Dietary acid, age, and serum bicarbonate levels among adults in the United States.

PubMed

Amodu, Afolarin; Abramowitz, Matthew K

2013-12-01

Greater dietary acid has been associated with lower serum bicarbonate levels in patients with CKD. Whether this association extends to the general population and if it is modified by age are unknown. This study examined the association of the dietary acid load, estimated by net endogenous acid production, with serum bicarbonate levels in adult participants in the National Health and Nutrition Examination Survey 1999-2004. The mean serum bicarbonate was 24.9 mEq/L (SEM=0.1), and the mean estimated net endogenous acid production was 57.4 mEq/d (SEM=0.4). Serum bicarbonate was linearly associated with age, such that the oldest participants had the highest serum bicarbonate levels. After multivariable adjustment, participants in the highest quartile of net endogenous acid production had 0.40 mEq/L (95% confidence interval, -0.55 to -0.26) lower serum bicarbonate and a 33% (95% confidence interval, 3 to 72) higher likelihood of acidosis compared with those participants in the lowest quartile. There was a significant interaction by age of the association of net endogenous acid production with serum bicarbonate (P=0.005). Among participants 20-39, 40-59, and ≥60 years old, those participants in the highest net endogenous acid production quartile had 0.26 (95% confidence interval, -0.49 to -0.03), 0.60 (95% confidence interval, -0.92 to -0.29), and 0.49 (95% confidence interval, -0.84 to -0.14) mEq/L lower serum bicarbonate, respectively, compared with participants in the lowest quartile. Greater dietary acid is associated with lower serum bicarbonate in the general US population, and the magnitude of this association is greater among middle-aged and elderly persons than younger adults.

Implementation and assessment of a curriculum for bedside ultrasound training.

PubMed

Turner, Elizabeth E; Fox, J Christian; Rosen, Mark; Allen, Angela; Rosen, Sasha; Anderson, Craig

2015-05-01

This study assessed a curriculum for bedside ultrasound (US) and compared outcomes from 2 common training pathways. The program consisted of e-learning paired with expert-led hands-on training administered to pulmonary/critical care and cardiology fellows with no prior formal training in bedside US. This "simulation-based learner" group completed a survey of attitudes and confidence before and after training, and knowledge and skills were assessed after training. The surveys and scores of the simulation-based learners were compared to the scores of "experts," who were US-trained emergency physicians, and "apprentice learners," who were intensivist physicians informally trained in bedside US on the job during fellowships. There was a significant difference in the self-reported level of prior training between the groups (simulation-based learners, 2.8; apprentice learners, 3.7; experts, 4.1, on a scale of 1-5 [P= .02]) but no difference in the interest level or perceived importance of bedside US. The study curriculum was successful, as shown by scores that exceeded the comparison groups in the cardiac and pulmonary courses (cardiac: simulation-based learners, 80%; apprentice learners, 73%; experts, 62% [P= .001]; pulmonary: 84%, 75%, and 72%, respectively [P =.02]). The simulation-based learners gained confidence in skills, whereas the comparison groups lost confidence after testing (P < .005); however, the simulation-based learners gained confidence in US subject areas that were not taught (abdomen [P <.002] and miscellaneous [P =.005]). The simulation-based learner curriculum resulted in comparable or greater knowledge and confidence in each area of US versus the comparison groups. Findings of overgeneralization of confidence highlight the importance of quality assurance and supervision in bedside US training programs. © 2015 by the American Institute of Ultrasound in Medicine.

Method and system for assigning a confidence metric for automated determination of optic disc location

DOEpatents

Karnowski, Thomas P [Knoxville, TN; Tobin, Jr., Kenneth W.; Muthusamy Govindasamy, Vijaya Priya [Knoxville, TN; Chaum, Edward [Memphis, TN

2012-07-10

A method for assigning a confidence metric for automated determination of optic disc location that includes analyzing a retinal image and determining at least two sets of coordinates locating an optic disc in the retinal image. The sets of coordinates can be determined using first and second image analysis techniques that are different from one another. An accuracy parameter can be calculated and compared to a primary risk cut-off value. A high confidence level can be assigned to the retinal image if the accuracy parameter is less than the primary risk cut-off value and a low confidence level can be assigned to the retinal image if the accuracy parameter is greater than the primary risk cut-off value. The primary risk cut-off value being selected to represent an acceptable risk of misdiagnosis of a disease having retinal manifestations by the automated technique.

Making strides towards better mental health care in Peru: Results from a primary care mental health training

PubMed Central

Borba, C. P.C.; Gelaye, B.; Zayas, L.; Ulloa, M.; Lavelle, J.; Mollica, R.F.; Henderson, D.C.

2015-01-01

Our program attempted to improve attitudes and confidence of Peruvian primary care physicians (PCPs) providing mental health care. The training program underwent an evaluation to determine impact of sustained confidence in performing medical and psychiatric procedures, and application of learned skills. Fifty-two Peruvian primary care practitioners were trained at the Harvard Program in Refugee Trauma (HPRT) over a two-week period. There was significant improvement in PCPs’ confidence levels of performing psychiatric procedures (counseling, prescribing medications, psychiatric diagnosis, assessing the risk for violence, and treating trauma victims) when comparing baseline and post-two-week to one year follow-up. When comparing post-two-week and one-year follow-up quantitative measures, confidences levels went slightly down. This may be an implication that the frequency of trainings and supervisions are needed more frequently. In contrast, qualitative responses from the one-year follow-up revealed increase in victims of violence clinical care, advocacy, awareness, education, training, policy changes, accessibility of care, and sustainment of diagnostic tools. This study supports the feasibility of training PCP's in a culturally effective manner with sustainability over time. PMID:27054141

Curling for Confidence: Psychophysical Benefits of Curling for Older Adults.

PubMed

Stone, Rachael C; Rakhamilova, Zina; Gage, William H; Baker, Joseph

2018-04-01

While physical activity is increasingly promoted for older adults, there is a paucity of sport promotion, which has distinct benefits from exercise and remains stereotypically associated with younger age. Curling is a moderately intense and safe sport that continues to gain popularity; however, no research has investigated psychophysical benefits of curling for older adults. The present study compares high-experience (20+ years; n = 63) and low-experience (<20 years; n = 53) curlers (aged 60+ years) with older adult noncurlers (n = 44) on measures of daily functionality, balance confidence, and perceptions of the aging process. While no significant differences were found between high- and low-experience curlers, any level of experience reported significantly better functionality, physical confidence, and aging attitudes compared to noncurlers (p ≤ .05). Although further research is necessary, the results suggest that any level of curling experience can enhance older adult psychophysical well-being, and warrants consideration for physical activity promotion and falls prevention programs.

Evaluating the use of simulation with beginning nursing students.

PubMed

Alfes, Celeste M

2011-02-01

The purpose of this quasi-experimental study was to evaluate and compare the effectiveness of simulation versus a traditional skills laboratory method in promoting self-confidence and satisfaction with learning among beginning nursing students. A single convenience sample of 63 first-semester baccalaureate nursing students learning effective comfort care measures were recruited to compare the two teaching methods. Students participating in the simulation experience were statistically more confident than students participating in the traditional group. There was a slight, nonsignificant difference in satisfaction with learning between the two groups. Bivariate analysis revealed a significant positive relationship between self-confidence and satisfaction. Students in both groups reported higher levels of self-confidence following the learning experiences. Findings may influence the development of simulation experiences for beginning nursing students and encourage the implementation of simulation as a strand from beginning to end in nursing curricula. Copyright 2011, SLACK Incorporated.

Lipoprotein(a) levels, genotype, and incident aortic valve stenosis: a prospective Mendelian randomization study and replication in a case-control cohort.

PubMed

Arsenault, Benoit J; Boekholdt, S Matthijs; Dubé, Marie-Pierre; Rhéaume, Eric; Wareham, Nicholas J; Khaw, Kay-Tee; Sandhu, Manjinder S; Tardif, Jean-Claude

2014-06-01

Although a previous study has suggested that a genetic variant in the LPA region was associated with the presence of aortic valve stenosis (AVS), no prospective study has suggested a role for lipoprotein(a) levels in the pathophysiology of AVS. Our objective was to determine whether lipoprotein(a) levels and a common genetic variant that is strongly associated with lipoprotein(a) levels are associated with an increased risk of developing AVS. Serum lipoprotein(a) levels were measured in 17 553 participants of the European Prospective Investigation into Cancer (EPIC)-Norfolk study. Among these study participants, 118 developed AVS during a mean follow-up of 11.7 years. The rs10455872 genetic variant in LPA was genotyped in 14 735 study participants, who simultaneously had lipoprotein(a) level measurements, and in a replication study of 379 patients with echocardiography-confirmed AVS and 404 controls. In EPIC-Norfolk, compared with participants in the bottom lipoprotein(a) tertile, those in the top lipoprotein(a) tertile had a higher risk of AVS (hazard ratio, 1.57; 95% confidence interval, 1.02-2.42) after adjusting for age, sex, and smoking. Compared with rs10455872 AA homozygotes, carriers of 1 or 2 G alleles were at increased risk of AVS (hazard ratio, 1.78; 95% confidence interval, 1.11-2.87, versus hazard ratio, 4.83; 95% confidence interval, 1.77-13.20, respectively). In the replication study, the genetic variant rs10455872 also showed a positive association with AVS (odds ratio, 1.57; 95% confidence interval, 1.10-2.26). Patients with high lipoprotein(a) levels are at increased risk for AVS. The rs10455872 variant, which is associated with higher lipoprotein(a) levels, is also associated with increased risk of AVS, suggesting that this association may be causal. © 2014 American Heart Association, Inc.

Preparation For Medical School via an Intensive Summer Program for Future Doctors: A Pilot Study of Student Confidence and Reasoning Skills

ERIC Educational Resources Information Center

Musick, David W.; Ray, Richard H.

2016-01-01

A medical school conducted a summer pre-matriculation program. The program provided basic sciences content comparable to first year medical student instruction along with clinical and other learning experiences. The study purpose was to examine self-confidence levels and reasoning skills of a single cohort of students. We examined the association…

Evaluating the Effectiveness of the General Surgery Intern Boot Camp.

PubMed

Schoolfield, Clint S; Samra, Navdeep; Kim, Roger H; Shi, Runhua; Zhang, Wayne W; Tan, Tze-Woei

2016-03-01

The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants' confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P < 0.001) after the boot camp. Additionally, there were improvements for all subcategories including medical knowledge (2.65 vs 3.36, P < 0.001), technical skill (3.02 vs 3.51, P < 0.001), interpersonal skills and communication (3.04 vs 3.53, P = 0.001), and practice-based learning (2.65 vs 3.41, P = 0.001). There was an improvement in confidence level for both home institution graduates (2.89 vs 3.53, P = 0.022) and other graduates (2.74 vs 3.34, P < 0.001). Similarly, participants from general surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P < 0.001) reported significant improvement in confidence. General surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.

Dietary Acid, Age, and Serum Bicarbonate Levels among Adults in the United States

PubMed Central

Amodu, Afolarin

2013-01-01

Summary Background and objectives Greater dietary acid has been associated with lower serum bicarbonate levels in patients with CKD. Whether this association extends to the general population and if it is modified by age are unknown. Design, setting, participants, & measurements This study examined the association of the dietary acid load, estimated by net endogenous acid production, with serum bicarbonate levels in adult participants in the National Health and Nutrition Examination Survey 1999–2004. Results The mean serum bicarbonate was 24.9 mEq/L (SEM=0.1), and the mean estimated net endogenous acid production was 57.4 mEq/d (SEM=0.4). Serum bicarbonate was linearly associated with age, such that the oldest participants had the highest serum bicarbonate levels. After multivariable adjustment, participants in the highest quartile of net endogenous acid production had 0.40 mEq/L (95% confidence interval, −0.55 to −0.26) lower serum bicarbonate and a 33% (95% confidence interval, 3 to 72) higher likelihood of acidosis compared with those participants in the lowest quartile. There was a significant interaction by age of the association of net endogenous acid production with serum bicarbonate (P=0.005). Among participants 20–39, 40–59, and ≥60 years old, those participants in the highest net endogenous acid production quartile had 0.26 (95% confidence interval, −0.49 to −0.03), 0.60 (95% confidence interval, −0.92 to −0.29), and 0.49 (95% confidence interval, −0.84 to −0.14) mEq/L lower serum bicarbonate, respectively, compared with participants in the lowest quartile. Conclusion Greater dietary acid is associated with lower serum bicarbonate in the general US population, and the magnitude of this association is greater among middle-aged and elderly persons than younger adults. PMID:24052219

Benefits for Adults with Transfemoral Amputations and Peripheral Artery Disease Using Microprocessor Compared with Nonmicroprocessor Prosthetic Knees.

PubMed

Wong, Christopher Kevin; Rheinstein, John; Stern, Michelle A

2015-10-01

Approximately 50% of people with leg amputation fall annually. Evidence suggests that microprocessor knees (MK) may decrease falls and improve prosthetic function in people with traumatic amputations. This study explored whether adults with transfemoral amputations and peripheral artery disease would have reduced falls and improved balance confidence, balance, and walking ability when using prostheses with MK compared with non-MK. This was a prospective cohort study. Eight subjects averaged 60.8 ± 11.3 yrs or age and 9.5 ± 16.1 yrs since first amputation. Four were K1-K2-level and four were K3-level functional walkers; only Houghton prosthetic use score was different between K1-K2 and K3 walkers (P = 0.03). After 48.3 ± 38.1 wks of acclimation using MK, subjects demonstrated improvements in fear of falling, balance confidence, Timed Up-and-Go time, and rate of falls (P < 0.05). The improvements in fear of falling, balance confidence, and rate of falls had large effect sizes (d > 0.80). Average decreased Timed Up-and-Go time (12.3 secs) had a medium effect size (d = 0.34). Decreases in the number of falls correlated with faster Timed Up-and-Go speed (ρ = -0.76) and greater balance confidence (ρ = 0.83). People with peripheral artery disease and transfemoral amputations had fewer falls and improved balance confidence and walking performance when using prostheses with MK.

Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals.

PubMed

Milutinović, Dragana; Andrijević, Ilija; Ličina, Milijana; Andrijević, Ljiljana

2015-01-01

This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals' confidence level in their own ability to perform first and last venipuncture. The average score on the knowledge test was higher in nurses' than in laboratory technicians (8.11±1.7, and 7.4±1.5, respectively). The difference in average scores was statistically significant (P=0.035) and Cohen's d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P=0.551). Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample.

Context retrieval and description benefits for recognition of unfamiliar faces.

PubMed

Jones, Todd C; Robinson, Kealagh; Steel, Brenna C

2018-04-19

Describing unfamiliar faces during or immediately after their presentation in a study phase can produce better recognition memory performance compared with a view-only control condition. We treated descriptions as elaborative information that is part of the study context and investigated how context retrieval influences recognition memory. Following general dual-process theories, we hypothesized that recollection would be used to recall descriptions and that description recall would influence recognition decisions, including the level of recognition confidence. In four experiments description conditions produced higher hit rates and higher levels of recognition confidence than control conditions. Participants recalled descriptive content on some trials, and this context retrieval was linked to an increase in the recognition confidence level. Repeating study faces in description conditions increased recognition scores, recognition confidence level, and context retrieval. Estimates of recollection from Yonelinas' (1994) dual-process signal detection ROCs were, on average, very close to the measures of context recall. Description conditions also produced higher estimates of familiarity. Finally, we found evidence that participants engaged in description activity in some ostensibly view-only trials. An emphasis on the information participants use in making their recognition decisions can advance understanding on description effects when descriptions are part of the study trial context. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma.

PubMed

Wegener, Stephen T; Carroll, Eben A; Gary, Joshua L; McKinley, Todd O; OʼToole, Robert V; Sietsema, Debra L; Castillo, Renan C; Frey, Katherine P; Scharfstein, Daniel O; Huang, Yanjie; Collins, Susan C J; MacKenzie, Ellen J

2017-08-01

The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC. Prospective cohort design. Level-I trauma centers. Attending surgeons and fellows (N = 95 Pre and N = 82 Post). Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources. Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery. Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Senior Medical Student Mock Interview Program in Pediatrics.

PubMed

Multerer, Sara; Carothers, Becky; Patel, Pradip D; Ziegler, Craig; Rowland, Michael; Davis, Deborah Winders

2016-02-01

Residency interviews play an integral part in medical residency placement. We aimed to develop and evaluate a mock interview program for fourth-year medical students interested in a pediatric specialty. A mock interview program for fourth-year medical students interested in pediatrics was developed and implemented. Preinterview quantitative data and postinterview qualitative data were collected. Fifty-nine students completed the program across three consecutive academic years. Preinterview surveys were completed regarding comfort and confidence levels specific to aspects of the interview process. Descriptive analyses were used. In addition, a focus group was held with nine of the participating students to obtain qualitative data via a paper blog process. Themes in student responses were identified through constant comparative analysis. Before the mock interview, students were most uncomfortable with introductory and closing remarks and their confidence levels varied by topic. A thematic analysis of focus group data identified five themes (preparation, stress reduction, interview process familiarity, confidence of skills, and receiving feedback) for which the mock interviews were most helpful. Implementation of a mock interview program was feasible and acceptable for senior medical students and may improve comfort and confidence levels in the residency interview process. Further longitudinal research is needed.

Nonparametric test of consistency between cosmological models and multiband CMB measurements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aghamousa, Amir; Shafieloo, Arman, E-mail: amir@apctp.org, E-mail: shafieloo@kasi.re.kr

2015-06-01

We present a novel approach to test the consistency of the cosmological models with multiband CMB data using a nonparametric approach. In our analysis we calibrate the REACT (Risk Estimation and Adaptation after Coordinate Transformation) confidence levels associated with distances in function space (confidence distances) based on the Monte Carlo simulations in order to test the consistency of an assumed cosmological model with observation. To show the applicability of our algorithm, we confront Planck 2013 temperature data with concordance model of cosmology considering two different Planck spectra combination. In order to have an accurate quantitative statistical measure to compare betweenmore » the data and the theoretical expectations, we calibrate REACT confidence distances and perform a bias control using many realizations of the data. Our results in this work using Planck 2013 temperature data put the best fit ΛCDM model at 95% (∼ 2σ) confidence distance from the center of the nonparametric confidence set while repeating the analysis excluding the Planck 217 × 217 GHz spectrum data, the best fit ΛCDM model shifts to 70% (∼ 1σ) confidence distance. The most prominent features in the data deviating from the best fit ΛCDM model seems to be at low multipoles  18 < ℓ < 26 at greater than 2σ, ℓ ∼ 750 at ∼1 to 2σ and ℓ ∼ 1800 at greater than 2σ level. Excluding the 217×217 GHz spectrum the feature at ℓ ∼ 1800 becomes substantially less significance at ∼1 to 2σ confidence level. Results of our analysis based on the new approach we propose in this work are in agreement with other analysis done using alternative methods.« less

Etiological classifications of transient ischemic attacks: subtype classification by TOAST, CCS and ASCO--a pilot study.

PubMed

Amort, Margareth; Fluri, Felix; Weisskopf, Florian; Gensicke, Henrik; Bonati, Leo H; Lyrer, Philippe A; Engelter, Stefan T

2012-01-01

In patients with transient ischemic attacks (TIA), etiological classification systems are not well studied. The Trial of ORG 10172 in Acute Stroke Treatment (TOAST), the Causative Classification System (CCS), and the Atherosclerosis Small Vessel Disease Cardiac Source Other Cause (ASCO) classification may be useful to determine the underlying etiology. We aimed at testing the feasibility of each of the 3 systems. Furthermore, we studied and compared their prognostic usefulness. In a single-center TIA registry prospectively ascertained over 2 years, we applied 3 etiological classification systems. We compared the distribution of underlying etiologies, the rates of patients with determined versus undetermined etiology, and studied whether etiological subtyping distinguished TIA patients with versus without subsequent stroke or TIA within 3 months. The 3 systems were applicable in all 248 patients. A determined etiology with the highest level of causality was assigned similarly often with TOAST (35.9%), CCS (34.3%), and ASCO (38.7%). However, the frequency of undetermined causes differed significantly between the classification systems and was lowest for ASCO (TOAST: 46.4%; CCS: 37.5%; ASCO: 18.5%; p < 0.001). In TOAST, CCS, and ASCO, cardioembolism (19.4/14.5/18.5%) was the most common etiology, followed by atherosclerosis (11.7/12.9/14.5%). At 3 months, 33 patients (13.3%, 95% confidence interval 9.3-18.2%) had recurrent cerebral ischemic events. These were strokes in 13 patients (5.2%; 95% confidence interval 2.8-8.8%) and TIAs in 20 patients (8.1%, 95% confidence interval 5.0-12.2%). Patients with a determined etiology (high level of causality) had higher rates of subsequent strokes than those without a determined etiology [TOAST: 6.7% (95% confidence interval 2.5-14.1%) vs. 4.4% (95% confidence interval 1.8-8.9%); CSS: 9.3% (95% confidence interval 4.1-17.5%) vs. 3.1% (95% confidence interval 1.0-7.1%); ASCO: 9.4% (95% confidence interval 4.4-17.1%) vs. 2.6% (95% confidence interval 0.7-6.6%)]. However, this difference was only significant in the ASCO classification (p = 0.036). Using ASCO, there was neither an increase in risk of subsequent stroke among patients with incomplete diagnostic workup (at least one subtype scored 9) compared with patients with adequate workup (no subtype scored 9), nor among patients with multiple causes compared with patients with a single cause. In TIA patients, all etiological classification systems provided a similar distribution of underlying etiologies. The increase in stroke risk in TIA patients with determined versus undetermined etiology was most evident using the ASCO classification. Copyright © 2012 S. Karger AG, Basel.

Sunlight exposure and cardiovascular risk factors in the REGARDS study: a cross-sectional split-sample analysis

PubMed Central

2014-01-01

Background Previous research has suggested that vitamin D and sunlight are related to cardiovascular outcomes, but associations between sunlight and risk factors have not been investigated. We examined whether increased sunlight exposure was related to improved cardiovascular risk factor status. Methods Residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine previous-year sunlight radiation exposure for 17,773 black and white participants aged 45+ from the US. Exploratory and confirmatory analyses were performed by randomly dividing the sample into halves. Logistic regression models were used to examine relationships with cardiovascular risk factors. Results The lowest, compared to the highest quartile of insolation exposure was associated with lower high-density lipoprotein levels in adjusted exploratory (−2.7 mg/dL [95% confidence interval: −4.2, −1.2]) and confirmatory (−1.5 mg/dL [95% confidence interval: −3.0, −0.1]) models. The lowest, compared to the highest quartile of insolation exposure was associated with higher systolic blood pressure levels in unadjusted exploratory and confirmatory, as well as the adjusted exploratory model (2.3 mmHg [95% confidence interval: 0.8, 3.8]), but not the adjusted confirmatory model (1.6 mg/dL [95% confidence interval: −0.5, 3.7]). Conclusions The results of this study suggest that lower long-term sunlight exposure has an association with lower high-density lipoprotein levels. However, all associations were weak, thus it is not known if insolation may affect cardiovascular outcomes through these risk factors. PMID:24946776

Attitudes towards credit and finances among college students in China and the United States.

PubMed

Norvilitis, Jill M; Mao, Yingmei

2013-01-01

Although there is growing concern about the issue of credit card debt among college students in China, little research has examined attitudes to money and debt among that group. The present study compared financial self-confidence, perceived financial wellbeing, attitudes to debt, and parent education about money and debt in 410 college students from the US and China. Although college students in China reported fewer credit cards and less debt, they also reported lower levels of financial self-confidence and financial wellbeing. In both cultures, delay of gratification and parental education predicted both self-confidence and financial wellbeing.

Calibration with confidence: a principled method for panel assessment.

PubMed

MacKay, R S; Kenna, R; Low, R J; Parker, S

2017-02-01

Frequently, a set of objects has to be evaluated by a panel of assessors, but not every object is assessed by every assessor. A problem facing such panels is how to take into account different standards among panel members and varying levels of confidence in their scores. Here, a mathematically based algorithm is developed to calibrate the scores of such assessors, addressing both of these issues. The algorithm is based on the connectivity of the graph of assessors and objects evaluated, incorporating declared confidences as weights on its edges. If the graph is sufficiently well connected, relative standards can be inferred by comparing how assessors rate objects they assess in common, weighted by the levels of confidence of each assessment. By removing these biases, 'true' values are inferred for all the objects. Reliability estimates for the resulting values are obtained. The algorithm is tested in two case studies: one by computer simulation and another based on realistic evaluation data. The process is compared to the simple averaging procedure in widespread use, and to Fisher's additive incomplete block analysis. It is anticipated that the algorithm will prove useful in a wide variety of situations such as evaluation of the quality of research submitted to national assessment exercises; appraisal of grant proposals submitted to funding panels; ranking of job applicants; and judgement of performances on degree courses wherein candidates can choose from lists of options.

Calibration with confidence: a principled method for panel assessment

PubMed Central

MacKay, R. S.; Low, R. J.; Parker, S.

2017-01-01

Frequently, a set of objects has to be evaluated by a panel of assessors, but not every object is assessed by every assessor. A problem facing such panels is how to take into account different standards among panel members and varying levels of confidence in their scores. Here, a mathematically based algorithm is developed to calibrate the scores of such assessors, addressing both of these issues. The algorithm is based on the connectivity of the graph of assessors and objects evaluated, incorporating declared confidences as weights on its edges. If the graph is sufficiently well connected, relative standards can be inferred by comparing how assessors rate objects they assess in common, weighted by the levels of confidence of each assessment. By removing these biases, ‘true’ values are inferred for all the objects. Reliability estimates for the resulting values are obtained. The algorithm is tested in two case studies: one by computer simulation and another based on realistic evaluation data. The process is compared to the simple averaging procedure in widespread use, and to Fisher's additive incomplete block analysis. It is anticipated that the algorithm will prove useful in a wide variety of situations such as evaluation of the quality of research submitted to national assessment exercises; appraisal of grant proposals submitted to funding panels; ranking of job applicants; and judgement of performances on degree courses wherein candidates can choose from lists of options. PMID:28386432

Regional intensity attenuation models for France and the estimation of magnitude and location of historical earthquakes

USGS Publications Warehouse

Bakun, W.H.; Scotti, O.

2006-01-01

Intensity assignments for 33 calibration earthquakes were used to develop intensity attenuation models for the Alps, Armorican, Provence, Pyrenees and Rhine regions of France. Intensity decreases with ?? most rapidly in the French Alps, Provence and Pyrenees regions, and least rapidly in the Armorican and Rhine regions. The comparable Armorican and Rhine region attenuation models are aggregated into a French stable continental region model and the comparable Provence and Pyrenees region models are aggregated into a Southern France model. We analyse MSK intensity assignments using the technique of Bakun & Wentworth, which provides an objective method for estimating epicentral location and intensity magnitude MI. MI for the 1356 October 18 earthquake in the French stable continental region is 6.6 for a location near Basle, Switzerland, and moment magnitude M is 5.9-7.2 at the 95 per cent (??2??) confidence level. MI for the 1909 June 11 Trevaresse (Lambesc) earthquake near Marseilles in the Southern France region is 5.5, and M is 4.9-6.0 at the 95 per cent confidence level. Bootstrap resampling techniques are used to calculate objective, reproducible 67 per cent and 95 per cent confidence regions for the locations of historical earthquakes. These confidence regions for location provide an attractive alternative to the macroseismic epicentre and qualitative location uncertainties used heretofore. ?? 2006 The Authors Journal compilation ?? 2006 RAS.

Traffic-related air pollution: Exposure and health effects in Copenhagen street cleaners and cemetery workers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raaschou-Nielsen, O.; Nielsen, M.L.; Gehl, J.

This questionaire-based study found a significantly higher prevalence of chronic bronchitis, asthma, and several other symptoms in 116 Copenhagen street cleaners who were exposed to traffic-related air pollution at levels that were slightly lower than the 1987 World Health Organization-recommended threshold values, compared with 115 Copenhagen cemetery workers exposed to lower pollution levels. Logistic regression analysis, controlling for age and smoking, was conducted, and odds ratios and 95% confidence intervals were calculated to be 2.5 for chronic bronchitis (95% confidence interval = 1.2-5.1), 2.3 for asthma (95% confidence interval = 1.0-5.1), and 1.8-7.9 for other symptoms (95% confidence interval =more » 1.0-28.2). Except for exposure to air pollution, the two groups were comparable, i.e., they had similar terms of employment and working conditions. the exposure ranges during an 8-h work day, averaged from readings taken at five monitored street positions, were: 41-257 ppb nitric oxide (1-h max: 865 ppb); 23-43 ppb nitrogen dioxide (1-h max: 208 ppb); 1.0-4.3 ppm carbon monoxide (8-h max: 7.1 ppm); 14-28 ppb sulfur dioxide (1-h max; 112 ppb); and 10-38 ppb ozone (1-h max: 72 ppb). 33 refs., 7 tabs.« less

Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals

PubMed Central

Milutinović, Dragana; Andrijević, Ilija; Ličina, Milijana; Andrijević, Ljiljana

2015-01-01

Introduction This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. Materials and methods A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals’ confidence level in their own ability to perform first and last venipuncture. Results The average score on the knowledge test was higher in nurses’ than in laboratory technicians (8.11 ± 1.7, and 7.4 ± 1.5, respectively). The difference in average scores was statistically significant (P = 0.035) and Cohen’s d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P = 0.551). Conclusion Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample. PMID:26527124

The assessment of data sources for influenza virologic surveillance in New York State.

PubMed

Escuyer, Kay L; Waters, Christine L; Gowie, Donna L; Maxted, Angie M; Farrell, Gregory M; Fuschino, Meghan E; St George, Kirsten

2017-03-01

Following the 2013 USA release of the Influenza Virologic Surveillance Right Size Roadmap, the New York State Department of Health (NYSDOH) embarked on an evaluation of data sources for influenza virologic surveillance. To assess NYS data sources, additional to data generated by the state public health laboratory (PHL), which could enhance influenza surveillance at the state and national level. Potential sources of laboratory test data for influenza were analyzed for quantity and quality. Computer models, designed to assess sample sizes and the confidence of data for statistical representation of influenza activity, were used to compare PHL test data to results from clinical and commercial laboratories, reported between June 8, 2013 and May 31, 2014. Sample sizes tested for influenza at the state PHL were sufficient for situational awareness surveillance with optimal confidence levels, only during peak weeks of the influenza season. Influenza data pooled from NYS PHLs and clinical laboratories generated optimal confidence levels for situational awareness throughout the influenza season. For novel influenza virus detection in NYS, combined real-time (rt) RT-PCR data from state and regional PHLs achieved ≥85% confidence during peak influenza activity, and ≥95% confidence for most of low season and all of off-season. In NYS, combined data from clinical, commercial, and public health laboratories generated optimal influenza surveillance for situational awareness throughout the season. Statistical confidence for novel virus detection, which is reliant on only PHL data, was achieved for most of the year. © 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Growth hormone in intra-uterine growth retarded newborns.

PubMed

Setia, Sajita; Sridhar, M G; Bhat, Vishnu; Chaturvedula, Latha

2007-11-01

To study growth hormone levels in IUGR and healthy controls and its association with birth weight and ponderal index. We studied 50 Intra uterine growth retarded (IUGR) and 50 healthy newborns born at term by vaginal delivery in JIPMER, Pondicherry, India. Cord blood was collected at the time of delivery for measurement of growth hormone. When compared with healthy newborns, IUGR newborns had higher growth hormone levels (mean +/- SD, 23.5 +/- 15.6 vs 16.2 +/- 7.61 ngm/ml, P = 0.019). A negative correlation was identified between growth hormone levels and birth weight (r2 = - 0.22, P = 0.03) and ponderal index (r2 = - 0.36, P = 0.008). Correlation of growth hormone levels was much more confident with ponderal index than with birth weight. At birth IUGR infants display increased growth hormone levels which correlate with ponderal index much more confidently than with birth weight.

Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

PubMed Central

Patel, Archita D.; Meurer, David A.; Shuster, Jonathan J.

2016-01-01

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P < 0.001). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77). Conclusion. Simulation training improved prehospital care providers' confidence level in performing two life-saving procedures. PMID:27563467

[Effects of a workbook program on the perceived stress level, maternal role confidence and breast feeding practice of mothers of premature infants].

PubMed

Jang, Yung-Sook

2005-04-01

The purpose of this study was to identify the effects of a workbook program on percieved stress levels, maternal role confidence and breastfeeding practices of mothers of premature infants. This study employed a quasi-experimental non-equivalent pre-and-post test to compare the two groups. Data was collected from 32 subjects from March 10. to September 5, 2003 at an NICU located in S. city. In the sample, fifteen mothers were in the experimental group and seventeen were in the control group. A workbook program was provided twice during a period from two-three days after the baby's admission to one week after the first intervention. The instruments used were the PSS and self confidence scale. Data was analyzed by means of frequency, SD, chi(2)-test, Fisher's exact test, Mann-Whitney test, and the Wilcoxon signed rank test. There was a significant difference in perceived stress levels between the experimental and control group (U=2.366, p=.018). There was not a significant difference in maternal role confidence between the two groups (U=1.002, p=.316). There was a significant difference in breastfeeding practice between the two groups (chi(2)= 4.910, p=.035). It is concluded that a program using a workbook has a positive effect on decreasing the perceived stress level and increasing breastfeeding practice.

Comparison of physical examination performance of medical students trained by musculoskeletal versus non-musculoskeletal specialists.

PubMed

Melo, Luciano; Schrieber, Leslie; Eyles, Jillian; Deveza, Leticia A; Meneses, Sarah R F; Hunter, David J

2017-04-01

To compare the musculoskeletal (MSK) physical examination skills, knowledge acquisition and performance of first-year medical students trained by MSK specialist tutors to students trained by non-MSK specialist tutors, after a 6-week MSK physical examination tutorial program. Twenty-first year medical students took part in the study. They were recruited into two groups, according to their exposure to either an MSK specialist or a non-MSK specialist tutor during their 6-week MSK training block. Knowledge acquisition was measured via a pre- and post-training objective structured clinical examination (OSCE). We assessed students' self-belief and confidence levels regarding their newly acquired skills via a questionnaire. Independent t tests were used to examine mean group differences of OSCE scores and perceived level of confidence. Both groups demonstrated a significant improvement (3.9 and 3.8 points, respectively, on an eight-point scale for shoulder assessment, P < 0.01, 3.3 and 3.5, respectively, on a five-point scale for spine assessment, P < 0.01) in OSCE scores compared to baseline after completing the 6-week MSK physical examination tutorial program. There was no between-group difference in the OSCE scores from pre- to post-training (P = 0.92 for shoulder, P = 0.66 for spine) or for perceived level of confidence in performing a basic MSK examination after training (P = 0.91). Students exposed to MSK specialist tutors did not demonstrate increased skill levels or knowledge in the area of MSK physical examination compared to those receiving the same training under the supervision of non-MSK specialist tutors. Both student groups demonstrated improvement. © 2017 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

The effects of divided attention at study and reporting procedure on regulation and monitoring for episodic recall.

PubMed

Sauer, James; Hope, Lorraine

2016-09-01

Eyewitnesses regulate the level of detail (grain size) reported to balance competing demands for informativeness and accuracy. However, research to date has predominantly examined metacognitive monitoring for semantic memory tasks, and used relatively artificial phased reporting procedures. Further, although the established role of confidence in this regulation process may affect the confidence-accuracy relation for volunteered responses in predictable ways, previous investigations of the confidence-accuracy relation for eyewitness recall have largely overlooked the regulation of response granularity. Using a non-phased paradigm, Experiment 1 compared reporting and monitoring following optimal and sub-optimal (divided attention) encoding conditions. Participants showed evidence of sacrificing accuracy for informativeness, even when memory quality was relatively weak. Participants in the divided (cf. full) attention condition showed reduced accuracy for fine- but not coarse-grained responses. However, indices of discrimination and confidence diagnosticity showed no effect of divided attention. Experiment 2 compared the effects of divided attention at encoding on reporting and monitoring using both non-phased and 2-phase procedures. Divided attention effects were consistent with Experiment 1. However, compared to those in the non-phased condition, participants in the 2-phase condition displayed a more conservative control strategy, and confidence ratings were less diagnostic of accuracy. When memory quality was reduced, although attempts to balance informativeness and accuracy increased the chance of fine-grained response errors, confidence provided an index of the likely accuracy of volunteered fine-grained responses for both condition. Copyright © 2016 Elsevier B.V. All rights reserved.

A Comparison of Various Stress Rupture Life Models for Orbiter Composite Pressure Vessels and Confidence Intervals

NASA Technical Reports Server (NTRS)

Grimes-Ledesma, Lorie; Murthy, Pappu L. N.; Phoenix, S. Leigh; Glaser, Ronald

2007-01-01

In conjunction with a recent NASA Engineering and Safety Center (NESC) investigation of flight worthiness of Kevlar Overwrapped Composite Pressure Vessels (COPVs) on board the Orbiter, two stress rupture life prediction models were proposed independently by Phoenix and by Glaser. In this paper, the use of these models to determine the system reliability of 24 COPVs currently in service on board the Orbiter is discussed. The models are briefly described, compared to each other, and model parameters and parameter uncertainties are also reviewed to understand confidence in reliability estimation as well as the sensitivities of these parameters in influencing overall predicted reliability levels. Differences and similarities in the various models will be compared via stress rupture reliability curves (stress ratio vs. lifetime plots). Also outlined will be the differences in the underlying model premises, and predictive outcomes. Sources of error and sensitivities in the models will be examined and discussed based on sensitivity analysis and confidence interval determination. Confidence interval results and their implications will be discussed for the models by Phoenix and Glaser.

Exact one-sided confidence limits for the difference between two correlated proportions.

PubMed

Lloyd, Chris J; Moldovan, Max V

2007-08-15

We construct exact and optimal one-sided upper and lower confidence bounds for the difference between two probabilities based on matched binary pairs using well-established optimality theory of Buehler. Starting with five different approximate lower and upper limits, we adjust them to have coverage probability exactly equal to the desired nominal level and then compare the resulting exact limits by their mean size. Exact limits based on the signed root likelihood ratio statistic are preferred and recommended for practical use.

Detection of simulated microcalcifications in fixed mammary tissue: An ROC study of the effect of local versus global histogram equalization.

PubMed

Sund, T; Olsen, J B

2006-09-01

To investigate whether sliding window adaptive histogram equalization (SWAHE) of digital mammograms improves the detection of simulated calcifications, as compared to images normalized by global histogram equalization (GHE). Direct digital mammograms were obtained from mammary tissue phantoms superimposed with different frames. Each frame was divided into forty squares by a wire mesh, and contained granular calcifications randomly positioned in about 50% of the squares. Three radiologists read the mammograms on a display monitor. They classified their confidence in the presence of microcalcifications in each square on a scale of 1 to 5. Images processed with GHE were first read and used as a reference. In a later session, the same images processed with SWAHE were read. The results were compared using ROC methodology. When the total areas AZ were compared, the results were completely equivocal. When comparing the high-specificity partial ROC area AZ,0.2 below false-positive fraction (FPF) 0.20, two of the three observers performed best with the images processed with SWAHE. The difference was not statistically significant. When the reader's confidence threshold in malignancy is set at a high level, increasing the contrast of mammograms with SWAHE may enhance the visibility of microcalcifications without adversely affecting the false-positive rate. When the reader's confidence threshold is set at a low level, the effect of SWAHE is an increase of false positives. Further investigation is needed to confirm the validity of the conclusions.

Education level and inequalities in stroke reperfusion therapy: observations in the Swedish stroke register.

PubMed

Stecksén, Anna; Glader, Eva-Lotta; Asplund, Kjell; Norrving, Bo; Eriksson, Marie

2014-09-01

Previous studies have revealed inequalities in stroke treatment based on demographics, hospital type, and region. We used the Swedish Stroke Register (Riksstroke) to test whether patient education level is associated with reperfusion (either or both of thrombolysis and thrombectomy) treatment. We included 85 885 patients with ischemic stroke aged 18 to 80 years registered in Riksstroke between 2003 and 2009. Education level was retrieved from Statistics Sweden, and thrombolysis, thrombectomy, patient, and hospital data were obtained from Riksstroke. We used multivariable logistic regression to analyze the association between reperfusion therapy and patient education. A total of 3649 (4.2%) of the patients received reperfusion therapy. University-educated patients were more likely to be treated (5.5%) than patients with secondary (4.6%) or primary education (3.6%; P<0.001). The inequality associated with education was still present after adjustment for patient characteristics; university education odds ratio, 1.14; 95% confidence interval, 1.03 to 1.26 and secondary education odds ratio, 1.08; 95% confidence interval, 1.00 to 1.17 compared with primary education. Higher hospital specialization level was also associated with higher reperfusion levels (P<0.001). In stratified multivariable analyses by hospital type, significant treatment differences by education level existed only among large nonuniversity hospitals (university education odds ratio, 1.20; 95% confidence interval, 1.04-1.40; secondary education odds ratio, 1.14; 95% confidence interval, 1.01-1.29). We demonstrated a social stratification in reperfusion, partly explained by patient characteristics and the local hospital specialization level. Further studies should address treatment delays, stroke knowledge, and means to improve reperfusion implementation in less specialized hospitals. © 2014 American Heart Association, Inc.

Numeracy skills of undergraduate entry level nurse, midwife and pharmacy students.

PubMed

Arkell, Sharon; Rutter, Paul M

2012-07-01

The ability of healthcare professionals to perform basic numeracy and therefore dose calculations competently is without question. Research has primarily focused on nurses, and to a lesser extent doctors, ability to perform this function with findings highlighting poor aptitude. Studies involving pharmacists are few but findings are more positive than other healthcare staff. To determine first year nursing, midwifery and pharmacy students ability to perform basic numeracy calculations. All new undergraduate entrants to nursing, midwifery and pharmacy sat a formative numeracy test within the first two weeks of their first year of study. Test results showed that pharmacy students significantly outperformed midwifery and nursing students on all questions. In turn midwifery students outperformed nurses, although this did not achieve significance. When looking at each cohorts general attitude towards mathematics, pharmacy students were more positive and confident compared to midwifery and nursing students. Pharmacy students expressed greater levels of enjoyment and confidence in performing mathematics and correspondingly showed the greatest proficiency. In contrast nurse, and to a lesser extent midwifery students showed poor performance and low confidence levels. Copyright © 2012 Elsevier Ltd. All rights reserved.

Associations between age-related nuclear cataract and lutein and zeaxanthin in the diet and serum in the Carotenoids in the Age-Related Eye Disease Study, an Ancillary Study of the Women's Health Initiative.

PubMed

Moeller, Suzen M; Voland, Rick; Tinker, Lesley; Blodi, Barbara A; Klein, Michael L; Gehrs, Karen M; Johnson, Elizabeth J; Snodderly, D Max; Wallace, Robert B; Chappell, Richard J; Parekh, Niyati; Ritenbaugh, Cheryl; Mares, Julie A

2008-03-01

To evaluate associations between nuclear cataract (determined from slitlamp photographs between May 2001 and January 2004) and lutein and zeaxanthin in the diet and serum in patients between 1994 and 1998 and macula between 2001 and 2004. A total of 1802 women aged 50 to 79 years in Iowa, Wisconsin, and Oregon with intakes of lutein and zeaxanthin above the 78th (high) and below the 28th (low) percentiles in the Women's Health Initiative Observational Study (1994-1998) were recruited 4 to 7 years later (2001-2004) into the Carotenoids in Age-Related Eye Disease Study. Women in the group with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of nuclear cataract (age-adjusted odds ratio, 0.77; 95% confidence interval, 0.62-0.96) compared with those with low levels. Multivariable adjustment slightly attenuated the association (odds ratio, 0.81; 95% confidence interval, 0.65-1.01). Women in the highest quintile category of diet or serum levels of lutein and zeaxanthin as compared with those in the lowest quintile category were 32% less likely to have nuclear cataract (multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.97; P for trend = .04; and multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.47-0.98; P for trend = .01, respectively). Cross-sectional associations with macular pigment density were inverse but not statistically significant. Diets rich in lutein and zeaxanthin are moderately associated with decreased prevalence of nuclear cataract in older women. However, other protective aspects of such diets may in part explain these relationships.

Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation.

PubMed

Fuenzalida Squella, Sara Agueda; Kannenberg, Andreas; Brandão Benetti, Ângelo

2018-04-01

Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes. To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees. Comparative within-subject clinical study. A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor-enhanced knee. Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions. The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects' satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees. Clinical relevance This study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

76 FR 60572 - Self-Regulatory Organizations; The Options Clearing Corporation; Order Approving Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

..., 2008), 73 FR 42646 (July 22, 2008) (SR-OCC-2007-20)); give itself time to prepare updated comparative...\\ Proposed Interpretation and Policy .01 to OCC Rule 1001. The new formula is designed to more directly take...\\ \\10\\ Note the comparative data described in this paragraph was obtained using confidence levels set at...

Assessing pharmacists' readiness to prescribe oral antibiotics for limited infections using a case-vignette technique.

PubMed

Ung, Elizabeth; Czarniak, Petra; Sunderland, Bruce; Parsons, Richard; Hoti, Kreshnik

2017-02-01

Background Pharmacist's skills are underutilized whilst they are directly involved with antibiotic supply to the community. Addressing this issue could lead to better use of antibiotics and hence decreased resistance. Objective Explore how pharmacists can prescribe oral antibiotics to treat a limited range of infections whilst focusing on their confidence and appropriateness of prescribing. Setting Community pharmacies, Western Australia. Method Data were collected using a self-administered questionnaire also containing case vignettes. These were distributed to a random sample of metropolitan and rural community pharmacies in Western Australia. A Generalised Estimating Equation was used to compare respondents' level of confidence in treating various infections and to assess appropriateness of prescribing. Main outcome measure Appropriateness and confidence of antibiotic prescribing. Results A response rate of 34.2% (i.e. 425 responses to case vignettes) was achieved from 240 pharmacies. There were high levels of confidence to treat simple infections such as uncomplicated UTIs (n = 73; 89.0%), impetigo (n = 65; 79.3%), mild bacterial skin infections (n = 62; 75.6%) and moderate acne (n = 61; 72.4%). Over 80% of respondents were confident to prescribe amoxicillin (n = 73; 89%), trimethoprim (n = 72; 87.8%), amoxicillin and clavulanic acid (n = 70; 85.4%), flucloxacillin (n = 70; 85.4%) and cephalexin (n = 68; 82.9%). High levels of appropriate antibiotic prescribing were shown for uncomplicated UTI (97.2%), cellulitis (98.2%) and adolescent acne (100.0%). Conclusion This study identified key limited infections and antibiotics for which pharmacists were supportive and confident to prescribe. This role could lead to better use of antibiotics in the community and minimisation of resistance.

Confidence level estimation in multi-target classification problems

NASA Astrophysics Data System (ADS)

Chang, Shi; Isaacs, Jason; Fu, Bo; Shin, Jaejeong; Zhu, Pingping; Ferrari, Silvia

2018-04-01

This paper presents an approach for estimating the confidence level in automatic multi-target classification performed by an imaging sensor on an unmanned vehicle. An automatic target recognition algorithm comprised of a deep convolutional neural network in series with a support vector machine classifier detects and classifies targets based on the image matrix. The joint posterior probability mass function of target class, features, and classification estimates is learned from labeled data, and recursively updated as additional images become available. Based on the learned joint probability mass function, the approach presented in this paper predicts the expected confidence level of future target classifications, prior to obtaining new images. The proposed approach is tested with a set of simulated sonar image data. The numerical results show that the estimated confidence level provides a close approximation to the actual confidence level value determined a posteriori, i.e. after the new image is obtained by the on-board sensor. Therefore, the expected confidence level function presented in this paper can be used to adaptively plan the path of the unmanned vehicle so as to optimize the expected confidence levels and ensure that all targets are classified with satisfactory confidence after the path is executed.

Comparison of Practices, Knowledge, Confidence, and Attitude toward Oral Cancer among Oral Health Professionals between Japan and Australia.

PubMed

Haresaku, Satoru; Makino, Michiko; Sugiyama, Seiichi; Naito, Toru; Mariño, Rodrigo Jose

2018-04-01

The purpose of this study was to investigate the practices, knowledge, confidence, and attitude toward oral cancer among Japanese oral health professionals (J-OHPs) and to identify Japanese-specific problems in oral cancer practices by comparing them between Japan and Australia. A questionnaire survey regarding oral cancer practices among Australian oral health professionals (Au-OHPs) was conducted in Australia in 2014-2015. The questionnaire was translated into Japanese, and a Web-based questionnaire survey was conducted among 131 Japanese dentists (J-Dentists) and 131 dental hygienists (J-DHs) in 2016. To compare the J-OHPs' findings with the Au-OHPs', the data of Australian dentists (Au-dentists) and Australian dental hygienists (Au-DHs) were extracted from the Australian survey. Those findings were then compared via a statistical analysis. Eighty-two J-Dentists, 55 J-DHs, 214 Au-Dentists, and 45 Au-DHs participated in this study. Only 34.1 % of J-Dentists and 36.4 % of J-DHs performed oral cancer screenings on their patients; J-OHPs were significantly less likely to perform them than Au-OHPs. The level of knowledge and confidence regarding oral cancer among JOHPs were significantly lower than among Au-OHPs. About 90 % of J-OHPs felt that they needed additional training in oral cancer practices. Less than 40 % of J-OHPs performed oral cancer screenings in their patients. The low level of knowledge and confidence regarding oral cancer among JOHPs may contribute to their low performance of oral cancer practices. Therefore, further education and training programs for oral cancer practices should be provided to Japanese OHPs for the prevention and early detection of oral cancer.

Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction.

PubMed

Hwang, Shin Hye; You, Je Sung; Song, Mi Kyong; Choi, Jin-Young; Kim, Myeong-Jin; Chung, Yong Eun

2015-04-01

To evaluate feasibility of radiation dose reduction by optimal phase selection of computed tomography (CT) in patients who visited the emergency department (ED) for abdominal pain. We included 253 patients who visited the ED for abdominal pain. They underwent multiphasic CT including precontrast, late arterial phase (LAP), and hepatic venous phase (HVP). Three image sets (HVP, precontrast + HVP, and precontrast + LAP + HVP) were reviewed. Two reviewers determined the most appropriate diagnosis with five-point confidence scale. Diagnostic performances were compared among image sets by weighted-least-squares method or DeLong's method. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. There was no difference in diagnostic performance among three image sets, although diagnostic confidence level was significantly improved after review of triphasic images compared with both HVP images only or HVP with precontrast images (confidence scale, 4.64 ± 0.05, 4.66 ± 0.05, and 4.76 ± 0.04 in the order of the sets; overall P = 0.0008). Similar trends were observed in the subgroup analysis for diagnosis of pelvic inflammatory disease and cholecystitis. There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. • There was no difference in diagnostic performance of HVP CT and multiphasic CT. • The diagnostic confidence level was improved after review of the LAP images. • HVP CT can achieve diagnostic performance similar to that of multiphasic CT, while minimizing radiation.

Lead in a Baltimore shipyard.

PubMed

Hall, Francis X

2006-12-01

The goal was to monitor the effectiveness of the Coast Guard Yard's lead program by comparing a shipyard period in 1991 to one in 2002-2003. Comparisons of airborne lead levels by paint removal techniques, airborne lead levels by welding techniques, and blood lead levels of workers were evaluated by chi2 analysis. Airborne lead levels in paint removal techniques decreased over time for all methods used. Airborne lead levels in welding techniques decreased over time for all methods used. Blood lead levels of the high-risk group revealed a 2-fold reduction (prevalence rate ratio = 8.3; 95% confidence interval, 3.7-18.6) and in the low-risk group revealed a 1.6-fold reduction (prevalence rate ratio = 6.2; 95% confidence interval, 0.86-44.7). The Coast Guard Yard runs an effective lead program that exceeds the national Healthy People 2010 goal for lead. The results validate the Coast Guard Yard's use of air-line respirators and lead-free paint on all vessels.

Impact of Balance Confidence on Daily Living Activities of Older People with Knee Osteoarthritis with Regard to Balance, Physical Function, Pain, and Quality of Life - A Preliminary Report.

PubMed

Bobić Lucić, Lana; Grazio, Simeon

2018-01-01

The objective of this study was to explore the impact of balance confidence on different activities of daily living (ADL) in older people with knee osteoarthritis (OA). Forty-seven consecutive participants with knee OA were included in this cross-sectional study. They were divided according to the results of the Activities-specific Balance Confidence (ABC) Scale into a group with a low level of confidence in physical functioning (ABC < 50, n = 22) and a group with moderate and high levels of confidence (ABC ≥ 50, n = 25). In the ABC < 50 group, the effect of pain on ADL, the physician's global assessment of the disease, and the Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly higher, while quality of life (Short form-36) was lower compared to the ABC ≥ 50 group. No significant difference was found between the two groups regarding the static and dynamic balance measurements. Older people with knee OA who were less confident in their daily physical activities had more physical difficulties and a greater effect of pain on ADL, lower quality of life, and a higher physician's global assessment, but no differences were obtained in balance tests. In people with knee OA, decreased balance confidence is associated with more physical difficulties, an increased effect of pain on ADL, and lower quality of life. An improved awareness of decreased balance confidence may lead to more effective management of older people with knee OA by improving their mobility and QOL through rehabilitation. Furthermore, future research in that direction is warranted.

Socioeconomic position and education in patients with coeliac disease.

PubMed

Olén, Ola; Bihagen, Erik; Rasmussen, Finn; Ludvigsson, Jonas F

2012-06-01

Socioeconomic position and education are strongly associated with several chronic diseases, but their relation to coeliac disease is unclear. We examined educational level and socioeconomic position in patients with coeliac disease. We identified 29,096 patients with coeliac disease through biopsy reports (defined as Marsh 3: villous atrophy) from all Swedish pathology departments (n=28). Age- and sex-matched controls were randomly sampled from the Swedish Total Population Register (n=145,090). Data on level of education and socioeconomic position were obtained from the Swedish Education Register and the Occupational Register. We calculated odds ratios for the risk of having coeliac disease based on socioeconomic position according to the European Socioeconomic Classification (9 levels) and education. Compared to individuals with high socioeconomic position (level 1 of 9) coeliac disease was less common in the lowest socioeconomic stratum (routine occupations=level 9 of 9: adjusted odds ratio=0.89; 95% confidence interval=0.84-0.94) but not less common in individuals with moderately low socioeconomic position: (level 7/9: adjusted odds ratio=0.96; 95% confidence interval=0.91-1.02; and level 8/9: adjusted odds ratio=0.99; 95% confidence interval=0.93-1.05). Coeliac disease was not associated with educational level. In conclusion, diagnosed coeliac disease was slightly less common in individuals with low socioeconomic position but not associated with educational level. Coeliac disease may be unrecognised in individuals of low socioeconomic position. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Comparison of human and algorithmic target detection in passive infrared imagery

NASA Astrophysics Data System (ADS)

Weber, Bruce A.; Hutchinson, Meredith

2003-09-01

We have designed an experiment that compares the performance of human observers and a scale-insensitive target detection algorithm that uses pixel level information for the detection of ground targets in passive infrared imagery. The test database contains targets near clutter whose detectability ranged from easy to very difficult. Results indicate that human observers detect more "easy-to-detect" targets, and with far fewer false alarms, than the algorithm. For "difficult-to-detect" targets, human and algorithm detection rates are considerably degraded, and algorithm false alarms excessive. Analysis of detections as a function of observer confidence shows that algorithm confidence attribution does not correspond to human attribution, and does not adequately correlate with correct detections. The best target detection score for any human observer was 84%, as compared to 55% for the algorithm for the same false alarm rate. At 81%, the maximum detection score for the algorithm, the same human observer had 6 false alarms per frame as compared to 29 for the algorithm. Detector ROC curves and observer-confidence analysis benchmarks the algorithm and provides insights into algorithm deficiencies and possible paths to improvement.

Electives in complementary medicine: are we preaching to the choir?

PubMed

Kemper, Kathi J; Larrimore, Deborah; Dozier, Jean; Woods, Charles

2005-11-01

Many medical schools offer electives on complementary medicine, but little is known about the characteristics of students who sign up for such electives compared with those who do not. Compare enrollees to nonenrollees in an elective course on therapeutic touch and healing touch (TTHT). Cross-sectional survey. Wake Forest University School of Medicine, second-year course on medicine as a profession. Second-year medical students who returned surveys: 22 who signed up for an elective on TTHT and 58 who did not. Anonymous surveys included questions about demographics, attitudes, practices, and the Maslach Burnout Inventory (MBI). Those who signed up for the elective were more likely to be women (73% for TTHT vs 33% for others, P < .01). Nearly all students thought that being centered and compassionate were very important. Students who signed up for TTHT were less likely to report feeling confident in being able to be centered when it was quiet (41% vs 64%, respectively, very confident, P < .04) and less confident in their ability to demonstrate nonverbal comforting behaviors (9% vs 43%, respectively, very confident, P = .02). Only 18% of elective vs 66% of others reported being centered during patient encounters (P < .001). The TTHT students and their classmates reported comparable levels of burnout. Elective students were no more likely than classmates to believe that it is very important to be centered and to extend compassion toward patients; they reported being less confident and practicing these skills less often than their classmates. Burnout was not less common among those in the elective. Electives may not be "preaching to the choir." Future studies need to determine whether training enhances confidence and skills and whether it protects against developing burnout.

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey.

PubMed

Larson, Heidi J; de Figueiredo, Alexandre; Xiahong, Zhao; Schulz, William S; Verger, Pierre; Johnston, Iain G; Cook, Alex R; Jones, Nick S

2016-10-01

Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey - which we believe represents the largest survey on confidence in immunization to date - examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. Regular monitoring of vaccine attitudes - coupled with monitoring of local immunization rates - at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Optimal Monochromatic Energy Levels in Spectral CT Pulmonary Angiography for the Evaluation of Pulmonary Embolism

PubMed Central

Wu, Huawei; Zhang, Qing; Hua, Jia; Hua, Xiaolan; Xu, Jianrong

2013-01-01

Background The aim of this study was to determine the optimal monochromatic spectral CT pulmonary angiography (sCTPA) levels to obtain the highest image quality and diagnostic confidence for pulmonary embolism detection. Methods The Institutional Review Board of the Shanghai Jiao Tong University School of Medicine approved this study, and written informed consent was obtained from all participating patients. Seventy-two patients with pulmonary embolism were scanned with spectral CT mode in the arterial phase. One hundred and one sets of virtual monochromatic spectral (VMS) images were generated ranging from 40 keV to 140 keV. Image noise, clot diameter and clot to artery contrast-to-noise ratio (CNR) from seven sets of VMS images at selected monochromatic levels in sCTPA were measured and compared. Subjective image quality and diagnostic confidence for these images were also assessed and compared. Data were analyzed by paired t test and Wilcoxon rank sum test. Results The lowest noise and the highest image quality score for the VMS images were obtained at 65 keV. The VMS images at 65 keV also had the second highest CNR value behind that of 50 keV VMS images. There was no difference in the mean noise and CNR between the 65 keV and 70 keV VMS images. The apparent clot diameter correlated with the keV levels. Conclusions The optimal energy level for detecting pulmonary embolism using dual-energy spectral CT pulmonary angiography was 65–70 keV. Virtual monochromatic spectral images at approximately 65–70 keV yielded the lowest image noise, high CNR and highest diagnostic confidence for the detection of pulmonary embolism. PMID:23667583

Impact of tabletop exercises on participants' knowledge of and confidence in legal authorities for infectious disease emergencies.

PubMed

Savoia, Elena; Biddinger, Paul D; Fox, Priscilla; Levin, Donna E; Stone, Lisa; Stoto, Michael A

2009-06-01

Legal preparedness is a critical component of comprehensive public health preparedness for public health emergencies. The scope of this study was to assess the usefulness of combining didactic sessions with a tabletop exercise as educational tools in legal preparedness, to assess the impact of the exercise on the participants' level of confidence about the legal preparedness of a public health system, and to identify legal issue areas in need of further improvement. The exercise scenario and the pre- and postexercise evaluation were designed to assess knowledge gained and level of confidence in declaration of emergencies, isolation and quarantine, restrictions (including curfew) on the movement of people, closure of public places, and mass prophylaxis, and to identify legal preparedness areas most in need of further improvement at the system level. Fisher exact test and paired t test were performed to compare pre- and postexercise results. Our analysis shows that a combination of didactic teaching and experiential learning through a tabletop exercise regarding legal preparedness for infectious disease emergencies can be effective in both imparting perceived knowledge to participants and gathering information about sufficiency of authorities and existence of gaps. The exercise provided a valuable forum to judge the adequacy of legal authorities, policies, and procedures for dealing with pandemic influenza at the state and local levels in Massachusetts. In general, participants were more confident about the availability and sufficiency of legal authorities than they were about policies and procedures for implementing them. Participants were also more likely to report the need for improvement in authorities, policies, and procedures in the private sector and at the local level than at the state level.

Patient confidence regarding secondary lifestyle modification and knowledge of ‘heart attack’ symptoms following percutaneous revascularisation in Japan: a cross-sectional study

PubMed Central

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-01-01

Objective To assess patient perspectives on secondary lifestyle modification and knowledge of ‘heart attack’ after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Design Observational cross-sectional study. Setting A single university-based hospital centre in Japan. Participants In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). Primary outcome measure The primary outcome assessed was the patients’ confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Results Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered ‘yes’ to the item ‘I should go to the hospital as soon as possible when I have a heart attack’; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. Conclusions There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. PMID:29549203

Adolescent confidence in immunisation: Assessing and comparing attitudes of adolescents and adults.

PubMed

Wang, Bing; Giles, Lynne; Afzali, Hossein Haji Ali; Clarke, Michelle; Ratcliffe, Julie; Chen, Gang; Marshall, Helen

2016-11-04

There is limited knowledge of adolescent views and attitudes towards immunisation. Our study investigated adolescent attitudes to immunisation and compared differences in vaccination attitudes between adolescents and adults. This study was a cross-sectional, national online survey. Recruitment was stratified by state and gender to ensure findings were nationally representative. Regression analyses were performed to assess and compare adolescent and adult views on vaccine benefits, community protection, risks, side effects, sources of information, and decision-making preference. In 2013, 502 adolescents and 2003 adults completed the online survey. Lower levels of vaccine confidence were observed in adolescents with adolescents less likely to believe vaccines are beneficial and/or safe compared to adults (p=0.043). Compared to females, males were less confident of vaccine benefits (p<0.05) but less concern about vaccine side effects (p<0.05). Adolescents were more concerned about vaccine side effects than adults for pain (p<0.001), redness or swelling (p<0.001), and fever (p=0.006). Adolescents were less likely than adults to consider health professionals (p<0.001) and the media (e.g. internet) (p=0.010) as important sources of information, and were more likely to seek information from social networks (p<0.001) including families and schools. Although 62.0% of adolescents agreed that parents should make the decision about vaccination for them, adolescents were more likely to prefer a joint decision with parents (p<0.001) or by themselves (p=0.007) compared with adults. Adolescents have a lesser understanding of vaccine safety and benefits than adults and have higher concerns about potential vaccine reactions. Improving adolescent awareness and knowledge of the benefits and risks of vaccination through school-based educational programs may improve confidence in and uptake of vaccines for adolescents and increase vaccine confidence in the next generation of parents. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of physical impairment, functional, and psychosocial measures based on fear of reinjury/lack of confidence and return-to-sport status after ACL reconstruction.

PubMed

Lentz, Trevor A; Zeppieri, Giorgio; George, Steven Z; Tillman, Susan M; Moser, Michael W; Farmer, Kevin W; Chmielewski, Terese L

2015-02-01

Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL) reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidence as their primary barrier to resuming sports participation is unknown. To compare physical impairment, functional, and psychosocial measures between subgroups based on return-to-sport status and fear of reinjury/lack of confidence in the return-to-sport stage and to determine the association of physical impairment and psychosocial measures with function for each subgroup at 6 months and 1 year after surgery. Case-control study; Level of evidence, 3. Physical impairment (quadriceps index [QI], quadriceps strength/body weight [QSBW], hamstring:quadriceps strength ratio [HQ ratio], pain intensity), self-report of function (International Knee Documentation Committee [IKDC]), and psychosocial (Tampa Scale for Kinesiophobia-shortened form [TSK-11]) measures were collected at 6 months and 1 year after surgery in 73 patients with ACL reconstruction. At 1 year, subjects were divided into "return-to-sport" (YRTS) or "not return-to-sport" (NRTS) subgroups based on their self-reported return to preinjury sport status. Patients in the NRTS subgroup were subcategorized as NRTS-Fear/Confidence if fear of reinjury/lack of confidence was the primary reason for not returning to sports, and all others were categorized as NRTS-Other. A total of 46 subjects were assigned to YRTS, 13 to NRTS-Other, and 14 to NRTS-Fear/Confidence. Compared with the YRTS subgroup, the NRTS-Fear/Confidence subgroup was older and had lower QSBW, lower IKDC score, and higher TSK-11 score at 6 months and 1 year; however, they had similar pain levels. In the NRTS-Fear/Confidence subgroup, the IKDC score was associated with QSBW and pain at 6 months and QSBW, QI, pain, and TSK-11 scores at 1 year. Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguish patients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence. Despite low average pain ratings, fear of pain may influence function in this subgroup. Assessment of fear of reinjury, quadriceps strength, and self-reported function at 6 months may help identify patients at risk for not returning to sports at 1 year and should be considered for inclusion in return-to-sport guidelines. © 2014 The Author(s).

Open cholecystectomy: Exposure and confidence of surgical trainees and new fellows.

PubMed

Campbell, Beth M; Lambrianides, Andreas L; Dulhunty, Joel M

2018-03-01

The laparoscopic approach to cholecystectomy has overtaken open procedures in terms of frequency, despite open procedures playing an important role in certain clinical situations. This study explored exposure and confidence of Australasian surgical trainees and new fellows in performing an open versus laparoscopic cholecystectomy. An online survey was disseminated via the Royal Australasian College of Surgeons to senior general surgery trainees (years 3-5 of surgical training) and new fellows (fellowship within the previous 5 years). The survey included questions regarding level of experience and confidence in performing an open cholecystectomy and converting from a laparoscopic to an open approach. A total of 135 participants responded; 58 (43%) were surgical trainees, 58 (43%) were fellows and 19 (14%) did not specify their level of training. Respondents who were involved in more than 20 open cholecystectomy procedures as an assistant or independent operator compared with those less exposed were more likely to feel confident to independently perform an elective open cholecystectomy (87.8% vs. 57.3%, P = 0.001), independently convert from a laparoscopic to open cholecystectomy (87.8% vs. 58.7%, P = 0.001) and independently perform an open cholecystectomy as a surgical consultant based on their level of exposure as a trainee (73.2% vs. 45.3%, P = 0.004). This study suggests the need to ensure surgical trainees are exposed to sufficient open cholecystectomies to enable confidence and skill with performing these procedures when indicated. Greater recognition of the need for exposure during training, including meaningful simulation, may assist. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

[Orthopaedics' megalomania - myth or mobbing?

PubMed

Gundtoft, Per Hviid; Brand, Eske; Klit, Jakob; Weisskirchner, Kristoffer Barfod

2016-12-12

It is a general impression in the world of medicine that orthopaedic surgeons differ from doctors of other specialities in terms of intellect and self-confidence. The purpose of this study was to evaluate the self-confidence of orthopaedics. We asked doctors from 30 different specialities to fill out a questionnaire. In addition to this, the participating orthopaedics were asked to rate their self-perceived surgical skills. In all, 120 orthopaedics and 416 non-orthopaedic doctors completed the questionnaire. There was no difference in GSE scores between orthopaedics and other doctors (p = 0.58). 98% of young orthopaedics estimated that their surgical talent was average or above average when compared with their colleagues on the same level of education. 72% believed that they were "equally talented", "more talented", or "far more talented" than their colleagues on a higher level of education. 76% believed that when assisting a senior surgeon the patients would "sometimes" (60%), "often" (14%) or "always" (2%) be better off if they were the ones performing the operation. More orthopaedics than non-orthopaedics believed that their speciality was regarded as one of the least important specialities in the world of medicine (p = 0.001). Orthopaedic surgeons in general are not more self-confident than other doctors or the average population, but young orthopaedic surgeons have a very high level of confidence in their own operation skills. none. none.

Applying Mondrian Cross-Conformal Prediction To Estimate Prediction Confidence on Large Imbalanced Bioactivity Data Sets.

PubMed

Sun, Jiangming; Carlsson, Lars; Ahlberg, Ernst; Norinder, Ulf; Engkvist, Ola; Chen, Hongming

2017-07-24

Conformal prediction has been proposed as a more rigorous way to define prediction confidence compared to other application domain concepts that have earlier been used for QSAR modeling. One main advantage of such a method is that it provides a prediction region potentially with multiple predicted labels, which contrasts to the single valued (regression) or single label (classification) output predictions by standard QSAR modeling algorithms. Standard conformal prediction might not be suitable for imbalanced data sets. Therefore, Mondrian cross-conformal prediction (MCCP) which combines the Mondrian inductive conformal prediction with cross-fold calibration sets has been introduced. In this study, the MCCP method was applied to 18 publicly available data sets that have various imbalance levels varying from 1:10 to 1:1000 (ratio of active/inactive compounds). Our results show that MCCP in general performed well on bioactivity data sets with various imbalance levels. More importantly, the method not only provides confidence of prediction and prediction regions compared to standard machine learning methods but also produces valid predictions for the minority class. In addition, a compound similarity based nonconformity measure was investigated. Our results demonstrate that although it gives valid predictions, its efficiency is much worse than that of model dependent metrics.

Triggering of acute coronary occlusion by episodes of anger.

PubMed

Buckley, Thomas; Hoo, Soon Y Soo; Fethney, Judith; Shaw, Elizabeth; Hanson, Peter S; Tofler, Geoffrey H

2015-12-01

The aim of this study was to report the association between episodes of anger and acute myocardial infarction (MI) in patients with angiographically confirmed coronary occlusion. 313 participants with acute coronary occlusion (Thrombolysis In Myocardial Infarction 0 or 1 at emergency angiography) reported frequency of anger episodes in the 48 h prior to MI. In primary analysis, anger exposures within 2 h and 2-4 h prior to symptom onset were compared with subjects' own usual yearly exposure to anger using case-crossover methodology. Anger level ≥5 (on an anger scale of 1-7) was reported by seven (2.2%) participants within 2 h of MI. Compared with usual frequency, the relative risk of onset of MI symptoms occurring within 2 h of anger level ≥5 (defined as very angry) was 8.5 (95% confidence interval 4.1-17.6). Anger level <5 was not associated with onset of MI symptoms. Compared with 24-26 h pre MI, anxiety scores >75th percentile on State-Trait Personality Inventory were associated with a relative risk of 2.0 (95% confidence interval 1.1-3.8) and in those above the 90th percentile, the relative risk of MI symptom onset was 9.5 (95% confidence interval 2.2-40.8). Findings confirm that episodes of intense anger, defined as being 'very angry, body tense, clenching fists or teeth' (within 2 h) are associated with increased relative risk for acute coronary occlusion. Additionally, increased anxiety was associated with coronary occlusion. Further study, including the role of potential modifiers, may provide insight into prevention of MI during acute emotional episodes. © The European Society of Cardiology 2015.

Rapid Contour-based Segmentation for 18F-FDG PET Imaging of Lung Tumors by Using ITK-SNAP: Comparison to Expert-based Segmentation.

PubMed

Besson, Florent L; Henry, Théophraste; Meyer, Céline; Chevance, Virgile; Roblot, Victoire; Blanchet, Elise; Arnould, Victor; Grimon, Gilles; Chekroun, Malika; Mabille, Laurence; Parent, Florence; Seferian, Andrei; Bulifon, Sophie; Montani, David; Humbert, Marc; Chaumet-Riffaud, Philippe; Lebon, Vincent; Durand, Emmanuel

2018-04-03

Purpose To assess the performance of the ITK-SNAP software for fluorodeoxyglucose (FDG) positron emission tomography (PET) segmentation of complex-shaped lung tumors compared with an optimized, expert-based manual reference standard. Materials and Methods Seventy-six FDG PET images of thoracic lesions were retrospectively segmented by using ITK-SNAP software. Each tumor was manually segmented by six raters to generate an optimized reference standard by using the simultaneous truth and performance level estimate algorithm. Four raters segmented 76 FDG PET images of lung tumors twice by using ITK-SNAP active contour algorithm. Accuracy of ITK-SNAP procedure was assessed by using Dice coefficient and Hausdorff metric. Interrater and intrarater reliability were estimated by using intraclass correlation coefficients of output volumes. Finally, the ITK-SNAP procedure was compared with currently recommended PET tumor delineation methods on the basis of thresholding at 41% volume of interest (VOI; VOI 41 ) and 50% VOI (VOI 50 ) of the tumor's maximal metabolism intensity. Results Accuracy estimates for the ITK-SNAP procedure indicated a Dice coefficient of 0.83 (95% confidence interval: 0.77, 0.89) and a Hausdorff distance of 12.6 mm (95% confidence interval: 9.82, 15.32). Interrater reliability was an intraclass correlation coefficient of 0.94 (95% confidence interval: 0.91, 0.96). The intrarater reliabilities were intraclass correlation coefficients above 0.97. Finally, VOI 41 and VOI 50 accuracy metrics were as follows: Dice coefficient, 0.48 (95% confidence interval: 0.44, 0.51) and 0.34 (95% confidence interval: 0.30, 0.38), respectively, and Hausdorff distance, 25.6 mm (95% confidence interval: 21.7, 31.4) and 31.3 mm (95% confidence interval: 26.8, 38.4), respectively. Conclusion ITK-SNAP is accurate and reliable for active-contour-based segmentation of heterogeneous thoracic PET tumors. ITK-SNAP surpassed the recommended PET methods compared with ground truth manual segmentation. © RSNA, 2018.

Improvement of Immediate Performance in Neonatal Resuscitation Through Rapid Cycle Deliberate Practice Training.

PubMed

Magee, Maclain J; Farkouh-Karoleski, Christiana; Rosen, Tove S

2018-04-01

Simulation training is an effective method to teach neonatal resuscitation (NR), yet many pediatrics residents do not feel comfortable with NR. Rapid cycle deliberate practice (RCDP) allows the facilitator to provide debriefing throughout the session. In RCDP, participants work through the scenario multiple times, eventually reaching more complex tasks once basic elements have been mastered. We determined if pediatrics residents have improved observed abilities, confidence level, and recall in NR after receiving RCDP training compared to the traditional simulation debriefing method. Thirty-eight pediatrics interns from a large academic training program were randomized to a teaching simulation session using RCDP or simulation debriefing methods. The primary outcome was the intern's cumulative score on the initial Megacode Assessment Form (MCAF). Secondary outcome measures included surveys of confidence level, recall MCAF scores at 4 months, and time to perform critical interventions. Thirty-four interns were included in analysis. Interns in the RCDP group had higher initial MCAF scores (89% versus 84%, P  < .026), initiated positive pressure ventilation within 1 minute (100% versus 71%, P  < .05), and administered epinephrine earlier (152 s versus 180 s, P  < .039). Recall MCAF scores were not different between the 2 groups. Immediately following RCDP interns had improved observed abilities and decreased time to perform critical interventions in NR simulation as compared to those trained with the simulation debriefing. RCDP was not superior in improving confidence level or retention.

Continuous 1985-2012 Landsat monitoring to assess fire effects on meadows in Yosemite National Park, California

USGS Publications Warehouse

Soulard, Christopher E.; Albano, Christine M.; Villarreal, Miguel; Walker, Jessica

2016-01-01

To assess how montane meadow vegetation recovered after a wildfire that occurred in Yosemite National Park, CA in 1996, Google Earth Engine image processing was applied to leverage the entire Landsat Thematic Mapper archive from 1985 to 2012. Vegetation greenness (normalized difference vegetation index [NDVI]) was summarized every 16 days across the 28-year Landsat time series for 26 meadows. Disturbance event detection was hindered by the subtle influence of low-severity fire on meadow vegetation. A hard break (August 1996) was identified corresponding to the Ackerson Fire, and monthly composites were used to compare NDVI values and NDVI trends within burned and unburned meadows before, immediately after, and continuously for more than a decade following the fire date. Results indicate that NDVI values were significantly lower at 95% confidence level for burned meadows following the fire date, yet not significantly lower at 95% confidence level in the unburned meadows. Burned meadows continued to exhibit lower monthly NDVI in the dormant season through 2012. Over the entire monitoring period, the negative-trending, dormant season NDVI slopes in the burned meadows were also significantly lower than unburned meadows at 90% confidence level. Lower than average NDVI values and slopes in the dormant season compared to unburned meadows, coupled with photographic evidence, strongly suggest that evergreen vegetation was removed from the periphery of some meadows after the fire. These analyses provide insight into how satellite imagery can be used to monitor low-severity fire effects on meadow vegetation.

High Normal Uric Acid Levels Are Associated with an Increased Risk of Diabetes in Lean, Normoglycemic Healthy Women.

PubMed

Shani, Michal; Vinker, Shlomo; Dinour, Dganit; Leiba, Merav; Twig, Gilad; Holtzman, Eliezer J; Leiba, Adi

2016-10-01

The risk associated with serum uric acid (SUA) levels within the normal range is unknown, especially among lean and apparently healthy adults. Evaluating whether high-normal SUA levels, 6.8 mg/dL and below, are associated with an increased diabetes risk, compared with low-normal SUA. This was a cohort study with 10 years of followup involving all clinics of the largest nationally distributed Health Maintenance Organization in Israel. Participants included 469,947 examinees, 40-70 years old at baseline, who had their SUA measured during 2002. We excluded examinees who had hyperuricemia (SUA > 6.8 mg/dL), impaired fasting glucose, overweight or obesity and chronic cardiovascular or renal disorders. The final cohort was composed of 30 302 participants. Participants were followed up to a new diagnosis of diabetes during the study period. Odds ratio of developing diabetes among participants with high-normal baseline SUA were compared with low-normal (2 ≤ uric acid < 3 and 3 ≤ uric acid < 4 in women and men, respectively). In a logistic regression model adjusted for age, body mass index, socioeconomic status, smoking, baseline estimated glomerular filtration rate, and baseline glucose, SUA levels of 4-5 mg/dL for women were associated with 61% increased risk for incident diabetes (95% confidence interval, 1.1-2.3). At the highest normal levels for women (SUA, 5-6 mg/dL) the odds ratio was 2.7 (1.8-4.0), whereas men had comparable diabetes risk at values of 6-6.8 mg/dL (hazard ratio, 1.35; 95% confidence interval, 0.9-2.1). SUA levels within the normal range are associated with an increased risk for new-onset diabetes among healthy lean women when compared with those with low-normal values.

