to topography; and (3) the development of both bright and dark linear streaks, generally emanating from craters. Some splotches and streaks vary on characteristic timescales of about two weeks; they have characteristic dimensions of kilometers to tens of kilometers. The morphology and variability of streaks and splotches, and the resolution of at least one splotch into an extensive dune system, implicate windblown dust as the principal agent of Martian albedo differences and variability.

[Mobbing: its relationships with organizational culture and personal outcomes].

Science.gov (United States)

Topa Cantisano, Gabriela; Morales Domínguez, José Francisco; Gallastegui Galán, José Antonio

2006-11-01

A study dealing with the effects of both organizational culture and mobbing on personal and organizational outcomes of a sample of Spanish emergency workers, is reported here. It was found that there is a strong impact of organizational culture dimensions on mobbing, and that mobbing affects job satisfaction, organizational commitment and organizational citizenship behaviour. Results concerning organizational commitment show that this variable is not a mere effect of mobbing in general, but rather that it is also a direct impact of culture on this outcome.

Child sexual abuse and family outcomes

NARCIS (Netherlands)

de Jong, Rinke; Bijleveld, C.C.J.H.

2015-01-01

This study aimed to examine the association between different characteristics of sexual abuse and adverse family outcomes in later life. Through archived court files, a large sample of Dutch men and women who have been sexually abused as a child could be identified. Outcome variables were assessed

Bell inequalities for continuous-variable measurements

International Nuclear Information System (INIS)

He, Q. Y.; Reid, M. D.; Drummond, P. D.; Cavalcanti, E. G.

2010-01-01

Tests of local hidden-variable theories using measurements with continuous-variable (CV) outcomes are developed, and a comparison of different methods is presented. As examples, we focus on multipartite entangled Greenberger-Horne-Zeilinger and cluster states. We suggest a physical process that produces the states proposed here, and investigate experiments both with and without binning of the continuous variable. In the former case, the Mermin-Klyshko inequalities can be used directly. For unbinned outcomes, the moment-based Cavalcanti-Foster-Reid-Drummond inequalities are extended to functional inequalities by consideration of arbitrary functions of the measurements at each site. By optimizing these functions, we obtain more robust violations of local hidden-variable theories than with either binning or moments. Recent inequalities based on the algebra of quaternions and octonions are compared with these methods. Since the prime advantage of CV experiments is to provide a route to highly efficient detection via homodyne measurements, we analyze the effect of noise and detection losses in both binned and unbinned cases. The CV moment inequalities with an optimal function have greater robustness to both loss and noise. This could permit a loophole-free test of Bell inequalities.

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

Influence of warfarin and low-dose aspirin on the outcomes of geriatric patients with traumatic intracranial hemorrhage resulting from ground-level fall.

Science.gov (United States)

Inamasu, Joji; Nakatsukasa, Masashi; Miyatake, Satoru; Hirose, Yuichi

2012-10-01

Ground-level fall is the most common cause of traumatic intracranial hemorrhage (TICH) in the elderly, and is a major cause of morbidity and mortality in that population. A retrospective study was carried out to evaluate whether the use of warfarin/low-dose aspirin (LDA) is predictive of unfavorable outcomes in geriatric patients who sustain a fall-induced TICH. Charts of 76 geriatric patients (≥ 65 years-of-age) with fall-induced TICH were reviewed. The number of patients taking warfarin and LDA was 12 and 21, respectively, whereas the other 43 took neither medication (non-user group). The frequency of patients with unfavorable outcomes (Glasgow Outcome Scale score of 1-3) at discharge was calculated. Furthermore, variables predictive of unfavorable outcomes were identified by logistic regression analysis. The frequency of patients with unfavorable outcomes was 75% in the warfarin group, 33% in the LDA group and 27% in the non-user group, respectively. The risk of having unfavorable outcomes was significantly higher in the warfarin group compared with the LDA group (P = 0.03) and non-user group (P fall-induced TICH. The risk of TICH should be communicated properly to elderly taking warfarin. The information might be important not only to trauma surgeons who take care of injured elderly, but also to geriatric physicians who prescribe warfarin/LDA to them. © 2012 Japan Geriatrics Society.

Variables associated with active spondylolysis.

Science.gov (United States)

Gregg, Chris D; Dean, Sarah; Schneiders, Anthony G

2009-11-01

Retrospective non-experimental study. To investigate variables associated with active spondylolysis. A retrospective study audited clinical data over a two year period from patients with suspected spondylolysis that were referred for a SPECT bone scan. Six exploratory variables were identified and analysed using uni- and multi-variate regression from 82 patient records to determine the association between symptomatic, physical and demographic characteristics, and the presence of an active spondylolysis. Tertiary level multidisciplinary private practice sports medicine clinic. All patients with low back pain that required a SPECT bone scan to confirm suspected spondylolysis. 82 subjects were included in the final sample group. The six exploratory variables included Age, Gender, Injury duration, Injury onset, Sports participation and the result of the Single Leg Hyperextension Test. The dependent outcome variable was the result of the SPECT bone scan (scan-positive or scan-negative). Adolescent males had a higher incidence of spondylolysis detected by SPECT bone scan compared to other patients and a statistically significant association was demonstrated for both age (p=0.01) and gender (p=0.01). Subjects with an active spondylolysis were nearly five times more likely to be male and aged less than 20 years. Furthermore, the likelihood ratio indicated that adolescent males with suspected spondylolysis were three and a half times more likely to have a positive bone scan result. The Single Leg Hyperextension Test did not demonstrate a statistically significant association with spondylolysis (p=0.47). Clinicians assessing for a predisposition to the development of spondylolysis should consider the gender and age of the patient and not rely on the predictive ability of the Single Leg Hyperextension Test.

Elevated outcome-anticipation and outcome-evaluation ERPs associated with a greater preference for larger-but-delayed rewards.

Science.gov (United States)

Pornpattananangkul, Narun; Nadig, Ajay; Heidinger, Storm; Walden, Keegan; Nusslock, Robin

2017-06-01

Although waiting for a reward reduces or discounts its value, some people have a stronger tendency to wait for larger rewards and forgo smaller-but-immediate rewards. This ability to delay gratification is captured by individual differences in so-called intertemporal choices in which individuals are asked to choose between larger-but-delayed versus smaller-but-immediate rewards. The current study used event-related potentials (ERPs) to examine whether enhancement in two neurocognitive processes, outcome anticipation and outcome evaluation, modulate individual variability in intertemporal responses. After completing a behavioral intertemporal choice task, 34 participants performed an ERP gambling task. From this ERP task, we separately examined individual differences in outcome anticipation (stimulus-preceding negativity; SPN), early outcome valuation (feedback-related negativity; FRN), and late outcome evaluation (P3). We observed that both elevated outcome-anticipation (SPN) and late outcome-evaluation (P3) neural processes predicted a stronger preference toward larger-but-delayed rewards. No relationship was observed between intertemporal responses and early outcome evaluation (FRN), indicating that the relationship between outcome evaluation and intertemporal responses was specific to the late outcome-evaluation processing stream. Moreover, multiple regression analyses indicated that the SPN and P3 independently modulate individual differences in intertemporal responses, suggesting separate mechanisms underlie the relationship between these two neurocognitive processes and intertemporal responses. Accordingly, we identify two potential neurocognitive modulators of individual variability in intertemporal responses. We discuss the mechanisms underlying these modulators in terms of anticipation-related processing (SPN) and a saliency bias toward gain (compared to loss) outcomes (P3).

Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms.

Science.gov (United States)

Kamide, Tomoya; Tabani, Halima; Safaee, Michael M; Burkhardt, Jan-Karl; Lawton, Michael T

2018-01-26

OBJECTIVE While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks. The authors, therefore, undertook this study to define patient, visual, and aneurysm outcomes in the most common type of paraclinoid aneurysm: ophthalmic artery (OphA) aneurysms. METHODS Results from microsurgical clipping of 208 OphA aneurysms in 198 patients were retrospectively reviewed. Patient demographics, aneurysm morphology (size, calcification, etc.), clinical characteristics, and patient outcomes were recorded and analyzed. RESULTS Despite 20% of these aneurysms being large or giant in size, complete aneurysm occlusion was accomplished in 91% of 208 cases, with OphA patency preserved in 99.5%. The aneurysm recurrence rate was 3.1% and the retreatment rate was 0%. Good outcomes (modified Rankin Scale score 0-2) were observed in 96.2% of patients overall and in all 156 patients with unruptured aneurysms. New visual field defects (hemianopsia or quadrantanopsia) were observed in 8 patients (3.8%), decreased visual acuity in 5 (2.4%), and monocular blindness in 9 (4.3%). Vision improved in 9 (52.9%) of the 17 patients with preoperative visual deficits. CONCLUSIONS The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially

Bias and Bias Correction in Multi-Site Instrumental Variables Analysis of Heterogeneous Mediator Effects

Science.gov (United States)

Reardon, Sean F.; Unlu, Faith; Zhu, Pei; Bloom, Howard

2013-01-01

We explore the use of instrumental variables (IV) analysis with a multi-site randomized trial to estimate the effect of a mediating variable on an outcome in cases where it can be assumed that the observed mediator is the only mechanism linking treatment assignment to outcomes, as assumption known in the instrumental variables literature as the…

Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

Science.gov (United States)

Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

2016-01-01

The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case

Evaluating the Effectiveness Roles of Variables in the Novice Programmers Learning

Science.gov (United States)

Shi, Nianfeng; Cui, Wen; Zhang, Ping; Sun, Ximing

2018-01-01

This research applies the roles of variables to the novice programmers in the C language programming. The results are evaluated using the Structure of Observed Learning Outcomes (SOLO) taxonomy. The participants were divided into an experimental group and a control group. The students from the control group learned programming in the traditional…

Extraction Methods, Variability Encountered in

NARCIS (Netherlands)

Bodelier, P.L.E.; Nelson, K.E.

2014-01-01

Synonyms Bias in DNA extractions methods; Variation in DNA extraction methods Definition The variability in extraction methods is defined as differences in quality and quantity of DNA observed using various extraction protocols, leading to differences in outcome of microbial community composition

Female College Students' Media Use and Academic Outcomes: Results from a Longitudinal Cohort Study.

Science.gov (United States)

Walsh, Jennifer L; Fielder, Robyn L; Carey, Kate B; Carey, Michael P

2013-09-01

This longitudinal study describes women's media use during their first year of college and examines associations between media use and academic outcomes. Female students ( N = 483, M age = 18.1 years) reported on their use of 11 media forms and their grade point average, academic behaviors, academic confidence, and problems affecting schoolwork. Allowing for multi-tasking, women reported nearly 12 hours of media use per day; use of texting, music, the Internet, and social networking was heaviest. In general, media use was negatively associated with academic outcomes after controlling for prior academics and demographics. Exceptions were newspaper reading and music listening, which were positively associated with academic outcomes. There were significant indirect effects of magazine reading and social networking on GPA via academic behaviors, confidence, and problems. Results show that female college students are heavy users of new media, and that some forms of media use may adversely impact academic performance.

Educational Outcomes After Serving with Electronic Monitoring

DEFF Research Database (Denmark)

Larsen, Britt Østergaard

2016-01-01

are based on a comprehensive longitudinal dataset (n = 1013) constructed from multiple official administrative registers and including a high number of covariates. Results The EM-program increases the completion rates of upper secondary education by 18 % points among program participants 3 years post......Objectives The paper explores the effects of electronic monitoring (EM) on young offenders’ educational outcomes and contributes to the evaluation of EM as a non-custodial sanction with a new outcome measure. Methods The study is based on a natural experiment exploiting a reform in Denmark in 2006...... introducing electronic monitoring to all offenders under the age of 25 with a maximum prison sentence of 3 months. Information on program participation is used to estimate instrument variable models in order to assess the causal effects of EM on young offenders’ educational outcomes. The empirical analyses...

Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration.

Science.gov (United States)

Jeung, Kyung Woon; Ryu, Hyun Ho; Song, Kyung Hwan; Lee, Byung Kook; Lee, Hyoung Youn; Heo, Tag; Min, Yong Il

2011-07-01

Adjustment of adrenaline (epinephrine) dosage according to cardiac arrest (CA) duration, rather than administering the same dose, may theoretically improve resuscitation outcomes. We evaluated variable effects of high-dose adrenaline (HDA) relative to standard-dose adrenaline (SDA) on resuscitation outcomes according to CA duration. Twenty-eight male domestic pigs were randomised to the following 4 groups according to the dosage of adrenaline (SDA 0.02 mg/kg vs. HDA 0.2mg/kg) and duration of CA before beginning cardiopulmonary resuscitation (CPR): 6 min SDA, 6 min HDA, 13 min SDA, or 13 min HDA. After the predetermined duration of untreated ventricular fibrillation, CPR was provided. All animals in the 6 min SDA, 6 min HDA, and 13 min HDA groups were successfully resuscitated, while only 4 of 7 pigs in the 13 min SDA group were successfully resuscitated (p=0.043). HDA groups showed higher right atrial pressure, more frequent ventricular ectopic beats, higher blood glucose, higher troponin-I, and more severe metabolic acidosis than SDA groups. Animals of 13 min groups showed more severe metabolic acidosis and higher troponin-I than animals of 6 min groups. All successfully resuscitated animals, except two animals in the 13 min HDA group, survived for 7 days (p=0.121). Neurologic deficit score was not affected by the dose of adrenaline. HDA showed benefit in achieving restoration of spontaneous circulation in 13 min CA, when compared with 6 min CA. However, this benefit did not translate into improved long-term survival or neurologic outcome. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Is there a relationship between service integration and differentiation and patient outcomes?

Directory of Open Access Journals (Sweden)

Robin P. Newhouse

2003-11-01

Full Text Available Objective: To examine the level of service integration within Maryland hospitals and service differentiation across the hospital system or network and its affect on heart failure patient clinical and economic outcomes. Data sources/Study setting: Maryland Health Services Cost Review Commission Inpatient Data for 1997 and 1998 were used for secondary data analysis. Study design: Retrospective cross sectional. Independent variables were the level of service integration and differentiation created from the 1998 American Hospital Association Annual Survey based on the work of Bazzoli et al. [1]. The primary dependent variables were readmission, in-hospital mortality, length of stay and costs. Data collection/Extraction methods: Patients discharged from Maryland hospitals with a diagnosis that grouped to DRG 127 (heart failure were extracted. Multivariate linear and logistic models clustered by hospital were used to analyse results at the patient level. Principal findings: A higher likelihood of readmission was found as the level of Community Differentiation increased. Although costs were higher as Total Differentiation increased in 1998, these results were not validated by 1997 data. No significant relationship was found between integration of services and outcomes. Conclusions: Similar outcomes were achieved regardless of the level of service integration or differentiation. Community hospitals produce similar patient outcomes at the same cost for this diagnosis.

Preschool Predictors of Kindergarten Language Outcomes

Directory of Open Access Journals (Sweden)

Anne Walk

2015-01-01

Full Text Available The aim of the present study is to explore a variety of cognitive and social variables which are most relevant to children’s linguistic success in an educational setting. The study examines kindergarten English language outcomes in classrooms containing monolingual English speaking children and bilingual children who speak English and one other language. Data from the National Center for Early Development and Learning Multistate Study of Pre-Kindergarten (2001-2003 regarding classroom and student characteristics were used for bilingual (N = 120 and monolingual (N = 534 children. Hierarchical regression analysis (Study 1 and path analysis (Study 2 were conducted to determine the cognitive and social variables present in preschool that are most predictive of English skills in kindergarten. The results of the studies demonstrate that social variables were important for both monolingual and bilingual children. Personality variables were more predictive for monolingual children, whereas teacher relationship variables were more important for bilingual children. Simple and routine adult interaction was predictive of English skills in both groups, which may indicate the importance of implicit learning over explicit instruction in early language acquisition. The present studies found different predictors of English language skills for monolingual and bilingual kindergarteners.

Beyond the mean estimate: a quantile regression analysis of inequalities in educational outcomes using INVALSI survey data

Directory of Open Access Journals (Sweden)

Antonella Costanzo

2017-09-01

Full Text Available Abstract The number of studies addressing issues of inequality in educational outcomes using cognitive achievement tests and variables from large-scale assessment data has increased. Here the value of using a quantile regression approach is compared with a classical regression analysis approach to study the relationships between educational outcomes and likely predictor variables. Italian primary school data from INVALSI large-scale assessments were analyzed using both quantile and standard regression approaches. Mathematics and reading scores were regressed on students' characteristics and geographical variables selected for their theoretical and policy relevance. The results demonstrated that, in Italy, the role of gender and immigrant status varied across the entire conditional distribution of students’ performance. Analogous results emerged pertaining to the difference in students’ performance across Italian geographic areas. These findings suggest that quantile regression analysis is a useful tool to explore the determinants and mechanisms of inequality in educational outcomes. A proper interpretation of quantile estimates may enable teachers to identify effective learning activities and help policymakers to develop tailored programs that increase equity in education.

Female College Students’ Media Use and Academic Outcomes: Results from a Longitudinal Cohort Study

Science.gov (United States)

Walsh, Jennifer L.; Fielder, Robyn L.; Carey, Kate B.; Carey, Michael P.

2013-01-01

This longitudinal study describes women’s media use during their first year of college and examines associations between media use and academic outcomes. Female students (N = 483, Mage = 18.1 years) reported on their use of 11 media forms and their grade point average, academic behaviors, academic confidence, and problems affecting schoolwork. Allowing for multi-tasking, women reported nearly 12 hours of media use per day; use of texting, music, the Internet, and social networking was heaviest. In general, media use was negatively associated with academic outcomes after controlling for prior academics and demographics. Exceptions were newspaper reading and music listening, which were positively associated with academic outcomes. There were significant indirect effects of magazine reading and social networking on GPA via academic behaviors, confidence, and problems. Results show that female college students are heavy users of new media, and that some forms of media use may adversely impact academic performance. PMID:24505554

Negative decision outcomes are more common among people with lower decision-making competence: An item-level analysis of the Decision Outcome Inventory (DOI

Directory of Open Access Journals (Sweden)

Andrew M Parker

2015-04-01

Full Text Available Most behavioral decision research takes place in carefully controlled laboratory settings, and examination of relationships between performance and specific real-world decision outcomes is rare. One prior study shows that people who perform better on hypothetical decision tasks, assessed using the Adult Decision-Making Competence (A-DMC measure, also tend to experience better real-world decision outcomes, as reported on the Decision Outcomes Inventory (DOI. The DOI score reflects avoidance of outcomes that could result from poor decisions, ranging from serious (e.g., bankruptcy to minor (e.g., blisters from sunburn. The present analyses go beyond the initial work, which focused on the overall DOI score, by analyzing the relationships between specific decision outcomes and A-DMC performance. Most outcomes are significantly more likely among people with lower A-DMC scores, even after taking into account two variables expected to produce worse real-world decision outcomes: younger age and lower socio-economic status. We discuss the usefulness of DOI as a measure of successful real-world decision making.

A survey for variable young stars with small telescopes: First results from HOYS-CAPS

Science.gov (United States)

Froebrich, D.; Campbell-White, J.; Scholz, A.; Eislöffel, J.; Zegmott, T.; Billington, S. J.; Donohoe, J.; Makin, S. V.; Hibbert, R.; Newport, R. J.; Pickard, R.; Quinn, N.; Rodda, T.; Piehler, G.; Shelley, M.; Parkinson, S.; Wiersema, K.; Walton, I.

2018-05-01

Variability in Young Stellar Objects (YSOs) is one of their primary characteristics. Long-term, multi-filter, high-cadence monitoring of large YSO samples is the key to understand the partly unusual light-curves that many of these objects show. Here we introduce and present the first results of the HOYS-CAPScitizen science project which aims to perform such monitoring for nearby (d < 1 kpc) and young (age < 10 Myr) clusters and star forming regions, visible from the northern hemisphere, with small telescopes. We have identified and characterised 466 variable (413 confirmed young) stars in 8 young, nearby clusters. All sources vary by at least 0.2 mag in V, have been observed at least 15 times in V, R and I in the same night over a period of about 2 yrs and have a Stetson index of larger than 1. This is one of the largest samples of variable YSOs observed over such a time-span and cadence in multiple filters. About two thirds of our sample are classical T-Tauri stars, while the rest are objects with depleted or transition disks. Objects characterised as bursters show by far the highest variability. Dippers and objects whose variability is dominated by occultations from normal interstellar dust or dust with larger grains (or opaque material) have smaller amplitudes. We have established a hierarchical clustering algorithm based on the light-curve properties which allows the identification of the YSOs with the most unusual behaviour, and to group sources with similar properties. We discuss in detail the light-curves of the unusual objects V2492 Cyg, V350 Cep and 2MASS J21383981+5708470.

Distress among women receiving uninformative BRCA1/2 results: 12-month outcomes.

Science.gov (United States)

O'Neill, Suzanne C; Rini, Christine; Goldsmith, Rachel E; Valdimarsdottir, Heiddis; Cohen, Lawrence H; Schwartz, Marc D

2009-10-01

Few data are available regarding the long-term psychological impact of uninformative BRCA1/2 test results. This study examines change in distress from pretesting to 12-months post-disclosure, with medical, family history, and psychological variables, such as pretesting perceived risk of carrying a deleterious mutation prior to testing and primary and secondary appraisals, as predictors. Two hundred and nine women with uninformative BRCA1/2 test results completed questionnaires at pretesting and 1-, 6-, and 12-month post-disclosure, including measures of anxiety and depression, cancer-specific and genetic testing distress. We used a mixed models approach to predict change in post-disclosure distress. Distress declined from pretesting to 1-month post-disclosure, but remained stable thereafter. Primary appraisals predicted all types of distress at 1-month post-disclosure. Primary and secondary appraisals predicted genetic testing distress at 1-month as well as change over time. Receiving a variant of uncertain clinical significance and entering testing with a high expectation for carrying a deleterious mutation predicted genetic testing distress that persisted through the year after testing. As a whole, women receiving uninformative BRCA1/2 test results are a resilient group. For some women, distress experienced in the month after testing does not dissipate. Variables, such as heightened pretesting perceived risk and cognitive appraisals, predict greater likelihood for sustained distress in this group and could be amenable to intervention.

MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard

Energy Technology Data Exchange (ETDEWEB)

Maijers, M.C.; Ritt, M.J.P.F. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Niessen, F.B. [VU University Medical Centre, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, PO Box 7057, Amsterdam (Netherlands); Jan van Goyen Clinic, Department of Plastic Surgery, Amsterdam (Netherlands); Veldhuizen, J.F.H. [MRI Centre, Amsterdam (Netherlands); Manoliu, R.A. [MRI Centre, Amsterdam (Netherlands); VU University Medical Centre, Department of Radiology, Amsterdam (Netherlands)

2014-06-15

The recall of Poly Implant Prothese (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study's aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage. A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard. In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92). MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon. (orig.)

MRI screening for silicone breast implant rupture: accuracy, inter- and intraobserver variability using explantation results as reference standard

International Nuclear Information System (INIS)

Maijers, M.C.; Ritt, M.J.P.F.; Niessen, F.B.; Veldhuizen, J.F.H.; Manoliu, R.A.

2014-01-01

The recall of Poly Implant Prothese (PIP) silicone breast implants in 2010 resulted in large numbers of asymptomatic women with implants who underwent magnetic resonance imaging (MRI) screening. This study's aim was to assess the accuracy and interobserver variability of MRI screening in the detection of rupture and extracapsular silicone leakage. A prospective study included 107 women with 214 PIP implants who underwent explantation preceded by MRI. In 2013, two radiologists blinded for previous MRI findings or outcome at surgery, independently re-evaluated all MRI examinations. A structured protocol described the MRI findings. The ex vivo findings served as reference standard. In 208 of the 214 explanted prostheses, radiologists agreed independently about the condition of the implants. In five of the six cases they disagreed (2.6 %), but subsequently reached consensus. A sensitivity of 93 %, specificity of 93 %, positive predictive value of 77 % and negative predictive value of 98 % was found. The interobserver agreement was excellent (kappa value of 0.92). MRI has a high accuracy in diagnosing rupture in silicone breast implants. Considering the high kappa value of interobserver agreement, MRI appears to be a consistent diagnostic test. A simple, uniform classification, may improve communication between radiologist and plastic surgeon. (orig.)

Spontaneous subarachnoid haemorrhage and outcome--results from Tan Tock Seng Hospital, Singapore.

Science.gov (United States)

Wong, S H; Yeo, T T; Seow, W T; Tan, K K; Ong, P L

1999-07-01

To ascertain the number of cases of spontaneous (aneurysmal) subarachnoid haemorrhage presenting to Tan Tock Seng Hospital, Singapore, over a one year period, the demographics of the patients involved, their treatment and their eventual outcome. A retrospective study from June 1995 to June 1996. There were 62 patients admitted over this period with an average of 5 patients per month. Their ages ranged from 9 to 85 years with a mean of 54 years. All 62 patients underwent 4-vessel cerebral angiograms. Forty-three patients (69%) underwent clipping of their aneurysms. Twelve patients (19%) had negative angiograms. Four patients (6%) underwent coiling of their aneurysms via interventional neuroradiology techniques. Patients with subarachnoid haemorrhage of Grades 1 to 3 on the WFNS (World Federation of Neurological Surgeons) grading had a favourable outcome (Glasgow Outcome Score of 4 and 5) in 85% of the cases. The overall mortality rate for the operated group (all grades) was 11%. However for the group with good WFNS grading, namely the Grade 1 to 2 groups, there were no deaths. Twenty-four percent of patients developed clinically symptomatic vasospasm. Eighteen percent of patients required ventriculo-peritoneal shunting for hydrocephalus secondary to the subarachnoid haemorrhage. The overall management mortality (operated and non-operated cases) was 14% for proven aneurysmal and angiographically-negative spontaneous subarachnoid haemorrhage. These results are comparable to that of other reputable centers reported in the literature.

Decisional Outcomes of Maternal Disclosure of BRCA1/2 Genetic Test Results to Children

Science.gov (United States)

Tercyak, Kenneth P.; Mays, Darren; DeMarco, Tiffani A.; Peshkin, Beth N.; Valdimarsdottir, Heiddis B.; Schneider, Katherine A.; Garber, Judy E.; Patenaude, Andrea Farkas

2013-01-01

Background Although BRCA1/2 genetic testing is discouraged in minors, mothers may disclose their own results to their children. Factors affecting patients’ disclosure decisions and patient outcomes of disclosure are largely unknown. Methods Mothers (N = 221) of children ages 8-21 enrolled in this prospective study of family communication about cancer genetic testing. Patients underwent BRCA1/2 genetic counseling and testing, and completed standardized behavioral assessments prior to and 1-month following receipt of their results. Results Most patients (62.4%) disclosed BRCA1/2 test results to their child. Patients were more likely to disclose if they received negative or uninformative vs. positive results (OR = 3.11; 95% CI = 1.11 - 8.71; P = .03), their child was ≥ 13 years of age vs. younger (OR = 5.43; 95% CI = 2.18 - 13.53; P Post-decision satisfaction about disclosure was lowest among nondisclosing patients (P information is perceived as beneficial. Satisfaction with disclosure decision-making remains lowest among nondisclosing and conflicted patients. Family communication decision support adjuncts to genetic counseling are needed to help ameliorate these effects. Impact This study describes the prevalence of family communication about maternal BRCA1/2 genetic testing with minor children, and decisions and outcomes of disclosure. PMID:23825307

Moderating Influence of Critical Psychological States on Work Engagement and Personal Outcomes in the Telecom Sector

Directory of Open Access Journals (Sweden)

Harold Andrew Patrick

2014-06-01

Full Text Available Organizations want their employees to be engaged with their work, exhibiting proactive behavior, initiative, and responsibility for personal development. Existing literature has a dearth of studies that evaluate all the three key variables that lead to optimal employee performance—critical psychological states (CPSs, work engagement, and personal outcomes. The present study attempts to fill that gap by linking the variable CPSs (which measures experienced meaningfulness, responsibility, and knowledge of results with the other two. The study surveyed 359 sales personnel in the Indian telecom industry and adopted standardized, valid, and reliable instruments to measure their work engagement, CPSs, and personal outcomes. Analysis was done using structural equation modeling (SEM. Findings indicated that CPSs significantly moderate the relationship between personal outcomes and work engagement.

Factors contributing to outcome following traumatic brain injury.

Science.gov (United States)

Ponsford, Jennie

2013-01-01

Traumatic brain injury results in some distinctive patterns of cognitive, behavioural and physical impairment which impact significantly on independent living skills and participation in work or study, social and leisure activities and interpersonal relationships. There is, however, still considerable variability in outcome across individuals in each of the reported domains. This has led to a significant body of research examining factors associated with outcome. A range of injury-related, personal and social factors have been shown to influence survival, as well as cognitive, functional and employment outcome. This paper reviews the factors associated with each of these aspects of outcome specifically injury-related factors, including neuroimaging findings, GCS and PTA, other injuries, and cognitive and behavioural impairments; demographic factors, including age, gender, genetic status, education, pre-injury IQ and employment status; and social factors including family and other social support, cultural factors, pre-injury psychiatric history and coping style. The paper identifies contributions and complex interrelationships of all of these factors to outcome following TBI. It concludes with a brief discussion of the implications of these factors for the rehabilitation process.

Frequency of hepatitis C in pregnancy and pregnancy outcome

International Nuclear Information System (INIS)

Jaffery, T.; Tariq, N.; Ayub, R.; Yawar, A.

2005-01-01

Objective: To determine the frequency of HCV infections in pregnant women, to find out the risk factors of HCV infection in pregnant women and to compare pregnancy outcome of the sero-positive women with sero-negative women. Design: Case-control study. Place and Duration of Study: Shifa International Hospital, Islamabad, from June 2001 to May 2002. Patients and Methods: Study was conducted on 947 booked pregnant women who were screened for HCV antibodies during antenatal consultation and were admitted for delivery in labor room. At the time of admission in labor ward, medical records of all patients were reviewed for anti HCV antibody testing and the presence of risk factors for HCV infection. Previous vaginal deliveries with episiotomy, previous surgeries, blood transfusions, and D and C for abortion or dysfunctional uterine bleeding were taken as independent variables. The obstetric outcome variables studied were: completed weeks of gestation by mother, birth weight and apgar score of newborns. The risk factors under study and the outcome variables were compared among HCV positive and negative women through a case-control study and measures of association calculated. Results: The proportion of HCV sero-positively among pregnant woman in our study was 3.27%. Among all the risk factors under study, previous surgery was found to have a significant association with HCV positive status of women (p=0.001). Other variables did not have significant association with HCV positive status in our study. There was no statistical difference in the mean birth weight of newborns (p=0.94), mean Apgar score of newborns (p=0.73) and mean gestational period among HCV positive cases and controls (p=0.47). Conclusion: Prevalence of hepatitis C in pregnant women was 3.27%. Past history of surgical procedures was the most important factor for transmission of hepatitis C virus infection. No adverse effect on pregnancy outcome was observed in terms of gestational age, Apgar score and baby

Instrumental variables I: instrumental variables exploit natural variation in nonexperimental data to estimate causal relationships.

Science.gov (United States)

Rassen, Jeremy A; Brookhart, M Alan; Glynn, Robert J; Mittleman, Murray A; Schneeweiss, Sebastian

2009-12-01

The gold standard of study design for treatment evaluation is widely acknowledged to be the randomized controlled trial (RCT). Trials allow for the estimation of causal effect by randomly assigning participants either to an intervention or comparison group; through the assumption of "exchangeability" between groups, comparing the outcomes will yield an estimate of causal effect. In the many cases where RCTs are impractical or unethical, instrumental variable (IV) analysis offers a nonexperimental alternative based on many of the same principles. IV analysis relies on finding a naturally varying phenomenon, related to treatment but not to outcome except through the effect of treatment itself, and then using this phenomenon as a proxy for the confounded treatment variable. This article demonstrates how IV analysis arises from an analogous but potentially impossible RCT design, and outlines the assumptions necessary for valid estimation. It gives examples of instruments used in clinical epidemiology and concludes with an outline on estimation of effects.

Presence relates to distinct outcomes in two virtual environments employing different learning modalities.

Science.gov (United States)

Persky, Susan; Kaphingst, Kimberly A; McCall, Cade; Lachance, Christina; Beall, Andrew C; Blascovich, Jim

2009-06-01

Presence in virtual learning environments (VLEs) has been associated with a number of outcome factors related to a user's ability and motivation to learn. The extant but relatively small body of research suggests that a high level of presence is related to better performance on learning outcomes in VLEs. Different configurations of form and content variables such as those associated with active (self-driven, interactive activities) versus didactic (reading or lecture) learning may, however, influence how presence operates and on what content it operates. We compared the influence of presence between two types of immersive VLEs (i.e., active versus didactic techniques) on comprehension and engagement-related outcomes. The findings revealed that the active VLE promoted greater presence. Although we found no relationship between presence and learning comprehension outcomes for either virtual environment, presence was related to information engagement variables in the didactic immersive VLE but not the active environment. Results demonstrate that presence is not uniformly elicited or effective across immersive VLEs. Educational delivery mode and environment complexity may influence the impact of presence on engagement.

