Enlarged tracheoesophageal puncture: A systematic review and retrospective analysis

Background. An enlarged tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The aims of this research were: (1) to conduct a systematic review and meta-analysis on enlarged TEP; (2) to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP; and (3) to evaluate control of leakage around the VP using conservative treatments and adverse events in patients with enlarged TEP.^ Methods. A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model. A retrospective cohort study was completed. Patients who underwent total laryngectomy and TEP at The University of Texas M. D. Anderson Cancer Center (MDACC) were included. Multiple logistic regression methods were used to assess risk factors for enlargement. Descriptive and bivariate statistics were calculated to evaluate outcomes and adverse events. Results: Twenty-seven manuscripts were included in the systematic review. The summary risk estimate of enlarged TEP/leakage around the VP was 7.2% (95% CI: 4.8%-9.6%). Temporary VP removal and TEP-site injections were the most commonly reported treatments. Neither prosthetic diameter (p=0.076) nor timing of TEP (p=0.297) significantly increased risk of enlargement per stratified analyses of published outcomes. The cumulative incidence of enlarged TEP was 18.6% (36/194, 95% CI: 13.0%-24.1%) in the MDACC cohort. Enlarged TEP occurred exclusively in irradiated patients. Adjusting for length of follow-up and timing of TEP, advanced nodal disease (ORadjusted: 4.3, 95% CI: 1.0-19.1), stricture (ORadjusted : 3.2, 95% CI: 1.2-8.6), and locoregional recurrence/distant metastasis after laryngectomy (ORadjusted: 6.2, 95% CI: 2.3-16.4) increased risk of enlarged TEP. At last follow-up, conservative methods controlled leakage around the VP in 81% (29/36) of patients. Unresolved leakage was associated with recurrent cancer (p=0.081) and TEP-site irregularity (p=0.003). Relative to those without enlargement, enlarged TEP patients had significantly higher risk of pneumonia (RR: 3.4, 95% CI: 1.9-6.2).^ Conclusions. These data establish that enlarged TEP poses serious health risks, and provide insight into medical and oncologic factors that may contribute to development of this complication. In addition, this research supports the use of conservative treatments to address leakage after enlarged TEP in lieu of complete TEP closure.^

Motivational interviewing and feedback for college drinkers: Handling missing values with complete case analysis and multiple imputation

Objective: In this secondary data analysis, three statistical methodologies were implemented to handle cases with missing data in a motivational interviewing and feedback study. The aim was to evaluate the impact that these methodologies have on the data analysis. ^ Methods: We first evaluated whether the assumption of missing completely at random held for this study. We then proceeded to conduct a secondary data analysis using a mixed linear model to handle missing data with three methodologies (a) complete case analysis, (b) multiple imputation with explicit model containing outcome variables, time, and the interaction of time and treatment, and (c) multiple imputation with explicit model containing outcome variables, time, the interaction of time and treatment, and additional covariates (e.g., age, gender, smoke, years in school, marital status, housing, race/ethnicity, and if participants play on athletic team). Several comparisons were conducted including the following ones: 1) the motivation interviewing with feedback group (MIF) vs. the assessment only group (AO), the motivation interviewing group (MIO) vs. AO, and the intervention of the feedback only group (FBO) vs. AO, 2) MIF vs. FBO, and 3) MIF vs. MIO.^ Results: We first evaluated the patterns of missingness in this study, which indicated that about 13% of participants showed monotone missing patterns, and about 3.5% showed non-monotone missing patterns. Then we evaluated the assumption of missing completely at random by Little's missing completely at random (MCAR) test, in which the Chi-Square test statistic was 167.8 with 125 degrees of freedom, and its associated p-value was p=0.006, which indicated that the data could not be assumed to be missing completely at random. After that, we compared if the three different strategies reached the same results. For the comparison between MIF and AO as well as the comparison between MIF and FBO, only the multiple imputation with additional covariates by uncongenial and congenial models reached different results. For the comparison between MIF and MIO, all the methodologies for handling missing values obtained different results. ^ Discussions: The study indicated that, first, missingness was crucial in this study. Second, to understand the assumptions of the model was important since we could not identify if the data were missing at random or missing not at random. Therefore, future researches should focus on exploring more sensitivity analyses under missing not at random assumption.^

