High Level Of Standardization Research Articles

A quantitative methodology to evaluate thermal bridges in buildings

The use of multi-layer walls with high thermal resistance values is widely used to reduce heat losses in buildings during wintertime. Nevertheless, it is extremely important to treat also weaker components of the envelope such as doors, windows and all the various thermal bridges, otherwise the efforts in increasing walls thermal resistance can be vanished.If the improvement of the thermal performance of windows and doors has reached a significant development and a high level of standardization, the same is not true for the corrections related to thermal bridges, which therefore require a specific analysis in the design phase.Thermal bridges, of whatever nature, are therefore a crucial point in the energy analysis of the building envelope. The analysis on existing constructions can be performed on site with thermographic techniques that describe in first approximation the qualitative energy performance of the building and put in evidence the main heat losses.The paper proposes a methodology to perform a quantitative analysis of some types of thermal bridges, through simple thermographic surveys and subsequent analytical processing. From the simple measurement of the air temperature and the analysis of the thermogram, the thermal bridge effect can be estimated as a percentage increase of the homogenous wall thermal transmittance. This term is obtained without further information on the structure of both the thermal bridge and the stratigraphy of the wall.The analytical methodology – which was validated with experimental and numerical analyses – is described and the results of surveys on different types of thermal bridges are reported. This method represents a quick and effective tool to define the actual heat loss of high-insulation buildings and to evaluate the benefits in treating thermal bridges.

A Flexible Database Architecture for Mining DICOM Objects: the DICOM Data Warehouse

Digital Imaging and Communications in Medicine (DICOM) has brought a very high level of standardization to medical images, allowing interoperability in many cases. However, there are still challenges facing the informaticist attempting to data mine DICOM objects. Images (and other objects) from different vintage equipment will encompass different levels of the standard, and there are also proprietary "shadow" tags to be aware of. The database architecture described herein "flattens" such differences by compiling a knowledge base of specific DICOM implementations and mapping variable data elements to a common lexicon for subsequent queries. The project is open sourced, built on open infrastructure, and is available at GitHub.

Treatment Integrity: An Unresolved Issue in Psychotherapy Research

Background: Treatment integrity is defined as the extent to which a treatment is carried out as intended. It includes several interrelated components (e.g. therapy adherence, therapist competence and therapy differentiation). Treatment integrity is regarded to play an essential role in psychotherapy outcome research. Objective: This article discusses (1) conceptual aspects, (2) empirical results and (3) methodological problems of research on treatment integrity. Results: (1) Therapy integrity refers to different aspects of experimental validity. It is usually discussed with regard to internal validity. Maybe even more important, however, treatment integrity also refers to construct validity. Treatment integrity is also related to external validity and validity of statistical conclusions. (2) Results for the relationship between treatment integrity (adherence to a treatment model and competent delivery of techniques) and outcome are heterogeneous and suggest that the relationship between outcome and treatment integrity is not yet clear. Even in studies which found a relationship between treatment integrity and outcome, the proportion of variance explained by intended techniques was between 10% and 30%. Thus, the majority of variance was not explained by intended techniques. (3) Methodological problems may contribute to the lack of consistent results. As most results come from randomized controlled efficacy studies, the ranges of data for both outcome and adherence/competence may be restricted by the selection of patients and therapists, as well as by training of therapists, manualization and monitoring of treatment. These factors attenuate the association between treatment integrity and outcome. Other factors that may contribute to the inconsistent results are unreliability of measures, instability of adherence and competence during the process of psychotherapy or nonlinear relationships between treatment integrity and outcome. Conclusions: Further studies are required that address the relationship between adherence, competence and outcome, especially for those methods of psychotherapy that were shown to be effective in a particular disorder. Factors that moderate or mediate the relationship between outcome and therapy integrity should be included. Due to their high level of standardization, randomized controlled efficacy studies seem to be only of limited use to study the relationship between treatment integrity and outcome. The recent shift from a single-disorder focus of the traditional manualized interventions to transdiagnostic, modular and component-based interventions may lead to a change in the conceptualization of treatment integrity. It allows for a more flexible use of interventions while maintaining treatment integrity. This shift may both enhance the external validity of studies using manualized treatments and lead to more consistent results regarding the relationship between treatment integrity and outcome.

Can we improve the reliability of the Constant-Murley score?

