Anaemia may add information to standardised disease activity assessment to predict radiographic damage in rheumatoid arthritis: a prospective cohort study

OBJECTIVE: Anaemia in rheumatoid arthritis (RA) is prototypical of the chronic disease type and is often neglected in clinical practice. We studied anaemia in relation to disease activity, medications and radiographic progression. METHODS: Data were collected between 1996 and 2007 over a mean follow-up of 2.2 years. Anaemia was defined according to WHO (♀ haemoglobin<12 g/dl, ♂: haemoglobin<13 g/dl), or alternative criteria. Anaemia prevalence was studied in relation to disease parameters and pharmacological therapy. Radiographic progression was analysed in 9731 radiograph sets from 2681 patients in crude longitudinal regression models and after adjusting for potential confounding factors, including the clinical disease activity score with the 28-joint count for tender and swollen joints and erythrocyte sedimentation rate (DAS28ESR) or the clinical disease activity index (cDAI), synthetic antirheumatic drugs and antitumour necrosis factor (TNF) therapy. RESULTS: Anaemia prevalence decreased from more than 24% in years before 2001 to 15% in 2007. Erosions progressed significantly faster in patients with anaemia (p<0.001). Adjusted models showed these effects independently of clinical disease activity and other indicators of disease severity. Radiographic damage progression rates were increasing with severity of anaemia, suggesting a 'dose-response effect'. The effect of anaemia on damage progression was maintained in subgroups of patients treated with TNF blockade or corticosteroids, and without non-selective nonsteroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Anaemia in RA appears to capture disease processes that remain unmeasured by established disease activity measures in patients with or without TNF blockade, and may help to identify patients with more rapid erosive disease.

Systemic Determinants of the Information Systems Outsourcing Decision: A Comparative Study of German and United States Firms

The practice of information systems (IS) outsourcing is widely established among organizations. Nonetheless, evidence suggests that organizations differ considerably in the extent to which they deploy IS outsourcing. This variation has motivated research into the determinants of the IS outsourcing decision. Most of this research is based on the assumption that a decision on the outsourcing of a particular IS function is made independently of other IS functions. This modular view ignores the systemic nature of the IS function, which posits that IS effectiveness depends on how the various IS functions work together effectively. This study proposes that systemic influences are important criteria in evaluating the outsourcing option. It further proposes that the recognition of systemic influences in outsourcing decisions is culturally sensitive. Specifically, we provide evidence that systemic effects are factored into the IS outsourcing decision differently in more individualist cultures than in collectivist ones. Our results of a survey of United States and German firms indicate that perceived in-house advantages in the systemic impact of an IS function are, indeed, a significant determinant of IS outsourcing in a moderately individualist country (i.e., Germany), whereas insignificant in a strongly individualist country (i.e., the United States). The country differences are even stronger with regard to perceived in-house advantages in the systemic view of IS professionals. In fact, the direction of this impact is reversed in the United States sample. Other IS outsourcing determinants that were included as controls, such as cost efficiency, did not show significant country differences.

Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature

AIM Information regarding the selection procedure for selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP) is scarce. Therefore, the aim of this study was to summarize the selection criteria for SDR in children with spastic CP. METHOD A systematic review was carried out using the following databases: MEDLINE, CINAHL, EMBASE, PEDro, and the Cochrane Library. Additional studies were identified in the reference lists. Search terms included 'selective dorsal rhizotomy', 'functional posterior rhizotomy', 'selective posterior rhizotomy', and 'cerebral palsy'. Studies were selected if they studied mainly children (<18y of age) with spastic CP, if they had an intervention of SDR, if they had a detailed description of the selection criteria, and if they were in English. The levels of evidence, conduct of studies, and selection criteria for SDR were scored. RESULTS Fifty-two studies were included. Selection criteria were reported in 16 International Classification of Functioning, Disability and Health model domains including 'body structure and function' (details concerning spasticity [94%], other movement abnormalities [62%], and strength [54%]), 'activity' (gross motor function [27%]), and 'personal and environmental factors' (age [44%], diagnosis [50%], motivation [31%], previous surgery [21%], and follow-up therapy [31%]). Most selection criteria were not based on standardized measurements. INTERPRETATION Selection criteria for SDR vary considerably. Future studies should describe clearly the selection procedure. International meetings of experts should develop more uniform consensus guidelines, which could form the basis for selecting candidates for SDR.

Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies

Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.

Identifying observable criteria defining a critical situation involving football fans: an expert focus group study

Critical situations (CSs) involving football fans is a well-researched phenomenon with most studies examining factors leading to an escalation of violence (e.g. Braun & Vliegenthart, 2008). However, research so far has fallen short of analysing CSs that do not escalate (e.g. Hylander & Guvå, 2010) as well as establishing observable criteria that constitute such CSs. Granström et al. (2009), for instance, put forward a definition of a CS describing such situations as characterised by a discrepancy between peace and war-making behaviours between police and demonstrators. Still, this definition remains vague and does not provide concrete, defining criteria that can be identified on site. The present study looks beyond fans’ violent acts per se and focuses on these situations with a potentially – but not necessarily - violent outcome. The aim of this preliminary study is to identify observable criteria defining such a CS involving football fans. This focus group comprised of five experts working with football fans in the German-speaking area of Switzerland who discussed observable characteristics of a CS. Inductive content analysis led to the identification of specific criteria such as, “arrest of a fan”, “insufficient distance (<30m) between fans and police” and “fans mask themselves”. These criteria were then assigned to four phases of a CS highlighting the dynamic aspect of this phenomenon: Antecedents, Causes, Reactions, Consequence. Specifically, Causes, Reactions and Consequences are observable on site, while Antecedents include relevant, background information directly influencing a CS. This study puts forward a working definition of a CS that can facilitate the assessment of actual situations in the football context as well as for further research on fan violence prevention and control. These results also highlight similarities with studies investigating fan violence in other European countries while acknowledging unique characteristics of the Swiss German fan culture.

The use of social media to communicate child health information to low-income parents: A formative study

The Internet, and specifically web 2.0 social media applications, offers an innovative method for communicating child health information to low-income parents. The main objective of this study was to use qualitative data to determine the value of using social media to reach low-income parents with child health information. A qualitative formative evaluation employing focus groups was used to determine the value of using social media for dissemination of child health information. Inclusion criteria included: (1) a parent with a child that attends a school in a designated Central Texas school district; and (2) English-speaking. The students who attend these schools are generally economically disadvantaged and are predominately Hispanic. The classic analysis strategy was used for data analysis. Focus group participants (n=19) were female (95%); White (53%), Hispanic (42%) or African American (5%); and received government assistance (63%). Most had access to the Internet (74%) and were likely to have low health literacy (53%). The most preferred source of child health information was the family pediatrician or general practitioner. Many participants were familiar with social media applications and had profiles on popular social networking sites, but used them infrequently. Objections to social media sites as sources of child health information included lack of credibility and parent time. Social media has excellent potential for reaching low-income parents when used as part of a multi-channel communication campaign. Further research should focus on the most effective type and format of messages that can promote behavior change in this population, such as story-telling. ^

Evaluating the Utility of Clinical Criteria for the Identification of Lynch Syndrome among Endometrial Cancer Patients

Background: Lynch Syndrome (LS) is a familial cancer syndrome with a high prevalence of colorectal and endometrial carcinomas among affected family members. Clinical criteria, developed from information obtained from familial colorectal cancer registries, have been generated to identify individuals at elevated risk for having LS. In 2007, the Society of Gynecologic Oncology (SGO) codified criteria to assist in identifying women presenting with gynecologic cancers at elevated risk for having LS. These criteria have not been validated in a population-based setting. Materials and Methods: We retrospectively identified 412, unselected endometrial cancer cases. Clinical and pathologic information were obtained from the electronic medical record, and all tumors were tested for expression of the DNA mismatch repair proteins through immunohistochemistry. Tumors exhibiting loss of MSH2, MSH6 and PMS2 were designated as probable Lynch Syndrome (PLS). For tumors exhibiting immunohistochemical loss of MLH1, we used the PCR-based MLH1 methylation assay to delineate PLS tumors from sporadic tumors. Samples lacking methylation of the MLH1 promoter were also designated as PLS. The sensitivity and specificity for SGO criteria for detecting PLS tumors was calculated. We compared clinical and pathologic features of sporadic tumors and PLS tumors. A simplified cost-effectiveness analysis was also performed comparing the direct costs of utilizing SGO criteria vs. universal tumor testing. Results: In our cohort, 43/408 (10.5%) of endometrial carcinomas were designated as PLS. The sensitivity and specificity of SGO criteria to identify PLS cases were 32.7 and 77%, respectively. Multivariate analysis of clinical and pathologic parameters failed to identify statistically significant differences between sporadic and PLS tumors with the exception of tumors arising from the lower uterine segment. These tumors were more likely to occur in PLS tumors. Cost-effectiveness analysis showed clinical criteria and universal testing strategies cost $6,235.27/PLS case identified and $5,970.38/PLS case identified, respectively. Conclusions: SGO 5-10% criteria successfully identify PLS cases among women who are young or have significant family history of LS related tumors. However, a larger proportion of PLS cases occurring at older ages with less significant family history are not detected by this screening strategy. Compared to SGO clinical criteria, universal tumor testing is a cost effective strategy to identify women presenting with endometrial cancer who are at elevated risk for having LS.