A methodology for airplane parameter estimation and confidence interval determination in nonlinear estimation problems. Ph.D. Thesis - George Washington Univ., Apr. 1985

NASA Technical Reports Server (NTRS)

Murphy, P. C.

1986-01-01

An algorithm for maximum likelihood (ML) estimation is developed with an efficient method for approximating the sensitivities. The ML algorithm relies on a new optimization method referred to as a modified Newton-Raphson with estimated sensitivities (MNRES). MNRES determines sensitivities by using slope information from local surface approximations of each output variable in parameter space. With the fitted surface, sensitivity information can be updated at each iteration with less computational effort than that required by either a finite-difference method or integration of the analytically determined sensitivity equations. MNRES eliminates the need to derive sensitivity equations for each new model, and thus provides flexibility to use model equations in any convenient format. A random search technique for determining the confidence limits of ML parameter estimates is applied to nonlinear estimation problems for airplanes. The confidence intervals obtained by the search are compared with Cramer-Rao (CR) bounds at the same confidence level. The degree of nonlinearity in the estimation problem is an important factor in the relationship between CR bounds and the error bounds determined by the search technique. Beale's measure of nonlinearity is developed in this study for airplane identification problems; it is used to empirically correct confidence levels and to predict the degree of agreement between CR bounds and search estimates.

Alternative methods to evaluate trial level surrogacy.

PubMed

Abrahantes, Josè Cortiñas; Shkedy, Ziv; Molenberghs, Geert

2008-01-01

The evaluation and validation of surrogate endpoints have been extensively studied in the last decade. Prentice [1] and Freedman, Graubard and Schatzkin [2] laid the foundations for the evaluation of surrogate endpoints in randomized clinical trials. Later, Buyse et al. [5] proposed a meta-analytic methodology, producing different methods for different settings, which was further studied by Alonso and Molenberghs [9], in their unifying approach based on information theory. In this article, we focus our attention on the trial-level surrogacy and propose alternative procedures to evaluate such surrogacy measure, which do not pre-specify the type of association. A promising correction based on cross-validation is investigated. As well as the construction of confidence intervals for this measure. In order to avoid making assumption about the type of relationship between the treatment effects and its distribution, a collection of alternative methods, based on regression trees, bagging, random forests, and support vector machines, combined with bootstrap-based confidence interval and, should one wish, in conjunction with a cross-validation based correction, will be proposed and applied. We apply the various strategies to data from three clinical studies: in opthalmology, in advanced colorectal cancer, and in schizophrenia. The results obtained for the three case studies are compared; they indicate that using random forest or bagging models produces larger estimated values for the surrogacy measure, which are in general stabler and the confidence interval narrower than linear regression and support vector regression. For the advanced colorectal cancer studies, we even found the trial-level surrogacy is considerably different from what has been reported. In general the alternative methods are more computationally demanding, and specially the calculation of the confidence intervals, require more computational time that the delta-method counterpart. First, more flexible modeling techniques can be used, allowing for other type of association. Second, when no cross-validation-based correction is applied, overly optimistic trial-level surrogacy estimates will be found, thus cross-validation is highly recommendable. Third, the use of the delta method to calculate confidence intervals is not recommendable since it makes assumptions valid only in very large samples. It may also produce range-violating limits. We therefore recommend alternatives: bootstrap methods in general. Also, the information-theoretic approach produces comparable results with the bagging and random forest approaches, when cross-validation correction is applied. It is also important to observe that, even for the case in which the linear model might be a good option too, bagging methods perform well too, and their confidence intervals were more narrow.

Training student pharmacists to administer emergency pediatric influenza vaccine: A comparison of traditional vs. just-in-time training.

PubMed

Terriff, Colleen M; McKeirnan, Kimberly

2017-07-01

This study compared traditional training (TT) and just-in-time training (JITT) of P3 student pharmacists regarding interest, confidence, and comfort pre- and post-training (primary objective); and assessment and administration competency (secondary objective) during a simulated influenza vaccination clinic. Student pharmacists were randomized 1:1 to receive either TT or JITT, completed pre- and post-training surveys assessing interest, confidence and comfort; and evaluated on performance during a simulated emergency infant vaccination. An infant manikin simulated a child <1 year of age, and an actor role-played the mother. All students received a briefing about the simulated mass vaccination prior to their performance assessment. Survey differences between groups were analyzed by ANOVA. The competency assessment was analyzed by a Chi-square or Fisher's exact test for individual steps and Student t-test for mean scores. Pre-training interest was high and maintained post-training. Pre-training confidence and comfort levels were low and improved in both groups. Mean competency scores were comparable between the TT and JITT groups. Comparing groups, TT students more commonly missed proper injection site selection and care; while JITT missed distracting the infant and administration documentation. JITT for student pharmacists to learn skills required to immunize infants elicits similar outcomes (interest, confidence, comfort, and administration competency) as TT for emergency pediatric influenza vaccination. Copyright © 2017 Elsevier Inc. All rights reserved.

Prepregnancy obesity and complement system activation in early pregnancy and the subsequent development of preeclampsia.

PubMed

Lynch, Anne M; Eckel, Robert H; Murphy, James R; Gibbs, Ronald S; West, Nancy A; Giclas, Patricia C; Salmon, Jane E; Holers, V Michael

2012-05-01

We hypothesized that women who are obese before they become pregnant and also have elevations of complement Bb and C3a in the top quartile in early pregnancy would have the highest risk of preeclampsia compared with a referent group of women who were not obese and had levels of complement less than the top quartile. This was a prospective study of 1013 women recruited at less than 20 weeks' gestation. An EDTA-plasma sample was obtained, and complement fragments were measured using enzyme-linked immunosorbent assays. The data were analyzed using univariable and multivariable logistic regression analysis. Women who were obese with levels of Bb or C3a in the top quartile were 10.0 (95% confidence interval, 3.3-30) and 8.8 (95% confidence interval, 3-24) times, respectively, more likely to develop preeclampsia compared with the referent group. We demonstrate a combined impact of obesity and elevated complement on the development of preeclampsia. Copyright © 2012. Published by Mosby, Inc.

Evidence for a confidence-accuracy relationship in memory for same- and cross-race faces.

PubMed

Nguyen, Thao B; Pezdek, Kathy; Wixted, John T

2017-12-01

Discrimination accuracy is usually higher for same- than for cross-race faces, a phenomenon known as the cross-race effect (CRE). According to prior research, the CRE occurs because memories for same- and cross-race faces rely on qualitatively different processes. However, according to a continuous dual-process model of recognition memory, memories that rely on qualitatively different processes do not differ in recognition accuracy when confidence is equated. Thus, although there are differences in overall same- and cross-race discrimination accuracy, confidence-specific accuracy (i.e., recognition accuracy at a particular level of confidence) may not differ. We analysed datasets from four recognition memory studies on same- and cross-race faces to test this hypothesis. Confidence ratings reliably predicted recognition accuracy when performance was above chance levels (Experiments 1, 2, and 3) but not when performance was at chance levels (Experiment 4). Furthermore, at each level of confidence, confidence-specific accuracy for same- and cross-race faces did not significantly differ when overall performance was above chance levels (Experiments 1, 2, and 3) but significantly differed when overall performance was at chance levels (Experiment 4). Thus, under certain conditions, high-confidence same-race and cross-race identifications may be equally reliable.

Parents' confidence in recommended childhood vaccinations: Extending the assessment, expanding the context

PubMed Central

Nowak, Glen J.; Cacciatore, Michael A.

2017-01-01

ABSTRACT There has been significant and growing interest in vaccine hesitancy and confidence in the United States as well as across the globe. While studies have used confidence measures, few studies have provided in-depth assessments and no studies have assessed parents' confidence in vaccines in relationship to other frequently recommended health-related products for young children. This study used a nationally representative sample of 1000 US parents to identify confidence levels for recommended vaccinations, antibiotics, over-the-counter (OTC) medicines, and vitamins for children. The analyses examined associations between confidence ratings, vaccination behaviors and intentions, and trust in healthcare provider, along with associations between confidence ratings and use of the other health-related products. Parents' confidence in vaccines was relatively high and high relative to antibiotics, OTC medicines and vitamins. For all 4 health-related products examined, past product experience and knowledge of bad or adverse outcomes negatively impacted parents' confidence levels. Confidence levels were associated with both trust in advice from their child's healthcare provider and acceptance of healthcare provider recommendations. Parents in some groups, such as those with lower income and education levels, were more likely to have less confidence not just in vaccines, but also in antibiotics and OTC medicines for children. Overall, the findings extend understanding of vaccine confidence, including by placing it into a broader context. PMID:27682979

Stapled versus handsewn methods for colorectal anastomosis surgery.

PubMed

Lustosa, S A; Matos, D; Atallah, A N; Castro, A A

2001-01-01

Randomized controlled trials comparing stapled with handsewn colorectal anastomosis have not shown either technique to be superior, perhaps because individual studies lacked statistical power. A systematic review, with pooled analysis of results, might provide a more definitive answer. To compare the safety and effectiveness of stapled and handsewn colorectal anastomosis. The following primary hypothesis was tested: the stapled technique is more effective because it decreases the level of complications. The RCT register of the Cochrane Review Group was searched for any trial or reference to a relevant trial (published, in-press, or in progress). All publications were sought through computerised searches of EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and through letters to industrial companies and authors. There were no limits upon language, date, or other criteria. All randomized clinical trials (RCTs) in which stapled and handsewn colorectal anastomosis were compared. Adult patients submitted electively to colorectal anastomosis. Endoluminal circular stapler and handsewn colorectal anastomosis. a) Mortality b) Overall Anastomotic Dehiscence c) Clinical Anastomotic Dehiscence d) Radiological Anastomotic Dehiscence e) Stricture f) Anastomotic Haemorrhage g) Reoperation h) Wound Infection i) Anastomosis Duration j) Hospital Stay. Data were independently extracted by the two reviewers (SASL, DM) and cross-checked. The methodological quality of each trial was assessed by the same two reviewers. Details of the randomization (generation and concealment), blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up were recorded. The results of each RCT were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. External validity was defined by characteristics of the participants, the interventions and the outcomes. The RCTs were stratified according to the level of colorectal anastomosis. The Risk Difference method (random effects model) and NNT for dichotomous outcomes measures and weighted mean difference for continuous outcomes measures, with the corresponding 95% confidence interval, were presented in this review. Statistical heterogeneity was evaluated by using funnel plot and chi-square testing. Of the 1233 patients enrolled ( in 9 trials), 622 were treated with stapled, and 611 with manual, suture. The following main results were obtained: a) Mortality: result based on 901 patients; Risk Difference - 0.6% Confidence Interval -2.8% to +1.6%. b) Overall Dehiscence: result based on 1233 patients; Risk Difference 0.2%, 95% Confidence Interval -5.0% to +5.3%. c) Clinical Anastomotic Dehiscence : result based on 1233 patients; Risk Difference -1.4%, 95% Confidence Interval -5.2 to +2.3%. d) Radiological Anastomotic Dehiscence : result based on 825 patients; Risk Difference 1.2%, 95% Confidence Interval -4.8% to +7.3%. e) Stricture: result based on 1042 patients; Risk Difference 4.6%, 95% Confidence Interval 1.2% to 8.1%. Number needed to treat 17, 95% confidence interval 12 to 31. f) Anastomotic Hemorrhage: result based on 662 patients; Risk Difference 2.7%, 95% Confidence Interval - 0.1% to +5.5%. g) Reoperation: result based on 544 patients; Risk Difference 3.9%, 95% Confidence Interval 0.3% to 7.4%. h) Wound Infection: result based on 567 patients; Risk Difference 1.0%, 95% Confidence Interval -2.2% to +4.3%. i) Anastomosis duration: result based on one study (159 patients); Weighted Mean Difference -7.6 minutes, 95% Confidence Interval -12.9 to -2.2 minutes. j) Hospital Stay: result based on one study (159 patients), Weighted Mean Difference 2.0 days, 95% Confidence Interval -3.27 to +7.2 days. The evidence found was insufficient to demonstrate any superiority of stapled over handsewn techniques in colorectal anastomosis, regardless of the level of anastomosis.

Differentiating Small (≤1 cm) Focal Liver Lesions as Metastases or Cysts by means of Computed Tomography: A Case-Study to Illustrate a Fuzzy Logic-Based Method to Assess the Impact of Diagnostic Confidence on Radiological Diagnosis

PubMed Central

Zanella, Gloria; Pullini, Serena; Como, Giuseppe; Bazzocchi, Massimo

2014-01-01

Purpose. To quantify the impact of diagnostic confidence on radiological diagnosis with a fuzzy logic-based method. Materials and Methods. Twenty-two oncologic patients with 20 cysts and 30 metastases ≤1 cm in size found at 64-row computed tomography were included. Two readers (R1/R2) expressed diagnoses as a subjective level of confidence P(d) in malignancy within the interval [0,1] rather than on a “crisp” basis (malignant/benign); confidence in benignancy was 1 − p(d). When cross-tabulating data according to the standard of reference, 2 × 2 table cells resulted from the aggregation between p(d)/1 − p(d) and final diagnosis. We then assessed (i) readers diagnostic performance on a fuzzy and crisp basis; (ii) the “divergence” δ(F, C) (%) as a measure of how confidence impacted on crisp diagnosis. Results. Diagnoses expressed with lower confidence increased fuzzy false positives compared to crisp ones (from 0 to 0.2 for R1; from 1 to 2.4 for R2). Crisp/fuzzy accuracy was 94.0%/93.6% (R1) and 94.0/91.6% (R2). δ(F, C) (%) was larger in the case of the less experienced reader (R2) (up to +7.95% for specificity). According to simulations, δ(F, C) (%) was negative/positive depending on the level of confidence in incorrect diagnoses. Conclusion. Fuzzy evaluation shows a measurable effect of uncertainty on radiological diagnoses. PMID:24587815

Probabilistic Analysis for Comparing Fatigue Data Based on Johnson-Weibull Parameters

NASA Technical Reports Server (NTRS)

Hendricks, Robert C.; Zaretsky, Erwin V.; Vicek, Brian L.

2007-01-01

Probabilistic failure analysis is essential when analysis of stress-life (S-N) curves is inconclusive in determining the relative ranking of two or more materials. In 1964, L. Johnson published a methodology for establishing the confidence that two populations of data are different. Simplified algebraic equations for confidence numbers were derived based on the original work of L. Johnson. Using the ratios of mean life, the resultant values of confidence numbers deviated less than one percent from those of Johnson. It is possible to rank the fatigue lives of different materials with a reasonable degree of statistical certainty based on combined confidence numbers. These equations were applied to rotating beam fatigue tests that were conducted on three aluminum alloys at three stress levels each. These alloys were AL 2024, AL 6061, and AL 7075. The results were analyzed and compared using ASTM Standard E739-91 and the Johnson-Weibull analysis. The ASTM method did not statistically distinguish between AL 6010 and AL 7075. Based on the Johnson-Weibull analysis confidence numbers greater than 99 percent, AL 2024 was found to have the longest fatigue life, followed by AL 7075, and then AL 6061. The ASTM Standard and the Johnson-Weibull analysis result in the same stress-life exponent p for each of the three aluminum alloys at the median or L(sub 50) lives.

Contrasting Academic Behavioural Confidence in Mexican and European Psychology Students

ERIC Educational Resources Information Center

Ochoa, Alma Rosa Aguila; Sander, Paul

2012-01-01

Introduction: Research with the Academic Behavioural Confidence scale using European students has shown that students have high levels of confidence in their academic abilities. It is generally accepted that people in more collectivist cultures have more realistic confidence levels in contrast to the overconfidence seen in individualistic European…

A randomized controlled study of manikin simulator fidelity on neonatal resuscitation program learning outcomes.

PubMed

Curran, Vernon; Fleet, Lisa; White, Susan; Bessell, Clare; Deshpandey, Akhil; Drover, Anne; Hayward, Mark; Valcour, James

2015-03-01

The neonatal resuscitation program (NRP) has been developed to educate physicians and other health care providers about newborn resuscitation and has been shown to improve neonatal resuscitation skills. Simulation-based training is recommended as an effective modality for instructing neonatal resuscitation and both low and high-fidelity manikin simulators are used. There is limited research that has compared the effect of low and high-fidelity manikin simulators for NRP learning outcomes, and more specifically on teamwork performance and confidence. The purpose of this study was to examine the effect of using low versus high-fidelity manikin simulators in NRP instruction. A randomized posttest-only control group study design was conducted. Third year undergraduate medical students participated in NRP instruction and were assigned to an experimental group (high-fidelity manikin simulator) or control group (low-fidelity manikin simulator). Integrated skills station (megacode) performance, participant satisfaction, confidence and teamwork behaviour scores were compared between the study groups. Participants in the high-fidelity manikin simulator instructional group reported significantly higher total scores in overall satisfaction (p = 0.001) and confidence (p = 0.001). There were no significant differences in teamwork behaviour scores, as observed by two independent raters, nor differences on mandatory integrated skills station performance items at the p < 0.05 level. Medical students' reported greater satisfaction and confidence with high-fidelity manikin simulators, but did not demonstrate overall significantly improved teamwork or integrated skills station performance. Low and high-fidelity manikin simulators facilitate similar levels of objectively measured NRP outcomes for integrated skills station and teamwork performance.

Education and the risk for Alzheimer's disease: sex makes a difference. EURODEM pooled analyses. EURODEM Incidence Research Group.

PubMed

Letenneur, L; Launer, L J; Andersen, K; Dewey, M E; Ott, A; Copeland, J R; Dartigues, J F; Kragh-Sorensen, P; Baldereschi, M; Brayne, C; Lobo, A; Martinez-Lage, J M; Stijnen, T; Hofman, A

2000-06-01

The hypothesis that a low educational level increases the risk for Alzheimer's disease remains controversial. The authors studied the association of years of schooling with the risk for incident dementia and Alzheimer's disease by using pooled data from four European population-based follow-up studies. Dementia cases were identified in a two-stage procedure that included a detailed diagnostic assessment of screen-positive subjects. Dementia and Alzheimer's disease were diagnosed by using international research criteria. Educational level was categorized by years of schooling as low (< or =7), middle (8-11), or high (> or =12). Relative risks (95% confidence intervals) were estimated by using Poisson regression, adjusting for age, sex, study center, smoking status, and self-reported myocardial infarction and stroke. There were 493 (328) incident cases of dementia (Alzheimer's disease) and 28,061 (27,839) person-years of follow-up. Compared with women with a high level of education, those with low and middle levels of education had 4.3 (95% confidence interval: 1.5, 11.9) and 2.6 (95% confidence interval: 1.0, 7.1) times increased risks, respectively, for Alzheimer's disease. The risk estimates for men were close to 1.0. Finding an association of education with Alzheimer's disease for women only raises the possibility that unmeasured confounding explains the previously reported increased risk for Alzheimer's disease for persons with low levels of education.

Arsenic exposure and oral cavity lesions in Bangladesh.

PubMed

Syed, Emdadul H; Melkonian, Stephanie; Poudel, Krishna C; Yasuoka, Junko; Otsuka, Keiko; Ahmed, Alauddin; Islam, Tariqul; Parvez, Faruque; Slavkovich, Vesna; Graziano, Joseph H; Ahsan, Habibul; Jimba, Masamine

2013-01-01

To evaluate the relationship between arsenic exposure and oral cavity lesions among an arsenic-exposed population in Bangladesh. We carried out an analysis utilizing the baseline data of the Health Effects of Arsenic Exposure Longitudinal Study, which is an ongoing population-based cohort study to investigate health outcomes associated with arsenic exposure via drinking water in Araihazar, Bangladesh. We used multinomial regression models to estimate the risk of oral cavity lesions. Participants with high urinary arsenic levels (286.1 to 5000.0 μg/g) were more likely to develop arsenical lesions of the gums (multinomial odds ratio = 2.90; 95% confidence interval, 1.11 to 7.54), and tongue (multinomial odds ratio = 2.79; 95% confidence interval, 1.51 to 5.15), compared with those with urinary arsenic levels of 7.0 to 134.0 μg/g. Higher level of arsenic exposure was positively associated with increased arsenical lesions of the gums and tongue.

Patient confidence regarding secondary lifestyle modification and knowledge of 'heart attack' symptoms following percutaneous revascularisation in Japan: a cross-sectional study.

PubMed

Kitakata, Hiroki; Kohno, Takashi; Kohsaka, Shun; Fujino, Junko; Nakano, Naomi; Fukuoka, Ryoma; Yuasa, Shinsuke; Maekawa, Yuichiro; Fukuda, Keiichi

2018-03-16

To assess patient perspectives on secondary lifestyle modification and knowledge of 'heart attack' after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). Observational cross-sectional study. A single university-based hospital centre in Japan. In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident). The primary outcome assessed was the patients' confidence level regarding lifestyle modification and the recognition of heart attack symptoms. Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered 'yes' to the item 'I should go to the hospital as soon as possible when I have a heart attack'; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions. There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Reduced gamma-aminobutyric acid concentration is associated with physical disability in progressive multiple sclerosis

PubMed Central

Solanky, Bhavana S.; Muhlert, Nils; Tur, Carmen; Edden, Richard A. E.; Wheeler-Kingshott, Claudia A. M.; Miller, David H.; Thompson, Alan J.; Ciccarelli, Olga

2015-01-01

Neurodegeneration is thought to be the major cause of ongoing, irreversible disability in progressive stages of multiple sclerosis. Gamma-aminobutyric acid is the principle inhibitory neurotransmitter in the brain. The aims of this study were to investigate if gamma-aminobutyric acid levels (i) are abnormal in patients with secondary progressive multiple sclerosis compared with healthy controls; and (ii) correlate with physical and cognitive performance in this patient population. Thirty patients with secondary progressive multiple sclerosis and 17 healthy control subjects underwent single-voxel MEGA-PRESS (MEscher-GArwood Point RESolved Spectroscopy) magnetic resonance spectroscopy at 3 T, to quantify gamma-aminobutyric acid levels in the prefrontal cortex, right hippocampus and left sensorimotor cortex. All subjects were assessed clinically and underwent a cognitive assessment. Multiple linear regression models were used to compare differences in gamma-aminobutyric acid concentrations between patients and controls adjusting for age, gender and tissue fractions within each spectroscopic voxel. Regression was used to examine the relationships between the cognitive function and physical disability scores specific for these regions with gamma-aminobuytric acid levels, adjusting for age, gender, and total N-acetyl-aspartate and glutamine-glutamate complex levels. When compared with controls, patients performed significantly worse on all motor and sensory tests, and were cognitively impaired in processing speed and verbal memory. Patients had significantly lower gamma-aminobutyric acid levels in the hippocampus (adjusted difference = −0.403 mM, 95% confidence intervals −0.792, −0.014, P = 0.043) and sensorimotor cortex (adjusted difference = −0.385 mM, 95% confidence intervals −0.667, −0.104, P = 0.009) compared with controls. In patients, reduced motor function in the right upper and lower limb was associated with lower gamma-aminobutyric acid concentration in the sensorimotor cortex. Specifically for each unit decrease in gamma-aminobutyric acid levels (in mM), there was a predicted −10.86 (95% confidence intervals −16.786 to −4.482) decrease in grip strength (kg force) (P < 0.001) and −8.74 (95% confidence intervals −13.943 to −3.015) decrease in muscle strength (P < 0.006). This study suggests that reduced gamma-aminobutyric acid levels reflect pathological abnormalities that may play a role in determining physical disability. These abnormalities may include decreases in the pre- and postsynaptic components of gamma-aminobutyric acid neurotransmission and in the density of inhibitory neurons. Additionally, the reduced gamma-aminobutyric acid concentration may contribute to the neurodegenerative process, resulting in increased firing of axons, with consequent increased energy demands, which may lead to neuroaxonal degeneration and loss of the compensatory mechanisms that maintain motor function. This study supports the idea that modulation of gamma-aminobutyric acid neurotransmission may be an important target for neuroprotection in multiple sclerosis. See De Stefano and Giorgio (doi:10.1093/brain/awv213) for a scientific commentary on this article. PMID:26304151

Implementation and testing of a sensor-netting algorithm for early warning and high confidence C/B threat detection

NASA Astrophysics Data System (ADS)

Gruber, Thomas; Grim, Larry; Fauth, Ryan; Tercha, Brian; Powell, Chris; Steinhardt, Kristin

2011-05-01

Large networks of disparate chemical/biological (C/B) sensors, MET sensors, and intelligence, surveillance, and reconnaissance (ISR) sensors reporting to various command/display locations can lead to conflicting threat information, questions of alarm confidence, and a confused situational awareness. Sensor netting algorithms (SNA) are being developed to resolve these conflicts and to report high confidence consensus threat map data products on a common operating picture (COP) display. A data fusion algorithm design was completed in a Phase I SBIR effort and development continues in the Phase II SBIR effort. The initial implementation and testing of the algorithm has produced some performance results. The algorithm accepts point and/or standoff sensor data, and event detection data (e.g., the location of an explosion) from various ISR sensors (e.g., acoustic, infrared cameras, etc.). These input data are preprocessed to assign estimated uncertainty to each incoming piece of data. The data are then sent to a weighted tomography process to obtain a consensus threat map, including estimated threat concentration level uncertainty. The threat map is then tested for consistency and the overall confidence for the map result is estimated. The map and confidence results are displayed on a COP. The benefits of a modular implementation of the algorithm and comparisons of fused / un-fused data results will be presented. The metrics for judging the sensor-netting algorithm performance are warning time, threat map accuracy (as compared to ground truth), false alarm rate, and false alarm rate v. reported threat confidence level.

Assessing the significance of health information seeking in chronic condition management.

PubMed

Dean, Caress A; Geneus, Christian J; Rice, Shahida; Johns, Marquisha; Quasie-Woode, Delores; Broom, Kevin; Elder, Keith

2017-08-01

To examine the relationship between health information seeking and confidence in performing self-management activities, and to assess the influence of predisposing, enabling, and perceive need factors on confidence to perform self-management activities among adults with chronic conditions. The sample included 6724 adults from the 2007 Health Tracking Household Survey who were ≥18 years with a chronic condition. Binary logistic regression examined the relationship between health information seeking, predisposing, enabling, and perceive need factors and confidence in performing three self-management activities; prevent symptoms, tell doctor concerns, and know when to get medical care. Analyses indicated that 63.7% of adults sought health information. Rural residents who sought health information had 50% (95% CI: 0.28-0.89) lower odds of being confident to tell doctor concerns compared to urban residents who did not seek health information. The relationship between health information seeking and confidence to perform self-management varies by self-management activity. Rurality, education level, having a usual source of care, and perceived health status strongly predict confidence to perform self-management activities. Self-management strategies should incorporate health information seeking behavior that will enhance confidence to perform specific self-management activities, and should incorporate predisposing, enabling, and perceive need factors. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative factor analysis of the effect of postoperative peripheral parenteral nutrition on recovery of right lobe liver donors.

PubMed

Hsieh, Chia-En; Lin, Kuo-Hua; Lin, Chia-Cheng; Hwu, Yueh-Juen; Lin, Ping-Yi; Lin, Hui-Chuan; Ko, Chih-Jan; Wang, Su-Han; Chen, Yao-Li

2015-04-01

Intensive nutritional support can reduce the catabolic response, improve protein synthesis, and promote liver regeneration. This study examined whether postoperative peripheral parenteral nutrition may improve recovery and reduce the length of hospital stay in right lobe liver donors. In this retrospective study, we enrolled liver donors with residual liver volume < 50%. Donors were classified into 2 groups: donors who received (n = 44) or did not receive (n = 40) postoperative peripheral parenteral nutrition. Liver function tests included alanine aminotransferase and total bilirubin levels, and postoperative complications included pleural effusion, atelectasis, and wound complications. Hospital length of stay was included as a potential risk factor for the evaluation of the effect of postoperative peripheral parenteral nutrition on recovery of right lobe liver donors. Male sex (β, 22.04; 95% confidence interval: 6.22 - 37.86) was a significant predictor of changes in postoperative alanine aminotransferase level. Male sex (β, 0.045; 95% confidence interval: 0.16 - 37.86) and receipt of peripheral parenteral nutrition (β, -0.045; 95% confidence interval: -0.72 - 0.17) were significant predictors of changes in total bilirubin level. Postoperative atelectasis (P < .001), pleural effusion (P < .011), and total complications (P = .015) had significantly lower incidence in the peripheral parenteral nutrition than control group. Multivariate logistic regression showed that recipients of peripheral parenteral nutrition (odds ratio, 0.161; 95% confidence interval: 0.043 - 0.598) and age (odds ratio, 0.870; 95% confidence interval: 0.782 - 0.968) were significant preoperative risk factors for postoperative complications. Postoperative peripheral parenteral nutrition is associated with a lower incidence of pleural effusion and atelectasis, a more rapid recovery of hyperbilirubinemia, and shorter length of stay in right lobe liver donors.

Alternate methods for FAAT S-curve generation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kaufman, A.M.

The FAAT (Foreign Asset Assessment Team) assessment methodology attempts to derive a probability of effect as a function of incident field strength. The probability of effect is the likelihood that the stress put on a system exceeds its strength. In the FAAT methodology, both the stress and strength are random variables whose statistical properties are estimated by experts. Each random variable has two components of uncertainty: systematic and random. The systematic uncertainty drives the confidence bounds in the FAAT assessment. Its variance can be reduced by improved information. The variance of the random uncertainty is not reducible. The FAAT methodologymore » uses an assessment code called ARES to generate probability of effect curves (S-curves) at various confidence levels. ARES assumes log normal distributions for all random variables. The S-curves themselves are log normal cumulants associated with the random portion of the uncertainty. The placement of the S-curves depends on confidence bounds. The systematic uncertainty in both stress and strength is usually described by a mode and an upper and lower variance. Such a description is not consistent with the log normal assumption of ARES and an unsatisfactory work around solution is used to obtain the required placement of the S-curves at each confidence level. We have looked into this situation and have found that significant errors are introduced by this work around. These errors are at least several dB-W/cm{sup 2} at all confidence levels, but they are especially bad in the estimate of the median. In this paper, we suggest two alternate solutions for the placement of S-curves. To compare these calculational methods, we have tabulated the common combinations of upper and lower variances and generated the relevant S-curves offsets from the mode difference of stress and strength.« less

Prospective Teachers' Problem Solving Skills and Self-Confidence Levels

ERIC Educational Resources Information Center

Gursen Otacioglu, Sena

2008-01-01

The basic objective of the research is to determine whether the education that prospective teachers in different fields receive is related to their levels of problem solving skills and self-confidence. Within the mentioned framework, the prospective teachers' problem solving and self-confidence levels have been examined under several variables.…

Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

PubMed

VandenBerg, James; Osei, Daniel; Boyer, Martin I; Gardner, Michael J; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M

2017-06-01

To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preservice and In-Service Teachers' Perceptions toward Technology Benefits and Integration

ERIC Educational Resources Information Center

Spaulding, Michael

2013-01-01

This study examined preservice teacher attitudes toward and expected technology integration practices as compared to in-service teachers' attitudes toward and actual (self-reported) practice of technology integration. The preservice teachers revealed a greater level of confidence in their ability to integrate technology and more positive beliefs…

Simulation and Advanced Practice Nursing Education

ERIC Educational Resources Information Center

Blue, Dawn I.

2016-01-01

This quantitative study compared changes in level of confidence resulting from participation in simulation or traditional instructional methods for BSN (Bachelor of Science in Nursing) to DNP (Doctor of Nursing Practice) students in a nurse practitioner course when they entered the clinical practicum. Simulation has been used in many disciplines…

Effect of CALIPSO Cloud Aerosol Discrimination (CAD) Confidence Levels on Observations of Aerosol Properties near Clouds

NASA Technical Reports Server (NTRS)

Yang, Weidong; Marshak, Alexander; Varnai, Tamas; Liu, Zhaoyan

2012-01-01

CALIPSO aerosol backscatter enhancement in the transition zone between clouds and clear sky areas is revisited with particular attention to effects of data selection based on the confidence level of cloud-aerosol discrimination (CAD). The results show that backscatter behavior in the transition zone strongly depends on the CAD confidence level. Higher confidence level data has a flatter backscatter far away from clouds and a much sharper increase near clouds (within 4 km), thus a smaller transition zone. For high confidence level data it is shown that the overall backscatter enhancement is more pronounced for small clear-air segments and horizontally larger clouds. The results suggest that data selection based on CAD reduces the possible effects of cloud contamination when studying aerosol properties in the vicinity of clouds.

The confidence in health care and social services in northern Sweden--a comparison between reindeer-herding Sami and the non-Sami majority population.

PubMed

Daerga, Laila; Sjölander, Per; Jacobsson, Lars; Edin-Liljegren, Anette

2012-08-01

To investigate the confidence in primary health care, psychiatry and social services among the reindeer-herding Sami and the non-Sami population of northern Sweden. A semi-randomized, cross-sectional study design comprising 325 reindeer-herding Sami (171 men, 154 women) and a control population of 1,437 non-Sami (684 men, 753 women). A questionnaire on the confidence in primary health care, psychiatry, social services, and work colleagues was distributed to members of reindeer-herding families through the Sami communities and to the control population through the post. The relative risk for poor confidence was analyzed by calculating odds ratios with 95% confidence intervals adjusted for age and level of education. The confidence in primary health care and psychiatry was significantly lower among the reindeer-herding Sami compared with the control group. No differences were found between men and women in the reindeer-herding Sami population. In both the reindeer-herding Sami and the control population, younger people (≤ 48 years) reported significantly lower confidence in primary health care than older individuals (>48 years). A conceivable reason for the poor confidence in health care organizations reported by the reindeer-herding Sami is that they experience health care staff as poorly informed about reindeer husbandry and Sami culture, resulting in unsuitable or unrealistic treatment suggestions. The findings suggest that the poor confidence constitutes a significant obstacle of the reindeer-herding Sami to fully benefit from public health care services.

Instability of self-esteem, self-confidence, self-liking, self-control, self-competence and perfectionism: associations with oral health status and oral health-related behaviours.

PubMed

Dumitrescu, A L; Zetu, L; Teslaru, S

2012-02-01

Our aim was to explore whether instability of self-esteem, self-confidence, self-liking, self-control, self-competence and perfectionism each has an independent contribution to the self-rated oral health and oral health-related behaviours. A cross-sectional study design was used. Data were collected between November 2008 and May 2009. The sample consisted of 205 Romanian adults (mean age: 29.84 years; 65.2% women; 40% married) who were a random population drawn consecutively from the registry file of two private dental practices in the Iasi area. The questionnaire included information about demographic, psychological, self-reported oral health and oral health-related behaviour items. The comparison of participants who never flossed their teeth with those who flossed everyday showed statistically significant lower levels of self-confidence (P < 0.05), self-liking (P = 0.001), self-competence (P < 0.0001), self-control (P < 0.05) and Perfectionism Scores (P < 0.05). Significant higher levels of self-competence were scored in persons who used weekly mouthrinses comparing with never users (P = 0.012). Also patients who visited the dentist mainly when treatment is needed or when pain presented lower levels of self-competence and self-control comparing with those who visited the dentist mainly for check-up or for tooth cleaning and scaling (P < 0.05). Oral health behaviours (toothbrushing and mouthrinse frequencies) were predicted by multiple regression analyses using sociodemographic (age, gender), self-competence and perfectionism variables. Our study showed that instability of self-esteem, self-confidence, self-competence, self-liking, self-control and perfectionism was associated not only with self-rated dental health but also with oral health behaviours. Understanding the psychological factors associated with oral hygiene can further the development and improvement in therapeutic strategies to be used in oral health-improving programs, as well as of programs aimed at prevention and education. © 2011 John Wiley & Sons A/S.

Impact of CVS Pharmacy's Discontinuance of Tobacco Sales on Cigarette Purchasing (2012-2014).

PubMed

Polinski, Jennifer M; Howell, Benjamin; Gagnon, Michael A; Kymes, Steven M; Brennan, Troyen A; Shrank, William H

2017-04-01

To assess the impact of CVS Health's discontinuation of tobacco sales on cigarette purchasing. We used households' purchasing data to assess rates at which households stopped cigarette purchasing for at least 6 months during September 2014 to August 2015 among 3 baseline groups: CVS-exclusive cigarette purchasers, CVS+ (CVS and other retailers), and other-exclusive (only non-CVS retailers). In state-level analyses using retailers' point-of-sale purchase data, an interrupted time series compared cigarette purchasing before (January 2012 to August 2014) and after (September 2014 to April 2015) tobacco removal in 13 intervention states with CVS market share of at least 15% versus 3 control states with no CVS stores. Compared with other-exclusive purchasers, CVS-exclusive purchasers were 38% likelier (95% confidence interval = 1.06, 1.81) to stop cigarette purchasing after tobacco removal. Compared with control states, intervention states had a significant mean decrease of 0.14 (95% confidence interval = 0.06, 0.22) in packs per smoker per month. After CVS's tobacco removal, household- and population-level cigarette purchasing declined significantly. Private retailers can play a meaningful role in restricting access to tobacco. This highlights one approach to reducing tobacco use and improving public health.

Community pharmacists and mental illness: a survey of service provision, stigma, attitudes and beliefs.

PubMed

Giannetti, Vincent; Caley, Charles F; Kamal, Khalid M; Covvey, Jordan R; McKee, Jerry; Wells, Barbara G; Najarian, Dean M; Dunn, Tyler J; Vadagam, Pratyusha

2018-06-04

Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, service provision, stigma, attitudes and beliefs of a national sample of community pharmacists towards individuals with mental illness. Setting National random sample of 3008 community pharmacists in the USA. Method 101-item cross-sectional mailed survey questionnaire on: (1) demographics, (2) knowledge and practice characteristics, (3) provision of clinical pharmacy services, and (4) comparative opinions. Main outcome measure Scaled measures of service provision (comfort, confidence, willingness and interest) and comparative opinions (stigma, attitudes and beliefs) of mental illness, four linear regression models to predict service provision. Results A total of 239 responses were received (response rate 7.95%). Across pharmacy services, ratings for willingness/interest were higher than those for comfort/confidence. Pharmacists who reported providing medication therapy management (MTM) services for patients reported higher comfort (18.36 vs. 17.46, p < 0.05), confidence (17.73 vs. 16.01, p < 0.05), willingness (20.0 vs. 18.62, p < 0.05) and interest (19.13 vs. 17.66, p < 0.05). Pharmacists with personal experience with mental illness also resulted in higher scores across all four domains of service provision, lower levels of stigma (18.28 vs. 20.76, p < 0.05) and more positive attitudes (52.24 vs. 50.53, p < 0.01). Regression analyses demonstrated increased frequency of MTM service delivery and more positive attitudes as significantly predictive across all four models for comfort, confidence, willingness and interest. Increased delivery of pharmacy services was significantly associated with both willingness and interest to provide mental illness-specific services. Conclusion Despite willingness/interest to provide services to patients with mental illness, decreased levels of comfort/confidence remain service-related barriers for community pharmacists.

Socioeconomic status inconsistency and risk of stroke among Japanese middle-aged women.

PubMed

Honjo, Kaori; Iso, Hiroyasu; Inoue, Manami; Sawada, Norie; Tsugane, Shoichiro

2014-09-01

Little research has been conducted to examine the effect of inconsistencies in socioeconomic status on cardiovascular health. In particular, no studies have been reported in Asian countries, including Japan, which is thought to have high socioeconomic status inconsistency among women. We examined the effect of status inconsistency between education level and occupation on stroke risk in a prospective 20-year study of 14 742 middle-aged Japanese women included in the prospective Japan Public Health Center-based (JPHC) Study Cohort I in 1990. Status inconsistency between education level and occupation was determined (qualified, overqualified, and underqualified), and the association with risk of stroke was examined. Cox proportional regression analysis was used to determine hazard ratios, which were adjusted for age, marital status, and geographical area. Adjusted hazard ratio for stroke in overqualified compared with qualified women was 2.06 (95% confidence interval, 1.13-3.78). Adjusted hazard ratios for stroke among highly educated manual workers and workers in service industry were 3.47 (95% confidence interval, 1.54-7.84) and 3.21 (95% confidence interval, 1.49-6.90), respectively, when compared with highly educated professionals/managers. High academic qualifications without an appropriate job could be a risk factor for stroke among Japanese women. Our result suggests that status inconsistency could be a potential explanation for the increased stroke risk among highly educated women. © 2014 American Heart Association, Inc.

Efficacy and Clinical Utility of a High-Attenuation Object Artifact Reduction Algorithm in Flat-Detector Image Reconstruction Compared With Standard Image Reconstruction.

PubMed

Naehle, Claas P; Hechelhammer, Lukas; Richter, Heiko; Ryffel, Fabian; Wildermuth, Simon; Weber, Johannes

To evaluate the effectiveness and clinical utility of a metal artifact reduction (MAR) image reconstruction algorithm for the reduction of high-attenuation object (HAO)-related image artifacts. Images were quantitatively evaluated for image noise (noiseSD and noiserange) and qualitatively for artifact severity, gray-white-matter delineation, and diagnostic confidence with conventional reconstruction and after applying a MAR algorithm. Metal artifact reduction reduces noiseSD and noiserange (median [interquartile range]) at the level of HAO in 1-cm distance compared with conventional reconstruction (noiseSD: 60.0 [71.4] vs 12.8 [16.1] and noiserange: 262.0 [236.8] vs 72.0 [28.3]; P < 0.0001). Artifact severity (reader 1 [mean ± SD]: 1.1 ± 0.6 vs 2.4 ± 0.5, reader 2: 0.8 ± 0.6 vs 2.0 ± 0.4) at level of HAO and diagnostic confidence (reader 1: 1.6 ± 0.7 vs 2.6 ± 0.5, reader 2: 1.0 ± 0.6 vs 2.3 ± 0.7) significantly improved with MAR (P < 0.0001). Metal artifact reduction did not affect gray-white-matter delineation. Metal artifact reduction effectively reduces image artifacts caused by HAO and significantly improves diagnostic confidence without worsening gray-white-matter delineation.

The Effect of a Surgical Skills Course on Confidence Levels of Rural General Practitioners: An Observational Study.

PubMed

Byrd, Pippa; Ward, Olga; Hamdorf, Jeffrey

2016-10-01

Objective  To investigate the effect of a short surgical skills course on general practitioners' confidence levels to perform procedural skills. Design  Prospective observational study. Setting  The Clinical Evaluation and Training Centre, a practical skills-based educational facility, at The University of Western Australia. Participants  Medical practitioners who participated in these courses. Nurses, physiotherapists, and medical students were excluded. The response rate was 61% with 61 participants providing 788 responses for pre- and postcourse confidence levels regarding various surgical skills. Intervention  One- to two-day surgical skills courses consisting of presentations, demonstrations, and practical stations, facilitated by specialists. Main Outcome Measures  A two-page precourse and postcourse questionnaire was administered to medical practitioners on the day. Participants rated their confidence levels to perform skills addressed during the course on a 4-point Likert scale. Results  Of the 788 responses regarding confidence levels, 621 were rated as improved postcourse, 163 were rated as no change, and 4 were rated as lower postcourse. Seven of the courses showed a 25% median increase in confidence levels, and one course demonstrated a 50% median increase. All courses showed statistically significant results ( p  < 0.001). Conclusion  A short surgical skills course resulted in a statistically significant improvement in the confidence levels of rural general practitioners to perform these skills.

Correlating Student Knowledge and Confidence Using a Graded Knowledge Survey to Assess Student Learning in a General Microbiology Classroom †

PubMed Central

Favazzo, Lacey; Willford, John D.; Watson, Rachel M.

2014-01-01

Knowledge surveys are a type of confidence survey in which students rate their confidence in their ability to answer questions rather than answering the questions. These surveys have been discussed as a tool to evaluate student in-class or curriculum-wide learning. However, disagreement exists as to whether confidence is actually an accurate measure of knowledge. With the concomitant goals of assessing content-based learning objectives and addressing this disagreement, we present herein a pretest/posttest knowledge survey study that demonstrates a significant difference correctness on graded test questions at different levels of reported confidence in a multi-semester timeframe. Questions were organized into Bloom’s taxonomy, allowing for the data collected to further provide statistical analyses on strengths and deficits in various levels of Bloom’s reasoning with regard to mean correctness. Collectively, students showed increasing confidence and correctness in all levels of thought but struggled with synthesis-level questions. However, when students were only asked to rate confidence and not answer the accompanying test questions, they reported significantly higher confidence than the control group which was asked to do both. This indicates that when students do not attempt to answer questions, they have significantly greater confidence in their ability to answer those questions. Additionally, when students rate only confidence without answering the question, resolution across Bloom’s levels of reasoning is lost. Based upon our findings, knowledge surveys can be an effective tool for assessment of both breadth and depth of knowledge, but may require students to answer questions in addition to rating confidence to provide the most accurate data. PMID:25574291

Calculation of Confidence Intervals for the Maximum Magnitude of Earthquakes in Different Seismotectonic Zones of Iran

NASA Astrophysics Data System (ADS)

Salamat, Mona; Zare, Mehdi; Holschneider, Matthias; Zöller, Gert

2017-03-01

The problem of estimating the maximum possible earthquake magnitude m_max has attracted growing attention in recent years. Due to sparse data, the role of uncertainties becomes crucial. In this work, we determine the uncertainties related to the maximum magnitude in terms of confidence intervals. Using an earthquake catalog of Iran, m_max is estimated for different predefined levels of confidence in six seismotectonic zones. Assuming the doubly truncated Gutenberg-Richter distribution as a statistical model for earthquake magnitudes, confidence intervals for the maximum possible magnitude of earthquakes are calculated in each zone. While the lower limit of the confidence interval is the magnitude of the maximum observed event,the upper limit is calculated from the catalog and the statistical model. For this aim, we use the original catalog which no declustering methods applied on as well as a declustered version of the catalog. Based on the study by Holschneider et al. (Bull Seismol Soc Am 101(4):1649-1659, 2011), the confidence interval for m_max is frequently unbounded, especially if high levels of confidence are required. In this case, no information is gained from the data. Therefore, we elaborate for which settings finite confidence levels are obtained. In this work, Iran is divided into six seismotectonic zones, namely Alborz, Azerbaijan, Zagros, Makran, Kopet Dagh, Central Iran. Although calculations of the confidence interval in Central Iran and Zagros seismotectonic zones are relatively acceptable for meaningful levels of confidence, results in Kopet Dagh, Alborz, Azerbaijan and Makran are not that much promising. The results indicate that estimating m_max from an earthquake catalog for reasonable levels of confidence alone is almost impossible.

Flexible and Transparent User Authentication for Mobile Devices

NASA Astrophysics Data System (ADS)

Clarke, Nathan; Karatzouni, Sevasti; Furnell, Steven

The mobile device has become a ubiquitous technology that is capable of supporting an increasingly large array of services, applications and information. Given their increasing importance, it is imperative to ensure that such devices are not misused or abused. Unfortunately, a key enabling control to prevent this, user authentication, has not kept up with the advances in device technology. This paper presents the outcomes of a 2 year study that proposes the use of transparent and continuous biometric authentication of the user: providing more comprehensive identity verification; minimizing user inconvenience; and providing security throughout the period of use. A Non-Intrusive and Continuous Authentication (NICA) system is described that maintains a continuous measure of confidence in the identity of the user, removing access to sensitive services and information with low confidence levels and providing automatic access with higher confidence levels. An evaluation of the framework is undertaken from an end-user perspective via a trial involving 27 participants. Whilst the findings raise concerns over education, privacy and intrusiveness, overall 92% of users felt the system offered a more secure environment when compared to existing forms of authentication.

Sources of sport confidence, imagery type and performance among competitive athletes: the mediating role of sports confidence.

PubMed

Levy, A R; Perry, J; Nicholls, A R; Larkin, D; Davies, J

2015-01-01

This study explored the mediating role of sport confidence upon (1) sources of sport confidence-performance relationship and (2) imagery-performance relationship. Participants were 157 competitive athletes who completed state measures of confidence level/sources, imagery type and performance within one hour after competition. Among the current sample, confirmatory factor analysis revealed appropriate support for the nine-factor SSCQ and the five-factor SIQ. Mediational analysis revealed that sport confidence had a mediating influence upon the achievement source of confidence-performance relationship. In addition, both cognitive and motivational imagery types were found to be important sources of confidence, as sport confidence mediated imagery type- performance relationship. Findings indicated that athletes who construed confidence from their own achievements and report multiple images on a more frequent basis are likely to benefit from enhanced levels of state sport confidence and subsequent performance.

Child witnesses' metamemory realism.

PubMed

Allwood, Carl Martin; Granhag, Pär Anders; Jonsson, Anna-Carin

2006-12-01

This study investigated the degree of realism in the confidence judgments of 11 to 12-year-olds (41 girls and 40 boys) of their answers to questions relating to a short film clip showing a kidnapping event. Four different confidence scales were used: a numeric scale, a picture scale, a line scale and a written scale. The results demonstrated that the children showed a high level of overconfidence in their memories. However, no significant differences between the four confidence scales were found. Weak gender differences were found in that the girls were slightly, but significantly, better calibrated than the boys. In addition, although both boys and girls overestimated the total number of memory questions they had answered correctly, the boys gave higher estimates compared with the girls. In brief, the results indicate that, at least in the context investigated, 11-12 year-old children's confidence in and estimations of their own event memory show poor realism (overconfidence and overestimation). A comparison with previous research on adults indicates that 11 to 12-year-old children show noticeably poorer realism.

Joint Direct Attack Munition (JDAM)

DTIC Science & Technology

2015-12-01

February 19, 2015 and the O&S cost are based on an ICE dated August 28, 2014 Confidence Level Confidence Level of cost estimate for current APB: 50% A...mathematically derived confidence level was not computed for this Life-Cycle Cost Estimate (LCCE). This LCCE represents the expected value, taking into...consideration relevant risks, including ordinary levels of external and unforeseen events. It aims to provide sufficient resources to execute the

A case control study of nutritional factors and cervical dysplasia.

PubMed

Liu, T; Soong, S J; Wilson, N P; Craig, C B; Cole, P; Macaluso, M; Butterworth, C E

1993-01-01

The association of nutritional factors with cervical dysplasia was examined through a case-control study. Analysis was conducted in 257 cases and 133 controls confirmed both by cytological examination and colposcopic findings. A 24-h dietary recall questionnaire was used to assess nutritional intake. Various risk factors (including age at first intercourse, number of sexual partners, parity, cigarette smoking, oral contraceptive use, human papillomavirus type 16 infection, and age and race) were adjusted for their potential confounding effects. While analyses were also performed to adjust for total calories, results were not changed significantly. Among the nutrients examined, vitamin A intake showed a significantly increased risk at the lowest quartile compared to the highest quartile, with an odds ratio of 2.2 (95% confidence interval, 1.2-4.2). A significant trend of increasing risk was also observed with lower intake of vitamin A (P = 0.05). Riboflavin showed increased risk at the two lower quartiles of intake with a trend test P value of 0.04. Increased risk was also found for lower intakes of vitamin C compared to the highest intake level. For folate, increased risk was found in the second highest quartile compared with the highest quartile with an odds ratio of 2.0 (95% confidence interval, 1.0-3.8). The calcium:phosphorus ratio showed an increased risk at the lowest level (odds ratio, 2.0; 95% confidence interval, 1.0-4.3). Insufficient intake of vitamin A, riboflavin, ascorbate, and folate is associated with an increased risk of cervical dysplasia.

Public speaking attitudes: does curriculum make a difference?

PubMed

Hancock, Adrienne B; Stone, Matthew D; Brundage, Shelley B; Zeigler, Mark T

2010-05-01

In light of infamous levels of fear associated with public speaking, businesses are training staff in communication effectiveness and universities are requiring courses in public speaking. A variety of approaches to individual training are available, but few studies have assessed effectiveness of group instruction, as in academic curricula. The specific purpose of this study was to compare changes in scores on measures of self-perceived confidence, competence, and apprehension associated with public speaking after two types of courses: one focused on knowledge of the vocal mechanism and mastering vocal characteristics (pitch, volume, rate, quality), and one addressing general communication theory and public speaking. Seventy-one undergraduate students enrolled in "Voice and Diction" at George Washington University (GWU) and 68 enrolled in "Fundamental Speech" at Florida State University completed questionnaires before and after the courses. Scores on Self-Perceived Communication Competence Scale, Personal Report of Confidence as a Speaker, and Personal Report of Communication Apprehension-24, were compared within subjects (ie, prepost course) and between courses. Significant differences (p<0.05) were found on all measures: students reported less apprehension and more confidence and competence after the courses. No differences were found between the two courses when comparing the mean changes from pre- to postscore. Traditional public speaking curriculum of how to design and deliver a speech and curriculum tailored to the voice and speech mechanism succeeded in reducing public speaking apprehension and increasing feelings of confidence and competency for these undergraduate students. (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics.

PubMed

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-02-01

It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface--in particular 'effective information presentation', 'consistency', 'efficient interactions', 'effective use of language', and 'minimizing cognitive load'--seemed to improve perceived usability and confidence in the system.

A combined microfinance and training intervention can reduce HIV risk behaviour in young female participants.

PubMed

Pronyk, Paul M; Kim, Julia C; Abramsky, Tanya; Phetla, Godfrey; Hargreaves, James R; Morison, Linda A; Watts, Charlotte; Busza, Joanna; Porter, John Dh

2008-08-20

To assess effects of a combined microfinance and training intervention on HIV risk behavior among young female participants in rural South Africa. : Secondary analysis of quantitative and qualitative data from a cluster randomized trial, the Intervention with Microfinance for AIDS and Gender Equity study. Eight villages were pair-matched and randomly allocated to receive the intervention. At baseline and after 2 years, HIV risk behavior was assessed among female participants aged 14-35 years. Their responses were compared with women of the same age and poverty group from control villages. Intervention effects were calculated using adjusted risk ratios employing village level summaries. Qualitative data collected during the study explored participants' responses to the intervention including HIV risk behavior. After 2 years of follow-up, when compared with controls, young participants had higher levels of HIV-related communication (adjusted risk ratio 1.46, 95% confidence interval 1.01-2.12), were more likely to have accessed voluntary counseling and testing (adjusted risk ratio 1.64, 95% confidence interval 1.06-2.56), and less likely to have had unprotected sex at last intercourse with a nonspousal partner (adjusted risk ratio 0.76, 95% confidence interval 0.60-0.96). Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality. Although women noted challenges associated with acceptance of condoms by men, increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships. In addition to impacts on economic well being, women's empowerment and intimate partner violence, interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior.

Effectiveness of applying flipped learning to clinical nursing practicums for nursing students in Korea: A randomized controlled trial.

PubMed

Kim, Hyun Sook; Kim, Mi Young; Cho, Mi-Kyoung; Jang, Sun Joo

2017-10-01

The purpose of this study was to develop flipped learning models for clinical practicums and compare their effectiveness regarding learner motivation toward learning, satisfaction, and confidence in performing core nursing skills among undergraduate nursing students in Korea. This study was a randomized clinical trial designed to compare the effectiveness of 2 flipped learning models. Data were collected for 3 days from October 21 to 23, 2015 before the clinical practicum was implemented and for 2 weeks from October 26 to December 18, 2015 during the practicum period. The confidence of the students in performing core nursing skills was likely to increase after they engaged in the clinical practicum in both study groups. However, while learner confidence and motivation were not affected by the type of flipped learning, learner satisfaction did differ between the 2 groups. The findings indicate that applying flipped learning allows students to conduct individualized learning with a diversity of clinical cases at their own level of understanding and at their own pace before they participate in real-world practicums. © 2017 John Wiley & Sons Australia, Ltd.

Implementation Of Fuzzy Approach To Improve Time Estimation [Case Study Of A Thermal Power Plant Is Considered

NASA Astrophysics Data System (ADS)

Pradhan, Moumita; Pradhan, Dinesh; Bandyopadhyay, G.

2010-10-01

Fuzzy System has demonstrated their ability to solve different kinds of problem in various application domains. There is an increasing interest to apply fuzzy concept to improve tasks of any system. Here case study of a thermal power plant is considered. Existing time estimation represents time to complete tasks. Applying fuzzy linear approach it becomes clear that after each confidence level least time is taken to complete tasks. As time schedule is less than less amount of cost is needed. Objective of this paper is to show how one system becomes more efficient in applying Fuzzy Linear approach. In this paper we want to optimize the time estimation to perform all tasks in appropriate time schedules. For the case study, optimistic time (to), pessimistic time (tp), most likely time(tm) is considered as data collected from thermal power plant. These time estimates help to calculate expected time(te) which represents time to complete particular task to considering all happenings. Using project evaluation and review technique (PERT) and critical path method (CPM) concept critical path duration (CPD) of this project is calculated. This tells that the probability of fifty percent of the total tasks can be completed in fifty days. Using critical path duration and standard deviation of the critical path, total completion of project can be completed easily after applying normal distribution. Using trapezoidal rule from four time estimates (to, tm, tp, te), we can calculate defuzzyfied value of time estimates. For range of fuzzy, we consider four confidence interval level say 0.4, 0.6, 0.8,1. From our study, it is seen that time estimates at confidence level between 0.4 and 0.8 gives the better result compared to other confidence levels.

Preservice Educators' Confidence in Addressing Sexuality Education

ERIC Educational Resources Information Center

Wyatt, Tammy Jordan

2009-01-01

This study examined 328 preservice educators' level of confidence in addressing four sexuality education domains and 21 sexuality education topics. Significant differences in confidence levels across the four domains were found for gender, academic major, sexuality education philosophy, and sexuality education knowledge. Preservice educators…

False memories and memory confidence in borderline patients.

PubMed

Schilling, Lisa; Wingenfeld, Katja; Spitzer, Carsten; Nagel, Matthias; Moritz, Steffen

2013-12-01

Mixed results have been obtained regarding memory in patients with borderline personality disorder (BPD). Prior reports and anecdotal evidence suggests that patients with BPD are prone to false memories but this assumption has to been put to firm empirical test, yet. Memory accuracy and confidence was assessed in 20 BPD patients and 22 healthy controls using a visual variant of the false memory (Deese-Roediger-McDermott) paradigm which involved a negative and a positive-valenced picture. Groups did not differ regarding veridical item recognition. Importantly, patients did not display more false memories than controls. At trend level, borderline patients rated more items as new with high confidence compared to healthy controls. The results tentatively suggest that borderline patients show uncompromised visual memory functions and display no increased susceptibility for distorted memories. Copyright © 2013 Elsevier Ltd. All rights reserved.

Helping Mothers Survive Bleeding After Birth: retention of knowledge, skills, and confidence nine months after obstetric simulation-based training.

PubMed

Nelissen, Ellen; Ersdal, Hege; Mduma, Estomih; Evjen-Olsen, Bjørg; Broerse, Jacqueline; van Roosmalen, Jos; Stekelenburg, Jelle

2015-08-25

It is important to know the decay of knowledge, skills, and confidence over time to provide evidence-based guidance on timing of follow-up training. Studies addressing retention of simulation-based education reveal mixed results. The aim of this study was to measure the level of knowledge, skills, and confidence before, immediately after, and nine months after simulation-based training in obstetric care in order to understand the impact of training on these components. An educational intervention study was carried out in 2012 in a rural referral hospital in Northern Tanzania. Eighty-nine healthcare workers of different cadres were trained in "Helping Mothers Survive Bleeding After Birth", which addresses basic delivery skills including active management of third stage of labour and management of postpartum haemorrhage (PPH). Knowledge, skills, and confidence were tested before, immediately after, and nine months after training amongst 38 healthcare workers. Knowledge was tested by completing a written 26-item multiple-choice questionnaire. Skills were tested in two simulated scenarios "basic delivery" and "management of PPH". Confidence in active management of third stage of labour, management of PPH, determination of completeness of the placenta, bimanual uterine compression, and accessing advanced care was self-assessed using a written 5-item questionnaire. Mean knowledge scores increased immediately after training from 70 % to 77 %, but decreased close to pre-training levels (72 %) at nine-month follow-up (p = 0.386) (all p-levels are compared to pre-training). The mean score in basic delivery skills increased after training from 43 % to 51 %, and was 49 % after nine months (p = 0.165). Mean scores of management of PPH increased from 39 % to 51 % and were sustained at 50 % at nine months (p = 0.003). Bimanual uterine compression skills increased from 19 % before, to 43 % immediately after, to 48 % nine months after training (p = 0.000). Confidence increased immediately after training, and was largely retained at nine-month follow-up. Training resulted in an immediate increase in knowledge, skills, and confidence. While knowledge and simulated basic delivery skills decayed after nine months, confidence and simulated obstetric emergency skills were largely retained. These findings indicate a need for continuation of training. Future research should focus on the frequency and dosage of follow-up training.

An Algorithm for Efficient Maximum Likelihood Estimation and Confidence Interval Determination in Nonlinear Estimation Problems

NASA Technical Reports Server (NTRS)

Murphy, Patrick Charles

1985-01-01

An algorithm for maximum likelihood (ML) estimation is developed with an efficient method for approximating the sensitivities. The algorithm was developed for airplane parameter estimation problems but is well suited for most nonlinear, multivariable, dynamic systems. The ML algorithm relies on a new optimization method referred to as a modified Newton-Raphson with estimated sensitivities (MNRES). MNRES determines sensitivities by using slope information from local surface approximations of each output variable in parameter space. The fitted surface allows sensitivity information to be updated at each iteration with a significant reduction in computational effort. MNRES determines the sensitivities with less computational effort than using either a finite-difference method or integrating the analytically determined sensitivity equations. MNRES eliminates the need to derive sensitivity equations for each new model, thus eliminating algorithm reformulation with each new model and providing flexibility to use model equations in any format that is convenient. A random search technique for determining the confidence limits of ML parameter estimates is applied to nonlinear estimation problems for airplanes. The confidence intervals obtained by the search are compared with Cramer-Rao (CR) bounds at the same confidence level. It is observed that the degree of nonlinearity in the estimation problem is an important factor in the relationship between CR bounds and the error bounds determined by the search technique. The CR bounds were found to be close to the bounds determined by the search when the degree of nonlinearity was small. Beale's measure of nonlinearity is developed in this study for airplane identification problems; it is used to empirically correct confidence levels for the parameter confidence limits. The primary utility of the measure, however, was found to be in predicting the degree of agreement between Cramer-Rao bounds and search estimates.

Integration of multiple biological features yields high confidence human protein interactome.

PubMed

Karagoz, Kubra; Sevimoglu, Tuba; Arga, Kazim Yalcin

2016-08-21

The biological function of a protein is usually determined by its physical interaction with other proteins. Protein-protein interactions (PPIs) are identified through various experimental methods and are stored in curated databases. The noisiness of the existing PPI data is evident, and it is essential that a more reliable data is generated. Furthermore, the selection of a set of PPIs at different confidence levels might be necessary for many studies. Although different methodologies were introduced to evaluate the confidence scores for binary interactions, a highly reliable, almost complete PPI network of Homo sapiens is not proposed yet. The quality and coverage of human protein interactome need to be improved to be used in various disciplines, especially in biomedicine. In the present work, we propose an unsupervised statistical approach to assign confidence scores to PPIs of H. sapiens. To achieve this goal PPI data from six different databases were collected and a total of 295,288 non-redundant interactions between 15,950 proteins were acquired. The present scoring system included the context information that was assigned to PPIs derived from eight biological attributes. A high confidence network, which included 147,923 binary interactions between 13,213 proteins, had scores greater than the cutoff value of 0.80, for which sensitivity, specificity, and coverage were 94.5%, 80.9%, and 82.8%, respectively. We compared the present scoring method with others for evaluation. Reducing the noise inherent in experimental PPIs via our scoring scheme increased the accuracy significantly. As it was demonstrated through the assessment of process and cancer subnetworks, this study allows researchers to construct and analyze context-specific networks via valid PPI sets and one can easily achieve subnetworks around proteins of interest at a specified confidence level. Copyright © 2016 Elsevier Ltd. All rights reserved.

Advanced Extremely High Frequency Satellite (AEHF)

DTIC Science & Technology

2015-12-01

control their tactical and strategic forces at all levels of conflict up to and including general nuclear war, and it supports the attainment of...10195.1 10622.2 Confidence Level Confidence Level of cost estimate for current APB: 50% The ICE) that supports the AEHF SV 1-4, like all life-cycle cost...mathematically the precise confidence levels associated with life-cycle cost estimates prepared for MDAPs. Based on the rigor in methods used in building

Wideband Global SATCOM (WGS)

DTIC Science & Technology

2015-12-01

system level testing. ​The WGS-6 financial data is not reported in this SAR because funding is provided by Australia in exchange for access to a...A 3831.3 3539.7 3539.7 3801.9 Confidence Level Confidence Level of cost estimate for current APB: 50% The ICE to support WGS Milestone C decision...to calculate mathematically the precise confidence levels associated with life-cycle cost estimates prepared for MDAPs. Based on the rigor in

Examination of the Relationship between TEOG Score Transition (from Basic to Secondary Education), Self-Confidence, Self-Efficacy and Motivation Level

ERIC Educational Resources Information Center

Usta, H. Gonca

2017-01-01

The relationship between individuals' academic success, motivation and self-confidence and self-efficacy levels cannot be ignored. The aim of this study is to develop and test a theoretical model considering the relationship between academic motivation, self-confidence and self-efficacy levels in transition from middle school to high school. For…

An Analysis of Training Effects on School Personnel's Knowledge, Attitudes, Comfort, and Confidence Levels toward Educating Students about HIV/AIDS in Pennsylvania

ERIC Educational Resources Information Center

Deutschlander, Sharon

2010-01-01

The purpose of this study was to determine the training effects on school personnel's knowledge, attitudes, comfort, and confidence levels toward educating students about HIV/AIDS in Pennsylvania. The following four research questions were explored: (a) What is the knowledge, attitudes, confidence, and comfort levels of school personnel regarding…

Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients.

PubMed

Bennett, Tellen D; Hayward, Kristen N; Farris, Reid W D; Ringold, Sarah; Wallace, Carol A; Brogan, Thomas V

2011-11-01

To determine whether an elevated serum ferritin level is independently associated with mortality and receipt of critical care in pediatric patients. Retrospective cohort study, open population. Seattle Children's Hospital, Seattle, WA, from September 2, 2003, to February 15, 2008. All patients tested for serum ferritin level from September 2, 2003, to August 16, 2007, with a level ≥1000 ng/mL. None. MAIN ANALYSIS: Cox regression. The predictor of interest was the patient-specific peak serum ferritin level, dichotomized a priori at 3000 ng/mL. The outcomes were mortality and intensive care unit admission. A total of 171 patients met the inclusion criteria. The observation time without death or intensive care unit admission ranged from 184 to 1621 days. The hazard ratio of death with peak ferritin of >3000 ng/mL was 4.32 (95% confidence interval 2.21-8.47, p < .001) compared to peak ferritin of 1000-3000 ng/mL. The hazard ratio of intensive care unit admission with peak ferritin of >3000 ng/mL was 2.49 (95% confidence interval 1.53-4.05, p < .001) compared to peak ferritin of 1000-3000 ng/mL. Both estimates were adjusted for bone marrow transplant, solid organ transplant, hemoglobinopathy, and existing rheumatologic disease. In this pediatric population, with serum ferritin levels of >3000 ng/mL, there was increased risk for both receipt of critical care and subsequent death.

Nurse leader certification preparation: how are confidence levels impacted?

PubMed

Junger, Stacey; Trinkle, Nicole; Hall, Norma

2016-09-01

The aim was to examine the effect of a nurse leader certification preparation course on the confidence levels of the participants. Limited literature is available regarding nurse leader development and certifications. Barriers exist related to lack of confidence, high cost, time and lack of access to a preparation course. Nurse leaders (n = 51) completed a pre- and post-survey addressing confidence levels of participants related to the topics addressed in the nurse leader certification preparation course. There were statistically significant increases in confidence levels related to all course content for the participants. At the time of the study, there were 31.4% of participants intending to sit for the certification examination, and 5 of the 51 participants successfully sat for and passed the examination. A nurse leader certification preparation course increases confidence levels of the participants and removes barriers, thereby increasing the number of certifications obtained. The health-care climate is increasingly complex and nurse leaders need the expertise to navigate the ever-changing health-care environment. Certification in a specialty, such as leadership, serves as an indicator of a high level of competence in the field. © 2016 John Wiley & Sons Ltd.

Plasma Levels of Fatty Acid-Binding Protein 4, Retinol-Binding Protein 4, High-Molecular-Weight Adiponectin, and Cardiovascular Mortality Among Men With Type 2 Diabetes: A 22-Year Prospective Study.

PubMed

Liu, Gang; Ding, Ming; Chiuve, Stephanie E; Rimm, Eric B; Franks, Paul W; Meigs, James B; Hu, Frank B; Sun, Qi

2016-11-01

To examine select adipokines, including fatty acid-binding protein 4, retinol-binding protein 4, and high-molecular-weight (HMW) adiponectin in relation to cardiovascular disease (CVD) mortality among patients with type 2 diabetes mellitus. Plasma levels of fatty acid-binding protein 4, retinol-binding protein 4, and HMW adiponectin were measured in 950 men with type 2 diabetes mellitus in the Health Professionals Follow-up Study. After an average of 22 years of follow-up (1993-2015), 580 deaths occurred, of whom 220 died of CVD. After multivariate adjustment for covariates, higher levels of fatty acid-binding protein 4 were significantly associated with a higher CVD mortality: comparing extreme tertiles, the hazard ratio and 95% confidence interval of CVD mortality was 1.78 (1.22-2.59; P trend=0.001). A positive association was also observed for HMW adiponectin: the hazard ratio (95% confidence interval) was 2.07 (1.42-3.06; P trend=0.0002), comparing extreme tertiles, whereas higher retinol-binding protein 4 levels were nonsignificantly associated with a decreased CVD mortality with an hazard ratio (95% confidence interval) of 0.73 (0.50-1.07; P trend=0.09). A Mendelian randomization analysis suggested that the causal relationships of HMW adiponectin and retinol-binding protein 4 would be directionally opposite to those observed based on the biomarkers, although none of the Mendelian randomization associations achieved statistical significance. These data suggest that higher levels of fatty acid-binding protein 4 and HMW adiponectin are associated with elevated CVD mortality among men with type 2 diabetes mellitus. Biological mechanisms underlying these observations deserve elucidation, but the associations of HMW adiponectin may partially reflect altered adipose tissue functionality among patients with type 2 diabetes mellitus. © 2016 American Heart Association, Inc.

Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials

PubMed Central

Zabetian, Azadeh; Ferket, Bart S.; Zhou, Jing; Testani, Jeffrey M.; Garg, Amit X.; Parikh, Chirag R.

2016-01-01

Observational studies have shown that acute change in kidney function (specifically, AKI) is a strong risk factor for poor outcomes. Thus, the outcome of acute change in serum creatinine level, regardless of underlying biology or etiology, is frequently used in clinical trials as both efficacy and safety end points. We performed a meta-analysis of clinical trials to quantify the relationship between positive or negative short–term effects of interventions on change in serum creatinine level and more meaningful clinical outcomes. After a thorough literature search, we included 14 randomized trials of interventions that altered risk for an acute increase in serum creatinine level and had reported between–group differences in CKD and/or mortality rate ≥3 months after randomization. Seven trials assessed interventions that, compared with placebo, increased risk of acute elevation in serum creatinine level (pooled relative risk, 1.52; 95% confidence interval, 1.22 to 1.89), and seven trials assessed interventions that, compared with placebo, reduced risk of acute elevation in serum creatinine level (pooled relative risk, 0.57; 95% confidence interval, 0.44 to 0.74). However, pooled risks for CKD and mortality associated with interventions did not differ from those with placebo in either group. In conclusion, several interventions that affect risk of acute, mild to moderate, often temporary elevation in serum creatinine level in placebo–controlled randomized trials showed no appreciable effect on CKD or mortality months later, raising questions about the value of using small to moderate changes in serum creatinine level as end points in clinical trials. PMID:26712525

Empirical likelihood-based confidence intervals for the sensitivity of a continuous-scale diagnostic test at a fixed level of specificity.

PubMed

Gengsheng Qin; Davis, Angela E; Jing, Bing-Yi

2011-06-01

For a continuous-scale diagnostic test, it is often of interest to find the range of the sensitivity of the test at the cut-off that yields a desired specificity. In this article, we first define a profile empirical likelihood ratio for the sensitivity of a continuous-scale diagnostic test and show that its limiting distribution is a scaled chi-square distribution. We then propose two new empirical likelihood-based confidence intervals for the sensitivity of the test at a fixed level of specificity by using the scaled chi-square distribution. Simulation studies are conducted to compare the finite sample performance of the newly proposed intervals with the existing intervals for the sensitivity in terms of coverage probability. A real example is used to illustrate the application of the recommended methods.

Neonatal hyperbilirubinemia and risk of autism spectrum disorders.

PubMed

Croen, Lisa A; Yoshida, Cathleen K; Odouli, Roxana; Newman, Thomas B

2005-02-01

To investigate the association between neonatal hyperbilirubinemia and autism spectrum disorders (ASD). We conducted a large case-control study nested within the cohort of singleton term infants born between 1995 and 1998 at a northern California Kaiser Permanente hospital. Case subjects (n = 338) were children with an ASD diagnosis recorded in Kaiser Permanente outpatient databases; control subjects (n = 1817) were children without an ASD diagnosis, who were randomly sampled and frequency-matched to case subjects according to gender, birth year, and birth hospital. Approximately 28% of case and control subjects received > or =1 bilirubin test in the first 30 days of life. No case-control differences were observed for maximal bilirubin levels of > or =15 mg/dL (10.1% vs 12.1%), > or =20 mg/dL (2.1% vs 2.5%), or > or =25 mg/dL (0.3% vs 0.2%). Compared with children whose maximal neonatal bilirubin levels were <15 mg/dL or not measured, children with any degree of bilirubin level elevation were not at increased risk of ASD, after adjustment for gender, birth facility, maternal age, maternal race/ethnicity, maternal education, and gestational age (for bilirubin levels of 15-19.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.5-1.2; for bilirubin levels of 20-24.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.3-1.6; for bilirubin levels of > or =25 mg/dL: odds ratio: 1.1; 95% confidence interval: 0.1-11.2). These data suggest that neonatal hyperbilirubinemia is not a risk factor for ASD.

Confidence limits and sample size for determining nonhost status of fruits and vegetables to tephritid fruit flies as a quarantine measure.

PubMed

Follett, Peter A; Hennessey, Michael K

2007-04-01

Quarantine measures including treatments are applied to exported fruit and vegetable commodities to control regulatory fruit fly pests and to reduce the likelihood of their introduction into new areas. Nonhost status can be an effective measure used to achieve quarantine security. As with quarantine treatments, nonhost status can stand alone as a measure if there is high efficacy and statistical confidence. The numbers of insects or fruit tested during investigation of nonhost status will determine the level of statistical confidence. If the level of confidence of nonhost status is not high, then additional measures may be required to achieve quarantine security as part of a systems approach. Certain countries require that either 99.99 or 99.9968% mortality, as a measure of efficacy, at the 95% confidence level, be achieved by a quarantine treatment to meet quarantine security. This article outlines how the level of confidence in nonhost status can be quantified so that its equivalency to traditional quarantine treatments may be demonstrated. Incorporating sample size and confidence levels into host status testing protocols along with efficacy will lead to greater consistency by regulatory decision-makers in interpreting results and, therefore, to more technically sound decisions on host status.

Reduced gamma-aminobutyric acid concentration is associated with physical disability in progressive multiple sclerosis.

