User perspectives on the Swedish Maternal Health Care Register

Background: Established in 1999, the Swedish Maternal Health Care Register (MHCR) collects data on pregnancy, birth, and the postpartum period for most pregnant women in Sweden. Antenatal care (ANC) midwives manually enter data into the Web-application that is designed for MHCR. The aim of this study was to investigate midwives? experiences, opinions and use of the MHCR. Method: A national, cross-sectional, questionnaire survey, addressing all Swedish midwives working in ANC, was conducted January to March 2012. The questionnaire included demographic data, preformed statements with six response options ranging from zero to five (0 = totally disagree and 5 = totally agree), and opportunities to add information or further clarification in the form of free text comments. Parametric and non-parametric methods and logistic regression analyses were applied, and content analysis was used for free text comments. Results: The estimated response rate was 53.1%. Most participants were positive towards the Web-application and the included variables in the MHCR. Midwives exclusively engaged in patient-related work tasks perceived the register as burdensome (70.3%) and 44.2% questioned the benefit of the register. The corresponding figures for midwives also engaged in administrative supervision were 37.8% and 18.5%, respectively. Direct electronic transfer of data from the medical records to the MHCR was emphasised as significant future improvement. In addition, the midwives suggested that new variables of interest should be included in the MHCR ? e.g., infertility, outcomes of previous pregnancy and birth, and complications of the index pregnancy. Conclusions: In general, the MHCR was valued positively, although perceived as burdensome. Direct electronic transfer of data from the medical records to the MHCR is a prioritized issue to facilitate the working situation for midwives. Finally, the data suggest that the MHCR is an underused source for operational planning and quality assessment in local ANC centres.

Recent developments in statistical methods for detecting genetic loci affecting phenotypic variability

A number of recent works have introduced statistical methods for detecting genetic loci that affect phenotypic variability, which we refer to as variability-controlling quantitative trait loci (vQTL). These are genetic variants whose allelic state predicts how much phenotype values will vary about their expected means. Such loci are of great potential interest in both human and non-human genetic studies, one reason being that a detected vQTL could represent a previously undetected interaction with other genes or environmental factors. The simultaneous publication of these new methods in different journals has in many cases precluded opportunity for comparison. We survey some of these methods, the respective trade-offs they imply, and the connections between them. The methods fall into three main groups: classical non-parametric, fully parametric, and semi-parametric two-stage approximations. Choosing between alternatives involves balancing the need for robustness, flexibility, and speed. For each method, we identify important assumptions and limitations, including those of practical importance, such as their scope for including covariates and random effects. We show in simulations that both parametric methods and their semi-parametric approximations can give elevated false positive rates when they ignore mean-variance relationships intrinsic to the data generation process. We conclude that choice of method depends on the trait distribution, the need to include non-genetic covariates, and the population size and structure, coupled with a critical evaluation of how these fit with the assumptions of the statistical model.

Fatores genéticos e não genéticos em formas avançadas de Retinopatia Diabética em pacientes com Diabete Melito tipo 2