Dominance Measuring Method Performance under Incomplete Information about Weights.

In multi-attribute utility theory, it is often not easy to elicit precise values for the scaling weights representing the relative importance of criteria. A very widespread approach is to gather incomplete information. A recent approach for dealing with such situations is to use information about each alternative?s intensity of dominance, known as dominance measuring methods. Different dominancemeasuring methods have been proposed, and simulation studies have been carried out to compare these methods with each other and with other approaches but only when ordinal information about weights is available. In this paper, we useMonte Carlo simulation techniques to analyse the performance of and adapt such methods to deal with weight intervals, weights fitting independent normal probability distributions orweights represented by fuzzy numbers.Moreover, dominance measuringmethod performance is also compared with a widely used methodology dealing with incomplete information on weights, the stochastic multicriteria acceptability analysis (SMAA). SMAA is based on exploring the weight space to describe the evaluations that would make each alternative the preferred one.

Dominance intensity methods for ranking of alternatives in mcdm with imprecise information

Los decisores cada vez se enfrentan a problemas más complejos en los que tomar una decisión implica tener que considerar simultáneamente muchos criterios que normalmente son conflictivos entre sí. En la mayoría de los problemas de decisión es necesario considerar criterios económicos, sociales y medioambientales. La Teoría de la Decisión proporciona el marco adecuado para poder ayudar a los decisores a resolver estos problemas de decisión complejos, al permitir considerar conjuntamente la incertidumbre existente sobre las consecuencias de cada alternativa en los diferentes atributos y la imprecisión sobre las preferencias de los decisores. En esta tesis doctoral nos centramos en la imprecisión de las preferencias de los decisores cuando éstas pueden ser representadas mediante una función de utilidad multiatributo aditiva. Por lo tanto, consideramos imprecisión tanto en los pesos como en las funciones de utilidad componentes de cada atributo. Se ha considerado el caso en que la imprecisión puede ser representada por intervalos de valores o bien mediante información ordinal, en lugar de proporcionar valores concretos. En este sentido, hemos propuesto métodos que permiten ordenar las diferentes alternativas basados en los conceptos de intensidad de dominación o intensidad de preferencia, los cuales intentan medir la fuerza con la que cada alternativa es preferida al resto. Para todos los métodos propuestos se ha analizado su comportamiento y se ha comparado con los más relevantes existentes en la literatura científica que pueden ser aplicados para resolver este tipo de problemas. Para ello, se ha realizado un estudio de simulación en el que se han usado dos medidas de eficiencia (hit ratio y coeficiente de correlación de Kendall) para comparar los diferentes métodos. ABSTRACT Decision makers increasingly face complex decision-making problems where they have to simultaneously consider many often conflicting criteria. In most decision-making problems it is necessary to consider economic, social and environmental criteria. Decision making theory provides an adequate framework for helping decision makers to make complex decisions where they can jointly consider the uncertainty about the performance of each alternative for each attribute, and the imprecision of the decision maker's preferences. In this PhD thesis we focus on the imprecision of the decision maker's preferences represented by an additive multiattribute utility function. Therefore, we consider the imprecision of weights, as well as of component utility functions for each attribute. We consider the case in which the imprecision is represented by ranges of values or by ordinal information rather than precise values. In this respect, we propose methods for ranking alternatives based on notions of dominance intensity, also known as preference intensity, which attempt to measure how much more preferred each alternative is to the others. The performance of the propose methods has been analyzed and compared against the leading existing methods that are applicable to this type of problem. For this purpose, we conducted a simulation study using two efficiency measures (hit ratio and Kendall correlation coefficient) to compare the different methods.