Immune response to hepatitis B vaccination in drug using populations: A systematic review and meta-regression analysis

Hepatitis B virus (HBV) is a significant cause of liver diseases and related complications worldwide. Both injecting and non-injecting drug users are at increased risk of contracting HBV infection. Scientific evidence suggests that drug users have subnormal response to HBV vaccination and the seroprotection rates are lower than that in the general population; potentially due to vaccine factors, host factors, or both. The purpose of this systematic review is to examine the rates of seroprotection following HBV vaccination in drug using populations and to conduct a meta-analysis to identify the factors associated with varying seroprotection rates. Seroprotection is defined as developing an anti-HBs antibody level of ≥ 10 mIU/ml after receiving the HBV vaccine. Original research articles were searched using online databases and reference lists of shortlisted articles. HBV vaccine intervention studies reporting seroprotection rates in drug users and published in English language during or after 1989 were eligible. Out of 235 citations reviewed, 11 studies were included in this review. The reported seroprotection rates ranged from 54.5 – 97.1%. Combination vaccine (HAV and HBV) (Risk ratio 12.91, 95% CI 2.98-55.86, p = 0.003), measurement of anti-HBs with microparticle immunoassay (Risk ratio 3.46, 95% CI 1.11-10.81, p = 0.035) and anti-HBs antibody measurement at 2 months after the last HBV vaccine dose (RR 4.11, 95% CI 1.55-10.89, p = 0.009) were significantly associated with higher seroprotection rates. Although statistically nonsignificant, the variables mean age>30 years, higher prevalence of anti-HBc antibody and anti-HIV antibody in the sample population, and current drug use (not in drug rehabilitation treatment) were strongly associated with decreased seroprotection rates. Proportion of injecting drug users, vaccine dose and accelerated vaccine schedule were not predictors of heterogeneity across studies. Studies examined in this review were significantly heterogeneous (Q = 180.850, p = 0.000) and factors identified should be considered when comparing immune response across studies. The combination vaccine showed promising results; however, its effectiveness compared to standard HBV vaccine needs to be examined systematically. Immune response in DUs can possibly be improved by the use of bivalent vaccines, booster doses, and improving vaccine completion rates through integrated public programs and incentives.^

Particle size spectrum analysis during Maria S. Merian cruise MSM26, spring 2013

A Laser In-Situ Scattering Transmissometer (LISST) was used to collect vertical distribution data of particles from 2.5 to 500 µm in size. The LISST uses a multi-ring detector to measure scattering light of particles from a laser diode. Particles are classified into 32 log-spaced bins and the concentration of each bin is calculated as micro-liters per liter (µl/l). The instrument is rated to a depth of 300 m, and also records temperature and pressure. The sample interval was set to record every second. The LISST was attached to the LOPC frame to conduct casts and allow for particle-size comparisons between the two instruments. The LOPC is rated to a depth of 2000 m, thus a short deployment to a depth of 300 m was first conducted with both instruments. The instruments were then returned to the deck and the LISST removed via a quick release bracket so deep LOPC casts could be continued at a station. Raw LISST size-spectrum data is presented as concentrations for each of the 32 size bins for every second of the cast.

An Empirical Analysis of the Monetary Policy Reaction Function in India

This paper empirically analyzes India’s monetary policy reaction function by applying the Taylor (1993) rule and its open-economy version which employs dynamic OLS. The analysis uses monthly data from the period of April 1998 to December 2007. When the simple Taylor rule was estimated for India, the output gap coefficient was statistically significant, and its sign condition was found to be consistent with theoretical rationale; however, the same was not true of the inflation coefficient. When the Taylor rule with exchange rate was estimated, the coefficients of output gap and exchange rate had statistical significance with the expected signs, whereas the results of inflation remained the same as before. Therefore, the inflation rate has not played a role in the conduct of India’s monetary policy, and it is inappropriate for India to adopt an inflation-target type policy framework.

