Mean Of Differences Research Articles

The role of glucagon-like peptide 1 in the postprandial effects of metformin in type 2 diabetes: a randomized crossover trial.

Although metformin is widely used for treatment of type 2 diabetes (T2D), its glucose-lowering mechanism remains unclear. Using the glucagon-like peptide 1 (GLP-1) receptor (GLP-1R) antagonist exendin(9-39)NH2, we tested the hypothesis that postprandial GLP-1-mediated effects contribute to the glucose-lowering potential of metformin in T2D. In a randomized, placebo-controlled, double-blind, crossover study, 15 individuals with T2D (median HbA1c 50 mmol/mol [6.7%], body mass index 30.1 kg/m2, age 71 years) underwent, in randomized order, 14 days of metformin and placebo treatment, respectively. Each treatment period was preceded by 14 days without any glucose-lowering medicine and concluded by two 4 h mixed meal tests performed in randomized order and separated by >24 h with either continuous intravenous exendin(9-39)NH2 or saline infusion. Compared to placebo, metformin treatment lowered fasting plasma glucose (mean of differences [MD] 1.4 mmol/L × min [95% CI 0.8-2.0]) as well as postprandial plasma glucose excursions during both saline infusion (MD 186 mmol/L × min [95% CI 64-307]) and exendin(9-39)NH2 infusion (MD 268 mmol/L × min [95% CI 108-427]). The metformin-induced improvement in postprandial glucose tolerance was unaffected by GLP-1R antagonization (MD 82 mmol/L × min [95% CI -6564-170]). Metformin treatment increased fasting plasma GLP-1 (MD 1.7 pmol/L × min [95% CI 0.39-2.9]) but did not affect postprandial GLP-1 responses (MD 820 pmol/L × min [95% CI -1750-111]). Using GLP-1R antagonization, we could not detect GLP-1-mediated postprandial glucose-lowering effect of metformin in individuals with T2D. We show that 2 weeks of metformin treatment increases fasting plasma GLP-1, which may contribute to metformin's beneficial effect on fasting plasma glucose in T2D. Trial registration: Clinicaltrials.gov NCT03246451.

ПРАВОВОЕ ОБЕСПЕЧЕНИЕ УПРАВЛЕНИЯ

In the second part of the article the author analyzes the emergence and expanse of the term “head of state”, the diffi culties involved by usage of the Russian collocation “head of state” and related word combinations, the chronological and spatial spread of the heads of states in various meanings. Besides, considering the conceptual plurality revealed in the fi rst part of the article, the problems of classifying heads of states are discussed. Based on the study of the listed issues, the article demonstrates the limitations of interlingual analogies, proposes an updated presentation of the features that characterize the head of state in its offi cial (representative) meaning, shows discreteness and locality of the phenomena denoted by the term “head of state”, identifies high risk of substituting a perfect classification of heads of state (as homogeneous phenomena) with a pseudo classifi cation that combines phenomena corresponding to the heads of state in diff erent meanings.

Respiratory Rate Estimation during Walking and Running Using Breathing Sounds Recorded with a Microphone.

Emerging evidence suggests that respiratory frequency (fR) is a valid marker of physical effort. This has stimulated interest in developing devices that allow athletes and exercise practitioners to monitor this vital sign. The numerous technical challenges posed by breathing monitoring in sporting scenarios (e.g., motion artifacts) require careful consideration of the variety of sensors potentially suitable for this purpose. Despite being less prone to motion artifacts than other sensors (e.g., strain sensors), microphone sensors have received limited attention so far. This paper proposes the use of a microphone embedded in a facemask for estimating fR from breath sounds during walking and running. fR was estimated in the time domain as the time elapsed between consecutive exhalation events retrieved from breathing sounds every 30 s. Data were collected from ten healthy subjects (both males and females) at rest and during walking (at 3 km/h and 6 km/h) and running (at 9 km/h and 12 km/h) activities. The reference respiratory signal was recorded with an orifice flowmeter. The mean absolute error (MAE), the mean of differences (MOD), and the limits of agreements (LOAs) were computed separately for each condition. Relatively good agreement was found between the proposed system and the reference system, with MAE and MOD values increasing with the increase in exercise intensity and ambient noise up to a maximum of 3.8 bpm (breaths per minute) and -2.0 bpm, respectively, during running at 12 km/h. When considering all the conditions together, we found an MAE of 1.7 bpm and an MOD ± LOAs of -0.24 ± 5.07 bpm. These findings suggest that microphone sensors can be considered among the suitable options for estimating fR during exercise.

