Bayesian generalized linear models for meta-analysis of diagnostic tests

With the recognition of the importance of evidence-based medicine, there is an emerging need for methods to systematically synthesize available data. Specifically, methods to provide accurate estimates of test characteristics for diagnostic tests are needed to help physicians make better clinical decisions. To provide more flexible approaches for meta-analysis of diagnostic tests, we developed three Bayesian generalized linear models. Two of these models, a bivariate normal and a binomial model, analyzed pairs of sensitivity and specificity values while incorporating the correlation between these two outcome variables. Noninformative independent uniform priors were used for the variance of sensitivity, specificity and correlation. We also applied an inverse Wishart prior to check the sensitivity of the results. The third model was a multinomial model where the test results were modeled as multinomial random variables. All three models can include specific imaging techniques as covariates in order to compare performance. Vague normal priors were assigned to the coefficients of the covariates. The computations were carried out using the 'Bayesian inference using Gibbs sampling' implementation of Markov chain Monte Carlo techniques. We investigated the properties of the three proposed models through extensive simulation studies. We also applied these models to a previously published meta-analysis dataset on cervical cancer as well as to an unpublished melanoma dataset. In general, our findings show that the point estimates of sensitivity and specificity were consistent among Bayesian and frequentist bivariate normal and binomial models. However, in the simulation studies, the estimates of the correlation coefficient from Bayesian bivariate models are not as good as those obtained from frequentist estimation regardless of which prior distribution was used for the covariance matrix. The Bayesian multinomial model consistently underestimated the sensitivity and specificity regardless of the sample size and correlation coefficient. In conclusion, the Bayesian bivariate binomial model provides the most flexible framework for future applications because of its following strengths: (1) it facilitates direct comparison between different tests; (2) it captures the variability in both sensitivity and specificity simultaneously as well as the intercorrelation between the two; and (3) it can be directly applied to sparse data without ad hoc correction. ^

A meta-analysis: Obesity and colorectal cancer screening

Of cancer death, colorectal cancer death ranks second in the United States. Obesity is an important risk factor for colorectal cancer (1). Early detection of colorectal cancer when it is localized can effectively reduce mortality of colorectal cancer and increase survival time of patients if they are treated. Also, previous studies showed that obese women were more likely to delay breast cancer screening and cervical cancer screening than normal weight women (2-5). However, results from prior studies demonstrating the relationship between obesity and colorectal cancer screening are not consistent. This research was done to conduct a meta-analysis of previous cross-sectional studies selected from the Medline database and to evaluate the association between obesity and colorectal cancer screening. While the odds ratio was not statistically different from one, the results from this meta-analysis under the random effects model showed that obese people are slightly less likely to have colorectal cancer screening compared to normal weight individuals (OR,0.93;95% CI 0.75-1.15). This meta-analysis was particularly sensitive to one individual study (6) and the effect of obesity on colorectal cancer screening was statistically significant (OR, 0.87; 95% CI, 0.81-0.92) after removing Heo's study. Further systematic studies focused on whether the effect of obesity on colorectal cancer screening is limited to women only are suggested. ^

O'CIAO an object oriented programming model using CIAO Prolog

There have been several previous proposals for the integration of Object Oriented Programming features into Logic Programming, resulting in much support theory and several language proposals. However, none of these proposals seem to have made it into the mainstream. Perhaps one of the reasons for these is that the resulting languages depart too much from the standard logic programming languages to entice the average Prolog programmer. Another reason may be that most of what can be done with object-oriented programming can already be done in Prolog through the meta- and higher-order programming facilities that the language includes, albeit sometimes in a more cumbersome way. In light of this, in this paper we propose an alternative solution which is driven by two main objectives. The first one is to include only those characteristics of object-oriented programming which are cumbersome to implement in standard Prolog systems. The second one is to do this in such a way that there is minimum impact on the syntax and complexity of the language, i.e., to introduce the minimum number of new constructs, declarations, and concepts to be learned. Finally, we would like the implementation to be as straightforward as possible, ideally based on simple source to source expansions.

