Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.

Chemotherapy versus support cancer treatment in advanced gastric cancer: a meta-analysis

The aim of the present study was to compare the efficacy of chemotherapy and support treatment in patients with advanced non-resectable gastric cancer in a systematic review and meta-analysis of randomized clinical trials that included a comparison of chemotherapy and support care treatment in patients diagnosed with gastric adenocarcinoma, regardless of their age, gender or place of treatment. The search strategy was based on the criteria of the Cochrane Base, using the following key words: 1) randomized clinical trials and antineoplastic combined therapy or gastrointestinal neoplasm, 2) stomach neoplasm and drug therapy, 3) clinical trial and multi-modality therapy, 4) stomach neoplasm and drug therapy or quality of life, 5) double-blind method or clinical trial. The search was carried out using the Cochrane, Medline and Lilacs databases. Five studies fulfilled the inclusion criteria, for a total of 390 participants, 208 (53%) receiving chemotherapy, 182 (47%) receiving support care treatment and 6 losses (1.6%). The 1-year survival rate was 8% for support care and 20% for chemotherapy (RR = 2.14, 95% CI = 1.00-4.57, P = 0.05); 30% of the patients in the chemotherapy group and 12% in the support care group attained a 6-month symptom-free period (RR = 2.33, 95% CI = 1.41-3.87, P < 0.01). Quality of life evaluated after 4 months was significantly better for the chemotherapy patients (34%; RR = 2.07, 95% CI = 1.31-3.28, P < 0.01) with tumor mass reduction (RR = 3.32, 95% CI = 0.77-14.24, P = 0.1). Chemotherapy increased the 1-year survival rate of the patients and provided a longer symptom-free period of 6 months and an improvement in quality of life.

Novel Cellular Luminescence Probes for Immunological and Toxicological Assessments

Escherichia coli K-12 (pEGFPluxABCDEAmp) (E. coli-lux), constitutively emitting bioluminescence (BL), was constructed and its BL emitting properties tested in different growth and killing conditions. The BL emission directly correlated with the number of viable E. coli-lux cells, and when subjected to the antimicrobial agent, the diminishment of the BL signal was linked directly to the number of killed bacterial cells. The method provided a very convenient application, especially when compared to conventional plate counting assays. This novel real-time based method was utilized in both immunological and toxicological assessments. The parameters such as the activation phase, the lytic phase and the capacity of the killing of the serum complement system were specified not only in humans but also in other species. E. coli-lux was also successfully used to study the antimicrobial activities of insect haemolymph. The mechanisms of neutrophil activity, like that of a myeloperoxidase (MPO)-H2O2-halide system, were studied using the E. coli-lux approach. The fundamental role of MPO was challenged, since during the actual killing in described circumstances in phagolysosome the MPO system was inactivated and chlorination halted. The toxicological test system, assessing indoor air total toxicity, particularly suitable for suspected mold damages, was designed based on the E. coli-lux method. Susceptibility to the vast number of various toxins, both pure chemicals and dust samples from the buildings and extracts from molds, were investigated. The E. coli-lux application was found to possess high sensitivity and specificity attributes. Alongside the analysis system, the sampling kit for indoor dust was engineered based on the swipe stick and the container. The combination of practical specimen collector and convenient analysis system provided accurate toxic data from the dust sample within hours. Neutrophils are good indicators of the pathophysiological state of the individual, and they can be utilized as a toxicological probe due to their ability to emit chemiluminescence (CL). Neutrophils can either be used as probe cells, directly exposed to the agent studied, or they can act as indicators of the whole biological system exposed to the agent. Human neutrophils were exposed to the same toxins as tested with the E. coli-lux system and measured as luminol amplified CL emission. The influence of the toxins on the individuals was investigated by exposing rats with moniliniformin, the mycotoxin commonly present in Finnish grains. The activity of the rat neutrophils was found to decrease significantly during the 28 days of exposure.

