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OMITTED VARIABLES, CONFIDENCE INTERVALS, AND THE PRODUCTIVITY OF EXCHANGE RATESPACIFIC ECONOMIC REVIEW, Issue 1 2007
Jonathan E. Leightner
This paper develops confidence intervals for BD-RTPLS and uses BD-RTPLS to estimate the relationship between the exchange rate (e) and gross domestic product (GDP) using annual data from 1984 to 2000 for 23 developing Asian and Pacific countries. BD-RTPLS produces estimates for the exchange rate multiplier (dGDP/de) for these countries and shows how omitted variables affected these multipliers across countries and over time. [source]
UPPER BOUNDS ON THE MINIMUM COVERAGE PROBABILITY OF CONFIDENCE INTERVALS IN REGRESSION AFTER MODEL SELECTIONAUSTRALIAN & NEW ZEALAND JOURNAL OF STATISTICS, Issue 3 2009
Summary We consider a linear regression model, with the parameter of interest a specified linear combination of the components of the regression parameter vector. We suppose that, as a first step, a data-based model selection (e.g. by preliminary hypothesis tests or minimizing the Akaike information criterion , AIC) is used to select a model. It is common statistical practice to then construct a confidence interval for the parameter of interest, based on the assumption that the selected model had been given to us,a priori. This assumption is false, and it can lead to a confidence interval with poor coverage properties. We provide an easily computed finite-sample upper bound (calculated by repeated numerical evaluation of a double integral) to the minimum coverage probability of this confidence interval. This bound applies for model selection by any of the following methods: minimum AIC, minimum Bayesian information criterion (BIC), maximum adjusted,R2, minimum Mallows' CP and,t -tests. The importance of this upper bound is that it delineates general categories of design matrices and model selection procedures for which this confidence interval has poor coverage properties. This upper bound is shown to be a finite-sample analogue of an earlier large-sample upper bound due to Kabaila and Leeb. [source]
Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinomaDISEASES OF THE ESOPHAGUS, Issue 5 2006
P. J. Veugelers
SUMMARY., The aim of this study was to examine the association of obesity with esophageal adenocarcinoma, and with the precursor lesions Barrett esophagus and gastroesophageal reflux disease (GERD). This case-control study included cases with GERD (n = 142), Barrett esophagus (n = 130), and esophageal adenocarcinoma (n = 57). Controls comprised 102 asymptomatic individuals. Using logistic regression methods, we compared obesity rates between cases and controls adjusting for differences in age, gender, and lifestyle risk factors. Relative to normal weight, obese individuals were at increased risk for esophageal adenocarcinoma (Odds Ratio [OR] 4.67, 95% Confidence Interval [CI] 1.27,17.9). Diets high in vitamin C were associated with a lower risk for GERD (OR 0.40, 95% CI 0.19,0.87), Barrett esophagus (OR 0.44, 95% CI 0.20,0.98), and esophageal adenocarcinoma (OR 0.21, 95% CI 0.06,0.77). For the more established risk factors, we confirmed that smoking was a significant risk factor for esophageal adenocarcinoma, and that increased liquor consumption was associated with GERD and Barrett esophagus. In light of the current obesity epidemic, esophageal adenocarcinoma incidence rates are expected to continue to increase. Successful promotion of healthy body weight and diets high in vitamin C may substantially reduce the incidence of this disease. [source]
Study of Five Discrete-Interval-Type Ground Water Sampling DevicesGROUND WATER MONITORING & REMEDIATION, Issue 3 2004
Louise V. Parker
Five relatively newly developed discrete-interval-type ground water sampling devices,the KABIS, HydraSleeve, Discrete Interval, Pneumo-Bailer, and USGS passive diffusion bag (PDB) samplers,were tested to determine their ability to recover representative concentrations of a variety of analytes,volatile organics, explosives, pesticides, and metals,from a standpipe and trichloroethylene (TCE) from a deep monitoring well. Samples taken from a well were compared with samples taken using low-flow sampling. The PDB sampler was the easiest to use, but could only be used to sample volatile organic compounds (VOCs). The HydraSleeve and the KABIS samplers were also easy to use; these devices produced representative concentrations of explosives, pesticides, and metals in the standpipe experiments, but elevated the turbidity in our monitoring well. Although there were statistically significant differences for some VOCs with both devices, these differences were generally very small (< 5%). The one exception was an 18% loss of TCE with the KABIS sampler. The Discrete Interval sampler and the Pneumo-Bailer are pressurized devices that are designed to only collect a sample when activated. The Pneumo-Bailer was heavy and awkward to handle, required a nitrogen tank in the field, and involved many steps to operate. The Discrete Interval sampler only required a bicycle pump to pressurize the chamber and was lighter and easier to handle and operate than its counterpart. Both devices generally delivered representative concentrations of all the analytes tested. [source]
Interval, Sexual Difference: Luce Irigaray and Henri BergsonHYPATIA, Issue 1 2008
Henri Bergson's philosophy has attracted increasing feminist attention in recent years as a fruitful locus for re-theorizing temporality. Drawing on Luce Irigaray's well-known critical description of metaphysics as phallocentrism, Hill argues that Bergson's deduction of duration is predicated upon the disavowal of a sexed hierarchy. She concludes the article by proposing a way to move beyond Bergson's phallocentrism to articulate duration as a sensible and transcendental difference that articulates a nonhierarchical qualitative relation between the sexes. [source]