The Constant-Murley score (CMS) is one of the most used scales for shoulder dysfunction. The aim of this study is to determine whether the reliability of the CMS can be improved by enhancing the standardization of the items. Two consecutive series of 55 patients with shoulder dysfunction were enrolled in a test-retest study and examined by 2 orthopedic surgeons with different levels of expertise. The following scores were measured: CMS, individual relative CMS, relative CMS, and standardized CMS. For each variable, the intraobserver and interobserver reliability was calculated. The less experienced observer had worse intraobserver reliability using the CMS (error, 4 points; 95% limit of agreement, 22) than the expert observer (error, 2.4 points; 95% limit of agreement, 16). The standardized CMS showed better intraobserver reliability, with an error of 0.4 points and 95% limits of agreement of 9 for the expert observer and 13 for the less experienced observer. The correction against the contralateral unaffected side and the reference population determined a worsening of reliability in both observers. Interobserver reliability showed an improvement similar to that of intraobserver reliability (systematic error, 4; 95% limit of agreement, 24) by use of the CMS and improved to 1 point when the standardized CMS was adopted (95% limit of agreement, 12). This study showed that the standardization of the items significantly improved both the intraobserver reliability and interobserver reliability of the CMS. The level of expertise of the observer has less of an effect on reliability when the score is applied with a higher level of standardization.

Examining the determinants of hotel chain expansion through international franchising

This study proposes and tests an agency-based organizational model of internationalization through franchising in the hotel sector. Using data obtained from a Franchisor Questionnaire 2001–2008, we analyzed a panel of 117 observations of 17 U.S.-based hotels. Our analysis reveals that a hotel franchisor's decision to internationalize through franchising is positively related to the percentage of franchises, the ratio of franchised units to the total number of units. The article contributes to the literature by empirically modeling international franchising of hotels, which present unique characteristics among franchising companies, with a high investment capital requirement, maturity in the product life cycle, and a high level of standardization and globalization of operations. The unique characteristics of individual chains and their segment in the industry are particularly important, as revealed by both data analysis and expert opinion.

The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials

Cognitive stimulation, training or rehabilitation can achieve modest, skill-specific gains in cognitively healthy older adults. With regard to the limited efficacy of currently available anti-dementia drugs it is crucial to investigate whether such treatments also provide clinically meaningful benefits to cognitively impaired older individuals. We conducted a systematic review of randomized controlled trials evaluating cognition-focused interventions in participants with mild cognitive impairment or dementia. Meta-analytic strategies were used to calculate effect sizes. Cognition-focused interventions confer small and inconsistent effects on trained cognitive skills which, according to some studies, translate into gains on general cognitive ability. Instruments measuring such effects such as the Mini-Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale, cognitive part (ADAS-Cog) show standardized mean differences of 0.20 and 0.30, respectively, which are comparable with those of current antidementia drug treatments. However, convincing evidence of clinical significance was only obtained from single trials in terms of delay of cognitive decline, improvement in activities of daily living, or enhanced attainment of personally relevant goals. The potential of cognition-focused interventions has probably been obscured by the methodological inconsistencies and limitations of the clinical studies conducted thus far. Further randomized controlled trials on the efficacy of these treatment modalities are required using optimized and consistent methods. Emphasis should be placed on tailoring interventions to individual needs and resources while maintaining a high level of standardization, on implementing newly acquired skills and strategies in the everyday context, on appropriate treatment duration, and on including person-centered outcomes.

Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections

Pancreatic surgery is a technically challenging intervention with high demands for preoperative diagnostics and perioperative management. A perioperative mortality rate below 5% is achieved in high-volume centers due to the high level of standardization in surgical procedures and perioperative care. Besides standard resections, certain indications may require individualized surgical concepts such as tumor enucleations. The aim of the study was to evaluate the indications, technique, and outcome of this limited local approach compared to major resections. Data from patients undergoing pancreatic surgery were prospectively recorded. All patients with tumor enucleations were compared with classical resections (pancreaticoduodenectomy or left resection) in a matched-pair analysis (1:2). Tumor type, localization, operative parameters, complications, and outcome were evaluated. Fifty-three patients underwent pancreatic tumor enucleation between October 2001 and December 2009. Indications included cystic lesions, IPMNs, and neuroendocrine pancreatic tumors. Enucleations were associated with shorter operation time, less blood loss as well as shorter ICU and hospital stay compared to pancreaticoduodenectomy and left resections. The overall surgical morbidity of enucleations was 28.3% without major complications. Leading clinical problems were ISGPF type A fistulas (20.8%) requiring prolonged primary drainage. No surgical revisions were necessary, and no deaths occurred. Pancreatic tumor enucleations can be carried out with good results and no mortality. Decisions regarding enucleations are highly individual compared to standard resections, underlining the importance of treatment in experienced high-volume institutions. Enucleations should be carried out whenever possible and oncologically feasible to prevent the typical complications of major pancreatic resection.