Fuzzy real option analysis in patent related decision making and patent valuation

The shift towards a knowledge-based economy has inevitably prompted the evolution of patent exploitation. Nowadays, patent is more than just a prevention tool for a company to block its competitors from developing rival technologies, but lies at the very heart of its strategy for value creation and is therefore strategically exploited for economic pro t and competitive advantage. Along with the evolution of patent exploitation, the demand for reliable and systematic patent valuation has also reached an unprecedented level. However, most of the quantitative approaches in use to assess patent could arguably fall into four categories and they are based solely on the conventional discounted cash flow analysis, whose usability and reliability in the context of patent valuation are greatly limited by five practical issues: the market illiquidity, the poor data availability, discriminatory cash-flow estimations, and its incapability to account for changing risk and managerial flexibility. This dissertation attempts to overcome these impeding barriers by rationalizing the use of two techniques, namely fuzzy set theory (aiming at the first three issues) and real option analysis (aiming at the last two). It commences with an investigation into the nature of the uncertainties inherent in patent cash flow estimation and claims that two levels of uncertainties must be properly accounted for. Further investigation reveals that both levels of uncertainties fall under the categorization of subjective uncertainty, which differs from objective uncertainty originating from inherent randomness in that uncertainties labelled as subjective are highly related to the behavioural aspects of decision making and are usually witnessed whenever human judgement, evaluation or reasoning is crucial to the system under consideration and there exists a lack of complete knowledge on its variables. Having clarified their nature, the application of fuzzy set theory in modelling patent-related uncertain quantities is effortlessly justified. The application of real option analysis to patent valuation is prompted by the fact that both patent application process and the subsequent patent exploitation (or commercialization) are subject to a wide range of decisions at multiple successive stages. In other words, both patent applicants and patentees are faced with a large variety of courses of action as to how their patent applications and granted patents can be managed. Since they have the right to run their projects actively, this flexibility has value and thus must be properly accounted for. Accordingly, an explicit identification of the types of managerial flexibility inherent in patent-related decision making problems and in patent valuation, and a discussion on how they could be interpreted in terms of real options are provided in this dissertation. Additionally, the use of the proposed techniques in practical applications is demonstrated by three fuzzy real option analysis based models. In particular, the pay-of method and the extended fuzzy Black-Scholes model are employed to investigate the profitability of a patent application project for a new process for the preparation of a gypsum-fibre composite and to justify the subsequent patent commercialization decision, respectively; a fuzzy binomial model is designed to reveal the economic potential of a patent licensing opportunity.

Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD)=-0.14, 95% confidence interval (CI)=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009). There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR)=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38). Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001) was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02). We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

A systematic mapping study on open data

This thesis presented the overview of Open Data research area, quantity of evidence and establishes the research evidence based on the Systematic Mapping Study (SMS). There are 621 such publications were identified published between years 2005 and 2014, but only 243 were selected in the review process. This thesis highlights the implications of Open Data principals’ proliferation in the emerging era of the accessibility, reusability and sustainability of data transparency. The findings of mapping study are described in quantitative and qualitative measurement based on the organization affiliation, countries, year of publications, research method, star rating and units of analysis identified. Furthermore, units of analysis were categorized by development lifecycle, linked open data, type of data, technical platforms, organizations, ontology and semantic, adoption and awareness, intermediaries, security and privacy and supply of data which are important component to provide a quality open data applications and services. The results of the mapping study help the organizations (such as academia, government and industries), re-searchers and software developers to understand the existing trend of open data, latest research development and the demand of future research. In addition, the proposed conceptual framework of Open Data research can be adopted and expanded to strengthen and improved current open data applications.

Systematic mapping study on integration of B2B customers in ERP

Business-to-business terminology is relatively new as a business concept, so is the enterprise resource planning system in information technology. Research, implementation and integration of these two concept has been observed for last two decades in this paper. One of the major success point for growth in business-to-business environment is the availability of internal and partner data. Enterprise resource planning system facilitates storing, analysis of such data and enables different business process automation, forecasting and numerous value creating activity. In order to achieve such functionality for B2B customers, integrating them within ERP is very useful. This paper aims at understanding and suggesting such integration through investigating related documentation of similar integration scenarios, infrastructure, models and architectures. The investigation of the topic of this paper has been made using systematic mapping study of related papers and listing and suggesting necessary ingredients that enables such integration. Furthermore, this paper also suggests possibilities to overcome challenges integration experts might face during the integration phase and opens doors to future research scope in the related fields.