Bias and Bias Correction in Multisite Instrumental Variables Analysis of Heterogeneous Mediator Effects

Science.gov (United States)

Reardon, Sean F.; Unlu, Fatih; Zhu, Pei; Bloom, Howard S.

2014-01-01

We explore the use of instrumental variables (IV) analysis with a multisite randomized trial to estimate the effect of a mediating variable on an outcome in cases where it can be assumed that the observed mediator is the only mechanism linking treatment assignment to outcomes, an assumption known in the IV literature as the exclusion restriction.…

Variables predictive of outcome in patients with acute hypercapneic respiratory failure treated with noninvasive ventilation

International Nuclear Information System (INIS)

Salahuddin, N.; Irfan, M.; Khan, S.; Naeem, M.; Haque, A.S.

2010-01-01

To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors. This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of 35 Meq/L (adjusted Odds ratio 0.9; 95% CI 0.83, 0.98, p < 0.015) identified those less at risk for intubation. NIV was found to be both safe and effective in the management of acute hypercapneic respiratory failure. Sepsis and serum HCO/sub 3/ at admission identified patients having poor outcomes (JPMA 60:13; 2010). (author)

Guidelines for the Investigation of Mediating Variables in Business Research.

Science.gov (United States)

MacKinnon, David P; Coxe, Stefany; Baraldi, Amanda N

2012-03-01

Business theories often specify the mediating mechanisms by which a predictor variable affects an outcome variable. In the last 30 years, investigations of mediating processes have become more widespread with corresponding developments in statistical methods to conduct these tests. The purpose of this article is to provide guidelines for mediation studies by focusing on decisions made prior to the research study that affect the clarity of conclusions from a mediation study, the statistical models for mediation analysis, and methods to improve interpretation of mediation results after the research study. Throughout this article, the importance of a program of experimental and observational research for investigating mediating mechanisms is emphasized.

EVALUATION OF ADJUSTABLE SUTURE TECHNIQUE IN OUTCOME OF PTOSIS SURGERY

Directory of Open Access Journals (Sweden)

Nagaraju

2015-10-01

Full Text Available AIM: To evaluate the outcome of adjustable suture technique in ptosis surgery. INTRODUCTION : Surgical management of blepharoptosis is indicated in multiple situations and the post - operative outcomes can be as variable as the indications for surgery. Adjustable suture techniques in ptosis repair have been introduced and variable efficacies have been reported. MATERIALS AND METHODS: A retrospective case review of medical records from June 2010 to May 2011 (12 months of 5 eyes of 5 consecutive patients operated by a single surgeon at a Tertiary Eye care center in South India were reviewed. The clinical profile of patients included was r ecorded and results of adjustable suture technique described by Borman and collegues for these patients was reported. RESULTS: 5 eyes of 5 patients underwent adjustable suture ptosis repair in the study duration. 4 patients with moderate and 1 with severe ptosis, all having good levator function were diagnosed to have c ongenital ptosis in 3 cases and a cquired involutional ptosis in 2 cases. All 5 cases had a satisfactory outcome at day 4 post - operative after adjustment of lid height in the out - patient clini c. 1 patient with acquired involutional ptosis, identified with levator dehiscence intra - operatively had overcorrection at 6 months warranting re - surgery while the other 4 patients had satisfactory cosmetic lid height and functional outcome at 6 months fol low up after the adjustable suture technique for ptosis repair. CONCLUSION: Use of adjustable sutures in ptosis surgery can eliminate the intraoperative lid factors that can lead to unpredictable results. The technique described is easy to adapt and perfor m and can give repeatable and well acceptable results in the properly selected cases

Bias due to two-stage residual-outcome regression analysis in genetic association studies.

Science.gov (United States)

Demissie, Serkalem; Cupples, L Adrienne

2011-11-01

Association studies of risk factors and complex diseases require careful assessment of potential confounding factors. Two-stage regression analysis, sometimes referred to as residual- or adjusted-outcome analysis, has been increasingly used in association studies of single nucleotide polymorphisms (SNPs) and quantitative traits. In this analysis, first, a residual-outcome is calculated from a regression of the outcome variable on covariates and then the relationship between the adjusted-outcome and the SNP is evaluated by a simple linear regression of the adjusted-outcome on the SNP. In this article, we examine the performance of this two-stage analysis as compared with multiple linear regression (MLR) analysis. Our findings show that when a SNP and a covariate are correlated, the two-stage approach results in biased genotypic effect and loss of power. Bias is always toward the null and increases with the squared-correlation between the SNP and the covariate (). For example, for , 0.1, and 0.5, two-stage analysis results in, respectively, 0, 10, and 50% attenuation in the SNP effect. As expected, MLR was always unbiased. Since individual SNPs often show little or no correlation with covariates, a two-stage analysis is expected to perform as well as MLR in many genetic studies; however, it produces considerably different results from MLR and may lead to incorrect conclusions when independent variables are highly correlated. While a useful alternative to MLR under , the two -stage approach has serious limitations. Its use as a simple substitute for MLR should be avoided. © 2011 Wiley Periodicals, Inc.

Results of the study of variables related to tasks of workers of a radioactive facility

Energy Technology Data Exchange (ETDEWEB)

Alves, Alice S.; Campos, Daniela; Carneiro, Janete C.G.G., E-mail: alicesante@usp.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

2015-07-01

This paper presents the results of the evaluation study of the association degree between physical risk agent, ionizing radiation, and tasks performed by the occupationally exposed individuals (OEI), in the production of radioisotopes and radiopharmaceuticals of a radioactive facility. Initially, has been performed a qualitative assessment of the workplace, work groups and the processes as well. Starting from the inventoried subjective information, interviews and observations were identified seven homogeneous exposure groups, assuming they receive the same exposure to a range of specific agents. The data were analyzed by means of descriptive statistics with quantitative and qualitative approaches of the variables. In the analysis was used nonparametric tests (Equality of two proportions, Chi-square and Yates correction), descriptive measures of location (mean, median and quartiles) and dispersion (standard deviation and coefficient of variation). A significance level of 5% (p < 0.05) was adopted. The results have shown five risk factors (variables) related to the tasks performance. After the characterization distribution of the relative frequencies, all variables showed a significant degree of association (p < 0.001) to the exposure to ionizing radiation. Descriptive analysis of effective doses received by OEIs (n=102) resulted in the average of 4.06 mSv obtained in 2013 and 3.41 mSv in 2014. The collective doses corresponding to the same year were 414.41 mSv.person and 347.61 mSv.person. The doses values found during the analyzed period are in accordance to the limits established by the current national standards. (author)

Results of the study of variables related to tasks of workers of a radioactive facility

International Nuclear Information System (INIS)

Alves, Alice S.; Campos, Daniela; Carneiro, Janete C.G.G.

2015-01-01

This paper presents the results of the evaluation study of the association degree between physical risk agent, ionizing radiation, and tasks performed by the occupationally exposed individuals (OEI), in the production of radioisotopes and radiopharmaceuticals of a radioactive facility. Initially, has been performed a qualitative assessment of the workplace, work groups and the processes as well. Starting from the inventoried subjective information, interviews and observations were identified seven homogeneous exposure groups, assuming they receive the same exposure to a range of specific agents. The data were analyzed by means of descriptive statistics with quantitative and qualitative approaches of the variables. In the analysis was used nonparametric tests (Equality of two proportions, Chi-square and Yates correction), descriptive measures of location (mean, median and quartiles) and dispersion (standard deviation and coefficient of variation). A significance level of 5% (p < 0.05) was adopted. The results have shown five risk factors (variables) related to the tasks performance. After the characterization distribution of the relative frequencies, all variables showed a significant degree of association (p < 0.001) to the exposure to ionizing radiation. Descriptive analysis of effective doses received by OEIs (n=102) resulted in the average of 4.06 mSv obtained in 2013 and 3.41 mSv in 2014. The collective doses corresponding to the same year were 414.41 mSv.person and 347.61 mSv.person. The doses values found during the analyzed period are in accordance to the limits established by the current national standards. (author)

Tracing the accretion history of supermassive black holes through X-ray variability: results from the ChandraDeep Field-South

Science.gov (United States)

Paolillo, M.; Papadakis, I.; Brandt, W. N.; Luo, B.; Xue, Y. Q.; Tozzi, P.; Shemmer, O.; Allevato, V.; Bauer, F. E.; Comastri, A.; Gilli, R.; Koekemoer, A. M.; Liu, T.; Vignali, C.; Vito, F.; Yang, G.; Wang, J. X.; Zheng, X. C.

2017-11-01

We study the X-ray variability properties of distant active galactic nuclei (AGNs) in the ChandraDeep Field-South region over 17 yr, up to z ˜ 4, and compare them with those predicted by models based on local samples. We use the results of Monte Carlo simulations to account for the biases introduced by the discontinuous sampling and the low-count regime. We confirm that variability is a ubiquitous property of AGNs, with no clear dependence on the density of the environment. The variability properties of high-z AGNs, over different temporal time-scales, are most consistent with a power spectral density (PSD) described by a broken (or bending) power law, similar to nearby AGNs. We confirm the presence of an anticorrelation between luminosity and variability, resulting from the dependence of variability on black hole (BH) mass and accretion rate. We explore different models, finding that our acceptable solutions predict that BH mass influences the value of the PSD break frequency, while the Eddington ratio λEdd affects the PSD break frequency and, possibly, the PSD amplitude as well. We derive the evolution of the average λEdd as a function of redshift, finding results in agreement with measurements based on different estimators. The large statistical uncertainties make our results consistent with a constant Eddington ratio, although one of our models suggest a possible increase of λEdd with lookback time up to z ˜ 2-3. We conclude that variability is a viable mean to trace the accretion history of supermassive BHs, whose usefulness will increase with future, wide-field/large effective area X-ray missions.

How Teachers' Beliefs About Climate Change Influence Their Instruction and Resulting Student Outcomes

Science.gov (United States)

Nation, M.; Feldman, A.; Smith, G.

2017-12-01

The purpose of the study was to understand the relationship between teachers' beliefs and understandings of climate change and their instructional practices to determine if and how they impact student outcomes. Limited research has been done in the area of teacher beliefs on climate change, their instruction, and resulting student outcomes. This study contributes to the greater understanding of teachers' beliefs and impact on climate change curriculum implementation. The study utilized a mixed methods approach to data collection and analysis. Data were collected in the form of classroom observations, surveys, and interviews from teachers and students participating in the study over a four-month period. Qualitative and quantitative findings were analyzed through thematic coding and descriptive analysis and compared in an effort to triangulate findings. The results of the study suggest teachers and students believe climate change is occurring and humans are largely to blame. Personal beliefs are important when teaching controversial topics, such as climate change, but participants maintained neutrality within their instruction of the topic, as not to appear biased or influence students' decisions about climate change, and avoid political controversy in the classroom. Overall, the study found teachers' level of understandings and beliefs about climate change had little impact on their instruction and resulting student outcomes. Based on the findings, simply adding climate change to the existing science curriculum is not sufficient for teachers or students. Teachers need to be better prepared about effective pedagogical practices of the content in order to effectively teach a climate-centered curriculum. The barriers that exist for the inclusion of teachers' personal beliefs need to be removed in order for teachers to assert their own personal beliefs about climate change within their classroom instruction. Administrators and stakeholders need to support science

Assessing Factors Related to Waist Circumference and Obesity: Application of a Latent Variable Model

Directory of Open Access Journals (Sweden)

Sahar Dalvand

2015-01-01

Full Text Available Background. Because the use of BMI (Body Mass Index alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome and obesity (binary outcome among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity with independent variables including age, gender, PR (Place of Residence, PA (physical activity, smoking status, SBP (Systolic Blood Pressure, DBP (Diastolic Blood Pressure, CHOL (cholesterol, FBG (Fasting Blood Glucose, diabetes, and FHD (family history of diabetes. Results. All variables were related to both obesity and waist circumference (WC. Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Conclusions. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

Assessing the variability of outcome for patients treated with localized prostate irradiation using different definitions of biochemical control

International Nuclear Information System (INIS)

Horwitz, Eric; Ziaja, Ellen; Vicini, Frank; Dmuchowski, Carl; Gonzalez, Jose; Stromberg, Jannifer; Brabbins, Donald; Hollander, Jay; Chen, Peter; Martinez, Alvaro

1995-01-01

Purpose: Biochemical control is rapidly becoming the standard to assess treatment outcome of clinically localized prostate cancer. However, no standardized definition of biochemical control has been established. We reviewed our experience treating patients with localized prostate cancer and applied 3 different commonly used definitions to estimate the variability in rates of biochemical control. Materials and Methods: Between (1(87)) and (12(91)), 480 patients with clinically localized prostate cancer received uniform treatment with external beam irradiation (RT) using localized prostate fields at William Beaumont Hospital. The median dose to the prostate was 66.6 Gy (range 58 to 70.4 Gy) through a 4 field technique. A total of 14 patients received pelvic nodal RT (median dose 45 Gy). Four hundred seventy patients had post-treatment (posttx) PSA values and 414 patients had pre-treatment (pretx) PSA values. Three different definitions of biochemical control were used: 1) Biochemical control was defined as posttx PSA nadir < 1 ng/ml within 1 year. After achieving nadir, if there were 2 consecutive increases, the patient was scored a failure at the time of the first increase; 2) Biochemical control was defined as posttx PSA nadir < 1.5 ng/ml within 1 year. After achieving nadir, if there were 2 consecutive increases, the patient was scored a failure at the time of the first increase; 3) Posttx PSA nadir < 4 ng/ml without a time limit. Once the nadir was achieved, and it did not rise above normal, the patient was considered controlled. Clinical local control was defined as no palpable prostate nodularity beyond 18 months, no new prostate nodularity, or a negative biopsy. If hormonal therapy was started, the patient was censored for biochemical failure at that time. Results: Median follow-up is 48 months (range 3 to 112 months). Pre-treatment PSA values were correlated with biochemical response using the 3 definitions of biochemical control as well as clinical local

Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

DEFF Research Database (Denmark)

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

1999-01-01

and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty...... and by the absence of 'agonizing' pain and of symptoms coinciding with pain (P model 15 of 18 predicted patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overall accuracy...... was 89%. CONCLUSION: From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies....

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

Science.gov (United States)

Ellenbecker, Carol Hall; Cushman, Margaret

2012-08-01

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

Diet matters, particularly in pregnancy – Results from MoBa studies of maternal diet and pregnancy outcomes

Directory of Open Access Journals (Sweden)

Anne Lise Brantsæter

2014-12-01

Full Text Available Awareness that maternal diet may influence the outcome of pregnancy as well as the long-term health of mother and child has increased in recent years. A new food frequency questionnaire (FFQ was developed and validated specifically for the Norwegian Mother and Child Cohort Study (MoBa. The MoBa FFQ is a semi-quantitative tool which covers the average intake of food, beverages and dietary supplements during the first 4 to 5 months of pregnancy. It includes questions about intakes of 255 foods and dishes and was used from 2002 onwards. Data assessed by the MoBa FFQ is available for 87,700 pregnancies. Numerous sub-studies have examined associations between dietary factors and health outcomes in MoBa. The aim of this paper is to summarize the results from 19 studies of maternal diet and pregnancy outcomes, which is the complete collection of studies based on the MoBa FFQ and published before September 2014. The overall research question is whether maternal diet – from single substances to dietary patterns – matters for pregnancy outcome. The pregnancy outcomes studied till now include birth size measures, infants being small and large for gestational age, pregnancy duration, preterm delivery, preeclampsia, as well as maternal gestational weight gain and postpartum weight retention. As a whole, the results from these studies corroborate that the current dietary recommendations to pregnant women are sound and that maternal diet during pregnancy is likely to contribute to reduce the risk of pregnancy complications including preterm birth, preeclampsia, and reduced foetal growth. The results provide supporting evidence for recommending pregnant women to consume vegetables, fruit, whole grain, fish, dairy, and water regularly and lower the intake of sugar sweetened beverages, processed meat products and salty snacks. The results showing negative impact of even low levels of environmental contaminants support the precautionary advice on consumption

Results of Propellant Mixing Variable Study Using Precise Pressure-Based Burn Rate Calculations

Science.gov (United States)

Stefanski, Philip L.

2014-01-01

A designed experiment was conducted in which three mix processing variables (pre-curative addition mix temperature, pre-curative addition mixing time, and mixer speed) were varied to estimate their effects on within-mix propellant burn rate variability. The chosen discriminator for the experiment was the 2-inch diameter by 4-inch long (2x4) Center-Perforated (CP) ballistic evaluation motor. Motor nozzle throat diameters were sized to produce a common targeted chamber pressure. Initial data analysis did not show a statistically significant effect. Because propellant burn rate must be directly related to chamber pressure, a method was developed that showed statistically significant effects on chamber pressure (either maximum or average) by adjustments to the process settings. Burn rates were calculated from chamber pressures and these were then normalized to a common pressure for comparative purposes. The pressure-based method of burn rate determination showed significant reduction in error when compared to results obtained from the Brooks' modification of the propellant web-bisector burn rate determination method. Analysis of effects using burn rates calculated by the pressure-based method showed a significant correlation of within-mix burn rate dispersion to mixing duration and the quadratic of mixing duration. The findings were confirmed in a series of mixes that examined the effects of mixing time on burn rate variation, which yielded the same results.

Personality disorder and alcohol treatment outcome: systematic review and meta-analysis.

Science.gov (United States)

Newton-Howes, Giles M; Foulds, James A; Guy, Nicola H; Boden, Joseph M; Mulder, Roger T

2017-07-01

Background Personality disorders commonly coexist with alcohol use disorders (AUDs), but there is conflicting evidence on their association with treatment outcomes. Aims To determine the size and direction of the association between personality disorder and the outcome of treatment for AUD. Method We conducted a systematic review and meta-analysis of randomised trials and longitudinal studies. Results Personality disorders were associated with more alcohol-related impairment at baseline and less retention in treatment. However, during follow-up people with a personality disorder showed a similar amount of improvement in alcohol outcomes to that of people without such disorder. Synthesis of evidence was hampered by variable outcome reporting and a low quality of evidence overall. Conclusions Current evidence suggests the pessimism about treatment outcomes for this group of patients may be unfounded. However, there is an urgent need for more consistent and better quality reporting of outcomes in future studies in this area. © The Royal College of Psychiatrists 2017.

Multiple Measures of Outcome in Assessing a Prison-Based Drug Treatment Program

Science.gov (United States)

Prendergast, Michael L.; Hall, Elizabeth A.; Wexler, Harry K.

2003-01-01

Evaluations of prison-based drug treatment programs typically focus on one or two dichotomous outcome variables related to recidivism. In contrast, this paper uses multiple measures of outcomes related to crime and drug use to examine the impact of prison treatment. Crime variables included self-report data of time to first illegal activity,…

Admission Chest CT Complements Fiberoptic Bronchoscopy in Prediction of Adverse Outcomes in Thermally Injured Patients

Science.gov (United States)

2012-08-01

full-thickness burn (% FT), injury severity score (ISS), presence of tracheos- tomy, arterial carboxyhemoglobin levels (COHb), and the ratio (PFR) of...RADS, radiologist score; COHb, carboxyhemoglobin . Table 3. Results* Variable Inhalation Injury, N = 25 No Inhalation Injury, N = 19 P RADS 109 (74... carboxyhemoglobin . Table 6. Logistic regression predictor of composite outcome* Variable P Odds Ratio 95% Confidence Interval Limit I nhalation injury + RADS

Predicting Battle Outcomes with Classification Trees

National Research Council Canada - National Science Library

Coban, Muzaffer

2001-01-01

... from the actual battlefield, The models built by using classification trees reveal that the objective variables alone cannot explain the outcome of battles, Relative factors, such as leadership, have deep...

Systematically Tabulated Outcomes Research Matrix (STORM): a methodology to generate research hypotheses.

Science.gov (United States)

Crompton, Joseph G; Oyetunji, Tolulope A; Haut, Elliott R; Cornwell, Edward E; Haider, Adil H

2014-03-01

Here we describe the Systematically Tabulated Outcomes Research Matrix (STORM) method to generate research questions from pre-existing databases with the aim of improving patient outcomes. STORM can be applied to a database by tabulating its variables into a matrix of independent variables (y-axis) and dependent variables (x-axis) and then applying each unique pairing of an independent and dependent variable to a patient population to generate potentially meaningful research questions. To demonstrate this methodology and establish proof-of-principle, STORM was applied on a small scale to the National Trauma Data Bank and generated at least seven clinically meaningful research questions. When coupled with rigorous clinical judgment, the STORM approach complements the traditional method of hypothesis formation and can be generalized to outcomes research using registry databases across different medical specialties. Copyright © 2014 Mosby, Inc. All rights reserved.

Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage

Directory of Open Access Journals (Sweden)

Bonilha Leonardo

2001-01-01

Full Text Available OBJECTIVE: Clinical and surgical outcome of patients with subarachnoid hemorrhage (SAH due to ruptured aneurysm were assessed in comparison to pre-operative data and risk factors such as previous medical history, clinical presenting condition, CT findings and site of bleeding. METHODS: We evaluated 100 consecutive patients with aneurysmal SAH. Gender, color, history of hypertension, smoking habit, site and size of aneurysm, admittance and before surgery Hunt Hess scale, need for cerebro-spinal fluid shunt, presence of complications during the surgical procedure, Glasgow Outcome Scale, presence of vasospasm and of rebleeding were assessed and these data matched to outcome. For statistical analysis, we applied the chi-squared test or Fisher's test using the pondered kappa coeficient. Kruskal-Wallis test was used for comparison of continue variables. Tendency of proportion was analyzed through Cochran-Armitage test. Significance level adopted was 5%. RESULTS: Patients studied were mainly white, female, without previous history of hypertension and non-smokers. Upon hospital admittance, grade 2 of Hunt-Hess scale was most frequently observed (34%, while grade 3 of Fisher scale was the most prevalent. Single aneurysms were most frequent at anterior circulation, between 12 and 24 mm. The most frequent Glasgow Outcome Scale observed was 5 (60%. Hunt Hess upon the moment of surgery and presence of complications during surgical procedure showed positive correlation with clinical outcome (p=0.00002 and p=0.001, respectively. Other variables were not significantly correlated to prognosis. Tendency of proportion was observed between Hunt-Hess scale and Fisher scale. CONCLUSION: Among variables such as epidemiological data, previous medical history and presenting conditions of patients with ruptured aneurysms, the Hunt-Hess scale upon the moment of surgery and the presence of surgical adversities are statistically related to degree of disability.

The textbook as classroom context variable

NARCIS (Netherlands)

Krammer, H.P.M.

1985-01-01

To explore the role of the textbook as a context variable in process—product relationships, data on teaching practices and learning outcomes from the IEA Classroom Environment Study in The Netherlands were used. The sample consisted of 50 secondary school mathematics classes and their teachers.

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

Science.gov (United States)

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

2016-04-28

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

Results Evaluation in Reduction Rhinoplasty

Directory of Open Access Journals (Sweden)

Arima, Lisandra Megumi

2011-01-01

Full Text Available Introduction: Final results evaluation after rhinoplasty is a not a topic widely studied from the patient's viewpoint. Objective:Evaluate the satisfaction of the patients submitted to reduction rhinoplasty, from the questionnaire Rhinoplasty Outcomes Evaluation (ROE. Method: Longitudinal study, retrospective cut type, of the preoperative and postoperative satisfaction. The sample was composed by 28 patients who were submitted to rhinoplasty and answered the ROE questionnaire. Three variables were obtained: satisfaction note that the patient had with his/her image before the surgery; note of satisfaction with the current appearance; the difference of the average satisfaction notes between postoperative and preoperative approaches. Results: The postoperative note was higher than the preoperative in all patients. We noticed a difference between the average of the postoperative and preoperative of 48.3 (p75 considered to be an excellent outcome (67.9%. Conclusions: The ROE questionnaire is a helpful tool to show the satisfaction of the patient submitted to reduction rhinoplasty. About 92% of the patients submitted to reduction rhinoplasty consider the postoperative result to be good or excellent.

Children who screen positive for autism at 2.5 years and receive early intervention: a prospective naturalistic 2-year outcome study

Science.gov (United States)

Spjut Jansson, Birgitta; Miniscalco, Carmela; Westerlund, Joakim; Kantzer, Anne-Katrin; Fernell, Elisabeth; Gillberg, Christopher

2016-01-01

Background Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. Methods Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis – Intensive Learning (IL) – in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions. Results There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. Conclusion The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child’s function and behavior throughout the intervention period. PMID:27621636

Measuring the Impact of Gastrointestinal Variables on the Systemic Outcome of Two Suspensions of Posaconazole by a PBPK Model.

Science.gov (United States)

Hens, Bart; Talattof, Arjang; Paixão, Paulo; Bermejo, Marival; Tsume, Yasuhiro; Löbenberg, Raimar; Amidon, Gordon L

2018-03-29

For the last two decades, the application of physiologically based pharmacokinetic (PBPK) models has grown exponentially in the field of oral absorption and in a regulatory context. Although these models are widely used, their predictive power should be validated and optimized in order to rely on these models and to know exactly what is going on "under the hood". In this study, an automated sensitivity analysis (ASA) was performed for 11 gastrointestinal (GI) variables that are integrated into the PBPK software program Simcyp®. The model of interest was a previously validated workspace that was able to predict the intraluminal and systemic behavior of two different suspensions of posaconazole in the Simcyp® Simulator. The sensitivity of the following GI parameters was evaluated in this model: gastric and duodenal pH, gastric and duodenal bicarbonate concentrations (reflecting buffer capacity), duodenal bile salts concentration, gastric emptying, the interdigestive migrating motor complex (IMMC), small intestinal transit time (SITT), gastric and jejunal volumes, and permeability. The most sensitive parameters were gastric/duodenal pH and gastric emptying, for both suspensions. The outcome of the sensitivity analyses highlights the important GI variables that must be integrated into an in vivo predictive dissolution test to help and create a rational and scientific framework/design for product development of novel and generic drug products.

Birth outcome racial disparities: A result of intersecting social and environmental factors.

Science.gov (United States)

Burris, Heather H; Hacker, Michele R

2017-10-01

Adverse birth outcomes such as preterm birth, low-birth weight, and infant mortality continue to disproportionately affect black and poor infants in the United States. Improvements in healthcare quality and access have not eliminated these disparities. The objective of this review was to consider societal factors, including suboptimal education, income inequality, and residential segregation, that together lead to toxic environmental exposures and psychosocial stress. Many toxic chemicals, as well as psychosocial stress, contribute to the risk of adverse birth outcomes and black women often are more highly exposed than white women. The extent to which environmental exposures combine with stress and culminate in racial disparities in birth outcomes has not been quantified but is likely substantial. Primary prevention of adverse birth outcomes and elimination of disparities will require a societal approach to improve education quality, income equity, and neighborhoods. Copyright © 2017 Elsevier Inc. All rights reserved.

Predicting radiotherapy outcomes using statistical learning techniques

International Nuclear Information System (INIS)

El Naqa, Issam; Bradley, Jeffrey D; Deasy, Joseph O; Lindsay, Patricia E; Hope, Andrew J

2009-01-01

Radiotherapy outcomes are determined by complex interactions between treatment, anatomical and patient-related variables. A common obstacle to building maximally predictive outcome models for clinical practice is the failure to capture potential complexity of heterogeneous variable interactions and applicability beyond institutional data. We describe a statistical learning methodology that can automatically screen for nonlinear relations among prognostic variables and generalize to unseen data before. In this work, several types of linear and nonlinear kernels to generate interaction terms and approximate the treatment-response function are evaluated. Examples of institutional datasets of esophagitis, pneumonitis and xerostomia endpoints were used. Furthermore, an independent RTOG dataset was used for 'generalizabilty' validation. We formulated the discrimination between risk groups as a supervised learning problem. The distribution of patient groups was initially analyzed using principle components analysis (PCA) to uncover potential nonlinear behavior. The performance of the different methods was evaluated using bivariate correlations and actuarial analysis. Over-fitting was controlled via cross-validation resampling. Our results suggest that a modified support vector machine (SVM) kernel method provided superior performance on leave-one-out testing compared to logistic regression and neural networks in cases where the data exhibited nonlinear behavior on PCA. For instance, in prediction of esophagitis and pneumonitis endpoints, which exhibited nonlinear behavior on PCA, the method provided 21% and 60% improvements, respectively. Furthermore, evaluation on the independent pneumonitis RTOG dataset demonstrated good generalizabilty beyond institutional data in contrast with other models. This indicates that the prediction of treatment response can be improved by utilizing nonlinear kernel methods for discovering important nonlinear interactions among model

Goal specificity: a proxy measure for improvements in environmental outcomes in collaborative governance.

Science.gov (United States)

Biddle, Jennifer C; Koontz, Tomas M

2014-12-01

Collaborative governance critics continually call for evidence to support its prevalent use. As is often the case in environmental policy, environmental outcomes occur at a rate incompatible with political agendas. In addition, a multitude of possibly confounding variables makes it difficult to correlate collaborative governance processes with environmental outcomes. The findings of this study offer empirical evidence that collaborative processes have a measurable, beneficial effect on environmental outcomes. Through the use of a unique paired-waterbody design, our dataset reduced the potential for confounding variables to impact our environmental outcome measurements. The results of a path analysis indicate that the output of setting specific pollutant reduction goals is significantly related to watershed partnerships' level of attainment of their environmental improvement goals. The action of setting specific goals (e.g. percentage of load reductions in pollutant levels) is fostered by sustained participation from partnership members throughout the lifecycle of the collaborative. In addition, this study demonstrates the utility of logic modeling for environmental planning and management, and suggests that the process of setting specific pollutant reduction goals is a useful proxy measure for reporting progress towards improvements in environmental outcomes when long-term environmental data are not available. Copyright © 2014 Elsevier Ltd. All rights reserved.

An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making.

Science.gov (United States)

McGirt, Matthew J; Bydon, Mohamad; Archer, Kristin R; Devin, Clinton J; Chotai, Silky; Parker, Scott L; Nian, Hui; Harrell, Frank E; Speroff, Theodore; Dittus, Robert S; Philips, Sharon E; Shaffrey, Christopher I; Foley, Kevin T; Asher, Anthony L

2017-10-01

OBJECTIVE Quality and outcomes registry platforms lie at the center of many emerging evidence-driven reform models. Specifically, clinical registry data are progressively informing health care decision-making. In this analysis, the authors used data from a national prospective outcomes registry (the Quality Outcomes Database) to develop a predictive model for 12-month postoperative pain, disability, and quality of life (QOL) in patients undergoing elective lumbar spine surgery. METHODS Included in this analysis were 7618 patients who had completed 12 months of follow-up. The authors prospectively assessed baseline and 12-month patient-reported outcomes (PROs) via telephone interviews. The PROs assessed were those ascertained using the Oswestry Disability Index (ODI), EQ-5D, and numeric rating scale (NRS) for back pain (BP) and leg pain (LP). Variables analyzed for the predictive model included age, gender, body mass index, race, education level, history of prior surgery, smoking status, comorbid conditions, American Society of Anesthesiologists (ASA) score, symptom duration, indication for surgery, number of levels surgically treated, history of fusion surgery, surgical approach, receipt of workers' compensation, liability insurance, insurance status, and ambulatory ability. To create a predictive model, each 12-month PRO was treated as an ordinal dependent variable and a separate proportional-odds ordinal logistic regression model was fitted for each PRO. RESULTS There was a significant improvement in all PROs (p disability, QOL, and pain outcomes following lumbar spine surgery were employment status, baseline NRS-BP scores, psychological distress, baseline ODI scores, level of education, workers' compensation status, symptom duration, race, baseline NRS-LP scores, ASA score, age, predominant symptom, smoking status, and insurance status. The prediction discrimination of the 4 separate novel predictive models was good, with a c-index of 0.69 for ODI, 0.69 for EQ-5

Service provision and outcome for deliberate self-poisoning in adults--results from a six centre descriptive study.

Science.gov (United States)

Kapur, Navneet; House, Allan; May, Chris; Creed, Francis

2003-07-01

The aim of the study was to compare the hospital management and direct costs of self-poisoning in six United Kingdom hospitals and to investigate whether hospital management influences outcome. This was a prospective descriptive study carried out at three teaching hospitals and three district general hospitals in North West England on adults (aged 16 or over) presenting to the study centres with deliberate self-poisoning over a 5-month period. Data were based on demographic and clinical characteristics, management of the current episode, direct costs and repetition of self-poisoning within 12 weeks of index episode. There were 1778 episodes of self-poisoning during the study period. There were marked differences in management between centres. There was a fivefold difference in the rate of admission to a medical bed (16.5%-81.3%), and a twofold difference in the rate of psychosocial assessment (28.5%-57.7%). These differences remained after adjustment for demographic and clinical factors. Hospital costs per episode varied from pound 228 to pound 422 and repetition rate ranged from 10% to 16%. Psychosocial assessment was associated with a twofold reduction in the risk of repetition. The marked variability of services for self-poisoning continue. It seems likely that this is having a detrimental effect on patient outcomes. Large scale intervention studies are required to inform both clinical practice and service provision.