The End of Phenomenology: Bergson's Interval in IrigarayHYPATIA, Issue 3 2000
DOROTHEA E. OLKOWSKI
Luce Irigaray is often cited as the principle feminist who adheres to phenomenology as a method of descriptive philosophy. A different approach to Irigaray might well open the way to not only an avoidance of phenomenology's sexist tendencies, but the recognition that the breach between Irigaray's ideas and those of phenomenology is complete. I argue that this occurs and that Irigaray's work directly implicates a Bergsonian critique of the limits of phenomenology. [source]
Mortality and incidence trends from esophagus cancer in selected geographic areas of China circa 1970,90INTERNATIONAL JOURNAL OF CANCER, Issue 3 2002
Abstract China was one of the countries with the highest esophagus cancer risk in the world during the 1970s. This report provides data on time trends of esophagus cancer incidence and mortality during the 1970s,90s in selected geographic areas of China. Information on newly diagnosed cancer cases and cancer deaths is based on data collected by local population-based registries and Disease Surveillance Points (DSP). For the whole country, esophagus cancer mortality decreased slightly, 17.4 per 105 populations during 1990,92 in contrast to 18.8 per 105 populations in 1973,75. In the Linxian area, trends in the incidence and mortality rates for esophagus+gastric cardia cancer reversed over time; incidence rates increased significantly during 1959,72 but were decreased significantly on average ,2.26% (95% Confidence Interval [CI]: ,1.74, ,2.77) and ,1.10% (95% CI = ,0.58, ,1.62) per year for males and females, respectively, during 1972,97. In urban Shanghai, incidence trend for esophagus cancer decreased monotonically and significantly on average by ,4.99% (95% CI = ,4.28, ,5.70) and ,5.18% (95% CI = ,4.99, ,5.70) per year for males and females, respectively. In Nanao islet, esophagus+gastric cardia cancer mortality rates increased during 1970,82 but decreased slowly from 1982,99 (,0.96% per year; 95% CI = ,0.14, ,1.78). Our study indicates that incidence and mortality rates for esophagus or esophagus+gastric cardia cancer are now decreasing in China. The declines may be due to an unplanned success of prevention, such as changes in population dietary patterns and food preservation methods. © 2002 Wiley-Liss, Inc. [source]
The role of patient personality in the identification of depression in older primary care patientsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2007
Laura W. McCray
Abstract Background Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. Methods We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. Results High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). Conclusion Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care. Copyright © 2007 John Wiley & Sons, Ltd. [source]
The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2007
Hillary R. Bogner
Abstract Objective To describe the influence of domains of cognition on remission and response of depression in an intervention trial among older primary care patients. Methods Twenty primary care practices were randomly assigned to Usual Care or to an Intervention consisting of a depression care manager offering algorithm-based care for depression. In all, 599 adults 60 years and older with a depression diagnosis were included in these analyses. Depression severity and remission of depression were assessed by the 24-item Hamilton Depression Rating Scale. The Mini-Mental State Examination (MMSE) was our global measure of cognitive function. Verbal memory was assessed with the memory subscale of the Dementia Rating Scale. Attention was measured with the digit span from the Weschler Adult Intelligence Test. Response inhibition, one of the executive functions, was assessed with the Stroop Color-Word test. Results The intervention was associated with improved remission and response rates regardless of cognitive impairment. Response inhibition as measured by the Stroop Color-Word test appeared to significantly modify the intervention versus usual care difference in remission and response at 4 months. Patients in the poorest performance quartile at baseline on the Stroop Color-Word test in the Intervention Condition were more likely to achieve remission of depression at 4 months than comparable patients in Usual Care [odds ratio (OR),=,17.76, 95% Confidence Interval (CI), 3.06, 103.1]. Conclusions Depressed older adults in primary care with executive dysfunction have low remission and response rates when receiving usual care but benefit from depression care management. Copyright © 2007 John Wiley & Sons, Ltd. [source]
Interval type-2 fuzzy logic for edges detection in digital imagesINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 11 2009
Edges detection in a digital image is the first step in an image recognition system. In this paper, we show an efficient edges detector using an interval type-2 fuzzy inference system (FIS-2). The FIS-2 uses as input the original images after applying Sobel filters and attenuation filters, then the fuzzy rules infer normalized values for the edges images, especially useful to enhance the performance of neural networks. To illustrate the results, we built frequency histograms of some images and compare the results of the FIS-2 edge's detector with the gradient magnitude method and a type-1 fuzzy inference system (FIS-1). The FIS-2 results are better than the gradient magnitude and FIS-1, because the edges preserve more detail of the original images, and the backgrounds are more homogeneous than with FIS-1 and the gradient's magnitude method. © 2009 Wiley Periodicals, Inc. [source]
Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2010
CHUNG-WAH SIU M.B.B.S.