Psychometric functions for detection and discrimination with and without flankers

Recent studies have reported that flanking stimuli broaden the psychometric function and lower detection thresholds. In the present study, we measured psychometric functions for detection and discrimination with and without flankers to investigate whether these effects occur throughout the contrast continuum. Our results confirm that lower detection thresholds with flankers are accompanied by broader psychometric functions. Psychometric functions for discrimination reveal that discrimination thresholds with and without flankers are similar across standard levels, and that the broadening of psychometric functions with flankers disappears as standard contrast increases, to the point that psychometric functions at high standard levels are virtually identical with or without flankers. Threshold-versus-contrast (TvC) curves with flankers only differ from TvC curves without flankers in occasional shallower dippers and lower branches on the left of the dipper, but they run virtually superimposed at high standard levels. We discuss differences between our results and other results in the literature, and how they are likely attributed to the differential vulnerability of alternative psychophysical procedures to the effects of presentation order. We show that different models of flanker facilitation can fit the data equally well, which stresses that succeeding at fitting a model does not validate it in any sense.

Optimizing the use of activity traps for aquatic biodiversity studies

I investigated the effectiveness of activity traps for macroinvertebrate monitoring in shallow, heavily vegetated drainage ditches and explored 2 ways to optimize the use of activity traps for monitoring purposes. I tested the effects of trapping duration (48, 96, and 168 h) and use of attractants (bait and preconditioned leaves). The number of taxa and individuals captured increased with trapping duration. Based on the taxon accumulation curves, deployment times of 48 h and 96 h were equally efficient in capturing new taxa, but a trapping duration of 168 h was much more efficient and resulted in a larger number of taxa collected with every new sample added. Of the attractants offered in the traps, only bait caused differences in the macroinvertebrate assemblage recorded. After 48 h, more predators were captured in traps with bait than in control traps and traps with preconditioned leaves. This effect disappeared with longer trapping duration. Because of their relatively low labor requirements and high level of standardization, activity traps appear to be a valuable tool in lentic biodiversity surveys, especially when deployed for a longer period than has usually been reported. The use of bait is advisable only if capture of specific taxa is required and not for standard monitoring purposes.

Urinary Proteome Analysis using Capillary Electrophoresis Coupled to Mass Spectrometry: A Powerful Tool in Clinical Diagnosis, Prognosis and Therapy Evaluation

Urinary Proteome Analysis using Capillary Electrophoresis Coupled to Mass Spectrometry: A Powerful Tool in Clinical Diagnosis, Prognosis and Therapy EvaluationProteome analysis has emerged as a powerful tool to decipher (patho) physiological processes, resulting in the establishment of the field of clinical proteomics. One of the main goals is to discover biomarkers for diseases from tissues and body fluids. Due to the enormous complexity of the proteome, a separation step is required for mass spectrometry (MS)-based proteome analysis. In this review, the advantages and limitations of protein separation by two-dimensional gel electrophoresis, liquid chromatography, surface-enhanced laser desorption/ionization and capillary electrophoresis (CE) for proteomic analysis are described, focusing on CE-MS. CE-MS enables separation and detection of the small molecular weight proteome in biological fluids with high reproducibility and accuracy in one single processing step and in a short time. As sensitive and specific single biomarkers generally may not exist, a strategy to overcome this diagnostic void is shifting from single analyte detection to simultaneous analysis of multiple analytes that together form a disease-specific pattern. Such approaches, however, are accompanied with additional challenges, which we will outline in this review. Besides the choice of adequate technological platforms, a high level of standardization of proteomic measurements and data processing is also necessary to establish proteomic profiling. In this regard, demands concerning study design, choice of specimens, sample preparation, proteomic data mining, and clinical evaluation should be considered before performing a proteomic study.

Synthetic Excellence: Standards, Play, and Unintended Outcomes

Today, more and more efforts are devoted to promoting an open network environment (Libicki 2000). This growing enthusiasm for interoperability is understandable, given the economics of networks. (Shapiro and Varian, 1998; Varian, Shapiro, and Farrell, 2005). To make the most of interconnection today, businesses must enhance their services by adding a variety of functions (Blumenthal and Clark 2000). For these purposes, they are seeking higher-level standards in support of middleware and software applications.
 