Estimating ground reaction force with novel carbon nanotube-based textile insole pressure sensors.

This study presents a new wearable insole pressure sensor (IPS), composed of fabric coated in a carbon nanotube-based composite thin film, and validates its use for quantifying ground reaction forces (GRFs) during human walking. Healthy young adults (n = 7) walked on a treadmill at three different speeds while data were recorded simultaneously from the IPS and a force plate (FP). The IPS was compared against the FP by evaluating differences between the two instruments under two different assessments: (1) comparing the two peak forces at weight acceptance and push-off (2PK) and (2) comparing the absolute maximum (MAX) of each gait cycle. Agreement between the two systems was evaluated using the Bland-Altman method. For the 2PK assessment, the group mean of differences (MoD) was -1.3 ± 4.3% body weight (BW) and the distance between the MoD and the limits of agreement (2S) was 25.4 ± 11.1% BW. For the MAX assessment, the average MoD across subjects was 1.9 ± 3.0% BW, and 2S was 15.8 ± 9.3% BW. The results of this study show that this sensor technology can be used to obtain accurate measurements of peak walking forces with a basic calibration and consequently open new opportunities to monitor GRF outside of the laboratory.

Vliyanie russkoj literatury na literaturnoe tvorchestvo Kitaya XX – nachala XXI v.

The content of Russian literature is rich and diverse: the writings of diff erent historical epochs carry diff erent meanings and imprints. In the course of the development of the literary tradition of China, appeals to the literary heritage of Russia were oft en made. Russian literature acceptance process in China was extremely long, during which not only the content, but also the spirit of Russian culture was perceived, which infl uenced the formation of the image of Chinese literature. In this paper, an att empt is made to study the nature and features of the infl uence of Russian literature on the work of Chinese writers of the 20th century.

Dissociation between two-dimensional and three-dimensional echocardiography – clinical implications

Abstract Objectives To investigate the agreement between two-dimensional (2DE) and three-dimensional echocardiography (3DE) in a general population, along with clinical impact of the differences. Background Left ventricular ejection fraction (LVEF) has prognostic value and is used to guide cardiac treatment. The preferred technique is two-dimensional (2D) echo, although three-dimensional (3D) echo is more accurate when compared to MRI. Our study evaluates the agreement between 2D and 3D LVEF and the potential clinical impact of disagreements. Methods Study population ware participants from the Copenhagen City Heart Study, who underwent 2DE and 3DE between 2011–2014. Means of difference (MD) were assessed in participant groups with a LVEF below 40%, 40–50%, and above 50%. Age-adjusted Cox proportional hazard ratios (HR) were calculated for all-cause mortality, major adverse cardiovascular event (MACE) and cardiac event of any kind. Results In total 2554 participants from the Copenhagen City Heart Study were included. Median age was 58.3 (IQR: 44.2–69.8) years and 1137 (44.5%) were male. Mean LVEF in 2D was 56.6% (95% CI: 56.4–56.9%) and 52.0% (95% CI: 51.7–52.4%) in 3D, p<0.05. MD increased the further LVEF deteriorated: −14.9% (95% CI: −16.0 to −13.9%) (LVEF <40%), −9.3% (95% CI: −9.8 to −8.9%) (LVEF 40–50%) and −1.2% (95% CI: −1.6 to −0.9%) (LVEF ≥50%). 2DE overestimated the LVEF relative to 3D in 1824 (71.4%) instances. 3D LVEF <40% was associated with a HR for all-cause mortality of 2.58 (95% CI: 1.55–4.31, p<0.05), MACE: 1.90 (95% CI: 1.22–2.98, p<0.05) and cardiovascular event: 1.61 (95% CI: 1.04–2.48, p<0.05). HR for 2D LVEF <40% 0.84 (95% CI: 0.21–3.41, p=0.80) (all-cause), 3.12 (95% CI: 1.64–5.94, p<0.05) (MACE) and 2.68 (95% CI: 1.42–5.09, p<0.05) (cardiovascular event). Conclusion With declining LVEF, 2D echo is prone to significantly overestimate LVEF and a 3D LVEF less than 40% is associated with excess all-cause mortality but less with MACE and cardiovascular events when compared to 2D LVEF. Funding Acknowledgement Type of funding sources: None.