Scale model research for room acoustics purposes

In the field of Room Acoustics it is common using scale models to study a room. Through this method it is possible to predict its behavior, which may be very useful to detect and correct any problem prior to build it, saving many resources. Nowadays this method has been relegated to a secondary position due to the peak of simulation software, which makes possible studying rooms in a cheap, flexible and simple way, as well as it is potentially less time consuming. Nevertheless, the scale model method is still under study, as it may give some additional information. This project intends to focus in pedagogic possibilities of the scale model method. This method offers the student the opportunity of study and grasp some of the most important phenomena in Room Acoustics, in a more intuitive way than just a software simulation. Furthermore most of the existing software in this field is aimed to the technician working in the lab, as efficiently as possible, not to the student trying to understand and learn something. Here, the facilities and resources of Syddansk Universitet regarding this matter will be studied and evaluated, as well as the procedure for the experiments, paying special attention not only to its reliability and accuracy, but also to its didactic possibilities. Besides, if possible, any improvement that could help to enhance any of the listed aspects will be suggested. En el ámbito de la Acústica Arquitectónica es común el uso de modelos a escala para estudiar un recinto determinado. Mediante esta técnica es posible por ejemplo predecir el comportamiento del recinto y detectar problemas antes de su construcción, con el consecuente ahorro de recursos. Actualmente el uso de modelos a escala está desplazado a un segundo plano por el uso de software simulación, debido a la sencillez y flexibilidad que puede aportar la simulación por ordenador, así como a la economía de tiempo y recursos que supone. Sin embargo sigue siendo objeto de estudio, dado que puede aportar información muy valiosa para el ingeniero. Este proyecto se centra en las posibilidades pedagógicas de dicho método. El uso de modelos a escala brinda la oportunidad a los estudiantes de estudiar y comprender algunos de los fenómenos más importantes en la Acústica Arquitectónica de una forma más directa e intuitiva que una simulación por ordenador. Se pretende estudiar y evaluar los medios al alcance de los estudiantes en la Syddansk Universitet, así como los métodos usados, atendiendo no sólo a su precisión y fiabilidad, si no a su potencial pedagógico. Así mismo, si es posible, se propondrán cambios que puedan suponer una mejora en cualquiera de estos aspectos. Así el proyecto se divide en varias secciones claramente diferenciadas. En el apartado Background and Theoretical Basis se introduce el tema del estudio y simulación de recintos acústicos. Se explica su importancia y utilidad, y se comenta la situación actual de estas técnicas, abordando diferentes métodos usados así como sus bases teóricas y principales ventajas e inconvenientes. Bajo el apartado de Project se analizan diferentes factores relacionados con el problema. Se estudian los recursos a disposición del alumno, desde el software y hardware implicados hasta el equipo de medida y otros recursos necesarios para la realización de las prácticas. Es en esta parte donde se centra la parte más importante del trabajo, consistente en la medición y comprobación de las características más relevantes del equipo implicado. Haciendo posible así confirmar su validez y precisión, tanto desde el punto de vista técnico como pedagógico, así como estableciendo los límites dentro de los que se puede considerar fiable el modelo. Al final de este apartado se aborda la influencia de la absorción del aire en altas frecuencias, y la variación en los coeficientes de absorción y dispersión de los materiales respecto de la frecuencia. Por último se realiza una verificación subjetiva del sistema completo, debido a que por limitaciones técnicas no ha sido posible evaluar el montaje en el rango equivalente a toda la banda audible, y que los métodos estudiados tienen como meta última asegurar una buena percepción por parte del oyente en el recinto dado. Dentro del apartado Conclusions se hace un breve resumen de las conclusiones extraídas anteriormente, y se valora el rendimiento y utilidad general del modelo, que a pesar de algunos problemas de precisión y repetibilidad lógicos debido a los medios usados, es válido para ilustrar los fenómenos físicos que se quieren enseñar al alumno. En la sección de Future Work se proponen diferentes vías de trabajo para futuros proyectos en la Syddansk Universitet que podrían ser útiles confirmar el trabajo realizado en este proyecto, mejorar la precisión y fiabilidad del montaje o enriquecer las posibilidades pedagógicas de las prácticas relacionadas. Por último se encuentra, tras el apartado de referencias, los anexos con tablas y gráficas relativas a las medidas realizadas en diferentes partes del trabajo. También se puede encontrar información y material relacionado con el proyecto en el CD adjunto.