[Inter-and intra-operator variability in the analysis of semen parameters: results from a quality control program].

Science.gov (United States)

Daoud, Salima; Chakroun-Feki, Nozha; Sellami, Afifa; Ammar-Keskes, Leila; Rebai, Tarek

2016-01-01

Semen analysis is a key part of male infertility investigation. The necessity of quality management implementation in the andrology laboratory has been recognized in order to ensure the reliability of its results. The aim of this study was to evaluate intra- and inter-individual variability in the assessment of semen parameters in our laboratory through a quality control programme. Four participants from the laboratory with different experience levels have participated in this study. Semen samples of varying quality were assessed for sperm motility, concentration and morphology and the results were used to evaluate inter-participant variability. In addition, replicates of each semen sample were analyzed to determine intra-individual variability for semen parameters analysis. The average values of inter-participant coefficients of variation for sperm motility, concentration and morphology were 12.8%, 19.8% and 48.9% respectively. The mean intra-participant coefficients of variation were, respectively, 6.9%, 12.3% and 42.7% for sperm motility, concentration and morphology. Despite some random errors of under- or overestimation, the overall results remained within the limits of acceptability for all participants. Sperm morphology assessment was particularly influenced by the participant's level of experience. The present data emphasize the need for appropriate training of the laboratory staff and for regular participation in internal quality control programmes in order to improve the reliability of laboratory results.

Price-Matching leads to the Cournot Outcome

DEFF Research Database (Denmark)

Batsaikhan, Mongoljin; Tumennasan, Norovsambuu

Bertrand competition that the market price in the presence of a price-matching option ranges from the monopolistic price to the Bertrand price. Our result suggests that the effect of price-matching depends on whether the output is a choice variable for the firms.......We study the effects of price-matching in a duopoly setting in which each firm selects both its price and output, simultaneously. We show that the availability of a pricematching option leads to the Cournot outcome in this setting. This result is a stark contrast to the one obtained in the standard...

Longer dialysis session length is associated with better intermediate outcomes and survival among patients on in-center three times per week hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Science.gov (United States)

Tentori, Francesca; Zhang, Jinyao; Li, Yun; Karaboyas, Angelo; Kerr, Peter; Saran, Rajiv; Bommer, Juergen; Port, Friedrich; Akiba, Takashi; Pisoni, Ronald; Robinson, Bruce

2012-11-01

Longer dialysis session length (treatment time, TT) has been associated with better survival among hemodialysis (HD) patients. The impact of TT on clinical markers that may contribute to this survival advantage is not well known. Using data from the international Dialysis Outcomes and Practice Patterns Study, we assessed the association of TT with clinical outcomes using both standard regression analyses and instrumental variable approaches. The study included 37,414 patients on in-center HD three times per week with prescribed TT from 120 to 420 min. Facility mean TT ranged from 214 min in the USA to 256 min in Australia-New Zealand. Accounting for country effects, mortality risk was lower for patients with longer TT {hazard ratio for every 30 min: all-cause mortality: 0.94 [95% confidence interval (CI): 0.92-0.97], cardiovascular mortality: 0.95 (95% CI: 0.91-0.98) and sudden death: 0.93 (95% CI: 0.88-0.98)}. Patients with longer TT had lower pre- and post-dialysis systolic blood pressure, greater intradialytic weight loss, higher hemoglobin (for the same erythropoietin dose), serum albumin and potassium and lower serum phosphorus and white blood cell counts. Similar associations were found using the instrumental variable approach, although the positive associations of TT with weight loss and potassium were lost. Favorable levels of a variety of clinical markers may contribute to the better survival of patients receiving longer TT. These findings support longer TT prescription in the setting of in-center, three times per week HD.

Outcomes of Asthma Education: Results of a Multisite Evaluation

Directory of Open Access Journals (Sweden)

Wilma M Hopman

2004-01-01

Full Text Available BACKGROUND: This observational study compared the effectiveness of a standardized adult asthma education program administered in a variety of sites and practice settings on health care utilization, absenteeism, amount of leisure time missed and quality of life (using the Medical Outcomes Study 36-Item Short Form 1.0 [SF-36].

Effects of categorization method, regression type, and variable distribution on the inflation of Type-I error rate when categorizing a confounding variable.

Science.gov (United States)

Barnwell-Ménard, Jean-Louis; Li, Qing; Cohen, Alan A

2015-03-15

The loss of signal associated with categorizing a continuous variable is well known, and previous studies have demonstrated that this can lead to an inflation of Type-I error when the categorized variable is a confounder in a regression analysis estimating the effect of an exposure on an outcome. However, it is not known how the Type-I error may vary under different circumstances, including logistic versus linear regression, different distributions of the confounder, and different categorization methods. Here, we analytically quantified the effect of categorization and then performed a series of 9600 Monte Carlo simulations to estimate the Type-I error inflation associated with categorization of a confounder under different regression scenarios. We show that Type-I error is unacceptably high (>10% in most scenarios and often 100%). The only exception was when the variable categorized was a continuous mixture proxy for a genuinely dichotomous latent variable, where both the continuous proxy and the categorized variable are error-ridden proxies for the dichotomous latent variable. As expected, error inflation was also higher with larger sample size, fewer categories, and stronger associations between the confounder and the exposure or outcome. We provide online tools that can help researchers estimate the potential error inflation and understand how serious a problem this is. Copyright © 2014 John Wiley & Sons, Ltd.

Assessing variability in results in systematic reviews of diagnostic studies

NARCIS (Netherlands)

Naaktgeboren, Christiana A; Ochodo, Eleanor A; Van Enst, Wynanda A; de Groot, Joris A H; Hooft, Lotty; Leeflang, Mariska M G; Bossuyt, Patrick M; Moons, Karel G M; Reitsma, Johannes B

2016-01-01

BACKGROUND: To describe approaches used in systematic reviews of diagnostic test accuracy studies for assessing variability in estimates of accuracy between studies and to provide guidance in this area. METHODS: Meta-analyses of diagnostic test accuracy studies published between May and September

Postoperative outcomes and functional results after Deloyer's procedure – a retrospective cohort study

Directory of Open Access Journals (Sweden)

Noel Salgado-Nesme

2017-04-01

Full Text Available Introduction: The objective of our study was to describe surgical outcomes of Deloyers procedure in our referral center, and to compare the results of patients with and without protective ileostomy. Methods: Patients undergoing a Deloyers procedure from 2013 to 2016 were prospectively included. General characteristics, intraoperative variables, postoperative course, and functional outcomes were analyzed. Patients were compared into two groups: group (1 patients undergoing Deloyers procedure without ileostomy, and group (2 Deloyers procedure with protective ileostomy. Results: Sixteen patients undergoing isoperistaltic transposition of the right colon remnant were included, of which 9 (63% were males with a median age of 47 (range 22–76 years. The main surgical indication was the restoration of bowel transit (62.5%. There was higher major morbidity rate in the Deloyers procedure with protective ileostomy group, but without statistical significance (20% vs. 9%, p = 0.92. No leaks or deaths were reported. The length of hospital stay was 7 days. The mean number of bowel movements per day was 4 at 18 months of follow up. Only four (25% patients used irregularly loperamide. Conclusions: The Deloyers procedure has satisfactory results and is reproducible with low morbidity. The major and minor morbidity rates were similar between groups, suggesting that the costs and risks of a second procedure can be avoided by providing a safe primary anastomosis. Resumo: Introdução: O objetivo de nosso estudo foi descrever os resultados cirúrgicos do procedimento de Deloyer em nosso centro de referência e comparar os resultados de pacientes com e sem ileostomia de proteção. Métodos: Pacientes submetidos ao procedimento de Deloyer de 2013 a 2016 foram incluídos prospectivamente. Foram analisadas as características gerais, as variáveis intraoperatórias, o curso pós-operatório e os desfechos funcionais. Os pacientes foram comparados em dois grupos

Randomized trial of intermittent or continuous amnioinfusion for variable decelerations.

Science.gov (United States)

Rinehart, B K; Terrone, D A; Barrow, J H; Isler, C M; Barrilleaux, P S; Roberts, W E

2000-10-01

To determine whether continuous or intermittent bolus amnioinfusion is more effective in relieving variable decelerations. Patients with repetitive variable decelerations were randomized to an intermittent bolus or continuous amnioinfusion. The intermittent bolus infusion group received boluses of 500 mL of normal saline, each over 30 minutes, with boluses repeated if variable decelerations recurred. The continuous infusion group received a bolus infusion of 500 mL of normal saline over 30 minutes and then 3 mL per minute until delivery occurred. The ability of the amnioinfusion to abolish variable decelerations was analyzed, as were maternal demographic and pregnancy outcome variables. Power analysis indicated that 64 patients would be required. Thirty-five patients were randomized to intermittent infusion and 30 to continuous infusion. There were no differences between groups in terms of maternal demographics, gestational age, delivery mode, neonatal outcome, median time to resolution of variable decelerations, or the number of times variable decelerations recurred. The median volume infused in the intermittent infusion group (500 mL) was significantly less than that in the continuous infusion group (905 mL, P =.003). Intermittent bolus amnioinfusion is as effective as continuous infusion in relieving variable decelerations in labor. Further investigation is necessary to determine whether either of these techniques is associated with increased occurrence of rare complications such as cord prolapse or uterine rupture.

Cognitive mediators of treatment outcomes in pediatric functional abdominal pain.

Science.gov (United States)

Levy, Rona L; Langer, Shelby L; Romano, Joan M; Labus, Jennifer; Walker, Lynn S; Murphy, Tasha B; Tilburg, Miranda A L van; Feld, Lauren D; Christie, Dennis L; Whitehead, William E

2014-12-01

Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain. Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

Experience by children and adolescents of more than one type of maltreatment: Association of different classes of maltreatment profiles with clinical outcome variables.

Science.gov (United States)

Witt, Andreas; Münzer, Annika; Ganser, Helene G; Fegert, Jörg M; Goldbeck, Lutz; Plener, Paul L

2016-07-01

Most victims of child abuse have experienced more than one type of maltreatment, yet there is a lack of understanding of the impact of specific combinations of types of maltreatment. This study aimed to identify meaningful classes of maltreatment profiles and to associate them with short-term clinical outcomes. A total of 358 German children and adolescents aged 4-17 with a known history of child maltreatment were included in the study. Through interviews and questionnaires, information was obtained from participants and their primary caregivers on history of maltreatment, sociodemographics, psychopathology, level of psychosocial functioning, and health-related quality of life. Types of abuse were categorized into six major groups: sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic violence. A latent class analysis (LCA) was performed to determine distinct multi-type maltreatment profiles, which were then assessed for their associations with the sociodemographic and clinical outcome variables. The LCA revealed that participants could be categorized into three meaningful classes according to history of maltreatment: (1) experience of multiple types of maltreatment excluding sexual abuse (63.1%), (2) experience of multiple types of maltreatment including sexual abuse (26.5%), and (3) experience of predominantly sexual abuse (10.3%). Members of Class 2 showed significantly worse short-term outcomes on psychopathology, level of functioning, and quality of life compared to the other classes. Three distinct profiles of multiple types of maltreatment were empirically identified in this sample. Exposure to multiple types of abuse was associated with poorer outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

A prospective 2-year examination of cognitive and behavioral correlates of provoked vestibulodynia outcomes.

Science.gov (United States)

Davis, Seth N P; Bergeron, Sophie; Bois, Katy; Sadikaj, Gentiana; Binik, Yitzchak M; Steben, Marc

2015-04-01

Provoked vestibulodynia (PVD) is a common genital pain disorder in women that is associated with sexual dysfunction and lowered sexual satisfaction. A potentially applicable cognitive-behavioral model of chronic pain and disability is the fear-avoidance model (FAM) of pain. The FAM posits that cognitive variables, such as pain catastrophizing, fear, and anxiety lead to avoidance of pain-provoking behaviors (eg, intercourse), resulting in continued pain and disability. Although some of the FAM variables have been shown to be associated with PVD pain and sexuality outcomes, the model as a whole has never been tested in this population. An additional protective factor, pain self-efficacy (SE), is also associated with PVD, but has not been tested within the FAM model. Using a 2-year longitudinal design, we examine (1) whether initial levels (T1) of the independent FAM variables and pain SE were associated with changes in pain, sexual function, and sexual satisfaction over the 2-year time period; (2) the prospective contribution of changes in cognitive-affective (FAM) variables to changes in pain, and sexuality outcomes; and (3) whether these were mediated by behavioral change (avoidance of intercourse). A sample of 222 women with PVD completed self-report measures of FAM variables, SE, pain, sexual function, and sexual satisfaction at time 1 and at a 2-year follow-up. Structural equation modeling with Latent Difference Scores was used to examine changes and to examine mediation between variables. Questionnaires included the Pain Catastrophizing Scale, McGill Pain Questionnaire, Trait Anxiety Inventory, Pain Self-Efficacy Scale, and Global Measure of Sexual Satisfaction, Female Sexual Function Index. Participants who reported higher SE at T1 reported greater declines in pain, greater increases in sexual satisfaction, and greater declines in sexual function over the 2 time points. The overall change model did not support the FAM using negative cognitive

Estimation of genetic variability and heritability of wheat agronomic traits resulted from some gamma rays irradiation techniques

International Nuclear Information System (INIS)

Wijaya Murti Indriatama; Trikoesoemaningtyas; Syarifah Iis Aisyah; Soeranto Human

2016-01-01

Gamma irradiation techniques have significant effect on frequency and spectrum of macro-mutation but the study of its effect on micro-mutation that related to genetic variability on mutated population is very limited. The aim of this research was to study the effect of gamma irradiation techniques on genetic variability and heritability of wheat agronomic characters at M2 generation. This research was conducted from July to November 2014, at Cibadak experimental station, Indonesian Center for Agricultural Biotechnology and Genetic Resources Research and Development, Ministry of Agriculture. Three introduced wheat breeding lines (F-44, Kiran-95 & WL-711) were treated by 3 gamma irradiation techniques (acute, fractionated and intermittent). M1 generation of combination treatments were planted and harvested its spike individually per plants. As M2 generation, seeds of 75 M1 spike were planted at the field with one row one spike method and evaluated on the agronomic characters and its genetic components. The used of gamma irradiation techniques decreased mean but increased range values of agronomic traits in M2 populations. Fractionated irradiation induced higher mean and wider range on spike length and number of spike let per spike than other irradiation techniques. Fractionated and intermittent irradiation resulted greater variability of grain weight per plant than acute irradiation. The number of tillers, spike weight, grain weight per spike and grain weight per plant on M2 population resulted from induction of three gamma irradiation techniques have high estimated heritability and broad sense of genetic variability coefficient values. The three gamma irradiation techniques increased genetic variability of agronomic traits on M2 populations, except plant height. (author)

Outcomes Definitions and Statistical Tests in Oncology Studies: A Systematic Review of the Reporting Consistency.

Science.gov (United States)

Rivoirard, Romain; Duplay, Vianney; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Magne, Nicolas; Bourmaud, Aurelie

2016-01-01

Quality of reporting for Randomized Clinical Trials (RCTs) in oncology was analyzed in several systematic reviews, but, in this setting, there is paucity of data for the outcomes definitions and consistency of reporting for statistical tests in RCTs and Observational Studies (OBS). The objective of this review was to describe those two reporting aspects, for OBS and RCTs in oncology. From a list of 19 medical journals, three were retained for analysis, after a random selection: British Medical Journal (BMJ), Annals of Oncology (AoO) and British Journal of Cancer (BJC). All original articles published between March 2009 and March 2014 were screened. Only studies whose main outcome was accompanied by a corresponding statistical test were included in the analysis. Studies based on censored data were excluded. Primary outcome was to assess quality of reporting for description of primary outcome measure in RCTs and of variables of interest in OBS. A logistic regression was performed to identify covariates of studies potentially associated with concordance of tests between Methods and Results parts. 826 studies were included in the review, and 698 were OBS. Variables were described in Methods section for all OBS studies and primary endpoint was clearly detailed in Methods section for 109 RCTs (85.2%). 295 OBS (42.2%) and 43 RCTs (33.6%) had perfect agreement for reported statistical test between Methods and Results parts. In multivariable analysis, variable "number of included patients in study" was associated with test consistency: aOR (adjusted Odds Ratio) for third group compared to first group was equal to: aOR Grp3 = 0.52 [0.31-0.89] (P value = 0.009). Variables in OBS and primary endpoint in RCTs are reported and described with a high frequency. However, statistical tests consistency between methods and Results sections of OBS is not always noted. Therefore, we encourage authors and peer reviewers to verify consistency of statistical tests in oncology studies.

The association between visual, nonverbal cognitive abilities and speech, phonological processing, vocabulary and reading outcomes in children with cochlear implants.

Science.gov (United States)

Edwards, Lindsey; Anderson, Sara

2014-01-01

The aim of this study was to explore the possibility that specific nonverbal, visual cognitive abilities may be associated with outcomes after pediatric cochlear implantation. The study therefore examined the relationship between visual sequential memory span and visual sequential reasoning ability, and a range of speech, phonological processing, vocabulary knowledge, and reading outcomes in children with cochlear implants. A cross-sectional, correlational design was used. Sixty-six children aged 5 to 12 years completed tests of visual memory span and visual sequential reasoning, along with tests of speech intelligibility, phonological processing, vocabulary knowledge, and word reading ability (the outcome variables). Auditory memory span was also assessed, and its relationship with the other variables examined. Significant, positive correlations were found between the visual memory and reasoning tests, and each of the outcome variables. A series of regression analyses then revealed that for all the outcome variables, after variance attributable to the age at implantation was accounted for, visual memory span and visual sequential reasoning ability together accounted for significantly more variance (up to 25%) in each outcome measure. These findings have both clinical and theoretical implications. Clinically, the findings may help improve the identification of children at risk of poor progress after implantation earlier than has been possible to date as the nonverbal tests can be administered to children as young as 2 years of age. The results may also contribute to the identification of children with specific learning or language difficulties as well as improve our ability to develop intervention strategies for individual children based on their specific cognitive processing strengths or difficulties. Theoretically, these results contribute to the growing body of knowledge about learning and development in deaf children with cochlear implants.

A Correlational Study on Critical Thinking in Nursing as an Outcome Variable for Success

Science.gov (United States)

Porter, Rebecca Jean

2018-01-01

Critical thinking is a required curricular outcome for nursing education; however, the literature shows a gap related to valid and reliable tools to measure critical thinking specific to nursing and relating that critical thinking measurement to meaningful outcomes. This study examined critical thinking scores, as measured by Assessment…

Effects of surgeon variability on oncologic and functional outcomes in a population-based setting.

Science.gov (United States)

Carlsson, Sigrid; Berglund, Anders; Sjoberg, Daniel; Khatami, Ali; Stranne, Johan; Bergdahl, Svante; Lodding, Pär; Aus, Gunnar; Vickers, Andrew; Hugosson, Jonas

2014-03-06

Oncologic and functional outcomes after radical prostatectomy (RP) can vary between surgeons to a greater extent than is expected by chance. We sought to examine the effects of surgeon variation on functional and oncologic outcomes for patients undergoing RP for prostate cancer in a European center. The study comprised 1,280 men who underwent open retropubic RP performed by one of nine surgeons at an academic institution in Sweden between 2001 and 2008. Potency and continence outcomes were measured preoperatively and 18 months postoperatively by patient-administered questionnaires. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value > 0.2 ng/mL with at least one confirmatory rise. Multivariable random effect models were used to evaluate heterogeneity between surgeons, adjusting for case mix (age, PSA, pathological stage and grade), year of surgery, and surgical experience. Of 679 men potent at baseline, 647 provided data at 18 months with 122 (19%) reporting potency. We found no evidence for heterogeneity of potency outcomes between surgeons (P = 1). The continence rate for patients at 18 months was 85%, with 836 of the 979 patients who provided data reporting continence. There was statistically significant heterogeneity between surgeons (P = 0.001). We did not find evidence of an association between surgeons' adjusted probabilities of functional recovery and 5-year probability of freedom from BCR. Our data support previous studies regarding a large heterogeneity among surgeons in continence outcomes for patients undergoing RP. This indicates that some patients are receiving sub-optimal care. Quality assurance measures involving performance feedback, should be considered. When surgeons are aware of their outcomes, they can improve them to provide better care to patients.

Food Environment and Weight Outcomes: A Stochastic Frontier Approach

OpenAIRE

Li, Xun; Lopez, Rigoberto A.

2013-01-01

Food environment includes the presence of supermarkets, restaurants, warehouse clubs and supercenters, and other food outlets. This paper evaluates weight outcomes from a food environment using a stochastic production frontier and an equation for the determinants of efficiency, where the explanatory variables of the efficiency term include food environment indicators. Using individual consumer data and food environment data from New England counties, empirical results indicate that fruit and ...

PREDICTING THE MATCH OUTCOME IN ONE DAY INTERNATIONAL CRICKET MATCHES, WHILE THE GAME IS IN PROGRESS

Directory of Open Access Journals (Sweden)

Michael Bailey

2006-12-01

Full Text Available Millions of dollars are wagered on the outcome of one day international (ODI cricket matches, with a large percentage of bets occurring after the game has commenced. Using match information gathered from all 2200 ODI matches played prior to January 2005, a range of variables that could independently explain statistically significant proportions of variation associated with the predicted run totals and match outcomes were created. Such variables include home ground advantage, past performances, match experience, performance at the specific venue, performance against the specific opposition, experience at the specific venue and current form. Using a multiple linear regression model, prediction variables were numerically weighted according to statistical significance and used to predict the match outcome. With the use of the Duckworth-Lewis method to determine resources remaining, at the end of each completed over, the predicted run total of the batting team could be updated to provide a more accurate prediction of the match outcome. By applying this prediction approach to a holdout sample of matches, the efficiency of the "in the run" wagering market could be assessed. Preliminary results suggest that the market is prone to overreact to events occurring throughout the course of the match, thus creating brief inefficiencies in the wagering market

Patient-reported outcomes and socioeconomic status as predictors of clinical outcomes following hematopoietic stem cell transplantation: A study from the BMT CTN 0902 trial

Science.gov (United States)

Knight, Jennifer M; Syrjala, Karen L; Majhail, Navneet S; Martens, Michael; Le-Rademacher, Jennifer; Logan, Brent R; Lee, Stephanie J; Jacobsen, Paul B; Wood, William A; Jim, Heather SL; Wingard, John R; Horowitz, Mary M; Abidi, Muneer H; Fei, Mingwei; Rawls, Laura; Rizzo, J Douglas

2016-01-01

This secondary analysis of a large, multi-center Blood and Marrow Transplant Clinical Trials Network (BMT CTN) randomized trial assessed whether patient-reported outcomes (PROs) and socioeconomic status (SES) before hematopoietic stem cell transplantation (HCT) are associated with each other and predictive of clinical outcomes including time to hematopoietic recovery, acute graft-versus-host disease, hospitalization days, and overall survival (OS) among 646 allogeneic and autologous HCT recipients. Pre-transplant Cancer and Treatment Distress (CTXD), Pittsburgh Sleep Quality Index (PSQI), and mental and physical component scores (MCS and PCS) of the SF-36 were correlated with each other and with SES variables. PROs and SES variables were further evaluated as predictors of clinical outcomes, with the PSQI and CTXD evaluated as OS predictors (pincome was related to worse physical functioning (p=.005) and increased distress (p=.008); lack of employment pre-transplant was associated with worse physical functioning (p<.01); unmarried status was associated with worse sleep (p=.003). In this large heterogeneous cohort of HCT recipients, while PROs and SES variables were correlated at baseline, they were not associated with any clinical outcomes. Future research should focus on HCT recipients at greater psychosocial disadvantage. PMID:27565521

Travel time variability and rational inattention

DEFF Research Database (Denmark)

Fosgerau, Mogens; Jiang, Gege

2017-01-01

This paper sets up a rational inattention model for the choice of departure time for a traveler facing random travel time. The traveler chooses how much information to acquire about the travel time out-come before choosing departure time. This reduces the cost of travel time variability compared...

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

Science.gov (United States)

Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

Family, Community, and Educational Outcomes in South Asia

Science.gov (United States)

Chudgar, Amita; Shafiq, M. Najeeb

2010-01-01

In this article, we review research on the economics and sociology of education to assess the relationships between family and community variables and children's educational outcomes in South Asia. At the family level, we examine the variables of family socioeconomic status (SES), parental education, family structure, and religion and caste. At…

Improving Work Outcome in Supported Employment for Serious Mental Illness: Results From 2 Independent Studies of Errorless Learning.

Science.gov (United States)

Kern, Robert S; Zarate, Roberto; Glynn, Shirley M; Turner, Luana R; Smith, Kellie M; Mitchell, Sharon S; Sugar, Catherine A; Bell, Morris D; Liberman, Robert P; Kopelowicz, Alex; Green, Michael F

2018-01-13

Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI). In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure. For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies. Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history. These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center 2017.

Outcome Prediction in Mathematical Models of Immune Response to Infection.

Directory of Open Access Journals (Sweden)

Manuel Mai

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

The Relation between Nonverbal IQ and Postoperative CI Outcomes in Cochlear Implant Users: Preliminary Result

Directory of Open Access Journals (Sweden)

Mina Park

2015-01-01

Full Text Available Objectives. This study assessed the correlation between performance intelligence and the postoperative cochlear implant (CI outcome in Korean-speaking children. In addition, the relationship between the performance intelligence subscales and the post-CI speech outcome was evaluated. Materials and Methods. Thirteen pediatric CI users (five males, eight females; median age at implantation 6.2 (range 1.3–14.2 years; median age at intelligence test 9.3 (range 5–16 years who were tested using the Korean Educational Development Institute-Wechsler Intelligence Scale for children were studied. The correlations between the intelligence scores and 1-2 years postoperative Categories of Auditory Performance (CAP scores and between subscales of performance and 1-2 years postoperative CAP scores were analyzed. Results. There was no correlation between the categories of verbal intelligence quotient (IQ and performance IQ for “mentally retarded” and “average,” respectively (Spearman’s rho = 0.42, P=0.15. There was a strong correlation between performance IQ and the postoperative CAP scale (Spearman’s rho = 0.8977, P=0.0008. “Picture arrangement” and “picture completion,” reflecting social cognition, were strongly correlated with the postoperative CAP scales. Conclusion. Performance intelligence, especially social cognition, was strongly related to the postoperative CI outcome of cochlear implant users. Therefore, auditory rehabilitation, including social rehabilitation, should maximize the postoperative CI outcomes.

Investigation of load reduction for a variable speed, variable pitch, and variable coning wind turbine

Energy Technology Data Exchange (ETDEWEB)

Pierce, K. [Univ. of Utah, Salt Lake City, UT (United States)

1997-12-31

A two bladed, variable speed and variable pitch wind turbine was modeled using ADAMS{reg_sign} to evaluate load reduction abilities of a variable coning configuration as compared to a teetered rotor, and also to evaluate control methods. The basic dynamic behavior of the variable coning turbine was investigated and compared to the teetered rotor under constant wind conditions as well as turbulent wind conditions. Results indicate the variable coning rotor has larger flap oscillation amplitudes and much lower root flap bending moments than the teetered rotor. Three methods of control were evaluated for turbulent wind simulations. These were a standard IPD control method, a generalized predictive control method, and a bias estimate control method. Each control method was evaluated for both the variable coning configuration and the teetered configuration. The ability of the different control methods to maintain the rotor speed near the desired set point is evaluated from the RMS error of rotor speed. The activity of the control system is evaluated from cycles per second of the blade pitch angle. All three of the methods were found to produce similar results for the variable coning rotor and the teetered rotor, as well as similar results to each other.

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe.

Science.gov (United States)

Mahdavi, Mahdi; Vissers, Jan; Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena; van de Klundert, Joris

2018-01-01

While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian's Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Data collection consisted of: a) systematic modelling of provider network's structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011-2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian's SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. While the selected structure and process variables explain much of the variance in service satisfaction, this is

Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes

Directory of Open Access Journals (Sweden)

Aisha W Shaheen

2016-01-01

Full Text Available Context: Abdominal compartment syndrome (ACS is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications. Aims: This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS. Settings and Design: A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA. Subjects and Methods:A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts. Statistical Analysis:Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes. Results: Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU, more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level 7 days were moderately associated with a disposition to long-term support facility. Conclusions: Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers.

The impact of obstructive sleep apnea variability measured in-lab versus in-home on sample size calculations

Directory of Open Access Journals (Sweden)

Levendowski Daniel

2009-01-01

Full Text Available Abstract Background When conducting a treatment intervention, it is assumed that variability associated with measurement of the disease can be controlled sufficiently to reasonably assess the outcome. In this study we investigate the variability of Apnea-Hypopnea Index obtained by polysomnography and by in-home portable recording in untreated mild to moderate obstructive sleep apnea (OSA patients at a four- to six-month interval. Methods Thirty-seven adult patients serving as placebo controls underwent a baseline polysomnography and in-home sleep study followed by a second set of studies under the same conditions. The polysomnography studies were acquired and scored at three independent American Academy of Sleep Medicine accredited sleep laboratories. The in-home studies were acquired by the patient and scored using validated auto-scoring algorithms. The initial in-home study was conducted on average two months prior to the first polysomnography, the follow-up polysomnography and in-home studies were conducted approximately five to six months after the initial polysomnography. Results When comparing the test-retest Apnea-hypopnea Index (AHI and apnea index (AI, the in-home results were more highly correlated (r = 0.65 and 0.68 than the comparable PSG results (r = 0.56 and 0.58. The in-home results provided approximately 50% less test-retest variability than the comparable polysomnography AHI and AI values. Both the overall polysomnography AHI and AI showed a substantial bias toward increased severity upon retest (8 and 6 events/hr respectively while the in-home bias was essentially zero. The in-home percentage of time supine showed a better correlation compared to polysomnography (r = 0.72 vs. 0.43. Patients biased toward more time supine during the initial polysomnography; no trends in time supine for in-home studies were noted. Conclusion Night-to-night variability in sleep-disordered breathing can be a confounding factor in assessing

Retrospective Analysis of Inflight Exercise Loading and Physiological Outcomes

Science.gov (United States)

Ploutz-Snyder, L. L.; Buxton, R. E.; De Witt, J. K.; Guilliams, M. E.; Hanson, A. M.; Peters, B. T.; Pandorf, M. M. Scott; Sibonga, J. D.

2014-01-01

Astronauts perform exercise throughout their missions to counter the health declines that occur as a result of long-term exposure to weightlessness. Although all astronauts perform exercise during their missions, the specific prescriptions, and thus the mechanical loading, differs among individuals. For example, inflight ground reaction force data indicate that subject-specific differences exist in foot forces created when exercising on the second-generation treadmill (T2) [1]. The current exercise devices allow astronauts to complete prescriptions at higher intensities, resulting in greater benefits with increased efficiency. Although physiological outcomes have improved, the specific factors related to the increased benefits are unknown. In-flight exercise hardware collect data that allows for exploratory analyses to determine if specific performance factors relate to physiological outcomes. These analyses are vital for understanding which components of exercise are most critical for optimal human health and performance. The relationship between exercise performance variables and physiological changes during flight has yet to be fully investigated. Identifying the critical performance variables that relate to improved physiological outcomes is vital for creating current and future exercise prescriptions to optimize astronaut health. The specific aims of this project are: 1) To quantify the exercise-related mechanical loading experienced by crewmembers on T2 and ARED during their mission on ISS; 2) To explore relationships between exercise loading variables, bone, and muscle health changes during the mission; 3) To determine if specific mechanical loading variables are more critical than others in protecting physiology; 4) To develop methodology for operational use in monitoring accumulated training loads during crew exercise programs. This retrospective analysis, which is currently in progress, is being conducted using data from astronauts that have flown long

Parametric methods outperformed non-parametric methods in comparisons of discrete numerical variables

Directory of Open Access Journals (Sweden)

Sandvik Leiv

2011-04-01

Full Text Available Abstract Background The number of events per individual is a widely reported variable in medical research papers. Such variables are the most common representation of the general variable type called discrete numerical. There is currently no consensus on how to compare and present such variables, and recommendations are lacking. The objective of this paper is to present recommendations for analysis and presentation of results for discrete numerical variables. Methods Two simulation studies were used to investigate the performance of hypothesis tests and confidence interval methods for variables with outcomes {0, 1, 2}, {0, 1, 2, 3}, {0, 1, 2, 3, 4}, and {0, 1, 2, 3, 4, 5}, using the difference between the means as an effect measure. Results The Welch U test (the T test with adjustment for unequal variances and its associated confidence interval performed well for almost all situations considered. The Brunner-Munzel test also performed well, except for small sample sizes (10 in each group. The ordinary T test, the Wilcoxon-Mann-Whitney test, the percentile bootstrap interval, and the bootstrap-t interval did not perform satisfactorily. Conclusions The difference between the means is an appropriate effect measure for comparing two independent discrete numerical variables that has both lower and upper bounds. To analyze this problem, we encourage more frequent use of parametric hypothesis tests and confidence intervals.