Introdução: A retinopatia diabética (RD) é a principal causa de novos casos de cegueira entre norte-americanos em idade produtiva. Existe uma associação entre RD e as outras complicações microvasculares do diabete melito. A associação da RD com a fase inicial da nefropatia, a microalbuminúria, não está esclarecida em pacientes com diabete melito (DM) tipo 2. Polimorfismos de genes (ENNP1; FABP2) relacionados à resistência insulínica, entre outros, poderiam estar associados à RD. Objetivo: O objetivo deste estudo foi avaliar fatores genéticos e não genéticos associados à RD avançada em pacientes com DM tipo 2. Métodos: Neste estudo caso-controle foram incluídos pacientes DM tipo 2 submetidos à avaliação clínica, laboratorial e oftalmológica. Foi realizada oftalmoscopia binocular indireta sob midríase e obtidas retinografias coloridas em 7 campos padronizados. Foram classificados como casos os pacientes portadores de RD avançada (formas graves de RD não proliferativa e RD proliferativa) e como controles os pacientes sem RD avançada (fundoscopia normal, e outras formas de RD). Foram estudados os polimorfismos K121Q do gene ENNP1 e A54T do gene FABP2. Na análise estatística foram utilizados testes paramétricos e não paramétricos conforme indicado. Foi realizada análise de regressão logística múltipla para avaliar fatores associados à RD avançada. O nível de significância adotado foi de 0,05%. Resultados: Foram avaliados 240 pacientes com DM tipo 2 com 60,6 ± 8,4 anos de idade e duração conhecida de DM de 14,4 ± 8,4 anos. Destes, 67 pacientes (27,9%) apresentavam RD avançada. Os pacientes com RD avançada apresentaram maior duração conhecida de DM (18,1 ± 8,1 vs. 12,9 ± 8,2 anos; P< 0,001), menor índice de massa corporal (IMC) (27,5 ± 4,2 vs. 29,0 ± 9,6 kg/m2; P= 0,019), além de uso de insulina mais freqüente (70,8% vs 35,3%; P< 0,001) e presença de nefropatia diabética (81,1% vs 34,8%; P< 0,001) quando comparados com os pacientes sem RD avançada. Na avaliação laboratorial os pacientes com RD avançada apresentaram valores mais elevados de creatinina sérica [1,4 (0,6 -13,6) vs 0,8 (0,5-17,9) mg/dl; P<0,001] e de albuminúria [135,0 (3,6-1816,0) vs 11,3 (1,5-5105,0) μg/min; P<0,001] quando comparados com pacientes sem RD avançada. A distribuição dos genótipos dos polimorfismos do ENNP1 e FABP2 não foi diferente entre os grupos. A análise de regressão logística múltipla demonstrou que a presença de nefropatia (OR=6,59; IC95%: 3,01-14,41; P<0,001) e o uso de insulina (OR=3,47; IC95%: 1,60- 7,50; P=0,002) foram os fatores associados à RD avançada, ajustados para a duração de DM, presença de hipertensão arterial, glicohemoglobina e IMC. Quando na análise foram incluídos apenas pacientes normoalbuminúricos e microalbuminúricos, a microalbuminúria (OR=3,8; IC95%: 1,38-10,47; P=0,010), o uso de insulina (OR=5,04; IC95%: 1,67-15,21; P=0,004), a duração do DM (OR=1,06 IC95%: 1,00-1,13; P=0,048) e a glicohemoglobina (OR=1,35; IC95%: 1,02-1,79; P=0,034) foram os fatores associados à RD avançada, ajustados para a presença de hipertensão arterial e IMC. Conclusão: Pacientes com DM tipo 2 portadores de formas avançadas de RD apresentam mais freqüentemente envolvimento renal pelo DM, incluindo o estágio de microalbuminúria. Uma avaliação renal com medida de albuminúria dever ser incorporada como avaliação de rotina nestes pacientes.

Os efeitos das reclamações online na lealdade dos consumidores: um estudo experimental

In an environment of constant change, technological developments, market competition and more informed consumers, the search for a lasting relationship through the conquest of loyalty has become the objective of companies. However, several authors suggest that this loyalty can be affected by negative comments available on the internet. Therefore, this dissertation has as objective to examine if the complaints are available on the internet impact the loyalty to a brand of mobile phone. The research used as the basis the Expanded NCSB model suggest by Johnson et al. (2001), studying five prominent drives of loyalty: image/brand reputation, affective commitment, calculative commitment, perceived value and trust, beyond the satisfaction construct as moderator variable. The research method adopted was the experimental design which included 285 undergraduate students, with the trial which included 285 undergraduate students, with the field study of the mobile industry, specifically, the brands of cell phones. The research approach was quantitative and methods were descriptive statistics, factor analysis, cluster analysis, linear regression and non-parametric test of Wilcoxon for data analysis. Of the 16 hypothesis stemmed from the research model proposed, 12 were confirmed. The results showed that the complaint available on the internet, here represented by the available on the site Reclame Aqui, may impact consumer perceptions about brand loyalty, as well as its antecedents, being that these complaints can affect all the consumers, regardless of historical satisfaction with the brand. It also noted the positive relationship between the independent variables trust, image/brand reputation, perceived value, affective commitment and calculative commitment and the dependent variable - loyalty, even when considering the data obtained after exposure to the complaint. However, no unanimous conclusion that the relationship between these variables was strongest in the group with satisfactory experience. At the first moment of the research, the trust was the most important variable for the formation of loyalty. However, after exposure to treatment, the image/brand reputation, was more relevant. Contributions of the study, limitations and recommendations for future researches are approached in the present investigation