MADIT II Criteria for Implantable Cardioverter.,Background: MADIT-II demonstrated that prophylactic implantation of an implantable cardioverter-defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT-II criteria for ICD implantation are appropriate for Chinese patients. Methods and Results: We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT-II criteria for ICD implantation with the original published MADIT-II population. Seventy consecutive patients who satisfied MADIT-II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT-II cohort with the exception of a higher incidence of diabetes mellitus. After follow-up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2-year SCD rate (10.0%) was comparable with that of the MADIT-II conventional group (12.1%), but higher than the MADIT-II defibrillator group (4.9%). Similarly, the 2-year non-SCD rate was 3.0%, also comparable with the MADIT-II conventional group (4.6%), but lower than the MADIT-II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48,8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35,10.17, P = 0.011) were independent predictors for mortality in the MADIT-II eligible patients. Conclusion: Chinese patients who satisfy MADIT-II criteria for ICD implantation are at similar risk of SCD and non-SCD as the original MADIT-II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231,235, March 2010) [source]
Substrate and Procedural Predictors of Outcomes After Catheter Ablation for Atrial Fibrillation in Patients with Hypertrophic CardiomyopathyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2008
T. JARED BUNCH M.D.
Background: Hypertrophic cardiomyopathy (HCM) is often accompanied by atrial fibrillation (AF) due to diastolic dysfunction, elevated left atrial pressure, and enlargement. Although catheter ablation for drug-refractory AF is an effective treatment, the efficacy in HCM remains to be established. Methods: Thirty-three consecutive patients (25 male, age 51 ± 11 years) with HCM underwent pulmonary vein (PV) isolation (n = 8) or wide area circumferential ablation with additional linear ablation (n = 25) for drug-refractory AF. Twelve-lead and 24-hour ambulating ECGs, echocardiograms, event monitor strips, and SF 36 quality of life (QOL) surveys were obtained before ablation and for routine follow-up. Results: Twenty-one (64%) patients had paroxysmal AF and 12 (36%) had persistent/permanent AF for 6.2 ± 5.2 years. The average ejection fraction was 0.63 ± 0.12. The average left atrial volume index was 70 ± 24 mL/m2. Over a follow-up of 1.5 ± 1.2 years, 1-year survival with AF elimination was 62%(Confidence Interval [CI]: 66-84) and with AF control was 75%(CI: 66-84). AF control was less likely in patients with a persistent/chronic AF, larger left atrial volumes, and more advanced diastolic disease. Additional linear ablation may improve outcomes in patient with severe left atrial enlargement and more advanced diastolic dysfunction. Two patients had a periprocedureal TIA, one PV stenosis, and one died after mitral valve replacement from prosthetic valve thrombosis. QOL scores improved from baseline at 3 and 12 months. Conclusion: Outcomes after AF ablation in patients with HCM are favorable. Diastolic dysfunction, left atrial enlargement, and AF subtype influence outcomes. Future studies of rhythm management approaches in HCM patients are required to clarify the optimal clinical approach. [source]
Differentiating Atrioventricular Nodal Reentrant Tachycardia from Junctional Tachycardia: Novel Application of the Delta H-A IntervalJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2008
KOMANDOOR SRIVATHSAN M.D.
Introduction: Junctional tachycardia (JT) and atrioventricular nodal reentrant tachycardia (AVNRT) can be difficult to differentiate. Yet, the two arrhythmias require distinct diagnostic and therapeutic approaches. We explored the utility of the delta H-A interval as a novel technique to differentiate these two tachycardias. Methods: We included 35 patients undergoing electrophysiology study who had typical AVNRT, 31 of whom also had JT during slow pathway ablation, and four of whom had spontaneous JT during isoproterenol administration. We measured the H-A interval during tachycardia (H-AT) and during ventricular pacing (H-AP) from the basal right ventricle. Interobserver and intraobserver reliability of measurements was assessed. Ventricular pacing was performed at approximately the same rate as tachycardia. The delta H-A interval was calculated as the H-AP minus the H-AT. Results: There was excellent interobserver and intraobserver agreement for measurement of the H-A interval. The average delta H-A interval was ,10 ms during AVNRT and 9 ms during JT (P < 0.00001). For the diagnosis of JT, a delta H-A interval , 0 ms had the sensitivity of 89%, specificity of 83%, positive predictive value of 84%, and negative predictive value of 88%. The delta H-A interval was longer in men than in women with JT, but no gender-based differences were seen with AVNRT. There was no difference in the H-A interval based on age , 60 years. Conclusion: The delta H-A interval is a novel and reproducibly measurable interval that aids the differentiation of JT and AVNRT during electrophysiology studies. [source]
The Normal Effects of Epinephrine and Isoproterenol on Heart Rate and QT Interval: Role in Unmasking the Long QT SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2006
DAVID M. FITZGERALD M.D., F.H.R.S.Article first published online: 26 JUL 200
No abstract is available for this article. [source]
Effects of Isoproterenol and Amiodarone on the Double Potential Interval After Ablation of the Cavotricuspid IsthmusJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2003
HIROSHI TADA M.D.
