Distribution by Scientific Domains

Kinds of Agreement

  • acceptable agreement
  • american free trade agreement
  • belfast agreement
  • best agreement
  • bilateral free trade agreement
  • broad agreement
  • change agreement
  • climate change agreement
  • close agreement
  • collective agreement
  • complete agreement
  • conservation agreement
  • considerable agreement
  • contractual agreement
  • cooperation agreement
  • diagnostic agreement
  • environmental agreement
  • exact agreement
  • excellent agreement
  • fair agreement
  • find good agreement
  • framework agreement
  • free trade agreement
  • friday agreement
  • full agreement
  • general agreement
  • good agreement
  • good friday agreement
  • good qualitative agreement
  • good quantitative agreement
  • high agreement
  • inter-observer agreement
  • inter-rater agreement
  • international agreement
  • international environmental agreement
  • interobserver agreement
  • interrater agreement
  • intra-observer agreement
  • intraobserver agreement
  • key agreement
  • level agreement
  • little agreement
  • moderate agreement
  • multilateral agreement
  • north american free trade agreement
  • partial agreement
  • partnership agreement
  • peace agreement
  • perfect agreement
  • poor agreement
  • preferential trade agreement
  • qualitative agreement
  • quantitative agreement
  • reasonable agreement
  • round agreement
  • satisfactory agreement
  • self-other agreement
  • service level agreement
  • sharing agreement
  • show good agreement
  • showed good agreement
  • showing good agreement
  • shows excellent agreement
  • shows good agreement
  • significant agreement
  • strong agreement
  • substantial agreement
  • total agreement
  • trade agreement
  • universal agreement
  • uruguay round agreement
  • very close agreement
  • very good agreement
  • very poor agreement
  • voluntary agreement
  • widespread agreement

  • Terms modified by Agreement

  • agreement analysis
  • agreement rate

  • Selected Abstracts

    Multicenter Study of the Safety and Efficacy of a 585 nm Pulsed-Dye Laser for the Nonablative Treatment of Facial Rhytides

    T. S. Jeffrey Hsu MD
    Objective The objective of this study was to assess the safety and efficacy of a 585 nm flashlamp pulsed-dye laser for the nonablative treatment of facial rhytides. Methods A multicenter prospective randomized controlled study on 58 volunteers was performed. A split-face approach was adopted, with one periorbital region acting as a control and the other receiving either one or two treatments. Patients were photographed and imaged three-dimensionally before and after treatment. Histologic sections were analyzed. Results Three-dimensional topographic evaluation showed improvements of 9.8% (p= .0022) and 15% (p= .0029) in surface roughness for single and double treatments, respectively. Histology revealed an increase in type I collagen messenger ribonucleic acid expression, type III procollagen, chondroitin sulfate, and grenz zone thickness. Two treatments resulted in greater improvement than one treatment. Conclusion Clinical improvement was achieved following a single treatment. Further improvement was observed following a second treatment. The subjective evaluation of clinical improvement was consistent with both histologic and topographic quantitative measurements. SUZANNE KILMER, MD, AND JAY BURNS, MD, RECEIVED THE USE OF THE LASER FOR RESEARCH AND A DISCOUNTED PURCHASE AGREEMENT. THEY BOTH ACKNOWLEDGE RECEIVING HONORARIA FOR LECTURING FROM THE MANUFACTURER. BRIAN ZELICKSON, MD, RECEIVED RESEARCH GRANTS FROM ICN. [source]


    The launch of negotiations for an Australia-China free trade agreement (ACFTA) started on 18 April 2005, following completion of the joint feasibility study that showed substantial economic and trade benefits for the two countries. The paper reassesses these benefits by means of an empirical analysis with a view to providing improved inputs for informed debate on the benefits and costs of an ACFTA from the perspective of Australia and China. The implications of the findings for policy uses are also discussed. [source]


    This article provides an analysis of the potential economic effects of the China,Australia free trade agreement, and provides a set of policy recommendations regarding such an agreement. The article begins with a review of China,Australia trade relations, showing the widening gap in the importance of one country relative to the other. Next, the article examines the competitive advantages of China and Australia in trade by way of local revealed comparative advantage (RCA) and finds that trade between China and Australia is predicated on differences in their factor endowments. The study then investigates the main problems in the negotiations for the China,Australia Free Trade Agreement and concludes with a set of policy suggestions. [source]


