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Substantial Differences (substantial + difference)
Selected AbstractsAsymptotical Tests on the Equivalence, Substantial Difference and Non-inferiority Problems with Two ProportionsBIOMETRICAL JOURNAL, Issue 3 2004A. Martín Andrés Abstract Let d = p2 , p1 be the difference between two binomial proportions obtained from two independent trials. For parameter d, three pairs of hypothesis may be of interest: H1: d , , vs. K1: d > ,; H2: d ,, (,1, ,2) vs. K2: d , (,1, ,2); and H3: d , [,1, ,2] vs. K3: d ,, [,1, ,2], where Hi is the null hypothesis and Ki is the alternative hypothesis. These tests are useful in clinical trials, pharmacological and vaccine studies and in statistics generally. The three problems may be investigated by exact unconditional tests when the sample sizes are moderate. Otherwise, one should use approximate (or asymptotical) tests generally based on a Z -statistics like those suggested in the paper. The article defines a new procedure for testing H2 or H3, demonstrates that this is more powerful than tests based on confidence intervals (the classic TOST , two one sided tests , test), defines two corrections for continuity which reduce the liberality of the three tests, and selects the one that behaves better. The programs for executing the unconditional exact and asymptotic tests described in the paper can be loaded at http://www.ugr.es/~bioest/software.htm. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] International survey on esophageal cancer: part II staging and neoadjuvant therapyDISEASES OF THE ESOPHAGUS, Issue 3 2009J. Boone SUMMARY The outcome of esophagectomy could be improved by optimal diagnostic strategies leading to adequate preoperative patient selection. Neoadjuvant therapy could improve outcome by increasing the number of radical resections and by controlling metastatic disease. The purposes of this study were to gain insight into the current worldwide practice of staging modalities and neoadjuvant therapy in esophageal cancer, and to detect intercontinental differences. Surgeons with particular interest in esophageal surgery, including members of the International Society for Diseases of the Esophagus, the European Society of Esophagology , Group d'Etude Européen des Maladies de l'Oesophage, and the OESO, were invited to participate in an online questionnaire. Questions were asked regarding staging modalities, neoadjuvant therapy, and response evaluation applied in esophageal cancer patients. Of 567 invited surgeons, 269 participated resulting in a response rate of 47%. The responders currently performing esophagectomies (n= 250; 44%) represented 41 countries across the six continents. Esophagogastroscopy with biopsy and computed tomography (CT) scanning were routinely performed by 98% of responders for diagnosing and staging esophageal cancer, while endoscopic ultrasound (EUS) and barium esophagography were routinely applied by 58% and 51%, respectively. Neoadjuvant therapy is routinely administered by 33% and occasionally by 63% of responders. Of the responders that administer identical neoadjuvant regimens to esophageal adenocarcinoma (AC) and squamous cell carcinoma, 54% favor chemoradiotherapy. For AC, chemotherapy is preferred by 31% of the responders that administer neoadjuvant therapy, whereas for squamous cell carcinoma, the majority of responders (38%) prefer chemoradiotherapy. Response to neoadjuvant therapy is predominantly assessed by CT scanning of the chest and abdomen (86%). Barium esophagography, EUS, and combined CT/PET scan are requested for response monitoring in equal frequency (25%). Substantial differences in applied staging modalities and neoadjuvant regimens were detected between surgeons from different continents. In conclusion, currently the most commonly applied diagnostic modalities for staging and restaging esophageal cancer are CT scanning of the chest and abdomen, gastroscopy, barium esophagography and EUS. Neoadjuvant therapy is routinely applied by one third of the responders. Intercontinental differences have been detected in the diagnostic modalities applied in esophageal cancer staging and in the administration of neoadjuvant therapy. The results of this survey provide baseline data for future research and for the development of international guidelines. [source] Competition and Profitability in European Banking: Why Are British Banks So Profitable?ECONOMIC NOTES, Issue 3 2005David T. Llewellyn Substantial differences remain between the profitability of banks in different European countries. This article considers the relationship between competition and profitability in European banking focussing on the experience of the UK where two issues are considered: why British banks have been earning excess returns for more than a decade and why British banks seem to be more profitable than their Continental counterparts. A paradigm is offered to explain this. A distinction is made between shareholder value (SHV) and stakeholder value (STV) banks whose business objectives are often different. Significant differences exist between European countries in the balance of SHV and STV banks. The UK is almost unique in Europe in having almost exclusively SHV-based banks. Pressures will intensify for all European banks to adopt SHV strategies, which will imply substantial changes in bank strategies and business operations. [source] Cognitive toxicity of pharmacotherapeutic agents used in social anxiety disorderINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2009I. Hindmarch Summary Objective:, To compare cognitive impairment of medications used in social anxiety disorder (SAD). Methods:, Data from peer-reviewed publications (1975,2007) of controlled, crossover design, pharmacodynamic studies on SAD medications in healthy volunteers were analysed. The number of objective psychometrics for each drug/dose level at all time points after dosing, and of instances of statistically significant impairment of cognitive function, enabled calculation of drug-induced cognitive impairment. The magnitude of impairment between drugs was compared using proportional impairment ratios (PIRs). Results:, Olanzapine, oxazepam, lorazepam and mianserin had twice the average cognitive toxicity of other treatments. Selective serotonin reuptake inhibitors (SSRIs) impaired cognition to a lesser extent than other pharmacological groupings. There was extensive intra-class variation: fluvoxamine (PIR = 0.08) possessed little detrimental cognitive activity, whereas sertraline (PIR = 5.33) caused impairment over five times the SSRI group average. Benzodiazepines caused noticeable cognitive impairment. Conclusions:, Substantial differences exist, both between and within therapeutic classes, in the behavioural toxicity of medications used for SAD. [source] In Vivo Determination of Bone Structure in Postmenopausal Women: A Comparison of HR-pQCT and High-Field MR Imaging,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2008Galateia J Kazakia PhD Abstract Bone structural measures obtained by two noninvasive imaging tools,3T MRI and HR-pQCT,were compared. Significant but moderate correlations and 2- to 4-fold discrepancies in parameter values were detected, suggesting that differences in acquisition and analysis must be considered when interpreting data from these imaging modalities. Introduction: High-field MRI and high resolution (HR)-pQCT are currently being used in longitudinal bone structure studies. Substantial differences in acquisition and analysis between these modalities may influence the quantitative data produced and could potentially influence clinical decisions based on their results. Our goal was to compare trabecular and cortical bone structural measures obtained in vivo by 3T MRI and HR-pQCT. Materials and Methods: Postmenopausal osteopenic women (n = 52) were recruited for this study. HR-pQCT imaging of the radius and tibia was performed using the XtremeCT scanner, with a voxel size of 82 × 82 × 82 ,m3. MR imaging was performed on a 3T Signa scanner using SSFP imaging sequences, with a pixel size of 156 × 156 ,m2 and slice thickness of 500 ,m. Structure parameters were calculated using standard HR-pQCT and MRI analysis techniques. Relationships between measures derived from HR-pQCT, MRI, and DXA were studied. Results: Significant correlations between HR-pQCT and MRI parameters were found (p < 0.0001) and were strongest for Tb.N (r2 = 0.52), Ct.Th (r2 = 0.59), and site-specific Tb.Sp (r2 = 0.54,0.60). MRI and HR-pQCT provided statistically different values of structure parameters (p < 0.0001), with BV/TV and Tb.Th exhibiting the largest discrepancies (MR/HR-pQCT = 3,4). Although differences in the Tb.N values were statistically significant, the mean differences were on the order of our reproducibility measurements. Systematic differences between MRI and HR-pQCT analysis procedures leading to discrepancies in cortical thickness values were observed, with MRI values consistently higher. Minimal correlations were found between MRI or HR-pQCT parameters and DXA BMD or T-score, except between HR-pQCT measures at the radius and the ultradistal radius T-scores, where moderate correlations were found (r2 = 0.19,0.58). Conclusions: This study provides unique insight into two emerging noninvasive tools for bone structure evaluation. Our findings highlight the significant influence of analysis technique on results of in vivo assessment and underscore the importance of accounting for these differences when interpreting results from these modalities. [source] Expression of basement membrane components in odontogenic cystsORAL DISEASES, Issue 3 2006S Poomsawat Objective:, To compare the expression of basement membrane components (BMCs), including laminins 1 and 5, collagen type IV, and fibronectin in odontogenic keratocysts (OKCs) with dentigerous cysts (DCs) and radicular cysts (RCs). Materials and methods:, Basement membrane components were analysed in 20 OKCs, 20 DCs and 20 RCs using an immunohistochemical technique. Results:, Odontogenic keratocysts, DCs and RCs showed positive reaction to all BMCs studied, with different distributions and intensity. OKCs showed continuous linear deposits for laminins 1 and 5 but two staining patterns (continuous and discontinuous) for collagen type IV and fibronectin. DCs exhibited continuous linear deposits for laminins 1 and 5 and collagen type IV but a discontinuous linear deposit for fibronectin. RCs displayed similar results to DCs for laminin 1, collagen type IV and fibronectin. Laminin 5 in RCs had two staining patterns. Constant results in all cysts were strong intensity for laminin 1 and moderate intensity for laminin 5. Conclusions:, Substantial differences in the expression of BMCs among studied cysts were not observed, suggesting that the separation of the epithelial lining in OKCs is not associated with the existence of these proteins. [source] Emanuel Miller Lecture: Attachment insecurity, disinhibited attachment, and attachment disorders: where do research findings leave the concepts?THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2009Michael Rutter Background:, Despite the evidence on anomalous attachment patterns, there has been a tendency to interpret most of these as reflecting differences in security/insecurity. Methods:, Empirical research findings are reviewed in relation to attachment/insecurity as evident in both infancy and later