Evaluation of two alternative methods for disinfection of toothbrushes and tongue scrapers

Objective: The aim of this study was to investigate the effectiveness of two alternatives methods for the disinfection of oral cleaning devices. Methods: One type of toothbrush and two types of tongue scrapers (steel and plastic) were tested in this study. Sixteen specimens of each group were cut with standardized dimensions, contaminated separately with Candida albicans, Streptococcus mutans and Staphylococcus aureus and incubated for 24 h. After this, oral cleaning devices were washed in saline solution to remove non-adhered cells and divided into two groups (n = 8), one irradiated in microwave and other immersed in 3.78% sodium perborate solution, and evaluated for microbial recovery. The values of cfu of each group of microorganism after disinfection were compared by Kruskal-Wallis and Dunn non-parametric test, considering 95% of confidence. Results: The toothbrush harboured a significant larger number of viable organisms than the tongue scrapers. The steel tongue scraper was less susceptible to adhesion of the three oral microorganisms. The time required to inactivate all contaminating microorganisms using microwave oven was 1 min and, for the immersion in 3.78% sodium perborate solution, was 2 and 3 h, respectively, for C. albicans and S. mutans/S. aureus. Conclusion: Microwave irradiation proved to be an effective alternative method to the disinfection of tongue cleaners and toothbrushes.

Progression of liver fibrosis in blood donors infected with hepatitis C virus

Background/Aims. Chronic hepatitis by HCV is progressive towards cirrhosis, with variable rate. We evaluated the rate of fibrosis progression (RFP), risk factors associated with advanced fibrosis (F3 and F4), and estimated the evolution time to cirrhosis. Methods. We transversely selected 142 blood donors infected only with HCV, with a known route of infection, submitted to liver biopsy at admission. RFP= ratio between stage of fibrosis (METAVIR)/estimated duration of infection in years. Non-parametric tests and logistic regression analysis, with significance level of 5% were used. Results. Median RFP was 0.086 U/year (0.05 - 0.142). Ten patients had F4 and 25 had F3. Median RFP values were significantly different (p=0.001) from one age group at contamination to the others and ALT and AST levels. There were no differences in the expected evolution to cirrhosis between intermediate fibrosers (F2) and the rapid fibrosers (F3 and F4). The independent variables associated with advanced fibrosis were ALT (OR 7.2) and GGT (OR 6.4) and age at inclusion (OR 1.12). Conclusion. This study suggests that RFP is extremely variable, it is exponential with age, and mainly influenced by host characteristics, especially age at contamination and possibly ethnical group. These asymptomatic patients had high percentage of fibrosis F2, F3 and F4.

Metodologia para determinar a relação dose-resposta de produtos fluoretados utilizando esmalte bovino e modelo de ciclagem de pH

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dental development of children and adolescents with cleft lip and palate

Aim: To evaluate the dental development of Brazilian children and adolescents with cleft lip and palate. Methods: The sample consisted of 107 panoramic radiographs of children and adolescents with cleft lip and/or palate (cleft group) and 107 panoramic radiographs of children and adolescents without cleft lip and/or palate (control group), with chronological ages ranging from 6 to 15 years, matched in gender and chronological age within 60 days. Radiographs were digitized and masked and dental age was assessed using the method described by Demirjian et al. (1973). Three trained examiners conducted the assessments. Each examiner evaluated the radiographs three times. Data were statistically analyzed using non-parametric tests and univariate linear regression (p<0.05). Results: The dental age was overestimated in relation to the chronological age in both groups (p<0.0001). Compared to the control group, there was a delay in the dental age in the cleft group of 0.17 years (2.1 months). However, no statistically significant difference in the dental age between the cleft and the control group was found even when considering the different cleft types (p=0.152). Conclusions: There was no statistically significant difference in the dental age between the cleft and the control groups. The evaluation of dental development in individuals with cleft lip and palate should be approached in the same way as in individuals without clefts, with a focus on the individualization of diagnosis and treatment planning.

