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Post Hoc (post + hoc)
Terms modified by Post Hoc Selected AbstractsT2-Weighted and T2 Relaxometry Images in Patients with Medial Temporal Lobe EpilepsyJOURNAL OF NEUROIMAGING, Issue 3 2006Ana Carolina Coan MD ABSTRACT Purpose. Quantification of increased T2-weighted MRI signal that is associated with hippocampal sclerosis (HS) can be performed through (1) mean of hippocampal signal in single-echo T2 MRI and (2) hippocampal T2 relaxometry. It is not clear whether these two techniques are equivalent. In this study, we compare the hippocampal signal, detected by single-echo T2 quantification and by T2 relaxometry, in patients with medial temporal lobe epilepsy (MTLE). Methods. We studied magnetic resonance images from 50 MTLE patients and 15 healthy subjects. We compared the quantification of a T2 signal from single echo images to T2 relaxometry, both obtained from a manually traced region of interest (ROI) in coronal slices involving the whole hippocampus. Repeated measures ANOVA was used to evaluate the differences in the distribution of the Z -scores from single-echo T2 quantification and T2 relaxometry within subjects. Results. We observed a significant difference between the measurements obtained from single-echo T2 quantification and T2 relaxometry (P < .001). Measurements from head, body, and tail of the hippocampus were different (P=.04), with a significant interaction between anatomic location and type of measurement used (P= .008). Post hoc paired comparisons revealed that T2 relaxometry yielded greater Z -scores for the body (P= .002) and tail (P < .0001). Conclusions. For each subject with MTLE, T2 relaxometry was able to detect a higher signal in the body and tail of the hippocampus compared to single-echo T2. This is a possible indicator that T2 relaxometry is more sensitive in detecting T2 abnormalities within the body and tail of the hippocampus in patients with MTLE. [source] The effects of manual therapy and exercise directed at the cervical spine on pain and pressure pain sensitivity in patients with myofascial temporomandibular disordersJOURNAL OF ORAL REHABILITATION, Issue 9 2009R. LA TOUCHE Summary, No studies have investigated the effects of the treatments directed at the cervical spine in patients with temporomandibular disorders (TMD). Our aim was to investigate the effects of joint mobilization and exercise directed at the cervical spine on pain intensity and pressure pain sensitivity in the muscles of mastication in patients with TMD. Nineteen patients (14 females), aged 19,57 years, with myofascial TMD were included. All patients received a total of 10 treatment session over a 5-week period (twice per week). Treatment included manual therapy techniques and exercise directed at the cervical spine. Outcome measures included bilateral pressure pain threshold (PPT) levels over the masseter and temporalis muscles, active pain-free mouth opening (mm) and pain (Visual Analogue Scale) and were all assessed pre-intervention, 48 h after the last treatment (post-intervention) and at 12-week follow-up period. Mixed-model anovas were used to examine the effects of the intervention on each outcome measure. Within-group effect sizes were calculated in order to assess clinical effect. The 2 × 3 mixed model anova revealed significant effect for time (F = 77·8; P < 0·001) but not for side (F = 0·2; P = 0·7) for changes in PPT over the masseter muscle and over the temporalis muscle (time: F = 66·8; P < 0·001; side: F = 0·07; P = 0·8). Post hoc revealed significant differences between pre-intervention and both post-intervention and follow-up periods (P < 0·001) but not between post-intervention and follow-up period (P = 0·9) for both muscles. Within-group effect sizes were large (d > 1·0) for both follow-up periods in both muscles. The anova found a significant effect for time (F = 78·6; P < 0·001) for changes in pain intensity and active pain-free mouth opening (F = 17·1; P < 0·001). Significant differences were found between pre-intervention and both post-intervention and follow-up periods (P < 0·001) but not between the post-intervention and follow-up period (P > 0·7). Within-group effect sizes were large (d > 0·8) for both post-intervention and follow-up periods. The application of treatment directed at the cervical spine may be beneficial in decreasing pain intensity, increasing PPTs over the masticatory muscles and an increasing pain-free mouth opening in patients with myofascial TMD. [source] Indicators of pretreatment suicidal ideation in adults with major depressive disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010D. W. Morris Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective:, In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method:, This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results:, Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion:, Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI. [source] Epoetin alfa corrects anemia and improves quality of life in patients with hematologic malignancies receiving non-platinum