Introduction: A corridor of double potentials along the ablation line has been recognized to be an indicator of complete cavotricuspid isthmus block. Isoproterenol is used to confirm cavotricuspid isthmus block, but the effects of isoproterenol on the double potential interval (DPI), either in the absence or presence of amiodarone, are unknown. Methods and Results: Thirty-two patients with isthmus-dependent atrial flutter underwent successful ablation of the cavotricuspid isthmus. The procedure was performed in the drug-free state in 23 patients, and 2 to 7 days after discontinuation of chronic amiodarone therapy in 9 patients. Electrograms recorded along the ablation line before and during isoproterenol infusion were analyzed after isthmus block was achieved. Double potentials were recorded along the entire ablation line upon achievement of complete isthmus block in all patients. The DPI in 9 patients treated with amiodarone was longer than in the other patients (147 ± 32 msec vs 119 ± 19 msec, P < 0.001). The DPI increased as the pacing cycle length shortened in patients treated with amiodarone, but not in the other patients. At all pacing cycle lengths, isoproterenol shortened the DPI to a greater extent in the patients treated with amiodarone than in the other patients. Conclusion: Amiodarone results in rate-dependent prolongation of the DPI during coronary sinus pacing after ablation of the cavotricuspid isthmus. Isoproterenol shortens the DPI despite the presence of complete isthmus block, and this effect is accentuated in the presence of amiodarone. (J Cardiovasc Electrophysiol, Vol. 14, pp. 935-939, September 2003) [source]
Prolongation of Activation-Recovery Interval over a Preexcited Region before and after Catheter Ablation in Patients with Wolff-Parkinson-White SyndromeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2001
YASUYA INDEN M.D.
Activation-Recovery Interval in WPW Syndrome. Introduction: Preexisting changes in repolarization properties play an important role in T wave abnormalities (cardiac memory) after ablation in patients with Wolff-Parkinson-White (WPW) syndrome. However, no report has provided direct evidence for prolongation of action potential duration (APD) over a preexcited region before and after ablation. Methods and Results: We studied 10 patients with ventricular preexcitation due to a left-sided accessory pathway (AP) (group M) and 12 patients with concealed left-sided AP (group C) to clarify prolongation of APD using activation-recovery intervals (ARIs) from epicardial and endocardial unipolar electrograms in patients with WPW syndrome. ARI was calculated from unipolar electrograms at the His bundle and the coronary sinus adjacent to the AP during atrial pacing (100 beats/min) before and 30 minutes after ablation. Before ablation, ARIs at the AP site were significantly longer in group M than in group C (255 ± 21 msec vs 211 ± 24 msec; P < 0.01), whereas ARIs at the His bundle did not differ between the two groups (255 ± 20 msec vs 245 ± 27 msec; P = NS). After ablation, group M showed no significant changes in ARIs at the AP and His bundle (256 ± 19 msec and 253 ± 15 msec) compared with before ablation. Conclusion: We found by direct analysis of ARIs from the epicardium that APD prolongation over the preexcited region was present before catheter ablation and persisted after catheter ablation. The gradual changes in repolarization properties, including APD prolongation after discontinuation of AP, may be one mechanism of cardiac memory after catheter ablation in patients with WPW syndrome. [source]
Ablation of Atypical Atrial Flutter Guided by the Use of Concealed Entrainment in Patients Without Prior Cardiac SurgeryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2000
FRANK BOGUN M.D.