Effects produced by the facemask with and without skeletal anchorage for the orthopaedic treatment of Class III malocclusion in growing patients: a systematic review and meta-analysis of RCTs.

Skeletally anchored facemask has been proposed to maximize skeletal effects and minimize dental effects in the treatment of Class III malocclusion in growing patients. To compare the dento-skeletal effects produced by the facemask with or without skeletal anchorage for the treatment of Class III malocclusion in growing patients. PubMed, Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey were used for the electronic search without language, publication status, and year restrictions. Only RCTs were included. Inclusion criteria were: growing patients (age under 18 years) with Class III malocclusion, with indications for treatment with the facemask. Data were extracted by two independent reviewers. GRADE statement was executed. The mean of differences (MD) and the risk ratio (RR) were used. Three articles with a total of 123 patients were included. One article was at low risk of bias while two were at high risk of bias. There were no significant differences between the two groups in ANB angle, Wits appraisal, SNB angle, and SN-MP angle. SNA angle was significantly increased in the skeletally anchored facemask (pooled MD = 0.80 favouring skeletal anchorage, 95% CI from 0.29 to 1.31, P = 0.002, I2 = 12 per cent, three studies, GRADE moderate). The U1-SN angle was significantly reduced in the skeletally anchored facemask (pooled MD = -5.91 favouring skeletal anchorage, 95% CI from -7.64 to -4.27, P < 0.00001, I2 = 0 per cent, two studies, GRADE moderate). There were significantly less complications in tooth-anchored facemask (pooled RR = 7.98 favouring dental anchorage, 95 per cent CI from 1.04 to 61.27, P = 0.05, I2 = 0 per cent, two studies, GRADE low). Few RCTs (three) were included, and two studies were at high risk of bias. There were no long-term RCTs comparing skeletally anchored facemask with dental-anchored facemask. Only Asiatic patients were included in this systematic review. Skeletally anchored facemask was associated to a greater increase of SNA angle at the end of treatment though clinically not significant. Facemask with skeletal anchorage determined a reduced inclination of maxillary incisors compared to dental-anchored facemask with greater risks of complications. PROSPERO register (CRD42020221982).

First play about the railway

The article considers the first essay in Russian literature in which the image of the railway appears. We will talk about the comedy-vaudeville P.S. Fedorov “A Trip to Tsarskoye Selo by Rail” (1838). In the future, this image became one of the key in Russian culture at the turn of the 19th–20th centuries, writers such as L. Tolstoy, Nekrasov, Kuprin, Leskov and others addressed it, endowing it with diff erent meanings — from positive to sharply negative and all the more interesting to learn about the origins of its occurrence. The author of the article concludes that in Fedorov’s comedy, the railway is a locus that determines the plot of the play and the happy resolution of the conflict. In general, the railway is considered by the author of vaudeville as a miracle and a great achievement of progress, and almost every character in the play utters praise words to her. Attention is also paid to the figure of the author of the play, Pavel S. Fedorov, one of the largest playwrights and translators, who for 26 years led the repertoire of the St. Petersburg theaters, whose work was forgotten in the 21st century. The facts outlined in the article may be useful for interdisciplinary connections in the lessons of history and literature, as well as special disciplines for future railway workers.

The variability of 2D and 3D transthoracic echocardiography applied in a general population : Intermodality, inter- and intraobserver variability.