childhood, disorganised attachment, inhibited attachment disorder, and disinhibited attachment disorder. Findings:, Substantial differences are found in the correlates and meaning of these different features, as well as in the patterns associated with conditions such as autism, psychopathy, and Williams syndrome. Conclusions:, It is seriously misleading to view all of these patterns through the lens of security/insecurity. This heterogeneity in social relationship features necessarily has implications for the assessment measures for social relationships that need to be used. [source] An interinstitutional and interspecialty comparison of treatment outcome data for patients with prostate carcinoma based on predefined prognostic categories and minimum follow-up,CANCER, Issue 10 2002Frank A. Vicini M.D. Abstract BACKGROUND The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, prospective, randomized trials. The current study was conducted to compare and contrast outcomes with different forms of therapy for patients with prostate carcinoma who were treated at several institutions using predefined prognostic categories. METHODS A retrospective study of 6877 men with prostate carcinoma who were treated between 1989 and 1998 at 7 different institutions with 6 different types of therapy was conducted. Five-year actuarial rates of prostate specific antigen (PSA) failure were calculated based on predefined prognostic categories, which included combinations of pretreatment PSA level, tumor stage, and Gleason score. In addition, outcome was calculated using consistent biochemical failure definitions and a minimum, median length of follow-up. RESULTS Substantial differences in outcome were observed for the same type of treatment and at the same institution, depending on the number of prognostic variables used to define treatment groups. However, estimates of 5-year PSA outcomes after all forms of therapy for low-risk and intermediate-risk patient groups were remarkably similar (regardless of the type of treatment) when all three pretreatment variables were used to define prognostic categories. For patients in high-risk groups, the 5-year PSA outcomes were suboptimal, regardless of the treatment technique used. CONCLUSIONS The current data suggest that interinstitutional and interspecialty comparisons of treatment outcome for patients with prostate carcinoma are possible but that results must be based on all major prognostic variables to be meaningful. Analyzed in this fashion, 5-year PSA results were similar for patients in low-risk and intermediate-risk groups, regardless of the form of therapy. Findings from prospective, randomized trials using survival (cause specific and overall) as the end point for judging treatment efficacy and longer follow-up will be needed to validate these findings and to identify the most appropriate management option for patients with all stages of disease. Cancer 2002;95:2126,35. © 2002 American Cancer Society. DOI 10.1002/cncr.10919 [source] A survey of neonatal resuscitation in Spain: gaps between guidelines and practiceACTA PAEDIATRICA, Issue 5 2009M Iriondo Abstract Objectives: To audit the knowledge and application of internationally recommended newborn resuscitation (NR) guidelines among delivery room (DR) caregivers of Spanish hospitals. Methods: A questionnaire-type survey on NR equipment and practices was performed in hospitals of the Spanish National Health System classified according to level of care provided. Results: 88% of the questionnaires were complimented. Limit of viability was set in 23,24 weeks in 78% of the centres. Availability of board-certified and instructors in NRwas significantly higher in level III versus level I,II centres (94 vs. 70% and 78 vs. 51%, respectively). No differences in equipment or knowledge of guidelines of resuscitation were found between centres. Substantial differences were observed in supplementation and monitorization of oxygen, and positive pressure ventilation during resuscitation and transportation. Conclusion: Equipment availability and knowledge of guidelines of NR does not differ between hospitals independent of their level of care. However, performance during resuscitation and transportation in level III hospitals is in significantly greater acquaintance with internationally recommended NR guidelines. [source] Multiple attack study on the available triptans in Italy versus placeboEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2005C. Vollono The aim of the study is to evaluate the efficacy and tolerability of the five triptans that are commercially available in Italy (zolmitriptan 2.5 mg, rizatriptan 10 mg, sumatriptan 100 mg, almotriptan 12.5 mg and eletriptan 40 mg). The study was conducted in single-blind versus placebo and its duration was 18 months. At the Headache Centre of the ,Agostino Gemelli' Hospital in Rome we selected 42 patients, suffering from headache with and without aura (International Headache Society Committee on Headache Classification, 1988 Cephalalgia 8:1,96), whose headache frequency ranged between 1- and 4-monthly crises. For a total of 25 crises, for every five consecutive crises, a different triptan was taken. The end-points of the study were as follows: response at 2 h, ,pain free' at 2 h and ,sustained pain free' (at 24 h). The intra-patient consistency and the tolerability were also evaluated. Thirty patients completed the study and the statistical analysis was only applied to these patients. No substantial difference in terms of the efficacy of the triptans was noted; all triptans were well tolerated. These results suggest the possibility of testing different triptans in the same patient in order to identify the ideal drug for every