Ablation of Atypical Atrial Flutter. Introduction: Mapping techniques have not been systematically evaluated with respect to atypical atrial flutter (AF) not involving the inferior vena cava isthmus. The purpose of this study was to assess prospectively the use of concealed entrainment (CE) in mapping of AF and to assess the clinical benefit of ablation of clinically relevant atypical AF. Methods and Results: In seven consecutive patients without prior cardiac surgery presenting with atypical AF, mapping was performed in the right and, if necessary, left atrium. At sites with CE, radiofrequency energy was delivered. In a posthoc analysis, the endocardial activation time, stimulus-flutter wave (F) interval, presence of split potentials and diastolic potentials, and postpacing Interval were assessed, and effective sites were compared to ineffective sites. A total of 22 forms of atypical AE either could be induced or were present at the time of the study. Eleven of the 13 targeted atypical AFs (85%) were successfully ablated. The positive predictive value of CE increased from 45% to 75% in the presence of matching electrogram-F and stimulus-F intervals or if flutter terminated during entrainment pacing, and to 88% in the presence of split atrial electrograms or diastolic potentials. During short-term clinical follow-up, none of the patients had recurrence of the ablated AE. However, the majority of patients required either medication for atrial fibrillation or repeated interventions for new forms of AF. Conclusion: Mapping and ablation of atypical AF is feasible if sites with CE can be identified. However, the clinical benefit of successful ablations in patients with atypical flutter appears to be limited. [source]
The Influence of Time Interval between Bleaching and Enamel BondingJOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 2 2007
Jéfferson Da Silva Machado dds
ABSTRACT Objectives:, The purpose of this study was to investigate the penetration of a conventional adhesive material into enamel bleached with 16% carbamide peroxide and 38% hydrogen peroxide using optical light microscopy. Methods:, Extracted human teeth were randomly divided into eight experimental groups with six specimens each, according to the bleaching material and time interval after bleaching and before the bonding procedure. Groups were designated as follows: control group, restorations in unbleached teeth; restorations performed immediately after bleaching; restorations performed 7 days after bleaching; restorations performed 14 days after bleaching; and restorations performed 30 days after bleaching. The length of resin tags was measured with an Axiophot photomicroscope at 400× magnification for the calculation of the proportion of tags of study groups compared to the respective control groups. Analysis of variance was applied for comparison between groups; data were transformed into arcsine (p < 0.05). Results:, The specimens of experimental groups, in which restorations were performed 7, 14, and 30 days after bleaching, showed better penetration of adhesive material into enamel than specimens restored immediately after bleaching. There was no statistically significant difference between the bleaching materials employed or in the interaction between bleaching agent and time interval. Conclusions:, This suggests that a time interval of at least 7 days should be allowed between enamel bleaching and placement of adhesive bonding agents for accomplishment of composite resin restorations. CLINICAL SIGNIFICANCE Establishment of adequate time after bleaching is fundamental to allow the normal penetration of a one-bottle conventional adhesive onto the enamel surface. [source]
The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in JapanJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2009
Haruhisa Fukuda MPH
Abstract Objective, To reveal the amount of time and financial cost required to obtain informed consent and to preserve documentation. Methods, The questionnaire was delivered to all staff in six acute care public hospitals in Japan. We examined health care staff perceptions of the time they spent obtaining informed consent and documenting information. All data were collected in 2006 and estimates in the past week in 2006 were compared to estimates of time spent in a week in 1999. We also calculated the economic costs of incremental amounts of time spent in these procedures. Results, In 2006, health care staff took about 3.89 hours [95% Confidence Interval (CI) 3.71,4.07] per week to obtain informed consent and 6.64 hours (95% CI 6.40,6.88) per week to write documentation on average. Between 1999 and 2006, the average amount of time for conducting informed consent was increased to 0.67 (P < 0.001) hours per person-week, and the average amount of time for documentation was increased to 0.70 (P < 0.001) hours per person-week. The annual economic cost of activities for informed consent and documentation in a 100-bed hospital increased from 117 755 to 449 402 US dollars. Conclusions, We found a considerable increase in time spent on informed consent and documentation, and associated cost over a 7-year time period. Although greater attention to the informed consent process should be paid to ensure the notions of patient autonomy and self-determination, the increased resources devoted to these practices must be considered in light of current cost containment policies. [source]
Predicting the Postmortem Submersion Interval for Human Remains Recovered from U.K. Waterways,JOURNAL OF FORENSIC SCIENCES, Issue 2 2010
Vivienne Heaton M.Sc.
Abstract:, This article aims to increase accuracy in estimating the postmortem submersion interval (PMSI) for bodies recovered from rivers in the United Kingdom. Data were collected from closed case files, crime scene reports, and autopsy files concerning bodies recovered over a 15-year period from the River Clyde, Scotland, and the River Mersey and canals in northwest England. One hundred and eighty-seven cases met the study criteria and were scored by quantifying the overall amount of decomposition observed in each case. Statistical analysis showed that the duration of a body's submergence in water and the temperatures to which it was exposed, as measured in accumulated degree days (ADD), had a significant effect on the decay process. Further analysis indicated that there were no significant differences in decomposition between the waterways. By combining the data from all study samples, it was possible to produce a single linear regression model for predicting ADD from observed decomposition. [source]
The Effects of Soil Environment on Postmortem Interval: A Macroscopic AnalysisJOURNAL OF FORENSIC SCIENCES, Issue 6 2009
Kimberley A. Jaggers H.B.Sc.
Abstract:, Burial environment, in particular soil moisture, has a significant impact on the type, rate, and extent of bone degradation, which ultimately affects estimations of the postmortem interval (PMI). The purpose of this research is to determine the effects of soil moisture on the color, weight, condition, and texture of bone as it relates to the PMI. Bone changes occurring over two different time intervals (2 and 5 months) were examined using 120 sus scrofa leg bones. During each time interval bones were buried in two soil environments, one of which was drier than the other. The bones in both environments lost weight over time but the net weight loss was greater for bones in the higher moisture environment. There was no change in color, texture, or overall condition, indicating that 150 days is not long enough for such alterations to occur, regardless of the moisture level of the burial environment. [source]
Detection of Acute Diazepam Exposure in Bone and Marrow: Influence of Tissue Type and the Dose-Death Interval on Sensitivity of Detection by ELISA with Liquid Chromatography Tandem Mass Spectrometry Confirmation,JOURNAL OF FORENSIC SCIENCES, Issue 3 2009
D.A.B.F.T., James H. Watterson Ph.D.