    This study sought to understand employees' level of behavioral engagement in response to feedback received in developmental assessment center (DAC) programs. Hypotheses were drawn from theories of self-enhancement and self-consistency and from findings in the multisource feedback and assessment center literatures regarding recipients' perceptions of feedback. Data were gathered from 172 U.S. middle managers participating in a DAC program. Results suggested that more favorable feedback was related to higher behavioral engagement. When discrepancies between self- and assessor ratings were examined, overraters (participants whose overall self-ratings were higher than their assessor ratings) tended to show less engagement in the program compared to underraters. However, pattern agreement on the participant's dimension profile did not significantly correlate with behavioral engagement. Based on these findings, avenues for future research are presented and practical implications are discussed. [source]


    This study investigated (a) the relative importance of a number of biographic (e.g., age, race, gender) and contextual (e.g., span of control, functional area) variables and their interactions on self-other agreement and (b) the relationship between self-other agreement and outcome variables such as performance and compensation. Usable data were collected from 3,217 managers and their multi-source raters in 527 organizations. Multivariate regression procedures (as opposed to categorization procedures) were used to determine the sources of rating disagreement. Results indicated that a significant portion of variance in self-other ratings was accounted for by the set of background/context variables. Self-other agreement was also related to performance, compensation, and organizational level, though rating patterns differed. [source]


    ADDICTION, Issue 1 2010
    First page of article [source]


    ADDICTION, Issue 1 2010
    No abstract is available for this article. [source]


    Kamal SaggiArticle first published online: 23 JAN 200
    Are preferential trade agreements (PTAs) building or stumbling blocks for multilateral trade liberalization? I address this question in an infinitely repeated tariff game between three countries engaged in intraindustry trade under oligopoly. The central result is that when countries are symmetric, a free trade agreement (FTA) undermines multilateral tariff cooperation by adversely affecting the cooperation incentive of the nonmember whereas a customs union (CU) does so via its effect on the cooperation incentives of members. However, when countries are asymmetric with respect to either market size or cost, there exist circumstances where PTAs facilitate multilateral tariff cooperation. [source]


    ABSTRACT. We analyze the formation of self-enforcing international environmental agreements under the assumption that countries announce their participation either simultaneously or sequentially. It is shown that a sequential formation process opens up possibilities for strategic behavior of countries that may lead to inferior outcomes in terms of global abatement and welfare. We then analyze whether and under which conditions a regulator like an international organization, even without enforcement power, can improve upon globally suboptimal outcomes through coordination and moderation, given that recommendations must be Pareto-improving to all parties. [source]


    ABSTRACT. A public goods model of global biodiversity conservation is exposited. Distinguishing features of global biodiversityconservation tasks are identified. Global efficiencyof biodiversityconservation is discussed and some comparative statics of efficient programs provided. The transfers required from high-existence-value, low-conservation-productivitynations to low-existence-value, high-conservation-productivitynations, to realize global efficiencyin conservation effort, are analyzed. [source]

    Searching for Better Negotiation Agreement Based on Genetic Algorithm

    Ren-Jye Dzeng
    In current practice, contractors negotiate with suppliers according to negotiators' experiences instead of extensive exploration of negotiable options and negotiators' preferences. Consequently, negotiators often reach suboptimal agreements, and leave money on the table. This research intends to help negotiators explore negotiable options by developing a computer system, named C-Negotiator, using the genetic algorithm. This article also describes experiments conducted to determine how much money was left on the table on typical realistic construction procurements. The result shows that C-Negotiator's negotiation improved the joint payoff of the contractor and supplier from 1.5% to 9.8% compared with conventional human negotiation. The improvement may increase for more complex negotiation problems with more options and complicated preferences or for inexperienced negotiators. [source]

    Categorizing Urgency of Infant Emergency Department Visits: Agreement between Criteria

