Linking the Tinnitus Questionnaire and the subjective Clinical Global Impression: Which differences are clinically important?

PubMed Central

2012-01-01

Background Development of new tinnitus treatments requires prospective placebo-controlled randomized trials to prove their efficacy. The Tinnitus Questionnaire (TQ) is a validated and commonly used instrument for assessment of tinnitus severity and has been used in many clinical studies. Defining the Minimal Clinically Important Difference (MCID) for TQ changes is an important step to a better interpretation of the clinical relevance of changes observed in clinical trials. In this study we aimed to estimate the minimum change of the TQ score that could be considered clinically relevant. Methods 757 patients with chronic tinnitus were pooled from the TRI database and the RESET study. An anchor-based approach using the Clinical Global Impression (CGI) scale and distributional approaches were used to estimate MCID. Receiver Operating Characteristic (ROC) curves were calculated to define optimal TQ change cutoffs discriminating between minimally changed and unchanged subjects. Results The relationship between TQ change scores and CGI ratings of change was good (r = 0.52, p < 0.05). Mean change scores associated with minimally better and minimally worse CGI categories were −6.65 and +2.72 respectively. According to the ROC method MCID for improvement was −5 points and for deterioration +1 points. Conclusion Distribution and anchor-based methods yielded comparable results in identifying MCIDs. ΔTQ scores of −5 and +1 points were identified as the minimal clinically relevant change for improvement and worsening respectively. The asymmetry of the MCIDs for improvement and worsening may be related to expectation effects. PMID:22781703

Clinical Importance of Steps Taken per Day among Persons with Multiple Sclerosis

PubMed Central

Motl, Robert W.; Pilutti, Lara A.; Learmonth, Yvonne C.; Goldman, Myla D.; Brown, Ted

2013-01-01

Background The number of steps taken per day (steps/day) provides a reliable and valid outcome of free-living walking behavior in persons with multiple sclerosis (MS). Objective This study examined the clinical meaningfulness of steps/day using the minimal clinically important difference (MCID) value across stages representing the developing impact of MS. Methods This study was a secondary analysis of de-identified data from 15 investigations totaling 786 persons with MS and 157 healthy controls. All participants provided demographic information and wore an accelerometer or pedometer during the waking hours of a 7-day period. Those with MS further provided real-life, health, and clinical information and completed the Multiple Sclerosis Walking Scale-12 (MSWS-12) and Patient Determined Disease Steps (PDDS) scale. MCID estimates were based on regression analyses and analysis of variance for between group differences. Results The mean MCID from self-report scales that capture subtle changes in ambulation (1-point change in PDSS scores and 10-point change in MSWS-12 scores) was 779 steps/day (14% of mean score for MS sample); the mean MCID for clinical/health outcomes (MS type, duration, weight status) was 1,455 steps/day (26% of mean score for MS sample); real-life anchors (unemployment, divorce, assistive device use) resulted in a mean MCID of 2,580 steps/day (45% of mean score for MS sample); and the MCID for the cumulative impact of MS (MS vs. control) was 2,747 steps/day (48% of mean score for MS sample). Conclusion The change in motion sensor output of ∼800 steps/day appears to represent a lower-bound estimate of clinically meaningful change in free-living walking behavior in interventions of MS. PMID:24023843

Minimally Clinically Important Change in the Activity Measure for Post-Acute Care (AM-PAC), a Generic Patient-Reported Outcome Tool, in People With Low Back Pain.

PubMed

Lee, Natalie; Thompson, Nicolas R; Passek, Sandra; Stilphen, Mary; Katzan, Irene L

2017-11-01

The Activity Measure for Post-Acute Care (AM-PAC) is a generic metric of patient-reported functional status. The minimal clinically important difference (MCID) in the AM-PAC score has not been determined. The study objective was to determine the MCID for AM-PAC in people with low back pain. This was a retrospective cohort study. Anchor-based and distribution-based methods were used to estimate the MCID. The Modified Low Back Pain Disability Questionnaire was used as the anchor. Adults who had a primary ICD-9 code for low back pain in at least 1 outpatient physical therapist visit during an episode of care and who completed both the AM-PAC and the Modified Low Back Pain Disability Questionnaire in at least 2 visits during the care episode were included. The MCID was calculated for the AM-PAC basic mobility version as well its adapted version, which the Cleveland Clinic uses for patients 65 years old or older. A total of 1,271 participants were eligible for study. For the AM-PAC basic mobility version, anchor-based methods yielded MCID estimates of between 3.4 and 5.1, whereas distribution-based methods yielded estimates of 1.7 to 4.2. The minimal detectable change (MDC) for the AM-PAC basic mobility version was 3.3. For the adapted AM-PAC basic mobility version, the MCID was estimated to be between 2.9 and 4.0 via anchor-based methods and between 1.2 to 3.5 via distribution-based methods. The MDC for the adapted AM-PAC basic mobility version was 3.5. The estimated MCID was designed for people with low back pain only. The MCID ranged from 3.3 to 5.1 for the AM-PAC basic mobility version and 3.5 to 4 for the adapted version, with the MDC as the lower limit. Changes in the AM-PAC for people with low back pain may be interpreted using the estimated MCID. Future studies are needed to determine the AM-PAC MCID for populations other than those with low back pain. © 2017 American Physical Therapy Association

Pre-operative Thresholds for Achieving Meaningful Clinical Improvement after Arthroscopic Treatment of Femoroacetabular Impingement

PubMed Central

Nwachukwu, Benedict U.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2016-01-01

Objectives: Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) treatment is evolving. The primary purpose of this study was to define pre-operative outcome score thresholds that can be used to predict patients most likely to achieve meaningful clinically important difference (MCID) after arthroscopic FAI treatment. Secondarily determinants of achieving MCID were evaluated. Methods: A prospective institutional hip arthroscopy registry was reviewed to identify patients with FAI treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) tools were administered at baseline and at one year post-operatively. MCID was calculated using a distribution-based method. A receiver operating characteristic (ROC) analysis was used to calculate cohort-based threshold values predictive of achieving MCID. Area under the curve (AUC) was used to define predictive ability (strength of association) with AUC >0.7 considered acceptably predictive. Univariate and multivariable analyses were used to analyze demographic, radiographic and intra-operative factors associated with achieving MCID. Results: There were 374 patients (mean + SD age, 32.9 + 10.5) and 56.4% were female. The MCID for mHHS, HOS activities of daily living (HOS-ADL), HOS Sports, and iHOT-33 was 8.2, 8.4,14.5, and 12.0 respectively. ROC analysis (threshold, % achieving MCID, strength of association) for these tools in our population was: mHHS (61.6, 78%, 0.68), HOS-ADL (83.8, 68%, 0.84), HOS-Sports (63.9, 64%, 0.74), and iHOT-33 (54.3, 82%, 0.65). Likelihood for achieving MCID declined above and increased below these thresholds. In univariate analysis female sex, femoral version, lower acetabular outerbridge score and increasing CT sagittal center edge angle (CEA) were predictive of achieving MCID. In multivariable analysis sagittal CEA was the only variable maintaining significance (p = 0.032). Conclusion: We used a large prospective hip arthroscopy database to identify pre-operative patient outcome score thresholds predictive of meaningful post-operative outcome improvement after arthroscopic FAI treatment. This is the largest reported hip arthroscopy cohort to define MCID and the first to do so for iHOT-33. The HOS-ADL may have the best predictive ability for achieving MCID after hip arthroscopy. Patients with relatively high pre-operative ADL, quality of life and functional status appear to have a high chance for achieveing MCID up to our defined thresholds. Hip dysplasia is an important outcome modifier. The findings of this study may be useful for managing preoperative expectation for patients undergoing arthroscopic FAI surgery.

Minimum Clinically Important Difference and Substantial Clinical Benefit in Pain, Functional, and Quality of Life Scales in Failed Back Surgery Syndrome Patients.

PubMed

Park, Ki Byung; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-Riong; Lee, Jun-Hwan; Shin, Kyung-Min; Shin, Byung-Cheul; Cho, Jae-Heung; Ha, In-Hyuk

2017-04-15

.: Prospective observational 1-year study. .: To determine minimum clinically important difference (MCID) and substantial clinical benefit (SCB) of outcome measures in failed back surgery syndrome (FBSS) patients, as these metrics enable assessment of whether and when an intervention produces clinically meaningful effects in a patient. .: Several methods have been devised to quantify clinically important difference, but MCID and SCB for FBSS patients has yet to be determined. .: Patients with persisting/recurrent low back pain (LBP) and/or leg pain after lumbar surgery who completed 16 weeks of treatment (n = 105) at two hospitals in Korea from November 2011 to September 2014 were analyzed. Global perceived effect was used to determine receiver operating characteristic curves in visual analogue scale (VAS), Oswestry disability index (ODI), and short form-36 (SF-36) in an anchor-based approach. .: MCIDs for ODI, LBP and leg pain VAS, physical component summary, mental health component summary (MCS), and overall health scores of SF-36 were 9.0, 22.5, 27.5, 10.2, 4.0, and 8.9, and SCBs were 15.0, 32.5, 37.0, 19.7, 19.3, and 21.1, respectively. MCID and SCB area under the curve was ≥0.8, and ≥0.7, respectively. .: LBP and leg pain VAS, ODI, and physical component summary of SF-36 may be used to measure responsiveness in FBSS patients. 3.

Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.

PubMed

Chen, Poyu; Lin, Keh-Chung; Liing, Rong-Jiuan; Wu, Ching-Yi; Chen, Chia-Ling; Chang, Ku-Chou

2016-06-01

To examine the criterion validity, responsiveness, and minimal clinically important difference (MCID) of the EuroQoL 5-Dimensions Questionnaire (EQ-5D-5L) and visual analog scale (EQ-VAS) in people receiving rehabilitation after stroke. The EQ-5D-5L, along with four criterion measures-the Medical Research Council scales for muscle strength, the Fugl-Meyer assessment, the functional independence measure, and the Stroke Impact Scale-was administered to 65 patients with stroke before and after 3- to 4-week therapy. Criterion validity was estimated using the Spearman correlation coefficient. Responsiveness was analyzed by the effect size, standardized response mean (SRM), and criterion responsiveness. The MCID was determined by anchor-based and distribution-based approaches. The percentage of patients exceeding the MCID was also reported. Concurrent validity of the EQ-Index was better compared with the EQ-VAS. The EQ-Index has better power for predicting the rehabilitation outcome in the activities of daily living than other motor-related outcome measures. The EQ-Index was moderately responsive to change (SRM = 0.63), whereas the EQ-VAS was only mildly responsive to change. The MCID estimation of the EQ-Index (the percentage of patients exceeding the MCID) was 0.10 (33.8 %) and 0.10 (33.8 %) based on the anchor-based and distribution-based approaches, respectively, and the estimation of EQ-VAS was 8.61 (41.5 %) and 10.82 (32.3 %). The EQ-Index has shown reasonable concurrent validity, limited predictive validity, and acceptable responsiveness for detecting the health-related quality of life in stroke patients undergoing rehabilitation, but not for EQ-VAS. Future research considering different recovery stages after stroke is warranted to validate these estimations.

Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy.

PubMed

Lauche, Romy; Langhorst, Jost; Dobos, Gustav J; Cramer, Holger

2013-08-01

The assessment of clinically meaningful differences in patients' self-reported outcomes has become increasingly important when interpreting the results of clinical studies. Although these assessments have become quite common there are hardly any data for nonspecific neck pain, especially in the context of complementary and alternative medicine. The aim of this analysis is the determination of minimal clinically important differences (MCID) and substantial clinical benefits (SCB) in patients with chronic nonspecific neck pain after cupping treatment. The data set comprised a total of 200 patients with chronic nonspecific neck pain participating in clinical trials on cupping therapy. The MCID and SCB for pain intensity (VAS), neck disability index (NDI) and the subscale bodily pain (SF-36-BP) as well as physical component summary (SF-36-PCS) of the SF-36 were determined using receiver operating characteristic (ROC) curve analysis with an adapted assessment of change in health status (SF-36), i.e. a 5-point Likert scale ranging from "much better" to "much worse", as anchor. MCID derived from the ROC was the score to distinguish "somewhat better" from "about the same", and the SCB was the score to distinguish "much better" from "somewhat better". The calculated MCIDs were: -8mm (-21%) for VAS, -3 points (-10.2%) for NDI, +10 points (+20.5%) for SF-36-BP and +2.6 points (+7.7%) for SF-36-PCS. The SCBs were: -26.5mm (-66.8%) for VAS, -8.4 points (-29%) for NDI, +15.5 points (+43.1%) for SF-36-BP and +5.1 points (+12.9%) for SF-36-PCS. Accuracy of the estimations was good for MCID in general and for SCB regarding VAS and NDI. The results support the assumption that patients' perceptions of treatment benefits measured by VAS in these trials might be comparable to others in conventional therapies. For NDI and SF-36-PCS the estimated differences were smaller than in previous reports indicating that context factors such as patient characteristics and specific treatment conditions might play an important role. Further studies on MCIDS and SCBs for chronic nonspecific neck pain seem warranted. Copyright © 2013 Elsevier Ltd. All rights reserved.

GABAergic drug use and global, cognitive, and motor functional outcomes after stroke.

PubMed

Schwitzguébel, A J-P; Benaïm, C; Carda, S; Torea Filgueira, A M; Frischknecht, R; Rapin, P-A

2016-12-01

In animal models and healthy volunteers, the use of GABA A receptor agonists (GABA-AGs) seem deleterious for functional recovery. The agents are widely used for subacute stroke, but their effect on functional recovery remains unclear. We aimed to evaluate the association between GABA-AG use and functional recovery after stroke. We retrospectively recruited 434 survivors of subacute stroke admitted for inpatient rehabilitation between 2000 and 2013 in our institution (107 with and 327 without GABA-AG use). We used multivariate regression to assess the association of GABA-AG use and successful functional recovery, defined as reaching, between admission and discharge, the minimal clinically important difference (MCID) of 22 points on the global Functional Independence Measure (FIM). Secondary analyses were the associations of GABA-AG with cognitive and motor FIM MCID and constant GABA-AG exposure (24h/24 GABA-AG) with global, cognitive and motor FIM MCID. A new estimation of the MCID was performed with the standard error of measurement. Reaching the global FIM MCID was associated with GABA-AG use (adjusted odds ratio [aOR] 0.54 [95% CI 0.31-0.91], P=0.02) as well as 24h/24 GABA-AG use (aOR 0.25 [0.08-0.83]; P=0.02). Furthermore, GABA-AG and 24h/24 GABA-AG use was inversely but not always significantly associated with reaching the cognitive FIM MCID (aOR 0.56, P=0.07; aOR 0.26, P=0.06, respectively) and motor FIM MCID (aOR 0.51, P=0.07; aOR 0.13, P=0.01, respectively). The estimated MCID was 19 for global FIM, 4 for cognitive FIM, and 16 for motor FIM. GABA-AG use is associated with not reaching successful functional recovery during stroke rehabilitation. Randomised trials are needed to formally establish the potential deleterious effect of GABA-AG use on functional recovery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

THE 6-MINUTE WALK TEST AND OTHER CLINICAL ENDPOINTS IN DUCHENNE MUSCULAR DYSTROPHY: RELIABILITY, CONCURRENT VALIDITY, AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES FROM A MULTICENTER STUDY

PubMed Central

McDonald, Craig M; Henricson, Erik K; Abresch, R Ted; Florence, Julaine; Eagle, Michelle; Gappmaier, Eduard; Glanzman, Allan M; Spiegel, Robert; Barth, Jay; Elfring, Gary; Reha, Allen; Peltz, Stuart W

2013-01-01

Introduction: An international clinical trial enrolled 174 ambulatory males ≥5 years old with nonsense mutation Duchenne muscular dystrophy (nmDMD). Pretreatment data provide insight into reliability, concurrent validity, and minimal clinically important differences (MCIDs) of the 6-minute walk test (6MWT) and other endpoints. Methods: Screening and baseline evaluations included the 6-minute walk distance (6MWD), timed function tests (TFTs), quantitative strength by myometry, the PedsQL, heart rate–determined energy expenditure index, and other exploratory endpoints. Results: The 6MWT proved feasible and reliable in a multicenter context. Concurrent validity with other endpoints was excellent. The MCID for 6MWD was 28.5 and 31.7 meters based on 2 statistical distribution methods. Conclusions: The ratio of MCID to baseline mean is lower for 6MWD than for other endpoints. The 6MWD is an optimal primary endpoint for Duchenne muscular dystrophy (DMD) clinical trials that are focused therapeutically on preservation of ambulation and slowing of disease progression. Muscle Nerve 48: 357–368, 2013 PMID:23674289

The minimal clinically important difference of six-minute walk in Asian older adults.

PubMed

Kwok, Boon Chong; Pua, Yong Hao; Mamun, Kaysar; Wong, Wai Pong

2013-03-06

Rehabilitation interventions promote functional recovery among frail older adults and little is known about the clinical significance of physical outcome measure changes. The purpose of our study is to examine the minimal clinically important difference (MCID) for the 6-minute walk distance (6MWD) among frail Asian older adults. Data from the "Evaluation of the Frails' Fall Efficacy by Comparing Treatments" study were analyzed. Distribution-based and anchor-based methods were used to estimate the MCID of the 6MWD. Participants who completed the trial rated their perceived change of overall health on the Global Rating of Change (GROC) scale. The receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of the cut-off values of 6MWD (in meters) for GROC rating of "a little bit better" (+2), based on feedback from participants. The mean (SD) change in 6MWD was 37.3(46.2) m among those who perceived a change (GROC ≥ 2), while those who did not was 9.3(18.2) m post-intervention (P = 0.011). From the anchor-based method, the MCID value for the 6MWD was 17.8 m (sensitivity 56.7% and specificity 83.3%) while distribution-based method estimated 12.9 m. The MCID estimate for 6MWD was 17.8 m in the moderately frail Asian older adults with a fear of falling. The results will aid the clinicians in goal setting for this patient population.

Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis.

PubMed

Young, VyVy N; Jeong, Kwonho; Rothenberger, Scott D; Gillespie, Amanda I; Smith, Libby J; Gartner-Schmidt, Jackie L; Rosen, Clark A

2018-06-01

The Voice Handicap Index-10 (VHI-10) is commonly used to measure patients' perception of vocal handicap. Clinical consensus has previously defined clinically meaningful improvement as a decrease ≥5. This study determines the minimal clinically important difference (MCID) for VHI-10 in patients with unilateral vocal fold paralysis (UVFP) using anchor-based methodology. Prospective cohort questionnaire analysis. Two hundred eighty-one UVFP patients completed the VHI-10 on two consecutive visits (within 3 months). At the follow-up visit, patients answered an 11-point Global Rating of Change Questionnaire (GRCQ) scored from -5 to +5. Relationship between the GRCQ and change in VHI-10 was quantified using analysis of variance, and MCID for the VHI-10 was determined using receiver operating characteristic (ROC) curve analysis. Overall mean VHI-10 change was -3.71 (standard deviation [SD] = 8.89) and mean GRCQ was 1.37 (SD = 2.51). Average interval between measurements was 1.73 months (SD = 0.83). Mean changes in VHI-10 scores were -7.45, -0.53, and +4.40 for patients whose GRCQ scores indicated improvement, no change, and worsening, respectively. Differences between mean scores were statistically significant (P < .001). Area under the ROC curve was 0.80, demonstrating the classification accuracy of VHI-10 change scores. A VHI-10 change of -4 was determined to be the optimal threshold that discriminated between improvement and no improvement (sensitivity and specificity 0.62 and 0.88, respectively). The MCID for improvement in VHI-10 in UVFP patients is a decrease of 4. This information improves understanding of patients' response to treatment and allows comparison between different treatments. Future research should determine MCID for VHI-10 across all voice disorders. 4. Laryngoscope, 128:1419-1424, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

RELATIONSHIP BETWEEN ISOMETRIC THIGH MUSCLE STRENGTH AND MINIMAL CLINICALLY IMPORTANT DIFFERENCES (MCIDS) IN KNEE FUNCTION IN OSTEOARTHRITIS – DATA FROM THE OSTEOARTHRITIS INITIATIVE

PubMed Central

Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

2014-01-01

Objective To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower limb function. Methods Isometric knee extensor and flexor strength of 4553 Osteoarthritis Initiative participants (2651 women/1902 men) was related to Western Ontario McMasters Universities (WOMAC) physical function scores by linear regression. Further, groups of Male and female participant strata with minimal clinically important differences (MCIDs) in WOMAC function scores (6/68) were compared across the full range of observed values, and to participants without functional deficits (WOMAC=0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Results Per regression equations, a 3.7% reduction in extensor and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and a 3.6%/4.8% reduction in men. For strength divided by body weight, reductions were 5.2%/6.7% in women and 5.8%/6.7% in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest non-linear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Conclusion Reductions of approximately 4% in isometric muscle strength and of 6% in strength/weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower limb function. PMID:25303012

Preoperative Short Form Health Survey Score Is Predictive of Return to Play and Minimal Clinically Important Difference at a Minimum 2-Year Follow-up After Anterior Cruciate Ligament Reconstruction.

PubMed

Nwachukwu, Benedict U; Chang, Brenda; Voleti, Pramod B; Berkanish, Patricia; Cohn, Matthew R; Altchek, David W; Allen, Answorth A; Williams, Riley J

2017-10-01

There is increased interest in understanding the preoperative determinants of postoperative outcomes. Return to play (RTP) and the patient-reported minimal clinically important difference (MCID) are useful measures of postoperative outcomes after anterior cruciate ligament reconstruction (ACLR). To define the MCID after ACLR and to investigate the role of preoperative outcome scores for predicting the MCID and RTP after ACLR. Case-control study; Level of evidence, 3. There were 294 active athletes enrolled as part of an institutional ACL registry with a minimum 2-year follow-up who were eligible for inclusion. A questionnaire was administered to elicit factors associated with RTP. Patient demographic and clinical data as well as patient-reported outcome measures were captured as part of the registry. Outcome measures included the International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm scale, and 12-Item Short Form Health Survey (SF-12) physical component summary (PCS) and mental component summary (MCS). Preoperative outcome score thresholds predictive of RTP were determined using a receiver operating characteristic (ROC) with area under the curve (AUC) analysis. The MCID was calculated using a distribution-based method. Multivariable logistic models were fitted to identify predictors for achieving the MCID and RTP. At a mean (±SD) follow-up of 3.7 ± 0.7 years, 231 patients were included from a total 294 eligible patients. The mean age and body mass index were 26.7 ± 12.5 years and 23.7 ± 3.2 kg/m 2 , respectively. Of the 231 patients, 201 (87.0%) returned to play at a mean time of 10.1 months. Two-year postoperative scores on all measures were significantly increased from preoperative scores (IKDC: 50.1 ± 15.6 to 87.4 ± 10.7; Lysholm: 61.2 ± 18.1 to 89.5 ± 10.4; SF-12 PCS: 41.5 ± 9.0 to 54.7 ± 4.6; SF-12 MCS: 53.6 ± 8.1 to 55.7 ± 5.7; P < .001 for all). The corresponding MCID values were 9.0 (IKDC), 10.0 (Lysholm), 5.1 (SF-12 PCS), and 4.3 (SF-12 MCS). Preoperative score thresholds predictive of RTP were the following: IKDC, 60.9; Lysholm, 57.0; SF-12 PCS, 42.3; and SF-12 MCS, 48.3. These thresholds were not independently predictive but achieved significance as part of the multivariable analysis. In the multivariable analysis for RTP, preoperative SF-12 PCS scores above 42.3 (odds ratio [OR], 2.73; 95% CI, 1.09-7.62) and SF-12 MCS scores above 48.3 (OR, 4.41; 95% CI, 1.80-10.98) were predictive for achieving RTP; an ACL allograft (OR, 0.26; 95% CI, 0.06-1.00) was negatively predictive of RTP. In the multivariable analysis for the MCID, patients with higher preoperative scores were less likely to achieve the MCID ( P < .0001); however, a higher preoperative SF-12 MCS score was predictive of achieving the MCID on the IKDC form (OR, 1.27; 95% CI, 1.11-1.52) and Lysholm scale (OR, 1.08; 95% CI, 1.00-1.16). Medial meniscal injuries, older age, and white race were also associated with a decreased likelihood for achieving the MCID. Preoperative SF-12 MCS and PCS scores were predictive of RTP after ACLR; patients scoring above 42.3 on the SF-12 PCS and 48.3 on the SF-12 MCS were more likely to achieve RTP. Additionally, we defined the MCID after ACLR and found that higher SF-12 MCS scores were predictive of achieving the MCID on knee-specific questionnaires.

Responsiveness and MCID Estimates for CAT, CCQ, and HADS in Patients With COPD Undergoing Pulmonary Rehabilitation: A Prospective Analysis.

PubMed

Smid, Dionne E; Franssen, Frits M E; Houben-Wilke, Sarah; Vanfleteren, Lowie E G W; Janssen, Daisy J A; Wouters, Emiel F M; Spruit, Martijn A

2017-01-01

Pulmonary rehabilitation enhances health status and mood status in patients with chronic obstructive pulmonary disease (COPD). The aim was to determine the responsiveness of St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), COPD Clinical Questionnaire (CCQ), and Hospital Anxiety and Depression Scale (HADS) to pulmonary rehabilitation in patients with COPD, and estimate minimum clinically important differences (MCIDs) for CAT, CCQ, and HADS. A prospective analysis. MCIDs were estimated with anchor-based (anchor: SGRQ) and distribution-based methods. Newly estimated MCIDs were compared to known MCID estimates from a systematic literature search. Newly estimated MCIDs were calculated in patients treated in pulmonary rehabilitation. A subsample of 419 individuals with COPD (55.4% male, mean age 64.3 ± 8.8 years) were included from the Chance study. Health status was measured with SGRQ, CAT, and CCQ, before and after pulmonary rehabilitation. Mood status was assessed using HADS. 419 patients with COPD (forced expiratory volume in the first second 37.3% ± 12.1% predicted) completed pulmonary rehabilitation. SGRQ (-9.1 ± 14.0 points), CAT (-3.0 ± 6.8 points), CCQ (-0.6 ± 0.9 points), HADS-Anxiety (-1.7 ± 3.7 points), and HADS-Depression (-2.1 ± 3.7 points) improved significantly. New MCIDs were estimated for CAT (range: -3.8 to -1.0 points), CCQ (range: -0.8 to -0.2 points), HADS-Anxiety (range: -2.0 to -1.1 points), and HADS-Depression (range: -1.8 to -1.4 points). The SGRQ, CAT, CCQ, and HADS are responsive to pulmonary rehabilitation in patients with COPD. We propose MCID estimates ranging between -3.0 and -2.0 points for CAT; -0.5 and -0.3 points for CCQ, -1.8 and -1.3 points for HADS-Anxiety, and -1.7 and -1.5 points for HADS-Depression. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts

PubMed Central

van der Leeuw, Sander; van der Molen, Thys; Dekhuijzen, PN Richard; Fonseca, Joao A; van Gemert, Frederik A; Gerth van Wijk, Roy; Kocks, Janwillem WH; Oosterom, Helma; Riemersma, Roland A; Tsiligianni, Ioanna G; de Weger, Letty A; Oude Elberink, Joanne NG; Flokstra-de Blok, Bertine MJ

2015-01-01

Background: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis. Aims: To determine the CARAT’s minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT. Methods: CARAT was applied in three measurements at 1-month intervals. Patients diagnosed with asthma and/or rhinitis were approached. MCID was evaluated using Global Rating of Change (GRC) and standard error of measurement (s.e.m.). Cronbach’s alpha was used to evaluate internal consistency. Spearman’s correlation coefficients were calculated between CARAT, the Asthma Control Questionnaire (ACQ5) and the Visual Analog Scale (VAS) on airway symptoms to determine construct and longitudinal validity. Test–retest reliability was evaluated with intra-class correlation coefficient (ICC). Changes in pollen counts were compared with delta CARAT and ACQ5 scores. Results: A total of 92 patients were included. The MCID of the CARAT was 3.50 based on GRC scores; the s.e.m. was 2.83. Cronbach’s alpha was 0.82. Correlation coefficients between CARAT and ACQ5 and VAS questions ranged from 0.64 to 0.76 (P<0.01). Longitudinally, correlation coefficients between delta CARAT scores and delta ACQ5 and VAS scores ranged from 0.41 to 0.67 (P<0.01). Test–retest reliability showed an ICC of 0.81 (P<0.01) and 0.80 (P<0.01). Correlations with pollen counts were higher for CARAT than for ACQ5. Conclusions: This is the first investigation of the MCID of the CARAT. The CARAT uses a whole-point scale, which suggests that the MCID is 4 points. The CARAT is a valid and reliable tool that is also applicable in the Dutch population. PMID:25569880

Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle Patients.

PubMed

Ho, Bryant; Houck, Jeff R; Flemister, Adolph S; Ketz, John; Oh, Irvin; DiGiovanni, Benedict F; Baumhauer, Judith F

2016-09-01

The use of patient-reported outcomes continues to expand beyond the scope of clinical research to involve standard of care assessments across orthopedic practices. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic. We prospectively examined the relationship between preoperative patient-reported outcomes (PROMIS Physical Function, Pain Interference and Depression scores), determined minimal clinical important differences for these values, and assessed if these preoperative values were predictors of improvement after operative intervention. Prospective collection of all consecutive patient visits to a multisurgeon tertiary foot and ankle clinic was obtained between February 2015 and April 2016. This consisted of 16 023 unique visits across 7996 patients, with 3611 new patients. Patients undergoing elective operative intervention were identified by ICD-9 and CPT code. PROMIS physical function, pain interference, and depression scores were assessed at initial and follow-up visits. Minimum clinically important differences (MCIDs) were calculated using a distribution-based method. Receiver operating characteristic (ROC) curves were calculated to determine whether preoperative PROMIS scores were predictive of achieving MCID. Cutoff values for PROMIS scores that would predict achieving MCID and not achieving MCID with 95% specificity were determined. Prognostic pre- and posttest probabilities based off these cutoffs were calculated. Patients with a minimum of 7-month follow-up (mean 9.9) who completed all PROMIS domains were included, resulting in 61 patients. ROC curves demonstrated that preoperative physical function scores were predictive of postoperative improvement in physical function (area under the curve [AUC] 0.83). Similarly, preoperative pain interference scores were predictive of postoperative pain improvement (AUC 0.73) and preoperative depression scores were also predictive of postoperative depression improvement (AUC 0.74). Patients with preoperative physical function T score below 29.7 had an 83% probability of achieving a clinically meaningful improvement in function as defined by MCID. Patients with preoperative physical function T score above 42 had a 94% probability of failing to achieve MCID. Patients with preoperative pain above 67.2 had a 66% probability of achieving MCID, whereas patients with preoperative pain below 55 had a 95% probability of failing to achieve MCID. Patients with preoperative depression below 41.5 had a 90% probability of failing to achieve MCID. Patient-reported outcomes (PROMIS) scores obtained preoperatively predicted improvement in foot and ankle surgery. Threshold levels in physical function, pain interference, and depression can be shared with patients as they decide whether surgery is a good option and helps place a numerical value on patient expectations. Physical function scores below 29.7 were likely to improve with surgery, whereas those patients with scores above 42 were unlikely to make gains in function. Patients with pain scores less than 55 were similarly unlikely to improve, whereas those with scores above 67 had clinically significant pain reduction postoperatively. Reported prognostic cutoff values help to provide guidance to both the surgeon and the patient and can aid in shared decision making for treatment. Level II, prognostic study. © The Author(s) 2016.

Minimal Clinically Important Differences for American Orthopaedic Foot & Ankle Society Score in Hallux Valgus Surgery.

PubMed

Chan, Hiok Yang; Chen, Jerry Yongqiang; Zainul-Abidin, Suraya; Ying, Hao; Koo, Kevin; Rikhraj, Inderjeet Singh

2017-05-01

The American Orthopaedic Foot & Ankle Society (AOFAS) score is one of the most common and adapted outcome scales in hallux valgus surgery. However, AOFAS is predominantly physician based and not patient based. Although it may be straightforward to derive statistical significance, it may not equate to the true subjective benefit of the patient's experience. There is a paucity of literature defining MCID for AOFAS in hallux valgus surgery although it could have a great impact on the accuracy of analyzing surgical outcomes. Hence, the primary aim of this study was to define the Minimal Clinically Important Difference (MCID) for the AOFAS score in these patients, and the secondary aim was to correlate patients' demographics to the MCID. We conducted a retrospective cross-sectional study. A total of 446 patients were reviewed preoperatively and followed up for 2 years. An anchor question was asked 2 years postoperation: "How would you rate the overall results of your treatment for your foot and ankle condition?" (excellent, very good, good, fair, poor, terrible). The MCID was derived using 4 methods, 3 from an anchor-based approach and 1 from a distribution-based approach. Anchor-based approaches were (1) mean difference in 2-year AOFAS scores of patients who answered "good" versus "fair" based on the anchor question; (2) mean change of AOFAS score preoperatively and at 2-year follow-up in patients who answered good; (3) receiver operating characteristic (ROC) curves method, where the area under the curve (AUC) represented the likelihood that the scoring system would accurately discriminate these 2 groups of patients. The distribution-based approach used to calculate MCID was the effect size method. There were 405 (90.8%) females and 41 (9.2%) males. Mean age was 51.2 (standard deviation [SD] = 13) years, mean preoperative BMI was 24.2 (SD = 4.1). Mean preoperative AOFAS score was 55.6 (SD = 16.8), with significant improvement to 85.7 (SD = 14.4) in 2 years ( P value < .001). There were no statistical differences between demographics or preoperative AOFAS scores of patients with good versus fair satisfaction levels. At 2 years, patients who had good satisfaction had higher AOFAS scores than fair satisfaction (83.9 vs 78.1, P < .001) and higher mean change (30.2 vs 22.3, P = .015). Mean change in AOFAS score in patients with good satisfaction was 30.2 (SD = 19.8). Mean difference in good versus fair satisfaction was 7.9. Using ROC analysis, the cut-off point is 29.0, with an area under the curve (AUC) of 0.62. Effect size method derived an MCID of 8.4 with a moderate effect size of 0.5. Multiple linear regression demonstrated increasing age (β = -0.129, CI = -0.245, -0.013, P = .030) and higher preoperative AOFAS score (β = -0.874, CI = -0.644, -0.081, P < .001) to significantly decrease the amount of change in the AOFAS score. The MCID of AOFAS score in hallux valgus surgery was 7.9 to 30.2. The MCID can ensure clinical improvement from a patient's perspective and also aid in interpreting results from clinical trials and other studies. Level III, retrospective comparative series.

Minimal Clinically Important Difference and Substantial Clinical Benefit After Revision Hip Arthroscopy.

PubMed

Nwachukwu, Benedict U; Chang, Brenda; Rotter, Ben-Zion; Kelly, Bryan T; Ranawat, Anil S; Nawabi, Danyal H

2018-06-01

To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) in revision hip arthroscopy. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered to revision hip arthroscopy patients. At 1 year postoperatively, patients graded their hip function based on anchor responses. SCB was defined as both a net change and an absolute value. Receiver operating characteristic analysis with area under the curve was used to confirm psychometric values. A distribution-based method was used for MCID. Forty-nine patients were included with a mean age of 29.7 (±8.6) years. The most common indication for revision hip arthroscopy was residual femoroacetabular impingement (FAI; N = 34; 69.4%) followed by capsular management (N = 8; 16.3%). At 1-year follow-up, 34 patients reported feeling improved. Outcome score change corresponding to MCID and SCB net change for the mHHS, HOS Activities of Daily Living (ADL), HOS Sports, and iHOT-33 was 7.9/23.1, 7.9/16.2, 13.1/25.0, and 12.8/25.5, respectively. A higher proportion of patients with residual FAI achieved MCID compared with patients with other diagnoses. On the preoperative HOS ADL, HOS Sports, and iHOT-33, patients scoring below 67.7 (0.78), 55.6 (0.81), and 35.7 (0.73) were significantly more likely to achieve SCB postoperatively. Thirty-four patients (73.9%) were classified as receiving physical function improvement, and on the HOS Sports, MCID was achieved by 65% whereas 43% met the SCB criteria. MCID values ranged from 7.9 on the mHHS and the HOS ADL to 13.1 on the HOS Sports. SCB net change ranged from 16.2 on the HOS ADL to 25.2 on the iHOT-33, whereas absolute SCB ranged from 82.4 on the iHOT-33 to 84.7 on the mHHS. Residual FAI and capsular management were the most common indications for revision surgery with patients who underwent surgery for the former found to be most likely to achieve clinically significant improvement. Level IV, case series. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

What is the effect of surgery on the quality of life of the adolescent with adolescent idiopathic scoliosis? A review and statistical analysis of the literature.

PubMed

Rushton, Paul R P; Grevitt, Michael P

2013-04-20

Review and statistical analysis of studies evaluating the effect of surgery on the health-related quality of life of adolescents with adolescent idiopathic scoliosis, using Scoliosis Research Society (SRS) outcomes. Apply published minimum clinical important differences (MCID) values for the SRS22r questionnaire to the literature to identify what areas of health-related quality of life are consistently affected by surgery and whether changes are clinically meaningful. The interpretation of published studies using the SRS outcomes has been limited by the lack of MCID values for the questionnaire domains. The recent publication of these data allows the clinical importance of any changes in these studies to be examined for the first time. A literature search was undertaken to locate suitable studies that were then analyzed. Statistically significant differences from baseline to 2 years postoperatively were ascertained by narratively reporting the analyses within included studies. When possible, clinically significant changes were assessed using 95% confidence intervals for the change in mean domain score. If the lower bound of the confidence intervals for the change exceeded the MCID for that domain, the change was considered clinically significant. The numbers of cohorts available for the different analyses varied (5-16). Eighty-one percent and 94% of included cohorts experienced statistically significant improvements in pain and self-image domains. In terms of clinical significance, it was only self-image that regularly improved by more than MCID, doing so in 4 of 5 included cohorts (80%) compared with 1 of 12 cohorts (8%) for pain. No clinically relevant changes occurred in mental health or activity domains. Evidence suggests that surgery can lead to clinically important improvement in patient self-image. Surgeons and patients should be aware of the limited evidence for improvements in domains other than self-image after surgery. Surgical decision-making will also be influenced by the natural history of adolescent idiopathic scoliosis.

Monitoring somatic symptoms in patients with mental disorders: Sensitivity to change and minimal clinically important difference of the Somatic Symptom Scale - 8 (SSS-8).

PubMed

Gierk, Benjamin; Kohlmann, Sebastian; Hagemann-Goebel, Marion; Löwe, Bernd; Nestoriuc, Yvonne

2017-09-01

The SSS-8 is a brief questionnaire for the assessment of somatic symptom burden. This study examines its sensitivity to change and the minimal clinically important difference (MCID) in patients with mental disorders. 55 outpatients with mental disorders completed the SSS-8 and measures of anxiety, depression, and disability before and after receiving treatment. Effect sizes and correlations between the change scores were calculated. The MCID was estimated using a one standard error of measurement threshold and the change in disability as an external criterion. There was a medium decline in somatic symptom burden for the complete sample (n=55, d z =0.53) and a large decline in a subgroup with very high somatic symptom burden at baseline (n=11, d z =0.94). Decreases in somatic symptom burden were associated with decreases in anxiety (r=0.68, p<0.001), depression (r=0.62, p<0.001) and disability (r=0.51, p<0.001). The MCID was estimated as a 3-point decrease. The SSS-8 is sensitive to change. A 3-point decrease reflects a clinically important improvement. Due to its brevity and sound psychometric properties, the SSS-8 is useful for monitoring somatic symptom burden. Copyright © 2017 Elsevier Inc. All rights reserved.

The Patient-Oriented Eczema Measure in young children: responsiveness and minimal clinically important difference.

PubMed

Gaunt, D M; Metcalfe, C; Ridd, M

2016-11-01

The Patient-Oriented Eczema Measure (POEM) has been recommended as the core patient-reported outcome measure for trials of eczema treatments. Using data from the Choice of Moisturiser for Eczema Treatment randomized feasibility study, we assess the responsiveness to change and determine the minimal clinically important difference (MCID) of the POEM in young children with eczema. Responsiveness to change by repeated administrations of the POEM was investigated in relation to change recalled using the Parent Global Assessment (PGA) measure. Five methods of determining the MCID of the POEM were employed; three anchor-based methods using PGA as the anchor: the within-patient score change, between-patient score change and sensitivity and specificity method, and two distribution-based methods: effect size estimate and the one half standard deviation of the baseline distribution of POEM scores. Successive POEM scores were found to be responsive to change in eczema severity. The MCID of the POEM change score, in relation to a slight improvement in eczema severity as recalled by parents on the PGA, estimated by the within-patient score change (4.27), the between-patient score change (2.89) and the sensitivity and specificity method (3.00) was similar to the one half standard deviation of the POEM baseline scores (2.94) and the effect size estimate (2.50). The Patient-Oriented Eczema Measure as applied to young children is responsive to change, and the MCID is around 3. This study will encourage the use of POEM and aid in determining sample size for future randomized controlled trials of treatments for eczema in young children. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Minimal clinically important difference and the effect of clinical variables on the ankle osteoarthritis scale in surgically treated end-stage ankle arthritis.

PubMed

Coe, Marcus P; Sutherland, Jason M; Penner, Murray J; Younger, Alastair; Wing, Kevin J

2015-05-20

There is much debate regarding the best outcome tool for use in foot and ankle surgery, specifically in patients with ankle arthritis. The Ankle Osteoarthritis Scale (AOS) is a validated, disease-specific score. The goals of this study were to investigate the clinical performance of the AOS and to determine a minimal clinically important difference (MCID) for it, using a large cohort of 238 patients undergoing surgery for end-stage ankle arthritis. Patients treated with total ankle arthroplasty or ankle arthrodesis were prospectively followed for a minimum of two years at a single site. Data on demographics, comorbidities, AOS score, Short Form-36 results, and the relationship between expectations and satisfaction were collected at baseline (preoperatively), at six and twelve months, and then yearly thereafter. A linear regression analysis examined the variables affecting the change in AOS scores between baseline and the two-year follow-up. An MCID in the AOS change score was then determined by employing an anchor question, which asked patients to rate their relief from symptoms after surgery. Surgical treatment of end-stage ankle arthritis resulted in a mean improvement (and standard deviation) of 31.2 ± 22.7 points in the AOS score two years after surgery. The MCID of the AOS change score was a mean of 28.0 ± 17.9 points. The change in AOS score was significantly affected by the preoperative AOS score, smoking, back pain, and age. Patients undergoing arthroplasty or arthrodesis for end-stage ankle arthritis experienced a mean improvement in AOS score that was greater than the estimated MCID (31.2 versus 28.0 points). Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Longitudinal telomere shortening and early Alzheimer's disease progression in adults with down syndrome.

PubMed

Jenkins, Edmund C; Marchi, Elaine J; Velinov, Milen T; Ye, Lingling; Krinsky-McHale, Sharon J; Zigman, Warren B; Schupf, Nicole; Silverman, Wayne P

2017-12-01

Telomere shortening was shown to parallel Alzheimer's disease (AD) associated dementia. By using a dual PNA Probe system we have developed a practical method for comparing telomere length in T-lymphocyte interphases from individuals with Down syndrome (DS) with and without "mild cognitive impairment" (MCI-DS) and demonstrated that telomere length can serve as a valid biomarker for the onset of MCI-DS in this high-risk population. To verify progressive cognitive decline we have now examined sequential changes in telomere length in 10 adults with DS (N = 4 Female, N = 6 Male) developing MCI-DS. Cases were selected blind to telomere length from a sample of adults with DS previously enrolled in a prospective longitudinal study at 18-month intervals with clinical and telomere assessments: (1) MCI-DS group data were collected approximately three years prior to development of MCI-DS; (2) 18 months later; (3) when MCI-DS was first observed. These telomere measures were compared to those from another 10 adults with DS matched by sex and approximate age but without indications of MCI-DS (Controls). PNA (peptide nucleic acid) probes for telomeres together with a chromosome two centromere probe were used. Findings indicated telomere shortening over time for both Cases and Controls. Group differences emerged by 18-months prior to recognition of MCI-DS onset and completely non-overlapping distributions of telomere measures were observed by the time of MCI-DS onset. This study adds to accumulating evidence of the value of telomere length, as an early biomarker of AD progression in adults with Down syndrome. © 2017 Wiley Periodicals, Inc.

Progress in defining clinically meaningful changes for clinical trials in nonrenal manifestations of SLE disease activity.

PubMed

Choi, Chan-Bum; Liang, Matthew H; Bae, Sang-Cheol

2016-01-06

Since the 2002 Dusseldorf meeting, one new agent, Benlysta, has been approved by the US Food and Drug Administration for systemic lupus erythematosus. Experiences from the field in conducting trials of all the agents tested during this period have provided valuable practical insights. There has been incremental progress in defining the minimal clinically important difference (MCID) of key disease manifestations and the view is largely that of the health care providers and not that of the person suffering the disease. This basic methodological work on the MCID should improve the efficiency and the clinical relevance of future trials and their design.

Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status.

PubMed

Michener, Lori A; Snyder, Alison R; Leggin, Brian G

2011-02-01

The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices. To determine the minimal clinically important difference (MCID) of the NPRS. Single-group repeated measures. Outpatient rehabilitation clinics. Patients with shoulder pain (N = 136). At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3-4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0-60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen's effect sizes were calculated as a measure of group responsiveness for the NPRS average. Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74-.76 (95%CI: .55-.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively. The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3-4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.

Comparison of IKDC and SANE Outcome Measures Following Knee Injury in Active Female Patients

PubMed Central

Winterstein, Andrew P.; McGuine, Timothy A.; Carr, Kathleen E.; Hetzel, Scott J.

2013-01-01

Background: Knee injury among young, active female patients remains a public health issue. Clinicians are called upon to pay greater attention to patient-oriented outcomes to evaluate the impact of these injuries. Little agreement exists on which outcome measures are best, and clinicians cite several barriers to their use. Single Assessment Numerical Evaluation (SANE) may provide meaningful outcome information while lessening the time burden associated with other patient-oriented measures. Hypothesis: The SANE and International Knee Documentation Committee (IKDC) scores would be strongly correlated in a cohort of young active female patients with knee injuries from preinjury through 1-year follow-up and that a minimal clinically important difference (MCID) could be calculated for the SANE score. Study Design: Observational prospective cohort. Methods: Two hundred sixty-three subjects completed SANE and IKDC at preinjury by recall, time of injury, and 3, 6, and 12 months postinjury. Pearson correlation coefficients were used to assess the association between SANE and IKDC. Repeated-measures analysis of variance was used to determine differences in SANE and IKDC over time. MCID was calculated for SANE using IKDC MCID as an anchor. Results: Moderate to strong correlations were seen between SANE and IKDC (0.65-0.83). SANE, on average, was 2.7 (95% confidence interval, 1.5-3.9; P < 0.00) units greater than IKDC over all time points. MCID for the SANE was calculated as 7 for a 6-month follow-up and 19 for a 12-month follow-up. Conclusion: SANE scores were moderately to strongly correlated to IKDC scores across all time points. Reported MCID values for the SANE should be utilized to measure meaningful changes over time for young, active female patients with knee injuries. Clinical Relevance: Providing clinicians with patient-oriented outcome measures that can be obtained with little clinician and patient burden may allow for greater acceptance and use of outcome measures in clinical settings. PMID:24427427

Interpretability of Change Scores in Measures of Balance in People With COPD.

PubMed

Beauchamp, Marla K; Harrison, Samantha L; Goldstein, Roger S; Brooks, Dina

2016-03-01

Balance deficits and an increased fall risk are well documented in individuals with COPD. Despite evidence that balance training programs can improve performance on clinical balance tests, their minimal clinically important difference (MCID) is unknown. The aim of this study was to determine the MCID of the Berg Balance Scale (BBS), Balance Evaluation Systems Test (BESTest), and Activities-Specific Balance Confidence (ABC) scale in patients with COPD undergoing pulmonary rehabilitation. We performed a secondary analysis of data from two studies of balance training in COPD (n = 55). The MCID for each balance measure was estimated using the following anchor and distribution-based approaches: (1) mean change scores on a patient-reported global change in balance scale, (2) optimal cut-point from receiver operating characteristic curves (ROCs), and (3) the minimal detectable change with 95% confidence (MDC95). Data from 55 patients with COPD (mean age, 71.2 ± 7.1 y; mean FEV1, 39.2 ± 15.8% predicted) were used in the analysis. The smallest estimate of MCID was from the ROC method. Anchor-based estimates of the MCID ranged from 3.5 to 7.1 for the BBS, 10.2 to 17.4 for the BESTest, and 14.2 to 18.5 for the ABC scale; their MDC95 values were 5.0, 13.1, and 18.9, respectively. Among patients with COPD undergoing pulmonary rehabilitation, a change of 5 to 7 points for the BBS, 13 to 17 points for the BESTest, and 19 points for the ABC scale is required to be both perceptible to patients and beyond measurement error. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Minimal clinically important difference in the fibromyalgia impact questionnaire.

PubMed

Bennett, Robert M; Bushmakin, Andrew G; Cappelleri, Joseph C; Zlateva, Gergana; Sadosky, Alesia B

2009-06-01

The Fibromyalgia Impact Questionnaire (FIQ) is a disease-specific composite instrument that measures the effect of problems experienced by patients with fibromyalgia (FM). Utilization of the FIQ in measuring changes due to interventions in FM requires derivation of a clinically meaningful change for that instrument. Analyses were conducted to estimate the minimal clinically important difference (MCID), and to propose FIQ severity categories. Data from 3 similarly designed, 3-month placebo-controlled, clinical treatment trials of pregabalin 300, 450, and 600 mg/day in patients with FM were modeled to estimate the change in the mean FIQ total and stiffness items corresponding to each category on the Patient Global Impression of Change. FIQ severity categories were modeled and determined using established pain severity cutpoints as an anchor. A total of 2228 patients, mean age 49 years, 93% women, with a mean baseline FIQ total score of 62 were treated in the 3 studies. Estimated MCID on a given measure were similar across the studies. In a pooled analysis the estimated MCID (95% confidence interval) was 14% (13; 15) and for FIQ stiffness it was 13% (12; 14). In the severity analysis a FIQ total score from 0 to <39 was found to represent a mild effect, >or= 39 to <59 a moderate effect, and >or=59 to 100 a severe effect. The analysis indicates that a 14% change in the FIQ total score is clinically relevant, and results of these analyses should enhance the clinical utility of the FIQ in research and practice.

Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Han, Jing L; Cheng, Joseph; Karikari, Isaac; Bagley, Carlos A

2016-12-01

OBJECTIVE With the recent passage of the Patient Protection and Affordable Care Act, there has been a dramatic shift toward critical analyses of quality and longitudinal assessment of subjective and objective outcomes after lumbar spine surgery. Accordingly, the emergence and routine use of real-world institutional registries have been vital to the longitudinal assessment of quality. However, prospectively obtaining longitudinal outcomes for patients at 24 months after spine surgery remains a challenge. The aim of this study was to assess if 12-month measures of treatment effectiveness accurately predict long-term outcomes (24 months). METHODS A nationwide, multiinstitutional, prospective spine outcomes registry was used for this study. Enrollment criteria included available demographic, surgical, and clinical outcomes data. All patients had prospectively collected outcomes measures and a minimum 2-year follow-up. Patient-reported outcomes instruments (Oswestry Disability Index [ODI], SF-36, and visual analog scale [VAS]-back pain/leg pain) were completed before surgery and then at 3, 6, 12, and 24 months after surgery. The Health Transition Index of the SF-36 was used to determine the 1- and 2-year minimum clinically important difference (MCID), and logistic regression modeling was performed to determine if achieving MCID at 1 year adequately predicted improvement and achievement of MCID at 24 months. RESULTS The study group included 969 patients: 300 patients underwent anterior lumbar interbody fusion (ALIF), 606 patients underwent transforaminal lumbar interbody fusion (TLIF), and 63 patients underwent lateral interbody fusion (LLIF). There was a significant correlation between the 12- and 24-month ODI (r = 0.82; p < 0.0001), SF-36 Physical Component Summary score (r = 0.89; p < 0.0001), VAS-back pain (r = 0.90; p < 0.0001), and VAS-leg pain (r = 0.85; p < 0.0001). For the ALIF cohort, patients achieving MCID thresholds for ODI at 12 months were 13-fold (p < 0.0001) more likely to achieve MCID at 24 months. Similarly, for the TLIF and LLIF cohorts, patients achieving MCID thresholds for ODI at 12 months were 13-fold and 14-fold (p < 0.0001) more likely to achieve MCID at 24 months. Outcome measures obtained at 12 months postoperatively are highly predictive of 24-month outcomes, independent of the surgical procedure. CONCLUSIONS In a multiinstitutional prospective study, patient-centered measures of surgical effectiveness obtained at 12 months adequately predict long-term (24-month) outcomes after lumbar spine surgery. Patients achieving MCID at 1 year were more likely to report meaningful and durable improvement at 24 months, suggesting that the 12-month time point is sufficient to identify effective versus ineffective patient care.

Determining the non-inferiority margin for patient reported outcomes.

PubMed

Gerlinger, Christoph; Schmelter, Thomas

2011-01-01

One of the cornerstones of any non-inferiority trial is the choice of the non-inferiority margin delta. This threshold of clinical relevance is very difficult to determine, and in practice, delta is often "negotiated" between the sponsor of the trial and the regulatory agencies. However, for patient reported, or more precisely patient observed outcomes, the patients' minimal clinically important difference (MCID) can be determined empirically by relating the treatment effect, for example, a change on a 100-mm visual analogue scale, to the patient's satisfaction with the change. This MCID can then be used to define delta. We used an anchor-based approach with non-parametric discriminant analysis and ROC analysis and a distribution-based approach with Norman's half standard deviation rule to determine delta in three examples endometriosis-related pelvic pain measured on a 100-mm visual analogue scale, facial acne measured by lesion counts, and hot flush counts. For each of these examples, all three methods yielded quite similar results. In two of the cases, the empirically derived MCIDs were smaller or similar of deltas used before in non-inferiority trials, and in the third case, the empirically derived MCID was used to derive a responder definition that was accepted by the FDA. In conclusion, for patient-observed endpoints, the delta can be derived empirically. In our view, this is a better approach than that of asking the clinician for a "nice round number" for delta, such as 10, 50%, π, e, or i. Copyright © 2011 John Wiley & Sons, Ltd.

Defining surgical criteria for empty nose syndrome: Validation of the office-based cotton test and clinical interpretability of the validated Empty Nose Syndrome 6-Item Questionnaire.

PubMed

Thamboo, Andrew; Velasquez, Nathalia; Habib, Al-Rahim R; Zarabanda, David; Paknezhad, Hassan; Nayak, Jayakar V

2017-08-01

The validated Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) identifies empty nose syndrome (ENS) patients. The unvalidated cotton test assesses improvement in ENS-related symptoms. By first validating the cotton test using the ENS6Q, we define the minimal clinically important difference (MCID) score for the ENS6Q. Individual case-control study. Fifteen patients diagnosed with ENS and 18 controls with non-ENS sinonasal conditions underwent office cotton placement. Both groups completed ENS6Q testing in three conditions-precotton, cotton in situ, and postcotton-to measure the reproducibility of ENS6Q scoring. Participants also completed a five-item transition scale ranging from "much better" to "much worse" to rate subjective changes in nasal breathing with and without cotton placement. Mean changes for each transition point, and the ENS6Q MCID, were then calculated. In the precotton condition, significant differences (P < .001) in all ENS6Q questions between ENS and controls were noted. With cotton in situ, nearly all prior ENS6Q differences normalized between ENS and control patients. For ENS patients, the changes in the mean differences between the precotton and cotton in situ conditions compared to postcotton versus cotton in situ conditions were insignificant among individuals. Including all 33 participants, the mean change in the ENS6Q between the parameters "a little better" and "about the same" was 4.25 (standard deviation [SD] = 5.79) and -2.00 (SD = 3.70), giving an MCID of 6.25. Cotton testing is a validated office test to assess for ENS patients. Cotton testing also helped to determine the MCID of the ENS6Q, which is a 7-point change from the baseline ENS6Q score. 3b. Laryngoscope, 127:1746-1752, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference.

PubMed

Levy, David M; Kuhns, Benjamin D; Chahal, Jaskarndip; Philippon, Marc J; Kelly, Bryan T; Nho, Shane J

2016-09-01

To determine whether the hip arthroscopy literature to date has shown outcomes consistent with published patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) estimates. All clinical investigations of hip arthroscopy using modified Harris Hip Score (mHHS) and/or Hip Outcome Score (HOS) outcomes with at least 1 year of follow-up were reviewed. Ninety-one studies (9,746 hips) were included for review. Eighty-one studies (9,317 hips) contained only primary hip arthroscopies and were the primary focus of this review. The remaining studies (429 hips) did not exclude patients with prior surgical history and were thus considered separately. Mean mHHS, HOS-ADL (Activities of Daily Living) and HOS-SS (Sports-Specific) scores were compared with previously published PASS and MCID values. After 31 ± 20 months, 5.8% of study populations required revision arthroscopy and 5.5% total hip arthroplasty. A total of 88%, 25%, and 30% of study populations met PASS for mHHS, HOS-ADL, and HOS-SS, respectively, and 97%, 90%, and 93% met MCID. On bivariate analysis, increasing age was associated with significantly worse postoperative mHHS (P < .01, R(2) = 0.14), HOS-SS (P = .05, R(2) = 0.12), and rates of reoperation (P = .02, R(2) = 0.08). Increasing body mass index was associated with significantly worse HOS-ADL (P = .02, R(2) = 0.35) and HOS-SS (P = .03, R(2) = 0.30). In this meta-analysis of 81 studies of primary hip arthroscopy, we have found that more than 90% of study populations meet MCID standards for the most commonly used patient-reported outcomes measures in hip arthroscopy literature, mHHS and HOS. Eighty-eight percent meet PASS standards for the mHHS, but PASS standards are far more difficult to achieve for HOS-ADL (25%) and HOS-SS (30%) subscales. Differences in psychometric properties of the mHHS and HOS likely account for the discrepancies in PASS. Level IV, systematic review of Level I to IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: a systematic literature review

PubMed Central

Holthe, Torhild; Halvorsrud, Liv; Karterud, Dag; Hoel, Kari-Anne; Lund, Anne

2018-01-01

Background The objective of this review was to obtain an overview of the technologies that have been explored with older adults with mild cognitive impairment and dementia (MCI/D), current knowledge on the usability and acceptability of such technologies, and how people with MCI/D and their family carers (FCs) were involved in these studies. Materials and methods Primary studies published between 2007 and 2017 that explored the use of technologies for community-dwelling people with MCI/D were identified through five databases: MEDLINE, PsycINFO, Embase, AMED, and CINAHL. Twenty-nine out of 359 papers met the criteria for eligibility. We used the Mixed Methods Appraisal Tool for quality assessment. Results A wide range of technologies was presented in the 29 studies, sorted into four domains: 1) safe walking indoors and outdoors; 2) safe living; 3) independent living; and 4) entertainment and social communication. The current state of knowledge regarding usability and acceptability reveals that even if researchers are aware of these concepts and intend to measure usability and acceptability, they seem difficult to assess. Terms such as “user friendliness” and “acceptance” were used frequently. User participation in the 29 studies was high. Persons with MCI/D, FCs, and staff/other older adults were involved in focus groups, workshops, and interviews as part of the preimplementation process. Conclusion Research regarding technologies to support people with MCI/D seems optimistic, and a wide range of technologies has been evaluated in homes with people with MCI/D and their FCs. A major finding was the importance of including people with MCI/D and their FCs in research, in order to learn about required design features to enhance usability and acceptability. Surprisingly, very few studies reported on the consequences of technology use with regard to quality of life, occupational performance, or human dignity. PMID:29765211

Usability and acceptability of technology for community-dwelling older adults with mild cognitive impairment and dementia: a systematic literature review.

PubMed

Holthe, Torhild; Halvorsrud, Liv; Karterud, Dag; Hoel, Kari-Anne; Lund, Anne

2018-01-01

The objective of this review was to obtain an overview of the technologies that have been explored with older adults with mild cognitive impairment and dementia (MCI/D), current knowledge on the usability and acceptability of such technologies, and how people with MCI/D and their family carers (FCs) were involved in these studies. Primary studies published between 2007 and 2017 that explored the use of technologies for community-dwelling people with MCI/D were identified through five databases: MEDLINE, PsycINFO, Embase, AMED, and CINAHL. Twenty-nine out of 359 papers met the criteria for eligibility. We used the Mixed Methods Appraisal Tool for quality assessment. A wide range of technologies was presented in the 29 studies, sorted into four domains: 1) safe walking indoors and outdoors; 2) safe living; 3) independent living; and 4) entertainment and social communication. The current state of knowledge regarding usability and acceptability reveals that even if researchers are aware of these concepts and intend to measure usability and acceptability, they seem difficult to assess. Terms such as "user friendliness" and "acceptance" were used frequently. User participation in the 29 studies was high. Persons with MCI/D, FCs, and staff/other older adults were involved in focus groups, workshops, and interviews as part of the preimplementation process. Research regarding technologies to support people with MCI/D seems optimistic, and a wide range of technologies has been evaluated in homes with people with MCI/D and their FCs. A major finding was the importance of including people with MCI/D and their FCs in research, in order to learn about required design features to enhance usability and acceptability. Surprisingly, very few studies reported on the consequences of technology use with regard to quality of life, occupational performance, or human dignity.

Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference.

PubMed

du Bois, Roland M; Weycker, Derek; Albera, Carlo; Bradford, Williamson Z; Costabel, Ulrich; Kartashov, Alex; Lancaster, Lisa; Noble, Paul W; Sahn, Steven A; Szwarcberg, Javier; Thomeer, Michiel; Valeyre, Dominique; King, Talmadge E

2011-05-01

The 6-minute-walk test (6MWT) is a practical and clinically meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases. Performance characteristics in patients with idiopathic pulmonary fibrosis (IPF) have not been systematically evaluated. To assess the reliability, validity, and responsiveness of the 6MWT and estimate the minimal clinically important difference (MCID) in patients with IPF. The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b (n = 822). Six-minute walk distance (6MWD) and other parameters were measured at baseline and at 24-week intervals using a standardized protocol. Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function, dyspnea, and health-related quality of life. Both distribution-based and anchor-based methods were used to estimate the MCID. Comparison of two proximal measures of 6MWD (mean interval, 24 d) demonstrated good reliability (coefficient = 0.83; P < 0.001). 6MWD was weakly correlated with measures of physiologic function and health-related quality of life; however, values were consistently and significantly lower for patients with the poorest functional status, suggesting good construct validity. Importantly, change in 6MWD was highly predictive of mortality; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year (hazard ratio, 4.27; 95% confidence interval, 2.57- 7.10; P < 0.001). The estimated MCID was 24-45 m. The 6MWT is a reliable, valid, and responsive measure of disease status and a valid endpoint for clinical trials in IPF.

Health related quality of life of women in TEACH, a randomised placebo controlled adjuvant trial of lapatinib in early stage Human Epidermal Growth Factor Receptor (HER2) overexpressing breast cancer.

PubMed

Boyle, Frances M; Smith, Ian E; O'Shaughnessy, Joyce; Ejlertsen, Bent; Buzdar, Aman U; Fumoleau, Pierre; Gradishar, William; Martin, Miguel; Moy, Beverly; Piccart-Gebhart, Martine; Pritchard, Kathleen I; Lindquist, Deborah; Amonkar, Mayur; Huang, Yingjie; Rappold, Erica; Williams, Lisa S; Wang-Silvanto, Jing; Kaneko, Tomomi; Finkelstein, Dianne M; Goss, Paul E

2015-04-01

To evaluate health related quality of life (HRQOL) in TEACH, a phase III randomized placebo controlled trial of 12 months of adjuvant lapatinib in HER2 positive (HER2+) early breast cancer which demonstrated marginal benefit in disease-free survival. Women on TEACH completed the Short Form 36-item health survey (version2; SF-36v2) at the baseline, six and 12 months after therapy initiation and six monthly thereafter. Mean changes were compared between treatment groups for two summary measures (Physical and Mental Component Summary scores; PCS and MCS) and eight domain measures (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional and mental health), and in patients discontinuing therapy. A five-point change was deemed a Minimally Clinically Important Difference (MCID). Response analysis compared the proportion of patients demonstrating a MCID in HRQOL, and a regression analysis identified predictors of worsening HRQOL. 3074 (97%) subjects completed baseline SF-36v2. During the initial 12 months, summary SF-36v2 scores decreased in both arms but did not reach Minimally Clinically Important Difference (MCID) despite significant incidences of diarrhoea and rash in lapatinib treated patients. At six months, women receiving lapatinib had more significant reductions (p < 0.01 versus placebo) in social functioning. Early treatment discontinuations were more frequent on lapatinib (32% versus 18%), and were associated with more substantial decrements of HRQOL in both arms. For those discontinuing primarily due to adverse events, decrements in HRQOL reached MCID in Mental Summary scores (MCS) only. Lower baseline HRQOL was a significant predictor of worsening HRQOL (p < 0.05). Despite frequent but usually mild toxicities, adjuvant lapatinib is not associated with clinically significant decreases in overall HRQOL. These placebo-controlled results may also help to inform physicians and patients using lapatinib in metastatic HER2 positive breast cancer. GlaxoSmithKline. The AVON Foundation NY supported PEG, DF and BM and The Friends of the Mater Foundation supported FB. Copyright © 2015 Elsevier Ltd. All rights reserved.

77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-07

... trials and device study design. Date and Time: The public workshop will be held on November 27, 2012... problem for PRO instruments. There have been various methodological approaches to determine MCID for... rationales for regulatory guidance of clinical trials and device study design. Approximately 45 days after...

Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation.

PubMed

Monticone, Marco; Ambrosini, Emilia; Rocca, Barbara; Foti, Calogero; Ferrante, Simona

2017-06-01

The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported. Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion. Population-based cohort study. Secondary care rehabilitation hospital. In-patients undergoing rehabilitation after lumbar fusion. At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values. The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830). The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion. The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.

Is the DLQI appropriate for medical decision-making in psoriasis patients?

PubMed

Poór, Adrienn Katalin; Brodszky, Valentin; Péntek, Márta; Gulácsi, László; Ruzsa, Gábor; Hidvégi, Bernadett; Holló, Péter; Kárpáti, Sarolta; Sárdy, Miklós; Rencz, Fanni

2018-01-01

Dermatology Life Quality Index (DLQI) is the most commonly applied measure of health-related quality of life (HRQoL) in psoriasis patients. It is among defining criteria of moderate-to-severe psoriasis and present in treatment guidelines. Our objective was to estimate preference-based HRQoL values (i.e., utilities) for hypothetical health states described by the 10 items of the DLQI in psoriasis patients. Moreover, we compare results to findings of a similar study previously conducted among the general public. A cross-sectional survey was carried out among 238 psoriasis patients. Seven hypothetical DLQI-defined health states with total scores of 6, 11, and 16 (3-3 and 1 states, respectively) were evaluated by time trade-off method. The difference in DLQI scores between hypothetical health states was set at 5 points, as it exceeds the minimal clinically important difference (MCID). Utility scores were found to be homogenous across the seven hypothetical health states (range of means for the 6-point states 0.85-0.91, range of means for the 11-point states 0.83-0.85, and mean of 0.84 for the 16-point state). Overall, mean utilities assessed by psoriasis patients were higher for all seven states compared with the general public (mean difference 0.16-0.28; p < 0.001). In 11 out of the 15 comparisons between health states with DLQI scores differing larger than the MCID, there was no statistically significant difference in utility. Thus, in clinical settings, patients with DLQI scores differing more than the MCID may have identical HRQoL. Improving the definition of moderate-to-severe disease and reconsideration of the DLQI in clinical assessment of psoriasis patients are suggested.

Visual analogue scales for interstitial lung disease: a prospective validation study.

PubMed

Yates, Helen; Adamali, Huzaifa I; Maskell, Nick; Barratt, Shaney; Sharp, Charles

2018-05-16

Visual analogue scales (VAS) are simple symptom assessment tools which have not been validated in interstitial lung disease (ILD). Simple measures of ILD disease burden would be valuable for non-specialist clinicians monitoring disease away from ILD specialist centres. To validate VAS to assess change in dyspnoea, cough and fatigue in ILD, and to define the minimal clinically important difference (MCID) for change in these. 64 patients with ILD completed VAS for dyspnoea, cough and fatigue. Baseline King's Brief ILD questionnaire (K-BILD) scores, lung function and 6-minute walk test results were collected. Tests were repeated 3-6 months later, in addition to a 7-point Likert scale. The MCID was estimated using median change in VAS in patients who reported "small but just worthwhile change" in symptoms at follow-up. Methods were repeated in a validation cohort of 31 ILD patients to confirm findings. VAS scores were significantly higher for patients who reported a "small but just worthwhile change" in symptoms versus "no change" or "not worthwhile change" (p < 0.01). The MCID for VAS Dyspnoea was estimated as 22.0mm and 14.5mm for VAS Fatigue. These results were reproducible in the validation cohort. Results were not significant for VAS Cough. Change in VAS Dyspnoea correlated with change in K-BILD (r=-0.51, p < 0.01), forced vital capacity (r=-0.32, p = 0.01) and 6-minute walking distance (r=-0.37, p = 0.01). The VAS is valid for assessing change in dyspnoea and fatigue in ILD. The MCID is estimated as 22.0mm for dyspnoea and 14.5mm for fatigue. This could be used to monitor disease in settings away from ILD specialist review.

Relationship between isometric thigh muscle strength and minimum clinically important differences in knee function in osteoarthritis: data from the osteoarthritis initiative.