Abstract:, Enzyme-linked immunosorbent assay (ELISA) and liquid chromatography tandem mass spectrometry (LC/MS/MS) were used to detect diazepam exposure in skeletal tissues of rats (n = 15) given diazepam acutely (20 mg/kg, i.p.), and killed at various times postdose. Marrow, epiphyseal, and diaphyseal bone were isolated from extracted femora. Bone was cleaned, ground, and incubated in methanol. Marrow underwent ultrasonic homogenization. Extracts and homogenates were diluted in phosphate buffer, and then underwent solid-phase extraction and ELISA. Relative sensitivity of detection was examined in terms of relative decrease in absorbance (ELISA) and binary classification sensitivity (ELISA and LC/MS/MS). Overall, the data showed differences in relative sensitivity of detection of diazepam exposure in different tissue types (marrow > epiphyseal bone > diaphyseal bone), which is suggestive of heterogenous distribution in these tissues, and a decreasing sensitivity with increasing dose-death interval. Thus, the tissue type sampled and dose-death interval may contribute to the probability of detection of diazepam exposure in skeletal tissues. [source]
Estimating the Timing of Long Bone Fractures: Correlation Between the Postmortem Interval, Bone Moisture Content, and Blunt Force Trauma Fracture Characteristics,JOURNAL OF FORENSIC SCIENCES, Issue 5 2008
Danielle A.M. Wieberg M.A.
Abstract:, There is very limited knowledge about how long perimortem fracture characteristics persist into the postmortem interval (PMI). Therefore, in this study, 60 porcine long bones were exposed to natural taphonomic conditions and fractured with a steel bone breaking apparatus every 28 days throughout a 141-day period. Differences between macroscopic blunt force trauma fracture characteristics (fracture angle, surface morphology, and outline) were examined to determine if they varied over time or in relationship to bone moisture content (ash weight) and overall assessment. There are significant relationships between (1) PMI and percent ash weight (%AW), fracture surface, and fracture angle and (2) %AW and fracture surface and fracture angle. Bone moisture content correlates significantly with fracture morphology and other characteristics commonly used by forensic anthropologists to determine the timing of traumatic injuries. However, fracture characteristics normally associated with perimortem trauma can persist long into the PMI. [source]
Y-STR Profiling in Extended Interval (,3 days) Postcoital Cervicovaginal Samples,JOURNAL OF FORENSIC SCIENCES, Issue 2 2008
Kathleen A. Mayntz-Press M.S.
Abstract:, Depending upon specific situations, some victims of sexual assault provide vaginal samples more than 36,48 h after the incident. We have tested the ability of commercial and in-house Y-STR systems to provide DNA profiles from extended interval (,3 days) postcoital samples. The commercial Y-STR systems tested included the AmpF,STR® YfilerÔ (Applied Biosystems), PowerPlex® Y (Promega) and Y-PLEXÔ 12 (Reliagene) products whereas the in-house systems comprised Multiplex I (MPI) and Multiplex B (MPB). Three donor couples were recruited for the study. Postcoital cervicovaginal swabs (x2) were recovered by each of the three females at specified intervals after sexual intercourse (3,7 days). Each time point sample was collected after a separate act of sexual intercourse and was preceded by a 7-day abstention period. As a negative control, a precoital swab was also recovered prior to coitus for each sampling and only data from postcoital samples that demonstrated a lack of male DNA in the associated precoital sample was used. A number of DNA profile enhancement strategies were employed including sampling by cervical brushing, nondifferential DNA extraction methodology, and post-PCR purification. Full Y-STR profiles from cervicovaginal samples recovered 3,4 days after intercourse were routinely obtained. Profiles were also obtainable 5,6 days postcoitus although by this stage partial profiles rather than full profiles were a more likely outcome. The DNA profiles from the sperm fraction of a differential lysis were superior to that obtained when a nondifferential method was employed in that the allelic signal intensities were generally higher and more balanced and exhibited less baseline noise. The incorporation of a simple post-PCR purification process significantly increased the ability to obtain Y-STR profiles, particularly from 5- to 6-day postcoital samples. Remarkably an 8 locus Y-STR profile was obtained from a 7-day postcoital sample, which is approaching the reported time limit for sperm detection in the cervix. [source]
Giant Axonal Neuropathy Locus Refinement To A < 590 KB Critical IntervalJOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2001