patient. [source] Inhibition of poly adenosine diphosphate-ribose polymerase decreases hepatocellular carcinoma growth by modulation of tumor-related gene expression,HEPATOLOGY, Issue 1 2010Rosa Quiles-Perez Hepatocellular carcinoma (HCC) is associated with a poor prognosis due to a lack of effective treatment options. In HCC a significant role is played by DNA damage and the inflammatory response. Poly (ADP-ribose) polymerase-1 (PARP-1) is an important protein that regulates both these mechanisms. The objective of this study was to examine the effect of pharmacology PARP-1 inhibition on the reduction of tumor volume of HCC xenograft and on the hepatocarcinogenesis induced by diethyl-nitrosamine (DEN). Pharmacologic PARP-1 inhibition with DPQ greatly reduces tumor xenograft volume with regard to a nontreated xenograft (394 mm3 versus 2,942 mm3, P < 0.05). This observation was paralleled by reductions in xenograft mitosis (P = 0.02) and tumor vasculogenesis (P = 0.007, confirmed by in vitro angiogenesis study), as well as by an increase in the number of apoptotic cells in DPQ-treated mice (P = 0.04). A substantial difference in key tumor-related gene expression (transformed 3T3 cell double minute 2 [MDM2], FLT1 [vascular endothelial growth factor receptor-1, VEGFR1], epidermal growth factor receptor [EPAS1]/hypoxia-inducible factor 2 [HIF2A], EGLN1 [PHD2], epidermal growth factor receptor [EGFR], MYC, JUND, SPP1 [OPN], hepatocyte growth factor [HGF]) was found between the control tumor xenografts and the PARP inhibitor-treated xenografts (data confirmed in HCC cell lines using PARP inhibitors and PARP-1 small interfering RNA [siRNA]). Furthermore, the results obtained in mice treated with DEN to induce hepatocarcinogenesis showed, after treatment with a PARP inhibitor (DPQ), a significant reduction both in preneoplastic foci and in the expression of preneoplastic markers and proinflammatory genes (Gstm3, Vegf, Spp1 [Opn], IL6, IL1b, and Tnf), bromodeoxyuridine incorporation, and NF-,B activation in the initial steps of carcinogenesis (P < 0.05). Conclusion: This study shows that PARP inhibition is capable of controlling HCC growth and preventing tumor vasculogenesis by regulating the activation of different genes involved in tumor progression. (HEPATOLOGY 2010;51:255,266.) [source] Polymorphisms of tumour necrosis factors A and B in breast cancerINTERNATIONAL JOURNAL OF IMMUNOGENETICS, Issue 1 2002K. S. Park Summary We assayed for germline single nucleotide polymorphisms (SNPs) in the TNFB and TNFA genes in patients with breast cancer. SNPs were observed in the first intron of TNFB (G/A) and at ,1031 (T/C), ,863 (C/A), ,857 (C/T) and ,308 (G/A) in the promoter region of TNFA from peripheral leucocytes in 95 breast cancer patients and 190 healthy subjects as controls. The TNFB*G/TNFB*G homozygote (23.2% vs. 5.8%, P= 0.001) was predominant in patients, while the TNFB*A/TNFB*A homozygote was less frequent in patients (34.7% vs. 46.3%, P = 0.041) than in the control subjects. Breast cancer was not associated with SNPs in the TNFA promoters. Although the TNFB SNP failed to associate with any clinicopathological parameter of breast cancer, a substantial difference in pathology among tumour stages for the ,857 SNP in TNFA was detected. These results indicate that TNFB has both tumorigenic and antitumorigenic capabilities depending on the genotype: the TNFB SNP TNFB*G/TNFB*G genotype gave an increased risk for breast cancer and that of TNFB*A/TNFB*A gave resistance to breast cancer (OR = 5.3395%; CI: 2.33,12.19). The results suggest that the TNFB*G allele plays some role in the tumorigenesis or activation of dormant tumour cells, but the TNFB*A allele induces some function(s) leading to the inhibition of tumorigenesis. [source] "Reactive Ethnicity" or "Assimilation"?INTERNATIONAL MIGRATION REVIEW, Issue 4 2006Arguments, First Empirical Evidence for Labor Migrants in Germany, Statements In this article, we scrutinize the often stated assumption that labor migrants in Germany turn away from integration and reaffirm their ethnicity by examining their identificational, cognitive, and social assimilation processes. Using data from the German Socio-economic Panel, we present trend analyses of different hostland- and homeland-related indicators for the past fifteen years. Results are presented separately for first- and second-generation migrants from Turkey, the EU, and the former Yugoslavia. While not all assimilation-related indicators change a great deal over time, they show at least a substantial difference between the first and the second generation. With regard to the homeland-related indicators, the results by no means suggest that Turkish migrants try to compensate for their comparatively disadvantaged social status by revitalizing ethnic cultural habits or homeland-oriented identifications. [source] Effect of First Treatment with Aminobisphosphonates Pamidronate and Ibandronate on Circulating Lymphocyte SubpopulationsJOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2000Martin Pecherstorfer Abstract Up to 60% of patients receiving their first infusion of the bisphosphonate pamidronate experience an acute-phase reaction. In this study, we used flow cytometry to determine the effects of pamidronate treatment on circulating lymphocyte subpopulations, and we investigated whether pamidronate and ibandronate treatment affect lymphocyte subpopulations differently. Twenty patients received a pamidronate infusion, 20 patients received intravenously injected ibandronate, and 10 controls received a clodronate infusion. Pamidronate treatment was followed by a significant increase in median body temperature at the 10-hour measurement and a significant decrease in counts