Assessment of the left ventricular (LV) function by three-dimensional echocardiography (3DE) is potentially superior to 2D echo echocardiography (2DE) for LV performance assessment. However, intra- and interobserver variation needs further investigation. We examined the intra- and interobserver variability between 2 and 3DE in a general population. In total, 150 participants from the Copenhagen City Heart Study were randomly chosen. Two observers assessed left ventricular ejection fraction (LVEF), end-diastolic (EDV) and end-systolic volumes (ESV) by 2DE and 3DE. Inter-, intraobserver and intermodality variabilities are presented as means of difference (MD), limits of agreement (LoA), coefficient of correlation (r), intraclass correlation coefficients (ICC). The lowest MD and LoA and highest r- and ICC-values was generally seen among the 3D acquisitions, with the 3D EDV interobserver as the best performing estimate (r = 0.95, ICC = 0.94). The largest MD, LoA and lowest r- and ICC-values was found in the interobserver 2D LVEF (r = 0.76, ICC = 0.63. For the intraobserver analysis, there were statistically significant differences between observations for all but 3DE EDV (p = 0.06). For interobserver analysis, there were statistically significant differences between observers for all estimates but 2DE EDV (p = 0.11), 3D ejection fraction (p = 0.9), 3DE EDV (p = 0.11) and 3D ESV (p = 0.15). Three-dimensional echocardiography is more robust and reproducible than 2DE and should be preferred for assessment of LV function.

Technology-based tobacco cessation training in Indian context.

In tobacco use disorders (TUDs), technology-based training of health-care professionals can reduce the treatment gap and bring attitudinal change. The study aimed to assess the practices and determine the change in knowledge and attitude among health-care professionals following an online training program (OTP). Half-day OTP on tobacco cessation using prepost quasi-experimental study design with a structured questionnaire-based assessment was conducted. Among 293 completed surveys, knowledge post-OTP was higher but insignificant (P = 1.2). Post-OTP, participants felt less angry and disappointed toward tobacco users (mean of difference (MOD) =0.21, P = 0.0007); more sympathetic and concerned (MOD = -0.22, P = 0.0005); and acknowledged tobacco users deserve the same medical care as nonusers (MOD = -0.177, P = 0.001). Post-OTP scores in attitudes did not change significantly for the responsibility domain (P < 0.05). In practice, relatively greater number of health-care professionals asked about tobacco use and advised cessation, however lesser assessed, assisted, and referred. To conclude, technology-based training program can result in attitudinal changes toward tobacco users.

Infrared thermographic assessment of spinal anaesthesia-related cutaneous temperature changes during caesarean section

IntroductionAssessment of adequacy of spinal anaesthesia, prior to obstetric surgery is extremely important but can be problematic because currently available clinical assessment methods are indirect and subjective. As the sympathectomy associated with spinal anaesthesia is known to cause vasodilation and heat redistribution, we sought to assess whether spinal anaesthesia led to significant and consistent cutaneous temperature changes as measured by infrared thermography. MethodsFollowing ethics committee approval, this observational study was conducted in a tertiary level obstetric centre. Participants included women undergoing elective caesarean section under spinal anaesthesia. Following consent, a Flir T540 infrared camera captured thermographic images over the feet, patella, buttock, iliac crests, xiphisternum and axilla. Temperature was measured prior to spinal needle insertion (T0) and following clinical assessment when the block was deemed adequate. ResultsThirty patients were included. Baseline temperature varied considerable by site. Spinal anaesthesia altered skin temperature in all areas of interest: right and left hallux (mean of differences (MD) +4.0°C and 5.2°C respectively, P <0.0001), right and left plantar (MD +6.1°C and 6.8°C respectively, P <0.0001), patella (MD −0.33°C, P=0.0445), buttock (MD −0.5°C, P=0.009), iliac crest (MD −0.7°C, P=0.0004), xiphisternum (MD −0.95°C, P <0.0001) and axilla (MD −0.71°C, P=0.0002). ConclusionsFollowing spinal anaesthesia thermographic imaging identified different patterns of skin temperature changes, with pronounced temperature increases measured in the feet and cooling of a lesser amplitude in the thoracic and lumbar dermatomes. Infrared thermography has the potential to provide objective measurement of sympathectomy.