Giant axonal neuropathy (GAN) is a rare autosomal recessive neurodegenerative disorder, characterised clinically by the development of chronic distal polyneuropathy during childhood, mental retardation, kinky or curly hair, skeletal abnormalities and, ultrastructurally, by axons in the central and peripheral nervous systems distended by masses of tightly woven neurofilaments. We recently localised the CAN locus in 16q24.1 to a 5-cM interval between the D16S507 and D16S511 markers by homozygosity mapping in three consanguineous Tunisian families. We have now established a contig-based physical map of the region comprising YACs and BACs where we have placed four genes, ten ESTs, three STSs and two additional microsatellite markers, and where we have identified six new SSCP polymorphisms and six new microsatellite markers. Using these markers, we have refined the position of our previous flanking recombinants. We also identified a shared haplotype between two Tunisian families and a small region of homozygosity in a Turkish family with distant consanguinity, both suggesting the occurrence of historic recombinations and supporting the conclusions based on the phase-known recombinations. Taken together, these results allow us to establish a transcription map of the region, and to narrow down the GAN position to a < 590 kb critical interval, an important step toward the identification of the defective gene. [source]
Systematic review: standard- and double-dose proton pump inhibitors for the healing of severe erosive oesophagitis , a mixed treatment comparison of randomized controlled trialsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
S. J. EDWARDS
Summary Background, No randomized controlled trial (RCT) has compared all European-licensed standard- and double-dose PPIs for the healing of severe erosive oesophagitis. Aim, To compare the effectiveness of licensed doses of PPIs for healing severe erosive oesophagitis (i.e. esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg and 40 mg, pantoprazole 40 mg and rabeprazole 20 mg). Methods, Systematic review of CENTRAL, EMBASE and MEDLINE for RCTs in patients with erosive oesophagitis (completed October 2008). Endoscopically verified healing rates at 4 and 8 weeks were extracted and re-calculated if not analysed by intention-to-treat. A mixed treatment comparison was used to combine direct treatment comparisons with indirect trial evidence while maintaining randomization. Odds ratios (OR) are reported compared to omeprazole 20 mg. Results, A total of 3021 papers were identified in the literature search; 12 were of sufficient quality to be included in the analysis. Insufficient data were available to included rabeprazole. Esomeprazole 40 mg was found to provide significantly higher healing rates at 4 weeks [OR 1.84, 95% Credible Interval (95% CrI): 1.50 to 2.22] and 8 weeks (OR 1.91, 95% CrI: 1.13 to 2.88). No other PPI investigated had significantly higher healing rates than omeprazole 20 mg. Conclusion, Esomeprazole 40 mg consistently demonstrates higher healing rates compared with licensed standard- and double-dose PPIs. [source]
Optimization of treatment parameters for Foscan®-PDT of basal cell carcinomasLASERS IN SURGERY AND MEDICINE, Issue 5 2008
Christian S. Betz MD
Abstract Background and Objective Basal cell carcinomas (BCCs) are the most common form of skin cancers with high and increasing incidence rates. Photodynamic therapy (PDT) with mTHPC (Foscan®) has shown to be a promising treatment alternative with good cosmetic results. The current study was aimed to determine optimal treatment parameters for this indication. Study Design/Materials and Methods mTHPC-PDT was performed in 117 patients with a total of 460 BCCs with diagnosis confirmed by scratch cytology. Treatment parameters were altered as follows: Foscan® dose 0.03,0.15 mg/kg, drug-light interval (DLI) 1,96 hours, total energy density 20,120 J/cm2. Outcomes were assessed 8 weeks post-PDT following WHO guidelines. Results The overall rate of complete remissions (CR) was 96.7% and the cosmetic outcome was very good. In the largest subgroup (n,=,80) where low-dose Foscan® was applied (0.05 mg/kg mTHPC; 48 hours DLI; 50 J/cm2 total energy density), a CR rate of 100% with a high and narrow 95% Confidence Interval of 0.955,1.000 was achieved. Smaller variations of the treatment parameters (i.e., reducing the photosensitizer dose to 0.04 mg/kg or shortening the DLI to 24 hours) yielded similarly good results. Side effects were encountered in 52 out of 133 PDT sessions. They were more common in patients who had received high drug doses (0.06,0.15 mg/kg) and comprised mostly pain and phototoxic reactions. Three patients developed severe sunburns with subsequent scarring at the injection site following bright sunlight exposure 15,19 days after photosensitizer administration. Conclusions The presented data suggest that mTHPC-PDT with the treatment parameters mentioned above seems to be an effective treatment option for BCCs. If sensibly applied, it is well tolerated and provides mostly excellent cosmetic results. Long-term results are yet to be evaluated. Lesers Surg. Med. 40:300,311, 2008. © 2008 Wiley-Liss, Inc. [source]
ABUNDANCE OF BOTTLENOSE DOLPHINS IN THE BAYS, SOUNDS, AND ESTUARIES OF NORTH CAROLINAMARINE MAMMAL SCIENCE, Issue 1 2003
Andrew J. Read