PubMed

Cawley, Niamh; Solanky, Bhavana S; Muhlert, Nils; Tur, Carmen; Edden, Richard A E; Wheeler-Kingshott, Claudia A M; Miller, David H; Thompson, Alan J; Ciccarelli, Olga

2015-09-01

Neurodegeneration is thought to be the major cause of ongoing, irreversible disability in progressive stages of multiple sclerosis. Gamma-aminobutyric acid is the principle inhibitory neurotransmitter in the brain. The aims of this study were to investigate if gamma-aminobutyric acid levels (i) are abnormal in patients with secondary progressive multiple sclerosis compared with healthy controls; and (ii) correlate with physical and cognitive performance in this patient population. Thirty patients with secondary progressive multiple sclerosis and 17 healthy control subjects underwent single-voxel MEGA-PRESS (MEscher-GArwood Point RESolved Spectroscopy) magnetic resonance spectroscopy at 3 T, to quantify gamma-aminobutyric acid levels in the prefrontal cortex, right hippocampus and left sensorimotor cortex. All subjects were assessed clinically and underwent a cognitive assessment. Multiple linear regression models were used to compare differences in gamma-aminobutyric acid concentrations between patients and controls adjusting for age, gender and tissue fractions within each spectroscopic voxel. Regression was used to examine the relationships between the cognitive function and physical disability scores specific for these regions with gamma-aminobuytric acid levels, adjusting for age, gender, and total N-acetyl-aspartate and glutamine-glutamate complex levels. When compared with controls, patients performed significantly worse on all motor and sensory tests, and were cognitively impaired in processing speed and verbal memory. Patients had significantly lower gamma-aminobutyric acid levels in the hippocampus (adjusted difference = -0.403 mM, 95% confidence intervals -0.792, -0.014, P = 0.043) and sensorimotor cortex (adjusted difference = -0.385 mM, 95% confidence intervals -0.667, -0.104, P = 0.009) compared with controls. In patients, reduced motor function in the right upper and lower limb was associated with lower gamma-aminobutyric acid concentration in the sensorimotor cortex. Specifically for each unit decrease in gamma-aminobutyric acid levels (in mM), there was a predicted -10.86 (95% confidence intervals -16.786 to -4.482) decrease in grip strength (kg force) (P < 0.001) and -8.74 (95% confidence intervals -13.943 to -3.015) decrease in muscle strength (P < 0.006). This study suggests that reduced gamma-aminobutyric acid levels reflect pathological abnormalities that may play a role in determining physical disability. These abnormalities may include decreases in the pre- and postsynaptic components of gamma-aminobutyric acid neurotransmission and in the density of inhibitory neurons. Additionally, the reduced gamma-aminobutyric acid concentration may contribute to the neurodegenerative process, resulting in increased firing of axons, with consequent increased energy demands, which may lead to neuroaxonal degeneration and loss of the compensatory mechanisms that maintain motor function. This study supports the idea that modulation of gamma-aminobutyric acid neurotransmission may be an important target for neuroprotection in multiple sclerosis.See De Stefano and Giorgio (doi:10.1093/brain/awv213) for a scientific commentary on this article. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Global Positioning System III (GPS III)

DTIC Science & Technology

2015-12-01

Vacuum (TVAC) testing on October 12, 2015, and successfully completed baseline TVAC testing on December 23, 2015 – a major system- level event...0.0 0.0 Total 4142.9 5285.2 N/A 5180.4 4269.8 5650.1 5557.4 Current APB Cost Estimate Reference SCP dated July 02, 2015 Confidence Level Confidence... Level of cost estimate for current APB: 60% The current APB is established at the 60% confidence level . This estimate is built upon the February 2015

Family Partner Intervention Influences Self-Care Confidence and Treatment Self-Regulation in Patients with Heart Failure

PubMed Central

Stamp, Kelly D.; Dunbar, Sandra B.; Clark, Patricia C.; Reilly, Carolyn M.; Gary, Rebecca A.; Higgins, Melinda; Ryan, Richard M

2015-01-01

Background Heart failure self-care requires confidence in one’s ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors. Aims To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups. Methods Heart failure patients (N = 117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient’s perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months. Results Family functioning was related to self-care confidence for diet (p=.02) and autonomous motivation for adhering to their medications (p=.05 and diet p=0.2). The family partnership intervention group significantly improved confidence (p=.05) and motivation (medications (p=.004; diet p=.012) at four months whereas patient-family education group and usual care did not change. Conclusion Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes. PMID:25673525

Prognostic value of changes in galectin-3 levels over time in patients with heart failure: data from CORONA and COACH.

PubMed

van der Velde, A Rogier; Gullestad, Lars; Ueland, Thor; Aukrust, Pål; Guo, Yu; Adourian, Aram; Muntendam, Pieter; van Veldhuisen, Dirk J; de Boer, Rudolf A

2013-03-01

In several cross-sectional analyses, circulating baseline levels of galectin-3, a protein involved in myocardial fibrosis and remodeling, have been associated with increased risk for morbidity and mortality in patients with heart failure (HF). The importance and clinical use of repeated measurements of galectin-3 have not yet been reported. Plasma galectin-3 was measured at baseline and at 3 months in patients enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA) trial (n=1329), and at baseline and at 6 months in patients enrolled in the Coordinating Study Evaluating Outcomes of Advising and Counseling Failure (COACH) trial (n=324). Patient results were analyzed by categorical and percentage changes in galectin-3 level. A threshold value of 17.8 ng/mL or 15% change from baseline was used to categorize patients. Increasing galectin-3 levels over time, from a low to high galectin-3 category, were associated with significantly more HF hospitalization and mortality compared with stable or decreasing galectin-3 levels (hazard ratio in CORONA, 1.60; 95% confidence interval, 1.13-2.25; P=0.007; hazard ratio in COACH, 2.38; 95% confidence interval, 1.02-5.55; P=0.046). In addition, patients whose galectin-3 increased by >15% between measurements had a 50% higher relative hazard of adverse event than those whose galectin-3 stayed within ±15% of the baseline value, independent of age, sex, diabetes mellitus, left ventricular ejection fraction, renal function, medication (β-blocker, angiotensin converting enzyme inhibitor, and angiotensin receptor blocker), and N-terminal probrain natriuretic peptide (hazard ratio in CORONA, 1.50; 95% confidence interval, 1.17-1.92; P=0.001). The impact of changing galectin-3 levels on other secondary end points was comparable. In 2 large cohorts of patients with chronic and acute decompensated HF, repeated measurements of galectin-3 level provided important and significant prognostic value in identifying patients with HF at elevated risk for subsequent HF morbidity and mortality.

From tissue iron retention to low systemic haemoglobin levels, new pathophysiological biomarkers of human abdominal aortic aneurysm.

PubMed

Martinez-Pinna, R; Lindholt, J S; Madrigal-Matute, J; Blanco-Colio, L M; Esteban-Salan, M; Torres-Fonseca, M M; Lefebvre, T; Delbosc, S; Laustsen, J; Driss, F; Vega de Ceniga, M; Gouya, L; Weiss, G; Egido, J; Meilhac, O; Michel, J-B; Martin-Ventura, J

2014-07-03

Iron deposits are observed in tissue of abdominal aortic aneurysm (AAA) patients, although the underlying mechanisms are not completely elucidated. Therefore we explored circulating markers of iron metabolism in AAA patients, and tested if they could serve as biomarkers of AAA. Increased red blood cell (RBC)-borne iron retention and transferrin, transferrin receptor and ferritin expression was observed in AAA tissue compared to control aorta (immunohistochemistry and western blot). In contrast, decreased circulating iron, transferrin, mean corpuscular haemoglobin concentration (MCHC) and haemoglobin concentration, along with circulating RBC count, were observed in AAA patients (aortic diameter >3 cm, n=114) compared to controls (aortic diameter <3 cm, n=88) (ELISA), whereas hepcidin concentrations were increased in AAA subjects (MS/MS assay). Moreover, iron, transferrin and haemoglobin levels were negatively, and hepcidin positively, correlated with aortic diameter in AAA patients. The association of low haemoglobin with AAA presence or aortic diameter was independent of specific risk factors. Moreover, MCHC negatively correlated with thrombus area in another cohort of AAA patients (aortic diameter 3-5 cm, n=357). We found that anaemia was significantly more prevalent in AAA patients (aortic diameter >5 cm, n=8,912) compared to those in patients with atherosclerotic aorto-iliac occlusive disease (n=17,737) [adjusted odds ratio=1.77 (95% confidence interval: 1.61;1.93)]. Finally, the mortality risk among AAA patients with anaemia was increased by almost 30% [adjusted hazard ratio: 1.29 (95% confidence interval: 1.16;1.44)] as compared to AAA subjects without anaemia. In conclusion, local iron retention and altered iron recycling associated to high hepcidin and low transferrin systemic concentrations could lead to reduced circulating haemoglobin levels in AAA patients. Low haemoglobin levels are independently associated to AAA presence and clinical outcome.

Pretransplantation Cystatin C, but not Creatinine, Predicts 30-day Cardiovascular Events and Mortality in Liver Transplant Recipients With Normal Serum Creatinine Levels.

PubMed

Kwon, H-M; Moon, Y-J; Jung, K-W; Jun, I-G; Song, J-G; Hwang, G-S

2018-05-01

The connection between renal dysfunction and cardiovascular dysfunction has been consistently shown. In patients with liver cirrhosis, renal dysfunction shows a tight correlation with prognosis after liver transplantation (LT); therefore, precise renal assessment is mandatory. Cystatin C, a sensitive biomarker for assessing renal function, has shown superiority in detecting mild renal dysfunction compared to classical biomarker creatinine. In this study, we aimed to compare cystatin C and creatinine in predicting 30-day major cardiovascular events (MACE) and all-cause mortality in LT recipients with normal serum creatinine levels. Between May 2010 and October 2015, 1181 LT recipients (mean Model for End-stage Liver Disease score 12.1) with pretransplantation creatinine level ≤1.4 mg/dL were divided into tertiles according to each renal biomarker. The 30-day MACE was a composite of troponin I >0.2 ng/mL, arrhythmia, congestive heart failure, death, and cerebrovascular events. The highest tertile of cystatin C (≥0.95 mg/L) was associated with a higher risk for a 30-day MACE event (odds ratio: 1.62; 95% confidence interval: 1.07 to 2.48) and higher risk of death (hazard ratio: 1.96; 95% confidence interval: 1.04 to 3.67) than the lowest tertile (<0.74 mg/L) after multivariate adjustments. However, the highest tertile of creatinine level showed neither increasing MACE event rate nor worse survival rate compared with the lowest tertile (both insignificant after multivariate adjustment). Pretransplantation cystatin C is superior in risk prediction of MACE and all-cause mortality in LT recipients with normal creatinine, compared to creatinine. It would assist further risk stratification which may not be detected with creatinine. Copyright © 2018 Elsevier Inc. All rights reserved.

Nonportable computed radiography of the chest--radiologists' acceptance

NASA Astrophysics Data System (ADS)

Gennari, Rose C.; Gur, David; Miketic, Linda M.; Campbell, William L.; Oliver, James H., III; Plunkett, Michael B.

1994-04-01

Following a large ROC study to assess diagnostic accuracy of PA chest computed radiography (CR) images displayed in a variety of formats, we asked nine experienced radiologists to subjectively assess their acceptance of and preferences for display modes in primary diagnosis of erect PA chest images. Our results indicate that radiologists felt somewhat less comfortable interpreting CR images displayed on either laser-printed films or workstations as compared to conventional films. The use of four minified images were thought to somewhat decrease diagnostic confidence, as well as to increase the time of interpretation. The reverse mode (black bone) images increased radiologists' confidence level in the detection of soft tissue abnormalities.

Glucose Levels and Risk of Frailty.

PubMed

Zaslavsky, Oleg; Walker, Rod L; Crane, Paul K; Gray, Shelly L; Larson, Eric B

2016-09-01

The association between glucose levels and incident frailty in older persons remains unclear. We examined the extent to which higher glucose levels in older adults with and without diabetes are related to risk of frailty. The data are from the Adult Changes in Thought study. We identified 1,848 individuals aged 65+ without dementia for whom glucose levels from laboratory measurements of glucose and glycated hemoglobin were available. Physical frailty using modified Fried's criteria was determined from biennial assessments. Frailty hazard was modeled as a function of time-varying measures of diabetes and average glucose levels using Cox regression. A total of 578 incident frailty cases (94 with diabetes, 484 without) occurred during a median follow-up of 4.8 years. The adjusted hazard ratio for frailty comparing those with and without diabetes was 1.52 (95% confidence interval = 1.19-1.94). In participants without diabetes, modeling suggested elevated frailty risk with greater average glucose levels (p = .019); for example, a glucose level of 110mg/dL compared with 100mg/dL yielded a hazard ratio of 1.32 (95% confidence interval = 1.09-1.59). In participants with diabetes, glucose levels less than 160mg/dL and greater than 180mg/dL were related to increased risk of frailty (p = .001). Higher glucose levels may be a risk factor for frailty in older adults without diabetes. The apparent U-shape association between glucose levels and frailty in people with diabetes is consistent with the literature on glycemia and mortality and deserves further examination. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Relationship between self-confidence and sex role identity among managerial women and men.

PubMed

Chusmir, L H; Koberg, C S

1991-12-01

The self-confidence and sex role identities of 437 American female and male managers were examined by using three subscales of the Adjective Check List. Results showed that, contrary to stereotypes and older research, female and male managers were strikingly similar. Women and men with cross-sex role identities showed lower levels of self-confidence than those did with androgynous orientations; high self-confidence was linked with masculine and androgynous orientations. The managers were not significantly different in self-confidence when demographic variables and sex role identity were held constant. Sex role identity (but not gender) was a major factor in the level of self-confidence.

The confidence and knowledge of health practitioners when interacting with people with aphasia in a hospital setting.

PubMed

Cameron, Ashley; McPhail, Steven; Hudson, Kyla; Fleming, Jennifer; Lethlean, Jennifer; Tan, Ngang Ju; Finch, Emma

2018-06-01

The aim of the study was to describe and compare the confidence and knowledge of health professionals (HPs) with and without specialized speech-language training for communicating with people with aphasia (PWA) in a metropolitan hospital setting. Ninety HPs from multidisciplinary teams completed a customized survey to identify their demographic information, knowledge of aphasia, current use of supported conversation strategies and overall communication confidence when interacting with PWA using a 100 mm visual analogue scale (VAS) to rate open-ended questions. Conventional descriptive statistics were used to examine the demographic information. Descriptive statistics and the Mann-Whitney U test were used to analyse VAS confidence rating data. The responses to the open-ended survey questions were grouped into four previously identified key categories. The HPs consisted of 22 (24.4%) participants who were speech-language pathologists and 68 (75.6%) participants from other disciplines (non-speech-language pathology HPs, non-SLP HPs). The non-SLP HPs reported significantly lower confidence levels (U = 159.0, p < 0.001, two-tailed) and identified fewer strategies for communicating effectively with PWA than the trained speech-language pathologists. The non-SLP HPs identified a median of two strategies identified [interquartile range (IQR) 1-3] in contrast to the speech-language pathologists who identified a median of eight strategies (IQR 7-12). These findings suggest that HPs, particularly those without specialized communication education, are likely to benefit from formal training to enhance their confidence, skills and ability to successfully communicate with PWA in their work environment. This may in turn increase the involvement of PWA in their health care decisions. Implications for Rehabilitation Interventions to remediate health professional's (particularly non-speech-language pathology health professionals) lower levels of confidence and ability to communicate with PWA may ultimately help ensure equal access for PWA. Promote informed collaborative decision-making, and foster patient-centred care within the health care setting.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Needleman, H.L.; Schell, A.; Bellinger, D.

To determine whether the effects of low-level lead exposure persist, we reexamined 132 of 270 young adults who had initially been studied as primary school-children in 1975 through 1978. In the earlier study, neurobehavioral functioning was found to be inversely related to dentin lead levels. As compared with those we restudied, the other 138 subjects had had somewhat higher lead levels on earlier analysis, as well as significantly lower IQ scores and poorer teachers' ratings of classroom behavior. When the 132 subjects were reexamined in 1988, impairment in neurobehavioral function was still found to be related to the lead contentmore » of teeth shed at the ages of six and seven. The young people with dentin lead levels greater than 20 ppm had a markedly higher risk of dropping out of high school (adjusted odds ratio, 7.4; 95 percent confidence interval, 1.4 to 40.7) and of having a reading disability (odds ratio, 5.8; 95 percent confidence interval, 1.7 to 19.7) as compared with those with dentin lead levels less than 10 ppm. Higher lead levels in childhood were also significantly associated with lower class standing in high school, increased absenteeism, lower vocabulary and grammatical-reasoning scores, poorer hand-eye coordination, longer reaction times, and slower finger tapping. No significant associations were found with the results of 10 other tests of neurobehavioral functioning. Lead levels were inversely related to self-reports of minor delinquent activity. We conclude that exposure to lead in childhood is associated with deficits in central nervous system functioning that persist into young adulthood.« less

A comparison of two global datasets of extreme sea levels and resulting flood exposure

NASA Astrophysics Data System (ADS)

Muis, Sanne; Verlaan, Martin; Nicholls, Robert J.; Brown, Sally; Hinkel, Jochen; Lincke, Daniel; Vafeidis, Athanasios T.; Scussolini, Paolo; Winsemius, Hessel C.; Ward, Philip J.

2017-04-01

Estimating the current risk of coastal flooding requires adequate information on extreme sea levels. For over a decade, the only global data available was the DINAS-COAST Extreme Sea Levels (DCESL) dataset, which applies a static approximation to estimate extreme sea levels. Recently, a dynamically derived dataset was developed: the Global Tide and Surge Reanalysis (GTSR) dataset. Here, we compare the two datasets. The differences between DCESL and GTSR are generally larger than the confidence intervals of GTSR. Compared to observed extremes, DCESL generally overestimates extremes with a mean bias of 0.6 m. With a mean bias of -0.2 m GTSR generally underestimates extremes, particularly in the tropics. The Dynamic Interactive Vulnerability Assessment model is applied to calculate the present-day flood exposure in terms of the land area and the population below the 1 in 100-year sea levels. Global exposed population is 28% lower when based on GTSR instead of DCESL. Considering the limited data available at the time, DCESL provides a good estimate of the spatial variation in extremes around the world. However, GTSR allows for an improved assessment of the impacts of coastal floods, including confidence bounds. We further improve the assessment of coastal impacts by correcting for the conflicting vertical datum of sea-level extremes and land elevation, which has not been accounted for in previous global assessments. Converting the extreme sea levels to the same vertical reference used for the elevation data is shown to be a critical step resulting in 39-59% higher estimate of population exposure.

Self-confidence of anglers in identification of freshwater sport fish

USGS Publications Warehouse

Chizinski, C.J.; Martin, D. R.; Pope, Kevin L.

2014-01-01

Although several studies have focused on how well anglers identify species using replicas and pictures, there has been no study assessing the confidence that can be placed in angler's ability to identify recreationally important fish. Understanding factors associated with low self-confidence will be useful in tailoring education programmes to improve self-confidence in identifying common species. The purposes of this assessment were to quantify the confidence of recreational anglers to identify 13 commonly encountered warm water fish species and to relate self-confidence to species availability and angler experience. Significant variation was observed in anglers self-confidence among species and levels of self-declared skill, with greater confidence associated with greater skill and with greater exposure. This study of angler self-confidence strongly highlights the need for educational programmes that target lower skilled anglers and the importance of teaching all anglers about less common species, regardless of skill level.

Disconnections Between Teacher Expectations and Student Confidence in Bioethics

NASA Astrophysics Data System (ADS)

Hanegan, Nikki L.; Price, Laura; Peterson, Jeremy

2008-09-01

This study examines how student practice of scientific argumentation using socioscientific bioethics issues affects both teacher expectations of students’ general performance and student confidence in their own work. When teachers use bioethical issues in the classroom students can gain not only biology content knowledge but also important decision-making skills. Learning bioethics through scientific argumentation gives students opportunities to express their ideas, formulate educated opinions and value others’ viewpoints. Research has shown that science teachers’ expectations of student success and knowledge directly influence student achievement and confidence levels. Our study analyzes pre-course and post-course surveys completed by students enrolled in a university level bioethics course ( n = 111) and by faculty in the College of Biology and Agriculture faculty ( n = 34) based on their perceptions of student confidence. Additionally, student data were collected from classroom observations and interviews. Data analysis showed a disconnect between faculty and students perceptions of confidence for both knowledge and the use of science argumentation. Student reports of their confidence levels regarding various bioethical issues were higher than faculty reports. A further disconnect showed up between students’ preferred learning styles and the general faculty’s common teaching methods; students learned more by practicing scientific argumentation than listening to traditional lectures. Students who completed a bioethics course that included practice in scientific argumentation, significantly increased their confidence levels. This study suggests that professors’ expectations and teaching styles influence student confidence levels in both knowledge and scientific argumentation.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fresquez, Philip R.

Field mice are effective indicators of contaminant presence. This paper reports the concentrations of various radionuclides, heavy metals, polychlorinated biphenyls, high explosives, perchlorate, and dioxin/furans in field mice (mostly deer mice) collected from regional background areas in northern New Mexico. These data, represented as the regional statistical reference level (the mean plus three standard deviations = 99% confidence level), are used to compare with data from field mice collected from areas potentially impacted by Laboratory operations, as per the Environmental Surveillance Program at Los Alamos National Laboratory.

Mock-juror evaluations of traditional and ratings-based eyewitness identification evidence.

PubMed

Sauer, James D; Palmer, Matthew A; Brewer, Neil

2017-08-01

Compared to categorical identifications, culprit likelihood ratings (having the witness rate, for each lineup member, the likelihood that the individual is the culprit) provide a promising alternative for assessing a suspect's likely guilt. Four experiments addressed 2 broad questions about the use of culprit likelihood ratings evidence by mock-jurors. First, are mock-jurors receptive to noncategorical forms of identification evidence? Second, does the additional information provided by ratings (relating to discrimination) affect jurors' evaluations of the identification evidence? Experiments 1 and 1A manipulated confidence (90% vs. 50%) and discrimination (good, poor, no information) between participants. Evaluations were influenced by confidence, but not discrimination. However, a within-participant manipulation of discrimination (Experiment 2) demonstrated that evidence of good discrimination enhanced the persuasiveness of moderate levels of confidence, while poor discrimination reduced the persuasiveness of high levels of confidence. Thus, participants can interpret ratings-based evidence, but may not intuit the discrimination information when evaluating ratings for a single identification procedure. Providing detailed instructions about interpreting ratings produced clear discrimination effects when evaluating a single identification procedure (Experiment 3). Across 4 experiments, we found no evidence that mock-jurors perceived noncategorical identification evidence to be less informative than categorical evidence. However, jurors will likely benefit from instruction when interpreting ratings provided by a single witness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Racial Differences in Satisfaction with VA Health Care: A Mixed Methods Pilot Study.

PubMed

Zickmund, Susan L; Burkitt, Kelly H; Gao, Shasha; Stone, Roslyn A; Rodriguez, Keri L; Switzer, Galen E; Shea, Judy A; Bayliss, Nichole K; Meiksin, Rebecca; Walsh, Mary B; Fine, Michael J

2015-09-01

As satisfied patients are more adherent and play a more active role in their own care, a better understanding of factors associated with patient satisfaction is important. In response to a United States Veterans Administration (VA) Hospital Report Card that revealed lower levels of satisfaction with health care for African Americans compared to Whites, we conducted a mixed methods pilot study to obtain preliminary qualitative and quantitative information about possible underlying reasons for these racial differences. We conducted telephone interviews with 30 African American and 31 White veterans with recent inpatient and/or outpatient health care visits at three urban VA Medical Centers. We coded the qualitative interviews in terms of identified themes within defined domains. We summarized racial differences using ordinal logistic regression for Likert scale outcomes and used random effects logistic regression to assess racial differences at the domain level. Compared to Whites, African Americans were younger (p < 0.001) and better educated (p = 0.04). Qualitatively, African Americans reported less satisfaction with trust/confidence in their VA providers and healthcare system and less satisfaction with patient-provider communication. Quantitatively, African Americans reported less satisfaction with outpatient care (odds ratio = 0.28; 95 % confidence interval (CI) 0.10-0.82), but not inpatient care. At the domain level, African Americans were significantly less likely than Whites to express satisfaction themes in the domain of trust/confidence (odds ratio = 0.36; 95 % CI 0.18-0.73). The current pilot study demonstrates racial differences in satisfaction with outpatient care and identifies some specific sources of dissatisfaction. Future research will include a large national cohort, including Hispanic veterans, in order to gain further insight into the sources of racial and ethnic differences in satisfaction with VA care and inform future interventions.

Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis

PubMed Central

Abduljabbar, Tariq; Abu Hassan, Mohamed Ibrahim; Vohra, Fahim

2016-01-01

To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with and without obesity, MEDLINE/PubMed, EMBASE, ScienceDirect, and SCOPUS databases were combined with handsearching of articles published from 1977 up to May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines: resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1β. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and nonobese patients with CP. Four studies reported comparable levels of interleukin- (IL-) 6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1β and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels compared to nonobese individuals remains debatable. PMID:27795608

Effectiveness of Immersive Virtual Reality in Surgical Training-A Randomized Control Trial.

PubMed

Pulijala, Yeshwanth; Ma, Minhua; Pears, Matthew; Peebles, David; Ayoub, Ashraf

2018-05-01

Surgical training methods are evolving with the technological advancements, including the application of virtual reality (VR) and augmented reality. However, 28 to 40% of novice residents are not confident in performing a major surgical procedure. VR surgery, an immersive VR (iVR) experience, was developed using Oculus Rift and Leap Motion devices (Leap Motion, Inc, San Francisco, CA) to address this challenge. Our iVR is a multisensory, holistic surgical training application that demonstrates a maxillofacial surgical technique, the Le Fort I osteotomy. The main objective of the present study was to evaluate the effect of using VR surgery on the self-confidence and knowledge of surgical residents. A multisite, single-blind, parallel, randomized controlled trial (RCT) was performed. The participants were novice surgical residents with limited experience in performing the Le Fort I osteotomy. The primary outcome measures were the self-assessment scores of trainee confidence using a Likert scale and an objective assessment of the cognitive skills. Ninety-five residents from 7 dental schools were included in the RCT. The participants were randomly divided into a study group of 51 residents and a control group of 44. Participants in the study group used the VR surgery application on an Oculus Rift with Leap Motion device. The control group participants used similar content in a standard PowerPoint presentation on a laptop. Repeated measures multivariate analysis of variance was applied to the data to assess the overall effect of the intervention on the confidence of the residents. The study group participants showed significantly greater perceived self-confidence levels compared with those in the control group (P = .034; α = 0.05). Novices in the first year of their training showed the greatest improvement in their confidence compared with those in their second and third year. iVR experiences improve the knowledge and self-confidence of the surgical residents. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Urinary Levels of N-Nitroso Compounds in Relation to Risk of Gastric Cancer: Findings from the Shanghai Cohort Study

PubMed Central

Xu, Ling; Qu, Yong-Hua; Chu, Xin-Di; Wang, Renwei; Nelson, Heather H.; Gao, Yu-Tang; Yuan, Jian-Min

2015-01-01

Background N-Nitroso compounds are thought to play a significant role in the development of gastric cancer. Epidemiological data, however, are sparse in examining the associations between biomarkers of exposure to N-nitroso compounds and the risk of gastric cancer. Methods A nested case-control study within a prospective cohort of 18,244 middle-aged and older men in Shanghai, China, was conducted to examine the association between urinary level of N-nitroso compounds and risk of gastric cancer. Information on demographics, usual dietary intake, and use of alcohol and tobacco was collected through in-person interviews at enrollment. Urinary levels of nitrate, nitrite, N-nitroso-2-methylthiazolidine-4-carboxylic acid (NMTCA), N-nitrosoproline (NPRO), N-nitrososarcosine (NSAR), N-nitrosothiazolidine-4-carboxylic acid (NTCA), as well as serum H. pylori antibodies were quantified in 191 gastric cancer cases and 569 individually matched controls. Logistic regression method was used to assess the association between urinary levels of N-nitroso compounds and risk of gastric cancer. Results Compared with controls, gastric cancer patients had overall comparable levels of urinary nitrate, nitrite, and N-nitroso compounds. Among individuals seronegative for antibodies to H. pylori, elevated levels of urinary nitrate were associated with increased risk of gastric cancer. The multivariate-adjusted odds ratios for the second and third tertiles of nitrate were 3.27 (95% confidence interval = 0.76–14.04) and 4.82 (95% confidence interval = 1.05–22.17), respectively, compared with the lowest tertile (P for trend = 0.042). There was no statistically significant association between urinary levels of nitrite or N-nitroso compounds and risk of gastric cancer. Urinary NMTCA level was significantly associated with consumption of alcohol and preserved meat and fish food items. Conclusion The present study demonstrates that exposure to nitrate, a precursor of N-nitroso compounds, may increase the risk of gastric cancer among individuals without a history of H. pylori infection. PMID:25658333

Urinary levels of N-nitroso compounds in relation to risk of gastric cancer: findings from the shanghai cohort study.

PubMed

Xu, Ling; Qu, Yong-Hua; Chu, Xin-Di; Wang, Renwei; Nelson, Heather H; Gao, Yu-Tang; Yuan, Jian-Min

2015-01-01

N-Nitroso compounds are thought to play a significant role in the development of gastric cancer. Epidemiological data, however, are sparse in examining the associations between biomarkers of exposure to N-nitroso compounds and the risk of gastric cancer. A nested case-control study within a prospective cohort of 18,244 middle-aged and older men in Shanghai, China, was conducted to examine the association between urinary level of N-nitroso compounds and risk of gastric cancer. Information on demographics, usual dietary intake, and use of alcohol and tobacco was collected through in-person interviews at enrollment. Urinary levels of nitrate, nitrite, N-nitroso-2-methylthiazolidine-4-carboxylic acid (NMTCA), N-nitrosoproline (NPRO), N-nitrososarcosine (NSAR), N-nitrosothiazolidine-4-carboxylic acid (NTCA), as well as serum H. pylori antibodies were quantified in 191 gastric cancer cases and 569 individually matched controls. Logistic regression method was used to assess the association between urinary levels of N-nitroso compounds and risk of gastric cancer. Compared with controls, gastric cancer patients had overall comparable levels of urinary nitrate, nitrite, and N-nitroso compounds. Among individuals seronegative for antibodies to H. pylori, elevated levels of urinary nitrate were associated with increased risk of gastric cancer. The multivariate-adjusted odds ratios for the second and third tertiles of nitrate were 3.27 (95% confidence interval = 0.76-14.04) and 4.82 (95% confidence interval = 1.05-22.17), respectively, compared with the lowest tertile (P for trend = 0.042). There was no statistically significant association between urinary levels of nitrite or N-nitroso compounds and risk of gastric cancer. Urinary NMTCA level was significantly associated with consumption of alcohol and preserved meat and fish food items. The present study demonstrates that exposure to nitrate, a precursor of N-nitroso compounds, may increase the risk of gastric cancer among individuals without a history of H. pylori infection.

Comparing facility-level methane emission rate estimates at natural gas gathering and boosting stations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vaughn, Timothy L.; Bell, Clay S.; Yacovitch, Tara I.

Coordinated dual-tracer, aircraft-based, and direct component-level measurements were made at midstream natural gas gathering and boosting stations in the Fayetteville shale (Arkansas, USA). On-site component-level measurements were combined with engineering estimates to generate comprehensive facility-level methane emission rate estimates ('study on-site estimates (SOE)') comparable to tracer and aircraft measurements. Combustion slip (unburned fuel entrained in compressor engine exhaust), which was calculated based on 111 recent measurements of representative compressor engines, accounts for an estimated 75% of cumulative SOEs at gathering stations included in comparisons. Measured methane emissions from regenerator vents on glycol dehydrator units were substantially larger than predicted bymore » modelling software; the contribution of dehydrator regenerator vents to the cumulative SOE would increase from 1% to 10% if based on direct measurements. Concurrent measurements at 14 normally-operating facilities show relative agreement between tracer and SOE, but indicate that tracer measurements estimate lower emissions (regression of tracer to SOE = 0.91 (95% CI = 0.83-0.99), R2 = 0.89). Tracer and SOE 95% confidence intervals overlap at 11/14 facilities. Contemporaneous measurements at six facilities suggest that aircraft measurements estimate higher emissions than SOE. Aircraft and study on-site estimate 95% confidence intervals overlap at 3/6 facilities. The average facility level emission rate (FLER) estimated by tracer measurements in this study is 17-73% higher than a prior national study by Marchese et al.« less

Comparing facility-level methane emission rate estimates at natural gas gathering and boosting stations

DOE PAGES

Vaughn, Timothy L.; Bell, Clay S.; Yacovitch, Tara I.; ...

2017-02-09

Coordinated dual-tracer, aircraft-based, and direct component-level measurements were made at midstream natural gas gathering and boosting stations in the Fayetteville shale (Arkansas, USA). On-site component-level measurements were combined with engineering estimates to generate comprehensive facility-level methane emission rate estimates ('study on-site estimates (SOE)') comparable to tracer and aircraft measurements. Combustion slip (unburned fuel entrained in compressor engine exhaust), which was calculated based on 111 recent measurements of representative compressor engines, accounts for an estimated 75% of cumulative SOEs at gathering stations included in comparisons. Measured methane emissions from regenerator vents on glycol dehydrator units were substantially larger than predicted bymore » modelling software; the contribution of dehydrator regenerator vents to the cumulative SOE would increase from 1% to 10% if based on direct measurements. Concurrent measurements at 14 normally-operating facilities show relative agreement between tracer and SOE, but indicate that tracer measurements estimate lower emissions (regression of tracer to SOE = 0.91 (95% CI = 0.83-0.99), R2 = 0.89). Tracer and SOE 95% confidence intervals overlap at 11/14 facilities. Contemporaneous measurements at six facilities suggest that aircraft measurements estimate higher emissions than SOE. Aircraft and study on-site estimate 95% confidence intervals overlap at 3/6 facilities. The average facility level emission rate (FLER) estimated by tracer measurements in this study is 17-73% higher than a prior national study by Marchese et al.« less

Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study.

PubMed

Jukes, Alistair K; Mascarenhas, Annika; Murphy, Jae; Stepan, Lia; Muñoz, Tamara N; Callejas, Claudio A; Valentine, Rowan; Wormald, P J; Psaltis, Alkis J

2017-06-01

Major vessel hemorrhage in endoscopic, endonasal skull-base surgery is a rare but potentially fatal event. Surgical simulation models have been developed to train surgeons in the techniques required to manage this complication. This mixed-methods study aims to quantify the stress responses the model induces, determine how realistic the experience is, and how it changes the confidence levels of surgeons in their ability to deal with major vascular injury in an endoscopic setting. Forty consultant surgeons and surgeons in training underwent training on an endoscopic sheep model of jugular vein and carotid artery injury. Pre-course and post-course questionnaires providing demographics, experience level, confidence, and realism scores were taken, based on a 5-point Likert scale. Objective markers of stress response including blood pressure, heart rate, and salivary alpha-amylase levels were measured. Mean "realism" score assessed posttraining showed the model to be perceived as highly realistic by the participants (score 4.02). Difference in participant self-rated pre-course and post-course confidence levels was significant (p < 0.0001): mean pre-course confidence level 1.66 (95% confidence interval [CI], 1.43 to 1.90); mean post-course confidence level 3.42 (95% CI, 3.19 to 3.65). Differences in subjects' heart rates (HRs) and mean arterial blood pressures (MAPs) were significant between injury models (p = 0.0008, p = 0.0387, respectively). No statistically significant difference in salivary alpha-amylase levels pretraining and posttraining was observed. Results from this study indicate that this highly realistic simulation model provides surgeons with an increased level of confidence in their ability to deal with the rare but potentially catastrophic event of major vessel injury in endoscopic skull-base surgery. © 2017 ARS-AAOA, LLC.

Detection of crestal radiolucencies around dental implants: an in vitro experimental study.

PubMed

Sirin, Yigit; Horasan, Sinan; Yaman, Duygu; Basegmez, Cansu; Tanyel, Cem; Aral, Ali; Guven, Koray

2012-07-01

The aim of this study was to compare the diagnostic potentials and practical advantages of different imaging modalities in detecting bone defects around dental implants. Crestal bone defects with sequentially larger diameters were randomly prepared around 100 implants that were inserted in bovine bone blocks. Conventional periapical radiography (PR), direct digital radiography (DDR), panoramic radiography (PANO), cone-beam computed tomography (CBCT), and multislice computed tomography (MSCT) were performed for all specimens. The diagnostic accuracies of the devices, confidence of the answers, subjective image quality, defect visibility in planar orientations, and duration of diagnosis were analyzed based on the interpretations of 7 calibrated observers. The agreement levels of intra- and interobserver scores were rated good. PR, DDR, and CBCT were mostly more accurate than PANO and MSCT (P < .05). Confidence levels were positively correlated with the defect size (ρ = 0.20, P < .01), and that of DDR was the highest (P < .05). The subjective image quality of PR and DDR was higher than that of CBCT, PANO, and MSCT (P < .05 for all comparisons). Axial-coronal-sagittal visibilities of the defects were higher for CBCT compared with MSCT (P < .05). The diagnostic time was shorter for DDR (P < .05) and longer for the tomographic systems (P < .05) than for the other devices. DDR may provide a faster and more confident diagnostic option that is as accurate as PR in detecting peri-implant radiolucencies. CBCT has a comparable potential to these intraoral systems but with slower decision making and lower image quality, whereas PANO and MSCT become more reliable when bone defects have a diameter that is at least 1.5 mm larger than that of the implant. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Assessing Mental Health First Aid Skills Using Simulated Patients

PubMed Central

Chen, Timothy F.; Moles, Rebekah J.; O’Reilly, Claire

2018-01-01

Objective. To evaluate mental health first aid (MHFA) skills using simulated patients and to compare self-reported confidence in providing MHFA with performance during simulated patient roleplays. Methods. Pharmacy students self-evaluated their confidence in providing MHFA post-training. Two mental health vignettes and an assessment rubric based on the MHFA Action Plan were developed to assess students’ observed MHFA skills during audio-recorded simulated patient roleplays. Results. There were 163 students who completed the MHFA training, of which 88% completed self-evaluations. There were 84% to 98% of students who self-reported that they agreed or strongly agreed they were confident providing MHFA. Postnatal depression (PND) and suicide vignettes were randomly assigned to 36 students. More students participating in the PND roleplay took appropriate actions, compared to those participating in the suicide role-play. However, more students participating in the suicide role play assessed alcohol and/or drug use. Ten (71%) participants in the PND roleplay and six (40%) in the suicide roleplay either avoided using suicide-specific terminology completely or used multiple terms rendering their inquiry unclear. Conclusion. Self-evaluated confidence levels in providing MHFA did not always reflect observed performance. Students had difficulty addressing suicide with only half passing the suicide vignette and many avoiding suicide-specific terminology. This indicates that both self-reported and observed behaviors should be used for post-training assessments. PMID:29606711

Metal Artifact Reduction With MAVRIC SL at 3-T MRI in Patients With Hip Arthroplasty

PubMed Central

Choi, Soo-Jung; Koch, Kevin M.; Hargreaves, Brian A.; Stevens, Kathryn J.; Gold, Garry E.

2015-01-01

OBJECTIVE The objective of our study was to compare the multiacquisition variable-resonance image combination selective (MAVRIC SL) sequence with the 2D fast spin-echo (FSE) sequence for metal artifact reduction on 3-T MRI in patients with hip arthroplasty (HA). MATERIALS AND METHODS Matched 2D FSE and MAVRIC SL images of 21 hips (19 patients with HA) were included in the study group. Paired image sets, composed of 13 coronal and 12 axial slices (total, 25 image sets), of the 21 hips were evaluated. For quantitative analysis, the artifact area was measured at the level of the hip and femur. For qualitative analysis, two musculoskeletal radiologists independently compared paired 2D FSE and MAVRIC SL sets in terms of artifacts, depiction of anatomic detail, level of diagnostic confidence, and detection of abnormal findings. RESULTS The measured artifact area was significantly smaller (p < 0.05) on MAVRIC SL than 2D FSE at both the level of hip (59.9% reduction with MAVRIC SL) and femur (31.3% reduction with MAVRIC SL). The artifact score was also significantly decreased (p < 0.0001) with MAVRIC SL compared with 2D FSE for both reviewers. The hip joint capsule and the tendon attachment sites of the obturator externus and iliopsoas muscles were better depicted with MAVRIC SL than 2D FSE (p < 0.0125). Abnormal findings were significantly better shown on MAVRIC SL imaging compared with 2D FSE imaging (p < 0.0001). CONCLUSION The MAVRIC SL sequence can significantly reduce metal artifact on 3-T MRI compared with the 2D FSE sequence and can increase diagnostic confidence of 3-T MRI in patients with total HA. PMID:25539249

Three-dimensional CT enterography using oral gastrografin in patients with small bowel obstruction: comparison with axial CT images or fluoroscopic findings.

PubMed

Hong, Seong Sook; Kim, Ah Young; Kwon, Seok Beom; Kim, Pyo Nyun; Lee, Moon-Gyu; Ha, Hyun Kwon

2010-10-01

To evaluate the feasibility of 3D CT enterography using oral gastrografin in patients with small bowel obstruction (SBO), focusing on improving diagnostic performance as compared with the use of axial CT imagings and fluoroscopic findings. For a 10-month period, 18 patients with known SBO detected clinically and radiologically were enrolled. In all patients, gastrografin was ingested prior to CT enterography. Twelve patients underwent a fluoroscopic examination. Images were randomly assessed for confidence for the level, for the cause of SBO, and for the assessment of the interpretability of each image by two gastrointestinal radiologists. The results were considered statistically significant using the Wilcoxon rank sum test. All patients (100%) well tolerated the administration of oral gastrografin. The use of 3D CT enterography significantly improved diagnostic confidence for the interpretation of the level, cause of SBO, and the assessment of the interpretability of each image as compared with the use of axial CT images (P < 0.05). 3D CT enterography was superior as compared to fluoroscopic examination (P < 0.05). The use of gastrografin for 3D CT enterography is a safe and feasible technique for precise evaluation of known or suspected SBO.

Comparison of two kinds of interface, based on guided navigation or usability principles, for improving the adoption of computerized decision support systems: application to the prescription of antibiotics

PubMed Central

Tsopra, Rosy; Jais, Jean-Philippe; Venot, Alain; Duclos, Catherine

2014-01-01

Context It is important to consider the way in which information is presented by the interfaces of clinical decision support systems, to favor the adoption of these systems by physicians. Interface design can focus on decision processes (guided navigation) or usability principles. Objective The aim of this study was to compare these two approaches in terms of perceived usability, accuracy rate, and confidence in the system. Materials and methods We displayed clinical practice guidelines for antibiotic treatment via two types of interface, which we compared in a crossover design. General practitioners were asked to provide responses for 10 clinical cases and the System Usability Scale (SUS) for each interface. We assessed SUS scores, the number of correct responses, and the confidence level for each interface. Results SUS score and percentage confidence were significantly higher for the interface designed according to usability principles (81 vs 51, p=0.00004, and 88.8% vs 80.7%, p=0.004). The percentage of correct responses was similar for the two interfaces. Discussion/conclusion The interface designed according to usability principles was perceived to be more usable and inspired greater confidence among physicians than the guided navigation interface. Consideration of usability principles in the construction of an interface—in particular ‘effective information presentation’, ‘consistency’, ‘efficient interactions’, ‘effective use of language’, and ‘minimizing cognitive load’—seemed to improve perceived usability and confidence in the system. PMID:24008427

Association of heart rate profile during exercise with the severity of coronary artery disease.

PubMed

Cay, Serkan; Ozturk, Sezgin; Biyikoglu, Funda; Yildiz, Abdulkadir; Cimen, Tolga; Uygur, Belma; Tuna, Funda

2009-05-01

Coronary artery disease is the leading cause of morbidity and mortality around the world. Autonomic nervous system abnormalities are associated with coronary artery disease and its complications. Exercise stress tests are routinely used for the detection of the presence of coronary artery disease. In this study, we observed the association between heart rate profile during exercise and the severity of coronary artery disease. One hundred and sixty patients with abnormal exercise treadmill test (> or =1 mm horizontal or downsloping ST-segment depression; 119 men, 41 women; mean age = 57 +/- 9 years) were included in the study. Use of any drug affecting heart rate was not permitted. Resting heart rate before exercise, maximum heart rate during exercise, and resting heart rate after exercise (5 min later) were measured and two parameters were calculated: heart rate increment (maximum heart rate - resting heart rate before exercise) and heart rate decrement (maximum heart rate - resting heart rate after exercise). All patients underwent selective coronary angiography and subclassified into two groups according to stenotic lesion severity. Group 1 had at least 50% of stenotic lesion and group 2 had less than 50%. Patients in the first group had increased resting heart rate, decreased maximum heart rate, decreased heart rate increment, and decreased heart rate decrement compared with second group. All patients were classified into tertiles of resting heart rate, heart rate increment, and heart rate decrement level to evaluate whether these parameters were associated with severity of coronary artery stenosis in the study. The multiple-adjusted odds ratio of the risk of severe coronary atherosclerosis was 21.888 (95% confidence interval 6.983-68.606) for the highest tertile of resting heart rate level compared with the lowest tertile. In addition, the multiple-adjusted odds ratio of the risk of severe coronary atherosclerosis was 20.987 (95% confidence interval 6.635-66.387) for the lowest tertile of heart rate increment level compared with the highest tertile and 2.360 (95% confidence interval 1.004-5.544) for the lowest tertile of heart rate decrement level compared with the highest tertile. Altered autonomic nervous system regulation affects heart rate profile, increased resting heart rate, decreased heart rate increment, and decreased heart rate decrement, during exercise and this effect is strongly and independently associated with the severity of coronary artery disease.

Faith Is Confidence: The Implication of Psychosocial Components in Faith-Based Educational Programs on Expressive Communication Skills of Adult Learners

ERIC Educational Resources Information Center

Lynch, Erin M.

2016-01-01

Faith-based programs for adult learners have environmental factors that differentiate them from non-faith based programs, but explicit empirical studies evaluating the impact of the psychosocial factors have been lacking in the literature. This study comparatively examines the achievement level of expressive communication skills as measured…

Stress, Self-Esteem, and Mental Health: How Does Gender Make a Difference?

ERIC Educational Resources Information Center

Zuckerman, Diana M.

1989-01-01

Compares the stress levels and reactions to stress of 804 female and 127 male college students and examines their relationship to self-esteem, confidence, and self-concept. Concludes that sex differences in dysfunctional reactions to stress are related to sex differences in self-concepts, whereas sex differences in areas of stress are not related…

Career Decision Making in the Shadow of Economic Downturn: A Study of Cape Breton High School Students.

ERIC Educational Resources Information Center

Chisholm, Joe; Edmunds, Alan

2001-01-01

Examines differences in levels of career decision-making self-efficacy in Cape Breton high school students who lived in communities with recent closures of mining and steel industries compared to students from communities with no such closures. Students demonstrated considerable confidence in their career decision-making abilities implying that…

Nutrition Instruction in Seventh Grade: A Comparison of Teachers with and without FCS Background

ERIC Educational Resources Information Center

Murimi, Mary W.; Sample, Alicia; Hunt, Alice

2008-01-01

This study compared attitudes and confidence levels, regarding classroom nutrition education, of seventh grade teachers of nutrition, family and consumer sciences (FCS), or health education. A 17-item online questionnaire was used to obtain the data from randomly selected schools in Louisiana. Teachers who reported an educational background in FCS…

Confidence in the safety of standard childhood vaccinations among New Zealand health professionals.

PubMed

Lee, Carol; Duck, Isabelle; Sibley, Chris G

2018-05-04

To investigate the level of confidence in the safety of standard childhood vaccinations among health professionals in New Zealand. Data from the 2013/14 New Zealand Attitudes and Values Study (NZAVS) was used to investigate the level of agreement that "it is safe to vaccinate children following the standard New Zealand immunisation schedule" among different classes of health professionals (N=1,032). Most health professionals showed higher levels of vaccine confidence, with 96.7% of those describing their occupation as GP or simply 'doctor' (GPs/doctor) and 90.7% of pharmacists expressing strong vaccine confidence. However, there were important disparities between some other classes of health professionals, with only 65.1% of midwives and 13.6% of practitioners of alternative medicine expressing high vaccine confidence. As health professionals are a highly trusted source of vaccine information, communicating the consensus of belief among GPs/doctors that vaccines are safe may help provide reassurance for parents who ask about vaccine safety. However, the lower level of vaccine confidence among midwives is a matter of concern that may have negative influence on parental perceptions of vaccinations.

Investigating the psychological resilience, self-confidence and problem-solving skills of midwife candidates.

PubMed

Ertekin Pinar, Sukran; Yildirim, Gulay; Sayin, Neslihan

2018-05-01

The high level of psychological resilience, self-confidence and problem solving skills of midwife candidates play an important role in increasing the quality of health care and in fulfilling their responsibilities towards patients. This study was conducted to investigate the psychological resilience, self-confidence and problem-solving skills of midwife candidates. It is a convenience descriptive quantitative study. Students who study at Health Sciences Faculty in Turkey's Central Anatolia Region. Midwife candidates (N = 270). In collection of data, the Personal Information Form, Psychological Resilience Scale for Adults (PRSA), Self-Confidence Scale (SCS), and Problem Solving Inventory (PSI) were used. There was a negatively moderate-level significant relationship between the Problem Solving Inventory scores and the Psychological Resilience Scale for Adults scores (r = -0.619; p = 0.000), and between Self-Confidence Scale scores (r = -0.524; p = 0.000). There was a positively moderate-level significant relationship between the Psychological Resilience Scale for Adults scores and the Self-Confidence Scale scores (r = 0.583; p = 0.000). There was a statistically significant difference (p < 0.05) between the Problem Solving Inventory and the Psychological Resilience Scale for Adults scores according to getting support in a difficult situation. As psychological resilience and self-confidence levels increase, problem-solving skills increase; additionally, as self-confidence increases, psychological resilience increases too. Psychological resilience, self-confidence, and problem-solving skills of midwife candidates in their first-year of studies are higher than those who are in their fourth year. Self-confidence and psychological resilience of midwife candidates aged between 17 and 21, self-confidence and problem solving skills of residents of city centers, psychological resilience of those who perceive their monthly income as sufficient are high. Psychological resilience and problem-solving skills for midwife candidates who receive social support are also high. The fact that levels of self-confidence, problem-solving skills and psychological resilience of fourth-year students are found to be low presents a situation that should be taken into consideration. Copyright © 2018 Elsevier Ltd. All rights reserved.

Medium to long-term results of the UNIX uncemented unicompartmental knee replacement.

PubMed

Hall, Matthew J; Connell, David A; Morris, Hayden G

2013-10-01

We report the first non-designer study of the Unix uncemented unicompartmental knee prosthesis. Eighty-five consecutive UKRs were carried out with sixty-five available for follow-up. Oxford Knee Scores, WOMAC questionnaire and radiological assessment were completed. The mean Oxford Knee Score was thirty-eight and WOMAC Score was twenty. Overall Kaplan Meier survival estimate is 76% (95% confidence interval 60%-97%) at 12years and 88% (95% confidence interval 76-100%) with aseptic loosening as the endpoint. Radiographic assessment showed lysis in the tibia in 6% of patients with no lysis evident around the central fin. Survivorship is comparable to other published series of UKRs. We suggest the central fin design is key to dissipating large forces throughout the proximal tibia, resulting in low levels of tibial loosening. Level of evidence IV. Copyright © 2012 Elsevier B.V. All rights reserved.

Experimental Analysis of Steel Beams Subjected to Fire Enhanced by Brillouin Scattering-Based Fiber Optic Sensor Data.

PubMed

Bao, Yi; Chen, Yizheng; Hoehler, Matthew S; Smith, Christopher M; Bundy, Matthew; Chen, Genda

2017-01-01

This paper presents high temperature measurements using a Brillouin scattering-based fiber optic sensor and the application of the measured temperatures and building code recommended material parameters into enhanced thermomechanical analysis of simply supported steel beams subjected to combined thermal and mechanical loading. The distributed temperature sensor captures detailed, nonuniform temperature distributions that are compared locally with thermocouple measurements with less than 4.7% average difference at 95% confidence level. The simulated strains and deflections are validated using measurements from a second distributed fiber optic (strain) sensor and two linear potentiometers, respectively. The results demonstrate that the temperature-dependent material properties specified in the four investigated building codes lead to strain predictions with less than 13% average error at 95% confidence level and that the Europe building code provided the best predictions. However, the implicit consideration of creep in Europe is insufficient when the beam temperature exceeds 800°C.

Remote Minehunting System (RMS)

DTIC Science & Technology

2015-12-01

1449.4 1449.4 744.6 Confidence Level Confidence Level of cost estimate for current APB: 50% The Independent Cost Estimate to support the RMS Nunn...which the Derpartment has been successful. It is difficult to calculate mathematically the precise confidence levels associated with life-cycle cost...Baseline (TY $M) Initial PAUC Production Estimate Changes PAUC Development Estimate Econ Qty Sch Eng Est Oth Spt Total 12.957 -0.752 3.262 2.950 0.454

Associations of Lipoprotein(a) Levels With Incident Atrial Fibrillation and Ischemic Stroke: The ARIC (Atherosclerosis Risk in Communities) Study.

PubMed

Aronis, Konstantinos N; Zhao, Di; Hoogeveen, Ron C; Alonso, Alvaro; Ballantyne, Christie M; Guallar, Eliseo; Jones, Steven R; Martin, Seth S; Nazarian, Saman; Steffen, Brian T; Virani, Salim S; Michos, Erin D

2017-12-15

Lipoprotein(a) (Lp[a]) is proatherosclerotic and prothrombotic, causally related to coronary disease, and associated with other cardiovascular diseases. The association of Lp(a) with incident atrial fibrillation (AF) and with ischemic stroke among individuals with AF remains to be elucidated. In the community-based ARIC (Atherosclerosis Risk in Communities) study cohort, Lp(a) levels were measured by a Denka Seiken assay at visit 4 (1996-1998). We used multivariable-adjusted Cox models to compare AF and ischemic stroke risk across Lp(a) levels. First, we evaluated incident AF in 9908 participants free of AF at baseline. AF was ascertained by electrocardiography at study visits, hospital International Statistical Classification of Diseases, 9th Revision ( ICD-9 ) codes, and death certificates. We then evaluated incident ischemic stroke in 10 127 participants free of stroke at baseline. Stroke was identified by annual phone calls, hospital ICD-9 Revision codes, and death certificates. The baseline age was 62.7±5.6 years. Median Lp(a) levels were 13.3 mg/dL (interquartile range, 5.2-39.7 mg/dL). Median follow-up was 13.9 and 15.8 years for AF and stroke, respectively. Lp(a) was not associated with incident AF (hazard ratio, 0.98; 95% confidence interval, 0.82-1.17), comparing those with Lp(a) ≥50 with those with Lp(a) <10 mg/dL. High Lp(a) was associated with a 42% relative increase in stroke risk among participants without AF (hazard ratio, 1.42; 95% confidence interval, 1.07-1.90) but not in those with AF (hazard ratio, 1.06; 95% confidence interval, 0.70-1.61 [ P interaction for AF=0.25]). There were no interactions by race or sex. No association was found for cardioembolic stroke subtype. High Lp(a) levels were not associated with incident AF. Lp(a) levels were associated with increased ischemic stroke risk, primarily among individuals without AF but not in those with AF. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Stability in the metamemory realism of eyewitness confidence judgments.

PubMed

Buratti, Sandra; Allwood, Carl Martin; Johansson, Marcus

2014-02-01

The stability of eyewitness confidence judgments over time in regard to their reported memory and accuracy of these judgments is of interest in forensic contexts because witnesses are often interviewed many times. The present study investigated the stability of the confidence judgments of memory reports of a witnessed event and of the accuracy of these judgments over three occasions, each separated by 1 week. Three age groups were studied: younger children (8-9 years), older children (10-11 years), and adults (19-31 years). A total of 93 participants viewed a short film clip and were asked to answer directed two-alternative forced-choice questions about the film clip and to confidence judge each answer. Different questions about details in the film clip were used on each of the three test occasions. Confidence as such did not exhibit stability over time on an individual basis. However, the difference between confidence and proportion correct did exhibit stability across time, in terms of both over/underconfidence and calibration. With respect to age, the adults and older children exhibited more stability than the younger children for calibration. Furthermore, some support for instability was found with respect to the difference between the average confidence level for correct and incorrect answers (slope). Unexpectedly, however, the younger children's slope was found to be more stable than the adults. Compared to the previous research, the present study's use of more advanced statistical methods provides a more nuanced understanding of the stability of confidence judgments in the eyewitness reports of children and adults.

Evaluation of Short-Term Changes in Serum Creatinine Level as a Meaningful End Point in Randomized Clinical Trials.

PubMed

Coca, Steven G; Zabetian, Azadeh; Ferket, Bart S; Zhou, Jing; Testani, Jeffrey M; Garg, Amit X; Parikh, Chirag R

2016-08-01

Observational studies have shown that acute change in kidney function (specifically, AKI) is a strong risk factor for poor outcomes. Thus, the outcome of acute change in serum creatinine level, regardless of underlying biology or etiology, is frequently used in clinical trials as both efficacy and safety end points. We performed a meta-analysis of clinical trials to quantify the relationship between positive or negative short-term effects of interventions on change in serum creatinine level and more meaningful clinical outcomes. After a thorough literature search, we included 14 randomized trials of interventions that altered risk for an acute increase in serum creatinine level and had reported between-group differences in CKD and/or mortality rate ≥3 months after randomization. Seven trials assessed interventions that, compared with placebo, increased risk of acute elevation in serum creatinine level (pooled relative risk, 1.52; 95% confidence interval, 1.22 to 1.89), and seven trials assessed interventions that, compared with placebo, reduced risk of acute elevation in serum creatinine level (pooled relative risk, 0.57; 95% confidence interval, 0.44 to 0.74). However, pooled risks for CKD and mortality associated with interventions did not differ from those with placebo in either group. In conclusion, several interventions that affect risk of acute, mild to moderate, often temporary elevation in serum creatinine level in placebo-controlled randomized trials showed no appreciable effect on CKD or mortality months later, raising questions about the value of using small to moderate changes in serum creatinine level as end points in clinical trials. Copyright © 2016 by the American Society of Nephrology.

The outcome of trauma patients with do-not-resuscitate orders.

PubMed

Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B

2016-02-01

Institutional variation in outcome of patients with do-not-resuscitate (DNR) orders has not been well described in the setting of trauma. The purpose of this study was to assess the impact of trauma center designation on outcome of patients with DNR orders. A statewide trauma database (Pennsylvania Trauma Outcome Study) was used for the analysis. Characteristics of patients with DNR orders were compared between state-designated level 1 and 2 trauma centers. Inhospital mortality and major complication rates were compared using hierarchical logistic regression models that included a random effect for trauma centers. We adjusted for a number of potential confounders and allowed for nonlinearity in injury severity score and age in these models. A total of 106,291 patients (14 level 1 and 11 level 2 trauma centers) were identified in the Pennsylvania Trauma Outcome Study database between 2007 and 2011. We included 5953 patients with DNR orders (5.6%). Although more severely injured patients with comorbid disease were made DNR in level 1 trauma centers, trauma center designation level was not a significant factor for inhospital mortality of patients with DNR orders (odds ratio, 1.33; 95% confidence interval, 0.81-2.18; P = 0.26). Level 1 trauma centers were significantly associated with a higher rate of major complications (odds ratio, 1.75; 95% confidence interval, 1.11-2.75; P = 0.016). Inhospital mortality of patients with DNR orders was not significantly associated with trauma designation level after adjusting for case mix. More aggressive treatment or other unknown factors may have resulted in a significantly higher complication rate at level 1 trauma centers. Copyright © 2016 Elsevier Inc. All rights reserved.

Guided Multiple Launch Rocket System/Guided Multiple Launch Rocket System Alternative Warhead (GMLRS/GMLRS AW)

DTIC Science & Technology

2015-12-01

Physical Configuration Audit for the GMLRS AW was completed at the system level in March 2015. ​Director of Operational Test and Evaluation Assessment...Confidence Level Confidence Level of cost estimate for current APB: 50% The confidence level used in establishing the cost estimate for GMLRS/GMLRS AW...PAUC Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 0.039 -0.003 0.001 0.001 0.009 0.037 0.000 0.000 0.045

Joint Tactical Radio System Handheld, Manpack, and Small Form Fit Radios (JTRS HMS)

DTIC Science & Technology

2015-12-01

Waveform (SRW). It is the primary squad level communication system. The Manpack Radio is for use in a classified environment and ports the following...0.0 0.0 0.0 0.0 Acq O&M 0.0 0.0 -- 0.0 0.0 0.0 0.0 Total 8242.6 8242.6 N/A 8755.6 9201.0 9201.0 10907.0 Confidence Level Confidence Level of cost...acquisition programs in which the Department has been successful. It is difficult to calculate mathematically the precise confidence levels

Contamination monitoring approaches for EUV space optics

NASA Technical Reports Server (NTRS)

Ray, David C.; Malina, Roger F.; Welsh, Barry J.; Battel, Steven J.

1989-01-01

Data from contaminant-induced UV optics degradation studies and particulate models are used here to develop end-of-service-life instrument contamination requirements which are very stringent but achievable. The budget is divided into allocations for each phase of hardware processing. Optical and nonoptical hardware are monitored for particulate and molecular contamination during initial cleaning and baking, assembly, test, and calibration phases. The measured contamination levels are compared to the requirements developed for each phase to provide confidence that the required end-of-life levels will be met.

Student-selected projects: can they enhance lifelong learning skills?

PubMed

Whittle, Sue R; Murdoch-Eaton, Deborah G

2002-01-01

Student-selected projects with clearly identified transferable skill objectives have been introduced in Year 1, to help students focus on developing their lifelong learning skills. This study aimed to assess the impact of this innovation on students' perceptions of their skills, and to compare these views with those of students from the previous course. Students' views of their skill abilities were assessed by questionnaire at the beginning and end of the first year, and at the end of each project. Students report improvements, particularly in their IT and presentation skills, but an overall decrease in confidence in their transferable skills at the end of the year compared with the previous cohort. Students appear to recognize development of new skills, but seem less able to identify improvement in existing skills. Increased emphasis on skills development, together with practice of self-evaluation, has reduced students' self-confidence, probably to a more realistic level.

Using standardized patients in enhancing undergraduate students' learning experience in mental health nursing.

PubMed

Goh, Yong-Shian; Selvarajan, Sunil; Chng, Mui-Lee; Tan, Chee-Shiong; Yobas, Piyanee

2016-10-01

Conducting mental status examination and suicide risk assessment is an important skill required of nurses when they are in the clinical setting. With nursing students often expressing the anxiety and lack of confidence in doing so, the use of standardized patients provide an excellent opportunity to practice and become proficient with this skill in a simulated environment. To explore the learning experience of undergraduate nursing students using standardized patients while practising their mental status examination and suicide risk assessment skills in mental health nursing module. A pre- and post-test, single group quasi experimental design was used in this study. A standard didactic tutorial session and a standardized patient session was conducted to evaluate the learning experience of undergraduate nursing students learning mental status examination and suicide risk assessment. Outcome measures for this study include Student Satisfaction and Self-Confidence in learning scale. Qualitative comments in the form of open-ended questions were also collected in this study. A University offering nursing program from undergraduate to postgraduate level. A convenience sample of Year 2 undergraduate nursing students undertaking the mental health nursing module was included in this study. The use of standardized patient session had significantly increased students' satisfaction and confidence level before they are posted to a mental health setting for their clinical attachment. There was a significant difference on students' self-confidence level for those who have taken care of a patient with mental illness after adjusting for pre-test on score in learning. Qualitative feedback obtained from students showed a positive outlook towards the use of standardized patient as an effective tool in augmenting didactic learning into practical skills. Using standardized patient in mental health nursing education enhanced the integration of didactic content into clinical setting allowing students to practice their assessment skills learned in classroom and transfer it to the clinical area. The benefits of using standardized patient include allowing students to practice their communication skills and improving their confidence level in conducting mental status examination and suicide risk assessment by reducing anxiety as compared with traditional classroom and textbook-based pedagogy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Independent and Synergistic Associations of Biomarkers of Vitamin D Status With Risk of Coronary Heart Disease.

PubMed

Qi, Lu; Ma, Wenjie; Heianza, Yoriko; Zheng, Yan; Wang, Tiange; Sun, Dianjianyi; Rimm, Eric B; Hu, Frank B; Giovannucci, Edward; Albert, Christine M; Rexrode, Kathryn M; Manson, JoAnn E

2017-11-01

To comprehensively evaluate the independent associations and potential interactions of vitamin D-related biomarkers including total and bioavailable 25-hydroxyvitamin D (25OHD), VDBP (vitamin D binding protein), and parathyroid hormone (PTH) with risk of coronary heart disease (CHD). We prospectively identified incident cases of nonfatal myocardial infarction and fatal CHD among women in the Nurses' Health Study during 20 years of follow-up (1990-2010). Using risk-set sampling, 1 to 2 matched controls were selected for each case. The analysis of 25OHD and PTH included 382 cases and 575 controls; the analysis of VDBP included 396 cases and 398 controls. After multivariate adjustment, plasma levels of total 25OHD, bioavailable 25OHD, and PTH were not significantly associated with CHD risk. VDBP was associated with a lower CHD risk with an extreme-quartile odds ratio of 0.60 (95% confidence interval, 0.39-0.92; P trend=0.02). When examining the biomarkers jointly, a significant, inverse association between 25OHD and CHD was observed among participants with higher PTH levels ( P for interaction=0.02). The odds ratio (95% confidence interval) comparing the highest quartile of 25OHD to lowest was 0.43 (0.23-0.82; P trend=0.003) when PTH levels were above population median (35.3 pg/mL), whereas among the rest of participants the corresponding odds ratio (95% confidence interval) was 1.28 (0.70-2.36; P trend=0.43). Our data suggest that higher 25OHD levels were associated with a lower CHD risk when PTH levels were high, whereas no association was observed for participants with low PTH levels. VDBP but not bioavailable 25OHD was independently associated with lower CHD risk. © 2017 American Heart Association, Inc.

Measuring Confidence Levels of Male and Female Students in Open Access Enabling Courses

ERIC Educational Resources Information Center

Atherton, Mirella

2015-01-01

The study of confidence was undertaken at the University of Newcastle with students selecting science courses at two campuses. The students were enrolled in open access programs and aimed to gain access to undergraduate studies in various disciplines at University. The "third person effect" was used to measure the confidence levels of…

"But I Thought I Knew That!" Student Confidence Judgments on Course Examinations in Introductory Psychology

ERIC Educational Resources Information Center

Nevid, Jeffrey S.; Cheney, Brianna; Thompson, Clarissa

2015-01-01

Students in an introductory psychology class rated their level of confidence in their answers to exam questions on four multiple-choice exams through the course of a semester. Correlations between confidence judgments and accuracy (correct vs. incorrect) at the individual item level showed modest but significant relationships for item sets scaled…

On how the brain decodes vocal cues about speaker confidence.

PubMed

Jiang, Xiaoming; Pell, Marc D

2015-05-01

In speech communication, listeners must accurately decode vocal cues that refer to the speaker's mental state, such as their confidence or 'feeling of knowing'. However, the time course and neural mechanisms associated with online inferences about speaker confidence are unclear. Here, we used event-related potentials (ERPs) to examine the temporal neural dynamics underlying a listener's ability to infer speaker confidence from vocal cues during speech processing. We recorded listeners' real-time brain responses while they evaluated statements wherein the speaker's tone of voice conveyed one of three levels of confidence (confident, close-to-confident, unconfident) or were spoken in a neutral manner. Neural responses time-locked to event onset show that the perceived level of speaker confidence could be differentiated at distinct time points during speech processing: unconfident expressions elicited a weaker P2 than all other expressions of confidence (or neutral-intending utterances), whereas close-to-confident expressions elicited a reduced negative response in the 330-500 msec and 550-740 msec time window. Neutral-intending expressions, which were also perceived as relatively confident, elicited a more delayed, larger sustained positivity than all other expressions in the 980-1270 msec window for this task. These findings provide the first piece of evidence of how quickly the brain responds to vocal cues signifying the extent of a speaker's confidence during online speech comprehension; first, a rough dissociation between unconfident and confident voices occurs as early as 200 msec after speech onset. At a later stage, further differentiation of the exact level of speaker confidence (i.e., close-to-confident, very confident) is evaluated via an inferential system to determine the speaker's meaning under current task settings. These findings extend three-stage models of how vocal emotion cues are processed in speech comprehension (e.g., Schirmer & Kotz, 2006) by revealing how a speaker's mental state (i.e., feeling of knowing) is simultaneously inferred from vocal expressions. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of a just-in-time educational intervention placed on wound dressing packages: a multicenter randomized controlled trial.

PubMed

Kent, Dea J

2010-01-01

I compared the effects of a just-in-time educational intervention (educational materials for dressing application attached to the manufacturer's dressing package) to traditional wound care education on reported confidence and dressing application in a simulated model. Nurses from a variety of backgrounds were recruited for this study. The nurses possessed all levels of education ranging from licensed practical nurse to master of science in nursing. Both novice and seasoned nurses were included, with no stipulations regarding years of nursing experience. Exclusion criteria included nurses who spent less than 50% of their time in direct patient care and nurses with advanced wound care training and/or certification (CWOCN, CWON). Study settings included community-based acute care facilities, critical access hospitals, long-term care facilities, long-term acute care facilities, and home care agencies. No level 1 trauma centers were included in the study for geographical reasons. Participants were randomly allocated to control or intervention groups. Each participant completed the Kent Dressing Confidence Assessment tool. Subjects were then asked to apply the dressing to a wound model under the observation of either the principal investigator or a trained observer, who scored the accuracy of dressing application according to established criteria. None of the 139 nurses who received traditional dressing packaging were able to apply the dressing to a wound model correctly. In contrast, 88% of the nurses who received the package with the educational guide attached to it were able to apply the dressing to a wound model correctly (χ2 = 107.22, df = 1, P = .0001). Nurses who received the dressing package with the attached educational guide agreed that this feature gave them confidence to correctly apply the dressing (88%), while no nurse agreed that the traditional package gave him or her the confidence to apply the dressing correctly (χ2 = 147.47, df = 4, P < .0001). A just-in-time education intervention improved nurses' confidence when applying an unfamiliar dressing and accuracy of application when applying the dressing to a simulated model compared to traditional wound care education.

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

PubMed Central

Neubauer, Jakob; Benndorf, Matthias; Reidelbach, Carolin; Krauß, Tobias; Lampert, Florian; Zajonc, Horst; Kotter, Elmar; Langer, Mathias; Fiebich, Martin; Goerke, Sebastian M.

2016-01-01

Purpose To compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures. Methods As study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT. Results Pooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities’ specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001). Conclusion The diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run. PMID:27788215

Evaluation of YB-1 levels in patients with endometriosis.

PubMed

Ahrens, Thorben; Silveira, Cassia G T; Banz-Jansen, Constanze; Rody, Achim; Hornung, Daniela

2015-08-01

The objective of this study is the evaluation of serum YB-1 levels in the diagnosis of endometriosis. Serum samples of 12 patients with histologically confirmed endometriosis and of 10 control patients were collected. Western blot analysis was used to assess serum YB-1 levels. Groups were compared with Student's t-test or, if not normally distributed, with the Mann-Whitney test. Sensitivity and specificity for the potential diagnostic performance of serum YB-1 were assessed by receiver operating characteristic (ROC) curves. Serum YB-1 levels were significantly higher in patients with endometriosis (=0.004). The area under the curve was 0.867 (95% confidence interval 0.714-1.019) with sensitivity and specificity of 83.3% and 70% respectively. Serum YB-1 levels in patients with endometriosis are significantly higher compared to control patients and may be used as a potential diagnostic biomarker for endometriosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Engineering Student Self-Assessment through Confidence-Based Scoring

ERIC Educational Resources Information Center

Yuen-Reed, Gigi; Reed, Kyle B.

2015-01-01

A vital aspect of an answer is the confidence that goes along with it. Misstating the level of confidence one has in the answer can have devastating outcomes. However, confidence assessment is rarely emphasized during typical engineering education. The confidence-based scoring method described in this study encourages students to both think about…

Factors influencing undergraduates' self-evaluation of numerical competence

NASA Astrophysics Data System (ADS)

Tariq, Vicki N.; Durrani, Naureen

2012-04-01

This empirical study explores factors influencing undergraduates' self-evaluation of their numerical competence, using data from an online survey completed by 566 undergraduates from a diversity of academic disciplines, across all four faculties at a post-1992 UK university. Analysis of the data, which included correlation and multiple regression analyses, revealed that undergraduates exhibiting greater confidence in their mathematical and numeracy skills, as evidenced by their higher self-evaluation scores and their higher scores on the confidence sub-scale contributing to the measurement of attitude, possess more cohesive, rather than fragmented, conceptions of mathematics, and display more positive attitudes towards mathematics/numeracy. They also exhibit lower levels of mathematics anxiety. Students exhibiting greater confidence also tended to be those who were relatively young (i.e. 18-29 years), whose degree programmes provided them with opportunities to practise and further develop their numeracy skills, and who possessed higher pre-university mathematics qualifications. The multiple regression analysis revealed two positive predictors (overall attitude towards mathematics/numeracy and possession of a higher pre-university mathematics qualification) and five negative predictors (mathematics anxiety, lack of opportunity to practise/develop numeracy skills, being a more mature student, being enrolled in Health and Social Care compared with Science and Technology, and possessing no formal mathematics/numeracy qualification compared with a General Certificate of Secondary Education or equivalent qualification) accounted for approximately 64% of the variation in students' perceptions of their numerical competence. Although the results initially suggested that male students were significantly more confident than females, one compounding variable was almost certainly the students' highest pre-university mathematics or numeracy qualification, since a higher percentage of males (24%) compared to females (15%) possessed an Advanced Subsidiary or A2 qualification (or equivalent) in mathematics. Of particular concern is the fact that undergraduates based in Health and Social Care expressed significantly less confidence in their numeracy skills than students from any of the other three faculties.

CH-47F Improved Cargo Helicopter (CH-47F)

DTIC Science & Technology

2015-12-01

Confidence Level Confidence Level of cost estimate for current APB: 50% The Confidence Level of the CH-47F APB cost estimate, which was approved on April...M) Initial PAUC Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 10.316 -0.491 3.003 -0.164 2.273 7.378...SAR Baseline to Current SAR Baseline (TY $M) Initial APUC Development Estimate Changes APUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total

How Does Student Ability and Self-Efficacy Affect the Usage of Computer Technology?

ERIC Educational Resources Information Center

Isman, Aytekin; Celikli, Gulsun Ersoy

2009-01-01

The main aim of this research was to find out the self-efficacy level among participant students and analyze their beliefs. This study showed that male students are more confident comparing to female student, similar to research of Bimer (2000), the computer usage has been known as biased toward the interests and fashion of men, this research also…

A Comparison of Seyfert 1 and 2 Host Galaxies

NASA Astrophysics Data System (ADS)

De Robertis, M.; Virani, S.

2000-12-01

Wide-field, R-band CCD data of 15 Seyfert 1 and 15 Seyfert 2 galaxies taken from the CfA survey were analysed in order to compare the properties of their host galaxies. As well, B-band images for a subset of 12 Seyfert 1s and 7 Seyfert 2s were acquired and analysed in the same way. A robust technique for decomposing the three components---nucleus, bulge and disk---was developed in order determine the structural parameters for each galaxy. In effect, the nuclear contribution was removed empirically by using a spatially nearby, high signal-to-noise ratio point source as a template. Profile fits to the bulge+disk ignored data within three seeing disks of the nucleus. Of the many parameters that were compared between Seyfert 1s and 2s, only two distributions differed at greater than the 95% confidence level for the K-S test: the magnitude of the nuclear component, and the radial color gradient outside the nucleus. The former is expected. The latter could be consistent with some proposed evolutionary models. There is some suggestion that other parameters may differ, but at a lower confidence level.

Does dental undergraduate education and postgraduate training enable intention to provide inhalation sedation in primary dental care? A path analytical exploration.

PubMed

Yuan, S; J Carson, S; Rooksby, M; McKerrow, J; Lush, C; Humphris, G; Freeman, R

2017-08-01

To examine how quality standards of dental undergraduate education, postgraduate training and qualifications together with confidence and barriers could be utilised to predict intention to provide inhalation sedation. All 202 dentists working within primary dental care in NHS Highland were invited to participate. The measures in the questionnaire survey included demographic information, undergraduate education and postgraduate qualifications, current provision and access to sedation service, attitudes towards confidence, barriers and intention to provide inhalation sedation. A path analytical approach was employed to investigate the fit of collected data to the proposed mediational model. One hundred and nine dentists who completed the entire questionnaire participated (response rate of 54%). Seventy-six per cent of dentists reported receiving lectures in conscious sedation during their undergraduate education. Statistically significantly more Public Dental Service dentists compared with General Dental Service (GDS) dentists had postgraduate qualification and Continuing Professional Development training experience in conscious sedation. Only twenty-four per cent of the participants stated that they provided inhalation sedation to their patients. The findings indicated that PDS dentists had higher attitudinal scores towards inhalation sedation than GDS practitioners. The proposed model showed an excellent level of fit. A multigroup comparison test confirmed that the level of association between confidence in providing inhalation sedation and intention varied by group (GDS vs. PDS respondents). Public Dental Service respondents who showed extensive postgraduate training experience in inhalation sedation were more confident and likely to provide this service. The quality standards of dental undergraduate education, postgraduate qualifications and training together with improved confidence predicted primary care dentists' intention to provide inhalation sedation. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Unifying interdisciplinary education: designing and implementing an intern simulation educational curriculum to increase confidence in critical care from PGY1 to PGY2.

PubMed

Bullard, Mark J; Leuck, Jo Anna; Howley, Lisa D

2017-11-06

A longitudinal, multidisciplinary critical care simulation curriculum was developed and implemented within a teaching hospital to address the need for consistent, safe, efficient, and unified critical care training within graduate medical education. Primary goals were to increase learner confidence in critical care topics and procedural skills across all specialties. Secondary goals included improving communication skills and obtaining a high level of learner satisfaction. All interns caring for adult patients within our hospital participated in three 4-h simulation-based sessions scheduled over the second half of their intern year. Pre- and postcurricular surveys evaluated self-confidence in critical care topics, procedures, and communication skills. The Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form was used to evaluate facilitator debriefing. Data were compared with Wilcoxon rank sum and signed rank test. Pre- and postcurricular surveys were collected from 51 of 52 interns (98% response rate) in curricular year 1 and 59 of 59 interns (100% response rate) in curricular year 2 in six programs within the hospital. Resident confidence significantly improved in all areas (p < .05). DASH-SV demonstrated overall effective facilitator debriefing and > 75% of interns in both curricular years 1 and 2 expressed a desire for future educational sessions. The implemented curriculum increased learner confidence in select critical care topics, procedures, and communication skills and demonstrated a high level of learner satisfaction. The curriculum has expanded to learners from three other teaching hospitals within our system to unify critical care education for all interns caring for adult patients.

Teachers' confidence in teaching HIV/AIDS and sexuality in South African and Tanzanian schools.