Analytical bearing capacity of strip footing in weightless materials with power-law failure criteria

Sokolovskii’s method of characteristics is extended to provide analytical solutions for the ultimate load at the moment of plastic failure under plane-strain conditions of shallow strip foundations on weightless rigid-plastic media with a noncohesive power-law failure envelope. The formulation is made parametrically in terms of the instantaneous friction angle, and the key idea to obtain the bearing capacity is that information can be transmitted from the free surface (where external loads are known) to the contact plane of the foundation. The methodology can consider foundations adjacent to a slope, external surcharges at the free surface, and inclined loads (both on the slope and on the foundation). Sensitivity analyses illustrate the influence on bearing capacity of changes in the different geometrical parameters involved. An application example is presented and design plots are provided, and model predictions are compared with results of bearing capacity tests under low gravity.

Exploring the economic value of personal information from firms' financial statements

Currently personal data gathering in online markets is done on a far larger scale and much cheaper and faster than ever before. Within this scenario, a number of highly relevant companies for whom personal data is the key factor of production have emerged. However, up to now, the corresponding economic analysis has been restricted primarily to a qualitative perspective linked to privacy issues. Precisely, this paper seeks to shed light on the quantitative perspective, approximating the value of personal information for those companies that base their business model on this new type of asset. In the absence of any systematic research or methodology on the subject, an ad hoc procedure is developed in this paper. It starts with the examination of the accounts of a number of key players in online markets. This inspection first aims to determine whether the value of personal information databases is somehow reflected in the firms’ books, and second to define performance measures able to capture this value. After discussing the strengths and weaknesses of possible approaches, the method that performs best under several criteria (revenue per data record) is selected. From here, an estimation of the net present value of personal data is derived, as well as a slight digression into regional differences in the economic value of personal information.

Criteria to determine seismic risk on sites. Application to Spanish dams

In this paper, the main steps necessary to evaluate the seismic risk on a site are discussed. Several examples from the authors practical experience are reported and a systematic procedure to study the seismic risk on a dam site is also shown. The characteristics of the available Spanish seismic information - mainly historical and non instrumental seismic records - are commented. Different types of seismic and geologic techniques to investigate the area under the dam are given. Finally, a probabilistic method to obtain from the given seismic intensities the design earthquake is summarized

The Zebrafish Information Network (ZFIN): a resource for genetic, genomic and developmental research

The Zebrafish Information Network, ZFIN, is a WWW community resource of zebrafish genetic, genomic and developmental research information (http://zfin.org). ZFIN provides an anatomical atlas and dictionary, developmental staging criteria, research methods, pathology information and a link to the ZFIN relational database (http://zfin.org/ZFIN/). The database, built on a relational, object-oriented model, provides integrated information about mutants, genes, genetic markers, mapping panels, publications and contact information for the zebrafish research community. The database is populated with curated published data, user submitted data and large dataset uploads. A broad range of data types including text, images, graphical representations and genetic maps supports the data. ZFIN incorporates links to other genomic resources that provide sequence and ortholog data. Zebrafish nomenclature guidelines and an automated registration mechanism for new names are provided. Extensive usability testing has resulted in an easy to learn and use forms interface with complex searching capabilities.

Tracing the Development of Athletes Using Retrospective Interview Methods: A Proposed Interview and Validation Procedure for Reported Information

A new interview procedure is proposed for collecting valid information on the acquisition of high-level performance in sport. The procedure elicits verifiable information on the development of athletes' achievements in their primary sport, as well as factors that might influence performance, including involvement in other sporting activities, injuries, physical growth and quality of training resources. Interviewed athletes also describe their engagement in specific training and other relevant activities during each year of their development as well as how they experienced each type of activity. The collected information is then examined to identify those aspects of the athletes' recall of their development that meet criteria of reliability and validity. Recommendations to coaches and scientists are discussed for how retrospective interviews can uncover aspects of development that distinguish elite from less accomplished athletes.