Reliability of a New Semi-automatic Image Analysis Method for Evaluating the Doppler Signal and Intratendinous Vascular Resistance in Patellar Tendinopathy.

The aim of this study was to determine the intra- and inter-rater reliability of a new semi-automatic image analysis method for quantification of the shape of the Doppler signal and the intratendinous vascular resistance in patellar tendinopathy. Thirty athletes (27.4 y, standard deviation=8.57 y) with patellar intratendinous vascularity were included in a cross-sectional study (42 tendons analyzed). The intratendinous blood flow was assessed with power Doppler and ImageJ (Version 1.50b, National Institutes of Health, Bethesda, MD, USA) quantification software over a manually selected region of interest. Two blinded observers performed the analysis of the Doppler signal (vascular resistance) and shape descriptors (number of signals, pixel intensity, area, perimeter, major diameter, minor diameter, circularity and solidity). The intraclass correlation coefficient (ICC) was calculated, and the Bland-Altman mean of differences (MoD) and 95% limits of agreement (LoA) were determined. Also, small real differences (SRDs) and the standard error of measurement (SEM) were calculated. Intra-rater reliability was at a maximum for area (ICC=0.999, 95% confidence interval [CI]=0.998-0.999) and at a minimum for solidity (ICC=0.782, 95% CI: 0.682-0.853). The MoD and 95% LoA were very low, and the relative SRD and SEM were below 5.3% and 2%, respectively. The inter-rater reliability was the maximum for area (ICC=0.993, 95% CI=0.989-0.996) and the minimum for circularity (ICC=0.73; 95% CI=0.611-0.817). The MoD and 95% LoA were low, with the SRD and SEM below 6% and 2.2%. The proposed quantitative method for studying the intratendinous Doppler signal in the patellar tendon is reliable and reproducible.

Validity Analysis of WalkerViewTM Instrumented Treadmill for Measuring Spatiotemporal and Kinematic Gait Parameters.

The detection of gait abnormalities is essential for professionals involved in the rehabilitation of walking disorders. Instrumented treadmills are spreading as an alternative to overground gait analysis. To date, the use of these instruments for recording kinematic gait parameters is still limited in clinical practice due to the lack of validation studies. This study aims to investigate the performance of a multi-sensor instrumented treadmill (i.e., WalkerViewTM, WV) for performing gait analysis. Seventeen participants performed a single gait test on the WV at three different speeds (i.e., 3 km/h, 5 km/h, and 6.6 km/h). In each trial, spatiotemporal and kinematic parameters were recorded simultaneously by the WV and by a motion capture system used as the reference. Intraclass correlation coefficient (ICC) of spatiotemporal parameters showed fair to excellent agreement at the three walking speeds for steps time, cadence, and step length (range 0.502–0.996); weaker levels of agreement were found for stance and swing time at all the tested walking speeds. Bland–Altman analysis of spatiotemporal parameters showed a mean of difference (MOD) maximum value of 0.04 s for swing/stance time and WV underestimation of 2.16 cm for step length. As for kinematic variables, ICC showed fair to excellent agreement (ICC > 0.5) for total range of motion (ROM) of hip at 3 km/h (range 0.579–0.735); weaker levels of ICC were found at 5 km/h and 6.6 km/h (range 0.219–0.447). ICC values of total knee ROM showed poor levels of agreement at all the tested walking speeds. Bland–Altman analysis of hip ROM revealed a higher MOD value at higher speeds up to 3.91°; the MOD values of the knee ROM were always higher than 7.67° with a 60° mean value of ROM. We demonstrated that the WV is a valid tool for analyzing the spatiotemporal parameters of walking and assessing the hip’s total ROM. Knee total ROM and all kinematic peak values should be carefully evaluated, having shown lower levels of agreement.

Effects of a standardized distraction on caregivers' perceptive performance with avatar-based and conventional patient monitoring: a multicenter comparative study.