    Rakesh D. Mistry MD
    Abstract Background The lack of valid classification methods for emergency department (ED) visit urgency has resulted in large variation in reported rates of nonurgent ED utilization. Objectives To compare four methods of defining ED visit urgency with the criterion standard, implicit criteria, for infant ED visits. Methods This was a secondary data analysis of a prospective birth cohort of Medicaid-enrolled infants who made at least one ED visit in the first six months of life. Complete ED visit data were reviewed to assess urgency via implicit criteria. The explicit criteria (adherence to prespecified criteria via complete ED charts), ED triage, diagnosis, and resources methods were also used to categorize visit urgency. Concordance and agreement (,) between the implicit criteria and alternative methods were measured. Results A total of 1,213 ED visits were assessed. Mean age was 2.8 (SD 1.78) months, and the most common diagnosis was upper respiratory infection (21.0%). Using implicit criteria, 52.3% of ED visits were deemed urgent. Urgent visits using other methods were as follows: explicit criteria, 51.8%; ED triage, 60.6%; diagnosis, 70.3%; and resources, 52.7%. Explicit criteria had the highest concordance (78.3%) and agreement (,= 0.57) with implicit criteria. Of limited data methods, resources demonstrated the best concordance (78.1%) and agreement (,= 0.56), while ED triage (67.9%) and diagnosis (71.6%) exhibited lower concordance and agreement (,= 0.35 and ,= 0.42, respectively). Explicit criteria and resources equally misclassified urgency for 11.1% of visits; ED triage and diagnosis tended to overclassify visits as urgent. Conclusions The explicit criteria and resources methods best approximate implicit criteria in classifying ED visit urgency in infants younger than six months of age. If confirmed in further studies, resources utilized has the potential to be an inexpensive, easily applicable method for urgency classification of infant ED visits when limited data are available. [source]

    Does NAFTA (North American Free Trade Agreement) Chapter 19 make a difference?

    Dispute settlement, the incentive structure of U.S./Canada unfair trade petitions
    NAFTA Chapter 19 sets up bilateral review panels to replace the domestic judicial appeals process of resolving disputes among NAFTA members over the enforcement of unfair trade laws. In principle, such panels can change the incentive structure of filing unfair trade law petitions by reducing the likelihood of an affirmative finding of injurious unfair trade. Using data from U.S. and Canadian unfair trade petition filings, empirical tests show support for this hypothesis. However, a more comprehensive settlement of conflicts will require progressive legal integration, including an extension of national treatment measures to alleged "unfair trade" that is not currently envisaged under the NAFTA. [source]

    Interobserver Agreement on Dermoscopic Features of Pigmented Basal Cell Carcinoma

    Ketty Peris MD
    background. A dermoscopic method based on the absence of a pigment network and the presence of at least one of six positive features has been described for diagnosis of pigmented basal cell carcinoma (BCC). objective. To evaluate the observers' global agreement and interobserver agreement on each dermoscopic parameter of the method recently proposed. methods. Dermoscopic images of 56 pigmented BCCs were examined by five observers with different degrees of experience in dermoscopy. results. An overall full agreement was reached for the absence of pigment network (k = 1). Very good agreement was detected for the presence of spoke wheel areas (k = 0.85) and arborizing vessels (k = 0.72), and good agreement was shown for ulceration (k = 0.49) and multiple blue-gray globules (k = 0.41). No agreement was identified on large blue-gray ovoid nests (k = 0.28) and leaflike areas (k = 0.26). conclusion. We confirm the reproducibility of the method and show that ulceration, spoke wheel areas, and arborizing tel- angiectases represent the most robust positive parameters. [source]

    TRIPs and Public Health: The Doha Declaration and Africa

    Stine Jessen Haakonsson
    The Doha Declaration on the TRIPs Agreement and Public Health (2001), aimed at improving access to medicines, especially for HIV/AIDS, malaria and tuberculosis in developing and least developed countries, has not yet been used for compulsory licences to import generic medicines or for expanding production for export to poor countries. By analysing HIV/AIDS treatment in Uganda, this article discusses the variety of TRIPs-related channels for ensuring drugs for domestic treatment, and argues that emphasising the restrictive nature of TRIPs provisions fails to grasp the scale of the obstacles involved. Lack of domestic resources leaves African countries dependent on donor financing, which in turn constrains their ability to exploit international trade provisions. [source]

    Rights and Access to Plant Genetic Resources under India's New Law

    Anitha Ramanna
    Recognition of ,Farmer's Rights' is an attempt by developing countries to evolve a counterclaim to breeders' Intellectual Property Rights (IPRs) promoted under the TRIPs Agreement of the WTO. India is one of the first countries to have granted rights to both breeders and farmers under the Protection of Plant Varieties and Farmers' Rights Act, 2001. This multiple rights system aims to distribute rights equitably, but may pose the threat of an ,anticommons tragedy' i.e. too many parties independently possessing the right to exclude others from utilising a resource. If under-utilisation of plant genetic resources results, the Act will have negative consequences for sustaining crop productivity and for the welfare of the very farming communities it seeks to compensate. [source]