What is the current state of cloud service research and its promise for the future? A systematic literature review

The information technology (IT) industry has recently witnessed the proliferation of cloud services, which have allowed IT service providers to deliver on-demand resources to customers over the Internet. This frees both service providers and consumers from traditional IT-related burdens such as capital and operating expenses and allows them to respond rapidly to new opportunities in the market. Due to the popularity and growth of cloud services, numerous researchers have conducted studies on various aspects of cloud services, both positive and negative. However, none of those studies have connected all relevant information to provide a holistic picture of the current state of cloud service research. This study aims to investigate that current situation and propose the most promising future directions. In order to determine achieve these goals, a systematic literature review was conducted on studies with a primary focus on cloud services. Based on carefully crafted inclusion criteria, 52 articles from highly credible online sources were selected for the review. To define the main focus of the review and facilitate the analysis of literature, a conceptual framework with five main factors was proposed. The selected articles were organized under the factors of the proposed framework and then synthesized using a narrative technique. The results of this systematic review indicate that the impacts of cloud services on enterprises were the factor best covered by contemporary research. Researchers were able to present valuable findings about how cloud services impact various aspects of enterprises such as governance, performance, and security. By contrast, the role of service provider sub-contractors in the cloud service market remains largely uninvestigated, as do cloud-based enterprise software and cloud-based office systems for consumers. Moreover, the results also show that researchers should pay more attention to the integration of cloud services into legacy IT systems to facilitate the adoption of cloud services by enterprise users. After the literature synthesis, the present study proposed several promising directions for cloud service research by outlining research questions for the underexplored areas of cloud services, in order to facilitate the development of cloud service markets in the future.

Systematic studies of the effect of pressure on magnetic and electronic properties of La2/3Ca1/3MnO3 thin films with various thicknesses /

Interest in mixed-valent perovskite manganese oxides of La\-xAxMnO^ (v4-divalent alkaline earth Ca, Sr or Ba), whose unusual properties were discovered nearly a half century ago, has recently been revived. The discovery of the colossal magnetoresistance and pressure effects introduced new questions concerning the complex interplay between lattice structure, magnetism and transport in doped perovskite manganites. In this study, we report our experimental investigations of pressure and magnetic field dependencies of La-i/sCai/sMnOs (LCMO) epitaxial films with various thickness on SrTiO$ substrate. An analysis of film thickness dependency of the resistivity of LCMO epitaxial films under pressure and magnetic field has been performed by taking into account substrate contributions. This verifies the correlation of lattice distortion with magnetic and transport properties. Strong dependencies of Mn — O — Mn bond bending and Mn — O bond stretching with pressure as well as Mn spin alignment with magnetic field, and the lattice distortion induced by the substrate are discussed.

Socially Constructed Environmental Issues and Sport: A Content Analysis of Ski Resort Environmental Communications

Due to the impact of sport on the natural environment (UN, 2010), it is important to examine the interplay between environmental issues and sport (Hums, 2010, Mallen & Chard, 2011; Nauright & Pope, 2009; Ziegler, 2007). This research content analyzed 82 ski resort environmental communications (SRECs). These communications were rated for their prominence, breadth, and depth using the delineation of environmental issues provided by the Sustainable Slopes Program (SSP) Charter. This data was compared to the resorts’ degree of environmentally responsible action as rated by the Ski Area Citizens’ Coalition (SACC). An adaptation of Hudson and Miller's (2005) model was then used to classify the ski resorts as inactive, reactive, exploitive, or proactive in their environmental activities. Recommendations have been made for standardization and transparency in environmental disclosures and an environmental management system to aid ski resorts in moving from ad hoc processes to a systematic and comprehensive framework for improving environmental performance.

What is reflection? A conceptual analysis of major definitions and a proposal of a five-component definition and model

La réflexion est considérée comme un élément significatif de la pédagogie et de la pratique médicales sans qu’il n’existe de consensus sur sa définition ou sur sa modélisation. Comme la réflexion prend concurremment plusieurs sens, elle est difficile à opérationnaliser. Une définition et un modèle standard sont requis afin d’améliorer le développement d’applications pratiques de la réflexion. Dans ce mémoire, nous identifions, explorons et analysons thématiquement les conceptualisations les plus influentes de la réflexion, et développons de nouveaux modèle et définition. La réflexion est définie comme le processus de s’engager (le « soi » (S)) dans des interactions attentives, critiques, exploratoires et itératives (ACEI) avec ses pensées et ses actions (PA), leurs cadres conceptuels sous-jacents (CC), en visant à les changer et en examinant le changement lui-même (VC). Notre modèle conceptuel comprend les cinq composantes internes de la réflexion et les éléments extrinsèques qui l’influencent.