chemotherapyHEMATOLOGICAL ONCOLOGY, Issue 4 2003Timothy J. Littlewood Abstract Anemia, a commonly occurring morbidity in patients with cancer, often leads to diminished quality of life (QOL). Numerous clinical trials have shown that epoetin alfa treatment improves hematologic and QOL variables in cancer patients. The clinical trial analysis reported here was performed to assess response to epoetin alfa in patients with hematologic malignancies. Cancer patients with anemia undergoing non-platinum-based chemotherapy who were enrolled in a multinational, randomized (2:1), double-blind, placebo-controlled trial were prospectively stratified by tumor type (hematologic, solid). Efficacy endpoints included proportion of patients transfused after day 28; change in hemoglobin (Hb) level from baseline to last assessment; proportion of treatment responders (increase in Hb ,2,g/dl unrelated to transfusion) and correctors (patients whose Hb levels reached ,12,g/dl during the study); and QOL. The protocol was amended before unblinding to prospectively collect and assess survival data 12 months after the last patient completed the study, and survival for the full study cohort was estimated using Kaplan,Meier techniques. Efficacy analyses of hematologic and QOL variables, as well as Kaplan,Meier estimates of survival, were performed post hoc for the hematologic tumor stratum. Among patients with hematologic malignancies, the mean increase in Hb levels was greater with epoetin alfa than with placebo treatment (2.2 vs. 0.3,g/dl). Transfusion requirements were lower in patients who received epoetin alfa versus placebo (25.2 vs. 43.1%), and the proportion of responders and correctors was higher with epoetin alfa than with placebo (75.2 vs. 16.7% and 72.6 vs. 14.8%, respectively). Patients who received epoetin alfa had improved QOL while patients who received placebo had decreased QOL. These results are similar to those seen in the full study cohort, where differences between epoetin alfa and placebo were significant (P<0.05) for all five primary cancer- and anemia-specific QOL domains evaluated. Although the study was not powered for survival, Kaplan,Meier estimates showed a trend in overall survival favoring epoetin alfa in both the full study cohort and the hematologic subgroup. Epoetin alfa treatment was well tolerated. Epoetin alfa therapy increased Hb levels, reduced transfusion requirements, and improved QOL in patients with anemia undergoing non-platinum chemotherapy for hematologic malignancies. Copyright © 2004 John Wiley & Sons, Ltd. [source] Prevalence of storage and voiding symptoms among men aged 40 years and older in a US population-based study: results from the Male Attitudes Regarding Sexual Health studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2007D. B. Glasser Summary Aims:, Lower urinary tract symptoms (LUTS) are categorised as storage (urgency, frequency, nocturia and incontinence), voiding (sensation of incomplete emptying, hesitancy, weak stream and straining) or mixed symptoms. Methods:, In this US population-based study, we investigated the prevalence of male LUTS and the relative frequency of the LUTS subtypes, and we evaluated associations between LUTS and age, race/ethnicity and erectile dysfunction (ED). The Male Attitudes Regarding Sexual Health study included a nationally representative sample of non-Hispanic black, non-Hispanic white and Hispanic men aged , 40 years. Participants completed a questionnaire including items on ED and the International Prostate Symptom Score (IPSS). The prevalence and subtypes of LUTS were investigated post hoc by age, race/ethnicity and the presence of ED. Results:, The overall prevalence rates of storage (13%) and mixed (9%) symptoms were higher than that of voiding symptoms (6%). The prevalence of storage symptoms was similar across age groups, whereas voiding and mixed symptoms increased with age. Among men with IPSS , 8, the rates of storage (29%) and mixed (38%) symptoms were also higher than voiding symptoms (23%). Distributions of the LUTS subtypes were comparable among black, white and Hispanic respondents with IPSS , 8. The overall prevalence rate of ED (40%) increased with age among those with IPSS , 8. Isolated storage symptoms were more than twice as common as isolated voiding symptoms among US men , 40 years of age. Conclusion:, Careful attention to individual symptoms may help distinguish storage LUTS from voiding LUTS, a distinction that has important implications for treatment. [source] Regression modelling of correlated data in ecology: subject-specific and population averaged response patternsJOURNAL OF APPLIED ECOLOGY, Issue 5 2009John Fieberg Summary 1.,Statistical methods that assume independence among observations result in optimistic estimates of uncertainty when applied to correlated data, which are ubiquitous in applied ecological research. Mixed effects models offer a potential solution and rely on the assumption that latent or unobserved characteristics of individuals (i.e. random effects) induce correlation among repeated measurements. However, careful consideration must be given to the interpretation of parameters when using a nonlinear link function (e.g. logit). Mixed model regression parameters reflect the change in the expected response within an individual associated with a change in that individual's covariates [i.e. a subject-specific (SS) interpretation], which may not address a relevant scientific question. In particular, a SS interpretation is not natural for covariates that do not vary within individuals (e.g. gender). 