    Investment and Competition Policy in the WTO: Issues for Developing Countries

    Oliver Morrissey
    This article uses the case of trade-related investment measures (TRIMs) to examine the liberalisation of investment and its potential impact on developing countries. Very few developing countries actually use TRIMs to any appreciable degree, but, when taken in conjunction with the broader liberalisation of investment, the 1994 TRIMs Agreement has significant implications that will constrain governments' policy options and require issues of competition policy to be addressed. Multilateral competition policy would be difficult to agree and implement and the article considers alternative strategies that developing countries could adopt. [source]

    Developing Countries' Position in WTO Agricultural Trade Negotiations

    Alan Matthews
    Four themes in the developing countries' position are highlighted. (i) They are seeking meaningful improvements in market access for their agricultural exports. (ii) They have highlighted the asymmetry of current WTO obligations under the Uruguay Round Agreement on Agriculture, and are seeking greater equality of outcomes in the new round. (iii) Meaningful concessions on special and differential treatment will be necessary to satisfy the interests of both exporters and importers, especially on the scope to be allowed for tariff protection to domestic food production. (iv) Innovative and reliable guarantees will need to be provided to the least developed food importers to protect them against the risk of world price volatility. [source]

    Validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe for the classification of cerebral palsy

    Mary Gainsborough MRCPCH
    The validity and reliability of the guidelines of the Surveillance of Cerebral Palsy in Europe (SCPE) for the classification of cerebral palsy (CP) were tested by administering 10 written case vignettes via an interactive web-based link to 30 SCPE partners. There was a moderately good level of agreement (,=0.59) about inclusion as a CP case on the SCPE database. Classification by CP subtype differed in two main areas: assigning spastic versus dyskinetic and judgement of distribution of spastic involvement. Agreement on Gross Motor Function Classification System (GMFCS) level was less good than reported in previous studies. Twenty respondents repeated the test 5 months later and there was good repeatability for case inclusion (,= 0.72) but considerable variation in assignment of CP subtype and GMFCS level. There is a need for further collaborative work and training to improve harmonization of the classification of CP, including examination, application of SCPE guidelines, and register coding. [source]

    Gait characteristics of diabetic patients: a systematic review

    L. Allet
    Abstract Patients with diabetes are at higher risk of experiencing fall-related injuries when walking than healthy controls. The underlying mechanism responsible for this is not yet clear. Thus we intend to summarize diabetic patients' gait characteristics and emphasize those which could be the possible underlying mechanisms for increased fall risk. This systematic review aims, in particular, to: (1) evaluate the quality of existing studies which investigate the gait characteristics of diabetic patients, (2) highlight areas of agreement and contradiction in study results, (3) discuss and emphasize parameters associated with fall risk, and (4) propose new orientations and further domains for research needed for their fall risk prevention. We conducted an electronic search of Pedro, PubMed, Ovid and Cochrane. Two authors independently assessed all abstracts. Quality of the selected articles was scored, and the study results summarized and discussed. We considered 236 abstracts of which 28 entered our full text review. Agreement on data quality between two reviewers was high (kappa: 0.90). Authors investigating gait parameters in a diabetic population evaluated in particular parameters either associated with fall risk (speed, step length or step-time variability) or with ulcers (pressure). There is agreement that diabetic patients walk slower, with greater step variability, and present higher plantar pressure than healthy controls. We concluded that diabetic patients present gait abnormalities, some of which can lead to heightened fall risk. To understand its' underlying mechanisms, and to promote efficient prevention, further studies should analyse gait under ,real-life' conditions. Copyright 2008 John Wiley & Sons, Ltd. [source]

    The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen-detected Type 2 diabetes mellitus: a comparison of two screening tools