Model-based Self-awareness Patterns for Autonomy

Los sistemas técnicos son cada vez más complejos, incorporan funciones más avanzadas, están más integrados con otros sistemas y trabajan en entornos menos controlados. Todo esto supone unas condiciones más exigentes y con mayor incertidumbre para los sistemas de control, a los que además se demanda un comportamiento más autónomo y fiable. La adaptabilidad de manera autónoma es un reto para tecnologías de control actualmente. El proyecto de investigación ASys propone abordarlo trasladando la responsabilidad de la capacidad de adaptación del sistema de los ingenieros en tiempo de diseño al propio sistema en operación. Esta tesis pretende avanzar en la formulación y materialización técnica de los principios de ASys de cognición y auto-consciencia basadas en modelos y autogestión de los sistemas en tiempo de operación para una autonomía robusta. Para ello el trabajo se ha centrado en la capacidad de auto-conciencia, inspirada en los sistemas biológicos, y se ha explorado la posibilidad de integrarla en la arquitectura de los sistemas de control. Además de la auto-consciencia, se han explorado otros temas relevantes: modelado funcional, modelado de software, tecnología de los patrones, tecnología de componentes, tolerancia a fallos. Se ha analizado el estado de la técnica en los ámbitos pertinentes para las cuestiones de la auto-consciencia y la adaptabilidad en sistemas técnicos: arquitecturas cognitivas, control tolerante a fallos, y arquitecturas software dinámicas y computación autonómica. El marco teórico de ASys existente de sistemas autónomos cognitivos ha sido adaptado para servir de base para este análisis de autoconsciencia y adaptación y para dar sustento conceptual al posterior desarrollo de la solución. La tesis propone una solución general de diseño para la construcción de sistemas autónomos auto-conscientes. La idea central es la integración de un meta-controlador en la arquitectura de control del sistema autónomo, capaz de percibir la estado funcional del sistema de control y, si es necesario, reconfigurarlo en tiempo de operación. Esta solución de metacontrol se ha formalizado en cuatro patrones de diseño: i) el Patrón Metacontrol, que define la integración de un subsistema de metacontrol, responsable de controlar al propio sistema de control a través de la interfaz proporcionada por su plataforma de componentes, ii) el patrón Bucle de Control Epistémico, que define un bucle de control cognitivo basado en el modelos y que se puede aplicar al diseño del metacontrol, iii) el patrón de Reflexión basada en Modelo Profundo propone una solución para construir el modelo ejecutable utilizado por el meta-controlador mediante una transformación de modelo a modelo a partir del modelo de ingeniería del sistema, y, finalmente, iv) el Patrón Metacontrol Funcional, que estructura el meta-controlador en dos bucles, uno para el control de la configuración de los componentes del sistema de control, y otro sobre éste, controlando las funciones que realiza dicha configuración de componentes; de esta manera las consideraciones funcionales y estructurales se desacoplan. La Arquitectura OM y el metamodelo TOMASys son las piezas centrales del marco arquitectónico desarrollado para materializar la solución compuesta de los patrones anteriores. El metamodelo TOMASys ha sido desarrollado para la representación de la estructura y su relación con los requisitos funcionales de cualquier sistema autónomo. La Arquitectura OM es un patrón de referencia para la construcción de una metacontrolador integrando los patrones de diseño propuestos. Este meta-controlador se puede integrar en la arquitectura de cualquier sistema control basado en componentes. El elemento clave de su funcionamiento es un modelo TOMASys del sistema decontrol, que el meta-controlador usa para monitorizarlo y calcular las acciones de reconfiguración necesarias para adaptarlo a las circunstancias en cada momento. Un proceso de ingeniería, complementado con otros recursos, ha sido elaborado para guiar la aplicación del marco arquitectónico OM. Dicho Proceso de Ingeniería OM define la metodología a seguir para construir el subsistema de metacontrol para un sistema autónomo a partir del modelo funcional del mismo. La librería OMJava proporciona una implementación del meta-controlador OM que se puede integrar en el control de cualquier sistema autónomo, independientemente del dominio de la aplicación o de su tecnología de implementación. Para concluir, la solución completa ha sido validada con el desarrollo de un robot móvil autónomo que incorpora un meta-controlador con la Arquitectura OM. Las propiedades de auto-consciencia y adaptación proporcionadas por el meta-controlador han sido validadas en diferentes escenarios de operación del robot, en los que el sistema era capaz de sobreponerse a fallos en el sistema de control mediante reconfiguraciones orquestadas por el metacontrolador. ABSTRACT Technical systems are becoming more complex, they incorporate more advanced functionalities, they are more integrated with other systems and they are deployed in less controlled environments. All this supposes a more demanding and uncertain scenario for control systems, which are also required to be more autonomous and dependable. Autonomous adaptivity is a current challenge for extant control technologies. The ASys research project proposes to address it by moving the responsibility for adaptivity from the engineers at design time to the system at run-time. This thesis has intended to advance in the formulation and technical reification of ASys principles of model-based self-cognition and having systems self-handle at runtime for robust autonomy. For that it has focused on the biologically inspired capability of self-awareness, and explored the possibilities to embed it into the very architecture of control systems. Besides self-awareness, other themes related to the envisioned solution have been explored: functional modeling, software modeling, patterns technology, components technology, fault tolerance. The state of the art in fields relevant for the issues of self-awareness and adaptivity has been analysed: cognitive architectures, fault-tolerant control, and software architectural reflection and autonomic computing. The extant and evolving ASys Theoretical Framework for cognitive autonomous systems has been adapted to provide a basement for this selfhood-centred analysis and to conceptually support the subsequent development of our solution. The thesis proposes a general design solution for building self-aware autonomous systems. Its central idea is the integration of a metacontroller in the control architecture of the autonomous system, capable of perceiving the functional state of the control system and reconfiguring it if necessary at run-time. This metacontrol solution has been formalised into four design patterns: i) the Metacontrol Pattern, which defines the integration of a metacontrol subsystem, controlling the domain control system through an interface provided by its implementation component platform, ii) the Epistemic Control Loop pattern, which defines a modelbased cognitive control loop that can be applied to the design of such a metacontroller, iii) the Deep Model Reflection pattern proposes a solution to produce the online executable model used by the metacontroller by model-to-model transformation from the engineering model, and, finally, iv) the Functional Metacontrol pattern, which proposes to structure the metacontroller in two loops, one for controlling the configuration of components of the controller, and another one on top of the former, controlling the functions being realised by that configuration; this way the functional and structural concerns become decoupled. The OM Architecture and the TOMASys metamodel are the core pieces of the architectural framework developed to reify this patterned solution. The TOMASys metamodel has been developed for representing the structure and its relation to the functional requirements of any autonomous system. The OM architecture is a blueprint for building a metacontroller according to the patterns. This metacontroller can be integrated on top of any component-based control architecture. At the core of its operation lies a TOMASys model of the control system. An engineering process and accompanying assets have been constructed to complete and exploit the architectural framework. The OM Engineering Process defines the process to follow to develop the metacontrol subsystem from the functional model of the controller of the autonomous system. The OMJava library provides a domain and application-independent implementation of an OM Metacontroller than can be used in the implementation phase of OMEP. Finally, the complete solution has been validated in the development of an autonomous mobile robot that incorporates an OM metacontroller. The functional selfawareness and adaptivity properties achieved thanks to the metacontrol system have been validated in different scenarios. In these scenarios the robot was able to overcome failures in the control system thanks to reconfigurations performed by the metacontroller.