PubMed

Helleve, Arnfinn; Flisher, Alan J; Onya, Hans; Kaaya, Sylvia; Mukoma, Wanjiru; Swai, Caroline; Klepp, Knut-Inge

2009-06-01

This study aimed to investigate how confident and comfortable teachers at Tanzanian and South African urban and rural schools are in teaching HIV/AIDS and sexuality. It also aimed at identifying factors associated with teacher confidence and investigated how reported confidence was associated with the implementation of educational programmes on HIV/AIDS and sexuality. A survey was conducted among South African grade 8 and 9 Life Orientation teachers, and among science teachers for grade 5 to 7 in public primary schools in Tanzania. Teachers' confidence levels were measured on a four-item scale (0-3). A total number of 266 teachers participated in a survey in 86 schools in South Africa and Tanzania. Overall, teachers report to be rather confident in teaching HIV/AIDS and sexuality. Tanzanian teachers reported higher levels of confidence then did their South Africa colleagues (2.1 vs. 1.8; p < 0.01). Confidence in teaching was significantly associated with the numbers of years teaching HIV/AIDS and sexuality, formal training in these subjects, experience in discussing the topics with others, school policy and priority given to teaching HIV/AIDS and sexuality at school. Finally, confidence in teaching remained positively associated with self-reported successful implementation of school-based programmes after adjusting for gender, age, religion and numbers of years teaching HIV/AIDS and sexuality. Across urban and rural sites in South Africa and Tanzania teachers reported to be fairly confident in teaching HIV/AIDS and sexuality. Further strengthening of their confidence levels could, however, be an important measure for improving the implementation of such programmes.

Hydroxyurea for reducing blood transfusion in non-transfusion dependent beta thalassaemias.

PubMed

Foong, Wai Cheng; Ho, Jacqueline J; Loh, C Khai; Viprakasit, Vip

2016-10-18

Non-transfusion dependent beta thalassaemia is a subset of inherited haemoglobin disorders characterised by reduced production of the beta globin chain of the haemoglobin molecule leading to anaemia of varying severity. Although blood transfusion is not a necessity for survival, it is required when episodes of chronic anaemia occur. This chronic anaemia can impair growth and affect quality of life. People with non-transfusion dependent beta thalassaemia suffer from iron overload due to their body's increased capability of absorbing iron from food sources. Iron overload becomes more pronounced in those requiring blood transfusion. People with a higher foetal haemoglobin level have been found to require fewer blood transfusions. Hydroxyurea has been used to increase foetal haemoglobin level; however, its efficacy in reducing transfusion, chronic anaemia complications and its safety need to be established. To assess the effectiveness, safety and appropriate dose regimen of hydroxyurea in people with non-transfusion dependent beta thalassaemia (haemoglobin E combined with beta thalassaemia and beta thalassaemia intermedia). We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of relevant journals. We also searched ongoing trials registries and the reference lists of relevant articles and reviews.Date of last search: 30 April 2016. Randomised or quasi-randomised controlled trials of hydroxyurea in people with non-transfusion dependent beta thalassaemia comparing hydroxyurea with placebo or standard treatment or comparing different doses of hydroxyurea. Two authors independently applied the inclusion criteria in order to select trials for inclusion. Both authors assessed the risk of bias of trials and extracted the data. A third author verified these assessments. No trials comparing hydroxyurea with placebo or standard care were found. However, we included one randomised controlled trial (n = 61) comparing 20 mg/kg/day with 10 mg/kg/day of hydroxyurea for 24 weeks.Both haemoglobin and foetal haemoglobin levels were lower at 24 weeks in the 20 mg group compared with the 10 mg group, mean difference -2.39 (95% confidence interval - 2.8 to -1.98) and mean difference -1.5 (95% confidence interval -1.83 to -1.17), respectively. Major adverse effects were significantly more common in the 20 mg group, for neutropenia risk ratio 9.93 (95% confidence interval 1.34 to 73.97) and for thrombocytopenia risk ratio 3.68 (95% confidence interval 1.13 to 12.07). No difference was reported for minor adverse effects (gastrointestinal disturbances and raised liver enzymes). The effect of hydroxyurea on transfusion frequency was not reported.The overall quality for the outcomes reported was graded as very low mainly because the outcomes were derived from only one small study with an unclear method of allocation concealment. There is no evidence from randomised controlled trials to show whether hydroxyurea has any effect compared with controls on the need for blood transfusion. Administration of 10 mg/kg/day compared to 20 mg/kg/day of hydroxyurea resulted in higher haemoglobin levels and seems safer with fewer adverse effects. It has not been reported whether hydroxyurea is capable of reducing the need for blood transfusion. Large well-designed randomised controlled trials with sufficient duration of follow up are recommended.

Simulated Patients in Physical Therapy Education: Systematic Review and Meta-Analysis.

PubMed

Pritchard, Shane A; Blackstock, Felicity C; Nestel, Debra; Keating, Jenny L

2016-09-01

Traditional models of physical therapy clinical education are experiencing unprecedented pressures. Simulation-based education with simulated (standardized) patients (SPs) is one alternative that has significant potential value, and implementation is increasing globally. However, no review evaluating the effects of SPs on professional (entry-level) physical therapy education is available. The purpose of this study was to synthesize and critically appraise the findings of empirical studies evaluating the contribution of SPs to entry-level physical therapy education, compared with no SP interaction or an alternative education strategy, on any outcome relevant to learning. A systematic search was conducted of Ovid MEDLINE, PubMed, AMED, ERIC, and CINAHL Plus databases and reference lists of included articles, relevant reviews, and gray literature up to May 2015. Articles reporting quantitative or qualitative data evaluating the contribution of SPs to entry-level physical therapy education were included. Two reviewers independently extracted study characteristics, intervention details, and quantitative and qualitative evaluation data from the 14 articles that met the eligibility criteria. Pooled random-effects meta-analysis indicated that replacing up to 25% of authentic patient-based physical therapist practice with SP-based education results in comparable competency (mean difference=1.55/100; 95% confidence interval=-1.08, 4.18; P=.25). Thematic analysis of qualitative data indicated that students value learning with SPs. Assumptions were made to enable pooling of data, and the search strategy was limited to English. Simulated patients appear to have an effect comparable to that of alternative educational strategies on development of physical therapy clinical practice competencies and serve a valuable role in entry-level physical therapy education. However, available research lacks the rigor required for confidence in findings. Given the potential advantages for students, high-quality studies that include an economic analysis should be conducted. © 2016 American Physical Therapy Association.

Effects of the Diabetes Manual 1:1 structured education in primary care.

PubMed

Sturt, J A; Whitlock, S; Fox, C; Hearnshaw, H; Farmer, A J; Wakelin, M; Eldridge, S; Griffiths, F; Dale, J

2008-06-01

To determine the effects of the Diabetes Manual on glycaemic control, diabetes-related distress and confidence to self-care of patients with Type 2 diabetes. A cluster randomized, controlled trial of an intervention group vs. a 6-month delayed-intervention control group with a nested qualitative study. Participants were 48 urban general practices in the West Midlands, UK, with high population deprivation levels and 245 adults with Type 2 diabetes with a mean age of 62 years recruited pre-randomization. The Diabetes Manual is 1:1 structured education designed for delivery by practice nurses. Measured outcomes were HbA(1c), cardiovascular risk factors, diabetes-related distress measured by the Problem Areas in Diabetes Scale and confidence to self-care measured by the Diabetes Management Self-Efficacy Scale. Outcomes were assessed at baseline and 26 weeks. There was no significant difference in HbA(1c) between the intervention group and the control group [difference -0.08%, 95% confidence interval (CI) -0.28, 0.11]. Diabetes-related distress scores were lower in the intervention group compared with the control group (difference -4.5, 95% CI -8.1, -1.0). Confidence to self-care Scores were 11.2 points higher (95% CI 4.4, 18.0) in the intervention group compared with the control group. The patient response rate was 18.5%. In this population, the Diabetes Manual achieved a small improvement in patient diabetes-related distress and confidence to self-care over 26 weeks, without a change in glycaemic control. Further study is needed to optimize the intervention and characterize those for whom it is more clinically and psychologically effective to support its use in primary care.

THE PREVALENCE OF COLONIC POLYPS IN PATIENTS WITH ACROMEGALY: A CASE-CONTROL, NESTED IN A COHORT COLONOSCOPIC STUDY.

PubMed

Gonzalez, Baldomero; Vargas, Guadalupe; Mendoza, Victoria; Nava, Mariana; Rojas, Moisés; Mercado, Moisés

2017-05-01

Acromegaly is associated with an increased risk of colonic polyps. The magnitude of such risk is controversial, and the characteristics that distinguish patients who develop polyps from those who do not are not well established. This study was performed to determine the prevalence of colonic polyps upon the diagnosis of acromegaly and to compare the clinical and biochemical features of patients with and without polyps. Out of 165 patients who underwent a full colonoscopy upon diagnosis of acromegaly, 53 were found to harbor colonic lesions (cases), whereas the remaining 112 were used as controls. Demographic, clinical, and biochemical characteristics were compared between the 2 groups. The prevalence of colonic polyps was 32%, with an estimated relative risk of 6.21 (95% confidence interval [CI] 4.08-9.48). Adenomatous and nonadenomatous polyps were found in 22 and 31 patients, respectively. The most common location was the descending colon. Compared to patients without polyps, subjects with polyps were somewhat older and had significantly higher insulin-like growth factor-1 (IGF-1) levels and a higher prevalence of diabetes. Upon multivariate analysis, only IGF-1 level at diagnosis remained significantly associated with colonic polyps in general and with hyperplastic polyps in particular. Acromegaly is associated with an elevated risk of developing colonic polyps, particularly, distally located hyperplastic lesions. Except for a higher IGF-1 level at diagnosis, no distinctive clinical or biochemical features can be found among those who develop polyps compared to those who do not. CI = confidence interval GH = growth hormone IGF-1 = insulin-like growth factor 1 IQR = inter-quartile range RR = relative risk ULN = upper limit of normal.

Determinants of observed confidant support for divorced mothers.

PubMed

DeGarmo, D S; Forgatch, M S

1997-02-01

Marital separation can be a time of extreme stress and can significantly disrupt support networks and support processes when they are needed most. The purpose of this investigation was to test mechanisms of support erosion in a multimethod study of 138 divorced mothers and their confidants. Previous work was extended by using observational measures of confidant support in a process model including (a) maternal characteristics over time, (b) support person characteristics, and (c) relationship characteristics (intimacy and confidant relationship type). A hypothesized mechanism of erosion was supported in which ongoing maternal distress was positively associated with levels of confidant negativity, which in turn was related to lower levels of observed support. Having a partner was related to more intimacy than was having family and friends. Contrary to expectation, however, having a partner was related to lower levels of support, and intimacy was not related to observed support.

Augmenting Chinese hamster genome assembly by identifying regions of high confidence.

PubMed

Vishwanathan, Nandita; Bandyopadhyay, Arpan A; Fu, Hsu-Yuan; Sharma, Mohit; Johnson, Kathryn C; Mudge, Joann; Ramaraj, Thiruvarangan; Onsongo, Getiria; Silverstein, Kevin A T; Jacob, Nitya M; Le, Huong; Karypis, George; Hu, Wei-Shou

2016-09-01

Chinese hamster Ovary (CHO) cell lines are the dominant industrial workhorses for therapeutic recombinant protein production. The availability of genome sequence of Chinese hamster and CHO cells will spur further genome and RNA sequencing of producing cell lines. However, the mammalian genomes assembled using shot-gun sequencing data still contain regions of uncertain quality due to assembly errors. Identifying high confidence regions in the assembled genome will facilitate its use for cell engineering and genome engineering. We assembled two independent drafts of Chinese hamster genome by de novo assembly from shotgun sequencing reads and by re-scaffolding and gap-filling the draft genome from NCBI for improved scaffold lengths and gap fractions. We then used the two independent assemblies to identify high confidence regions using two different approaches. First, the two independent assemblies were compared at the sequence level to identify their consensus regions as "high confidence regions" which accounts for at least 78 % of the assembled genome. Further, a genome wide comparison of the Chinese hamster scaffolds with mouse chromosomes revealed scaffolds with large blocks of collinearity, which were also compiled as high-quality scaffolds. Genome scale collinearity was complemented with EST based synteny which also revealed conserved gene order compared to mouse. As cell line sequencing becomes more commonly practiced, the approaches reported here are useful for assessing the quality of assembly and potentially facilitate the engineering of cell lines. Copyright © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Students' Confidence in the Ability to Transfer Basic Math Skills in Introductory Physics and Chemistry Courses at a Community College

ERIC Educational Resources Information Center

Quinn, Reginald

2013-01-01

The purpose of this study was to examine the confidence levels that community college students have in transferring basic math skills to science classes, as well as any factors that influence their confidence levels. This study was conducted with 196 students at a community college in central Mississippi. The study was conducted during the month…

The 2009 Retirement Confidence Survey: economy drives confidence to record lows; many looking to work longer.

PubMed

Helman, Ruth; Copeland, Craig; VanDerhei, Jack

2009-04-01

RECORD LOW CONFIDENCE LEVELS: Workers who say they are very confident about having enough money for a comfortable retirement this year hit the lowest level in 2009 (13 percent) since the Retirement Confidence Survey started asking the question in 1993, continuing a two-year decline. Retirees also posted a new low in confidence about having a financially secure retirement, with only 20 percent now saying they are very confident (down from 41 percent in 2007). THE ECONOMY, INFLATION, COST OF LIVING ARE THE BIG CONCERNS: Not surprisingly, workers overall who have lost confidence over the past year about affording a comfortable retirement most often cite the recent economic uncertainty, inflation, and the cost of living as primary factors. In addition, certain negative experiences, such as job loss or a pay cut, loss of retirement savings, or an increase in debt, almost always contribute to loss of confidence among those who experience them. RETIREMENT EXPECTATIONS DELAYED: Workers apparently expect to work longer because of the economic downturn: 28 percent of workers in the 2009 RCS say the age at which they expect to retire has changed in the past year. Of those, the vast majority (89 percent) say that they have postponed retirement with the intention of increasing their financial security. Nevertheless, the median (mid-point) worker expects to retire at age 65, with 21 percent planning to push on into their 70s. The median retiree actually retired at age 62, and 47 percent of retirees say they retired sooner than planned. WORKING IN RETIREMENT: More workers are also planning to supplement their income in retirement by working for pay. The percentage of workers planning to work after they retire has increased to 72 percent in 2009 (up from 66 percent in 2007). This compares with 34 percent of retirees who report they actually worked for pay at some time during their retirement. GREATER WORRY ABOUT BASIC AND HEALTH EXPENSES: Workers who say they very confident in having enough money to take care of basic expenses in retirement dropped to 25 percent in 2009 (down from 40 percent in 2007), while only 13 percent feel very confident about having enough to pay for medical expenses (down from 20 percent in 2007. Among retirees, only a quarter (25 percent, down from 41 percent in 2007) feel very confident about covering their health expenses. HOW WORKERS ARE RESPONDING: Among workers who have lost confidence in their ability to secure a comfortable retirement, most (81 percent) say they have reduced their expenses, while others are changing the way they invest their money (43 percent), working more hours or a second job (38 percent), saving more money (25 percent), and seeking advice from a financial professional (25 percent). Among all workers, 75 percent say they and/or their spouse have saved money for retirement, one of the highest levels ever measured by the RCS. IGNORANCE STILL A MAJOR FACTOR: Many workers still do not have a good idea of how much they need to save for retirement. Only 44 percent of workers report they and/or their spouse have tried to calculate how much money they will need to have saved by the time they retire--and an equal proportion (44 percent) simply guess at how much they will need for a comfortable retirement.

Circulating SFRP5 levels are elevated in drug-naïve recently diagnosed type 2 diabetic patients as compared with prediabetic subjects and controls.

PubMed

Canivell, Silvia; Rebuffat, Sandra; Ruano, Elena G; Kostov, Belchin; Sisó-Almirall, Antoni; Novials, Anna; Ceriello, Antonio; Gomis, Ramon

2015-02-01

Secreted frizzled-related protein 5 (SFRP5) has been linked to obesity. Results are conflicting regarding its association with type 2 diabetes (T2D) in humans. We aimed to investigate circulating SFRP5 in prediabetes and T2D and its potential association with parameters of insulin resistance and beta-cell function. We studied 70 drug-naïve T2D patients, 70 prediabetic subjects and 70 controls. All subjects were body mass index matched to the T2D patients and overweight or obese. SFRP5, hormones and cytokines levels were measured by ELISA. Serum SFRP5 levels were elevated in T2D patients as compared with prediabetic subjects (median 15.6, interquartile range [9-24.5] ng/mL vs 9.8 [5-14.2] ng/mL, p < 0.001, respectively) and controls (15.6 [9-24.5] ng/mL vs 10.4 [6.7-16.6] ng/mL, P < 0.001, respectively). No differences were found in serum SFRP5 levels between prediabetic subjects and controls (9.8 [5-14.2] ng/mL vs 10.4 [6.7-16.6] ng/mL, p = 0.472, respectively). After adjusting for potential confounders (age, gender, body mass index, triglycerides, high-density lipoprotein cholesterol and blood pressure), T2D was still associated with higher values of SFRP5 as compared with prediabetes in multinomial logistic regression analysis (fully adjusted odds ratio 3.50, 95% confidence interval 1.40-8.79, p = 0.008). The association was more subtle when comparing T2D with normal glucose tolerance state (fully adjusted odds ratio 2.18, 95% confidence interval 0.91-5.21, p = 0.078). Circulating SFRP5 levels were independently associated with T2D as compared with prediabetes and normal glucose tolerance state. Copyright © 2014 John Wiley & Sons, Ltd.

Vitamin D Status at Birth and Future Risk of Attention Deficit/Hyperactivity Disorder (ADHD).

PubMed

Gustafsson, Peik; Rylander, Lars; Lindh, Christian H; Jönsson, Bo A G; Ode, Amanda; Olofsson, Per; Ivarsson, Sten A; Rignell-Hydbom, Anna; Haglund, Nils; Källén, Karin

2015-01-01

To investigate whether children with Attention Deficit/Hyperactivity Disorder have lower levels of Vitamin D3 at birth than matched controls. Umbilical cord blood samples collected at birth from 202 children later diagnosed with Attention Deficit/Hyperactivity Disorder were analysed for vitamin D content and compared with 202 matched controls. 25-OH vitamin D3 was analysed by liquid chromatography tandem mass spectrometry. No differences in cord blood vitamin D concentration were found between children with Attention Deficit/Hyperactivity Disorder (median 13.0 ng/ml) and controls (median 13.5 ng/ml) (p = 0.43). In a logistic regression analysis, Attention Deficit/Hyperactivity Disorder showed a significant association with maternal age (odds ratio: 0.96, 95% confidence interval: 0.92-0.99) but not with vitamin D levels (odds ratio: 0.99, 95% confidence interval: 0.97-1.02). We found no difference in intrauterine vitamin D levels between children later developing Attention Deficit/Hyperactivity Disorder and matched control children. However, the statistical power of the study was too weak to detect an eventual small to medium size association between vitamin D levels and Attention Deficit/Hyperactivity Disorder.

Perceived confidence to use female condoms among students in Tertiary Institutions of a Metropolitan City, Southwestern, Nigeria.

PubMed

Obembe, Taiwo A; Adebowale, Ayo S; Odebunmi, Kehinde O

2017-08-11

Latex condoms for men have been documented to offer high efficacy as both a contraceptive and protection against sexually transmitted diseases. This equally establishes the importance of continued research on female condoms. This study aims to investigate the perceived confidence to use the female condoms amongst undergraduate female students from selected tertiary institutions from Ibadan Southwestern Nigeria. The study was a descriptive cross-sectional survey involving 388 female undergraduate students selected through a multistage sampling technique. The survey was carried using pre-tested semi-structured questionnaires. Quantitative data were analyzed using the Statistical Package for the Social Sciences to generate frequencies, cross tabulations of variables at 5% level of significance. Mean age of respondents 18.26 ± 3.45 with most students being 20-24 years (55.2%), single (92.8%), Yorubas (85.6%) and from the polytechnic institutions (41.0%). Only 10.8% had good perceived confidence to use a female condom. Perceived confidence was significantly higher amongst other ethnicities (19.59 ± 3.827) compared to Yoruba ethnicity (18.04 ± 3.337) (F = 9.935; p < 0.05). Likewise, students from the Polytechnic campuses exhibited significantly higher mean scores (18.81 ± 3.187) compared to others (F = 3.724; p < 0.05). Perception towards the condom was a significant factor that influenced the confidence to use a female condom (F = 9.896; p < 0.000). Concerted efforts are advocated to improve the low perception exhibited towards the use of female condoms and the low perceived confidence to its utilization. This would help to transfer the decision making and control to women thus contributing to their empowerment and increased protection from unplanned pregnancies and sexually transmitted diseases.

The Vaccination Confidence Scale: A Brief Measure of Parents’ Vaccination Beliefs

PubMed Central

Gilkey, Melissa B.; Magnus, Brooke E.; Reiter, Paul L.; McRee, Annie-Laurie; Dempsey, Amanda F.; Brewer, Noel T.

2015-01-01

Purpose The success of national immunization programs depends on the public’s confidence in vaccines. We sought to develop a scale for measuring confidence about adolescent vaccination in diverse populations of parents. Methods Data came from 9,623 parents who completed the 2010 National Immunization Survey-Teen, an annual, population-based telephone survey. Parents reported on a 13- to 17-year-old child in their households. We used exploratory and confirmatory factor analysis to identify latent constructs underlying parents’ responses to 8 vaccination belief survey items (response scale 0–10) conceptualized using the Health Belief Model. We assessed the scale’s psychometric properties overall and across demographic subgroups. Results Parents’ confidence about adolescent vaccination was generally high. Analyses provided support for three factors assessing benefits of vaccination (mean = 8.5), harms of vaccination (mean = 3.3), and trust in healthcare providers (mean = 9.0). The model showed good fit both overall (comparative fit index = 0.97) and across demographic subgroups, although internal consistency was variable for the three factors. We found lower confidence among several potentially vulnerable subpopulations, including mothers with lower levels of education and parents whose children were of Hispanic ethnicity (both p<.05). Conclusions Our brief, three-factor scale offers an efficient way to measure confidence in adolescent vaccination across demographic subgroups. Given evidence of lower confidence by educational attainment and race/ethnicity, program planners should consider factors such as health literacy and cultural competence when designing interventions to promote adolescent vaccination to ensure these programs are fully accessible. PMID:25258098

SU-F-J-54: Towards Real-Time Volumetric Imaging Using the Treatment Beam and KV Beam

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, M; Rozario, T; Liu, A

Purpose: Existing real-time imaging uses dual (orthogonal) kV beam fluoroscopies and may result in significant amount of extra radiation to patients, especially for prolonged treatment cases. In addition, kV projections only provide 2D information, which is insufficient for in vivo dose reconstruction. We propose real-time volumetric imaging using prior knowledge of pre-treatment 4D images and real-time 2D transit data of treatment beam and kV beam. Methods: The pre-treatment multi-snapshot volumetric images are used to simulate 2D projections of both the treatment beam and kV beam, respectively, for each treatment field defined by the control point. During radiation delivery, the transitmore » signals acquired by the electronic portal image device (EPID) are processed for every projection and compared with pre-calculation by cross-correlation for phase matching and thus 3D snapshot identification or real-time volumetric imaging. The data processing involves taking logarithmic ratios of EPID signals with respect to the air scan to reduce modeling uncertainties in head scatter fluence and EPID response. Simulated 2D projections are also used to pre-calculate confidence levels in phase matching. Treatment beam projections that have a low confidence level either in pre-calculation or real-time acquisition will trigger kV beams so that complementary information can be exploited. In case both the treatment beam and kV beam return low confidence in phase matching, a predicted phase based on linear regression will be generated. Results: Simulation studies indicated treatment beams provide sufficient confidence in phase matching for most cases. At times of low confidence from treatment beams, kV imaging provides sufficient confidence in phase matching due to its complementary configuration. Conclusion: The proposed real-time volumetric imaging utilizes the treatment beam and triggers kV beams for complementary information when the treatment beam along does not provide sufficient confidence for phase matching. This strategy minimizes the use of extra radiation to patients. This project is partially supported by a Varian MRA grant.« less

Tracing the evolution of chiropractic students’ confidence in clinical and patient communication skills during a clinical internship: a multi-methods study

PubMed Central

2012-01-01

Background Anecdotal evidence points to variations in individual students’ evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. Methods A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students’ accounts and reflections on what affected the evolution of their confidence during the internship. Results At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students’ levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and maturing as a student clinician. Conclusion This study provides insight into the factors perceived by students as affecting the development of professional confidence during internships. One particularly promising area for educational intervention may be the promotion of a pro-active approach to professional learning. PMID:22713168

Tracing the evolution of chiropractic students' confidence in clinical and patient communication skills during a clinical internship: a multi-methods study.

PubMed

Hecimovich, Mark; Volet, Simone

2012-06-19

Anecdotal evidence points to variations in individual students' evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study. A multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students' accounts and reflections on what affected the evolution of their confidence during the internship. At the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students' levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and maturing as a student clinician. This study provides insight into the factors perceived by students as affecting the development of professional confidence during internships. One particularly promising area for educational intervention may be the promotion of a pro-active approach to professional learning.

Release of (and lessons learned from mining) a pioneering large toxicogenomics database.

PubMed

Sandhu, Komal S; Veeramachaneni, Vamsi; Yao, Xiang; Nie, Alex; Lord, Peter; Amaratunga, Dhammika; McMillian, Michael K; Verheyen, Geert R

2015-07-01

We release the Janssen Toxicogenomics database. This rat liver gene-expression database was generated using Codelink microarrays, and has been used over the past years within Janssen to derive signatures for multiple end points and to classify proprietary compounds. The release consists of gene-expression responses to 124 compounds, selected to give a broad coverage of liver-active compounds. A selection of the compounds were also analyzed on Affymetrix microarrays. The release includes results of an in-house reannotation pipeline to Entrez gene annotations, to classify probes into different confidence classes. High confidence unambiguously annotated probes were used to create gene-level data which served as starting point for cross-platform comparisons. Connectivity map-based similarity methods show excellent agreement between Codelink and Affymetrix runs of the same samples. We also compared our dataset with the Japanese Toxicogenomics Project and observed reasonable agreement, especially for compounds with stronger gene signatures. We describe an R-package containing the gene-level data and show how it can be used for expression-based similarity searches. Comparing the same biological samples run on the Affymetrix and the Codelink platform, good correspondence is observed using connectivity mapping approaches. As expected, this correspondence is smaller when the data are compared with an independent dataset such as TG-GATE. We hope that this collection of gene-expression profiles will be incorporated in toxicogenomics pipelines of users.

Lipoprotein(a) predicts the development of diabetic retinopathy in people with type 2 diabetes mellitus.

PubMed

Yun, Jae-Seung; Lim, Tae-Seok; Cha, Seon-Ah; Ahn, Yu-Bae; Song, Ki-Ho; Choi, Jin A; Kwon, Jinwoo; Jee, Donghyun; Cho, Yang Kyung; Park, Yong-Moon; Ko, Seung-Hyun

2016-01-01

Lipoprotein(a) [Lp(a)] has mainly been considered to be a predictor of the incidence of cardiovascular disease. In addition, previous studies have shown potential linkage between Lp(a) and diabetic microvascular complications. We investigated the incidence and risk factors for the development of diabetic retinopathy (DR) in patients with type 2 diabetes. A total of 787 patients with type 2 diabetes without DR were consecutively enrolled and followed up prospectively. Retinopathy evaluation was annually performed by ophthalmologists. The main outcome was new onset of DR. The median follow-up time was 11.1 years. Patients in the DR group had a longer duration of diabetes (P < .001), higher baseline HbA1c (P < .001), higher albuminuria level (P = .033), and higher level of Lp(a) (P = .005). After adjusting for sex, age, diabetes duration, presence of hypertension, renal function, LDL cholesterol, mean HbA1c, and medications, the development of DR was significantly associated with the serum Lp(a) level (HR 1.57, 95% confidence interval [1.11-2.24]; P = .012, comparing the 4th vs 1st quartile of Lp(a)). The patient group with the highest quartile range of Lp(a) and mean HbA1c levels ≥7.0% had an HR of 5.09 (95% confidence interval [2.63-9.84]; P < .001) for developing DR compared with patients with lower levels of both factors. In this prospective cohort study, we demonstrated that the DR was independently associated with the serum Lp(a) level in patients with type 2 diabetes. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

B-2 Extremely High Frequency SATCOM and Computer Increment 1 (B-2 EHF Inc 1)

DTIC Science & Technology

2015-12-01

Confidence Level Confidence Level of cost estimate for current APB: 55% This APB reflects cost and funding data based on the B-2 EHF Increment I SCP...This cost estimate was quantified at the Mean (~55%) confidence level . Total Quantity Quantity SAR Baseline Production Estimate Current APB...Production Estimate Econ Qty Sch Eng Est Oth Spt Total 33.624 -0.350 1.381 0.375 0.000 -6.075 0.000 -0.620 -5.289 28.335 Current SAR Baseline to Current

Comparing daily drivers of problem drinking among older and younger adults: An electronic daily diary study using smartphones.

PubMed

Kuerbis, Alexis; Treloar Padovano, Hayley; Shao, Sijing; Houser, Jessica; Muench, Frederick J; Morgenstern, Jon

2018-02-01

By 2030, numbers and proportions of older adults with substance-use problems are expected to increase. While risk factors for problem drinking in late life have been identified, it remains unknown whether these factors drive daily drinking among older problem drinkers. This study examined the daily drivers of drinking among problem drinkers, moderated by age, utilizing ecological momentary assessment (EMA). Participants (N = 139), ages 20-73, received daily EMA online surveys completed via a smartphone prior to initiation of treatment. Multilevel modeling tested the moderating impact of age on within- and between-person relationships between drinking and focal predictors (mood, loneliness, boredom, stress, poor sleep, social factors, alcohol salience, commitment and confidence not to drink heavily). Older adults reported greater alcohol consumption when daily boredom levels were higher. Heavier drinking among younger adults was associated with poorer sleep quality. Greater daily confidence, daily commitment and daily alcohol salience did not impact drinking to the same extent for older adults as for younger adults. Greater person-level commitment predicted reduced drinking equivalently across age, but low person-level commitment predicted greater drinking among older adults compared to their younger counterparts. Older adults may have unique daily drivers of drinking that are not fully realized in current research and intervention efforts. Addressing the growing substance-use treatment needs among this population will require identifying the unique drivers of drinking among older adults, such as boredom, when compared to younger adults. Copyright © 2018 Elsevier B.V. All rights reserved.

Explorations in Statistics: Confidence Intervals

ERIC Educational Resources Information Center

Curran-Everett, Douglas

2009-01-01

Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This third installment of "Explorations in Statistics" investigates confidence intervals. A confidence interval is a range that we expect, with some level of confidence, to include the true value of a population parameter…

Mass media and heterogeneous bounds of confidence in continuous opinion dynamics

NASA Astrophysics Data System (ADS)

Pineda, M.; Buendía, G. M.

2015-02-01

This work focuses on the effects of an external mass media on continuous opinion dynamics with heterogeneous bounds of confidence. We modified the original Deffuant et al. and Hegselmann and Krause models to incorporate both, an external mass media and a heterogeneous distribution of confidence levels. We analysed two cases, one where only two bounds of confidence are taken into account, and other where each individual of the system has her/his own characteristic level of confidence. We found that, in the absence of mass media, diversity of bounds of confidence can improve the capacity of the systems to reach consensus. We show that the persuasion capacity of the external message is optimal for intermediate levels of heterogeneity. Our simulations also show the existence, for certain parameter values, of a counter-intuitive effect in which the persuasion capacity of the mass media decreases if the mass media intensity is too large. We discuss similarities and differences between the two heterogeneous versions of these continuous opinion dynamic models under the influence of mass media.

Relations of competitive state anxiety and efficacy of young volleyball players.

PubMed

Milavić, Boris; Jurko, Damir; Grgantov, Zoran

2013-05-01

With the aim of validating the Competitive State Anxiety Inventory on a population of young Croatian volleyball players, 286 examinees, 106 male and 180 female volleyball players (average age of 16.09+/-1.83), filled out the CSAI-2, constructed by Martens, Vealey, Burton, Bump and Smith (1990)1. Given the fact that all scales of the Competitive State Anxiety Inventory have good homogeneity, reliability and sensitivity, it can be concluded that they represent high-quality measuring instruments for measuring psychological characteristics of young volleyball players. Young male and female volleyball players generally have a moderate level of self-confidence, and their cognitive anxiety is more prominent that somatic anxiety. In order to determine the age and gender differences in somatic and cognitive anxiety and self-confidence, parametric analysis of differences was performed and coefficients of the independent samples t-test were calculated. By analysis of differences according to age, it has been established that female junior players, in relation to female youth players, express a significantly lower level of somatic and cognitive anxiety and a significantly higher level of self-confidence. As opposed to female players, male youth and junior players do not differ in any of the analysed variables. By analysis of differences according to gender, it has been established that male youth players have a significantly higher level of self-confidence in comparison to female youth players. No significant differences were found in the level of competitive anxiety and self-confidence by analysis of variance between different player roles. No significant differences were found by discriminant analysis in somatic and cognitive anxiety, and self-confidence of female volleyball players of different situational efficacy. The group of least efficient male volleyball players is characterized by a very low level of self-confidence, while the most efficient group of volleyball players is characterized by a somewhat lower level of cognitive and somatic anxiety.

Use of a Photosimulation Laboratory for Estimating Vehicle Detection Probability and Comparing Detection Metrics

DTIC Science & Technology

2003-04-15

the monitors, the authors are confident that the color fidelity is accurate. The primary physical difference of field versus lab tests is the level... Creelman , C. Douglas, Detection theory: A user’s guide, Cambridge University Press, Cambridge, U.K., 1991, pp. 189-190. *For more information, contact Dr. Thomas Meitzler at (586) 574-5405, email: meitzlet@tacom.army.mil

Dead certain: confidence and conservatism predict aggression in simulated international crisis decision-making.

PubMed

Johnson, Dominic D P; McDermott, Rose; Cowden, Jon; Tingley, Dustin

2012-03-01

Evolutionary psychologists have suggested that confidence and conservatism promoted aggression in our ancestral past, and that this may have been an adaptive strategy given the prevailing costs and benefits of conflict. However, in modern environments, where the costs and benefits of conflict can be very different owing to the involvement of mass armies, sophisticated technology, and remote leadership, evolved tendencies toward high levels of confidence and conservatism may continue to be a contributory cause of aggression despite leading to greater costs and fewer benefits. The purpose of this paper is to test whether confidence and conservatism are indeed associated with greater levels of aggression-in an explicitly political domain. We present the results of an experiment examining people's levels of aggression in response to hypothetical international crises (a hostage crisis, a counter-insurgency campaign, and a coup). Levels of aggression (which range from concession to negotiation to military attack) were significantly predicted by subjects' (1) confidence that their chosen policy would succeed, (2) score on a liberal-conservative scale, (3) political party affiliation, and (4) preference for the use of military force in real-world U.S. policy toward Iraq and Iran. We discuss the possible adaptive and maladaptive implications of confidence and conservatism for the prospects of war and peace in the modern world.

The effect and durability of a pregraduation boot cAMP on the confidence of senior medical student entering surgical residencies.

PubMed

Okusanya, Olugbenga T; Kornfield, Zev N; Reinke, Caroline E; Morris, Jon B; Sarani, Babak; Williams, Noel N; Kelz, Rachel R

2012-01-01

Medical school does not specifically prepare students for surgical internship. Preinternship courses are known to increase confidence in multiple key areas. We examined the immediate effect and durability of effect of a surgical pregraduation preparatory course or "boot camp" on provider confidence in technical and medical management skills. A 5-day boot camp was offered to senior medical students (SMS) entering surgical programs. SMS were anonymously surveyed before, after, and 6 months following the course. The same survey was given 6 months into internship to a control group of surgical interns who graduated from the same medical school but did not participate in boot camp before graduation. Data were compared between the time intervals and across cases and controls using the Wilcoxon rank-sum and signed-rank tests and the Student t test. A joint effort between the University of Pennsylvania School of Medicine, the Department of Surgery at the Hospital of the University of Pennsylvania, and the Penn Medicine Simulation Center in Philadelphia, PA. All senior medical students set to graduate from a single institution entering general surgery or surgery subspecialties were offered the course. Twenty-nine students participated in the course. Post-boot camp confidence scores of SMS were significantly greater in all areas except placement of a peripheral intravenous catheter compared with pre-boot camp scores. Six months into internship, the SMS boot camp group felt more confident than controls in their ability to perform a cricothyroidotomy (median 2.5 vs 1.0, p = 0.04) and to insert a chest tube (median 3.3 vs 1.0, p = 0.05). Otherwise, there was no residual difference in confidence levels between the boot camp group and the controls. Boot camps can improve self-confidence in young doctors in many areas of perioperative care before enrolling in surgical residency. The effect is most durable in high risk, infrequently performed technical tasks. Future studies are under design to examine the impact of boot camps on the "July Effect." Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Do People Who Believe in God Report More Meaning in Their Lives? The Existential Effects of Belief.

PubMed

Cranney, Stephen

2013-09-01

I conduct the first large-N study explicitly exploring the association between belief in God and sense of purpose in life. This relationship, while often discussed informally, has received little empirical attention. Here I use the General Social Survey to investigate how form of and confidence in belief in God is related to sense of purpose in life, as measured by a Likert item level of agreement with the statement "In my opinion, life does not serve any purpose." Using logistic regression analysis, I find that those who indicate that they are confident in God's existence report a higher sense of purpose compared to nonbelievers, believers in a higher power, and those who believe but occasionally doubt.

Neural basis for recognition confidence in younger and older adults.

PubMed

Chua, Elizabeth F; Schacter, Daniel L; Sperling, Reisa A

2009-03-01

Although several studies have examined the neural basis for age-related changes in objective memory performance, less is known about how the process of memory monitoring changes with aging. The authors used functional magnetic resonance imaging to examine retrospective confidence in memory performance in aging. During low confidence, both younger and older adults showed behavioral evidence that they were guessing during recognition and that they were aware they were guessing when making confidence judgments. Similarly, both younger and older adults showed increased neural activity during low- compared to high-confidence responses in the lateral prefrontal cortex, anterior cingulate cortex, and left intraparietal sulcus. In contrast, older adults showed more high-confidence errors than younger adults. Younger adults showed greater activity for high compared to low confidence in medial temporal lobe structures, but older adults did not show this pattern. Taken together, these findings may suggest that impairments in the confidence-accuracy relationship for memory in older adults, which are often driven by high-confidence errors, may be primarily related to altered neural signals associated with greater activity for high-confidence responses.

Neural basis for recognition confidence in younger and older adults

PubMed Central

Chua, Elizabeth F.; Schacter, Daniel L.; Sperling, Reisa A.

2008-01-01

Although several studies have examined the neural basis for age-related changes in objective memory performance, less is known about how the process of memory monitoring changes with aging. We used fMRI to examine retrospective confidence in memory performance in aging. During low confidence, both younger and older adults showed behavioral evidence that they were guessing during recognition, and that they were aware they were guessing when making confidence judgments. Similarly, both younger and older adults showed increased neural activity during low compared to high confidence responses in lateral prefrontal cortex, anterior cingulate cortex, and left intraparietal sulcus. In contrast, older adults showed more high confidence errors than younger adults. Younger adults showed greater activity for high compared to low confidence in medial temporal lobe structures, but older adults did not show this pattern. Taken together, these findings may suggest that impairments in the confidence-accuracy relationship for memory in older adults, which are often driven by high confidence errors, may be primarily related to altered neural signals associated with greater activity for high confidence responses. PMID:19290745

Constraints on the unified dark energy dark matter model from latest observational data

NASA Astrophysics Data System (ADS)

Wu, Puxun; Yu, Hongwei

2007-03-01

The generalized Chaplygin gas (GCG) is studied in this paper by using the latest observational data including 182 gold sample type Ia supernovae (Sne Ia) data, the ESSENCE Sne Ia data, the distance ratio from z = 0.35 to 1089 (the redshift of decoupling), the cosmic microwave background shift parameter and the Hubble parameter data. Our results rule out the standard Chaplygin gas model (α = 1) at the 99.7% confidence level, but allow for the λCDM model (α = 0) at the 68.3% confidence level. At a 95.4% confidence level, we obtain w = -0.74-0.09+0.10 and α = -0.14-0.19+0.30. In addition, we find that the phase transition from deceleration to acceleration occurs at redshift zq = 0~0.78-0.89 at a 1σ confidence level for the GCG model.

A preliminary study investigating the factors influencing STEM major selection by African American females

NASA Astrophysics Data System (ADS)

Ray, Tiffany Monique

The purpose of this study was to investigate the significant factors influencing STEM major selection by African American females. A quantitative research design with a qualitative component was employed. Ex post facto survey research was conducted utilizing an online questionnaire to collect data from participants. African American undergraduate females that had declared a major in STEM comprised the target population for the study. As a basis for comparison, a second data collection ensued. All non-African American undergraduate females majoring in STEM also received the survey instrument to determine if there was a significant difference between factors that influence STEM major selection between the two groups. The Social Cognitive Career Choice Model comprised the conceptual framework for this study. Frequencies and percentages illustrated the demographic characteristics of the sample, as well as the average influence levels of each of the items without regard for level of significance. The researcher conducted an independent samples t-test to compare the mean scores for undergraduate African American females majoring in STEM and non-African American females majoring in STEM on each influential factor on the survey instrument. The researcher coded responses to open-ended questions to generate themes and descriptions. The data showed that African American female respondents were very influenced by the following items: specific interest in the subject, type of work, availability of career opportunities after graduation, parent/guardian, precollege coursework in science, and introductory college courses. In addition, the majority of respondents were very influenced by each of the confidence factors. African American females were overwhelmingly not influenced by aptitude tests. African American females were more influenced than their non-African American female counterparts for the following factors: reputation of the university, college or department, high level of compensation in fields, religious leaders, precollege coursework in mathematics, confidence in mathematics ability, confidence in ability to be successful in mathematics in college, confidence in science ability, and confidence in ability to be successful in science in college. Non-African American females were more influenced than African American females by the precollege coursework in technology and the precollege STEM experience factors. Four themes emerged regarding the items that most influenced success in STEM for African American females: high level of compensation in the field, parents/legal guardians and family members, specific interest in the subject, and confidence in science and math ability. One theme emerged regarding the items that least influenced success in STEM majors for African American females: personal interactions with individuals excluding family members.

Socioeconomic inequality and peripheral artery disease prevalence in US adults.

PubMed

Pande, Reena L; Creager, Mark A

2014-07-01

Lower socioeconomic status is associated with cardiovascular disease. We sought to determine whether there is a higher prevalence of peripheral artery disease (PAD) in individuals with lower socioeconomic status. We analyzed data from the National Health and Nutrition Examination Survey 1999 to 2004. PAD was defined based on an ankle.brachial index .0.90. Measures of socioeconomic status included poverty.income ratio,a ratio of self-reported income relative to the poverty line, and attained education level. Of 6791 eligible participants,overall weighted prevalence of PAD was 5.8% (SE, 0.3). PAD prevalence was significantly higher in individuals with low income and lower education. Individuals in the lowest of the 6 poverty.income ratio categories had more than a2-fold increased odds of PAD compared with those in the highest poverty-income ratio category (odds ratio, 2.69; 95%confidence interval, 1.80.4.03; P<0.0001). This association remained significant even after multivariable adjustment(odds ratio, 1.64; 95% confidence interval, 1.04.2.6; P=0.034). Lower attained education level also associated with higher PAD prevalence (odds ratio, 2.8; 95% confidence interval, 1.96.4.0; P<0.0001) but was no longer significant after multivariable adjustment. Low income and lower attained education level are associated with PAD in US adults. These data suggest that individuals of lower socioeconomic status remain at high risk and highlight the need for education and advocacy efforts focused on these at-risk populations.

School neighborhood disadvantage as a predictor of long-term sick leave among teachers: prospective cohort study.

PubMed

Virtanen, Marianna; Kivimäki, Mika; Pentti, Jaana; Oksanen, Tuula; Ahola, Kirsi; Linna, Anne; Kouvonen, Anne; Salo, Paula; Vahtera, Jussi

2010-04-01

This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.

Simultaneous confidence sets for several effective doses.

PubMed

Tompsett, Daniel M; Biedermann, Stefanie; Liu, Wei

2018-04-03

Construction of simultaneous confidence sets for several effective doses currently relies on inverting the Scheffé type simultaneous confidence band, which is known to be conservative. We develop novel methodology to make the simultaneous coverage closer to its nominal level, for both two-sided and one-sided simultaneous confidence sets. Our approach is shown to be considerably less conservative than the current method, and is illustrated with an example on modeling the effect of smoking status and serum triglyceride level on the probability of the recurrence of a myocardial infarction. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Overconfidence and Career Choice.

PubMed

Schulz, Jonathan F; Thöni, Christian

2016-01-01

People self-assess their relative ability when making career choices. Thus, confidence in their own abilities is likely an important factor for selection into various career paths. In a sample of 711 first-year students we examine whether there are systematic differences in confidence levels across fields of study. We find that our experimental confidence measures significantly vary between fields of study: While students in business related academic disciplines (Political Science, Law, Economics, and Business Administration) exhibit the highest confidence levels, students of Humanities range at the other end of the scale. This may have important implications for subsequent earnings and professions students select themselves in.

Serum Insulin-Like Growth Factor 1 and the Risk of Ischemic Stroke: The Framingham Study.

PubMed

Saber, Hamidreza; Himali, Jayandra J; Beiser, Alexa S; Shoamanesh, Ashkan; Pikula, Aleksandra; Roubenoff, Ronenn; Romero, Jose R; Kase, Carlos S; Vasan, Ramachandran S; Seshadri, Sudha

2017-07-01

Low insulin-like growth factor 1 (IGF-1) has been associated with increased risk of atherosclerosis and atrial fibrillation in cross-sectional studies. Yet, prospective data linking IGF-1 levels to the development of ischemic stroke remain inconclusive. We examined prospectively the association between serum IGF-1 levels and incident ischemic stroke. We measured serum IGF-1 levels in 757 elderly individuals (mean age 79±5, 62% women), free of prevalent stroke, from the Framingham original cohort participants at the 22nd examination cycle (1990-1994) and were followed up for the development of ischemic stroke. Cox models were used to relate IGF-1 levels to the risk for incident ischemic stroke, adjusted for potential confounders. During a mean follow-up of 10.2 years, 99 individuals developed ischemic stroke. After adjustment for age, sex, and potential confounders, higher IGF-1 levels were associated with a lower risk of incident ischemic stroke, with subjects in the lowest quintile of IGF-1 levels having a 2.3-fold higher risk of incident ischemic stroke (95% confidence interval, 1.09-5.06; P =0.03) as compared with those in the top quintile. We observed an effect modification by diabetes mellitus and waist-hip ratio for the association between IGF-1 and ischemic stroke ( P <0.1). In subgroup analyses, the effects were restricted to subjects with diabetics and those in top waist-hip ratio quartile, in whom each standard deviation increase in IGF-1 was associated with a 61% (hazard ratio, 0.39; 95% confidence interval, 0.20-0.78; P =0.007) and 41% (hazard ratio, 0.59; 95% confidence interval, 0.37-0.95; P =0.031) lower risk of incident ischemic stroke, respectively. IGF-1 levels were inversely associated with ischemic stroke, especially among persons with insulin resistance. © 2017 American Heart Association, Inc.

Constraints on the Generalized Chaplygin Gas Model from Recent Supernova Data and Baryonic Acoustic Oscillations

NASA Astrophysics Data System (ADS)

Wu, Puxun; Yu, Hongwei

2007-04-01

Constraints from the Gold sample Type Ia supernova (SN Ia) data, the Supernova Legacy Survey (SNLS) SN Ia data, and the size of the baryonic acoustic oscillation (BAO) peak found in the Sloan Digital Sky Survey (SDSS) on the generalized Chaplygin gas (GCG) model, proposed as a candidate for the unified dark matter-dark energy scenario (UDME), are examined in the cases of both a spatially flat and a spatially curved universe. Our results reveal that the GCG model is consistent with a flat universe up to the 68% confidence level, and the model parameters are within the allowed parameter ranges of the GCG as a candidate for UDME. Meanwhile, we find that in the flat case, both the Gold sample + SDSS BAO data and the SNLS sample + SDSS BAO data break the degeneracy of As and α and allow for the scenario of a cosmological constant plus dark matter (α=0) at the 68% confidence level, although they rule out the standard Chaplygin gas model (α=1) at the 99% confidence level. However, for the case without a flat prior, the SNLS SN Ia + SDSS BAO data do not break the degeneracy between As and α, and they allow for ΛCDM (α=0) and the standard Chaplygin gas model (α=1) at a 68% confidence level, while the Gold SN Ia + SDSS BAO break the degeneracy of As and α and rule out ΛCDM at a 68% confidence level and the standard Chaplygin gas model at a 99% confidence level.

Accuracy of glenohumeral joint injections: comparing approach and experience of provider.

PubMed

Tobola, Allison; Cook, Chad; Cassas, Kyle J; Hawkins, Richard J; Wienke, Jeffrey R; Tolan, Stefan; Kissenberth, Michael J

2011-10-01

The purpose of this study was to prospectively evaluate the accuracy of three different approaches used for glenohumeral injections. In addition, the accuracy of the injection was compared to the experience and confidence of the provider. One-hundred six consecutive patients with shoulder pain underwent attempted intra-articular injection either posteriorly, supraclavicularly, or anteriorly. Each approach was performed by an experienced and inexperienced provider. A musculoskeletal radiologist blinded to technique used and provider interpreted fluoroscopic images to determine accuracy. Providers were blinded to these results. The accuracy of the anterior approach regardless of experience was 64.7%, the posterior approach was 45.7%, and the supraclavicular approach was 45.5%. With each approach, experience did not provide an advantage. For the anterior approach, the experienced provider was 50% accurate compared to 85.7%. For the posterior approach, the experienced provider had a 42.1% accuracy rate compared to 50%. The experienced provider was accurate 50% of the time in the supraclavicular approach compared to 38.5%. The providers were not able to predict their accuracy regardless of experience. The experienced providers, when compared to those who were less experienced, were more likely to be overconfident, particularly with the anterior and supraclavicular approaches. There was no statistically significant difference between the 3 approaches. The anterior approach was the most accurate, independent of the experience level of the provider. The posterior approach produced the lowest level of confidence regardless of experience. The experienced providers were not able to accurately predict the results of their injections, and were more likely to be overconfident with the anterior and supraclavicular approaches. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

On-Call Communication in Orthopaedic Trauma: "A Picture Is Worth a Thousand Words"--A Survey of OTA Members.

PubMed

Molina, Cesar S; Callan, Alexandra K; Burgos, Eduardo J; Mir, Hassan R

2015-05-01

To quantify the effects of varying clinical communication styles (verbal and pictorial) on the ability of orthopaedic trauma surgeons in understanding an injury and formulate an initial management plan. A Research Electronic Data Capture survey was e-mailed to all OTA members. Respondents quantified (5-point Likert scale) how confident they felt understanding an injury and establishing an initial management plan based on the information provided for 5 common orthopaedic trauma scenarios. Three verbal descriptions were created for each scenario and categorized as limited, moderate, or detailed. The questions were repeated with the addition of a radiographic image and then repeated a third time including a clinical photograph. Statistical evaluation consisted of descriptive statistics and Kruskal-Wallis analyses using STATA (version 12.0). Of the 221 respondents, there were a total of 95 who completed the entire survey. Nearly all were currently taking call (92/95 = 96.8%) and the majority were fellowship trained (79/95 = 83.2%). Most practice at a level I trauma center (58/95 = 61.1%) and work with orthopaedic residents (62/95 = 65.3%). There was a significant increase in confidence scores between a limited, moderate, and detailed description in all clinical scenarios for understanding the injury and establishing an initial management plan (P < 0.05). There was a significant difference in confidence scores between all 3 types of evidence presented (verbal, verbal + x-ray, verbal + x-ray + photograph) in both understanding and managing the injury for limited and moderate descriptions (P < 0.001). No differences were seen when adding pictorial information to the detailed verbal description. When comparing confidence scores between a detailed description without images and a limited description that includes radiographs and a photograph, no difference in confidence levels was seen in 7 of the 10 scenarios (P > 0.05). The addition of images in the form of radiographs and/or clinical photographs greatly improves the confidence of orthopaedic trauma surgeons in understanding injuries and establishing initial management plans with limited verbal information (P < 0.001). The inclusion of x-rays and photographs raises the confidence for understanding and management with limited verbal information to the level of a detailed verbal description in most scenarios. Mobile technology allows for easy secure transfer of images that can make up for the lack of available information from limited verbal descriptions because of the knowledge base of communicating providers.

Android Robot-Mediated Mock Job Interview Sessions for Young Adults with Autism Spectrum Disorder: A Pilot Study

PubMed Central

Kumazaki, Hirokazu; Warren, Zachary; Corbett, Blythe A.; Yoshikawa, Yuichiro; Matsumoto, Yoshio; Higashida, Haruhiro; Yuhi, Teruko; Ikeda, Takashi; Ishiguro, Hiroshi; Kikuchi, Mitsuru

2017-01-01

The feasibility and preliminary efficacy of an android robot-mediated mock job interview training in terms of both bolstering self-confidence and reducing biological levels of stress in comparison to a psycho-educational approach human interview was assessed in a randomized study. Young adults (ages 18–25 years) with autism spectrum disorder (ASD) were randomized to participate either in a mock job interview training with our android robot system (n = 7) or a self-paced review of materials about job-interviewing skills (n = 8). Baseline and outcome measurements of self-reported performance/efficacy and salivary cortisol were obtained after a mock job interview with a human interviewer. After training sessions, individuals with ASD participating in the android robot-mediated sessions reported marginally improved self-confidence and demonstrated significantly lower levels of salivary cortisol as compared to the control condition. These results provide preliminary support for the feasibility and efficacy of android robot-mediated learning. PMID:28955254

Android Robot-Mediated Mock Job Interview Sessions for Young Adults with Autism Spectrum Disorder: A Pilot Study.

PubMed

Kumazaki, Hirokazu; Warren, Zachary; Corbett, Blythe A; Yoshikawa, Yuichiro; Matsumoto, Yoshio; Higashida, Haruhiro; Yuhi, Teruko; Ikeda, Takashi; Ishiguro, Hiroshi; Kikuchi, Mitsuru

2017-01-01

The feasibility and preliminary efficacy of an android robot-mediated mock job interview training in terms of both bolstering self-confidence and reducing biological levels of stress in comparison to a psycho-educational approach human interview was assessed in a randomized study. Young adults (ages 18-25 years) with autism spectrum disorder (ASD) were randomized to participate either in a mock job interview training with our android robot system ( n  = 7) or a self-paced review of materials about job-interviewing skills ( n  = 8). Baseline and outcome measurements of self-reported performance/efficacy and salivary cortisol were obtained after a mock job interview with a human interviewer. After training sessions, individuals with ASD participating in the android robot-mediated sessions reported marginally improved self-confidence and demonstrated significantly lower levels of salivary cortisol as compared to the control condition. These results provide preliminary support for the feasibility and efficacy of android robot-mediated learning.

Possible signals of vacuum dynamics in the Universe

NASA Astrophysics Data System (ADS)

Peracaula, Joan Solà; de Cruz Pérez, Javier; Gómez-Valent, Adrià

2018-05-01

We study a generic class of time-evolving vacuum models which can provide a better phenomenological account of the overall cosmological observations as compared to the ΛCDM. Among these models, the running vacuum model (RVM) appears to be the most motivated and favored one, at a confidence level of ˜3σ. We further support these results by computing the Akaike and Bayesian information criteria. Our analysis also shows that we can extract fair signals of dynamical dark energy (DDE) by confronting the same set of data to the generic XCDM and CPL parametrizations. In all cases we confirm that the combined triad of modern observations on Baryonic Acoustic Oscillations, Large Scale Structure formation, and the Cosmic Microwave Background, provide the bulk of the signal sustaining a possible vacuum dynamics. In the absence of any of these three crucial data sources, the DDE signal can not be perceived at a significant confidence level. Its possible existence could be a cure for some of the tensions existing in the ΛCDM when confronted to observations.

Experimental Analysis of Steel Beams Subjected to Fire Enhanced by Brillouin Scattering-Based Fiber Optic Sensor Data

PubMed Central

Bao, Yi; Chen, Yizheng; Hoehler, Matthew S.; Smith, Christopher M.; Bundy, Matthew; Chen, Genda

2016-01-01

This paper presents high temperature measurements using a Brillouin scattering-based fiber optic sensor and the application of the measured temperatures and building code recommended material parameters into enhanced thermomechanical analysis of simply supported steel beams subjected to combined thermal and mechanical loading. The distributed temperature sensor captures detailed, nonuniform temperature distributions that are compared locally with thermocouple measurements with less than 4.7% average difference at 95% confidence level. The simulated strains and deflections are validated using measurements from a second distributed fiber optic (strain) sensor and two linear potentiometers, respectively. The results demonstrate that the temperature-dependent material properties specified in the four investigated building codes lead to strain predictions with less than 13% average error at 95% confidence level and that the Europe building code provided the best predictions. However, the implicit consideration of creep in Europe is insufficient when the beam temperature exceeds 800°C. PMID:28239230

Limits on Axion Couplings from the First 80 Days of Data of the PandaX-II Experiment.

PubMed

Fu, Changbo; Zhou, Xiaopeng; Chen, Xun; Chen, Yunhua; Cui, Xiangyi; Fang, Deqing; Giboni, Karl; Giuliani, Franco; Han, Ke; Huang, Xingtao; Ji, Xiangdong; Ju, Yonglin; Lei, Siao; Li, Shaoli; Liu, Huaxuan; Liu, Jianglai; Ma, Yugang; Mao, Yajun; Ren, Xiangxiang; Tan, Andi; Wang, Hongwei; Wang, Jimin; Wang, Meng; Wang, Qiuhong; Wang, Siguang; Wang, Xuming; Wang, Zhou; Wu, Shiyong; Xiao, Mengjiao; Xie, Pengwei; Yan, Binbin; Yang, Yong; Yue, Jianfeng; Zhang, Hongguang; Zhang, Tao; Zhao, Li; Zhou, Ning

2017-11-03

We report new searches for solar axions and galactic axionlike dark matter particles, using the first low-background data from the PandaX-II experiment at China Jinping Underground Laboratory, corresponding to a total exposure of about 2.7×10^{4}  kg day. No solar axion or galactic axionlike dark matter particle candidate has been identified. The upper limit on the axion-electron coupling (g_{Ae}) from the solar flux is found to be about 4.35×10^{-12} in the mass range from 10^{-5} to 1  keV/c^{2} with 90% confidence level, similar to the recent LUX result. We also report a new best limit from the ^{57}Fe deexcitation. On the other hand, the upper limit from the galactic axions is on the order of 10^{-13} in the mass range from 1 to 10  keV/c^{2} with 90% confidence level, slightly improved compared with the LUX.

Testing the Distance-Duality Relation in the Rh = ct Universe

NASA Astrophysics Data System (ADS)

Hu, J.; Wang, F. Y.

2018-04-01

In this paper, we test the cosmic distance duality (CDD) relation using the luminosity distances from joint light-curve analysis (JLA) type Ia supernovae (SNe Ia) sample and angular diameter distance sample from galaxy clusters. The Rh = ct and ΛCDM models are considered. In order to compare the two models, we constrain the CCD relation and the SNe Ia light-curve parameters simultaneously. Considering the effects of Hubble constant, we find that η ≡ DA(1 + z)2/DL = 1 is valid at the 2σ confidence level in both models with H0 = 67.8 ± 0.9 km/s/Mpc. However, the CDD relation is valid at 3σ confidence level with H0 = 73.45 ± 1.66 km/s/Mpc. Using the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC), we find that the ΛCDM model is very strongly preferred over the Rh = ct model with these data sets for the CDD relation test.

Testing the distance-duality relation in the Rh = ct universe

NASA Astrophysics Data System (ADS)

Hu, J.; Wang, F. Y.

2018-07-01

In this paper, we test the cosmic distance-duality (CDD) relation using the luminosity distances from joint light-curve analysis Type Ia supernovae (SNe Ia) sample and angular diameter distance sample from galaxy clusters. The Rh = ct and Λ cold dark matter (CDM) models are considered. In order to compare the two models, we constrain the CDD relation and the SNe Ia light-curve parameters simultaneously. Considering the effects of Hubble constant, we find that η ≡ DA(1 + z)2/DL = 1 is valid at the 2σ confidence level in both models with H0= 67.8 ± 0.9 km -1s-1 Mpc. However, the CDD relation is valid at 3σ confidence level with H0= 73.45 ± 1.66 km -1s-1Mpc. Using the Akaike Information Criterion and the Bayesian Information Criterion, we find that the ΛCDM model is very stongly preferred over the Rh = ct model with these data sets for the CDD relation test.

Search for the Standard Model Higgs boson in the decay channel H → Z Z ( * ) → 4 ℓ with the ATLAS detector

DOE PAGES

Aad, G.; Abbott, B.; Abdallah, J.; ...

2011-10-17

A search for the Standard Model Higgs boson in the decay channel H→ZZ(*)→ℓ+ℓ-ℓ'+ℓ'-, where ℓ=e,μ, is presented. Proton–proton collision data at s=7TeV recorded with the ATLAS detector and corresponding to an average integrated luminosity of 2.1fb -1 are compared to the Standard Model expectations. Upper limits on the production cross section of a Standard Model Higgs boson with a mass between 110 and 600GeV are derived. The observed (expected) 95% confidence level upper limit on the production cross section for a Higgs boson with a mass of 194 GeV, the region with the best expected sensitivity for this search, ismore » 0.99 (1.01) times the Standard Model prediction. The Standard Model Higgs boson is excluded at 95% confidence level in the mass ranges 191–197, 199–200 and 214–224 GeV« less

Optimization and validation of a method for the determination of the refractive index of milk serum based on the reaction between milk and copper(II) sulfate to detect milk dilutions.

PubMed

Rezende, Patrícia Sueli; Carmo, Geraldo Paulo do; Esteves, Eduardo Gonçalves

2015-06-01

We report the use of a method to determine the refractive index of copper(II) serum (RICS) in milk as a tool to detect the fraudulent addition of water. This practice is highly profitable, unlawful, and difficult to deter. The method was optimized and validated and is simple, fast and robust. The optimized method yielded statistically equivalent results compared to the reference method with an accuracy of 0.4% and quadrupled analytical throughput. Trueness, precision (repeatability and intermediate precision) and ruggedness are determined to be satisfactory at a 95.45% confidence level. The expanded uncertainty of the measurement was ±0.38°Zeiss at the 95.45% confidence level (k=3.30), corresponding to 1.03% of the minimum measurement expected in adequate samples (>37.00°Zeiss). Copyright © 2015 Elsevier B.V. All rights reserved.

Analysis of ground water by different laboratories: a comparison of chloride and nitrate data, Nassau and Suffolk counties, New York

USGS Publications Warehouse

Katz, Brian G.; Krulikas, Richard K.

1979-01-01

Water samples from wells in Nassau and Suffolk Counties were analyzed for chloride and nitrate. Two samples were collected at each well; one was analyzed by the U.S. Geological Survey, the other by a laboratory in the county from which the sample was taken. Results were compared statistically by paired-sample t-test to indicate the degree of uniformity among laboratory results. Chloride analyses from one of the three county laboratories differed significantly (0.95 confidence level) from that of a Geological Survey laboratory. For nitrate analyses, a significant difference (0.95 confidence level) was noted between results from two of the three county laboratories and the Geological Survey laboratory. The lack of uniformity among results reported by the participating laboratories indicates a need for continuing participation in a quality-assurance program and exercise of strong quality control from time of sample collection through analysis so that differences can be evaluated. (Kosco-USGS)

Women׳s birthplace decision-making, the role of confidence: Part of the Evaluating Maternity Units study, New Zealand.

PubMed

Grigg, Celia P; Tracy, Sally K; Schmied, Virginia; Daellenbach, Rea; Kensington, Mary

2015-06-01

to explore women׳s birthplace decision-making and identify the factors which enable women to plan to give birth in a freestanding midwifery-led primary level maternity unit rather than in an obstetric-led tertiary level maternity hospital in New Zealand. a mixed methods prospective cohort design. data from eight focus groups (37 women) and a six week postpartum survey (571 women, 82%) were analysed using thematic analysis and descriptive statistics. The qualitative data from the focus groups and survey were the primary data sources and were integrated at the analysis stage; and the secondary qualitative and quantitative data were integrated at the interpretation stage. Christchurch, New Zealand, with one tertiary maternity hospital and four primary level maternity units (2010-2012). well (at 'low risk' of developing complications), pregnant women booked to give birth in one of the primary units or the tertiary hospital. All women received midwifery continuity of care, regardless of their intended or actual birthplace. five core themes were identified: the birth process, women׳s self-belief in their ability to give birth, midwives, the health system and birth place. 'Confidence' was identified as the overarching concept influencing the themes. Women who chose to give birth in a primary maternity unit appeared to differ markedly in their beliefs regarding their optimal birthplace compared to women who chose to give birth in a tertiary maternity hospital. The women who planned a primary maternity unit birth expressed confidence in the birth process, their ability to give birth, their midwife, the maternity system and/or the primary unit itself. The women planning to give birth in a tertiary hospital did not express confidence in the birth process, their ability to give birth, the system for transfers and/or the primary unit as a birthplace, although they did express confidence in their midwife. birthplace is a profoundly important aspect of women׳s experience of childbirth. Birthplace decision-making is complex, in common with many other aspects of childbirth. A multiplicity of factors needs converge in order for all those involved to gain the confidence required to plan what, in this context, might be considered a 'countercultural' decision to give birth at a midwife-led primary maternity unit. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Using an R Shiny to Enhance the Learning Experience of Confidence Intervals

ERIC Educational Resources Information Center

Williams, Immanuel James; Williams, Kelley Kim

2018-01-01

Many students find understanding confidence intervals difficult, especially because of the amalgamation of concepts such as confidence levels, standard error, point estimates and sample sizes. An R Shiny application was created to assist the learning process of confidence intervals using graphics and data from the US National Basketball…

Relations among affect, abstinence motivation and confidence, and daily smoking lapse risk.

PubMed

Minami, Haruka; Yeh, Vivian M; Bold, Krysten W; Chapman, Gretchen B; McCarthy, Danielle E

2014-06-01

This study tested the hypothesis that changes in momentary affect, abstinence motivation, and confidence would predict lapse risk over the next 12-24 hr using Ecological Momentary Assessment (EMA) data from smokers attempting to quit smoking. One hundred and three adult, daily, treatment-seeking smokers recorded their momentary affect, motivation to quit, abstinence confidence, and smoking behaviors in near real time with multiple EMA reports per day using electronic diaries postquit. Multilevel models indicated that initial levels of negative affect were associated with smoking, even after controlling for earlier smoking status, and that short-term increases in negative affect predicted lapses up to 12, but not 24, hr later. Positive affect had significant effects on subsequent abstinence confidence, but not motivation to quit. High levels of motivation appeared to reduce increases in lapse risk that occur over hours although momentary changes in confidence did not predict lapse risk over 12 hr. Negative affect had short-lived effects on lapse risk, whereas higher levels of motivation protected against the risk of lapsing that accumulates over hours. An increase in positive affect was associated with greater confidence to quit, but such changes in confidence did not reduce short-term lapse risk, contrary to expectations. Relations observed among affect, cognitions, and lapse seem to depend critically on the timing of assessments.

White blood cell count correlates with mood symptom severity and specific mood symptoms in bipolar disorder.

PubMed

Köhler, Ole; Sylvia, Louisa G; Bowden, Charles L; Calabrese, Joseph R; Thase, Michael; Shelton, Richard C; McInnis, Melvin; Tohen, Mauricio; Kocsis, James H; Ketter, Terence A; Friedman, Edward S; Deckersbach, Thilo; Ostacher, Michael J; Iosifescu, Dan V; McElroy, Susan; Nierenberg, Andrew A

2017-04-01

Immune alterations may play a role in bipolar disorder etiology; however, the relationship between overall immune system functioning and mood symptom severity is unknown. The two comparative effectiveness trials, the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder Study (Bipolar CHOICE) and the Lithium Treatment Moderate-Dose Use Study (LiTMUS), were similar trials among patients with bipolar disorder. At study entry, white blood cell count and bipolar mood symptom severity (via Montgomery-Aasberg Depression Rating Scale and Bipolar Inventory of Symptoms Scale) were assessed. We performed analysis of variance and linear regression analyses to investigate relationships between deviations from median white blood cell and multinomial regression analysis between higher and lower white blood cell levels. All analyses were adjusted for age, gender, body mass index, smoking, diabetes, hypertension and hyperlipidemia. Among 482 Bipolar CHOICE participants, for each 1.0 × 10 9 /L white blood cell deviation, the overall Bipolar Inventory of Symptoms Scale severity increased significantly among men (coefficient = 2.13; 95% confidence interval = [0.46, -3.79]; p = 0.013), but not among women (coefficient = 0.87; 95% confidence interval = [-0.87, -2.61]; p = 0.33). Interaction analyses showed a trend toward greater Bipolar Inventory of Symptoms Scale symptom severity among men (coefficient = 1.51; 95% confidence interval = [-0.81, -3.82]; p = 0.2). Among 283 LiTMUS participants, higher deviation from the median white blood cell showed a trend toward higher Montgomery-Aasberg Depression Rating Scale scores among men (coefficient = 1.33; 95% confidence interval = [-0.22, -2.89]; p = 0.09), but not among women (coefficient = 0.34; 95% confidence interval = [-0.64, -1.32]; p = 0.50). When combining LiTMUS and Bipolar CHOICE, Montgomery-Aasberg Depression Rating Scale scores increased significantly among men (coefficient = 1.09; 95% confidence interval = [0.31, -1.87]; p = 0.006) for each 1.0 × 10 9 /L white blood cell deviation, whereas we found a weak association among women (coefficient = 0.55; 95% confidence interval = [-0.20, -1.29]; p = 0.14). Lower and higher white blood cell levels correlated with greater symptom severity and specific symptoms, varying according to gender. Deviations in an overall immune system marker, even within the normal white blood cell range, correlated with mood symptom severity in bipolar disorder, mostly among males. Studies are warranted investigating whether white blood cell count may predict response to mood-stabilizing treatment.

Satisfaction and gender issues in otolaryngology residency.

PubMed

Wynn, Rhoda; Rosenfeld, Richard M; Lucente, Frank E

2005-06-01

To evaluate the otolaryngology residency experience with attention to operative experience, career guidance, and gender. Otolaryngology residents were anonymously surveyed by mail about their residency experience. The 22-item survey was scored on a 5-point ordinal Likert scale. Responses were analyzed with respect to gender and postgraduate year (PGY) level. Complete surveys were returned by 261 otolaryngology residents (24% female). PGY level correlated with confidence that surgical skills were appropriate (P = 0.003), establishment of solid career network (P = 0.003), and confidence that surgical abilities are adequate for practice (P = 0.028). Female residents reported less confidence that surgical skills were appropriate (P = 0.050) and that surgical abilities were adequate for postresidency practice (P = 0.035). Women were encouraged to enter private practice more often (P = 0.012), were less likely to have a solid career network ( P = 0.025), and were less confident about being able to run their own practice (P = 0.036) Significant differences exist for several questions regarding surgical confidence and career issues, even after correction for PGY level.

Degree of Anger During Anger-Generating Situations Among Psychiatric Staff Nurses: Association Between Nurses' Attitudes Toward Service Users' Aggression and Confidence in Intervening in Aggressive Situations.

PubMed

Shimosato, Seiji; Kinoshita, Aimi

2018-04-17

Some situations require psychiatric staff nurses to respond to service users' negativity or aggression. As a result, psychiatric staff nurses may experience anger. The current study examined how anger levels of psychiatric staff nurses triggered by anger-generating situations by service users affected nurses' confidence and attitudes. A questionnaire survey was administered among 386 psychiatric staff nurses. The questionnaire surveyed anger levels in anger-generating situations, aggressiveness, nurses' attitudes toward aggression, and self-efficacy of intervening in aggressive situations. Path analysis revealed differences between male and female nurses. Male nurses' anger in response to physical aggression was mild when they were confident in handling aggression. Furthermore, female nurses who had high confidence in intervening in an aggressive situation had low anger levels. Confidence in intervening in aggressive situations appeared to dissipate anger and ease nurses during aggressive interactions. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

[Effects of newborn care education for first-time fathers on their knowledge and confidence in newborn care at postpartum one month].

PubMed

An, Hye-Sun; Bang, Kyung-Sook

2014-08-01

This study was conducted to identify the effects of newborn care education for fathers on their knowledge and confidence in newborn care at postpartum one month. A nonequivalent control group pretest posttest design was used. The participants were 53 first-time fathers of newborns, 27 in experimental group, and 26 in control group. They were recruited at the nursery of one municipal hospital in Seoul. For the experimental group, a 50-minute education on newborn care using video, verbal education, demonstration and practice were provided prior to discharge. Fathers' knowledge and confidence in newborn care and their satisfaction with the education program were measured at postpartum one month. The fathers in the experimental group showed significantly higher knowledge (t=-4.51, p<.001), and confidence in newborn care (t=-2.29, p=.026) compared to the control group at postpartum one month. Fathers in the experimental group had a satisfaction score of 27.37±2.73 immediately after the education, and 25.30±3.40 at postpartum one month. Results indicate that newborn care education for first-time fathers is an effective method in enhancing the level of knowledge and confidence in newborn care. It can be used in the nursery department before discharge as a useful nursing intervention.

Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study.

PubMed

Schroeder, Emily B; Chonchol, Michel; Shetterly, Susan M; Powers, J David; Adams, John L; Schmittdiel, Julie A; Nichols, Gregory A; O'Connor, Patrick J; Steiner, John F

2018-05-07

In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown. We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added β -blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting. The composite significant kidney event end point was defined as the first occurrence of a ≥30% decline in eGFR to an eGFR<60 ml/min per 1.73 m 2 , initiation of dialysis, or kidney transplant. The composite cardiovascular event end point was defined as the first occurrence of hospitalization for acute myocardial infarction, acute coronary syndrome, stroke, or congestive heart failure; coronary artery bypass grafting; or percutaneous coronary intervention, and it was only examined in those free of cardiovascular disease at baseline. Over a maximum of 5 years, there were 4707 significant kidney events, 1498 deaths, and 818 cardiovascular events. Compared with thiazide diuretics, hazard ratios for significant kidney events for β -blockers, calcium channel blockers, and loop diuretics were 0.81 (95% confidence interval, 0.74 to 0.89), 0.67 (95% confidence interval, 0.58 to 0.78), and 1.19 (95% confidence interval, 1.00 to 1.41), respectively. Compared with thiazide diuretics, hazard ratios of mortality for β -blockers, calcium channel blockers, and loop diuretics were 1.19 (95% confidence interval, 0.97 to 1.44), 0.73 (95% confidence interval, 0.52 to 1.03), and 1.67 (95% confidence interval, 1.31 to 2.13), respectively. Compared with thiazide diuretics, hazard ratios of cardiovascular events for β -blockers, calcium channel blockers, and loop diuretics compared with thiazide diuretics were 1.65 (95% confidence interval, 1.39 to 1.96), 1.05 (95% confidence interval, 0.80 to 1.39), and 1.55 (95% confidence interval, 1.05 to 2.27), respectively. Compared with thiazide diuretics, calcium channel blockers were associated with a lower risk of significant kidney events and a similar risk of cardiovascular events. Copyright © 2018 by the American Society of Nephrology.

Confidence Moderates the Role of Control Beliefs in the Context of Age-Related Changes in Misinformation Susceptibility.

PubMed

Auslander, Margeaux V; Thomas, Ayanna K; Gutchess, Angela H

2017-01-01

Background/Study Context: The present experiment investigated the role of confidence and control beliefs in susceptibility to the misinformation effect in young and older adults. Control beliefs are perceptions about one's abilities or competence and the extent to which one can influence performance outcomes. It was predicted that level of control beliefs would influence misinformation susceptibility and overall memory confidence. Fifty university students (ages 18-26) and 37 community-dwelling older adults (ages 62-86) were tested. Participants viewed a video, answered questions containing misinformation, and then completed a source-recognition test to determine whether the information presented was seen in the video, the questionnaire only, both, or neither. For each response, participants indicated their level of confidence. The relationship between control beliefs and memory performance was moderated by confidence. That is, individuals with lower control beliefs made more errors as confidence decreased. Additionally, the relationship between confidence and memory performance differed by age, with greater confidence related to more errors for young adults. Confidence is an important factor in how control beliefs and age are related to memory errors in the misinformation effect. This may have implications for the legal system, particularly with eyewitness testimony. The confidence of an individual should be considered if the eyewitness is a younger adult.

Analysis of confidence level scores from an ROC study: comparison of three mammographic systems for detection of simulated calcifications

NASA Astrophysics Data System (ADS)

Lai, Chao-Jen; Shaw, Chris C.; Whitman, Gary J.; Yang, Wei T.; Dempsey, Peter J.

2005-04-01

The purpose of this study is to compare the detection performance of three different mammography systems: screen/film (SF) combination, a-Si/CsI flat-panel (FP-), and charge-coupled device (CCD-) based systems. A 5-cm thick 50% adipose/50% glandular breast tissue equivalent slab phantom was used to provide an uniform background. Calcium carbonate grains of three different size groups were used to simulate microcalcifications (MCs): 112-125, 125-140, and 140-150 μm overlapping with the uniform background. Calcification images were acquired with the three mammography systems. Digital images were printed on hardcopy films. All film images were displayed on a mammographic viewer and reviewed by 5 mammographers. The visibility of the MC was rated with a 5-point confidence rating scale for each detection task, including the negative controls. Scores were averaged over all readers for various detectors and size groups. Receiver operating characteristic (ROC) analysis was performed and the areas under the ROC curves (Az"s) were computed for various imaging conditions. The results shows that (1) the FP-based system performed significantly better than the SF and CCD-based systems for individual size groups using ROC analysis (2) the FP-based system also performed significantly better than the SF and CCD-based systems for individual size groups using averaged confidence scale, and (3) the results obtained from the Az"s were largely correlated with these from confidence level scores. However, the correlation varied slightly among different imaging conditions.

Prediction of Falls in Subjects Suffering From Parkinson Disease, Multiple Sclerosis, and Stroke.