    DIABETIC MEDICINE, Issue 8 2010
    N. Aujla
    Diabet. Med. 27, 896,905 (2010) Abstract Aims, To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM). Methods, Eight hundred and sixty-four white European (40,75 years old) and 290 South Asian people (25,75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score , 13, and CES-D score , 16. Results, Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (, = 0.48, 95% confidence intervals 0.42,0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of , 10 was optimal. Conclusions, Depressive symptoms, identified by WHO-5 or CES-D, were not significantly more prevalent in people with Type2 DM or IGR. The WHO-5 and CES-D differed in their identification of depressive symptoms in people with Type2 DM, though discrepancies between sex and ethnicity were not identified. [source]

    The metabolic syndrome and changing relationship between blood pressure and insulin with age, as observed in Aboriginal and Torres Strait Islander peoples

    DIABETIC MEDICINE, Issue 11 2005
    A. E. Schutte
    Abstract Aims To determine the prevalence of the metabolic syndrome (MS) among Aboriginal and Torres Strait Islander peoples. A further objective was to investigate the relationships between fasting insulin and blood pressure (BP) within these groups with increasing age. Methods A cross-sectional population-based study included 369 Torres Strait Islanders (residing in Torres Strait and Far North Queensland), and 675 Aborigines from central Australia. Data necessary for classification of MS was collected, including fasting and 2-h glucose and insulin, urinary albumin and creatinine, anthropometric measurements, BP, serum lipids. Results The ATPIII criteria classified 43% of Torres Strait Islanders and 44% of Aborigines with MS, whereas 32 and 28%, respectively, had the MS according to WHO criteria. Agreement between the two criteria was only modest (kappa coefficient from 0.28 to 0.57). Factor analyses indicated no cluster including both insulin and BP in either population. Significant correlations (P < 0.05) [adjusted for gender, body mass index (BMI) and waist circumference] were observed between BP and fasting insulin: a positive correlation for Torres Strait Islanders aged 15,29 years, and an inverse correlation for Aborigines aged 40 years and older. Conclusion Torres Strait Islanders and Aborigines had very high prevalences of the MS. Specific population characteristics (high prevalences of central obesity, dyslipidaemia, renal disease) may make the WHO definition preferable to the ATPIII definition in these population groups. The poor agreement between criteria suggests a more precise definition of the metabolic syndrome that is applicable across populations is required. This study showed an inverse relationship with age for the correlation of BP and fasting insulin. [source]

    Reliability of Computerized Emergency Triage

    Sandy L. Dong MD
    Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care. This study compared agreement between two blinded, independent users of a Web-based triage tool (eTRIAGE) and examined the effects of ED crowding on triage reliability. Methods: Consecutive patients presenting to a large, urban, tertiary care ED were assessed by the duty triage nurse and an independent study nurse, both using eTRIAGE. Triage score distribution and agreement are reported. The study nurse collected data on ED activity, and agreement during different levels of ED crowding is reported. Two methods of interrater agreement were used: the linear-weighted , and quadratic-weighted ,. Results: A total of 575 patients were assessed over nine weeks, and complete data were available for 569 patients (99.0%). Agreement between the two nurses was moderate if using linear , (weighted ,= 0.52; 95% confidence interval = 0.46 to 0.57) and good if using quadratic , (weighted ,= 0.66; 95% confidence interval = 0.60 to 0.71). ED overcrowding data were available for 353 patients (62.0%). Agreement did not significantly differ with respect to periods of ambulance diversion, number of admitted inpatients occupying stretchers, number of patients in the waiting room, number of patients registered in two hours, or nurse perception of busyness. Conclusions: This study demonstrated different agreement depending on the method used to calculate interrater reliability. Using the standard methods, it found good agreement between two independent users of a computerized triage tool. The level of agreement was not affected by various measures of ED crowding. [source]

    Cervical biopsy-based comparison of a new liquid-based thin-layer preparation with conventional Pap smears