Structuring research methods and data with the research object model: genomics workflows as a case study

Background: One of the main challenges for biomedical research lies in the computer-assisted integrative study of large and increasingly complex combinations of data in order to understand molecular mechanisms. The preservation of the materials and methods of such computational experiments with clear annotations is essential for understanding an experiment, and this is increasingly recognized in the bioinformatics community. Our assumption is that offering means of digital, structured aggregation and annotation of the objects of an experiment will provide necessary meta-data for a scientist to understand and recreate the results of an experiment. To support this we explored a model for the semantic description of a workflow-centric Research Object (RO), where an RO is defined as a resource that aggregates other resources, e.g., datasets, software, spreadsheets, text, etc. We applied this model to a case study where we analysed human metabolite variation by workflows. Results: We present the application of the workflow-centric RO model for our bioinformatics case study. Three workflows were produced following recently defined Best Practices for workflow design. By modelling the experiment as an RO, we were able to automatically query the experiment and answer questions such as “which particular data was input to a particular workflow to test a particular hypothesis?”, and “which particular conclusions were drawn from a particular workflow?”. Conclusions: Applying a workflow-centric RO model to aggregate and annotate the resources used in a bioinformatics experiment, allowed us to retrieve the conclusions of the experiment in the context of the driving hypothesis, the executed workflows and their input data. The RO model is an extendable reference model that can be used by other systems as well.