Prospective and Retrospective Studies of Substance Abuse Treatment Outcomes: Methods and Results of Four Large-Scale Follow-Up Studies.

Science.gov (United States)

Gerstein, Dean R.; Johnson, Robert A.

This report compares the research methods, provider and patient characteristics, and outcome results from four large-scale followup studies of drug treatment during the 1990s: (1) the California Drug and Alcohol Treatment Assessment (CALDATA); (2) Services Research Outcomes Study (SROS); (3) National Treatment Improvement Evaluation Study (NTIES);…

The compressed work week as organizational change: behavioral and attitudinal outcomes.

Science.gov (United States)

Ronen, S; Primps, S B

1981-01-01

The results from recent studies on the compressed work week have been compiled and categorized in order to provide some basis for generalizing the effects of the work schedule on employee attitudes and behavior. It appears that attitudes toward the compressed week are favorable, with some generalization to job attitudes. Performance outcomes are ambiguous, although there are no reported decreases; fatigue seems to be the only negative aspect of the longer day. An examination of mediating variables suggests more complex relationships between the implementation of the compressed work week and potential outcomes. These relationships are described and directions are indicated for future research.

Estimating impacts of the nuclear family and heritability of nutritional outcomes in a boat-dwelling community.

Science.gov (United States)

Starkweather, Kathrine E; Keith, Monica H

2018-05-01

General health status is reflected in measures of height, weight, and BMI. Assessing sources of variation in these outcomes reveals population-specific variables of importance to health and nutrition. We characterize the impacts of socioeconomic variables related to the nuclear family on health outcomes of boat-dwelling Shodagor children, mothers, and fathers, and to estimate the proportion of variation in height, weight, and BMI influenced by both genetic variation and nongenetic variation among household environments. Bayesian linear mixed models (LMMs) estimate heritability and household-effect variance components among the Shodagor. These models also assess the influences of specific socioeconomic predictor variables on different types of individuals within the household (children, mothers, and fathers). Overall, models explain 61.7% of variation in height, 59.4% in weight, and 65.8% in BMI for this sample of Shodagor. Mother's decision-making and household income have expected, positive associations with children's weight and BMI. Number of children has an unexpected positive relationship to children's height and a negative relationship to father's BMI. Genetic variation explains less than 26% of phenotypic variation for each of these traits on average. Our results show that resource flows and distributions within Shodagor households account for a significant amount of variance in nutritional outcomes. Problems commonly associated with increasing market integration may lead to negative outcomes for children, while mother's autonomy may lead to positive outcomes. Our models also indicate that environmental factors account for more variation in these outcomes than expected, relative to genetics, and we discuss the implications. © 2018 Wiley Periodicals, Inc.

How Are Students' Attitudes Related to Learning Outcomes?

Science.gov (United States)

Metsärinne, Mika; Kallio, Manne

2016-01-01

This article is a part of a research project aimed to find out how different background variables are related to learning outcomes in technology education related to the school subject Sloyd (craft). The research question of this article is: "How are ninth grade students' attitudes towards the subject related to their learning outcomes?"…

[Influence of Attachment Style on the Outcome of Bariatric Surgery - A Pilot Study].

Science.gov (United States)

Appel, Johanna Elisabeth; Ift, Franziska; Kißler, Hermann; Kloos, Christof; Lehmann, Thomas; Strauß, Bernhard; Wick, Katharina

2016-12-01

Background: Bariatric surgery can lower body weight and comorbidities. Different factors might influence the outcome of this treatment. This pilot study examines whether patients' attachment style can influence surgical outcome. Methods: The sample consisted of 32 patients (f=24; m=8; BMI preoperative=47,8 kg/m 2 ±5,2; age=53±9,84) who underwent a laparoscopic sleeve gastrectomy. The following variables were assessed pre- and postoperatively via questionnaires: quality of life (BAROS), self esteem (SES), depression, anxiety, psychological distress (SCL-90R), feelings of hunger, cognitive control, irritated eating behaviour (FEV) and weight related variables (BMI, EWL%, EBL%, TBL). Attachment style was determined postoperatively using the BPQE. Results: None of the participating patients suffered from a binge eating disorder. There was no significant difference of the BMI at any time between the 12 securely attached (SA) patients and the 19 insecurely attachted (IA) patients. Compared to the SA patients IA patients preoperatively showed lower outcomes in variables concerning eating behaviour and mental health. Comparing the 2 groups postoperatively the IA patients achieved lower levels in variables concerning mental health than SA patients and did not reach the preoperative values of the SA patients. Both groups benefited from surgery related to weight loss, mental health and eating behaviour. There was no difference found in the development from pre- to postoperative between SA and IA patients. Discussion & Conclusion: Patients profit by a bariatric intervention independent of their attachment style. By evaluating the attachment style, it could be possible to individually optimize pre- and postoperative patients support in order to gain more effective surgery results. Follow up studies extended to multi-site assessment are required. © Georg Thieme Verlag KG Stuttgart · New York.

Overall outcomes following early interventions for intracranial arteriovenous malformations with hematomas.

Science.gov (United States)

Bir, Shyamal C; Maiti, Tanmoy Kumar; Konar, Subhas; Nanda, Anil

2016-01-01

We evaluated the timing and predictors of surgical intervention for intracranial arteriovenous malformations (AVM) with hematoma. A ruptured intracranial AVM with hematoma is an emergency condition, and the optimal timing for surgical intervention is not well understood. In addition, the outcome predictors of surgical intervention have rarely been reported. We identified and analyzed 78 patients treated with microsurgical resection for pathologically proven AVM at Louisiana State University Health in Shreveport from February 1992 to December 2004. All 78 patients were diagnosed with ruptured AVM before surgery. The independent variables, including patient demographics, timing of surgery, location of the AVM and comorbidities were analyzed to assess outcome. The results of this series revealed that surgical intervention after 48hours resulted in poor outcomes for patients with hematoma, following a ruptured AVM. Several other prognostic factors, including younger age (11-40years), Spetzler-Martin Grade I and II, and AVM in a supratentorial location, had significant positive effects on outcomes. However, hypertension, smoking, and a prior embolization showed significant negative effects on outcomes after surgery. The multiple logistic regression analyses also revealed that the timing of surgical intervention had a significant effect on outcomes in patients with hematoma following ruptured AVM. Early intervention is the key to success in these patients. Published by Elsevier Ltd.

Do continuous assessment results affect final exam outcomes? Evidence from a microeconomics course

Directory of Open Access Journals (Sweden)

Juan Carlos Reboredo

2017-04-01

Full Text Available Continuous assessment aims to enhance student learning and understanding of a subject and so achieve better educational outcomes. We investigated how continuous assessment grades affected final exam grades. Using a dataset for six academic post-Bologna Process years (2009-2015 for a first-year undergraduate microeconomics course offered at a Spanish public university, we examined conditional dependence between continuous assessment and final exam grades. Our results would indicate a limited contribution of continuous assessment results to final exam results: the probability of the final exam performance improving on the continuous assessment grade was lower than the probability of the opposite occurring. A consistent exception, however, was students who obtained an A grade for continuous assessment. Our results would cast some doubt on the beneficial effects of continuous assessment advocated by the Bologna Process.

Improved Outcome Prediction Using CT Angiography in Addition to Standard Ischemic Stroke Assessment: Results from the STOPStroke Study

Science.gov (United States)

González, R. Gilberto; Lev, Michael H.; Goldmacher, Gregory V.; Smith, Wade S.; Payabvash, Seyedmehdi; Harris, Gordon J.; Halpern, Elkan F.; Koroshetz, Walter J.; Camargo, Erica C. S.; Dillon, William P.; Furie, Karen L.

2012-01-01

Purpose To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA). Methods In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as “major” by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores>10. Results Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS− (p10/BASIS+ compared to patients who are NIHSS≤10/BASIS−; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+. Conclusions BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment. PMID:22276182

Risk variables of external apical root resorption during orthodontic treatment

Directory of Open Access Journals (Sweden)

Maria Carolina Feio Barroso

2012-04-01

Full Text Available INTRODUCTION: External apical root resorption (EARR is an adverse outcome of the orthodontic treatment. So far, no single or associated factor has been identified as responsible for EARR due to tooth movement. OBJECTIVE: This study investigated the association of risk variables (age, gender, extraction for orthodontic treatment and Angle classification with EARR and orthodontic treatment. METHOD: The sample (n=72 was divided into two groups according to presence (n=32 or absence (n=40 of EARR in maxillary central and lateral incisors after orthodontic treatment. RESULTS: There were no statistically significant differences in EARR according to age, gender, extraction or type of malocclusion (p>0.05. CONCLUSION: The risk variables examined were not associated with EARR in the study population.

Teachers' and Students' Work-Culture Variables Associated with Positive School Outcome.

Science.gov (United States)

Goldwater, Orna D.; Nutt, Roberta L.

1999-01-01

Investigates whether goodness of fit between teachers' and students' backgrounds is associated with subjective grading and objective achievement at school. One hundred one seventh graders and twenty of their teachers completed the Self-Report Family Inventory. Similarity between teachers' and students' work-culture variables was associated with…

Pharmacogenetics and outcome with antipsychotic drugs.

Science.gov (United States)

Pouget, Jennie G; Shams, Tahireh A; Tiwari, Arun K; Müller, Daniel J

2014-12-01

Antipsychotic medications are the gold-standard treatment for schizophrenia, and are often prescribed for other mental conditions. However, the efficacy and side-effect profiles of these drugs are heterogeneous, with large interindividual variability. As a result, treatment selection remains a largely trial-and-error process, with many failed treatment regimens endured before finding a tolerable balance between symptom management and side effects. Much of the interindividual variability in response and side effects is due to genetic factors (heritability, h(2)~ 0.60-0.80). Pharmacogenetics is an emerging field that holds the potential to facilitate the selection of the best medication for a particular patient, based on his or her genetic information. In this review we discuss the most promising genetic markers of antipsychotic treatment outcomes, and present current translational research efforts that aim to bring these pharmacogenetic findings to the clinic in the near future.

The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population.

Science.gov (United States)

Newman, Andrea K; Van Dyke, Benjamin P; Torres, Calia A; Baxter, Jacob W; Eyer, Joshua C; Kapoor, Shweta; Thorn, Beverly E

2017-09-01

Chronic pain is a pervasive condition that is complicated by economic, educational, and racial disparities. This study analyzes key factors associated with chronic pain within an understudied and underserved population. The sample is characterized by a triple disparity with respect to income, education/literacy, and racial barriers that substantially increase the vulnerability to the negative consequences of chronic pain. The study examined the pretreatment data of 290 participants enrolled in the Learning About My Pain trial, a randomized controlled comparative effectiveness trial of psychosocial interventions (B.E.T., Principal Investigator, Patient-Centered Outcomes Research Institute Contract No. 941; clinicaltrials.gov identifier NCT01967342) for chronic pain. Hierarchical multiple regression analyses evaluated the relationships among sociodemographic (sex, age, race, poverty status, literacy, and education level) and psychological (depressive symptoms and pain catastrophizing) variables and pain interference, pain severity, and disability. The indirect effects of depressive symptoms and pain catastrophizing on the sociodemographic and pain variables were investigated using bootstrap resampling. Reversed mediation models were also examined. Results suggested that the experience of chronic pain within this low-income sample is better accounted for by psychological factors than sex, age, race, poverty status, literacy, and education level. Depressive symptoms and pain catastrophizing mediated the relationships between age and pain variables, whereas pain catastrophizing mediated the effects of primary literacy and poverty status. Some reversed models were equivalent to the hypothesized models, suggesting the possibility of bidirectionality. Although cross-sectional findings cannot establish causality, our results highlight the critical role psychological factors play in individuals with chronic pain and multiple health disparities.

The relationships between depression and other outcomes of chronic illness caregiving

Directory of Open Access Journals (Sweden)

Jirovec Mary M

2005-02-01

Full Text Available Abstract Background Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction. Methods The sample for this secondary data analysis consisted of 236 and 271 subjects from the Americans' Changing Lives, Wave 1, 1986, and Wave 2, 1989, data sets. Measures were constructed from the original study. Structural equation modeling was used to test the hypothesized model, and an exploratory structural modeling method, specification search, was used to develop a data-derived model. Cross-validation was used to verify the paths among variables. Results Hours of care, age, and gender predicted caregivers' outcomes directly or through perceived caregiver stress (p Conclusion Depression predicted psychological outcomes. Whether depression predicts physical health outcomes needs to be further explored.

Do Patient Characteristics Predict Outcome of Psychodynamic Psychotherapy for Social Anxiety Disorder?

Directory of Open Access Journals (Sweden)

Jörg Wiltink

Full Text Available Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT. No study has addressed which patient variables predict outcome of PDT for social anxiety disorder.In the largest multicenter trial on psychotherapy of social anxiety (SA to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems and outcome was analysed using logistic and linear regressions.Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems with a limited proportion of incremental variance (5.5 to 10 percent, while, e.g., shame, self-esteem or harm avoidance did not.We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research.Controlled-trials.com/ISRCTN53517394.

Nonorganic Failure to Thrive: Developmental Outcomes and Psychosocial Assessment and Intervention Issues.

Science.gov (United States)

Heffer, Robert W.; Kelley, Mary L.

1994-01-01

This review describes Nonorganic Failure to Thrive, presents developmental outcomes, and discusses psychosocial assessment and intervention issues relevant to this developmental disability of early childhood, focusing on child-specific variables, situational and family variables, parent-child interaction variables, and biopsychosocial formulation…

Determinants of safety outcomes and performance: A systematic literature review of research in four high-risk industries.

Science.gov (United States)

Cornelissen, Pieter A; Van Hoof, Joris J; De Jong, Menno D T

2017-09-01

In spite of increasing governmental and organizational efforts, organizations still struggle to improve the safety of their employees as evidenced by the yearly 2.3 million work-related deaths worldwide. Occupational safety research is scattered and inaccessible, especially for practitioners. Through systematically reviewing the safety literature, this study aims to provide a comprehensive overview of behavioral and circumstantial factors that endanger or support employee safety. A broad search on occupational safety literature using four online bibliographical databases yielded 27.527 articles. Through a systematic reviewing process 176 online articles were identified that met the inclusion criteria (e.g., original peer-reviewed research; conducted in selected high-risk industries; published between 1980-2016). Variables and the nature of their interrelationships (i.e., positive, negative, or nonsignificant) were extracted, and then grouped and classified through a process of bottom-up coding. The results indicate that safety outcomes and performance prevail as dependent research areas, dependent on variables related to management & colleagues, work(place) characteristics & circumstances, employee demographics, climate & culture, and external factors. Consensus was found for five variables related to safety outcomes and seven variables related to performance, while there is debate about 31 other relationships. Last, 21 variables related to safety outcomes and performance appear understudied. The majority of safety research has focused on addressing negative safety outcomes and performance through variables related to others within the organization, the work(place) itself, employee demographics, and-to a lesser extent-climate & culture and external factors. This systematic literature review provides both scientists and safety practitioners an overview of the (under)studied behavioral and circumstantial factors related to occupational safety behavior. Scientists

Association between changes on the Negative Symptom Assessment scale (NSA-16) and measures of functional outcome in schizophrenia.

Science.gov (United States)

Velligan, Dawn I; Alphs, Larry; Lancaster, Scott; Morlock, Robert; Mintz, Jim

2009-09-30

We examined whether changes in negative symptoms, as measured by scores on the 16-item Negative Symptom Assessment scale (NSA-16), were associated with changes in functional outcome. A group of 125 stable outpatients with schizophrenia were assessed at baseline and at 6 months using the NSA-16, the Brief Psychiatric Rating Scale, and multiple measures of functional outcome. Baseline adjusted regression coefficients indicated moderate correlations between negative symptoms and functional outcomes when baseline values of both variables were controlled. Results were nearly identical when we controlled for positive symptoms. Cross-lag panel correlations and Structural Equation Modeling were used to examine whether changes in negative symptoms drove changes in functional outcomes over time. Results indicated that negative symptoms drove the changes in the Social and Occupational Functioning Scale (SOFAS) rather than the reverse. Measures of Quality of Life and measures of negative symptoms may be assessing overlapping constructs or changes in both may be driven by a third variable. Negative symptoms were unrelated over time to scores on a performance-based measure of functional capacity. This study indicates that the relationship between negative symptom change and the change in functional outcomes is complex, and points to potential issues in selection of assessments.

Executive Summary of the NHLBI Workshop Report: Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes.

Science.gov (United States)

Maier, Lisa A; Crouser, Elliott D; Martin, William J; Eu, Jerry

2017-12-01

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung; it is associated with significant disparities, more commonly impacting those in the prime of their lives (age 20-50 yr, with a second peak after age 60 yr), black individuals, and women. However, the burden of disease, the ability to diagnose and prognose organ involvement and course, as well as specific treatment options, management options, and disease pathogenesis remain poorly understood. As a result, the National Heart, Lung, and Blood Institute undertook a sarcoidosis workshop, "Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes," to help address these issues by defining the scientific and clinical priorities to improve sarcoidosis care. The overarching recommendations from this workshop are outlined in the following summary and detailed in the accompanying articles. The recommendations included establishing collaborations and networks to conduct research based on consensus definitions of disease phenotypes and standards of care, and to provide clinical outreach to areas with a burden of disease to improve care. These collaborative networks would also serve as the hub to conduct clinical trials of devastating phenotypes (e.g., cardiac, neurologic, and fibrotic disease) not only for treatment but to enhance our understanding of the burden of disease. In addition, the networks would be used to leverage state-of-the-art "omics" and systems biology research, as well as other studies to advance understanding of disease pathogenesis, and development of biomarkers and therapeutic targets, with a goal to translate this information to improve care of individuals with sarcoidosis.

Mercury in fish and adverse reproductive outcomes: results from South Carolina

Science.gov (United States)

2014-01-01

Background Mercury is a metal with widespread distribution in aquatic ecosystems and significant neurodevelopmental toxicity in humans. Fish biomonitoring for total mercury has been conducted in South Carolina (SC) since 1976, and consumption advisories have been posted for many SC waterways. However, there is limited information on the potential reproductive impacts of mercury due to recreational or subsistence fish consumption. Methods To address this issue, geocoded residential locations for live births from the Vital Statistics Registry (1995–2005, N = 362,625) were linked with spatially interpolated total mercury concentrations in fish to estimate potential mercury exposure from consumption of locally caught fish. Generalized estimating equations were used to test the hypothesis that risk of low birth weight (LBW, mercury in fish, after adjustment for confounding. Separate analyses estimated term LBW and PTB risks using residential proximity to rivers with fish consumption advisories to characterize exposure. Results Term LBW was more likely among women residing in areas in the upper quartile of predicted total mercury in fish (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.00-1.09) or within 8 kilometers of a river with a ‘do not eat’ fish advisory (1.05; 1.00-1.11) compared to the lowest quartile, or rivers without fish consumption restrictions, respectively. When stratified by race, risks for term LBW or PTB were 10-18% more likely among African-American (AA) mothers living in areas with the highest total fish mercury concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between fish total mercury concentrations and adverse reproductive outcomes in a large population-based sample that included AA women. The ecologic nature of exposure assessment in this study precludes causal inference. However, the results suggest a need for more detailed investigations to characterize patterns of local

Use of and confidence in administering outcome measures among clinical prosthetists: Results from a national survey and mixed-methods training program.

Science.gov (United States)

Gaunaurd, Ignacio; Spaulding, Susan E; Amtmann, Dagmar; Salem, Rana; Gailey, Robert; Morgan, Sara J; Hafner, Brian J

2015-08-01

Outcome measures can be used in prosthetic practices to evaluate interventions, inform decision making, monitor progress, document outcomes, and justify services. Strategies to enhance prosthetists' ability to use outcome measures are needed to facilitate their adoption in routine practice. To assess prosthetists' use of outcome measures and evaluate the effects of training on their confidence in administering performance-based measures. Cross-sectional and single-group pretest-posttest survey. Seventy-nine certified prosthetists (mean of 16.0 years of clinical experience) were surveyed about their experiences with 20 standardized outcome measures. Prosthetists were formally trained by the investigators to administer the Timed Up and Go and Amputee Mobility Predictor. Prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor was measured before and after training. The majority of prosthetists (62%) were classified as non-routine outcome measure users. Confidence administering the Timed Up and Go and Amputee Mobility Predictor prior to training was low-to-moderate across the study sample. Training significantly (p measures. Interactive training resulted in a statistically significant increase of prosthetists' confidence in administering the Timed Up and Go and Amputee Mobility Predictor and may facilitate use of outcome measures in clinical practice. Frequency of outcome measure use in the care of persons with limb loss has not been studied. Study results suggest that prosthetists may not regularly use standardized outcome measures and report limited confidence in administering them. Training enhances confidence and may encourage use of outcome measures in clinical practice. © The International Society for Prosthetics and Orthotics 2014.

Artificial Neural Network System to Predict the Postoperative Outcome of Percutaneous Nephrolithotomy.

Science.gov (United States)

Aminsharifi, Alireza; Irani, Dariush; Pooyesh, Shima; Parvin, Hamid; Dehghani, Sakineh; Yousofi, Khalilolah; Fazel, Ebrahim; Zibaie, Fatemeh

2017-05-01

To construct, train, and apply an artificial neural network (ANN) system for prediction of different outcome variables of percutaneous nephrolithotomy (PCNL). We calculated predictive accuracy, sensitivity, and precision for each outcome variable. During the study period, all adult patients who underwent PCNL at our institute were enrolled in the study. Preoperative and postoperative variables were recorded, and stone-free status was assessed perioperatively with computed tomography scans. MATLAB software was used to design and train the network in a feed forward back-propagation error adjustment scheme. Preoperative and postoperative data from 200 patients (training set) were used to analyze the effect and relative relevance of preoperative values on postoperative parameters. The validated adequately trained ANN was used to predict postoperative outcomes in the subsequent 254 adult patients (test set) whose preoperative values were serially fed into the system. To evaluate system accuracy in predicting each postoperative variable, predicted values were compared with actual outcomes. Two hundred fifty-four patients (155 [61%] males) were considered the test set. Mean stone burden was 6702.86 ± 381.6 mm 3 . Overall stone-free rate was 76.4%. Fifty-four out of 254 patients (21.3%) required ancillary procedures (shockwave lithotripsy 5.9%, transureteral lithotripsy 10.6%, and repeat PCNL 4.7%). The accuracy and sensitivity of the system in predicting different postoperative variables ranged from 81.0% to 98.2%. As a complex nonlinear mathematical model, our ANN system is an interconnected data mining tool, which prospectively analyzes and "learns" the relationships between variables. The accuracy and sensitivity of the system for predicting the stone-free rate, the need for blood transfusion, and post-PCNL ancillary procedures ranged from 81.0% to 98.2%.The stone burden and the stone morphometry were among the most significant preoperative characteristics that

An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement.

Science.gov (United States)

Maximiano, Constanza; López, Iker; Martín, Cristina; Zugazabeitia, Luis; Martí-Ciriquián, Juan L; Núñez, Miguel A; Contreras, Jorge; Herdman, Michael; Traseira, Susana; Provencio, Mariano

2018-01-01

There have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL. Large, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores. 1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (pbreast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL. In the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.

Conducting Systematic Outcome Assessment in Private Addictions Treatment Settings

Directory of Open Access Journals (Sweden)

Gerard J Connors

2017-07-01

Full Text Available Systematic outcome assessment is central to ascertaining the impact of treatment services and to informing future treatment initiatives. This project was designed to be conducted within the clinical operations of 4 private addictions treatment centers. A structured interview was used to assess patients’ alcohol and other drug use and related variables (on treatment entry and at 1, 3, and 6 months following treatment discharge. The primary outcomes were percentage of days abstinent (PDA from alcohol and drugs, PDA from alcohol, and PDA from other drugs. Collateral reports during follow-up also were gathered. A total of 280 patients (56% men across the 4 programs participated. Percentage of days abstinent for each outcome increased significantly from baseline to the 1-month follow-up assessment, and this change was maintained at the 3- and 6-month follow-up assessments. Collateral reports mirrored the patient follow-up reports. Secondary outcomes of patient ratings of urges/cravings, depression, anxiety, and general life functioning all indicated significant improvement from baseline over the course of the follow-up. The results suggest the feasibility of conducting systematic outcome assessment in freestanding private addictions treatment environments.

Less Is More: Results of a Statewide Analysis of the Impact of Blood Transfusion on Coronary Artery Bypass Grafting Outcomes.

Science.gov (United States)

Crawford, Todd C; Magruder, J Trent; Fraser, Charles; Suarez-Pierre, Alejandro; Alejo, Diane; Bobbitt, Jennifer; Fonner, Clifford E; Canner, Joseph K; Horvath, Keith; Wehberg, Kurt; Taylor, Bradley; Kwon, Christopher; Whitman, Glenn J; Conte, John V; Salenger, Rawn

2018-01-01

Debate persists over the association between blood transfusions, especially those considered discretionary, and outcomes after cardiac operations. Using data from the Maryland Cardiac Surgery Quality Initiative, we sought to determine whether outcomes differed among coronary artery bypass grafting (CABG) patients receiving 1 U of red blood cells (RBCs) vs none. We used a statewide database to review patients who underwent isolated CABG from July 1, 2011, to June 30, 2016, across 10 Maryland cardiac surgery centers. We included patients who received 1 U or fewer of RBCs from the time of the operation through discharge. Propensity scoring, using 20 variables to control for treatment effect, was performed among patients who did and did not receive a transfusion. These two groups were matched 1:1 to assess for differences in our primary outcomes: operative death, prolonged postoperative length of stay (>14 days), and a composite postoperative respiratory complication of pneumonia or reintubation, or both. Of 10,877 patients who underwent CABG, 6,124 (56%) received no RBCs (group 1) during their operative hospitalization, and 981 (9.0%) received 1 U of RBCs (group 2), including 345 of 981 patients (35%) who received a transfusion intraoperatively. Propensity score matching generated 937 well-matched pairs. Compared with group 2, propensity-matched analysis revealed significantly greater 30-day survival in group 1 (99% vs 98%, p = 0.02) and reduced incidence of prolonged length of stay (3.7% vs 4.0%, p < 0.01). Our collaborative statewide analysis demonstrated that even 1 unit of blood was associated with significantly worse survival and longer length of stay after CABG. Multiinstitutional quality initiatives may seek to address discretionary transfusions and possess the potential to improve patient outcomes. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Immigration Ethnic Diversity and Political Outcomes

DEFF Research Database (Denmark)

Harmon, Nikolaj Arpe

2017-01-01

I study the impact of immigration and increasing ethnic diversity on political outcomes in immigrant-receiving countries, focusing on immigration and election outcomes in Danish municipalities 1981-2001. A rich set of control variables isolates ethnic diversity effects from those of other immigrant...... characteristics and a novel IV strategy based on historical housing stock data addresses issues of endogenous location choices of immigrants. Increases in local ethnic diversity lead to right-ward shifts in election outcomes by shifting electoral support away from traditional "big government" left-wing parties...... and towards anti-immigrant nationalist parties in particular. These effects appear in both local and national elections....

Variability Bugs:

DEFF Research Database (Denmark)

Melo, Jean

. Although many researchers suggest that preprocessor-based variability amplifies maintenance problems, there is little to no hard evidence on how actually variability affects programs and programmers. Specifically, how does variability affect programmers during maintenance tasks (bug finding in particular......)? How much harder is it to debug a program as variability increases? How do developers debug programs with variability? In what ways does variability affect bugs? In this Ph.D. thesis, I set off to address such issues through different perspectives using empirical research (based on controlled...... experiments) in order to understand quantitatively and qualitatively the impact of variability on programmers at bug finding and on buggy programs. From the program (and bug) perspective, the results show that variability is ubiquitous. There appears to be no specific nature of variability bugs that could...

Brain Natriuretic Peptide Is a Powerful Predictor of Outcome in Stroke Patients with Atrial Fibrillation

Directory of Open Access Journals (Sweden)

Kenji Maruyama

2017-03-01

categorical or continuous variables and mRS score, uni- and multivariate logistic regression models using the stepwise variable selection method were applied. Results: Among 157 patients with NVAF after AIS, 63.7% were male and the mean age was 75.9 years. In univariate regression analysis, poor outcome (mRS score ≥3 was associated with use of tPA, infarct size, age, SBP, BNP, EF, and NIHSS score. In multivariate regression analysis, BNP levels (odds ratio [OR] 6.40; 95% confidence interval [CI] 1.26–32.43; p = 0.0235 and NIHSS score (OR 2.87; 95% CI 1.84–4.47; p < 0.001 were significantly associated with poor outcome (mRS score ≥3 after adjusting for use of tPA, infarct size, age, BNP, EF, and NIHSS score. Conclusions: Apart from NIHSS score, BNP was a very useful predictor for long-term outcomes of patients with NVAF after AIS.

Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue.

Science.gov (United States)

Desuter, Gauthier; Henrard, Sylvie; Van Lith-Bijl, Julie T; Amory, Avigaëlle; Duprez, Thierry; van Benthem, Peter Paul; Sjögren, Elisabeth

2017-03-01

This study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS). A retrospective cohort study was performed on 20 consecutive patients who underwent MTIS. Voice outcome variables were the relative decrease in Voice Handicap Index (%) and the absolute increase in maximum phonation time (MPT) (in seconds). Material variables were the angle between the thyroid cartilage laminae (α-angle), the size of the prosthesis, and a combination of both (the α-ratio). Continuous variables were analyzed using medians and were compared between groups using the Mann-Whitney U test. Factors associated with the outcome variables were assessed by multivariable linear regression. A Pearson coefficient was calculated between material variables. The absolute increase in MPT between the pre- and postoperative period was significantly different between men and women, with a median absolute increase of 11.0 seconds for men and of 1.3 seconds for women (P gender issue that needs to be further studied and eventually tackled. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

Science.gov (United States)

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

Neuropsychological Outcomes of Army Personnel Following Deployment to the Iraq War

Science.gov (United States)

2006-08-02

Neuropsychological Outcomes · Model 1: Core Covariates p Diroction of Effect Outcome Variable No. ~(95%Cl)t Value of DeploymCflt+ &.ojectivo OUICOOlO R::iros MQ... consequences . (l!l outcome domain with high relevance to occupational and psy- chosocial functioning and highly sen- sitive to brain dysfunction. The memory...eg. cardiovascu- lar) and mental (eg, IXlsllraumalic stress disorder) health disorders_ Epidemiological investigations of exposure - outcome

Standardization of SMP procedure and its impact on outcome

Directory of Open Access Journals (Sweden)

Rachita S Dhurat

2017-01-01

Full Text Available Background: Cosmetic deformities can result from various types of alopecia or even post hair transplantation procedures. Patients with such deformities seek aesthetically appealing longer-lasting options. Scalp concealers are commonly used by men and women to camouflage these deformities. Scalp micropigmentation (SMP is one of the concealers recently gaining popularity. Objectives: SMP is a novel technique wherein microdot tattoos are placed in a stippling pattern to mimic hair follicles that are cut close to the scalp and various variables affecting its outcome were evaluated. Methods: Forty-five subjects were recruited for the study. The various factors affecting outcome of SMP—angle of needle against the scalp, depth of needle into the scalp, time of the needle contact in scalp, speed of the rotor, resistance of scalp, color of pigment, viscosity of dye, needle number, needle thickness, and pattern of dot placement—were systematically studied in 15 patients through clinical photographs and trichoscopy. Ideal depth of pigment deposition was assessed through histopathological examination. After using these optimum variables, standardized SMP was performed in 30 patients with hair loss (3 patients with cicatricial and 27 patients with diffuse non-cicatricial alopecia. SMP was also used to create an aesthetically denser hairline. The outcome of the procedure was evaluated using standardized global photographs. Results: The ideal parameters were established to achieve standard reproducible results. There were great patient satisfaction and acceptance of the procedure. All the patients showed moderate to great improvement after the procedure with satisfactory scalp coverage. Adverse events were transient which were seen in the form of edema and redness. Conclusion: SMP offers a non-medical, tattoo-based cosmetically appealing and effective “cover-up” that hides the unsightly conditions. The cosmetic tattoo placement creates an illusion of

Reward-dependent modulation of movement variability.