    Maria da Gloria Mattosinho de Castro Ferraz M.D.
    Abstract The objective of this study is to compare the diagnostic efficacy of universal collection medium (UCM) liquid-based cytology (LBC) (Digene Corp., MD) and the conventional Pap smear in a comparative study, using histologic results as the gold standard. This was a cross-sectional study. Conventional Pap smears and UCM LBC specimens, obtained from women in a low socioeconomic outpatient population referred to a tertiary center for gynecologic care, were compared. For the purpose of this study, when cervical specimens were collected for cytology, all women underwent colposcopy and biopsy was done if a cervical abnormality was observed. Cytologic evaluation of UCM LBC and conventional Pap smears were carried out separately, masked to the results of the other method. Agreement beyond chance between the two cytologic methods was ascertained by means of the unweighted , statistic. Sensitivity, specificity, and predictive values with 95% confidence intervals were calculated for both methods. McNemar's test was used to determine the level of association between the two cytology procedures. A total of 800 women were evaluated. Assessment of the overall agreement between the two cytologic methods yielded a , of 0.777 (P < 0.0001). After adjustment for histologic diagnosis, the computed , in each stratum was as follows: normal = 0.733; CIN 1 = 0.631; CIN 2/3 = 0.735; cancer = 0.652. The sensitivity and specificity of UCM LBC for detection of cervical intraepithelial lesions and cancer were 75.3% and 86.4%, respectively, not statistically different from the 81.8% and 85.2% seen with the conventional method. This study demonstrates that the UCM LBC method is as accurate as the conventional Pap smear cytology in detecting cervical intraepithelial lesions and cancer even so the UCM samples were systematically prepared from a second sampling of the cervix. Diagn. Cytopathol. 2004;30:220,226. 2004 Wiley-Liss, Inc. [source]

    Assessment of specimen adequacy reproducibility: An Italian experience

    Gioia Montanari M.D.
    Abstract Interobserver disagreement on smear adequacy may influence the evaluation of the performance of samplers as well as Pap test sensitivity and follow-up. In 1998, the Italian Group for Cervical Cancer Screening (GISCi) promoted a study on the reproducibility of adequacy criteria using a modified version of the Bethesda system. A set of 200 smears was circulated among six Italian laboratories situated in different parts of the country. For each smear, participants were requested to provide a summary judgment on its adequacy and on the cause(s) of inadequacy, if any. Agreement was measured using kappa-type statistics. The agreement among laboratories was generally good. In comparisons, among five laboratories, kappa values ranged from 0.47 to 0.66. At the consensus meeting on 42 slides, on which at least 2 laboratories dissented from the majority, agreement was reached unanimously for 31 reviewed slides and among 5,6 centers for 11. In this article, some guidance is given in order to attribute to one of the two categories satisfactory/unsatisfactory those smears that have been traditionally considered as candidates for the category of "satisfactory but limited by ," (SBLB). New Italian guidelines on adequacy proposed the GISCi are presented and the recommendation is made to eliminate the SBLB category. Diagn. Cytopathol. 2003;28:224,226. 2003 Wiley-Liss, Inc. [source]

    Psychopathology in treated Wilson's disease determined by means of CPRS expert and self-ratings

    K. Portala
    Objective: To examine the occurrence and severity of psychopathological symptoms in patients with treated Wilson's disease (WD) and to evaluate the clinical utility of a self-assessment. Method: Twenty-six consecutive patients with confirmed WD were investigated using the Comprehensive Psychopathological Rating Scale (CPRS) and the CPRS Self-rating Scale. Results: The total CPRS scores ranged from 2.5 to 59.0 (mean 29.415.5). Most common symptoms were: autonomic disturbances, observed muscular tension, fatiguability, reduced sexual interest, lack of appropriate emotion, concentration difficulties, reduced sleep, aches and pains, hostile feelings, apparent sadness and failing memory. Agreement between interview-based ratings and self-ratings was low. Conclusion: The patients with treated WD have prominent psychopathology in the same range as in patients with moderate to severe depressive disorders. A specific symptom profile has been identified. If confirmed, the identification of the typical symptom profile might be of great importance. The patients with WD tend to underestimate the presence of psychopathological symptoms. [source]

    Conflict, trade and the medium-term future of food security in Sudan

    DISASTERS, Issue 2007
    David Keen
    Recent economic growth and the Comprehensive Peace Agreement (CPA) have both been seen as grounds for optimism about the future of food security in Sudan. However, solving the North- South conflict (if indeed it is solved) does not resolve conflicts within either the North or the South and may even encourage a variety of conflicts. The classic neoliberal prescription of peace, growth and foreign investment may deepen (and obscure) the needs and grievances of those who have historically been left behind in a dysfunctional development process. Historically, some of those marginalised by patterns of development in Sudan have chosen to rebel, while others have had their grievances diverted against those even more marginal than themselves. Dysfunctional and violent processes of development must be reversed. They cannot be adequately compensated for-but may be legitimised-by attempts to use food aid as a ,safety net'. Meanwhile, those who benefited from war may have incentives to derail the peace. [source]