PubMed

Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

2015-04-01

To determine the relationship between thigh muscle strength and clinically relevant differences in self-assessed lower leg function. Isometric knee extensor and flexor strength of 4,553 Osteoarthritis Initiative participants (2,651 women and 1,902 men) was related to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scores by linear regression. Further, groups of male and female participant strata with minimum clinically important differences (MCIDs) in WOMAC function scores (6 of 68 units) were compared across the full range of observed values and to participants without functional deficits (WOMAC score 0). The effect of WOMAC knee pain and body mass index on the above relationships was explored using stepwise regression. Per regression equations, a 3.7% reduction in extensor strength and a 4.0% reduction in flexor strength were associated with an MCID in WOMAC function in women, and, respectively, a 3.6% and 4.8% reduction in men. For strength divided by body weight, reductions were 5.2% and 6.7%, respectively, in women and 5.8% and 6.7%, respectively, in men. Comparing MCID strata across the full observed range of WOMAC function confirmed the above estimates and did not suggest nonlinear relationships across the spectrum of observed values. WOMAC pain correlated strongly with WOMAC function, but extensor (and flexor) muscle strength contributed significant independent information. Reductions of approximately 4% in isometric muscle strength and of 6% in strength per body weight were related to a clinically relevant difference in WOMAC functional disability. Longitudinal studies will need to confirm these relationships within persons. Muscle extensor (and flexor) strength (per body weight) provided significant independent information in addition to pain in explaining variability in lower leg function. Copyright © 2015 by the American College of Rheumatology.

Shorter telomeres may indicate dementia status in older individuals with Down Syndrome

PubMed Central

Jenkins, Edmund C.; Ye, Lingling; Gu, Hong; Ni, Samantha A.; Velinov, Milen; Pang, Deborah; Krinsky-McHale, Sharon J.; Zigman, Warren B.; Schupf, Nicole; Silverman, Wayne P.

2009-01-01

We have recently reported reduced telomere length in T lymphocytes of individuals with Down syndrome (DS) and dementia due to Alzheimer’s disease (AD). We have now replicated and extended that study by finding that people with DS and mild cognitive impairment (MCI-DS) also have shorter telomeres than people with DS without MCI-DS. Additional new findings demonstrated that light intensity measurements from chromosome 21 alone, or in concert with chromosomes 1, 2, and 16, exhibited shorter telomeres in adults with DS and with either dementia or MCI-DS compared to aging per se. Chromosome 21 measurements appeared to be especially promising for use as a biomarker because there was no overlap in the distribution of light intensity measurement scores between demented or MCI-DS and non-demented participants. Given that early clinical symptoms of AD can be very difficult to recognize in this population of adults due to their pre-existing cognitive impairments, a valid biomarker would be of great value. Early detection is especially important because it would allow treatments to begin before significant damage to the central nervous system has occurred. Our findings suggest that it may be feasible to use telomere shortening as a biomarker for accurately inferring dementia status. PMID:18635289

Change in Quality of Life with Velopharyngeal Insufficiency Surgery

PubMed Central

Skirko, Jonathan R.; Weaver, Edward M.; Perkins, Jonathan A.; Kinter, Sara; Eblen, Linda; Martina, Julie; Sie, Kathleen C.Y.

2018-01-01

Objective 1) Define the minimal clinically important difference (MCID) of the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument, and 2) test for change in quality of life after VPI surgery. Study Design Prospective observational cohort. Setting VPI clinic at a tertiary pediatric medical center. Subjects and Methods Children with VPI and their parents completed the VELO instrument (higher score is better quality of life) at enrollment and then underwent VPI surgery (Furlow palatoplasty or sphincter pharyngoplasty, n=32), other treatments (obturator or oronasal fistula repair, n=7), or no treatment (n=18). They completed the VELO instrument again and an instrument of global rating of change in quality of life at one year. MCID was anchored to the global change instrument scores corresponding to “a little” or “somewhat” better. Within-group (paired t-test) and between-group (Student’s t-test) changes in VELO were tested for the VPI surgery and no treatment groups. The association between treatment group and VELO change was tested with multivariate linear regression, adjusting for confounders. Results Follow up was obtained on 37/57 (65%) of patients. The mean (SD) VELO change scores corresponding to the MCID anchor was 15 (13). The VELO score improved significantly more in the VPI surgery group (change 22 [15]), p<0.001) than in the no-treatment group (change 9 [12], p=0.04), after adjusting for confounders (p=0.007 between groups). Conclusion VPI surgery using the Furlow palatoplasty or sphincter pharyngoplasty improves VPI specific quality-of-life, and the improvement is clinically important. PMID:26124262

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

PubMed Central

De Smedt, Kris; Mitchell, Bruce; Vivian, David; Russo, Marc; Georgius, Peter; Green, Matthew; Vieceli, John; Eldabe, Sam; Gulve, Ashish; van Buyten, Jean‐Pierre; Smet, Iris; Mehta, Vivek; Ramaswamy, Shankar; Baranidharan, Ganesan; Sullivan, Richard; Gassin, Robert; Rathmell, James; Gilligan, Chris

2017-01-01

Objectives The purpose of the international multicenter prospective single arm clinical trial was to evaluate restorative neurostimulation eliciting episodic contraction of the lumbar multifidus for treatment of chronic mechanical low back pain (CMLBP) in patients who have failed conventional therapy and are not candidates for surgery or spinal cord stimulation (SCS). Materials and Methods Fifty‐three subjects were implanted with a neurostimulator (ReActiv8, Mainstay Medical Limited, Dublin, Ireland). Leads were positioned bilaterally with electrodes close to the medial branch of the L2 dorsal ramus nerve. The primary outcome measure was low back pain evaluated on a 10‐Point Numerical Rating Scale (NRS). Responders were defined as subjects with an improvement of at least the Minimal Clinically Important Difference (MCID) of ≥2‐point in low back pain NRS without a clinically meaningful increase in LBP medications at 90 days. Secondary outcome measures included Oswestry Disability Index (ODI) and Quality of Life (QoL; EQ‐5D). Results For 53 subjects with an average duration of CLBP of 14 years and average NRS of 7 and for whom no other therapies had provided satisfactory pain relief, the responder rate was 58%. The percentage of subjects at 90 days, six months, and one year with ≥MCID improvement in single day NRS was 63%, 61%, and 57%, respectively. Percentage of subjects with ≥MCID improvement in ODI was 52%, 57%, and 60% while those with ≥MCID improvement in EQ‐5D was 88%, 82%, and 81%. There were no unanticipated adverse events (AEs) or serious AEs related to the device, procedure, or therapy. The initial surgical approach led to a risk of lead fracture, which was mitigated by a modification to the surgical approach. Conclusions Electrical stimulation to elicit episodic lumbar multifidus contraction is a new treatment option for CMLBP. Results demonstrate clinically important, statistically significant, and lasting improvement in pain, disability, and QoL. PMID:29244235

Is the Oswestry Disability Index a valid measure of response to sacroiliac joint treatment?

PubMed

Copay, Anne G; Cher, Daniel J

2016-02-01

Disease-specific measures of the impact of sacroiliac (SI) joint pain on back/pelvis function are not available. The Oswestry Disability Index (ODI) is a validated functional measure for lower back pain, but its responsiveness to SI joint treatment has yet to be established. We sought to assess the validity of ODI to capture disability caused by SI joint pain and the minimum clinically important difference (MCID) after SI joint treatment. Patients (n = 155) participating in a prospective clinical trial of minimally invasive SI joint fusion underwent baseline and follow-up assessments using ODI, visual analog scale (VAS) pain assessment, Short Form 36 (SF-36), EuroQoL-5D, and questions (at follow-up only) regarding satisfaction with the SI joint fusion and whether the patient would have the fusion surgery again. All outcomes were compared from baseline to 12 months postsurgery. The health transition item of the SF-36 and the satisfaction scale were used as external anchors to calculate MCID. MCID was estimated for ODI using four calculation methods: (1) minimum detectable change, (2) average ODI change of patients' subsets, (3) change difference between patients' subsets, and (4) receiver operating characteristic (ROC) curve. After SI fusion, patients improved significantly (p < .0001) on all measures: SI joint pain (48.8 points), ODI (23.8 points), EQ-5D (0.29 points), EQ-5D VAS (11.7 points), PCS (8.9 points), and MCS (9.2 points). The improvement in ODI was significantly correlated (p < .0001) with SI joint pain improvement (r = .48) and with the two external anchors: SF-36 health transition item (r = .49) and satisfaction level (r = .34). The MCID values calculated for ODI using the various methods ranged from 3.5 to 19.5 points. The ODI minimum detectable change was 15.5 with the health transition item as the anchor and 13.5 with the satisfaction scale as the anchor. ODI is a valid measure of change in SI joint health. Hence, researchers and clinicians may rely on ODI scores to measure disability caused by SI pain. We estimated the MCID for ODI to be 13-15 points, which falls within the range of that previously reported for lumbar back pain and indicates that an improvement in disability should be at least 15 % to be beyond random variation.

Assessing health-related quality of life in gynecologic oncology: a systematic review of questionnaires and their ability to detect clinically important differences and change.

PubMed

Luckett, Tim; King, Madeleine; Butow, Phyllis; Friedlander, Michael; Paris, Tim

2010-05-01

Researchers wishing to assess the health-related quality of life (HRQoL) of women with gynecologic cancers have a range of questionnaires to choose from. In general, disease-, treatment-, or symptom-specific questionnaires are assumed to be better able to identify between-group differences (sensitivity) and changes over time (responsiveness) than are cancer-specific or generic questionnaires. However, little work has tested this assumption in oncology. We set out to (a) identify all multidimensional HRQoL questionnaires used in studies with women with gynecologic cancer and (b) evaluate their track records in identifying minimal clinically important differences (MCIDs), with a view to making recommendations. We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires. We used 10% of the scale range as the threshold for an MCID. We identified 1 generic (SF-36/SF-12), 3 cancer-specific (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] C30, Functional Assessment of Cancer Therapy-General [FACT-G], and short-form Cancer Rehabilitation Evaluation System [CARES-SF]), and 1 disease-specific (QOL-Ovarian Cancer Patient Version) HRQoL questionnaires and 5 disease-specific (QLQ-OV28, FACT-O for ovarian, QLQ-CX24, FACT-Cx for cervical and FACT-V for vulvar), 1 treatment-specific (FACT and Gynecologic Oncology Group-Ntx for neurotoxicity), and 2 symptom-specific (FACT-Anemia and Functional Assessment of Chronic Illness and Therapy [FACIT]-Fatigue) modules. Twenty-seven articles reported results from 26 studies in which an MCID had been identified. The FACIT's anemia and fatigue subscales were more sensitive, and the neurotoxicity subscale more sensitive and responsive than the FACT-G on at least 1 comparison. However, we found no evidence for superior performance by the FACT-G compared with the SF-36 or EORTC and FACIT disease-specific modules versus the QLQ-C30 and FACT-G. There was also little evidence to favor EORTC versus FACIT questionnaires or vice versa. The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.

Do spouses know how much fatigue, pain, and physical limitation their partners with rheumatoid arthritis experience? Implications for social support.

PubMed

Lehman, Allen J; Pratt, Daniel D; DeLongis, Anita; Collins, John B; Shojania, Kam; Koehler, Barry; Offer, Robert; Esdaile, John M

2011-01-01

To determine whether perceptions of clinical manifestations (fatigue, pain, and physical limitation) of rheumatoid arthritis (RA) differ between spouses and their partners with RA, and to determine whether the differences are associated with the perception of beneficial and problematic spousal social support. English-speaking adults with RA of ≥ 6 months' duration and their spouses (n = 222 couples) completed standardized questionnaires for fatigue, pain, physical limitation, beneficial spousal support, and problematic spousal support. Spouses completed questionnaires based on their perception of their partner with RA. Agreement scores for fatigue, pain, and physical limitation were calculated by subtracting spouse scores from the scores of the partner with RA. Agreement levels were defined a priori: agreement (within ± one-half of a minimum clinically important difference [MCID] unit), overestimator (< one-half an MCID), and underestimator (> one-half an MCID). Separate hierarchical linear regression models were used to measure the association between beneficial support and problematic support after adjusting for RA duration, physical health, sex, educational level, relationship duration, and satisfaction. Response rate for couples was 82%. Relative to participants with RA, spouses overestimated fatigue (26%), pain (29%), and physical limitation (39%), and underestimated fatigue (11%), pain (17%), and physical limitation (34%). After statistically controlling for demographic, disease, and psychosocial variables, participants with RA whose spouses underestimated fatigue received more problematic support (R(2) = 3.7%, P = 0.002), as did those whose spouses underestimated or overestimated physical limitation (R(2) = 3.4%, P = 0.017). Persons with RA perceived more problematic spousal support when their spouse underestimated fatigue, or underestimated or overestimated physical limitation levels. Copyright © 2011 by the American College of Rheumatology.

Age and Preoperative Knee Society Score Are Significant Predictors of Outcomes Among Asians Following Total Knee Arthroplasty.

PubMed

Bin Abd Razak, Hamid Rahmatullah; Tan, Chuen-Seng; Chen, Yongqiang Jerry Delphi; Pang, Hee-Nee; Tay, Keng-Jin Darren; Chin, Pak-Lin; Chia, Shi-Lu; Lo, Ngai-Nung; Yeo, Seng-Jin

2016-05-04

The ability to predict patients' functional outcomes will add value to preoperative counseling. The purpose of this study was to evaluate predictors of good outcomes following total knee arthroplasty (TKA) among Asian patients. Registry data from 2006 to 2010 were extracted. The Oxford Knee Score (OKS) and the Short Form (SF)-36 physical component summary (PCS) were used to evaluate outcomes. A "good outcome" was defined as an improvement in scores of greater than or equal to the minimal clinically important difference (MCID) in the primary analysis. The MCID for the OKS was 5, and the MCID for the PCS was 10. For the sensitivity analyses, a "good outcome" was defined as an OKS of <30 and a PCS score of >50. Clinical variables were used to develop a multiple logistic regression model for a good outcome following total knee arthroplasty at 5 years. Follow-up data were available for 3,062 patients who underwent primary TKA (mean age of 66.4 years; 79.5% female). Eighty-five percent had a good outcome on the basis of the OKS and 83%, on the basis of the SF-36 PCS. Age and preoperative Knee Society score (KSS) were found to be significant predictors. When outcomes were assessed by the MCID, lesser age and lower (worse) preoperative KSS predicted a good outcome at 5 years. When outcomes were assessed by absolute criteria (postoperative scores measured against OKS and PCS thresholds), a higher (better) preoperative KSS predicted a good outcome at 5 years. Body mass index, preoperative flexion range, SF-36 mental component summary (MCS) score, mechanical alignment, sex, education level, ethnicity, operative side, number of comorbidities, type of anesthesia, and type of implant were found not to be significant predictors. The majority of Asian patients with osteoarthritis had good outcomes according to the MCID criterion and benefitted from primary TKA. On the basis of our findings, we believe that older patients with a lower (worse) preoperative KSS can be informed that they have a high likelihood of improvement but a lower likelihood of achieving as good a functional outcome as those with better scores. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Validating the use of the evaluation tool of children's handwriting-manuscript to identify handwriting difficulties and detect change in school-age children.

PubMed

Brossard-Racine, Marie; Mazer, Barbara; Julien, Marilyse; Majnemer, Annette

2012-01-01

In this study we sought to validate the discriminant ability of the Evaluation Tool of Children's Handwriting-Manuscript in identifying children in Grades 2-3 with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists. Thirty-four therapists judged and compared 35 pairs of handwriting samples. Receiver operating characteristic (ROC) analyses were performed to determine (1) the optimal cutoff values for word and letter legibility scores that identify children with handwriting difficulties who should be seen in rehabilitation and (2) the minimal clinically important difference (MCID) in handwriting scores. Cutoff scores of 75.0% for total word legibility and 76.0% for total letter legibility were found to provide excellent levels of accuracy. A difference of 10.0%-12.5% for total word legibility and 6.0%-7.0% for total letter legibility were found as the MCID. Study findings enable therapists to quantitatively support clinical judgment when evaluating handwriting. Copyright © 2012 by the American Occupational Therapy Association, Inc.

Does Hip Arthroscopy Provide Meaningful Outcome Improvement for Adolescent Femoroacetabular Impingement

PubMed Central

Nwachukwu, Benedict Uchenna; Chang, Brenda; Kahlenberg, Cynthia A.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2017-01-01

Objectives: Arthroscopic treatment of femoroacetabular impingement (FAI) produces meaningful outcome improvement in adults. Hip arthroscopy for pediatric FAI is now established as a safe procedure however there is a paucity of evidence reporting on outcome improvement after arthroscopic treatment of FAI in this population. Methods: A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for pediatric FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) are routinely collected as part of the registry. Minimal clinically important difference (MCID) was calculated using a distribution based method and substantial clinical benefit (SCB) was calculated using the an anchor question. Receiver operating characteristic (ROC) analysis with area under the curve was used. AUC > 0.7 was considered significantly predictive. Results: Forty-seven children and adolescents were identified. The majority of patients were female (N=32, 68.1%) with a mean age of 16.5 (+ 1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%) and 10.7 (94%) respectively. MCID values on these outcome tools were comparable to adult patients within the registry however for each outcome measure pediatric patients were more likely to achieve MCID. In univariate analysis acetabular version was the only predictive variable for achieving MCID in pediatric FAI (p<0.05). The majority of children (91%) reported improved physical ability based on the anchor question and 53% (compared to 40% in adult registry patients) were classified as achieving SCB. The following one-year raw outcome scores were significantly predictive of SCB on the mHHS, HOS ADL, HOS Sport and mHHS respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), 85.9 (0.76). These pediatric SCB values were all higher than SCB values for adult registry patients (82.5, 93.3, 84.4, 63.5 respectively) Conclusion: Pediatric patients undergoing arthroscopic FAI treatment can achieve meaningful outcome improvement and compared to adults, a larger proportion of children achieve meaningful outcome improvement. Additionally, while MCID values are comparable in children and adults, children appear to require substantially higher overall post-operative scores to perceive SCB. These findings highlight that commonly administered adult FAI outcome tools may have a relative ceiling effect in capturing outcome after treatment of pediatric FAI.

Measuring IBS patient reported outcomes with an abdominal pain numeric rating scale: results from the proof cohort

PubMed Central

SPIEGEL, B.; BOLUS, R.; HARRIS, L. A.; LUCAK, S.; NALIBOFF, B.; ESRAILIAN, E.; CHEY, W. D.; LEMBO, A.; KARSAN, H.; TILLISCH, K.; TALLEY, J.; MAYER, E.; CHANG, L.

2009-01-01

Background Controversy exists about how to effectively measure patient reported outcomes in IBS clinical trials. Pain numeric rating scales (NRS) are widely used in the non-IBS pain literature. The FDA has proposed using the NRS in IBS. Aim To test the psychometrics of an abdominal pain NRS in IBS. Methods We analyzed data from a longitudinal cohort of Rome III IBS subjects. At entry, subjects completed a 10-point NRS, bowel symptoms, IBS severity measurements (IBSSS, FBDSI), health related quality of life indices (IBS-QOL, EQ5D), and the worker productivity activity index (WPAI). We repeated assessments at 3 months along with a response scale to calculate the minimal clinically important difference (MCID). Results There were 277 subjects (82% women; age=42±15) at baseline and 90 at 3 months. The NRS correlated cross-sectionally with IBSSS (r=0.60; p<0.0011), FBDSI (r=0.49; p<0.0001), IBS-QOL (r=0.43; p<0.0001), EQ5D (r=0.48; p<0.0001), presenteeism (r=0.39; p<0.0001), absenteeism (r=0.17; p=0.04), and distension (r=0.46; p<0.0001), but not stool frequency or form. The MCID was 2.2 points, correlating with a 29.5% reduction over time. Conclusions An abdominal pain NRS exhibits excellent validity and can be readily interpreted with an MCID in patients with IBS. These data support the use of the NRS in IBS clinical trials. PMID:19751360

Severity and functional disability of patients with occupational contact dermatitis: validation of the German version of the Occupational Contact Dermatitis Disease Severity Index.

PubMed

Ofenloch, Robert F; Diepgen, Thomas L; Popielnicki, Ana; Weisshaar, Elke; Molin, Sonja; Bauer, Andrea; Mahler, Vera; Elsner, Peter; Schmitt, Jochen; Apfelbacher, Christian

2015-02-01

The Occupational Contact Dermatitis Disease Severity Index (ODDI) was designed in Australia to measure severity and functional disability in patients with occupational contact dermatitis (OCD) of the hands. The ODDI was translated into the German language with a linguistic validation process. The psychometric properties of the German version of the ODDI are still unclear. To report the linguistic validation procedure and to perform a psychometric validation by investigating the validity and reliability of the German ODDI version in a sample of patients with OCD. Data were drawn from the baseline assessment (T0) and first follow-up (T1) of the German chronic hand eczema (CHE) registry (CARPE). Spearman correlations of the ODDI with reference measures were computed to assess validity. Cronbach's alpha was calculated as a measure of internal consistency, and the intraclass correlation coefficient (ICC) was calculated to assess retest reliability. The smallest real difference (SRD) and minimal clinically important difference (MCID) were calculated to assess sensitivity to change. Physician Global Assessment (PGA) was used as an anchor for the MCID. Four hundred and twenty-two patients (54.5% female, mean age 45.1 years) were included for analysis. Cronbach's alpha was found to be 0.73. The ICC was 0.79. Correlations between the ODDI total and the Dermatology Life Quality Index (rho = 0.36), and between PGA (rho = 0.48) and patient-assessed disease severity (rho = 0.40), were of moderate strength. The MCID (1.29) was found to be smaller than the SRD (1.87). The German ODDI version is reliable and valid for the measurement of functional impairment and disease severity in patients suffering from OCD. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up.

PubMed

Brusco, Natasha Kareem; Watts, Jennifer J; Shields, Nora; Taylor, Nicholas F

2014-05-29

Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay, yet the economic implications are not known. The aim of this study was to determine from a health service perspective if the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone. Cost utility and cost effectiveness analyses were undertaken alongside a multi-center, single-blind randomized controlled trial with a 30-day follow up after discharge. Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday. Incremental cost utility ratio was reported as cost per quality adjusted life year (QALY) gained and an incremental cost effectiveness ratio (ICER) was reported as cost for a minimal clinically important difference (MCID) in functional independence. 996 patients (mean age 74 (standard deviation 13) years) were randomly assigned to the intervention (n = 496) or the control group (n = 500). Mean difference in cost of AUD$1,673 (95% confidence interval (CI) -271 to 3,618) was a saving in favor of the intervention group. The incremental cost utility ratio found a saving of AUD$41,825 (95% CI -2,817 to 74,620) per QALY gained for the intervention group. The ICER found a saving of AUD$16,003 (95% CI -3,074 to 87,361) in achieving a MCID in functional independence for the intervention group. If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96% and 95%, respectively. A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome. From a health service perspective, the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per QALY gained and for a MCID in functional independence. Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213.

Changes in quality of life after elective surgery: an observational study comparing two measures.

PubMed

Kronzer, Vanessa L; Jerry, Michelle R; Ben Abdallah, Arbi; Wildes, Troy S; McKinnon, Sherry L; Sharma, Anshuman; Avidan, Michael S

2017-08-01

Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty. This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964). By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration. Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.

Physical function improvements and relief from fatigue and pain are associated with increased productivity at work and at home in rheumatoid arthritis patients treated with certolizumab pegol

PubMed Central

Taylor, Peter; Strand, Vibeke; Purcaru, Oana; Coteur, Geoffroy; Mease, Philip

2010-01-01

Objectives. To evaluate the association between improvements in physical function, fatigue and pain and improvements in productivity at work and at home in patients treated with certolizumab pegol (CZP) in combination with MTX. Methods. Physical function, fatigue and pain were assessed in two CZP clinical trials (Rheumatoid Arthritis PreventIon of structural Damage 1 and 2) using the HAQ-Disability Index (HAQ-DI), Fatigue Assessment Scale (FAS) and Patient Assessment of Pain, with minimal clinically important differences (MCIDs) defined as ≥0.22, ≥1 and ≥10 points, respectively. Work and home productivity were evaluated using the RA-specific Work Productivity Survey (WPS-RA). The odds of achieving an HAQ-DI, FAS or pain ‘response’ at Week 12, defined as improvements ≥MCID, were compared between CZP and control groups. Improvements in productivity at Week 12 were compared between CZP-treated HAQ-DI, FAS or pain responders and non-responders. Results. The odds of achieving improvements ≥MCID were five times higher for pain, and two to three times higher for physical function and fatigue, in patients receiving CZP vs control. Per month, responders reported significantly greater improvements in productivity at work and reduced interference of RA with their work productivity than non-responders. Responders also reported significantly greater improvements in productivity at home and participation in family, social and leisure activities. Conclusions. This study demonstrated a clear association between patient-reported improvements in physical function, fatigue and pain, and improvements in productivity both at work and home. PMID:20547658

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders.

PubMed

Negahban, Hossein; Behtash, Zeinab; Sohani, Soheil Mansour; Salehi, Reza

2015-01-01

To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis. The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings. The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

Changes in female veterans' neck pain following chiropractic care at a hospital for veterans.

PubMed

Corcoran, Kelsey L; Dunn, Andrew S; Green, Bart N; Formolo, Lance R; Beehler, Gregory P

2018-02-01

To determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management at a Veterans Affairs (VA) hospital. This was a retrospective cross-sectional study of medical records from female veterans attending a VA chiropractic clinic for neck pain from 2009 to 2015. Paired t-tests were used to compare baseline and discharge numeric rating scale (NRS) and Neck Bournemouth Questionnaire (NBQ) scores with a minimum clinically important difference (MCID) set at a 30% change from baseline. Thirty-four veterans met the inclusion criteria and received a mean of 8.8 chiropractic treatments. For NRS, the mean score improvement was 2.7 (95%CI, 1.9-3.5, p < .001). For the NBQ, the mean score improvement was 13.7 (95%CI, 9.9-17.5, p < .001). For the MCID, the average percent improvement was 45% for the NRS and 38% for the NBQ. Female veterans with neck pain experienced a statistically and clinically significant reduction in NRS and NBQ scores. Copyright © 2017 Elsevier Ltd. All rights reserved.

Transcranial direct current stimulation associated with gait training in Parkinson's disease: A pilot randomized clinical trial.

PubMed

Costa-Ribeiro, Adriana; Maux, Ariadne; Bosford, Thamyris; Aoki, Yumi; Castro, Rebeca; Baltar, Adriana; Shirahige, Lívia; Moura Filho, Alberto; Nitsche, Michael A; Monte-Silva, Kátia

2017-04-01

The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.

Change in KOOS and WOMAC Scores in a Young Athletic Population With and Without Anterior Cruciate Ligament Injury.

PubMed

Antosh, Ivan J; Svoboda, Steven J; Peck, Karen Y; Garcia, E'Stephan J; Cameron, Kenneth L

2018-06-01

Several studies have examined changes in patient-reported outcome measures (PROMs) after anterior cruciate ligament (ACL) injury, but no studies to date have prospectively evaluated changes from preinjury baseline through injury and follow-up among ACL-injured patients compared to the baseline and follow-up changes of uninjured patients. To examine changes in PROMs over time from preinjury baseline to at least 2 years after ACL reconstruction and to compare these changes with those of an uninjured control group having similar physical activity requirements. Cohort study; Level of evidence, 2. The authors conducted a prospective cohort study with a nested case-control analysis at a US service academy. All incoming first year students were recruited to participate in this study. Consenting participants completed a baseline questionnaire that included the KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and MARS (Marx Activity Rating Scale). Participants who sustained a subsequent ACL injury completed assessments at the time of surgery and at 6, 12, and 24 months after surgery. Healthy participants were recruited to repeat the baseline assessments within 1 year of graduation. Inter- and intragroup differences at these time points were evaluated with dependent and independent t tests, respectively. We also compared these results with established minimum clinically important difference (MCID) values. Of 1268 first year students entering the academy, 1005 with no previous injuries consented to participate in this study (82% male, mean ± SD age 19 ± 1 years). Of those enrolled, 30 suffered an ACL injury and met the inclusion criteria for this study. Ninety uninjured control students who met the inclusion criteria completed follow-up assessments. There were statistically significant differences across all KOOS and WOMAC subscales between ACL-injured group and uninjured group at the time of the final follow-up assessment. Four KOOS subscales (Pain, Symptoms, Sports and Recreation Function, and Knee-Related Quality of Life) and the WOMAC Stiffness subscale demonstrated >8-point differences between groups, which exceeded the established MCID for these instruments. There were no significant differences between the ACL-injured group and uninjured groups noted for the MARS ( P = .635). At the time of final follow-up, the ACL-injured group also reported significant deficits on the WOMAC Stiffness subscale ( P = .032), the MARS ( P = .030), and all KOOS subscales, with the exception of Functional Activities of Daily Living, as compared with their preinjury baseline scores. These deficits exceeded the established MCID values for 3 KOOS subscales and the MARS. Patients with ACL injuries reported significant deficits on PROMs at least 2 years after surgical reconstruction in relation to preinjury baseline scores and an uninjured control group. Many of these deficits exceeded established MCID values.

Item response theory analysis to evaluate reliability and minimal clinically important change of the Roland-Morris Disability Questionnaire in patients with severe disability due to back pain from vertebral compression fractures.

PubMed

Lee, Minji K; Yost, Kathleen J; McDonald, Jennifer S; Dougherty, Ryne W; Vine, Roanna L; Kallmes, David F

2017-06-01

The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability. To evaluate the psychometric quality of the RMDQ in patients with severe disability. Observational clinical study. The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty. The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up. With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID). Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods. Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ. Copyright © 2017 Elsevier Inc. All rights reserved.

The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials.

PubMed

Lee, Chang-Hyun; Chung, Chun Kee; Kim, Chi Heon

2017-11-01

Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. A meta-analysis of randomized controlled trials was carried out. Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments. Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. Copyright © 2017 Elsevier Inc. All rights reserved.

Omalizumab substantially improves dermatology-related quality of life in patients with chronic spontaneous urticaria.

PubMed

Finlay, A Y; Kaplan, A P; Beck, L A; Antonova, E N; Balp, M-M; Zazzali, J; Khalil, S; Maurer, M

2017-10-01

Chronic spontaneous/idiopathic urticaria (CSU/CIU) has substantial detrimental effects on health-related quality of life (HRQoL) with an effect comparable to or worse than many other skin diseases. To assess the effect of omalizumab on CSU patients' HRQoL, measured by the Dermatology Life Quality Index (DLQI) in three phase III studies ASTERIA I, ASTERIA II and GLACIAL. A post hoc analysis examined changes in DLQI scores, distribution of patients across DLQI bands and the proportion reaching minimal clinically important difference (MCID) following omalizumab vs. placebo. Omalizumab 300 mg significantly improved total DLQI scores vs. placebo, with a mean decrease from baseline to week 12 of -10.3 vs. -6.1 (P < 0.0001) in ASTERIA I, -10.2 vs. -6.1 (P = 0.0004) in ASTERIA II and -9.7 vs. -5.1 (P < 0.0001) in GLACIAL. A significant shift from high disease impact on life at baseline towards less impact at week 12 was seen with omalizumab 300 mg vs. placebo (P < 0.001; all studies). The proportion of patients where change in mean total DLQI score from baseline to week 12 reached an MCID of ≥4 was 74.1%, 76.0% and 77.2% in ASTERIA I, II and GLACIAL, respectively (P < 0.01; all studies). Maximum duration of omalizumab treatment was 24 weeks. This additional analysis assessed the impact of CSU and benefit of treatment with omalizumab by exploring different facets of DLQI data by treatment arm at multiple assessment points. The original aspects of analysis included applying the concept of the recently validated score for the MCID of the DLQI, changes in DLQI domain scores and in the distribution of subjects based on validated total DLQI score bands. It showed consistently that omalizumab provides significant and clinically relevant improvements in many aspects of HRQoL that are important to patients with CSU. These results contribute to a better understanding of the impact of CSU and its treatment on patients and can support clinical decision-making in routine medical practice. © 2017 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial.

PubMed

Viana, R T; Laurentino, G E C; Souza, R J P; Fonseca, J B; Silva Filho, E M; Dias, S N; Teixeira-Salmela, L F; Monte-Silva, K K

2014-01-01

Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies. This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals. Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data. Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID. These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.

Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial.

PubMed

Brusco, Natasha Kareem; Watts, Jennifer J; Shields, Nora; Taylor, Nicholas F

2015-04-18

Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs. Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence. A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI -4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention. From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community. Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213.

Is the effectiveness of patellofemoral bracing modified by patellofemoral alignment and trochlear morphology?

PubMed

Zhang, Xi; Eyles, Jillian P; Makovey, Joanna; Williams, Matthew J; Hunter, David J

2017-04-21

This study was performed to determine if the effectiveness of patellofemoral bracing as a treatment for patellofemoral osteoarthritis is influenced by patellofemoral joint alignment and trochlear morphology. We hypothesized that those with more extreme patellar malalignment would benefit more from bracing. Thirty-eight patients who had received bracing as part of a comprehensive treatment plan for patellofemoral osteoarthritis were selected for this study. Ten measures of patellar alignment were taken from X-rays. These alignment measures were divided into percentile groups (tertiles) for contingency table analysis. Treatment outcome was measured by Western Ontario and Macmasters Universities Osteoarthritis Index (WOMAC) scores and these were dichotomised into two groups according to "Improved" or "Not Improved" according to the minimum clinically important difference (MCID). Spearman's rho test was performed for continuous variables and Fisher's exact test was performed for correlation between tertile groups and MCID categories. Thirty-eight patients (9 male and 29 female) between the ages of 51 to 89 were included in this study. WOMAC scores ranged from -25 to 41.67, with a mean change of -3.97, 31.6, 44.7 and 31.6% of patients falling into the "Improved" group for Global, Pain and Function scores respectively. We found a non-significant trend shown (p = 0.058, correlation coefficient 0.31) between bisect offset and change in WOMAC global, indicating a trend for higher change in WOMAC scores with increasing bisect offset. Statistically significant correlations were found between mean MCID categories for the WOMAC global and function groups when analysed against percentile groups for bisect offset (p < 0.01) and patellar subluxation distance (p < 0.05), indicating those in higher percentile groups were more likely not to improve after six months. Higher bisect offset and patellar subluxation distance measures were associated with poorer outcomes. However, due to the limited sample size, more studies are required to fully examine this relationship.

Migalastat improves diarrhea in patients with Fabry disease: clinical-biomarker correlations from the phase 3 FACETS trial.

PubMed

Schiffmann, Raphael; Bichet, Daniel G; Jovanovic, Ana; Hughes, Derralynn A; Giugliani, Roberto; Feldt-Rasmussen, Ulla; Shankar, Suma P; Barisoni, Laura; Colvin, Robert B; Jennette, J Charles; Holdbrook, Fred; Mulberg, Andrew; Castelli, Jeffrey P; Skuban, Nina; Barth, Jay A; Nicholls, Kathleen

2018-04-27

Fabry disease is frequently characterized by gastrointestinal symptoms, including diarrhea. Migalastat is an orally-administered small molecule approved to treat the symptoms of Fabry disease in patients with amenable mutations. We evaluated minimal clinically important differences (MCID) in diarrhea based on the corresponding domain of the patient-reported Gastrointestinal Symptom Rating Scale (GSRS) in patients with Fabry disease and amenable mutations (N = 50) treated with migalastat 150 mg every other day or placebo during the phase 3 FACETS trial (NCT00925301). After 6 months, significantly more patients receiving migalastat versus placebo experienced improvement in diarrhea based on a MCID of 0.33 (43% vs 11%; p = .02), including the subset with baseline diarrhea (71% vs 20%; p = .02). A decline in kidney peritubular capillary globotriaosylceramide inclusions correlated with diarrhea improvement; patients with a reduction > 0.1 were 5.6 times more likely to have an improvement in diarrhea than those without (p = .031). Migalastat was associated with a clinically meaningful improvement in diarrhea in patients with Fabry disease and amenable mutations. Reductions in kidney globotriaosylceramide may be a useful surrogate endpoint to predict clinical benefit with migalastat in patients with Fabry disease. NCT00925301 ; June 19, 2009.

Effects of vedolizumab on health-related quality of life in patients with ulcerative colitis: results from the randomised GEMINI 1 trial.

PubMed

Feagan, B G; Patel, H; Colombel, J-F; Rubin, D T; James, A; Mody, R; Lasch, K

2017-01-01

Health-related quality of life (HRQL) is often diminished in patients with ulcerative colitis. To evaluate the effects of vedolizumab on HRQL in patients with ulcerative colitis. Using maintenance phase data from the GEMINI 1 study, an analysis of covariance model was used to calculate mean differences between the vedolizumab and placebo groups in changes from baseline to week 52 for 3 HRQL instruments: The Inflammatory Bowel Disease Questionnaire (IBDQ), 36-Item Short Form Health Survey (SF-36), and EQ-5D. Proportions of patients meeting minimal clinically important difference (MCID) thresholds for changes on these instruments were compared between treatment groups for the overall population and for clinically important subgroups. Concordance between clinical remission and remission defined using IBDQ scores was examined. Compared with placebo-treated patients, vedolizumab-treated patients had greater improvements (152-201%) in IBDQ, EQ-5D visual analogue scale (VAS), and EQ-5D utility scores. Greater proportions (6.9-19.9%) of vedolizumab-treated patients than placebo-treated patients met MCID thresholds for all the instruments. Vedolizumab-treated patients with lower baseline disease activity and those without prior tumour necrosis factor (TNF) antagonist failure had greater HRQL improvements. Among 127 patients with clinical remission based on complete Mayo Clinic scores, >80% also had IBDQ remission; >70% of the 150 patients with IBDQ remission demonstrated clinical remission. Vedolizumab therapy was associated with significant improvements in HRQL measures compared with placebo. Benefits were greater in patients with lower disease activity and no prior TNF antagonist failure. © 2016 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

A responder analysis of the effects of yoga for individuals with COPD: who benefits and how?

PubMed

Donesky, DorAnne; Melendez, Michelle; Nguyen, Huong Q; Carrieri-Kohlman, Virginia

2012-01-01

We previously reported that a twice-weekly, modified Iyengar yoga program was a safe and viable self-management strategy for patients with chronic obstructive pulmonary disease (COPD). 1 The primary purpose of this exploratory analysis was to classify yoga participants into 1 of 3 responder categories by using minimum clinically important difference (MCID) criteria for each of 3 variables: 6-minute walk distance (6MW), distress related to dyspnea (shortness of breath; DD), and functional performance (FPI). Changes in health-related quality of life (HRQL) and in psychological well-being (anxiety and depression), and participants' self-reported improvements by responder category were also examined. A secondary goal was to identify baseline participant characteristics, including initial randomization assignment that might predict response to treatment. Participants were randomly assigned to either an initial yoga (IY) or an enhanced wait-list control (WLC) group. Those in the WLC group were offered the yoga program immediately following the IY group's participation. Individuals from both groups who completed at least 18 of 24 yoga classes were categorized as responders, partial responders, or non-responders for each of the 3 outcome variables (6MW, DD, FPI) on the basis of MCID criteria. Baseline characteristics and changes in HRQL and psychological well-being were also analyzed. None of the participants demonstrated MCIDs for all 3 outcomes; however, 6 were classified as responders for 2 out-come variables and 4 were classified as non-responders for all 3 outcome variables. Two-thirds of the female participant group and one-third of the male participant group completed the yoga program. DD responders showed increased anxiety levels, whereas anxiety levels of the DD non-responders remained unchanged. FPI responders reported significant improvements in physical function, whereas partial and non-FPI responders noted declined function. Participants assigned to the IY group demonstrated greater benefit from yoga than did those in the W LC group. Although this modified Iyengar yoga program appears to have benefited some individuals with COPD, further studies are required to assess who the intervention works for and under what conditions.

Assessing the impact of a remote digital coaching engagement program on patient-reported outcomes in asthma.

PubMed

Rasulnia, Mazi; Burton, Billy Stephen; Ginter, Robert P; Wang, Tracy Y; Pleasants, Roy Alton; Green, Cynthia L; Lugogo, Njira

2017-08-11

Low adherence and poor outcomes provide opportunity for digital coaching to engage patients with uncontrolled asthma in their care to improve outcomes. To examine the impact of a remote digital coaching program on asthma control and patient experience. We recruited 51 adults with uncontrolled asthma, denoted by albuterol use of >2 times per week and/or exacerbations requiring corticosteroids, and applied a 12-week patient-centered remote digital coaching program using a combination of educational pamphlets, symptom trackers, best peak flow establishment, physical activity, and dietary counseling, as well as coaches who implemented emotional enforcement to motivate disease self-management through telephone, text, and email. Baseline and post-intervention measures were quality of life (QOL), spirometry, Asthma Control Test (ACT), Asthma Symptom Utility Index (ASUI), rescue albuterol use, and exacerbation history. Among 51 patients recruited, 40 completed the study. Eight subjects required assistance reading medical materials. Significant improvements from baseline were observed for Patient-Reported Outcomes Measurement Information System mental status (p = 0.010), body weight, and outpatient exacerbation frequency (p = 0.028). The changes from baseline in ACT (p = 0.005) were statistically significant but did not achieve the pre-specified minimum clinically important difference (MCID), whereas for ASUI, the MCID and statistical significance were achieved. Spirometry and rescue albuterol use were no different. A patient-oriented, remote digital coaching program that utilized trained health coaches and digital materials led to statistically significant improvement in mental status, outpatient exacerbations, body weight, and ASUI. Digital coaching programs may improve some outcomes in adults with uncontrolled asthma.

Patient reported outcome measures (PROMs) for goalsetting and outcome measurement in primary care physiotherapy, an explorative field study.

PubMed

van Dulmen, Simone A; van der Wees, Philip J; Bart Staal, J; Braspenning, J C C; Nijhuis-van der Sanden, Maria W G

2017-03-01

Routine use of patient reported outcome measures (PROMs) may provide an effective way of monitoring patient valued outcomes. In this study we explored (1) the current use of PROMs; (2) to what extent the goals correspond with the selected PROMs; (3) the health outcomes based on PROMs. Observational clinical cohort study. Dutch primary care physiotherapy practices (n=43). Patients (n=299) with neck pain or low back pain. The number of PROMs used per patient were calculated. The International Classification of Functioning, Disability and Health was used to map the patients' goals and the percentages of PROMS selected that match the domains of the goals were calculated. Health outcomes were assessed using two approaches for estimating the minimal clinically important difference (MCID). Repeated measurements with the Visual Analogue Scale, the Patient Specific Complaints questionnaire, the Quebec Back Pain Disability Scale, or the Neck Disability Index were completed by more than 60% of the patients. The PROMs used matched in 46% of the cases with goals for pain improvement, and in 43% with goals set at activity/participation level. The mean differences between baseline and follow up scores for all PROMs were statistically significant. Improvements of patients based on MCID varied from 57% to 90%. PROMs were used in the majority of the patients, showed improved health outcomes and fitted moderately with goals. The results of this study can be used for future research assessing the routine use of outcome measurements with PROMs. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Impact of oral cyclophosphamide on health-related quality of life in patients with active scleroderma lung disease: results from the scleroderma lung study.

PubMed

Khanna, Dinesh; Yan, Xiaohong; Tashkin, Donald P; Furst, Daniel E; Elashoff, Robert; Roth, Michael D; Silver, Richard; Strange, Charlie; Bolster, Marcy; Seibold, James R; Riley, David J; Hsu, Vivien M; Varga, John; Schraufnagel, Dean E; Theodore, Arthur; Simms, Robert; Wise, Robert; Wigley, Fredrick; White, Barbara; Steen, Virginia; Read, Charles; Mayes, Maureen; Parsley, Ed; Mubarak, Kamal; Connolly, M Kari; Golden, Jeffrey; Olman, Mitchell; Fessler, Barri; Rothfield, Naomi; Metersky, Mark; Clements, Philip J

2007-05-01

To assess the impact of cyclophosphamide (CYC) on the health-related quality of life (HRQOL) of patients with scleroderma after 12 months of treatment. One hundred fifty-eight subjects participated in the Scleroderma Lung Study, with 79 each randomized to CYC and placebo arms. The study evaluated the results of 3 measures of health status: the Short Form 36 (SF-36), the Health Assessment Questionnaire (HAQ) disability index (DI), and Mahler's dyspnea index, and the results of 1 preference-based measure, the SF-6D. The differences in the HRQOL between the 2 groups at 12 months were calculated using a linear mixed model. Responsiveness was evaluated using the effect size. The proportion of subjects in each treatment group whose scores improved at least as much as or more than the minimum clinically important difference (MCID) in HRQOL measures was assessed. After adjustment for baseline scores, differences in the HAQ DI, SF-36 role physical, general health, vitality, role emotional, mental health scales, and SF-36 mental component summary (MCS) score were statistically significant for CYC versus placebo (P < 0.05). Effect sizes were negligible (<0.20) for all of the scales of the SF-36, HAQ DI, and SF-6D at 12 months. In contrast, a higher proportion of patients who received CYC achieved the MCID compared with placebo in the HAQ DI score (30.9% versus 14.8%), transitional dyspnea index score (46.4% versus 12.7%), SF-36 MCS score (33.3% versus 18.5%), and SF-6D score (21.3% versus 3.8%). One year of treatment with CYC leads to an improvement in HRQOL in patients with scleroderma lung disease.

Cosmetic outcomes of facial lacerations repaired with tissue-adhesive, absorbable, and nonabsorbable sutures.

PubMed

Holger, Joel S; Wandersee, Steve C; Hale, David B

2004-07-01

The objective of this study was to compare the 9- to 12-month cosmetic outcome of facial lacerations closed with rapid-absorbing gut suture (RG), octylcyanoacrylate (OC), or nylon suture (NL). We hypothesized that no important differences would exist between these methods. This prospective, randomized study enrolled consecutive patients with facial lacerations when experienced physician assistants were on duty for wound closure. Patients returned at 9 to 12 months for cosmetic evaluation. Two blinded physicians performed visual analog cosmesis scale (VACS) scoring, and the patient completed a VAS satisfaction score. One hundred forty-five patients were enrolled. Nine-month follow up occurred in 84 patients. The maximum difference within each evaluator's set of scores was 3.6 mm, well below the minimum clinically important difference (MCID) of 10 to 15 mm. We did not detect clinically important differences in cosmetic outcome at 9 to 12 months in patients with facial lacerations closed with RG, OC, or NL, although RG or OC could be preferred to eliminate follow-up visits for suture removal.

Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

PubMed

Sciurba, Frank C; Criner, Gerard J; Strange, Charlie; Shah, Pallav L; Michaud, Gaetane; Connolly, Timothy A; Deslée, Gaëtan; Tillis, William P; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T; Angel, Luis; Maxfield, Roger; Herth, Felix J F; Wahidi, Momen M; Mehta, Atul; Slebos, Dirk-Jan

Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. To determine the effectiveness and safety of endobronchial coil treatment. Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015. Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications. Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in median change in FEV1 was 7.0% (97.5% CI, 3.4% to ∞; 1-sided P < .001), and the between-group St George's Respiratory Questionnaire score improved -8.9 points (97.5% CI, -∞ to -6.3 points; 1-sided P < .001), each favoring the coil group. Major complications (including pneumonia requiring hospitalization and other potentially life-threatening or fatal events) occurred in 34.8% of coil participants vs 19.1% of usual care (P = .002). Other serious adverse events including pneumonia (20% coil vs 4.5% usual care) and pneumothorax (9.7% vs 0.6%, respectively) occurred more frequently in the coil group. Among patients with emphysema and severe hyperinflation treated for 12 months, the use of endobronchial coils compared with usual care resulted in an improvement in median exercise tolerance that was modest and of uncertain clinical importance, with a higher likelihood of major complications. Further follow-up is needed to assess long-term effects on health outcomes. clinicaltrials.gov Identifier: NCT01608490.

Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease: The HONOR Randomized Clinical Trial.

PubMed

McDermott, Mary M; Spring, Bonnie; Berger, Jeffrey S; Treat-Jacobson, Diane; Conte, Michael S; Creager, Mark A; Criqui, Michael H; Ferrucci, Luigi; Gornik, Heather L; Guralnik, Jack M; Hahn, Elizabeth A; Henke, Peter; Kibbe, Melina R; Kohlman-Trighoff, Debra; Li, Lingyu; Lloyd-Jones, Donald; McCarthy, Walter; Polonsky, Tamar S; Skelly, Christopher; Tian, Lu; Zhao, Lihui; Zhang, Dongxue; Rejeski, W Jack

2018-04-24

Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance. To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD. Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017. The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention. The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity. Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, -8.9 m; 95% CI, -26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs -2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores. Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD. clinicaltrials.gov Identifier: NCT02462824.

A value proposition for early physical therapist management of neck pain: a retrospective cohort analysis.

PubMed

Horn, Maggie E; Brennan, Gerard P; George, Steven Z; Harman, Jeffrey S; Bishop, Mark D

2016-07-12

Neck pain is one of the most common reasons for entry into the healthcare system. Recent increases in healthcare utilization and medical costs have not correlated with improvements in health. Therefore there is a need to identify management strategies for neck pain that are effective for the patient, cost efficient for the payer and provided at the optimal time during an episode of neck pain. One thousand five hundred thirty-one patients who underwent physical therapist management with a primary complaint of non-specific neck pain from January 1, 2008 to December 31, 2012 were identified from the Rehabilitation Outcomes Management System (ROMS) database at Intermountain Healthcare. Patients reporting duration of symptoms less than 4 weeks were designated as undergoing "early" management and patients with duration of symptoms greater than 4 weeks were designated as receiving "delayed" management. These groups were compared using binary logistic regression to examine odds of achieving Minimal Clinically Important Difference (MCID) on the Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS). Separate generalized linear modeling examined the effect of timing of physical therapist management on the metrics of value and efficiency. Patients who received early physical therapist management had increased odds of achieving MCID on the NDI (aOR = 2.01, 95 % CI 1.57, 2.56) and MCID on the NPRS (aOR = 1.82, 95 % CI 1.42, 2.38), when compared to patients receiving delayed management. Patients who received early management demonstrated the greatest value in decreasing disability with a 2.27 percentage point change in NDI score per 100 dollars, best value in decreasing pain with a 0.38 point change on the NPRS per 100 dollars. Finally, patients receiving early management were managed more efficiently with a 3.44 percentage point change in NDI score per visit and 0.57 point change in NPRS score per visit. These findings suggest that healthcare systems that provide pathways for patients to receive early physical therapist management of neck pain may realize improved patient outcomes, greater value and higher efficiency in decreasing disability and pain compared to delayed management. Further research is needed to confirm this assertion.

Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers.

PubMed

Bhatt, Surya P; Terry, Nina L J; Nath, Hrudaya; Zach, Jordan A; Tschirren, Juerg; Bolding, Mark S; Stinson, Douglas S; Wilson, Carla G; Curran-Everett, Douglas; Lynch, David A; Putcha, Nirupama; Soler, Xavi; Wise, Robert A; Washko, George R; Hoffman, Eric A; Foreman, Marilyn G; Dransfield, Mark T

2016-02-02

Central airway collapse greater than 50% of luminal area during exhalation (expiratory central airway collapse [ECAC]) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown. To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease. Analysis of paired inspiratory-expiratory computed tomography images from a large multicenter study (COPDGene) of current and former smokers from 21 clinical centers across the United States. Participants were enrolled from January 2008 to June 2011 and followed up longitudinally until October 2014. Images were initially screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen-positive scans, cross-sectional area of the trachea was measured manually at 3 predetermined levels (aortic arch, carina, and bronchus intermedius) to confirm ECAC (>50% reduction in cross-sectional area). Expiratory central airway collapse. The primary outcome was baseline respiratory quality of life (St George's Respiratory Questionnaire [SGRQ] scale 0 to 100; 100 represents worst health status; minimum clinically important difference [MCID], 4 units). Secondary outcomes were baseline measures of dyspnea (modified Medical Research Council [mMRC] scale 0 to 4; 4 represents worse dyspnea; MCID, 0.7 units), baseline 6-minute walk distance (MCID, 30 m), and exacerbation frequency (events per 100 person-years) on longitudinal follow-up. The study included 8820 participants with and without COPD (mean age, 59.7 [SD, 6.9] years; 4667 [56.7%] men; 4559 [51.7%] active smokers). The prevalence of ECAC was 5% (443 cases). Patients with ECAC compared with those without ECAC had worse SGRQ scores (30.9 vs 26.5 units; P < .001; absolute difference, 4.4 [95% CI, 2.2-6.6]) and mMRC scale scores (median, 2 [interquartile range [IQR], 0-3]) vs 1 [IQR, 0-3]; P < .001]), but no significant difference in 6-minute walk distance (399 vs 417 m; absolute difference, 18 m [95% CI, 6-30]; P = .30), after adjustment for age, sex, race, body mass index, forced expiratory volume in the first second, pack-years of smoking, and emphysema. On follow-up (median, 4.3 [IQR, 3.2-4.9] years), participants with ECAC had increased frequency of total exacerbations (58 vs 35 events per 100 person-years; incidence rate ratio [IRR], 1.49 [95% CI, 1.29-1.72]; P < .001) and severe exacerbations requiring hospitalization (17 vs 10 events per 100 person-years; IRR, 1.83 [95% CI, 1.51-2.21]; P < .001). In a cross-sectional analysis of current and former smokers, the presence of ECAC was associated with worse respiratory quality of life. Further studies are needed to assess long-term associations with clinical outcomes.

Psychometric and Clinimetric Properties of the Melbourne Assessment 2 in Children With Cerebral Palsy.

PubMed

Wang, Tien-Ni; Liang, Kai-Jie; Liu, Yi-Chia; Shieh, Jeng-Yi; Chen, Hao-Ling

2017-09-01

To examine the psychometric and clinimetric properties of the Melbourne Assessment 2 (MA2), an outcome measurement that is increasingly used in clinical studies. Psychometric and clinimetric study. Community. Seventeen children with cerebral palsy (CP) from 5 to 12 years were recruited for the estimation of the test-retest reliability and minimal detectable change (MDC). Thirty-five children with CP were recruited to receive an 8-week intensive neurorehabilitation intervention to estimate the validity, responsiveness, and minimal clinically important difference (MCID). Thirty-five children with CP received upper limb neurorehabilitation programs for 8 weeks. The MA2 and the criterion measures, including the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2), the Box and Blocks Test (BBT), and the Pediatric Motor Activity Log-Revised (PMAL-R), were evaluated at pretreatment and posttreatment. The MA2 has 4 subscales: range of motion, fluency, accuracy, and dexterity. The test-retest reliability of the MA2 is high (intraclass correlation coefficient, .92-.98). The significant relationships between the MA2 and BBT, BOT-2, and PMAL-R support its validity. The significance of paired t test results (P<.001) and large magnitudes of the standardized response mean (1.70-2.00) confirm the responsiveness of the MA2. The MDC values of the 4 subscales of the MA2 are 2.85, 1.63, 1.97, and 1.84, respectively, and the suggested MCID values of these 4 subscales are 2.35, 3.20, 2.09, and 2.22, respectively, indicating the minimum scores of improvement to be interpreted as both statistically significant and clinically important. The study findings indicate that the MA2 has sound psychometric and clinimetric properties and is thus an adequate measurement for research and clinical applications. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Results of hip arthroscopy in patients with MRI diagnosis of subchondral cysts—a case series

PubMed Central

Hartigan, David E; Perets, Itay; Yuen, Leslie C

2017-01-01

Abstract The aim of this article is to examine the results of arthroscopic management of patients with labral pathology who have preoperative magnetic resonance images (MRIs) demonstrating subchondral cysts. This institution’s database was searched for patients who underwent hip arthroscopy and had subchondral cysts on MRI and >2-year follow-up. Exclusion criteria included previous hip surgery, Tönnis grade >1, inflammatory arthritis, Perthes, slipped capital femoral epiphysis or abductor repair. Patient-reported outcome (PRO) scores including visual analog scale, modified Harris hip score (mHHS), non-arthritic hip score and hip outcome score sports-specific subscale (HOS-SSS) were gathered preoperatively, at 3 months, and annually thereafter. The change in PRO scores was compared with the minimally clinical important difference (MCID) to quantify improvement. Sixty-nine patients were eligible for this study, of which 65 (94%) had >2-year follow-up. All PROs were significantly improved at latest follow-up (P < 0.001). Mean patient satisfaction was 7.2. There was no correlation between Outerbridge grade III or IV cartilage damage noted during arthroscopy and subchondral femoral and acetabular cysts noted on MRI. Seventeen patients required reoperation [13 total hip arthroplasty (THAs) and 4 revision arthroscopies]. Patients with femoral subchondral cysts converted to THA 36% of the time. MCIDs for mHHS and HOS-SSS were surpassed by 63% and 68% of patients, respectively. Hip arthroscopies performed on patients with subchondral cysts present on preoperative MRI should be approached with caution. The rate of conversion to hip arthroplasty appears to be higher than that reported in the literature for patients who undergo arthroscopy without preoperative subchondral cysts. For patients who did not require hip arthroplasty or revision arthroscopy, patients demonstrated significant improvement in symptoms compared with the preoperative state. PMID:29250341

Pain and Opioid use Outcomes Following Minimally Invasive Sacroiliac Joint Fusion with Decortication and Bone Grafting: The Evolusion Clinical Trial.

PubMed

Araghi, Ali; Woodruff, Robert; Colle, Kyle; Boone, Christopher; Ingham, Lisa; Tomeh, Antoine; Fielding, Louis C

2017-01-01

This report documents six-month results of the first 50 patients treated in a prospective, multi-center study of a minimally invasive (MI) sacroiliac (SI) joint fusion system. This cohort includes 50 patients who had MI SI joint fusion surgery and completed 6 month follow-up. Average age at baseline was 61.5, 58% were female, and SI joint-related pain duration was ≥2yrs in 54.0% of patients. Visual Analog Scale (VAS) SI joint pain, Oswestry Disability Index (ODI), quality of life and opioid use were assessed preoperatively and at 6 months. At 6 months, mean VAS pain demonstrated a significant reduction from 76.2 at baseline to 35.1 (54% reduction, p<0.0001), with 72% of patients attaining the minimal clinically important difference (MCID, ≥20 point improvement). Mean ODI improved from 55.5 to 35.3 at 6 months (p < 0.001), with 56% of patients achieving the MCID (≥15 point improvement). Prior to surgery 33/50 (66%) of patients were taking opioids, but by 6 months the number of patients taking opioids had decreased by 55% to 15/50 (30%). Few procedural complications were reported. Two procedure-related events required hospitalization: a revision procedure (2%) for nerve impingement and one case of ongoing low back pain. Analysis of patients treated with MI SI joint fusion using the SImmetry System demonstrated that the procedure can be performed safely and results in significant improvements in pain, disability, and opioid use at 6 months. Longer term follow-up in this study will determine whether these improvements are durable, as well as the associated radiographic fusion rates.

Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery

PubMed Central

Kube, Richard A.; Muir, Jeffrey M.

2016-01-01

Background: Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited. Objective: To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion. Methods: SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure. Results: Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported. Conclusion: Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure. PMID:28144378

Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery.

PubMed

Kube, Richard A; Muir, Jeffrey M

2016-01-01

Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited. To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion. SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure. Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported. Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure.

Treatment response to sildenafil in men with erectile dysfunction relative to concomitant comorbidities and age.

PubMed

Goldstein, Irwin; Stecher, Vera; Carlsson, Martin

2017-03-01

To evaluate treatment response in men with erectile dysfunction (ED) and concomitant comorbidities. Data were pooled from 42 placebo-controlled, flexible-dose sildenafil trials. In most trials, the sildenafil dose was 50 mg, taken ~1 hour before sexual activity but not more than once daily, with adjustment to 100 or 25 mg as needed. The overall population (N=9413) was stratified by age (<45, 46-64, ≥65 years). Treatment response was defined as a minimal clinically important difference (MCID) from baseline in the International Index of Erectile Function-Erectile Function (IIEF-EF) domain score of >2, >5 and >7 for men with mild, moderate and severe ED at baseline, respectively, or an IIEF-EF domain score ≥26 (no ED) at end-point. In the overall population, treatment response using the IIEF-EF MCID definition was significantly greater (P<.0001) with sildenafil vs placebo in men with no comorbidity (77% vs 33%), cardiovascular disease/hypertension only (71% vs 27%), diabetes only (63% vs 24%) or depression only (78% vs 29%). Using an IIEF-EF score ≥26, treatment response was significantly greater (P<.0001) with sildenafil vs placebo in men with no comorbidity (49% vs 17%), cardiovascular disease/hypertension only (48% vs 12%), diabetes only (40% vs 12%) or depression only (60% vs 17%). With each definition, the treatment response for each age and comorbidity was significantly greater (P≤.0065) with sildenafil vs placebo. The treatment response was significantly greater with sildenafil vs placebo in men with ED and each comorbidity regardless of age. © 2017 John Wiley & Sons Ltd.

Responsiveness to Change of Functional Limitation Reporting: Cross-sectional Study Using the Intermountain ROMS Scale in Outpatient Rehabilitation.

PubMed

Brennan, Gerard P; Hunter, Stephen J; Snow, Greg; Minick, Kate I

2017-12-01

The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. 
A systematic approach to determine a patient's functional limitations and responsiveness to change is needed. The purpose of this study is to compare patient-reported outcomes (PROs) responsiveness to change using 7-level severity/complexity modifier scale proposed by Medicare to a derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes Management System (ROMS). This was a retrospective, observational cohort design. 165,183 PROs prior to July 1, 2013, were compared to 46,334 records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots illustrate distribution and change of patients' scores. ROMS raw score ranges were calculated and compared to CMS' severity/complexity levels based on score percentage. Distribution of the population was compared based on the 2 methods. Sensitivity and specificity were compared for responsiveness to change based on minimal clinically important difference (MCID). Histograms demonstrated few patient scores placed in CMS scale levels at the extremes, whereas the majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores more evenly across levels. Ribbon plots illustrated advantage of ROMS' using narrower score ranges. Greater chance for patients to change levels was observed with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in greater sensitivity and good specificity. Geographic representation for the United States was limited. Without patients' global rating of change, a reference standard to gauge validation of improvement could not be provided. ROMS provides a standard approach to identify accurately functional limitation modifier levels and to detect improvement more accurately than a straight across transposition using the CMS scale. © 2017 American Physical Therapy Association

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series*

PubMed Central

Crowell, Michael S.; Deyle, Gail D.; Owens, Johnny; Gill, Norman W.

2016-01-01

Objectives Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Methods Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Results Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Discussion Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function. PMID:27252581

Change in health-related quality of life in the context of pediatric obesity interventions: A meta-analytic review.

PubMed

Steele, Ric G; Gayes, Laurie A; Dalton, William T; Smith, Courtney; Maphis, Laura; Conway-Williams, Elizabeth

2016-10-01

To quantitatively characterize change in health-related quality of life (HRQoL) in the context of behavioral (n = 16), surgical (n = 5), and pharmacological (n = 1) interventions for pediatric overweight and obesity. A secondary goal was to examine the relationship between change in HRQoL and change in body mass index (ΔBMI) by treatment type. The amount of weight loss necessary to observe a minimally clinically important difference (MCID) in HRQoL was determined. Data were gathered from studies reporting on weight change and ΔHRQoL over the course of obesity interventions (N = 22) in youths (N = 1,332) with average ages between 7.4 and 16.5 years (M = 12.2). An overall effect size was calculated for ΔHRQoL. Moderation analyses were conducted using analysis of variance and weighted regression. MCID analyses were conducted by converting HRQoL data to standard error of measurement units. The overall effect size for ΔHRQoL in the context of pediatric obesity interventions was medium (g = 0.51). A significant linear relationship was detected between ΔBMI and ΔHRQoL (R2 = 0.87). This relationship was moderated by treatment type, with medical (i.e., surgical) interventions demonstrating a stronger relationship. Results indicated that it takes a change of 0.998 BMI units to detect true change in HRQoL. This study provides the first known quantitative examination of changes in HRQoL associated with weight loss in pediatric interventions. Medical interventions appear to offer a more substantial increase in HRQoL per unit of BMI change. These results offer a concrete weight loss goal for noticing positive effects in daily life activities. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article.

PubMed

Smith, Justin S; Singh, Manish; Klineberg, Eric; Shaffrey, Christopher I; Lafage, Virginie; Schwab, Frank J; Protopsaltis, Themistocles; Ibrahimi, David; Scheer, Justin K; Mundis, Gregory; Gupta, Munish C; Hostin, Richard; Deviren, Vedat; Kebaish, Khaled; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P

2014-08-01

Increased sagittal vertical axis (SVA) correlates strongly with pain and disability for adults with spinal deformity. A subset of patients with sagittal spinopelvic malalignment (SSM) have flatback deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10°) but remain sagittally compensated with normal SVA. Few data exist for SSM patients with flatback deformity and normal SVA. The authors' objective was to compare baseline disability and treatment outcomes for patients with compensated (SVA < 5 cm and PI-LL mismatch > 10°) and decompensated (SVA > 5 cm) SSM. The study was a multicenter, prospective analysis of adults with spinal deformity who consecutively underwent surgical treatment for SSM. Inclusion criteria included age older than 18 years, presence of adult spinal deformity with SSM, plan for surgical treatment, and minimum 1-year follow-up data. Patients with SSM were divided into 2 groups: those with compensated SSM (SVA < 5 cm and PI-LL mismatch > 10°) and those with decompensated SSM (SVA ≥ 5 cm). Baseline and 1-year follow-up radiographic and health-related quality of life (HRQOL) outcomes included Oswestry Disability Index, Short Form-36 scores, and Scoliosis Research Society-22 scores. Percentages of patients achieving minimal clinically important difference (MCID) were also assessed. A total of 125 patients (27 compensated and 98 decompensated) met inclusion criteria. Compared with patients in the compensated group, patients in the decompensated group were older (62.9 vs. 55.1 years; p = 0.004) and had less scoliosis (43° vs 54°; p = 0.002), greater SVA (12.0 cm vs. 1.7 cm; p < 0.001), greater PI-LL mismatch (26° vs. 20°; p = 0.013), and poorer HRQOL scores (Oswestry Disability Index, Short Form-36 physical component score, Scoliosis Research Society-22 total; p ≤ 0.016). Although these baseline HRQOL differences between the groups reached statistical significance, only the mean difference in Short Form-36 physical component score reached threshold for MCID. Compared with baseline assessment, at 1 year after surgery improvement was noted for patients in both groups for mean SVA (compensated -1.1 cm, decompensated +4.8 cm; p ≤ 0.009), mean PI-LL mismatch (compensated 6°, decompensated 5°; p < 0.001), and all HRQOL measures assessed (p ≤ 0.005). No significant differences were found between the compensated and decompensated groups in the magnitude of HRQOL score improvement or in the percentages of patients achieving MCID for each of the outcome measures assessed. Decompensated SSM patients with elevated SVA experience significant disability; however, the amount of disability in compensated SSM patients with flatback deformity caused by PI-LL mismatch but normal SVA is underappreciated. Surgical correction of SSM demonstrated similar radiographic and HRQOL score improvements for patients in both groups. Evaluation of SSM should extend beyond measuring SVA. Among patients with concordant pain and disability, PI-LL mismatch must be evaluated for SSM patients and can be considered a primary indication for surgery.

The Short-Term Effect of Integrated Complementary and Alternative Medicine Treatment in Inpatients Diagnosed with Lumbar Intervertebral Disc Herniation: A Prospective Observational Study.

PubMed

Shin, Joon-Shik; Lee, Jinho; Kim, Me-Riong; Jung, Jaehoon; Shin, Byung-Cheul; Lee, Myeong Soo; Ha, In-Hyuk

2016-07-01

This study aimed to investigate the short-term effect of hospital-based intensive nonsurgical treatment in lumbar intervertebral disc herniation (IDH) inpatients admitted to an integrated hospital that offers both complementary and alternative medicine (CAM) and conventional medicine treatment. A prospective observational study. A private Korean medicine hospital inpatient setting in Korea. A total of 524 inpatients diagnosed with lumbar IDH admitted from June 1, 2012, to May 31, 2013. The participants received treatment according to a CAM treatment protocol (herbal medicine, acupuncture, bee venom pharmacopuncture, and Chuna manipulation) and conventional medicine treatment as needed. Numeric rating scale (NRS) of low back pain (LBP) and leg pain, Oswestry Disability Index (ODI), and patient global impression of change. The study also assessed whether improvement was obtained over minimal clinically important difference (MCID) in LBP or leg pain. The average hospital stay was 24.4 ± 13.2 days. The majority of patients received CAM treatment and a few selected conventional medicine, such as pain killers (22.7%; 4.2 ± 3.0 administrations) or nerve blocks (14.1%; 1.4 ± 0.7 sessions). At discharge, the average reduction in NRS was 3.18 ± 2.29 (95% confidence interval [CI], 2.99-3.38) for LBP and 2.61 ± 2.60 (95% CI, 2.38-2.83) for leg pain the average reduction in ODI was 19.45 ± 19.53 (95% CI, 17.77-21.12). Two-hundred and seventy patients (51.5%) showed improvement over MCID in both NRS and ODI, 150 (28.6%) in either NRS or ODI, and 104 (19.8%) in neither. Integrated CAM treatment during hospitalization was effective for patients with lumbar IDH who had severe LBP and disability. However, these results must be investigated further to assess whether the effects surpass those seen with placebo and are cost-effective.

A physical function test for use in the intensive care unit: validity, responsiveness, and predictive utility of the physical function ICU test (scored).