Parametric Sensitivity Analysis of the Most Recent Computational Models of Rabbit Cardiac Pacemaking

The cellular basis of cardiac pacemaking activity, and specifically the quantitative contributions of particular mechanisms, is still debated. Reliable computational models of sinoatrial nodal (SAN) cells may provide mechanistic insights, but competing models are built from different data sets and with different underlying assumptions. To understand quantitative differences between alternative models, we performed thorough parameter sensitivity analyses of the SAN models of Maltsev & Lakatta (2009) and Severi et al (2012). Model parameters were randomized to generate a population of cell models with different properties, simulations performed with each set of random parameters generated 14 quantitative outputs that characterized cellular activity, and regression methods were used to analyze the population behavior. Clear differences between the two models were observed at every step of the analysis. Specifically: (1) SR Ca2+ pump activity had a greater effect on SAN cell cycle length (CL) in the Maltsev model; (2) conversely, parameters describing the funny current (If) had a greater effect on CL in the Severi model; (3) changes in rapid delayed rectifier conductance (GKr) had opposite effects on action potential amplitude in the two models; (4) within the population, a greater percentage of model cells failed to exhibit action potentials in the Maltsev model (27%) compared with the Severi model (7%), implying greater robustness in the latter; (5) confirming this initial impression, bifurcation analyses indicated that smaller relative changes in GKr or Na+-K+ pump activity led to failed action potentials in the Maltsev model. Overall, the results suggest experimental tests that can distinguish between models and alternative hypotheses, and the analysis offers strategies for developing anti-arrhythmic pharmaceuticals by predicting their effect on the pacemaking activity.