 While supporting the overall goal of interoperability, this paper sounds a cautionary note. It argues that the value of standards is contextual. Thus, while interoperability may be highly beneficial in a purely economic context, and with respect to the lower levels of the network, it might engender unintended consequences at higher levels where the network is intertwined with political and cultural realms. This paper contends that, as standards efforts become increasingly focused on the upper layers of the Internet, a broader set of evaluative criteria will be required to determine their true costs and benefits.
 
 Employing an interdisciplinary approach, this paper takes a first step in exploring these issues. Focusing on the highest–level applications in particular, it examines recent calls to create standards across virtual worlds, using the MPEG-V working group as a case study. Advocates for these standards foresee clear economic benefits for producers and maintainers of virtual worlds, as well as for their inhabitants (Sivan). We argue that such faith in the predictable outcomes of standards betrays a tendency both to think of virtual worlds as the intentional outcome of rational design, as well as to misapprehend the roles of diversity and play in discrete environments. We question this narrow economic perspective. Arguing that a metaverse—like all worlds—is highly complex, we contend that virtual world standards—ranging from EULAs to the software code itself—can only beget unpredictable outcomes, which will not only affect relationships between worlds, but inevitably within communities. Definitions and standards, whether integral to a world or positioned "between" worlds, nonetheless comprise its finite bounds and become part of what Steinkuehler calls "the mangle of play:" Inhabitants of synthetic worlds habitually "amplify, enhance, negate, accommodate, complement, and at times even ignore" even hard-coded rules (200). To identify the costs and benefits of standards in these complex environments, all of these relationships must be considered (Steinkuehler, 2004).
 
 As importantly, we argue that virtual diversity, like biological variety, is inherently beneficial to users of synthetic worlds. Inherently arbitrary, virtual worlds are de facto sites of playful activity: This is the source of corporate and individual interest in them as sites of innovation. To realize the benefits of what Sutton-Smith calls “the potentiation of adaptive variability,” we contend that what is needed is not standards across virtual worlds but rather a broad diversity of synthetic, discrete ecosystems.
 
 To make our case we briefly identify the economic rationale for network interoperability; next, characterize the metaverse as a complex environment, and describe the role that standards might play within it; and finally, we examine the case of the MPEG-V Working Group to determine the evaluative criteria being used to develop standards, employing a rhetorical analysis of the documents, both formal and informal, associated with this process.

5088 Analysis of factors predicting response to second-line trastuzumab- based therapy in patients (pts) with Her2-positive advanced breast cancer (ABC)

Tissue microarrays (TMAs) as current medical research tools significantly lower the costs of immunohistochemical examinations (IHC) and fluorescence in situ hybridization (FISH) while enabling high levels of standardization and reliability. Taking HER2 testing of breast cancer into consideration, we assessed the routine applicability of TMAs. A hundred and seventy-four consecutive samples of invasive breast cancer cases were selected. TMAs were constructed in order to conduct double HER2 immunohistochemical analysis and FISH abreast using the conventional slide by slide method. Comparing the immunohistochemical data obtained from TMAs with the routinely processed large sections, we found a 94.5%/92.7%, 85.7%/88.9% and 91.2%/90% concordance at immunohistochemically HER2-negative, HER2 2+ and 3+ cases using the CB11/HercepTest, respectively.FISH performed on TMAs helped to determine Herceptin therapy suitability in all cases, and when discordance was found, we controlled FISH on “large sections”. Being able to conduct FISH examinations at a reasonable price with or without prior immunohistochemical analysis, departments confronted with a certain frequency of breast cancer cases might extensively use the type of TMAs applied in our study. This is a relieve not only with regard to diagnostic work using microarrays, but this also allows to take new directions in research by shedding light on certain unusual cases.

Toward a relational perspective of franchising chains

In many professional and services industries, firms try to scale up their operations by reproducing practices in new locations through franchising arrangements, especially business format franchising. The classic but still prevailing explanations for franchising related phenomena, especially the initiative of franchising, the propensity to franchise, and the franchise performance, are mostly based on two orders of reasons (or a combination of them): franchising is either explained as a means to deal with resource scarcity or (and) as a mechanism for franchisor and franchisee to align incentives between themselves. However, empirical studies have shown limited support for both such claims, especially in face of the so called plural form, where proprietary and franchised units of the same franchisor co-exist. It may also be argued that the traditional literature on franchising has assumed a high level of homogeneity within and between franchising “networks,” possibly due to the perception that they tend to be “dominated” by a high level of standardization and replication of practices, both operative and relational. However, learning processes in such “networks” have recently been brought in as an attempt to capture other mechanisms that may underlie their operation and sustainability. This article seeks to explore a third perspective to look at franchising “networks,” by drawing from the literatures on capabilities and industrial networks. Seen from this perspective, business format franchising may involve more than the mere replication or exploitation of a recipe, especially if we take into consideration the partly idiosyncratic nature of both the relationships between actors and their capabilities and intentions. Within this perspective, variety preservation, and not only uniformity, may be recognized by participants as relevant for the performance of the franchise chain. In other words, variety may reflect the need for the refinement of the “package” throughout time, in more than one ways, together with the gradual development of the network and the learning experiences that take place in that context.