PubMed

Denehy, Linda; de Morton, Natalie A; Skinner, Elizabeth H; Edbrooke, Lara; Haines, Kimberley; Warrillow, Stephen; Berney, Sue

2013-12-01

Several tests have recently been developed to measure changes in patient strength and functional outcomes in the intensive care unit (ICU). The original Physical Function ICU Test (PFIT) demonstrates reliability and sensitivity. The aims of this study were to further develop the original PFIT, to derive an interval score (the PFIT-s), and to test the clinimetric properties of the PFIT-s. A nested cohort study was conducted. One hundred forty-four and 116 participants performed the PFIT at ICU admission and discharge, respectively. Original test components were modified using principal component analysis. Rasch analysis examined the unidimensionality of the PFIT, and an interval score was derived. Correlations tested validity, and multiple regression analyses investigated predictive ability. Responsiveness was assessed using the effect size index (ESI), and the minimal clinically important difference (MCID) was calculated. The shoulder lift component was removed. Unidimensionality of combined admission and discharge PFIT-s scores was confirmed. The PFIT-s displayed moderate convergent validity with the Timed "Up & Go" Test (r=-.60), the Six-Minute Walk Test (r=.41), and the Medical Research Council (MRC) sum score (rho=.49). The ESI of the PFIT-s was 0.82, and the MCID was 1.5 points (interval scale range=0-10). A higher admission PFIT-s score was predictive of: an MRC score of ≥48, increased likelihood of discharge home, reduced likelihood of discharge to inpatient rehabilitation, and reduced acute care hospital length of stay. Scoring of sit-to-stand assistance required is subjective, and cadence cutpoints used may not be generalizable. The PFIT-s is a safe and inexpensive test of physical function with high clinical utility. It is valid, responsive to change, and predictive of key outcomes. It is recommended that the PFIT-s be adopted to test physical function in the ICU.

Outcome of Expedited Rotator Cuff Surgery in Injured Workers: Determinants of Successful Recovery.

PubMed

Razmjou, Helen; Boljanovic, Dragana; Lincoln, Sandra; Holtby, Richard; Gallay, Stephen; Henry, Patrick; Macritchie, Iona; Borthwick, Cheryl; Mayer, Lauren; Roknic, Carolyn; Shore, Deborah; Kamino, Allison; Grossman, Julie; Hill, Joanne; Singh, Gargi; Travers, Niki; Yanofsky, Loraine; Wilson, Marni; Sumar, Shellina; Savona, Alicia; De Medeiros, Filomena; Mann, Helen; Champsi, Aisha; Chau, Stefanie; Medeiros, Danielle; Richards, Robin R

2017-05-01

Work-related rotator cuff injuries are a common cause of disability and employee time loss. To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery. Case series; Level of evidence, 4. Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The impact of surgery was assessed by whether the change in the ASES score exceeded the minimal clinically important difference (MCID) of 17 points. Secondary outcomes were range of motion (ROM), medication consumption, and work status. One hundred forty-six patients (43 women [29%], 103 men [71%]; mean age, 52 years; SD, 8 years) completed the study. Sixty-seven (46%) patients underwent rotator cuff repair. The mean time between the date the patient consented to have surgery and the date of surgery was 82 (SD, 44) days. There was a statistically significant improvement in ASES score and ROM and work status (52 returned to regular duties and 59 to modified duties) ( P < .0001). Eighty-four percent (n = 122) of patients exceeded the MCID of 17 points. Individual factors that affected patient overall disability were preoperative ASES, work status prior to surgery, access to care, and autonomy at work. Achieving a minimal clinically meaningful change was influenced by perceived access to care, autonomy and stress at work, and overall satisfaction with the job. Expedited rotator cuff surgery improved disability, ROM, and work status in injured workers. Successful recovery after work-related shoulder injuries may further be facilitated by improving the psychosocial work environment and increasing access to care.

Does Reducing the Concentration of Bupivacaine When Performing Therapeutic Shoulder Joint Injections Impact the Clinical Outcome?

PubMed

Fox, Michael G; Patrie, James T

2016-04-01

Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5-10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5-10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and -3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5-10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13-0.77 points; p = 0.01). Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5-10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.

The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial.

PubMed

Rocha, Sérgio; Silva, Evelyn; Foerster, Águida; Wiesiolek, Carine; Chagas, Anna Paula; Machado, Giselle; Baltar, Adriana; Monte-Silva, Katia

2016-01-01

This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients. Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl-Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA. An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group. The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients. The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke. The improvement in motor recovery (assessed by Fugl-Meyer scale) was only observed after anodal tDCS. The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.

Association Between Palliative Care and Patient and Caregiver Outcomes

PubMed Central

Kavalieratos, Dio; Corbelli, Jennifer; Zhang, Di; Dionne-Odom, J. Nicholas; Ernecoff, Natalie C.; Hanmer, Janel; Hoydich, Zachariah P.; Ikejiani, Dara Z.; Klein-Fedyshin, Michele; Zimmermann, Camilla; Morton, Sally C.; Arnold, Robert M.; Heller, Lucas; Schenker, Yael

2017-01-01

IMPORTANCE The use of palliative care programs and the number of trials assessing their effectiveness have increased. OBJECTIVE To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. DATA SOURCES MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016. STUDY SELECTION Randomized clinical trials of palliative care interventions in adults with life-limiting illness. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy–palliative care scale (FACIT-Pal) instrument (range, 0–184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0–90 [best-worst]; MCID, 5.7 points). MAIN OUTCOMES AND MEASURES Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. RESULTS Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95%CI, 0.08 to 0.83; FACIT-Pal mean difference, 11.36] and symptom burden at the 1- to 3-month follow-up (standardized mean difference, −0.66; 95%CI, −1.25 to −0.07; ESAS mean difference, −10.30). When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95%CI, 0.06 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, −0.21; 95%CI, −0.42 to 0.00; ESAS mean difference, −3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95%CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed. CONCLUSIONS AND RELEVANCE In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival. PMID:27893131

Association Between Expiratory Central Airway Collapse and Respiratory Outcomes Among Smokers

PubMed Central

Bhatt, Surya P.; Terry, Nina L.J.; Nath, Hrudaya; Zach, Jordan A.; Tschirren, Juerg; Bolding, Mark S.; Stinson, Douglas S.; Wilson, Carla G.; Curran-Everett, Douglas; Lynch, David A.; Putcha, Nirupama; Soler, Xavi; Wise, Robert A.; Washko, George R.; Hoffman, Eric A.; Foreman, Marilyn G.; Dransfield, Mark T.

2016-01-01

Importance Central airway collapse greater than 50% of luminal area during exhalation (Expiratory Central Airway Collapse, ECAC) is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, its prevalence and clinical significance are unknown. Objective To determine whether ECAC is associated with respiratory morbidity in smokers independent of underlying lung disease. Design, Setting and Participants We analyzed paired inspiratory-expiratory computerized tomography (CT) images from a large multicenter study (COPDGene) of current and former smokers aged 45–80 years. Participants were enrolled from January 2008 to June 2011, and followed longitudinally till October 2014. Images were screened using a quantitative method to detect at least a 30% reduction in minor axis tracheal diameter from inspiration to end-expiration. From this sample of screen positive scans, cross-sectional area of the trachea was measured manually for confirmation of ECAC at three predetermined levels (aortic arch, carina and bronchus intermedius) in the inspiratory-expiratory scans. Participants with ≥50% reduction in cross-sectional area were diagnosed with ECAC. Exposure(s) Expiratory Central Airway Collapse Main Outcome(s) and Measure(s) Primary outcome was baseline respiratory quality of life [St George’s Respiratory Questionnaire (SGRQ) scale 0 to 100, 100 represents worst health status, minimum clinically important difference MCID 4 units] and secondary outcomes were dyspnea [modified Medical Research Council (mMRC) scale 0 to 4, 4 represents worse dyspnea, MCID 0.7 units] and six minute walk distance [MCID 30 m] at enrollment and exacerbation frequency (events per 100 person-years) on longitudinal follow-up. Results 8820 current and former smokers with and without COPD were included. The prevalence of ECAC was 5%. On multivariable analyses, ECAC was associated with older age [65.0 vs. 59.4 years, absolute difference = 5.6, 95%CI 4.8 to 6.4, adjusted Odds Ratio, OR for every 1-year increase 1.06,95%CI 1.04–1.07;p<0.001], female sex [297 (67%) vs. 3856 (46%), absolute difference = 21.0%, 95%CI 16.4 to 25.4, OR 2.08,95%CI 1.63–2.63;p<0.001], white race compared to African American [374 (84.4%) vs. 5654 (67.5%), absolute difference = 16.9%, 95%CI 13.1 to 20.2, OR 1.85,95%CI 1.38–2.48;p<0.001], higher BMI [31.2 vs. 28.7, absolute difference = 2.5, 95%CI 1.9 to 3.1, OR for every 1 unit increase 1.07,95%CI 1.06–1.09;p<0.001] and lower FEV1 [1.82 vs. 2.28 L, absolute difference = −0.46, 95%CI −0.54 to −0.38, OR for every 1L decrease 0.74,95%CI 0.62–0.89;p<0.001]. ECAC was associated with worse SGRQ scores [30.9 vs. 26.5 units, p<0.001, absolute difference =4.4, 95%CI 2.2 to 6.6)] and mMRC [median 2, Interquartile range IQR 0–3 vs. 1, IQR 0–3, p<0.001] and independent of age, sex, race, BMI, FEV1, smoking burden and emphysema. On follow-up, participants without COPD but with ECAC had increased frequency of total (54 vs. 35 events per 100 person-years, IRR 2.19; 95%CI 1.78 to 2.71;p<0.001) and severe respiratory events requiring hospitalization (16 vs. 10 events per 100 person-years, IRR 2.95; 95%CI 2.20 to 3.95;p<0.001). Conclusions and Relevance In a cross-sectional analysis of current and former smokers, the presence of expiratory central airway collapse was associated with worse respiratory quality of life. Further studies are needed to assess long-term effects on clinical outcomes. Trial Registration ClinicalTrials.gov: Identifier: NCT00608764 https://clinicaltrials.gov/ct2/show/NCT00608764?term=copdgene&rank=1 Phase 1 protocol available here: http://www.copdgene.org/sites/default/files/COPDGeneProtocol-5-0_06-19-2009.pdf Phase 2 protocol available here: http://www.copdgene.org/sites/default/files/CentralStudyProtocol_06%20Oct%202014_Clean.pd PMID:26836732

Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

PubMed

Bakhsheshian, Joshua; Scheer, Justin K; Gum, Jeffrey L; Hostin, Richard; Lafage, Virginie; Bess, Shay; Protopsaltis, Themistocles S; Burton, Douglas C; Keefe, Malla Kate; Hart, Robert A; Mundis, Gregory M; Shaffrey, Christopher I; Schwab, Frank; Smith, Justin S; Ames, Christopher P

2017-01-01

OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.

Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement

PubMed Central

Nwachukwu, Benedict U.; Chang, Brenda; Fields, Kara; Rinzler, Jeremy; Nawabi, Danyal H.; Ranawat, Anil S.; Kelly, Bryan T.

2017-01-01

Background: Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation. Purpose: To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery. Study Design: Case series; Level of evidence, 4. Methods: A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool–33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive. Results: Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o’clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools. Conclusion: There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression. PMID:28840150

Outcomes for Arthroscopic Treatment of Anterior Inferior Iliac Spine (Subspine) Hip Impingement.

PubMed

Nwachukwu, Benedict U; Chang, Brenda; Fields, Kara; Rinzler, Jeremy; Nawabi, Danyal H; Ranawat, Anil S; Kelly, Bryan T

2017-08-01

Femoroacetabular hip impingement (FAI) is now well recognized; however, anterior inferior iliac spine (AIIS; or subspine) impingement is a form of hip impingement that is underrecognized and can be an important source of hip disability and functional limitation. To investigate the outcomes after arthroscopic treatment of AIIS/subspine-related hip impingement in the absence of FAI surgery. Case series; Level of evidence, 4. A prospective institutional hip preservation registry was reviewed to identify patients who underwent arthroscopic AIIS decompression without concurrent treatment of FAI. Primary outcome tools captured in the registry included the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the International Hip Outcome Tool-33 (iHOT-33). Patients with minimum 1-year follow-up were included. Meaningful outcome improvement was determined per minimal clinically important difference (MCID). Statistical analyses were primarily descriptive. Thirty-three patients with a mean follow-up of 19.1 months (range, 12-44 months) were identified. All patients were female, with a mean ± SD age of 26.1 ± 10.3 years. All patients were found to have an associated labral tear, and the mean acetabular version was increased at 2 and 3 o'clock (14.5° and 19.8°, respectively). Mean preoperative outcome scores on the mHHS, HOS ADL (activities of daily living), HOS sport, and iHOT-33 were 57.2 ± 15.3, 66.9 ± 18.8, 43.9 ± 23.6, and 33.5 ± 18.3, respectively. At final available follow-up, mean scores on these outcome measures were 79.5 ± 19.0, 86.8 ± 15.8, 70.4 ± 32.8, and 65.0 ± 31.0, respectively. By the 1-year follow-up, MCID had been achieved in the majority of patients across all 4 tools. There is a paucity of outcomes evidence on AIIS/subspine-related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability, even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and to present with low patient-reported outcome scores. However, meaningful outcome improvement can be achieved with arthroscopic AIIS decompression.

Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.

PubMed

Kavalieratos, Dio; Corbelli, Jennifer; Zhang, Di; Dionne-Odom, J Nicholas; Ernecoff, Natalie C; Hanmer, Janel; Hoydich, Zachariah P; Ikejiani, Dara Z; Klein-Fedyshin, Michele; Zimmermann, Camilla; Morton, Sally C; Arnold, Robert M; Heller, Lucas; Schenker, Yael

2016-11-22

The use of palliative care programs and the number of trials assessing their effectiveness have increased. To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016. Randomized clinical trials of palliative care interventions in adults with life-limiting illness. Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-palliative care scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0-90 [best-worst]; MCID, 5.7 points). Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95% CI, 0.08 to 0.83; FACIT-Pal mean difference, 11.36] and symptom burden at the 1- to 3-month follow-up (standardized mean difference, -0.66; 95% CI, -1.25 to -0.07; ESAS mean difference, -10.30). When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95% CI, 0.06 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, -0.21; 95% CI, -0.42 to 0.00; ESAS mean difference, -3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95% CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed. In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival.

Relationship between Human Immunodeficiency Virus Neuroretinal Disorder and Vision-Specific Quality of Life among People with AIDS.

PubMed

Ashraf, Davin C; May, K Patrick; Holland, Gary N; Van Natta, Mark L; Wu, Albert W; Thorne, Jennifer E; Jabs, Douglas A

2015-12-01

Some human immunodeficiency virus (HIV)-infected individuals have evidence of optic nerve or retinal dysfunction that manifests as decreased contrast sensitivity, even with good best-corrected visual acuity (BCVA). This condition, termed HIV-related neuroretinal disorder (HIV-NRD), is a risk factor for vision impairment (BCVA <20/40), blindness (BCVA ≤20/200), and increased mortality. We investigated the effect of HIV-NRD on vision-specific quality of life (QOL). Cross-sectional analysis of data from a prospective, observational study. Individuals from the Longitudinal Study of the Ocular Complications of AIDS cohort who completed the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25), had BCVA of 20/40 or better, and had no evidence of ocular opportunistic infection or cataract. We compared QOL by HIV-NRD status, adjusting for potential confounding variables, using multiple linear regression. Among those with HIV-NRD, we assessed the relationship between VFQ-25 and the logarithm of contrast sensitivity (logCS), using Spearman correlation. We defined a minimum clinically important difference (MCID) as 1 standard error of measurement from a well-characterized, historical population of individuals with a variety of ophthalmic disorders. Subscales and composite VFQ-25 scores (0 = worst, 100 = best). A total of 813 individuals met study criteria. Those with HIV-NRD (n = 39 [4.8%]) had a lower mean composite score than those without HIV-NRD (81 vs. 89; P = 0.0002) and lower mean scores in the following subscales: near activities (77 vs. 86; P = 0.004), distance activities (85 vs. 91; P = 0.01), social functioning (89 vs. 96; P = 0.0005), mental health (75 vs. 87; P = 0.0001), dependency (81 vs. 94; P < 0.0001), driving (75 vs. 85; P = 0.02), color vision (90 vs. 97; P < 0.0001), and peripheral vision (85 vs. 91; P = 0.0496). Score differences for each of these subscales met criteria for MCID. Among those with HIV-NRD, there was a positive correlation between logCS and composite score (r = 0.36; 95% confidence interval, 0.04-0.60). HIV-NRD has a statistically significant and clinically meaningful association with decreased vision-specific QOL among people with AIDS and good BCVA. Published by Elsevier Inc.

Reliability and Responsiveness of NutriQoL® Questionnaire.

PubMed

Cuerda, Maria Cristina; Apezetxea, Antonio; Carrillo, Lourdes; Casanueva, Felipe; Cuesta, Federico; Irles, Jose Antonio; Virgili, Maria Nuria; Layola, Miquel; Lizán, Luis

2016-10-01

NutriQoL ® (Nestlé Health Science, Vevay, Switzerland) is a questionnaire developed to assess the health-related quality-of-life (HRQoL) of patients with home enteral nutrition (HEN) irrespective of their underlying condition and route of administration. The aim of this work is assessing the questionnaire's reliability and responsiveness to change. Two cohorts of patients with HEN and their primary caregivers were enrolled to assess reliability and responsiveness, respectively. All participants had to be 18 years of age or older, without mental deterioration (≤3 or 4 errors in the Pfeiffer's test) and with sufficient functional status (>40 points on Karnovsky's performance status scale). When the patients' ability to respond to the questionnaire was impaired due to underlying disease, their caregivers answered on their behalf. NutriQoL was administered in two and three visits to reliability and responsiveness cohorts, respectively. Test-retest reliability and internal consistency were assessed by the intra-class correlation coefficient (ICC) and the Cronbach's α, respectively. Responsiveness was evaluated by standardized effect size and standardized response mean between basal visit and third visit. Finally, the minimal clinically important difference (MCID) was estimated. A total of 54 and 86 participants were recruited to the reliability and responsiveness cohort, respectively. Thirty-five caregivers were selected to assess the inter-observer reliability. ICC values confirmed the good reproducibility level (ICC >0.75) of the questionnaire in both "physical functioning and activities of daily living" and "social life" domains and total score. The assessment of internal consistency in both domains of the questionnaire showed good internal consistency in visit 2. ICC showed the excellent agreement level between caregiver and patient in the global NutriQoL score. Finally, patients classified as having a minimal change in their health reported a mean (standard deviation) MCID in NutriQoL score of 0.63 (11.51). NutriQoL is a reliable and unique instrument to measure the HRQoL in HEN patients. NutriQoL detects changes in the health status of the patient. Nevertheless, further research is needed to determine the full extent of the questionnaire responsiveness.

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

PubMed Central

Shaw, Martin; Iwashyna, Theodore J.; Daniel, Malcolm; Devine, Helen; Jarvie, Lyndsey; Kinsella, John; MacTavish, Pamela; Quasim, Tara

2017-01-01

Background Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. Methods Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. Results 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). Conclusions and relevance This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further. PMID:29186177

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention.

PubMed

McPeake, Joanne; Shaw, Martin; Iwashyna, Theodore J; Daniel, Malcolm; Devine, Helen; Jarvie, Lyndsey; Kinsella, John; MacTavish, Pamela; Quasim, Tara

2017-01-01

Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008-2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07-0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.

Repeat treatment with rifaximin improves irritable bowel syndrome-related quality of life: a secondary analysis of a randomized, double-blind, placebo-controlled trial.

PubMed

Cash, Brooks D; Pimentel, Mark; Rao, Satish S C; Weinstock, Leonard; Chang, Lin; Heimanson, Zeev; Lembo, Anthony

2017-09-01

Diarrhea-predominant irritable bowel syndrome (IBS-D) impairs patient quality of life (QOL). Rifaximin is an oral, nonsystemic antibiotic indicated for IBS-D. The objective of this secondary analysis was to evaluate rifaximin retreatment on IBS-related QOL in patients with IBS-D. Patients received open-label rifaximin 550 mg three times daily for 2 weeks. Clinical responders [simultaneously meeting weekly response criteria for abdominal pain (⩾30% improvement from baseline in mean weekly pain score) and stool consistency (⩾50% decrease from baseline in number of days/week with Bristol Stool Scale (BSS) type 6 or 7 stools) during ⩾2 of first 4 weeks posttreatment] who relapsed during an up to 18-week treatment-free observation phase were randomly assigned to receive two 2-week courses of double-blind rifaximin or placebo, separated by 10 weeks. A validated 34-item IBS-QOL questionnaire examined patient responses in 8 domains. The 2579 patients receiving open-label rifaximin experienced a mean improvement from baseline in IBS-QOL overall score of 54.9%. Responders to open-label rifaximin ( n = 1074 of 2438 evaluable; 44.1%) had significantly greater improvement from baseline in IBS-QOL overall and all eight subdomain scores, including dysphoria, food avoidance, interference with activity, body image, and sexual function versus nonresponders at 4 weeks posttreatment ( n = 1364; p < 0.001 for all comparisons). A significantly greater percentage of responders to open-label rifaximin achieved the minimally clinically important difference (MCID; ⩾14-point improvement from baseline) in the overall IBS-QOL score versus nonresponders [ n = 561 (52.2%) versus n = 287 (21.0%); p < 0.0001]. Among 636 patients with IBS-D relapse, the MCID in the overall IBS-QOL score was achieved by a significantly greater percentage of patients receiving double-blind rifaximin versus placebo (38.6% versus 29.6%, respectively; p = 0.009). Open-label and blinded retreatment with a short course (2 weeks) of rifaximin improved IBS-QOL in patients with IBS-D [ClinicalTrials.gov identifier: NCT01543178].

Outcome for Arthroscopic Treatment of Anterior Inferior Iliac Spine/Subspine Related Hip Impingement

PubMed Central

Nwachukwu, Benedict Uchenna; Chang, Brenda; Schairer, William W.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

2017-01-01

Objectives: Extra-articular disorders of the hip are under-recognized and under-reported. Extra-articular forms of hip impingement can include anterior inferior iliac spine (AIIS) related subspine impingement. The purpose of this study was to investigate the outcome after arthroscopic treatment of anterior inferior iliac spine (AIIS)/Subspine related hip impingement. Methods: A prospective institutional hip preservation registry was reviewed to identify patients that underwent isolated arthroscopic AIIS decompression. Primary outcome tools captured in the registry included: the modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33). Patients with minimum one-year follow-up were included. Meaningful outcome improvement was determined based on minimal clinically important difference (MCID). Statistical analyses were primarily descriptive. Results: Thirty-three patients with mean follow-up 19.1 months (range: 12-44 months) were identified. All patients were female with a mean age of 26.1 (+ 10.3) years. All patients were found to have an associated labral tear and the mean acetabular version was increased at 2 and 3 o’clock (14.5 and 19.8 respectively). Mean pre-operative outcome scores on the mHHS, HOS activities of daily living (ADL), HOS Sport and iHOT-33 were 57.2 (SD+15.3), 66.9 (SD+18.8), 43.9 (SD+23.6) and 33.5 (SD+18.3) respectively. At final available follow-up, mean scores on these outcome measures were 79.5 (SD+19.0), 86.8 (SD+15.8), 70.4 (SD+32.8) and 65.0 (SD+31.0) respectively. By the one-year follow-up interval MCID had been achieved in the majority of patients across all four tools. Conclusion: There is a paucity of outcome evidence on AIIS/Subspine related hip impingement. This study demonstrates that isolated subspine impingement can be a cause of hip disability even in the absence of FAI. Patients with isolated subspine impingement are more likely to be women and they present with low patient reported outcome scores. Meaningful outcome improvement can be achieved however with arthroscopic AIIS decompression.

The use of lumbar epidural injection of platelet lysate for treatment of radicular pain.

PubMed

Centeno, Christopher; Markle, Jason; Dodson, Ehren; Stemper, Ian; Hyzy, Matthew; Williams, Christopher; Freeman, Michael

2017-11-25

Epidural steroid injections (ESI) are the most common pain management procedure performed in the US, however evidence of efficacy is limited. In addition, there is early evidence that the high dose of corticosteroids used can have systemic side effects. We describe the results of a case series evaluating the use of platelet lysate (PL) epidural injections for the treatment of lumbar radicular pain as an alternative to corticosteroids. Registry data was obtained for patients (N = 470) treated with PL epidural injections presenting with symptoms of lumbar radicular pain and MRI findings that were consistent with symptoms. Collected outcomes included numeric pain score (NPS), functional rating index (FRI), and a modified single assessment numeric evaluation (SANE) rating. Patients treated with PL epidurals reported significantly lower (p < .0001) NPS and FRI change scores at all time points compared to baseline. Post-treatment FRI change score means exceeded the minimal clinically important difference beyond 1 month. Average modified SANE ratings showed 49.7% improvement at 24 months post-treatment. Twenty-nine (6.3%) patients reported mild adverse events related to treatment. Patients treated with PL epidurals reported significant improvements in pain, exceeded the minimal clinically important difference (MCID) for FRI, and reported subjective improvement through 2-year follow-up. PL may be a promising substitute for corticosteroid.

Influence of Previous Failed Antispasticity Therapy on the Efficacy and Tolerability of THC:CBD Oromucosal Spray for Multiple Sclerosis Spasticity.

PubMed

Haupts, Michael; Vila, Carlos; Jonas, Anna; Witte, Kerstin; Álvarez-Ossorio, Lourdes

2016-01-01

Sativex® (THC:CBD oromucosal spray) is indicated as add-on treatment for patients with moderate to severe multiple sclerosis (MS) spasticity. We aimed to determine whether antispasticity treatment history influenced the efficacy and safety of add-on THC:CBD oromucosal spray in MS spasticity patients. Post hoc analysis of an enriched-design clinical trial of THC:CBD oromucosal spray versus placebo, using records of patients under previous and current ineffective antispasticity therapies. Subgroups were patients with at least 1 failed therapy attempt with either baclofen or tizanidine (Group 1) or at least 2 failed therapy attempts with both baclofen and tizanidine (Group 2). Of 241 patients in the intent-to-treat population, 162 and 57 patients met the criteria for Groups 1 and 2, respectively. In all groups, response on the spasticity 0-10 Numerical Rating Scale was significantly greater with THC:CBD oromucosal spray versus placebo, for minimal clinically important difference (MCID ≥18% improvement vs. baseline) and clinically important difference (CID, ≥30% improvement vs. baseline). THC:CBD oromucosal spray improved spasticity-related symptoms such as sleep quality and timed 10-meter walk independent of the number of prior failed therapy attempts. Tolerability was not influenced by pre-treatment history. THC:CBD oromucosal spray provided consistent relief with good tolerability in MS spasticity patients irrespective of their antispasticity pre-treatment history. © 2016 S. Karger AG, Basel.

Responsiveness of clinical tests for people with neck pain.

PubMed

Jørgensen, René; Ris, Inge; Juhl, Carsten; Falla, Deborah; Juul-Kristensen, Birgit

2017-12-28

Responsiveness of a clinical test is highly relevant in order to evaluate the effect of a given intervention. However, the responsiveness of clinical tests for people with neck pain has not been adequately evaluated. The objective of the present study was to examine the responsiveness of four clinical tests which are low cost and easy to perform in a clinical setting, including the craniocervical flexion test, cervical active range of movement, test for the cervical extensors and pressure pain threshold testing. This study is a secondary analysis of data collected in a previously published randomised controlled trial. Participants were randomized to either physical training, exercises and pain education combined or pain education only. Participants were tested on the clinical tests at baseline and at 4-month follow-up. An anchor-based approach using Receiver Operator Characteristics (ROC) curves was used to evaluate responsiveness of the clinical tests. The Neck Disability Index was used to discriminate between those who had improved and those who were unchanged at the 4-month follow-up. Minimum Clinically Important Difference (MCID), together with sensitivity, specificity, positive and negative predictive values, in addition to positive and negative likelihood ratios were calculated. In total, 164 participants completed the 4 month follow up. One-hundred forty four participants were classified as unchanged whereas 20 patients were considered to be improved. Twenty-six participants didn't complete all of the clinical tests, leaving a total of 138 to be included for analyses. Area Under Curve (AUC) ranged from 0.50-0.62 for the clinical tests, and were all below an acceptable level. MCID was generally large, and the corresponding sensitivity and specificity was low with sensitivity ranging from 20 to 60%, and specificity from 54 to 86%. LR+ (0.8-2.07) and LR- (0.7-1.1) showed low diagnostic value for all variables, with PPV ranging from 12.1 to 26.1 and NPV ranging from 84.7 to 89.2. Responsiveness of the included clinical tests was generally low when using change in NDI score as the anchor from baseline to the 4-month follow up. Further investigations of responsiveness are warranted, possibly using other anchors, which to a higher degree resemble similar dimensions as the clinical tests.

Patient-reported allergies predict postoperative outcomes and psychosomatic markers following spine surgery.

PubMed

Xiong, David D; Ye, Wenda; Xiao, Roy; Miller, Jacob A; Mroz, Thomas E; Steinmetz, Michael P; Nagel, Sean J; Machado, Andre G

2018-05-22

Prior studies have shown that patient-reported allergies can be prognostic of poorer postoperative outcomes. To investigate the correlation between self-reported allergies and outcomes after cervical or lumbar spine surgery. Retrospective cohort study at a single tertiary-care institution. All patients undergoing cervical or lumbar spine surgery from 2009-2014. The primary outcome measure was change in the EuroQol-5 Dimensions (EQ-5D) following surgery. Secondary outcomes included change in the Pain Disability Questionnaire (PDQ) and Patient Health Questionnaire-9 (PHQ-9), achieving the minimal clinically important difference (MCID) in these measures, as well as cost of admission. Prior to and following surgery, EQ-5D, PDQ, and PHQ-9 were recorded for patients with available data. Paired student's t-tests were used to compare change in these measures following surgery. Multivariable linear and logistic regression were used to assess the relationship between the log transformation of the total number of allergies and outcomes. 592 cervical patients and 4,465 lumbar patients were included. The median number of reported allergies was two. The EQ-5D index increased from 0.539 to 0.703 for cervical patients and from 0.530 to 0.676 for lumbar patients (p<0.01 for both). Patients experienced significant pain improvement by the PDQ (80.1 to 58.2 for cervical patients, 79.4 to 58.1 for lumbar patients; p<0.01). Using multivariable logistic regression, the log transformation of number of allergies predicted significantly higher odds of achieving the PDQ MCID (OR = 2.09, 95% CI 1.05-4.15, p=0.02 for cervical patients; OR = 1.30, 95% CI 1.03-1.68, p=0.03 for lumbar patients). However, this relationship was not durable for patients with follow-up exceeding 1 year. The log transformation of number of allergies for lumbar patients predicted significantly increased cost of admission (β=$3,597, p<0.01) and trended towards significance among cervical patients (β=$1,842, p=0.10). Patient-reported allergies correlate with subjective improvement in pain and disability following spine surgery and may serve as a marker of postoperative outcomes. The relationship between allergies and PDQ improvement may be secondary to the short-term expectation-actuality discrepancy, as this relationship was not durable beyond 1 year. Copyright © 2018 Elsevier Inc. All rights reserved.

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

PubMed

Luque-Moreno, C; Oliva-Pascual-Vaca, A; Kiper, P; Rodríguez-Blanco, C; Agostini, M; Turolla, A

2016-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study.

PubMed

Stienen, Martin N; Joswig, Holger; Chau, Ivan; Neidert, Marian C; Bellut, David; Wälchli, Thomas; Schaller, Karl; Gautschi, Oliver P

2018-03-01

OBJECTIVE The purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy. METHODS This study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6. RESULTS Fifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066). CONCLUSIONS Intraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited. ■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective cohort trial; evidence: Class II.

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke

PubMed Central

Winstein, Carolee J.; Wolf, Steven L.; Dromerick, Alexander W.; Lane, Christianne J.; Nelsen, Monica A.; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P.

2016-01-01

IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and DEUCC vs UCC: −0.14; 95% CI, −0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, −8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, −8.1 seconds, and SIS, 72%; and UCC group, WMFT, −7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, −0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, −12% to 13%; P = .54; ASAP vs UCC: WMFT, −0.6 seconds, 95% CI, −3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, −9% to 16%; P = .48; and DEUCC vs UCC: WMFT, −2.1 seconds; 95% CI, −4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, −9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715 PMID:26864411

Comparison of Wood Preservatives in Stake Tests (1981 Progress Report).

DTIC Science & Technology

1981-12-01

infected with Trichoderma mold, plus other selected species such as oak, Douglas-fir, and Engelmann spruce. Southern pine untreated control stakes...acetylated wood, cyanoethylated wood, that with thiamine destroyed, chemically modified wood, wood infected with Trichoderma mold, embedded fiberboard (western...14 toA4 41U(4 a ...- 44- Table 31.--Condition of southern pine stakes (2 x 4 in. nominal x 18 in.) of uninfected and Trichoderma mcid-infected wood

Can Cognitive Behavioral Therapy for Insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? - A multiple case report.

PubMed

Lu, William; Krellman, Jason W; Dijkers, Marcel P

2016-01-01

Individuals with traumatic brain injury (TBI) often develop sleep disorders post-injury. The most common one is insomnia, which can exacerbate other post-injury symptoms, including fatigue, impaired cognition, depression, anxiety, and pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations. This paper reviews the use of CBT-I for three participants with TBI of different severities. Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires. The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity. We conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.

The Hand-Foot Skin Reaction and Quality of Life Questionnaire: An Assessment Tool for Oncology.

PubMed

Anderson, Roger T; Keating, Karen N; Doll, Helen A; Camacho, Fabian

2015-07-01

Skin toxicity (hand-foot syndrome/hand-foot skin reaction, HFS/R) related to antineoplastic therapy is a significant issue in oncology practice, with potentially large impacts on health-related quality of life (HRQL). A patient-reported questionnaire, the hand-foot skin reaction and quality of life (HF-QoL) questionnaire was developed to measure the HFS/R symptoms associated with cancer therapeutic agents and their effect on daily activities. The validity and reliability of the HF-QoL questionnaire was tested in a randomized trial of capecitabine with sorafenib/placebo in 223 patients with locally advanced/metastatic breast cancer. Other measures completed included patient ratings of condition severity, the Functional Assessment of Cancer Therapy-Breast cancer (FACT-B), and the clinician-rated National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 3.0, hand-foot skin reaction grade. The psychometric properties of the HF-QoL tested included structural validity, internal consistency, construct validity, discriminant validity, and responsiveness. Finally, the minimal clinically important difference (MCID) was estimated. The HF-QoL instrument comprises a 20-item symptom scale and an 18-item daily activity scale. Each scale demonstrated excellent measurement properties and discriminated between NCI-CTCAE grade and patient-rated condition severity with large effect sizes. The daily activity scale had excellent internal consistency and correlated with the FACT-B and HF-QoL symptom scores. Both HF-QoL scale scores increased linearly with increasing patient-rated condition severity. The MCIDs were estimated as 5 units for daily activities and 8 units for symptoms mean scores. The HF-QoL was sensitive to symptoms and HRQL issues associated with HFS/R among participants treated with capecitabine with and without sorafenib. The HF-QoL appears suitable for assessing the HRQL impairment associated with HFS/R to cancer therapies. Skin toxicity related to anticancer therapies is a significant issue in oncology practice. Several newer agents, as well as older therapies, are associated with the skin toxicity known as hand-foot skin reaction (HFSR) or hand-foot syndrome (HFS). This study describes the development and validation of a brief, patient-reported questionnaire (the hand-foot skin reaction and quality of life questionnaire) supporting its suitability for use in clinical research to aid in early recognition of symptoms, to evaluate the effectiveness of agents for HFS/R treatment within clinical trials, and to evaluate the impact of these treatments on HFS/R-associated patients' health-related quality of life. ©AlphaMed Press.

Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity in patients with psoriatic arthritis

PubMed Central

2014-01-01

Introduction The novel arthritis-specific Work Productivity Survey (WPS) was developed to estimate patient productivity limitations associated with arthritis within and outside the home, which is an unmet need in psoriatic arthritis (PsA). The WPS has been validated in rheumatoid arthritis. This report assesses the discriminant validity, responsiveness and reliability of the WPS in adult-onset PsA. Methods Psychometric properties were assessed using data from the RAPID-PsA trial (NCT01087788) investigating certolizumab pegol (CZP) efficacy and safety in PsA. WPS was completed at baseline and every 4 weeks until Week 24. Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients’ Disease Activity Score 28 based on C-reactive protein (DAS28(CRP)), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short Form-36 (SF-36) items and PsA Quality of Life (PsAQoL) scores. Responsiveness and reliability were assessed by comparing WPS mean changes at Week 12 in American College of Rheumatology 20% improvement criteria (ACR20) or HAQ-DI Minimal Clinically Important Difference (MCID) 0.3 responders versus non-responders, as well as using standardized response means (SRM). All comparisons were conducted on the observed cases in the Randomized Set, regardless of the randomization group, using a non-parametric bootstrap-t method. Results Compared with patients with a better health state, patients with a worse health state had on average 2 to 6 times more household work days lost, more days with reduced household productivity, more days missed of family/social/leisure activities, more days with outside help hired and a significantly higher interference of arthritis per month. Among employed patients, those with a worse health state had 2 to 4 times more workplace days lost, more days with patient workplace productivity reduced, and a significantly higher interference of arthritis on patient workplace productivity versus patients with a better health state. WPS was also responsive to clinical changes, with responders having significantly larger improvements at Week 12 in WPS scores versus non-responders. The effect sizes for changes in productivity in ACR20 or HAQ-DI MCID responders were moderate (0.5 < SRM < 0.8) or small. Conclusions These analyses demonstrate the validity, responsiveness and reliability of the WPS, as an instrument for the measurement of patient productivity within and outside the home in an adult-onset PsA population. PMID:24996416

ASSOCIATION OF KNEE PAIN WITH A REDUCTION IN THIGH MUSCLE STRENGTH – A CROSS-SECTIONAL ANALYSIS INCLUDING 4553 OSTEOARTHRITIS INITIATIVE PARTICIPANTS

PubMed Central

Ruhdorfer, Anja; Wirth, Wolfgang; Eckstein, Felix

2016-01-01

Objective To cross-sectionally determine the quantitative relationship of age-adjusted, sex-specific isometric knee extensor and flexor strength to patient-reported knee pain. Methods Difference of thigh muscle strength by age, and that of age-adjusted strength per unit increase on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain scale, was estimated from linear regression analysis of 4553 Osteoarthritis Initiative participants (58% women). Strata encompassing the minimal clinically important difference (MCID) in knee pain were compared to evaluate a potentially non-linear relationship between WOMAC pain levels and muscle strength. Results In Osteoarthritis Initiative participants without pain, the age-related difference in isometric knee extensor strength was −9.0%/−8.2% (women/men) per decade, and that of flexor strength was −11%/−6.9%. Differences in age-adjusted strength values for each unit of WOMAC pain (1/20) amounted to −1.9%/−1.6% for extensor and −2.5%/−1.7% for flexor strength. Differences in torque/weight for each unit of WOMAC pain ranged from −3.3 to − 2.1%. There was no indication of a non-linear relationship between pain and strength across the range of observed WOMAC values, and similar results were observed in women and men. Conclusion Each increase by 1/20 units in WOMAC pain was associated with a ~2% lower age-adjusted isometric extensor and flexor strength in either sex. As a reduction in muscle strength is known to prospectively increase symptoms in knee osteoarthritis and as pain appears to reduce thigh muscle strength, adequate therapy of pain and muscle strength is required in knee osteoarthritis patients to avoid a vicious circle of self-sustaining clinical deterioration. PMID:27836675

Can Preoperative Patient-reported Outcome Measures Be Used to Predict Meaningful Improvement in Function After TKA?

PubMed

Berliner, Jonathan L; Brodke, Dane J; Chan, Vanessa; SooHoo, Nelson F; Bozic, Kevin J

2017-01-01

Despite the overall effectiveness of total knee arthroplasty (TKA), a subset of patients do not experience expected improvements in pain, physical function, and quality of life as documented by patient-reported outcome measures (PROMs), which assess a patient's physical and emotional health and pain. It is therefore important to develop preoperative tools capable of identifying patients unlikely to improve by a clinically important margin after surgery. The purpose of this study was to determine if an association exists between preoperative PROM scores and patients' likelihood of experiencing a clinically meaningful change in function 1 year after TKA. A retrospective study design was used to evaluate preoperative and 1-year postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-12 version 2 (SF12v2) scores from 562 patients who underwent primary unilateral TKA. This cohort represented 75% of the 750 patients who underwent surgery during that time period; a total of 188 others (25%) either did not complete PROM scores at the designated times or were lost to follow-up. Minimum clinically important differences (MCIDs) were calculated for each PROM using a distribution-based method and were used to define meaningful clinical improvement. MCID values for KOOS and SF12v2 physical component summary (PCS) scores were calculated to be 10 and 5, respectively. A receiver operating characteristic analysis was used to determine threshold values for preoperative KOOS and SF12v2 PCS scores and their respective predictive abilities. Threshold values defined the point after which the likelihood of clinically meaningful improvement began to diminish. Multivariate regression was used to control for the effect of preoperative mental and emotional health, patient attributes quantified by SF12v2 mental component summary (MCS) scores, on patients' likelihood of experiencing meaningful improvement in function after surgery. Threshold values for preoperative KOOS and SF12v2 PCS scores were a maximum of 58 (area under the curve [AUC], 0.76; p < 0.001) and 34 (AUC, 0.65; p < 0.001), respectively. Patients scoring above these thresholds, indicating better preoperative function, were less likely to experience a clinically meaningful improvement in function after TKA. When accounting for mental and emotional health with a multivariate analysis, the predictive ability of both KOOS and SF12v2 PCS threshold values improved (AUCs increased to 0.80 and 0.71, respectively). Better preoperative mental and emotional health, as reflected by a higher MCS score, resulted in higher threshold values for KOOS and SF12v2 PCS. We identified preoperative PROM threshold values that are associated with clinically meaningful improvements in functional outcome after TKA. Patients with preoperative KOOS or SF12v2 PCS scores above the defined threshold values have a diminishing probability of experiencing clinically meaningful improvement after TKA. Patients with worse baseline mental and emotional health (as defined by SF12v2 MCS score) have a lower probability of experiencing clinically important levels of functional improvement after surgery. The results of this study are directly applicable to patient-centered informed decision-making tools and may be used to facilitate discussions with patients regarding the expected benefit after TKA. Level III, prognostic study.

A clinically meaningful training effect in walking speed using functional electrical stimulation for motor-incomplete spinal cord injury.

PubMed

Street, Tamsyn; Singleton, Christine

2018-05-01

The study aimed to investigate the presence of a training effect for rehabilitation of walking function in motor-incomplete spinal cord injury (SCI) through daily use of functional electrical stimulation (FES). A specialist FES outpatient centre. Thirty-five participants (mean age 53, SD 15, range 18-80; mean years since diagnosis 9, range 5 months - 39 years) with drop foot and motor-incomplete SCI (T12 or higher, ASIA Impairment Scale C and D) able to ambulate 10 metres with the use of a walking stick or frame. FES of the peroneal nerve, glutei and hamstrings as clinically indicated over six months in the community. The data was analysed for a training effect (difference between unassisted ten metre walking speed at baseline and after six months) and orthotic effects (difference between walking speed with and without FES) initially on day one and after six months. The data was further analysed for a minimum clinically important difference (MCID) (>0.06 m/s). A clinically meaningful, significant change was observed for initial orthotic effect (0.13m/s, CI: 0.04-0.17, P = 0.013), total orthotic effect (0.11m/s, CI: 0.04-0.18, P = 0.017) and training effect (0.09m/s, CI: 0.02-0.16, P = 0.025). The results suggest that daily independent use of FES may produce clinically meaningful changes in walking speed which are significant for motor-incomplete SCI. Further research exploring the mechanism for the presence of a training effect may be beneficial in targeting therapies for future rehabilitation.

Differences in change in coping styles between good responders, moderate responders and non-responders to pulmonary rehabilitation.

PubMed

Stoilkova-Hartmann, Ana; Janssen, Daisy J A; Franssen, Frits M E; Wouters, Emiel F M

2015-12-01

Pulmonary rehabilitation (PR) improves exercise tolerance and health status in patients with chronic obstructive pulmonary disease (COPD). Data on the effects of PR on coping styles are limited. Aim of the present study was to compare changes in coping styles between patients who had a good, moderate and no improvement in either exercise tolerance or health status after PR. Coping styles of 439 COPD patients undergoing PR were assessed by the Utrecht Coping List (UCL) at baseline and after PR. Patients' pulmonary function, six-minute walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) were recorded. Good, moderate and non-responders were defined on the basis of minimally clinically important difference (MCID) for SGRQ total score and/or 6MWD. Overall, 54.0% of the patients fulfilled the criteria for good responders, while 22.1% were moderate responders. Change in passive reaction pattern coping style differed significantly between good responders and non-responders following PR (p < 0.001). Moreover, within the groups, changes in coping styles after PR occurred among the good responders, whereas the majority of moderate responders' and non-responders' coping styles were not significantly influenced by PR. Good responders decreased their passive reaction pattern coping style in contrast to non-responders after PR. In general, PR did not change the coping among moderate and non-responders. Further research is warranted to determine whether including interventions targeting coping styles may modify coping behaviour of COPD patients, as well as improvement in exercise tolerance or health status after PR. Copyright © 2015 Elsevier Ltd. All rights reserved.

Financial Time Series Prediction Using Elman Recurrent Random Neural Networks

PubMed Central

Wang, Jie; Wang, Jun; Fang, Wen; Niu, Hongli

2016-01-01

In recent years, financial market dynamics forecasting has been a focus of economic research. To predict the price indices of stock markets, we developed an architecture which combined Elman recurrent neural networks with stochastic time effective function. By analyzing the proposed model with the linear regression, complexity invariant distance (CID), and multiscale CID (MCID) analysis methods and taking the model compared with different models such as the backpropagation neural network (BPNN), the stochastic time effective neural network (STNN), and the Elman recurrent neural network (ERNN), the empirical results show that the proposed neural network displays the best performance among these neural networks in financial time series forecasting. Further, the empirical research is performed in testing the predictive effects of SSE, TWSE, KOSPI, and Nikkei225 with the established model, and the corresponding statistical comparisons of the above market indices are also exhibited. The experimental results show that this approach gives good performance in predicting the values from the stock market indices. PMID:27293423

Financial Time Series Prediction Using Elman Recurrent Random Neural Networks.

PubMed

Wang, Jie; Wang, Jun; Fang, Wen; Niu, Hongli

2016-01-01

In recent years, financial market dynamics forecasting has been a focus of economic research. To predict the price indices of stock markets, we developed an architecture which combined Elman recurrent neural networks with stochastic time effective function. By analyzing the proposed model with the linear regression, complexity invariant distance (CID), and multiscale CID (MCID) analysis methods and taking the model compared with different models such as the backpropagation neural network (BPNN), the stochastic time effective neural network (STNN), and the Elman recurrent neural network (ERNN), the empirical results show that the proposed neural network displays the best performance among these neural networks in financial time series forecasting. Further, the empirical research is performed in testing the predictive effects of SSE, TWSE, KOSPI, and Nikkei225 with the established model, and the corresponding statistical comparisons of the above market indices are also exhibited. The experimental results show that this approach gives good performance in predicting the values from the stock market indices.

Brain-computer interfaces for post-stroke motor rehabilitation: a meta-analysis.

PubMed

Cervera, María A; Soekadar, Surjo R; Ushiba, Junichi; Millán, José Del R; Liu, Meigen; Birbaumer, Niels; Garipelli, Gangadhar

2018-05-01

Brain-computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations, enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here, we provide a first meta-analysis evaluating the clinical effectiveness of BCI-based post-stroke motor rehabilitation. Trials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post-stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random-effects inverse variance method was used to calculate the summary effect size. We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post-stroke survivors that fulfilled the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta-analysis. Motor improvements, mostly quantified by the upper limb Fugl-Meyer Assessment (FMA-UE), exceeded the minimal clinically important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was associated with a standardized mean difference of 0.79 (95% CI: 0.37 to 1.20) in FMA-UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI-induced functional and structural neuroplasticity at a subclinical level. This suggests that BCI technology could be an effective intervention for post-stroke upper limb rehabilitation. However, more studies with larger sample size are required to increase the reliability of these results.

Manual physical therapy and perturbation exercises in knee osteoarthritis.

PubMed

Rhon, Daniel; Deyle, Gail; Gill, Norman; Rendeiro, Daniel

2013-11-01

Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA. This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program. Mean total WOMAC score significantly improved (P = 0.001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session. A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.

Is there a difference in range of motion, neck pain, and outcomes in patients with ossification of posterior longitudinal ligament versus those with cervical spondylosis, treated with plated laminoplasty?

PubMed

Fujimori, Takahito; Le, Hai; Ziewacz, John E; Chou, Dean; Mummaneni, Praveen V

2013-07-01

There are little data on the effects of plated, or plate-only, open-door laminoplasty on cervical range of motion (ROM), neck pain, and clinical outcomes. The purpose of this study was to compare ROM after a plated laminoplasty in patients with ossification of posterior longitudinal ligament (OPLL) versus those with cervical spondylotic myelopathy (CSM) and to correlate ROM with postoperative neck pain and neurological outcomes. The authors retrospectively compared patients with a diagnosis of cervical stenosis due to either OPLL or CSM who had been treated with plated laminoplasty in the period from 2007 to 2012 at the University of California, San Francisco. Clinical outcomes were measured using the modified Japanese Orthopaedic Association (mJOA) scale and neck visual analog scale (VAS). Radiographic outcomes included assessment of changes in the C2-7 Cobb angle at flexion and extension, ROM at C2-7, and ROM of proximal and distal segments adjacent to the plated lamina. Sixty patients (40 men and 20 women) with an average age of 63.1 ± 10.9 years were included in the study. Forty-one patients had degenerative CSM and 19 patients had OPLL. The mean follow-up period was 20.9 ± 13.1 months. The mean mJOA score significantly improved in both the CSM and the OPLL groups (12.8 to 14.5, p < 0.01; and 13.2 to 14.2, respectively; p = 0.04). In the CSM group, the mean VAS neck score significantly improved from 4.2 to 2.6 after surgery (p = 0.01), but this improvement did not reach the minimum clinically important difference (MCID). Neither was there significant improvement in the VAS neck score in the OPLL group (3.6 to 3.1, p = 0.17). In the CSM group, ROM at C2-7 significantly decreased from 32.7° before surgery to 24.4° after surgery (p < 0.01). In the OPLL group, ROM at C2-7 significantly decreased from 34.4° to 20.8° (p < 0.01). In the CSM group, the change in the VAS neck score significantly correlated with the change in the flexion angle (r = - 0.31) and the extension angle (r = - 0.37); however, it did not correlate with the change in ROM at C2-7 (r = - 0.1). In the OPLL group, the change in the VAS neck score did not correlate with the change in the flexion angle (r = 0.03), the extension angle (r = - 0.17), or the ROM at C2-7 (r = - 0.28). The OPLL group had a significantly greater loss of ROM after surgery than did the CSM group (p = 0.04). There was no significant correlation between the change in ROM and the mJOA score in either group. Plated laminoplasty in patients with either OPLL or CSM decreases cervical ROM, especially in the extension angle. Among patients who have undergone laminoplasty, those with OPLL lose more ROM than do those with CSM. No correlation was observed between neck pain and ROM in either group. Neither group had a change in neck pain that reached the MCID following laminoplasty. Both groups improved in neurological function and outcomes.

Manual unloading of the lumbar spine: can it identify immediate responders to mechanical traction in a low back pain population? A study of reliability and criterion referenced predictive validity

PubMed Central

Swanson, Brian T.; Riley, Sean P.; Cote, Mark P.; Leger, Robin R.; Moss, Isaac L.; Carlos,, John

2016-01-01

Background To date, no research has examined the reliability or predictive validity of manual unloading tests of the lumbar spine to identify potential responders to lumbar mechanical traction. Purpose To determine: (1) the intra and inter-rater reliability of a manual unloading test of the lumbar spine and (2) the criterion referenced predictive validity for the manual unloading test. Methods Ten volunteers with low back pain (LBP) underwent a manual unloading test to establish reliability. In a separate procedure, 30 consecutive patients with LBP (age 50·86±11·51) were assessed for pain in their most provocative standing position (visual analog scale (VAS) 49·53±25·52 mm). Patients were assessed with a manual unloading test in their most provocative position followed by a single application of intermittent mechanical traction. Post traction, pain in the provocative position was reassessed and utilized as the outcome criterion. Results The test of unloading demonstrated substantial intra and inter-rater reliability K = 1·00, P = 0·002, K = 0·737, P = 0·001, respectively. There were statistically significant within group differences for pain response following traction for patients with a positive manual unloading test (P<0·001), while patients with a negative manual unloading test did not demonstrate a statistically significant change (P>0·05). There were significant between group differences for proportion of responders to traction based on manual unloading response (P = 0·031), and manual unloading response demonstrated a moderate to strong relationship with traction response Phi = 0·443, P = 0·015. Discussion and conclusion The manual unloading test appears to be a reliable test and has a moderate to strong correlation with pain relief that exceeds minimal clinically important difference (MCID) following traction supporting the validity of this test. PMID:27559274

Measuring communicative participation using the FOCUS©1: Focus on the Outcomes of Communication Under Six

PubMed Central

Thomas-Stonell, N; Washington, K; Oddson, B; Robertson, B; Rosenbaum, P

2013-01-01

Background The FOCUS© is a new outcome tool for use by both parents and clinicians that measures changes in the communicative participation skills of preschool children. Changes in communicative participation skills as measured by the FOCUS were compared across three groups of children: those with speech impairments only (SI), those with language impairments only (LI) and those with both speech and language impairments (S/LI). Methods Participating families (n = 112, 75 male children) were recruited through 13 Canadian organizations. Children ranged from 10 months to 6 years 0 months (mean = 2.11 years; SD = 1.18 years) and attended speech-language intervention. Parents completed the FOCUS at the start and end of treatment. There were 23 children in the SI group, 62 children in the LI group and 27 children in the S/LI group. The average amount of the children's therapy varied from 7 to 10 h. Results The FOCUS captures changes in communicative participation for children with a range of communication disorder types and severities. All three groups of children made clinically important improvements according to their FOCUS scores (MCID ≥ 16 points). The FOCUS captured improvements in intelligibility, independent communication, play and socialization. Conclusions The FOCUS measured positive changes in communicative participation skills for all three groups of children after 7–10 h of speech-language therapy. An outcome measure that targets only specific speech and language skills would miss many of the important social function changes associated with speech-language treatment. PMID:23763248

Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery.

PubMed

Dawson, Jill; Boller, Irene; Doll, Helen; Lavis, Grahame; Sharp, Robert; Cooke, Paul; Jenkinson, Crispin

2014-06-01

To ascertain the smallest amounts of change for the three Manchester-Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36). A prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery. Four hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ~13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC90) values for the MOXFQ were ~11, ~12, and ~16 score points for the W/S, Pain, and S-I scales, respectively. This article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Associations between community-based physiotherapy for musculoskeletal injury and health related quality of life (EQ-5D): a multi-centre retrospective analysis.

PubMed

Caplan, Nick; Robson, H; Robson, A; Barry, G; Wilkes, G

2017-10-25

Community-based musculoskeletal physiotherapy is used to improve function and health related quality of life (HRQoL). The purpose of this retrospective, multi-centre observational study was to determine the association between community-based physiotherapy management for musculoskeletal disorders and changes in HRQoL. Four thousand one hundred twelve patients' data were included in the study. Patients were included if they received a single period of treatment for a musculoskeletal injury or disorder. Patients were only included if they were being treated for a single morbidity. Patients received standard physiotherapy appropriate to their specific disorder, which could include health education/advice, exercise therapy, manual therapy, taping, soft tissue techniques, electrotherapy and/or acupuncture. Health related quality of life was assessed using the EQ-5D index. EQ-5D improved by 0.203 across all patients (d = 1.10). When grouped by anatomical site of symptom, the largest increases in EQ-5D was in foot pain (0.233; d = 1.29) and lumbar pain (0.231; d = 1.13). Improvements in EQ-5D greater than the minimum clinically important difference (MCID) were seen in 68.4% of all patients. The highest proportion of patients with positive responses to treatment were in ankle pain (74.2%) and thoracic pain (73.4%). The hand (40.5%), elbow (34.7%), and hip (33.9%) showed the greatest proportion of patients that did not respond to treatment. Community-based musculoskeletal physiotherapy is associated with improved health related quality of life. A randomised controlled trial is needed to determine any causal relationship between community-based physiotherapy and health related quality of life improvements.

Short- and long-term clinical outcomes following a standardized protocol of orthopedic manual physical therapy and exercise in individuals with osteoarthritis of the hip: a case series

PubMed Central

Hando, Ben R; Gill, Norman W; Walker, Michael J; Garber, Mathew

2012-01-01

Objectives: Describe short- and long-term outcomes observed in individuals with hip osteoarthritis (OA) treated with a pre-selected, standardized set of best-evidence manual therapy and therapeutic exercise interventions. Methods: Fifteen consecutive subjects (9 males, 6 females; mean age: 52±7.5 years) with unilateral hip OA received an identical protocol of manual therapy and therapeutic exercise interventions. Subjects attended 10 treatment sessions over an 8-week period for manual therapy interventions and performed the therapeutic exercise as a home program. Results: Baseline to 8-week follow-up outcomes were as follows: Harris Hip Scale (HHS) scores improved from 60.3(±10.4) to 80.7(±10.5), Numerical Pain Rating Scale (NPRS) scores improved from 4.3(±1.9) to 2.0(±1.9), hip flexion range of motion (ROM) improved from 99 degrees (±10.6) to 127 degrees (±6.3) and hip internal rotation ROM improved from 19 degrees (±9.1) to 31 degrees (±11.5). Improvements in HHS, NPRS, and hip ROM measures reached statistical significance (P<0.05) at 8-weeks and remained significant at the 29-week follow-up. Mean changes in NPRS and HHS scores exceeded the minimal clinically important difference (MCID) at 8-weeks and for the HHS scores alone at 29 weeks. The 8 and 29 week mean Global Rating of Change scores were 5.1(±1.4) and 2.1(±4.2), respectively. Improved outcomes observed following a pre-selected, standardized treatment protocol were similar to those observed in previous studies involving impairment-based manual therapy and therapeutic exercise for hip OA. Future studies might directly compare the two approaches. Discussion: PMID:24179327

Evaluation of health related quality of life in children with immune thrombocytopenia with the PedsQL™ 4.0 Generic Core Scales: a study on behalf of the pays de Loire pediatric hematology network.

PubMed

Strullu, Marion; Rakotonjanahary, Josué; Tarral, Eliane; Savagner, Christophe; Thomas, Caroline; Méchinaud, Françoise; Reguerre, Yves; Poignant, Sylvaine; Boutet, Arnaud; Bassil, Joachim; Médinger, Dominique; Quemener, Emmanuel; Young, Nancy L; Rachieru, Petronela; Klaassen, Robert J; Pellier, Isabelle

2013-11-13

Immune thrombocytopenia (ITP) is a childhood disorder that is often life-altering for children and their parents. Health related quality of life (HRQL) has never been chronologically monitored in children with ITP. We initiated a prospective study to assess HRQL from diagnosis to six months and define factors that influence this outcome in children with ITP. 73 children with acute ITP aged from 2 to 18 years were prospectively enrolled in the study. According to the presence of bleeding, they were or were not given a 4-day course of corticosteroid treatment. The PedsQL™ 4.0 Generic Core Scale was completed by children and parents upon their inclusion in the study and 6 months after diagnosis. Over the six month period, quality of life improved in terms of their global, physical and psychosocial well-being for 54.5%, 35.6% and 36.2% of patients respectively. This improvement is clinically relevant compared to scores at diagnosis, corresponding at least to a minimal clinically important difference (MCID). Factors such as sex, age, platelet count, bleeding scores, bone marrow aspiration and persistence of ITP at 6 months were not significantly associated with HRQL scores. However, preceding viral infection was identified to have an impact on HRQL. This first longitudinal study assessing HRQL in children with ITP reveals a global improvement in PedSQL™ 4.0. However, these results should be considered with caution since our data also confirm that self-report HRQL scores are not influenced by any analyzed biologic or clinical parameters. Others tools, such as Kids' ITP Tools, would probably be required to assess the HRQL of this population. Trial registration clinical trials.gov Identifier: NCT00331357.

Use of electromyography to optimize Lokomat® settings for subject-specific gait rehabilitation in post-stroke hemiparetic patients: A proof-of-concept study.

PubMed

Cherni, Yosra; Begon, Mickael; Chababe, Hicham; Moissenet, Florent

2017-09-01

While generic protocols exist for gait rehabilitation using robotic orthotics such as the Lokomat ® , several settings - guidance, body-weight support (BWS) and velocity - may be adjusted to individualize patient training. However, no systematic approach has yet emerged. Our objective was to assess the feasibility and effects of a systematic approach based on electromyography to determine subject-specific settings with application to the strengthening of the gluteus maximus muscle in post-stroke hemiparetic patients. Two male patients (61 and 65 years) with post-stroke hemiparesis performed up to 9 Lokomat ® trials by changing guidance and BWS while electromyography of the gluteus maximus was measured. For each subject, the settings that maximized gluteus maximus activity were used in 20 sessions of Lokomat ® training. Modified Functional Ambulation Classification (mFAC), 6-minutes walking test (6-MWT), and extensor strength were measured before and after training. The greatest gluteus maximus activity was observed at (Guidance: 70% -BWS: 20%) for Patient 1 and (Guidance: 80% - BWS: 30%) for Patient 2. In both patients, mFAC score increased from 4 to 7. The additional distance in 6-MWT increased beyond minimal clinically important difference (MCID=34.4m) reported for post-stroke patients. The isometric strength of hip extensors increased by 43 and 114%. Defining subject-specific settings for a Lokomat ® training was feasible and simple to implement. These two case reports suggest a benefit of this approach for muscle strengthening. It remains to demonstrate the superiority of such an approach for a wider population, compared to the use of a generic protocol. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Short- and long-term clinical outcomes following a standardized protocol of orthopedic manual physical therapy and exercise in individuals with osteoarthritis of the hip: a case series.

PubMed

Hando, Ben R; Gill, Norman W; Walker, Michael J; Garber, Mathew

2012-11-01

Describe short- and long-term outcomes observed in individuals with hip osteoarthritis (OA) treated with a pre-selected, standardized set of best-evidence manual therapy and therapeutic exercise interventions. Fifteen consecutive subjects (9 males, 6 females; mean age: 52±7.5 years) with unilateral hip OA received an identical protocol of manual therapy and therapeutic exercise interventions. Subjects attended 10 treatment sessions over an 8-week period for manual therapy interventions and performed the therapeutic exercise as a home program. Baseline to 8-week follow-up outcomes were as follows: Harris Hip Scale (HHS) scores improved from 60.3(±10.4) to 80.7(±10.5), Numerical Pain Rating Scale (NPRS) scores improved from 4.3(±1.9) to 2.0(±1.9), hip flexion range of motion (ROM) improved from 99 degrees (±10.6) to 127 degrees (±6.3) and hip internal rotation ROM improved from 19 degrees (±9.1) to 31 degrees (±11.5). Improvements in HHS, NPRS, and hip ROM measures reached statistical significance (P<0.05) at 8-weeks and remained significant at the 29-week follow-up. Mean changes in NPRS and HHS scores exceeded the minimal clinically important difference (MCID) at 8-weeks and for the HHS scores alone at 29 weeks. The 8 and 29 week mean Global Rating of Change scores were 5.1(±1.4) and 2.1(±4.2), respectively. Improved outcomes observed following a pre-selected, standardized treatment protocol were similar to those observed in previous studies involving impairment-based manual therapy and therapeutic exercise for hip OA. Future studies might directly compare the two approaches.

A comparison of clinical- and patient-reported outcomes of the cemented ATTUNE and PFC sigma fixed bearing cruciate sacrificing knee systems in patients who underwent total knee replacement with both prostheses in opposite knees.

PubMed

Carey, Brian W; Harty, James

2018-03-15

The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion. A review was carried out on 21 patients who underwent primary total knee replacement with both the ATTUNE and PFC knee systems. These were staged operations performed in the same institution and by the same surgeon. All cases were followed up for a minimum of 6 months. WOMAC, Oxford Knee and SF-12 scores, as well as knee range of motion were recorded preoperatively and at 6 months postoperatively. There was a significant difference in pre- to 6-month post-operative outcomes in PFC and ATTUNE groups with regard to improvement in range of motion (10° ± 8 and 13° ± 11, respectively). There was also a significant improvement in WOMAC scores (PFC group) and Oxford Knee Scores (ATTUNE group) (8.9 ± 7.7 and 12.1 ± 8.4, respectively). There was a significant improvement in SF-12 Score in both groups (10.1 ± 9.3 for PFC and 15.8 ± 13.3 for ATTUNE). The minimum clinically important difference (MCID) in scoring systems at 6 months was reached by 6 patients in the PFC group and 12 in the ATTUNE group. A significant difference was demonstrated in clinical outcome at 6 months postoperatively between PFC and ATTUNE knee systems in patients who underwent total knee arthroplasty with both prostheses. Superior results were recorded for the ATTUNE knee system.

Impact of Response Shift on Time to Deterioration in Quality of Life Scores in Breast Cancer Patients

PubMed Central

Hamidou, Zeinab; Dabakuyo-Yonli, Tienhan S.; Guillemin, Francis; Conroy, Thierry; Velten, Michel; Jolly, Damien; Causeret, Sylvain; Graesslin, Olivier; Gauthier, Mélanie; Mercier, Mariette; Bonnetain, Franck.

2014-01-01

Background This prospective multicenter study aimed to study the impact of the recalibration component of response-shift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD. Methods The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD. Results From February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, social-functioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38–0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD. Conclusions Our results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients. PMID:24828426

Health related quality of life assessment in acute coronary syndrome patients: the effectiveness of early phase I cardiac rehabilitation.

PubMed

Anchah, Lawrence; Hassali, Mohamed Azmi; Lim, Melissa Siaw Han; Ibrahim, Mohamed Izham Mohamed; Sim, Kui Hian; Ong, Tiong Kiam

2017-01-13

Acute Coronary Syndrome (ACS) is one of the most burdensome cardiovascular diseases in terms of the cost of interventions. The Cardiac Rehabilitation Programme (CRP) is well-established in improving clinical outcomes but the assessment of actual clinical improvement is challenging, especially when considering pharmaceutical care (PC) values in phase I CRP during admission and upon discharge from hospital and phase II outpatient interventions. This study explores the impact of pharmacists' interventions in the early stages of CRP on humanistic outcomes and follow-up at a referral hospital in Malaysia. We recruited 112 patients who were newly diagnosed with ACS and treated at the referral hospital, Sarawak General Hospital, Malaysia. In the intervention group (modified CRP), all medication was reviewed by the clinical pharmacists, focusing on drug indication; understanding of secondary prevention therapy and adherence to treatment strategy. We compared the "pre-post" quality of life (QoL) of three groups (intervention, conventional and control) at baseline, 6 months and 12 months post-discharge with Malaysian norms. QoL data was obtained using a validated version of Short-Form 36 Questionnaire (SF-36). Analysis of variance (ANOVA) with repeated measure tests was used to compare the mean differences of scores over time. A pre-post quasi-experimental non-equivalent group comparison design was applied to 112 patients who were followed up for one year. At baseline, the physical and mental health summaries reported poor outcomes in all three groups. However, these improved gradually but significantly over time. After the 6-month follow-up, the physical component summary reported in the modified CRP (MCRP) participants was higher, with a mean difference of 8.02 (p = 0.015) but worse in the mental component summary, with a mean difference of -4.13. At the 12-month follow-up, the MCRP participants performed better in their physical component (PCS) than those in the CCRP and control groups, with a mean difference of 11.46 (p = 0.008), 10.96 (p = 0.002) and 6.41 (p = 0.006) respectively. Comparing the changes over time for minimal important differences (MICD), the MCRP group showed better social functioning than the CCRP and control groups with mean differences of 20.53 (p = 0.03), 14.47 and 8.8, respectively. In role emotional subscales all three groups showed significant improvement in MCID with mean differences of 30.96 (p = 0.048), 31.58 (p = 0.022) and 37.04 (p < 0.001) respectively. Our results showed that pharmaceutical care intervention significantly improved HRQoL. The study also highlights the importance of early rehabilitation in the hospital setting. The MCRP group consistently showed better QoL, was more highly motivated and benefitted most from the CRP. Medical Research and Ethics Committee (MREC) Ministry of Health Malaysia, November 2007, NMRR-08-246-1401.

The clinimetric qualities of patient-assessed instruments for measuring chronic ankle instability: a systematic review.

PubMed

Eechaute, Christophe; Vaes, Peter; Van Aerschot, Lieve; Asman, Sara; Duquet, William

2007-01-18

The assessment of outcomes from the patient's perspective becomes more recognized in health care. Also in patients with chronic ankle instability, the degree of present impairments, disabilities and participation problems should be documented from the perspective of the patient. The decision about which patient-assessed instrument is most appropriate for clinical practice should be based upon systematic reviews. Only rating scales constructed for patients with acute ligament injuries were systematically reviewed in the past. The aim of this study was to review systematically the clinimetric qualities of patient-assessed instruments designed for patients with chronic ankle instability. A computerized literature search of Medline, Embase, Cinahl, Web of Science, Sport Discus and the Cochrane Controlled Trial Register was performed to identify eligible instruments. Two reviewers independently evaluated the clinimetric qualities of the selected instruments using a criteria list. The inter-observer reliability of both the selection procedure and the clinimetric evaluation was calculated using modified kappa coefficients. The inter-observer reliability of the selection procedure was excellent (k = .86). Four instruments met the eligibility criteria: the Ankle Joint Functional Assessment Tool (AJFAT), the Functional Ankle Outcome Score (FAOS), the Foot and Ankle Disability Index (FADI) and the Functional Ankle Ability Measure (FAAM). The inter-observer reliability of the quality assessment was substantial to excellent (k between .64 and .88). Test-retest reliability was demonstrated for the FAOS, the FADI and the FAAM but not for the AJFAT. The FAOS and the FAAM met the criteria for content validity and construct validity. For none of the studied instruments, the internal consistency was sufficiently demonstrated. The presence of floor- and ceiling effects was assessed for the FAOS but ceiling effects were present for all subscales. Responsiveness was demonstrated for the AJFAT, FADI and the FAAM. Only for the FAAM, a minimal clinical important difference (MCID) was presented. The FADI and the FAAM can be considered as the most appropriate, patient-assessed tools to quantify functional disabilities in patients with chronic ankle instability. The clinimetric qualities of the FAAM need to be further demonstrated in a specific population of patients with chronic ankle instability.

Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma.

PubMed

Hoskins, Gaylor; Williams, Brian; Abhyankar, Purva; Donnan, Peter; Duncan, Edward; Pinnock, Hilary; van der Pol, Marjon; Rauchhaus, Petra; Taylor, Anne; Sheikh, Aziz

2016-12-08

Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review. The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data. Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76-6.65) versus UC 6.1: SD 0.81 (CI 5.63-6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17. Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma. The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial. ISRCTN18912042 . Registered on 26 June 2012.

Molecular computational elements encode large populations of small objects

NASA Astrophysics Data System (ADS)

Prasanna de Silva, A.; James, Mark R.; McKinney, Bernadine O. F.; Pears, David A.; Weir, Sheenagh M.

2006-10-01

Since the introduction of molecular computation, experimental molecular computational elements have grown to encompass small-scale integration, arithmetic and games, among others. However, the need for a practical application has been pressing. Here we present molecular computational identification (MCID), a demonstration that molecular logic and computation can be applied to a widely relevant issue. Examples of populations that need encoding in the microscopic world are cells in diagnostics or beads in combinatorial chemistry (tags). Taking advantage of the small size (about 1nm) and large `on/off' output ratios of molecular logic gates and using the great variety of logic types, input chemical combinations, switching thresholds and even gate arrays in addition to colours, we produce unique identifiers for members of populations of small polymer beads (about 100μm) used for synthesis of combinatorial libraries. Many millions of distinguishable tags become available. This method should be extensible to far smaller objects, with the only requirement being a `wash and watch' protocol. Our focus on converting molecular science into technology concerning analog sensors, turns to digital logic devices in the present work.

Molecular computational elements encode large populations of small objects.

PubMed

de Silva, A Prasanna; James, Mark R; McKinney, Bernadine O F; Pears, David A; Weir, Sheenagh M

2006-10-01

Since the introduction of molecular computation, experimental molecular computational elements have grown to encompass small-scale integration, arithmetic and games, among others. However, the need for a practical application has been pressing. Here we present molecular computational identification (MCID), a demonstration that molecular logic and computation can be applied to a widely relevant issue. Examples of populations that need encoding in the microscopic world are cells in diagnostics or beads in combinatorial chemistry (tags). Taking advantage of the small size (about 1 nm) and large 'on/off' output ratios of molecular logic gates and using the great variety of logic types, input chemical combinations, switching thresholds and even gate arrays in addition to colours, we produce unique identifiers for members of populations of small polymer beads (about 100 microm) used for synthesis of combinatorial libraries. Many millions of distinguishable tags become available. This method should be extensible to far smaller objects, with the only requirement being a 'wash and watch' protocol. Our focus on converting molecular science into technology concerning analog sensors, turns to digital logic devices in the present work.

Application of the OMERACT filter to measures of core outcome domains in recent clinical studies of acute gout

PubMed Central

Taylor, William J; Redden, David; Dalbeth, Nicola; Schumacher, H Ralph; Edwards, N Lawrence; Simon, Lee S; John, Markus R; Essex, Margaret N; Watson, Douglas J; Evans, Robert; Rome, Keith; Singh, Jasvinder A

2014-01-01

Objective To determine the extent to which instruments that measure core outcome domains in acute gout fulfil the OMERACT filter requirements of truth, discrimination and feasibility. Methods Patient-level data from four randomised controlled trials of agents designed to treat acute gout and one observational study of acute gout were analysed. For each available measure construct validity, test-retest reliability, within-group change using effect size, between-group change using the Kruskall-Wallis statistic and repeated measures generalised estimating equations were assessed. Floor and ceiling effects were also assessed and MCID was estimated. These analyses were presented to participants at OMERACT 11 to help inform voting for possible endorsement. Results There was evidence for construct validity and discriminative ability for 3 measures of pain (0 to 4 Likert, 0 to 10 numeric rating scale, 0 to 100 mm visual analogue scale). Likewise, there appears to be sufficient evidence for a 4-point Likert scale to possess construct validity and discriminative ability for physician assessment of joint swelling and joint tenderness. There was some evidence for construct validity and within-group discriminative ability for the Health Assessment Questionnaire as a measure of activity limitations, but not for discrimination between groups allocated to different treatment. Conclusions There is sufficient evidence to support measures of pain (using Likert, numeric rating scale or visual analogue scales), joint tenderness and swelling (using Likert scale) as fulfilling the requirements of the OMERACT filter. Further research on a measure of activity limitations in acute gout clinical trials is required. PMID:24429178

Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression.

PubMed

Warth, Ryan J; Dornan, Grant J; James, Evan W; Horan, Marilee P; Millett, Peter J

2015-02-01

The purpose of this study was to perform a systematic review, meta-analysis, and meta-regression of all Level I and Level II studies comparing the clinical or structural outcomes, or both, after rotator cuff repair with and without platelet-rich product (PRP) supplementation. A literature search of the PubMed and EMBASE databases was performed to identify all Level I or II studies comparing the clinical or structural outcomes, or both, after arthroscopic repair of full-thickness rotator cuff tears with (PRP+ group) and without (PRP- group) PRP supplementation. Data included outcome scores (American Shoulder and Elbow Surgeons [ASES], University of California Los Angeles [UCLA], Constant, Simple Shoulder Test [SST] and visual analog scale [VAS] scores) and retears diagnosed with imaging studies. Meta-analyses compared preoperative, postoperative, and gain in outcome scores and relative risk ratios for retears. Meta-regression compared the effect of PRP treatment on outcome scores and retear rates according to 6 covariates. Minimum effect sizes that were detectable with 80% power were also calculated for each study. Eleven studies were included in this review and a maximum of 8 studies were used for meta-analyses according to data availability. There were no statistically significant differences between the PRP+ and PRP- groups for overall outcome scores or retear rates (P > .05). Overall gain in the Constant score was decreased when liquid PRP was injected over the tendon surface compared with PRP application at the tendon-bone interface (-6.88 points v +0.78 points, respectively; P = .046); however, this difference did not reach the previously reported minimum clinically important difference (MCID) for Constant scores. When the initial tear size was greater than 3 cm in anterior-posterior length, the PRP+ group exhibited decreased retear rates after double-row repairs when compared with the PRP- group (25.9% v 57.1%, respectively; P = .046). Sensitivity power analyses revealed that most included studies were only powered to detect large differences in outcome scores between groups. There were no statistically significant differences in overall gain in outcome scores or retear rates between treatment groups. Gain in Constant scores was significantly increased when PRPs were applied at the tendon-bone interface when compared with application over the top of the repaired tendon. Retear rates were significantly decreased when PRPs were used for the treatment of tears greater than 3 cm in anterior-posterior length using a double-row technique. Most of the included studies were only powered to detect large differences in outcome scores between treatment groups. In addition, an increased risk for selection, performance, and attrition biases was found. Level II, meta-analysis of Level I and Level II studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Use of the FLUKA Monte Carlo code for 3D patient-specific dosimetry on PET-CT and SPECT-CT images*

PubMed Central

Botta, F; Mairani, A; Hobbs, R F; Vergara Gil, A; Pacilio, M; Parodi, K; Cremonesi, M; Coca Pérez, M A; Di Dia, A; Ferrari, M; Guerriero, F; Battistoni, G; Pedroli, G; Paganelli, G; Torres Aroche, L A; Sgouros, G

2014-01-01

Patient-specific absorbed dose calculation for nuclear medicine therapy is a topic of increasing interest. 3D dosimetry at the voxel level is one of the major improvements for the development of more accurate calculation techniques, as compared to the standard dosimetry at the organ level. This study aims to use the FLUKA Monte Carlo code to perform patient-specific 3D dosimetry through direct Monte Carlo simulation on PET-CT and SPECT-CT images. To this aim, dedicated routines were developed in the FLUKA environment. Two sets of simulations were performed on model and phantom images. Firstly, the correct handling of PET and SPECT images was tested under the assumption of homogeneous water medium by comparing FLUKA results with those obtained with the voxel kernel convolution method and with other Monte Carlo-based tools developed to the same purpose (the EGS-based 3D-RD software and the MCNP5-based MCID). Afterwards, the correct integration of the PET/SPECT and CT information was tested, performing direct simulations on PET/CT images for both homogeneous (water) and non-homogeneous (water with air, lung and bone inserts) phantoms. Comparison was performed with the other Monte Carlo tools performing direct simulation as well. The absorbed dose maps were compared at the voxel level. In the case of homogeneous water, by simulating 108 primary particles a 2% average difference with respect to the kernel convolution method was achieved; such difference was lower than the statistical uncertainty affecting the FLUKA results. The agreement with the other tools was within 3–4%, partially ascribable to the differences among the simulation algorithms. Including the CT-based density map, the average difference was always within 4% irrespective of the medium (water, air, bone), except for a maximum 6% value when comparing FLUKA and 3D-RD in air. The results confirmed that the routines were properly developed, opening the way for the use of FLUKA for patient-specific, image-based dosimetry in nuclear medicine. PMID:24200697

Reliability and validity of functional health status and health-related quality of life questionnaires in children with recurrent acute otitis media

PubMed Central

Brouwer, Carole N. M.; Schilder, Anne G. M.; van Stel, Henk F.; Rovers, Maroeska M.; Veenhoven, Reinier H.; Grobbee, Diederick E.; Sanders, Elisabeth A. M.

2007-01-01

In this study the reliability and validity of generic and disease-specific questionnaires has been assessed focusing on responsiveness. This is part of a study on the effects of recurrent acute otitis media (rAOM) on functional health status (FHS) and health-related quality of life (HRQoL) in 383 children with rAOM participating in a randomized clinical trial. The following generic questionnaires were studied: 1. RAND general health rating index, 2. Functional Status Questionnaire (FSQ Generic and FSQ Specific), 3. TNO-AZL Infant Quality of Life (TAIQOL), and the following disease-specific questionnaires: 1. Otitis Media-6 (OM-6), 2. Numerical rating scales (NRS) for child and caregiver (NRS Child and NRS Caregiver), and 3. a new Family Functioning Questionnaire (FFQ). Reliability was good to excellent (Cronbach’s α range 0.80–0.90, intraclass correlation coefficient range 0.76–0.93). Moderate to strong correlations were found between the questionnaires as well as between questionnaires and relevant clinical indicators (r = 0.29–0.49), demonstrating construct validity. Discriminant validity for children with few versus frequent episodes of acute otitis media per year was good for most questionnaires (P < 0.004) but poor for the otitis media-related subscales of the TAIQOL (P = 0.10–0.97) and both NRS (P = 0.22 and 0.48). Except for the TAIQOL subscales, change scores were significant (P < 0.003) for generic and disease-specific questionnaires. Effect sizes were somewhat higher for disease-specific compared to generic questionnaires (0.55–0.95 versus 0.32–0.60) except for the TAIQOL subscales, which showed very poor sensitivity to change. Anchor-based methods resulted in a somewhat larger range of estimates of MCID than distribution-based methods. Combining distribution-based and anchor-based methods resulted in similar ranges for the minimally clinical important differences for generic and disease-specific questionnaires: 2–15 points on a 0–100 scale. Apart from the generic TAIQOL subscales, both generic and disease-specific questionnaires used in this study showed good psychometric qualities and responsiveness for use in clinical studies on children with rAOM. PMID:17668290

The ECOS-16 questionnaire for the evaluation of health related quality of life in post-menopausal women with osteoporosis

PubMed Central

Badia, Xavier; Díez-Pérez, Adolfo; Lahoz, Raquel; Lizán, Luis; Nogués, Xavier; Iborra, Jordi

2004-01-01

Background The aim of this study is to validate the questionnaire ECOS-16 (Assessment of health related quality of life in osteoporosis) for the evaluation of health related quality of life (HRQoL) in post-menopausal women with osteoporosis. Methods An observational, prospective and multi-centre study was carried out among post-menopausal women with osteoporosis in primary care centres and hospital outpatient clinics. All patients attended 2 visits: at baseline and at 6 months. In addition, the subgroup of outpatients attended another visit a month after the baseline to assess the test-retest reliability. The psychometric properties of the questionnaire were evaluated in terms of feasibility, validity (content validity and construct validity) and internal consistency in baseline, and in terms of test-retest reliability and responsiveness to change in visit at month and visit at 6 months, respectively. In all visits, ECOS-16, EUROQoL-5D (EQ-5D) and four 7-point items about health status (general health status, back pain, limitation in daily activities and emotional status) were administered, whereas only outpatients were given MINI-OQLQ (Mini Osteoporosis Quality of Life Questionnaire), besides all clinical variables; and sociodemographic variables at baseline. Results 316 women were consecutively included, 212 from primary care centres and 104 from hospital outpatient clinics. Feasibility: 94.3% of patients answered all items of the questionnaire. The mean administration time was 12.3 minutes. Validity: factor analysis suggested that the questionnaire was unidimensional. In the multivariate analysis, patients with vertebral fractures, co-morbidity and a lower education level showed to have worse HRQoL. Moderate to high correlations were found between the ECOS-16 score and the other health status questionnaires (0.47–0.82). Reliability: internal consistency (Cronbach's α) was 0.92 and test-retest reliability (ICC) was 0.80. Responsiveness to change: ECOS-16 scores increased according to change perceived by the patient, as well as the effect size (ranges between 1.35 to 0.43), the greater the perception of change in patients' general health status, the greater the changes in patients' scores. The Minimal Clinically Important Difference (MCID) suggested a change of 0.5 points in the ECOS-16 score, representing the least improvement in general health status due to their osteoporosis: "slightly better". Conclusion ECOS-16 has been proven preliminarily to have good psychometric properties, so that it can be potentially a useful tool to evaluate HRQoL of post-menopausal women with osteoporosis in research and routine clinical practice. PMID:15291959

Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial.

PubMed

Winstein, Carolee J; Wolf, Steven L; Dromerick, Alexander W; Lane, Christianne J; Nelsen, Monica A; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P

2016-02-09

Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC: 0.14; 95% CI, -0.05 to 0.33; P = .16; ASAP vs UCC: -0.01; 95% CI, -0.22 to 0.21; P = .94; and DEUCC vs UCC: -0.14; 95% CI, -0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, -8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, -8.1 seconds, and SIS, 72%; and UCC group, WMFT, -7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, -0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, -12% to 13%; P = .54; ASAP vs UCC: WMFT, -0.6 seconds, 95% CI, -3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, -9% to 16%; P = .48; and DEUCC vs UCC: WMFT, -2.1 seconds; 95% CI, -4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, -9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. clinicaltrials.gov Identifier: NCT00871715.

Does partial coating with titanium improve the radiographic fusion rate of empty PEEK cages in cervical spine surgery? A comparative analysis of clinical data.

PubMed

Kotsias, Andreas; Mularski, Sven; Kühn, Björn; Hanna, Michael; Suess, Olaf

2017-01-01

Anterior cervical diskectomy and fusion (ACDF) is a well-established surgical treatment. Several types of intervertebral spacers can be used, but there is increasing evidence that PEEK cages yield insufficient fusion and thus less clinical improvement. The study aim was to assess the outcomes of single-level ACDF with an empty PEEK cage partially coated with titanium. This prospective multicenter single-arm clinical study collected follow-up data at 6, 12, and 18 months. A post hoc comparison was made to closely matched patients from another similar trial treated with identically designed, empty, uncoated PEEK cages. There were 49 of 50 patients (98%) who met the MCID of 3+ points of improvement on VAS pain or had an 18-month VAS ≤ 1. Yet even by 18 months post-op, only 40 of 50 (80%) PEEK + Ti patients achieved complete bony fusion. The PEEK + Ti group ( n  = 49) seemed to have somewhat better fusion scores and significantly better pain relief at 6 M than the matched controls ( n  = 49), but these differences did not persist at 12 M or 18 M. Patients (with either implant) who achieved complete bony fusion had significantly better improvement of pain at 6 M and disability at 6 M and 12 M than patients that remained unfused. ACDF is effective treatment for cervical myelopathy and radiculopathy. Although this and other studies show that titanium fuses better, partial coating of a PEEK cage does not improve the fusion rate sufficiently or confer other lasting clinical benefit. PEEK cages fully coated with titanium should be tested in prospective randomized comparative trials. Prospective, multicenter, single-arm clinical observational study without an individual Trial registration number. Study design and post hoc data analysis according to the "PIERCE-PEEK study", ISRCTN42774128, retrospectively registered 14 April 2009.

Effect of Prolonged Exposure Therapy Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD Symptom Severity in Military Personnel: A Randomized Clinical Trial.

PubMed

Foa, Edna B; McLean, Carmen P; Zang, Yinyin; Rosenfield, David; Yadin, Elna; Yarvis, Jeffrey S; Mintz, Jim; Young-McCaughan, Stacey; Borah, Elisa V; Dondanville, Katherine A; Fina, Brooke A; Hall-Clark, Brittany N; Lichner, Tracey; Litz, Brett T; Roache, John; Wright, Edward C; Peterson, Alan L

2018-01-23

Effective and efficient treatment is needed for posttraumatic stress disorder (PTSD) in active duty military personnel. To examine the effects of massed prolonged exposure therapy (massed therapy), spaced prolonged exposure therapy (spaced therapy), present-centered therapy (PCT), and a minimal-contact control (MCC) on PTSD severity. Randomized clinical trial conducted at Fort Hood, Texas, from January 2011 through July 2016 and enrolling 370 military personnel with PTSD who had returned from Iraq, Afghanistan, or both. Final follow-up was July 11, 2016. Prolonged exposure therapy, cognitive behavioral therapy involving exposure to trauma memories/reminders, administered as massed therapy (n = 110; 10 sessions over 2 weeks) or spaced therapy (n = 109; 10 sessions over 8 weeks); PCT, a non-trauma-focused therapy involving identifying/discussing daily stressors (n = 107; 10 sessions over 8 weeks); or MCC, telephone calls from therapists (n = 40; once weekly for 4 weeks). Outcomes were assessed before and after treatment and at 2-week, 12-week, and 6-month follow-up. Primary outcome was interviewer-assessed PTSD symptom severity, measured by the PTSD Symptom Scale-Interview (PSS-I; range, 0-51; higher scores indicate greater PTSD severity; MCID, 3.18), used to assess efficacy of massed therapy at 2 weeks posttreatment vs MCC at week 4; noninferiority of massed therapy vs spaced therapy at 2 weeks and 12 weeks posttreatment (noninferiority margin, 50% [2.3 points on PSS-I, with 1-sided α = .05]); and efficacy of spaced therapy vs PCT at posttreatment. Among 370 randomized participants, data were analyzed for 366 (mean age, 32.7 [SD, 7.3] years; 44 women [12.0%]; mean baseline PSS-I score, 25.49 [6.36]), and 216 (59.0%) completed the study. At 2 weeks posttreatment, mean PSS-I score was 17.62 (mean decrease from baseline, 7.13) for massed therapy and 21.41 (mean decrease, 3.43) for MCC (difference in decrease, 3.70 [95% CI,0.72 to 6.68]; P = .02). At 2 weeks posttreatment, mean PSS-I score was 18.03 for spaced therapy (decrease, 7.29; difference in means vs massed therapy, 0.79 [1-sided 95% CI, -∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment was 18.88 for massed therapy (decrease, 6.32) and 18.34 for spaced therapy (decrease, 6.97; difference, 0.55 [1-sided 95% CI, -∞ to 2.05; P = .03 for noninferiority]). At posttreatment, PSS-I scores for PCT were 18.65 (decrease, 7.31; difference in decrease vs spaced therapy, 0.10 [95% CI, -2.48 to 2.27]; P = .93). Among active duty military personnel with PTSD, massed therapy (10 sessions over 2 weeks) reduced PTSD symptom severity more than MCC at 2-week follow-up and was noninferior to spaced therapy (10 sessions over 8 weeks), and there was no significant difference between spaced therapy and PCT. The reductions in PTSD symptom severity with all treatments were relatively modest, suggesting that further research is needed to determine the clinical importance of these findings. clinicaltrials.gov Identifier: NCT01049516.

Increasing Access to Mental Health Care With Breathe, an Internet-Based Program for Anxious Adolescents: Study Protocol for a Pilot Randomized Controlled Trial

PubMed Central

Wozney, Lori; Bagnell, Alexa; Fitzpatrick, Eleanor; Curtis, Sarah; Jabbour, Mona; Johnson, David; Rosychuk, Rhonda J; Young, Michael; Ohinmaa, Arto; Joyce, Anthony; McGrath, Patrick

2016-01-01

Background There is a demand to make first-line treatments, including cognitive behavioural therapy (CBT) for adolescent anxiety disorders, more widely available. Internet-based CBT is proposed to circumvent access and availability barriers and reduce health care system costs. Recent reviews suggest more evidence is needed to establish the treatment effects of Internet-based CBT in children and adolescents and to determine related economic impacts. Objective This pilot trial aims to collect the necessary data to inform the planning of a full-scale RCT to test the effectiveness of the Internet-based CBT program Breathe (Being Real, Easing Anxiety: Tools Helping Electronically). Methods We are conducting a 27-month, 2-arm parallel-group, pilot randomized controlled trial (RCT). Outcomes will inform the planning of a full-scale RCT aimed to test the effectiveness of Internet-based CBT with a population of adolescents with moderate to mild anxiety problems. In the pilot RCT we will: (1) define a minimal clinically important difference (MCID) for the primary outcome measure (total anxiety score using the Multidimensional Anxiety Scale for Children); (2) determine a sample size for the full-scale RCT; (3) estimate recruitment and retention rates; (4) measure intervention acceptability to inform critical intervention changes; (5) determine the use of co-interventions; and (6) conduct a cost-consequence analysis to inform a cost-effectiveness analysis in the full-scale RCT. Adolescents aged 13-17 years seeking care for an anxiety complaint from a participating emergency department, mobile or school-based crisis team, or primary care clinic are being screened for interest and eligibility. Enrolled adolescents are being randomly allocated to either 8 weeks of Internet-based CBT with limited telephone and e-mail support, or a control group with access to a static webpage listing anxiety resources. Adolescents are randomly assigned using a computer generated allocation sequence. Data are being collected at baseline, treatment completion, and at a 3-month follow-up. Results Currently, adolescents are being enrolled in the study. Enrolment is taking place between March 2014 and February 2016; data collection will conclude May 2016. We expect that analysis and results will be available by August 2016. Conclusions In many communities, the resources available for front-line anxiety treatment are outweighed by the need for care. This pilot RCT is an essential step to designing a robust RCT to evaluate the effectiveness of an Internet-based CBT program for adolescents with moderate to mild anxiety problems. Trial Registration Clinicaltrials.gov NCT02059226; http://clinicaltrials.gov/ct2/show/NCT02059226 (Archived by WebCite at http://www.webcitation.org/6epF8v7k4) PMID:26825111

Look--but also listen! ReQuest: an essay on a new validated scale to assess the outcome of GERD treatment.

PubMed

Bardhan, Karna D; Berghöfer, Peter

2007-01-01

The ReQuest (Reflux Questionnaire) is a new instrument: a diary developed specifically to allow patients to measure the totality of their gastroesophageal reflux disease (GERD) symptoms and to track changes each day during treatment, an increasingly important need in clinical trials. This paper reviews the background, development, testing, and validation of the instrument and shows how its flexibility allows it to be used in new ways to assess different aspects of GERD. There were four key steps. (1) A full symptom spectrum was gathered from experts, literature and, crucially, from GERD patients, and comprised 67 symptom descriptions. (2) By expert consensus, these symptom descriptions were empirically condensed into six easier-to-handle 'dimensions' (acid complaints, upper abdominal/stomach complaints, lower abdominal/digestive complaints, nausea, sleep disturbances, other complaints), to which the seventh, general well-being, was added, a key feature of the instrument. The symptom burden of each dimension is measured as frequency x intensity (general well-being: intensity only). (3) This prototype instrument was tested in PPI clinical trials involving patients with erosive and non-erosive GERD, while the data generated were used to validate the prototype. (4) Finally, the scale was refined by factor analysis, a statistical process. Detailed statistical testing validating the scale and factor analysis confirmed that empirically condensing the symptom descriptions into dimensions did not affect the measurement properties of the instrument. FURTHER APPLICATION: The structure of ReQuest and its product, which is numerical, makes the instrument highly flexible and allows for its use in other GERD areas. (1) Its subscales, ReQuest-GI and ReQuest-WSO, measure symptoms traditionally associated with reflux and with general well-being, respectively, and permit these to be quantified and tracked independently. (2) Minor degrees of reflux symptoms are common amongst the healthy. The level was determined in a large population without evidence of disease, and a 'GERD symptom threshold' calculated. Reduction below this threshold to 'background levels' is a more realistic end point in clinical trials than the rarely achieved 'complete absence'. (3) ReQuest-GI was re-scaled and integrated with the modified Los Angeles scale used to grade esophageal appearances at endoscopy. The new instrument is a matrix, the ReQuest/LA-classification, which allows both symptoms and endoscopy appearances to be expressed by a single set of numbers in individual patients and in populations. (4) This in turn allows identification of patients who on treatment achieve 'complete remission', i.e. healing and symptom relief. PPI clinical trials confirm that it takes a longer period of treatment to reach this endpoint than healing or symptom relief alone. Thus the conventional 4-8 weeks of PPI therapy may unwittingly result in under-treatment. (5) Studies are in progress to determine the 'minimum clinically important difference' (MCID). This is the minimum change measured on treatment, which is judged as being of clinical benefit, an increasingly important subject. (6) Finally, the ReQuest used in clinical trials has been simplified for application in day-to-day clinical practice. The results obtained with 'ReQuest in Practice', the simplified version, are similar to those observed with the full version, as confirmed in a large-scale study in general practice. The clinical practice version has also been validated. (1) The characteristics of ReQuest make it suitable for use as the primary endpoint in clinical trials assessing the outcome of GERD. (2) The subscales allows for closer examination on the nature of GERD and response to treatment. (3) A simplified version has proven suitable for use in daily practice. Copyright 2007 S. Karger AG, Basel.

[Validation of a Spanish version of the Childhood Asthma Control Test (Sc-ACT) for use in Spain].

PubMed

Pérez-Yarza, E G; Castro-Rodriguez, J A; Villa Asensi, J R; Garde Garde, J; Hidalgo Bermejo, F J

2015-08-01

The Childhood Asthma Control Test (c-ACT) is a validated tool for determining pediatric asthma control. However, it is not validated in the Spanish language in Spain. We evaluated the psychometric properties of the Spanish version of the Childhood Asthma Control Test (Sc-ACT) for assessing asthma control in children ages 4 to11. This national, multicentre, prospective study was conducted in Spain with asthmatic children and their caregivers. Patients were assessed at 3 visits (Baseline, 2 Weeks, and 4 Months). Clinical variables included: symptoms, exacerbations, FEV1, asthma classification, PAQLQ and PACQLQ questionnaire scores, and asthma control as perceived by physicians, patients and caregivers. The Sc-ACT feasibility, validity, reliability, and sensitivity to change were assessed. A total of 394 children were included; mean (SD) time to complete the Sc-ACT was 5.3 (4.4) minutes. Sc-ACT score was correlated with asthma control as perceived by physician (-0.52), patient (-0.53), and caregiver (-0.51) and with the PAQLQ (0.56) and PACQLQ (0.55) scores. Sc-ACT was found to be significantly related to intensity and frequency of asthma symptoms. Cronbach alpha coefficient α was 0.81 and intraclass correlation coefficient was ≥0.85 for all of the items. The global effect size of Sc-ACT was 0.55. The cutoff point scores of 21 or higher indicated a good asthma control and their MCID was 4 points. The Spanish version of the c-ACT was found to be a reliable and valid questionnaire for evaluating asthma control in Spanish-speaking children ages 4 to 11 in Spain. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Statistically derived factors of varied importance to audiologists when making a hearing aid brand preference decision.

PubMed

Johnson, Earl E; Mueller, H Gustav; Ricketts, Todd A

2009-01-01

To determine the amount of importance audiologists place on various items related to their selection of a preferred hearing aid brand manufacturer. Three hundred forty-three hearing aid-dispensing audiologists rated a total of 32 randomized items by survey methodology. Principle component analysis identified seven orthogonal statistical factors of importance. In rank order, these factors were Aptitude of the Brand, Image, Cost, Sales and Speed of Delivery, Exposure, Colleague Recommendations, and Contracts and Incentives. While it was hypothesized that differences among audiologists in the importance ratings of these factors would dictate their preference for a given brand, that was not our finding. Specifically, mean ratings for the six most important factors did not differ among audiologists preferring different brands. A statistically significant difference among audiologists preferring different brands was present, however, for one factor: Contracts and Incentives. Its assigned importance, though, was always lower than that for the other six factors. Although most audiologists have a preferred hearing aid brand, differences in the perceived importance of common factors attributed to brands do not largely determine preference for a particular brand.

Cross-cultural comparison of need importance and need satisfaction during adolescence: Turkey and the United States.

PubMed

Hortaçsu, N

1997-09-01

Turkish and U.S. adolescents' views concerning the importance of different needs and instrumentality of relationships with mothers, fathers, siblings, and same-sex friends for need satisfaction were examined and compared. Questionnaires covered needs related to crucial issues of adolescence, namely, relatedness and autonomy/individuation. Participants were 12- to 17-year-old boys and girls from intact families. Cross-cultural differences in ascribed importance of needs related to some aspects of relatedness and autonomy/individuation emerged. Cross-cultural similarities in ascribed importance of needs related to feelings of basic acceptance and need for self-understanding/development also emerged. Turkish adolescents perceived mothers as more instrumental for need satisfaction than did U.S. adolescents. Gender differences in importance ascribed to different needs also emerged. Cross-cultural differences were consistent with differences in predominant values and model family dynamics of the respective countries.

Measuring the importance of health domains in psoriasis - discrete choice experiment versus rating scales.

PubMed

Gutknecht, Mandy; Schaarschmidt, Marthe-Lisa; Danner, Marion; Blome, Christine; Augustin, Matthias

2018-01-01

Psoriasis affects different aspects of health-related quality of life (eg, physical, psychological, and social impairments); these health domains can be of different importance for patients. The importance of domains can be measured with the Patient Benefit Index (PBI). This questionnaire weights the achievement of treatment goals by Likert scales (0, "not important at all" to 4, "very important") using the Patient Needs Questionnaire (PNQ). Treatment goals assessed with the PBI have been assigned to five health domains; the importance of each domain can be calculated as the average importance of the respective treatment goals. In this study, the PBI approach of deriving importance weights is contrasted to a discrete choice experiment (DCE), in order to determine the importance of health domains in psoriasis, and to find if the resulting weights will differ when derived from these two methods. Adult patients with psoriasis completed both questionnaires (PNQ, DCE). The PBI domains were used as attributes in the DCE with the levels "did not help at all", "helped moderately", and "helped a lot". Using DCE, "improving physical functioning" was the most important health domain, followed by "improving psychological well-being". Using PNQ, these domains were ranked in position two and three following "strengthening confidence in the therapy and in a possible healing". The latter was least important using DCE. The only agreement of ranking was shown in "reducing impairments due to therapy" (position four). "Improving social functioning" was ranked in position three (DCE) and five (PNQ). Health domains have different importance to patients with psoriasis. Using PNQ or DCE to determine the importance of domains results in markedly different rankings; both approaches can thus not be considered equivalent. However, in this study, importance was assessed at the domain level in DCE and at the single item level in PNQ, which may have added to the differences.

Preference weights for cost-outcome analyses of schizophrenia treatments: comparison of four stakeholder groups.

PubMed

Shumway, Martha

2003-01-01

This study quantified preferences for schizophrenia outcomes in four stakeholder groups, tested the hypotheses that outcomes differ in importance and stakeholder groups have different preferences, and produced preference weights for seven outcomes for cost-outcome analysis. Fifty patients with schizophrenia, 50 clinicians, 41 family members of patients, and 50 members of the general public rated 16 schizophrenia-related health states, yielding preference weights for seven outcomes: positive symptoms, negative symptoms, extrapyramidal symptoms, tardive dyskinesia, social function, independent living, and vocational function. Outcomes differed in importance (F = 23.4, p < 0.01). All stakeholders rated positive symptoms and social functioning as more important than negative and extrapyramidal symptoms. Stakeholder groups had different preferences (F = 1.9, p = 0.01). Patients rated extrapyramidal symptoms as more important than did other groups (p < 0.01); clinicians rated social functioning as more important than did patients or family members (p < 0.05); and clinicians and family members rated vocational functioning as more important than did patients and the general public (p < 0.05). Results show that schizophrenia outcomes are not equally important and that stakeholder groups value outcomes differently, demonstrating the importance of incorporating stakeholder preferences in cost-outcome analyses and other treatment comparisons.

The Perceived Social Costs and Importance of Seeking Emotional Support in the Workplace: Gender Differences and Similarities.

ERIC Educational Resources Information Center

Cahill, Daniel J.; Sias, Patricia M.

1997-01-01

Investigates gender differences and similarities in the perceived social costs and importance of seeking emotional support regarding work-related problems. Finds women perceived such support to be more important than did men. Finds no gender differences regarding perceived social costs associated with seeking support from coworkers. Finds women…

Similar or Different?: The Importance of Similarities and Differences for Support between Siblings

ERIC Educational Resources Information Center

Voorpostel, Marieke; van der Lippe, Tanja; Dykstra, Pearl A.; Flap, Henk

2007-01-01

Using a large-scale Dutch national sample (N = 7,126), the authors examine the importance of similarities and differences in the sibling dyad for the provision of support. Similarities are assumed to enhance attraction and empathy; differences are assumed to be related to different possibilities for exchange. For helping with housework, helping…

Knowledge Importance in Rehabilitation Counseling.

ERIC Educational Resources Information Center

Leahy, Michael J.; And Others

1993-01-01

Examined differences among certified rehabilitation counselors (n=1,535) in level of importance attributed to various knowledge domains. Found that grouping respondents according to employment setting and job title accounted for most frequent differences in knowledge importance among all variables examined. Respondents' educational background and…

The Plasmodium vivax in China: decreased in local cases but increased imported cases from Southeast Asia and Africa.

PubMed

Feng, Jun; Xiao, Huihui; Zhang, Li; Yan, He; Feng, Xinyu; Fang, Wen; Xia, Zhigui

2015-03-05

Currently the local P. vivax was sharply decreased while the imported vivax malaria increased in China. Despite Southeast Asia was still the main import source of vivax malaria, the trend of Africa become serious, especially for west and central Africa. Herein we have clarified the trend of P. vivax in China from 2004-2012, and made some analysis for the differences of imported vivax back from different regions. There are significantly different of P. vivax between Southeast Asia and Africa, also the difference was observed for different regions in Africa. Additionally, we have explored the possibility for the difference of the P. vivax between migrant workers back from west and central Africa and the prevalence of local population. This reminds us that surveillance and training should be strengthened by medical staffs on the imported P. vivax cases reported especially from west and central Africa, in order to reduce the risk of malaria reintroduction and, specific tools should be developed, as well as the epidemiological study to avoid the misdiagnosis such as P. ovale and P. vivax.

What Does It Take to Change an Editor's Mind? Identifying Minimally Important Difference Thresholds for Peer Reviewer Rating Scores of Scientific Articles.

PubMed

Callaham, Michael; John, Leslie K

2018-01-05

We define a minimally important difference for the Likert-type scores frequently used in scientific peer review (similar to existing minimally important differences for scores in clinical medicine). The magnitude of score change required to change editorial decisions has not been studied, to our knowledge. Experienced editors at a journal in the top 6% by impact factor were asked how large a change of rating in "overall desirability for publication" was required to trigger a change in their initial decision on an article. Minimally important differences were assessed twice for each editor: once assessing the rating change required to shift the editor away from an initial decision to accept, and the other assessing the magnitude required to shift away from an initial rejection decision. Forty-one editors completed the survey (89% response rate). In the acceptance frame, the median minimally important difference was 0.4 points on a scale of 1 to 5. Editors required a greater rating change to shift from an initial rejection decision; in the rejection frame, the median minimally important difference was 1.2 points. Within each frame, there was considerable heterogeneity: in the acceptance frame, 38% of editors did not change their decision within the maximum available range; in the rejection frame, 51% did not. To our knowledge, this is the first study to determine the minimally important difference for Likert-type ratings of research article quality, or in fact any nonclinical scientific assessment variable. Our findings may be useful for future research assessing whether changes to the peer review process produce clinically meaningful differences in editorial decisionmaking. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Sex Differences in the Perceived Importance of Mentoring Functions

ERIC Educational Resources Information Center

Levesque, Laurie L.; O'Neill, Regina M.; Nelson, Teresa; Dumas, Colette

2005-01-01

Purpose: To be the first study to consider the difference between men's and women's perceptions of most important mentoring functions. Design/methodology/approach: Survey recipients identified the three most important things that mentors can do for their proteges. Two independent coders categorized the behaviors listed by the 637 respondents.…

Texture Profile and Color Determination on Local and Imported Meat Available in Semarang City, Indonesia

NASA Astrophysics Data System (ADS)

Arifin, Mukh; Ni'matullah Al-Baarri, Ahmad; Etza Setiani, Bhakti; Fazriyati Siregar, Risa

2018-02-01

This study was done for analysing the texture profile and colour performance in local and imported meat in Semarang, Indonesia. Two types of available meat were compared in the hardness, cohesiveness, springiness, adhesiveness and the colour L*a*b* performance. Five fresh beef cut of round meats from local and imported meat were used in this experiments. Data were analysed statistically using T-test. The results showed that local beef exhibit higher in the springiness than imported beef resulting in the remarkable differences. The colour analysis showed that imported beef provided remarkable higher in L* value than local beef. Resulting significant differences among two types of beef. As conclusion, these value might provide the notable of differences among local and imported meat and may give preferences status to the user for further application in meat processing.

Module 1: Text Versions | State, Local, and Tribal Governments | NREL

Science.gov Websites

U.S., cities are setting different types of renewable energy goals based on different priorities. Air will talk about different types of goals for renewable energy development, and the importance of , you'll be able to understand the nuances between different types of goals, the importance of terminology

Towards an Auditory Account of Speech Rhythm: Application of a Model of the Auditory "Primal Sketch" to Two Multi-Language Corpora

ERIC Educational Resources Information Center

Lee, Christopher S.; Todd, Neil P. McAngus

2004-01-01

The world's languages display important differences in their rhythmic organization; most particularly, different languages seem to privilege different phonological units (mora, syllable, or stress foot) as their basic rhythmic unit. There is now considerable evidence that such differences have important consequences for crucial aspects of language…

Comparison of Milk Yield and Animal Health in Turkish Farms with Differing Stall Types and Resting Surfaces

PubMed Central

Kara, Nurcan Karslioglu; Galic, Askin; Koyuncu, Mehmet

2015-01-01

The current study was carried out to determine the influence of different resting surfaces and stall types on milk yield and animal health. Study was carried out in Bursa that is one of the most important cities of Turkey in terms of dairy production. Effects of resting surfaces and stall types on milk yield were found to be important. Also influence of different resting surfaces and stall types on lactation length was examined and found that rubber mats were different from the two other options. Relationships between different resting surfaces or stall types and health problems were examined and connection between stall type and repeat breeding (RB), dystocia, retained placenta and a connection between resting surface types and RB and clinical mastitis were found to be important. Considering their economic reflections, it can be said that results are quite important to the Turkish dairy industry. PMID:25557824

The Relative Importance of Specific Self-Efficacy Sources in Pretraining Self-Efficacy Beliefs

ERIC Educational Resources Information Center

Howardson, Garett N.; Behrend, Tara S.

2015-01-01

Self-efficacy is clearly important for learning. Research identifying the most important sources of self-efficacy beliefs, however, has been somewhat limited to date in that different disciplines focus largely on different sources of self-efficacy. Whereas education researchers focus on Bandura's original sources of "enactive mastery,"…

Measuring Dependence on Imported Oil

EIA Publications

1995-01-01

U.S. dependence on imported oil can be measured in at least two ways. The differences hinge largely on whether oil imports are defined as net imports (total imports minus exports) or as total imports. EIA introduces a revised table that expresses dependence on imports in terms of both measures.

Younger and Older Adults’ Associative Memory for Social Information: The Role of Information Importance

PubMed Central

Hargis, Mary B.; Castel, Alan D.

2017-01-01

The ability to associate items in memory is critical for social interactions. Older adults show deficits in remembering associative information, but can sometimes remember high-value information. In two experiments, younger and older participants studied faces, names, and occupations that were of differing social value. There were no age differences in the recall of important information in Experiment 1, but age differences were present for less important information. In Experiment 2, when younger adults’ encoding time was reduced, age differences were largely absent. These findings are considered in light of value-directed strategies when remembering social associative information. PMID:28581330

Science and engineering students' classroom experiences: An analysis by gender and discipline

NASA Astrophysics Data System (ADS)

Barrett, Martha Cohen

Based on a concern about the persistence of women in science-related disciplines, this study sought to determine whether science and engineering students' classroom experiences and the importance students attributed to their experiences differed by gender and discipline. Using Chickering & Gamson's (1987) "Seven Principles for Good Practice in Undergraduate Education" as a framework, students' classroom experiences were separated into eight broad categories: Student Preparation, Feedback to Students, Instructor's Expectations of Students, Active Learning, Student Interaction, Instructor's Response to Differences Among Students, Student-Faculty Contact, and Learning Experiences. A survey instrument that included questions related to the eight broad classroom experience dimensions was used to collect data on students' classroom experiences and values in 22 undergraduate biology, chemistry, and mechanical engineering classrooms in a total of three institutions. Most of the classes were sophomore/junior level, and the number of students in each of the classes varied. 896 surveys met the study criteria and were included in the analyses. A total of 23 indices were created using the data collected in the study. Although there were no significant differences in how men and women perceived instructors' classroom behaviors, there were differences in the extent to which men and women reported that they valued particular classroom experiences. For each of these differences (importance of preparation, importance of requirements, importance of cooperative environment, importance of diversity flexibility, and importance of familiarity and respect), women valued the experience more highly than did men. There were also differences in classroom experiences and in the extent to which students valued their experiences across the three disciplines, with more disciplinary differences in students' classroom experiences than in the value they attached to their experiences. While some of the variables included in the study, such as size of class, encouragement from teachers, and expected grade, accounted for a portion of the reported differences in students' experiences and the importance they attached to their experiences, gender and discipline did not add much to the overall understanding of differences in experiences and values.

The Relationship between Self-Efficacy and Perceptions of Different Literacy Types among College Students

ERIC Educational Resources Information Center

Bui, Ngoc H.

2017-01-01

Studies on reading literacy have yet to connect how students perceive the importance of different literacy areas to their ability perception in those areas. This article analyzes students' importance ranking of four different areas of literacy: prose (comprehending written information), document (interpreting information in forms, schedules,…

Cognitive Functions Buffer Age Differences in Technology Ownership.

PubMed

Kamin, Stefan T; Lang, Frieder R

2016-01-01

Technology plays a major role in enhancing quality of life and everyday competence in old age. Mechanic and pragmatic cognitive functions are known to serve as resources when using technology in everyday life. Not much is known about the differential role of mechanic and pragmatic cognitive functions when moderating reduced technology ownership in old age. In this research, we explored whether perceptual speed or verbal fluency is more important for buffering age differences in technology ownership. We investigate possible moderation effects of cognitive functions relative to demographic characteristics, socioeconomic status, and household composition variables. We report findings based on a nationally representative German sample of 3,357 younger and older adults between 18 and 94 years of age (mean = 51.2, SD = 17.3). Interaction and relative importance analyses were conducted to examine the relative importance of perceptual speed and verbal fluency for the moderation of age differences in technology ownership across adulthood. Findings suggest that perceptual speed (B = 0.0008, t = 6.23, p < 0.001) and verbal fluency (B = 0.0003, t = 2.70, p < 0.01) buffered age differences in technology ownership. The moderating role of perceptual speed remained robust (B = 0.0007, t = 5.48, p < 0.001) when including interactions of age with demographic, socioeconomic, and household composition variables; however, the interaction between age and verbal fluency was no longer significant (B = 0.0002, t = 1.82, p = 0.069). Relative importance analysis indicates that perceptual speed was the most important moderator of age differences (DW = 0.0121), whereas verbal fluency was less important for moderating the relation between age and technology ownership (DW = 0.0039). Mechanic and pragmatic cognitive functions may serve differently as moderators of the relation between age and technology ownership. Our findings suggest that perceptual speed was more important for buffering age differences in technology ownership than verbal fluency. Such findings underscore the relevance of information processing for the ownership of technological devices in late life. © 2015 S. Karger AG, Basel.

Gender, Education and Child Labour: A Sociological Perspective

ERIC Educational Resources Information Center

Bhat, Bilal Ahmad

2010-01-01

In all societies, boys and girls are assigned different societal roles and experience different perspectives of life as a result of their being male or female. Such differences have a gigantic impact on their lives. The importance of gender perspective is very important in understanding the convolution of child labour. Gender, as opposed to sex,…

Leadership quality: a factor important for social capital in healthcare organizations.

PubMed

Strömgren, Marcus; Eriksson, Andrea; Ahlstrom, Linda; Bergman, David Kristofer; Dellve, Lotta

2017-04-10

Purpose The purpose of this paper is to investigate the relation between leadership and social capital and what qualities of leadership are important for social capital among employees in hospital settings over time. Design/methodology/approach A cohort of employees in hospitals answered a questionnaire at three occasions. Five small (approx. 100-bed) or mid-sized (approx. 500-bed) hospitals were included. The response rate was 54 percent at baseline ( n=865), 59 percent at one-year follow-up ( n=908) and 67 percent at two-year follow-up ( n=632). Findings Repeated measures over time showed differences between groups in levels of social capital with respect to levels of leadership quality. Relation-oriented leadership had the strongest association with social capital. There was evidence that leadership was associated with social capital over time and that different kinds of leadership qualities were associated with social capital. Research limitations/implications This study conducted and analyzed quantitative data, and therefore, there is no knowledge of managers' or employees' own perceptions in this study. However, it would be interesting to compare managers' decreased and increased leadership quality and how such differences affect social capital over time. Practical implications The findings feature the possibility for healthcare leaders to build high quality leadership as an important resource for social capital, by using different leadership orientations under different circumstances. Originality/value The paper showed that leadership was an important factor for building social capital and that different leadership qualities have different importance with respect to certain circumstances.

Younger and older adults' associative memory for social information: The role of information importance.

PubMed

Hargis, Mary B; Castel, Alan D

2017-06-01

The ability to associate items in memory is critical for social interactions. Older adults show deficits in remembering associative information but can sometimes remember high-value information. In two experiments, younger and older participants studied faces, names, and occupations that were of differing social value. There were no age differences in the recall of important information in Experiment 1, but age differences were present for less important information. In Experiment 2, when younger adults' encoding time was reduced, age differences were largely absent. These findings are considered in light of value-directed strategies when remembering social associative information. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A point of minimal important difference (MID): a critique of terminology and methods.

PubMed

King, Madeleine T

2011-04-01

The minimal important difference (MID) is a phrase with instant appeal in a field struggling to interpret health-related quality of life and other patient-reported outcomes. The terminology can be confusing, with several terms differing only slightly in definition (e.g., minimal clinically important difference, clinically important difference, minimally detectable difference, the subjectively significant difference), and others that seem similar despite having quite different meanings (minimally detectable difference versus minimum detectable change). Often, nuances of definition are of little consequence in the way that these quantities are estimated and used. Four methods are commonly employed to estimate MIDs: patient rating of change (global transition items); clinical anchors; standard error of measurement; and effect size. These are described and critiqued in this article. There is no universal MID, despite the appeal of the notion. Indeed, for a particular patient-reported outcome instrument or scale, the MID is not an immutable characteristic, but may vary by population and context. At both the group and individual level, the MID may depend on the clinical context and decision at hand, the baseline from which the patient starts, and whether they are improving or deteriorating. Specific estimates of MIDs should therefore not be overinterpreted. For a given health-related quality-of-life scale, all available MID estimates (and their confidence intervals) should be considered, amalgamated into general guidelines and applied judiciously to any particular clinical or research context.

Do drivers of biodiversity change differ in importance across marine and terrestrial systems - Or is it just different research communities' perspectives?

PubMed

Knapp, Sonja; Schweiger, Oliver; Kraberg, Alexandra; Asmus, Harald; Asmus, Ragnhild; Brey, Thomas; Frickenhaus, Stephan; Gutt, Julian; Kühn, Ingolf; Liess, Matthias; Musche, Martin; Pörtner, Hans-O; Seppelt, Ralf; Klotz, Stefan; Krause, Gesche

2017-01-01

Cross-system studies on the response of different ecosystems to global change will support our understanding of ecological changes. Synoptic views on the planet's two main realms, the marine and terrestrial, however, are rare, owing to the development of rather disparate research communities. We combined questionnaires and a literature review to investigate how the importance of anthropogenic drivers of biodiversity change differs among marine and terrestrial systems and whether differences perceived by marine vs. terrestrial researchers are reflected by the scientific literature. This included asking marine and terrestrial researchers to rate the relevance of different drivers of global change for either marine or terrestrial biodiversity. Land use and the associated loss of natural habitats were rated as most important in the terrestrial realm, while the exploitation of the sea by fishing was rated as most important in the marine realm. The relevance of chemicals, climate change and the increasing atmospheric concentration of CO 2 were rated differently for marine and terrestrial biodiversity respectively. Yet, our literature review provided less evidence for such differences leading to the conclusion that while the history of the use of land and sea differs, impacts of global change are likely to become increasingly similar. Copyright © 2016 Office national des forêts. Published by Elsevier B.V. All rights reserved.

Variations in "Party Line" Information Importance Between Pilots of Difference Characteristics

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.; Hansman, R. John

1995-01-01

The introduction of digital datalink communications into the air traffic control (ATC) system may cause a reduction of the situation awareness of flight crews due to the reduction of 'Party Line' Information (PLI) that can be overheard on the shared voice frequencies. A survey was distributed to determine current PLI use by pilots from different geographic regions, operational groups, experience levels, and aircraft equipage. Pilots indicated highest perceived importance for PLI during the phases of flight nearest the airport and lowest importance during cruise. Several specific traffic and weather information elements were identified as particularly important; traffic and weather information was also cited by pilots as information required for global situation awareness. Some variations in responses were found between pilots from different operational types.

The importance of biodiversity and dominance for multiple ecosystem functions in a human-modified tropical landscape.

PubMed

Lohbeck, Madelon; Bongers, Frans; Martinez-Ramos, Miguel; Poorter, Lourens

2016-10-01

Many studies suggest that biodiversity may be particularly important for ecosystem multifunctionality, because different species with different traits can contribute to different functions. Support, however, comes mostly from experimental studies conducted at small spatial scales in low-diversity systems. Here, we test whether different species contribute to different ecosystem functions that are important for carbon cycling in a high-diversity human-modified tropical forest landscape in Southern Mexico. We quantified aboveground standing biomass, primary productivity, litter production, and wood decomposition at the landscape level, and evaluated the extent to which tree species contribute to these ecosystem functions. We used simulations to tease apart the effects of species richness, species dominance and species functional traits on ecosystem functions. We found that dominance was more important than species traits in determining a species' contribution to ecosystem functions. As a consequence of the high dominance in human-modified landscapes, the same small subset of species mattered across different functions. In human-modified landscapes in the tropics, biodiversity may play a limited role for ecosystem multifunctionality due to the potentially large effect of species dominance on biogeochemical functions. However, given the spatial and temporal turnover in species dominance, biodiversity may be critically important for the maintenance and resilience of ecosystem functions. © 2016 The Authors. Ecology, published by Wiley Periodicals, Inc., on behalf of the Ecological Society of America.

How engineers perceive the importance of ethics in Finland

NASA Astrophysics Data System (ADS)

Taajamaa, Ville; Majanoja, Anne-Maarit; Bairaktarova, Diana; Airola, Antti; Pahikkala, Tapio; Sutinen, Erkki

2018-01-01

Success in complex and holistic engineering practices requires more than problem-solving abilities and technical competencies. Engineering education must offer proficient technical competences and also train engineers to think and act ethically. A technical 'engineering-like' focus and demand have made educators and students overlook the importance of ethical awareness and transversal competences. Using two Finnish surveys, conducted in 2014 and 2016, we examine how engineers perceive working life needs regarding ethics. The data consider different age groups. We research whether an engineer's age affects their perception of the importance of ethics in their work and if there are differences between young experts and young managers in their use of ethics within work. The results indicate that practising engineers do not consider ethical issues important in their work. This especially applies to younger engineers; the older an engineer, the more important they consider ethics. No statistically significant difference was found between young engineering experts and managers.

Assessment of Minimum Important Difference and Substantial Clinical Benefit with the Vascular Quality of Life Questionnaire-6 when Evaluating Revascularisation Procedures in Peripheral Arterial Disease.

PubMed

Nordanstig, J; Pettersson, M; Morgan, M; Falkenberg, M; Kumlien, C

2017-09-01

Patient reported outcomes are increasingly used to assess outcomes after peripheral arterial disease (PAD) interventions. VascuQoL-6 (VQ-6) is a PAD specific health-related quality of life (HRQoL) instrument for routine clinical practice and clinical research. This study assessed the minimum important difference for the VQ-6 and determined thresholds for the minimum important difference and substantial clinical benefit following PAD revascularisation. This was a population-based observational cohort study. VQ-6 data from the Swedvasc Registry (January 2014 to September 2016) was analysed for revascularised PAD patients. The minimum important difference was determined using a combination of a distribution based and an anchor-based method, while receiver operating characteristic curve analysis (ROC) was used to determine optimal thresholds for a substantial clinical benefit following revascularisation. A total of 3194 revascularised PAD patients with complete VQ-6 baseline recordings (intermittent claudication (IC) n = 1622 and critical limb ischaemia (CLI) n = 1572) were studied, of which 2996 had complete VQ-6 recordings 30 days and 1092 a year after the vascular intervention. The minimum important difference 1 year after revascularisation for IC patients ranged from 1.7 to 2.2 scale steps, depending on the method of analysis. Among CLI patients, the minimum important difference after 1 year was 1.9 scale steps. ROC analyses demonstrated that the VQ-6 discriminative properties for a substantial clinical benefit was excellent for IC patients (area under curve (AUC) 0.87, sensitivity 0.81, specificity 0.76) and acceptable in CLI (AUC 0.736, sensitivity 0.63, specificity 0.72). An optimal VQ-6 threshold for a substantial clinical benefit was determined at 3.5 scale steps among IC patients and 4.5 in CLI patients. The suggested thresholds for minimum important difference and substantial clinical benefit could be used when evaluating VQ-6 outcomes following different interventions in PAD and in the design of clinical trials. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

A history of gravity: An introduction to the epistemology of Paul Feyerabend

NASA Astrophysics Data System (ADS)

Rodrigues, Danilo Miranda

2015-08-01

The goal of this work is to show an historical introduction to epistemology of Paul Feyerabend and the importance of his concept of epistemological anarchism for education.Feyerabend defended that different and even contradictory theories must be used in education, this multiplicity of possible explanations for natural phenomena is important to express the real development of science.There are many different explanations for the fall of bodies, since the "natural places" in Aristotle until the Newtonian Gravitation or the General Relativity. The contact with many different explanations has as important contribution for the learning of Astronomy.

Success strivings and their relationship to affective work behaviors: gender differences.

PubMed

Chusmir, L H; Parker, B

1992-02-01

Gender differences in the importance of six life success dimensions and their relationships to job satisfaction, job involvement, and propensity to stay on the job were examined among 756 working women and men in southeast Florida. Results showed that the female participants rated family relationships, personal fulfillment, and security as more important success measures than their male counterparts did, and they rated status/wealth as less important. Professional fulfillment and security were not significantly different. The relationships between measures of success and work behaviors also varied significantly by gender, even after controlling for demographic and job position variables.

Differential investment in visual and olfactory brain areas reflects behavioural choices in hawk moths

PubMed Central

Stöckl, Anna; Heinze, Stanley; Charalabidis, Alice; el Jundi, Basil; Warrant, Eric; Kelber, Almut

2016-01-01

Nervous tissue is one of the most metabolically expensive animal tissues, thus evolutionary investments that result in enlarged brain regions should also result in improved behavioural performance. Indeed, large-scale comparative studies in vertebrates and invertebrates have successfully linked differences in brain anatomy to differences in ecology and behaviour, but their precision can be limited by the detail of the anatomical measurements, or by only measuring behaviour indirectly. Therefore, detailed case studies are valuable complements to these investigations, and have provided important evidence linking brain structure to function in a range of higher-order behavioural traits, such as foraging experience or aggressive behaviour. Here, we show that differences in the size of both lower and higher-order sensory brain areas reflect differences in the relative importance of these senses in the foraging choices of hawk moths, as suggested by previous anatomical work in Lepidopterans. To this end we combined anatomical and behavioural quantifications of the relative importance of vision and olfaction in two closely related hawk moth species. We conclude that differences in sensory brain volume in these hawk moths can indeed be interpreted as differences in the importance of these senses for the animal’s behaviour. PMID:27185464

From pediatric history. Important personalities in relation to some genetic defects - "trisomies".

PubMed

Brucknerova, Ingrid; Holomanova, Anna; Mach, Mojmir; Ujhazy, Eduard

2012-01-01

The aim of this study is to present a short biography of some important physicians and describe the most prominent differences between trisomy 13, 18 and 21. The authors present the most prominent differences between trisomy 13, 18 and 21. The work of many important physicians, geneticists, has helped in the process of recognition of congenital anomalies. This group of famous persons includes Patau, Edwards and Down.

Quantifying the importance of image and perception to bus rapid transit : March 2009.

DOT National Transportation Integrated Search

2009-03-01

This study was designed to quantify the importance of image and perception to Bus Rapid Transit, by identifying the different underlying : tangible and intangible factors that drive any perceived differences between BRT and other forms of rapid trans...

The role of cultural models in local perceptions of SFM--differences and similarities of interest groups from three boreal regions.

PubMed

Berninger, Kati; Kneeshaw, Daniel; Messier, Christian

2009-02-01

Differences in the way local and regional interest groups perceive Sustainable Forest Management in regions with different forest use histories were studied using Southeastern Finland, the Mauricie in Quebec and Central Labrador in Canada as examples of regions with high, medium and low importance of commercial forestry. We present a conceptual model illustrating the cyclic interaction between the forest, cultural models about forests and forest management. We hypothesized that peoples' perceptions would be influenced by their cultural models about forests and would thus vary amongst regions with different forest use histories and among different interest groups. The weightings of the environmental, economic and social components of sustainability as well as themes important for each of the interest groups were elicited using individual listing of SFM indicators and group work aimed at developing a consensus opinion on a common indicator list. In Southeastern Finland the views of the different groups were polarized along the environment-economy axis, whereas in Central Labrador all groups were environmentally oriented. The social dimension was low overall except among the Metis and the Innu in Labrador. Only environmental groups were similar in all three research regions, the largest differences between regions were found among the forestry professionals in their weightings concerning economy and nature. As the importance of commercial forestry increased, a greater importance of economic issues was expressed whereas the opposite trend was observed for issues regarding nature. Also inter-group differences grew as the importance of commercial forestry increased in the region. Forest management and forest use can be seen as factors strongly influencing peoples' cultural models on forests.

A Single Peroxisomal Targeting Signal Mediates Matrix Protein Import in Diatoms

PubMed Central

Gonzalez, Nicola H.; Felsner, Gregor; Schramm, Frederic D.; Klingl, Andreas; Maier, Uwe-G.; Bolte, Kathrin

2011-01-01

Peroxisomes are single membrane bound compartments. They are thought to be present in almost all eukaryotic cells, although the bulk of our knowledge about peroxisomes has been generated from only a handful of model organisms. Peroxisomal matrix proteins are synthesized cytosolically and posttranslationally imported into the peroxisomal matrix. The import is generally thought to be mediated by two different targeting signals. These are respectively recognized by the two import receptor proteins Pex5 and Pex7, which facilitate transport across the peroxisomal membrane. Here, we show the first in vivo localization studies of peroxisomes in a representative organism of the ecologically relevant group of diatoms using fluorescence and transmission electron microscopy. By expression of various homologous and heterologous fusion proteins we demonstrate that targeting of Phaeodactylum tricornutum peroxisomal matrix proteins is mediated only by PTS1 targeting signals, also for proteins that are in other systems imported via a PTS2 mode of action. Additional in silico analyses suggest this surprising finding may also apply to further diatoms. Our data suggest that loss of the PTS2 peroxisomal import signal is not reserved to Caenorhabditis elegans as a single exception, but has also occurred in evolutionary divergent organisms. Obviously, targeting switching from PTS2 to PTS1 across different major eukaryotic groups might have occurred for different reasons. Thus, our findings question the widespread assumption that import of peroxisomal matrix proteins is generally mediated by two different targeting signals. Our results implicate that there apparently must have been an event causing the loss of one targeting signal even in the group of diatoms. Different possibilities are discussed that indicate multiple reasons for the detected targeting switching from PTS2 to PTS1. PMID:21966495

Comparing the importance of different aspects of quality of life to older adults across diverse cultures.

PubMed

Molzahn, Anita E; Kalfoss, Mary; Schick Makaroff, Kara; Skevington, Suzanne M

2011-03-01

there is limited research examining the relative importance of aspects of quality of life (QOL) to older adults across cultures. to examine the relative importance of 31 internationally agreed areas of QOL to older adults in 22 countries in relation to health status, age and level of economic development. a survey quota sampling design was used to collect cross-cultural data. This study reports a secondary analysis of WHOQOL-OLD pilot study, which was collected simultaneously in 22 centres. a variety of community, primary, secondary and tertiary health care settings located in Australia, France, Switzerland, England, Scotland, USA, Israel, Spain, Japan, China (mainland and Hong Kong), Turkey, Lithuania, Czech Republic, Hungary, Canada, Norway, Sweden, Denmark, Germany, Brazil and Uruguay. the total sample contained 7,401 people over 60 years with a mean age of 73.1 years; 57.8% were women and 70.1% considered themselves 'healthy'. there were significant differences in the importance given to various aspects of QOL for people living in medium and high-development countries. Culture explained 15.9% of the variance in the importance ratings of QOL. However, the interaction showed that cultural differences were reduced once health status, gender and age were taken into account. The importance of QOL to age bands in different cultures was not significantly affected by whether or not participants perceived themselves to be healthy. understanding the self-reported importance of diverse aspects of QOL for different cultures and for healthy and less healthy people may assist national and international policy makers to decide on priorities for the development of programmes for the ageing population.

The goals of communicating bad news in health care: do physicians and patients agree?

PubMed Central

Sweeny, Kate; Shepperd, James A.; Han, Paul K. J.

2011-01-01

Abstract Background  Communicating bad news serves different goals in health care, and the extent to which physicians and patients agree on the goals of these conversations may influence their process and outcomes. However, we know little about what goals physicians and patients perceive as important and how the perceptions of physicians and patients compare. Objective  To compare physicians’ and patients’ perceptions of the importance of different communication goals in bad news conversations. Design  Survey‐based descriptive study. Participants  Physicians in California recruited via a medical board mailing list (n = 67) and patients (n = 77) recruited via mailing lists and snowball recruitment methods. Measurements  Physicians reported their experience communicating bad news, the extent to which they strive for various goals in this task and their perceptions of the goals important to patients. Patients reported their experience receiving bad news, the goals important to them and their perceptions of the goals important to physicians. Main results  Physicians and patients were quite similar in how important they personally rated each goal. However, the two groups perceived differences between their values and the values of the other group. Conclusions  Physicians and patients have similar perceptions of the importance of various goals of communicating bad news, but inaccurate perceptions of the importance of particular goals to the other party. These findings raise important questions for future research and clinical practice. PMID:21771225

Culture and Happiness.

PubMed

Ye, Dezhu; Ng, Yew-Kwang; Lian, Yujun

Culture is an important factor affecting happiness. This paper examines the predictive power of cultural factors on the cross-country differences in happiness and explores how different dimensions of cultural indices differ in their effects on happiness. Our empirical results show that the global leadership and organizational behavior effectiveness nine culture indices are all significantly related with happiness. Out of these nine indices, power distance (PDI) and gender egalitarianism (GEI) play the most important and stable role in determining subjective well-being (SWB). We further examine the relative importance of the various variables in contributing to the R-squared of the regression. The results show that PDI is the most important, accounting for 50 % of the contributions to R-squared of all variables, or equalling the combined contributions of income, population density and four other traditional variables. The contribution of GEI is 37.1 %, also well surpassing other variables. Our results remain robust even taking account of the different data for culture and SWB.

Gender intensification of peer socialization during puberty.

PubMed

Pettitt, Lisa M

2004-01-01

Gender differences are a provocative subject with good reason: they are implicated as contributors to important societal problems. Gender differences in math achievement contribute to limited career options for women (Center for Early Adolescence, 1984; Stipp, 1992), which may in turn affect their economic self-sufficiency. Gender differences in social norms about competition and closeness contribute to power and communication problems in female-male relationships, with consequences for family stability and domestic violence (Leaper, 1994). Understanding the origins of gender differences, therefore, has important societal implications.

Ethnic, gender, and BMI differences in athletic identity in children and adolescents.

PubMed

Anderson, Cheryl Braselton; Mâsse, Louise C; Zhang, Hong; Coleman, Karen J; Chang, Shine

2011-02-01

Little is known about differences in athletic self-concept that are related to ethnicity, gender, and overweight status, which may influence physical activity behavior. Children (N=936) and adolescents (N=1071) completed the Athletic Identity Questionnaire, measuring athletic appearance, competence, importance of activity, and encouragement from parents, teachers, and friends. Multivariate ANOVA assessed group differences and interactions on the 6 subscales. Interaction effects were found in children (Ethnic×Gender; Ethnic×BMI), and ethnic, gender, and BMI (body mass index) main effects in adolescents. In children, Hispanic girls had lower appearance and competence ratings. Within weight categories, normal-weight Hispanic children had lower appearance and importance ratings compared with whites, and obese black children had lower importance ratings than obese whites and Hispanics. In adolescents, there were lower appearance and competence ratings among Hispanics and obese students, lower importance ratings among girls and Hispanics, and less parental encouragement in Hispanics. No gender, ethnic, or BMI differences on encouragement from teachers were found in either children or adolescents. More negative athletic self-perceptions and less parental encouragement were seen in minorities. Consideration of these factors will be important in interventions to promote physical activity.

Total materials consumption; an estimation methodology and example using lead; a materials flow analysis

USGS Publications Warehouse

Biviano, Marilyn B.; Wagner, Lorie A.; Sullivan, Daniel E.

1999-01-01

Materials consumption estimates, such as apparent consumption of raw materials, can be important indicators of sustainability. Apparent consumption of raw materials does not account for material contained in manufactured products that are imported or exported and may thus under- or over-estimate total consumption of materials in the domestic economy. This report demonstrates a methodology to measure the amount of materials contained in net imports (imports minus exports), using lead as an example. The analysis presents illustrations of differences between apparent and total consumption of lead and distributes these differences into individual lead-consuming sectors.

When Autobiographical Memory Begins

ERIC Educational Resources Information Center

Howe, Mark L.; Courage, Mary L.; Edison, Shannon C.

2003-01-01

The authors review competing theories concerning the emergence and early development of autobiographical memory. It is argued that the differences between these accounts, although important, may be more apparent than real. The crux of these disagreements lies not in "what" processes are important, but rather, the role these different processes…

Quality of Life: An Exploratory Study.

ERIC Educational Resources Information Center

Lankhorst, Gustaaf J.

1989-01-01

A 12-item list of human abilities/activities was developed to measure quality of life of 9 rheumatoid arthritis adults from 2 aspects: "present condition" and "relative importance" of each item. Pilot testing indicated that importance and present condition represent different aspects. Differences between self-assessments and physicians'…

North/South Differences Among Italian Emerging Adults Regarding Criteria Deemed Important for Adulthood and Life Satisfaction

PubMed Central

Piumatti, Giovanni; Garro, Maria; Pipitone, Laura; Di Vita, Angela Maria; Rabaglietti, Emanuela

2016-01-01

The main goal of this study was to compare Northern and Southern Italian emerging adult university students, regarding the importance attributed to criteria for adulthood and the levels of life and education satisfaction. Self-report questionnaires were filled by 475 Northern and Southern Italian University students (Age M = 22.91, 76% females, n = 359). Multivariate analysis of variance revealed that Southern emerging adults were more likely to place importance on family capacities, norm compliance, interdependence and role transitions as criteria for achieving adulthood than Northern emerging adults. Regarding gender differences, females were more likely to believe in the importance of norm compliance than males, while males were more likely to espouse the importance of legal transitions. Finally, emerging adults from the North reported higher levels of life satisfaction than their Southern counterparts. We interpreted these findings in light of socio-economical and gender socialization differences among Northern and Southern Italian emerging adults. PMID:27298636

Cultural differences in the development and characteristics of depression.

PubMed

Juhasz, Gabriella; Eszlari, Nora; Pap, Dorottya; Gonda, Xenia

2012-12-01

Depression is a highly prevalent mental illness with increasing burden for the patients, their families and society as well. In spite of its increasing importance, we still do not have complete understanding either of the phenomenology or the etiopathological background of depression, and cross-country, cross-ethnic and cross-cultural differences in the prevalence and symptomatic manifestation of depression further obscure this picture. Culturally-related features of depressive illness are gaining more importance in clinical practice with the increasing migration trends worldwide. In spite of the differences replicated in multiple studies, no exhaustive explanations are offered so far. In the present paper we describe the most consistently replicated findings concerning the most important cross-national differences in the rates and characteristics of depression with a short comment on possible background factors.

Evaluating firms' R&D performance using best worst method.