Science.gov (United States)

Pekny, Sarah E; Izawa, Jun; Shadmehr, Reza

2015-03-04

Movement variability is often considered an unwanted byproduct of a noisy nervous system. However, variability can signal a form of implicit exploration, indicating that the nervous system is intentionally varying the motor commands in search of actions that yield the greatest success. Here, we investigated the role of the human basal ganglia in controlling reward-dependent motor variability as measured by trial-to-trial changes in performance during a reaching task. We designed an experiment in which the only performance feedback was success or failure and quantified how reach variability was modulated as a function of the probability of reward. In healthy controls, reach variability increased as the probability of reward decreased. Control of variability depended on the history of past rewards, with the largest trial-to-trial changes occurring immediately after an unrewarded trial. In contrast, in participants with Parkinson's disease, a known example of basal ganglia dysfunction, reward was a poor modulator of variability; that is, the patients showed an impaired ability to increase variability in response to decreases in the probability of reward. This was despite the fact that, after rewarded trials, reach variability in the patients was comparable to healthy controls. In summary, we found that movement variability is partially a form of exploration driven by the recent history of rewards. When the function of the human basal ganglia is compromised, the reward-dependent control of movement variability is impaired, particularly affecting the ability to increase variability after unsuccessful outcomes. Copyright © 2015 the authors 0270-6474/15/354015-10$15.00/0.

Optimizing time management after perforation by colonoscopy results in better outcome for the patients.

Science.gov (United States)

Rumstadt, Bernhard; Schilling, Dieter

2008-01-01

Perforation during colonoscopy is a rare but severe complication. The aim of this study was to assess the time management and laparoscopic therapy of this complication and to evaluate patient outcomes. A retrospective analysis was done on 15 patients operated for a perforation from colonoscopy between January 2000 and December 2006. Three perforations occurred during diagnostic and 12 perforations during interventional colonoscopy. Two perforations occurred as transmural thermal injury to the colon wall. Peritonitis was found in 4 cases and significantly correlated with the mean time between perforation and operation. Twelve perforations were oversewn laparoscopically and 3 perforations were oversewn by laparotomy. After laparoscopic treatment, hospital stay was significantly shorter than after laparotomy. One patient had a postoperative wound infection, mortality was 0%. Laparoscopic oversewing is a safe and effective method in the treatment of perforation from colonoscopy. Optimizing the time range between perforation and laparoscopic therapy results in a better outcome for the patients.

Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

Science.gov (United States)

Mascia, George V.; And Others

The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

The productivity of mental health care: an instrumental variable approach.

Science.gov (United States)

Lu, Mingshan

1999-06-01

BACKGROUND: Like many other medical technologies and treatments, there is a lack of reliable evidence on treatment effectiveness of mental health care. Increasingly, data from non-experimental settings are being used to study the effect of treatment. However, as in a number of studies using non-experimental data, a simple regression of outcome on treatment shows a puzzling negative and significant impact of mental health care on the improvement of mental health status, even after including a large number of potential control variables. The central problem in interpreting evidence from real-world or non-experimental settings is, therefore, the potential "selection bias" problem in observational data set. In other words, the choice/quantity of mental health care may be correlated with other variables, particularly unobserved variables, that influence outcome and this may lead to a bias in the estimate of the effect of care in conventional models. AIMS OF THE STUDY: This paper addresses the issue of estimating treatment effects using an observational data set. The information in a mental health data set obtained from two waves of data in Puerto Rico is explored. The results using conventional models - in which the potential selection bias is not controlled - and that from instrumental variable (IV) models - which is what was proposed in this study to correct for the contaminated estimation from conventional models - are compared. METHODS: Treatment effectiveness is estimated in a production function framework. Effectiveness is measured as the improvement in mental health status. To control for the potential selection bias problem, IV approaches are employed. The essence of the IV method is to use one or more instruments, which are observable factors that influence treatment but do not directly affect patient outcomes, to isolate the effect of treatment variation that is independent of unobserved patient characteristics. The data used in this study are the first (1992

Emergency medicine task shifting: Quick dash outcome scores of upper extremity injury management

Directory of Open Access Journals (Sweden)

D.S. Frank*

2013-12-01

Results and conclusions: There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 29.5 (range 5.0– 56.8. When compared to the standardized Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6 the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.

Influence of Cognitive Variables in the Iowa Gambling Task

Directory of Open Access Journals (Sweden)

Marino D., Julián C.

2010-07-01

Full Text Available The objective of this work was to analyze the influence of cognitive and personality variables in the Decision Making (DM construct, evaluated by the Iowa Gambling Task (IGT. For this propose, a battery of neuropsychological tests was applied to 116 individuals of both genders between 18 and 35 years olds. The results showed that the IGT performance was not associated to the cognitive variables evaluated, only it has been found moderated relationship between working memory and DM. These outcomes suggest that DM seems to be an independent construct of the “cool” cognitive functions and could be influenced for the emotional or motivational aspects related to “hot” cognitive process. Finally, the DM process seems to be more associated to the ability to avoid punishment than the capacity of evaluate long term benefits.

Functional outcomes in patients with chronic obstructive pulmonary disease: a multivariate analysis

Directory of Open Access Journals (Sweden)

Filipe T. S. Athayde

2014-01-01

Full Text Available Background: Multiple factors can influence the severity of chronic obstructive pulmonary disease (COPD and the functioning of patients with COPD, such as personal characteristics and systemic manifestations. Objective: To evaluate the different factors that can influence the activity and psychosocial impact domains of the Saint George's Respiratory Questionnaire (SGRQ in COPD patients. Method: Participants, recruited in a university-based hospital, responded to the SGRQ, and in addition, personal, anthropometric, and clinical data were collected. The study was approved by the Institutional Ethics Committee. Data were analyzed using multiple linear regression models, with the SGRQ activity and psychosocial impact scores as outcome variables, and 10 explanatory variables (age, gender, forced expiratory volume in the first second - FEV1, smoking load, body mass index, oxygen therapy, associated diseases, regular physical activity, participation in a formal rehabilitation program, and SGRQ symptoms score were considered. Results: The best regression model for predicting the SGRQ activity score (r2=0.477 included gender, FEV1, and SGRQ symptoms. In contrast, the predictive model with the highest proportion of explained variance in psychosocial impact score (r2=0.426 included the variables gender, oxygen therapy, and SGRQ symptoms. Conclusions: The results indicate that the outcomes, while based on functioning parameters in COPD patients, could be partly explained by the personal and clinical factors analyzed, especially by the symptoms assessed by the SGRQ. Thus, it appears that the health conditions of these patients cannot be described by isolated variables, including pulmonary function parameters.

Core outcome sets in women's and newborn health: a systematic review.

Science.gov (United States)

Duffy, Jmn; Rolph, R; Gale, C; Hirsch, M; Khan, K S; Ziebland, S; McManus, R J

2017-09-01

Variation in outcome collection and reporting is a serious hindrance to progress in our specialty; therefore, over 80 journals have come together to support the development, dissemination, and implementation of core outcome sets. This study systematically reviewed and characterised registered, progressing, or completed core outcome sets relevant to women's and newborn health. Systematic search using the Core Outcome Measures in Effectiveness Trial initiative and the Core Outcomes in Women's and Newborn Health initiative databases. Registry entries, protocols, systematic reviews, and core outcome sets. Descriptive statistics to describe characteristics and results. There were 49 core outcome sets registered in maternal and newborn health, with the majority registered in 2015 (n = 22; 48%) or 2016 (n = 16; 32%). Benign gynaecology (n = 8; 16%) and newborn health (n = 3; 6%) are currently under-represented. Twenty-four (52%) core outcome sets were funded by international (n = 1; core outcome sets were completed: reconstructive breast surgery (11 outcomes), preterm birth (13 outcomes), epilepsy in pregnancy (29 outcomes), and maternity care (48 outcomes). The quantitative, qualitative, and consensus methods used to develop core outcome sets varied considerably. Core outcome sets are currently being developed across women's and newborn health, although coverage of topics is variable. Development of further infrastructure to develop, disseminate, and implement core outcome sets is urgently required. Forty-nine women's and newborn core outcome sets registered. 50% funded. 7 protocols, 20 systematic reviews, and 4 core outcome sets published. @coreoutcomes @jamesmnduffy. © 2017 Royal College of Obstetricians and Gynaecologists.

Is there a relationship between patient satisfaction and favorable outcomes?

Science.gov (United States)

Kennedy, Gregory D; Tevis, Sarah E; Kent, K Craig

2014-10-01

Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys correlates with favorable outcomes. Medical centers were identified from the University HealthSystem Consortium database from 2011 to 2012. Variables included hospital characteristics, process measure compliance, and surgical outcomes. Chi-squared analysis was used to evaluate for variables associated with high patient satisfaction (defined as hospitals that scored above the 50th percentile of top box scores). We identified 171 hospitals with complete data. The following variables were significantly associated with high overall patient satisfaction: large hospitals, high surgical volume, and low mortality (P patient satisfaction. Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains. We found that hospital size, surgical volume, and low mortality were associated with high overall patient satisfaction. However, with the exception of low mortality, favorable surgical outcomes were not consistently associated with high HCAHPS scores. With existing satisfaction surveys, we conclude that factors outside of surgical outcomes appear to influence patients' perceptions of their care.

Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

LENUS (Irish Health Repository)

Killeen, Shane D

2012-02-03

BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

The taxonomic structure of rewards as work outcomes

Directory of Open Access Journals (Sweden)

W. I. Myburgh

1986-04-01

Full Text Available Contemporary cognitive process theories of motivation, specifically expectancy/valence theory, use rewards as an important work outcome variable, to explain and predict the interaction processes between motivation and other variables. To date, relatively little attention has been given to define and describe work outcomes empirically. Use is currently made of a hierarchical extrinsic/intrinsic structure, representing outcomes grouped together with universal valence and related to each other. This investigation aims to investigate this taxonomy. Opsomming In kontemporere kognitiewe prosesteoriee van motivering en veral verwagtingsteorie, word verwys na werksuitkomstes (vergoeding as 'n belangrike veranderlike in die verklaring en voorspelling van die interaksieprosesse tussen ander motiveringsfaktore. Tot dusver is relatiefmin aandag bestee om werksuitkomstes empiries te ontleed en te beskryfen teoretici gebruik tans 'n hierargiese struktuur om, uitkomstes wat oor universiele valensie beskik en onderling met mekaar verband hou, te groepeer in ekstrinsieke en intrinsieke uitkomstes of vergoedings. In hierdie ondersoek word gepoog om hierdie taksonomie empirics na te vors.

The rank-heat plot is a novel way to present the results from a network meta-analysis including multiple outcomes.

Science.gov (United States)

Veroniki, Areti Angeliki; Straus, Sharon E; Fyraridis, Alexandros; Tricco, Andrea C

2016-08-01

To present a novel and simple graphical approach to improve the presentation of the treatment ranking in a network meta-analysis (NMA) including multiple outcomes. NMA simultaneously compares many relevant interventions for a clinical condition from a network of trials, and allows ranking of the effectiveness and/or safety of each intervention. There are numerous ways to present the NMA results, which can challenge their interpretation by research users. The rank-heat plot is a novel graph that can be used to quickly recognize which interventions are most likely the best or worst interventions with respect to their effectiveness and/or safety for a single or multiple outcome(s) and may increase interpretability. Using empirical NMAs, we show that the need for a concise and informative presentation of results is imperative, particularly as the number of competing treatments and outcomes in an NMA increases. The rank-heat plot is an efficient way to present the results of ranking statistics, particularly when a large amount of data is available, and it is targeted to users from various backgrounds. Copyright © 2016 Elsevier Inc. All rights reserved.

Micro-macro multilevel latent class models with multiple discrete individual-level variables

NARCIS (Netherlands)

Bennink, M.; Croon, M.A.; Kroon, B.; Vermunt, J.K.

2016-01-01

An existing micro-macro method for a single individual-level variable is extended to the multivariate situation by presenting two multilevel latent class models in which multiple discrete individual-level variables are used to explain a group-level outcome. As in the univariate case, the

Measuring and communicating meaningful outcomes in neonatology: A family perspective.

Science.gov (United States)

Janvier, Annie; Farlow, Barbara; Baardsnes, Jason; Pearce, Rebecca; Barrington, Keith J

2016-12-01

Medium- and long-term outcomes have been collected and described among survivors of neonatal intensive care units for decades, for a number of purposes: (1) quality control within units, (2) comparisons of outcomes between NICUs, (3) clinical trials (whether an intervention improves outcomes), (4) end-of-life decision-making, (5) to better understand the effects of neonatal conditions and/or interventions on organs and/or long-term health, and finally (6) to better prepare parents for the future. However, the outcomes evaluated have been selected by investigators, based on feasibility, availability, cost, stability, and on what investigators consider to be important. Many of the routinely measured outcomes have major limitations: they may not correlate well with long-term difficulties, they may artificially divide continuous outcomes into dichotomous ones, and may have no clear relationship with quality of life and functioning of children and their families. Several investigations, such as routine term cerebral resonance imaging for preterm infants, have also not yet been shown to improve the outcome of children nor their families. In this article, the most common variables used in neonatology as well as some variables which are rarely measured but may be of equal importance for families are presented. The manner in which these outcomes are communicated to families will be examined, as well as recommendations to optimize communication with parents. Copyright © 2016 Elsevier Inc. All rights reserved.

Is the Prediction of Adolescent Outcomes From Early Child Care Moderated by Later Maternal Sensitivity? Results From the NICHD Study of Early Child Care and Youth Development

Science.gov (United States)

Burchinal, Margaret R.; Vandell, Deborah Lowe; Belsky, Jay

2016-01-01

Longitudinal data are used to examine whether effects of early child care are amplified and/or attenuated by later parenting. Analyses tested these interactions using parenting as both a categorical and continuous variable to balance power and flexibility in testing moderation. The most consistent finding was that maternal sensitivity during adolescence accentuated the association between child care quality and adolescent academic-cognitive skills at age 15 years when maternal sensitivity during adolescence was high. This interaction was obtained in analyses with maternal sensitivity as both a categorical and continuous variable. Relations between early child care hours and adolescent behavioral outcomes also were moderated by maternal sensitivity, with longer child care hours predicting more impulsivity and externalizing at age 15 when maternal sensitivity during middle childhood, scored as a categorical variable, was low to moderate and when maternal sensitivity during adolescence, scored as a continuous variable, was lower. These findings suggest that some child care effects are moderated by subsequent parenting and that this moderation may take both linear and nonlinear forms. PMID:23937381

Neutropenia in Patients with Common Variable Immunodeficiency: a Rare Event Associated with Severe Outcome.

Science.gov (United States)

Guffroy, Aurélien; Mourot-Cottet, Rachel; Gérard, Laurence; Gies, Vincent; Lagresle, Chantal; Pouliet, Aurore; Nitschké, Patrick; Hanein, Sylvain; Bienvenu, Boris; Chanet, Valérie; Donadieu, Jean; Gardembas, Martine; Karmochkine, Marina; Nove-Josserand, Raphaele; Martin, Thierry; Poindron, Vincent; Soulas-Sprauel, Pauline; Rieux-Laucat, Fréderic; Fieschi, Claire; Oksenhendler, Eric; André-Schmutz, Isabelle; Korganow, Anne-Sophie

2017-10-01

Common variable immunodeficiency (CVID) is characterized by infections and hypogammaglobulinemia. Neutropenia is rare during CVID. The French DEFI study enrolled patients with primary hypogammaglobulinemia. Patients with CVID and neutropenia were retrospectively analyzed. Among 473 patients with CVID, 16 patients displayed neutropenia (lowest count [0-1400]*10 6 /L). Sex ratio (M/F) was 10/6. Five patients died during the follow-up (11 years) with an increased percentage of deaths compared to the whole DEFI group (31.3 vs 3.4%, P < 0.05). Neutropenia was diagnosed for 10 patients before 22 years old. The most frequent symptoms, except infections, were autoimmune cytopenia, i.e., thrombopenia or anemia (11/16). Ten patients were affected with lymphoproliferative diseases. Two patients were in the infection only group and the others belonged to one or several other CVID groups. The median level of IgG was 2.6 g/L [0.35-4.4]. Most patients presented increased numbers of CD21 low CD38 low B cell, as already described in CVID autoimmune cytopenia group. Neutropenia was considered autoimmune in 11 cases. NGS for 52 genes of interest was performed on 8 patients. No deleterious mutations were found in LRBA, CTLA4, and PIK3. More than one potentially damaging variant in other genes associated with CVID were present in most patients arguing for a multigene process. Neutropenia is generally associated with another cytopenia and presumably of autoimmune origin during CVID. In the DEFI study, neutropenia is coupled with more severe clinical outcomes. It appears as an "alarm bell" considering patients' presentation and the high rate of deaths. Whole exome sequencing diagnosis should improve management.

Nonspecific abdominal pain in pediatric primary care: evaluation and outcomes.

Science.gov (United States)

Wallis, Elizabeth M; Fiks, Alexander G

2015-01-01

To describe the characteristics of children with nonspecific abdominal pain (AP) in primary care, their evaluation, and their outcomes. Between 2007 and 2009, a retrospective cohort of children from 5 primary care practices was followed from an index visit with AP until a well-child visit 6 to 24 months later (outcome visit). Using International Classification of Disease, 9th Revision (ICD-9), codes and chart review, we identified afebrile children between 4 and 12 years old with AP. Use of diagnostic testing was assessed. Multivariable logistic regression was used to model the association of index visit clinical and demographic variables with persistent pain at the outcome visit, and receipt of a specific diagnosis. Three hundred seventy-five children presented with AP, representing 1% of the total population of 4- to 12-year-olds during the study period. Eighteen percent of children had persistent pain, and 70% of the study cohort never received a specific diagnosis for their pain. Seventeen percent and 14% of children had laboratory and radiology testing at the index visit, respectively. Only 3% of laboratory evaluations helped to yield a diagnosis. Among variables considered, only preceding pain of more than 7 days at the index visit was associated with persistent pain (odds ratio 2.15, 95% confidence interval 1.19-3.89). None of the variables considered was associated with receiving a specific diagnosis. Most children with AP do not receive a diagnosis, many have persistent pain, and very few receive a functional AP diagnosis. Results support limited use of diagnostic testing and conservative management consistent with national policy statements. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Inside Quality Reform: Early Results on Using Outcomes for Improvement

Science.gov (United States)

El-Khawas, Elaine

2014-01-01

This article offers evidence on ways in which assessment of student learning outcomes made a difference for some academic institutions in the United States. It offers perspectives on the internal changes that took place, especially within academic programmes. Even after the capacity for assessment was developed, challenges remained in evaluating…

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment.

Science.gov (United States)

Hiller, Wolfgang; Leibbrand, Rolf; Rief, Winfried; Fichter, Manfred M

2002-01-01

Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R(2) = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis. Copyright 2002 S. Karger AG, Basel

Assessing Factors Related to Waist Circumference and Obesity: Application of a Latent Variable Model

OpenAIRE

Dalvand, Sahar; Koohpayehzadeh, Jalil; Karimlou, Masoud; Asgari, Fereshteh; Rafei, Ali; Seifi, Behjat; Niksima, Seyed Hassan; Bakhshi, Enayatollah

2015-01-01

Background. Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Methods. Data included 18,990 Iranian individuals aged 20–65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variabl...

Intra-night Optical Variability Monitoring of Fermi Blazars: First Results from 1.3 m J. C. Bhattacharya Telescope

Energy Technology Data Exchange (ETDEWEB)

Paliya, Vaidehi S.; Ajello, M.; Kaur, A. [Department of Physics and Astronomy, Clemson University, Kinard Lab of Physics, Clemson, SC 29634-0978 (United States); Stalin, C. S., E-mail: vpaliya@g.clemson.edu [Indian Institute of Astrophysics, Block II, Koramangala, Bangalore-560034 (India)

2017-07-20

We report the first results obtained from our campaign to characterize the intra-night-optical variability (INOV) properties of Fermi detected blazars, using the observations from the recently commissioned 1.3 m J. C. Bhattacharya telescope (JCBT). During the first run, we were able to observe 17 blazars in the Bessel R filter for ∼137 hr. Using C- and scaled F -statistics, we quantify the extent of INOV and derive the duty cycle (DC), which is the fraction of time during which a source exhibits a substantial flux variability. We find a high DC of 40% for BL Lac objects and the flat spectrum radio quasars are relatively less variable (DC ∼ 15%). However, when estimated for blazars sub-classes, a high DC of ∼59% is found in low synchrotron peaked (LSP) blazars, whereas, intermediate and high synchrotron peaked objects have a low DC of ∼11% and 13%, respectively. We find evidence of the association of the high amplitude INOV with the γ -ray flaring state. We also notice a high polarization during the elevated INOV states (for the sources that have polarimetric data available), thus supporting the jet based origin of the observed variability. We plan to enlarge the sample and utilize the time availability from the small telescopes, such as 1.3 m JCBT, to strengthen/verify the results obtained in this work and those existing in the literature.

PREDICTIVE CONTRIBUTION OF MORPHOLOGICAL CHARACTERISTICS AND MOTOR ABILITIES ON THE RESULT OF RUNNING THE 60m HURDLES IN BOYS AGED 12 - 13 YEARS

Directory of Open Access Journals (Sweden)

Zana Bujak

2014-06-01

Full Text Available The subject of this study is to determine predictive contributions of morphological characteristics and motor abilities on the 60m hurdles, with an aim to form a group of easily applicable field tests so as to identify boys who are talented in hurdl e racing . The subject sample of this study was comprised of 60 boys aged 12 - 13. The variable sample consisted of a 60m hurdles criterion variable and a set of 13 p re dictor variables comprising of morphological characteristics, speed - strength abilities and the subjects' coordina tion qualities . Applying the regression analysis , the predictive contribution of a complete variable s et of morpholog ical characteristics and motor abilities was determined as an above average statistical significance, influencing 60m hurdle outcome. The greatest individual statistically significant predictive contribution was achieved by the variables of speed - strength quality assessment: 20m flying start r ace result with a standing long jump; and only one variable from the field of morphological characteristics: the shin length. The results support the following conclusion: the two specific variables of speed - strength quality, and 20m flying start race results along with standing long jump , can be relevant predictors of successful outcome in hurdle races .

Maternal nutrition and birth outcomes.

Science.gov (United States)

Abu-Saad, Kathleen; Fraser, Drora

2010-01-01

In this review, the authors summarize current knowledge on maternal nutritional requirements during pregnancy, with a focus on the nutrients that have been most commonly investigated in association with birth outcomes. Data sourcing and extraction included searches of the primary resources establishing maternal nutrient requirements during pregnancy (e.g., Dietary Reference Intakes), and searches of Medline for "maternal nutrition"/[specific nutrient of interest] and "birth/pregnancy outcomes," focusing mainly on the less extensively reviewed evidence from observational studies of maternal dietary intake and birth outcomes. The authors used a conceptual framework which took both primary and secondary factors (e.g., baseline maternal nutritional status, socioeconomic status of the study populations, timing and methods of assessing maternal nutritional variables) into account when interpreting study findings. The authors conclude that maternal nutrition is a modifiable risk factor of public health importance that can be integrated into efforts to prevent adverse birth outcomes, particularly among economically developing/low-income populations.

Input variable selection for data-driven models of Coriolis flowmeters for two-phase flow measurement

International Nuclear Information System (INIS)

Wang, Lijuan; Yan, Yong; Wang, Xue; Wang, Tao

2017-01-01

Input variable selection is an essential step in the development of data-driven models for environmental, biological and industrial applications. Through input variable selection to eliminate the irrelevant or redundant variables, a suitable subset of variables is identified as the input of a model. Meanwhile, through input variable selection the complexity of the model structure is simplified and the computational efficiency is improved. This paper describes the procedures of the input variable selection for the data-driven models for the measurement of liquid mass flowrate and gas volume fraction under two-phase flow conditions using Coriolis flowmeters. Three advanced input variable selection methods, including partial mutual information (PMI), genetic algorithm-artificial neural network (GA-ANN) and tree-based iterative input selection (IIS) are applied in this study. Typical data-driven models incorporating support vector machine (SVM) are established individually based on the input candidates resulting from the selection methods. The validity of the selection outcomes is assessed through an output performance comparison of the SVM based data-driven models and sensitivity analysis. The validation and analysis results suggest that the input variables selected from the PMI algorithm provide more effective information for the models to measure liquid mass flowrate while the IIS algorithm provides a fewer but more effective variables for the models to predict gas volume fraction. (paper)

Homocysteine-Lowering and Cardiovascular Disease Outcomes in Kidney Transplant Recipients: Primary Results from the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) Trial

Science.gov (United States)

Bostom, Andrew G.; Carpenter, Myra A.; Kusek, John W.; Levey, Andrew S.; Hunsicker, Lawrence; Pfeffer, Marc A.; Selhub, Jacob; Jacques, Paul F.; Cole, Edward; Gravens-Mueller, Lisa; House, Andrew A.; Kew, Clifton; McKenney, Joyce L.; Pacheco-Silva, Alvaro; Pesavento, Todd; Pirsch, John; Smith, Stephen; Solomon, Scott; Weir, Matthew

2015-01-01

Background Kidney transplant recipients, like other patients with chronic kidney disease (CKD), experience excess risk of cardiovascular disease (CVD) and elevated total homocysteine (tHcy) concentrations. Observational studies of patients with CKD suggest increased homocysteine is a risk factor for CVD. The impact of lowering total homocysteine (tHcy) levels in kidney transplant recipients is unknown. Methods and Results In a double-blind controlled trial, we randomized 4110 stable kidney transplant recipients to a multivitamin that included either a high dose (n=2056) or low dose (n=2054) of folic acid, vitamin B6, and vitamin B12 to determine whether decreasing tHcy concentrations reduced the rate of the primary composite arteriosclerotic CVD outcome (myocardial infarction, stroke, CVD death, resuscitated sudden death, coronary artery or renal artery revascularization, lower extremity arterial disease, carotid endarterectomy or angioplasty, or abdominal aortic aneurysm repair). Mean follow-up was 4.0 years. Treatment with the high dose multivitamin reduced homocysteine but did not reduce the rates of the primary outcome (n= 547 total events; hazards ratio [95% confidence interval] = 0.99 [0.84–1.17]), or secondary outcomes of all-cause mortality (n=431 deaths; 1.04 [0.86–1.26]) or dialysis-dependent kidney failure (n=343 events; 1.15 [0.93–1.43]) compared to the low dose multivitamin. Conclusions Treatment with a high dose folic acid, B6, and B12 multivitamin in kidney transplant recipients did not reduce a composite cardiovascular disease outcome, all-cause mortality, or dialysis-dependent kidney failure despite significant reduction in homocysteine level. PMID:21482964

Does cannabis use affect treatment outcome in bipolar disorder? A longitudinal analysis

DEFF Research Database (Denmark)

van Rossum, Inge; Boomsma, Maarten; Tenback, Diederik

2009-01-01

Research suggests that cannabis use affects negatively on onset and outcome of schizophrenia, but less is known about possible effects in mood disorders. Bipolar in- and outpatients (N = 3459) were enrolled in an observational study. The influence of cannabis exposure on clinical and social...... treatment outcome measures was examined over the course of 1 year, as well as the effects on these associations of third mediating variables. Over 12 months of treatment, cannabis users exhibited less compliance and higher levels of overall illness severity, mania, and psychosis compared with nonusers....... Additionally, cannabis users experienced less satisfaction with life and had a lower probability of having a relationship compared with nonusers. There was little evidence that cannabis-outcome associations were mediated by third variables. An independent impact of cannabis use on psychopathologic outcomes...

Claimed Effects, Outcome Variables and Methods of Measurement for Health Claims on Foods Related to Vision Proposed Under Regulation (EC) 1924/2006

Science.gov (United States)

Bedogni, Giorgio; Biasini, Beatrice; Zavaroni, Ivana; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Bonadonna, Riccardo C.; Passeri, Giovanni

2018-01-01

Adequate visual function has a strong impact on the quality of life of people. Several foods and food components have been hypothesized to play a role in the maintenance of normal visual function and in the prevention of eye diseases. Some of these foods/food components have been the object of a request of authorization for use of health claims under Articles 13(5) or 14 of the Regulation (EC) 1924/2006. Most of these requests have received a negative opinion from the European Food Safety Authority (EFSA) due to the choice of inappropriate outcome variables (OVs) and/or methods of measurement (MMs) applied in the studies used to substantiate the claims. This manuscript refers to the collection, collation and critical analysis of OVs and MMs related to vision. Guidance document and requests for authorization of health claims were used to collect OVs and MMs related to vision. A literature review was performed to critically analyse OVs and MMs, with the aim of defining their appropriateness in the context of a specific claimed effect related to vision. The results highlight the importance of adequate choices of OVs and MMs for an effective substantiation of claims related to visual function. PMID:29443929

Preliminary results of variable star search using KMTNet data

Directory of Open Access Journals (Sweden)

Jeon Young-Beom

2017-01-01

Full Text Available The KMTNet (Korea Microlensing Telescope Network was completed on October 2nd in 2015. There are three 1.6 m telescopes in Chile (CTIO, Australia (SSO and South Africa (SAAO. The field of view of the CCD camera is 2 degree × 2 degree. We are monitoring and observing the bulge region for 24-hour continuous observations using the KMTNet telescopes. I present the characteristics of CCD camera and telescope, and the status of observation programs. We are still developing CCD cameras to accurate photometry. From the KMTNet data, we can obtain accurate 24-hour continuous time-series data for many variable stars.

Patient reported outcome measures (PROMs) following forward planned field-in field IMRT: Results from the Cambridge Breast IMRT trial

International Nuclear Information System (INIS)

Mukesh, Mukesh B.; Qian, Wendi; Wilkinson, Jennifer S.; Dorling, Leila; Barnett, Gillian C.; Moody, Anne M.; Wilson, Charles; Twyman, Nicola; Burnet, Neil G.; Wishart, Gordon C.; Coles, Charlotte E.

2014-01-01

Background: The use of intensity-modulated radiotherapy (IMRT) in breast cancer reduces clinician-assessed breast tissue toxicity including fibrosis, telangectasia and sub-optimal cosmesis. Patient reported outcome measures (PROMs) are also important as they provide the patient’s perspective. This longitudinal study reports on (a) the effect of forward planned field-in-field IMRT (∼simple IMRT) on PROMs compared to standard RT at 5 years after RT, (b) factors affecting PROMs at 5 years after RT and (c) the trend of PROMs over 5 years of follow up. Methods: PROMs were assessed at baseline (pre-RT), 6, 24 and 60 months after completion of RT using global health (EORTC QLQ C30) and 4 breast symptom questions (BR23). Also, 4 breast RT-specific questions were included at 6, 24 and 60 months: change in skin appearance, firmness to touch, reduction in breast size and overall change in breast appearance since RT. The benefits of simple IMRT over standard RT at 5 years after RT were assessed using standard t-test for global health and logistic regression analysis for breast symptom questions and breast RT-specific questions. Clinical factors affecting PROMs at 5 years were investigated using a multivariate analysis. A repeated mixed model was applied to explore the trend over time for each of PROMs. Results: (89%) 727/815, 84%, 81% and 61% patients completed questionnaires at baseline, 6, 24 and 60 months respectively. Patients reported worse toxicity for all four BR23 breast symptoms at 6 months, which then improved over time (p < 0.0001). They also reported improvement in skin appearance and breast hardness over time (p < 0.0001), with no significant change for breast shrinkage (p = 0.47) and overall breast appearance (p = 0.13). At 5 years, PROMs assessments did not demonstrate a benefit for simple IMRT over standard radiotherapy. Large breast volume, young age, baseline surgical cosmesis and post-operative infection were the most important variables to affect PROMs

Alpha male replacements in nonhuman primates: Variability in processes, outcomes, and terminology.

Science.gov (United States)

Teichroeb, Julie A; Jack, Katharine M

2017-07-01

Alpha male replacements occur in all primates displaying a dominance hierarchy but the process can be extremely variable. Here, we review the primate literature to document differences in patterns of alpha male replacements, showing that group composition and dispersal patterns account for a large proportion of this variability. We also examine the consequences of alpha male replacements in terms of sexual selection theory, infanticide, and group compositions. Though alpha male replacements are often called takeovers in the literature, this term masks much of the variation that is present in these processes. We argue for more concise terminology and provide a list of terms that we suggest more accurately define these events. Finally, we introduce the papers in this special issue on alpha male replacements in the American Journal of Primatology and discuss areas where data are still lacking. © 2017 Wiley Periodicals, Inc.

Cluster analysis as a prediction tool for pregnancy outcomes.

Science.gov (United States)

Banjari, Ines; Kenjerić, Daniela; Šolić, Krešimir; Mandić, Milena L

2015-03-01

Considering specific physiology changes during gestation and thinking of pregnancy as a "critical window", classification of pregnant women at early pregnancy can be considered as crucial. The paper demonstrates the use of a method based on an approach from intelligent data mining, cluster analysis. Cluster analysis method is a statistical method which makes possible to group individuals based on sets of identifying variables. The method was chosen in order to determine possibility for classification of pregnant women at early pregnancy to analyze unknown correlations between different variables so that the certain outcomes could be predicted. 222 pregnant women from two general obstetric offices' were recruited. The main orient was set on characteristics of these pregnant women: their age, pre-pregnancy body mass index (BMI) and haemoglobin value. Cluster analysis gained a 94.1% classification accuracy rate with three branch- es or groups of pregnant women showing statistically significant correlations with pregnancy outcomes. The results are showing that pregnant women both of older age and higher pre-pregnancy BMI have a significantly higher incidence of delivering baby of higher birth weight but they gain significantly less weight during pregnancy. Their babies are also longer, and these women have significantly higher probability for complications during pregnancy (gestosis) and higher probability of induced or caesarean delivery. We can conclude that the cluster analysis method can appropriately classify pregnant women at early pregnancy to predict certain outcomes.