Patient monitoring requires constant attention and may be particularly vulnerable to distractions, which frequently occur during perioperative work. In this study, we compared anesthesia providers' perceptive performance and perceived workload under distraction for conventional and avatar-based monitoring, a situation awareness-based technology that displays patient status as an animated patient model. In this prospective, multicenter study with a within-subject design, 38 participants evaluated scenarios of 3- and 10-s durations using conventional and avatar-based monitoring, under standardized distraction in the form of a simple calculation task. We quantified perceptual performance as the number of vital signs correctly remembered out of the total of 11 vital signs shown. We quantified perceived workload using the National Aeronautics and Space Administration Task Load Index score. Anesthesia providers remembered more vital signs under distraction using the avatar monitoring technology in the 3-s scenario: 6 (interquartile range [IQR] 5-7) vs. 3 (IQR 2-4), p < 0.001, mean of differences (MoD): 3 (95% confidence interval [95% CI] 1 to 4), and in the 10-s monitoring task: 6 (IQR 5-8) vs. 4 (IQR 2-7), p = 0.028, MoD: 1 (95% CI 0.2 to 3). Participants rated perceived workload lower under distraction with the avatar in the 3-s scenario: 65 (IQR 40-79) vs. 75 (IQR 51-88), p = 0.007, MoD: 9 (95% CI 3 to 15), and in the 10-s scenario: 68 (IQR 50-80) vs. 75 (IQR 65-86), p = 0.019, MoD: 10 (95% CI 2 to 18). Avatar-based monitoring improved anesthesia providers' perceptive performance under distraction and reduced perceived workload. This technology could help to improve caregivers' situation awareness, especially in high-workload situations.

Repeatability and Reproducibility of Virtual Subjective Refraction.

To establish the repeatability and reproducibility of a virtual refraction process using simulated retinal images. With simulation software, aberrated images corresponding with each step of the refraction process were calculated following the typical protocol of conventional subjective refraction. Fifty external examiners judged simulated retinal images until the best sphero-cylindrical refraction and the best visual acuity were achieved starting from the aberrometry data of three patients. Data analyses were performed to assess repeatability and reproducibility of the virtual refraction as a function of pupil size and aberrometric profile of different patients. SD values achieved in three components of refraction (M, J0, and J45) are lower than 0.25D in repeatability analysis. Regarding reproducibility, we found SD values lower than 0.25D in the most cases. When the results of virtual refraction with different pupil diameters (4 and 6 mm) were compared, the mean of differences (MoD) obtained were not clinically significant (less than 0.25D). Only one of the aberrometry profiles with high uncorrected astigmatism shows poor results for the M component in reproducibility and pupil size dependence analysis. In all cases, vision achieved was better than 0 logMAR. A comparison between the compensation obtained with virtual and conventional subjective refraction was made as an example of this application, showing good quality retinal images in both processes. The present study shows that virtual refraction has similar levels of precision as conventional subjective refraction. Moreover, virtual refraction has also shown that when high low order astigmatism is present, the refraction result is less precise and highly dependent on pupil size.

The interpretation of the mind and the anticipation of nature in Bacon’s «Novum Organum»

Th e F. Bacon’s work “Novum Organum” contains a certain amount of terminological inaccuracies and some of them should be considered closely. Some terms mentioned in this work are defi ned insuffi ciently or not defi ned at all, therefore they have several meanings which cannot be reduced to each other. It’s necessary to fi nd diff erent meanings of such concepts as “nature”, “mind”, “understanding”, “reasoning” and to reveal their positive and precise content. Th e meanings of these concepts will be discovered in the text of Th e Novum Organum by method explained in this work. By consistent realization of F. Bacon’s method and by drawing up tables of presence, absence and degrees, we will proceed to gathering the results and we will discover three natures. First one is the nature which develops and off ers the method. Second nature is considered wrong and therefore should be eliminated. Th ird nature should imply the method; its task is to eliminate the second one or to keep the second nature out of the active actions. Th ere is no doubt that all these three natures are closely connected, but they are not identical. Th eir connection is carried out within the wrong nature, which is analyzed in the most well-known passages from Th e Novum Organum about four types of idles. Eventually, it will be clear that F. Bacon, who understood perfectly his main task of describing and demonstrating a new method, has unconsciously come to the origins of absolutely new issue. Th is issue is the subject of thinking which subsequently will be the main concern of Modern philosophers. Also, the article shows the insuffi ciency of induction method for considering the nature of this new object of philosophy. Refs 4.