PubMed

Salimi, Negin; Rezaei, Jafar

2018-02-01

Since research and development (R&D) is the most critical determinant of the productivity, growth and competitive advantage of firms, measuring R&D performance has become the core of attention of R&D managers, and an extensive body of literature has examined and identified different R&D measurements and determinants of R&D performance. However, measuring R&D performance and assigning the same level of importance to different R&D measures, which is the common approach in existing studies, can oversimplify the R&D measuring process, which may result in misinterpretation of the performance and consequently fallacy R&D strategies. The aim of this study is to measure R&D performance taking into account the different levels of importance of R&D measures, using a multi-criteria decision-making method called Best Worst Method (BWM) to identify the weights (importance) of R&D measures and measure the R&D performance of 50 high-tech SMEs in the Netherlands using the data gathered in a survey among SMEs and from R&D experts. The results show how assigning different weights to different R&D measures (in contrast to simple mean) results in a different ranking of the firms and allow R&D managers to formulate more effective strategies to improve their firm's R&D performance by applying knowledge regarding the importance of different R&D measures. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors.

PubMed

Forrest, Lauren N; Smith, April R; Fussner, Lauren M; Dodd, Dorian R; Clerkin, Elise M

2016-01-01

"Fast" (i.e., implicit) processing is relatively automatic; "slow" (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes. We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms. Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms. Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised. Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors

PubMed Central

Forrest, Lauren N.; Smith, April R.; Fussner, Lauren M.; Dodd, Dorian R.; Clerkin, Elise M.

2015-01-01

Objectives ”Fast” (i.e., implicit) processing is relatively automatic; “slow” (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes. Design We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms. Method Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms. Results Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised. Conclusion Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence. PMID:26195916

Regulation of Water in Plant Cells

ERIC Educational Resources Information Center

Kowles, Richard V.

2010-01-01

Cell water relationships are important topics to be included in cell biology courses. Differences exist in the control of water relationships in plant cells relative to control in animal cells. One important reason for these differences is that turgor pressure is a consideration in plant cells. Diffusion and osmosis are the underlying factors…

Educators' Perceived Importance of Web 2.0 Technology Applications

ERIC Educational Resources Information Center

Pritchett, Christal C.; Wohleb, Elisha C.; Pritchett, Christopher G.

2013-01-01

This research study was designed to examine the degree of perceived importance of interactive technology applications among various groups of certified educators; the degree to which education professionals utilized interactive online technology applications and to determine if there was a significant difference between the different groups based…

Determining the importance of fundamental hearing aid attributes.

PubMed

Meister, Hartmut; Lausberg, Isabel; Kiessling, Juergen; Walger, Martin; von Wedel, Hasso

2002-07-01

To determine the importance of fundamental hearing aid attributes and to elicit measures of satisfaction and dissatisfaction. A prospective study based on a survey using a decompositional approach of preference measurement (conjoint analysis). Ear, nose, and throat university hospitals in Cologne and Giessen; various branches of hearing aid dispensers. A random sample of 175 experienced hearing aid users aged 20 to 91 years (mean age, 61 yr) recruited at two different sites. Relative importance of different hearing aid attributes, satisfaction and dissatisfaction with hearing aid attributes. Of the six fundamental hearing aid attributes assessed by the hearing aid users, the two features concerning speech perception attained the highest relative importance (25% speech in quiet, 27% speech in noise). The remaining four attributes (sound quality, handling, feedback, localization) had significantly lower values in a narrow range of 10 to 12%. Comparison of different subgroups of hearing aid wearers based on sociodemographic and user-specific data revealed a large interindividual scatter of the preferences for the attributes. A similar examination with 25 clinicians revealed overestimation of the importance of the attributes commonly associated with problems. Moreover, examination of satisfaction showed that speech in noise was the most frequent source of dissatisfaction (30% of all statements), whereas the subjects were satisfied with speech in quiet. The results emphasize the high importance of attributes related to speech perception. Speech discrimination in noise was the most important but also the most frequent source of negative statements. This attribute will be the outstanding parameter of future developments. Appropriate handling becomes an important factor for elderly subjects. However, because of the large interindividual scatter of data, the preferences of different hearing aid users were hardly predictable, giving evidence of multifactorial influences.

tRNA travels from the cytoplasm to organelles

PubMed Central

Rubio, Mary Anne T.; Hopper, Anita K.

2011-01-01

Transfer RNAs (tRNAs) encoded by the nuclear genome are surprisingly dynamic. Although tRNAs function in protein synthesis occurring on cytoplasmic ribosomes, tRNAs can transit from the cytoplasm to the nucleus and then again return to the cytoplasm by a process known as the tRNA retrograde process. Subsets of the cytoplasmic tRNAs are also imported into mitochondria and function in mitochondrial protein synthesis. The numbers of tRNA species that are imported into mitchondria differ among organisms, ranging from just a few to the entire set needed to decode mitochondrially encoded mRNAs. For some tRNAs, import is dependent on the mitochondrial protein import machinery, whereas the majority of tRNA mitochondrial import is independent of this machinery. Although cytoplasmic proteins and proteins located on the mitochondrial surface participating in the tRNA import process have been described for several organisms, the identity of these proteins differ among organisms. Likewise, the tRNA determinants required for mitochondrial import differ among tRNA species and organisms. Here, we present an overview and discuss the current state of knowledge regarding the mechanisms involved in the tRNA retrograde process and continue with an overview of tRNA import into mitochondria. Finally, we highlight areas of future research to understand the function and regulation of movement of tRNAs between the cytoplasm and organelles. PMID:21976284

Largely ignored: the impact of the threshold value for a QALY on the importance of a transferability factor.

PubMed

Vemer, Pepijn; Rutten-van Mölken, Maureen P M H

2011-10-01

Recently, several checklists systematically assessed factors that affect the transferability of cost-effectiveness (CE) studies between jurisdictions. The role of the threshold value for a QALY has been given little consideration in these checklists, even though the importance of a factor as a cause of between country differences in CE depends on this threshold. In this paper, we study the impact of the willingness-to-pay (WTP) per QALY on the importance of transferability factors in the case of smoking cessation support (SCS). We investigated, for several values of the WTP, how differences between six countries affect the incremental net monetary benefit (INMB) of SCS. The investigated factors were demography, smoking prevalence, mortality, epidemiology and costs of smoking-related diseases, resource use and unit costs of SCS, utility weights and discount rates. We found that when the WTP decreased, factors that mainly affect health outcomes became less important and factors that mainly effect costs became more important. With a WTP below 1,000, the factors most responsible for between country differences in INMB were resource use and unit costs of SCS and the costs of smoking-related diseases. Utility values had little impact. At a threshold above 10,000, between country differences were primarily due to different discount rates, utility weights and epidemiology of smoking-related diseases. Costs of smoking-related diseases had little impact. At all thresholds, demography had little impact. We concluded that, when judging the transferability of a CE study, we should consider the between country differences in WTP threshold values.

Darwinism and cultural change.

PubMed

Godfrey-Smith, Peter

2012-08-05

Evolutionary models of cultural change have acquired an important role in attempts to explain the course of human evolution, especially our specialization in knowledge-gathering and intelligent control of environments. In both biological and cultural change, different patterns of explanation become relevant at different 'grains' of analysis and in contexts associated with different explanatory targets. Existing treatments of the evolutionary approach to culture, both positive and negative, underestimate the importance of these distinctions. Close attention to grain of analysis motivates distinctions between three possible modes of cultural evolution, each associated with different empirical assumptions and explanatory roles.

Sex-based Differences in Common Sports Injuries.

PubMed

Carter, Cordelia W; Ireland, Mary Lloyd; Johnson, Anthony E; Levine, William N; Martin, Scott; Bedi, Asheesh; Matzkin, Elizabeth G

2018-05-28

The patient's sex plays an important role in mediating the risk for, and experience of, disease. Injuries of the musculoskeletal system are no exception to this phenomenon. Increasing evidence shows that the incidence, clinical presentation, and treatment outcomes for male and female patients with common sports injuries may vary widely. Stress fracture, which is associated with the female athlete triad, is a sports injury with known sex-based differences. Other common sports-related injuries may also have distinct sex-based differences. Understanding these differences is important to optimize each patient's musculoskeletal care.

A Reexamination of Sex Differences in Job Preferences.

ERIC Educational Resources Information Center

Siegfried, William D.; And Others

1981-01-01

Both male and female college students rated motivators as important, but females also placed importance on environmental factors. The subject's sex could be predicted by both the importance for self and importance for opposite sex ratings. Females' job preferences were related to their mothers' educational achievement. (Author)

Family needs after brain injury: A cross cultural study.

PubMed

Norup, Anne; Perrin, Paul B; Cuberos-Urbano, Gustavo; Anke, Audny; Andelic, Nada; Doyle, Sarah T; Cristina Quijano, Maria; Caracuel, Alfonso; Mar, Dulce; Guadalupe Espinosa Jove, Irma; Carlos Arango-Lasprilla, Juan

2015-01-01

The objective of this study was to explore differences by country in the importance of family needs after traumatic brain injury (TBI), as well as differences in met/unmet needs. Two hundred and seventy-one family members of an individual with TBI in Mexico, Colombia, Spain, Denmark, and Norway completed the Family Needs Questionnaire. Eight of the ten needs rated as most important globally were from the Health Information subscale. Importance ratings on the Health Information, Professional Support, and Involvement With Care subscales were similar across countries, but Mexican family members rated Instrumental Support needs as less important than Colombian, Spanish, and Danish family members, and also rated their Community Support needs as less important than Danish and Spanish family members. Mexican family member's rated emotional support needs as less important than Colombian, Spanish, and Danish family members. Globally, the needs rated as most often met were from the Health Information subscale, and the most unmet needs were from the Emotional Support subscale. Despite some similarities across countries several differences were identified, and these can help professionals to provide more culturally appropriate rehabilitation services for family members in order to improve informal care for TBI.

Associations between Discussions of Racial and Ethnic Differences in Internationally Adoptive Families and Delinquent Behavior among Korean Adopted Adolescents.

PubMed

Anderson, Kayla N; Lee, Richard M; Rueter, Martha A; Kim, Oh Myo

2015-04-01

Internationally adopted adolescents may have more delinquent behavior than non-adopted adolescents. One explanation is these adolescents experience discrimination and loss of culture, and adoptive parents are not adequately addressing these experiences. However, studies have not examined the effects of family discussions of racial and ethnic differences within adoptive families on adopted adolescents' delinquent behavior. To test this relationship, this study utilized data from 111 U.S. internationally adoptive families with 185 South Korean adopted adolescents (55% female, M age = 17.75). During an observational assessment, families discussed the importance of their racial and ethnic differences, and adolescents completed a delinquent behavior questionnaire. Analysis of covariance showed differences in adolescent delinquent behavior across three ways adoptive families discussed racial and ethnic differences; adolescents whose families acknowledged differences had the fewest mean delinquent behaviors. There were no significant differences in delinquent behavior between adolescents whose families acknowledged or rejected the importance of racial and ethnic differences. However, adopted adolescents whose families held discrepant views of differences had significantly more problem behavior than adolescents whose families either acknowledged or rejected the importance of racial and ethnic differences. Clinicians, adoption professionals, and other parenting specialists should focus on building cohesive family identities about racial and ethnic differences, as discrepant views of differences are associated with the most adoptee delinquent behavior.

Associations between Discussions of Racial and Ethnic Differences in Internationally Adoptive Families and Delinquent Behavior among Korean Adopted Adolescents

PubMed Central

Anderson, Kayla N.; Lee, Richard M.; Rueter, Martha A.; Kim, Oh Myo

2015-01-01

Internationally adopted adolescents may have more delinquent behavior than non-adopted adolescents. One explanation is these adolescents experience discrimination and loss of culture, and adoptive parents are not adequately addressing these experiences. However, studies have not examined the effects of family discussions of racial and ethnic differences within adoptive families on adopted adolescents’ delinquent behavior. To test this relationship, this study utilized data from 111 U.S. internationally adoptive families with 185 South Korean adopted adolescents (55% female, M age = 17.75). During an observational assessment, families discussed the importance of their racial and ethnic differences, and adolescents completed a delinquent behavior questionnaire. Analysis of covariance showed differences in adolescent delinquent behavior across three ways adoptive families discussed racial and ethnic differences; adolescents whose families acknowledged differences had the fewest mean delinquent behaviors. There were no significant differences in delinquent behavior between adolescents whose families acknowledged or rejected the importance of racial and ethnic differences. However, adopted adolescents whose families held discrepant views of differences had significantly more problem behavior than adolescents whose families either acknowledged or rejected the importance of racial and ethnic differences. Clinicians, adoption professionals, and other parenting specialists should focus on building cohesive family identities about racial and ethnic differences, as discrepant views of differences are associated with the most adoptee delinquent behavior. PMID:25729119

Analysis of the Importance of Oxides and Clays in Cd, Cr, Cu, Ni, Pb and Zn Adsorption and Retention with Regression Trees

PubMed Central

González-Costa, Juan José; Reigosa, Manuel Joaquín; Matías, José María; Fernández-Covelo, Emma

2017-01-01

This study determines the influence of the different soil components and of the cation-exchange capacity on the adsorption and retention of different heavy metals: cadmium, chromium, copper, nickel, lead and zinc. In order to do so, regression models were created through decision trees and the importance of soil components was assessed. Used variables were: humified organic matter, specific cation-exchange capacity, percentages of sand and silt, proportions of Mn, Fe and Al oxides and hematite, and the proportion of quartz, plagioclase and mica, and the proportions of the different clays: kaolinite, vermiculite, gibbsite and chlorite. The most important components in the obtained models were vermiculite and gibbsite, especially for the adsorption of cadmium and zinc, while clays were less relevant. Oxides are less important than clays, especially for the adsorption of chromium and lead and the retention of chromium, copper and lead. PMID:28072849

Family, money, and health: Regional differences in the determinants of life satisfaction over the life course

PubMed Central

Margolis, Rachel; Myrskylä, Mikko

2013-01-01

We examine how family, money, and health explain variation in life satisfaction over the life cycle across seven global regions using data from the World Values Survey. With a life domain approach, we study whether the importance of the life domains varies by region and age groups and whether the variation explained by each factor is due to the magnitude or prevalence of each factor. Globally, family, money, and health explain a substantial fraction of life satisfaction, increasing from 12 percent in young adulthood to 15 percent in mature adulthood. Health is the most important factor, and its importance increases with age. Income is unimportant above age 50. Remarkably, the contribution of family is small across ages. Across regions health is most important in the wealthier, and income in the poorer regions of the world. Family explains a substantial fraction of life satisfaction only in Western Europe and Anglophone countries. Findings highlight that the population-level importance of family, money, and health in explaining variation in life satisfaction across regions is mainly attributable to the individual-level life satisfaction differences between people of different statuses rather than differences in the distribution of various states such as poor health across regions. PMID:24796263

Preliminary comparison of different immune and production components in local and imported Saanen goats reared under a sub-tropical environment.

PubMed

Barbour, Elie K; Itani, Houssam H; Sleiman, Fawwak T; Saade, Maya F; Harakeh, Steve; Nour, Afif M Abdel; Shaib, Houssam A

2012-01-01

Three objectives were included in this research work. The first objective compared different immune components in healthy mature males, mature females, and female kids of local and imported Saanen goats, reared under a sub-tropical environment. The significantly differing immune components were the blood monocyte percent, blood CD8 count, and the total white blood cell count. The second objective compared the performance of Saanen versus local does. The means of the milk yield and prolificacy of the imported Saanen does were significantly higher than those of the local does (p<0.05). The third objective compared the immune responses (hemagglutination-HA titers) and complement fixation (CF) titers in mature does of the two breeds to chicken red blood cells (c-RBC). The HA titers showed a significant seroconversion only in imported Saanen (p<0.05) but not in local does; however, the CF titers increased significantly at 4 weeks following priming with c-RBC in local (p<0.05) but not in the imported Saanen does. The impact of the differences in blood immune components and responses to antigens in the compared goats on protection potential against prevalent diseases in the sub-tropical zone of the eastern Mediterranean countries is discussed.

Soft Skills in Higher Education: Importance and Improvement Ratings as a Function of Individual Differences and Academic Performance

ERIC Educational Resources Information Center

Chamorro-Premuzic, Tomas; Arteche, Adriane; Bremner, Andrew J.; Greven, Corina; Furnham, Adrian

2010-01-01

Three UK studies on the relationship between a purpose-built instrument to assess the importance and development of 15 "soft skills" are reported. "Study 1" (N = 444) identified strong latent components underlying these soft skills, such that differences "between-skills" were over-shadowed by differences…

Measuring Anxiety in Children: The Importance of Separate Mother and Father Reports

ERIC Educational Resources Information Center

Jansen, Mélou; Bodden, Denise H. M.; Muris, Peter; van Doorn, Marleen; Granic, Isabela

2017-01-01

Background: Previous research suggests that it is important to use parental reports when assessing children's anxiety, but it remains unclear to what extent there are differences between mothers' and fathers' scores and whether these potential differences have any repercussions for the psychometric properties of the scale being used. Objective:…

Parent and Teacher Opinions of Eight Different Ways of Thinking and Learning

ERIC Educational Resources Information Center

Maycock, George

2017-01-01

Parents and teachers at seven elementary schools were surveyed to determine their opinions of the importance of Gardner's eight different ways of thinking and learning. Parent and teacher opinions were highest in the four areas of logical-mathematical, intrapersonal, linguistic and interpersonal, which were all rated very important. Next in…

Rank Advancement in Academic Careers: Sex Differences and the Effects of Productivity.

ERIC Educational Resources Information Center

Long, J. Scott; And Others

1993-01-01

Presents evidence on sex differences in rank advancement in academic careers, and considers the relative importance of quality and quantity of publications. Results for 556 male and 450 female biochemists show the importance of time in rank and number of publications and that rates of promotion are lower for women. (SLD)

Decisions that Make a Difference in Detecting Differential Item Functioning

ERIC Educational Resources Information Center

Sireci, Stephen G.; Rios, Joseph A.

2013-01-01

There are numerous statistical procedures for detecting items that function differently across subgroups of examinees that take a test or survey. However, in endeavouring to detect items that may function differentially, selection of the statistical method is only one of many important decisions. In this article, we discuss the important decisions…

Judgments of Similarity Are Psychological: The Importance of Importance

ERIC Educational Resources Information Center

Zuriff, G. E.

2006-01-01

Comments on the article by J. S. Hyde (see record EJ733581), which concluded that males and females are similar on most psychological variables. Zuriff suggests that Hyde missed the fact judgments of similarity and difference are psychological, not scientific, and that Hyde was dismissive of dismissal of any gender difference that is dependent…

Value Differentiation in Adolescence: The Role of Age and Cultural Complexity

ERIC Educational Resources Information Center

Daniel, Ella; Schiefer, David; Mollering, Anna; Benish-Weisman, Maya; Boehnke, Klaus; Knafo, Ariel

2012-01-01

Living in complex social worlds, individuals encounter discordant values across life contexts, potentially resulting in different importance of values across contexts. Value differentiation is defined here as the degree to which values receive different importance depending on the context in which they are considered. Early and mid-adolescents (N…

Genetic and environmental influences on the allocation of adolescent leisure time activities.

PubMed

Haberstick, Brett C; Zeiger, Joanna S; Corley, Robin P

2014-01-01

There is a growing recognition of the importance of the out-of-school activities in which adolescents choose to participate. Youth activities vary widely in terms of specific activities and in time devoted to them but can generally be grouped by the type and total duration spent per type. We collected leisure time information using a 17-item leisure time questionnaire in a large sample of same- and opposite-sex adolescent twin pairs (N = 2847). Using both univariate and multivariate genetic models, we sought to determine the type and magnitude of genetic and environmental influences on the allocation of time toward different leisure times. Results indicated that both genetic and shared and nonshared environmental influences were important contributors to individual differences in physical, social, intellectual, family, and passive activities such as watching television. The magnitude of these influences differed between males and females. Environmental influences were the primary factors contributing to the covariation of different leisure time activities. Our results suggest the importance of heritable influences on the allocation of leisure time activity by adolescents and highlight the importance of environmental experiences in these choices.

Genetic and Environmental Influences on the Allocation of Adolescent Leisure Time Activities

PubMed Central

Haberstick, Brett C.; Zeiger, Joanna S.; Corley, Robin P.

2014-01-01

There is a growing recognition of the importance of the out-of-school activities in which adolescents choose to participate. Youth activities vary widely in terms of specific activities and in time devoted to them but can generally be grouped by the type and total duration spent per type. We collected leisure time information using a 17-item leisure time questionnaire in a large sample of same- and opposite-sex adolescent twin pairs (N = 2847). Using both univariate and multivariate genetic models, we sought to determine the type and magnitude of genetic and environmental influences on the allocation of time toward different leisure times. Results indicated that both genetic and shared and nonshared environmental influences were important contributors to individual differences in physical, social, intellectual, family, and passive activities such as watching television. The magnitude of these influences differed between males and females. Environmental influences were the primary factors contributing to the covariation of different leisure time activities. Our results suggest the importance of heritable influences on the allocation of leisure time activity by adolescents and highlight the importance of environmental experiences in these choices. PMID:24967407

What Matters Most to Whom: Racial, Ethnic, and Language Differences in the Health Care Experiences Most Important to Patients.

PubMed

Collins, Rebecca L; Haas, Ann; Haviland, Amelia M; Elliott, Marc N

2017-11-01

Some aspects of patient experience are more strongly related to overall ratings of care than others, reflecting their importance to patients. However, little is known about whether the importance of different aspects of this experience differs across subgroups. To determine whether the aspects of health care most important to patients differ according to patient race, ethnicity, and language preference. In response to the 2013 Medicare Consumer Assessment of Health Plans Study (CAHPS) survey, patients rated their overall health care and completed items measuring five patient experience domains. We estimated a linear regression model to assess associations between overall rating of care and the 5 domains, testing for differences in these relationships for race/ethnicity/language groups, controlling for covariates. In total 242,782 Medicare beneficiaries, age 65 years or older. Overall rating of health care, composite patient experience scores for: doctor communication, getting needed care, getting care quickly, customer service, and care coordination. A joint test of the interactions between the composite scores and the 5 largest racial/ethnic/language subgroups was statistically significant (P <0.0001), suggesting the importance of domains varied across subgroups. Doctor communication had the strongest relationship with care ratings for non-Hispanic whites and English-preferring Hispanics. Getting needed care had the strongest relationship for Spanish-preferring Hispanics and Asian/Pacific Islanders. Doctor communication and getting care quickly were strongest for African Americans. Tailoring quality improvement programs to the factors most important to the racial, ethnic, and language mix of the patient population of the practice, hospital, or plan may more efficiently reduce disparities and improve quality.

Cross-Cultural Comparisons of the Perceived Importance of Conversational Constraints.

ERIC Educational Resources Information Center

Kim, Min-Sun

1994-01-01

Investigates how cultural groups differ in the relative importance they attach to conversational constraints. Suggests that the perceived importance of clarity is higher in the more individualistic cultures but that the perceived importance of avoiding hurting the hearer's feelings and of minimizing imposition is higher in the more collectivistic…

Comparison of anchor-based and distributional approaches in estimating important difference in common cold.

PubMed

Barrett, Bruce; Brown, Roger; Mundt, Marlon

2008-02-01

Evaluative health-related quality-of-life instruments used in clinical trials should be able to detect small but important changes in health status. Several approaches to minimal important difference (MID) and responsiveness have been developed. To compare anchor-based and distributional approaches to important difference and responsiveness for the Wisconsin Upper Respiratory Symptom Survey (WURSS), an illness-specific quality of life outcomes instrument. Participants with community-acquired colds self-reported daily using the WURSS-44. Distribution-based methods calculated standardized effect size (ES) and standard error of measurement (SEM). Anchor-based methods compared daily interval changes to global ratings of change, using: (1) standard MID methods based on correspondence to ratings of "a little better" or "somewhat better," and (2) two-level multivariate regression models. About 150 adults were monitored throughout their colds (1,681 sick days.): 88% were white, 69% were women, and 50% had completed college. The mean age was 35.5 years (SD = 14.7). WURSS scores increased 2.2 points from the first to second day, and then dropped by an average of 8.2 points per day from days 2 to 7. The SEM averaged 9.1 during these 7 days. Standard methods yielded a between day MID of 22 points. Regression models of MID projected 11.3-point daily changes. Dividing these estimates of small-but-important-difference by pooled SDs yielded coefficients of .425 for standard MID, .218 for regression model, .177 for SEM, and .157 for ES. These imply per-group sample sizes of 870 using ES, 616 for SEM, 302 for regression model, and 89 for standard MID, assuming alpha = .05, beta = .20 (80% power), and two-tailed testing. Distribution and anchor-based approaches provide somewhat different estimates of small but important difference, which in turn can have substantial impact on trial design.

[Serum calcium and phosphorus concentration and alkaline phosphatase activity in healthy children during growth and development].

PubMed

Savić, Ljiljana; Savić, Dejan

2008-01-01

Many changes happen during growth and development in an organism as a result of important hormon changes, especially biohumoral ones. These changes make a problem when interpreting biochemical results in pediatric population. The most important changes are intensive calcium and phosphorus metabolic turnover in bone tissue with changes in alkaline phosphatase activity as a result of osteoblast activity. The aim of this study was to follow the serum calcium and phosphorus concentration and alkaline phosphatase activity in children 1-15 years old in different growth and development period and of different sexes and to fortify the influence of growth and development dynamics on biohumoral status in healthy male and female children. We evaluated 117 healthy children of both sexes from 1-15 years of age and divided them into three age groups: 1-5, 6-10 and 11-15 years. We followed the serum calcium and phosphorus concentration and alkaline phosphatase activity in different groups and in different sexes. Our investigation found significantly higher values of serum calcium in boys than in girls with no important changes between the age groups and significantly higher values of serum phosphorus in the youngest age group in all children and in different sexes with no important sex differences. Alkaline phosphatase activity followed the growth spurt and was the biggest in 6-10 years group in girls and in 11-15 years group in boys.

Survey of Expert Opinion on Intelligence: Causes of International Differences in Cognitive Ability Tests

PubMed Central

Rindermann, Heiner; Becker, David; Coyle, Thomas R.

2016-01-01

Following Snyderman and Rothman (1987, 1988), we surveyed expert opinions on the current state of intelligence research. This report examines expert opinions on causes of international differences in student assessment and psychometric IQ test results. Experts were surveyed about the importance of culture, genes, education (quantity and quality), wealth, health, geography, climate, politics, modernization, sampling error, test knowledge, discrimination, test bias, and migration. The importance of these factors was evaluated for diverse countries, regions, and groups including Finland, East Asia, sub-Saharan Africa, Southern Europe, the Arabian-Muslim world, Latin America, Israel, Jews in the West, Roma (gypsies), and Muslim immigrants. Education was rated by N = 71 experts as the most important cause of international ability differences. Genes were rated as the second most relevant factor but also had the highest variability in ratings. Culture, health, wealth, modernization, and politics were the next most important factors, whereas other factors such as geography, climate, test bias, and sampling error were less important. The paper concludes with a discussion of limitations of the survey (e.g., response rates and validity of expert opinions). PMID:27047425

Gender, psychosis and psychotropic drugs: differences and similarities.

PubMed

Groleger, Urban; Novak-Grubic, Virginija

2010-06-01

Acute psychosis is diagnosed by clearly defined operational criteria embedded into international classification systems. Many studies have tried to determine the role of gender in psychosis but mainly in terms of epidemiology and course of illness, most often schizophrenia. There are however also important gender-specific differences in clinical symptoms of acute psychosis. No guidelines or treatment recommendations suggest gender as an important factor in the choice of antipsychotic treatment, which is true for all treatment modalities (antipsychotic, dose, duration). We will review shortly available literature and present some of our own research data on gender differences in clinical presentations of acute psychosis. When the diagnosis of an illness depends almost entirely on symptoms and their presentations as in the case of acute psychosis, important gender specific differences might challenge the diagnostic process as well as treatment choice and course of psychosis. Our as well as other data confirm that acute psychosis manifest itself differently in males and females. To define further the impact of observed differences we need further research into gender specific clinical and not just epidemiological variables.

Comparison of untreated adolescent idiopathic scoliosis with normal controls: a review and statistical analysis of the literature.

PubMed

Rushton, Paul R P; Grevitt, Michael P

2013-04-20

Review and statistical analysis of studies evaluating health-related quality of life (HRQOL) in adolescents with untreated adolescent idiopathic scoliosis (AIS) using Scoliosis Research Society (SRS) outcomes. To apply normative values and minimum clinical important differences for the SRS-22r to the literature. Identify whether the HRQOL of adolescents with untreated AIS differs from unaffected peers and whether any differences are clinically relevant. The effect of untreated AIS on adolescent HRQOL is uncertain. The lack of published normative values and minimum clinical important difference for the SRS-22r has so far hindered our interpretation of previous studies. The publication of this background data allows these studies to be re-examined. Using suitable inclusion criteria, a literature search identified studies examining HRQOL in untreated adolescents with AIS. Each cohort was analyzed individually. Statistically significant differences were identified by using 95% confidence intervals for the difference in SRS-22r domain mean scores between the cohorts with AIS and the published data for unaffected adolescents. If the lower bound of the confidence interval was greater than the minimum clinical important difference, the difference was considered clinically significant. Of the 21 included patient cohorts, 81% reported statistically worse pain than those unaffected. Yet in only 5% of cohorts was this difference clinically important. Of the 11 cohorts included examining patient self-image, 91% reported statistically worse scores than those unaffected. In 73% of cohorts this difference was clinically significant. Affected cohorts tended to score well in function/activity and mental health domains and differences from those unaffected rarely reached clinically significant values. Pain and self-image tend to be statistically lower among cohorts with AIS than those unaffected. The literature to date suggests that it is only self-image which consistently differs clinically. This should be considered when assessing the possible benefits of surgery.

A 3.5 year diary study: Remembering and life story importance are predicted by different event characteristics.

PubMed

Thomsen, Dorthe Kirkegaard; Jensen, Thomas; Holm, Tine; Olesen, Martin Hammershøj; Schnieber, Anette; Tønnesvang, Jan

2015-11-01

Forty-five participants described and rated two events each week during their first term at university. After 3.5 years, we examined whether event characteristics rated in the diary predicted remembering, reliving, and life story importance at the follow-up. In addition, we examined whether ratings of life story importance were consistent across a three year interval. Approximately 60% of events were remembered, but only 20% of these were considered above medium importance to life stories. Higher unusualness, rehearsal, and planning predicted whether an event was remembered 3.5 years later. Higher goal-relevance, importance, emotional intensity, and planning predicted life story importance 3.5 years later. There was a moderate correlation between life story importance rated three months after the diary and rated at the 3.5 year follow-up. The results suggest that autobiographical memory and life stories are governed by different mechanisms and that life story memories are characterized by some degree of stability. Copyright © 2015 Elsevier Inc. All rights reserved.

Which aspects of health are most important for patients with spondyloarthritis? A Best Worst Scaling based on the ASAS Health Index.

PubMed

Kiltz, Uta; Essers, Ivette; Hiligsmann, Mickael; Braun, Juergen; Maksymowych, Walter P; Taylor, William J; van der Heijde, Désirée; Boonen, Annelies

2016-10-01

The aim was to investigate the importance of aspects of health for patients with axial SpA (axSpA) and to explore differences across different subgroups. A Best Worst Scaling exercise was conducted in patients with axSpA from 20 countries (10 patients per country) worldwide. Using the 17 items of the Assessment of SpondyloArthritis international Society Health Index, a set of 17 choice tasks was generated. Patients had to indicate in each choice task the most and least important out of four varying items. The hierarchical Bayes method was used to estimate the relative importance score for each item (summing to 100). Subgroup comparisons were performed for relevant demographic (gender, age, work status, geographical area and education) and disease characteristics (SpA phenotype, disease duration and disease activity) using one-way analysis of variance or the Mann-Whitney U-test. The experiment was completed by 199 patients with axSpA [117 (58.8%) men, mean (sd) age 42.3 (13.6) years, mean (sd) disease duration 11.1 (11.2) years, 130 (65.3%) AS]. The highest relative importance was assigned to pain (14.2; 95% CI: 13.8, 14.6), sleep (10.3; 95% CI: 9.6, 11.0), being exhausted (9.6; 95% CI: 9.0, 10.3), standing (9.25; 95% CI: 8.5, 10.0) and motivation to do anything that requires physical effort (8.7; 95% CI: 8.1, 9.3). The lowest relative importance was assigned to sexual relationships, toileting, contact with people, driving and washing hair. Differences between subgroups were small or in aspects with lower importance. A clear gradient was seen in the importance of the different aspects of health that impact functioning of patients with axSpA. Differences between subgroups were small or non-existent. These findings help to align clinical care to patients' needs. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex.

PubMed

Steinke, S; Bruland, P; Blome, C; Osada, N; Dugas, M; Fritz, F; Augustin, M; Ständer, S

2017-02-01

Chronic pruritus (CP) is present in approximately one-third of all dermatological patients. Diagnostics and treatment are challenging and impair patients' quality of life. To analyse therapeutic needs in terms of the importance of treatment goals in a large sample of patients with CP. Routine data of 2747 patients with CP were analysed with descriptive methods and significance tests (univariate and multivariate variance analyses). The importance of 27 need items was measured using the Patient Needs Questionnaire of the Patient Benefit Index. The most important needs were to find a clear diagnosis and treatment, to no longer experience itching and to have confidence in the therapy, which were quite or very important to > 90% of the patients. The least important goals concerned a normal working or sex life. Nine needs related mostly to disease and psychological symptoms, and some social needs differed in importance between sexes (P ≤ 0·05). Patients with pruritus on inflamed skin or with chronic scratch lesions judged more than half of all needs as more important than did patients with pruritus on noninflamed skin (P ≤ 0·05). In the multivariate model, age, pruritus intensity and quality of life had a significant effect on the importance of therapeutic needs besides sex and pruritus classification. Patients with CP present high levels of various therapeutic needs with differences by sex and clinical phenotype. The most important needs can be addressed through medical activities such as appropriate itch medication and a trustful doctor-patient relationship. © 2016 British Association of Dermatologists.

In vitro antimicrobial susceptibility of Mycoplasma bovis isolated in Israel from local and imported cattle.

PubMed

Gerchman, Irena; Levisohn, Sharon; Mikula, Inna; Lysnyansky, Inna

2009-06-12

Monitoring of susceptibility to antibiotics in field isolates of pathogenic bovine mycoplasmas is important for appropriate choice of treatment. Our study compared in vitro susceptibility profiles of Mycoplasma bovis clinical strains, isolated during 2005-2007 from Israeli and imported calves. Minimal inhibitory concentration (MIC) values were determined for macrolides by the microbroth dilution test, for aminoglycosides by commercial Etest, and for fluoroquinolones and tetracyclines by both methods. Notably, although correlation between the methods was generally good, it was not possible to determine the MIC endpoint for enrofloxacin-resistant strains (MIC > or =2.5 microg/ml in the microtest) by Etest. Comparison of antibiotic susceptibility profiles between local and imported M. bovis strains revealed that local strains were significantly more resistant to macrolides than most isolates from imported animals, with MIC(50) of 128 microg/ml vs. 2 microg/ml for tilmicosin and 8 microg/ml vs. 1 microg/ml for tylosin, respectively. However, local strains were more susceptible than most imported strains to fluoroquinolones and spectinomycin. Difference in susceptibility to tetracycline, doxycycline and oxytetracycline between local and imported strains was expressed in MIC(90) values for imported strains in the susceptible range compared to intermediate susceptibility for local strains. The marked difference in susceptibility profiles of M. bovis strains isolated from different geographical regions seen in this study emphasizes the necessity for performing of the antimicrobial susceptibility testing periodically and on a regional basis.

Setting Preferences of High and Low Use River Recreationists: How Different are They?

NASA Astrophysics Data System (ADS)

Kainzinger, Silvia; Arnberger, Arne; Burns, Robert C.

2016-11-01

Whitewater boaters often choose a river based on their preferences for attributes important for their trip experience. This study explored whether preferences and tradeoffs of whitewater boaters for social, resource, and managerial attributes of riverscapes differ among a high and a low use river in the United States by employing a stated choice approach. River trip scenarios were displayed using verbal descriptions and computer-generated photographs. Results indicate that use levels were more important for boaters on the low use river, whereas river difficulty and river access fee was of higher importance for the high use river boaters, who are more involved in this whitewater activity. Preferences for waiting times and trip length did not differ between the samples. Findings suggest that whitewater boaters of high and low use rivers have a different tradeoff behavior among river setting attributes, which has implications for river recreation management.

A comparison of six potential evapotranspiration methods for regional use in the Southeastern United States

Treesearch

Jianbiao Lu; Ge Sun; Steven G. McNulty; Devendra Amatya

2005-01-01

Potential evapotranspiration (PET) is an important index of hydrologic budgets at different spatial scales and is a critical variable for understanding regional biological processes. It is often an important variable in estimating actual evapotranspiration (AET) in rainfall-runoff and ecosystem modeling. However, PET is defined in different ways in the literature and...

Language, Space, Time: Anthropological Tools and Scientific Exploration on Mars

NASA Technical Reports Server (NTRS)

Wales, Roxana

2005-01-01

This viewgraph presentation reviews the importance of social science disciplines in the scientific exploration of Mars. The importance of language, workspace, and time differences are reviewed. It would appear that the social scientist perspective in developing a completely new workspace, keeping track of new vocabulary and the different time zones (i.e., terrestrial and Martian) was useful.

Diminishing the Divisions among Us: Reading and Writing across Difference in Theory and Method in the Sociology of Education

ERIC Educational Resources Information Center

Weis, Lois; Jenkins, Heather; Stich, Amy

2009-01-01

Evidenced in several now classic reviews of the field, much has been made of theoretical and methodological "difference" with regard to research in the sociology of education. Although such renditions often constitute important intellectual contributions, the authors suggest that it is increasingly important to read across theoretical and…

Childhood Social Anxiety and Social Support-Seeking: Distinctive Links with Perceived Support from Teachers

ERIC Educational Resources Information Center

Leeves, Sylvia; Banerjee, Robin

2014-01-01

Social support-seeking is recognised as an important strategy used by children to cope with negative emotions. However, there are important gaps in our knowledge about children's perceptions of different sources of social support, and the associations that these perceptions have with individual differences in socio-emotional functioning. The…

Pancultural self-enhancement.

PubMed

Sedikides, Constantine; Gaertner, Lowell; Toguchi, Yoshiyasu

2003-01-01

The culture movement challenged the universality of the self-enhancement motive by proposing that the motive is pervasive in individualistic cultures (the West) but absent in collectivistic cultures (the East). The present research posited that Westerners and Easterners use different tactics to achieve the same goal: positive self-regard. Study 1 tested participants from differing cultural backgrounds (the United States vs. Japan), and Study 2 tested participants of differing self-construals (independent vs. interdependent). Americans and independents self-enhanced on individualistic attributes, whereas Japanese and interdependents self-enhanced on collectivistic attributes. Independents regarded individualistic attributes, whereas interdependents regarded collectivistic attributes, as personally important. Attribute importance mediated self-enhancement. Regardless of cultural background or self-construal, people self-enhance on personally important dimensions. Self-enhancement is a universal human motive.

Comparison of the efficacy and safety of pollen allergen extracts using skin prick testing and serum specific IgE as references.

PubMed

Visitsunthorn, Nualanong; Visitsuntho, Kittipos; Pacharn, Punchama; Jirapongsananuruk, Orathai; Bunnag, Chaweewan

2017-12-01

Allergen extracts may be different due to the difference in dissemination of allergen-containing species in various geographical areas. Therefore, we wish to develop our own extracts to ensure the precision and quality of diagnosis. To compare the efficacy and safety of our locally prepared pollen allergen extracts to imported ones, using skin prick testing (SPT) and serum specific IgE (sIgE) as references. This prospective, randomized, double-blinded, self-controlled study was performed in respiratory allergic adult volunteers who are sensitized to at least one kind of pollen. Each subject was pricked with our Bermuda grass, Johnson grass and careless weed pollen allergen extracts, and also with the imported ones. sIgE levels were measured by using ImmunoCAP?. In 68 volunteers, our Bermuda, Johnson and careless weed extracts showed 91.2%, 45.6% and 54.4% positive SPTs, respectively, while for the imported ones 73.5%, 45.6% and 54.4% SPTs were positive, respectively. No adverse reaction was found in all procedures. The concentration of 10,000 BAU/mL of Bermuda grass, 1 : 20 w/v or 10,000 PNU/mL of Johnson grass and 1 : 40 w/v or 10,000 PNU/mL of careless weed yielded the most positive SPT results. There was no significant difference in mean wheal diameter (MWD) yielded from using local and imported extracts. Significant correlation was found between MWDs of imported pollen extracts and serum sIgE levels (p < 0.01). No significant difference between SPT results of local and imported pollen allergen extracts was found. Significant correlation was found between MWDs of imported pollen extract SPT and serum sIgE levels.

Signals of speciation: Volatile organic compounds resolve closely related sagebrush taxa, suggesting their importance in evolution

Treesearch

Deidre M. Jaeger; Justin B. Runyon; Bryce A. Richardson

2016-01-01

Volatile organic compounds (VOCs) play important roles in the environmental adaptation and fitness of plants. Comparison of the qualitative and quantitative differences in VOCs among closely related taxa and assessing the effects of environment on their emissions are important steps to deducing VOC function and evolutionary importance.

Sex and gender differences in pain and analgesia.

PubMed

Mogil, Jeffrey S; Bailey, Andrea L

2010-01-01

It is a clinical reality that women make up the large majority of chronic pain patients, and there is now consensus from laboratory experiments that when differences are seen, women are more sensitive to pain than men. Research in this field has now begun to concentrate on finding explanations for this sex difference. Although sex differences in sociocultural, psychological, and experiential factors likely play important roles, evidence largely from animal studies has revealed surprisingly robust and often qualitative sex differences at low levels of the neuraxis. Although not yet able to affect clinical practice, the continued study of sex differences in pain may have important implications for the development of new analgesic strategies. Copyright © 2010 Elsevier B.V. All rights reserved.

Stakeholder Perspectives on Creating and Maintaining Trust in Community-Academic Research Partnerships.

PubMed

Frerichs, Leah; Kim, Mimi; Dave, Gaurav; Cheney, Ann; Hassmiller Lich, Kristen; Jones, Jennifer; Young, Tiffany L; Cene, Crystal W; Varma, Deepthi S; Schaal, Jennifer; Black, Adina; Striley, Catherine W; Vassar, Stefanie; Sullivan, Greer; Cottler, Linda B; Brown, Arleen; Burke, Jessica G; Corbie-Smith, Giselle

2017-02-01

Community-academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders' perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members ( n = 66), health care providers ( n = 38), and academic researchers ( n = 44). All stakeholder groups rated "authentic communication" and "reciprocal relationships" the highest in importance. Community members rated "communication/methodology to resolve problems" ( M = 4.23, SD = 0.58) significantly higher than academic researchers ( M = 3.87, SD = 0.67) and health care providers ( M = 3.89, SD = 0.62; p < .01) and had different perspectives regarding the importance of issues related to "sustainability." The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.

Exploring preferences for symptom management in primary care: a discrete choice experiment using a questionnaire survey.

PubMed

McAteer, Anne; Yi, Deokhee; Watson, Verity; Norwood, Patricia; Ryan, Mandy; Hannaford, Philip C; Elliott, Alison M

2015-07-01

Symptoms are important drivers for the use of primary care services. Strategies aimed at shifting the focus away from the GP have broadened the range of primary healthcare available. To explore preferences for managing symptoms and investigate trade-offs that the public are willing to make when deciding between different primary care services. UK-wide postal questionnaire survey of 1370 adults. A discrete choice experiment examined management preferences for three symptoms of differing seriousness (diarrhoea, dizziness, and chest pain). Willingness-to-pay estimates compared preferences between symptoms, and by sex, age, and income. Preferences differed significantly between symptoms. 'Self-care' was the preferred action for diarrhoea and 'consulting a GP' for dizziness and chest pain. 'Waiting time' and 'chance of a satisfactory outcome' were important factors for all three symptoms, although their relative importance differed. Broadly, people were more prepared to wait longer and less prepared to trade a good chance of a satisfactory outcome for symptoms rated as more serious. Generally, preferences within subgroups followed similar patterns as for the whole sample, although there were differences in the relative strength of preferences. Despite increased choices in primary care, 'traditional' actions of 'self-care' for minor symptoms and 'GP consultation' for more serious symptoms were preferred. The present findings suggest, however, that people may be willing to trade between different health services, particularly for less serious symptoms. Understanding the relative importance of different factors may help inform interventions aimed at changing management behaviour or improving services. © British Journal of General Practice 2015.

The Importance of Teacher Training for Development of Gifted Students' Creativity: Contributions of Vygotsky

ERIC Educational Resources Information Center

Piske, Fernanda Hellen Ribeiro; Stoltz, Tania; Guérios, Ettiène; de Camargo, Denise; Vestena, Carla Luciane Blum; de Freitas, Samarah Perszel; de Oliveira Machado Barby, Ana Aparecida; Santinello, Jamille

2017-01-01

The creativity is expressed in all individuals, but it manifests itself in different proportions and it may be carried out at different levels. Development levels of this attribute depend on the teacher's mediation in the process of learning. Creativity can be a challenge for most teachers, since they are unaware of its importance and unwittingly…

How can I help you? A study of the perceived importance of different kinds of hospice palliative care volunteer support.

PubMed

Claxton-Oldfield, Stephen; Gosselin, Natasha

2011-06-01

A total of 143 adults were asked to imagine that they had recently been diagnosed with a life-threatening illness. After reading about the roles of hospice palliative care volunteers, participants were asked whether they would use the services of a volunteer to help them and their loved ones get through this difficult time. The vast majority (94.4%) of the participants said they would choose to have a volunteer. These participants were then asked to rate the importance of 23 different supportive tasks that volunteers can perform. These tasks reflected the different kinds of support--emotional, social, practical, informational, and religious/spiritual--that hospice palliative care volunteers typically provide. Overall, the practical support category (eg, ''Having the volunteer run errands for me'') received the highest mean importance rating. Significant gender differences were found for the categories of emotional support (eg, ''Having the volunteer hold my hand'') and social support (eg, ''Having the volunteer share hobbies and interests with me''), with females rating both of these kinds of support as being more important to them than males did. The findings of this study may have practical implications for volunteer program coordinators.

Scorpions from Mexico: From Species Diversity to Venom Complexity.

PubMed

Santibáñez-López, Carlos E; Francke, Oscar F; Ureta, Carolina; Possani, Lourival D

2015-12-24

Scorpions are among the oldest terrestrial arthropods, which are distributed worldwide, except for Antarctica and some Pacific islands. Scorpion envenomation represents a public health problem in several parts of the world. Mexico harbors the highest diversity of scorpions in the world, including some of the world's medically important scorpion species. The systematics and diversity of Mexican scorpion fauna has not been revised in the past decade; and due to recent and exhaustive collection efforts as part of different ongoing major revisionary systematic projects, our understanding of this diversity has changed compared with previous assessments. Given the presence of several medically important scorpion species, the study of their venom in the country is also important. In the present contribution, the diversity of scorpion species in Mexico is revised and updated based on several new systematic contributions; 281 different species are recorded. Commentaries on recent venomic, ecological and behavioral studies of Mexican scorpions are also provided. A list containing the most important peptides identified from 16 different species is included. A graphical representation of the different types of components found in these venoms is also revised. A map with hotspots showing the current knowledge on scorpion distribution and areas explored in Mexico is also provided.

Scorpions from Mexico: From Species Diversity to Venom Complexity

PubMed Central

Santibáñez-López, Carlos E.; Francke, Oscar F.; Ureta, Carolina; Possani, Lourival D.

2015-01-01

Scorpions are among the oldest terrestrial arthropods, which are distributed worldwide, except for Antarctica and some Pacific islands. Scorpion envenomation represents a public health problem in several parts of the world. Mexico harbors the highest diversity of scorpions in the world, including some of the world’s medically important scorpion species. The systematics and diversity of Mexican scorpion fauna has not been revised in the past decade; and due to recent and exhaustive collection efforts as part of different ongoing major revisionary systematic projects, our understanding of this diversity has changed compared with previous assessments. Given the presence of several medically important scorpion species, the study of their venom in the country is also important. In the present contribution, the diversity of scorpion species in Mexico is revised and updated based on several new systematic contributions; 281 different species are recorded. Commentaries on recent venomic, ecological and behavioral studies of Mexican scorpions are also provided. A list containing the most important peptides identified from 16 different species is included. A graphical representation of the different types of components found in these venoms is also revised. A map with hotspots showing the current knowledge on scorpion distribution and areas explored in Mexico is also provided. PMID:26712787

Motives underlying healthy eating: using the Food Choice Questionnaire to explain variation in dietary intake.

PubMed

Pollard, T M; Steptoe, A; Wardle, J

1998-04-01

The Food Choice Questionnaire (FCQ), which measures the reported importance to a given individual of nine factors underlying food choice, and a food frequency questionnaire, were administered to 241 participants, who were also required to classify their diet as either 'standard', 'low in red meat' or 'vegetarian'. Respondents describing their diet as low in red meat attributed greater importance to health, natural content, weight control and ethical concern in their food choice than did those who described their diets as standard, whereas vegetarians differed significantly from those with a standard diet only on the score for ethical concern. Differences between men and women and between students and non-students in the frequency of consumption of a number of foods were shown to be mediated by differences in the importance attached to FCQ factors. Thus the generally healthier diets of women compared to men appeared to be accounted for by the greater importance attributed by women to weight control, natural content and ethical concerns.

Perceptions of Oncologists, Healthcare Policy Makers, Patients and the General Population on the Value of Pharmaceutical Treatments in Oncology.

PubMed

Sacristán, José A; Lizan, Luís; Comellas, Marta; Garrido, Pilar; Avendaño, Cristina; Cruz-Hernández, Juan J; Espinosa, Javier; Dilla, Tatiana

2016-11-01

The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients' individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. Eli Lilly & Co, Madrid (Spain).

A cross-cultural survey of residents' perceived barriers in questioning/challenging authority.

PubMed

Kobayashi, H; Pian-Smith, M; Sato, M; Sawa, R; Takeshita, T; Raemer, D

2006-08-01

To identify perceived barriers to residents' questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents' willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents' decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. We have identified attributes of residents' beliefs of communication, including several cross-cultural differences in the importance of values and issues affecting one's decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage "speaking up". Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.

Identification and Recall of Structurally Important Units in Prose by Mentally Retarded Learners.

ERIC Educational Resources Information Center

Luftig, Richard L.; Johnson, Ronald E.

The study investigated the ability of 80 mildly mentally retarded students (19 to 17 years old) to make accurate judgments of textual idea importance and to differentially and spontaneously remember important rather than unimportant ideas. Ss were assigned to one of six conditions which differed as a function of whether importance judgments were…

Empirical assessment of indices of prey importance in the diets of predacious fish

USGS Publications Warehouse

Liao, H.; Pierce, C.L.; Larscheid, J.G.

2001-01-01

Determining the importance of prey taxa in the diets of predacious species is a frequent objective in fisheries research. Various indices of prey importance are in common use, and all give different results because of their emphasis on different aspects of fish diets. We explored these differences by empirically comparing four well-known indices-percent weight (%W), percent occurrence (%O), percent number (%N), and percent index of relative importance (%IRI)-as well as a modified %IRI (%MIRI), as applied to an extensive data set on the diets of six fish species in Spirit Lake, Iowa. Correlations among all indices were positive but were weaker among component indices (%W, %O, and %N) than between the two compound indices (%IRI and %MIRI); correlations among component indices were also weaker than correlations of compound with component indices. Correlation strength of %MIRI with the three component indices varied greatly (%N %O %W), whereas the correlation strength of %IRI with component indices was similar. Importance values based on %W, %MIRI, and %N depend more on prey size than those based on %IRI and %O. The %W and %MIRI emphasized the importance of large prey taxa, whereas %N emphasized small prey in diets; %IRI and %O were similarly unbiased with respect to prey size. The %O yielded substantially higher importance values than all other indices. Thus, for use as a general index of dietary importance, we believe %IRI provides the optimal balancing of frequency of occurrence, numerical abundance, and abundance by weight of taxa in fish diets.

FoodCASE: A system to manage food composition, consumption and TDS data.

PubMed

Presser, Karl; Weber, David; Norrie, Moira

2018-01-01

Food and nutrition scientists, nowadays, need to manage an increasing amount of data regarding food composition, food consumption and Total Diet Studies (TDS). The corresponding datasets can contain information about several thousand different foods, in different versions from different studies. FoodCASE is a system that has been developed to manage these different datasets. It also support flexible means of linking between datasets and generally provide support for the different processes involved in the acquisition, management and processing of data. In this paper, the most important concepts to implement existing guidelines and standards for proper food data management are presented, as well as different use cases of data import and proofs of concepts demonstrating the ability to manage data in FoodCASE. Copyright © 2016 Elsevier Ltd. All rights reserved.

Separating the impacts of climate change and human activities on streamflow: A review of methodologies and critical assumptions

NASA Astrophysics Data System (ADS)

Dey, Pankaj; Mishra, Ashok

2017-05-01

Climate change and human activity are two major drivers that alter hydrological cycle processes and cause change in spatio-temporal distribution of water availability. Streamflow, the most important component of hydrological cycle undergoes variation which is expected to be influenced by climate change as well as human activities. Since these two affecting conditions are time dependent, having unequal influence, identification of the change point in natural flow regime is of utmost important to separate the individual impact of climate change and human activities on streamflow variability. Subsequently, it is important as well for framing adaptation strategies and policies for regional water resources planning and management. In this paper, a comprehensive review of different approaches used by research community to isolate the impacts of climate change and human activities on streamflow are presented. The important issues pertaining to different approaches, to make rational use of methodology, are discussed so that researcher and policymaker can understand the importance of individual methodology and its use in water resources management. A new approach has also been suggested to select a representative change point under different scenarios of human activities with incorporation of climate variability/change.

Eyes wide open: enhanced pupil dilation when selectively studying important information.

PubMed

Ariel, Robert; Castel, Alan D

2014-01-01

Remembering important information is imperative for efficient memory performance, but it is unclear how we encode important information. The current experiment evaluated two non-exclusive hypotheses for how learners selectively encode important information at the expense of less important information (differential resource allocation and information reduction). To evaluate these hypotheses, we measured changes in learners' pupil diameter and fixation durations while participants performed a selectivity task that involved studying lists consisting of words associated with different point values. Participants were instructed to maximize their score on a free recall task that they completed after studying each list. Participants' pupils dilated more when studying high-valued than low-valued words, and these changes were associated with better memory for high-valued words. However, participants fixated equally on words regardless of their value, which is inconsistent with the information reduction hypothesis. Participants also increased their memory selectivity across lists, but changes in pupil diameter and differences in fixations could not account for this increased selectivity. The results suggest that learners allocate attention differently to items as a function of their value, and that multiple processes and operations contribute to value-directed remembering.

Eyes Wide Open: Enhanced Pupil Dilation When Selectively Studying Important Information

PubMed Central

Ariel, Robert; Castel, Alan D.

2013-01-01

Remembering important information is imperative for efficient memory performance, but it is unclear how we encode important information. The current experiment evaluated two non-exclusive hypotheses for how learners selectively encode important information at the expense of less important information (differential resource allocation and information reduction). To evaluate these hypotheses, we measured changes in learners’ pupil diameter and fixation durations while participants performed a selectivity task that involved studying lists consisting of words associated with different point values. Participants were instructed to maximize their score on a free recall task that they completed after studying each list. Participants’ pupils dilated more when studying high-valued than low-valued words, and these changes were associated with better memory for high-valued words. However, participants fixated equally on words regardless of their value, which is inconsistent with the information reduction hypothesis. Participants also increased their memory selectivity across lists, but changes in pupil diameter and differences in fixations could not account for this increased selectivity. The results suggest that learners allocate attention differently to items as a function of their value, and that multiple processes and operations contribute to value-directed remembering. PMID:24162863

QM/MM MD and Free Energy Simulation Study of Methyl Transfer Processes Catalyzed by PKMTs and PRMTs.

PubMed

Chu, Yuzhuo; Guo, Hong

2015-09-01

Methyl transfer processes catalyzed by protein lysine methyltransferases (PKMTs) and protein arginine methyltransferases (PRMTs) control important biological events including transcriptional regulation and cell signaling. One important property of these enzymes is that different PKMTs and PRMTs catalyze the formation of different methylated product (product specificity). These different methylation states lead to different biological outcomes. Here, we review the results of quantum mechanics/molecular mechanics molecular dynamics and free energy simulations that have been performed to study the reaction mechanism of PKMTs and PRMTs and the mechanism underlying the product specificity of the methyl transfer processes.

QM/MM MD and free energy simulation study of methyl transfer processes catalyzed by PKMTs and PRMTs.

PubMed

Chu, Yuzhuo; Guo, Hong

2015-01-16

Methyl transfer processes catalyzed by protein lysine methyltransferases (PKMTs) and protein arginine methyltransferases (PRMTs) control important biological events including transcriptional regulation and cell signaling. One important property of these enzymes is that different PKMTs and PRMTs catalyze the formation of different methylated product (product specificity). These different methylation states lead to different biological outcomes. Here we review the results of quantum mechanics/molecular mechanics (QM/MM) molecular dynamics (MD) and free energy simulations that have been performed to study the reaction mechanism of PKMTs and PRMTs and the mechanism underlying the product specificity of the methyl transfer processes.

Differences in perceptions of managerial roles by gender among southern business students.

PubMed

Smith, J O; Schellenberger, R E

1991-12-01

Perception of the roles necessary for managerial success based on the 10 verbal descriptors of the Mintzberg roles were gathered from 128 business students at a southern U.S. university. The objective was to assess whether these 72 men and 56 women viewed the importance of the roles differently. Ratings were collected on the 10 roles for each of four different types of managers. The data were analyzed by one-way analysis of variance, chi-squared analysis, and Spearman rank-order correlation. No differences were observed in the perception of men and women in these roles or of their relative importance.

Are Different Professionals Ready to Support Children of Parents with Mental Illness? Evaluating the Impact of a Pan-European Training Programme.

PubMed

Viganò, Giovanni; Kaunonen, Marja; Ryan, Peter; Simpson, Wendy; Dawson, Ian; Tabak, Izabela; Scherbaum, Norbert; Poma, Stefano Zanone

2017-04-01

A training package (pre-tested in a pilot phase) about supporting children who have parents with a mental illness and/or with substance misuse (COPMI) was developed and delivered to 131 different professionals from six different European Countries. A questionnaire about importance, awareness and competence on the issue (8 items on knowledge and 15 items on skills) was developed and completed by participants before and after the training. The training was evaluated by participants as generally very successful in terms of improving the importance, awareness and competence of their knowledge and skills, with a statistically significant difference in the pre-/post-analyses (no decreases occurred). Different professional groups performed differently in the pre-training self-rating scores. The participants in some countries were mainly drawn from one professional group (i.e. teachers in Finland, social workers in Germany and psychologists in Poland). It was found that stigma was considered an extremely important concern even before the training, whilst country-specific legal issues were not taken into proper account in the training. Some possibilities for further refinement of the training programme are suggested.

[Gastritis and gastropathy].

PubMed

Mihály, Emese; Micsik, Tamás; Juhász, Márk; Herszényi, László; Tulassay, Zsolt

2014-01-12

Alterations of the stomach mucosa in response to different adverse effects result in various morphological and clinical symptoms. Gastric mucosa alterations can be classified on the bases of diverse viewpoints. It makes this overview difficult, that identical toxic effects may cause different mucosal changes and different toxic agents may produce similar mucosal appearance. The more accurate understanding of the pathological processes which develop in the stomach mucosa needs reconsideration. The authors make an attempt to define gastritis and gastropathy in order to classify and present their features. Gastritis is a histological definition indicating mucosal inflammation. Acute gastritis is caused by infections. The two most important forms of chronic gastritis are metaplastic atrophic gastritis with an autoimmune origin and Helicobacter pylori inflammation. Gastropathy is the name of different structural alterations of the mucosa. Its most important feature is the paucity of inflammatory signs. Gastropathies can be divided into 4 categories based on the nature of the underlying pathological effect, on its morphological appearance and the way of the development. Differential diagnosis is an important pathological and clinical task because different treatment methods and prognosis.

Estimating the Effect of Health Insurance on Personal Prescription Drug Importation

PubMed Central

Zullo, Andrew R.; Howe, Chanelle J.; Galárraga, Omar

2016-01-01

Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. Importation carries a risk of exposure to counterfeit (i.e., falsified, fraudulent), adulterated, and substandard drugs. Inadequate health insurance may increase the risk of importation. We use inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations. The marginal prevalence difference [95% confidence limits] for those without (prevalence = 0.031) versus those with health insurance was 0.016 [0.011, 0.021]. The prevalence difference was higher among persons who were Hispanic, born in Latin America, Russia, or Europe, traveled to developing countries, and did not use the Internet to fill prescriptions or to find health information. Health insurance coverage may effectively reduce importation, especially among particular subpopulations. PMID:26837427

Faculty perspectives regarding the importance and place of nontechnical competencies in veterinary medical education at five North American colleges of veterinary medicine.

PubMed

Lane, India F; Bogue, E Grady

2010-07-01

To explore perceptions of faculty educators regarding the importance of nontechnical competencies in veterinary graduates and the placement of nontechnical competency development in veterinary education. Survey. All faculty members at 5 North American veterinary medical institutions. Participants rated the importance of 14 nontechnical competencies and indicated in which phase or phases of veterinary education such competencies should be developed (ie, curriculum placement). Differences in mean ratings were statistically evaluated, as were associations between ratings or curriculum placement and respondent institution, gender, experience, and discipline. Mean ratings of importance were above neutral for all competencies and were highest for ethical, critical thinking, and interpersonal and intrapersonal competencies; development of these competencies was favored in preveterinary and veterinary training. Ratings were lower for management and business competencies; development of these and other competencies was placed primarily in the clinical phase of the veterinary curriculum. Basic science, nonveterinarian, and junior faculty appeared to more strongly appreciate the importance of nontechnical skills, whereas large animal and midcareer faculty reported a more reserved degree of support. Female faculty were more likely to place nontechnical competency development throughout the educational process. Participants agreed nontechnical competencies are important for veterinary graduates; however, faculty perceptions differed from previously published findings regarding the relative importance of business and management skills. Those involved in faculty hiring, faculty development, and curricular planning should also be aware of disciplinary and career stage differences affecting faculty perspectives.

Measuring the Enzyme Activity of Arabidopsis Deubiquitylating Enzymes.

PubMed

Kalinowska, Kamila; Nagel, Marie-Kristin; Isono, Erika

2016-01-01

Deubiquitylating enzymes, or DUBs, are important regulators of ubiquitin homeostasis and substrate stability, though the molecular mechanisms of most of the DUBs in plants are not yet understood. As different ubiquitin chain types are implicated in different biological pathways, it is important to analyze the enzyme characteristic for studying a DUB. Quantitative analysis of DUB activity is also important to determine enzyme kinetics and the influence of DUB binding proteins on the enzyme activity. Here, we show methods to analyze DUB activity using immunodetection, Coomassie Brilliant Blue staining, and fluorescence measurement that can be useful for understanding the basic characteristic of DUBs.

A Features Selection for Crops Classification

NASA Astrophysics Data System (ADS)

Liu, Yifan; Shao, Luyi; Yin, Qiang; Hong, Wen

2016-08-01

The components of the polarimetric target decomposition reflect the differences of target since they linked with the scattering properties of the target and can be imported into SVM as the classification features. The result of decomposition usually concentrate on part of the components. Selecting a combination of components can reduce the features that importing into the SVM. The features reduction can lead to less calculation and targeted classification of one target when we classify a multi-class area. In this research, we import different combinations of features into the SVM and find a better combination for classification with a data of AGRISAR.

Personally important posttraumatic growth in adolescents: The effect on self-esteem beyond commonly defined posttraumatic growth.

PubMed

Taku, Kanako; McDiarmid, Leah

2015-10-01

Research on posttraumatic growth (PTG), positive psychological changes that may occur as a result of highly stressful life events, reveals adolescents are able to experience PTG. The current study tests individual differences among adolescents in relative importance of PTG and examines the relationships among personally important PTG, commonly defined PTG, and self-esteem. Adolescents (N = 145) with the mean age of 15.75 (SD = 1.13) completed the Rosenberg Self-Esteem Scale and PTG Inventory, and then reported which items on the PTG Inventory were personally important to them. Results indicated within-scale differences in item importance on the PTG Inventory. Personally important PTG was a better predictor of adolescent self-esteem than commonly defined PTG, measured as total PTGI score or each of the five factors. These findings suggest future research should look at both short-term and long-term effects of personally important PTG as well as commonly defined PTG. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The importance of environmental quality and catch potential to fishing site selection by freshwater anglers in Mississippi

USGS Publications Warehouse

Schramm, H.L.; Gerard, P.D.; Gill, D.A.

2003-01-01

We measured the importance of 24 fishing site attributes to Mississippi freshwater anglers. Factor analysis identified four multiattribute factors as important in the selection of fishing location: CLEAN ENVIRONMENT CATCH, COST AND HARVEST and AMENITIES AND SAFETY. In general, the importance of site selection factors differed little among anglers grouped by preferred type of fish, preferred fishing location (lakes and reservoirs, rivers and streams, ponds, or reservoir tailwaters), usual manner of fishing (engine-powered boat, nonpowered boat, or shore), or change in fishing frequency. COST AND HARVEST was more important to anglers with high harvest orientations. We found low correlations between site selection factor importance scores and angler age, fishing frequency, fishing expenditures, or fishing motivation factors. We suggest that the general lack of differences in site selection factors among angler groups indicates that management strategies to improve fishing site attributes should benefit all angler groups. Clean fishing environments and awareness of the availability of desired sport fishes were "very" or "extremely" important to fishing site selection by more than 70% of Mississippi freshwater anglers and should be priority management objectives.

Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States.

PubMed

Grace, Elsie L; Allen, Rebecca S; Ivey, Keisha; Knapp, Shannon M; Burgio, Louis D

2018-04-01

Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use. Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group. Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use. Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.

Species contributions to single biodiversity values under-estimate whole community contribution to a wider range of values to society.

PubMed

Hiron, Matthew; Pärt, Tomas; Siriwardena, Gavin M; Whittingham, Mark J

2018-05-03

A major task for decision makers is deciding how to consider monetary, cultural and conservation values of biodiversity explicitly when planning sustainable land use. Thus, there is a great need to understand just what "valuing" biodiversity or species really means, e.g. regarding how many and which species are important in providing ecosystem services or other values. Constructing ecosystem-level indices, however, requires weighting the relative contribution of species to the different values. Using farmland birds, we illustrate how species contribute to different biodiversity values, namely utilitarian (pest seed predation potential), cultural (species occurrence in poetry), conservational (declines and rarity) and inherent (all species equal) value. Major contributions to each value are often made by a subset of the community and different species are important for different values, leading to no correlations or, in some cases, negative correlations between species' relative contributions to different values. Our results and methods using relative contributions of species to biodiversity values can aid decisions when weighing different values in policies and strategies for natural resource management. We conclude that acknowledging the importance of the range of biodiversity values that are apparent from different perspectives is critical if the full value of biodiversity to society is to be realised.

Gender differences in emotion expression in children: a meta-analytic review.

PubMed

Chaplin, Tara M; Aldao, Amelia

2013-07-01

Emotion expression is an important feature of healthy child development that has been found to show gender differences. However, there has been no empirical review of the literature on gender and facial, vocal, and behavioral expressions of different types of emotions in children. The present study constitutes a comprehensive meta-analytic review of gender differences and moderators of differences in emotion expression from infancy through adolescence. We analyzed 555 effect sizes from 166 studies with a total of 21,709 participants. Significant but very small gender differences were found overall, with girls showing more positive emotions (g = -.08) and internalizing emotions (e.g., sadness, anxiety, sympathy; g = -.10) than boys, and boys showing more externalizing emotions (e.g., anger; g = .09) than girls. Notably, gender differences were moderated by age, interpersonal context, and task valence, underscoring the importance of contextual factors in gender differences. Gender differences in positive emotions were more pronounced with increasing age, with girls showing more positive emotions than boys in middle childhood (g = -.20) and adolescence (g = -.28). Boys showed more externalizing emotions than girls at toddler/preschool age (g = .17) and middle childhood (g = .13) and fewer externalizing emotions than girls in adolescence (g = -.27). Gender differences were less pronounced with parents and were more pronounced with unfamiliar adults (for positive emotions) and with peers/when alone (for externalizing emotions). Our findings of gender differences in emotion expression in specific contexts have important implications for gender differences in children's healthy and maladaptive development. 2013 APA, all rights reserved

Gender Differences in Emotion Expression in Children: A Meta-Analytic Review

PubMed Central

Chaplin, Tara M.; Aldao, Amelia

2012-01-01

Emotion expression is an important feature of healthy child development that has been found to show gender differences. However, there has been no empirical review of the literature on gender and facial, vocal, and behavioral expressions of different types of emotions in children. The present study constitutes a comprehensive meta-analytic review of gender differences, and moderators of differences, in emotion expression from infancy through adolescence. We analyzed 555 effect sizes from 166 studies with a total of 21,709 participants. Significant, but very small, gender differences were found overall, with girls showing more positive emotions (g = −.08) and internalizing emotions (e.g., sadness, anxiety, sympathy; g = −.10) than boys, and boys showing more externalizing emotions (e.g., anger; g = .09) than girls. Notably, gender differences were moderated by age, interpersonal context, and task valence, underscoring the importance of contextual factors in gender differences. Gender differences in positive emotions were more pronounced with increasing age, with girls showing more positive emotions than boys in middle childhood (g = −.20) and adolescence (g = −.28). Boys showed more externalizing emotions than girls at toddler/preschool age (g = .17) and middle childhood (g = .13) and fewer externalizing emotions than girls in adolescence (g = −.27). Gender differences were less pronounced with parents and were more pronounced with unfamiliar adults (for positive emotions) and with peers/when alone (for externalizing emotions). Our findings of gender differences in emotion expression in specific contexts have important implications for gender differences in children’s healthy and maladaptive development. PMID:23231534

The Importance of Factors Related to Nurse Retention: Using the Baptist Health Nurse Retention Questionnaire, Part 2.