Confirming the Association Between Affective Disturbance and Perceived Cognitive Dysfunction Among Breast Cancer Patients: A Meta-Analysis of Available Literature

Purpose: Breast cancer is the most frequently diagnosed cancer among women worldwide. While undergoing chemotherapy treatment for breast cancer, patients often report experiencing "chemobrain." Previous literature reports correlations between psychological distress and these perceived cognitive problems. The aim of the present study was to examine the strength of the association between affective disturbance and subjective cognitive dysfunction.Methods: This study included a meta-analysis of the literature reporting a correlation between mood and subjective cognitive dysfunction. Eight studies with 1344 breast cancer patients treated with chemotherapy were selected based on stringent study inclusion criteria. Studies reporting a correlation coefficient between mood and subjective cognitive dysfunction were included.Results: In these data, there was no significant correlation between affective disturbance and subjective cognitive dysfunction. A random effects model yielded an overall weighted mean effect size of 0.12.Conclusion: Although this meta-analysis did not confirm the correlation between mood and subjective cognitive dysfunction, there was a clear association between these factors in the original disaggregated analyses, and they are clearly impactful from the time of diagnosis through long-term after care. The clinical implications of the present study and future directions for research are discussed.

A structural model of cognitive-motivational variables as explanatory factors of academic achievement in Spanish Language and Mathematics

In recent years, several explanatory models have been developed which attempt to analyse the predictive worth of various factors in relation to academic achievement, as well as the direct and indirect effects that they produce. The aim of this study was to examine a structural model incorporating various cognitive and motivational variables which influence student achievement in the two basic core skills in the Spanish curriculum: Spanish Language and Mathematics. These variables included differential aptitudes, specific self-concept, goal orientations, effort and learning strategies. The sample comprised 341 Spanish students in their first year of Compulsory Secondary Education. Various tests and questionnaires were used to assess each student, and Structural Equation Modelling (SEM) was employed to study the relationships in the initial model. The proposed model obtained a satisfactory fit for the two subjects studied, and all the relationships hypothesised were significant. The variable with the most explanatory power regarding academic achievement was mathematical and verbal aptitude. Also notable was the direct influence of specific self-concept on achievement, goal-orientation and effort, as was the mediatory effect that effort and learning strategies had between academic goals and final achievement.

Evaluación participativa de los impactos sociales del turismo residencial y meta-análisis de resultados: un caso de estudio en Pipa (Rio Grande do Norte, Brasil)

Este artículo presenta una propuesta metodológica para la evaluación participativa de impactos sociales. Se ejemplifica mediante la descripción del proceso y resultados de una investigación realizada en la comunidad turística de Pipa (Rio Grande do Norte, Brasil) en la que se desarrolló un proceso de participación orientado a discutir el modelo de turismo residencial implantado en este territorio mediante el identificación y evaluación de sus impactos sociales. La novedad de esta propuesta reside en que se añade, a los beneficios y utilidades de la evaluación participativa de impactos sociales, un meta-análisis realizado sobre los resultados del proceso de participación. Este meta-análisis hace uso de las herramientas informáticas propias del Análisis de Redes Sociales aplicadas al estudio de los mapas causa-efecto elaborados por los participantes. Los resultados de este análisis cuantitativo se completan e interpretan con la información obtenida a través de entrevistas en profundidad y revisión documental, permitiendo: 1) identificar las causas últimas de los impactos sociales derivados del turismo residencial a escala local y 2) una mejor comprensión de la complejidad causal de estos impactos. El meta-análisis ha identificado que la primacía de los intereses de las empresas inmobiliarias internacionales sobre el interés general local se sustenta sobre su capacidad ilusoria de controlar la demanda mediante agresivas campañas de marketing. Esta información permite la deconstrucción del discurso desarrollista del turismo y posibilita la demarcación de nuevas áreas de acción estratégica orientadas a la maximización del beneficio colectivo.

An explanatory model of academic achievement based on aptitudes, goal orientations, self-concept and learning strategies

As a result of studies examining factors involved in the learning process, various structural models have been developed to explain the direct and indirect effects that occur between the variables in these models. The objective was to evaluate a structural model of cognitive and motivational variables predicting academic achievement, including general intelligence, academic self-concept, goal orientations, effort and learning strategies. The sample comprised of 341 Spanish students in the first year of compulsory secondary education. Different tests and questionnaires were used to evaluate each variable, and Structural Equation Modelling (SEM) was applied to contrast the relationships of the initial model. The model proposed had a satisfactory fit, and all the hypothesised relationships were significant. General intelligence was the variable most able to explain academic achievement. Also important was the direct influence of academic self-concept on achievement, goal orientations and effort, as well as the mediating ability of effort and learning strategies between academic goals and final achievement.