‘Reliability Concepts in Quantile-based Analysis of Lifetime Data

Reliability analysis is a well established branch of statistics that deals with the statistical study of different aspects of lifetimes of a system of components. As we pointed out earlier that major part of the theory and applications in connection with reliability analysis were discussed based on the measures in terms of distribution function. In the beginning chapters of the thesis, we have described some attractive features of quantile functions and the relevance of its use in reliability analysis. Motivated by the works of Parzen (1979), Freimer et al. (1988) and Gilchrist (2000), who indicated the scope of quantile functions in reliability analysis and as a follow up of the systematic study in this connection by Nair and Sankaran (2009), in the present work we tried to extend their ideas to develop necessary theoretical framework for lifetime data analysis. In Chapter 1, we have given the relevance and scope of the study and a brief outline of the work we have carried out. Chapter 2 of this thesis is devoted to the presentation of various concepts and their brief reviews, which were useful for the discussions in the subsequent chapters .In the introduction of Chapter 4, we have pointed out the role of ageing concepts in reliability analysis and in identifying life distributions .In Chapter 6, we have studied the first two L-moments of residual life and their relevance in various applications of reliability analysis. We have shown that the first L-moment of residual function is equivalent to the vitality function, which have been widely discussed in the literature .In Chapter 7, we have defined percentile residual life in reversed time (RPRL) and derived its relationship with reversed hazard rate (RHR). We have discussed the characterization problem of RPRL and demonstrated with an example that the RPRL for given does not determine the distribution uniquely

Not the outside but the inside matters : functional analysis of Capricious and Tartan during Drosophila tracheal morphogenesis

The tubular structures, which transport essential gases, liquids, or cells from one site to another, are shared among various divergent organisms. These highly organized tubular networks include lung, kidney, vasculature and mammary gland in mammals as well as trachea and salivary gland in Drosophila melanogaster. Many questions regarding the tubular morphogenesis cannot be addressed sufficiently by investigating the mammalian organs because their structures are extremely complex and therefore, systematic analyses of genetic and cellular programs guiding the development is not possible. In contrast, the Drosophila tracheal development provides an excellent model system since many molecular markers and powerful tools for genetic manipulations are available. Two mechanisms were shown to be important for the outgrowth of tracheal cells: the FGF signaling pathway and the interaction between the tracheal cells and the surrounding mesodermal cells. The Drosophila FGF ligand encoded by branchless (bnl) is localized in groups of cells near tracheal metameres. The tracheal cells expressing the FGF receptor breathless (btl) respond to these sources of FGF ligand and extend towards them. However, this FGF signaling pathway is not sufficient for the formation of continuous dorsal trunk, the only muticellular tube in tracheal system. Recently, it was found out that single mesodermal cells called bridge-cells are essential for the formation of continuous dorsal trunk as they direct the outgrowth of dorsal trunk cells towards the correct targets. The results in this PhD thesis demonstrate that a cell adhesion molecule Capricious (Caps), which is specifically localized on the surface of bridge-cells, plays an essential role in guiding the outgrowing dorsal trunk cells towards their correct targets. When caps is lacking, some bridge-cells cannot stretch properly towards the adjacent posterior tracheal metameres and thus fail to interconnect the juxtaposing dorsal trunk cells. Consequently, discontinuous dorsal trunks containing interruptions at several positions are formed. On the other hand, when caps is ectopically expressed in the mesodermal cells through a twi-GAL4 driver, these mesodermal cells acquire a guidance function through ectopic caps and misguide the outgrowing dorsal trunk cells in abnormal directions. As a result, disconnected dorsal trunks are formed. These loss- and gain-of-function studies suggest that Caps presumably establishes the cell-to-cell contact between the bridge-cells and the tracheal cells and thereby mediates directly the guidance function of bridge-cells. The most similar protein known to Caps is another cell adhesion molecule called Tartan (Trn). Interestingly, trn is expressed in the mesodermal cells but not in the bridge-cells. When trn is lacking, the outgrowth of not only the dorsal trunks but also the lateral trunks are disrupted. However, in contrast to the ectopic expression of caps, the misexpression of trn does not affect tracheal development. Whereas Trn requires only its extracellular domain to mediate the matrix function, Caps requires both its extracellular and intracellular domains to function as a guidance molecule in the bridge-cells. These observations suggest that Trn functions differently from Caps during tracheal morphogenesis. Presumably, Trn mediates a matrix function of mesodermal cells, which support the tracheal cells to extend efficiently through the surrounding mesodermal tissue. In order to determine which domains dictate the functional specificity of Caps, two hybrid proteins CapsEdTrnId, which contains the Caps extracellular domain and the Trn intracellular domain, and TrnEdCapsId, which consists of the Trn extracellular domain and the Caps intracellular domain, were constructed. Gain of function and rescue experiments with these hybrid proteins suggest on one hand that the extracellular domains of Caps and Trn are functionally redundant and on the other hand that the intracellular domain dictates the functional specificity of Caps. In order to identify putative interactors of Caps, yeast two-hybrid screening was performed. An in vivo interaction assay in yeast suggests that Ras64B interacts specifically with the Caps intracellular domain. In addition, an in vitro binding assay reveals a direct interaction between an inactive form of Ras64B and the Caps intracellular domain. ras64B, which encodes a small GTPase, is expressed in the mesodermal cells concurrently as caps. Finally, a gain-of-function study with the constitutively active Ras64B suggests that Ras64B presumably functions downstream of Caps. All these results suggest consistently that the small GTPase Ras64B binds specifically to the Caps intracellular domain and may thereby mediate the guidance function of Caps.

