Pentafecta: A New Concept for Reporting Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy

Background: Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. Objective: A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. Design, setting, and participants: From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. Measurements: In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Results and limitations: Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p = 0.001) was confirmed as the only factor independently associated with the pentafecta. Conclusions: A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients` expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries. Copyright (C) 2010 John Wiley & Sons, Ltd.

Surveillance for adverse events after DTwP/Hib vaccination in Brazil: Sensitivity and factors associated with reporting

We estimated the sensitivity, i.e., the proportion of all cases of adverse events following immunization (AEFIs) reported to the Brazilian passive surveillance for adverse events following immunization (PSAEFI) with the diphtheria-tetanus-whole-cell pertussis-Haemophilus influenzae type b (DTwP/Hib) vaccine, as well as investigating factors associated with AEFIs reporting. During 2003-2004, 8303 AEFIs associated with DTwP-Hib were reported; hypotonic-hyporesponsive episodes (HHEs), fever and convulsions being the most common. Cure without sequel was achieved in 98.4% of the cases. The mean sensitivity of the PSAEFI was 22.3% and 31.6%, respectively, for HHE and convulsions, varying widely among states. Reporting rates correlated positively with the Human Development Index and coverage of adequate prenatal care, correlating negatively with infant mortality rates. Quality of life indicators and the degree of organization of health services are associated with greater PSAEFI sensitivity. In addition to consistently describing the principal AEFIs, PSAEFI showed the DTwP/Hib vaccine to be safe and allayed public fears related to its use. (C) 2010 Elsevier Ltd. All rights reserved.

Under-reporting of energy intake is more prevalent in a healthy dietary pattern cluster

The aim of the present study was to determine whether under-reporting rates vary between dietary pattern Clusters. Subjects were sixty-five Brazilian women. During 3 weeks, anthropometric data were collected. total energy expenditure (TEE) was determined by the doubly labelled water method and diet Was Measured. Energy intake (El) and the daily frequency of consumption per 1000 kJ of twenty-two food groups were obtained from a FFQ. These frequencies were entered into a Cluster analysis procedure in order to obtain dietary patterns. Under-reporters were defined Lis those who did not lose more than 1 kg of body weight during the study and presented EI:TEE less than 0.82. Three dietary pattern clusters were identified and named according to their most recurrent food groups: sweet foods (SW). starchy foods (ST) and health), (H). Subjects from the healthy cluster had the lowest mean EI:TEE (SW = 0.86, ST = 0.71 and H = 0.58: P = 0.003) and EI - TEE (SW = -0.49 MJ, ST = - 3.20 MJ and H = -5.09 MJ; P = 0.008). The proportion of Under-reporters was 45.2 (95 % CI 35.5, 55.0) % in the SW Cluster: 58.3 (95 % CI 48.6, 68.0) % in the ST Cluster and 70.0 (95 % CI 61.0, 79) % in the H cluster (P=0.34). Thus, in Brazilian women, Under-reporting of El is not uniformly distributed among, dietary pattern clusters and tends to be more severe among subjects from the healthy cluster. This cluster is more consistent with both dietary guidelines and with what lay individuals usually consider `healthy eating`.

Bayesian Estimation for Performance Measures of Two Diagnostic Tests in the Presence of Verification Bias

Sensitivity and specificity are measures that allow us to evaluate the performance of a diagnostic test. In practice, it is common to have situations where a proportion of selected individuals cannot have the real state of the disease verified, since the verification could be an invasive procedure, as occurs with biopsy. This happens, as a special case, in the diagnosis of prostate cancer, or in any other situation related to risks, that is, not practicable, nor ethical, or in situations with high cost. For this case, it is common to use diagnostic tests based only on the information of verified individuals. This procedure can lead to biased results or workup bias. In this paper, we introduce a Bayesian approach to estimate the sensitivity and the specificity for two diagnostic tests considering verified and unverified individuals, a result that generalizes the usual situation based on only one diagnostic test.

Perpendicular exchange bias in IrMn/Pt/[Co/Pt](3) multilayers with cone magnetization

The perpendicular exchange bias and magnetic anisotropy were investigated in IrMn/Pt/[Co/Pt](3) multilayers through the analysis of in-plane and out-of-plane magnetization hysteresis loops. A phenomenological model was used to simulate the in-plane curves and the effective perpendicular anisotropies were obtained employing the area method. The canted state anisotropy was introduced by taking into account the first and second uniaxial anisotropy terms of the ferromagnet with the corresponding uniaxial anisotropy direction allowed to make a nonzero angle with the film`s normal. This angle, obtained from the fittings, was of approximately 15 degrees for IrMn/[Co/Pt](3) film and decreases with the introduction of Pt in the IrMn/Pt/[Co/Pt](3) system, indicating that the Pt interlayer leads to a predominant perpendicular anisotropy. A maximum of the out-of-plane anisotropy was found between 0.5 and 0.6 nm of Pt, whereas a maximum of the perpendicular exchange bias was found at 0.3 nm. These results are very similar to those obtained for IrMn/Cu/[Co/Pt](3) system; however, the decrease of the exchange bias with the spacer thickness is more abrupt and the enhacement of the perpendicular anisotropy is higher for the case of Cu spacer as compared with that of Pt spacer. The existence of a maximum in the perpendicular exchange bias as a function of the Pt layer thickness was attributed to the predominance of the enhancement of exchange bias due to more perpendicular Co moment orientation over the exponential decrease of the ferromagnetic/antiferromagnetic exchange coupling and, consequently, of the exchange-bias field. (C) 2011 Elsevier B.V. All rights reserved.

Thermal dependence of the zero-bias conductance through a nanostructure

We show that the conductance of a quantum wire side-coupled to a quantum dot, with a gate potential favoring the formation of a dot magnetic moment, is a universal function of the temperature. Universality prevails even if the currents through the dot and the wire interfere. We apply this result to the experimental data of Sato et al. (Phys. Rev. Lett., 95 (2005) 066801). Copyright (C) EPLA, 2009

Bias-corrected estimators for dispersion models with dispersion covariates

In this paper we discuss bias-corrected estimators for the regression and the dispersion parameters in an extended class of dispersion models (Jorgensen, 1997b). This class extends the regular dispersion models by letting the dispersion parameter vary throughout the observations, and contains the dispersion models as particular case. General formulae for the O(n(-1)) bias are obtained explicitly in dispersion models with dispersion covariates, which generalize previous results obtained by Botter and Cordeiro (1998), Cordeiro and McCullagh (1991), Cordeiro and Vasconcellos (1999), and Paula (1992). The practical use of the formulae is that we can derive closed-form expressions for the O(n(-1)) biases of the maximum likelihood estimators of the regression and dispersion parameters when the information matrix has a closed-form. Various expressions for the O(n(-1)) biases are given for special models. The formulae have advantages for numerical purposes because they require only a supplementary weighted linear regression. We also compare these bias-corrected estimators with two different estimators which are also bias-free to order O(n(-1)) that are based on bootstrap methods. These estimators are compared by simulation. (C) 2011 Elsevier B.V. All rights reserved.

Bias correction in a multivariate normal regression model with general parameterization

This paper derives the second-order biases Of maximum likelihood estimates from a multivariate normal model where the mean vector and the covariance matrix have parameters in common. We show that the second order bias can always be obtained by means of ordinary weighted least-squares regressions. We conduct simulation studies which indicate that the bias correction scheme yields nearly unbiased estimators. (C) 2009 Elsevier B.V. All rights reserved.