    Global factors shaping the future of food aid: the implications for WFP

    DISASTERS, Issue 2007
    Daniel Maxwell
    Food aid is a key component of a humanitarian response but its use in other programming contexts is subject to numerous criticisms. Even in humanitarian emergencies food aid is often late, unreliable and out of proportion to other elements of the response. Three major factors will shape the future of food aid. First, mechanisms of food aid governance are being reviewed and may undergo major changes,particularly the Food Aid Convention now that hopes have diminished for an Agreement on Agriculture at the World Trade Organisation. The second significant factor is donor agency trends. Overall levels of food aid have dropped fairly steadily in recent decades and there are several discernible trends in resource allocation, procurement and the use of food aid. The third factor is an emerging body of best practice that will define acceptable standards of food aid programming in the future. [source]

    Utility of software analysis of esophageal manometry studies in patients with aperistalsis

    P. A. Hart
    SUMMARY Esophageal manometry is the gold standard for the diagnosis of esophageal aperistalsis. There is computer software that analyzes peristalsis on esophageal manometry, but this automated analysis has not been formally evaluated. Our primary aim was to evaluate the software analysis of esophageal aperistalsis by esophageal manometry in patients diagnosed with aperistalsis by an experienced clinician. Esophageal manometry studies from January 2006 to November 2007 were retrospectively reviewed for evidence of aperistalsis by an experienced clinician. All studies demonstrating aperistalsis were selected for further review. The automated analysis performed by our software program for each study was recorded. Agreement between the automated analysis and the clinician was measured by the proportion of agreement on the absence of peristalsis. Eighty-seven of the 962 esophageal manometry studies reviewed demonstrated aperistalsis. The automated analysis reported esophageal body peristalsis with wet swallows in 66 out of 87 patients (75.9%). In these patients, the software analyzed an average of 34.2% of the wet swallows as peristaltic. The agreement between the clinician's review and software analysis of aperistalsis was 24.1%. These data suggest there is poor agreement between the automated analysis of peristalsis and that of an experienced reviewer. Automated analysis cannot be relied upon in the diagnostic evaluation of esophageal aperistalsis as it overestimates the presence of peristalsis and may lead to incorrect diagnoses and management strategies. [source]

    Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M: A validation study in a cohort of Japanese endoscopists

    H. Miwa
    SUMMARY., The Los Angeles classification system is the most widely employed criteria associated with the greatest interobserver agreement among endoscopists. In Japan, the Los Angeles classification system has been modified (modified LA system) to include minimal changes as a distinct grade of reflux esophagitis, rather than as auxiliary findings. This adds a further grading M defined as minimal changes to the mucosa, such as erythema and/or whitish turbidity. The modified LA system has come to be used widely in Japan. However, there have been few reports to date that have evaluated the interobserver agreement in diagnosis when using the modified LA classification system incorporating these minimal changes as an additional grade. A total of 100 endoscopists from university hospitals and community hospitals, as well as private practices in the Osaka-Kobe area participated in the study. A total of 30 video clips of 30,40 seconds duration, mostly showing the esophagocardiac junction, were created and shown to 100 endoscopists using a video projector. The participating endoscopists completed a questionnaire regarding their clinical experience and rated the reflux esophagitis as shown in the video clips using the modified LA classification system. Agreement was assessed employing kappa (,) statistics for multiple raters. The , -value for all 91 endoscopists was 0.094, with a standard error of 0.002, indicating poor interobserver agreement. The endoscopists showed the best agreement on diagnosing grade A esophagitis (0.167), and the poorest agreement when diagnosing grade M esophagitis (0.033). The , -values for the diagnoses of grades N, M, and A esophagitis on identical video pairs were 0.275,0.315, with a standard error of 0.083,0.091, indicating fair intraobserver reproducibility among the endoscopists. The study results consistently indicate poor agreement regarding diagnoses as well as fair reproducibility of these diagnoses by endoscopists using the modified LA classification system, regardless of age, type of practice, past endoscopic experience, or current workload. However, grade M reflux esophagitis may not necessarily be irrelevant, as it may suggest an early form of reflux disease or an entirely new form of reflux esophagitis. Further research is required to elucidate the pathophysiological basis of minimal change esophagitis. [source]