Exploration of geological variability and possible processes through the use of compositional data analysis: an example using scottish metamorphosed

Developments in the statistical analysis of compositional data over the last two decades have made possible a much deeper exploration of the nature of variability, and the possible processes associated with compositional data sets from many disciplines. In this paper we concentrate on geochemical data sets. First we explain how hypotheses of compositional variability may be formulated within the natural sample space, the unit simplex, including useful hypotheses of subcompositional discrimination and specific perturbational change. Then we develop through standard methodology, such as generalised likelihood ratio tests, statistical tools to allow the systematic investigation of a complete lattice of such hypotheses. Some of these tests are simple adaptations of existing multivariate tests but others require special construction. We comment on the use of graphical methods in compositional data analysis and on the ordination of specimens. The recent development of the concept of compositional processes is then explained together with the necessary tools for a staying- in-the-simplex approach, namely compositional singular value decompositions. All these statistical techniques are illustrated for a substantial compositional data set, consisting of 209 major-oxide and rare-element compositions of metamorphosed limestones from the Northeast and Central Highlands of Scotland. Finally we point out a number of unresolved problems in the statistical analysis of compositional processes

Statistical Analysis of Eco-Toxicologic Data of Mammals from a Polluted Area

Several eco-toxicological studies have shown that insectivorous mammals, due to their feeding habits, easily accumulate high amounts of pollutants in relation to other mammal species. To assess the bio-accumulation levels of toxic metals and their in°uence on essential metals, we quantified the concentration of 19 elements (Ca, K, Fe, B, P, S, Na, Al, Zn, Ba, Rb, Sr, Cu, Mn, Hg, Cd, Mo, Cr and Pb) in bones of 105 greater white-toothed shrews (Crocidura russula) from a polluted (Ebro Delta) and a control (Medas Islands) area. Since chemical contents of a bio-indicator are mainly compositional data, conventional statistical analyses currently used in eco-toxicology can give misleading results. Therefore, to improve the interpretation of the data obtained, we used statistical techniques for compositional data analysis to define groups of metals and to evaluate the relationships between them, from an inter-population viewpoint. Hypothesis testing on the adequate balance-coordinates allow us to confirm intuition based hypothesis and some previous results. The main statistical goal was to test equal means of balance-coordinates for the two defined populations. After checking normality, one-way ANOVA or Mann-Whitney tests were carried out for the inter-group balances