The analysis of the basketball coach speech during the moments of game and pause in relation to the performance in competition

In the area of the professional competition, the coach is a fundamental part in the management of a team and more concretely in the game planning. During the competition, the management of the times of pause and times out as well as the conduct of the coach during the same ones is an aspect to analyze in the sports performance. It is for this that it becomes necessary to know some of the behaviors that turn out to be more frequent by the coach and that are more related to a positive performance of his players. For it there has been realized a study of 7 cases of expert coaches in those that his verbal behavior has observed during 4 games. It has focused on the content of the information only to verbal level, on his meaning. The information that have been obtained in the study shows a major quantity of information elaborated during the pauses of the games and a major tactical content with regard to the moments of game. On the other hand, a relation exists between a major number of questions and a minor number of psychological instructions when the score is adverse, whereas in case of victory, a direct relation does not exist with any category. The rest of categories of the speech do not meet influenced directly for the result, for what it is not possible to consider a direct and immediate relation between the coach verbal behavior during the pauses and the result of the game, except in punctual moments.

Optimisation of a Low-Speed Wind Tunnel. Analysis and Redesign of Corner Vanes.

This paper includes the experimental study, analysis, redesign and subsequent test of the parts of a closed circuit, low speed wind tunnel which are relevant in terms of total pressure loss. The objective is to lower the energy consumption of this system for given conditions in test chamber, so as to reduce the operational costs. In order to achieve this objective, several tasks were performed as the text shows in its different parts. For these tasks, the ETSIAE wind tunnel was used, although the results of this work can be extrapolated to any wind tunnel with the same characteristics. Part II presents a theoretical previous study of the general running of a closed circuit, low speed wind tunnel, as well as the followed procedure to conduct experimental tests for obtaining the total pressure loss in its parts. Results from these tests and their analysis are included in this part. In part III, the analysis of the influence of corner 1 on the pressure loss takes place. As it is said in this part, corner 1 has great importance in the total pressure loss of the wind tunnel. Therefore, it is the first part that should be modified in order to improve the performances of the wind tunnel. During part IV, an optimised guide vane is designed in order to reduce the pressure loss in corner 1 of the wind tunnel. Software MISES is used to achieve this goal by means of selecting the optimum guide vane. In order to introduce the new guide vane in wind tunnels with affordable costs, the easily constructable criterion is kept during design. For this reason, the guide vane will consist of simple aerodynamic contours. Part V includes some possible improvements for the proposed guide vane, in order to evaluate if there is room for improvement in its design. Finally, part VI includes the tests that were conducted in the wind tunnel with the new guide vane cascade and the analysis of their results, in order to asses whether the proposed design fulfills the requirement of lowering the total pressure loss in the wind tunnel. Part VII gathers the main ideas resulting from the whole work.

Road fright transport decoupling: A comparative analysis between the United Kingdom and Spain

Economic growth has traditionally been linked to road freight transport demand, leading to a steady rise in social and environmental impacts. Concern about this problem has caused the EU to promote a decoupling strategy aimed at boosting sustainable development in European countries by improving the efficiency of transport systems without curbing economic growth. Over the last few years empirical evidence in some countries such as the United Kingdom has shown an increase in GDP while the volume of road freight traffic has remained stable or even decreased. This paper compares recent decoupling trends by analyzing the evolution of road tonne-kms/GDP relationship in the United Kingdom and Spain from 1999 to 2007. This comparison seeks to identify the main differences and key drivers of decoupling in both countries. We first provide an overview of the divergences between both economic structures and levels of road transport intensity. Then we conduct a decomposition analysis in order to identify the variables that explain the evolution of truck traffic per unit of GDP in each country. The results show that the increasing share of services in GDP has substantially contributed to decreasing road transport demand in both cases. Changes in road transport intensity due to improvements in logistic and supply chain management have been more successful in the UK than in Spain.

Soft Skills: A Comparative Analysis Between Online and Classroom Teaching

Currently the Spanish universities are making a great effort to effectively incorporate the development and assessment of generic skills in their training programs. Information and communications technologies (ICT) offer a wide range of possibilities but create uncertainty among teachers about the process and results. It is considered of interest to conduct a study to analyze the extent to which social skills like commitment, communication and teamwork are acquired by students and teachers. It seeks to ascertain the influence of the learning context, online or classroom training, in the development of these personal skills among the participants in the sample. For this study two universities have been chosen, Universidad a Distancia de Madrid (UDIMA) offering online training environment, and Universidad Politécnica de Madrid (UPM) with classroom training modality. A total of 257 individuals, 230 students and 27 teachers have answered the survey called Evalsoft. This instrument was designed in the project with the same name by a research team from Universidad Complutense of Madrid (UCM). Some interesting conclusions can be highlighted: it is in the online context where there are higher levels of commitment and teamwork than in the classroom modality; teachers have higher social skills that students and these improve with age. Sex and the training program appear to influence these social skills.