PubMed

Beghi, Ettore; Gervasoni, Elisa; Pupillo, Elisabetta; Bianchi, Elisa; Montesano, Angelo; Aprile, Irene; Agostini, Michela; Rovaris, Marco; Cattaneo, Davide

2018-04-01

To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design. Multicenter prospective cohort study. Institutions for physical therapy and rehabilitation. Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation. Not applicable. Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used. Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD). PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study.

PubMed

Silva, Lindsay M; Coolman, Marianne; Steegers, Eric Ap; Jaddoe, Vincent Wv; Moll, Henriëtte A; Hofman, Albert; Mackenbach, Johan P; Raat, Hein

2008-06-01

To examine whether maternal socioeconomic status, as indicated by maternal educational level, is associated with preeclampsia, and if so, to what extent known risk factors for preeclampsia mediate the effect of educational level. In the Generation R Study, a population-based cohort study, we examined data of 3547 pregnant women. Odds ratios of preeclampsia for low, mid-low and mid-high educational level compared with high educational level were calculated after adjustment for confounders and additional adjustment for a selection of potential mediators (family history, material factors, psychosocial factors, substance use, working conditions, preexisting medical conditions, maternal anthropometrics and blood pressure at enrollment) that individually caused more than 10% change in the odds ratio for low education. Adjusted for the confounding effects of age, gravidity and multiple pregnancy, women with low educational level were more likely to develop preeclampsia (odds ratio 5.12; 95% confidence interval: 2.20, 11.93) than women with high educational level. After additional adjustment for financial difficulties, smoking in pregnancy, working conditions, body mass index and blood pressure at enrollment, the odds ratio was 4.91 (95% confidence interval: 1.93, 12.52). Low maternal socioeconomic status is a strong risk factor for preeclampsia. Only a small part of this association can be explained by the mediating effects of established risk factors for preeclampsia. Further research is needed to disentangle the pathway from low socioeconomic status to preeclampsia.

Students perceived stress in academic programs: consequences for its management.

PubMed

Neveu, D; Doron, J; Visier, L; Boiché, J; Trouillet, R; Dujols, P; Ninot, G

2012-08-01

Academic stress contributes to the deterioration of the students' quality of life. Psychological determinants involved in the stress process, trait anxiety and coping, have been neglected when assessing the role of academic programs in stress. This study aimed at determining whether academic programs are associated with a high level of perceived stress above and beyond potential personal and environmental risk factors, as well as coping strategies. A cross-sectional survey was conducted in 2009 among third-year medical (total n=170, participants 88%), dental (n=63, 94%), psychology (n=331, 61%) and sports sciences (n=312, 55%) students in Montpellier (France). The stress level experienced during the last 2months, trait anxiety and coping strategies were appraised. Substance use, psychological care, and stress triggers were also collected using a self-administered questionnaire. Compared with medicine and after adjusting for gender and age, only the sports program was associated with a lower perceived stress risk: adjusted odds ratio: 0.54 [95% Confidence interval: 0.30; 0.99]. Substantial reductions in perceived stress risks were observed in science students after additional adjustments for non-academic stress triggers, substance use, psychological care (adjusted odds ratio: 0.20 [95% Confidence interval: 0.09; 0.41]), and also for trait anxiety and coping strategies (adjusted odds ratio: 0.23 [95% Confidence interval: 0.10; 0.54]). Compared with medicine and after these additional adjustments, psychology had a significantly lower perceived stress risk (0.34 [0.18; 0.64]; 0.40 [0.19; 0.86], respectively), dentistry had a similar risk (0.82 [0.35; 1.91]; 0.53 [0.20; 1.43], respectively). Sports and psychology programs had a lower perceived stress risk compared with medicine. Personal and environmental risk factors and coping strategies modified the association between academic program and perceived stress. Developing efficient coping strategies in students and improving academic environment could contribute to prevent the potential deleterious consequences of stress. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Readability of Trauma-Related Patient Education Materials From the American Academy of Orthopaedic Surgeons.

PubMed

Eltorai, Adam E M; P Thomas, Nathan; Yang, Heejae; Daniels, Alan H; Born, Christopher T

2016-02-01

According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS's online trauma-related patient education materials meet recommended readability guidelines for medical information. Ninety-nine articles from the "Broken Bones and Injuries" section of the AAOS-produced patient education website, orthoinfo.org, were analyzed for grade level readability using the Flesch-Kincaid formula, a widely-used and validated tool to evaluate the text reading level. Results for each webpage were compared to the AMA/NIH recommended sixth-grade reading level and the average reading level of U.S. adults (eighth-grade). The mean (SD) grade level readability for all patient education articles was 8.8 (1.1). All but three of the articles had a readability score above the sixth-grade level. The readability of the articles exceeded this level by an average of 2.8 grade levels (95% confidence interval, 2.6 - 3.0; P < 0.0001). Furthermore, the average readability of the articles exceeded the average reading skill level of U.S. adults (eighth grade) by nearly an entire grade level (95% confidence interval, 0.6-1.0; P < 0.0001). The majority of the trauma-related articles from the AAOS patient education website have readability levels that may make comprehension difficult for a substantial portion of the patient population.

Electrically induced contraction levels of the quadriceps femoris muscles in healthy men: the effects of three patterns of burst-modulated alternating current and volitional muscle fatigue.

PubMed

Parker, Michael G; Broughton, Alex J; Larsen, Ben R; Dinius, Josh W; Cimbura, Mac J; Davis, Matthew

2011-12-01

The purpose of this study was to compare electrically induced contraction levels produced by three patterns of alternating current in fatigued and nonfatigued skeletal muscles. Eighteen male volunteers without health conditions, with a mean (SD) age of 24.9 (3.4) yrs were randomly exposed to a fatiguing volitional isometric quadriceps contraction and one of three patterns of 2.5-KHz alternating current; two were modulated at 50 bursts per second (10% burst duty cycle with five cycles per burst and 90% burst duty cycle with 45 cycles per burst), and one pattern was modulated at 100 bursts per second (10% burst duty cycle with 2.5 cycles per burst). The electrically induced contraction levels produced by the three patterns of electrical stimulation were compared before and after the fatiguing contraction. The 10% burst duty cycles produced 42.9% (95% confidence interval, 29.1%-56.7%) and 32.1% (95% confidence interval, 18.2%-45.9%) more muscle force (P < 0.001) than did the 90% burst duty cycle pattern. There was no significant interaction effect (P = 0.392) of electrical stimulation patterns and fatigue on the electrically induced contraction levels. The lower burst duty cycle (10%) patterns of electrical stimulation produced stronger muscle contractions. Furthermore, the stimulation patterns had no influence on the difference in muscle force before and after the fatiguing quadriceps contraction. Consequently, for clinical applications in which high forces are desired, the patterns using the 10% burst duty cycle may be helpful.

Standardized likelihood ratio test for comparing several log-normal means and confidence interval for the common mean.

PubMed

Krishnamoorthy, K; Oral, Evrim

2017-12-01

Standardized likelihood ratio test (SLRT) for testing the equality of means of several log-normal distributions is proposed. The properties of the SLRT and an available modified likelihood ratio test (MLRT) and a generalized variable (GV) test are evaluated by Monte Carlo simulation and compared. Evaluation studies indicate that the SLRT is accurate even for small samples, whereas the MLRT could be quite liberal for some parameter values, and the GV test is in general conservative and less powerful than the SLRT. Furthermore, a closed-form approximate confidence interval for the common mean of several log-normal distributions is developed using the method of variance estimate recovery, and compared with the generalized confidence interval with respect to coverage probabilities and precision. Simulation studies indicate that the proposed confidence interval is accurate and better than the generalized confidence interval in terms of coverage probabilities. The methods are illustrated using two examples.

Zinc supplements for treating thalassaemia and sickle cell disease.

PubMed

Swe, Kye Mon Min; Abas, Adinegara B L; Bhardwaj, Amit; Barua, Ankur; Nair, N S

2013-06-28

Haemoglobinopathies, inherited disorders of haemoglobin synthesis (thalassaemia) or structure (sickle cell disease), are responsible for significant morbidity and mortality throughout the world. The WHO estimates that, globally, 5% of adults are carriers of a haemoglobin condition, 2.9% are carriers of thalassaemia and 2.3% are carriers of sickle cell disease. Carriers are found worldwide as a result of migration of various ethnic groups to different regions of the world. Zinc is an easily available supplement and intervention programs have been carried out to prevent deficiency in people with thalassaemia or sickle cell anaemia. It is important to evaluate the role of zinc supplementation in the treatment of thalassaemia and sickle cell anaemia to reduce deaths due to complications. To assess the effect of zinc supplementation in the treatment of thalassaemia and sickle cell disease. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Date of most recent search: 01 February 2013. Randomised, placebo-controlled trials of zinc supplements for treating thalassaemia or sickle cell disease administered at least once a week for at least a month. Two review authors assessed the eligibility and risk of bias of the included trials, extracted and analysed data and wrote the review. We summarised results using risk ratios or rate ratios for dichotomous data and mean differences for continuous data. We combined trial results where appropriate. We identified nine trials for inclusion with all nine contributing outcome data. Two trials reported on people with thalassaemia (n = 152) and seven on sickle cell anaemia (n = 307).In people with thalassaemia, in one trial, the serum zinc level value showed no difference between the zinc supplemented group and the control group, mean difference 47.40 (95% confidence interval -12.95 to 107.99). Regarding anthropometry, in one trial, height velocity was significantly increased in patients who received zinc supplementation for one to seven years duration, mean difference 3.37 (95% confidence interval 2.36 to 4.38) (total number of participants = 26). In one trial, however, there was no difference in body mass index between treatment groups.Zinc acetate supplementation for three months (in one trial) and one year (in two trials) (total number of participants = 71) was noted to increase the serum zinc level significantly in patients with sickle cell anaemia, mean difference 14.90 (95% confidence interval 6.94 to 22.86) and 20.25 (95% confidence interval 11.73 to 28.77) respectively. There was no significant difference in haemoglobin level between intervention and control groups, at either three months (one trial) or one year (one trial), mean difference 0.06 (95% confidence interval -0.84 to 0.96) and mean difference -0.07 (95% confidence interval -1.40 to 1.26) respectively. Regarding anthropometry, one trial showed no significant changes in body mass index or weight after one year of zinc acetate supplementation. In patients with sickle cell disease, the total number of sickle cell crises at one year were significantly decreased in the zinc sulphate supplemented group as compared to controls, mean difference -2.83 (95% confidence interval -3.51 to -2.15) (total participants 130), but not in zinc acetate group, mean difference 1.54 (95% confidence interval -2.01 to 5.09) (total participants 22). In one trial at three months and another at one year, the total number of clinical infections were significantly decreased in the zinc supplemented group as compared to controls, mean difference 0.05 (95% confidence interval 0.01 - 0.43) (total number of participants = 36), and mean difference -7.64 (95% confidence interval -10.89 to -4.39) (total number of participants = 21) respectively. According to the results, there is no evidence from randomised controlled trials to indicate any benefit of zinc supplementation with regards to serum zinc level in patients with thalassaemia. However, height velocity was noted to increase among those who received this intervention.There is mixed evidence on the benefit of using zinc supplementation in people with sickle cell disease. For instance, there is evidence that zinc supplementation for one year increased the serum zinc levels in patients with sickle cell disease. However, though serum zinc level was raised in patients receiving zinc supplementation, haemoglobin level and anthropometry measurements were not significantly different between groups. Evidence of benefit is seen with the reduction in the number of sickle cell crises among sickle cell patients who received one year of zinc sulphate supplementation and with the reduction in the total number of clinical infections among sickle cell patients who received zinc supplementation for both three months and for one year.The conclusion is based on the data from a small group of trials,which were generally of good quality, with a low risk of bias. The authors recommend that more trials on zinc supplementation in thalassaemia and sickle cell disease be conducted given that the literature has shown the benefits of zinc in these types of diseases.

Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis.

PubMed

Tomassetti, Sara; Wells, Athol U; Costabel, Ulrich; Cavazza, Alberto; Colby, Thomas V; Rossi, Giulio; Sverzellati, Nicola; Carloni, Angelo; Carretta, Elisa; Buccioli, Matteo; Tantalocco, Paola; Ravaglia, Claudia; Gurioli, Christian; Dubini, Alessandra; Piciucchi, Sara; Ryu, Jay H; Poletti, Venerino

2016-04-01

Surgical lung biopsy is often required for a confident multidisciplinary diagnosis of idiopathic pulmonary fibrosis (IPF). Alternative, less-invasive biopsy methods, such as bronchoscopic lung cryobiopsy (BLC), are highly desirable. To address the impact of BLC on diagnostic confidence in the multidisciplinary diagnosis of IPF. In this cross-sectional study we selected 117 patients with fibrotic interstitial lung disease without a typical usual interstitial pneumonia pattern on high-resolution computed tomography. All cases underwent lung biopsies: 58 were BLC, and 59 were surgical lung biopsy (SLB). Two clinicians, two radiologists, and two pathologists sequentially reviewed clinical-radiologic findings and biopsy results, recording at each step in the process their diagnostic impressions and confidence levels. We observed a major increase in diagnostic confidence after the addition of BLC, similar to SLB (from 29 to 63%, P = 0.0003 and from 30 to 65%, P = 0.0016 of high confidence IPF diagnosis, in the BLC group and SLB group, respectively). The overall interobserver agreement in IPF diagnosis was similar for both approaches (BLC overall kappa, 0.96; SLB overall kappa, 0.93). IPF was the most frequent diagnosis (50 and 39% in the BLC and SLB group, respectively; P = 0.23). After the addition of histopathologic information, 17% of cases in the BLC group and 19% of cases in the SLB group, mostly idiopathic nonspecific interstitial pneumonia and hypersensitivity pneumonitis, were reclassified as IPF. BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of interstitial lung disease and may prove useful in the diagnosis of IPF. This study provides a robust rationale for future studies investigating the diagnostic accuracy of BLC compared with SLB.

Development of a reliable, valid measure to assess parents' and teachers' understanding of postural care for children with physical disabilities: the (UKC PostCarD) questionnaire.

PubMed

Hotham, S; Hutton, E; Hamilton-West, K E

2015-11-01

Previous research has highlighted lack of knowledge, understanding and confidence among parents and teachers responsible for the postural care of children with physical disability. Interventions designed to improve these qualities require a reliable and validated tool to assess pre- and post-intervention levels. Currently, however, no validated measure of postural care confidence (i.e. self-efficacy) exists. Hence, the aim of this research was to develop a reliable and valid questionnaire to assess parents' and teachers' confidence, alongside knowledge and understanding of postural care - the Understanding Knowledge and Confidence in providing POSTural CARe for children with Disabilities (UKC PostCarD) questionnaire. Items were developed by a multidisciplinary team and designed to map onto the content of 'An A-to-Z of Postural Care'. Parents, teachers and therapists assessed items for face validity. Scale reliability was then assessed using Cronbach's alpha and known-group validity was assessed by comparing scores of an 'expert' group (physiotherapists and occupational therapists) with those of a 'non-expert' group (with no formal training in postural care). The total scale and all three subscales (understanding and knowledge, confidence and concerns) demonstrated adequate reliability (α > 0.83) and subscale correlations formed a logical pattern (understanding and knowledge correlated positively with confidence and negatively with concerns). Experts' (n = 111) scores were higher than non-experts' (n = 79) for the total scale and all subscales (P < 0.001). Findings support the reliability and validity of the UKC PostCarD questionnaire as a measure of understanding, knowledge and confidence in providing postural care for children with disabilities. © 2015 John Wiley & Sons Ltd.

The effect of sodium bicarbonate and validation of beckman coulter AU680 analyzers for measuring total carbon dioxide (TCO2) concentrations in horse serum.

PubMed

Dirikolu, Levent; Waller, Pamela; Waguespack, Mona Landry; Andrews, Frank Michael; Keowen, Michael Layne; Gaunt, Stephen David

2017-11-01

This study evaluated the usage of Beckman Coulter AU680 analyzers for measurement of TCO 2 in horse serum, and the effect of sodium bicarbonate administrations on serum TCO 2 levels in resting horses. Treatment of horses with sodium bicarbonate did not result in any adverse events. Mean TCO 2 concentration was significantly higher from 1 to 8 h in the sodium bicarbonate-treated horses compared to the untreated controls. Within an hour, administration of sodium bicarbonate increased the TCO 2 level from 31.5 ± -2.5 (SD) to 34.0 ± 2.65 (SD) mmol/L and at 2-8 h post-administration, the TCO 2 level was above the 36 mmol/L cut-off level. In all quality control analysis of Australian standard by Beckman Coulter AU680 analyzer, the instrument slightly over estimated the TCO 2 level but the values were in close agreement with mean TCO 2 level being 38.03 with ± 0.87 mmol/L (SD). Expanded uncertainty was calculated using different levels of confidence interval. Based on 99.5% confidence interval using 0.805% expanded uncertainty using mean measured concentration of 38.05 mmol/L, it was estimated that any race samples TCO 2 level higher than 38.5 mmol/L will be indicative of sodium bicarbonate administration using Beckman Coulter AU680 analyzer in Louisiana.

Overconfidence and Career Choice

PubMed Central

Schulz, Jonathan F.; Thöni, Christian

2016-01-01

People self-assess their relative ability when making career choices. Thus, confidence in their own abilities is likely an important factor for selection into various career paths. In a sample of 711 first-year students we examine whether there are systematic differences in confidence levels across fields of study. We find that our experimental confidence measures significantly vary between fields of study: While students in business related academic disciplines (Political Science, Law, Economics, and Business Administration) exhibit the highest confidence levels, students of Humanities range at the other end of the scale. This may have important implications for subsequent earnings and professions students select themselves in. PMID:26808273

Comparison of Online and Traditional Basic Life Support Renewal Training Methods for Registered Professional Nurses.

PubMed

Serwetnyk, Tara M; Filmore, Kristi; VonBacho, Stephanie; Cole, Robert; Miterko, Cindy; Smith, Caitlin; Smith, Charlene M

2015-01-01

Basic Life Support certification for nursing staff is achieved through various training methods. This study compared three American Heart Association training methods for nurses seeking Basic Life Support renewal: a traditional classroom approach and two online options. Findings indicate that online methods for Basic Life Support renewal deliver cost and time savings, while maintaining positive learning outcomes, satisfaction, and confidence level of participants.

OFFGEL electrophoresis and tandem mass spectrometry approach compared with DNA-based PCR method for authentication of meat species from raw and cooked ground meat mixtures containing cattle meat, water buffalo meat and sheep meat.

PubMed

Naveena, Basappa M; Jagadeesh, Deepak S; Jagadeesh Babu, A; Madhava Rao, T; Kamuni, Veeranna; Vaithiyanathan, S; Kulkarni, Vinayak V; Rapole, Srikanth

2017-10-15

The present study compared the accuracy of an OFFGEL electrophoresis and tandem mass spectrometry-based proteomic approach with a DNA-based method for meat species identification from raw and cooked ground meat mixes containing cattle, water buffalo and sheep meat. The proteomic approach involved the separation of myofibrillar proteins using OFFGEL electrophoresis, SDS-PAGE and protein identification by MALDI-TOF MS. Species-specific peptides derived from myosin light chain-1 and 2 were identified for authenticating buffalo meat spiked at a minimum 0.5% level in sheep meat with high confidence. Relative quantification of buffalo meat mixed with sheep meat was done by quantitative label-free mass spectrometry using UPLC-QTOF and PLGS search engine to substantiate the confidence level of the data. In the DNA-based method, PCR amplification of mitochondrial D loop gene using species specific primers found 226bp and 126bp product amplicons for buffalo and cattle meat, respectively. The method was efficient in detecting a minimum of 0.5% and 1.0% when buffalo meat was spiked with cattle meat in raw and cooked meat mixes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association Between Serum 25-Hydroxy Vitamin D Levels and Blood Pressure Among Adolescents in Two Resource-Limited Settings in Peru

PubMed Central

Tomaino, Katherine; Romero, Karina M.; Robinson, Colin L.; Baumann, Lauren M.; Hansel, Nadia N.; Pollard, Suzanne L.; Gilman, Robert H.; Mougey, Edward; Lima, John J.

2015-01-01

INTRODUCTION Serum 25-hydroxyvitamin D (25OHD) deficiency (<50 nmol/l or 20ng/ml) has been associated with increased blood pressure (BP) in observational studies. A paucity of data on this relationship is available in Latin American or child populations. This study investigates the association between 25OHD levels and BP in adolescents at risk for vitamin D deficiency in 2 Peruvian settings. METHODS In a population-based study of 1,441 Peruvian adolescents aged 13–15 years, 1,074 (75%) provided a serum blood sample for 25OHD analysis and BP measurements. Relationships between 25OHD and BP metrics were assessed using multiple linear regressions, adjusted for anthropometrics and sociodemographic factors. RESULTS 25OHD deficiency was associated with an elevated diastolic BP (DBP) (1.09mm Hg increase, 95% confidence interval: 0.04 to 2.14; P = 0.04) compared to nondeficient adolescents. Systolic BP (SBP) trended to increase with vitamin D deficiency (1.30mm Hg increase, 95% confidence interval: −0.13 to 2.72; P = 0.08). Mean arterial pressure (MAP) was also greater in adolescents with 25OHD (1.16mm Hg increase, 95% confidence interval: 0.10 to 2.22; P = 0.03). SBP was found to demonstrate a U-shaped relationship with 25OHD, while DBP and MAP demonstrated inverse J-shaped relationships with serum 25OHD status. The association between 25OHD deficiency and BP was not different across study sites (all P ≥ 0.19). DISCUSSION Adolescents deficient in 25OHD demonstrated increased DBP and MAP and a trend toward increased SBP, when compared to nondeficient subjects. 25OHD deficiency early in life was associated with elevated BP metrics, which may predispose risk of hypertension later in adulthood. PMID:25600222

Exercise in pregnancy: an association with placental weight?

PubMed

Hilde, Gunvor; Eskild, Anne; Owe, Katrine Mari; Bø, Kari; Bjelland, Elisabeth K

2017-02-01

Women with high levels of physical exercise have an increased demand for oxygen and nutrients. Thus, in pregnancies of women with high levels of exercise, it is conceivable that the supply of oxygen and nutrients to the placenta is suboptimal, and growth could be impaired. The objective was to study the association of frequency of exercise during pregnancy with placental weight and placental to birthweight ratio. This was a prospective study of 80,515 singleton pregnancies in the Norwegian Mother and Child Cohort Study. Frequency of exercise was self-reported by a questionnaire at pregnancy weeks 17 and 30. Information on placental weight and birthweight was obtained by linkage to the Medical Birth Registry of Norway. Placental weight decreased with increasing frequency of exercise (tests for trend, P < .001). For nonexercisers in pregnancy week 17, the crude mean placental weight was 686.1 g compared with 667.3 g in women exercising ≥6 times weekly (difference, 18.8 g; 95% confidence interval, 12.0-25.5). Likewise, in nonexercisers in pregnancy week 30, crude mean placental weight was 684.9 g compared with 661.6 g in women exercising ≥6 times weekly (difference, 23.3 g; 95% confidence interval, 14.9-31.6). The largest difference in crude mean placental weight was seen between nonexercisers at both time points and women exercising ≥6 times weekly at both time points (difference, 31.7 g; 95% confidence interval, 19.2-44.2). Frequency of exercise was not associated with placental to birthweight ratio. We found decreasing placental weight with increasing frequency of exercise in pregnancy. The difference in placental weight between nonexercisers and women with exercising ≥6 times weekly was small and may have no clinical implications. Copyright © 2016 Elsevier Inc. All rights reserved.

Work-related stress, education and work ability among hospital nurses.

PubMed

Golubic, Rajna; Milosevic, Milan; Knezevic, Bojana; Mustajbegovic, Jadranka

2009-10-01

This paper is a report of a study conducted to determine which occupational stressors are present in nurses' working environment; to describe and compare occupational stress between two educational groups of nurses; to estimate which stressors and to what extent predict nurses' work ability; and to determine if educational level predicts nurses' work ability. Nurses' occupational stress adversely affects their health and nursing quality. Higher educational level has been shown to have positive effects on the preservation of good work ability. A cross-sectional study was conducted in 2006-2007. Questionnaires were distributed to a convenience sample of 1392 (59%) nurses employed at four university hospitals in Croatia (n = 2364). The response rate was 78% (n = 1086). Data were collected using the Occupational Stress Assessment Questionnaire and Work Ability Index Questionnaire. We identified six major groups of occupational stressors: 'Organization of work and financial issues', 'public criticism', 'hazards at workplace', 'interpersonal conflicts at workplace', 'shift work' and 'professional and intellectual demands'. Nurses with secondary school qualifications perceived Hazards at workplace and Shift work as statistically significantly more stressful than nurses a with college degree. Predictors statistically significantly related with low work ability were: Organization of work and financial issues (odds ratio = 1.69, 95% confidence interval 122-236), lower educational level (odds ratio = 1.69, 95% confidence interval 122-236) and older age (odds ratio = 1.07, 95% confidence interval 1.05-1.09). Hospital managers should develop strategies to address and improve the quality of working conditions for nurses in Croatian hospitals. Providing educational and career prospects can contribute to decreasing nurses' occupational stress levels, thus maintaining their work ability.

Korean consumers' perceptions of health/functional food claims according to the strength of scientific evidence

PubMed Central

Kim, Ji Yeon; Kang, Eun Jin; Kwon, Oran

2010-01-01

In this study, we investigated that consumers could differentiate between levels of claims and clarify how a visual aid influences consumer understanding of the different claim levels. We interviewed 2,000 consumers in 13 shopping malls on their perception of and confidence in different levels of health claims using seven point scales. The average confidence scores given by participants were 4.17 for the probable level and 4.07 for the possible level; the score for the probable level was significantly higher than that for the possible level (P < 0.05). Scores for confidence in claims after reading labels with and without a visual aid were 5.27 and 4.43, respectively; the score for labeling with a visual aid was significantly higher than for labeling without a visual aid (P < 0.01). Our results provide compelling evidence that providing health claims with qualifying language differentiating levels of scientific evidence can help consumers understand the strength of scientific evidence behind those claims. Moreover, when a visual aid was included, consumers perceived the scientific levels more clearly and had greater confidence in their meanings than when a visual aid was not included. Although this result suggests that consumers react differently to different claim levels, it is not yet clear whether consumers understand the variations in the degree of scientific support. PMID:21103090

Antimicrobial knowledge and confidence amongst final year medical students in Australia.

PubMed

Weier, Naomi; Thursky, Karin; Zaidi, Syed Tabish R

2017-01-01

Inappropriate use of antimicrobials is one of the major modifiable contributors to antimicrobial resistance. There is currently no validated survey tool available to assess knowledge and confidence of medical students in infectious diseases (ID) compared to other diseases states, and little is known about this topic. A cross-sectional survey of final year medical students attending universities around Australia was conducted between August and September, 2015. A survey unique from other published studies was developed to survey satisfaction in education, confidence and knowledge in ID, and how this compared to these factors in cardiovascular diseases. Reliability and validity was demonstrated in the survey tool used. Students were more likely to rate university education as sufficient for cardiovascular diseases (91.3%) compared to ID (72.5%), and were more confident in their knowledge of cardiovascular diseases compared to ID (74.38% vs. 53.76%). Students tended to answer more cardiovascular disease related clinical questions correctly (mean score 78%), compared to questions on antimicrobial use (mean score 45%). Poor knowledge and confidence amongst final year medical students in Australia were observed in ID. Antimicrobial stewardship agenda should include the provision of additional training in antimicrobial prescribing to the future medical workforce.

Confidence level in performing clinical procedures among medical officers in nonspecialist government hospitals in Penang, Malaysia.

PubMed

Othman, Mohamad Sabri; Merican, Hassan; Lee, Yew Fong; Ch'ng, Kean Siang; Thurairatnam, Dharminy

2015-03-01

A prospective cross-sectional study was conducted at 3 government hospitals over 6 months to evaluate the confidence level of medical officers (MOs) to perform clinical procedure in nonspecialist government hospitals in Penang. An anonymous self-administered questionnaire in English was designed based on the elective and emergency procedures stated in the houseman training logbook. The questionnaire was distributed to the MOs from Penang State Health Department through the respective hospital directors and returned to Penang State Health Department on completion. The results showed that there was statistically significant difference between those who had undergone 12 months and 24 months as houseman in performing both elective and emergency procedures. MOs who had spent 24 months as housemen expressed higher confidence level than those who had only 12 months of experience. We also found that the confidence level was statistically and significantly influenced by visiting specialist and working together with cooperative experienced paramedics. © 2013 APJPH.

Results of upper airway radiography and ultrasonography predict dynamic laryngeal collapse in affected horses.

PubMed

Fjordbakk, C T; Chalmers, H J; Holcombe, S J; Strand, E

2013-11-01

The pathogenesis of dynamic bilateral laryngeal collapse (DLC) associated with poll flexion is unknown. Diagnosis is dependent upon exercise endoscopy while replicating the flexed head position harness racehorses experience during racing. To describe the effects of poll flexion on rostrocaudal laryngeal positioning and laryngeal lumen width in resting horses diagnosed with DLC compared to controls, and to establish diagnostic criteria for DLC by use of diagnostic imaging. Case-control study. Fifty harness racehorses were prospectively included in the study: 25 cases diagnosed with DLC by treadmill endoscopy and 25 controls in which treadmill endoscopy revealed no abnormal findings. Laryngeal radiography and ultrasonography were obtained in neutral and flexed head positions. Laryngeal positioning and laryngohyoid conformation were compared between the groups and head positions. Poll flexion induced a greater rostral advancement of the larynx in relation to the hyoid apparatus in resting harness racehorses affected with DLC compared to controls (P = 0.007). At the level of the vocal folds, poll flexion resulted in a smaller laryngeal lumen width in horses affected with DLC compared to controls (P = 0.04). Horses were significantly more likely to be affected with DLC when the thyrohyoid bone to thyroid cartilage distance was ≥12 mm in poll flexion (odds ratio 21.3, 95% confidence interval 3.65-124.8, P = 0.004) and when laryngeal lumen width at the level of the vocal folds was less in poll flexion than in the neutral head position (odds ratio 8.4; 95% confidence interval 1.6-44.1, P = 0.012). In DLC horses, poll flexion advanced the larynx more rostrally and resulted in a decreased airway lumen width compared to control horses. Laryngeal ultrasound and radiography may facilitate the diagnosis of DLC at rest. © 2013 EVJ Ltd.

Comparison of Mental Toughness and Power Test Performances in High-Level Kickboxers by Competitive Success.

PubMed

Slimani, Maamer; Miarka, Bianca; Briki, Walid; Cheour, Foued

2016-06-01

Kickboxing is a high-intensity intermittent striking combat sport, which is characterized by complex skills and tactical key actions with short duration. The present study compared and verified the relationship between mental toughness (MT), countermovement jump (CMJ) and medicine ball throw (MBT) power tests by outcomes of high-level kickboxers during National Championship. Thirty two high-level male kickboxers (winner = 16 and loser = 16: 21.2 ± 3.1 years, 1.73 ± 0.07 m, and 70.2 ± 9.4 kg) were analyzed using the CMJ, MBT tests and sports mental toughness questionnaire (SMTQ; based in confidence, constancy and control subscales), before the fights of the 2015 national championship (16 bouts). In statistical analysis, Mann-Withney test and a multiple linear regression were used to compare groups and to observe relationships, respectively, P ≤ 0.05. The present results showed significant differences between losers vs. winners, respectively, of total MT (7(7;8) vs. 11(10.2;11), confidence (3(3;3) vs. 4(4;4)), constancy (2(2;2) vs. 3(3;3)), control (2(2;3) vs. 4(4;4)) subscales and MBT (4.1(4;4.3) vs. 4.6(4.4;4.8)). The multiple linear regression showed a strong associations between MT results and outcome (r = 0.89), MBT (r = 0.84) and CMJ (r = 0.73). The findings suggest that MT will be more predictive of performance in those sports and in the outcome of competition.

Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion.

PubMed

Dibble, Elizabeth H; Lourenco, Ana P; Baird, Grayson L; Ward, Robert C; Maynard, A Stanley; Mainiero, Martha B

2018-01-01

To compare interobserver variability (IOV), reader confidence, and sensitivity/specificity in detecting architectural distortion (AD) on digital mammography (DM) versus digital breast tomosynthesis (DBT). This IRB-approved, HIPAA-compliant reader study used a counterbalanced experimental design. We searched radiology reports for AD on screening mammograms from 5 March 2012-27 November 2013. Cases were consensus-reviewed. Controls were selected from demographically matched non-AD examinations. Two radiologists and two fellows blinded to outcomes independently reviewed images from two patient groups in two sessions. Readers recorded presence/absence of AD and confidence level. Agreement and differences in confidence and sensitivity/specificity between DBT versus DM and attendings versus fellows were examined using weighted Kappa and generalised mixed modeling, respectively. There were 59 AD patients and 59 controls for 1,888 observations (59 × 2 (cases and controls) × 2 breasts × 2 imaging techniques × 4 readers). For all readers, agreement improved with DBT versus DM (0.61 vs. 0.37). Confidence was higher with DBT, p = .001. DBT achieved higher sensitivity (.59 vs. .32), p < .001; specificity remained high (>.90). DBT achieved higher positive likelihood ratio values, smaller negative likelihood ratio values, and larger ROC values. DBT decreases IOV, increases confidence, and improves sensitivity while maintaining high specificity in detecting AD. • Digital breast tomosynthesis decreases interobserver variability in the detection of architectural distortion. • Digital breast tomosynthesis increases reader confidence in the detection of architectural distortion. • Digital breast tomosynthesis improves sensitivity in the detection of architectural distortion.

Confidence limit variation for a single IMRT system following the TG119 protocol.

PubMed

Gordon, J D; Krafft, S P; Jang, S; Smith-Raymond, L; Stevie, M Y; Hamilton, R J

2011-03-01

To evaluate the robustness of TG119-based quality assurance metrics for an IMRT system. Four planners constructed treatment plans for the five IMRT test cases described in TG119. All plans were delivered to a 30 cm x 30 cm x 15 cm solid water phantom in one treatment session in order to minimize session-dependent variation from phantom setup, film quality, machine performance, etc. Composite measurements utilized film and an ionization chamber. Per-field measurements were collected using a diode array device at an effective depth of 5 cm. All data collected were analyzed using the TG119 specifications to determine the confidence limit values for each planner separately and then compared. The mean variance of ion chamber measurements for each planner was within 1.7% of the planned dose. The resulting confidence limits were 3.13%, 1.98%, 3.65%, and 4.39%. Confidence limit values determined by composite film analysis were 8.06%, 13.4%, 9.30%, and 16.5%. Confidence limits from per-field measurements were 1.55%, 0.00%, 0.00%, and 2.89%. For a single IMRT system, the accuracy assessment provided by TG119-based quality assurance metrics showed significant variations in the confidence limits between planners across all composite and per-field evaluations. This observed variation is likely due to the different levels of modulation between each planner's set of plans. Performing the TG119 evaluation using plans produced by a single planner may not provide an adequate estimation of IMRT system accuracy.

Perceived changes in the knowledge and confidence of doctors and midwives to manage obstetric emergencies following completion of an Advanced Life Support in Obstetrics course in Australia.

PubMed

Walker, Laura J M; Fetherston, Catherine M; McMurray, Anne

2013-12-01

The Advanced Life Support in Obstetrics (ALSO) course is an internationally recognised interprofessional course to support health professionals to develop and maintain the knowledge and skills to manage obstetric emergencies. This study investigated changes in confidence and perceived changes in the knowledge of doctors and midwives to manage specific obstetric emergency situations following completion of an ALSO course in Australia. A prospective repeated-measures survey design was used to survey 165 course attendees from four Australian states pre- and postcourse and at six weeks (n = 101). Data were analysed using a Friedman two-way repeated-measures analysis of variance and the Wilcoxon signed rank test. There was a significant improvement in confidence and perceived knowledge of the recommended management of all 17 emergency situations immediately postcourse (P < 0.001) and at six weeks postcourse (P < 0.001) when compared to precourse levels for both groups of health professionals. However, a significant decrease in knowledge and confidence for many emergency situations from immediately postcourse to six weeks postcourse (P < 0.05) was also observed in both groups. Completion of the Australian ALSO course in Australia has a positive effect on the confidence and perceived knowledge of doctors and midwives to manage obstetric emergencies. However, there needs to be some means of reinforcing the effects of the course for longer term maintenance of knowledge and confidence. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Do People Who Believe in God Report More Meaning in Their Lives? The Existential Effects of Belief

PubMed Central

Cranney, Stephen

2014-01-01

I conduct the first large-N study explicitly exploring the association between belief in God and sense of purpose in life. This relationship, while often discussed informally, has received little empirical attention. Here I use the General Social Survey to investigate how form of and confidence in belief in God is related to sense of purpose in life, as measured by a Likert item level of agreement with the statement “In my opinion, life does not serve any purpose.” Using logistic regression analysis, I find that those who indicate that they are confident in God's existence report a higher sense of purpose compared to nonbelievers, believers in a higher power, and those who believe but occasionally doubt. PMID:24729632

Normal fasting plasma glucose levels and type 2 diabetes in young men.

PubMed

Tirosh, Amir; Shai, Iris; Tekes-Manova, Dorit; Israeli, Eran; Pereg, David; Shochat, Tzippora; Kochba, Ilan; Rudich, Assaf

2005-10-06

The normal fasting plasma glucose level was recently defined as less than 100 mg per deciliter (5.55 mmol per liter). Whether higher fasting plasma glucose levels within this range independently predict type 2 diabetes in young adults is unclear. We obtained blood measurements, data from physical examinations, and medical and lifestyle information from men in the Israel Defense Forces who were 26 to 45 years of age. A total of 208 incident cases of type 2 diabetes occurred during 74,309 person-years of follow-up (from 1992 through 2004) among 13,163 subjects who had baseline fasting plasma glucose levels of less than 100 mg per deciliter. A multivariate model, adjusted for age, family history of diabetes, body-mass index, physical-activity level, smoking status, and serum triglyceride levels, revealed a progressively increased risk of type 2 diabetes in men with fasting plasma glucose levels of 87 mg per deciliter (4.83 mmol per liter) or more, as compared with those whose levels were in the bottom quintile (less than 81 mg per deciliter [4.5 mmol per liter], P for trend <0.001). In multivariate models, men with serum triglyceride levels of 150 mg per deciliter (1.69 mmol per liter) or more, combined with fasting plasma glucose levels of 91 to 99 mg per deciliter (5.05 to 5.50 mmol per liter), had a hazard ratio of 8.23 (95 percent confidence interval, 3.6 to 19.0) for diabetes, as compared with men with a combined triglyceride level of less than 150 mg per deciliter and fasting glucose levels of less than 86 mg per deciliter (4.77 mmol per liter). The joint effect of a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or more and a fasting plasma glucose level of 91 to 99 mg per deciliter resulted in a hazard ratio of 8.29 (95 percent confidence interval, 3.8 to 17.8), as compared with a body-mass index of less than 25 and a fasting plasma glucose level of less than 86 mg per deciliter. Higher fasting plasma glucose levels within the normoglycemic range constitute an independent risk factor for type 2 diabetes among young men, and such levels may help, along with body-mass index and triglyceride levels, to identify apparently healthy men at increased risk for diabetes. Copyright 2005 Massachusetts Medical Society.

Soluble CD40L Is a Useful Marker to Predict Future Strokes in Patients With Minor Stroke and Transient Ischemic Attack.

PubMed

Li, Jiejie; Wang, Yilong; Lin, Jinxi; Wang, David; Wang, Anxin; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, Yongjun

2015-07-01

Elevated soluble CD40 ligand (sCD40L) was shown to be related to cardiovascular events, but the role of sCD40L in predicting recurrent stroke remains unclear. Baseline sCD40L levels were measured in 3044 consecutive patients with acute minor stroke and transient ischemic attack, who had previously been enrolled in the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial. Cox proportional-hazards model was used to assess the association of sCD40L with recurrent stroke. Patients in the top tertile of sCD40L levels had increased risk of recurrent stroke comparing with those in the bottom tertile, after adjusted for conventional confounding factors (hazard ratio, 1.49; 95% confidence interval, 1.11-2.00; P=0.008). The patients with elevated levels of both sCD40L and high-sensitive C-reactive protein also had increased risk of recurrent stroke (hazard ratio, 1.81; 95% confidence interval, 1.23-2.68; P=0.003). Elevated sCD40L levels independently predict recurrent stroke in patients with minor stroke and transient ischemic attack. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00979589. © 2015 American Heart Association, Inc.

Enzyme replacement therapy for Anderson-Fabry disease.

PubMed

El Dib, Regina; Gomaa, Huda; Carvalho, Raíssa Pierri; Camargo, Samira E; Bazan, Rodrigo; Barretti, Pasqual; Barreto, Fellype C

2016-07-25

Anderson-Fabry disease is an X-linked defect of glycosphingolipid metabolism. Progressive renal insufficiency is a major source of morbidity, additional complications result from cardio- and cerebro-vascular involvement. Survival is reduced among affected males and symptomatic female carriers.This is an update of a Cochrane review first published in 2010, and previously updated in 2013. To evaluate the effectiveness and safety of enzyme replacement therapy compared to other interventions, placebo or no interventions, for treating Anderson-Fabry disease. We searched the Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register (date of the most recent search: 08 July 2016). We also searched 'Clinical Trials' on The Cochrane Library, MEDLINE, Embase and LILACS (date of the most recent search: 24 September 2015). Randomized controlled trials of agalsidase alfa or beta in participants diagnosed with Anderson-Fabry disease. Two authors selected relevant trials, assessed methodological quality and extracted data. Nine trials comparing either agalsidase alfa or beta in 351 participants fulfilled the selection criteria.Both trials comparing agalsidase alfa to placebo reported on globotriaosylceramide concentration in plasma and tissue; aggregate results were non-significant. One trial reported pain scores measured by the Brief Pain Inventory severity, there was a statistically significant improvement for participants receiving treatment at up to three months, mean difference -2.10 (95% confidence interval -3.79 to -0.41; at up to five months, mean difference -1.90 (95% confidence interval -3.65 to -0.15); and at up to six months, mean difference -2.00 (95% confidence interval -3.66 to -0.34). There was a significant difference in the Brief Pain Inventory pain-related quality of life at over five months and up to six months, mean difference -2.10 (95% confidence interval -3.92 to -0.28) but not at other time points. Death was not an outcome in either of the trials.One of the three trials comparing agalsidase beta to placebo reported on globotriaosylceramide concentration in plasma and tissue and showed significant improvement: kidney, mean difference -1.70 (95% confidence interval -2.09 to -1.31); heart, mean difference -0.90 (95% confidence interval -1.18 to -0.62); and composite results (renal, cardiac, and cerebrovascular complications and death), mean difference -4.80 (95% confidence interval -5.45 to -4.15). There was no significant difference between groups for death; no trials reported on pain.Only two trials compared agalsidase alfa to agalsidase beta. One of them showed no significant difference between the groups regarding adverse events, risk ratio 0.36 (95% confidence interval 0.08 to 1.59), or any serious adverse events; risk ratio 0.30; (95% confidence interval 0.03 to 2.57).Two trials compared different dosing schedules of agalsidase alfa. One of them involved three different doses (0.2 mg/kg every two weeks; 0.1 mg/kg weekly and; 0.2 mg/kg weekly), the other trial evaluated two further doses to the dosage schedules: 0.4 mg/kg every week and every other week. Both trials failed to show significant differences with various dosing schedules on globotriaosylceramide levels. No significant differences were found among the schedules for the primary efficacy outcome of self-assessed health state, or for pain scores.One trial comparing agalsidase alfa to agalsidase beta showed no significant difference for any adverse events such as dyspnoea and hypertension.The methodological quality of the included trials was generally unclear for the random sequence generation and allocation concealment. Trials comparing enzyme replacement therapy to placebo show significant improvement with enzyme replacement therapy in regard to microvascular endothelial deposits of globotriaosylceramide and in pain-related quality of life. There is, however, no evidence identifying if the alfa or beta form is superior or the optimal dose or frequency of enzyme replacement therapy. With regards to safety, adverse events (i.e., rigors, fever) were more significant in the agalsidase beta as compared to placebo. The long-term influence of enzyme replacement therapy on risk of morbidity and mortality related to Anderson-Fabry disease remains to be established. This review highlights the need for continued research into the use of enzyme replacement therapy for Anderson-Fabry disease.

Relations among Affect, Abstinence Motivation and Confidence, and Daily Smoking Lapse Risk

PubMed Central

Minami, Haruka; Yeh, Vivian M.; Bold, Krysten W.; Chapman, Gretchen B.; McCarthy, Danielle E.

2016-01-01

Aims This study tested the hypothesis that changes in momentary affect, abstinence motivation, and confidence would predict lapse risk over the next 12–24 hours using Ecological Momentary Assessment (EMA) data from smokers attempting to quit smoking. Method 103 adult, daily, treatment-seeking smokers recorded their momentary affect, motivation to quit, abstinence confidence, and smoking behaviors in near real time with multiple EMA reports per day using electronic diaries post-quit. Results Multilevel models indicated that initial levels of negative affect were associated with smoking, even after controlling for earlier smoking status, and that short-term increases in negative affect predicted lapses up to 12, but not 24, hours later. Positive affect had significant effects on subsequent abstinence confidence, but not motivation to quit. High levels of motivation appeared to reduce increases in lapse risk that occur over hours while momentary changes in confidence did not predict lapse risk over 12 hours. Conclusion Negative affect had short-lived effects on lapse risk, whereas higher levels of motivation protected against the risk of lapsing that accumulates over hours. An increase in positive affect was associated with greater confidence to quit, but such changes in confidence did not reduce short-term lapse risk, contrary to expectations. Relations observed among affect, cognitions, and lapse seem to depend critically on the timing of assessments. PMID:24955665

Relationship between Teachers' ICT Competency, Confidence Level, and Satisfaction toward ICT Training Programmes: A Case Study among Postgraduate Students

ERIC Educational Resources Information Center

Tasir, Zaidatun; Abour, Khawla Mohammed El Amin; Halim, Noor Dayana Abd; Harun, Jamalludin

2012-01-01

There are three main variables that would make the integration of ICT tools as an easy process. Those three variables are teachers' ICT competency, teachers' confidence level in using ICT, and teachers' satisfaction on ICT training programmes. This study investigated the relationships among these three variables and measured the levels of the…

An Examination of Teacher's Occupational Burnout Levels in Terms of Organizational Confidence and Some Other Variables

ERIC Educational Resources Information Center

Caglar, Caglar

2011-01-01

An effort is made in this research to determine the correlations between primary school teachers' levels of confidence in their organization and their burnout levels and other variables. The research population is composed of teachers teaching in the primary schools located in the city center of Adiyaman in 2009-2010 academic year whereas the…

The relationship between fundamental movement skill proficiency and physical self-confidence among adolescents.

PubMed

McGrane, Bronagh; Belton, Sarahjane; Powell, Danielle; Issartel, Johann

2017-09-01

This study aims to assess fundamental movement skill (FMS) proficiency, physical self-confidence levels, and the relationship between these variables and gender differences among adolescents. Three hundred and ninety five adolescents aged 13.78 years (SD = ±1.2) from 20 schools were involved in this study. The Test of Gross Motor Development-2nd Edition (TGMD), TGMD-2 and Victorian Skills Manual were used to assess 15 FMS. Participants' physical self-confidence was also assessed using a valid skill-specific scale. A significant correlation was observed between FMS proficiency and physical self-confidence for females only (r = 0.305, P < 0.001). Males rated themselves as having significantly higher physical self-confidence levels than females (P = 0.001). Males scored significantly higher than females in FMS proficiency (P < 0.05), and the lowest physical self-confidence group were significantly less proficient at FMS than the medium (P < 0.001) and high physical self-confidence groups (P < 0.05). This information not only highlights those in need of assistance to develop their FMS but will also facilitate in the development of an intervention which aims to improve physical self-confidence and FMS proficiency.

Educating Providers in Return-to-Play Suggested Guidelines Postconcussion.

PubMed

Bires, Angela Macci; Leonard, Amanda L; Thurber, Brandon

As the awareness of concussions increases, it is imperative to be able to evaluate, diagnose, and treat concussed individuals properly to prevent further complications or death. The primary purpose of this study was to compare a provider's current awareness and comfort level as it relates to the return-to-play guidelines for concussions. A secondary aim was to evaluate current protocols that are in use and determine whether they coincide with the suggested guidelines. An educational intervention was implemented to assess the knowledge and confidence of health care providers. The study design was a quantitative, convenient sample, pretest/posttest questionnaire. The questionnaire was administered to participants who were nurse practitioners prior to an educational PowerPoint presentation. At 8 weeks, the posttest was administered. Approximately 19% of individuals were not aware of a graded return-to-play protocols. The findings suggest that the educational intervention increased their confidence levels in making a diagnosis of a concussion, in assessing danger signs, and in understanding when to refer to a specialist. Additional supporting evidence from this study indicates that the educational intervention allowed the participants to achieve a greater comfort level in finding appropriate resources for them and their patients.

In vitro and in vivo testing of a totally implantable left ventricular assist system.

PubMed

Jassawalla, J S; Daniel, M A; Chen, H; Lee, J; LaForge, D; Billich, J; Ramasamy, N; Miller, P J; Oyer, P E; Portner, P M

1988-01-01

The totally implantable Novacor LVAS is being tested under NIH auspices to demonstrate safety and efficacy before clinical trials. Twelve complete systems (submerged in saline at 37 degrees C) are being tested, with an NIH goal of demonstrating 80% reliability for 2 year operation with a 60% confidence level. The systems, which are continuously monitored, are diurnally cycled between two output levels by automatically varying preload and afterload. Currently, 14.3 years of failure-free operation have been accumulated, with a mean duration of 14 months. Using an exponential failure distribution model, the mean time to failure (MTTF) is greater than 8.8 years, corresponding to a demonstrated reliability (for a 2 year mission time) of 80% (80% confidence level). Recent ovine experiments with VAS subsystems include a 767 day volume compensator implant, a 279 day pump/drive unit implant and a 1,448 day BST implant. The last 12 chronic pump/drive unit experiments had a mean duration of 153 days (excluding early postoperative complications). This compares favorably with the NIH goals for complete systems (5 month mean duration). Complete system experiments are currently underway.

Evidence-Based Practice Knowledge, Attitude, Access and Confidence: A comparison of dental hygiene and dental students.

PubMed

Santiago, Victoria; Cardenas, Melissa; Charles, Anne Laure; Hernandez, Estefany; Oyoyo, Udochukwu; Kwon, So Ran

2018-04-01

Purpose: The purpose of this study was to evaluate whether current educational strategies at a dental institution in the United States made a difference in dental hygiene (DNHY) and dental students' (D3) learning outcomes in the four domains of evidence-based practice (EBP), knowledge, attitude, accessing evidence, and confidence (KACE), following a 12-week research design course. Methods: All participants DNHY (n=19) and D3 (n=96) enrolled in the research design course at Loma Linda University completed a paper KACE survey distributed on the first day of class. Students completed the KACE survey once more at the end of the 12-week course. Pre- and post-survey results were compared both within and between the DNHY and D3 student groups to identify the learning outcomes in the four domains of EBP; knowledge, attitude, accessing evidence, and confidence in EBP. Descriptive statistics were conducted to profile all variables in the study; the level of significance was set at α=0.05. Results: All DNHY students (n=19) completed the pre and post KACE surveys; of the D3 (n=96) students enrolled in the course 82% (n=79) competed the post-survey. Comparison of the survey results showed that both DNHY and D3 students demonstrated statistically significant increases in their level of knowledge and attitude (p < 0.05) towards EBP. In the attitude domain, DNHY students indicated more positive attitudes towards EBP (p < 0.001) than their D3 student cohorts. Neither group demonstrated significant changes in confidence in applying EBP (p > 0.05). Conclusion: DNHY and D3 students increased their knowledge and developed more positive attitudes towards EBP following a 12-week research design course. Study results identify improvement areas for EBP knowledge acquisition including determining levels of evidence, analysis of study results, and evaluating the appropriateness of research study designs through the use of validated EBP survey instrument. Copyright © 2018 The American Dental Hygienists’ Association.

Confidence in communicating with patients with cancer mediates the relationship between rehabilitation therapists' autistic-like traits and perceived difficulty in communication.

PubMed

Hayashibara, Chinatsu; Inagaki, Masatoshi; Fujimori, Maiko; Higuchi, Yuji; Fujiwara, Masaki; Terada, Seishi; Okamura, Hitoshi; Uchitomi, Yosuke; Yamada, Norihito

2018-01-21

Recently, rehabilitation therapists have become involved in cancer rehabilitation; however, no communication skills training that increases the ability to provide emotional support for cancer patients has been developed for rehabilitation therapists. In addition, no study has examined associations between rehabilitation therapists' communication skills and their level of autistic-like traits (ALT), which are in-born characteristics including specific communication styles and difficulty communicating with patients. In this study, we aimed to investigate whether confidence in communicating with patients mitigates communication difficulties experienced by rehabilitation therapists who have high levels of ALT. Rehabilitation therapists who treat patients with cancer completed self-administered postal questionnaires anonymously. Scores were obtained on the Autism-Spectrum Quotient short form, confidence in communication, and communication difficulties. We used covariance structure analyses to test hypothetical models, and confirmed that confidence in communication mediates the relationship between ALT and perceived communication difficulties. Participants included 1,343 respondents (49.6%). Autism-Spectrum Quotient scores were positively correlated with communication difficulties (r = 0.16, p < 0.001). The correlation was mitigated by confidence in communication in the fit model. However, higher confidence in creating a supportive atmosphere was associated with more difficulty in communication (r = 0.16, p < 0.001). Significance of results Communication difficulty was linked to rehabilitation therapists' ALTs. By increasing confidence in areas of communication other than creation of a supportive atmosphere, ALT-related difficulties in communication may be ameliorated. Confidence to create supportive environments correlated positively with difficulty. Communication skills training to increase confidence in communication for rehabilitation therapists should be developed with vigilance regarding ALT levels.

Patient confidence and quality of life in idiopathic pulmonary fibrosis and sarcoidosis.

PubMed

Kotecha, Jalpa; Atkins, Christopher; Wilson, Andrew

2016-12-23

Idiopathic pulmonary fibrosis (IPF) and sarcoidosis impact significantly on health-related quality of life (HRQOL). There are few studies on the impact of patient confidence on HRQOL in these conditions. 1. To investigate whether patient confidence is associated with HRQOL, anxiety, depression, dyspnoea or fatigue. 2. To assess if patient confidence is associated with inpatient admissions, access to community healthcare and, for IPF patients, mortality and disease severity. Study participants self-completed seven questionnaires: Hospital Anxiety and Depression Scale, EuroQol 5D (EQ5D), King's Brief Interstitial Lung Disease questionnaire, St George's Respiratory Questionnaire, MRC dyspnoea scale, Fatigue Assessment Scale and a non-validated questionnaire assessing patient confidence, symptom duration and access to community healthcare. Lung function and follow-up data were collected from hospital electronic databases. Spearman's rank correlation coefficients were calculated to assess for correlation between patient confidence, questionnaire variables and inpatient admissions. Chi-square tests were performed to assess for association between patient confidence, mortality and disease severity. 75 IPF patients and 69 sarcoidosis patients were recruited to the study. Patient confidence in IPF was significantly negatively correlated with depression and fatigue, and significantly positively correlated with EQ5D scores, but not healthcare outcomes. No associations were found between confidence and any of the variables assessed in sarcoidosis. Lower levels of confidence in IPF patients are associated with higher levels of depression and fatigue and worse HRQOL. Efforts should be made to improve patient confidence to assess the impact on HRQOL.

Lucid dreaming: an age-dependent brain dissociation.

PubMed

Voss, Ursula; Frenzel, Clemens; Koppehele-Gossel, Judith; Hobson, Allan

2012-12-01

The current study focused on the distribution of lucid dreams in school children and young adults. The survey was conducted on a large sample of students aged 6-19 years. Questions distinguished between past and current experience with lucid dreams. Results suggest that lucid dreaming is quite pronounced in young children, its incidence rate drops at about age 16 years. Increased lucidity was found in those attending higher level compared with lower level schools. Taking methodological issues into account, we feel confident to propose a link between the natural occurrence of lucid dreaming and brain maturation. © 2012 European Sleep Research Society.

The effects of a confidant and a peer group on the well-being of single elders.

PubMed

Gupta, V; Korte, C

1994-01-01

A study of 100 elderly people was carried out to compare the predictions of well-being derived from the confidant model with those derived from the Weiss model. The confidant model predicts that the most important feature of a person's social network for the well-being of that person is whether or not the person has a confidant. The Weiss model states that different persons are needed to fulfill the different needs of the person and in particular that a confidant is important to the need for intimacy and emotional security while a peer group of social friends is needed to fulfill sociability and identity needs. The two models were evaluated by comparing the relative influence of the confidant variable with the peer group variable on subject's well-being. Regression analysis was carried out on the well-being measure using as predictor variables the confidant variable, peer group variable, age, health, and financial status. The confidant and peer group variables were of equal importance to well-being, thus confirming the Weiss model.

Evaluation of PCR Systems for Field Screening of Bacillus anthracis

PubMed Central

Ozanich, Richard M.; Colburn, Heather A.; Victry, Kristin D.; Bartholomew, Rachel A.; Arce, Jennifer S.; Heredia-Langner, Alejandro; Jarman, Kristin; Kreuzer, Helen W.

2017-01-01

There is little published data on the performance of hand-portable polymerase chain reaction (PCR) systems that can be used by first responders to determine if a suspicious powder contains a potential biothreat agent. We evaluated 5 commercially available hand-portable PCR instruments for detection of Bacillus anthracis. We used a cost-effective, statistically based test plan to evaluate systems at performance levels ranging from 0.85-0.95 lower confidence bound (LCB) of the probability of detection (POD) at confidence levels of 80% to 95%. We assessed specificity using purified genomic DNA from 13 B. anthracis strains and 18 Bacillus near neighbors, potential interference with 22 suspicious powders that are commonly encountered in the field by first responders during suspected biothreat incidents, and the potential for PCR inhibition when B. anthracis spores were spiked into these powders. Our results indicate that 3 of the 5 systems achieved 0.95 LCB of the probability of detection with 95% confidence levels at test concentrations of 2,000 genome equivalents/mL (GE/mL), which is comparable to 2,000 spores/mL. This is more than sufficient sensitivity for screening visible suspicious powders. These systems exhibited no false-positive results or PCR inhibition with common suspicious powders and reliably detected B. anthracis spores spiked into these powders, though some issues with assay controls were observed. Our testing approach enables efficient performance testing using a statistically rigorous and cost-effective test plan to generate performance data that allow users to make informed decisions regarding the purchase and use of field biodetection equipment. PMID:28192050

Characteristics of stepfamilies and maternal mental health compared with non-stepfamilies in Japan.

PubMed

Sugimoto, Masako; Yokoyama, Yoshie

2017-05-18

Stepfamilies remain poorly understood in Japanese society, and the support needs of stepfamily mothers are unclear. This study aimed to identify characteristics of stepfamilies and maternal mental health as compared with non-stepfamilies in Japan to utilize as a primary resource for providing effective support through community-based health care for stepfamilies. From December 2011 to July 2012, we conducted this questionnaire survey with mothers at 3- and 4-month checkups for infants. The response rate was 75.1%. The sample for analysis included responses of 2246 mothers, excluding single mothers. Respondents comprised 47 (2.1%) stepfamilies and 2199 (97.9%) non-stepfamilies. There were significantly higher rates of parents with not more than a high school education and ≥3 children among stepfamilies compared with non-stepfamilies. Stepfamily mothers had significantly higher rates of feeling a lack of economic resources, absence of participation in childbirth education classes, smoking during pregnancy, and unplanned pregnancy. Furthermore, they also had significantly higher rates of depression and a lack of confidence in the parent role. Maternal depression was associated with factors such as maternal age, self-perceived health, stress level, confidence in breastfeeding, confidence in the parent role, and number of children. These findings suggest that stepfamilies exhibit many characteristics related to social disadvantage and problems with community-based health care in Japan. Healthcare providers should be aware of stepfamily mothers' support needs and should put in place a support system for stepfamilies. Moreover, compared with non-stepfamily mothers, stepfamily mothers have a significantly higher prevalence of depression. However, stepfamily composition does not necessarily increase the risk of maternal depression. Therefore, healthcare providers should put in place a system for obtaining more thorough information about stepfamilies and conduct an early assessment to identify their support needs.

Benefits of off-pump coronary artery bypass grafting in high-risk patients.

PubMed

Marui, Akira; Okabayashi, Hitoshi; Komiya, Tatsuhiko; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Kimura, Takeshi; Sakata, Ryuzo

2012-09-11

The benefits of off-pump coronary artery bypass graft (OPCAB) compared with conventional on-pump coronary artery bypass graft (CCAB) remain controversial. Thus, it is important to investigate which patient subgroups may benefit the most from OPCAB rather than CCAB. Among the patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto Registry (a registry of first-time percutaneous coronary intervention and coronary artery bypass graft patients in Japan), 2468 patients undergoing coronary artery bypass graft were entered into the study (mean age, 67 ± 9 years). Predicted risk of operative mortality (PROM) of each patient was calculated by logistic EuroSCORE. Patients were divided into tertile based on their PROM. Mortality rates and the incidences of cardiovascular events were compared between CCAB and OPCAB within each PROM tertile using propensity score analysis. A total of 1377 patients received CCAB whereas 1091 received OPCAB. Adjusted 30-day mortality was not significantly different between CCAB and OPCAB patients regardless of their PROM range. However, the odds ratio of 30-day stroke in CCAB compared with OPCAB in the high-risk tertile was 8.30 (95% confidence interval, 2.25-30.7; P<0.01). Regarding long-term outcomes, hazard ratio of stroke in CCAB compared with OPCAB in the high-risk tertile was 1.80 (95% confidence interval, 1.07-3.02; P=0.03). Nevertheless, hazard ratio of overall mortality in the high-risk tertile was 1.44 (95% confidence interval, 0.98-2.11; P=0.06), indicating no statistically significant difference between the 2 procedures. OPCAB as opposed to CCAB is associated with short-term and long-term benefits in stroke prevention in patients at higher risk as estimated by EuroSCORE. No survival benefit of OPCAB was shown regardless of preoperative risk level.

Effect of improving the realism of simulated clinical judgement tasks on nurses' overconfidence and underconfidence: evidence from a comparative confidence calibration analysis.

PubMed

Yang, Huiqin; Thompson, Carl; Bland, Martin

2012-12-01

Apparent overconfidence and underconfidence in clinicians making clinical judgements could be a feature of evaluative research designs that fail to accurately represent clinical environments. To test the effect of improved realism of clinical judgement tasks on confidence calibration performance of nurses and student nurses. A comparative confidence calibration analysis. The study was conducted in a large university of Northern England. Ninety-seven participants rated their confidence - using a scale that ranged from 0 (no confidence) to 100 (totally confident) on dichotomous clinical judgements of critical event risk. The judgements were in response to 25 paper-based and 25 higher fidelity scenarios using a computerised patient simulator and clinical equipment. Scenarios, and judgement criteria of 'correctness', were generated from real patient cases. Using a series of calibration measures (calibration, resolution and over/underconfidence), participants' confidence was calibrated against the proportion of correct judgements. The calibration measures generated by the paper-based and high fidelity clinical simulation conditions were compared. Participants made significantly less accurate clinical judgements of risk in the high fidelity clinical simulations compared to the paper simulations (P=0.0002). They were significantly less confident in high fidelity clinical simulations than paper simulations (P=0.03). However, there was no significant difference of over/underconfidence for participants between the two simulated settings (P=0.06). Participants were no better calibrated in the high fidelity clinical simulations than paper simulations, P=0.85. Likewise, participants had no better ability of discriminating correct judgements from incorrect judgements as measured by the resolution statistic in high fidelity clinical simulations than paper simulations, P=0.76. Improving the realism of simulated judgement tasks led to reduced confidence and judgement accuracy in participants but did not alter confidence calibration. These findings suggest that judgemental miscalibration of confidence in nurses may be a systematic cognitive bias and that simply making scenarios more realistic may not be a sufficient condition for correction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Cardiorespiratory fitness and future risk of pneumonia: a long-term prospective cohort study.

PubMed

Kunutsor, Setor K; Laukkanen, Tanjaniina; Laukkanen, Jari A

2017-09-01

We aimed to assess the prospective association of cardiorespiratory fitness (CRF) with the risk of pneumonia. Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed using a respiratory gas exchange analyzer in 2244 middle-aged men in the Kuopio Ischemic Heart Disease cohort. We corrected for within-person variability in CRF levels using data from repeat measurements taken several years apart. During a median follow-up of 25.8 years, 369 men received a hospital diagnosis of pneumonia. The age-adjusted regression dilution ratio of CRF was 0.58 (95% confidence interval: 0.53-0.63). Cardiorespiratory fitness was linearly associated with pneumonia risk. The hazard ratio (95% confidence interval) for pneumonia per 1 standard deviation increase in CRF in analysis adjusted for several risk factors for pneumonia was 0.77 (0.68-0.87). The association remained consistent on additional adjustment for total energy intake, socioeconomic status, physical activity, and C-reactive protein 0.82 (0.72-0.94). The corresponding adjusted hazard ratios (95% confidence intervals) were 0.58 (0.41-0.80) and 0.67 (0.48-0.95) respectively, when comparing the extreme quartiles of CRF levels. Our findings indicate a graded inverse and independent association between CRF and the future risk of pneumonia in a general male population. Copyright © 2017 Elsevier Inc. All rights reserved.

Elevated serum α-linolenic acid levels are associated with decreased chance of pregnancy after in vitro fertilization.

PubMed

Jungheim, Emily S; Macones, George A; Odem, Randall R; Patterson, Bruce W; Moley, Kelle H

2011-10-01

To analyze relationships between serum free fatty acid (FFA) concentrations and pregnancy. Prospective cohort. University hospital. Ninety-one women undergoing IVF. Serum was analyzed for total and specific serum FFAs, including myristic, palmitic, stearic, oleic, linoleic, and α-linolenic acids. Univariate analyses were used to identify specific FFAs and other factors associated with pregnancy after IVF. Logistic regression was performed modeling relationships between identified factors and chance of pregnancy. In unadjusted analyses, women with elevated serum α-linolenic acid (ALA) levels (highest quartile) demonstrated a decreased chance of pregnancy compared with women with the lowest levels (odds ratio 0.24, 95% confidence interval 0.052-0.792). No associations between other FFAs and pregnancy were identified. In a multivariable regression model, associations between elevated serum ALA levels and decreased chance of pregnancy remained after adjusting for patient age, body mass index, and history of endometriosis or previous live birth (adjusted odds ratio 0.139, 95% confidence interval 0.028-0.686). Elevated serum ALA levels are associated with decreased chance of pregnancy in women undergoing IVF. Further work is needed to determine whether ALA is involved in early reproductive processes and whether the relationship between ALA and pregnancy is associated with excess ALA intake, impaired ALA metabolism, or both. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Providing responsive nursing care to new mothers with high and low confidence.

PubMed

Mantha, Shannon; Davies, Barbara; Moyer, Alwyn; Crowe, Katherine

2008-01-01

To describe new mothers' experiences with family-centered maternity care in relation to their confidence level and to determine how care could have been more responsive to their needs. Using data from a prospective Canadian survey of 596 postpartum women, a subsample of women with low and high confidence (N = 74) was selected. Data were analyzed using descriptive statistics and content analysis. Women with both high and low confidence expressed negative experiences with similar frequency (n = 47/74, 64%). Women wanted more nursing support for breastfeeding and postpartum teaching and education. Women who reported a language other than English or French as their first language were significantly less confident than English- and French-speaking women (p < .05). A multilevel framework about family-centered care is presented for healthcare providers in prenatal, labor and birth, and postpartum care. It is recommended that nurses ask new mothers about their confidence level and give special consideration to cultural background in order to provide supportive care in hospital and community settings.

High-fidelity nursing simulation: impact on student self-confidence and clinical competence.

PubMed

Blum, Cynthia A; Borglund, Susan; Parcells, Dax

2010-01-01

Development of safe nursing practice in entry-level nursing students requires special consideration from nurse educators. The paucity of data supporting high-fidelity patient simulation effectiveness in this population informed the development of a quasi-experimental, quantitative study of the relationship between simulation and student self-confidence and clinical competence. Moreover, the study reports a novel approach to measuring self-confidence and competence of entry-level nursing students. Fifty-three baccalaureate students, enrolled in either a traditional or simulation-enhanced laboratory, participated during their first clinical rotation. Student self-confidence and faculty perception of student clinical competence were measured using selected scale items of the Lasater Clinical Judgment Rubric. The results indicated an overall improvement in self-confidence and competence across the semester, however, simulation did not significantly enhance these caring attributes. The study highlights the need for further examination of teaching strategies developed to promote the transfer of self-confidence and competence from the laboratory to the clinical setting.

Metamemory in schizophrenia: retrospective confidence ratings interact with neurocognitive deficits.

PubMed

Eifler, Sarah; Rausch, Franziska; Schirmbeck, Frederike; Veckenstedt, Ruth; Mier, Daniela; Esslinger, Christine; Englisch, Susanne; Meyer-Lindenberg, Andreas; Kirsch, Peter; Zink, Mathias

2015-02-28

Prior studies with schizophrenia patients described a reduced ability to discriminate between correct and false memories in terms of confidence compared to control groups. This metamemory bias has been associated with the emergence and maintenance of delusions. The relation to neuropsychological performance and other clinical dimensions is incompletely understood. In a cross-sectional study, metamemory functioning was explored in 32 schizophrenia patients and 25 healthy controls. Metamemory was assessed using a verbal recognition task combined with retrospective confidence level ratings. Associations of metamemory performance with six neuropsychological domains (executive functioning/problem solving, speed of processing, working memory, verbal and visual learning, and attention/vigilance) and psychopathological measures were analyzed. Results revealed a significantly smaller discrepancy between confidence ratings for correct and incorrect recognitions in the patient group. Furthermore, patients showed significantly lower recognition accuracy in the metamemory task and marked deficits in all neuropsychological domains. Across all participants, metamemory performance significantly correlated with executive functioning and working memory. No associations with delusions were found. This data confirms prior findings of metamemory biases in schizophrenia. Selective neuropsychological abilities seem to be modulating factors of metamemory functioning. Longitudinal studies in at risk mental state and first-episode patients are needed to reveal causal interrelations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Physical activity and mortality: is the association explained by genetic selection?

PubMed

Carlsson, Sofia; Andersson, Tomas; Lichtenstein, Paul; Michaëlsson, Karl; Ahlbom, Anders

2007-08-01

Public health recommendations promote physical activity to improve health and longevity. Recent data suggest that the association between physical activity and mortality may be due to genetic selection. Using data on twins, the authors investigated whether genetic selection explains the association between physical activity and mortality. Data were based on a postal questionnaire answered by 13,109 Swedish twin pairs in 1972. The national Cause of Death Register was used for information about all-cause mortality (n=1,800) and cardiovascular disease mortality (n=638) during 1975-2004. The risk of death was reduced by 34% for men (relative risk=0.64, 95% confidence interval: 0.50, 0.83) and by 25% for women (relative risk=0.75, 95% confidence interval: 0.50, 1.14) reporting high physical activity levels. Within-pair comparisons of monozygotic twins showed that, compared with their less active co-twin, the more active twin had a 20% (odds ratio=0.80, 95% confidence interval: 0.65, 0.99) reduced risk of all-cause mortality and a 32% (odds ratio=0.68, 95% confidence interval: 0.49, 0.95) reduced risk of cardiovascular disease mortality. Results indicate that physical activity is associated with a reduced risk of mortality not due to genetic selection. This finding supports a causal link between physical activity and mortality.

Development and Validation of Methodology to Model Flow in Ventilation Systems Commonly Found in Nuclear Facilities. Phase I

DOE Office of Scientific and Technical Information (OSTI.GOV)

Strons, Philip; Bailey, James L.; Davis, John

2016-03-01

In this work, we apply the CFD in modeling airflow and particulate transport. This modeling is then compared to field validation studies to both inform and validate the modeling assumptions. Based on the results of field tests, modeling assumptions and boundary conditions are refined and the process is repeated until the results are found to be reliable with a high level of confidence.

Effects of experimental design on calibration curve precision in routine analysis

PubMed Central

Pimentel, Maria Fernanda; Neto, Benício de Barros; Saldanha, Teresa Cristina B.

1998-01-01

A computational program which compares the effciencies of different experimental designs with those of maximum precision (D-optimized designs) is described. The program produces confidence interval plots for a calibration curve and provides information about the number of standard solutions, concentration levels and suitable concentration ranges to achieve an optimum calibration. Some examples of the application of this novel computational program are given, using both simulated and real data. PMID:18924816

Determination of confidence limits for experiments with low numbers of counts. [Poisson-distributed photon counts from astrophysical sources

NASA Technical Reports Server (NTRS)

Kraft, Ralph P.; Burrows, David N.; Nousek, John A.

1991-01-01

Two different methods, classical and Bayesian, for determining confidence intervals involving Poisson-distributed data are compared. Particular consideration is given to cases where the number of counts observed is small and is comparable to the mean number of background counts. Reasons for preferring the Bayesian over the classical method are given. Tables of confidence limits calculated by the Bayesian method are provided for quick reference.

Confident difference criterion: a new Bayesian differentially expressed gene selection algorithm with applications.

PubMed

Yu, Fang; Chen, Ming-Hui; Kuo, Lynn; Talbott, Heather; Davis, John S

2015-08-07

Recently, the Bayesian method becomes more popular for analyzing high dimensional gene expression data as it allows us to borrow information across different genes and provides powerful estimators for evaluating gene expression levels. It is crucial to develop a simple but efficient gene selection algorithm for detecting differentially expressed (DE) genes based on the Bayesian estimators. In this paper, by extending the two-criterion idea of Chen et al. (Chen M-H, Ibrahim JG, Chi Y-Y. A new class of mixture models for differential gene expression in DNA microarray data. J Stat Plan Inference. 2008;138:387-404), we propose two new gene selection algorithms for general Bayesian models and name these new methods as the confident difference criterion methods. One is based on the standardized differences between two mean expression values among genes; the other adds the differences between two variances to it. The proposed confident difference criterion methods first evaluate the posterior probability of a gene having different gene expressions between competitive samples and then declare a gene to be DE if the posterior probability is large. The theoretical connection between the proposed first method based on the means and the Bayes factor approach proposed by Yu et al. (Yu F, Chen M-H, Kuo L. Detecting differentially expressed genes using alibrated Bayes factors. Statistica Sinica. 2008;18:783-802) is established under the normal-normal-model with equal variances between two samples. The empirical performance of the proposed methods is examined and compared to those of several existing methods via several simulations. The results from these simulation studies show that the proposed confident difference criterion methods outperform the existing methods when comparing gene expressions across different conditions for both microarray studies and sequence-based high-throughput studies. A real dataset is used to further demonstrate the proposed methodology. In the real data application, the confident difference criterion methods successfully identified more clinically important DE genes than the other methods. The confident difference criterion method proposed in this paper provides a new efficient approach for both microarray studies and sequence-based high-throughput studies to identify differentially expressed genes.

Determinants of waterpipe use amongst adolescents in Northern Sweden: a survey of use pattern, risk perception, and environmental factors.

PubMed

Ramji, Rathi; Arnetz, Judy; Nilsson, Maria; Jamil, Hikmet; Norström, Fredrik; Maziak, Wasim; Wiklund, Ywonne; Arnetz, Bengt

2015-09-15

Determinants of waterpipe use in adolescents are believed to differ from those for other tobacco products, but there is a lack of studies of possible social, cultural, or psychological aspects of waterpipe use in this population. This study applied a socioecological model to explore waterpipe use, and its relationship to other tobacco use in Swedish adolescents. A total of 106 adolescents who attended an urban high-school in northern Sweden responded to an anonymous questionnaire. Prevalence rates for waterpipe use were examined in relation to socio-demographics, peer pressure, sensation seeking behavior, harm perception, environmental factors, and depression. Thirty-three percent reported ever having smoked waterpipe (ever use), with 30% having done so during the last 30 days (current use). Among waterpipe ever users, 60% had ever smoked cigarettes in comparison to 32% of non-waterpipe smokers (95% confidence interval 1.4-7.9). The odds of having ever smoked waterpipe were three times higher among male high school seniors as well as students with lower grades. Waterpipe ever users had three times higher odds of having higher levels of sensation-seeking (95% confidence interval 1.2-9.5) and scored high on the depression scales (95% confidence interval 1.6-6.8) than non-users. The odds of waterpipe ever use were four times higher for those who perceived waterpipe products to have pleasant smell compared to cigarettes (95% confidence interval 1.7-9.8). Waterpipe ever users were twice as likely to have seen waterpipe use on television compared to non-users (95% confidence interval 1.1-5.7). The odds of having friends who smoked regularly was eight times higher for waterpipe ever users than non-users (95% confidence interval 2.1-31.2). The current study reports a high use of waterpipe in a select group of students in northern Sweden. The study adds the importance of looking at socioecological determinants of use, including peer pressure and exposure to media marketing, as well as mental health among users.

Real view radiology-impact on search patterns and confidence in radiology education.