Standardization's Role in Care Quality Studied

Standardization's Role in Care Quality Studied

LOADS INTERACTION DOMAINS METHODOLOGY FOR THE DESIGN OF STEEL GREENHOUSE STRUCTURES

Aim of this research is to develop a design methodology which correlates main structural design parameters, whose production is characterised by high levels of standardization, such as the height of gutter or the distance between frames, with actions on the greenhouse. The methodology, based on the use of charts and abacus, permits a clear and a direct interpretation of the structural response to design load combinations and allows the design of structural improvements with the aim of the optimization of the ratio benefits (structural strength)/costs. The study of structural interaction domains allowed a clear and a direct interpretation of the structural response to design load combinations. The diagrams highlight not only if the structure fulfils the standard requirements but also the safety levels with respect to design load combinations and allow the structural designer how to operate in order to optimize the structural response with standard requirements achieving the best ratio benefits (structural safety)/ costs. The methodology was developed basing on criteria assigned by EN13031 on two different kinds of greenhouse structures: an arched greenhouse with a film plastic covering and a duo pitched roof greenhouse cover with rigid plastic membranes. Structural interaction domains for arched greenhouse showed a better capability of the structure to resist to vertical loads then to horizontal one. Moreover, the climatic load distribution on the structure assigned by EN13031 is such that the combination of climatic actions is less dangerous for the structure then their individual application. Whilst, duo pitched roof steel greenhouse interaction domains, showed a better capability of the structure to resist to vertical loads then to horizontal one and that, in any case, the serviceability limit states analysis is more strict then the ULS one. The shape of structural domains highlighted that the combination of actions is more dangerous for the structure then the application of single loads. Charts and abacus very easy to interpret and can be used also by non technicians in order to arrange a quick and reliable estimate of the costs of the structure. For instance, it is sufficient to know characteristic values of snow loads and wind speed to evaluate what is the distance of frame of the arched greenhouse to fulfil EN13031 requirements.

Tissue microarray technology in breast cancer HER2 diagnostics

Tissue microarrays (TMAs) as current medical research tools significantly lower the costs of immunohistochemical examinations (IHC) and fluorescence in situ hybridization (FISH) while enabling high levels of standardization and reliability. Taking HER2 testing of breast cancer into consideration, we assessed the routine applicability of TMAs. A hundred and seventy-four consecutive samples of invasive breast cancer cases were selected. TMAs were constructed in order to conduct double HER2 immunohistochemical analysis and FISH abreast using the conventional slide by slide method. Comparing the immunohistochemical data obtained from TMAs with the routinely processed large sections, we found a 94.5%/92.7%, 85.7%/88.9% and 91.2%/90% concordance at immunohistochemically HER2-negative, HER2 2+ and 3+ cases using the CB11/HercepTest, respectively. FISH performed on TMAs helped to determine Herceptin therapy suitability in all cases, and when discordance was found, we controlled FISH on “large sections”. Being able to conduct FISH examinations at a reasonable price with or without prior immunohistochemical analysis, departments confronted with a certain frequency of breast cancer cases might extensively use the type of TMAs applied in our study. This is a relieve not only with regard to diagnostic work using microarrays, but this also allows to take new directions in research by shedding light on certain unusual cases.