2.,An alternative approach combines the solution to an unbiased estimating equation with robust measures of uncertainty to make inferences regarding predictor,outcome relationships. Regression parameters describe changes in the average response among groups of individuals differing in their covariates [i.e. a population-averaged (PA) interpretation]. 3.,We compare these two approaches [mixed models and generalized estimating equations (GEE)] with illustrative examples from a 3-year study of mallard (Anas platyrhynchos) nest structures. We observe that PA and SS responses differ when modelling binary data, with PA parameters behaving like attenuated versions of SS parameters. Differences between SS and PA parameters increase with the size of among-subject heterogeneity captured by the random effects variance component. Lastly, we illustrate how PA inferences can be derived (post hoc) from fitted generalized and nonlinear-mixed models. 4.,Synthesis and applications. Mixed effects models and GEE offer two viable approaches to modelling correlated data. The preferred method should depend primarily on the research question (i.e. desired parameter interpretation), although operating characteristics of the associated estimation procedures should also be considered. Many applied questions in ecology, wildlife management and conservation biology (including the current illustrative examples) focus on population performance measures (e.g. mean survival or nest success rates) as a function of general landscape features, for which the PA model interpretation, not the more commonly used SS model interpretation may be more natural. [source] Predicting avian patch occupancy in a fragmented landscape: do we know more than we think?JOURNAL OF APPLIED ECOLOGY, Issue 5 2009Danielle F. Shanahan Summary 1.,A recent and controversial topic in landscape ecology is whether populations of species respond to habitat fragmentation in a general fashion. Empirical research has provided mixed support, resulting in controversy about the use of general rules in landscape management. Rather than simply assessing post hoc whether individual species follow such rules, a priori testing could shed light on their accuracy and utility for predicting species response to landscape change. 2.,We aim to create an a priori model that predicts the presence or absence of multiple species in habitat patches. Our goal is to balance general theory with relevant species life-history traits to obtain high prediction accuracy. To increase the utility of this work, we aim to use accessible methods that can be applied using readily available inexpensive resources. 3.,The classification tree patch-occupancy model we create for birds is based on habitat suitability, minimum area requirements, dispersal potential of each species and overall landscape connectivity. 4.,To test our model we apply it to the South East Queensland region, Australia, for 17 bird species with varying dispersal potential and habitat specialization. We test the accuracy of our predictions using presence,absence information for 55 vegetation patches. 5.,Overall we achieve Cohen's kappa of 0·33, or ,fair' agreement between the model predictions and test data sets, and generally a very high level of absence prediction accuracy. Habitat specialization appeared to influence the accuracy of the model for different species. 6.,We also compare the a priori model to the statistically derived model for each species. Although this ,optimal model' generally differed from our original predictive model, the process revealed ways in which it could be improved for future attempts. 7.,Synthesis and applications. Our study demonstrates that ecological generalizations alongside basic resources (a vegetation map and some species-specific information) can provide conservative accuracy for predicting species occupancy in remnant vegetation patches. We show that the process of testing and developing models based on general rules could provide basic tools for conservation managers to understand the impact of current or planned landscape change on wildlife populations. [source] Tibolone Rapidly Attenuates the GABAB Response in Hypothalamic NeuronesJOURNAL OF NEUROENDOCRINOLOGY, Issue 12 2008J. Qiu Tibolone is primarily used for the treatment of climacteric symptoms. Tibolone is rapidly converted into three major metabolites: 3,- and 3,-hydroxy (OH)-tibolone, which have oestrogenic effects, and the ,4-isomer (,4-tibolone), which has progestogenic and androgenic effects. Because tibolone is effective in treating climacteric symptoms, the effects on the brain may be explained by