Food market analysis: a case study of the Glocal methodology in the Dominican Republic

The present paper provides an insight into the food value chain of three specific sectors (fruit and vegetables, poultry and rice) in the Dominican Republic. The Glocal methodology used for the study combines a global view with local conditions and thus it can be applied to food markets. Each of these food chains is analyzed by following traditional industrial organization theory, based on structure, conduct and performance. Regarding the specific case of the Dominican Republic, different sources of information are used to analyze the weaknesses of the studied chains, including direct interviews. The food value chains of fruit and vegetables, poultry and rice in the Dominican Republic show a lack of structure and they are undergoing changes; however, they also have great opportunities to improve efficiency by making some changes.

Transcending Cultural and Language Differences: Ethical Codes of Conduct for Translators and Interpreters in Afghanistan

This project examines what an ethical code of conduct would look like in Afghanistan through analysis of historical, cultural and linguistic aspects found within its regions, as well as an examination of ethical codes of conduct for translators and interpreters in other countries. While numerous ethical guidelines and codes of conduct for translators and interpreters exist throughout global communities, it seems that creating a successful standardized ethical code of conduct in Afghanistan may be difficult to achieve given cultural and linguistic complexities. An ethical code of conduct for translators and interpreters in Afghanistan should include particular focus on: cultural sensitivity and courtesy, impartiality, conflict of interest, options for withdrawal, as well as reflect the importance of Pashtunwali.

Looking inside for good practice in Deaf bilingual education: a participatory SWOT analysis

Presentation to the Disability Studies Conference, Lancaster University, September 7-9, 2010.

Analysis of Hyporheic Flow Induced by a Bar in a Gravel Stream: an Experimental Study

Thesis (Master, Civil Engineering) -- Queen's University, 2016-06-01 00:03:02.939

Making Autonomies Matter: Sub-State Actor Accommodation in the Nordic Council and the Nordic Council of Ministers - An Analysis of the Institutional Framework for Accommodating the Faroe Islands, Greenland and Åland within ‘Norden’. EDAP Paper 03/2014

Sovereign powers are not absolute but exercised in varying areas and to varying degrees by sub-state, state and supra-state entities. The upward dispersion of power to international organisations carries implications for the sub-state level, while sub-state governance poses demands as to the conduct of governance at the international level. It is well recognised that sub-state entities, such as federal states and autonomies, may have the (restricted) capacity to enter into international relations. But what capacities do international organisations have to accommodate autonomies in their institutional frameworks? This paper shall present a case study of one such framework, namely Nordic co-operation and the accommodation of the Nordic autonomies, the Faroe Islands, Greenland and Åland, within its institutional framework. Within ‘Norden’, the position of autonomies has been scrutinised and adapted on several occasions, in the late 1960s, early 1980s and in the mid-2000s. The accommodation of the autonomies has been discussed in light of evident implications of statehood and international legal personality and the institutional arrangements eventually carved serve well to illustrate the challenges and opportunities international organisations face in the attempt to accommodate multi-level systems.

Scaling Social Impact in Europe: Quantitative Analysis of National and Transnational Scaling Strategies of 358 Social Enterprises

A wide variety of different socially motivated organisations perform exceptional feats in alleviating societal ills using creativity and entrepreneurial spirit in their quest to scale their social impact. Their focus is seldom limited to one specific region – instead they strive to benefit the largest possible number of people, thereby often transcending national borders. After all, societal issues usually don’t stop at a countries’ borders – why then should good ideas and impactful concepts aimed at solving these issues? For many socially motivated organisations, the goal of disseminating their social impact remains a solemn wish due to lacking experience and know-how of how to plan and conduct systematic scaling.