of circulating lymphocytes, natural killer cells, T cells, and CD4+ and CD8+ T-cell subsets. Ibandronate treatment did not affect median body temperature, and it was associated at the 10-hour measurement with maximum increases in total lymphocyte count, B cells, T cells, and CD4+ and CD8+ T-cell subsets. Thus, there is a substantial difference in the hematologic response to initial treatments with pamidronate and ibandronate. Clodronate treatment did not induce changes in body temperature or significantly affect the number of circulating T cells and NK cells. The reduction in lymphocyte subsets after initial pamidronate therapy might be mediated by the release of tumor necrosis factor ,, whose source in the acute-phase reaction could be T cells. [source] The effects of Panax ginseng on quality of lifeJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2003C. I. Coleman Pharm D SummaryPanax ginseng is marketed and used to maintain natural energy, increase mental and physical abilities, improve mood and promote general health and well-being. Panax ginseng has been studied in a number of randomized clinical trials investigating its effect on physical and psychomotor performance, cognitive function, immunomodulation, diabetes mellitus and herpes simples type-II infections. Equivocal results have been demonstrated for many of these indications. P. ginseng is also commonly used to promote quality of life (QoL). As a result, ginseng's effect on QoL has become an increasingly important endpoint in clinical trials. We reviewed all studies (n = 9) that determined the effect of P. ginseng on QoL. P. ginseng's has been evaluated at dosages of 80,400 mg. Study duration has spanned from 2 to 9 months. Several QoL measures have been used, ranging from widely accepted core instruments to unpublished investigator-derived questionnaires. In addition, many of the investigators utilized ginseng extracts that were supplemented with vitamins and minerals while others used only standardized ginseng extract. Populations evaluated also differed in terms of underlying morbidity. Nearly every study evaluated (n = 8) demonstrated some degree of QoL improvement. Beneficial effects were evident within instrument summary component scores but improvement in overall composite scores of QoL was rarely seen. However, findings were equivocal. While populations evaluated varied in terms of underlying morbidity, there did not appear to be a substantial difference in their response to ginseng with respect to QoL. Despite some positive results, improvement in overall health-related quality of life cannot, given the current research, be attributed to P. ginseng. However, the possibility that various facets of QoL may have improved and the potential of early transient effects cannot be discounted. [source] Gravity-dependent signal gradients on MR images of the lung in supine and prone positions: A comparison with isogravitational signal variabilityJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2006Alexander A. Bankier MD Abstract Purpose To investigate the tendency of proton MR signal intensity (SI) gradients to be steeper in the supine than in the prone body position, and to quantify the relation between gravity-related and isogravitational changes of SI on proton MR images of the lung. Materials and Methods In eight healthy volunteers, MR images were obtained in the supine and prone positions using a multiple inversion recovery turbo spin-echo (TSE) sequence. The variation in SI along the gravity-dependent direction and within isogravitational planes was measured on a pixel-by-pixel basis. Ratios of slopes were calculated for comparisons among volunteers. Comparisons of ratios were made using Fisher's exact test. Isogravitational variability was compared with the mean SI, the signal-to-noise ratio (SNR), and the image noise. Results The average ratios of slopes showed that the overall SI gradient was steeper in the supine than the prone position, with a substantial difference in the supine/prone ratios between inspiration (1.21) and expiration (1.72). In both the supine and prone positions, gravity-dependent gradients were steeper in expiration than in inspiration (P = 0.001). The SI variability along the gravitational direction was larger than the isogravitational variability. The isogravitational variability in turn was larger than the image noise but smaller than the mean SI of the MR images. Conclusion Gravity-dependent gradients in proton MR SI are steeper in the supine than in the prone position. The magnitudes of these gradients were larger than the isogravitational signal variability, showing that MRI is sensitive to gravitationally induced effects. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] A qualitative systematic review of peri-operative dextromethorphan in post-operative painACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2006T. H. Duedahl Background:, The N -methyl- d -aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods:, Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results:, DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion:, Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect. [source] 60 GHz multi-chip module based on cost effective hybrid multilayer PWBMICROWAVE AND OPTICAL TECHNOLOGY LETTERS, Issue 9 2007Sung Tae Choi Abstract A novel cost-effective 60-GHz multi-chip module (MCM) is proposed and demonstrated. It is based on a low-cost multilayer printed wiring board (PWB) with a novel vertical transition and a single layer waveguide transition which enables the use of low-cost substrates with high dielectric loss for millimeter wave applications. The proposed MCM technology has been successfully applied to the packaging