Using the effect size to model change in preference values from descriptive health status

Objectives: This pilot study describes a modelling approach to translate group-level changes in health status into changes in preference values, by using the effect size (ES) to summarize group-level improvement. Methods: ESs are the standardized mean difference between treatment groups in standard deviation (SD) units. Vignettes depicting varying severity in SD decrements on the SF-12 mental health summary scale, with corresponding symptom severity profiles, were valued by a convenience sample of general practitioners (n = 42) using the rating scale (RS) and time trade-off methods. Translation factors between ES differences and change in preference value were developed for five mental disorders, such that ES from published meta-analyses could be transformed into predicted changes in preference values. Results: An ES difference in health status was associated with an average 0.171-0.204 difference in preference value using the RS, and 0.104-0.158 using the time trade off. Conclusions: This observed relationship may be particular to the specific versions of the measures employed in the present study. With further development using different raters and preference measures, this approach may expand the evidence base available for modelling preference change for economic analyses from existing data.

Meta-analysis of the population and phenotypic expression of CYP2C9/2C19 polymorphism on drug metabolism in different ethnicities

The term "pharmacogenetics" has been defined as the scientific study of inherited factors that affect the human drug response. Many pharmacogenetie studies have been published since 1995 and have focussed on the principal enzyme family involved in drug metabolism, the cytochrome P450 family, particularly cytochrome P4502C9 and 2C19. In order to investigate the pharmacogenetic aspect of pharmacotherapy, the relevant studies describing the association of pharmacogenetic factor(s) in drug responses must be retrieved from existing literature using a systematic review approach. In addition, the estimation of variant allele prevalence for the gene under study between different ethnic populations is important for pharmacogenetic studies. In this thesis, the prevalence of CYP2C9/2C19 alleles between different ethnicities has been estimated through meta-analysis and the population genetic principle. The clinical outcome of CYP2C9/2C19 allelic variation on the pharmacotherapy of epilepsy has been investigated; although many new antiepileptic drugs have been launched into the market, carbamazepine, phenobarbital and phenytoin are still the major agents in the pharmacotherapy of epilepsy. Therefore, phenytoin was chosen as a model AED and the effect of CYP2C9/2C19 genetic polymorphism on phenytoin metabolism was further examined.An estimation of the allele prevalence was undertaken for three CYP2C9/2C19 alleles respectively using a meta-analysis of studies that fit the Hardy-Weinberg equilibrium. The prevalence of CYP2C9*1 is approximately 81%, 96%, 97% and 94% in Caucasian, Chinese, Japanese, African populations respectively; the pooled prevalence of CYP2C19*1 is about 86%, 57%, 58% and 85% in these ethnic populations respectively. However, the studies of association between CYP2C9/2C19 polymorphism and phenytoin metabolism failed to achieve any qualitative or quantitative conclusion. Therefore, mephenytoin metabolism was examined as a probe drug for association between CYP2C19 polymorphism and mephenytoin metabolic ratio. Similarly, analysis of association between CYP2C9 polymorphism and warfarin dose requirement was undertaken.It was confirmed that subjects carrying two mutated CYP2C19 alleles have higher S/R mephenytoin ratio due to deficient CYP2C19 enzyme activity. The studies of warfarin and CYP2C9 polymorphism did not provide a conclusive result due to poor comparability between studies.The genetic polymorphism of drug metabolism enzymes has been studied extensively, however other genetic factors, such as multiple drug resistance genes (MDR) and genes encoding ion channels, which may contribute to variability in function of drug transporters and targets, require more attention in future pharmacogenetic studies of antiepileptic drugs.