Antimicrobial breakpoint estimation accounting for variability in pharmacokinetics

Directory of Open Access Journals (Sweden)

Nekka Fahima

2009-06-01

Full Text Available Abstract Background Pharmacokinetic and pharmacodynamic (PK/PD indices are increasingly being used in the microbiological field to assess the efficacy of a dosing regimen. In contrast to methods using MIC, PK/PD-based methods reflect in vivo conditions and are more predictive of efficacy. Unfortunately, they entail the use of one PK-derived value such as AUC or Cmax and may thus lead to biased efficiency information when the variability is large. The aim of the present work was to evaluate the efficacy of a treatment by adjusting classical breakpoint estimation methods to the situation of variable PK profiles. Methods and results We propose a logical generalisation of the usual AUC methods by introducing the concept of "efficiency" for a PK profile, which involves the efficacy function as a weight. We formulated these methods for both classes of concentration- and time-dependent antibiotics. Using drug models and in silico approaches, we provide a theoretical basis for characterizing the efficiency of a PK profile under in vivo conditions. We also used the particular case of variable drug intake to assess the effect of the variable PK profiles generated and to analyse the implications for breakpoint estimation. Conclusion Compared to traditional methods, our weighted AUC approach gives a more powerful PK/PD link and reveals, through examples, interesting issues about the uniqueness of therapeutic outcome indices and antibiotic resistance problems.

Factors affecting outcome in ocular myasthenia gravis.

Science.gov (United States)

Mazzoli, Marco; Ariatti, Alessandra; Valzania, Franco; Kaleci, Shaniko; Tondelli, Manuela; Nichelli, Paolo F; Galassi, Giuliana

2018-01-01

50%-60% of patients with ocular myasthenia gravis (OMG) progress to generalized myasthenia gravis (GMG) within two years. The aim of our study was to explore factors affecting prognosis of OMG and to test the predictive role of several independent clinical variables. We reviewed a cohort of 168 Caucasian patients followed from September 2000 to January 2016. Several independent variables were considered as prognostic factors: gender, age of onset, results on electrophysiological tests, presence and level of antibodies against acetylcholine receptors (AChR Abs), treatments, thymic abnormalities. The primary outcome was the progression to GMG and/or the presence of bulbar symptoms. Secondary outcomes were either achievement of sustained minimal manifestation status or worsening in ocular quantitative MG subscore (O-QMGS) or worsening in total QMG score (T-QMGS), assessed by Myasthenia Gravis Foundation of America (MGFA) quantitative scores. Changes in mental and physical subscores of health-related quality of life (HRQoL) were assessed with SF-36 questionnaire. Variance analysis was used to interpret the differences between AChR Ab titers at different times of follow up among the generalized and non-generalized patients. Conversion to GMG occurred in 18.4% of patients; it was significantly associated with sex, later onset of disease and anti-AChR Ab positivity. Antibody titer above the mean value of 25.8 pmol/mL showed no significant effect on generalization. Sex and late onset of disease significantly affected T-QMGS worsening. None of the other independent variables significantly affected O-QMGS and HRQoL. Sex, later onset and anti-AChR Ab positivity were significantly associated with clinical worsening.

Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.

Science.gov (United States)

Hudson, Jennifer L; Kendall, Philip C; Chu, Brian C; Gosch, Elizabeth; Martin, Erin; Taylor, Alan; Knight, Ashleigh

2014-01-01

This study examined the relations between treatment process variables and child anxiety outcomes. Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters. Copyright © 2013 Elsevier Ltd. All rights reserved.

Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality

Directory of Open Access Journals (Sweden)

Jeffrey J. Guterman

2016-09-01

Full Text Available Introduction: Attending physician judgment is the traditional standard of care for emergency department (ED admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods: We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days, and quality indicators (15- and 30-day ED returns; delayed hospital admissions. We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results: Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0% and correlated with Medicaid denied-payment day rates (p=0.038. There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission. There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion: Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.

Illness beliefs and psychological outcome in people with Parkinson's disease.

Science.gov (United States)

Simpson, Jane; Lekwuwa, Godwin; Crawford, Trevor

2013-06-01

Illness beliefs are important predictors of psychological outcome in people with chronic illness and evidence suggests these could also be significant in furthering our understanding of psychological functioning in people with Parkinson's disease. Illness beliefs are specific, dynamic representations of an illness and cover dimensions such as cause, identity, consequences and controllability. Eighty-one people with Parkinson's disease completed a series of questionnaires to provide demographic, clinical and psychosocial data, which were then used to assess the relative impact of illness beliefs on their psychological functioning. Psychological functioning was assessed by measuring levels of depression, anxiety, stress, positive affect and emotional well-being. Hierarchical block regression indicated that illness beliefs were important independent predictors across some but not all outcomes and the results emphasised the importance of testing new predictors against more established predictors of outcome such as physical functioning and self-esteem. The illness beliefs most important in psychological outcome in people with PD were causal beliefs (particularly in psychosocial causes) and illness coherence (the level of understanding of the illness). The therapeutic potential of psychosocial variables was discussed given that these can be modified during therapy and this change can positively influence psychological outcome.

Small scale denitrification variability in riparian zones: Results from a high-resolution dataset

Science.gov (United States)

Gassen, Niklas; Knöller, Kay; Musolff, Andreas; Popp, Felix; Lüders, Tillmann; Stumpp, Christine

2017-04-01

Riparian zones are important compartments at the interface between groundwater and surface water where biogeochemical processes like denitrification are often enhanced. Nitrate loads of either groundwater entering a stream through the riparian zone or streamwater infiltrating into the riparian zone can be substantially reduced. These processes are spatially and temporally highly variable, making it difficult to capture solute variabilities, estimate realistic turnover rates and thus to quantify integral mass removal. A crucial step towards a more detailed characterization is to monitor solutes on a scale which adequately resemble the highly heterogeneous distribution and on a scale where processes occur. We measured biogeochemical parameters in a spatial high resolution within a riparian corridor of a German lowland river system over the course of one year. Samples were taken from three newly developed high-resolution multi-level wells with a maximum vertical resolution of 5 cm and analyzed for major ions, DOC and N-O isotopes. Sediment derived during installation of the wells was analyzed for specific denitrifying enzymes. Results showed a distinct depth zonation of hydrochemistry within the shallow alluvial aquifer, with a 1 m thick zone just below the water table with lower nitrate concentrations and EC values similar to the nearby river. Conservative parameters were consistent inbetween the three wells, but nitrate was highly variable. In addition, spots with low nitrate concentrations showed isotopic and microbial evidence for higher denitrification activities. The depth zonation was observed throughout the year, with stronger temporal variations of nitrate concentrations just below the water table compared to deeper layers. Nitrate isotopes showed a clear seasonal trend of denitrification activities (high in summer, low in winter). Our dataset gives new insight into river-groundwater exchange processes and shows the highly heterogeneous distribution of

The effect of Using Mind Mapping and Learning Styles to Geography Learning outcomes of Junior High School Students

Directory of Open Access Journals (Sweden)

Sigit Purwoko

2015-02-01

Full Text Available Pengaruh Penggunaan Peta Pikiran dan Gaya Belajar terhadap Hasil Belajar Geografi Siswa SMP Abstract: This study aimed to determine the effect of the use of mind maps, learning styles and inter-action using a mind map learning style on geography learning outcomes. This study was a quasi-experimental study, with a 2 x 3 factorial design study subject consisted of two classes of class VII G as experimental class and class VII F as a control class. Variables consisted of: (1 the dependent variable is the student learning outcomes; (2 the independent variable is the use of mind maps; and (3 is the moderator variable learning styles. Geography learning outcomes were measured using an objective test, whereas learning styles with questionnaires. Measurement data are then analyzed using ANOVA two paths with SPSS v.7. Results of data analysis using ANOVA two path showed that: (1 the use of mind maps significantly effect on learning outcomes geography; (2 learning style does not significantly affect the results of learning geography; and (3 there is no interaction between the use of mind maps and learning style on learning outcomes. Key Words: mind maps, learning styles, learning outcomes   Abstrak: Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan peta pikiran, gaya belajar dan interaksi penggunaan peta pikiran dengan gaya belajar terhadap hasil belajar geografi. Penelitian ini merupakan penelitian eksperimen semu, dengan desain faktorial 2 x 3. Subjek penelitian terdiri dari dua kelas yaitu kelas VII G sebagai kelas eksperimen dan kelas VII F sebagai kelas kontrol. Variabel penelitian terdiri dari: (1 variabel terikat adalah hasil belajar siswa; (2 variabel bebas adalah pengguna-an peta pikiran; dan (3 variabel moderator adalah gaya belajar. Hasil belajar geografi diukur menggunakan tes objektif, sedangkan gaya belajar dengan angket. Data hasil pengukuran dianalisis menggunakan anova dua jalur dengan bantuan SPSS v.7. Hasil analisis data

A search for β Cephei variable stars in the Magellanic Clouds: motivation and first results for the LMC

International Nuclear Information System (INIS)

Sterken, C.; Jerzykiewicz, M.

1988-01-01

Motivation for starting a programme of detecting and investigating β Cephei variables in the Magellanic Clouds is given. Differential photoelectric observations are then reported of six LMC stars which fall in the instability strip defined by the galactic β Cephei variables. Three programme stars are found to exhibit short-term brightness variations. One of them, showing a sinusoidal light-curve with an amplitude (half-range) equal to 0.0070 ± 0.0011 mag and a period equal to about 5 hr, is a promising β Cephei candidate. In the case of the other two variable programme stars, the interpretation of the results is less straightforward. The remaining three programme stars are shown to be constant on a short time-scale, two to within ± 0.010 mag, and one to within ± 0.005 magn. (author)

The Impact of The Quality of Financial Statements on Local Revenue Using Examination Opinion Results as Moderating Variable

Directory of Open Access Journals (Sweden)

Arik - Susbiyani

2017-02-01

Full Text Available Abstract   This study aimed to examine the influence of the financial statements on local revenue by using the results of the examination opinion as moderating variable. The study used Legitimacy Theory to explain and analyze the relationship between variables. The population in the study was all the districts and cities in Indonesia totaling 497 county and city governments. The sampling method used in the study was judgment sampling. Samples that met the criteria of the study were 116 local governments. The analytical tool used in this research was the analysis of MRA (Moderated Regression Analysis. The results showed that the effects of the partial test of the quality of financial reports to local revenues were not significant positive effects. While the partial test results stating the influence of audit opinion on local revenue having positive effects were not significant. Other results showed that the interaction between the results of the examination opinion to the quality of financial statements was  insignificant on the quality of financial statements. In other words, the results of the examination opinions moderated (strengthened the relationship between quality of financial report on local revenue of district and city governments in Indonesia.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting.

Science.gov (United States)

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

2012-09-01

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research. © 2012 John Wiley & Sons A/S.

The effect of hospital volume on patient outcomes in severe acute pancreatitis

Directory of Open Access Journals (Sweden)

Shen Hsiu-Nien

2012-08-01

Full Text Available Abstract Background We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP. The determination is important because patient outcome may be improved through volume-based selective referral. Methods In this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009 from Taiwan’s National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year. The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1, and additional treatment variables (model 2. Results Irrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase. The patients treated in the highest volume quartile (≥14 cases per hospital-year had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83. However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures. Conclusions These findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume

Conventional heart rate variability analysis of ambulatory electrocardiographic recordings fails to predict imminent ventricular fibrillation

Science.gov (United States)

Vybiral, T.; Glaeser, D. H.; Goldberger, A. L.; Rigney, D. R.; Hess, K. R.; Mietus, J.; Skinner, J. E.; Francis, M.; Pratt, C. M.

1993-01-01

OBJECTIVES. The purpose of this report was to study heart rate variability in Holter recordings of patients who experienced ventricular fibrillation during the recording. BACKGROUND. Decreased heart rate variability is recognized as a long-term predictor of overall and arrhythmic death after myocardial infarction. It was therefore postulated that heart rate variability would be lowest when measured immediately before ventricular fibrillation. METHODS. Conventional indexes of heart rate variability were calculated from Holter recordings of 24 patients with structural heart disease who had ventricular fibrillation during monitoring. The control group consisted of 19 patients with coronary artery disease, of comparable age and left ventricular ejection fraction, who had nonsustained ventricular tachycardia but no ventricular fibrillation. RESULTS. Heart rate variability did not differ between the two groups, and no consistent trends in heart rate variability were observed before ventricular fibrillation occurred. CONCLUSIONS. Although conventional heart rate variability is an independent long-term predictor of adverse outcome after myocardial infarction, its clinical utility as a short-term predictor of life-threatening arrhythmias remains to be elucidated.

Tuberculosis treatment outcome monitoring in European Union countries: systematic review

Science.gov (United States)

van Hest, Rob; Ködmön, Csaba; Verver, Suzanne; Erkens, Connie G.M.; Straetemans, Masja; Manissero, Davide; de Vries, Gerard

2013-01-01

Treatment success measured by treatment outcome monitoring (TOM) is a key programmatic output of tuberculosis (TB) control programmes. We performed a systematic literature review on national-level TOM in the 30 European Union (EU)/European Economic Areas (EEA) countries to summarise methods used to collect and report data on TOM. Online reference bibliographic databases PubMed/MEDLINE and EMBASE were searched to identify relevant indexed and non-indexed literature published between January 2000 and August 2010. The search strategy resulted in 615 potentially relevant indexed citations, of which 27 full-text national studies (79 data sets) were included for final analysis. The selected studies were performed in 10 EU/EEA countries and gave a fragmented impression of TOM in the EU/EEA. Publication year, study period, sample size, databases, definitions, variables, patient and outcome categories, and population subgroups varied widely, portraying a very heterogeneous picture. This review confirmed previous reports of considerable heterogeneity in publications of TOM results across EU/EEA countries. PubMed/MEDLINE and EMBASE indexed studies are not a suitable instrument to measure representative TOM results for the 30 EU/EEA countries. Uniform and complete reporting to the centralised European Surveillance System will produce the most timely and reliable results of TB treatment outcomes in the EU/EEA. PMID:22790913

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

Science.gov (United States)

Gilmartin, Heather M; Sousa, Karen H

2016-01-01

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

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

Science.gov (United States)

Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

Interrater variability of EEG interpretation in comatose cardiac arrest patients

DEFF Research Database (Denmark)

Westhall, Erik; Rosén, Ingmar; Rossetti, Andrea O

2015-01-01

OBJECTIVE: EEG is widely used to predict outcome in comatose cardiac arrest patients, but its value has been limited by lack of a uniform classification. We used the EEG terminology proposed by the American Clinical Neurophysiology Society (ACNS) to assess interrater variability in a cohort...... who were blinded for patient outcome. Percent agreement and kappa (κ) for the categories in the ACNS EEG terminology and for prespecified malignant EEG-patterns were calculated. RESULTS: There was substantial interrater agreement (κ 0.71) for highly malignant patterns and moderate agreement (κ 0.......42) for malignant patterns. Substantial agreement was found for malignant periodic or rhythmic patterns (κ 0.72) while agreement for identifying an unreactive EEG was fair (κ 0.26). CONCLUSIONS: The ACNS EEG terminology can be used to identify highly malignant EEG-patterns in post cardiac arrest patients...

Variable-bias coin tossing

International Nuclear Information System (INIS)

Colbeck, Roger; Kent, Adrian

2006-01-01

Alice is a charismatic quantum cryptographer who believes her parties are unmissable; Bob is a (relatively) glamorous string theorist who believes he is an indispensable guest. To prevent possibly traumatic collisions of self-perception and reality, their social code requires that decisions about invitation or acceptance be made via a cryptographically secure variable-bias coin toss (VBCT). This generates a shared random bit by the toss of a coin whose bias is secretly chosen, within a stipulated range, by one of the parties; the other party learns only the random bit. Thus one party can secretly influence the outcome, while both can save face by blaming any negative decisions on bad luck. We describe here some cryptographic VBCT protocols whose security is guaranteed by quantum theory and the impossibility of superluminal signaling, setting our results in the context of a general discussion of secure two-party computation. We also briefly discuss other cryptographic applications of VBCT

Variable-bias coin tossing

Science.gov (United States)

Colbeck, Roger; Kent, Adrian

2006-03-01

Alice is a charismatic quantum cryptographer who believes her parties are unmissable; Bob is a (relatively) glamorous string theorist who believes he is an indispensable guest. To prevent possibly traumatic collisions of self-perception and reality, their social code requires that decisions about invitation or acceptance be made via a cryptographically secure variable-bias coin toss (VBCT). This generates a shared random bit by the toss of a coin whose bias is secretly chosen, within a stipulated range, by one of the parties; the other party learns only the random bit. Thus one party can secretly influence the outcome, while both can save face by blaming any negative decisions on bad luck. We describe here some cryptographic VBCT protocols whose security is guaranteed by quantum theory and the impossibility of superluminal signaling, setting our results in the context of a general discussion of secure two-party computation. We also briefly discuss other cryptographic applications of VBCT.

Treatment outcome in psychiatric inpatients: the discriminative value of self-esteem.

Science.gov (United States)

Talbot, France; Harris, Gregory E; French, Douglas J

2009-01-01

Self-esteem has been identified as an important clinical variable within various psychological and psychiatric conditions. Surprisingly, its prognostic and discriminative value in predicting treatment outcome has been understudied. The current study aims to assess, in an acute psychiatric setting, the comparative role of self-esteem in predicting treatment outcome in depression, anxiety, and global symptom severity, while controlling for socio-demographic variables, pre-treatment symptom severity, and personality pathology. Treatment outcome was assessed with pre- and post-treatment measures. A heterogeneous convenience sample of 63 psychiatric inpatients completed upon admission and discharge self-report measures of depression, anxiety, global symptom severity, and self-esteem. A significant one-way repeated-measures multivariate analysis of variance (MANOVA) followed up by analyses of variance (ANOVAs) revealed significant reductions in depression (eta2 = .72), anxiety (eta2 = .55), and overall psychological distress (eta2 = .60). Multiple regression analyses suggested that self-esteem was a significant predictor of short-term outcome in depression but not for anxiety or overall severity of psychiatric symptoms. The regression model predicting depression outcome explained 32% of the variance with only pre-treatment self-esteem contributing significantly to the prediction. The current study lends support to the importance of self-esteem as a pre-treatment patient variable predictive of psychiatric inpatient treatment outcome in relation with depressive symptomatology. Generalization to patient groups with specific diagnoses is limited due to the heterogeneous nature of the population sampled and the treatments provided. Implications for clinical practice and future research are discussed.

Survival Outcomes in Resected Extrahepatic Cholangiocarcinoma: Effect of Adjuvant Radiotherapy in a Surveillance, Epidemiology, and End Results Analysis

International Nuclear Information System (INIS)

Vern-Gross, Tamara Z.; Shivnani, Anand T.; Chen, Ke; Lee, Christopher M.; Tward, Jonathan D.; MacDonald, O. Kenneth; Crane, Christopher H.; Talamonti, Mark S.; Munoz, Louis L.; Small, William

2011-01-01

Purpose: The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. Methods and Materials: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. Results: The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p < .001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. Conclusion: Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.

Effects of central nervous system drugs on driving: speed variability versus standard deviation of lateral position as outcome measure of the on-the-road driving test.

Science.gov (United States)

Verster, Joris C; Roth, Thomas

2014-01-01

The on-the-road driving test in normal traffic is used to examine the impact of drugs on driving performance. This paper compares the sensitivity of standard deviation of lateral position (SDLP) and SD speed in detecting driving impairment. A literature search was conducted to identify studies applying the on-the-road driving test, examining the effects of anxiolytics, antidepressants, antihistamines, and hypnotics. The proportion of comparisons (treatment versus placebo) where a significant impairment was detected with SDLP and SD speed was compared. About 40% of 53 relevant papers did not report data on SD speed and/or SDLP. After placebo administration, the correlation between SDLP and SD speed was significant but did not explain much variance (r = 0.253, p = 0.0001). A significant correlation was found between ΔSDLP and ΔSD speed (treatment-placebo), explaining 48% of variance. When using SDLP as outcome measure, 67 significant treatment-placebo comparisons were found. Only 17 (25.4%) were significant when SD speed was used as outcome measure. Alternatively, for five treatment-placebo comparisons, a significant difference was found for SD speed but not for SDLP. Standard deviation of lateral position is a more sensitive outcome measure to detect driving impairment than speed variability.

Discrimination, work outcomes, and mental health among women of color: The protective role of womanist attitudes.

Science.gov (United States)

Velez, Brandon L; Cox, Robert; Polihronakis, Charles J; Moradi, Bonnie

2018-03-01

With a sample of employed women of color (N = 276), we tested the associations of sexist and racist discrimination with poor work outcomes (job-related burnout and turnover intentions) and mental health outcomes (i.e., psychological distress). Drawing from the Theory of Work Adjustment, Organizational Support Theory, and scholarship on discrimination, we tested perceived person-organization (P-O) fit, perceived organizational support, and self-esteem as mediators of the associations of workplace discrimination with the outcomes. Based on intersectionality scholarship, womanist attitudes were tested as a moderator. Participants provided cross-sectional data via an online survey. Latent variable structural equation modeling results indicated that a second-order latent workplace discrimination variable yielded better fit to the data than modeling sexist and racist discrimination separately. Workplace discrimination was directly and indirectly (via the mediating role of self-esteem) associated with higher psychological distress. Furthermore, workplace discrimination was indirectly associated with poor work outcomes through the mediating roles of perceived P-O fit, perceived organizational support, and self-esteem. Last, moderation analyses indicated that higher womanist attitudes weakened the direct association of workplace discrimination with psychological distress. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Variables predicting elevated portal pressure in alcoholic liver disease. Results of a multivariate analysis

DEFF Research Database (Denmark)

Krogsgaard, K; Christensen, E; Gluud, C

1987-01-01

In 46 alcoholic patients the association of wedged-to-free hepatic-vein pressure with other variables (clinical, histologic, hemodynamic, and liver function data) was studied by means of multiple regression analysis, taking the wedged-to-free hepatic-vein pressure as the dependent variable. Four ...

Childhood Maltreatment and Educational Outcomes.

Science.gov (United States)

Romano, Elisa; Babchishin, Lyzon; Marquis, Robyn; Fréchette, Sabrina

2015-10-01

Children (0-18 years) with maltreatment histories are vulnerable to experiencing difficulties across multiple domains of functioning, including educational outcomes that encompass not only academic achievement but also mental well-being. The current literature review adopted Slade and Wissow's model to examine (1) the link between childhood maltreatment and academic achievement, (2) the link between childhood maltreatment and mental health outcomes (i.e., emotional and behavioral difficulties), and (3) the bidirectional relationship between childhood academic achievement and mental health. In addition, we reviewed variables that might influence or help explain the link between childhood maltreatment and educational outcomes, drawing on developmental perspectives and Bronfenbrenner's ecological model. Finally, whenever possible, we presented findings specific to maltreated children in out-of-home care to highlight the unique challenges experienced by this population. Results indicated that children with maltreatment histories often experience impairments in both their academic performance (e.g., special education, grade retention, lower grades) and mental well-being (e.g., anxiety, low mood, aggression, social skills deficits, poor interpersonal relationships). These impairments appeared to be particularly pronounced among maltreated children in out-of-home care. Findings, albeit sparse, also indicated that mental health difficulties are negatively associated with children's academic achievement and, similarly, that academic achievement deficits are linked with mental health problems. The link between childhood maltreatment and educational outcomes may be partly explained through the disruption of key developmental processes in children, such as attachment, emotion regulation, and sense of agency. As well, maltreatment characteristics and the functioning of various systems in which children are embedded (e.g., family, school, child welfare) can serve to positively

Analysis of Genome-Wide Association Studies with Multiple Outcomes Using Penalization

Science.gov (United States)

Liu, Jin; Huang, Jian; Ma, Shuangge

2012-01-01

Genome-wide association studies have been extensively conducted, searching for markers for biologically meaningful outcomes and phenotypes. Penalization methods have been adopted in the analysis of the joint effects of a large number of SNPs (single nucleotide polymorphisms) and marker identification. This study is partly motivated by the analysis of heterogeneous stock mice dataset, in which multiple correlated phenotypes and a large number of SNPs are available. Existing penalization methods designed to analyze a single response variable cannot accommodate the correlation among multiple response variables. With multiple response variables sharing the same set of markers, joint modeling is first employed to accommodate the correlation. The group Lasso approach is adopted to select markers associated with all the outcome variables. An efficient computational algorithm is developed. Simulation study and analysis of the heterogeneous stock mice dataset show that the proposed method can outperform existing penalization methods. PMID:23272092

Subtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomes

Science.gov (United States)

Arostegui, Inmaculada; Esteban, Cristobal; García-Gutierrez, Susana; Bare, Marisa; Fernández-de-Larrea, Nerea; Briones, Eduardo; Quintana, José M.

2014-01-01

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify

Social-Ecological Correlates in Adult Autism Outcome Studies: A Scoping Review.

Science.gov (United States)

Anderson, Kristy A; Roux, Anne M; Kuo, Alice; Shattuck, Paul T

2018-04-01

The transition into adulthood is a critical period in the life course that shapes later outcomes. Many adults on the autism spectrum fare poorly across a wide range of quality of life indicators. Understanding the multilevel factors that influence transition outcomes is necessary to develop strategies that promote better outcomes. In this scoping review, we characterize the use of social-ecological factors in adult autism outcome studies, identify understudied areas of research, and provide recommendations for future research. We conducted a literature search for studies in which the relationship between social-ecological factors and transition outcomes among transition-age youth with autism was assessed. We organized variables used in studies across 5 levels of influence: family-, interpersonal-, institutional-, community-, and policy-level factors. Our findings reveal that both breadth and depth of social-ecological factors usage in autism outcomes studies is limited because of the narrow inclusion of variables across social-ecological levels, the overreliance on a limited number of national data sets, and the overall lack of variation in research design. We propose 9 recommendations to inform the development of multilevel studies. Copyright © 2018 by the American Academy of Pediatrics.

Soft Tissue Sarcoma: A Prognostic Variables and Treatment Outcomes after Chemo - Radiotherapy and Conservative Surgery

International Nuclear Information System (INIS)

Abaza, A.; El-Shanshoury, H.

2015-01-01

Soft tissue sarcomas (STS) constitute a group of rare and heterogeneous cancers, that diverse a wide spectrum of histology and varied clinical behavior. The aim was to study, retrospectively the clinico-epidemiologic manifestation, response to therapy and prognostic factors of retroperitoneal (RPS), extremity and other STS patients treated with conservative surgery plus chemo - radiotherapy (CRT) attending the Pediatric Oncology Clinic, National Cancer Institute (NCI), Cairo University during 6 years period (inclusive). Files of 66 STS patients were revised for history, staging, investigations, treatment modalities and outcome of therapy. Their ages ranged from 6 months to 21 years. The male to female ratio was 1.87:1. Most of the patients belong to stage 3 and 1. Radiotherapy (RTH) and surgery remains the backbone of the multi - modality treatment plan. Complete remission (CR) was obtained in 80.3% of STS patients. Meanwhile, 6% of cases had disease progression and 6% died. The 2 - years overall survival rate (OS) and Disease - free survivals (DFS) we re 74.2% and 57.6% respectively. However, 20.8% of patients develop relapse>2 years after the end of treatment. Age at diagnosis, stage of the disease, tumor mass, pathological subtype and the RTH used were statistically significant prognostic variables affecting survival. Finally, the use of RTH in the treatment of STS gives positive impact on the survival of patients. Recommendation regarding further studies would be required to identify methods of increasing the radiation dose selectively. Also, using the newly developed radiation technologies to make dose escalation and sparing normal tissue

Regulating task-monitoring systems in response to variable reward contingencies and outcomes in cocaine addicts.

Science.gov (United States)

Morie, Kristen P; De Sanctis, Pierfilippo; Garavan, Hugh; Foxe, John J

2016-03-01

We investigated anticipatory and consummatory reward processing in cocaine addiction. In addition, we set out to assess whether task-monitoring systems were appropriately recalibrated in light of variable reward schedules. We also examined neural measures of task-monitoring and reward processing as a function of hedonic tone, since anhedonia is a vulnerability marker for addiction that is obviously germane in the context of reward processing. High-density event-related potentials were recorded while participants performed a speeded response task that systematically varied anticipated probabilities of reward receipt. The paradigm dissociated feedback regarding task success (or failure) from feedback regarding the value of reward (or loss), so that task-monitoring and reward processing could be examined in partial isolation. Twenty-three active cocaine abusers and 23 age-matched healthy controls participated. Cocaine abusers showed amplified anticipatory responses to reward predictive cues, but crucially, these responses were not as strongly modulated by reward probability as in controls. Cocaine users also showed blunted responses to feedback about task success or failure and did not use this information to update predictions about reward. In turn, they showed clearly blunted responses to reward feedback. In controls and users, measures of anhedonia were associated with reward motivation. In cocaine users, anhedonia was also associated with diminished monitoring and reward feedback responses. Findings imply that reward anticipation and monitoring deficiencies in addiction are associated with increased responsiveness to reward cues but impaired ability to predict reward in light of task contingencies, compounded by deficits in responding to actual reward outcomes.

Do Assault-Related Variables Predict Response to Cognitive Behavioral Treatment for PTSD?

Science.gov (United States)

Hembree, Elizabeth A.; Street, Gordon P.; Riggs, David S.; Foa, Edna B.

2004-01-01

This study examined the hypothesis that variables such as history of prior trauma, assault severity, and type of assault, previously found to be associated with natural recovery, would also predict treatment outcome. Trauma-related variables were examined as predictors of posttreatment posttraumatic stress disorder (PTSD) severity in a sample of…

Long term results of kissing stents in the aortic bifurcation

NARCIS (Netherlands)

Hinnen, J.W.; Konickx, M.A.; Meerwaldt, Robbert; Kolkert, J.L.P.; van der Palen, Jacobus Adrianus Maria; Huisman, A.B.

2015-01-01

BACKGROUND: To evaluate the long-term outcome after aortoiliac kissing stent placement and to analyze variables, which potentially influence the outcome of endovascular reconstruction of the aortic bifurcation. METHODS: All patients treated with aortoiliac kissing stents at our institution between

Functional Outcome of Anorectal Malformations and Associated Anomalies in Era of Krickenbeck Classification

International Nuclear Information System (INIS)

Qazi, S. H.; Faruque, A. V.; Khan, M. A. M.

2016-01-01

Objective: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. Methodology: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. Results: There were 84 children in study group. Most common associated anomaly was cardiac (38 percent), followed by urological anomaly (33 percent). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76 percent) cases. The most common fistula was rectourethral (33 percent), followed by recto vestibular (31 percent). According to Krickenbeck classification, continence was achieved in 62 percent children; however 27 percent children were constipated, followed by 12 percent children having fecal soiling. Conclusion: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38 percent) and genitourinary abnormalities (33 percent). (author)

Symptoms and Association with Health Outcomes in Relapsing-Remitting Multiple Sclerosis: Results of a US Patient Survey

Directory of Open Access Journals (Sweden)

Angela E. Williams

2014-01-01

Full Text Available Background. A variety of symptoms have been reported, but the prevalence of specific symptoms in relapsing-remitting multiple sclerosis (RRMS, how they are related to one another, and their impact on patient reported outcomes is not well understood. Objective. To describe how symptoms of RRMS cooccur and their impact on patient-reported outcomes. Methods. Individuals who reported a physician diagnosis of RRMS in a large general health survey in the United States indicated the symptoms they experience because of RRMS and completed validated scales, including the work productivity and activity impairment questionnaire and either the SF-12v2 or SF-36v2. Symptom clusters were identified through hierarchical cluster analysis, and the relationship between clusters and outcomes was assessed through regression. Results. Fatigue, difficulty walking, and numbness were the most commonly reported symptoms. Seven symptom clusters were identified, and several were significantly related to patient reported outcomes. Pain, muscle spasms, and stiffness formed a cluster strongly related to physical quality of life; depression was strongly related to mental quality of life and cognitive difficulty was associated with work impairment. Conclusions. Symptoms in RRMS show a strong relationship with quality of life and should be taken into consideration in treatment decisions and evaluation of treatment success.

Spontaneous variability of pre-dialysis concentrations of uremic toxins over time in stable hemodialysis patients.