Statistical modeling and verification for the synthesis of median survival time in multilevel meta-analysis of survival data

Objective: Past meta-analyses of survival data have been over simplistic because of restricting to proportional hazard model, lackof intuitive results, and potential omitting information. These had the potential to recommend sub-optimal policies. Here wedevelop multilevel methods for combining median survival times (MSTs) for meta-analysis of survival data.Methods: We used simulated data to test and verify the synthesis model we developed. We generated the study-level data to fit multilevel model and individual patient data to calculate gold standard. We then used the Bland-Altman method and the relativechange from the gold standard to evaluate the fit of the models. Examples were presented in a meta-analysis to illustrate the feasibility of the models.Results: We generated eight sets of simulated datasets of different number of studies and sample size. We established themulti-level fixed and random effect models to pool the MSTs. The test of the fitness of the model showed that the means ofdifference (d) for all simulated datasets between the calculated values and the gold standards are no more than -0.230 and -0.329days and the largest 95% CIs of d are -3.823 3.364 and -3.936 3.278 days respectively. At least 91.9% and 92.3% of the difference between the estimated values and the gold standards are small. The real examples of a meta-analysis were provided with combined MSTs along with pooled HR.Conclusions: The multilevel models of synthesizing MSTs in survival data AD meta-analysis were verified with good fitting effects and provide more intuitive information.

MIRROR EPISTEMOLOGICAL AND COMPOSITIONAL CAPACITIES IN THE FORMATION OF PICTURE SURFACE SPACE

In this article mirror pictorial and compositional capacities on a picture surface and connected with them processes of visual culture and visual way of thinking formation are viewed. Functional characteristics of mirror surface in the context of a piece of art are defi ned. An additional plane of projection multiplying points of perception highlights cognitive aspect of an image. It is noted that in communication process a piece of art containing refl ective surfaces gives to audience the intention to open new reality, underlying space that proposes diff erent meanings but keep a distance.

Clinical faculty members in the schools of education in the united states: an overview

In the United States of America, the term “clinical faculty” has been used to define diff erent positions academic personnel hold in various fields and job sett ings. Although it possesses diff erent meanings, the main argument is that the clinical faculty position in general, is designated to bring practical knowledge and expertise to the professional schools by filling the gap between theory and practice. Schools of education, as in other professional schools, also off er this type of clinical faculty position to provide practical knowledge to their students who will need it in their future lives as teachers, administrators and practitioners. Th is study aims to discuss the future of clinical faculty in schools of education through analyzing the position, in terms of job specifications, eff ectiveness, job requirements, personnel rights and the issues this category of faculty encounters in a cross comparative way across the fields of education, law and medicine. One of the main recommendations of the paper is that the future of clinical faculty should be secured through creating a clinical – tenure - track faculty positions in schools of education as in other professional schools instead of keeping them under the general appointment and promotion rules and regulations with the other faculty members. In this way, both the clinical faculty members’ problems related to job security, compensation, and promotion and non-clinical faculty members’ concerns related to quality will be resolved.

Regions and regionalism

It is notoriously diffi cult to defi ne the region. It is a territorial space, certainly, so we can exclude virtual spaces from our consideration, but it can take a number of territorial confi gurations. There is a conventional but still useful distinction between substate regionalism, studied traditionally by geographers, planners, sociologists, political scientists and historians, and supra-state regions, studied by other geographers and in international relations and strategic studies. Economists may make use of both. A third conception is the transnational region, which cuts across the boundaries of states, taking in some but not all of the territory or more than one political community. All these meanings, however, are relative to the nation-state, being above, below, or across it but not questioning its standing as the authoritative defi ner of territorial boundaries. Most of them also unproblematically use the term “nation-state” to defi ne both a sovereign polity and one in which state and nation coincide, although in plurinational polities these are quite diff erent meanings.