PubMed

Bugajski, Andrew; Lengerich, Alex; Marchese, Matthew; Hall, Brittany; Yackzan, Susan; Davies, Claire; Brockopp, Dorothy

2017-06-01

The purpose of this study was to examine the importance of factors related to nurse retention. Retaining nurses within the healthcare system is a challenge for hospital administrators. Understanding factors important to nurse retention is essential. Responses of nurses (n = 279) to the Baptist Health Nurse Retention Questionnaire (BHNRQ) at a 391-bed Magnet® redesignated community hospital were analyzed to explore differences in importance scores of bedside nurses. The results demonstrate that each of the 12 items on the BHNRQ was moderately to highly important. A multivariate analysis of variance based on generation, degree, unit, and experience revealed no significant differences on subscale scores (nursing practice, management, and staffing). Themes derived from the comment section on the BHNRQ were consistent with quantitative findings. Clinical and managerial competence, engagement with their employees, and presence on the unit are keys to retaining a satisfied nursing workforce.

Citizenship beyond politics: the importance of political, civil and social rights and responsibilities among women and men.

PubMed

Bolzendahl, Catherine; Coffé, Hilde

2009-12-01

Previous research has suggested that men are more engaged as citizens than are women. Yet, little is known about gender cleavages across a variety of citizenship norms. To what extent do men and women define citizenship differently? To address that question, this study examines the importance men and women assign various citizenship rights and responsibilities using 2004 ISSP data from 18 Western, industrialized nations. Using a disaggregated approach to understanding definitions of citizenship, we examine political, civil, and social rights and responsibilities. After controlling for a variety of demographic and attitudinal influences, we find that men and women are not different in their views regarding the importance of political responsibilities. However, women do view political rights as significantly more important than do men. Further, in comparison to men, women view both civil and social responsibilities and rights domains as significantly more important.

Soldier as a System Value Analysis

DTIC Science & Technology

2008-09-01

effort is to use established quantitative methods in the development of the framework and explore possible metrics for the assessment of applicable...and ease of use is an important part of the development of the holistic Soldier system. Small details can make a big difference to a Soldier in harsh...important (Friedl and Allan, 2004). Different kinds of environmental stressors include heat, cold, hypobaric hypoxia, physical work, energy

An assessment of dead wood patterns and their relationships with biophysical characteristics in two landscapes with different disturbance histories in coastal Oregon, USA

Treesearch

Rebeccam S.H. Kennedy; Thomas A. Spies

2007-01-01

Understanding the relative importance of landscape history, topography, vegetation, and climate to dead wood patterns is important for assessing pattern-process relationships related to dead wood and associated biodiversity. We sampled dead wood at four topographic positions in two landscapes (1400 to 2100 km2) that experienced different wildfire...

Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

PubMed

Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan

2015-01-01

The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

Gender awareness among physicians--the effect of specialty and gender. A study of teachers at a Swedish medical school.

PubMed

Risberg, Gunilla; Hamberg, Katarina; Johansson, Eva E

2003-10-27

An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties. Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups. There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.

The complex roles of space and environment in structuring functional, taxonomic and phylogenetic beta diversity of frogs in the Atlantic Forest

PubMed Central

Luiz, Amom Mendes; Sawaya, Ricardo J.

2018-01-01

Ecological communities are complex entities that can be maintained and structured by niche-based processes such as environmental conditions, and spatial processes such as dispersal. Thus, diversity patterns may be shaped simultaneously at different spatial scales by very distinct processes. Herein we assess whether and how functional, taxonomic, and phylogenetic beta diversities of frog tadpoles are explained by environmental and/or spatial predictors. We implemented a distance–based redundancy analysis to explore variation in components of beta diversity explained by pure environmental and pure spatial predictors, as well as their interactions, at both fine and broad spatial scales. Our results indicated important but complex roles of spatial and environmental predictors in structuring phylogenetic, taxonomic and functional beta diversities. The pure fine-scales spatial fraction was more important in structuring all beta diversity components, especially to functional and taxonomical spatial turnover. Environmental variables such as canopy cover and vegetation structure were important predictors of all components, but especially to functional and taxonomic beta diversity. We emphasize that distinct factors related to environment and space are affecting distinct components of beta diversity in different ways. Although weaker, phylogenetic beta diversity, which is structured more on biogeographical scales, and thus can be represented by spatially structured processes, was more related to broad spatial processes than other components. However, selected fine-scale spatial predictors denoted negative autocorrelation, which may be revealing the existence of differences in unmeasured habitat variables among samples. Although overall important, local environmental-based processes explained better functional and taxonomic beta diversity, as these diversity components carry an important ecological value. We highlight the importance of assessing different components of diversity patterns at different scales by spatially explicit models in order to improve our understanding of community structure and help to unravel the complex nature of biodiversity. PMID:29672575

Trial outcomes and information for clinical decision-making: a comparative study of opinions of health professionals.

PubMed

McNair, Angus G K; Brookes, Sara T; Whistance, Robert N; Forsythe, Rachael O; Macefield, Rhiannon; Rees, Jonathan; Jones, James; Smith, George; Pullyblank, Anne M; Avery, Kerry N L; Thomas, Michael G; Sylvester, Paul A; Russell, Anne; Oliver, Alfred; Morton, Dion; Kennedy, Robin; Jayne, David G; Huxtable, Richard; Hackett, Rowland; Dutton, Susan J; Coleman, Mark G; Card, Mia; Brown, Julia; Blazeby, Jane M

2016-07-25

Trials are robust sources of data for clinical practice; however, trial outcomes may not reflect what is important to communicate for decision-making. The study compared clinicians' views of outcomes to include in a core outcome set for colorectal cancer (CRC) surgery, with what clinicians considered important information for clinical practice (core information). Potential outcome/information domains were identified through systematic literature reviews, reviews of hospital information leaflets and interviews with patients. These were organized into six categories and used to design a questionnaire survey that asked surgeons and nurses from a sample of CRC centers to rate the importance of each domain as an outcome or as information on a nine-point Likert scale. Respondents were re-surveyed (round 2) following group feedback (Delphi methods). Comparisons were made by calculating the difference in mean scores between the outcomes and information domains, and paired t tests were used to explore the difference between mean scores of the six outcome/information categories. Data sources identified 1216 outcome/information items for CRC surgery that informed a 94-item questionnaire. First-round questionnaires were returned from 63/81 (78 %) of centers. Clinicians rated 76/94 (84 %) domains of higher importance to measure in trials than information to communicate to patients in round 1. This was reduced to 24/47 (51 %) in round 2. The greatest difference was evident in domains regarding survival, which was rated much more highly as a trial outcome than an important piece of information for decision-making (difference in mean 2.3, 95 % CI 1.9 to 2.8, p <0.0001). Specific complications and quality-of-life domains were rated similarly (difference in mean 0.18, 95 % CI -0.1 to 0.4, p = 0.2 and difference in mean 0.2, 95 % CI -0.1 to 0.5, p = 0.2, respectively). Whilst clinicians want to measure key outcomes in trials, they rate these as less important to communicate in decision-making with patients. This discrepancy needs to be explored and addressed to maximize the impact of trials on clinical practice.

A Cross-Sectional Investigation of the Importance of Park Features for Promoting Regular Physical Activity in Parks.

PubMed

Costigan, Sarah A; Veitch, Jenny; Crawford, David; Carver, Alison; Timperio, Anna

2017-11-02

Parks in the US and Australia are generally underutilised, and park visitors typically engage in low levels of physical activity (PA). Better understanding park features that may encourage visitors to be active is important. This study examined the perceived importance of park features for encouraging park-based PA and examined differences by sex, age, parental-status and participation in PA. Cross-sectional surveys were completed by local residents ( n = 2775) living near two parks (2013/2015). Demographic variables, park visitation and leisure-time PA were self-reported, respondents rated the importance of 20 park features for encouraging park-based PA in the next fortnight. Chi-square tests of independence examined differences in importance of park features for PA among sub-groups of local residents (sex, age, parental-status, PA). Park features ranked most important for park-based PA were: well maintained (96.2%), feel safe (95.4%), relaxing atmosphere (91.2%), easy to get to (91.7%), and shady trees (90.3%). All subgroups ranked 'well maintained' as most important. Natural and built environment features of parks are important for promoting adults' park-based PA, and should be considered in park (re)design.

19 CFR 142.42 - Application for Line Release processing.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

19 CFR 142.42 - Application for Line Release processing.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

19 CFR 142.42 - Application for Line Release processing.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

19 CFR 142.42 - Application for Line Release processing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Company Information: name, address, city, state, contact person, phone number of contact person, and... identification number of the shipper or manufacturer. (f) Importer information (if importer is different than filer): Name, address, city, state and country, zip code, importer number, bond number, and surety code...

An EXCEL macro for importing log ASCII standard (LAS) files into EXCEL worksheets

NASA Astrophysics Data System (ADS)

Özkaya, Sait Ismail

1996-02-01

An EXCEL 5.0 macro is presented for converting a LAS text file into an EXCEL worksheet. Although EXCEL has commands for importing text files and parsing text lines, LAS files must be decoded line-by-line because three different delimiters are used to separate fields of differing length. The macro is intended to eliminate manual decoding of LAS version 2.0. LAS is a floppy disk format for storage and transfer of log data as text files. LAS was proposed by the Canadian Well Logging Society. The present EXCEL macro decodes different sections of a LAS file, separates, and places the fields into different columns of an EXCEL worksheet. To import a LAS file into EXCEL without errors, the file must not contain any unrecognized symbols, and the data section must be the last section. The program does not check for the presence of mandatory sections or fields as required by LAS rules. Once a file is incorporated into EXCEL, mandatory sections and fields may be inspected visually.

Factors Important for Work Participation Among Older Workers with Depression, Cardiovascular Disease, and Osteoarthritis: A Mixed Method Study.

PubMed

Boot, Cécile R L; de Kruif, Anja Th C M; Shaw, William S; van der Beek, Allard J; Deeg, Dorly J; Abma, Tineke

2016-06-01

Purpose The aim of this study was to gain insight into differences and similarities in factors important for work participation in older (58-65 years) workers among three different chronic diseases: depression (D), cardiovascular disease (C), and osteoarthritis (O). Methods A mixed method design was used, with a qualitative part (in-depth interviews) with 14 patients with D, C or O and a quantitative part based on the 2002-2003 cohort of the Longitudinal Aging Study Amsterdam. We analysed and compared 3-year (response 93 %) predictors of paid work in 239 participants with D, C, or O using regression analyses. The qualitative findings were integrated with the quantitative findings aiming at complementarity. Results Common factors important for work participation were: working at baseline; male gender; lower age; partner with paid work; better physical and mental health; and higher mastery scores. The qualitative analyses added autonomy in work and provided contextual information regarding the perceived importance of working as factors important for participation in paid work. For D and C, work gave purpose in life and enhanced social contacts. Participation in work was perceived as necessary to structure life only for D. Conclusion Most factors important for work participation were similar for D, C, and O. However, the interviews revealed that for D, the context and the meaning attributed to these factors differed.

Utilizing doctors' attitudes toward staff training to inform a chiropractic technology curriculum.

PubMed

Eberhart, Catherine A; Martel, Stacie S

2015-03-01

The purpose of this study is to determine attitudes of doctors of chiropractic regarding the importance of staff training in specific skill areas to inform the curriculum management process of a chiropractic technology program. A survey was distributed to registrants of a chiropractic homecoming event. On a 5-point Likert scale, respondents were asked to rate the degree of importance that staff members be trained in specific skills. Descriptive statistics were derived, and a 1-way analysis of variance (ANOVA) was used to test differences between groups based on years in practice and level of staff training. Doctors place a high level of importance on oral communication skills and low importance on nutrition and physical examinations. Comparing groups based on years in practice revealed differences in the areas of passive physiotherapies (F = 3.61, p = .015), legal issues/regulations (F = 3.01, p = .032), occupational safety and health regulation (F = 4.27, p = .006), and marketing (F = 2.67, p = .049). Comparing groups based on level of staff training revealed differences in the areas of occupational safety and health regulations (F = 4.56, p = .005) and cardiopulmonary resuscitation (F = 4.91, p = .003). With regard to their assistants, doctors of chiropractic tend to place high importance on office skills requiring effective communication and place less importance on clinical skills such as physical examinations and physiotherapy.

Virtual water trade of agri-food products: Evidence from italian-chinese relations.

PubMed

Lamastra, Lucrezia; Miglietta, Pier Paolo; Toma, Pierluigi; De Leo, Federica; Massari, Stefania

2017-12-01

At global scale, the majority of world water withdrawal is for the agricultural sector, with differences among countries depending on the relevance of agri-food sector in the economy. Virtual water and water footprint could be useful to express the impact on the water resources of each production process and good with the objective to lead to a sustainable use of water at a global level. International trade could be connected to the virtual water flows, in fact through commodities importation, water poor countries can save their own water resources. The present paper focuses on the bilateral virtual water flows connected to the top ten agri-food products traded between Italy and China. Comparing the virtual water flow related to the top 10 agri-food products, the virtual water flow from Italy to China is bigger than the water flow in the opposite direction. Moreover, the composition of virtual water flows is different; Italy imports significant amounts of grey water from China, depending on the different environmental strategies adopted by the two selected countries. This difference could be also related to the fact that traded commodities are very different; the 91% of virtual water imported by Italy is connected to crops products, while the 95% of virtual water imported by China is related to the animal products. Considering national water saving and global water saving, appears that Italy imports virtual water from China while China exerts pressure on its water resources to supply the exports to Italy. This result at global scale implies a global water loss of 129.29millionm3 because, in general, the agri-food products are traded from the area with lower water productivity to the area with the higher water productivity. Copyright © 2017 Elsevier B.V. All rights reserved.

Variations Among Pilots from Different Flight Operations in Party Line Information Requirements for Situation Awareness

NASA Technical Reports Server (NTRS)

Pritchett, Amy; Hansman, John

1997-01-01

Current air traffic control communications use shared VHF voice frequencies from which pilots can obtain 'party line' information (PLI) by overhearing communications addressed to other aircraft. Previous studies have shown that pilots perceive PLI to be important. There is concern that some critical PLI may be lost in the proposed data link environment, where communications will be discretely addressed. Different types of flight operations will be equipped with data link equipment at different times, generating a mixed environment in which some pilots will rely on PLI, while others will receive their information by data link. To research the importance, availability, and accuracy of PLI and to query pilots on the information they feel is necessary for global situation awareness, a survey was distributed to pilots. The pilots were selected from four flight operation groups to study the variations in PLI requirements in the mixed data link environment. Pilots perceived PLI to be important overall, with specific traffic and weather information elements identified as critical. Most PLI elements followed a pattern of higher perceived importance during terminal area operations, final approach, and landing. Pilots from the different flight operation groups identified some elements as particularly important. In a free-response question designed to identify the information requirements for global situation awareness, pilots frequently indicated a need for traffic and weather information. The results of this survey reveal specific concerns to be addressed when implementing data link communications.

Turkish community pharmacists’ self-report of their pharmacies’ physical atmosphere

PubMed Central

Cagirci, Simge; Yegenoglu, Selen; Uner, Mehmet Mithat

2012-01-01

Objective: There is a great recognition that store interiors and exteriors can be designed to create feelings in potential customers which can have an important reinforcing effect on purchase. In this study it is mainly aimed to explore the behaviors of the community pharmacists related to their store's physical environment. Also we aimed to determine whether any difference exist between behaviors of pharmacists serving in high and low socio-economic regions. Methods: A total of 200 pharmacists that work socio-economically different regions were randomly selected from 1424 pharmacists registered in Ankara Chamber of Pharmacists. A uniform questionnaire was applied to the pharmacists by using a face-to-face interview technique. Findings: There are differences in terms of behavior between the pharmacists serving in high and low socio-economic regions within the context of putting importance to their stores’ atmosphere. More pharmacists attach importance to the physical sight of their pharmacy serving in high socio-economic regions (90%) vs. pharmacists in low socio-economic regions (70%). Also pharmacists in high socio-economic regions indicated higher importance level of selection of the decoration equipments (84%) than pharmacists serving in high socio-economic regions (60%). Conclusion: Our study suggests that some pharmacists pay more attention to interior atmospheric elements and others do not. There is a difference in terms of attaching importance to some store atmospheric elements (i.e. physical site, decoration equipment, it's color, wall color, etc.) serving in high versus low socio-economic regions in this context. PMID:24991582

Overview on relative importance of house dust ingestion in human exposure to polybrominated diphenyl ethers (PBDEs): International comparison and Korea as a case.

PubMed

Kim, Seung-Kyu; Kim, Kyoung-Soo; Sang, Hee Hong

2016-11-15

Human exposure studies to polybrominated diphenyl ethers (PBDEs) have reached different results about the relative importance of diet intake and house dust ingestion. In the present study, concentrations of PBDEs in Korean house dust (n=15) from geographically different cities were measured, which were in agreement with a previous result, and compared with those for 22 countries of five continents collected from the most recent scientific literature. Compared with other exposure pathways, diet intake was the most important contributor to total PBDEs exposure of Korean adults (i.e., 71% of overall intake). On global comparison, total PBDE levels in house dust differed by two to three orders of magnitude among the countries investigated, with a significant relationship with gross domestic product (GDP). Whereas, dietary daily intakes exhibited a narrow difference within one order of magnitude worldwide and no relationship with GDP. Consequently, the relative importance of major two pathways depended on the contamination extent of PBDEs in house dust, which may be associated with the amount of PBDE products in use. In most countries except for UK and USA, the contribution of house dust ingestion was less important than diet intake in the current and are expected to much more mitigate in the future. However, how fast the effect of regulation will be reflected to house dust and human exposure is necessary to be monitored steadily. Copyright © 2016 Elsevier B.V. All rights reserved.

The roles of deliberate practice and innate ability in developing expertise: evidence and implications.

PubMed

Kulasegaram, Kulamakan M; Grierson, Lawrence E M; Norman, Geoffrey R

2013-10-01

Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance. This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search. Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability. No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance. © 2013 John Wiley & Sons Ltd.

[Gender differences in the perception of professional achievement in family medicine, Spain].

PubMed

Saletti-Cuesta, Lorena; Delgado, Ana; Ortiz-Gómez, Teresa; López-Fernández, Luis Andrés

2013-01-01

The concept of achievement is important to study the professional development. In medicine there are gender inequalities in career. The purpose was to know and compare the professional achievement's perceptions and attributions of female and male primary care physicians in Andalusia. Qualitative study with 12 focus groups (October 2009 to November 2010). primary care physicians. intentionally segmented by age, sex and health care management. Were conducted by sex: two groups with young physicians, two groups with middle aged and two with health care management. TOTAL: 32 female physician and 33 male physicians. Qualitative content analysis with Nuddist Vivo. Female and male physicians agree to perceive internal achievements and to consider aspects inherent to the profession as external achievements. The most important difference is that female physician related professional achievement with affective bond and male physician with institutional merit. Internal attributions are more important for female physician who also highlight the importance of family, the organization of working time and work-family balance. Patients, continuing education, institutional resources and computer system are the most important attributions for male physician. There are similarities and differences between female and male physicians both in the understanding and the attributions of achievement. The differences are explained by the gender system. The perception of achievement of the female physicians questions the dominant professional culture and incorporates new values in defining achievement. The attributions reflect the unequal impact of family and organizational variables and suggest that the female physicians would be changing gender socialization.

Relative importance of top-down and bottom-up forces in food webs of Sarracenia pitcher communities at a northern and a southern site.

PubMed

Hoekman, David

2011-04-01

The relative importance of resources (bottom-up forces) and natural enemies (top-down forces) for regulating food web dynamics has been debated, and both forces have been found to be critical for determining food web structure. How the relative importance of top-down and bottom-up forces varies between sites with different abiotic conditions is not well understood. Using the pitcher plant inquiline community as a model system, I examine how the relative importance of top-down and bottom-up effects differs between two disparate sites. Resources (ant carcasses) and top predators (mosquito larvae) were manipulated in two identical 4 × 4 factorial press experiments, conducted at two geographically distant sites (Michigan and Florida) within the range of the purple pitcher plant, Sarracenia purpurea, and the aquatic community that resides in its leaves. Overall, top predators reduced the density of prey populations while additional resources bolstered them, and the relative importance of top-down and bottom-up forces varied between sites and for different trophic levels. Specifically, top-down effects on protozoa were stronger in Florida than in Michigan, while the opposite pattern was found for rotifers. These findings experimentally demonstrate that the strength of predator-prey interactions, even those involving the same species, vary across space. While only two sites are compared in this study, I hypothesize that site differences in temperature, which influences metabolic rate, may be responsible for variation in consumer-resource interactions. These findings warrant further investigation into the specific factors that modify the relative importance of top-down and bottom-up effects.

Estimation of the incubation period of influenza A (H1N1-2009) among imported cases: addressing censoring using outbreak data at the origin of importation.

PubMed

Nishiura, Hiroshi; Inaba, Hisashi

2011-03-07

Empirical estimates of the incubation period of influenza A (H1N1-2009) have been limited. We estimated the incubation period among confirmed imported cases who traveled to Japan from Hawaii during the early phase of the 2009 pandemic (n=72). We addressed censoring and employed an infection-age structured argument to explicitly model the daily frequency of illness onset after departure. We assumed uniform and exponential distributions for the frequency of exposure in Hawaii, and the hazard rate of infection for the latter assumption was retrieved, in Hawaii, from local outbreak data. The maximum likelihood estimates of the median incubation period range from 1.43 to 1.64 days according to different modeling assumptions, consistent with a published estimate based on a New York school outbreak. The likelihood values of the different modeling assumptions do not differ greatly from each other, although models with the exponential assumption yield slightly shorter incubation periods than those with the uniform exposure assumption. Differences between our proposed approach and a published method for doubly interval-censored analysis highlight the importance of accounting for the dependence of the frequency of exposure on the survival function of incubating individuals among imported cases. A truncation of the density function of the incubation period due to an absence of illness onset during the exposure period also needs to be considered. When the data generating process is similar to that among imported cases, and when the incubation period is close to or shorter than the length of exposure, accounting for these aspects is critical for long exposure times. Copyright © 2010 Elsevier Ltd. All rights reserved.

Origin of resources and trophic pathways in a large SW Atlantic estuary: An evaluation using stable isotopes

NASA Astrophysics Data System (ADS)

Botto, Florencia; Gaitán, Esteban; Mianzan, Hermes; Acha, Marcelo; Giberto, Diego; Schiariti, Agustín; Iribarne, Oscar

2011-03-01

The Río de la Plata (34° 36' S, 55° 58' W; Argentina and Uruguay) estuary, one of the most important South American estuarine environments, is characterized by weak seasonal freshwater discharge, low tidal amplitude (<1 m), a wide and permanent connection to the sea, and a salt-wedge regime. Using stable isotope analysis, we explored the relative importance of the different sources of primary production in the food web. Our results show that phytoplankton and macrodetritus from terrestrial salt and freshwater marshes both contribute to the food web of the Río de la Plata estuary. On the basis of the sampled species, we identified four trophic levels. The clam Mactra isabelleana, the calanoid copepod Acartia tonsa, and the opossum shrimp Neomysis americana are the primary consumers. The rays Atlantoraja castelnaui and Squatina guggenheim and the shark Galeorhinus galeus are the top predators. The Río de la Plata food web shows an important input of nutrients derived from phytoplankton. Rays, sharks, and predatory gastropods reveal an important contribution of C4 plants (likely Spartina spp.). However, production derived from C3 plants is also important for some species. The fishes Brazilian menhaden, Brevoortia aurea; the stripped weakfish Cynoscion guatucupa; and the whitemouth croaker, Micropogonias furnieri, showed differences in their isotopic signatures as juveniles and adults, indicating different food sources, and they were therefore treated as different components of the food web. Our data suggest that detritus from salt and freshwater marshes is reaching the Río de la Plata estuary and can be an important allocthonous source of energy to this environment.

Scale-up of the electrokinetic fence technology for the removal of pesticides. Part I: Some notes about the transport of inorganic species.

PubMed

López-Vizcaíno, R; Risco, C; Isidro, J; Rodrigo, S; Saez, C; Cañizares, P; Navarro, V; Rodrigo, M A

2017-01-01

This work describes the application electrokinetic fence technology to a soil polluted with herbicides in a large prototype containing 32 m 3 of soil. It compares performance in this large facility with results previously obtained in a pilot-scale mockup (175 L) and with results obtained in a lab-scale soil column (1 L), all of them operated under the same driving force: an electric field of 1.0 V cm -1 . Within this wide context, this work focuses on the effect on inorganic species contained in soil and describes the main processes occurring in the prototype facility, as well as the differences observed respect to the lower scale plants. Thus, despite the same processes can be described in the three plants, important differences are observed in the evolution of the current intensity, moisture and conductivity. They can be related to the less important electroosmotic fluxes in the larger facilities and to the very different distances between electrodes, which lead to very different distribution of species and even to a very different evolution of the resulting current intensity. 2-D maps of the main species at different relevant moments of the test are discussed and important information is drawn from them. Ions depletion from soil appears as a very important problem which should be prevented if the effect of natural bioremediation and/or phytoremediation on the removal or organics aims to be accounted. Copyright © 2016 Elsevier Ltd. All rights reserved.

Structural similarities and differences between the human and the mouse pancreas

PubMed Central

Dolenšek, Jurij; Rupnik, Marjan Slak; Stožer, Andraž

2015-01-01

Mice remain the most studied animal model in pancreas research. Since the findings of this research are typically extrapolated to humans, it is important to understand both similarities and differences between the 2 species. Beside the apparent difference in size and macroscopic organization of the organ in the 2 species, there are a number of less evident and only recently described differences in organization of the acinar and ductal exocrine tissue, as well as in the distribution, composition, and architecture of the endocrine islets of Langerhans. Furthermore, the differences in arterial, venous, and lymphatic vessels, as well as innervation are potentially important. In this article, the structure of the human and the mouse pancreas, together with the similarities and differences between them are reviewed in detail in the light of conceivable repercussions for basic research and clinical application. PMID:26030186

Migration and Tissue Tropism of Innate Lymphoid Cells

PubMed Central

Kim, Chang H.; Hashimoto-Hill, Seika; Kim, Myunghoo

2016-01-01

Innate lymphoid cell (ILCs) subsets differentially populate various barrier and non-barrier tissues, where they play important roles in tissue homeostasis and tissue-specific responses to pathogen attack. Recent findings have provided insight into the molecular mechanisms that guide ILC migration into peripheral tissues, revealing common features among different ILC subsets as well as important distinctions. Recent studies have also highlighted the impact of tissue-specific cues on ILC migration, and the importance of the local immunological milieu. We review these findings here and discuss how the migratory patterns and tissue tropism of different ILC subsets relate to the development and differentiation of these cells, and to ILC-mediated tissue-specific regulation of innate and adaptive immune responses. In this context we outline open questions and important areas of future research. PMID:26708278

Evaluation of Demographics and Social Life Events of Asian (Elephas maximus) and African Elephants (Loxodonta africana) in North American Zoos.

PubMed

Prado-Oviedo, Natalia A; Bonaparte-Saller, Mary K; Malloy, Elizabeth J; Meehan, Cheryl L; Mench, Joy A; Carlstead, Kathy; Brown, Janine L

2016-01-01

This study quantified social life events hypothesized to affect the welfare of zoo African and Asian elephants, focusing on animals that were part of a large multi-disciplinary, multi-institutional elephant welfare study in North America. Age was calculated based on recorded birth dates and an age-based account of life event data for each elephant was compiled. These event histories included facility transfers, births and deaths of offspring, and births and deaths of non-offspring herd mates. Each event was evaluated as a total number of events per elephant, lifetime rate of event exposure, and age at first event exposure. These were then compared across three categories: species (African vs. Asian); sex (male vs. female); and origin (imported vs. captive-born). Mean age distributions differed (p<0.05) between the categories: African elephants were 6 years younger than Asian elephants, males were 12 years younger than females, and captive-born elephants were 20 years younger than imported elephants. Overall, the number of transfers ranged from 0 to 10, with a 33% higher age-adjusted transfer rate for imported African than imported Asian elephants, and 37% lower rate for imported females than males (p<0.05). Other differences (p<0.05) included a 96% higher rate of offspring births for captive-born females than those imported from range countries, a 159% higher rate of birthing event exposures for captive-born males than for their imported counterparts, and Asian elephant females being 4 years younger than African females when they produced their first calf. In summarizing demographic and social life events of elephants in North American zoos, we found both qualitative and quantitative differences in the early lives of imported versus captive-born elephants that could have long-term welfare implications.

Differences in the importance of weather and weather-based decisions among campers in Ontario parks (Canada)

NASA Astrophysics Data System (ADS)

Hewer, Micah J.; Scott, Daniel J.; Gough, William A.

2017-10-01

Parks and protected areas represent an important resource for tourism in Canada, in which camping is a common recreational activity. The important relationship between weather and climate with recreation and tourism has been widely acknowledged within the academic literature. Howbeit, the need for activity-specific assessments has been identified as an on-going need for future research in the field of tourism climatology. Furthermore, very little is known about the interrelationships between personal characteristics and socio-demographics with weather preferences and behavioural thresholds. This study uses a stated climate preferences approach (survey responses) to explore differences in the importance of weather and related weather-based decisions among summer campers in Ontario parks. Statistically significant differences were found among campers for each of the four dependent variables tested in this study. Physically active campers placed greater importance on weather but were still more tolerant of adverse weather conditions. Older campers placed greater importance on weather. Campers travelling shorter distances placed greater importance on weather and were more likely to leave the park early due to adverse weather. Campers staying for longer periods of time were less likely to leave early due to weather and were willing to endure longer durations of adverse weather conditions. Beginner campers placed greater importance on weather, were more likely to leave early due to weather and recorded lower temporal weather thresholds. The results of this study contribute to the study of tourism climatology by furthering understanding of how personal characteristics such as gender, age, activity selection, trip duration, distance travelled, travel experience and life cycles affect weather preferences and decisions, focusing this time on recreational camping in a park tourism context.

Differences in the importance of weather and weather-based decisions among campers in Ontario parks (Canada).

PubMed

Hewer, Micah J; Scott, Daniel J; Gough, William A

2017-10-01

Parks and protected areas represent an important resource for tourism in Canada, in which camping is a common recreational activity. The important relationship between weather and climate with recreation and tourism has been widely acknowledged within the academic literature. Howbeit, the need for activity-specific assessments has been identified as an on-going need for future research in the field of tourism climatology. Furthermore, very little is known about the interrelationships between personal characteristics and socio-demographics with weather preferences and behavioural thresholds. This study uses a stated climate preferences approach (survey responses) to explore differences in the importance of weather and related weather-based decisions among summer campers in Ontario parks. Statistically significant differences were found among campers for each of the four dependent variables tested in this study. Physically active campers placed greater importance on weather but were still more tolerant of adverse weather conditions. Older campers placed greater importance on weather. Campers travelling shorter distances placed greater importance on weather and were more likely to leave the park early due to adverse weather. Campers staying for longer periods of time were less likely to leave early due to weather and were willing to endure longer durations of adverse weather conditions. Beginner campers placed greater importance on weather, were more likely to leave early due to weather and recorded lower temporal weather thresholds. The results of this study contribute to the study of tourism climatology by furthering understanding of how personal characteristics such as gender, age, activity selection, trip duration, distance travelled, travel experience and life cycles affect weather preferences and decisions, focusing this time on recreational camping in a park tourism context.

Chloroplast precursor proteins compete to form early import intermediates in isolated pea chloroplasts.

PubMed

Row, P E; Gray, J C

2001-01-01

In order to ascertain whether there is one site for the import of precursor proteins into chloroplasts or whether different precursor proteins are imported via different import machineries, chloroplasts were incubated with large quantities of the precursor of the 33 kDa subunit of the oxygen-evolving complex (pOE33) or the precursor of the light-harvesting chlorophyll a/b-binding protein (pLHCP) and tested for their ability to import a wide range of other chloroplast precursor proteins. Both pOE33 and pLHCP competed for import into chloroplasts with precursors of the stromally-targeted small subunit of Rubisco (pSSu), ferredoxin NADP(+) reductase (pFNR) and porphobilinogen deaminase; the thylakoid membrane proteins LHCP and the Rieske iron-sulphur protein (pRieske protein); ferrochelatase and the gamma subunit of the ATP synthase (which are both associated with the thylakoid membrane); the thylakoid lumenal protein plastocyanin and the phosphate translocator, an integral membrane protein of the inner envelope. The concentrations of pOE33 or pLHCP required to cause half-maximal inhibition of import ranged between 0.2 and 4.9 microM. These results indicate that all of these proteins are imported into the chloroplast by a common import machinery. Incubation of chloroplasts with pOE33 inhibited the formation of early import intermediates of pSSu, pFNR and pRieske protein.

Parents' Judgments of the Acceptability and Importance of Socially Interactive Robots for Intervening with Young Children with Disabilities. Social Robots Research Reports, Number 1

ERIC Educational Resources Information Center

Dunst, Carl J.; Trivette, Carol M.; Prior, Jeremy; Hamby, Deborah W.; Embler, Davon

2013-01-01

A number of different types of socially interactive robots are being used as part of interventions with young children with disabilities to promote their joint attention and language skills. Parents' judgments of two dimensions (acceptance and importance) of the social validity of four different social robots were the focus of the study described…

THE EDUCATION-HEALTH GRADIENT.

PubMed

Conti, Gabriella; Heckman, James; Urzua, Sergio

2010-05-01

In this paper, we determine the role played by early cognitive, noncognitive, and health endowments. We identify the causal effect of education on health and health-related behaviors. We develop an empirical model of schooling choice and post-schooling outcomes, where both schooling and the outcomes determined in part by schooling are influenced by measured early family environments and latent capabilities (cognitive, noncognitive and health). We show that family background characteristics, and cognitive, noncognitive, and health endowments developed by age 10, are important determinants of labor market and health disparities at age 30. Not properly accounting for personality traits overestimates the importance of cognitive ability in determining adult health. Selection on factors determined early in life explains more than half of the observed difference by education in poor health, depression, and obesity. Education has an important causal effect in explaining differences in many adult outcomes and healthy behaviors. We uncover significant gender differences. We go beyond the current literature which typically estimates mean effects to compute distributions of treatment effects. We show how the health returns to education can vary among individuals who are similar with respect to their observed characteristics, and how a mean effect can hide gains and losses for different individuals. Our research highlights the important role played by the early years in producing health.

The important role of scattered trees on the herbaceous diversity of a grazed Mediterranean dehesa

NASA Astrophysics Data System (ADS)

López-Sánchez, Aida; San Miguel, Alfonso; López-Carrasco, Celia; Huntsinger, Lynn; Roig, Sonia

2016-10-01

Scattered trees are considered keystone structures and play an important role in Mediterranean sylvopastoral systems. Such systems are associated with high biodiversity and provide important natural resources and ecosystem services. In this study, we measured the contribution of scattered trees and different grazing management (cattle, sheep and wildlife only) to the diversity of the grassland sward in a dehesa (open holm oak woodland) located in Central Spain. We analyzed alpha and beta diversity through measurement of species richness, Shannon-Wiener, and Whittaker indices, respectively; and the floristic composition of the herb layer using subplots within two adjacent plots (trees present vs. trees absent) under three different grazing management regimes, including wildlife only, during a year. We found a 20-30% increment in the alpha diversity of wooded plots, compared to those without trees, regardless of grazing management. All beta indices calculated showed more than 60% species turnover. Wooded plots were occupied by different herbaceous species in different heterogeneous microsites (under the canopy, in the ecotone or on open land) created by the trees. Livestock grazing modified species composition (e.g. more nitrophilous species) compared to wildlife only plots. In addition to all their other benefits, trees are important to maintaining grassland diversity in Mediterranean dehesas.

Functional analysis of the MAPK pathways in fungi.

PubMed

Martínez-Soto, Domingo; Ruiz-Herrera, José

The Mitogen-Activated Protein Kinase (MAPK) signaling pathways constitute one of the most important and evolutionarily conserved mechanisms for the perception of extracellular information in all the eukaryotic organisms. The MAPK pathways are involved in the transfer to the cell of the information perceived from extracellular stimuli, with the final outcome of activation of different transcription factors that regulate gene expression in response to them. In all species of fungi, the MAPK pathways have important roles in their physiology and development; e.g. cell cycle control, mating, morphogenesis, response to different stresses, resistance to UV radiation and to temperature changes, cell wall assembly and integrity, degradation of cellular organelles, virulence, cell-cell signaling, fungus-plant interaction, and response to damage-associated molecular patterns (DAMPs). Considering the importance of the phylogenetically conserved MAPK pathways in fungi, an updated review of the knowledge on them is discussed in this article. This information reveals their importance, their distribution in fungal species evolutionarily distant and with different lifestyles, their organization and function, and the interactions occurring between different MAPK pathways, and with other signaling pathways, for the regulation of the most complex cellular processes. Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.

ANTENATAL DETERMINANTS OF PARENTAL ATTACHMENT AND PARENTING ALLIANCE: HOW DO MOTHERS AND FATHERS DIFFER?

PubMed

Luz, Rita; George, Astrid; Vieux, Rachel; Spitz, Elisabeth

2017-03-01

Parental (parent-to-infant) attachment and parenting alliance are defined as two important components of psychoaffective adjustment to the parental role. This study aimed to build a predictive model of parental attachment and parenting alliance for mothers and fathers using partial least squares-structural equation modeling. Specifically, we were interested in assessing how adult romantic attachment, marital quality, and psychological distress influenced parental attachment (parent-to-infant) and parenting alliance. Forty heterosexual couples completed questionnaires during the third trimester of pregnancy and 2 months after childbirth. Results showed that adult romantic attachment, marital quality, and psychological distress were important antenatal determinants of parental attachment and parenting alliance, although they behaved differently for mothers and fathers. Hence, different predictive models were therefore proposed for mothers and fathers. Mothers' attachment to the child was influenced by internal factors as adult attachment dimensions; for fathers, it also depended on mothers' antenatal attachment to the child and on marital quality. Concerning parenting alliance, both mothers and fathers depended on own and partner's variables. Antenatal variables are important for what occurs during the transition to parenthood in terms of parenting adjustment and act differently for mothers and fathers. It thus is important to assess the psychological functioning of both mothers and fathers. © 2017 Michigan Association for Infant Mental Health.

A Broader View: Microbial Enzymes and Their Relevance in Industries, Medicine, and Beyond

PubMed Central

Bose, Sutapa; Rai, Vivek

2013-01-01

Enzymes are the large biomolecules that are required for the numerous chemical interconversions that sustain life. They accelerate all the metabolic processes in the body and carry out a specific task. Enzymes are highly efficient, which can increase reaction rates by 100 million to 10 billion times faster than any normal chemical reaction. Due to development in recombinant technology and protein engineering, enzymes have evolved as an important molecule that has been widely used in different industrial and therapeutical purposes. Microbial enzymes are currently acquiring much attention with rapid development of enzyme technology. Microbial enzymes are preferred due to their economic feasibility, high yields, consistency, ease of product modification and optimization, regular supply due to absence of seasonal fluctuations, rapid growth of microbes on inexpensive media, stability, and greater catalytic activity. Microbial enzymes play a major role in the diagnosis, treatment, biochemical investigation, and monitoring of various dreaded diseases. Amylase and lipase are two very important enzymes that have been vastly studied and have great importance in different industries and therapeutic industry. In this review, an approach has been made to highlight the importance of different enzymes with special emphasis on amylase and lipase in the different industrial and medical fields. PMID:24106701

Assessing Student Theses: Differences and Similarities between Examiners from Different Academic Disciplines

ERIC Educational Resources Information Center

Lundström, Mats; Åström, Maria; Stolpe, Karin; Björklund, Lasse

2016-01-01

The writing of student theses is an important activity at universities and is expected to demonstrate the students' academic skills. In the teacher-education programme, examiners from different academic disciplines are involved in supervising and examining student theses. Moreover, different subject disciplines have different traditions concerning…

Minerals

MedlinePlus

Minerals are important for your body to stay healthy. Your body uses minerals for many different jobs, including keeping your bones, muscles, heart, and brain working properly. Minerals are also important for making enzymes and hormones. ...

Detection of Nonverbal Synchronization through Phase Difference in Human Communication

PubMed Central

Kwon, Jinhwan; Ogawa, Ken-ichiro; Ono, Eisuke; Miyake, Yoshihiro

2015-01-01

Nonverbal communication is an important factor in human communication, and body movement synchronization in particular is an important part of nonverbal communication. Some researchers have analyzed body movement synchronization by focusing on changes in the amplitude of body movements. However, the definition of “body movement synchronization” is still unclear. From a theoretical viewpoint, phase difference is the most important factor in synchronization analysis. Therefore, there is a need to measure the synchronization of body movements using phase difference. The purpose of this study was to provide a quantitative definition of the phase difference distribution for detecting body movement synchronization in human communication. The phase difference distribution was characterized using four statistical measurements: density, mean phase difference, standard deviation (SD) and kurtosis. To confirm the effectiveness of our definition, we applied it to human communication in which the roles of speaker and listener were defined. Specifically, we examined the difference in the phase difference distribution between two different communication situations: face-to-face communication with visual interaction and remote communication with unidirectional visual perception. Participant pairs performed a task supposing lecture in the face-to-face communication condition and in the remote communication condition via television. Throughout the lecture task, we extracted a set of phase differences from the time-series data of the acceleration norm of head nodding motions between two participants. Statistical analyses of the phase difference distribution revealed the characteristics of head nodding synchronization. Although the mean phase differences in synchronized head nods did not differ significantly between the conditions, there were significant differences in the densities, the SDs and the kurtoses of the phase difference distributions of synchronized head nods. These results show the difference in nonverbal synchronization between different communication types. Our study indicates that the phase difference distribution is useful in detecting nonverbal synchronization in various human communication situations. PMID:26208100

Detection of Nonverbal Synchronization through Phase Difference in Human Communication.

PubMed

Kwon, Jinhwan; Ogawa, Ken-ichiro; Ono, Eisuke; Miyake, Yoshihiro

2015-01-01

Nonverbal communication is an important factor in human communication, and body movement synchronization in particular is an important part of nonverbal communication. Some researchers have analyzed body movement synchronization by focusing on changes in the amplitude of body movements. However, the definition of "body movement synchronization" is still unclear. From a theoretical viewpoint, phase difference is the most important factor in synchronization analysis. Therefore, there is a need to measure the synchronization of body movements using phase difference. The purpose of this study was to provide a quantitative definition of the phase difference distribution for detecting body movement synchronization in human communication. The phase difference distribution was characterized using four statistical measurements: density, mean phase difference, standard deviation (SD) and kurtosis. To confirm the effectiveness of our definition, we applied it to human communication in which the roles of speaker and listener were defined. Specifically, we examined the difference in the phase difference distribution between two different communication situations: face-to-face communication with visual interaction and remote communication with unidirectional visual perception. Participant pairs performed a task supposing lecture in the face-to-face communication condition and in the remote communication condition via television. Throughout the lecture task, we extracted a set of phase differences from the time-series data of the acceleration norm of head nodding motions between two participants. Statistical analyses of the phase difference distribution revealed the characteristics of head nodding synchronization. Although the mean phase differences in synchronized head nods did not differ significantly between the conditions, there were significant differences in the densities, the SDs and the kurtoses of the phase difference distributions of synchronized head nods. These results show the difference in nonverbal synchronization between different communication types. Our study indicates that the phase difference distribution is useful in detecting nonverbal synchronization in various human communication situations.

Erickson and Rogers: The Differences Do Make a Difference.

ERIC Educational Resources Information Center

Lopez, Frederick G.

1987-01-01

Extends an earlier discussion by Gunnison (1985) of the similarities between Milton Erickson and Carl Rogers by citing several important differences in their respective counseling approaches. Briefly discusses implications of these differences to the continuing evolution of counseling theory and practice. (Author)

Resting-state fMRI in sleeping infants more closely resembles adult sleep than adult wakefulness

PubMed Central

Snyder, Abraham Z.; Tagliazucchi, Enzo; Laufs, Helmut; Elison, Jed; Emerson, Robert W.; Shen, Mark D.; Wolff, Jason J.; Botteron, Kelly N.; Dager, Stephen; Estes, Annette M.; Evans, Alan; Gerig, Guido; Hazlett, Heather C.; Paterson, Sarah J.; Schultz, Robert T.; Styner, Martin A.; Zwaigenbaum, Lonnie; Schlaggar, Bradley L.

2017-01-01

Resting state functional magnetic resonance imaging (rs-fMRI) in infants enables important studies of functional brain organization early in human development. However, rs-fMRI in infants has universally been obtained during sleep to reduce participant motion artifact, raising the question of whether differences in functional organization between awake adults and sleeping infants that are commonly attributed to development may instead derive, at least in part, from sleep. This question is especially important as rs-fMRI differences in adult wake vs. sleep are well documented. To investigate this question, we compared functional connectivity and BOLD signal propagation patterns in 6, 12, and 24 month old sleeping infants with patterns in adult wakefulness and non-REM sleep. We find that important functional connectivity features seen during infant sleep closely resemble those seen during adult sleep, including reduced default mode network functional connectivity. However, we also find differences between infant and adult sleep, especially in thalamic BOLD signal propagation patterns. These findings highlight the importance of considering sleep state when drawing developmental inferences in infant rs-fMRI. PMID:29149191

Family Background Buys an Education in Minnesota but Not in Sweden

PubMed Central

Johnson, Wendy; Deary, Ian J.; Silventoinen, Karri; Tynelius, Per; Rasmussen, Finn

2010-01-01

Educational attainment, the highest degree or level of schooling obtained, is associated with important life outcomes, at both the individual level and the group level. Because of this, and because education is expensive, the allocation of education across society is an important social issue. A dynamic quantitative environmental-genetic model can help document the effects of social allocation patterns. We used this model to compare the moderating effect of general intelligence on the environmental and genetic factors that influence educational attainment in Sweden and the U.S. state of Minnesota. Patterns of genetic influence on educational outcomes were similar in these two regions, but patterns of shared environmental influence differed markedly. In Sweden, shared environmental influence on educational attainment was particularly important for people of high intelligence, whereas in Minnesota, shared environmental influences on educational attainment were particularly important for people of low intelligence. This difference may be the result of differing access to education: state-supported access (on the basis of ability) to a uniform higher-education system in Sweden, versus family-supported access to a more diverse higher-education system in the United States. PMID:20679521

Resting-state fMRI in sleeping infants more closely resembles adult sleep than adult wakefulness.

PubMed

Mitra, Anish; Snyder, Abraham Z; Tagliazucchi, Enzo; Laufs, Helmut; Elison, Jed; Emerson, Robert W; Shen, Mark D; Wolff, Jason J; Botteron, Kelly N; Dager, Stephen; Estes, Annette M; Evans, Alan; Gerig, Guido; Hazlett, Heather C; Paterson, Sarah J; Schultz, Robert T; Styner, Martin A; Zwaigenbaum, Lonnie; Schlaggar, Bradley L; Piven, Joseph; Pruett, John R; Raichle, Marcus

2017-01-01

Resting state functional magnetic resonance imaging (rs-fMRI) in infants enables important studies of functional brain organization early in human development. However, rs-fMRI in infants has universally been obtained during sleep to reduce participant motion artifact, raising the question of whether differences in functional organization between awake adults and sleeping infants that are commonly attributed to development may instead derive, at least in part, from sleep. This question is especially important as rs-fMRI differences in adult wake vs. sleep are well documented. To investigate this question, we compared functional connectivity and BOLD signal propagation patterns in 6, 12, and 24 month old sleeping infants with patterns in adult wakefulness and non-REM sleep. We find that important functional connectivity features seen during infant sleep closely resemble those seen during adult sleep, including reduced default mode network functional connectivity. However, we also find differences between infant and adult sleep, especially in thalamic BOLD signal propagation patterns. These findings highlight the importance of considering sleep state when drawing developmental inferences in infant rs-fMRI.

Estimating minimally important difference (MID) in PROMIS pediatric measures using the scale-judgment method.

PubMed

Thissen, David; Liu, Yang; Magnus, Brooke; Quinn, Hally; Gipson, Debbie S; Dampier, Carlton; Huang, I-Chan; Hinds, Pamela S; Selewski, David T; Reeve, Bryce B; Gross, Heather E; DeWalt, Darren A

2016-01-01

To assess minimally important differences (MIDs) for several pediatric self-report item banks from the National Institutes of Health Patient-Reported Outcomes Measurement Information System(®) (PROMIS(®)). We presented vignettes comprising sets of two completed PROMIS questionnaires and asked judges to declare whether the individual completing those questionnaires had an important change or not. We enrolled judges (including adolescents, parents, and clinicians) who responded to 24 vignettes (six for each domain of depression, pain interference, fatigue, and mobility). We used item response theory to model responses to the vignettes across different judges and estimated MID as the point at which 50 % of the judges would declare an important change. We enrolled 246 judges (78 adolescents, 85 parents, and 83 clinicians). The MID estimated with clinician data was about 2 points on the PROMIS T-score scale, and the MID estimated with adolescent and parent data was about 3 points on that same scale. The MIDs enhance the value of PROMIS pediatric measures in clinical research studies to identify meaningful changes in health status over time.

Family background buys an education in Minnesota but not in Sweden.

PubMed

Johnson, Wendy; Deary, Ian J; Silventoinen, Karri; Tynelius, Per; Rasmussen, Finn

2010-09-01

Educational attainment, the highest degree or level of schooling obtained, is associated with important life outcomes, at both the individual level and the group level. Because of this, and because education is expensive, the allocation of education across society is an important social issue. A dynamic quantitative environmental-genetic model can help document the effects of social allocation patterns. We used this model to compare the moderating effect of general intelligence on the environmental and genetic factors that influence educational attainment in Sweden and the U.S. state of Minnesota. Patterns of genetic influence on educational outcomes were similar in these two regions, but patterns of shared environmental influence differed markedly. In Sweden, shared environmental influence on educational attainment was particularly important for people of high intelligence, whereas in Minnesota, shared environmental influences on educational attainment were particularly important for people of low intelligence. This difference may be the result of differing access to education: state-supported access (on the basis of ability) to a uniform higher-education system in Sweden versus family-supported access to a more diverse higher-education system in the United States.

Virtual screening of compound libraries.

PubMed

Cerqueira, Nuno M F S A; Sousa, Sérgio F; Fernandes, Pedro A; Ramos, Maria João

2009-01-01

During the last decade, Virtual Screening (VS) has definitively established itself as an important part of the drug discovery and development process. VS involves the selection of likely drug candidates from large libraries of chemical structures by using computational methodologies, but the generic definition of VS encompasses many different methodologies. This chapter provides an introduction to the field by reviewing a variety of important aspects, including the different types of virtual screening methods, and the several steps required for a successful virtual screening campaign within a state-of-the-art approach, from target selection to postfilter application. This analysis is further complemented with a small collection important VS success stories.

Family physicians' beliefs about genetic contributions to racial/ethnic and gender differences in health and clinical decision-making.

PubMed

Warshauer-Baker, Esther; Bonham, Vence L; Jenkins, Jean; Stevens, Nancy; Page, Zintesia; Odunlami, Adebola; McBride, Colleen M

2008-01-01

Greater attention towards genetics as a contributor to group health differences may lead to inappropriate use of race/ethnicity and gender as genetic heuristics and exacerbate health disparities. As part of a web-based survey, 1,035 family physicians (FPs) rated the contribution of genetics and environment to racial/ethnic and gender differences in health outcomes, and the importance of race/ethnicity and gender in their clinical decision-making. FPs attributed racial/ethnic and gender differences in health outcomes equally to environment and genetics. These beliefs were not associated with rated importance of race/ethnicity or gender in clinical decision-making. FPs appreciate the complexity of genetic and environmental influences on health differences by race/ethnicity and gender. Copyright 2008 S. Karger AG, Basel.

The Effect and Relative Importance of Neutral Genetic Diversity for Predicting Parasitism Varies across Parasite Taxa

PubMed Central

Ruiz-López, María José; Monello, Ryan J.; Gompper, Matthew E.; Eggert, Lori S.

2012-01-01

Understanding factors that determine heterogeneity in levels of parasitism across individuals is a major challenge in disease ecology. It is known that genetic makeup plays an important role in infection likelihood, but the mechanism remains unclear as does its relative importance when compared to other factors. We analyzed relationships between genetic diversity and macroparasites in outbred, free-ranging populations of raccoons (Procyon lotor). We measured heterozygosity at 14 microsatellite loci and modeled the effects of both multi-locus and single-locus heterozygosity on parasitism using an information theoretic approach and including non-genetic factors that are known to influence the likelihood of parasitism. The association of genetic diversity and parasitism, as well as the relative importance of genetic diversity, differed by parasitic group. Endoparasite species richness was better predicted by a model that included genetic diversity, with the more heterozygous hosts harboring fewer endoparasite species. Genetic diversity was also important in predicting abundance of replete ticks (Dermacentor variabilis). This association fit a curvilinear trend, with hosts that had either high or low levels of heterozygosity harboring fewer parasites than those with intermediate levels. In contrast, genetic diversity was not important in predicting abundance of non-replete ticks and lice (Trichodectes octomaculatus). No strong single-locus effects were observed for either endoparasites or replete ticks. Our results suggest that in outbred populations multi-locus diversity might be important for coping with parasitism. The differences in the relationships between heterozygosity and parasitism for the different parasites suggest that the role of genetic diversity varies with parasite-mediated selective pressures. PMID:23049796

What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?

PubMed

de Snoo-Trimp, Janine; Widdershoven, Guy; Svantesson, Mia; de Vet, Riekie; Molewijk, Bert

2017-05-01

There has been little attention paid to research on the outcomes of clinical ethics support (CES) or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation (MCD), prior to MCD participation, and to compare results between respondents. This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were 'more open communication', 'better mutual understanding', 'concrete actions', 'see the situation from different perspectives', 'consensus on how to manage the situation' and 'find more courses of action'. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. © 2017 John Wiley & Sons Ltd.

Human presence diminishes the importance of climate in driving fire activity across the United States

USGS Publications Warehouse

Syphard, Alexandra D.; Keeley, Jon E.; Pfaff, Anne Hopkins; Ferschweiler, Ken

2017-01-01

Growing human and ecological costs due to increasing wildfire are an urgent concern in policy and management, particularly given projections of worsening fire conditions under climate change. Thus, understanding the relationship between climatic variation and fire activity is a critically important scientific question. Different factors limit fire behavior in different places and times, but most fire-climate analyses are conducted across broad spatial extents that mask geographical variation. This could result in overly broad or inappropriate management and policy decisions that neglect to account for regionally specific or other important factors driving fire activity. We developed statistical models relating seasonal temperature and precipitation variables to historical annual fire activity for 37 different regions across the continental United States and asked whether and how fire-climate relationships vary geographically, and why climate is more important in some regions than in others. Climatic variation played a significant role in explaining annual fire activity in some regions, but the relative importance of seasonal temperature or precipitation, in addition to the overall importance of climate, varied substantially depending on geographical context. Human presence was the primary reason that climate explained less fire activity in some regions than in others. That is, where human presence was more prominent, climate was less important. This means that humans may not only influence fire regimes but their presence can actually override, or swamp out, the effect of climate. Thus, geographical context as well as human influence should be considered alongside climate in national wildfire policy and management.

Examination of important life experiences of the oldest-old: cross-cultural comparisons of U.S. and Japanese centenarians.

PubMed

da Rosa, Grace; Martin, Peter; Gondo, Yasuyuki; Hirose, Nobuyoshi; Ishioka, Yoshiko; Poon, Leonard W

2014-06-01

The purpose of this study was to compare the most important life events reported by U.S. and Japanese centenarians. This study included a population-based sample of 239 U.S. centenarians from the Georgia Centenarian Study and 304 Japanese centenarians from the Tokyo Centenarian Study. Two open-ended life events questions were categorized and grouped into different life event domains. Several cross-tabulations were computed to investigate culture and gender differences in most important life event domains. Next, four configural frequency analyses were conducted using Neuroticism, Extraversion, and the first most often mentioned life event domain for each sample (i.e., marriage and historical life events). Results suggest that events related to marriage were the most frequent important event domains mentioned by U.S. centenarians. The Japanese sample was more likely to report historical events. Men from the U.S. were more likely to report events related to work and retirement compared to U.S. women, and U.S. women reported events related to family as the most important life events when compared to U.S. men. Japanese women considered events related to marriage, death and grief as the most important life events when compared to Japanese men. In addition, Japanese men reported events related to work and retirement as the most important life events. A cross-cultural difference was found in life events: U.S. centenarians were more likely to mention positive experiences related to marriage and children, whereas Japanese centenarians reported mostly negative and traumatic experiences such as historical, death/grief, and work/retirement events.

Why do multi-attribute utility instruments produce different utilities: the relative importance of the descriptive systems, scale and 'micro-utility' effects.

PubMed

Richardson, Jeff; Iezzi, Angelo; Khan, Munir A

2015-08-01

Health state utilities measured by the major multi-attribute utility instruments differ. Understanding the reasons for this is important for the choice of instrument and for research designed to reconcile these differences. This paper investigates these reasons by explaining pairwise differences between utilities derived from six multi-attribute utility instruments in terms of (1) their implicit measurement scales; (2) the structure of their descriptive systems; and (3) 'micro-utility effects', scale-adjusted differences attributable to their utility formula. The EQ-5D-5L, SF-6D, HUI 3, 15D and AQoL-8D were administered to 8,019 individuals. Utilities and unweighted values were calculated using each instrument. Scale effects were determined by the linear relationship between utilities, the effect of the descriptive system by comparison of scale-adjusted values and 'micro-utility effects' by the unexplained difference between utilities and values. Overall, 66 % of the differences between utilities was attributable to the descriptive systems, 30.3 % to scale effects and 3.7 % to micro-utility effects. Results imply that the revision of utility algorithms will not reconcile differences between instruments. The dominating importance of the descriptive system highlights the need for researchers to select the instrument most capable of describing the health states relevant for a study. Reconciliation of inconsistent utilities produced by different instruments must focus primarily upon the content of the descriptive system. Utility weights primarily determine the measurement scale. Other differences, attributable to utility formula, are comparatively unimportant.

Investigating the Role of Auditory and Tactile Modalities in Violin Quality Evaluation

PubMed Central

Wollman, Indiana; Fritz, Claudia; Poitevineau, Jacques; McAdams, Stephen

2014-01-01

The role of auditory and tactile modalities involved in violin playing and evaluation was investigated in an experiment employing a blind violin evaluation task under different conditions: i) normal playing conditions, ii) playing with auditory masking, and iii) playing with vibrotactile masking. Under each condition, 20 violinists evaluated five violins according to criteria related to violin playing and sound characteristics and rated their overall quality and relative preference. Results show that both auditory and vibrotactile feedback are important in the violinists’ evaluations but that their relative importance depends on the violinist, the violin and the type of evaluation (different criteria ratings or preference). In this way, the overall quality ratings were found to be accurately predicted by the rating criteria, which also proved to be perceptually relevant to violinists, but were poorly correlated with the preference ratings; this suggests that the two types of ratings (overall quality vs preference) may stem from different decision-making strategies. Furthermore, the experimental design confirmed that violinists agree more on the importance of criteria in their overall evaluation than on their actual ratings for different violins. In particular, greater agreement was found on the importance of criteria related to the sound of the violin. Nevertheless, this study reveals that there are fundamental differences in the way players interpret and evaluate each criterion, which may explain why correlating physical properties with perceptual properties has been challenging so far in the field of musical acoustics. PMID:25474036

Differences in environmental preferences towards cycling for transport among adults: a latent class analysis.

PubMed

Mertens, Lieze; Van Cauwenberg, Jelle; Ghekiere, Ariane; De Bourdeaudhuij, Ilse; Deforche, Benedicte; Van de Weghe, Nico; Van Dyck, Delfien

2016-08-12

Increasing cycling for transport can contribute to improve public health among adults. Micro-environmental factors (i.e. small-scaled street-setting features) may play an important role in affecting the street's appeal to cycle for transport. Understanding about the interplay between individuals and their physical environment is important to establish tailored environmental interventions. Therefore, the current study aimed to examine whether specific subgroups exist based on similarities in micro-environmental preferences to cycle for transport. Responses of 1950 middle-aged adults (45-65 years) on a series of choice tasks depicting potential cycling routes with manipulated photographs yielded three subgroups with different micro-environmental preferences using latent class analysis. Although latent class analysis revealed three different subgroups in the middle-aged adult population based on their environmental preferences, results indicated that cycle path type (i.e. a good separated cycle path) is the most important environmental factor for all participants and certainly for individuals who did not cycle for transport. Furthermore, only negligible differences were found between the importances of the other micro-environmental factors (i.e. traffic density, evenness of the cycle path, maintenance, vegetation and speed limits) regarding the two at risk subgroups and that providing a speed bump obviously has the least impact on the street's appeal to cycle for transport. Results from the current study indicate that only negligible differences were found between the three subgroups. Therefore, it might be suggested that tailored environmental interventions are not required in this research context.

The Effectiveness of Simulator Motion in the Transfer of Performance on a Tracking Task Is Influenced by Vision and Motion Disturbance Cues.

PubMed

Grundy, John G; Nazar, Stefan; O'Malley, Shannon; Mohrenshildt, Martin V; Shedden, Judith M

2016-06-01

To examine the importance of platform motion to the transfer of performance in motion simulators. The importance of platform motion in simulators for pilot training is strongly debated. We hypothesized that the type of motion (e.g., disturbance) contributes significantly to performance differences. Participants used a joystick to perform a target tracking task in a pod on top of a MOOG Stewart motion platform. Five conditions compared training without motion, with correlated motion, with disturbance motion, with disturbance motion isolated to the visual display, and with both correlated and disturbance motion. The test condition involved the full motion model with both correlated and disturbance motion. We analyzed speed and accuracy across training and test as well as strategic differences in joystick control. Training with disturbance cues produced critical behavioral differences compared to training without disturbance; motion itself was less important. Incorporation of disturbance cues is a potentially important source of variance between studies that do or do not show a benefit of motion platforms in the transfer of performance in simulators. Potential applications of this research include the assessment of the importance of motion platforms in flight simulators, with a focus on the efficacy of incorporating disturbance cues during training. © 2016, Human Factors and Ergonomics Society.

Representations of Disability: School and Its Cultural Effects

NASA Astrophysics Data System (ADS)

Medeghini, Roberto; Fornasa, Walter; Vadalà, Giuseppe

School plays a significant role in cultural production where representations of difference and disability are very important: educational and pedagogical practices (implicit and explicit) help to form cultural and social representations of the world and, consequently, to confirm some stereotypes too. In this regard the study of social representations linked in with disability assumes some importance: in fact disability becomes a difference excluded from educational and social dynamics as well as from full participation in citizenship. This research will try to draw some dominant social representations about differences and disability, through analysis of young university students stories and memories.

Childhood Hemorrhagic Stroke: An Important but Understudied Problem

PubMed Central

Lo, Warren

2013-01-01

Hemorrhagic stroke in children occurs more frequently than is commonly appreciated. There are important differences in the factors associated with hemorrhagic stroke in children when compared with adults. These differences likely play a role in the different outcomes, which tend to worsen with age. In this review, we describe the estimated frequency, clinical presentation, acute management of hemorrhagic stroke, and an overview of rehabilitation techniques. We identify key topics for future basic and clinical research. Findings from future studies will help improve our ability to optimize treatment for and long-term rehabilitation of these patients. PMID:21633104

A day in the life of a monitor!

PubMed

Shah, Kunal

2012-01-01

When at a site, the monitor will meet with the Study Coordinator, review the hospital medical records, use the internet database or paper to 'monitor' their data versus their medical records, issue queries, check master files, count tablets or vials, provide the update to the doctor, and so on. When not traveling, the monitor will work in the office, printing letters, filing documents collected from sites, writing reports and follow-up letters, responding to e-mails, calling sites, to follow-up on the pending action items, in addition to calling sites not visited recently, attending study teleconferences, attending study and company training programs, reading standard operating procedures, completing excel spreadsheets or company specific software systems, and so on. The monitor is loaded with all these different types of work requirements and most importantly each and every task is important and time bound. Different skill sets are required for different tasks and the monitor plays different roles, while doing different tasks. This article enlists the tasks that are required to be done by the monitor, the different roles played by the monitor while doing these tasks, analyze which is the most important day for a monitor, what are the tasks performed during this day, and what knowledge and skills are required for performing these tasks.

Effect of different implementations of the same ice history in GIA modeling

NASA Astrophysics Data System (ADS)

Barletta, V. R.; Bordoni, A.

2013-11-01

This study shows the effect of changing the way ice histories are implemented in Glacial Isostatic Adjustment (GIA) codes to solve the sea level equation. The ice history models are being constantly improved and are provided in different formats. The overall algorithmic design of the sea-level equation solver often forces to implement the ice model in a representation that differs from the one originally provided. We show that using different representations of the same ice model gives important differences and artificial contributions to the sea level estimates, both at global and at regional scale. This study is not a speculative exercise. The ICE-5G model adopted in this work is widely used in present day sea-level analysis, but discrepancies between the results obtained by different groups for the same ice models still exist, and it was the effort to set a common reference for the sea-level community that inspired this work. Understanding this issue is important to be able to reduce the artefacts introduced by a non-suitable ice model representation. This is especially important when developing new GIA models, since neglecting this problem can easily lead to wrong alignment of the ice and sea-level histories, particularly close to the deglaciation areas, like Antarctica.

History of science content analysis of Chinese science textbooks from the perspective of acculturation

NASA Astrophysics Data System (ADS)

Ma, Yongjun; Wan, Yanlan

2017-08-01

Based on previous international studies, a content analysis scheme has been designed and used from the perspective of culture to study the history of science (HOS) in science textbooks. Nineteen sets of Chinese science textbooks have been analyzed. It has been found that there are noticeable changes in the quantity, content, layout, presentation, and writing intention of the HOS sections in textbooks from different time periods. What's more, the textbooks aim at presenting the scientific culture and aim to help students understand it better. However, the cultural associations of the HOS in textbooks is insufficient and significant differences exist among textbooks of different subjects. In order to explore the reasons why the presentation of HOS in various subjects is different, we made a specific comparison of curriculum standards of two subjects with great differences and interviewed the editors-in-chief of two textbooks. Results show that one of the most important reasons for the different writings of the HOS in textbooks is that different subject curriculum standards attach greater importance to the HOS. In addition, the attention to the HOS by editors-in-chief, the tradition of studying the HOS within the history of the discipline, and the reference textbooks in compiling textbooks are all important influence factors. Some suggestions for future textbooks compilation are given at the end.

Choices Behind Numbers: a Review of the Major Air Pollution Health Impact Assessments in Europe.

PubMed

Malmqvist, E; Oudin, A; Pascal, M; Medina, S

2018-03-01

The aim of this review is to identify the key contextual and methodological differences in health impact assessments (HIA) of ambient air pollution performed for Europe. We limited our review to multi-country reviews. An additional aim is to quantify some of these differences by applying them in a HIA template in three European cities. Several HIAs of ambient air pollution have been performed for Europe, and their key results have been largely disseminated. Different studies have, however, come up with substantial differences in attributed health effects. It is of importance to review the background contributing to these differences and to quantify their importance for decision makers who will use them. We identified several methodological differences that could explain the discrepancy behind the number of attributable deaths or years of life lost. The main differences are due to the exposure-response functions chosen, the ways of assessing air pollution levels, the air pollution scenarios and the study population. In the quantification part, we found that using risk estimates from the European Study of Cohorts for Air Pollution Effects (ESCAPE) instead of the American Cancer Society (ACS) study could nearly double the attributable burden of ambient air pollution. This study provides some insights into the differential results in previously published HIAs on air pollution in Europe. These results are important for stakeholders in order to make informed decisions.

Parasitism and olfactory responses of Dastarcus helophoroides (Coleoptera: Bothrideridae) to different Cerambycid hosts

Treesearch

Jian-Rong Wei; Zhong-Qi Yang; Therese M. Poland; Jia-Wei Du

2009-01-01

Dastarcus helophoroides (Fairmaire) (Coleoptera: Bothrideridae) is an important natural enemy of longhorned beetles (Coleoptera: Cerambycidae). It is distributed throughout most Provinces in China. We investigated whether there were differences among D. helophoroides populations collected from different hosts in different...

Individual differences in perceiving and recognizing faces-One element of social cognition.

PubMed

Wilhelm, Oliver; Herzmann, Grit; Kunina, Olga; Danthiir, Vanessa; Schacht, Annekathrin; Sommer, Werner

2010-09-01

Recognizing faces swiftly and accurately is of paramount importance to humans as a social species. Individual differences in the ability to perform these tasks may therefore reflect important aspects of social or emotional intelligence. Although functional models of face cognition based on group and single case studies postulate multiple component processes, little is known about the ability structure underlying individual differences in face cognition. In 2 large individual differences experiments (N = 151 and N = 209), a broad variety of face-cognition tasks were tested and the component abilities of face cognition-face perception, face memory, and the speed of face cognition-were identified and then replicated. Experiment 2 also showed that the 3 face-cognition abilities are clearly distinct from immediate and delayed memory, mental speed, general cognitive ability, and object cognition. These results converge with functional and neuroanatomical models of face cognition by demonstrating the difference between face perception and face memory. The results also underline the importance of distinguishing between speed and accuracy of face cognition. Together our results provide a first step toward establishing face-processing abilities as an independent ability reflecting elements of social intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Importance of Practices: A National Study of General and Special Early Childhood Educators.

ERIC Educational Resources Information Center

Kilgo, Jennifer L.; Johnson, Larry; Lamontagne, Maggie; Stayton, Vicky; Cook, Martha; Cooper, Carolyn

1999-01-01

A study examined the perceptions of 169 early childhood educators and 238 early childhood special educators on the importance of practices when applied to young children with and without disabilities. Findings indicate that few differences existed between the two professional groups' perceptions of the importance of these practices. (Author/CR)

Physical Therapists' Perceptions of Leadership across the Health Care Continuum: A Brief Report.