Directory of Open Access Journals (Sweden)

Sunny Eloot

Full Text Available Numerous outcome studies and interventional trials in hemodialysis (HD patients are based on uremic toxin concentrations determined at one single or a limited number of time points. The reliability of these studies however entirely depends on how representative these cross-sectional concentrations are. We therefore investigated the variability of predialysis concentrations of uremic toxins over time.Prospectively collected predialysis serum samples of the midweek session of week 0, 1, 2, 3, 4, 8, 12, and 16 were analyzed for a panel of uremic toxins in stable chronic HD patients (N = 18 while maintaining dialyzer type and dialysis mode during the study period.Concentrations of the analyzed uremic toxins varied substantially between individuals, but also within stable HD patients (intra-patient variability. For urea, creatinine, beta-2-microglobulin, and some protein-bound uremic toxins, Intra-class Correlation Coefficient (ICC was higher than 0.7. However, for phosphorus, uric acid, symmetric and asymmetric dimethylarginine, and the protein-bound toxins hippuric acid and indoxyl sulfate, ICC values were below 0.7, implying a concentration variability within the individual patient even exceeding 65% of the observed inter-patient variability.Intra-patient variability may affect the interpretation of the association between a single concentration of certain uremic toxins and outcomes. When performing future outcome and interventional studies with uremic toxins other than described here, one should quantify their intra-patient variability and take into account that for solutes with a large intra-patient variability associations could be missed.

Social inequalities in patient-reported outcomes among older multimorbid patients--results of the MultiCare cohort study.

Science.gov (United States)

von dem Knesebeck, Olaf; Bickel, Horst; Fuchs, Angela; Gensichen, Jochen; Höfels, Susanne; Riedel-Heller, Steffi G; König, Hans-Helmut; Mergenthal, Karola; Schön, Gerhard; Wegscheider, Karl; Weyerer, Siegfried; Wiese, Birgitt; Scherer, Martin; van den Bussche, Hendrik; Schäfer, Ingmar

2015-02-07

In this article three research questions are addressed: (1) Is there an association between socioeconomic status (SES) and patient-reported outcomes in a cohort of multimorbid patients? (2) Does the association vary according to SES indicator used (income, education, occupational position)? (3) Can the association between SES and patient-reported outcomes (self-rated health, health-related quality of life and functional status) be (partly) explained by burden of disease? Analyses are based on the MultiCare Cohort Study, a German multicentre, prospective, observational cohort study of multimorbid patients from general practice. We analysed baseline data and data from the first follow-up after 15 months (N = 2,729). To assess burden of disease we used the patients' morbidity data from standardized general practitioner (GP) interviews based on a list of 46 groups of chronic conditions including the GP's severity rating of each chronic condition ranging from marginal to very severe. In the cross-sectional analyses SES was significantly associated with the patient-reported outcomes at baseline. Associations with income were more consistent and stronger than with education and occupational position. Associations were partly explained (17% to 44%) by burden of disease. In the longitudinal analyses only income (but not education and occupational position) was significantly related to the patient-reported outcomes at follow-up. Associations between income and the outcomes were reduced by 18% to 27% after adjustment for burden of disease. Results indicate social inequalities in self-rated health, functional status and health related quality of life among older multimorbid patients. As associations with education and occupational position were inconsistent, these inequalities were mainly due to income. Inequalities were partly explained by burden of disease. However, even among patients with a similar disease burden, those with a low income were worse off in terms of the

Outcome of biopsy proven minimal change disease (MCD) in children

African Journals Online (AJOL)

Background and Objectives: MCD is the most common histological sub-type of nephrotic syndrome with variable clinical course in children. There are limited studies in literature on the outcome of biopsy proven MCD. The objective was to look at the treatment response and outcome of patients with MCD treated at a tertiary ...

Assessment of Outcomes of Treatment of Fractures of Distal Femur with a Locking Plate Taking into Account Factors Influencing the Result.

Science.gov (United States)

Pakuła, Grzegorz; Kwiatkowski, Krzysztof; Kuczmera, Piotr; Fudalej, Piotr

2015-10-01

The aim of this paper is to evaluate the results of treatment of distal femoral fractures (DFF) fixed with locking plates and analysis of factors that influence the final outcome. The patients were treated at the Department of Traumatology and Orthopedics, Military Medical Institute in Warsaw, and the Department of Orthopedics and Traumatology, 4th Military Research Hospital in Wroclaw. We analysed 39 patients with 42 fractures of the distal femur. Treatment results were analysed using the KOOS and KSS scales. Factors influencing the outcome were also investigated. Statistical analysis was performed using STATISTICA v. 10. Mean KOOS scores indicate a predominance of poor outcomes, while mean KSS scores indicate good outcomes. Treatment outcomes were significantly influenced by pain and limited mobility. 1. Subjective evaluation of treatment of fractures of the distal femur using the KOOS scale per form edworse than a clinical evaluation using the KSS. 2. Post-operative management should emphasise pain relief and restoration of the performance of the treated lower limb to ensure good mobility without crutches. 3. Despite the use of modern operational methods of fracture fixation, treatment of distal femur fractures is still a challenge.

Instrumental variables estimation under a structural Cox model

DEFF Research Database (Denmark)

Martinussen, Torben; Nørbo Sørensen, Ditte; Vansteelandt, Stijn

2017-01-01

Instrumental variable (IV) analysis is an increasingly popular tool for inferring the effect of an exposure on an outcome, as witnessed by the growing number of IV applications in epidemiology, for instance. The majority of IV analyses of time-to-event endpoints are, however, dominated by heurist...

Exploring Outcome Measures for Exercise Intervention in People with Parkinson’s Disease

Directory of Open Access Journals (Sweden)

L. A. King

2013-01-01

Full Text Available Background. It is widely believed that exercise improves mobility in people with Parkinson’s disease (PD. However, it is difficult to determine whether a specific type of exercise is the most effective. The purpose of this study was to determine which outcome measures were sensitive to exercise intervention and to explore the effects of two different exercise programs for improving mobility in patients with PD. Methods. Participants were randomized into either the Agility Boot Camp (ABC or treadmill training; 4x/week for 4 weeks. Outcome measures were grouped by the International Classification of Function/Disability (ICF. To determine the responsiveness to exercise, we calculated the standardized response means. t-tests were used to compare the relative benefits of each exercise program. Results. Four of five variables at the structure/function level changed after exercise: turn duration (P=0.03, stride velocity (P=0.001, peak arm speed (P=0.001, and horizontal trunk ROM during gait (P=0.02. Most measures improved similarly for both interventions. The only variable that detected a difference between groups was postural sway in ABC group (F=4.95; P=0.03. Conclusion. Outcome measures at ICF body structure/function level were most effective at detecting change after exercise and revealing differences in improvement between interventions.

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties.

Science.gov (United States)

Matsen, Frederick A; Russ, Stacy M; Vu, Phuong T; Hsu, Jason E; Lucas, Robert M; Comstock, Bryan A

2016-11-01

Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a "better" outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p factors listed above. The area under the receiver operating characteristic curve generated from the cross-validated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as

Predictors of Outcome and Severity in Adult Filipino Patients with Febrile Neutropenia

Directory of Open Access Journals (Sweden)

Marc Gregory Y. Yu

2015-01-01

Full Text Available Aim. The study aimed to describe the profile of Filipino febrile neutropenia patients and to determine parameters associated with severe outcomes. Methods. This is a retrospective study of Filipino febrile neutropenia patients admitted to the Philippine General Hospital. Patients were described in terms of clinical presentation and stratified according to the presence or absence of severe outcomes. Prognostic factors were then identified using regression analysis. Results. 115 febrile episodes in 102 patients were identified. Regression analysis yielded prolonged fever >7 days prior to admission (OR 2.43; 95% CI, 0.77–7.74, isolation of a pathogen on cultures (OR 2.69; 95% CI, 1.04–6.98, and nadir absolute neutrophil count (ANC 7 days prior to admission, positive pathogen on cultures, and nadir ANC < 100 during admission predicted severe outcomes, whereas G-CSF use and complete antibiotic therapy were associated with better outcomes. These prognostic variables might be useful in identifying patients that need more intensive treatment and monitoring.

Spoken language outcomes after hemispherectomy: factoring in etiology.

Science.gov (United States)

Curtiss, S; de Bode, S; Mathern, G W

2001-12-01

We analyzed postsurgery linguistic outcomes of 43 hemispherectomy patients operated on at UCLA. We rated spoken language (Spoken Language Rank, SLR) on a scale from 0 (no language) to 6 (mature grammar) and examined the effects of side of resection/damage, age at surgery/seizure onset, seizure control postsurgery, and etiology on language development. Etiology was defined as developmental (cortical dysplasia and prenatal stroke) and acquired pathology (Rasmussen's encephalitis and postnatal stroke). We found that clinical variables were predictive of language outcomes only when they were considered within distinct etiology groups. Specifically, children with developmental etiologies had lower SLRs than those with acquired pathologies (p =.0006); age factors correlated positively with higher SLRs only for children with acquired etiologies (p =.0006); right-sided resections led to higher SLRs only for the acquired group (p =.0008); and postsurgery seizure control correlated positively with SLR only for those with developmental etiologies (p =.0047). We argue that the variables considered are not independent predictors of spoken language outcome posthemispherectomy but should be viewed instead as characteristics of etiology. Copyright 2001 Elsevier Science.

Predicting Inpatient Detoxification Outcome of Alcohol and Drug Dependent Patients: The Influence of Sociodemographic Environment, Motivation, Impulsivity, and Medical Comorbidities

Directory of Open Access Journals (Sweden)

Yvonne Sofin

2017-01-01

Full Text Available Aims. This prospective study aims to identify patient characteristics as predictors for treatment outcome during inpatient detoxification treatment for drug and alcohol dependent patients. Methods. A mixed gender sample of 832 consecutively admitted drug and alcohol dependent patients were interviewed by an experienced physician. The impact of a variety of factors concerning social environment, therapy motivation, impulsivity related variables, medical history, and addiction severity on treatment outcome was examined. Results. 525 (63.1% of the patients completed detoxification treatment whereas 307 (36.9% dropped out prematurely. Being female, living in a partnership, having children, being employed, and having good education were predictive for a positive outcome. Family, health, the fear of losing the job, prosecution, and emergency admission were significant motivational predictors for treatment outcome. Being younger, history of imprisonment, and the number of previous drop-outs were predictive for a negative outcome. Conclusions. Variables concerning social environment and the number of previous drop-outs have been identified as best predictors for treatment outcome. Socially stable patients benefit from the current treatment setting and treatment shall be adapted for patients with negative predictors. Treatment may consequently be tailored with respect to intervention type, duration, and intensity to improve the outcome for those patients that fulfil criteria with negative impact on treatment retention.

Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

Science.gov (United States)

Koffmann, Andrew

2017-03-02

Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

Populations and outcome measures used in ongoing research in sarcopenia.

Science.gov (United States)

Peña Ordóñez, Gloria Gabriela; Bustamante Montes, Lilia Patricia; Ramírez Duran, Ninfa; Sánchez Castellano, Carmen; Cruz-Jentoft, Alfonso J

2017-08-01

Sarcopenia research may be hampered by the heterogeneity of populations and outcome measures used in clinical studies. The aim of this study was to describe the inclusion/exclusion criteria and outcome measures used in ongoing research in sarcopenia. All active intervention studies registered in the World Health Organization with the keyword sarcopenia were included. Study design, type of intervention, inclusion/exclusion criteria and outcome measures were registered and classified. In April 2014, 151 studies on sarcopenia were registered in the WHO database. One hundred twenty-three were intervention studies. Most trials (94.3 %) were single centre and randomized (93.5 %), 51.2 % were double blind. Nutritional interventions (36.6 %), physical exercise (12.2 %) or both (19.5 %) were the most common interventions tested. Only 54.4 % included subjects of both genders, and 46.3 % had an upper age limit. Definition of the target populations was heterogeneous, with 57.7 % including healthy subjects and none using recent definitions of sarcopenia. Lifestyle and the degree of physical activity of subjects were not described or considered in most cases (79.7 %). Subjects with cardiovascular, neuropsychiatric or metabolic disorders and those with physical disability were usually excluded. Muscle mass and muscle strength were the primary outcome variables in 28.5 and 29.5 % of studies and physical performance in 19.5 %, but only 4.1 % used the three variables used the three of them. An additional 26.8 % used biological outcome variables. Little information and agreement existed in the way muscle and physical performance parameters were measured. We found a large heterogeneity in trial design, definition of populations and outcome measures in present research.

Bayesian methods for meta-analysis of causal relationships estimated using genetic instrumental variables

DEFF Research Database (Denmark)

Burgess, Stephen; Thompson, Simon G; Thompson, Grahame

2010-01-01

Genetic markers can be used as instrumental variables, in an analogous way to randomization in a clinical trial, to estimate the causal relationship between a phenotype and an outcome variable. Our purpose is to extend the existing methods for such Mendelian randomization studies to the context o...

Variability in Pretest-Posttest Correlation Coefficients by Student Achievement Level. NCEE 2011-4033

Science.gov (United States)

Cole, Russell; Haimson, Joshua; Perez-Johnson, Irma; May, Henry

2011-01-01

State assessments are increasingly used as outcome measures for education evaluations. The scaling of state assessments produces variability in measurement error, with the conditional standard error of measurement increasing as average student ability moves toward the tails of the achievement distribution. This report examines the variability in…

Early Adolescent Affect Predicts Later Life Outcomes.

Science.gov (United States)

Kansky, Jessica; Allen, Joseph P; Diener, Ed

2016-07-01

Subjective well-being as a predictor for later behavior and health has highlighted its relationship to health, work performance, and social relationships. However, the majority of such studies neglect the developmental nature of well-being in contributing to important changes across the transition to adulthood. To examine the potential role of subjective well-being as a long-term predictor of critical life outcomes, we examined indicators of positive and negative affect at age 14 as predictors of relationship, adjustment, self-worth, and career outcomes a decade later at ages 23 to 25, controlling for family income and gender. We utilised multi-informant methods including reports from the target participant, close friends, and romantic partners in a demographically diverse community sample of 184 participants. Early adolescent positive affect predicted fewer relationship problems (less self-reported and partner-reported conflict, and greater friendship attachment as rated by close peers) and healthy adjustment to adulthood (lower levels of depression, anxiety, and loneliness). It also predicted positive work functioning (higher levels of career satisfaction and job competence) and increased self-worth. Negative affect did not significantly predict any of these important life outcomes. In addition to predicting desirable mean levels of later outcomes, early positive affect predicted beneficial changes across time in many outcomes. The findings extend early research on the beneficial outcomes of subjective well-being by having an earlier assessment of well-being, including informant reports in measuring a large variety of outcome variables, and by extending the findings to a lower socioeconomic group of a diverse and younger sample. The results highlight the importance of considering positive affect as an important component of subjective well-being distinct from negative affect. © 2016 The International Association of Applied Psychology.

Long-Term Outcomes of Cultivated Limbal Epithelial Transplantation: Evaluation and Comparison of Results in Children and Adults

Directory of Open Access Journals (Sweden)

Anita Ganger

2015-01-01

Full Text Available Purpose. To compare the long-term clinical outcomes of cultivated limbal epithelial transplantation (CLET in children and adults with limbal stem cell deficiency. Design. Retrospective case series. Methods. Case records of patients with limbal stem cell deficiency (LSCD who underwent CLET from April 2004 to December 2014 were studied. Outcome measures were compared in terms of anatomical success and visual improvement. Parameters for total anatomical success were avascular, epithelized, and clinically stable corneal surface without conjunctivalization, whereas partial anatomical success was considered when mild vascularization (sparing centre of cornea and mild conjunctivalization were noted along with complete epithelization. Results. A total of 62 cases underwent the CLET procedure: 38 (61.3% were children and 24 (38.7% were adults. Patients with unilateral LSCD (33 children and 21 adults had autografts and those with bilateral LSCD (5 children and 3 adults had allografts. Amongst the 54 autografts partial and total anatomical success were noted in 21.2% and 66.6% children, respectively, and 19.0% and 80.9% in adults, respectively (p value 0.23. Visual improvement of 1 line and ≥2 lines was seen in 57.5% and 21.2% children, respectively, and 38% and 38% in adults, respectively (p value 0.31. Conclusion. Cultivated limbal epithelial transplantation gives good long-term results in patients with LSCD and the outcomes are comparable in children and adults.

A framework for monitoring social process and outcomes in environmental programs.

Science.gov (United States)

Chapman, Sarah

2014-12-01

When environmental programs frame their activities as being in the service of human wellbeing, social variables need to be integrated into monitoring and evaluation (M&E) frameworks. This article draws upon ecosystem services theory to develop a framework to guide the M&E of collaborative environmental programs with anticipated social benefits. The framework has six components: program need, program activities, pathway process variables, moderating process variables, outcomes, and program value. Needs are defined in terms of ecosystem services, as well as other human needs that must be addressed to achieve outcomes. The pathway variable relates to the development of natural resource governance capacity in the target community. Moderating processes can be externalities such as the inherent capacity of the natural system to service ecosystem needs, local demand for natural resources, policy or socio-economic drivers. Internal program-specific processes relate to program service delivery, targeting and participant responsiveness. Ecological outcomes are expressed in terms of changes in landscape structure and function, which in turn influence ecosystem service provision. Social benefits derived from the program are expressed in terms of the value of the eco-social service to user-specified goals. The article provides suggestions from the literature for identifying indicators and measures for components and component variables, and concludes with an example of how the framework was used to inform the M&E of an adaptive co-management program in western Kenya. Copyright © 2014 Elsevier Ltd. All rights reserved.

Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty.

Science.gov (United States)

Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J

2015-05-01

Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. Copyright © 2014 Elsevier Inc. All rights reserved.

Does socioeconomic status predict course and outcome in patients with psychosis?

Science.gov (United States)

Samele, C; van Os, J; McKenzie, K; Wright, A; Gilvarry, C; Manley, C; Tattan, T; Murray, R

2001-12-01

We examined the relationship between socioeconomic status (SES) and course and outcome of patients with psychosis. Two hypotheses were examined: a) patients with higher best-ever SES will have better course and outcome than those with lower best-ever SES, and b) patients with greater downward drift in SES will have poorer course and outcome than those with less downward drift. Data were drawn from the baseline and 2-year follow-up assessments of the UK700 Case Management Trial of 708 patients with severe psychosis. The indicators of SES used were occupational status and educational achievement. Drift in SES was defined as change from best-ever occupation to occupation at baseline. For the baseline data highly significant differences were found between best-ever groups and negative symptoms (non-manual vs. unemployed--coef -10.5, p=0.000, 95% CIs 5.1-15.8), functioning (non-manual vs. unemployed--coef -0.6, p=0.000, 95% CIs 0.3 to -0.8) and unmet needs (manual vs. unemployed - coef 0.5, p=0.004, 95% CIs 0.2-0.9). No significant differences between best-ever groups were found for days in hospital, symptoms, perceived quality of life and dissatisfaction with services. Significant differences for clinical and social variables were found between drift and non-drift SES groups. There were no significant findings between educational groups and clinical and social variables. Best-ever occupation, but not educational qualifications, appeared to predict prognosis in patients with severe psychosis. Downward drift in occupational status did not result in poorer illness course and outcome.

Motivation as an independent and a dependent variable in medical education: a review of the literature.

Science.gov (United States)

Kusurkar, R A; Ten Cate, Th J; van Asperen, M; Croiset, G

2011-01-01

Motivation in learning behaviour and education is well-researched in general education, but less in medical education. To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation. A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included. Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT. Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.

Instrumental variable methods in comparative safety and effectiveness research.

Science.gov (United States)

Brookhart, M Alan; Rassen, Jeremy A; Schneeweiss, Sebastian

2010-06-01

Instrumental variable (IV) methods have been proposed as a potential approach to the common problem of uncontrolled confounding in comparative studies of medical interventions, but IV methods are unfamiliar to many researchers. The goal of this article is to provide a non-technical, practical introduction to IV methods for comparative safety and effectiveness research. We outline the principles and basic assumptions necessary for valid IV estimation, discuss how to interpret the results of an IV study, provide a review of instruments that have been used in comparative effectiveness research, and suggest some minimal reporting standards for an IV analysis. Finally, we offer our perspective of the role of IV estimation vis-à-vis more traditional approaches based on statistical modeling of the exposure or outcome. We anticipate that IV methods will be often underpowered for drug safety studies of very rare outcomes, but may be potentially useful in studies of intended effects where uncontrolled confounding may be substantial.

Instrumental variable methods in comparative safety and effectiveness research†

Science.gov (United States)

Brookhart, M. Alan; Rassen, Jeremy A.; Schneeweiss, Sebastian

2010-01-01

Summary Instrumental variable (IV) methods have been proposed as a potential approach to the common problem of uncontrolled confounding in comparative studies of medical interventions, but IV methods are unfamiliar to many researchers. The goal of this article is to provide a non-technical, practical introduction to IV methods for comparative safety and effectiveness research. We outline the principles and basic assumptions necessary for valid IV estimation, discuss how to interpret the results of an IV study, provide a review of instruments that have been used in comparative effectiveness research, and suggest some minimal reporting standards for an IV analysis. Finally, we offer our perspective of the role of IV estimation vis-à-vis more traditional approaches based on statistical modeling of the exposure or outcome. We anticipate that IV methods will be often underpowered for drug safety studies of very rare outcomes, but may be potentially useful in studies of intended effects where uncontrolled confounding may be substantial. PMID:20354968

Clinical outcome and radiographic results after operative treatment of Scheuermann's disease

NARCIS (Netherlands)

Poolman, R. W.; Been, H. D.; Ubags, L. H.

2002-01-01

The aim of this prospective study was to evaluate radiographic findings, patient satisfaction and clinical outcome, and to report complications and instrumentation failure after operative treatment of Scheuermann's disease using a combined anterior and posterior spondylodesis. The loss of sagittal

Do Syrian refugees have increased risk for worser pregnancy outcomes? Results of a tertiary center in İstanbul.

Science.gov (United States)

Güngör, Emre Sinan; Seval, Olcay; İlhan, Gülşah; Verit, Fatma Ferda

2018-03-01

To compare obstetric and perinatal outcomes of Syrian refugee pregnants and Turkish counterparts who gave birth at a tertiary center in İstanbul. A retrospective study including the birth records of 704 Syrian refugees and 744 Turkish pregnant women between January 2016 and May 2017 were analyzed. Demographic data, obstetric and neonatal outcomes were compared. The primary aims of this study were to evaluate the pregnancy outcomes and cesarean rates between the groups. The secondary outcomes were the use of antenatal vitamin supplementation, hemoglobin-hematocrit values, and maternal complications. Our results showed that the use of folic acid and iron supplementation rates during pregnancy were similar between the groups (folic acid supplementation 8.1% vs 6.5%, p=0.264; iron supplementation 20.7% vs 19.6%, p=0.125; respectively for Turkish women and Syrian refugees). Cesarean rates were significantly higher for Turkish patients than in Syrian refugees (42.7% vs 32.7%; pyrian refugees (37.7±2.3 vs 36.4±2.3 weeks, pyrian refugees, respectively, p=0.105). Although obstetric complications were seen more often in Syrian refugees, it did not reach statistical difference (9.7% vs 8.1%, respectively, p=0.285). Syrian refugees use antenatal vitamin supplementations at similar rates to Turkish citizens and obstetric and perinatal outcomes are similar between the groups.

Individualized anemia management reduces hemoglobin variability in hemodialysis patients.

Science.gov (United States)

Gaweda, Adam E; Aronoff, George R; Jacobs, Alfred A; Rai, Shesh N; Brier, Michael E

2014-01-01

One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA doses guided by the Smart Anemia Manager algorithm (treatment) or by a standard protocol (control). Dose recommendations, performed on a monthly basis, were validated by an expert physician anemia manager. The primary outcome was the percentage of hemoglobin concentrations between 10 and 12 g/dl over the follow-up period. A total of 258 of 356 (72.5%) hemoglobin concentrations were between 10 and 12 g/dl in the treatment group, compared with 208 of 336 (61.9%) in the control group; 42 (11.8%) hemoglobin concentrations were hemoglobin concentrations were >12 g/dl in the treatment group compared with 46 (13.4%) in the control group. The median ESA dosage per patient was 2000 IU/wk in both groups. Five participants received 6 transfusions (21 U) in the treatment group, compared with 8 participants and 13 transfusions (31 U) in the control group. These results suggest that individualized ESA dosing decreases total hemoglobin variability compared with a population protocol-based approach. As hemoglobin levels are declining in hemodialysis patients, decreasing hemoglobin variability may help reduce the risk of transfusions in this population.

T Cell-Replete Peripheral Blood Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide Results in Outcomes Similar to Transplantation from Traditionally Matched Donors in Active Disease Acute Myeloid Leukemia.

Science.gov (United States)

How, Joan; Slade, Michael; Vu, Khoan; DiPersio, John F; Westervelt, Peter; Uy, Geoffrey L; Abboud, Camille N; Vij, Ravi; Schroeder, Mark A; Fehniger, Todd A; Romee, Rizwan

2017-04-01

Outcomes for patients with acute myeloid leukemia (AML) who fail to achieve complete remission remain poor. Hematopoietic cell transplantation (HCT) has been shown to induce long-term survival in AML patients with active disease. HCT is largely performed with HLA-matched unrelated or HLA-matched related donors. Recently, HCT with HLA-haploidentical related donors has been identified as a feasible option when HLA-matched donors are not immediately available. However, there are little data comparing outcomes for AML patients with active disease who receive haploidentical versus traditionally matched HCT. We retrospectively analyzed data from 99 AML patients with active disease undergoing allogeneic HCT at a single institution. Forty-three patients received unrelated donor HCT, 32 patients received matched related donor HCT, and 24 patients received peripheral blood haploidentical HCT with post-transplantation cyclophosphamide. We found no significant differences between treatment groups in terms of overall survival (OS), event-free survival, transplantation-related mortality, cumulative incidence of relapse, and cumulative incidence of acute and chronic graft-versus-host disease (GVHD). We performed univariate regression analysis of variables that modified OS in all patients and found only younger age at transplantation and development of chronic GVHD significantly improved outcome. Although limited by our relatively small sample size, these results indicate that haploidentical HCT in active AML patients have comparable outcomes to HCT with traditionally matched donors. Haploidentical HCT can be considered in this population of high-risk patients when matched donors are unavailable or when wait times for transplantation are unacceptably long. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety.

Science.gov (United States)

Davies, Carolyn D; Niles, Andrea N; Pittig, Andre; Arch, Joanna J; Craske, Michelle G

2015-03-01

Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety disorders. Sixty individuals with a DSM-IV defined principal anxiety disorder completed 12 sessions of either CBT or ACT. Baseline physiological and behavioral variables were measured prior to entering treatment. Self-reported anxiety symptoms were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Higher pre-treatment heart rate variability was associated with worse outcome across ACT and CBT. ACT outperformed CBT for individuals with high behavioral avoidance. Subjective anxiety levels during laboratory tasks did not predict or moderate treatment outcome. Due to small sample sizes of each disorder, disorder-specific predictors were not tested. Future research should examine these predictors in larger samples and across other outcome variables. Lower heart rate variability was identified as a prognostic indicator of overall outcome, whereas high behavioral avoidance was identified as a prescriptive indicator of superior outcome from ACT versus CBT. Investigation of pre-treatment physiological and behavioral variables as predictors and moderators of outcome may help guide future treatment-matching efforts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes.

Science.gov (United States)

Mahaney, Kelly B; Todd, Michael M; Bayman, Emine O; Torner, James C

2012-06-01

Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, even among patients who reach medical attention in good neurological condition. Many patients have neurological decline in the perioperative period, which contributes to long-term outcomes. The focus of this study is to characterize the incidence of, characteristics predictive of, and outcomes associated with acute postoperative neurological deterioration in patients undergoing surgery for ruptured intracranial aneurysm. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) was a multicenter randomized clinical trial that enrolled 1001 patients and assesssed the efficacy of hypothermia as neuroprotection during surgery to secure a ruptured intracranial aneurysm. All patients had a radiographically confirmed SAH, were classified as World Federation of Neurosurgical Societies (WFNS) Grade I-III immediately prior to surgery, and underwent surgery to secure the ruptured aneurysm within 14 days of SAH. Neurological assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed preoperatively, at 24 and 72 hours postoperatively, and at time of discharge. The primary outcome variable was a dichotomized scoring based on an IHAST version of the Glasgow Outcome Scale (GOS) in which a score of 1 represents a good outcome and a score > 1 a poor outcome, as assessed at 90-days' follow-up. Data from IHAST were analyzed for occurrence of a postoperative neurological deterioration. Preoperative and intraoperative variables were assessed for associations with occurrence of postoperative neurological deterioration. Differences in baseline, intraoperative, and postoperative variables and in outcomes between patients with and without postoperative neurological deterioration were compared with Fisher exact tests. The Wilcoxon rank-sum test was used to compare variables reported as means. Multiple logistic regression was used to adjust for covariates associated with occurrence

Birth plan compliance and its relation to maternal and neonatal outcomes

Directory of Open Access Journals (Sweden)

Pedro Hidalgo-Lopezosa

2017-12-01

Full Text Available ABSTRACT Objective: to know the degree of fulfillment of the requests that women reflect in their birth plans and to determine their influence on the main obstetric and neonatal outcomes. Method: retrospective, descriptive and analytical study with 178 women with birth plans in third-level hospital. Inclusion criteria: low risk gestation, cephalic presentation, single childbirth, delivered at term. Scheduled and urgent cesareans without labor were excluded. A descriptive and inferential analysis of the variables was performed. Results: the birth plan was mostly fulfilled in only 37% of the women. The group of women whose compliance was low (less than or equal to 50% had a cesarean section rate of 18.8% and their children had worse outcomes in the Apgar test and umbilical cord pH; while in women with high compliance (75% or more, the percentage of cesareans fell to 6.1% and their children had better outcomes. Conclusion: birth plans have a low degree of compliance. The higher the compliance, the better is the maternal and neonatal outcomes. The birth plan can be an effective tool to achieve better outcomes for the mother and her child. Measures are needed to improve its compliance.

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

Claimed effects, outcome variables and methods of measurement for health claims on foods proposed under European Community Regulation 1924/2006 in the area of appetite ratings and weight management.

Science.gov (United States)

Martini, Daniela; Biasini, Beatrice; Rossi, Stefano; Zavaroni, Ivana; Bedogni, Giorgio; Musci, Marilena; Pruneti, Carlo; Passeri, Giovanni; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Dei Cas, Alessandra; Bonadonna, Riccardo C; Del Rio, Daniele

2018-06-01

All the requests for authorisation to bear health claims under Articles 13(5) and 14 in the context of appetite ratings and weight management have received a negative opinion by the European Food Safety Authority (EFSA), mainly because of the insufficient substantiation of the claimed effects (CEs). This manuscript results from an investigation aimed to collect, collate and critically analyse the information related to outcome variables (OVs) and methods of measurement (MMs) in the context of appetite ratings and weight management compliant with Regulation 1924/2006. Based on the literature review, the appropriateness of OVs and MMs was evaluated for specific CEs. This work might help EFSA in the development of updated guidance addressed to stakeholders interested in bearing health claims in the area of weight management. Moreover, it could drive the applicants during the design of randomised controlled trials aimed to substantiate such claims.

The Relationships Between Doctor-Patient Affectionate Communication and Patient Perceptions and Outcomes.

Science.gov (United States)

Hesse, Colin; Rauscher, Emily A

2018-02-20

The current article combines the literature on doctor-patient communication and affectionate communication. Using Affection Exchange Theory (AET), the study predicts that the need for affection and the benefits of affectionate communication translate to the doctor-patient setting, proposing a series of relationships from both perceived doctor affectionate communication and affection deprivation to several patient outcome variables (patient perception of the doctor, patient communication with the doctor, and patient satisfaction/adherence). The results strongly supported the predictions for both affectionate communication and affection deprivation, with affectionate communication positively relating to most outcome measures and affection deprivation negatively relating to most outcome measures. Affection deprivation served as a moderator for the relationship between provider competence and patient satisfaction, although affectionate communication moderated the relationship between provider competence and patient adherence. Implications and possible directions for future research are discussed.

[Variable magnetic fields in the treatment of tics disorders - preliminary results].

Science.gov (United States)

Pasek, Jarosław; Jędrzejewska, Anna; Jagodziński, Leszek; Obuchowicz, Anna; Flak, Maria; Sieroń, Aleksander

Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk. The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated. After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents. The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.

Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review.

Science.gov (United States)

Ide, Mark; Papapanou, Panos N

2013-04-01

There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association. Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases. Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (pregnancy loss or miscarriage, or pre-eclampsia. Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders. Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis "case definitions," these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia. There is a high degree of variability in study populations, recruitment

Transcriptome profiling from adipose tissue during a low-calorie diet reveals predictors of weight and glycemic outcomes in obese, nondiabetic subjects

DEFF Research Database (Denmark)

Armenise, Claudia; Lefebvre, Gregory C; Carayol, Jérôme

2017-01-01

and glycemic outcomes both at LCD termination and 6 mo after the LCD.Design: Using RNA sequencing (RNAseq), we analyzed transcriptome changes in AT from 191 obese, nondiabetic patients within a multicenter, controlled dietary intervention. Expression changes were associated with outcomes after an 8-wk LCD (800......-1000 kcal/d) and 6 mo after the LCD. Results were validated by using quantitative reverse transcriptase-polymerase chain reaction in 350 subjects from the same cohort. Statistical models were constructed to classify weight maintainers or glycemic improvers.Results: With RNAseq analyses, we identified 1173...... expression combined with clinical variables enabled us to distinguish weight and glycemic responders from nonresponders. These potential biomarkers may help clinicians understand intersubject variability and better predict the success of dietary interventions. This trial was registered at clinicaltrials...