of a 60-GHz self-heterodyne mixer, and no substantial difference in the RF performance is observed with the packaging. © 2007 Wiley Periodicals, Inc. Microwave Opt Technol Lett 49: 2303,2305, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/mop.22719 [source] Family history information on essential tremor: Potential biases related to the source of the casesMOVEMENT DISORDERS, Issue 2 2001Elan D. Louis MD Abstract The proportion of essential tremor (ET) cases that can be attributed to genetic factors is unknown; estimates range from 17,100%. One possible reason for this variability is that clinic and community cases may differ with regard to family history of ET. This is because clinic patients are self-selected and represent as few as 0.5% of all ET cases. Our goal was to determine whether ET cases ascertained from a clinic differed from those ascertained from a community in terms of the family history information that they provided. Subjects (57 clinic, 64 community) underwent a family history interview. Clinic cases were 4.73 times more likely to report an affected relative than were community cases. We conclude that there was a substantial difference between our clinic and community ET cases in terms of the information they provided regarding their family history. Selection and reporting biases could have accounted for this difference. Because of these biases, the source of the cases must be taken into consideration when investigators are trying to synthesize the widely variable results of studies that have estimated the genetic contribution to ET. © 2001 Movement Disorder Society. [source] Irving Fisher and the Contribution of Improved Longevity to Living StandardsAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 1 2005Article first published online: 22 MAR 200, William D. Nordhaus The present study discusses the theory of the measurement of national income, proposes a new concept called "health income" that can be used to incorporate improvements in health status, and applies the theory to data for the United States over the 20th century. It concludes that accounting for improvements in the health status would, over the twentieth century in the United States, make a substantial difference to our measures of economic welfare. [source] The nucleotidase/phosphatase SAL1 is a negative regulator of drought tolerance in ArabidopsisTHE PLANT JOURNAL, Issue 2 2009Pip B. Wilson Summary An Arabidopsis thaliana drought-tolerant mutant, altered expression of APX2 (alx8), has constitutively increased abscisic acid (ABA) content, increased expression of genes responsive to high light stress and is reported to be drought tolerant. We have identified alx8 as a mutation in SAL1, an enzyme that can dephosphorylate dinucleotide phosphates or inositol phosphates. Previously identified mutations in SAL1, including fiery (fry1-1), were reported as being more sensitive to drought imposed by detachment of rosettes. Here we demonstrate that alx8, fry1-1 and a T-DNA insertional knockout allele all have markedly increased resistance to drought when water is withheld from soil-grown intact plants. Microarray analysis revealed constitutively altered expression of more than 1800 genes in both alx8 and fry1-1. The up-regulated genes included some characterized stress response genes, but few are inducible by ABA. Metabolomic analysis revealed that both mutants exhibit a similar, dramatic reprogramming of metabolism, including increased levels of the polyamine putrescine implicated in stress tolerance, and the accumulation of a number of unknown, potential osmoprotectant carbohydrate derivatives. Under well-watered conditions, there was no substantial difference between alx8 and Col-0 in biomass at maturity; plant water use efficiency (WUE) as measured by carbon isotope discrimination; or stomatal index, morphology or aperture. Thus, SAL1 acts as a negative regulator of predominantly ABA-independent and also ABA-dependent stress response pathways, such that its inactivation results in altered osmoprotectants, higher leaf relative water content and maintenance of viable tissues during prolonged water stress. [source] Autobiographical and event memories for surprising and unsurprising eventsAPPLIED COGNITIVE PSYCHOLOGY, Issue 2 2010Emanuele Coluccia Although research converges on the idea that surprise is not essential to form a ,flashbulb memory' (FBM), no study has explicitly shown that a FBM that develops from an unexpected event has the same structure as a FBM that develops from an expected event. In the present research, we explored whether there is any substantial difference on veridicality, consistency and confidence in both autobiographical and event memories for surprising and expected events. Two groups of participants were tested for their memories of a surprising (Study I) or an expected (Study II) event at different delays of indexing from the original news. All participants were then re-tested after 6 months and again after 1 year from the first interview. The same patterns of results were found for both events. Consistent with the ,narrative and rehearsal' hypothesis, our results provide direct evidence that surprise does not affect the structure of a FBM. Copyright © 2009 John Wiley & Sons, Ltd. [source] Information Technology, Organizational Transformation and Productivity Growth: An Examination of the Brynjolfsson,Hitt PropositionASIAN ECONOMIC JOURNAL, Issue 1 2010Ky-hyang Yuhn O31; O32; O33 This study investigates what happened to productivity growth during the Information Technology (IT) revolution in an IT-driven economy, Korea. To this end, we have decomposed the source of productivity growth into technological change, technical efficiency and scale