the oestrogenic activity of tibolone. Using whole-cell patch clamp recording, we found previously that 17,-oestradiol (E2) rapidly altered ,-aminobutyric acid (GABA) neurotransmission in hypothalamic neurones through a membrane oestrogen receptor (mER). E2 reduced the potency of the GABAB receptor agonist baclofen to activate G-protein-coupled, inwardly rectifying K+ (GIRK) channels in hypothalamic neurones. Therefore, we hypothesised that tibolone may have some rapid effects through the mER and sought to elucidate the signalling pathway of tibolone's action using selective inhibitors and whole cell recording in ovariectomised female guinea pigs and mice. A sub-population of neurones was identified post hoc as pro-opiomelanocortin (POMC) neurones by immunocytochemical staining. Similar to E2, we have found that tibolone and its active metabolite 3,OH-tibolone rapidly reduced the potency of the GABAB receptor agonist baclofen to activate GIRK channels in POMC neurones. The effects were blocked by the ER antagonist ICI 182 780. Other metabolites of tibolone (3,OH-tibolone and ,4-tibolone) had no effect. Furthermore, tibolone (and 3,OH-tibolone) was fully efficacious in ER, knockout (KO) and ER,KO mice to attenuate GABAB responses. The effects of tibolone were blocked by phospholipase C inhibitor U73122. However, in contrast to E2, the effects of tibolone were not blocked by protein kinase C inhibitors or protein kinase A inhibitors. It appears that tibolone (and 3,OH-tibolone) activates phospholipase C leading to phosphatidylinositol bisphosphate metabolism and direct alteration of GIRK channel function. Therefore, tibolone may enhance synaptic efficacy through the Gq signalling pathways of mER in brain circuits that are critical for maintaining homeostatic functions. [source] Cement Selection for Cement-Retained Crown Technique with Dental ImplantsJOURNAL OF PROSTHODONTICS, Issue 2 2008James L. Sheets DDS Abstract Purpose: The purpose of this study was to assess and compare the retentive nature of common dental cements that have been adapted for use in the implant abutment cement-retained crown (CRC) technique with those specifically formulated for this purpose. Materials and Methods: Ten regular diameter implant analogs were embedded in stainless steel disks. Unmodified CRC abutments were attached and torqued to 30 Ncm. Test crowns were waxed and cast with base metal alloy. Castings were fitted, cleaned with aluminum oxide, and steam cleaned prior to application of the cement. The cements used were: (1) Temp Bond, (2) UltraTemp, regular, (3) UltraTemp firm, (4) ImProv with petroleum jelly coating of crown, (5) ImProv without petroleum jelly, (6) Premier Implant with KY Jelly coating of abutment, (7) Premier Implant without KY jelly, (8) TR-2, (9) Fleck's, (10) Ketac Cem Aplicap, and (11) Fuji Plus Capsule. After cementation, assemblies were stored for 24 hours. Each sample was subjected to a pull-out test using an Instron universal testing machine at a crosshead speed of 5.0 mm/min. Loads required to remove the crowns were recorded, and mean values for each group determined. A one-way ANOVA and a post hoc least square difference (LSD) test were done for pairwise comparison at a confidence interval of 95%. Results: The mean values (±SD) of loads at failure (n = 10) for various cements were as follows (N): Ultratemp, regular 358.6 (±38.2) (Group A), ImProv without petroleum jelly 172.4 (±59.6) (Group B), Fleck's 171.8 (±62.2) (Group B), Ketac Cem 167.8 (±69.1) (Group B), UltraTemp firm 158.8 (±62.7) (Group BC), Fuji Plus 147.5 (±69.7) (Group BC), Premier without KY jelly 131.6 (±31.8) (Group BC), ImProv using petroleum jelly 130.8 (±42.5) (Group BC), Temp Bond 117.8 (±48.3) (Group C), TR-2 41.2 (±16.6) (Group D), and Premier with KY jelly 31.6 (±24.8) (Group D). Groups with the same letter were not significantly different. Conclusions: Within the limitations of this in vitro study, it is not suggested that any one cement is better than another at retaining cement-retained crowns (CRCs) to implant abutments or that a threshold value must be accomplished to ensure retention. The ranking of cements presented is meant to be a discretionary guide for the clinician in deciding the amount of desired retention between castings and implant abutments. [source] A historical analysis of the relationship between encephalitis lethargica and postencephalitic parkinsonism: A complex rather than a direct relationship,MOVEMENT DISORDERS, Issue 9 2010Joel A. Vilensky PhD Abstract Postencephalitic parkinsonism has been considered unique among disorders with parkinsonian features because it is believed to have a unitary etiology associated with the virus that presumably caused encephalitis lethargica. Careful analysis of the historical record, however, suggests that this relationship is more complex than commonly perceived. In most cases, the diagnosis of acute encephalitis lethargica was made post hoc, and virtually any catarrh-like illness was considered to have represented encephalitis lethargica, often after an oral history-taking that was undoubtedly