PubMed

Bailey, Jared H; Roth, Trenton D; Kohli, Mark D; Heitkamp, Darel E

2014-07-01

Search patterns are important for radiologists because they enable systematic case review. Because radiology residents are exposed to so many imaging modalities and anatomic regions, and they rotate on-and-off service so frequently, they may have difficulty establishing effective search patterns. We developed Real View Radiology (RVR), an educational system founded on guided magnetic resonance imaging (MRI) case review and evaluated its impact on search patterns and interpretative confidence of junior radiology residents. RVR guides learners through unknown examinations by sequentially prompting learners to certain aspects of a case via a comprehensive question set and then providing immediate feedback. Junior residents first completed a brief evaluation regarding their level of confidence when interpreting certain joint MRI cases and frequency of search pattern use. They spent four half-days interpreting cases using RVR. Once finished, they repeated the evaluations. The junior resident results were compared to third-year residents who had not used RVR. The data were analyzed for change in confidence, use of search patterns, and number of cases completed. Twelve first-year and thirteen second-year residents (trained cohort) were enrolled in the study. During their 4-week musculoskeletal rotations, they completed on average 29.3 MRI knee (standard deviation [SD], 1.6) and 17.4 shoulder (SD, 1.2) cases using RVR. Overall search pattern scores of the trained cohort increased significantly both from pretraining to posttraining (knee P < .01, shoulder P < .01) and compared to the untrained third-year residents (knee (P < .01, and shoulder P < .01). The trained cohort confidence scores also increased significantly from pre to post for all joints (knee P < .01, shoulder P < .01, pelvis P < .01, and ankle P < .01). Radiology residents can increase their MRI case interpretation confidence and improve the consistency of search pattern use by training with a question-based sequential reveal educational program. RVR could be used to supplement training and assist with search pattern creation in areas in which residents often do not acquire adequate clinical exposure. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Allied restorative functions training in Minnesota: a case study.

PubMed

Cooper, Brigette R; Monson, Angela L

2007-03-01

In 2003, the Minnesota Dental Practice Act was modified to allow dental hygienists and assistants to place amalgam, composite, glass ionomer, and stainless steel crowns. The concept of utilizing allied professionals to perform expanded functions has been suggested as a way to increase access to care and productivity. A continuing education course was offered to provide required certification for interested dental practitioners (N=12). The objectives of this study were to examine confidence levels and effectiveness of the continuing education program. Pre- and post-course restorative content knowledge, along with confidence levels in knowledge, technical skills, and the ability to implement skills were measured. A matched pairs t-test found a significant increase in participants' restorative content knowledge (p<.001). Wilcoxen signed rank tests revealed an increase in confidence in all content knowledge (p<.01) and technical skill (p<.05) categories. Participants did not significantly increase in confidence to implement restorative functions skills into practice (p<.7). Interview data revealed that participants remain unclear about ways to incorporate restorative functions into the schedule. Findings in this case study suggest that content knowledge and confidence levels increase following completion of a restorative functions course. To improve education and training, research is needed to identify why participants' confidence in implementation did not increase.

The role of students’ self-confidence in relation with swimming routines, frequency, and tutor in swimming class

NASA Astrophysics Data System (ADS)

Hartoto, S.; Khory, F. D.; Prakoso, B. B.

2018-01-01

It is compulsory for prospective physical education teachers to have the ability to perform swimming. The average of students’ passing in swimming class has reached 72%. Most students who failed to pass the class are those who have had aquaphobia, the condition in which one failed to perceive a situation in a positive and objective, some of which are hard to detect. This perception may come from past experience and it could diminish students’ confidence. Furthermore, the lack of confidence in students may cause unsatisfactory learning results. Therefore it is critical for the teachers to have a comprehensive knowledge of their students’ past experience in formulating a lesson. This research used descriptive qualitative approach. The aim of this article is to investigate the correlation between students’ confidence level and swimming routines, frequency, and tutors in order to succeed swimming class. This article will attempt to describe the results of a research conducted to 139 students of Department of Sport Education Universitas Negeri Surabaya as prospective physical education teachers in Indonesia who took swimming class. Past experience and confidence level are measured by a questionnaire. The results of the research show that students who have a higher level of confidence are those who follow practice routines with adequate frequency and helped by a compatible tutor.

Comparison of human observer and algorithmic target detection in nonurban forward-looking infrared imagery

NASA Astrophysics Data System (ADS)

Weber, Bruce A.

2005-07-01

We have performed an experiment that compares the performance of human observers with that of a robust algorithm for the detection of targets in difficult, nonurban forward-looking infrared imagery. Our purpose was to benchmark the comparison and document performance differences for future algorithm improvement. The scale-insensitive detection algorithm, used as a benchmark by the Night Vision Electronic Sensors Directorate for algorithm evaluation, employed a combination of contrastlike features to locate targets. Detection receiver operating characteristic curves and observer-confidence analyses were used to compare human and algorithmic responses and to gain insight into differences. The test database contained ground targets, in natural clutter, whose detectability, as judged by human observers, ranged from easy to very difficult. In general, as compared with human observers, the algorithm detected most of the same targets, but correlated confidence with correct detections poorly and produced many more false alarms at any useful level of performance. Though characterizing human performance was not the intent of this study, results suggest that previous observational experience was not a strong predictor of human performance, and that combining individual human observations by majority vote significantly reduced false-alarm rates.

Comparative efficacy of chloroquine and sulphadoxine--pyrimethamine in pregnant women and children: a meta-analysis.

PubMed

Kalanda, Gertrude C; Hill, Jenny; Verhoeff, Francine H; Brabin, Bernard J

2006-05-01

To compare the efficacy of chloroquine and sulphadoxine-pyremethamine against Plasmodium falciparum infection in pregnant women and in children from the same endemic areas of Africa, with the aim of determining the level of correspondence in efficacy determinations in these two risk groups. Meta-analysis of nine published and unpublished in vivo antimalarial efficacy studies in pregnant women and in children across five African countries. Pregnant women (all gravidae) were more likely to be sensitive than children to both chloroquine (odds ratio: 2.07; 95% confidence interval: 1.5, 2.9) and sulphadoxine-pyrimethamine (odds ratio: 2.66; 95% confidence interval: 11.1, 6.7). Pregnant women demonstrated an almost uniform increased sensitivity for peripheral parasite clearance at day 14 compared with children. This finding was consistent across a wide range of drug sensitivities. Primigravidae at day 14 showed lower clearance to antimalarial drugs than multigravidae (P<0.05). There was no significant difference between parasite clearance in primigravidae and in children. The greater drug sensitivity in pregnant women probably indicates differences in host susceptibility rather than parasite resistance. Parasite sensitivity patterns in children may be a suitable guide to antimalarial policy in pregnant women.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

PubMed

Vyas, Dinesh; Hollis, Michael; Abraham, Rohit; Rustagi, Neeti; Chandra, Siddharth; Malhotra, Ajai; Rajpurohit, Vikas; Purohit, Harshada; Pal, Ranabir

2016-06-01

The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur. These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise. Published by Elsevier Inc.

Preemptive Deceased Donor Kidney Transplantation: Considerations of Equity and Utility

PubMed Central

Chen, B. Po-Han; Coresh, Josef; Segev, Dorry L.

2013-01-01

Summary Background and objectives There exists gross disparity in national deceased donor kidney transplant availability and practice: waiting times exceed 6 years in some regions, but some patients receive kidneys before they require dialysis. This study aimed to quantify and characterize preemptive deceased donor kidney transplant recipients and compare their outcomes with patients transplanted shortly after dialysis initiation. Design, setting, participants, & measurements Using the Scientific Registry of Transplant Recipients database, first-time adult deceased donor kidney transplant recipients between 1995 and 2011 were classified as preemptive, early (on dialysis≤1 year), or late recipients. Random effects logistic regression and multivariate Cox proportional hazards regression were used to identify characteristics of preemptive deceased donor kidney transplant and evaluate survival in preemptive and early recipients, respectively. Results Preemptive recipients were 9.0% of the total recipient population. Patients with private insurance (adjusted odds ratio=3.15, 95% confidence interval=3.01–3.29, P<0.001), previous (nonkidney) transplant (adjusted odds ratio=1.94, 95% confidence interval=1.67–2.26, P<0.001), and zero-antigen mismatch (adjusted odds ratio=1.45, 95% confidence interval=1.37–1.54, P<0.001; Caucasians only) were more likely to receive preemptive deceased donor kidney transplant, even after accounting for center-level clustering. African Americans were less likely to receive preemptive deceased donor kidney transplant (adjusted odds ratio=0.44, 95% confidence interval=0.41–0.47, P<0.001). Overall, patients transplanted preemptively had similar survival compared with patients transplanted within 1 year after initiating dialysis (adjusted hazard ratio=1.06, 95% confidence interval=0.99–1.12, P=0.07). Conclusions Preemptive deceased donor kidney transplant occurs most often among Caucasians with private insurance, and survival is fairly similar to survival of recipients on dialysis for <1 year. PMID:23371953

Pre- and postoperative assessment of sinus grafting procedures using cone-beam computed tomography compared with panoramic radiographs.

PubMed

Baciut, Mihaela; Hedesiu, Mihaela; Bran, Simion; Jacobs, Reinhilde; Nackaerts, Olivia; Baciut, Grigore

2013-05-01

The present study evaluated the clinical validity of cone-beam computed tomography (CBCT) scans in comparison to panoramic radiographs regarding preoperative implant planning in combination with sinus grafting procedures. Preoperative assessment of the maxillary sinuses and implant planning using panoramic radiographs and CBCT scans was performed on 16 sinuses (13 patients) and comprised choice of treatment, timing of implant placement, sinus morphology, level of confidence, complication prediction and graft volume assessment. Six examiners were involved in the study. In the majority of cases there was a concordance between the treatment type based on either panoramic radiographs or CBCT. If any difference was found, this was due to an overestimation of bone quantity and quality on panoramic radiographs. The assessment of sinus morphology showed a significantly higher detection rate of sinus mucosal hypertrophy on CBCT. The most appealing result is a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT. A preoperative planning based on CBCT seems to improve sinus diagnostics and surgical confidence. © 2012 John Wiley & Sons A/S.

Contraction induced h reflexes in the diagnosis of cervical radiculopathy.

PubMed

Bodofsky, Elliot B; Campellone, Joseph V; Cohen, Stephen J; Caten, Holly N; Schindelheim, Adam M

2015-06-01

To determine whether Contraction Induced H Reflexes (CIHR) can accurately detect cervical radiculopathy. Comparison of CIHR results with Needle Electromyography at academic outpatient Electromyography/Nerve Conduction laboratories. Participants were all patients over 18 with a needle electromyography diagnosis of cervical radiculopathy. Patients were tested for CIHR in at least two upper extremity muscles in electromyographically proven myotomes bilaterally. Patients were requested to perform a moderate contraction while stimulus was applied proximally (elbow or Erb's point). Outcome measures included H Reflex onset latency and side-to-side latency differences. These were compared against previously established normal values. Overall, 10 of 15 patients who met criteria for cervical radiculopathy showed CIHR abnormalities (sensitivity = 67%; 95% confidence interval, 43-91). Counting each side and level separately, CIHR identified 16/27 radiculopathies (sensitivity = 59.2%; 95% confidence interval, 40.6-77.8). Contraction Induced H Reflexes identified 1 possible radiculopathy not seen on electromyography (specificity = 98%; 95% confidence interval, 95-100). Contraction induced H Reflexes have a sensitivity and specificity for cervical radiculopathy similar to the resting Gastroc-Soleus H Reflex.

Radon exposure and cancers other than lung cancer in Swedish iron miners.

PubMed Central

Darby, S C; Radford, E P; Whitley, E

1995-01-01

Data are presented on the risks of cancers other than lung cancer in a cohort of iron miners from northern Sweden occupationally exposed to elevated levels of the radioactive gas radon. Compared with rates for the four northernmost counties of Sweden, mortality was increased for all cancers other than lung cancer (ratio of observed to expected deaths 1.21, 95% confidence interval 1.03-1.41), stomach cancer (ratio of observed to expected deaths 1.45, 95% confidence interval 1.04-1.98), and rectal cancer (ratio of observed to expected deaths 1.94, 95% confidence interval 1.03-3.31). Despite these overall increases, mortality was not significantly associated with cumulative exposure to radon, either for all cancers other than lung cancer or for any site of cancer other than lung cancer individually. However, the data from this cohort on its own have limited power; and for several sites of cancer the data in this study would be consistent with a radon-related increase. Further study of cancers other than lung cancer in populations exposed to radon is required. PMID:7614946

Service-Learning Enhances Physical Therapy Students' Ability to Examine Fall Risk in Older Adults.

PubMed

Nordon-Craft, Amy; Schwarz, Brandy; Kowalewski, Victoria; Hartos, Jessica; Jurado Severance, Jennifer; Bugnariu, Nicoleta

2017-01-01

Service-learning (SL) is one educational methodology that provides students opportunities to practice and refine affective, cognitive and psychomotor skills in a community-based setting. The aims of this study were: 1) to investigate the impact of SL on physical therapy (PT) students' attitudes and perceived clinical competence when working with older adults, and 2) to evaluate the difference between perceptions of students who developed and implemented the SL activity vs those who implemented only. Eighty PT students, (from two consecutive cohorts) enrolled in a first-year geriatrics course, participated in this study. The first cohort designed and implemented the SL activities, while the second cohort only implemented these activities. Student self-perceived anxiety, confidence, knowledge and skills were assessed by pre- and post-SL surveys using a 5- point Likert-like scale. Both cohorts reported similar anxiety and confidence levels pre-SL. For both cohorts, with the exception of one item, all responses to anxiety items significantly decreased from pre- to post-SL. All students' confidence levels for assessing and mitigating fall risk in older adults increased post-SL (p<0.01). Moreover, students in cohort 1, who designed and delivered SL activities, expressed self-perceived improvement in their ability to interpret results of evaluations, to determine type and severity of balance impairments, and to serve a geriatric population (p<0.05) compared to students in cohort 2 who only implemented the activities. Embedding SL into a geriatrics course decreased self-perceived anxiety and improved student confidence regarding working with older adults. Also, empowering students to be actively involved in the design and implementation of SL increased self-perceived ability in interpreting results from assessments.

Improving sixth year medical students' performance in knee arthrocentesis using a synthetic knee model.

PubMed

Chiowchanwisawakit, Praveena; Ratanarat, Ranistha; Srinonprasert, Varalak

2015-09-01

A knee arthrocentesis (KA) workshop using synthetic knee model was arranged for all sixth-year medical students (MS) in our institute to ensure equity in receiving training. We evaluated confidence level and knowledge of KA and synovial fluid analysis testing pre- and post-workshop for MS. The workshop was divided into two parts. The first part was to provide knowledge in arthrocentesis and synovial fluid interpretation and the second was a practice session on the synthetic model under supervision. This is a report of pre-and post-workshop self-evaluation about the confidence in performing KA (0-10 scales), improvement of knowledge in KA, and synovial fluid analysis earned from attending the workshop. Pearson χ(2) test or Fisher's exact test was used to compare categorical variables, where appropriate. There were 247 MS attended and 228 (92.3%) evaluated the workshops. Ninety-six (42.1%) MS had experience in KA prior to this workshop. The mean (SD) levels of confidence in performing the procedure before and after the workshop were 3.6 (2.5) and 7.5 (1.7), respectively, P < 0.001. Improvement was shown regardless of previous exposure to KA. Knowledge of appropriate testing for synovial fluid was significantly improved in all items explored after the workshop and extended to the better scores earned from a competency examination. A hands-on structured workshop using a synthetic knee model for KA is a successful model for improving medical students' confidence in performing the procedure with evidence of sustaining knowledge in short-term follow-up. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Validation of a Projection-domain Insertion of Liver Lesions into CT Images

PubMed Central

Chen, Baiyu; Ma, Chi; Leng, Shuai; Fidler, Jeff L.; Sheedy, Shannon P.; McCollough, Cynthia H.; Fletcher, Joel G.; Yu, Lifeng

2016-01-01

Rationale and Objectives The aim of this study was to validate a projection-domain lesion-insertion method with observer studies. Materials and Methods A total of 51 proven liver lesions were segmented from computed tomography images, forward projected, and inserted into patient projection data. The images containing inserted and real lesions were then reconstructed and examined in consensus by two radiologists. First, 102 lesions (51 original, 51 inserted) were viewed in a randomized, blinded fashion and scored from 1 (absolutely inserted) to 10 (absolutely real). Statistical tests were performed to compare the scores for inserted and real lesions. Subsequently, a two-alternative-forced-choice test was conducted, with lesions viewed in pairs (real vs. inserted) in a blinded fashion. The radiologists selected the inserted lesion and provided a confidence level of 1 (no confidence) to 5 (completely certain). The number of lesion pairs that were incorrectly classified was calculated. Results The scores for inserted and proven lesions had the same median (8) and similar interquartile ranges (inserted, 5.5–8; real, 6.5–8). The means scores were not significantly different between real and inserted lesions (P value = 0.17). The receiver operating characteristic curve was nearly diagonal, with an area under the curve of 0.58 ± 0.06. For the two-alternative-forced-choice study, the inserted lesions were incorrectly identified in 49% (25 out of 51) of pairs; radiologists were incorrect in 38% (3 out of 8) of pairs even when they felt very confident in identifying the inserted lesion (confidence level ≥4). Conclusions Radiologists could not distinguish between inserted and real lesions, thereby validating the lesion-insertion technique, which may be useful for conducting virtual clinical trials to optimize image quality and radiation dose. PMID:27432267

Comparison of the effects of two low-density lipoprotein cholesterol goals for secondary prevention after acute myocardial infarction in real-world practice: ≥ 50% reduction from baseline versus <70 mg/dL.

PubMed

Cho, Kyung Hoon; Jeong, Myung Ho; Park, Kyung Woo; Kim, Hyo-Soo; Lee, Sang Rok; Chae, Jei Keon; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun

2015-01-01

The present study compared the effects of two low-density lipoprotein cholesterol (LDL-C) goals for secondary prevention after acute myocardial infarction (AMI) in real-world practice. Of 3091 consecutive patients with AMI who had baseline LDL-C levels ≥ 70 mg/dL and underwent successful percutaneous coronary intervention, 1305 eligible patients who received discharge statin prescriptions were analyzed. Patients were categorized into 2 groups according to the values of LDL-C at 1 year in two different manners using percent reduction from baseline (≥ 50% reduction, n=428 versus <50% reduction, n=877) and fixed levels (< 70 mg/dL, n=625 versus ≥ 70 mg/dL, n=680). The primary outcome was defined by the composite of 2-year major cardiac events including cardiac death, non-fatal myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting after hospital discharge. At 2 years, major cardiac events occurred in 139 patients (10.7%). Compared with <50% LDL-C reduction from baseline, patients with ≥ 50% LDL-C reduction had a 47% risk reduction in major cardiac events (adjusted hazard ratio, 0.53; 95% confidence interval, 0.36 to 0.79; P=0.002). But, compared with LDL-C levels ≥ 70 mg/dL at 1 year, patients with LDL-C levels < 70 mg/dL at 1 year had a similar risk of major cardiac events (adjusted hazard ratio, 0.96; 95% confidence interval, 0.68 to 1.34; P=0.793). Obtaining a ≥ 50% reduction in LDL-C was associated with better clinical outcomes after AMI in real-world practice, whereas achieving a < 70 mg/dL was not. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Antimicrobial knowledge and confidence amongst final year medical students in Australia

PubMed Central

Weier, Naomi; Thursky, Karin

2017-01-01

Introduction Inappropriate use of antimicrobials is one of the major modifiable contributors to antimicrobial resistance. There is currently no validated survey tool available to assess knowledge and confidence of medical students in infectious diseases (ID) compared to other diseases states, and little is known about this topic. Materials and methods A cross-sectional survey of final year medical students attending universities around Australia was conducted between August and September, 2015. A survey unique from other published studies was developed to survey satisfaction in education, confidence and knowledge in ID, and how this compared to these factors in cardiovascular diseases. Results Reliability and validity was demonstrated in the survey tool used. Students were more likely to rate university education as sufficient for cardiovascular diseases (91.3%) compared to ID (72.5%), and were more confident in their knowledge of cardiovascular diseases compared to ID (74.38% vs. 53.76%). Students tended to answer more cardiovascular disease related clinical questions correctly (mean score 78%), compared to questions on antimicrobial use (mean score 45%). Conclusions Poor knowledge and confidence amongst final year medical students in Australia were observed in ID. Antimicrobial stewardship agenda should include the provision of additional training in antimicrobial prescribing to the future medical workforce. PMID:28771549

Multi-reader ROC studies with split-plot designs: a comparison of statistical methods.

PubMed

Obuchowski, Nancy A; Gallas, Brandon D; Hillis, Stephen L

2012-12-01

Multireader imaging trials often use a factorial design, in which study patients undergo testing with all imaging modalities and readers interpret the results of all tests for all patients. A drawback of this design is the large number of interpretations required of each reader. Split-plot designs have been proposed as an alternative, in which one or a subset of readers interprets all images of a sample of patients, while other readers interpret the images of other samples of patients. In this paper, the authors compare three methods of analysis for the split-plot design. Three statistical methods are presented: the Obuchowski-Rockette method modified for the split-plot design, a newly proposed marginal-mean analysis-of-variance approach, and an extension of the three-sample U-statistic method. A simulation study using the Roe-Metz model was performed to compare the type I error rate, power, and confidence interval coverage of the three test statistics. The type I error rates for all three methods are close to the nominal level but tend to be slightly conservative. The statistical power is nearly identical for the three methods. The coverage of 95% confidence intervals falls close to the nominal coverage for small and large sample sizes. The split-plot multireader, multicase study design can be statistically efficient compared to the factorial design, reducing the number of interpretations required per reader. Three methods of analysis, shown to have nominal type I error rates, similar power, and nominal confidence interval coverage, are available for this study design. Copyright © 2012 AUR. All rights reserved.

Emotional Confidants in Ethnic Communities: Social Network Analysis of Korean American Older Adults

PubMed Central

Jang, Yuri; Kim, Kyungmin; Park, Nan Sook; Chiriboga, David A.

2017-01-01

Objective Ethnic communities often serve as the primary source of emotional support for older immigrants. This study aims to identify individuals who are more likely to be nominated as emotional confidants by age peers in the ethnic community and to examine factors contributing to the likelihood of being a more frequently endorsed confidant. Method Data were drawn from a survey with 675 older Korean Americans. Using the name-generator approach in Social Network Analysis (SNA), participants were asked to list the names of three emotional confidants among age peers in the community. Results A higher level of popularity (i.e., in-degree centrality) was predicted by male gender, advanced education, lower functional disability, fewer symptoms of depression, and higher levels of participation in social activities. Discussion: Our findings suggest the value of SNA as a means of identifying the key emotional confidants in the community and utilizing them in community-based interventions. PMID:26082133

Test of the cosmic transparency with the standard candles and the standard ruler

NASA Astrophysics Data System (ADS)

Chen, Jun

In this paper, the cosmic transparency is constrained by using the latest baryon acoustic oscillation (BAO) data and the type Ia supernova data with a model-independent method. We find that a transparent universe is consistent with observational data at the 1σ confidence level, except for the case of BAO+ Union 2.1 without the systematic errors where a transparent universe is favored only at the 2σ confidence level. To investigate the effect of the uncertainty of the Hubble constant on the test of the cosmic opacity, we assume h to be a free parameter and obtain that the observations favor a transparent universe at the 1σ confidence level.

Determining Normal-Distribution Tolerance Bounds Graphically

NASA Technical Reports Server (NTRS)

Mezzacappa, M. A.

1983-01-01

Graphical method requires calculations and table lookup. Distribution established from only three points: mean upper and lower confidence bounds and lower confidence bound of standard deviation. Method requires only few calculations with simple equations. Graphical procedure establishes best-fit line for measured data and bounds for selected confidence level and any distribution percentile.

Confidence and Competence with Mathematical Procedures

ERIC Educational Resources Information Center

Foster, Colin

2016-01-01

Confidence assessment (CA), in which students state alongside each of their answers a confidence level expressing how certain they are, has been employed successfully within higher education. However, it has not been widely explored with school pupils. This study examined how school mathematics pupils (N?=?345) in five different secondary schools…

Written Language Disorders: Speech-Language Pathologists' Training, Knowledge, and Confidence

ERIC Educational Resources Information Center

Blood, Gordon W.; Mamett, Callie; Gordon, Rebecca; Blood, Ingrid M.

2010-01-01

Purpose: This study examined speech-language pathologists' (SLPs') perceptions of their (a) educational and clinical training in evaluating and treating written language disorders, (b) knowledge bases in this area, (c) sources of knowledge about written language disorders, (d) confidence levels, and (e) predictors of confidence in working with…

Confidence Scoring of Speaking Performance: How Does Fuzziness become Exact?

ERIC Educational Resources Information Center

Jin, Tan; Mak, Barley; Zhou, Pei

2012-01-01

The fuzziness of assessing second language speaking performance raises two difficulties in scoring speaking performance: "indistinction between adjacent levels" and "overlap between scales". To address these two problems, this article proposes a new approach, "confidence scoring", to deal with such fuzziness, leading to "confidence" scores between…

The Entry-Level System

ERIC Educational Resources Information Center

Pepper, Mark

2012-01-01

Assessment of performance, when national standards are required, has to be sustained by confidence. Confidence in the learner that they are engaged in learning that will provide them with a qualification that is worthwhile, and the confidence of the end user that the assessment is rigorous, equitable institution to institution, and accurate.…

Interpretation of Confidence Interval Facing the Conflict

ERIC Educational Resources Information Center

Andrade, Luisa; Fernández, Felipe

2016-01-01

As literature has reported, it is usual that university students in statistics courses, and even statistics teachers, interpret the confidence level associated with a confidence interval as the probability that the parameter value will be between the lower and upper interval limits. To confront this misconception, class activities have been…

Improving geriatric trauma outcomes: A small step toward a big problem.

PubMed

Hammer, Peter M; Storey, Annika C; Bell, Teresa; Bayt, Demetria; Hockaday, Melissa S; Zarzaur, Ben L; Feliciano, David V; Rozycki, Grace S

2016-07-01

Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p < 0.05 was considered significant). χ or Fisher's exact test was used as appropriate for bivariate analyses of categorical variables; patients' ages were compared using the Wilcoxon rank-sum test. A total of 2,269 patients (mean, 80.63 years; mean ISS, 12.2; PRE, 1,271; POST, 933) were included in the study. On multivariable analysis, increasing age, higher ISS, and hypotension were associated with higher mortality. POST patients were more likely to have an ED LOS of 2 hours or shorter (odds ratio, 1.614; 95% confidence interval, 1.088-2.394) after controlling for hypotension, ISS, and comorbidities. POST mortality significantly decreased (odds ratio, 0.689; 95% confidence interval, 0.484-0.979). Based on age alone, the focused intervention of a higher level of trauma activation decreased ED LOS and mortality in injured geriatric patients. Therapeutic/care management study, level IV.

Comparing Uniplanar and Multiaxial Pedicle Screws in the Derotation of Apical Vertebrae for Lenke V Adolescent Idiopathic Scoliosis: A Case-Controlled Study.

PubMed

Lin, Tao; Li, Tangbo; Jiang, Heng; Ma, Jun; Zhou, Xuhui

2018-03-01

To compare effects of uniplanar and multiaxial pedicle screws on apical vertebral derotation efficiency in patients with Lenke V adolescent idiopathic scoliosis. For this retrospective study, patients with Lenke V adolescent idiopathic scoliosis with uniplanar pedicle screws (group I) and multiaxial pedicle screws (group II) were collected from January 2013 to December 2015. Grade of apical vertebral rotation was evaluated before and after surgery using the Nash-Moe and Upasani methods, respectively. The Scoliosis Research Society-22 scale was also used to evaluate patient satisfaction. There were no significant differences in terms of age, duration of follow-up, correction ratio, and preoperative level of apical rotation between groups (P < 0.05). Group I showed better apical vertebral derotation than group II (level 0, 10.5% vs. 2.3%; level I, 71.1% vs. 38.6%; level II, 18.4% vs. 59.1%; P = 0.001). The progression group showed lower bone maturity (odds ratio 52.0; 95% confidence interval, 6.3-430.7; P < 0.0001) in group I, and similar results were observed in group II (OR 12.3; 95% confidence interval, 1.3-121.3; P = 0.057). Patients in group I showed better satisfaction than patients in group II based on Scoliosis Research Society-22 scores (P < 0.05). Both types of pedicle screws could provide effective correction, but the uniplanar pedicle screw was better for derotation of vertebrae and provided patients with better satisfaction. Skeleton immaturity was positively correlated with progression of vertebral rotation after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Eligibility for statin therapy by the JUPITER trial criteria and subsequent mortality.

PubMed

Cushman, Mary; McClure, Leslie A; Lakoski, Susan G; Jenny, Nancy S

2010-01-01

Justification for the Use of Statins in Primary Prevention: An Intervention Trial Using Rosuvastatin (JUPITER) reported reduced cardiovascular and all-cause mortality with statin treatment in patients with elevated C-reactive protein (CRP) and average cholesterol levels who were not eligible for lipid-lowering treatment on the basis of existing guidelines. The aim of this study was to determine the prevalence of eligibility and mortality in a general population sample on the basis of eligibility for statin treatment using the JUPITER criteria. The study group consisted of 30,229 participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, an observational study of US African American and white participants aged > or =45 years, enrolled in their homes from 2003 to 2007 and followed biannually by telephone. Among 11,339 participants age eligible for JUPITER and without vascular diagnoses or using lipid-lowering treatment, 21% (n = 2,342) met JUPITER entry criteria. Compared with JUPITER participants, they had similar low-density lipoprotein cholesterol and CRP levels, were more often women, were more often black, had metabolic syndrome, and used aspirin for cardioprotection. Over 3.5 years of follow-up, the mortality rate in REGARDS participants eligible for JUPITER was 1.17 per 100 patient-years (95% confidence interval 0.94 to 1.42). Compared with those otherwise JUPITER eligible who had CRP levels <2 mg/L (n = 2,620), those with CRP levels > or =2 mg/L had a multivariate-adjusted relative risk of 1.5 (95% confidence interval 1.1 to 2.2) for total mortality. In conclusion, 21% not otherwise eligible would be newly eligible for lipid lowering treatment on the basis of JUPITER trial eligibility.

Comparison of Risk Factor Control in the Year After Discharge for Ischemic Stroke Versus Acute Myocardial Infarction.

PubMed

Bravata, Dawn M; Daggy, Joanne; Brosch, Jared; Sico, Jason J; Baye, Fitsum; Myers, Laura J; Roumie, Christianne L; Cheng, Eric; Coffing, Jessica; Arling, Greg

2018-02-01

The Veterans Health Administration has engaged in quality improvement to improve vascular risk factor control. We sought to examine blood pressure (<140/90 mm Hg), lipid (LDL [low-density lipoprotein] cholesterol <100 mg/dL), and glycemic control (hemoglobin A1c <9%), in the year post-hospitalization for acute ischemic stroke or acute myocardial infarction (AMI). We identified patients who were hospitalized (fiscal year 2011) with ischemic stroke, AMI, congestive heart failure, transient ischemic attack, or pneumonia/chronic obstructive pulmonary disease. The primary analysis compared risk factor control after incident ischemic stroke versus AMI. Facilities were included if they cared for ≥25 ischemic stroke and ≥25 AMI patients. A generalized linear mixed model including patient- and facility-level covariates compared risk factor control across diagnoses. Forty thousand two hundred thirty patients were hospitalized (n=75 facilities): 2127 with incident ischemic stroke and 4169 with incident AMI. Fewer stroke patients achieved blood pressure control than AMI patients (64%; 95% confidence interval, 0.62-0.67 versus 77%; 95% confidence interval, 0.75-0.78; P <0.0001). After adjusting for patient and facility covariates, the odds of blood pressure control were still higher for AMI than ischemic stroke patients (odds ratio, 1.39; 95% confidence interval, 1.21-1.51). There were no statistical differences for AMI versus stroke patients in hyperlipidemia ( P =0.534). Among patients with diabetes mellitus, the odds of glycemic control were lower for AMI than ischemic stroke patients (odds ratio, 0.72; 95% confidence interval, 0.54-0.96). Given that hypertension control is a cornerstone of stroke prevention, interventions to improve poststroke hypertension management are needed. © 2017 The Authors.

Treatment of uncertainties in the IPCC: a philosophical analysis

NASA Astrophysics Data System (ADS)

Jebeile, J.; Drouet, I.

2014-12-01

The IPCC produces scientific reports out of findings on climate and climate change. Because the findings are uncertain in many respects, the production of reports requires aggregating assessments of uncertainties of different kinds. This difficult task is currently regulated by the Guidance note for lead authors of the IPCC fifth assessment report on consistent treatment of uncertainties. The note recommends that two metrics—i.e. confidence and likelihood— be used for communicating the degree of certainty in findings. Confidence is expressed qualitatively "based on the type, amount, quality, and consistency of evidence […] and the degree of agreement", while likelihood is expressed probabilistically "based on statistical analysis of observations or model results, or expert judgment". Therefore, depending on the evidence evaluated, authors have the choice to present either an assigned level of confidence or a quantified measure of likelihood. But aggregating assessments of uncertainties of these two different kinds express distinct and conflicting methodologies. So the question arises whether the treatment of uncertainties in the IPCC is rationally justified. In order to answer the question, it is worth comparing the IPCC procedures with the formal normative theories of epistemic rationality which have been developed by philosophers. These theories—which include contributions to the philosophy of probability and to bayesian probabilistic confirmation theory—are relevant for our purpose because they are commonly used to assess the rationality of common collective jugement formation based on uncertain knowledge. In this paper we make the comparison and pursue the following objectives: i/we determine whether the IPCC confidence and likelihood can be compared with the notions of uncertainty targeted by or underlying the formal normative theories of epistemic rationality; ii/we investigate whether the formal normative theories of epistemic rationality justify treating uncertainty along those two dimensions, and indicate how this can be avoided.

Community nursing needs more silver surfers: a questionnaire survey of primary care nurses' use of information technology

PubMed Central

Chan, Tom; Brew, Sarah; de Lusignan, Simon

2004-01-01

Background In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals. Objective To examine the influence of age and nursing profession on the level of computer use. Methods A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK. Results The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001). Conclusions Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues. PMID:15469616

An assessment of DDT and other chlorinated compounds and the reproductive success of American robins (Turdus migratonrius) breeding in fruit orchards.

PubMed

Gill, Harpreet; Wilson, Laurie K; Cheng, Kimberly M; Elliott, John E

2003-01-01

Although DDT was banned in the 1970s, American robins (Turdus migratorius) breeding in fruit orchards of the Okanagan Valley, British Columbia, continue to be contaminated with DDT and its metabolites. The objectives of our study were (1) to assess organochlorine (OC) contamination in robins breeding in Okanagan orchards (1993-1995, 1997-1998) and (2) to determine if exposure affected reproductive success when compared to robins from non-orchard habitat (lower mainland, British Columbia). Robins in orchards had total DDT egg residues of 48.64 mg/kg (geometric mean; n = 92) while those in non-orchard habitat had 1.10 mg/kg (geometric mean; n = 26), wet weight. The probability of nest survival during the incubation period was 96.7% (confidence interval: 95.7-97.5%; n = 165) in orchard habitat and 96.7% (confidence interval: 94.6-98.1%; n = 28) in non-orchard habitat. During the nestling period the probability of nest survival was 98.2% (confidence interval: 97.2-98.9%; n = 123) in orchard habitat and 96.2% (confidence interval: 92.8-98.0%; n = 34) in non-orchard habitat. Clutch (p < 0.0001) and brood size (p = 0.0133) were larger in orchards (n = 150 and n = 93, respectively) compared to non-orchard nests (n = 42 and n = 23, respectively) with no difference in fledge rate. DDE (r2 = 0.11, p = 0.0030, n = 68) and dieldrin (r2 = 0.29, p < 0.0001, n = 68) were negatively correlated with fledge rate in robin eggs collected from orchard habitat, however, low r2 values signify minimal biological significance. Although American robins nesting in Okanagan orchards are exposed to high OC levels, reproductive success does not appear to be negatively impacted.

Accuracy and precision of as-received implant torque wrenches.

PubMed

Britton-Vidal, Eduardo; Baker, Philip; Mettenburg, Donald; Pannu, Darshanjit S; Looney, Stephen W; Londono, Jimmy; Rueggeberg, Frederick A

2014-10-01

Previous implant torque evaluation did not determine if the target value fell within a confidence interval for the population mean of the test groups, disallowing determination of whether a specific type of wrench met a standardized goal value. The purpose of this study was to measure both the accuracy and precision of 2 different configurations (spring style and peak break) of as-received implant torque wrenches and compare the measured values to manufacturer-stated values. Ten wrenches from 4 manufacturers, representing a variety of torque-limiting mechanisms and specificity of use (with either a specific brand or universally with any brand of implant product). Drivers were placed into the wrench, and tightening torque was applied to reach predetermined values using a NIST-calibrated digital torque wrench. Five replications of measurement were made for each wrench and averaged to provide a single value from that instrument. The target torque value for each wrench brand was compared to the 95% confidence interval for the true population mean of measured values to see if it fell within the measured range. Only 1 wrench brand (Nobel Biocare) demonstrated the target torque value falling within the 95% confidence interval for the true population mean. For others, the targeted torque value fell above the 95% confidence interval (Straumann and Imtec) or below (Salvin Torq). Neither type of torque-limiting mechanism nor designation of a wrench to be used as a dedicated brand-only product or to be used as a universal product on many brands affected the ability of a wrench to deliver torque values where the true population mean included the target torque level. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Cosmological parameter estimation from CMB and X-ray cluster after Planck

NASA Astrophysics Data System (ADS)

Hu, Jian-Wei; Cai, Rong-Gen; Guo, Zong-Kuan; Hu, Bin

2014-05-01

We investigate constraints on cosmological parameters in three 8-parameter models with the summed neutrino mass as a free parameter, by a joint analysis of CCCP X-ray cluster data, the newly released Planck CMB data as well as some external data sets including baryon acoustic oscillation measurements from the 6dFGS, SDSS DR7 and BOSS DR9 surveys, and Hubble Space Telescope H0 measurement. We find that the combined data strongly favor a non-zero neutrino masses at more than 3σ confidence level in these non-vanilla models. Allowing the CMB lensing amplitude AL to vary, we find AL > 1 at 3σ confidence level. For dark energy with a constant equation of state w, we obtain w < -1 at 3σ confidence level. The estimate of the matter power spectrum amplitude σ8 is discrepant with the Planck value at 2σ confidence level, which reflects some tension between X-ray cluster data and Planck data in these non-vanilla models. The tension can be alleviated by adding a 9% systematic shift in the cluster mass function.

A rational approach to legacy data validation when transitioning between electronic health record systems.

PubMed

Pageler, Natalie M; Grazier G'Sell, Max Jacob; Chandler, Warren; Mailes, Emily; Yang, Christine; Longhurst, Christopher A

2016-09-01

The objective of this project was to use statistical techniques to determine the completeness and accuracy of data migrated during electronic health record conversion. Data validation during migration consists of mapped record testing and validation of a sample of the data for completeness and accuracy. We statistically determined a randomized sample size for each data type based on the desired confidence level and error limits. The only error identified in the post go-live period was a failure to migrate some clinical notes, which was unrelated to the validation process. No errors in the migrated data were found during the 12- month post-implementation period. Compared to the typical industry approach, we have demonstrated that a statistical approach to sampling size for data validation can ensure consistent confidence levels while maximizing efficiency of the validation process during a major electronic health record conversion. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Estimation of Value-at-Risk for Energy Commodities via CAViaR Model

NASA Astrophysics Data System (ADS)

Xiliang, Zhao; Xi, Zhu

This paper uses the Conditional Autoregressive Value at Risk model (CAViaR) proposed by Engle and Manganelli (2004) to evaluate the value-at-risk for daily spot prices of Brent crude oil and West Texas Intermediate crude oil covering the period May 21th, 1987 to Novermber 18th, 2008. Then the accuracy of the estimates of CAViaR model, Normal-GARCH, and GED-GARCH was compared. The results show that all the methods do good job for the low confidence level (95%), and GED-GARCH is the best for spot WTI price, Normal-GARCH and Adaptive-CAViaR are the best for spot Brent price. However, for the high confidence level (99%), Normal-GARCH do a good job for spot WTI, GED-GARCH and four kind of CAViaR specifications do well for spot Brent price. Normal-GARCH does badly for spot Brent price. The result seems suggest that CAViaR do well as well as GED-GARCH since CAViaR directly model the quantile autoregression, but it does not outperform GED-GARCH although it does outperform Normal-GARCH.

Biomass Thermogravimetric Analysis: Uncertainty Determination Methodology and Sampling Maps Generation

PubMed Central

Pazó, Jose A.; Granada, Enrique; Saavedra, Ángeles; Eguía, Pablo; Collazo, Joaquín

2010-01-01

The objective of this study was to develop a methodology for the determination of the maximum sampling error and confidence intervals of thermal properties obtained from thermogravimetric analysis (TG), including moisture, volatile matter, fixed carbon and ash content. The sampling procedure of the TG analysis was of particular interest and was conducted with care. The results of the present study were compared to those of a prompt analysis, and a correlation between the mean values and maximum sampling errors of the methods were not observed. In general, low and acceptable levels of uncertainty and error were obtained, demonstrating that the properties evaluated by TG analysis were representative of the overall fuel composition. The accurate determination of the thermal properties of biomass with precise confidence intervals is of particular interest in energetic biomass applications. PMID:20717532

Test Statistics and Confidence Intervals to Establish Noninferiority between Treatments with Ordinal Categorical Data.

PubMed

Zhang, Fanghong; Miyaoka, Etsuo; Huang, Fuping; Tanaka, Yutaka

2015-01-01

The problem for establishing noninferiority is discussed between a new treatment and a standard (control) treatment with ordinal categorical data. A measure of treatment effect is used and a method of specifying noninferiority margin for the measure is provided. Two Z-type test statistics are proposed where the estimation of variance is constructed under the shifted null hypothesis using U-statistics. Furthermore, the confidence interval and the sample size formula are given based on the proposed test statistics. The proposed procedure is applied to a dataset from a clinical trial. A simulation study is conducted to compare the performance of the proposed test statistics with that of the existing ones, and the results show that the proposed test statistics are better in terms of the deviation from nominal level and the power.

Pilot perception and confidence of location during a simulated helicopter navigation task.

PubMed

Yang, Ji Hyun; Cowden, Bradley T; Kennedy, Quinn; Schramm, Harrison; Sullivan, Joseph

2013-09-01

This paper aims to provide insights into human perception, navigation performance, and confidence in helicopter overland navigation. Helicopter overland navigation is a challenging mission area because it is a complex cognitive task, and failing to recognize when the aircraft is off-course can lead to operational failures and mishaps. A human-in-the-loop experiment to investigate pilot perception during simulated overland navigation by analyzing actual navigation trajectory, pilots' perceived location, and corresponding confidence levels was designed. There were 15 military officers with prior overland navigation experience who completed 4 simulated low-level navigation routes, 2 of which entailed auto-navigation. This route was paused roughly every 30 s for the subject to mark their perceived location on the map and their confidence level using a customized program. Analysis shows that there is no correlation between perceived and actual location of the aircraft, nor between confidence level and actual location. There is, however, some evidence that there is a correlation (rho = -0.60 to approximately 0.65) between perceived location and intended route of flight, suggesting that there is a bias toward believing one is on the intended flight route. If aviation personnel can proactively identify the circumstances in which usual misperceptions occur in navigation, they may reduce mission failure and accident rate. Fleet squadrons and instructional commands can benefit from this study to improve operations that require low-level flight while also improving crew resource management.

Motor onset and diagnosis in Huntington disease using the diagnostic confidence level.

PubMed

Liu, Dawei; Long, Jeffrey D; Zhang, Ying; Raymond, Lynn A; Marder, Karen; Rosser, Anne; McCusker, Elizabeth A; Mills, James A; Paulsen, Jane S

2015-12-01

Huntington disease (HD) is a neurodegenerative disorder characterized by motor dysfunction, cognitive deterioration, and psychiatric symptoms, with progressive motor impairments being a prominent feature. The primary objectives of this study are to delineate the disease course of motor function in HD, to provide estimates of the onset of motor impairments and motor diagnosis, and to examine the effects of genetic and demographic variables on the progression of motor impairments. Data from an international multisite, longitudinal observational study of 905 prodromal HD participants with cytosine-adenine-guanine (CAG) repeats of at least 36 and with at least two visits during the followup period from 2001 to 2012 was examined for changes in the diagnostic confidence level from the Unified Huntington's Disease Rating Scale. HD progression from unimpaired to impaired motor function, as well as the progression from motor impairment to diagnosis, was associated with the linear effect of age and CAG repeat length. Specifically, for every 1-year increase in age, the risk of transition in diagnostic confidence level increased by 11% (95% CI 7-15%) and for one repeat length increase in CAG, the risk of transition in diagnostic confidence level increased by 47% (95% CI 27-69%). Findings show that CAG repeat length and age increased the likelihood of the first onset of motor impairment as well as the age at diagnosis. Results suggest that more accurate estimates of HD onset age can be obtained by incorporating the current status of diagnostic confidence level into predictive models.

Assessment of safety margins in zircaloy oxidation and embrittlement criteria for ECCS acceptance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williford, R.E.

1986-04-01

Current Emergency Core Cooling System (ECCS) Acceptance Criteria for light-water reactors include certain requirements pertaining to calculations of core performance during a Loss of Coolant Accident (LOCA). The Baker-Just correlation must be used to calculate Zircaloy-steam oxidation, calculated peak cladding temperatures (PCT) must not exceed 1204/sup 0/C, and calculated oxidation must not exceed 17% equivalent cladding reacted (17% ECR). The minimum margin of safety was estimated for each of these criteria, based on research performed in the last decade. Margins were defined as the amounts of conservatism over and above the expected extreme values computed from the data base atmore » specified confidence levels. The currently required Baker-Just oxidation correlation provides margins only over the 1100/sup 0/C to 1500/sup 0/C temperature range at the 95% confidence level. The PCT margins for thermal shock and handling failures are adequate at oxidation temperatures above 1204/sup 0/C for 210 and 160 seconds, respectively, at the 95% confidence level. ECR thermal shock and handling margins at the 50% and 95% confidence levels, respectively, range between 2% and 7% ECR for the Baker-Just correlation, but vanish at temperatures between 1100/sup 0/C and 1160/sup 0/C for the best-estimate Cathcart-Pawel correlation. Use of the Cathcart-Pawel correlation for LOCA calculations can be justified at the 85% to 88% confidence level if cooling rate effects can be neglected. 75 refs., 21 figs.« less

Presentation of frozen shoulder among diabetic and non-diabetic patients.

PubMed

Uddin, Mohammad Moin; Khan, Aminuddin A; Haig, Andrew J; Uddin, Mohammad Kafil

2014-12-01

The literature is inconsistent regarding the level of pain and disability in frozen shoulder patients with or without diabetes mellitus. The aim of this study is to evaluate some demographic features of frozen shoulder patients and to look into the disparity of information by comparing the level of pain and disability due to frozen shoulder between diabetic and non-diabetic people. This is a prospective comparative study. People with frozen shoulder attending an outpatient department were selected by consecutive sampling. Disability levels were assessed by the Shoulder Pain & Disability Index (SPADI). Means of pain and disability scores were compared using unpaired t-test. Among 140 persons with shoulder pain 99 (71.4%) had frozen shoulder. From the participating 40 frozen shoulder patients, 26 (65%) were males and 14 (35%) were females. Seventeen participants (42.5%) were diabetic, two (5%) had impaired glucose tolerance and 21 (52.5%) patients were non-diabetic. Mean disability scores (SPADI) were 51 ± 15.5 in diabetic and 57 ± 16 in non-diabetic persons. The differences in pain and disability level were not statistically significance (respectively, p = 0.24 and p = 0.13 at 95% confidence interval). No difference was found in level of pain and disability level between frozen shoulder patients with and without diabetes.

A prospective study of the effect of pregnancy on CD4 counts and plasma HIV-1 RNA concentrations of antiretroviral-naive HIV-1-infected women.

PubMed

Heffron, Renee; Donnell, Deborah; Kiarie, James; Rees, Helen; Ngure, Kenneth; Mugo, Nelly; Were, Edwin; Celum, Connie; Baeten, Jared M

2014-02-01

In HIV-1-infected women, CD4 count declines occur during pregnancy, which has been attributed to hemodilution. However, for women who have not initiated antiretroviral therapy, it is unclear if CD4 declines are sustained beyond pregnancy and accompanied by increased viral levels, which could indicate an effect of pregnancy on accelerating HIV-1 disease progression. In a prospective study among 2269 HIV-1-infected antiretroviral therapy-naive women from 7 African countries, we examined the effect of pregnancy on HIV-1 disease progression. We used linear mixed models to compare CD4 counts and plasma HIV-1 RNA concentrations between pregnant, postpartum, and nonpregnant periods. Women contributed 3270 person-years of follow-up, during which time 476 women became pregnant. In adjusted analysis, CD4 counts were an average of 56 (95% confidence interval: 39 to 73) cells/mm lower during pregnant compared with nonpregnant periods and 70 (95% confidence interval: 53 to 88) cells/mm lower during pregnant compared with postpartum periods; these results were consistent when restricted to the subgroup of women who became pregnant. Plasma HIV-1 RNA concentrations were not different between pregnant and nonpregnant periods (P = 0.9) or pregnant and postpartum periods (P = 0.3). Neither CD4 counts nor plasma HIV-1 RNA levels were significantly different in postpartum compared with nonpregnant periods. CD4 count declines among HIV-1-infected women during pregnancy are temporary and not sustained in postpartum periods. Pregnancy does not have a short-term impact on plasma HIV-1 RNA concentrations.

Probability assessment with response times and confidence in perception and knowledge.

PubMed

Petrusic, William M; Baranski, Joseph V

2009-02-01

In both a perceptual and a general knowledge comparison task, participants categorized the time they took to decide, selecting one of six categories ordered from "Slow" to Fast". Subsequently, they rated confidence on a six-category scale ranging from "50%" to "100%". Participants were able to accurately scale their response times thus enabling the treatment of the response time (RT) categories as potential confidence categories. Probability assessment analyses of RTs revealed indices of over/underconfidence, calibration, and resolution, each subject to the "hard-easy" effect, comparable to those obtained with the actual confidence ratings. However, in both the perceptual and knowledge domains, resolution (i.e., the ability to use the confidence categories to distinguish correct from incorrect decisions) was significantly better with confidence ratings than with RT categorization. Generally, comparable results were obtained with scaling of the objective RTs, although subjective categorization of RTs provided probability assessment indices superior to those obtained from objective RTs. Taken together, the findings do not support the view that confidence arises from a scaling of decision time.

Large-scale clustering of galaxies in the CfA Redshift Survey

NASA Technical Reports Server (NTRS)

Vogeley, Michael S.; Park, Changbom; Geller, Margaret J.; Huchra, John P.

1992-01-01

The power spectrum of the galaxy distribution in the Center for Astrophysics Redshift Survey (de Lapparent et al., 1986; Geller and Huchra, 1989; and Huchra et al., 1992) is measured up to wavelengths of 200/h Mpc. Results are compared with several cosmological simulations with Gaussian initial conditions. It is shown that the power spectrum of the standard CDM model is inconsistent with the observed power spectrum at the 99 percent confidence level.

Evaluations of refraction competencies of ophthalmic technicians in Mozambique.

PubMed

Shah, Kajal; Naidoo, Kovin; Chagunda, Margarida; Loughman, James

2016-01-01

Ophthalmic technicians (OT) work at health facilities in Mozambique and are trained to provide primary and secondary eye care services including basic refraction. This study was designed to assess OT competence and confidence in refraction, and investigate whether an upskilling programme is effective in developing their competence and confidence at refraction. Thirty-one trainee OTs and 16 qualified OTs were recruited to the study. A background questionnaire was administered to determine the demographic profile of the OTs. A confidence levels questionnaire explored their self-reported skills. Clinical competencies were assessed in relation to knowledge (theory exam) and clinical skills (patient exams). 11 OTs were upskilled and the clinical evaluations carried out post training. Initial evaluations demonstrated that confidence and competence levels varied depending on the OTs training (location and duration), and their location of work (clinical load, availability of equipment and other eye care personnel). The qualified OTs were more competent than trainee OTs in most of the evaluations. Post upskilling results demonstrated significant positive impact on confidence and competence levels. These evaluations identified factors affecting the refraction competencies of the OTs and demonstrated that upskilling is effective in improving confidence and competence levels for refraction. They demonstrate the need for a refraction competency framework. The overarching aim of this research was to inform the development of a nationwide programme of OT mentoring, upskilling and leading to the establishment of clinical competency standards for the new OT curricula, relevant to the professional demands. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Students' confidence in the ability to transfer basic math skills in introductory physics and chemistry courses at a community college

NASA Astrophysics Data System (ADS)

Quinn, Reginald

2013-01-01

The purpose of this study was to examine the confidence levels that community college students have in transferring basic math skills to science classes, as well as any factors that influence their confidence levels. This study was conducted with 196 students at a community college in central Mississippi. The study was conducted during the month of November after all of the students had taken their midterm exams and received midterm grades. The instrument used in this survey was developed and validated by the researcher. The instrument asks the students to rate how confident they were in working out specific math problems and how confident they were in working problems using those specific math skills in physics and chemistry. The instrument also provided an example problem for every confidence item. Results revealed that students' demographics were significant predictors in confidence scores. Students in the 18-22 year old range were less confident in solving math problems than others. Students who had retaken a math course were less confident than those who had not. Chemistry students were less confident in solving math problems than those in physics courses. Chemistry II students were less confident than those in Chemistry I and Principals of Chemistry. Students were least confident in solving problems involving logarithms and the most confident in solving algebra problems. In general, students felt that their math courses did not prepare them for the math problems encountered in science courses. There was no significant difference in confidence between students who had completed their math homework online and those who had completed their homework on paper. The researcher recommends that chemistry educators find ways of incorporating more mathematics in their courses especially logarithms and slope. Furthermore, math educators should incorporate more chemistry related applications to math class. Results of hypotheses testing, conclusions, discussions, and recommendations for future research are included.

Investigating students' perceptions of graduate learning outcomes in mathematics

NASA Astrophysics Data System (ADS)

King, Deborah; Varsavsky, Cristina; Belward, Shaun; Matthews, Kelly

2017-11-01

The purpose of this study is to explore the perceptions mathematics students have of the knowledge and skills they develop throughout their programme of study. It addresses current concerns about the employability of mathematics graduates by contributing much needed insight into how degree programmes are developing broader learning outcomes for students majoring in mathematics. Specifically, the study asked students who were close to completing a mathematics major (n = 144) to indicate the extent to which opportunities to develop mathematical knowledge along with more transferable skills (communication to experts and non-experts, writing, working in teams and thinking ethically) were included and assessed in their major. Their perceptions were compared to the importance they assign to each of these outcomes, their own assessment of improvement during the programme and their confidence in applying these outcomes. Overall, the findings reveal a pattern of high levels of students' agreement that these outcomes are important, but evidence a startling gap when compared to students' perceptions of the extent to which many of these - communication, writing, teamwork and ethical thinking - are actually included and assessed in the curriculum, and their confidence in using such learning.

Constraint on the primordial gravitational waves from the joint analysis of BICEP2 and Planck HFI 353 GHz dust polarization data

NASA Astrophysics Data System (ADS)

Cheng, Cheng; Huang, Qing-Guo; Wang, Sai

2014-12-01

We make a joint analysis of BICEP2 and recently released Planck HFI 353 GHz dust polarization data, and find that there is no evidence for the primordial gravitational waves and the bound on the tensor-to-scalar ratio becomes r < 0.083 at 95% confidence level in the base ΛCDM + tensor model. Extending to the model with running of scalar spectral index, the bound is a little bit relaxed to r < 0.116 at 95% confidence level. Our results imply that the inflation model with a single monomial potential is marginally disfavored at around 95% confidence level. Especially, the m2phi2/2 inflation model is disfavored at more than 2σ level. However, the Starobinsky inflation model gives a nice fit.

Exploring the Relationship between K-12 Public School Teachers' Conceptions of Assessment and Their Classroom Assessment Confidence Levels

ERIC Educational Resources Information Center

Ludwig, Naomi Wayne

2014-01-01

Studies have shown that teachers' beliefs influence their assessment practices. However, the overarching framework of those beliefs in relation to teachers' classroom assessment confidence has been largely unexamined. This research explored teachers' conceptions of assessment and their confidence regarding the implementation of sound classroom…

I Think I Can: Improving Teaching Self-Confidence of International Teaching Assistants.

ERIC Educational Resources Information Center

Salinas, Moises F.; Kozuh, Ghislaine; Seraphine, Anne E.

1999-01-01

Explored the effect of a teaching orientation for international teaching assistants (ITAs) on their teaching self-confidence. Surveys of ITAs before and after attending a 4-day orientation to teaching designed to improve interactive teaching skills suggested a positive effect of the orientation on their perceived level of self-confidence about…

Extreme compression for extreme conditions: pilot study to identify optimal compression of CT images using MPEG-4 video compression.

PubMed

Peterson, P Gabriel; Pak, Sung K; Nguyen, Binh; Jacobs, Genevieve; Folio, Les

2012-12-01

This study aims to evaluate the utility of compressed computed tomography (CT) studies (to expedite transmission) using Motion Pictures Experts Group, Layer 4 (MPEG-4) movie formatting in combat hospitals when guiding major treatment regimens. This retrospective analysis was approved by Walter Reed Army Medical Center institutional review board with a waiver for the informed consent requirement. Twenty-five CT chest, abdomen, and pelvis exams were converted from Digital Imaging and Communications in Medicine to MPEG-4 movie format at various compression ratios. Three board-certified radiologists reviewed various levels of compression on emergent CT findings on 25 combat casualties and compared with the interpretation of the original series. A Universal Trauma Window was selected at -200 HU level and 1,500 HU width, then compressed at three lossy levels. Sensitivities and specificities for each reviewer were calculated along with 95 % confidence intervals using the method of general estimating equations. The compression ratios compared were 171:1, 86:1, and 41:1 with combined sensitivities of 90 % (95 % confidence interval, 79-95), 94 % (87-97), and 100 % (93-100), respectively. Combined specificities were 100 % (85-100), 100 % (85-100), and 96 % (78-99), respectively. The introduction of CT in combat hospitals with increasing detectors and image data in recent military operations has increased the need for effective teleradiology; mandating compression technology. Image compression is currently used to transmit images from combat hospital to tertiary care centers with subspecialists and our study demonstrates MPEG-4 technology as a reasonable means of achieving such compression.

Comparison of Mental Toughness and Power Test Performances in High-Level Kickboxers by Competitive Success

PubMed Central

Slimani, Maamer; Miarka, Bianca; Briki, Walid; Cheour, Foued

2016-01-01

Background Kickboxing is a high-intensity intermittent striking combat sport, which is characterized by complex skills and tactical key actions with short duration. Objectives The present study compared and verified the relationship between mental toughness (MT), countermovement jump (CMJ) and medicine ball throw (MBT) power tests by outcomes of high-level kickboxers during National Championship. Materials and Methods Thirty two high-level male kickboxers (winner = 16 and loser = 16: 21.2 ± 3.1 years, 1.73 ± 0.07 m, and 70.2 ± 9.4 kg) were analyzed using the CMJ, MBT tests and sports mental toughness questionnaire (SMTQ; based in confidence, constancy and control subscales), before the fights of the 2015 national championship (16 bouts). In statistical analysis, Mann-Withney test and a multiple linear regression were used to compare groups and to observe relationships, respectively, P ≤ 0.05. Results The present results showed significant differences between losers vs. winners, respectively, of total MT (7(7;8) vs. 11(10.2;11), confidence (3(3;3) vs. 4(4;4)), constancy (2(2;2) vs. 3(3;3)), control (2(2;3) vs. 4(4;4)) subscales and MBT (4.1(4;4.3) vs. 4.6(4.4;4.8)). The multiple linear regression showed a strong associations between MT results and outcome (r = 0.89), MBT (r = 0.84) and CMJ (r = 0.73). Conclusions The findings suggest that MT will be more predictive of performance in those sports and in the outcome of competition. PMID:27625755

Navy Multiband Terminal (NMT)

DTIC Science & Technology

2015-12-01

AEHF satellites and MILSTAR satellites in the backwards-compatible mode. Mission requirements specific to Navy operations, including threat levels and...Center for Cost Analysis (NCCA) Component Cost Position (CCP) memo dated December 18, 2015 Confidence Level Confidence Level of cost estimate for... Econ Qty Sch Eng Est Oth Spt Total 6.970 0.082 0.637 0.034 0.000 -1.210 0.000 -0.418 -0.875 6.095 Current SAR Baseline to Current Estimate (TY $M) PAUC

Impact of High-Fidelity Simulation and Pharmacist-Specific Didactic Lectures in Addition to ACLS Provider Certification on Pharmacy Resident ACLS Performance.

PubMed

Bartel, Billie J

2014-08-01

This pilot study explored the use of multidisciplinary high-fidelity simulation and additional pharmacist-focused training methods in training postgraduate year 1 (PGY1) pharmacy residents to provide Advanced Cardiovascular Life Support (ACLS) care. Pharmacy resident confidence and comfort level were assessed after completing these training requirements. The ACLS training requirements for pharmacy residents were revised to include didactic instruction on ACLS pharmacology and rhythm recognition and participation in multidisciplinary high-fidelity simulation ACLS experiences in addition to ACLS provider certification. Surveys were administered to participating residents to assess the impact of this additional education on resident confidence and comfort level in cardiopulmonary arrest situations. The new ACLS didactic and simulation training requirements resulted in increased resident confidence and comfort level in all assessed functions. Residents felt more confident in all areas except providing recommendations for dosing and administration of medications and rhythm recognition after completing the simulation scenarios than with ACLS certification training and the didactic components alone. All residents felt the addition of lectures and simulation experiences better prepared them to function as a pharmacist in the ACLS team. Additional ACLS training requirements for pharmacy residents increased overall awareness of pharmacist roles and responsibilities and greatly improved resident confidence and comfort level in performing most essential pharmacist functions during ACLS situations. © The Author(s) 2013.

Occupational Exposure to Multi-Walled Carbon Nanotubes During Commercial Production Synthesis and Handling

PubMed Central

Kuijpers, Eelco; Bekker, Cindy; Fransman, Wouter; Brouwer, Derk; Tromp, Peter; Vlaanderen, Jelle; Godderis, Lode; Hoet, Peter; Lan, Qing; Silverman, Debra; Vermeulen, Roel; Pronk, Anjoeka

2016-01-01

The world-wide production of carbon nanotubes (CNTs) has increased substantially in the last decade, leading to occupational exposures. There is a paucity of exposure data of workers involved in the commercial production of CNTs. The goals of this study were to assess personal exposure to multi-walled carbon nanotubes (MWCNTs) during the synthesis and handling of MWCNTs in a commercial production facility and to link these exposure levels to specific activities. Personal full-shift filter-based samples were collected, during commercial production and handling of MWCNTs, R&D activities, and office work. The concentrations of MWCNT were evaluated on the basis of EC concentrations. Associations were studied between observed MWCNT exposure levels and location and activities. SEM analyses showed MWCNTs, present as agglomerates ranging between 200nm and 100 µm. Exposure levels of MWCNTs observed in the production area during the full scale synthesis of MWCNTs (N = 23) were comparable to levels observed during further handling of MWCNTs (N = 19): (GM (95% lower confidence limit–95% upper confidence limit)) 41 μg m−3 (20–88) versus 43 μg m−3 (22–86), respectively. In the R&D area (N = 11) and the office (N = 5), exposure levels of MWCNTs were significantly (P < 0.05) lower: 5 μg m−3 (2–11) and 7 μg m−3 (2–28), respectively. Bagging, maintenance of the reactor, and powder conditioning were associated with higher exposure levels in the production area, whereas increased exposure levels in the R&D area were related to handling of MWCNTs powder. PMID:26613611

A Comparison of Student Confidence Levels in Open Access and Undergraduate University Courses

ERIC Educational Resources Information Center

Atherton, Mirella

2017-01-01

Confidence levels of students enrolled in open access programs and undergraduate courses were measured at the University of Newcastle. The open access science students aimed to gain access to undergraduate studies in various disciplines at University. The undergraduate students were enrolled in a variety of degrees and were surveyed during their…

Automotive Stirling engine development program. [fuel economy assessment

NASA Technical Reports Server (NTRS)

Kitzner, E. W.

1978-01-01

The Ford/DOE automotive Stirling engine development program is directed towards establishing the technological and developmental base that would enable a decision on whether an engineering program should be directed at Stirling engine production. The fuel economy assessment aims to achieve, with a high degree of confidence, the ERDA proposal estimate of 20.6 MPG (gasoline) for a 4500 lb 1WC Stirling engine passenger car. The current M-H fuel economy projection for the 170 HP Stirling engine is 15.7 MPG. The confidence level for this projection is 32%. A confidence level of 29% is projected for a 22.1 MPG estimate. If all of the planned analyses and test work is accomplished at the end of the one year effort, and the projected improvements are substantiated, the confidence levels would rise to 59% for the 20.6 MPG projection and 54% for the 22.1 MPG projection. Progress achieved thus far during the fuel economy assessment is discussed.

Student certainty answering misconception question: study of Three-Tier Multiple-Choice Diagnostic Test in Acid-Base and Solubility Equilibrium

NASA Astrophysics Data System (ADS)

Ardiansah; Masykuri, M.; Rahardjo, S. B.

2018-04-01

Students’ concept comprehension in three-tier multiple-choice diagnostic test related to student confidence level. The confidence level related to certainty and student’s self-efficacy. The purpose of this research was to find out students’ certainty in misconception test. This research was quantitative-qualitative research method counting students’ confidence level. The research participants were 484 students that were studying acid-base and equilibrium solubility subject. Data was collected using three-tier multiple-choice (3TMC) with thirty questions and students’ questionnaire. The findings showed that #6 item gives the highest misconception percentage and high student confidence about the counting of ultra-dilute solution’s pH. Other findings were that 1) the student tendency chosen the misconception answer is to increase over item number, 2) student certainty decreased in terms of answering the 3TMC, and 3) student self-efficacy and achievement were related each other in the research. The findings suggest some implications and limitations for further research.

A boost of confidence: The role of the ventromedial prefrontal cortex in memory, decision-making, and schemas.

PubMed

Hebscher, Melissa; Gilboa, Asaf

2016-09-01

The ventromedial prefrontal cortex (vmPFC) has been implicated in a wide array of functions across multiple domains. In this review, we focus on the vmPFC's involvement in mediating strategic aspects of memory retrieval, memory-related schema functions, and decision-making. We suggest that vmPFC generates a confidence signal that informs decisions and memory-guided behaviour. Confidence is central to these seemingly diverse functions: (1) Strategic retrieval: lesions to the vmPFC impair an early, automatic, and intuitive monitoring process ("feeling of rightness"; FOR) often associated with confabulation (spontaneous reporting of erroneous memories). Critically, confabulators typically demonstrate high levels of confidence in their false memories, suggesting that faulty monitoring following vmPFC damage may lead to indiscriminate confidence signals. (2) Memory schemas: the vmPFC is critically involved in instantiating and maintaining contextually relevant schemas, broadly defined as higher level knowledge structures that encapsulate lower level representational elements. The correspondence between memory retrieval cues and these activated schemas leads to FOR monitoring. Stronger, more elaborate schemas produce stronger FOR and influence confidence in the veracity of memory candidates. (3) Finally, we review evidence on the vmPFC's role in decision-making, extending this role to decision-making during memory retrieval. During non-mnemonic and mnemonic decision-making the vmPFC automatically encodes confidence. Confidence signal in the vmPFC is revealed as a non-linear relationship between a first-order monitoring assessment and second-order action or choice. Attempting to integrate the multiple functions of the vmPFC, we propose a posterior-anterior organizational principle for this region. More posterior vmPFC regions are involved in earlier, automatic, subjective, and contextually sensitive functions, while more anterior regions are involved in controlled actions based on these earlier functions. Confidence signals reflect the non-linear relationship between first-order, posterior-mediated and second-order, anterior-mediated processes and are represented along the entire axis. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-Reported Recovery from 2-Week 12-Hour Shift Work Schedules: A 14-Day Follow-Up.

PubMed

Merkus, Suzanne L; Holte, Kari Anne; Huysmans, Maaike A; van de Ven, Peter M; van Mechelen, Willem; van der Beek, Allard J

2015-09-01

Recovery from fatigue is important in maintaining night workers' health. This study compared the course of self-reported recovery after 2-week 12-hour schedules consisting of either night shifts or swing shifts (i.e., 7 night shifts followed by 7 day shifts) to such schedules consisting of only day work. Sixty-one male offshore employees-20 night workers, 16 swing shift workers, and 25 day workers-rated six questions on fatigue (sleep quality, feeling rested, physical and mental fatigue, and energy levels; scale 1-11) for 14 days after an offshore tour. After the two night-work schedules, differences on the 1(st) day (main effects) and differences during the follow-up (interaction effects) were compared to day work with generalized estimating equations analysis. After adjustment for confounders, significant main effects were found for sleep quality for night workers (1.41, 95% confidence interval 1.05-1.89) and swing shift workers (1.42, 95% confidence interval 1.03-1.94) when compared to day workers; their interaction terms were not statistically significant. For the remaining fatigue outcomes, no statistically significant main or interaction effects were found. After 2-week 12-hour night and swing shifts, only the course for sleep quality differed from that of day work. Sleep quality was poorer for night and swing shift workers on the 1(st) day off and remained poorer for the 14-day follow-up. This showed that while working at night had no effect on feeling rested, tiredness, and energy levels, it had a relatively long-lasting effect on sleep quality.

Cigarette smoking, androgen levels, and hot flushes in midlife women.

PubMed

Cochran, Chrissy J; Gallicchio, Lisa; Miller, Susan R; Zacur, Howard; Flaws, Jodi A

2008-11-01

To test the hypothesis that cigarette smoking is associated with hot flushes through a mechanism involving androgen levels, progesterone levels, sex hormone-binding globulin levels, or the ratio of androgens to estrogens. Women with and without hot flushes were recruited from Baltimore, Maryland, and the surrounding counties. Women were between 45 and 54 years of age, with at least three menstrual periods in the previous 12 months, and were not postmenopausal. Study participants completed a questionnaire and gave a blood sample for hormone measurements. Current smokers had significantly higher androstenedione levels and a higher androgen-to-estrogen ratio than never smokers. Current smokers had significantly lower progesterone levels compared with never smokers. Former and current cigarette smokers had increased odds of experiencing hot flushes compared with never smokers (former: odds ratio [OR] 1.41, 95% confidence interval [CI] 0.99-2.01; current: OR 2.43, 95% CI 1.28-4.62). This association, however, was not attenuated by the addition of hormones to the smoking and hot-flush model. Cigarette smoking is associated with hot flushes through a mechanism that may not involve alterations in hormone levels or their ratios. II.

Homocysteine Level and Risk of Abdominal Aortic Aneurysm: A Meta-Analysis

PubMed Central

Cao, Hui; Hu, Xinhua; Zhang, Qiang; Li, Jun; Wang, Junpeng; Shao, Yang; Liu, Bing; Xin, Shijie

2014-01-01

Objectives Previous studies have reported inconsistent findings regarding the association between elevated plasma homocysteine (Hcy) levels and abdominal aortic aneurysm (AAA). We investigated this association between Hcy levels in patients with AAA and unaffected controls by conducting a meta-analysis and systematic review. Methods We conducted a systematic literature search (up to August 2013) of the PubMed database and Embase. We selected observational studies that evaluated Hcy levels in subjects with AAA compared to unaffected controls. Criteria for inclusion were the assessment of baseline Hcy and risk of AAA as an outcome. The results were presented as odd ratio (OR) and corresponding 95% confidence intervals (CI) comparing AAA patients to the control subjects. Results 7 studies with 6,445 participants were identified and analyzed. Overall, elevated plasma Hcy was associated with an increased risk of AAA (3.29; 95% CI 1.66–6.51). The pooled adjusted OR from a random effect model of only men participants in the AAA compared with the control group was 2.36 (95% CI 0.63–8.82). Conclusion This meta-analysis and systematic review suggested that Hcy significantly increased the risk of AAA. PMID:24465733

Study of storm surge trends in typhoon-prone coastal areas based on observations and surge-wave coupled simulations

NASA Astrophysics Data System (ADS)

Feng, Xingru; Li, Mingjie; Yin, Baoshu; Yang, Dezhou; Yang, Hongwei

2018-06-01

This is a study of the storm surge trends in some of the typhoon-prone coastal areas of China. An unstructured-grid, storm surge-wave-tide coupled model was established for the coastal areas of Zhejiang, Fujian and Guangdong provinces. The coupled model has a high resolution in coastal areas, and the simulated results compared well with the in situ observations and satellite altimeter data. The typhoon-induced storm surges along the coast of the study areas were simulated based on the established coupled model for the past 20 years (1997-2016). The simulated results were used to analyze the trends of the storm surges in the study area. The extreme storm surge trends along the central coast of Fujian Province reached up to 0.06 m/y, significant at the 90% confidence level. The duration of the storm surges greater than 1.0 and 0.7 m had an increasing trend along the coastal area of northern Fujian Province, significant at confidence levels of 70%-91%. The simulated trends of the extreme storm surges were also validated by observations from two tide gauge stations. Further studies show that the correlation coefficient (RTE) between the duration of the storm surge greater than 1 m and the annual ENSO index can reach as high as 0.62, significant at the 99% confidence level. This occurred in a location where the storm surge trend was not significant. For the areas with significant increasing storm surge trends, RTE was small and not significant. This study identified the storm surge trends for the full complex coastline of the study area. These results are useful both for coastal management by the government and for coastal engineering design.

A hybrid Q-learning sine-cosine-based strategy for addressing the combinatorial test suite minimization problem

PubMed Central

Zamli, Kamal Z.; Din, Fakhrud; Bures, Miroslav

2018-01-01

The sine-cosine algorithm (SCA) is a new population-based meta-heuristic algorithm. In addition to exploiting sine and cosine functions to perform local and global searches (hence the name sine-cosine), the SCA introduces several random and adaptive parameters to facilitate the search process. Although it shows promising results, the search process of the SCA is vulnerable to local minima/maxima due to the adoption of a fixed switch probability and the bounded magnitude of the sine and cosine functions (from -1 to 1). In this paper, we propose a new hybrid Q-learning sine-cosine- based strategy, called the Q-learning sine-cosine algorithm (QLSCA). Within the QLSCA, we eliminate the switching probability. Instead, we rely on the Q-learning algorithm (based on the penalty and reward mechanism) to dynamically identify the best operation during runtime. Additionally, we integrate two new operations (Lévy flight motion and crossover) into the QLSCA to facilitate jumping out of local minima/maxima and enhance the solution diversity. To assess its performance, we adopt the QLSCA for the combinatorial test suite minimization problem. Experimental results reveal that the QLSCA is statistically superior with regard to test suite size reduction compared to recent state-of-the-art strategies, including the original SCA, the particle swarm test generator (PSTG), adaptive particle swarm optimization (APSO) and the cuckoo search strategy (CS) at the 95% confidence level. However, concerning the comparison with discrete particle swarm optimization (DPSO), there is no significant difference in performance at the 95% confidence level. On a positive note, the QLSCA statistically outperforms the DPSO in certain configurations at the 90% confidence level. PMID:29771918

Changing patterns of breast cancer incidence and mortality by education level over four decades in Norway, 1971-2009.

PubMed

Trewin, Cassia B; Strand, Bjørn Heine; Weedon-Fekjær, Harald; Ursin, Giske

2017-02-01

In the last century, breast cancer incidence and mortality was higher among higher versus lower educated women in developed countries. Post-millennium, incidence rates have flattened off and mortality declined. We examined breast cancer trends by education level, to see whether recent improvements in incidence and mortality rates have occurred in all education groups. We linked individual registry data on female Norwegian inhabitants aged 35 years and over during 1971–2009. Using Poisson models, we calculated absolute and relative educational differences in age-standardised breast cancer incidence and mortality over four decades. We estimated educational differences by Slope and Relative Index of Inequality, which correspond to rate difference and rate ratio, comparing the highest to lowest educated women. Pre-millennium, incidence and mortality of breast cancer were significantly higher in higher versus lower educated women. Post-millennium, educational differences in breast cancer incidence and mortality attenuated. During 2000–2009, breast cancer incidence was still 38% higher for higher versus lower educated women (Relative Index of Inequality: 1.38, 95% confidence interval: 1.31–1.44), but mortality no longer varied significantly by education level (Relative Index of Inequality: 1.09, 95% confidence interval: 0.99–1.19). Among women below 50 years, however, the education gradient for mortality reversed, and mortality was 28% lower for the highest versus lowest educated women during 2000–2009 (Relative Index of Inequality: 0.72, 95% confidence interval: 0.51–0.93). Post-millennium improvements in breast cancer incidence and mortality have primarily benefited higher educated women. Breast cancer mortality is now highest among the lowest educated women below 50 years. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A hybrid Q-learning sine-cosine-based strategy for addressing the combinatorial test suite minimization problem.

PubMed

Zamli, Kamal Z; Din, Fakhrud; Ahmed, Bestoun S; Bures, Miroslav

2018-01-01

The sine-cosine algorithm (SCA) is a new population-based meta-heuristic algorithm. In addition to exploiting sine and cosine functions to perform local and global searches (hence the name sine-cosine), the SCA introduces several random and adaptive parameters to facilitate the search process. Although it shows promising results, the search process of the SCA is vulnerable to local minima/maxima due to the adoption of a fixed switch probability and the bounded magnitude of the sine and cosine functions (from -1 to 1). In this paper, we propose a new hybrid Q-learning sine-cosine- based strategy, called the Q-learning sine-cosine algorithm (QLSCA). Within the QLSCA, we eliminate the switching probability. Instead, we rely on the Q-learning algorithm (based on the penalty and reward mechanism) to dynamically identify the best operation during runtime. Additionally, we integrate two new operations (Lévy flight motion and crossover) into the QLSCA to facilitate jumping out of local minima/maxima and enhance the solution diversity. To assess its performance, we adopt the QLSCA for the combinatorial test suite minimization problem. Experimental results reveal that the QLSCA is statistically superior with regard to test suite size reduction compared to recent state-of-the-art strategies, including the original SCA, the particle swarm test generator (PSTG), adaptive particle swarm optimization (APSO) and the cuckoo search strategy (CS) at the 95% confidence level. However, concerning the comparison with discrete particle swarm optimization (DPSO), there is no significant difference in performance at the 95% confidence level. On a positive note, the QLSCA statistically outperforms the DPSO in certain configurations at the 90% confidence level.