economies using a stochastic frontier function and examined how the composition of productivity growth has changed with different phases of IT developments. We have used panel data that is comprised of 4022 firms from 1996 to 2000. We have found that Korean firms have been quick to embrace organizational restructuring to adapt to a new business environment brought about by IT, which seems to be the major source of the success of Korean firms. We have also found that: (i) there is no substantial difference in productivity gains between IT-producing firms and IT-using firms; (ii) productivity growth is more robust to business cycles in an IT-driven economy than in the traditional economy; and (iii) efficiency improvement attributed to organizational transformation plays a greater role in productivity growth as IT applications become more widespread. [source] Fisher Information Matrix of the Dirichlet-multinomial DistributionBIOMETRICAL JOURNAL, Issue 2 2005Sudhir R. Paul Abstract In this paper we derive explicit expressions for the elements of the exact Fisher information matrix of the Dirichlet-multinomial distribution. We show that exact calculation is based on the beta-binomial probability function rather than that of the Dirichlet-multinomial and this makes the exact calculation quite easy. The exact results are expected to be useful for the calculation of standard errors of the maximum likelihood estimates of the beta-binomial parameters and those of the Dirichlet-multinomial parameters for data that arise in practice in toxicology and other similar fields. Standard errors of the maximum likelihood estimates of the beta-binomial parameters and those of the Dirichlet-multinomial parameters, based on the exact and the asymptotic Fisher information matrix based on the Dirichlet distribution, are obtained for a set of data from Haseman and Soares (1976), a dataset from Mosimann (1962) and a more recent dataset from Chen, Kodell, Howe and Gaylor (1991). There is substantial difference between the standard errors of the estimates based on the exact Fisher information matrix and those based on the asymptotic Fisher information matrix. (© 2005 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Economic evaluation of surgically trained assistant medical officers in performing major obstetric surgery in MozambiqueBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2007ME Kruk Objective, To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Técnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians. Design, Economic evaluation of costs and productivity of surgically trained assistant medical officers and specialist physicians. Setting, Hospitals and health science training institutions in Mozambique. Population, Surgically trained assistants, medical officers, surgeons and obstetrician/gynaecologists in Mozambique. Methods, The costs of training and deploying the two cadres of health workers were derived from a review of budgets, annual expenditure reports, enrolment registers, and accounting statements from training institutions and interviews with directors and administrators. Productivity estimates were based on a hospital survey of physicians and técnicos de cirurgia. Main outcome measures, Cost per major obstetric surgical procedure over 30 years in 2006 US dollars. Results, The 30-year cost per major obstetric surgery was $38.9 for técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of técnicos de cirurgia resulted in a smaller but still substantial difference in cost per surgery between the groups ($60.3 versus $144.1 per procedure). One-way sensitivity analysis to test the impact of varying other inputs did not substantially change the magnitude of the cost advantage of técnicos de cirurgia. Conclusion, Training more mid-level health workers in surgery can be part of the response to the health worker shortage, which today threatens the achievement of the health Millennium Development Goals in developing countries. [source] Does Playing Blindfold Chess Reduce the Quality of Game: Comments on Chabris and Hearst (2003)COGNITIVE SCIENCE - A MULTIDISCIPLINARY JOURNAL, Issue 1 2010Veljko Jeremic Abstract Blindfold chess is a special type of chess game where both the board and pieces are not visible to its players. This paper aims to determine whether the quality of the game played blindfolded is lower than when played under normal conditions. The best chess program was used to analyze games played by the world's top Grandmasters under both conditions. We have analyzed the Monaco 1993,1998 data set introduced by Chabris and Hearst (2003). The results showed that although a larger number of mistakes occurred while playing blindfolded, no significant statistical difference between the rapid and blindfold games has been found. Nevertheless, by applying the same methodology to the Monaco 2002,2007 data set a substantial difference between the blindfold and the rapid chess game was noticed. In this paper, we have addressed the possible improvement of the chess game quality and the advances in chess programs that may be responsible for detecting more blunders. [source] Strategic corporate environmental management within the South African automotive industry: motivations, benefits, hurdlesCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 6 2009Anderson Gwanyebit Kehbila Abstract This paper conveys the experiences of the South African automotive industry as it attempted to implement the ISO 14001 standard. Through a questionnaire-based survey, small and medium-sized enterprises (SMEs) as well as larger companies were asked about the key motivations for engaging in environmental change, the benefits accrued and the barriers that prevented them