Climate change in Libya and desertification of Jifara Plain

The study was arranged to manifest its objectives through preceding it with an intro-duction. Particular attention was paid in the second part to detect the physical settings of the study area, together with an attempt to show the climatic characteristics in Libya. In the third part, observed temporal and spatial climate change in Libya was investigated through the trends of temperature, precipitation, relative humidity and cloud amount over the peri-ods (1946-2000), (1946-1975), and (1976-2000), comparing the results with the global scales. The forth part detected the natural and human causes of climate change concentrat-ing on the greenhouse effect. The potential impacts of climate change on Libya were ex-amined in the fifth chapter. As a case study, desertification of Jifara Plain was studied in the sixth part. In the seventh chapter, projections and mitigations of climate change and desertification were discussed. Ultimately, the main results and recommendations of the study were summarized. In order to carry through the objectives outlined above, the following methods and approaches were used: a simple linear regression analysis was computed to detect the trends of climatic parameters over time; a trend test based on a trend-to-noise-ratio was applied for detecting linear or non-linear trends; the non-parametric Mann-Kendall test for trend was used to reveal the behavior of the trends and their significance; PCA was applied to construct the all-Libya climatic parameters trends; aridity index after Walter-Lieth was shown for computing humid respectively arid months in Libya; correlation coefficient, (after Pearson) for detecting the teleconnection between sun spot numbers, NAOI, SOI, GHGs, and global warming, climate changes in Libya; aridity index, after De Martonne, to elaborate the trends of aridity in Jifara Plain; Geographical Information System and Re-mote Sensing techniques were applied to clarify the illustrations and to monitor desertifi-cation of Jifara Plain using the available satellite images MSS, TM, ETM+ and Shuttle Radar Topography Mission (SRTM). The results are explained by 88 tables, 96 figures and 10 photos. Temporal and spatial temperature changes in Libya indicated remarkably different an-nual and seasonal trends over the long observation period 1946-2000 and the short obser-vation periods 1946-1975 and 1976-2000. Trends of mean annual temperature were posi-tive at all study stations except at one from 1946-2000, negative trends prevailed at most stations from 1946-1975, while strongly positive trends were computed at all study stations from 1976-2000 corresponding with the global warming trend. Positive trends of mean minimum temperatures were observed at all reference stations from 1946-2000 and 1976-2000, while negative trends prevailed at most stations over the period 1946-1975. For mean maximum temperature, positive trends were shown from 1946-2000 and from 1976-2000 at most stations, while most trends were negative from 1946-1975. Minimum tem-peratures increased at nearly more than twice the rate of maximum temperatures at most stations. In respect of seasonal temperature, warming mostly occurred in summer and au-tumn in contrast to the global observations identifying warming mostly in winter and spring in both study periods. Precipitation across Libya is characterized by scanty and sporadically totals, as well as high intensities and very high spatial and temporal variabilities. From 1946-2000, large inter-annual and intra-annual variabilities were observed. Positive trends of annual precipi-tation totals have been observed from 1946-2000, negative trends from 1976-2000 at most stations. Variabilities of seasonal precipitation over Libya are more strikingly experienced from 1976-2000 than from 1951-1975 indicating a growing magnitude of climate change in more recent times. Negative trends of mean annual relative humidity were computed at eight stations, while positive trends prevailed at seven stations from 1946-2000. For the short observation period 1976-2000, positive trends were computed at most stations. Annual cloud amount totals decreased at most study stations in Libya over both long and short periods. Re-markably large spatial variations of climate changes were observed from north to south over Libya. Causes of climate change were discussed showing high correlation between tempera-ture increasing over Libya and CO2 emissions; weakly positive correlation between pre-cipitation and North Atlantic Oscillation index; negative correlation between temperature and sunspot numbers; negative correlation between precipitation over Libya and Southern Oscillation Index. The years 1992 and 1993 were shown as the coldest in the 1990s result-ing from the eruption of Mount Pinatubo, 1991. Libya is affected by climate change in many ways, in particular, crop production and food security, water resources, human health, population settlement and biodiversity. But the effects of climate change depend on its magnitude and the rate with which it occurs. Jifara Plain, located in northwestern Libya, has been seriously exposed to desertifica-tion as a result of climate change, landforms, overgrazing, over-cultivation and population growth. Soils have been degraded, vegetation cover disappeared and the groundwater wells were getting dry in many parts. The effect of desertification on Jifara Plain appears through reducing soil fertility and crop productivity, leading to long-term declines in agri-cultural yields, livestock yields, plant standing biomass, and plant biodiversity. Desertifi-cation has also significant implications on livestock industry and the national economy. Desertification accelerates migration from rural and nomadic areas to urban areas as the land cannot support the original inhabitants. In the absence of major shifts in policy, economic growth, energy prices, and con-sumer trends, climate change in Libya and desertification of Jifara Plain are expected to continue in the future. Libya cooperated with United Nations and other international organizations. It has signed and ratified a number of international and regional agreements which effectively established a policy framework for actions to mitigate climate change and combat deserti-fication. Libya has implemented several laws and legislative acts, with a number of ancil-lary and supplementary rules to regulate. Despite the current efforts and ongoing projects being undertaken in Libya in the field of climate change and desertification, urgent actions and projects are needed to mitigate climate change and combat desertification in the near future.

Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results

BACKGROUND: Peri-implantitis is common in patients with dental implants. We performed a single-blinded longitudinal randomized study to assess the effects of mechanical debridement on the peri-implant microbiota in peri-implantitis lesions. MATERIALS AND METHODS: An expanded checkerboard DNA-DNA hybridization assay encompassing 79 different microorganisms was used to study bacterial counts before and during 6 months following mechanical treatment of peri-implantitis in 17 cases treated with curettes and 14 cases treated with an ultrasonic device. Statistics included non-parametric tests and GLM multivariate analysis with p<0001 indicating significance and 80% power. RESULTS: At selected implant test sites, the most prevalent bacteria were: Fusobacterium nucleatum sp., Staphylococci sp., Aggregatibacter actinomycetemcomitans, Helicobacter pylori, and Tannerella forsythia. 30 min. after treatment with curettes, A. actinomycetemcomitans (serotype a), Lactobacillus acidophilus, Streptococcus anginosus, and Veillonella parvula were found at lower counts (p<0.001). No such differences were found for implants treated with the ultrasonic device. Inconsistent changes occurred following the first week. No microbiological differences between baseline and 6-month samples were found for any species or between treatment study methods in peri-implantitis. CONCLUSIONS: Both methods failed to eliminate or reduce bacterial counts in peri-implantitis. No group differences were found in the ability to reduce the microbiota in peri-implantitis.

Operator variability using different polishing methods and surface geometry of a nanohybrid composite

This study evaluated the operator variability of different finishing and polishing techniques. After placing 120 composite restorations (Tetric EvoCeram) in plexiglassmolds, the surface of the specimens was roughened in a standardized manner. Twelve operators with different experience levels polished the specimens using the following finishing/polishing procedures: method 1 (40 ?m diamond [40D], 15 ?m diamond [15D], 42 ?m silicon carbide polisher [42S], 6 ?m silicon carbide polisher [6S] and Occlubrush [O]); method 2 (40D, 42S, 6S and O); method 3 (40D, 42S, 6S and PoGo); method 4 (40D, 42S and PoGo) and method 5 (40D, 42S and O). The mean surface roughness (Ra) was measured with a profilometer. Differences between the methods were analyzed with non-parametric ANOVA and pairwise Wilcoxon signed rank tests (?=0.05). All the restorations were qualitatively assessed using SEM. Methods 3 and 4 showed the best polishing results and method 5 demonstrated the poorest. Method 5 was also most dependent on the skills of the operator. Except for method 5, all of the tested procedures reached a clinically acceptable surface polish of Ra?0.2 ?m. Polishing procedures can be simplified without increasing variability between operators and without jeopardizing polishing results.

A Decision-Tree-Based Approach to Smoke Spike Detection in a Heavy-Duty Diesel Engine

Smoke spikes occurring during transient engine operation have detrimental health effects and increase fuel consumption by requiring more frequent regeneration of the diesel particulate filter. This paper proposes a decision tree approach to real-time detection of smoke spikes for control and on-board diagnostics purposes. A contemporary, electronically controlled heavy-duty diesel engine was used to investigate the deficiencies of smoke control based on the fuel-to-oxygen-ratio limit. With the aid of transient and steady state data analysis and empirical as well as dimensional modeling, it was shown that the fuel-to-oxygen ratio was not estimated correctly during the turbocharger lag period. This inaccuracy was attributed to the large manifold pressure ratios and low exhaust gas recirculation flows recorded during the turbocharger lag period, which meant that engine control module correlations for the exhaust gas recirculation flow and the volumetric efficiency had to be extrapolated. The engine control module correlations were based on steady state data and it was shown that, unless the turbocharger efficiency is artificially reduced, the large manifold pressure ratios observed during the turbocharger lag period cannot be achieved at steady state. Additionally, the cylinder-to-cylinder variation during this period were shown to be sufficiently significant to make the average fuel-to-oxygen ratio a poor predictor of the transient smoke emissions. The steady state data also showed higher smoke emissions with higher exhaust gas recirculation fractions at constant fuel-to-oxygen-ratio levels. This suggests that, even if the fuel-to-oxygen ratios were to be estimated accurately for each cylinder, they would still be ineffective as smoke limiters. A decision tree trained on snap throttle data and pruned with engineering knowledge was able to use the inaccurate engine control module estimates of the fuel-to-oxygen ratio together with information on the engine control module estimate of the exhaust gas recirculation fraction, the engine speed, and the manifold pressure ratio to predict 94% of all spikes occurring over the Federal Test Procedure cycle. The advantages of this non-parametric approach over other commonly used parametric empirical methods such as regression were described. An application of accurate smoke spike detection in which the injection pressure is increased at points with a high opacity to reduce the cumulative particulate matter emissions substantially with a minimum increase in the cumulative nitrogrn oxide emissions was illustrated with dimensional and empirical modeling.