PubMed

Desveaux, Laura; Verrier, Molly C

2014-01-01

To describe and compare Canadian physical therapists' perspectives on the importance of characteristics required for leadership in the workplace and in society and to explore the implications for the profession. This quantitative, cross-sectional study used a web-based survey of members of the Canadian Physiotherapy Association (CPA) with a registered email address (n=6156). The perceived importance of leadership characteristics at the workplace level versus the societal level was examined using a Mann-Whitney U test, with the significance set at α=0.05. A total of 1,511 respondents completed the questionnaire for a 24.5% response rate; they rated communication, professionalism, and credibility as the most important characteristics. For each of the 15 leadership characteristics, significantly fewer physical therapists chose the rating "extremely important" at the societal level than did so at the workplace level (p<0.001 for all characteristics). Physical therapists consistently rate leadership characteristics as more important in the workplace than at the societal level. Future research should aim to guide understanding about the reasons for this difference in perceived importance of leadership characteristics across different contexts.

Which Feedback Is More Effective for Pursuing Multiple Goals of Differing Importance? The Interaction Effects of Goal Importance and Performance Feedback Type on Self-Regulation and Task Achievement

ERIC Educational Resources Information Center

Lee, Hyunjoo

2016-01-01

This study examined how performance feedback type (progress vs. distance) affects Korean college students' self-regulation and task achievement according to relative goal importance in the pursuit of multiple goals. For this study, 146 students participated in a computerised task. The results showed the interaction effects of goal importance and…

The effect of various drugs on experimentally induced ulcers in immobilized rats

NASA Technical Reports Server (NTRS)

Schramm, H.

1978-01-01

Experiments related to the importance of functional disorders in the central nervous system in connection with stomach diseases were performed on Wistar rats. Assuming that severe mental strains may be triggering factors for such disorders, testing of the effects of different drugs on experimentally induced ulcers in these rats was done. The immobilization method described by Bonfils was used. Particular importance was placed on the sex related difference which appeared.

Medicolegal aspects of sports medicine.

PubMed

Boggess, Blake R; Bytomski, Jeffrey R

2013-06-01

Legal issues in sports medicine are rapidly developing and establishing an important body of jurisprudence that defines the legal rights and duties of all those involved with protecting the health and safety of athletes. The law makes important distinctions between the relevant duty of care owed to high-school, college, and professional athletes because of the differing legal relationships that arise out of athletic participation at different levels of competition. Copyright © 2013 Elsevier Inc. All rights reserved.

Surface relief model for photopolymers without cover plating.

PubMed

Gallego, S; Márquez, A; Ortuño, M; Francés, J; Marini, S; Beléndez, A; Pascual, I

2011-05-23

Relief surface changes provide interesting possibilities for storing diffractive optical elements on photopolymers and are an important source of information to characterize and understand the material behaviour. In this paper we present a 3-dimensional model based on direct measurements of parameters to predict the relief structures generated on the material. This model is successfully applied to different photopolymers with different values of monomer diffusion. The importance of monomer diffusion in depth is also discussed.

Understanding the City Size Wage Gap*

PubMed Central

Baum-Snow, Nathaniel; Pavan, Ronni

2013-01-01

In this paper, we decompose city size wage premia into various components. We base these decompositions on an estimated on-the-job search model that incorporates latent ability, search frictions, firm-worker match quality, human capital accumulation and endogenous migration between large, medium and small cities. Counterfactual simulations of the model indicate that variation in returns to experience and differences in wage intercepts across location type are the most important mechanisms contributing to observed city size wage premia. Variation in returns to experience is more important for generating wage premia between large and small locations while differences in wage intercepts are more important for generating wage premia betwen medium and small locations. Sorting on unobserved ability within education group and differences in labor market search frictions and distributions of firm-worker match quality contribute little to observed city size wage premia. These conclusions hold for separate samples of high school and college graduates. PMID:24273347

Differences in autonomic physiological responses between good and poor inductive reasoners.

PubMed

Melis, C; van Boxtel, A

2001-11-01

We investigated individual- and task-related differences in autonomic physiological responses induced by time limited figural and verbal inductive reasoning tasks. In a group of 52 participants, the percentage of correctly responded task items was evaluated together with nine different autonomic physiological response measures and respiration rate (RR). Weighted multidimensional scaling analyses of the physiological responses revealed three underlying dimensions, primarily characterized by RR, parasympathetic, and sympathetic activity. RR and sympathetic activity appeared to be relatively more important response dimensions for poor reasoners, whereas parasympathetic responsivity was relatively more important for good reasoners. These results suggest that poor reasoners showed higher levels of cognitive processing intensity than good reasoners. Furthermore, for the good reasoners, the dimension of sympathetic activity was relatively more important during the figural than during the verbal reasoning task, which was explained in terms of hemispheric lateralization in autonomic function.

Space Weathering in the Mercurian Environment

NASA Technical Reports Server (NTRS)

Noble, S. K.; Pieters, C. M.

2001-01-01

Space weathering processes are known to be important on the Moon. These processes both create the lunar regolith and alter its optical properties. Like the Moon, Mercury has no atmosphere to protect it from the harsh space environment and therefore it is expected that it will also incur the effects of space weathering. However, there are many important differences between the environments of Mercury and the Moon. These environmental differences will almost certainly affect the weathering processes and the products of those processes. It should be possible to observe the effects of these differences in Vis (visible)/NIR (near infrared) spectra of the type expected to be returned by MESSENGER. More importantly, understanding these weathering processes and their consequences is essential for evaluating the spectral data returned from MESSENGER and other missions in order to determine the mineralogy and the Fe content of the Mercurian surface. Additional information is contained in the original extended abstract.

Understanding the City Size Wage Gap.

PubMed

Baum-Snow, Nathaniel; Pavan, Ronni

2012-01-01

In this paper, we decompose city size wage premia into various components. We base these decompositions on an estimated on-the-job search model that incorporates latent ability, search frictions, firm-worker match quality, human capital accumulation and endogenous migration between large, medium and small cities. Counterfactual simulations of the model indicate that variation in returns to experience and differences in wage intercepts across location type are the most important mechanisms contributing to observed city size wage premia. Variation in returns to experience is more important for generating wage premia between large and small locations while differences in wage intercepts are more important for generating wage premia betwen medium and small locations. Sorting on unobserved ability within education group and differences in labor market search frictions and distributions of firm-worker match quality contribute little to observed city size wage premia. These conclusions hold for separate samples of high school and college graduates.

Engineering students' sustainability approaches

NASA Astrophysics Data System (ADS)

Haase, S.

2014-05-01

Sustainability issues are increasingly important in engineering work all over the world. This article explores systematic differences in self-assessed competencies, interests, importance, engagement and practices of newly enrolled engineering students in Denmark in relation to environmental and non-environmental sustainability issues. The empirical base of the article is a nation-wide, web-based survey sent to all newly enrolled engineering students in Denmark commencing their education in the fall term 2010. The response rate was 46%. The survey focused on a variety of different aspects of what can be conceived as sustainability. By means of cluster analysis, three engineering student approaches to sustainability are identified and described. The article provides knowledge on the different prerequisites of engineering students in relation to the role of sustainability in engineering. This information is important input to educators trying to target new engineering students and contribute to the provision of engineers equipped to meet sustainability challenges.

Methodologic support in habilitation and rehabilitation: communicative action between practice and science.

PubMed

Iwarsson, S; Jernryd, E; Rutström, C; Boqvist, A

2000-01-01

This study evaluated the early phase of development of a model for quality improvement of habilitation and rehabilitation project processes. The focus of the methodologic support in habilitation and rehabilitation model was on cooperation between practice contexts and science. Habermas' theory about communicative action was a theoretical frame of reference. Three project coordinators and ten project leaders were interviewed. The results revealed different attitudes towards methodologic support activities, demonstrating the importance of acknowledging cognitive and social functions, the process of legitimization, different approaches of practice versus science, and problems regarding information and communication. The model was shown to be important in bridging the gap between practice and science. To support reflective and emancipatory cognitive learning, more efforts to foster communicative action are called for, and more attention must be paid to the importance different missions and organizational structures have for the development of the dialog between practitioners and researchers.

Animal Models in Sexual Medicine: The Need and Importance of Studying Sexual Motivation.

PubMed

Ventura-Aquino, Elisa; Paredes, Raúl G

2017-01-01

Many different animal models of sexual medicine have been developed, demonstrating the complexity of studying the many interactions that influence sexual responses. A great deal of effort has been invested in measuring sexual motivation using different behavioral models mainly because human behavior is more complex than any model can reproduce. To compare different animal models of male and female behaviors that measure sexual motivation as a key element in sexual medicine and focus on models that use a combination of molecular techniques and behavioral measurements. We review the literature to describe models that evaluate different aspects of sexual motivation. No single test is sufficient to evaluate sexual motivation. The best approach is to evaluate animals in different behavioral tests to measure the motivational state of the subject. Different motivated behaviors such as aggression, singing in the case of birds, and sexual behavior, which are crucial for reproduction, are associated with changes in mRNA levels of different receptors in brain areas that are important in the control of reproduction. Research in animal models is crucial to understand the complexity of sexual behavior and all the mechanisms that influence such an important aspect of human well-being to decrease the physiologic and psychological impact of sexual dysfunctions. In other cases, research in different models is necessary to understand and recognize, not cure, the variability of sexuality, such as asexuality, which is another form of sexual orientation. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Aggression and violence around the world: A model of CLimate, Aggression, and Self-control in Humans (CLASH).

PubMed

Van Lange, Paul A M; Rinderu, Maria I; Bushman, Brad J

2017-01-01

Worldwide there are substantial differences within and between countries in aggression and violence. Although there are various exceptions, a general rule is that aggression and violence increase as one moves closer to the equator, which suggests the important role of climate differences. While this pattern is robust, theoretical explanations for these large differences in aggression and violence within countries and around the world are lacking. Most extant explanations focus on the influence of average temperature as a factor that triggers aggression (The General Aggression Model), or the notion that warm temperature allows for more social interaction situations (Routine Activity Theory) in which aggression is likely to unfold. We propose a new model, CLimate, Aggression, and Self-control in Humans (CLASH), that helps us to understand differences within and between countries in aggression and violence in terms of differences in climate. Lower temperatures, and especially larger degrees of seasonal variation in climate, call for individuals and groups to adopt a slower life history strategy, a greater focus on the future (vs. present), and a stronger focus on self-control. The CLASH model further outlines that slow life strategy, future orientation, and strong self-control are important determinants of inhibiting aggression and violence. We also discuss how CLASH differs from other recently developed models that emphasize climate differences for understanding conflict. We conclude by discussing the theoretical and societal importance of climate in shaping individual and societal differences in aggression and violence.

mRNA translation and protein synthesis: an analysis of different modelling methodologies and a new PBN based approach

PubMed Central

2014-01-01

Background mRNA translation involves simultaneous movement of multiple ribosomes on the mRNA and is also subject to regulatory mechanisms at different stages. Translation can be described by various codon-based models, including ODE, TASEP, and Petri net models. Although such models have been extensively used, the overlap and differences between these models and the implications of the assumptions of each model has not been systematically elucidated. The selection of the most appropriate modelling framework, and the most appropriate way to develop coarse-grained/fine-grained models in different contexts is not clear. Results We systematically analyze and compare how different modelling methodologies can be used to describe translation. We define various statistically equivalent codon-based simulation algorithms and analyze the importance of the update rule in determining the steady state, an aspect often neglected. Then a novel probabilistic Boolean network (PBN) model is proposed for modelling translation, which enjoys an exact numerical solution. This solution matches those of numerical simulation from other methods and acts as a complementary tool to analytical approximations and simulations. The advantages and limitations of various codon-based models are compared, and illustrated by examples with real biological complexities such as slow codons, premature termination and feedback regulation. Our studies reveal that while different models gives broadly similiar trends in many cases, important differences also arise and can be clearly seen, in the dependence of the translation rate on different parameters. Furthermore, the update rule affects the steady state solution. Conclusions The codon-based models are based on different levels of abstraction. Our analysis suggests that a multiple model approach to understanding translation allows one to ascertain which aspects of the conclusions are robust with respect to the choice of modelling methodology, and when (and why) important differences may arise. This approach also allows for an optimal use of analysis tools, which is especially important when additional complexities or regulatory mechanisms are included. This approach can provide a robust platform for dissecting translation, and results in an improved predictive framework for applications in systems and synthetic biology. PMID:24576337

Issues in testing the new national seismic hazard model for Italy

NASA Astrophysics Data System (ADS)

Stein, S.; Peresan, A.; Kossobokov, V. G.; Brooks, E. M.; Spencer, B. D.

2016-12-01

It is important to bear in mind that we know little about how earthquake hazard maps actually describe the shaking that will actually occur in the future, and have no agreed way of assessing how well a map performed in the past, and, thus, whether one map performs better than another. Moreover, we should not forget that different maps can be useful for different end users, who may have different cost-and-benefit strategies. Thus, regardless of the specific tests we chose to use, the adopted testing approach should have several key features: We should assess map performance using all the available instrumental, paleo seismology, and historical intensity data. Instrumental data alone span a period much too short to capture the largest earthquakes - and thus strongest shaking - expected from most faults. We should investigate what causes systematic misfit, if any, between the longest record we have - historical intensity data available for the Italian territory from 217 B.C. to 2002 A.D. - and a given hazard map. We should compare how seismic hazard maps developed over time. How do the most recent maps for Italy compare to earlier ones? It is important to understand local divergences that show how the models are developing to the most recent one. The temporal succession of maps is important: we have to learn from previous errors. We should use the many different tests that have been proposed. All are worth trying, because different metrics of performance show different aspects of how a hazard map performs and can be used. We should compare other maps to the ones we are testing. Maps can be made using a wide variety of assumptions, which will lead to different predicted shaking. It is possible that maps derived by other approaches may perform better. Although Italian current codes are based on probabilistic maps, it is important from both a scientific and societal perspective to look at all options including deterministic scenario based ones. Comparing what works better, according to different performance measures, will give valuable insight into key map parameters and assumptions. We may well find that different maps perform better in different applications.

Protein construct storage: Bayesian variable selection and prediction with mixtures.

PubMed

Clyde, M A; Parmigiani, G

1998-07-01

Determining optimal conditions for protein storage while maintaining a high level of protein activity is an important question in pharmaceutical research. A designed experiment based on a space-filling design was conducted to understand the effects of factors affecting protein storage and to establish optimal storage conditions. Different model-selection strategies to identify important factors may lead to very different answers about optimal conditions. Uncertainty about which factors are important, or model uncertainty, can be a critical issue in decision-making. We use Bayesian variable selection methods for linear models to identify important variables in the protein storage data, while accounting for model uncertainty. We also use the Bayesian framework to build predictions based on a large family of models, rather than an individual model, and to evaluate the probability that certain candidate storage conditions are optimal.

Cultural diversity in causal attributions for illness: the role of the supernatural.

PubMed

Landrine, H; Klonoff, E A

1994-04-01

We investigated cultural diversity in beliefs about the causes of illness and assessed the possibility that popular free-form methodologies (asking subjects to generate causes) inhibit minorities from expressing their belief in supernatural causes. As predicted, when asked to generate causes of illness and rate these in terms of their importance, whites and minorities did not differ in the number or type (natural vs supernatural) of causes they generated or in the importance rating they assigned to these. However, when these same subjects were provided with natural and supernatural causes to rate in terms of importance, minorities rated supernatural causes significantly more important than did whites, and more minorities than whites endorsed such causes. Cultural differences in causal attributions for illness are examined, and the role of methodology in determining such attributions is highlighted.

Credit Risk Evaluation Using a C-Variable Least Squares Support Vector Classification Model

NASA Astrophysics Data System (ADS)

Yu, Lean; Wang, Shouyang; Lai, K. K.

Credit risk evaluation is one of the most important issues in financial risk management. In this paper, a C-variable least squares support vector classification (C-VLSSVC) model is proposed for credit risk analysis. The main idea of this model is based on the prior knowledge that different classes may have different importance for modeling and more weights should be given to those classes with more importance. The C-VLSSVC model can be constructed by a simple modification of the regularization parameter in LSSVC, whereby more weights are given to the lease squares classification errors with important classes than the lease squares classification errors with unimportant classes while keeping the regularized terms in its original form. For illustration purpose, a real-world credit dataset is used to test the effectiveness of the C-VLSSVC model.

Auditory psychophysics and perception.

PubMed

Hirsh, I J; Watson, C S

1996-01-01

In this review of auditory psychophysics and perception, we cite some important books, research monographs, and research summaries from the past decade. Within auditory psychophysics, we have singled out some topics of current importance: Cross-Spectral Processing, Timbre and Pitch, and Methodological Developments. Complex sounds and complex listening tasks have been the subject of new studies in auditory perception. We review especially work that concerns auditory pattern perception, with emphasis on temporal aspects of the patterns and on patterns that do not depend on the cognitive structures often involved in the perception of speech and music. Finally, we comment on some aspects of individual difference that are sufficiently important to question the goal of characterizing auditory properties of the typical, average, adult listener. Among the important factors that give rise to these individual differences are those involved in selective processing and attention.

Journal news

USGS Publications Warehouse

Conroy, M.J.; Samuel, M.D.; White, Joanne C.

1995-01-01

Statistical power (and conversely, Type II error) is often ignored by biologists. Power is important to consider in the design of studies, to ensure that sufficient resources are allocated to address a hypothesis under examination. Deter- mining appropriate sample size when designing experiments or calculating power for a statistical test requires an investigator to consider the importance of making incorrect conclusions about the experimental hypothesis and the biological importance of the alternative hypothesis (or the biological effect size researchers are attempting to measure). Poorly designed studies frequently provide results that are at best equivocal, and do little to advance science or assist in decision making. Completed studies that fail to reject Ho should consider power and the related probability of a Type II error in the interpretation of results, particularly when implicit or explicit acceptance of Ho is used to support a biological hypothesis or management decision. Investigators must consider the biological question they wish to answer (Tacha et al. 1982) and assess power on the basis of biologically significant differences (Taylor and Gerrodette 1993). Power calculations are somewhat subjective, because the author must specify either f or the minimum difference that is biologically important. Biologists may have different ideas about what values are appropriate. While determining biological significance is of central importance in power analysis, it is also an issue of importance in wildlife science. Procedures, references, and computer software to compute power are accessible; therefore, authors should consider power. We welcome comments or suggestions on this subject.

Motivations for recreating on farmlands, private forests, and state or national parks.

PubMed

Sotomayor, Sandra; Barbieri, Carla; Wilhelm Stanis, Sonja; Aguilar, Francisco X; Smith, Jordan W

2014-07-01

This study explores the importance of different motivations to visit three types of recreational settings--farms, private forests, and state or national parks. Data were collected via a mail-back questionnaire administered to a stratified random sample of households in Missouri (USA). Descriptive and inferential statistics reveal both similarities and discontinuities in motivations for visiting farms, private forests, and state or national parks for recreation. Being with family, viewing natural scenery, and enjoying the smells and sounds of nature were all highly important motivations for visiting the three types of settings. However, all 15 motivations examined were perceived to be significantly more important for visits to state or national parks than to farms or private forests. Findings suggest that individuals are more strongly motivated to recreate at state and national parks relative to farmlands or forests. Post hoc paired t tests comparing motivations between both agricultural settings (farms and private forests) revealed significant differences in eight different recreational motivations. Individuals tended to place more importance on the ability to use equipment and test their skills when considering recreating on private forests. Conversely, social motivations (e.g., doing something with the family) were more important when individuals were considering recreating on farmland. Collectively, the findings suggest individuals expect distinctly different outcomes from their visits to farmlands, private forests, or state or national parks. Consequently, all three types of recreational settings have competitive advantages that their managers could capitalize on when making decisions about how to attract new visitors or produce the most desirable experiences for current recreationists.

Analysis of functional importance of binding sites in the Drosophila gap gene network model.

PubMed

Kozlov, Konstantin; Gursky, Vitaly V; Kulakovskiy, Ivan V; Dymova, Arina; Samsonova, Maria

2015-01-01

The statistical thermodynamics based approach provides a promising framework for construction of the genotype-phenotype map in many biological systems. Among important aspects of a good model connecting the DNA sequence information with that of a molecular phenotype (gene expression) is the selection of regulatory interactions and relevant transcription factor bindings sites. As the model may predict different levels of the functional importance of specific binding sites in different genomic and regulatory contexts, it is essential to formulate and study such models under different modeling assumptions. We elaborate a two-layer model for the Drosophila gap gene network and include in the model a combined set of transcription factor binding sites and concentration dependent regulatory interaction between gap genes hunchback and Kruppel. We show that the new variants of the model are more consistent in terms of gene expression predictions for various genetic constructs in comparison to previous work. We quantify the functional importance of binding sites by calculating their impact on gene expression in the model and calculate how these impacts correlate across all sites under different modeling assumptions. The assumption about the dual interaction between hb and Kr leads to the most consistent modeling results, but, on the other hand, may obscure existence of indirect interactions between binding sites in regulatory regions of distinct genes. The analysis confirms the previously formulated regulation concept of many weak binding sites working in concert. The model predicts a more or less uniform distribution of functionally important binding sites over the sets of experimentally characterized regulatory modules and other open chromatin domains.

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

PubMed

Schultz, Marcus J; Dunser, Martin W; Dondorp, Arjen M; Adhikari, Neill K J; Iyer, Shivakumar; Kwizera, Arthur; Lubell, Yoel; Papali, Alfred; Pisani, Luigi; Riviello, Beth D; Angus, Derek C; Azevedo, Luciano C; Baker, Tim; Diaz, Janet V; Festic, Emir; Haniffa, Rashan; Jawa, Randeep; Jacob, Shevin T; Kissoon, Niranjan; Lodha, Rakesh; Martin-Loeches, Ignacio; Lundeg, Ganbold; Misango, David; Mer, Mervyn; Mohanty, Sanjib; Murthy, Srinivas; Musa, Ndidiamaka; Nakibuuka, Jane; Serpa Neto, Ary; Nguyen Thi Hoang, Mai; Nguyen Thien, Binh; Pattnaik, Rajyabardhan; Phua, Jason; Preller, Jacobus; Povoa, Pedro; Ranjit, Suchitra; Talmor, Daniel; Thevanayagam, Jonarthan; Thwaites, C Louise

2017-05-01

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

Motivations for Recreating on Farmlands, Private Forests, and State or National Parks

NASA Astrophysics Data System (ADS)

Sotomayor, Sandra; Barbieri, Carla; Wilhelm Stanis, Sonja; Aguilar, Francisco X.; Smith, Jordan W.

2014-07-01

This study explores the importance of different motivations to visit three types of recreational settings—farms, private forests, and state or national parks. Data were collected via a mail-back questionnaire administered to a stratified random sample of households in Missouri (USA). Descriptive and inferential statistics reveal both similarities and discontinuities in motivations for visiting farms, private forests, and state or national parks for recreation. Being with family, viewing natural scenery, and enjoying the smells and sounds of nature were all highly important motivations for visiting the three types of settings. However, all 15 motivations examined were perceived to be significantly more important for visits to state or national parks than to farms or private forests. Findings suggest that individuals are more strongly motivated to recreate at state and national parks relative to farmlands or forests. Post hoc paired t tests comparing motivations between both agricultural settings (farms and private forests) revealed significant differences in eight different recreational motivations. Individuals tended to place more importance on the ability to use equipment and test their skills when considering recreating on private forests. Conversely, social motivations (e.g., doing something with the family) were more important when individuals were considering recreating on farmland. Collectively, the findings suggest individuals expect distinctly different outcomes from their visits to farmlands, private forests, or state or national parks. Consequently, all three types of recreational settings have competitive advantages that their managers could capitalize on when making decisions about how to attract new visitors or produce the most desirable experiences for current recreationists.

Genetic Differences and School Readiness

ERIC Educational Resources Information Center

Dickens, William T.

2005-01-01

The author considers whether differences in genetic endowment may account for racial and ethnic differences in school readiness. While acknowledging an important role for genes in explaining differences "within" races, he nevertheless argues that environment explains most of the gap "between" blacks and whites, leaving little role for genetics.…

The role of the society of Latin American specialists on remote sensing (SELPER) in the analysis and actions related to the main advances and needs of spatial remote sensing for Latin America

NASA Astrophysics Data System (ADS)

Araya, Mauricio F.

The existence of SELPER (Sociedad de Especialistas Latinoamericanos en Percepción Remota / Society of Latinamerican Specialists on Remote Sensing) has filled a great gap among latinamerican countries. SELPER was formed in 1980 and several important activities, having international support, have been performed and are planned in the near future. SELPER consolidation will help develop several important regional cooperation programs and the next years look very promisory in this sense. Different steps are planned but the most important is related with the formation of such a Latin American Council on Remote Sensing, having official support from different countries of the region; SELPER can help this important objective. Main advances and needs are summarized in this paper and it is possible to conclude that SELPER will be important for regional and inter-regional scientific and technical cooperation on remote sensing.

Socially Important Faces Are Processed Preferentially to Other Familiar and Unfamiliar Faces in a Priming Task across a Range of Viewpoints

PubMed Central

Keyes, Helen; Zalicks, Catherine

2016-01-01

Using a priming paradigm, we investigate whether socially important faces are processed preferentially compared to other familiar and unfamiliar faces, and whether any such effects are affected by changes in viewpoint. Participants were primed with frontal images of personally familiar, famous or unfamiliar faces, and responded to target images of congruent or incongruent identity, presented in frontal, three quarter or profile views. We report that participants responded significantly faster to socially important faces (a friend’s face) compared to other highly familiar (famous) faces or unfamiliar faces. Crucially, responses to famous and unfamiliar faces did not differ. This suggests that, when presented in the context of a socially important stimulus, socially unimportant familiar faces (famous faces) are treated in a similar manner to unfamiliar faces. This effect was not tied to viewpoint, and priming did not affect socially important face processing differently to other faces. PMID:27219101

New Insights into Various Production Characteristics of Streptococcus thermophilus Strains

PubMed Central

Cui, Yanhua; Xu, Tingting; Qu, Xiaojun; Hu, Tong; Jiang, Xu; Zhao, Chunyu

2016-01-01

Streptococcus thermophilus is one of the most valuable homo-fermentative lactic acid bacteria, which, for a long time, has been widely used as a starter for the production of fermented dairy products. The key production characteristics of S. thermophilus, for example the production of extracellular polysaccharide, proteolytic enzymes and flavor substances as well as acidifying capacity etc., have an important effect on the quality of dairy products. The acidification capacity of the strains determines the manufacturing time and quality of dairy products. It depends on the sugar utilization ability of strains. The production of extracellular polysaccharide is beneficial for improving the texture of dairy products. Flavor substances increase the acceptability of dairy products. The proteolytic activity of the strain influences not only the absorption of the nitrogen source, but also the formation of flavor substances. Different strains have obvious differences in production characteristics via long-time evolution and adaptation to environment. Gaining new strains with novel and desirable characteristics is an important long-term goal for researchers and the fermenting industry. The understanding of the potential molecular mechanisms behind important characteristics of different strains will promote the screening and breeding of excellent strains. In this paper, key technological and functional properties of different S. thermophilus strains are discussed, including sugar metabolism, proteolytic system and amino acid metabolism, and polysaccharide and flavor substance biosynthesis. At the same time, diversity of genomes and plasmids of S. thermophilus are presented. Advances in research on key production characteristics and molecular levels of S. thermophilus will increase understanding of molecular mechanisms of different strains with different important characteristics, and improve the industrialization control level for fermented foods. PMID:27754312

Pornography and teenagers: the importance of individual differences.

PubMed

Malamuth, Neil; Huppin, Mark

2005-06-01

This article focuses on the effects of exposure to pornography on teenagers, particularly males, and concentrates on sexually aggressive outcomes and on the characteristics of the individual as crucial in determining whether pornography consumption may or may not lead to sexually aggressive outcomes. In future work, it is important not to use an overly simplistic lens of focus in which pornography exposure is seen as generally harmful or not. Depending on particular constellations of personality characteristics, the effects of pornography may differ considerably among different teenagers as well as within different cultures. The research suggests that particular concerns may be needed for those who are highly frequent consumers of pornography, those who seek out sexually violent content, and those who also have other risk factors.

Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome.

PubMed

Kim, Jae Kwang; Park, Eun Soo

2013-05-01

Patient-reported questionnaires have been widely used to predict symptom severity and functional disability in musculoskeletal disease. Importantly, questionnaires can detect clinical changes in patients; however, this impact has not been determined for ulnar impaction syndrome. We asked (1) which of Patient-Rated Wrist Evaluation (PRWE), DASH, and other physical measures was more responsive to clinical improvements, and (2) what was the minimal clinically important difference for the PRWE and DASH after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. All patients who underwent ulnar shortening osteotomy between March 2008 and February 2011 for idiopathic ulnar impaction syndrome were enrolled in this study. All patients completed the PRWE and DASH questionnaires, and all were evaluated for grip strength and wrist ROM, preoperatively and 12 months postoperatively. We compared the effect sizes observed by each of these instruments. Effect size is calculated by dividing the mean change in a score of each instrument during a specified interval by the standard deviation of the baseline score. In addition, patient-perceived overall improvement was used as the anchor to determine the minimal clinically important differences on the PRWE and DASH 12 months after surgery. The average score of each item except for wrist flexion and supination improved after surgery. The PRWE was more sensitive than the DASH or than physical measurements in detecting clinical changes. The effect sizes and standardized response means of the outcome measures were as follows: PRWE (1.51, 1.64), DASH (1.12, 1.24), grip strength (0.59, 0.68), wrist pronation (0.33, 0.41), and wrist extension (0.28, 0.36). Patient-perceived overall improvement and score changes of the PRWE and DASH correlated significantly. Minimal clinically important differences were 17 points (of a possible 100) for the PRWE and 13.5 for the DASH (also of 100), and minimal detectable changes were 7.7 points for the PRWE and 9.3 points for the DASH. Although the PRWE and DASH were highly sensitive to clinical changes, the PRWE was more sensitive in terms of detecting clinical changes after ulnar shortening osteotomy for idiopathic ulnar impaction syndrome. A minimal change of 17 PRWE points or 13.5 DASH points was necessary to achieve a benefit that patients perceived as clinically important. The minimal clinically important differences using these instruments were higher than the values produced by measurement errors.

Numerical simulation and fracture identification of dual laterolog in organic shale

NASA Astrophysics Data System (ADS)

Maojin, Tan; Peng, Wang; Qiong, Liu

2012-09-01

Fracture is one of important spaces in shale oil and shale gas reservoirs, and fractures identification and evaluation are an important part in organic shale interpretation. According to the fractured shale gas reservoir, a physical model is set up to study the dual laterolog logging responses. First, based on the principle of dual laterolog, three-dimensional finite element method (FEM) is used to simulate the dual laterolog responses in various formation models with different fractures widths, different fracture numbers, different fractures inclination angle. All the results are extremely important for the fracture identification and evaluation in shale reservoirs. Appointing to different base rock resistivity models, the fracture models are constructed respectively through a number of numerical simulation, and the fracture porosity can be calculated by solving the corresponding formulas. A case study about organic shale formation is analyst and discussed, and the fracture porosity is calculated from dual laterolog. The fracture evaluation results are also be validated right by Full borehole Micro-resistivity Imaging (FMI). So, in case of the absence of borehole resistivity imaging log, the dual laterolog resistivity can be used to estimate the fracture development.

Active remodelling of the TIM23 complex during translocation of preproteins into mitochondria.

PubMed

Popov-Celeketić, Dusan; Mapa, Koyeli; Neupert, Walter; Mokranjac, Dejana

2008-05-21

The TIM23 (translocase of the mitochondrial inner membrane) complex mediates translocation of preproteins across and their insertion into the mitochondrial inner membrane. How the translocase mediates sorting of preproteins into the two different subcompartments is poorly understood. In particular, it is not clear whether association of two operationally defined parts of the translocase, the membrane-integrated part and the import motor, depends on the activity state of the translocase. We established conditions to in vivo trap the TIM23 complex in different translocation modes. Membrane-integrated part of the complex and import motor were always found in one complex irrespective of whether an arrested preprotein was present or not. Instead, we detected different conformations of the complex in response to the presence and, importantly, the type of preprotein being translocated. Two non-essential subunits of the complex, Tim21 and Pam17, modulate its activity in an antagonistic manner. Our data demonstrate that the TIM23 complex acts as a single structural and functional entity that is actively remodelled to sort preproteins into different mitochondrial subcompartments.

Active remodelling of the TIM23 complex during translocation of preproteins into mitochondria

PubMed Central

Popov-Čeleketić, Dus̆an; Mapa, Koyeli; Neupert, Walter; Mokranjac, Dejana

2008-01-01

The TIM23 (translocase of the mitochondrial inner membrane) complex mediates translocation of preproteins across and their insertion into the mitochondrial inner membrane. How the translocase mediates sorting of preproteins into the two different subcompartments is poorly understood. In particular, it is not clear whether association of two operationally defined parts of the translocase, the membrane-integrated part and the import motor, depends on the activity state of the translocase. We established conditions to in vivo trap the TIM23 complex in different translocation modes. Membrane-integrated part of the complex and import motor were always found in one complex irrespective of whether an arrested preprotein was present or not. Instead, we detected different conformations of the complex in response to the presence and, importantly, the type of preprotein being translocated. Two non-essential subunits of the complex, Tim21 and Pam17, modulate its activity in an antagonistic manner. Our data demonstrate that the TIM23 complex acts as a single structural and functional entity that is actively remodelled to sort preproteins into different mitochondrial subcompartments. PMID:18418384

A closer look at prion strains: characterization and important implications.

PubMed

Solforosi, Laura; Milani, Michela; Mancini, Nicasio; Clementi, Massimo; Burioni, Roberto

2013-01-01

Prions are infectious proteins that are responsible for transmissible spongiform encephalopathies (TSEs) and consist primarily of scrapie prion protein (PrP (Sc) ), a pathogenic isoform of the host-encoded cellular prion protein (PrP (C) ). The absence of nucleic acids as essential components of the infectious prions is the most striking feature associated to these diseases. Additionally, different prion strains have been isolated from animal diseases despite the lack of DNA or RNA molecules. Mounting evidence suggests that prion-strain-specific features segregate with different PrP (Sc) conformational and aggregation states. Strains are of practical relevance in prion diseases as they can drastically differ in many aspects, such as incubation period, PrP (Sc) biochemical profile (e.g., electrophoretic mobility and glycoform ratio) and distribution of brain lesions. Importantly, such different features are maintained after inoculation of a prion strain into genetically identical hosts and are relatively stable across serial passages. This review focuses on the characterization of prion strains and on the wide range of important implications that the study of prion strains involves.

Emotional sensitivity, emotion regulation and impulsivity in borderline personality disorder: a critical review of fMRI studies.

PubMed

van Zutphen, Linda; Siep, Nicolette; Jacob, Gitta A; Goebel, Rainer; Arntz, Arnoud

2015-04-01

Emotional sensitivity, emotion regulation and impulsivity are fundamental topics in research of borderline personality disorder (BPD). Studies using fMRI examining the neural correlates concerning these topics is growing and has just begun understanding the underlying neural correlates in BPD. However, there are strong similarities but also important differences in results of different studies. It is therefore important to know in more detail what these differences are and how we should interpret these. In present review a critical light is shed on the fMRI studies examining emotional sensitivity, emotion regulation and impulsivity in BPD patients. First an outline of the methodology and the results of the studies will be given. Thereafter important issues that remained unanswered and topics to improve future research are discussed. Future research should take into account the limited power of previous studies and focus more on BPD specificity with regard to time course responses, different regulation strategies, manipulation of self-regulation, medication use, a wider range of stimuli, gender effects and the inclusion of a clinical control group. Copyright © 2015 Elsevier Ltd. All rights reserved.

Phytochemical relationship of Euphorbia helioscopia and Euphorbia pulcherrima with Lactuca sativa.

PubMed

Rehman, Hafiza Ayesha; Yousaf, Zubaida; Rashid, Madiha; Younas, Afifa; Arif, Ayesha; Afzal, Ismah; Akram, Waheed

2014-01-01

Allelopathy is an important phenomenon that modifies the ecosystem. A plant can enhance or reduce the growth of other plant due to the presence of a number of allelochemicals in its different parts. Euphorbia helioscopia and Euphorbia pulcherrima are medicinal plant species. Both these species are collected from wild resources for various purposes. To reduce the pressure on wild population, it is important to bring them into cultivation. Therefore, the allelopathic effects of E. helioscopia and E. pulcherrima on the growth of lettuce seeds were studied. Three different concentrations (2%, 4% and 6%) of five different solvents (methanol, acetone, ethyl acetate, n-hexane and distilled water) were used to estimate the allelopathic potential of the above-mentioned Euphorbia species. Results indicated a non-significant growth inhibitory effect of both plants on lettuce seeds. Different extracts reduced the growth of test plant to some extent but this inhibition was not significant. From the observed results, it was concluded that the studied Euphorbia species, being medicinally important crops, can be introduced as intercrop with other cash crops.

Classroom Demonstrations: Individual Differences.

ERIC Educational Resources Information Center

Singer, Sandra M.

These demonstrations stress individual differences, a concept becoming increasingly important in psychological research. Intended for use in undergraduate psychology courses, four demonstrations that illustrate common examples of human variation are described. The demonstrations deal with the following individual differences: taste blindness,…

Keynote Address.

ERIC Educational Resources Information Center

Smith, Virginia B.

1980-01-01

Reflects on the impact of the broad values that motivated Mina Shaughnessy's work and life. Characterizes three of her beliefs--that teaching makes a difference, that the individual is important, and that literacy is power--and expands on their importance. (RL)

Feeding Your 1- to 2-Year-Old

MedlinePlus

... begun the meal. Some kids don't like cows milk at first because it's different from the breast ... the mixture so that it eventually becomes 100% cow's milk. Why Is Iron Important? It's important to watch ...

Peer Exclusion at Physical Education

ERIC Educational Resources Information Center

Sotosek, Gorazd

2016-01-01

School sports give all pupils opportunity to learn to be tolerant to others regardless of their differences or shortcomings. This is getting more and more important due to the growing differences in physical and motor skills, different social backgrounds, besides there is a growing number of pupils having different backgrounds, nationalities, etc.…

Challenges of DHS and MIS to capture the entire pattern of malaria parasite risk and intervention effects in countries with different ecological zones: the case of Cameroon.

PubMed

Massoda Tonye, Salomon G; Kouambeng, Celestin; Wounang, Romain; Vounatsou, Penelope

2018-04-06

In 2011, the demographic and health survey (DHS) in Cameroon was combined with the multiple indicator cluster survey. Malaria parasitological data were collected, but the survey period did not overlap with the high malaria transmission season. A malaria indicator survey (MIS) was also conducted during the same year, within the malaria peak transmission season. This study compares estimates of the geographical distribution of malaria parasite risk and of the effects of interventions obtained from the DHS and MIS survey data. Bayesian geostatistical models were applied on DHS and MIS data to obtain georeferenced estimates of the malaria parasite prevalence and to assess the effects of interventions. Climatic predictors were retrieved from satellite sources. Geostatistical variable selection was used to identify the most important climatic predictors and indicators of malaria interventions. The overall observed malaria parasite risk among children was 33 and 30% in the DHS and MIS data, respectively. Both datasets identified the Normalized Difference Vegetation Index and the altitude as important predictors of the geographical distribution of the disease. However, MIS selected additional climatic factors as important disease predictors. The magnitude of the estimated malaria parasite risk at national level was similar in both surveys. Nevertheless, DHS estimates lower risk in the North and Coastal areas. MIS did not find any important intervention effects, although DHS revealed that the proportion of population with an insecticide-treated nets access in their household was statistically important. An important negative relationship between malaria parasitaemia and socioeconomic factors, such as the level of mother's education, place of residence and the household welfare were captured by both surveys. Timing of the malaria survey influences estimates of the geographical distribution of disease risk, especially in settings with seasonal transmission. In countries with different ecological zones and thus different seasonal patterns, a single survey may not be able to identify all high risk areas. A continuous MIS or a combination of MIS, health information system data and data from sentinel sites may be able to capture the disease risk distribution in space across different seasons.

What Do Job Candidates Consider Important When Assessing an Academic Position?

ERIC Educational Resources Information Center

Honeycutt, Earl D., Jr.; Thelen, Shawn T.

2016-01-01

Surveyed job candidates and academic mavens differ in regard to what the candidates should consider most important (e.g., quality-of-life issues, characteristics of the position, and school/department dynamics) when interviewing for an academic position. A principal finding is that candidates weigh quality of life as the most important issue,…

The Importance of Politics: A Study of French Secondary School Students. Draft.

ERIC Educational Resources Information Center

Schonfeld, William R.

The relative importance of government as measured in a sample of French secondary students is examined. Drawn from four different schools, 481 Parisian pupils served as the sample for the study. The students responded to a questionnaire ranking the importance of their relationships with the government and the police with seven other specific…

Gender Differences in the Importance of Personality Traits in Predicting Leadership Self-Efficacy

ERIC Educational Resources Information Center

Huszczo, Gregory; Endres, Megan Lee

2017-01-01

Our goal in this study was to investigate antecedents to formation of leadership self-efficacy (LSE) for men versus women. We used a relative importance analysis, which allows more precise identification of important predictors without concern of multicollinearity effects on R[superscript 2]. Using a sample of 325 business students, we found that…

Profiles of Attribution of Importance to Life Roles and Their Implications for the Work-Family Conflict

ERIC Educational Resources Information Center

Cinamon, Rachel Gali; Rich, Yisrael

2002-01-01

Cluster analysis identified 3 groups of individuals who differed systematically on attributions of relative importance to work and to family roles. Participants were 213 married computer workers and lawyers, 126 men and 87 women. Questionnaires gathered data on attributions of importance to life roles, work-family conflict, spousal and managerial…

Expression of interest: transcriptomics and the designation of conservation units.

PubMed

Hansen, Michael M

2010-05-01

An important task within conservation genetics consists in defining intraspecific conservation units. Most conceptual frameworks involve two steps: (i) identifying demographically independent units, and (ii) evaluating their degree of adaptive divergence. Whereas a plethora of methods are available for delineating genetic population structure, assessment of functional genetic divergence remains a challenge. In this issue, Tymchuk et al. (2010) study Atlantic salmon (Salmo salar) populations using both microsatellite markers and analysis of global gene expression. They show that important gene expression differences exist that can be interpreted in the context of different ecological conditions experienced by the populations, along with the populations' histories. This demonstrates an important potential role of transcriptomics for designating conservation units.

Congenital brain infections.

PubMed

Arbelaez, Andres; Restrepo, Feliza; Davila, Jorge; Castillo, Mauricio

2014-06-01

Pediatric congenital intracranial infections are a group of different and important entities that constitute a small percentage of all pediatric infections. The causal factors and clinical presentations are different in children compared with adults. They require early recognition because delay diagnosis and initiation of treatment may have catastrophic consequences. Despite improvements in prenatal screening, vaccine safety, and antibiotics, infections of the central nervous system remain an important cause of neurological disabilities worldwide. This article reviews the most common congenital infections and their imaging findings.

Experimental evidence that evolutionary relatedness does not affect the ecological mechanisms of coexistence in freshwater green algae.

PubMed

Narwani, Anita; Alexandrou, Markos A; Oakley, Todd H; Carroll, Ian T; Cardinale, Bradley J

2013-11-01

The coexistence of competing species depends on the balance between their fitness differences, which determine their competitive inequalities, and their niche differences, which stabilise their competitive interactions. Darwin proposed that evolution causes species' niches to diverge, but the influence of evolution on relative fitness differences, and the importance of both niche and fitness differences in determining coexistence have not yet been studied together. We tested whether the phylogenetic distances between species of green freshwater algae determined their abilities to coexist in a microcosm experiment. We found that niche differences were more important in explaining coexistence than relative fitness differences, and that phylogenetic distance had no effect on either coexistence or on the sizes of niche and fitness differences. These results were corroborated by an analysis of the frequency of the co-occurrence of 325 pairwise combinations of algal taxa in > 1100 lakes across North America. Phylogenetic distance may not explain the coexistence of freshwater green algae. © 2013 John Wiley & Sons Ltd/CNRS.

Women's advantage at remembering others' appearance: A systematic look at the why and when of a gender difference.

PubMed

Mast, Marianne Schmid; Hall, Judith A

2006-03-01

Women recall the appearance of others better than men. The goal of the present research was to shed light on the explanations and boundary conditions of this gender difference. In three studies (592 participants), the authors tested potential mediators and moderators of the gender difference. Results corroborated the robustness of the gender difference. General task motivation, general memory ability, importance of appearance, appearance knowledge, attention paid to target, gazing at target, and communal or agentic orientation could not explain why women were better at recalling others' appearance than men were. Except for importance of appearance and appearance knowledge, which both decreased the magnitude of the gender difference, general task motivation, attention paid to target, length of exposure to target, delay in responding, cognitive load, and response format (verbal vs. nonverbal) had no effect on the gender difference. Results are discussed in relation to gender differences found in the nonverbal sensitivity literature.

Discussions about Racial and Ethnic Differences in Internationally Adoptive Families: Links with Family Engagement, Warmth, & Control.

PubMed

Anderson, Kayla N; Rueter, Martha A; Lee, Richard M

Discussions about racial and ethnic differences may allow international, transracial adoptive families to construct multiracial and/or multiethnic family identities. However, little is known about the ways family communication influences how discussions about racial and ethnic differences occur. This study examined associations between observed family communication constructs, including engagement, warmth, and control, and how adoptive families discuss racial and ethnic differences using a sample of families with adolescent-aged children adopted internationally from South Korea ( N = 111 families, 222 adolescents). Using data collected during mid-adolescence and again during late adolescence, higher levels of maternal control and positive adolescent engagement were independently associated with a greater likelihood that family members acknowledged the importance of racial and ethnic differences and constructed a multiracial and/or multiethnic family identity. Adolescent engagement was also related to a greater likelihood that family members disagreed about the importance of racial and ethnic differences, and did not build a cohesive identity about differences.

Discussions about Racial and Ethnic Differences in Internationally Adoptive Families: Links with Family Engagement, Warmth, & Control

PubMed Central

Anderson, Kayla N.; Rueter, Martha A.; Lee, Richard M.

2015-01-01

Discussions about racial and ethnic differences may allow international, transracial adoptive families to construct multiracial and/or multiethnic family identities. However, little is known about the ways family communication influences how discussions about racial and ethnic differences occur. This study examined associations between observed family communication constructs, including engagement, warmth, and control, and how adoptive families discuss racial and ethnic differences using a sample of families with adolescent-aged children adopted internationally from South Korea (N = 111 families, 222 adolescents). Using data collected during mid-adolescence and again during late adolescence, higher levels of maternal control and positive adolescent engagement were independently associated with a greater likelihood that family members acknowledged the importance of racial and ethnic differences and constructed a multiracial and/or multiethnic family identity. Adolescent engagement was also related to a greater likelihood that family members disagreed about the importance of racial and ethnic differences, and did not build a cohesive identity about differences. PMID:26648791

Difference in tree growth responses to climate at the upper treeline: Qilian Juniper in the Anyemaqen Mountains.

PubMed

Peng, Jianfeng; Gou, Xiaohua; Chen, Fahu; Li, Jinbao; Liu, Puxing; Zhang, Yong; Fang, Keyan

2008-08-01

Three ring-width chronologies were developed from Qilian Juniper (Sabina przewalskii Kom.) at the upper treeline along a west-east gradient in the Anyemaqen Mountains. Most chronological statistics, except for mean sensitivity (MS), decreased from west to east. The first principal component (PC1) loadings indicated that stands in a similar climate condition were most important to the variability of radial growth. PC2 loadings decreased from west to east, suggesting the difference of tree-growth between eastern and western Anyemaqen Mountains. Correlations between standard chronologies and climatic factors revealed different climatic influences on radial growth along a west-east gradient in the study area. Temperature of warm season (July-August) was important to the radial growth at the upper treeline in the whole study area. Precipitation of current May was an important limiting factor of tree growth only in the western (drier) upper treeline, whereas precipitation of current September limited tree growth in the eastern (wetter) upper treeline. Response function analysis results showed that there were regional differences between tree growth and climatic factors in various sampling sites of the whole study area. Temperature and precipitation were the important factors influencing tree growth in western (drier) upper treeline. However, tree growth was greatly limited by temperature at the upper treeline in the middle area, and was more limited by precipitation than temperature in the eastern (wetter) upper treeline.

Genotype and local environment dynamically influence growth, disturbance response and survivorship in the threatened coral, Acropora cervicornis.

PubMed

Drury, Crawford; Manzello, Derek; Lirman, Diego

2017-01-01

The relationship between the coral genotype and the environment is an important area of research in degraded coral reef ecosystems. We used a reciprocal outplanting experiment with 930 corals representing ten genotypes on each of eight reefs to investigate the influence of genotype and the environment on growth and survivorship in the threatened Caribbean staghorn coral, Acropora cervicornis. Coral genotype and site were strong drivers of coral growth and individual genotypes exhibited flexible, non-conserved reaction norms, complemented by ten-fold differences in growth between specific G-E combinations. Growth plasticity may diminish the influence of local adaptation, where foreign corals grew faster than native corals at their home sites. Novel combinations of environment and genotype also significantly affected disturbance response during and after the 2015 bleaching event, where these factors acted synergistically to drive variation in bleaching and recovery. Importantly, small differences in temperature stress elicit variable patterns of survivorship based on genotype and illustrate the importance of novel combinations of coral genetics and small differences between sites representing habitat refugia. In this context, acclimatization and flexibility is especially important given the long lifespan of corals coping with complex environmental change. The combined influence of site and genotype creates short-term differences in growth and survivorship, contributing to the standing genetic variation needed for adaptation to occur over longer timescales and the recovery of degraded reefs through natural mechanisms.

Incidence of Aeromonas spp. infection in fish and chicken meat and its related public health hazards: A review.

PubMed

Praveen, Praveen Kumar; Debnath, Chanchal; Shekhar, Shashank; Dalai, Nirupama; Ganguly, Subha

2016-01-01

Aeromonas is recognized to cause a variety of diseases in man. In humans, they are associated with intestinal and extra-intestinal infections. With the growing importance of Aeromonas as an emerging pathogen, it is important to combat this organism. It is indisputable that Aeromonas strains may produce many different putative virulence factors such as enterotoxins, hemolysins or cytotoxins, and antibiotic resistance against different antibiotics. The ability of these bacteria to grow competitively at 5°C may be indicative of their potential as a public health hazard. Comprehensive enteric disease surveillance strategies, prevention and education are essential for meeting the challenges in the years ahead. It is important for us to promote the value of enteric cultures when patients have a gastrointestinal illness or bloody diarrhea or when multiple cases of enteric disease occur after a common exposure. With the growing importance of Aeromonas as an emerging pathogen, it is important to combat this organism. It is indisputable that Aeromonas strains may produce many different putative virulence factors, such as enterotoxins, hemolysins or cytotoxins. It has been established that aerolysin is a virulence factor contributing to the pathogenesis of Aeromonas hydrophila infection. Fish and chicken play an important role in the transmission of this pathogen to humans. In the present study, the high prevalence of toxin-producing strains was found among the Aeromonas isolates. The ability of these bacteria to grow competitively at 5°C may be indicative of their potential as a public health hazard. The present review was constructed with a view to highlight the zoonotic importance of Aeromonas pathogen in fish and chicken meat.

Incidence of Aeromonas spp. infection in fish and chicken meat and its related public health hazards: A review

PubMed Central

Praveen, Praveen Kumar; Debnath, Chanchal; Shekhar, Shashank; Dalai, Nirupama; Ganguly, Subha

2016-01-01

Aeromonas is recognized to cause a variety of diseases in man. In humans, they are associated with intestinal and extra-intestinal infections. With the growing importance of Aeromonas as an emerging pathogen, it is important to combat this organism. It is indisputable that Aeromonas strains may produce many different putative virulence factors such as enterotoxins, hemolysins or cytotoxins, and antibiotic resistance against different antibiotics. The ability of these bacteria to grow competitively at 5°C may be indicative of their potential as a public health hazard. Comprehensive enteric disease surveillance strategies, prevention and education are essential for meeting the challenges in the years ahead. It is important for us to promote the value of enteric cultures when patients have a gastrointestinal illness or bloody diarrhea or when multiple cases of enteric disease occur after a common exposure. With the growing importance of Aeromonas as an emerging pathogen, it is important to combat this organism. It is indisputable that Aeromonas strains may produce many different putative virulence factors, such as enterotoxins, hemolysins or cytotoxins. It has been established that aerolysin is a virulence factor contributing to the pathogenesis of Aeromonas hydrophila infection. Fish and chicken play an important role in the transmission of this pathogen to humans. In the present study, the high prevalence of toxin-producing strains was found among the Aeromonas isolates. The ability of these bacteria to grow competitively at 5°C may be indicative of their potential as a public health hazard. The present review was constructed with a view to highlight the zoonotic importance of Aeromonas pathogen in fish and chicken meat. PMID:27051177

Important aspects of participation and participation restrictions in people with a mild intellectual disability.

PubMed

Arvidsson, Patrik; Granlund, Mats; Thyberg, Ingrid; Thyberg, Mikael

2014-01-01

This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability. Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n = 69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being. Rankings of performance highlighted about the same items as "important participation", while rankings of low performance addressed quite different items compared with "important participation restriction". Significant correlations were found between subjective general well-being and high performance (r = 0.56), high performance/high importance (important participation) (r = 0.56), low performance (r = -0.56) and low performance/high importance (important participation restriction; r = -0.55). The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation. The concepts of participation and participation restriction are highly relevant in people with a mild intellectual disability. Self-rated performance might be sufficient to assess participation at a group level. In clinical practices, the relationship between the perceived importance and the actual performance of an activity is essential to assess.

Disparities in Sense of Community: True Race Differences or Differential Item Functioning?

ERIC Educational Resources Information Center

Coffman, Donna L.; BeLue, Rhonda

2009-01-01

The sense of community index (SCI) has been widely used to measure psychological sense of community (SOC). Furthermore, SOC has been found to differ among racial groups. Because different ethnic groups have different cultural and historical experiences that may lead to different interpretations of measurement items, it is important to know whether…

Gender Differences and Intra-Gender Differences amongst Management Information Systems Students

ERIC Educational Resources Information Center

Beyer, Sylvia

2008-01-01

Few women major in Management Information Systems (MIS). The purpose of this paper is to examine the reasons for women's underrepresentation in MIS. In addition to examining gender differences, an important and novel goal of this study is to examine intra-gender differences in undergraduate students, i.e., differences among female MIS majors and…

Sleep-Related Behaviors and Beliefs Associated With Race/Ethnicity in Women

PubMed Central

Grandner, Michael A.; Patel, Nirav P.; Jean-Louis, Girardin; Jackson, Nicholas; Gehrman, Philip R.; Perlis, Michael L.; Gooneratne, Nalaka S.

2013-01-01

Explore how social factors influence sleep, especially sleep-related beliefs and behaviors. Sleep complaints, sleep hygiene behaviors, and beliefs about sleep were studied in 65 black/African American and white/European American women. Differences were found for snoring and discrepancy between sleep duration and need. Sleep behaviors differed across groups for napping, methods for coping with sleep difficulties, and nonsleep behaviors in bed. Beliefs also distinguished groups, with differences in motivation for sleep and beliefs about sleep being important for health and functioning. These findings have important public health implications in terms of developing effective sleep education interventions that include consideration of cultural aspects. PMID:23862291

How important is importance for prospective memory? A review

PubMed Central

Walter, Stefan; Meier, Beat

2014-01-01

Forgetting to carry out an intention as planned can have serious consequences in everyday life. People sometimes even forget intentions that they consider as very important. Here, we review the literature on the impact of importance on prospective memory performance. We highlight different methods used to manipulate the importance of a prospective memory task such as providing rewards, importance relative to other ongoing activities, absolute importance, and providing social motives. Moreover, we address the relationship between importance and other factors known to affect prospective memory and ongoing task performance such as type of prospective memory task (time-, event-, or activity-based), cognitive loads, and processing overlaps. Finally, we provide a connection to motivation, we summarize the effects of task importance and we identify important venues for future research. PMID:25018743

21 CFR 316.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... differences in amino acid sequence; other potentially important differences, such as different glycosylation... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE... subject to investigation and approval under the act or the biologics provisions of the Public Health...

21 CFR 316.3 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... differences in amino acid sequence; other potentially important differences, such as different glycosylation... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE... subject to investigation and approval under the act or the biologics provisions of the Public Health...

Electrospray Ionization Efficiency Is Dependent on Different Molecular Descriptors with Respect to Solvent pH and Instrumental Configuration

PubMed Central

Kiontke, Andreas; Oliveira-Birkmeier, Ariana; Opitz, Andreas

2016-01-01

Over the past decades, electrospray ionization for mass spectrometry (ESI-MS) has become one of the most commonly employed techniques in analytical chemistry, mainly due to its broad applicability to polar and semipolar compounds and the superior selectivity which is achieved in combination with high resolution separation techniques. However, responsiveness of an analytical method also determines its suitability for the quantitation of chemical compounds; and in electrospray ionization for mass spectrometry, it can vary significantly among different analytes with identical solution concentrations. Therefore, we investigated the ESI-response behavior of 56 nitrogen-containing compounds including aromatic amines and pyridines, two compound classes of high importance to both, synthetic organic chemistry as well as to pharmaceutical sciences. These compounds are increasingly analyzed employing ESI mass spectrometry detection due to their polar, basic character. Signal intensities of the peaks from the protonated molecular ion (MH+) were acquired under different conditions and related to compound properties such as basicity, polarity, volatility and molecular size exploring their quantitative impact on ionization efficiency. As a result, we found that though solution basicity of a compound is the main factor initially determining the ESI response of the protonated molecular ion, other factors such as polarity and vaporability become more important under acidic solvent conditions and may nearly outweigh the importance of basicity under these conditions. Moreover, we show that different molecular descriptors may become important when using different types of instruments for such investigations, a fact not detailed so far in the available literature. PMID:27907110

The Sensory Difference Threshold of Menthol Odor in Flavored Tobacco Determined by Combining Sensory and Chemical Analysis.

PubMed

Krüsemann, Erna J Z; Cremers, Johannes W J M; Visser, Wouter F; Punter, Pieter H; Talhout, Reinskje

2017-03-01

Cigarettes are an often-used consumer product, and flavor is an important determinant of their product appeal. Cigarettes with strong nontobacco flavors are popular among young people, and may facilitate smoking initiation. Discriminating flavors in tobacco is important for regulation purposes, for instance to set upper limits to the levels of important flavor additives. We provide a simple and fast method to determine the human odor difference threshold for flavor additives in a tobacco matrix, using a combination of chemical and sensory analysis. For an example, the human difference threshold for menthol odor, one of the most frequently used tobacco flavors, was determined. A consumer panel consisting of 20 women compared different concentrations of menthol-flavored tobacco to unflavored cigarette tobacco using the 2-alternative forced choice method. Components contributing to menthol odor were quantified using headspace GC-MS. The sensory difference threshold of menthol odor corresponded to a mixture of 43 (37-50)% menthol-flavored tobacco, containing 1.8 (1.6-2.1) mg menthol, 2.7 (2.3-3.1) µg menthone, and 1.0 (0.9-1.2) µg neomenthyl acetate per gram of tobacco. Such a method is important in the context of the European Tobacco Product Directive, and the US Food and Drug Administration Tobacco Control Act, that both prohibit cigarettes and roll-your-own tobacco with a characterizing flavor other than tobacco. Our method can also be adapted for matrices other than tobacco, such as food. © The Author 2016. Published by Oxford University Press.

Research collaboration in groups and networks: differences across academic fields.

PubMed

Kyvik, Svein; Reymert, Ingvild

2017-01-01

The purpose of this paper is to give a macro-picture of collaboration in research groups and networks across all academic fields in Norwegian research universities, and to examine the relative importance of membership in groups and networks for individual publication output. To our knowledge, this is a new approach, which may provide valuable information on collaborative patterns in a particular national system, but of clear relevance to other national university systems. At the system level, conducting research in groups and networks are equally important, but there are large differences between academic fields. The research group is clearly most important in the field of medicine and health, while undertaking research in an international network is most important in the natural sciences. Membership in a research group and active participation in international networks are likely to enhance publication productivity and the quality of research.

Comparing and contrasting the formal and informal crime control views of Indian and U.S. College students: a preliminary study.

PubMed

Lambert, Eric G; Pasupuleti, Sudershan; Jiang, Shanhe; Jaishankar, Karuppannan; Bhimarasetty, Jagadish V

2012-12-01

This study examined the importance of formal and informal crime control in the United States and India. Formal crime control relies on the law and official government agencies to deter criminal actions and to respond to criminal activity. Informal crime control relies on moral and social institutions (e.g., family, peers, and neighbors) to promote lawful behavior. Using the data collected from 928 college students, the study found that the Indian and U.S. respondents differed on most of the formal and informal control measures. Overall, the Indian respondents were more likely to rank informal control as more important than were their U.S. counterparts. Although there were differences, both groups of respondents shared similar views on the importance of both forms of crime control and held that family was the most important form of crime control.

Perceived importance of caring behaviors to Swedish psychiatric inpatients and staff, with comparisons to somatically-ill samples.

PubMed

von Essen, L; Sjödén, P O

1993-08-01

The present study identified psychiatric inpatient (N = 61) and staff (N = 63) perceptions of most and least important nurse caring behaviors using a modified Swedish version of the CARE-Q instrument (Larson, 1981) and compared the results with data from somatic care (von Essen & Sjödén, 1991a, 1991b). The results demonstrated 13 significant mean between-group differences in the rating of 50 specific CARE-Q behaviors. Two significant mean value differences out of six subscales combining individual items were demonstrated between groups. Psychiatric inpatients considered the cognitive aspect, and somatic inpatients the task-oriented aspect of caring as the most important. Staff, in psychiatric as well as somatic care, considered the emotional aspect of caring as the most important. The results suggest that staff has a relatively invariant, human-oriented perception of caring, irrespective of subdisciplines, while patients' perceptions of caring vary more over specialties.

Physical activities and their importance to the health of people with severe mental illness in Sweden.

PubMed

Erdner, Anette; Magnusson, Annabella

2012-10-01

It is well known that people with severe mental illness often suffer from constant fatigue, insomnia, and somatic complaints that are too often overlooked. In addition, these persons die earlier in life than others in the population. The purpose of this study was to investigate patients' descriptions of activities and the importance of these activities for their health. Eight persons living in their own home were interviewed about both their views about exercise and their exercising activities. Two themes emerged: Getting Control over One's Life and The Need for Contact with Family & Friends. All of the informants were aware of the importance of physical activity to feel good. The informants described three different forms of activities: daily activities in the home, activities in a rehabilitation centre, and various forms of jogging. These different forms of activity were important to the informants since they reduced their anxiety and stress.

An empirical study of the influence of demographic variable on the choice criteria for assisted living facilities.

PubMed

O'Bryan, D; Clow, K E; O'Bryan, J; Kurtz, D

1996-01-01

Despite the growth and prevalence of assisted-living facilities, empirical marketing research for these facilities is scarce. The objectives of this study were to determine the relative importance of three sets of evaluation criteria in the initial selection of an assisted-living facility, and determine whether the relative importance of these three sets of criteria differed by gender, marital status, level of household, age, or income of the consumer. Survey responses from 279 households indicates that primary service criteria are relatively more important than facilities amenities or organized social activities in the initial selection of an assisted-living facility. The relative importance of the choice criteria differed markedly by gender of the consumer, but marital status, level of household income, and age of the consumer did not have as great an impact on consumers' choice criteria.

Remembering and forecasting: The relation between autobiographical memory and episodic future thinking.

PubMed

Berntsen, Dorthe; Bohn, Annette

2010-04-01

Episodic future thinking is a projection of the self into the future to mentally preexperience an event. Previous work has shown striking similarities between autobiographical memory and episodic future thinking in response to various experimental manipulations. This has nurtured the idea of a shared neurocognitive system underlying both processes. Here, undergraduates generated autobiographical memories and future event representations in response to cue words and requests for important events and rated their characteristics. Important and word-cued events differed markedly on almost all measures. Past, as compared with future, events were rated as more sensorially vivid and less relevant to life story and identity. However, in contrast to previous work, these main effects were qualified by a number of interactions, suggesting important functional differences between the two temporal directions. For both temporal directions, sensory imagery dropped, whereas self-narrative importance and reference to normative cultural life script events increased with increasing temporal distance.

4C-ker: A Method to Reproducibly Identify Genome-Wide Interactions Captured by 4C-Seq Experiments.

PubMed

Raviram, Ramya; Rocha, Pedro P; Müller, Christian L; Miraldi, Emily R; Badri, Sana; Fu, Yi; Swanzey, Emily; Proudhon, Charlotte; Snetkova, Valentina; Bonneau, Richard; Skok, Jane A

2016-03-01

4C-Seq has proven to be a powerful technique to identify genome-wide interactions with a single locus of interest (or "bait") that can be important for gene regulation. However, analysis of 4C-Seq data is complicated by the many biases inherent to the technique. An important consideration when dealing with 4C-Seq data is the differences in resolution of signal across the genome that result from differences in 3D distance separation from the bait. This leads to the highest signal in the region immediately surrounding the bait and increasingly lower signals in far-cis and trans. Another important aspect of 4C-Seq experiments is the resolution, which is greatly influenced by the choice of restriction enzyme and the frequency at which it can cut the genome. Thus, it is important that a 4C-Seq analysis method is flexible enough to analyze data generated using different enzymes and to identify interactions across the entire genome. Current methods for 4C-Seq analysis only identify interactions in regions near the bait or in regions located in far-cis and trans, but no method comprehensively analyzes 4C signals of different length scales. In addition, some methods also fail in experiments where chromatin fragments are generated using frequent cutter restriction enzymes. Here, we describe 4C-ker, a Hidden-Markov Model based pipeline that identifies regions throughout the genome that interact with the 4C bait locus. In addition, we incorporate methods for the identification of differential interactions in multiple 4C-seq datasets collected from different genotypes or experimental conditions. Adaptive window sizes are used to correct for differences in signal coverage in near-bait regions, far-cis and trans chromosomes. Using several datasets, we demonstrate that 4C-ker outperforms all existing 4C-Seq pipelines in its ability to reproducibly identify interaction domains at all genomic ranges with different resolution enzymes.

4C-ker: A Method to Reproducibly Identify Genome-Wide Interactions Captured by 4C-Seq Experiments

PubMed Central

Raviram, Ramya; Rocha, Pedro P.; Müller, Christian L.; Miraldi, Emily R.; Badri, Sana; Fu, Yi; Swanzey, Emily; Proudhon, Charlotte; Snetkova, Valentina

2016-01-01

4C-Seq has proven to be a powerful technique to identify genome-wide interactions with a single locus of interest (or “bait”) that can be important for gene regulation. However, analysis of 4C-Seq data is complicated by the many biases inherent to the technique. An important consideration when dealing with 4C-Seq data is the differences in resolution of signal across the genome that result from differences in 3D distance separation from the bait. This leads to the highest signal in the region immediately surrounding the bait and increasingly lower signals in far-cis and trans. Another important aspect of 4C-Seq experiments is the resolution, which is greatly influenced by the choice of restriction enzyme and the frequency at which it can cut the genome. Thus, it is important that a 4C-Seq analysis method is flexible enough to analyze data generated using different enzymes and to identify interactions across the entire genome. Current methods for 4C-Seq analysis only identify interactions in regions near the bait or in regions located in far-cis and trans, but no method comprehensively analyzes 4C signals of different length scales. In addition, some methods also fail in experiments where chromatin fragments are generated using frequent cutter restriction enzymes. Here, we describe 4C-ker, a Hidden-Markov Model based pipeline that identifies regions throughout the genome that interact with the 4C bait locus. In addition, we incorporate methods for the identification of differential interactions in multiple 4C-seq datasets collected from different genotypes or experimental conditions. Adaptive window sizes are used to correct for differences in signal coverage in near-bait regions, far-cis and trans chromosomes. Using several datasets, we demonstrate that 4C-ker outperforms all existing 4C-Seq pipelines in its ability to reproducibly identify interaction domains at all genomic ranges with different resolution enzymes. PMID:26938081

Emollient product design: objective measurements of formulation structure, texture and performance, and subjective assessments of user acceptability.

PubMed

Antonijević, M D; Owusu-Ware, S; Sanchon-Lopez, B

2018-06-01

The choice of prescribed emollients is usually based on cost and patient preference. Differences in formulations can affect user acceptability. To compare the physical performance, user acceptability and various product design features of two emollient gels that are prescribed in the UK and alleged to be therapeutically interchangeable because their formulations are described as having the same contents of oily ingredients. We found that here are in fact significant measurable differences between the structure and performance of the two formulations, which materially affect their user acceptability. These differences are attributed to the use of different types of gelling agents and other ingredients of differing grades/quality and concentrations, and probably due to the formulations being made by different manufacturing processes. We also identified other product design features that are important to user appeal, including the type of container in which the formulations are presented, the type of dispensing devices provided, and the nature and form of the supplied user instructions. Patients and prescribers should be aware that there can be important differences in performance and user appeal between emollients, even between products that, superficially, may appear to be very similar. These important performance aspects should be characterized for new emollient introductions to encourage better informed product selection. © 2018 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists, North American Clinical Dermatologic Society and St Johns Dermatological Society.