from doing so. This paper analyzes the variation in adoption rates in order to establish different relationships between them. The results reveal substantial differences and some similarities with regard to the hurdles, benefits and motivations behind the implementation of environmental management systems (EMSs) that are hidden behind corporate rhetoric and commitment to sustainability. This paper concludes by prescribing robust recommendations that would set off the pace for government officials to incorporate effective and realistic incentives into future policy to better encourage environmental compliance and improved performance while minimizing costs both to businesses and to the Government. Copyright © 2009 John Wiley & Sons, Ltd and ERP Environment. [source] Approaches to corporate sustainability among German companiesCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2006Tobias Hahn Abstract In this article we present the results of an online survey on the state of corporate sustainability in German companies. The survey focused on the meaning and relevance of sustainability to German companies, the motivations behind their commitment to sustainability and the use of different management tools to implement sustainability in corporate practice. Although the majority of the companies declared that sustainability plays an important role, our analysis reveals considerable differences between these companies' approaches to corporate sustainability. A cluster analysis enables us to distinguish between three significantly distinct types of approach to corporate sustainability among the respondents: sustainability leaders, environmentalists and traditionalists. These three types are characterized and discussed against previous research. The results suggest that there are substantial differences with regard to the motivation for and the implementation of corporate sustainability that are covered behind the corporate rhetoric of a high commitment to sustainability. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] The Stockholm non-affective psychoses study (snaps): the importance of including out-patient data in incidence studiesACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. Jörgensen Jörgensen L, Ahlbom A, Allebeck P, Dalman C. The Stockholm non-affective psychoses study (snaps): the importance of including out-patient data in incidence studies. Objective:, To estimate the incidence rate of schizophrenia and non-affective psychoses from registers, to highlight the importance of including data from out-patient care, and to assess the proportion of persons treated in out-patient care only. Method:, Data from out-patient and in-patient psychiatric care in Stockholm and information from several national registers constitute ,The Stockholm Non-Affective Psychoses Study' (SNAPS). Incidence rates based on SNAPS data were calculated and compared to in-patient care incidence rates. Results:, The incidence rate was 72/100 000 for non-affective psychoses (age group 18,44) and 28/100 000 for schizophrenia (age group 18,34) in the SNAPS. This was higher compared to in-patient based incidence rates (42 and 13/100 000 respectively). The proportion of individuals with psychosis treated in out-patient care only was 25%. Conclusion:, There are substantial differences in the incidence rates of non-affective psychoses and schizophrenia depending on the availability of data. Not including out-patient care will underestimate the incidence rates. [source] BIODIVERSITY RESEARCH: Genetic diversity in two introduced biofouling amphipods (Ampithoe valida & Jassa marmorata) along the Pacific North American coast: investigation into molecular identification and cryptic diversityDIVERSITY AND DISTRIBUTIONS, Issue 5 2010Erik M. Pilgrim Abstract Aim, We investigated patterns of genetic diversity among invasive populations of Ampithoe valida and Jassa marmorata from the Pacific North American coast to assess the accuracy of morphological identification and determine whether or not cryptic diversity and multiple introductions contribute to the contemporary distribution of these species in the region. Location, Native range: Atlantic North American coast; Invaded range: Pacific North American coast. Methods, We assessed indices of genetic diversity based on DNA sequence data from the mitochondrial cytochrome c oxidase subunit I (COI) gene, determined the distribution of COI haplotypes among populations in both the invasive and putative native ranges of A. valida and J. marmorata and reconstructed phylogenetic relationships among COI haplotypes using both maximum parsimony and Bayesian approaches. Results, Phylogenetic inference indicates that inaccurate species-level identifications by morphological criteria are common among Jassa specimens. In addition, our data reveal the presence of three well supported but previously unrecognized clades of A. valida among specimens in the north-eastern Pacific. Different species of Jassa and different genetic lineages of Ampithoe exhibit striking disparity in geographic distribution across the region as well as substantial differences in genetic diversity indices. Main conclusions, Molecular genetic methods greatly improve the accuracy and resolution of identifications for invasive benthic marine amphipods at the species level and below. Our data suggest that multiple cryptic introductions of Ampithoe have occurred in the north-eastern Pacific and highlight uncertainty regarding the origin and invasion histories of both Jassa and Ampithoe species. Additional morphological and genetic analyses are necessary to clarify the taxonomy and native biogeography of both amphipod genera. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||