Who benefits? Outcome following a coping skills group intervention for traumatically brain injured individuals.

Science.gov (United States)

Anson, Katie; Ponsford, Jennie

2006-01-01

To investigate the variables associated with positive psychological outcome following a group intervention for 33 individuals with traumatic brain injury. Evaluation study which used multiple regression analysis to examine the variables associated with change in psychological adjustment following a 10-session cognitive behaviour therapy-based group. The predictor variables were age at injury, time since injury, injury severity, self-awareness, pre-morbid intellectual function, memory function, executive function and level of depression and anxiety prior to intervention. The predictor variables contributed a significant proportion of the variance in percentage change in depression. The major finding was that better outcomes following intervention were associated with greater self-awareness of injury-related deficits. The present study identified a number of variables that were associated with improvement in depression following psychological intervention and may assist future treatment resources to be directed most effectively.

Maternal Vitamin D Status and the Relationship with Neonatal Anthropometric and Childhood Neurodevelopmental Outcomes: Results from the Seychelles Child Development Nutrition Study.

Science.gov (United States)

Laird, Eamon; Thurston, Sally W; van Wijngaarden, Edwin; Shamlaye, Conrad F; Myers, Gary J; Davidson, Philip W; Watson, Gene E; McSorley, Emeir M; Mulhern, Maria S; Yeates, Alison J; Ward, Mary; McNulty, Helene; Strain, J J

2017-11-11

Vitamin D has an important role in early life; however, the optimal vitamin D status during pregnancy is currently unclear. There have been recent calls for pregnant women to maintain circulating 25-hydroxyvitamin D (25(OH)D) concentrations >100 nmol/L for health, yet little is known about the long-term potential benefits or safety of achieving such high maternal 25(OH)D concentrations for infant or child health outcomes. We examined maternal vitamin D status and its associations with infant anthropometric and later childhood neurocognitive outcomes in a mother-child cohort in a sun-rich country near the equator (4.6° S). This study was conducted in pregnant mothers originally recruited to the Seychelles Child Development Nutrition Study. Blood samples ( n = 202) taken at delivery were analysed for serum 25-hydroxyvitamin D (25(OH)D) concentrations. Multiple linear regression models assessed associations between maternal 25(OH)D and birth weight, infant head circumference, and neurocognitive outcomes in the children at age 5 years. Mothers were, on average, 27 years of age, and the children's average gestational age was 39 weeks. None of the women reported any intake of vitamin D supplements. Maternal 25(OH)D concentrations had a mean of 101 (range 34-218 nmol/L) and none were deficient (<30 nmol/L). Maternal 25(OH)D concentrations were not associated with child anthropometric or neurodevelopmental outcomes. These findings appear to indicate that a higher vitamin D status is not a limiting factor for neonatal growth or neurocognitive development in the first 5 years of life. Larger studies with greater variability in vitamin D status are needed to further explore optimal cut-offs or non-linear associations (including for maternal health) that might exist among populations with sub-optimal exposure.

Maternal Vitamin D Status and the Relationship with Neonatal Anthropometric and Childhood Neurodevelopmental Outcomes: Results from the Seychelles Child Development Nutrition Study

Directory of Open Access Journals (Sweden)

Eamon Laird

2017-11-01

Full Text Available Vitamin D has an important role in early life; however, the optimal vitamin D status during pregnancy is currently unclear. There have been recent calls for pregnant women to maintain circulating 25-hydroxyvitamin D (25(OHD concentrations >100 nmol/L for health, yet little is known about the long-term potential benefits or safety of achieving such high maternal 25(OHD concentrations for infant or child health outcomes. We examined maternal vitamin D status and its associations with infant anthropometric and later childhood neurocognitive outcomes in a mother-child cohort in a sun-rich country near the equator (4.6° S. This study was conducted in pregnant mothers originally recruited to the Seychelles Child Development Nutrition Study. Blood samples (n = 202 taken at delivery were analysed for serum 25-hydroxyvitamin D (25(OHD concentrations. Multiple linear regression models assessed associations between maternal 25(OHD and birth weight, infant head circumference, and neurocognitive outcomes in the children at age 5 years. Mothers were, on average, 27 years of age, and the children’s average gestational age was 39 weeks. None of the women reported any intake of vitamin D supplements. Maternal 25(OHD concentrations had a mean of 101 (range 34–218 nmol/L and none were deficient (<30 nmol/L. Maternal 25(OHD concentrations were not associated with child anthropometric or neurodevelopmental outcomes. These findings appear to indicate that a higher vitamin D status is not a limiting factor for neonatal growth or neurocognitive development in the first 5 years of life. Larger studies with greater variability in vitamin D status are needed to further explore optimal cut-offs or non-linear associations (including for maternal health that might exist among populations with sub-optimal exposure.

Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study).

Science.gov (United States)

Montoro, Miguel A; Brandt, Lawrence J; Santolaria, Santos; Gomollon, Fernando; Sánchez Puértolas, Belén; Vera, Jesús; Bujanda, Luis; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P; Chaparro, María; Jimenez Bernadó, Alfredo; Gómez-Camacho, Federico; Cerezo, Antonio; Casal Nuñez, Enrique

2011-02-01

There is a lack of prospective studies evaluating the natural history of colonic ischaemia (CI). We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. An open, prospective, and multicentre study was conducted in 24 Spanish hospitals serving a population of 3.5 million people. The study included only patients who met criteria for definitive or probable CI. A website (www.colitisisquemica.org) provided logistical support. A total of 364 patients met criteria for inclusion. CI was suspected clinically in only 24.2% of cases. The distribution of clinical patterns was as follows: reversible colopathy (26.1%), transient colitis (43.7%), gangrenous colitis (9.9%), fulminant pancolitis (2.5%), and chronic segmental colitis (17.9%). A total of 47 patients (12.9%) had an unfavorable outcome as defined by mortality and/or the need for surgery. Multivariate analysis identified the following signs as independent risk factors for an unfavorable outcome: abdominal pain without rectal bleeding [odds ratio (OR) 3.9; 95% confidence interval (CI) = 1.6-9.3], non-bloody diarrhoea (OR 10; 95% CI = 3.7-27.4), and peritoneal signs (OR 7.3; 95% CI = 2.7-19.6). Unfavorable outcomes also were more frequent in isolated right colon ischaemia (IRCI) compared with non-IRCI (40.9 vs. 10.3%, respectively; p < 0.0001). The overall mortality rate was 7.7%. The clinical presentation of CI is very heterogeneous, perhaps explaining why clinical suspicion of this disease is so low. The presence of IRCI, and occurrence of peritoneal signs or onset of CI as severe abdominal pain without bleeding, should alert the physician to a potentially unfavorable course.

Socioeconomic Status, a Forgotten Variable in Lateralization Development

Science.gov (United States)

Boles, David B.

2011-01-01

Socioeconomic status (SES), a variable combining income, education, and occupation, is correlated with a variety of social health outcomes including school dropout rates, early parenthood, delinquency, and mental illness. Several studies conducted in the 1970s and 1980s largely failed to report a relationship between SES and hemispheric asymmetry…

A simulation study on estimating biomarker-treatment interaction effects in randomized trials with prognostic variables.

Science.gov (United States)

Haller, Bernhard; Ulm, Kurt

2018-02-20

To individualize treatment decisions based on patient characteristics, identification of an interaction between a biomarker and treatment is necessary. Often such potential interactions are analysed using data from randomized clinical trials intended for comparison of two treatments. Tests of interactions are often lacking statistical power and we investigated if and how a consideration of further prognostic variables can improve power and decrease the bias of estimated biomarker-treatment interactions in randomized clinical trials with time-to-event outcomes. A simulation study was performed to assess how prognostic factors affect the estimate of the biomarker-treatment interaction for a time-to-event outcome, when different approaches, like ignoring other prognostic factors, including all available covariates or using variable selection strategies, are applied. Different scenarios regarding the proportion of censored observations, the correlation structure between the covariate of interest and further potential prognostic variables, and the strength of the interaction were considered. The simulation study revealed that in a regression model for estimating a biomarker-treatment interaction, the probability of detecting a biomarker-treatment interaction can be increased by including prognostic variables that are associated with the outcome, and that the interaction estimate is biased when relevant prognostic variables are not considered. However, the probability of a false-positive finding increases if too many potential predictors are included or if variable selection is performed inadequately. We recommend undertaking an adequate literature search before data analysis to derive information about potential prognostic variables and to gain power for detecting true interaction effects and pre-specifying analyses to avoid selective reporting and increased false-positive rates.

Employment outcomes of transition-aged adults with autism spectrum disorders: a state of the States report.

Science.gov (United States)

Burgess, Sloane; Cimera, Robert E

2014-01-01

The primary purpose of this study was to evaluate the employment outcomes of transition-aged adults with autism spectrum disorders (ASD) served by vocational rehabilitation services (VR) over the last 10 years by state. A secondary purpose was to compare employment outcomes of individuals with ASD to those of the overall transition-aged population served by VR for the same time period. Although there was variability both within and among states, the results of this study indicate that, over time, the number of young adults with ASD seeking VR services has increased; however, employment outcomes including the percent of adults with ASD achieving employment, the number of hours worked, and wages earned have not improved for this group. The cost to provide VR services to transition-aged adults with ASD was relatively stable over time. Transition-aged adults with ASD were more likely to become successfully employed as a result of receiving VR services than the overall population of transition-aged adults served by VR. However, the employed transition-aged adults consistently worked fewer hours and earned lower wages than those in the overall population. Factors that may influence variability within and among states, and between groups, and implications for research and practice are discussed.

Guidelines for the Investigation of Mediating Variables in Business Research

OpenAIRE

MacKinnon, David P.; Coxe, Stefany; Baraldi, Amanda N.

2011-01-01

Business theories often specify the mediating mechanisms by which a predictor variable affects an outcome variable. In the last 30 years, investigations of mediating processes have become more widespread with corresponding developments in statistical methods to conduct these tests. The purpose of this article is to provide guidelines for mediation studies by focusing on decisions made prior to the research study that affect the clarity of conclusions from a mediation study, the statistical mo...

Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa.

Science.gov (United States)

Castro, J; Toro, J; Cruz, M

2000-01-01

Studies of family relationships in anorexia nervosa have produced conflicting results. Some authors claim that family factors are related to short-term outcomes. Perceived rearing practices, as measured by the EMBU (Egna Minnen Betraffande Uppfostran: 'My memories of Upbringing') were examined in a sample (N = 158) of adolescents with anorexia nervosa and compared with the perceptions of adolescents (N = 159) from the general population. A further comparison was made between the groups of patients with good and bad short-term outcomes. Logistic regression analysis was performed to evaluate the predictive value of different variables on short-term outcome. Overall, small differences were observed in the perceptions of rearing practices as expressed by the controls and the anorexic patients. Patients with bad short-term outcome perceived more rejection and control-overprotection from both parents than those with good outcome. In the logistic regression analysis only Rejection from father and the EAT (Eating Attitudes Test) total score gave independent prediction of treatment response. Taken as a whole, these results do not support the idea of altered rearing practices in anorexic patients, at least in young patients with a short evolution of the disease. Perceived rearing practices, especially 'rejection', appear to have an appreciable effect on the short-term outcome.

Falsification Testing of Instrumental Variables Methods for Comparative Effectiveness Research.

Science.gov (United States)

Pizer, Steven D

2016-04-01

To demonstrate how falsification tests can be used to evaluate instrumental variables methods applicable to a wide variety of comparative effectiveness research questions. Brief conceptual review of instrumental variables and falsification testing principles and techniques accompanied by an empirical application. Sample STATA code related to the empirical application is provided in the Appendix. Comparative long-term risks of sulfonylureas and thiazolidinediones for management of type 2 diabetes. Outcomes include mortality and hospitalization for an ambulatory care-sensitive condition. Prescribing pattern variations are used as instrumental variables. Falsification testing is an easily computed and powerful way to evaluate the validity of the key assumption underlying instrumental variables analysis. If falsification tests are used, instrumental variables techniques can help answer a multitude of important clinical questions. © Health Research and Educational Trust.

Statistical analysis of nuclear power plant pump failure rate variability: some preliminary results

International Nuclear Information System (INIS)

Martz, H.F.; Whiteman, D.E.

1984-02-01

In-Plant Reliability Data System (IPRDS) pump failure data on over 60 selected pumps in four nuclear power plants are statistically analyzed using the Failure Rate Analysis Code (FRAC). A major purpose of the analysis is to determine which environmental, system, and operating factors adequately explain the variability in the failure data. Catastrophic, degraded, and incipient failure severity categories are considered for both demand-related and time-dependent failures. For catastrophic demand-related pump failures, the variability is explained by the following factors listed in their order of importance: system application, pump driver, operating mode, reactor type, pump type, and unidentified plant-specific influences. Quantitative failure rate adjustments are provided for the effects of these factors. In the case of catastrophic time-dependent pump failures, the failure rate variability is explained by three factors: reactor type, pump driver, and unidentified plant-specific influences. Finally, point and confidence interval failure rate estimates are provided for each selected pump by considering the influential factors. Both types of estimates represent an improvement over the estimates computed exclusively from the data on each pump

Test-retest variability of multifocal electroretinography in normal volunteers and short-term variability in hydroxychloroquine users

Directory of Open Access Journals (Sweden)

Browning DJ

2014-08-01

Full Text Available David J Browning,1 Chong Lee2 1Charlotte Eye, Ear, Nose and Throat Associates, 2University of North Carolina – Charlotte, Charlotte, NC, USA Purpose: To determine measurement variability of N1P1 amplitudes and the R1/R2 ratio in normal subjects and hydroxychloroquine users without retinopathy. Design: Retrospective, observational study. Subjects: Normal subjects (n=21 and 44 patients taking hydroxychloroquine (n=44 without retinopathy. Methods: Multifocal electroretinography (mfERG was performed twice in one session in the 21 normal subjects and twice within 1 year in the hydroxychloroquine users, during which time no clinical change in macular status occurred. Main outcome measures: N1P1 amplitudes of rings R1–R5, the R1/R2 ratio, and coefficients of repeatability (COR for these measurements. Results: Values for N1P1 amplitudes in hydroxychloroquine users were reduced compared with normal subjects by the known effect of age, but R1/R2 was not affected by age. The COR for R1–R5 ranged from 43% to 52% for normal subjects and from 43% to 59% for hydroxychloroquine users; for R1/R2 the COR was 29% in normal subjects and 45% in hydroxychloroquine users. Conclusion: mfERG measurements show high test-retest variability, limiting the ability of a single mfERG test to influence a decision to stop hydroxychloroquine; corroborative evidence with a different ancillary test is recommended in a suspicious case. Keywords: multifocal electroretinography, hydroxychloroquine, test-retest variability 

Association between thymic function and allogeneic hematopoietic stem cell transplantation outcome: results of a pediatric study.

Science.gov (United States)

Saglio, Francesco; Cena, Silvia; Berger, Massimo; Quarello, Paola; Boccasavia, Viola; Ferrando, Federica; Pittana, Laura; Bruno, Benedetto; Fagioli, Franca

2015-06-01

Robust T cell function recovery has been shown to be crucial in determining allogeneic hematopoietic stem cell transplantation (HSCT) outcome, and there is growing evidence that the thymus plays a central role in regulating this process. We performed a long-term analysis of the role of thymic activity recovery in a population of pediatric patients undergoing allogeneic HSCT by signal joint T cell receptor excision circle (sjTREC) quantification. In this study, characterized by a long-term follow-up (median, 72 months), we found patients with higher levels of sjTRECs before transplantation had a statistically significant reduced risk of death compared with patients with lower values (relative risk, .31; 95% confidence interval, .30 to .32; P = .02), showing this different outcome was mainly related to a reduction of relapse incidence (14% versus 43%, P = .02). Unlike previous reports, we observed no correlation between sjTREC levels and lymphocyte recovery. Moreover, we confirmed that only graft-versus-host disease influenced thymic activity after transplantation. In conclusion, our results suggest an association between pretransplantation thymic activity and the long-term outcome of pediatric patients undergoing HSCT, mainly through a reduction of relapse opportunities. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

40 Variability Bugs in the Linux Kernel

DEFF Research Database (Denmark)

Abal Rivas, Iago; Brabrand, Claus; Wasowski, Andrzej

2014-01-01

Feature-sensitive verification is a recent field that pursues the effective analysis of the exponential number of variants of a program family. Today researchers lack examples of concrete bugs induced by variability, and occurring in real large-scale software. Such a collection of bugs is a requi......Feature-sensitive verification is a recent field that pursues the effective analysis of the exponential number of variants of a program family. Today researchers lack examples of concrete bugs induced by variability, and occurring in real large-scale software. Such a collection of bugs...... the outcome of our analysis into a database. In addition, we provide self-contained simplified C99 versions of the bugs, facilitating understanding and tool evaluation. Our study provides insights about the nature and occurrence of variability bugs in a large C software system, and shows in what ways...

Outcomes assessment in rotator cuff pathology: what are we measuring?

Science.gov (United States)

Makhni, Eric C; Steinhaus, Michael E; Morrow, Zachary S; Jobin, Charles M; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

2015-12-01

Assessments used to measure outcomes associated with rotator cuff pathology and after repair are varied. This lack of standardization leads to difficulty drawing comparisons across studies. We hypothesize that this variability in patient-reported outcome measures and objective metrics used in rotator cuff studies persists even in high-impact, peer reviewed journals. All studies assessing rotator cuff tear and repair outcomes in 6 orthopedic journals with a high impact factor from January 2010 to December 2014 were reviewed. Cadaveric and animal studies and those without outcomes were excluded. Outcome measures included range of motion (forward elevation, abduction, external rotation, and internal rotation), strength (in the same 4 planes), tendon integrity imaging, patient satisfaction, and functional assessment scores. Of the 156 included studies, 63% documented range of motion measurements, with 18% reporting range of motion in all 4 planes. Only 38% of studies reported quantitative strength measurements. In 65% of studies, tendon integrity was documented with imaging (38% magnetic resonance imaging/magnetic resonance anrhrogram, 31% ultrasound, and 8% computed tomography arthrogram). Finally, functional score reporting varied significantly, with the 5 most frequently reported scores ranging from 16% to 61% in studies, and 15 of the least reported outcomes were each reported in ≤6% of studies. Significant variability exists in outcomes reporting after rotator cuff tear and repair, making comparisons between clinical studies difficult. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Molecular Classification Substitutes for the Prognostic Variables Stage, Age, and MYCN Status in Neuroblastoma Risk Assessment

Directory of Open Access Journals (Sweden)

Carolina Rosswog

2017-12-01

Full Text Available BACKGROUND: Current risk stratification systems for neuroblastoma patients consider clinical, histopathological, and genetic variables, and additional prognostic markers have been proposed in recent years. We here sought to select highly informative covariates in a multistep strategy based on consecutive Cox regression models, resulting in a risk score that integrates hazard ratios of prognostic variables. METHODS: A cohort of 695 neuroblastoma patients was divided into a discovery set (n = 75 for multigene predictor generation, a training set (n = 411 for risk score development, and a validation set (n = 209. Relevant prognostic variables were identified by stepwise multivariable L1-penalized least absolute shrinkage and selection operator (LASSO Cox regression, followed by backward selection in multivariable Cox regression, and then integrated into a novel risk score. RESULTS: The variables stage, age, MYCN status, and two multigene predictors, NB-th24 and NB-th44, were selected as independent prognostic markers by LASSO Cox regression analysis. Following backward selection, only the multigene predictors were retained in the final model. Integration of these classifiers in a risk scoring system distinguished three patient subgroups that differed substantially in their outcome. The scoring system discriminated patients with diverging outcome in the validation cohort (5-year event-free survival, 84.9 ± 3.4 vs 63.6 ± 14.5 vs 31.0 ± 5.4; P < .001, and its prognostic value was validated by multivariable analysis. CONCLUSION: We here propose a translational strategy for developing risk assessment systems based on hazard ratios of relevant prognostic variables. Our final neuroblastoma risk score comprised two multigene predictors only, supporting the notion that molecular properties of the tumor cells strongly impact clinical courses of neuroblastoma patients.

Predicting outcome from coma : man-in-the-barrel syndrome as potential pitfall

NARCIS (Netherlands)

Elting, JW; Haaxma, R; De Keyser, J; Sulter, G.

The Glasgow coma scale motor score is often used in predicting outcome after hypoxic ischemic coma. Judicious care should be exerted when using this variable in predicting outcome in patients with coma following hypotension since borderzone infarction can obscure the clinical picture. We describe a

Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

DEFF Research Database (Denmark)

Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom

2010-01-01

Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...

Outcomes of role stress: a multisample constructive replication.

Science.gov (United States)

Kemery, E R; Bedeian, A G; Mossholder, K W; Touliatos, J

1985-06-01

Responses from four separate samples of accountants and hospital employees provided a constructive replication of the Bedeian and Armenakis (1981) model of the causal nexus between role stress and selected outcome variables. We investigated the relationship between both role ambiguity and role conflict--as specific forms of role stress--and job-related tension, job satisfaction, and propensity to leave, using LISREL IV, a technique capable of providing statistical data for a hypothesized population model, as well as for specific causal paths. Results, which support the Bedeian and Armenakis model, are discussed in light of previous research.

Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling.

Science.gov (United States)

Factor, Roni; Kang, Minah

2015-09-01

The current study aims to develop a theoretical framework for understanding the antecedents of corruption and the effects of corruption on various health indicators. Using structural equation models, we analyzed a multinational dataset of 133 countries that included three main groups of variables--antecedents of corruption, corruption measures, and health indicators. Controlling for various factors, our results suggest that corruption rises as GDP per capita falls and as the regime becomes more autocratic. Higher corruption is associated with lower levels of health expenditure as a percentage of GDP per capita, and with poorer health outcomes. Countries with higher GDP per capita and better education for women have better health outcomes regardless of health expenditures and regime type. Our results suggest that there is no direct relationship between health expenditures and health outcomes after controlling for the other factors in the model. Our study enhances our understanding of the conceptual and theoretical links between corruption and health outcomes in a population, including factors that may mediate how corruption can affect health outcomes.

Evolution of dispersal in spatially and temporally variable environments: The importance of life cycles.

Science.gov (United States)

Massol, François; Débarre, Florence

2015-07-01

Spatiotemporal variability of the environment is bound to affect the evolution of dispersal, and yet model predictions strongly differ on this particular effect. Recent studies on the evolution of local adaptation have shown that the life cycle chosen to model the selective effects of spatiotemporal variability of the environment is a critical factor determining evolutionary outcomes. Here, we investigate the effect of the order of events in the life cycle on the evolution of unconditional dispersal in a spatially heterogeneous, temporally varying landscape. Our results show that the occurrence of intermediate singular strategies and disruptive selection are conditioned by the temporal autocorrelation of the environment and by the life cycle. Life cycles with dispersal of adults versus dispersal of juveniles, local versus global density regulation, give radically different evolutionary outcomes that include selection for total philopatry, evolutionary bistability, selection for intermediate stable states, and evolutionary branching points. Our results highlight the importance of accounting for life-cycle specifics when predicting the effects of the environment on evolutionarily selected trait values, such as dispersal, as well as the need to check the robustness of model conclusions against modifications of the life cycle. © 2015 The Author(s). Evolution © 2015 The Society for the Study of Evolution.

WE-F-304-00: Outcomes of Hypofractionated Treatments - Results of the WGSBRT

International Nuclear Information System (INIS)

2015-01-01

Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

WE-F-304-00: Outcomes of Hypofractionated Treatments - Results of the WGSBRT

Energy Technology Data Exchange (ETDEWEB)

NONE

2015-06-15

Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

Does the Early Bird Catch the Worm? Instrumental Variable Estimates of Educational Effects of Age of School Entry in Germany

OpenAIRE

Puhani, Patrick A.; Weber, Andrea M.

2006-01-01

We estimate the effect of age of school entry on educational outcomes using two different data sets for Germany, sampling pupils at the end of primary school and in the middle of secondary school. Results are obtained based on instrumental variable estimation exploiting the exogenous variation in month of birth. We find robust and significant positive effects on educational outcomes for pupils who enter school at seven instead of six years of age: Test scores at the end of primary school incr...

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

Science.gov (United States)

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

2016-07-01

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

Action-outcome learning and prediction shape the window of simultaneity of audiovisual outcomes.

Science.gov (United States)

Desantis, Andrea; Haggard, Patrick

2016-08-01

To form a coherent representation of the objects around us, the brain must group the different sensory features composing these objects. Here, we investigated whether actions contribute in this grouping process. In particular, we assessed whether action-outcome learning and prediction contribute to audiovisual temporal binding. Participants were presented with two audiovisual pairs: one pair was triggered by a left action, and the other by a right action. In a later test phase, the audio and visual components of these pairs were presented at different onset times. Participants judged whether they were simultaneous or not. To assess the role of action-outcome prediction on audiovisual simultaneity, each action triggered either the same audiovisual pair as in the learning phase ('predicted' pair), or the pair that had previously been associated with the other action ('unpredicted' pair). We found the time window within which auditory and visual events appeared simultaneous increased for predicted compared to unpredicted pairs. However, no change in audiovisual simultaneity was observed when audiovisual pairs followed visual cues, rather than voluntary actions. This suggests that only action-outcome learning promotes temporal grouping of audio and visual effects. In a second experiment we observed that changes in audiovisual simultaneity do not only depend on our ability to predict what outcomes our actions generate, but also on learning the delay between the action and the multisensory outcome. When participants learned that the delay between action and audiovisual pair was variable, the window of audiovisual simultaneity for predicted pairs increased, relative to a fixed action-outcome pair delay. This suggests that participants learn action-based predictions of audiovisual outcome, and adapt their temporal perception of outcome events based on such predictions. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Correlation between audiovestibular function tests and hearing outcomes in severe to profound sudden sensorineural hearing loss.

Science.gov (United States)

Wang, Chi-Te; Huang, Tsung-Wei; Kuo, Shih-Wei; Cheng, Po-Wen

2009-02-01

This study investigated whether audiovestibular function tests, namely auditory brain stem response (ABR) and vestibular-evoked myogenic potential (VEMP) tests were correlated to hearing outcomes after controlling the effects of other potential confounding factors in severe to profound sudden sensorineural hearing loss (SSHL). Eighty-eight patients with severe to profound SSHL were enrolled in this study. Pretreatment hearing levels, results of audiovestibular function tests, and final hearing outcomes were recorded from retrospective chart reviews. Other factors, including age, gender, delay of treatment, vertigo, diabetes mellitus, and hypertension, were collected as well. Comparative analysis between multiple variables and hearing outcomes was conducted using the cumulative logits model in overall subjects. Further, multivariate analysis of prognostic factors was conducted in the stratified groups of severe (70 dB HL 90 dB HL) SSHL. Multivariate analysis showed that pretreatment hearing levels, presence of vertigo, and results of ABR and VEMP testing were significant outcome predictors in the overall subjects. Stratification analysis demonstrated that both the presence of ABR and VEMP waveforms were significantly correlated with better hearing outcomes in the group of severe SSHL [ABR: adjusted odds ratio (aOR) = 14.7, 95% confidence interval (CI) = 1.78 to 122, p = 0.01; VEMP: aOR = 5.91, 95% CI = 1.18 to 29.5, p = 0.03], whereas the presence of vertigo was the only significant negative prognostic factor in the group of profound SSHL (aOR = 0.24, 95% CI = 0.06 to 0.95, p = 0.04). Other variables, including age, gender, diabetes mellitus, hypertension, and delay of treatment, were not significantly related to hearing outcomes in both groups (p > 0.05). A predictive hearing recovery table with the combined ABR and VEMP results was proposed for the group of severe SSHL. ABR and VEMP tests should be included in the battery of neurootological examinations in

The long-term outcome of delinquent children: a 30-year follow-up study.

Science.gov (United States)

Remschmidt, Helmut; Walter, Reinhard

2010-05-01

This study reports the results of a longitudinal study of unselected samples of German delinquent children, stratified by frequency of offences recorded before and after the age of criminal responsibility (14 years). A total of 256 young adults (mean age, 22 years), juvenile offenders and control non-offenders, were assessed using the following: a standardized interview regarding family, child development and life history; a multidimensional personality inventory (the Freiburg Personality Inventory, FPI); a version of the Wechsler Adult Intelligence Scale; a self-report questionnaire on the delinquency for which the subject was not apprehended during childhood; and a questionnaire concerning parental child-rearing style. The subsequent criminal records of subjects were followed over the next 20 years. It was possible to define three outcome groups (non-offenders, persisters and desisters), which differed in many respects. The outcome was significantly predicted by several variables. Psychosocial risk variables were the most effective predictors, followed by personality variables and childhood delinquency for which the subject had not been apprehended. The distinction between early-onset and late-onset delinquency as a predictor of adult criminality proved valid only if non-apprehended childhood offending was taken into account. The implications of the study for preventive intervention are discussed.

Collaborative Proposal: Improving Decadal Prediction of Arctic Climate Variability and Change Using a Regional Arctic System Model (RASM)

Energy Technology Data Exchange (ETDEWEB)

Maslowski, Wieslaw [Naval Postgraduate School, Monterey, CA (United States). Dept. of Oceanography; Cassano, John J. [Univ. of Colorado, Boulder, CO (United States); Gutowski, Jr., William J. [Iowa State Univ., Ames, IA (United States); Lipscomb, William H. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Nijssen, Bart [Univ. of Washington, Seattle, WA (United States); Roberts, Andrew [Naval Postgraduate School, Monterey, CA (United States). Dept. of Oceanography; Robertson, William [Univ. of Texas, El Paso, TX (United States); Tulaczyk, Slawek [Univ. of California, Santa Cruz, CA (United States); Zeng, Xubin [Univ. of Arizona, Tucson, AZ (United States)

2011-05-15

The primary outcome of the project was the development of the Regional Arctic System Model (RASM) and evaluation of its individual model components, coupling among them and fully coupled model results. Overall, we have demonstrated that RASM produces realistic mean and seasonal surface climate as well as its interannual and decadal variability and trends.

Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

NARCIS (Netherlands)

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F.; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

2012-01-01

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes

Towards global consensus on outcome measures for atopic eczema research : Results of the HOME II meeting

NARCIS (Netherlands)

Schmitt, Jochen; Spuls, Phyllis; Boers, Maarten; Thomas, Kim; Chalmers, Joanne; Roekevisch, Evelien; Schram, Mandy; Allsopp, Richard; Aoki, Valeria; Apfelbacher, Christian; Bruijnzeel-Koomen, Carla; Bruin-Weller, Marjolein; Charman, Carolyn; Cohen, Arnon; Dohil, Magdalene; Flohr, Carsten; Furue, Masutaka; Gieler, Uwe; Hooft, Lotty; Humphreys, Rosemary; Ishii, Henrique Akira; Katayama, Ichiro; Kouwenhoven, Willem; Langan, Sinéad; Lewis-Jones, Sue; Merhand, Stephanie; Murota, Hiroyuki; Murrell, Dedee F; Nankervis, Helen; Ohya, Yukihiro; Oranje, Arnold; Otsuka, Hiromi; Paul, Carle; Rosenbluth, Yael; Saeki, Hidehisa; Schuttelaar, Marie-Louise; Stalder, Jean-Francois; Svensson, Ake; Takaoka, Roberto; Wahlgren, Carl-Fredrik; Weidinger, Stephan; Wollenberg, Andreas; Williams, Hywel

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes

A Systematic Review of Associations between Amount of Meditation Practice and Outcomes in Interventions Using the Four Immeasurables Meditations.

Science.gov (United States)

Zeng, Xianglong; Chio, Floria H N; Oei, Tian P S; Leung, Freedom Y K; Liu, Xiangping

2017-01-01

Interventions using the "Four Immeasurables Meditations" (FIM) are effective for various outcomes; however, whether increased meditation practice in these interventions leads to better results has not been well investigated. This systematic review included 22 FIM interventions that reported associations between the amount of meditation practice and its outcomes. Despite the heterogeneity in intervention components and outcome variables, there were generally few significant associations between amount of meditation practice and its outcomes. Specifically, only five studies reported that more than half of the calculated results were significant. In comparison with correlations between total amount of practice and overall outcomes, the short-term influence of meditation practice was evaluated in fewer studies; however, it had a better association with outcomes. More studies are required that address the underlying mechanisms that elucidate how meditation practice leads to outcome changes in daily life. In this study, two promising mechanisms with initial evidence were discussed. This review also summarized common methodological issues including a lack of experimental manipulation and inaccurate measuring of meditation practice.