Effect of Opuntia ficus indica on symptoms of the alcohol hangover.

PubMed

Wiese, Jeff; McPherson, Steve; Odden, Michelle C; Shlipak, Michael G

2004-06-28

The severity of the alcohol hangover may be related to inflammation induced by impurities in the alcohol beverage and byproducts of alcohol metabolism. An extract of the Opuntia ficus indica (OFI) plant diminishes the inflammatory response to stressful stimuli. In this double-blind, placebo-controlled, crossover trial, 64 healthy, young adult volunteers were randomly assigned to receive OFI (1600 IU) and identical placebo, given 5 hours before alcohol consumption. During 4 hours, subjects consumed up to 1.75 g of alcohol per kilogram of body weight. Hangover severity (9 symptoms) and overall well-being were assessed on a scale (0-6), and blood and urine samples were obtained the following morning. Two weeks later, the study protocol was repeated with OFI and placebo reversed. Fifty-five subjects completed both the OFI and placebo arms of the study. Three of the 9 symptoms-nausea, dry mouth, and anorexia-were significantly reduced by OFI (all P<.05). Overall, the symptom index was reduced by 2.7 points on average (95% confidence interval, -0.2 to 5.5; P =.07), and the risk of a severe hangover (>/=18 points) was reduced by half (odds ratio, 0.38; 95% confidence interval, 0.16-0.88; P =.02). C-reactive protein levels were strongly associated with hangover severity; the mean symptom index was 4.1 (95% confidence interval, 1.2-7.1; P =.007) higher in subjects with morning C-reactive protein levels greater than 1.0 mg/L. In addition, C-reactive protein levels were 40% higher after subjects consumed placebo compared with OFI. The symptoms of the alcohol hangover are largely due to the activation of inflammation. An extract of the OFI plant has a moderate effect on reducing hangover symptoms, apparently by inhibiting the production of inflammatory mediators.

CURRENT AND KINETIC HELICITY OF LONG-LIVED ACTIVITY COMPLEXES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Komm, Rudolf; Gosain, Sanjay, E-mail: komm@nso.edu

2015-01-01

We study long-lived activity complexes and their current helicity at the solar surface and their kinetic helicity below the surface. The current helicity has been determined from synoptic vector magnetograms from the NSO/SOLIS facility, and the kinetic helicity of subsurface flows has been determined with ring-diagram analysis applied to full-disk Dopplergrams from NSO/GONG and SDO/HMI. Current and kinetic helicity of activity complexes follow the hemispheric helicity rule with mainly positive values (78%; 78%, respectively, with a 95% confidence level of 31%) in the southern hemisphere and negative ones (80%; 93%, respectively, with a 95% confidence level of 22% and 14%,more » respectively) in the northern hemisphere. The locations with the dominant sign of kinetic helicity derived from Global Oscillation Network Group (GONG) and SDO/HMI data are more organized than those of the secondary sign even if they are not part of an activity complex, while locations with the secondary sign are more fragmented. This is the case for both hemispheres even for the northern one where it is not as obvious visually due to the large amount of magnetic activity present as compared to the southern hemisphere. The current helicity shows a similar behavior. The dominant sign of current helicity is the same as that of kinetic helicity for the majority of the activity complexes (83% with a 95% confidence level of 15%). During the 24 Carrington rotations analyzed here, there is at least one longitude in each hemisphere where activity complexes occur repeatedly throughout the epoch. These ''active'' longitudes are identifiable as locations of strong current and kinetic helicity of the same sign.« less

How trust in institutions and organizations builds general consumer confidence in the safety of food: a decomposition of effects.

PubMed

de Jonge, J; van Trijp, J C M; van der Lans, I A; Renes, R J; Frewer, L J

2008-09-01

This paper investigates the relationship between general consumer confidence in the safety of food and consumer trust in institutions and organizations. More specifically, using a decompositional regression analysis approach, the extent to which the strength of the relationship between trust and general confidence is dependent upon a particular food chain actor (for example, food manufacturers) is assessed. In addition, the impact of specific subdimensions of trust, such as openness, on consumer confidence are analyzed, as well as interaction effects of actors and subdimensions of trust. The results confirm previous findings, which indicate that a higher level of trust is associated with a higher level of confidence. However, the results from the current study extend on previous findings by disentangling the effects that determine the strength of this relationship into specific components associated with the different actors, the different trust dimensions, and specific combinations of actors and trust dimensions. The results show that trust in food manufacturers influences general confidence more than trust in other food chain actors, and that care is the most important trust dimension. However, the contribution of a particular trust dimension in enhancing general confidence is actor-specific, suggesting that different actors should focus on different trust dimensions when the purpose is to enhance consumer confidence in food safety. Implications for the development of communication strategies that are designed to regain or maintain consumer confidence in the safety of food are discussed.

Calf and replacement heifer mortality from birth until weaning in pasture-based dairy herds in New Zealand.

PubMed

Cuttance, E L; Mason, W A; McDermott, J; Laven, R A; McDougall, S; Phyn, C V C

2017-10-01

The aims of this study were to (1) estimate the perinatal (birth to 24 h) and postnatal (∼24 h to the mean weaning age of 13 wk) mortality risk in pasture-based dairy calves until weaning, and (2) identify associated risk factors in the 2015 calving season. A prospective survey of 32 seasonal calving dairy farms was undertaken. Farmers recorded (daily) the number and sex of the calves alive or dead in the paddocks where cows calved. All daily animal movements in and out of the calf rearing facilities, including death and euthanasia, and the identification of the animals (if applicable) were recorded, and a survey of the farm management practices was undertaken. Individual and farm-level risk factors for perinatal mortality were modeled separately using generalized logistic mixed models with a random effect fitted for herd. Postnatal mortality incidence risk was calculated using time at risk for each calf from 24 h of age, collapsed into weeks, and multiplying the incidence risk by the mean weaning age of the study population. Farm-level risk factors contributing to postnatal mortality in the first week of life were assessed using a multivariable logistic mixed regression model. The mean perinatal mortality risk was 5.7% (95% confidence interval 5.4 to 6.1%) with a range from 2.2 to 8.6% (18,437 calves, 30 farms). Perinatal calf mortality was greater for male relative to female calves (odds ratio 1.39; 95% confidence interval 1.22 to 1.59), calves born in the first week of the calving period in comparison to wk 2 to 11 (odds ratio 0.32 to 0.66), and those born on days with greater rainfall (odds ratio 1.01 per 1 mm increase; 95% confidence interval 1.00 to 1.02). At the farm level, perinatal mortality increased for every extra week of calving period length (odds ratio 1.12; 95% confidence interval 1.06 to 1.17). The mean postnatal mortality risk was 4.1% (95% confidence interval 3.6 to 4.6%) with a range of 0 to 11% between farms. Farm-level risk factors contributing to mortality in the first week of life included farmer-reported disease problems in calves (odds ratio 2.2; 95% confidence interval 1.62 to 2.96), or calves hand-fed colostrum in the first 12 h of life (odds ratio 1.66; 95% confidence interval 1.26 to 2.19), which was assumed to be associated with poor colostrum quality and bacterial contamination. Regional differences were also observed in both perinatal and postnatal mortality risks, indicating that weather conditions, herd size, and management variations contribute to mortality incidence. In summary, the mortality risk of perinatal calves and postnatal calves until weaning on pasture-based farms is comparable with data published from other dairying systems despite the notable management differences. Several risk factors were identified that could be managed to reduce mortality incidence of dairy calves. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Impact of Type 2 Myocardial Infarction (MI) on Hospital-Level MI Outcomes: Implications for Quality and Public Reporting.

PubMed

Arora, Sameer; Strassle, Paula D; Qamar, Arman; Wheeler, Evan N; Levine, Alexandra L; Misenheimer, Jacob A; Cavender, Matthew A; Stouffer, George A; Kaul, Prashant

2018-03-26

The International Classification of Diseases (ICD) coding system does not recognize type 2 myocardial infarction (MI) as a separate entity; therefore, patients with type 2 MI continue to be categorized under the general umbrella of non-ST-segment-elevation myocardial infarction (NSTEMI). We aim to evaluate the impact of type 2 MI on hospital-level NSTEMI metrics and discuss the implications for quality and public reporting. We conducted a single-center retrospective analysis of 1318 patients discharged with a diagnosis of NSTEMI between July 2013 and October 2014. The Third Universal Definition was used to define type 1 and type 2 MI. Weighted Kaplan-Meier curves were used to analyze risk of mortality and readmission. Overall, 1039 patients met NSTEMI criteria per the Third Universal Definition; of those, 264 (25.4%) had type 2 MI. Patients with type 2 MI were older, were more likely to have chronic kidney disease, and had lower peak troponin levels. Compared with type 1 MI patients, those with type 2 MI had higher inpatient mortality (17.4% versus 4.7%, P <0.0001) and were more likely to die from noncardiovascular causes (71.7% versus 25.0%, P <0.0001). Despite weighting for patient characteristics and discharge medications, patients with type 2 MI had higher mortality at both 30 days (risk ratio: 3.63; 95% confidence interval, 1.67-7.88) and 1 year (risk ratio: 1.98; 95% confidence interval, 1.44-2.73) after discharge. Type 2 MI was also associated with a lower 30-day cardiovascular-related readmission (risk ratio: 0.49; 95% confidence interval, 0.12-2.06). NSTEMI metrics are significantly affected by type 2 MI patients. Type 2 MI patients have distinct etiologies, are managed differently, and have higher mortality compared with patients with type 1 MI. Moving forward, it may be appropriate to exclude type 2 MI data from NSTEMI quality metrics. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Comparison of trends and abrupt changes of the South Asia high from 1979 to 2014 in reanalysis and radiosonde datasets

NASA Astrophysics Data System (ADS)

Shi, Chunhua; Huang, Ying; Guo, Dong; Zhou, Shunwu; Hu, Kaixi; Liu, Yu

2018-05-01

The South Asian High (SAH) has an important influence on atmospheric circulation and the Asian climate in summer. However, current comparative analyses of the SAH are mostly between reanalysis datasets and there is a lack of sounding data. We therefore compared the climatology, trends and abrupt changes in the SAH in the Japanese 55-year Reanalysis (JRA-55) dataset, the National Centers for Environmental Prediction Climate Forecast System Reanalysis (NCEP-CFSR) dataset, the European Center for Medium-Range Weather Forecasts Reanalysis Interim (ERA-interim) dataset and radiosonde data from China using linear analysis and a sliding t-test. The trends in geopotential height in the control area of the SAH were positive in the JRA-55, NCEP-CFSR and ERA-interim datasets, but negative in the radiosonde data in the time period 1979-2014. The negative trends for the SAH were significant at the 90% confidence level in the radiosonde data from May to September. The positive trends in the NCEP-CFSR dataset were significant at the 90% confidence level in May, July, August and September, but the positive trends in the JRA-55 and ERA-Interim were only significant at the 90% confidence level in September. The reasons for the differences in the trends of the SAH between the radiosonde data and the three reanalysis datasets in the time period 1979-2014 were updates to the sounding systems, changes in instrumentation and improvements in the radiation correction method for calculations around the year 2000. We therefore analyzed the trends in the two time periods of 1979-2000 and 2001-2014 separately. From 1979 to 2000, the negative SAH trends in the radiosonde data mainly agreed with the negative trends in the NCEP-CFSR dataset, but were in contrast with the positive trends in the JRA-55 and ERA-Interim datasets. In 2001-2014, however, the trends in the SAH were positive in all four datasets and most of the trends in the radiosonde and NCEP-CFSR datasets were significant. It is therefore better to use the NCEP-CFSR dataset than the JRA-55 and ERA-Interim datasets when discussing trends in the SAH.

Prolactin and hostility in hospitalised patients and healthy women: A systematic review and meta-analysis.

PubMed

Barry, J A; Moran, E; Thomas, M; Hardiman, P J

2015-01-01

The aim of this systematic review and meta-analysis was to assess any difference in the self-ratings of hostility in mentally healthy women with different levels of prolactin (PRL). Electronic databases (PubMed, MEDLINE, EMBASE and the Cochrane Library) were searched up to 2nd July 2012 for published literature comparing hostility levels in women with different levels of PRL. Keyword pairs ('prolactin' and 'aggression', 'prolactin' and 'hostil*', 'prolactin' and 'anger', and 'prolactin' and 'angry') were entered simultaneously. From 1065 resulting titles, and one unpublished study, 214 articles underwent full-text review by authors JB and EM. Studies were selected based on clinical relevance. Eight comparative studies consisting of 242 female patients with high PRL levels, 207 female patients with normal PRL levels and 127 healthy controls with normal PRL levels were included. Data were analysed using the inverse variance method with a random-effects model. Analysis revealed significantly higher hostility in patients with high PRL compared with that in healthy control women (Z = 1.94, p < 0.05; Hedges' g = 0.72; 95% confidence interval [CI]: -0.01-1.45), significantly higher hostility in patient controls compared with that in healthy controls (Z = 1.94, p < 0.05; Hedges' g = 0.47; 95% CI: 0.00-0.94) and non-significantly higher hostility levels in patients with high PRL compared with that in patients with normal PRL levels (Z = 1.45, p < 0.15; Hedges' g = 0.38; 95% CI: -0.13-0.89). In this meta-analysis, hostility appears to be accounted for partly by PRL levels and also partly by patient status, perhaps due to the stress of being a patient. Methodological considerations and implications for patient care are discussed.

[Knowledge, trust, and the decision to donate organs : A comparison of medical students and students of other disciplines in Germany].

PubMed

Terbonssen, T; Settmacher, U; Dirsch, O; Dahmen, U

2018-02-01

Following the organ transplant scandal in Germany in 2011, the willingness to donate organs postmortem decreased dramatically. This was explained by a loss of confidence in the German organ donation system. The aim of this study was to evaluate the relationship between knowledge, trust, and fear in respect to organ donation and the explicit willingness to potentially act as an organ donor by comparing medical students to students of other disciplines. We conducted a Facebook-based online survey (June-July 2013). The participating students were divided into two groups according to their discipline: medical students and other students. Based on questions covering different aspects of organ donation, a knowledge, trust, and fear score was established and calculated. The answers were related to an explicitly expressed decision to donate organs as expressed in a signed organ donor card. In total, 2484 participants took part in our survey. Of these, 1637 were students, 83.7% (N = 1370) of which were medical students and 16.3% (N = 267) other students. As expected, medical students reached a higher knowledge score regarding organ donation compared with other students (knowledge score 4.13 vs. 3.38; p < 0.001). They also demonstrated more confidence in organ donation, resulting in a higher confidence score (3.94 vs. 3.33; p < 0.001) and expressed less fear towards organ donation as indicated by the lower fear score (1.76 vs. 2.04; p < 0.01). Medical students declared their written willingness to donate organs more often than did other students (78.2% vs. 55.2%; p < 0.001). Entries on organ donation cards did not differ significantly between medical students and other students. Medical students possessing an organ donor card showed a higher knowledge and a higher trust score than did medical students without an organ donor card. In contrast, other students possessing an organ donor card showed a higher trust score but did not show a higher knowledge score. The higher level of knowledge and trust demonstrated by the medical students was associated with a higher rate of written decisions to donate organs. In contrast, the lower level of knowledge and trust observed in the non-medical students was associated with a lower rate of organ donor cards. Interestingly, in the group of non-medical students, the decision regarding organ donation was associated with a higher level of trust, but not with a higher level of knowledge. It would appear that knowledge, trust, and the decision to donate organs are closely related. In cases of a low level of knowledge, confidence is even more important. Therefore, organ donation campaigns should focus on increasing knowledge and fostering trust.

Comparison of phenotypic methods and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry for the identification of aero-tolerant Actinomyces spp. isolated from soft-tissue infections.

PubMed

Ng, L S Y; Sim, J H C; Eng, L C; Menon, S; Tan, T Y

2012-08-01

Aero-tolerant Actinomyces spp. are an under-recognised cause of cutaneous infections, in part because identification using conventional phenotypic methods is difficult and may be inaccurate. Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) is a promising new technique for bacterial identification, but with limited data on the identification of aero-tolerant Actinomyces spp. This study evaluated the accuracy of a phenotypic biochemical kit, MALDI-TOF MS and genotypic identification methods for the identification of this problematic group of organisms. Thirty aero-tolerant Actinomyces spp. were isolated from soft-tissue infections over a 2-year period. Species identification was performed by 16 s rRNA sequencing and genotypic results were compared with results obtained by API Coryne and MALDI-TOF MS. There was poor agreement between API Coryne and genotypic identification, with only 33% of isolates correctly identified to the species level. MALDI-TOF MS correctly identified 97% of isolates to the species level, with 33% of identifications achieved with high confidence scores. MALDI-TOF MS is a promising new tool for the identification of aero-tolerant Actinomyces spp., but improvement of the database is required in order to increase the confidence level of identification.

Long-term object tracking combined offline with online learning

NASA Astrophysics Data System (ADS)

Hu, Mengjie; Wei, Zhenzhong; Zhang, Guangjun

2016-04-01

We propose a simple yet effective method for long-term object tracking. Different from the traditional visual tracking method, which mainly depends on frame-to-frame correspondence, we combine high-level semantic information with low-level correspondences. Our framework is formulated in a confidence selection framework, which allows our system to recover from drift and partly deal with occlusion. To summarize, our algorithm can be roughly decomposed into an initialization stage and a tracking stage. In the initialization stage, an offline detector is trained to get the object appearance information at the category level, which is used for detecting the potential target and initializing the tracking stage. The tracking stage consists of three modules: the online tracking module, detection module, and decision module. A pretrained detector is used for maintaining drift of the online tracker, while the online tracker is used for filtering out false positive detections. A confidence selection mechanism is proposed to optimize the object location based on the online tracker and detection. If the target is lost, the pretrained detector is utilized to reinitialize the whole algorithm when the target is relocated. During experiments, we evaluate our method on several challenging video sequences, and it demonstrates huge improvement compared with detection and online tracking only.

Proximal pulmonary vein stenosis detection in pediatric patients: value of multiplanar and 3-D VR imaging evaluation.

PubMed

Lee, Edward Y; Jenkins, Kathy J; Muneeb, Muhammad; Marshall, Audrey C; Tracy, Donald A; Zurakowski, David; Boiselle, Phillip M

2013-08-01

One of the important benefits of using multidetector computed tomography (MDCT) is its capability to generate high-quality two-dimensional (2-D) multiplanar (MPR) and three-dimensional (3-D) images from volumetric and isotropic axial CT data. However, to the best of our knowledge, no results have been published on the potential diagnostic role of multiplanar and 3-D volume-rendered (VR) images in detecting pulmonary vein stenosis, a condition in which MDCT has recently assumed a role as the initial noninvasive imaging modality of choice. The purpose of this study was to compare diagnostic accuracy and interpretation time of axial, multiplanar and 3-D VR images for detection of proximal pulmonary vein stenosis in children, and to assess the potential added diagnostic value of multiplanar and 3-D VR images. We used our hospital information system to identify all consecutive children (< 18 years of age) with proximal pulmonary vein stenosis who had both a thoracic MDCT angiography study and a catheter-based conventional angiography within 2 months from June 2005 to February 2012. Two experienced pediatric radiologists independently reviewed each MDCT study for the presence of proximal pulmonary vein stenosis defined as ≥ 50% of luminal narrowing on axial, multiplanar and 3-D VR images. Final diagnosis was confirmed by angiographic findings. Diagnostic accuracy was compared using the z-test. Confidence level of diagnosis (scale 1-5, 5 = highest), perceived added diagnostic value (scale 1-5, 5 = highest), and interpretation time of multiplanar or 3-D VR images were compared using paired t-tests. Interobserver agreement was measured using the chance-corrected kappa coefficient. The final study population consisted of 28 children (15 boys and 13 girls; mean age: 5.2 months). Diagnostic accuracy based on 116 individual pulmonary veins for detection of proximal pulmonary vein stenosis was 72.4% (84 of 116) for axial MDCT images, 77.5% (90 of 116 cases) for multiplanar MDCT images, and 93% (108 of 116 cases) for 3-D VR images with significantly higher accuracy with 3-D VR compared to axial (z = 4.17, P < 0.001) and multiplanar (z = 3.34, P < 0.001) images. Confidence levels for detection of proximal pulmonary vein stenosis were significantly higher with 3-D VR images (mean level: 4.6) compared to axial MDCT images (mean level: 1.7) and multiplanar MDCT images (mean level: 2.0) (paired t-tests, P < 0.001). Thus, 3-D VR images (mean added diagnostic value: 4.7) were found to provide added diagnostic value for detecting proximal pulmonary vein stenosis (paired t-test, P < 0.001); however, multiplanar MDCT images did not provide added value (paired t-test, P = 0.89). Interpretation time was significantly longer and interobserver agreement was higher when using 3-D VR images than using axial MDCT images or MPR MDCT images for diagnosing proximal pulmonary vein stenosis (paired t-tests, P < 0.001). Use of 3-D VR images in the diagnosis of proximal pulmonary vein stenosis in children significantly increases accuracy, confidence level, added diagnostic value and interobserver agreement. Thus, the routine use of this technique should be encouraged despite its increased interpretation time.

Evaluation of knowledge and confidence following opioid overdose prevention training: A comparison of types of training participants and naloxone administration methods.

PubMed

Ashrafioun, Lisham; Gamble, Stephanie; Herrmann, Michele; Baciewicz, Gloria

2016-01-01

The purpose of the current study was to assess the effect of opioid overdose prevention training on participants' knowledge about opioid overdose and confidence to recognize and respond to opioid overdose situations as a function of naloxone administration (i.e., injection vs. intranasal spray) and participant type (friend/family, provider, "other"). Opioid overdose prevention trainings were offered throughout a mid-sized metropolitan area in the northeast. Participants (n = 428) were trained to administer naloxone via intramuscular injection (n = 154) or intranasal spray (n = 274). All training participants were given pre-post assessments of knowledge about opioid overdose and confidence to recognize and respond to opioid overdose situations. Participants' overall knowledge and confidence increased significantly from pre- to post-training (ps < .001). There was no significant association between knowledge and route of administration or participant type. Knowledge significantly increased from pre- to post-training in all participant types (ps < .001). Confidence improved significantly from pre- to post-training across both routes of administration (ps < .001). However, confidence was higher among those who were trained using the intranasal naloxone compared to those who were trained using the intramuscular injection naloxone at pre- (p = .011) and post-training (p < .001). Confidence increased from pre- to post-training in each of the participant types (ps < .001). Post-hoc tests revealed that confidence was higher among providers and friends/family members compared to "other" participants, such as first responders, only at post-training (p < .05). Opioid overdose trainings are effective in increasing knowledge and confidence related to opioid overdose situations. Findings suggest that trainees are more confident administering naloxone via intranasal spray compared to injection. Future research should attempt to identify other factors that may increase the likelihood of trainees' effectively intervening in opioid overdose situations.

Methylenetetrahydrofolate reductase polymorphisms, serum methylenetetrahydrofolate reductase levels, and risk of childhood acute lymphoblastic leukemia in a Chinese population.

PubMed

Tong, Na; Fang, Yongjun; Li, Jie; Wang, Meilin; Lu, Qin; Wang, Shizhi; Tian, Yuanyuan; Rong, Liucheng; Sun, Jielin; Xu, Jianfeng; Zhang, Zhengdong

2010-03-01

Methylenetetrahydrofolate reductase (MTHFR), involved in DNA methylation and nucleotide synthesis, is thought to be associated with a decreased risk of adult and childhood acute lymphoblastic leukemia (ALL). Accumulating evidence has indicated that two common genetic variants, C677T and A1298C, are associated with cancer risk. We hypothesized that these two variants were associated with childhood ALL susceptibility and influence serum MTHFR levels. We genotyped these two polymorphisms and detected MTHFR levels in a case-control study of 361 cases and 508 controls. Compared with the 677CC and 677CC/CT genotypes, the 677TT genotype was associated with a statistically significantly decreased risk of childhood ALL (odds ratio = 0.53, 95% confidence interval = 0.32-0.88, and odds ratio = 0.55, 95% confidence interval = 0.35-0.88, respectively). In addition, a pronounced reduced risk of ALL was observed among low-risk ALL and B-phenotype ALL. Moreover, the mean serum MTHFR level was 8.01 ng/mL (+/-4.38) in cases and 9.27 ng/mL (+/-4.80) in controls (P < 0.001). MTHFR levels in subjects with 677TT genotype was significantly higher than those with 677CC genotype (P = 0.010) or 677CT genotype (P = 0.043) in controls. In conclusion, our results provide evidence that the MTHFR polymorphisms might contribute to reduced childhood ALL risk in this population.

Brief Education Intervention Increases Nutrition Knowledge and Confidence of Coaches of Junior Australian Football Teams.

PubMed

Belski, Regina; Donaldson, Alex; Staley, Kiera; Skiadopoulos, Anne; Randle, Erica; O'Halloran, Paul; Kappelides, Pam; Teakel, Steve; Stanley, Sonya; Nicholson, Matthew

2018-05-03

This study evaluated the impact of a brief (20-min) nutrition education intervention embedded in an existing mandatory coach education course for coaches of junior (8-12 years old) Australian football teams. A total of 284 coaches (68% of 415 coaching course participants) completed a presession questionnaire, and 110 coaches (27% of coaching course participants) completed an identical postsession questionnaire. The responses to the pre- and postsession surveys were matched for 78 coaches. Coaches' ratings of their own understanding of the nutritional needs of young athletes (6.81, 8.95; p < .001), the importance of young athletes adhering to a healthy diet (9.09, 9.67; p = .001), their confidence in their own nutrition knowledge (7.24, 8.64; p < .001), and their confidence in advising young athletes on nutrition and hydration practices (6.85, 8.62; p < .001), all significantly improved following the education session. Nearly all coaches (>95%) provided a correct response to six of the 15 nutrition and hydration knowledge questions included in the presession questionnaire. Even with this high level of presession knowledge, there was a significant improvement in the coaches' nutrition and hydration knowledge after the education session across five of the 15 items, compared with before the education session. The results of this study suggest that a simple, short nutrition education intervention, embedded in an existing coach education course, can positively influence the nutrition knowledge and self-efficacy of community-level, volunteer coaches of junior sports participants.

Bone images from dual-energy subtraction chest radiography in the detection of rib fractures.

PubMed

Szucs-Farkas, Zsolt; Lautenschlager, Katrin; Flach, Patricia M; Ott, Daniel; Strautz, Tamara; Vock, Peter; Ruder, Thomas D

2011-08-01

To assess the sensitivity and image quality of chest radiography (CXR) with or without dual-energy subtracted (ES) bone images in the detection of rib fractures. In this retrospective study, 39 patients with 204 rib fractures and 24 subjects with no fractures were examined with a single exposure dual-energy subtraction digital radiography system. Three blinded readers first evaluated the non-subtracted posteroanterior and lateral chest radiographs alone, and 3 months later they evaluated the non-subtracted images together with the subtracted posteroanterior bone images. The locations of rib fractures were registered with confidence levels on a 3-grade scale. Image quality was rated on a 5-point scale. Marks by readers were compared with fracture localizations in CT as a standard of reference. The sensivity for fracture detection using both methods was very similar (34.3% with standard CXR and 33.5% with ES-CXR, p=0.92). At the patient level, both sensitivity (71.8%) and specificity (92.9%) with or without ES were identical. Diagnostic confidence was not significantly different (2.61 with CXR and 2.75 with ES-CXR, p=0.063). Image quality with ES was rated higher than that on standard CXR (4.08 vs. 3.74, p<0.001). Despite a better image quality, adding ES bone images to standard radiographs of the chest does not provide better sensitivity or improved diagnostic confidence in the detection of rib fractures. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Evaluation of PCR Systems for Field Screening of Bacillus anthracis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ozanich, Richard M.; Colburn, Heather A.; Victry, Kristin D.

There is little published data on the performance of hand-portable polymerase chain reaction (PCR) instruments that could be used by first responders to determine if a suspicious powder contains a potential biothreat agent. We evaluated five commercially available hand-portable PCR instruments for detection of Bacillus anthracis (Ba). We designed a cost-effective, statistically-based test plan that allows instruments to be evaluated at performance levels ranging from 0.85-0.95 lower confidence bound (LCB) on the probability of detection (POD) at confidence levels of 80-95%. We assessed specificity using purified genomic DNA from 13 Ba strains and 18 Bacillus near neighbors, interference with 22more » common hoax powders encountered in the field, and PCR inhibition when Ba spores were spiked into these powders. Our results indicated that three of the five instruments achieved >0.95 LCB on the POD with 95% confidence at test concentrations of 2,000 genome equivalents/mL (comparable to 2,000 spores/mL), displaying more than sufficient sensitivity for screening suspicious powders. These instruments exhibited no false positive results or PCR inhibition with common hoax powders, and reliably detected Ba spores spiked into common hoax powders, though some issues with instrument controls were observed. Our testing approach enables efficient instrument performance testing to a statistically rigorous and cost-effective test plan to generate performance data that will allow users to make informed decisions regarding the purchase and use of biodetection equipment in the field.« less

A novel approach for needs assessment to build global orthopedic surgical capacity in a low-income country.

PubMed

Bhashyam, Abhiram R; Fils, Jacky; Lowell, Jim; Meara, John G; Dyer, George S M

2015-01-01

Visiting surgical teams are a vital aspect of capacity-building continuing medical education (CME) in low-income countries like Haiti. Imperfect understanding of the genuine needs of local surgeons limit CME initiatives. Previous paper-based needs assessment efforts have been unsuccessful because of low response rates. We explored using an electronic audience response system (ARS) during a Haitian CME conference to improve the response rates and better assess needs. Data were prospectively collected using an ARS from 78 conference participants (57 Haitian and 21 foreign) about current and desired knowledge of 7 topic and 8 skill areas using a 5-point Likert scale presented in English and in French. The response rates using ARS vs a similar paper survey were compared using a 2-sample test of proportions. The current and desired knowledge levels were compared using paired t tests. Analysis of variance and post hoc unpaired t tests were used to compare between demographic groups. The response rates were significantly greater for ARS vs a paper survey (87.7 vs 63.2%, p = 0.002). The 4 areas of least self-confidence for Haitians were pelvic and articular injury, joint dislocation, and osteomyelitis. The 4 skills of least self-confidence for Haitians were arthroscopy, open reduction and internal fixation-plate, external fixation, and fasciotomy. Haitians desired improvements in knowledge and management of articular, diaphyseal, and pelvic injury, joint dislocation, and osteomyelitis to a greater extent than foreigners (p < 0.05). Participants who previously attended the conference on open fractures felt more knowledgeable about open fractures as a topic (p < 0.05), but not in its management. We are the first to show that an ARS improves response rates to allow for better characterization of surgeon needs in the developing world. We also demonstrate the importance of skill building paired with topic area teaching. Lastly, we show how a CME conference is an effective tool to build surgical capacity and increase confidence level. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evaluation of PET and MR datasets in integrated 18F-FDG PET/MRI: A comparison of different MR sequences for whole-body restaging of breast cancer patients.

PubMed

Grueneisen, Johannes; Sawicki, Lino Morris; Wetter, Axel; Kirchner, Julian; Kinner, Sonja; Aktas, Bahriye; Forsting, Michael; Ruhlmann, Verena; Umutlu, Lale

2017-04-01

To investigate the diagnostic value of different MR sequences and 18F-FDG PET data for whole-body restaging of breast cancer patients utilizing PET/MRI. A total of 36 patients with suspected tumor recurrence of breast cancer based on clinical follow-up or abnormal findings in follow-up examinations (e.g. CT, MRI) were prospectively enrolled in this study. All patients underwent a PET/CT and subsequently an additional PET/MR scan. Two readers were instructed to identify the occurrence of a tumor relapse in subsequent MR and PET/MR readings, utilizing different MR sequence constellations for each session. The diagnostic confidence for the determination of a malignant or benign lesion was qualitatively rated (3-point ordinal scale) for each lesion in the different reading sessions and the lesion conspicuity (4-point ordinal scale) for the three different MR sequences was additionally evaluated. Tumor recurrence was present in 25/36 (69%) patients. All three PET/MRI readings showed a significantly higher accuracy as well as higher confidence levels for the detection of recurrent breast cancer lesions when compared to MRI alone (p<0.05). Furthermore, all three PET/MR sequence constellations showed comparable diagnostic accuracy for the identification of a breast cancer recurrence (p>0.05), yet the highest confidence levels were obtained, when all three MR sequences were used for image interpretation. Moreover, contrast-enhanced T1-weighted VIBE imaging showed significantly higher values for the delineation of malignant and benign lesions when compared to T2w HASTE and diffusion-weighted imaging. Integrated PET/MRI provides superior restaging of breast cancer patients over MRI alone. Facing the need for appropriate and efficient whole-body PET/MR protocols, our results show the feasibility of fast and morphologically adequate PET/MR protocols. However, considering an equivalent accuracy for the detection of breast cancer recurrences in the three PET/MR readings, the application of contrast-agent and the inclusion of DWI in the study protocol seems to be debatable. Copyright © 2017 Elsevier B.V. All rights reserved.

Using Asymptotic Results to Obtain a Confidence Interval for the Population Median

ERIC Educational Resources Information Center

Jamshidian, M.; Khatoonabadi, M.

2007-01-01

Almost all introductory and intermediate level statistics textbooks include the topic of confidence interval for the population mean. Almost all these texts introduce the median as a robust measure of central tendency. Only a few of these books, however, cover inference on the population median and in particular confidence interval for the median.…

Confidence Sharing in the Vocational Counselling Interview: Emergence and Repercussions

ERIC Educational Resources Information Center

Olry-Louis, Isabelle; Bremond, Capucine; Pouliot, Manon

2012-01-01

Confidence sharing is an asymmetrical dialogic episode to which both parties consent, in which one reveals something personal to the other who participates in the emergence and unfolding of the confidence. We describe how this is achieved at a discursive level within vocational counselling interviews. Based on a corpus of 64 interviews, we analyse…

EA 18G Growler Aircraft (EA 18G)

DTIC Science & Technology

2015-12-01

10051.9 N/A 13186.9 8636.4 11550.1 15672.4 1 APB Breach Confidence Level Confidence Level of cost estimate for current APB: 50% The current...estimate recommendation aims to provide sufficient resources to execute the program under normal conditions, encountering average levels of technical...TY $M) Initial PAUC Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 93.573 4.150 1.442 -0.319 0.947 -0.348

Development of an Online Learning Module to Improve Pediatric Residents' Confidence and Knowledge of the Pubertal Examination.

PubMed

Ens, Andrea; Janzen, Katharine; Palmert, Mark R

2017-03-01

Pediatric residents must know how to perform pubertal examinations. The initial objective of this study was to evaluate pediatric resident knowledge and comfort related to the pubertal examination and to determine whether and why these examinations are avoided. The subsequent objective was to develop and assess a learning module (LM) addressing identified education gaps. A learning needs assessment (LNA) was administered to residents in four Canadian pediatric training programs. Identified themes and knowledge gaps were used to develop an online, case-based LM. A randomized assessment of the LM was conducted among residents from nine training programs across Canada. Sixty-four residents completed the LNA. About 52% reported discomfort introducing the pubertal examination, 50% reported a lack of confidence related to the examination, and 56% reported having avoided a warranted examination. Ninety-seven residents participated in the LM assessment. The baseline results were similar to those from the LNA in terms of discomfort, lack of confidence, and avoidance related to pubertal examinations. However, the intervention group showed improvement on a knowledge assessment compared with control group (p < .001). Confidence levels also improved in the intervention group LM (p < .01). Most residents (95%) stated they found the LM to be useful. Residents report being uncomfortable with and avoiding the pubertal examination and have significant knowledge gaps. The online, case-based LM used in this study improved the knowledge and confidence related to this aspect of pediatric care and may be an effective adjunct to pediatric training. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

C-5 Reliability Enhancement and Re-engining Program (C-5 RERP)

DTIC Science & Technology

2015-12-01

Production Estimate Current APB Production Objective/Threshold Demonstrated Performance Current Estimate Time To Climb/Initial Level Off 837,000 lbs...RCR - Runway Condition Reading SDD - System Design and Development SL - Sea Level C-5 RERP December 2015 SAR March 23, 2016 16:10:28 UNCLASSIFIED 12...5.3 5.3 Acq O&M 0.0 0.0 -- 0.0 0.0 0.0 0.0 Total 7146.6 7135.7 N/A 6698.0 7694.1 7510.7 7066.6 Confidence Level Confidence Level of cost estimate

Vitamin E supplementation in people with cystic fibrosis.

PubMed

Okebukola, Peter O; Kansra, Sonal; Barrett, Joanne

2017-03-06

People with cystic fibrosis are at an increased risk of fat-soluble vitamin deficiency including vitamin E. Vitamin E deficiency can cause a host of conditions such as haemolytic anaemia, cerebellar ataxia and cognitive difficulties. Vitamin E supplementation is widely recommended in cystic fibrosis and aims to ameliorate this deficiency. This is an updated version of the review. To determine the effects of any level of vitamin E supplementation on the frequency of vitamin E deficiency disorders in people with cystic fibrosis. We searched the Cochrane Group's Cystic Fibrosis Trials Register and also searched international trial registers for any ongoing clinical trials that were not identified during our register search.Date of last search of the Register: 10 October 2016. Date of last search of international trial registers: 15 February 2017. Randomised controlled trials and quasi-randomised controlled trials comparing any preparation of vitamin E supplementation to placebo or no supplement, regardless of dosage or duration. Two authors extracted outcome data from each study (published information) and assessed the risk of bias of each included study. Four studies with a total of 141 participants were included in the review, two of these were in children (aged six months to 14.5 years), and the other two did not specify participants' age. All studies used different formulations and doses of vitamin E for various durations of treatment (10 days to six months). Two studies compared the supplementation of fat-soluble as well as water-soluble formulations to no supplementation in different arms of the same study. A third study compared a water-soluble formulation to a placebo; and in the fourth study a fat-soluble formulation of vitamin E was assessed against placebo.At one month, three months and six months, water-soluble vitamin E significantly improved serum vitamin E levels compared with control: at one month, two studies, mean difference 17.66 (95% confidence interval 10.59 to 24.74); at three months, one study, mean difference 11.61 (95% confidence interval 4.77 to 18.45); and at six months, one study, mean difference 19.74 (95% confidence interval 13.48 to 26.00). At one month fat-soluble vitamin E significantly improved serum vitamin E levels compared with control: one month, two studies, mean difference 13.59 (95% CI 9.52 to 17.66). The findings at three months were imprecise; one study; mean difference 6.40 (95% confidence interval -1.45 to 14.25).None of the studies report the review's primary outcomes of vitamin E total lipid ratio or the incidence of vitamin E-specific deficiency disorders, or the secondary outcomes lung function or quality of life. Only one study, comparing water-soluble vitamin E with placebo, reported the secondary outcome of growth and nutritional status (weight), but the results are uncertain due to imprecision around the effect estimate.There was limited detail about randomisation and blinding in the included studies which compromises the quality of the evidence base for the review. The heterogeneous mix of the formulations with differing biovailabilities among these studies also limits the generalisability of the data to the wider cystic fibrosis population. Vitamin E supplementation led to an improvement in vitamin E levels in people with cystic fibrosis, although the studies may have been at risk of bias. No data on other outcomes of interest were available to allow conclusions about any other benefits of this therapy.In future, larger studies are needed, especially in people already being treated with enteric-coated pancreatic enzymes and supplemented with vitamin E, to look at more specific outcome measures such as vitamin E status, lung function and nutritional status. Future studies could also look at the optimal dose of vitamin E required to achieve maximal clinical effectiveness.

The development and validation of measures to assess cooking skills and food skills.

PubMed

Lavelle, Fiona; McGowan, Laura; Hollywood, Lynsey; Surgenor, Dawn; McCloat, Amanda; Mooney, Elaine; Caraher, Martin; Raats, Monique; Dean, Moira

2017-09-02

With the increase use of convenience food and eating outside the home environment being linked to the obesity epidemic, the need to assess and monitor individuals cooking and food skills is key to help intervene where necessary to promote the usage of these skills. Therefore, this research aimed to develop and validate a measure for cooking skills and one for food skills, that are clearly described, relatable, user-friendly, suitable for different types of studies, and applicable across all sociodemographic levels. Two measures were developed in light of the literature and expert opinion and piloted for clarity and ease of use. Following this, four studies were undertaken across different cohorts (including a sample of students, both 'Food preparation novices' and 'Experienced food preparers', and a nationally representative sample) to assess temporal stability, psychometrics, internal consistency reliability and construct validity of both measures. Analysis included T-tests, Pearson's correlations, factor analysis, and Cronbach's alphas, with a significance level of 0.05. Both measures were found to have a significant level of temporal stability (P < 0.001). Factor analysis revealed three factors with eigenvalues over 1, with two items in a third factor outside the two suggested measures. The internal consistency reliability for the cooking skills confidence measure ranged from 0.78 to 0.93 across all cohorts. The food skills confidence measure's Cronbach's alpha's ranged from 0.85 to 0.94. The two measures also showed a high discriminate validity as there were significant differences (P < 0.05 for cooking skills confidence and P < 0.01 for food skills confidence) between Food preparation novices' and 'Experienced food preparers.' The cooking skills confidence measure and the food skills confidence measure have been shown to have a very satisfactory reliability, validity and are consistent over time. Their user-friendly applicability make both measures highly suitable for large scale cross-sectional, longitudinal and intervention studies to assess or monitor cooking and food skills levels and confidence.

The antecedents and belief-polarized effects of thought confidence.

PubMed

Chou, Hsuan-Yi; Lien, Nai-Hwa; Liang, Kuan-Yu

2011-01-01

This article investigates 2 possible antecedents of thought confidence and explores the effects of confidence induced before or during ad exposure. The results of the experiments indicate that both consumers' dispositional optimism and spokesperson attractiveness have significant effects on consumers' confidence in thoughts that are generated after viewing the advertisement. Higher levels of thought confidence will influence the quality of the thoughts that people generate, lead to either positively or negatively polarized message processing, and therefore induce better or worse advertising effectiveness, depending on the valence of thoughts. The authors posit the belief-polarization hypothesis to explain these findings.

Teaching motivational interviewing to first-year medical students to improve counseling skills in health behavior change.

PubMed

Poirier, Maria K; Clark, Matthew M; Cerhan, Jane H; Pruthi, Sandhya; Geda, Yonas E; Dale, Lowell C

2004-03-01

To examine the effectiveness of motivational interviewing training on improving medical students' knowledge of and confidence in their ability to counsel patients regarding health behavior change. In the spring of 2002, 42 first-year medical students participated in a counseling course on health behavior change. Three small groups focused on learning and practicing motivational interviewing techniques using brief lectures, interactive class activities, student role-plays, and simulated patients. Students completed an identical precourse and postcourse questionnaire that measured their confidence and knowledge regarding counseling skills in health behavior change. The medical students reported improved confidence in their understanding of motivational interviewing after participation in the course (very confident, 77%) compared with before the course (very confident, 2%). Each of the 8 confidence items were compared before and after the course using a signed rank test. All comparisons indicated a significant improvement (P < .001) in confidence. Regarding knowledge-based questions, students showed significant improvement; 31% of students answered all the questions correctly before the course, and 56% answered all the questions correctly after the course (P = .004). These results show that teaching motivational interviewing techniques to first-year medical students can enhance student confidence in and knowledge of providing counseling to patients regarding health behavior change.

Constraint on the primordial gravitational waves from the joint analysis of BICEP2 and Planck HFI 353 GHz dust polarization data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, Cheng; Huang, Qing-Guo; Wang, Sai, E-mail: chcheng@itp.ac.cn, E-mail: huangqg@itp.ac.cn, E-mail: wangsai@itp.ac.cn

2014-12-01

We make a joint analysis of BICEP2 and recently released Planck HFI 353 GHz dust polarization data, and find that there is no evidence for the primordial gravitational waves and the bound on the tensor-to-scalar ratio becomes r < 0.083 at 95% confidence level in the base ΛCDM + tensor model. Extending to the model with running of scalar spectral index, the bound is a little bit relaxed to r < 0.116 at 95% confidence level. Our results imply that the inflation model with a single monomial potential is marginally disfavored at around 95% confidence level. Especially, the m{sup 2}φ{supmore » 2}/2 inflation model is disfavored at more than 2σ level. However, the Starobinsky inflation model gives a nice fit.« less

The ICT Level of Confidence of Course Specialists in Distance Education: The Polytechnic University of the Philippines Experience

ERIC Educational Resources Information Center

Sumande, Caroline T.; Castolo, Carmencita L.; Comendador, Benilda Eleanor V.

2016-01-01

The study addressed two questions: what is the ICT level of confidence of the course specialists handling Open University classes, and to what extent do course specialists integrated ICT applications such as word processing, electronic spread sheet, presentation software, YouTube and etc. in their OUS classes? The instruments were administered to…

Intraclass Correlation Coefficients in Hierarchical Design Studies with Discrete Response Variables: A Note on a Direct Interval Estimation Procedure

ERIC Educational Resources Information Center

Raykov, Tenko; Marcoulides, George A.

2015-01-01

A latent variable modeling procedure that can be used to evaluate intraclass correlation coefficients in two-level settings with discrete response variables is discussed. The approach is readily applied when the purpose is to furnish confidence intervals at prespecified confidence levels for these coefficients in setups with binary or ordinal…

Ethnic Differences in Incidence and Outcomes of Childhood Nephrotic Syndrome.

PubMed

Banh, Tonny H M; Hussain-Shamsy, Neesha; Patel, Viral; Vasilevska-Ristovska, Jovanka; Borges, Karlota; Sibbald, Cathryn; Lipszyc, Deborah; Brooke, Josefina; Geary, Denis; Langlois, Valerie; Reddon, Michele; Pearl, Rachel; Levin, Leo; Piekut, Monica; Licht, Christoph P B; Radhakrishnan, Seetha; Aitken-Menezes, Kimberly; Harvey, Elizabeth; Hebert, Diane; Piscione, Tino D; Parekh, Rulan S

2016-10-07

Ethnic differences in outcomes among children with nephrotic syndrome are unknown. We conducted a longitudinal study at a single regional pediatric center comparing ethnic differences in incidence from 2001 to 2011 census data and longitudinal outcomes, including relapse rates, time to first relapse, frequently relapsing disease, and use of cyclophosphamide. Among 711 children, 24% were European, 33% were South Asian, 10% were East/Southeast Asian, and 33% were of other origins. Over 10 years, the overall incidence increased from 1.99/100,000 to 4.71/100,000 among children ages 1-18 years old. In 2011, South Asians had a higher incidence rate ratio of 6.61 (95% confidence interval, 3.16 to 15.1) compared with Europeans. East/Southeast Asians had a similar incidence rate ratio (0.76; 95% confidence interval, 0.13 to 2.94) to Europeans. We determined outcomes in 455 children from the three largest ethnic groups with steroid-sensitive disease over a median of 4 years. South Asian and East/Southeast Asian children had significantly lower odds of frequently relapsing disease at 12 months (South Asian: adjusted odds ratio; 0.55; 95% confidence interval, 0.39 to 0.77; East/Southeast Asian: adjusted odds ratio; 0.42; 95% confidence interval, 0.34 to 0.51), fewer subsequent relapses (South Asian: adjusted odds ratio; 0.64; 95% confidence interval, 0.50 to 0.81; East/Southeast Asian: adjusted odds ratio; 0.47; 95% confidence interval, 0.24 to 0.91), lower risk of a first relapse (South Asian: adjusted hazard ratio, 0.74; 95% confidence interval, 0.67 to 0.83; East/Southeast Asian: adjusted hazard ratio, 0.65; 95% CI, 0.63 to 0.68), and lower use of cyclophosphamide (South Asian: adjusted hazard ratio, 0.82; 95% confidence interval, 0.53 to 1.28; East/Southeast Asian: adjusted hazard ratio, 0.54; 95% confidence interval, 0.41 to 0.71) compared with European children. Despite the higher incidence among South Asians, South and East/Southeast Asian children have significantly less complicated clinical outcomes compared with Europeans. Copyright © 2016 by the American Society of Nephrology.

A simple Bayesian approach to quantifying confidence level of adverse event incidence proportion in small samples.

PubMed

Liu, Fang

2016-01-01

In both clinical development and post-marketing of a new therapy or a new treatment, incidence of an adverse event (AE) is always a concern. When sample sizes are small, large sample-based inferential approaches on an AE incidence proportion in a certain time period no longer apply. In this brief discussion, we introduce a simple Bayesian framework to quantify, in small sample studies and the rare AE case, (1) the confidence level that the incidence proportion of a particular AE p is over or below a threshold, (2) the lower or upper bounds on p with a certain level of confidence, and (3) the minimum required number of patients with an AE before we can be certain that p surpasses a specific threshold, or the maximum allowable number of patients with an AE after which we can no longer be certain that p is below a certain threshold, given a certain confidence level. The method is easy to understand and implement; the interpretation of the results is intuitive. This article also demonstrates the usefulness of simple Bayesian concepts when it comes to answering practical questions.

Probabilistic Solar Energetic Particle Models

NASA Technical Reports Server (NTRS)

Adams, James H., Jr.; Dietrich, William F.; Xapsos, Michael A.

2011-01-01

To plan and design safe and reliable space missions, it is necessary to take into account the effects of the space radiation environment. This is done by setting the goal of achieving safety and reliability with some desired level of confidence. To achieve this goal, a worst-case space radiation environment at the required confidence level must be obtained. Planning and designing then proceeds, taking into account the effects of this worst-case environment. The result will be a mission that is reliable against the effects of the space radiation environment at the desired confidence level. In this paper we will describe progress toward developing a model that provides worst-case space radiation environments at user-specified confidence levels. We will present a model for worst-case event-integrated solar proton environments that provide the worst-case differential proton spectrum. This model is based on data from IMP-8 and GOES spacecraft that provide a data base extending from 1974 to the present. We will discuss extending this work to create worst-case models for peak flux and mission-integrated fluence for protons. We will also describe plans for similar models for helium and heavier ions.

Cosmological parameter estimation from CMB and X-ray cluster after Planck

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, Jian-Wei; Cai, Rong-Gen; Guo, Zong-Kuan

We investigate constraints on cosmological parameters in three 8-parameter models with the summed neutrino mass as a free parameter, by a joint analysis of CCCP X-ray cluster data, the newly released Planck CMB data as well as some external data sets including baryon acoustic oscillation measurements from the 6dFGS, SDSS DR7 and BOSS DR9 surveys, and Hubble Space Telescope H{sub 0} measurement. We find that the combined data strongly favor a non-zero neutrino masses at more than 3σ confidence level in these non-vanilla models. Allowing the CMB lensing amplitude A{sub L} to vary, we find A{sub L} > 1 atmore » 3σ confidence level. For dark energy with a constant equation of state w, we obtain w < −1 at 3σ confidence level. The estimate of the matter power spectrum amplitude σ{sub 8} is discrepant with the Planck value at 2σ confidence level, which reflects some tension between X-ray cluster data and Planck data in these non-vanilla models. The tension can be alleviated by adding a 9% systematic shift in the cluster mass function.« less

Combined effect of pulse density and grid cell size on predicting and mapping aboveground carbon in fast‑growing Eucalyptus forest plantation using airborne LiDAR data

Treesearch

Carlos Alberto Silva; Andrew Thomas Hudak; Carine Klauberg; Lee Alexandre Vierling; Carlos Gonzalez‑Benecke; Samuel de Padua Chaves Carvalho; Luiz Carlos Estraviz Rodriguez; Adrian Cardil

2017-01-01

LiDAR measurements can be used to predict and map AGC across variable-age Eucalyptus plantations with adequate levels of precision and accuracy using 5 pulses m− 2 and a grid cell size of 5 m. The promising results for AGC modeling in this study will allow for greater confidence in comparing AGC estimates with varying LiDAR sampling densities for Eucalyptus plantations...

Estimation procedures to measure and monitor failure rates of components during thermal-vacuum testing

NASA Technical Reports Server (NTRS)

Williams, R. E.; Kruger, R.

1980-01-01

Estimation procedures are described for measuring component failure rates, for comparing the failure rates of two different groups of components, and for formulating confidence intervals for testing hypotheses (based on failure rates) that the two groups perform similarly or differently. Appendix A contains an example of an analysis in which these methods are applied to investigate the characteristics of two groups of spacecraft components. The estimation procedures are adaptable to system level testing and to monitoring failure characteristics in orbit.

High Pressure Regenerative Turbine Engine: 21st Century Propulsion

NASA Technical Reports Server (NTRS)

Lear, W. E.; Laganelli, A. L.; Senick, Paul (Technical Monitor)

2001-01-01

A novel semi-closed cycle gas turbine engine was demonstrated and was found to meet the program goals. The proof-of-principle test of the High Pressure Regenerative Turbine Engine produced data that agreed well with models, enabling more confidence in designing future prototypes based on this concept. Emission levels were significantly reduced as predicted as a natural attribute of this power cycle. Engine testing over a portion of the operating range allowed verification of predicted power increases compared to the baseline.

Transport Test Problems for Hybrid Methods Development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shaver, Mark W.; Miller, Erin A.; Wittman, Richard S.

2011-12-28

This report presents 9 test problems to guide testing and development of hybrid calculations for the ADVANTG code at ORNL. These test cases can be used for comparing different types of radiation transport calculations, as well as for guiding the development of variance reduction methods. Cases are drawn primarily from existing or previous calculations with a preference for cases which include experimental data, or otherwise have results with a high level of confidence, are non-sensitive, and represent problem sets of interest to NA-22.

Neutron detection in a high gamma-ray background with EJ-301 and EJ-309 liquid scintillators

NASA Astrophysics Data System (ADS)

Stevanato, L.; Cester, D.; Nebbia, G.; Viesti, G.

2012-10-01

Using a fast digitizer, the neutron-gamma discrimination capability of the new liquid scintillator EJ-309 is compared with that obtained using standard EJ-301. Moreover the capability of both the scintillation detectors to identify a weak neutron source in a high gamma-ray background is demonstrated. The probability of neutron detection is PD=95% at 95% confidence level for a gamma-ray background corresponding to a dose rate of 100 μSv/h.

Normal and hemiparetic walking

NASA Astrophysics Data System (ADS)

Pfeiffer, Friedrich; König, Eberhard

2013-01-01

The idea of a model-based control of rehabilitation for hemiparetic patients requires efficient models of human walking, healthy walking as well as hemiparetic walking. Such models are presented in this paper. They include 42 degrees of freedom and allow especially the evaluation of kinetic magnitudes with the goal to evaluate measures for the hardness of hemiparesis. As far as feasible, the simulations have been compared successfully with measurements, thus improving the confidence level for an application in clinical practice. The paper is mainly based on the dissertation [19].

A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance.

PubMed

Wise, Christopher H; Schenk, Ronald J; Lattanzi, Jill Black

2016-07-01

Despite emerging evidence to support the use of high velocity thrust manipulation in the management of lumbar spinal conditions, utilization of thrust manipulation among clinicians remains relatively low. One reason for the underutilization of these procedures may be related to disparity in training in the performance of these techniques at the professional and post professional levels. To assess the effect of using a new model of active learning on participant confidence in the performance of spinal thrust manipulation and the implications for its use in the professional and post-professional training of physical therapists. A cohort of 15 DPT students in their final semester of entry-level professional training participated in an active training session emphasizing a sequential partial task practice (SPTP) strategy in which participants engaged in partial task practice over several repetitions with different partners. Participants' level of confidence in the performance of these techniques was determined through comparison of pre- and post-training session surveys and a post-session open-ended interview. The increase in scores across all items of the individual pre- and post-session surveys suggests that this model was effective in changing overall participant perception regarding the effectiveness and safety of these techniques and in increasing student confidence in their performance. Interviews revealed that participants greatly preferred the SPTP strategy, which enhanced their confidence in technique performance. Results indicate that this new model of psychomotor training may be effective at improving confidence in the performance of spinal thrust manipulation and, subsequently, may be useful for encouraging the future use of these techniques in the care of individuals with impairments of the spine. Inasmuch, this method of instruction may be useful for training of physical therapists at both the professional and post-professional levels.

Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey.

PubMed

Chuang, Yeu-Hui; Kuo, Li-Min

2018-05-24

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression. © 2018 Australian College of Mental Health Nurses Inc.

Trust increases euthanasia acceptance: a multilevel analysis using the European Values Study.

PubMed

Köneke, Vanessa

2014-12-20

This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance. The effects of various trust indicators on euthanasia acceptance were tested using multilevel analysis, and data from the European Values Study 2008 (N = 49,114, 44 countries). More precisely, the influence of people's general levels of trust in other people, and their confidence in the health care system, were measured--both at the individual and at the country level. Confidence in the state and the press were accounted for as well, since both institutions might monitor and safeguard euthanasia practices. It was shown that the level of trust in a country was strongly positively linked to euthanasia attitudes, both for general trust and for confidence in health care. In addition, within countries, people who perceived their fellow citizens as trustworthy, and who had confidence in the press, were more supportive of euthanasia than their less trusting counterparts. The pattern was, however, not true for confidence in the state and for confidence in the health care system at the individual level. Notably, all confirmative effects held, even when other variables such as religiosity, education, and values regarding autonomy were controlled for. Trust seems to be a noteworthy construct to explain differences in attitudes towards euthanasia, especially when drawing cross-country comparisons. Therefore, it should be added to the existing literature on correlates of euthanasia attitudes.

Emergency department patient satisfaction survey in Imam Reza Hospital, Tabriz, Iran

PubMed Central

2011-01-01

Introduction Patient satisfaction is an important indicator of the quality of care and service delivery in the emergency department (ED). The objective of this study was to evaluate patient satisfaction with the Emergency Department of Imam Reza Hospital in Tabriz, Iran. Methods This study was carried out for 1 week during all shifts. Trained researchers used the standard Press Ganey questionnaire. Patients were asked to complete the questionnaire prior to discharge. The study questionnaire included 30 questions based on a Likert scale. Descriptive and analytical statistics were used throughout data analysis in a number of ways using SPSS version 13. Results Five hundred patients who attended our ED were included in this study. The highest satisfaction rates were observed in the terms of physicians' communication with patients (82.5%), security guards' courtesy (78.3%) and nurses' communication with patients (78%). The average waiting time for the first visit to a physician was 24 min 15 s. The overall satisfaction rate was dependent on the mean waiting time. The mean waiting time for a low rate of satisfaction was 47 min 11 s with a confidence interval of (19.31, 74.51), and for very good level of satisfaction it was 14 min 57 s with a (10.58, 18.57) confidence interval. Approximately 63% of the patients rated their general satisfaction with the emergency setting as good or very good. On the whole, the patient satisfaction rate at the lowest level was 7.7 with a confidence interval of (5.1, 10.4), and at the low level it was 5.8% with a confidence interval of (3.7, 7.9). The rate of satisfaction for the mediocre level was 23.3 with a confidence interval of (19.1, 27.5); for the high level of satisfaction it was 28.3 with a confidence interval of (22.9, 32.8), and for the very high level of satisfaction, this rate was 32.9% with a confidence interval of (28.4, 37.4). Conclusion The study findings indicated the need for evidence-based interventions in emergency care services in areas such as medical care, nursing care, courtesy of staff, physical comfort and waiting time. Efforts should focus on shortening waiting intervals and improving patients' perceptions about waiting in the ED, and also improving the overall cleanliness of the emergency room. PMID:21407998

Ethnic minority inequalities in access to treatments for schizophrenia and schizoaffective disorders: findings from a nationally representative cross-sectional study.

PubMed

Das-Munshi, Jayati; Bhugra, Dinesh; Crawford, Mike J

2018-04-18

Ethnic minority service users with schizophrenia and schizoaffective disorders may experience inequalities in care. There have been no recent studies assessing access to evidence-based treatments for psychosis amongst the main ethnic minority groups in the UK. Data from nationally representative surveys from England and Wales, for 10,512 people with a clinical diagnosis of schizophrenia or schizoaffective disorders, were used for analyses. Multi-level multivariable logistic regression analyses were used to assess ethnic minority inequalities in access to pharmacological treatments, psychological interventions, shared decision making and care planning, taking into account a range of potential confounders. Compared with white service users, black service users were more likely prescribed depot/injectable antipsychotics (odds ratio 1.56 (95% confidence interval 1.33-1.84)). Black service users with treatment resistance were less likely to be prescribed clozapine (odds ratio 0.56 (95% confidence interval 0.39-0.79)). All ethnic minority service users, except those of mixed ethnicity, were less likely to be offered cognitive behavioural therapy, compared to white service users. Black service users were less likely to have been offered family therapy, and Asian service users were less likely to have received copies of care plans (odds ratio 0.50 (95% confidence interval 0.33-0.76)), compared to white service users. There were no clinician-reported differences in shared decision making across each of the ethnic minority groups. Relative to white service users, ethnic minority service users with psychosis were generally less likely to be offered a range of evidence-based treatments for psychosis, which included pharmacological and psychological interventions as well as involvement in care planning.

Prolonged use of the etonogestrel implant and levonorgestrel intrauterine device: 2 years beyond Food and Drug Administration-approved duration.

PubMed

McNicholas, Colleen; Swor, Erin; Wan, Leping; Peipert, Jeffrey F

2017-06-01

The subdermal contraceptive implant and the 52-mg levonorgestrel intrauterine device are currently Food and Drug Administration approved for 3 and 5 years of use, respectively. Limited available data suggested both of these methods are effective beyond that time. Demonstration of prolonged effectiveness will improve the cost-effectiveness of the device, and potentially patient continuation and satisfaction. We sought to evaluate the effectiveness of the contraceptive implant and the 52-mg hormonal intrauterine device in women using the method for 2 years beyond the current Food and Drug Administration-approved duration. We initiated this ongoing prospective cohort study in January 2012. We are enrolling women using the contraceptive implant or 52-mg levonorgestrel intrauterine device for a minimum of 3 and 5 years, respectively (started intrauterine device in ≥2007 or implant in ≥2009). Demographic and reproductive health histories, as well as objective body mass index, were collected. Implant users were offered periodic venipuncture for analysis of serum etonogestrel levels. The primary outcome, unintended pregnancy rate, was calculated per 100 woman-years. We analyzed baseline demographic characteristics using χ 2 test and Fisher exact test, and compared serum etonogestrel levels stratified by body mass index using the Kruskal-Wallis test. Implant users (n = 291) have contributed 444.0 woman-years of follow-up. There have been no documented pregnancies in implant users during the 2 years of postexpiration follow-up. Calculated failure rates in the fourth and fifth years for the implant are calculated as 0 (1-sided 97.5% confidence interval, 0-1.48) per 100 woman-years at 4 years and 0 (1-sided 97.5% confidence interval, 0-2.65) per 100 woman-years at 5 years. Among 496 levonorgestrel intrauterine device users, 696.9 woman-years of follow-up have been completed. Two pregnancies have been reported. The failure rate in the sixth year of use of the levonorgestrel intrauterine device is calculated as 0.25 (95% confidence interval, 0.04-1.42) per 100 woman-years; failure rate during the seventh year is 0.43 (95% confidence interval, 0.08-2.39) per 100 woman-years. Among implant users with serum etonogestrel results, the median etonogestrel level was 207.7 pg/mL (range 63.8-802.6 pg/mL) at the time of method expiration, 166.1 pg/mL (range 67.9 25.0-470.5 pg/mL) at the end of the fourth year, and 153.0 pg/mL (range 72.1-538.8 pg/mL) at the end of the fifth year. Median etonogestrel levels were compared by body mass index at each time point and a statistical difference was noted at the end of 4 years of use with overweight women having the highest serum etonogestrel (195.9; range 25.0-450.5 pg/mL) when compared to normal (178.9; range 87.0-463.7 pg/mL) and obese (137.9; range 66.0-470.5 pg/mL) women (P = .04). This study indicates that the contraceptive implant and 52-mg hormonal intrauterine device continue to be highly effective for at least 2 additional years of use. Serum etonogestrel evaluation demonstrates median levels remain above the ovulation threshold of 90 pg/mL for women in all body mass index classes. Copyright © 2017 Elsevier Inc. All rights reserved.

Working Memory Encoding and False Memory in Schizophrenia and Bipolar Disorder in a Spatial Delayed Response Task

PubMed Central

Mayer, Jutta S.; Park, Sohee

2014-01-01

Working memory (WM) impairment is a core feature of schizophrenia, but the contributions of different WM components are not yet specified. Here, we investigated the potential role of inefficient encoding in reduced WM performance in patients with schizophrenia (PSZ). Twenty-eight PSZ, 16 patients with bipolar disorder (PBP), 16 unaffected and unmedicated relatives of PSZ (REL), and 29 demographically matched healthy controls (HC) performed a spatial delayed response task with either low or high WM demands. The demands on attentional selection were also manipulated by presenting distractor stimuli during encoding in some of the trials. After each trial, participants rated their level of response confidence. This allowed us to analyze different types of WM responses. WM was severely impaired in PSZ compared to HC; this reduction was mainly due to an increase in the amount of false memory responses (incorrect responses that were given with high confidence) rather than an increase in the amount of incorrect and not-confident responses. Although PBP showed WM impairments, they did not have increased false memory errors. In contrast, reduced WM in REL was also accompanied by an increase in false memory errors. The presentation of distractors led to a decline in WM performance, which was comparable across groups indicating that attentional selection was intact in PSZ. These findings suggest that inefficient WM encoding is responsible for impaired WM in schizophrenia and point to differential mechanisms underlying WM impairments in PSZ and PBP. PMID:22708888

Examining depressive symptoms and use of counseling in the past year among Filipino and non-Hispanic white adolescents in California.

PubMed

Javier, Joyce R; Lahiff, Maureen; Ferrer, Rizaldy R; Huffman, Lynne C

2010-05-01

We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California. This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed. Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score > or = 7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes > or = 300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004-0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00-15.89). Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

Examining Depressive Symptoms and Use of Counseling in the Past Year Among Filipino and Non-Hispanic White Adolescents in California

PubMed Central

Javier, Joyce R.; Lahiff, Maureen; Ferrer, Rizaldy R.; Huffman, Lynne C.

2014-01-01

Objective We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California. Methods This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed. Results Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score >7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes >300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004 – 0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00 –15.89). Conclusion Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents. PMID:20431400

Is fear perception special? Evidence at the level of decision-making and subjective confidence.

PubMed

Koizumi, Ai; Mobbs, Dean; Lau, Hakwan

2016-11-01

Fearful faces are believed to be prioritized in visual perception. However, it is unclear whether the processing of low-level facial features alone can facilitate such prioritization or whether higher-level mechanisms also contribute. We examined potential biases for fearful face perception at the levels of perceptual decision-making and perceptual confidence. We controlled for lower-level visual processing capacity by titrating luminance contrasts of backward masks, and the emotional intensity of fearful, angry and happy faces. Under these conditions, participants showed liberal biases in perceiving a fearful face, in both detection and discrimination tasks. This effect was stronger among individuals with reduced density in dorsolateral prefrontal cortex, a region linked to perceptual decision-making. Moreover, participants reported higher confidence when they accurately perceived a fearful face, suggesting that fearful faces may have privileged access to consciousness. Together, the results suggest that mechanisms in the prefrontal cortex contribute to making fearful face perception special. © The Author (2016). Published by Oxford University Press.

Pulmonary disease in cystic fibrosis: assessment with chest CT at chest radiography dose levels.

PubMed

Ernst, Caroline W; Basten, Ines A; Ilsen, Bart; Buls, Nico; Van Gompel, Gert; De Wachter, Elke; Nieboer, Koenraad H; Verhelle, Filip; Malfroot, Anne; Coomans, Danny; De Maeseneer, Michel; de Mey, Johan

2014-11-01

To investigate a computed tomographic (CT) protocol with iterative reconstruction at conventional radiography dose levels for the assessment of structural lung abnormalities in patients with cystic fibrosis ( CF cystic fibrosis ). In this institutional review board-approved study, 38 patients with CF cystic fibrosis (age range, 6-58 years; 21 patients <18 years and 17 patients >18 years) underwent investigative CT (at minimal exposure settings combined with iterative reconstruction) as a replacement of yearly follow-up posteroanterior chest radiography. Verbal informed consent was obtained from all patients or their parents. CT images were randomized and rated independently by two radiologists with use of the Bhalla scoring system. In addition, mosaic perfusion was evaluated. As reference, the previous available conventional chest CT scan was used. Differences in Bhalla scores were assessed with the χ(2) test and intraclass correlation coefficients ( ICC intraclass correlation coefficient s). Radiation doses for CT and radiography were assessed for adults (>18 years) and children (<18 years) separately by using technical dose descriptors and estimated effective dose. Differences in dose were assessed with the Mann-Whitney U test. The median effective dose for the investigative protocol was 0.04 mSv (95% confidence interval [ CI confidence interval ]: 0.034 mSv, 0.10 mSv) for children and 0.05 mSv (95% CI confidence interval : 0.04 mSv, 0.08 mSv) for adults. These doses were much lower than those with conventional CT (median: 0.52 mSv [95% CI confidence interval : 0.31 mSv, 3.90 mSv] for children and 1.12 mSv [95% CI confidence interval : 0.57 mSv, 3.15 mSv] for adults) and of the same order of magnitude as those for conventional radiography (median: 0.012 mSv [95% CI confidence interval : 0.006 mSv, 0.022 mSv] for children and 0.012 mSv [95% CI confidence interval : 0.005 mSv, 0.031 mSv] for adults). All images were rated at least as diagnostically acceptable. Very good agreement was found in overall Bhalla score ( ICC intraclass correlation coefficient , 0.96) with regard to the severity of bronchiectasis ( ICC intraclass correlation coefficient , 0.87) and sacculations and abscesses ( ICC intraclass correlation coefficient , 0.84). Interobserver agreement was excellent ( ICC intraclass correlation coefficient , 0.86-1). For patients with CF cystic fibrosis , a dedicated chest CT protocol can replace the two yearly follow-up chest radiographic examinations without major dose penalty and with similar diagnostic quality compared with conventional CT.

Building hospital pharmacy practice research capacity in Qatar: a cross-sectional survey of hospital pharmacists.

PubMed

Stewart, Derek; Al Hail, Moza; Abdul Rouf, P V; El Kassem, Wessam; Diack, Lesley; Thomas, Binny; Awaisu, Ahmed

2015-06-01

There is a need to systematically develop research capacity within pharmacy practice. Hamad Medical Corporation (HMC) is the principal non-profit health care provider in Qatar. Traditionally, pharmacists in Qatar have limited training related to research and lack direct experience of research processes. To determine the interests, experience and confidence of hospital pharmacists employed by HMC, Qatar in relation to research, attitudes towards research, and facilitators and barriers. Hospital pharmacy, Qatar. A cross-sectional survey of all pharmacists (n = 401). Responses were analysed using descriptive and inferential statistics, and principal component analysis (PCA). Interests, experience and confidence in research; attitudes towards research; and facilitators and barriers to participation in research. The response rate was 53.1 % (n = 213). High levels of interest were expressed for all aspects of research, with respondents less experienced and less confident. Summary scores for items of interest were significantly higher than experience and confidence (p < 0.001). PCA identified four components: general attitudes towards research; confidence, motivation and resources; research culture; and support. While respondents were generally positive in response to all items, they were less sure of resources to conduct research, access to training and statistical support. They were also generally unsure of many aspects relating to research culture. Half (50.7 %, n = 108) had either never thought about being involved in research or taken no action. In multivariate binary logistic regression analysis, the significant factors were possessing postgraduate qualifications [odds ratio (OR) 3.48 (95 % CI 1.73-6.99), p < 0.001] and having more positive general attitudes to research [OR 3.24 (95 % CI 1.62-4.67), p = 0.001]. Almost all (89.7 %, n = 172) expressed interest in being involved in research training. HMC pharmacists expressed significantly higher levels of interest in research compared to experience and confidence. While general attitudes towards research were positive, there were some barriers relating to support (e.g. administration) and research culture. Positive attitudes towards research and possessing postgraduate qualifications were significant in relation to readiness to participate in research and research training. Findings are of key relevance when considering the aims of research capacity building of encouraging research, improving skills and identifying skills gaps.

Effect of environmental molds on risk of death from asthma during the pollen season.

PubMed

Targonski, P V; Persky, V W; Ramekrishnan, V

1995-05-01

Many studies have noted an association of ambient aeroallergen levels with exacerbation of asthma. This study was undertaken to examine the relationship of aeroallergen levels with asthma-related mortality in Chicago. The association of environmental aeroallergen levels with death caused by asthma among 5- to 34-year-olds in Chicago was examined for the period of 1985 through 1989. Logistic regression analysis was used to compare the probability of a death caused by asthma occurring on the basis of environmental tree, grass, or ragweed pollen and mold spore levels. Mean mold spore levels but not tree, grass, or ragweed pollen levels were significantly higher for days on which asthma-related death occurred than for days on which no deaths occurred (z = 2.80, p < 0.005). The odds of a death caused by asthma occurring on days with mold spore counts of 1000 spores per cubic meter or greater was 2.16 times higher (95% confidence interval = 1.31, 3.56, p = 0.003) than on days on which mold spore counts were less than 1000 spores per cubic meter. The association with mold spore levels remained significant on multivariate logistic regression with mold spore counts measured as a continuous variable and controlling for pollens, with the odds of an asthma-related death occurring being 1.2 times higher (95% confidence interval = 1.07-1.34) for every increase of 1000 spores per cubic meter in daily mold spore levels. Although death caused by asthma also involves personal, social, and medical access factors, these data suggest that exposure to environmental molds may play a role in asthma-related mortality and should be considered in prevention strategies.

Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study.

PubMed

Kelly, J Daniel; Reid, Michael J; Lahiff, Maureen; Tsai, Alexander C; Weiser, Sheri D

2017-08-01

Although HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations. We pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. Of 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs. This study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.

Child Neurology Education for Pediatric Residents.

PubMed

Albert, Dara V F; Patel, Anup D; Behnam-Terneus, Maria; Sautu, Beatriz Cunill-De; Verbeck, Nicole; McQueen, Alisa; Fromme, H Barrett; Mahan, John D

2017-03-01

The aim of this study was to evaluate whether the current state of child neurology education during pediatric residency provides adequate preparation for pediatric practice. A survey was sent to recent graduates from 3 pediatric residency programs to assess graduate experience, perceived level of competence, and desire for further education in child neurology. Responses from generalists versus subspecialists were compared. The response rate was 32%, half in general pediatric practice. Only 22% feel very confident in approaching patients with neurologic problems. This may represent the best-case scenario as graduates from these programs had required neurology experiences, whereas review of Accreditation Council of Graduate Medical Education-accredited residency curricula revealed that the majority of residencies do not. Pediatric neurologic problems are common, and pediatric residency graduates do encounter such problems in practice. The majority of pediatricians report some degree of confidence; however, some clear areas for improvement are apparent.

Empirical likelihood-based confidence intervals for mean medical cost with censored data.

PubMed

Jeyarajah, Jenny; Qin, Gengsheng

2017-11-10

In this paper, we propose empirical likelihood methods based on influence function and jackknife techniques for constructing confidence intervals for mean medical cost with censored data. We conduct a simulation study to compare the coverage probabilities and interval lengths of our proposed confidence intervals with that of the existing normal approximation-based confidence intervals and bootstrap confidence intervals. The proposed methods have better finite-sample performances than existing methods. Finally, we illustrate our proposed methods with a relevant example. Copyright © 2017 John Wiley & Sons, Ltd.

Burnout among the clinical dental students in the jordanian universities.

PubMed

Amin, Wala Majid; Al-Ali, Muna H; Duaibis, Ramzi B; Oweis, Tamara; Badran, Darwish H

2009-10-01

The study aimed to evaluate the level of burnout among the clinical dental students in two Jordanian universities. A total of 307 students from the two schools were surveyed using Maslach Burnout Inventory survey. Scores for the inventory's subscales were calculated and the mean values for the students' groups were computed separately. Kruskal-Wallis and Mann-Whitney tests were carried out and the results were compared at 95% confidence level. The results showed that the dental students in both Jordanian universities suffered high levels of emotional exhaustion and depersonalization compared to reported levels for dental students in other countries. The dental students of the University of Jordan demonstrated a significantly higher (p < 0.05) level of emotional exhaustion than their counterparts in the Jordan University of Science and Technology. The findings indicated that dental students in the Jordanian universities presented considerable degrees of burnout manifested by high levels of emotional exhaustion and depersonalization. Studies targeting students health and psychology should be carried out to determine the causes of burnout among dental students. The curricula of the dental schools in the two universities should be accordingly improved to minimize burnout among the students. Burnout; Emotional exhaustion; Depersonalization; Personal accomplishment; Maslach Burnout Inventory.

The association between urbanization and rheumatoid arthritis in Taiwan.

PubMed

Chiang, Yi-Chun; Yen, Yu-Hsuan; Chang, Wei-Chiao; Cheng, Kuei-Ju; Chang, Wei-Pin; Chen, Hsiang-Yin

2016-01-01

To investigate the association between rheumatoid arthritis (RA) and urbanization and compare the medication selection for RA patients in urban vs. rural areas. RA patients were identified among 1,000,000 random individuals from a 23-million-person nationwide health insurance database, and controls were matched at a 1 : 10 ratio. Taiwan's 359 townships were grouped into 7 urbanization levels. Geographic region and monthly income were also analyzed. Medication use in the most urbanized and less-urbanized areas were also compared. Rural dwellers had lower odds of having an RA diagnosis. The odds ratio (OR) for level 5 area residents of having an RA diagnosis was 0.62 (95% confidence interval (CI) 0.46 - 0.85; p = 0.002), and they were both 0.76 for level 6 - 7 area residents (95% CI, 0.61 - 0.95 for level 6; p = 0.017 and 0.60 - 0.96 for level 7; p = 0.021) compared to level 1 (the most urban dwellers). The ORs of having a new RA diagnosis were 0.57 (95% CI 0.41 - 0.79, p = 0.001) in eastern Taiwan and 0.33 (95% CI 0.15 - 0.69, p = 0.004) on offshore islands compared to northern Taiwan. No association was found between monthly income and RA. Urban-dwelling RA patients used more tumor necrosis factor-α antagonists (level 1 urbanization; n = 24; 2.3%) than RA patients in less-urbanized areas (level 2 - 7 urbanization n = 30; 1.3%; p = 0.038). Results of this study suggested that an RA diagnosis and treatment are associated with urbanization.