NC-stat as a Screening Tool for Carpal Tunnel Syndrome

To the Editor: We read with interest the article by Dr Katz1 on use of the NC-stat instrument in an industrial population and commend the author for investigating the complex issue of nerve conduction studies in industrial populations.2 We agree with the author in the conclusion that the NC-stat median nerve distal motor latency (DML) is comparable to the same measurement performed in traditional electromyography settings and that nerve conduction parameters in some industrial populations may be shifted relative to other populations.2 However, we think that some of the statements as to the implications of this particular data set are overstated. Although Dr Katz appears to be under the impression that the NC-stat normal values and methods are proprietary and have not been published, that is not the case. The methods and correction factors for the median DML and F-wave latency have been described.3 Furthermore, we have shared our normative data with many physicians and organizations. We would be pleased to provide this data to Dr Katz. It is clear from the presented data (Fig. 1) that a significant number of job applicants had an abnormal NC-stat DML, as would be expected in applicants to heavy industry jobs. This data and similar results by others2 clearly validate the need to carefully and quantitatively interpret abnormal DMLs in this population.4 However, we think that the accompanying analysis overstates the effect. First, the mean (3.81 msec) and standard deviation (0.57 msec) are both quite high relative to both the NC-stat and other published reference ranges.5 Although Dr Katz takes the position that the DMLs are normally distributed, the peak of the distribution appears to be closer to 3.6 msec, which suggests a substantial effect of the positive tail. However, most importantly, if this population is to be used to “judge” the specificity of the NC-stat and comparable5 reference ranges, the subject population must be known to be free of disease. As pointed out by Dorfman and Robinson,6 asymptomatic and disease-free are not equivalent. It is not clear that this study population withstands such scrutiny. Applicants could have falsely denied symptoms and could have had asymptomatic median neuropathy at the wrist due to prior occupational exposure. In addition, it is not clear that applicants with overt or subclinical polyneuropathies were excluded. Because applicants fitting into any one of these groups would likely have prolonged median DMLs, we are not convinced that the 95th percentile value of 4.75 msec is a valid operating point for assessing specificity in this population. In both the Abstract and Conclusion sections, Dr Katz comments on the “sensitivity” of the NC-stat. However, the data presented in this study do not support an evaluation of sensitivity. As defined in the Methods section, all subjects were deemed to be asymptomatic and therefore not to have carpal tunnel syndrome. In the absence of a positive case definition, sensitivity cannot be determined. By contrast, in two prior studies,3,7 the NC-stat demonstrated high DML sensitivity relative to an electromyography laboratory case definition. We agree with Dr Katz that sensory nerve conduction, which has now been validated for the NC-stat,8 and ulnar nerve measurements are important in the clinical assessment of patients with upper extremity symptoms using the NC-stat. The author concludes by stating that “NeuroMetrix significantly overdiagnoses CTS in an asymptomatic population of industrial workers.” This statement is factually incorrect and requires clarification. NeuroMetrix, Inc. is a medical device company that manufactures equipment. The company does not examine, diagnose, or treat patients or workers in any way. Physicians purchase our equipment and use it as an extension of their history and clinical examination. The NC-stat is an electrodiagnostic instrument with a high level of standardization and automation.9 Like with any nerve conduction study, the data must be interpreted in the context of the subject’s presentation and study purpose. We trust that Dr Katz is aware of the manner in which the NC-stat equipment is used and the implication that NeuroMetrix or the NC-stat “makes diagnoses” was unintentional. J. Thomas Megerian, MD, PhD Xuan Kong, PhD Eugene Lesser, DO Shai N. Gozani, MD, PhD NeuroMetrix, Inc. Waltham, Massachusetts

Causes of recurrence in laparoscopic inguinal hernia repair

The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal. The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report. Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh. Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.

Méthodes d’évaluation : échelles, paramètres cliniques et biologiques

Assessing depressive symptomatology in antidepressant drug trials is limited by the absence of external validators of depression. Moreover, a high level of standardisation is required by regulatory authorities for registering new drugs. Consequently, the methods used are relatively old, and recent improvements have been minor. Methods used to assess new antidepressants appear highly standardised and lack objectivity. Improvements to these methods may emerge from the discovery of external validators of depression on the one hand and of drugs with new mechanisms of action on the other.

Closing the Math Learning Gap between Chile and Developed Countries

Latin American students maintained a low achievement level during the 1990s in spite of huge investments in education, but significant increments in Chilean students’ learning were the result of a carefully designed development project implemented in 2001-2002 in a high standard level K-12 school. The use of “interactive learning scripts (guidebooks)” plainly telling the actors (students and the teacher) “activities” to be carried out in each session (grades 1-8) made it easy for teachers to upgrade teaching methods. Less than 5% of the teachers were unable to adapt to the scripted methods while students kept demanding this “easier” way to learn. The external innovation team replicated methods used in the successful massive Colombian Escuela Nueva program, and supervised the project through a monthly two-day visit plus a local team monitoring of every day operations. Given that national test scores in Chile and Colombia are close to the average in Latin America, the findings of this project are relevant for the whole region and may be useful for other developing countries.