subject to patient recall and physician bias. Also, postencephalitic parkinsonism and oculogyric crises were not recognized as sequelae to encephalitis lethargica until well after other sequelae such as movement disorders and mental disturbances had been identified (see previous paper). We suggest here that the relationship between encephalitis lethargica and postencephalitic parkinsonism is not simplistic, i.e., encephalitis lethargica was not solely responsible for the etiology of postencephalitic parkinsonism, thus aligning the latter with most other parkinsonian disorders that are now believed to have multiple causes. © 2010 Movement Disorder Society [source] Two-year clinical and radiographic results with combination etanercept,methotrexate therapy versus monotherapy in early rheumatoid arthritis: A two-year, double-blind, randomized study,ARTHRITIS & RHEUMATISM, Issue 3 2010Paul Emery Objective To evaluate how continuation of and alterations to initial year 1 combination etanercept,methotrexate (MTX) therapy and MTX monotherapy regimens affect long-term remission and radiographic progression in early, active rheumatoid arthritis. Methods Subjects were randomized at baseline for the entire 2-year period; those who completed 1 year of treatment with combination or MTX monotherapy entered year 2. The original combination group either continued combination therapy (the EM/EM group; n = 111) or received etanercept monotherapy (the EM/E group; n = 111) in year 2; the original MTX monotherapy group either received combination therapy (the M/EM group; n = 90) or continued monotherapy (the M/M group; n = 99) in year 2. Efficacy end points included remission (a Disease Activity Score in 28 joints [DAS28] <2.6) and radiographic nonprogression (change in the modified Sharp/van der Heijde score ,0.5) at year 2. A last observation carried forward analysis from the modified intention-to-treat population (n = 398) and a post hoc nonresponder imputation (NRI) analysis (n = 528) were performed for remission. Results At year 2, DAS28 remission was achieved by 62/108, 54/108, 51/88, and 33/94 subjects in the EM/EM, EM/E, M/EM, and M/M groups, respectively (P < 0.01 for the EM/EM and M/EM groups versus the M/M group). This effect was corroborated by a more conservative post hoc 2-year NRI analysis, with remission observed in 59/131, 50/134, 48/133, and 29/130 of the same respective groups (P < 0.05 for each of the EM/EM, EM/E, and M/EM groups versus the M/M group). The proportions of subjects achieving radiographic nonprogression (n = 360) were 89/99, 74/99, 59/79, and 56/83 in the EM/EM (P < 0.01 versus each of the other groups), EM/E, M/EM, and M/M groups, respectively. No new safety signals or between-group differences in serious adverse events were seen. Conclusion Early sustained combination etanercept,MTX therapy was consistently superior to MTX monotherapy. Combination therapy resulted in important clinical and radiographic benefits over 2 study years, without significant additional safety risk. [source] Golimumab, a human anti,tumor necrosis factor , monoclonal antibody, injected subcutaneously every four weeks in methotrexate-naive patients with active rheumatoid arthritis: Twenty-four,week results of a phase III, multicenter, randomized, double-blind, placebo-controlled study of golimumab before methotrexate as first-line therapy for early-onset rheumatoid arthritis,ARTHRITIS & RHEUMATISM, Issue 8 2009Paul Emery Objective To assess the safety and efficacy of golimumab in methotrexate (MTX),naive patients with active rheumatoid arthritis (RA). Methods MTX-naive patients with RA (n = 637) were randomized to receive placebo plus MTX (group 1), golimumab 100 mg plus placebo (group 2), golimumab 50 mg plus MTX (group 3), or golimumab 100 mg plus MTX (group 4). Subcutaneous injections of golimumab or placebo were administered every 4 weeks. The dosage of MTX/placebo capsules started at 10 mg/week and escalated to 20 mg/week. The primary end point, the proportion of patients meeting the American College of Rheumatology 50% improvement criteria (achieving an ACR50 response) at week 24, required significant differences between groups 3 and 4 combined (combined group) versus group 1 and significant differences in a pairwise comparison (group 3 or group 4 versus group 1). Results An intent-to-treat (ITT) analysis of the ACR50 response at week 24 did not show a significant difference between the combined group and group 1 (38.4% and 29.4%, respectively; P = 0.053), while a post hoc modified ITT analysis (excluding 3 untreated patients) of the ACR50 response showed statistically significant differences between the combined group and group 1 (38.5% versus 29.4%; P = 0.049) and between group 3 (40.5%; P = 0.038) but not group 4 (36.5%; P = 0.177) and group 1. Group 2 was noninferior to group 1 for the ACR50 response at week 24 (33.1%; 95% confidence interval lower bound ,5.2%; predefined delta value for noninferiority ,10%). The combination of golimumab plus MTX demonstrated a significantly better response compared with placebo plus MTX in most other efficacy