We conducted a mark-recapture survey of bottlenose dolphins Tursiops truncatus in the bays, sounds, and estuaries of North Carolina during July 2000, using photographic identification techniques. During this survey we took 7,682 photographs of dolphins and, of these, 3,457 images were of sufficient quality for analysis. We identified 306 dolphins from distinctive nicks and notches on their dorsal fins. Eighry-six dolphins were photographed on more than one occasion during the course of the survey; one dolphin was photographed on four separate days. We then applied the results of our photographic analyses to several mark-recapture models and examined potential violations of the assumptions of these models, including an unexpected correlation between photo quality and mark distinctiveness. Our analysis suggests that our results are robusr to possible violations of these assumptions. The resulting estimates were then scaled to account for the proportion (0.46) of unmarked dolphins in the population. Our best estimate of the number of dolphins present in the inshore waters of North Carolina during July 2000 is 1,033 with a 95% Confidence Interval of 860,1,266 (CV = 0.099). Most dolphins were found in the northern part of the study area, which includes the second largest estuarine system in the United States. [source]
Factors associated with the temporomandibular disorder, pain dysfunction syndrome (PDS): Manchester case,control studyORAL DISEASES, Issue 6 2001
OBJECTIVES:,To determine the individual and combined effects of potential risk factors in relation to the temporomandibular disorder, Pain Dysfunction Syndrome (PDS). DESIGN:,Case,control study. MATERIAL AND METHODS:,Cases were new referrals to the temporomandibular disorder clinic of the University Dental Hospital of Manchester, diagnosed with PDS. Controls were randomly selected from 24 dental practices. Using a postal questionnaire information was collected on socio-demographic, local mechanical, psychological factors, co-morbidities and illness behaviour. The adjusted participation rate was similar in cases and controls (64%), and 131 cases and 196 controls finally participated in the study. RESULTS:,Compared with the controls, the cases were more likely to report that their teeth felt as though they did not fit together properly [odds ratio (OR) 8, 95% Confidence Interval (CI) 6,13] and report history of facial trauma (OR 3, 95% CI 2,6). Both diurnal and nocturnal grinding were significantly associated with PDS, and individuals who reported grinding their teeth both during the day and at night had a risk of 6; 95% CI 3,13 for PDS compared with those who did not. A history of orthodontic treatment, having any dentures, having missing teeth, use of chewing gum or biting the fingernails did not show any relationship with PDS. People who took medication for the bowels had a higher risk of PDS (OR 2, 95% CI 1,4). Participants with frequent headaches had a threefold increase in risk of having PDS (OR 3, 95% CI 2,5) while having pain in parts of the body other than the head was associated with an OR of 3 (95% CI 2,5). An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress (OR 3; 95% CI 1,4 in the highest category, test for trend P < 0.001) and sleep disturbance (OR 5; 95% CI 2,94 in the highest category, test for trend P < 0.001). Aspects of illness behaviour, such as disease conviction (OR 4; 95% CI 2,9 in the highest category) and perception of illness (0.3; 95% CI 0.2,0.5) were associated with PDS. The result for the denial scale became statistically significant after adjustment for age and gender (2; 95% CI 1,3). CONCLUSIONS:,The current case,control study provides complementary epidemiological information on oro-facial pain (OFP) and supports a multifactorial aetiology of PDS, with factors from many domains, including local mechanical factors, psychological and co-morbidities. People with PDS were characterized by frequent headaches, history of facial trauma, teeth grinding, sleep problems, pain elsewhere in the body and high levels of psychological distress. From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP. [source]
Reduction of RV Pacing by Continuous Optimization of the AV IntervalPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006
Background: In patients requiring permanent pacing, preservation of intrinsic ventricular activation is preferred whenever possible. The Search AV+ (SAV+) algorithm in Medtronic EnPulseÔ dual-chamber pacemakers can increase atrioventricular (AV) intervals to 320 ms in patients with intact or intermittent AV conduction. This prospective, multicenter study compared the percentage of ventricular pacing with and without AV interval extension. Methods: Among 197 patients enrolled in the study, the percentage of ventricular-paced beats was evaluated via device diagnostics at the 1-month follow-up. Patient cohorts were defined by clinician assessment of conduction via a 1:1 AV conduction test at the 2-week follow-up. The observed percentage of ventricular pacing with SAV + ON and the predicted percentage of ventricular pacing with SAV + OFF were determined from the SAV + histogram data for the period between the 2-week and 1-month follow-up visits. Results: Of 197 patients, 110 (55.8%) had intact 1:1 AV conduction, of which 109 had 1-month data. SAV + remained ON in 99/109 patients; 10 patients had intrinsic A-V conduction intervals beyond SAV + nominal and therefore SAV + disabled. The mean percentage of ventricular pacing in the 109 patients was SAV+ ON = 23.1% (median 3.7%) versus SAV + OFF = 97.2% (median 99.7%). In 87 patients without 1:1 AV conduction, SAV + was programmed OFF in 6, automatically disabled in 52, and remained ON in 29. In 8 of these patients, 80,100% reduction in ventricular pacing was observed with SAV + ON. Conclusion: The Search AV+ algorithm in the EnPulse pacemaker effectively promotes intrinsic ventricular activation and substantially reduces unnecessary ventricular pacing. [source]