Comparative analysis of disease pathogenesis and molecular mechanisms of New World and Old World arenavirus infections

PubMed Central

McLay, Lisa; Liang, Yuying

2014-01-01

Arenaviruses can cause fatal human haemorrhagic fever (HF) diseases for which vaccines and therapies are extremely limited. Both the New World (NW) and Old World (OW) groups of arenaviruses contain HF-causing pathogens. Although these two groups share many similarities, important differences with regard to pathogenicity and molecular mechanisms of virus infection exist. These closely related pathogens share many characteristics, including genome structure, viral assembly, natural host selection and the ability to interfere with innate immune signalling. However, members of the NW and OW viruses appear to use different receptors for cellular entry, as well as different mechanisms of virus internalization. General differences in disease signs and symptoms and pathological lesions in patients infected with either NW or OW arenaviruses are also noted and discussed herein. Whilst both the OW Lassa virus (LASV) and the NW Junin virus (JUNV) can cause disruption of the vascular endothelium, which is an important pathological feature of HF, the immune responses to these related pathogens seem to be quite distinct. Whereas LASV infection results in an overall generalized immune suppression, patients infected with JUNV seem to develop a cytokine storm. Additionally, the type of immune response required for recovery and clearance of the virus is different between NW and OW infections. These differences may be important to allow the viruses to evade host immune detection. Understanding these differences will aid the development of new vaccines and treatment strategies against deadly HF viral infections. PMID:24068704

A class of solution-invariant transformations of cost functions for minimum cost flow phase unwrapping.

PubMed

Hubig, Michael; Suchandt, Steffen; Adam, Nico

2004-10-01

Phase unwrapping (PU) represents an important step in synthetic aperture radar interferometry (InSAR) and other interferometric applications. Among the different PU methods, the so called branch-cut approaches play an important role. In 1996 M. Costantini [Proceedings of the Fringe '96 Workshop ERS SAR Interferometry (European Space Agency, Munich, 1996), pp. 261-272] proposed to transform the problem of correctly placing branch cuts into a minimum cost flow (MCF) problem. The crucial point of this new approach is to generate cost functions that represent the a priori knowledge necessary for PU. Since cost functions are derived from measured data, they are random variables. This leads to the question of MCF solution stability: How much can the cost functions be varied without changing the cheapest flow that represents the correct branch cuts? This question is partially answered: The existence of a whole linear subspace in the space of cost functions is shown; this subspace contains all cost differences by which a cost function can be changed without changing the cost difference between any two flows that are discharging any residue configuration. These cost differences are called strictly stable cost differences. For quadrangular nonclosed networks (the most important type of MCF networks for interferometric purposes) a complete classification of strictly stable cost differences is presented. Further, the role of the well-known class of node potentials in the framework of strictly stable cost differences is investigated, and information on the vector-space structure representing the MCF environment is provided.

Comparative analysis of disease pathogenesis and molecular mechanisms of New World and Old World arenavirus infections.

PubMed

McLay, Lisa; Liang, Yuying; Ly, Hinh

2014-01-01

Arenaviruses can cause fatal human haemorrhagic fever (HF) diseases for which vaccines and therapies are extremely limited. Both the New World (NW) and Old World (OW) groups of arenaviruses contain HF-causing pathogens. Although these two groups share many similarities, important differences with regard to pathogenicity and molecular mechanisms of virus infection exist. These closely related pathogens share many characteristics, including genome structure, viral assembly, natural host selection and the ability to interfere with innate immune signalling. However, members of the NW and OW viruses appear to use different receptors for cellular entry, as well as different mechanisms of virus internalization. General differences in disease signs and symptoms and pathological lesions in patients infected with either NW or OW arenaviruses are also noted and discussed herein. Whilst both the OW Lassa virus (LASV) and the NW Junin virus (JUNV) can cause disruption of the vascular endothelium, which is an important pathological feature of HF, the immune responses to these related pathogens seem to be quite distinct. Whereas LASV infection results in an overall generalized immune suppression, patients infected with JUNV seem to develop a cytokine storm. Additionally, the type of immune response required for recovery and clearance of the virus is different between NW and OW infections. These differences may be important to allow the viruses to evade host immune detection. Understanding these differences will aid the development of new vaccines and treatment strategies against deadly HF viral infections.

Rough sets and Laplacian score based cost-sensitive feature selection

PubMed Central

Yu, Shenglong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of “good” features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms. PMID:29912884

Global multi-layer network of human mobility

PubMed Central

Belyi, Alexander; Bojic, Iva; Sobolevsky, Stanislav; Sitko, Izabela; Hawelka, Bartosz; Rudikova, Lada; Kurbatski, Alexander; Ratti, Carlo

2017-01-01

ABSTRACT Recent availability of geo-localized data capturing individual human activity together with the statistical data on international migration opened up unprecedented opportunities for a study on global mobility. In this paper, we consider it from the perspective of a multi-layer complex network, built using a combination of three datasets: Twitter, Flickr and official migration data. Those datasets provide different, but equally important insights on the global mobility – while the first two highlight short-term visits of people from one country to another, the last one – migration – shows the long-term mobility perspective, when people relocate for good. The main purpose of the paper is to emphasize importance of this multi-layer approach capturing both aspects of human mobility at the same time. On the one hand, we show that although the general properties of different layers of the global mobility network are similar, there are important quantitative differences among them. On the other hand, we demonstrate that consideration of mobility from a multi-layer perspective can reveal important global spatial patterns in a way more consistent with those observed in other available relevant sources of international connections, in comparison to the spatial structure inferred from each network layer taken separately. PMID:28553155

Understanding tropical upper tropospheric warming: The role of SSTs, convective parameterizations, and observational uncertainties

NASA Astrophysics Data System (ADS)

Po-Chedley, S.; Thorsen, T. J.; Fu, Q.

2015-12-01

Recent research has compared CMIP5 general circulation model (GCM) simulations with satellite observations of warming in the tropical upper troposphere relative to the lower-middle troposphere. Although the pattern of SST warming is important, this research demonstrated that models overestimate increases in static stability between the mid- to upper- tropical troposphere, even when they are forced with historical sea surface temperatures. This discrepancy between satellite-borne microwave sounding unit measurements (MSU) and GCMs is important because it has implications for the strength of the lapse rate and water vapor feedback. The apparent model-observational difference for changes in static stability in the tropical upper troposphere represents an important problem, but it is not clear whether the difference is a result of common biases in GCMs, biases in observational datasets, or both. In this work, we will use GCM simulations to examine the importance of the spatial pattern of SST warming and different convective parameterizations in determining the lapse rate changes in tropical troposphere. We will also consider uncertainties in MSU satellite observations, including changes in the diurnal sampling of temperature and instrument calibration biases when comparing GCMs with the observed record.

The Effects of Gendered Social Capital on U.S. Migration: A Comparison of Four Latin American Countries.

PubMed

Côté, Rochelle R; Jensen, Jessica Eva; Roth, Louise Marie; Way, Sandra M

2015-06-01

This article contributes to understandings of gendered social capital by analyzing the effects of gendered ties on the migration of men and women from four Latin American countries (Mexico, Costa Rica, Nicaragua, and the Dominican Republic) to the United States. The research theorizes the importance of strong and weak ties to men and women in each sending country as a product of the gender equity gap in economic participation (low/high) and incidence of female-led families (low/high). The findings reveal that ties to men increase the odds of migration from countries where gender equity and incidence of female-led families are low, while ties to women are more important for migration from countries where gender equity and female-led families are high. Previous research on migration and social capital details the importance of network ties for providing resources and the role of gender in mediating social capital quality and access to network support. Results reveal that not only are different kinds of ties important to female and male migration, but migrants from different countries look to different sources of social capital for assistance.

The Fractal Patterns of Words in a Text: A Method for Automatic Keyword Extraction.

PubMed

Najafi, Elham; Darooneh, Amir H

2015-01-01

A text can be considered as a one dimensional array of words. The locations of each word type in this array form a fractal pattern with certain fractal dimension. We observe that important words responsible for conveying the meaning of a text have dimensions considerably different from one, while the fractal dimensions of unimportant words are close to one. We introduce an index quantifying the importance of the words in a given text using their fractal dimensions and then ranking them according to their importance. This index measures the difference between the fractal pattern of a word in the original text relative to a shuffled version. Because the shuffled text is meaningless (i.e., words have no importance), the difference between the original and shuffled text can be used to ascertain degree of fractality. The degree of fractality may be used for automatic keyword detection. Words with the degree of fractality higher than a threshold value are assumed to be the retrieved keywords of the text. We measure the efficiency of our method for keywords extraction, making a comparison between our proposed method and two other well-known methods of automatic keyword extraction.

The Fractal Patterns of Words in a Text: A Method for Automatic Keyword Extraction

PubMed Central

Najafi, Elham; Darooneh, Amir H.

2015-01-01

A text can be considered as a one dimensional array of words. The locations of each word type in this array form a fractal pattern with certain fractal dimension. We observe that important words responsible for conveying the meaning of a text have dimensions considerably different from one, while the fractal dimensions of unimportant words are close to one. We introduce an index quantifying the importance of the words in a given text using their fractal dimensions and then ranking them according to their importance. This index measures the difference between the fractal pattern of a word in the original text relative to a shuffled version. Because the shuffled text is meaningless (i.e., words have no importance), the difference between the original and shuffled text can be used to ascertain degree of fractality. The degree of fractality may be used for automatic keyword detection. Words with the degree of fractality higher than a threshold value are assumed to be the retrieved keywords of the text. We measure the efficiency of our method for keywords extraction, making a comparison between our proposed method and two other well-known methods of automatic keyword extraction. PMID:26091207

Kinematic predictors of loading during running differ by demographic group.

PubMed

Harrison, Kathryn; Thakkar, Bhushan; Kwon, Yong Ung; Crosswell, Gregory; Morgan, Jacqueline; Williams, D S Blaise

2018-05-24

To investigate whether previously-determined kinematic predictors of kinetics during running differ between demographic groups. Young male (n = 13, age = 22 (2) yrs), young female (n = 13, age = 25 (4) yrs), older male (n = 13, age = 50 (4) yrs) and older female (n = 13, age = 52 (3) yrs) runners. Sagittal plane kinematics and kinetics were assessed while participants ran at their preferred pace. Linear regression models were developed to predict kinetics in each group using kinematics as independent variables. Step length was positively associated with magnitude of at least one kinetic variable in all groups. Step position was inversely associated with vertical ground reaction force variables in all groups. Step frequency and CoM excursion were also important to all groups, however direction of the associations varied. Foot angle at initial contact was important to all groups except older females. Peak knee flexion was most important to older females, but was not important to any other groups. Optimal parameters for gait analysis of runners may depend on demographics of the individual. This provides insight for clinicians into the most effective evaluation and interventions strategies for different types of runners. Copyright © 2018. Published by Elsevier Ltd.

Rough sets and Laplacian score based cost-sensitive feature selection.

PubMed

Yu, Shenglong; Zhao, Hong

2018-01-01

Cost-sensitive feature selection learning is an important preprocessing step in machine learning and data mining. Recently, most existing cost-sensitive feature selection algorithms are heuristic algorithms, which evaluate the importance of each feature individually and select features one by one. Obviously, these algorithms do not consider the relationship among features. In this paper, we propose a new algorithm for minimal cost feature selection called the rough sets and Laplacian score based cost-sensitive feature selection. The importance of each feature is evaluated by both rough sets and Laplacian score. Compared with heuristic algorithms, the proposed algorithm takes into consideration the relationship among features with locality preservation of Laplacian score. We select a feature subset with maximal feature importance and minimal cost when cost is undertaken in parallel, where the cost is given by three different distributions to simulate different applications. Different from existing cost-sensitive feature selection algorithms, our algorithm simultaneously selects out a predetermined number of "good" features. Extensive experimental results show that the approach is efficient and able to effectively obtain the minimum cost subset. In addition, the results of our method are more promising than the results of other cost-sensitive feature selection algorithms.

Evaluating different methods used in ethnobotanical and ecological studies to record plant biodiversity

PubMed Central

2014-01-01

Background This study compares the efficiency of identifying the plants in an area of semi-arid Northeast Brazil by methods that a) access the local knowledge used in ethnobotanical studies using semi-structured interviews conducted within the entire community, an inventory interview conducted with two participants using the previously collected vegetation inventory, and a participatory workshop presenting exsiccates and photographs to 32 people and b) inventory the vegetation (phytosociology) in locations with different histories of disturbance using rectangular plots and quadrant points. Methods The proportion of species identified using each method was then compared with Cochran’s Q test. We calculated the use value (UV) of each species using semi-structured interviews; this quantitative index was correlated against values of the vegetation’s structural importance obtained from the sample plot method and point-centered quarter method applied in two areas with different historical usage. The analysis sought to correlate the relative importance of plants to the local community (use value - UV) with the ecological importance of the plants in the vegetation structure (importance value - IV; relative density - RD) by using different sampling methods to analyze the two areas. Results With regard to the methods used for accessing the local knowledge, a difference was observed among the ethnobotanical methods of surveying species (Q = 13.37, df = 2, p = 0.0013): 44 species were identified in the inventory interview, 38 in the participatory workshop and 33 in the semi-structured interviews with the community. There was either no correlation between the UV, relative density (RD) and importance value (IV) of some species, or this correlation was negative. Conclusion It was concluded that the inventory interview was the most efficient method for recording species and their uses, as it allowed more plants to be identified in their original environment. To optimize researchers’ time in future studies, the use of the point-centered quarter method rather than the sample plot method is recommended. PMID:24916833

The influence of drought on flow‐ecology relationships in Ozark Highland streams

USGS Publications Warehouse

Lynch, Dustin T.; Leasure, D. R.; Magoulick, Daniel D.

2018-01-01

Drought and summer drying can have strong effects on abiotic and biotic components of stream ecosystems. Environmental flow‐ecology relationships may be affected by drought and drying, adding further uncertainty to the already complex interaction of flow with other environmental variables, including geomorphology and water quality.Environment–ecology relationships in stream communities in Ozark Highland streams, USA, were examined over two years with contrasting environmental conditions, a drought year (2012) and a flood year (2013). We analysed fish, crayfish and benthic macroinvertebrate assemblages using two different approaches: (1) a multiple regression analysis incorporating predictor variables related to habitat, water quality, geomorphology and hydrology and (2) a canonical ordination procedure using only hydrologic variables in which forward selection was used to select predictors that were most related to our response variables.Reach‐scale habitat quality and geomorphology were found to be the most important influences on community structure, but hydrology was also important, particularly during the flood year. We also found substantial between‐year variation in environment–ecology relationships. Some ecological responses differed significantly between drought and flood years, while others remained consistent. We found that magnitude was the most important flow component overall, but that there was a shift in relative importance from low flow metrics during the drought year to average flow metrics during the flood year, and the specific metrics of importance varied markedly between assemblages and years.Findings suggest that understanding temporal variation in flow‐ecology relationships may be crucial for resource planning. While some relationships show temporal variation, others are consistent between years. Additionally, different kinds of hydrologic variables can differ greatly in terms of which assemblages they affect and how they affect them. Managers can address this complexity by focusing on relationships that are temporally stable and flow metrics that are consistently important across groups, such as flood frequency and flow variability.

Education of pediatric subspecialty fellows in transport medicine: a national survey.

PubMed

Mickells, Geoffrey E; Goodman, Denise M; Rozenfeld, Ranna A

2017-01-13

The transport of critically ill patients to children's hospitals is essential to current practice. The AAP Section on Transport Medicine has raised concerns about future leadership in the field as trainees receive less exposure to transport medicine. This study identifies the priorities of pediatric subspecialty fellows, fellowship directors and nursing directors in transport medicine education. Internet based surveys were distributed to fellows, fellowship directors and nursing directors of transport teams affiliated with ACGME-approved fellowships in Neonatal-Perinatal Medicine (NPM), Pediatric Critical Care Medicine (PCCM), and Pediatric Emergency Medicine (PEM). Data collection occurred November 2013 to March 2014. Four hundred and sixty-six responses were collected (357 fellows, 82 directors, 27 nursing directors): Six curricular elements were ranked by respondents: Transport Physiology (TP), Medical Control (MC), Vehicle Safety (VS), Medicolegal Issues (ML), Medical Protocols (MP) and State and Federal Regulations (SFR). Fellows and fellowship directors were not significantly different: TP (p = 0.63), VS (p = 0.45), SFR (p = 0.58), ML (p = 0.07), MP (p = 0.98), and MC (p = 0.36). Comparison of subspecialties found significant differences: PEM considered TP less important than NPM and PCCM (p < 0.001, p < 0.001), VS less important than NPM (p = 0.001). PEM viewed SFR and MC more important than PCCM (p = 0.006, p = 0.002); ML more important than PCCM and NPM (p = 0.001, p < 0.001). PCCM ranked MC more important than NPM (p = 0.004). Nursing directors considered TP less important than NPM and PCCM (p < 0.001, p = 0.002). When ranking curricular elements in transport medicine, fellows and fellowship directors do not differ, but comparison of subspecialties notes significant differences. A fellow curriculum in transport medicine will utilize these results.

Formulary considerations in selection of beta-blockers.

PubMed

Yedinak, K C

1993-08-01

Selection of beta-adrenergic blockers for formulary addition can be a difficult task, especially with the increasing availability of new beta-blockers, as well as the numerous differences in pharmacodynamic and pharmacokinetic properties of currently available agents. Nevertheless, appropriate evaluation of the important characteristics of beta-blockers should allow selection of the most cost-effective agents for formulary addition. Most importantly, differences in efficacy, product formulation and cost should be carefully considered when making formulary decisions. Notably, evidence from clinical trials indicates differences in efficacy among beta-blockers for post-myocardial infarction prophylaxis, situational anxiety, essential tremor, thyrotoxicosis, migraine prophylaxis and prevention of bleeding associated with oesophageal varices. For many clinical situations, it is also important to select an effective agent that is available in both an oral and intravenous formulation, especially for cardioprotection after acute myocardial infarction and for use in supraventricular arrhythmias. In addition, availability of sustained release products and generic formulations should be considered for their potential to increase compliance and decrease cost, respectively. Comparative drug costs, as well as costs associated with decreased compliance, should also be carefully evaluated. Differences in beta-receptor selectivity, duration of action and presence of intrinsic sympathomimetic activity (ISA) are also important considerations in the selection of beta-blockers for formulary consideration. Although degree of selectivity is relative, beta 1-selective agents may be less likely to induce bronchospasm in patients with chronic obstructive pulmonary disease (COPD) and may be less likely to affect glucose homeostasis in patients with diabetes mellitus. Duration of action of a beta-blocker is an important consideration for evaluation of efficacy throughout the recommended dosage interval. In addition, beta-blockers with a long duration of action can often be administered once or twice daily, potentially leading to increased compliance and thereby improved effectiveness and economic efficiency. The presence of ISA is an important consideration because certain beta-blockers with ISA may be less effective than those without ISA for certain indications. Factors considered to be less important when making formulary decisions of choice of beta-blockers include the route of elimination, lipophilicity and presence of membrane stabilising activity.

Investigating the relative importance of individual differences on the work-family interface and the moderating role of boundary preference for segmentation.

PubMed

Michel, Jesse S; Clark, Malissa A

2013-10-01

This study examines the relative importance of individual differences in relation to perceptions of work-family conflict and facilitation, as well as the moderating role of boundary preference for segmentation on these relationships. Relative importance analyses, based on a diverse sample of 380 employees from the USA, revealed that individual differences were consistently predictive of self-reported work-family conflict and facilitation. Conscientiousness, neuroticism, negative affect and core self-evaluations were consistently related to both directions of work-family conflict, whereas agreeableness predicted significant variance in family-to-work conflict only. Positive affect and core self-evaluations were consistently related to both directions of work-family facilitation, whereas agreeableness and neuroticism predicted significant variance in family-to-work facilitation only. Collectively, individual differences explained 25-28% of the variance in work-family conflict (primarily predicted by neuroticism and negative affect) and 11-18% of the variance in work-family facilitation (primarily predicted by positive affect and core self-evaluations). Moderated regression analyses showed that boundary preference for segmentation strengthened many of the relationships between individual differences and work-family conflict and facilitation. Implications for addressing the nature of work and family are discussed. Copyright © 2012 John Wiley & Sons, Ltd.

Race, common genetic variation, and therapeutic response disparities in heart failure.

PubMed

Taylor, Mathew R; Sun, Albert Y; Davis, Gordon; Fiuzat, Mona; Liggett, Stephen B; Bristow, Michael R

2014-12-01

Because of its comparatively recent evolution, Homo sapiens exhibit relatively little within-species genomic diversity. However, because of genome size, a proportionately small amount of variation creates ample opportunities for both rare mutations that may cause disease as well as more common genetic variations that may be important in disease modification or pharmacogenetics. Primarily because of the East African origin of modern humans, individuals of African ancestry (AA) exhibit greater degrees of genetic diversity than more recently established populations, such as those of European ancestry (EA) or Asian ancestry. Those population effects extend to differences in frequency of common gene variants that may be important in heart failure natural history or therapy. For cell-signaling mechanisms important in heart failure, we review and present new data for genetic variation between AA and EA populations. Data indicate that: 1) neurohormonal signaling mechanisms frequently (16 of the 19 investigated polymorphisms) exhibit racial differences in the allele frequencies of variants comprising key constituents; 2) some of these differences in allele frequency may differentially affect the natural history of heart failure in AA compared with EA individuals; and 3) in many cases, these differences likely play a role in observed racial differences in drug or device response. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The relationship between educational attainment and waiting time among the elderly in Norway.

PubMed

Carlsen, Fredrik; Kaarboe, Oddvar Martin

2015-11-01

We investigate whether educational attainment affects waiting time of elderly patients in somatic hospitals. We consider three distinct pathways; that patients with different educational attainment have different disease patterns, that patients with different levels of education receive treatments at different hospitals, and that patient choice and supply of local health services within hospital catchment areas explain unequal waiting time of different educational groups. We find evidence of an educational gradient in waiting time for male patients, but not for female patients. Conditional on age, male patients with tertiary education wait 45% shorter than male patients with secondary or primary education. The first pathway is not quantitatively important as controlling for disease patters has little effect on relative waiting times. The second pathway is important. Relative to patients with primary education, variation in waiting time and education level across local hospitals contributes to higher waiting time for male patients with secondary education and female patients with secondary or tertiary education and lower waiting time for male patients with tertiary education. These effects are in the order of 15-20%. The third pathway is also quantitatively important. The educational gradients within catchment areas disappear when we control for travel distance and supply of private specialists. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Basics of compounding sterile preparations: nomenclature and considerations.

PubMed

Allen, Loyd V

2014-01-01

This article focuses on sterile dosage forms and serves as a review for those trained in compounding sterile preparations, as well as to educate those that have not received any formal training on the topics of nomenclature and composition. The use of proper terminology is important for proper/accurate communications among healthcare practitioners. Proper terminology also has potential legal/liability implications. In addition to terminology considerations, it is important to be aware of the different routes of administration of sterile formulations and their different compositions and uses.

Epigenetic modifications: An important mechanism in diabetic disturbances.

PubMed

Rorbach-Dolata, Anna; Kubis, Adriana; Piwowar, Agnieszka

2017-11-29

In the search for explanations of diabetes pathomechanisms, especially the development of its vascular complications (micro- and macrovascular ), although current, good metabolic control of diabetes, attention was drawn to the role of epigenetic inheritance associated with epigenetic modifications of histone proteins and DNA in hyperglycemia conditions. This study showed the significant role of DNA methylation and histone epigenetic modifications (a different nature and a different degree) in the transmission of information that is not connected with gene inheritance but concerns the persistent changes induced by hyperglycemia..Attention was paid to the role of DNA methylation of pancreatic cells in the pathogenesis of type 1 diabetes, but also type 2. The important role of DNA methylation changes in a so-called intrauterine growth restriction (IUGR) as reason of subsequent development of diabetes was particularly emphasized. In the pathogenesis of type 2 diabetes and its complications, especially microvascular complications, the greatest share and importance of epigenetic modifications on mitochondrial DNA metylation are the most important. The multidirectionality Complicaand complexity of epigenetic modifications of histone proteins indicate their importance in the development of diabetic disturbances. An especially important role is attributed to methylation and acetylation of histone proteins, in particular on arginine and lysine, whose changes occur most frequently. Moreover, epigenetic modifications of the enzymes, especially methylases, responsible for these processes are the underlying. It has been indicated that the identification of epigenetic differences within the DNA or histone proteins may be a useful prognostic biomarker of susceptibility to the disease development in the future. Moreover, they may become a potential target for future therapeutic interventions for clinical disorders in diabetes.

When is connectivity important? A case study of the spatial pattern of sudden oak death

Treesearch

A. Ellis; T. Vaclavik; R.K. Meentemeyer

2010-01-01

Although connectivity has been examined from many different angles and in many ecological disciplines, few studies have tested in which systems and under what conditions connectivity is important in determining ecological dynamics. Identifying general rules governing when connectivity is important is crucial not only for basic ecology, but also for our ability to...

19 CFR 7.3 - Duty-free treatment of goods imported from insular possessions of the United States other than...

Code of Federal Regulations, 2010 CFR

2010-04-01

... INSULAR POSSESSIONS AND GUANTANAMO BAY NAVAL STATION § 7.3 Duty-free treatment of goods imported from...) The goods became a new and different article of commerce as a result of production or manufacture... possession or the United States results from the original commercial transaction between the importer and the...

Perception of managerial and administrative competencies of professional pharmacists in the U.S. Department of Defense.

PubMed

Meadows, Andrew B; Finstuen, Kenn; Hudak, Ronald P; Carrillo, Jorge D; Lawrence, Joseph B; Wright, Kevin

2003-01-01

To determine whether executive and junior pharmacists perceive skills, knowledge, and abilities (SKA) items differently. Two-factor split-plot analysis of variance (ANOVA) mixed design with repeated measures. U.S. Department of Defense (DoD). One hundred fifty-one active duty pharmacy officers in DoD, classified as either executive pharmacists (serving in the military grades of lieutenant colonel/commander [0-5] and colonel/captain [0-6], as well as pharmacists selected for promotion to those grades) or junior pharmacists (serving in the military grades of second lieutenant/ensign [0-1], first lieutenant/lieutenant junior grade [0-2], and captain/lieutenant [0-3], as well as pharmacists selected for promotion to those grades). Seven-point relative importance rating scales, with 1 = extremely unimportant to 7 = extremely important, were used to assess respondents' judgments of SKAs. Main effects of group membership (executive versus junior pharmacists), differences among items within eight specific domains, and assessment of potential interaction effects for the dependent variable of SKA item importance ratings. No main effects for overall rating differences between pharmacist groups were found for any of the eight domains; however, statistically significant and systematic within-main-effect differences were detected for SKA items in all domains. Additionally, statistically significant interaction effects emerged in five of the eight domains. The importance ratings given SKAs in the domains of human resources, pharmacy operations and business practices, drug therapy management, and leadership were highly similar between the two groups. However, executive pharmacists tended to place a much greater emphasis on the importance of SKAs within the financial resources and the pharmacy benefit management domains.

Bird Responses to Lowland Rainforest Conversion in Sumatran Smallholder Landscapes, Indonesia

PubMed Central

Clough, Yann; Toledo-Hernandez, Manuel; Arlettaz, Raphael; Mulyani, Yeni A.; Tscharntke, Teja

2016-01-01

Rapid land-use change in the tropics causes dramatic losses in biodiversity and associated functions. In Sumatra, Indonesia, lowland rainforest has mainly been transformed by smallholders into oil palm (Elaeis guineensis) and rubber (Hevea brasiliensis) monocultures, interspersed with jungle rubber (rubber agroforests) and a few forest remnants. In two regions of the Jambi province, we conducted point counts in 32 plots of four different land-use types (lowland rainforest, jungle rubber, rubber plantation and oil palm plantation) as well as in 16 nearby homegardens, representing a small-scale, traditional agricultural system. We analysed total bird abundance and bird abundance in feeding guilds, as well as species richness per point count visit, per plot, and per land-use system, to unveil the conservation importance and functional responses of birds in the different land-use types. In total, we identified 71 species from 24 families. Across the different land-use types, abundance did not significantly differ, but both species richness per visit and per plot were reduced in plantations. Feeding guild abundances between land-use types were variable, but homegardens were dominated by omnivores and granivores, and frugivorous birds were absent from monoculture rubber and oil palm. Jungle rubber played an important role in harbouring forest bird species and frugivores. Homegardens turned out to be of minor importance for conserving birds due to their low sizes, although collectively, they are used by many bird species. Changes in functional composition with land-use conversion may affect important ecosystem functions such as biological pest control, pollination, and seed dispersal. In conclusion, maintaining forest cover, including degraded forest and jungle rubber, is of utmost importance to the conservation of functional and taxonomic bird diversity. PMID:27224063

Community health information sources--a survey in three disparate communities.

PubMed

Dart, Jared; Gallois, Cindy; Yellowlees, Peter

2008-02-01

To determine the current utilisation, importance, trust and future preference for contemporary sources of health information in three different socioeconomic groups. A pilot study including key informant interviews and direct observation was conducted in a low socioeconomic community. From this work a survey questionnaire was designed and implemented across three different communities. Semi-structured key informant interviews and focus groups capturing 52 respondents. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic (LSE) community on the outskirts of Ipswich, Queensland, a mid-high socioeconomic (MSE) community in the western suburbs of Brisbane, and at a local university. Rank of current and preferred future sources of health information, importance and trustworthiness of health information sources. Across all three communities the local doctor was the most currently used, important, trusted and preferred future source of health information. The most striking difference between the three communities related to the current use and preferred future use of the internet. The internet was a more currently used source of health information and more important source in the university population than the LSE or MSE populations. It was also a less preferred source of future health information in the LSE population than the MSE or university populations. Importantly, currently used sources of health information did not reflect community members' preferred sources of health information. People in different socioeconomic communities obtain health information from various sources. This may reflect access issues, education and awareness of the internet as a source of health information, less health information seeking as well as a reluctance by the e-health community to address the specific needs of this group.

Bird Responses to Lowland Rainforest Conversion in Sumatran Smallholder Landscapes, Indonesia.

PubMed

Prabowo, Walesa Edho; Darras, Kevin; Clough, Yann; Toledo-Hernandez, Manuel; Arlettaz, Raphael; Mulyani, Yeni A; Tscharntke, Teja

2016-01-01

Rapid land-use change in the tropics causes dramatic losses in biodiversity and associated functions. In Sumatra, Indonesia, lowland rainforest has mainly been transformed by smallholders into oil palm (Elaeis guineensis) and rubber (Hevea brasiliensis) monocultures, interspersed with jungle rubber (rubber agroforests) and a few forest remnants. In two regions of the Jambi province, we conducted point counts in 32 plots of four different land-use types (lowland rainforest, jungle rubber, rubber plantation and oil palm plantation) as well as in 16 nearby homegardens, representing a small-scale, traditional agricultural system. We analysed total bird abundance and bird abundance in feeding guilds, as well as species richness per point count visit, per plot, and per land-use system, to unveil the conservation importance and functional responses of birds in the different land-use types. In total, we identified 71 species from 24 families. Across the different land-use types, abundance did not significantly differ, but both species richness per visit and per plot were reduced in plantations. Feeding guild abundances between land-use types were variable, but homegardens were dominated by omnivores and granivores, and frugivorous birds were absent from monoculture rubber and oil palm. Jungle rubber played an important role in harbouring forest bird species and frugivores. Homegardens turned out to be of minor importance for conserving birds due to their low sizes, although collectively, they are used by many bird species. Changes in functional composition with land-use conversion may affect important ecosystem functions such as biological pest control, pollination, and seed dispersal. In conclusion, maintaining forest cover, including degraded forest and jungle rubber, is of utmost importance to the conservation of functional and taxonomic bird diversity.

Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation.

PubMed

Kennedy, David P; Brown, Ryan A; Morrison, Penelope; Vie, Loryana; Ryan, Gery W; Tucker, Joan S

2015-01-31

Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs.

Sex Differences in Drug Disposition

PubMed Central

Soldin, Offie P.; Chung, Sarah H.; Mattison, Donald R.

2011-01-01

Physiological, hormonal, and genetic differences between males and females affect the prevalence, incidence, and severity of diseases and responses to therapy. Understanding these differences is important for designing safe and effective treatments. This paper summarizes sex differences that impact drug disposition and includes a general comparison of clinical pharmacology as it applies to men and women. PMID:21403873

Food choice motives and the importance of family meals among immigrant mothers.

PubMed

Marquis, Marie; Shatenstein, Bryna

2005-01-01

To determine the health and social benefits of the family mealtime, we examined the contribution of immigrant mothers' food motives to the importance placed on family meals, and cultural differences in mothers' food motives and the importance ascribed to family meals. Data were taken from a study on food choice factors among ten- to 12-year-old children from three cultural communities in Montreal. A 24-item, self-administered questionnaire was used to explore food choice motives. Each mother was also asked how important it was for her family to take the time to eat together, and if the child enjoyed sharing meals with his or her family. In all, 209 of the 653 questionnaires distributed were valid; 68 were from Haitian, 75 from Portuguese, and 66 from Vietnamese mothers. Five factors emerging from factor analyses explained 61.67% of the variance. Analysis of variance indicated significant differences between mothers' countries of origin for the importance placed on health, pleasure, familiarity, and ingredient properties (p<0.005). Among Haitian and Portuguese mothers, health motivations emerged as the only significant predictor of the importance given to family meals, whereas for Vietnamese mothers, both health and eating familiar foods were predictors (p<0.05).

Effect of gold wire bonding process on angular correlated color temperature uniformity of white light-emitting diode.

PubMed

Wu, Bulong; Luo, Xiaobing; Zheng, Huai; Liu, Sheng

2011-11-21

Gold wire bonding is an important packaging process of lighting emitting diode (LED). In this work, we studied the effect of gold wire bonding on the angular uniformity of correlated color temperature (CCT) in white LEDs whose phosphor layers were coated by freely dispersed coating process. Experimental study indicated that different gold wire bonding impacts the geometry of phosphor layer, and it results in different fluctuation trends of angular CCT at different spatial planes in one LED sample. It also results in various fluctuating amplitudes of angular CCT distributions at the same spatial plane for samples with different wire bonding angles. The gold wire bonding process has important impact on angular uniformity of CCT in LED package. © 2011 Optical Society of America

Evaluation of Demographics and Social Life Events of Asian (Elephas maximus) and African Elephants (Loxodonta africana) in North American Zoos

PubMed Central

Prado-Oviedo, Natalia A.; Bonaparte-Saller, Mary K.; Malloy, Elizabeth J.; Meehan, Cheryl L.; Mench, Joy A.; Carlstead, Kathy; Brown, Janine L.

2016-01-01

This study quantified social life events hypothesized to affect the welfare of zoo African and Asian elephants, focusing on animals that were part of a large multi-disciplinary, multi-institutional elephant welfare study in North America. Age was calculated based on recorded birth dates and an age-based account of life event data for each elephant was compiled. These event histories included facility transfers, births and deaths of offspring, and births and deaths of non-offspring herd mates. Each event was evaluated as a total number of events per elephant, lifetime rate of event exposure, and age at first event exposure. These were then compared across three categories: species (African vs. Asian); sex (male vs. female); and origin (imported vs. captive-born). Mean age distributions differed (p<0.05) between the categories: African elephants were 6 years younger than Asian elephants, males were 12 years younger than females, and captive-born elephants were 20 years younger than imported elephants. Overall, the number of transfers ranged from 0 to 10, with a 33% higher age-adjusted transfer rate for imported African than imported Asian elephants, and 37% lower rate for imported females than males (p<0.05). Other differences (p<0.05) included a 96% higher rate of offspring births for captive-born females than those imported from range countries, a 159% higher rate of birthing event exposures for captive-born males than for their imported counterparts, and Asian elephant females being 4 years younger than African females when they produced their first calf. In summarizing demographic and social life events of elephants in North American zoos, we found both qualitative and quantitative differences in the early lives of imported versus captive-born elephants that could have long-term welfare implications. PMID:27415437

A widespread plant-fungal-bacterial symbiosis promotes plant biodiversity, plant nutrition and seedling recruitment.

PubMed

van der Heijden, Marcel G A; de Bruin, Susanne; Luckerhoff, Ludo; van Logtestijn, Richard S P; Schlaeppi, Klaus

2016-02-01

Highly diverse microbial assemblages colonize plant roots. It is still poorly understood whether different members of this root microbiome act synergistically by supplying different services (for example, different limiting nutrients) to plants and plant communities. In order to test this, we manipulated the presence of two widespread plant root symbionts, arbuscular mycorrhizal fungi and nitrogen-fixing rhizobia bacteria in model grassland communities established in axenic microcosms. Here, we demonstrate that both symbionts complement each other resulting in increased plant diversity, enhanced seedling recruitment and improved nutrient acquisition compared with a single symbiont situation. Legume seedlings obtained up to 15-fold higher productivity if they formed an association with both symbionts, opposed to productivity they reached with only one symbiont. Our results reveal the importance of functional diversity of symbionts and demonstrate that different members of the root microbiome can complement each other in acquiring different limiting nutrients and in driving important ecosystem functions.

Introducing a modular activity monitoring system.

PubMed

Reiss, Attila; Stricker, Didier

2011-01-01

In this paper, the idea of a modular activity monitoring system is introduced. By using different combinations of the system's three modules, different functionality becomes available: 1) a coarse intensity estimation of physical activities 2) different features based on HR-data and 3) the recognition of basic activities and postures. 3D-accelerometers--placed on lower arm, chest and foot--and a heart rate monitor were used as sensors. A dataset with 8 subjects and 14 different activities was recorded to evaluate the performance of the system. The overall performance on the intensity estimation task, relying on the chest-worn accelerometer and the HR-monitor, was 94.37%. The overall performance on the activity recognition task, using all three accelerometer placements and the HR-monitor, was 90.65%. This paper also gives an analysis of the importance of different accelerometer placements and the importance of a HR-monitor for both tasks.

Evaluating structural connectomics in relation to different Q-space sampling techniques.

PubMed

Rodrigues, Paulo; Prats-Galino, Alberto; Gallardo-Pujol, David; Villoslada, Pablo; Falcon, Carles; Prckovska, Vesna

2013-01-01

Brain networks are becoming forefront research in neuroscience. Network-based analysis on the functional and structural connectomes can lead to powerful imaging markers for brain diseases. However, constructing the structural connectome can be based upon different acquisition and reconstruction techniques whose information content and mutual differences has not yet been properly studied in a unified framework. The variations of the structural connectome if not properly understood can lead to dangerous conclusions when performing these type of studies. In this work we present evaluation of the structural connectome by analysing and comparing graph-based measures on real data acquired by the three most important Diffusion Weighted Imaging techniques: DTI, HARDI and DSI. We thus come to several important conclusions demonstrating that even though the different techniques demonstrate differences in the anatomy of the reconstructed fibers the respective connectomes show variations of 20%.

Introducing Shakespeare.

ERIC Educational Resources Information Center

Leinwand, Theodore B.

2002-01-01

Discusses the short introductions by literary scholars that more often than not precede Shakespeare's plays. Considers the importance and lack of importance that readers put on these introductions. Describes the use and creation, over time, of these introductions to many different plays by Shakespeare. (SG)

Engineering Students' Sustainability Approaches

ERIC Educational Resources Information Center

Haase, S.

2014-01-01

Sustainability issues are increasingly important in engineering work all over the world. This article explores systematic differences in self-assessed competencies, interests, importance, engagement and practices of newly enrolled engineering students in Denmark in relation to environmental and non-environmental sustainability issues. The…

Development and Monte Carlo Study of a Procedure for Correcting the Standardized Mean Difference for Measurement Error in the Independent Variable

ERIC Educational Resources Information Center

Nugent, William Robert; Moore, Matthew; Story, Erin

2015-01-01

The standardized mean difference (SMD) is perhaps the most important meta-analytic effect size. It is typically used to represent the difference between treatment and control population means in treatment efficacy research. It is also used to represent differences between populations with different characteristics, such as persons who are…

Physician opinions about an anatomy core curriculum: a case for medical imaging and vertical integration.

PubMed

Orsbon, Courtney P; Kaiser, Rebecca S; Ross, Callum F

2014-01-01

Pre-clinical anatomy curricula must provide medical students with the knowledge needed in a variety of medical and surgical specialties. But do physicians within specialties agree about what anatomical knowledge is most important in their practices? And, what is the common core of anatomical knowledge deemed essential by physicians in different specialties? Answers to these questions would be useful in designing pre-clinical anatomy courses. The primary aim of this study was to assess the importance of a human gross anatomy course by soliciting the opinions of physicians from a range of specialties. We surveyed 93 physicians to determine the importance of specific anatomical topics in their own practices. Their responses were analyzed to assess variation in intra- and inter-departmental attitudes toward the importance of anatomy. Nearly all of the topics taught in the course were deemed important by the clinicians as a group, but respondents showed little agreement on the rank order of importance of anatomical topics. Overall, only medical imaging received high importance by nearly all respondents, and lower importance was attached to embryology and lymphatic anatomy. Our survey data, however, also suggested distinct hierarchies in the importance assigned to anatomical topics within specialties. Given that physicians view the importance of anatomy differently, we suggest that students revisit anatomy through a vertically integrated curriculum tailored to provide specialty-specific anatomical training to advanced students based on their areas of clinical interest. Integration of medical imaging into pre-clinical anatomy courses, already underway in many medical schools, is of high clinical relevance. © 2013 American Association of Anatomists.

Validating a conceptual framework for the core concept of "cell-cell communication".

PubMed

Michael, Joel; Martinkova, Patricia; McFarland, Jenny; Wright, Ann; Cliff, William; Modell, Harold; Wenderoth, Mary Pat

2017-06-01

We have created and validated a conceptual framework for the core physiology concept of "cell-cell communication." The conceptual framework is composed of 51 items arranged in a hierarchy that is, in some instances, four levels deep. We have validated it with input from faculty who teach at a wide variety of institutional types. All items making up the framework were deemed essential to moderately important. However, some of the main ideas were clearly judged to be more important than others. Furthermore, the lower in the hierarchy an item is, the less important it is thought to be. Finally, there was no significant difference in the ratings given by faculty at different types of institutions. Copyright © 2017 the American Physiological Society.

Modeling the Classic Meselson and Stahl Experiment.

ERIC Educational Resources Information Center

D'Agostino, JoBeth

2001-01-01

Points out the importance of molecular models in biology and chemistry. Presents a laboratory activity on DNA. Uses different colored wax strips to represent "heavy" and "light" DNA, cesium chloride for identification of small density differences, and three different liquids with varying densities to model gradient…

Urban/Rural and Gender Differences among Canadian Emerging Adults

ERIC Educational Resources Information Center

Cheah, Charissa S. L.; Trinder, Krista M.; Gokavi, Tara N.

2010-01-01

Although cultural and subcultural differences during the transition to adulthood have been examined, important factors like rural/urban upbringing and gender differences among Canadian emerging adults have been neglected. The present study explored developmentally significant tasks including criteria for adulthood, beliefs about religiosity, and…

Pest measurement and management

USDA-ARS?s Scientific Manuscript database

Pest scouting, whether it is done only with ground scouting methods or using remote sensing with some ground-truthing, is an important tool to aid site-specific crop management. Different pests may be monitored at different times and using different methods. Remote sensing has the potential to provi...

Origins of individual differences in anxiety proneness: a twin/adoption study of the anxiety-related scales from the Karolinska Scales of Personality (KSP).

PubMed

Gustavsson, J P; Pedersen, N L; Asberg, M; Schalling, D

1996-06-01

The genetic and environmental origins of individual differences in scores on the anxiety-proneness scales from the Karolinska Scales of Personality were explored using a twin/adoption study design in a sample consisting of 15 monozygotic twin pairs reared apart, and 26 monozygotic and 29 dizygotic twin pairs reared together. The results showed that genetic factors accounted for individual differences in scores on the psychasthenia and somatic anxiety scales. The genetic determinants were not specific to each scale, but were common to both scales. Shared-rearing environmental determinants were important for individual differences in lack of assertiveness and psychic anxiety, and were common to both scales. Individual differences in muscular tension were found to be attributable to the effects of correlated environments. The most important factor explaining individual differences for all scales was the non-shared environment component. The evidence for an aetiologically heterogeneous anxiety-proneness construct emphasizes the appropriateness of a multi-dimensional approach to anxiety proneness.

[Differences in mortality between indigenous and non-indigenous persons in Brazil based on the 2010 Population Census].

PubMed

Campos, Marden Barbosa de; Borges, Gabriel Mendes; Queiroz, Bernardo Lanza; Santos, Ricardo Ventura

2017-06-12

There have been no previous estimates on differences in adult or overall mortality in indigenous peoples in Brazil, although such indicators are extremely important for reducing social iniquities in health in this population segment. Brazil has made significant strides in recent decades to fill the gaps in data on indigenous peoples in the national statistics. The aim of this paper is to present estimated mortality rates for indigenous and non-indigenous persons in different age groups, based on data from the 2010 Population Census. The estimates used the question on deaths from specific household surveys. The results indicate important differences in mortality rates between indigenous and non-indigenous persons in all the selected age groups and in both sexes. These differences are more pronounced in childhood, especially in girls. The indicators corroborate the fact that indigenous peoples in Brazil are in a situation of extreme vulnerability in terms of their health, based on these unprecedented estimates of the size of these differences.

Different effects of variation in Xanthium strumarium L. (Compositae) on two insect seed predators.

PubMed

Hare, J Daniel; Futuyma, Douglas J

1978-01-01

To determine the relative importance of variation in several plant characters on susceptibility to herbivores, we examined patterns of seed predation by two monophagous insect species and patterns of variation in ten populations of the cocklebur, Xanthium strumarium. Multiple regression analysis disclosed that one seed predator was most influenced by plant chemical variation, the other was significantly influenced by both chemical and morphological variation, but variation in yet another character, general burr size, was most important in conferring resistance to both insects simultaneously. The plant populations differed most in this character. Although many of the plant characters were correlated with each other, those important in determining susceptibility to each insect species were uncorrelated and independent of those conferring resistance to both insects simultaneously.These results imply that ecological similar herbivores may be influenced by different aspects of plant variation, and that predictions of evolutionary responses of local plant populations to herbivory may require knowledge of the structure of local herbivore communities and the dynamics of their establishment.

Speaking in Character: Voice Communication in Virtual Worlds

NASA Astrophysics Data System (ADS)

Wadley, Greg; Gibbs, Martin R.

This chapter summarizes 5 years of research on the implications of introducing voice communication systems to virtual worlds. Voice introduces both benefits and problems for players of fast-paced team games, from better coordination of groups and greater social presence of fellow players on the positive side, to negative features such as channel congestion, transmission of noise, and an unwillingness by some to use voice with strangers online. Similarly, in non-game worlds like Second Life, issues related to identity and impression management play important roles, as voice may build greater trust that is especially important for business users, yet it erodes the anonymity and ability to conceal social attributes like gender that are important for other users. A very different mixture of problems and opportunities exists when users conduct several simultaneous conversations in multiple text and voice channels. Technical difficulties still exist with current systems, including the challenge of debugging and harmonizing all the participants' voice setups. Different groups use virtual worlds for very different purposes, so a single modality may not suit all.

A review of recent theoretical studies in nonlinear crystals: towards the design of new materials

NASA Astrophysics Data System (ADS)

Luppi, Eleonora; Véniard, Valérie

2016-12-01

Nonlinear optics is an important and exciting field of fundamental and applied research, with applications in many different disciplines such as physics chemistry, material science and biology. In the recent years, nonlinear optical phenomena started to be also widely used in technological applications for optoelectronics and photovoltaics. This coincided with an important experimental and theoretical search for new materials with an efficient and exploitable nonlinear optical response. Here, starting from the discovery of nonlinear optics, we review the most important theoretical formalisms developed to understand, interpret and predict the nonlinear optical phenomena. We show the different level of approximation of the many-electrons interactions that these formalisms can describe which are fundamental in the interpretation of the experiments. The impact of the theory is then analyzed on different classes of new materials particularly studied in these years: silicon bulk to nano, compound semiconductors, graphene, transition metal dichalcogenide, hexagonal boron nitride and borate crystals.

Self-efficacy, mathematics' anxiety and perceived importance: an empirical study with Portuguese engineering students

NASA Astrophysics Data System (ADS)

Alves, Manuela; Rodrigues, Cristina S.; Rocha, Ana Maria A. C.; Coutinho, Clara

2016-01-01

The accomplishment in mathematics has gained attention from educators and arises as an emerging field of study, including in engineering education. However, in Portugal, there is still incipient research in the area; so it is high time to explore factors that might enlighten the gap in the study of the relationship between Portuguese engineering students and the learning of mathematics. The main purpose of this study is to explore three factors identified in the literature as influencing the learning of mathematical concepts - self-efficacy, anxiety towards mathematics and perceived importance of mathematics - and search for differences by gender and by type of engineering course, a dimension not much reported in the literature but which was revealed as important in the team's previous research. Based on a sample of 140 undergraduate students of different engineering courses from University of Minho, results only identify differences in the type of course and not in gender. These results constitute a contribution and open new paths for future research in the engineering education.

Racial Disparities in Early Criminal Justice Involvement

PubMed Central

Crutchfield, Robert D.; Skinner, Martie L.; Haggerty, Kevin P.; McGlynn, Anne; Catalano, Richard F.

2010-01-01

Criminologists have long reported the existence of racial disparity in the criminal justice system, but the important question is why. While some argue that observed differences are a consequence of more criminal behavior among minorities, the weight of the evidence indicates that this is but a partial explanation. In this paper we study data from a sample of juveniles to examine how racial differences in early police contact, and important social environments—family, school, and neighborhoods—affect later contact and arrests, controlling for self-reported delinquency. We find that early (in middle school) contact with police is an important predictor of later (high school) arrests. Also we found that, in addition to being male and living in a low-income family, children who have parents who have a history of arrest, who have experienced school disciplinary actions, who have delinquent peers, and who are in networks with deviant adults are more likely to have problems with law enforcement. These factors help to explain racial differences in police contacts and arrests. PMID:20190860

Who Sees Human? The Stability and Importance of Individual Differences in Anthropomorphism

PubMed Central

Waytz, Adam; Cacioppo, John; Epley, Nicholas

2014-01-01

Anthropomorphism is a far-reaching phenomenon that incorporates ideas from social psychology, cognitive psychology, developmental psychology, and the neurosciences. Although commonly considered to be a relatively universal phenomenon with only limited importance in modern industrialized societies—more cute than critical—our research suggests precisely the opposite. In particular, we provide a measure of stable individual differences in anthropomorphism that predicts three important consequences for everyday life. This research demonstrates that individual differences in anthropomorphism predict the degree of moral care and concern afforded to an agent, the amount of responsibility and trust placed on an agent, and the extent to which an agent serves as a source of social influence on the self. These consequences have implications for disciplines outside of psychology including human–computer interaction, business (marketing and finance), and law. Concluding discussion addresses how understanding anthropomorphism not only informs the burgeoning study of nonpersons, but how it informs classic issues underlying person perception as well. PMID:24839457

A Statistical Analysis of Reviewer Agreement and Bias in Evaluating Medical Abstracts 1

PubMed Central

Cicchetti, Domenic V.; Conn, Harold O.

1976-01-01

Observer variability affects virtually all aspects of clinical medicine and investigation. One important aspect, not previously examined, is the selection of abstracts for presentation at national medical meetings. In the present study, 109 abstracts, submitted to the American Association for the Study of Liver Disease, were evaluated by three “blind” reviewers for originality, design-execution, importance, and overall scientific merit. Of the 77 abstracts rated for all parameters by all observers, interobserver agreement ranged between 81 and 88%. However, corresponding intraclass correlations varied between 0.16 (approaching statistical significance) and 0.37 (p < 0.01). Specific tests of systematic differences in scoring revealed statistically significant levels of observer bias on most of the abstract components. Moreover, the mean differences in interobserver ratings were quite small compared to the standard deviations of these differences. These results emphasize the importance of evaluating the simple percentage of rater agreement within the broader context of observer variability and systematic bias. PMID:997596

Expression of Epithelial Mesenchymal Transition and Cancer Stem Cell Markers in Circulating Tumor Cells.

PubMed

Werner, Stefan; Stenzl, Arnulf; Pantel, Klaus; Todenhöfer, Tilman

2017-01-01

The characterization of circulating tumor cells (CTC) has the potential not only to provide important insights into molecular alterations of advanced tumor disease but also to facilitate risk prediction. Epithelial mesenchymal transition (EMT) has been discovered as important process for the development of metastases and the dissemination of tumor cells into the blood stream. In different tumor types, CTC with a mesenchymal phenotype have been reported that have presumably underwent EMT. Moreover, CTC with stem-cell like characteristics have been postulated as important drivers of tumor progression. Different platforms have been introduced to allow CTC enrichment independent of expression of epithelial antigens, as these may be downregulated in EMT- or stem-cell-like CTC. Both for CTCs with EMT- or stem-cell features different markers have been proposed. However, there is still a lack of evidence on the association of these markers with functional features and characteristics for stem cells and cells undergoing EMT.

A Perspective on the Evolving story of PSMA Biology and PSMA Based Imaging and Endoradiotherapeutic Strategies.

PubMed

O'Keefe, Denise S; Bacich, Dean J; Huang, Steve S; Heston, Warren D

2018-04-19

We will review the evolution of knowledge of the biology of Prostate-Specific Membrane Antigen (PSMA) and how the translation to therapy has also developed. The usual key to discovery is a realistic model for experimentation and hypothesis testing. This is especially true for the prostate where the human prostate differs significantly from that of other often used species for research models. We will emphasize the genetic characterization of PSMA, The nature of the PSMA protein and its role as a carboxypeptidase, with differing important substrates and products in different tissues. We will give special prominence to its importance as a target for imaging and therapy in prostate cancer and its under-developed role for imaging and targeting the neovasculature of tumors other than prostate cancer. Lastly we will bring attention to its importance in other non-prostatic tissues. Copyright © 2018 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Two years comparative studies on biological effects of environmental UV radiation

NASA Astrophysics Data System (ADS)

Grof, P.; Ronto, Gyorgyi; Gaspar, S.; Berces, A.; Szabo, Laszlo D.

1994-07-01

A method has been developed for determination of the biologically effective UV dose based on T7 phage as biosensor. In field experiments clockwork driven telescope has been used for determining doses from direct and global (direct plus diffuse) solar radiation. On fine summer days at mid-latitude this arrangement allowed the following comparisons: measured doses from direct and global radiation obtained at the same time and measuring site reflecting the biological importance of diffuse radiation; direct and global radiation obtained at the same time and measuring site reflecting the biological importance of diffuse radiation; direct and global doses obtained at the same time on different measuring sites (downtown, suburb, outside the town) reflecting the differences caused by air quality; direct and global doses obtained on the same measuring place, in summertime of two different years reflecting the importance of the long-term measurements for estimating the biological risk caused by increased UV-B radiation; measured data and model calculations.

A US Army Reserve (USAR) Noncommissioned Officer (NCO) Tacit Knowledge Inventory: Flexible Structure for Squad-Level Leader Self-Development

DTIC Science & Technology

2008-06-01

biases about people or racism 6 Very Important THEN you will quickly learn to change your mind or hide your true feelings AND you will 5 Moderately...Very Important race, religion, gender or culture AND you want to build an effective team THEN you Moderately Important must educate yourself AND your...Soldiers on 4 Important cultural, racial, religious, or gender -related differences in the Soldiers which may impact Moderately Unimportant how

A painful reminder: the role of level and salience of attitude importance in cognitive dissonance.

PubMed

Starzyk, Katherine B; Fabrigar, Leandre R; Soryal, Ashley S; Fanning, Jessie J

2009-01-01

In his seminal book, L. Festinger (1957) emphasized the role of attitude importance in cognitive dissonance. This study (N = 308) explored whether people's use of dissonance reduction strategies differs as a function of level of attitude importance and whether the personal importance of an attitude is salient. Results showed that level and salience of attitude importance interacted to affect high-choice (HC) participants' tendency to use attitude change and trivialization to reduce dissonance. When HC participants were not reminded of the personal importance of their attitude (i.e., it was not salient), they changed their attitudes equally irrespective of attitude importance, but engaged in greater trivialization with increasing levels of importance. In contrast, when attitude importance was salient, HC participants changed their attitudes less with increasing attitude importance and showed no evidence of trivializing under any level of importance.

The spatial and metabolic basis of colony size variation.

PubMed

Chacón, Jeremy M; Möbius, Wolfram; Harcombe, William R

2018-03-01

Spatial structure impacts microbial growth and interactions, with ecological and evolutionary consequences. It is therefore important to quantitatively understand how spatial proximity affects interactions in different environments. We tested how proximity influences colony size when either Escherichia coli or Salmonella enterica are grown on various carbon sources. The importance of colony location changed with species and carbon source. Spatially explicit, genome-scale metabolic modeling recapitulated observed colony size variation. Competitors that determine territory size, according to Voronoi diagrams, were the most important drivers of variation in colony size. However, the relative importance of different competitors changed through time. Further, the effect of location increased when colonies took up resources quickly relative to the diffusion of limiting resources. These analyses made it apparent that the importance of location was smaller than expected for experiments with S. enterica growing on glucose. The accumulation of toxic byproducts appeared to limit the growth of large colonies and reduced variation in colony size. Our work provides an experimentally and theoretically grounded understanding of how location interacts with metabolism and diffusion to influence microbial interactions.

[Are risk factors in prenatal and perinatal period important for develompent of schizophrenia?

PubMed

Ambroz, P; Janoutová, J; Machaczka, O; Kovaľová, M; Pohlídalová, A; Vařechová, K; Košta, O; Tomášková, H; Šerý, O; Hosák, L; Janout, V

Schizophrenia is an important psychical disease of multifactorial origin and not yet clear etiology. In prenatal and perinatal period some potential risk factors for schizophrenia are taken into consideration. Case-control study of 815 subjects, 407 cases and 408 controls was performed in 2013 to 2015. In this study environmental and genetic risk factors were evaluated including potential risk factors of prenatal and perinatal period. Statistically important difference was found in child-birth done by cesarean section (p = 0.009) and in patients with schizophrenia were 15.7% complications in the course of childbirth (p < 0.001). Hypoxia, passed umbilical cord were the most frequent complications. In prenatal period premature childbirth, injury and psychical complications were the most frequent. On the other hand difference in weight and length of newborns, breast feeding and infection during pregnancy were found not statistically important. In this study statistically important diference were found in way of carrying childbirth and in some complications during pregnancy and delivery. Influence of infection during pregnancy and influence of weight and length of newborn were not demonstrated.

Type of litter determines the formation and properties of charred material during wildfires

NASA Astrophysics Data System (ADS)

Chavez, Bruno; Fonturbel, M. Teresa; Salgado, Josefa; García-Oliva, Felipe; Vega, Jose A.; Merino, Agustin

2014-05-01

Wildfire is one of the most important disturbances all over the World, affecting both the amount and composition of forest floor and mineral soils. In comparison with unburnt areas, wildfire-affected forest floor usually shows lower contents of labile C compounds and higher concentrations of recalcitrant aromatic forms. These changes in composition can have important impact on biogeochemical cycles and therefore ecosystem functions. Although burning of different types of litter can lead to different amount and types of pyrogenic compounds, this aspect has not been evaluated yet. The effect of wildfire on SOM composition and stability were evaluated in five major types of non-wood litter in Mediterranean ecosystems: Pinus nigra, E. arborea, P. pinaster, U. europaeus and Eucalyptus globulus. In each of these ecosystems, forest floor samples from different soil burn severities were sampled. Soil burnt severities were based on visual signs of changes in forest floor and deposition of ash. Pyrogenic carbon quality were analysed using elementary analysis, solid-state 13 C nuclear magnetic resonance spectroscopy, Reflectance Infrared Fourier Transform (FTIR) and thermal analysis (simultaneous DSC-TG). The study showed that the different types of litter influenced the formation and characteristics of charred material. They differed in the temperature at which they start to be formed, the amounts of charred compounds and in their chemical composition. The resulting charred materials from the different litter, showed an important variability in the degree of carbonitation/aromatization. Unlike the biochar obtained through pyrolysis of woody sources, which contains exclusively aromatic structures, in the charred material produced in some litter, lignin, cellulose and even cellulose persist even in the high soil burnt severity. Coinciding with increases in aromatic contents, important decreases in atomic H/C and O/C ratios were recorded. However, the values found in some litters, were higher than 0.5, suggesting that low degree of carbonization/aromatization. Although burning also led to compounds of higher thermal recalcitrance (increases in T50 values), values recorded in some litters were lower than those measured in highly polycondensed aromatic compounds. The differences found among the different forest floor cannot be only attributable to the initial SOM composition of the litter. Other aspects, such as the different thermal sensitivity, flammability and different conditions during wildfire (temperatures, combustion duration, oxygen concentrations) could also have contributed.

Population dynamics of the red shrimp Aristeus antennatus in the Balearic Islands (western Mediterranean): Short spatio-temporal differences and influence of environmental factors

NASA Astrophysics Data System (ADS)

Guijarro, Beatriz; Massutí, Enric; Moranta, Joan; Díaz, Paz

2008-06-01

The red shrimp Aristeus antennatus is one of the target species of the bottom trawl fishery of the Balearic Islands. The objective of the present paper is to study the short spatial and temporal differences of this important economic resource between two different locations off Mallorca (Cabrera: CA; Sóller: SO), where a fleet mobility pattern has been detected, and to study the influence of environmental conditions on this species. Six simultaneous bottom-trawl and oceanographic surveys were carried out at these two locations in order to collect data from the demersal species, hydrography (temperature and salinity), trophic resources and sediment characteristics. The commercial fleet from both locations was monitored by monthly on-board sampling, log-books and daily landings obtained from sales slips. Additional data was obtained from other fishing surveys. Short spatial and temporal differences have been detected between both locations. The population at CA was more demographically homogeneous, while that at SO showed important variations, like high abundance of juveniles recruiting to fishing grounds in autumn-winter and high abundance of large females during summer. Several differences have also been found in the biology of the species between locations, such as males were more abundant in SO than in CA. Also, the reproductive period started sooner in SO than in CA, and the condition of pre-spawning females was better in SO. The percentage of total lipids in the hepatopancreas was minimal during the spawning period, showing their importance as a reserve of energy for the ovary ripening. Water masses could play an important role in these differences, the characteristics of water masses being more stable in CA than in SO. Red shrimp adult females seemed to be more correlated with the warmer and more saline Levantine Intermediate Waters, while juveniles (males and females) and adult males were more correlated with the colder Western Mediterranean Deep Waters, detected only in SO during autumn-winter. Two different hypothesis of mobility patterns for the species are discussed in relation to these observed differences.

Differential wolf-pack-size persistence and the role of risk when hunting dangerous prey

USGS Publications Warehouse

Barber-Meyer, Shannon M.; Mech, L. David; Newton, Wesley E.; Borg, Bridget

2016-01-01

Risk to predators hunting dangerous prey is an emerging area of research and could account for possible persistent differences in gray wolf (Canis lupus) pack sizes. We documented significant differences in long-term wolf-pack-size averages and variation in the Superior National Forest (SNF), Denali National Park and Preserve, Yellowstone National Park, and Yukon, Canada (p<0.01). The SNF differences could be related to the wolves’ risk when hunting primary prey, for those packs (N=3) hunting moose (Alces americanus) were significantly larger than those (N=10) hunting white-tailed deer (Odocoileus virginianus) (F1,8=16.50, p=0.004). Our data support the hypothesis that differential pack-size persistence may be perpetuated by differences in primary prey riskiness to wolves, and we highlight two important extensions of this idea: (1) the potential for wolves to provision and defend injured packmates from other wolves and (2) the importance of less-risky, buffer prey to pack-size persistence and year-to-year variation. Risk to predators hunting dangerous prey is an emerging area of research and could account for possible persistent differences in gray wolf (Canis lupus) pack sizes. We documented significant differences in long-term wolf-pack-size averages and variation in the Superior National Forest (SNF), Denali National Park and Preserve, Yellowstone National Park, and Yukon, Canada (p<0.01). The SNF differences could be related to the wolves’ risk when hunting primary prey, for those packs (N=3) hunting moose (Alces americanus) were significantly larger than those (N=10) hunting white-tailed deer (Odocoileus virginianus) (F1,8=16.50, p=0.004). Our data support the hypothesis that differential pack-size persistence may be perpetuated by differences in primary prey riskiness to wolves, and we highlight two important extensions of this idea: (1) the potential for wolves to provision and defend injured packmates from other wolves and (2) the importance of less-risky, buffer prey to pack-size persistence and year-to-year variation.

A new perspective on trait differences between native and invasive exotic plants.

PubMed

Leffler, A Joshua; James, Jeremy J; Monaco, Thomas A; Sheley, Roger L

2014-02-01

Functional differences between native and exotic species potentially constitute one factor responsible for plant invasion. Differences in trait values between native and exotic invasive species, however, should not be considered fixed and may depend on the context of the comparison. Furthermore, the magnitude of difference between native and exotic species necessary to trigger invasion is unknown. We propose a criterion that differences in trait values between a native and exotic invasive species must be greater than differences between co-occurring natives for this difference to be ecologically meaningful and a contributing factor to plant invasion. We used a meta-analysis to quantify the difference between native and exotic invasive species for various traits examined in previous studies and compared this value to differences among native species reported in the same studies. The effect size between native and exotic invasive species was similar to the effect size between co-occurring natives except for studies conducted in the field; in most instances, our criterion was not met although overall differences between native and exotic invasive species were slightly larger than differences between natives. Consequently, trait differences may be important in certain contexts, but other mechanisms of invasion are likely more important in most cases. We suggest that using trait values as predictors of invasion will be challenging.

Achievement and Affiliation: A Motivational Perspective of Sex Differences.

ERIC Educational Resources Information Center

Kelemen, Victor Paul, Jr.

1980-01-01

For both males and females, age and education are important factors in the determination of achievement behavior. While results fail to resolve the achievement versus affiliation argument, they nevertheless support the lessening importance of sex-role stereotyping today. (Author)

[Science, charity, and social networks: Hospício de Pedro II from different perspectives].

PubMed

Ribeiro, Daniele Corrêa

2016-01-01

This article is part of an effort to compile the analyses made for my master's dissertation from 2012. It contains new perspectives on Hospício de Pedro II (Pedro II Hospice) between 1883 and 1889, drawing on research of admissions records and files of patients staying at the institution, founded in 1852 in Rio de Janeiro. The involvement of different players and the interplay of different interests and demands with regard to the hospice are highlighted. It is important to expand the debate concerning the institution beyond medical and scientific aspects, considering its importance both as a charity and for its key role in the political and social relations of the empire.

The importance of fetal gender in intrauterine growth restriction

PubMed Central

Radulescu, L; Ferechide, D; Popa, F

2013-01-01

One of the most important causes of perinatal mortality and morbidity complicating significant percentage pregnancies is intrauterine growth restriction (IUGR). Fetal growth restriction is the main cause of intrauterine fetal death and the second leading cause of death in the neonatal period. Numerous studies in different populations reveal an association between intrauterine growth restriction and perinatal and postnatal developments, which differ according to the sex of newborns with intrauterine growth restriction. However, the mechanisms of intrauterine programming, the critical time necessary to cause injury and involvement of other factors are unclear and although several authors’ opinions differ, it seems that females are more likely to develop intrauterine growth restriction. Abbreviations: IUGR=intrauterine growth restriction PMID:23599816

Valuing hope.

PubMed

McMillan, John; Walker, Simon; Hope, Tony

2014-01-01

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it, from three different kinds of hope, or 'hopes for', and then relate these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make.

Different EGFR gene mutations in two patients with synchronous multiple lung cancers: A case report

PubMed Central

Sakai, Hiroki; Kimura, Hiroyuki; Tsuda, Masataka; Wakiyama, Yoichi; Miyazawa, Tomoyuki; Marushima, Hideki; Kojima, Koji; Hoshikawa, Masahiro; Takagi, Masayuki; Nakamura, Haruhiko

2017-01-01

Routine clinical and pathological evaluations to determine the relationship between different lesions are often not completely conclusive. Interestingly, detailed genetic analysis of tumor samples may provide important additional information and identify second primary lung cancers. In the present study, we report cases of two synchronous lung adenocarcinomas composed of two distinct pathological subtypes with different EGFR gene mutations: a homozygous deletion in exon 19 of the papillary adenocarcinoma subtype and a point mutation of L858R in exon 21 of the tubular adenocarcinoma. The present report highlights the clinical importance of molecular cancer biomarkers to guide management decisions in cases involving multiple lung tumors. PMID:29090842

Non-equilibrium effects on the chemistry of nebular condensates - Implications for the planets and asteroids

NASA Technical Reports Server (NTRS)

Blander, M.

1979-01-01

Kinetic effects, for example nucleation constraints and slow reactions, should have been important in nebular condensation. Consideration of these effects leads to the prediction of pressure-dependent compositions and physical properties of nebular condensates which is consistent with (1) the differences between different classes of chondritic meteorites, (2) some of the differences between planets, and (3) the presence of oxidized iron on the moon and in the eucrite parent body (presumably an asteroid) despite the low abundance of volatiles. Diffusion effects appear to be important for understanding oxygen isotope anomalies in refractory inclusions in Allende. The consideration of kinetic effects leads to more information concerning nebular processes than if equilibrium is assumed.

Between trust and accountability: different perspectives on the modernization of postgraduate medical training in the Netherlands.

PubMed

Wallenburg, Iris; van Exel, Job; Stolk, Elly; Scheele, Fedde; de Bont, Antoinette; Meurs, Pauline

2010-06-01

Postgraduate medical training was reformed to be more responsive to changing societal needs. In the Netherlands, as in various other Western countries, a competency-based curriculum was introduced reflecting the clinical and nonclinical roles a modern doctor should fulfill. It is still unclear, however, what this modernization process exactly comprises and what its consequences might be for clinical practice and medical work. The authors conducted a Q methodological study to investigate which different perspectives exist on the modernization of postgraduate medical training among actors involved. The authors found four distinct perspectives, reflecting the different features of medical training. The accountability perspective stresses the importance of formal regulations within medical training and the monitoring of results in order to be more transparent and accountable to society. According to the educational perspective, medical training should be more formalized and directed at the educational process. The work-life balance perspective stresses the balance between a working life and a private life, as well as the changing professional relationship between staff members and residents. The trust-based perspective reflects the classic view of medical training in which role modeling and trust are considered most important. The four perspectives on the modernization of postgraduate medical training show that various aspects of the modernization process are valued differently by stakeholders, highlighting important sources of agreement and disagreement between them. An important source of disagreement is diverging expectations of the role of physicians in modern medical practice.