Individual education, area income, and mortality and recurrence of myocardial infarction in a Medicare cohort: the National Longitudinal Mortality Study.

PubMed

Coady, Sean A; Johnson, Norman J; Hakes, Jahn K; Sorlie, Paul D

2014-07-09

The Medicare program provides universal access to hospital care for the elderly; however, mortality disparities may still persist in this population. The association of individual education and area income with survival and recurrence post Myocardial Infarction (MI) was assessed in a national sample. Individual level education from the National Longitudinal Mortality Study was linked to Medicare and National Death Index records over the period of 1991-2001 to test the association of individual education and zip code tabulation area median income with survival and recurrence post-MI. Survival was partitioned into 3 periods: in-hospital, discharge to 1 year, and 1 year to 5 years and recurrence was partitioned into two periods: 28 day to 1 year, and 1 year to 5 years. First MIs were found in 8,043 women and 7,929 men. In women and men 66-79 years of age, less than a high school education compared with a college degree or more was associated with 1-5 year mortality in both women (HRR 1.61, 95% confidence interval 1.03-2.50) and men (HRR 1.37, 1.06-1.76). Education was also associated with 1-5 year recurrence in men (HRR 1.68, 1.18-2.41, < High School compared with college degree or more), but not women. Across the spectrum of survival and recurrence periods median zip code level income was inconsistently associated with outcomes. Associations were limited to discharge-1 year survival (RR lowest versus highest quintile 1.31, 95% confidence interval 1.03-1.67) and 28 day-1 year recurrence (RR lowest versus highest quintile 1.72, 95% confidence interval 1.14-2.57) in older men. Despite the Medicare entitlement program, disparities related to individual socioeconomic status remain. Additional research is needed to elucidate the barriers and mechanisms to eliminating health disparities among the elderly.

Association Between Serum 25-Hydroxy Vitamin D Levels and Blood Pressure Among Adolescents in Two Resource-Limited Settings in Peru.

PubMed

Tomaino, Katherine; Romero, Karina M; Robinson, Colin L; Baumann, Lauren M; Hansel, Nadia N; Pollard, Suzanne L; Gilman, Robert H; Mougey, Edward; Lima, John J; Checkley, William

2015-08-01

Serum 25-hydroxyvitamin D (25OHD) deficiency (<50 nmol/l or 20 ng/ml) has been associated with increased blood pressure (BP) in observational studies. A paucity of data on this relationship is available in Latin American or child populations. This study investigates the association between 25OHD levels and BP in adolescents at risk for vitamin D deficiency in 2 Peruvian settings. In a population-based study of 1,441 Peruvian adolescents aged 13-15 years, 1,074 (75%) provided a serum blood sample for 25OHD analysis and BP measurements. Relationships between 25OHD and BP metrics were assessed using multiple linear regressions, adjusted for anthropometrics and sociodemographic factors. 25OHD deficiency was associated with an elevated diastolic BP (DBP) (1.09 mm Hg increase, 95% confidence interval: 0.04 to 2.14; P = 0.04) compared to nondeficient adolescents. Systolic BP (SBP) trended to increase with vitamin D deficiency (1.30 mm Hg increase, 95% confidence interval: -0.13 to 2.72; P = 0.08). Mean arterial pressure (MAP) was also greater in adolescents with 25OHD (1.16 mm Hg increase, 95% confidence interval: 0.10 to 2.22; P = 0.03). SBP was found to demonstrate a U-shaped relationship with 25OHD, while DBP and MAP demonstrated inverse J-shaped relationships with serum 25OHD status. The association between 25OHD deficiency and BP was not different across study sites (all P ≥ 0.19). Adolescents deficient in 25OHD demonstrated increased DBP and MAP and a trend toward increased SBP, when compared to nondeficient subjects. 25OHD deficiency early in life was associated with elevated BP metrics, which may predispose risk of hypertension later in adulthood. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Enhancing self-management in children with sickle cell disease through playing a CD-ROM educational game: a pilot study.

PubMed

Yoon, Saunjoo L; Godwin, Angela

2007-01-01

To determine whether playing a simple CD-ROM educational game (developed specifically for children with sickle cell disease), improved children's knowledge and confidence in selected symptom management and practice. Twenty-two eligible children completed a pretest to determine knowledge and confidence levels, played the Sickle Cell Slime-O-Rama Game, then completed an identical posttest. Significant increases in knowledge (t = 2.828, p =.010) and confidence (t = 3.759, p =.001) levels between pre- and posttests were identified. It is promising that a simple, interacting CD-ROM game allowed children with sickle cell disease to quickly acquire knowledge about the disease and symptom management, and increased their confidence to apply this new knowledge. Results suggest the high utility of this tailored game to foster active self-management behaviors in this population.

Final year dental students in New Zealand: Self-reported confidence levels prior to BDS graduation.

PubMed

Murray, C; Chandler, N

2016-12-01

It is expected that the graduating dental student will have acquired the skills and knowledge to confidently treat most circumstances that they may encounter in private practice. The aims of this study were to evaluate final year dental students' self-reported levels of confidence in expected core skills just prior to graduation and to explore their career intentions both directly after graduating as well as in the longer term. After ethical approval was obtained, a survey and participant information sheet was distributed to all final year undergraduate dental students in 2014. Statistical analysis was carried out using SPSS version 22.0 with the alpha value set at 0.05. The response rate was 69% (58/84). Most (44.8%) were going to be working in New Zealand private practices with 34.5% definitely considering specializing. The majority reported high self-confidence levels for sealant restorations (96.6%) and radiography (94.8%), while very few were confident in carrying out soft tissue biopsies (1 .8%) or restoring dental implants and treating medical emergencies (10.5%). Some gender differences were found. The general finding was that most NZ graduates perceived themselves to be confident in managing the most fundamental aspects of general practice. Similar to their counterparts around the world, they will benefit from further mentoring and additional exposure to the more complex clinical tasks such as the restoration of implants and soft tissue biopsies.

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork.

PubMed

Honey, J; Lynch, C D; Burke, F M; Gilmour, A S M

2011-05-01

The aim of this study was to describe the self-reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings. A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five-point scale (1=very little confidence, 5=very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation. A response rate of 74% was achieved (n=70). The greatest self-reported confidence scores were for 'scale and polish' (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22).   Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students' confidence in those areas. © 2011 John Wiley & Sons A/S.

Comparing the Effects of Simulation-Based and Traditional Teaching Methods on the Critical Thinking Abilities and Self-Confidence of Nursing Students.

PubMed

Alamrani, Mashael Hasan; Alammar, Kamila Ahmad; Alqahtani, Sarah Saad; Salem, Olfat A

2018-06-01

Critical thinking and self-confidence are imperative to success in clinical practice. Educators should use teaching strategies that will help students enhance their critical thinking and self-confidence in complex content such as electrocardiogram interpretation. Therefore, teaching electrocardiogram interpretation to students is important for nurse educators. This study compares the effect of simulation-based and traditional teaching methods on the critical thinking and self-confidence of students during electrocardiogram interpretation sessions. Thirty undergraduate nursing students volunteered to participate in this study. The participants were divided into intervention and control groups, which were taught respectively using the simulation-based and traditional teaching programs. All of the participants were asked to complete the study instrumentpretest and posttest to measure their critical thinking and self-confidence. Improvement was observed in the control and experimental groups with respect to critical thinking and self-confidence, as evidenced by the results of the paired samples t test and the Wilcoxon signed-rank test (p < .05). However, the independent t test and Mann-Whitney U test indicate that the difference between the two groups was not significant (p > .05). This study evaluated an innovative simulation-based teaching method for nurses. No significant differences in outcomes were identified between the simulator-based and traditional teaching methods, indicating that well-implemented educational programs that use either teaching method effectively promote critical thinking and self-confidence in nursing students. Nurse educators are encouraged to design educational plans with clear objectives to improve the critical thinking and self-confidence of their students. Future research should compare the effects of several teaching sessions using each method in a larger sample.

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills.

PubMed

Browne, C; Norton, S; Nolan, J M; Whelan, C; Sullivan, J F; Quinlan, M; Sheikh, M; Mc Dermott, T E D; Lynch, T H; Manecksha, R P

2018-02-01

Undergraduate training in core urology skills is lacking in many Irish training programmes. Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies. A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course. Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2. This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

PubMed Central

Pearson, Amy CS; Moman, Rajat N; Moeschler, Susan M; Eldrige, Jason S; Hooten, W Michael

2017-01-01

Introduction Many providers report lack of confidence in managing patients with chronic pain. Thus, the primary aim of this study was to investigate the associations of provider confidence in managing chronic pain with their practice behaviors and demographics. Materials and methods The primary outcome measure was the results of the Opioid Therapy Provider Survey, which was administered to clinicians attending a pain-focused continuing medical education conference. Nonparametric correlations were assessed using Spearman’s rho. Results Of the respondents, 55.0% were women, 92.8% were white, and 56.5% were physicians. Primary care providers accounted for 56.5% of the total respondents. The majority of respondents (60.8%) did not feel confident managing patients with chronic pain. Provider confidence in managing chronic pain was positively correlated with 1) following an opioid therapy protocol (P=0.001), 2) the perceived ability to identify patients at risk for opioid misuse (P=0.006), and 3) using a consistent practice-based approach to improve their comfort level with prescribing opioids (P<0.001). Provider confidence was negatively correlated with the perception that treating pain patients was a “problem in my practice” (P=0.005). Conclusion In this study, the majority of providers did not feel confident managing chronic pain. However, provider confidence was associated with a protocolized and consistent practice-based approach toward managing opioids and the perceived ability to identify patients at risk for opioid misuse. Future studies should investigate whether provider confidence is associated with measurable competence in managing chronic pain and explore approaches to enhance appropriate levels of confidence in caring for patients with chronic pain. PMID:28652805

Effects of same-sex versus coeducational physical education on the self-perceptions of middle and high school students.

PubMed

Lirgg, C D

1993-09-01

The purpose of this field experiment was to investigate the effects of attending either a coeducational or a same-sex physical education class on several self-perception variables. Middle and high school youth who had previously been in coeducational classes were assigned to either a same-sex or a new coeducational physical education class for a 10-lesson unit of basketball. Analyses were conducted at both the group and the individual levels. Self-perception variables examined included perceived self-confidence of learning basketball, perceived usefulness of basketball, and perceived gender-appropriateness of basketball. Results of hierarchical linear model group level analyses indicated that the variability in groups for self-confidence could be explained by grade, class type, and the interaction between gender and class type. At the individual level, multivariate results showed that, after the unit, males in coeducational classes were significantly more confident in their ability to learn basketball than males in same-sex classes. Also, males in same-sex classes decreased in confidence from pretreatment to posttreatment. Perceived usefulness of basketball emerged as the strongest predictor of self-confidence for learning basketball for both genders. In general, middle school students preferred same-sex classes, whereas high school students preferred coeducational classes.

Prevalence and distribution of metabolic syndrome in a southern Chinese population. Relation to exercise, smoking, and educational level.

PubMed

Li, Yong-Qiang; Zhao, Li-Qin; Liu, Xin-Yu; Wang, Hong-Lei; Wang, Xiao-Hong; Li, Bin; Deng, Kang-Ping; Zhang, Ying; Liu, Qin; Holthofer, Harry; Zou, He-Qun

2013-09-01

To investigate the prevalence and distribution of metabolic syndrome (MetS) and the impact of exercise, smoking, and educational level on the risk of MetS in a southern Chinese population. A cross-sectional study was conducted in Zhuhai City, China from June to August 2012. Data on exercise, smoking, and educational level, anthropometric parameters, blood pressure, lipid, and glucose levels were collected. The prevalence of MetS (as defined by the International Diabetes Federation) was determined. Data necessary to evaluate MetS, the socio-economic characteristics, and lifestyle were obtained for 4645 subjects aged 18-75 years old. A total of 19.8% of the participants had MetS. The adjusted odds of having MetS were lower among males (adjusted odds: 0.75; 95% confidence interval [CI]: 0.57-1.01) compared with females. Those participants who currently smoked had a higher risk of developing MetS compared with non-smokers (adjusted odds: 1.61; 95% CI: 1.13-2.50). Those who had no physical exercise had a higher risk of developing MetS compared with those who physically exercised more than 60 minutes/day (adjusted odds: 1.51; 95% CI: 1.12-2.23;). Compared with those with no education, every category of attained educational level had a lower risk of developing MetS (p<0.001). The findings in this study revealed that current smokers had a greater risk of developing MetS compared with non-smokers. Increased physical activity and higher levels of education attained served as protective factors for the population.

Reliable Multi-Label Learning via Conformal Predictor and Random Forest for Syndrome Differentiation of Chronic Fatigue in Traditional Chinese Medicine

PubMed Central

Wang, Huazhen; Liu, Xin; Lv, Bing; Yang, Fan; Hong, Yanzhu

2014-01-01

Objective Chronic Fatigue (CF) still remains unclear about its etiology, pathophysiology, nomenclature and diagnostic criteria in the medical community. Traditional Chinese medicine (TCM) adopts a unique diagnostic method, namely ‘bian zheng lun zhi’ or syndrome differentiation, to diagnose the CF with a set of syndrome factors, which can be regarded as the Multi-Label Learning (MLL) problem in the machine learning literature. To obtain an effective and reliable diagnostic tool, we use Conformal Predictor (CP), Random Forest (RF) and Problem Transformation method (PT) for the syndrome differentiation of CF. Methods and Materials In this work, using PT method, CP-RF is extended to handle MLL problem. CP-RF applies RF to measure the confidence level (p-value) of each label being the true label, and then selects multiple labels whose p-values are larger than the pre-defined significance level as the region prediction. In this paper, we compare the proposed CP-RF with typical CP-NBC(Naïve Bayes Classifier), CP-KNN(K-Nearest Neighbors) and ML-KNN on CF dataset, which consists of 736 cases. Specifically, 95 symptoms are used to identify CF, and four syndrome factors are employed in the syndrome differentiation, including ‘spleen deficiency’, ‘heart deficiency’, ‘liver stagnation’ and ‘qi deficiency’. The Results CP-RF demonstrates an outstanding performance beyond CP-NBC, CP-KNN and ML-KNN under the general metrics of subset accuracy, hamming loss, one-error, coverage, ranking loss and average precision. Furthermore, the performance of CP-RF remains steady at the large scale of confidence levels from 80% to 100%, which indicates its robustness to the threshold determination. In addition, the confidence evaluation provided by CP is valid and well-calibrated. Conclusion CP-RF not only offers outstanding performance but also provides valid confidence evaluation for the CF syndrome differentiation. It would be well applicable to TCM practitioners and facilitate the utilities of objective, effective and reliable computer-based diagnosis tool. PMID:24918430

Tactical Tomahawk RGM-109E/UGM-109E Missile (TACTOM)

DTIC Science & Technology

2015-12-01

2004: Operational Requirements Document for Tomahawk Weapons Systems Baseline IV signed. TACTOM is authorized in Chapter 2 of this system level ...5124.8 3290.3 6885.4 6390.4 1 APB Breach Confidence Level Confidence Level of cost estimate for current APB: 51% The estimate to support this program...Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 1.365 -0.015 0.324 0.117 0.000 -0.716 0.000 0.104 -0.186 1.179

Warfighter Information Network-Tactical Increment 2 (WIN-T Inc 2)

DTIC Science & Technology

2015-12-01

Company- level . Using equipment mounted on combat platforms, WIN-T Inc 2 delivers a mobile capability that reduces reliance on fixed infrastructure...Cost Estimate Reference Army Cost Position (ACP) dated April 28, 2015 Confidence Level Confidence Level of cost estimate for current APB: 50% The...Development Estimate Changes PAUC Production Estimate Econ Qty Sch Eng Est Oth Spt Total 2.064 -0.055 -0.063 0.016 0.000 0.093 0.000 0.200 0.191 2.255

The integrated model of sport confidence: a canonical correlation and mediational analysis.

PubMed

Koehn, Stefan; Pearce, Alan J; Morris, Tony

2013-12-01

The main purpose of the study was to examine crucial parts of Vealey's (2001) integrated framework hypothesizing that sport confidence is a mediating variable between sources of sport confidence (including achievement, self-regulation, and social climate) and athletes' affect in competition. The sample consisted of 386 athletes, who completed the Sources of Sport Confidence Questionnaire, Trait Sport Confidence Inventory, and Dispositional Flow Scale-2. Canonical correlation analysis revealed a confidence-achievement dimension underlying flow. Bias-corrected bootstrap confidence intervals in AMOS 20.0 were used in examining mediation effects between source domains and dispositional flow. Results showed that sport confidence partially mediated the relationship between achievement and self-regulation domains and flow, whereas no significant mediation was found for social climate. On a subscale level, full mediation models emerged for achievement and flow dimensions of challenge-skills balance, clear goals, and concentration on the task at hand.

Diagnosis of Child Maltreatment: A Family Medicine Physician's Dilemma.

PubMed

Eniola, Kehinde; Evarts, Lori

2017-05-01

Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.

A Cross-Sectional Survey on Japanese English-Major University Students' Confidence in the TOEIC Can-Do List

ERIC Educational Resources Information Center

Ozawa, Shinya

2018-01-01

This survey was conducted to investigate how university students gain or lose confidence in English communicative domains over four years at university. Self-assessment has been a useful instrument for measuring learners' English proficiency, and the students in this study were required to self-assess their confidence levels in TOEIC Can-Do list…

Understanding Creativity in the Workplace: An Examination of Individual Styles and Training in Relation to Creative Confidence and Creative Self-Leadership

ERIC Educational Resources Information Center

Phelan, Sherry; Young, Angela M.

2003-01-01

Creative Self-Leadership and Creative Confidence were examined in relation to Creative Style Preference and Training. It was hypothesized that perceptions of Creative Self-Leadership and Creative Confidence were related to personal Creative Style Preferences and that Training would be associated with higher levels of Creative Self-Leadership and…

Easy and Informative: Using Confidence-Weighted True-False Items for Knowledge Tests in Psychology Courses

ERIC Educational Resources Information Center

Dutke, Stephan; Barenberg, Jonathan

2015-01-01

We introduce a specific type of item for knowledge tests, confidence-weighted true-false (CTF) items, and review experiences of its application in psychology courses. A CTF item is a statement about the learning content to which students respond whether the statement is true or false, and they rate their confidence level. Previous studies using…

Probabilistic model for quick detection of dissimilar binary images

NASA Astrophysics Data System (ADS)

Mustafa, Adnan A. Y.

2015-09-01

We present a quick method to detect dissimilar binary images. The method is based on a "probabilistic matching model" for image matching. The matching model is used to predict the probability of occurrence of distinct-dissimilar image pairs (completely different images) when matching one image to another. Based on this model, distinct-dissimilar images can be detected by matching only a few points between two images with high confidence, namely 11 points for a 99.9% successful detection rate. For image pairs that are dissimilar but not distinct-dissimilar, more points need to be mapped. The number of points required to attain a certain successful detection rate or confidence depends on the amount of similarity between the compared images. As this similarity increases, more points are required. For example, images that differ by 1% can be detected by mapping fewer than 70 points on average. More importantly, the model is image size invariant; so, images of any sizes will produce high confidence levels with a limited number of matched points. As a result, this method does not suffer from the image size handicap that impedes current methods. We report on extensive tests conducted on real images of different sizes.

Understanding speaker attitudes from prosody by adults with Parkinson's disease.

PubMed

Monetta, Laura; Cheang, Henry S; Pell, Marc D

2008-09-01

The ability to interpret vocal (prosodic) cues during social interactions can be disrupted by Parkinson's disease, with notable effects on how emotions are understood from speech. This study investigated whether PD patients who have emotional prosody deficits exhibit further difficulties decoding the attitude of a speaker from prosody. Vocally inflected but semantically nonsensical 'pseudo-utterances' were presented to listener groups with and without PD in two separate rating tasks. Task I required participants to rate how confident a speaker sounded from their voice and Task 2 required listeners to rate how polite the speaker sounded for a comparable set of pseudo-utterances. The results showed that PD patients were significantly less able than HC participants to use prosodic cues to differentiate intended levels of speaker confidence in speech, although the patients could accurately detect the politelimpolite attitude of the speaker from prosody in most cases. Our data suggest that many PD patients fail to use vocal cues to effectively infer a speaker's emotions as well as certain attitudes in speech such as confidence, consistent with the idea that the basal ganglia play a role in the meaningful processing of prosodic sequences in spoken language (Pell & Leonard, 2003).

What Inverted U Can Do for Your Country: A Curvilinear Relationship Between Confidence in the Social System and Political Engagement.

PubMed

Cichocka, Aleksandra; Górska, Paulina; Jost, John T; Sutton, Robbie M; Bilewicz, Michał

2017-08-24

We examined the link between political engagement and the tendency to justify the sociopolitical system. On one hand, confidence in the system should be negatively related to political engagement, insofar as it entails reduced desire for social change; on the other hand, system confidence should also be positively related to political engagement to the extent that it carries an assumption that the system is responsive to citizens' political efforts. Because of the combination of these 2 opposing forces, the motivation for political engagement should be highest at intermediate levels of system confidence. Five studies revealed a negative quadratic relationship between system confidence and normative political engagement. In 2 representative surveys, Polish participants with moderate levels of system confidence were more likely to vote in political elections (Study 1) and to participate in solidarity-based collective action (Study 2). Two field studies demonstrated a negative quadratic relationship between system confidence and actual participation in political demonstrations (gender equality and teachers' protests in Poland; Studies 3 and 4). This pattern of results was further corroborated by analyses of data from 50 countries drawn from the World Value Survey: we observed negative quadratic relationships between system confidence and collective action as well as voting. These relationships were stronger in democratic (vs. nondemocratic) regimes (Study 5). Our results suggest that some degree of system confidence might be useful to stimulate political engagement within the norms of the system. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Evaluation of dental students’ perception and self-confidence levels regarding endodontic treatment

PubMed Central

Tanalp, Jale; Güven, Esra Pamukçu; Oktay, Inci

2013-01-01

Objectives: The aim of this study was to obtain information about senior dental students’ perceptions and self-confidence levels regarding endodontic practice. Materials and Methods: Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. Results: The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). Conclusions: The results showing students’ lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment. PMID:24883030

Evaluation of dental students' perception and self-confidence levels regarding endodontic treatment.

PubMed

Tanalp, Jale; Güven, Esra Pamukçu; Oktay, Inci

2013-04-01

The aim of this study was to obtain information about senior dental students' perceptions and self-confidence levels regarding endodontic practice. Anonymous survey forms were handed out to senior students at Yeditepe University, Faculty of Dentistry. The students were asked to score their level of confidence using a 5-point scale and comment about future practices. The response rate of the survey was 88%. 11.9% expressed endodontics as the first branch in terms of difficulty. The majority (90.5%) indicated they would perform root canal treatments within their expertise limit in the future but refer difficult cases to an endodontist. Bleaching of endodontically treated teeth, managing flare-ups, placement of a rubber dam were procedures in which students reported the lowest confidence (2.55 ± 1.17, 3.24 ± 0.96, 3.24 ± 1.19, respectively). On the other hand, students felt the lowest confidence in the treatment of maxillary molars followed by mandibular molars (3.43 ± 1.02 and 3.93 ± 0.97, respectively). Students also reported the lowest confidence in root resorptions, endo-perio lesions, traumas, retreatments and apexifications (2.93 ± 1.16, 3.07 ± 0.89, 3.24 ± 0.85, 3.33 ± 1.7 and 3.36 ± 1.1, respectively). The results showing students' lower confidence in more challenging aspects of dentistry may be related with the attitude of dental schools to refer these cases to post graduate students and instilling information about these cases on a theoretical basis only. Though there seems to be a tendency for students to refer challenging cases to a specialist in future, authorities should give priority to enhance the way information and experience is conveyed regarding various aspects of endodontic treatment.

Teaching and learning: Novice teachers' descriptions of their confidence to teach science content

NASA Astrophysics Data System (ADS)

Ford, Barbara Ann

Statement of the problem. The problem being studied in this research is the relationship between a specific series of integrated science courses in a science teacher preparation program and the actual needs of the science teacher during the first years of teaching practice. Teachers often report that there is a disconnect between the coursework they have taken in college as pre-service teachers and the reality of their classroom practice during their first years of teaching. The intent of this study was to record the descriptions of three teachers who were members of a cohort and took a series of integrated science courses (NSCI series) during their teacher preparation program as it related to the influence of these courses on their teaching practice. The focus of inquiry is guided by a single question: How do former participants in the series of science courses who are currently novice teachers describe their confidence in their ability to teach science content to their middle school students? The theoretical framework was based on Shulman's (1987) pedagogical content knowledge (PCK). PCK involves the teacher understanding the content of science so thoroughly that ways are identified of representing and formulating the subject matter to make it understandable to others. The teacher who has a strong PCK uses powerful analogies, illustrations, examples, explanations and demonstrations that promote personally meaningful student understandings. Novice teachers' reflections on their confidence to teach science content to their middle school students were observed through the lens of PCK. All three novice teachers reported a high confidence level to teach middle school science and attributed their confidence level to a great degree to the integrated science series of courses (NSCI). Method. A qualitative design, specifically a case study, was used for this study. Multiple forms of data collection were employed including a semi structured interview and a focus group. Data was collected, categorized and analyzed over a six week period. A constant comparative method (Bogdan & Biklen, 1998) was used to examine the data. Triangulation, member checking and a peer reviewer were used to reduce the risk of bias and increase the trustworthiness of the data.

Confidence bounds for normal and lognormal distribution coefficients of variation

Treesearch

Steve Verrill

2003-01-01

This paper compares the so-called exact approach for obtaining confidence intervals on normal distribution coefficients of variation to approximate methods. Approximate approaches were found to perform less well than the exact approach for large coefficients of variation and small sample sizes. Web-based computer programs are described for calculating confidence...

Self-reported and laboratory evaluation of late pregnancy nicotine exposure and drugs of abuse.

PubMed

Hall, E S; Wexelblatt, S L; Greenberg, J M

2016-10-01

The objective of this study was to evaluate the prevalence of late pregnancy nicotine exposures, including secondhand smoke exposures, and to evaluate the associated risk of exposure to drugs of abuse. The study was a retrospective single-center cohort analysis of more than 18 months. We compared self-reported smoking status from vital birth records with mass spectrometry laboratory results of maternal urine using a chi-square test. Logistic regression estimated adjusted odds for detection of drugs of abuse based on nicotine detection. Compared with 8.6% self-reporting cigarette use, mass spectrometry detected high-level nicotine exposures for 16.5% of 708 women (P<0.001) and an additional 7.5% with low-level exposures. We identified an increased likelihood of exposure to drugs of abuse, presented as adjusted odds ratios, (95% confidence interval (CI), for both low-level (5.69, CI: 2.09 to 15.46) and high-level (13.93, CI: 7.06 to 27.49) nicotine exposures. Improved measurement tactics are critically needed to capture late pregnancy primary and passive nicotine exposures from all potential sources.

Using the Reliability Theory for Assessing the Decision Confidence Probability for Comparative Life Cycle Assessments.

PubMed

Wei, Wei; Larrey-Lassalle, Pyrène; Faure, Thierry; Dumoulin, Nicolas; Roux, Philippe; Mathias, Jean-Denis

2016-03-01

Comparative decision making process is widely used to identify which option (system, product, service, etc.) has smaller environmental footprints and for providing recommendations that help stakeholders take future decisions. However, the uncertainty problem complicates the comparison and the decision making. Probability-based decision support in LCA is a way to help stakeholders in their decision-making process. It calculates the decision confidence probability which expresses the probability of a option to have a smaller environmental impact than the one of another option. Here we apply the reliability theory to approximate the decision confidence probability. We compare the traditional Monte Carlo method with a reliability method called FORM method. The Monte Carlo method needs high computational time to calculate the decision confidence probability. The FORM method enables us to approximate the decision confidence probability with fewer simulations than the Monte Carlo method by approximating the response surface. Moreover, the FORM method calculates the associated importance factors that correspond to a sensitivity analysis in relation to the probability. The importance factors allow stakeholders to determine which factors influence their decision. Our results clearly show that the reliability method provides additional useful information to stakeholders as well as it reduces the computational time.

Presentation of frozen shoulder among diabetic and non-diabetic patients☆

PubMed Central

Uddin, Mohammad Moin; Khan, Aminuddin A.; Haig, Andrew J.; Uddin, Mohammad Kafil

2014-01-01

Objective The literature is inconsistent regarding the level of pain and disability in frozen shoulder patients with or without diabetes mellitus. The aim of this study is to evaluate some demographic features of frozen shoulder patients and to look into the disparity of information by comparing the level of pain and disability due to frozen shoulder between diabetic and non-diabetic people. Design This is a prospective comparative study. People with frozen shoulder attending an outpatient department were selected by consecutive sampling. Disability levels were assessed by the Shoulder Pain & Disability Index (SPADI). Means of pain and disability scores were compared using unpaired t-test. Results Among 140 persons with shoulder pain 99 (71.4%) had frozen shoulder. From the participating 40 frozen shoulder patients, 26 (65%) were males and 14 (35%) were females. Seventeen participants (42.5%) were diabetic, two (5%) had impaired glucose tolerance and 21 (52.5%) patients were non-diabetic. Mean disability scores (SPADI) were 51 ± 15.5 in diabetic and 57 ± 16 in non-diabetic persons. The differences in pain and disability level were not statistically significance (respectively, p = 0.24 and p = 0.13 at 95% confidence interval). Conclusions No difference was found in level of pain and disability level between frozen shoulder patients with and without diabetes. PMID:25983497

Association between Homocysteine and Cerebral Small Vessel Disease: A Meta-Analysis.

PubMed

Piao, Xiangyu; Wu, Guangyao; Yang, Pei; Shen, Jing; De, Ailing; Wu, Jianlin; Qu, Qiumin

2018-05-22

This study aimed to evaluate whether elevated homocysteine levels is associated with risk of different subtypes of cerebral small vessel disease (CSVD) by using meta-analysis. Electronic databases were systematically searched up to April 2018 for collecting the studies reporting homocysteine levels in CSVD or CSVD subtypes. After an inclusion and exclusion criteria, the data was extracted. All data was analyzed using Stata software v.12.0 (Stata Corp LP, College Station, TX). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables. Eighteen studies met eligibility criteria with 5088 participants (1987 patients with CSVD and 3101 controls) included in the meta-analysis. Meta-analysis revealed that, compared with the controls group, the CSVD group had significantly higher homocysteine levels, with the SMD of .50 and 95% CI (.36-.64). Subgroup analyses suggested white matter lesion had significantly higher levels of homocysteine compared with controls (SMD = .56, 95% CI .39-.73), followed by silent brain infarction (SMD = .33, 95% CI .24-.42) and lacunar infarction (SMD = .17, 95% CI -.06 to .40). This meta-analysis found that CSVD or CSVD subtypes have a significantly higher homocysteine levels than in controls. Further prospective population-based studies are needed to longitudinally evaluate the association between homocysteine levels and progression of different CSVD subtypes. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Sample size, confidence, and contingency judgement.

PubMed

Clément, Mélanie; Mercier, Pierre; Pastò, Luigi

2002-06-01

According to statistical models, the acquisition function of contingency judgement is due to confidence increasing with sample size. According to associative models, the function reflects the accumulation of associative strength on which the judgement is based. Which view is right? Thirty university students assessed the relation between a fictitious medication and a symptom of skin discoloration in conditions that varied sample size (4, 6, 8 or 40 trials) and contingency (delta P = .20, .40, .60 or .80). Confidence was also collected. Contingency judgement was lower for smaller samples, while confidence level correlated inversely with sample size. This dissociation between contingency judgement and confidence contradicts the statistical perspective.

Temporary Hearing Threshold Shift in Healthy Volunteers with Hearing Protection Caused by Acoustic Noise Exposure during 3-T Multisequence MR Neuroimaging.

PubMed

Jin, Chao; Li, Huan; Li, Xianjun; Wang, Miaomiao; Liu, Congcong; Guo, Jianxin; Yang, Jian

2018-02-01

Purpose To determine whether a single 51-minute exposure to acoustic noise during 3-T multisequence magnetic resonance (MR) neuroimaging could affect the hearing threshold of healthy adults with earplugs and sponge mats as hearing protection. Materials and Methods With earplugs and motion-refraining sponge mats as hearing protection, 26 healthy young adults underwent 3-T MR neuroimaging imaging that included T1-weighted three-dimensional gradient-echo sequence, T2-weighted fast spin-echo sequence, diffusion-tensor imaging, diffusion-kurtosis imaging, T2*-weighted three-dimensional multiecho gradient-echo sequence, and blood oxygen level-dependent imaging. Automated auditory brainstem response (ABR) was used to measure the hearing thresholds within 24 hours before, within 20 minutes after, and 25 days after the MR examination. One-way repeated-measure analysis of variance with Bonferroni adjustment was used to compare automated ABR results among the three tests and partial η 2 (η p 2 ) was reported as a measure of effect size. Results Automated ABR results showed significantly increased mean threshold shift of 5.0 dB ± 8.1 (standard deviation) (left ear: 4.8 dB ± 9.2 [95% confidence interval: 1.09, 8.53], η p 2 = 0.221, P = .013; right ear: 5.2 dB ± 6.9 [95% confidence interval: 2.36, 8.02], η p 2 = 0.364, P = .001) immediately after the MR examination compared with the baseline study. This shift is below the temporary threshold shift of 40-50 dB that is associated with cochlea nerve changes. Automated ABR obtained at day 25 after MR imaging showed no significant differences from baseline (left ear: -2.3 dB ± 8.6 [95% confidence interval: -5.79, 1.78], η p 2 = 0.069, P = .185; right ear: 0.4 dB ± 7.3 [95% confidence interval: -3.35, 2.58], η p 2 = 0.003, P = .791). Conclusion A 3-T MR neuroimaging examination with the acoustic noise at equivalent sound pressure level of 103.5-111.3 dBA lasting 51 minutes can cause temporary hearing threshold shift in healthy volunteers with hearing protection. © RSNA, 2017.

Testosterone and androgen receptor gene polymorphism are associated with confidence and competitiveness in men.

PubMed

Eisenegger, Christoph; Kumsta, Robert; Naef, Michael; Gromoll, Jörg; Heinrichs, Markus

2017-06-01

A contribution to a special issue on Hormones and Human Competition. Studies in non-human animals and humans have demonstrated the important role of testosterone in competitive interactions. Here, we investigated whether endogenous testosterone levels predict the decision to compete, in a design excluding spite as a motive underlying competitiveness. In a laboratory experiment with real monetary incentives, 181 men solved arithmetic problems, first under a noncompetitive piece rate, followed by a competition incentive scheme. We also assessed several parameters relevant to competition, such as risk taking, performance, and confidence in one's own performance. Salivary testosterone levels were measured before and 20min after the competition task using mass spectrometry. Participants were also genotyped for the CAG repeat polymorphism of the androgen receptor gene, known to influence the efficacy of testosterone signaling in a reciprocal relationship to the number of CAG repeats. We observed a significant positive association between basal testosterone levels and the decision to compete, and that higher testosterone levels were related to greater confidence in one's own performance. Whereas the number of CAG repeats was not associated with the choice to compete, a lower number of CAG repeats was related to greater confidence in those who chose to compete, but this effect was attributable to the polymorphism's effect on actual performance. An increase in testosterone levels was observed following the experiment, and this increase varied with self-reported high-school math grades. We expand upon the latest research by documenting effects of the androgen system in confidence in one's own ability, and conclude that testosterone promotes competitiveness without spite. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of educational level with delay of prehospital care before reperfusion in STEMI.

PubMed

Heo, Ju Yeon; Hong, Ki Jeong; Shin, Sang Do; Song, Kyoung Jun; Ro, Young Sun

2015-12-01

Rapid access to reperfusion is important in ST-segment elevation myocardial infarction (STEMI). The goal of this study is to assess the association of the educational level of patients with STEMI and prehospital and inhospital delay before reperfusion. We used a nationwide database of 31 emergency departments for cardiovascular disease surveillance operated by the Korean Centers for Disease Control and Prevention. ST-segment elevation myocardial infarction cases registered from November 2007 to December 2012 were enrolled. Cases younger than 18 years old or missing educational history were excluded. Educational level was characterized as low (completion of elementary school or less), medium (completion of middle or high school), and high (completion of a bachelor's degree or higher). We compared prehospital and inhospital delay for 3 educational groups. A general linear regression was used to assess the association of educational level with the time from symptom to hospital arrival. A total of 9028 patients with STEMI were included. The median time from symptom to hospital arrival was 144, 76, and 68 minutes in the low, medium, and high education groups, respectively (P < .01). Educational level had no significant effect on the door-to-balloon time. Low and medium education groups experienced significant delays of symptom to hospital to high education group (low: β = 27.2 minutes; 95% confidence interval, 15.9-38.5; medium: β = 19.1 minutes; 95% confidence interval, 15.9-38.5). In patients with STEMI, the time from symptom to hospital arrival increased as educational level decreased, but educational level had no significant association with the inhospital delay to reperfusion. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of unaffordable medical need on distress level of family member: analyses of 1997-2013 United States National Health Interview Surveys.

PubMed

Chih, Hui Jun; Liang, Wenbin

2017-09-02

Reduced funding to public health care systems during economic downturns is a common phenomenon around the world. The effect of health care cost on family members of the patients has not been established. This paper aims to explore the relationship between affordability of health care and vulnerability of family members to distress levels. Data of a total of 262,843 participants were obtained from 17 waves (1997-2013) of the United States National Health Interview Survey. Multinomial logistic regression was used to investigate psychological distress level as a result of having family members who experienced unmet medical needs due to cost. Among participants without family members who experienced unmet needs for medical care due to cost, risks of having 'moderate' (score of 5-12) or 'serious' (score of 13 or above) level of psychological distress were 1.0% and 11.5%, respectively. Risks of having 'moderate' or 'serious' level of psychological distress were 3.1% and 23.4%, respectively among participants with family members who experienced unmet needs. The adjusted relative risk ratio of 'moderate' and 'serious', as compared to 'normal' level of psychological distress, were 1.58 (95% confidence interval: 1.47-1.69) and 2.09 (95% confidence interval: 1.78-2.45) if one's family members experienced unmet medical needs. Unmet medical needs due to cost increases risk of distress levels experienced by family members. Careful planning and adequate funding to public health care system could be implemented to prevent any unnecessary detrimental effect on mental health among family members of the unwell and any further increment of the prevalence of mental illnesses. This recommendation aligns with the World Health Organization Mental Health Action Plan 2013-2020.

Effect of Smoking and Folate Levels on the Efficacy of Folic Acid Therapy in Prevention of Stroke in Hypertensive Men.

PubMed

Zhou, Ziyi; Li, Jianping; Yu, Yaren; Li, Youbao; Zhang, Yan; Liu, Lishun; Song, Yun; Zhao, Min; Wang, Yu; Tang, Genfu; He, Mingli; Xu, Xiping; Cai, Yefeng; Dong, Qiang; Yin, Delu; Huang, Xiao; Cheng, Xiaoshu; Wang, Binyan; Hou, Fan Fan; Wang, Xiaobin; Qin, Xianhui; Huo, Yong

2018-01-01

We aimed to examine whether the efficacy of folic acid therapy in the primary prevention of stroke is jointly affected by smoking status and baseline folate levels in a male population in a post hoc analysis of the CSPPT (China Stroke Primary Prevention Trial). Eligible participants of the CSPPT were randomly assigned to a double-blind daily treatment of a combined enalapril 10-mg and folic acid 0.8-mg tablet or an enalapril 10-mg tablet alone. In total, 8384 male participants of the CSPPT were included in the current analyses. The primary outcome was first stroke. The median treatment duration was 4.5 years. In the enalapril-alone group, the first stroke risk varied by baseline folate levels and smoking status (never versus ever). Specifically, there was an inverse association between folate levels and first stroke in never smokers ( P for linear trend=0.043). However, no such association was found in ever smokers. A test for interaction between baseline folate levels and smoking status on first stroke was significant ( P =0.045). In the total sample, folic acid therapy significantly reduced the risk of first stroke in never smokers with folate deficiency (hazard risk, 0.36; 95% confidence interval, 0.16-0.83) and in ever smokers with normal folate levels (hazard risk, 0.69; 95% confidence interval, 0.48-0.99). Baseline folate levels and smoking status can interactively affect the risk of first stroke. Our data suggest that compared with never smokers, ever smokers may require a higher dosage of folic acid to achieve a greater beneficial effect on stroke. Our findings need to be confirmed by future randomized trials. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00794885. © 2017 American Heart Association, Inc.

Diabetes mellitus and Parkinson disease.

PubMed

Pagano, Gennaro; Polychronis, Sotirios; Wilson, Heather; Giordano, Beniamino; Ferrara, Nicola; Niccolini, Flavia; Politis, Marios

2018-05-08

To investigate whether diabetes mellitus is associated with Parkinson-like pathology in people without Parkinson disease and to evaluate the effect of diabetes mellitus on markers of Parkinson pathology and clinical progression in drug-naive patients with early-stage Parkinson disease. We compared 25 patients with Parkinson disease and diabetes mellitus to 25 without diabetes mellitus, and 14 patients with diabetes mellitus and no Parkinson disease to 14 healthy controls (people with no diabetes mellitus or Parkinson disease). The clinical diagnosis of diabetes mellitus was confirmed by 2 consecutive fasting measurements of serum glucose levels >126 mL/dL. Over a 36-month follow-up period, we then investigated in the population with Parkinson disease whether the presence of diabetes mellitus was associated with faster motor progression or cognitive decline. The presence of diabetes mellitus was associated with higher motor scores ( p < 0.01), lower striatal dopamine transporter binding ( p < 0.05), and higher tau CSF levels ( p < 0.05) in patients with Parkinson disease. In patients with diabetes but without Parkinson disease, the presence of diabetes mellitus was associated with lower striatal dopamine transporter binding ( p < 0.05) and higher tau ( p < 0.05) and α-synuclein ( p < 0.05) CSF levels compared to healthy controls. At the Cox survival analysis in the population of patients with Parkinson disease, the presence of diabetes mellitus was associated with faster motor progression (hazard ratio = 4.521, 95% confidence interval = 1.468-13.926; p < 0.01) and cognitive decline (hazard ratio = 9.314, 95% confidence interval = 1.164-74.519; p < 0.05). Diabetes mellitus may predispose toward a Parkinson-like pathology, and when present in patients with Parkinson disease, can induce a more aggressive phenotype. © 2018 American Academy of Neurology.

Adjunctive Aripiprazole Versus Placebo for Antipsychotic-Induced Hyperprolactinemia: Meta-Analysis of Randomized Controlled Trials

PubMed Central

Li, Xianbin; Tang, Yilang; Wang, Chuanyue

2013-01-01

Objective To compare the safety and efficacy of adjunctive aripiprazole versus placebo for antipsychotic-induced hyperprolactinemia. Methods Population: adult patients presenting with antipsychotic-induced hyperprolactinemia diagnosed by prolactin level with or without prolactin-related symptoms. Interventions: adjunctive aripiprazole vs. adjunctive placebo. Outcome measures: adverse events and efficacy of treatment. Studies: randomized controlled trials. Results Five randomized controlled trials with a total of 639 patients (326 adjunctive aripiprazole, 313 adjunctive placebo) met the inclusion criteria. Adjunctive aripiprazole was associated with a 79.11% (125/158) prolactin level normalization rate. Meta-analysis of insomnia, headache, sedation, psychiatric disorder, extrapyramidal symptom, dry mouth, and fatigue showed no significant differences in the adjunctive aripiprazole treatment group compared with the placebo group (risk difference (Mantel-Haenszel, random or fixed) −0.05 to 0.04 (95% confidence interval −0.13 to 0.16); I2 = 0% to 68%, P = 0.20 to 0.70). However, sedation, insomnia, and headache were more frequent when the adjunctive aripiprazole dose was higher than 15 mg/day. Meta-analysis of the prolactin level normalization indicated adjunctive aripiprazole was superior to placebo (risk difference (Mantel-Haenszel, random) 0.76 (95% confidence interval 0.67 to 0.85); I2 = 43%, P<0.00001). The subgroup analysis confirmed that the subjects who received adjunctive aripiprazole 5 mg/day showed a degree of prolactin normalization similar to that of all participants. No significant differences between groups in discontinuation and improvements of psychiatric symptoms. Conclusion Adjunctive aripiprazole is both safe and effective as a reasonable choice treatment for patients with antipsychotic-induced hyperprolactinemia. The appropriate dose of adjunctive aripiprazole may be 5 mg/day. PMID:23936389

Knowledge, experience and perceptions regarding Molar-Incisor Hypomineralisation (MIH) amongst Australian and Chilean public oral health care practitioners.

PubMed

Gambetta-Tessini, K; Mariño, R; Ghanim, A; Calache, H; Manton, D J

2016-08-18

Molar-Incisor Hypomineralisation (MIH) is a prevalent developmental defect of tooth enamel associated with a high burden of disease. The present study aimed to survey Australian and Chilean oral health care practitioners (OHCPs) working in public dental facilities and to compare their knowledge, clinical experience and perceptions about MIH. Findings would give insights about how current knowledge has penetrated into OHCPs working into the public systems. A mixed-mode survey regarding MIH was carried out amongst Australian and Chilean OHCPs from the public sector. The survey required responses to questions regarding sociodemographics, clinical experience, perceptions, clinical management and preferences for further training. The level of knowledge regarding MIH was determined by Delphi methods for consensus. Data analysis utilised Chi-square, linear and logistic regression models using SPSS Ver. 22.0. The majority of respondents had observed MIH in their patients (88.6 %) and the level of knowledge regarding MIH was high in Australian participants (p = 0.03). Australian respondents felt more confident when diagnosing (OR 8.80, 95 % CI 2.49-31.16) and treating MIH-affected children (OR 4.56, 95 % CI 2.16-9.76) compared to Chilean respondents. Oral health therapists reported higher levels of confidence than Australian general dental practitioners when providing treatment to children with MIH (OR 7.53; 95 % CI 1.95-29.07). Continuing to update clinical guidelines may help practitioners increase their understanding when diagnosing and treating MIH-affected children. Dissemination of information and awareness regarding MIH is necessary in public clinics, and in particular Chilean general dental practitioners should be alerted to these factors.

Relation of Perceived Health Competence to Physical Activity in Patients With Coronary Heart Disease.

PubMed

Bachmann, Justin M; Mayberry, Lindsay S; Wallston, Kenneth A; Huang, Shi; Roumie, Christianne L; Muñoz, Daniel; Patel, Niral J; Kripalani, Sunil

2018-05-01

Physical inactivity is highly associated with mortality, especially in patients with coronary heart disease. We evaluated the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on cumulative physical activity levels in the Mid-South Coronary Heart Disease Cohort Study. The Mid-South Coronary Heart Disease Cohort Study consists of 2,587 outpatients (32% were female) with coronary heart disease at an academic medical center network in the United States. Cumulative physical activity was quantified in metabolic equivalent (MET)-minutes per week with the International Physical Activity Questionnaire. We investigated associations between the 2-item Perceived Health Competence Scale (PHCS-2) and MET-minutes/week after adjusting for co-morbidities and psychosocial factors with linear regression. Nearly half of participants (47%) exhibited low physical activity levels (<600 MET-minutes/week). Perceived health competence was highly associated with physical activity after multivariable adjustment. A nonlinear relation was observed, with the strongest effect on physical activity occurring at lower levels of perceived health competence. There was effect modification by gender (p = 0.03 for interaction). The relation between perceived health competence and physical activity was stronger in women compared with men; an increase in the PHCS-2 from 3 to 4 was associated with a 73% increase in MET-minutes/week in women (95% confidence interval 43% to 109%, p <0.0001) compared with a 53% increase in men (95% confidence interval 27% to 84%, p <0.0001). In conclusion, low perceived health competence was strongly associated with less physical activity in patients with coronary heart disease and may represent a potential target for behavioral interventions. Published by Elsevier Inc.

Option A improved HIV-free infant survival and mother to child HIV transmission at 9-18 months in Zimbabwe.

PubMed

Buzdugan, Raluca; Kang Dufour, Mi-Suk; McCoy, Sandra I; Watadzaushe, Constancia; Dirawo, Jeffrey; Mushavi, Angela; Mujuru, Hilda Angela; Mahomva, Agnes; Kangwende, Rugare Abigail; Hakobyan, Anna; Mugurungi, Owen; Cowan, Frances M; Padian, Nancy S

2016-06-19

We evaluated the impact of Option A on HIV-free infant survival and mother-to-child transmission (MTCT) in Zimbabwe. Serial cross-sectional community-based serosurveys. We analyzed serosurvey data collected in 2012 and 2014 among mother-infant pairs from catchment areas of 132 health facilities from five of 10 provinces in Zimbabwe. Eligible infants (alive or deceased) were born 9-18 months before each survey to mothers at least 16 years old. We randomly selected mother-infant pairs and conducted questionnaires, verbal autopsies, and collected blood samples. We estimated the HIV-free infant survival and MTCT rate within each catchment area and compared the 2012 and 2014 estimates using a paired t test and number of HIV infections averted because of the intervention. We analyzed 7249 mother-infant pairs with viable maternal specimens collected in 2012 and 8551 in 2014. The mean difference in the catchment area level MTCT between 2014 and 2012 was -5.2 percentage points (95% confidence interval = -8.1, -2.3, P < 0.001). The mean difference in the catchment area level HIV-free survival was 5.5 percentage points (95% confidence interval = 2.6, 8.5, P < 0.001). Between 2012 and 2014, 1779 infant infections were averted compared with the pre-Option A regimen. The association between HIV-free infant survival and duration of Option A implementation was NS at the multivariate level (P = 0.093). We found a substantial and statistically significant increase in HIV-free survival and decrease in MTCT among infants aged 9-18 months following Option A rollout in Zimbabwe. This is the only evaluation of Option A and shows the effectiveness of Option A and Zimbabwe's remarkable progress toward eMTCT.

Diagnostic potential of endotoxin scattering photometry for sepsis and septic shock.

PubMed

Shimizu, Tomoharu; Obata, Toru; Sonoda, Hiromichi; Akabori, Hiroya; Miyake, Tohru; Yamamoto, Hiroshi; Tabata, Takahisa; Eguchi, Yutaka; Tani, Tohru

2013-12-01

Endotoxin scattering photometry (ESP) is a novel Limulus amebocyte lysate (LAL) assay that uses a laser light-scattering particle-counting method. In the present study, we compared ESP, standard turbidimetric LAL assay, and procalcitonin assay for the evaluation of sepsis after emergency gastrointestinal surgery. A total of 174 samples were collected from 40 adult patients undergoing emergency gastrointestinal surgery and 10 patients with colorectal cancer undergoing elective surgery as nonseptic controls. Plasma endotoxin levels were measured with ESP and turbidimetric LAL assay, and plasma procalcitonin levels were assessed with a standard procalcitonin assay. Plasma endotoxin and procalcitonin levels increased corresponding to the degree of sepsis. Endotoxin scattering photometry significantly discriminated between patients with or without septic shock: sensitivity, 81.1%; specificity, 76.6%; positive predictive value, 48.4%; negative predictive value, 93.8%; and accuracy, 77.6%. The area under the receiver operating characteristic curve for septic shock with the ESP assay (endotoxin cutoff value, 23.8 pg/mL) was 0.8532 ± 0.0301 (95% confidence interval, 0.7841-0.9030; P < 0.0001). The predictive power of ESP was superior to that of turbidimetric assay (difference, 0.1965 ± 0.0588; 95% confidence interval, 0.0812-0.3117; P = 0.0008). There was no significant difference in predictive power between ESP and procalcitonin assay. Endotoxin scattering photometry also discriminated between patients with and without sepsis. Area under the receiver operating characteristic curve analysis showed that ESP had the best predictive power for diagnosing sepsis. In conclusion, compared with turbidimetric LAL assay, ESP more sensitively detected plasma endotoxin and significantly discriminated between sepsis and septic shock in patients undergoing gastrointestinal emergency surgery.

Confidence as a Common Currency between Vision and Audition

PubMed Central

de Gardelle, Vincent; Le Corre, François; Mamassian, Pascal

2016-01-01

The idea of a common currency underlying our choice behaviour has played an important role in sciences of behaviour, from neurobiology to psychology and economics. However, while it has been mainly investigated in terms of values, with a common scale on which goods would be evaluated and compared, the question of a common scale for subjective probabilities and confidence in particular has received only little empirical investigation so far. The present study extends previous work addressing this question, by showing that confidence can be compared across visual and auditory decisions, with the same precision as for the comparison of two trials within the same task. We discuss the possibility that confidence could serve as a common currency when describing our choices to ourselves and to others. PMID:26808061

Motivators for children with severe intellectual disabilities in the self-contained classroom: a movement analysis.

PubMed

DeBedout, Jennifer K; Worden, Melissa C

2006-01-01

The purpose of this study was to analyze the impact of the presence of a music therapist versus the use of switch-activated toys and recorded music in evoking physiological, affective, and vocal responses in school-aged children who are considered SID, or Severely Intellectually Disabled. Researchers studied movement responses to determine how these children might respond more readily to a music therapist interacting musically with them than to the toys and to the recorded music. Each of the 17 children participated in a videotaped session that included 5 trials. Other than the rest trial, motivators presented were: a switch-activated pig toy, switch-activated recorded music, the music therapist playing and singing to the child contingent upon his touching the guitar, and the therapist playing and singing to the child continually. A data collection sheet was developed by the researchers to assess positive responses by measuring limb and head movement, vocal sound, and facial expression change. The Kruskal-Wallis test was used to determine differences in means responses to music and nonmusic trials. At a 90% level of confidence, statistical significance was attained in comparing the responses to the pig toy, recorded music, and "activated guitar" trial to the trial during which the therapist played guitar and sang continually to the child. In addition, at a 95% level of confidence, statistically significant differences were found in comparing the pig and the recorded music trials with the therapist trial.

The effect of multiple internal representations on context-rich instruction

NASA Astrophysics Data System (ADS)

Lasry, Nathaniel; Aulls, Mark W.

2007-11-01

We discuss n-coding, a theoretical model of multiple internal mental representations. The n-coding construct is developed from a review of cognitive and imaging data that demonstrates the independence of information processed along different modalities such as verbal, visual, kinesthetic, logico-mathematic, and social modalities. A study testing the effectiveness of the n-coding construct in classrooms is presented. Four sections differing in the level of n-coding opportunities were compared. Besides a traditional-instruction section used as a control group, each of the remaining three sections were given context-rich problems, which differed by the level of n-coding opportunities designed into their laboratory environment. To measure the effectiveness of the construct, problem-solving skills were assessed as conceptual learning using the force concept inventory. We also developed several new measures that take students' confidence in concepts into account. Our results show that the n-coding construct is useful in designing context-rich environments and can be used to increase learning gains in problem solving, conceptual knowledge, and concept confidence. Specifically, when using props in designing context-rich problems, we find n-coding to be a useful construct in guiding which additional dimensions need to be attended to.

The intricate Galaxy disk: velocity asymmetries in Gaia-TGAS

NASA Astrophysics Data System (ADS)

Antoja, T.; de Bruijne, J.; Figueras, F.; Mor, R.; Prusti, T.; Roca-Fàbrega, S.

2017-06-01

We use Gaia-TGAS data to compare the transverse velocities in Galactic longitude (coming from proper motions and parallaxes) in the Milky Way disk for negative and positive longitudes as a function of distance. The transverse velocities are strongly asymmetric and deviate significantly from the expectations for an axisymmetric galaxy. The value and sign of the asymmetry changes at spatial scales of several tens of degrees in Galactic longitude and about 0.5 kpc in distance. The asymmetry is statistically significant at 95% confidence level for 57% of the region probed, which extends up to 1.2 kpc. A percentage of 24% of the region shows absolute differences at this confidence level larger than 5 km s-1 and 7% larger than 10 km s-1. The asymmetry pattern shows mild variations in the vertical direction and with stellar type. A first qualitative comparison with spiral arm models indicates that the arms are probably not the main source of the asymmetry. We briefly discuss alternative origins. This is the first time that global all-sky asymmetries are detected in the Milky Way kinematics beyond the local neighbourhood and with a purely astrometric sample.

The validity of visual acuity assessment using mobile technology devices in the primary care setting.

PubMed

O'Neill, Samuel; McAndrew, Darryl J

2016-04-01

The assessment of visual acuity is indicated in a number of clinical circumstances. It is commonly conducted through the use of a Snellen wall chart. Mobile technology developments and adoption rates by clinicians may potentially provide more convenient methods of assessing visual acuity. Limited data exist on the validity of these devices and applications. The objective of this study was to evaluate the assessment of distance visual acuity using mobile technology devices against the commonly used 3-metre Snellen chart in a primary care setting. A prospective quantitative comparative study was conducted at a regional medical practice. The visual acuity of 60 participants was assessed on a Snellen wall chart and two mobile technology devices (iPhone, iPad). Visual acuity intervals were converted to logarithm of minimum angle of resolution (logMAR) scores and subjected to intraclass correlation coefficient (ICC) assessment. The results show a high level of general agreement between testing modality (ICC 0.917 with a 95% confidence interval of 0.887-0.940). The high level of agreement of visual acuity results between the Snellen wall chart and both mobile technology devices suggests that clinicians can use this technology with confidence in the primary care setting.

Confidence and self-attribution bias in an artificial stock market.

PubMed

Bertella, Mario A; Pires, Felipe R; Rego, Henio H A; Silva, Jonathas N; Vodenska, Irena; Stanley, H Eugene

2017-01-01

Using an agent-based model we examine the dynamics of stock price fluctuations and their rates of return in an artificial financial market composed of fundamentalist and chartist agents with and without confidence. We find that chartist agents who are confident generate higher price and rate of return volatilities than those who are not. We also find that kurtosis and skewness are lower in our simulation study of agents who are not confident. We show that the stock price and confidence index-both generated by our model-are cointegrated and that stock price affects confidence index but confidence index does not affect stock price. We next compare the results of our model with the S&P 500 index and its respective stock market confidence index using cointegration and Granger tests. As in our model, we find that stock prices drive their respective confidence indices, but that the opposite relationship, i.e., the assumption that confidence indices drive stock prices, is not significant.

Confidence and self-attribution bias in an artificial stock market

PubMed Central

Bertella, Mario A.; Pires, Felipe R.; Rego, Henio H. A.; Vodenska, Irena; Stanley, H. Eugene

2017-01-01

Using an agent-based model we examine the dynamics of stock price fluctuations and their rates of return in an artificial financial market composed of fundamentalist and chartist agents with and without confidence. We find that chartist agents who are confident generate higher price and rate of return volatilities than those who are not. We also find that kurtosis and skewness are lower in our simulation study of agents who are not confident. We show that the stock price and confidence index—both generated by our model—are cointegrated and that stock price affects confidence index but confidence index does not affect stock price. We next compare the results of our model with the S&P 500 index and its respective stock market confidence index using cointegration and Granger tests. As in our model, we find that stock prices drive their respective confidence indices, but that the opposite relationship, i.e., the assumption that confidence indices drive stock prices, is not significant. PMID:28231255

Personality and Cultural Modeling for Agent-Based Representation of a Terrorist Cell, Phase 1

DTIC Science & Technology

2003-01-01

domains of Neuroticism, Extroversion, Openness, Agreeableness and Conscientiousness into six 5 facets each. The six facets alone provide a level of...confident confident timid--- bold no easily embarrassed---not easily embarrassed doubting---confident OK defensive---open OK inhibited---expressive...working alone pleasure-seeking---not no pleasure-seeking involved---aloof OK seeks out others---seeks isolation talkative---reticent OK spontaneous---not

The Development and Validation of a Tool to Measure Self-Confidence and Anxiety in Nursing Students While Making Clinical Decisions

ERIC Educational Resources Information Center

White, Krista Alaine

2011-01-01

Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety are two affective influences that impact the learning and adeptness of CDM. Currently, no instruments exist that measure perceived self-confidence and anxiety level of undergraduate nursing students related to CDM. The purpose of this research was to…

Big Stimulus, Little Ears: Safety in Administering Vestibular Evoked Myogenic Potentials (VEMP) in Children

PubMed Central

Thomas, Megan L.A.; Fitzpatrick, Denis; McCreery, Ryan; Janky, Kristen L.

2017-01-01

Background Cervical and ocular Vestibular Evoked Myogenic Potentials (VEMPs) have become common clinical vestibular assessments. However, VEMP testing requires high intensity stimuli, raising concerns regarding safety with children, where sound pressure levels may be higher due to their smaller ear canal volumes. Purpose The purpose of this study was to estimate the range of peak-to-peak equivalent sound pressure levels (peSPLs) in child and adult ears in response to high intensity stimuli (i.e., 100 dB normal hearing level (nHL)) commonly used for VEMP testing and make a determination of whether acoustic stimuli levels with VEMP testing are safe for use in children. Research Design Prospective Experimental. Study Sample Ten children (4–6 years) and ten young adults (24 – 35 years) with normal hearing sensitivity and middle ear function participated in the study. Data Collection and Analysis Probe microphone peSPL measurements of clicks and 500 Hz tonebursts (TBs) were recorded in tubes of small, medium, and large diameter, and in a Brüel & Kjær Ear Simulator Type 4157 to assess for linearity of the stimulus at high levels. The different diameter tubes were used to approximate the range of cross-sectional areas in infant, child, and adult ears, respectively. Equivalent ear canal volume and peSPL measurements were then recorded in child and adult ears. Lower intensity levels were used in the participant’s ears to limit exposure to high intensity sound. The peSPL measurements in participant ears were extrapolated using predictions from linear mixed models to determine if equivalent ear canal volume significantly contributed to overall peSPL and to estimate the mean and 95% confidence intervals of peSPLs in child and adult ears when high intensity stimulus levels (100 dB nHL) are used for VEMP testing without exposing subjects to high-intensity stimuli. Results Measurements from the coupler and tubes suggested: 1) each stimuli was linear, 2) there were no distortions or non-linearities at high levels, and 3) peSPL increased with decreased tube diameter. Measurements in participant ears suggested: 1) peSPL was approximately 3 dB larger in child compared to adult ears, and 2) peSPL was larger in response to clicks compared to 500 Hz TBs. The model predicted the following 95% confidence interval for a 100 dB nHL click: 127–136.5 dB peSPL in adult ears and 128.7–138.2 dB peSPL in child ears. The model predicted the following 95% confidence interval for a 100 dB nHL 500 Hz TB stimulus: 122.2 – 128.2 dB peSPL in adult ears and 124.8–130.8 dB peSPL in child ears. Conclusions Our findings suggest that 1) when completing VEMP testing, the stimulus is approximately 3 dB higher in a child’s ear, 2) a 500 Hz TB is recommended over a click as it has lower peSPL compared to the click, and 3) both duration and intensity should be considered when choosing VEMP stimuli. Calculating the total sound energy exposure for your chosen stimuli is recommended as it accounts for both duration and intensity. When using this calculation for children, consider adding 3 dB to the stimulus level. PMID:28534730

Big Stimulus, Little Ears: Safety in Administering Vestibular-Evoked Myogenic Potentials in Children.

PubMed

Thomas, Megan L A; Fitzpatrick, Denis; McCreery, Ryan; Janky, Kristen L

2017-05-01

Cervical and ocular vestibular-evoked myogenic potentials (VEMPs) have become common clinical vestibular assessments. However, VEMP testing requires high intensity stimuli, raising concerns regarding safety with children, where sound pressure levels may be higher due to their smaller ear canal volumes. The purpose of this study was to estimate the range of peak-to-peak equivalent sound pressure levels (peSPLs) in child and adult ears in response to high intensity stimuli (i.e., 100 dB normal hearing level [nHL]) commonly used for VEMP testing and make a determination of whether acoustic stimuli levels with VEMP testing are safe for use in children. Prospective experimental. Ten children (4-6 years) and ten young adults (24-35 years) with normal hearing sensitivity and middle ear function participated in the study. Probe microphone peSPL measurements of clicks and 500 Hz tonebursts (TBs) were recorded in tubes of small, medium, and large diameter, and in a Brüel & Kjær Ear Simulator Type 4157 to assess for linearity of the stimulus at high levels. The different diameter tubes were used to approximate the range of cross-sectional areas in infant, child, and adult ears, respectively. Equivalent ear canal volume and peSPL measurements were then recorded in child and adult ears. Lower intensity levels were used in the participant's ears to limit exposure to high intensity sound. The peSPL measurements in participant ears were extrapolated using predictions from linear mixed models to determine if equivalent ear canal volume significantly contributed to overall peSPL and to estimate the mean and 95% confidence intervals of peSPLs in child and adult ears when high intensity stimulus levels (100 dB nHL) are used for VEMP testing without exposing subjects to high-intensity stimuli. Measurements from the coupler and tubes suggested: 1) each stimuli was linear, 2) there were no distortions or nonlinearities at high levels, and 3) peSPL increased with decreased tube diameter. Measurements in participant ears suggested: 1) peSPL was approximately 3 dB larger in child compared to adult ears, and 2) peSPL was larger in response to clicks compared to 500 Hz TBs. The model predicted the following 95% confidence interval for a 100 dB nHL click: 127-136.5 dB peSPL in adult ears and 128.7-138.2 dB peSPL in child ears. The model predicted the following 95% confidence interval for a 100 dB nHL 500 Hz TB stimulus: 122.2-128.2 dB peSPL in adult ears and 124.8-130.8 dB peSPL in child ears. Our findings suggest that 1) when completing VEMP testing, the stimulus is approximately 3 dB higher in a child's ear, 2) a 500 Hz TB is recommended over a click as it has lower peSPL compared to the click, and 3) both duration and intensity should be considered when choosing VEMP stimuli. Calculating the total sound energy exposure for your chosen stimuli is recommended as it accounts for both duration and intensity. When using this calculation for children, consider adding 3 dB to the stimulus level. American Academy of Audiology

Critical Appraisal Skills Among Canadian Obstetrics and Gynaecology Residents: How Do They Fare?

PubMed

Bougie, Olga; Posner, Glenn; Black, Amanda Y

2015-07-01

Evidence-based medicine has become the standard of care in clinical practice. In this study, our objectives were to (1) determine the type of epidemiology and/or biostatistical training being given in Canadian obstetrics and gynaecology post-graduate programs, (2) determine obstetrics and gynaecology residents' level of confidence with critical appraisal, and (3) assess knowledge of fundamental biostatistical and epidemiological principles among Canadian obstetrics and gynaecology trainees. During a national standardized in-training examination, all Canadian obstetrics and gynaecology residents were invited to complete an anonymous cross-sectional survey to determine their levels of confidence with critical appraisal. Fifteen critical appraisal questions were integrated into the standardized examination to assess critical appraisal skills objectively. Primary outcomes were the residents' level of confidence interpreting biostatistical results and applying research findings to clinical practice, their desire for more biostatistics/epidemiological training in residency, and their performance on knowledge questions. A total of 301 of 355 residents completed the survey (response rate=84.8%). Most (76.7%) had little/no confidence interpreting research statistics. Confidence was significantly higher in those with increased seniority (OR=1.93), in those who had taken a previous epidemiology/statistics course (OR=2.65), and in those who had prior publications (OR=1.82). Many (68%) had little/no confidence applying research findings to clinical practice. Confidence increased significantly with increasing training year (P<0.001) and with formal epidemiology training during residency (OR=2.01). The mean score of the 355 residents on the knowledge assessment questions was 69.8%. Increasing seniority was associated with improved overall test performance (P=0.02). Poorer performance topics included analytical study method (9.9%), study design (36.9%), and sample size (42.0%). Most (84.4%) wanted more epidemiology teaching. Canadian obstetrics and gynaecology residents may have the biostatistical and epidemiological knowledge to interpret results published in the literature, but lack confidence applying these skills in clinical settings. Most residents want additional training in these areas, and residency programs should include training in formal curriculums to improve their confidence and prepare them for a lifelong practice of evidence-based medicine.

Methodology for building confidence measures

NASA Astrophysics Data System (ADS)

Bramson, Aaron L.

2004-04-01

This paper presents a generalized methodology for propagating known or estimated levels of individual source document truth reliability to determine the confidence level of a combined output. Initial document certainty levels are augmented by (i) combining the reliability measures of multiply sources, (ii) incorporating the truth reinforcement of related elements, and (iii) incorporating the importance of the individual elements for determining the probability of truth for the whole. The result is a measure of confidence in system output based on the establishing of links among the truth values of inputs. This methodology was developed for application to a multi-component situation awareness tool under development at the Air Force Research Laboratory in Rome, New York. Determining how improvements in data quality and the variety of documents collected affect the probability of a correct situational detection helps optimize the performance of the tool overall.

Effectiveness of an education intervention to strengthen nurses' readiness for evidence-based practice: A single-blind randomized controlled study.

PubMed

Saunders, Hannele; Vehviläinen-Julkunen, Katri; Stevens, Kathleen R

2016-08-01

Nurses' lack of readiness for evidence-based practice slows down the uptake, adoption, and implementation of evidence-based practice which is of international concern as it impedes attainment of the highest quality of care and best patient outcomes. There is limited evidence about the most effective approaches to strengthen nurses' readiness for evidence-based practice. To evaluate the effectiveness of an Advanced Practice Nurse-delivered education program to strengthen nurses' readiness for evidence-based practice at a university hospital. A single-blind randomized controlled trial with repeated measures design, with measures completed during spring and fall 2015, before the education program (T0), within 1week after (T1), 8weeks after (T2), and 4months after completion of education interventions (T3). One large university hospital system in Finland, consisting of 15 acute care hospitals. The required sample size, calculated by a priori power analysis and including a 20% estimated attrition rate, called for 85 nurse participants to be recruited. Nurses working in different professional nursing roles and care settings were randomly allocated into two groups: intervention (evidence-based practice education, N=43) and control (research utilization education, N=34). The nurse participants received live 4-h education sessions on the basic principles of evidence-based practice (intervention group) and on the principles of research utilization (control group). The intervention group also received a web-based interactive evidence-based practice education module with a booster mentoring intervention. Readiness for evidence-based practice data, previous experience with evidence-based practice, and participant demographics were collected using the Stevens' EBP Readiness Inventory. Nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge were lower at T0, compared with the post-education scores, specifically at T1. The improvement in the confidence or actual evidence-based practice knowledge levels did not differ between the intervention and control groups. Confidence in employing evidence-based practice was directly correlated with level of education and inversely correlated with age. Actual evidence-based practice knowledge was lowest among nurses who had no previous knowledge or experience of evidence-based practice. Both the evidence-based practice and research utilization education interventions improved nurses' confidence in employing evidence-based practice and actual evidence-based practice knowledge, strengthening their evidence-based practice readiness at least in the short-term. Most of the variation in the confidence in employing evidence-based practice and actual evidence-based practice knowledge levels was due to background factors, such as primary role and education level, which emphasize differences in educational needs between nurses with diverse backgrounds. Copyright © 2016 Elsevier Inc. All rights reserved.

Self-Reported Recovery from 2-Week 12-Hour Shift Work Schedules: A 14-Day Follow-Up

PubMed Central

Merkus, Suzanne L.; Holte, Kari Anne; Huysmans, Maaike A.; van de Ven, Peter M.; van Mechelen, Willem; van der Beek, Allard J.

2015-01-01

Background Recovery from fatigue is important in maintaining night workers' health. This study compared the course of self-reported recovery after 2-week 12-hour schedules consisting of either night shifts or swing shifts (i.e., 7 night shifts followed by 7 day shifts) to such schedules consisting of only day work. Methods Sixty-one male offshore employees—20 night workers, 16 swing shift workers, and 25 day workers—rated six questions on fatigue (sleep quality, feeling rested, physical and mental fatigue, and energy levels; scale 1–11) for 14 days after an offshore tour. After the two night-work schedules, differences on the 1st day (main effects) and differences during the follow-up (interaction effects) were compared to day work with generalized estimating equations analysis. Results After adjustment for confounders, significant main effects were found for sleep quality for night workers (1.41, 95% confidence interval 1.05–1.89) and swing shift workers (1.42, 95% confidence interval 1.03–1.94) when compared to day workers; their interaction terms were not statistically significant. For the remaining fatigue outcomes, no statistically significant main or interaction effects were found. Conclusion After 2-week 12-hour night and swing shifts, only the course for sleep quality differed from that of day work. Sleep quality was poorer for night and swing shift workers on the 1st day off and remained poorer for the 14-day follow-up. This showed that while working at night had no effect on feeling rested, tiredness, and energy levels, it had a relatively long-lasting effect on sleep quality. PMID:26929834

Asynchronous web-based learning, a practical method to enhance teaching in emergency medicine.

PubMed

Pourmand, Ali; Lucas, Raymond; Nouraie, Mehdi

2013-03-01

Abstract Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform. During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during both phases were compared using a repeated-measures analysis to evaluate the effect of the supplemental online module on knowledge acquisition. Thirty-nine EM residents (equally distributed in postgraduate years 1-4) were studied during a 15-week period. Overall and after adjusting for sex and postgraduate year level, both lecture attendance (b=27; 95% confidence interval, 22-32; p<0.0001) and Web-based learning (b=32; 95% confidence interval, 26-37; p<0.0001) were associated with significant increases in test scores compared with residents who were absent and not receiving supplemental Web-based learning. Neither the self-perceived level of mastery with the lecture topic nor the amount of reported reading was found to be a predictor of test scores. In an EM residency program, asynchronous Web-based learning may result in medical knowledge acquisition similar to or better than attending traditional core content lectures. The percentage of curriculum delivery by asynchronous learning that may be used to achieve overall terminal learning objectives in medical knowledge acquisition requires further study.

Four applications of permutation methods to testing a single-mediator model.

PubMed

Taylor, Aaron B; MacKinnon, David P

2012-09-01

Four applications of permutation tests to the single-mediator model are described and evaluated in this study. Permutation tests work by rearranging data in many possible ways in order to estimate the sampling distribution for the test statistic. The four applications to mediation evaluated here are the permutation test of ab, the permutation joint significance test, and the noniterative and iterative permutation confidence intervals for ab. A Monte Carlo simulation study was used to compare these four tests with the four best available tests for mediation found in previous research: the joint significance test, the distribution of the product test, and the percentile and bias-corrected bootstrap tests. We compared the different methods on Type I error, power, and confidence interval coverage. The noniterative permutation confidence interval for ab was the best performer among the new methods. It successfully controlled Type I error, had power nearly as good as the most powerful existing methods, and had better coverage than any existing method. The iterative permutation confidence interval for ab had lower power than do some existing methods, but it performed better than any other method in terms of coverage. The permutation confidence interval methods are recommended when estimating a confidence interval is a primary concern. SPSS and SAS macros that estimate these confidence intervals are provided.

JCL Implementation On A Human Spaceflight Program

NASA Technical Reports Server (NTRS)

Kulpa, Vyga; Karpowich, Mike; Abel, Diana; Archiable, Wes; Carson, William

2013-01-01

Joint Confidence Level (JCL) analysis focuses on the integration of traditionally stove-piped programmatic components (schedule, cost and risk) to establish projected resource and schedule requirements at various confidence levels and to identify programmatic cost and schedule risk drivers. SLS Program consists of multiple Prime Contractors managed by independent SLS Elements which are integrated using SE&I and Program Management. SLS further integrates with GSDO and MPCV through ESD integrated working groups.

Safety margins in zircaloy oxidation and embrittlement criteria for emergency core cooling system acceptance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williford, R.E.

1986-09-01

Current emergency core cooling system acceptance criteria for light water reactors specify that, under loss-of-coolant accident (LOCA) conditions, the Baker-Just (BJ) correlation must be used to calculate Zircaloy-steam oxidation, calculated peak cladding temperatures (PCT) must not exceed 1204/sup 0/C, and calculated oxidation must not exceed 17% equivalent cladding reacted (ECR). An appropriately defined minimum margin of safety was estimated for each of these criteria. The currently required BJ oxidation correlation provides margins only over the 1100 to 1500/sup 0/C temperature range at the 95% confidence level. The PCT margins for thermal shock and handling failures are adequate at oxidation temperaturesmore » above 1204/sup 0/C for up to 210 and 160 s, respectively, at the 95% confidence level. The ECR thermal shock and handling margins at the 50 and 95% confidence levels, respectively, range between 2 and 7% ECR for the BJ correlation, but vanish at temperatures above 1100 to 1160/sup 0/C for the best-estimate Cathcart-Pawel correlation. However, use of the Cathcart Pawel correlation for ''design basis'' LOCA calculations can be justified at the 85 to 88% confidence level if cooling rate effects can be neglected.« less

An experimental predeployment training program improves self-reported patient treatment confidence and preparedness of Army combat medics.

PubMed

Gerhardt, Robert T; Hermstad, Erik L; Oakes, Michael; Wiegert, Richard S; Oliver, Jeffrey

2008-01-01

To develop and assess impact of a focused review of International Trauma Life Support (ITLS) and combat casualty care with hands-on procedure training for U.S. Army medics deploying to Iraq. The setting was a U.S. Army Medical Department Center and School and Camp Eagle, Iraq. Investigators developed and implemented a command-approved prospective educational intervention with a post hoc survey. Subjects completed a three-day course with simulator and live-tissue procedure laboratories. At deployment's end, medics were surveyed for experience, confidence, and preparedness in treating various casualty severity levels. Investigators used two-tailed t-test with unequal variance for continuous data and chi-square for categorical data. Twenty-nine medics deployed. Eight completed the experimental program. Twenty-one of 25 (84%) available medics completed the survey including six of the eight (75%) experimental medics. The experimental group reported significantly greater levels of preparedness and confidence treating "minimal," "delayed," and "immediate" casualties at arrival in Iraq. These differences dissipated progressively over the time course of the deployment. This experimental program increased combat medic confidence and perceived level of preparedness in treating several patient severity levels. Further research is warranted to determine if the experimental intervention objectively improves patient care quality and translates into lives saved early in deployment.