parameters, including response/remission according to the Disease Activity Score in 28 joints. Serious adverse events occurred in 7%, 3%, 6%, and 6% of patients in groups 1, 2, 3, and 4, respectively. Conclusion Although the primary end point was not met, the modified ITT analysis of the primary end point and other prespecified efficacy measures demonstrated that the efficacy of golimumab plus MTX is better than, and the efficacy of golimumab alone is similar to, the efficacy of MTX alone in reducing RA signs and symptoms in MTX-naive patients, with no unexpected safety concerns. [source] Using Patient Care Quality Measures to Assess Educational OutcomesACADEMIC EMERGENCY MEDICINE, Issue 5 2007Susan R. Swing PhD ObjectivesTo report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine. MethodsA workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures. The workgroup completed a structured exercise to examine the linkage of patient care process and outcome measures to educational effectiveness. ResultsThe workgroup selected 62 measures for inclusion in its final set, including 43 measures for 21 clinical conditions, eight medication measures, seven measures for procedures, and four measures for department efficiency. Twenty-six measures met the more stringent criteria applied post hoc to further stratify and prioritize measures for development. Nineteen of these measures received high ratings from 75% of the workgroup and external stakeholder raters on importance for care in the ED, measures quality of care, and measures educational effectiveness; the majority of the raters considered these indicators feasible to measure. The workgroup utilized a simple framework for exploring the relationship of residency program educational activities, competencies from the six Accreditation Council for Graduate Medical Education general competency domains, patient care quality measures, and external factors that could intervene to affect care quality. ConclusionsNumerous patient care quality measures have potential for use in assessing the educational effectiveness and performance of graduate medical education programs in emergency medicine. The measures identified in this report can be used as a starter set for further development, implementation, and study. Implementation of the measures, especially for high-stakes use, will require resolution of significant measurement issues. [source] EFFECTS OF AGAR AND PECTIN ON GASTRIC EMPTYING AND POST-PRANDIAL GLYCAEMIC PROFILES IN HEALTHY HUMAN VOLUNTEERSCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 11 2007Masaki Sanaka SUMMARY 1Dietary fibre, such as pectin, delays gastric emptying and may enhance post-prandial glucose tolerance. Agar, which is high in fibre content, is widely used in the traditional Japanese diet. Although long-term diet therapy with agar decreases fasting plasma glucose levels in diabetes, knowledge is lacking about the acute effects of agar on gastric emptying and the post-prandial glycaemic profiles. The present study was designed to investigate the acute effects of agar. 2Ten healthy male volunteers were studied on three occasions with three different test meals (450 kcal/500 mL): (i) a fibre-free meal; (ii) a meal with 2.0 g agar; or (iii) a meal with 5.2 g pectin. On each occasion, participants underwent a [13C]-acetate breath test along with serial blood sampling. To quantify gastric emptying, the half [13CO2] excretion time () and the time for maximal [13CO2] excretion rate (tlag) were determined. The post-prandial glycaemic response was expressed as an incremental change from the fasting value at each sampling time. Data were analysed using repeated-measures analysis of variance (anova), followed by a post hoc paired Student's t -test with Bonferroni adjustment. 3The time-course for respiratory [13CO2] excretion differed significantly among the three test meals (P = 0.0004, anova). Compared with the control meal, [13CO2] excretion was significantly lower following consumption of the agar meal (between 40 and 105 min post-prandially; P < 0.025, Student's t -test) and the pectin meal (between 40 and 180 min post-prandially; P < 0.025, Student's t -test). Among the three meals, significant differences were found in (P = 0.002, anova) and tlag (P = 0.011, anova). Compared with the control meal, the agar and pectin meals exhibited a significantly prolonged (P = 0.007 and P < 0.0001, respectively, Student's t -test) and tlag (P = 0.006 and P = 0.002, respectively, Student's t -test). Neither the agar nor pectin meal affected the post-prandial glucose profile. 4In healthy adults, agar and pectin delay gastric emptying but have no impact on the post-prandial glucose response. [source] CSA Will Not Be Prosecuted Scientifically: A Comment on Sbraga and O'DonohueCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 3 2003Paul A. Spiers Sbraga and O'Donohue (2003, this issue) focus on the post hoc reasoning inherent in theories of child sexual abuse (CSA). This comment provides some perspective on the judicial context in which these theories are presented. [source] | ||||||||||