Efficacy of memantine on behavioral and psychological symptoms related to dementia:a systematic meta-analysis

BACKGROUND: The behavioral and psychological symptoms related to dementia (BPSD) are difficult to manage and are associated with adverse patient outcomes. OBJECTIVE: To systematically analyze the data on memantine in the treatment of BPSD. METHODS: We searched MEDLINE, EMBASE, Pharm-line, the Cochrane Centre Collaboration, www.clinicaltrials.gov, www.controlled-trials.com, and PsycINFO (1966-July 2007). We contacted manufacturers and scrutinized the reference sections of articles identified in our search for further references, including conference proceedings. Two researchers (IM and CF) independently reviewed all studies identified by the search strategy. We included 6 randomized, parallel-group, double-blind studies that rated BPSD with the Neuropsychiatric Inventory (NPI) in our meta-analysis. Patients had probable Alzheimer's disease and received treatment with memantine for at least one month. Overall efficacy of memantine on the NPI was established with a t-test for the average difference between means across studies, using a random effects model. RESULTS: Five of the 6 studies identified had NPI outcome data. In these 5 studies, 868 patients were treated with memantine and 882 patients were treated with placebo. Patients on memantine improved by 1.99 on the NPI scale (95% Cl -0.08 to -3.91; p = 0.041) compared with the placebo group. CONCLUSIONS: Initial data appear to indicate that memantine decreases NPI scores and may have a role in managing BPSD. However, there are a number of limitations with the current data; the effect size was relatively small, and whether memantine produces significant clinical benefit is not clear.

Proteomic analysis of a noninvasive human model of acute inflammation and its resolution:the twenty-one day gingivitis model

The 21-day experimental gingivitis model, an established noninvasive model of inflammation in response to increasing bacterial accumulation in humans, is designed to enable the study of both the induction and resolution of inflammation. Here, we have analyzed gingival crevicular fluid, an oral fluid comprising a serum transudate and tissue exudates, by LC-MS/MS using Fourier transform ion cyclotron resonance mass spectrometry and iTRAQ isobaric mass tags, to establish meta-proteomic profiles of inflammation-induced changes in proteins in healthy young volunteers. Across the course of experimentally induced gingivitis, we identified 16 bacterial and 186 human proteins. Although abundances of the bacterial proteins identified did not vary temporally, Fusobacterium outer membrane proteins were detected. Fusobacterium species have previously been associated with periodontal health or disease. The human proteins identified spanned a wide range of compartments (both extracellular and intracellular) and functions, including serum proteins, proteins displaying antibacterial properties, and proteins with functions associated with cellular transcription, DNA binding, the cytoskeleton, cell adhesion, and cilia. PolySNAP3 clustering software was used in a multilayered analytical approach. Clusters of proteins that associated with changes to the clinical parameters included neuronal and synapse associated proteins.

Success factors of product innovation:an updated meta-analysis

Assessing factors that predict new product success (NPS) holds critical importance for companies, as research shows that despite considerable new product investment, success rates are generally below 25%. Over the decades, meta-analytical attempts have been made to summarize empirical findings on NPS factors. However, market environment changes such as increased global competition, as well as methodological advancements in meta-analytical research, present a timely opportunity to augment their results. Hence, a key objective of this research is to provide an updated and extended meta-analytic investigation of the factors affecting NPS. Using Henard and Szymanski's meta-analysis as the most comprehensive recent summary of empirical findings, this study updates their findings by analyzing articles published from 1999 through 2011, the period following the original meta-analysis. Based on 233 empirical studies (from 204 manuscripts) on NPS, with a total 2618 effect sizes, this study also takes advantage of more recent methodological developments by re-calculating effects of the meta-analysis employing a random effects model. The study's scope broadens by including overlooked but important additional variables, notably “country culture,” and discusses substantive differences between the updated meta-analysis and its predecessor. Results reveal generally weaker effect sizes than those reported by Henard and Szymanski in 2001, and provide evolutionary evidence of decreased effects of common success factors over time. Moreover, culture emerges as an important moderating factor, weakening effect sizes for individualistic countries and strengthening effects for risk-averse countries, highlighting the importance of further investigating culture's role in product innovation studies, and of tracking changes of success factors of product innovations. Finally, a sharp increase since 1999 in studies investigating product and process characteristics identifies a significant shift in research interest in new product development success factors. The finding that the importance of success factors generally declines over time calls for new theoretical approaches to better capture the nature of new product development (NPD) success factors. One might speculate that the potential to create competitive advantages through an understanding of NPD success factors is reduced as knowledge of these factors becomes more widespread among managers. Results also imply that managers attempting to improve success rates of NPDs need to consider national culture as this factor exhibits a strong moderating effect: Working in varied cultural contexts will result in differing antecedents of successful new product ventures.