Similarities and differences between physician and non-physician acupuncturists in using diagnostic methods - an explorative study

Purpose: Acupuncture is one of the complementary medicine therapies with the greatest demand in Switzerland and many other countries in the West and in Asia. Over the past decades, the pool of scientific literature in acupuncture has markedly increased. The diagnostic methods upon which acupuncture treatment is based, have only been addressed sporadically in scientific journals. The goal of this study is to assess the use of different diagnostic methods in the acupuncture practices and to investigate similarities and differences in using these diagnostic methods between physician and non-physician acupuncturists. Methods: 44 physician acupuncturists with certificates of competence in acupuncture – traditional chinese medicine (TCM) from ASA (Assoziation Schweizer Ärztegesellschaften für Akupunktur und Chinesische Medizin: the Association of Swiss Medical Societies for Acupuncture and Chinese Medicine) and 33 non-physician acupuncturists listed in the EMR (Erfahrungsmedizinisches Register: a national register, which assigns a quality label for CAM therapists in complementary and alternative medicine) in the cantons Basel-Stadt and Basel-Land were asked to fill out a questionnaire on diagnostic methods. The responder rate was 46.8% (69.7% non-physician acupuncturists and 29, 5% physician acupuncturists). Results: The results show that both physician and non-physician acupuncturists take patients’ medical history (94%), use pulse diagnosis (89%), tongue diagnosis (83%) and palpation of body and ear acupuncture points (81%) as diagnostic methods to guide their acupuncture treatments. Between the two groups, there were significant differences in the diagnostic tools being used. Physician acupuncturists do examine their patients significantly more often with western medical methods (p<.05) than this is the case for nonphysician acupuncturists. Non-physician acupuncturists use pulse diagnosis more often than physicians (p<.05). A highly significant difference was observed in the length of time spent with collecting patients’ medical history, where nonphysician acupuncturists clearly spent more time (p<.001). Conclusion: Depending on the educational background of the acupuncturist, different diagnostic methods are used for making the diagnosis. Especially the more time consuming methods like a comprehensive anamnesis and pulse diagnosis are more frequently employed by non-physician practitioners. Further studies will clarify if these results are valid for Switzerland in general, and to what extent the differing use of diagnostic methods has an impact on the diagnosis itself and on the resulting treatment methods, as well as on the treatment success and the patients’ satisfaction.

Advantages and Applications of Transforming Empirical Model Input Space with Dimensional Models

Model-based calibration of steady-state engine operation is commonly performed with highly parameterized empirical models that are accurate but not very robust, particularly when predicting highly nonlinear responses such as diesel smoke emissions. To address this problem, and to boost the accuracy of more robust non-parametric methods to the same level, GT-Power was used to transform the empirical model input space into multiple input spaces that simplified the input-output relationship and improved the accuracy and robustness of smoke predictions made by three commonly used empirical modeling methods: Multivariate Regression, Neural Networks and the k-Nearest Neighbor method. The availability of multiple input spaces allowed the development of two committee techniques: a 'Simple Committee' technique that used averaged predictions from a set of 10 pre-selected input spaces chosen by the training data and the "Minimum Variance Committee" technique where the input spaces for each prediction were chosen on the basis of disagreement between the three modeling methods. This latter technique equalized the performance of the three modeling methods. The successively increasing improvements resulting from the use of a single best transformed input space (Best Combination Technique), Simple Committee Technique and Minimum Variance Committee Technique were verified with hypothesis testing. The transformed input spaces were also shown to improve outlier detection and to improve k-Nearest Neighbor performance when predicting dynamic emissions with steady-state training data. An unexpected finding was that the benefits of input space transformation were unaffected by changes in the hardware or the calibration of the underlying GT-Power model.